BACKGROUND: It has been known that blood group antibodies are not produced in the neonatal period and that if the antibodies exist, they are probably maternal in origin which had crossed the placenta. There have been several studies conducted abroad on when these antibodies are formed but none has been done in Korea. This study was carried out to determine the ABO blood type and blood group antibodies in children from neonates up to 5 year old. We hoped to determine when and in what pattern blood group antibodies were produced. METHODS: We selected 337 children from neonates up to 5 year old who were admitted to Hanyang university Hospital in Seoul or Kuri from 1994 to 1996. Cell typing was done immediately by the slide method. The anti-A and anti-B used for cell typing were supplied by Immucor (Norcrosis, Ga) . Sera were stored at -70 degrees C until they were tested for ABO blood group antibodies by the standard saline test tube method. When uncertain results were obtained, a drop of the mixture was placed on a slide and observed under a microscope. RESULTS: ABO blood group antibodies were detected in 9 of 50 (18%) infants less than 1 week old and in 10 of 51 (20%) infants between 1 week and 3 months of age. The pattern of ABO blood group antibody production was similar to that of the fetal period up to 3 months after birth, after which antibody production increased rapidly to reach approximately 80% at 6 months of age, There was no difference in ABO antibody production between boys and girls. The antibody formation pattern of group A and group B infants less than 6 months of age showed anti-A to be 35% and anti-B to be 20%. In group O infants of the same age, anti-A was positive In 42% and antral-B In 33%. However, after 6 months of age, there was no difference in antibody production among groups A, B, or O. CONCLUSIONS: Antibodies directed toward ABO antigens were detected in 19 out of 101 (19%) infants less than 3 months old. We therefore believe it is necessary to Perform serologic typing as well as cell typing in these Infants. Furthermore, the emergency transfusion of type A or B blood to a type O infant under the impression that anti-A and anti-B do not exist should be forbidden.
Antibodies* ; Antibody Formation ; Child* ; Child, Preschool ; Emergencies ; Female ; Hope ; Humans ; Infant ; Infant, Newborn ; Korea ; Parturition ; Placenta ; Seoul

BACKGROUND: The Diego blood group system consists of two independent pairs of antigens, Dia and Dib. Immunization to Dia or Dib is clinically significant, because anti-Dia and anti-Dib may cause hemolytic transfusion reactions of transfused incompatible red cells or hemolytic disease of the newborn. At the nucleotide level, the difference between the Di a and Di b alleles is a single-base change of exon 19 that results in the substitution of leucine (CTG) for proline (CCG) at position 854. METHODS: Peripheral blood was collected from 116 patients. DNA was isolated from 50 L of blood. PCR was performed with previously described primers by Bruce et al (S22: 5'-GTC ACGTCGCTCAGCGG, AS13: 5'-GACCTTCCTCCTCATCAA). The 5 L of PCR products were digested by Nae I. We analyzed 10ul of each digested PCR product by electrophoresis on 1.5 % agarose gel with ethidium bromide staining. RESULTS: A concordance rate of 100 percent was observed between genotyping and phenotyping (105 Di (a-b+), 11 Di (a+b+)). CONCLUSIONS: This method can be effectively used for the Diego typing and is particularly useful in cases where the serological typing method is difficult as in autoimmune hemolytic anemia.
Alleles ; Anemia, Hemolytic, Autoimmune ; Blood Group Incompatibility ; DNA ; Electrophoresis ; Ethidium ; Exons ; Humans ; Immunization ; Infant, Newborn ; Leucine ; Polymerase Chain Reaction* ; Proline ; Sepharose

