After analyzing the electrocardiographic findings during anesthesia, we estimated the difference in the incidence of the operative arrhythmia according to preoperative electrocardiographic findings and compared the influence on the occurrence of the operative arrhythmia according to the type of anesthesia(general and spinal) and major inhalational anesthetics. The results were as follows: 1) On the preanesthetic electrocardiographic findings, the number of patients with only normal rhythm was 15 cases. 2) During anesthesia arrhythmias appeared in 15 patients(305) and the most frquent arrhythymis was premsture ventricular contraction. 3) Between the patients with normal presnesthetic electrocardiographic findings and abnormal electrocardiographic finedings, the incidences of operative arrythmias were not significantly different. 4) Thirty percent of patients developed the arrhythmia both in general and spinal anesthesia. 5) The incidence of arrhythmia in halothane and enflurane aneshtesia was respectively 32% and 28% but the difference was not significant.
Anesthesia* ; Anesthesia, Spinal ; Anesthetics ; Arrhythmias, Cardiac* ; Electrocardiography* ; Enflurane ; Halothane ; Humans ; Incidence

BACKGROUND: Infections are the second leading cause of morbidity and mortality in hemodialysis patients. Vascular access is a major risk factor for infection-related hospitalization and mortality. This study aimed to characterize the presenting features and outcome of vascular access infection in hemodialysis patients. MATERIALS AND METHODS: Between May 2003 and March 2010, 224 patients admitted to a 750 bed tertiary care hospital for treatment of vascular access infection were retrospectively analyzed. Vascular access infections were defined by local infection signs (pus or redness) at the vascular access site or by a positive blood culture with no known source other than the vascular access. RESULTS: Of the 224 patients, 179 (79.7%) had an arteriovenous (AV) graft, 28 (12.5%) had a tunneled cuffed catheter, 12 (5.4%) had AV fistulas, and five (2.2%) had a temporary central catheter. The mean+/-SD time between the creation of each type of vascular access and onset of infection were as follows: temporary central catheter 46.6+/-36.9 days, tunneled cuffed catheter 180.3+/-168.8 days, AV fistulas 928.6+/-1,299.7 days, and AV graft 1,066.3+/-1321.1 days (P value=0.006). The most common causative organism was Staphylococcus aureus (62.5%; methicillin-susceptible 35.2%, methicillin-resistant 27.3%) followed by coagulase negative staphylococci (17.0%) and gram negative bacilli (15.9%). The involved vascular accesses in infected cases were: temporary central catheter (4/5, 80%), tunneled cuffed catheter (13/27, 48%), AV graft (68/179, 38%) and AV fistulas (4/12, 33%). The complications of vascular access infection included septic pulmonary embolism (n=9, 4%), pneumonia (n=9, 4%), endocarditis (n=6, 2.7%), osteomyelitis (n=3, 1.3%) and abdominal abscess (n=2, 0.9%). A multivariable analysis showed that Staphylococcus aureus was a risk factor of septic pulmonary embolism and osteomyelitis. The all-cause mortality was 8.4%, 30-day mortality was 2.2% and infection-related mortality was 5.4%. CONCLUSIONS: Staphylococcus was responsible for 79.5% of infections, with methicillin-susceptible S. aureus being the most commonly implicated strain. Temporary accesses have the potential to become infected earlier. Septic pulmonary embolism and pneumonia were common complications. Efforts should be focused on prevention and early detection of VA infection with pulmonary complications.
Abdominal Abscess ; Catheter-Related Infections ; Catheters ; Coagulase ; Endocarditis ; Fistula ; Hospitalization ; Humans ; Methicillin Resistance ; Osteomyelitis ; Pneumonia ; Pulmonary Embolism ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Sprains and Strains ; Staphylococcus ; Staphylococcus aureus ; Tertiary Healthcare ; Transplants

