Paragangliomas of the mediastinum are rare neoplasms. We report a case of a unsuspected mediastinal paraganglioma in 55-year-old man. The mediastnal tumor was accidentally discovered on a chest roentgenogram and there was no history of hypertension, sweating, flushing and headache. Surgical resection was difficult with bleeding and fluctuation of arterial blood pressure reaching up to 190/130 mmHg with tachycardia. The blood pressure was controlled with nitroglycerine and tachycardia controlled with beta-blocker. After tumor resection, hypotension was treated with dopamine and blood transfusion. Postoperative recovery was satisfactory and the patient discharged after 20 days. The diagnosis of aorticosympathetic paraganglioma was established by histologic examination.
Arterial Pressure ; Blood Pressure ; Blood Transfusion ; Diagnosis ; Dopamine ; Flushing ; Headache ; Hemorrhage ; Humans ; Hypertension ; Hypotension ; Mediastinum ; Middle Aged ; Nitroglycerin ; Paraganglioma* ; Sweat ; Sweating ; Tachycardia ; Thorax

The purpose of this study is to investigate the morphologic changes of the sinusoidal endothelial cells and the associated structures of the cirrhotic rat liver induced by repeat intraperitoneal injections of N-diethylnitrosamine (DEN) (100 mg/kg/week). One day to 6 weeks later, rat livers were observed under the light, transmission and scanning electron microscopy, and immunostained with laminin antibody. Two weeks after DEN treatment, the fibrillar material in Disse's space was noted, and then a basement membrane-like structure was found at 4 weeks after treatment. Laminin was detected in perisinusoidal areas after 4 weeks. Laminin was strongly positive on the fibrous septum and in the sinusoidal wall of cirrhotic nodules after 6 weeks of treatment. The diameters and numbers of sinusoidal endothelial fenestrations did not change significantly until 2 weeks. They decreased within 4 weeks, and then the sinusoidal endothelium was poorly fenestrated at 6 weeks after DEN treatment. These results suggest that as fibrosis develops in cirrhosis, the deposit of extracellular matrix such as laminin within Disse's space is a major contributing factor in the structural alteration of sinusoidal endothelial cells, and the capillarization of the sinusoidal endothelial cells may be a contributor to impairment of the hepatic function in cirrhosis.
Rats ; Animals

PURPOSE: Myocardial infarction in children with total occlusion of a coronary artery after Kawasaki disease is rare due to multiple collateral vessels. We aimed to investigate the changes in coronary perfusion associated with coronary artery occlusion after Kawasaki disease. MATERIALS AND METHODS: Eleven patients with coronary artery occlusion after Kawasaki disease were investigated. Serial coronary angiographies after total occlusion of a coronary artery were reviewed and the changes were described in all patients with additive information collected. RESULTS: The median age at the occlusion was 5.9 years old. The interval to occlusion was 6.2+/-6.9 years. Four left anterior descending coronary artery total occlusions and 10 right coronary artery total occlusions were detected. Immediate coronary artery bypass graft for left anterior descending coronary artery total occlusion made right coronary total occlusion occurred in all except one patient and the intervals thereof were 1 year, 1.8 years, and 4 years. Collaterals to the left coronary artery regressed after recanalization, while new collaterals to the right coronary artery developed. In three, collaterals to the right coronary artery decreased without recanalization without clinical signs. CONCLUSION: The right coronary artery should be followed up carefully because of possible occlusion of new onset or changes in collaterals.
Child ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Occlusion ; Coronary Vessels* ; Humans ; Methods ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction ; Perfusion* ; Transplants

PURPOSE: To assess union and complication rates associated with the use of 2 small diameter headless compression screws and volar wedge bone grafting for the treatment of scaphoid fracture waist nonunions with collapse. METHODS: A total of 12 patients (11 male and 1 female) at an average age of 32.5 years were treated with open reduction and internal fixation with 2 small diameter headless compression screws for scaphoid nonunions with a mean follow-up of 11 months. Tricortical wedge shaped autograft were harvested from the iliac crest and placed into the nonunion site to restore length and alignment in all patients. Union was determined by radiographs and computed tomography, and scapholunate and radiolunate angles, and height-to-length ratio were calculated on final radiographs and follow-up computed tomography. RESULTS: All 12 scaphoids united with a mean time for 2.8 months. The mean postoperative scapholunate angle was significantly reduced from 73° preoperatively to 56° postoperatively. The mean radiolunate angle was significantly improved from 21° from neutral preoperatively to 12° postoperatively. The height-to-length ratio was also demonstrated significant improvement from 0.73 preoperatively to 0.60 postoperatively. No hardware problems were identified and no revision procedures have been necessary. CONCLUSION: Our results indicate that the use of 2 small diameter headless compression screws with volar structural bone graft stabilizes the fracture for predictable union, while reducing the deformity reliably from a collapsed scaphoid nonunion. The presented technique is safe and effective, and may provide superior biomechanical stability, especially against the torsional force.
Autografts ; Bone Transplantation ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Male ; Torsion, Mechanical ; Transplants

