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Hemophagocytic Syndrome Presenting as Severe Acute Hepatitis (중증 급성 간염으로 발현한 혈구탐식증후군에 관한 연구)

  • Ryu, Jeong Min;Chang, Soo Hee;Kim, Joon Sung;Lee, Joo Hoon;Lee, Mi Jeong;Park, Kie Young;Kim, Kyung Mo;Seo, Jong Jin;Moon, Hyung Nam;Ghim, Thad;Chi, Hyun Sook
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.8 no.2
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    • pp.213-221
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    • 2005
  • Purpose: Hemophagocytic syndrome (HPS) is characterized by persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, and/or hypofibrinogenemia. Hepatic manifestations including overt hepatic failure and fulminant hepatitis are common in HPS. Liver transplantation (LT) should be considered in a case of fulminant hepatitis by other than HPS, but LT is contraindicated and complete cure is possible by chemotherapy in HPS. Therefore, we conducted this study to define the characteristics of HPS presenting as severe acute hepatitis. Methods: Among the total of 23 patients diagnosed as HPS by bone marrow examination between 1994 and 2005 in Asan Medical Center, 11 cases presented as severe acute hepatitis were enrolled in this study. We analyzed the clinical features, laboratory findings and outcome retrospectively. Results: Seven (64%) of the 11 children with HPS and hepatitis were referred to pediatric gastroenterologist at first. The mean age of onset was 50 months. There was no case with family history of primary HPS. Epstein-Barr virus was positive in 4, and herpes Simplex virus was positive simultaneously in 1 case. As the presenting symptoms and signs, fever was present in 10, hepatosplenomagaly was noted in all and jaundice in 10. Anemia was observed in 10, thrombocytopenia in 10, leukopenia in 8, hypertriglyceridemia in 9, hypofibrinogenemia in 8 and hyperferritinemia in 7 cases, respectively. Nine children received chemotherapy including etopside. The overall mortality rate was 72% (8/11). Conclusion: HPS, which needs chemotherapy, should be considered as a cause of severe acute hepatitis especially when accompanied with prolonged high fever and cytopenias.

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Intravenous immunoglobulin for severe gastrointestinal manifestation of Henoch-Schönlein purpura refractory to corticosteroid therapy (스테로이드 치료에 반응하지 않는 심한 위장관 증세의 Henoch-Schönlein 자반증 환아에서 정맥 면역글로불린 치료)

  • Yang, Hye Ran;Choi, Won Jung;Ko, Jae Sung;Seo, Jeong Kee
    • Clinical and Experimental Pediatrics
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    • v.49 no.7
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    • pp.784-789
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    • 2006
  • Purpose : $Henoch-Sch{\ddot{o}}nlein$ purpura(HSP) is a systemic vasculitis involving small vessels of skin, gastrointestinal(GI) tract and kidney. Digestive involvement of HSP can be serious with massive GI bleeding, perforation, and intussusception. However, some patients do not respond to conventional corticosteroid therapy. In this study, we investigated the efficacy of intravenous immunoglobulin (IVIG) for serious digestive manifestations not responding to steroid. Methods : From April 1999 to January 2005, 22 children diagnosed as HSP with severe GI symptoms were included. Initially, all patients were treated with intravenous methylprednisolone. IVIG 2 g/kg of body weight was infused in children refractory to steroid therapy. Clinical data were reviewed retrospectively. Results : Among 22 children, 12 children underwent IVIG therapy. The mean duration of corticosteroid therapy was $5.61{\pm}4.9$ days before IVIG therapy, and 11 of 12 patients experienced disappearance of GI manifestations after the initiation of IVIG infusion. In one patient, IVIG was ineffective in relieving abdominal pain, but melena subsided. Comparison of the duration of hospitalization between IVIG group and corticosteroid group revealed no significant difference($12.8{\pm}7.6$ days vs. $13.2{\pm}7.8$ days, P=0.777). But, the total duration of abdominal pain decreased in IVIG group although the difference between two groups was not significant($8.8{\pm}8.1$ days vs. $14.8{\pm}16.9$ days, P=0.306). Among 10 children treated with steroid only, 2 children were operated for bowel perforation and intussusception. In contrast, there was no perforation in 12 children who underwent IVIG therapy. Conclusion : IVIG could be the alternative therapy to corticosteroids in children with severe digestive manifestations of HSP.

