PURPOSE: Creatine kinase (CK) elevation is caused by rhabdomyolysis, intense exercise, muscle damage, and several drugs. This study evaluated the clinical significance of elevated serum CK levels in patients with an intensive care unit (ICU) and their effects on muscle strength. METHODS: The database of 179 patients, who were examined with CK a t least once among patients in the Samsung Medical Center ICU database, was reviewed retrospectively. Forty-eight patients with a myocardial infarction were excluded and 131 patients were analyzed. The clinical features of patients with an elevated CK of more than 2,000 IU/L (more than 10 times the normal value) and those who did not were compared. RESULTS: The ICU stay days were longer in the high elevation group than the other group (8.6 days vs. 21.7 days, p=0.002). The high elevation group was more likely to go to other treatment centers than home after discharge (14.6% vs. 60.0%, p=0.007). When the Medical Research Council scale was measured, the score of the high elevation group was lower than that of the other group (17.2 vs. 13.3, p=0.006). CONCLUSION: Patients with high CK levels were more likely to receive invasive treatment in the ICU, so their muscle strength may decrease with increasing ICU stay and were less likely to be discharged home because of difficulties in living alone. Therefore, in patients with high CK, anticipating long-term treatment in an ICU, minimizing muscle loss, and maintaining functional muscle strength through active rehabilitation will be helpful for the prognosis of the patient.
Creatine Kinase* ; Creatine* ; Critical Illness* ; Humans ; Intensive Care Units ; Muscle Strength ; Myocardial Infarction ; Prognosis ; Rehabilitation ; Retrospective Studies ; Rhabdomyolysis

Hypoxia-inducible factor 1 alpha (HIF1 alpha) is a transcription factor that plays a key role in the adaptation of cells to low oxygen stress and oxygen homeostasis. The oxygen-dependent degradation (ODD) domain of HIF1 alpha is responsible for the negative regulation of HIF1 alpha in normoxia. The interactions of the HIF1 alpha ODD domain with partner proteins such as von Hippel-Lindau tumor suppressor (pVHL) and p53 are mediated by two sequence motifs, the N- and C-terminal ODD (NODD and CODD). Multiple sequence alignment with HIF1 alpha homologs from human, monkey, pig, rat, mouse, chicken, frog, and zebrafish has demonstrated that the NODD and CODD motifs have noticeably high conservation of the primary sequence across different species and isoforms. In this study, we carried out molecular dynamics simulation of the structure of the HIF1 alpha CODD motif in complex with the p53 DNA-binding domain (DBD). The structure reveals specific functional roles of highly conserved residues in the CODD sequence motif of HIF1 alpha for the recognition of p53.
Animals ; Chickens ; Conserved Sequence ; Haplorhini ; Homeostasis ; Humans ; Hypoxia-Inducible Factor 1 ; Mice ; Molecular Dynamics Simulation ; Oxygen ; Protein Isoforms ; Proteins ; Rats ; Sequence Alignment ; Transcription Factors ; Zebrafish

OBJECTIVE: In the human body the embryo initially gmws in the fallopian tube which is maintained in an 3-8% O2 concentration environment, and various substances such as growth factors and antioxidants present in tbe tubal fluid assists in maintaining a healthy environment for embryo development. But in IVF programs embryo cultures are conducted in incubators with 21.9% O2 and 5% CO2 condition, and such high oxygen concentrations have been reported to increase the production of oxygen free radicals within the embryo and is detrimental to the growth and development of the embryo. The objective of this study, therefore, is to determine the culture conditions which will decrease oxygen free radical production and thereby minimize the injury to the embryo. METHODS: Six to eight week old ICR strain mice embryos were cultured in 5% or 21.9% O2 conditions and in culture media to which inaement concentrations of superoxide dismutase (SOD) had been and the H2O2 concentration within the embryo, embryo developmental rate, and degree of fragmentation of the embryos was investigated. RESULTS: The control gmup embryos which were cultured in 21.9% O2 condition without addition of SOD showed developmental arrest at the 2-cell stage or fragmentation, while those cultured in 21.9% O2 condition with addition of SOD showed development to the blastocyst stage with deaeased fragmentation. In particular, the blastulation and fragmentation rates were the lowest in the group to which 500 IU/ml of SOD was added, but in the 5% O2 enviranment group many embryos reached the blastocyst stage and with no difference in frapnentation with or without addition of SOD. The HO relative intensity (120.5+/-20.2) within the embryos cultured in 21.9% O2 environment without SOD was significantly higher than that (56.8+/-10.8) of group with SOD (p<0.05). As showing that in the 5% O2 environment group without SOD it was 43.8+/-7.8 and in the group with SOD it was 37.3+/-5.4, the H2O2 concentration within embryos cultured in 5% 02 condition was significantly lower those that of 21,9% 02 environment regardless of SOD addition (p<0.05). CONCLUSION: The optimal oxygen concentration in incubator for mice embryo cultures is that which is similar to the 5% 0 concentration in vivo. When 20% 02 incubators are routinely used, the addition of SOD to the culture media will decrease the H2O2 concentration within the embryos with subsequent improvement in development. The optimal concentration which should be used is thought to be 500 IU/ml. It is suggested that the use of the above method in human IVF-ET programs will lead to improved embryo quality and enhanced pregnancy rates.
Animals ; Antioxidants ; Blastocyst ; Culture Media ; Embryonic Development ; Embryonic Structures* ; Fallopian Tubes ; Female ; Free Radicals ; Growth and Development ; Human Body ; Humans ; Incubators ; Intercellular Signaling Peptides and Proteins ; Mice* ; Oxygen* ; Pregnancy ; Pregnancy Rate ; Superoxide Dismutase* ; Superoxides*

