BACKGROUND: Our previous data suggested that IgE-mediated histamine release from basophil was elevated in the atopic asthmatic children. Basophil may play an important role in the development of the IgE-dependent, late phase response in allergen induced airway disease. So the existence of enhanced basophil histamine release in asthma could promote airway reactivity and obstruction. PURPOSE: The purpose of this study is to determine the relationship between IgE-mediated basophil histamine releasability (BHR) and airway hyperresponsiveness or markers of atopy in atopic children. METHODS: Twelve atopic asthmatics and four healthy atopics who were sensitive to D.p and D.f were selected. Their median age was 11.2 years old, their mean serum IgE level was 897+/-276 IU/mL and mean total eosinophil count was 536+/-71/mm3. Total eosinophil counts, total IgE, D.p and D.f-specific IgE, pulmonary function test, and methacholine provocation test were performed. IgE-mediated basophil histamine release by D.f allergen and goat-antihuman IgE antibody were measured by automated fluorometric assay. The relationship between histamine release and airway hyperresponsiveness or atopic markers was investigated. RESULTS: PC20 inversely correlated with anti-IgE antibody-mediated BHR (r=-0.50, P<0.05). Serum total IgE concentration correlated with anti-IgE antibody-mediated BHR (r=0.54, P<0.05). Serum concentrations of specific IgE to D.p correlated with anti-IgE antibody-mediated BHR (r=0.66, P<0.05). PC20 correlated correlated with FEF25-75% (r=0.75, P<0.05) and inversely with the total eosinophil counts (r=-0.69, P< 0.01). CONCLUSION: IgE-mediated basophil histamine releasability is inversely correlated with airway hyperresponsiveness, and correlated with total or specific-IgE in atopic children. These findings suggest that basophil histamine releasability is easy and useful method of diagnosis and monitoring response to treatment in atopic disease.
Asthma ; Basophils* ; Child* ; Diagnosis ; Eosinophils ; Histamine Release ; Histamine* ; Humans ; Immunoglobulin E ; Methacholine Chloride ; Respiratory Function Tests

Aneurysmal fibrous histiocytoma(AFH) is a histologic variant of dermatofibroma. The importance of the recognition of AFH as a variant of dermatofibroma lies in the differential diagnosis because the histologic appearance of AFH is very similar to dermatofibrosarcoma protuberans and other vascular malignancies, such as Kaposi's sarcoma and angiosarcoma. A 32-year-old man was seen for a nodular mass on the right popliteal fossa of 4 years' duration. The excisional biopsy specimen showed a relatively well circumscribed tumor mass in the dermis. In addition to compact storiform proliferation of spindle cells, there were multiple, irregular, blood-filled, aneurysmal tissue spaces that were devoid of lining of endothelial cells. Also, deposition of hemosiderin was prominent, particularly in the periphery of the aneurysmal spaces. Immunohistochemical stain for CD34 were negative to most tumor cells. After excisional therapy, there was no evidence of recurrence during the period of ten months' follow-up.
Adult ; Aneurysm* ; Biopsy ; Dermatofibrosarcoma ; Dermis ; Diagnosis, Differential ; Endothelial Cells ; Follow-Up Studies ; Hemangiosarcoma ; Hemosiderin ; Histiocytoma, Benign Fibrous* ; Humans ; Recurrence ; Sarcoma, Kaposi

BACKGROUND: Many tumor markers have been investigated for early diagnosis of the malignancy, yet they were turned out to be inappropriate for the purpose. This study was carried out to investigate the efficacy of tumor markers. METHODS: Employing radioimmunoassay, CEA, AFP, CA19-9, PSA, CA125 were done in 31,389 patients(20,878 males, 10,511 females) who visited our medical screening center from Jan. 1 1997 to Dec. 31 1997. RESULTS: Total mean value of CEA is 1.90+/-1.37 ng/mL(male: 2.17+/-1.37, female: 1.37+/-0.86). Male showed significantly higher level of CEA. Only 2 subjects had values over 25 ng/mL, and one was diagnosed to have stomach cancer but the other did not. Total mean value of AFP is 2.46+/-6.47 ng/mL (male: 2.32+/-3.55 ng/mL, female: 2.73+/-10.06 ng/mL). Female showed significantly higher level of measured AFP. One had AFP value over 400 ng/mL and was diagnosed of hepatoma. Total mean value of CA19-9 is 11.48+/-7.61 ng/mL,(male: 10.9+/-26.78 ng/mL, female: 12.61+/-8.97 ng/mL). Female showed significantly higher CA19-9. 65 subjects (male: 31, female: 34) showed measured CA19-9 level over 37 ng/mL. 5 subjects had values over 100 ng/mL and 1 subject was diagnosed of pancrease cancer. Total mean value of PSA is 0.79+/-1.88 ng/mL. 90 subjects showed measured PSA level over 4 ng/mL and mean value in this group was 10.92 ng/mL. 54 subjects were older than age 50. 4 out of 90 subjects were diagnosed of prostate cancer. Total mean value of CA125 is 13.08+/-10.93 ng/mL. 160 subjects showed measured CA125 level over 35 ng/mL. 19 subjects had value over 100 ng/mL and none of the malignancy was detected. CONCLUSION: Tumor markers are inappropriate measures for screening of malignancy.
alpha-Fetoproteins ; Carcinoembryonic Antigen ; Carcinoma, Hepatocellular ; Early Diagnosis ; Female ; Humans ; Male ; Mass Screening* ; Pancreas ; Pancrelipase ; Prostatic Neoplasms ; Radioimmunoassay ; Stomach Neoplasms ; Biomarkers, Tumor*

