Cause of Intracellular ATP dependency on Zn2++ Blockade of KATP Channels in Pancreatic Beta Cells

In order to clarify the cause of intracellular ATP dependency on Zn2+ blockade of KATP channels in pancreatic beta cells, we investigated the KATP channel activity during external Zn2+ application using voltage clamp technique. Cultured beta cells were used for patch-clamp experiment. When 3 mM glucose was applied in bath, KATP channel activity was increased transiently by externally applied Zn2+ in the cell-attached mode and was recoverable. The KATP channel activity was, however, consistently increased by Zn2+ application during the 0 mM glucose in bath. Inside-out mode, internally applied Zn2+ elicited no response on the KATP channels. Another divalent cation, Mn2+, didn't have any effect on the KATP channels. Therefore, This effect, so-called external glucose-dependency on Zn2+ blockade of the KATP channels, might be due to intracellular Zn2+ metabolism which induces ATP consumption. This appears to be a mechanism that the Zn2+ blockade of the KATP channels in the pancreatic beta cells depends on the intracellular ATP concentration.

A Clinical Study of Acute Pancreatitis

This study was designed retrospectively to evaluate Ranson's criteria and APACHE II scores as a predictor of mortality in patients with acute pancreatitis. Acute pancreatitis is a common disorder. From mild disease to multiorgan failure, it is a disorder that has numerous causes, an obscure pathogenesis. An accurate history and through physical examination will often raise clinical suspicion of acute pancreatitis in the differential diagnosis of a patient with acute abdominal pain. The retrospective analysis by chart review of 86 cases of acute pancreatitis who visited emergency department of Dongsan hospital from Jan to Dec 1996. The results were as follows. The majority of the patients with acute pancreatitis presented with chief complaints of abdominal pain. The male patient outnumbered female by the ratio of 2.9:1. The highest incidence of age group was between 40 and 50. The majority of our patients had past histories of either chronic alcoholic or gallbladder problems e.g.. the number being 53 cases(61.6%) and 31 cases(36%) respectively. Among 7 patients who had changes in consciousness, 5 were expired. Of those expired, 3 patients had less than 90 mmHg of systolic blood pressure. The overall mortality rate was 10.5%(9 cases). It has been known that acute pancreatitis would be the results of traumatic and non-traumatic causes. The exact mechanism of its pathophysiolgy has not been known yet, but it has been well known that the majority of patients who in forties and fifties had history of alcoholic abuse, the rest being mainly gallbladder problem and, some other diseases implicated too. The relationship of acute pancreatitis with familiar Ranson's criteria was such that 3 patients of the Ranson's out of 9 death were noted to have more than 3 of the criteria, but another 3 had less than 3. Among the 60 patients in whom the required physiologic variables were available out of total 86 patients studied, 9 were expired and 51 survived, average APACHE II scores for the survival and the expired being 6.92+/-3.99 & 18.11+/-5.68 respectively (P<0.05). We concluded that the APACHE II score could be used to better than Ranson's criteria to predict hospital mortality in patients with acute pancreatitis.

