Idiopathic pulmonary alveolar proteinosis (PAP) is a rare disorder in which lipoproteinaceous material accumulates within alveoli. There were few reports on Asian populations with idiopathic PAP. We retrospectively reviewed 38 patients with idiopathic PAP in Korea. We assessed clinical features, therapeutic efficacy and outcomes of whole lung lavage in patients with idiopathic PAP. The mean age at diagnosis was 52 yr. Eighty six percent of patients were symptomatic at diagnosis. Dyspnea and cough were the most common symptoms. Crackles were the most common physical examination finding. On pulmonary function test, a mild restrictive ventilatory defect was common, with a predicted mean forced vital capacity (FVC) of 77% and forced expiratory volume in one second (FEV1) of 84.6%. Diffusing capacity was disproportionately reduced at 67.7%. Arterial blood gas analysis revealed hypoxemia with a decreased PaO2 of 69.0 mmHg and an increased D(A-a)O2 of 34.2 mmHg. After whole lung lavage, PaO2, D(A-a)O2 and DLCO were significantly improved, but FVC and total lung capacity (TLC) were not different. This is the first multicenter study to analyze 38 Korean patients with idiopathic PAP. The clinical features and pulmonary parameters of Korean patients with idiopathic PAP are consistent with reports in other published studies. Whole lung lavage appears to be the most effective form of treatment.
Adult ; Biopsy ; Bronchoalveolar Lavage ; Female ; Humans ; Korea ; Male ; Middle Aged ; Pulmonary Alveolar Proteinosis/diagnosis/pathology/*physiopathology/*therapy ; Respiratory Function Tests ; Retrospective Studies ; Survival Rate ; Treatment Outcome

Acute myocardial infarction and subsequent heart failure are leading causes of death worldwide. Stem cell-based therapies have improved cardiac function in recent clinical trials, but cardiomyocyte regeneration has not been demonstrated in human hearts. Angiogenesis and restoration of cardiac perfusion have been successfully performed using bone marrow derived stem cells and other adult stem cells. Resident cardiac stem cells are known to differentiate into multiple heart cell types, including cardiomyocytes. Furthermore, induced pluripotent stem cells are a focus of research due to the great potential for customized stem cell therapy.
Adult Stem Cells ; Bone Marrow ; Cause of Death ; Cell Differentiation ; Heart ; Heart Failure ; Humans ; Induced Pluripotent Stem Cells ; Myocardial Infarction ; Myocytes, Cardiac ; Perfusion ; Regeneration ; Stem Cells

BACKGROUND AND OBJECTIVES It is being increasing recognized that the morbidities of migraine and balance disorders are interrelated. In fact, migrainous vertigo (MV) is one of frequent causes of recurrent vertigo in patients presenting to specialized dizziness clinics. Nevertheless, not many studies have reported clinical manifestations and treatment. Therefore, the aim of study was designed to assess clinical features and treatment patterns by a nationwide multicenter study. MATERIALS AND METHODS Patients between 9 and 74 years of age who visited 17 Korean tertiary referral centers and 1 clinic from February to March 2009 were investigated using two forms of questionnaires. RESULTS Overall, 318 patients with MV were enrolled. MV was responsible for ~8.45% of visits to the specialized dizziness clinics. One hundred seventy-five of these patients had definite MV and were included in assessing the clinical features. Vertigo characteristics of patients with definite MV were various. Vertigo was regularly as sociated with headache in 87% of the patients. The duration of vertigo ranged from seconds to days. For the treatment patterns, an acute and prophylactic therapies were carried in most clinics. There were no differences in either acute or prophylactic therapies between department of neurology and otorhinolaryngology. CONCLUSIONS The results of this study suggest that MV the clinical features of MV also varies in Korea. In addition, most clinics provide similar patterns of practice in treatment for MV. The syndrome of MV deserves further research activity as it is relatively common and clinically relevant.
Dizziness ; Headache ; Humans ; Korea ; Migraine Disorders ; Neurology ; Prospective Studies ; Tertiary Care Centers ; Vertigo

Even though arterial embolization was introduced as a treatment tool for postpartum hemorrhage, it is not performed frequently. As authors applied arterial embolization successfully to the patient who contracted retroperitoneal hematoma after delivery, we reported this case with a brief review of literature.
Arteries* ; Hematoma ; Humans ; Postpartum Hemorrhage

