Hemolytic uremic syndrome is characterized by the symptoms of microangiopathic hemolytic anemia, thrombocytopenia and renal failure. The incidence of hemolytic uremic syndrome associated with pregnancy is 10 to 25 percent. Hemolytic uremic syndrome is treated with adjunctive therapies, such as anti-platelet agents, glucocorticoid and plasma exchange. However, many patients experience a residual impairment in renal function and some of them progress to end-stage renal disease requiring dialysis or renal transplantation. Immunosuppression with cyclosporine has been implicated as a significant risk factor for post- transplant hemolytic uremic syndrome. A number of reports on transplant recipients have recognized cyclosporine-induced hemolytic uremic syndrome as a distinct entity and a potentially serious complication of cyclosporine administration.We report a case of a patient with successful renal transplantation using cyclosporine who had a severe case of post-partum hemolytic uremic syndrome that progressed to end-stage renal disease. After cadaver-donor renal transplantation using cyclosporine, mycophenolate mofetil and prednisolone her graft function at two years is normal with serum creatinine 1.0 mg/dl.
Anemia, Hemolytic ; Creatinine ; Cyclosporine* ; Dialysis ; Hemolytic-Uremic Syndrome* ; Humans ; Immunosuppression* ; Incidence ; Kidney Failure, Chronic* ; Kidney Transplantation* ; Plasma Exchange ; Postpartum Period* ; Prednisolone ; Pregnancy ; Renal Insufficiency ; Risk Factors ; Thrombocytopenia ; Transplantation ; Transplants

PURPOSE: To investigate the characteristics of congenital and acquired color vision defects with Seohan computerized hue test and SNU (Seoul National University) computerized color test and to help to discriminate between congenital and acquired color vision defect METHODS: from June 2003 to January 2004, patient with congenital and acquired color vision defect and visual acuities more than 20/30 underwent Seohan computerized hue and SNU computerized color tests. Their results were compared with each other. Quadrant analysis and RQ calculation were done. RESULTS: On Seohan computerized hue and SNU computerized color tests, congenital color vision defects showed mainly red-green color vision defects (p<0.01, paired t-test) while acquired color vision defects showed blue-yellow color vision defect(p<0.01, paired t-test). RQ had 95% sensitivity and 98% specificity with a standard of 1.5 by Seohan computerized hue test, and 96% sensitivity and 98% specificity with standard of 1.0 by SNU computerized color test, for the discrimination of congenital and acquired color vision defects (ROC curve, confidence interval 95%). CONCLUSIONS: Seohan computerized hue and SNU computerized color tests were effective to classify types of color vision defects and discriminate between the congenital and acquired color vision defects.
Color Vision Defects* ; Color Vision* ; Confidence Intervals ; Discrimination (Psychology) ; Humans ; Sensitivity and Specificity ; Visual Acuity

Boerhaave's syndrome, spontaneous esophageal rupture, is lethal and associated with a 70% survival rate despite emergent surgical management in recent reports. Early diagnosis and management is critical for more favorable outcome. But, it is difficult to diagnose early because of the low incidence and lack of specific symptoms and signs. We experienced 37 year-old male patient with Boerhaave's syndrome who was heavy drinker, and suffered from chronic renal failure. He visited a hospital because of hematemesis and severe back pain. He was transferred to our hospital with a nasogastric tube insertion, which was penetrating the distal esophagus. A radiologic examination revealed that the distal tip was located in the left pleural cavity. It was assumed that the tube had passed through the preexisting perforation site. Operation was not performed emergently due to delay in diagnosis and severe hyperkalemia. The patient was in a septic condition, but had recovered slowly after systemic broad spectrum antibiotic therapy, pleural drainage and intrapleural antibiotic injections. An esophagography revealed no leakage of gastro-grafin on the 14th hospital day, and he later completely recovered from sepsis.
Adult ; Back Pain ; Diagnosis ; Drainage ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Hematemesis ; Humans ; Hyperkalemia ; Incidence ; Kidney Failure, Chronic ; Male ; Pleural Cavity* ; Rupture ; Sepsis ; Survival Rate

