• Tuberculosis and Respiratory Diseases
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• v.69 no.6
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• pp.469-473
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• 2010

Nocardia farcinia, an aerobic, gram-positive bacilli actinomycetes of the genus Nocardia, is an uncommon pathogen found in humans. The most common Nocardia infection sites are the lung, central nervous system, and skin. Even though hematogenous dissemination can occur, isolation of the organism from blood cultures is very rare. We report a case of Nocardia infection that was isolated on blood cultures. A 59-year-old male with a medical history that includes a liver transplantation 6-years prior due to hepatocellular carcinoma secondary to chronic hepatitis B, developed pneumonia and was transferred to Severance Hospital. At the time of admission, the patient's initial exam showed hypothermia, tachypnea, and hypotension. His chest radiograph showed severe pneumonia and a large abscess on left upper lobe. Under the presumptive diagnosis of bacterial pneumonia or other opportunistic infection, we started broad spectrum antibiotics. However, he developed Nocardia sepsis, rapidly deteriorated, and subsequently died.

• Journal of Trauma and Injury
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• v.24 no.2
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• pp.68-74
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• 2011

Purpose: Although pancreas injury is rare in abdominal trauma, it poses a challenge to the surgeon because its clinical features are not prominent and the presence of main duct injury cannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. Methods: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosed as having pancreas injury by using an explo-laparotomy. Patients successfully treated by non-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. Results: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases).Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due to massive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively, three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. Conclusion: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverse outcomes.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.762-774
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• 1984

A clinical analysis was performed on 49 cases of the benign esophageal diseases experienced at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital during 7 year period from 1977 to 1983. Of 49 cases Of the benign esophageal diseases, there were 19 patients of esophageal stricture, 11 of achalasia, 6 of perforation, 3 of bronchoesophageal fistula, 3 of esophageal perforation, 3 of esophageal leiomyoma and one of esophageal foreign body. Twenty three patients were male and 26 were female. Ages ranged from 4 years to 74 years with the average age of 34.7 years. Of 19 patients of esophageal strictures, 7 patients were male and 12 were female and ages ranged from 6 years to 74 years with the average being 33.8 years. Causes of esophageal strictures were corrosive of esophageal strictures were dysphagia, vomiting, general weakness, weight loss and pain that order and developed on several different parts of esophagus. Operations were performed in 18 cases, of whom 7 patients were performed by esophagocologastrostomy, 4 gastrostomy, 4 esophagogastrostomy, 1 esophageal resection and esophagoesophagostomy, 1 esophagotomy and dilatation and 1 scar revision. Five patients had one or two complications; 2 anastomotic leakage, 1 wound infection, 1 localized empyema, 1 bilateral pneumothorax and 1 respiratory failure. One patient expired due to respiratory failure arising from aspiration pneumonia. The average age of achalasia patients was 33.1 years and symptom durations were from 2 months to 10 years with the average of 3.3 years. Main symptoms were dysphagia, vomiting, weight loss, pain and cough in that order. Modified Hellers myotomy was performed in 11 patients with one complication of restenosis. One patient was operated on by using longitudinal incision and transverse sutures with good result. Of 6 patient of esophageal diverticulum, 2 patients were traction diverticulum on the midesophagus, 2 were pulsion diverticulum on the midesophagus and 2 were pulsion diverticulum on the lower esophagus. Diverticulectomy was performed on 2 cases of traction diverticulum and esophagocardiomyotomy with or without diverticulectomy was erformed on 4 cases of pulsion diverticulum with good results. Of 5 patients of congenital bronchoesophageal fistula, the chief complaints were productive cough in 4 patients and hematemesis without respiratory symptoms in one patient. Two patients were operated on by using fistulectomy only and 3 by fistulectomy with pulmonary lobectomy. Of 3 patients of esophageal perforation, causes were foreign body ingestion, esophageal stricture after ECG and corrosive esophagitis. Two patient were operated on by using drainage and gastrostomy with symptomatic improvement but one patient died due to septic shock after thoracotomy. Three patients of esophageal leiomyoma were all male and 2 patients were operated on by using enucleation and one by distal esophagectomy with esophagogastrostomy. In one patient of esophageal foreign body, it was removed by esophagotomy through the right thoracotomy.

