BACKGROUND: Formaldehyde is used to preserve cadaver in medical schools, and students are exposed to formaldehyde during cadaver dissection classes. When humans are exposed to formaldehyde, it induces mucosal inflammation, skin inflammation, and declining of neurobehavioral function including attention and memory executive functions. The purpose of this study is to identify the effects of formaldehyde exposure on student's neurobehavioral performance during cadaver dissection classes. METHODS: The level of formaldehyde was measured in a cadaver dissection class. A total of 16 students were randomly divided into two groups. One group wore respiratory protection masks, while the other group did not. Among many subtests in Korean Computerized Neurobehavioral test, backward digit span was tested on all subjects before and after the class. RESULTS: The length of memorized digit span between the two groups was not significant; however there was a greater decrease in neurobehavioral function after formaldehyde exposure in the non-mask group than the mask group. CONCLUSION: Formaldehyde exposure during cadaver dissection may likely decrease neurobehavioral performance of students. Therefore, proper ventilation system and respiratory protective equipment are necessary to protect medical school students from adverse effects of formaldehyde exposure.
Cadaver* ; Executive Function ; Formaldehyde* ; Humans ; Inflammation ; Masks ; Memory ; Schools, Medical ; Skin ; Ventilation

Ceramide, a product of sphingomyelin hydrolysis, is now recognized as an intracellular lipid messenger, which mediates the effects of extracellular agents on cellular growth, differentiation and apoptosis. Recently, ceramide has been implicated in the regulation of phospholipase D (PLD). In this study, we examined the effects of ceramide on the activity and mRNA level of PLD during apoptotic process in FRTL-5 thyroid cells. C2-ceramide (N-acetyl sphingosine) induced apoptosis in FRTL-5 thyroid cells. Fluorescent staining showed that ceramide induced the typical features of apoptosis including condensed or fragmented nuclei. DNA fragmentation was also observed by agarose gel electrophoresis. Flow cytometric cell cycle analysis showed more clearly that ceramide induced apoptotic cell death in FRTL-5 thyroid cells. The treatment of FRTL-5 thyroid cells with thyroid-stimulating hormone (TSH) resulted in an increased PLD activity in a dose- and time-dependent manner. However, the TSH-induced increase in PLD activity was down-regulated within 2 h after ceramide treatment. Furthermore, the levels of PLD mRNA were found to be decreased throughout apoptotic process as inferred by reverse transcription-polymerase chain reaction. However, the decreases in PLD mRNA levels were not correlated with those in PLD activities after ceramide treatment. Taken together, these data suggest that ceramide inhibits the PLD activity in an early apoptotic phase and down-regulation of the levels of PLD mRNA may be implicated in apoptotic process in FRTL-5 thyroid cells.
Animal ; Apoptosis/drug effects* ; Cells, Cultured ; DNA Fragmentation ; Enzyme Activation/drug effects ; Flow Cytometry ; Gene Expression Regulation, Enzymologic/drug effects ; Phospholipase D/metabolism* ; Phospholipase D/genetics ; RNA, Messenger/genetics ; Rats ; Rats, Inbred Strains ; Sphingosine/pharmacology ; Sphingosine/analogs & derivatives* ; Thyroid Gland/enzymology ; Thyroid Gland/drug effects* ; Thyrotropin/pharmacology

STUDY DESIGN: Experimental animal study OBJECTIVES: To examine the ability of human umbilical cord blood (hUCB) stem cells to target a zone of injury and to determine the efficacy of hUCB cells to ameliorate the behavioral deficits after a hUCB cell infusion in paralyzed rats. SUMMARY OF LITERTURE: Many groups have investigated the use of stem cells as potential treatments for a CNS injury. hUCB cells have recently been reported to alleviate the behavioral consequences of a stroke injury. MATERIALS AND METHODS: Thirty Sprague Dawley rats were divided into 6 groups (Gr) (Gr 1. SCI (spinal cord injury) + hUCB delivered at one day postinjury, Gr 2. SCI + hUCB delivered at 3 days postinjury, Gr 3. SCI + hUCB delivered at 5 days postinjury, Gr 4. laminectomy + hUCB, Gr 5. SCI only, Gr 6. Laminectomy only). SCI was produced by compressing the spinal cord to the level of the 8-9th thoracic spine for 1 minute with an aneurysm clip that was calibrated to a closing pressure of 50 gms. The hUCB cells (0.5 ml, 1.5x106) were administered intravenously to the rats. The rat was assessed behaviorally at one, two and three weeks using the BBB behavioral scale. Four weeks after the injury, the animals were sacrificed and the hUCB positiveresponse neural cells (mouse anti-human mitochondria monoclonal antibody=MAB 1273) at the injury level observed using optical and fluorescent microscopy. RESULTS: MAB 1273 positive cells were observed in groups 1, 2 and 3 but not in groups 4, 5 and 6. In particular, there were 870 cells distributed over an area of 1.2 mm(2) in group 3. Group 3 showed the most significant recovery over time in the open field exam, and the most improvement in another tests of incline, leg extension, and toe spread compared with group 1 (p<0.01). CONCLUSION: After infusing the hUCB stem cells to SCI rats, it was confirmed that hUCB cells migrate to an injured area and ameliorate the behavioral deficits. A hUCB infusion 5 days after the injury produced best results in terms of the number of cells and motor recovery.
Aneurysm ; Animals ; Fetal Blood* ; Humans* ; Laminectomy ; Leg ; Microscopy ; Mitochondria ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Spinal Cord Injuries ; Spine ; Stem Cells ; Stroke ; Toes ; Umbilical Cord*

