Massive Cerebral Microemboli after Protected Carotid Artery Angioplasty and Stenting Using a Distal Filter Embolic Protection Device for a Vulnerable Plaque with a Lipid Rich Necrotic Core and Intraplaque Hemorrhage: A Case Report

A major concern associated with carotid artery angioplasty and stenting (CAS) is a periprocedural distal cerebral embolization. To prevent distal embolization, embolic protection devices (EPDs) have been developed. However, the risk of cerebral embolism after protected CAS in patents with a vulnerable plaque is controversial and either a silent or a symptomatic stroke can occur despite the use of EPDs. Here, we report a case of a massive cerebral microemboli after a protected CAS using a distal filter EPD for a vulnerable plaque with a lipid rich necrotic core and intraplaque hemorrhage.

Metastasis of Poorly Differentiated Thyroid Carcinoma to the Sternum: A Case Report

Sternal metastasis of poorly differentiated thyroid carcinoma (PDTC) is rare, and only a few cases have been reported in the literature. Here, we report a case of sternal metastasis of PDTC in an 83-year-old woman, 2 years after right hemithyroidectomy, treated with sternal resection and reconstruction.

Accessory Belly of the Piriformis Muscle as a Cause of Piriformis Syndrome: a Case Report with Magnetic Resonance Imaging and Magnetic Resonance Neurography Imaging Findings

Piriformis syndrome caused by an accessory belly of the piriformis muscle is very rare. Only a few cases have been reported. Here, we report a case of piriformis syndrome resulting from an extremely rare type of accessory belly of the piriformis muscle originated at the proximal third portion of the main piriformis muscle and attached separately to the greater trochanter inferior to the insertion of the main piriformis muscle. A definitive diagnosis of piriformis syndrome was made based on magnetic resonance imaging and magnetic resonance neurography findings that were consistent with results of nerve conduction study and needle electromyography.

An analysis of caregivers' preference regarding fever management in the emergency department

PURPOSE: To investigate caregivers' preference regarding fever management in the emergency department. METHODS: Between July 2011 and June 2014, we surveyed the preference in fever management by caregivers of febrile children aged 7 years or younger who visited the emergency department. The questionnaire consisted of the characteristics of the children and their caregivers, usefulness of tepid massage, and the caregivers' preference in fever management, in particular the combination of methods and the doses of antipyretics. RESULTS: Among a total of 161 children, 161 were enrolled in the study, with the mean age of 5.0 years. Of the caregivers, 64.6% were in their 30s and 50.9% were parents, and 70.2% and 24.2% reported that tepid massage was "very useful" and "a little useful," respectively. The most preferred combination of methods was "tepid massage, acetaminophen, and ibuprofen (50.9%; P < 0.001)." "Tepid massage and ibuprofen" was preferred to "tepid massage and acetaminophen (24.2% vs 7.5%)." The most preferred dose of antipyretics was 1 mL/kg/day (divided into 3 doses; 60.2%; P = 0.012), followed by 1 mL/kg/day (divided into 3 doses) plus 2 mL/dose (29.1%). CONCLUSION: Caregivers may recognize tepid massage as a useful fever management. The most preferred fever management was the combination of tepid massage, acetaminophen, and ibuprofen with a dose of 1 mL/kg/day.

Delayed diagnosis of 22q11 deletion syndrome due to late onset hypocalcemia in a 11-year-old girl with imperforated anus

Neonatal hypocalcemia and congenital heart defects has been known as the first clinical manifestation of the chromosome 22q11.2 deletion syndrome (22q11DS). However, because of its wide clinical spectrum, diagnosis of 22q11DS can be delayed in children without classic symptoms. We report the case of a girl with the history of imperforate anus but without neonatal hypocalcemia or major cardiac anomaly, who was diagnosed for 22q11DS at the age of 11 after the onset of overt hypocalcemia. She was born uneventfully from phenotypically normal Korean parents. Imperforate anus and partial cleft palate were found at birth, which were surgically repaired thereafter. There was no history of neonatal hypocalcemia, and karyotyping by GTG banding was normal. At the age of 11, hypocalcemia (serum calcium, 5.0 mg/dL) and decreased parathyroid hormone level (10.8 pg/mL) was noted when she visited our Emergency Department for fever and vomiting. The 22q11DS was suspected because of her mild mental retardation and velopharyngeal insufficiency, and a microdeletion on chromosome 22q11.2 was confirmed by fluorescence in situ hybridization. The 22q11DS should be considered in the differential diagnosis of hypocalcemia at any age because of its wide clinical spectrum.

