In contrast to the nodular renal blastema which is defined by nests of primitive metanephric cells after 36 weeks of gestation, the nephroblastomatosis is characterized by neoplastic proliferation of the primitive cells. This lesion is presumed to be closely related to the development of Wilms' tumor. We report a case of bilateral nephroblastomatosis associated with Wilms' tumor in a child. This 4 1/2 year-old girl was admitted because of a 10 cm-sized round mass in the right kidney, and smaller nodules in the left kidney and the lung. After three cycles of chemotherapy and subsequent disappearance of the nodules in the left kidney and lung, she underwent a right nephrectomy and a wedge resection of the left kidney. A round Wilms' tumor mass was seen in the lower pole of the right kidney. Remaining right renal cortex showed multiple, slightly depressed gray-white nodules associated with multiple samll cysts. They were comprised of multifocal subcapsular nests of primitive nephrogenic cells with focal tubular or glomerular differentiation. They resembled fetal renal tissue. In the left kidney, similar nests of primitive cells were also noted. These lesions were interpreted as multifocal perilobar type of nephroblastomatosis.
Child ; Male ; Female ; Humans

BACKGROUND: This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33degrees C target temperature management. METHODS: A retrospective study was conducted on patients who underwent 33degrees C target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia. RESULTS: A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 +/- 0.15 microg/kg/h. Decisions of charged doctor's were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole. CONCLUSIONS: Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33degrees C target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33degrees C targeted temperature management.
Atropine ; Body Weight ; Bradycardia* ; Carbon Monoxide Poisoning ; Dexmedetomidine* ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Hypothermia, Induced ; Logistic Models ; Odds Ratio ; Retrospective Studies

PURPOSE: Defensins are important components of innate immune system. These peptides have antimicrobial activity against a wise variety of pathogens that associated with burn wound infection. In particular, human beta-defensins are expressed in normal epidermal region and showed differential expression of some skin disease. We investigated that expression of human beta-defensin by in vitro and ex-vivo by thermal condition. METHODS: To investigate the expression of human beta-defensins in acute burn condition, we cultured keratinocytes and used to rat's skin at this experiment. After thermal condition, we showed the expression of beta-defensins-2 (hBD-2), -3 (hBD-3), keratins, keratinocyte differentiation and junction protein levels by RT-PCR and immunohistochemistry (IHC). RESULTS: HBD-2 & involucrin were down-regulated from 1 hr to 8 hrs in mRNA level. But others were not changed in mRNA level. In protein level, hBD-3 was decreased but pan-cytokeratin and beta-catenin were not changed. CONCLUSION: HBD-2 was down-regulated in thermal injury. Because thermal injury could induce the influence of keratinocyte differentiation and the decrease of skin protection ability. Our results suggested that human beta-defensins plays an important role in protection by several injury.
beta Catenin ; beta-Defensins ; Burns ; Defensins ; Humans ; Immune System ; Immunohistochemistry ; Keratinocytes ; Keratins ; Peptides ; Protein Precursors ; RNA, Messenger ; Skin ; Skin Diseases ; Wound Infection

PURPOSE: Burn injury cause pruritis, pain, psychological and functional sequelae. The one of burn injury sequelae is the hypertrophic scar. It is difficult to control devastating fibrotic condition for hypertrophic scar. The objective of this study was to investigated the therapeutic effect on burn hypertrophic scar and wound healing for sequelae of burn injury by Porcine placenta extract (PPE). METHODS: To investigate the effect of PPE, we performed in vitro cell cytotoxity test (MTT assay), antioxidant activity assay (SOD like activity), melanin content assay, cell migration asssay and RT-PCR. RESULTS: As a result of cell cytotoxity test (MTT assay), PPE showed above 80% cell viability. From Antioxidant activity assay (SOD like activity), this effect was similar to vitamin C. In the melanin content assay, melanin synthesis was inhibited 23% on PPE treatment than control. PPE enhanced cell migration on human fibroblast and decreased the expression of hypertropic scar related gene (a-SMA and P311). CONCLUSION: Our data showed anti-oxidant effect, diminution of melanin and decrease of the expression of hypertropic scar related gene on the treatment of PPE. These results may provide the insight into the potential use of porcine placenta extract as support to control skin fibrosis related to burn hypertrophic scar and alternative medicine for burn sequelae.
Antioxidants ; Ascorbic Acid ; Burns ; Cell Migration Assays ; Cell Movement ; Cell Survival ; Cicatrix ; Cicatrix, Hypertrophic ; Complementary Therapies ; Fibroblasts ; Fibrosis ; Humans ; Melanins ; Placenta ; Pruritus ; Skin ; Wound Healing