Arthroscopic Management for Pyogenic Arthritis with Positive Culture in the Knee Joint (배양 검사로 증명된 화농성 슬관절염의 관절경적 치료)

  • Baek, Seung-Hoon;Kim, Se Sik
    • Journal of the Korean Arthroscopy Society
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    • v.16 no.2
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    • pp.167-174
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    • 2012
  • Purpose: The purpose of this study is investigation of clinical and functional outcomes in homogeneous group with positive culture after arthroscopic management for pyogenic knee arthritis and analysis of factors affecting those outcomes. Materials and Methods: Thirty-two patients with positive culture after arthroscopic management were included. Mean follow-up period was 41.6 months. Clinical evaluation included death related to infection, recurrence, time to normalize erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), duration of administration of intravenous antibiotics and readmission. Radiographic evaluation was performed according to Kellgren and Lawrence. The prevalence of total knee arthroplasty was investigated and functional evaluation included modified Lysholm, Tegner activity and Korean version of the Western Ontario and McMaster Universities (K-WOMAC) score. Results: Staphylococcus aureus was identified in 21 patients. Time to normalize ESR and CRP was 78.0 and 67.6 days, respectively. Two patients died while there were six recurrences and five readmissions. Rate of recurrence was significantly high in patients with chronic renal failure (P=0.034) and incidence of readmission was associated with higher radiographic grade of osteoarthritis and rate of reoperation (P=0.032 and P=0.006, respectively). At the final follow-up, radiographic grade worsened in 21 patients and was associated with those at first visit. Five arthroplasties were performed. Average modified Lysholm score, Tegner activity score and K-WOMAC score were 53.5, 2.7, 44.2 points, respectively. Conclusion: The severity of osteoarthritis on final radiographs was associated with those at first visit. Patients with higher grade of osteoarthritis at first visit showed higher incidence of readmission and those with chronic renal failure demonstrated higher chances of recurrence.

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Dietary behaviors of female marriage immigrants residing in Gwangju, Korea (광주지역에 거주하는 결혼이주 여성의 식생활 조사)

  • Yang, Eun Ju
    • Journal of Nutrition and Health
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    • v.49 no.3
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    • pp.179-188
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    • 2016
  • Purpose: This cross-sectional study aimed to document the dietary behaviors, dietary changes, and health status of female marriage immigrants residing in Gwangju, Korea. Methods: The survey included 92 female immigrants attending Korean language class at a multi-cultural family support center. General characteristics, health status, anthropometric data, dietary behaviors, and dietary changes were collected. Results: Mean age of subjects was 31.3 years, and home countries of subjects were Vietnam (50.0%), China (26.0%), Philippines (12.0%), and others (12.0%). Frequently reported chronic diseases were digestive diseases (13.2%), anemia (12.1%), and neuropsychiatry disorder (8.9%). Seventeen percent of the subjects was obese ($BMI{\geq}25kg/m^2$). Dietary score by Mini Dietary Assessment was 3.45 out of 5 points. Dietary scores for dairy foods, meat/fish/egg/bean intake, meal regularity, and food variety were low, and those for fried foods and high fat meat intake were also low. Thirty-three percent of subjects answered that they have changed their diet and increased their consumption of fruits and vegetables after immigration. Length of residence in Korea was positively associated with BMI and waist circumference. Length of residence tends to be positively associated with dietary changes and obesity as well as inversely associated with disease prevalence. Conclusion: The study shows that length of residence is inversely related to disease prevalence. However, this association is thought to be due to the relatively short period of residence in Korea and thus the transitional phase to adapting to dietary practices. As the length of residence increases, disease patterns related to obesity are subject to change. Healthy dietary behaviors and adaptation to dietary practices in Korea in female marriage immigrants will not only benefit individuals but also their families and social structure. Therefore, varied, long-term, and target-specific studies on female marriage immigrants are highly needed.

