BACKGROUND: In eczematous skin it is expected that altered defense mechanisms are employed against an injury, which mechanisms include alterations in the stratum corneum barrier function and lipid contents. OBJECTIVE: To investigaten aspect of pathophysiology of hand eczema by comparing the water holding capacities and transepidermal water loss(TEWL) after injuries on the skin and by comparing the epidermal lipid contents between hand eczema and normal subjects. METHODS: The water holding capacities were checked by corneometer, and the TEWL were checked after epidermal barrie! destruction with acetone or adhesive tapes. The epidermal lipids were extracted with acetone, ther (1: 1 v/v) mixture solvent and analysed by HP- TLC. RESULTS: The water holdingapacities were decreased in eczema of the palm, but the recoveries of TEWL and the lipid content did not differ between hand eczema and normal subjects. CONCLUSION: The water holding capacities were decreased in the eczematous skin. But there were no significant differencies in the recovery of destructed epidermal barrier and the epidermal lipid contents.
Acetone ; Adhesives ; Defense Mechanisms ; Eczema* ; Hand* ; Skin ; Water

PURPOSE: Loss of hippocampal interneurons in dentate gyrus has been reported in patients with severe temporal lobe epilepsy and in animals treated with kainic acid(KA). Interneurons contain Ca2+- binding protein parvalbumin(PV). The effects of kainic acid on parvalbumin-immunoreactive (PV-IR) interneurons in dentate gyrus were investigated in organotypic hippocampal slice cultures. METHODS: Cultured hippocampal slices from postnatal day nine C57/BL6 mice were exposed to 10 muM KA, and were observed at 0, 8, 24, 48, 72 hours after a one hour KA exposure. Neuronal injury was determined by morphologic changes of PV-IR interneuron in dentate gyrus. RESULTS: Transient(1 hour) exposure of hippocampal explant cultures to KA produced marked varicosities in dendrites of PV-IR interneuron in dentate gyrus and the shaft of interbeaded dendrite is often much thinner than those in control. The presence of varicosities in dendrites was reversible with KA washout. The dendrites of KA treated explants were no longer beaded at 8, 24, 48 and 72 hours after KA exposure. The number of cells in PV-IR interneurons in dentate gyrus was decreased at 0, 8 hours after exposure. But there was no significant difference in 24, 48 and 72 hours recovery group compared with control group. CONCLUSIONS: The results suggested that loss of PV-IR interneurons in dentate gyrus is transient, and is not accompanied by PV-IR interneuronal cell death.
Animals ; Carrier Proteins ; Cell Death ; Dendrites ; Dentate Gyrus* ; Epilepsy* ; Epilepsy, Temporal Lobe ; Humans ; Interneurons* ; Kainic Acid ; Mice* ; Neurons

OBJECTIVE: To evaluate the efficacy of clinical use of a intrauterine Sengstaken-Blakemore tube (S-B tube) in postpartum hemorrhage not controlled with medication and conservative treatment. METHODS: Retrospective review was done in 18 women with insertion of S-B tube into intrauterine cavity who did not controlled with medication and conservative treatment for postpartum hemorrhage. After third stage of labor, women were treated with prophylactic intramuscular Methylergonovine 0.2 mg and intravenous infusions of oxytocin routinely. If the postpartum bleeding continued, Misoprostol 800 microgram (per rectal) and intravenous infusions of Dinoprost 2 mg mixed with 5% D/S 500 cc were employed. And then women were examined for retained placenta and laceration of birth canal. Where necessary, retained placenta was removed and lacerations were sutured. If the postpartum bleeding did not controlled despite all of procedures, we decided use of intrauterine S-B tube. RESULTS: The mean age of the patients was 30.9+/-4.4 (27-39) years, their mean body weights and parities were 67.8+/-8.2 (56.2-85.7) kg, 1.8+/-0.8 (1-4) and mean gestational age was 38.5+/-2.9 (37-42) weeks respectively. The mean time from delivery to insertion of S-B tube was 107.6+/-94.0 (24-360) minutes. The mean filled normal saline amount was 190.5+/-35.2 (120-230) cc. Of 18 who was inserted of S B tube, 15 cases needed not additional surgical therapy. So success rate was 83.3%. CONCLUSION: Insertion of intrauterine S-B tube appears as a simple and effective means of treating postpartum hemorrhage not controlled with medication and conservative treatment.
Body Weight ; Dinoprost ; Female ; Gestational Age ; Hemorrhage ; Humans ; Infusions, Intravenous ; Lacerations ; Methylergonovine ; Misoprostol ; Oxytocin ; Parturition ; Placenta, Retained ; Postpartum Hemorrhage* ; Postpartum Period* ; Retrospective Studies

