BACKGROUND: The improved technique for cardiopulmonary resuscitation(CPR) has resulted in the survival of many patient who experienced cardiac arrest. However, mortality in resuscitated patients is high, and the survival rate without brain damage is very low. Various neurological examination models, neuro-imaging techniques, electrophysiological procedures, and biochemical tests have been studied with respect to the detection of cerebral damage and outcome, but an early, reliable prediction of individual outcomes is still uncertain. METHODS: We studied twenty patient who had been in a coma for more than 24 hours after CPR, Somatosensory evoked potentials(SEP) were measured within the first three days after CPR. RESULTS: Of the twenty patients, seven patients(35%) had a good outcome, and thirteen patients(65%) had a bad outcome. Of the eleven patients with loss of the cortical evoked potential's N20 peak, all had a bad outcome. CONCLUSION: SEPs are of great benefit in prognostic evaluation after CPR.
Brain ; Cardiopulmonary Resuscitation* ; Coma* ; Evoked Potentials, Somatosensory* ; Heart Arrest ; Humans ; Mortality ; Neurologic Examination ; Survival Rate

BACKGROUND: Tumor necrosis factor-alpha(TNF-alpha) has been thought to play a major role in neurological injury during global brain ischemia and subsequent reperfusion following resuscitation in cardiac arrest. So, we hypothesized that the elevation in TNF-alpha was dependent upon the duration of the global brain ischemia, and related to delayed neuronal damage. METHODS: Fourteen rats were divided two groups ; 1 minute-cardiac arrest group(n=7) and 3 minute-cardiac arrest group(n=7). we induced cardiac arrest by chest compression and damping of tracheal tube for 1 minute and 3 minutes respectively. And then, resuscitation was initiated. To measure the plasma activity of TNF-alpha, blood samples were drawn before and at the end of cardiac arrest, and 30, 60, 90, and 120 minutes after initiation reperfusion. At 72 hours after resuscitation, the ND(neurologic deficit) score was determined and the histopathologic outcome of hippocampal CA1 neuron was observed by the percent dead hippocampal CA1 neurons. RESULTS: 1. TNF-alpha level during the early reperfusion period(<2h) was significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(p=0.0001). 2. There was a no significant difference of neurologic deficit score between 1 min- and 3 min-cardiac arrest. 3. Percent dead hippocampal neurons were significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(9.1+/-1.2% vs 1.2+/-0.9%, p<0.05). CONCLUSION: The results suggest that longer duration of global brain ischemia causes a more profound increase in plasma TNF-alpha level during the early reperfusion period(<2h) and more delayed neuronal damage than lessor duration of global brain ischemia, and that increase in TNF-alpha level during the early reperfusion period(<2h) is related to delayed neuronal damage.
Animals ; Brain Ischemia ; Brain* ; Heart Arrest* ; Heart Arrest, Induced ; Necrosis ; Neurologic Manifestations ; Neurons ; Plasma ; Rats* ; Reperfusion ; Reperfusion Injury* ; Resuscitation ; Thorax ; Tumor Necrosis Factor-alpha*

PURPOSE: Cholestasis is a major complication in prolonged use of TPN, especially in the neonatal period, but there are few long-term reviews examining the clinical course in premature infants. Thus, in this study, we reviewed premature infants with TPN-associated cholestasis(TPNAC) to determine the incidence, clinical courses and possible risk factors. METHODS: Retrospective review of 66 premature infants less than 2,000 gm of birth weight and on TPN for more than two weeks was performed. Cholestasis was defined as a serum direct bilirubin level greater than 2.0 mg/dL. The clinical course of cholestasis was described, and perinatal risk factors were evaluated. RESULTS: TPNAC developed in 21 out of 66 infants(31.8%). The onset was 41.7+/-17.4 days after receiving TPN, and the mean duration was 33.6 +/- 23.4 days. The incidence of TPNAC was significantly correlated with birth weight, and gestational age, and duration of TPN. But, possible etiologic factors, such as incidence of perinatal asphyxia or infection, showed no remarkable differences between infants with TPNAC and those without TPNAC(control). The enteral intake in the third postnatal week was significantly smaller in infants with TPNAC than in the control infants(P=0.033). CONCLUSION: The enteral intake in the third postnatal week was smaller in the infants with TPNAC than in the control infants. Thus, the incidence of TPNAC may be reduced by increasing the amount of oral intake during TPN in high risk infants.
Infant ; Male ; Female ; Infant, Newborn ; Humans ; Incidence ; Risk Factors

No abstract available.