A prospective and longitudinal investigation concerning clinical outcomes and morphologic changes of large lumbar disc herniations by MR imaging. To compare the clinical outcomes and the natural morphologic changes of between sequestered and large central extruded disc herniations. The spontaneous disappearance or diminution of large herniated lumbar discs in the spinal canal is known. Poor clinical outcome and small changes of herniated discs have been shown for large central extruded disc herniations with conservative treatment. The study population consisted of 22 patients with sequestration and a large central as extrusion established by an MR imaging study. Seventeen (11 patients with sequestration, and 6 patients with a large central extrusion) patients underwent a follow-up MR imaging study. The size of the herniated disc was measured on serial MR imaging studies, and the changes in size were classified into four categories. Clinical evaluations were also performed using a visual analogue scale (VAS), the Oswestry lowback pain disability questionnaire, the straight leg raising test (SLRT) and so forth. Both the sequestered and large central extruded disc herniations showed a successful clinical outcome after conservative treatment in 17 of 22 patients (77%) in total: 11 of 13 patients (85%) with sequestered disc herniations, and 6 of 9 patients (67%) with large central extruded disc herniations. VAS and Oswestry disability scoring showed a greater change in the group with sequestration than in the group with large central extrusions. In the group with sequestration, seven patients reported the disappearance of herniated disc materials, and four patients showed a marked decrease in the size of their herniated discs in follow-up MR images. However, in the group with large central extrusions, only two patients showed a decrease in the size of their herniated discs. Large central extruded disc herniations can be treated successfully by conservative treatment. Outcomes seemed to be as good as or slightly inferior to those of sequestered disc herniations. However, a greater morphologic decrease in the herniated discs occurred more frequently for sequestered disc herniations than for large central extruded disc herniations.
Adult ; Aged ; Comparative Study ; Female ; Human ; Intervertebral Disk Displacement/*diagnosis/*therapy ; Longitudinal Studies ; *Magnetic Resonance Imaging ; Male ; Middle Age ; Prospective Studies ; Treatment Outcome

OBJECTIVE: Our purpose was to investigate lipid peroxide levels, total peroxyl radical-trapping antioxidative parameter (TRAP) values, and antioxidant vitamin levels in placental tissues of women with preeclampsia and to evaluate their roles in the pathophysiology of preeclampsia. STUDY DESIGN: Samples of placental tissue homogenates were obtained from 23 normal and 18 preeclamptic women between 33 and 40 weeks gestation. TNF-alpha was assayed by an enzyme-linked immunoassay. Lipid peroxide levels measured by thiobarbituric acid reaction. The TRAP values were measured by modified Wayners method. Ascorbic acid, uric acid, retinol, alpha-tocopherol, and gamma-tocopherol were measured by high performance liquid chromatography (HPLC) CoulArray detector. RESULTS: TNF-alpha levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (21.4+/-3.39 vs. 10.3+/-1.06 pg/ml, p<0.05). Lipid peroxide levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (6.65+/-0.57 vs. 4.98+/-0.37 nmol/mg protein, p<0.05). TRAP values in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (0.24+/-0.02 vs. 0.31+/-0.03 mM, p<0.05). Ascorbic acid levels in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (217.0+/-21.0 vs. 333.3+/-32.8 nmol/ml, p<0.05). CONCLUSION: The above results suggest that increased oxidative stress in placenta is involved in the pathophysiology of preeclampsia and ascorbic acid may act as an important preventive factor in the development of preeclampsia.
alpha-Tocopherol ; Ascorbic Acid ; Chromatography, Liquid ; Female ; gamma-Tocopherol ; Humans ; Immunoassay ; Oxidative Stress ; Placenta* ; Pre-Eclampsia* ; Pregnancy* ; Tumor Necrosis Factor-alpha ; Uric Acid ; Vitamin A ; Vitamins

