We experienced a case of acquired bronchial stenosis in a male premature infant who had recurrent postextubation atelectasis of the right lung. Bronchography showed the stenosis of the distal portion of right main bronchus and the proximal portion of intermediate bronchus and autopsy findings showed ill-defined irregularly elevated nodule with fibrotic scarring in the trifurcation of right main bronchus. Endotracheal suction was suspected as the main cause. A brief review of literature was made.
Autopsy ; Bronchi ; Bronchography ; Cicatrix ; Constriction, Pathologic* ; Humans ; Infant, Newborn ; Infant, Premature ; Lung ; Male ; Pulmonary Atelectasis ; Suction*

PURPOSE: This study was performed to investigate the epidemiologic features of the patients who were admitted and diagnosed as aseptic meningitis from 1996 to 2002 in Seoul Red Cross Hospital. In this study, we report the time of outbreaks, clinical manifestations, laboratory data and CSF examination results. METHODS: We reviewed the clinical records of 544 aseptic meningitis patients who were admitted to Seoul Red Cross Hospital from 1996 to 2002. We collected the data of the sex, age, clinical manifestations, peripheral blood and CSF examination results of the patients. RESULTS: The ratio of male to female was 2.3 : 1. The majority of the patients were between 1 and 5 years of age. 82.3% of the cases occurred from May to August with a peak incidence rate of 31.4% in June. The clinical manifestations were fever(92.6%), headache(88.9%), vomiting(87.9%), poor oral intake(54.9%), abdominal pain(35.8%) and neck stiffness(65.9%). On the blood examination, leukocytosis(WBC>10,000/mm3) was shown in 57.5%. On the CSF examination, WBC counts were less than 500/mm3 in 89% and protein levels were less than 45 mg/dL in 62.3% and glucose levels were more than 40 mg/dL in 97.1%. We did not isolate the causative viral agents. CONCLUSION: The clinical manifestations, and the blood and CSF profiles of the aseptic meningitis patients in this study showed no great differences compared to those in other aseptic meningitis studies.
Disease Outbreaks ; Epidemiologic Studies ; Female ; Glucose ; Humans ; Incidence ; Male ; Meningitis, Aseptic ; Neck ; Red Cross ; Seoul

Suicide is a major public health problem among Korean military personnel. As multiple factors and their interactions are related to suicide, multicomponent intervention might be useful for reducing suicide and suicide-related outcomes. The United States Air Force Suicide Prevention Program (AFSPP) launched in 1996 is a good example of an evidence-based multifaceted program focusing on leadership involvement and whole community-level efforts. For early identification and management of an at-risk population, AFSPP aims to encourage help-seeking and reduce stigma by changing the community's social norms regarding mental health and suicide. The present study reviewed the key elements of this successful intervention and made a proposal for improving the suicide prevention strategy in the Korean armed forces. This review might be useful for establishing a comprehensive intervention in local communities and organizations outside of the military.
Arm* ; Humans ; Leadership ; Mental Health ; Military Personnel ; Military Psychiatry ; Public Health ; Social Norms ; Suicide* ; United States

PURPOSE: To find out whether or not the computed tomographic (CT) classification systems of the calcaneal fracture are efficient in illuminating displaced posterior facet fragment and the degree of displacement can be evaluated by analyzing serial CT images. MATERIALS AND METHODS: Seventy-seven hundred calcaneal fractures were classified by CT classification systems including Sanders classification, and the sagittal rotation angle of the posteior facet fragment was measured on the plain lateral radiograph. Among the serial axial CT images, a number of images with the cortical bone embedded in the cancellous portion were recorded and any significant relationship between each data were evaluated. RESULTS: The conventional CT classification systems are rather insufficient in illuminating the extent of sagittal rotatory displacement. However, the number of CT images in which the cortical radiodensity was observed showed a significantly related with the degree of displacement. CONCLUSION: The conventional CT classification of the calcaneal fractures is unsatisfactory in expressing the degree of sagittal rotatory displacement of the posterior facet fragment; this problem may be alleviated by observing the number of axial CT images in which cortical radiodensity was revealed within the calcaneal body.
Calcaneus ; Classification

