BACKGROUND AND OBJECTIVES: Risk assessment methods specially designed for coronary care unit (CCU) are lacking. The aims of this study were first to assess the utility of the Acute Physiology and Chronic Health Evaluation III (APACHE III) scoring system for the prediction of mortality in CCU patients and second to derive an equation for estimation of death risk. MATERIALS AND METHOD: 310 patients were retrospectively investigated. The day 1-scores of APACHE III were determinated. An equation for estimation of death risk was derived, using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve for APACHE III score was plotted. RESULTS: The average APACHE III scores of non-survivors were significantly higher than those of survivors (P<0.01). Multivariate logistic regression analysis showed that the APACHE III scores and the diagnoses on admission were two significant predictors of mortality. we formulated an equation which could predict outcomes : Probability of death =eX / 1+X, where X = -8.64 +diagnostic category weight +(0.10xAPACHE III scores). The ROC curve for APACHE III confirmed it as a predictor of mortality, with an area under the curve of 0.933 (standard error(SE)=.016). The sensitivity (95% confidence limit(CL)), specificity (95%CL) for APACHE III scores were, respectively, 0.84 (0.72-0.92), 0.88 (0.83-0.92). CONCLUSION: We conclude that the APACHE III scoring system is a useful tool for the overall assessment and management of cardiovascular disease patients in CCUs.
APACHE* ; Cardiovascular Diseases* ; Coronary Care Units* ; Diagnosis ; Humans ; Logistic Models ; Mortality ; Retrospective Studies ; Risk Assessment ; ROC Curve ; Sensitivity and Specificity ; Survivors

BACKGROUND AND OBJECTIVES: Risk assessment methods specially designed for coronary care unit (CCU) are lacking. The aims of this study were first to assess the utility of the Acute Physiology and Chronic Health Evaluation III (APACHE III) scoring system for the prediction of mortality in CCU patients and second to derive an equation for estimation of death risk. MATERIALS AND METHOD: 310 patients were retrospectively investigated. The day 1-scores of APACHE III were determinated. An equation for estimation of death risk was derived, using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve for APACHE III score was plotted. RESULTS: The average APACHE III scores of non-survivors were significantly higher than those of survivors (P<0.01). Multivariate logistic regression analysis showed that the APACHE III scores and the diagnoses on admission were two significant predictors of mortality. we formulated an equation which could predict outcomes : Probability of death =eX / 1+X, where X = -8.64 +diagnostic category weight +(0.10xAPACHE III scores). The ROC curve for APACHE III confirmed it as a predictor of mortality, with an area under the curve of 0.933 (standard error(SE)=.016). The sensitivity (95% confidence limit(CL)), specificity (95%CL) for APACHE III scores were, respectively, 0.84 (0.72-0.92), 0.88 (0.83-0.92). CONCLUSION: We conclude that the APACHE III scoring system is a useful tool for the overall assessment and management of cardiovascular disease patients in CCUs.
APACHE* ; Cardiovascular Diseases* ; Coronary Care Units* ; Diagnosis ; Humans ; Logistic Models ; Mortality ; Retrospective Studies ; Risk Assessment ; ROC Curve ; Sensitivity and Specificity ; Survivors

