BACKGROUND: Liver ischemia and reperfusion injury is associated with activation of several inflammatory pathways including cytokines, tumor necrosis factor (TNF) and cell-mediated tissue damage. tacrolimus causes a regulatory effect on some inflammatory pathways, such as cytokines, TNF, adhesion molecule and inflammatory cells. Prostaglandin E1 (PGE1) has shown vasodilatation by relaxing vascular smooth muscles and inhibits the effect of proinflammatory cytokines which could reduce leukocyte- sinusoidal and platelet-sinusoidal interactions. METHODS: Liver ischemia was induced in rats by occluding the vessels, the supplying median segment, and the left lateral segment with an aneurysmal clip for 60 minutes. The rats received tacrolimus (0.5 mg/kg, tacrolimus group) or PGE1 (100 ug/kg, PGE1 group) or normal saline (Control group) 30 and 5 minutes before ischemia and reperfusion of the liver, respectively. The serum ALT, nitric oxide, and TNF were determined at 1, 24, and 48 hours after reperfusion, and hepatic necrosis was determined at the same times by using HE staining and a microscopic grading system. RESULTS: 1) In the control group, the serum ALT and TNF levels had peak values at 1 hour and were gradually decreased, but the serum nitric-oxide level was gradually increased after the time of reperfusion (p<0.05). No necrosis existed at in one hour, but the tissue necrosis at 24 hours was higher than that at 48 hours (p<0.05). 2) At one hour, the tacrolimus group had significantly lower serum ALT and TNF levels and a higher serum nitric-oxide level in the liver compared with the control group, but the serum nitric-oxide level did not change significantly after reperfusion (p<0.05). The extent of hepatic necrosis was significantly inhibited in the tacrolimus group when compared with that in the control group and the PGE1 group (p<0.05). 3) The PGE1 group exhibited improved hepatic necrosis compared with the control group (p<0.05). The improved hepatic necrosis was reflected in reductions of the serum ALT and TNF and an increase in the serum nitric-oxide level. CONCLUSIONS: These result suggest that tacrolimus and PGE1 protect the liver against ischemia- reperfusion injury by reducing the serum TNF level and increasing the serum nitric-oxide level. The protective effect of tacrolimus is more beneficial than that of PGE1.
Alprostadil* ; Aneurysm ; Animals ; Cytokines ; Ischemia ; Liver* ; Muscle, Smooth, Vascular ; Necrosis ; Nitric Oxide ; Rats* ; Reperfusion ; Reperfusion Injury* ; Tacrolimus* ; Tumor Necrosis Factor-alpha ; Vasodilation

BACKGROUND: Nowadays, as public awareness of t,he Acquired immunedeficiency syndrome(AIDS) epidemic was increasing, athletes have become more concerned about their risk of infection with human immunedeficiency virus(HIV) since it, was announced that Magic Johnson, hero of basketball in the United States, was infected. Because there are no exact cure method about AIDS, the only treatment is prevention through the education and awareness of AIDS. Therefore, we researched the athletes knowledge of AIDS to provide the b#asis of preventive methods. METHODS: A questionnaire was given directly to the 110 wrestling and taekwondo athletes attending a sports college. RESULT: Athletes are all men and their mean age is 24.6 years old. Concerning the question of latent period, 54.5% had correct answer that AIDS development took more than several years after HIV infection. The person who had educated about the preventive methods of infection during the sports was 4.6%. The person who answered AIDS athletes should be excluded from the sports was 64.5% and the reason of exclusion was the risk of infection through the small bleeding(49.8%), sweating(38.0%), and simple skin cont,acts(19. 7%) during the sports. The correct recognition rate of preventive method of infection during the sports was 51.8 to 62%. Concerning the risk routes and behaviors of infection during daily life, most of them recognized correctly(from 76,3% to 99.0% by each item), but some have also misconception about transfusion(61.0%), skin contact(33%) and mosquitos bite(30%) etc. CONCLUSION: Almost all of athletes recognized correctly the risky behavior of sex and blood in transmission of infection, but some have also misconception in daily activities, e.g. transfusion and mosquitos. Many persons answered AIDS infected athletes should be excluded from the sports and they didnt receive any education about preventive methods of AIDS infection during the sports. The knowledge of preventive methods of infection recommended during the sports was relatively high.
Athletes* ; Basketball ; Culicidae ; Education ; HIV Infections ; Humans ; Korea* ; Magic ; Male ; Skin ; Sports ; United States ; Wrestling ; Surveys and Questionnaires

