Primary pulmonary hypertension is a rar, incurable, and progressive clinical entity. When associated with pregnancy, the prognosis of primary pulmonary hypertension is worsened with maternal mortality rates of at least 50%. The patient was a 29-year-old mother in her 2nd pregnancy, with previous uncomplicated gestation, 5 years ago. She had been well until the 28th week of present gestation when she was admitted because of increasing dyspnea on exertion. She was a housewife with no remarkable family and past histories. We have experienced a patient with primary pulmonary hypertension in pregnancy. She was treated with an oral calcium-channel blocker and low-molecular-weight heparin and was delivered vaginally with good maternal and fetal outcome. So we report a case of primary pulmonary hypertension associated with pregnancy and review literature.
Adult ; Dyspnea ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension, Pulmonary* ; Maternal Mortality ; Mothers ; Pregnancy* ; Prognosis

OBJECTIVE: This study was to change of pulp blood flow among maxillary and mandibular anterior tooth with mild crowding and adjacent teeth using Ultrasound Doppler graphy. METHODS: The change of pulp blood flow was measured three times using Ultrasound Doppler graphy; before the attachment of brackets, after 3 week, and after 6 week. The sample consists of 15 year old eighteen patients. RESULTS: Before the attachment of brackets, after 3 weeks, and after 6 weeks, there were no significant differences in the change of pulp blood flow in each part (maxilla and mandible) and each tooth according to period. In addition, to compare internal dangerousness of loss of the pulp vitality, when pulp blood flow is compared in each tooth before orthodontic treatment, there were no statistically significant differences in maxillary lateral incisor and mandibular canine but it showed low values in all measurement items (p > 0.05). CONCLUSIONS: Results of this study can be not only methodological preliminary data in further study such as tooth movement type of Ultrasound Doppler graphy and particular study considered the patient age, but also reference materials for the loss of pulp vitality in orthodontic treatment.
Crowding ; Dangerous Behavior ; Humans ; Incisor ; Tooth ; Tooth Movement

The gene for tyrosinase has been mapped to the long arm of chromosome 11 at 11q14-21. The gene is at least 50Kb in length and its coding region is divided into five exons. Until now several mutations of the tyrosinase gene have been identifed in patient with typical oculocutaneous albinism (OCA) who are responsible for tyrosinase negative OCA. It may be possible to determine the types of OCA by measuring the hairbulb tyrosinase activity. Hairbulb tyrosinase activity was examined in a Korean albino to determine the type of OCA. And also tyrosinase assay was carried out in normally pigmented individuals and all members of a Korean albino's family to examine the tyrosinase activities. Five exons of tyrosinase gene from a Korean albino were amplified by polymerase chain reaction. Each amplified exon segments were independently subcloned and DNA sequences of clones were determined. The results obtained were as follows : 1. A Korean albino had no measurable hairbulb tyrosinase activity and was identified as type IA (tyrosinase negative) oculocutaneous albinism. 2. Normally pigmented individuals had different ranges of hairbulb tyrosinase activity. 3. A Korean albino had two single base insertions within exon V (between 337bp and 338bp, 353bp and 354bp) of tyrosinase gene. These insertional mutations might disrupt tyrosinase function and were associated with a total lack of melanin biosynthesis.
Albinism* ; Albinism, Oculocutaneous ; Arm ; Base Sequence ; Chromosomes, Human, Pair 11 ; Clinical Coding ; Clone Cells ; Exons ; Humans ; Melanins ; Monophenol Monooxygenase* ; Polymerase Chain Reaction

BACKGROUND: Shivering during spinal anesthesia is a frequent complication and is induced by the core-to-peripheral redistribution of heat. Nefopam has minimal side effects and prevents shivering by reducing the shivering threshold. Electroacupuncture is known to prevent shivering by preserving the core body temperature. We compared the efficacies of electroacupuncture and nefopam for the prevention of shivering during spinal anesthesia. METHODS: Ninety patients scheduled for elective urological surgery under spinal anesthesia were enrolled in the study. Patients were randomly divided into the control group (Group C, n = 30), the electroacupuncture group (Group A, n = 30), and the nefopam group (Group N, n = 30). Groups C and A received 100 ml of isotonic saline intravenously for 30 minutes before spinal anesthesia, while Group N received nefopam (0.15 mg/kg) mixed in 100 ml of isotonic saline. Group A received 30 minutes of electroacupuncture before receiving anesthesia. Shivering scores, mean arterial pressure, heart rate, body temperature and side effects were recorded before, and at 5, 15, 30, and 60 minutes after spinal anesthesia. RESULTS: The incidence of postanesthetic shivering was significantly lower in Group N (10 of 30) and Group A (4 of 30) compared with that in Group C (18 of 30)(P < 0.017). Body temperature was higher in Group N and Group A than in Group C (P < 0.05). Hemodynamic parameters were not different among the groups. CONCLUSIONS: By maintaining body temperature during spinal anesthesia, electroacupuncture is as effective as nefopam in preventing postanesthetic shivering.
Anesthesia ; Anesthesia, Spinal* ; Arterial Pressure ; Body Temperature ; Electroacupuncture* ; Heart Rate ; Hemodynamics ; Hot Temperature ; Humans ; Incidence ; Nefopam* ; Shivering*

