Thrombomodulin (TM) is thrombin receptor present on the luminal surface of endothelial cells. Because the thrombin-TM complex acts as an anticoagulant, the functional variants or deficiency of TM may lead to increment of thrombotic tendency. In this study, we screened the genetic variants of the TM gene in patients with myocardial infarction (MI) and analyzed the genotype to elucidate the effects of genetic variations of TM gene on the development of the MI. We screened a promoter region and coding sequence of the TM gene using single strand conformation polymorphism-heteroduplex analysis and identified three common genetic variants: those were TM G-33A, TM Ala455Val, and TM C1922T. The genotype frequencies were investigated in the patients with MI (n=234) and control subjects (n=291) by the method of allele-specific oligomer hybridization. The frequencies of mutant genotypes (TM -33A, TM 455Val, and TM 1922T) were higher in patient group compared to the control subjects in males while there were no significant differences in females. In the multiple logistic regression analysis, TM 455Val and TM 1922T alleles were independent risk factors for MI (OR[95% CI: 1.799[1.125-2.878] p=0.014 and 5.624[1.019-31.025], p=0.048, respectively) in males. However, the genetic variations were not independent risk factors for MI in females. There were significant linkage disequilibriums among three genetic variants. These linkage disequilibriums explain the similar effects of three genetic variants on the development of MI. To investigate the effect of the TM G-33A mutation on TM promoter activity, the two TM promoter constructs (pTM-355 and pTM-125, bearing TM -33G or TM -33A) containing of firefly luciferase gene were transfected into HepG2, BAE, and CHO cells. The promoter activities were higher in the promoter constructs with TM -33G compared to the constructs with TM -33A in pTM-355. These results suggest the possibility of the positive predisposing effect of TM -33A allele on MI in males. The functional study for TM Ala455Val and TM C1922T should be followed to elucidate the genotype effects of these mutations on the development of MI. In this study, we identified three genetic variants of TM gene and showed the significant associations between genetic variants and MI in males. These results proposed that TM gene is an attractive candidate for genetic risk factor for MI in Koreans.
Alleles ; Animals ; CHO Cells ; Clinical Coding ; Cricetinae ; Endothelial Cells ; Female ; Fireflies ; Genetic Variation ; Genotype ; Humans ; Linkage Disequilibrium ; Logistic Models ; Luciferases ; Male ; Myocardial Infarction* ; Phenobarbital ; Promoter Regions, Genetic ; Receptors, Thrombin ; Risk Factors* ; Thrombomodulin

The crossing laminar screw fixation might be the most recently developed approach among various fixation techniques for C2. The new construct has stability comparable to transarticular or transpedicular screw fixation without risk of vertebral artery injury. Quantitative anatomical studies about C2 vertebra suggest significant variation in the thickness of C2 lamina as well as cross sectional area of junction of lamina and spinous process. We present an elderly patient who underwent an occipito-cervical stabilization incorporating crossed C2 laminar screw fixation. We preoperatively recognized that she had low profiles of C2 lamina, and thus made a modification of trajectory for the inferiorly crossing screw. We introduce a simple modification of crossing C2 laminar screw technique to improve stability in patients with low laminar profiles.
Aged ; Humans ; Spine ; Vertebral Artery

Spontaneous testicular hemorrhagic necrosis is a rare disease usually associated with testicular torsion. Partially involved and suspicious testis tumor cases are also defined from orchiectomy specimens. Herein, a spontaneous hemorrhagic necrosis, without any testicular torsion, but with involvement of the whole testicle and epididymis, is reported. A 21 year old patient, who presented with a painless left testicular enlargement of several days duration was believed, based on physical examination, ultrasonography and elevation of serum LDH, to have a testicular tumor. Diagnosis was made only after radical orchiectomy and histopathological examination.
Diagnosis ; Epididymis ; Hemorrhage ; Humans ; Male ; Necrosis* ; Orchiectomy ; Physical Examination ; Rare Diseases ; Spermatic Cord Torsion ; Testis* ; Ultrasonography ; Young Adult

