Extracorporeal membrane oxygenation (ECMO) is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs)/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.
Adult ; Blood Transfusion* ; Child ; Critical Illness ; Erythrocytes ; Extracorporeal Membrane Oxygenation* ; Heart Failure ; Hemorrhage ; Hospital Costs ; Humans ; Infant, Newborn ; Mortality ; Platelet Transfusion ; Respiratory Insufficiency

BACKGROUND: Outbreaks of multidrug-resistant tuberculosis(MDR-TB) are caused by the low rate of treatment response due to limitation in number of available drugs and high rates of adverse drug side-effects. This study analysed the risk factors for MDR-TB patients, who did not respond to treatment, with an aim to improve the rate of treatment response. METHODS: Retrospective study of 111 MDR-TB patients at National Mokpo Tuberculosis Hospital from Jan. 1996 to Dec. 1998 was made. The patients were separated into tow groups ; group I comprised of patients who were treated successfully and group II comprised of those were not treated successfully. In order to analyze the risk facotrs for treatment faulure, differences between the two groups were compared and the confidence limit regarding the results were tested using an independent t-test, chi-square test and a Fisher's exact tets. RESULTS: The treatment failure rate of MDO-TB patients was 32% (36 patients), and treatment success rate 68%(75 patients). This study found no significant difference between two groups in terms of age, sex, family history, extent of the disease on the chest X-ray, the number of sensitive drugs in the treatment regimen, and the number of sensitive bactericidal drugs in the treatement regimen (p>0.05). However, a past history of pulmonary tuberculosis, cavitary lesions on the chest X-ray, the number of tretaments, the number of resistant drugs and the number of drugs used showed a significant difference(p<0.05). CONCLUSION: The rate of treatment failure in MDR-TB was increased by a past history of pulmonary tuberculosis, cavitary lesions on the chest X-ray, the number of treatments, the number of resistant drugs and the number of drugs used. For improving the treatment response of MDR-TB, every effort should be made to reduce the drug resistance caused by failure of the first treatment.
Disease Outbreaks ; Drug Resistance ; Hospitals, Chronic Disease ; Humans ; Jeollanam-do ; Retrospective Studies ; Risk Factors* ; Thorax ; Treatment Failure* ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary

No abstract available.
Incisor*

BACKGROUND: Desmosomes are adhesive intercellular junctions that form an important component of the junction complexes of epithelial cells. They provide intercellular links between the intermediate filament cytoskeletons of adjacent cells and are thus involved in maintaining the structural integrity of tissues. OBJECTIVE: Calcium and retinoids are major regulators of epidermal differentiation and their role on keratin proteins are well known. However, their effects on desmosome moleucles are unknown. To address this question we initiated a study of the effects of these epidermal differentiation regulators on desmosomal components, i.e., desmoplakin, desmoglein, and pemphigus antigens. METHODS: We used monoclonal antibodies against desmoplakin(DP) and desmoglein(DG), and sera from patients with pemphigus vulgaris(PV), pemphigus foliaceus(PF) and paraneoplastic pemphigus (PNP) to study the effects of calcium and retinoic acids, which are major regulators of epidermal differentation, on desmosomal protein formation in human cultured deratinocytes. We performed immunofluorescence, immunoblotting and immunoprecipitation study using human keratinocytes cultured in high calcium media with or without retinoic acid and in low calcium media with or without retinoic acid. RESULTS: 1. In low calcium (0.15mM) media, PV antigen and DG were produced in a small amount and it appeared that these desmosomal proteins were located in cytosol. Whereas in high calcium (1.8mM) media, production of these desmosomal proteins was increased not they were assembled at the desmosomal structures located in cell-cell contact margins. 2. PF antigen, which was identical to the DG, were not produced or expressed in cultured keratinocytes even when cultured in high calcium media. 3. PNP antigen and DP were produced in cultured keratinocytes grown in both high low calcium media but their production was increased in high calcium media and only in high calcium media they were assembled at the desmosomal structures. 4. Retinoic acids induced loosening of cell-cell contacts of cultured keratinocytes and decreased the production of desmosomal proteins. CONCLUSION: Our results suggests calcium is a major regulator of the production and assembly of desmosomal proteins including pemphigus antigens, but PF sera and monoclonal antibodies against DG show different antigen binding characteristics. It appears that retinoic acids inhibit production of desmosomal proteins.
Adhesives ; Antibodies, Monoclonal ; Calcium* ; Cytoskeleton ; Cytosol ; Desmogleins ; Desmoplakins ; Desmosomes* ; Epithelial Cells ; Fluorescent Antibody Technique ; Humans ; Immunoblotting ; Immunoprecipitation ; Intercellular Junctions ; Intermediate Filaments ; Keratinocytes ; Pemphigus ; Retinoids ; Tretinoin*

