Successfully Treated Acute Fulminant Myocarditis Induced by Ulcerative Colitis with Extracorporeal Life Support and Infliximab

We report a case of successfully treated acute fulminant myocarditis induced by ulcerative colitis with extracorporeal life support and infliximab. Myocarditis is a rare but crucial complication during an exacerbation of inflammatory bowel disease. In our case, we applied extracorporeal membrane oxygenation (ECMO) for cardiac rest under impression of acute myocarditis associated with ulcerative colitis, and added infliximab for uncontrolled inflammation by corticosteroid. As a result, our patient was completely recovered with successful weaning of ECMO.

Sarcopenia Is Not Associated with Depression in Korean Adults: Results from the 2010-2011 Korean National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: Sarcopenia is associated with metabolic disorders, cardiovascular disease, and mortality; however, its association with depression in the general population remains unknown. Therefore, we investigated this association in Korea. METHODS: This study included 8,958 and 8,518 subjects from the 2010-2011 Korean National Health and Nutrition Examination Survey V-1, 2. The study was restricted to participants > or =20 years of age who had completed the survey, including whole-body dual-energy X-ray absorptiometry scans. After exclusion, 7,364 subjects were included in our final analysis. Age was categorized into three groups (20-39, 40-59, and > or =60 years), and subjects were categorized according to their sarcopenic and obesity status. Depression was categorized into three groups (not depressed, depressed, and depression). RESULTS: The sarcopenia group did not have a higher prevalence of depression or depressive symptoms compared to the nonsarcopenia group; the same was true even when obesity was considered. All age groups showed non-significant associations between sarcopenia and depression. In multivariate logistic regression models, no significant associations were observed between sarcopenia and prevalence of depression or depressed symptoms in men and women. CONCLUSION: We found no associations between sarcopenia and the prevalence of depression or depressed symptoms in Korean adults. Future large prospective studies and randomized controlled trials are needed to further assess this relationship.

Graves disease following rabbit antithymocyte globulin treatment of severe aplastic anemia in a Korean child / 소아과

Antithymocyte globulin (ATG) is used as an immunosuppressive treatment (IST) to deplete clonal suppressor T cells in patients with severe aplastic anemia (SAA). The depletion of suppressor T cells by ATG may affect the activation of B cells, which results in an increased risk for autoimmune conditions. A 12-year-old boy was diagnosed with idiopathic SAA. As he did not have an human leukocyte antigen-matched sibling, he was treated with rabbit ATG (3.5 mg/kg/day for 5 days) and cyclosporine. Five months later, he became transfusion independent. However, 23 months after IST, he complained of mild hand tremors, sweating, weight loss, palpitations, and goiter. Results of thyroid function tests revealed hyperthyroidism (free thyroxine, 3.42 ng/dL; thyroid stimulating hormone [TSH], <0.01 nIU/mL; triiodothyronine, 3.99 ng/mL). Results of tests for autoantibodies were positive for the antimicrosome antibody and TSH-binding inhibitory immunoglobulin, but negative for the antithyroglobulin antibody and antinuclear antibody. He was treated with methimazole, and his symptoms improved. The patient has been disease free for 39 months after IST and 9 months after methimazole treatment. This case report suggests that although rare, rabbit ATG may have implications in the pathogenesis of autoimmune hyperthyroidism. Our findings suggest that thyroid function tests should be incorporated in the routine follow-up of SAA patients treated with ATG.

