BACKGROUND: Although hypochlorhydria, hypergastrinemia and antiparietal cell antibody have been well documented in the patients with hyperthyroidism, a cause of hypochlorhydria or hypergastrinemia is unknown at the present time. Therefore, in order to clarify an inhibitory mechansim of gastric acid secretion in the patients with hyperthyroidism, interrelationship among hypochlorhydria, hypergastrinemia and antiparietal cell antibody was investigated in this study. METHODS: The gastric secretory function, fasting and postprandial plasma concentrations of gastrin and titer of antiparietal cell antibody in the plasma were determined in the patients with hyperthyroidism and normal subjects. Immunoblot analysis was performed to identify the gastric membrane protein, a possible gastric antigen to antiparietal cell antibody. Using a immunocytochemical technique with electron microscopy, intracellular structure of the parietal cell reacted with antiparietal cell antibody was observed. RESULTS: The basal and pentagastrin-stimulated maximal acid output were reduced in the patients with hyperthyroidism. The fasting and postprandial plasma concentrations of gastrin were markedly elevated in the patients. The plasma gastrin concentration in the patients with the antiparietal cell antibody was higher than that of the norrnal subjects as well as the patients without the antibody not only in the fasting state but also in the postprandial state. However, the plasma gastrin concentration of the patients without the antiparietal cell antibody was elevated in the fasting state only. There was no difference in the gastrin content of the antral mucosa between the norrnal subjects and the patients. The antiparietal cell antibody was detected in 5 (38.5 %) out of 13 patients by using the indirect immunofluorescence method. Patient IgG dose-dependently inhibited rabbit gastric H (+),K (+)-ATPase activity. Among proteins of the rabbit gastric mucosa membrane, four high molecular weight proteins (91, 140, 170 and 210 K dalton) were reacted to the patient IgG. The patient IgG positive peroxidase-antiperoxidase (PAP) activity was electron microscopically detected on the intracellular cannalicular membrane of the parietal cell CONCLUSION: We conclude that hypochlorhydria and hypergastrinemia in the patients with hyperthyroidism are partially related to the antiparietal cell antibody and that the antigen to the antiparietal cell antibody may be H (+),K (+)-ATPase in the intracellular canalicular membrane of the parietal cell.
Achlorhydria ; Fasting ; Fluorescent Antibody Technique, Indirect ; Gastric Acid* ; Gastric Mucosa ; Gastrins ; Humans ; Hyperthyroidism* ; Immunoglobulin G ; Membrane Proteins ; Membranes ; Microscopy, Electron ; Molecular Weight ; Mucous Membrane ; Plasma ; Rabeprazole

Background: Bullous pemphigoid (BP) is an autoimmune blistering disease. Studies have focused on eosinophils for their significant role in the pathogenesis of BP, as they not only secrete proteases and proinflammatory cytokines but also recruit other inflammatory cells. Objective: To investigate the correlation among peripheral eosinophil count, clinical severity, and laboratory findings in patients with BP. Methods: A total of 59 patients with BP were included in this study. Correlation analyses between peripheral eosinophil count and bullous pemphigoid disease activity index (BPDAI) score, duration of hospitalization, anti-bullous pemphigoid antigen 180 (anti-BP180) immunoglobulin G (IgG) antibody, anti-bullous pemphigoid antigen 230 (anti-BP230) IgG antibody, immunoglobulin E (IgE), C-reactive protein, and procalcitonin levels were performed. Simple and multiple linear regression analyses were conducted to evaluate whether peripheral eosinophil counts could independently affect the BPDAI score and hospitalization duration. Results: The peripheral eosinophil count was positively correlated with the initial skin, mucosa, total BPDAI score (p＜0.001, p=0.027, and p＜0.001, respectively), hospitalization days (p=0.032), anti-BP180 IgG antibody (p ＜0.001), anti-BP230 IgG antibody (p＜0.001), and IgE (p＜0.001). Furthermore, not only peripheral eosinophil count but also anti-BP180 IgG antibody, anti-BP230 IgG antibody, and IgE levels independently affected both the initial total BPDAI score (p＜0.05) and hospitalization duration (p＜0.05). Conclusion Based on our results, the peripheral eosinophil count can influence both clinical severity and laboratory findings. Additionally, it can indicate the clinical severity and prognosis of BP. Therefore, we suggest that the peripheral eosinophil count could be a useful marker for predicting clinical outcomes in patients with BP.