Bladder cancer is generally manifested with gross hematuria and this is the most common urinary tract neoplasm in Korea, but it is very rare to find it combined with a contracted bladder. A case of contracted bladder was suspected as being recurred urinary tuberculosis; because of her past history, the urine analysis and cystoscopic findings seemed to resemble the chronic inflammation associated with urinary tuberculosis, and the transurethral biopsy reported only chronic inflammation. Yet the final histopathologic report after cystectomy and urinary diversion revealed that there was no tuberculosis, but rather, there was bladder transitional cell carcinoma (TCC). Therefore, any contracted bladder found in an older age patient is considered to be a urinary TCC until proven otherwise. To the best of our knowledge, this is the first case of bladder TCC combined with contracted bladder.
Biopsy ; Carcinoma, Transitional Cell* ; Cystectomy ; Hematuria ; Humans ; Inflammation ; Korea ; Tuberculosis ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Diversion ; Urologic Neoplasms

BACKGROUND/AIMS: The ballooning time in endoscopic papillary large balloon dilation (EPLBD) remains controversial. The aim of this study was to evaluate the significance of the ballooning time comparing an immediate balloon deflation method with a conventional ballooning time of > 45 seconds. METHODS: Between January 2010 and December 2010, 126 patients with bile duct stones treated with EPLBD and endoscopic sphincterotomy were divided according to the ballooning time: the immediate deflation group (n=56) and the conventional inflation group (ballooning time 45s to < 60s) (n=70). RESULTS: The overall success rate and the success rate of the first attempt of ERCP (endoscopic retrograde cholangio-pancreatography) were 96.4% (54/56) and 80.4% (45/56) in the immediate group and 97.1% (68/70) and 77.1% (54/70) in the conventional inflation group. There were no statistically significant differences in the overall success and the first attempt of ERCP success rate (p=0.99, p=0.66). The frequency of mechanical lithotripsy was 0% in the immediate deflation group and 7.1% in the conventional inflation group (p=0.065). Complications occurred in 3.6% (2/56) patients in the immediate deflation group and 8.6% (4/70) patients in the conventional inflation group (p=0.298). CONCLUSIONS: The ballooning time in EPLBD does not affect the outcomes of the treatment for bile duct stones. And the feasibility of the immediate deflation method in EPLBD is acceptable.
Bile Ducts* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Humans ; Inflation, Economic ; Lithotripsy ; Sphincterotomy, Endoscopic

No abstract available.
Endocardial Cushion Defects* ; Endocardial Cushions* ; Hernia, Diaphragmatic*

PURPOSE: Interleukin 18(IL-18) is a potent proinflammatory cytokine which induces IFN-gamma, GM-CSF, TNF-alpha and IL-1, to activate killing by lymphocytes, and to up-regulate the expression of certain chemokine receptors. Kawasaki disease (KD) is an inflammatory disease which increases serum levels of inflammatory cytokines, such as TNF-alpha and IL-6. This study was performed to examine the serum levels of proinflammatory cytokine IL-18 in KD. METHODS: Twenty patients with KD and 10 healthy children were enrolled in this study. Serum levels of IL-18 and TNF-alpha from the patients with acute and subacute stage of KD and normal controls were measured by using ELISA. Acute phase reactants such as ESR and C-reactive protein were measured during the acute stage of the disease. RESULTS: There was a significant increase in serum levels of IL-18 measured at the acute stage of KD(818.0+/-253.4 pg/mL) compared with those of subacute stage (367.7+/-140.1 pg/mL) (P<0.01) and normal controls(348.6+/-122.9 pg/mL)(P<0.01). However, the increase of IL-18 was not correlated with the increase of TNF-alpha(R=-0.156, P=0.488) or other acute phase reactants. CONCLUSION: The results showed that IL-18 was increased during the acute stage of KD, but the increase of IL-18 was not directly correlated with TNF-alpha. This results suggest that Il-18 is not a useful marker to estimate the severity of inflammation in KD.
Acute-Phase Proteins ; C-Reactive Protein ; Child ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Granulocyte-Macrophage Colony-Stimulating Factor ; Homicide ; Humans ; Inflammation ; Interleukin-1 ; Interleukin-18* ; Interleukin-6 ; Interleukins ; Lymphocytes ; Mucocutaneous Lymph Node Syndrome* ; Receptors, Chemokine ; Tumor Necrosis Factor-alpha