PURPOSE: This study aimed to define the relationship among self-care, symptom experiences, and health-related quality of life(HRQoL) according to the severity of disease in chronic obstructive pulmonary disease(COPD) patients. METHODS: The participants, 195 COPD patients, were recruited at a pulmonology clinic of a universityaffiliated medical center in B metropolitan city. Inclusion criteria were patients who were diagnosed as COPD and had less than 0.7 of FEV1/FVC(Forced Expiratory Volume for 1 second/Forced Vital Capacity) ratio. The severity was classified with GOLD(Global initiative for Obstructive Lung Disease) stages, FEV1% predicted value from mild to very severe. The data were gathered by the medical records and self-reported questionnaires. RESULTS: The self-care, symptom experience, and HRQoL were all significantly different by COPD severity based on pulmonary function(p<.05). There were significant moderate negative relationships between symptom experiences and self-care(r=-.54, p<.001) and between symptom experiences and HRQoL(r=-.64, p<.001). There was a moderate positive correlation between self-care and HRQoL(r=.63, p<.001). CONCLUSION: It suggests that the assessment of disease severity based on pulmonary function and subjective symptom experience in patients with COPD may be a key component to develop a tailored self-management program and to improve their quality of life.
Humans ; Lung ; Medical Records ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Medicine ; Quality of Life ; Self Care

PURPOSE: To evaluate the role of repetitive vascular surgery in below-knee amputation for critical lower-limb ischemia. METHODS: The data of the 39 below-knee amputee despite receiving one more vascular surgery for critical limb ischemia from Jaunary 1990 through October 1995 were retrospectively reviewed. A total of 102 surgical operation was included. RESULTS: The mean age was 46 years old ranged from 21 through 78 and the forth decade was the most prevalent group by proportion of 33% (13 cases). The frequency of Buerger's disease is 20, and that of atherosclerotic occlusion (ASO), ASO with diabetes, and diabetic arteriopathy (DA) were 11, 4, 3, respectively. The number of operative procedures before amputation and the total mean duration (TMD: days) from initial operation to final amputation for femoral, popliteal and tibial occlusion were 45/485, 26/921 and 13/1725, respectively. Those for Buerger's disease, ASO, ASO with diabetes and DA were 42/960, 25/865, 9.1027, and 7/251 respectively. The proportions of duration between initial vascular procedure and second one in the TMD for the patients of tibial occlusion and ASO with diabetes revealed 95.0% and 98.4%. Smoking revealed shortened the duration until amputation in cases of popliteal artery involvement. CONCLUSION: The frequency of below-knee amputation due to critical limb ischemia is high in Buerger's disease and in the age of fourth decade. Patients of the tibial artery involvement and ASO with diabetes may not have benifits from repetitive operative procedures after initial vascular surgery in postponing the below-knee amputation. More study is needed with incresed number of cases.
Amputation* ; Amputees ; Extremities ; Humans ; Ischemia* ; Lower Extremity* ; Middle Aged ; Popliteal Artery ; Retrospective Studies* ; Smoke ; Smoking ; Surgical Procedures, Operative ; Thromboangiitis Obliterans ; Tibial Arteries

PURPOSE: A scoring system could be clinically useful in determining cases in which a throat culture may be omitted or in cases whether antibiotics may be initiated or not. We propose to make a clinical guideline of antibiotics administration in patients with pharyngitis. METHODS: From Apr. 1996. to Mar. 1997, throat cultures were taken from 321 cases (72 cases from Kyung-Hee Medical Center, 249 cases from 3 local pediatric clinics). On the first day of visit, 9 clinical items on a score-card were checked and a tentative diagnosis for streptococcal or non-streptococcal infection was made. These clinical scores were compared with the results of the throat swab cultures. RESULTS: Of 321 cases with pharyngitis, 55 cases (17%) proved to have group A streptococci by throat culture. The positive culture rate of group A streptococci was 18.5% from 3 local pediatric clinics, and 12.5% from Kyung-Hee Medical Center. The positive culture rate of group A streptococci were 40% in above 31 points of score, 31.5% in 29 to 30 points, 20.5% in 27 to 28 points. The sensitivity and specificity of the scoring system using a score at least 28 above points were 71% and 67%, respectively. CONCLUSION: The clinical diagnosis of streptococcal pharyngitis indicates that patients age 5 to 10 years, findings of abnormal pharynx, high fever and no past history of antibiotics use. Further modification of the scoring system for diagnosis of streptococcal pharyngitis should be made to prevent antibiotics abuse and correct diagnosis of pharyngitis.
Anti-Bacterial Agents ; Diagnosis* ; Fever ; Humans ; Pharyngitis* ; Pharynx ; Sensitivity and Specificity

Ectopic thyroid is defined as any thyroid tissues not located in the usual site of the thyroid gland, which is anterolateral to 2-4th tracheal rings in the lower neck. These tissues could be present anywhere along the descending tract of a developing thyroid primordium. It is rare for dual ectopic thyroid to have two ectopic foci simultaneously. Twenty-seven cases of dual ectopic thyroid have been reported in the English literature. Physical examinations are usually performed for oral cavity, oropharynx and anterior neck to test for thyroid function, and CT scanning and thyroid scintigraphy are usually performed for the diagnosis of these entities. We report a 19-year-old male with dual ectopic thyroid tissues in lingual and suprahyoid regions but without thyroid tissue in its normal area.
Humans ; Male ; Mouth ; Neck ; Oropharynx ; Physical Examination ; Thyroid Dysgenesis ; Thyroid Gland ; Young Adult

