Rheumatic fever with renal involvement is rarely seen. The prevalence is found to be low although it may differ by reporters. We report a case of rheumatic fever with IgA nephropathy. The patient was a 14-year-old male. The patient's chief complaint were fatigue and gross hematuria. On the physical examination, the pansystolic murmur (grade II) on the left lower sternal border was noted. Cardiomegaly was seen on chest X-ray and pulmonary vasculatures were increased. Prolonged PR intervals were found on EKG. Echocardiogram showed rheumatic carditis with grade mild to moderate MR, regurgitant shunt from LV to LA through anterior leaflet. On the laboratory findings, ESR, CRP and ASO were increased, C3, C4 and IgA were normal. On the urine analysis, gross hematuria was noted as RBC over 30/HPF and RBC dysmorphism 90%. On the immunofluoroscent microscope of renal biopsy, IgA deposit on mesangial matrix was noted.
Adolescent ; Biopsy ; Cardiomegaly ; Electrocardiography ; Fatigue ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Male ; Myocarditis ; Physical Examination ; Prevalence ; Rheumatic Fever* ; Thorax

We experienced a case of malignant mucinous tumor of ovary developed in 17-year-oldnulliparous women and brief review of the case and its literature are presented.
Adenocarcinoma, Mucinous* ; Adolescent* ; Female* ; Humans ; Mucins* ; Ovarian Neoplasms ; Ovary

PURPOSE: Pneumonia is a common complication of organophosphate poisoning and increases the incidence of respiratory failure and the duration of mechanical ventilator support. Therefore, we investigated the clinical characteristics of pneumonia as a complication of organophosphate insecticide poisoning and then determined the factors related to the development of pneumonia. METHODS: A retrospective study was performed on patients with organophosphate insecticide poisoning, who were treated at our hospital with medical records and chest radiograph of patients. From January 1, 2001, to July 31, 2004, eighty five patients were included in this study. RESULTS: 1) Thirty-two (71% of the patients developing pneumonia) patients developed pneumonia later than 48 hours from admission and twenty-five (55.6% of the patients developing pneumonia) patients developed pneumonia later than 48 hours after mechanical ventilatory support. 2) The mean onset of pneumonia resistant to initial empirical antibiotics was 4.8 days from admission, and that of susceptible pneumonia was 3.7 days from admission. 3) Patients with pneumonia as a complication needed larger doses of atropine and more 2-pralidoxime injections, as well as longer mechanical ventilatory support, ICU admission, and total hospital admission. CONCLUSION: Most Pneumonia in organophosphate poisoning patients were nosocomial pneumonia & ventilator-associated pneumonia. Thus, to reduce the incidence of pneumonia complication in organophosphate poisoning patients, Physicians must take measures, such as hand-washing and careful periodic drainage of tubing condensate, etc., to reduce the incidence of nosocomial pneumonia. In selecting empirical antibiotics for pneumonia complicating organophosphate poisoning patients, physicians should take regional prevalence of nosocomial pathogens into consideration. In late-onset ventilator-associated pneumonia, physicians must consider pneumonia caused by organisms resistant to commonly used empirical antibiotics.
Anti-Bacterial Agents ; Atropine ; Drainage ; Humans ; Incidence ; Medical Records ; Organophosphate Poisoning ; Pneumonia* ; Pneumonia, Aspiration* ; Pneumonia, Ventilator-Associated ; Poisoning* ; Prevalence ; Radiography, Thoracic ; Respiratory Insufficiency ; Retrospective Studies ; Ventilators, Mechanical