PURPOSE: To evaluate factors that can influence the prevalence of amblyopia in children with anisometropia. METHODS: We retrospectively reviewed the records of 63 children 2 to 13 years of age who had anisometropic amblyopia with a difference in the refractive errors between the eyes of at least two diopters (D). The type of anisometropia (myopia, hyperopia, and astigmatism), degree of anisometropia (<2-3 D, <3-4 D, or >4 D), best corrected visual acuity (BCVA) of the amblyopic eye at the time of initial examination, BCVA differences between sound and amblyopic eyes, whether or not occlusion therapy was performed, compliance with occlusion therapy, and the patient's age when eyeglasses were first worn were investigated. RESULTS: There was an increase in the risk of amblyopia with increased magnitude of anisometropia (p=0.021). The prevalence of amblyopia was higher in the BCVA <20/40 group and in patients with BCVA differences >4 lines between sound and amblyopic eyes (p=0.008 and p=0.045, respectively). There was no statistical relationship between the prevalence of amblyopia and the type of anisometropia or the age when eyeglasses were first worn. Poor compliance with occlusion therapy was less likely to achieve successful outcome (p=0.015). CONCLUSIONS: Eyes with poor initial visual acuities of <20/40, a high magnitude of anisometropia, and a >4 line difference in the BCVA between sound and amblyopic eyes at the initial visit may require active treatment.
Angiogenesis Inhibitors/*administration & dosage ; Animals ; Antibodies, Monoclonal/*administration & dosage ; Cornea/metabolism/*pathology ; Corneal Neovascularization/*drug therapy/metabolism/pathology ; Disease Models, Animal ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Male ; Ophthalmic Solutions ; Rabbits ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors/metabolism

PURPOSE: Nodular duodenitis is defined as two or more erythematous nodules in the duodenum, with surrounding inflammation and with or without apical erosions. But the clinical features and natural history of nodular duodenitis remain largely undefined, therefore we examined clinical, endoscopic and pathologic features of nodular duodenitis in children to find about its natural history, relationship between endoscopic and pathologic findings, relationship between Helicobacter pylori and nodular duodenitis as well as clinical response to antisecretory therapy. METHODS: Forty-nine children presented with chronic abdominal pain, chronic diarrhea, vomiting and indigestion showed nodular duodenitis on gastroduodenoscopic examinations at the Department of pediatrics of Hangyang University Hospital from January 1995 to August 1997. Endoscopic and pathologic findings were graded and the correlation coefficient between endoscopic and pathologic grades were analyzed. Clinical responses to therapy were compared between Helicobacter pylori (H. pylori)-associated and non H. pylori-associated children. RESULTS: The chief most common complaint was chronic abdominal pain and this disease was most commonly developed in females and in school-aged children. In endoscopic examinations, Grade 1 was the most commonly noted, while in pathologic examinations, Grade 2 was most common. The correlation coefficient between endoscopic and pathologic findings was 0.278 (P= 0.053). Clinical symptoms were improved by H2-blocker or anti-H. pylori therapy in most patients. CONCLUSION: There was no significant correlation between endoscopic and pathologic grades. H. pylori infection may be an etiologic factor of nodular duodenitis in some cases.
Abdominal Pain ; Child* ; Diarrhea ; Duodenitis* ; Duodenum ; Dyspepsia ; Female ; Helicobacter pylori ; Humans ; Inflammation ; Natural History ; Pediatrics ; Vomiting

Transforming growth factor-j31 (TGF-p1) has potential for therapeutic use in common clinical conditions for which there are no adequate pharmacological agents. However, in vivo studies using TGF-p1 were hindered by high price of this cytokine. As a first step towards large scale purification of TGF-p1, it was purified in a small scale (10 unit platelets) from human platelets by four purification steps: platelet extraction, gel filtration, cation exchange chromatography, and reversed phase high performance liquid chromatography (HPLC). A single protein band with a molecular weight of 25 Kd corresponding to purchased TGF-p1 (R8D Systems) was confirmed by silver staining after SDS-polyacrylamide gel electrophoresis (SDS-PAGE) of eluant from reversed phase HPLC. Recovery (%) of each step was about 50-60%, resulting in the final recovery of 20% based on the detection by a sandwich ELISA. Approximately, 3.7 p,g of purified TGF-p1 was obtained from 18 pg of platelet extracts. This result was confirmed by receptor (TGF-j31 type II) ELISA and bioassay using a mink lung epithelial'cell line (MV1LU). Further, in vitro characterization study showed that purified TGF-p1 inhibits G1/S transition of LPS-activated murine spleen B cells and increases surface IgA expression by the same cell population, which are typical activities of TGF-p1 in B cell differentiation. Taken together, the results from the present study reveals that purified TGF-p1 is fully biologically active and our purification methodology could be usbful to obtain a large scale of recombinant TGF-p1 in the future.
B-Lymphocytes ; Biological Assay ; Blood Platelets ; Cell Cycle ; Cell Differentiation ; Chromatography ; Chromatography, Gel ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Electrophoresis ; Enzyme-Linked Immunosorbent Assay ; Humans* ; Immunoglobulin A ; Lung ; Mink ; Molecular Weight ; Silver Staining ; Spleen ; Transforming Growth Factors*