Gaussian Filtering Effects on Brain Tissue-masked Susceptibility Weighted Images to Optimize Voxel-based Analysis (화소 분석의 최적화를 위해 자화감수성 영상에 나타난 뇌조직의 가우시안 필터 효과 연구)

  • Hwang, Eo-Jin;Kim, Min-Ji;Jahng, Geon-Ho
    • Investigative Magnetic Resonance Imaging
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    • v.17 no.4
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    • pp.275-285
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    • 2013
  • Purpose : The objective of this study was to investigate effects of different smoothing kernel sizes on brain tissue-masked susceptibility-weighted images (SWI) obtained from normal elderly subjects using voxel-based analyses. Materials and Methods: Twenty healthy human volunteers (mean $age{\pm}SD$ = $67.8{\pm}6.09$ years, 14 females and 6 males) were studied after informed consent. A fully first-order flow-compensated three-dimensional (3D) gradient-echo sequence ran to obtain axial magnitude and phase images to generate SWI data. In addition, sagittal 3D T1-weighted images were acquired with the magnetization-prepared rapid acquisition of gradient-echo sequence for brain tissue segmentation and imaging registration. Both paramagnetically (PSWI) and diamagnetically (NSWI) phase-masked SWI data were obtained with masking out non-brain tissues. Finally, both tissue-masked PSWI and NSWI data were smoothed using different smoothing kernel sizes that were isotropic 0, 2, 4, and 8 mm Gaussian kernels. The voxel-based comparisons were performed using a paired t-test between PSWI and NSWI for each smoothing kernel size. Results: The significance of comparisons increased with increasing smoothing kernel sizes. Signals from NSWI were greater than those from PSWI. The smoothing kernel size of four was optimal to use voxel-based comparisons. The bilaterally different areas were found on multiple brain regions. Conclusion: The paramagnetic (positive) phase mask led to reduce signals from high susceptibility areas. To minimize partial volume effects and contributions of large vessels, the voxel-based analysis on SWI with masked non-brain components should be utilized.

The Production of Adventitious Sprouts by Water-soak and Vegetative Propagation of Plus tree of Ash Species Through Cuttings of Their Sprouts (물푸레나무속(屬) 수형목(秀型木)의 수심(水沈)에 의(依)한 지조맹아(枝條萌芽) 발생력(發生力)과 이를 이용(利用)한 녹지삽목(綠枝揷木) 증식시험(增殖試驗))

  • Han, Sang Don;Hong, Sung Ho;Min, Young Taek;Kim, Young Mo;Kim, Hong Eun
    • Journal of Korean Society of Forest Science
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    • v.83 no.2
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    • pp.148-154
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    • 1994
  • As a vegetative propagation method for ash species, which is a dioecism and a long cycle of fructification, cut-stem was soaked in water to induce adventitious sprouts, and 2-year-old ash seedling was cut in a nursery to induce adventitious sprouts. We obtained the 1,019 adventitious sprouts from branches of 101 plus trees througout the country. The mean ortet-age is 48. There is not a correlation between ortet ages and production of adventitious sprouts. These sprouts were placed in a cutting bed for rooting. Root ability varied with environmental factors of cuttings. The best rooting(87%) resulted from cutting performed in a vinyl-plastic greenhouse. Rooting was better on perlite+peat moss(2 : 1) medium than other media tested. The rooting ability was generally higher in 2-year-old ortet than plus tree ortet. In the root development of cuttings the non-container cuttings was better than container cuttings.

