The treatment for full thickness skin defect with the full or split-thickness autograft was often associated with aesthetically poor result, hypertrophic scar or extensive injury on donor site. Because of this donor morbidity, the use of artificial dermis was considered, which was the substrate of collagen or collagen cross-linked with polyglactin or polylactin. Unfortunately this substrate was void of advantages for the artificial dermis but was of easy biodegradability, antigenicity, or cytotoxic property. Currently chitosan is given attention by many investigators for its biochemical properties in wound healing process. Chitosan is the deacetylated derivative of chitin, which is a polymer of 2-amino-2-deoxy glucose with chemically active free amino group. Chitosan facilitates wound healing process, and then stimulates migration of polymorphonuclear cell(PMN) and macrophage, release of IL-8 and accelerates collagen synthesis surely with vascularization. Indeed chitosan supplies the resistance against bacterial infection of the wound. In this study, we have investigated the clinical applicability of the artificial dermal substrate which is cross-linked of collagen and GAG with chitosan, which we have applied on the full thickness skin defect in Fisher rat. The conclusions are as the follows: 1. There was sufficient vascularization in the grafted dermal substrate for STSG after 2 weeks of artificial dermis grafting. 2. Four 4 weeks after artificial dermis grafting, the architecture of the dermal substrate was maintained in about half amounts and the half of dermal skeleton was replaced with the newly formed dermis(neodermis). In conclusion, the dermal substrate used in this study is available enough for wound of full thickness skin defect.
Animals ; Autografts ; Bacterial Infections ; Chitin ; Chitosan ; Cicatrix, Hypertrophic ; Collagen ; Dermis ; Equipment and Supplies ; Glucose ; Humans ; Interleukin-8 ; Macrophages ; Polyglactin 910 ; Polymers ; Rats ; Research Personnel ; Skeleton ; Skin ; Tissue Donors ; Transplants ; Wound Healing ; Wounds and Injuries

PURPOSE: Distinguishing malaria from severe infection among febrile patients in emergency room is difficult, so we tried to analyze the clinical manifestations of malaria and the results of using devices as a quick way to detect malaria among febrile patients visiting an emergency medical center (EMC). METHODS: We retrospectively reviewed the clinical records of patients visiting a local EMC from January 2001 to December 2004 and confirmed as having vivax malaria by using a peripheral blood smear and Malaria antibody test (Immunochromatographic assay). RESULTS: All of the 108 included patients were infected with Plasmodium vivax and suffered from high fever, but tertian fever was seen in only 41 patients (37.9%). Various symptoms included headache, myalgia, abdominal pain, and so on. Laboratory findings noted thrombocytopenia, anemia, elevated alanin aminotransferase, and coagulopathies. Malaria antibody test was used in all cases for early diagnosis in the EMC. Compared with the peripheral blood smear, malaria antibody test identified 103 cases as positive, and five cases as negative. The diagnostic sensitivity of the malaria antibody test is 95.3%. CONCLUSION: Since south Korea is a malaria endemic area, for patients visiting an emergency room with a high fever, accompanied by thrombocytopenia and anemia, malaria must be included in the differential diagnosis whether the fever is tertian or not. The Malaria antibody test can be done by even an unskilful person, so it is a very helpful screening test and an early detection tool for malaria.
Abdominal Pain ; Anemia ; Diagnosis, Differential ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Fever ; Headache ; Humans ; Korea ; Malaria* ; Malaria, Vivax ; Mass Screening ; Myalgia ; Plasmodium vivax ; Retrospective Studies ; Thrombocytopenia

