PURPOSE: The aims of this study were to investigate the frequencies and role of hepatitis B virus(HBV) precore and core promotor mutations in children with chronic hepatitis B infection. METHODS: Sera from 31 children with chronic HBV infection were analyzed by direct sequencing of polymerase chain reaction amplification of HBV DNA. RESULTS: Twenty-nine adr type were analyzed. The mutations in HBV precore region were observed in 8(27.6%) of 29 cases. The G->A mutation of nucleotide 1896(A1896; stop codon) were observed in 4 cases(13.8%). The mutations in HBV core promotor region were observed in 27 (93.1%) of 29 cases. The G(1764)->A mutation(A1764) was observed in 14 cases(48.3%), and among these 12 cases combined with a A to T change at nucleotide 1762(T1762). The mutations in HBV precore region were obsereved in 4(21%) of 19 cases of HBeAg positive group and 9(90%) of 10 cases of HBeAg negative group. A1896 mutation was observed in 2 cases in both HBeAg positive and negative group, respectively. The mutations in HBV core promotor region were observed in 18(94.7%) of 19 cases of HBeAg positive group and 9(90%) of 10 cases of HBeAg negative group. T1762 mutation were observed in 6(31.6%) of 19 cases of HBeAg positive group and 6(60%) of 10 cases of HBeAg negative group(P=0.14). A1764 mutation was obsereved in 7 (36.8%) of 19 cases of HBeAg positive group and 7(70%) of 10 cases of HBeAg negative group (P=0.089). A1896 mutation was observed in 2(18.2%) of 11 cases in increased AST/ALT group and 2(11.1%) of 18 cases in normal AST/ALT group. A1764 and T1762 mutations were higher (61.1%) in AST/ALT increased group than those(27.3%) in AST/ALT normal group, but there was no statistical significance(P=0.077). CONCLUSION: Mutations in the precore and core promotor regions can be frequently detected in children with chronic HBV infection. T1762 and A1764 mutations were observed more frequently in HBeAg negative group and in AST/ALT increased group but there was no statistical significance.
Child* ; DNA ; Hepatitis B e Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis B, Chronic* ; Hepatitis* ; Hepatitis, Chronic* ; Humans ; Polymerase Chain Reaction ; Promoter Regions, Genetic

BACKGROUND: This study was designed to estabilish serum LDL cholesterol(LDL-C) and HDL cholestrol(HDL-C) levels in the Korean adult population and to identify the difference in sex, age, and living place and the incidence of high risk group and the affecting factors on the serum lipid levels. METHODS: The serum LDL-C and HDL-C distribution in the normal Korean abult population were studied in 5,278 cases(males 2,802 and females 2,476) in the age groups of 3rd to 8th decade. Data were collected from 33 institutes and hospitals throughout the country during the period of June 1989 to December 1990. The serum Lipid levels were examined in the state of fasting of at least 12 hours. Total cholesterol and triglyceride levels were measured by enzymatic assays and HDL-C levels were determined by precipitation methods. The level of LDL-C was determined indirectly using the formula by Friedwald [LDL-C=total cholesterol-(HDL-C+triglyceride/5)]. RESULTS: The mean level of LDL-C was 112.1mg/dl. Males had 110.0mg/dl and females had 114.5mg/dl without statistical significance between gender, but levels were significantly higher in the 4th decade in males and in the 6th, 7th and 8th decade in females. The LDL-C levels rose gradually with the increase of age. The peak level of LDL-C for the males was in the 7th decade and that for the females was in the 8th decade. The mean level of serum HDL-C was 45.1mg/dl. Males had 43.8mg/dl and females had 46.6mg/dl without statistical significance between gender, but levels were significantly higher in the 3rd, 4th, 5th and 6th decade in females. The incidence LDL-C level of > or = 160mg/dl was 10.0%. Males had 8.2% and females had 12.1% with significantly higher incidence in females, especially in 6th decade females. The incidence of LDL-C level of > or = 160mg/dl of big cities was 10.7% and that of smaller cities & towns was 8.8% with significantly higher incidence in big cities. But, there was no significant difference in gender between big cities and smaller cities & towns. The incidence of LDL-C level of > or = 160mg/dl was significantly higher in 7th decade males in big cities and that of big cities and smaller cities and smaller cities & towns was 15.9% and 5.2%, respectively. The incidence of HDL-C level of <35mg/dl was 17.4% Males had 20.0% and females had 14.5% with significantly higher incidence in males, especially in 4th decade males. The incidence of HDL-C level of <35mg/dl of smaller cities & towns was 19.8% and that of big cities was 16.2% with significantly higher incidence in smaller cities & towms. Males in smaller cities & towns had 23.1% and males in big cities had 18.1% with statistical higher in smaller cities & towns. But, there was no significant difference in females between big cities and smaller cities & towns. The incidence of HDL-C level of <35mg/dl was significantly higher in 4th and 6th decade males in smaller cities & towns and that of smaller cities & towns and big cities was 26.8%, 25.6% and 16.2%, 17.7%, repectively. The significantly positively related factors for serum LDL-C level were age, BMI, systolic blood pressure(SBP), location and occupation. And those for serum HDL-C level were SBP and family history and negatively related factor for HDL-C level were BMI, smoking, and exercise. CONCLUSION: This study can provide the basic date base for prevention and management of coronary heart disease among Korean population.
Academies and Institutes ; Adult* ; Cholesterol ; Cholesterol, HDL* ; Cholesterol, LDL* ; Coronary Disease ; Enzyme Assays ; Fasting ; Female ; Humans ; Incidence ; Korea ; Male ; Occupations ; Smoke ; Smoking ; Triglycerides

