OBJECTIVES: To assess innate and humoral immune responses in middle ear effusion of obese pediatric patients with otitis media with effusion (OME). METHODS: We evaluated 219 children with OME, of whom 21 were obese and 198 were non-obese. We compared the expression in middle ear effusion of mRNAs encoding toll-like receptors (TLR) 2, 4, 5, and 9; nucleotide-binding oligomerization domains (NOD) 1 and 2; retinoic acid-inducible gene (RIG)-I; interleukins (IL)-6, -10, and -12; interferon (IFN)-gamma; and tumor necrosis factor (TNF)-alpha mRNAs. We also compared the expression of immunoglobulins IgG, IgA, and IgM and the bacterial detection rate in the two groups. RESULTS: TLR2-mediated expression of IL-6 mRNA, TLR4-mediated expression of IL-6 and IL-10 mRNA, TLR5-mediated expression of IL-6, IL-10, and TNF-alpha mRNA, TLR9-mediated expression of IL-6 mRNA, and NOD2-mediated expression of IL-6, IL-12, and TNF-alpha mRNA were significantly lower in obese than in non-obese children (P<0.05). However, concentrations of IgG, IgA, and IgM in middle ear effusion were lower in obese than in non-obese children, but none of these differences was significant (P>0.05). CONCLUSION: Mean body mass index was higher and pattern-recognition receptor-mediated cytokine mRNA expression was lower in obese than in non-obese children with OME.
Bacteria ; Body Mass Index ; Child* ; Humans ; Immunity, Humoral ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Interferons ; Interleukin-10 ; Interleukin-12 ; Interleukin-6 ; Interleukins ; Obesity ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; RNA, Messenger* ; Toll-Like Receptors ; Tumor Necrosis Factor-alpha

PURPOSE: Most treatment decisions for breast cancer patients are based on an assesment of prognostic factors. Tumor markersB (p53, c-erbB2, bcl-2, Cathepsin D) have been evaluated for their prognostic factors and many studies suggest that these factors as assessed by immunohistochemistry (IHC) may be helpful for treatment decisions, while the risk group for high relapse can not be discriminated by single tumor marker alone. In order to obtain useful prognostic information, several tumor marker expressions must be combined and weighted. METHODS: The expressions of ER, PR, p53, c-erbB2, bcl-2, Cathepsin D were detected by IHC on paraffin-embedded sections from 449 primary breast cancer patients treated at Seoul National University Hospital between January 1996 and December 1998. In the present study, tumor marker expressions were analyzed along with conventional clinicopathologic factors. Additionally, correlations between various tumor marker expressions were examined and combinations of tumor marker expressions relating pathologic parameters currently in use for primary breast cancer prognosis were investigated. RESULTS: ER, PR, bcl-2, Cathepsin D expressions were related to smaller tumor size and PR was related to less axillary nodal involvement. ER, PR, bcl-2 expressions were related to good NG and HG, while p53 expression wasrelatedto poor NG and HG. ER and PR expression were related to bcl-2 expression, c-erbB2 expression was related to p53 expression and c-erbB2 expression was related to Cathepsin D expression. ER /bcl-2 was more prevalent in NG 1 and HG III tumors. ER /p53 and p53 /bcl-2 were more prevalent in NG 2/3 and HG I/II tumors. p53 /c-erbB2 was more prevalent in NG 1 tumors. CONCLUSION: Combinations of tumor marker expressions ER/bcl-2, ER/p53, p53/c-erbB2, p53/bcl2 provides more detailed information concerning cancer aggressiveness.
Breast Neoplasms* ; Cathepsin D* ; Cathepsins* ; Equidae ; Humans ; Immunohistochemistry ; Prognosis ; Recurrence ; Seoul

