The autoinfective filariform larva of Strongyloides stercoralis causes hyperinfection in immunosuppressed hosts. Here we report on the case of a male patient who was admitted to the emergency room at Gwangju Veterans Hospital with a complaint of dyspnea, and who was receiving corticosteroid therapy for asthma. Many slender larvae of S. stercoralis with a notched tail were detected in Papanicolaou stained sputum. They measured 269 +/- 21.2 micrometer in length and 11 +/- 0.6 micrometer in width. The esophagus extended nearly half of the body length. The larvae were identified putatively as autoinfective third-stage filariform larvae, and their presence was fatal. The autoinfective filariform larva of S. stercoralis has not been previously reported in Korea.
Aged ; Animals ; Fatal Outcome ; Humans ; Immunocompromised Host ; Larva ; Male ; Sputum ; Strongyloides/growth & development/*isolation & purification ; Strongyloidiasis/*etiology ; Superinfection/*parasitology

No abstract available.
Fertilization in Vitro* ; Humans* ; Micromanipulation* ; Pregnancy Rate* ; Pregnancy*

OBJECTS: Depressive symptoms are common in the elderly medical inpatients. But depressive disorders are considerably underdiagnosed and undertreated. Especially in major depressive disorder, patients show cognitive impairments and do not respond adequately to medical treatment. The goals of this study were to examine what are the patterns of depressive symptoms of major depressive disorders which differentiate from minor depressive disorders in the elderly medical inpatients. METHODS: A 4-month prospective study of 312 patients (65 years and older) was conducted in a general hospital. Depression was screened with Hamilton Depression Rating Scale and cognitive function was screened with Mini-Mental State Examination-K. The subjects were diagnosed according to DSM-IV for depression. And according to DSM-IV diagnosis, HDRS and MMSE-K subscales were analysed. RESULTS: In the 228 patients who were investigated, 16 (7%) patients were major depressive disorder, 53 (23%) were minor depressive disorder. Females were more depressed than males but there was no statistical significance. While the patients of major depressive disorder complained of depression and anxiety, the control subjects complained of loss of body weight, somatic symptoms and somatic anxiety, and the minor depressive disorders shows mixed symptoms of the two. The complaining frequency of the somatic symptoms and somatic anxiety were similar among the three groups. Significant differences were found among the three groups in terms of HDRS total scores. Among the three groups in terms of HDRS subscale scores all subscale scores except for the genital symptoms and body weight were significantly high in depressive disorders. Initial insomnia (p<0.01), middle insomnia (p<0.05), GI symptoms (p<0.01) and somatic symptomgeneral (p<0.05) were significantly different between the control subjects and the depressive disorder group. The subscales of terminal insomnia, agitation and loss of insight were significantly different between the minor depressives and major depressives (p<0.01), but no difference between the control subjects and the minor depressives. MMSE total scores were significantly correlated in major depressive disorders among the 3 groups. Comparing subscales of the three groups, significant correlation were found in time orientation, attention and calculation (p<0.05) and language (p<0.01). CONCLUSION: Major depressive disorder patients in elderly medical inpatients chiefly complained of depression and anxiety, but they also complained somatic symptoms. If elderly medical inpatients complain of agitation, terminal insomnia, cognitive impairment associated with depressive symptoms, consultants will pay attention for the major depressive disorders. This study suggests that further systematic study is necessary for the recognition of major depressive disorder in the elderly medical inpatients.
Aged* ; Anxiety ; Body Weight ; Consultants ; Depression ; Depressive Disorder* ; Depressive Disorder, Major* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Dihydroergotamine ; Female ; Hospitals, General ; Humans ; Inpatients* ; Male ; Prospective Studies ; Sleep Initiation and Maintenance Disorders

Invasive diseases caused by Trichosporon beigelii are rare, usually fatal, opportunistic infections that occur exclusively in immunocompromised patients. This fungus has been known to produce cutaneous involvement in immunocompetent hosts, and is rarely reported to cause systemic disease in patients with cardiac valve replacement. In this report, we described a case of invasive Trichosporon beigelii pneumonia in a 9-year-old boy who presented with persistent cough and dyspnea for 1 week. He showed no abnormality in immunologic function tests and had no predisposing factors. Trichosporon beigelii was isolated from the bronchoalveolar lavage culture.
Bronchoalveolar Lavage ; Causality ; Child ; Cough ; Dyspnea ; Fungi ; Heart Valves ; Humans ; Immunocompromised Host ; Male* ; Opportunistic Infections ; Pneumonia* ; Trichosporon*

