Nowadays, to evaluate growth hormone(GH) deficiency-suspicious short stature, we usually use more than two kinds of provocative tests using various pharmacologic agents such as clonodine, L-dopa, insulin, etc. However, the importance of physiologic natural secretion of GH was recently approved. In the past, diagnosis of GH neurosecretory dysfunction was made by studying the 24-hour spantaneous GH secretion profile. But, because it is very clinically difficult, and so we measured and evaluated the mean GH concentrations of blood samples, obtained every 30 minutes during the first 3 hours' nocturnal sleep, instead of that. At the department of Pediatrics, Hanyang University Hospital from November, 1992 to February, 1994, we selected 34 GH deficiency-suspected children on the base of their growth data and bone age, etc. After GH stimulation with clonidine(100-150 ug/m2) and L-dopa(200-250 mg/m2), we measured their peak GH values by the immunoradiometric assay(IRMA) kit. And, we measured the mean GH concentrations of blood samples, obtained every 30 minutes during the first 3 hours noctumal sleep(22:OOPM-1:OOAM). RESULTS: 1. We analyzed the relationship between the mean of 3-hours' physiologic night-time surge of GH(X) and the phamacologically stimulated peak GH level(Y), except for the two neurosecretory dysfunction suspicious children. And so, for the 32 children, the relationship was Y=1.806X+ 3.177, r= 0.794, p<0.01. However, for all the tested children(34), the relationship is Y=1.709X+ 4.06, r=0.737, p<0.01. 2. We analyzed the relationship between the peak of 3-hours' physiologic night-time surge of GH(X) and the phamacologicaUy stimulated peak GH level(Y), except for the two neurosecretory dysfunction suspieious children. And so, for the 32 children, the relationship was Y=0.683X+ 3.686, r=737, p<0.01. CONCLUSION: For all the tested children(34), the relationship between the mean 3hr physiologic GH night time surge and stimulated peak GH value is Y=1.709X+4.06, r=0.737, p<0.01. The percentage of GH neurosecretory dysfunction is 5.8%(2/34). And, except for the two childrren, the relationship is more good, Y=1.806X+3.177, r=0,794, p<0.01. On the above relationship, the 3-hour GH night time-surge test might to give us some helpful information for the diagnosis of neurosecretory dysfunction.
Child* ; Diagnosis ; Growth Hormone* ; Humans ; Insulin ; Levodopa ; Pediatrics

BACKGROUND: To explore an interaction(s) of endothelin with other blood pressure regulating systems, effects of either a high concentration of sodium chloride vehicle or pretreatment with atrial natriuretic peptide (ANP) on the pressor response to endothelin were investigated in rats. METHOD: Sprague-Dawley rats were anesthetized with thiopental (50mg/kg, IP) and were cannulated into left lateral cerebral ventricle. The left femoral artery and vein were also catheterized to measure blood pressure and to serve as an infusion route, respectively. Endothelin (10pmol) dissolved in either normal (0.15M) or high concentration (3.0M) of NaCl vehicle with ANP (1 nmol, ICV). For intravenous (IV) infusion, endothelin(1pmol/min) dissolved either in normal or high concentration of NaCl vehicle was infused for 20min. RESULT: ICV endothelin caused an increase of arterial pressure, in which the NaCl did not affect but ANP-pretreatment significantly attenuated the pressor magnitude. IV endothelin also increased the arterial pressure, which was potentiated by NaCl, ie, the maximum increase caused by the IV endothelin in the high NaCl vehicle was greater than the sum of that induced by endothelin (infused in normal NaCl vehicle) and that induced by high NaCl vehicle only. CONCLUSION: These results suggest that endothelin has separate central and peripheral pressor actions, in which the former is not affected by high NaCl but is attenuated by the ANP system and the latter is potentiated by high NaCl.
Animals ; Arterial Pressure ; Atrial Natriuretic Factor ; Blood Pressure ; Catheters ; Cerebral Ventricles ; Endothelins* ; Femoral Artery ; Rats* ; Rats, Sprague-Dawley ; Sodium Chloride* ; Sodium* ; Thiopental ; Veins

Cerebral gigantism(Sotos syndrome) is a growth disorder that consists of large size at birth, rapid early growth rate with accompanying advanced bone age, acromegalic features, and developmental delay. Clumsiness in the absence of other abnormal neurologic findings is common. The cause is unknown. We report here a case of 238/12-year-old Sotos syndrome with final adult height above 97 percentile, abnormal brain MRI findings(large ventricles, prominent trigone, prominent occipital horn & thining of corpus callosum), clumsiness, and some behavioral problems.
Adult ; Animals ; Brain ; Growth Disorders ; Horns ; Humans ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Parturition ; Sotos Syndrome