BACKGROUND: Immunoglobulin A nephropathy (IgAN) and thin glomerular basement membrane nephropathy (TBMN) are the most common causes of persistent hematuria during childhood. The objective of this study is to determine the difference in clinicl features and laboratory findings between pediatric patients with IgA deposited TBMN and IgAN alone. METHODS: Between January 2000 and March 2009, 95 children were diagnosed with IgAN by renal biopsy. Clinical features and laboratory findings of patients with isolated IgAN and with IgAN plus TBMN were compared; the children diagnosed with IgAN were compared to 127 children who had been diagnosed with TBMN alone during the same period. RESULTS: There were 71 (74.7%) of a total 95 patients that were diagnosed with isolated IgAN (Group 1); in 24 (25.3%) of the 95 patients IgAN was combined with TBMN (Group 2). There was marked difference in the gender distribution between Group 2 and isolated TBMN patients. The degree of proteinuria and pathologic severity was higher in Group 1 compared with Group 2. Gross hematuria was present in both groups. There were no distinguishing features in the other laboratory parameters. CONCLUSION: Patients with both IgAN and TBMN seem to have similar clinical features to patients with isolated IgAN; however, the latter tend to have better pathologic and laboratory findings, compared to the patients with IgAN alone.
Biopsy ; Child* ; Glomerular Basement Membrane* ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Proteinuria

Common variable immunodeficiency (CVID) is a heterogenous syndrome characterized by hypogammaglobulinemia, various immunologic abnormalities and recurrent bacterial infections. Associated immunologic abnormalities consists of various kinds of autoimmune diseases and lymphoproliferative disorders. The lymphoproliferative disorder take several forms, such as malignant lymphoma, atypical lymphoid hyperplasia, and beniegn lymphoid hyperplasia. Lymphocytic interstitial pneumonia (LIP), which is a kind of atypical lymphoid hyperplasia, develop in young age groups and has controversy on its clonality. We experienced a 14-year-old female patient with LIP and CVID. We analysed the third complementarity-determining region (CDR3) of the immunoglobulin heavy chain gene for clonality analysis. Clonality analysis of lung biopsy specimen revealed that 6 of 13 colony and 4 of 13 colony have identical sequences respectively. We speculate that one of these 2 lymphoid cell clone may develop into malignant lymphoma in the future.
Adolescent ; Agammaglobulinemia ; Autoimmune Diseases ; Bacterial Infections ; Biopsy ; Clone Cells ; Common Variable Immunodeficiency* ; Complementarity Determining Regions ; Female ; Humans ; Hyperplasia ; Immunoglobulin Heavy Chains ; Lip ; Lung ; Lung Diseases, Interstitial* ; Lymphocytes ; Lymphoma ; Lymphoproliferative Disorders

OBJECTIVE: Incompetent internal os of cervix is one of the most common causes of midtrimester abortion in which interventions such as, transvaginal cerglage and transabdominal cervicoisthmic cerclage (TCIC) have been performed to prolong pregnancy. Transabdominal cerclage is beneficial in treating patients with cervices that are either extremely short, congenitally deformed, deeply lacerated after operative delivery, or markedly scarred because of previously failed transvaginal cerclage procedures. Due to technical difficulties and the fact that a cesarean section is necessary for delivery, has not been a procedure easily adopted. The purpose of our study was to compare the effectiveness of selected Modified McDonald cerclage (MTVC) and TCIC was compared in patients who had history of a previously failed transvaginal cerclage in other hospital. MATERIALS AND METHODS: Pregnancy outcomes of 13 patients who underwent TCIC from November 1997 to January 2002 and those of 28 patients who underwent MTVC from January 2000 to January 2002 were compared. Statistical analysis was done using Chi-square test and Mann-Whitney. RESULTS: The fetal salvage rates for total 13 cases of TCIC and 28 cases of MTVC were 100% (13/13) and 85.7% (24/28), respectively. The fetal salvage rates between these two groups were not statistically different. The mean gestational age at the time of operation in TCIC group was 13.15 (+/-1.63) weeks, mean gestational weeks delayed until delivery was 23.85 (+/-3.24) weeks and mean fetal body weight was 2780.77 (+/-667.33) gm. Comparably, the mean gestational age at the time of operation in MTVC group was 15.00 (+/-2.05) week, mean gestational weeks delayed until delivery was 9.96 (+/-6.65) week and mean fetal body weight was 2530 (+/-1071.26) gm. CONCLUSION: In patients who had a history of failure of TVC, the effectiveness of TCIC and MTVC had no statistical significance. Treatment with MTVC should be considered since TCIC is technically difficult and requires cesarean section.
Cervix Uteri* ; Cesarean Section ; Cicatrix ; Female ; Fetal Weight ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second