We report a case of subcutaneous panniculitic T-cell lymphoma (SPTCL) which occurred in a 10-year-old Korean girl. Her disease presented as multiple erythematous subcutaneous nodules on the right cheek, left chest, abdomen, left flank, both calves, and left shin with systemic symptoms. She had a protracted course of multiple erythematous subcutaneous nodules for 2 months often with spiking fever. Histopathologic findings for the subcutaneous nodules revealed lobular panniculitis-like findings composed of atypical small, bland lymphocytes and histiocytes. Characteristically, atypical lymphocytes rimmed individual fat cells in a lace-like pattern and some histiocytes occasionally phagocytosed WBCs. Bone marrow findings revealed increased phagocytic histiocytes with engulfed hematopoietic cell. The immunophenotypic studies showed CD45RO (UCHLl)+, CD20-, CD4-, CD8+ and CD56+ (focal), lysozyme+, CD45 (LCA)+ and EBV-. She received three cycles of high-dose cyclophosphamide, adriamycin, vincristine, prednisolone (CHOP) and methotrexate, intrathecal methotrexate and one cycle of fludarabine, mitoxantrone and dexamethasone (FND) chemotherapy. She died of acute renal failure during multiple chemotherapy.
Abdomen ; Acute Kidney Injury ; Adipocytes ; Bone Marrow ; Cheek ; Child* ; Cyclophosphamide ; Dexamethasone ; Doxorubicin ; Drug Therapy ; Female ; Fever ; Glycogen Storage Disease Type VI ; Histiocytes ; Humans ; Lymphocytes ; Lymphoma, T-Cell* ; Lymphoma, T-Cell, Cutaneous ; Methotrexate ; Mitoxantrone ; Prednisolone ; T-Lymphocytes* ; Thorax ; Vincristine

The residual tense false lumen following surgical repair of aortic dissection remains one of the most difficult and challenging postsurgical problems. Percutaneous fenestration of the dissecting membrane under the guidance of intravascular ultrasound has been recently introduced to depressurize the tense false lumen. A 63-year-old woman who underwent repair of acute type I dissection was readmitted because of claudication and numbness of the left lower extremity. Angiography, computed tomography, and magnetic resonance imaging clearly showed a dissection flap starting from the thoracic aorta distal to the left subclavian artery. Compressed true lumen by the markedly enlarged tense false lumen was also noted in the double-channeled descending thoracoabdominal aorta. Under intravascular ultrasound guidance, the intimal flap was punctured with a Brockenbrough needle advanced to the true lumen through a femoral artery, and then, a balloon catheter was introduced over the guidewire which was placed across the dissection flap. Desired fenestration was obtained successfully by inflation of the balloon without complications. After procedure, symptoms resolved promptly and she is currently(clinical follow-up of 12 months postfenestration) ambulating without claudication. In conclusion, percutaneous fenestration of the intimal flap is a technically feasible and an effective alternative procedure to surgical repair for restoration of perfusion to an ischemic extremity in selected patients complicated with aortic dissection.
Angiography ; Aorta ; Aorta, Thoracic ; Catheters ; Extremities* ; Female ; Femoral Artery ; Follow-Up Studies ; Humans ; Hypesthesia ; Inflation, Economic ; Ischemia* ; Lower Extremity ; Magnetic Resonance Imaging ; Membranes ; Middle Aged ; Needles ; Perfusion ; Subclavian Artery ; Transcutaneous Electric Nerve Stimulation ; Ultrasonography