PURPOSE: There have been many reports that point to the increasing death and emergency operation rate in traumatic hemorrhagic shock patients. The purpose of this study was to discover the clinical difference between the hypotensive traumatic patients and the non-hypotensive traumatic patients that had been managed in intensive care unit (ICU). METHODS: We retrospectively reviewed the medical records of 122 patients admitted to ICU for trauma from January 2001 to December 2002. We compared the hypotensive (systolic blood pressure (SBP) < 90 mmHg) group with the non-hypotensive group about age, diastolic blood pressure, initial hemoglobin, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), transfusion volume at emergency department, blood pH, blood base deficit, duration of admission, ICU stay, death rate, transfusion volume and others. RESULTS: There was no difference between two groups in age, causes of injury, situation whether or not the patient was directly transported from the scene and ISS. But there were differences between two groups in initial hemoglobins, GCS, RTS, blood pH, blood base deficit, duration of admission, ICU stay, and death rate. It was documented that the ICU stay correlated with systolic blood pressure, diastolic blood pressure, initial hemoglobin, blood base deficit, ISS, GCS, and RTS but not correlated with transfusion volume in emergency department. CONCLUSION: Systolic blood pressure is not the sensitive parameter of blood loss. Various kinds of indices of hypotensive group are more severe than non-hypotensive group. If traumatic patients are hypotensive blood pressure on arrival at emergency department, we should be careful of the state of these patients.
Blood Pressure ; Emergencies ; Emergency Service, Hospital ; Glasgow Coma Scale ; Humans ; Hydrogen-Ion Concentration ; Injury Severity Score ; Intensive Care Units ; Medical Records ; Mortality ; Retrospective Studies ; Shock, Hemorrhagic

Peritonitis is a frequent and serious complication in continuous ambulatory peritoneal dialysis (CAPD) patients. Recently, due to educational promotion in general hygiene and development of laboratory technique for bacterial cultures and sensitivity test, proper use of antibiotics, the incidence of CAPD peritonitis has gradually decreased. However, CAPD peritonitis is still one of the most common causes of peritoneal dialysis failure and of removal peritoneal catheter. It has been suggested that the formation of biofilm on the inner surface of peritoneal catheter leads to relapsing peritonitis and removal of the peritoneal catheter in CAPD patients. The biofilm is a kind of protecting coat which consists of fibrin inhibiting the penetration of antibiotics. It surrounds and covers the bacteria, making them to survive from the attack of antibiotics. Therefore thrombolytic therapy, urokinase modifies the structure of biofilm, and helps the antibiotics penetrating the fibrin coat, eventually amplify the bacteriocidal effect. We experienced two cases of successful treatment with urokinase and antibiotics in CAPD peritonitis patients. The combination of thrombolytic agents and antibiotics might be one of the strategies for the treatment of CAPD patients who experienced it frequently.
Anti-Bacterial Agents ; Bacteria ; Biofilms ; Catheters ; Fibrin ; Fibrinolytic Agents ; Humans ; Hygiene ; Incidence ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator*

Splenic artery aneurysms are an uncommon form of vascular disease that carry the risk of rupture and fatal hemorrhage. Precise cause of splenic artery aneurysms are not be established, the most common pathologic finding is defect of the media. Splenic artery aneurysms occur in patient with multiple pregnancies, portal hypertension, splenomegaly, after orthotopic liver transplantation and fibrodysplasia. Most patients who are diagnosised with splenic artery aneurysm are asymptomatic. Arteriography is a confirmed diagnostic method for detecting splenic artery aneurysms and searching the location of aneurysms. Operative treatment and therapeutic catheter embolization have been used for treatment of splenic artery aneurysms.
Aneurysm* ; Angiography ; Catheters ; Diagnosis ; Embolization, Therapeutic ; Female ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Transplantation ; Pregnancy ; Pregnancy, Multiple ; Rupture* ; Splenic Artery* ; Splenomegaly ; Vascular Diseases

OBJECTIVE: To explore the association of p53 codon 72 polymorphism with endometriosis. METHODS: Two hundred seventy-one women with surgically or histologically diagnosed edometriosis of stage I-IV, and 219 patients with no evidence of endometriosis by laparoscopy or laparotomy served as control. Allele frequencies and genotype distribution of p53 polymorphisms (arginine homozygosity, heterozygosity, and proline homozygosity) in affected women and controls were evaluated. RESULTS: The genotype distributions of p53 codon 72 polymorphisms did not differ significantly between endometriosis group and control group (p=0.086). However, the genotype distributions of p53 codon 72 polymorphisms differ significantly between stage I-II endometriosis group and control group (p=0.043). Proline homozygotes had higher risk for stage I-II endometriosis compared to arginine homozygotes (odds ratio=2.75, p=0.013). CONCLUSION: These results suggest that proline homozygote of p53 codon 72 polymorphism is associated with the risk of minimal or mild stage of endometriosis in the Korean population.
Arginine ; Codon* ; Endometriosis* ; Female ; Gene Frequency ; Genotype ; Homozygote ; Humans ; Laparoscopy ; Laparotomy ; Proline