Lichen nitidus(LN) is an uncommon chronic inflammatory disease of shiny, flat-topped, flesh-colored uniform papules most commonly located on the penis, forearms and wrists, lower abdomen, and thighs. LN almost has localized distribution, but in rare cases, it may become generalized. In Korea, three cases of generalized LN were reported. We report here three cases of generalized lichen nitidus in 31-year-old man, 8-year-old boy, and 6-year-old girl who had generalized numerous pinhead-sized, erythematous to flesh-colored, shiny papules. Microscopically, they had typical appearance of LN.
Abdomen ; Adult ; Child ; Female ; Forearm ; Humans ; Korea ; Lichen Nitidus* ; Lichens* ; Male ; Penis ; Thigh ; Wrist

BACKGROUND: Facioscapulohumeral muscular dystrophy (FSHD) is associated with contractions of the polymorphic D4Z4-repeat array in 4q35 and has the distinctive clinical presentation of an initial involvement of the facial, shoulder-girdle, and upper-arm muscles. The aim of the present study was to determine clinical characteristics in Korean patients with FSHD and potential relationships between contracted D4Z4-repeat size and the FSHD phenotype. METHODS: We studied 34 genetically confirmed patients who had repeat sizes less than 38 kb, and analyzed their clinical manifestations with a structured protocol. The expressed phenotypes were scored according to the Clinical Severity Score formulated by Ricci and van Overveld. RESULTS: The clinical spectrum ranged widely, from asymptomatic individuals with minimal signs to wheelchair- bound patients. The initial affects were mainly in the facial muscles (68.8%), followed by the shoulder-girdle muscle (28.1%). Asymmetric features of the face and shoulder girdle were also important findings (71.9% and 90.0%, respectively). Winging scapular (87.5%), transverse smile (84.4%), Beevor's sign (68.8%), and sleeping with eyes opened (59.4%) were clinically important signs. There was a significant negative correlation between repeat size and clinical severity (r=-0.38, p=0.03). CONCLUSIONS: Distinctive clinical characteristics of FSHD are descending progression and asymmetric distribution of the muscle weakness. Our results also confirmed that the severity of FSHD increases with decreasing D4Z4-repeat size.
Contracts ; Eye ; Facial Muscles ; Genotype ; Humans ; Muscle Weakness ; Muscles ; Muscular Dystrophies ; Muscular Dystrophy, Facioscapulohumeral ; Phenotype ; Shoulder

This study evaluated the possibility of clinical application using matrigel-based bioceramic/polymer scaffolds treated with bone morphogenetic protein, angiogenic factor, and mesenchymal stem cells (MSCs) for new bone formation. In the in vitro study, bone morphogenetic protein (BMP-2) and vascular endothelial growth factor (VEGF) containing matrigel, which is a basement membrane gel, was injected into HA/PCL scaffolds to estimate the release rates of growth factors. In the in vivo study, BMP-2, VEGF, and MSCs with matrigel-based scaffolds were implanted into rat femoral segmental defects, and new bone formation was evaluated at 4 and 8 weeks. In the results, the release rates of BMP-2 and VEGF explosively increased by day 5. For the in vivo study results, radiological evaluation revealed that the matrigel-based HA/PCL scaffolds with BMP-2 and VEGF grafted (M+B+V) and matrigel-based HA/PCL scaffolds with BMP-2, VEGF, and MSC grafted (MSC) groups showed increased bone volume and bone mineral density. Moreover, in the histological evaluation, large new bone formation was observed in the M+B+V group, and high cellularity in the scaffold was observed in the MSC group. In conclusion, grafted matrigel-based HA/PCL scaffolds with BMP-2, angiogenic factor, and MSCs increased new bone formation, and in clinical cases, it may be effective and useful to enhance healing of delayed fractures.
Angiogenesis Inducing Agents ; Animals ; Basement Membrane ; Bone Density ; Bone Morphogenetic Proteins ; Intercellular Signaling Peptides and Proteins ; Mesenchymal Stromal Cells* ; Osteogenesis ; Rats ; Regeneration* ; Transplants ; Vascular Endothelial Growth Factor A*

