Systemic Classification for a New Diagnostic Approach to Acute Abdominal Pain in Children / 대한소아소화기영양학회지

PURPOSE: With previous methods based on only age and location, there are many difficulties in identifying the etiology of acute abdominal pain in children. We sought to develop a new systematic classification of acute abdominal pain and to give some helps to physicians encountering difficulties in diagnoses. METHODS: From March 2005 to May 2010, clinical data were collected retrospectively from 442 children hospitalized due to acute abdominal pain with no apparent underlying disease. According to the final diagnoses, diseases that caused acute abdominal pain were classified into nine groups. RESULTS: The nine groups were group I "catastrophic surgical abdomen" (7 patients, 1.6%), group II "acute appendicitis and mesenteric lymphadenitis" (56 patients, 12.7%), group III "intestinal obstruction" (57 patients, 12.9%), group IV "viral and bacterial acute gastroenteritis" (90 patients, 20.4%), group V "peptic ulcer and gastroduodenitis" (66 patients, 14.9%), group VI "hepatobiliary and pancreatic disease" (14 patients, 3.2%), group VII "febrile viral illness and extraintestinal infection" (69 patients, 15.6%), group VIII "functional gastrointestinal disorder (acute manifestation)" (20 patients, 4.5%), and group IX "unclassified acute abdominal pain" (63 patients, 14.3%). Four patients were enrolled in two disease groups each. CONCLUSION: Patients were distributed unevenly across the nine groups of acute abdominal pain. In particular, the "unclassified abdominal pain" only group was not uncommon. Considering a systemic classification for acute abdominal pain may be helpful in the diagnostic approach in children.

Bone response around immediately placed titanium implant in the extraction socket of diabetic and insulin-treated rat maxilla

INTRODUCTION: Dental implants are used routinely with high success rates in generally healthy individuals. By contrast, their use in patients with diabetes mellitus is controversial because altered bone healing around implants has been reported. This study examined the bone healing response around titanium implants placed immediately in rats with controlled and uncontrolled diabetes. MATERIALS AND METHODS: Twenty rats were divided into the control, insulin-treated and diabetic groups. The rats received streptozotocin (60 mg/kg) to induce diabetes; animals in the insulin-treated group also received three units of subcutaneous slow-release insulin. A titanium implant (1.2x3 mm) was placed in the extraction socket of the maxillary first molar and bone block was harvested at 1, 2 and 4 weeks. RESULTS: Bone formation around the implants was consistently (from 1 to 4 week post-implantation) slower for the diabetic group than the control and insulin-treated group. Bone morphogenesis in the diabetic rats was characterized by fragmented bone tissues and extensive soft tissue intervention. CONCLUSION: The immediate placement of titanium implants in the maxilla of diabetic rats led to an unwanted bone healing response. These results suggest that immediate implant insertion in patients with poorly controlled diabetes might be contraindicated.

Muscle Mass in the Calf as a Presenting Symptom of Sarcoidosis / 대한류마티스학회지

Sarcoidosis is a multisystemic granulomatous disease of unknown cause. Lung, skin, eye, liver and lymph nodes are commonly affected. But the nodular type of muscular sarcoidosis is rare. The nodular type can be presented with a soft tissue mass that may be confused with a tumor. Magnetic resonance imaging and muscle biopsy are useful methods for early diagnosis. Optimal management of nodular sarcoidosis is not well known, but surgical excision or corticosteroid may be considered as an initial management. We report a case of nodular muscular sarcoidosis as an initial manifestation of sarcoidosis in a 56-year-old woman who was treated with corticosteroid therapy after surgical excision.

