Purpose: This study aimed to investigate the presence of autoantigens in the gastric juices of children. Methods: Gastric juice and serum samples were obtained from 53 children <15 years of age who underwent gastric endoscopy. Among these, 8, 22, and 23 participants were in the age groups 0–5, 6–10, and 11–15 years, respectively. These samples were analyzed using two-dimensional electrophoresis (2-DE), immunoblot analysis, and matrix-assisted laser desorption ionization-time of-flight mass spectrometry. Furthermore, we reviewed the histopathological findings and urease test results and compared them with the results of 2-DE and immunoblot analysis. Results: There were no statistically significant differences in urease test positivity, grades of chronic gastritis, active gastritis, or Helicobacter pylori infiltration of the antrum and body among the three age groups. Three distinct patterns of gastric juice were observed on 2-DE. Pattern I was the most common, and pattern III was not observed below the age of 5 years.Histopathological findings were significantly different among active gastritis (p=0.037) and H. pylori infiltration (p=0.060) in the gastric body. The immunoblots showed large spots at an approximate pH of 3–4 and molecular weights of 31–45 kDa. These distinct, large positive spots were identified as gastric lipase and pepsin A and C. Conclusion Three enzymes, which are normally secreted under acidic conditions were identified as autoantigens. Further investigation of the pathophysiology and function of autoantigens in the stomach is required.

PURPOSE: Various immune cells, including eosinophils and neutrophils, are known to contribute to the development of chronic rhinosinusitis with nasal polyps (CRSwNP). However, the current understanding of the role of neutrophils in the development of CRSwNP still remains unclear. Therefore, we investigated risk factors for refractoriness of CRSwNP in an Asian population. METHODS: Protein levels of 17 neutrophil-related mediators in nasal polyps (NPs) were determined by multiplex immunoassay, and exploratory factor analysis using principal component analysis was performed. Immunofluorescence analysis was conducted to detect human neutrophil elastase (HNE) or myeloperoxidase (MPO)-positive cells. Tissue eosinophilic nasal polyp (ENP) and tissue neutrophilia (Neu(high)) were defined as greater than 70 eosinophils and 20 HNE-positive cells, otherwise was classified into non-eosinophilic nasal polyp (NENP) and absence of tissue neutrophilia (Neu(low)). RESULTS: In terms of disease control status, NENP-Neu(low) patients showed the higher rate of disease control than NENP-Neu(high) and ENP-Neu(high) patients. Linear by linear association demonstrated the trend in refractoriness from NENP-Neu(low) to NENP-Neu(high) or ENP-Neu(low) to ENP-Neu(high). When multiple logistic regression was performed, tissue neutrophilia (hazard ratio, 4.38; 95% confidence interval, 1.76-10.85) was found as the strongest risk factor for CRSwNP refractoriness. Additionally, exploratory factor analysis revealed that interleukin (IL)-18, interferon-γ, IL-1Ra, tumor necrosis factor-α, oncostatin M, and MPO were associated with good disease control status, whereas IL-36α and IL-1α were associated with refractory disease control status. In subgroup analysis, HNE-positive cells and IL-36α were significantly upregulated in the refractory group (P = 0.0132 and P = 0.0395, respectively), whereas MPO and IL-18 showed higher expression in the controlled group (P = 0.0002 and P = 0.0009, respectively). Moreover, immunofluorescence analysis revealed that IL-36R⁺HNE⁺-double positive cells were significantly increased in the refractory group compared to the control group. We also found that the ratio of HNE-positive cells to α1 anti-trypsin was increased in the refractory group. CONCLUSIONS: Tissue neutrophilia had an influence on treatment outcomes in the Asian CRSwNP patients. HNE-positive cells and IL-36α may be biomarkers for predicting refractoriness in Asians with CRSwNP. Additionally, imbalances in HNE and α1 anti-trypsin may be associated with pathophysiology of neutrophilic chronic rhinosinusitis.
Asian Continental Ancestry Group ; Biomarkers ; Eosinophils ; Fluorescent Antibody Technique ; Humans ; Immunoassay ; Interleukin 1 Receptor Antagonist Protein ; Interleukin-18 ; Interleukins ; Leukocyte Elastase ; Logistic Models ; Nasal Polyps ; Necrosis ; Neutrophils ; Oncostatin M ; Peroxidase ; Principal Component Analysis ; Rhinitis ; Risk Factors ; Sinusitis

