PURPOSE: Neonatal jaundice is one of the most common problems in our country leading to hospitalization. Agar is low cost, low risk, and easily fed orally; it can bind bilirubin in the intestine, decreasing its enterohepatic circulation, thereby decreasing serum bilirubin levels. At present, however, the effectiveness of agar in the prevention and treament of neonatal jaundice is quite conflicting and controversy. Recently we have read Caglayan's 'Superiority of Oral Agar and Phototherapy Combination in the Treatment of Neonatal Hyperbilirubinemia'. The result was very hopeful and attractive enough, and which gave us a motivation to study if it was really of value. METHODS: From May 1995 to April 1996, a total 50 term neonates admitted in nursery of Dong-Eui Medical Center with the capillary serum bilirubin levels greater than 10mg/ dl were enrolled in the study. Those with pathologic causes and breast fed infants were all excluded. The neonates were randomly devided into two groups; 25 of conventional phototherapy alone (P group) and 25 of oral agar plus conventional phototherapy combination (A+P group). The study was terminated when the capillary serum bilirubins were decreased to 8mg/dl. Pastagar B (Pasteur Institute 64946) 500mg in 10ml distilled water were fed four times a day using 10ml syringes prior to bottle feeding. Capillary serum bilirubin levels were measured daily at 10:00 a.m. with heel pad samples. Daily stool frequency and adverse effects of treatment were observed closely. RESULTS: 1) The decrement of the serum bilirubin levels at first 24 hours of therapy was significantly different between P and A+P groups showing as 1.7+/-1.2 and 2.4+/-1.0mg/dl respectively (p<0.05). 2) Mean time for bilirubin to decrease to 8mg/dl was shorter in A+P group than in P group showing as 45.7+/-20.8 and 57.5+/-32.3 hours each other, but those differences were statistically insignificant (p>0.05). 3) No adverse effects such as rashes or abdominal pains were observed during treatment. Differences of mean stool frequency were significant between P and A+P groups showing as 3.7+/-1.2 and 4.7+/-2.0 times per day respectively (p<0.05). CONCLUSION: The agar plus conventional phototherapy combination was superior to conventional phototherapy alone at first 24 hours of therapy in neonatal hyperbilirubinemia, but further more careful researches would be necessary for using it routinely in the treatment of neonatal hyperbilirubinemia in future.
Abdominal Pain ; Agar* ; Bilirubin ; Bottle Feeding ; Breast ; Capillaries ; Enterohepatic Circulation ; Exanthema ; Heel ; Hope ; Hospitalization ; Humans ; Hyperbilirubinemia, Neonatal* ; Infant ; Infant, Newborn ; Intestines ; Jaundice, Neonatal ; Motivation ; Nurseries ; Phototherapy* ; Syringes ; Water

Negative pressure pulmonary edema (also known as postobstructive pulmonary edema) is a medical emergency that usually arises from attempted ventilations against an acutely obstructed upper airway, such as occurs during laryngospasm. Often this occurs in the perioperative period when general anesthesia is used. It is most important to the clinician because it must be promptly recognized and appropriately managed. Since hypoxia is the chief problem associated with this complication, adequate oxygen saturation remains the primary goal of treatment. We report a case of a 42-year-old female patient who was submitted to laparoscopic tubal reversal under general anesthesia and developed negative pressure pulmonary edema after an acute airway obstruction.
Adult ; Airway Obstruction ; Anesthesia, General ; Anoxia ; Emergencies ; Female ; Humans ; Laparoscopy* ; Laryngismus ; Oxygen ; Perioperative Period ; Pulmonary Edema* ; Ventilation

Immunohistochemical staining on paraffin sections for S-100 protein improved diagnostic accuracy for melanocytic tumor. But specificity of S-100 protein in the diagnosis of melanocytic tumor is very low, because S-100 protein was also expressed in neurogenic tumor and salivary gland tumor. To investigate a specific tumor marker for the malignant melanoma, immunohistochemical staining for HMB-45 and S-100 protein was performed on the paraffin sections of 25 cases of malignant melanoma and 46 cases of nevi. Positive reaction for HMB-45 and S-100 protein was diffusely identified in the cytoplasm of tumor cells. Positive ratio for HMB-45 was 100% in malignant melanoma, 92% in junctional component of compound nevus and 0% in intradermal nevus. Positive ratio for S-100 protein was 92% in malignant melanoma, 100% in compound nevus and 100% in intradermal nevus. The sensitivity and specificity for HMB-45 in malignant melanoma were 100%, but those for S-100 protein were 92% in sensitivity and 86.7% in specificity. These results indicate that HMB-45 has a high sensitivity and specificity for malignant melanoma cells and it can be quite useful for the histopathological diagnosis of malignant melanoma.
Sensitivity and Specificity ; Tumor Markers, Biological