BACKGROUND: Selective 2-agonists cause decrease in serum K+ concentration. Midazolam is an anxiolytic, sedative, and amnestic drug. Premedication of midazolam prevents increase of catecholamine with anxiety. Clonidine, alpha 2-adrenergic receptor agonist, supresses sympathetic outflow from central nervous system. So we can expect that premedication of clonidine or midazolam will prevent hypokalemia before induction of anesthesia. METHODS: Twenty two patients received 300 mcg clonidine per oral, 22 patients 0.05 mg/kg midazolan IM and 22 patients had no premedication. We measured serum K+ level at out-patient Department (T1), at 11:00 P.M. of the day before surgery (T2) and immediately before induction of anesthesia (T3). RESULTS: Serum K+ levels at T2 decreased compared to serum K+ level at T1 in all groups. Serum K+ levels T3 decreased compared to serum K+ level at T2 in control and midazolam groups but clonidine group did not decrease in serum K+ level. CONCLUSIONS: We can not prevent decrease of serum K+ level with premedication of midazolam but we can prevent decrease of serum K+ level with premedication of clonidine. So premedication of clonidine is more effective than midazolam in prevention of hypokalemia before induction of anesthesia.
Anesthesia* ; Anxiety ; Central Nervous System ; Clonidine* ; Humans ; Hypokalemia* ; Midazolam* ; Outpatients ; Premedication

BACKGORUND/AIMS: Endoscopic choledochoduodenal fistulotomy(fistulotomy), using a needle-knife sphin-cterotome as an alternative to failed duct cannulation and subsequent endoscopic drainage in patients with ampullary cancer, can be performed in patients with a suprapapillary bulged or distorted papilla. The purpose of this prospective sutdy was to evaluate the safety and clinical usefulness of endoscopic fistulotomy in patients with ampullary cancer. METHODS: Of the 29 patients with ampullary cancer requiring biliary drainage, 13 patients with a suprapapillary bulged papilla underwent fistulotomy either alone or followed by an upward extension of the fistulous orifice using a standard sphincterotome (fistulotomy group). Of the remaing 16 patients, transpapillary biliary stenting was successful in 13 patients (biliary stenting group). In both group, the rate of successful bile duct cannulation and effective biliary drainage were assessed and compared. RESULTS: Bile duct cannulation was successful in 92.3% of the patients in the fistulotomy group and 81.3% of patients in the biliary stenting group, and the only complications were mild bleeding in 1 patient (7.7%) and cholangitis in 1 patient(6.3%). The success rate for initial biliary drainage with the fistulotomy or transpapillary stenting were 100% and 84.6%, respectively. Of the 12 patients in whom biliary drainage was used as the definite treatment, the symptom-free duration was 3.2 months in 6 patients of the fistulotomy group and 3.9 months in 6 patients in the biliary stenting group. CONCLUSIONS: Endoscopic fistulotomy is safe and effective for both preoperative and palliative biliary decompression in patients with ampullary cancer and it is suggested that the procedure can be applied primarily to increase the success rate of biliary access and subsequent biliary drainage especially in patients with a bulged papilla.
Bile Ducts ; Catheterization ; Cholangitis ; Decompression ; Drainage ; Hemorrhage ; Humans ; Prospective Studies ; Stents

Transplantation of ABO-nmatched solid organs has been associated with the development of immune hemolysis due to donor-erived antibodies produced by passenger lymphocytes in the graft, called "Passenger Lymphocyte Syndrome". In a liver transplantation, about 40% of patients at risk has detectable donor-erived antibodies and hemolytic anemia occurs in 29% of patients. It is characterized by hemoglobinemia, a rapid fall in hemoglobin, hyperbilirubinemia, and an excessive red cell transfusion requirement occurring 1 to 3 weeks after the transplantation. These clinical findings are accompanied by the laboratory findings of a positive direct antiglobulin test and the detection of unexpected antibodies in the patients' red cell eluate and serum. Both the hemolytic anemia and serology resolve over the course of weeks to months. To the best of our knowledge, this is the first case of hemolytic anemia due to passenger lymphocyte syndrome after ABO-nmatched liver transplantation in Korea.
Anemia, Hemolytic ; Antibodies ; Coombs Test ; Hemolysis ; Humans ; Hyperbilirubinemia ; Korea ; Liver Transplantation ; Liver* ; Lymphocytes* ; Transplants