The authors report a case of a 16-year-old girl with pituitary hyperplasia and primary hypothyroidism caused by Hashimoto's thyroiditis. She presented with growth arrest, and hormonal studies showed decreased level of free thyroxine (T4), and increased levels of thyroid-stimulating hormone (TSH) and prolactin. A pituitary magnetic resonance imaging (MRI) showed a suprasellar mass. After 2 months of thyroxine replacement, thyroid function and high prolactin levels normalized, and the pituitary hyperplasia disappeared. This case represents relatively rapid normalization of pituitary hyperplasia, compare to the previous studies.
Adolescent ; Female ; Humans ; Hyperplasia ; Hypothyroidism ; Magnetic Resonance Imaging ; Pituitary Gland ; Prolactin ; Thyroid Gland ; Thyroiditis ; Thyrotropin ; Thyroxine

OBJECTS:We investigated a possible association between the polymorphic trinucleotide repeat(TNR) expansion in neuronal potassium channel gene KCNN3 and schizophrenia. METHODS: CAG/CTG repeat distribution in KCNN3, CTG18.1 and ERDA1 was examined and the copy number of ligation product in repeat expansion detection(RED) was measured in Korean patients with schizophrenia(n=245) and ethnically matched healthy controls(n=116). RESULTS: Longer alleles in the KCNN3 gene were over-represented in patients. The frequency of alleles with CAG repeats longer than 19 copy in the KCNN3 gene was higher in the patients with schizophrenia as compared to controls(73.3% vs. 65.1%;p=0.029, Fisher's exact test). And this difference was more prominent in schizophrenic patients with familial background(p=0.03, Fisher's exact test). We found no difference in the frequency of longer alleles between negative and positive subtypes of schizophrenia. Ligation product size in RED and alleles with CAG repeat number in the CTG18.1 gene was not increased in the patients. The copy number of ligation product in RED was highly correlated with CAG/CTG copies of ERDA1 in the patient group(r=0.45, p<0.001) as well as in the control group(r=0.44, p<0.001). However, CAG repeat length in the KCNN3 gene was not correlated with ERDA1 score. CONCLUSIONS: Our results support the hypothesis that the longer allele of KCNN3 may be considered as a candidate gene for schizophrenia, especially in the case with familial background. And the RED assay results was affected by the CAG copy number of ERDA1.
Alleles ; Humans ; Ligation ; Neurons ; Potassium Channels ; Schizophrenia*

BACKGROUND: Functional defects of neutrophils are regarded as a major factors for the susceptibility to bacterial infection in diabetes. The attribution of low antioxidant status, which is shown in uncontrolled diabetic patients, to the dysfunction in neutrophils has not been illucidated. We purposed to evaluate the correlation of respiratory burst activity in neutrophils to total antioxidant status (TAS) and lipid peroxidation. MATERIALS: Neutrophil respiratory burst activity (NRBA) before and after stimulation by PMA was measured by flowcytometry in diabetic patients with poor glucose control (n=10, HbA1C > 8.0%) and good glucose control (n=11, HbA1C < or = 6.4%) and non-diabetic subjects (n=18). TAS and lipid peroxidation assay were measured by colorimetry. RESULTS: The results of HbA1C, TAS and lipid peroxidation of diabetic patients with poor glucose control were 11.6+/-9.2%, 1.407+/-0.041 mmol/L, 2.66+/-1.84 M, and with good glucose control were 5.7+/-0.5%, 1.440+/-0.061 mmol/L, 2.64+/-1.29 M, respectively. In non-diabetic subjects were 5.2+/-0.4%, 1.464+/-0.003 mmol/L, 2.07+/-1.18 M, respectively. NRBA of diabetic patients with poor glucose control before and after stimulation by PMA was 0.858+/-0.001 and 0.897+/-0.007 of non-diabetic subjects, respectively. NRBA of diabetic patients with good glucose control before and after stimulation by PMA was 0.832+/-0.002, 0.949+/-0.002 of non-diabetic subjects, respectively. TAS of diabetic patients with poor glucose control was significantly lower than that of non-diabetic subjects (P<0.05). NRBA were significantly decreased both before and after stimulation by PMA in poor glucose control (P<0.05). TAS and NRBA after stimulation by PMA of patients with good glucose control was not statistically significant and NRBA only before stimulation by PMA was significantly decreased (P<0.05). Significant positive correlations were evident between NRBA and total antioxidant activity (r=0.507, P<0.05). CONCLUSION: Only NRBA before stimulation by PMA of diabetic patients with good glucose control was significantly decreased, but NRBA of diabetic patients with poor glucose control was significantly decreased before and after stimulation by PMA and significantly correlated with TAS.
Bacterial Infections ; Colorimetry ; Diabetes Mellitus* ; Glucose ; Humans ; Lipid Peroxidation* ; Neutrophils* ; Respiratory Burst

