Inflammatory mediators, such as oxidants, TNF-alpha, and IL-6, play a major role in the systemic response to bum injury It has been known that a continuing inflammatory response cause a sepsis and subsequent multiple organ failure. Recent studies have shown that burn patients receiving recombinant human growth hormone(rhGH) therapy have an improvement of the general condition, but the mechanism by which rhGH exerts its effects has not been clearly understood. The aim of this study was to evaluate the effect of rhGH on the early bum injury. Female Sprague-Dawley rats were divided into four groups : control group, bum group, burn plus rhGH treated group, and rhGH only treated group. Animals were killed at 30min., 3, 6, 24, and 48 hours after treatment. Histology and biochemical changes including malondialdehyde(MDA) content, tissue reduced glutathione(GSH) and catalase activity in the lung and liver, and plasma TNF-alpha and IL-6 levels were examined. Lung histology in the bum plus rhGH treated group showed decreased inflammtory response such as neutrophil and lymphocyte infiltrations, interstitial thickening, and edema compared with the bum group. Liver histology in the bum group revealed mild neutrophil and lymphocyte infiltrations, vacuolization .of hepatocytes, disrupted lobular structures, and dilated sinusoids. But liver histology of the bum plus rhGH was similar to control group. Lung and liver MDA in the burn plus rhGH and rhGH only treated groups were decreased with time compared with the burn group. Lung and liver GSH and catalase activities in the bum plus rhGH and GH only treated groups remained significantly increased compared with the bum group for the 48-hours period. Plasma TNF-alpha levels in the bum group remained elevated for the 48-hours period compared with the bum plus rhGH and rhGH only treated groups. Plasma IL-6 levels in the burn group were significantly increased only at first compared with the bum plus rhGH and rhGH only treated groups. These results suggested that rhGH showed inhibitory effects on the inflammatory cell infiltration and lipid peroxidation in the lung and liver after bum injury. Increased GSH levels and catalase activities seemed to be associated with the antioxidant effect of rhGH. But the inhibitory effect of rhGH on plasma TNF- and R-6 levels was not clearly demonstrated.
Animals ; Antioxidants ; Burns ; Catalase ; Edema ; Female ; Hepatocytes ; Human Growth Hormone* ; Humans* ; Interleukin-6* ; Lipid Peroxidation* ; Liver ; Lung ; Lymphocytes ; Multiple Organ Failure ; Neutrophils ; Oxidants ; Plasma* ; Rats* ; Rats, Sprague-Dawley ; Sepsis ; Tumor Necrosis Factor-alpha*

PURPOSE: To introduce a new convenient and accurate method to measure the angle kappa using ultrasound biomicroscopy (UBM) and corneal topography. METHODS: Data from 42 eyes (13 males and 29 females) were analyzed in this study. The angle kappa was measured using Orbscan II and calculated with UBM and corneal topography. The angle kappa of the dominant eye was compared with measurements by Orbscan II. RESULTS: The mean patient age was 36.4 ± 13.8 years. The average angle kappa measured by Orbscan II was 3.98°± 1.12°, while the average angle kappa calculated with UBM and corneal topography was 3.19°± 1.15°. The difference in angle kappa measured by the two methods was statistically significant (p < 0.001). The two methods showed good reliability (intraclass correlation coefficient, 0.671; p < 0.001). Bland-Altman plots were used to demonstrate the agreement between the two methods. CONCLUSIONS: We designed a new method using UBM and corneal topography to calculate the angle kappa. This method is convenient to use and allows for measurement of the angle kappa without an expensive device.
Corneal Topography* ; Humans ; Male ; Methods ; Microscopy, Acoustic* ; Ultrasonography*

