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

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

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

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

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

BACKGROUND/AIMS: Thiazolidinediones reduce urinary albumin excretion and may prevent the development of renal injury. We evaluated the long-term effects of rosiglitazone on the progression of renal dysfunction in patients with type 2 diabetes mellitus. METHODS: We enrolled patients with type 2 diabetes mellitus who initially had normal or mildly impaired renal function, defined as an estimated glomerular filtration rate (eGFR) of 60-120 mL/min per 1.73 m2, and normoalbuminuria. Patients were divided into two groups according to their use of rosiglitazone during 3 years of follow-up: those treated with rosiglitazone (rosiglitazone group, n=52) and those treated without rosiglitazone (control group, n=85). Progression of renal dysfunction was defined as a decrease in eGFR of > or =9 mL/min per 1.73 m2 after 3 years. RESULTS: A greater difference was observed in the decrease in eGFR between the rosiglitazone and control groups after 3 years (3.8+/-9.9 vs. 12.6+/-10.5 mL/min per 1.73 m2, p<0.001). Seventeen of 52 (32.7%) patients in the rosiglitazone group and 53 of 85 (62.3%) patients in the control group showed progression of renal dysfunction (p=0.001). The progressors had a longer duration of diabetes (6.7+/-5.9 vs. 3.9+/-4.1 years, p=0.002), higher HbA1c levels (7.4+/-1.8 vs. 6.8+/-1.3%, p=0.023), and less frequent use of rosiglitazone (24.2 vs. 52.2%, p<0.001) compared to non-progressors. Multiple logistic regression analysis revealed that the use of rosiglitazone was a significant and independent predictor of the progression of renal dysfunction. CONCLUSIONS: This study suggests that rosiglitazone theatment slows the progressive deterioration of renal function in patients with type 2 diabetes.
Adult ; Aged ; Diabetes Mellitus, Type 2/*drug therapy/physiopathology ; Diabetic Nephropathies/*prevention & control ; Female ; Glomerular Filtration Rate ; Humans ; Hypoglycemic Agents/*therapeutic use ; Kidney/*physiopathology ; Male ; Middle Aged ; Retrospective Studies ; Thiazolidinediones/*therapeutic use

PURPOSE: Kabuki syndrome is a multiple congenital malformation syndrome, with characteristic facial features, mental retardation, and skeletal and congenital heart anomalies. However, the cardiac anomalies are not well described in the Korean population. We analyzed the cardiac anomalies and clinical features of Kabuki syndrome in a single tertiary center. METHODS: A retrospective analysis was conducted for a total of 13 patients with Kabuki syndrome. RESULTS: The median age at diagnosis of was 5.9 years (range, 9 days to 11 years and 8 months). All patients showed the characteristic facial dysmorphisms and congenital anomalies in multiple organs, and the diagnosis was delayed by 5.9 years (range, 9 days to 11 years and 5 months) after the first visit. Noncardiac anomalies were found in 84% of patients, and congenital heart diseases were found in 9 patients (69%). All 9 patients exhibited left-side heart anomalies, including hypoplastic left heart syndrome in 3, coarctation of the aorta in 4, aortic valve stenosis in 1, and mitral valve stenosis in 1. None had right-side heart disease or isolated septal defects. Genetic testing in 10 patients revealed 9 novel MLL2 mutations. All 11 patients who were available for follow-up exhibited developmental delays during the median 4 years (range, 9 days to 11 years 11 months) of follow-up. The leading cause of death was hypoplastic left heart syndrome. CONCLUSION: Pediatric cardiologist should recognize Kabuki syndrome and the high prevalence of left heart anomalies with Kabuki syndrome. Genetic testing can be helpful for early diagnosis and counseling.
Abnormalities, Multiple ; Aortic Coarctation ; Aortic Valve Stenosis ; Cause of Death ; Counseling ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Genetic Testing ; Heart Defects, Congenital ; Heart Diseases ; Heart* ; Humans ; Hypoplastic Left Heart Syndrome ; Intellectual Disability ; Mitral Valve Stenosis ; Prevalence ; Retrospective Studies