The malignant potential of a tumor is related to its ability to dissociate invasion and seed other sites-metastasis. In either instance, the tumor cells are confronted with a barrier signif icantly composed of type IV collagen. This type IV collagen is a major structural protein of basement membranes. Using immunohistochemical method to detect type IV collagen, intensity of stain and continuity of basement membrane at the tumor-stromal border was studied in surgical specimens from 47 colorectal carcinomas at the Pusan Paik-Hospital. Immunoreactivity was evaluated semi-quantitatively as three categories; Type-1, thick or normal basement membrane with or without minimal discontinuity; Type-2, thin basement membrane with or without moderate discontinuity; Type-3, fragmented or absent basement membrane. Also, in each case the tumor morphologic features were identified. The histologic type, differentiated grade, desmoplastic response, lymphatic and vascular invasion, lymph node involvement, tumor size and modified Dukes' stage were estabilished. Type-1 immunoreactivity was significantly observed in well-differentiated, negative lymph node, Dukes' stage B1/B2 tumors, and Type-3 was in poorly differentiated, positive lymph node, Dukes' stage C2/D. The expres sion of collagen IV in basement membrane was statistically significant correlated with differentiated grade, lymph node metastasis and modified Dukes' stage. By contrast, no statistically significant correlation was found between paucity of type IV collagen and the other parameters. The result suggest that expression of type IV collagen in basement membrane may be a useful prognostic marker, and may play a part in the invasive and metastatic process of colorectal carcinomas.
Basement Membrane ; Busan ; Collagen Type IV ; Collagen* ; Colorectal Neoplasms* ; Lymph Nodes ; Neoplasm Metastasis

PURPOSE: The prevalence of renal anomalies in Turner syndrome(TS) has been reported to vary from 33% to 60%. The purpose of this study was to clarify the true incidence of renal malformations in Korean TS. METHODS: We evaluated 33 patients with Turner syndrome diagnosed by karyotype in Inje University Busan Paik hospital and Youngnam University from January 1995. Intravenous pyelography(IVP) was performed on all patients; abdominal ultrasonography and 99mTc-DMSA renal scan were performed on some. Cytogenetic analysis was performed on all patients with peripheral blood lymphocytes. RESULTS: Of the total 33 patients, the karyotype showed 45, X in 18(54.5%) patients, mosaicism in 11(33.3%) patients and structural aberration in 4(12.2%) patients. The overall incidence of renal anomalies was 36.4%. The renal anomalies included four cases of horeshoe kidney, six cases of abnormal renal collecting system one case of single kidney and one case of malrotation. The incidence of renal anomalies in 45, X karotype(44.4%) showed a higher rate than that of mosaicism and structural aberration(26.7%), but there is no statistical significance. CONCLUSION: The incidence of renal anomalies in Korean TS reveals 36.4%. This rate is similar to other foreign TS studies. We recommend that renal ultrasonography or IVP for investigation of renal anomalies should be done as a screening procedure for the better quality of life in patients with TS.
Busan ; Child* ; Cytogenetic Analysis ; Humans ; Incidence ; Karyotype ; Kidney ; Lymphocytes ; Mass Screening ; Mosaicism ; Prevalence ; Quality of Life ; Technetium Tc 99m Dimercaptosuccinic Acid ; Turner Syndrome* ; Ultrasonography

OBJECTIVE: The purpose of this study was to investigate the complication using carotid intima media thickness (CIMT) as an indicator for atherosclerosis and to verify the risk factors in systemic lupus erythematosus (SLE) patients compared with those of control group. METHODS: The study recruited 48 asymptomatic SLE and 32 healthy control group. These are examined by B-mode ultrasound (Acuson(TM) SequoiaC256 8 MHz linear transducer) to measure the CIMT at the far wall of the common carotid artery. A wide range of contribution factors to CIMT including age, body mass index, lipid profile, total cumulative steroid dose, SLEDAI, and proteinuria were considered. RESULTS: Although the results of CIMT in both groups were within normal limit (In healthy adult 0.25~1.5 mm, values > 1.0 mm often regarded as abnormal), the mean CIMT in patient group was 0.721+/-0.162 mm, which was thicker than that of control group with 0.5219+/-0.096 mm (p<0.001). In multiple regression analysis, only age showed significant contribution to CIMT (p<0.01). Disease duration, SLEDAI and serum lipids were of no statistical significance with CIMT. CONCLUSION: We were to elucidate the advance of atherosclerosis with measuring CIMT and assess factors associated with SLE. Even if the results of CIMT in both groups were within normal range, it is significant that the arterial thickening is more advanced in SLE than that of healthy control. Further studies based on CIMT are needed to screen and prevent cardiovascular complications from disease progression.
Adult ; Atherosclerosis ; Body Mass Index ; Carotid Artery, Common ; Carotid Intima-Media Thickness* ; Disease Progression ; Humans ; Lupus Erythematosus, Systemic ; Proteinuria ; Reference Values ; Risk Factors* ; Ultrasonography

