This study was conducted to evaluate the postnatal changes of serum creatine kinase (CK) and its isoenzymes in normal and asphyxiated newborns. In normal newborns total CK, CK-MM and CK-MB reached a plateau between 2 and 24 hr after birth whereas the serum CK-BB remained stable after birth. CK-MM, CK-MB and CK-BB respectivily composed 90~94%, 5~7% and 1~5% of total CK during study period. In asphyxiated newborns total CK, CK-MM and CK-MB reached maximal value at 12 hr after birth whereas CK-BB decreased after birth. There were no significant differences between normal and asphyxiated newborns in total CK, CK-MM and CK-MB during study period (up to 24 hrs after birth). But CK-BB of asphyxiated newborn was elevated significantly (p<0.05) within 6 hrs after birth compared to normal newborns. There were no significant differences of CK and its isoenzymes between patients evaluated by 5 min Apgar scores(0~3, 4~6 and 7~10) or degree of HIE (HIE stage 0~I, II and III). According to these results, the serum CK-BB is elevated in asphyxiated newborns during 1st 6hrs after birth but has no predictive values of the extent of cerebral damage.
Creatine Kinase* ; Creatine* ; Humans ; Infant, Newborn* ; Isoenzymes ; Parturition

Churg-Strauss syndrome is one of idiopathic, systemic necrotizing vasulitides and characterized by a history of asthma or allergic rhinitis, eosinophilia of peripheral blood and variable symptoms of the systemic vasculitis. This is a case report of classical Churg-Strauss syndrome in a 6- year-old male who has the multiple mononeuropathy as a symptom of the systemic vasculitis. The sural nerve biopsy showed a few myelin digestion chambers suggesting axonal degeneration which was not suspected on the electrophysiological study, and the specimen of right gastrocnemius muscle revealed the typical pathological findings of eosinophilic infiltration, extravascular granuloma and necrotizing small vessel vasculitis. The therapeutic response of cyclophosphamide looked better than the oral prednisolone treatment only.
Asthma ; Axons ; Biopsy ; Churg-Strauss Syndrome* ; Cyclophosphamide ; Digestion ; Eosinophilia ; Eosinophils ; Granuloma ; Humans ; Male ; Mononeuropathies ; Muscle, Skeletal ; Myelin Sheath ; Prednisolone ; Rhinitis ; Sural Nerve ; Systemic Vasculitis ; Vasculitis

Anthracycline drugs are chemotherapeutic agents highly effective against a wide range of neoplasms. However, its administration may be complicated by cardiotoxic reactions. There is a continuum of increasing risk with increasing total dose of drug rather than an absolute cutoff point for total dose drug of that should not be exceeded under any circumstances. At the present time it appears that a potentially important clinical application of Doppler echocardiography would be the noninvasive evaluation of global ventricular function. To assess the value of serial Doppler echocardiography in detecting early signs of anthracycline cardiotoxicity in children, we studied 50 patients (35 male and 15 female children, age range 1.6 to 20 years) admitted to the Department of Pediatrics in the Kyungpook National University Hospital for treatment of neoplasia between July 20, 1988 and April 20, 1991 prospectively. Eight three Doppler echocardiograms were performed prior to and at intervals after receiving varying doses of anthracycline and aortic velocity, acceleration time (AT), ejection time (ET), ratio at AT to ET (AT/ET), acceleration and velocity time integral, and mitral velocity of E and A waves and velocity time integral were measured. Pretreatment parameters were not differ from those of normal age matched control children. The aortic AT/ET showed significant increase with increase in anthracycline dosage, being a mean (+/-SD) of 0.30+/-0.07 in the pretreatment group, 0.33 (+/-0.09) after 100 mg/M2 (p<0.001) but the mitral E/A peak velocity ratio showed significant decrease, being a mean (+/-SD) of 1.47 (+/-0.26) in the pretreatment group and 1.36 (+/-0.09) after 400mg/M2(p<0.05). We could not reliably ascertain the relationship between Doppler echocardiographic changes and development of anthracycline cardiomyopathy but these preliminary data show that Doppler echocardiography may detect incremental changes in left ventricular function in anthracycline cardiomyopathy. It is hoped that further study at higher dose levels in large populations for a sufficient follow up time will identify those patients with a risk of developing cardiomyopathy and then manage them appropriately.
Acceleration ; Cardiomyopathies ; Child* ; Echocardiography* ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Gyeongsangbuk-do ; Hope ; Humans ; Male ; Pediatrics ; Prospective Studies ; Ventricular Dysfunction, Left* ; Ventricular Function ; Ventricular Function, Left