The case of a 56-year-old woman with a keratoacarithoma(KA) of the labial mucosa is herein reported, The tumor was excised and the pathological features were characteristic of a KA, This case is reported because the oral mucosa is such an unexpected location for solitary KA and the labial mucosa of this patient received chronic actinic damage, which suggested an etiological relationship. Follow-up examination of the patient after four months showed no recurrence.
Actins ; Female ; Follow-Up Studies ; Humans ; Keratoacanthoma* ; Middle Aged ; Mouth Mucosa ; Mucous Membrane* ; Recurrence ; Solar System*

Biomechanically, the posterior cruciate ligament has been considered the basic stabilizer in the knee, So a torn cruciate ligament should be sutured as soon as possible, otherwise within a few weeks it will undergo resorption, making suture impossible. Currently available reconstructive procedures of the posterior cruciate ligament are often inadequate. We have performed 6 cases of the reconstruction of the posterior cruciate ligament using medial meniscus. The results were as follows; 1. Functionally all cases were improved and objectively 5 cases(83.3% ) among them were achieved stability of the knee rather than preoperative condition. 2. Reconstruction of the posterior cruciate ligament using medial meniscus is technically simple and reliable and can therefore be recommended. But further investigation is necessary to answer question regarding the long term results.
Knee ; Ligaments ; Menisci, Tibial ; Posterior Cruciate Ligament ; Sutures

In the Dept. of Thoracic Surgery, Korea University Hospital, Preoperative diagnosis as Ebstein anomaly was made on the 11-year old female through the preoperative examination including right cardioangiography and the Glenn Operation was performed to this patients as palliative treatment. During closure of the thoracic wall just after the anastomosis of S.V.C. and right pulmonary artery, sudden cardiac arrest developed. One day later after death, autopsy was performed in order to confirm the pathologic anatomy of the cardiac anomaly and to clarify the cause of death. Pathologic anatomy of the heart revealed the huge dilatation of right atrium, Patent Foramin Ovale, and the deformed and descended posterior and the septal leaflets of tricuspid value by which right ventricle was devided into the atrialized and the functional portion. The diagnosis of the autopsy showed (1) Ebstein Anomaly (2) bilateral total atelectasis of the lung, (3) multiple petechial hemorrhage and edema of the myocardium, brain and liver due to acute hypoxia, (4) fibrocaseous tuberculosis of the liver and tuberculous pericholangitis.
Anoxia ; Autopsy ; Brain ; Cause of Death ; Child ; Death, Sudden, Cardiac ; Diagnosis ; Dilatation ; Ebstein Anomaly* ; Edema ; Female ; Heart ; Heart Atria ; Heart Ventricles ; Hemorrhage ; Humans ; Korea ; Liver ; Lung ; Myocardium ; Palliative Care ; Pulmonary Artery ; Pulmonary Atelectasis ; Thoracic Surgery ; Thoracic Wall ; Tuberculosis

