Objectives: According to the 10th revision of the International Classification of Diseases, the main categories of tic disorders (F95.0, F95.1, and F95.2) follow a diagnostic hierarchy based on the duration and diversity of tic symptoms. The present study investigated the use of this diagnostic hierarchy in real-world clinical practice. Methods: Based on the National Health Insurance Service-National Health Information Database, the diagnosis of transient tic disorder (F95.0) made after a diagnosis of chronic motor or vocal tic disorder (F95.1) or Tourette’s syndrome (F95.2) and diagnosis of chronic motor or vocal tic disorder (F95.1) made after a diagnosis of Tourette’s syndrome (F95.2) were referred to as type A errors. The diagnosis of transient tic disorder (F95.0) repeated after a period of >12 months was referred to as type B error. Demographic and clinical differences according to the diagnostic error types were analyzed using analysis of variance, Student’s t-tests, and chi-squared tests. Results: Most participants (96.5%) were without errors in the diagnosis of tic disorders. Higher proportions of males (p=0.005) and antipsychotic prescriptions (p<0.001) were observed in patients with type A or B diagnostic errors. A higher proportion of health insurance holders was observed among those with type A errors (p=0.027). Conclusion Errors were absent in majority of the tic diagnoses in real-world clinical practice in terms of the diagnostic hierarchy.

Interferon(IFN) has been noted to augment the cytotoxicity of cisplatin analogues and S-FU, and varying degrees of success were reported when combined with chemotherapy in a number of squamous cell carcinomas. The aims of this study were to assess its therapeutic efficacy and to establish the feasibility and toxicity of biochemical modulation of the interferon-a-2a when combined with 5-FU and carboplatin(CBDCA) in locally advanced(> or =FIGO clinical stage IJb) and/or bulky(largest diameter > or = 3cm) cervical cancer. From January 1995 to December 1996, 20 patients with bulky and/or locally advanced cervical cancer were enrolled in this study and received FAC(5-FU/Interferon-a/CBDCA) combination chemotherapy as a neoadjuvant setting. The FAC regimen was composed of IFN- a -2a 3x10(6) IU/day from day l to day 6, 5-FU 750mg/m2/day from day 2 to day 6, and carboplatin at a dose calculated by Calvert formula with AUC(area under the curve) 6.0 on day 2. Three cycles of neoadjuvant chemotherapy was performed with 3 weeks interval if toxicity permitted it. Patients were examined after every treatment cycle and evaluated for toxicities and responses using standard GOG criteria. Two patients(10.0%) showed complete clinical response and 15 patients(75,0%) had partial response. The other patients had stable(10.0%) or progressive disease(5.0%). Among fifteen patients who have undergone radical hysterectomy, pathological complete response was not noted. Surgery was possible in 15 patients(75.0%) and 10 patients received adjuvant radiotherapy. Lymph node metastases were found in 5 patients(33.3%) and the number of positive nodes was ranged from 1 to 5. The most frequent grade 3 or 4 toxicity was neutropenia(60.0%) followed by alopecia(40.0%), nausea/vomiting(35.0%), thrombocytopenia(15.0%), diarrhea(5.0%), and anemia(5.0%). (continue)
Carboplatin ; Carcinoma, Squamous Cell ; Cisplatin ; Drug Therapy* ; Drug Therapy, Combination ; Fluorouracil ; Humans ; Hysterectomy ; Lymph Nodes ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Uterine Cervical Neoplasms

