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Predictive Factors for Prognosis of Neonatal Intrahepatic Cholestasis : Non-Familial, Non-Metabolic, Non-Syndromic Cholestasis (신생아 간내 담즙 정체증의 예후 인자: 비가족성, 비대사성, 비증후성 담즙 정체증)

  • Kim, Hyung Suck;Lee, Chang Hoon;Kim, In Ju;Park, Jae Hong
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.7 no.2
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    • pp.208-214
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    • 2004
  • Purpose: The prognosis of neonates with cholestasis is not clear. Some factors, such as high peak bilirubin levels and liver histologic findings have been claimed to affect the prognosis adversely. Our study aims to define which factors influence the prognosis of neonatal intrahepatic cholestasis. Methods: Retrospective reviews of the medical records were performed in 32 cases with neonatal intrahepatic cholestasis, who were admitted to Department of Pediatrics, Pusan National University Hospital from July 1995 to July 2002. Neonates were classified into 2 groups according to the duration of elevated serum alanine aminotransferase (ALT) levels more or less than 6 months. The data, such as biochemical, histopathologic and radiologic findings, were compared in both groups. Biochemical data included mean peak level of serum ALT, total bilirubin, direct bilirubin, and alkaline phosphatase. Histologic parameters related to lobular architecture, fibrosis, inflammatory infiltration and degenerative features of hepatocytes were arbitrary estimated on a scale of 1 to 3. Results: There were 19 males and 13 females, whose mean age was 48 days (14~77 days). The peak serum ALT levels were higher in the poor outcome group. Ductular proliferation and portoportal bridging were more severe in the poor outcome group. But the degree of multinucleated hepatocytes, hepatocellular swelling and canalicular plug did not appear to be significantly related to the long-term outcome. The DISIDA scintigraphy by visualization time of gall bladder and intestine was not useful in predicting outcome of neonatal intrahepatic cholestasis. Conclusion: Neonates who have intrahepatic cholestasis with high serum ALT levels, severe ductular proliferation and portoportal bridging in the liver biopsy specimen should be carefully followed up because they may have a poor prognosis.

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Effects of the Comfort Promotion Program for Prevention of Delirium among Elderly Patients Hospitalized in Long-term Care Hospital (요양병원 입원 노인환자의 섬망예방을 위한 안위증진 프로그램 개발 및 효과 검증)

  • Hwang, Hye-Jeong;Shin, Yeonghee;Kim, Gaeun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.9
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    • pp.203-215
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    • 2017
  • Delirium is an acute confused state associated with poor outcomes among hospitalized long-term care hospital elderly patients. This study was conducted to examine the effects of acomfort promotion program based on Kolcaba's comfort theory for prevention of delirium among elderly patients who have been hospitalized in long-term care hospitals. The study used was a quasi-experimental type, with two groups of patients; those who received their usual care plus comfort nursing intervention (n=34) and those who only received usual care methods. Using the IBMSPSS/PC (Version 21), the homogeneity of the control and intervention group wereevaluated by the chi-squared test and an independent t-test, and all collected data wereanalyzed. Hypotheses were tested by independent t-tests and repeated measures of ANOVA. Delirium occurred at a rate of 2.9% (1/34) in the intervention group and 14% (5/34) -in the control group ($x^2=3.98$, p=0.047). The severity of the delirium in theintervention group was lower than that of the control (t=2.27, p=.027). The duration of delirium was 2days in the intervention group and 2-10days in the control group, indicating delirium in the intervention group lasted for a significantly shorter period ($x^2=3.22$, p=0.048). According to the change of time, the intervention group showed improvement in all areas including comfort scores (F=108.85, p<0.001), anxiety scores (F=63.39, p<0.001), depression scores (F=89.78, p<0.001), quality of sleep scores (F=63.63, p<0.001), and pain scores (F=93.64, p<0.001). In conclusion, elderly patients who were admitted to nursing homes were advised to participate in nursing intervention,which effectivelyprevented delirium based on the Kolcaba's comfort theory of physical, psychological, spiritual, social, cultural and environmental approaches to prevent delirium. Therefore, it is necessary to extend the program for prevention of delirium in the physical, psychological, spiritual, social, cultural, and environmental contexts to prevent delirium in geriatric hospitalized elderly patients.