Confirmation of the Relation between Femoral Artery and Vein for Central Venous Cannulation: A Prospective Investigation Using Ultrasound

PURPOSE: Femoral vein catheterization is often performed using a landmark technique, despite the recommended method of using ultrasound guidance. Although the landmark-based procedure is a well-known, widely adopted method to date, there are insufficient studies validating the effectiveness of this method. Hence, the purpose of this study was to confirm the relationship between femoral artery and vein using an ultrasound, as well as to validate the effectiveness of the femoral vein catheterization method using the landmark technique. METHODS: This was a prospective, repeated measurement study. Using an ultrasound with a 10 MHz transducer, the femoral vein cross-sectional areas on the right side were saved at a distance of 1, 2, 3, and 4 cm from the inguinal ligament with supine and hip abduction-external rotation positions. The width of the femoral vessels, center-to-center distance between the femoral artery and vein(horizontal distance between the center of the femoral artery and vein) and width of exposed femoral vein (not posterior to femoral artery) were measured. RESULTS: The width of the femoral vein, the center-to-center distance between the femoral artery and vein, as well as the width of the exposed femoral vein were significantly decreased as the distance from the inguinal ligament was increased, regardless of the posture change (p<0.001). However, at a distance of 1 cm from the inguinal ligament, only 5.4% of the femoral veins were exposed without disturbance of the femoral artery, and there were also a few cases in which the femoral veins were not exposed at all. CONCLUSION: It appears that an ultrasound-guided femoral vein catheterization is recommended over the conventional landmark technique.

Biological activities and acute oral toxicity of citronella and lemongrass oil / 대한수의학회지

This study was performed to investigate the antibacterial, antioxidant, and termite repellent effects of citronella oil (CiO) and lemongrass oil (LO). When the antibacterial activity against Staphylococcus (S.) aureus with various levels of antibacterial resistance were tested, a 0.05% concentration of CiO and LO completely inhibited the growth of all tested S. aureus strains. Evaluation of the antioxidant effect demonstrated that the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity of CiO was 2~3 times greater than that of LO. Among trial products made with various combinations of CiO and LO, a CiO : LO ratio of 6 : 4 had the most potent termite repellent effects. Assessment of acute toxicity of the trial product showed that the LD50 was more than 2,000 mg/kg. Based on the above results, CiO and LO have antibacterial, antioxidant, and termite repellent activities. Therefore, both compounds could be potential termites repellent reagents.

Vitamin D deficiency in Korean children: prevalence, risk factors, and the relationship with parathyroid hormone levels

PURPOSE: This study was performed to investigate the relationship between serum vitamin D and parathyroid hormone (PTH) levels as well as to describe the prevalence and the risk factors of vitamin D deficiency (VDD) in Korean children. METHODS: Participants were 1,212 children aged 4 to 15 years, who visited Bundang CHA Medical Center (located at 37degreesN) between March 2012 and February 2013. Overweight was defined as body mass index> or =85th percentile. Participants were divided into 4 age groups and 2 seasonal groups. VDD was defined by serum 25-hydroxyvitamin D (25OHD) <20 ng/mL. RESULTS: The level of 25OHD was significantly lower in overweight group than in normal weight group (17.1+/-5.1 ng/mL vs. 19.1+/-6.1 ng/mL, P<0.001). Winter-spring season (odds ratio [OR], 4.46; 95% confidence interval [CI], 3.45-5.77), older age group (OR, 1.60; 95% CI, 1.36-1.88), and overweight (OR, 2.21; 95% CI, 1.62-3.01) were independently related with VDD. The PTH levels were significantly higher in VDD group compared to vitamin D insufficiency and sufficiency group (P<0.001). In normal weight children, 25OHD (beta=-0.007, P<0.001) and ionized calcium (beta=-0.594, P=0.007) were independently related with PTH, however, these associations were not significant in overweight children. CONCLUSION: VDD is very common in Korean children and its prevalence increases in winter-spring season, in overweight children and in older age groups. Further investigation on the vitamin D and PTH metabolism according to adiposity is required.