Clinical Observation in 1211 Cases of Burn Patients

We have reviewed 1211 burn patients who had visited our emergency department of Keimyung University Dongsan medical center between April 1995 to March 1997. The following results were obtained; 1) On age and sex distribution, the highest incidence of age group was under 10 year and old in 321 cases(26.5%). Male was affected more frequently than female, the incidence being 847 cases(70.1%) and 364 cases(29.9%). The ratio of male to female was 2.3:1. 2) No monthly and seasonal differences could be recognized. We found winter season having the highest 319 cases(26.3%), followed by autumn, spring and summer. 3) An analysis of causes in burns showed that flame burns were 527 cases(43.1%), scalding burns, 486 cases(40.2%), electrical burns, 96 cases(8.1%) and chemical burns, 48 cases(4.1%). 4) Domestic accidents accounted for 639 cases(52.7%), occupational for 286 cases(23.6%), traffic accidents for 160 cases(13.2%), suicides for 122 cases(10.1%), formentation for 4 cases(0.4%). 5) Most of patients 699 cases(57.7%) were affected with 2nd degree burn in depth, 1st degree for 413 cases(34.1%) and 3rd degree for 99 cases(8.2%). 6) The trunk was the anatomical region most commonly affected followed by upper and lower limbs. 7) 243 cases(20.5%) of all were accompanied by some complications. The main complications were would infection noted in 212 cases(17.5%), pneumonia in 179 cases(14.8%), acute renal failure in 160 cases(13.2), contracture in 155 cases(13.0), urinary tract infection in 24 cases(2.0%), Curling ulcer in 20 cases(1.6%) in order. 8) The over-all mortality rate was 73 cases(6.1%). The mortality rate of the patients with inhalation injury were 33 cases(45.3%). Causes of death were due to sepsis in 54 cases(4.5%), ARDS in 11 cases(0.9%), acute renal failure in 5 cases(0.4%), upper GI bleeding in 2 cases(0.2%), purmonary edema in 1 cases(0.1%).

CLINICAL ANALYSIS OF THE MUSHROOM POISONING

BACKGROUND: Mushroom poisonings are infrequent but potentially fatal. Most fatalities are due to the amatoxin containing species, particularly Amanita phalloides, Amanita virosa, Amanita verna which cause fulminant hepatic failure often with encephalopathy. METHODS: We experienced twenty two patients with acute mushroom poisoning admitted to Dong San hospital, Keimyung University through emergency department between January 1990 and September 1997. RESULTS: Mean age of the patients was 40.0 years and the ratio of male to female was 1 : 0.83. Seasonal distribution is 10 patients in July, 3 in August and 9 in September. The mean interval between ingestion and early symptom onset was 9.7 hours. Most of the patients had early gastrointestinal symptoms; abdominal pain, nausea, vomiting and diarrhea. except for a patient with associated mental change. The subsequent symptoms and signs follow up admission were fulminant hepatic failure(72.7%), renal failure(31.8%), mental change(27.3%), acute pancreatitis(9.1%), pericardial effusion(4.5%) and erythematous rash(4.5%). The outcomes of the patients were recovery(72.7%), death(18.2%) and hopeless discharge(9.1%). CONCLUSION: The patients who have mushroom poisoning are misdiagnosed as having viral gastroenteritis and are discharged frequently. The doctors and people should be educated not to overlook the severity of mushroom poisoning.

Activation of Eosinophil in Cow's Milk Allergy(CMA)-Related Chronic Diarrhea / 소아알레르기및호흡기학회지

PURPOSE: Cow's milk allergy(CMA) is one of common problems during first yearof life. Sometimes it causes chronic intractable diarrhea and serious nutritional problems in young infants. CMA is defined as an immunologically mediated adverse reaction against cow's milk antigens. Eosinophil granules contain cationic proteins, which have been known to be tissue-destructive. Detection of eosinophil-derived granular proteins reflects earlier activation and degranulation or cytolysis of eosinophils and provides evidence of involvement of these cells. The purpose of this study was to investigate the involvement of eosinophils in the mechanism of immunoinflammatory reaction of CMA-related chronic diarrhea. METHODS: The study population included 13 patients, aged from 18 days to 124 days who were admitted with chronic diarrhea and proved to have CMA by challenge test with cow's milk. The activation of eosinophil was evaluated by measurement of serum and urine eosinophil cationic protein(ECP) levels(by CAP, Pharmacia). The measurement were repeated on admission, and before and mean 27 hours after the challenge with cow's milk. RESULTS: 1) Serum and urine ECP levels on admission showed no significant difference from those of age matched controls. 2) During cow's milk challenge, serum ECP level increased from 5.49+/-3.08micorgram/L to 13.6+/-8.3micorgram/L(P<0.005) without significant change in urine ECP level. CONCLUSION: The activation of eosinophil might be one of important immunologic mechanisms of CMA-related chronic diarrhea in young infants.