Pseudohypoparathyroidism(PHP) is a genetic disorder characterized by target cell resistance to the effect of parathyroid hormone(PTH). The disorder is classified into type I a, I b, I c and II depending on the phenotype and biochemical findings. In type I a, urinary cyclic AMP and urinary phosphate excretion are not increased after PTH stimulation because of deficient G unit activity in target cells. Deficiency of the G unit is a generalized cellular defect and accounts for the association of other endocrine disorders with type I a PHP. Type I b PHP shows resistance to PTH but not to other hormones and normal phenotypic appearance. In type I c PHP affected children have defect in catalytic unit of adenylate cyclase and in addition to resistance to PTH, resistance to the metabolic effects of TSH, gonadotropins, and glucagon may be detected. Typical appearance of Albright's hereditary osteodystrophy is common in PHP type Ia and Ic. In type II PHP, urinary cyclic AMP response is generated but this does not lead to phosphaturia. We experienced two patients with PHP. One is a 11-year-old girl diagnosed type I a PHP and the other is a 11-year-old boy suspected type I b PHP. They visited emergency room because of tetanic movement. Both patients had no previous history of tetany and showed low serum calcium level, high phosphorus level and high PTH level. The girl had typical features of Albright's hereditary osteodystrophy such as round face, short neck, obese feature, brachydactyly and mental retardation but didn't have basal ganglia calcification on brain CT. The boy showed normal appearance and no mental retardation.
Adenylyl Cyclases ; Basal Ganglia ; Brachydactyly ; Brain ; Calcium ; Child ; Cyclic AMP ; Emergency Service, Hospital ; Female ; Glucagon ; Gonadotropins ; Humans ; Hypophosphatemia, Familial ; Intellectual Disability ; Male ; Neck ; Phenotype ; Phosphorus ; Pseudohypoparathyroidism* ; Tetany

OBJECTIVES: Dysregulation of the central noradrenergic system may be involved in the pathophysiology of attention-deficit hyperactivity disorder (ADHD). The aim of this study was to examine the differences in pre- and post-treatment cerebral perfusion according to the MspI polymorphisms of the alpha-2A-adrenergic receptor gene (ADRA2A) in children with ADHD. METHODS: Thirty seven drug-naive ADHD children (8.9+1.8 years old, M=32, F=5) were genotyped. Baseline single-photon emission computed tomography (SPECT) and clinical assessments were performed for ADHD children. After treatment with methylphenidate for eight weeks, SPECT and clinical assessment were repeated. RESULTS: No differences in baseline clinical assessments or cerebral perfusion were observed according to the MspI genotype. However, after treatment, ADHD children with the G/G genotype at the MspI polymorphism showed hyperperfusion in the right cerebellar declive (p=.001, uncorrected) and hypoperfusion in the left lentiform nucleus and left cingulate gyrus (p<.001 and p=.001, uncorrected), compared to children without the G/G genotype. CONCLUSION: Although the results of this study should be interpreted cautiously, they suggest a possible role of the MspI polymorphisms of the ADRA2A gene in methylphenidate-induced changes in cerebral perfusion.
Brain ; Child ; Corpus Striatum ; Genotype ; Gyrus Cinguli ; Humans ; Methylphenidate ; Perfusion ; Pharmacogenetics ; Receptors, Adrenergic, alpha-2 ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

