BACKGROUND: The implementation of intraoperative normovolemic hemodilution is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential complications. The goal of this study was to evaluate the safety and efficacy of moderate intraoperative normovolemic hemodilution. METHODS: Fifteen patients scheduled for posterolateral spinal fusion underwent intraoperative normovolemic hemodilution with 10% pentastarch to a target hematocrit level of 25% (hemodilution group). All units of blood procured by hemodilution and additional allogeneic blood was transfused in the perioperative period to maintain the hematocrit level of>25%. We investigated the effect of hemodilution on whole blood coagulation as measured by the thromboelastography and, evaluated its efficacy of decreasing the need for allogeneic blood transfusion as compared to the nonhemodilution group, retrospectively. RESULTS: Hemodilution with pentastarch caused a decrease in response and coagulation time (p<0.01) but did not influence on the alpha angle and maximum amplitude on thromboelstogram. Amount of transfusion of allogeneic blood was 4.1 1.7 units for the hemodilution group and 5.0 1.5 units for the nonhemodilution group. Net red blood cell volume ""saved"" from hemodilution was about 120 ml. CONCLUSION: Moderate intraoperative normovolemic hemodilution with pentastarch does not affect the coagulability of whole blood. But its efficacy of decreasing the need for allogeneic blood transfusion is minimal.
Blood Coagulation ; Blood Transfusion ; Erythrocytes ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Perioperative Period ; Retrospective Studies ; Spinal Fusion* ; Thrombelastography

OBJECTIVE: To compare the scar formation and hand function between moist exposed burn ointment (MEBO) treatment and conventional skin graft in full thickness hand burns. METHOD: Prospective comparative study was done between MEBO treatment group and conventional skin graft group. Full thickness burn wound scars on dorsal hand were compared. Scars were assessed with the Vancouver scar scale and other objective measurement tools such as pigmentation, erythema, pliability, transepideramal water loss, thickness and perfusion. Hand function was evaluated by the Jebsen hand function test and Michigan Hand Function Questionnaire. RESULTS: Vancouver Scar scale showed significantly better scores in the MEBO group than in the conventional skin graft group. Scar thickness and transepidermal water loss were greater in the MEBO treatment group whereas pigmentation value was greater in the conventional skin graft group. There was no significant difference in the hand function between the two groups. CONCLUSION: MEBO application could be an alternative treatment to conventional skin graft treatment in full thickness hand burn wounds. In the future, more studies are yet to come how MEBO treatment may affect the skin condition of the burn injuries.
Burns* ; Cicatrix* ; Erythema ; Hand* ; Michigan ; Perfusion ; Pigmentation ; Pliability ; Prospective Studies ; Surveys and Questionnaires ; Skin* ; Transplants* ; Wounds and Injuries

Superficial siderosis is attributed to hemosiderin deposition in the subpial layers of the nervous system. The clinical features of infratentorial superficial siderosis (ISS) are hearing loss, cerebellar ataxia, and corticospinal tract signs and the most common cause of idiopathic ISS is a dural defect. As magnetic resonance imaging (MRI) has advanced, the diagnosis of infratentorial superficial siderosis can be confirmed by unique radiological findings in MRI. Here, we report on a female patient diagnosed with idiopathic ISS by means of clinical symptoms and radiological findings.

BACKGROUNDS: Peripheral blood stem cells (PBSC) are increasingly used because of ease of collection and rapid kinetics of recovery relative to bone marrow transplantation (BMT). Here we summarize laboratory and clinical experiences of 671 PBSC harvests performed at a single institution. METHODS: PBSC harvests were performed mainly with Fenwal CS3000 plus blood cell separator. 126 cancer patients and 12 allogeneic BMT donors (54 children, 84 adults) were enrolled in this study. Total WBC and mononuclear cells (MNC) were analyzed in peripheral blood before procedure, and total WBC, MNC and CD34+ cell count on PBSC product. Correlation between dose of CD34+ cells and hematologic recovery was evaluated by Wilcoxon rank sum test and Pearson correlation analysis. RESLUTS: A mean of 4.8 leukapheresis was performed and 9,155 mL blood was processed. A mean volume of PBSC product was 66 mL and MNC purity of that was 84%. An average of 3.0 +/- 3.3x108 WBC/kg, 2.4 +/- 2.6x108 MNC/kg, and 2.7 +/- 5.4x106 CD34+ cells/kg was collected in each procedure. A goal of 1x108/kg MNCs was reached in 98.4% (127/129) of the patients and more than 1x106/kg CD34+ cells were collected in 91.8% (90/98). Various complications of PBSC harvests were observed but the incidence of serious adverse reaction was low. Median times to an absolute neutrophil count over 500/uL were 11 (7-34) and 11 (8-29) days respectively, in adult and children, and those to a sustained platelet count over 50,000/uL were 18.5 (9-118) and 36 (16-85) days, respectively. CONCLUSION: We analyzed yield, adverse reaction and hematologic recovery of PBSC harvests and this can serve basic data for the PBSC procedure.
Adult ; Blood Cells ; Bone Marrow Transplantation ; Cell Count ; Child ; Humans ; Incidence ; Kinetics ; Leukapheresis ; Neutrophils ; Platelet Count ; Stem Cells* ; Tissue Donors

