PURPOSE: The incidence of type 1 diabetes mellitus is increasing worldwide, the complications such as growth impairment, thyroid dysfunction, microvascular disease can be accompanied in type 1 diabetes mellitus. So, it is important to study initial clinical characteristics of type 1 diabetes mellitus for long-term managements of such complications. METHODS: Forty children and adolescents with type 1 diabetes mellitus who had been followed up in the department of pediatrics, Ajou university hospital from December 1997 to June 2006 were enrolled in this study. Sex, Onset Age, onset season, body mass index, family history, serum blood glucose, urine ketone, admission duration, HbA1c, serum and 24 hours urine C-peptide, islet cell antibody, daily insulin dose, insulin like growth factor-I, thyroid function test, lipid profile, bone age of patients were reviewed retrospectively. RESULTS: Forty patients were enrolled:19 boys and 21 girls. The mean age of diagnosis was 9.2+/-3.5 years. There were no seasonal variation in onset time. The body mass index were 15.9+/-2.7 kg/m2. In family history, 1 patient had type 1 and 16 patients (40%) had type 2 diabetes. Blood glucose was 509+/-172 mg/dL. Urine ketone was positive in 77.8% of patients. HbA1c was 12.5+/-2.4%. Serum C-peptide was 0.76+/-0.65 ng/mL and there was statistically significant positive relationship between patient's age and serum C-peptide level (P<0.05). Daily insulin dose was 0.89+/-0.28 unit/kg/day and negatively correlated with serum C-peptide level (P<0.05), but there were no differences in daily insulin dose between prepubertal and pubertal patients. In 82.4% of patients, at least one of 3 antibody (glutamic acid decarboxylase antibody, islet cell antibody, insulin auto antibody) were detected. Serum C-peptide were higher in GAD Ab positive group than in negative group (P<0.05). In 63.6% of patients, Insulin like growth factor-I levels were lower than normal control group. Thyroid dysfunction were found in 7.5% of patients. 48.7% of patients were accompanied with dyslipidemia. In 51.9% of patients, bone age was advanced by at least 6 months. CONCLUSION: For the most part, our results were consistent with previous studies. But some points like, 1) there was no seasonal variation in onset time, 2) serum C-peptide was not low, 3) there were no differences in daily insulin dose between prepubertal and pubertal patients, differed from previous studies.
Adolescent ; Age of Onset ; Blood Glucose ; Body Mass Index ; C-Peptide ; Child ; Diabetes Mellitus, Type 1* ; Diagnosis* ; Dyslipidemias ; Female ; Humans ; Incidence ; Insulin ; Islets of Langerhans ; Pediatrics ; Retrospective Studies ; Seasons ; Thyroid Function Tests ; Thyroid Gland

Purpose: The aim of this study was to investigate the optimal washout criteria of perfluorobutane-enhanced ultrasonography (PFB-US) for the diagnosis of hepatocellular carcinoma (HCC) in high-risk individuals. Methods: Participants at risk of HCC with treatment-naïve solid hepatic observations (≥1 cm) who underwent PFB-US from March 2019 to September 2020 were prospectively recruited. Arterial phase hyperenhancement (APHE), washout time, and washout degree were evaluated. The diagnosis of HCC was made by non-rim APHE with late and mild washout. The per-lesion diagnostic performance for diagnosing HCC using different cutoffs for late washout (50, 55, 60, 65, and 70 seconds postcontrast) and the different time windows for determining washout (until 2, 3, 4, 5, 6, 7, 8, 9, and 10 minutes postcontrast) were compared using the McNemar test. Results: In total, 101 participants with 113 observations (mean size, 33.5±2.8 mm; HCCs [n=82], non-HCC malignancies [n=16], benign [n=15]) were evaluated. Non-rim APHE was observed in 86.6% (71/82) of HCCs. As the cutoff time for late washout increased, the specificity increased to 100% (95% confidence interval [CI], 88.8% to 100%) at the 60-second cutoff with 62.2% sensitivity (95% CI, 50.8% to 72.7%). When the time window for determining washout became wider, the sensitivity and accuracy increased until 6 minutes, with 100% specificity at all times. Conclusion Determining washout within 6 minutes after contrast injection with a 60-second cutoff for late washout showed the highest sensitivity without losing specificity for diagnosing HCC using PFB-US in individuals at high risk.