Loss of Heterozygosity and Microsatellite Instability at Multiple Tumor Suppressor Genes in Gastric Carcinomas

PURPOSE: The aim of this study was to investigate the frequency of loss of heterozygosity and the microsatellite instability at multiple tumor suppressor gene loci in gastric adenocarcinomas. MATENRIALS AND METHODS: Loss of heterozygosity and the microsatellite instability at several tumor suppressor gene loci were analyzed in 29 primary gastric carcinomas by using microdissection and the polymerase chain reaction. RESULTS: Twenty-three (79%) of the 29 cases demonstrated loss of heterozygosity at one or more loci. The frequency of loss of heterozygosity at the p53 locus was the highest (63%) and those at the VHL, APC, p16, Rb, MEN1, BRCA1, DPC4, 3p21, and 16p13 region were 41%, 36%, 19%, 29%, 33%, 26%, 21%, 32%, and 11%, respectively. Compared with histological type, loss of heterozygosity was more common in diffuse-type gastric cancer (P<0.01). Interestingly, 9 of 10 tumors with allelic deletion at the p53 locus showed loss of heterozygosity at other tumor suppressor gene loci. The microsatellite instability was also detected in 6 (20%) of the 29 cases at one or more loci. CONCLUSION: These data suggest that frequent loss of heterozygosity and the microsatellite instability at multiple tumor suppressor genes might be required for the development and the progression of gastric carcinomas and that p53 allelic loss may be the most frequent event in the development of gastric carcinomas.

Functional Defect of the Fas Mutants Detected in Gastric Cancers

PURPOSE: The balance between cell proliferation and apoptosis is crucial for homeostatic maintenance in a cell population. Decreased apoptosis or uncontrolled proliferation can lead to cancer. The Fas receptor signal through a cytoplasmic death domain is very important in the apoptotic pathway. To identify the effect of the death domain of the Fas gene in the development and/or progression of gastric cancer, we examined the apoptotic potential of five known Fas mutants detected in gastric cancers. MATENRIALS AND METHODS: A wild-type Fas gene was cloned with cDNA from normal liver tissue and full length Fas was sequenced. Mutants of the gene were generated with site- directed mutagenesis by using the wild-type gene and specific primers. Wild- and mutant-type genes were transfected to HEK293 cells. Forty-eight hours after transfection the cells were stained with DAPI and cell death was counted under fluorescent microscopy. RESULTS: In wild-type Fas-transfected cells, the percentage of apoptotic cells was 85.9+/-3.6%, and significant cell death and classic morphologic signs of apoptosis were observed. However, the percentages of apoptotic cells transfected with N239D, E240G, D244V, and R263H of tumor-derived mutant Fas were 29.5+/-2.08%, 28.5+/-3.34%, 25.225+/-2.06%, and 36.625+/-4.49%, respectively. CONCLUSION: These results suggest that inactivation of Fas caused by mutations in the death domain of the Fas gene may be one of the possible escape mechanisms against Fas-mediated apoptosis and that inactivating mutation of the Fas may contribute to the development or progression of gastric cancers.

Expression Pattern of Caspase 2 in Korean Gastric Cancers

PURPOSE: Caspase 2, a member of the family of ICE-like proteases, is activated by the Fas pathway and induces apoptosis by triggering the caspase cascade. The purpose of this study was to determine whether the expression pattern of caspase 2 might be associated with gastric cancer development and if so, to determine to which pathologic parameter it is linked. MATENRIALS AND METHODS: For the construction of the gastric cancer tissue microarray, 78 paraffin-embedded tissues containing gastric cancer areas were cored 3 times and transferred to the recipient master block. The expression pattern of caspase 2 was examined on tissue microarray slides by using immunohistochemistry and was compared with pathologic parameters, including histologic type, depth of invasion, lymph node metastasis, and peritoneal dissemination. RESULTS: Caspase 2 was expressed on superficial and foveolar epithelial cells and lymphocytes in the gastric mucosa, mainly in cytoplasm. We found loss of caspase 2 expression in 41 (52.6%) of the 78 gastric cancer tissues. Statistically, histologic type and other pathologic parameters were not related with loss of caspase 2 expression. CONCLUSION: Our findings provide enough evidence that loss of caspase 2 expression may contribute to the development of Korean gastric cancer and that it might be one of the possible escape mechanisms from apoptosis in gastric cancer.

