BACKGROUND: This study aimed to compare the topical anesthetic lignocaine, adrenaline, and tetracaine (LAT) (4% lignocaine, 1:2000 adrenaline, 1% tetracaine) with the conventional lignocaine infiltration(LI) for repair of minor lacerations, for the comfort of anesthetic administration, efficacy, adverse effects and cost. METHODS: This was a prospective randomized clinical trial. Forty Asian patients who required toilet and suture for minor lacerations in the emergency department of the Singapore General Hospital over a 4-month period. The patients were assigned randomly to 2 arms of treatment. The first was the LAT gel group who had LAT gel applied to the laceration prior to suturing. The second was the control group in whom the anesthetic administered was lignocaine infiltration (LI) via a syringe. The pain of the process of administering anesthetic and efficacy of anesthesia were scored using the visual pain scale included within. The efficacy of LAT vs. lignocaine infiltration as an anesthetic prior to the toilet and suture of minor lacerations and complications of therapy. RESULTS: Twenty patients were randomized to LAT gel and 16 to LI on an intention to treat analysis. The mean pain score by patients in the LAT gel group was 2.5 (0.52 SE), and 2.5 (0.58 SE) in the LI group. The pain score for pain during application of the anesthetic was 1.5 (0.40) in the LAT gel group, and 3.5 (0.46) in the LI group. There was no difference in complications between the LAT and LI groups. CONCLUSION: LAT gel prior to the toilet and suture of minor lacerations is proven to be as efficacious as LI in terms of patient comfort and effectiveness of anesthesia. The complications are also comparable to those treated with LI.

OBJECTIVE: To evaluate the correlation of HPV infection and E6 oncoprotein expression with carcinogenesis and prognostic role of cervical carcinoma METHODS: Paraffin embedded tissues were obtained from 35 invasive cervical carcinoma, 15 carcinoma in situ, 12 dysplasia of cervix and 20 patients with benign uterine disease as control. HPV type was determined by polymerase chain reaction using type specific primers. E6 oncoprotein expression was analyzed by immunohistochemical staining using C1P5 mouse monoclonal antibody. RESULTS: 1. The positivity of HPV type 16 PCR in invasive cervical carcinoma was 77.1% and it was significantly higher than carcinoma in situ(53.3%), cervical dysplasia(25%), and control (10%). But the positivity of HPV type 18 was not correlated between above groups. 2. The positivity of HPV type 16/18 in cervical carcinoma was not correlated to patient's age. 3. The positivity of HPV in cervical carcinoma was correlated to clinical stage of cervical carcinoma but the positivity of HPV in cervical dysplasia was not correlated to the degree of dysplasia. 4. The positivity of E6 oncoprotein expression was 77.1% in invasive cervical carcinoma, 66.7% in carcinoma in situ and 20% in control group. E6 oncoprotein was not decteted among the cases which negative was for HPV 16/18. The E6 oncoprotein expression in 35 cases of invasive cervical carcinoma was negative in 8, weakly positive in 7, positive in 12, and strong positive in 8 ases. But in 20 cases of normal control group, there was no case of strong positive or posirive E6 oncoprotein expression. 5. The E6 oncoprotein expression was significantly correlated to the clinical stage and lymph node metastasis. The incidence of lymph node metastasis increased and the stage became higher as the E6 oncoprotein expression increased. CONCLUSION: These results suggest that HPV is one of the most important factors in the carcinogenesis of cervical carcinoma and the E6 oncoprotein expression may be associated with biological aggressiveness of cervical carcinoma.
Animals ; Carcinogenesis ; Carcinoma in Situ ; Cervix Uteri ; Female ; Humans* ; Incidence ; Lymph Nodes ; Mice ; Neoplasm Metastasis ; Paraffin ; Polymerase Chain Reaction ; Uterine Cervical Neoplasms* ; Uterine Diseases

It is been known that the deltoid ligament of the ankle joint plays an important role in the stabiliy of the ankle joint. In cases of deltoid ligament rupture, associated with lateral malleolar fractures, cannot be maintained the integrity of the mortise and the stability of the talus. Controversy remains about the treatment of deltoid ligament injuries. Many authors advocate an operative repair for deltoid ligament ruptures for optimal reduction of lateral malleolar fracture. However, according to recent cadaveric studies and many satisfactory results of clinical studies, excellent results have been reported regarding the ankle joint stability by anatomical reduction of the lateral structure, but only without surgical repair of the medial structure. Fourteen patients with lateral malleolar fractures with associated deltoid ligament injuries treated at Sun General Hospital between January 1990 and June 1995. There were examined clinically and radiologically. We concluded that deltoid ligament repairs should be considered unnecessary as long as fibular fracture are stabilized anatomically with normal medial joint space. However, in cases with higher fracture levels of lateral malleolus, associated with syndesmotic injury, we recommend syndesmotic screw fixation or deltoid ligament repair.
Ankle ; Ankle Injuries ; Ankle Joint ; Cadaver ; Fibula* ; Hospitals, General ; Humans ; Joints ; Ligaments* ; Rupture ; Solar System ; Talus

