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Biomedical subjects

W K Kim

Publications and source records attributed to W K Kim.

At least 109 records · Page 6Linked to original sources
PubMed1998

Multiple pigmented basal cell carcinomas.

Basal cell carcinoma is the most common of all skin cancers and the most prevalent one among Caucasians. Rarely, these tumors are seen in other races. We report a 77-year-old Korean woman who presented with multiple darkly pigmented enlarging nodules on her scalp, face, trunk, and extremities. The patient had first noted a 6-mm pigmented lesion on her left eyebrow 10 years previously. Since then, other lesions had appeared in many locations on her body. She had been otherwise healthy and without a history of exposure to arsenic or radiation. There was no family history of skin cancer, xeroderma pigmentosum, or basal cell nevus syndrome. On physical examination, multiple darkly pigmented dome-shaped papules and nodules were present on her scalp, face, right forearm, lower abdomen, and inguinal areas. They ranged in size from 0.5 mm to 2 cm. The larger ones showed central ulceration. Multiple biopsy specimens from different sites showed pigmented basal cell carcinomas. Clinically, there was no evidence of nevus sebaceus, xeroderma pigmentosum, basal cell nevus syndrome, or immunodeficiency. Clinical workup including chest radiography, abdominal ultrasound, bone scan, and brain computerized axial tomography scan did not demonstrate primary or secondary tumors. The results of serologic and hematologic tests were also within normal limits. This is an unusual case report of multiple pigmented basal cell carcinomas in an Asian woman without any predisposing risk factors.

Aged↗
PubMed1998

The reverse digital artery island flap: clinical experience in 120 fingers.

Fingertip injuries represent the most common type of injuries seen in the upper extremity. Their management is functionally and aesthetically important but at the same time very controversial. The aim of this study is to report usefulness and postoperative results of reverse digital artery island flaps for fingertip reconstruction. From July of 1984 to December of 1995, 120 fingers in 110 patients with defects of the distal phalanx were reconstructed by reverse digital artery island flaps at Korea University Guro Hospital. We reviewed the medical records of our cases and analyzed them in several aspects. In 21 cases, neurorrhaphy was performed to improve sensibility. In the majority of the cases, the defect was covered primarily, whereas in 27 cases it was covered secondarily after composite graft, replantation, and so on. All the flaps survived except for one. Long-term follow-up for more than 6 months was possible in 44 fingers in 41 patients. Light touch and temperature sensation could be detected in all the evaluated flaps. The mean values of the static two-point discrimination test in sensate and insensate flaps were 6.2 and 10.2 mm, respectively. The reverse digital artery island flap is a safe and reliable procedure with a high survival rate and therefore is an excellent choice for coverage of fingertip defects.

Adolescent↗
PubMed1998

Effect of topical Na-hyaluronan on hemidesmosome formation in n-heptanol-induced corneal injury.

The present study investigated the effect of Na-hyaluronan (Na-HA) on the hemidesmosome morphogenesis in n-heptanol-induced corneal wounds. Central epithelial wounds were induced in the rabbit cornea by applying a 5.5-mm round filter paper, which was soaked in n-heptanol, for 60 s. 1% Na-HA in phosphate-buffered saline (PBS) or PBS alone were topically administered to the wounded cornea 4 times daily for up to 7 days. Epithelial healing rates during the first 2 days were not altered by Na-HA. The number of hemidesmosomes in the basement membrane of the central cornea was significantly increased in both 3- and 7-day groups after treatment with 1% Na-HA. The results suggest that topically applied 1% Na-HA may enhance the formation of hemidesmosomes during the early healing phase in n-heptanol-induced corneal wounds.

Administration, Topical↗
PubMed1998

Severe aplastic anemia induced by ticlopidine: report of two cases.

Aplastic anemia is a rare side-effect associated with ticlopidine therapy. We report two cases of severe aplastic anemia developed after the use of ticlopidine. A 51-year-old woman took ticlopidine at 500 mg/day for 49 days to prevent a secondary stroke. She developed fever and dizziness within 49 days of initiating ticlopidine therapy. A 70-year-old woman was started on ticlopidine after coronary stent insertion. Fifty days after starting ticlopidine, she developed fever and dizziness. Both patients showed pancytopenia and were diagnosed as aplastic anemia which were confirmed by bone marrow examination. Both patients were hospitalized and received antibiotics, blood products and hematopoietic growth factors. Four and seven weeks after the withdrawal of ticlopidine, the hematologic parameters of each patient improved. A complete blood count should be monitored during ticlopidine therapy to check for cytopenia.

