INTRODUCTION: Cast immobilisation remains the mainstay of treatment for various fractures in paediatric patients, yet patients commonly complain of skin irritation and discomfort. This study aimed to perform a qualitative and quantitative evaluation of the effects of cast immobilisation on the skin of children and adolescents. MATERIALS AND METHODS: Patients aged 6-17 years of age with a fracture treated in a fiberglass short-arm or short-leg cast were recruited. Transepidermal water loss (TEWL), stratum corneum (SC) hydration, hair density and presence of any skin signs were assessed before and after cast. Patients were required to complete a weekly questionnaire to rate itch, malodour, warmth, and dampness of the skin under the cast. RESULTS: A total of 60 subjects completed the study. Thirty-six patients received a short-arm cast; 24 received a short-leg cast. Upon cast removal, TEWL was significantly increased on the volar surface of the arms and legs ( <0.05), and the dorsal surface of the arm ( <0.05). Likewise, SC hydration was significantly increased at most sites ( <0.05), except the volar surface of the leg ( = 0.513). There was no change in hair density. Throughout the duration of casting, there was an increase in itch and malodour scores. CONCLUSION Moderate but significant changes in TEWL, SC hydration and subjective symptoms were observed during the duration of cast immobilisation, demonstrating that cast immobilisation for up to 4 weeks exerts moderate adverse impact on patients' skin. Further studies to explore the use of better materials for cast immobilisation to improve skin barrier function and overall patient satisfaction are warranted.

Amiodarone is a di-iodated benzofuran derivative that is commonly used to treat patients with various cardiac arrhythmias. It is associated with side effects that involve the liver, thyroid, and other organs. Approximately 1-3% of patients treated with amiodarone suffer from symptomatic liver disease. Thyroid dysfunction occurs in 10% of patients treated with amiodarone. A 65-year-old woman with coronary heart disease and atrial fibrillation was administered with amiodarone. She developed nausea, vomiting, dyspepsia, and sweating within 9 months of amiodarone administration (200 mg orally once a day). Results of the laboratory finding showed increased hepatic enzymes, and low thyroid hormone levels. A liver biopsy showed irregular arrangement of hepatocytes and diffuse micro- and macrovesicular fatty changes. Electron microscopy findings showed pleomorphic mitochondria with crystalloid inclusions and membrane-bound lysosomal structures. The liver and thyroid functions returned to normal, after the amiodarone was stopped. We describe an unusual case in which amiodarone induced hepatitis and hypothyroidism simultaneously. Physicians should take a close look to the adverse event when using amiodarone which can cause adverse effects in multiple organs.
Aged ; Amiodarone/*adverse effects/therapeutic use ; Arrhythmias, Cardiac/drug therapy ; Drug-Induced Liver Injury/*complications/pathology/*radiography ; Female ; Fibrosis/pathology ; Humans ; Hypothyroidism/*chemically induced/*complications ; Microscopy, Electron ; Mitochondria/drug effects/metabolism ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND: Bile acids were important for the regulation of cholesterol homeostasis. Thyroid hormone increased the expression of CYP7A1 (cholesterol 7alpha-hydroxylase), catalyzing the first step in the biosynthesis of bile acids. However, the effect of thyroid hormone on bile acid export has not been previously assessed. The principal objective of this study is to evaluate the effects of thyroid hormone on the bile salt export pump (BSEP). METHODS: Thyroid hormone, T3 (1 mg/g) was administered to male mice via intraperitoneal injection. After 6 hours and 5 days of T3 treatment, we measured serum total and LDL cholesterol and hepatobiliary bile acid concentrations. We assessed the changes associated with bile acid synthesis and transport. In order to evaluate the direct effect of thyroid hormone, we assessed the changes in the levels of BSEP protein after T3 administration in human hepatoma cells. RESULTS: Serum total and LDL cholesterol were reduced and hepatobiliary bile acid concentrations were increased following T3 treatment. Expressions of Cyp7a1 and BSEP mRNA were increased following T3 treatment. The levels of the BSEP protein in the mouse liver as well as in the human hepatoma cells were increased after T3 treatment. CONCLUSION: Thyroid hormone can regulate LDL cholesterol metabolism. It increases bile acid synthesis and the excretion of bile acids via increased BSEP expression.
Animals ; Bile ; Bile Acids and Salts ; Carcinoma, Hepatocellular ; Cholesterol ; Cholesterol, LDL ; Homeostasis ; Humans ; Injections, Intraperitoneal ; Liver ; Male ; Mice ; Resin Cements ; RNA, Messenger ; Thyroid Gland ; Triiodothyronine

Introduction: Giving two intravenous anaesthetic agents simultaneously generally results in an additive effect. The aim of this study was to investigate the interaction between propofoland thiopental when given to patients who have had sedative premedication. Methods: Fifty patients were admitted into the study. All patients received oral midazolam 3.75mg and intravenous fentanyl 100mg before induction of anaesthesia. Twenty patients received an infusion of their propofol or thiopental while 30 patients received an infusion of an admixture of both drugs. Results: The interaction between propofol and thiopental was additive. The average dose at loss of the eyelash reflex for propofol and thiopental was 0.71mg kg-1 and 1.54mg kg-1 respectively. Premedication decreased the induction dose by 38.2%. Conclusion: Propofol and thiopental interact in an additive fashion when given at induction of anaesthesia

Introduction: The aims of this randomised study were to compare the induction characteristics of sevoflurane using vital capacity breath technique to that of tidal breathingtechnique in adults undergoing day-care surgery., and to compare patients' acceptance of these two techniques. Methods: Sixty ASA I and II adult patients undergoing day-care surgery were randomly allocated to receive either the vital capacity breath or tidal breathing technique for induction of anaesthesia with 7.5% sevoflurane in nitrous oxide and oxygen. Haemodynamic changes, induction characteristics and patients' acceptance were compared. Results: The mean time for induction was significantly faster with the vital capacity breath technique. There were no significant differences in haemodynamic changes and oxygenation during induction between these two groups. There was a significant increase in incidence of exictatory movement in patients receiving the tidal breathing technique. Either technique was found to be acceptable by most of the patients studied. Conclusion: The vital capacity breath technique appears to be better tolerated with shorter onset time and less movement during induction of anaesthesia. As it is well accepted by the patients and has a stable haemodynamic profile, its use should be encouraged.

