The incidence of severe hepatitis A virus (HAV) infection has been increasing. However, clinicopathologic features of severe HAV infection that lead to liver transplantation (LT) have not been reported in Korea. We retrieved 16 LT cases with HAV infection during the last 3 years at Asan Medical Center, Seoul, Korea. Fifteen cases progressed to hepatic encephalopathy. Thirteen cases survived with or without complications, and three patients died of sepsis. The explanted liver showed massive or zonal necrosis with moderate to severe cholestasis. The zonal distribution of necrosis was frequently associated with endothelialitis of portal and/or central veins. Degenerative changes of hepatocytes were various in degree and distribution. Viral inclusions were suspected in two cases. Although HAV infection is usually confirmed by serological tests, significant venulitis of central and/or portal veins and viral inclusions, which are rarely observed, can suggest an HAV infection as a cause of massive hepatic necrosis of unknown mechanism.
Cholestasis ; Fluconazole ; Hepatic Encephalopathy ; Hepatitis ; Hepatitis A ; Hepatitis A virus ; Hepatocytes ; Humans ; Incidence ; Korea ; Liver ; Liver Transplantation ; Massive Hepatic Necrosis ; Necrosis ; Portal Vein ; Sepsis ; Serologic Tests ; Veins

BACKGROUND: Although postmenopausal estrogen replacement therapy is known to reduce cardiovascular mortality, the mechanism is not clear yet. Furthermore, the effect of estrogen on vascular tonus is reportedly variable according to the animal models, vascular beds and agonists used. MATERIALS AND METHOD: Bilateral ovariectomies were performed in 12 week-old, 18 spontaneously hypertensive rats (SHR) and 18 normotensive Wistar-Kyoto rats (WKY). Rats were divided into three groups according to the dose of 17beta-estradiol (E 2 ) pellets implanted subcutaneously two weeks after ovariectomy: control (no implantation), low-dose (0.5 mg) and high-dose (5 mg) E 2 replacement group. Two weeks after pellet implantation, organ bath experiments were performed using descending thoracic aortae. For endothelium-dependent relaxation, acetylcholine (10(-9) -3x10(-6) M) was cumulatively added into the vessels precontracted with 10(-7) M norepinephrine (NE). For vasoconstrictor responses, cumulative concentration-contraction curves were constructed in quiescent vessels using NE (10(-9) -10(-5) M), U46619 (10(-9) -3x10(-6) M), endothelin-1 (10(-10) -10(-7) M). In addition, contraction to angiotensin II (10(-7) M) was also obtained. Serum 17beta-estradiol levels were measured by radioimmunoassay. Blood pressure was measured by tail-cuff method in some SHRs before ovariectomy and after placebo/E 2 replacement. RESULTS: Endothelium-dependent relaxation to acetylcholine was impaired in WKY treated with 5 mg E 2 (pIC 50 : control vs 5mg E 2 : 7.75+/-0.13 vs 7.27+/-0.16: n=6: p<0.05). No significant effect was noted in SHR. Contraction to angiotensin II was inhibited by low-dose E 2 in WKY and high-dose E 2 in SHR (% of the contraction to 60 mM KCl: WKY: control vs 0.5 mg E 2 : 39+/-5 vs 25+/-2: SHR: control vs 5 mg E 2 : 34+/-4 vs 22+/-2: n=6 and p<0.05 in WKY and SHR). In contrast, NE-induced contraction was enhanced by E 2 replacement (both low- and high-dose) in WKY and SHR (WKY: control vs 0.5 mg E 2 vs 5 mg E 2 : AUC: 280+/-24 vs 387+/-26 vs 374+/-25: maximal contraction: 137+/-8 vs 166+/-8 vs 162+/-3: pD 2 : 7.63+/-0.11 vs 8.17+/-0.13 vs 8.13+/-0.13: SHR: control vs 0.5 mg E 2 vs 5 mg E 2 : AUC: 265+/-17 vs 349+/-16 vs 406+/-19: maximal contraction: 152+/-6 vs 181+/-9 vs 203+/-16: pD 2 : 7.45+/-0.13 vs 7.91+/-0.08 vs 8.04+/-0.04: n=6 and p<0.05 between control and treated groups in WKY and SHR for all parameters). Contraction to U46619 was enhanced by E 2 replacement in SHR (control vs 0.5 mg E 2 : AUC: 478+/-30 vs 574+/-23: maximal contraction: 181+/-9 vs 230+/-10: n=6: p<0.05 for both parameters). Maximal contractile response to endothelin-1 was also enhanced in SHR (control vs 0.5 mg E 2 vs 5 mg E 2 : maximal contraction: 165+/-7 vs 189+/-7 vs 199+/-8: n=6 and p<0.05 between control and treated groups) but not in WKY. Blood pressure was not different between placebo and E 2- treated SHR (171+/-2 vs 174+/-4 mmHg). CONCLUSION: In WKY, chronic high-dose estrogen replacement impairs endothelium-dependent relaxation to acetylcholine.: low-dose estrogen replacement does not affect endothelium-dependent relaxation in SHR and WKY. Estrogen replacement enhances the contraction to most of the contractile agonists tested except angiotensin II in both WKY and SHR. These results suggest that estrogen replacement affect the vascular tonus differently according to the vasoactive substances and/or hormones without significant effect on blood pressure.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid ; Acetylcholine ; Angiotensin II ; Animals ; Aorta, Thoracic ; Area Under Curve ; Baths ; Blood Pressure ; Endothelin-1 ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Models, Animal ; Mortality ; Norepinephrine ; Ovariectomy ; Radioimmunoassay ; Rats ; Rats, Inbred SHR* ; Relaxation

