BACKGROUND AND OBJECTIVES: The Oriental herbal materials known as aconitine have long been used in oriental traditional medicine for their analgesic and antiinflammatory effects. Aconitine and its related alkaloids are known cardiotoxins with no therapeutic role in modern western medicine. We have studied the cardiovascular side effects of intoxication that took place in otherwise healthy individuals after ingestion of herbal decoctions containing aconite alkaloids. MATERIALS AND METHOD: During a six-year interval from 1990 to 1996, 9 cases of accidental herb-induced aconitine intoxication were managed in Kyung Hee university medical center. Hospital records were reviewed in detail. RESULTS: All patients developed symptoms of aconitine toxicity within 4 hours of herb ingestion. The frequency of the order in cardinal symptoms of acute aconitine poisoning was nausea or vomiting, irritability, chest discomfort, dizziness, etc. Nine patients developed arrhythmias, including multifocal APC with aberrancy, multifocal VPC, ventricular tachycardia, etc. Administration of isotonic saline, dopamine, atropine and lidocaine with supportive cares brought clinical recovery and disappearance of arrhythmias in most cases within several hours. However, one case of acute aconitine poisoning had been dead of cardiac arrest due to ventricular fibrillation. CONCLUSION: Aconitine and its related alkaloids can cause toxic effects and even fatal poisoning. These cases point to the need for strict surveillance of herbal substances with low safety margins.
Academic Medical Centers ; Aconitine* ; Aconitum ; Alkaloids ; Arrhythmias, Cardiac ; Atropine ; Cardiotoxins ; Dizziness ; Dopamine ; Eating ; Heart Arrest ; Hospital Records ; Humans ; Lidocaine ; Medicine, East Asian Traditional ; Nausea ; Poisoning* ; Tachycardia, Ventricular ; Thorax ; Ventricular Fibrillation ; Vomiting

A case of metastatic adrenal cortical carcinoma in which partial remission was achieved with transarterial embolization is presented as probably the first reported case in the literature to date. A 29-year-old woman was admitted because of adrenal cortical carcinoma which had not responded to mitotane. A left adrenalectomy with segmentectomy of the involved liver had been done previously. Abdominal computerized tomography demonstrated multiple large metastatic tumors in the liver. Transarterial embolization with Gelfoam and 20 mCi of 131I-labeled lipiodol was performed and resulted in a decrease in tumor size and biochemical parameters. Transarterial embolization can be one of the therapeutic modalities for metastatic adrenal cortical carcinomas.
Adrenal Cortex Neoplasms/metabolism/*therapy ; Adult ; *Embolization, Therapeutic ; Female ; Gelatin Sponge, Absorbable ; Hepatic Artery ; Humans ; Hydrocortisone/metabolism ; Iodine Radioisotopes ; Iodized Oil ; Liver Neoplasms/metabolism/*secondary/*therapy

BACKGROUND: Knowledge of the roles of tacrolimus and minidose methotrexate (MTX) in the prevention of acute graft-versus-host disease (aGVHD) in pediatric allogeneic hematopoietic stem cell transplantation (HSCT) is limited. We retrospectively evaluated the engraftment status, incidence of aGVHD and chronic GVHD (cGVHD), and toxicities of tacrolimus and minidose MTX in aGVHD prophylaxis in children undergoing allogeneic HSCT. METHODS: Seventeen children, who underwent allogeneic HSCT and received tacrolimus and minidose MTX as GVHD prophylaxis from March 2003 to February 2011, were reviewed retrospectively. All the patients received tacrolimus since the day before transplantation at a dose of 0.03 mg/kg/day and MTX at a dose of 5 mg/m2 on days 1, 3, 6, and 11. RESULTS: Of the 17 patients, 9 received human leukocyte antigen (HLA)-matched related donor transplants, and 8 received HLA-matched, or partially mismatched unrelated donor transplants. The median time for follow-up was 55 months. The incidence of aGVHD in the related and unrelated donor groups was 22.2% and 42.9%, respectively. cGVHD was not observed. To maintain therapeutic blood levels of tacrolimus, the younger group (<8 years of age) required an increased mean dose compared to the older group (> or =8 years) (P=0.0075). The adverse events commonly associated with tacrolimus included hypomagnesemia (88%), nephrotoxicity (23%), and hyperglycemia (23%). CONCLUSION: Tacrolimus and minidose MTX were well tolerated and effective in GVHD prophylaxis in pediatric patients undergoing allogeneic HSCT. Children <8 years of age undergoing HSCT required increased doses of tacrolimus to achieve therapeutic levels.
Child ; Follow-Up Studies ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Hyperglycemia ; Incidence ; Korea ; Leukocytes ; Methotrexate ; Retrospective Studies ; Tacrolimus ; Tissue Donors ; Transplants ; Unrelated Donors

