PURPOSE: It is not clear that the development of glomerular injury and aggravation by tumor necrosis factor alpha (TNF-alpha) is related to intrarenal or serum concentration of TNF-alpha. So, we studied the relationship between the concentration of TNF-alpha and aggravation of glomerular damage in the Henoch-Schonlein nephritis(HSN) and idiopathic nephrotic syndrome(INS). METHODS: We collected the sera and urines of 21 patients with Henoch-Schonlein purpura(HSP) and 22 patients with INS visited Chungbuk National University hospital from March 1998 to March 2001. The concentration of TNF-alpha in the sera and urines were measured by sandwich ELISA. RESULTS: Serum TNF-alpha levels in the HSP patients with renal involvement were significantly higher than those without renal involvement(P=0.009). But urine TNF-alpha levels have no correlation with renal involvement(P=0.088). In the HSN patients, proteinuria have a significant correlation with serum TNF-alpha levels(P=0.004) but less correlation with urine TNF-alpha levels(P=0.053). Otherwise, proteinuria have no correlation with serum TNF-alpha levels(P=0.763) but have a significant correlation with urine TNF-alpha levels(P=0.007) in INS. CONCLUSION: These result suggest that the serum concentration of TNF-alpha would be important to glomerular involvement in HSP. And, it is interesting that proteinuria shows a significant relation with serum TNF-alpha levels in the HSN, but with urine TNF-alpha levels in the INS. This means the major production of TNF-alpha may be originated by extrarenal inflammation in the HSN and by intrarenal tubulo-interstitial damage due to proteinuria in the INS.
Chungcheongbuk-do ; Enzyme-Linked Immunosorbent Assay ; Humans ; Inflammation ; Nephritis* ; Nephrotic Syndrome* ; Proteinuria* ; Tumor Necrosis Factor-alpha*

Background: Reversal of neuromuscular blockade (NMB) at the end of surgery is important for reducing postoperative residual NMB; this is associated with an increased risk of postoperative pulmonary complications (PPCs). Moreover, PPCs are associated with poor prognosis after video-assisted thoracoscopic surgery (VATS) for lobectomy. We compared the effects of two reversal agents, sugammadex and neostigmine, on the incidence of PPCs and duration of hospital stay in patients undergoing VATS lobectomy. Methods: After VATS lobectomy was completed under neuromuscular monitoring, the sugammadex group (n = 46) received sugammadex 2 mg/kg, while the neostigmine group (n = 47) received neostigmine 0.05 mg/kg with atropine 0.02 mg/kg after at least the third twitch in response to the train of four stimulation. The primary outcome was incidence of PPCs. The secondary outcomes were duration of hospital stay and intensive care unit (ICU) admission. Results: There was no significant difference in the incidence of PPCs for both the sugammadex and neostigmine groups (32.6% and 40.4%, respectively; risk difference = 0.08; 95% confidence interval = [−0.12, 0.27]; P = 0.434). The lengths of hospital (P = 0.431) and ICU (P = 0.964) stays were not significantly different between the two groups. Conclusions The clinical use of sugammadex and neostigmine in NMB reversal for patients undergoing VATS lobectomy was not significantly different in the incidence of PPCs and duration of hospital and ICU stay.

The pattern of thickening of the extrahepatic bile duct on computed tomography was analysed in 30 cases with recurrent pyogenic cholangitis diagnosed by surgery (n=19) or clinical basis (n=11). The mean wall thickness of the extrahepatic bile duct was 3.3mm (range, 1-6.3mm). Diffuse thickening of the extrahepatic bile ductal wall was demonstrated in 26 of 30 cases. Diffuse thickening of the extrahepatic bile duct in recurrent pyogenic cholangitis may be differentiated from focal thickening of duct in a common duct cancer or pancreatic cancer.
Bile Ducts, Extrahepatic* ; Cholangitis* ; Pancreatic Neoplasms

The pattern of thickening of the extrahepatic bile duct on computed tomography was analysed in 30 cases with recurrent pyogenic cholangitis diagnosed by surgery (n=19) or clinical basis (n=11). The mean wall thickness of the extrahepatic bile duct was 3.3mm (range, 1-6.3mm). Diffuse thickening of the extrahepatic bile ductal wall was demonstrated in 26 of 30 cases. Diffuse thickening of the extrahepatic bile duct in recurrent pyogenic cholangitis may be differentiated from focal thickening of duct in a common duct cancer or pancreatic cancer.
Bile Ducts, Extrahepatic* ; Cholangitis* ; Pancreatic Neoplasms

Congenital auricular deformities such as lop ear, cup ear, prominent ear, and Stahl's ear can be corrected nonsurgically in the early neonatal period(first week after birth) obtaining satisfactory results. Auricular cartilage consists of chondrocytes and intercellular materials that are mainly assembled from collagen, elastin, and a proteoglycan aggergate. Cartilageelasticity is dependent upon the concentration of the proteoglycan aggregate. Hyaluronic acid, which is a constituent of proteoglycan aggregate and is increased by estrogens, has an important play on disconnecting the proteoglycan aggregate. So the increased estrogen results in the lack of elasticity. The circulating levels of free estradiol are higher during the first 72 hours after birth and decreases thereafter, so the ear is soft and easily malleable in this early neonatal period. In this study, we have applied aluminium splint (90 degree-angulated, 180 degree-angulated, and rolled) on rabbit ear. All of the rabbit was divided into 3 groups containing 3 types of deformities. In group 1, estrogen was applied to the deformed ear with regional injection to the perichondrium of auricular cartilage. In group 2. estrogen was applied topically with ointment. In group 3, as control group, saline was injected to the perichondrium. Four weeks later, in group 2, the shape of the deformed rabbit ear was maintained, and did not return to its original shape even after splint removal. From these results, we concluded that estrogen ointment could be tried as adjunctive therapeutic modalities to the nonsurgical treatment of the congenital auricular deformities.
Chondrocytes ; Collagen ; Congenital Abnormalities ; Ear Cartilage ; Ear* ; Elasticity ; Elastin ; Estradiol ; Estrogens* ; Hyaluronic Acid ; Parturition ; Proteoglycans ; Splints