Objective: To investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) and its role as a second-line imaging modality after gadoxetate-enhanced MRI (Gd-EOB-MRI) in the diagnosis of hepatocellular carcinoma (HCC) among at risk observations. Materials and Methods: We prospectively enrolled participants at risk of HCC with treatment-naïve solid hepatic observations (≥ 1 cm) of Liver Imaging Reporting and Data System (LR)-3/4/5/M during surveillance and performed Gd-EOB-MRI. A total of one hundred and three participants with 103 hepatic observations (mean size, 28.2 ± 24.5 mm; HCCs [n = 79], non-HCC malignancies [n = 15], benign [n = 9]; diagnosed by pathology [n = 57], or noninvasive method [n = 46]) were included in this study. The participants underwent CEUS with sulfur hexafluoride. Arterial phase hyperenhancement (APHE) and washout on Gd-EOB-MRI and CEUS were evaluated. The distinctive washout in CEUS was defined as mild washout 60 seconds after contrast injection. The diagnostic ability of Gd-EOB-MRI and of CEUS as a second-line modality for HCC were determined according to the European Association for the Study of the Liver (EASL) and the Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) guidelines. The diagnostic abilities of both imaging modalities were compared using the McNemar’s test. Results: The sensitivity of CEUS (60.8%) was lower than that of Gd-EOB-MRI (72.2%, p = 0.06 by EASL; 86.1%, p < 0.01 by KLCA-NCC); however, the specificity was 100%. By performing CEUS on the inconclusive observations in Gd-EOB-MRI, HCCs without APHE (n = 10) or washout (n = 12) on Gd-EOB-MRI further presented APHE (80.0%, 8/10) or distinctive washout (66.7%, 8/12) on CEUS, and more HCCs were diagnosed than with Gd-EOB-MRI alone (sensitivity: 72.2% vs. 83.5% by EASL, p < 0.01; 86.1% vs. 91.1% by KCLA-NCC, p = 0.04). There were no false-positive cases for HCC on CEUS. Conclusion The addition of CEUS to Gd-EOB-MRI as a second-line diagnostic modality increases the frequency of HCC diagnosis without changing the specificities.

BACKGROUND AND OBJECTIVES: Although the complication of using e-PTFE as augmentation material in rhinoplasty for occidental patients have been reported, but only a little information is available for oriental patients. The aim of the present study is to analyze complications of e-PTFE for nasal augmentation in rhinoplasty for oriental patients. MATERIALS AND METHOD: The subjects consisted of 1376 patients who had been performed augmentation rhinoplasty with e-PTFE between January 1994 and October 2002. The subjects were classified according to experience of rhinoplasty. The first group included primary cases and second group revision cases. The revision group was divided into two groups according to the different techniques performed, one being the minor group that had been performed the simple technique, and the other group that had been performed the complicated technique. We reviewed postoperative complications of augmentation rhinoplasty with artificial implants including displacement, surface irregularity, infection, dorsal line and height problem, soft tissue reaction, extrusion and resorption. RESULTS: Side effects occurred in 127 (9.2%) of the 1376 patients: 38 (29.9%) was displacement, 29 (22.8%) dorsal height problem, 23 (18.1%) surface irregularity, 18 (14.2%) dorsal line and 18 (14.2%) infection and others. CONCLUSION: Compared with other autogenous and artificial materials, the study found e-PTFE as a good material for augmentation rhinoplasty for the orientals.
Humans ; Polytetrafluoroethylene ; Postoperative Complications ; Prostheses and Implants ; Rhinoplasty

