PURPOSE: Challenge of asthmatic patients by means of inhalation of allergens may produce both an early and a late asthmatic reaction. This Study was designed to understand th late-phase asthmatic reaction animal models of asthma and to using facilitate basic pathophysiologic research relevant to this clinical disorder. METHODS: We examined light microscopic and transmission electron microscopic pulmonary morphology of experirnentally allergen-induced asthmatic model of Sprague-Dowley rat to get more precise and time-ordered morphologic changes. The animals were sensitized and induced by ovalbumin with aluminum hydroxide and Pertussis vaccine as adjuvants. RESULTS: The morphologic changes of early reaction were identified in the group sacrificed at 15 minute after induction. The major change was noted in bronchial epithelium revealed as cytologic vacuolization and desquamation into the lumina. There were no identifiable changes in bronchial smooth muscle and no increased infiltration of eosinophils in the lung. The late reaction was identified in the group sacrificed at 4 hours after induction. The major changes were increased infiltration of eosinophils in the bronchial and bronchiolar mucosa and submucosa, increased deposition of collagen beneath the bronchial subepithelial basement membrane, and morphologic changes of bronchial smooth muscle layer. The thickness of the bronchial smooth muscle layer were increased and the smooth muscle cell showed nuclear contraction, increased numbers of mitochondria near the nuclei, irregular distribution of actin filaments in the cytoplasm and focal ballooning of the cytoplasm. Smooth muscle was the most pronounced in the group sacrificed 1 week after induction. The group of sensitization only revealed no identifiable morphologic changes compared with the control group. The group of induction only showed increased infiltration of eosinophils and increased numbers of perinuclear mitochondria in smooth muscle cells, and which features were similar but milder than sensitization and induction group. CONCLUSION: This study will help us to understand time-ordered precise histologic changes of allergic airway inflammation.
Actin Cytoskeleton ; Allergens ; Aluminum Hydroxide ; Animals ; Asthma ; Basement Membrane ; Collagen ; Cytoplasm ; Eosinophils ; Epithelium ; Humans ; Inflammation ; Inhalation ; Lung ; Mitochondria ; Models, Animal ; Mucous Membrane ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Ovalbumin ; Pertussis Vaccine ; Rats*

Intussusception is a frequent cause of intestinal obstruction in early childhood and most are idiopathic in origin. In a minority of cases a definite pathological lead point is identified by imaging studying or during surgery. As the pathologic lead point of intussusception, Meckel's diverticulum is the most common lesion. In symptomatic patients, 40~60% of Meckel's diverticulum contain ectopic tissue, with gastric mucosa being far the most common type. A few Meckel's diverticulum contain pancreatic tissue. Combined heterotopic pancreatic and gastric tissues in the Meckel's diverticulum especially causing intussusception is extremely rare. We report the case of 5-year-old girl with an intussusception caused by Meckel's diverticulum containing both heterotopic gastric and pancreatic tissues.
Child, Preschool ; Choristoma ; Female ; Gastric Mucosa ; Humans ; Intestinal Obstruction ; Intussusception* ; Meckel Diverticulum*

Drawing on our observation that many medical professionals have considerable difficulty in using what they know about ethics, we have developed a course for teaching the fifth year medical students a systematic approach to ethical reasoning and problem-solving, rather than teaching bioethical theories or prominent current ethical issues in developed countries. This course consisted of a series of guided group discussions and debates in classroom using over 50 cases classified under seven major headings. Responses and reactions from students and participating clinicians are encouraging. Several ideas for improving medical ethics curricula are discussed, including emphases on the thorough understanding of various aspects of human relations in medical practice, enhancing the ability of articulate the students own values, provoking the student to get involved in the ethical situation when studying the cases, and the need to introduce social science concepts in analyzing the ethical issues in the health care system.
Curriculum ; Delivery of Health Care ; Developed Countries ; Ethics ; Ethics, Medical* ; Head ; Humans ; Social Sciences ; Students, Medical

