Fatal complications including cerebral edema and neurologic collapse occur during treatment of diabetic ketoacidosis(DKA). A 6-week-old female infant with fever, dehydration and drowsy mental status was diagnosed as DKA and neurologically deteriorated during treatment. The cranial computed tomography scan revealed multifocal brain infarctions of the left caudate nucleus, bilateral frontal periventricular white matter, and right parietal cortex. A moderate amount of hemorrhage was also noted in both lateral ventricles. She recovered rapidly with supportive treatment over time. The clinical course and radiologic findings of this patient emphasize the importance of brain infarction as a cause of persistent neurologic loss in children with DKA.
Brain Edema ; Brain Infarction* ; Brain* ; Caudate Nucleus ; Child ; Dehydration ; Diabetic Ketoacidosis* ; Female ; Fever ; Hemorrhage* ; Humans ; Infant* ; Lateral Ventricles ; Rabeprazole

No abstract available.
Breast Neoplasms* ; Breast*

PURPOSE: We aimed to investigate the clinical manifestations of and antibiotic resistance in culture-proven childhood salmonellosis. METHODS: Clinical manifestations and laboratory data of and antibiotic use in subjects with culture-proven childhood salmonellosis, who were treated at the Chonbuk National University Hospital between September 1998 and August 2008, were analyzed retrospectively. Patients with underlying diseases or concomitant illnesses were excluded. RESULTS: We assessed a total of 72 patients. There were 68 stool culture-positive cases, 7 blood culture-positive cases, and 3 both stool culture- and blood culture-positive cases. Salmonella group D was the most frequent pathogen in stool (63.9%) and blood (71.4%) cultures. Salmonella typhi was isolated in 1 case. Of the 72 patients, 45 (62.5%) were male children, of which 29 (40.3%) were aged <3 years. The patients most commonly presented with diarrhea (90.2%) and fever (83.3%). Leukocytosis (leukocyte count, >15,000/microliter) and leukopenia (leukocyte count, <4,000/microliter) were detected in 8.3% and 5.6% of the patients, respectively. Elevated serum C-reactive protein concentration (>5 mg/dL) and erythrocyte sedimentation rate (>20 mm/h) were observed in 88.9% and 58.3% of the patients, respectively. Fifty-two (85.2%) of 61 patients who had undergone antibiotic treatment received a third-generation cephalosporin as definitive antibiotic therapy. Multidrug resistance rate was 40.0% in the first 5 years of the study and 71.4% in the last 5 years. No fatalities occurred in this series. CONCLUSION: Children with culture-proven salmonellosis showed relatively benign clinical outcomes. Appropriate antibiotic treatment of <2 weeks is probably adequate for those without a suppurative focus of infection. The incidence of antibiotic resistant isolates was recently seen to increase.
Aged ; Blood Sedimentation ; C-Reactive Protein ; Child ; Diarrhea ; Drug Resistance, Microbial ; Drug Resistance, Multiple ; Fever ; Humans ; Incidence ; Leukocytosis ; Leukopenia ; Male ; Retrospective Studies ; Salmonella ; Salmonella Infections ; Salmonella typhi

PURPOSE: Deproteinized bovine bone substitutes are commonly used in dental regenerative surgery for treatment of alveolar defects. In this study, three different bovine bone minerals - OCS-B (NIBEC, Seoul, Korea), Bio-Oss (Geistlich - Pharma, Switzerland), Osteograft/N - 300 (OGN, Dentsply Friadent Ceramed. TN, USA) - were investigated to analyze the basic characteristics of commercially available bone substitutes. METHODS:Their physicochemical properties were evaluated by scanning electron microscopy, energy dispersive X-ray spectrometer (EDS), surface area analysis, and Kjeldahl protein analysis. Cell proliferation and alkaline phosphatase (ALP) activity of human osteosarcoma cells on different bovine bone minerals were evaluated. RESULTS: Three kinds of bone substitutes displayed different surface properties. Ca/P ratio of OCS - B shown to be lower than other two bovine bone minerals in EDS analysis. Bio-Oss had wider surface area and lower amount of residual protein than OCS - B and OGN. In addition Bio - Oss was proved to have lower cell proliferation and ALP activity due to lots of residual micro particles, compared with OCS - B and OGN. CONCLUSIONS: Based on the results of this study, three bovine bone minerals that produced by similar methods appear to have different property and characteristics. It is suggested that detailed studies and quality management is needed in operations for dental use and its biological effects on new bone formation.
Alkaline Phosphatase ; Bone Substitutes ; Cell Proliferation ; Humans ; Microscopy, Electron, Scanning ; Minerals ; Osteogenesis ; Osteosarcoma ; Polymethyl Methacrylate ; Statistics as Topic ; Surface Properties

