Intravenous immunoglobulin (IVIG) infusion is an effective therapy for acute Kawasaki disease (KD). Nonetheless, approximately 10 percent to 20 percent of patients have persistent or recrudescent fever despite IVIG treatment, leading to a higher risk for coronary artery aneurysms (CAA). This unresponsiveness may pose a challenge to the clinicians. Tumor necrosis factor-alpha levels are elevated in the acute phase of the disease, especially in patients who develop CAA. We report a 10-month-old male with KD who failed to respond to multiple doses of IVIG and methylprednisolone and who then was treated with infliximab (5 mg/kg single dose). After infliximab treatment, he became afebrile with normalization of inflammatory markers and no further progression of CAA.
Aneurysm ; Coronary Vessels ; Fever ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Infant ; Male ; Methylprednisolone ; Mucocutaneous Lymph Node Syndrome* ; Tumor Necrosis Factor-alpha ; Infliximab

Proliferating trichilemmal tumor is one of rare benign tumors of the skin appendages, considering as hamartoma of the terminal hair follicle, isthmic segment of the outer root sheath. We report a case of numerous proliferating trichilemmal tumors admixed with ordinary trichilemmal cysts with femilial history in 64-year-old man. He has total 157 lesions, which are chiefly located in scalp (48), back (32), and also face, neck, trunk, extremities. Histologically, the tumor is composed of irregularly arranged and ansatomosed trabeculae, lobules, or sheets of proliferated trichilemmal squamous epithelium with peripheral palisading of the basaloid cells. Several layers of squamoid or ovoid cells have PAS-positive clear cytoplasm. And it also shows abrupt amorphous, trichilemmal keratinization. Some squamous eddies with mild cellular atypism are associated, but definite invasion or other evidence of the malignancy is not found. usual multiple trichilemmal cysts are admixed with tumor and occasionally exhibit connection between them.
Cysts ; Hamartoma

Hemorrhagic radiation proctitis is infrequently seen in patients receiving pelvic irradiation. The treatment of hemorrhagic ralation proctitis is often difficult. Many patients need reyeated hospitalizations and blood transfusions. Occasionally patiets will develop severe or recurrent rectal bleeding. In case of massive bleeding requiring excessive transfusion, colonic diversion by construction of a colostomy or excision of the diseased segment may be inevitable. However, surgical procedures in these patients are associated with a high mortality and morbidity. Moreover, medical therapy is usually ineffective. Recently formalin therapy has been introduced as a simple and effective treatment for hemorrhagic radiation proctitis. We experienced a 69 year-old woman patient who developed severe homorrhagic proctitis 1 year after radiotherapy for carcinoma of the cervix. She had not improved by conservative management and required blood tranafusions and repetitive hospitalizations. After local application of a 4% formalin solution in the diseased rectum under caudal anesthesia, the bleeding immediately stopped and the patient was discharged from the hospital, and no recurrence has been observed until now.
Aged ; Anesthesia, Caudal ; Blood Transfusion ; Cervix Uteri ; Colon ; Colostomy ; Female ; Formaldehyde* ; Hemorrhage ; Hospitalization ; Humans ; Mortality ; Proctitis* ; Radiotherapy ; Rectum ; Recurrence

No abstract available.
Child* ; Humans ; Interferons* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive*

Cerebral paragonimiasis, occuring as an extrapulmonary infestation, still reamans an important intracranial parasitic disease in Korea. The authors report a 32-year-old female patient who had developed headache, vomiting and signs of the left hemispheric dysfunction for 5 months. A diagnosis of the cerebral paragonimiasis was made on the basis of brain CT findings, a positive intradermal test, and the positive results of serum and CSF levels of the anti-Paragonimus IgG antibodies(by micro-ELISA). She was treated with 75 mg/kg/day of praziquantel for 7days to confirm healing of the intracranial lesion by the follow-up brain CT and micro-ELISA associated with a marked clinical improvement. This case report highly suggests the anticipated effectiveness of praziquantel in the treatment of the cerebral infestation of Paragonimus westermani, especially in its early stage.
Adult ; Brain ; Diagnosis ; Female ; Follow-Up Studies ; Headache ; Humans ; Immunoglobulin G ; Intradermal Tests ; Korea ; Paragonimiasis* ; Paragonimus westermani ; Parasitic Diseases ; Praziquantel* ; Vomiting

