PURPOSE:The prevalence of childhood obesity has been increased rapidly, associated with high morbidity of dyslipidemia, cardiovascular risk factors and insulin resistance/hyperinsulinemia. Hyperinsulinemia in obese children may depend on either increased insulin secretion or decreased insulin clearance. We investigate whether insulin secretion and clearance are different between obese and normal weight children. METHODS:The body mass index(BMI), fasting serum glucose, insulin and C-peptide levels were measured in 101 children(52 obese children and 49 non-obese controls) in Ansan area, from 6 to 14 years old. Fasting serum C-peptide/insulin ratio, insulin/glucose ratio, homeostasis model assessment(HOMA) were calculated and compared between obese and control group. RESULTS:The fasting serum insulin and C-peptide levels were significantly higher in obese group than in controls. The C-peptide/insulin ratio was significantly lower and insulin/glucose ratio was significantly higher in obese group than in controls. There were positive correlations between BMI and fasting serum insulin level, fasting insulin/glucose ratio and HOMA. The prevalence of hyperinsulinemia is higher in obese adolescents than in controls. CONCLUSION: Our findings suggest that increased insulin secretion and decreased insulin clearance may contribute to hyperinsulinemia in obese children.
Adolescent ; Blood Glucose* ; C-Peptide* ; Child* ; Dyslipidemias ; Fasting* ; Gyeonggi-do ; Homeostasis ; Humans ; Hyperinsulinism ; Insulin* ; Obesity* ; Pediatric Obesity ; Prevalence ; Risk Factors

No abstract available.
Arthrogryposis* ; Pyloric Stenosis*

Cystathionine is well-known intermediate in the metabolism of methionine. It is cleaved to cysteine and homoserine by gamma-cystathionase. This enzyme utilize pyridoxal 5'-phosphate as coenzyme. gamma-cystathionase deficiency leads to persistent excretion of large amount of cystathionine in urine, as well as to accumulation of cystathionine in body tissues and fluids. It is inherited as an autosomal recessive trait and shows wide variety of clinical manifestations. No clinical abnormality seems to be specifically associated with gamma-cystathionase deficiency. The majority of patients responded to high dose administration of pyridoxine. We report the first case of cystathioninuric patient in Korea, 19 months of female with developmental delay. In brain MRI, there was generalized mild brain atrophy. There were several times of brief paroxysmal generalized polyspike and wave discharges in electroencephalography(EEG). In amino acid analysis of urine, there was elevated level of cystathionine. She was treated with high dose of pyridoxine. In follow up analysis of urinary amino acid, the cystathionine level was markedly decreased to normal range, and EEG was normalized. Her development shows improvement.
Atrophy ; Brain ; Cystathionine ; Cystathionine gamma-Lyase ; Cysteine ; Electroencephalography ; Female ; Follow-Up Studies ; Homoserine ; Humans ; Korea ; Magnetic Resonance Imaging ; Metabolism ; Methionine ; Pyridoxal ; Pyridoxine ; Reference Values

PURPOSE: To assess the clinical characteristics of the 2000-2001 measles outbreak in the Seoul metropolitan area, Korea, the clinical data of measles inpatients were analyzed. METHODS: Three hundred and five children diagnosed with measles by clinical manifestation from July, 2000 to February, 2001, in Seoul, Ilsan and Ansan City were grouped according to their age and investigated for clinical manifestations, vaccination history and measles-specific IgM/IgG antibody positivity. RESULTS: Thirty eight point seven percent of the subjects were less than 12 months of age, 27.5 % were 12-47 months of age and 33.8% were 48 months of age or older. There was no significant sexual difference(male : female=1.2 : 1). This epidemic started in June, 2000 and the number of patients increased abruptly in October, peaked in December and finally decreased after February, 2001. It started from the older age group and moved to the younger. Sixty five point two percent had a history of more than 1-dose vaccination and 13.6% of the patients equal or more than 48 months of age had a history of 2-dose vaccination. Primary vaccine failure rate was 59.4%(107/ 180) and secondary vaccine failure rate was 3.9%(7/180) in 1 dose vaccinees. Sixty one point six percent showed more than one complication and 38.4% had no complication. The most common complication was pneumonia(31.8 %), followed by bronchitis(11.5%) and acute otitis media(4.6%). Vaccination and dose were not related significantly with the occurrence of complications. CONCLUSION: Compared with previous outbreaks in Korea, clinical features showed no specific change in the 2000-2001 measles epidemic. However, primary vaccine failure rate was so high that the second vaccination at four to six years of age must be emphasized in Korea.
Child ; Disease Outbreaks ; Gyeonggi-do ; Humans ; Inpatients ; Korea ; Measles* ; Otitis ; Seoul* ; Vaccination