PURPOSE: Febrile convulsions (FC) were considered to be a benign seizure syndrome that is distinct from epilepsy. But it is thought that children with complex features i.e., partial or prolonged seizures or multiple episodes of FC would bear a higher risk of developing unprovoked seizures. The aim of this study is to look into the relative significance of each criteria that define complex febrile convulsions (CFC) as a predictor of subsequent epilepsy. METHODS: All children were retrospectively identified for a febrile seizure through pediatric departments of the Konyang University Hospital. Information was collected from medical records and interviews with parents. Patients with abnormal neurological examinations at presentation were excluded. RESULTS: This study was performed from March 2000 to December 2003. Sixty-three out of 314 children (20.0%) with febrile convulsion fulfilled the criteria for CFC and forty-four children of them have been followed for 12 months or more. Ten of these (23.2%) had unprovoked seizures for 14-62 months (median 34.2+/-11.6 months). The patients with partial FC showed a trend toward a higher risk (57.1%) of developing epilepsy than the patients with multiple or prolonged febrile convulsions (26.7%, 24.1% respectively). CONCLUSION: We found that the partial feature of febrile convulsion is associated with subsequent epilepsy.
Child* ; Epilepsy ; Humans ; Medical Records ; Neurologic Examination ; Parents ; Retrospective Studies ; Seizures* ; Seizures, Febrile*

Purpose: This study aimed to identify the mediating effect of Psychological stress of COVID-19 stress on the relationship between nursing work environment and turnover intention of nurses in long-term care hospitals. Methods: The participants were 176 nurses working at three long-term care hospitals in Changwon City. Data were collected from August 11 to 14, 2021, using self-report questionnaires. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficients, and hierarchical regression, using the SPSS 23.0 software. A mediation analysis was performed according to the Baron and Kenny’s test, and Sobel test. Results: Turnover intention was positively correlated with Psychological stress of COVID-19 stress (r=.23, p=.002) and negatively correlated with nursing work environment (r=-.44, p<.001). Psychological stress of COVID-19 stress had a significantly negative relationship with nursing work environment (r=-.15, p=.045). Psychological stress of COVID-19 stress partially mediated the relationship between nursing work environment and turnover intention. Conclusion The findings of this study indicate that a positive nursing work environment can help nurses reduce their Psychological stress of COVID-19 stress and turnover intention. To reduce the turnover intention among nurses’ in long-term care, it is necessary to promote better work environments suitable for COVID-19 and to establish detailed strategies for reducing their physiological stress.

We report a case of thymic hyperplasia accompanied by pericardial lipomatosis and right facial hemihypertrophy in an 8-year-old boy. On imaging studies, the hyperplastic thymus had prominent curvilinear and nodular fatty areas simulating a fat-containing anterior mediastinal mass, which is an unusual finding in children. To our knowledge, this is the first report on a child with a combination of thymic hyperplasia, pericardial lipomatosis, and right facial hemihypertrophy. The radiologic findings are presented with a brief discussion.
Child ; Diagnosis, Differential ; Facial Asymmetry/complications/*diagnosis ; Heart Diseases/complications/*diagnosis/surgery ; Humans ; Hypertrophy/pathology ; Lipomatosis/complications/*diagnosis/surgery ; Magnetic Resonance Imaging ; Male ; Pericardium/*pathology ; Thymus Hyperplasia/complications/*diagnosis/surgery ; Tomography, X-Ray Computed

OBJECTIVE: In the present study, we evaluate visual outcomes after surgical removal of craniopharyngiomas and analyze the factors that are considered to affect visual outcomes. METHODS: This study includes 30 patients with craniopharyngioma, who underwent surgery in this clinic during the last 10 years. The changes of visual function (visual acuity and field) of the patients were assessed preoperatively and postoperatively, and paired data of this change were compared. Also, the factors that influence on this change were analysed. RESULTS: Among the 21 patients complaining of decreased vision before the operation, 8 patients were improved (38.0%), and 7 patients were worse (33.3%). However, Four out of 9 patients without any preoperative visual symptoms developed worse vision after the operation (44.4%). The average duration of symptom was 17.2 months in the improved group and 23.6 months in the aggravated group. The tumors recurred in only 5 patients after the gross total resection: Four of them showed the aggravation of visual function after surgical removal and 1 had improvement. CONCLUSION: After removal of craniopharyngiomas, the overall rate of vision improvement, no change and aggravation are 26.6%, 36.7% and 36.7%, respectively. Aggravation of postoperative visual function is higher in males, children and patients with a longer duration of symptom and the tumor recurres more frequently in patients who complained of worsened vision after surgical removal.
Child ; Craniopharyngioma* ; Humans ; Male