Reduction of patients Treatment Time Through Quality Assurance Program

In modem medical industries as in others, it has been emphasized by many experts such as Dr. Mayer and Dr. Donabedean that there should be quality assurance activities applying statistical knowledges in the processes of medical management and medical staff themselves for the better medical care and customer satisfaction. Three of our quality assurance programs for the purpose of shortening the treatment time In the department of emergency medicine in Keimyung University, Dong-San Medical Center had been carried out during the period of June 94 through December 95. Our methodology was mainly the process emphasized ; finding the causes of delaying factors in various processes related to the works of nurses, doctors, laboratory services, radiology services etc. in the emergency room, holding various meetings among the related groups with genuine discussions, notifying the new results in each step, encouraging the positive ones and also applying the new leadership technics. During the period of June 94 through December 95(for 1.5 years), the average E.R. patient treatment time from registrations to dispositions had been reduced by about 2 hours (from 5 hours 3 minutes to 2 hours 5 minutes) and its variations among the different specialities had been narrowed down to significant degree (p<0.05) revealing the preprogram base line standard deviation of 2.43 to 1.28 in post program through continuous quality assurance programs. It was also noted that the successful results of Q/A program have been closely related to the fact that the process should be designed and redesigned repeatly as needed and that all the participants related were actively involved in the planning and redesigning processes.

A Clinical Evaluation of the Esophagogastroduodenoscopy Studies in Infants and Early Children

PURPOSE: Even though the causes and appearance of upper gastrointestinal tract lesions vary with age, attention has seldomly been focused on the infancy and early childhood. This study aimed to provide, as basic material, the experience of esophagogastroduodenoscopy(EGD) in infants and early children. METHODS: The objects were 66 patients(male 40, female 26) who underwent EGD examination in case of endoscopic indication at department of pediatrics of Taegu Hyosung Catholic University Hospital from March 1993 to February 1996. The scope of study included age distribution, chief complaints, endoscopic findings, final diagnosis. RESULTS: 1) The frequency of age distribution was 31.8% under 12 months, 16.6% in 13-24 months, 7.5% in 25-36 months, 7.5% in 37-48 months, 19.6% in 49-60 months and 16.6% in 61-72 months. The 48.4% of total application was done in children under 24 months. 2) The indications were vomiting(29.4%), epigastric pain(20.0%), melena or hematemesis(20.0%), chronic diarrhea(12.9%), recurrent abdominal pain(8.2%), foreign body ingestion(3.5%), drug intoxication(2.3%), chronic cough(1.1%), generalized edema(1.1%) and diagnosis of Peutz-Jeghers syndrome(1.1%). 3) Endoscopic findings were chronic gastritis or duodenitis(21.2%), gastric or duodenal ulcer(13.6%), acute gastritis or duodenitis(7.5%), acute hemorrhagic gastritis or duodenitis(6.0%), reflux esophagitis(4.5%), pyloric stenosis(4.5%), pseudomembranous esophagitis(1.5%), esophageal varix(1.5%), gastric polyp(1.5%), dilatation of distal esophagus (1.5%), whitish discharge through the duodenum(1.5%) and nonspecific findings(34.8%). 4) Final diagnosis were gastroduodenal mucosal lesions with unidentified underlying diseases(37.8%), protracted diarrhea(16.6%), gastroesophageal reflux disease(4.5%), cyclic vomiting syndrome(4.5%), cow's milk allergy(4.5%), idiopathic hypertrophic pyloric stenosis(4.5%), foreign body removal(4.5%), recurrent abdominal pain syndrome(3.0%), drug intoxication(3.0%), Henoch-Schoenlein purpura(1.5%), Peutz-Jeghers syndrome (1.5%), portal vein thrombosis(1.5%), esophageal web(1.5%), intestinal lymphangiectasia (1.5%), small intestinal hemangioma(1.5%), fungal esophagitis(1.5%) and unidentified underlying disease(6.0%). 5) The practices of EGD in infants and early children were done without serious adverse effects. The occurrence of bradycardia was developed in a newborn case during the procedure and was improved shortly after removal of scopy. CONCLUSIONS: The EGD studies were useful means of identifying the upper gastrointestinal anatomy and pathology in infants and early children with upper gastrointestinal symptoms. The practice of pediatric EGD in infants and early children was done without serious side effects. Pediatric EGD is now an integral part of the practice of pediatric gastroenterology.

