No abstract available.
Checklist* ; Child ; Child Behavior* ; Child* ; Conduct Disorder* ; Humans

PURPOSE: To compare the feasibility and safety of US-guided right and left percutaneous transhepatic biliary drainage (PTBD). MATERIALS AND METHODS: Between March 1998 and May 1999, 32 patients underwent 36 US-guided right or left PTBD in referred order, alternatively. The causes of biliary obstruction were bile duct stone (n=2), bile duct carcinoma (n=10), carcinoma of the pancreas (n=9), GB carcinoma (n=7), metastasis to the porta hepatis (n=3), and carcinoma of the ampulla of vater (n=1). Technical success, procedure time, fluoroscopic time, and complications were evaluated. RESULTS: PTBD was successful in 94% of both right and left approach. The average procedure time was 9.7+/-3.8 min. in the right approach and 9.6+/-3.1 min. in the left approach, respectively (p=0.794). The average fluoroscopic time were 3.9+/-2.4 min. in the right approach and 3.8+/-2.2 min. in the left approach (p=0.892). A major complication, bile peritonitis, occurred in one of 16 patient with right-sided approach. Minor complications occurred in six right (2 hemobilia, 3 tube malfunction, 1 cholangitis) and three left (1 hemobilia, 1 fever, 1 cholangitis) PTBD. There were no significant difference in the complication rates between right and left PTBD (p=0.729). CONCLUSION: There were no significant differences in feasibility and safety in US-guided right and left PTBD.
Ampulla of Vater ; Bile ; Bile Ducts ; Drainage* ; Fever ; Hemobilia ; Humans ; Neoplasm Metastasis ; Pancreas ; Peritonitis

PURPOSE: Height-specific blood pressure (BP) is the standard parameter used to diagnose childhood hypertension. However, there has been some argument that weight may be a better variable than height in the reference BP standards. Therefore, before assessing the BP status using the reference BP standards, a basic understanding of the fundamental association of weight and height with BP is required. METHODS: In the present study, we analyzed the correlation of BP with height and weight in Korean adolescents (age, 10-19 years), using data from the Korean National Health and Nutrition Examination Surveys (2009-2011). RESULTS: Systolic BP (SBP) was more closely correlated with weight than with height in the normal weight (body mass index [BMI], < or =85th percentile) and overweight (BMI, >85th percentile) groups and in the normal waist circumference (WC, < or =90th percentile) and high WC (>90th percentile) groups in both sexes. Diastolic BP (DBP) had a higher correlation with height than with weight in the normal weight and normal WC groups, whereas weight was more closely associated with DBP than height in the overweight and high WC groups in both boys and girls. CONCLUSION: In Korean adolescents, weight had a greater effect on SBP than height in both the normal weight and overweight groups. DBP was mainly affected by height in the normal weight group, whereas weight was the major determinant of DBP in the overweight group. Therefore, it may be necessary to consider weight in the establishment of reference BP standards.
Adolescent* ; Blood Pressure* ; Body Height ; Body Weight ; Female ; Humans ; Hypertension ; Obesity ; Overweight ; Waist Circumference

It is well known that hemodynamic load is one of the most important determinants of cardiac structure and function. Circadian variations in blood pressure (BP) are usually accompanied by consensual changes in peripheral resistance and/or cardiac output. In recent years, reduction in circadian variations in BP and, in particular, loss of nocturnal decline of BP were observed in hypertensive patients with left ventricular hypertrophy (LVH). The patients with only a slight or no loss of nocturnal decline of BP were considered "non-dippers". Regression of LVH was observed after prolonged antihypertensive therapy. Restoration of the circadian rhythm of BP was also observed. However, the classification of patients into "dippers" and "non-dippers" is arbitrary and poorly standardized and repeatable, and in the recent studies, most hypertensive patients with LVH were "dippers". Therefore, we should be particularly cautious about the conclusions drawn using this index. On the other hand, reduced activity of low-pressure cardiopulmonary baroreceptors and impaired day-to-night modulation of autonomic nervous system activity were observed in patients with only LVH. Therefore, alterations in cardiac structure may impair BP modulation. On the other hand, the reverse can also be trueprimary alterations in BP modulation, through a persistently elevated afterload, can increase cardiac mass. Thus, the interrelationship between cardiac structure and BP modulation is complex. Hence, new and more specific methods of evaluating circadian changes in BP are needed to better clarify the abovementioned reciprocal influences.
Autonomic Nervous System ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Cardiac Output ; Circadian Rhythm ; Hand ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Pressoreceptors ; Vascular Resistance