BACKGROUND: Multi-organ failure from sepsis is very lethal disease entity, which is suspected to be caused by activated inflammatory cells. Inflammatory cells activated by endotoxins generate oxidants and cytokines such as TNF-alpha and IL-6, which in turn stimulate macrophages and neutrophils. Augmented inflammation makes an organ-injury deteriorate into an organ-failure, which may progress to multi-organ failure. This study is designed to evaluate the therapeutic effects of vitamin-C, a scavenger of oxidants, in sepsis. METHODS: Male Sprague-Dawley rats were divided into 3 groups : a control group, a group injected intrapetoneally with LPS(lipopolysaccharide), and a group injected intraperitoneally with LPS and vitamin-C. Each eight rats were sacrified 24 hours and 48 hours after injection, and samples of the blood, the liver and the lung were obtained. Biochemical assays of TNF-alpha level in the blood and malondialdehyde(MDA) level, catalase activity and nitric oxide synthase(NOS) activity in the liver and the lung tissues were performed. RESULTS: Serum TNF-alpha level, tissue lipid peroxidation and tissue i-NOS activity were dramatically increased, and tissue catalase activity was exhausted rapidly in sepsis. High dose vitamin-C administration decreased serum TNF-alpha level, tissue lipid peroxidation and tissue i-NOS induction, and protected against catalase exhaustion. CONCLUSION: high dose vitamin-C therapy was proved to have definite antioxidant effect in septic condition.
Animals ; Antioxidants ; Catalase ; Cytokines ; Endotoxins ; Humans ; Inflammation ; Interleukin-6 ; Lipid Peroxidation ; Liver ; Lung ; Macrophages ; Male ; Models, Animal* ; Neutrophils ; Nitric Oxide ; Oxidants ; Rats* ; Rats, Sprague-Dawley ; Sepsis* ; Tumor Necrosis Factor-alpha

BACKGROUND: The toxicity of paraquat has been known to be caused by oxygen free radicals which leads to the lipid peroxidation and multiple organ failure. Although vitamin C has been known to be a potent antioxidant, recently there are numerous data which have shown that a low dose of vitamin C may act as a prooxidant due to the stimulation of the Fenton reaction with metal ions, which produces hydroxyl radicals. It has been reported that a deferoxamine in paraquat intoxication could reduce the production of the hydroxyl radicals by the inhibition of the Fenton reaction through the reduction of iron ion in tissue. The aim of this study was to evaluate the effect of the high and low dose of vitamin C and deferoxamine on lipid peroxidation and plasma TNF-alpha in paraquat intoxication. METHODS: Female Sprague-Dawley rats were divided into seven groups: control group which was not given paraquat(20mg/kg), P group which was given paraquat only, PVH group given paraquat and high dose of vitamin C(100mg/kg), PVL group given paraquat and low dose of vitamin C(10mg/kg), PVHD given paraquat, high dose of vitamine C and deferoxamine(100mg/kg), PVLD given paraquat, low dose of vitamin C and deferoxamine, and PD given paraquat and deferoxamine. Animals were killed at 6 and 24 hours after treatment. Malondialdehyde(MDA), superoxide dismutase(SOD) and glutathione(GSH) contents, catalase activity, plasma TNF-alpha, and histologic changes in the lung and liver tissue were measured. RESULTS: The lung histology in the PVH and PD or PVHD groups showed the significant decreases in the alveolar edema and interstitial thickness compared to the P group. The liver histology in the PVH and PVHD groups demonstrated marked differences in the central venous and sinusoidal dilatation compared to that of the P group. While the MDA levels of the lung and liver in the PVH and PD groups showed the significant reduction compared to that of the P group at 6 hours after treatment, all groups showed the significant changes compared to the P group at 24 hours. There was no significant change of the SOD levels of the lung and liver at 6 hours among all groups. At 24 hours, the SOD levels of the lung in PVH, PVL, and PVHD groups showed the significant increases compared to the P group. The increase of the SOD level in groups combined with deforoxamine, however, revealed a little reduction. The SOD level of the liver in PVH group only significantly increased compared to the P group at 24 hours. There was no significant change of the GSH level of the lung and liver among all groups at 6 hours. At 24 hours, the GSH level of the lung and liver were significantly increased in both PVH and PD group and PVH group, respectively, compared to the P group. Although the catalase activity of the lung was not significantly increased, that of liver was significantly increased in both PVHD and PD groups compared to the P group at 6 hours. The catalase activities of the lung and liver were significantly increased in PVH, PD, and PVHD at 24 hours. The concentrations of the Plasma TNF-alpha were slightly decreased at 6 hours and slightly increased at 24 hours compared to that of the P group, but they were not significant. CONCLUSION: This study showed that although the low dose of vitamin C had no effect, the high dose of vitamin C revealed a decrease of the MDA level and an increase of SOD, GSH, and catalase activity in the lung and lung and liver tissues, and the effect of the high dose of vitamin C increased with time. The administration of the deferoxamine with or without high dose of vitamin C, however, significantly showed the inhibition of the lipid peroxidation and antioxidant effect and low dose vitamin C decreased the effect of deferoxamine. The effects of the vitamin C and deferoxamine on plasma TNF-alpha were not clearly shown.
Animals ; Antioxidants* ; Ascorbic Acid* ; Catalase ; Deferoxamine* ; Dilatation ; Edema ; Female ; Free Radicals ; Humans ; Ions ; Iron ; Lipid Peroxidation* ; Liver ; Lung ; Multiple Organ Failure ; Oxygen ; Paraquat* ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Superoxides ; Tumor Necrosis Factor-alpha ; Vitamins*

