To study the site of release and factors affecting the release of the atrial natriuretic peptide(ANP) in the pediatric patients, we measured the plasma ANP concentrations in 23 normal healthy children, 19 patients with congestive heat failure and 16 patients with cardiac disease undergoing diagnostic cardiac catheterization. The following results were obtained. 1) The plasma ANP concentrations of the vein(226.3(74.9pg/ml)in patients with congestive heart failure were significantly higher than those(p<0.01)of the mormal healthy children(13.4 (7.9pg/ml)and those(43.3 40(.7pg/ml)in patients undergoing cardiac catheterization. The plasma ANP concentrations of the femoral vein in patients undergoing cardiac catheterization were also significantly higher than that of the peripheral vein in the normal healthy children(p<0.01). 2) The plasma ANP concentrations of the pulmonary artery(110.9( 80.7pg/ml)were 2 to 3 times higher than that of the femoral vein(43.3( 40.3pg/ml, p<0.01). However there were no significant differences of the plasma ANP concentrations between pulmonary artery and aorta(65.4 (36.1pg/ml),and between aorta and femoral vein. 3) There was a significant correlations of the plasma ANP concentrations vetween pulmonary artery and femoral vein, and pulmonary artery and aorta, but no correlation of those between femoral vein and aorta. 4) The plasma ANP concentrations of the vein were over 3 times more higher in cases of left atrial area over 20 cm2/M2 measured by 2-dimensional echocardiography(213.2 (292.9pg/ml)than those in cases of left atrial area under 20(65.0 66.9pg/ml, p<0.05). The plasma ANP concentrations of the vein were over 3 times more highger in cases of left atrial area over 20 cm2/M2(88.6(19.1pg/ml) than those in cases of left atrial area under 14(57.1 (39.5pg/ml,p<0.05), and in cases of the sum of both atrial mean pressure over 11mmHg(189.5( 42.8pg/ml) than those in cases of the sum under 11(79.3 (52.3pg/ml, p<0.01). The plasma ANP cocentrations of the aorta were significantly higher in cases of left atrial area over 14 cm2/M2(88.6 (19.1pg/ml)than those in cases of left atrial area under 14(57.1 (39.5pg/ml;p 0.05), in cases of the sum of both atrial area over 25cm2/M2(93.9 (21.7pg/ml)those in cases of the sum under 25(46.6 (33.8pg/ml, p<0.01), in cases of sum of mean atrial pressure over 11 mmHg(90.5 (30.3pg/ml)than those in cases of under 11(53.8( 24.6pg/ml, p<0.05),in cases of the sum of both atrial wall stress over 190 mmHg.cm2/M2(101.4 (23.5pg/ml) than those in cases of the sumunder 190(57.5 (26.4pg/ml, p<0.01), and also in cases of pulmonary artery mean pressure over 20mmHg(83.3( 18.2pg/ml) than those in cases o pulmonary artery under 20(47.8( 39.8pg/ml, p<0.05). In conclusion, the plasma ANP concentrations of the pulmonary artery were significantly higher than those of the frmoral vein and the aorta, which indicater that the ANP is predominantly secreted via coronary sinus into the right atrium. The plasma ANP concentrations of the peripheral and femoral vein, the pulmonary artery and the aorta, especially that of the aorta, correlated well with the atrial pressure, the area and the wall stress. This suggests that the arterial blood may be the most appropriate sample for measurement of the ANP.
Aorta* ; Atrial Natriuretic Factor ; Atrial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Child* ; Coronary Sinus ; Estrogens, Conjugated (USP) ; Femoral Vein ; Heart Atria ; Heart Diseases ; Heart Failure ; Hot Temperature ; Humans ; Plasma* ; Pulmonary Artery* ; Veins*

