Electrical storm induced by hypokalemia associated with herbal medicines containing licorice

A 60-year-old woman presented with polymorphic ventricular tachycardia secondary to hypokalemia, which necessitated dozens of DC cardioversions. She was not taking any other medication and denied any vomiting or diarrhea. Further investigation for hypokalemia suggested a hypermineralocorticoid state. Repeated inquiry prompted the patient to admit to taking herbal medicine containing licorice. She was treated with magnesium sulfate, potassium infusion, and intravenous lidocaine. A potassium-sparing diuretic was also prescribed. On the seventh day, the patient was discharged from the hospital with advice to discontinue taking herbal medicines containing licorice. She has been followed up at our outpatient clinic without further symptoms for 3 years. This case highlights the potential for cardiovascular complications associated with consumption of herbal medicines such as licorice. Clinicians should be aware that patients presenting to the emergency department with ventricular arrhythmia and uncertain hypokalemia should be questioned about licorice intake. Obtaining a detailed history from patients admitted to the hospital for electrical storm is essential.

The Effect of Education and Vitamin D Supplementation on the Achievement of Optimal Vitamin D Level in Korean Postmenopausal Women

BACKGROUND: Despite daily vitamin D recommendations, women with osteoporosis may not achieve optimal 25-hydroxy-vitamin D (25[OH]D) levels. We retrospectively evaluated the effect of education and vitamin D supplementation (1,000 IU/day) in Korean women with osteoporosis. METHODS: Sixty-one women with osteoporosis who were taking cholecalciferol (800–1,000 IU/day) were enrolled during 2011 to 2012. Forty patients (education only, Edu group) were educated on the importance of >30 min sunlight exposure daily while taking vitamin D. Twenty-one patients (education with vitamin D supplementation, Add group) were prescribed 1,000 IU/day cholecalciferol (total 1,800–2,000 IU/day) plus education. Patients were divided into 3 groups according to serum 25(OH)D status: deficiency (<20 ng/mL), insufficiency (20–30 ng/mL), and sufficiency (≥30 ng/mL). Furthermore, 25(OH)D levels were compared at baseline and after intervention for 3 months. RESULTS: The median (interquartile range) serum 25(OH)D concentration at baseline was 25.10 (18.95–33.60) ng/mL. The mean (±standard error) differences in 25(OH)D levels from baseline to post-intervention were 19.85±3.86 and 31.73±4.82 ng/mL in the Edu group and Add group, respectively. Eighteen patients (29.5%) had vitamin D deficiency, 25 (41.0%) had insufficiency, and 18 (29.5%) had sufficient levels. Optimal 25(OH)D (30 ng/mL or more) was achieved in 54.5% and 95.2% patients in the Edu group and Add group, respectively (P=0.003). CONCLUSIONS: We consider that vitamin D concentration should be measured on a regular basis in order to maintain an optimal level of vitamin D concentration, and education and supplementation is needed if not sufficient.

Early Postnatal Valproic Acid Exposure Increase the Protein Level of Astrocyte Markers in Frontal Cortex of Rat

OBJECTIVE: In our previous study, it has been reported that valproic acid (VPA) effects gliogenesis and increases the number of glial precursor cells during the early postnatal period. However there is no specific report that whether this process is going on up to the age of mature brain development and the consequence effect of this ongoing gliogenesis process. METHODS: As an ongoing study, using Immunoblotting analysis, we checked the level of glial protein and glial-derived factor markers in the frontal cortex of a rat brain at postnatal day (PND) 21. RESULTS: The finding of the study suggests that, in the VPA group (p < 0.05), early exposure elicited significantly to increase the expression level of glial protein cells at PND 21 in the frontal cortex of rat brain. CONCLUSION: Therefore we suggest that, alter gliogenesis and abnormal number of glial cells modulate the neurobiological dysfunction and induces the risk of neurodevelopmental disorders.

