OBJECTIVES: Autism is a complex neurodevelopmental spectrum disorder with a strong genetic component. Previous neurochemical and genetic studies have suggested the possible involvement of the serotonin system in autism. Tryptophan 2,3-dioxygenase(TDO2) is the rate-limiting enzyme in the catabolism of tryptophan, which is the precursor of serotonin synthesis. The aim of this study was to investigate the association between the TDO2 gene and autism spectrum disorders(ASD) in a Korean population. METHODS: The patients were diagnosed with ASD on the basis of the DSM-IV diagnostic classification outlined in the Korean version of the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. The present study included the detection of four single nucleotide polymorphisms(SNPs) in the TDO2 gene(rs2292536, rs6856558, rs6830072, rs6830800) and the family-based association analysis of the single nucleotide polymorphisms in Korean ASD trios using a transmission disequilibrium test(TDT) and haplotype analysis. The family trios of 136 probands were included in analysis. 87.5% were male and 86.0% were diagnosed with autism. The mean age of the probands was 78.5+/-35.8 months(range: 26-264 months). RESULTS: Two SNPs showed no polymorphism, and there was no significant difference in transmission in the other two SNPs. We also could not find any significant transmission in the haplotype analysis(p>.05). CONCLUSION: We could not find any significant statistical association between the transmission of SNPs in the TDO2 gene and ASD in a Korean population. This result may not support the possible involvement of the TDO2 gene in the development of ASD, and further exploration might be needed to investigate other plausible SNP sites.
Appointments and Schedules ; Autistic Disorder* ; Child ; Autism Spectrum Disorder* ; Classification ; Diagnostic and Statistical Manual of Mental Disorders ; Haplotypes ; Humans ; Male ; Metabolism ; Polymorphism, Single Nucleotide ; Serotonin ; Tryptophan

PURPOSE: Kawasaki disease(KD) is a multisystemic inflammatory vasculitis of unknown etiology, but immunological abnormalities have been documented and implicated in the pathogenesis of KD. Matrix metalloproteinases(MMPs) have proteolytic activity against connective tissue proteins, and increased activity of MMPs and a quantitative imbalance between MMP and tissue inhibitor of MMP (TIMP) can result in several pathologic conditions. MMP and TIMP may also be involved in the formation of coronary arterial lesions in KD. METHODS: Serum levels of MMP1, MMP2, MMP9, TIMP1, TIMP2, interleukin(IL)-6 and tumor necrosis factor(TNF)-alpha were measured in 27 KD patients(group I, 10 patients with normal coronary artery; group II, 17 patients with coronary arterial lesions) and 15 healthy children(group III). Blood samples from each study group were drawn before and after intravenous immunoglobulin(IVIG) therapy and in the convalescent stage. RESULTS: The MMP9 levels and MMP9/TIMP2 ratios before and after IVIG therapy were significantly higher in group II. The MMP9 levels were significantly higher before IVIG therapy, and decreased through the convalescent stage. The IL-6 and TNF-alpha levels were also significantly higher in group II than in the other groups. The serum MMP9 levels showed significantly positive correlation with the circulating leukocyte counts and IL-6 levels. CONCLUSION: The increased levels of MMP and the imbalance between MMP and TIMP increase the susceptibility to the coronary arterial lesions in KD. The cytokines including IL-6 and TNF-alpha are also important in the activation of MMP and formation of coronary arterial lesions in KD.
Connective Tissue ; Coronary Vessels ; Cytokines* ; Humans ; Immunoglobulins, Intravenous ; Interleukin-6 ; Leukocyte Count ; Matrix Metalloproteinases* ; Mucocutaneous Lymph Node Syndrome* ; Necrosis ; Tumor Necrosis Factor-alpha ; Vasculitis