PURPOSE: Overweight can be defined by the body mass index (BMI) and is likely associated with an increased cardiovascular disease risk. However, waist circumference (WC), a central adiposity index, may be a better indicator of cardiovascular disease risk. Studies comparing the effects of BMI and WC on cardiovascular risk factors, such as high blood pressure (BP), are rare in adolescents. METHODS: We analyzed the correlations of BMI and WC with BP in 3,363 Korean adolescents (aged 10-19 years), using data from the Korean National Health and Nutrition Examination Surveys (2009-2011). RESULTS: Systolic BP (SBP) in both sexes and diastolic BP (DBP) in boys were higher in the high BMI (>85th percentile) and high WC (>90th percentile) groups. High BMI and high WC were positively correlated with high SBP (>90th percentile) in both sexes, and high DBP (>90th percentile), in boys. BMI maintained its positive associations with SBP, DBP, high SBP, and high DBP in the normal weight (BMI< or =85th percentile) and overweight (BMI>85th percentile) groups in both boys and girls, as well as in all subjects of both sexes, even after adjustment for WC. However, WC did not correlate with SBP, DBP, high SBP, or high DBP after adjustment for BMI in any group in either sex. CONCLUSION: In Korean adolescents, BMI correlated better with BP and high BP levels than WC. Further, BMI was positively associated with BP and high BP in the normal weight group as well as in the overweight group.
Adiposity ; Adolescent* ; Blood Pressure* ; Body Mass Index* ; Cardiovascular Diseases ; Female ; Humans ; Hypertension ; Obesity ; Overweight* ; Risk Factors ; Waist Circumference*

Arrhythmias can develop in various cardiac diseases, such as ischemic heart disease, cardiomyopathy and congenital heart disease. It can also contribute to the aggravation of heart failure and sudden cardiac death. Redox stress and Ca2+ overload are thought to be the important triggering factors in the generation of arrhythmias in failing myocardium. From recent studies, it appears evident that Ca2+/calmodulin-dependent protein kinase II (CaMKII) plays a central role in the arrhythmogenic processes in heart failure by sensing intracellular Ca2+ and redox stress, affecting individual ion channels and thereby leading to electrical instability in the heart. CaMKII, a multifunctional serine/threonine kinase, is an abundant molecule in the neuron and the heart. It has a specific property as "a memory molecule" such that the binding of calcified calmodulin (Ca2+/CaM) to the regulatory domain on CaMKII initially activates this enzyme. Further, it allows autophosphorylation of T287 or oxidation of M281/282 in the regulatory domain, resulting in sustained activation of CaMKII even after the dissociation of Ca2+/CaM. This review provides the understanding of both the structural and functional properties of CaMKII, the experimental findings of the interactions between CaMKII, redox stress and individual ion channels, and the evidences proving the potential participation of CaMKII and oxidative stress in the diverse arrhythmogenic processes in a diseased heart.
Arrhythmias, Cardiac ; Calcium-Calmodulin-Dependent Protein Kinase Type 2 ; Calmodulin ; Cardiomyopathies ; Death, Sudden, Cardiac ; Heart ; Heart Diseases ; Heart Failure ; Ion Channels ; Memory ; Myocardial Ischemia ; Myocardium ; Neurons ; Oxidation-Reduction ; Oxidative Stress ; Protein Kinases

