Usefulness of Pleural Adenosine Deaminase in Children for the Differentiation Tuberculous Pleural Effusion from Mycoplasma pneumonia with Pleural Effusion / 소아알레르기및호흡기학회지

PURPOSE: Determination of adenosine deaminase (ADA) in pleural fluid has been suggested as another tool to establish early diagnosis of tuberculous pleural effusion. However, there are few studies concerning its usefulness in children. The objective of this study was to evaluate the utility of the determination of ADA level in pleural fluid for the differential diagnosis between tuberculous pleural effusion (TPE) and Mycoplasma pneumonia with pleural effusion (MP) in children. METHODS: We retrospectively reviewed the clinical records of 13 TPE patients and 21 MP patients with pleural effusion. Also, we analyzed ADA levels, and clinical, biochemical, microbiologic and cytologic findings in the pleural fluid. RESULTS: The pleural fluid of all the subjects revealed exudative rather than transudate characteristics. The mean ADA level in the TPE group was significantly higher than that in the MP group (106.27+/-43.71 IU/L vs. 65.28+/-26.27 IU/L, P=0.003). The area under the curve in receiver operating characteristic analysis was 0.810. With a cut-off level for ADA of 60 U/L, the sensitivity, specificity, positive predictive value, and negative predictive value were 92.3%, 61.9%, 60.0%, and 92.9%, respectively. As many as 38.9% of patients with MP were false-positive with this ADA cut-off setting. CONCLUSION: Although the measurement of ADA activity in pleural fluid can help TPE diagnosis, we should consider that some cases of MP with pleural effusion showed high ADA activities. Accordingly, the utility of the ADA level in pleural fluid for the differentiation of TPE from MP declines and additional relevant studies are required.

The Usefulness of Measuring the Second Metacarpal Length as a Predictive Index for Growth Velocity during GnRH Agonist Treatment in Girls with Central Precocious Puberty

PURPOSE: The growth velocity in patients with central precocious puberty during treatment cannot be predicted. There is a positive correlation in growth among the long bones of the body and the length of the femur and tibia may determine individual height. We want to determine whether the second metacarpal bone can be used as a predictive index for growth velocity during gonadotropin-releasing hormone (GnRH) agonist treatment. METHODS: Thirty-four female children who were diagnosed with precocious puberty at our clinic and treated with GnRH agonist for about 1 year were included in this study. Patients who had growth-related disease, such as growth hormone deficiency and thyroid diseases were excluded. We reviewed their medical records retrospectively. We measured their height and the second metacarpal length from the X-ray film (left hand Anterior-Posterior at the time of their diagnosis and about a year after their GnRH agonist treatment. RESULTS: The age of the subjects was 8.5+/-0.6 years. The growth velocity during treatment was 4.9+/-1.2 cm/yr. There was a positive correlation between height and the second metacarpal length at diagnosis (P = 0.000, r = 0.666) and at one year after treatment (P = 0.000, r = 0.654). There was no correlation between the second metacarpal length at diagnosis and growth velocity during treatment for 1 year. CONCLUSION: We could not find the correlation between the second metacarpal length and growth velocity during GnRH agonist treatment for 1 year. However, the second metacarpal length showed a positive correlation with height before and after treatment. Therefore further study should be done to discovering the mechanisms working during GnRH agonist treatment including bone age, midparental height and so on.

The Usefulness of Measuring the Second Metacarpal Length as a Predictive Index for Growth Velocity during GnRH Agonist Treatment in Girls with Central Precocious Puberty