Trends of Pars Plana Vitrectomy Rates in South Korea: A Nationwide Cohort Study

PURPOSE: To assess the trends in pars plana vitrectomy surgery rates and factors affecting rate change between 2002 and 2013 in South Korea. METHODS: Data from National Health Insurance Service-National Sample Cohort 2002–2013, which represents 1,025,340 samples with a sampling rate of 2.2% from the total eligible Korean population, was analyzed. RESULTS: A total of 3,816 vitrectomy procedures were performed (male, 2,010; female, 1,806) from 2002 to 2013. Annual rates of vitrectomy increased from 15.1 (in 2002) to 49.4 (in 2013) per 100,000 individuals, and this trend was prominent in those aged 60 years or older. As for the anesthetic method, vitrectomy under local anesthesia increased more prominently than vitrectomy under general anesthesia. The most common diagnoses associated with vitrectomy were diabetic retinopathy, retinal detachment, epiretinal membrane, and macular hole. CONCLUSIONS: The average annual rate of vitrectomy surgery was 31.5 per 100,000 between 2002 and 2013, and the rate has steadily increased.

Vitamin D Status and Response to Initial Vitamin D Supplementation in Korean Women with Osteoporosis

BACKGROUND: The aim of this study is to evaluate whether the optimal vitamin D level is achieved after taking recommended dose in vitamin D deficient patients. METHODS: This was a retrospective study. Women (n=52) first diagnosed with osteoporosis were recruited in outpatient clinic. They were recommended to be exposed to sun light for more than 30 min a day. Subjects were divided into 3 groups according to serum 25-hydroxy-vitamin D3 (25-[OH]D3) status: deficiency (less than 20 ng/mL), insufficiency (20-30 ng/mL) and sufficiency (30 ng/mL or more). Insufficient and sufficient patients received the recommended dose (1,000 IU/day) but deficient patients received recommended or double dose (1,800-2,000 IU/day). We compared 25-(OH)D levels at baseline and after vitamin D supplementation for 3 months. RESULTS: Median (interquartile range) serum 25-(OH)D concentration at baseline was 15.10 (13.30-16.97) ng/mL and the proportion of deficient, insufficient and sufficient groups were 69.2%, 23.1%, and 7.7% respectively. The optimal 25-(OH)D level (30 ng/mL or more) was achieved in 83.3% of insufficient patients with the recommended dose and was did in 55.6% of deficient patients with recommended dose (P=0.117). However, 88.9% of the deficient patient with double dose achieved optimal level (P=0.030). CONCLUSIONS: About 44% of vitamin D deficient patients did not attain the optimal level of serum 25-(OH)D despite recommended daily intake of vitamin D to 1,000 IU in patients with osteoporosis. Follow-up of serum 25-(OH)D levels may be required for vitamin D supplementation in vitamin D deficient patients with osteoporosis.

Acute Pancreatitis Secondary to Ciprofloxacin Therapy in Patients with Infectious Colitis

BACKGROUND/AIMS: Ciprofloxacin is considered to be a safe and effective treatment for acute infectious colitis. However, this drug may cause drug-induced pancreatitis, albeit rarely. METHODS: From March 2007 to February 2012, we studied 227 patients who were hospitalized for infectious colitis at St. Mary's Hospital. All of the patients received ciprofloxacin therapy for the treatment of infectious colitis. We observed a few cases of rare adverse events, including ciprofloxacin-induced acute pancreatitis diagnosed based on the Naranjo algorithm. RESULTS: During ciprofloxacin therapy, seven of 227 patients (3.1%) developed rare pancreatitis as defined by the Naranjo algorithm; pancreatic enzyme activity was sporadically elevated with ciprofloxacin use. After ciprofloxacin administration, the average interval until the development of pancreatitis was 5.5 days (range, 4 to 7 days). On abdominal computed tomography, pancreatic swelling and homogenous enhancement was noted in three of seven patients. Complicating acute pancreatitis was gradually but completely resolved after cessation of ciprofloxacin administration. The mean recovery time was 11.3 days (range, 8 to 15 days). CONCLUSIONS: We observed that ciprofloxacin-induced pancreatitis may occur with an incidence of approximately 3%. Ciprofloxacin-induced pancreatitis presents a short latency, suggesting an idiosyncratic hypersensitivity reaction. Practitioners should be aware that drug-induced pancreatitis can occur during ciprofloxacin therapy.

