PURPOSE: Unstable bladder has been known to be one of the reasons for the genesis and persistance of primary vesicoureteral reflux(VUR) in children. And treatment of unstable bladder by anticholinergic agent may contribute to the resolution of primary VUR. We evaluated the effect of an anticholinergic agent(oxybutynin) on the resolution of primary VUR in children with different toilet training and voiding functions. METHODS: 152 children with persistant primary VUR after one year of follow up were randomly assigned to the oxybutynin group(n=59, oxybutynin 0.2 mg/kg twice daily) and the control group(n=93, no oxybutynin) at Ewha Womans University Mok-Dong Hospital from October 1996 to April 2002. The resolution rate of the VUR and the difference according to the status of toilet training and voiding dysfunction were analyzed. Statistical analysis was done by the Chi-square test and a P-value of less than 0.05 was considered as significant. RESULTS: VUR was resolved in 49.2%, improved in 20.3% and not changed in 30.5% in the oxybutynin group(n=59) which was not significantly different to 45.2%, 16.1%, 38.7% in the control group(n=93), respectively. In the non-toilet trained young children, VUR was resolved in 50.0%, improved in 23.5% and not changed in 26.5% in the oxybutynin group(n=34) which was not significantly different to 44.2%, 19.2%, 36.6% in the control group(n=52), respectively. In the toilet trained older children, VUR was resolved in 48.0%, improved in 16.0% and not changed in 36.0% in the oxybutynin group(n=25) which was not significantly different to 46.3%, 12.2%, 41.5% in the control group(n=41), respectively. In the toilet trained older children with no voiding dysfunction, VUR was resolved in 33.3%, improved in 11.1% and not changed in 55.6% in the oxybutynin group(n=9) which was not significantly different to 53.6 %, 10.7%, 35.7% in the control group(n=28), respectively. In the toilet trained older children with voiding dysfunction, VUR was resolved in 56.3%, improved in 18.7% and not changed in 25.0% in the oxybutynin group(n=16), which looked higher than 30.7%, 15.4%, 53.9% in the control group(n=13), respectively, but these were not significantly different either. CONCLUSION: Oxybutynin was not effective in the resolution of primary VUR in non-toilet trained young children and toilet trained older children. Oxybutynin showed slightly higher tendency of reflux resolution in toilet-trained older children with voiding dysfunction but the difference was not statistically significant. Judicious use of oxybutynin is required in selected older children with VUR and voiding dysfunction.
Child ; Female ; Follow-Up Studies ; Humans ; Toilet Training ; Urinary Bladder ; Vesico-Ureteral Reflux*

PURPOSE: Unstable bladder has been known to be one of the reasons for the genesis and persistance of primary vesicoureteral reflux(VUR) in children. And treatment of unstable bladder by anticholinergic agent may contribute to the resolution of primary VUR. We evaluated the effect of an anticholinergic agent(oxybutynin) on the resolution of primary VUR in children with different toilet training and voiding functions. METHODS: 152 children with persistant primary VUR after one year of follow up were randomly assigned to the oxybutynin group(n=59, oxybutynin 0.2 mg/kg twice daily) and the control group(n=93, no oxybutynin) at Ewha Womans University Mok-Dong Hospital from October 1996 to April 2002. The resolution rate of the VUR and the difference according to the status of toilet training and voiding dysfunction were analyzed. Statistical analysis was done by the Chi-square test and a P-value of less than 0.05 was considered as significant. RESULTS: VUR was resolved in 49.2%, improved in 20.3% and not changed in 30.5% in the oxybutynin group(n=59) which was not significantly different to 45.2%, 16.1%, 38.7% in the control group(n=93), respectively. In the non-toilet trained young children, VUR was resolved in 50.0%, improved in 23.5% and not changed in 26.5% in the oxybutynin group(n=34) which was not significantly different to 44.2%, 19.2%, 36.6% in the control group(n=52), respectively. In the toilet trained older children, VUR was resolved in 48.0%, improved in 16.0% and not changed in 36.0% in the oxybutynin group(n=25) which was not significantly different to 46.3%, 12.2%, 41.5% in the control group(n=41), respectively. In the toilet trained older children with no voiding dysfunction, VUR was resolved in 33.3%, improved in 11.1% and not changed in 55.6% in the oxybutynin group(n=9) which was not significantly different to 53.6 %, 10.7%, 35.7% in the control group(n=28), respectively. In the toilet trained older children with voiding dysfunction, VUR was resolved in 56.3%, improved in 18.7% and not changed in 25.0% in the oxybutynin group(n=16), which looked higher than 30.7%, 15.4%, 53.9% in the control group(n=13), respectively, but these were not significantly different either. CONCLUSION: Oxybutynin was not effective in the resolution of primary VUR in non-toilet trained young children and toilet trained older children. Oxybutynin showed slightly higher tendency of reflux resolution in toilet-trained older children with voiding dysfunction but the difference was not statistically significant. Judicious use of oxybutynin is required in selected older children with VUR and voiding dysfunction.
Child ; Female ; Follow-Up Studies ; Humans ; Toilet Training ; Urinary Bladder ; Vesico-Ureteral Reflux*