OBJECTIVE: The authors report a result of application of cervical hollow cage(RABEA(TM)) without bone graft to the patients of one-level cervical spondylosis or acute cervical disc herniation to fill and stabilize a vacant space following anterior decompression. METHODS: Twenty-one patients from May 1999 to April 2001 had been taken procedure with cervical hollow cage system following anterior decompression and there had been no additional bone graft or screw fixation or fusion. Pain relief and clinical outcome were evaluated, and the intervertebral disc height and segmental angle for radiological assessment were examined. All patient were followed up for 12 months at least. RESULTS: The result was excellent in 14 cases(66.7%), good in 6 cases(28.6%) and poor in 1 case(4.8%). In the lateral projection, the mean of preoperative disc height and segmental angle were significantly improved after surgery and maintained during follow-up periods. No abnormal displacement were recorded at dynamic flexion and extension lateral X-ray and no cage rotation or retropulsion was noted in follow-up periods. Three patients(14.3%) was observed to subside of disc height on the postoperative periods and only one of their patients was dissatisfied with surgery. CONCLUSION: Cervical hollow cage is simple to perform and reduces the operation time. Besides clinical improvement, it improves mechanical stability and radiological profile as the physiologic level. The cervical hollow cage might be an alternative to traditional cervical interbody fusion with bone graft.
Decompression ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Postoperative Period ; Spondylosis ; Transplants*

BACKGROUND: Kaposi's sarcoma (KS) is a mesenchymal tumor involving blood and lymphatic vessels. Viral oncogenesis by human herpesvirus 8 (HHV8) and cytokine-induced growth together with some state of immunocompromise represent important conditions for this tumor to develop. OBJECTIVE: The purpose of this study was to document the clinical and histopathological features of KS in Korea. METHODS: The medical records and histopathologic slides of patients with KS diagnosed at Yonsei University Medical Center from January, 1992 to March, 2003 were reviewed. We used immunohistochemical stains for HHV8 to determine whether HHV8 is present in KS. RESULTS: Among the 21 patients, classic KS was found in 7, acquired immunodeficiency syndrome (AIDS)-associated KS in 3, and iatrogenic, immunosuppressive KS in 11. Classic and iatrogenic KS most often have a preference for the lower extremities, while the upper body in AIDS-KS. Mucosal involvement and systemic organ involvement could be detected in AIDS-KS. Immunohistochemical stains for HHV8 were positive in 100% with classic KS and AIDS?KS, and 90.9% with immunosuppressive KS. Classic KS responded well to local therapy and showed indolent course. Iatrogenic, immunosuppressive KS generally regressed after reduction or cessation of immunosuppressive drug therapy, but some of them showed resistance to therapy. For AIDS-KS, no systemic treatments have been shown to prolong survival. CONCLUSION: Because classic KS and iatrogenic, immunosuppressive KS generally have a benign course, cautions are taken not to overtreat them. However, some cases of organ transplantation associated KS have an aggressive course, prompting us to consider active treatments to save transplanted organ.
Academic Medical Centers ; Acquired Immunodeficiency Syndrome ; Carcinogenesis ; Coloring Agents ; Drug Therapy ; Herpesvirus 8, Human ; Humans ; Korea ; Lower Extremity ; Lymphatic Vessels ; Medical Records ; Organ Transplantation ; Sarcoma, Kaposi* ; Transplants

