Ticlopidine, a widely used antiplatelet agent, has been rarely reported to cause thrombotic thrombocytopenic purpura (TTP). To the best of our knowledge, its occurrence has never before been reported in Korea. A 69 years old female patient suffered from an acute ischemic stroke. Ticlopidine 250mg bid was started and she followed an uneventful clin-ical course. The platelet count was normal on the 1st and the 12th day of ticlopidine administration. Around the 31st day, at home, she developed purpura, dyspnea and a stuporous mental status. Under the diagnosis of TTP, a plasma exchange was performed and her condition eventually returned to the baseline status. Ticlopidine induced TTP can developed abruptly despite close monitoring of platelet count, as illustrated by this case. Physicians prescribing ticlopi-dine should be aware of this potentially dangerous complication.
Aged ; Diagnosis ; Dyspnea ; Female ; Humans ; Korea ; Plasma Exchange ; Platelet Count ; Purpura ; Purpura, Thrombotic Thrombocytopenic* ; Stroke ; Stupor ; Ticlopidine*

Most loci associated with type 2 diabetes mellitus (T2DM) discovered to date are within noncoding regions of unknown functional significance. By contrast, exonic regions have advantages for biological interpretation.

Most loci associated with type 2 diabetes mellitus (T2DM) discovered to date are within noncoding regions of unknown functional significance. By contrast, exonic regions have advantages for biological interpretation.

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is common disorder of the school-age population. ADHD is familial and genetic studies estimate heritability at 80–90%. The aim of the present study was to investigate the association between the genetic type and alleles for RELNgene (rs736707, rs2229864, rs362746, rs362726, rs362691, rs1062831, rs607755, and rs2072403) in Korean children with ADHD. METHODS: The sample consisted of 180 ADHD children and 159 control children. We diagnosed ADHD according to DSM-IV. ADHD symptoms were evaluated with Conners' Parent Rating Scales and Dupaul Parent ADHD Rating Scales. Blood samples were taken from the 339 subjects, DNA was extracted from blood lymphocytes, and PCR was performed for RELN Polymorphism. Alleles and genotype frequencies were compared using the chi-square test. We compared the allele and genotype frequencies of RELN gene polymorphism in the ADHD and control groups. RESULTS: This study showed that there was a significant correlation among the frequencies of the rs736707 (OR=1.40, 95% CI=1.03–1.90, p=0.031) of alleles of RELN, but the final conclusions are not definite. CONCLUSION: Follow up studies with larger patient or pure subgroups are expected. These results suggested that RELN might be related to ADHD symptoms.
Alleles ; Attention Deficit Disorder with Hyperactivity* ; Child* ; Diagnostic and Statistical Manual of Mental Disorders ; DNA ; Follow-Up Studies ; Genotype ; Humans ; Lymphocytes ; Parents ; Polymerase Chain Reaction ; Weights and Measures

No abstract available.
Acromegaly* ; Fibrous Dysplasia, Polyostotic*

PURPOSE: Cooling and rewarming have been described to contribute to the pathogenesis of exercise induced asthma. However, little is known about the cellular response to cooling and rewarming of respiratory epithelial cells. Hypersecretion of mucus and allergic inflammation are important pathologic finding of patients who suffered from asthma. We investigated whether cooling and rewarming of respiratory epithelial cells induce mucin gene (MUC5AC, MUC5B) expression and IL-8 production. METHODS: NCI-H292 (human lung mucoepidermoid carcinoma cell line) cells were cultured in 6 well plates. Experimental groups were preserved at 1degree C, 4degrees C, 18degrees C and control groups at 37degrees C for 2 hours. And then both group were kept at 37degrees C. MUC5AC, MUC5B and IL-8 mRNA expressions were examined by RT-PCR. IL-8 concentration in the cell culture medium after rewarming was measured by ELISA. RESULTS: Cooling and cooling-rewarming stimuli did not increase MUC5AC and MUC5B expression. IL-8 concentration was remarkably decreased in experimental groups after cooling and then markedly increased during first 6 hours. IL-8 concentration of 1degrees C, 4degrees Cgroups were significantly increased compared to control group at 6 hour, of 18degrees C group at 12 hour and then persisted until 24 hour. CONCLUSION: Cooling and rewarming stimuli to respiratory epithelial cells did not increase MUC gene expression. However, increased IL-8 production provides evidence of cooling and rewarming induced airway inflammation. Further investigation will be needed to support this result.
Asthma ; Asthma, Exercise-Induced ; Carcinoma, Mucoepidermoid ; Cell Culture Techniques ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells* ; Gene Expression ; Humans ; Inflammation ; Interleukin-8* ; Interleukins* ; Lung ; Mucins ; Mucus ; Rewarming* ; RNA, Messenger

PURPOSE: The estimation of fluid deficit is crucial to the proper management of dehydrated children. Without well-documented serial weights on the same scale, the estimation of any given child's fluid deficit is imprecise and dependent largely on subjective clinical criteria. Despite the abundance of literature on clinical and laboratory evaluation of dehydration, few studies have focused on serum uric acid. So, we examined the usefulness of serum uric acid in gastroenteritis patients with dehydration. METHODS: Medical records of 90 gastroenteritis patients were retrospectively reviewed. By the body weight loss, we classified patients with mild, moderate, and severe dehydration groups. We studied the relevance of laboratory data (BUN, creatinine, serum bicarbonate, glucose, urine specific gravity, and uric acid) with dehydration. RESULTS: 54 children (60%) were dehydrated mildly, 24 (26%) dehydrated moderately, and 12 (14%) dehydrated severely. Statistically significant differences in BUN, creatinine, serum bicarbonate, glucose, and urine specific gravity could not be observed. But there was significant relationship between uric acid and the degree of dehydration. Data analysis suggested that the level of 7.0 mg/dL is the best cut-off value for predicting the development of moderate or severe dehydration. At this cut-off value, the sensitivity and specificity were 66.6% and 87.1%. CONCLUSION: Our study supports that the measurement of serum uric acid with traditional scales is useful for predicting the development of dehydration. But, in order to be used as the indicator for proper treatment at an earlier stage, further validation about serum uric acid is necessary.
Body Weight ; Child ; Creatinine ; Dehydration* ; Gastroenteritis* ; Glucose ; Humans ; Medical Records ; Retrospective Studies ; Sensitivity and Specificity ; Specific Gravity ; Statistics as Topic ; Uric Acid* ; Weights and Measures

