Background/Aims: Lactase deficiency, which has many similarities with small intestinal bacterial overgrowth (SIBO), causes various gastrointestinal symptoms. We estimate the prevalence of SIBO in patients with intestinal symptoms from dairy products and investigate the association between lactase deficiency (LD) and SIBO. Methods: This prospective study included patients with functional intestinal symptoms from dairy product indigestion. A questionnaire on gastrointestinal symptoms, a hydrogen (H 2 )-methane glucose breath test (GBT) for SIBO, and lactose intolerance quick test (LQT) for LD using upper gastrointestinal endoscopy were performed. Results: A total of 88 patients, 29 (33.0%) with severe and 36 (40.9%) with mild LD were included. Sixteen patients (18.2%) were GBT positive. Patients with LQT negativity indicating severe LD showed a higher positivity to GBT or GBT (H 2 ) than the historic controls (27.6% vs 6.7%, P = 0.032). There was no difference in the items on the symptom questionnaire according to the presence of LD or SIBO, except for higher symptom scores for urgency in GBT-positive patients. There were more LQT-negative patients in the GBT (H 2 )-positive group than in the other groups (27.6% vs 10.2%, P = 0.036). Moreover, only GBT (H 2 )-positivity was significantly associated with a higher risk of LQT negativity in multivariate analysis (OR, 4.19; P = 0.029). Conclusions SIBO producing H 2is common in patients with severe LD suspected lactose intolerance. SIBO may be a new therapeutic target for managing intestinal symptoms in patients with lactose intolerance.

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

PURPOSE: Hypertension accelerates the progression of chronic renal disease, whether it results from, or causes, the renal disease. Therefore, the control of hypertension is one of the important factors that retard the rate of renal deterioration. We compared the effects of different antihypertensive agents on renal function and glomerular morphology in subtotal nephrectomized rats. MATERIALS AND METHODS: After induction of chronic renal failure with 5/6 nephrectomy, the rats were divided into three groups; control group (Group C), enalapril group (Group E), and nicardipine group (Group N). Systolic blood pressure was measured by tail cuff method every 4 weeks until 12 weeks after nephrectomy. At 12 weeks after nephrectomy, all rats were placed in metabolic cages for 24 hour urine collections to measure urinary protein and creatinine excretion. After urine collection and blood sampling for serum creatinine, all rats were sacrificed. The renal tissue was processed for morphometric study with light microscope and electron microscope. RESULTS: 1. The blood pressure of Group C increased progressively, but both enalapril and nicardipine prevented the development of hypertension, and the two drugs were equally effective in maintaining normal blood pressure throughout the study. 2. Twenty-four hour urinary protein excretion was lower in Group E compared to Group C and Group N. 3. Mesangial expansion score in both treated groups were significantly lower than the control group. Mean glomerular volume in Group E was significantly reduced compared to Group C and Group N. There was no significant difference in mean glomerular volume between Group C and Group N. 4. There was no significant difference in podocyte structural changes, estimated by filtration slit length density, among control, enalapril and nicardipine treated groups. CONCLUSION: Control of hypertension with enalapril or nicardipine afforded considerable protection from mesangial expansion in the rat remnant kidney model. But protein excretion and glomerular growth were significantly reduced in Group E compared to Group N. There was no significant difference in podocyte structural changes among the 3 groups.
Animals ; Antihypertensive Agents* ; Blood Pressure ; Creatinine ; Enalapril ; Filtration ; Hypertension ; Kidney ; Kidney Failure, Chronic* ; Nephrectomy ; Nicardipine ; Podocytes ; Rats* ; Renal Insufficiency, Chronic ; Tail ; Urine Specimen Collection

BACKGROUND: It is well known that the inferior parathyroids are more difficult to preserved than the superior parathyroid glands because the inferior parathyroid glands have more anatomical variations. METHODS: The authors analysed the gross surgical findings of a total of 411 inferior parathyroid glands in 314 total thyroidectomy cases. The inferior parathyroid glands were grouped according to patterns based on their location and arterial blood supply. RESULTS: Type 1 (location: posterior surface of the lower thyroid pole; artery: inferior branch of the inferior thyroid artery): incidence 51% and presevation rate 62%. Type 2 (location: thyrothymic ligament or in the thymus; artery: inferior branch of the inferior thyroid artery): incidence 27% and preservation rate 86%. Type 3 (location: apart from the lower thyroid pole; artery: inferior branch of the inferior thyroid artery): incidence 6.1% and preservation rate 92%. Type 4 (location: anteriorly on the lower thyroid pole; artery: inferior branch of the inferior thyroid artery): incidence 4.1% and preservation rate 33%. Type 5 (location: lower thyroid pole; artery: comes out from the thyroid gland): incidence 4.1% and preservation rate 0%. Type 6 (location: lower thyroid pole; artery: branch of the superior thyroid artery): incidence 3.6% and preservation rate 80%. Type 7 (location: lower thyroid pole; artery: embedded in the thyroid gland): incidence 2.9% and preservation rate 36%. Type 8 (location: more superior than usual; artery: superior branch of the inferior thyroid artery): incidence 0.7% and preservation rate 67%. Type 9 (location: lower thyroid pole; artery: thyroid ima artery): incidence 0.5% and preservation rate 100%. CONCLUSIONS: The most identified inferior parathyroids belonged to the usual types, and their pre-servation rate were relatively high. However there were some unusual types though their incidence was low. Thus, accurate anatomical knowledge of variations in the location and the blood supply of the inferior parathyroids is needed to enhance the preservation rate.
Arteries ; Incidence ; Ligaments ; Parathyroid Glands* ; Thymus Gland ; Thyroid Gland ; Thyroidectomy*