BACKGROUND: Most febrile neutropenic patients are treated in an aggressive manner. However, identification of low-risk patients may enable clinicians to administer risk-based treatment. The object of this study is to certify the factors associated with increased risk at the time of visiting the emergency department. METHODS: This is a retrospective study. We reviewed the medical records of 101 febrile neutropenic patients who had visited the emergency department of Seoul National University Hospital from January 1998 to August 1999. We assumed 22 risk prediction factors that could be assessed at admission to the emergency department and 5 factors that could be assessed during treatment course. To find independent risk-prediction factors, we analyzed these factors respectively by using multiple regression analysis. RESULTS: Tachycardia(aOR=136.5), altered mentality(aOR=28.8), decreased renal function(aOR=20.1), and significant comorbidity(aOR=17.2) are the independent factors associated with higher mortality. Altered mentality(aOR=31.6) and decreased renal function(CCr<75ml/min, aOR=5.4) are those associated with a higher incidence of septic shock. Independent factors associated with persistent(more than 3 days) fever are the early(within 10 days) onset of fever after last chemotherapy(aOR=8.8) and the existence of new pulmonary infiltrates on a simple chest X-ray(aOR=4.3). CONCLUSION: The stability of vital signs, the change of mentality, the renal function, the existence of significant comorbidity, the existence of new pulmonary infiltrates, and the rate of neutropenia are clinically useful risk-predication factors in febrile neutropenia at the time of visiting the emergency department.
Comorbidity ; Emergency Service, Hospital ; Febrile Neutropenia ; Fever ; Humans ; Incidence ; Medical Records ; Mortality ; Neutropenia ; Retrospective Studies ; Seoul ; Shock, Septic ; Thorax ; Vital Signs

PURPOSE: A psoas abscess is a rare, but life-threatening disease. We report 11 cases of a psoas abscess in adults and discuss its clinical presentations, diagnosis, and treatments. METHODS: Retrospective analysis of patients who presented to the emergency department with a psoas abscess from Jan. 2000 to Aug. 2004 was conducted. RESULTS: Of the 11 patients with a psoas abscess, 9 (81.8%) had a secondary psoas abscess. The most common causes of the secondary psoas abscess were various invasive procedures, such as acupuncture, a nerve block, etc. The main clinical presentations were fever (72.7%) and back pain (45.5%). The mean time to presentation was 12.0+/-10.6 days. All patients had leukocytosis and elevated CRP. Computed tomography (81.8%) and magnetic resonance imaging (18.2%) were performed for the diagnosis. The mean diagnostic lag time (from admission to the treatment) was 7.8+/-7.5 days. All patients received intravenous antibiotics. Four patients (36.4%) underwent surgical drainage, and three patients (27.3%) underwent percutaneous drainage. Two patients (18.2%) were treated with simple aspiration, and another two (18.2%) received no procedure. Six patients (54.5%) had complications. Three (27.3%) had a recurrent abscess, and two (18.2%) had a epidural abscess. In one patient, femoral neuropathy developed. The time from clinical presentation to diagnosis in the complication associated group was longer than it was in complication non-associated group (27.5+/-19.6 vs 10.6+/-3.2 days, p=0.03). CONCLUSION: A psoas abscess is difficult to diagnose because of vague clinical symptoms and can have serious complications if the diagnosis is missed or delayed.
Abscess ; Acupuncture ; Adult ; Anti-Bacterial Agents ; Back Pain ; Diagnosis* ; Drainage ; Emergency Service, Hospital ; Epidural Abscess ; Femoral Neuropathy ; Fever ; Humans ; Leukocytosis ; Magnetic Resonance Imaging ; Nerve Block ; Psoas Abscess* ; Retrospective Studies