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Only a few patients reach adulthood without surgical correction. Unrepaired TOF patients with mild to moderate right ventricular outflow tract (RVOT) obstruction may be clinically silent until adulthood. TOF with hypoxic spells present as periods of profound cyanosis that occur because of almost total RVOT obstruction. So, hypoxic spell typically occurs in a crying infant but is rare in an adult. In this report, we presented a case of a 75-year-old patient with uncorrected TOF presenting with hypoxic spell, consequent pulmonary hypertension and chronic heart failure. This is the oldest case of natural survivor with uncorrected TOF in Korea and the oldest patient presenting hypoxic spell worldwide.
Adult ; Aged* ; Anoxia ; Crying ; Cyanosis ; Heart Defects, Congenital ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Infant ; Korea ; Survivors* ; Tetralogy of Fallot*

BACKGROUND AND OBJECTIVES: Immunological variability in Kawasaki disease (KD) shows age-specific differences; however, specific differences in laboratory values have not been compared between infants and non-infants with KD. We compared age-adjusted Z-values (Z) of white and red blood cells in infants with KD with those in non-infants with KD. METHODS: This study retrospectively investigated 192 infants and 667 non-infants recruited between 2003 and 2015 at the Korea University Hospital. Laboratory values for infants with KD and non-infants with KD were analyzed and age-unadjusted raw values (R) and age-adjusted Z for blood cells counts were determined. RESULTS: Z in infants with KD during pre-intravenous immunoglobulin (IVIG), post-IVIG, and chronic phases showed increased lymphopenia and eosinophilia, low neutrophil:lymphocyte and neutrophil:eosinophil ratios, worse anemia, increased thrombocytosis, and reduced erythrocyte sedimentation rates compared with those in non-infants with KD. The optimal cut-off value for pre-IVIG Z-hemoglobin for prediction of KD in all patients was <−0.01 (area under the curve [AUC], 0.914; sensitivity/specificity, 0.999/0.886; p=0.04). The optimal cut-off value for pre-IVIG C-reactive protein (CRP) for prediction of KD in infants compared to that in febrile control infants was >40 mg/L (AUC, 0.811; sensitivity/specificity, 0.712/0.700; p=0.04). CONCLUSIONS: Laboratory characteristics enable differentiation between infants and non-infants with KD and contribute to a better understanding of changes in blood cell counts. Infants with incomplete KD can be more easily differentiated from infants with simple febrile illness using pre-IVIG Z-hemoglobin and pre-IVIG CRP values.
Anemia ; Blood Cell Count ; Blood Cells ; Blood Sedimentation ; C-Reactive Protein ; Eosinophilia ; Erythrocytes ; Humans ; Immunoglobulins ; Infant ; Korea ; Leukocyte Count ; Lymphopenia ; Mucocutaneous Lymph Node Syndrome ; Retrospective Studies ; Thrombocytosis

There is a limitation to estimate vitamin B12 intake due to a lack of data on vitamin B12 content in many Korean foods. In this study, vitamin B12 content was determined in some seaweeds, fish, and shellfish and their product that are consumed in Korea using a modified microbioassay with Lactobacillus delbruecki ATCC 7830. Dried laver and dried seasoned and toasted laver contained very high levels of vitamin B12 (66.8 and 55.2-71.3 microg/100 g, respectively. Sea lettuce and seaweed fulvescene also contained high vitamin B12 content of 5.47-9.41 and 6.46-7.20 microg/100 g, respectively, whereas sea mustard and sea tangle contained low levels of vitamin B12; vitamin B12 was not detected in seaweed fusifome. Pacific saury, trout, sea-bass, or squid contained 12.01, 2.00, 0.49 and 2.33 microg vitamin B12/100 g, respectively. Ochellatus octopus, and naked sand lance contained 0.72-1.43 and 3.68 microg vitamin B12/100 g, respectively. Dried Alaska pollack contained 0.19-2.64 microg vitamin B12/100 g. Shellfish such as little neck clam and small ark shellfish contained high levels of vitamin B12 of 30.5-40.5 microg/100 g, and mussel and abalone contained 17.71 and 7.82 microg/100 g, respectively. Of unique Korean traditional fermented seafood products, salt-fermented products of squid (2.91 microg/100 g), clams (34.31 microg/100 g), Alaska pollack roe (9.98-12.02 microg/100 g), hairtail guts (4.58 microg/100 g) or small shrimp (0.58-1.55 microg/100 g), and fish sauce from anchovies (1.52-1.78 microg/100 mL), sand eel (0.22-0.24 microg/100 mL) or small shrimp (0.19-0.78 microg/100 mL) were analyzed. A few commercial brands of flying fish roe (0.73-1.73 microg/100 g), canned tuna (0.40 microg/100 g), and fried fish paste (0.25-0.69 microg /100 g) were also analyzed. In conclusion, vitamin B12 content in these foods, chosen considering the Korean food culture, should contribute to improve the present vitamin B12 food database. It may be helpful to estimate vitamin B12 intake more correctly than before, and provide additional information for dietary education related to vitamin B12 and meal management.
Alaska ; Bivalvia ; Decapodiformes ; Diptera ; Eels ; Korea ; Lactobacillus ; Meals ; Mustard Plant ; Neck ; Octopodiformes ; Seafood ; Seasons ; Seaweed ; Shellfish ; Silicon Dioxide ; Trout ; Tuna ; Ulva ; Vitamin B 12 ; Vitamins