BACKGROUND AND OBJECTIVES: Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Nasal polyps are also prominent features of cystic fibrosis. The purpose of this study is to investigate the CFTR expression and CF mutation genes in nasal polyps to verify genetic influence in the nasal polyp formation. MATERIALS AND METHODS: We have evaluated 30 nasal polyps, 10 recurrent nasal polyps, and 10 inferior turbinates. RT-PCR was done for the CFTR mRNA expression and mutaion genes were studied by RFLP. Immunohistochemical study and western blotting were done for CFTR expression. RESULTS: RT-PCR revealed no differences in the expressions of CFTR transcripts between nasal polyps and nasal turbinates. The expression of CFTR protein was localized on apical portion of some ciliated cells on immunohistochemistry, and western blotting showed no differences in expression levels of CFTR protein. Three different mutations (deltaF508, 591 del 18, G551D) were analysed. One case of deltaF508 was detected in the samples. CONCLUSIONS: The expression levels of CFTR mRNA and CFTR protein may not be associated with the pathogenesis of nasal polyps, but it needs to be studied further on the physiological base. We also need to study further regarding the relation between CFTR mutaion genes and the development of nasal polyps with more mutaional screenings in cDNA levels.
Blotting, Western ; Cystic Fibrosis Transmembrane Conductance Regulator ; Cystic Fibrosis* ; DNA, Complementary ; Immunohistochemistry ; Mass Screening ; Nasal Polyps* ; Polymorphism, Restriction Fragment Length ; RNA, Messenger ; Turbinates

BACKGROUND AND OBJECTIVES: Pemphigus is an autoimmune bullous disease of the skin and mucous membranes. There are two major types of pemphigus, namely pemphigus vulgaris(PV) and pemphigus foliaceus(PF) which can be classified by the specificity of the autoantibodies against the epidermal desmosomal antigens in this disease. Like many other autoimmune diseases, pemphigus is also considered to be strongly associated with certain HLA alleles; some alleles can be detected with higher frequencies as compared with those found in ethnically matched populations. At this time, we tried to find out if there were certain HLA class II allele(s) associated significantly with Korean patients of pemphigus. PATIENTS AND METHODS: Thirty patients with pemphigus (fifteen of PV and fifteen of PF), and one hundred healthy Korean controls were enrolled in this study. For the genotyping of HLA class II alleles in DRB1 loci, genomic DNAs prepared from buccal epithelia were amplified by polymerase chain reactions with nucleotide sequence-specific primers. Each allele of thirteen different generic types belonging to the DRB1 loci were used to identify the existence of each allele in both patient and control groups on gel electrophoreses. RESULTS: In PV, there was a significantly increased frequency of HLA-DRB1*01 alleles than from the findings observed in the controls(pc=0.0013, RR:5). In patients with PF, there was a significant degree of association with HLA-DRB1*01(pc=0.00013, RR:5.5) when compared with that in normal controls. However, no allele of negative association with a significantly low frequency in the patient group was detected in both types of the disease. CONCLUSION: It can be suggested that DRB1*01 alleles may be susceptibility genes in Korean patients with PV, and DRB1*01 alleles could contribute to the autoimmune reactivity in patients with PF. This data shows different patterns in the frequency of each DRB1 allele in patient groups compared with those found in patients of other ethnic backgrounds.
Alleles* ; Autoantibodies ; Autoimmune Diseases ; DNA ; Electrophoresis ; HLA-DRB1 Chains* ; Humans ; Mucous Membrane ; Pemphigus* ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Skin

