PURPOSE: To report the decreasing incidence of HBV(Hepatitis B virus)-associated membranous nephropathy in children after HBV vaccination and to elucidate the clinical course and treatment strategies of IMN (Idiopathic membranous nephropathy). METHODS: We retrospectively reviewed the clinico-pathological findings of HBV-MN and IMN patients who underwent a renal biopsy from 1986 to 2005. We compared the HBV-MN and the IMN groups and the remission and the non-remission groups of patients with IMN. RESULTS: Among 24 cases of MN patients, HBV-MN comprised 6 cases(25%) and IMN 18 cases(75%). Clinical masnifestations were nephrotic syndrome(3 cases, 50%), nephritic syndrome(1 case, 16.7%), asymptomatic(2 cases, 33.4%) in the HBV-MN group, asymptomatic(10 cases, 55.5%), nephrotic syndrome(5 cases, 27.8%), and gross hematuria(3 cases, 16.7%) in the IMN group. From 1996 to 2000, there were 2 cases(28%) of HBV-MN and 5 cases(72%) of IMN. After 2001, all 10 cases were IMN. In the HBV-MN group, 4 cases(66.7%) received interferon and 1 case received methylprednisolone pulse therapy. In the IMN group, 16 cases (88.9%) received methylprednisolone, 8 cases(44.4%) were in complete remission, 2 cases (11.1%) were in partial remission, 2 cases(11.1%) were in chronic renal failure, and 5 cases (27.8%) were lost to follow-up with sustained proteinuria, 1 case(5.6%) continued to have frequent relapse of nephrotic syndrome without renal insufficiency. In the comparison between remission and non-remission groups, nephrotic range proteinuria and hypertension were more significantly common in the non-remission group(P<0.05). CONCLUSION: With HBV vaccination, HBV-MN has decreased markedly. IMN is a rare glomerular disease in children. Because the prognosis for patients with nephrotic range proteinuria is poor, this group needs more aggressive treatment.
Biopsy ; Child* ; Glomerulonephritis, Membranous* ; Humans ; Hypertension ; Incidence ; Interferons ; Kidney Failure, Chronic ; Lost to Follow-Up ; Methylprednisolone ; Nephrotic Syndrome ; Prognosis ; Proteinuria ; Recurrence ; Renal Insufficiency ; Retrospective Studies ; Vaccination

Spontaneous intracranial hypotension is a syndrome caused by cerebrospinal fluid (CSF) leakage from the spinal dural sac. The most common symptom is a postural headache and other clinical symptoms may include nausea, vomiting, photophobia, diplopia, dizziness, and tinnitus. Usually, conservative treatments like hydration, bed rest, and administration of caffeine are recommended first, but epidural blood patch is regarded as the mainstay of treatment in the patients who do not respond to conservative therapy. Epidural blood patch was known that it provides the tamponade and seal of dural sac when performed at the leak site. Our patient was suspected the CSF leakage at cervicothoracic junction, but epidural blood patch was performed in lumbar level and the headache of patient was managed successfully for at least 1 year.
Bed Rest ; Blood Patch, Epidural* ; Caffeine ; Cerebrospinal Fluid ; Diplopia ; Dizziness ; Headache ; Humans ; Intracranial Hypotension* ; Nausea ; Photophobia ; Tinnitus ; Vomiting

Pericentric inversion of chromosome 4 can give rise to 2 alternate recombinant (rec) chromosomesby duplication or deletion of 4p. The deletion of distal 4p manifests as Wolf-Hirschhorn syndrome (WHS). Here, we report the molecular cytogenetic findings and clinical manifestations observed in an infant with 46,XX,rec(4)dup(4q)inv(4)(p16q31.3)pat. The infant was delivered by Cesarean section at the 33rd week of gestation because pleural effusion and polyhydramnios were detected on ultrasonography. At birth, the infant showed no malformation or dysfunction, except for a preauricular skin tag. Array comparative genomic hybridization analysis of neonatal peripheral blood samples showed a gain of 38 Mb on 4q31.3-qter and a loss of 3 Mb on 4p16.3, and these results were consistent with WHS. At the last follow-up at 8 months of age (corrected age, 6 months), the infant had not achieved complete head control.
*Chromosome Deletion ; *Chromosome Duplication ; *Chromosome Inversion ; *Chromosomes, Human, Pair 4 ; Comparative Genomic Hybridization ; Female ; Gestational Age ; Humans ; Infant ; Pleural Effusion/ultrasonography ; Polyhydramnios/ultrasonography ; Pregnancy ; Wolf-Hirschhorn Syndrome/*genetics