PURPOSE: To evaluate the efficacy and stability of the wrap-clipping methods as a reconstructive strategy in the treatment of unclippable cerebral aneurysms. MATERIALS AND METHODS: Twenty four patients who had undergone wrap-clipping microsurgery were retrospectively reviewed. Type and morphology of the treated aneurysm, utilized technique for wrap-clip procedure, and clinical outcome with angiographic results at their last follow-up were evaluated. RESULTS: Of 24 patients, eleven patients had internal carotid artery (ICA) blister-like aneurysms, three had dissecting type aneurysms, and ten had fusiform aneurysms. The follow-up period for the late clinical and angiographic results ranged from 10 to 75 months (mean 35 months). Wrap-clipping was performed in eleven, wrap-holding clipping was in ten, and combination of wrap-clip and wrap-holding clip was in three cases. At the last angiographic follow-up study, twelve aneurysms (50%) were found to have completely healed, and nine aneurysms (38%) were at least stable. However, wrap-holding clip for the elongated blister type of ICA aneurysm was found failed, leading to fatal rebleeding in one case, and two cases of combination of wrap-clip-wrap-holding clip revealed delayed branch occlusion and marked regrowing, respectively. CONCLUSION: Wrap-clipping strategy could be an easy and safe alternative for unclippable aneurysms. The wrapped aneurysm mostly disappeared, or at least remained stationary, after a long-term period. However, surgeons should be aware of that the wrapped aneurysm might become worse. Therefore, follow-up surveillance for an extended period should be mandatory.
Aneurysm ; Blister ; Carotid Artery, Internal ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Methods ; Microsurgery ; Retrospective Studies

PURPOSE: Commercial enzyme-linked immunosorbent assay (ELISA) kits have been considered less reliable for children than for adults. The aim of this study was to compare four ELISA kits and in-house immunoblotting based on the analysis of anti-H. pylori-IgG antibody reactivity. METHODS: A total of 399 serum samples were collected at the GNU Hospital during 1998-1999. All sera were tested using ELISA and immunoblotting. Statistically significant differences were determined by the chi2 test. RESULTS: The overall seropositivity rates using GAP IgG, Genedia IgG, HM-CAP, Pyloriset EIA-G, and immunoblotting were 13.0%, 25.1%, 18.3%, 15.8%, and 62.9%, respectively. Immunoblotting showed a higher seropositivity rate than did all four ELISA kits in all age groups. Genedia IgG had the highest seropositivity among the ELISA kits. The seropositivity rate for children aged 13 to 18 months was lowest, and that of children aged 15 years was highest (90.0%). The seropositivity rate for children aged 7 months to 5 years was significantly lower than that for children aged 6 to 15 years among the four ELISA kits (p<0.0001) and immunoblotting (p=0.02). CONCLUSION: Immunoblotting is the most sensitive test for detection of anti-Helicobacter pylori IgG antibodies among the serological tests in this study. These results emphasize the need for standardization when commercial ELISA tests are used in different nations or in young age groups. Immunoblotting could be a suitable noninvasive assay for serodiagnosis and seroepidemiologic study of H. pylori infection in Korean children.
Adult ; Aged ; Antibodies ; Child ; Enzyme-Linked Immunosorbent Assay ; Helicobacter ; Helicobacter pylori ; Humans ; Immunoblotting ; Immunoglobulin G ; Seroepidemiologic Studies ; Serologic Tests

OBJECTIVE: The aim of this study was to define the clinical characteristics of pediatric cerebral aneurysms. METHODS: During the past 30 years, among a total of 3,330 patients treated for cerebral aneurysms, 12 patients were under the age of 18. The authors reviewed the database and imaging studies as sources for identification and analysis. RESULTS: Seven patients were male and 5 were female. The mean age was 12.9 years old (range: 3~18). Nine patients had ruptured lesions and the remaining 3 had unruptured lesions. Four patients presented with a subarachnoid hemorrhage, and the other 5 patients presented with an intracerebral hemorrhage (ICH). Five aneurysms were located at the posterior cerebral artery or vertebrobasilar artery, 4 at the middle cerebral artery, and 3 at the internal carotid artery, respectively. The giant aneurysm was observed in 2 (18%) patients. Eleven aneurysms were saccular, and 1 was serpentine in shape. No patient had multiple aneurysms. Rebleeding was observed in 3 cases (33%). No child suffered from clinical vasospasm. All but one patient showed a favorable outcome (good: 11, dead: 1). CONCLUSIONS: Pediatric cerebral aneurysms in this study showed a male predominance, a high incidence of presentation with ICH, a location on the distal circulation of the major arteries or on the posterior circulation, and a large or giant aneurysm, high rebleeding rate and a low incidence of vasospasm. The overall clinical outcome was excellent in 91.7% in this study. With the knowledge of these features, aneurysmal obliteration and active brain resuscitation can improve the clinical outcome and prognosis.
Aneurysm ; Arteries ; Brain ; Carotid Artery, Internal ; Cerebral Hemorrhage ; Child ; Female ; Humans ; Incidence ; Intracranial Aneurysm* ; Male ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Prognosis ; Resuscitation ; Subarachnoid Hemorrhage