Aged↗
PubMed1998

Low prevalence of activated protein C resistance and coagulation factor V Arg506 to Gln mutation among Korean patients with deep vein thrombosis.

Activated protein C (APC) is a naturally occurring anticoagulant that interacts with factor V and VIII to inhibit the clotting cascade. The prevalence of APC resistance among Korean patients with deep vein thrombosis is ill defined. The aim of the present study was to investigate the prevalence of APC resistance and factor V Leiden mutation in Korean patients with deep vein thrombosis. The presence of factor V Leiden mutation was determined in 49 patients who visited Asan Medical Center. APC ratio was performed in 33 individuals from the above 49 patients. Three patients were excluded from the analysis because their baseline aPTT was prolonged. Resistance to APC was diagnosed when the APC ratio was below 2.55. APC resistance was documented in 8 individuals, representing 27% (8/30) of the patients on whom APC resistance test was performed. The 2 patients, who showed APC resistance, were positive for lupus anticoagulant. None of the 49 patients demonstrated factor V Leiden mutation. These findings indicate that factor V Leiden mutation is rare and APC resistance is less prevalent in Korean patients with deep vein thrombosis than in Caucasians. APC resistance not caused by factor V Leiden mutation may be a risk factor for deep vein thrombosis in this population.

Activated Protein C Resistance↗
PubMed1997

Neurotoxicity associated with dual actions of homocysteine at the N-methyl-D-aspartate receptor.

Severely elevated levels of total homocysteine (approximately millimolar) in the blood typify the childhood disease homocystinuria, whereas modest levels (tens of micromolar) are commonly found in adults who are at increased risk for vascular disease and stroke. Activation of the coagulation system and adverse effects of homocysteine on the endothelium and vessel wall are believed to underlie disease pathogenesis. Here we show that homocysteine acts as an agonist at the glutamate binding site of the N-methyl-D-aspartate receptor, but also as a partial antagonist of the glycine coagonist site. With physiological levels of glycine, neurotoxic concentrations of homocysteine are on the order of millimolar. However, under pathological conditions in which glycine levels in the nervous system are elevated, such as stroke and head trauma, homocysteine's neurotoxic (agonist) attributes at 10-100 microM levels outweigh its neuroprotective (antagonist) activity. Under these conditions neuronal damage derives from excessive Ca2+ influx and reactive oxygen generation. Accordingly, homocysteine neurotoxicity through overstimulation of N-methyl-D-aspartate receptors may contribute to the pathogenesis of both homocystinuria and modest hyperhomocysteinemia.

2-Amino-5-phosphonovalerate↗
PubMed1997

Currarino triad: anorectal malformation, sacral bony abnormality, and presacral mass--a review of 11 cases.

Currarino et al, in 1981, described an association of a congenital anorectal stenosis, or another type of low anorectal malformation, an anterior sacral defect, and presacral mass. Eleven patients with this anomaly were treated at the Department of Pediatric Surgery, Seoul National University Children's Hospital from 1984 to 1995. Among these patients, low-type imperforate anus (IA) was seen in three cases and anorectal stenosis was present in eight cases. Presacral masses included seven teratomas, two meningoceles, one dermoid cyst, and one enteric cyst with dermoid cyst. All had a deformed sacrum. Among the eight with anorectal stenoses, posterior sagittal anorectoplasty (PSARP) with diverting colostomy was performed in seven cases, and repeated rectal dilatation was performed in one case. Among the three low-type IA, anoplasty was performed in two cases and PSARP was performed in one case. Although PSARP is a safe and satisfactory method facilitating the excision of the presacral mass, in meningoceles the repair should be performed before correction of anorectal malformation because of the risk of meningitis that can occur when surgeries are done simultaneously. In two cases, untethering of a tethered spinal cord was performed. All patients are continent. Because the incidence of Currarino triad is high when there is an anorectal stenosis (38% in the present series), the Currarino triad should be suspected in anorectal stenosis. Magnetic resonance imaging is a preferred diagnostic method because the incidence of association of tethered cord in this triad is high (18% in the present series).

Anal Canal↗
PubMed1997

Silo formation without suturing in gastroschisis: use of Steridrape for delayed repair.

