No abstract available.
Korea*

Hypematremia is a rare but important medical condition and is associated with mortality rate of 40 to 70%. However, little has been known about its prognostic factors or treatment guidlines. To evaluate the prognostic factors and the outcome following treatment, we reviewed 22 available medical records among twenty five hypernatremic patients (0.2%) in 12841 admissions at medical ward from January to December 1995. We defined hypernatremia as serum sodium concentration more than or equal to 150 mEq/L. Of these patients, two had hypematrernia at admission and the remaining patients became hypernatremic during admission. Mean peak serum sodium concentration was 158 (150-178) mEq/L and mean total body water deficit was 11.4 (6.7-21.3)%. Factors correlated with the development of hypernatremia were diverse and multiple, and the most frequent factor was diminished access to water. Mortality rate was 59%, but mortality was not correlated with age, correction rate of hyper-natremia, primary route of fluid loss, and the severity of hypernatremia or total body water deficit. Mortality rate was higher in patients whose serum sodium concentrations were below 130 mEq/L at admission (P<0.05). In our study, development of hypernatremia from initial hyponatremic state was significantly associated with poor outcome, and age, rapidity of correction, route of fluid loss, and the severity of hypernatremia or total body water deficit were not.
Body Water ; Humans ; Hypernatremia* ; Medical Records ; Mortality ; Sodium ; Water

No abstract available.
Humans*

Purpose: Real-world experience with tocilizumab in combination with dexamethasone in patients with severe coronavirus disease (COVID-19) needs to be investigated. Materials and Methods: A retrospective cohort study was conducted to evaluate the effect of severity-adjusted dosing of dexamethasone in combination with tocilizumab for severe COVID-19 from August 2020 to August 2021. The primary endpoint was 30-day clinical recovery, which was defined as no oxygen requirement or referral after recovery. Results: A total of 66 patients were evaluated, including 33 patients in the dexamethasone (Dexa) group and 33 patients in the dexamethasone plus tocilizumab (DexaToci) group. The DexaToci group showed a statistically significant benefit in 30-day clinical recovery, compared to the Dexa group (p=0.024). In multivariable analyses, peak FiO2 within 3 days and tocilizumab combination were consistently significant for 30-day recovery (all p<0.05). The DexaToci group showed a significantly steeper decrease in FiO2 (-4.2±2.6) than the Dexa group (−2.7±2.6; p=0.021) by hospital day 15. The duration of oxygen requirement was significantly shorter in the DexaToci group than the Dexa group (median, 10.0 days vs. 17.0 days; p=0.006). Infectious complications and cellular and humoral immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the convalescence stage were not different between the two groups. Conclusion A combination of severity-adjusted dexamethasone and tocilizumab for the treatment of severe COVID-19 improved clinical recovery without increasing infectious complications or hindering the immune response against SARS-CoV-2.

PURPOSE: This study was aimed to assess the growth of neo-aorta and its implication to neo-aortic insufficiency in children with complete transposition of great arteries (TGA) after arterial switch operation (ASO). METHOD: We retrospectively reviewed medical records, echocardiograms and cardiac catheterization of 40 patients who had underwent ASO at Samsung Medical Center from 1995 through 2001. Pulmonary artery and aorta were evaluated regarding its stenosis and regurgitation, respectively. The growth of the neo-aortic valve, sinus of neo-aortic Valsalva, and the site of aortic anastomosis were evaluated by measuring the change of the diameter. RESULT: The mean duration of follow-up after ASO was 17.2+/-12.4 months (range 1.2-67 months). Aortic insufficiency (AI) developed in 45%, in which all were mild. The neo-aortic annulus (originally pulmonary annulus) had grown as normal pulmonic valve does do (diameter of pulmonary valve annulus preoperatively, 8.9+/-1.22 mm; postoperatively at more than 6 months, 12.8+/-2.2mm). The anastomotic site of neo-aorta showed a growth curve equivalent to that of sinotubular junction of normal aorta (preoperative diameter, 7.7+/-1.4 mm; postoperatively at more than 6months, 12.7+/-3.1mm). However, the growth rate of sinus of Valsalva showed a extremely higher compared to that of normal aorta (preoperative diameter, 10.5+/-1.2 mm; postoperatively at more than 6 months, 18.8+/-2.6 mm). No significant relations could be revealed between the change of dimension of aortic root and aortic insufficiency. CONCLUSION: Aortic insufficiency was not uncommon but mild aortic dilatation was not significantly associated with AI. Although the short term result is encouraging, long-term surveillance for aortic root dilatation and aortic insufficiency remains necessary.
Aorta ; Cardiac Catheterization ; Cardiac Catheters ; Child ; Constriction, Pathologic ; Dilatation ; Follow-Up Studies ; Humans ; Medical Records ; Pulmonary Artery ; Pulmonary Valve ; Retrospective Studies ; Sinus of Valsalva ; Transposition of Great Vessels*

