BACKGROUND: The central physiological derangement of hemorrhagic fever with renal syndrome (HFRS) caused by hantaan virus (HTNV) is a vascular dysfunction, manifested by hemorrhage, impaired vascular tone and increased vascular permeability. Platelet activating factor (PAF), whose actions are mediated through a specific receptor, is a potent bioactive lipid. PAF has diverse biological functions in the vascular system, such as increasing vascular permeability, adhesion of leukocytes to the endothelium and reduction of cardiac output, which result in hypotension and shock. The goal of the present study was to investigate whether PAF is involved in the pathogenesis of HFRS. For this purpose, we evaluated the effect of HTNV on the expression of PAF receptor (PAF-R) and on the activity of PAF-acetylhydrolase (PAF-AH) instead of PAF because PAF is rapidly degraded by PAF-AH in vivo. MATERIALS AND METHODS: To evaluate the expression of PAF-R, we performed reverse-transcription PCR, western blot and FACS analyses using HTNV-infected human umbilical vein endothelial cells (HUVECs) and non-infected (control) HUVECs. In addition, we measured the activity of plasma PAF-AH in HFRS patients and normal healthy persons. RESULTS: The mRNA and protein expression of PAF-R was increased in HTNV-infected HUVECs compared with control HUVECs at 2 and 3 days post-infection (d.p.i.). FACS analysis showed that HTNV induced the surface expression of PAF-R in HUVECs from 2 d.p.i. The activity of plasma PAF-AH was 2.5-fold lower in HFRS patients than in normal healthy persons. CONCLUSION: Increased PAF-R expression by HTNV might increase the responsiveness to PAF in endothelial cells. Reduced PAF-AH activity in the blood of HFRS patients might delay PAF degradation. These results suggest that changes in PAF-R and PAF-AH by HTNV might influence to PAF activity and might be involved in the vascular dysfunction of HFRS.
Blood Platelets ; Blotting, Western ; Capillary Permeability ; Cardiac Output ; Endothelial Cells ; Endothelium ; Hantaan virus ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome ; Human Umbilical Vein Endothelial Cells ; Humans ; Hypotension ; Leukocytes ; Plasma ; Platelet Activating Factor ; Platelet Membrane Glycoproteins ; Polymerase Chain Reaction ; Receptors, G-Protein-Coupled ; RNA, Messenger ; Shock

Ectopic ureteroceles have a broad spectrum of presentation, anatomy and pathophysiology and the management is controversial. Herein, we report our experience of the management in 7 children with 8 ectopic ureteroceles associated with complete duplicated systems. Two functioning upper renal segments were able to be salvaged with ureteropyeIostomy and common sheath ureteral reimplantation. Four small ureteroceles not associated with reflux managed successfully with upper tract correction only(3 heminephrectomy and 1 ureteropyelostomy). Three children with ectopic ureteroceles associated with reflux and/or outlet obstruction underwent successful one stage total reconstruction which included heminephrectomy, ureterectomy, ureterocelectomy and lower pole ureter reimplantation. In summary, the management of ectopic ureterocele must be individualized taking into considerations the salvageability of renal segments, presence of reflux and/or outlet obstruction.
Child* ; Humans ; Replantation ; Ureter ; Ureterocele*