No abstract available.
Meningitis, Aseptic*

Gastrointestinal cytomegalovirus(CMV) infection in adults is observed as a part of a generalized or localized infection in patients who are immunocompromized. We report a case of CMV infection of the small intestine. The patient is a 34 year-old woman who has complained of palpable purpura in the lower extremities and buttocks, and arthralgia of large joints. The skin biopsy showed fibrinoid necrosis and neutrophils with leukocytoclasis, which findings are compatible with hypersensitivity angiitis. The patient received steroid and cyclophosphamide. During the follow-up period, generalized edema and bloody stool were detected. Resected specimen of small bowel has multiple aphthous ulcer. Microscopically, cytomegalic cells are observed along the endothelial cells and mesenchymal cells. In situ hybridization using DNA probes against CMV revealed positive staining in the cytomegalic inclusions in vascular endothelial and mesenchymal cells.
Adult ; Male ; Female ; Humans ; Biopsy

PURPOSE: The Purposes of this study are to identify the circulating etiologic viruses of acute lower respiratory tract infection in children and to understand the relation with clinical diagnosis. METHODS: We obtained a total of 418 nasopharyngeal aspirates from children admitted for their acute lower respiratory tract infections at three tertiary hospitals in Seoul from September 2008 to March 2009. We performed multiplex RT-PCR to identify 14 etiologic viruses and analyzed their emerging patterns and clinical features. RESULTS: Average age of patients was 16.4 months old and the ratio of male to female was 1.36. Viruses were detected in 56.2% of a total of 418 samples. Respiratory syncytial virus (35%) was the most frequently detected and followed by human rhinovirus (22%), human bocavirus, adenovirus, human metapneumovirus, parainfluenza virus, influenza virus and human coronavirus. Co-infection reached 21.9% of positive patients. CONCLUSION: When we manage the patients with acute lower respiratory infectious diseases, we should remind the role of various viral pathogens, which might be circulating by seasons and by local areas.
Adenoviruses, Human ; Child ; Coinfection ; Communicable Diseases ; Coronavirus ; Female ; Human bocavirus ; Humans ; Male ; Metapneumovirus ; Orthomyxoviridae ; Paramyxoviridae Infections ; Respiratory Syncytial Viruses ; Respiratory System ; Respiratory Tract Infections ; Rhinovirus ; Seasons ; Tertiary Care Centers ; Viruses

PURPOSE: Bilirubin values may vary depending on the site of sampling. The purpose of this study is to compare simultaneously obtained capillary and venous serum bilirubin to assess neonatal jaundice. METHODS: The subjects for the study included 135 healthy inborn as well as outborn full-term infants admitted to Dong-Eui Medical Center for evaluation of jaundice from May 1997 to February 1999. A paired capillary and venous sample was simultaneously drawn from each neonate, and their serum bilirubins were measured by direct spectrophotometric method. RESULTS: A high correlation between capillary and venous serum bilirubin(correlation coefficient(r) =0.949, P<0.05) was observed. No significant difference between mean capillary and venous bilirubin was detected when capillary bilirubin was less than 10 mg/dL(P>0.05), however, the mean venous bilirubin was significantly higher than the mean capillary bilirubin(mean difference;0.65+/-1.04 mg/dL, P<0.0001) when the capillary bilirubin was greater or equal to 10 g/dL(P>0.05). CONCLUSION: There was a trend toward venous bilirubin being higher than capillary bilirubin at higher serum bilirubin levels. However, further studies are needed to ascer-tain the relationship between the site of the sampling and methodology in measurement of bilirubin.
Bilirubin* ; Capillaries* ; Humans ; Infant ; Infant, Newborn ; Jaundice ; Jaundice, Neonatal*