BACKGROUND: Exposure to airborne allergens exacerbates symptoms of atopic dermatitis in sensitive patients. OBJECTIVE: We attempted to evaluate the therapeutic effect of Dermatophagoides farinae antigen-autoantibody immune complex therapy in atopic dermatitis. METHODS: Four patients with atopic dermatitis were treated with antigen-autoantibody immune complex therapy using D. farinae antigen for 1 year. The therapeutic effect was evaluated by clinical severity (erythema, excoriations, scale, pruritus, lichenification) and D. farinae specific antibodies, skin test to D. farinae, total IgE, eosinophil count and soluble vascular cell adhesion molecule-1 (VCAM-1). RESULTS: One of four patients had significant improvement in clinical severity and decrease in serum eosinophil count, but three of four patients had no significant improvement in clinical severity, skin test to D. farinae, total IgE, specific antibodies and soluble VCAM-1 after allergenantibody complex therapy except specific IgE to D. farinae. CONCLUSION: The efficacy of allergen-antibody complex therapy may be limited in some atopic dermatitis patients.
Allergens ; Antibodies ; Antigen-Antibody Complex* ; Dermatitis, Atopic* ; Dermatophagoides farinae* ; Eosinophils ; Humans ; Immunoglobulin E ; Pruritus ; Pyroglyphidae* ; Skin Tests ; Vascular Cell Adhesion Molecule-1

The implications of germline de novo variants (DNVs) in diseases are well documented. Despite extensive research, inconsistencies between studies remain a challenge, and the distribution and genetic characteristics of DNVs need to be precisely evaluated. To address this issue at the whole-genome scale, a large number of DNVs identified from the whole-genome sequencing of 1,902 healthy trios (i.e., parents and progeny) from the Simons Foundation for Autism Research Initiative study and 20 healthy Korean trios were analyzed. These apparently nonpathogenic DNVs were enriched in functional elements of the genome but relatively depleted in regions of common copy number variants, implying their potential function as triggers of evolution even in healthy groups. No strong mutational hotspots were identified. The pathogenicity of the DNVs was not strongly elevated, reflecting the health status of the cohort. The mutational signatures were consistent with previous studies. This study will serve as a reference for future DNV studies.
Autistic Disorder ; Cohort Studies ; Genome ; Humans ; Parents ; Virulence

The implications of germline de novo variants (DNVs) in diseases are well documented. Despite extensive research, inconsistencies between studies remain a challenge, and the distribution and genetic characteristics of DNVs need to be precisely evaluated. To address this issue at the whole-genome scale, a large number of DNVs identified from the whole-genome sequencing of 1,902 healthy trios (i.e., parents and progeny) from the Simons Foundation for Autism Research Initiative study and 20 healthy Korean trios were analyzed. These apparently nonpathogenic DNVs were enriched in functional elements of the genome but relatively depleted in regions of common copy number variants, implying their potential function as triggers of evolution even in healthy groups. No strong mutational hotspots were identified. The pathogenicity of the DNVs was not strongly elevated, reflecting the health status of the cohort. The mutational signatures were consistent with previous studies. This study will serve as a reference for future DNV studies.

BACKGROUND: Hypertension, diabetes, hyperlipidemia and coronary heart disease are closely related to obesity. Recently incidence of such diseases are remarkably increased. Many researches have been done to find out to implement prevention and treatment of such diseases. Abdominal obesity is one of the most important contributing factors of metabolic complications. This study was done to compare indicators of obesity with abdominal fat amount which was measured by anthropometric parameters and computed tomogram, and to find correlation between the risk factors of atherosclerosis and the indicators of obesity. METHODS: Fifty nine healthy premenopausal women without diabetes, coronary heart disease or history of other chronic disease were enrolled. Blood pressure and simple anthropometric parameter were measured. Computed tomograms in umbilical and femoral regions were performed. From serial blood samples, plasma fasting glucose and insulin, cholesterol and triglyceride were measured and atherogenic index was calculated. RESULTS: The ratio of visceral fat area and skeletal muscle area at the mid-thigh level was found to be highly correlated(R=0.965, p<0.001) and atherogenic index showed similar patterns to the waist circumference, the waist/height ratio and the waist/hip ratio. Especially, the waist/height ratio was found to be the most reliable indicator of obesity to predict atherogenic index. CONCLUSION: Although the ratio of visceral fat and skeletal muscle areas at the mid-thigh level which is measured by computed tomogram was the best indicator of visceral fat, these results proved that waist circumference and the waist/height ratio were also good indicators of the risk factors of atherosclerosis. By simple anthropometric measurements, it can help to find the remedy and preventiono of obesity in primary practices.
Abdominal Fat ; Atherosclerosis* ; Blood Pressure ; Cholesterol ; Chronic Disease ; Coronary Disease ; Fasting ; Female ; Glucose ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Insulin ; Intra-Abdominal Fat ; Muscle, Skeletal ; Obesity ; Obesity, Abdominal ; Plasma ; Risk Factors ; Triglycerides ; Waist Circumference