A parasitic survey on vegetables collected from markets and vegetable gardens in Taegu area was conducted for the discovery of human parasitic eggs and larvae. Three species of vegetable, lettuce (Lactuca sativa), young radish(Raphanus sapivus) and Chinese cabbage (Brassica pekinensis) were selected. All vegetable leaves were washed with a hard brush, and then species of parasites and the approximate mean number of parasitic eggs per 200 grams of vegetable leaves were investigated. When vegetables collected from markets were examined, 5 species of parasite eggs (ascarid, trichurid, Trichostrongylus, Clonorchis and hookworms) and 2 larvae (filariform and rhabditoid ) were found. Furthermore, a number of eggs and larvae of undetermined species were also observed. Of the parasites studied, ascarid egg was found to be highest (49.0%), followed Trichostrongylus egg(18.0%) as well as filariform larva of hookworms (19.7%), and the least often observed was rhabditoid larva of hookworms(0.7%). The recovery rate of parasites among lettuce, young radish and Chinese cabbage collected from markets ranged from 23.2 to 91.9 percent and was similar to that from vegetable gardens, where Chinese cabbage showed the highest (91.1%) and lettuce being next(49.0%) in positivity of ascarid eggs. In the case of filariform larva, the rate of Chinese cabbage was twice as high as that of lettuce and young radish. There was a significant reduction in the rate of filariform larva, suggesting that a single washing of vegetables at the vegetable washing stand would reduce the number of parasites attached to vegetable leaves, when young radish washed at the stand was compared with that unwashed. In the monthly rate of parasites recovered from young radish, there was significant fluctuations between the eggs and filariform larva of hookworms. The mean number of ascarid egg per 200 grams of vegetable was 7.5 in young radishes, 3.1 in lettuces, and 0.5 in Chinese cabbages, in decreasing order. It is noteworthy that young radish contained more than 10 times more than Chinese cabbage. These results would seem to indicate that one of the important routes of infection is due to consumption of pickled young radishes in summer than pickled Chinese cabbages in winter.
parasitology-nematoda-trematoda ; Ascaris lumbricoides ; Trichuris trichiura ; Trichostrongylus orientalis ; Clonorchis sinensis ; hookworm ; epidemiology

Therapeutic leukapheresis is a treatment modality which selectively remove abnormal leukocytes and relieve symptoms produced by abnormally high concentration of leukocytes in the blood stream. Authors report the experiences of therapeutic leukapheresis at Seoul National University Hospital during the past 7 years(1988 to 1995). A total of 48 procedures were done for 29 patients(24 males and 5 females). The age distribution was from 16 years to 60 years and mean age was 30 years. The most common diagnosis of patients were acute lymphoblastic leukemia(7/15, 46.7%) and major indications for therapeutic leukapheresis were dyspnea, headache, abdominal pain and mental alteration. The mean leukocyte count before and after leukapheresis were 277,300/micro liter and 220,700/micro liter, respectively(20% decrease, P<0.001). Hemoglobin concentration was also decreased from 7.7g/dL to 7.1g/dL after leukapheresis(P<0.01). The mean number of leukocytes removed per procedure was 3.1x1011. Adverse reactions such as abdominal pain and dizziness were observed in two cases. The leukocyte count was decreased in all patients and improvement of symptoms was observed in four patients. In conclusion, therapeutic leukapheresis is relatively safe and can be used to relieve leukostatic symptoms in leukemic patients.
Abdominal Pain ; Age Distribution ; Diagnosis ; Dizziness ; Dyspnea ; Headache ; Humans ; Leukapheresis* ; Leukocyte Count ; Leukocytes ; Male ; Rivers ; Seoul