PURPOSE: The growth velocity in patients with central precocious puberty during treatment cannot be predicted. There is a positive correlation in growth among the long bones of the body and the length of the femur and tibia may determine individual height. We want to determine whether the second metacarpal bone can be used as a predictive index for growth velocity during gonadotropin-releasing hormone (GnRH) agonist treatment. METHODS: Thirty-four female children who were diagnosed with precocious puberty at our clinic and treated with GnRH agonist for about 1 year were included in this study. Patients who had growth-related disease, such as growth hormone deficiency and thyroid diseases were excluded. We reviewed their medical records retrospectively. We measured their height and the second metacarpal length from the X-ray film (left hand Anterior-Posterior at the time of their diagnosis and about a year after their GnRH agonist treatment. RESULTS: The age of the subjects was 8.5+/-0.6 years. The growth velocity during treatment was 4.9+/-1.2 cm/yr. There was a positive correlation between height and the second metacarpal length at diagnosis (P = 0.000, r = 0.666) and at one year after treatment (P = 0.000, r = 0.654). There was no correlation between the second metacarpal length at diagnosis and growth velocity during treatment for 1 year. CONCLUSION: We could not find the correlation between the second metacarpal length and growth velocity during GnRH agonist treatment for 1 year. However, the second metacarpal length showed a positive correlation with height before and after treatment. Therefore further study should be done to discovering the mechanisms working during GnRH agonist treatment including bone age, midparental height and so on.

Change of the Disposal and the Cancellation Ratio after Enforcement of a Precedent Antibody Screening Test / 대한수혈학회지

BACKGROUND: In the clinical setting, for convenience of transfusion, blood is requested in advance, even though 'the type and screen' method has been used for the efficient supply of blood. We employed the precedent antibody screening test method for all patients who were scheduled for surgery, and compared the disposal rate and the clear rate pre and post-activity. METHODS: We evaluated the disposal rate and the cancellation ratio before and after employment of the precedent antibody screening test method for all patients expected to undergo surgery. A comparison of the frequency and type of side effects of transfusion was also performed. RESULTS: The disposal rate and the cancellation ratio showed a decrease, from 1.48% to 1.29%, and from 17.0% to 11.0%. No significant change was observed in the cause of disposal and the side effects of transfusion. CONCLUSION: Enforcement of a precedent antibody screening test resulted in a decrease in the disposal and clear rates. In addition, it aided in reduction of the amount of work performed at the blood bank by establishing the proper utilization of blood and reducing unnecessary cross match testing. There appears to be no problem regarding the stability of transfusion. However, for the sample showing a positive result on the antibody screening test, an effort to decrease the side effects of transfusion, such as exhaustive cross-matching and increasing the rate of identification, would be needed.

Change of the Disposal and the Cancellation Ratio after Enforcement of a Precedent Antibody Screening Test / 대한수혈학회지

BACKGROUND: In the clinical setting, for convenience of transfusion, blood is requested in advance, even though 'the type and screen' method has been used for the efficient supply of blood. We employed the precedent antibody screening test method for all patients who were scheduled for surgery, and compared the disposal rate and the clear rate pre and post-activity. METHODS: We evaluated the disposal rate and the cancellation ratio before and after employment of the precedent antibody screening test method for all patients expected to undergo surgery. A comparison of the frequency and type of side effects of transfusion was also performed. RESULTS: The disposal rate and the cancellation ratio showed a decrease, from 1.48% to 1.29%, and from 17.0% to 11.0%. No significant change was observed in the cause of disposal and the side effects of transfusion. CONCLUSION: Enforcement of a precedent antibody screening test resulted in a decrease in the disposal and clear rates. In addition, it aided in reduction of the amount of work performed at the blood bank by establishing the proper utilization of blood and reducing unnecessary cross match testing. There appears to be no problem regarding the stability of transfusion. However, for the sample showing a positive result on the antibody screening test, an effort to decrease the side effects of transfusion, such as exhaustive cross-matching and increasing the rate of identification, would be needed.