The most common cause of obstructive sleep apnea syndrome (OSAS) in childhood is adenotonsillar hypertrophy. Adenotonsillectomy improves the symptoms quite well in most cases. However, some patients could experience the OSAS again after adenotonsillectomy, who might have several risk factors such as incomplete operation, misdiagnosis, combined anatomical malformation, sinusitis or chronic allergic rhinitis, obesity, initial severe OSAS, and early onset OSAS. We report a case of 11-year-old obese boy who presented with snoring for several years. He was obese with body mass index (BMI) of 26.3 kg/m2 and also found to have fatty liver by ultrasonogram. Initial polysomnography (PSG) showed that he met the criteria of severe OSAS with the apnea-hypopnea index (AHI) of 70.5. He underwent adenotonsillectomy and symptoms improved immediately. Four months later symptoms were relieved with AHI of 0, but 1 year after the adenotonsillectomy he started to complain snoring again and the subsequent PSG results showed that OSAS has relapsed with AHI of 43. Paranasal sinus X-ray and physical examination showed sinusitis and re-growth of adenoid. Obesity was proved not to be a contributing factor because his BMI decreased to normal range (23.1 kg/m2) after diet control and regular exercise. Also, liver transaminase was normalized and fatty liver was disappeared on follow-up abdominal ultrasonogram. After treatment of sinusitis, symptoms were relieved with decreased AHI (8.5). This case suggests that simple adenotonsillectomy might not be the end of OSAS treatment in childhood. Patients who had adenotonsillectomy should be followed by subsequent PSG if symptoms recur. It is also important to be aware of risk factors in the recurrent OSAS for the proper intervention according to the cause.
Adenoids ; Body Mass Index ; Child ; Diagnostic Errors ; Diet ; Fatty Liver ; Follow-Up Studies ; Humans ; Hypertrophy ; Liver ; Obesity ; Physical Examination ; Polysomnography ; Reference Values ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors ; Sinusitis ; Sleep Apnea, Obstructive ; Snoring

No abstract available.
Polychondritis, Relapsing*

Objectives: Most developmental screening tests have been built as parent-performed questionnaires. However, they often do not guide parents on how to answer the questionnaire. This study aimed to develop easily applicable parent guidelines. Methods: We implemented the Delphi procedure with 20 panelists. The development of the initial questionnaire was based on the results of two surveys of parents and experts provided by a policy research report that investigated the item adequacy of the Korean Developmental Screening Test. Round one included 33 items comprising all possible measurements in six categories that were identified as difficult to understand or confusing. Round two merged and modified some items and included 32 items. We defined consensus as a median agreement value of one or less and convergence and stability values of 0.5 or less. The subjective usefulness of the parent guidelines was examined based on their previous test experiences. Results: Consensus was reached after the second round, reflecting the items with the highest level of accuracy in each category. Of the 167 parents who participated in the survey, 113 (67.7%) affirmed the usefulness of the guidelines, while 10 (6.0%) answered that they were not useful. Items that recommended a different scoring strategy in answering the questionnaire from their previous measurements were found to be more useful by the parents. Conclusion The parent guidelines, composed of five bullet points, drew on the consensus of the experts. Further studies are required to assess whether these guidelines improve the accuracy of screening tests in clinical settings.

Objectives: This study examined the validity of the Childhood Autism Rating Scale, Second Edition (CARS-2) compared with the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) in identifying autism spectrum disorder (ASD). Methods: A total of 237 children were tested using both the CARS-2 and ADOS-2. We examined the correlation using Pearson’s correlation analysis. In addition, we used a receiver operating characteristic graph to determine the optimal standard version of the CARS-2 (CARS2-ST) cutoff score for ASD diagnosis using the ADOS-2. Results: The concurrent validity of the CARS2-ST was demonstrated by a significant correlation with the ADOS-2 (r=0.864, p<0.001). The optimal CARS2-ST cutoff scores were 30 and 28.5 for identifying autism and autism spectrum, respectively, based on the ADOS-2. Conclusion We suggest a newly derived CARS2-ST cutoff score of 28.5 for screening ASD and providing early intervention.

No abstract available.
Humans ; Lymphocytes*

Vaginal foreign bodies in children are often associated with intermittent vaginal disch-arge, vaginal bleeding and create a clinical scenario similar to that of certain cases of sex-ual abuse and isolated premature menarche. Intravaginal foreign body of especially long duration can pose a diagnostic dilemma, since a number of diagnostic modalities may fail to detect its existence. A 4-year-old girl who suffered from a bloody, malodorous vaginal discharge visited SNUH. She had had such problems for over a year and had been evaluat-ed by several gynecologists. Preoperative evaluations including ultrasound was performed and pelvis MRI strengthened the suspicion that some foreign bodies could be an etiologic factor. A vaginal inspection performed under general anesthesia with 0degrees endoscope and nasal speculum size no. 43 revealed "pen top of ink pen" lodged in her vaginal mucosa of posterior fornix area. We were allowed to remove a foreign body without trauma of genital tract by nasal forceps. We report a case of intravaginal foreign body in a 4-year-old girl with a brief review.
Anesthesia, General ; Child ; Child, Preschool* ; Endoscopes ; Female* ; Foreign Bodies* ; Humans ; Ink ; Magnetic Resonance Imaging ; Menarche ; Mucous Membrane ; Pelvis ; Surgical Instruments ; Ultrasonography ; Uterine Hemorrhage ; Vagina ; Vaginal Discharge