Although primary repair is preferred for gastroschisis, this cannot be performed in many patients because of the visceroabdominal disproportion or other accompanying conditions. Several prosthetic materials are used for a silo or patch. When prosthetics are used, staged operations are necessary and infection is an inherent problem. However, these problems can be avoided by using Steridrape for a silo without suturing. The authors used the Steridrape to create a covering for two patients. The eviscerated bowel was irrigated and the abdominal wall was cleansed. A sheet of Steridrape was attached onto the abdominal wall and the herniated viscera was wrapped with it. A second sheet was applied over the first one. Antibiotics were administered and parenteral nutrition was started. The Steridrape covering was changed twice a week. In 1 week the edema subsided remarkably and in 2 weeks the bowel had an almost normal appearance except for hyperemic serosa. Primary repair was performed on the 19th hospital day in patient 1, the 14th day in patient 2. Oral feeding was started 7 days after repair in patient 1, and 22 days after repair in patient 2. Patient 2 developed aspiration pneumonia during transport. Discharge was on the 18th day after surgery in patient 1 and the 50th day in patient 2. The patients are now 18 months and 14 months old, respectively, and are doing well. Steridrape application in gastroschisis is economical, easy to perform, and is a better method to use when transporting the patient. It also facilitates drainage of purulent exudate, and allows the bowel to be inspected easily. This method has proved useful in treating two patients with gastroschisis.

Abdominal Muscles↗
PubMed1997

Prevalence of childhood asthma based on questionnaires and methacholine bronchial provocation test in Korea.

BACKGROUND: In most epidemiological survey studies, only subjective symptoms and past medical history of asthma have been used as diagnostic criteria. Even though a questionnaire survey can be performed in a large population study at low cost, limitations such as lack of objectivity and poor predictability in non-specific bronchial hyperresponsiveness cannot be avoided. OBJECTIVES: The purpose of this study was to elucidate the prevalence of current asthma based on questionnaires and methacholine bronchial provocation test, and the prevalence of atopy in Korea. METHODS: We performed modified ATS respiratory questionnaires and allergen skin-prick test with 10 common inhalant allergens among 3219 subjects aged 7-19 years in Seoul and a rural part of a small city, Chungju in Korea. Methacholine bronchial provocation tests were also performed among those who had asthma symptoms according to the questionnaire. The criteria of asthma was presence of both asthma symptoms and non-specific bronchial hyperresponsiveness. Atopy was defined as when an allergen induced weal size is same or larger than that caused by histamine. RESULTS: The prevalence of asthma based on questionnaires and methacholine bronchial provocation tests was 4.6%, while the prevalence of wheeze was 8.2% and 19.3% of total population complained of one or more respiratory symptoms related to asthma on the questionnaires. There was no significant difference according to age, sex and living area. The mean prevalence of atopy was 35.0% and the most common allergens were Dermatophagoides farinae (30.9%), Dermatophagoides pteronyssinus (27.5%), cat fur (20.4%) and cockroach (11.8%). The atopy prevalence in Chungju area was higher than that in Seoul and males showed a higher prevalence than females. The asthma prevalence was higher among atopics (6.8%) than among non-atopics (2.7%). None of questionnaire items were enough to predict the presence of bronchial hyperresponsiveness in terms of sensitivity, specificity and positive predictive value. CONCLUSION: The prevalence rate of current asthma in Korea was 4.6% and the prevalence rate of atopy in Korea was 35.0%. Questionnaire-based surveys are not enough to predict the actual prevalence of asthma.

Adolescent↗
PubMed1996

Involvement of N-methyl-d-aspartate receptor and free radical in homocysteine-mediated toxicity on rat cerebellar granule cells in culture.

The present study investigates the possible mechanism responsible for the neurotoxicity of D,L-homocysteine in primary culture of rat cerebellar granule cells. Neurotoxicity was assessed by measuring the amount of lactate dehydrogenase released from the cells following homocysteine treatment. D,L-Homocysteine (> 300 microM; 16-22 h) induced the release of lactate dehydrogenase from the cells in a concentration-dependent manner. The N-methyl-D-aspartate (NMDA) antagonist (+/-)-2-amino-5-phosphonopentanoic acid (APV) partially blocked the homocysteine-mediated neurotoxicity. However, the non-NMDA receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) did not block the homocysteine-mediated toxicity. The homocysteine-mediated neurotoxicity was mostly prevented by the co-administration of superoxide dismutase and catalase or catalase alone. The results suggest that homocysteine induces neuronal cell death by stimulating NMDA receptor as well as by producing free radicals.

2-Amino-5-phosphonovalerate↗
PubMed1996

Fingertip replantations: clinical evaluation of 135 digits.