An analytic study on 431 cases of cardiac conduction disturbance has been made by review of the clinical records and electrocardiograms taken from the adult patients registered at Kyung Hee University Hospital for 3 years from May, 1973 to April, 1976. 1. The total incidence of conduction disturbance was 6.50%, the atrioventricular block 3.14% and the intraventricular block was 3.36% of total 6,616 cases of E.C.G. reviewed. Among of these, the first degree atrioventricular block was 3.02% which was the most common occurred one, the incomplete right bundle branch block was 2.25% and the complete right bundle branch block was 0.57%. 2. The ratio of male to female was 1.6:1 for the first degree atrioventricular block, and 1.6:1 for the incomplete right bundle branch block, 2.5:1 for the complete atrioventricular block, 2:1 for the left bundle branch block, and 1.7:1 for the complete right bundle branch block. The first degree atrioventricular block was seen most frequently in the fifth and sixth decade of age group, and the third degree block was over 40 years. The incomplete right bundle branch block in order was forth decade, third decade and fifth decade. The complete right bundle branch block and left posterior hemiblock were common in the sixth decade. The left bundle block and the posterior hemiblock were common in fifty years of age group. 3. The cardinal underlying diseases of the first degree atrioventricular block among cardiac diseases group in order of frequency were: hypertensive heart disease (25.0%) arteriosclerotic heart disease (8.0%) and rheumatic valvular heart disease (5.0%). The most common etiology of those non-cardiac disease group was neuropsychiatry disorder (11.5%) and the next was infection (11.0%). 4. All of the complete atrioventricular block were associated with the cardiac disease, that is, 57.0% with arteriosclerotic heart disease, 28.5% with pericarditis and 14.3% with hypertensive heart disease, respectively. 5. The cardinal underlying disease of the incomplete right bundle branch block in order of frequency were: hypertensive heart disease (10.7%), arteriosclerotic heart disease (8.1%) among the cardiac disease group, and infections (15.4%) among the non-cardiac disease group. The incidence of healthy persons was 14.1%. 6. Those of complete right bundle branch block in order of frequency were: arteriosclerotic heart disease (13.2%), and hypertensive heart disease (10.1%) among the cardiac disease group, and infection(13.2%) and neurosis (10.1%), respectively among the non-cardiac disease group. 7. The major etiologies of the left bundle branch block was hypertensive heart disease and arteriosclerotic heart disease (33.3% each), and that of left posterior hemiblock was showed arteriosolerotic heart disease and cor-pulmonale. The most common etiological disease of the left anterior hemiblock was hypertensive heart disease in cardiac disease group, and infection and gatrointestinal disease in non-cariac disease group. 8. The abnormal electrocardiographic findings with the first degree atrioventricular block were left ventricular hypertrophy (24.8%), sinus tachycardia (11.0) and sinus bradycardia (5.8%). Those with the complete atrioventricular block were right ventricular hypertrophy (15.8%) and left bundle branch block (15.8%). In complete right bundle branch block, the majority (52.5%) showed single sign without other abnormality on E.C.G. In the left bundle branch block, there were 18.9% of left ventricular hypertrophy and 15.7% of first degree atrioventricular block. In the left anterior hemiblock, there were 28.5% of right bundle branch block, and 19.0% of right ventricular hypertrophy. In the left posterior hemiblock, there were 40.0% of atrial fibrillation and 20.0% of left atrial hypertrophy.
Adult ; Male ; Female ; Humans ; Incidence

PURPOSE: We evaluated the efficacy of an endoscopic subureteral injection of polydimethylsiloxane (Macroplastique) for the correction of vesicoureteral reflux in children. MATERIALS AND METHODS: The medical records of 15 children (19 refluxing ureters), who had undergone a single endoscopic subureteral injection of polydimethylsiloxane for the treatment of vesicoureteral reflux, were reviewed. After the injection, voiding cystourethrograms were performed after 3 to 10 months to evaluate the results. Renal and bladder ultrasonograms were taken after 3 to 30 months to check for the development of de novo hydroureteronephrosis and the presence of the implant at the bladder base. The follow-up duration was between 7 and 43 months. RESULTS: Of the 15 patients, there were 6 boys and 9 girls, with ages ranging from 12 months to 14 years. The reflux was resolved in 10 of the 19 ureters, in 8 of the 15 children, after a single injection. The resolutions of reflux, by grade, were none in 2, 2 in 4, 5 in 7, 1 in 4 and 2 in 2 of the ureters of grade I to V, respectively. The unilateral reflux was resolved in 7 of the 12, the bilateral reflux in 2 (3 ureters) of the 3 and the reflux in a duplicated system in 1 of the 3 cases (2 ureters out of 4 ureters). In two cases with persistent reflux, ureteral reimplantations were performed due to repeated urinary tract infections and de novo upper pole ureteral refluxes. The remaining 5 cases with persistent reflux were observed with prophylactic antibiotics. Refluxes recurred in 2 of the ureters at 29 and 36 months after the injection, so chemoprophylaxis was restarted. CONCLUSIONS: The single endoscopic subureteral polydimethylsiloxane injections resulted in a low success rate, but at a high cost. This procedure is considered inappropriate as a first line method for the correction of vesicoureteral reflux in children.
Anti-Bacterial Agents ; Chemoprevention ; Child* ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Medical Records ; Replantation ; Ultrasonography ; Ureter ; Urinary Bladder ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

Laparoscopy was performed successfully at operation in 18 consecutive boys who had 19 nonpalpable testes Of the testes. 2 were in the inguinal region. 6 were in the just proximal to the internal inguinal ring. 2 were high intra-abominal position. and 9 were vanished testes (intracana1icular). In every case of vanished inguinal testis and intracanalicular testis. vas and gonadal vessels were observed laparoscopically to exit the internal inguinal ring. In these vanished testes. hernia or patent processus vaginalis was not observed and contralateral testes were located normally in the scrotum. OF 8 intraabdominal testes. 6 were detected laparoscopically. Laparoscopy provided localization or either testis or the course of spermatic vessels in all patients and these information facilitated accurate planning of operative repair.
Gonads ; Hernia ; Humans ; Inguinal Canal ; Laparoscopy* ; Scrotum ; Testis*