Extramammary Paget's disease (EMPD) is a uncommon neoplastic condition of apocrine gland-bearing skin and its occurrence in combination with Bowen's disease is very rare. The most common site of involvement is the vulva, although perineal, perianal, scrotal and penile skin may also be affected. EMPD is usually not combined with Bowen's disease. We report an interesting case of EMPD combined with Bowen's disease, which was confirmed by immunohistochemical stain.
Bowen's Disease ; Paget Disease, Extramammary ; Skin ; Vulva

PURPOSE: Kawasaki disease is a multisystemic inflammatory vasculitis and associated with neurologic features such as aseptic meningitis. High-dose intravenous immunoglobulin(IVIG) is used to treat Kawasaki disease and generally considered to be safe, but rare cases of aseptic meningitis with unknown etiology have been reported. The aseptic meningitis associated with Kawasaki disease was compared with meningitis as the adverse reaction of high-dose IVIG. METHODS: Sixteen Kawasaki disease patients with typical meningeal irritation symptoms were reviewed from January 1997 to July 2002. Group I(n=11) had meningitis associated with Kawasaki disease and Group II(n=5) had meningitis as the adverse reaction of high-dose IVIG therapy. The clinical features and hematologic and cerebrospinal fluid(CSF) findings were compared between the two groups. RESULTS: The duration of fever was significantly longer in group I than group II. Meningeal irritation symptoms were milder in group II than group I. Hemoglobin levels were lower in group II than group I. Monocyte counts were higher in group I than group II. In the CSF analysis, neutrophil counts were significantly higher in group II than group I. Otherwise, there were no significant differences in CSF protein and sugar levels between the two groups. CONCLUSION: Aseptic meningitis occurred in patients with Kawasaki disease after administration of high-dose IVIG. High-dose IVIG was considered to be safe in general. However, clinicians should be aware of the potential for neurologic complications such as acute aseptic meningitis in patients receiving high-dose IVIG for Kawasaki disease.
Fever ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Meningitis ; Meningitis, Aseptic* ; Monocytes ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Vasculitis

PURPOSE: The purpose of this study is to investigate the clinical manifestations and the risk factors of recurrent Kawasaki disease(KD). METHODS: From March 1995 to June 2003, 14 children with recurrent KD in Ewha Womans University Hospital were etrospectively evaluated by reviewing their admission reports. The clinical characteristics, laboratory findings, treatment and complications of the recurrent KD group were compared to that of a control group. The control group was admitted once for KD. Also, for the patients in the recurrent KD group, the clinical characteristics, laboratory findings, treatment and com plications were compared between an initial and a second episode. RESULTS: Among the 561 children with KD, 14 cases(2.4%) were included in the recurrent KD. At the initial episode of recurrent KD group, the sex ratio was 1.3 : 1(male : female) and the mean age was 23+/-13 months. There were no differences in demographic characteristics, clinical characteristics, laboratory results, treatment and complications between the recurrent KD group and control group. The interval between two episodes in the recurrent KD group was 17.9+/-16.2 months(1-60 months). The total febrile period showed no differences between the two episodes in the recurrent KD group but the febrile period before admission was shorter in the second episode(P=0.02). The clinical characteristics, laboratory findings, treatment and coronary artery complications were not different in the two episodes of the recurrent KD group. CONCLUSION: There were no predictive clinical characteristics or laboratory findings for recurrent KD. Treatment and coronary artery complications were not different between an initial and a second episode of the recurrent KD.
Child ; Coronary Vessels ; Female ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Recurrence ; Risk Factors ; Sex Ratio

OBJECTIVE: Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. METHODS: We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. RESULTS: SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m², respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. CONCLUSION: Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery.
Body Mass Index ; Cystectomy ; Female ; Follow-Up Studies ; Humans ; Laparoscopy* ; Laparotomy ; Medical Records ; Minimally Invasive Surgical Procedures ; Operative Time ; Ovary ; Postoperative Complications ; Retrospective Studies