BACKGROUND: Forkhead box P3 (Foxp3) is the most reliable marker for regulatory T cells, which play an important role in maintaining renal allograft tolerance. Recently, Foxp3 polymorphisms have been reported to be associated with graft outcome in kidney transplantation. We analyzed the association of Foxp3 polymorphisms with renal allograft outcome. METHODS: Foxp3 polymorphisms (rs3761548 A/C, rs2280883 C/T, rs5902434 del/ATT, and rs2232365 A/G) were tested by PCR with sequence-specific primers (PCR-SSP) in 231 adult kidney transplantation recipients from 1996-2004 at Seoul National University Hospital. RESULTS: Patients with the rs3761548 CC genotype showed better graft survival than those with the AC or AA genotype (log rank test, P=0.03). Patients with the rs3761548 CC genotype also showed a lower rate of recurrence of the original glomerular disease than those with the AC or AA genotype (P=0.01). The frequency of acute rejection (AR) in patients with the rs2280883 TT genotype was lower than that in patients with the rs2280883 CT or CC genotype (26.9% vs 53.3%, P=0.038). Patients with the rs2280883 TT genotype also showed better graft survival than those with the CT or CC genotype (P=0.03). CONCLUSIONS: Foxp3 rs3761548 CC and rs2280883 TT genotypes were associated with superior graft outcome of kidney transplantation. Further studies involving a larger number of patients are needed.
Adult ; Allografts* ; Genotype ; Graft Survival ; Humans ; Kidney Transplantation* ; Kidney* ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Recurrence ; Seoul ; T-Lymphocytes, Regulatory ; Transplantation Tolerance ; Transplants

Background: There is still unmet need in treating neuropathic pain and increasing awareness regarding the use of drug combinations to increase the effectiveness of treatment and reduce adverse effects in patients with neuropathic pain. Methods: This study was performed to determine the individual and combined effects of pregabalin, tianeptine, and clopidogrel in a rat model of neuropathic pain.The model was created by ligation of the L5-L6 spinal nerve in male Sprague–Dawley rats; mechanical allodynia was confirmed using von Frey filaments. Drugs were administered to the intrathecal space and mechanical allodynia was assessed; drug interactions were estimated by isobolographic or fixed-dose analyses. Results: Intrathecal pregabalin and tianeptine increased the mechanical withdrawal threshold in a dose-dependent manner, but intrathecal clopidogrel had little effect on the mechanical withdrawal threshold. An additive effect was noted between pregabalin and tianeptine, but not between pregabalin and clopidogrel. Conclusions These findings suggest that intrathecal coadministration of pregabalin and tianeptine effectively attenuated mechanical allodynia in the rat model of neuropathic pain. Thus, pregabalin plus tianeptine may be a valid option to enhance the efficacy of neuropathic pain treatment.

BACKGROUND/AIMS: As the incidence rate of and mortality from pseudomembranous colitis (PMC) are increasing worldwide, it is important to study the simple predictive risk factors for PMC among patients with hospital-acquired diarrhea (HAD). This study focused on identifying the clinical risk factors that can easily predict PMC. METHODS: The presumed HAD patients were prospectively recruited at the Hallym University Kangdong Sacred Heart Hospital. RESULTS: Age of 70 and older (adjusted odds ratio [OR], 1.76; 95% confidence interval [CI], 1.12 to 0.75), use of proton pump inhibitors (adjusted OR, 4.07; 95% CI, 2.512 to 6.57), use of cephalosporins (adjusted OR, 2.99; 95% CI, 1.82 to 4.94), and underlying cancer (adjusted OR, 1.72; 95% CI, 1.04 to 2.82) were independent risk factors for PMC in the multivariate logistic regression analysis. The prevalence of PMC was very low in the patients with HAD who exhibited no risk factors. CONCLUSIONS: The risk factors for PMC in patients with HAD included cephalosporin use, proton pump inhibitor use, old age, and cancer. Considering the strongly negative predictive values of these risk factors, endoscopic evaluation can be delayed in patients with HAD without risk of developing PMC.
Adult ; Aged ; Aged, 80 and over ; *Clostridium difficile ; Cross Infection/complications/*epidemiology ; Diarrhea/complications/*epidemiology ; Enterocolitis, Pseudomembranous/complications/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors

OBJECTIVE: Communication problems are a prevalent symptom of autism spectrum disorders (ASDs), which have a genetic background. Although several genome-wide studies on ASD have suggested a number of candidate genes, few studies have reported the association or linkage of specific endophenotypes to ASDs. METHODS: Forty-two Korean ASD patients who showed a language delay were enrolled in this study with their parents. We performed a genome-wide scan by using the Affymetrix SNP Array 5.0 platform to identify candidate genes responsible for language delay in ASDs. RESULTS: We detected candidate single-nucleotide polymorphisms (SNPs) in chromosome 11, rs11212733 (p-value=9.76x10(-6)) and rs7125479 (p-value=1.48x10(-4)), as a marker of language delay in ASD using the transmission disequilibrium test and multifactor dimensionality reduction test. CONCLUSION: Although our results suggest that several SNPs are associated with language delay in ASD, rs11212733 we were not able to observe any significant results after correction of multiple comparisons. This may imply that more samples may be required to identify genes associated with language delay in ASD.
Autistic Disorder ; Child ; Autism Spectrum Disorder ; Chromosomes, Human, Pair 11 ; Endophenotypes ; Genome-Wide Association Study ; Humans ; Language Development Disorders ; Multifactor Dimensionality Reduction ; Parents ; Polymorphism, Single Nucleotide

The increase in number of nuclear families and double-income families contributed to the birth of many post-delivery care facilities, and this trend also bolstered such facilities that are not registered as a medical institution to provide post-delivery care to group of infants and new mothers. The fear of anthrax that hit America after the September 11 Attack has attributed to aggravation of the fear of virus in Korea, and the cause of infant deaths at post-delivery care facilities drew unprecedented public attention. In this context, it would be worth to note the cause of infant deaths in six cases that took place in October and November of 2001, March of 2002 at post-delivery care facilities. The age of the victims were 11 days(twin boys), 17 days(girl), 21 days(girl), 15 days(girl), 14 days(girl) and 14 days(boy). The circumstances under which those infants died were varied, but with a exception of one infant, all were presumed to have suffered from diarrhea at the facilities, and were brought to hospitals after suffering from respiratory difficulties only after care providers suspected more serious medical problems than initial thought. The first two autopsies indicated positive for rotavirus test. Autopsies of all cases except one reveal no specific findings that are noteworthy. One case shows global ischemic myocardial necrosis and pneumonia. In five cases where the amount of feeding was tracked down, the less than normal amount of feeding and the slower than normal body-weight increase were noted that lasted for several days before deaths. It is our opinion that even healthy infants in a group care facility require a higher standard of sanitation to prevent various infection and that the use of measurement that easily indicates the correlation between the amount of feeding and the body-weight increase will be helpful to prevent deaths from virus infection at group care type of post-delivery facilities.
Americas ; Anthrax ; Autopsy ; Diarrhea ; Humans ; Infant ; Infant, Newborn* ; Korea ; Mothers ; Necrosis ; Nuclear Family ; Parturition ; Pneumonia ; Rotavirus ; Sanitation

BACKGROUND AND OBJECTIVES: The thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG) is associated with the long term clinical outcomes. This study compared the TMPG with the myocardial viability as determined by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and with improvement of the left ventricular (LV) function on echocardiography. SUBJECTS AND METHODS: We enrolled 44 consecutive patients (37 men: age 56+/-11 years) who underwent primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). We assessed the coronary flow reserve (CFR), the diastolic deceleration time (DDT), the coronary wedge pressure (Pcw) and the coronary wedge pressure/mean aortic pressure (Pcw/Pa). All the patients underwent FDG-PET scans on the 7th day after primary PCI. The patients were divided into 3 groups according to the TMPG (TMPG 0/1: n=18, TMPG 2: n=14, TMPG 3: n=12). RESULTS: There was a significant correlation between the TMPG and the CFR, DDT, Pcw and Pcw/Pa (r=0.367, p=0.017; r=0.587, p<0.001; r=-0.513, p<0.001; r=-0.614, p<0.001, respectively). There was a significant correlation between the TMPG and the % of FDG uptake (r=0.587, p<0.001) and the patients with TMPG 3 had the most favorable % of FDG uptake (TMPG 0/1 vs TMPG 2 vs TMPG 3; 42.0+/-12.3% vs 53.9+/-11.2% vs 59.3+/-13.3%, p=0.001). On echocardiography, the patients with TMPG 3 revealed an improvement of the LV ejection fraction (53.4+/-9.9% vs 60.0+/-7.0%, p=0.004) and the patients with TMPG 2 and TMPG 3 revealed improvement of their regional wall motion abnormality (RWMA) index (1.44+/-0.26 vs 1.24+/-0.18, p=0.022; 1.35+/-0.26 vs 1.15+/-0.18, p=0.018, respectively). CONCLUSION: The angiographically determined TMPG might be clinically useful for the assessment of myocardial viability and it might be a useful predictor for improvement of the LV function in patients suffering with STEMI.
Angioplasty ; Arterial Pressure ; DDT ; Deceleration ; Echocardiography ; Humans ; Male ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Perfusion* ; Positron-Emission Tomography ; Pulmonary Wedge Pressure ; Ventricular Function, Left