OBJECTIVE: The aim of this study was to identify the relationship between the progression of CIN (cervical intraepithelial neoplasia) to cervical cancer and expression pattern of VEGF, PCNA and apoptosis. METHODS: We prepared forty paraffinized cervical tissue blocks consisting of each 10 CINI, CINII, CINIII, and invasive cervical cancer tissues, which had been already diagnosed histologically in Seoul National University Hospital from July, 1998 to June, 1999. The protein expression of VEGF and PCNA were examined by immunohistochemical staining. We defined PI (positive index) as the percentage of cells that were positive PCNA staining when examined in high power fields with light microscope (x400). We used TUNEL staining to calculate apoptotic index defined as the number of the cells undergoing apoptosis per 1,000 tumor cells. To detect HPV type 16 or 18 from paraffin-embedded tissues, we selected the nested PCR method. RESULTS: The VEGF expression showed significant difference between early cervical lesions (CINI & II) and advanced cervical lesions (CINIII & cancer) (p=0.041). In case of PCNA expression there was no significant difference. When we define positive case as the case of which AI was greater than 5, AI according to each diagnosis showed no difference. In the aspect of HPV infection we could find that there was significant increment of HPV 16/18 infection rate in advanced cervical lesions (CINIII, cervical cancer) comparing with early cervical lesions such as CINI, CINII. CONCLUSION: Our results suggest that the evaluation of VEGF expression and HPV infection is potentially useful for the prediction of the progression of CIN to carcinoma.
Apoptosis* ; Diagnosis ; In Situ Nick-End Labeling ; Paraffin ; Polymerase Chain Reaction ; Proliferating Cell Nuclear Antigen* ; Seoul ; Uterine Cervical Neoplasms* ; Vascular Endothelial Growth Factor A*

PURPOSE: Deposition of polymeric IgA1 in the kidney mesangium is the hallmark of IgA nephropathy, but the molecular mechanisms of IgA-mediated mesangial responses and inflammatory injuries remain poorly understood. We hypothesize that Toll-like receptor 4 (TLR4) is involved in IgA-induced mesangial cell activation. MATERIALS AND METHODS: Mouse mesangial cells were stimulated with lipopolysaccharide (LPS) (1 microg/mL), IgA (20 microg/mL), or both, and TLR4 expression was measured by real time RT-PCR and Western blot. Intracellular responses to LPS or IgA were assessed by Western blot for ERK1/2, JNK, p38 MAP kinases (MAPKs), Ikappa-Balpha degradation and fibronectin secretion. MCP-1 secretion was assessed by ELISA. Small interfering RNA (siRNA) of TLR4 was used to confirm that the effects were caused by TLR4 activity. RESULTS: LPS- or IgA-treatment upregulated the levels of TLR4 mRNA and protein in cultured MMC at 24 h. LPS and IgA induced rapid phosphorylation of MAPKs, but degradation of Ikappa-Balpha was observed only in LPS-treated MMC. LPS, but not IgA, induced increased secretion of MCP-1 and fibronectin at 24 h or 48 h. Combined LPS and IgA treatment did not cause additional increases in TLR4 mRNA and protein levels or Ikappa-Balpha degradation, and MCP-1 and fibronectin secretions were less than with LPS alone. LPS- or IgA-induced TLR4 protein levels and MAPK activation were inhibited by transfection with TLR4 siRNA. CONCLUSION: These results indicate that the activation of MAPKs and MCP-1 secretion are mediated by TLR4, at least in part, in IgA-treated mesangial cells. TLR4 is involved in mesangial cell injury by induction of pro-inflammatory cytokines in IgA nephropathy.
Animals ; Chemokine CCL2/secretion ; Enzyme-Linked Immunosorbent Assay ; Extracellular Signal-Regulated MAP Kinases/metabolism ; Fibronectins/secretion ; Glomerulonephritis, IGA/*metabolism ; I-kappa B Proteins/metabolism ; Mesangial Cells/*metabolism/secretion ; Mice ; Mice, Transgenic ; Phosphorylation ; RNA Interference ; RNA, Messenger/metabolism ; *Signal Transduction ; Toll-Like Receptor 4/antagonists & inhibitors/genetics/*metabolism