We recently encountered a case of hereditary spherocytosis coexisting with Gilbert's syndrome. Patient was initially diagnosed with Gilbert's syndrome and observed, but other findings suggestive of concurrent hemolysis, such as splenomegaly and gallstones were noted during the follow-up period. Therefore, further evaluations, including a peripheral blood smear, osmotic fragility test, autohemolysis test, and red blood cell membrane protein test were performed, and coexisting hereditary spherocytosis was diagnosed. Genotyping of the conjugation enzyme uridine diphosphate-glucuronosyltransferase was used to confirm Gilbert's syndrome. Because of the high prevalence rates and similar symptoms of these 2 diseases, hereditary spherocytosis can be masked in patients with Gilbert's syndrome. In review of a case and other article, the possibility of the coexistence of these 2 diseases should be considered, especially in patients with unconjugated hyperbilirubinemia who also have splenomegaly and gallstones.
Adult ; Erythrocytes/physiology ; Gallstones/etiology ; Genotype ; Gilbert Disease/complications/*diagnosis/genetics ; Glucuronosyltransferase/genetics ; Hemolysis ; Humans ; Hyperbilirubinemia/etiology ; Male ; Polymorphism, Single Nucleotide ; Spherocytosis, Hereditary/complications/*diagnosis/genetics ; Splenomegaly/etiology

PURPOSE: Enterovirus (EV) infection in children can manifest various diseases from asymptomatic infection to nonspecific febrile illness, hand-foot-mouth disease, and aseptic meningitis. This study was aimed to investigate epidemiology and clinical significance of various genotypes of EV infections in pediatric inpatient. METHODS: We collected the stool samples from the admitted pediatric patients in Inha University Hospital from March 2014 to March 2015. EV detection and genotype identification were performed by real-time RT-PCR and semi-nested RT-PCR. Phylogenetic trees were constructed by neighbor joining method. RESULTS: A total of 400 samples were collected during study period and 112 patients (28%) were diagnosed with EV infections. The mean age of EV positive patients was 2.66 years (0.1-14) and sex ratio was 1.73:1. Genetic sequences of EVs were identified; coxsackievirus B5 (17, 15.2%), coxsackievirus A16 (13, 11.6%), enterovirus 71 (10, 8.9%), and coxsackievirus A2 (9, 8.0%). Nonspecific febrile illness (96, 86%) was the most common clinical manifestation and the duration of fever was 0-11 days (mean 3.1 days). Rash (44, 39%) and meningitis (43, 38%) were followed. Patients who were attending daycare center or had siblings accounted for 82.1%. Phylogenetic relationship tree revealed 6 distinct genogroups among 56 types of EVs. CONCLUSIONS: This study is the report of epidemiology, serotype distribution and clinical manifestations of children with EV infection in Incheon. This data will be helpful for further study about the epidemiology of EV infection in Korea.
Asymptomatic Infections ; Child ; Enterovirus* ; Epidemiology* ; Exanthema ; Fever ; Genotype ; Humans ; Incheon* ; Inpatients* ; Korea ; Meningitis ; Meningitis, Aseptic ; Sex Ratio ; Siblings ; Trees