BACKGROUND: Pemphigus are chronic autoimmune blistering disorcers characterized by acantholysis. In addition to pemphigus vulgaris(PV), the major clinical variarts are pemphigus foliaceus(PF), paraneoplastic pemphigus(PNP) and drug-induced pemphigus(DP). Detection of pemphigus antigen is important for differential diagnosis as well as research work. Most investigators have identified pemphigus antigens by means of immunoprecipitation using metabolically radiolabeled cultured keratinocytes. However, immunorepitation is generally more expensive, hazardous and time-consuming than immunoblotting. Therefore, establishment of the immunoblotting as a standard technique for the detection of the pemphig us antigens is desirable. OBJECTIVE: To characterized pemphigus antigens by an immunobloting analysis of human epidermal extract and by indirect itnmunofluroscence study using human of cultured keratinocytes as a substraie. METHOD: We performed imrnunoblotting analysis af sera from patieiits with PV, PF, PNP and DP with human epidermal extract as a source of antigen. Indirect immunof uorescence study was also performed using human keratinocytes cultured in high or low calcium media for detection of pemphigus antigens. RESULTS: In an immunoblotting analysis, all(9/9) PV sera showed secific reactivities with a 130-KD protein and all(5/5) FF sera showed reactivities with a 150-KK protein, which is most likely desmoglein 1. Furthermore, one of nine PV serum also reacted with a 150-KD protein, which seems to be the identical antigen detected in PF. All PNP(3/3) sera showed reactivities with two protein bands, 210KD and 190KD. In our indirect imrnunofluorescence study using culltured human keratinocytes as a substrate, when keratinocytes were grown in low calcium media, no pimphigus antigens could be detected. However, when grown in high calciurn media, pemphigus vulga ris and paraneoplastic pernphigus antigens were present t the cell-cell contact areas with a puncta;e pattern, whereas pemphigus foliaceus antigen was not, presint in keratinocytes even when cultured in high calcium media. CONCLUSION: Our results suggests (1) immunoblotting analysis is a reliable technique for defining pemphigus antigen and could be a valuable tool for the differentiation of PV, PF and PNP and(2) PF antigen rnay not be expresseden cultured keratinocytes.
Acantholysis ; Blister ; Calcium ; Desmoglein 1 ; Diagnosis, Differential ; Fluorescent Antibody Technique, Indirect* ; Humans ; Immunoblotting ; Immunoprecipitation ; Keratinocytes* ; Pemphigus* ; Research Personnel

No abstract available.

OBJECTIVE: In recent years, the neurosurgeon's role in managing cerebrovascular diseases (CVD) has becomes rapidly challenged and overlapped with other specialists. Furthermore, the patterns of CVD and patient recruitment have also changed. We conducted a retrospective study regarding the practical trends of CVD with reference to the management paradigms at our institute. METHOD: We reviewed all the available data, including the annual reports, the daily department records, the medical records and the radiographic films of the CVD patients who had been admitted to our Neurosurgery Department during the five years between Jan. 2004 and Dec. 2008. RESULTS: The total numbers of CVD operations showed a slight initial increase, but then they remained steady for the latter 3 years. The number of cases of non-angiomatous hemorrhage has been relatively steady, regardless of surgery. The total numbers of treated aneurysms increased, but the main body of this increment was attributed to the initiation of endovascular treatment and increased identification of unruptured vascular lesions. Vascular malformations were sustained with a small number of cases due to referring them to other institutes for radiosurgery, except for the cases that required urgent hemorrhagic evacuation. CONCLUSION: Hemorrhagic CVDs tended to decrease either due to increasing identification before rupture or shifting such patients into a large volume hospital. The increasing awareness of ischemic CVD, the early detection of unruptured aneurysms, and the separation of medical responsibilities from neurologists have all pushed neurosurgeons to make treatment plans in a more cooperative fashion, instead of a competitive way. Neurosurgeons should be furnished with several revolutionary surgical options to widen their scope of managing patients with CVD.
Academies and Institutes ; Aneurysm ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Medical Records ; Neurosurgery ; Patient Selection ; Radiosurgery ; Retrospective Studies ; Rupture ; Specialization ; Subarachnoid Hemorrhage ; Vascular Malformations ; X-Ray Film