Association of the Interleukin-1beta and Interleukin-1 Receptor Antagonist Genetic Polymorphism and Korean Gastric Cancer

PURPOSE: Interleukin 1beta (IL-1beta) polymorphisms are associated with hypochlorhydria, atrophic gastritis, and increased risk of gastric cancer in Caucasians. We tried to determine whether the IL-1beta and IL-1 receptor antagonist (IL-1 RN) genetic polymorphisms contribute to the development of gastric cancer and the specific type of gastritis in Korean. MATENRIALS AND METHODS: The study population was comprised of 128 gastric cancer patients with histologically proven carcinoma and 63 normal healthy individuals. Sixty-eight carcinomas were of intestinal-type and sixty tumors were of diffuse-type. No patient had a familial gastric cancer history. The 511 bp and 31 bp polymorphisms in the IL-1beta were genotyped by polymerase chain reaction (PCR)-restriction fragment length polymorphism. The polymorphism of the IL-1 RN was analyzed with variable number tandem repeat after PCR. RESULTS: The genotype of 511C/-31T of IL-1beta and allele 1 of IL-1 RN was dominant in the present subjects. The allelic frequencies of the C allele IL-1beta, which is a high risk genotype for gastric cancer, were 0.551 and 0.429 in gastric cancer and normal controls, respectively. Statistically, significant difference in allelic frequencies of three polymorphic sites between gastric cancer patients and normal controls, and between intestinal-type and diffuse-type was not observed. CONCLUSION: These results suggest that the polymorphisms of IL-1beta and IL-1 RN may not contribute to the development of Korean gastric caner and that other endogenous or exogenous factors will be important for gastric carcinogenesis.

Expression Pattern of the Trefoil Factor Family 1 in Gastric Adenoma and Carcinoma

PURPOSE: The trefoil factor family 1 (TFF1) has a protective effect against gastric mucosal damage induced by nonsteroidal anti-inflammatory drugs or ethanol. In addition, a TFF1 knockout mouse model has exhibited circumferential adenomas with high-grade dysplasia, of which 30% progressed into frankly invasive carcinomas. We tried to determine whether the expression pattern of the TFF1 could be involved in the development of sporadic gastric carcinomas. MATENRIALS AND METHODS: We examined TFF1 expression in a series of 43 sporadic gastric carcinomas and 18 gastric adenomas by immunohistochemistry. RESULTS: Strong positive TFF1 staining was identified primarily in the normal gastric mucosa, mainly in the cytoplasm of the superficial and foveolar epithelium. We found TFF1 expression in 55.8% (24 out of 43) of the gastric carcinomas and in 16.7% (3 out of 18) of the gastric adenomas. Statistically, TFF1 immunoreactivity was significantly higher in diffuse-type (82.4%) than in intestinal-type (38.5%) carcinomas (p=0.0058, Fisher's exact test). CONCLUSION: Our findings provide sufficient evidence that the expression of TFF1 in gastric cancer may simply disclose gastric-type differentiation of neoplastic cells and provide further support for the existence of at least two pathways of malignant transformation of the gastric mucosa: one via intestinal metaplasia and adenomatous dysplasia, leading to glandular carcinomas with intestinal-type differentiation, and the other via hyperplastic changes or de novo changes, leading to diffuse carcinomas and to a subset of glandular carcinomas displaying gastric-type differentiation.

Immunohistochemical Study on the Expression of c-erbB-2 Oncoprotein in the Odontogenic cysts