Sleep Disturbances in Children Younger than 36 Months of Age with Iron Deficiency Anemia

PURPOSE: Iron deficiency anemia (IDA) and sleep problems are prevalent in infancy and early childhood and are more associated with poor cognitive, motor, and social-emotional development. The aim of this study was to access the relationship between IDA and sleep disorders in a population of Korean children <36 months. METHODS: One hundred and ninety six children, who visited the outpatient clinic for a routine check-up were consecutively enrolled from March 2011 to March 2012. All parents answered a questionnaire about sleep patterns of their children using a modified expanded version of the Brief Infant Sleep Questionnaire. Among the subjects, 93 children with strong evidence of sleep disordered breathing were excluded. Hundred three children were then divided into the IDA group (n=23) and the control group (n=80). Sleep-wake parameters and prevalence of sleep disturbances were compared between the two groups. A multivariate analysis was performed to determine the independent risk factors for sleep disturbances in children. RESULTS: Children with IDA had more frequent nocturnal waking, restless sleep, and inconsolable crying during sleep than those in the control. Children with IDA also had more inappropriate sleep onset associations. No difference in sleep-wake parameters was observed between the two groups. The presence of IDA in children and maternal anemia were significant independent risk factors for sleep disturbances in children <36 months. CONCLUSION: The results suggest that prevention, early detection, and treatment of IDA would be important for good sleep in young children <36 months.

Signet Ring Cell Carcinoma Arising from a Solitary Juvenile Polyp in the Colon

Juvenile polyps are relatively common polyps that affect predominantly young patients and may occur in isolated, multiple, and/or familial forms. They have been considered to be benign lesions without neoplastic potential, but for patients with multiple juvenile polyposis, the cumulative malignant risk is greater than fifty percents. In patients with a solitary polyp, the risks are minimal, and only a few cases of malignant change from a solitary juvenile polyp have been reported. We describe the case of a twenty one year old female with one solitary juvenile polyp, which contained a signet ring cell carcinoma in the mucosal layer.

Intestinal Obstruction Aggravated by Colonoscopy: A Case Report

Colonoscopy is a frequently performed procedure used for colorectal cancer screening. Most frequent complication is colonic perforation and bleeding. Other visceral injuries are very rare, but injuries to the spleen and liver have been described. We report on 66-yr-old female who presented with abdominal pain after uneventful colonoscopy. Abdominal CT scan revealed a band at previous hysterectomy site and dilated small bowel suggesting strangulated loop. A broad based knowledge of the different complication is necessary to decrease the risk of associated morbidity and mortality.

Effect of curing methods of resin cements on bond strength and adhesive interface of post / 대한치과보존학회지

The purpose of this study was to compare the effect of curing methods of adhesive resins and resin cements in the root canal. Crown portions of 32 single-rooted mandibular premolars were removed. Routine endodontic treatment was done, and 9 mm deep post spaces were prepared within root canals. No. 3 FRC Postec posts (Ivoclar-Vivadent AG, Liechtenstein) were cemented in the post spaces by self-(SC) or light-curing (LC) using two dual-cured adhesives (Adper Scotchbond multi-purpose plus and Exite DSC )and resin cements (RelyX ARC and Variolink II). They were assigned to 4 groups (n=8); R-SC, R-LC, V-SC, V-LC group. After stored in distilled water for 24 hours, each root was transversally sectioned with 1.5 mm thick and made three slices. The specimens were subjected to push-out test in a universal testing machine (EZ Test, Shimadzu Co., Japan) with a crosshead speed of 1 mm/min. The data were analyzed with repeated ANOVA and one-way. ANOVA. Also the interface of post-resin cement and resin cement-canal wall of each group was observed under FE-SEM. When fiber posts were cemented into the root canal using total-etch adhesives, the bond strength and adaptation between post and root canal dentin was affected by curing method. Self-cure of adhesives and resin cements showed higher bond strength and closer adaptation than light-cure of them.

Cognitive Behavioral Therapy for Sexually Abused Children

OBJECTIVES: Child sexual abuse is a highly prevalent societal problem that cuts across all ethnic, racial, educational, and socioeconomic groups. There has been mounting empirical evidence for the efficacy of manual-based, cognitive behavioral treatment(CBT) for sexually abused children. Therefore, the aim of this review was to address the rationale and efficacy of CBT for sexually abused children, and to introduce a broad outline of a typical CBT program for young people suffering the emotional and behavioral consequences of sexual abuse. METHODS: A selective literature review was undertaken. RESULTS: To date, trauma-focused CBT is the most effective treatment for the sexually abused child. The rationale and efficacy of CBT was reviewed and a typical CBT program was outlined session by session. CONCLUSION: Based on trauma-focused CBT for sexually abused children, the results demonstrate the need for future development of a standard CBT program for the Korean population.