Surface characteristics and bioactivity of an anodized titanium surface

PURPOSE: The aim of this study was to evaluate the surface properties and biological response of an anodized titanium surface by cell proliferation and alkaline phosphatase activity analysis. METHODS: Commercial pure titanium (Ti) disks were prepared. The samples were divided into an untreated machined Ti group and anodized Ti group. The anodization of cp-Ti was formed using a constant voltage of 270 V for 60 seconds. The surface properties were evaluated using scanning electron microscopy, X-ray photoelectron spectroscopy, and an image analyzing microscope. The surface roughness was evaluated by atomic force microscopy and a profilometer. The contact angle and surface energy were analyzed. Cell adhesion, cell proliferation, and alkaline phosphatase activity were evaluated using mouse MC3T3-E1 cells. RESULTS: The anodized Ti group had a more porous and thicker layer on its surface. The surface roughness of the two groups measured by the profilometer showed no significant difference (P>0.001). The anodized Ti dioxide (TiO2) surface exhibited better corrosion resistance and showed a significantly lower contact angle than the machined Ti surface (P>0.001). Although there was no significant difference in the cell viability between the two groups (P>0.001), the anodized TiO2 surface showed significantly enhanced alkaline phosphatase activity (P<0.001). CONCLUSIONS: These results suggest that the surface modification of Ti by anodic oxidation improved the osteogenic response of the osteoblast cells.

Effect of Indomethacin Treatment in Full-term Infants with Symptomatic Patent Ductus Arteriosus / 대한주산의학회잡지

PURPOSE: Indomethacin has been reported as the prophylaxis and initial treatment of preterm infants with patent ductus arteriosus (PDA). However, there was controversy over indomethacin treatment in full-term infants with symptomatic PDA. Therefore, we evaluate the effect of indomethacin as a treatment of full-term infants with symptomatic PDA. METHODS: A retrospective study was performed to evaluate the effectiveness of indomethacin in full-term infants who had birth weight > or =2,500 g and a gestational age > or =37 weeks with symptomatic PDA at Chonnam National University Hospital between January 2007 and December 2009. According to responsiveness of indomethacin, we classified them into three groups: 1) complete responder which were completely closed after indomethacin treatment, 2) partial responder which were incompletely closed but symptoms were improved, 3) non responder which were conducted surgical ligation because did not respond. RESULTS: Among the total 29 full-term infants treated with indomethacin, 13 (44.8%) were complete responder, 8 (27.6%) were partial responder, and 8 (27.6%) were non responder. There were no significant differences in birth weight, narrow diameter of PDA, and dose of indomethacin between three groups. However, the age at initiation of treatment using indomethacin of complete (4.8+/-4.5 days, P=0.03) and partial responder (6.3+/-2.0 days, P=0.04) were earlier than those of non responder (13.8+/-8.1 days). CONCLUSION: Indomethacin can expect an effective treatment of PDA in full-term infants prior to surgical ligation.

Gonadotropin-releasing Hormone Stimulation Test for Precocious Puberty / 대한진단검사의학회지

BACKGROUND: Gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard to identify central precocious puberty (CPP). This test requires multiple blood samples at different time points to measure gonadotropin levels, and is therefore expensive, time-consuming, and uncomfortable for patients. We aimed to simplify the GnRH stimulation test to require fewer blood samples. METHODS: A study of 166 girls with precocious puberty was undertaken. Blood samples were obtained at 0, 15, 30, 45, 60, 90, and 120 min after GnRH administration, and the levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured. For each parameter, the sensitivities and specificities were estimated and ROC curves were constructed. RESULTS: One hundred and twenty-eight patients (77.1%) were diagnosed for CPP. Peak LH levels were achieved 30 min after GnRH stimulation in patients with CPP. Further, 98.4% of the 45-min samples were diagnostic for CPP, and the cumulative frequency of LH values of > or =5 IU/L was 100% at 45 min. Using this cut-off value for LH, the ROC curve for LH at 45 min showed the highest sensitivity (98.4%) and specificity (100%) in the diagnosis of CPP. CONCLUSIONS: Values of LH measured from a single blood sample obtained at 45 min in the GnRH stimulation test may be adequate for the diagnosis of CPP. Two samples, taken at 30 and 45 min after stimulation, were able to accurately diagnose CPP in 100% of the patients in this study.

