No abstract available.
Child* ; Humans

Ticlopidine hydrochloride is world-wide used antiplatelet agent that inhibit ADP pathway. Its clinical side effects are the change of the blood picture, allergic skin reaction and gastrointestinal symptoms. We report three patients with severe cholestatic hepatitis caused by ticlopidine. They developed jaundice about 20days after taking ticlopidine (500 mg/day). Infectious and immunological etiologies were excluded by serology. There was no history of alcohol or drug abuse. Their symptoms were gradually subsided for a few months after discontinuing ticlopidine.
Adenosine Diphosphate ; Hepatitis* ; Humans ; Jaundice ; Skin ; Substance-Related Disorders ; Ticlopidine

BACKGROUND: Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. METHODS: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. RESULTS: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). CONCLUSIONS: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.
Anti-Infective Agents ; Humans ; Critical Care ; Intensive Care Units* ; Korea ; Nutritional Support ; Observational Study ; Pharmacists* ; Pharmacokinetics ; Retrospective Studies

Purpose: This study aimed to investigate the diagnostic performance of features suggestive of nodal metastasis on preoperative MRI in patients with invasive breast cancer. Materials and Methods: We retrospectively reviewed the preoperative breast MRI of 192 consecutive patients with surgically proven invasive breast cancer. We analyzed MRI findings of axillary lymph nodes with regard to the size, long/short ratio, cortical thickness, shape and margin of the cortex, loss of hilum, asymmetry, signal intensity (SI) on T2-weighted images (T2WI), degree of enhancement in the early phase, and enhancement kinetics. Receiver operating characteristic (ROC) analysis, chi-square test, t test, and McNemar’s test were used for statistical analysis. Results: Increased shorter diameter, uneven cortical shape, increased cortical thickness, loss of hilum, asymmetry, irregular cortical margin, and low SI on T2WI were significantly suggestive of metastasis. ROC analysis revealed the cutoff value for the shorter diameter and cortical thickness as 8.05 mm and 2.75 mm, respectively. Increased cortical thickness (> 2.75 mm) and uneven cortical shape showed significantly higher sensitivity than other findings in McNemar’s test. Irregular cortical margins showed the highest specificity (100%). Conclusion Cortical thickness > 2.75 mm and uneven cortical shape are more sensitive parameters than other findings, and an irregular cortical margin is the most specific parameter for predicting axillary metastasis in patients with invasive breast cancer.

The central neural pathways of the sciatic and femoral nerves of the rat were identified with tracing methods of fluorogold, cholera toxin-horseradish peroxidase and Bartha strain of pseudorabies virus as neurotracers. After injections of fluorogold and CT-HRP into the femoral and the sciatic nerves respectively, the spinal cords were removed and processed for fluroscent microscopy and histochemistry. Lower motor neurons were multipolar in shape and located in the ipsilateral L3-L5 and L5-S1 segments. The location of the femoral LMN's were ventromedial to those of the sciatic nerve. There was no double labeled neurons and the lower motor neurons of the femoral nerves were located in ventromedially to sciatic LMN in the spinal cord. After injections of fluorogold and PRV-Ba into the femoral and the sciatic nerves respectively, the fluorogold labeled neurons were identified only in the ventral horn of ipsilateral L3-L5 segments and PRV-Ba labeled cells in L5-S1 segments. Besides L5-S1 segments, some PRV-Ba labeled cells were found in the ipsilateral L3-L4 segments and a portion of them were double labeled with fluorogold and PRV-Ba. Sequential tracing of retrograde labeled cells was done after injection of PRV-Ba into the femoral and sciatic nerves. The upper motor neurons of both nerves were mostly ovoid or polygonal in shape and present in the same nuclei of supraspinal central nervous system. In conclusion, lower motor neurons of the femoral and the sciatic nerves were arranged in somatotopic organization and some of them were connected with synaptic route. But the central pathways of both nerves were similar in locations.
Animals ; Central Nervous System ; Cholera ; Femoral Nerve* ; Herpesvirus 1, Suid ; Horns ; Microscopy ; Motor Neurons ; Neural Pathways* ; Neurons ; Peroxidase ; Rats* ; Sciatic Nerve ; Spinal Cord