To investigate epithelial cell proliferation reactivity in the odontogenic cysts, the expression of c-erbB-2 oncoprotein by epithelial lining was studied in odontogenic keratocyst(OKC, n=10), dentigerous cyst(DC, n=12), radicular cyst(RC, n=12) and normal dental follicle(n=7). The c-erbB-2 immunoreactivity was studied using a streptavidine- biotin- peroxidase method with polyclonal rabbit anti-human antibody to c-erbB-2 oncoprotein which is known to react with formalin fixed, paraffin-embedded sections and the intensity of staining was determined by manually. In all of 10(100%) OKCs, showed positive expression for c-erbB-2 oncoprotein compared with 10/12(83.3%) in DCs, 11/12(91.7%) in RCs and 5/7(71.4%) in normal dental follicles. The expression within OKC was higher than that of DC, RC and dental follicle but statistically not significant(p>0.05) and but may reflects underlying genetic defect. These results demonstrate differences in c-erbB-2 expression between the epithelial linings of the three major odontogenic cyst types, indicating differences in proliferation activity and differentiation processes within these lesions. And, in particular, these results are able to explain the peculiar aggressive growth pattern of OKC.

A Case of Trichilemmal Carcinoma on the Lower Lip / 대한피부과학회지

We report a case of Trichilemmal carcinoma in a 75-year-old man who was presented with an exophytic nodule on the lower lip. The tumor was composed of glycogen-rich cytoplasmic cells with PAS-positive, diastase-labile and had a characteristic trichilemmal keratinization. The trichilemmal carcinoma is well known to have originated from the outer root sheath of the hair follicle in the hair bearing area. It is interesting that our case had developed on the lip, an exceptional site for a follicular tumor : the hair follicle could not be seen. It might have been developed from an ectopic follicle or at the follicle of vermillion border and grew up into the lip.

A Case of Segmental Ischemic Colitis Associated with Nonsteroidal Antiinflammatory Drugs / 대한류마티스학회지

Acute colonic ischemia is the most common form of gastrointestinal ischemia. The majority of cases of non-occlusive ischemic colitis are associated with severe congestive heart failure with low cardiac output, or disease states resulting in dehydration, or the splanchnic vasoconstrictive effect of some dedications. Reactive splanchnic vasoconstriction is responsible for nonocclusive ischemic colitis. The authors report a case of 37-year-old man, who had a history of 8-year gout and no evidence of heart disease or severe dehydration and developed segmental ischemic colitis during nonsteroidal antinflammatory drug treatment, which ultimitely progressed to transmural infacrction, therby undergone extended right hemicolectomy

A Case of Tracheal Agenesis with Tracheoesphageal Fistula / 대한주산의학회잡지

Tracheal agenesis with bronchoesophageal fistula should be suspected in any newborn who is cyanotic at birth, has an absent cry, and cannot be intubated but shows some improvement when ventilated by bag and mask. It is important to make the diagnosis as soon as possible because esophageal intubation or a distal tracheostomy may be the only method to provide an airway while other measures and/or diagnostic confirmation are being sought. We experienced a case of complete tracheal agenesis with carinoesophageal fistula, cloacal anomalies in a male neonate.

A Study on Immunity of Welders / 대한산업의학회지

The authors examined human immunity indicators such as CD4, CD8, Natural Killer (NK) cell, IgG, IgA, and IgM, and heavy metals such as Pb, Cr, Cd to evaluate the health hazard of welders. We selected total 126 male subjects, 60 welders who had more than 5 year working history as an exposure group, and 66 office workers and medical college students as a control group. This immunity evaluation approach is the first newly designed study that has never been tried in past studios on welder's heath evaluation. And the results were as follows. 1. Total lymphocyte count of peripheral blood was significantly higher in welder group, 2,615+/-650 ea/microliter compared with 2,368+/-681 ea/microliter in control group (p or =0.05). 3. IgG, IgA, and IgM in welder group were 15.9 mg/dl, 2.7 mg/dl, and 1.5 mg/dl, respectively, and 15.6 mg/dl, 2.9 mg/dl and 1.7 mg/dl in control group. There was no statistical significance between two groups(p> or =0.05). 4. Blood lead, cadmium and chromium concentrations were 4.2+/-1.8 microgram/dl, 0.4+/-0.38 microgram/dl, 1.2+/-0.6 microgram/dl in welder group and 3.2+/-1.7 microgram/dl, 0.44+/-0.29 microgram/dl, 1.1+/-0.6 microgram/dl in control group, respectively, and these value were within normal ranges.