PURPOSE: Appendicitis is the most common abdominal surgical emergency. The diagnosis of appendicitis can be difficult, occasionally taxing the diagnostic skills of even the most experienced surgeon, and especially for diagnosing reproductive women. This study was designed to evaluate the various pathologies of the appendix and the other intraabdominal organs in patients who were preoperatively diagnosed with acute appendicitis, and we wanted to analyze the difference of the perioperative results between the reproductive women and the other patients. METHODS: The study was a retrospective analysis of 1,108 appendectomies that were performed from September 2003 to August 2006. The data were analyzed for the following parameters: the age-related and sex-related incidence of acute appendicitis, the rates of negative appendectomy, negative operation and appendicular perforation, and the incidence of other encountered pathologies. In addition, we present the clinical results of the reproductive women. RESULTS: The diagnostic accuracy for acute appendicitis was 87.2%. The negative appendectomy rate was 11.6% and it was significantly higher (20.8%) in the reproductive women than in the male patients of the same age (P=0.001). On the clinical analyses of the reproductive aged appendicitis group showed they a shorter pain duration and a higher WBC count, and more frequent epigastric discomfort, nausea, vomiting and RLQ tenderness (P< 0.05). CONCLUSION: We noted a high rate of negative appendectomy among reproductive female patients, so more care should be taken to diagnose these patients.
Appendectomy ; Appendicitis* ; Appendix ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Female ; Humans ; Incidence ; Male ; Nausea ; Pathology ; Retrospective Studies ; Taxes ; Vomiting

PURPOSE: Simulation using computed tomography (CT) is now widely available for radiation treatment planning for breast cancer. It is an important tool to help define the tumor target and normal tissue based on anatomical features of an individual patient. In Korea, most patients have small sized breasts and the purpose of this study was to review the margin of treatment field between conventional two-dimensional (2D) planning and CT based three-dimensional (3D) planning in patients with small breasts. MATERIALS AND METHODS: Twenty-five consecutive patients with early breast cancer undergoing breast conservation therapy were selected. All patients underwent 3D CT based planning with a conventional breast tangential field design. In 2D planning, the treatment field margins were determined by palpation of the breast parenchyma (In general, the superior: base of the clavicle, medial: midline, lateral: mid - axillary line, and inferior margin: 2 m below the inframammary fold). In 3D planning, the clinical target volume (CTV) ought to comprise all glandular breast tissue, and the PTV was obtained by adding a 3D margin of 1 cm around the CTV except in the skin direction. The difference in the treatment field margin and equivalent field size between 2D and 3D planning were evaluated. The association between radiation field margins and factors such as body mass index, menopause status, and bra size was determined. Lung volume and heart volume were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. RESULTS: The margins of the treatment field were smaller in the 3D planning except for two patients. The superior margin was especially variable (average, 2.5 cm; range, -2.5 to 4.5 cm; SD, 1.85). The margin of these targets did not vary equally across BMI class, menopause status, or bra size. The average irradiated lung volume was significantly lower for 3D planning. The average irradiated heart volume did not decrease significantly. CONCLUSION: The use of 3D CT based planning reduced the radiation field in early breast cancer patients with small breasts in relation to conventional planning. Though a coherent definition of the breast is needed, CT-based planning generated the better plan in terms of reducing the irradiation volume of normal tissue. Moreover it was possible that 3D CT based planning showed better CTV coverage including postoperative change.
Body Mass Index ; Breast ; Breast Neoplasms ; Cardiac Volume ; Clavicle ; Female ; Humans ; Korea ; Lung ; Menopause ; Palpation ; Skin