No abstract available.
Cardiac Output* ; Ultrasonography*

To study the site of release and factors affecting the release of the atrial natriuretic peptide(ANP) in the pediatric patients, we measured the plasma ANP concentrations in 23 normal healthy children, 19 patients with congestive heat failure and 16 patients with cardiac disease undergoing diagnostic cardiac catheterization. The following results were obtained. 1) The plasma ANP concentrations of the vein(226.3(74.9pg/ml)in patients with congestive heart failure were significantly higher than those(p<0.01)of the mormal healthy children(13.4 (7.9pg/ml)and those(43.3 40(.7pg/ml)in patients undergoing cardiac catheterization. The plasma ANP concentrations of the femoral vein in patients undergoing cardiac catheterization were also significantly higher than that of the peripheral vein in the normal healthy children(p<0.01). 2) The plasma ANP concentrations of the pulmonary artery(110.9( 80.7pg/ml)were 2 to 3 times higher than that of the femoral vein(43.3( 40.3pg/ml, p<0.01). However there were no significant differences of the plasma ANP concentrations between pulmonary artery and aorta(65.4 (36.1pg/ml),and between aorta and femoral vein. 3) There was a significant correlations of the plasma ANP concentrations vetween pulmonary artery and femoral vein, and pulmonary artery and aorta, but no correlation of those between femoral vein and aorta. 4) The plasma ANP concentrations of the vein were over 3 times more higher in cases of left atrial area over 20 cm2/M2 measured by 2-dimensional echocardiography(213.2 (292.9pg/ml)than those in cases of left atrial area under 20(65.0 66.9pg/ml, p<0.05). The plasma ANP concentrations of the vein were over 3 times more highger in cases of left atrial area over 20 cm2/M2(88.6(19.1pg/ml) than those in cases of left atrial area under 14(57.1 (39.5pg/ml,p<0.05), and in cases of the sum of both atrial mean pressure over 11mmHg(189.5( 42.8pg/ml) than those in cases of the sum under 11(79.3 (52.3pg/ml, p<0.01). The plasma ANP cocentrations of the aorta were significantly higher in cases of left atrial area over 14 cm2/M2(88.6 (19.1pg/ml)than those in cases of left atrial area under 14(57.1 (39.5pg/ml;p 0.05), in cases of the sum of both atrial area over 25cm2/M2(93.9 (21.7pg/ml)those in cases of the sum under 25(46.6 (33.8pg/ml, p<0.01), in cases of sum of mean atrial pressure over 11 mmHg(90.5 (30.3pg/ml)than those in cases of under 11(53.8( 24.6pg/ml, p<0.05),in cases of the sum of both atrial wall stress over 190 mmHg.cm2/M2(101.4 (23.5pg/ml) than those in cases of the sumunder 190(57.5 (26.4pg/ml, p<0.01), and also in cases of pulmonary artery mean pressure over 20mmHg(83.3( 18.2pg/ml) than those in cases o pulmonary artery under 20(47.8( 39.8pg/ml, p<0.05). In conclusion, the plasma ANP concentrations of the pulmonary artery were significantly higher than those of the frmoral vein and the aorta, which indicater that the ANP is predominantly secreted via coronary sinus into the right atrium. The plasma ANP concentrations of the peripheral and femoral vein, the pulmonary artery and the aorta, especially that of the aorta, correlated well with the atrial pressure, the area and the wall stress. This suggests that the arterial blood may be the most appropriate sample for measurement of the ANP.
Aorta* ; Atrial Natriuretic Factor ; Atrial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Child* ; Coronary Sinus ; Estrogens, Conjugated (USP) ; Femoral Vein ; Heart Atria ; Heart Diseases ; Heart Failure ; Hot Temperature ; Humans ; Plasma* ; Pulmonary Artery* ; Veins*

