Kawasaki disease or mucocutaneous lymph node syndrome is an acute inflammatory illness of childhood characterized by systemic panvasculitis. It presents with high fever, dramatic changes of the skin and mucous membranes, and lymphadenopathy. Adult-onset Kawasaki disease is rare and reports on coronary involvement in adult are even rarer. Herein, we report a case of adult-onset Kawasaki disease complicated by splenic infarction and development of coronary aneurysm even despite of treatment with intravenous gamma globulin. A 20-year-old man presented with fever, erytheatous rash, induration and desquamation of hands and feet, pulmonary edema and shock due to cardiomyopathy, splenic infarction, bilateral conjunctivitis, jaundice, and cervical lymphadenopathy. After Kawasaki disease was suspected, intravenous gamma globulin (2 g/kg once) and aspirin (6 g/day) were administered. On the 30th hospital day, transesophageal echocardiography showed one coronary aneurysm and coronary angiography showed three aneurysms. Eight months after the first admission, follow-up coronary angiography showed normalization of the previous coronary abnormalities.
Adult ; Aneurysm ; Aspirin ; Cardiomyopathies ; Conjunctivitis ; Coronary Aneurysm* ; Coronary Angiography ; Echocardiography, Transesophageal ; Exanthema ; Fever ; Follow-Up Studies ; Foot ; gamma-Globulins ; Hand ; Humans ; Jaundice ; Lymphatic Diseases ; Mucocutaneous Lymph Node Syndrome ; Mucous Membrane ; Pulmonary Edema ; Shock ; Skin ; Splenic Infarction* ; Young Adult

The indications and applications of arthroscopic surgery for the knee joint have increased with the development in surgical techniques and the improvement of arthroscopic equipment. The use of arthroscopic surgery has led to a significant decrease in morbidity for the patient with intra-articular abnormalities, in terms of both the diagnosis and the surgical treatments. Even though arthroscopy is a minimally invasive technique with relatively low morbidity, it is not without risk of complications, of which neurovascular complications are among the most serious and devastating. Here we report on 2 cases of popliteal artery injury during arthroscopic knee surgery and its specific diagnosis and treatment.
Arthroscopes ; Arthroscopy ; Humans ; Knee ; Knee Joint ; Popliteal Artery

Dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) is an acute febrile illness characterized by hemorrhagic phenomenon and hypovolemic shock due to increased vascular permeability and plasma leakage in patients infected with any one of four serotypes of dengue virus. The disease is one of the principal causes of hospitalization and death among children in several south-east Asian, central and south American, and African countries. With increasing use of air or ship transport, more travelers and sailors to the tropics are returning within the incubation period of acute febrile infection. Herein we reported the first Korean case of dengue hemorrhagic fever imported from Africa. We experienced a Korean sailor who complains of fever, chill, nausea, and epistaxis after the return from Mombasa, Kenya. His fellows also showed the similar complains. His illness improved spontaneously and the indirect immunofluorescent antibody testing revealed antibody titer of 1:1024 or more.
Africa* ; Asian Continental Ancestry Group ; Capillary Permeability ; Child ; Dengue Virus ; Dengue* ; Epistaxis ; Fever ; Hospitalization ; Humans ; Kenya ; Military Personnel ; Nausea ; Plasma ; Severe Dengue* ; Ships ; Shock

The aims of this study are to demonstrate the reliability and the validity of the Korean version of Behavioral Dyscontrol Scale (BDS-K) and to present the normative values of BDS-K among the Korean elderly. The BDS-K was administered in a standardized manner to 1,389 healthy volunteers aged over 65 years recruited from the community. The elderly with serious neurological, medical or psychiatric disorders were excluded using screening tests. BDS-K showed good internal consistency (Cronbach's alpha=0.812), test-retest reliability (r=0.88) and inter-rater reliability (r=0.99). Age and educational level were found to affect BDS-K score. Based on this result, normative values of BDS-K were calculated by age and educational level. The validity of the BDS-K were demonstrated in comparison with MMSE-KC (r=0.72). BDS-K is reliable and valid instrument for measuring executive function of the elderly. The normative values suggested by this study can be widely used as reference values to objectively interpret BDS-K scores of the Korean elderly.
Aged* ; Executive Function ; Healthy Volunteers ; Humans ; Mass Screening ; Reference Values