PURPOSE: Periodontal ligament (PDL) cell differentiation into osteoblasts is important in bone formation. Bone formation is a complex biological process and involves several tightly regulated gene expression patterns of bone-related proteins. The expression patterns of bone related proteins are regulated in a temporal manner both in vivo and in vitro. The aim of this study was to observe the gene expression profile in PDL cell proliferation, differentiation, and mineralization in vitro. METHODS: PDL cells were grown until confluence, which were then designated as day 0, and nodule formation was induced by the addition of 50 microg/mL ascorbic acid, 10 mM beta-glycerophosphate, and 100 nM dexamethasone to the medium. The dishes were stained with Alizarin Red S on days 1, 7, 14, and 21. Real-time polymerase chain reaction was performed for the detection of various genes on days 0, 1, 7, 14, and 21. RESULTS: On day 0 with a confluent monolayer, in the active proliferative stage, c-myc gene expression was observed at its maximal level. On day 7 with a multilayer, alkaline phosphatase, bone morphogenetic protein (BMP)-2, and BMP-4 gene expression had increased and this was followed by maximal expression of osteocalcin on day 14 with the initiation of nodule mineralization. In relationship to apoptosis, c-fos gene expression peaked on day 21 and was characterized by the post-mineralization stage. Here, various genes were regulated in a temporal manner during PDL fibroblast proliferation, extracellular matrix maturation, and mineralization. The gene expression pattern was similar. CONCLUSIONS: We can speculate that the gene expression pattern occurs during PDL cell proliferation, differentiation, and mineralization. On the basis of these results, it might be possible to understand the various factors that influence PDL cell proliferation, extracellular matrix maturation, and mineralization with regard to gene expression patterns.
Alkaline Phosphatase ; Anthraquinones ; Apoptosis ; Ascorbic Acid ; Biological Processes ; Bone Morphogenetic Proteins ; Cell Differentiation ; Cell Proliferation ; Dexamethasone ; Durapatite ; Extracellular Matrix ; Fibroblasts ; Gene Expression ; Genes, fos ; Genes, myc ; Glycerophosphates ; Humans ; Osteoblasts ; Osteocalcin ; Osteogenesis ; Periodontal Ligament ; Proteins ; Real-Time Polymerase Chain Reaction ; Transcriptome

PURPOSE: Under different culture conditions, periodontal ligament (PDL) stem cells are capable of differentiating into cementoblast-like cells, adipocytes, and collagen-forming cells. Several previous studies reported that because of the stem cells in the PDL, the PDL have a regenerative capacity which, when appropriately triggered, participates in restoring connective tissues and mineralized tissues. Therefore, this study analyzed the genes involved in mineralization during differentiation of human PDL (hPDL) cells, and searched for candidate genes possibly associated with the mineralization of hPDL cells. METHODS: To analyze the gene expression pattern of hPDL cells during differentiation, the hPDL cells were cultured in two conditions, with or without osteogenic cocktails (beta-glycerophosphate, ascorbic acid and dexamethasone), and a DNA microarray analysis of the cells cultured on days 7 and 14 was performed. Reverse transcription-polymerase chain reaction was performed to validate the DNA microarray data. RESULTS: The up-regulated genes on day 7 by hPDL cells cultured in osteogenic medium were thought to be associated with calcium/iron/metal ion binding or homeostasis (PDE1A, HFE and PCDH9) and cell viability (PCDH9), and the down-regulated genes were thought to be associated with proliferation (PHGDH and PSAT1). Also, the up-regulated genes on day 14 by hPDL cells cultured in osteogenic medium were thought to be associated with apoptosis, angiogenesis (ANGPTL4 and FOXO1A), and adipogenesis (ANGPTL4 and SEC14L2), and the down-regulated genes were thought to be associated with cell migration (SLC16A4). CONCLUSIONS: This study suggests that when appropriately triggered, the stem cells in the hPDL differentiate into osteoblasts/cementoblasts, and the genes related to calcium binding (PDE1A and PCDH9), which were strongly expressed at the stage of matrix maturation, may be associated with differentiation of the hPDL cells into osteoblasts/cementoblasts.
Adipocytes ; Adipogenesis ; Apoptosis ; Ascorbic Acid ; Calcium ; Cell Differentiation ; Cell Movement ; Cell Survival ; Connective Tissue ; Durapatite ; Gene Expression ; Gene Expression Profiling ; Homeostasis ; Humans ; Microarray Analysis ; Oligonucleotide Array Sequence Analysis ; Periodontal Ligament ; Stem Cells

