PURPOSE: The major cause of cardiac dysfunction, after open heart surgery for congenital heart disease, is perioperative myocardial injury. Cardiac troponin I is found only within the myocardial cell, so it can be used as a biochemical marker of the myocardial injury. We performed this study to evaluate the worth of cardiac troponin I as a biochemical marker reflecting the extent of perioperative myocardial injury and recovery. METHODS: Thirty-four patients who had undergone elective open heart surgery of congenital heart disease(CHD) from April to July 2001 were enrolled in this study. We measured types of CHD, serial cardiac troponin I(baseline 1 day before operation, postoperative day 1, 2, 3, 7), duration of cardiopulmonary bypass(CPB), aortic cross clamping(ACC), intubation and postoperative hospital stay. RESULTS: Compared with the baseline before operation, there was a significant, increase of cardiac troponin I on the postoperative day 1 and a significant gradual decrease on the day 2, 3, 7. The levels of cardiac troponin I were the highest in the transposition of great artery(TGA) repair on the postoperative day 1 and high in the tetralogy of Fallot(TOF), atioventricular septal defect (AVSD), ventricular septal defect(VSD) and atrial septal defect(ASD) repair with decreasing sequence. The longer duration of CPB, ACC and intubation, the higher of cardiac troponin I, but there were no significant correlations between cardiac troponin I levels and duration of hospital stay. CONCLUSION: Because there was significant increases or decreases of cardiac troponin I according to the perioperative time and types of the congenital heart disease, it is a worthy biochemical marker which reflects the extent of perioperative myocardial injury and recovery after open heart surgery.
Biomarkers ; Heart Defects, Congenital ; Heart* ; Humans ; Intubation ; Length of Stay ; Thoracic Surgery* ; Troponin I* ; Troponin*

Stevens-Johnson syndrome (SJS) and acute generalized exanthematous pustulosis (AGEP) are 2 distinct entities that can overlap within the spectrum of severe cutaneous adverse reaction (SCAR). AGEP is a self-limiting and drug-induced eruption characterized by sudden onset of sterile pustules, erythema, and sometimes fever. SJS, in contrast, is a severe form of SCAR that causes blistering and necrosis of the skin and mucosal membranes, often leading to significant morbidity and mortality. However, there are cases where patients may present with symptoms that overlap between AGEP and SJS, making it challenging to differentiate the 2 conditions. This report describes a 70-year-old male with nontuberculous mycobacterium tenosynovitis in the left hand, coinfected with methicillin-resistant coagulase-negative Staphylococcus and Klebsiella oxytoca. After administration of additional antibiotics, the patient developed fever and erythematous macules with purpuric centers on the trunk and the extremities. Further examination revealed marked leukocytosis and elevated C-reactive protein levels. Skin biopsy histopathology showed subcorneal intraepidermal pustule formation with neutrophil infiltration. The patient’s clinical course improved after cessation of the culprit drugs and treatment with a high-dose systemic steroid. This case highlights the rare occurrence of SJS/AGEP overlap and underscores the importance of prompt diagnosis and appropriate management of these SCAR.

Stevens-Johnson syndrome (SJS) and acute generalized exanthematous pustulosis (AGEP) are 2 distinct entities that can overlap within the spectrum of severe cutaneous adverse reaction (SCAR). AGEP is a self-limiting and drug-induced eruption characterized by sudden onset of sterile pustules, erythema, and sometimes fever. SJS, in contrast, is a severe form of SCAR that causes blistering and necrosis of the skin and mucosal membranes, often leading to significant morbidity and mortality. However, there are cases where patients may present with symptoms that overlap between AGEP and SJS, making it challenging to differentiate the 2 conditions. This report describes a 70-year-old male with nontuberculous mycobacterium tenosynovitis in the left hand, coinfected with methicillin-resistant coagulase-negative Staphylococcus and Klebsiella oxytoca. After administration of additional antibiotics, the patient developed fever and erythematous macules with purpuric centers on the trunk and the extremities. Further examination revealed marked leukocytosis and elevated C-reactive protein levels. Skin biopsy histopathology showed subcorneal intraepidermal pustule formation with neutrophil infiltration. The patient’s clinical course improved after cessation of the culprit drugs and treatment with a high-dose systemic steroid. This case highlights the rare occurrence of SJS/AGEP overlap and underscores the importance of prompt diagnosis and appropriate management of these SCAR.

Stevens-Johnson syndrome (SJS) and acute generalized exanthematous pustulosis (AGEP) are 2 distinct entities that can overlap within the spectrum of severe cutaneous adverse reaction (SCAR). AGEP is a self-limiting and drug-induced eruption characterized by sudden onset of sterile pustules, erythema, and sometimes fever. SJS, in contrast, is a severe form of SCAR that causes blistering and necrosis of the skin and mucosal membranes, often leading to significant morbidity and mortality. However, there are cases where patients may present with symptoms that overlap between AGEP and SJS, making it challenging to differentiate the 2 conditions. This report describes a 70-year-old male with nontuberculous mycobacterium tenosynovitis in the left hand, coinfected with methicillin-resistant coagulase-negative Staphylococcus and Klebsiella oxytoca. After administration of additional antibiotics, the patient developed fever and erythematous macules with purpuric centers on the trunk and the extremities. Further examination revealed marked leukocytosis and elevated C-reactive protein levels. Skin biopsy histopathology showed subcorneal intraepidermal pustule formation with neutrophil infiltration. The patient’s clinical course improved after cessation of the culprit drugs and treatment with a high-dose systemic steroid. This case highlights the rare occurrence of SJS/AGEP overlap and underscores the importance of prompt diagnosis and appropriate management of these SCAR.

