BACKGROUND: Basic Fibroblast Growth Factor (bFGF) is known to be closely related to myelofibrosis and hematopoiesis including magakaryopoiesis. The main bone marrow finding in patients with idiopathic thrombocytopenic purpura (ITP) is an increased megakaryopoiesis without myelofibrosis. Purposes of this study are to evaluate the changes in bFGF expression pattern in the bone marrow of patients with ITP and to correlate them with the plasma concentrations of bFGF. METHODS: Paraffin-sections of bone marrow biopsies from 17 cases ITP and 7 cases normal controls, without pathological alterations, were investigated by immunohistochemistry for bFGF and CD68. The plasma levels of bFGF were evaluated by enzyme immunoassay in 7 cases of ITP and controls. RESULTS: The bFGF was strongly expressed in stromal cells and weakly in megakaryocytes in normal controls. The density of the bFGF-expressing stromal cells was decreased in 70% (12/17) of the patients with ITP, compared with none in the other controls. The number of stromal cells in patients with ITP was similar to those in the control groups. The bFGF plasma levels were significantly lower in almost all the ITP patients compared to the control group. CONCLUSIONS: The results indicate that concentrations of bFGF in plasma and bone marrow stromal cells of ITP were decreased. Although the mechanism of low cellular and plasma concentrations of bFGF needs to be elucidated, these findings may complement the serologic and morphological diagnosis of ITP.
Biopsy ; Bone Marrow* ; Complement System Proteins ; Diagnosis ; Fibroblast Growth Factor 2* ; Hematopoiesis ; Humans ; Immunoenzyme Techniques ; Immunohistochemistry ; Megakaryocytes ; Mesenchymal Stromal Cells ; Plasma* ; Primary Myelofibrosis ; Purpura, Thrombocytopenic, Idiopathic* ; Stromal Cells

Hemodialysis (HD) patients continually exposed to heparin are at risk of developing heparin-induced thrombocytopenia (HIT). However, HIT is very rare in chronic HD patients with end-stage renal disease (ESRD). The authors report the case of a chronic HD patient with ESRD who developed HIT complicated by recurrent thrombocytopenia and significant bleeding episodes. A 67-year-old man with diabetic ESRD on chronic HD suddenly developed recurrent acute bleeding episodes and severe thrombocytopenia (platelet count <1.0x10(3)/uL) 2 months prior to presentation. These bleeding episodes and the thrombocytopenia always occurred 1 week after initiating HD with heparin, and improved within 1 week of discontinuing heparin. HIT was confirmed by ELISA for anti-heparin/platelet factor 4 antibody. HD was conducted successfully and thrombocytopenia did not occur after switching argatroban for heparin. This case report suggests that clinicians must consider HIT in the differential diagnosis of thrombocytopenia during maintenance HD.
Aged ; Diagnosis, Differential ; Enzyme-Linked Immunosorbent Assay ; Hemorrhage ; Heparin ; Humans ; Kidney Failure, Chronic ; Pipecolic Acids ; Renal Dialysis ; Thrombocytopenia

BACKGROUND/AIMS: Capsule endoscope (CE) is a new method of investigating entire small bowel (SB). Some reported that current battery time was sufficient for observing entire SB, but others reported negatively. The aims of this study were to determine the factors influencing the entire SB transit rate. METHODS: From Sep. 2002 to Aug. 2003, CE was performed in 197 cases and they were devided into complete/incomplete transit according to getting ileocecal valve image within battery time. sixteen cases were excluded due to anatomical abnormality or artificial procedure. one hundred eighty one cases were analyzed with multiple logistic regression. RESULTS: The complete SB transit rate was 63.5%. Mean battery time was 7 and 1/2 hrs. Gastric transit time (GTT) was significantly shorter in complete group than in incomplete group but the other factors (age, sex, preparation, symptom) were not significant. Mean small bowel transit time in complete group was 4 and 1/2 hrs and ranged from 1 to 8 hrs. In incomplete group (66 cases), 2 cases were reached to distal jejunum, 11 cases to proximal ileum, and the other 53 cases to distal ileum. CONCLUSIONS: Complete SB transit rate of CE was 63.5% in the 181 cases under current battery time. GTT was the only significant factor influencing gastrointestinal transit rate of CE.
Capsule Endoscopes ; Capsule Endoscopy* ; Gastrointestinal Transit* ; Ileocecal Valve ; Ileum ; Jejunum ; Logistic Models

BACKGROUND/AIMS: Capsule endoscopy (CE) is a new method enabling noninvasive diagnosis of small bowel diseases. There have been few studies examining the possibility of interobserver variation according to proficiency. We evaluated the interobserver variability between expert and novice for reviewing CE images. METHODS: Among patients who were taken CE from June 2003 to July 2003, twenty patients were randomly selected. Captured images were assessed by an expert and a novice separately. The expert has experience of more than 150 CE interpretation and the novice only had experience in performing EGD and colonoscopy. The novice had trained on interpretation of the CE with 5 cases before this study. Interobserver agreement was evaluated using kappa coefficient. RESULT: CE findings were divided into normal/ abnormal groups. Abnormal groups were classified into small focal, large focal, multiple diffuse, structural deformity groups. Compared with the expert, the novice missed 2 cases (Meckel's diverticulum and angiodysplasia). There was no disagreement in other cases. CONCLUSION: There is 90% (18/20) interobserver agreement between the expert and the novice for the interpetation of findings CE (k=0.737). Normal findings and diffuse large lesions tended to have higher concordance, whereas small focal lesion and structural deformities were more likely to be a source of disagreement.
Capsule Endoscopy* ; Colonoscopy ; Congenital Abnormalities ; Diagnosis ; Diverticulum ; Humans ; Observer Variation