PURPOSE: Recently, a new animal model for permanent focal brain ischemia using macrospheres was developed wherein the hypothalamic area was free from ischemic injury. The purpose of this study was to evaluate spatiotemporal changes in the expressions of cFos, pERK, and pAkt proteins in the macrosphere model. METHOD: Three or four macrospheres were injected into the internal carotid artery after ligation of the external carotid artery to induce permanent focal brain ischemic injury. RESULT: Twenty-four hours after macrosphere injection, 2,3,5-Triphenyltetrazlium (TTC) staining showed a marked ischemic injury in the blood supply territory of the middle cerebral artery, for example, the cerebral cortex and striatum. Furthermore, TUNEL staining revealed apoptotic cell death in the ischemic injury region of the cerebral cortex and striatum. Expression of the cFos protein was significant in the penumbral zone, but not in the ischemic core of the cortex and striatum, two and six hours after ischemic insult. A transient prominent expression of the pERK1/2 protein was noted in the penumbral zone of the cortex and striatum two hours after injection of macrospheres. In contrast, there was a strong immunoreactivity for the pAkt protein in the ischemic core, but not in the penumbral zone of the cortex and striatum, six hours after ischemic injury. CONCLUSION: The above results suggest that early expressions of cFos, pERK1/2, and pAkt proteins take part in different signaling cascades for cell survival or death in macrosphere animal model of permanent focal brain ischemic injury.
Animals* ; Brain Ischemia ; Brain* ; Carotid Artery, External ; Carotid Artery, Internal ; Cell Death ; Cell Survival ; Cerebral Cortex ; In Situ Nick-End Labeling ; Ligation ; Middle Cerebral Artery ; Models, Animal*

PURPOSE: The laparoscopic cholecystectomy has become a common procedure for treating gallbladder disease. The objectives of this study was to evaluate the learning curve by reviewing 145 patients treated with laparoscopic cholecystectomy, between Group A (From January 1991 to December 1995) and Group B (From January 1996 to December 2000). METHODS: We retrospectively analyzed 145 laparoscopic cholecystectomies performed at the Department of General Surgery, National Medical Center, from January 1991 to December 2000. The sex, age, operation time, associated disease, previous operation history, hospital stay, and pathology were reviewed. RESULTS: The ratio of Females to males was 1.9:1, and their age ranged from 18 to 80 years with the majority in their fifties and sixties. Most of the operative indications were cholelithiasis. The mean operative time was 89 minutes, which varied between 40 and 180 minutes, and the average admission time was five days. The operation times of Group A and Group B were statistically significant with respect to learning curve (p value<0.000). A linear regression test of the operation time and operation cases was also significant. The postoperative analgesic injection and hospital stay were improved in Group B, but had no statistical significance. A conversion to open cholecystectomy was done in four cases due to bleeding, severe adhesion, or clip migration of the cystic duct during surgery. CONCLUSION: The laparoscopic cholecystectomy was a safe and effective treatment for gallbladder disease, and wepredict that the operation time will become shorter with more experience.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Cystic Duct ; Female ; Gallbladder Diseases ; Hemorrhage ; Humans ; Learning Curve ; Length of Stay ; Linear Models ; Male ; Operative Time ; Pathology ; Retrospective Studies

Minimal Change Nephrotic Syndrome(MCNS) reflects a disorder of T-lymphocytes. These T-cells are thought to release a vascular permeability factor (UPF) that injures the glomerular epithelial cells (GECs). Glomerular epithelial cellular damage may lead to proteinuria in MCNS by decreasing the synthesis of polyanions such as heparan sulfate proteoglycan(HSPG) : these polyanions constitute most of the normal charge barrier to glomerular filtration of macromolecules such as albumin. This study evaluates the direct effect of supernatant of culture media of peripheral blood mono- nuclear cells(PBMC) which was isolated from children with MCNS to GBM HSPG mRNA expression in rats GEC. GEC were cultured until confluent. Supernatant of culture media of PBMC from each group of 3 chilren with MCNS, IgA nephropathy or normal healthy were added. Total RNA was extracted at 12, 24 and 72hrs after adding supernatant. RT-PCR using Rat Perlecan Domain-I(RPD- I) specific primers and beta-actin as internal controls was done. Densities and areas of GRM HSPG corresponding bands to beta-actin bands were measured. At 24 hrs, supernatant of culture media of PBMC from 3 children with MCNS caused 62, 70, and 75Vo reductions, respectvely, in GEC's GBM HSPG mRNA expression compared to normal children. However, supernatant of culture media of PRMC from 3 children with IgA nephropathy did not. In addition, reductions of GEC's GBM HSK' mRNA expressions caused by supernatant of culture media of PBMC from 3 children with MCNS were restored upto levels of normal children at 72hrs after adding supernatant. Mutant cDNA was synthesized as primers for competitive PCR to quantify GBM HSPG mRNA expression. Mutant template was 212 base pairs shorter than RPD-I, 497 base pairs. In conclusion, we found that supernatant of culture media of PBMC from children with MCNS reversibly suppressed GBM HSPG mRNA expression in rats GEC. This study suggests cytokines of PBMC from children with MCNS directly injures GEC and leads to decrease in synthesis of GBM HSPG by GEC in the pathogenesis of MCNS.
Actins ; Animals ; Base Pairing ; Child* ; Culture Media ; Cytokines ; DNA, Complementary ; Epithelial Cells* ; Filtration ; Glomerulonephritis, IGA ; Heparan Sulfate Proteoglycans ; Heparitin Sulfate* ; Humans ; Polymerase Chain Reaction* ; Proteinuria ; Rats* ; RNA ; RNA, Messenger* ; T-Lymphocytes ; Vascular Endothelial Growth Factor A