OBJECTIVES: Powerful anticoagulant and antiplatelet therapies after coronary stenting may carry the risk of increased bleeding complications if large-bore guiding catheters are introduced via the femoral artery. Recently smaller radial artery is introduced as an entry site for coronary interventions owing to miniaturization of equipments, easy hemostasis and lower access site complications, and little hand ischemia. The purpose of this study is to evaluate the feasibility and safety of coronary stent implantation via the radial artery. METHODS: After a learning curve for transradial diagnostic coronary angiography, stent implantation was attempted in 131 consecutive patients, 135 lesions. Immediately after procedure, the introducer sheath was withdrawn and mobilization was initiated. Clinical follow-up was done for punctured radial arteries. RESULTS: Procedural success and uncomplicated clinical course was achieved in 129(98%) patients, 133(99%) lesions. No stent embolization or migration within the coronary artery, and no procedure-related death, Q wave myocardial infarction or emergent bypass surgery were happened. No stroke or severe arm vessel complications were happened except 4(3%) cases of moderate hematoma. Failed 2 cases were in early period and stents did not pass the lesions due to inappropriate selection and poor backup of guiding catheters. During follow-up of 124+/-36 days, punctured radial arteries showed weak or absent radial pulse in 10(7%) patients, but no claudication or ischemia of hand was observed. CONCLUSION: Transradial coronary stenting was performed safely with high success rate and low complication rate. This study supports that transradial approach is a promising primary route for coronary stenting.
Arm ; Catheters* ; Coronary Angiography ; Coronary Disease ; Coronary Vessels ; Femoral Artery ; Follow-Up Studies ; Hand ; Hematoma ; Hemorrhage ; Hemostasis ; Humans ; Ischemia ; Learning Curve ; Miniaturization ; Myocardial Infarction ; Radial Artery ; Stents* ; Stroke

Human adipose tissue-derived mesenchymal stem cell (hATMSC) have emerged as a potentially powerful tool for bone repair, but an appropriate evaluation system has not been established. The purpose of this study was to establish a preclinical assessment system to evaluate the efficacy and safety of cell therapies in a nude rat bone defect model. Segmental defects (5 mm) were created in the femoral diaphyses and transplanted with cell media (control), hydroxyapatite/tricalcium phosphate scaffolds (HA/TCP, Group I), hATMSCs (Group II), or three cell-loading density of hATMSC-loaded HA/TCP (Group III-V). Healing response was evaluated by serial radiography, micro-computed tomography and histology at 16 weeks. To address safety-concerns, we conducted a GLP-compliant toxicity study. Scanning electron microscopy studies showed that hATMSCs filled the pores/surfaces of scaffolds in a cell-loading density-dependent manner. We detected significant increases in bone formation in the hATMSC-loaded HA/TCP groups compared with other groups. The amount of new bone formation increased with increases in loaded cell number. In a toxicity study, no significant hATMSC-related changes were found in body weights, clinical signs, hematological/biochemical values, organ weights, or histopathological findings. In conclusion, hATMSCs loaded on HA/TCP enhance the repair of bone defects and was found to be safe under our preclinical efficacy/safety hybrid assessment system.
Adipose Tissue/*cytology ; Animals ; Biocompatible Materials/therapeutic use ; Bone Diseases/pathology/radiography/*therapy ; Bone Regeneration/physiology ; Calcium Phosphates/therapeutic use ; Diaphyses/radiography/surgery/ultrastructure ; Disease Models, Animal ; Durapatite/therapeutic use ; Femur/*pathology/radiography/surgery ; Humans ; Male ; *Mesenchymal Stem Cell Transplantation ; Mesenchymal Stem Cells/*cytology ; Rats ; Rats, Nude ; Tissue Engineering ; Tomography, X-Ray Computed ; Transplantation, Heterologous

Malignant melanoma arising from the mucosal surface is a rare, virulent malignant neoplasm frequently associated with an extremely poor prognosis. The sites of initial presentation include the nose, oral cavity, larynx, vulva, vagina, anal canal and rectum. Primary melanoma of the rectum is extremely rare and its histogenesis is controversial. We present a case of primary malignant melanoma arising from the rectum in a 77-year-old woman who presented with intermittent anal bleeding for 2 months. Colonoscopic examination of the rectum revealed a 3.5 3.0 2.7 cm exophytic tumor with a granular surface in the rectum, 5cm from the anal verge. Black colored pigmentation was detected. Distant metastasis to liver was detected on abdominal CT scan. Light microscopy of tumor revealed malignant melanocytes surrounded by normal mucosa. The tumor cells reacted positively for immunohistochemical staining with S-100 protein and HMB-45. Clinical and laboratory examination excluded the presence of melanoma at sites other than rectum. Local excision of the tumor was performed.
Aged ; Anal Canal ; Female ; Hemorrhage ; Humans ; Larynx ; Liver ; Melanocytes ; Melanoma* ; Microscopy ; Mouth ; Mucous Membrane ; Neoplasm Metastasis ; Nose ; Pigmentation ; Prognosis ; Rectum* ; S100 Proteins ; Tomography, X-Ray Computed ; Vagina ; Vulva

