We investigated the distribution of medical service uses for Bell’s palsy and Ramsay Hunt syndrome between medicine and traditional Korean medicine using the National Health Insurance Service National Sample Cohort data of Korea from 2006 to 2015. Patients were identified with diagnostic codes and medication or treatment claim codes. For Bell’s palsy, there were 5,970 (68.8%) patients who used traditional Korean medical service only, whereas for Ramsay Hunt syndrome, there were 749 (93.6%) patients who used medical service only.The proportion of traditional Korean medical service use was higher than that of medical service use in patients with Bell’s palsy, while the opposite was found in patients with Ramsay Hunt syndrome.

BACKGROUND: It is known that bupivacaine induce cell death in several immortalized cells. However, there is no report concerning bupivacaine-induced cell death in the primary cultured cardiomyocytes. We compared the direct cytotoxicity of local anesthetics in cardiomyocytes. Furthermore, the mechanisms of cell death were evaluated. METHODS: The myocardial cells of rat pups were cultured 3 days after seeding. The methyltetrazolium (MTT) assay was employed to quantify differences in cellular viability. To confirm apoptosis, Hoechst-propidium iodide staining, DNA fragmentation by electrophoresis and western blot analysis were performed. And to examine the mechanisms of cell death, intracellular calcium and expression levels of mitogen-activated protein kinases (MAPKs) family members were evaluated. RESULTS: Among the local anesthetics under 1 mM concentration for 18 h, only bupivacaine significantly decreased the MTT activity (P < 0.001). Bupivacaine induced cell death in a dose-responsive and time dependent manner. Cell death showed apoptotic characteristics, such as DNA fragmentation, chromatin condensation, decrease of precursor caspase-3 protein level, increased cleaved PARP, and cytochrome C release into the cytoplasm. Bupivacaine phosphorylated three major MAPKs, i.e. extracellular signal-regulated kinases (ERKs), p38 kinase and c-Jun N-terminal kinases (JNKs) stress-activated protein kinases. Administration of ERK inhibitor increase cell death, whereas inhibitors of p38 kinase and JNK decreased cell death (P < 0.05). In addition, the intracellular calcium level was approximately 4 times higher after the bupivacaine treatment (P < 0.001), which was inhibited by calcium chelators (P < 0.001). Calcium chelators inhibited expression of MAPKs. CONCLUSIONS: In bupivacaine-induced apoptosis in cardiomyocytes, intracellular calcium increase and MAPKs family plays important roles.
Anesthetics, Local ; Animals ; Apoptosis* ; Blotting, Western ; Bupivacaine ; Calcium ; Caspase 3 ; Cell Death ; Chelating Agents ; Chromatin ; Cytochromes c ; Cytoplasm ; DNA Fragmentation ; Electrophoresis ; Extracellular Signal-Regulated MAP Kinases ; Humans ; Mitogen-Activated Protein Kinases ; Myocytes, Cardiac* ; p38 Mitogen-Activated Protein Kinases* ; Phosphotransferases ; Protein Kinases ; Rats

BACKGROUND AND OBJECTIVES: Ventricular fibrillation (VF) can inadvertently occur during electrophysiologic study (EPS) or catheter ablation. We investigated the incidence, cause, and progress of inadvertently developed VF during EPS and catheter ablation. SUBJECTS AND METHODS: We reviewed patients who had developed inadvertent VF during EPS or catheter ablation. Patients who developed VF during programmed ventricular stimulation to induce ventricular tachycardia or VF were excluded. RESULTS: Inadvertent VF developed in 11 patients (46.7+/-9.3 years old) among 2624 patients (0.42%); during catheter ablation for atrial fibrillation (AF) in nine patients, frequent ventricular premature beats (VPBs) in one, and Wolff-Parkinson-White (WPW) syndrome were observed in one. VF was induced after internal cardioversion in six AF patients due to incorrect R-wave synchronization of a direct current shock. Two AF patients showed spontaneous VF induction during isoproterenol infusion while looking for AF triggering foci. The remaining AF patient developed VF after rapid atrial pacing to induce AF, but the catheter was accidentally moved to the right ventricular (RV) apex. A patient with VPB ablation spontaneously developed VF during isoproterenol infusion. The focus of VPB was in the RV outflow tract and successfully ablated. A patient with WPW syndrome developed VF after rapid RV pacing with a cycle length of 240 ms. Single high energy (biphasic 150-200 J) external defibrillation was successful in all patients, except in two, who spontaneously terminated VF. The procedure was uneventfully completed in all patients. At a mean follow-up period of 17.4+/-15.5 months, no patient presented with ventricular arrhythmia. CONCLUSION: Although rare, inadvertent VF can develop during EPS or catheter ablation. Special caution is required to avoid incidental VF during internal cardioversion, especially under isoproterenol infusion.
Atrial Fibrillation ; Cardiac Complexes, Premature ; Catheter Ablation ; Catheters ; Electric Countershock ; Electrophysiologic Techniques, Cardiac ; Follow-Up Studies ; Humans ; Incidence ; Isoproterenol ; Prognosis ; Shock ; Tachycardia, Ventricular ; Ventricular Fibrillation ; Wolff-Parkinson-White Syndrome