The intramedullary nailing for humeral shaft fractures has become popular fixation method. It affords less invasive procedure, good stability and early rehabilitation. However many complications were reported such as nonunion, pain and motion limitation of shoulder. We managed 33 patients using interlocking intramedullary nail for the humeral shaft fractures, and nonunion occurred in 9 patients. We reviewed these 9 cases and analyzed the relationship between the nonunions and the fracture sites as well as fracture types. The results were as follows; 1. Nonunion occurred in 9 patients of 25 patients treated closed reduction, but did not occur in 8 patients treated open reduction. 2. The union was obtained in all 6 patients with proximal one third fracture. But nonunion occurred in 6 patients of 19 patients with middle one third fracture and in 3 patients of 8 patients with distal one third fracture. 3. Nonunion after interlocking nails for humeral shaft fractures did not occur in all 6 spiral fracture patients. Nonunion occurred in 5 patients of 8 comminuted fracture patients, in 3 patients of 6 transverse fracture patients and in 1 patient of 3 oblique fracture patients with below the middle one third of humerus. Our study showed that the high rate of nonunion occurred in the comminuted, transverse and oblique fracture below the middle one third of humerus. On the basis of these findings, we recommend that closer attention should be paid when choose the fixation method in these types of the humeral shaft fractures.
Fracture Fixation, Intramedullary ; Fractures, Comminuted ; Humans ; Humerus ; Rehabilitation ; Shoulder

PURPOSE: Patients with Kawasaki disease (KD) who remain febrile after first dose of intravenous immunoglobulin (IVIG) are usually treated with a second dose of IVIG. However, the optimal dosage of IVIG in the retreatment of KD is still controversial. We evaluated the impact of IVIG dose difference on the coronary artery lesion (CAL) in the retreatment of KD. METHODS: We performed a prospective study on 24 patients with KD requiring IVIG retreatment from January 2000 to December 2004. The patients were assigned to receive IVIG in the retreatment of KD either as a single infusion of 2 g/kg (A group, 12 patients) or 1 g/kg (B group, 24 patients). We compared the CAL of B group to that of A group for comparable risk of both groups. RESULTS: The incidence of CAL was significantly higher in the 5 of 24 (20.9%) patients with IVIG retreatment vs the 18 of 315 (5.8%) afebrile patients after first course of IVIG treatment (P=0.016). There were no significant differences in age, sex, and other clinical and laboratory findings known as risk factors of CAL between the two groups. Among 24 patients with IVIG retreatment, there were no significant difference in the incidence of CAL between the two groups(Group A, 3/12=25%, vs Group B, 2/12=16.7%) (P>0.05). CONCLUSION: Single 1 g/kg IVIG therapy is comparable outcome to single 2 g/kg IVIG therapy in the retreatment of KD, although the efficacy of this practice requires assessment with a randomized controlled prospective trial in more patients.
Coronary Vessels ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Prospective Studies ; Retreatment* ; Risk Factors

PURPOSE:To investigate the impact of dietary pattern on the risk of asthma development, we undertook a nation-wide study with ISSAC written questionnaire. METHODS:We analyzed the relations between the previous 12-month dietary patterns (16 food groups) and asthma symptom prevalence, using the ISSAC written questionnaire and a domestically developed dietary questionnaire in 24,260 elementary school children. RESULTS:Odds ratios (OR) were significantly decreased by increased food intake of natural seafood (OR:0.88, P=0.0126, 95% CI:0.795-0.973), fruit (OR:0.785, P<0.0001, 95% CI:0.715-0.861), vegetables (OR:0.825, P<0.0001, 95% CI:0.764-0.891), and cow's milk (OR:0.9, P=0.0451, 95% CI:0.811-0.998). Compared to children that seldom consumed natural seafood, ORs of symptom development were lower in children that ate natural seafood 1-2 times per week (OR:0.863, P=0.028, 95% CI:0.761-0.978) and almost everyday (OR:0.802, P=0.0755, 95% CI:0.630-1.023), respectively. For green vegetables, ORs were significantly lower than in children who also ate gree vegetables 1-2 times per week (OR:0.753, P=0.0416, 95% CI:0.595-0.950) and almost everyday (OR:0.674, P=0.0179, 95% CI:0.408-0.752), respectively. Fruits showed the same pattern as green vegetables. CONCLUSION:Taken together, our study shows that the increased intake of natural seafood, fruit, and vegetables is significantly related to reduced asthma symptom prevalence in Korean children.
Asthma* ; Child* ; Eating ; Fruit ; Humans ; Milk ; Prevalence* ; Surveys and Questionnaires ; Risk Factors* ; Seafood ; Vegetables