To determine whether age, weight, height, vertebral column length, body mass index, or abdominal circumference might influence the distribution of sensory analgesia after epidural anesthesia, 100 women presenting for cesarean section were studied. All received 26 mg of 2.0% lidocaine mixed with 8.4% bicarbonate 1 ml/lidocaine 10 ml and 1:300,000 epinephrine, including 3 ml of test dose, through the epidural catheter inserted in L3-4 interspace. While the women lay supine on a horizontal operating table with the air bag under their right hip, 2, 5, 10, 20, and 30 minutes after injection, the cephalad extent of sensory analgesia (loss of sensation of sharpness to pin prick) was determined. Age (31.9+/-3.8 years), weight (69.2+/-9.3 kg), height (158.9+/-4,5 cm), vertebral column length (59.8+/-5.0 cm), body mass index (27.4+/-3.2 kg/m(2)), and abdominal circumference (103.5+/-10.2 cm) did not correlate with the maximum level of sensory analgesia. In conclusion, in parturients of age, weight, height, vertebral column length, body mass index and aMominal circumference of the above values, it is not necerrary to vary dose of injected local anesthetics with changes in any of the patient variables studied.
Air Bags ; Analgesia ; Anesthesia, Epidural* ; Anesthetics, Local ; Body Mass Index ; Catheters ; Cesarean Section* ; Epinephrine ; Female ; Hip ; Humans ; Lidocaine ; Operating Tables ; Pregnancy ; Sensation ; Spine

OBJECTIVES: This study was carried out to establish human embryonic stem cells derived from frozen-thawed embryos using mouse embryonic fibroblasts (mEFs), human fetal skin and muscle fibroblasts as feeder cells, and to identify the characteristic of embryonic stem cells. METHODS: When primary mEFs, human fetal skin and muscle fibroblasts were prepared, passaging on 4 days from replating could have effective trypsinization and clear feeder layers. Eight of 23 frozenthawed 4~8 cell stage embryos donated from consenting couples developed to blastocysts. Inner cell mass (ICM) was isolated by immunosurgery. ICM was co-cultured on mEFs, human fetal skin or muscle fibroblasts. The ICM colonies grown on mEFs, human fetal skin or muscle fibroblasts were tested the expression of stage specific embryonic antigen-3, -4 (SSEA-3, -4), octamer binding transcription factor-4 mRNA (Oct-4) and alkaline phosphatase surface marker. RESULTS: We obtained 1 ICM colony from 2 ICM co-cultured on mEFs as feeder cells and did not obtain any ICM colony from 6 ICM clumps co-cultured on human fetal skin or muscle fibroblasts. The colony formed on mEFs could be passaged 30 times every 5 days with sustaining undifferentiated colony appearance. When the colonies cultured on mEFs were grown on human fetal skin or muscle fibroblasts, the colonies could be passaged 15 times every 9 days with sustaining undifferentiated colony appearance. The colonies grown on mEFs and human fetal fibroblasts expressed SSEA-4 and alkaline phosphatase surface markers and positive for the expression of Oct-4 by reverse transcription-polymerase chain reaction (RT-PCR). The produced embryoid body differentiated spontaneously to neural progenitorlike cells, neuron-like cells and beating cardiomyocyte-like cells, and frozen-thawed embryonic stem cells displayed normal 46, XX karyotype. CONCLUSIONS: The human embryonic stem cells can be established by using mEFs and human fetal fibroblasts produced in laboratory as feeder cells.
Alkaline Phosphatase ; Animals ; Blastocyst ; Embryoid Bodies ; Embryonic Stem Cells* ; Embryonic Structures ; Family Characteristics ; Feeder Cells* ; Fibroblasts* ; Humans* ; Karyotype ; Mice* ; RNA, Messenger ; Skin ; Trypsin