Objective: Bacteremia is a common cause of increased morbidity and mortality in elderly patients, but early diagnosis and identification are complex. The neutrophil-to-lymphocyte count ratio (NLR) is suggested as a useful indicator for diagnosing bloodstream infections. This study evaluated whether the NLR at admission is associated with bloodstream infections in older patients admitted to the emergency department. Methods: A retrospective, multicenter analysis was performed on patients admitted to the emergency department from November 2016 to February 2017. We included patients aged 65 years and older who visited the emergency department with medical problems. Baseline NLR values were measured upon admission to the emergency department. The primary outcome was a positive blood culture. Results: A total of 1,815 patients were included in this study. The median age was 77.25±7.38 years, and bacteremia was identified in 290 older patients (15.9%). The NLR was significantly higher in the bacteremia group (15.95±22.03) than in the non-bacteremia group (8.76±8.74, P<0.001). In the multivariate logistic regression analysis, the NLR was associated with bacteremia after adjusting for confounding factors as continuous variables (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.009-1.057) and categorical variables (NLR ≥10; OR, 2.018; 95% CI, 1.246-3.268). The area under the curve of the NLR was determined to be 0.667 (95% CI, 0.639-0.694). Conclusion These results indicate that the NLR at admission to the emergency department is associated with bloodstream infections. Early suspicion of bacteremia, by determining the initial NLR value, will help treat bacteremia in elderly patients.

BACKGROUND/AIMS: Gastric motor function in patients with advanced gastric cancer (AGC) may dependent upon the extent, depth of invasion, and/or location of cancer. The network of interstitial cell of Cajal (ICC) acts as a pacemaker cell to produce the slow wave, and tyrosine kinase receptor, c-kit plays an important role in development and function of the ICC. We investigated the gastric motor function in patients with advanced gastric cancer, and examined the density of c-kit+ cells in circular muscle layer of the stomach to investigate a possible correlation between gastric motor function and the density of c-kit. METHODS: The subjects include 25 patients operated for non-obstructive AGC. Preoperative electrogastrography (EGG) and gastric emptying (GE) scan were performed in all patients. The frozen samples of circular muscle without cancer infiltration in midantrum and midbody, greater curvature were prepared from resected tissue and immunohistochemistry for c-kit was performed. The density of c-kit was quantitatively analyzed. RESULTS: Several GE parameters including T(1/2) were deranged in patients with AGC, especially antral lesion. There was no significant difference in GE parameters or frequency of slow wave between antrum and body in AGC. The density of c-kit in antrum was greater trend than that in body. No correlation was found among the density of c-kit, T(1/2) and the slow wave frequency. CONCLUSIONS: We observed a delayed gastric emptying in patients with advanced gastric cancer, especially antral lesion without any abnormalities in myoelectrical activity. No correlation was found among T(1/2), slow wave frequency and c-kit density in patients with advanced gastric cancer.
Gastric Emptying ; Humans ; Immunohistochemistry ; Protein-Tyrosine Kinases ; Stomach ; Stomach Neoplasms*

The role of oxygen-derived free radicals has been studied in acute gastric and esophageal mucosal injury. OBJECTIVES: The aim of this study was to determine whether acid reflux causes oxidative stress in the esophageal mucosa and to investigate the correlation between mucosal glutathione (GSH) levels as an endogenous free radical scavenger and lipid peroxidation. METHODS: Eight-week-old male Sprague-Dawley rats with a bodyweight of 250-300 g were used for the experiments. Acid reflux was caused by pyloric ligation. The sham operation included a midline laparotomy and served as controls. After 24 hr all rats were killed and esophageal samples were taken for measurement of gross mucosal injury and mucosal GSH level. Lipid peroxidation which is a marker of oxidative stress was determined by measuring the formation of thiobarbituric acid-reactive substances (TBARS) spectrophotometrically. RESULTS: Severe mucosal damage was noted in reflux group. TBARS level was 6 times greater in reflux group compared to the control group (p < 0.05), while GSH level was 4 times less in reflux group compared to the control group (p < 0.05). Increase of TBARS level and decrease of GSH level showed a strong correlation to the gross findings of esophageal mucosal damage in reflux esophagitis. CONCLUSIONS: Oxygen-derived free radicals are of pathophysiologic importance in esophagitis caused by acid reflux.
Animals ; Esophagitis ; Esophagitis, Peptic* ; Free Radicals ; Glutathione* ; Humans ; Laparotomy ; Ligation ; Lipid Peroxidation* ; Male ; Mucous Membrane ; Oxidative Stress ; Rats* ; Rats, Sprague-Dawley ; Thiobarbituric Acid Reactive Substances