BACKGROUND/AIMS: Little is known for the capacity and quality of colonoscopy, and adherence to colonoscopy surveillance guidelines in Korea. This study aimed to investigate the present and potential colonoscopic capacity, colonoscopic quality, and adherence to colonoscopy surveillance guidelines in Korea. METHODS: We surveyed representative endoscopists of 72 endoscopy units from June to August 2015, using a 36-item questionnaire regarding colonoscopic capacity, quality, and adherence to colonoscopy surveillance guidelines of each hospitals. RESULTS: Among the 62 respondents who answered the questionnaire, 51 respondents were analyzed after exclusion of 11 incomplete answers. Only 1 of 3 of endoscopy units can afford to perform additional colonoscopies in addition to current practice, and the potential maximum number of colonoscopies per week was only 42. The quality of colonoscopy was variable as reporting of quality indicators of colonoscopy were considerably variable (29.4%–94.1%) between endoscopy units. Furthermore, there are substantial gaps in the adherence to colonoscopy surveillance guidelines, as concordance rate for guideline recommendation was less than 50% in most scenarios. CONCLUSIONS: The potential capacity and quality of colonoscopy in Korea was suboptimal. Considering suboptimal reporting of colonoscopic quality indicators and low adherence rate for colonoscopy surveillance guidelines, quality improvement of colonoscopy should be underlined in Korea.
Colonoscopy ; Colorectal Neoplasms ; Endoscopy ; Korea ; Quality Improvement ; Surveys and Questionnaires

PURPOSE: ST-elevation myocardial infarction (STEMI) patients may visit the emergency department (ED) complaining of sensations of pain other than the chest. We investigated our performance of reperfusion therapy for STEMI patients presenting with non-chest pains. MATERIALS AND METHODS: This was a retrospective observational cohort study. STEMI patients who underwent primary percutaneous coronary intervention (PCI) were divided into a chest pain group and a non-chest pain group. Clinical differences between the two groups and the influence of presenting with non-chest pains on door-to-electrocardiograms (ECG) time, door-to-balloon time, and hospital mortality were evaluated. RESULTS: Of the 513 patients diagnosed with STEMI, 93 patients presented with non-chest pains. Patients in the non-chest pain group were older, more often female, and had a longer symptom onset to ED arrival time and higher Killip class than patients in the chest pain group. There was a statistically significant delay in door-to-ECG time (median, 2.0 min vs. 5.0 min; p<0.001) and door-to-balloon time (median, 57.5 min vs. 65.0 min; p<0.001) in patients without chest pain. In multivariate analysis, presenting with non-chest pains was an independent predictor for hospital mortality (odds ratio, 2.3; 95% confidence interval, 1.1-4.7). However, door-to-ECG time and door-to-balloon time were not factors related to hospital mortality. CONCLUSION: STEMI patients presenting without chest pain showed higher baseline risk and hospital mortality than patients presenting with chest pain. ECG acquisition and primary PCI was delayed for patients presenting with non-chest pains, but not influencing hospital mortality. Efforts to reduce pre-hospital time delay for these patients are necessary.
Aged ; Aged, 80 and over ; Chest Pain/*diagnosis ; Electrocardiography ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction/mortality/*surgery ; Retrospective Studies

Eosinophilic gastroenteritis (EG) is characterized by eosinophilic infiltration of the bowel wall and variable gastrointestinal manifestations. Clinicians should have a high index of suspicion for EG when faced with gastrointestinal symptoms and peripheral eosinophilia to avoid incorrect diagnosis and inappropriate treatments. A 24-year-old woman was admitted to our hospital complaining of acute right lower quadrant abdominal pain and a laparoscopic appendectomy performed for a presumed diagnosis of an acute appendicitis. However, the procedure revealed bowel edema and a moderate amount of ascites without evidence of a suppurative appendicitis. Postoperatively, she showed persistent and progressive eosinophilia, exudative eosinophilic ascites, eosinophilic infiltration of the resected appendix wall, and eosinophilic infiltration of gastroduodenal mucosa. A punch biopsy of the abdominal skin also revealed inflammation with marked eosinophilic infiltration of the skin. She recovered after the treatment with a low dose of steroid for the EG with eosinophilic dermatitis. EG with eosinophilic dermatitis has not been reported yet and is considered fortuitous in this case.
Adult ; Dermatitis/*diagnosis/drug therapy/pathology ; Eosinophilia/*diagnosis/drug therapy/pathology ; Female ; Gastroenteritis/*diagnosis/drug therapy/pathology ; Humans ; Steroids/therapeutic use ; Young Adult