BACKGROUND: There have recently been some reports suggesting that once-daily intravenous busulfan (IV Bu) as a conditioning regime for hematopoietic stem cell transplantation (HSCT) possibly reduces the toxicities without influencing the clinical outcome as compared with the traditional 4 times daily dosage schedule. We report here on the clinical outcome of once-daily IV Bu as a conditioning regime for HSCT in children with AML at a single treatment center. METHODS: We retrospectively analyzed nine AML children who received HSCT with using the once-daily IV Bu (110~130 mg/m2 on 4 consecutive days) conditioning regimen at the Department of Pediatrics, Pusan National University Hospital from 2003 to 2007. RESULTS: The median age at HSCT was 8.25 years. As for the conditioning regimens, the HLA-matched sibling peripheral HSCT (N=4) was Flu/Bu, the CBT and unrelated BMT (N=4) was Flu/Bu/ATG and the autologous HSCT (N=1) was Bu/Cy. There was only one case of primary graft failure in an unrelated donor CBT recipient. The median time to neutrophil engraftment was 14 days and the median time to platelet engraftment was 19 days. The transplant-related toxicities were acceptable; there were no case with CNS toxicity and VOD was observed in two cases (1 mild case of VOD and 1 moderate case of VOD). Acute GVHD was noted in two cases (1 case of grade I and 1 case of IV). With a median follow up of 33 months, there were two cases of relapse and two cases of death. CONCLUSION: Once-daily IV Bu as a conditioning regimen for HSCT in children with AML was well tolerated and convenient with relatively moderate toxicities, but additional studies are needed to determine the therapeutic efficacy and pharmacokinetics of once-daily IV Bu in children who are undergoing HSCT.
Appointments and Schedules ; Blood Platelets ; Busulfan ; Child ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Leukemia, Myeloid, Acute ; Neutrophils ; Pediatrics ; Recurrence ; Retrospective Studies ; Siblings ; Transplants ; Unrelated Donors

PURPOSE: The aim of this study was to investigate the incidence and course of neutropenia following intravenous immunoglobulin (IVIG) therapy in children with idiopathic thrombocytopenic purpura (ITP). METHODS: From January 2001 to June 2006, fifty-four patients with ITP were enrolled in this study. Forty-two of 54 patients were treated with IVIG, while the other 12 were treated with anti-D immunoglobulin (Anti-D Ig). Post-treatment absolute neutrophil counts (ANC) were compared between patients who received IVIG and those who received Anti-D Ig. Comparison of post-treatment ANC between patients who treated with two different IVIG regimens (400 mg/kg/day for 5 days and 1 g/kg/day for 2 days) was also performed. RESULTS: Pretreatment ANC were not significantly different between the two treatment groups. After treatment with IVIG, 32 out of 42 patients (76.2%) showed more than 50% decrease of ANC from the baseline. On the other hand, only 2 out of 12 patients (16.7%) showed more than 50% decrease of ANC from the baseline after treatment Anti-D Ig. No significant difference was observed in the decline of ANC between the first IVIG treatment (42 patients) and repeated IVIG treatment groups (7 patients). There was no statistical difference in post-treatment ANC between patients who treated with two different IVIG regimens. The neutropenia induced by IVIG had resolved spontaneously in 38 out of 39 patients (97%) after several days. CONCLUSION: Neutropenia following IVIG administration may not be an uncommon finding in children with ITP. It seems to be transient and self limited.
Child ; Hand ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Isoantibodies ; Neutropenia ; Neutrophils ; Purpura, Thrombocytopenic, Idiopathic