BACKGROUND: Procalcitonin (PCT) is a relatively new marker for bacterial infections, and its diagnostic utility has been variable across the studies. We investigated the diagnostic utility of PCT for the patients with blood culture-positive sepsis, and compared it with that of C-reactive protein (CRP). METHODS: In 1,270 consecutive blood samples, PCT and CRP were simultaneously measured and results were compared according to the five categories of PCT concentrations (<0.05 ng/mL; 0.05-0.49 ng/mL; 0.5-1.99 ng/mL; 2-9.99 ng/mL; > or =10 ng/mL). In 506 samples, they were further analyzed according to the result of blood culture. PCT and CRP were measured using enzyme-linked fluorescent assay (bioMerieux Co., France) and rate nephelometry (Beckman Coulter Co., USA), respectively. Their diagnostic utilities were compared using ROC curves. RESULTS: The mean concentrations of CRP in five categories of PCT were 15.4 mg/L, 42.1 mg/L, 101.2 mg/L, 125.0 mg/L, 167.1 mg/L, respectively (P<0.0001). Both PCT and CRP showed significant differences between the two positive and negative groups of blood culture (PCT, 8.47 vs 2.44 ng/mL, P=0.0133; CRP, 110.48 vs 59.78 mg/L, P<0.0001). The areas under the ROC curves (95% confidence interval) for PCT and CRP were 0.720 (0.644-0.788) and 0.558 (0.478-0.636), respectively, and showed a significant difference (P=0.005). CONCLUSIONS: The diagnostic utility of PCT is superior to that of CRP for the patients with blood culture-positive sepsis. PCT seems to be reliable for sepsis diagnosis, and may provide useful information for the critically ill patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; C-Reactive Protein/*analysis ; Calcitonin/*blood ; Child ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infant ; Infant, Newborn ; Middle Aged ; Nephelometry and Turbidimetry ; Protein Precursors/*blood ; ROC Curve ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; Sepsis/*diagnosis

PURPOSE: Most treatment decisions for breast cancer patients are based on an assesment of prognostic factors. Tumor markersB (p53, c-erbB2, bcl-2, Cathepsin D) have been evaluated for their prognostic factors and many studies suggest that these factors as assessed by immunohistochemistry (IHC) may be helpful for treatment decisions, while the risk group for high relapse can not be discriminated by single tumor marker alone. In order to obtain useful prognostic information, several tumor marker expressions must be combined and weighted. METHODS: The expressions of ER, PR, p53, c-erbB2, bcl-2, Cathepsin D were detected by IHC on paraffin-embedded sections from 449 primary breast cancer patients treated at Seoul National University Hospital between January 1996 and December 1998. In the present study, tumor marker expressions were analyzed along with conventional clinicopathologic factors. Additionally, correlations between various tumor marker expressions were examined and combinations of tumor marker expressions relating pathologic parameters currently in use for primary breast cancer prognosis were investigated. RESULTS: ER, PR, bcl-2, Cathepsin D expressions were related to smaller tumor size and PR was related to less axillary nodal involvement. ER, PR, bcl-2 expressions were related to good NG and HG, while p53 expression was relatedto poor NG and HG. ER and PR expression were related to bcl-2 expression, c-erbB2 expression was related to p53 expression and c-erbB2 expression was related to Cathepsin D expression. ER-/bcl-2- was more prevalent in NG 1 and HG III tumors. ER+/p53- and p53-/bcl-2+ were more prevalent in NG 2/3 and HG I/II tumors. p53+/c-erbB2+ was more prevalent in NG 1 tumors. CONCLUSION: Combinations of tumor marker expressions ER/bcl-2, ER/p53, p53/c-erbB2, p53/bcl2 provides more detailed information concerning cancer aggressiveness.
Breast Neoplasms* ; Cathepsin D* ; Cathepsins* ; Equidae ; Humans ; Immunohistochemistry ; Prognosis ; Recurrence ; Seoul