BACKGROUND: Long-term phenytoin therapy induces resistance to the neuromuscular blocking effects of metocurine, atracurium, doxacurium, and pipecuronium. This study examine neuromuscu-lar blocking effect and recovery of mivacurium in isolated rat phrenic-hemidiaphragm with two-weeks phenytoin pretreatment. METHOD: After the administration of 14 days of phenytoin 40 mg/kg, administered intraperitoneally twice daily (n=10), ED90, antagonism of neostigmine and 4-aminopyridine on the electrically evoked twitch response and train-of-four (TOF) stimulation were compared to control groups in isolated rat phrenic-hemidiaphragm preparation. RESULTS: ED90 was significantly greater in the phenytoin group than in the control group (319 +/- 39.5 g vs. 209.5 +/- 52.2 g, respectively). After the administration of neostigmine 0.75 M, the recovery of the single twitch and TOF ratio were significantly lesser in the phenytoin group than in the control group (single twitch; 19.6 +/- 6.6% vs. 69.2 +/- 9.4%, TOF ratio; 0.258 +/- 0.149 vs. 0.543 +/- 0.1, respectively). After the administration of 4-aminopyridine 40uM, the recovery of the single twitch and TOF ratio were no significant differrence between the phenytoin group and the control group (twitch; 118.1 +/- 25.3% vs. 122.6 +/- 24.8%, TOF ratio; 0.937 +/- 0.051 vs. 0.949 +/- 0.067, respectively). CONCLUSION: Long-term phenytoin therapy induces resistance to the neuromuscular blocking effects of mivacurium.
4-Aminopyridine ; Animals ; Atracurium ; Drug Interactions ; Neostigmine ; Neuromuscular Blockade* ; Phenytoin* ; Pipecuronium ; Rats*

OBJECTIVES: The incidence of zoonoses in Korea has increased recently. However, the study of high risk groups for zoonoses has not been conducted to date in Korea. Thus, we did this study to obtain data on brucellosis among slaughterhouse workers in Korea. METHODS: We evaluated the structure of slaughterhouses and the process of slaughtering by reviewing the relevant literature and doing field studies. We visited 73 slaughterhouses and 62 residual products handle houses across the country. In addition, we conducted a questionnaire survey of the work activities, and obtained blood samples in order to determine the seroprevalence and risk factors of brucellosis. The titers of brucellosis antibodies were measured using the standard tube agglutination test (SAT). We diagnosed subjects as seropositive for Brucellosis if the titers were more than 1:160. The data collected was evaluated using SPSS ver. 17.0. RESULTS: We included 1,503 subjects and obtained 1,482 blood samples among them: 849 workers involved in slaughtering, 351 handlers of residual products, 190 inspectors and their assistants, and 92 grading testers and their assistants. The seroprevalence of brucellosis among the slaughterhouse workers was 0.8% (95% CI=0.4-1.5). Broken down, the seroprevalence of brucellosis among the workers involved in slaughtering was 0.7% (95% CI=0.3-1.6), the handlers of residual products was 1.7% (95% CI=0.7-3.9) respectively. Risk factors for contracting brucellosis among slaughterhouse workers were being splashed with cattle blood around the mouth, cattle secretions around the body and not putting on protective apron while at work. CONCLUSIONS: An educational program is needed for high risk groups on zoonoses about the prevention of infection. Thus, effective working guidelines for workers who participate in the slaughter of animals must be developed in order to protect them from zoonoses.
*Abattoirs ; Animals ; Brucellosis/blood/*epidemiology ; Cattle ; Humans ; Korea/epidemiology ; Occupational Diseases/blood/*epidemiology/microbiology ; *Occupational Exposure ; Seroepidemiologic Studies ; Zoonoses/epidemiology/microbiology

Traumatic ventricular septal defect (VSD) resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.
Child ; Echocardiography ; Heart Failure ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Myocardial Infarction ; Preschool Child ; Rupture ; Thoracic Injuries ; Thorax ; Wounds, Nonpenetrating

This study was performed in order to evaluate the accuracy and the usefulness of the cytology of crush preparation in central nervous system(CNS) lesions. Forty four intraoperative biopsies were performed at the time of craniotomy including 34 benign and 10 malignant lesions. Crush preparations were prepared from tiny tissue fragments of craiotomy products. All cases were stained with toluidine blue. Intraoperative diagnoses made on cytologic examination were compared with the final paraffin section diagnoses. Comparison between the results of the cytologic and histologic findings revealed an overall diagnostic accuracy of 88.6%. This study attests to the diagnostic accuracy of cytologic examination in CNS lesions. The detailed cytologic features are described and important criteria for the cytodiagnosis of CNS lesions are discussed.
Biopsy ; Central Nervous System* ; Craniotomy ; Cytodiagnosis ; Diagnosis ; Paraffin ; Tolonium Chloride