No abstract available.
Neural Tube Defects* ; Spinal Canal*

BACKGROUND: Coronary artery disease is an important cause of death in adults and stent insertion is one of the treatment modalities. The most severe adverse effect of a stent insertion is the formation of a thrombus; therefore, antiplatelet agents are used. The addition of cilostazol to low-dose aspirin and clopidogrel results in a better antiplatelet effect. However, laboratory tests to monitor the effect of cilostazol are insufficient. METHODS: We tested the inhibitory effect of cilostazol using maximal platelet aggregation in 20 healthy volunteers. Conditions for incubation and concentrations of cilostazol and prostaglandin E1 (PGE1) were established and aggregation was induced by 5'-adenosine diphosphate (ADP) and measured with light transmission aggregometry (LTA). Blood samples were incubated with 1 µM and 2 µM cilostazol for 10 minutes at room temperature, and 80 nM PGE1 was added and incubated for an additional 10 minutes. Aggregation was induced by ADP and reactivity was evaluated. RESULTS: The average maximum aggregation (MA) was 58.1% at 1 µM cilostazol and 22.0% when PGE1 was added. The average MA was 42.8% when cilostazol concentration was increased to 2 µM and 21.2% when PGE1 was added. Average inhibition of aggregation at 1 µM cilostazol was not statistically significant (P=0.085), but was significant (P=0.004) at 2 µM cilostazol. Aggregation was not inhibited even with 2 µM cilostazol and PGE1 in 2 volunteers, which suggests possible resistance to cilostazol. CONCLUSIONS: We designed a method to monitor the effect of cilostazol using in vitro incubation with PGE1.
Adenosine Diphosphate ; Adult ; Alprostadil ; Aspirin ; Cause of Death ; Coronary Artery Disease ; Healthy Volunteers ; Humans ; In Vitro Techniques ; Methods ; Platelet Aggregation ; Platelet Aggregation Inhibitors ; Stents ; Thrombosis ; Volunteers

No abstract available.
Headache* ; Humans

To know recent status and the point at issue of postmortem investigation in Jeju, the southernmost island in Korea has short history of forensic practice, we analyzed unnatural deaths investigated in Jeju during the five years of 1988 through 2002 inclusively. Of the total number of unnatural deaths (1, 118), 349 of the deceased (31.2%) were studied by autopsy in this period. Advisably, the annual autopsy rate was increased gradually with an increase of unnatural deaths. Drowning occupied large proportion (25.6%) of unnatural deaths. A sudden increase of thermal injury and intoxication in 2002 has attracted attention. Postmortem investigation conducted by prosecutor without participation of expert witness involves a lot of risk and that is one of the current nationwide issue as well as in Jeju. In conclusion, the role of forensic specialist in scene investigation and necessity of administrative support for improvement of medicolegal investigation system in Jeju. is emphasized.
Autopsy ; Drowning ; Expert Testimony ; Korea ; Specialization