PURPOSE: The objective of this study was to evaluate the initial fixation strength of press-fit technique compared with titanium and biodegradable interference screws in ACL reconstruction using bone-patellar tendon-bone grafts. MATERIALS AND METHODS: Fifty porcine lower limbs were used. The graft in the press-fit group was harvested with a hollow oscillating saw to obtain a consistent and complete circular shape and that in the interference screw group was obtained with a conventional oscillating saw. With preload of 20 N, the specimens underwent 250 loading cycles between 0-2 mm of displacement. Thereafter, the specimens were loaded to failure after restoration of the preload. RESULTS: During the cyclic loading, none of press-fit or interference screw fixations failed and there was no significant difference in maximum loads between the groups. In groups of press-fit fixation with diameter of bone plug being larger that that of the femoral tunnel by 1.4 mm, the ultimate failure load was comparable with that of the titanium or biodegradable interference screw groups. The complete circular shape and increased diameter of the bone plug seemed to contribute the strong initial fixation. CONCOUSION: Press-fit fixation technique provides a secure and consistent fixation strength comparable with the metal or biodegradable interference screws.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Bone-Patellar Tendon-Bone Grafts ; Knee ; Lower Extremity* ; Titanium ; Transplants

PURPOSE: As the incidence of primary hyperparathyroidism is on the increase, a 26-year experience of primary hyperparathyroidism is described along with a review of the literature. METHODS: A total of 113 patients underwent surgery at Seoul National University Hospital from 1981 to 2006. Age, sex, presenting symptoms, biochemical analyses, imagefindings, operative findings, histopathology, and information on follow-ups were retrospectively investigated. Furthermore, patients were divided into two period groups and comparative analysis was performed. RESULTS: Among the 113 patients, 41 patients (36.3%) were male and 72 patients (73.7%) were female. The mean age of the patients was 51 years. Thirty-two patients (28.3%) were incidentally discovered and among the symptomatic patients, the presence of a urinary stone was the most frequent presentation. The average serum calcium level and PTH level were 12.4 mg/dl and 452.36 pg/ml, respectively. The calcium level of all patients was normalized the day after surgery, and the PTH level of all patients was reduced remarkably after surgery. Preoperative imaging studies included ultrasonography, computer tomography (CT), and scans such as a (99m)Tc-sestamibi scan and a ²⁰¹Tl-⁹⁹Tc subtraction scan. The sensitivities of CT, the (99m)Tc-sestamibi scan and ²⁰¹Tl-⁹⁹Tc subtraction scan were 80.2%, 68.8% and 75.4%, respectively. Unilateral neck exploration was performed in 97 cases (85.8%), and bilateral neck exploration was carried out in the remaining 16 cases (14.2%). Histopathology revealed 102 cases (90.3%) of adenoma, 3 cases (2.7%) of hyperplasia, 7 cases (6.2%) of carcinoma, and one case that was indeterminate between adenoma and hyperplasia. Fifty-six patients (49.6%) developed transient hypocalcemia, and onepatient required a second surgery due to postoperative bleeding. There was one case of a recurrent carcinoma during a mean follow-up period of 18.7 months. CONCLUSION: Primary hyperparathyroidism is on the increase and is a surgically curative disease. Understanding the nature of the disease is necessary for detection and management.
Adenoma ; Calcium ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hyperparathyroidism, Primary* ; Hyperplasia ; Hypocalcemia ; Incidence ; Male ; Neck ; Parathyroidectomy ; Retrospective Studies ; Seoul* ; Ultrasonography ; Urinary Calculi

Background: Most loci associated with type 2 diabetes mellitus (T2DM) discovered to date are within noncoding regions of unknown functional significance. By contrast, exonic regions have advantages for biological interpretation. Methods: We analyzed the association of exome array data from 14,026 Koreans to identify susceptible exonic loci for T2DM. We used genotype information of 50,543 variants using the Illumina exome array platform. Results: In total, 7 loci were significant with a Bonferroni adjusted P=1.03×10–6 . rs2233580 in paired box gene 4 (PAX4) showed the highest odds ratio of 1.48 (P=1.60×10−10 ). rs11960799 in membrane associated ring-CH-type fin­ger 3 (MARCH3) and rs75680863 in transcobalamin 2 (TCN2) were newly identified loci. When we built a model to predict the incidence of diabetes with the 7 loci and clinical variables, area under the curve (AUC) of the model improved significantly (AUC=0.72, P<0.05), but marginally in its magnitude, compared with the model using clinical variables (AUC=0.71, P<0.05). When we divided the entire population into three groups—normal body mass index (BMI; <25 kg/m2 ), overweight (25≤ BMI <30 kg/m2 ), and obese (BMI ≥30 kg/m2 ) individuals—the predictive performance of the 7 loci was greatest in the group of obese individuals, where the net reclassification improvement was highly significant (0.51; P=8.00×10–5 ). Conclusion We found exonic loci having a susceptibility for T2DM. We found that such genetic information is advantageous for predicting T2DM in a subgroup of obese individuals.