Two Cases of Entrapment Neuropathy

We presented two cases of entrapment neuropathy which were confused with herniated lumbar disc syndrome. One was "meralgia paresthetica in association with lumbar disc herniation", and "the other inguinal neuritis along with obturator neuritis". Syndromes of these entrapment neuropathies were confirmed by subcidence of pain and creation of progressively longer pain-free intervals after analgesic blocks of the corresponding nerves by infiltration of Xylocaine and prednisolone.

Experimental Injection Injury of the Sciatic Nerve: Part 11 Physiological Study

In clinical practice a serious sciatic nerve injury may result from an errornous injection of commonly used antibiotics and other therapeutic or prophylactic agents into the gluteal region which can occur at any age, especially common in infants, children and small debilitated patients. Although many isolated cases and several large series of injuries have been reported, the pathogenesis, pathology and its physiology of injection injury of the peripheral nerves in man have been poorly studied. This experimental study was conducted in order to observe the changes and degree of the functional disability of the sciatic nerve following injection of various drugs such as Rheumapyrine, Chloromycetin, Penicillin and physiological normal saline solution. Fourty-three normal adult rabbits were divided into four groups depending on injected materials and also divided into two groups of acute and chronic stages. The drugs were injected into the right sciatic nerve intraneurally and around the left sciatic nerve perineurally. For the functional study in the nerve, contractability of the calf muscle was recorded on a physiograph at intervals of 1, 3, 5, 15 and 30 minutes after the injection of the drugs. Rheobase, chronaxie and strength-duration curve of both extensor and flexor muscles of fet were recorded and measured on a chronaxie meter at intervals of 1, 2, 3 and 4 weeks after the injection. The physiogram showed the greatest reduction in contractability of the muscles in Rheumapyrine, moderate reduction in Penicillin and the least reduction in Chloromycetin group. In the measurements of rheobase and chronaxie there were marked increase of values in group of Rheumapyrine injection. There was no significant differences in values among the group of Penicillin, Chloromycetin and saline injections in comparison with those in the control group. In the analysis of strength-duration curve, it showed a pattern of complete denervation in 3 cases and a pattern of partial denervation in 3 out of 8 cases with Rheumapyrine injection, and a pattern of partial denervation in 3 out of 6 cases with Penicillin and 2 out of 8 cases with Chloromycetin injection. There was no significant differences in values of rheobase, chronaxie and strength-duration curve as time elapsed following the injury. It was postulated the functional and physiological disabilities were developed after the injection when there was a severe degree of nerve damages on the basis of histopathological study.

Experimental Injection Injury of the Sciatic Nerve: Part I Histopathology

Sciatic nerve injury can result from intragluteal administration of any kind of antibiotics or other agents therapeutically or prophylactically. This experimental study was conducted in order to observe the histopathological findings of injured sciatic nerve following injection with normal saline, chloromycetin, penicillin and rheumapyrine. Fifty-five experimental normal adult rabbits were divided into 4 groups and various substances were injected intraneurally on the right side and perineurally on the left side. Pathological specimens were then taken at intervals of 1, 3, 7, and 21 days after injection. The results obtained were summarized as follows: 1. Rheumapyrine produced the greatest reaction, penicllin was the next and chlomycetin was the least damaging of the drugs in this study. 2. More conspicuous pathological changes were observed on the right side than on the left side. 3. It was thought that major source of damage to the sciatic nerve was chemical toxicity to the peripheral nerve. 4. Intraneural injections of rheumaphyrine induced irreversible damage on nervous tissue and perineural fibrosis. 5. Intraneural injection of penicillin caused transient reversible damage on nervous tissue with perineural deposition of collagen. 6. Intraneural injection of chloromycetin induced early reversible damage on nervous tissue with persistant inflammatory reaction in soft tissue. 7. Perineural injection of rheumapyrine, penicillin and chloromycetin induced mild damage on nerveus tissue and revealed moderate inflammatory reaction on soft tissue.