CD43 cross-linking increases the Fas-induced apoptosis through induction of Fas aggregation in Jurkat T-cells

CD43 (sialophorin, leukosialin) is a heavily sialylated surface protein expressed on most leukocytes and platelets including T cells. Although CD43 antigen is known to have multiple and complex structure, exact function of CD43 in each cell type is not completely understood. Here we evaluated the role of CD43 in Fas (CD95)-induced cell death in human T lymphoblastoid cell line, Jurkat. Crosslinking CD43 antigen by K06 mAb increased the Fas-mediated Jurkat cell apoptosis and the augmentation was inhibited by treatment with caspase inhibitors. Further, CD43 signaling of Jurkat cells induced Fas oligomerization on the cell surfaces implying that CD43 ligation have effects on early stage of Fas-induced T cell death. These also suggest that CD43 might play an important role in contraction of the immune response by promotion of Fas-induced apoptosis in human T cells.

The Differential Staging of Murine Thymic Lymphoma Cell Lines, Scid.adh, R1.1 and EL-4

BACKGROUND: Scid.adh is a recently developed murine thymic lymphoma cell line, which has been used as in vitro model for the study of double negative stage III thymocytes. In this study, we compared the expression profile of a number of genes and proteins, which are tightly related to T cell development and apoptosis, in thymic lymphoma cell lines, R1.1, EL-4, and Scid.adh for the developmental staging. METHODS: We examined the expression of development marker genes and proteins in three lymphoma cell lines by flow cytometry and RT-PCR. In addition, the expression of apoptosis-related molecules including bcl-2, bax and Fas was also investigated. RESULTS: As previously reported, Scid.adh cell line expressed CD8 and CD25 but not TCR alpha chain, while R1.1 cells expressed TCR alpha chain and both CD4 and CD8 transcripts. These suggest that R1.1 might be in double positive stage, and low level of CD44 expression and the absence of CD25 support this suggestion. In contrast, EL-4 cells showed high level of TCR alpha chain transcript, and low-level of CD4 expression, suggesting that EL-4 is in more mature stage than R1.1. Further, this suggestion was supported by the lack of mT-20 in EL-4 cells, which is expressed in the immature thymocytes, and Scid.adh and R1.1 cell lines, but not in the terminally differentiated thymocytes and peripheral T cells. Among the apoptosis-related gene, transcripts of bcl-2 gene were detected in both R1.1 and EL-4 but not in Scid.adh cells, while bax was expressed in all cell lines. Fas expression was the highest in EL-4 cells and low in Scid.adh cell line. CONCLUSION: R1.1 cell may represent double positive stage, and EL-4 is more differentiated cell line. In addition, Scid.adh and EL-4 cell lines are suspected to be useful for the study of function of bcl-2 family and Fas during the thymocyte development, respectively.

The multi-center study of the comprehensive geriatric assessment in the Korean elderly

BACKGROUND: Comprehensive geriatric assessment is identified as a dynamic process responsive to the changes on health status that occurs over time in the context of extremely increasing trend in the numbers of the elderly people, their office visit, and the medical cost universally. We completed the comprehensive geriatric assessment and applied it to the Korean elderly through the multi-center trials. METHODS: We performed studies variables using questionnaires, with interviewing, physical examination to the number of total 312 elderly people who visited the department of family medicine or physical medicine and rehabilitation of the 11 university hospital or general hospital in Korea from July 1, 1999 through October 31, 1999. We, the geriatrician, met and discussed 3 times to complete the comprehensive geriatric assessment through the consensus panel. RESULTS: We found the sex ratio of 312 subjects was 1 to 2 (104 males and 208 females) and the average age was 73.2 years old. The orders of more frequency of self-reported health status of the respondents were hypertension, arthritis, cataract, gastrointestinal disturbance, diabetes mellitus, urinary/fecal incontinence, depression, cerebrovascular accident, anemia, and heart disease. Nearly 15% of those showed depression, 41.6% of those were in the status of socially isolation. We found 43.1% of those showed hypertension, 3.7% isolated systolic hypertension, and 20.2% orthostatic hypotension. Of those, cognitive impairment were measured in 37.1%, gait disturbance 13.0%, and the risk of malnutrition 39.6%. Geriatrician spent 21.1 minutes per person during the process of comprehensive geriatric assessment. CONCLUSION: We realized we could diagnose and intervene effectively certain hidden conditions/diseases, particularly urinary incontinence, falls, visual impairment, hearing impairment, pain, depression, social isolation, cognitive impairment, and orthostatic hypotension, with using the comprehensive geriatric assessment. These results reflected the fact that the comprehensive geriatric assessment might be necessary for the care of the elderly.

