Compartment syndrome is rarely associated with non-traumatic rhabdomyolysis. We report the case of a 23-year-old man who developed compartment syndrome associated with rhabdomyolysis caused by prolonged immobilization after antidepressive drug overdose. Elevation of serum creatine phosphokinase and myoglobinuria indicated rhabdomyolysis. Painful swelling of the right buttock and thigh and right lower limb paralysis with sensory and motor deficit were suggestive of gluteal and thigh compartment syndrome with the complication of sciatic nerve injury. The patient received an immediate fasciotomy, medical treatment and rehabilitation. At five months after initial treatment, the patient could walk independently with nearly full recovery of his right lower limb function.
Buttocks ; Compartment Syndromes ; Creatine Kinase ; Drug Overdose ; Humans ; Immobilization ; Lower Extremity ; Myoglobinuria ; Paralysis ; Rhabdomyolysis ; Sciatic Nerve ; Thigh ; Young Adult

Oxidative stress plays various roles in the development and progression of IgA nephropathy, while bilirubin is known as a potent antioxidant. We therefore hypothesized that serum bilirubin would be associated with renal prognosis in IgA nephropathy. The study subjects comprised 1,458 adult patients with primary IgA nephropathy in Korea. We grouped patients according to the following quartile levels of bilirubin: <0.4 mg/dL (Q1), 0.4-0.5 mg/dL (Q2), 0.6-0.7 mg/dL (Q3), and >0.8 mg/dL (Q4). The outcome data were obtained from the Korean Registry of end-stage renal disease (ESRD). Eighty patients (5.5%) contracted ESRD during a mean follow-up period of 44.9 months. The ESRD incidences were 10.7% in Q1, 8.2% in Q2, 2.8% in Q3, and 2.8% in Q4 (p<0.001). The relative risk of ESRD compared to that in Q1 was 0.307 (95% confidence interval [CI], 0.126-0.751) in Q3 and 0.315 (95% CI, 0.130-0.765) in Q4. The differences of ESRD incidence were greater in subgroups of males and of patients aged 35 yr or more, with serum albumin 4.0 g/dL or more, with normotension, with eGFR 60 mL/min/1.73 m2 or more, and with proteinuria less then 3+ by dipstick test. In conclusion, higher bilirubin level was negatively associated with ESRD incidence in IgA nephropathy.
Adult ; Bilirubin/*blood ; Disease Progression ; Female ; Glomerular Filtration Rate ; Glomerulonephritis, IGA/*blood/complications ; Humans ; Hypertension/complications ; Incidence ; Kidney Failure, Chronic/*blood/complications ; Male ; Middle Aged ; Risk ; Risk Factors ; Treatment Outcome

PURPOSE: We determine the Korean antibody titer and positive rate of tetanus by using a with qualitative test (ELISA) and a quantitative test (TQS(R)). METHODS: This study was prospective collecting study with uncontolled patients who were admitted in 21 Emergency Departments during 3 months in South Korea. We measured TQS(R) and collected the serum with a centrifuge for 5 groups, which was classified with age: 2~10 years (I), 11~20 years (II), 21~30 years (III), 31~40 years (IV), 41~60 years (V), in each hospital. The freezed serum and the protocol with TQS(R) results were taken at the Soonchunhyang University Bucheon hospital to be analyzed. RESULTS: The number of enrolled patients was 1816 (male 58%). The positive rate of TQS(R) was 835 patients (46%), and there was no relation with region or sex. In sex and age, there was a definitive decline in the group III fort males and females. The results of ELISA was showed that 62.8% (> 0.15 IU/ml) and 52.2% (> 0.2 IU/ml) had protective levels of tetanus antibody. The proportion decreased to approximately 43% and 18% among persons 40~60 years of age at each level of antibody titers. By region and population, there was no statistical relationship with TQS(R) and ELISA, but previous military service was associated with a higher prevalence of protective antibodies to tetanus (p<0.001). CONCLUSIONS: A substantial portion of adults in South Korea do not have antibody levels that are protective against tetanus. Also, the mean level of tetanus antibody titers was definitively lower than those of other developed conturies and consistently decreased with aging. Therefore, an adult formulation diphteria and tetanus toxoid every 5 or 10 years is recommended for all adults between 20 and 60 years of age after being tested with TQS(R) in South Korea.
Adult ; Aging ; Antibodies ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Epidemiology ; Female ; Gyeonggi-do ; Humans ; Korea ; Male ; Military Personnel ; Prevalence ; Prospective Studies ; Tetanus ; Tetanus Toxoid