OBJECTIVES: QT dispersion(QTd) is defined as the difference between the maximum and minimum average QT interval in any of the 12 leads of the surface ECG. QTd has been shown to reflect regional variations in ventricular repolarization. It was reported previously that QTd was dependent on the degree of reperfusion in myocardial infarction. The purpose of this study is to investigate the effects of percutaneous transluminal coronary angioplasty(PTCA) on QTd. METHODS: We studied in 21 patients(15 men and 6 women: mean age, 53 +/- 7.5 years: 14 acute myocardial infaction, 4 angina pectoris and 3 unstable angina). All standard 12-lead ECGs were recorded at a paper speed of 25mm/sec and examined retrospectively by single observer. QT interval was measured from 11.3 +/- 1.1 leads using a computerized program interfaced with digitizer. QTd corrected for heart rate(QTcd) was calculated by Bazett`s formula. Each cases were divided to 2 stages, before and after PTCA(mean obsevation duration, 16.8 +/- 9.7 days vs. 22.5 +/- 21.9 hours). The difference of QT dispersions was assessed by comparing by paired t-test. RESULTS: There were significant difference in QTd (mean 110.2 +/- 37.4 vs. 90.4 +/- 37.6 msec, p<0.05). Results did not change when Bazett`s QTc was substituted for QT(QTcd: mean 125.5 +/- 38.3 vs. 97.9 +/- 29.8 msec, p<0.05). CONCLUSION: Successful PTCA is associated with less QTd after PTGA. The results are equally significant when either QT or QTc is used for analysis. In our limited study, measurement of QT dispersion, an easily accessible, resonably accurate, noninvasive method, may be a valuable tool in assessment of patients before and after PTCA. However, this study must be confirmed in prospective trial.
Angina Pectoris ; Electrocardiography ; Female ; Heart ; Humans ; Male ; Myocardial Infarction ; Reperfusion ; Retrospective Studies

BACKGROUND: Pulmonary venous flow velocity pattern (PVFVP) is widely used to assess LV diastolic function. It is known that the parameters of PVFVP have a significant correlation with the ratio of peak early diastolic filling velocity (E) to peak filling velocity at atrial contraciton (A) measured in the transmitral flow. However, the correlations between parameters of superior vena caval flow (SVCF) and transtricuspid E/A ratio have not been reported. Therefore the present investigation was performed to elucidate these correlations. METHODS: Fifty patients (26 men, mean age 63.1+/-11.1 years), who did not have significant tricuspid valvular disease and restrictive filling pattern on tricuspid and superior vena caval doppler, were included in this study. SVCF was recorded with the transducer positioned at subxiphoid area and the sample volume placed 2 cm within the superior vena cava. Blood flow across the tricuspid valve was obtained from standard four chamber view or modified parasternal four chamber view with the sample volume placed on leaflet tips. Recording was made during midexpiratory apnea. The following doppler parameters were measured: transtricuspid E and A velocity, E/A ratio: systolic (S) and diastolic (D) peak velocities and time velocity integrals (TVI), S/D velocity ratio, S/D TVI ratio, atrial reversal peak velocity (ArV) and TVI (ArTVI) in SVCF. RESULTS: 1) In SVCF, S velocity (63.7+/-11.8 cm/s vs 73.4+/-13.6 cm/sec, p<0.05), S TVI (17.4+/-3.6 cm vs 21.1+/-6.2 cm, p<0.05), ArV (30.0+/-6.9 cm/s vs 37.2+/-7.3 cm/s, p<0.005), and ArTVI (2.7+/-0.8 cm vs 3.3+/-0.8 cm, p<0.01) were significantly decreased in group E/A>1. And D TVI (7.1+/-3.0 cm vs 5.2+/-3.1 cm, p<0.05) and D/S TVI ratio (0.41+/-0.13 vs 0.26+/-0.14, p<0.05) were significantly increased in group E/A>1. 2) As E/A ratio increased, diastolic TVI (r=0.315, p<0.05) and D/S TVI ratio (r=0.448, p<0.001) increased, and ArTVI (r=-0.376, p<0.01) and ArV (r=-0.416, p<0.01) decreased. 3) As E peak velocity increased, SVCF D peak velocity increased (r=0.305, p<0.05). CONCLUSIONS: Tricusupid E/A ratio has positive correlations with D TVI and D/S TVI ratio, and negative correlations with ArTVI and ArV. But there were no correlations in S velocity, D velocity, and S/D velocity ratio as the relation of mitral E/A ratio with PVFVP.
Apnea ; Humans ; Male ; Transducers ; Tricuspid Valve ; Vena Cava, Superior