Cholelithiasis in infancy is a rare disorder. A number of conditions that occur in the neonatal period predispose to the development of cholelithiasis. Cholelithiasis is more marked in the premature than adult, because of the immaturity of the enterohepatic circulation of bile acids which renders the newborn more susceptible to the cholestatic effect of total parenteral nutrition (TPN). Parenteral nutrition associated cholelithiasis is the major indication for cholecystectomy in the pediatric age group because of severe complication, but a number of recent studies report spontaneous resolution of the stones. We report a case of a female infant with cholelithiasis diagnosed by ultrasonogram at 88 days of age which is probably induced by prolonged lack of enteral feeding and TPN.
Adult ; Bile Acids and Salts ; Cholecystectomy ; Cholelithiasis* ; Enteral Nutrition* ; Enterohepatic Circulation ; Female ; Humans ; Infant ; Infant, Newborn ; Parenteral Nutrition ; Parenteral Nutrition, Total* ; Ultrasonography

Phenytoin is an anticonvulsant compound which modulates the voltage-dependent sodium channels. It has a neuroprotective effect in vitro against hypoxic damage in hippocampal slices of adult rats. The authors studied the efficacy of phenytion on cerebral ischemia in an vivo model of hypoxic-ischemic brain injury in developing rat brain. To elicit injury, 7 days old(P7) Sprague-dawley rats subjected to right common carotid ligation followed by 8% O2 exposure(humidified, balanced with nitrogen) for 3 hours under the halothane anesthesia(control group, N=58). Body temperature of the rats was accurately controlled before and during hypoxia. Before hypoxia, pups received intraperitoneal phenytoin(30mg/kg)(phenytoin-treated group, N=17). The animals were sacrificed one week later and histopathological evaluation of ischemic neuronal damage were conducted employing hematoxylin-eosin staining and measurement of the hemispheric weight differences were performed. Phenytoin was found to be effective in reducing neuronal damage in terms of weight comparison(24+/-2.4% atrophy of control vs. 5+/-2.9% atrophy of phenytoin group, p<0.001) and ischemic changes in hippocampal region(p<0.05 in CA1, CA2, and CA3 area). These data suggest that compounds like phenytoin, which modulates voltage-dependent sodium channels, can reduce the degree of injury from hypoxic-ischemic insults to the developing rat brain.
Adult ; Animals ; Anoxia ; Atrophy ; Body Temperature ; Brain Injuries ; Brain Ischemia ; Brain* ; Halothane ; Humans ; Ischemia ; Ligation ; Neurons ; Neuroprotective Agents* ; Phenytoin ; Rats* ; Rats, Sprague-Dawley ; Sodium Channels

Cryptococcosis commonly affects patients with immune dysfunction, as in the case of immunosuppression in organ transplant patients or as acquired immunodeficiency syndrome in patients afflicted with human immunodeficiency virus. The varied appearance of cryptococcal skin lesion makes clinical diagnosis of cutaneous cryptococcosis difficult. Cryptococcosis proves to be a fatal fungal infection in the immunocompromised patient. Therefore, diagnosis and early treatment of cryptococcosis become vital. A 56-year-old renal transplant recipient, with an ongoing immunosuppression regimen of cyclosporine, prednisolone, and mycophenolate mofetil, was admitted with a 2-week history of pain and edema of right arm without respiratory symptoms. Despite empiric antibiotic therapy, the patient continued to complain of severe tenderness of the involved arm and fever persisted as well. On the third day of hospital stay, a biopsy of the erythematous skin lesion was acquired. On the eighth day of hospital stay, results of both skin biopsy and blood cultures showed the presence of Cryptococcus neoformans. The treatment was begun with intravenous fluconazole (400 mg/day). After 4 days of antifungal treatment, the patient developed fever along with cough with purulent sputum. As the new developing symptoms were suggestive of pneumonia, especially of pulmonary cryptococcosis, the antifungal agent was changed from fluconazole to amphotericin B treatment (0.8 mg/kg, 50 mg/day). Chest computer tomography showed improvement in the pneumonic infiltration and consolidation after 4 weeks of amphotericin B treatment. In conclusion, cellulitis in immunocompromised patients should be suspected in case of highly atypical infectious etiology, and skin biopsy should not be delayed if empiric antibiotic therapy does not control the inflammatory response. Additionally, the patient should be treated with intravenous amphotericin B treatment in case of severe cryptococcosis.
Acquired Immunodeficiency Syndrome ; Amphotericin B ; Arm ; Biopsy ; Cellulitis ; Cough ; Cryptococcosis ; Cryptococcus neoformans ; Cyclosporine ; Edema ; Fever ; Fluconazole ; HIV ; Humans ; Immunocompromised Host ; Immunosuppression ; Kidney Transplantation ; Length of Stay ; Middle Aged ; Mycophenolic Acid ; Pneumonia ; Prednisolone ; Skin ; Sputum ; Thorax ; Transplants