To investigate the effects of prostaglandin E1(PGX1) in prevention of proliferative scar formation, we cultured fibroblasts of normal skin (NS), hypertrophic scar (HS) and keloid (KL) tissues obtained from patients. We have compared type I collagenase production of cultured fibroblasts from normal skin, hypertrophic scar, and keloid tissues under various concentrations of PGE1. Our results demonstrate that type I collagenase production was significantly increased after addition of PGE1 in HS and KL, but not NS. Type I collagenase production of HS and KL fibroblasts were increased similarly in 10M and 10M of PGE1 and maximally increased in the concentration of 10M. This promotive effects of PGE1 on the production of type I collagenase was larger in KL than in HS. These results also suggest that PGE1 may play the promotive effects on type I collagenase production in dose-dependent manner. PGE1 may have a role in the prevention of hypertrophic scar and keloid by enhancing the production of type I collagenase of HS and KL fibroblasts. The promotive effects of PGE1 on type I collagenase production was variable depending on its concentration, and its effects was maximum in certain optimal condition. The maximally effective concentration of PGE1 in the prevention of proliferative scar formation should be searched in further investigations for clinical use.
Alprostadil ; Cicatrix ; Cicatrix, Hypertrophic* ; Collagenases* ; Fibroblasts* ; Humans ; Keloid* ; RNA, Messenger* ; Skin

Although sacrococcygeal mass is rare and usually found in infants or children, adolescent or adult patients with protruding mass in sacrococcygeal region occasionally come to us simply for a cosmetic problem. In this situation, even though there is no definite neurological deficit, it should be evaluated whether or not the underlying bony pathology or dural defect exists. Few cases about the sacrococcygeal mass have been reported in adults. We reviewed our cases including preoperative evaluation methods and postoperative diagnosis. From March, 1993 to February, 1997, we experienced 6 adult patients with sacrococcygeal mass and no neurological abnormality. Preoperative evaluation were made by plain X-ray, myelogram, computed tomography(CT), and magnetic resonance imaging (MRI), as needed. Postoperative diagnoses were 2 meningoceles, 2 lipomyelomeningoceles, 1 desmoid tumor, and 1 teratoma. From our experiences, CT or MRI is essential to evaluate the sacrococcygeal mass preoperatively. These methods can visualize the precise anatomic location and extent of the mass, its relation to the spinal cord, and associated bony abnormalities. MRI is superior to CT, especially in defining the nature of the mass and involvement of the spinal cord. Conclusively, even a simple mass in the sacrococcygeal region in adults needs MRI or CT evaluation, and MRI is the most valuable method of evaluating the mass preoperatively and provides important information to establish a treatment plan.
Adolescent ; Adult* ; Child ; Diagnosis ; Fibromatosis, Aggressive ; Humans ; Infant ; Magnetic Resonance Imaging ; Meningocele ; Pathology ; Sacrococcygeal Region* ; Spinal Cord ; Teratoma

No abstract available.
Liver*

Proliferative scarring in the form of keloids and hypertrophic scars continues to be a clinical problem for some patients. The lack of an animal model for such scarring has been an obstacle to studying the biology and effective therapy of these entities. Consequently we created an accurate reproductive animal model to systematically study them. Human proliferative scars were explanted into flaps based on isolated vascular pedicles in congenitally rats. We compared the procollagen type III peptide levels of proliferative scar tissue before and after explanting. The procollagen type III peptide levels of explanted proliferative scar tissue remained increased as before explanting. Histological analysis of the explanted proliferative scar tissue revealed that all explants retained their original histotypic character even after 1 year. We could also retain the volume of implanted proliferative scar for 1 year and studied in vitro cellular proliferation. Fibroblast cultures from explanted scars demonstrated less aggressive growth characteristic than those from original surgical specimens. The advantages of this animal model are as follows: 1. The explants retain their histotypical character for a long period. 2. Placement of the explants outside the dorsum of a nude rat makes serial observation and measurement easier. 3. Agents under test can be injected into the explants through a catheter inserted into a single pedicle of island flap without the possibility of spreading systematically.
Animals* ; Biology ; Catheters ; Cell Proliferation ; Cicatrix* ; Cicatrix, Hypertrophic ; Collagen Type III ; Fibroblasts ; Humans ; Keloid ; Models, Animal* ; Rats ; Rats, Nude