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*

OBJECTIVE: This study was undertaken to evaluate the clinical significance of ASCUS and AGUS in routine Papanicolaou smears. METHOD: A review of retrospective medical records was conducted on 267 women whose Papanicolaou smears yielded diagnoses of either ASCUS or AGUS from March, 1998 to December, 2000 at Youngdong Severance Hospital. RESULT: The incidences of ASCUS and AGUS on PAP smears are 1.3%(258 cases) and 0.1%(23 cases). Of these, 89 cases with ASCUS and 9 cases with AGUS had subsequent cervical biopsies. The biopsy cases with ASCUS showed 68(74.4%) cervicitis, 2(2.2%) hyperkeratosis, 1(1.1%) condyloma, 9(9.9%) CIN 1, 5(5.5%) CIN 2, 1(1.1%) CIN 3, 2(2.2%) microinvasive squamous cell carcinoma and 1(1.1%) adenocarcinoma. Those with AGUS showed 6(6.6%) cervicitis, 1(1.1%) CIN 2, 1(1.1%) CIN 3, 1(1.1%) endometrial cancer. Women under 35 year-old(P=0.012) or who had coital history in younger periods(before 20 years old, P=0.014) had much higher frequency of high grade lesion. The overall incidence of HSIL was higher in the group with ASCUS favoring SIL than in the group with unqualified ASCUS. (P=0.042) The group with AGUS also had much higher frequency of high grade lesion than the group with ASCUS. (P=0.043) CONCLUSION: Immediate colposopic evaluation should be performed for AGUS and ASCUS favoring SIL. Regarding ASCUS, high risk patients who are under 35 years old or who have early coital history(< 20 yrears old) also should undergo colposcopic examination. With the exception of the aboves, we propose HPV screening and HPV DNA testing for intermediate screening test.
Adenocarcinoma ; Adult ; Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Endometrial Neoplasms ; Female ; Human Papillomavirus DNA Tests ; Humans ; Incidence ; Mass Screening ; Medical Records ; Papanicolaou Test ; Retrospective Studies ; Uterine Cervicitis ; Young Adult

Subclavian artery occlusion after blunt trauma is an extremely rare injury. This has been attributed to its wellprotected location deep in the scalene triangle, bounded by the first rib and clavicle. A case of post-traumatic occlusion of the subclavian artery with clavicle fracture was reported by Sodhi et al in 2006 and in Korea was reported by Han et al in 2001. We believe that is the first report of post-traumatic occlusion of the subclavian artery without clavicle and first rib fracture in Korea.
Clavicle ; Korea ; Rib Fractures ; Ribs ; Subclavian Artery ; Wounds, Nonpenetrating

Mucormycosis is a rare, fulminating, opportunistic fungal infection that occurs almost exclusively in immunocompromised hosts such as patients with diabetes, leukemia, lymphoma. These fungi are ubiquitous in nature, and can be found on decaying vegetation and in the soil. So they are relatively frequent contaminants in the clinical microbiology laboratory. Recently the incidence of mucormycosis is rising associated with the increasing use of immunosuppressive agents, antibiotics. Though mucormycosis is frequently fatal, there has been a significant improvement in the outcome by early diagnosis and aggressive treatment. Mucormycosis can be categorized as rhinocerebral, pulmonary, gastrointestinal, cutaneous, widely disseminated and miscellaneous; gastro-intestinal involvement is extremely rare. We report a patient with gastric mucormycosis who had diabetes mellitus and alcoholic hepatitis. His chief complaint was an epigastric pain, and the gastroscopy showed huge multiple ulcers, coated with exudates. The histologic examination revealed multiple broad, nonseptate hyphae with right angle branchings, diagnosed as mucormycosis.
Alcoholics* ; Anti-Bacterial Agents ; Diabetes Mellitus* ; Early Diagnosis ; Exudates and Transudates ; Fungi ; Gastroscopy ; Hepatitis, Alcoholic* ; Humans ; Hyphae ; Immunocompromised Host ; Immunosuppressive Agents ; Incidence ; Leukemia ; Lymphoma ; Mucormycosis* ; Soil ; Ulcer

Bacterial endophthalmitis is a very difficult ophthalmic disease to treat because of the consistently poor results with conventional therapy. lntravitreal injection of antibiotics is increasingly gaining the acceptance as a method of producing high vitreal concentrations that may be useful in the treatment of bacterial endophthalmitis. The author performed this experiment to determine the clerance rare of intravitreal gentamicin in the rabbit eyes. We observed the clearance of gentamicin in phakic and aphakic rabbit eyes into which 20 micro gram/0.1 ml of gentamicin was injected. In phakic eyes, about 52% of gentamicin was cleared at 24 hours after injection. In aphakic eyes with intact posterior capsule, 64% of gentamicin was cleared at 24 hours after injection. In aphakic eyes with incised posterior capsule, the clearance rate at 24 hours after injection was about 70%. Intravitreal gentamicin was cleared more rapidly from the aphakic eyes than from that of phakic eyes.
Anti-Bacterial Agents ; Endophthalmitis ; Gentamicins*

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

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

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

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

No abstract available.
Heart Neoplasms* ; Myxoma*