Pancreatic fistulae follows pancreatic duct disruption and may develop as a complication of pancreatic disease or injury. The escaping fluid may be walled off by the surrounding viscera to form a pseudocyst or an abscess. Fistulae may drain spontaneously into adjacent hollow viscera or communicate with the body surface externally. Although internal pancreatic fistulas that communicate with adjacent internal organs are much less common, vascular communication with the pancreatic ductal system is especially unusual and generally represents a serious clinical situation. We experienced one case of pancreatic duct-portal vein fistula in a patient with pancreatic cancer. Endoscopic retrograde cholangiopancreatography revealed a large vascular structure representing the portal vein filled at the time of the contrast injection, indicating the presence of a pancreatic duct-portal vein fistulae.
Abscess ; Cholangiopancreatography, Endoscopic Retrograde ; Fistula* ; Humans ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreatic Neoplasms* ; Portal Vein ; United Nations ; Veins* ; Viscera

BACKGROUND AND PURPOSE: Although thrombolytic strategies with streptokinase(STK) and tissue-type plasminogen activator(t-PA) in the treatment of acute myocardial infarction(AMI) have been studied in large-scale clinical trials in the western countries, such large-scale studies with urokinase(UK) are scanty. Even though UK is most commonly used thrombolytic agent for the treatment of AMI in Korea, there is no consensus on the dosage and the way of administration of UK in patients with AMI. Accordingly, a prospective clinical study was performed to evaluate the effects of thrombolytic strategies of intravenous double bolus method and standard double-infusion method with different dosage of UK in the treatment of AMI. SUBJECTS AND METHODS: Ninety there patients with AMI(male 75, female 18, age 57.5+/-10.8 years) were studied. The patients were divided into 3 groups according to dosage of UK and method of administration. Group I : 19 patients who received 1.5 million U of UK IV bolus, followed by 1.5 million U IV infusion for an hour(High Dose Group). Group II : 34 patients received 20,000U/kg body weight of UK IV bolus, followed by 20,000U/kg IV infusion for an hour(Double Dose Group). Group III : 40 patients received 1.5 million U of UK IV bolus and followed by 20,000U/kg IV bolus in 30 minutes with total dose of no more than 3 million U(Double Bolus Group). Coronary angiography(CAG) and left ventriculography(LVG) were performed 90 minutes after the administration of UK and post-AMI 7-10 days to investigate the patency of infarct-related artery(IRA) and LV function. Patency of IRA was graded according to the extent of flow of IRA. TIMI grade 0-1 was regarded as occluded, and grade 2-3 flow as patent. LV ejection fraction(EF) by echocardiography was measured on day 1, day 7-10 and 1 month after AMI. Indirect clinical parameters of thrombolysis were evaluated and were compared with CAG findings. RESULTS: 1) The 90 minutes IRA patency in Group III(Double bolus ; 79.0%) was higher than that in Group 1, but showed no statistically significant difference(High dose ; 61.5%, p=0.790). The 90 minutes IRA patency in Group III showed borderline significance with Group II(Double dose ; 57.1%, p=0.057). TIMI flow III in Group III(60.6%) was significantly higher than that in Group II(53.6%, p=0.0468) but showed no statistically significant difference with Group I(61.5%, p=0.158). 2) The EF by LVG were 49.1% in Group I, 41.7% in Group II and 49.2% in Group III. The difference in EF between Group I and Group III vs Group II was significant(p=0.008 in Group I, p=0.014 in Group III vs Group II). 3) Fatal bleeding complications(1 intracranial hemorrhage and 1 gastric ulcer bleeding) developed in Group II (Double dose). 4) Pain to door time, pain to needle time and door to needle time tended to be shorter in open(TIMI flow II-III) IRA group than in closed IRA group. 5) Initial EF were similar between open IRA group and closed IRA group(46.1% and 42.1% ; p=NS). The EF of open IRA group measured by LVG on initail coronary angiography(41.8% in closed IRA vs 48.0%, in open IRA, p=0.03) and by 2D-Echo on 7-10 day(41.7% in closed IRA vs 51.0% in open IRA, p=0.004) were better than those of closed IRA group. 6) Indirect clinical indices of reperfusion such as mean CPK peak, time to CPK peak significantly lower in open IRA group than in closed IRA group. 7) Fatal bleeding complications(1 intacranial hemorrhage and 1 gastric ulcer bleeding) developed in closed IRA group. CONCLUSION: The findings we observed in this trial showed that earlier initiation and more rapid infusion of UK were associated with more increased 90min patency of infarct-related artery and more improved LV function without any obviously increased bleeding complications or other serious life-threatening complications than conventional UK therapy. Specifically, double bolus IV injection of UK(1.5 million U bolus followed by 20,000 U/Kg bolus in 30min)was more effective method of thrombolysis than conventional method for achieving optimal reperfusion in AMI patients. Also, IRA patency at 90 minutes after the initiation of thrombolysis was important in preserving global LV function in early recovery phase of AMI. Further trials may be needed to determine more effective thrombolysis with UK in AMI.
Arteries ; Body Weight ; Consensus ; Echocardiography ; Female ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Korea ; Myocardial Infarction* ; Needles ; Plasminogen ; Prospective Studies ; Reperfusion ; Stomach Ulcer ; Urokinase-Type Plasminogen Activator*