PURPOSE: Despite improved surgical techniques, pulmonary regurgitation is a common postoperative sequelae in patients with tetralogy of Fallot. Pulmonary regurgitation may induce deterioration of right ventricular performance, right ventricular dilatation and ventricular arrhythmia. The evaluation of the clinical significance of pulmonary regurgitation in postoperative tetralogy of Fallot has been troublesome since there was no technique that could accurately quantitate volume of pulmonary flow. Magnetic resonance imaging (MRI) with velocity mapping provided data on the volumetric quantitation of pulmonary regurgitation. The purpose of this present study was to assess right ventricular function and the severity of pulmonary regurgitation after surgical correction of tetralogy of Fallot by echocardiography and MRI. METHODS: Echocardiography and MRI were performed on nine patients with total surgical correction of tetralogy of Fallot. Quantitative volumetric assessment of pulmonary reguritation and right ventricular function was done. RESULTS: The pulmonary regurgitant volume was similar between echocardiography and MRI, and the pulmonary velocity was significantly larger by MRI in comparison with echocardiography. Right ventricular end-diastolic volume and stroke volume were similar in both two methods, but end-systolic volume was significantly larger by MRI in comparison to echocardiography. Pulmonary regurgitant volume was positively correlated with right ventricular end-systolic volume, end-diastolic volume and stroke volume. Each parameter (pulmonic velocity, pulmonary regurgitant volume, right ventricular end-diastolic volume, end-systolic volume, stroke volume) was significantly correlated linearly between echocardiography and MRI. CONCLUSION: Cine MRI with velocity mapping is an accurate method for the noninvasive, volumetric quantitation of pulmonary regurgitation after surgical correction of tetralogy of Fallot.
Arrhythmias, Cardiac ; Dilatation ; Echocardiography* ; Humans ; Magnetic Resonance Imaging* ; Magnetic Resonance Imaging, Cine ; Pulmonary Valve Insufficiency* ; Stroke Volume ; Tetralogy of Fallot* ; Ventricular Function, Right*

Nineteen astrocytic neoplasms, such as 9 cases of glioblastoma multiforme, 6 cases of anaplastic astrocytoma and 4 cases of low grade astrocytoma, were analysed in view of the relationship between histopathologic grade, nuclear pleomorphism, grade of mutant p53 gene expression and mean survival time after operation. The histopathologic classification by Ringertz and immunohistochemical stain for mutant p53 gene with the DO-7 anti-p53 oncoprotein mouse monoclonal antibody were applied, and the results obtained were as follows; 1) Among 19 cases, 18 cases were located in the supratentorium, where 13 cases(42%) were located in the left and 17 cases(55%) in the right. 2) The p53 gene expression was detected in 12(63.2%) of the cases, as revealed by positive nuclear staining. All cases of glioblastoma multiforme showed p53 gene expression, compared with two(33.3%) cases of anaplastic astrocytoma and one(25%) case of low grade astrocytoma. The frequency and degree of histopathologic grade(p=0.03). 3) The mean survival time after operation was 29.49+/-4.08 months in cases with p53-negative tumors and 12.93+/-3.14 months in cases with p53-positive tumors(p<0.05). 4) Both histopathological classification and p53 gene expression showed a significant influence on servival(p=0.02 and p=0.03, respectively). 5) The relative risk for survival time was the highest in p53 gene expression. In conclusion, p53 gene expression appears to be one of the recommendable prognosticators among astrocytic neoplasms.
Animals ; Astrocytoma ; Classification ; Genes, p53* ; Glioblastoma ; Mice ; Survival Rate

Spontaneous rupture of renal artery aneurysm is a rare, but life threatening complication with high mortality. The etiology of non-traumatic renal artery aneurysm is fibromuscular dysplasia, atherosclerosis, vasculitis, and pregnancy. We here report a case of spontaneous rupture of renal artery aneurysm in a patient with untreated hypertension. A 39-year-old non-pregnant woman complained of sudden onset of right flank and lower quadrant abdominal pain. Ultrasonography showed large fluid collection in right lower abdomen. Emergency laparotomy demonstrated huge retroperitoneal hematoma due to spontaneous rupture of right renal artery aneurysm. Microscopic examination of the aneurysmal wall revealed intimal hyperplasia without atherosclerotic change.
Abdomen ; Abdominal Pain ; Adult ; Aneurysm* ; Atherosclerosis ; Emergencies ; Female ; Fibromuscular Dysplasia ; Hematoma ; Humans ; Hyperplasia ; Hypertension* ; Laparotomy ; Mortality ; Pregnancy ; Renal Artery* ; Rupture, Spontaneous* ; Ultrasonography ; Vasculitis