PURPOSE: To evaluate the factors affecting the visual acuity and stereoacuity of patients with refractive accommodative esotropia who have successful optical alignment obtained by refractive error management. METHODS: The charts of 60 patients, including medical history, age of onset, chief complaint at first visit, age at which glasses were first worn, refractive error, visual acuities with and without glasses, angle of deviation, and stereoacuity were retrospectively reviewed. RESULTS: The mean follow-up period was 59.20 +/- 40.26 months, and the mean hypermetropia at the initial visit was 4.90 +/- 1.75 diopters (D). Fifty-three patients had decreased hypermetropia, with a mean of 0.94 +/- 0.91 D, while seven patients had increased hypermetropia, with a mean of 0.38 +/- 0.17 D. The mean deviation at the initial visit was 28.40 +/- 9.05 prism diopters (PD) at near without glasses and decreased to 3.20 +/- 3.50 PD with glasses at the final visit. Children who had anisometropia at the initial visit had a higher prevalence for amblyopia at the final visit (p = 0.000). However, the degree of hypermetropia, age at onset, deviation before glasses correction, interval from onset to glasses correction, and amblyopia at diagnosis were not significant risk factors for amblyopia or anomalous streoacuity at the final visit. CONCLUSIONS: The degree of hypermetropia, age at onset, deviation before glasses correction, interval from onset to glasses correction, and amblyopia at diagnosis were not significant risk factors for amblyopia. However, anisometropia was a significant risk factor for the development of amblyopia in patients with refractive accommodative esotropia, and these children should receive careful and long-term follow-up management.
Age of Onset ; Amblyopia ; Anisometropia ; Child ; Esotropia ; Eyeglasses ; Follow-Up Studies ; Glass ; Humans ; Hyperopia ; Prevalence ; Refractive Errors ; Retrospective Studies ; Risk Factors ; Visual Acuity

PURPOSE: In this study, we investigated the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. METHODS: A retrospective analysis was conducted on medical records from January 2010 to June 2017 (7.5 years) of a university hospital NICU. RESULTS: There were 45 cases of EOS (1.2%) in 3,862 infants. The most common pathogen responsible for EOS was group B Streptococcus (GBS), implicated in 10 cases (22.2%), followed by Escherichia coli, implicated in 9 cases (20%). The frequency of gram-positive sepsis was higher in term than in preterm infants, whereas the rate of gram-negative infection was higher in preterm than in term infants (P < 0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There were significant differences in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. After adjustments based on the difference in gestational age and birth weight between the 2 groups, gram-negative pathogens (odds ratio [OR], 42; 95% confidence interval [CI], 1.4–1,281.8) and some clinical findings, such as neutropenia (OR, 46; 95% CI, 1.3–1,628.7) and decreased activity (OR, 34; 95% CI, 1.8–633.4), were found to be associated with fatality. CONCLUSION: The common pathogens found to be responsible for EOS in NICU patients are GBS and E. coli. Gram-negative bacterial infections, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.
Birth Weight ; Escherichia coli ; Gestational Age ; Gram-Negative Bacterial Infections ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal* ; Medical Records ; Mortality ; Neutropenia ; Prognosis ; Retrospective Studies ; Sepsis* ; Streptococcus

This study investigated the expression of osteopontin (OPN) in rat lumbar spinal cords after lumbar nerve root avulsion, using in situ hybridization histochemistry, immunocytochemistry and western blot analysis. Cells expressing OPN were motoneurons and interneurons in the ventral horn, but no signals were observed in neurons in the dorsal horn of the normal lumbar spinal cord. From day 1 after avulsion injury, OPN mRNA-labeled neurons increased in the ventral horn and the intermediate zone. By day 3, relatively strong OPN mRNA signals were found throughout the gray matter of the injured side of the spinal cord with OPN mRNA-labeled cells scattered in the superficial dorsal horn. By day 7, the labeling patterns for OPN mRNA were similar to those on day 3, but the numbers of OPN mRNA-labeled cells in the ventral horn and the intermediate zone peaked. At this point, these labeled cells were also more densely packed and the intensity of signals was stronger. Interestingly, these labeled cells were neurons, but not glial cells such as astrocytes or microglia. This OPN mRNA-labeled cell profile in the dorsal horn had nearly disappeared by day 14 after avulsion injury, and the labeling pattern became similar to that on day 1. By day 28, after avulsion injury, the numbers of OPN mRNA-labeled cells decreased further below control values. These results suggest that increased expression of OPN in the rat lumbar spinal cord after avulsion injury might play an important role in the pathogenesis of damaged neurons.
Animals ; Astrocytes ; Blotting, Western ; Horns ; Immunohistochemistry ; In Situ Hybridization ; Interneurons ; Microglia ; Neuroglia ; Neurons ; Osteopontin* ; Radiculopathy ; Rats* ; RNA, Messenger ; Spinal Cord*