Polyarteritis nodosa is a systemic necrotizing vasculitis that affects mainly small and medium-sized arteries that involve multiple organs. In addition to the systemic involvement of classical vasculitis, localized vasculitis involves blood vessels within a confined vascular distribution or single organ without clinical evidence of generalized inflammation. Localized vasculitis of the gastrointestinal tract is a rare entity. In particular, a limited involvement of the small bowel is an unusual manifestation of polyarteritis nodosa. In this report, we describe a case of biopsy-proven polyarteritis nodosa presenting as small bowel bleeding without other systemic manifestations.
Arteries ; Blood Vessels ; Gastrointestinal Tract ; Hemorrhage ; Inflammation ; Polyarteritis Nodosa ; Vasculitis

Lymphoid polyp is a very rare disease that commonly occurs in the rectum. It is a benign, focal or diffuse lesion that typically occurs where clusters of lymphoid follicles are present. The polyp is composed of well differentiated lymphoid tissue. It can generally be differentiated from malignant lymphoma by the proliferation of normal lymphoid tissue, which has a prominent follicular pattern and a clearly defined germinal center. There have been only a few reports of lymphoid polyps of the rectum, and there have been no reports of lymphoid polyp in the ampulla of Vater. We experienced a case of lymphoid polyp in the ampulla of Vater associated with tubulopapillary adenoma, and the patient first presented with jaundice, weight loss and general weakness.
Adenoma ; Ampulla of Vater ; Germinal Center ; Humans ; Jaundice ; Lymphoid Tissue ; Lymphoma ; Polyps ; Rare Diseases ; Rectum ; Weight Loss

BACKGROUND/AIMS: Recently, variable gastrointestinal track tumors including early stage malignancies are treated by endoscopic procedure. However, the discrepancy of histologic diagnosis may sometimes exist between the pretreatment forceps biopsy results and those of post treatment specimen. So the prediction of malignant lesion is important in the aspect of treatment selection. In this study, we investigated the predictable factors of the histologic discrepancy through the clinical, endoscopic features of the lesion diagnosed as adenocarcinoma in the post-endoscopic treatment specimen after the adenoma was diagnosed by the endoscopic forceps biopsy. METHODS: From March 2005 to April 2009, 129 gastric tumor lesions (129 patients) which were not diagnosed as malignancy and treated with endoscopic procedure were enrolled retrospectively. We compared the pretreatment endoscopic forceps biopsy results and post-treatment specimen biopsy results, then, analyzed the tumor characteristics. RESULTS: Twenty-one cases (16.3%) were diagnosed as malignancy after endoscopic treatment. Especially, discrepancy occurred more frequently in depressed lesions than in flat or elevated lesions (41.7% vs. 13.7%, p=0.012), and in lesions diagnosed as high grade adenomas than low or moderate grade adenomas (33.3% vs. 11.1%. p=0.004). CONCLUSIONS: In cases of depressed type lesions in the pretreatment endoscopy or those diagnosed as high grade adenoma in the pretreatment forceps biopsy, we should consider combined malignant lesion. Therefore, treatment modalities ensuring accurate diagnosis and potentially curative resection, should be carefully selected and performed in cases which have these features.
Adenoma/pathology/surgery ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Biopsy ; Female ; Gastroscopy ; Humans ; Male ; Middle Aged ; *Predictive Value of Tests ; Sex Factors ; Stomach Neoplasms/*pathology/surgery