PURPOSE: In order to review various complications and their frequencies and causes after chemoembolization in the patients with hepatic neoplasm. Subjects and Methods:Subjects were 362 patients who underwent chemoembolization for hepatic neoplasm during the recent 2 years from Jan. 1990 to Dec. 1992. A total of 954 procedures were performed in these patients. For the initial treatment, only the emulsion of Lipiodol and Adriamycin were infused in 225 patients and gelfoam embolization were followed in 126 patients. A retrospective analysis for the complications was undertaken with reviewing of clinical and radiologic findings. RESULTS: Severe post-embolization syndrome lasting longer than one week developed in 54 patients in whom Ihe tumor size was mostly larger than 6cm in diameter. Sepsis accompanying persistent fever was developed in 9 cases. There were various hepatic complications;transient deterioration of hepatic function(46 cases), persistent deterioration of hepatic function(15 cases), hepatic failure(9 cases), hepatic rupture(3 cases), intrahepatic bile duct injury(3 cases) and liver abscess(1 case). Complications involuing other organs were upper GI bleeding(9 cases), gallbladder infarction(3 cases), splenic infarction(4 cases), Pulmonary embolism(6 cases)and spinal arterial embolism(1 case). There were 9 mortalities within one month after the procedure. CONCLUSION: Various complications of liver and other organs after chemoembolization of hepatic neoplasm warrants more scrutinized preprocedure evaluations of related factors such as amount of embolic materials, vascular anatomy, protal invasion, biliary obstruction, and liver functional reservoir.
Bile Ducts, Intrahepatic ; Doxorubicin ; Ethiodized Oil ; Fever ; Gallbladder ; Gelatin Sponge, Absorbable ; Humans ; Liver ; Liver Neoplasms* ; Mortality ; Retrospective Studies ; Sepsis

INTRODUCTION: Hydroxyapatite (Ca10(PO4)6(OH)2, HA) is the main inorganic phase of human hard tissue that is used widely as the repair material for bones. When HA is applied to a bony defect, however, it can be encapsulated with fibrous tissue and float in the implanted area due to a lack of consolidation. Bioceramics as allogenic graft materials are added to HA to improve the rate and bone healing capacity. Fluoridated hydroxyapatite (Ca10(PO4)6(OH,F)2, FHA), where F- partially replaces the OH- in hydroxyapatite, is considered a good alternative material for bone repair owing to its solubility and biocompatibility. MATERIALS AND METHODS: This study was designed to determine the bone healing capacity of FHA newly produced as a nanoscale fiber in the laboratory. HA and FHA with bioglass was implanted in a rabbit cranium defect and the specimen was analysed histologically. RESULTS: 1. At 4 weeks, fibrous connective tissue and little bone formation was observed around the materials of the experimental group I implanted HA and bioglass. Newly formed bone was observed around the materials in the experimental group II implanted FHA and bioglass. 2. At 8 weeks, the amount of newly formed and matured bone was higher in experimental group II than in experimental group I and the control group. CONCLUSION: These results suggest that FHA and bioglass is a relatively favorable bone substitute with biocompatibility and better bone healing capacity than pure HA and bioglass.
Acrylic Resins ; Bone Regeneration ; Bone Substitutes ; Ceramics ; Connective Tissue ; Durapatite ; Humans ; Hydroxides ; Hydroxyapatites ; Osteogenesis ; Skull ; Solubility ; Transplants

No abstract available.
Cisplatin ; Paclitaxel ; Radiodermatitis