PURPOSE: This study was designed to investigate the characteristics and classification of congenital color vision deficiency (CVD) by the SNU computerized color test (SCCT) that was developed to sufficiently utilize the advantages of a computer. METHODS: Hardy-Rand-Rittler test (HRR test), Nagel anomaloscope and SCCT were performed on 60 eyes of 30 CVD patients and 30 normal subjects and the results were compared. RESULTS: In normal subjects, the error scores were all zero at all colors by SCCT. By SCCT protan color defectives showed a peak at hue 0 red in 7 eyes (29.2%), at hue 150 green in 3 eyes (12.5%), at hue 180 green in 18 eyes (75%), and at hue 330 red in 2 eyes (8.3%). By SCCT, deutan color defectives showed a peak at hue 0 red in 2 eyes (5.6%), at hue 150 green in 24 eyes (66.7%), at hue 180 green in 2 eyes (5.6%), and at hue 330 red in 23 eyes (63.9%). CONCLUSIONS: SCCT showed specific axes in CVD patients, with accuracy and high sensitivity to diagnosis. SCCT appears to be useful clinically as a color vision test to diagnose and classify CVD patients.
Classification* ; Color Vision Defects* ; Color Vision* ; Diagnosis ; Humans

PURPOSE: To investigate the color vision defect in diabetic patients using the SNU computerized color test (SCCT). METHODS: From May to September 2003, diabetic patients with visual acuity 0.6 or better underwent various examinations including biomicroscopy, fundus photography, Ishihara color test, Hardy?Rand?Rittler (HRR) test, Seohan computerized hue test (SCHT), and SNU computerized color test. The SCCT was developed by using the Matlab 6.0 program. RESULTS: A total of 160 eyes of 82 diabetic patients were included. Thirty-two patients had no diabetic retinopathy, 19 had mild nonproliferative diabetic retinopathy (NPDR), 12 had moderate NPDR, 12 had severe NPDR, and 7 had proliferative diabetic retinopathy (PDR). In the all diabetic patients, the average total error score (TES) of SCHT was 189 and that of SCCT was 8.5; in patients without diabetic retinopathy, the scores were 125 and 3.64; in patients with mild NPDR, 185 and 8.16; in patients with moderate NPDR, 209 and 11.1; in patients with severe NPDR, 288 and 15.6 ; and in patients with PDR, 324 and 17.6 respectively. On the HRR test, patients without diabetic retinopathy had 1 tritan defect; those with mild NPDR 2 tritan, 2 protan, and 2 deutan defects: those with moderate NPDR, no color defects ; and those with severe NPDR, 2 tritan, and 2 protan defects, and 1 deutan defect. CONCLUSIONS: In diabetic patients, TES of SCHT and SCCT was higher according to the severity of diabetic retinopathy. SCHT and SCCT were more useful than HRR test.
Color Vision Defects* ; Color Vision* ; Diabetic Retinopathy* ; Humans ; Photography ; Visual Acuity

PURPOSE: The locoregional recurrence (LRR) in breast cancer, without distant metastasis has traditionally been regarded as a predictor of subsequent distant metastasis. This study was designed to attain the survival rate, disease progress in patients with a LRR only and to approve a locoregional treatment able to increase the survival in specific locoregional recurrent breast cancer. METHODS: The records of 223 patients with LRR, after initial treatment at the Asan Medical Center, between 1989 and 2003, were retrospectively reviewed. The patients were classified into the LRR only and simultaneous distant metastasis groups with the LRR group subdivided into the operable and inoperable groups. The data were analyzed using SPSS 11.0. RESULTS: There were 152 and 71 patients in the LRR only and simultaneous distant metastasis groups respectively: 105 patients in the LRR only group were operable cases. The 5-year survival rate of LRR was 42.5%, but this was 50.1% in the LRR only group. The 5-year survival rates following a recurrence in the operable and inoperable groups were 66.2% and 21.1%. On multivariate analysis, age at the primary surgery, tumor size, hormone receptor status and DFI were independent prognostic factors for survival. The operable group indicated less tumor size at the primary surgery, less lymph node metastasis and more chest wall or axillary lymph node recurrences, compared to the inoperable group. CONCLUSION: In some of the LRR only cases, the survival rate was relatively good, especially in the operable group. Age at the primary surgery, tumor size, hormone receptor status and DFI were independent prognostic factors for survival. Surgical treatment could be resulted in good responses to the LRR patients with early stage or chest wall or axillary recurrences.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence* ; Retrospective Studies ; Survival Rate ; Thoracic Wall