Primary aldosteronism is a clinical syndrome characterized by hypertension, hyperkalemia and hyporeninemia due to increased aldosterone production from the adrenal gland. It is caused by adenoma, bilateral hyperplasia or carcinoma. We experienced anesthetic management of a 49-year-old female with adrenal adenoma accompanied by aortic dissection for left adrenalectomy. To avoid undesirable hypertension which may exacerbate the aortic dissection during general anesthesia, we performed adjunctive continuous thoracic epidural anesthesia under careful hemodynamic monitoring. The patient recovered uneventfully without extension of aortic dissection.
Adenoma ; Adrenal Glands ; Adrenalectomy ; Aldosterone ; Anesthesia, Epidural ; Anesthesia, General ; Aorta ; Arteries ; Female ; Hemodynamics ; Humans ; Hyperaldosteronism* ; Hyperkalemia ; Hyperplasia ; Hypertension ; Middle Aged

The osteopoikilosis is commonly known as harmatoma in which metaphyseal and epiphyseal area of long bones and the bone of pelvis, hands, feet and et al, contain islands of dense cortical bone with normal Harversian system without any symptoms. The radiologic findings of the osteopoikilosis is multitude of oval or well-circumscribed areas of increased density, 2 to 10 mm in size, in symmetrical distribution and normal uptake in bone scan. Buschke-Ollendorff syndrome, which is transmitted by autosomal dominant, is characterized by the association of osteopoikilosis and connective tissue nevi which are popular and symmetrically distributed lesions on chest, back, buttock, thigh or arm. Authors report three Buschke-Ollendorff syndrome, studied by CT scan, MRI, bone scan and bone and skin biopsy, among five patients associated with osteopoikilosis found by simple radiologic study from ten members in one family with their pedigree.
Arm ; Biopsy ; Buttocks ; Connective Tissue ; Foot ; Hand ; Humans ; Islands ; Magnetic Resonance Imaging ; Nevus ; Osteopoikilosis ; Pedigree ; Pelvis ; Skin ; Thigh ; Thorax ; Tomography, X-Ray Computed