PURPOSE: Most treatment decisions for breast cancer patients are based on an assesment of prognostic factors. Tumor markersB (p53, c-erbB2, bcl-2, Cathepsin D) have been evaluated for their prognostic factors and many studies suggest that these factors as assessed by immunohistochemistry (IHC) may be helpful for treatment decisions, while the risk group for high relapse can not be discriminated by single tumor marker alone. In order to obtain useful prognostic information, several tumor marker expressions must be combined and weighted. METHODS: The expressions of ER, PR, p53, c-erbB2, bcl-2, Cathepsin D were detected by IHC on paraffin-embedded sections from 449 primary breast cancer patients treated at Seoul National University Hospital between January 1996 and December 1998. In the present study, tumor marker expressions were analyzed along with conventional clinicopathologic factors. Additionally, correlations between various tumor marker expressions were examined and combinations of tumor marker expressions relating pathologic parameters currently in use for primary breast cancer prognosis were investigated. RESULTS: ER, PR, bcl-2, Cathepsin D expressions were related to smaller tumor size and PR was related to less axillary nodal involvement. ER, PR, bcl-2 expressions were related to good NG and HG, while p53 expression was relatedto poor NG and HG. ER and PR expression were related to bcl-2 expression, c-erbB2 expression was related to p53 expression and c-erbB2 expression was related to Cathepsin D expression. ER-/bcl-2- was more prevalent in NG 1 and HG III tumors. ER+/p53- and p53-/bcl-2+ were more prevalent in NG 2/3 and HG I/II tumors. p53+/c-erbB2+ was more prevalent in NG 1 tumors. CONCLUSION: Combinations of tumor marker expressions ER/bcl-2, ER/p53, p53/c-erbB2, p53/bcl2 provides more detailed information concerning cancer aggressiveness.
Breast Neoplasms* ; Cathepsin D* ; Cathepsins* ; Equidae ; Humans ; Immunohistochemistry ; Prognosis ; Recurrence ; Seoul

Bilateral femoral neck stress fractures have been rarely reported. When diagnosed, they are usually limited to athletes or military personnel. A 35-year-old man, previously healthy, visited the emergency department for right inguinal pain. On physical examination, no external wound, tenderness or limitation of motion were found in either lower extremity. Plain radiography showed normal findings but an magnetic resonance image showed a linear fracture in the femoral neck. In this case, bilateral femoral neck stress fractures were found in a young non-athlete adult with no prior medical history of related injuries. Surgery is generally not performed for stress fractures but considering the patient's early mobilization and the need for quick reintegration into society, surgery was done in this case.
Adult ; Athletes ; Early Ambulation ; Emergency Service, Hospital ; Fatigue ; Femur Neck ; Femur ; Fractures, Stress ; Humans ; Lower Extremity ; Military Personnel ; Physical Examination ; Radiography ; Wounds and Injuries ; Young Adult

Arterial thrombosis is relatively rare compared with venous thrombosis in nephrotic syndrome. However, the assessment of its pathogenesis and risk factors in individual patient with nephrotic syndrome is necessary to allow appropriate prophylactic management because it is a potentially serious problem. Hereby, with review of the literature, we report a case of a 53 yr-old man with cerebral infarction associated with nephrotic syndrome due to focal segmental glomerulosclerosis during the course of treatments with diuretics and steroid. It reveals that the hypercoagulable state in nephrotic syndrome can be associated with cerebral infarction in adults. Prophylactic anticoagulants can be considered to reduce the risk of serious cerebral infarction in nephrotic patients with risk factors such as severe hypoalbuminemia and on diuretics or steroid treatment, even in young patients regardless of types of underlying glomerular diseases.
Cerebral Infarction/epidemiology/*etiology/pathology ; Human ; Male ; Middle Aged ; Nephrotic Syndrome/*complications/epidemiology ; Risk Factors

PURPOSE: Medullary carcinoma of breast was known to have a better prognosis than other breast cancer, but the histopathological definition of medullary carcinoma has varied with time. This study was performed to clarify the clinicopathologic features of medullary breast cancer. MATERIALS AND METHODS: Twenty cases of breast cancer originally were diagnosed as medullary carcinoma at the Department of Surgery, Seoul National University Hospital from Jan. 1985 to Jun. 1995. The whole cases were reviewed and reclassified using the strictly defined histologic criteria applied by Ridolfi et al. RESULTS: When reclassified, 16 tumors fulfilled the criteria of typical medullary cancer. But the rest 4 tumors were found to be nonmedullary cancer. The patients ranged from 29 to 69 years in age with an average of 49. The main symptom was the painless mass. The diameter of the tumor ranged from 1 to 8 cm with a mean size of 2.7 cm. The axillary lymph node was positive in three cases. The estrogen receptor was positive in 10%, and the progesterone receptor was positive in 20% of the cases. There were no local recurrences or distant metastasis during a mean follow-up period of 5.5 years.. All patients survived until the last follow-up. CONCLUSION: Medullary breast cancer has good prognosis but strict, uniform histopathological diagnostic criteria are needed.
Breast Neoplasms* ; Breast* ; Carcinoma, Medullary ; Estrogens ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Receptors, Progesterone ; Recurrence ; Seoul