PURPOSE: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding pseudoaneurysms after pancreaticoduodenectomy. METHOD: The medical records of 905 consecutive patients who underwent pancreaticoduodenectomies between October 1994 and February 2007 were reviewed retrospectively. In 27 cases with hemorrhagic complications, pseudoaneurysms were diagnosed as the main cause of bleeding. The clinical characteristics, course, management, and outcomes were reviewed. RESULT: In 27 cases (3.0%) of the 905, the bleeding pseudoaneurysms were diagnosed by angiography, during surgery or clinically. In 11 cases, the hemorrhage was from the pseudoaneurysm on the ligated gastroduodenal artery-stump, in five it was from the right hepatic artery, in four from the proper hepatic artery or common hepatic artery, and two from the right gastric artery. Twelve cases had pancreatic leakage. Sentinel bleedings were observed in 21 cases, there were 11 cases of bleeding from the surgical drains, eight cases from the GI tract, and in two cases from both. In 23 cases, arterial embolization was attempted and 18 cases were successful. Four cases had secondary pseudoaneurysmal bleeding. After embolization at the common or proper hepatic artery, six cases had liver abscess or infarction and there was one case of hepatic failure. CONCLUSION: Delayed massive hemorrhage after pancreaticoduodenectomy should be ruled out to determine whether it is associated with an arterial pseudoaneurysm rupture. Transcatheter arterial embolization is an effective modality for control of the bleeding from an arterial pseudoaneurysm.
Aneurysm, False* ; Angiography ; Arteries ; Gastrointestinal Tract ; Hemorrhage* ; Hepatic Artery ; Humans ; Infarction ; Liver Abscess ; Liver Failure ; Medical Records ; Pancreaticoduodenectomy* ; Retrospective Studies ; Rupture

PURPOSE: The aim of this study is to compare the quality of chest compressions between cardiopulmonary resuscitation (CPR) performed by a single trained rescuer and two rescuer CPR performed by a trained rescuer and an untrained rescuer in a prolonged out-of-hospital CPR scenario. METHODS: For the phase I experiment, thirty-six emergency medical technician students (trained rescuers) were asked to perform 10 minutes of lone rescuer CPR on an instrumented manikin. For the phase II experiment, thirty-six volunteers with no previous CPR training (untrained rescuers) were recruited. Each untrained rescuer was randomly assigned to one trained rescuer. They were asked to perform 10 minutes of two rescuer CPR during the phase II experiment. RESULTS: During phase I, the percent of correct compressions diminished over time. The number of total compressions attempted for 10 minutes was increased significantly in phase II (786+/-50 versus 689+/-50 in phase I, p<0.01). However, the mean percentage of correct compressions for 10 minutes did not show a significant difference between phases (66+/-34% in phase I versus 64+/-22% in phase II). The duration of chest compression interruption was significantly reduced in phase II (3.0+/-0.4 versus 3.5+/-0.5 min in phase I, p<0.01). CONCLUSION: The quality of two rescuer CPR performed by a trained rescuer and an untrained rescuer was comparable to that of lone rescuer CPR performed by a single trained rescuer in a 10-min CPR scenario. When CPR goes on for a prolonged period, changing the person doing the chest compressions to an untrained rescuer may improve the quality of CPR.
Cardiopulmonary Resuscitation ; Emergency Medical Technicians ; Fatigue ; Humans ; Manikins ; Thorax

BACKGROUND/AIMS: It is difficult to clinically and endoscopically differentiate intestinal tuberculosis (ITB) and Crohn's disease (CD). The aim of this study was to evaluate the usefulness of in vitro interferon-gamma (INF-gamma) assay for differential diagnosis between ITB and CD. METHODS: Sixty patients for whom differential diagnosis between ITB and CD was difficult were enrolled between January 2007 and January 2009. The INF-gamma-producing T-cell response to early secreted antigenic target 6 and culture filtrate protein 10 were measured by T-SPOT.TB blood test in vitro. We evaluated the usefulness of T-SPOT.TB blood test by comparing its results with the final diagnosis. RESULTS: Twenty and forty patients were revealed to be positive and negative in T-SPOT.TB blood test, respectively. Of the 20 patients found to be positive, 12 patients (60%) were finally diagnosed as ITB, 6 patients as CD, and 2 patients as Behcet's enterocolitis. Of the 40 patients with negative results, 38 patients (95%) were diagnosed as CD; one as Behcet's enterocolitis; one as nonspecific colitis; none as ITB. The sensitivity and specificity of T-SPOT.TB blood test for ITB were 100% and 83.3%, respectively. Positive and negative predictive values of T-SPOT.TB blood test for ITB were 60.0% and 100%, respectively. CONCLUSIONS: When differential diagnosis between ITB and CD is difficult, T-SPOT.TB blood test may be a helpful and rapid diagnostic tool to exclude ITB. Prospective large-scaled studies are required for further evaluation of the usefulness of T-SPOT.TB blood test for differential diagnosis between ITB and CD.
Adolescent ; Adult ; Aged ; Crohn Disease/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Interferon-gamma/*blood ; Male ; Middle Aged ; Polymerase Chain Reaction ; Reagent Kits, Diagnostic ; Retrospective Studies ; Tuberculosis, Gastrointestinal/*diagnosis