OBJECTIVE: This study was to determine the levels of cytokines, lipid peroxides, and total peroxyl radical-trapping antioxidative prameter (TRAP) values of amniotic fluid in pregnant women with preterm premature rupture of membranes (PPROM). METHOD: Amniotic fluid samples were obtained by amniocenteses for chromosomal analyses and other indications(control, n=26). Amniotic fluid samples were also obtained by amnioceteses from pregnant women with preterm premature rupture of membranes (n=22). Amniotic fluid cytokines(IL-6, IL-8) were determined by enzyme-linked immunosorbent assay (ELISA). Lipid peroxide levels of amniotic fluid were measured by thiobarbituric acid (TBA) reaction. The TRAP value of amniotic fluid was assessed by measuring the rate of oxygen consuming during controlled lipid peroxidation by 2,2'-azobis-2-amidinopropane hydrochloride, a water soluble peroxyl radical generator. Ascorbic acid and uric acid were measured by high performance liquid chromatography (HPLC) CoulArray detector of water-soluble antioxidants. Retinol, alpha-tocopherol, and gamma- tocopherol were measured by HPLC-CoulArray detector of fat-soluble vitamins. RESULTS: Cytokine levels of amniotic fluid in pregnant women with PPROM(IL-6: 23.37+/-10.61 ng/ml, IL-8: 10.23+/-3.04 ng/ml) were significantly higher than those in normal pregnant women(IL-6: 0.62+/-0.32 ng/ml, IL-8: 0.55 +/- 0.15 ng/ml), (p<0.05). Lipid peroxide levels of the amniotic fluid in pregnant women with PPROM(10.42+/-1.11 nmol/mg protein) were significantly higher than those in normal pregnant women (7.32+/-0.65 nmol/mg protein), (p<0.05). The amniotic fluid obtained from pregnant women with PPROM showed significantly lower TRAP values (0.46+/-0.04 mM) than those from normal pregnant women(0.62+/- 0.03 mM), (p<0.01). Amniotic fluid ascorbic acid levels in pregnant women with PPROM (52.1+/-15.1 nmol/ml) were significantly lower than in normal pregnant women(231.9+/-33.9 nmol/ml), (p<0.01). There were no significant differences of amniotic fluid uric acid, retinol, alpha-tocopherol, and gamma-tocopherol levels between these groups. CONCLUSIONS: This findings suggest that a low antioxidant activity in amniotic fluid may cause PPROM and demonstrate that antioxidant vitamin, ascorbic acid, may act an important factor in the prevention of PPROM.
alpha-Tocopherol ; Amniocentesis ; Amniotic Fluid* ; Antioxidants ; Ascorbic Acid ; Chromatography, Liquid ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Female ; gamma-Tocopherol ; Humans ; Interleukin-8 ; Lipid Peroxidation ; Lipid Peroxides ; Membranes* ; Oxygen ; Pregnant Women* ; Rupture* ; Tocopherols ; Uric Acid ; Vitamin A ; Vitamins

PURPOSE: This retrospective study was designed to review and analyze the results of Delorme's procedure for rectal prolapse. METHODS: Between 1990 and 1999, twenty-nine patients with rectal prolapse underwent Delorme's procedure. These patients had had no previous operation for rectal prolapse. This study was proceeded retrospectively through the out-patient clinic and by telephone questionnare. RESULTS: Twelve cases (41%) were males and 17 cases (59%) were females. Mean age was 55.5 years (range, 23~86 years). The duration of the symptoms was ranged from 3 months to 60 years, with the mean period of 12.2 years. The follow-up period after the operation was from 3 months to 10 years (mean follow-up, 45 months). The internal rectal prolapses were 11 cases (38%), and the complete rectal prolapses were 18 cases (62%). The common preoperative bowel habits were incontinence with 6 cases (21%) and constipation with 10 cases (34%). After the operation, incontinence and constipation were improved in 4 cases (67%) and 6 cases (60%) respectively. Additional 2 cases of constipation occurred among 19 cases who hadn't had it preoperatively but the use of laxative helped in improving the symptom. The mean operation time was 71 minutes and in 24 cases (83%), the operation was proceeded with spinal anesthesia. In 27 cases (93%), the amount of bleeding during the operation was less than 100 cc, and in 1 case (3.4%), blood transfusion was needed because the amount was more than 400 cc. The three patients (10%) had postoperative complications(one perianal abscess due to anastomotic dehiscence and two urinary retention). There was one case of recurrence (3.4%) after the operation and no postoperative mortality. CONCLUSIONS: Delorme's procedure has the short operation time, causes less bleeding and is possible with regional anesthesia. Delorme's procedure has low complication rate, results in good bowel function and has a low recurrence rate. Therefore, Delorme's procedure can be performed with satisfactory outcome in elderly patients and the poor general conditioned patients as well as younger patients. As recurrence rates is low and continence is improved, this procedure may be the preferred initial treatment of all patients with rectal prolapse.
Abscess ; Aged ; Anesthesia, Conduction ; Anesthesia, Spinal ; Blood Transfusion ; Constipation ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Mortality ; Outpatients ; Rectal Prolapse* ; Recurrence ; Retrospective Studies ; Telephone