Fracture of odontoid process is relatively common, but fracture of axis body without fracture of odontoid precess is known to be exceptionally. Recently, we have experienced a case of axis body fracture complicating typical Brown-Sequard syndrome below the level of C4, and we present the case with the review of literature.
Axis, Cervical Vertebra* ; Brown-Sequard Syndrome* ; Odontoid Process

OBJECTIVES: The etiology for Kawasaki disease (KD) remains unknown, but several studies have suggested the involvement of immune dysregulation and genetic factors. The purpose of this study is to compare gene expressions before and after an infusion of intravenous immunoglobulin (IVIG) in KD patients. METHODS: Blood was obtained from both acute and sub-acute phases of 4 patients with KD and febrile control children. Blood was collected in PAXgene blood RNA tubes and RNA was extracted using a PAXgene blood RNA isolation kit. Labeled RNAs were analyzed using Roche NimbleGen human whole genome 12-plex array. RESULTS: KD patients prior to IVIG injection showed more than a two-fold increase in the expression of 88 genes and more than a two-fold decrease in the expression of 98 genes compared to the control group. They also showed more than two-fold increase in the expression of 226 genes and more than a two-fold decrease in 117 genes in KD patients after IVIG treatment compared to the patients before IVIG injection. Through microarray evaluation, the expressions of genes involved in proliferation, translation, inflammatory response, immune response, cell adhesion, cell migration, cell differentiation, apoptosis, cell growth, transport, cell cycle, transcription, signal transduction and metastasis were observed. CONCLUSION: Changes in gene expressions in pediatric patients with KD before and after IVIG were observed via microarray evaluation.
Apoptosis ; Cell Adhesion ; Cell Cycle ; Cell Differentiation ; Cell Movement ; Child ; Gene Expression ; Genome ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Microarray Analysis ; Mucocutaneous Lymph Node Syndrome ; Neoplasm Metastasis ; RNA ; Signal Transduction

OBJECTIVES: We aimed to evaluate discrepancies between self-awareness of memory functions and actual memory functions in the elderly community. METHODS: A total of 369 individuals aged over 65 years from four elderly community centers completed clinical evaluation, neuropsychological batteries of the Korean version of the Consortium to Establish a Registry for Alzheimer's disease (CERAD-K), the Geriatric Depression Scale (GDS), the Instrumental Activities of Daily Living (IADL), and the Hachinski Ischemic Score. RESULTS: Among the elderly particpants, 26.3% showed incorrect awareness regarding their memory function. Those with subjective memory complaints included 73.5% with no memory impairment, while those without memory complaints included 11.3% of those with amnestic mild cognitive impairment (aMCI) and 4.3% of those with Alzheimer's disease (AD). Subjective memory complaints were significantly associated with depression. Among the elderly with no memory complaints, incorrect awareness was associated with 'no previous education' (OR 3.6, 95% CI 1.3-9.8), 'age over 80' (OR 2.4, 95% CI 1.1-5.4), and 'male' (OR 2.3, 95% CI 1.0-5.2) ; however, it was not significantly associated with depression. CONCLUSION: Incorrect awareness of memory impairment is prevalent among the elderly. Further, elderly individuals of an advanced age with no education may have memory impairment without memory complaints.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Depression ; Humans ; Memory ; Mild Cognitive Impairment

