A 52-year-old woman with esential mixed cryoglobulinemia (type II ), which was confirmed by cryoglobulin elcct,rophoresis and immunofixation elect,rophoresis, had purpuric skin lesions on the legs. The lesions had a tendency of recurrence for the past 2 years, and moderate degrees of arthralgia and myalgia were accompanied in each time. However, the patient had not been suffered from any internal organ distress caused by the disease proress. Histological examinations of a skin lesions revealed a feature of leukocytoclatic vasculitis, and deposits of IgM, IgG and C; were also recognized. A regimen of small doses of prednisolone was effective for the cutaneous lesions in this patient for 4 months follow-up until this writing. It, seems that the patient has had a mild form of the disease among the clinical spectrum of mixed cryoglobulinemia, with a cryocrit value of 2.4% at the time of her initial visit..
Arthralgia ; Cryoglobulinemia* ; Female ; Follow-Up Studies ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Leg ; Middle Aged ; Myalgia ; Prednisolone ; Recurrence ; Skin ; Vasculitis ; Writing

The ovarian dermoid cyst is the most common ovarian neoplasm in young women and comprises approximately 10-20% of all ovarian tumors. But malignant transformation is an uncommon complication in an ovarian dermoid cyst, usually being reported in about 1.0-1.8% of cases. Most common malignant transformation of ovarian dermoid cyst is squamous cell carcinoma, which represents about 75-80% followed by adenocarcinoma in 6-7%. We report a case of adenocarcinoma arising from ovarian dermoid cyst with a brief review of literatures.
Adenocarcinoma* ; Carcinoma, Squamous Cell ; Dermoid Cyst* ; Female ; Humans ; Ovarian Neoplasms ; Ovary*

The group A streptococcus is capable of producing exotoxins that have been linked to a toxic shock-like syndrome. Streptococcal toxic shock syndrome is a rapidly progressive associated with injury to multiple organ systems and a 30-60% mortality rate. These cases are very rare in Korea. We present a case of 32-year-old prenant woman who developed streptococcal toxic shock syndrome following intrauterine fetal death. She manifestated hypotension, shock, increased level of creatinine, disseminated intravascular coagulopathy, liver impairment, renal failure, pulmonary edema and adult respiratory distress syndrome. Blood cultures yielded Streptococcus pyogenes. After 17 hours on admission, she died in spite of massive transfusion, antibiotics therapy and ventilatory support. Clinicians should be alert to the importance of early diagnosis and treatment of this lethal infection.
Adult ; Anti-Bacterial Agents ; Creatinine ; Early Diagnosis ; Exotoxins ; Female ; Fetal Death* ; Humans ; Hypotension ; Korea ; Liver ; Mortality ; Pulmonary Edema ; Renal Insufficiency ; Respiratory Distress Syndrome, Adult ; Shock ; Shock, Septic* ; Streptococcus ; Streptococcus pyogenes

PURPOSE: Systematic studies on the relationship between health literacy and health outcomes demonstrate that as health literacy declines, patients engage in fewer preventive health and self-care behaviors and have worse disease-related knowledge. The purpose of this study was to identify effective intervention strategies to improve health outcomes in patients with cardiovascular disease and low literacy skills. METHODS: This study employs the following criteria recommended by Khan Kunz, Keijnen, and Antes (2003) for systematic review: framing question, identifying relevant literature, assessing quality of the literature, summarizing the evidence, and interpreting the finding. A total of 235 articles were reviewed by the research team, and 9 articles met inclusion criteria. Although nine studies were reviewed for their health outcomes, only six studies, which had a positive quality grade evaluation were used to recommend effective intervention strategies. RESULTS: Interventions were categorized into three groups: tailored counseling, self-monitoring, and periodic reminder. The main strategies used to improve health outcomes of low literacy patients included tailored counseling, improved provider-patient interactions, organizing information by patient preference, self-care algorithms, and self-directed learning. Specific strategies included written materials tailored to appropriate reading levels, materials using plain language, emphasizing key points with large font size, and using visual items such as icons or color codes. CONCLUSION: With evidence-driven strategies, health care professionals can use tailored interventions to provide better health education and counseling that meets patient needs and improves health outcomes.
Ants ; Cardiovascular Diseases ; Counseling ; Delivery of Health Care ; Health Education ; Health Literacy ; Humans ; Learning ; Patient Preference ; Self Care