Gastroprotective Effects of Grape Seed Proanthocyanidin Extracts against Nonsteroid Anti-Inflammatory Drug-Induced Gastric Injury in Rats

BACKGROUND/AIMS: To investigate the gastroprotective effects of grape seed proanthocyanidin extracts (GSPEs) against nonsteroid anti-inflammatory drug (NSAID)-induced gastric mucosal injury in rats. METHODS: Sprague-Dawley rats were randomly allocated to the normal control, indomethacin, low-dose GSPE, high-dose GSPE and misoprostol groups. All groups except the normal control group received pretreatment drugs for 6 consecutive days. On the 5th and 6th day, indomethacin was administered orally to all groups except for normal control group. The microscopic features of injury were analyzed. The levels of gastric mucosal glutathione, gastric mucosal prostaglandin E2 (PGE2), and proinflammatory cytokines were investigated. RESULTS: The total areas of ulceration in the GSPE and misoprostol groups were significantly decreased compared with the indomethacin group (p<0.05). However, a difference in ulcer formation among the drug treatment groups was not observed. Meanwhile, the glutathione levels in the high-dose GSPE group were higher than those of both the indomethacin and misoprostol groups (p<0.05) and were similar to those of the normal control group. Additionally, there was no difference among the groups in the levels of gastric mucosal PGE2 and proinflammatory cytokines. CONCLUSIONS: High-dose GSPE has a strong protective effect against NSAID-induced gastric mucosal injury, which may be associated with the antioxidant effects of GSPE.

Bark Constituents from Mushroom-detoxified Rhus verniciflua Suppress Kainic Acid-induced Neuronal Cell Death in Mouse Hippocampus

Urushinol, a plant allergen, has significantly restricted the medical application of Rhus verniciflua, although it has been reported to possess a wide variety of biological activities such as anti-inflammatory, antioxidant, and anti-cancer actions. To reduce the urushinol content while maintaining the beneficial biological activities, mushroom-mediated fermentation of Rhus verniciflua was carried out and this method resulted in significantly attenuated allergenicity [1]. In the present study, to examine the neuroprotective properties of mushroom-fermented stem bark of Rhus verniciflua, two constituents were isolated from mushroom-fermented bark and their neuroprotective properties were examined in a mouse model of kainic acid (KA)-induced excitotoxicity. KA resulted in significant apoptotic neuronal cell death in the CA3 region of mouse hippocampus. However, seven daily administrations of RVH-1 or RVH-2 prior to KA injection significantly attenuated KA-induced pyramidal neuronal cell death in the CA3 region. Furthermore, pretreatment with RVH-1 and RVH-2 also suppressed KA-induced microglial activation in the mouse hippocampus. The present study demonstrates that RVH-1 and RVH-2 isolated from Rhus verniciflua and detoxified using mushroom species possess neuroprotective properties against KA-induced excitotoxicity. This leads to the possibility that detoxified Rhus verniciflua can be a valuable asset in herbal medicine.