BACKGROUND: Atherosclerosis is the most important disease that may cause ischemic syndrome in many organs including heart. It is supposed that apoptosis of vascular smooth muscle cells(VSMCs) is closely related to the progression and rupture of atheromatous plaque. Recent studies have documented evidence for elevated level of nitric oxide(NO) within advanced human atheroma and evidence of regression of atheroma by NO. So this study is designed to evaluate whether exogenous NO from NO donors can induce apoptosis of cultured rat VSMCs and which proapoptotic gene(s) is involved in this type of apoptosis. METHODS: Rat VSMCs were cultured and used for experiment at passage 5 through 7. For NO donor, sodium nitroprusside (SNP) and S-nitroso-N-acetylpenicillamine(SNAP) of 0.5, 1, 2, 4mM were exposed to subconfluent VSMCs. The cells were harvested at 6, 12, 24, 48, 72hours after exposure of NO donors. Apoptosis was to be identified by 4, 6-diamidino-2-phenylindole dihydrochloride(DAPI) staining of nuclei and in-situ nick end labeling(TUNEL). The amount of fragmented DNA was analyzed semiquantitatively by diphenylamine(DPA) assay. Immunocytochemical(ICC) staining and western bolt analyses were designed to detect apoptosisrelated gene products, such as Bax-a, Fas and Bcl-2. RESULTS: 1) Decreased mitotic activity was shown after 12 hours exposure of exogenous NO donors, and condensation and margination of chromatin was identified agter 24 hours exposure, by DAPI staining. 2) Percent DNA fragmentation assessed by DPA method was 0,2,9,48,45% at 0,6,12,24,48 hours after exposure of 2mM of NO donors respectively. 3) The expression of Bax-a and Bcl-2 proteins was demonstrated in apoptotic cells by ICC staining. 4) The expression of Bax-a protein in cells under 24 hours exposure of NO donors was elevated by more than 18% of control level on densitometric analysis of western blot. The level of Bcl-2 was suppressed by 26% of control. So, Bax-a/Bcl-2 ratio in cells under exposure of NO donors was elevated to 2.0 from 1.2 of control level. CONCLUSIONS: Exogenous NO from NO donors can induce apoptosis of cultured rat VSMCs, and it is considered that bax-a and bcl-2 genes are involved in this type of apoptosis.
Animals ; Apoptosis* ; Atherosclerosis ; Blotting, Western ; Chromatin ; DNA ; DNA Fragmentation ; Genes, bcl-2 ; Heart ; Humans ; Muscle, Smooth, Vascular* ; Nitric Oxide ; Nitroprusside ; Plaque, Atherosclerotic ; Rats* ; Rupture ; Tissue Donors

Previous reports raised question as to whether 8-chloro-cyclic adenosine 3,5-monophosphate (8-Cl-cAMP) is a prodrug for its metabolite, 8-Cl-adenosine which exerts growth inhibition in a broad spectrum of cancer cells. The present study was carried out to clarify overall cellular affects of 8-Cl-cAMP and 8-Cl-adenosine on SK-N-DZ human neuroblastoma cells by ystematically characterizing gene expression using radioactive human cDNA microarray. Microarray was prepared with PCR-amplified cDNA of 2,304 known genes spotted on nylon membranes, employing (1)P-labeled cDNAs of SK-N-DZ cells as a probe. the expression levels of approximately 100 cDNAs, representing about 8% of the total DNA elements on the array, were altered in 8-Cl-adenosine- or 8-Cl-cAMP-treated cells, respectively. The genome-wide expression of the two samples exhibited partial overlaps; different sets of up-regulated genes but the same set of down-regulated genes. 8-Cl-adenosine treatment up- egulated genes involved in differentiation and development (LIM protein, connexin 26, neogenin, neurofilament triplet L protein and p21( WAF1/CIP1)) and immune response such as natural killer cells protein 4, and down-regulated ones involved in proliferation and transformation (transforming growth factor-beta, DYRK2, urokinase-type plasminogen activator and proteins involved in transcription and translation) which were in close parallel with those by 8-Cl-cAMP. Our results indicated that the two drugs shared common genomic pathways for the down-regulation of certain genes, but used distinct pathways for the up-regulation of different gene clusters. Based on the findings, we suggest that the anti-cancer activity of 8-Cl-cAMP results at least in part through 8-Cl-adenosine. Thus, the systematic use of DNA arrays can provide insight into the dynamic cellular pathways involved in anticancer activities of chemotherapeutics.
2-Chloroadenosine/*analogs & derivatives/chemistry/*pharmacology ; 8-Bromo Cyclic Adenosine Monophosphate/*analogs & derivatives/chemistry/*pharmacology ; Antineoplastic Agents/chemistry/*pharmacology ; Blotting, Western ; *Gene Expression Profiling ; Gene Expression Regulation, Neoplastic/*drug effects ; Genome, Human ; Human ; Neuroblastoma/*genetics ; Oligonucleotide Array Sequence Analysis ; Reproducibility of Results ; Tumor Cells, Cultured ; Up-Regulation/drug effects