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) is an important cause of various gastrointestinal diseases. H. pylori eradication is essential for the cure and prevention of associated diseases. Nowdays, proton pump inhibitor (PPI)-based triple therapy is the standard eradication regimen. The aims of this study were to compare the H. pylori eradication rate of different PPI-based triple therapies and to find out the factors influencing the eradication rate. METHODS: From May 2002 through Febraury 2004, H. pylori infected patients were treated with the eradication regimen based on one of the four PPIs (omeprazole, rabeprazole, esomeprazole and lansoprazole) for 1 or 2 weeks. After two weeks, drug compliance, adverse effects, and smoking history during the eradication therapy were obtained. The follow-up H. pylori test was performed 4 weeks after the completion of therapy. The data were analyzed by Chi-square test and multiple logistic regression analysis. RESULTS: Overall eradication rate was 83.5%. There was no significant difference in eradication rate among four PPIs (p=0.379). Odds ratio (OR) for omeprazole and rabeprazole was 1.15 (95% CI 0.50-2.68); for omeprazole and esomeprazole, OR 1.63 (95% CI 0.68-3.89); and for omeprazole and lansoprazole, OR 1.13 (95% CI 0.50-2.56). Smoking habit, site of ulcer, and the duration of therapy affected the eradication rate significantly. CONCLUSIONS: The efficacy of four different PPIs for H. pylori eradication is similar to each other. Smoking, site of ulcer, and the duration of treatment have significant effects on eradication rates.
Adult ; Anti-Infective Agents/*therapeutic use ; Anti-Ulcer Agents/*therapeutic use ; Comparative Study ; Drug Therapy, Combination ; English Abstract ; Female ; Helicobacter Infections/*drug therapy/microbiology ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Proton Pumps/*antagonists & inhibitors

BACKGROUND/AIMS: As a second-line treatment for H. pylori eradication in the case of first-line OAC (omeprazole, amoxicillin, clarithromycin) treatment failure, a minimum of one-week OBMT quadruple therapy composed of omeprazole, bismuth, metronidazole, tetracycline has been recommended in European countries and one or two weeks in USA. In Korea, one-week OBMT quadruple therapy is recommended for the case of first-line OAC treatment failure. Because H. pylori eradication rate of one-week OBMT therapy in Korea is about 80%, the eradication rate of one week therapy is not satisfactory. We analyzed the effect of two-week second-line OBMT therapy. METHODS: Between June 2002 and June 2003, 107 patients who were H. pylori positive (44 males and 63 females: mean age 51.8 years) after primary eradication therapy received two-week OBMT therapy. Four weeks after completion of therapy, 13C-urea breath test was performed to detect H. pylori. RESULTS: After two weeks of OBMT therapy, eradication was achieved in 103 of 107 patients (96.3%) and in 68 of 71 peptic ulcer patients (95.8%). CONCLUSIONS: Two-week OBMT therapy should be considered as a retreatment regimen with the eradication rate more than 90%.
Adult ; Antacids/administration & dosage ; Anti-Bacterial Agents/administration & dosage ; Anti-Ulcer Agents/administration & dosage ; Bismuth/administration & dosage ; Drug Therapy, Combination ; English Abstract ; Female ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Metronidazole/administration & dosage ; Middle Aged ; Omeprazole/administration & dosage ; Retreatment ; Tetracycline/administration & dosage

OBJECTIVES: Firefighters and rescue workers are likely to be exposed to a variety of traumatic events; as such, they are vulnerable to the risk of post-traumatic stress disorder (PTSD). The psychometric properties of the Korean version of the PTSD Checklist (PCL), a widely used self-report screening tool for PTSD, were assessed in South Korean firefighters and rescue workers. METHODS: Data were collected via self-report questionnaires and semi-structured clinical interviews administered to 221 firefighters. Internal consistency, item-total correlation, one-week test-retest reliability, convergent validity, and divergent validity were examined. Content validity of the PCL was evaluated using factor analysis and receiver operating characteristic (ROC) analyses were used to estimate the optimal cutoff point and area under the curve. RESULTS: The PCL demonstrated excellent internal consistency (alpha = 0.97), item-total correlation (r = 0.72-0.88), test-retest reliability (r = 0.95), and convergent and divergent validity. The total score of PCL was positively correlated with the number of traumatic events experienced (p < 0.001). Factor analysis revealed two theoretically congruent factors: re-experience/avoidance and numbing/hyperarousal. The optimal cutoff was 45 and the area under the ROC curve was 0.97. CONCLUSIONS: The Korean version of the PCL may be a useful PTSD screening instrument for firefighters and rescue workers, further maximizing opportunities for accurate PTSD diagnosis and treatment.
Checklist* ; Diagnosis ; Firefighters* ; Humans ; Mass Screening ; Psychometrics ; Reproducibility of Results* ; Rescue Work* ; ROC Curve ; Stress Disorders, Post-Traumatic*