There is a limitation to estimate vitamin B12 intake due to the lack of data on vitamin B12 content of Korean commercial foods. In this study, vitamin B12 content was determined in favorite Korean restaurant foods, convenient or instant foods, fast foods and bakery products through a modified microbioassay using Lactobacillus delbrueckii ATCC 7830. Bulgogi and seafood & green pepper griddle had high vitamin B12 content, 3.50 and 2.96 microg/100 g, respectively. Pork suyook, pork griddle and pollack griddle had 0.48, 0.31 and 0.32 microg/100 g of vitamin B12, respectively. In stew, soft-tofu stew with seafood and doenjang stew with seafood had relatively high vitamin B12 content, 1.93 and 1.44 microg/100 g, respectively. Bibimbap and 4 different types of rice porridge, beef & mushroom, chicken & ginseng, seafood or abalone, had 0.36, 0.08, 0.09, 1.64 and 0.13 microg/100 g of vitamin B12, respectively. One serving of haejanggguk, yookejang, chuotang and galbitang had 5.97, 2.04, 2.63 and 1.91 microg of vitamin B12, respectively. One serving of samgetang and sulongtang had 2.89 microg and 6.64 microg of vitamin B12. In noodles, one serving of cram noodle soup, bibim-nangmyeon, and mul-nangmyeon had 18.8, 1.21 and 0.38 microg of vitamin B12, respectively. One regular gimbap and one triangle gimbap contained 1.09-2.53 and 0.54-1.11 microg of vitamin B12, respectively. One cheese-burger, chicken-burger and bulgogi-burger had 0.76, 0.62 and 0.54 microg of vitamin B12, respectively. A plain bagel and a waffle contained 0.13 and 0.17 microg/100 g of vitamin B12, respectively. Ready-made tomato sauce or cream sauce for spaghetti in a retort pouch contained only a trace of vitamin B12. In conclusion, these results should contribute to improving the present food vitamin B12 content database, most of which were cited from foreign data, thereby it could be helpful to estimate the vitamin B12 intake of Koreans more accurately than before. It will also provide new information for dietary education related to vitamin B12 and health.
Agaricales ; Capsicum ; Chickens ; Fast Foods ; Lactobacillus delbrueckii ; Lycopersicon esculentum ; Panax ; Restaurants ; Seafood ; Vitamin B 12 ; Vitamins

BACKGROUND AND OBJECTIVES: Immunological variability in Kawasaki disease (KD) shows age-specific differences; however, specific differences in laboratory values have not been compared between infants and non-infants with KD. We compared age-adjusted Z-values (Z) of white and red blood cells in infants with KD with those in non-infants with KD. METHODS: This study retrospectively investigated 192 infants and 667 non-infants recruited between 2003 and 2015 at the Korea University Hospital. Laboratory values for infants with KD and non-infants with KD were analyzed and age-unadjusted raw values (R) and age-adjusted Z for blood cells counts were determined. RESULTS: Z in infants with KD during pre-intravenous immunoglobulin (IVIG), post-IVIG, and chronic phases showed increased lymphopenia and eosinophilia, low neutrophil:lymphocyte and neutrophil:eosinophil ratios, worse anemia, increased thrombocytosis, and reduced erythrocyte sedimentation rates compared with those in non-infants with KD. The optimal cut-off value for pre-IVIG Z-hemoglobin for prediction of KD in all patients was <−0.01 (area under the curve [AUC], 0.914; sensitivity/specificity, 0.999/0.886; p=0.04). The optimal cut-off value for pre-IVIG C-reactive protein (CRP) for prediction of KD in infants compared to that in febrile control infants was >40 mg/L (AUC, 0.811; sensitivity/specificity, 0.712/0.700; p=0.04). CONCLUSIONS Laboratory characteristics enable differentiation between infants and non-infants with KD and contribute to a better understanding of changes in blood cell counts. Infants with incomplete KD can be more easily differentiated from infants with simple febrile illness using pre-IVIG Z-hemoglobin and pre-IVIG CRP values.