BACKGROUND: Catheter-associated peritonitis occurs frequently in patients with chronic renal failure with peritoneal dialysis. It can be controlled by antibiotics, but relapses are common due to biofilms that affect the pathogenesis of peritonitis. This study was designed to evaluate the efficacy of antibiotics against biofilm formed by Staphylococcus epidermidis which is the most common causative organism of peritonitis in patients with peritoneal dialysis. METHODS: After incubation of silastic plates for 24 hours in peritoneal dialysis fluid containing S. epidermidis, the establishment of bacterial biofilm on the plates was confirmed by scanning electron microscopy. Then the plates were incubated in dialysate containing various concentrations of antimicrobial agents, such as vancomycin, roxithromycin or rifampin, in combination or alone. The quantification of organisms on silastic plates was performed for evaluation of antibiotic efficacy against biofilm formed by S. epidermidis after getting samples of plates at 0 hour, 4, 24, and 48 hours after incubation. RESULTS: The reduction of colony counts in groups with antibiotics was significantly larger than that in the control group and the difference was increased as time passed. In vancomycin treated plates, the colony count per plate for 2xMIC (minimal inhibitory concentration) was significantly lower than that for 1/8xMIC or 1/64xMIC at 4 hour, but no significant differences were noted at 24 hours and 48 hours among those of the various concentrations. The reduction of colony counts in accordance with concentrations of roxithromycin was not significantly different at 4 hours, but the reduction for 1/8xMIC was larger than that for 1/64xMIC at 24 hours and 48 hours. The reduction of colony counts in accordance with concentrations of rifampin was not significantly different at 4 hours, but the reduction for 1/8xMIC was larger than that for 1/64xMIC at 24 hours and 48 hours. There was no significant difference in reduction of colony counts between groups of anti-biotic combination containing vancomycin and groups of vancomycin alone. CONCLUSIONS: It is suggested that the sub-inhibitory concentrations of vancomycin, roxithromycin, and rifampin might be effective on biofilm-forming S. epidermidis in in vitro model of infection related with peritoneal dialysis catheter. This result may be applicable for development of a new method to control biofilm-associated peritonitis during peritoneal dialysis.
Anti-Bacterial Agents ; Anti-Infective Agents ; Biofilms* ; Catheters ; Humans ; Kidney Failure, Chronic ; Microscopy, Electron, Scanning ; Peritoneal Dialysis ; Peritonitis ; Recurrence ; Rifampin* ; Roxithromycin* ; Staphylococcus epidermidis* ; Staphylococcus* ; Vancomycin*

A patient, 59 years old male, with paroxysmal AV reentrant tachycardia utilizing a concealed left lateral accessory pathway with long VA conduction time is presented. During tachycardia P waves were negative in leads I, aVL, and V6 and positive in leads aVR and V1. The R-P/P-R ratio was 1.6. Radiofrequency catheter ablation was successful to interrupt the VA conduction through the accessory pathway.
Catheter Ablation ; Humans ; Male ; Middle Aged ; Tachycardia*

Nicotine is one of the major components of cigarette smoking which causes various systemic and local diseases to human body. The purpose of the present study was to investigate the effects of nicotine on bone mineralization in human fetal osteoblasts cell line(hFOB1). To compare the alkaline ph-osphatase(ALP) synthesis, hFOB1 were cultured with DMEM/F-12 1:1 Mixture and 100 pg/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1 microgram/ml, 10 microgram/ml, 100 microgram/ml of nicotine. And to compare the calcium accumulation, hFOB1 cultured for 23 days were quantified and photographed. ALP activity of hFOB1 exposed to nicotine was not significantly changed at a lower concentrations of nicotine, but was significantly decreased at a higher concentrations (10 microgram/ml, 100 microgram/ml) of nicotine (p<0.05). A quantified calcium acculation in hFOB1 was significantly decreased at 1, 10, and 100microgram/ml of nicotine (p<0.05). Significantly decreased calcium deposition was observed at 1, 10, and 100microgram/ml of nicotine. These results indicate that a higher concentration of nicotine show a negative effects on mineralization of hFOB1.
Calcification, Physiologic ; Calcium ; Human Body ; Humans* ; Nicotine* ; Osteoblasts* ; Smoking