BACKGROUND/AIMS: To investigate the epidemiologic changing patterns of gallstone diseases in Korea during past 25 years. METHODS: A total of 5,671 gallstone patients who underwent surgery in our center during 1981-2005 were analyzed. The patients were divided into 5 periods: period I (1981-1985, n=831), period II (1986-1990, n=888), period III (1991-1995, n=1,040), period IV (1996-2000, n=1,261) and period V (2001-2005, n=1,651). Korean literatures published from 1961 to 2005 were reviewed to elucidate the nationwide trends of gallstone diseases. RESULTS: Number of gallstone disease cases were gradually increasing. Female predominance was not noted (male/female ratio, 1.07-1.37). Patients with common bile duct (CBD) stone were older than those with gallbladder (GB) stone or intrahepatic duct (IHD) stone. During past 25 years, relative proportion of GB stone cases increased from 53.0% to 89.7%, while that of CBD stone cases decreased from 68.0% to 15.1%. Relative proportion of IHD stone patients remained stationary. In rural areas, tendency of increasing GB stone and decreasing CBD stone disappeared since period III. However, in urban areas, these tendencies remained till period V. Relative frequency of IHD stone group remained unchanged in two areas. The body mass indexes of the GB stone group, CBD stone group, and IHD stone group were higher than that of the average population. CONCLUSIONS: In gallstone disease, increasing tendency of GB stone and decreasing tendency of CBD stone in rural area have disappeared. However, relative frequency of IHD stone is still high in Korea.
Body Mass Index ; Demography ; Female ; Gallstones/diagnosis/*epidemiology/surgery ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies

While endovascular aneurysm repair (EVAR) is prevailing for the treatment of abdominal aortic aneurysm (AAA) in modern vascular practice, PURPOSE: we conducted nationwide questionnaire survey to investigate the current status of AAA treatment and their results in Korea. METHOD: We reviewed the replies from 28 hospitals (33 departments) to the questionnaire inquiring annual number, clinical features, mode of treatment and results of AAA patients during the period from Jan. 2000 to Jul. 2004. Results: 980 AAA patients were reported including 292 ruptured AAA (29.8%) and 688 non-ruptured AAA (70.2%). For treatment of AAA, 834 (85.1%) surgical repairs (SRs) and 111 (11.3%) endovascualr aneurysm repairs (EVARs) were performed while 35 patients (3.6%) died of AAA rupture before operation. The locations of AAA were infrarenal in 889 (90.7%), juxtarenal in 62 (6.3%), and suprarenal in 29 patients (3.0%). Among 834 patients undergoing SR, 577 patients (69.2%) had non-ruptured AAAs and 257 patients (30.8%) had ruptured AAAs. Mean operative mortality rate was 4.1% after elective SRs, 30.7% after SR for ruptured AAAs, and 2.3% after EVARs. The reported brand name of stent graft devices were various including domestic custom-made in 56 (50.5%), imported brand in 18 (16.2%) while 37 (33.3%) stent grafts were not reported their brand name. The frequencies of type I and III endoleaks after EVAR were reported 5.8% and 5.8% respectively in 86 patients with an available data. CONCLUSION: SR has been used as a major treatment option in Korea for the treatment of AAA patients while EVAR is increasing. The mortality rate of SR of AAA was comparable to western multi-center trial reports but mortality or morbidity rates of EVAR were unable to know in this questionnaire survey.
Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Blood Vessel Prosthesis ; Endoleak ; Humans ; Korea* ; Mortality ; Questionnaires* ; Rupture ; Treatment Outcome