The aim of this study was to better understand the frequency of autoimmune thyroid and diabetes antibodies in patients with type 1 diabetes mellitus (T1DM) compared with their siblings. Glutamic acid decarboxylase antibodies (GADA), islet cell antibodies (ICA), insulin autoantibodies (IAA), and thyroid autoantibodies were studied in all subjects. The rates of positive GADA and IAA were significantly higher in probands compared to in siblings (p<0.001) or controls (p<0.001). All pancreatic autoantibodies were not significantly different between the siblings and the healthy controls. Thyroid antiperoxidase antibody (TPOAb) and antithyroglobulin antibody (TGAb) were significantly different between the probands and the control subjects (p=0.002 and p=0.018, respectively). The rates of TPOAb and TGAb positivity in siblings were higher than in those of the controls, but there was no significant difference between the two groups. However, thyroid autoimmunity (TA) was significantly different among the groups (p=0.004). Siblings of the TA-positive probands were shown to have a greater prevalence of thyroid antibodies than did the controls (p=0.022), but siblings of the TA-negative probands did not have such a prevalence compared with the control subjects. The prevalence of pancreatic and thyroid antibodies positivity in probands was statistically significant compared with the siblings and the controls. Siblings of TA-positive probands revealed a greater prevalence of thyroid antibodies than did the controls. Therefore, the screening for TA in siblings, particularly siblings of TA-positive probands, is as important as it is in probands.
Antibodies ; Autoantibodies ; Autoimmunity ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Glutamate Decarboxylase ; Humans ; Insulin ; Islets of Langerhans ; Mass Screening ; Prevalence ; Siblings ; Thyroid Gland ; Thyroiditis

It has been shown that dysregulation of IGF-1 signaling is associated with tumor incidence and progression, whereas blockade of the signaling can effectively inhibit carcinogenesis. Although several mechanisms of anticancer activity of quercetin were proposed, molecular targets of quercetin have not been identified yet. Hence, we assessed the effect of quercetin on IGF-1 signaling inhibition in BK5.IGF-1 transgenic (Tg) mice, which over-expresses IGF-1 in the skin epidermis. A quercetin diet (0.02% wt/wt) for 20 weeks remarkably delayed the incidence of skin tumor by 2 weeks and reduced tumor multiplicity by 35% in a 7,12-dimethylbenz(a)anthracene (DMBA)-tetradecanoyl phorbol-13-acetate (TPA) two stage mouse skin carcinogenesis protocol. Moreover, skin hyperplasia in Tg mice was significantly inhibited by a quercetin supplementation. Further analysis of the MT1/2 skin papilloma cell line showed that a quercetin treatment dose dependently suppressed IGF-1 induced phosphorylation of the IGF-1 receptor (IGF-1R), insulin receptor substrate (IRS)-1, Akt and S6K; however, had no effect on the phosphorylation of PTEN. Additionally, the quercetin treatment inhibited IGF-1 stimulated cell proliferation in a dose dependent manner. Taken together, these data suggest that quercetin has a potent anticancer activity through the inhibition of IGF-1 signaling.
Animals ; Anticarcinogenic Agents* ; Cell Line ; Cell Proliferation ; Diet ; Epidermis ; Hyperplasia ; Incidence ; Insulin-Like Growth Factor I ; Mice* ; Papilloma ; Phosphorylation ; Quercetin* ; Receptor, IGF Type 1 ; Receptor, Insulin ; Skin Neoplasms* ; Skin*