Interhemispheric approach has been accepted as a standard method approaching distal anterioir cerebral artery(DACA) aneurysm. In the approach, most authors use the surgical method retracting the superior sagittal sinus(SSS) after dural reflection. However, it results in limited surgical space and makes the surgical procedure difficult technically. To overcome the limitation, we tried to ligate and cut SSS in 13 patients out of 23 patients of DACA aneurysm from Mar. 1983 to Feb. 1993. Out of total 583 intracranial aneurysms operated on in that period, the proportion of DACA aneurysm was 3.95%. Mean age was 52.7 years ranging from 32 to 66 years. The sex ration was 7:16, showing female predominancy. As presenting symptoms, twenty two patients had subrachnoid hemorrhage and one patient had a third nerve palsy due to an unruptured posterior communicating artery aneurysm. On admission, 4 patients(17.4%) were in grade I, 10(43.5%) in grade II, 6(26.1%) in grade III, 3(13%) in grade IV according to the Hunt and Hess grading system. In 18 patients(78.3%), aneurysms were located at bifurcation of pericallosal and callosomarginal artery and in 5(21.7%) at bifurcation of frontopolar and pericallosal artery. Associated vascular anomalies were A1 hypoplasia(2 cases), multiple aneurysms(5 cases), fenestration of anterior cerebral(1 case) and arteriovenous malformation(1 case). Thirteen cases were operated on with ligation of the SSS and 10 without ligation. Overall surgical outcomes scored by Glasgow outcome scale were : 11 patients(47.8%) in Grade I, 6(26.1%) in Grade II, 2(8.7%) in Grade III, 4(17.4%) in Grade V. The outcomes in ligation group were : 8 patients(61.5%) in Grade I, 4(30.8%) in Grade II, 1(7.7%) in Grade III, and no death. The outcomes in non-ligation group were : 4 patients(40%) in Grade I, 1(10%) in Grade II, 1(10%) in Grade III, and 4(40%) in Grade V. These results showed that the patients operated on with ligation of SSS had more favorable outcomes than the patients without ligation. It seems that the SSS in the interhemispheric approach might provide several advantages and better operative outcome over the conventional method.
Aneurysm ; Anterior Cerebral Artery* ; Arteries ; Female ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Ligation* ; Oculomotor Nerve Diseases ; Superior Sagittal Sinus

Galactosemia is a group of inherited enzyme deficiencies characterized by increase in the blood galactose levels. This condition may be associated with deficiencies of galactose-1-phosphate uridyl transferase, galactokinase, or uridine diphosphate galactose-4-epimerase. However, the elevated galactose identified by neonatal screening tests has several other possible etiologies, including hepatic hemangioendothelioma, hepatic hemangioma, and patent ductus venosus with hypoplasia of the portal vein. We report a 13-day-old Korean male with hepatic hemangioendothelioma, which was incidentally detected during the evaluation for suspected galactosemia. Laboratory studies revealed that mildly elevated levels of galactose, galactose-1-phosphate and alpha-fetoprotein, at the time of admission, were gradually decreased to the normal range over the 6 months of observation. Ultrasonography showed a well-defined heterogeneous hypoechoic mass in the liver, and magnetic resonance imaging study showed multiple enhanced mass lesions, which was compatible with the diagnosis of a hepatic hemangioendothelioma. Thus, hepatic imaging, especially ultrasonography, should be performed if neonatal screening suggests galactosemia.
alpha-Fetoproteins ; Galactokinase ; Galactose ; Galactosemias ; Galactosephosphates ; Hemangioendothelioma ; Hemangioma ; Humans ; Infant ; Infant, Newborn ; Liver ; Magnetic Resonance Imaging ; Male ; Neonatal Screening ; Portal Vein ; Reference Values ; UDPglucose-Hexose-1-Phosphate Uridylyltransferase ; Uridine Diphosphate ; Vascular Malformations