Down syndrome (DS) is associated with a higher incidence of leukemia than general population; the subtype is acute megakaryoblastic leukemia (AMKL) in 50% of cases. DS is also strongly associated with transient myeloproliferative disorder (TMD), which is usually diagnosed during newborns and infants. Due to its difficulty in distinguishing TMD from acute leukemia (AL), the diagnosis of TMD should be made with extreme caution. Unlike AL, most cases of TMD resolve spontaneously within 3 months; blast cells disappear within 8 weeks in 80% and within 10 weeks in 90% of the surviving patients. Some infants with TMD, however, may have a severe complication leading into life-threatening clinical course with hepatosplenomegaly, lymphadenopathy, liver impairment, respiratory distress, anemia, infection and hemorrhage. Rarely, AL can develop after remission of TMD. We report a case of TMD with DS in newly born infant who presented hepatosplenomegaly on prenatal sonography and improved with exchange transfusion, steroid.
Anemia ; Diagnosis ; Down Syndrome* ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Leukemia ; Leukemia, Megakaryoblastic, Acute ; Liver ; Lymphatic Diseases ; Myeloproliferative Disorders*

PURPOSE: To improve survival and/or to avoid radiotherapy, high dose chemotherapy (HDCT) with autologous peripheral blood stem cell transplantation (PBSCT) was given to patients with recurrent or high risk medulloblastoma (MB)/primitive neuroectodermal tumor (PNET) as well as patients younger than 3 years of age. METHODS: Six patients (3 recurrent, 1 high risk, 2 younger than 3 years; 5 MBs and 1 PNET) received single or double HDCT and PBSCT with or without immunotherapy using interleukin-2. Chemotherapeutic regimen in the first HDCT included cyclophosphamide (1,500 mg/m2/ day for 4 days) and melphalan (60 mg/m2/day for 3 days). Chemotherapeutic regimen in the second HDCT included carboplatin (400 mg/m2/day for 3 days), thiotepa (250 mg/ m2/day for 3 days), and etoposide (200 mg/m2/day for 3 days). RESULTS: Nine HDCTs were applied in 6 patients. Three double HDCTs were rescued with peripheral blood stem cells collected during single round leukapheresis. Rapid hematologic recovery occurred in 4 patients. Engraft failure occurred in 1 patient and delayed granulocyte recovery and platelet engraft failure occurred in 1 patient. Three patients who had minimal disease before HDCT had event free survival for 7~18 months after HDCT. Tumor relapsed 8 and 12 months after single HDCT in 2 patients among 3 patients with recurrent MB/PNET. One patient with recurrent MB died due to engraft failure and sepsis. CONCLUSION: HDCT with autologous PBSCT is expected to improve survival of patients with poor prognosis MB/PNET including younger patients less than 3 years. Subsequent trials with larger number of patients and long-term follow-up are needed.
Blood Platelets ; Carboplatin ; Cyclophosphamide ; Disease-Free Survival ; Drug Therapy* ; Etoposide ; Follow-Up Studies ; Granulocytes ; Humans ; Immunotherapy ; Interleukin-2 ; Leukapheresis ; Medulloblastoma ; Melphalan ; Neural Plate* ; Neuroectodermal Tumors* ; Neuroectodermal Tumors, Primitive ; Peripheral Blood Stem Cell Transplantation* ; Prognosis ; Radiotherapy ; Sepsis ; Stem Cells ; Thiotepa

The purpose of our study was to evaluate the dietary intake of kidney transplant recipients (KTRs) and assess oral intake related nutrition problems. Fifty patients who had undergone kidney transplantation were included: 24 males, 26 females. The mean age was 46.8 +/- 11.2 years, height was 161.3 +/- 8.3 cm, and body weight was 60.5 +/- 8.7 kg. We conducted nutrition education based on the diet guideline for KTRs (energy 32 kcal/kg of ideal body weight [IBW], protein 1.3 g/kg of IBW) and neutropenic diet guideline before discharge. Dietary intake of the patients at 1 month after transplantation was investigated by 3-day food records. Body weight and laboratory values for nutritional status and graft function were also collected. Body weight was significantly decreased from admission to discharge. Body weight from discharge to 1 month and 3 months after transplantation was increased but was not significant. Biochemical measurements were generally improved but the number of patients with hypophosphatemia increased. The daily dietary intake of energy and protein was adequate (33.1 kcal/kg, 1.5 g/kg, respectively). However, the dietary intake of calcium, folate, and vitamin C did not meet the Korean Recommended Nutrient Intake of vitamins and minerals (86.8%, 62.4%, and 88.0%, respectively). Patients with low intake of calcium, folate, and vitamin C presented low intake in milk and dairy products, vegetables, and fruits, and these foods were related to restricted food items in neutropenic diet. More attention should be paid on improving quality of diet, and reconsideration of present neutropenic diet guideline is necessary. These results can be used to establish evidence-based medical nutrition therapy guideline for KTRs.
Ascorbic Acid ; Body Weight ; Calcium ; Dairy Products ; Diet ; Education ; Female ; Folic Acid ; Fruit ; Humans ; Hypophosphatemia ; Ideal Body Weight ; Kidney Transplantation ; Kidney* ; Male ; Milk ; Minerals ; Nutrition Therapy ; Nutritional Status ; Transplantation* ; Transplants ; Vegetables ; Vitamins