PURPOSE: Under different culture conditions, periodontal ligament (PDL) stem cells are capable of differentiating into cementoblast-like cells, adipocytes, and collagen-forming cells. Several previous studies reported that because of the stem cells in the PDL, the PDL have a regenerative capacity which, when appropriately triggered, participates in restoring connective tissues and mineralized tissues. Therefore, this study analyzed the genes involved in mineralization during differentiation of human PDL (hPDL) cells, and searched for candidate genes possibly associated with the mineralization of hPDL cells. METHODS: To analyze the gene expression pattern of hPDL cells during differentiation, the hPDL cells were cultured in two conditions, with or without osteogenic cocktails (beta-glycerophosphate, ascorbic acid and dexamethasone), and a DNA microarray analysis of the cells cultured on days 7 and 14 was performed. Reverse transcription-polymerase chain reaction was performed to validate the DNA microarray data. RESULTS: The up-regulated genes on day 7 by hPDL cells cultured in osteogenic medium were thought to be associated with calcium/iron/metal ion binding or homeostasis (PDE1A, HFE and PCDH9) and cell viability (PCDH9), and the down-regulated genes were thought to be associated with proliferation (PHGDH and PSAT1). Also, the up-regulated genes on day 14 by hPDL cells cultured in osteogenic medium were thought to be associated with apoptosis, angiogenesis (ANGPTL4 and FOXO1A), and adipogenesis (ANGPTL4 and SEC14L2), and the down-regulated genes were thought to be associated with cell migration (SLC16A4). CONCLUSIONS: This study suggests that when appropriately triggered, the stem cells in the hPDL differentiate into osteoblasts/cementoblasts, and the genes related to calcium binding (PDE1A and PCDH9), which were strongly expressed at the stage of matrix maturation, may be associated with differentiation of the hPDL cells into osteoblasts/cementoblasts.
Adipocytes ; Adipogenesis ; Apoptosis ; Ascorbic Acid ; Calcium ; Cell Differentiation ; Cell Movement ; Cell Survival ; Connective Tissue ; Durapatite ; Gene Expression ; Gene Expression Profiling ; Homeostasis ; Humans ; Microarray Analysis ; Oligonucleotide Array Sequence Analysis ; Periodontal Ligament ; Stem Cells

Blunt chest trauma can cause various types of cardiac injuries such as myocardial contusion,cardiac ruptrue, valvular or papillary muscle injuries, and pericardial or coronary artery injuries. Complete rupture of both papillary muscles accompanied by left ventricular(LV) rupture following blunt chest trauma to our knowledge has not been previously reported. A 40-year-old female was referred because of severe dyspnea and anterior chest pain which occured immedicately after blunt chest trauma. Echocardiography demonstrated a moderate pericardial effusion as well as rupture of both papillary muscle with severe mitral regurgitation. Hemopericardium and a complets tear of the anterolateral papillary muscle at the mid portion were observed. The posteromedial papillary muscle was totally transected at the attachment site of LV wall and accompanied by external rupture of left ventricle at that site. Mitral valve replacement and primary repair of LV ruptrue was performed successfully. In the case we report, complete rupture of both papillary muscles developed after blunt chest trauma and LV rupture occurred as the papillary muscle was torn from the LV wall.
Adult ; Chest Pain ; Coronary Vessels ; Dyspnea ; Echocardiography ; Female ; Heart Ventricles ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Papillary Muscles* ; Pericardial Effusion ; Rupture* ; Thorax*