PURPOSE: In children on anticancer chemotherapy, bloodstream infections (BSIs) are a major cause of morbidity and mortality. We investigated febrile episodes and bloodstream infections in pediatric cancer patients to guide proper selection of empiric antibiotics for febrile pediatric hemato-oncologic patients. METHODS: All febrile episodes treated in the division of hematology-oncology, the department of pediatrics, Hanyang University Hospital, between July 2005 and June 2008 were reviewed. Episodes with and without bloodstream infections were compared. RESULTS: Forty cases (18.9%, 25 patients) of BSI occurred in 212 febrile episodes (63 patients). Thirty-seven cases (23.6%, 22 patients) of BSI occurred in 157 febrile episodes with neutropenia (54 patients). Microorganisms identified in BSI corresponded to 23 gram-positive bacteria (51.2%), 20 gram-negative bacteria (44.5%), and 2 fungi (4.4%). Rates of BSI between those who had received umbilical cord blood transplantation and those who had received transplantation from other source were significantly different (55.0% vs. 7.7%, P=0.001). No differences in mortality rate were observed among organisms in BSI patients. For febrile episodes the rate of BSI was higher among those with Chemoport than those with Hickman catheter (P=0.029) and gram-positive pathogens were more likely to be associated with Chemoport (P=0.001). CONCLUSION: The study showed the rate of BSI, distribution of pathogens with regard to neutropenia, transplantation, central venous catheters, and antimicrobial susceptibility of pathogens in order to help guide in the choice of optimal empiric antibiotics in pediatric febrile neutropenic hemato-oncologic patients.
Anti-Bacterial Agents ; Bacteremia ; Catheters ; Central Venous Catheters ; Child ; Fetal Blood ; Fever ; Fungi ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Neutropenia ; Pediatrics ; Transplants

No abstract available.
Infant ; Infant, Newborn ; Lissencephaly* ; Spasms, Infantile*

The addition of epinephrine to local anesthetics for peipheral nerve blocks reduces the risk of local anesthetic toxicity by delaying systemic absorption and prolongs block duration. But there is general agreement that epinephrine causes a decrease in plama K+ in humans that can be associated with a variety of cardiac dysrhythmias. Clonidine, a selective 2 adrenergic agonist, has been reported to increase the local anesthetic effect. And the addition of clonidine to local anesthetics in peripheral nerve block prolongs block duration and postoperative analgesia. The admixture of clonidine or epinephrine to bupivacaine for brachial plexus block was studied with regard to plasma potassium concentrations and hemodynsmie changes. Thirty-three patients of ASA physical statue I and II received an admixture of clonidine (150g; n=11), epinephrine (200g; n=11), or normal saline (placebo; n=11) to 30 ml of 0.5% bupivacaine in a randomized, double blind fashion. There were no differences in arterial blood pressure and heart rate among the three groups. In patients who had received epinephrine admixture, decrease of plasma potassium at 15min after block was significant compared with patients who had received clonidine. Clonidine may be a useful adjunt to loeal anesthetics in those patients in whom the administration of epinephrine is contraindicated.
Absorption ; Adrenergic Agonists ; Analgesia ; Anesthetics ; Anesthetics, Local ; Arrhythmias, Cardiac ; Arterial Pressure ; Brachial Plexus* ; Bupivacaine* ; Clonidine* ; Epinephrine* ; Heart Rate ; Humans ; Nerve Block ; Peripheral Nerves ; Plasma* ; Potassium*

