BACKGROUND: Allergic diseases are characterized by immediate - and late - phase reactions to various allergens by the selective activation of a subset of CD4 + T cells. In response to allergen, T cells isolated from atopic donors are biased to low levels of IFN - y and high levels of IL - 4, and vice versa by T cells from non - atopic donor. Objective : The aim of this study was to evaluate the patterns of IL - 4 and IFN - y production after Der p I stimulation and the effect on the cytokine production from T cells by budesonide, disodium cromoglycate and cyclosporin A in atopic and non - atopic individuals. MATERIAL AND METHOD: Seven Der p I specific atopic and 7 non - atopic individuals were selected. We decided the 50% inhibiting concentration of each immunomodulator by lymphocyte proliferation assay, and measured their effects on the cytokine production in vitro by intracellular IL - 4, IFN - y staining and flow cytometry. Results and CONCLUSION: There was significant difference on stimulation index ( SI ) of production of IFN - y as well as IL-4 after Der p I stimulation between atopic and non-atopic individuals ( IL - 4 ; 1.57 +/- 0.7 : 0.98 +/- 0.2, p = 0.026, IFN - r : 1.45 +/- 0.5 : 0.95 +/- 0.2, p = 0.048 ). The synthesis of IL - 4, and IFN - r were significantly inhibited after the stimulation of every immunomodulators in atopic individuals, DSCG couldnt inhibit IL - 4 and IFN - r in nonatopic individuals. There was no significant difference in the inhibiting effect of these immunomodulators in both of them.
Allergens ; Bias (Epidemiology) ; Budesonide ; Cromolyn Sodium ; Cyclosporine ; Dust* ; Flow Cytometry ; Humans ; Immunologic Factors ; Interferons* ; Interleukin-4 ; Lymphocytes ; Pyroglyphidae* ; T-Lymphocytes* ; Tissue Donors

No abstract available.
Adenocarcinoma* ; Female ; Humans ; Lung* ; Neuromyelitis Optica*

BACKGROUND: The intrapleural instillation of tetracycline for pleural sclerosis had been most commonly used in patients with symptomatic malignant pleural effusion or recurrent pneumothorax for a long time. Unfortunately, at a time of expanding use of this agent, the production of injectable tetracycline hydrochloride used for pleurodesis was discontinued by its sole manufacturer in mid-1991 because the manufacturer was unable to meet US Food and Drug Administration purity standards. So we performed a preliminary study of doxycycline, as a alternative pleural sclerosant on rabbit pleura and compared its efficacy with that of tetracycline. METHOD: Eighteen New Zealand white rabbits weighing 2 to 3kg(mean 2.6kg) were divided into three groups. In each groups, one tetracycline(20 mg/ml/kg) and two doxycycline solutions(7 mg/ml/kg and 20 mg/ml/kg) instillated into the right pleural space through an 18-gauge angiocath with care to prevent pneumothorax. All rabbits were sacrificed after 28 days. RESULTS: 1) In the group of tetracycline 20 mg/ml/kg(six rabbits), five rabbits showed partial pleural symphysis with several fibrous bands, and one rabbit died on 22th day. 2) In the group of doxycycline 7 mg/ml/kg(six rabbits), three rabbits showed partial pleural symphysis and the other three rabbits showed complete pleural symphysis without necrosis of underlying parenchymal lung tissue. 3) In the group of doxycycline 20 mg/ml/kg(six rabbits), two rabbits showed complete pleural symphysis without lung necrosis, another two rabbits showed complete pleural symphysis with lung necrosis, and the other two rabbits died on 4th and 13th day, respectively. CONCLUSION: We concluded that doxycycline is a highly effective sclerosing agent having stronger pleurodesis effect with that of tetracycline by dose base and its optimal dosage was considered as 7 mg/ml/kg with minimal complications.
Doxycycline* ; Humans ; Lung ; Necrosis ; Pleura ; Pleural Effusion, Malignant ; Pleurodesis* ; Pneumothorax ; Rabbits ; Sclerosis ; Tetracycline ; United States Food and Drug Administration