From July 1985 to February 1993, 135 digits in 119 patients with complete amputations at or distal to the distal interphalangeal joint (zone I for amputations distal to the nail base of zone II for amputations between the distal interphalangeal joint and the nail base) were replanted using a microsurgical technique at Korea University Guro Hospital. Because of the high social value placed on body form and function, the indication for replantation was extended to cases with severe soft-tissue injuries and attempted replantation as a routine procedure in nearly all distal amputation cases. The overall survival rate was 78 percent, with the survival rate for zone I being 70 percent and that for zone II reaching 86 percent. Even in cases with severe soft-tissue injury, the survival rate was high, with viability in avulsion injuries and crush injuries reaching 75 percent each. The most common type of vascular repair in zone I cases was revascularization of one artery only and no vein repair (87 percent). Of these cases, interpositional vein grafts were used in 65 percent. In zone II cases, the most common combination repair was one artery and one vein anastomosis (70 percent), with interpositional vein grafts for arterial anastomosis in 49 percent; most of the venous repair was feasible by the direct method (78 percent). The follow-up period ranged from 1 month to 5 years with a mean of 14.8 months; 52 patients were followed-up for more than 6 months. In 52 long-term follow-up patients, the average two-point discrimination was 8 mm. Patient satisfaction, aesthetically and functionally, was high (91 percent).

Adult↗
PubMed1996

Eight cases of nine-digit and ten-digit replantations.

Amputations involving nine and all ten digits are very rare because of the different lengths of the digits, and it is also unusual to have all digits suitable for replantation. At Korea University Guro Hospital, from March 1987 to April 1992, three cases of 10-digit and five cases of 9-digit complete amputations were replanted by microsurgical technique. All eight cases involved young, healthy male patients, and the causes of amputation were either a cutter of press machine. The replantations were done under general anesthesia simultaneously on both hands by eight microsurgeons divided into a total of four teams. The operating times ranged from 19 to 31 hours, and the total amounts of transfused blood ranged from 6 to 38 pints. The warm ischemic times ranged from 10 minutes to 15 hours, and the cold ischemic times ranged from 3 to 29 hours. The sequence of replantation was radial digit to ulnar digit. In five of the eight patients, all of the replanted digits survived. Necrosis occurred in one and two digits in two patients with nine-digit replantations. Also, necrosis occurred in three digits in a patient who had had nine digits amputated by a press machine, sustaining severe crush injuries. The overall survival rate was 92 percent. In multidigit replantations involving 9 or 10 digits, there are a number of problems that must be overcome, including a long operating time, long ischemic times, and a large amount of blood loss. The long ischemic times were not critically related to survival rate. The total amount of blood transfused was reduced from 38 pints in one of the initial cases to 6 pints by intermittent use of the pneumatic tourniquet and venous anastomosis before arterial anastomosis. Static two-point discrimination ranged from 3 to 22 mm, and palm to pulp distance ranged from 0 to 7 cm, 1 to 5 years postoperatively. Grasping power ranged from 13 to 65 lb, and pinching power ranged from 5 to 26 lb, which was 42 and 50 percent of the average power of a Korean adult male, respectively. All eight patients returned to work and are satisfied with the result, functionally and aesthetically.

Adolescent↗
PubMed1996

Veno-occlusive disease (VOD) of the liver in Korean patients following allogeneic bone marrow transplantation (BMT): efficacy of recombinant human tissue plasminogen activator (rt-PA) treatment.

Veno-occlusive disease (VOD) of the liver is a clinical syndrome characterized by hyperbilirubinemia, painful hepatomegaly, and fluid retention. In the bone marrow transplantation (BMT) setting, VOD is caused by dose-intensive chemotherapy and/or radiotherapy used to prepare patients for transplant. VOD occurs in up to 50% of the patients who undergo BMT and is usually associated with a high mortality rate. Until recently, there was no proven effective medical therapy for this condition once it was clinically apparent. We report here on the frequency and treatment result of VOD with rt-PA in our allogeneic BMT patients. Eight patients (median age 28.5 years) underwent allogeneic BMT from December, 1993 to June, 1995 in Asan Medical Center. Six leukemia patients were prepared for BMT with busulfan and cyclophosphmide, while two aplastic anemia patients received cyclophosphamide and antithymocyte globulin. VOD was defined as having two of the following features before day 20 posttransplant: jaundice (bilirubin > or = 2 mg/dL), tender hepatomegaly and/or right upper quadrant pain, ascites and/or unexplained weight gain (> 2% from baseline). All patients who were diagnosed with VOD received rt-PA (10-20 mg/day) and heparin (10,000 U/day). Three (37.5%) of the eight patients developed VOD that occurred between 6 and 10 days posttransplant. All three patients developed jaundice, weight gain, and tender hepatomegaly. Ascites and renal insufficiency occurred in two patients and pleural effusion in one patient. rt-PA and heparin were begun 6 to 26 days posttransplant and rt-PA was administered for 7 to 14 days. All three patients responded to the therapy; bilirubin levels began to decrease at 4 to 13 days from the start of therapy. They are all alive at day 111, 316, and 548 days posttransplant. None of the patients had significant hemorrhagic complications after rt-PA treatment. Prolonged administration of rt-PA was feasible without bleeding episode and it seems that rt-PA may alter the natural course of VOD.