BACKGROUND/AIMS: When a submucosal lesion is discovered through an upper gastrointestinal endoscopy, it may be often difficult to differentiate an extra-gastric compression from a true submucosa1 tumor (SMT). An endoscopic ultrasonography (EUS) provides information about the relationship between a lesion and the gastric or esophageal wall. Furthermore, EUS helps in identifying the compression caused by surrounding organs. The diagnostic usefulness of EUS for extralumina1 compressed lesion was assessed. METHODS: The 261 patients who received an endoscopic diagnosis of submucosal tumors had EUS examinations performed. The results of EUS to additional diagnostic procedures such as UGI, USG, CT scan or tissue biopsy were then compared. RESULTS: Of 261 patients who received endoseopic diagnosis as SMT, extraluminal compression existed in 46 (17.6%) cases and true intramural lesion were found in 215 (82.4%) cases on EUS. The causes of extraluminal compression are lymph nodes (2 case.), the gallbladder (12 cases), the pancreas (9 cases), the spleen (6 cases), a pancreatic pseudocyst (5 cases), pancreatic cancer (2 cases), a hepatic cyst (2 cases), the left lobe of the liver (4 cases), hepatoma (1 case), a mesenteric tumor (2 caws) and a splenic vein (1 case). CONCLUSIONS: EUS is considered to be a useful diagnostic method not only for differential diagnosis of extraluminal compression from true SWT, but also for clarifying the cause of extraluminal compressed lesions.
Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Endosonography ; Gallbladder ; Humans ; Liver ; Lymph Nodes ; Pancreas ; Pancreatic Neoplasms ; Pancreatic Pseudocyst ; Spleen ; Splenic Vein ; Tomography, X-Ray Computed

BACKGROUND/AIMS: There were two blind spots during colonoscopy, one was on angulated portion of colon, other was on non-fixated portion of colon. In spite of careful inspection during routine colonoscopy, small lesions behind the semilunar folds can be situated in blind spots, where they are easily overlooked. The aim of this study was to evaluate the efficacy of total colonoscopy with transparent cap in identifying such lesions, in comparison with colonoscopy without the cap. METHODS: We performed colonoscopy with or without transparent cap in 30 patients and 30 controls. During colonoscopy, frequencies of ileal intubation, time required for intubation as far as the terminal ileum and degrees of patients discomfort were checked. RESULTS: Colonoscopy with a transparent cap ensured good visual fields during insertion and withdrawal of the colonoscopy. There were no significant differences in the intubation times to the terminal ileum or in the frequencies of terminal ileal intubation, degree of patients discomfort between the two procedures. CONCLUSIONS: Total Colonoscopy with a transparent cap allows inspection of the blind area of the colonic mucosa behind the semilunar folds, with good visual fields. But the statistical significance was not found in this study. This method may be potentially useful for both screening and diagnostic purposes. Further study in more cases would be needed.
Colon ; Colonoscopy* ; Humans ; Ileum ; Intubation ; Mass Screening ; Mucous Membrane ; Optic Disk ; Visual Fields