PURPOSE: Cytogenetic and genetic alterations of tumors are closely related with progressian and promotion of cancers. Comparative genomic hybridization (CGH) has known to be a novel tool for the detection of genetic alteration in solid cancers. We performed CGH for the detection of new genetic alterations of bladder tumors. MATERIALS AND METHODS: Biotin-labeled tumor DNA and digoxigenin-labeled normal DNA were hybridized to normal metaphase cells. The fluorescence signals were captured by fluorescence microscope after detection by avidin FITC and antidigoxigenin rhodamin. Then, the ratio of fluorescence was calculated by an image analyzer. RESULTS: CGH results showed amplifications on chromosomes 1q, 3q, 4q, 5p, 6pq, 7p, 8q, 11q, 12q, 13q, 17q, 18q and 20pq (more than 20% of cases). Deletions were on chromosome 2q21-qter, 4q13-q23, 5q, 8p12-p22, 9pq, 11p13-p15 (more than 20% of cases). High level amplifications were noted on chromosomes 1q31-qter, 3p21, 3q24, 4q26, Sq21-qter, llq14-qter, 12q15-q21, 12q21-q24, 13q21-q31, 17q22, 18q22. CONCLUSION: We considered that the amplification on chromosome 4q26, 11q14-qter, 12q21-q24, 18q12 and deletion on 4qll-4q13 as a novel genetic alterations of bladder cancer. Our results revealed different pattem of amplifications that affect other regions from previous study on chromosome 7, llq, 12q, 13q, and 18q. CGH was very useful for the screening of genetic alterations of solid tumors.
Avidin ; Chromosomes, Human, Pair 7 ; Comparative Genomic Hybridization* ; Cytogenetics ; DNA ; Fluorescein-5-isothiocyanate ; Fluorescence ; Mass Screening ; Metaphase ; Urinary Bladder Neoplasms* ; Urinary Bladder*

We report a rare case in which a 35-year-old multiparous healthy woman developed a right sciatic neuropathy after epidural anesthesia and analgesia for caesarean section.She presented with premature rupture of membrane at 37 weeks and 4 days gestation.Epidural anesthesia was done without any paresthesia or pain and there were no special events during operation. Postoperative pain was controlled by fentanyl, ropivacaine and saline through epidural catheter for 2 days.When the epidural catheter was removed, the patient complained of both legs weakness and hypoesthesia.On the 4th day after surgery, she gained normal sensation and motor function of left leg but was still unable to move and sense her right leg without medial side of femur. She dragged her right feet.MRI of the lumbarsacral spine showed no evidence of a lesion in the spinal cord.Electomyographic study (EMG) performed 25 days after surgery showed incomplete right sciatic nerve lesion.She received persistent physical therapies and put a ankle brace.Four months after surgery she had made a recovery but not full yet.
Adult ; Amides ; Analgesia ; Anesthesia ; Anesthesia, Epidural ; Animals ; Ankle ; Anniversaries and Special Events ; Catheters ; Cesarean Section ; Female ; Femur ; Fentanyl ; Humans ; Leg ; Membranes ; Pain, Postoperative ; Paresthesia ; Pregnancy ; Rupture ; Sciatic Nerve ; Sciatic Neuropathy ; Sensation ; Spine

PURPOSE: To find the risk factors associated with coronory artery lesions, non-responsiveness to intravenous immunoglobulin(IVIG) treatment, and recurrences in Kawasaki disease patients. METHODS: We retrospectively analyzed 1,000 Kawasaki disease patients who were admitted to Yonsei University Medical Center from September 1990 to December 2003. We compared between responder and non-responder groups to IVIG treatment as well as between relapsed and non-relapsed groups, and as to the relapsed group, we also compared variables between patients in their first and second attack states. Finally, factors associated with longer-fever duration from disease onset were evaluated. RESULTS: Longer fever durations before and after IVIG treatment, male sex, lower Hgb and Hct level, higher WBC count and segmented WBC proportion, and higher CRP and Harada's score were related with coronary artery lesions. Non-responsiveness was related to higher WBC count, segmented WBC proportion, CRP, SGPT, Harada's score, and pyuria. Moderate-to-severe coronary artery dilatations and recurrences were more commonly seen among the non-responder group. No significant predictive factors for recurrence were found. In the relapsed group, lower WBC count, CRP, and shorter fever duration from disease onset were observed in their second attack state. Fever duration from disease onset showed positive correlation with WBC count, CRP, and Harada's score and negative correlation with Hgb levels. CONCLUSION: Higher WBC count, CRP, and higher Harada's score were related to both higher incidences of coronary artery lesions and non-responsiveness to IVIG treatment, and these factors were also related with longer fever duration. Non-responders to IVIG treatment showed higher recurrence rate and more moderate-to-severe coronary artery dilatations than responders.
Academic Medical Centers ; Alanine Transaminase ; Arteries ; Coronary Vessels ; Dilatation ; Fever ; Humans ; Immunoglobulins, Intravenous ; Incidence ; Male ; Mucocutaneous Lymph Node Syndrome* ; Pyuria ; Recurrence ; Retrospective Studies ; Risk Factors ; Treatment Failure ; Treatment Outcome