Anti-Cancer Efficacy of Anti-CEA IgG3 in a Syngeneic Carcinoembryonix Antigen Tumor Model / 대한면역학회지

Development of antibody-based cancer therapies will be greatly facilitated if antibodies are better standardized in two fundamental issues that are specificity analysis of antibody reactivity and the detailed biodistribution and pharmacokinetic profile of antibodies. In the current endeavor we attempted to use an antibody binding specificity to target the tumor in a syngeneic carcinoembryonic antigen (CEA) tumor model. CEA, a 180 kDa glycoprotein, expressed at high levels on the surface of nearly all tumors of the gastrointestinal tract was used a potential target for antibody immunotherapy of gastrointestinal carcinomas. Using the CEA model antibody-based cancer therapy directed against CEA has been evaluated in a syngeneic animal model of disseminated disease. We constructed mouse/human chimeric anti-CEA IgG3, which has been evaluated for the specificity for CEA and the detailed biodistribution and pharmacokinetic profiles. Anti-CEA IgG3 heavy chain was expressed with the expected 180kDa molecular weight, assembled as H2L2 forms with a co-expressed mouse/human chimeric anti-CEA light chain, and were secreted. On FACS the purified anti-CEA IgG3 specifically recognized the mouse colon adenocarcinoma cell line MC-38 transduced with CEA (MCA32a), but not MC 38 without expressing CEA. After subcutaneous injection in C57BL/6 mice the half- lives of anti-CEA IgG3 and an irrelevant anti-dansyl IgG3 showed the bi-phasic kinetic patterns, and their pharmacokinetics of the distribution and the elimination were similar in mice. However, the biodistribution patterns of anti-CEA IgG3 were very different from those of anti-dansyl IgG3. Anti-dansyl IgG3 was mainly distributed into kidney until 72 hours, but anti-CEA IgG3 was slowly rernoved from blood and distributed into liver, kidney, spleen, and tumor. It is note worthy that anti- CEA IgG3 increased in targeting MCA32a tumor expressing human CEA by time, but the targeting to MC38 tumor was negligible. Thus, the increased targeting of anti- CEA IgG3 made MCA32a tumor grow slowly

Affinity Improvement of Antibody-Avidin Fusion Proteins for Biotin / 대한면역학회지

To generate drug delivery vector to locales in the body, genetic engineering and expression techniques have been used to produce antibody avidin fusion proteins. Chicken avidin has been fused to mouse-human chimeric IgG3 immediately after the hinge with a flexible linker (H-Flex-Av) and at the end of CH2 (CH2-Av). Fusion heavy chains were expressed with the expected molecular weight, assembled as H2L2 forms with a co-expressed light chain, and were secreted. The expression level of H- Flex-Av was 1~10 ug/ml/10(8)/24 hrs, but that of C2-Av was a very little (0.08~0.9 ug/ ml/10(8)/24 hrs). The resulting H-Flex-Av and CH2-Av fusion proteins continued to bind antigen dansyl and also bound biotinylated bovine serum albumin; both H-Flex-Av and CH2-Av had shown to retain 3-4 times higher relative affinity than that of CH3-Av in ELISA. Importantly the fact that both avidin fusion proteins had a higher relative affinity suggests that these avidin fusion proteins can be effectively used to deliver biotinylated ligands such as drugs and peptides to a certain locale, such as the brain.

Transitional Cell Carcinoma of the Ovary / 대한산부인과학회잡지

Transitional cell carcinoma of the ovary is extremely rare tumor and the category of transitional cell carcinoma has been proposed for those tumors in which definite urothelial features are present but no benign, metaplastic, and/or proliferating Brenner tumor is identified. We report a case of primary transitonal cell carcinoma of the ovary in 48-year old woman who presented with low abdominal pain and dyspepsia. Brief literature was reviewed about the features of its behavioral aggressiveness and characteristic chemosensitivity.

Four cases of malignant mixed mullerian tumors of uterus / 대한산부인과학회잡지

No abstract available.