BACKGROUND: There is a lack of basic epidemiological information on bacterial meningitis in children and adults in Korea. Therefore, more research is needed to investigate the causative organisms, clinical manifestations, and prognosis in Korean children and adults. METHODS: We analyzed retrospectively 148 medical records with final diagnosis of bacterial meningitis. The diagnosis of bacterial meningitis was based on culture-positive cases. RESULTS: Out of a total 148 patients, 71 were children and 77 were adults. In the children with community acquired meningitis, infection-related meningitis was the most common predisposing factor (23.3%). In adults, otitis media was the most common (21.7%). There were more frequent seizures in children than adults (38.1%, 17.1%, p<0.05). In community-acquired meningitis, Streptococcus pneumoniae was the most common type. However, in nosocomial meningitis, gram-negative bacilli was the most common type. The prognostic factors associated with mortality rate in adults were old age (>50 years), seizure (p<0.05), and mental change (p<0.001). CONCLUSIONS: Although a causative organism is not documented, we believe that our study will help to properly treat acute bacterial meningitis in children and adults regardless if it is community acquired or nosomial.
Adult ; Causality ; Child ; Cross Infection ; Diagnosis ; Epidemiology ; Humans ; Korea ; Medical Records ; Meningitis ; Meningitis, Bacterial* ; Meningitis, Pneumococcal ; Mortality ; Otitis Media ; Prognosis* ; Retrospective Studies ; Seizures

BACKGROUND: We investigated the interactions between spontaneous apoptosis-induced neutrophils and autoantibodies with attention to the reactivities of each autoantibody against intracellular antigenssuch as the antinuclear antibody (ANA) and the anti-neutrophil cytoplasmic antibody (ANCA) and the applicability as a conventional test for autoantibody detection. METHODS: The 127 serum samples from patients with autoimmune disease were mixed with whole blood from healthy donors and incubated for 20 hours. The bound antibody against substrate neutrophils was detected with anti-IgG-FITC by flow cytometry. The results of this anti-long incubated neutrophil antibody (ALINA) testing were compared with ANA, ANCA and clinical manifestations. RESULTS: The positivity rate was significantly higher in the 20 hour incubation than that of a 30 minute incubation (100% and 18%, respectively; P<0.000005). Agreement analyses between ANCA and ALINA (k=0.34) and between ANA and ALINA (k=0.39) were poor. In comparison, among the autoimmune diseases, systemic lupus erythematosus had a significantly higher ALINA positivity rate than did other diseases (P<0.000005). In patients with SLE, higher mean fluorescence intensity was significantly associated with the presence of lupus nephritis (11/12 cases vs. 2/10 cases, P<0.005). CONCLUSIONS: We detected antibodies against neutrophil antigens expressed by long incubation with patient sera. Those detected autoantibodies were significantly associated with SLE, especially lupus nephritis. Therefore, further studies are necessary to devise optimal protocols and to clarify specificities for detected autoantibodies or their target antigens.
Antibodies* ; Antibodies, Antineutrophil Cytoplasmic ; Antibodies, Antinuclear ; Autoantibodies ; Autoimmune Diseases ; Flow Cytometry* ; Fluorescence ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Neutrophils* ; Tissue Donors

BACKGROUND: We investigated the interactions between spontaneous apoptosis-induced neutrophils and autoantibodies with attention to the reactivities of each autoantibody against intracellular antigenssuch as the antinuclear antibody (ANA) and the anti-neutrophil cytoplasmic antibody (ANCA) and the applicability as a conventional test for autoantibody detection. METHODS: The 127 serum samples from patients with autoimmune disease were mixed with whole blood from healthy donors and incubated for 20 hours. The bound antibody against substrate neutrophils was detected with anti-IgG-FITC by flow cytometry. The results of this anti-long incubated neutrophil antibody (ALINA) testing were compared with ANA, ANCA and clinical manifestations. RESULTS: The positivity rate was significantly higher in the 20 hour incubation than that of a 30 minute incubation (100% and 18%, respectively; P<0.000005). Agreement analyses between ANCA and ALINA (k=0.34) and between ANA and ALINA (k=0.39) were poor. In comparison, among the autoimmune diseases, systemic lupus erythematosus had a significantly higher ALINA positivity rate than did other diseases (P<0.000005). In patients with SLE, higher mean fluorescence intensity was significantly associated with the presence of lupus nephritis (11/12 cases vs. 2/10 cases, P<0.005). CONCLUSIONS: We detected antibodies against neutrophil antigens expressed by long incubation with patient sera. Those detected autoantibodies were significantly associated with SLE, especially lupus nephritis. Therefore, further studies are necessary to devise optimal protocols and to clarify specificities for detected autoantibodies or their target antigens.
Antibodies* ; Antibodies, Antineutrophil Cytoplasmic ; Antibodies, Antinuclear ; Autoantibodies ; Autoimmune Diseases ; Flow Cytometry* ; Fluorescence ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Neutrophils* ; Tissue Donors