Heme oxygenase-1 (HO-1), an inducible heme-degrading enzyme, is expressed by macrophages and endothelial cells in response to inflammatory stresses. It has been known to show strong immunosuppressive properties although its mechanisms are not completely understood. This study was designed to determine the effects of HO-1 modulation on collagen induced arthritis (CIA) model. CIA model was induced by subcutaneous injection of collagen on tail of DBA/1J mice. For evaluation of HO-1 effects, an inducer of HO-1, cobalt protoporphyrin IX (CoPPIX), or an inhibitor of HO-1, tin protoporphyrin IX (SnPPIX), were administered every other days into peritoneal cavity from day 1 to day 42 after CIA induction. The macrocopic clinical findings of CIA were evaluated and histo-pathologic findings and radiographic analysis were carried out. The expressions of TNF-alpha, IL-6, and VEGF which have important roles in pathogenesis of rheumatoid arthritis were observed by immuno-histochemical staining. Collagen on DBA/1J mice induced arthritis at knee joint and ankle joint. Administration of CoPPIX significantly aggravated the severity of arthritis while SnPPIX protected collagen induced arthritis. SnPPIX strongly suppressed inflammatory cell infiltration, swelling of synovial membrane, and erosion and destruction of bone on CIA mice. Furthermore subcutaneous injection of collagen also increased expression of TNF-alpha, IL-6, and VEGF which are important pro-inflammatory mediators in rheumatoid arthritis. SnPPIX suppressed expression of the pro-inflammatory mediators on CIA mice. Finally, we suggest that HO-1 mediates the expression of pro-inflammatory mediators and bone destruction during pathogenesis of CIA, which indicates modulation of HO-1 can be a new therapeutic target of rheumatoid arthritis.
Animals ; Ankle Joint ; Arthritis* ; Arthritis, Rheumatoid ; Cobalt ; Collagen* ; Endothelial Cells ; Heme Oxygenase-1* ; Heme* ; Injections, Subcutaneous ; Interleukin-6 ; Knee Joint ; Macrophages ; Mice ; Peritoneal Cavity ; Synovial Membrane ; Tail ; Tin ; Tumor Necrosis Factor-alpha ; Vascular Endothelial Growth Factor A

Sphingosine 1-phosphate (S1P) is a bioactive lipid molecule that mediates cell proliferation, differentiation, migration, and angiogenesis in vivo. However, the roles of S1P on pathogenesis of arthritis have been not completely understood. This study was designed to determine the effects of S1P modulation on collageninduced arthritis (CIA) model. DBA/1J mice were injected with collagen into the tail for induction of CIA model. S1P was administered into the peritoneal cavity every other days from day 1 to day 42 after collagen injection. To determine the degree of damage in CIA, we examined macroscopic findings of CIA. The inflammation and bone destruction of CIA mice were evaluated by histo-patholigy and radiography (CT and microradiography). The expressions of TNF-alpha, IL-6, and RANKL which have important roles in pathogenesis of rheumatoid arthritis and bone destruction were observed by immuno-histochemical staining. After injection with collagen in the DBA/1J mice, CIA was induced by swelling in the knee and ankle joint. Administration of S1P suppressed damages and incidence of arthritis elicited by collagen. In histologic and radiographic studies, S1P strongly suppressed the infiltration of inflammatory cells, the swelling of synovial membrane, erosion, and the destruction of bone on CIA mice. Injection of S1P resulted in down-regulation of the expression of the pro-inflammatory and bone destruction mediators such as TNF-alpha, IL-6, and RANKL on CIA mice. Furthermore, S1P suppressed the differentiation of bone marrow cells into osteoclasts by RANKL. In conclusion, this study suggest that S1P has protective effects on inflammation and bone destruction during pathogenesis of CIA, which indicates S1P can be a new possible therapeutic strategy for rheumatoid arthritis
Animals ; Ankle Joint ; Arthritis ; Arthritis, Rheumatoid* ; Bone Marrow Cells ; Cell Proliferation ; Collagen ; Down-Regulation ; Incidence ; Inflammation* ; Interleukin-6 ; Knee ; Mice* ; Osteoclasts ; Peritoneal Cavity ; Radiography ; Sphingosine ; Synovial Membrane ; Tail ; Tumor Necrosis Factor-alpha