Intrahepatic portosystemic venous shunt(IPVS) is an uncommon pathologic condition which occurs mostly in adult patients with portal hypertension and cirrhosis of the liver with only scattered reports are on children. However, asymptomatic IPVS have been detected in an increasing number of patients with recent advances in imaging techniques, such as sonography, CT, MR imaging, and color Doppler sonography. The cause of IPVS remains unknown, but two probable origins have been proposed, congenital and acquired origin. In the congenital origin, it has been proposed that the IPVS develops from embryologic vascular remnants. Acquired IPVS can develop into intrahepatic collateral pathway in the presence of portal hypertension and cirrhosis of the liver. We report a case of congenital IPVS with suspicious sepsis in a 6-day-old female patient. An abdominal ultrasonography and color Doppler sonography demonstrated an aneurysmal type of anomalous shunt connecting the right portal vein to the right hepatic vein. The patient continued to be symptomatic after discharge and a follow-up ultrasonography 3 months later revealed the disappearance of the previous IPVS.
Adult ; Aneurysm ; Child ; Female ; Fibrosis ; Follow-Up Studies ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver ; Magnetic Resonance Imaging ; Portal Vein ; Sepsis ; Ultrasonography

OBJECTIVE: The aim of this study was to analyze the status of split tablet prescription in South Korea. METHODS: We conducted this analysis using 2016 National Patient Sample data from the Health Insurance Review and Assessment Service. We computed split tablet prescription rates by sex and age and determined which medicine and medical specialties had the highest split tablet prescribing rates. RESULTS: The proportion of prescriptions that included split tablets was 15.6% (n=6,687,35). The proportion of prescriptions that included split tablets was higher for females (56.7%) than for males (43.3%), while that of prescriptions including split tablets versus total prescriptions for each sex was higher for males (16.4%) than for females (14.9%) (p<0.001). In the age group under 19 years, the proportion of prescriptions including split tablets (53.7%) was more than half of the total. The highest tablet splitting rate was found to be 89.9% for formoterol fumarate (40 µg), and pseudoephedrine hydrochloride (60 mg) had the highest number of prescriptions. Pediatrics (65.6%) was the medical field with the highest rate of split tablet prescription. CONCLUSION Split tablets were most prescribed to pediatric patients. To minimize the use of split tablets, it is necessary to develop lower dose tablets and establish a policy that promotes prescription of these lower-dose tablets.

Bullous pemphigoid (BP) is a chronic, autoimmune blistering disease that has concerning morbidity and mortality rates. Recently, several studies have focused on eosinophils due to their significant role in the pathogenesis of BP, considering that they are ubiquitous in the serum, tissue, and blister fluids of patients with BP. With this context, precision therapy that targets mediators of eosinophil activity could be a possible novel therapeutic strategy.Interleukin (IL)-5 is crucial for B-cell maturation, which consequently results in immunoglobulin production, and promotes eosinophil differentiation, proliferation, and activation. To our best knowledge, reslizumab has not yet been reported to treat BP. Herein, we report a case of steroid- and omalizumab-resistant BP treated successfully using reslizumab. Our data suggest that IL-5 could be a novel specific biologic target within the entire immunopathogenesis of BP, and reslizumab would be a novel therapeutic modality.

Background: Myringotomy with tympanostomy tube insertion (MTI) is a superficial surgical procedure used to prevent hearing loss in children with serous otitis media. Intravenous anesthesia, often ketamine, is preferred for this procedure because of its ability to induce sedation without compromising airway reflexes. However, ketamine alone may be insufficient and potentially lead to spontaneous movement during surgery. This study evaluated the effectiveness of midazolam and fentanyl as adjuvants to ketamine in reducing spontaneous movement during MTI and enhancing the quality of recovery. Methods: This study involved two groups of 30 patients each: one group received intravenous ketamine (1.5 mg/kg) with an equal volume of normal saline (K group), while the other received a combination of midazolam, fentanyl, and ketamine (0.05 mg/kg, 1 μg/kg, and 1.5 mg/kg, respectively; MFK group). We assessed side effects, intraoperative patient movement, surgeon satisfaction, and emergence agitation scores. Results: The MFK group exhibited significantly lower scores for patient movement (p<0.01) and emergence agitation (p<0.01) and markedly higher surgeon satisfaction scores (p<0.01) than the K group. Conclusion Administering a midazolam-fentanyl-ketamine combination effectively reduced spontaneous movement during surgery and emergence agitation during recovery without prolonging discharge times in children undergoing MTI.

The widespread application of coronary angiography and poen heart surgery have resulted in more frequent detection of patients with coronary artery anomaly. In 0.6 to 1.2 percent of individials, the coronary arteries arise aberrantly from the aorta. Anomalous origin of the left coronary artery from the fight coronary sinus with subsequent coursing between the aorta and pulmonary artery is a rare and sometimes fatal coronary amonaly. This anomaly has been reported in young and healthy men who died suddenly during or immediately forllowing vigorous physical exercise. The exact mechanism of sudden death is unclear. It is believed to be related to either extrinsic compression of the left coronary artery or distorsion of the vessel orifice, with resultant global ischemia and ventricular fibrllation. A 13-years old healthy boy, who was completely asymptomatic until he had sudden chest pain after running, arrived at hospital with typical clinical picture of acute myocardial infarction. The electrocardiography taken on admission demonstrated pathologic Q wave changes on lead I, aVL, V2, V3 and V4. Cardiac enzymes were elevated. The selective coronary angiography demonstrated that left coronary artery arose from the right coronary sinus. The anomalous left coronary artery passed posterioly around aortic root to reach its normal position in the interventricular groove. We report the patient with anomalous origined left coronary artery which causes the acute myocardial infarction.
Adolescent ; Aorta ; Chest Pain ; Coronary Angiography ; Coronary Sinus* ; Coronary Vessels* ; Death, Sudden ; Electrocardiography ; Exercise ; Humans ; Ischemia ; Male ; Myocardial Infarction* ; Pulmonary Artery ; Running ; Thoracic Surgery