Effects of Antenatal Steroid on Postnatal Fluid Balance in Very Low Birth Weight (VLBW) Infants during the First Week of Life

PURPOSE: Antenatal steroid (AS) may result in lower insensible water loss (IWL), and higher urine output (UO) in early life. We examined if the postnatal fluid balance differed between infants exposed to AS or not (control) in VLBW infants. METHODS: Fifty-four VLBW infants were grouped into AS (n=24) or control (n=30). Fluid intake, UO, IWL and maximal % of weight loss on day 1, day 2, day 3 and day 7 after birth were analyzed. Daily maintenance fluid was determined in each infants by calculation of insensible water loss (IWL=[intake-output]-Delta wt) and UO. RESULTS: Fluid intake (AS vs control; 117.2+/-33.9 vs 126.0+/-29.6 mL/kg/d, P=0.315), IWL (28.1+/-23.7 vs 21.1+/-20.5 P=0.248), UO and maximal % of weight loss on day 7 were not different between groups: similar findings were observed on day 1, day 2, and day 3 after birth. Neonatal morbidities and clinical relevant factors were not different between groups. The duration of assisted ventilation was shorter in the AS than in the control (10.8+/-9.2 vs 27.6+/-26.2, P=0.002). However, the difference disappeared after adjustment for RDS severity and oxygenation index. CONCLUSION: VLBW infants exposed to AS did not have an alteration in postnatal fluid balance during the first week of life, when given fluid based on needs reflected by IWL and UO. The decreased need for assisted ventilation in the AS group may be related to the effects of steroid on fetal lung fluid absorption or maturity, but not on postnatal fluid balance.

Finite element stress analysis of implant prosthesis according to connection types of implant-abutment / 대한치과보철학회지

PURPOSE: This study was to assess the loading distributing characteristics of implant systems with internal connection or external connection under vertical and inclined loading using finite element analysis. MATERIALS AND METHODS: Two finite element models were designed according to type of internal connection or external connection. The crown for mandibular first molar was made using cemented abutment. Each three-dimensional finite element model was created with the physical properties of the implant and surrounding bone. This study simulated loads of 200N at the central fossa in a vertical direction (loading condition A), 200N at the centric cusp tip in a 15.inward inclined direction (loading condition B), or 200N at the centric cusp tip in a 30.outward inclined direction (loading condition C) respectively. Von Mises stresses were recorded and compared in the supporting bone, fixture, abutment and abutment screw. RESULTS: 1. In comparison with the whole stress of the model 1 and model 2, the stress pattern was shown through th contact of the abutment and the implant fixture in the model 1, while the stress pattern was shown through the abutment screw mainly in the model 2. 2. Without regard to the loading condition, greater stress was taken at the cortical bone, and lower stress was taken at the cancellous bone. The stress taken at the cortical bone was greater at the model 1 than at the model 2, but the stress taken at the cortical bone was much less than the stress taken at the abutment, the implant fixture, and the abutment screw in case of both model 1 and model 2. 3. Without regard to the loading condition, the stress pattern of the abutment was greater at the model 1 than at the model 2. 4. In comparison with the stress distribution of model 1 and model 2, the maximum stress was taken at the abutment in the model 1, while the maximum stress was taken at the abutment screw in the model 2. 5. The magnitude of the maximum stress taken at the supporting bone, the implant fixture, the abutment, and the abutment screw was greater in the order of loading condition A, B and C. CONCLUSION: The stress distribution pattern of the internal connection system was mostly distributed widely to the lower part along the inner surface of the implant fixture contacting the abutment core through its contact portion because of the intimate contact of the abutment and the implant fixture, and so the less stress was taken at the abutment screw, while the abutment screw can be the weakest portion clinically because the greater stress was taken at the abutment screw in case of the external connection system, and therefore the further clinical study about this problem is needed.

CAG repeat expansion in the SCA7 in Korean families presenting clinical features compatible with ADCA type II

BACKGROUND: Autosomal dominant cerebellar ataxia type II(ADCA type II) can be differentiated from other types of ADCA by visual disturbances due to pigmentary macular degeneration. Recent genetic studies repeatedly mapped the gene responsible for ADCA type II to chromosome 3p12-13(SCA7) in caucasian patients. However, in Asian patients CAG expansion at the SCA7 locus has not yet been reported. METHODS: We analyzed clinical data obtained from three Korean families in which 14 members presented clinical features compatible with ADCA type II. We also performed a genetic study for 17 members (7 affected and 10 asymptomatic) from two of the three families. RESULTS All seven affected patients had abnormally increased CAG repeat numbers (range : 38-59) in SCA7. One asymptomatic 23-year-old woman had 45 CAG repeats in the SCA7. Other 9 asymptomatic family members had 10 CAG repeats in the SCA7. CONCLUSION: We showed that as caucasian patients, Asian patients with ADCA type II also have abnormally increased CAG repeats at SCA7.