Although the incidence of bleeding complications during extracorporeal membrane oxygenator (ECMO) support has decreased in various trials, bleeding is still the most fatal complication. We investigated the ideal dosage and efficacy of nafamostat mesilate for use with ECMO in patients with acute cardiac or respiratory failure. We assessed 73 consecutive patients who received ECMO due to acute cardiac or respiratory failure between January 2006 and December 2009. To evaluate the efficacy of nafamostat mesilate, we divided the patients into 2 groups according to the anticoagulants used during ECMO support. All patients of nafamostat mesilate group were male with a mean age of 49.2 yr. Six, 3, 5, and 3 patients were diagnosed with acute myocardial infarction, cardiac arrest, septic shock, and acute respiratory distress syndrome, respectively. The mean dosage of nafamostat mesilate was 0.64 mg/kg/hr, and the mean duration of ECMO was 270.7 hr. The daily volume of transfused packed red blood cells, fresh frozen plasma, and cryoprecipitate and the number of complications related to hemorrhage and thrombosis was lower in the nafamostat mesilate group than in the heparin group. Nafamostat mesilate should be considered as an alternative anticoagulant to heparin to reduce bleeding complications during ECMO.
Acute Disease ; Anticoagulants/*administration & dosage ; Dose-Response Relationship, Drug ; *Extracorporeal Membrane Oxygenation ; Female ; Guanidines/*administration & dosage ; Heart Failure/diagnosis/mortality/therapy ; Heparin/administration & dosage ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis/mortality/therapy ; Respiratory Distress Syndrome, Adult/diagnosis/mortality/therapy ; Retrospective Studies ; Shock, Septic/diagnosis/mortality/therapy ; Survival Analysis

PURPOSE: To determine the effects of scan delay, hepatic function, and magnetic field strength on the performance of gadoxetic acid enhanced magnetic resonance imaging. MATERIALS AND METHODS: Gadoxetic acid enhanced MRI conducted in 72 patients with 10 minutes and 20 minutes delay were reviewed retrospectively. For quantitative analysis, liver-to-lesion signal difference ratio (SDR) was measured and compared according to scan delay time, hepatic function and magnetic field strength. For qualitative analysis, two board-certificated radiologists reviewed 10-minute delay and 20-minute delay images. The sensitivity and specificity of each reader was compared. RESULTS: The SDR of 20-minute images in non-cirrhotic patients was significantly higher (p < 0.01) than that of 10-minute delay images. However, in cirrhotic patients, it was comparable (p > 0.05) to 10-min delay images. In comparisons according to the magnetic strength, there was no significant difference between 1.5-T and 3.0-T systems. Comparisons of ROC curves showed no statistically significant differences in sensitivity and specificity between 10-minute and 20-minute delay images. CONCLUSION: An increase in the liver-to-lesion signal difference ratio was dependent on the patients' hepatic function but not dependent on the magnetic strength. There was no significant difference in sensitivity or specificity between the 10-minute and 20-minute delay images.
Gadolinium DTPA ; Humans ; Liver ; Magnetic Fields ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

Churg-Strauss Syndrome is a disorder of hypereosinophilia and systemic vasculitis in subjects with asthma and allergic rhinitis. Clinically, a multiple organ system can be involved with various manifestations of disease of lung, heart, skin, musculoskeletal system, nervous system, gastrointestinal and hepatobiliary tract. We experienced a case of Churg- Strauss syndrome presenting as the appendicitis and the lower gastrointestinal bleeding in a 37-year-old male patient with acute lower abdominal pain. He also showed peripheral eosinophilia, bronchial asthma, and mononeuritis multiplex. He initially received a high dose corticosteroid and was maintained with low doses of corticosteroid, cyclophosphomide and exchange plasmapheresis.
Abdominal Pain ; Adult ; Appendicitis* ; Asthma ; Churg-Strauss Syndrome* ; Eosinophilia ; Heart ; Hemorrhage* ; Humans ; Lung ; Male ; Mononeuropathies ; Musculoskeletal System ; Nervous System ; Plasmapheresis ; Rhinitis ; Skin ; Systemic Vasculitis