PURPOSE: We aimed to investigate the clinical characteristics and their relationship with the onset age of wheeze in school-age children and adolescents with asthma. METHODS: Three hundred twenty-six patients, aged 6 to 19 years, diagnosed with asthma at 6 hospitals from Seoul, Gyeonggi, Daegu, and Busan were enrolled. They were categorized into 3 groups by the onset age of wheeze: group A, early onset (age <3 years); group B, preschool onset (age 3-6 years); group C, late onset (age > or =6 years). Clinical characteristics including atopic sensitization, family history, combined allergic diseases, severity of asthma, and influence of asthma on daily life were examined. A history of hospitalization for early lower respiratory infection (LRI) and environmental tobacco smoking were studied and lung function tests were also performed. RESULTS: There was no difference in demographics, prevalence of atopy, combined allergic diseases, and family history of allergy between 3 groups. A history of sever LRI in early life was more common in groups A and B compared with group C. Sensitization to Dermatophagoides pteronyssinus was more prevalent in groups A and B than in group C. Forced expiratory flow between 25% to 75% (FEF(25%-75%)) was lower in groups A and B than in group C, and methacholine PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second) was lowest in group B. Significantly lower FEF(25%-75%) and methacholine PC20 were observed in the patients who had been hospitalized with LRI in early life. CONCLUSION: Our study shows significant difference in lung function and atopic sensitization in relation to the onset age of wheeze in school-age children and adolescents with asthma, and suggests that early LRI might contribute to the development of asthma in early life.
Adolescent* ; Age of Onset* ; Asthma* ; Busan ; Child* ; Daegu ; Demography ; Dermatophagoides pteronyssinus ; Forced Expiratory Volume ; Gyeonggi-do ; Hospitalization ; Humans ; Hypersensitivity ; Lung ; Methacholine Chloride ; Prevalence ; Respiratory Function Tests ; Seoul ; Smoking

BACKGROUND: In recent years, there has been increasing interest in the use of capnometry, the noninvasive, continuous measurement of end-tidal carbon dioxide(ETCO2) in expired air during CPR. The purpose of this study is to determine the significance of ETCO2 monitoring according to immediate cause of arrest during CPR as a prognostic indicator of successful resuscitation and survival. METHODS: A prospective, clinical study was performed from May 1997 to December 2000 at the Department of Emergency Medicine, Ewha Womans University Mokdong Hospital. The study included 220 patients(231cases). All patients were immediately connected to a mainstream capnometer sensor between the tube and the bag after endotracheal intubation using an infrared capnometer. RESULTS: The 107 patients(46.3%) with return of spontaneous circulation(ROSC) had higher maximal ETCO2 during CPR than the 113 patients without ROSC(31.0+/-19.4 vs 11.7+/-9.4 mmHg, P=0.000). The ETCO2 was not significantly different in relation to age, initial rhythm, and survival time after ROSC, but there was a significant difference in the immediate cause of arrest in the ROSC group(respiratory arrest: 4 0 . 2+/-23.5 mmHg, P=0.000). In case of cardiac arrest due to trauma, maximal ETCO2 was not significant in the ROSC group compared with the non-ROSC group(18.2+/-16.6 vs 10.8+/-7.5 mmHg, P=0.208). When maximal ETCO2 was less than 10 mmHg, we observed a sensitivity of 94.4% and a specificity of 39.5% in predicting ROSC. There were 6 patients with ROSC even though the maximal ETCO2 was less than 10 mmHg. CONCLUSION: Continuous ETCO2 monitoring during CPR may be noninvasive and valuable predictor of successful resuscitation and survival from cardiac arrest. However, ETCO2 should not be used as a single indicator for either cardiac arrest due to trauma or withdrawal of CPR.
Carbon ; Cardiopulmonary Resuscitation* ; Emergency Medicine ; Female ; Heart Arrest ; Humans ; Intubation, Intratracheal ; Prospective Studies ; Resuscitation* ; Sensitivity and Specificity