• Journal of Microbiology and Biotechnology
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• v.24 no.8
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• pp.1133-1142
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• 2014

Interleukin-32 (IL-32) is a cytokine and inducer of various proinflammatory cytokines such as $TNF{\alpha}$, IL-$1{\beta}$, and IL-6 as well as chemokines. There are five splicing variants (${\alpha}$, ${\beta}$, ${\gamma}$, ${\delta}$, and ${\varepsilon}$) and IL-$32{\gamma}$ is the most active isoform. We generated human IL-$32{\gamma}$ transgenic (IL-$32{\gamma}$ TG) mice to express high level of IL-$32{\gamma}$ in various tissues, including immune cells. The pathology of sepsis is based on the systemic inflammatory response that is characterized by upregulating inflammatory cytokines in whole body, particularly in response to gram-negative bacteria. We investigated the role of IL-$32{\gamma}$ in a mouse model of experimental sepsis by using lipopolysaccharides (LPS). We found that IL-$32{\gamma}TG$ mice resisted LPS-induced lethal endotoxemia. IL-$32{\gamma}$ reduced systemic cytokines release after LPS administration but not the local immune response. IL-$32{\gamma}TG$ increased neutrophil influx into the initial foci of the primary injected site, and prolonged local cytokines and chemokines production. These results suggest that neutrophil recruitment in IL-$32{\gamma}TG$ occurred as a result of the local induction of chemokines but not the systemic inflammatory cytokine circulation. Together, our results suggest that IL-$32{\gamma}$ enhances an innate immune response against local infection but inhibits the spread of immune responses, leading to systemic immune disorder.

• Tuberculosis and Respiratory Diseases
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• v.62 no.4
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• pp.308-313
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• 2007

Background: The nitric oxide (NO) released by inducible NO synthase (iNOS) plays an important role in the pathophysiology of sepsis. Corticosteroids also play a role in the hemodynamic and inflammatory reactions in sepsis. Both have been shown to have a relationship theoretically, but their correlation and clinical impacts have rarely been evaluated. Methods: 26 patients with sepsis and 14 healthy controls were enrolled in this study. The initial random plasma total NO and the serum cortisol levels were measured. The same measurements were serially carried out on the $3^{rd}$, $5^{th}$, and $7^{th}$ days. Results: The initial total plasma levels of NO and cortisol were higher in the patients with sepsis than in the healthy controls. The total NO levels were higher in patients with severe sepsis than in the those with mild sepsis. There was a correlation between the total NO and cortisol level throughout the study. Conclusion: In patients with sepsis, the levels of plasma NO and cortisol were well correlated during the first week of sepsis, which suggests an interrelationship. However, the clinical and pathogenetic implications await further evaluation.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1992.05a
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• pp.28-28
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• 1992