PURPOSE: The purpose of this study was to evaluate the clinical and abdominal ultrasonogra- phic (US) features of spontaneously reduced transient small bowel intussusception in chlidren. METHODS: We retrospectively reviewed the clinical and US findings of 98 children with intussusception who were admitted to the Pediatric Department of Ulsan Dong-Kang General Hospital from Mar. 1999 to Feb. 2000. RESULTS: 1) Among 98 cases, there were 12 cases (12.3%) of transient small bowel intussusception (TSBI) and 86 cases (87.7%) of classic intussusception (CI). 2) The peak incidence of age in TSBI was over 3 years, which was older than that in CI. With regard to sex distribution, male predominated in both type. 3) Clinical symptoms and signs including cyclic irritability, vomiting, bloody stool, and abdominal mass in TSBI group were less common than those in CI group (41.7%, 33.4%, 0.0%, 0.0% vs 91.9%, 59.3%, 41.9%, 26.7%, respectively) but persistent abdominal pain was more common in TSBI group than in CI group (58.5% vs 11.2% ). 4) The size of total target sign and surrounding peripheral hypoechoic rim of TSBI group on US were smaller than those of CI group (11.9±2.61 mm, 2.08±1.15 mm vs 26.91±5.98 mm, 7.86±2.77 mm, respectively). 5) Concomittant illness was found more frequently in TSBI group than in CI group (66.7% vs 26.7%). 6) All case of TSBI group were reduced spontaneouly, which were confirmed by US, but none of CI group. CONCLUSION: Transient small bowel intussusception is probably more common than generally thought and its clinical and US findings is quite different from classical obstructing intussus-ception. Because all of our cases resulted in spontaneous reduction, we recommend careful observation and repeat examination rather than an immediate operation in transient small bowel intussusception.
Abdominal Pain ; Child ; Hospitals, General ; Humans ; Incidence ; Intussusception ; Male ; Retrospective Studies ; Sex Distribution ; Ulsan ; Ultrasonography ; Vomiting

PURPOSE: The objective of this study was to investigate physicians' attitudes toward ethical end-of-life decision making about dying newborns. METHODS: Between October and December 2015, we surveyed 185 neonatal staff members working at 6 neonatal intensive care units to investigate their attitudes toward ethical end-of-life decision making about dying newborns. RESULTS: The respondents generally agreed with using sedatives/analgesics to suppress pain despite the risk of fatality (80%), continuing current treatment without using other treatment methods (56.2%), and withholding emergency treatment in the form of cardiac arrest resuscitation (48.1%). In contrast, most respondents disagreed with administering drugs for the purpose of ending life, withholding neonatal intensive care, and withholding mechanical ventilation. Although the respondents believed that it is necessary to suggest that the parents of dying neonates sign do-not-resuscitate (DNR) orders (62.7%), most of them found it difficult to talk to parents/families about DNR orders (90.8%), or wanted to refrain from obtaining families' consent in person (84.9%). CONCLUSION: Korean neonatal staff members believed that withholding or withdrawal of treatment is necessary when making ethical decisions about dying neonates; however, they preferred to use conservative, rather than active interventions.
Decision Making* ; Emergency Treatment ; Ethics ; Heart Arrest ; Humans ; Infant, Newborn* ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Parents ; Respiration, Artificial ; Resuscitation ; Surveys and Questionnaires

PURPOSE: This study was designed to clarify the osseointegration of the titanium screw coated with CMP, in regard to the time schedule, through the characteristic of early osseointegration. MATERIALS AND METHODS: Mechanical, radiological and histomophometric measurements were performed in 28 rabbit tibial proximal metaphyseal cortical bone screws 6, 12, 26 and 52 weeks after surgery for the in vivo comparison of the osseointegration of titanium screws (3.75 mm diameter, 5 mm length) with different surface treatments: CMP coating group, with the sol-gel method (experimental group) and uncoated group (control group). RESULTS: 1. Radiology: There were no differences between the two groups without a radiolucent line or in regard to the time schedule. 2. Histology: There were no differences between the two groups without a fibrous tissue intervening surface or in regard to the time schedule. 3. Torque test: The test results for the CMP coated group were 1.5 times higher than those for the uncoated group, which was statistically meaningful, but there was no difference in regard to the time schedule. CONCLUSION: CMP coating is an option to increase the osseointegration of the titanium screw.
Appointments and Schedules ; Bone Screws ; Ceramics* ; Osseointegration* ; Tibia ; Titanium ; Torque