BACKGROUND: Coughing is a side effect of opioids that is rarely studied. Here, we evaluated the incidence of remifentanil induced coughing during anesthesia induction in an attempt to identify its risk factors and to examine the preventive effects of lidocaine and salbutamol. METHODS: A total of 237 patients scheduled to undergo general anesthesia were allocated randomly into three groups. Group C received no medication, while Group L received 2% lidocaine at 0.5 mg/kg intravenously 1 minute prior to remifentanil infusion and Group S inhaled one metered aerosol puff of salbutamol 15 minutes prior to entering the operating room. Remifentanil was infused at 5 ng/ml by target controlled infusion and coughing was measured for five minutes and graded as none, mild, moderate, or severe based on the number of coughs. RESULTS: The incidences of coughing were 30.4%, 25.3%, and 35.4% in Groups C, L, and S, respectively. The incidences, onset times, and severity of coughing did not differ significantly among groups. In addition, multivariate analysis showed that non-smoking and a lower body weight were risk factors of remifentanil-induced coughing (odds ratio, 8.13; P = 0.024, 1.11, and 0.004, respectively). CONCLUSIONS: The incidence of remifentanil-induced coughing was 30%. A total of 0.5 mg/kg lidocaine and 1 metered aerosol puff of salbutamol did not prevent coughing. Non-smoking and low body weight were found to be risk factors of remifentanil-induced coughing.
Albuterol ; Analgesics, Opioid ; Anesthesia ; Anesthesia, General ; Body Weight ; Cough ; Humans ; Incidence ; Lidocaine ; Multivariate Analysis ; Operating Rooms ; Piperidines ; Risk Factors

Background: The purpose of this study was to establish effective measures and preventive managements to the cases of bloodborne exposures among the health care workers. Method: We reviewed 331 cases that were reported to the infection control services of five hospitals from March 2000 to February 2002. The SPSS PC 10.0 was used to analyze the date. Result: The proportion of registered nurses, doctors, housekeepers, unrse aid and technicians were 48.0%, 27.8%, 10.0%, 6.0%, and 5.4% in order. The proportion of female exposures was 75.2%. Fifty six point eight percent of exposure have been working less than 3 years. The data also indicated that there were differences by their Occupations. Thirty nine point six percent of the exposures occurred at the general ward, and 16.6% of them occurred at the operation room and 13.0% of them occurred at the intensive care unit. Most of the bloodborne exposures occurred during blood sampling (26.3%), putting away the needle including the recapping(18.4%). and giving injection (14.5%). The major instruments of exposures were syring-needle (79.6%), blade (7.3%), suture needle (6.1%), and direct contact with blood (2.7%). The hands were the most common body parts of exposures (95.2%). The bloodborne pathogens were hepatitis B virus (HBV, 38.1%(126/331), hepatitis C virus (10.3%), syphilis (4.5%), and human immuno-dificiency virus (2.7%). Forty one point three percent(52/127) of health care workers(HCWs) usually didn't realize whether they had antibody to the HBV or not at the time of exposure; Seventy five percent (39/52) of them found out later to be positive for HBV antibody. Only 48.7% (19/39) of them could get the medical treatment since they didn't know about immunity before the test. The cases with completion of management at the time of exposure, those of follow-up evaluations, and the cases with lost follow-up were 40.7%, 38.6% and 20.7%. in order. None of the cases were led to actual infections. Conclusion: The results from this study can be applied to establish effective measures of prevention and managements of the bloodborne exposures among the HCWs. If the laboratory data of HCWs were available at the time of exposure, more effective management would be possible. Also the results from this study emphasized the need for the systematic and practical follow-up.
Blood-Borne Pathogens ; Delivery of Health Care* ; Female ; Follow-Up Studies ; Gyeonggi-do* ; Hand ; Hepacivirus ; Hepatitis B virus ; Human Body ; Humans ; Infection Control ; Intensive Care Units ; Needles ; Occupations ; Patients' Rooms ; Seoul* ; Sutures ; Syphilis