브라디키닌은 체내에서 강력한 혈관 확장 작용을 일으키는 autacoid(local hormone)로서 혈압의 항상성 유지, 모세혈관 투과성 증진, 염증 및 통증 반응 등에 관여하고 여러 장관 평활근을 수축시킨다. 또한 septic 혹은 endotoxic shock의 여러 원인 물질로도 생각되어진다. 최근 rhinovirus로 인한 감기의 제증상 원인 물질로도 브라디키닌이 주목을 받고있다. 이와같이 브라디키닌온 다양한 질병에 있어 중요한 원인 물질로 여겨지므로 브라디키닌 길항제들은 한두 질병의 치료제로 개발될 가능성이 높음이 강력히 제시되고 있는 실정이다. 이의 개발을 위해서 브라디키닌 수용체에 대한 연구는 필수적이라고 할 수 있다. 본 연구는 두 부분으로 나누어 진행중인데 첫째, 이제까지 보고된 브라디키닌 길항 물질들은 대부분이 브라디키닌의 특정 아미노산 잔기를 치환시킨 펩타이드 유도체로서 이들을 경구 투여시 peptidase어 의하여 쉽게 분해되고 또한 부분적인 효능제 활성을 갖는 불리한 점을 감안하여, 비펩타이드성 브라디키닌 길항제를 개발할 목적으로 한방 및 민간에서 자주 사용되어온 생약중에 브라디키닌 작용에 선택적 길항효과가 있는 물질을 검색한 바 활성을 보인 황금으로부터 작용 성분을 추적중에 있다. 둘째, 브라디키닌 수용체를 순수하게 분리 정제하기 위한 첫 단계로서 이 수용체의 결합시험(binding assay) 방법을 확립하고 더불어 여러 조직내(흰쥐의 여러 기관, 토끼 및 사람의 신장)의 브라디키닌 수용체의 분포를 파악하는 일이다. 횐쥐 조직의 실험 결과로부터 신장에 브라디키닌 수용체가 많이 분포함을 확인되었고 향후 토끼 신장으로부터 동수용체를 분리하고자 한다. 또한 토끼 신장의 근위세뇨관일차배양세포을 이용하여 브라디키닌의 신장에서의 작용기전도 살펴보고 있다.+}$, $Na^{+}$, NH$_{4}$$^{+}$ 및 H$^{+}$) 수용액 메디움에서의 Cd(II), Mg(II) 및 Zn(II)의 Dowex 1-X8, Cl$^{-}$ 수지에 대한 흡착은 역시 어떤 메디움에서도 Cd(II) 흡착이 제일 크며, 다음이 Zn(II) 이고 착이온을 형성않는 Mg(II)이 제일 작았다. 한편 메디움 종류별 D값의 크기순위는 H$^{+}$>K$^{+}$> $Na^{+}$>NH$_{4}$$^{+}$이였다. 메디움의 종류에 따라 D값의 차이가 나는 것은 금속이온의 착이온 형성과 금속이온의 용액내에서의 이온종의 상태와 관련이 있다고 생각된다. 마. MCl(M:K$^{+}$, $Na^{+}$, NH$_{4}$$^{+}$ 및 H$^{+}$)과 MNO$_{3}$ 용리액에 의한 Cd(II), Mg(II) 및 Zn(II)의 용리는 예상한 바와 같이 MCl에서 작은 Dv 값을 갖는데, 이것은 CdCl$_{4}$$^{2-}$ 착이온을 형성하거나 ZnCl$_{4}$$^{2-}$ , ZnCl$_{3}$$^{-}$같은 이온과 MgCl$^{+}$, MgCl$_{2}$같은 이온종을 형성하기 때문인것 같다. 한편 어떠한 용리액에서던지 NH$_{4}$$^{+}$의 경우

• Journal of Gastric Cancer
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• v.18 no.1
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• pp.37-47
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• 2018

Purpose: The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. Materials and Methods: The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016. Results: The technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3-30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3-35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18-49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement. Conclusions: A benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.16 no.3
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• pp.148-154
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• 2016

A urea cycle disorder is a condition caused by a defect of the enzymes in the urea cycle, and deficiency of ornithine transcarbamylase (OTC), which converts carbamoyl phosphate and ornithine into citrulline, is the most common type of the disorder. OTC deficiency induces the accumulation of precursors of urea, ammonia, and glutamine, leading to neurological symptoms including hypotonia, respiratory failure, seizure, lethargy, and coma and sometimes to death. Because OTC deficiency is inherited in an X-linked manner, typical symptoms such as vomiting, poor feeding, and lethargy appear mainly in male neonates. We recently had a case that presented with neonatal onset lethargy, vomiting, and apnea in a 4-day-old boy. He was diagnosed with OTC deficiency by biochemical phenotype, including hyperammonemia and an increased orotic acid level in the urine. Genetic analysis of the OTC gene showed a novel mutation c.780_781insCAGGCAGTGT (p.Ile261Glnfs*35). He was treated for hyperammonemia using continuous venovenous hemofiltration (CVVH) at 118 hours after birth. After 4 days of CVVH, his consciousness and blood ammonia concentration were normalized, and he was discharged at the age of 53 days. At around 12 months of age, bilateral femur fractures and osteomyelitis occurred in this patient. Two months after the fracture, he died of septic shock, insulin-resistant hyperglycemia, and multi-organ failure.