BACKGROUND: Th2-like cells are thought to play a crucial role in the recruitment and activation of eosinophil in bronchial asthma. In contrast to Th2 cytokine, Thl cytokine IFN-y decreases eosinophil recruitment. Previous studies have shown that IL-12 promotes differentiation of Th0 into Thl and enhances production of Thl cytokine. IL-12 also prevents differentiation of Th0 into Th2 during primary immune response. Its effect on established Th2 cell, however, is well known. OBJECTIVE: The objective of aur study was focused on whether IL-12 prevents recruitment of eosinophil and expression of Th2 cytokine in murine model for bronchial asthma, and whether its effect differs according to timing of dosage. METHOD: Administration of IL-12 was tested in the 3 different time-frames; 1) allergic sensitization (early dosage) 2) allergic challenge (late doaage) or 3) both. The number of eosinophil in the bronchoalveolar lavage(BAL) fluid and tissue was examined for change of airway inflammation. The effect on cytokine expression was assessed by measuring cytokine in bronchoalveolar lavage fluid (ELISA) and mRNA in peribronchial lymph node (RT-PCR) RESULTS: Early dosage of IL-12, and the combination of early and late dosages, strikingly decreased the numbers of eosinophil in both BAL fluid and tissue(p<0.05). Late dosage of IL-12 decreased tissue eosinophilia, while the number of eosinophil in BAL fluid remained unchanged. IL-12 increased IL-4 and IL-5 levels, and decreased IL-2 and I~FN-r levels. There were no differences in Thl/Th2 cytokine regulation among the three dosage times. Early dosage of IL-12, and the combination of early and late dosages, increased IL-10 level, but late dosage had no effect on IL-10. CONCLUSION: These results demonstrate that depending upon whether IL-12 is administered during sensitization or during subsequent allergen exposure, Thl/Th2 cytokine regulation by IL -12 shows no difference because it seems that difference of inhibition of eosinophil recruitment by IL-12 might be related with the other factors, such as IL-10.
Animals ; Asthma* ; Bronchoalveolar Lavage Fluid ; Eosinophilia ; Eosinophils ; Inflammation* ; Interleukin-10 ; Interleukin-12* ; Interleukin-2 ; Interleukin-4 ; Interleukin-5 ; Lymph Nodes ; Mice* ; RNA, Messenger ; Th2 Cells

We analysed 58 patients who were admitted to the Department of Pediatrics, Yonsei University College of Medicine due to infectious mononucleosis from January 1986 to August 1992. Of 58 patients who had responses to IgM to EBV viral capsid antigen and/or heterophil antibody, 35 patients had hapatitis. Of 35 hepatitis patients, group I consisted of 22 patients who had only EBV infection and group II consisted of 13 patients who had hepatitis B markers or cytomegaloviral markers. The results were as follows: 1) Sex distribution revealed males to females to be 1.1:1. In the age distribution, the proportion of patients with 1 to 3 years of age occupied 40.9% for group I and 30.8% for group II. In non-hepatitis group, 73.9% of patients were in 2 months to 3 years of age. 2) The common presenting symptoms and signs of hepatitis group included hepatomegaly in 24 cases (68.6%), fever in 19 (54.3%), anorexia in 17 (48.6%), throat injection in 16 (45.7%), splenomegaly in 5 (42.9%), and cervical lymphadenopathy in 10 cases (28.6%) etc. 3) In group I, complications or combined diseases included pneumonia in 4 case, disseminated intravascular coagulation in 2 and 1 case in acute pancreatitis. Group II included 1 case of iron deficiency anemia, acute renal failure, peritonitis and pulmonary hemorrhage respectively. 4) Anemia (Hb: <10g/dl) was found in 3 cases (13.6%) for group I, and in 2 cases (15.4%) for group II. Leukocytosis above 10,000/mm3 was demonstrated in 15 cases (68.2%)for group I and in 3 cases (23.1%)for group II. The higher percentage (>15%)of atypical lymphocytes were found in 3 cases (13.6%)for group I and in 1 case(7.7%) for group II. Thrombocytopenia (platelet: <100,000/mm3) was detected in 1 case (4.5%) for group I and in 3 cases (23.1%)for group II. Total bilirubin above 1.0mg/dl was found in 6 cases (27.3%)for group I and in 5 cases(58.1%)for group II. 5) AST level of 100~500IU/L was found in 10 cases(45.4%)for group I, and in 5 cases (38.5%) for group II. AST level above 500IU/L was demonstrated in 1 case (4.5%) and in 3 cases (23.1%) respectively. The mean values of AST level were 253.4 455.3IU/L and 316.7 102.4 IU/L, respectively. 6) Elevated ALT level of 100~500 IU/L was found in 9 cases (40.9%)for group I and in 9 cases(69.2%)for group II. ALT level above 500IU/L was detected in 5 cases (22.7%)for group I and in 3 cases (15.4%)for group II. The mean values of ALT level were 356.9 561.2IU/L and 308.3 259.1IU/L, respectively. 7) Elevated ALT levels returned to normal values within 3 weeks in 14 cases (82.4%) for group I and in 6 cases (66.7%)for group II. The mean duration of normalization of ALT level were 17.3 14.1 days for group I and 19.9 14.8 days for group II. Our results suggest that it AST/ALT levels are elevated and hepatitis A, B, C markers are negative, or if sudden elevated AST/ALT levels are noted in hepatitis B carriers or a patient with cytomegaloviral hepatitis, Epstein-Barr virus infection should be suspected.
Acute Kidney Injury ; Age Distribution ; Anemia ; Anemia, Iron-Deficiency ; Anorexia ; Bilirubin ; Capsid ; Disseminated Intravascular Coagulation ; Epstein-Barr Virus Infections ; Female ; Fever ; Hemorrhage ; Hepatitis A ; Hepatitis B ; Hepatitis* ; Hepatomegaly ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Infectious Mononucleosis ; Leukocytosis ; Lymphatic Diseases ; Lymphocytes ; Male ; Pancreatitis ; Pediatrics ; Peritonitis ; Pharynx ; Pneumonia ; Reference Values ; Sex Distribution ; Splenomegaly ; Thrombocytopenia