Construction and Evaluation of Soonchunhyang University Hospital"s Computer Information Network / 대한의료정보학회지

These days, the computer network has become the most popular and widely used source of information. There are two kinds of computer networks, the first one is multimedia internet world wide web site and the second one is text based commercial network (etc. Hitel, Chollian. Nownuri, Unitel). With the rapid development of internet, various kinds of medical-related sites are newly appearing on the internet. Even in Korea, several medical-related information sites are on service, however, there are very few compared with foreign sites. World wide web is popular, and creating the homepage for each hospital is becoming more important. In Korea, the number of homepage of about medicine and medical institutes, is increasing. For the construction of Soonchunhyang University Hospital's Computer Information Network, the authors first investigate Korean medical-related information sites available in internet and commercial network. After researching the authors then construct the Computer Information Network of Soonchunhyang University Hospital. This article is written with the intent of assisting those interested in creating and managing their own computer information network system by means of providing relevant data obtained during this process.

A Study on obesity pattern and related factors of the doctors / 예방의학회지

The author surveyed overall obesity indicies and factors concerned with obesity such as dietary intake, physical activity, stress and life style with the subject of doctors. The number of subjects was total 508 with 396 men and 112 women. They were subgrouped into surgical part, medical part and service and basic part by speciality. And also subgrouped into intern and resident, pay doctor, and practitioner by working type. The results were as follows. 1) Obesity indices: BMI of total doctor was 23.1+/-2.8, and WHR was 0.87+/-0.08 and overweight prevalence(BMI>25.0) was 23.6 %. It was within normal limit but slightly over the Korean standard. The degree of obesity indices of subgroups by speciality was "surgical part > medical part > service and basic part", and by working type was "practitioner > pay doctor > intern and resident". 2) Dietary intake and Physical activity: Average dietary intake was 2148+/-451 kcal/day. The degree of dietary intake by speciality was "surgical part > medical part > service and basic part". By working type it was "practitioner > pay doctor > intern and resident". Average physical activity was 29+/-5 METs/day. The degree of physical activity also showed similar pattern. But there was no significant difference among each groups. 3) Comparison between over-weight and non-over-weight group: The items that showed significant difference between two groups were dietary intake, skip breakfast, regular exercise, smoking, heavy drinking, chronic disease etc.

A Study on Serum Lipid Levels of Children in Pusan / 예방의학회지

This is a cross-sectional study to evaluate the serum lipid levels of children living in Pusan in 1996. The distribution of age is from 2 years old to 12 years old. In female children mean total cholesterol is 171.4+/-26.2mg/dl, triglyceride is 104.7+/-50.6mg/dl, HDL-cholesterol is 54.4+/-14.8mg/dl, and LDL-cholesterol is 95.4+/-32.9mg/dl. In male children mean total cholesterol is 167.9+/-25.2mg/dl, triglyceride is 90.6+/-45.5mg/dl, HDL-cholesterol is 55.4+/-11.7mg/dll, and LDL-cholesterol is 94.4+/-23.6mg/dl. The percentile of serum lipid levels is measured in children. The 95th percentile of serum total cholesterol is 210mg/dl in male children, and 214mg/dl in female children. And, the 95th percentile of serum triglyceride is 184mg/dl in male children, and 191mg/dl in female children. And, the 95th percentile of LDL-cholesterol is 133mg/dl in male children, and 135mg/dl in female children. Serum total cholesterol is positively related to age(r=0.18), height(r=0.08), weight(r=0.17), obesity index(r=0.12), and negatively related to father's education level(r=-0.13), mother's education level(r=-0.13). Serum triglyceride is positively related to weight(r=0.23), age(r=0.31) and negatively related to father's education level(r=-0.12), mother's education level(r=-0.18). Serum HDL-C was positively related to mother's education level(r=0.07) and negatively related to height(r=-0.12), weight(r=-0.09). Conclusively, the serum lipid levels of children living in Pusan is generally so high that the family and school must try to control the serum lipid levels.