PURPOSE: There has been a rapid rise in the incidence of thyroid cancer, particularly papillary thyroid microcarcinoma (PTMC). However, there is a lack of consensus of treatment guidelines or follow-up strategies. METHODS: A retrospective analysis of 606 patients who underwent operation due to thyroid cancer from March 2000 to December 2008 was conducted. Of these patients, 587 with pure papillary carcinomas were studied, of whom 392 (67%) presented with PTMC. RESULTS: Only 23% of patients were symptomatic, but 75% of patients were positive using the imaging techniques ultrasonography or positron emission tomography. When the microcarcinoma patient group (G1) was compared with the group of remaining patients (G2), less aggressive operations were chosen for G1. A lobectomy was performed in 63.8% of G1 versus in 14% of G2, and the central compartment neck dissection was omitted in 30% of G1 versus 16% of G2. During the follow-up period (mean 37.9±25.2 months), there were 11 recurrences. Two patients developed contralateral cancers 42 and 49 months after lobectomy. One patient had recurrences on central compartment lymph nodes 34 months post-operatively. Eight patients had lateral neck lymph nodes metastases 13~52 months postoperatively. Three of these eight patients had concomitant central neck lymph node metastases. CONCLUSION: Less aggressive treatments can be chosen for PTMC patients compared to non-PTMC patients. To clarify these results, longer follow up and larger and multi-institutional data are needed.
Carcinoma, Papillary ; Consensus ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms ; Ultrasonography

This study was performed to investigate the association between hair mineral levels and nutrient intakes, age, and BMI in female adults who visited a woman's clinic located in Seoul. Dietary intakes were assessed by food frequency questionnaire and mineral levels were measured in collected hairs, and the relationship between these was examined. The average daily nutrient intakes of subjects were compared to those of the KDRIs, and the energy intake status was fair. The average intake of calcium in women of 50 years and over was 91.35% of KDRIs and the potassium intake was greatly below the recommended levels in all age groups. In the average hair mineral contents in subjects, calcium and copper exceeded far more than the reference range while selenium was very low with 85.19% of subjects being lower than the reference value. In addition, the concentrations of sodium, potassium, iron, and manganese in the hair were below the reference ranges in over 15% of subjects. The concentrations of sodium, chromium, sulfur, and cadmium in the hair showed positive correlations (P < 0.05) with age, but the hair zinc level showed a negative correlation (P < 0.05) with age. The concentrations of sodium, potassium, chromium, and cadmium in the hair showed positive correlations (P < 0.05) with BMI. Some mineral levels in subjects of this study showed significant correlations with nutrient intakes, but it seems that the hair mineral content is not directly influenced by each mineral intake. As described above, some hair mineral levels in female adults deviated from the normal range, and it is considered that nutritional intervention to control the imbalance of mineral nutrition is required. Also, as some correlations were shown between hair mineral levels and age, BMI, and nutrient intakes, the possibility of utilizing hair mineral analysis for specific purposes in the future is suggested.
Adult ; Body Mass Index ; Cadmium ; Calcium ; Chromium ; Copper ; Energy Intake ; Female ; Hair ; Humans ; Iron ; Manganese ; Potassium ; Surveys and Questionnaires ; Reference Values ; Selenium ; Sodium ; Sulfur ; Zinc

PURPOSE: Bone marrow contains many kinds of primitive cells and endothelial progenitor cells that secrete several growth factors. We hypothesized that angiogenesis could be induced by autogenous whole bone marrow stem cell implantation in an animal ischemic limb. METHOD: A chronic ischemic hind limb model was created by encircling the femoral artery with an ameroid constrictor (2 mm inner diameter) in a dog model. About 20 ml of autogenous whole bone marrow stem cells were aspirated from the femur and then injected into ischemic limb muscles. Contralateral limbs injected with 20 ml of normal saline as controls. To assess angiogenic effects, an angiogram and a histologic evaluation were performed at 8 weeks after bone marrow stem cell implantation. RESULT: Imaging analysis of angiograms showed that newly developed capillaries were significantly more plentiful in treated limbs. Mean capillary density in the treated limb group was significantly greater than that in the control group (151+/-11.7 vs 81.5+/-7.2 cap/mm2, respectively, P<0.05), and the proportion of larger diameter (Fig. 6) newly developed capillaries was significantly higher in treated limbs than in control limbs. CONCLUSION: These findings indicated that autogenous whole bone marrow stem cell implantation increases the efficiency of angiogenesis.
Animals* ; Bone Marrow* ; Capillaries ; Dogs ; Extremities ; Femoral Artery ; Femur ; Intercellular Signaling Peptides and Proteins ; Models, Animal* ; Muscles ; Stem Cells*