The Perception and Emotional Experiences of Rare and Intractable Diseases in Caregivers and Pediatric Patients with Mitochondrial diseases (미토콘드리아 질환 소아 환자 보호자에서의 질환 인식 및 정서변화)

  • Eom, Soyong;Lee, Joo Young;Hyun, Jiah;Lee, Young-Mock
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.17 no.1
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    • pp.1-10
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    • 2017
  • Purpose: This study aimed to investigate the perception and emotional experiences in rare and intractable diseases for caregivers of pediatric patients with mitochondrial diseases in order to provide therapeutic interventions for patients, caregivers, and families. Methods: A total of 83 caregivers of pediatric patients with mitochondrial diseases were recruited from the pediatric mitochondrial disease clinics of the Gangnam Severance Hospital in South Korea. Participants completed the survey about their perception of mitochondrial disease and emotional experiences after the diagnosis, and these clinical data were analyzed accordingly. Results: Surveys from a total of 83 caregivers of patients were analyzed, and the patients' age ranged from 6 to 12 years (33%), followed by ages 1 to 6 years (30%). Children with mitochondrial diseases were between 0 and 0.5 years of age at the time of first symptom onset (43%), and the duration of illness lasted more than 10 years in most cases (42%). Prior to diagnosis of mitochondrial diseases, the amount of awareness the caregivers had was 'Not at all' for both rare and intractable diseases and mitochondrial diseases in 44 cases and 68 cases, respectively. For the caregivers' emotional experiences, the most common initial responses were 'Discouraged/despair', 'Helpless/lethargic', and 'Disconcerted'. 'Anxious', 'Committed to treatment', and 'Responsibility as family members' were the most common emotional responses from the caregivers, followed by 'Disconcerted' and 'Helpless/lethargic'. Conclusion: It is important to consider the level of perception and emotional experiences of caregivers and patients with rare and intractable mitochondrial diseases for planning treatment programs.

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Histologic changes of tooth and periodontal tissues applying to contraction & intrusion force for the maxillary four incisors of dogs (성견 상악 4절치의 Contraction과 압하시 치아 및 주위 조직의 조직학적 변화에 관한 실험 연구)

  • Kim, Young-Kuk;Cha, Kyung-Suk;Lee, Jin-Woo
    • The korean journal of orthodontics
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    • v.29 no.5 s.76
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    • pp.535-549
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    • 1999
  • The Purposes of this study were to investigate the initial tissue changes on the teeth and surrounding tissues under contraction and intrusive force by contraction UTA. A control and experimental dogs, 10-months in age, were studied. Contraction and intrusive force(60gm) were applied at upper four incisors by contraction UTA. Experimental dogs were sacrificed at 2 weeks and 4 weeks after force application, respectively. In this study, 2 experimental groups were designed by the duration of force applied(E1, E2). The specimens were taken around the upper first and second incisor in each groups and were prepared for the H-E and MT stain for light microscopic observation. From the results of the study, the following conclusions may be drown. : 1. In control group, the periodontal ligament width was constant from apical third to cervical third of the root and periodontal fiber arrangement was horizontal or oblique in cervical third, oblique in middle third and apical third. In alveolar bond, smooth appearance was shown with osteoblast. 2. In experimental group 1, in proportion to force was concentrated at labial middle third and apical third of root of the upper first and second incisors, root of these tooth tipped labially and intruded at a time. 3. In experimental group 2, periodontal ligament width and arrangement was similar to control and observed strong calcified response at the labial middle third of root. But, alveolar bond resorption and cementum resorption were as before seen at labial middle third and apical third of root that force was concentrated.

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Segmental Resection and Replantation for Primary Malignant or Aggressive Tumors of the Upper Limb (상지에 발생한 악성 및 침윤성 종양의 분절절제 및 재접합술)