BACKGROUND: Routine typing for HLA-B27 has been usually accomplished by the microcytotoxicity assay in Korea because it does not require special equipment and is easily reproducible. Recently, an immunofluorescence method and the polymerase chain reaction have also been applied for HLA-B27 testing. However, the current economic crisis in Korea have led domestic manufacturers to develop a Korean HLA-B27 typing kit. The aim of this study was to assess the advantages and disadvantages of this kit and to assess the possibility of replacing the currently used foreign-made kits with this domestic one. METHODS: HLA-B27 testing by the microcytotoxicity test was performed on 116 patients during a period of 3 months in 1998. The Biotest typing tray and the Chongkundang typing tray were tested simultaneously. Results: There was no difference in results in 116 samples (positive: 39, negative: 77). The Korean typing tray showed high false positivity of the negative control well (8 point: 1 case, 6 point: 33 cases, 4 point: 47 cases, 2 point: 17 cases, 1 point: 18 cases) and 6 of the HLA-B27 negative cases showed false positivity in one of the four HLA-B27 wells. Typing of HLA-Bw4 and Bw6 revealed an inconsistency in five and six cases, respectively. CONCLUSIONS: Despite of the false positivity of the negative control in Korean panel, we believe that Korean typing tray can replace the foreign-made tray due to its low cost and adequate performance. Because placenta of Korean multiparous women was used for the kit, Chongkundang typing tray seems to correlate better with Korean HLA-B27 subtypes.
Cytotoxicity Tests, Immunologic ; Female ; Fluorescent Antibody Technique ; HLA-B27 Antigen* ; Humans ; Korea ; Placenta ; Polymerase Chain Reaction

Autopsy ; Forensic Pathology ; Humans ; Korea ; Mortality ; Public Health

OBJECTIVES: This study was conducted to propose the need of re-establishing the criteria of the body weight classification in the elderly. We compared the Asia-Pacific Region Criteria (APR-C) with Entropy Model Criteria (ENT-C) using Morbidity rate of chronic diseases which correlates significantly with Body Mass Index (BMI). METHODS: Subjects were 886 elderly female participating in the 2007-2009 Korea National Health and Nutrition Examination Survey (KNHANES). We compared APR-C with those of ENT-C using Receiver Operating Characteristics (ROC) curve and logistic regression analysis. RESULTS: In the case of the morbidity of hypertension, the results were as follows: Where it was in the T-off point of APR-C, sensitivity was 67.5%, specificity was 43.1%, and Youden's index was 10.6. While in the cut-off point of ENT-C, it was 56.7%, 56.6%, and 13.3 respectively. In the case of the morbidity of diabetes, the results were as follows: In the cut-off point of APR-C, Youden's index was 14.2. While in the cut-off point of ENT-C, it was 17.2 respectively. The Area Under the ROC Curve (AUC) of the subjects who had more than 2 diseases among hypertension, diabetes, and dyslipidemia was 0.615 (95% CI: 0.578-0.652). Compared to the normal group, the odds ratio of the hypertension group which will belong to the overweight or obesity was 1.79 (95% CI: 1.30-2.47) in the APR-C, and 2.04 (95% CI: 1.49-2.80) in the ENT-C (p > 0.001). CONCLUSIONS: We conclude that the optimal cut-off point of BMI to distinguish between normal weight and overweight was 24 kg/m2 (ENT-C) rather than 23 kg/m2 (APR-C).
Aged* ; Body Mass Index* ; Body Weight ; Chronic Disease* ; Classification ; Dyslipidemias ; Entropy* ; Female ; Humans ; Hypertension ; Korea ; Logistic Models ; Nutrition Surveys ; Obesity ; Odds Ratio ; Overweight ; ROC Curve ; Sensitivity and Specificity