BACKGROUND AND OBJECTIVES: Nicorandil is a potassium channel opener, and it has been known to have a cardioprotective effect against ischemia/reperfusion injury. However, the exact mechanisms of the effect are not known. In the previous studies on cardioprotection, administration of nicorandil was started early during the coronary occlusion. Therefore, it is not clear whether nicorandil can also be beneficial when it is administered from the time of coronary recannalization. MATERIALS AND METHODS: We studied 15 cats that had their chests surgically opened (8 nicorandil cats and 7 control cats). The proximal portion of the left anterior descending artery (LAD) was occluded with ligation for 90 minutes, then it was recannalized for 60 minutes. Intravenous injection of nicorandil was started at the time of recannalization of the artery (a bolus of 100 microgram.kg(-1) plus an infusion at a rate of 10 microgram.kg(-1).min(-1) ). At each stage of the experiments, the risk area and myocardial perfusion were assessed using color microspheres and myocardial contrast echocardiography. The size of the infarction was evaluated by postmortem triphenyltetrazolium chloride staining. Myocardial contrast echocardiography was performed with Pulse Inversion Harmonic Imaging (Sonoace9900, Medison). RESULTS: The risk area during coronary occlusion was 18.8+/-12.6% in the nicorandil group and 19.3+/-9.6% in the control group (p=NS). The perfusion defect immediately after and 1 hour after reperfusion was 13.0+/-8.7% and 8.4 +/-7.6%, respectively, in nicorandil group, and 16.7 +/-11.1 % and 13.4+/-8.8%, respectively, in the control group, (p=NS between groups). Myocardial blood flow in the LAD territory during occlusion immediately after and 1 hour after reperfusion was 56+/-31 %, 73+/-31 % and 69+/-28%, respectively, of the normal myocardium in the nicorandil group, and 65+/-20%, 101+/-75% and 77+/-42%, respectively, in the control group (p=NS between groups). The postmortem infarction size was 8.1+/-9.6% in the nicorandil group and 7.7+/-7.5% in the control group (p=NS). CONCLUSION: With administration of nicorandil from the time of recannalization in the ischemia/reperfusion injury model, we could not find any significant cardioprotective effect. The cardioprotective effect of nicorandil may be associated with preconditioning before reperfusion.
Animals ; Arteries ; Cats ; Coronary Artery Disease ; Coronary Occlusion ; Drug Therapy ; Echocardiography ; Infarction ; Injections, Intravenous ; Ischemia ; Ligation ; Microspheres ; Myocardium ; Nicorandil* ; Perfusion ; Potassium Channels ; Reperfusion ; Thorax

BACKGROUND: The opioid sparing effect of low dose ketamine is influenced by bolus dose, infusion rate, duration of infusion, and differences in the intensity of postoperative pain. In this study, we investigated the opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia (PCA) using fentanyl after lumbar spinal fusion surgery, which can cause severe postoperative pain. METHODS: Sixty patients scheduled for elective lumbar spinal fusion surgery were randomly assigned to receive one of three study medications (K1 group: ketamine infusion of 1 microg/kg/min following bolus 0.5 mg/kg, K2 group: ketamine infusion of 2 microg/kg/min following bolus 0.5 mg/kg, Control group: saline infusion following bolus of saline). Continuous infusion of ketamine began before skin incision intraoperatively, and continued until 48 h postoperatively. For postoperative pain control, patients were administered fentanyl using IV-PCA (bolus dose 15 microg of fentanyl, lockout interval of 5 min, no basal infusion). For 48 h postoperatively, the total amount of fentanyl consumption, postoperative pain score, adverse effects and patients' satisfaction were evaluated. RESULTS: The total amount of fentanyl consumption was significantly lower in the K2 group (474 microg) compared to the control group (826 microg) and the K1 group (756 microg) during the 48 h after surgery. Pain scores at rest or with movement, the incidence of adverse events and patient satisfaction were not significantly different among the groups. CONCLUSIONS: Low-dose ketamine at 2 microg/kg/min following bolus 0.5 mg/kg significantly reduced the total amount of fentanyl consumption during the 48 h after lumbar spinal fusion surgery without increasing adverse effects.
Analgesia, Patient-Controlled ; Fentanyl ; Humans ; Incidence ; Ketamine ; Pain, Postoperative ; Patient Satisfaction ; Skin ; Spinal Fusion