BACKGROUND AND OBJECTIVES: Although electrical cardioversion (CV) is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF), AF frequently recurs in spite of antiarrhythmic medications. We investigated the predictors of failed CV and AF recurrence after successful CV. SUBJECTS AND METHODS: In 81 patients (M:F=63:18, 59.1+/-10.5 years old) with AF who underwent CV, clinical findings and pre-CV serologic markers were evaluated. RESULTS: During 13.1+/-10.6 months of follow-up, 8.6% (7/81) showed failed CV, 27.16% (22/81) showed early recurrence atrial fibrillation (ERAF; < or =2 weeks), 32.1% (26/81) had late recurrence atrial fibrillation (LRAF; >2 weeks), and 32.1% (26/81) remained in SR and had no recurrence (NR). Plasma levels of transforming growth factor beta (TGF)-beta were significantly higher in patients with failed CV than in those with successful CV (p=0.0260). Patients in whom AF recurred were older (60.4+/-9.0 years old vs. 55.3+/-12.5 years old, p=0.0220), and had lower plasma levels of stromal cell derived factor (SDF)-1alpha (p=0.0105). However, there were no significant differences in these parameters between ERAF patients and LRAF patients. CONCLUSION: Post-CV recurrence commonly occurs in patients aged >60 years and who have low plasma levels of SDF-1alpha. High plasma levels of TGF-beta predict failure of electrical CV.
Aged ; Atrial Fibrillation ; Chemokine CXCL12 ; Electric Countershock ; Follow-Up Studies ; Humans ; Plasma ; Recurrence ; Stromal Cells ; Transforming Growth Factor beta

Klinefelter's syndrome (KFS) is a gonosomal aberration disease that occurs in males, and is characterized by 47, XXY karyotype, hypogonadism and a lack of secondary sexual characteristics. A potential link between this hormonally deficient syndrome and autoimmune disease, particularly systemic lupus erythematosus (SLE), has been reported. On the other hand, KFS is rarely reported to be accompanied by rheumatoid arthritis (RA), and there are no Korean cases reported. We report the first Korean case of a KFS patient with sero-positive RA and discuss the role of the pathogenesis of RA with KFS.
Aluminum Hydroxide ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Carbonates ; Hand ; Humans ; Hypogonadism ; Karyotype ; Klinefelter Syndrome ; Lupus Erythematosus, Systemic ; Male ; X Chromosome

We report a case of congenital and familial antithrombin III deficiency developing massive pulmonary thromboembolism. A 44-year-old man was admitted to our hospital because of sudden chest pain and severe dyspnea. Five years ago, he was operated due to a mesenteric vein thrombosis of unknown cause. On admission, radioisotopic venogram showed deep vein thrombosis and lung scintigram showed multiple segmental perfusion defects. His plasma antithrombin III level was 10.5 mg/dL which was less than 50% of normal and those of a son and two daughters were also decreased. After treatment with tissue plasminogen activator, heparin and coumadin, his symptom and lung scintigram were significantly improved. As far as we reviewed, there were very rare reports with congenital antithrombin III deficiency presenting as pulmonary thromboembolism in Korea.
Adult ; Antithrombin III ; Antithrombin III Deficiency* ; Chest Pain ; Dyspnea ; Heparin ; Humans ; Korea ; Lung ; Mesenteric Veins ; Nuclear Family ; Perfusion ; Plasma ; Pulmonary Embolism* ; Thrombosis ; Tissue Plasminogen Activator ; Venous Thrombosis ; Warfarin

Superior mesenteric artery syndrome is caused by compression of the third part of the duodenum between the superior mesenteric artery (SMA) and the aorta. Recently, we experienced a case of a gastric bezoar combined with SMA syndrome. A 58-year-old man presented with upper abdominal pain, bloating and weight loss of 5 kg. An endoscopic examination identified a huge gastric bezoar. The bezoar was broken and fragmented into small pieces using an argon plasma coagulator and endoscopic snare catheter. Hypotonic duodenography showed a longitudinal linear band that was presumed to be a vascular impression of the third portion of the duodenum and contrast-enhanced spiral CT showed a reduced distance of 8.4 mm but a normal angle of 38.5degrees between the arota and the SMA. A second endoscopic examination demonstrated prominent pulsations that compressed the duodenal wall at the third portion. Luminal expansion with full inflation of air was not attempted under endoscopy.
Abdominal Pain ; Aorta ; Argon ; Argon Plasma Coagulation ; Bezoars ; Catheters ; Duodenum ; Endoscopy ; Humans ; Inflation, Economic ; Mesenteric Artery, Superior ; Middle Aged ; Phenobarbital ; Plasma ; SNARE Proteins ; Superior Mesenteric Artery Syndrome ; Tomography, Spiral Computed ; Weight Loss