Huntington's disease is caused by CAG trinucleotide expansions in the gene encoding huntingtin. N- terminal fragments of huntingtin with polyglutamine produce aggregates in the endosome-lysosomal system, where proteolytic fragments of huntingtin is generated. Heat shock protein 70 (HSP70) prevents the formation of protein aggregates, but the effect of HSP70 on the huntingtin in the endosome-lysosomal system is unknown. This study was to determine whether HSP70 alters the distribution of huntingtin in endosome-lysosomal system. HSP70 expressing stable cells (NIH/3T3 or cerebral hybrid cell line A1) were generated, and mutant [(CAG)100] huntingtin was transiently overexpressed. Analysis of subcellular distribution by immnuocytochemistry or proteolysis cleavage by Western blotting was performed. 18 CAG repeat wild type [WT; (CAG)18] huntingtin was used as a control. Cells with huntingtin showed patterns of endosome- lysosomal accumulation, from a 'dispersed vacuole (DV)' type into a coalescent 'perinuclear vacuole (PV)' type over time. In WT huntingtin, HSP70 increased the cells with the PV types that enhanced the proteolytic cleavage of huntingtin. However, HSP70 reduced cells of the DV and PV types expressing mutant huntingtin, that result in less proteolysis than that of control. In addition, intranuclear inclusions were formed only in mutant cells, which was not affected by HSP70. These results suggest that HSP70 alters the distribution of huntingtin in the endosome-lysosomal system, and that this contributes to huntingtin proteolysis.
Peptide Hydrolases/metabolism ; Nuclear Proteins/genetics/*metabolism ; Nerve Tissue Proteins/genetics/*metabolism ; NIH 3T3 Cells ; Mice ; Lysosomes/*metabolism ; HSP70 Heat-Shock Proteins/genetics/*metabolism ; Endosomes/*metabolism ; Cytoplasm/metabolism ; Cell Survival ; Animals

PURPOSE: The cost and effectiveness of extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL), and combined therapy in the treatment of renal calculi larger than 2cm were examined. MATERIALS AND METHODS: A total of 122 patients with renal calculi larger than 2cm, including twenty three cases of staghorn calculi, were divided into two groups, the ESWL group (97 cases) and the PNL group (25 cases), according to the first line of treatment modalities. Each group was divided into two sub-groups according to the need for additional procedures. The stone free rate and duration of treatment of each group were examined. The costs were calculated per patient and based on the cumulative charge of the procedures, which included cost for in-patient care, and treatment of additional procedures and treated complications. RESULTS: In the ESWL group, eighty cases were treated with ESWL only and had a 69% stone free rate. Seventeen cases needed additional procedures including percutaneous nephrostomy, or ureteroscopic procedures, and had a stone free rate of only 41%. In the PNL group, six cases became stone free with PNL only. Nineteen cases required ESWL for residual fragments after PNL, and had a 90% stone free rate. The cumulative average cost per group was as follows: ESWL only, 1,593,260 won; ESWL with additional procedures, 2,130,475 won; PNL only, 1,654,760 won; and PNL with ESWL, 1,973,270 won. The average duration of treatment per group was 47, 112, 5.3 and 8.8 days, respectively. CONCLUSIONS: PNL followed by ESWL, if necessary, is considered the most cost effective method of treating large renal calculi.
Calculi ; Humans ; Kidney Calculi* ; Lithotripsy ; Nephrostomy, Percutaneous ; Shock

Wilms' tumor is the most common renal malignancy in childhood. However Wilms' tumor originating in horseshoe kidney is rare. We present a case of Wilms' tumor arising from the isthmus of horseshoe kidney, and aim to highlight the problems faced in the diagnosis and management.
Diagnosis ; Kidney* ; Wilms Tumor*

No abstract available.
Cryptorchidism* ; Humans ; Infant* ; Male

To evaluate the sensitivity and specificity of transthoracic fine needle aspiration cytology(TFNAC) in the preoperative diagnosis of pulmonary nodules, a retrospective analysis was carried out on a consecutive series of 200 TFNACs. They included 186 primary malignant tumors, 66 squamous cell carcinomas, 65 adenocarcinomas, 36 small cell carcinomas, 7 large cell carcinomas, 4 carcinoids, 8 others, 9 metastatic tumors, and 5 benign tumors. On cytohistologic correlation of malignant pulmonary tumors, the pro- cedure had a sensitivity of 97.3% and a specificity of 100%. A 86.6% correct correlation between the cytologic and histologic diagnoses was achieved. Five out of the 7 undifferentiated large cell carcinomas, 10 out of the 65 adenocarcinomas, 2 out of the 36 small cell carcinomas, and 2 out of the 66 squamous cell carcinomas were turned out to be mistyped in cytologic diagnosis. We concluded that TFNAC is a highly sensitive and specific preoperative diagnostic procedure in the investigation of patients with discrete pulmonary nodules in whom the specific cell type of the malignant neoplasm has important implications in treatment modality and prognosis.
Adenocarcinoma ; Bezafibrate ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Endometrial Neoplasms ; Female ; Humans ; Hydronephrosis* ; Kidney* ; Natural History* ; Papanicolaou Test ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity