• Journal of Trauma and Injury
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• v.24 no.1
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• pp.12-17
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• 2011

Purpose: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. Methods: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients' demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. Results: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. Conclusion: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures.

• Tuberculosis and Respiratory Diseases
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• v.51 no.2
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• pp.178-183
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• 2001

The nephrotic syndrome that occurs in the absence of renal vein thrombosis, amyloidosis, neoplastic infiltration of the kidneys is an unusual but a well recognized paraneoplastic syndrome. The most frequently reported neoplasms associated with nephrotic syndrome are Hodgkin's disease and various carcinomas. The most common renal lesions are membranous glomerulonephritis(MGN) associated with carcinomas and minimal change lesions associated with Hodgkin's disease. Approximately 40% to 45% of patients clinically manifest the MGN symptoms prior to the diagnosis of the tumor, 40% simultaneously with the tumor and the remaining 15% to 20% following the tumor. Therefore, evaluating the underlying malignancy in patients with MGN is important. Here we report a patient with squamous cell lung cancer, which was detected 12 months after a MGN had been diagnosed, with a review of the relevant literature.

• Journal of Physiology & Pathology in Korean Medicine
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• v.23 no.5
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• pp.1106-1115
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• 2009

Mori Ramulus has multiple applications in Korean traditional medicine prescription because it has antioxidant and anti-inflammatory effects by reducing macrophage activities. Yet, no studies on the anti-arthritic activity of EMR (extract of Mori Ramulus) have been reported in vitro and in vivo. Rheumatoid arthritis (RA) is a systemic autoimmune disease with chronic inflammation characterized by hyperplasia of synovial cells in affected joints, which ultimately leads to the destruction of cartilage and bone. Because collagen-induced arthritis (CIA) is similar to RA in pathological symptoms and immune reactions, there have been several reports concerning RA using CIA mouse model. Here, we investigated the effects of Mori Ramulus on RA using CIA mice. The importance of CD4+ Th1 cells in RA progress was previously indicated and studies further showed that Th17 cells play a prime role in severity of disease. Accordingly, the present study was focused on CIA associated with CD4+ Th1 cells and Th1 7 cells. DBA/1OlaHsd mice were immunized with bovine type II collagen (CII). After a second collagen immunization, mice were treated with EMR once a day for 4 weeks. The severity of arthritis within the paw joints was evaluated by histological assessment of cartilage destruction and pannus formation. Immune cells in peripheral blood mononuclear cells (PBMC), draining lymph node (DLN) and paw joints, cytokine production and gene expression were assessed from CIA mouse using ELISA, FACS and real-time PCR analysis. Administration of EMR significantly suppressed the progression of CIA and inhibited the production of TNF-$\alpha$, IL-6 and IL-17 in the serum. The erosion of cartilage was dramatically reduced in mouse knees after treatment with EMR. In conclusion, our results demonstrate that EMR significantly suppressed the progression of CIA and that this action was mediated by the decreased production of TNF-$\alpha$, IL-6, IL-17 and collagen II-specific antibody in the serum. EMR suppressed Th17 cells and reduced level of IL-6 via B cell suppression, and thus, the levels of autoantibodies produced from B cells were decreased. Furthermore, EMR suppressed NKT cells which directly stimulate B cells and develop imbalance of Th1/Th2 cell. Oral administration of EMR (100 mg/kg or 200 mg/kg) significantly suppressed the progression of CIA, which is comparable to that of methotrexate (MTX, 0.3 mg/kg) used as a positive control. We are currently studying the mechanism underlying the therapeutic role for EMR in CIA mice.

• Childhood Kidney Diseases
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• v.15 no.2
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• pp.125-137
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• 2011

Purpose : Men are generally more prone to chronic renal disease and progression to end stage renal disease than women. The purpose of this study is to prove the effect of gender and sex hormone on renal fibrosis in mice with unilateral ureteral obstruction (UUO) and to elucidate the specific underlying mechanisms. Methods :We compared the expression of ${\alpha}$-smooth muscle actin (${\alpha}$-SMA) in female and male mice with complete UUO (day 7). After this, we estimated the changes of renal fibrosis in the female mice with oophorectomy and in the female mice with oophorectomy and replacement of $17{\beta}$-estradiol, respectively. Results : The level of ${\alpha}$-SMA in the female kidney with UUO was significantly lower than that in the male kidney with UUO. oophorectomy and replacement of $17{\beta}$-estradiol did not change the expression of angiotensin II type 1 (AT1) receptor in the female kidney with UUO, whereas the expression of angiotensin II type 2 (AT2) receptor was significantly more elevated in the intact female (IF) and the oophorectomized female with estrogen (OF+E) than that in the oophorectomized female (OF). The expressions of inducible nitric oxide synthase (iNOS) in the IF and OF+E mice were significantly more elevated than that in the OF mice, which was similar to the expression of AT2 receptor. Conclusion : The female gender is associated with resistance to renal fibrosis in obstructive uropathy and this gender difference may originate from the existence of $17{\beta}$-estradiol, which has an anti-fibrotic effect via upregulation of the AT2 receptor and iNOS.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.15
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• pp.6705-6709
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• 2015

Background: Venous thromboembolisms (VTEs) constitute a group of diseases including deep vein thrombosis (DVT) and pulmonary embolism (PE). They regarded as the second leading cause of death in cancer patients and several studies have confirmed that VTEs have a negative impact on survival and recurrent rate in both ovarian and endometrial cancer cases. The incidence of VTEs differs worldwide and depends on several risk factors including race, underlying disease, lifestyle, body weight, BMI and genetic risk factors. There is heterogeneity of DVT rates between Asian and Western countries. This study was conducted in order to evaluate the character and incidence of VTEs in gynecologic oncology patients in King Chulalongkorn Memorial Hospital over a 10 year period. Materials and Methods: A retrospective chart review was performed with VTEs defined as objective diagnosis of acute DVT or PE with typical symptoms and signs. Diagnoses were approved byan internist and/or confirmed with imaging studies. Data from both outpatient and inpatient sessions of the affected cases from January 2004 to December 2013 were extracted. General characteristics of the patients were collected with details of the diseases, types of cancer, stage, date of diagnosis of cancer, operative data, treatment outcome, progression free survival and overall survival. Results: Thirty cases of VTEs were identified in a total 2,316 gynecologic oncology cases. The incidence of symptomatic VTEs in total gynecologic oncology patients in our institution is 1.295%. The incidence of VTEs in ovarian cancer patients in our institution was 5.9%. Duration for VTE detection ranged from 13 months before diagnosis of cancer to 33 months after diagnosis of cancer. Most of the VTE cases were detected in ovarian cancer patients (60%). The most common cell type was adenocarcinoma (moderately to poorly differentiated) which accounted for 26.7% of the cases. The second most common cell type was clear cell carcinoma with 23.3% of the cases. Thirty percent of VTE cases developed before cancer was diagnosed, 20% were diagnosed at the same time as cancer detection and fifty percent developed after cancer was diagnosed. Median disease free survival of the gynecologic oncology patients with VTE was 7.5 months. Median overall survival (OS) was 12 months. Median progession free survivals of DVT and PE groups were 11.5 and 5.5 months, respectively. OS of DVT and PE was 12.0 and 11.5 months respectively. Conclusions: The incidence of VTE in Asian countries is believed to be lower than in European or Western countries. From our retrospective review, the incidence of VTEs in all types of gynecologic oncology was 1.295%, much lower than reported in the West. The reason for the lower incidence may genetic differences. Another factor is that VTE in this review was symptomatic, which is less than asymptomatic VTE. More than half of VTEs in this study developed in ovarian cancer patients. The results are compatible with earlier reports that among gynecologic malignancies, the incidence of VTE is highest in ovarian cancer.

• Journal of Oral Medicine and Pain
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• v.36 no.1
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• pp.21-24
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• 2011

Xerostomia is subjective feeling of dry mouth, a symptom that may or may not be accompanied by hyposalivation, an objective decrease in salivary flow. There are many causes induced xerostomia like drugs, salivary gland diseases, radiation therapy to the head and neck region, Sjogren syndrome, emotional stress etc. Insufficient salivary flow creates complications with oral candidiasis, dental caries, periodontitis, halitosis, dysgeusia. So finally, these complications lead to an overall decline in quality of life. Managements of xerostomia are eliminating or alterating the etiologic factors, relieving symptoms, preventing or correcting the consequences of salivary dysfunction, treating underlying disease and stimulating salivation. One of the salivation stimulation agents studied to treat xerostomia was the pilocarpine muscarinic agonist. Pilocarpine is one of salivation stimulants, a parasympathomimetic drug and non-selective muscarinic receptor agonist. Systemic pilocarpine has been used to stimulate salivary secretion. But systemic administration of pilocarpine has limitations such as increased risk of side effects and contraindications. Side effects of systemic pilocarpine administration are sweating, urinary and gastrointestinal disturbance, risk of cardiovascular and pulmonary disorders. This drug must be used carefully by patients with controlled asthma, chronic bronchitis, pulmonary or cardiac disease. Patient with acute asthma, narrow angle glaucoma, iritis should not use pilocarpine. Like this, systemic pilocarpine has many limitations. So, many investigators also have looked at the effectiveness of topical pilocarpine. Here we present patients with xerostomia which was relieved by pilocarpine mouthwash.