BACKGROUND: Defects in mitochondrial function have been shown to participate in the induction of neuronal cell injury. The extracellular-signal-regulated kinase (ERK) signaling pathway plays a crucial role in almost all cell functions, including proliferation, differentiation, survival, and death. However, the effect of ERK inhibition on oxysterol-induced apoptosis remains uncertain. METHODS: This study assessed the effect of ERK inhibition on the apoptotic effect of 7-ketocholesterol. RESULTS: Treatment with 7-ketocholesterol increased phosphorylated-ERK1/2 levels in differentiated PC12 cells, while the total amount of ERK was not altered. 7-Ketocholesterol decreased Bid and Bcl-2 levels, increased Bax and p53 levels, and promoted cytochrome c release, which elicits the activation of caspases (-8, -9, and -3), nuclear damage, and cell death. ERK and farnesyltransferase inhibitors inhibited the 7-ketocholesterol-induced phosphorylation of ERK1/2, activation of apoptosis-related proteins, and cell death in PC12 cells. CONCLUSIONS: The ERK and farnesyltransferase inhibitors, which did not exhibit toxicity, may inhibit the 7-ketocholesterol toxicity on differentiated PC12 cells by suppressing the activation of the caspase-8-dependent pathway as well as activation of the mitochondria-mediated cell-death pathway, leading to the activation of caspases. The inhibition of ERK may confer a beneficial protective effect against the neuronal cell injury induced by cholesterol oxidation products.
Animals ; Apoptosis ; Caspases ; Cell Death ; Cholesterol ; Cytochromes c ; Farnesyltranstransferase ; Ketocholesterols ; Neurons ; PC12 Cells ; Phosphorylation ; Phosphotransferases ; Proteins

High tension electrical burns affecting the wrist are likely to produce full thickness necrosis of the skin and to damage deep vital structures beneath the eschar, affecting he local tendons, nerves, vessels, even bones and joints which result in serious dysfunction of the hand. An aggressive approach to the treatment of these severe wounds and adequate wound coverage are essential for the successful result. From October 1997 to February 2000, we had treated 23 electrical wrist injuries in 20 patients with free flaps. Among these, 13 anterolateral thigh flaps, 5 forearm flaps, 2 scapular flaps, 2 parascapular flaps, and 1 medial leg flap were executed. About 2-4 weeks after initial injury, we tried free flaps. Preoperative debridement was not carried out. At the time of surgery, debridement of all nonviable tissue was done, but nerves, tendons, and bones were left in place with minimal or no debridement when they had anatomic continuity, regardless of their appearance of viability. In all cases, successful soft tissue coverage and wound healing were achieved, and we obtained the following conclusions. 1. Flap coverage should be executed before damage of the tendons, nerves, vessels. 2. As long as the free flap survives, the infected tendons, nerves, and denuded bone can be salvaged. 3. For later reconstruction of the wrist, fasciocutaneous flap should be preferred to promise tendon gliding and endure several operative procedures.
Burns* ; Debridement ; Forearm ; Free Tissue Flaps* ; Hand ; Humans ; Joints ; Leg ; Necrosis ; Skin ; Surgical Procedures, Operative ; Tendons ; Thigh ; Wound Healing ; Wounds and Injuries ; Wrist Injuries ; Wrist*

BACKGROUND: Flavonoid luteolin has been shown to exhibit cell protective effect. However, it is still uncertain whether the effect of luteolin on cellular toxicity of the parkinsonian toxin 6-hydroxydopamine is mediated by apoptosis-related protein activation. METHODS: In differentiated PC12 cells exposed to 6-hydroxydopamine in combination with luteolin, we observed the apoptosis-related protein activation, nuclear damage, formation of reactive oxygen species and cell death. RESULTS: 6-Hydroxydopamine caused apoptosis by inducing a decrease in Bid, Bcl-2, Bcl-xL and survivin levels, increase in Bax levels, cytochrome c release and activation of caspases. Treatment with luteolin reduced changes in the apoptosis-related protein levels, formation of reactive oxygen species, nuclear damage and cell death. CONCLUSIONS: Luteolin may reduce the 6-hydroxydopamine-induced apoptosis in differentiated PC12 cells by suppressing the activation of the caspase-8- and Bid-dependent pathways and the mitochondria-mediated apoptotic pathway, leading to caspase activation. The preventive effect of luteolin may be associated with its inhibitory effect on the production of reactive oxygen species. Luteolin may attenuate the oxidative stress and mitochondrial dysfunction-induced neuronal cell death take place in Parkinson's disease.
Animals ; Apoptosis ; Caspases ; Cell Death ; Cytochromes c ; Hypogonadism ; Luteolin ; Mitochondrial Diseases ; Neurons ; Ophthalmoplegia ; Oxidative Stress ; Oxidopamine ; Parkinson Disease ; PC12 Cells ; Reactive Oxygen Species