• Journal of Chest Surgery
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• v.45 no.4
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• pp.236-241
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• 2012

Background: Prolonged usage of extracorporeal membrane oxygenation (ECMO) may induce multi-organ failure. This study is aimed to evaluate prognostic factors in the patients with ECMO. Also, the prognosis of ECMO with Kidney Injury Network Scoring system is studied. Materials and Methods: From May 2005 to July 2011, 172 cases of ECMO were performed. The cases of perioperative use of ECMO were excluded. Renal failure patient and younger than 15 years old one were also excluded. As a result, 26 cases were enrolled in this study. Male patients were 15 (57.7%), and mean age was $56.57{\pm}17.03$ years old. Demographic data, ECMO parameters, weaning from ECMO, and application of continuous renal replacement therapy are collected and Acute Kidney Injury Network (AKIN) scores were evaluated just before ECMO and day 1, day 2 during application of ECMO. Results: Venoarterial ECMO was applied in 22 cases (84.6%). The reasons for applications of ECMO were cardiac origin in 21 (80.8%), acute respiratory distress syndrome in 4, and septic shock in 1 case. Successful weaning from ECMO was achieved in 15 cases (57.7%), and survival discharge rate was 9 cases (34.6%). Mean duration of application of ECMO was $111.39{\pm}54.06$ hours. In univariate analysis, myocarditis was independent risk factors on weaning failure. Using the receiver operating characteristic curve, level of hemoglobin on 24 hours after ECMO, and base excess on 48 hours after ECMO were showed more than 0.7. AKIN score was not matched the prognosis of the patients with ECMO. Conclusion: In our study, the prognosis of the patients with myocarditis was poor. Hemoglobin level at first 24 hours, and degree of acidosis at 48 hours were useful methods in relating with prognosis of ECMO. AKIN scoring system was not related with the prognosis of the patients. Further study for prognosis and organ injury during application ECMO may be needed.

• Archives of Pharmacal Research
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• v.25 no.2
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• pp.170-177
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• 2002

The herb, Chrysanthemum zawadskii var, latilobum commonly known as Gu-Jul-Cho in Korea, used in traditional medicine to treat pneumonia, bronchitis, cough, common cold, pharyngitis, bladder-related disorders, gastroenteric disorders, and hypertension. Linarin is the main active compound and the biological mechanisms of its activity are unclear. It is believed that effects of this herb may be exerted through the pluripotent effectors of linarin due to its ability to treat a variety of afflictions. In this study, the effects of linarin on the mouse macrophages cell line, RAW 264.7, were investigated. It was found that linarin could activate macrophages by producing cytokines. Monocytes and tissue macrophages produce at least two groups of protein mediators of inflammation, interleukin 1 (IL-1 ) and the tumor necrosis factor (TNF). Recent studies have shown that TNF and IL-1 modulate the inflammatory function of endothelial cells, leukocytes, and fibroblasts. $TNF-{\alpha}$ production by macrophages treated with linarin occured in a dose dependent manner However, IL-1 production was largely unaffected by this natural product. This study demonstrated the ability of linarin to activate macrophages both directly and indirectly. Linarin also affect both cytosine production and nitric oxide inhibition, in addition to the expression of some surface molecules. Nitric oxide (NO), derived from L-argin-ine, is produced by two forms(constitutive and inducible) of nitric oxide synthase (NOS). The NO produced in large amounts by inducible NOS is known to be responsible for the vasodilation and hypotension observed in septic shock. Linarin was found to inhibit NO production in the LPS-activated RAW 264.7 cells. Linarin may be a useful candidate as a new drug for treating endotoxemia and the inflammation accompanied by NO overproduction. The linarin-treated total Iymphocytes exhibited cytotoxicity in a dose dependent manner between $20{\;}{\mu}g/ml{\;}and{\;}40{\;}{\mu}g/ml$. These results suggest that linarin may function through macrophage activation.