• Korean Journal of Veterinary Service
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• v.41 no.1
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• pp.1-8
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• 2018

Hematological and serum biochemical analyses are routinely used to screen dogs for disease and monitor their clinical progression. These values in dogs may be affected by internal factors, such as breed and age, and external factors like environment, diet, and lifestyle. Apparently, subclinical breed-related variations in hematologic and serum biochemical results have been characterized for Bernese Mountain dogs, Alaskan Malamutes, English Setters, and Golden Retrievers. It is possible that some breed-related differences in clinical pathology analyses may reflect evidence of underlying disease and impact clinical decision plan. In this study, we estimated hematologic and serum biochemical parameters in small breed dogs and compared among four different breed dogs. Blood samples were collected from 38 domestic dogs that were 10 Beagles, 9 Malteses, 10 Poodles, and 9 Miniature Schnauzers. In terms of RBC count, Beagle ($7.2{\pm}0.24{\times}10^3cells/{\mu}L$) showed significantly (P<0.05) higher count than other breeds (Maltese, $6.51{\pm}0.25{\times}10^3cells/{\mu}L$; Poodle, $6.35{\pm}0.24{\times}10^3cells/{\mu}L$; and Miniature Schnauzer, $6.35{\pm}0.25{\times}10^3cells/{\mu}L$). For MCV, Miniature Schnauzer ($67.05{\pm}0.84fl$) results were significantly (P<0.05) higher than Beagle with $64.33{\pm}0.8fl$. For cholesterol value, Beagle ($163.3{\pm}9.15mg/dl$) had significantly (P<0.05) higher values than Miniature Schnauzer with $119.12{\pm}9.64mg/dl$. There was no statistically difference among breeds in terms of enzyme markers of liver diseases. In conclusion, data obtained from this study may be valuable as breed-related variability for interpretation of the results in hematologic and serum biochemical analysis among four small breed dogs.

• The Journal of the Korean Society for Microbiology
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• v.13 no.1
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• pp.1-5
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• 1978

Listeria monocytogenes infection was considered a rather rare disease and occurs mostly either in newborn babies or in young children. However, there has been increasing reports of this infection in elderly person with various underlying disease. Recently we have experienced two cases of Listeria meningitis; one in a 4-year-old male with an acute lymphoblastic leukemia, and the other in a 43-year-old female with a breast cancer. Both were on various chemotherapeutic agents for their primary diseases when the organism, L. monocytogenes was found in their celebospinal fluid(CSF). The degree of CSF pleocytosis were quite different by cases. The former case showed a marked increase, $3,350/mm^3$, and the latter slight, $410/mm^3$, Both showed a slight decrease of CSF glucose ranging 39 to 43mg/100ml. It seems that a routine CSF analysis bears a limitted value in the diagnosis or Listeria meningitis. A direct smear of CSF with Gram's stain revealed gram-positive bacilli in one case, but none in the other. Bacterial culture of CSF yielded plenty colonies in one case, but a few in the other. It seems that isolation of L. monocytogenes must not be considered very easy, and a negative direct smear does not necessarily mean a negative culture. The two isolates we obtained showed the typical cultural and biochemical characteristics of L. monocytogenes and were found to belong to serotypes 1b and 4b. It was our experience that the identification of this organism was not very much matter because of its distinct characteristics, but the most important matter was how to think of the possibility of this organism at the begining. The two isolates were both susceptible to cephalothin, chloramphenicol, erythromycin, tetracycline and gentamicin; intermediate to ampicillin, penicillin and kanamycin; and resistant to cloxacillin.

• Tuberculosis and Respiratory Diseases
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• v.49 no.2
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• pp.162-168
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• 2000

Background : Joint symptoms frequently occur in the course of antituberculous chemotherapy and tend to be ignored and overlooked, but in some cases, they are often very troublesome in obstructing ordinary life. Joint symptoms that develop during antituberculous chemotherapy need to be understood, but there are few materials describing them systematically. Method : This study enrolled 33 patients with tuberculosis treated with first line antituberculous agents for more than 6months. In the course of treatment, joint symptoms not associated with specific cause, such as preexisting joint disease or trauma, were investigated and compared with thæe of the asymptomatic group. We confirmed the incidence of joint symptoms and factors associated with them. Results : Nineteen of 33 patients (58%) had joint symptoms. Joint symptoms developed 1.9$\pm$1.4 months after the beginning of chemotherapy and lasted for 3.6$\pm$2.5months. In 18 of 19 symptomatic patients, multiple joints were involved: shoulder (10 patients, 53%), knee (10, 53%), finger (6, 32 %). Joint symptoms were expressed as pain (19 patiens, 100%), stiffness (7, 37%) and/or swelling (3, 16%). Fourteen patients (74%) took analgesics to relieve their symptoms and in 2 patients, antituberculous agents were discontinued because of the severity of their symptoms. The symptoms seem to be caused by agents other than pyrazinamide, but it was very difficult to identify the definite causative agent. In age, sex, underlying disease and serum uric acid level, no significant differences were noted between the two groups. Conclusions : Although joint symptoms are common during antituberculous chemotherapy, their development is difficult to predict. Because some joint symptoms can become very bothersome, the physician should pay close attention to these symptoms.

• Tuberculosis and Respiratory Diseases
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• v.49 no.5
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• pp.633-638
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• 2000

Pulmonary mucormycosis is an opportunistic infection in patients with severe underlying illness such as immunocompromised diseases or uncontrolled diabetes mellitus. While patients with leukemia and lymphoma usually present with diffuse parenchymal disease, diabetic patients usually have a localized endobronchial disease involving central airways. We report upon a case of pulmonary mucormycosis in diabetes mellitus patient presenting as an endobronchial mass, which was cured with antifungal therapy, rigid bronchoscopic mass removal and right pneumonectomy.