Homograft has been the conduit of choice in various types of congenital malformations which require right ventricular outflow tract reconstruction. However it has been proven to be less than ideal in young age group because of early failure of the conduite due to valve dysfunction and calcification. Furthermore limitation of availability of homograft particularly small sized conduits for neonates and infants is the most serious problem. A 19 month old female patient with pulmonary atresia and ventricular septal defect was operated on with a bovine jugular venous valved conduit as an alternative to the homograft for her right ventricular outflow tract reconstruction. Postoperative hemodynamic performance of the conduit was excellent without pressure gradient or valve regurgitation. With this early result bovine jugular venous valved conduit seems to be another excellent conduit because of good hemodynamics and size availability but long term follow up is necessary.
Allografts ; Female ; Follow-Up Studies ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Infant ; Infant, Newborn ; Pulmonary Atresia

PURPOSE: Minimal Change Nephrotic Syndrome (MCNS) is one of the most common primary nephrotic syndromes in children. T-cell dysfunction has been thought to be involved in the pathogenesis of MCNS. However, the exact pathogenesis of MCNS has not been proven yet in spite of many studies which support T-cell dysfunction being involved in the pathogenesis of MCNS. A present study was done to determine the role of IL-8 and TNF-alpha in the pathogenesis of MCNS. METHODS: Study patients consisted of 19 biopsy-proven MCNS children aged 2-15 years old. Ten age-matched healthy children were used as controls. Both plasma and urinary IL-8 and TNF-alpha were measured during relapse and remission period using ELISA kit. Urinary cytokine values were corrected for urinary creatinine. RESULTS: Each value of urinary IL-8 measured during relapse and remission period in MCNS and controls was 13,996+/-2,811, 2,811+/-3,734 and 5,331+/-6,403ng/mg cr, respectively, and we noted that the value of urinary IL-8 measured during relapse period in MCNS significantly increased compared to those measured during remission period and in controls(p< 0.05). And each value of urinary TNF-alpha measured in the same group was 364.4+/-512.1, 55.3+/-208.0 and 36.0+/-45.0ng/mg cr, respectively, and we also noted that the value of urinary TNF-alpha measured during relapse period in MCNS was signficantly increased compared to those measured during remission period and in controls. The plasma cytokine values measured during relapse and remission period and in controls were 1.19+/-1.23, 0.51+/-0.84 and 0.77+/-0.62ng/mL, respectively, in the case of IL-8 and 2.42+/-3.86, 1.95+/-3.24 and 2.25+/-3.50ng/mL, respectively, in the case of TNF-alpha, and we noted the value of plasma IL-8 measured during relpase was also significantly increased compared to those of remission period and in control(p<0.05), but the change of plasma TNF-alpha values was not significant. CONCLUSION: It can be said that both IL-8 and TNF-alpha play an important role in the pathogenesis of MCNS in children. The fact that changes of urinary IL-8 and TNF-alpha were more prominent than those of plasma suggests that immune dysregulation may occur intrarenally rather than systemically in MCNS.
Child* ; Creatinine ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-8* ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Plasma* ; Recurrence ; T-Lymphocytes ; Tumor Necrosis Factor-alpha*

Leiomyosarcoma is a rare form of soft tissue neoplasm, with only 1% to 5% occurring in the head and neck region. Current recommended treatment suggests surgical excision with a wide lateral margin, but no definite guidelines regarding excisional margin have been established yet. Recently, complete excision with a narrow surgical margin has been recommended, and the authors present a case of cutaneous leiomyosarcoma on the face that was successfully managed by complete removal with a narrow excisional margin. A 74-year-old woman presented with a 3 cm sized, rapidly growing cutaneous mass on her right preauricular area. Preoperative biopsy of the skin lesion suggested a cutaneous leiomyosarcoma. The authors performed complete surgical excision with a 1 cm lateral margin, and the resulting skin defect was repaired with bilateral V-Y advancement local flaps. Histopathology and immunohistochemistry evaluation confirmed a moderately differentiated cutaneous leiomyosarcoma, with negative margin involvement. The patient refused of any additional treatment, but showed no locoregional recurrence during the 1.5 years of postoperative follow-up period. With a regular postoperative follow-up, cutaneous leiomyosarcomas may be successfully treated with a narrow surgical margin.
Aged ; Biopsy ; Female ; Follow-Up Studies ; Head ; Humans ; Immunohistochemistry ; Leiomyosarcoma* ; Neck ; Recurrence ; Skin ; Soft Tissue Neoplasms