BACKGROUND: Endoscopic thyroidectomy was recently introduced and has been rapidly accepted by surgeons and patients. The present study was conducted to estimate and compare the incidences of postoperative nausea and vomiting (PONV) after endoscopic thyroidectomy using two different anesthetic methods: sevoflurane based balanced anesthesia; total intravenous anesthesia (TIVA). METHODS: Ninety nine female patients that were scheduled to undergo elective endoscopic thyroidectomy under general anesthesia were enrolled. These patients were randomly allocated to receive sevoflurane based balanced anesthesia (BA group) or propofol-remifentanil anesthesia (TIVA group). PONV was evaluated using a 4-point Likert scale, and pain using a visual analogue scale (VAS; range 0 to 100) for 0-2, 2-6, and 6-24 hours postoperatively. At 24 hours postoperatively, overall patient satisfaction regarding PONV and pain were recorded. RESULTS: The incidence of PONV was 14.6% in the TIVA group and 51.3% in the BA group. The incidence of nausea at 0-2 and 2-6 hours postoperatively was lower in the TIVA group than in the BA group (4.2% vs. 35.9%, 6.3% vs. 23.1%, respectively), but no between-group difference was observed at 6-24 hours postoperatively (8.3% vs. 5.1%). Antiemetic usage at 0-2 and 2-6 hours was lower in the TIVA than the BA group (4.2% vs. 38.5%, 6.3% vs. 23.1%), but no between-group difference was observed for 6-24 hours (6.3% vs. 7.7%). There were no differences in pain or in patient satisfaction. CONCLUSIONS: After endoscopic thyroidectomy, total intravenous anesthesia with propofol-remifentanil is associated with less PONV during the early postoperative period (0-6 hours) than sevoflurane based balanced anesthesia.
Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Balanced Anesthesia ; Female ; Humans ; Incidence ; Methyl Ethers ; Nausea ; Patient Satisfaction ; Postoperative Nausea and Vomiting ; Postoperative Period ; Thyroidectomy

BACKGROUND: Interleukin-4 plays an important role in pathogenesis of asthma, especially in developing atopy by means of switching B lymphocytes to produce IgE. It has been shown that there is polymorphism in the Interleukin-4 promoter region, transversion of cytosine to thymine at-598 from translation initiation site of IL-4 gene. There has also been quite a few works to reveal the role of the polymorphism of IL-4 gene in patients with asthma. We performed this investigation to determine the role of the polymorphism in the severity of symptoms of patients with asthma. We also examined the frequency and the type of the polymorphism in asthmatics compared with non-asthmatics as well. METHOD: The subjects enrolled in this study were 49 asthmatics and 33 non-asthmatics. All the asthmatics were classified as mild and moderate to severe by the NHLBI/WHO Workshop. DNA from both asthmatics and non-asthmatics was extracted, then performed ARMS(Amplification Refractory Mutation System) as well as RFLP using BsmF1 restriction enzyme in order to confirm the polymorphism of IL-4 gene. RESULTS: There was no significant difference in the occurrence of polymorphism of the IL-4 promoter sequence between asthm and non-asthma groups(P=0.7). Among those with polymorphisms, the number of C/C type was slightly more than C/T type in both asthmatics and non-asthmatics, 26 vs 21 in asthmatics and 18 vs 15 in non-asthmatics, which was, however, insignificant statistically. No significant relationship between the severity of asthma and the polymorphism was found(P=0.7). CONCLUSION: There was no significant difference between the severity of asthma and the IL-4 promoter polymorphism(P=0.709). Interestingly, the frequency of the polymorphism in both asthmatics as well as non-asthmatics was found to be even higher than that occurred in Caucasians. However, no significant difference in the frequency of the polymorphism was found in both groups.
Asthma* ; B-Lymphocytes ; Cytosine ; DNA ; Education ; Humans ; Immunoglobulin E ; Interleukin-4* ; Polymorphism, Restriction Fragment Length ; Promoter Regions, Genetic ; Thymine