BACKGROUND: Staphylococcal scalded skin syndrome is a relatively uncommon but well described syndrome defined by clinical, microbiological and histological criteria. The spectrum of the disease in children includes not only a severe and acute exfoliative form(generalized form) but also a scarlatiniform eruption(abortive form) and bullous impetigo(localized form). OBJECTIVE: We performed the study to review the clinical, microbiological and histological features of staphylococcal scalded skin syndrome in Korean children. METHODS: We reviewed retrospectively medical records, clinical photographs, microbiologic results and histopathologic findings of 20 cases of staphylococcal scalded skin syndrome diagnosed at Hanyang University Kuri Hospital from February 1998 to November 2001. RESULTS: 1. Of the 20 patients, 13 were generalized type and 7 were abortive type and male to female sex ratio was 1:1.5. The mean age of onset was 3.2 years. 2. The ordinary cultures from the suspected sites of primary infection revealed methicillin-sensitive Staphylococcus aureus in 7 of the 18 patients, and methicillin-resistant Staphylococcus aureus in 6 of the 18 patients. The colonized sites were conjunctiva(23%), throat(23%), skin(23%), nasal cavity(23%) and ear(8%) in 13 cases. 3. Perioral crusting and fissuring was observed in all cases and the erythema was accentuated in the flexural areas. 4. Histopathologic findings of 11 cases showed intraepidermal cleavage, with splitting occuring beneath and within the stratum granulosum. In 6 of 8 generalized forms, several acantholytic epithelial cells were observed. 5. The coexisting diseases were variable, including atopic dermatitis(5 cases), polycystic kidney disease(1 case) and varicella(1 case). 6. All the patients were treated with first generation cephalosporin and vancomycin therapy without significant sequelae. CONCLUSION: There are no significant relation between clinical types of SSSS and causative organisms. Methicillin-resistant Staphylococcus aureus may induce generalized form and abortive form of staphylococcal scalded skin syndrome but should be confirmed by production of exfoliation in the new-born mouse assay.
Age of Onset ; Animals ; Child ; Colon ; Epithelial Cells ; Erythema ; Female ; Humans ; Male ; Medical Records ; Methicillin-Resistant Staphylococcus aureus ; Mice ; Polycystic Kidney Diseases ; Retrospective Studies ; Sex Ratio ; Staphylococcal Scalded Skin Syndrome* ; Staphylococcus aureus ; Vancomycin

Acute or chronic sinusitis is common disease of ENT. Most cases usually respond to appropriate treatment; however, some cases occasionally progress to the development of serious complication and poor prognosis. The orbital complications are most common complication fallowed by intracranial complications. The incidence of sinogenic intracranial complications is about 3.7-11.0% and these complications are progressively decreasing however the complications occur due to incorrect use of antibiotics, antibiotics resistant pathogens, decreasing host immunity, improper diagnosis and delayed surgical treatment. Therefore the case of epidural abscess in anterior portion of middle cranial fossa secondary to acute sphenoid sinusitis, which was treated with transnasal endoscopic sphenoidotomy and intravenous antibiotics, is being reported.
Anti-Bacterial Agents ; Cranial Fossa, Middle* ; Diagnosis ; Epidural Abscess* ; Incidence ; Orbit ; Prognosis ; Sinusitis ; Sphenoid Sinus* ; Sphenoid Sinusitis*

Berardinelli lipodystrophy syndrome is a rare autosomal recessive disorder, characterized by loss of body fat, muscular hypertrophy, acanthosis nigricans, hepatomegaly, hyperlipidemia, insulin resistant diabetes, and elevated metabolic rate. The mechanism(s) responsible for these abnormalities is not known. We report a forteen-month old girl with Berardinelli Lipodystriphy Syndrome, who had signs above mentioned, with a brief review and its related literatures.
Acanthosis Nigricans ; Adipose Tissue ; Female ; Hepatomegaly ; Humans ; Hyperlipidemias ; Hypertrophy ; Insulin ; Lipodystrophy*