The Seroprevalence and Related Factors of Helicobacter pylori Infection / 예방의학회지

Helicobacter pylori is now recognized as causative agent of chronic gastritis and peptic ulcer, and strongly associated with development of gastric carcinoma. With development of sensitive and specific serologic tests to identify individuals infected with Helicobacter pylori, the epidemiologic study of this diseases has been investigated. But it's transmission route is not established, yet. The purpose of this study is to measure the prevalence of Helicobacter pylori infection in healthy children and young adults and to evaluate related factors for Helicobacter pylori infection in Korea. The seroprevalence of Ig G antibodies to Helicobacter pylori was determined using a Enzyme Linked Immunosorbent Assay and we obtained the information, such as demographic characteristics, monthly household income, numbers of family members in the house, numbers of persons using same room, type of house, and type of drinking water through the questionnaire survey. The observed overall seropositivity rate was 25.7%. The rate is increased progressively from 5.8% in the age group 1~3 years to 44.4% in the age group 20~29 years(chi-square for trend, p<0.001). Especially, the rate increased steeply from 6.5% in the age group 4~6 years to 20.8% in the age group 7~9 years, and this suggested that elementary school age was the major acquisition time of Helicobacter pylori infection. In multivariate logistic regression model, age, numbers of family members in the house, and type of house was statistically significant variables for Helicobacter pylori infection. Each odds ratio(95% CI) were as follows; base to age group 1~9 years, age group 10~19 years 3.6(2.0~6.4), age group 20~29 years 7.3(4.1~13.1) and base to group of 1~3 family members, groups of 4~5 family members 2.1(1.1~4.0), group of 6 or more family members 2.7(1.3~5.4) and base to apartment, single and multihouse 1.9(1.1~3.5). Sex, monthly household income, numbers of persons using same room, and type of drinking water was not statistically significant for Helicobacter pylori infection.

A Study on the Factors related to the Cognitive Impairment of the Elderly in a Rural Area / 예방의학회지

To investigate the factors which affecting the cognitive impairment of the 60 or more age group, the authors surveyed for the subjects in some area of Kyungnam Province. 201 studied subjects were tested for cognitive function with mini-mental state examination(MMSE). Information on demographic characteristics and life style has been collected through direct interview. The concentration of Al and Ca of subject's drinking water, which might be related with cognition, was measured by Inductively Coupled Argon Plasma Spectrometer. The main results were summarized as follows. 1. The prevalence rate of cognitive impairment was 18.4% in male and 45.2% in female and this sexual difference was statistically significant(p=0.03). And the uneducated or illiterated showed significantly high prevalence rate of cognitive impairment(p=0.02). 2. In stratified analysis by sex and education year, we can not see significant trend indicating the neurotoxic effects of aluminum and protective effects of calcium to the cognitive function(p>0.05). 3. The correlation between the concentration of aluminum in drinking water and the MMSE score in whole subjects showed weak negative relationship(r=-0.066). But there was no statistical significance(p=0.434).

Preoperative Evaluation on Geriatric Patients / 대한마취과학회지

We have analysed 72 cases of geriatric patients over 70 year of age who underwent anesthesia in our Aospital from Jan. 1970 to May 1979 and the results were as follows; 1) Male patients were more than female(1.05: 1). (Male, 37 cases(51.4%) and female, 35cases (48. 6%). 2) By ASA classification, physical status was class II in 32 cases, E II in 24 cases, III in 12 cases, E III in 2 cases and IV in 2 eases. 3) The number of the patients of general surgery department(46.63%) was highest. 4) Preoperative problems were cardiovascular diseases including hypertension (11cases) and LVH(25 cases), arrhythmia(6cases), tachycardia(4cases), RBBB(2cases) and bradycardia (2 cases) in EKG. 5) Preoperative pulmonary disease including pulmonary tbc(14 cases), chronic bronchitis (6 cases), and emphysema(4 cases) was revealed in the chest PA. 6) There was no mortality during the operative or postoperative period.