Comparison of Eating Habits and Dietary Intake Patterns between People with and without Allergy

The aim of this study was to examine and compare the eating habits and dietary intake patterns of people with or without allergy by the survey during August-September, 2008. The 131 subjects aged 10'-50' (AG = allergy group, n = 62; NG = non-allergy group, n = 69) participated in this study. The questionnaire included general characteristics, dietary habits, and food frequency. Income level tended to be higher in AG than in NG, and AG had more pets and flower pots than NG (p<0.01). In AG, most affected area of allergy was the skin and the subjects in AG experienced the mixed symptoms and more than 2 types of allergy. Family history of allergy was highly related with allergy of the subjects (AG: 66.1%, NG: 33.9%). Both groups did not exercise regularly, but frequency of alcohol drinking in AG was significantly higher than in NG (p<0.01). AG skipped meals and had snacking more often than NG (p<0.05). Most favorite snacks in AG were instant foods, fast foods, cookies, and ice cream (p<0.05). Therefore, AG tended to consume more allergy-related foods than NG. Highly-consumed allergy-related foods were egg, pork, walnut, onion, tuna, shellfish, and kiwi (p<0.05). Therefore, nutrition education and guidance is needed to establish good eating habits, food intakes, and life style in people having allergy.

Hypolipidemic and Antioxidant Effects to Ginseng Extract (PD:PT = 1) in Apo E Null Mice

Panax ginseng C.A. Meyer (Panax ginseng) has been used for several thousand years to prolong longevity in Asian countries. Ginsenosides are the most active components isolated from ginseng and belong to damarane saponin which are separated into protopanaxadiol and protopanaxtriol. To evaluate the complex effect of ginsenoside in apo E null mice, ginseng extract were intraperioneally (i.p.) injected and provided high-cholesterol diet for 12 weeks. Ginseng extract came from were i.p. injected with dose of 100 mg/kg/day for 4 weeks in the last experimental duration. Ginseng extract used experiment was abundant Rb1, Rc, Re, and Rg1 and PD:PT ratio was 1.2. The high-cholesterol diet induced liver damage was significantly reduced by ginseng extract. Results from plasma lipid profiles and atherogenic index were improved by ginseng extracts. The GE group significantly decreased plasma TG and TC by 73% and 61% compared to apo E (-/-) group. Also ginseng extract tend to decrease lipid profiles and lipidperoxidation contents in liver and heart. Ginseng extract with an abundant amount of Rg1 significantly suppressed the apoptosis induction of cardiac tissue. In conclusion, ginseng extract (PD:PT = 1) was improved lipid profiles and anti-oxidant effects.

Neuroprotective Effects of Methanol Extracts of Jeju Native Plants on Hydrogen Peroxide-induced Cytotoxicity in SH-SY5Y Human Neuroblastoma Cells

Neuronal death is a common characteristic hallmark of a variety of neurodegenerative disorders including Alzheimer's disease and Parkinson's disease. However, there have been no effective drugs to successfully prevent neuronal death in those diseases, whereas oriental medicinal plants have to possess valuable therapeutic potentials to treat neurodegenerative diseases. In the present study, in an attempt to provide neuroprotective agents from natural plants, 80% methanol extracts of a wide range of medicinal plants, which are native to Jeju Island in Korea, were prepared and their protective effects on hydrogen peroxide-induced apoptotic cell death were examined. Among those tested, extracts from Smilax china and Saururus chinesis significantly decreased hydrogen peroxide-induced apoptotic cell death. The extracts attenuated hydrogen peroxide (H2O2)-induced caspase-3 activation in a dose-dependent manner. Further, plant extracts restored H2O2-induced depletion of intracellular glutathione, a major endogenous antioxidant. The data suggest that Jeju native medicinal plants could potentially be used as therapeutic agents for treating or preventing neurodegenerative diseases in which oxidative stress is implicated.

Inhibitory Effects of an Aqueous Extract of Gynura procumbens on Human Mesangial Cell Proliferation

Gynura procumbens (Lour.) Merr. has been used in some parts of Southeast Asia as a folk medicine to treat kidney diseases, diabetes mellitus, and hyperlipidemia. The present work was undertaken to prove the mechanisms of G. procumbens in the management of glomerular diseases. We investigated the effect of an aqueous extract of G. procumbens on cell proliferation, DNA synthesis, and the expressions of TGF-beta1, PDGF-BB, CDK1, CDK2, and CDK4 in fetal bovine serum-activated human mesangial cells (MCs). The G. procumbens extract inhibited proliferation, DNA synthesis, expressions of PDGF-BB, CDK1, and CDK2 mRNA, and expression of TGF-beta1 protein in MCs. The inhibitory effect of G. procumbens on MC proliferation may be mediated by suppression of PDGF-BB and TGF-beta1 expressions and the modulation of CDK1 and CDK2 expression. Therefore, G. procumbens shows promise as an adjunct therapy in preventing progressive renal diseases.