Basilar artery fenestration is infrequent and even rarer in association with a large aneurysm. With proximity to brain stem and vital perforators, endovascular coiling can be considered first. If the large ruptured aneurysm with a wide neck originated from fenestra of the proximal basilar artery and the fenestration loop has branches of posterior circulation, therapeutic consideration should be thorough and fractionized. We report endovascular therapeutic details for a case of a ruptured large saccular aneurysm in proximal basilar artery fenestration.
Aneurysm* ; Aneurysm, Ruptured ; Basilar Artery* ; Brain Stem ; Intracranial Aneurysm ; Neck ; Stents*

PURPOSE: To raise awareness of the clinical importance of, and the need for proper management of acute focal bacterial nephritis(AFBN), we analyzed 22 AFBN patients and 22 other upper urinary tract infection patients by use of comparative studies. METHODS: From January 2000 to May 2002, 22 AFBN patients aged from 1 month to 12 months were selected. As a control group, 22 UTI patients with no radiologic abnormalities were selected and matched by age and sex. RESULTS: The incidence of AFBN was more common in boys than in girls. Since both groups had similar symptoms, it was difficult to diagnose AFBN by clinical presentations alone. ESR and CRP were significantly higher in AFBN patients. The most common causative organism was E. coli in both groups. On the sonographic findings, the most lesions were seen on the upper lobe of the kidney; more frequently, on left kidney. The lesions showed globular or wedge-shaped increased echogenecity. 99mTc-DMSA scan showed the complete coincidence of the location, size and shape in all cases compared to the findings of renal sonography. CONCLUSION: The roles of renal sonography and DMSA scan were very important, and ultrasonography was an excellent initial tool in diagnosing AFBN. Since the degree of infection in AFBN is more severe than other urinary tract infections and evollution into a renal abscess is possible, early diagnosis and appropriate antibiotics therapy is essential.
Abscess ; Anti-Bacterial Agents ; Child* ; Early Diagnosis ; Female ; Humans ; Incidence ; Kidney ; Nephritis* ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Urinary Tract Infections

