PURPOSE: We compared the clinical manifestations of patients with tsutsugamushi disease between children and adults. METHODS: From January 2003 to December 2012, 768 patients diagnosed with tsutsugamushi disease were retrospectively reviewed, and the clinical characteristics, laboratory findings, and complications were compared between children and adults. RESULTS: No patterns of annual increases in the number of patients were noted in both children and adults. The higher incidences occurred in October and November respectively. By gender, male outnumbered female in children, but the opposite trend was seen in adults. By residential area, the urban distribution of children was higher than that of adults. Rashes (P=0.001) and eschar (P=0.004) were more common in children, while myalgia was more common in adults. Children had a high prevalence of anemia (P=0.041), and low incidence rates of thrombocytopenia, abnormal liver and renal function. Children yielded better results in the duration of their hospital stay and the incidence of complications (P<0.001). A comparison of the therapeutic effects of doxycycline and macrolide antibiotics, which was performed only on the children, did not reveal any significant differences. CONCLUSION: Compared to adults, children had higher incidence rates of male patients and more often suffered from rashes and eschar. Children yielded better results in the laboratory findings and duration of the hospital stay and complications. Therefore, when children are suspected to have tsutsugamushi disease, especially during its peak occurrence period, detailed physical examination and serological test should be performed to ensure a prompt diagnosis, and the use of macrolide antibiotics, which have fewer side effects, is expected to yield the same therapeutic effects.
Adult* ; Anemia ; Anti-Bacterial Agents ; Child* ; Diagnosis ; Doxycycline ; Exanthema ; Female ; Humans ; Incidence ; Length of Stay ; Liver ; Male ; Myalgia ; Physical Examination ; Prevalence ; Retrospective Studies ; Scrub Typhus* ; Serologic Tests ; Thrombocytopenia

OBJECTIVE: To evaluate quantitative changes in arterial blood flow in the legs and systemic changes in blood flow after hot pack therapy on a leg. METHOD: It was conducted on 60 legs of 30 adults without the symptom of peripheral vascular disease. The blood flow of both popliteal arteries were recorded before and after hot pack therapy on a leg. Also, the blood pressure and pulse rate were recorded every two minutes using a pulsimeter. T-test was done to examine differences between blood flow of the popliteal artery on both legs before and after hot pack therapy. Paired t-test was used to examine differences in each leg before and after hot pack therapy and systemic effect after hot pack therapy. RESULTS: After hot pack therapy, there were statistically meaningful changes in all the variables except the popliteal arterial diameter in a leg with hot pack therapy, whereas there were no significantly meaningful changes in a leg without therapy. Pulse rate was changed significantly, but blood pressures were not. CONCLUSION: There were an increase in regional arterial blood velocity and blood flow, skin temperature, and a reduction in peripheral resistance in a leg with hot pack therapy, but no meaningful changes without thrapy. There is no evidence of reflex vasodilatation. There is no meaningful changes in blood pressure, but an increase in pulse rate.
Adult ; Blood Pressure ; Heart Rate ; Humans ; Leg ; Lower Extremity* ; Peripheral Vascular Diseases ; Popliteal Artery ; Reflex ; Skin Temperature ; Vascular Resistance ; Vasodilation

The desired effect of vaccination is to elicit protective immune responses against infection with pathogenic agents. An inactivated influenza vaccine is able to induce the neutralizing antibodies directed primarily against two surface antigens, hemagglutinin and neuraminidase. These two antigens undergo frequent antigenic drift and hence necessitate the annual update of a new vaccine strain. Besides the antigenic drift, the unpredictable emergence of the pandemic influenza strain, as seen in the 2009 pandemic H1N1, underscores the development of a new influenza vaccine that elicits broadly protective immunity against the diverse influenza strains. Cold-adapted live attenuated influenza vaccines (CAIVs) are advocated as a more appropriate strategy for cross-protection than inactivated vaccines and extensive studies have been conducted to address the issues in animal models. Here, we briefly describe experimental and clinical evidence for cross-protection by the CAIVs against antigenically distant strains and discuss possible explanations for cross-protective immune responses afforded by CAIVs. Potential barriers to the achievement of a universal influenza vaccine are also discussed, which will provide useful guidelines for future research on designing an ideal influenza vaccine with broad protection without causing pathogenic effects such as autoimmunity or attrition of protective immunity against homologous infection.
Adaptive Immunity ; Antigens, Viral/immunology ; *Cross Protection ; Genome, Viral ; Humans ; Immunity, Innate ; Influenza Vaccines/*immunology/therapeutic use ; Influenza, Human/*prevention & control ; Orthomyxoviridae/genetics/immunology ; Vaccines, Attenuated

No abstract available.
Arterial Pressure* ; Aspirin ; Erythromelalgia* ; Thrombocytosis