  • Hahn, Soo-Bong;Lee, Woo-Suk;Shin, Kyoo-Ho
    • The Journal of the Korean bone and joint tumor society
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    • v.6 no.1
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    • pp.10-16
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    • 2000
  • Object : The aim of the current study is to assess the results of segmental resection and replantation for primary malignant or aggressive tumors of the upper limb. Materials and Methods : From 1986 to 1994, ten patients who had primary malignant or aggressive tumors of the upper limb were managed with segmental resection and replantation method. The average duration of follow-up was 7 years and 7 months. Primary indication of this method is stage II B tumors which, because of their extend, could otherwise be adequately treated only by amputation. Three patients had chondrosarcoma, two had osteosarcoma, two had giant cell tumors with pathologic fracture, one had extensive chondroblastoma, one had Ewings sarcoma, and one had leiomyosarcoma. The location of the tumor was humerus in 6 patients, scapula in 3 patients, and soft tissue of forearm in 1 patient. Wide resection margins were achieved in 7 patients and marginal margin in three. Results : One patient died on 40 months after surgery due to systemic metastasis. Nine patients have remained disease free without local recurrence or metastasis. The average overall functional rating was 65% (43~90%) for ten patients on the last follow-up by the functional rating system of Enneking. The mean grasping power and pinching power of operative hand was 75%(28~95%) and 65%(43~90%) of the opposite hand, respectively. Complications associated with this surgical method included three wound dehiscences and one nerve injury that resolved with proper wound care and time. Conclusion : It was concluded that segmental resection and replantation might be used for partial limb salvage in selected cases for the treatment of primary malignant or aggressive tumors of the upper limb.

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A Low Tillering Ideotype of Rice Plant for Increasing Grain Yield Potential (벼 수량성 증가를 위한 이상적인 소얼성 초형)

  • Kim, Je-kyu;Vergara, B.S.
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.36 no.2
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    • pp.134-142
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    • 1991
  • Since IR8, the first high-yielding rice cultivar characterised by semidwarf and high-tillering, was released in 1966, rice yields during the last two decades have apparently reached a plateau and subsequent efforts to further improve yielding ability have not resulted in visible gains. At this point of time, a new ideotype of rice plant would be necessary to increase grain yield potential. This experiment was conducted to investigate the yield contribution of different tillers within a plant in relation to an ideo type of rice plant. A low-tillering, large panicled IR25588 was compared with a high-tillering, small panicled IR58. Based on spikelet number and grain weight per panicle, the top six panicles in both low- and high-tillering cultivarswere significantly bigger than those in the other panicles. The top six panicles were M, PI, P2, P3, P4 and S1P2 in both cultivars. Their tillers had 100% probability of occurring. The top six tillers were characterised by earlier initiation and heading, longer growth duration, greater leaf area. and heavier culm and total dry weight per tiller. The top six panicles, based on grain weight was mainly due to higher spikelet number per panicle with little differences in 1,000 grain weight and percent fertility. They had also a greater number of high -density grains. The top six panicles were significantly bigger than the rest of the panicles in both low- and high-tilliering types suggesting that a new rice ideotype having six or fewer potential tillers or panicles per paint with 200 to 250 spikelets per panicle (a low-tillering, paicle weight type) may help increase grain yield potential since they have been shown to be superior physio-morphologically to the rest of the tillers.

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Low Grade Astrocytoma-Need Postoperative Radiotherapy or Not? (저분화 성상세포종-수술후 방사선치료가 필수적인가 ?)

  • Hong Seong Eon;Choi Doo Ho;Kim Tee Sung;Leem Won
    • Radiation Oncology Journal
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    • v.10 no.2
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    • pp.171-180
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    • 1992
  • The precise role of radiotherapy for low grade gliomas including the optimal radiation dose and timing of treatment remains unclear. The information given by a retrosepctive analysis may be useful in the design of prospective randomized studies looking at radiation dose and time of surgical and radiotherapeutic treatment. The records of 56 patients (M:F = 29:27) with histologically verified cerebral low grade gliomas (47 cases of grade 1 or 2 astrocytomas and 9 oligodendrogliomas) diagnosed between 1979 and 1989 were retrospectively reviewed. The extent of surgical tumor removal was gross total or radical subtotal in 38 patients ($68\%$) and partial or biopsy only in the remaining 18 patients ($32\%$). Postooperative radiation therapy was given to 36 patients ($64\%$) of the total 56 patients with minimum dose of 5000 cGy (range=1250 to 7220 cGy). The 5-and 10-year survival rates for the total 56 patients were $44\%$ and $32\%$ respectively with a median survival of 4.1 years. According to the histologic grade the 5- and 10-year survivals were $52\%$ and $35\%$ for the 24 patients respectively with grade I astrocytomas compared to $20\%$ and $10\%$ for the 23 patients with grade II astrocytomas. Survival of oligodendroglioma patients was greater than those with astrocytoma ($65\%$ vs $36\%$ at 5 years), and the difference was also remarkable in the long term period of follow up ($54\%$ vs $23\%$ at 10 years). Those who received high-dose radiation therapy ($\geq$5400 cGy) had significant better survival than those who received low-dose radiation (< 5400cGy) or surgery alone (p<0.05). The 5- and 10-year survival rates were, respectively $59\%$ and $46\%$ for the 23 patients receiving high-dose radiation, $36\%$ and $24\%$ for the 13 patients receiving low-dose radiation, and $35\%$ and $26\%$ for the 20 patients with surgery alone. Survival rates by the extent of surgical resection were similar at 5 years ($46\%$ vs $41\%$), but long term survival was quite different (p<0.01) between total/subtotal resection and partial resection/biopsy ($41\%$ and $12\%$, resepctively). Previously published studies have identified important prognostic factors in these tumor: age, extent of surgery, grade, performance status, and duration of symptoms. But in our cases statistical analysis revealed that grade I histology (p<0.025) and young age (p<0.001) were the most significant good prognostic variables.