Voglibose, an α-glucosidase inhibitor, inhibits breakdown of complex carbohydrates into simple sugar units in intestine. Studies showed that voglibose metabolism in the liver might be negligible due to its poor intestinal absorption. Numerous microorganisms live in intestine and have several roles in metabolism and detoxification of various xenobiotics. Due to the limited information, the possible metabolism of voglibose by intestinal microbiota was investigated in vitro and in vivo.

Neuroblastoma is the most common extracranial solid tumor of childhood which presents various clinical symptoms depending on the primary and metastatic sites. However, it has been rarely reported that sudden onset of blindness was the chief complaint of neuroblastoma. A four years old boy was admitted to the Yeungnam University Hospital with the chief complaint of a sudden onset of blindness due to a distant metastasis of abdominal neuroblastoma to the sphenoid sinus. On admission, both side pupils were dilated without light reflex, fundoscopy showed pale optic disk, electroretinogram was subnormal and visual evoked potential showed no response. The liver was palpable in 3 ½ finger breadth from the right costal margin and adult fist sized mass was palpable in the right flank. Skull X-ray showed destructed sphenoid bone and clinoid process and brain CT scan showed tumor mass in the sphenoid sinus and left orbit. Ultrasonogram and CT scan of the abdomen showed large tumor masses around the right kidney and para-aortic and retropancreatic lymph node. IVP showed displaced right calyceal system with preserved contour. Left supraclavicular lymph node which appeared after admission was biopsied and it showed poorly differentiated neuroblasts. He was treated according to the multiagent chemotherapy schedule for stage IV neuroblastoma patient of children's cancer study group. Abdominal tumor masses and sphenoid sinus mass were markedly reduced after 2 courses of the combination chemotherapy of cyclophosphamide, vincristine, DTIC, adriamycin and VM-26. Eventhough the blindness was not improved, the patient has been in good clinical codition.
Abdomen ; Adult ; Appointments and Schedules ; Blindness* ; Brain ; Cyclophosphamide ; Dacarbazine ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Evoked Potentials, Visual ; Fingers ; Humans ; Kidney ; Liver ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Neuroblastoma* ; Optic Disk ; Orbit ; Pupil ; Reflex ; Skull ; Sphenoid Bone ; Sphenoid Sinus ; Teniposide ; Tomography, X-Ray Computed ; Ultrasonography ; Vincristine

No abstract available.
Angiomyolipoma* ; Lymph Nodes*

Continuous observation based on the operator's clinical experience is impractical in monitoring free flap and the success rate of flap can be increased with the adjunctive monitoring system such as laser Doppler flowmetry. The author tried to establish the objective critical point to analyze the data in the postoperative period in microsurgical reconstruction. In this study, laser Doppler flowmetry(Periflux 4001 Master , Sweden) was used continuously for flap monitoring from the recovery room; every hour for 24hours, every 2 hours in the next 24 hours and every 3 - 6hours thereafter until the 7th day. Among 43 cases performed, 4 patients suffered from postoperative vascular insufficiency and they were decided to follow the exploration or salvage procedure. The value may be recorded at most 3.0 even when the tissue sufferes without flow due to its highly sensitive system, and it is quite reliable for flap survival if the initial value is above 3.0 with increasing trend. If the flow value persists below 3.0 continuously or show a plateau, vascular compromise can be doubted. Initial plateau or decline curve was caused by flap swelling and could be detected in 2 postoperative periods such as early (2-24hour) and /or late (26 -116 hour) period. Its decline was maximally up to 31.5% and this decline was more commonly observed in perforator- based free flap than others. However, its appearance and duration was quite unexpected especially in small free flap due to skin tension after suture. In conclusion, the laser Doppler flowmetry is a valuable adjunctive system in flap monitoring after operation by observing the trend in perfusion value.
Free Tissue Flaps* ; Humans ; Laser-Doppler Flowmetry* ; Perfusion ; Postoperative Period ; Recovery Room ; Skin ; Sutures

Arteriovenous malfomation poses an unsolved, uncontrollable surgical challenge. Many therapeutic modalities have been introduced, but the great recurrence of the malformation after the radical resection should not be ignored. The altered hemodynamic conditions and newly formed ischemic areas after the surgical resection can accelerate the dormant artervenous shunt and stimulate the expansion of regional collaterals. So, the appropriate reconstruction method must be considered to prevent its recurrence. We have our own therapeutic principles; preoperative selective embolization, radical resection with saving the important structures, and well-vascularized tissue reconstruction such as island or free flap. 5 patients with facial arteriovenous malformations (2 on the temple, 2 on the auricle, 1 on the cheek), were treated with this modality and this concept can be expected to provide great remission of arteriovenous malformation. Free flap transfers were used in 3 cases. The feeding vessels of the arteriovenous malformation were used as recipient vessels of free flap, and so such hemodynamic redistribution of flow also limited the development of new arteriovenous shunts in ischemic field of resection.
Arteriovenous Malformations* ; Free Tissue Flaps ; Hemodynamics ; Humans ; Recurrence