Visual Disturbance following Autologous Fat Injection into Periorbital Area

PURPOSE: Autologous fat injection into the facial area is a frequently used technique in aesthetic plastic surgery for augmentation of the soft tissue. Fat injection is a very safe procedure because of the advantage of being autologous tissue. Minimal foreign body reaction or infections are noted after fat injection. However, there may be some complications including those as severe as blindness. There have been some case reports on visual disturbances after autologous fat injection reported in the literature. METHODS: A 21-year-old female patient underwent autologous fat injection into left eyebrow area to correct depression of soft tissue. Immediately after injection of autologous fat, she complained sudden visual loss on the left eye. She had come to our emergency room and ophthalmologic evaluation showed that the patient could only recognize hand motion. There was no abnormality of the optic nerve on magnetic resonance imaging. Suspecting an ischemic optic neuritis from fat embolism of the central retinal artery, the patient was treated conservatively with occular massage, antiglaucomatic agent, anti-inflammatory drugs and antibiotics. Visual field examination showed visual defect of half the lower hemisphere. RESULTS: While maintaining antiglaucomatic agents and non steroidal anti inflammatory drugs, fundoscopic examination showed no abnormalities on the second day of admission. Visual field examination showed an improvement on the fourth day along with decreased eyeball pain. Significant improvement of vision was noted and the patient was discharged on the fifth day of admission. The patient was followed-up 2 days afterwards with improved vision and visual field defect. CONCLUSION: We describe an unusual case of sudden unilateral visual disturbance following autologous fat injection into periorbital area.

Photodynamic Therapy Results of Retinal Angiomatous Proliferation with Pigmented Epithelial Detachment in Age-related Macular Degeneration

PURPOSE: To evaluate the incidence of retinal angiomatous proliferation (RAP) and retinal pigmented epithelial detachment (PED) in Korean age-related macular degeneration (ARMD) patients and results of photodynamic therapy (PDT) with verteporfin. METHODS: Between May 2001 and December 2004, two hundred fifty-eight patients diagnosed of ARMD were evaluated and nine eyes of seven patients were as having RAP with PED. All patients underwent two or more sessions of PDT. Best-corrected visual acuity (BCVA), fundus photography, fluorescein angiography and ICG angiography were performed before and after treatment. RESULTS: The incidence of RAP with PED was 2.8%. The mean age of onset was 71.7 and five of seven patients were female. After 17 months and mean 2.3 PDT treatments, mean BCVA decreased from 0.2 to 0.04. In two eyes, additional Transpupillary thermotherapy was undertaken. Occlusion of RAP and flattening of PED was observed in one eye, and four evolved toward stage 3 RAP. Three eyes with PDT developed tear of retinal pigmented epithelium. CONCLUSIONS: Korean ARMD patients showed a low incidence of RAP and poor visual outcomes even with treatment.

Effects of Korean Red Ginseng on the Vaginal Blood Flow and Structure in Female Castrated Rats / 대한비뇨기과학회지