OBJECTIVE: To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities. METHODS: Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evaluation of upper limb spasticity, and Quality of Upper Extremity Skills Test (QUEST), Canadian Occupational Performance Measure (COPM), and Test of Visual-Motor Skills-Revised (TVMS-R) for the evaluation of upper limb function and performance. RESULTS: Upper limb spasticity continuously decreased until the end of the one-year follow-up. Upper limb function on QUEST and COPM showed the best performance at 3 months and deteriorated slightly, but still showed a significantly better performance at 9 and 12 months than at pre-injection. In more functional nine subjects who could perform TVMS-R, the performance enhancement effects remained constant after 12 months, suggesting that the reduced spasticity led to the learning effect acquired by the repeated use of the affected upper limb. CONCLUSION: For school age children with bilateral spastic cerebral palsy whose upper limb functions are important, BoNT-A injections seem to be of help in the performance of school activities and activities of daily living.
Activities of Daily Living ; Botulinum Toxins ; Botulinum Toxins, Type A ; Cerebral Palsy ; Child ; Follow-Up Studies ; Humans ; Learning ; Muscle Spasticity ; Prospective Studies ; Upper Extremity

BACKGROUND: Fluoxetine (Prozac), a selective serotonin reuptake inhibitor, has been shown to be effective in the treatment of depression. We investigated the effects of norfluoxetine, the major active metabolite of fluoxetine, on voltage-gated K+ currents in primary cultured hippocampal neurons, and determined the potency and modes of actions of norfluoxetine. METHODS: Voltage-gated K+ currents were studied in primary cultured rat hippocampal neurons using the whole-cell configuration of the patch-clamp technique. Electrophysiological recordings were done in hippocampal neurons between 5-10 days in culture. Transient A-type K+ currents (KA) and delayed-rectifier K+ (KDR) currents were isolated from whole-cell K+ currents using a pulse protocol. RESULTS: Norfluoxetine accelerated the decay rate of whole-cell K+ currents, and thus decreased the current amplitude at the end of a pulse in a concentration-dependent manner. Norfluoxetine inhibited KA and KDR currents in a concentration-dependent manner with IC50's of 0.93 and 0.70micro M, respectively. Norfluoxetine also reduced the areas of KA currents and the steady-state KDR current over the range of test potentials, and the reduction was voltage-dependent (greater increase at more positive potentials). From the onset of the fractional block of KA currents by norfluoxetine during the initial 40 ms of a clamp step, we calculated k1 = 53.26/micro M.s for the association rate constant, and k2 = 70.24/s for the dissociation rate constant. The resulting apparent KD was 1.32micro M, which is similar to the IC50 value obtained from the concentration-response curve. CONCLUSIONS: Our results indicate that norfluoxetine, the major metabolite of fluoxetine, at therapeutic levels, produces a concentration- and voltage-dependent inhibition of KA and KDR currents in primary cultured hippocampal neurons. These effects could perturb the neuronal excitability in the hippocampus, and may contribute to the therapeutic antidepressant action of fluoxetine.
Animals ; Depression ; Fluoxetine* ; Hippocampus ; Inhibitory Concentration 50 ; Neurons* ; Patch-Clamp Techniques ; Potassium Channels, Voltage-Gated* ; Rats* ; Serotonin

Acute pancreatitis is one of the major complications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). Various etiology such as mechanical, chemical, hydrostatic, and thermal factor are thought to be involved for this procedure-related pancreatitis. However, acute pancreatitis can occur as a direct complication of endoscopic biliary drainage (EBD). Although the exact mechanism remains unclear, it is postulated that the stent compresses pancreatic ductal orifice and resultant pancreatic outflow obstruction actually provokes pancreatitis. Using the larger stent diameter over 10 Fr and a straight stent rather than curved one, proximal rather than distal bile duct obstruction are risk factors for stent-induced pancreatitis. We report on three cases of acute pancreatitis complicating the EBD with a plastic stent, nasobiliary catheter, and covered-metallic stent respectively.
Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis ; Drainage ; Pancreatic Ducts ; Pancreatitis* ; Plastics ; Risk Factors ; Sphincterotomy, Endoscopic ; Stents*