PURPOSE: We studied the incidence, risk factors and spontaneous descent of cryptorchidism. MATERIALS AND METHODS: A total of 813 consecutive male neonates delivered at Keimyung University Dongsan Medical Center during the period from June 2001 to June 2002 were examined at birth for cryptorchidism. Eighty boys with cryptorchidism and 733 normal boys were enrolled in this study. Fifty-six boys with cryptorchidism (87 testes) were followed at 1, 2, 3 and 6 months of age for evaluation of spontaneous testicular descent. Risk factors included birth weight, gestational weeks, other congenital anomalies, Apgar score, birth order, twin birth, mode of delivery, family history of cryptorchidism, maternal age, parity history, previous abortion history and maternal disease history. Logistic regression analysis was used to estimate the odds ratios. RESULTS: The incidence of cryptorchidism was 4.4% in full term(28 out of 635) and 28.6% in preterm(52 out of 178) newborns. The overall incidence was 9.8%. All of the nonpalpable testes and 87.8% of bilateral undescended testes were found in premature babies. Low birth weight(<2,500g) and preterm deliveries(<37wks) were significant risk factors for cryptorchidism. All of 25 undescended testes in term boys and 50 undescended testes of premature boys had descended by age 6 months. CONCLUSIONS: The incidence of cryptorchidism in this study was higher than that of other studies. The premature newborns had a higher incidence of bilateral and nonpalpable cryptorchidism. Low birth weight and preterm deliveries were significant risk factors for cryptorchidism. There was an 86% chance of spontaneous descent by 6 months of age.
Abortion, Induced ; Apgar Score ; Birth Order ; Birth Weight ; Cryptorchidism* ; Female ; Follow-Up Studies ; Humans ; Incidence* ; Infant, Low Birth Weight ; Infant, Newborn ; Logistic Models ; Male ; Maternal Age ; Odds Ratio ; Parity ; Parturition ; Risk Factors* ; Testis ; Twins

Multicystic dysplastic kidney is the most frequent cause of abdominal mass in the neonate, but its presentation is variable depending on the size of cystic kidney, state of the opposite kidney and associated anomalies. multicystic dysplastic kidney also represents a spectrum of pathology from unilateral multicystic kidney through segmental and focal multicystic dysplasia to bilateral multicystic kidney. Herein we report 5 cases of MCK with different presentation and histology, a bilateral MCK associated with horseshoe kidney, a large MCK with uremia, a focal segmental MCK with contralateral UPJ obstruction, a small focal segmental MCK with contralateral megaureter and a small MCK detected by ultrasonogram for localization of impalpable testis.
Humans ; Infant, Newborn ; Kidney ; Kidney Diseases, Cystic ; Multicystic Dysplastic Kidney* ; Pathology ; Testis ; Ultrasonography ; Uremia

Since Memmalaar first reported the use of bladder mucosa graft technique in penoscrotal hypospadias in 1947, this technique has been used with reasonable success for the reconstruction of new urethra for the posterior hypospadias and hypospadias cripples. The a bladder mucosa is abundantly available, sterile and has good elasticity. This mucosa does not produce hair, does not excoriate, and does not desquamate from the exposure of the urin. Two new urethrae in patients with posterior hypospadias, aged 11 and 21, were successfully reconstructed with bladder mucosal graft technique. A minor meatal stricture developed in one patient. However, the over-all results of this technique appear to be satisfactory.
Constriction, Pathologic ; Elasticity ; Female ; Hair ; Humans ; Hypospadias* ; Male ; Mucous Membrane ; Transplants* ; Urethra ; Urinary Bladder*

Cysts of the adrenal gland are often misinterpreted and misdiagnosed because of their rarity. There are few reports in the literature of adrenal cyst in children, especially in the newborn. Adrenal cysts in the newborn are usually of the pseudocyst due to adrenal hemorrhage and have tendency to become adherent to surrounding structure, mimicking malignant tumor. We report a cases of pyogenic adrenal cyst in the newborn which was suspected malignancy because of adherence to adjacent organ.
Adrenal Glands ; Child ; Hemorrhage ; Humans ; Infant, Newborn*

The reconstruction of foot remains difficult problem with many surgical modalities because foot has unique structure, insufficient local soft tissue and poor vascularity. The medial plantar island flap is capable of providing sensate and structurally similar tissue with single operative procedure. We reconstructed 5 cases of soft tissue defects on the foot by using medial plantar island flap(3 cases proximally- based, 2 cases distally-based) in diabetics. Successful soft tissue coverage was achieved on medial malleolus, dorsal midfoot, tendo calcaneus, and forefoot. The size of flap ranged from 3.5 x 3.0 cm to 6.0 x 4.0 cm. Follow-up ranged from 8 months to 26 months. All flaps survived without serious complication. All patients had protective sensation in daily activities and were able to ambulate in normal footwear. This paper demonstrates that medial plantar island flap with proximally and distally-based pedicle should be considered as a useful technique for reconstruction of soft tissue defect from ankle to forefoot.
Ankle ; Calcaneus ; Follow-Up Studies ; Foot ; Humans ; Sensation ; Surgical Procedures, Operative