PURPOSE: Ginseng is a traditional Asian remedy for sexual dysfunction. The purposes of this study were to investigate the effects of Korean red ginseng (KRG) on the vaginal blood flow and tissue structure in female castrated rats. MATERIALS AND METHODS: Female Spague-Dawley rats (200-210gm) were divided into 4 groups: the control (n=20), castration (n=30), and castration plus oral administration of KRG extracts (50 and 100mg/kg/day, n=15 and n=15, respectively). After 1 month of treatment, the serum estrogen and total cholesterol levels were measured. The vaginal blood flow was measured using laser Doppler flowmeter before and after pelvic nerve stimulation (PNS). The vaginal tissue was processed for Masson's trichrome stain, immunohistochemistry and Western blotting. RESULTS: The serum estrogen level was significantly decreased in the castration group (0.8+/-1.9ng/ml); however, it increased up to the control level (2.2+/-1.3ng/ml) in both the KRG administration groups (p<0.05). The PNS-induced vaginal blood flow tended to improve in the KRG treatment groups. On the histology, the vaginal epithelial layer and submucosal microvasculature showed improvement in the KRG treatment groups. The expression of estrogen receptor increased in the KRG treatment groups compared to the castration group. CONCLUSIONS: These results suggested that KRG extracts seem to have an estrogenic effect on castrated female rats. This implies that the KRG extracts may have an ameliorating effect on sexual function in menopausal woman.

Influence of Intraoperative Ventriculostomy on the Occurrence of Shunt-Dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage / 대한뇌혈관외과학회지

OBJECTIVE: Neurosurgeons occasionally advocated intraoperative ventriculostomy to prevent traumatic brain retraction because of severe brain swelling in an acute stage of aneurysmal subarachnoid hemorrhage (SAH) surgery. The authors investigated the impact of the intraoperative ventriculostomy on the occurrence of shunt-dependent hydrocephalus in acute SAH. METHODS: The data of 141 ruptured aneurysm patients who underwent aneurysmal neck clipping in an acute stage were retrospectively reviewed. The patients were divided into three groups according to the cerebrospinal fluid (CSF) drainage amount via intraoperative ventriculostomy. Group 1 (n=44) included the patients who were not performed the intraoperative ventriculostomy, Group 2 (n=34) consisted of patients who were drained the CSF less than 40 cc ( or = 40 cc). By using statistical methods, the authors analyzed the influences of various variables including Hunt-Hess grade, Fisher grade, Glasgow coma scale, Glasgow outcome scale, presence of acute hydrocephalus and intraventricular hemorrhage (IVH) at admission on the occurrence of hydrocephalus. And also, we analyzed the relationships among the cisternal drainage, lamina terminalis fenestration, and the shunt-dependent hydrocephalus. RESULTS: Concerning the amount of CSF drainage via intraoperative ventriculostomy, the incidence of shunt-dependent hydrocephalus did not show any difference in three groups (p=0.146). Presence of the acute hydrocephalus, lamina terminalis fenestration, and cisternal drainage did not exert any influence on the incidence of shunt-dependent hydrocephalus, respectively (p=0.124, p=0.168, p=0.452). However, the incidence of shunt-dependent hydrocephalus in patients who had IVH at admission was significantly higher than in who did not have (p=0.010). CONCLUSIONS: Routine intraoperative ventriculostomy dose not increase the incidence of shunt-dependent hydrocephalus. Moreover, it obtains an adequate intraoperative brain relaxation, which results in the decrease of the brain retraction injury and the operation time.

Depression Level among Family Caregivers of Terminal Cancer Patients

BACKGROUND: As the importance of the quality of life is emphasiged in our society, efforts to improve the quality of life in the field of medicine have intensified. Terminal cancer patients, facing death, need not only biomedical therapy, but also systematic and continuous treatments such as mental or psycho-social intervention. The purpose of this study was to investigate the family caregiver's depression level and the associated factors. METHODS: The survey was conducted with 52 family caregivers of the terminal cancer patients who had been hospitalized at Chungnam National University Hospital from October 2003 to June 2004. The questionnaire consisted of the general characteristics of the subjects, BDI (Beck's Depression Inventory) evaluating the depression level and family APGAR score evaluating the family function. RESULTS: The mean age of the subjects was 50.4 years. The relationship with patients as 'spouse' accounted for 30 individuals (57.7%). The mean (+/-SD) BDI score was 24.0 (+/-10.9) points and 57.7 percent of the subjects were suggested to have depression tendency (> or =21 point). There was no relationship between the caregiver's depression level and their gender, religion, household income and family APGAR score. However, the depression level was significant related to the total caregiving duration (P=0.001), visiting frequency of visitors (P=0.004) and caregiving hours per day (P= 0.005). CONCLUSION: More than half of the family caregivers were suggested to have depression tendency. The depression level as influenced by the burden of caregiving and the visiting frequency of visitors. There is a need to activate social resources to share the burden of caregiving and to develop continuous and comprehensive care for terminal cancer patients and their families.