PURPOSE: Cow's milk protein-induced enterocolitis (CMPIE) is a symptom complex of vomiting and/ or diarrhea caused by delayed hypersensitivity and may result in serious complications. This study was undertaken to identify high risk factors to facilitate the early recognition of CMPIE. METHODS: We reviewed the data of 101 patients, aged 15 to 45 days, admitted due to vomiting and/ or diarrhea between 2003 and 2004. After excluding 13 patients absolutely breast-fed and 2 patients transferred from other hospitals with the impression of CMPIE, the 86 study subjects were divided into three groups based on the underlying etiologies; CMPIE, infectious and non-infectious group. RESULTS: CMPIE was diagnosed in 11 patients (12.8%). On admission, failure to gain weight (P= 0.003), hypoalbuminemia (P=0.003), peripheral leukocytosis (P=0.015), and metabolic acidosis (P=0.014) were more significant in the CMPIE group than in the others. Multiple logistic regression analysis showed that the independent predictors of high risks for CMPIE were failure to gain weight < 10 g/day (OR, 10.25[95% CI, 1.62-65.06]) and serum hypoalbuminemia < 3.5 g/dL (OR, 9.18[95% CI, 1.69- 49.74]). Cow's milk challenges were performed in the 11 CMPIE patients; vomiting (81.8%), abnormal stool test (80.0%), peripheral leukocyte count and absolute neutrophil count (ANC) increase (100.0%) (P< 0.05), and enteropathy (100.0%). CONCLUSION: CMPIE is not a rare clinical disease in early infancy. The high risk factors of CMPIE were identified as follow: failure to gain weight below 10 g/day, hypoalbuminemia on admission and a rapid decrease during admission. Cow's milk challenge test with endoscopic duodenal biopsy was helpful to confirm CMPIE.
Acidosis ; Biopsy ; Diarrhea ; Enterocolitis* ; Humans ; Hypersensitivity, Delayed ; Hypoalbuminemia ; Leukocyte Count ; Leukocytosis ; Logistic Models ; Milk* ; Neutrophils ; Risk Factors* ; Vomiting

As breast cancer in patients who have undergone augmentation mammoplasty is usually detected late, prognosis is worse than it would otherwise be. Mammography has led to remarkable in the diagnosis of breast cancer, but didnot so in cancer arising from augmented breasts. FDG-PET, which uses fluorine-18-fluorodeoxy glucose (FDG), a glucose non-metabolized analogue , is able to detect breast cancer which shows more active rates of glucose metabolism. Cancer in a radioopaque dense breast, such as breast with silicone- or paraffin-augmentation and is not found by mammography, might be detected by FDG-PET. We tried to find out diagnostic efficienty of FDG-PET in detecting breast cancer with augmented breast. Between June 1995 and November 1997, eight patients had a history of breast augmentation with silicone or paraffin. Although most of them were examined at local clinic by physical exam, mammography or ultrasonography before visiting our hospital, definitive diagnosis could not be made. One patients wanted both breasts augmentsed with paraffin to be removed, and PET evaluated a total of nine lesions with pathological confirmation. As a result, the mammography detected the breast cancer in only one out of three malignancies, and ultrasonography made false positive result in one patient in augmented breast. In contrast, PET scan predicted all of malignancies and five out of six benign lesions precisely. Two of three breast cancers had axillary FDG uptake interpreted as consistent with metastatic involvement, and in one case with cancer of negative axillary lymph node involvement there was no FDG uptake in the axilla, which were correlated to pathologic finding. Although its high cost made the use of PET as a screening test for all augmented breast not feasible, it would, however, be the best diagnostic choice if other methods failed.
Axilla ; Breast Neoplasms ; Breast* ; Diagnosis ; Electrons* ; Female ; Glucose ; Humans ; Lymph Nodes ; Mammaplasty ; Mammography ; Mass Screening ; Metabolism ; Paraffin ; Positron-Emission Tomography* ; Prognosis ; Silicones ; Ultrasonography