A new stereoisomeric monoterpene glycoside and five already-known compounds were isolated from the n-BuOH soluble fraction of Clematis heracleifolia leaves. On the basis of spectral data, the structures of the isolated compounds were identified as protocatechuic acid (1), ferulic acid (2), caffeic acid (3), aesculin (4), (6Z)-9-hydroxylinaloyl glucoside (5), and 9-hydroxylinaloyl glucoside (6) and these were isolated for the first time from this plant. Among these compounds, (6Z)-9-hydroxylinaloyl glucoside (5) is a newly isolated from plant source.
Clematis* ; Esculin ; Plants ; Stereoisomerism*

PURPOSE: A large number of studies have demonstrated that bronchiolitis by RSV can develop into recurrent wheezing or asthma in infancy. The severity on first attack, atopic finding and evironmental factors can be a risk factors for this recurrent wheezing but not yet defined clearly. We studied to know the risk factors to cause recurrent wheezing after bronchiolitis by RSV. METHODS: Sixty three children who were hospitalized for bronchiolitis by RSV from June 1996 through May 1997 were followed-up. They were classified into recurrent group with wheezing of more than 3 times and no-recurrent group and compared. RESULTS: 1) The recurrent group was 46%(29 of 63 cases) and was higher in both male and whom first wheezing occured in less than 6 months of age. 2) On the first admission, the degree of respiratory distress was more severe in recurrent group. 3) On the first admission, serum ECP was more higher in the recurrent group. And during follow-up, frequency of increased serum IgE and positive skin test to D.p, D.f was higher in the recurrent group. 4) The household environment, personal history of patients and familial history of atopy did not affect on recurrence of wheezing. CONCLUSION: This study demonstrated that younger age of lesser than 6 month of age and severity of respiratory distress on the first admission and positive skin test to D.p, D.f and higher serum IgE during follow-up had significant association with recurrent wheezing.
Asthma ; Bronchiolitis* ; Child ; Family Characteristics ; Follow-Up Studies ; Humans ; Immunoglobulin E ; Male ; Recurrence ; Respiratory Sounds ; Risk Factors ; Skin Tests

BACKGROUND: The antinociceptive action of intrathecal midazolam is well documented and the administration of midazolam by centroneuraxis route has been shown to produce segmental antinociception. This study was designed to evaluate the duration of sensory block and BIS sedation score of intrathecal midazolam-bupivacaine mixture in patients undergoing knee arthroscopy. METHODS: In this double-blind prospective study, one hundred twenty seven patinets were randomly assigned to receive 4.5 ml of one of the following intrathecal solutions: 15 mg of 0.5% isobaric bupivacaine plus 1.5 ml of 0.9% saline (Group C; n = 34); 15 mg of 0.5% bupivacaine plus 0.5 ml of 0.1% midazolam and normal saline 1 ml mixture (Group 0.5; n = 28); 15 mg of 0.5% bupivacaine plus 1 ml of 0.1% midazolam and normal saline 0.5 ml mixture (Group 1; n = 27); 15 mg of 0.5% bupivacaine plus 1.5 ml of 0.1% midazolam (Group 1.5; n = 38). Time of sensory block until L5-S1 level regression occurred and sedation score using BIS, duration of effective analgesia connecting IV-PCA pump, blood pressure, heart rate, oxygen saturation and nausea/vomiting were recorded and observed. RESULTS: A significantly longer sensory block duration was seen in group 0.5, 1, 1.5 patients compared with group C (P < 0.01). Correlation coefficent of midazolam dose and sensory block duration was 0.95. Duration of effective analgesia was also prolongated in midazolam-bupivacaine mixture groups (P < 0.01). Blood pressure, heart rate, oxygen saturation and nausea/ vomiting showed no differences among the groups. Sedation score was slightly decreased in only group 1.5, but not to the level of unconsciousness. CONCLUSIONS: The results suggest that addition of midazolam 1.5 mg to 0.5% bupivacaine intrathecally provided prolongation of sensory block without any adverse effects.
Analgesia ; Anesthesia, Spinal ; Arthroscopy ; Blood Pressure ; Bupivacaine* ; Heart Rate ; Humans ; Knee ; Midazolam* ; Oxygen ; Prospective Studies ; Unconsciousness ; Vomiting

Background: To date, no study has investigated whether the neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) have a clinical value in Mycobacterium avium complex (MAC)-pulmonary disease (PD). Methods: We aimed to assess whether the baseline NLR and MLR were different according to the severity of MAC-PD based on the radiologic classification by retrospectively analyzing 549 patients treated in a tertiary referral center in South Korea. Results: Both NLR and MLR were significantly higher as 3.33 and 0.43 respectively in the fibrocavitary type, followed by 2.34 and 0.27 in the cavitary nodular bronchiectatic type and significantly lower as 1.88 and 0.23 in the non-cavitary nodular bronchiectatic type. Conclusion The baseline NLR and MLR showed a distinct difference in accordance with the radiologic severity of MAC-PD.