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Evaluation and Comparison of Myocardial Perfusion Defects in Patients with Early Breast Cancer Subjected to Different Radiation Simulation Techniques (조기유방암 환자에서 방사선 모의치료 방법의 차이에 따른 심근관류결손의 비교 평가)

  • Nam, Ji-Ho;Ki, Yong-Kan;Kim, Dong-Won;Kim, Won-Taek
    • Radiation Oncology Journal
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    • v.25 no.1
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    • pp.26-33
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    • 2007
  • [ $\underline{Purpose}$ ]: The aim of this study is to evaluate and compare the incidence and aspects of myocardial perfusion defects in patients who were subjected to either two-dimensional or three-dimensional simulation techniques for early left-sided breast cancer. The myocardial perfusion defects were determined from using single photon emitted computerized tomography (SPECT) myocardial perfusion images. $\underline{Materials\;and\;Methods}$: Between January 2002 and August 2003, 32 patients were enrolled in this study. The patients were diagnosed as having early (AJCC stage T1-T2N0M0) left-sided breast cancer and were treated with tangential irradiation after breast-conserving surgery and systemic chemotherapy. The patients were divided into two groups according to the type of simulation received: two-dimensional simulation using an X-ray fluoroscope simulator or three-dimensional simulation with a CT simulator. All patients underwent technetium-99m-sestamibi gated perfusion SPECT at least 3 years after radiotherapy. The incidence and area of myocardial perfusion defects were evaluated and were compared in the two groups, and at the same time left ventricular ejection fraction and cardiac wall motion were also analyzed. The cardiac volume included in the radiation fields was calculated and evaluated to check for a correlation between the amount of irradiated cardiac volume and aspects of myocardial perfusion defects. $\underline{Results}$: A myocardial perfusion defect was detected in 11 of 32 patients (34.4%). There were 7 (46.7%) perfusion defect cases in 15 patients who underwent the two-dimensional simulation technique and 4 (23.5%) patients with perfusion defects in the three-dimensional simulation group (p=0.0312). In 10 of 11 patients who had myocardial perfusion changes, the perfusion defects were observed in the cardiac apex. The left ventricular ejection fraction was within the normal range and cardiac wall motion was normal in all patients. The irradiated cardiac volume of patients in the three-dimensional simulation group was less than that of patients who received the two-dimensional simulation technique, but there was no statistical significance as compared to the incidence of perfusion defects. $\underline{Conclusion}$: Radiotherapy with a CT simulator (three-dimensional simulation technique) for early left-sided breast cancer may reduce the size of the irradiated cardiac volume and the incidence of myocardial perfusion defects. Further investigation and a longer follow-up duration are needed to analyze the relationship between myocardial perfusion defects and clinical ischemic heart disease.