Adolescent↗
PubMed1996

Prognostic factors of acute myelocytic leukemia: an analysis of 132 patients in a single institution.

Patients with acute myelocytic leukemia (AML) have varied outlooks for survival after the diagnosis. To identify pretreatment prognostic indicators in AML, we analyzed 132 cases of AML seen at our hospital between June, 1989 and December, 1994. The median age of the patients was 40 years (range, 15-81). There were 63 male and 69 female patients. One hundred eight patients (82%) received induction chemotherapy which was based on cytarabine plus anthracyclines. Sixty six patients achieved complete remission (CR) and the CR rate among the patients given induction chemotherapy was 61%. The median duration of CR was 11.2 months. After median follow up of 6.6 months (range 0.5-51.4), 26 patients (39%) remain in continuous CR. The median duration of overall survival of the patients was 6.7 months. After median follow up of 10.6 months (range, 0.1-52.7), 41 patients (31%) are alive. Variables affecting duration of CR included the age of the patients, performance status of the patients, percentage of blast in the peripheral blood, hemoglobin level, percentage of blast in the bone marrow, FAB subtype, and CD7 marker positivity. Variables affecting survival duration included age of the patients, performance status of the patients, absolute blast count (ABC) in the peripheral blood, bone marrow cellularity, the percentage of blast in the bone marrow, and CD5 marker positivity. Multivariate analysis showed that the age of the patients and percentage of blast in the bone marrow were significant independent indicators for overall survival of the patients. Further studies utilizing cytogenetics and molecular characteristics of leukemic cell are warranted to better define the prognostic factors of patients with AML.

Adolescent↗
PubMed1995

Contribution of B cell subsets to delayed development of MAIDS in xid mice.

C57BL/6 (B6) mice develop a syndrome of progressive lymphoproliferation and immunodeficiency, murine AIDS (MAIDS), when infected with an etiologic replication-defective virus termed BM5def. Induction of MAIDS requires the presence of CD4+ T cells and B cells. B6 mice with altered conventional B cell function and a deficit in CD5+ B cells due to the xid mutation develop disease with a greatly prolonged latency. The association of this mutation with resistance to MAIDS was confirmed in studies of P.xid mice. To test the hypothesis that conventional B cells are required for rapid induction of disease, B6.xid mice were injected with spleen cells from nude mice or were given bone marrow from aged donors. Both sets of recipients developed advanced disease by 10 weeks post infection, suggesting that resistance to MAIDS in xid mutants may be due to effects of B cells other than the CD5+ subset.

Agammaglobulinaemia Tyrosine Kinase↗
PubMed1995

Adult Hirschsprung's disease. Results of the Duhamel's procedure.

Eleven patients with adult Hirschsprung's disease were treated at Seoul National University Hospital (SNUH, 8 cases) and Chosun University Hospital (CUH, 3 cases) between 1985 and 1992. Of the 11 patients, seven were male. The age of the patients ranged from 11 to 30 years, and all presented with chronic constipation and recurrent faecal impactions that required periodic enemas and laxatives. The Duhamel's operation, as a single or staged procedure, was performed in all patients. Levels of aganglionosis in 9 patients were confined to the rectosigmoid colon (82%). There were three major post-operative complications. Two patients developed fistula-in-ano at the anastomotic site, and one patient developed ileus. However, these complications resolved with conservative management. The longterm results were excellent except for one patient who developed impotence. The mean frequency of bowel movements was usually once or twice a day without the aid of other treatments. Our results indicate that Duhamel's operation is a highly acceptable procedure in the management of adult Hirschsprung's disease.

Adolescent↗