The purpose of this systematic review and meta-analysis was to assess the preventive effect of theophylline on acute kidney injury and the ameliorative effect of theophylline on renal function in asphyxiated neonates. A literature search of the PubMed/Medline, Embase, and Cochrane Library databases for information published up to February 2019 was conducted. All studies that reported the incidence rate of acute kidney injury, serum creatinine level, and glomerular filtration rate after the randomized administration of theophylline or placebo were included. In total, eight studies involving 498 neonates were eligible. The incidence rate of acute kidney injury was significantly lower in the theophylline group than in the placebo group (risk ratio [RR]: 0.42, 95% confidence interval [CI]: 0.32–0.55, p < 0.001). The changes in serum creatinine level in the theophylline group were significantly higher than those in the placebo group from the first day of life to 3 and 5 days of age (weighted mean difference [WMD]: −0.51, 95% CI: −0.62 to −0.40, p < 0.001, and WMD: −0.26, 95% CI: −0.34 to −0.18, p < 0.001, respectively). The changes in glomerular filtration rate in the theophylline group were significantly higher than those in the placebo group from the first day of life to 3 days of age and the last day of follow-up (WMD: 12.30, 95% CI: 9.39–15.21, p < 0.001, and WMD: 9.35, 95% CI: 6.43–12.27, p < 0.001, respectively). These results suggested that theophylline has a beneficial effect on the prevention of acute kidney injury in neonates with perinatal asphyxia.
Acute Kidney Injury ; Asphyxia ; Creatinine ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Incidence ; Infant, Newborn ; Theophylline

Background: With the emergent transition of online learning during the COVID-19 pandemic, the need for online/offline blended learning that can effectively be utilized in a team-based learning (TBL) course has emerged. Methods: We used the online metaverse platforms, Gather and Zoom, along with face-to-face teaching methods in a team-based Introductory Pharmacy Practice Experience (IPPE) course and examined students’ learning satisfaction and achievement, as well as their preferences to the learning platforms. A survey questionnaire was distributed to the students after the IPPE course completion. All data were analyzed using Excel and SPSS. Results: Students had high levels of course satisfaction (4.61±0.57 out of 5) and achievement of course learning objectives (4.49±0.70 out of 5), and these were positively correlated with self-directed learning ability. While students believed that the face-toface platform was the most effective method for many of the class activities, they responded that Gather was the most effective platform for team presentations. The majority of students (64.3%) indicated that blended learning was the most preferred method for a TBL course. Conclusion Students in a blended TBL IPPE course had high satisfaction and achievements with the use of various online/offline platforms, and indicated that blended learning was the most preferred learning method. In the post-COVID-19 era, it is important to utilize the blended learning approach in a TBL setting that effectively applies online/offline platforms according to the learning contents and activities to maximize students’ learning satisfaction and achievement.

PURPOSE: This study was designed to explore the association of diet with menopausal symptoms in Korean women. METHOD: For this cross-sectional survey, 276 women aged between 45-55 years visiting two branches of K-university hospital located in Seoul and Ansan of Kyunggi province were recruited from April to July, 2002. A menopause-specific quality-of-life questionnaire and a food frequency questionnaire were used to measure menopause-related symptoms and the intake of 28 types of foods. RESULT: No differences were found in the levels of bothersome total menopausal symptoms, physical symptoms, psychosocial symptoms, and sexual symptoms according to the intake of each food. Only higher intake of fishes, seaweeds, and vegetable oils were inversely associated with bothersome levels of vasomotor symptoms. Women with higher intake of yellow-green vegetables and lower intake of coffee, confectionery, and processed foods reported lower hot flush rate. CONCLUSION: The results suggest that higher intake of yellow-green vegetables and lower intake of coffee, confectionery and processed foods may relieve hot flushes. Further study needs to be pursued to study the relationship with nutrients of these foods and hot flushes.