Statins have been postulated to affect the bone metabolism. Recent experimental and epidemiologic studies have suggested that statins may also have bone protective effects. This study assessed the effects of simvastatin on the proliferation and differentiation of human bone marrow stromal cells (BMSCs) in an ex vivo culture. The bone marrow was obtained from healthy donors. Mononuclear cells were isolated and cultured to osteoblastic lineage. In the primary culture, 10(-6) M simvastatin diminished the mean size of the colony forming units-fibroblastic (CFU-Fs) and enhanced matrix calcification. At near confluence, the cells were sub-cultured. Thereafter, the alkaline phosphatase (ALP) activities of each group were measured by the time course of the secondary culture. Simvastatin increased the ALP activity in a dose dependent manner, and this stimulatory effect was more evident during the early period of culture. A 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide (MTT) assay was performed during the secondary culture in order to estimate the effect of simvastatin on the proliferation of human BMSCs. When compared to the control group, simvastatin significantly decreased the proliferation of cells of each culture well. 10(-6) M of simvastatin also significantly enhanced the osteocalcin mRNA expression level. This study shows that simvastatin has a stimulatory effect on bone formation through osteoblastic differentiation, and has an inhibitory effect on the proliferative potential of human BMSCs.
Alkaline Phosphatase/metabolism ; Bone Marrow Cells/cytology/*drug effects/metabolism ; Calcification, Physiologic/drug effects ; Cell Differentiation/*drug effects ; Cell Proliferation/*drug effects ; Cells, Cultured ; Colony-Forming Units Assay ; Comparative Study ; Dose-Response Relationship, Drug ; Gene Expression/drug effects ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology ; RNA, Messenger/genetics/metabolism ; Research Support, Non-U.S. Gov't ; Reverse Transcriptase Polymerase Chain Reaction ; Simvastatin/*pharmacology ; Stromal Cells/cytology/drug effects/metabolism ; Time Factors

Food allergies affect about 4% of the Korean population, and buckwheat allergy is one of the most severe food allergies in Korea. The purpose of the present study was to develop a murine model of IgE-mediated buckwheat hypersensitivity induced by intragastric sensitization. Young female C3H/HeJ mice were sensitized and challenged intragastricly with fresh buckwheat flour (1, 5, 25 mg/dose of proteins) mixed in cholera toxin, followed by intragastric challenge. Anaphylactic reactions, antigen-specific antibodies, splenocytes proliferation assays and cytokine productions were evaluated. Oral buckwheat challenges of sensitized mice provoked anaphylactic reactions such as severe scratch, perioral/periorbital swellings, or decreased activity. Reactions were associated with elevated levels of buckwheatspecific IgE antibodies. Splenocytes from buckwheat allergic mice exhibited significantly greater proliferative responses to buckwheat than non-allergic mice. Buckwheat-stimulated IL-4, IL-5, and INF-gamma productions were associated with elevated levels of buckwheat-specific IgE in sensitized mice. In this model, 1 mg and 5 mg dose of sensitization produced almost the same degree of Th2-directed immune response, however, a 25 mg dose showed blunted antibody responses. In conclusion, we developed IgE-mediated buckwheat allergy by intragastric sensitization and challenge, and this model could provide a good tool for future studies.
Anaphylaxis/blood/immunology ; Animals ; Cell Proliferation/drug effects ; Comparative Study ; Disease Models, Animal ; Dose-Response Relationship, Drug ; Enzyme-Linked Immunosorbent Assay ; Fagopyrum/*immunology ; Female ; *Flour ; Food Hypersensitivity/blood/*immunology ; Immunoglobulin E/blood/immunology ; Immunoglobulin G/blood/immunology ; Interferon Type II/biosynthesis ; Interleukin-4/biosynthesis ; Interleukin-5/biosynthesis ; Mice ; Mice, Inbred C3H ; Plant Extracts/administration & dosage/immunology ; Research Support, Non-U.S. Gov't ; Spleen/cytology/drug effects/metabolism ; Stomach/drug effects/*immunology ; T-Lymphocytes/cytology/drug effects/metabolism ; Time Factors