BACKGROUND/AIMS: Gelatinase (matrix metalloproteinase (MMP) -2 and 9) has an important role in the pathogenesis of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). In this study, we evaluated the relationship of gelatinase to chronic liver disease. METHODS: Four groups of subjects were examined; healthy control (10 cases), chronic hepatitis (18 cases), LC (15 cases), and HCC (28 cases). The plasma of each subject was obtained, and the equal quantification of plasma protein was done. The plasma activities of MMP-2 and 9 were measured by zymography. RESULTS: The activities of plasma MMP-2 in patients with LC were significantly higher than those in controls (p=0.009) and in patients with chronic hepatitis (p=0.011), but not different from those in patients with HCC. The activities of plasma MMP-9 in patients with LC were significantly higher than those in controls, but not different from those in patients with chronic hepatitis or HCC. In patients with LC (regardless of having HCC), the activities of MMP-2 correlated with total bilirubin (r=0.323, p=0.048) and Child-Pugh score (r=0.414, p=0.012). The activities of MMP-2 and 9 were higher in patients with LC (regardless of having HCC) caused by alcohol than caused by HBV (p=0.009 and 0.002 for each one). CONCLUSIONS: The plasma activity of MMP-2 may be a useful marker for the diagnosis and determination of the severity of LC. The plasma activity of MMP-9 was not useful for HCC, but may be a marker for alcoholic LC. Further study is needed to determine why the plasma activity of gelatinase was higher in patients with LC caused by alcohol than by HBV.
Adult ; Aged ; Biological Markers/blood ; Carcinoma, Hepatocellular/*diagnosis ; Chronic Disease ; Female ; Hepatitis B, Chronic/diagnosis ; Humans ; Liver Cirrhosis/*diagnosis/etiology ; Liver Neoplasms/*diagnosis ; Male ; Matrix Metalloproteinase 2/*blood ; Matrix Metalloproteinase 9/*blood ; Middle Aged

BACKGROUND/AIMS: The genetic polymorphism of transforming growth factor-beta1 (TGF-beta1) at codons 10 and 25 which influences the production of TGF-beta1 is related to fibrogenesis in the lung and liver. We evaluated the genetic polymorphism at codons 10 and 25 in controls and in patients with liver cirrhosis (LC) and hepatocellular carcinoma (HCC). METHODS: Blood samples were collected from controls (n=35), patients with LC (n=64), and HCC (n=49). Genomic DNA was isolated and polymerase chain reaction (PCR) was done for a segment including codons 10 and 25. The results of direct sequencing for PCR products were compared between the controls and the patients. RESULTS: There was no genetic polymorphism at codon 25 and three types of genetic polymorphism at codon 10. The leucine homozygous genotype (CTG/CTG) at codon 10 was more common in patients with LC than the controls (p=0.01) and especially in patients with LC caused by HBV (p=0.004). The polymorphism at codons 10 in patients with HCC was similar to the controls. However, leucine homozygous genotype was more common in patients with HCC of uninodular morphology than those of massive morphology (p=0.007). CONCLUSIONS: The genetic polymorphism of TGF-beta1 at codon 10 might be associated with LC and morphology of HCC. The potential usefulness of TGF-beta1 genotyping needs further studies in large scale.
Adult ; Aged ; Carcinoma, Hepatocellular/*genetics ; Codon/genetics ; Female ; Genotype ; Humans ; Korea ; Liver Cirrhosis/*genetics ; Liver Neoplasms/*genetics ; Male ; Middle Aged ; *Polymorphism, Genetic ; Sequence Analysis, Protein ; Transforming Growth Factor beta/*genetics ; Transforming Growth Factor beta1