PURPOSE: The proper reconstruction technique to use after a distal subtotal gastrectomy for a gastric carcinoma, there has been a subject for debated what is the proper reconstruction technique. The aim of this study was to compare the gastric- emptying time and the quality of life following both B-I and B-II reconstructions after a distal gastrectomy for a gastric adenocarcinoma. MATERIALS AND METHODS: We studied 122 patients who had undergone a distal gastrectomy for a gastric adenocarcinoma between June 1999 and July 2002 at our hospital. 51 patients underwent B-I group, and 71 patients underwent B-II group. To evaluate the gastric-emptying time, we analyzed the T1/2 time by means of radionuclide scintigraphy using a gamma camera after ingestion of an (99m)Tc-tin-colloid steamed egg. The nutritional status was measured by the weight change. Postgastrectomy syndrome was evaluated using an abdominal symptoms survey. Dumping syndrome was measured using the Sigstad dumping score. RESULTS: The gastric-emptying time was somewhat delayed in the B-I group after a 6 month period, but there was no difference after 12 months between the two groups. There was less weight loss in the B-I group than in the B-II group (P=0.023). Fewer abdominal symptoms were occurred in the B-I group than in the B-II group. Dumping syndrome occurred less frequently in the B-I group than in the B-II group (P=0.013). CONCLUSION: In our study, the Billroth I reconstruction led to less weight loss, a better nutritional status, and a better quality of life than the Billroth II reconstruction. We concluded that after a distal subtotal gastrectomy, the Billroth I reconstruction would be considered when the procedure is oncologically suitable.
Adenocarcinoma ; Dumping Syndrome ; Eating ; Gamma Cameras ; Gastrectomy ; Gastroenterostomy* ; Humans ; Nutritional Status ; Ovum ; Postgastrectomy Syndromes ; Quality of Life ; Radionuclide Imaging ; Steam ; Stomach Neoplasms ; Weight Loss

PURPOSE: Buerger's disease (Thromboangiitis obliterans, TAO) is characterized by non- atheromatous inflammatory disease, and segmental inflammatory thrombotic occlusions of the small & middle-sized arteries and veins of the upper or lower extremities. Any epidemiological study of Buerger's disease in Korea has not been carried out until now. This study was undertaken to investigate the incidence of Buerger's disease in Korea among the patients suffering with arterial disease. METHODS: We collected and analyzed the data on 11,128 patients who were admitted to or visited the participating 22 hospitals for chronic arterial diseases throughout the major region of the South Korea from January 1986 to December 2003. The clinical diagnostic inclusion criteria for Buerger's disease were the followings: (1) a history of smoking or tobacco abuse; (2) an age of onset less than 50 years; (3) infrapopliteal, segmental arterial occlusions with sparing of the proximal vasculature; (4) frequent distal upper extremity arterial involvement (Raynaud's syndrome or digital ulceration) or-superficial phlebitis; and (5) the absence of arteriosclerotic risk factors other than smoking. RESULTS: The incidence rate of Buerger's disease among the arterial disease (11,128 patients) was 93 patients (0.83%) when the strict criteria of Shionoya was applied. 699 male-patients (6.55%) and 30 female patients (4.12%) who met the less strict criteria (the extended clinical diagnostic criteria group) were also reviewed. The 4th and 5th decades were the most common ages with-249 patients (34.2%) and 222 patients (30.5%) respectively, being found at these ages. The mean age was 40.4+/-1.6 years (age range: 16~83 years) and this was similar in both the strict criteria group and the less strict criteria group. CONCLUSIONS: This study suggests there was a low incidence of Buerger's disease in Korea among the patients who visited the participating hospitals when the strict diagnostic criteria were used. The incidence was lower than expected even when the less strict criteria were used. The more accurate incidence of Buerger's disease among the general population can be obtained by performing careful prospective study that is participated in by not only vascular surgeons, but also the other medical specialists with utilizing the strict diagnostic criteria.
Age of Onset ; Arteries ; Epidemiologic Studies ; Female ; Humans ; Incidence ; Korea* ; Lower Extremity ; Phlebitis ; Risk Factors ; Smoke ; Smoking ; Specialization ; Thromboangiitis Obliterans* ; Tobacco ; Upper Extremity ; Veins