BACKGROUND AND PURPOSE: Although thrombolytic strategies with streptokinase(STK) and tissue-type plasminogen activator(t-PA) in the treatment of acute myocardial infarction(AMI) have been studied in large-scale clinical trials in the western countries, such large-scale studies with urokinase(UK) are scanty. Even though UK is most commonly used thrombolytic agent for the treatment of AMI in Korea, there is no consensus on the dosage and the way of administration of UK in patients with AMI. Accordingly, a prospective clinical study was performed to evaluate the effects of thrombolytic strategies of intravenous double bolus method and standard double-infusion method with different dosage of UK in the treatment of AMI. SUBJECTS AND METHODS: Ninety there patients with AMI(male 75, female 18, age 57.5+/-10.8 years) were studied. The patients were divided into 3 groups according to dosage of UK and method of administration. Group I : 19 patients who received 1.5 million U of UK IV bolus, followed by 1.5 million U IV infusion for an hour(High Dose Group). Group II : 34 patients received 20,000U/kg body weight of UK IV bolus, followed by 20,000U/kg IV infusion for an hour(Double Dose Group). Group III : 40 patients received 1.5 million U of UK IV bolus and followed by 20,000U/kg IV bolus in 30 minutes with total dose of no more than 3 million U(Double Bolus Group). Coronary angiography(CAG) and left ventriculography(LVG) were performed 90 minutes after the administration of UK and post-AMI 7-10 days to investigate the patency of infarct-related artery(IRA) and LV function. Patency of IRA was graded according to the extent of flow of IRA. TIMI grade 0-1 was regarded as occluded, and grade 2-3 flow as patent. LV ejection fraction(EF) by echocardiography was measured on day 1, day 7-10 and 1 month after AMI. Indirect clinical parameters of thrombolysis were evaluated and were compared with CAG findings. RESULTS: 1) The 90 minutes IRA patency in Group III(Double bolus ; 79.0%) was higher than that in Group 1, but showed no statistically significant difference(High dose ; 61.5%, p=0.790). The 90 minutes IRA patency in Group III showed borderline significance with Group II(Double dose ; 57.1%, p=0.057). TIMI flow III in Group III(60.6%) was significantly higher than that in Group II(53.6%, p=0.0468) but showed no statistically significant difference with Group I(61.5%, p=0.158). 2) The EF by LVG were 49.1% in Group I, 41.7% in Group II and 49.2% in Group III. The difference in EF between Group I and Group III vs Group II was significant(p=0.008 in Group I, p=0.014 in Group III vs Group II). 3) Fatal bleeding complications(1 intracranial hemorrhage and 1 gastric ulcer bleeding) developed in Group II (Double dose). 4) Pain to door time, pain to needle time and door to needle time tended to be shorter in open(TIMI flow II-III) IRA group than in closed IRA group. 5) Initial EF were similar between open IRA group and closed IRA group(46.1% and 42.1% ; p=NS). The EF of open IRA group measured by LVG on initail coronary angiography(41.8% in closed IRA vs 48.0%, in open IRA, p=0.03) and by 2D-Echo on 7-10 day(41.7% in closed IRA vs 51.0% in open IRA, p=0.004) were better than those of closed IRA group. 6) Indirect clinical indices of reperfusion such as mean CPK peak, time to CPK peak significantly lower in open IRA group than in closed IRA group. 7) Fatal bleeding complications(1 intacranial hemorrhage and 1 gastric ulcer bleeding) developed in closed IRA group. CONCLUSION: The findings we observed in this trial showed that earlier initiation and more rapid infusion of UK were associated with more increased 90min patency of infarct-related artery and more improved LV function without any obviously increased bleeding complications or other serious life-threatening complications than conventional UK therapy. Specifically, double bolus IV injection of UK(1.5 million U bolus followed by 20,000 U/Kg bolus in 30min)was more effective method of thrombolysis than conventional method for achieving optimal reperfusion in AMI patients. Also, IRA patency at 90 minutes after the initiation of thrombolysis was important in preserving global LV function in early recovery phase of AMI. Further trials may be needed to determine more effective thrombolysis with UK in AMI.
Arteries ; Body Weight ; Consensus ; Echocardiography ; Female ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Korea ; Myocardial Infarction* ; Needles ; Plasminogen ; Prospective Studies ; Reperfusion ; Stomach Ulcer ; Urokinase-Type Plasminogen Activator*