BACKGROUND: Volatile anesthetics exert direct depressant and vasodilator effects on vascular smooth muscle. These effects may result in clinically relevant hemodynamic changes. However, the mechanism is not well known whereby volatile anesthetics inhibit the vasoconstrictor actions of catecholamines at vascular smooth muscle. METHODS: The present study examined the direct effects of isoflurane on responses of isolated rabbit thoracic arteries to the norepinephrine(a mixed alpha1- and alpha2-adrenoceptor agonist) and phenylephrine(a selective alpha1-adrenoceptor agonist) applied exogenously. The role of extra- and intracellular Ca2+ in norepinephrine-induced contractions was also examined. RESULTS: Norepinephrine and phenylephrine produced maximal responses of about the same magnitude; however, norepinephrine was more potint than phenylephrine. Isoflurane depressed only the upper portion(10(-5)~10(-4)M) of norepinephrine dose-response curves. The depression of contraction caused by isoflurane on the dose-response curves of norepinephrine and phenylephrine was more marked with phenylephrine than with norepinephrine; isoflurane(2~3%) caused a concentration-dependent attenuatian of the responses evoked by 10(-5) to 10(-3)M phenylephrine. Ryanodine(a selective inhibitor of sarcoplasmic reticulum Ca2+ channels) attenuated the contractile response to norepinephrine. In the Ca2+-free medium the contractile response to norepinephrine was attenuated as compared to control. CONCLUSIONS: Theses results suggest that isoflurane attenuates the contractile responses of isolated rabbit thoracic arteries to norepinephrine and phenylephrine probably interfering with postjunctional alpha1-receptor function.
Anesthetics ; Catecholamines ; Depression ; Hemodynamics ; Isoflurane* ; Muscle, Smooth, Vascular ; Norepinephrine* ; Phenylephrine ; Rabbits* ; Receptors, Adrenergic, alpha ; Sarcoplasmic Reticulum ; Sympathetic Nervous System ; Thoracic Arteries

No abstract available.
Osteoblastoma*

Odontogenic myxoma is one of rare tumors in oral and maxillofacial region and it is thought to be mesenchymal or ectomesenchymal origin. Its characteristics are benign and non-metastatic but it has the potential of local invasion and high recurrence rate. It originally occurs in atrium of heart and in central case, my xoma is located mainly in the maxilla and mandible. Most odontogenic myxoma develops in 2nd or 3rd decades of life and rarely occurs in child or older persons over fifty. The distribution of reported cases between the sexes is similar and the maxilla and mandible are equally affected or slightly higher in mandible. Clinically it is usually asymptomatic, however it can cause pain and paresthesia is complained in the advanced stages. Displacement and mobility of teeth have also been reported Odontogenic myxoma is not a frequent tumor, but in case of slow and painless growing tumor it must be considered as a differential diagnosis.
Child ; Diagnosis, Differential ; Heart ; Humans ; Jaw ; Mandible ; Maxilla ; Myxoma* ; Paresthesia ; Recurrence ; Tooth

OBJECTIVES: Although mercury (Hg) exposure is known to be neurotoxic in humans, its effects on liver function have been less often reported. The aim of this study was to investigate whether total Hg exposure in Korean adults was associated with elevated serum levels of the liver enzymes aspartate aminotransferase (AST), alanine transaminase (ALT), and gamma-glutamyltransferase (GGT). METHODS: We repeatedly examined the levels of total Hg and liver enzymes in the blood of 508 adults during 2010-2011 and 2014-2015. Cross-sectional associations between levels of blood Hg and liver enzymes were analyzed using a generalized linear model, and nonlinear relationships were analyzed using a generalized additive mixed model. Generalized estimating equations were applied to examine longitudinal associations, considering the correlations of individuals measured repeatedly. RESULTS: GGT increased by 11.0% (95% confidence interval [CI], 4.5 to 18.0%) in women and 8.1% (95% CI, -0.5 to 17.4%) in men per doubling of Hg levels, but AST and ALT were not significantly associated with Hg in either men or women. In women who drank more than 2 or 3 times per week, AST, ALT, and GGT levels increased by 10.6% (95% CI, 4.2 to 17.5%), 7.7% (95% CI, 1.1 to 14.7%), and 37.5% (95% CI,15.2 to 64.3%) per doubling of Hg levels, respectively, showing an interaction between blood Hg levels and drinking. CONCLUSIONS: Hg exposure was associated with an elevated serum concentration of GGT. Especially in women who were frequent drinkers, AST, ALT, and GGT showed a significant increase, with a significant synergistic effect of Hg and alcohol consumption.
Adult* ; Alanine Transaminase ; Alcohol Drinking ; Aspartate Aminotransferases ; Drinking ; Female ; gamma-Glutamyltransferase ; Humans ; Linear Models ; Liver* ; Longitudinal Studies* ; Male

