The morphologic abnormalities of the endocrine pancreas that underlie persistent neonatal hyperinsulinemic hypoglycemia and are included under the heading "nesidioblastosis" appears to be heterogeneous. This characteristic morphologic finding is ductuloinsular complexes showing endocrine cells budding off the ductoepithelium and merging with adjacent endocrine cell clusters. A case of nesidioblastosis associated with hyperinsulinemic hypoglycemia occurred in a 6/365 year-old male neonate. Microscopic finding of near totally resected pancreas revealed irregular sized islets and ductuloinsular complexes, both of which contained hypertrophied B cells with a few mitosis. Because of persistent hypoglycemia after first operation, he received second operation 8 days after. This histologic finding was more severe comparative to that of first operation. According to these findings, the pathogenesis of nesidioblastosis may be congenital or developmental defect of a kind of compensatory mechanism by unknown stimuli to acquire persistent hypoglycemia.
Male ; Infant, Newborn ; Humans

No abstract available.
Pierre Robin Syndrome*

PURPOSE: The objective of this study was to characterize transdifferentiated lens epithelial cells analyzed by reverse transcription-polymerase chain reaction (RT-PCR) for the expression of mRNAs encoding growth factors, growth factor receptors and pathologic extracellular matrix proteins and by Western blot analysis for the proteins encoded by these mRNAs. Moreover, after antioxidants treatment, such as Nacetyl cysteine (NAC), we observed the effect on changes in the expression of growth factors, growth factor receptors and extracellular matrix proteins. METHODS: TGF-beta treated rat lens cultured with medium 199 (Sigma Co. St. Louis, MO) was subject to RT-PCR and Western blot analysis to assess expression of mRNAs and proteins encoded by these mRNAs. RESULTS: The expression of mRNAs for TGF-beta 1, TGF-beta 2, TGF-beta 3, TGF-beta receptor, epidermal growth factor (EGF), epidermal growth factor receptor, fibroblast growth factor (FGF), fibroblast growth factor receptor and connective tissue growth factor (CTGF) were increased. The levels of type I collagen, fibronectin, and alpha-smooth muscle actin (SMA) mRNAs were also increased. However, the expression of growth factors, receptors, extracellular matrix were decreased by antioxidant, such as NAC. CONCLUSIONS: The enhanced expression of growth factors, growth factor receptors and extracellular matrix in present the molecular mechanism underlying pathogenesis of cataracts. And the suppression of growth factors and growth factor receptors with treatment of antioxidants, such as NAC, suggests the possibility of using drugs in the prevention or treatment of cataracts.
Actins ; Animals ; Antioxidants ; Blotting, Western ; Cataract ; Collagen Type I ; Connective Tissue Growth Factor ; Cysteine ; Epidermal Growth Factor ; Epithelial Cells ; Extracellular Matrix Proteins ; Extracellular Matrix* ; Fibroblast Growth Factors ; Fibronectins ; Intercellular Signaling Peptides and Proteins ; Rats* ; Receptor, Epidermal Growth Factor ; Receptors, Fibroblast Growth Factor ; Receptors, Growth Factor ; Receptors, Transforming Growth Factor beta ; RNA, Messenger ; Transforming Growth Factor beta

A 5-year-old boy was admitted to the hospital with a high fever and abnormal gait. Magnetic resonance imaging showed extensive swelling of the quadriceps and adductor muscles around the right hip and anterior thigh. A duplex scan demonstrated a thrombus from the external iliac vein to below the popliteal vein. The blood culture revealed Streptococcus pyogenes. The patient was immediately treated with antibiotics and anticoagulants. Follow-up sonography demonstrated complete disappearance of the venous thrombosis. We report a case of streptococcal myositis complicated by deep vein thrombosis.
Anti-Bacterial Agents ; Anticoagulants ; Fever ; Follow-Up Studies ; Gait ; Hip ; Humans ; Iliac Vein ; Magnetic Resonance Imaging ; Muscles ; Myositis ; Popliteal Vein ; Preschool Child ; Streptococcus ; Streptococcus pyogenes ; Thigh ; Thrombosis ; Veins ; Venous Thrombosis