A Clinical Evaluation of the Esophagogastroduodenoscopy Studies in Infants and Early Children

PURPOSE: Even though the causes and appearance of upper gastrointestinal tract lesions vary with age, attention has seldomly been focused on the infancy and early childhood. This study aimed to provide, as basic material, the experience of esophagogastroduodenoscopy(EGD) in infants and early children. METHODS: The objects were 66 patients(male 40, female 26) who underwent EGD examination in case of endoscopic indication at department of pediatrics of Taegu Hyosung Catholic University Hospital from March 1993 to February 1996. The scope of study included age distribution, chief complaints, endoscopic findings, final diagnosis. RESULTS: 1) The frequency of age distribution was 31.8% under 12 months, 16.6% in 13-24 months, 7.5% in 25-36 months, 7.5% in 37-48 months, 19.6% in 49-60 months and 16.6% in 61-72 months. The 48.4% of total application was done in children under 24 months. 2) The indications were vomiting(29.4%), epigastric pain(20.0%), melena or hematemesis(20.0%), chronic diarrhea(12.9%), recurrent abdominal pain(8.2%), foreign body ingestion(3.5%), drug intoxication(2.3%), chronic cough(1.1%), generalized edema(1.1%) and diagnosis of Peutz-Jeghers syndrome(1.1%). 3) Endoscopic findings were chronic gastritis or duodenitis(21.2%), gastric or duodenal ulcer(13.6%), acute gastritis or duodenitis(7.5%), acute hemorrhagic gastritis or duodenitis(6.0%), reflux esophagitis(4.5%), pyloric stenosis(4.5%), pseudomembranous esophagitis(1.5%), esophageal varix(1.5%), gastric polyp(1.5%), dilatation of distal esophagus (1.5%), whitish discharge through the duodenum(1.5%) and nonspecific findings(34.8%). 4) Final diagnosis were gastroduodenal mucosal lesions with unidentified underlying diseases(37.8%), protracted diarrhea(16.6%), gastroesophageal reflux disease(4.5%), cyclic vomiting syndrome(4.5%), cow's milk allergy(4.5%), idiopathic hypertrophic pyloric stenosis(4.5%), foreign body removal(4.5%), recurrent abdominal pain syndrome(3.0%), drug intoxication(3.0%), Henoch-Schoenlein purpura(1.5%), Peutz-Jeghers syndrome (1.5%), portal vein thrombosis(1.5%), esophageal web(1.5%), intestinal lymphangiectasia (1.5%), small intestinal hemangioma(1.5%), fungal esophagitis(1.5%) and unidentified underlying disease(6.0%). 5) The practices of EGD in infants and early children were done without serious adverse effects. The occurrence of bradycardia was developed in a newborn case during the procedure and was improved shortly after removal of scopy. CONCLUSIONS: The EGD studies were useful means of identifying the upper gastrointestinal anatomy and pathology in infants and early children with upper gastrointestinal symptoms. The practice of pediatric EGD in infants and early children was done without serious side effects. Pediatric EGD is now an integral part of the practice of pediatric gastroenterology.

A Clinical Evaluation of the Gastrofiberscopy Studies in Children

No abstract available.

A Follow-up Study of Intractable Diarrhea in Early Infancy: Clinical Features of Cow's Milk Allergy and Cow Milk-Sensitive Enteropathy

No abstract available.

Angiodysplasia Involving the Sigmoid Colon in Children

No abstract available.

Intractable Diarrhea in Early Infancy: Clinical Features on Admission and A Nutritional Management

No abstract available.

Assessment of Cardiac Output by Doppler Ultrasound Technique Alone

No abstract available.

Chronic Renal Failure in Children

No abstract available.