Solitary necrotic nodule (SNN) of the liver is a very uncommon benign lesion, and it is detected incidentally as a rule. It is important to differentiate SNN radiologically from various single hepatic nodules because SNN mimics hepatic metastasis, especially in staging work up of known primary malignancy. The reported imaging findings of SNN are well-defined nodule without enhancement or with subtle peripheral enhancement. There has been no report about the target-like SNN of the liver and about the imaging finding of 3T magnetic resonance imaging and positron emission tomography. We report a case of targetlike SNN of the liver, mimicking hepatic metastasis, with findings of various imaging modalities and try to find a cause of this nodule according to the pathologic and literature review.
Humans ; Liver ; Liver Neoplasms ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Positron-Emission Tomography

PURPOSE: To compare satisfaction after laser in situ keratomileusis (LASIK) with satisfaction after wavefront guided customized LASIK. METHODS: One hundred fifty-nine patients were included in this randomized, comparative, clinical trial. A myopia-specific Quality of Life Questionnaire was used to evaluate postoperative satisfaction. RESULTS: Overall questionnaire scores improved after both procedures. Wavefront LASIK showed higher satisfaction scores with respect to "Difficulty in visiting others", "Need a lot of help from others", and "Improvement of quality of life". But, most of the questionnaires did not show differences in actual visual satisfaction of daily living. CONCLUSIONS: Conventional and wavefront LASIK improved the visual satisfaction of patients. However, for the most part there was no difference in improvement of daily living between the two procedures.
Humans ; Keratomileusis, Laser In Situ* ; Patient Satisfaction* ; Quality of Life ; Surveys and Questionnaires

PURPOSE: The purpose of this study is to compare the clinical characteristics and predisposing factors of necrotizing enterocolitis (NEC), primarily a disease of the premature, in between term and preterm groups. METHODS: We retrospectively reviewed the medical records of 36 neonates with NEC (> or =modified Bell's staging criteria IIa) who were admitted to the NICU of Seoul National University Children's Hospital from January 1, 2000 through December 31, 2004. 20 full and 16 preterm neonates were compared in regard to demographics, clinical characteristics and predisposing factors. RESULTS: 29/36 neonates(80.6%) were outborn. Mean gestational age and birth weight were 38.5+/-0.9 weeks and 3, 010+/-490 g, term and 31.4+/-3.4 weeks and 1, 460+/-750 g, in preterm respectively group. Mean age at diagnosis was 17.3+/-13.5 days in term versus 20.8+/-19.6 days in preterm group. Abdominal distension was the most common finding in both groups and diarrhea was significantly more common in term group. Congenital heart disease, intrauterine growth retardation, bacterial infection were found in 75.0% of term group. The rates of surgical intervention and complication were higher in preterms, however, mortality rate was higher in term group. Congenital heart disease, especially the presence of complex heart disease with poor systemic perfusion or heart failure, was associated with higher mortality. CONCLUSION: Diarrhea was more common in term group. Neonates with predisposing factors for NEC, especially in term neonates with congenital heart disease, should be followed closely for early diagnosis and proper treatment.
Bacterial Infections ; Birth Weight ; Causality* ; Demography ; Diagnosis ; Diarrhea ; Early Diagnosis ; Enterocolitis, Necrotizing* ; Fetal Growth Retardation ; Gestational Age ; Heart Defects, Congenital ; Heart Diseases ; Heart Failure ; Humans ; Infant, Newborn* ; Medical Records ; Mortality ; Perfusion ; Retrospective Studies ; Seoul

Congenital adrenal hyperplasia, which is caused by the disorder of the enzyme for synthesizingadrenal hormones, results in hypertropy of the clitoris due to overporduction of adrenalandrogen. Diagnosis of the congenital adrenal hyperplasia can be obtained by the study ofsteroid levels in blood and urine. The blood levels of ACTH, testosterone and 17-hydroxyprogesteronewere increased and the concentration of 17-ketosteroid were decreased after the dexamethasonesuppression test. The internal genital organ was normal appearance on the pelvic CTscan. Clitoromegaly due to congenital adrenal byperplasia was corrected previously by the variousoperational procedures in which the clitoris was removed entirely for only physial appearance.However the sensitive function of the clitoris after the operative correction throughpuberty is to be preserved by the method "clitoroplasty" for preserving neurovascular supply tothe clitoris. The writer experienced a case of a 5-year-old girl with congenital adrenalhyperplasia and tried this clitoroplasty for surgical treatment of clitoromegly for preservation ofpostoperative sensitivity of the clitoris.
Adrenal Hyperplasia, Congenital* ; Adrenocorticotropic Hormone ; Child, Preschool ; Clitoris* ; Diagnosis ; Female ; Genitalia ; Humans ; Testosterone