BACKGROUND: The outcome of hematopoietic stem cell transplantation (HSCT) for patients with severe aplastic anemia (SAA) in Seoul National University Hospital was analyzed retrospectively. METHODS: Between January, 1990 and March, 1999, 25 patients with SAA underwent HSCT. Their medical records were reviewed. Statistical analyses were done about survival and complication after HSCT. RESULTS: The median age of patients was 22 (range, 14~43) and male to female ratio was 18 : 7. Twenty two were HLA matched non- identical siblings. Three were one identical twin, one one-locus mismatched father and one HLA matched unrelated donor, respectively. Conditioning regimens were CY/TLI (cyclophosphamide, total lymphoid irradiation) for 18 patients, CY/ATG (CY, antithymocyte globulin) for 3, CY/ buffy (CY, unirradiated buffy- coat) for 2, CY/ ATG/TLI for 1, BU/CY (busulfan, CY) for 1. For prophylaxis of graft-versus-host disease (GVHD), cyclosporine and methotrexate were used in all patients except for identical twin. The median nucleated cell dose given to patients was 4.5x108/kg (range, 2.0~5.9). All evaluable patients achieved absolute neutrophil count of 500/microliter after median 17 days of HSCT (range, 12~27) and untransfused platelet count over 20,000/microliter after median 21 days of HSCT (range, 13~67). Six patients (24%, grade I : 3, II : 1, III : 1, IV : 1) developed acute GVHD and 8 (32%, limited : 4, extensive : 4) developed chronic GVHD. Hepatic venoocclusive disease (VOD) occurred in 2 patients (8%). Rejection occured in 4 patients (16 %), but among 22 allogeneic transplant recipients from HLA matched siblings, only one (5%) lost graft. After a median follow-up of 32 months (range 9~120 months), 5 year overall survival of all patients was 87%, and that of 22 allogeneic recipients from HLA matched sibling donors was 95%. Four patients (16%) died. Causes of death were VOD in one case, rejection with pneumonia one, acute GVHD one. One died from traffic accident in a cured state. CONCLUSION: Experiences from our center suggest that HSCT is an effective treatment for patients with severe aplastic anemia. Long- term survival is especially excellent for patients who have matched related donors.
Accidents, Traffic ; Anemia, Aplastic* ; Cause of Death ; Cyclosporine ; Fathers ; Female ; Follow-Up Studies ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Male ; Medical Records ; Methotrexate ; Neutrophils ; Platelet Count ; Pneumonia ; Retrospective Studies ; Seoul ; Siblings ; Tissue Donors ; Transplantation ; Transplants ; Twins, Monozygotic ; Unrelated Donors

PURPOSE: To evaluate the use of CT in patients with vocal cord paralysis due to extralaryngeal cause s ,andto use CT for the assessment of extralaryngeal diseases causing vocal cord paralysis. MATERIALS AND METHODS: Weprospectively studied the results of CT in 41 patients with vocal cord paralysis in whom laryngoscopy revealed nolaryngeal cause and physical examination demonstrated no definite extralaryngeal cause. The extralaryngeal causeof vocal cord palsy was determined after comprehensive clinical diagnosis. Enhanced CT scans were acquired fromthe skull base and continued to the level of the aorticopulmonary window. We used CT to assess the detection ratefor extralaryngeal causes and to extimate the extent of extralaryngeal disease and the distribution of lesions. RESULTS: CT revealed that in 20 of 41 patients(49%) the extralarygeal causes of vocal paralysis were as follows :thyroid cancer(n=10), nodal disease(n=6), esophageal cancer(n=2), neurogenic tumor(n=1), aortic aneurysm(n=1).Lesions were located on the left side in 13 patients(65%), and in the tracheoesophageal groove in 15(75%). CONCLUSION: In patients with vocal cord paralysis in whom no definite lesion is seen on physical examination, CT could be a useful primary imaging method for the assessment of extralaryngeal causes.
Diagnosis ; Humans ; Laryngoscopy ; Paralysis ; Physical Examination ; Skull Base ; Thyroid Gland ; Tomography, X-Ray Computed ; Vocal Cord Paralysis* ; Vocal Cords*