Single Caudal Anesthesia for Total Hip Replacement in Geriatric Patients / 대한마취과학회지

Caudal anesthesia for total hip replacement in geriatric patients has been evaluated clinically. The caudal epidural puncture was performed by a 22 G short needle through sacral hiatus with a lateral decubitus position. 1.5% lidocaine 20 mL and 0.5% bupivacaine 15 mL mixed with 1:200,000 epinephrine and 2 mg morphine was used as an anesthetics. The results were follows ; 1) The onset of caudal anesthesia was 7.9+/-4.5 min (2-20 min) and the duration was 4.8+/-3.0 hrs (1-12 hrs). 2) Anesthetic sensory level was not related with the patient's weight or height. 3) The failure rate including systemic toxicity was 13%. 4) The most common complication was hypotension and its incidence was 26.6%. 5) Time to first analgesics was 8.3+/-3.6 hrs. These results indicate that caudal anesthesia in lateral decubitus position is a recommendable anesthetic technique for total hip replacement in geriatric patients. However, the further studies for the determinations of the optimum dose of local anesthetics are needed.

Acral Lentiginous Melanoma: A report of three cases

Acral lentiginous melanoma is a rare variant of malignant melanoma and is characterized by a lentiginous (radial) growth phase that evolves over months or years to a dermal (vertical) invasive stage. Clinical and pathological features were reviewed in 3 cases of acral lentiginous melanoma of the soles. The first case was a 59-year-old female. On gross examination, there was a black, nodular, round, and ulcerated mass, 1.5 x 1.5 cm, on the posterior portion of the left sole. This mass was accompanied by peripheral pigmented macules. Histologically, the macular lesion revealed the pattern of a lentiginous growth phase, with a diffuse hyperplasia of atypical melamocytes in the basal layer of the epidermis. In the vertical growth component, atypical melanocytes (predominantly spindle cell) infiltrated the dermis, showing level 3 invasion. The second case was a 47-year-old male. On gross examination, there was a dark brown to black, nodular, hemorrhagic and ulcerated mass, 7x7 cm, on the middle portion of the right sole. This mass grew radially into neighboring tissue. Histologically, the radial growth component revealed atypical melanocytes which were distributed in the basal portion of epidermis. In the vertical growth component, atypical melanocytes (spindle, round, or polygonal cells) infiltrated the dermis, showing level 4 invasion. The third case was a 87-year-old female. There was a formation of satellite pigmented macules, up to 2x0.5 cm, on the right sole. The color of macules was usually not uniform but was likely to be scattered radially, being grayish brown, bluish black, or black. Histologically, the peripheral, macular, hyperpigmented lesion revaled the pattern of a lentiginous growth phase. In the vertical growth component, atypical melanocytes (predominently polygonal cells) infiltrated the dermis, showing level 13 invasion.

Malignant Acanthosis Nigricans Associated with Stomach Adenocarcinoma

Malignant acanthosis nigricans is very rare disease. The disease is related with internal malignancy, especially gastrointestinal tract malignancy. Reported occurrence rate of malignant acanthosis nigricans associated internal malignancies are 64% of stomach adenocarcinoma, 27% of other organs of abdomen (liver, gall bladder, small intestine, rectum, uterus, ovary), 9% of non-abdominal organs(breast, lung). We report a case of malignant acanthosis nigricans associated with stomach adenocarcinoma from 20-year-old female and discuss review of literature on a acanthosis nigricans briefly.