No abstract available.
Maxillary Sinus* ; Maxillary Sinusitis*

Acute digitalization with ouabain were performed 28 times in 20 intact Mongrel dogs, who were devided into four groups : i.e. 1) Control group; Acute digitalizations were performed to observe the changes of the plasma potassium and sodium concentrations and the concomittent electrocardiographic findings. 2) Group 1;-Electrolyte solution, either KCl or NaCl, was infused during acute digitalization to observe the influences of these ions on the actions of cardiac glycoside, especially arrhythmia producing action. 3) Group 2 ; -The K depleted group and the Na depleted group was each made by the measure of diet control and the usage of oral diuretics to observe the influences of the state of depleted electrolyte (K or Na) on the action of cardiac glycoside during acute digitalization. 4) Group 3 ; -The intravenous infusion of either KCl or NaCl solution was introduced as the cardiac arrhythmia by the ouabain was produced to observe the effects of these ions on the digitalis induced arrhythmia. The results obtained were summarized as follows. (1) The arterial plasma concentration of potassium was increased during acute digitalization. The rise occurred at early stage, and the maximal increase of potassium was observed at the ventricular tachycardia. The average increase was 0.65 mEq/L as compared to control value (p<0.05). The arterial plasma concentration of sodium was reduced during acute digitalization. The fall occurred following the rise of plasma K level. The maximal reduction of sodium was observed after ventricular tachycardia, and the average decrease was 5.2 mEq/L as compared to control value (p<0.05). (2) Rapid increase up to toxic level of the plasma potassium concentration occurred occasionally during acute digitalization in the group with KCl infusion. This result was best explained due to the inhibitory action of cardiac glycoside on the K transport. (3) The interesting change was on T wave, which showed the peaking at late portion. This change occured in 60.6% during digitalization with ouabain, and paralleled mostly, but not consistently and even sometimes inversely, with the shift of plasma potassium concentration. It is tempting to assume that the change of T wave was resulted from an altered potassium gradient across the myocardial cells rather than a ssuming the changes of the plasma K level. (4) Just prior to intoxication, the marked prolongation of PR interval and ST depression were observed in about 70~80% of the cases studied. These changes might be applicable to a clue of the cardiac glycoside overdosage. (5) The intravenous infusion of KCl suppressed markedly the arrhythmia producing action of the cardiac glycoside, and resulted in prompt and dramatic abolishing, of digitalis induced arrhythmia. The intravenous infusion of KCl solution, however, produced A-V block or dissociation occasionally. This finding would be likely resulted from the additive or synergistic action of K and cardiac glycoside in suppressing A-V conducting system. (6) The NaCl infusion affected nothing to the arrhythmia producing action of cardiac glycoside. (7) The K depletion reduced markedly the threshold of the heart to the toxic effects of cardiac glycoside. (8) Potent diuretics in the state of deficient diet would produce clinically significant hypopotassemia and hyponatremia or both. The inducced hypopotassemia may provoke serious cardiac arrhythmia in the digitalized patients or animals.
Animals ; Arrhythmias, Cardiac ; Depression ; Diet ; Digitalis ; Diuretics ; Dogs ; Electrocardiography ; Electrolytes* ; Heart ; Humans ; Hypokalemia ; Hyponatremia ; Infusions, Intravenous ; Ions ; Ouabain ; Plasma ; Potassium ; Sodium ; Tachycardia, Ventricular