PURPOSE: Early detection of arteriovenous fistula (AVF) dysfunction in hemodialysis patients and prompt corrective procedures reduces the AVF thrombosis rates and lengthens access survival. We tried to develop a new simple and cheap bedside measurement technique based on the Bernoulli's theory. METHOD: From a total of 20 case of vascular accesses for hemodialysis, of at least 3 months of construction, we twicely measured the AVF flow rate (QD) with Doppler ultrasonography and vascular conduit pressure. Four kinds of pressure were measured: tubing set free from dialysis machine and positioned on the patient's bed (PrF), two kinds of artificial stenosis made with tourniquet (PrS1, PrS2), pump flow rate at 100ml/min (Pr100), and pump off (Pr0). We calculated the flow rate of vascular conduit (QF) with PrF and mean arterial pressure on Bernouli's equation, and QF was compared with QD. RESULT: AVF was 26.0+/-28.6 (3~108) months after operation, with five cases (including 2 PTFE grafts) using brachial artery. PrF was closely correlated with Pr100 (R2=0.914), and inversely correlated with QD (R2=-0.026). QF was poorly correlated with QD (R2=0.003). There was no statistical difference in the double pressure measurement (P>0.05), but there was differenence in QD (P<0.05). When artificial stenosis was made, the pressures increased, and the calculated flow rates decreased in every patients. Thrombosis or stenosis was detected in all patients with decrement of QF, but not in all with decrement of QD. CONCLUSION: Pressure measurement and calculated flow rate in dialysis vascular conduit represent alterations of AVF flow rate. However its value in long-term follow up awaits further study with accurate constant number.
Arterial Pressure ; Arteriovenous Fistula ; Brachial Artery ; Constriction, Pathologic ; Dialysis ; Humans ; Polytetrafluoroethylene ; Renal Dialysis ; Thrombosis ; Tourniquets ; Ultrasonography, Doppler

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasm of the gastrointestinal tract. They are preferentially located in the stomach and small intestine. However, the duodenum is an unusual location for GIST. Here we present a case of a 67-year-old woman with a GIST of the 3rd portion of duodenum mimicking vascular neoplasm as an obscure acute gastrointestinal bleeding. The upper gastrointestinal endoscopy and colonoscopy failed to find the lesion. Finally, a large protruded lesion with ulcer was found at the 3rd portion of duodenum using a colonoscope through the oral approach. A spurting bleeding was developed during hypertonic saline epinephrine injection for treatment of oozing bleeding at the margin of the ulcer. Abdominal 3D CT-angiography showed a round and hypervascular structure at the posterior wall of duodenum. A wedge resection of the third portion of the duodenum was performed. Microscopic findings revealed GIST.
Aged ; Colonoscopes ; Colonoscopy ; Duodenum ; Endoscopy, Gastrointestinal ; Epinephrine ; Female ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Intestine, Small ; Stomach ; Ulcer ; Vascular Neoplasms

The purpose of this study was to demonstrate the cellular localization of cyclooxygenase-2 (COX-2) and caveolin-3 (Cav-3) in primarily cultured rat chondrocytes. In normal rat chondrocytes, we observed relatively high levels of Cav-3 and a very low level of COX-2 mRNA and protein. Upon treating the chondrocytes with 5 microM of CdCl2 (Cd) for 6 hr, the expressions of COX-2 mRNA and protein were increased with the decreased Cav-3 mRNA and protein expressions. The detergent insoluble caveolae-rich membranous fractions that were isolated from the rat chondrocytes and treated with Cd contained the both proteins of both COX-2 and Cav-3 in a same fraction. The immuno-precipitation experiments showed complex formation between the COX-2 and Cav-3 in the rat chondrocytes. Purified COX-2 with glutathione S-transferase-fused COX-2 also showed complex formation with Cav-3. Confocal and electron microscopy also demonstrated the co-localization of COX-2 and Cav-3 in the plasma membrane. The results from our current study show that COX-2 and Cav-3 are co-localized in the caveolae of the plasma membrane, and they form a protein-protein complex. The co-localization of COX-2 with Cav-3 in the caveolae suggests that the caveolins might play an important role for regulating the function of COX-2.
Animals ; Animals, Newborn ; Blotting, Western ; Cadmium Chloride/pharmacology ; Caveolae/drug effects/metabolism/ultrastructure ; Caveolin 3/*genetics/metabolism ; Cell Membrane/drug effects/metabolism ; Cells, Cultured ; Chondrocytes/cytology/drug effects/*metabolism ; Cyclooxygenase 2/*genetics/metabolism ; Gene Expression ; Immunoprecipitation ; Microscopy, Confocal ; Microscopy, Electron ; RNA, Messenger/genetics/metabolism ; Rats ; Reverse Transcriptase Polymerase Chain Reaction