PURPOSE: Gonadotropin releasing hormone analogue (GnRHa) or growth hormone (GH) improve final height in girls with central precocious puberty. We studied the effect of these agents on adult height in children with advanced puberty. METHODS: We analysed height, bone age, growth velocity, predicted adult height (PAH), and final adult height (FAH) in 61 girls and 19 boys with advanced puberty, who were treated with GnRHa combined GH or GH. RESULTS: In Girls 1) FAH (SDS) of combination group (GnRHa+GH, n=7) was similar to their pretreatment PAH (SDS) [153.9+/-6.0 cm (-1.3+/-1.2) vs 152.8+/-4.7 cm (-1.5+/-0.9)]. In GH group (n=18), FAH was significantly increased [155.7+/-4.9 cm (-0.9+/-1.0) vs 149.9+/-4.6 cm (-2.1+/-0.9)] (P<0.001). 2) PAH (SDS) of combination group increased from 151.5+/-5.9 cm (-1.8+/-1.2) to 157.8+/-7.1 cm (-0.5+/-1.4) and that of GH group increased from 149.5+/-5.9 cm (-2.2+/-1.2) to 155.8+/-5.8 cm (-0.9+/-1.2) (P<0.001). During first year of treatment, growth velocity of GH group was significantly higher than that of combination group (6.6+/-2.1 cm/year vs 9.4+/-2.5 cm/year, P=0.001) In boys 1) In both group (7 boys of combination group and 8 boys of GH group), FAH was similar to their pretreatment PAH and their growth velocity during first year of treatment had no significant difference (7.6+/-2.3 cm/year vs 9.2+/-2.9 cm/year). CONCLUSION: In girls with advanced puberty, GnRHa delayed bone maturation but had no significant effect on FAH. In contrast, GH increased FAH through increment of growth velociy. In boys with advanced puberty, no significant effect of GnRHa or GH.
Adolescent ; Adult ; Child* ; Female ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Growth Hormone* ; Humans ; Puberty* ; Puberty, Precocious