Together, neonatal hepatitis and biliary atresia make up approximately 70 to 80% of the causes of neonatal cholestasis. Biliary atresia must be differentiated from neonatal hepatitis as soon as possible in order to institute early surgical intervention. We performed this study to examine whether the measurement of the serum alpha-fetoprotein (AFP) and thyroxine-binding globulin(TBG) was useful for differentiating these two conditions. Serum AFP levels were measured using enzyme immunoassay in 76 infants with cholestasis and serum TBG levels were measured using radio immunoassay in 30 infants with cholestasis and 23 infants without cholestasis. Serum AFP and TBG concentrations in patients were compared with the normal ranges in infants and were expressed as standard deviation (SD) scores. 52.7% of the patients with neonatal hepatitis showed SD scores of AFP higher than 4.0. By contrast, 14.3% of the patients with biliary atresia showed SD scores of AFP highter than 4.0(p<0.005). The patients with either neonatal hepatitis or biliary atresia had TBG concentrations above the normal ranges, but there was no difference between neonatal hepatitis and biliary atresia. The patients with neonatal hepatitis who recovered from jaundice after 6 months of age or progressed to chronic liver disease of died of the liver disease showed hight serum levels of AFP and TBG than the patients who recovered from jaundice before 6 months of age. In conclusion. SD scores of AFP could be used to differentiate between neonatal heptatis and biliary atresia, and SD scores of AFP and TBG might be used as an indicator of prognosis of neonatal hepatitis.
alpha-Fetoproteins* ; Biliary Atresia* ; Cholestasis ; Hepatitis A ; Hepatitis* ; Humans ; Immunoassay ; Immunoenzyme Techniques ; Infant ; Jaundice ; Liver Diseases ; Prognosis ; Reference Values ; Thyroxine-Binding Globulin*

The histochemical study, especially the demonstration of alkaline phosphatase and acid phosphatase was carried out in order to differentiate ascarides of human and pigs. The experimental material were obtained from naturally contaminated men and pigs. As the histochemical staining methods the Gomori's was applied for acid phosphatase and Takeuchi and Takami's for alkaline phosphatase. The results obtained were summerized as follows : In the pig's ascarides, alkaline phosphatase was richly found in the subcuticular tissue, lateral line, median line, strial zone and epithelial cells of the intestine, epithelial cell and basal membrane of the ovary, the same part of the uterus and also in eggs. Acid phosphatase in the pig's ascarides were distributed in the same part as alkaline phosphatase. It, however, was darker brown in the soft tissue of the lateral line, epithelium of excretory canal, median bundle, whole zone of the intestine and intestinal contents. In the human ascarides, the alkaline phosphatase was distributed in the testes and the parts where the acid phosphatase was found in the pig ascarides. The acid phosphatase in the human ascarides was demonstrated in the subcuticular tissue, soft tissue of lateral line, epithelium of excretory cells, strial zone, transparent zone, granular zone and epithelial zone of esophagus and intestine, ovary, ova in the uterus, epithelial cell and basal membrane of the uterus and in testes. In the pig's ascarides, the area of distribution of alkaline phosphatase was restricted, but that of acid phosphatase was wider. In human ascarides, the area of distribution of alkaline phosphatase and acid phosphatase was not significantly different, but in some part showed slight difference. Above mentioned finding suggest that the distribution of phosphatase could be utilized for the differentiation of ascarides of human and pig.
parasitology-helminth-nematode-Ascaris lumbricoides ; Ascaris suum ; histochemistry ; differentiation ; alkaline phosphatase ; acid phosphatase ; animal ; human ; pig