A 71-year-old man was admitted due to abdominal distension and periumbilical pain. He was diagnosed as having mucinous ductal ectasia (MDE) of the pancreas three months prior, but refused an operation. Three months later, an abdominal computed tomography revealed more dilated pancreatic duct, newly developed liver metastasis and ascites in comparison with previous findings. Fine-needle aspiration cytology of the cystic lesion in the pancreatic head was conducted and yielded adenocarcinoma. Also, an ascitic fluid cytology determined adenocarcinoma. This patient was diagnosed to be inoperable and received palliative chemotherapy and pain control. The patient expired 5 months after the initial diagnosis.
Adenocarcinoma ; Aged ; Ascites* ; Ascitic Fluid ; Biopsy, Fine-Needle ; Diagnosis ; Dilatation, Pathologic* ; Drug Therapy ; Head ; Humans ; Liver* ; Mucins* ; Neoplasm Metastasis* ; Pancreas* ; Pancreatic Ducts

BACKGROUND: Intravenous tissue-type plasminogen activator (tPA) is recognized as the standard treatment for ischemic stroke. However, its narrow therapeutic window and association with an increased risk of intracranial hemorrhage have required caution when used. In this context, several approaches are required to deal with the shortcomings of such a double-edged drug. Anesthetics are known to protect against ischemic reperfusion injury, and their protective role in ischemic post-conditioning is crucial for reducing ischemia-related injury. The aim of this study was to assess the effect of isoflurane post-treatment on intracranial hemorrhage and cerebral infarction after tPA treatment for transient cerebral ischemia. METHODS: Cerebral ischemia was modeled in male Sprague-Dawley rats (n = 32) by occluding the right middle cerebral artery for 1 h, followed by intravenous tPA administration. Rats were randomly divided into control and isoflurane post-treatment group, and isoflurane post-treatment group was post-treated by administering 1.5% isoflurane for 1 h from the start of reperfusion. Twenty-four h after reperfusion, neurobehavioral changes were assessed. The extent of cerebral infarction and intracranial hemorrhage were also assessed by quantification of infarction volume and cerebral hemoglobin concentration from brain tissue, respectively. RESULTS: Neurobehavioral testing showed better functional outcomes in the isoflurane post-treatment group than the control group. The extent of cerebral infarction and intracranial hemorrhage were both reduced in isoflurane post-treatment group compared to control group. CONCLUSIONS: Isoflurane post-treatment may mitigate infarction volume and intracranial hemorrhage in tPA-exaggerated brain injury. Our findings provide an encouraging novel approach for enhancing clinical outcomes in tPA-exaggerated brain injury.
Anesthetics ; Animals ; Brain ; Brain Injuries* ; Brain Ischemia ; Cerebral Infarction ; Humans ; Infarction ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Ischemic Postconditioning ; Isoflurane* ; Male ; Middle Cerebral Artery ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Stroke* ; Tissue Plasminogen Activator

The term MYH9-related disorders indicates a group of autosomal dominant illnesses, formerly known as May-Hegglin anomaly, Sebastian syndrome, Fechtner syndrome and Epstein syndrome, caused by mutations of MYH9, the gene encoding for the heavy chain of non-muscle myosin IIA (NMMHC-IIA). We experienced a family with macrothrombocytopenia without leukocyte inclusion. A 5-year-old girl was found to have macrothrombocytopenia incidentally. Her father also had macrothromtocytopenia, but had been suffering from hearing loss and chronic renal failure. Meticulous search by light and electron microscopy failed to detect leukocyte inclusions. To our knowledge, these cases seem to be the first description of autosomal dominant Epstein giant platelet syndrome in Korea.
Bernard-Soulier Syndrome* ; Child, Preschool ; Fathers ; Female ; Hearing Loss ; Humans ; Kidney Failure, Chronic ; Korea ; Leukocytes ; Microscopy, Electron ; Nonmuscle Myosin Type IIA