PURPOSE: We studied the plasma neuron-specific enolase (NSE) and glutamic acid levels as a marker of the severity of acute ischemic stroke (AIS). METHODS: We enrolled 93 patients who visited to the emergency department from April to September, 2005. The AIS patients included those who visited the emergency department within 24 hours due to ischemic stroke symptoms. The AIS patients was subclassified according to large-vessel, small-vessel, cardioembolic, or unclassified infarction. RESULTS: The plasma NSE and glutamic acid level were 15.1+/-7.9 ng/ml and 204.5+/-86.5 nM/ml, respectively, in the AIS patients. Plasma NSE and Glutamic acid in the was higher than reference range (NSE 0-12 ng/ml, Glutamic acid 0-130 nM/ml). According to the type of infarction, no differences were observed in the plasma NSE and glutamic acid levels. CONCLUSION: In cases of AIS, NSE and glutamic acid have no statistical usefulness in classifying the type of infarction. However, the value of plasma NSE and glutamic acid levels have statistical usefulness in deciding on the existence or nonexistence of an AIS.
Cerebral Infarction ; Emergency Service, Hospital ; Glutamic Acid* ; Humans ; Infarction ; Phosphopyruvate Hydratase* ; Plasma* ; Reference Values ; Stroke*

OBJECTIVE: The aim of this study was to determine the optimal loading conditions for pure intrusion of the six maxillary anterior teeth with miniscrews according to alveolar bone loss. METHODS: A three-dimensional finite element model was created for a segment of the six anterior teeth, and the positions of the miniscrews and hooks were varied after setting the alveolar bone loss to 0, 2, or 4 mm. Under 100 g of intrusive force, initial displacement of the individual teeth in three directions and the degree of labial tilting were measured. RESULTS: The degree of labial tilting increased with reduced alveolar bone height under the same load. When a miniscrew was inserted between the two central incisors, the amounts of medial-lateral and anterior-posterior displacement of the central incisor were significantly greater than in the other conditions. When the miniscrews were inserted distally to the canines and an intrusion force was applied distal to the lateral incisors, the degree of labial tilting and the amounts of displacement of the six anterior teeth were the lowest, and the maximum von Mises stress was distributed evenly across all the teeth, regardless of the bone loss. CONCLUSIONS: Initial tooth displacement similar to pure intrusion of the six maxillary anterior teeth was induced when miniscrews were inserted distal to the maxillary canines and an intrusion force was applied distal to the lateral incisors. In this condition, the maximum von Mises stresses were relatively evenly distributed across all the teeth, regardless of the bone loss.
Alveolar Bone Loss* ; Finite Element Analysis* ; Incisor ; Tooth*

STATEMENT OF PROBLEM: Among the physical properties of adhesion luting cement, the aspect that requires the most important factor is the degree of solubility and water sorption. Dissolution or an inadequate due to excessive water sorption inside the oral cavity compromises the while concurrently increasing the susceptibility to secondary dental caries. Susceptibility to dissolution and difficulty of removing remnant cement from the gingival sulcus have hindered the use of dental resin cement in the clinical practice, but the improved characteristics of newer generation resin cements have interest in and enabled resin cements to be widely used in adhesion of fixed prosthesis, such as laminate veneers and all-ceramic crowns. PURPOSE: The purpose of this study is to compare and analyze the degrees of solubility and water sorption of a variety of resin cements widely used for clinical purposes with different curing methods. MATERIALS AND METHODS: Self-curing resin cements, Avanto(R), CandB(TM) CEMENT and Superbond CandB cements comprised group 1, 2 and 3. The dual-curing resin cements Panavia(TM) F, Calibra(R) and Variolink(R) II were divided into groups 4, 5, and 6, respectively. The investigation was carried out using disc-shaped specimens as specified by ANSI/ADA Specification No. 27. The degree of water sorption, water solubility and lactic acid solubility of each test group was analyzed statistically leading to the following conclusion. RESULTS: The degree of water sorption was shown to increase in the following order : group 6, 5, 4, 2, 1 and 3. There were significant differences between the water sorption of each group. Results of the degree of water solubility were shown to increase in the following order : group 6, 5, 4, 2, 1 and 3. Statistically significant differences were found between each group, with the exception of groups 1 and 3. Finally, the degree of lactic acid solubility was found to increase in the following order : group 6, 5, 4, 2, 3 and 1. Significant differences were found between each group. In general dual-curing resin cements displayed substantially lower values than self-curing resin cements with regard to water sorption, water solubility, and lactic acid solubility. CONCLUSIONS: From the results of this study, dual-curing resin cements show a significantly lower degree of water sorption and solubility than their self-curing counterparts. Clinically, when selecting resin cements, the product with a lower degree of water sorption and solubility are preferred. The results of this study indicate that the use-of dual-curing resin cements is preferable to self-curing cements.
Crowns ; Dental Caries ; Fibrinogen ; Lactic Acid ; Mouth ; Prostheses and Implants ; Resin Cements* ; Resins, Synthetic ; Solubility* ; Water*