PURPOSE: Lipofibromatous hamartoma (LFH) of nerve is a tumor-like lipomatous process principally involving the young persons. This is a rare disease characterized by a soft slowly growing mass surrounding and infiltrating major nerves and their branches of the palm and digits. LFH of nerve usually affects the median nerve, with the most common sites of presentation being the distal forearm and hand in the wrist or palm. It may cause symptoms of compression neuropathy and is associated with macrodactyly. Recently, MRI plays a major role in confirming the diagnosis of LFH. Therefore, we present two cases of LFH in the hand with MRI features and surgical management. METHODS: One is a 6-year-old girl with macrodactyly involving both soft tissue and bony parts of the second, third and forth digits of her right hand. The other is a 16-year-old boy involving the soft tissue of the second and third digits of his right hand, with pain and numbness, along with motor and sensory deficits in the median nerve distribution. To evaluate LFH, we enforced preoperative MRI and physical examination. After confirming the diagnosis of LFH, we proposed decompression of all compromised peripheral nerve to help alleviate pain and paresthesia to reduce the likelihood of permanent motor and sensory sequelae. RESULTS: A characteristic feature on MRI is the appearance of serpentiform nerve fascicle surrounded by fibro-fatty tissue within the expended nerve sheet. Distribution of fat between fascicles is asymmetric. Two cases were treated by limited debulking of the redundant tumor tissue and excision of epineurial fatty tissue. These cases were performed with relief of symptom. CONCLUSION: MRI confirms the diagnosis, and it also provides a detailed assessment of nerve involvement before the operation. Especially, on coronal images, the nerve has a spagetti-like appearance that is pathognomonic of LFH. Recommendations for early treatment include decompression of the carpal tunnel, debulking of the fibro-fatty sheath, microsurgical dissection of the neural elements and excision of the involved nerve with or without grafting.
Adipose Tissue ; Adolescent ; Child ; Decompression ; Fingers ; Forearm ; Hamartoma ; Hand ; Humans ; Hypesthesia ; Limb Deformities, Congenital ; Median Nerve ; Paresthesia ; Peripheral Nerves ; Physical Examination ; Rare Diseases ; Transplants ; Wrist

The complications of endotracheal intubation are inevitable, of which postintubation tracheal stenosis may be required for surgical resection with primary reconstruction. Before surgery, several less invasive therapeutic modalites including bougie dilatation, stenting, and Nd-YAG laser incision are still available in use. Especially, good results were noted in selected patients with lengthy scars of less than 1cm and without tracheomalacia using endoscopic laser incision and dilatation. We report a case of a 54 yr-old woman with postintubation tracheal stenosis who was successfully treated by endoscopic Nd-YAG laser incision and esophageal balloon catheter.
Catheters* ; Cicatrix ; Dilatation ; Female ; Humans ; Intubation, Intratracheal ; Lasers, Solid-State* ; Stents ; Tracheal Stenosis* ; Tracheomalacia

Background: We investigated the changing patterns of insulin secretion and resistance and risk factors contributing to the development of post-transplant diabetes mellitus (PTDM) in kidney recipients under tacrolimus-based immunosuppression regimen during 1 year after transplantation. Methods: This was a multicenter prospective cohort study. Of the 168 subjects enrolled in this study, we analyzed a total 87 kidney transplant recipients without diabetes which was assessed by oral glucose tolerance test before transplantation. We evaluated the incidence of PTDM and followed up the index of insulin secretion (insulinogenic index [IGI]) and resistance (homeostatic model assessment for insulin resistance [HOMA-IR]) at 3, 6, 9 months, and 1 year after transplantation by oral glucose tolerance test and diabetes treatment. We also assessed the risk factors for incident PTDM. Results: PTDM developed in 23 of 87 subjects (26.4%) during 1 year after transplantation. More than half of total PTDM (56.5%) occurred in the first 3 months after transplantation. During 1 year after transplantation, insulin resistance (HOMA-IR) was increased in both PTDM and no PTDM group. In no PTDM group, the increase in insulin secretory function to overcome insulin resistance was also observed. However, PTDM group showed no increase in insulin secretion function (IGI). Old age, status of prediabetes and episode of acute rejection were significantly associated with the development of PTDM. Conclusion In tacrolimus-based immunosuppressive drugs regimen, impaired insulin secretory function for reduced insulin sensitivity contributed to the development of PTDM than insulin resistance during 1 year after transplantation.