BACKGROUND: To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. METHOD: We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. RESULTS: 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. CONCLUSION: We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.
Anti-Bacterial Agents ; Bacteria, Anaerobic ; Chemistry ; Chest Tubes ; Diagnosis ; Drainage ; Empyema* ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Lung ; Pleural Effusion ; Retrospective Studies ; Staphylococcus aureus ; Thoracotomy ; Thorax* ; Tomography, X-Ray Computed* ; Ultrasonography

BACKGROUND: This study was purposed to find out the differences in the lymphocyte subsets and differential cell counts of the bronchoalveolar lavage (BAL) fluid in patients with interstitial lung disease (ILD) and to analyze the differences according to their ages, gender and smoking habits. METHODS: BAL fluid samples of 141 ILD patients were examined for lymphocyte subsets and differential cell counts, and the differences among the patients were analyzed according to their diseases. Then, within the three most common disease groups, the differences were further analyzed by the age, gender and smoking habit of the patients. RESULTS: There were no statistically significant differences in total cell counts (per millimeters of BAL fluid) among the patient groups with each ILD. However, significant differences were observed in the percentages of neutrophils, lymphocytes, eosinophils, and macrophages of BAL fluid. Also, in lymphocyte subset analyses, the percentages of total T cells, B cells, CD4+ T cells, CD8+ T cells, CD4/CD8 T cell ratios, and NK cells were significantly different among the patients with each ILD. However, within the same disease group, there were no differences in differential cell counts and lymphocyte subset analyses according to the age, smoking habit, and gender of the patients. CONCLUSIONS: Although the age, smoking habit and gender did not have an effect on the BAL fluid analyses among the patients with the same ILD, there were significant differences among the patients with each ILD; therefore, the differential cell counts and lymphocyte subset analyses of BAL fluid can be useful in differential diagnosis for determining the types of ILD.
Adult ; Aged ; Bronchoalveolar Lavage Fluid/*cytology ; Diagnosis, Differential ; Female ; Humans ; Lung Diseases, Interstitial/diagnosis/*epidemiology/etiology ; Lymphocyte Count ; Lymphocyte Subsets/immunology ; Male ; Middle Aged ; Smoking

Crohn's disease is a rare inflammatory bowel disease in Korea which requires a differential diagnosis with intestinal tuberculosis. In the early stages of Crohn's diseaae, the combiation of bowel wall edema and spasm produces intermittent obstructive manifestations, so the usual subjective symptoms were appeared long standing diarrhea, low grade fever and abdominal pain and distension. We recently experienced a case of Crohn's colitis with repeated bowel obstruction in female adult who underwent surgical resection.
Abdominal Pain ; Adult ; Colitis ; Crohn Disease* ; Diagnosis, Differential ; Diarrhea ; Edema ; Female ; Fever ; Humans ; Inflammatory Bowel Diseases ; Korea ; Spasm ; Tuberculosis

Crohn's disease is a rare inflammatory bowel disease in Korea which requires a differential diagnosis with intestinal tuberculosis. In the early stages of Crohn's diseaae, the combiation of bowel wall edema and spasm produces intermittent obstructive manifestations, so the usual subjective symptoms were appeared long standing diarrhea, low grade fever and abdominal pain and distension. We recently experienced a case of Crohn's colitis with repeated bowel obstruction in female adult who underwent surgical resection.
Abdominal Pain ; Adult ; Colitis ; Crohn Disease* ; Diagnosis, Differential ; Diarrhea ; Edema ; Female ; Fever ; Humans ; Inflammatory Bowel Diseases ; Korea ; Spasm ; Tuberculosis