Granular cell tumor is an uncommon benign tumor derived from Schwann cells. The most common location is the tongue, followed by striated muscle bundles at other sites, and the skin. About 6-8% of granular cell tumors occur in the breast. We report the sonographic findings of a case of graunlar cell tumor occurring at that site.
Breast* ; Granular Cell Tumor* ; Muscle, Striated ; Schwann Cells ; Skin ; Tongue ; Ultrasonography

PURPOSE: The essential triad for nerve regeneration is nerve conduit, supporting cell and neurotrophic factor. In order to improve the peripheral nerve regeneration, we used polyglycolic acid(PGA) tube and brain-derived neurotrophic factor(BDNF) gene transfected Schwann cells in sciatic nerve defects of SD rat. MATERIALS AND METHODS: Nerve conduits were made with PGA sheet and outer surface was coated with poly(lactic-co-glycolic acid) for mechanical strength and control the resorption rate. The diameter of conduit was 1.8mm and the length was 17mm. Schwann cells were harvested from dorsal root ganglion(DRG) of SD rat aged 1 day. Schwann cells were cultured on the PGA sheet to test the biocompatibility adhesion of Schwann cell. Human BDNF gene was obtained from cDNA library and amplified using PCR. BDNF gene was inserted into E1 deleted region of adenovirus shuttle vector, pAACCMVpARS. BDNF-adenovirus was multiplied in 293 cells and purified. The BDNF-Adenovirus was then infected to the cultured Schwann cells. Left sciatic nerve of SD rat (250g weighing) was exposed and 14mm defects were made. After bridging the defect with PGA conduit, culture medium(MEM), Schwann cells or BDNFAdenovirus infected Schwann cells were injected into the lumen of conduit, respectively. 12 weeks after operation, gait analysis for sciatic function index, electrophysiology and histomorphometry was performed. RESULTS: Cultured Schwann cells were well adhered to PGA sheet. Sciatic index of BDNF transfected group was -53.66+/-13.43 which was the best among three groups. The threshold of compound action potential was between 800 to 1000microA in experimental groups which is about 10 times higher than normal sciatic nerve. Conduction velocity and peak voltage of action potential of BDNF group was the highest among experimental groups. The myelin thickness and axonal density of BDNF group was significantly greater than the other groups. CONCLUSION: BDNF gene transfected Schwann cells could regenerate the sciatic nerve gap(14mm) of rat successfully.
Action Potentials ; Adenoviridae ; Animals ; Axons ; Brain-Derived Neurotrophic Factor* ; Electrophysiology ; Gait ; Gene Library ; Genetic Vectors ; Humans ; Myelin Sheath ; Nerve Regeneration ; Peripheral Nerves* ; Polyglycolic Acid* ; Polymerase Chain Reaction ; Rats* ; Regeneration* ; Schwann Cells* ; Sciatic Nerve* ; Spinal Nerve Roots

PURPOSE: To identify the characteristic ultrasonographic findings of the normal appendix in children in order to detect it more easily and so to exclude acute appendicitis from a diagnosis with more confidence. MATERIALS AND METHODS: Among 64 patients presenting with right lower quadrant pain, 44 patients, excluding 15 patients diagnosed as acute appendicitis and 5 patients with non-visualization of the appendix due to severe ileus and obesity, were evaluated for the point of incidence, the thickness and the presence of folding of the inner hypoechoic band of the normal appendix. The age of the patients ranged from 3 to 15 years with a mean age of 6.5 years. Two patients were operated on and we correlated the preoperative ultrasonographic findings with the histologic findings. RESULTS: In all the cases of the 44 patients with normal appendix, the inner hypoechoic band was discovered, which was seen as a linear structure without folding along the whole length of appendix. This measured as 0.75 mm (0.3-1.5 mm) for the mean thickness. The inner hypoechoic band corresponded to the mucosal layer that had abundant lymphoid tissue on the histologic examination. CONCLUSION:For the pediatric normal appendix, the inner hypoechoic band without folding is present, and this corresponds to the mucosal layer with abundant lymphoid tissue.
Appendicitis ; Appendix* ; Child* ; Diagnosis ; Humans ; Ileus ; Incidence ; Lymphoid Tissue ; Obesity ; Ultrasonography*