Stevens-Johnson syndrome (SJS) and acute generalized exanthematous pustulosis (AGEP) are 2 distinct entities that can overlap within the spectrum of severe cutaneous adverse reaction (SCAR). AGEP is a self-limiting and drug-induced eruption characterized by sudden onset of sterile pustules, erythema, and sometimes fever. SJS, in contrast, is a severe form of SCAR that causes blistering and necrosis of the skin and mucosal membranes, often leading to significant morbidity and mortality. However, there are cases where patients may present with symptoms that overlap between AGEP and SJS, making it challenging to differentiate the 2 conditions. This report describes a 70-year-old male with nontuberculous mycobacterium tenosynovitis in the left hand, coinfected with methicillin-resistant coagulase-negative Staphylococcus and Klebsiella oxytoca. After administration of additional antibiotics, the patient developed fever and erythematous macules with purpuric centers on the trunk and the extremities. Further examination revealed marked leukocytosis and elevated C-reactive protein levels. Skin biopsy histopathology showed subcorneal intraepidermal pustule formation with neutrophil infiltration. The patient’s clinical course improved after cessation of the culprit drugs and treatment with a high-dose systemic steroid. This case highlights the rare occurrence of SJS/AGEP overlap and underscores the importance of prompt diagnosis and appropriate management of these SCAR.

Stevens-Johnson syndrome (SJS) and acute generalized exanthematous pustulosis (AGEP) are 2 distinct entities that can overlap within the spectrum of severe cutaneous adverse reaction (SCAR). AGEP is a self-limiting and drug-induced eruption characterized by sudden onset of sterile pustules, erythema, and sometimes fever. SJS, in contrast, is a severe form of SCAR that causes blistering and necrosis of the skin and mucosal membranes, often leading to significant morbidity and mortality. However, there are cases where patients may present with symptoms that overlap between AGEP and SJS, making it challenging to differentiate the 2 conditions. This report describes a 70-year-old male with nontuberculous mycobacterium tenosynovitis in the left hand, coinfected with methicillin-resistant coagulase-negative Staphylococcus and Klebsiella oxytoca. After administration of additional antibiotics, the patient developed fever and erythematous macules with purpuric centers on the trunk and the extremities. Further examination revealed marked leukocytosis and elevated C-reactive protein levels. Skin biopsy histopathology showed subcorneal intraepidermal pustule formation with neutrophil infiltration. The patient’s clinical course improved after cessation of the culprit drugs and treatment with a high-dose systemic steroid. This case highlights the rare occurrence of SJS/AGEP overlap and underscores the importance of prompt diagnosis and appropriate management of these SCAR.

BACKGROUND AND OBJECTIVES: Kawasaki disease is an acute systemic vasculitis of which pathogenesis suspected is caused by immune dysregulation. The goal of this study is to evaluate the activation pattern of T helper cell type 1 (Th1) and T helper cell type 2 (Th2) in patients with Kawasaki disease. SUBJECTS AND METHODS: Prospective study of 60 patients (male 36, female 24) with diagnosis of Kawasaki disease were enrolled. One hundred and eighty blood samples from these patients were collected according to the different clinical stages {before initial intravenous immunoglobulin (IVIG), 5 days after initial IVIG, 2 months after initial IVIG}. The plasma level of Th1 cytokines; interferon-gamma (IFN-gamma) & interleukin (IL)-2 and Th2 cytokines; IL-4 & IL-10 were measured by enzyme-liked immunosorbent assay. RESULTS: In all patients, the plasma level of Th1 cytokines (IFN-gamma, IL-2) and Th2 cytokines (IL-4 and IL-10) were markedly elevated during the acute stage of Kawasaki disease. Since then, the plasma level of all these cytokines decreased significantly along with the process of clinical stages. Regardless of the existence of coronary artery lesion or no response to initial IVIG treatment, there were no significant differences between them. CONCLUSION: These data suggest that both Th1 and Th2 cells may be activated simultaneously during the acute stage of Kawasaki disease. Further studies are therefore required to establish the difference of activation pattern of T helper cells between Kawasaki disease and other inflammatory diseases.
Coronary Vessels ; Cytokines ; Diagnosis ; Female ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Interferon-gamma ; Interleukin-10 ; Interleukin-4 ; Interleukins ; Mucocutaneous Lymph Node Syndrome* ; Plasma ; Prospective Studies ; Systemic Vasculitis ; T-Lymphocytes, Helper-Inducer ; Th1-Th2 Balance ; Th2 Cells

