Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.
Cardiomyopathies* ; Catecholamines ; Child, Preschool ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Hypertension ; Myocarditis ; Neuroblastoma*

Oseltamivir has been used as a worldwide preparation for treatment of influenza A and B including H1N1. Gastrointestinal discomforts as like nausea, vomiting are commonly reported but acute hemorrhagic colitis is a very rare adverse effect. We report a case of a 17-year-old male who showed abdominal pain, diarrhea and hematochezia after the second administration of oseltamivir. Computed tomography revealed continuous, circumferential and edematous wall thickening involving ascending to descending colon with pericolic infiltration. Colonoscopic examination revealed diffuse mucosal edema, congestion and friability, suggesting hemorrhagic colitis. Histopathological examination showed ischemia and focal loss of the crypts. It also showed hyalinization and minimal inflammatory cell infiltration in the lamina propria, consistent with acute to subacute ischemic colitis. This report is the first case of oseltamivir-related ischemic colitis proved by both endoscopic examination and pathologic findings in the patient who had no risk factor of ischemic colitis in Korea.
Abdominal Pain ; Administration, Oral* ; Adolescent ; Colitis* ; Colitis, Ischemic ; Colon, Descending ; Diarrhea ; Edema ; Estrogens, Conjugated (USP) ; Gastrointestinal Hemorrhage ; Humans ; Hyalin ; Influenza, Human ; Ischemia ; Korea ; Male ; Mucous Membrane ; Nausea ; Oseltamivir* ; Risk Factors ; Vomiting

As molecular size of the most major allergens of house dust mite(HDM) are known to be less than 30 kD, allergic immune reactions may be different according to the molecular fractions of HDM allergens. In this study, we fractionated D. pteronyssinus (D. pt) antigen according to its molecular weights, fraction I(FI), II(FII, more than 30 kD), III( FIII, less than 30 kD), and evaluated the differences of allergic immune responses in 40 atopic patients. FIII(A/H ratio-2.44+/-0.61) elicited stronger response on intradermal skin test than FI (0.76 +/-0.10, p<0.001) and FII(0.88+/-0.12, p<0.001). The immunoblot analysis revealed that the nine out of 10 atopics had IgE binding bands with 15 kD protein of FIII which were not found in FI and FII. The geometric mean of absorben value of specific IgE to FIII was 0.067, which was higher than that of FII(0.013, p<0.001), with no difference from that of FI(0.042). The skin reactivity to whole D. pt antigen correlated with FIII- specific IgE(r=0.3862, p<0.01), not with FI-(r=0.2605, p=0.07) and FII-specific IgE(r=0. 1103, p=0.45). FI-specific IgG levels in atopic sera(n=40) were significantly higher than that of FII and FIII in all IgG subclasses (p<0.001). Both atopic(n=4) and nonatopic (n=4) groups showed multiple IgG, IgG1, and IgG2 binding bands at high molecular proteins in immunoblot analysis. The prevalence and density of the IgG and IgG1 binding bands to 15 kD were higher and more intense in atopics than those of nonatopics. In conclusion, we suggest that fractionated antigens of D. pteronyssinus had different antigenicities and that the allergic immune responses to HDMs in atopics and nonatopic are different according to molecular fractions of HDM.
Allergens ; Dermatophagoides pteronyssinus* ; Dust ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Molecular Weight ; Prevalence ; Pyroglyphidae* ; Skin ; Skin Tests

PURPOSE: To improve our understanding of the pharmacokinetics of triamcinolone acetonide (TA) and TA concentration in ocular tissue, TA concentration was measured in ocular tissue after intravitreal and subtenon injection. METHODS: Fifteen rabbit eyes underwent subtenon TA injection (40 mg/1 ml), and another 15 rabbit eyes underwent intravitreal TA (4 mg/0.1 ml) injection. All eyes were enucleated at 1, 2, 4, 8, and 12 weeks after subtenon and intravitreal injection, and TA concentration in the aqueous and vitreous humor and the retina-choroid were measured by high performance liquid chromatography (HPLC). RESULTS: In cases of subtenon's TA injection, TA concentrations were 0 ng/ml, 136.7 ng/ml, 178.7 ng/ml, 0 ng/ml, and 0 ng/ml in the aqueous humor; 99.1 ng/ml, 125.7 ng/ml, 726.8 ng/ml, 0 ng/ml, and 0 ng/ml in the vitreous humor; 72.7 ng/ml, 304.6 ng/ml, 459.0 ng/ml, 0 ng/ml, and 0 ng/ml in the retina-choroid after 1, 2, 4, 8, and 12 weeks, respectively. In cases of intravitreal TA injection, the measured values were 0 ng/ml, 0 ng/ml, 0 ng/ml, 654.1 ng/ml, and 0 ng/ml in the aqueous humor; 28152.2 ng/ml, 13646.4 ng/ml, 11388.8 ng/ml, 10297.2 ng/ml, and 183.0 ng/ml in the vitreous humor; and 0 ng/ml, 27.9 ng/ml, 108.3 ng/ml, 0 ng/ml, and 0 ng/ml in the retina-choroid at each time point. CONCLUSIONS: Intravitreal TA injection may be more effective for drug delivery than subtenon TA injection, but subtenon TA injection seems to be an effective and safe technique.
Chromatography, Liquid ; Eye ; Intravitreal Injections ; Rabbits ; Triamcinolone ; Triamcinolone Acetonide ; Vitreous Body

In children and young adults, secondary epiretinal membranes after ocular trauma, pars planitis, ocular toxocariasis, and Coat's disease are common and spontaneous separation occurs in a relatively higher rate with improvement in visual acuity than elderly patients. In a 31-year-old man with pars planitis, diffuse epiretinal membrane in the macula became thinner during systemic and topical steroid therapy. Two years after treatment, the preretinal membrane spontaneously separated from the macula to the inferior temporal arcade, and visual acuity improved from 0.15 to 1.0. The authors reviewed the available literatures regarding the possible mechanisms for the spontaneous separation ofepiretinal membrane.
Adult ; Aged ; Child ; Epiretinal Membrane* ; Humans ; Membranes ; Pars Planitis ; Toxocariasis ; Visual Acuity ; Young Adult*

We experienced a case of thoracic aortic aneurysm combined with coronary artery disease. A 68-year-old man complained of anginal pain in the left anterior chest and nonspecific pain in the posterior chest. The aneurysm was extending from left subclavian artery to the diaphragm and sign of impending rupture was noted in the chest CT. Coronary angiograms revealed significant obstruction of left circumflex coronary artery(>95%) and left anterior descending artery(>50%). Exposure was obtained through the left posterolateral thoracotomy incision in the 4th intercostal space and then partial femoro-femoral cardio- pulmonary bypass was established. After aortic cross clamping, the aneurysmal sac was opened and repaired with interposition of 26 mm Hemashield graft. Under the beating heart with femoro-femoral cardiopulmonary bypass, aorto-left circumflex coronary bypass with autogenous saphenous vein used as conduit was performed. Postoperatively multiple cerebral infarction ensued due to intraoperative hypovolemic shock and hypoxic brain damage during cardiopulmonary bypass. Currently, the patient's mental status is drowsy and in an improving state.
Aged ; Aneurysm ; Aneurysm, Dissecting ; Aortic Aneurysm, Thoracic* ; Cardiopulmonary Bypass ; Cerebral Infarction ; Constriction ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Diaphragm ; Heart ; Humans ; Hypoxia, Brain ; Rupture ; Saphenous Vein ; Shock ; Subclavian Artery ; Thoracotomy ; Thorax ; Tomography, X-Ray Computed ; Transplants

No abstract available.
Heart Neoplasms* ; Myxoma*

No abstract available.
Heart Neoplasms* ; Myxoma*

From May 1, 1993 to May 31 1995, the authers studied retrospectively 211 patients who underwent cardiovascular operation with cardiopulmonary bypass (CPB). Because we were interested in new development of ARF (prevalence, mortality rate, and main risk factors), we performed a multivariate statistical analysis about data of patients with preoperative serum creatinine values of less than 1.5 mg/dL. Normal renal function before operation (serum creatinine level less than 1.5 mg/dL) was registered in 198 (74%) patients. Of these, 27 (14%) patients showed postoperative renal complication, including 20 (10%) patients classified as renal dysfunction (serum creatinine level between 1.5 and 2.5 mg/dL) and 7 (4%) patients as acute renal failure (serum creatinine level higher than 2.5 mg/dL). The mortality rate was 5.8% in normal patients, 5% in patients with renal dysfunction, and 43% when acute renal failure developed (p=0.036). Indeed, the renal impairment proved to be an independent predictor of mortality (odd ratio 2.52~11.25), along with cardiovascular (odd ratio 4.20) and respiratory (odd ratio 2.18) complications. Multivariate analysis identified the following variables as independent risk factors for postoperative renal impairment : advanced age (odd ratio 1), need for emergency operation (odd ratio 3.78), low-output syndrome (odd ratio 3.66), respiratory complication (odd ratio 1.30), need for deep hypothermic circulatory arrest (odd ratio 1.4). The 13 patients (7%) with preoperative renal failure showed a significantly higher morbidity and mortality rate than those without renal complications before operation. We concluded that the likelihood of severe renal complications is resonably low in the patients undergoing cardiac operation without preexisting renal dysfunction, but associated mortality remains high. A prominant role of hemodynamic factor in the development of postoperative acute renal failure must be recognized during preoperative, intraoperative, and postoperative periods.
Acute Kidney Injury* ; Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced ; Creatinine ; Emergencies ; Hemodynamics ; Humans ; Mortality ; Multivariate Analysis ; Postoperative Period ; Renal Insufficiency ; Retrospective Studies ; Risk Factors

OBJECTIVE: The purpose of this study is to investigate the incidence of new compression and to analyze factors that influence the fractures in adjacent levels after percutaneous vertebroplasty (PVP). METHODS: This retrospective study examined 206 patients who had undergone PVP for single level osteoporotic or osteopenic compression fractures during the last seven years in our department. After PVP, the patients were observed for at least over one year, and 29 patients showed new additional compression fractures in adjacent levels. One hundred seventy seven patients who did not show additional compression fractures were analyzed as the control group. Statistical comparisons were performed between the groups, in terms of age, gender, bone mineral density, whether bisphosphonate (BPP) was treated, preoperative kyphosis, preoperative wedge angle, change in wedge angle, amount of bone cement, existence of intradiscal bone cement leakage, and initial fracture levels. RESULTS: The statistically significant factors that influence new compression fractures in adjacent levels after PVP were as follows: being female, initial thoracolumbar junction fracture, preoperative large kyphotic, preoperative large wedge angle, change in wedge angle, administration of BPP in osteopenia group, and intradiscal cement leakage. CONCLUSION: This study identified many factors that influence newly developed compression fractures in adjacent levels after PVP. Interestingly, the administration of BPP in osteopenia group had positive influence on new fractures in this study. Therefore, we recommend early administration of BPP to patients with osteopenia.
Aged* ; Bone Density ; Bone Diseases, Metabolic ; Diphosphonates ; Female ; Fractures, Compression* ; Humans ; Incidence ; Kyphosis ; Retrospective Studies ; Risk Factors* ; Spinal Fractures ; Vertebroplasty*