BACKGROUND AND OBJECTIVE: There have been several reports suggesting close relationships bet- ween problem behavior syndrome scale and/or social competence scale and pediatric allergic disorders such as bronchial asthma and atopic dermatitis. The aim of the present study was to confirm these relationships. We compared the behavioral symptoms and social competence scale between allergic and non-allergic patient groups using Korean-Child Behavior Checklist (K- CBCL). MATERIALS AND METHOD: One hundred and seventy-one subjects(aged 4-11 years) were enro- lled in this study. Allergy patient group(N=84) was divided into 4 subgroups, according to the allergic diseases such as atopic asthma(Group 1, BA), allergic rhinitis(Group 2, AR), atopic dermatitis(Group 3, AD), and chronic urticaria(Group 4, CU). Eighty-seven non-allergic patients (Group 5, NA) included those with pediatric general disorders, except psychomotor retardation, neurologic deficit, malignancy or other chronic disorders. K-CBCL which was filled in by parents or guardian, included eight dimensions of problem behavior: withdrawal, somatic problems, anxiety/ depression, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior. The first three scales were classified as an Internalizing broadband group and the last two scales as Externalizing group. In addition, the questionnaire included social scale, school scale, and total competence scale. RESULTS: There were no significant differences in age, sex, social economic status between 5 subgroups of allergic and non-allergic patients(p>0.05). The mean problem behavior scores tended to be higher in allergic patient group, but no statistical significance was noted(p>0.05). The mean school scale, social scale, total competence scale of allergic patient group were not significantly higher than those of non-allergic patient group(p>0.05). Combined disease group with more than 2 allergic disorders showed problem behaviors compared to non-allergic group or asthma only group. Total social competence scale was lower in allergic patient group with 1-3 years of disease duration than for shorter(less than 1 year) and longer(more than 3 years) durations. CONCLUSION: Taken together, combined disease group and allergic disease group with 1-3 years of duration showed more problem behaviors and the lowest total social competence scales, respectively.
Asthma ; Behavioral Symptoms ; Checklist* ; Child ; Child Behavior* ; Child* ; Depression ; Dermatitis, Atopic ; Humans ; Hypersensitivity ; Mental Competency ; Neurologic Manifestations ; Parents ; Social Problems ; Weights and Measures ; Surveys and Questionnaires

BACKGROUND/AIMS: Studies of genotypes and changes in nucleotide and amino acid sequences of hepatitis A virus (HAV) may provide valuable information on the epidemiological aspects of a particular region. In Korea the prevalence of anti-HAV in the 1 - 20 year age group declined from 60% in 1980 to 9% in 1995. As a result this age group has a high risk of HAV infection. Actually over 1,500 cases of clinically overt hepatitis A occurred in 1998 while few cases of clinical hepatitis A had been reported until the early 1990s. The aims of this study are to determine the genotypes of HAV which have been circulating in Korea and to define the phylogenetic relationships of geographically defined isolates. METHOD: From 1994 - 1998 a total of 18 serum specimens was obtained from patients in Korea with sporadic form acute hepatitis A. The HAV nucleic acid from serum specimens was subjected to genomic sequence analysis following viral RNA extraction, reverse transcription and amplification of the cDNA by PCR. DNA sequencing was performed in both directions of each PCR product. RESULTS: All isolates clustered within the subgenotype IA irrespective of the geographic locations and timing of the clinical hepatitis. Among 18 Korean isolates, 9 isolates had 2 amino acid sequence changes and 2 isolates had 1 amino acid sequence change. These changes in the amino acid sequences are unique and have never been reported in HAV subgenotype IA. CONCLUSIONS: All isolated HAV had genotype (IA). Eleven of 18 isolates had unique changes in amino acid sequences. These data indicate that the endemic HAV has been circulating in Korea over a long period of time.
Amino Acid Sequence ; DNA, Complementary ; Epidemiology ; Genotype ; Geographic Locations ; Hepatitis A Antibodies ; Hepatitis A virus* ; Hepatitis A* ; Hepatitis* ; Humans ; Korea ; Molecular Epidemiology* ; Polymerase Chain Reaction ; Prevalence ; Reverse Transcription ; RNA, Viral ; Sequence Analysis ; Sequence Analysis, DNA