No abstract available.
Central Nervous System ; Epilepsy ; Sarcoidosis

OBJECTIVE: This article was to review 10 years experience of cesarean hysterectomy at our hospital. To review risk factors, management & outcome of emergency peripartum hysterectomy performed in last 10 years at our hospital. MATERIAL & METHODS: The outcome of 33 cases of cesarean hysterectomy performed at St. Benedict hospital during 10 years from Jan. 1990 to Dec. 1999 was discussed & evaluated. RESULTS: During this time, there was 16014 deliveries, of which 5640 were cesarean section and 25 were cesarean hysterectomies, an incidence of 0.44%, and of which 10374 were vaginal deliveries 8 were. Cesarian hysterectomies are incidence of 0.08%. The age of patients varies from 18 to 42. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was placental abnormal presentation [placenta accreta (30.3%), placenta previa (27.2%)], uterine atony (33.3%), uterine myoma with pregnancy (6.0%) and Uterine ruture (3.0%). The complication were febrile morbidity, disseminated intravascular coagulopathy and urinary tract injury. There was one maternal death. CONCLUSION: Postoperative complication still remain the causes of maternal morbidity. There careful prenatal care momentary judgement of right operation time, fresh whole blood transfusion and reduction of operation time must be conjunction with maternal life saving. Cesarean delivery, prior cesarean delivery placenta accreta and uterine atony were identified as risk factors for emergency peripartum hysterectomy and abnormal presentation was the primary cause of cesarean hysterectomy. Still, cesarean hysterectomy remains a potentially life saving procedure with which every obstetrician must be familiar.
Blood Transfusion ; Cesarean Section ; Emergencies ; Female ; Humans ; Hysterectomy* ; Incidence ; Leiomyoma ; Maternal Death ; Parity ; Peripartum Period ; Placenta Accreta ; Placenta Previa ; Postoperative Complications ; Pregnancy ; Prenatal Care ; Risk Factors ; Urinary Tract ; Uterine Inertia

BACKGROUND: A number of different weaning techniques can be employed such as spontaneous breathing trial, Intermittent mandatory ventilation(IMV) or Pressure support ventilation(PSV). However, the conclusive data indicating the superiority of one technique over another have not been published. Usually, a conventional spontaneous breathing trial is undertaken by supplying humidified O2 through T-shaped adaptor connected to endotracheal tube or tracheostomy tube. In Korea, T-tube trial is not popular because the high-flow oxygen system is not always available. Also, the timing of extubation is not conclusive and depends on clinical experiences. It is known that to withdraw the endotracheal tube after weaning is far better than to go through any period. The tube produces varying degrees of resistance depending on its internal diameter and the flow rates encountered. The purpose of present study is to evaluate the effectiveness of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotracheal tube. METHODS: We analyzed the result of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotracheal tube in 18 subjects from June, 1993 to June, 1994. They consisted of 9 males and 9 females. The duration of mechanical ventilation was from 38 hours to 341 hours(mean: 105.9 +/- 83.4 hours). In all cases, the cause of ventilator dependency should be identified and precipitating factors should be corrected. The weaning trial was done when the patient became alert and arterial O2 tension was adequate(PaO2 > 55mmHg) with an inspired oxygen fraction of 40%. We conducted a careful physical examination when the patient was breathing spontaneously through the endotracheal tube. Failure of weaning trial was signaled by cyanosis, sweating, paradoxical respiration, intercostal recession. Weaning failure was defined as the need for mechanical ventilation within 48 hours. RESULTS: In 19 weaning trials of 18 patients, successful weaning and extubation was possible in 16/19(84.2% ). During the trial of spontaneous breathing for 60 minutes through the endotracheal tube, the patients who could wean developed slight increase in respiratory rates but significant changes of arterial blood gas values were not noted. But, the patients who failed weaning trial showed the marked increase in respiratory rates without significant changes of arterial blood gas values. CONCLUSION: The result of present study indicates that weaning from mechanical ventilation following a 60 minutes spontaneous breathing with O2 supply through the endotracheal tube is a simple and effective method. Extubation can be done at the same time of successful weaning except for endobronchial toilet or airway protection.
Cyanosis ; Female ; Humans ; Korea ; Male ; Oxygen ; Physical Examination ; Precipitating Factors ; Respiration* ; Respiration, Artificial ; Respiratory Rate ; Sweat ; Sweating ; Tracheostomy ; Ventilators, Mechanical ; Weaning*