BACKGROUND: Angiogenesis is essential for tumor growth and metastasis. Vascular endothelial growth factor(VEGF), also known as vascular permeability factor(VPF), is an angiogenic factor that plays important roles in tumor growth. Angiogenesis studies on VEGF deal with various types of malignant tumors, but little is known about the role or significance of VEGF in human thyroid neoplasms. Therefore, this study was performed to determine whether the VEGF expression in different histological types of thyroid tumors is altered and to see if there was a relationship between the expression of VEGF and either metastasis or the invasiveness of thyroid carcinomas. METHODS: Forty-two cases that underwent thyroidectomy at Kosin Medical Center, between March, 1999 and February, 2000, were included in this study. Of the 42 cases, 27 were malignant(26 papillary carcinoma, 1 Hurthle cell carcinoma) and 15 were benign lesions. The expression of VEGF was determined by immunohistochemistry using paraffin embedded thyroid tissue blocks, and was quantified as negative(absent), +(1~24%), ++(25~49%), +++(50~74%) and ++++(> or =75%), according to the extent of positive cells. RESULTS: VEGF was stained with red-brown colored granules in the cytoplasm of the thyroid tumor epithelium and was expressed in 27 of the 42 cases(+1, ++8, +++5, ++++13). Most malignant tumors(24 of 27 cases) were stained with VEGF, but only 3 of the 15 benign tumors cases were stained(P<0.001). When the VEGF expression was divided into ++ or below and +++ or above groups, the expression of VEGF was much more extensive in the malignant than benign tumors(P<0.001). Of the 27 malignant tumors cases, lymph node metastasis and/or invasion was noted in 13. VEGF expression was more extensive in malignant tumors with lymph node metastasis and/or invasion than in those without(P<0.001). CONCLUSION: In this study, the rate and extent of VEGF expression were greater in the malignant than the benign thyroid tumors, and also the extent of VEGF expression was the extent of VEGF greater in the malignant tumors with lymph node metastasis and/or invasion than those without
Angiogenesis Inducing Agents ; Capillary Permeability ; Carcinoma, Papillary ; Cytoplasm ; Epithelium ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Vascular Endothelial Growth Factor A*

The effects of epidural fentanyl in combination with 0.5% bupivacaine were observed in randomized 60 patients undergoing lower abdominal surgery. The time of onset, segmental spread and duration of analgesia, changes in arterial blood pressure and heart rate and the incidence of side effects were observed after epidural injection of the drugs. The patients were divided into three groups; Group I: 0.9% NaCl 2 ml combined with 20ml of 0.5% bupivacaine, Group II: 0.9% NaCl 1ml and fentanyl 50ug (1 ml) combined with 20 ml of 0.5% bupivacaine, Group III: fentanyl 100 ug (2ml) combined with 20 ml of 0.5% bupivacaine. The results were as follows. 1) The time of onset was significantly short in group III (P < 0.01) 2) The level of sensory blockade 30 minutes after epidural injection in group III was 2-3 segments higher than group I. 3) The mean duration of analgesia was significantly long in group III compared to groups I and II (P<0.01). 4) The cardiovascular changes were not significantly different among the patients of the three groups.6) The side effects including mild hypotension, nausea and vomiting, voiding difficulty, itching and backache were not significantly different in the occurrence among the patients of the three groups. From the above results, it is suggested that fentanyl 100ug combined with 0.5% bupivacaine for epidural anesthesia has some benefits in its onset, spread and postoperative analgesia.
Analgesia ; Anesthesia, Epidural ; Arterial Pressure ; Back Pain ; Bupivacaine* ; Fentanyl* ; Heart Rate ; Humans ; Hypotension ; Incidence ; Injections, Epidural ; Nausea ; Pruritus ; Vomiting

The effects of epidural fentanyl in combination with 0.5% bupivacaine were observed in randomized 60 patients undergoing lower abdominal surgery. The time of onset, segmental spread and duration of analgesia, changes in arterial blood pressure and heart rate and the incidence of side effects were observed after epidural injection of the drugs. The patients were divided into three groups; Group I: 0.9% NaCl 2 ml combined with 20ml of 0.5% bupivacaine, Group II: 0.9% NaCl 1ml and fentanyl 50ug (1 ml) combined with 20 ml of 0.5% bupivacaine, Group III: fentanyl 100 ug (2ml) combined with 20 ml of 0.5% bupivacaine. The results were as follows. 1) The time of onset was significantly short in group III (P < 0.01) 2) The level of sensory blockade 30 minutes after epidural injection in group III was 2-3 segments higher than group I. 3) The mean duration of analgesia was significantly long in group III compared to groups I and II (P<0.01). 4) The cardiovascular changes were not significantly different among the patients of the three groups.6) The side effects including mild hypotension, nausea and vomiting, voiding difficulty, itching and backache were not significantly different in the occurrence among the patients of the three groups. From the above results, it is suggested that fentanyl 100ug combined with 0.5% bupivacaine for epidural anesthesia has some benefits in its onset, spread and postoperative analgesia.
Analgesia ; Anesthesia, Epidural ; Arterial Pressure ; Back Pain ; Bupivacaine* ; Fentanyl* ; Heart Rate ; Humans ; Hypotension ; Incidence ; Injections, Epidural ; Nausea ; Pruritus ; Vomiting