Occupational dermatosis is one of the most prevalent occupational disorders. However, the extent of the occupational dermatoses including incidences and prevalencies of each disease entity, and etiologic materials are not yet well stated in Korea. Authors reviewed the literatures on the statistic data and reports on the occupational dermatoses, and surveyed on the occupational dermatoses in two factories, and surveyed the physicians responsible to the occupational dermatoses with formed questionnaire. The results are as follows; 1. Among medical journals published since 1964, there were 31 articles on the occupational dermatoses. Of 31 articles, 18 were case reports and all others were review articles. Of 18 case reports, 9 were epidemiologic survey. The Workers' Periodic Health Examinations revealed that prevalence of the occupational dermatoses was highest(4.36 per 10,000 workers) in 1974, but number of the cases reported were decreased sharply since 1978 with some tendency to increase since 1987. There were 2,240 reported cases of occupational dermatoses between 1966 and 1992, which is 1.90% of all the reported occupational diseases. Skin infection and injuries due to chemicals were most frequent and there were 6 cases of skin cancer. 2. In an epidemiological survey on the dermatoses among 995 workers in a metal product manufacturing factory and 225 workers with acne, 130 workers with scar, 123 workers with deformity of toe nails. Scars, photosensitivity dermatitis, deformity of finger and toe nails, and acne were more prevalent in the metal product manufacturing factory(p<0.05). In the metal product manufacturing factory, workers treating organic solvents and oils had more dermatoses than those without treating the materials(p<0.05). On the skin patch performed on 16 workers in the metal product manufacturing factory, there were 8 cases of irritation dermatitis and 5 cases of contact dermatitis. Prevalence of contact dermatitis in the metal product manufacturing factory was 1.3%. 3. On the questionnaire survey, 34 dermatologists, 29 doctors of preventive medicine, and 22 family physician replied. The proportion of occupational etiology among all dermatoses assumed by the physicians were below 9%, and the most important occupational dermatosis in Korea was contact dermatitis. Main etiologic materials related to the occupational dermatosis were organic solvent, acid and alkali, and metals. The reason for the scarcity of report of occupational dermatoses were difficulty in diagnosis and physician's ignorance of the occupational etiology. They replied that to prevent the occupational dermatosis in the workplace, the use of protective devices was most important, and development of diagnostic criteria on the occupational dermatoses is urgent. Above results shows us that there is many workers with occupational dermatoses, but they are mostly unreported. Measures to prevent and manage the occupational dermatoses are not satisfactory at present. Hence, authors suggest measures for the precises diagnosis, report and prevention of the occupational dermatoses. a. Dernatikigustm orevebtuve physician, and industrial hygienist should work as a team to examine the high risk group and establish the preventive measures. b. Disease entities, diagnostic criteria of occupational dermatoses should be listed, criteria for the compensation and job fitting at recruitment should be established, and manual for the proper treatment and effective prevention of each occupational dermatosis should be developed. c. Patch test antigens against each occupational category should be developed and it should be available to any physicians responsible. d. To facilitate the diagnosis of occupational dermatoses by the doctors responsible for the Workers' Periodic Health Examination, development of standardized questionnaire, education on the techniques of the patch test, and cooperation with the dermatologist in diagnosis of occupational dermatoses is essential.
Acne Vulgaris ; Alkalies ; Cicatrix ; Compensation and Redress ; Congenital Abnormalities ; Dermatitis ; Dermatitis, Contact ; Diagnosis ; Education ; Fingers ; Humans ; Incidence ; Korea ; Metals ; Occupational Diseases ; Oils ; Patch Tests ; Physicians, Family ; Prevalence ; Preventive Medicine ; Protective Devices ; Surveys and Questionnaires ; Skin ; Skin Diseases* ; Skin Neoplasms ; Solvents ; Toes

BACKGROUND: The effect of arterial carbon dioxide tension (PaCO2) during ischemia and reperfusion has been a controversial issue. In this study, the effect of PaCO2 during ischemia and reperfusion was evaluated by 31P magnetic resonance spectroscopy (MRS). METHODS: Incomplete global cerebral ischemia was induced by ligation of carotid artery under lowered mean blood pressure (mean blood pressure= 40 mmHg) for 30 minutes followed by 2 hours of reperfusion. Eighteen cats were divided into 3 groups: For group 1 (n=6) (control group), animals were subjected to normocarbia (PaCO2=28~33 mmHg) during ischemia and reperfusion, for group 2 (n=6), animals were subjected to hypocarbia (PaCO2=18~23 mmHg) during ischemia and reperfusion, and for group 3 (n=6), animals were subjected to normocarbia during ischemia and hypocarbia during reperfusion. RESULTS: For group 1, the energy metabolism measured by [PCr/Pi] was recovered about 74.7 6.4%. For group 2, the energy metabolism failed to be completely recovered by 120 minutes of reperfusion (69.3 7.3%), whereas for group 3, the energy matabolism was completely recovered by 120 minutes of reperfusion (97.6 2.4%). There were statistically significant differences between group 1 and group 3 (p<0.05). The changes in pH were not significantly different among the groups. CONCLUSION: In this study, a condition of hypocarbia during reperfusion seems better for the energy metabolism after incomplete global ischemia of cats.
Animals ; Blood Pressure ; Brain Ischemia ; Brain* ; Carbon Dioxide ; Carotid Arteries ; Cats* ; Energy Metabolism* ; Hydrogen-Ion Concentration ; Ischemia ; Ligation ; Magnetic Resonance Spectroscopy ; Reperfusion