BACKGROUND: The polymerase chain reaction(PCR) assay is rapid, sensitive analytical technique but has problem of high false-positive rate. We applied dUTP-UDG PCR (dU-PCR) method to prevent carryover contamination major source of high false positive in PCR assays, for detection of Mycobacterium tuberculosis. METHODS: The PCRs for detection of M. tuberculosis were performed with P1 and P2 primers based on IS6110 repeated sequence. FTC-2000 was used for capillary PCR and Uno-Thermoblock was used for heating block PCR. In order to evaluate the effect of dU-PCR controlling carryover contamination, PCRs were performed in the presence of UDG and the absence of UDG. To compare the sensitivity of usual dT-PCR with dU-PCR, chromosomal DNA of M. tuberculosis ranging 500pg to 0.5fg were amplified by dT-PCR and dU-PCR method using two different thermocycler, capillary and heating block type, respectively. RESULT: The dU-PCR using UDG prevented carryover contamination by amplicon DNA up to 500pg. By capillay PCR method, the lower limits of detectability of dT-PCR and dU-PCR were 0.5fg and 500fg, respectively, which indicates the sensitivity of dU-PCR was lower than dT-PCR. But by heating block method, the lower limits of detectability of both method of dU and dT-PCR were 0.5fg. So the sensitivity of dU-PCR was same as dT-PCR. CONCLUSION: The dU-PCR by heating-block method was sensitive test for detection of M. tuberculosis that effectively prevent carryover contamination by amplicon.
Capillaries ; DNA ; Heating ; Hot Temperature ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction* ; Tuberculosis

Airway problems are easiest to manage when they are anticipated. Difficult intubation might, however, occur in patients with no obvious signs or symptoms suggesting airway obstruction. We describe a case of difficult intubation where the laryngeal inlet was obscured by a large epiglottic cyst that was discovered during rapid-sequence induction of general anesthesia. A 3-year-old male weighing 15 kg was admitted for an emergency appendectomy. After preoxygenation, a rapid-sequence induction was carried out. Direct laryngoscopy (Macintosh 1 blade) revealed a large 2-cm cyst arising from the lingual surface of the epiglottis. The cyst completely obstructed the view of the epiglottis and larynx, and several attempts at endotracheal intubation were unsuccessful. Fortunately, the patient was mask ventilated without difficulty and oxygen saturation was 98 99%. After a second 10 mg dose of succinylcholine, intubation was attempted using the same laryngoscope blade and a styletted 4.5 mm endotracheal tube by another anesthesiologist as cricoid pressure was maintained. By using the tube to push the cyst upward, intubation of the trachea was performed after a brief view of the arytenoid cartilages. Anesthesia and the operation then proceeded uneventfully. Following an appendectomy, an ENT surgeon removed the cyst.
Airway Obstruction ; Anesthesia ; Anesthesia, General ; Appendectomy ; Arytenoid Cartilage ; Bays ; Child, Preschool ; Emergencies ; Epiglottis ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngoscopes ; Laryngoscopy ; Larynx ; Male ; Masks ; Oxygen ; Succinylcholine ; Trachea

The incidence of contralateral reflux after unilateral reimplantation in children with primary unilateral vesicoureteral reflux(VUR) is reported to be 0.8-32%. We evaluated the characteristics of contralateral reflux after endoscopic or open surgical correction of primary unilateral VUR in children. 30 children who underwent unilateral reimplantation by Paquin (25pts) and submucosal Macroplastique injection(5pts) were evaluated. The association between postoperative contralateral reflux and age, sex, ipsilateral implant side, postoperative urinary tract infection, and surgical method were evaluated. There were 18 male and 12 female patients. Initial reflux was observed in the right in 18 and 12 in left. The initial reflux grades were II, III, IV, and V in 2, 11, 14, and 3 patients, respectively. Postoperative urinary tract infection was observed in 4 patients of whom 1 had contralateral reflux. In conclusion, there was no single factor that could predict the development of contralateral reflux after unilateral correction of unilateral primary VUR. Furthermore, the fact that contralateral reflux occurred even after submucosal Macroplastique injection suggests that the method of surgery is not related to the subsequent development of contralateral reflux.
Child* ; Female ; Humans ; Incidence* ; Male ; Replantation ; Ureter ; Urinary Bladder ; Urinary Tract Infections ; Vesico-Ureteral Reflux*