We present a case of problematic tracheal intubation in an adult patient with an unrecognized tracheal bronchus. Immediately after tracheal intubation and position change to prone, bilateral breath sounds were almost absent, and there was a diminished tidal volume. In order to resolve the ventilatory difficulty, the wire-reinforced tube was replaced with a conventional tube, and proper positioning of the tube was completed under fiberoptic guidance. A tracheal bronchus (originating about 1.2 cm above the carina, and supplying the right upper lobe) was found on the postoperative chest CT. In the presence of tracheal bronchus, tracheal intubation may cause pulmonary complications. Anesthesiologists should keep in mind the anesthetic implications of tracheal bronchus, and must be familiar with the use of fiberoptic bronchoscopy for proper positioning of endotracheal tube.
Adult ; Bronchi ; Bronchoscopy ; Humans ; Intubation ; Intubation, Intratracheal ; Thorax ; Tidal Volume

In recent years a concern of excessive intakes of vitamins and minerals from various sources is increasing, since there has been a marked increase in production and consumption of vitamin and mineral supplements and fortified foods. The purpose of this study was to assess the maximum exposure of vitamins and minerals from various sources including diet, fortified foods, and health functional foods among Koreans. As a result, the highest exposure group of most vitamins and minerals from diet was adults (30 - 49 years of age) according to 2001 Korean National Nutrition and Health Survey Report. Maximum dietary intakes of vitamin A, B1, B2, C, nicotinamide, calcium, phosphorus and iron were 0.5 - 7 times of the RDA for Koreans, 7th ed. Maximum intakes of vitamins and minerals from fortified foods by adults (20 - 59 years of age) were 8 - 760% of the Korean RDA. In addition, maximum exposure of vitamins and minerals from vitamin.mineral health functional foods by middle aged people was 35 - 140% of the upper limits (UL: DRI for Koreans). As a consequence, maximum combined intakes of vitamin B6, vitamin C, calcium, iron and zinc from the above sources including diet, fortified foods and vitamin.mineral health functional foods were greater than the UL. These results would be applied for determining the safe upper limits of vitamin and mineral of health functional foods.
Adult ; Ascorbic Acid ; Asian Continental Ancestry Group ; Calcium ; Diet ; Food, Fortified ; Functional Food ; Health Surveys ; Humans ; Iron ; Middle Aged ; Minerals* ; Niacinamide ; Phosphorus ; Vitamin A ; Vitamin B 6 ; Vitamins* ; Zinc

The purposes of this study were to assess the preferences for one-dish items and the combination preferences of one-dish items and side dishes that were served and eaten together. Participants were 710 fifth grade of elementary school children who were asked to write three of their favorite one-dish items and to select a preferred side dish among 25 of items for each one-dish item. In this way total 41 one-dish items were assessed to combine with a preferred side dish. The results showed that schoolchildren chose Kuksu as their most favorite one-dish item followed by Jajangmyon and curry rice. Kimchi was the most preferred side dish when they consumed one-dish items, especially Ramyon, Jabchebab, and one-dishes containing much broth. Danmugy was liked when they consumed Gimbab, Jajangbab, and Jajangmeon. Kackdugi was chosen as a favourite side dish when they ate Chungmugimbab and fruit salad was most preferred with Spaggetti. There is a difference in preference for side dishes among the three areas of residence. More schoolchildren in Namhae than in Jinju or in Busan liked Kackdugi when they consumed several one-dish items, like curry rice and Dakjuk.
Busan ; Child ; Fruit ; Gyeongsangnam-do ; Humans