Isolated left main coronary ostial stenosis is a very rare condition. In the majority of cases there are coexisting diseases in multiple coronary vessels. Here, a case of isolated left main coronary ostial stenosis due to an acute angle take-off, with clockwise rotation of the coronary sinus, confirmed by cardiac MRI is presented. A 44-year old female patient presented with an exertional and stabbing anterior chest pain. The patient had no premedical history. A coronary angiogram showed an isolated left main coronary ostial stenosis due to an acute take-off of the left main coronary artery. A cardiac MRI showed an acute angle take-off of the left main coronary artery, with clockwise rotation of the coronary sinus. The patient underwent surgical angioplasty of the coronary ostia, with a patch of autologous pericardium. This acute angle take-off may be due to rotation of the coronary sinus.
Adult ; Angioplasty ; Chest Pain ; Constriction, Pathologic* ; Coronary Sinus* ; Coronary Stenosis ; Coronary Vessels ; Female ; Humans ; Magnetic Resonance Imaging* ; Pericardium

BACKGROUND AND OBJECTIVES: It is known that sympathetic reinnervation, following a heart transplantation, increases with time. 123I metaiodobenzylguanidine (123I-MIBG) is taken up by myocardial sympathetic neurons in a manner similar to norepinephrine (NE), and is used as an imaging agent. The purpose of this study was to evaluate cardiac sympathetic reinnervation, following an orthotopic heart transplantation, using 123I-MIBG scintigraphy. SUBJECTS AND METHODS: Twenty four 123I-MIBG images of the chest were taken in 15 patients (10 males, 5 females, mean age: 35+/-13 years), 1 to 48 (mean 10.8+/-11.9) months after a transplantation. Two healthy adults were studied as normal controls. The 123I-MIBG images were acquired at 15 minutes, and 4 and 24 hours, after an intravenous injection of 185 MBq 123I-MIBG. To quantitate the degree of myocardial uptake of the MIBG, the heart to mediastinal ratio (HMR) was measured. In nine patients, the 123I-MIBG scintigraphy was repeated one year later. RESULTS: The HMRs of the 4 and 24 hour images (1.26+/-0.23, 1.06+/-0.10, respectively) were lower than those of the 15 minute images (1.48+/-0.28). Twelve subjects, 1 to 12 months after the transplantation, showed no visible myocardial activities, but 12 subjects, 13 to 48 (28.6+/-12.8) months after the transplantation, showed visible myocardial 123I-MIBG uptakes (HMR: 1.65+/-0.21). The HMRs were high in normal controls (mean 2.84). One-year follow up scintigraphy showed increased HMRs compared with those taken immediately postoperatively (1.40+/-0.31 to 1.61+/-0.16, p<0.05). CONCLUSION: Partial sympathetic late reinnervation can occur one year after a transplantation.
3-Iodobenzylguanidine ; Adult ; Female ; Follow-Up Studies ; Heart ; Heart Transplantation ; Humans ; Injections, Intravenous ; Male ; Neurons ; Norepinephrine ; Radionuclide Imaging* ; Thorax

PURPOSE: Acute lymphoblastic leukemia (ALL) accounts for approximately 75% of all cases of childhood leukemia. We investigated epidemiology, clinical and laboratory features and treatment outcome of the children with ALL in Korea during recent 5 years. METHODS: One thousand forty nine patients were enrolled between January 1994 and December 1998 from 37 major hospitals in Korea. The data regarding the clinical and laboratory features including age, WBC counts at diagnosis, immunophenotype, morphology, cytogenetics and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed. The differences between groups analyzed by log-rank test. RESULTS: There were 597 males and 452 females. The distribution between the age 2 and 5 years is most common in 46.1%. The annual incidence rate per 100,000 population varied from 1.6 to 2.2. The 5 year event free survival (EFS) rates according to good prognostic factors were as follows: 67% bet ween 1-9 year of age at diagnosis, 69% in under 10,000/mm3of initial WBC count, 74% in early pre-B cell CALLA ( ) immunophenotype, 65% in L3 morphology, 68% in no CNS invasion. Most of patients were treated by CCG treatment protocol. The 5 year EFS was 63%. Main complications were sepsis (21.8%) and hemorrhage (12.5%). The relapse rate was 15.6%. The common causes of death were sepsis, DIC, pneumonia, relapse. CONCLUSION: Our results could provide the most recent and important information about acute lymphoblastic leukemia of children in Korea.
Cause of Death ; Child ; Clinical Protocols ; Cytogenetics ; Dacarbazine ; Diagnosis ; Disease-Free Survival ; Epidemiology* ; Female ; Hemorrhage ; Humans ; Incidence ; Kaplan-Meier Estimate ; Korea* ; Leukemia ; Male ; Medical Records ; Pneumonia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Recurrence ; Retrospective Studies ; Sepsis ; Treatment Outcome