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Alexithymia in Major Depressive Disorder and Subclinical Depression (주요 우울장애와 준임상적 우울증에서의 감정표현불능증)

  • Kim, Seog-Ju;Yu, Seung-Hee;Kim, Seong-Youn;Kim, Dong-Wook;Cho, In-Hee;Cho, Seong-Jin
    • Korean Journal of Psychosomatic Medicine
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    • v.15 no.2
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    • pp.100-106
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    • 2007
  • Objectives : The objective of the present study was to investigate alexithymia in major depressive disorder(MDD) and subclinical depression(SCD). Methods : Three hundred eighty-six community-dwelling adults(238 females and 148 males, age 19-79; mean age $43.0{\pm}13.9$) were recruited. Structured clinical Interview for DSM-IV(SCID) was conducted for the diagnosis of MDD or other Axis I psychiatric disorders. The Center for Epidemiological Studies for Depression Scale(CES-D) and the Totonto Alexithymia Scale(TAS) were administered to assess depressive symptom and alexithymia, respectively. Among subjects without MDD, those who had minor depressive disorder on the SCID or high scores(i.e. over 16) on the CES-D were defined as subjects with SCD. TAS total score and factor I, II, III scores of TAS in MDD, SCD, and non-depressive controls were compared. Results : Among 386 subjects, 38 subjects(9.8%) were diagnosed as MDD by DSM-IV criteria, while 57 subjects(14.8%) were classified into SCD group. There were significant differences between 3 groups(MDD, SCD and non-depressive controls) in total score($F_{2,383}=14.0$, p<0.01), factor I(difficulty in identifying feeling)($F_{2,383}=23.4$, p<0.01) and factor II(difficulty in describing feeling)($F_{2,383}=7.8$, p<0.01), but not factor III(external oriented thinking)($F_{2,383}=1.8$, p=0.16) of TAS. In post-hoc analysis, both MDD subjects and SCD subjects had higher scores in TAS total, factor I and factor II, compared to non-depressive controls(all p<0.01). In contrast, there were no significant differences between MDD subjects and SCD subjects in any TAS factor. Conclusion : In this study, both MDD subjects and SCD subjects were more alexithymic than non-depressive control subjects. These findings suggest that SCD, as well as MDD, is also related to alexithymia.

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Effect of Neem and Mustard oils on Entomopathogenic Nematodes and Silkworm (Neem과 mustard oil이 곤충병원성 선충과 누에에 미치는 영향)

  • Ha, Pan-Jung;Kim, Tae-Su;Lee, Shin-Hae;Choo, Ho-Yul;Choi, Sung-Hwan;Kim, Young-Sub;Lee, Dong-Woon
    • The Korean Journal of Pesticide Science
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    • v.14 no.1
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    • pp.54-64
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    • 2010
  • Effects of thirteen essential oils (anise oil, clove oil, marigold, mustard oil, neem oil, quassia, quilaja, rosemary oil, rotenone, tea tree extract, thyme oil, wintergreen oil, and yucca) and caffeine on typical industrial insect, silkworm (Bombyx mori) and two entomopathogenic nematodes, Steinernema carpocapsae GSN-1 strain (Sc) and Heterorhabditis sp. Gyeongsan strain (Hg) were investigated in the laboratory. When 1,000 ppm of each essential oils was treated, neem oil showed the highest insecticidal activity against silkworm. Mortality of silkworm fed on neem oil treated mulberry leaf was 55.3 and 100% 5 and 10 days after treatment, respectively. The silkworm fed on neem oil treated mulberry leaf did not make cocoon and pupa. Weight of cocoon and pupa was low in rotenone treatment showing 0.27 g and 1.01 g, respectively. Mustard oil had the highest nematicidal activity against entomopathogenic nematodes. 20 ppm of mustard oil resulted in 69.0% and 100% mortality of Sc and Hg 3 days after treatment, but 4% and 36% at 5 ppm in X-plate, respectively. Mortality of baited Galleria mellonella larva by Sc was not different from control at the concentration of 100 ppm of mustard oil while 30% lower in Hg in sand barrier. Mean numbers of established infective juveniles of Hg in Galleria larva were lower than Sc in sand barrier. Survival rate of Sc was similar to control at the concentration of <200 ppm of mustard oil in sand barrier.