Clinical Evaluation of TightRope Cranial Cruciate Ligament Technique for Treatment of Cranial Cruciate Ligament Deficiency in Dogs (전방 십자인대 결손을 보이는 개에서 TightRope을 이용한 치료방법 평가)

  • Yoon, Hun-Young;Kim, Kyung-Hee;Jeong, Soon-Wuk
    • Journal of Veterinary Clinics
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    • v.29 no.6
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    • pp.455-459
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    • 2012
  • Nine dogs presented to the Veterinary Medical Teaching Hospital of Konkuk University and Woosung Animal Hospital with a history of pelvic limb lameness. On physical examination, 9 dogs all showed a consistent weight bearing lameness and mild muscle atrophy. There was cranial drawer sign with pain in 9 dogs. Mediolateral radiographic projection revealed cranial subluxation of the tibial tuberosity in a tibial compression view. The right and left stifle joints were affected in 7 dogs and 2 dogs respectively. TightRope cranial cruciate ligament (CCL) technique for treatment of CCL deficiency was performed. Polyester and nylon were used to stabilize the stifle in 3 dogs and 6 dogs respectively. Suture sizes were 0.8 mm (n = 2), 0.9 mm (n = 4), 1.1 mm (n = 2), and $1.1mm{\times}2$ strands (n = 1) in diameter. Mean (${\pm}SD$) surgical duration was $48.3{\pm}8.5$ minutes (range 35 to 60 minutes). Preoperative and postoperative mean (${\pm}SD$) cranial drawer signs were $8.6{\pm}1.6$ mm (rage 7 to 12 mm) and $1.2{\pm}1.0$ mm (rage 0 to 3 mm) respectively. Immediate postoperative radiographs of the affected limb revealed no evidence of cranial subluxation of the tibial tuberosity in a tibial compression view of 9 dogs. Normal limb function was regained in 8 dogs within 8 weeks postoperatively. A consistent weight bearing lameness resolved in all dogs after TightRope CCL technique, but reoccurred in one dog (case No. 6) 2 weeks after surgery. Cranial subluxation of the tibial tuberosity was identified in a tibial compression test. During the second surgery, breakage of surgical button was identified and a tibial wedge osteotomy was performed. Based on surgical time, complication, stifle stability, and functional recovery, the present study indicated that TightRope CCL technique is effective treatment for the dogs with CCL deficiency.

Relationship of Fitness and Substance of Porphyrin Biosynthesis Pathway in Resistant Transgenic Rice to Protoporphyrinogen Oxidase (Protox) Inhibitor (Protoporphyrinogen oxidase (Protox) 저해제 저항성 형질전환 벼의 적응성과 Porphyrin 생합성 경로물질과 관련성)

  • Yun, Young-Beom;Kwon, Oh-Do;Back, Kyoung-Whan;Lee, Do-Jin;Jung, Ha-Il;Kuk, Yong-In
    • Korean Journal of Weed Science
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    • v.31 no.2
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    • pp.134-145
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    • 2011
  • The objectives of this study were to investigate fitness difference in growth and rice yield in herbicide-transgenic rice overexpressing Myxococcus xanthus and Arabidopsis thaliana protoporphyrinogen oxidase (Protox) genes and non-transgenic rice. We also aimed to determine whether these fitness differences are related to ALA synthesizing capacity, accumulation of terapyrroles, reactive oxygen species, lipid peroxidation, and antioxidative enzymes at different growth stages of rice. Plant height of the transgenic rice overexpressing M. xanthus (MX) and A. thaliana (AP37) Protox genes at 43, 50, and 65 days after transplanting (DAT) was significantly lower than that of WT. Number of tiller of PX as well as MX and AP37 at 50 and 65 DAT was significantly lower than that of WT. At harvest time, culm length and yield of MX, PX and AP37 and rice straw weight of MX and AP37 were significantly low compared with WT. The reduction of yield in MX, PX, and AP37 was caused by spikelets per panicle and 1000 grain weight, ripened grain, spikelets per panicle, 1000 grain weight, and ripened grain, respectively. On the other hand, 135 the reduction of yield in MX, PX, and AP37 was also observed in another yearly variation experiment. The reduction of rice growth in MX, PX, and AP37 was observed in seedling stage as well as growth duration in field. There were no differences in tetrapyrrole intermediate Proto IX, Mg-Proto IX and Mg-Proto IX monomethyl ester, reactive oxygen species ($H_2O_2$ and ${O_2}^-$), MDA, antioxidative enzymes (SOD, CAT, POX, APX, and GR) and chlorophyll between transgenic lines and wild type, indicating that accumulated tetrapyrrole intermediate and other parameters were not related to growth reduction in transgenic rice. However, ALA synthesizing capacity in MX, PX, and AP37 at one day after exposure to light and 52 DAT was significantly lower than that of WT. Further study is required to elucidate the mechanisms underlying the growth and yield difference between transgenic and WT lines.