PURPOSE: Heart transplantation on patients with previous cardiac operations has become more and more popular nowadays, and we assessed retrospectively the clinical features and surgical outcome of the patients who underwent redo heart transplantation after various cardiac operations. METHODS: From November 1992 to June 2002, one hundred and six patients received heart transplantation, and, among them, 12 patients (11.3%), 7 men and 5 women, had had previous cardiac operations (Group I). Their age ranged from 14 years to 61 years (median: 36). Previous cardiac procedures were mitral valve surgery in 3, coronary artery bypass in 3, total correction of tetralogy of Fallot in 2, tricuspid valve surgery in 2, Aortic valve surgery in 1 and placement of left ventricular assist device (LVAD) in 1. Interval between primary operation to cardiac transplantation ranged from 18 months to 142 months (median: 78 months) when we exclude one patient who underwent transplantation 1 month after LVAD placement. HLA cross matching was done in all patients to rule out the presence of preformed anti-HLA antibody in recipients' sera. Postoperative follow-up duration was 423 patient-months (median 36 months), and intra- operative findings and postoperative outcome were compared with those of 94 patients who received cardiac transplantation as a primary operation (Group II). RESULTS: There were no early and late mortality. Pre-bypass anesthetic time were longer in Group I (140 min) compared to Group II (100 min), and intra-operative events were more frequent in Group I (pre-bypass Hemodynamic instability in 5, Bleeding during reentry in 2, defibillation for ventricular fibrillation in 1, unplanned femoral cannulation in 1 and delayed sternal closure in 1. But there were no differences in bypass time, post-bypass anesthetic time, ventilatory support, ICU stay, hospital stay, inotropic support, chest tube drainage and transfusion amount between two groups. There was no space problem due to fibrotic and restrictive pericardial cavity in all but one patient, whose body weight was only 65% of donor body weight and pericardial cavity was relatively small. During the follow-up period, 3 patients (25%) experienced acute rejection necessitating steroid pulse therapy. CONCLUSION: Redo heart trasplantation is more complicated procedure compared to primary cardiac transplantation, but early and intermediate term result is comparable to the latter. Space problem may ensue if pericardial cavity is small and Donor-Recipient body weight mismatch is great.
Aortic Valve ; Body Weight ; Catheterization ; Chest Tubes ; Coronary Artery Bypass ; Drainage ; Female ; Follow-Up Studies ; Heart Transplantation* ; Heart* ; Heart-Assist Devices ; Hemodynamics ; Hemorrhage ; Humans ; Length of Stay ; Male ; Mitral Valve ; Mortality ; Retrospective Studies ; Tetralogy of Fallot ; Tissue Donors ; Tricuspid Valve ; Ventricular Fibrillation

Mercury occurs in various chemical forms, and it is different to health effects according to chemical forms. In consideration of the point, the evaluation of the mercury exposure to human distinguished from occupational and environmental exposure. With strict to manage occupational exposure in factory, it is declined mercury intoxication cases by metallic and inorganic mercury inhalation to occupational exposure. It is increasing to importance in environmental exposure and public health. The focus on the health impact of exposure to mercury is more on chronic, low or moderate grade exposure—albeit a topic of great controversy—, not high concentration exposure by methylmercury, which caused Minamata disease. Recently, the issue of mercury toxicity according to the mercury exposure level, health effects as well as the determination of what mercury levels affect health are in the spotlight and under active discussion. Evaluating the health effects and Biomarker of mercury exposure and establishing diagnosis and treatment standards are very difficult. It can implement that evaluating mercury exposure level for diagnosis by a provocation test uses chelating agent and conducting to appropriate therapy according to the result. but, indications for the therapy of chelating agents with mercury exposure have not yet been fully established. The therapy to symptomatic patients with mercury poisoning is chelating agents, combination therapy with chelating agents, plasma exchange, hemodialysis, plasmapheresis. But the further evaluations are necessary for the effects and side effects with each therapy.
Chelating Agents ; Diagnosis* ; Environmental Exposure ; Humans ; Inhalation ; Mercury Poisoning ; Mercury Poisoning, Nervous System ; Occupational Exposure ; Plasma Exchange ; Plasmapheresis ; Public Health ; Renal Dialysis