OBJECTIVE: To investigate serum 25-hydroxyl vitamin D (25(OH)D) and vitamin D-binding protein (VDBP) concentrations in women with endometriosis according to the severity of disease. METHODS: Women with mild endometriosis (n = 9) and advanced endometriosis (n = 7), as well as healthy controls (n = 16), were enrolled in this observational study. Serum total 25(OH)D concentrations were analyzed using the Elecsys vitamin D total kit with the Cobas e602 module. Concentrations of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using the Human Vitamin D BP Quantikine ELISA kit. Variables were tested for normality and homoscedasticity using the Shapiro-Wilk test and Leven F test, respectively. Correlation analysis was used to identify the variables related to total 25(OH)D and VDBP levels. To assess the effects of total 25(OH)D and VDBP levels in the three groups, multivariate generalized additive modeling (GAM) was performed. RESULTS: Gravidity and parity were significantly different across the three groups. Erythrocyte sedimentation rate (ESR) and CA-125 levels increased as a function of endometriosis severity, respectively (p= 0.051, p= 0.004). The correlation analysis showed that total 25(OH)D levels were positively correlated with gravidity (r = 0.59, p< 0.001) and parity (r = 0.51, p< 0.003). Multivariate GAM showed no significant relationship of total 25(OH)D levels with EMT severity after adjusting for gravidity and ESR. However, the coefficient of total 25(OH)D levels with gravidity was significant (1.87; 95% confidence interval, 0.12–3.63; p= 0.040). CONCLUSION: These results indicate that vitamin D and VDBP levels were not associated with the severity of endometriosis.
Blood Sedimentation ; Endometriosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Gravidity ; Humans ; Observational Study ; Parity ; Vitamin D ; Vitamin D-Binding Protein ; Vitamins

Dieulafoy's lesions are often unrecognized cause of obscure, massive gastrointestinal bleeding, reported to be 0.3~1.5% of cases of major gastrointestinal bleeding. It is characterized by severe bleeding from rupture of an exposed submucosal artery. Dieulafoy's lesion is usually occured in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been described in the esophagus, duodenum, small intestine, colon, and rectum. The diagnosis is made by endoscopy, angiography, laparoscopy, or laparotomy. Endoscopy showed protruding and eroded artery with pulsatile bleeding or adherent thrombus. Currently, various therapeutic options are available to the endoscopist for the treatment of Dieulafoy's lesions. Therapeutic endoscopy should now become first-line therapy for Dieulafoy's lesions. We experienced a rare case of bleeding from the duodenal Dieulafoy's lesion. Endoscopic hemoclipping was performed successfully. We report this case with a review of the literature.
Angiography ; Arteries ; Colon ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Duodenum ; Endoscopy ; Esophagogastric Junction ; Esophagus ; Hemorrhage* ; Intestine, Small ; Laparoscopy ; Laparotomy ; Rectum ; Rupture ; Stomach ; Thrombosis

Dieulafoy's lesion is an uncommon source of massive gastrointestinal hemorrhage. The lesion predominantly occurs in the proximal stomach, but may occur in all parts of the gastrointestinal tract including small bowel, colon and rectum. We herein report a case of a patient who presented with hematochezia from Dieulafoy's lesion of the terminal ileum with adherent blood clots. Bleeding was successfully controlled with endoscopic treatment by utilizing hemoclipping.
Colon ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileum ; Rectum ; Stomach

Gastrointestinal hemangiomatosis is a rare benign vascular lesion, which can produce massive or persistent blood loss. Numerous lesions, usually of the cavernous type, involve stomach, small bowel, and colon. The diagnosis of hemangiomatosis is difficult. It is diagnosed usually by endoscopic study or barium enema for bleeding or anemia evaluation in childhood. A 17-year-old female was admitted to our hospital with anemia and dizziness for several months. She was diagnosed as diffuse intestinal hemangiomatosis by gastroduodenoscopy and colonoscopy. Gastroduodenosocpic findings showed multiple, small, mound-like, reddish-purple hemangiomas on the lower body, fundus and prepyloric area of the stomach. Colonoscopic findings showed similar lesions on the ascending and descending colon. The polypoid lesion on the ascending colon was ligated by detachable snare due to bleeding. No other hemangioma was detected by ultrasonography, abdominal angiography or small bowel series. We report a case of diffuse hemangiomatosis, largely distrubuted in the stomach and colon, but without involvement of skin or other solid organ. The bleeding hemangioma on the ascending colon was treated by endoscopic ligation, and the anemia of the patient was improved.
Adolescent ; Anemia* ; Angiography ; Barium ; Colon ; Colon, Ascending ; Colon, Descending ; Colonoscopy ; Diagnosis ; Dizziness ; Endoscopy* ; Enema ; Female ; Hemangioma ; Hemorrhage ; Humans ; Ligation ; Skin ; SNARE Proteins ; Stomach ; Ultrasonography