The purposes of the study was to identify the depression of women after a hysterectomy and to clarify the factors related to depression. This was a cross-sectional descriptive study. The data was collected by a mailed questionnaire that was composed of the Zung Self-Rating Depression Scale(SDS), support scale of husband and socio-demographic variables from 255 women undergoing hysterectomies for any nonmalignant condition in S. University Hospital. They also must have lived with their spouses from 3 months to 2 years after the operation. The results were as follows: 1. The SDS mean was 42.25 and range was 21 to 67. The incidence of clinical depression (over SDS 50) was 20.8% from 3 months to 2 years after a hysterectomy. 2. The depression of women in 18-24 months after surgery (39.80) was lower than that of any other periods such as 3-5 months, 6-12 months, and 13-17 months (p<0.01). 3. The support form husband was negatively correlated with the depression of women after a hysterectomy. 4. Depression among women had hysterectomies were associated with lower income, less sexual satisfaction, the feeling of being asexual, and the bias of concept the uterus controlling general health.
Bias (Epidemiology) ; Depression* ; Female ; Humans ; Hysterectomy* ; Incidence ; Postal Service ; Surveys and Questionnaires ; Spouses ; Uterus

The purposes of the study was to identify the depression of women after a hysterectomy and to clarify the factors related to depression. This was a cross-sectional descriptive study. The data was collected by a mailed questionnaire that was composed of the Zung Self-Rating Depression Scale(SDS), support scale of husband and socio-demographic variables from 255 women undergoing hysterectomies for any nonmalignant condition in S. University Hospital. They also must have lived with their spouses from 3 months to 2 years after the operation. The results were as follows: 1. The SDS mean was 42.25 and range was 21 to 67. The incidence of clinical depression (over SDS 50) was 20.8% from 3 months to 2 years after a hysterectomy. 2. The depression of women in 18-24 months after surgery (39.80) was lower than that of any other periods such as 3-5 months, 6-12 months, and 13-17 months (p<0.01). 3. The support form husband was negatively correlated with the depression of women after a hysterectomy. 4. Depression among women had hysterectomies were associated with lower income, less sexual satisfaction, the feeling of being asexual, and the bias of concept the uterus controlling general health.
Bias (Epidemiology) ; Depression* ; Female ; Humans ; Hysterectomy* ; Incidence ; Postal Service ; Surveys and Questionnaires ; Spouses ; Uterus

No abstract available.
Humans ; Infant, Newborn*

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. THE SPECIFIC OBJECTIVES WERE: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i) FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the medically supervised deliveries, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. STUDY DESIGN: The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum "package" program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and "before and after" surveys were conducted to measure the change. SERVICE INPUT: This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. METHOD OF EVALUATION: a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed. b. Neverthless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the "intergration process" itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltructure, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable. Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. SUMMARY OF FINDINGS: A) PROGRAM EFFECTS AND IMPACT. 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 78% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller. 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) & delivery care (45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregnancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) EFFECTS ON INTERACTIVE LINKAGE. 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in carrying for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, 85-90% of the services provided by the health workers were other than FP/MCH, mainly for immunization such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs. 31%) and for more combined care (45% vs. 23%). C) ORGANIZATION FACTORS (ADMINISTRATIVE INTEGRATIVE ISSUES). 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub-center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwives's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea). 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through planning practice. 2) Goal consensus in FP/MCH should be made among the health workers & administrators, especially to emphasize the need of care of "wanted" child. But there is a long way to go to realize the "real" integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (ii) there should be a health sub-center director who can provide leadership training for managing the integrated program. There is a need for "organizational support", if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the management of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Workers, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.
Abortion, Induced ; Administrative Personnel ; Child ; Child Health ; Chungcheongnam-do ; Cohort Studies ; Community Health Workers ; Consensus ; Contraception ; Cooperative Behavior ; Delivery of Health Care ; Encephalitis ; Family Characteristics ; Family Health ; Family Planning Services* ; Female ; Hand ; Health Personnel ; Health Services ; House Calls ; Humans ; Immunization ; Infant ; Infant Mortality ; Insurance Benefits ; Clinical Trial* ; Jurisprudence ; Korea* ; Leadership ; Live Birth ; Local Government ; Midwifery ; Organization and Administration ; Parturition ; Population Growth ; Postnatal Care ; Pregnancy ; Prenatal Care ; Primary Health Care ; Referral and Consultation ; Social Control, Formal ; Specialization

No abstract available.
Hemolytic-Uremic Syndrome*

No abstract available.
Kartagener Syndrome*