Simultaneoulsy carpometacarpal fracture and dislocation is known to be uncommon past days. But Fisher1 reported that it is quite common injury of hand in 1984. Also high energy injury causes carpometacarpal joint fracture and dislocation, the result of treatment has wide spectrum of prognosis, so early diagnosis and treatment is essential. We reported 2 patients who had the fourth and fifth carpometacarpal fracture and dislocation.
Carpometacarpal Joints ; Dislocations ; Early Diagnosis ; Hand ; Humans ; Prognosis

PURPOSE: We intend to set up the plan by analyzing the case applying operative treatment for the diagnosis and treatment of the fourth and fifth metacarpal bone base fracture. MATERIALS AND METHODS: Among 15 cases treated operatively from January of 2004 to October of 2009, there were 9 cases being fifth isolated carpometacarpal fracture, 5 cases being the fourth and fifth carpometacarpal comminuted fracture, 2 cases accompanied by hamate body fracture, 10 cases were comminuted fracture of carpal bone or metacarpal bone. RESULTS: The 13 cases of 15 cases which have got operative treatment for the fourth and fifth carpometacarpal fracture were men, average age were 26.3 years old, injury mechanism were direct hit for 9 cases, slip-down for 6 cases. 12 cases were done closed reduction and pinning, 3cases were done open reduction because of comminution or accompanied by hamate fracture. CONCLUSION: Appropriate diagnostic tool such as computed tomography and careful physical examination are essential for good result of the fourth and fifth carpometacarpal fracture treatment.
Carpal Bones ; Fractures, Comminuted ; Humans ; Male ; Physical Examination

Melanosis can affect various parts of the gastrointestinal tract. Melanosis of the colon is not uncommon, while melanosis of the ileum is extremely rare. We report a case of melanosis ilei associated with chronic ingestion of oral iron (256 mg of ferrous sulfate once or twice daily for approximately 5 years) in a 32-year-old woman with end-stage renal disease. The findings of a colonoscopy, which was performed as a part of her medical checkup, were normal up to the cecum; however, numerous brownish-black punctuate pigmentations of the ileal mucosa were observed. Microscopic examination revealed hemosiderosis in the lamina propria of the ileal mucosa, particularly at the tips of villi. The diagnosis of melanosis (hemosiderosis) ilei was made based on the endoscopic and histological findings.
Adult ; Colon ; Colonoscopy ; Eating ; Female ; Ferrous Compounds ; Gastrointestinal Tract ; Hemosiderin ; Hemosiderosis ; Humans ; Ileum ; Iron ; Kidney Failure, Chronic ; Melanosis ; Mucous Membrane ; Pigmentation

Cryptococcus laurentii is one of several non-neoformans cryptococci that have rarely been associated with human infection. Candida zeylanoides, an unusual Candida species, is also infrequently reported as a human pathogen. We report a case of mixed fungemia with C. laurentii and C. zeylanoides in a 12-year-old girl. The patient with acute myelogenous leukemia was receiving intensive remission induction chemotherapy through a central venous catheter (CVC) and was severely neutropenic. She had been treated with oral fluconazole prophylaxis since admission. C. laurentii and C. zeylanoides were simultaneously isolated from the peripheral blood cultures collected on days 29 and 31 of her hospital stay. The culture of the removed catheter tip grew >15 CFU of both C. laurentii and C. zeylanoides. In vitro susceptibility testing of the strains showed that the MIC of fluconazole for C. laurentii and C. zeylanoides were 8 microgram/mL and 4 microgram/mL, respectively. The patient was successfully treated by CVC removal and by treatment with amphotericin B intravenously. To our knowledge, this represents the first report of C. laurentii and C. zeylanoides fungemia in Korea.
Amphotericin B ; Candida* ; Catheters ; Central Venous Catheters ; Child ; Cryptococcus* ; Drug Therapy ; Female ; Fluconazole ; Fungemia* ; Humans ; Korea ; Length of Stay ; Leukemia, Myeloid, Acute ; Remission Induction