Background: A considerable proportion of patients warranting total knee arthroplasty (TKA) have night pain, neuropathic pain, and/or depressive disorder, which may not be resolved by TKA. This prospective, longitudinal cohort study aimed to document the prevalence of night pain, neuropathic pain, and depressive disorder in patients with advanced knee osteoarthritis undergoing TKA and to determine whether the specific coexisting pain and/or disorder at the time of TKA adversely affected postoperative outcomes. Methods: In this study, 148 patients undergoing TKA were longitudinally evaluated. The presence of night pain, neuropathic pain (determined using Douleur Neuropathique 4 [DN4]) and depressive disorder (determined using the Patient Health Questionnaire-9 [PHQ-9]) was determined before and 6 weeks, 3 months and 1 year after TKA. In addition, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQol-5 Dimension (EQ-5D) scores were assessed before and 1 year after TKA. Potential associations of night pain, neuropathic pain, and/or depressive disorder with pre- and postoperative WOMAC and EQ-5D scores were examined in subgroup analyses. Results: Preoperatively, 72% (n = 106) of patients reported night pain, and the prevalences of neuropathic pain and depressive disorder were 15% and 17%, respectively. Preoperatively, compared with patients without night pain, those with night pain had significantly poorer preoperative WOMAC scores, but no significant difference was seen between groups 1 year after TKA. Preoperatively, the WOMAC, EQ-5D, and EQ-5D health scores of patients with neuropathic pain were not significantly different from those of patients without neuropathic pain, and there was no difference in clinical outcome scores 1 year after TKA between these groups. Preoperatively, the patients with depressive disorder showed significantly poorer preoperative WOMAC, EQ-5D, and EQ-5D health scores than those without depressive disorder, but no significant differences in scores were observed 1 year after TKA between these groups. Conclusion This study revealed a considerable prevalence of night pain, neuropathic pain, and depressive disorder in patients undergoing TKA and that patients with these specific conditions reported poorer functional and quality of life scores preoperatively. However, such adverse effects disappeared after TKA. Our study findings suggest that TKA can provide satisfactory outcomes for patients with these specific conditions.

Laminin, an extracellular matrix glycoprotein composed of three polypeptide chains such as alpha , beta, and gamma is distributed in basement membranes of epithelium, muscle, and nervous tissues. Laminin functions as an extracellular cytoskeleton and regulates the differentiation and polarization of cells adjacent to the basement membrane. Along with type IV collagen and heparan sulfate proteoglycan, laminin forms a spike -like structure in the renal glomerular basement membrane (GBM). It has been previously demonstrated that the distribution and immune reaction of laminin are changed in response to the conditions of glomerulonephritis and that laminin plays a role in the reformation of GBM as well as the regeneration of renal glomerular cells. In the present study, the profile of expression and distribution of laminin/laminin beta1 chain were examined in different developmental stages and upon adriamycin administration. Kidney obtained from fetuses (16, 18, and 20 days old) and infants (1 and 7 days old) of Sprague -Dawley rats were either cryosectioned for immunohistochemical assays or ultrathin -sectioned for electron microscopy using immunogold staining methods. The results were as follows: 1. Intensive expression of laminin was observed in the GBM and surrounding mesenchymal tissues obtained from 16, 18, and 20 days old fetuses and in the glomerulus from one day neonates, whereas the level of staining decreased in the glomerulus from 7 days old infants. 2. Immunogold particles were observed in the comma -shaped nephron, in particular in cisternae of rough endoplasmic reticulum, vesicles and nuclear membrane of endothelial cells and mesangial cells obtained from 18 days old fetuses. 3. The immune reactions of laminin beta1 chain were trace detected in the kidney from fetuses (16, 18, and 20 days old) and weakly in tissues surrounding blood capillary and mesangial tissues from one day old neonates. 4. After 24 hours following adriamycin treatment, the reactivity of laminin was slightly enhanced in the renal glomerulus, when compared with that of untreated controls. This enhancement persisted up to 1 week of adriamycin treatment. Laminin beta1 chain was weakly detectable, while further treatment with adriamycin for another 24 hours reduced the intensity of laminin beta1 chain. Taken together, these results suggest that laminin is localized in the GBM at the high level during early fetal stages but the expression levels decrease after birth. Moreover, administration with adriamycin may result in an increase in the immune reactivities of laminin and laminin beta1 chain by renal tissue damage followed by renal regeneration.
Animals ; Basement Membrane ; Capillaries ; Collagen Type IV ; Cytoskeleton ; Doxorubicin ; Endoplasmic Reticulum, Rough ; Endothelial Cells ; Epithelium ; Extracellular Matrix ; Fetus ; Glomerular Basement Membrane ; Glomerulonephritis ; Glycoproteins ; Heparan Sulfate Proteoglycans ; Humans ; Infant ; Infant, Newborn ; Kidney* ; Laminin* ; Mesangial Cells ; Microscopy, Electron ; Nephrons ; Nuclear Envelope ; Parturition ; Rats* ; Regeneration