Tracheal stenosis is now a well-recognized, and very serious complication following increased use endotracheal tubes of tracheostomies with air inflated cuffed tubes and assisted ventilation. Up to 10% of patients surviving treatment have been reported to develop stenosis following closure of tracheostomy and some prospective studies predict a 16~20% incidence of stricture following prolonged cuffed tube ventilation. The most important principle is prevention. Once stenosis is established, the logical approach is resection of the stenotic segment and reestablishment of an adequate airway by primary anastomosis or the insertion of a tracheal substitute. In this regard, Pearsor, Grillo, Naef and Binet have made major contributions to the technique of reconstruction of the tracheo-bornchial tree after extensive resection. Strictures are described both in the region of the stoma and at the level of the inflatable cuff. Anesthetic management of these patients should focus on maintenance of the airway and adequate ventilation. If not, hypoxia or cardiac arrest can occur during a prolonged operation due to alvsolar hypoventilation. Extracorporeal circulation for tracheal stenosis reconstruction was first used by Woods for prevention of hypercarbia and hypoxia. The Department of Anesthesiology of Yonsei University has had experience in the anesthetic management of two cases of tracheal stenosis reconstruction using extracorporeal circulation during surgery, these cases are reported along hear with references from the literature.
Anesthesiology ; Anoxia ; Constriction, Pathologic ; Extracorporeal Circulation ; Heart Arrest ; Humans ; Hypoventilation ; Incidence ; Logic ; Tracheal Stenosis* ; Tracheostomy ; Ventilation ; Wood

Neural stem cells (NSCs) have been suggested as a groundbreaking solution for stroke patients because they have the potential for self-renewal and differentiation into neurons. The differentiation of NSCs into neurons is integral for increasing the therapeutic efficiency of NSCs during inflammation. Apoptosis signal-regulating kinase 1 (ASK1) is preferentially activated by oxidative stress and inflammation, which is the fundamental pathology of brain damage in stroke. ASK1 may be involved in the early inflammation response after stroke and may be related to the differentiation of NSCs because of the relationship between ASK1 and the p38 mitogen-activated protein kinase pathway. Therefore, we investigated whether ASK1 is linked to the differentiation of NSCs under the context of inflammation. On the basis of the results of a microarray analysis, we performed the following experiments: western blot analysis to confirm ASK1, DCX, MAP2, phospho-p38 expression; fluorescence-activated cell sorting assay to estimate cell death; and immunocytochemistry to visualize and confirm the differentiation of cells in brain tissue. Neurosphere size and cell survival were highly maintained in ASK1-suppressed, lipopolysaccharide (LPS)-treated brains compared with only LPS-treated brains. The number of positive cells for MAP2, a neuronal marker, was lower in the ASK1-suppressed group than in the control group. According to our microarray data, phospho-p38 expression was inversely linked to ASK1 suppression, and our immunohistochemistry data showed that slight upregulation of ASK1 by LPS promoted the differentiation of endogenous, neuronal stem cells into neurons, but highly increased ASK1 levels after cerebral ischemic damage led to high levels of cell death. We conclude that ASK1 is regulated in response to the early inflammation phase and regulates the differentiation of NSCs after inflammatory-inducing events, such as ischemic stroke.
Animals ; Cell Death ; Infarction, Middle Cerebral Artery/*metabolism ; Lipopolysaccharides/pharmacology ; MAP Kinase Kinase Kinase 5/genetics/*metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Microtubule-Associated Proteins/genetics/metabolism ; Neural Stem Cells/cytology/drug effects/*metabolism ; *Neurogenesis ; Neuropeptides/genetics/metabolism ; p38 Mitogen-Activated Protein Kinases/genetics/metabolism

Adult polyglucosan body disease (APBD) is a rare neurological disease, characterized by adult onset (fifth to seventh decades), progressive sensorimotor or pure motor peripheral neuropathy, upper motor neuron symptoms, neurogenic bladder, and cognitive impairment. APBD is confirmed by a sural nerve biopsy that shows the widespread presence of polyglucosan bodies in the nerve. We report a 70 year old male patient who exhibited progressive weakness in all extremities and dementia. His electrodiagnostic studies showed sensorimotor polyneuropathy and muscle pathology that consisted of polyglucosan bodies located in small peripheral nerves. This is the first case of APBD reported in Korea.
Aged ; Biopsy ; *Glucans/metabolism ; Humans ; Inclusion Bodies ; Male ; Neurodegenerative Diseases/metabolism/*pathology