PURPOSE: We investigated the difference of glucose metabolism of medial and lateral temporal lobes of patients with temporal lobe epilepsy (TLE) utilizing quantitative comparison of regional metabolic activities using asymmetric index. MATERIALS AND METHODS: We studied 19 pathologically proven mesial TLE and 25 lateral TLE patients. Lateral TLE patients were either normal on magnetic resonance imaging (cryptogenic: n=14) or had structural lesions (lesional: n=11). Asymmetric index (ASI) was calculated as [(ipsilateral-contralateral)/(ipsilateral+ contralateral)]x200. RESULTS: ASI of medial and lateral lobes of mesial TLE was decreased (-16.4+/-8.3 and -12.7+/-5.5, respectively). In cryptogenic lateral TLE, ASI of lateral temporal lobe was decreased (-11.8+/-4.7), whereas that of medial temporal lobe was not decreased (-4.6+/-6.3). ASI of medial lobe of lesional lateral TLE was -7.3+/-9.1, which was significantly different from that of mesial TLE (p<0.05). Patients with lesional lateral TLE had evident metabolic defects or decrease (ASI: -22+/-10.5) in lateral temporal lobe. While we could not find the difference of metabolic activity in lateral temporal lobes between cryptogenic lateral TLE and mesial TLE patients, the difference of metabolic activity was significant in medial temporal lobes which was revealed by ASI quantitation. CONCLUSION: Asymmetric decrease of metabolic activity in both medial and lateral temporal lobes indicates medial temporal epilepsy. Symmetry of metabolic activity in medial temporal lobe combined with asymmetry of that in lateral temporal lobe may give hints that the epileptogenic zone is lateral.
Epilepsy ; Epilepsy, Temporal Lobe* ; Glucose* ; Humans ; Magnetic Resonance Imaging ; Metabolism* ; Temporal Lobe*

BACKGROUND: Green tea modulates neuropathic pain. Reactive oxygen species (ROS) are suggested as a key molecule in the underlying mechanism of neuropathic pain in the spinal cord. We examined the effect of epigallocatechin-3-gallate (EGCG), the major catechin in green tea, in neuropathic pain and clarified the involvement of ROS on the activity of EGCG. METHODS: Neuropathic pain was induced in male Sprague-Dawley rats by spinal nerve ligation (SNL). A polyethylene tube was intrathecally located. Nociceptive degree was estimated by a von Frey filament and expressed as a paw withdrawal threshold (PWT). To determine the role of ROS on the effect of EGCG, a free radical donor (tert-BuOOH) was pretreated before administration of EGCG. ROS activity was assayed by xanthine oxidase (XO) and malondialdehyde (MDA). RESULTS: SNL decreased the PWT compared to sham rats. The decrease remained during the entire observation period. Intrathecal EGCG increased the PWT at the SNL site. Intrathecal tert-BuOOH significantly decreased the effect of EGCG. The levels of both XO and MDA in the spinal cord were increased in SNL rats compared to sham. Intrathecal EGCG decreased the level of XO and MDA. CONCLUSIONS: EGCG may reduce neuropathic pain by SNL due to the suppression of ROS in the spinal cord.
Animals ; Catechin ; Humans ; Ligation ; Male ; Malondialdehyde ; Neuralgia ; Polyethylene ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species* ; Spinal Cord ; Spinal Nerves ; Tea ; Tissue Donors ; Xanthine Oxidase

PURPOSE: To analyze abnormal ventricular activation in childhood congenital heart disease induced by postoperative changes in ventricular volume and pressure and ventricular scar formation using signal-averaged electrocardiography (SAECG). METHODS: Fifty-two patients who had undergone open heart surgery (OHS) were enrolled. Patients were divided into the following 3 groups: right ventricular volume overload (atrial septal defect, group1), left ventricular volume overload (ventricular septal defect, group2), and right ventricular pressure overload (tetralogy of Fallot, group 3). The patients were monitored by standard 12-lead ECG and SAECG before and 2 months after the operation. QRS duration, QT and QTc intervals, filtered QRS (f-QRS), high frequency low amplitude potential (HFLA), and root mean square (RMS) voltage in the terminal 40 ms of SAECG were determined. RESULTS: In the preoperative period, group1 showed significant increase in QRS (P=0.011) compared to those of the other 2 groups. In the postoperative period, group3 showed significant increase in the QTc interval (P=0.004) compared to those in the other 2 groups. SAECG parameters showed no significant differences among the groups in the pre- or postoperative period. Of the 52 patients, 12 (23%) in the preoperative period and 21 (40%) in the postoperative period had at least 1 SAECG abnormality. The prevalence of SAECG abnormalities was significantly higher in the postoperative group 2 and group 3 (preoperative: 20% versus postoperative: 28%, P<0.001, preoperative: 14% versus postoperative: 64%, P<0.001, respectively). CONCLUSION: Abnormal SAECG patterns may be attributed to postoperative scars, OHS itself, and/or ventricular overload.
Cicatrix ; Electrocardiography ; Heart ; Heart Diseases ; Humans ; Postoperative Period ; Preoperative Period ; Prevalence ; Thoracic Surgery ; Ventricular Pressure