PURPOSE: To analyze the radiologic-especially angiographic-findings of deep seated cerebral arteriovenous malformation(AVM) involving nonvisualized straight sinus. MATERIALS AND METHODS: In six patients aged between 15 and 53 years with deep seated cerebral AVM, CT and MR images were retrospectively analyzed with regard to the following features : the presence of straight sinus, the location of AVM, and the occurrence of hemorrhage. Angiograms were analyzed for venous drainage routes of AVM, the appearance of veins, the presence of falcine sinus and venous drainage from normal deep brain parenchyme. In four patients who had undergone intravascular embolization therapy, pre- and post- embolization angiograms were compared. RESULTS: CT and MR images showed neither straight sinus nor thrombosis. AVMs were deeply seated in the brain, and in all cases there was cerebral hemorrhage. Angiograms disclosed that venous drainage of all AVMs occurred via the veins of Galen. In one case, venous flow via the falcine sinus to the superior sagittal sinus was noted, but in others, retrograde flow in the deep venous system was observed. Marked collateral routes followed in response to the obstruction of straight sinus included the basal vein of Rosenthal, the internal occipital, internal cerebral, and cerebellar hemispheric veins (which are Galenic afferents), and the inferior sagittal s-inus. In all patients, contralateral routes were partially involved. Venous drainage from normal deep parenchyme through the transcerebral veins to the superficial venous system was noted, and in one case, s-traight sinus which had been observed on an angiogram five years earlier was no longer present. CONCLUSION: Angiography offers effective evaluation of the dynamic aspect of venous flow in cases involving deep-seated AVM, and of normal deep parenchyme in cases in which AVM involves nonvisualized straight sinus. Before intravascular treatment of AVM, venous flow must be carefully analyzed.
Angiography ; Brain ; Cerebral Angiography ; Cerebral Hemorrhage ; Cerebral Veins ; Drainage ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations ; Retrospective Studies ; Superior Sagittal Sinus ; Thrombosis ; Veins

Although adriamycin is a potent chemotherapeutic agent, it elicits serious adverse effects, including cardiac toxicity. Evidence suggests that congestive heart failure induced by adriamycin is mediated by oxidative stress. We investigated whether regulators of adenosine A1 receptor and KATP channel, which have been demonstrated to mediate protective effects of ischemic -preconditioning in myocardium, are able to modulate adriamicin -induced impairment of cardiomyocyte. To study the effect of antioxidant, adenosine A1 receptor agonist & antagonist and KATP channel agonist & antagonist, ICR mice were pretreated with Cu,Zn -SOD, dimethyl thiourea, RPIA (R (-)N6 -(2 -Phenylisopropropyl)- adenosine, adenosine A1 receptor agonist), 8 -CPDPX (8 -Cyclopentyl -1, 3 -dipropylxanthine, adenosine A1 receptor antagonist), Pinacidil (KATP channel opener) and glibenclamide (KATP channel closer), followed by i.p injection with adriamycin. Mice were sacrificed day 1 or day 4 after adriamycin injection and cardiac toxicity was accessed by measurement of creatine phosphokinase (CK) levels in serum, immunohistochemistry using anti -Bcl -2 antibody and TUNEL histochemical assay. As expected, pretreatment of mice with Cu, Zn -SOD and DMTU reduced the frequency of TUNEL positive cells, indicating antioxidants protected cardiocytes from adriamycin -induced apoptosis. Interestingly, pretreatment with RPIA and pinacidil induced a significant decrease in adriamycin -induced cytotoxicity, whereas 8 -CPDPX and glibenclamide generated the opposite results. In Bcl -2 immunohistochemistry, an increased expression of Bcl -2 was found in all ADR treated groups, especially in glibenclamide pretreated group, and 8 -CPDPX pretreated groups, but Bcl -2 failed to protect myocytes from apoptosis. All ADR treated groups exhibited elevated levels of serum CK, compared with nomal controls, especially mice sacrificed at day 4 than those at day 1, and showed similar patterns of TUNNEL assay, reflecting heart tissue damages. This observation implicated cytoprotective roles of RPIA and pinacidil against adriamycin -induced cardiac toxicity. In conclusion, these results demonstrated that adriamycin -induced cardiotoxicity was associated with the generation of reactive oxygen species and that regulators including SOD, DMTU, RPIA and pinacidil elicited protective effects on this toxicity. In particular, pinacidil, the KATP channel opener, was more effective than RPIA, the adenosine A, receptor agonist, to attenate the adriamycin -induced cardiac toxicity.
Adenosine* ; Animals ; Antioxidants ; Apoptosis ; Creatine Kinase ; Doxorubicin* ; Glyburide ; Heart ; Heart Failure ; Immunohistochemistry ; In Situ Nick-End Labeling ; Mice ; Mice, Inbred ICR ; Muscle Cells ; Myocardium ; Myocytes, Cardiac ; Oxidative Stress ; Pinacidil ; Reactive Oxygen Species ; Receptor, Adenosine A1* ; Thiourea