Massage is generally accepted as a safe and a widely used modality for various conditions, such as pain, lymphedema, and facial palsy. However, several complications, some with devastating results, have been reported. We introduce a case of a 43-year-old man who suffered from tetraplegia after a neck massage. Imaging studies revealed compressive myelopathy at the C6 level, ossification of the posterior longitudinal ligament (OPLL), and a herniated nucleus pulposus (HNP) at the C5-6 level. After 3 years of rehabilitation, his motor power improved, and he is able to walk and drive with adaptation. OPLL is a well-known predisposing factor for myelopathy in minor trauma, and it increases the risk of HNP, when it is associated with the degenerative disc. Our case emphasizes the need for additional caution in applying manipulation, including massage, in patients with OPLL; patients who are relatively young (i.e., in the fifth decade of life) are not immune to minor trauma.
Adult ; Facial Paralysis ; Humans ; Longitudinal Ligaments ; Lymphedema ; Massage ; Neck ; Ossification of Posterior Longitudinal Ligament ; Quadriplegia ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases ; Spinal Cord Injuries

As the use of the antibiotics, antitumor substances, steroid hormone and immunosuppressive agent have been increased remarkably, the incidence of the fungal infection has also been increased. Aspergillus is a fungus belonged to ascomycetes family and distributed world-widely. Aspergillus infection of the spine is very rare. Mode of vertebral Aspergillosis is direct extension of primary lesion of lung in children, on the other hand, hematogenous metastasis in adults. We report a adult woman who suffered from thoracolumbar pain without any neurological deficit for 6 months prior to admission. Imaging studies revealed irregular bony destruction on the adajacent end plates of T12 and L1 vertebras with kyphotic change. We underwent operation via anterolateral approach using Z-plate fixation. followed by amphotericin-B administration.
Adult ; Anti-Bacterial Agents ; Ascomycota ; Aspergillosis* ; Aspergillus ; Child ; Female ; Fungi ; Hand ; Humans ; Incidence ; Lung ; Neoplasm Metastasis ; Spine*

BACKGROUND: Carpal tunnel syndrome(CTS) is a long-term complication in dialysis patients which results from compression of the median nerve within the carpal tunnel. It has been reported to occur with increased frequency in the hemodialysis population, but, there are few reports concering long-term complications in CAPD because of the relatively shorter duration of dialysis in most CAPD patients. The aim of this study was to determine the incidence of CTS in patients undergoing CAPD. METHODS: We analyzed 21 chronic renal failure (CRF) patients(males 14, females 7; age range 19-79 yr) undergoing CAPD. The patients were evaluated by questionnare, physical examination, and nerve conduction test(NCT). Age, gender, duration of CRF before CAPD, duration of CAPD, diabetic history were determined. RESULTS: Among the total 21 patients undergoing CAPD, only 5 patients(24%) were CTS, diagnosed by NCT. Two of these patients were symptomatic CTS, three patients were non-symptomtic CTS. So, there were no relationship between the incidence of CTS and clinical symptoms. Among the diabetic dialysis patients, the incidence of CTS was 28.57%. Also there was no increase in the number of diatetic patients with CTS. CONCLUSION: It is concluded that the incidence of CTS in CAPD patients was similar with the previous reported incidence(2-31%) of hemodialysis patients. Since CTS is treatable, annual or even semiannual nerve conduction tests is indicated all CRF patients on chronic dialysis.
Carpal Tunnel Syndrome* ; Dialysis ; Female ; Humans ; Incidence ; Kidney Failure, Chronic* ; Median Nerve ; Neural Conduction ; Peritoneal Dialysis, Continuous Ambulatory ; Physical Examination ; Renal Dialysis