BACKGROUND: Patients' perspectives of family medicine according to the physician's identity and role as a primary-care specialist need to be investigated. This study was conducted to investigate the perceived quality of the primary care of family medicine clinics as assessed by patients in a community setting. METHODS: Patients (or their guardians) visiting nine community family medicine clinics were surveyed using the Korean Primary Care Assessment Tool from April 2014 to June 2014. The scores of the Korean Primary Care Assessment Tool domains were compared according to the clinics' designation (or not) as 'family medicine' and the patients' recognition (or not) of the physicians as board-certified family medicine specialists. RESULTS: A total of 196 subjects responded to the questionnaire. They assessed the community clinics' quality of primary care as moderate to high. Of the clinics, those that were not designated as family medicine scored higher than those that were designated as family medicine (P<0.05). The group of patients that recognized a clinic as that of a board-certified family medicine specialist awarded higher scores than the non-recognition group in the domains of coordination function and personalized care (P<0.05). CONCLUSION: The moderate to high scores for the community family medicine clinics' quality of primary care are encouraging. It seems that patients' recognition of the family physician's role and of the physician-patient relationship has a significant influence on their assessment of the quality of primary care.
Awards and Prizes ; Family Practice ; Humans ; Physician's Role ; Primary Health Care* ; Quality of Health Care ; Specialization

BACKGROUND: The purpose of this study was to compare the long term effect of the cholesterol lowering diet education provided by physicians with the education provided by dieticians on serum lipid profiles of hypercholesterolemic patients. METHODS: Among 248 ambulatory patients who had mean baseline serum total cholesterol (TC) level > or = 200mg/dL and received cholesterol lowering diet education from physicians or dieticians, 41 patients who checked serum lipid profiles three times during the mean of 403 days after education were included as subjects. The differences in means of all serum lipid profiles associated with education methods after controlling for follow up duration, differences in means of all serum lipid profiles associated with follow up duration after controlling for education methods, any interaction between education methods and follow up duration on serum lipid profiles were analysed by using repeated measures of analysis of variance. The difference between the baseline lipid levels and the third lipid levels after education were analyzed by using Wilcoxon signed ranks tests in each group. Correlations between baseline serum lipid profiles and the last changes in serum lipid profiles were analyzed. RESULTS: There were no significant differences in means of all serum lipid profiles associated with education methods or follow up duration except LDL cholesterol (LDL C). The first LDL C level after education was significantly lower in the group educated by physicians compared with the baseline LDL C, but there was no such change in the group educated by dieticians. There were no interactions between education methods and follow up duration on all serum lipid profiles. The last change of total cholesterol in both groups and LDL C only in the group educated by dieticians were significant. Correlation coefficients between baseline triglyceride (TG) and change in TG, baseline LDL C and change in LDL C, baseline total cholesterol (TC) and change in TC in patients with TC > or = 240mg/dL were 0.500 (P=0.002), 0.597 (P<0.001), and 0.578 (P=0.001), respectively. CONCLUSION: The changes of serum lipid profile during more than 1 year after education were not significantly different according to diet education methods, but total cholesterol level was significantly decreased in both groups.
Cholesterol ; Cholesterol, LDL ; Diet* ; Education* ; Follow-Up Studies ; Humans ; Hypercholesterolemia ; Nutritionists* ; Triglycerides

Pregnancy-related osteoporosis is a very rare condition characterized by the occurrence of fracture during pregnancy or the puerperium. Despite its relative rarity, it can be a dangerous condition that causes severe back pain, height loss and disability. Normal physiologic changes during pregnancy, genetic or racial difference, obstetrical history and obstetrical disease, such as preterm labor or pregnancy-induced hypertension, are presumed risk factors of pregnancy-related osteooporosis. However, exact etiology and pathogenesis are uncertain. The management and natural history are still poorly defined. Traditional medications for osteoporosis are calcium/vitamin D and bisphosphonate. Concerns with bisphosphonate include accumulation in bone and fetal exposure in subsequent pregnancies. The newly developed medication, teriparatide, has shown good results. We report six cases of pregnancy-related osteoporosis and spinal fracture with literature review.
Back Pain ; Female ; Hypertension, Pregnancy-Induced ; Natural History ; Obstetric Labor, Premature ; Osteoporosis* ; Postpartum Period ; Pregnancy ; Risk Factors ; Spinal Fractures* ; Teriparatide