This study was conducted on 367 male workers to evaluate the change of vibration perception threshold (VPT) according to exposure degree to carbon disulfide. VPT was measured on both metacarpal bones of index and little fingers and on fibular malleoli by Vibrometer (Rion, on 125Hz). The exposure degree was classified by the name of department. Workers in department 1 had been exposed to high concentration of carbon disulfide, those in. department 2 had been exposed to carbon disulfide moderately or intermittently, and those in department 3 had been exposed to undetectable concentration of carbon disulfide. The results were as follows: 1. The mean values of VPT of metacarpal(MC) bones showed dose-response pattern, i.e., the mean values of VPT at department 1 were highest, and those of VPT at department 3 were lowest with similar work duration or age. But the mean values of VPT of fibular malleoli (FM) showed dose-response pattern only in workers having above 5 years of work duration or whose age were above 30. 2. The mean values of VPT of MC bone of workers increased by age. 3. There were statistically significant difference in mean values of VPT of MC bone only in workers having 5-10 year work duration. And there were statistically significant difference of mean values of VPT of left 2nd and 5th MC bone in workers whose age was 30's, of right 2nd MC bone in those whose age was 40's, and of left 2nd MC bone in those whose age was 50's. 4. The variables affecting VPT significantly were department and age (or age group) both in multiple regression and general linear model. The department showed to have more effect to VPT than age in multiple regression, but age group showed to have more effect to VPT than department in general linear model. 5. The variables were transformed to indicator variable to do logistic regression analysis. Department 1, 2, 3 were classified into high exposure (spinning department) and low exposure (other department), age was classified into old (above 30) and young, and work duration was classified into long(above 10 years) and short. The exposure and age were significant variables by logistic regression analysis. Odds ratios of department and VPT on metacarpal bones or malleoli were 2.7-3.2 and those of age and VPT were 2.6 or 2.7. Odds ratio of age and abnormality of VPT on'any point was 3.3(1.59-6.;8), and that of department and VPT was 2.8(1.5-5.5). We concluded that exposure of carbon disulfied was significantly associated with reduction of VPT regardless of age; and that the test of VPT would be useful tool for screening and early detection in neuropathy by carbon disulfide or other neurotoxic chemicals,even though it is simple and cheap.
Carbon Disulfide* ; Carbon* ; Fingers ; Humans ; Linear Models ; Logistic Models ; Male* ; Mass Screening ; Metacarpal Bones ; Odds Ratio ; Vibration*

Angiosarcoma accounts for 1% of all soft tissue sarcoma. Common sites of occurrence include the skin, breast, soft tissue, and liver. It metastasizes to the lungs, bone, and spleen. The cause of hepatic angiosarcoma in the 60% of cases is unknown, although specific risk factors such as vinyl chloride, arsenic, thorotrast and external-beam irradiation have been identified. Since 1986, about eight cases of hepatic angiosarcoma have been reported in Korea, but it had not been reported in which the hepatic angiosarcoma invaded to the stomach, yet. So we report a case of histopathologically confirmed primary hepatic angiosarcoma with gastric involvement. In this case, a sixtythree-year-old female was presented with indigestion and epigastric soreness for 1 year. Endoscopic examination of the stomach revealed a submucosal tumor-like protruding mass from the antrum to angle. The mucosal surface showed severe hyperemia and shallow ulcerative change was seen. Endoscopic biopsy and percutaneous liver biopsy confirmed the diagnosis of hepatic angiosarcoma invading the gastric wall.
Arsenic ; Biopsy ; Breast ; Diagnosis ; Dyspepsia ; Female ; Hemangiosarcoma* ; Humans ; Hyperemia ; Korea ; Liver ; Lung ; Risk Factors ; Sarcoma ; Skin ; Spleen ; Stomach ; Thorium Dioxide ; Ulcer ; Vinyl Chloride

Primary esophageal involvement by tuberculosis is rare. Clinical symptoms are variable and nonspecific in which dysphagia is the most common presenting symptom. Endoscopic findings are also diverse and nonspecific and ulcerative form is a common manifestation. For a definite diagnosis, Endoscopic biopsies are useful but typical granuloma is seen in approximately 50% of cases and acid-fast bacilli are demonstrated in less than 25% of patients. Fine needle aspiration cytology and polymerase chain reaction are helpful for diagnosis. A 54-year-old man was presented with throat discomport. Endoscopy demonstrated hematoma like lesion with pus discharge from ulceration in the proximal esophagus. Esophageal tuberculosis was confirmed based on the biopsy and culture results, and he was treated with antituberculous medications. At the follow-up endoscopy, 6 months later, previous lesion was completely healed to scar.
Abscess* ; Biopsy ; Biopsy, Fine-Needle ; Cicatrix ; Deglutition Disorders ; Diagnosis ; Endoscopy ; Esophagus ; Follow-Up Studies ; Granuloma ; Hematoma ; Humans ; Middle Aged ; Pharynx ; Polymerase Chain Reaction ; Suppuration ; Tuberculosis ; Ulcer