A pulmonary thromboembolism usually results from a serious complication of deep venous thrombosis (DVT). However, several prothrombotic genetic risk factors are known to predispose a patient to thrombotic events, with manifestation at a young age. Protein C and S deficiencies are known to increase the risk of venous thrombosis and pulmonary thromboembolism. We report a case of a young patient with protein C and S deficiencies suffering from a massive pulmonary thromboembolism.
Humans ; Protein C Deficiency* ; Protein C* ; Protein S Deficiency ; Pulmonary Embolism ; Risk Factors ; Venous Thrombosis

PURPOSE: We undertook this study to evaluate the effects and the appropriateness of CPR training for elementary school children. METHODS: The Kangwon National University developed a "Human Body Explorer Program", where local fifth and sixth grade students would learn about the human body. The 72 students who participated in this program were used in this study. The subjects were evaluated by comparing CPR data collected from nurses working at Kangwon National University Hospital. The education sessions consisted of a 30 minute video tape and slides; then, under the supervision of their teacher, the subjects were asked to practice what they had seen. Ten criteria were used to evaluate the subject's CPR proficiency. The CPR skill sessions used Laerdal's HeartSim(R) 4000, and the data stored from the HeartSim(R) 4000 were collected for further analysis. A statistical analysis was done using the SPSS statistical software package. A pvalue< 0.05 was considered to statistically significant. RESULTS: A total of 72 subjects were evaluated. Their average age was 13.2+/-0.5 years. The subjects had very little experience with CPR education(0.17) prior to this study. The data gathered were compared to the evaluation table and yielded an average score of 20.53. The criteria used in the study had the following results: The assessing responsiveness(2.0/2.0), activating the EMS (calling for help) (1.99/2.0), checking for breathing(3.47/4.0), and compression to ventilation ratio of 15:2(1.6/2.0) showed to be at the 80 percentile. However the follow criteria showed a less than 80 percentile: opening the airway(1.54/2.0), mouth-to-mouth breathing(2.04/4.0), checking the carotid pulse(2.0/4.0), chest compression(1.88/4.0), chest compression velocity(1.02/4.0), and reassessment(1.44/2.0). The data from the manikin was extrapolated, and upon examination, we found the following: Correct ventilation was 25+/-31%, insufficient ventilation was 67+/-38% and excessive ventilation was 3+/-10%. Correct chest compression was 9+/-23% and insufficient compression was 91+/-23%, and excessive compression was absent. We compared these scores to the score from nurses of Kangwon University Hospital and found that elementary school children scored higher in all variables except in rate of chest compression. The scores were statistically significant (p<0.05) in total score, check for breathing, and reassessment. The skills evaluation showed that the adults scored higher than the elementary school children. All variables were significant (p<0.05). CONCLUSION: We found that elementary school children were superior to adult counterparts in understanding the CPR scheme. An expansion of CPR training to elementary school children is needed.
Adult ; Cardiopulmonary Resuscitation* ; Child* ; Education ; Gangwon-do ; Human Body ; Humans ; Manikins ; Organization and Administration ; Respiration ; Thorax ; Ventilation

PURPOSE: To minimize an interruption in chest compression, reduce the hands-off time, the American Heart Association has recommended changing the ratio of chest compression to ventilation ratio to 30:2. However, current studies have shown that the hands-off time was >10 seconds with that method. For this reason, we reasoned that a chest compression to ventilation ratio of 15:1 would be a more suitable way to reduce hands-off time because this ratio will not change the total compression and ventilation count. METHODS: The subjects were asked to perform CPR for 5 cycles with a compression to ventilation ratio of 30:2. The subjects rested for 5 minutes, then performed CPR with a compression to ventilation of 15:1. The skill performance was measured and analyzed using a statistical program. RESULTS: In the group which performed CPR with a chest compression to ventilation ratio of 30:2, the average number of compressions per minute was 76+/-9, while at a chest compression to ventilation ratio of 15:1, the average number of compressions per minute was 68+/-9. Between the compression to ventilation ratios of 30:2 and 15:1, the count gap was 8.3+/-3.2. When CPR was performed at a chest compression to ventilation ratio of 30:2, the average hands-off time was 9.3+/-1.9. When CPR was performed at a chest compression to ventilation ratio of 15:1, the average hands-off time was 6.7+/-1.3. Between chest compression to ventilation ratios of 30:2 and 15:1, the time gap of the average hands-off time was 2.7+/-1.2 seconds. CONCLUSION: When the chest compression to ventilation ratio was 15:1, the hands-off time was significantly reduced, but the compressions per minute were also reduced.
American Heart Association ; Cardiopulmonary Resuscitation ; Manikins ; Thorax ; Ventilation