Spontaneously Reduced Invaginated Appendiceal Intussusception after Colonoscopic Examination / 대한소화기내시경학회지

Appendiceal intussusception is an uncommon type of intussusception with the incidence of 0.01% in children and adults. In many cases it was developed by secondary conditions, such as polyps, carcinoma or lymphoma. But some other cases was reduced after barium enema study and had none of initiating causes. Therefore, making an accurate diagnosis is important in providing the optimal treatment for the patient. We present an appendiceal intussusception spontaneously reduced after colonoscpic examination. A 61-year-old woman with indigestion, nausea and right lower quadrant abdominal tenderness was admitted for further evaluation and treatment. Colonoscopic exam revealed a invaginated appendix with normal appearing covring mucosa intraluminaly. Blind mucosal biopsies on the appendiceal orifice yielded mild inflammatory cell infiltration. Two days after the colonoscopic procedure, patient's abdominal symptoms and sign were disappeared. Abdominal CT scan revealed that appendiceal intussusception was spontaneously reduced and a few several reactive mesenteric lymphadenopathy was observed. The ultrasound scan revealed the appendiceal wall swelling. The patient was discharged after the relief of abdominal symptom without further treatment.

Effect of Ginseng Saponin on Cultured Osteoblast / 대한정형외과학회잡지

Earlier work suggested that Ginseng saponin had an effect on healing of fracture and osteoporosis, hut there has heen no report on saponin effects on cultured osteoblast. The purpose of this study was to investigate the effect of saponin on cultured osteovlast of the mouse. Osteohlastic cells were isolated from periosteum-stripped parietal bones of neonatal rat calvaria, seeded at 4 x 10 4 cells/cm2 density, and cultured in standard medium and deficient medium, with addition of saponin (0(control), 10, 20, 50 microgram/ml concentration). Plating efficiency(adhesiveness), proliferation and the alkaline phosphatase activity of the osteohlasts were evaluated on 2 hours, days 2 and 7 of culture. Saponin was found to enhance the adhesiveness of seeded osteoblasts which were cultured with a deficient medium in comparison to the controls. It promoted cell proliferation of the osteoblasts cultured with a deficient medium in comparison to the controls. There was also a significantly enhanced increase of alkaline phosphatase levels in the presence of saponin during culture with deficient medium in comparison to the controls. In summary, the results showed that the saponin increased adhesiveness, proliferation and the alkaline phosphatase activity of the osteoblast cultured only in deficient medium.

Clinical Study of Inguinal Hernia in Children

A total of 335 inguinal hernias in children were analyzed by the authors at the Department of General Surgery, St. Benedict Hospital, for last 10 years, from 1986 to 1995. The male patients were predominant (2.25:1), and 78.2% were under 2 years of age. Right side was 1.63 times more frequent than the left. Among the 19 cases of incarcerated hernias, 84% could be reduced preoperatively in safe. Only 3.6% of the cases were repaired by Bassini procedure, but the others didn't require posterior wall reconstruction. Bilaterality was 25 cases (7.5%), and 8 cases (2.4%) developed later contralateral hernias after primary ipsilateral fix. Complications were in 15 cases (4.5%) such as scrotal seroma and/or hematoma (3%), wound infection (0.6%), pneumonia (0.9%). For the more comprehensive care for the herniated children, specialized practice by a pediatric surgeon would be required in the future.