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

More than 80% of cases of patients with sporadic primary hyperparathyroidism are caused by a single parathyroid adenoma. Therefore, traditional bilateral neck exploration has been replaced by minimally invasive parathyroidectomy (MIP) in recent years. Benefits, of MIP include decreased pain and complications, a shorter length of hospital stay, and improved cosmesis. Preoperative imaging studies for localization and intraoperative PTH assay (IoPTH) play an essential role for in MIP. The standard imaging studies are cervical ultrasound and 99mTc sestamibi scanning (with SPECT/CT), while 4D CT is attracting significant interest. The half-life of PTH is less than 5 minutes and PTH rapidly drops after the resection of target lesions. These characteristics of PTH enable IoPTH. If target lesions are localized by recent imaging studies and IoPTH is adopted, MIP can be performed successfully in patients with primary hyperparathyroidism.
Four-Dimensional Computed Tomography ; Half-Life ; Humans ; Hyperparathyroidism, Primary ; Length of Stay ; Neck ; Parathyroid Neoplasms* ; Parathyroidectomy* ; Surgical Procedures, Minimally Invasive ; Technetium Tc 99m Sestamibi ; Ultrasonography

PURPOSE: This study was designed to evaluate the characteristics of exertional heat stroke between the non-survival and the survival groups. METHODS: From January 1996 to December 2002, patients with exertional heat stroke who came to the emergency department of a military hospital were enrolled. Data on individual factors, atmospheric conditions, pre-hospital management, initial vital signs, laboratory findings, presence of seizure attack, and performance of intubation were reviewed retrospectively and compared between the nonsurvival and the survival groups. RESULTS: During the study period, 22 patients were diagnosed as suffering from exertional heat stroke and 5 patients died. Most of the episodes occurred during the summer days with high ambient temperature (mean 30.6+/-3.0 degrees C) and humidity (mean 75.6+/-7.7%), and 13 patients were unacclimatized recruits. The non-survival group showed a lower initial systolic blood pressure, platelet count, arterial pH, and HCO3 - level, and a higher serum creatinine, ALT, and amylase level than did the survival group (p<0.05). However there were no significant differences in individual factors, atmospheric conditions, pre-hospital management, initial pulse rate, temperature, white blood cell count, hemoglobin count, and the sodium, potassium, BUN and AST levels between the two groups. CONCLUSION: Initial systolic blood pressure, platelet count, and arterial pH, as well as HCO3 -, serum creatinine, ALT, and amylase levels seem to be important factors for the prognosis of exertional heat stroke.
Amylases ; Blood Pressure ; Creatinine ; Emergency Service, Hospital ; Heart Rate ; Heat Stroke* ; Hospitals, Military ; Hot Temperature* ; Humans ; Humidity ; Hydrogen-Ion Concentration ; Intubation ; Leukocyte Count ; Military Personnel* ; Platelet Count ; Potassium ; Prognosis ; Retrospective Studies ; Seizures ; Sodium ; Vital Signs

OBJECTIVES: To assess innate and humoral immune responses in middle ear effusion of obese pediatric patients with otitis media with effusion (OME). METHODS: We evaluated 219 children with OME, of whom 21 were obese and 198 were non-obese. We compared the expression in middle ear effusion of mRNAs encoding toll-like receptors (TLR) 2, 4, 5, and 9; nucleotide-binding oligomerization domains (NOD) 1 and 2; retinoic acid-inducible gene (RIG)-I; interleukins (IL)-6, -10, and -12; interferon (IFN)-gamma; and tumor necrosis factor (TNF)-alpha mRNAs. We also compared the expression of immunoglobulins IgG, IgA, and IgM and the bacterial detection rate in the two groups. RESULTS: TLR2-mediated expression of IL-6 mRNA, TLR4-mediated expression of IL-6 and IL-10 mRNA, TLR5-mediated expression of IL-6, IL-10, and TNF-alpha mRNA, TLR9-mediated expression of IL-6 mRNA, and NOD2-mediated expression of IL-6, IL-12, and TNF-alpha mRNA were significantly lower in obese than in non-obese children (P<0.05). However, concentrations of IgG, IgA, and IgM in middle ear effusion were lower in obese than in non-obese children, but none of these differences was significant (P>0.05). CONCLUSION: Mean body mass index was higher and pattern-recognition receptor-mediated cytokine mRNA expression was lower in obese than in non-obese children with OME.
Bacteria ; Body Mass Index ; Child* ; Humans ; Immunity, Humoral ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Interferons ; Interleukin-10 ; Interleukin-12 ; Interleukin-6 ; Interleukins ; Obesity ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; RNA, Messenger* ; Toll-Like Receptors ; Tumor Necrosis Factor-alpha