In Vitro Intrinsic Radiosensitivity Of Human Squamous Cell Carcinoma in Primary Culture (인체 상피 세포암의 일차 배양을 이용한 방사선 민감도 측정)

  • Choi Eun Kyung;Yang Kwang Mo;Yi Byong Yong;Chang Hyesook;Kim Sang-Yoon;Nam Joo-Hyun;Yu Eunsil;Lee Inchul
    • Radiation Oncology Journal
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    • v.12 no.1
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    • pp.27-31
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    • 1994
  • There are a number of reports suggesting that there may be a correlation between the clinical response to radiotherapy in various tumors and the clonogenic survival of cell lines derived from these tumors following exposure to 2 Gy(SF2). Authors conducted this study to determine SF2 for cells in primary culture from surgical specimens. The tumor tissues with squamous cell carcinoma of uterine cervix and head and neck were obtained. The tumor tissues were disaggregated to single cells by incubating with collagenase type w for 2 hours with constant stirring. Single cell suspensions were inoculated in four 24-well plates precoated with cell adhesive matrix. After 24 hours of incubation at 37$ ^{\circ}C $, rows of four wells were then irradiated, consisting of control set and five other sets each receiving doses of 1,2,3,4, and 6 Gy. After incubation for a total of 13 days, the cultures were stained with crystal violet and survival at each dose was determined by quantitative image analysis system, To determine whether cell growth was of epithelial origin, immunocytochemical staining with a mixture of cytokeratin and epithelial monoclonal antibodies were performed on cell cultures. During the period of this study, we received 5 squamous cell carcinoma specimens of head and neck and 20 of uterine cervical carcinoma. Of these, 15 yielded enough cells for radiosensitivity testing. This resulted an overall success rate of 60$ \% $. The mean SF2 value for 15 tumours was 0.55$\pm$0.17 ranging from 0.20 to 0.79. These results indicate that there is a broad range of sensitivities to radiation in same histologic type. So with a large patient population, we plan to determine whether a different SF2 value is associated with tumours that are controlled with radiotherapy than those that are not.

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Clinical Features of Acute Pancreatitis in Children (소아 급성 췌장염의 임상적 고찰)

  • Seo, Jung-Ho;Kim, Seong-Heon;Jeong, Sang-Geon;Park, Jae-Hong
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.13 no.1
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    • pp.58-65
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    • 2010
  • Purpose: Since there are few studies involving acute pancreatitis in children, we reviewed our experience with this medical condition to describe the clinical features. Methods: A retrospective analysis was conducted by reviewing the medical records of 41 patients with AP who were admitted to the Department of Pediatrics of Pusan National University Hospital between January 1996 and June 2007. Results: Twenty males and 21 females (mean age, 8.7${\pm}$4.5 years) were included. In 22 patients (53.7%), no definitive causes were found. The most common etiologies were choledochal cysts (22.0%). Necrotizing pancreatitis was diagnosed in 5 patients (12.2%), and recurrent acute pancreatitis in 4 patients (9.8%). CT findings included pancreatic swelling (43.9%), peripancreatic fluid collection (29.3%), ascites (24.4%), and peripancreatic fat necrosis (12.2%). Serum amylase and lipase levels at diagnosis were 535.3${\pm}$553.2 and 766.2${\pm}$723.6 U/L, respectively, and were normalized within 1 week in 22 and 14 patients, respectively. On the basis of the Balthazar scale, 2 patients were diagnosed with severe AP. In 4 patients (9.8%), a surgical procedure was indicated. Major complications included ascites (32.3%), sepsis (16.1%), and pseudocyst and renal impairments (12.9%). Two patients died from multi-organ failure. Conclusion: The etiologies of AP in children are varied. Most children have a single episode and a self-limited course. However, AP of childhood still carries significant morbidity and mortality. Early diagnosis, appropriate treatment according to disease severity, and management of complications are important.