The passage of decidual cast in pregnancy is rare and mostly associated with some kind of congenital uterine malformation. Since the hemorrhage caused by the passage of decidual cast can easily be mistaken for other causes of the antepartum hemorrhge, it often leads to the premature delivery of the baby which results poor perinatal outcome. Moreover it mostly happened nonpregnant horn in didelphic or bicornuate uterus, although decidual cast was expelled. We have experienced a case of woman with didelphic uterus and past history of two consecutive premature deliveries, who delivered a female baby at 38 gestational weeks through intensive care after expelling decidual cast in pregnant uterus at 30 gestational weeks. We present this case with a brief review of literatures.
Animals ; Female ; Hemorrhage ; Horns ; Humans ; Critical Care ; Pregnancy ; Pregnancy Trimester, Second* ; Uterus*

OBJECTIVE: Topical steroids are a good option for preventing postoperative sore throat (POST). This study examined whether triamcinolone paste applied as lubricant reduces the severity of POST following laryngeal mask airway (LMA) insertion. METHODS: This was a prospective, randomized, double-blind, placebo-controlled clinical trial. The study enrolled 50 American Society of Anesthesiologists (ASA) I-II patients who were between 20 and 70 years of age and scheduled for elective surgery under general anesthesia. The patients were divided randomly into two groups. Patients in the chlorhexidine group (the placebo group) were inserted with a LMA lubricated with chlorhexidine gluconate jelly, whereas patients in the triamcinolone group were inserted with a LMA lubricated with 0.1% triamcinolone acetonide paste. The patients were interviewed 1, 6, and 24 hours after the operation. The incidence and severity of POST and the incidence of cough and hoarseness were recorded. RESULTS: The difference of the POST incidence during the 24 hours after the operation was not significant (34.8% in triamcinolone group vs. 45.5% in chlorhexidine group, P=0.381). The severity score in the triamcinolone group was significantly lower than the chlorhexidine group at 1 hour after the operation (P<0.001). No significant differences were found in the incidence of cough, hoarseness, dysphagia, nausea, or dry throat between the two groups. CONCLUSION: Triamcinolone paste applied as lubricant reduces the severity of POST following LMA insertion.
Analgesics ; Anesthesia, General ; Chlorhexidine ; Cough ; Deglutition Disorders ; Hoarseness ; Humans ; Incidence ; Laryngeal Masks ; Nausea ; Pharyngitis ; Pharynx ; Prospective Studies ; Steroids ; Triamcinolone ; Triamcinolone Acetonide

OBJECTIVE: The aim of this study was to investigate the effects of intravenous magnesium sulfate on the prevention of pain during the injection of microemulsion propofol. Magnesium is a known calcium channel blocker and a physiological N-methyl-D-aspartate receptor antagonist. METHODS: American Society of Anesthesiologists I and II adults (n=114) undergoing general anesthesia for surgery were randomly assigned into two groups (n=57 per group). This study was designed in prospective and double-blind manner. Patients in the LM group (n=57) received pretreatment with 2% lidocaine (40 mg) and magnesium sulfate 10 mg/kg, while patients in group L (n=57) received pretreatment with 2% lidocaine (40 mg) and normal saline (2 mL) accompanied by venous occlusion. Induction with microemulsion propofol (Aquafol) 2 mg/kg was accomplished following the release of venous occlusion. Pain intensity was assessed on a four-point scale according to patient movement (grade 0, no movement; grade 1, movement in wrist only; grade 2, movement in the upper arm & shoulder of injected arm; grade 3, generalized movement). Systolic blood pressure, diastolic blood pressure, and heart rate were evaluated. RESULTS: A significant difference in pain intensity following injection of microemulsion propofol between the groups was found (P<0.05). In addition, the incidence of hypertension after injection was lower in the LM group than in the L group (P<0.05). CONCLUSION: The combination of magnesium and lidocaine are effective in attenuating the pain induced by microemulsion propofol injection when compared with lidocaine alone.
Adult ; Anesthesia, General ; Arm ; Blood Pressure ; Calcium Channels ; Heart Rate ; Humans ; Hypertension ; Incidence ; Lidocaine ; Magnesium Sulfate* ; Magnesium* ; N-Methylaspartate ; Propofol* ; Prospective Studies ; Shoulder ; Wrist