OBJECTIVES: This study examined the use of health impact assessment (HIA) as a tool for intersectoral collaboration using the case of an HIA project conducted in Gwang Myeong City, Korea. METHODS: A typical procedure for rapid HIA was used. In the screening step, the Aegi-Neung Waterside Park Plan was chosen as the target of the HIA. In the scoping step, the specific methods and tools to assess potential health impacts were chosen. A participatory workshop was held in the assessment step. Various interest groups, including the Department of Parks and Greenspace, the Department of Culture and Sports, the Department of Environment and Cleansing, civil societies, and residents, discussed previously reviewed literature on the potential health impacts of the Aegi-Neung Waterside Park Plan. RESULTS: Potential health impacts and inequality issues were elicited from the workshop, and measures to maximize positive health impacts and minimize negative health impacts were recommended. The priorities among the recommendations were decided by voting. A report on the HIA was submitted to the Department of Parks and Greenspace for their consideration. CONCLUSIONS: Although this study examined only one case, it shows the potential usefulness of HIA as a tool for enhancing intersectoral collaboration. Some strategies to formally implement HIA are discussed.
*Health Policy ; Humans ; Organizational Case Studies ; Politics ; *Public Health ; Public Policy ; Urban Health

OBJECTS: The purpose of this study was to evaluate the relative usefulness of the morphologic scoring system and spectral doppler ultrasonographic analysis in differentiating between benign and malignant adnexal masses. METHODS: All patients scanned between July 1995 and June 1998 with sonographically identified and pathologically confirmed adnexal masses formed the study group. The adnexal masses were scored as benign or malignant on the basis of their sonographic appearance. Specific categories included inner wall structure, wall thickness, septal structure, and echogenicity. Women whose morphologic findings were suspicious for malignancy underwent doppler sonography. A threshold pulsatility index of 1.0 and resistance index of 0.4 were used to differentiate benign from malignant lesions. The findings were correlated with the presence of malignancy. RESULTS: Two hundred fifty one patients formed the study group; 215 patients were benign and 36 patients were malignant pathologically. Using the morphologic scoring system, 31 of the 36 malignant masses were classified as suggestive of malignant tumor, and 147 of the 215 benign masses were classified as not suggestive of malignant tumor (sensitivity, 86%; specificity, 68%; positive predictive value, 31%; negative predictive value, 97%). Doppler velocimetry was performed on a total of 62 patients, 19 patients with malignant tumors and 43 patients with benign tumors. A mean PI value of 0.85 and RI value of 0.52 for malignant tumors and mean PI value of 2.00 and RI value of 0.75 for benign tumors was shown. The PI value was significantly lower (p 0.001) in malignant than that of in benign masses, but RI value was not significant (p 0.184). The sensitivity and specificity in the detection of malignancy combined with doppler velocimetry was 86% and 67%, respectively. CONCLUSION: Doppler velocimetry studies did not add substantially to the prediction of malignancy using the morphologic scoring system.
Diagnosis* ; Female ; Humans ; Rheology ; Sensitivity and Specificity ; Ultrasonography

Methotrexate is a very potent inhibitor of dihydrofolate reductase and causes bone marrow suppression and megaloblastic anemia. It is widely used in combination with other chemotherapeutic agents in lymphoproliferative disorders. A 63 year old man with ischioneuralgia developed exertional dyspnea and dizziness after he had intentionally taken methotrexate in doses of 5mg per day for 2months. Five months after discontinuation of methotrexate, his bone marrow showed the hypercellular marrow with 90% cellularity, 15% blasts and marked dysgranulopoiesis, suggestive of refractory anemia with excess blasts(RAEB). The hematopoietic cells were not enough aspirated for proper diagnosis in follow up bone marrow after three months. The bone marrow aspirates showed 13% blasts, and marked dysgranulopoiesis. The bone marrow biopsy showed hypercellular marrow with 100% cellularity, but marked fibrosis was developed. The cytogenetic study revealed normal karyotype.
Anemia, Megaloblastic ; Anemia, Refractory ; Biopsy ; Bone Marrow ; Cytogenetics ; Diagnosis ; Dizziness ; Dyspnea ; Fibrosis ; Follow-Up Studies ; Humans ; Intention ; Karyotype ; Lymphoproliferative Disorders ; Methotrexate* ; Middle Aged ; Myelodysplastic Syndromes* ; Tetrahydrofolate Dehydrogenase