PURPOSE: Estrogen signal transduction plays very important roles in both normal mammary development and neoplastic progression. Since the discovery of estrogen receptor-beta (ER-beta) there have been many controversial reports on the role of ER-beta in breast carcinogenesis and progression, and prognostic implications. ER-beta mRNA levels were investigated in various mammary tissues in order to verify the role of ER-beta expression in breast carcinogenesis. METHODS: Using messenger RNA (mRNA) in situ hybridization, we examined ER-beta expression in 60 paired normal and cancer tissues, 11 paired normal and benign breast tumor tissues, and 10 metastatic lymph nodes. We determined the intensity and extent (proportion of cells with positive hybridization) of the mRNA hybridization signals and gave scores 0 to 3; no hybridization (0), minimal (1), moderate (2), and strong (3) by the hybridization intensity and no hybridization (0), hybridization in less than 10% of cells (1), 10~50% (2), and more than 50% of cells (3) by the proportion of positively hybridized cells. Chi-square test, independent t-test or one-way ANOVA test was used for the statistical analysis and differences were considered to be significant with a p-value of less than 0.05. RESULTS: There was no statistically difference in ER-beta expression between normal and benign mammary tissues. ERbeta expression was significantly decreased in breast cancer and metastatic lymph node tissues compared with normal mammary and benign breast tumor tissues (P<0.01). The intensity and extent of ER beta expression were also significantly lower in breast cancer and metastatic lymph node tissues than in the normal mammary and benign breast tumor tissues (P<0.01). In cases of positive hybridization, the sum of scores of intensity and area were also significantly higher in normal and fibroadenoma tissues than in cancer or metastatic lymph nodes (P<0.01). CONCLUSION: ER beta transcription decreases in the process of breast cancer development, which suggests a protective role of ER beta in breast carcinogenesis.
Breast ; Breast Neoplasms ; Carcinogenesis ; Estrogen Receptor beta ; Estrogens* ; Fibroadenoma ; In Situ Hybridization ; Lymph Nodes ; RNA, Messenger* ; Signal Transduction

An analysis was performed to evaluate the problems in Emegency Medical Service System(EMSS) through the review of the 119 transport chart of 1,229 patients who visited to emergency center of Chonnam University Hospital via 119 system during the period from January 1998 to December 1998. The results were obtained as follows: 1) 1,229(4.9%) of the 25,253 patients were transported to emergency center via 119 system. Among 1.229 patients, male were 691(56%) and female 538(44%), and nontraumatic patients were 946(77%) and traumatic patients 283(23%). The peak age was 5th to 6th decades. 2) Mean arrival time to scene(ambulance response time) was 4.8 +/-.8minutes and mean arrival time to hospital 19.6 +/-0.1minutes. In the distribution of the requested place for ambulance, 73% was house and 23% was field. 3) In the severity of patients, 154(12.5%) patients were classified into emergent, 442(36%) into urgent, and 633(51.5%) into non-emergent. Among 1,229 patients, number of patients admitted were 419cases(34.1%), operated 85(6.9%), discharged in emergency department 536(43.6%), dead 70(5.7%), and transferred 119(9.7%), respectively. 4) The assessment of prehospital treatment by Emergency Medical Technician(EMT) revealed that checking the vital sign was only 49.5%, and prehospital care was limited to airway management, O2 inhalation and immobilization. There was no case of the notification to medical institute or the consultation to doctor. These results show that over the half of patients transported to level III emergency center via 119 system were classified into non-emergent and the prehospital management of the patient by EMT was not adequate. This study suggests the need of more simple and objective triage guideline for patient transport, the improvement of prehospital care system, and reconstruction of the computerized communication system.
Airway Management ; Ambulances ; Emergencies ; Emergency Service, Hospital ; Female ; Humans ; Immobilization ; Inhalation ; Jeollanam-do ; Male ; Triage ; Vital Signs