This study was designed to examine the influences of antioxidants on toxicity of paraquat in male rats. Paraquat and ascorbic acid were given orally ad libitum with tap water containing paraquat 30 ppm and 100 ppm and ascorbic acid 1000ppm for 10 days, respectively, alpha-tocopherol(60 mg/kg) was administered orally by sonde at 2 days intervals for 10 days. Paraquat at given doses produced markedly a dose-related reduction in water-intake, ratio of liver weight/body weight and glutathione along with the increased aspartate aminotransferase, alkaline phosphatase, serum lipid and ratio of lung weight/body weight. However the combined administration of ascorbic acid and paraquat did not affect the toxic effects of paraquat, whereas combined administration of paraquat and alpha-tocopherol showed relative reduction in the toxicities of paraquat. From these experimental results, it could be concluded that alpha-tocopherol has detoxifying effect on paraquat poisoning as the antioxidant, meanwhile ascorbic acid, one of the antioxidance, does not exert any detoxifying effects.
Alkaline Phosphatase ; alpha-Tocopherol ; Animals ; Antioxidants ; Ascorbic Acid ; Aspartate Aminotransferases ; Glutathione ; Humans ; Liver ; Lung ; Male ; Paraquat* ; Poisoning ; Rats* ; Water

BACKGROUND: Surgical correction of patent ductus arteriosus (PDA) is relatively safe and effective since it does not remain in the category of open-heart-surgery. Although the surgical practice for PDA is performed in almost all hospitals, they contain the problems of anxiety of patients, remained surgical wounds on patients' chests and complications of surgery and general anesthesia. Recently non-surgical methods for the obstruction of PDA have been developed and some of them including buttoned devices are used now. The success rates of these methods approach to 84%. But the problems of embolization, incomplete closure, hemolysis, stenosis of aorta and left pulmonary artery have been reported. We invented new PDA occluder , using stainless steel wire and polyurethane foam. Therefore we investigated the efficacy of occluding blood flow with the new PDA occluder in the vessels of experimental animals. METHOD: Using 304 stainless steel wire which is self-expandable stent, two star-shaped frames were made, each frame forming cone and facing the other's tip. And in the center of the frames polyurethane foam was inserted. 316L stainless steel wire was used to fix the elements described above and some portion of the wire was extracted outside of the frames, shaping hook or round loop with which the occluder could be pulled out in case of misplacement. To create the similar situation to PDA, we made shunts from artery to vein between carotid arteries and jugular veins with surgical bypass grafts or made shunts of direct artery to vein connections without grafts in 4 dogs and 1 pig. Through 8F sheath, we deployed the occluders into the shunts made of 5 grafts or made of 3 arterial ends. Also the occluders were inserted into the femoral artery of dog and iliac artery of pig. After deployment of occluders, angiograms were performed to obscure the efficacy of blocking blood flow and follow-up angiogrms were done in one and two weeks. The animals were sacrificed in one and two weeks to get the tissues including occluders inside. Gross findings were checked about thrombi formation in and around polyurethane foam. RESULTS: The 10 occluders were placed successfully except one site due to misplacement. The occluders successfully blocked the blood flows in all 10 sites within 3 - 60 minutes. Each follow-up angiogram for occluders in one and two weeks revealed good maintenance of blockade in blood flow. Observed gross findings on tissues were packed thrombi formation in the polyurethane foam and membrane formation along the occluder. CONCLUSIONS: This newly developed device revealed good efficacy for occlusion of blood flow including shunts in immediate and follow-up study. Practical method for the delivery of the device and some design modification for proper fitting into the PDA especially for small patients would be required. Longer period of follow-up with more animal experiments for other possible complications including distal embolization would be required also before clinical trial.
Anesthesia, General ; Animal Experimentation ; Animals ; Anxiety ; Aorta ; Arteries ; Carotid Arteries ; Constriction, Pathologic ; Dogs ; Ductus Arteriosus, Patent* ; Femoral Artery ; Follow-Up Studies ; Hemolysis ; Humans ; Iliac Artery ; Jugular Veins ; Membranes ; Polyurethanes ; Pulmonary Artery ; Stainless Steel ; Stents ; Thorax ; Transplants ; Veins ; Wounds and Injuries

No abstract available.
Collodion ; Influenza, Human