PURPOSE: To evaluate the clinical characteristics, treatments and outcome of patients with hemorrhagic shock and encephalopathy(HSE) syndrome. METHODS: We performed a clinical study on 14 patients who were diagnosed as hemorrhagic shock and having encephalopathy syndrome in the Department of Pediatrics, from 1984 to 1998. Age, sex, clinical symptoms and physical findings at admission, the most deranged laboratory findings, radiologic findings, treatments and outcome were analyzed. RESULTS: The age of onset was 1.0+/-0.9 years and the male to female ratio was 1: 1.8. At admission, clinical findings included dehydration in 85.7%, shock in 85.7%, fever in 71.4%, vomiting in 71.4%, diarrhea in 64.3%, GI bleeding in 50%, convulsion in 42.9%, and edema in 35.7%. Altered mental state was found in 100%, hepatomegaly in 64.3%, and splenomegaly in 21.4%. Laboratory findings revealed D-dimer positive in 92.9%, the mean hemoglobin level 8.2+/-2.1g/dL, BUN 35.7+/-24.0mg/dL, creatinine 1.9+/-1.5mg/dL, AST 561.0+/-1,412.1IU/L, ALT 858.9+/-1,649.8IU/L, blood glucose 229.5+/-197.4mg/dL, ammonia 195.4+/-129.7pg/dL, and total bilirubin 4.9+/-8.2mg/dL. On serologic tests, rotavirus and Epstein-Barr virus was found in 1 patient(7.1%), respectively. The mortality rate was 78.6%. CONCLUSION: We found that shock and disseminated intravascular coagulation(DIC) played important roles in the pathogensis of HSE syndrome, and encephalopathy, hepatic and renal insufficiency, and respiratory failure were secondary complications resulting from shock and DIC. Despite vigorous treatment, the prognosis was very poor. We feel more efforts should be focused on investigating the etiology and pathophysiology of HSE to prevent as well as develop a specific therapy. (J Korean Pediatr Soc 2000;43:814-819)
Age of Onset ; Ammonia ; Bilirubin ; Blood Glucose ; Creatinine ; Dacarbazine ; Death, Sudden* ; Dehydration ; Diarrhea ; Edema ; Female ; Fever ; Hemorrhage ; Hepatic Encephalopathy ; Hepatomegaly ; Herpesvirus 4, Human ; Humans ; Infant* ; Male ; Mortality ; Pediatrics ; Prognosis ; Renal Insufficiency ; Respiratory Insufficiency ; Rotavirus ; Seizures ; Serologic Tests ; Shock ; Shock, Hemorrhagic* ; Splenomegaly ; Vomiting

No abstract available.
Immunization, Passive* ; Immunoglobulins*

No abstract available.
Antibody Formation* ; Dust* ; Immunotherapy* ; Pyroglyphidae*

No abstract available.
Hepatolenticular Degeneration*

Glomus tumor shows histologically characteristic three components of glomus cells, vascular structures, and spindle-shaped smooth muscle cells. It is classified into solid glomus tumor, glomangioma and glomangiomyoma according to relative proportions of components. Glomangiomyoma, the least frequent type of glomus tumor, has its overall histopathologic pattern identical to common solid glomus tumor or glomangioma. In contrast to the foregoing types, however, it has an important number of spindle-shaped smooth muscle cells, which blend with the glomus cells. A 49-year-old woman presented with 2-year history of painful bluish red nodule beneath nail plate of right 4th finger. We made a diagnosis of glomangiomyoma by virtue of routine histopathologic examinations and immunohistochemical stains such as vimentin, smooth muscle actin and desmin.
Actins ; Coloring Agents ; Desmin ; Diagnosis ; Female ; Fingers ; Glomus Tumor ; Humans ; Intervertebral Disc ; Middle Aged ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Spine ; Vimentin ; Virtues

Although our present knowledge of the etiology of peptic ulcer is incomplete, the presence or absence of peptic ulcer is determined by the delicate interplay between aggressive factors (secreted gastric acid and pepsin) and defensive factors (mucosal resistance). Peptic ulcer is produced when the aggressive effects of acid-pepsin dominate the protective effects of gastric or duodenal mucosal resistance by predominance of aggressive factors or interruption of defensive factors. KU-54 enhances mucosal resistance to tissue injury by the increase of gastric mucosal blood flow, the stimulation of gastric mucosal metabolism, the increase of glycoprotein of gastric mucus, and the increase of ATP of gastric mucosa. We have treated 38 cases of gastric ulcers with KU-54 300 mg daily for 4-12 weeks for the evaluation of the therapeutic efficacy. Endoscopic, clinical, and laboratory assessments were undergone before and after 4 ~ 12 weeks of the treatment. Major symptoms of gastric ulcer have been improved in 83.3% after the medication with KU-54. The healing rate of gastric ulcer evaluated by endoscopy was observed in 33.3% after 4 weeks, 73.3% after 8 weeks, 76.6% after 12 weeks of the medication with KU-54. The utility rate of KU-54 was 86.7%. We could conclude that KU-54 is the utilizable drug for gastric ulcer.
Adenosine Triphosphate ; Endoscopy ; Gastric Acid ; Gastric Mucosa ; Glycoproteins ; Metabolism ; Mucus ; Peptic Ulcer ; Stomach Ulcer*