This study was designed to identify the ultrastructural changes of mouse endometrum during peri-implantation period and obtain the fundamental information for the establishment of 3-dimensional culture system of mouse endometrial cells in vitro. The used female ICR mice (6~8 wks) were conducted on pregnant. The biopsies were obtained from whole uterus at cycle day 1 (D1) and day 5 (D5) after hCG injection and mating. The biopsies materials were fixed 2.5% glutaraldehyde and 1% osmium tetroxide. Subsequently, for observation using light and transmission electron microscopy (LM and TEM), they were dehydrated and embedded in Epon and the embedded biopsies were sectioned and stained. For scanning electron microscypy (SEM), the fixed specimens were dehydrated, dried and coated with gold. 1)For LM, the biopsied materials at D5 (late secretory phase) were appeared the extended stromal layer by increased connective tissues and the fully developed endometrial glands and vessels compared with D1 (early secretory phase). 2) For TEM, the mouse endometrium was consisted of 3-layers, a simple polarized columnar epithelial cells, basement membrane and stromal cells. At D5, the distribution of microvilli, endoplasmic reticulum, Golgi body, lipid and glycogen deposits, secretory granules and surface area of basement membrane were increased. 3) For SEM, the degree of folding and microvilli of surface of mouse epithelial cells was became more and more according to the process of secretory phase, and at D5, implantation time of mouse, the appearance of pinopodes as a specific marker of uterine receptivity was found. The uterine pinopodes of mouse were found in narrow sites at the luminal surface, irregularity and appeared the different stages in the same sample. Therefore, these results indicated that the mouse endometrium was experienced dramatic morphological changes during peri-implantation period.
Animals ; Basement Membrane ; Biopsy ; Connective Tissue ; Endometrium* ; Endoplasmic Reticulum ; Epithelial Cells ; Female ; Glutaral ; Glycogen ; Humans ; Mice* ; Mice, Inbred ICR ; Microscopy, Electron, Transmission ; Microvilli ; Osmium Tetroxide ; Phenobarbital ; Secretory Vesicles ; Stromal Cells ; Uterus

We experienced two cases of Boerhaave syndrome (spontaneous esophageal rupture). The first patient was a 62-year-old male who presented epigastric pain after several violent vomitings associated with alcohol ingestion. Diagnosis was done early and promptly in our emergency center and then definitive treatment was done only after 12hrs from onset of his symptom and he was discharged in relatively good condition 256ays after his admission. The second patient was a 44-year-old male who was transfered to our emergency center with chest pain, dyspnea and fever after vomitings associated with autobicycle accident. Diagnosis was delayed due to initial trauma oriented evaluation and incidious develpement of typical clinical findings and then he was managed conservatively but he died of multiple organ failure due to sepsis. We report these cases with literature review.
Adult ; Chest Pain ; Diagnosis ; Dyspnea ; Eating ; Emergencies ; Esophageal Perforation* ; Fever ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Sepsis

Syphilis is a rare cause of aortic inflammatory lesion and stroke. A 65-year-old woman presented with sudden onset of right hemiplegia and hemianopsia. Magnetic Resonance (MR) imaging of the brain revealed bihemispheric cerebral infarctions. Echocardiography demonstrated aortic regurgitation, pericardial effusion, and dilatation of the aortic root. MR aortography showed intramural hematoma in dilated ascending and descending aorta. The serum Venereal Disease Research Laboratory and Treponema Pallidum Haemagglutination test were positive. The level of protein in cerebrospinal fluid was increased. After treatment with penicillin for three weeks, her neurological status progressively improved. As syphilis can lead to aortitis and aortic dissection, it should be considered as a treatable cause of stroke.
Aged ; Aorta, Thoracic ; Aortic Valve Insufficiency ; Aortitis ; Aortography ; Brain ; Cerebral Infarction ; Dilatation ; Echocardiography ; Female ; Hematoma ; Hemianopsia ; Hemiplegia ; Humans ; Magnetic Resonance Spectroscopy ; Penicillins ; Pericardial Effusion ; Sexually Transmitted Diseases ; Stroke ; Syphilis ; Syphilis, Cardiovascular ; Treponema pallidum