Acid ingestion causes a coagulative necrosis of the surface epithelium of the upper gastromtestinal tract. Its late sequence is luminal stenosis which frequently requires surgical repair. Nevertherless, in many cases, non-operative dilatation of luminal stenosis have been applicated, such as bouginations, balloon dilatations, endoscopic laser therapy, endoscopic electrocoagulation, endescopic microwave coagulation. These methods may give some considerable benefits in unoperable cases. Recently, we experienced a case of a 60-year-old man who had severe corrosive esophageal and gastric angular strictures by accidentally ingested hydrochloric acid and after many tiems of application of non-operative dilatation was able to have normal diet without dysphagia. So, we report this case with a review of literatures.
Constriction, Pathologic* ; Deglutition Disorders ; Diet ; Dilatation* ; Eating ; Electrocoagulation ; Epithelium ; Humans ; Hydrochloric Acid ; Laser Therapy ; Microwaves ; Middle Aged ; Necrosis ; Phenobarbital

Bacteroides fragilis is a Gram negative nonsporulating anaerobic rod bacterium that makes up about 1 to 2% of the norrnal human colonic microflora. In 1984, Myer et al. reported that some strains of B. fragilis produce enterotoxin and cause diarrheal disease in cattle and human. Since then it has been termed enterotoxigenic B. fragilis (ETBF). In this study, we tried to detect enterotoxin gene from 37 B. fragilis strains, isolated in Korean patients, to confirm the existence of ETBF and usefulness of PCR as a rapid diagnosis method. By this method, we identified 9 ETBF strains and confirmed their pathogenesis by cytotoxicity test. No significant cross- reactivity with other anaerobes or aerobes was observed. Thus, the PCR method may be considered useful for the sensitive and rapid detection of anaerobic infections. And the entire amplified PCR mixture was ligated into a pT7Blue T-vector and transformed into E. coli. When the nucleotide sequences of cloned PCR products were compared with reported enterotoxin gene, pBF529 inserted DNA sequence was nearly in good agreement with it but pBF570 inserted DNA sequence showed some difference at nucleotide 270-300. A search for nucleotide sequence homologies revealed that pBF529 exhibited 99%, but pBF570 indicated only 90% identity with reported enterotoxin gene. According to these results, it was suggested that ETBF toxin can be differentiated into at least 2 subtypes.
Animals ; Bacteroides fragilis* ; Bacteroides* ; Base Sequence ; Cattle ; Clone Cells ; Colon ; Diagnosis ; Enterotoxins* ; Humans ; Korea* ; Polymerase Chain Reaction*

Sclerosing lymphangitis of the penis is a rare disorder characterized by painless. firm. cord-like lesion in the coronary sulcus of the penis. Although sexual trauma may be causative factor the etiology is unknown. Histologic findings reveal hypertrophy and sclerosis of lymphatic vessel wells, and some cases show thrombus formation within dilated vessels. Most cases are self-limited and conservative management is indicated. We report two cases of sclerosing lymphangitis of the penis in a 37-year-old man and a 28-year-old man.
Adult ; Humans ; Hypertrophy ; Lymphangitis* ; Lymphatic Vessels ; Male ; Penis* ; Sclerosis ; Thrombosis

Objective: This study determined the threshold for recurrent depressive episodes that predicted conversion from major depressive disorder (MDD) to bipolar disorder (BD). Methods: We retrospectively reviewed the medical records of 296 patients diagnosed with MDD for a minimum of 5 years in two university hospitals. We examined their the Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnoses and detailed clinical information at the initial admission and yearly assessments after discharge to establish the threshold for recurrent depressive episodes indicating a risk of diagnostic conversion from MDD to BD. Optimal cut-offs were derived using receiver operating characteristic (ROC) curves. Results: ROC curve analysis revealed that more than four recurrent depressive episodes was indicative of potential diagnostic conversion from MDD to BD (area under the curve, 0.604; sensitivity, 0.353; specificity, 0.855; positive predictive value, 0.421; negative predictive value, 0.816). Conclusion These findings suggest that the best predictor of conversion from MDD to BD is more than four recurrent depressive episodes. Our findings have the potential to enhance diagnostic accuracy and treatment efficiency. To validate our results, longitudinal prospective studies are necessary.