BACKGROUNDS: Living-donor liver transplantation (LDLT) has been established as an efficacious option to resolve the shortage of cadaveric donor organs for pediatric recipients. This surgical innovation has significantly reduced the pretransplantation mortality for children, but the crisis of increasing scarcity of donor organs in our hospital has led us to extend LDLT to adult recipients. However, the extension of LDLT from pediatric recipients to adult recipients has been made only with limited success largely because of the inability of a relatively small-size left-lobe graft to meet the metabolic demands of an adult recipient. It has been postulated that a left-lobe graft smaller than 40% of the recipient's standard liver volume will not result in a successful adult-to-adult LDLT in chronic parenchymal liver disease. METHODS: From February 1997 to October 1997, 10 LDLTs, using 9 extended left-lobe grafts and 1 right-lobe graft, were performed on patients with end-stage parenchymal liver diseases (9 cases of B-hepatitis-induced cirrhosis with or without an associated hepatocellular carcinoma and 1 case of alcoholic cirrhosis) at the Department of Surgery, Asan Medical Center. The ratios of the graft to the standard liver volume of the recipients were in the range of 30% to 55%. RESULTS: All grafts showed immediate function, but delayed normalization of the serum total bilirubin was demonstrated in all recipients receiving left-lobe grafts. There were no mortalities and serious complications in donors. Two recipients died of sepsis 21 days and 40 days after transplantation, and 8 recipients (80%) are alive with good liver function at a median follow-up of 5.1 months (range 2~10 months). CONCLUSIONS: The aim of this article is to report our experience with adult-to-adult LDLT shows that a graft size greater than 30% of the recipient's standard liver volume is able to meet the metabolic demands of adult recipients with chronic parenchymal liver disease and that LDLT might open a new donor pool for adult recipients when the supply of cadaveric organs is severely restricted.
Adult ; Alcoholics ; Bilirubin ; Cadaver ; Carcinoma, Hepatocellular ; Child ; Chungcheongnam-do ; Fibrosis ; Follow-Up Studies ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors* ; Mortality ; Sepsis ; Tissue Donors ; Transplants

BACKGROUND: Chlamydia trachomatis is most common sexually transmitted pathogen in the world, and a common cause of urethritis and cervicitis. Also it is common cause of preterm premature rupture of membranes and premature labor in pregnant women, and pneumonitis and conjunctivitis in neonate. A rapid and sensitive polymerase chain reaction(PCR)-based assay for detection of C. trachomatis is recently introduced. OBJECTIVES: We studied to determine whether a PCR assay is useful to detect Chlamydial infection in pregnant women. We also studied to compare its prevalence rate according to maternal age, trimester and parity, respectively. Study Design: Specimens were collected from 149 pregnant women by transcervical swab or endocervical lavage. If a specific band was detected in PCR assay, we considered as Chlamydial infection. RESULTS: In general, the positive bands were detected in the 45 of 149 pregnant women(30.2%). The positive bands were detected the 6 of 55(10.9%), 16 of 49(32.7%), and 23 of 45(51.1%) pregnant women in each trimester, respectively. Therefore, there was significantly increased according to the gestational age(p<0.05). However, there were not significantly different according to maternal age and parity(p> 0.05). CONCLUSION: We concluded that the PCR assay is a fast and useful test for the detection of C. trachomatis in transcevical cells from the pregnant women. This study suggested that Chlamydial infection seems to be increased according to the gestational age.
Chlamydia trachomatis* ; Chlamydia* ; Conjunctivitis ; Diagnosis* ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Maternal Age ; Membranes ; Obstetric Labor, Premature ; Parity ; Pneumonia ; Polymerase Chain Reaction* ; Pregnancy ; Pregnant Women* ; Prevalence ; Rupture ; Therapeutic Irrigation ; Urethritis ; Uterine Cervicitis

Clinico-pathological, parasitological, microbiological and immunologic studies were made in 238 of islanders Cheju, a highly endemic area of amebiasis in Korea. Ameba immobilization test was carried out using immunized rabbit sera and several strains of Entamoeba histolytica. The results are summarized and concluded as follows; I. The number of males with liver abscess was markedly greater than female, and the largest group distribution was observed in ages 30-39. In liver abscess patients, an increase of white blood cells(W.B.C.) and a decrease of red blood cells'R.B.C.) was noted. The differential count of W.B.C. showed an increase of segmented neutrophils and a decrease of 1ymphocytes. The level of total cholesterol and its ester was also diminished, and urobilinogen in patients, urine was increased in comparison with healthy controls. 2. The detection rate for microorganisms in aspirated liver abscess was 42.1%. Most of the recovered microorganisms were Gram negative enteric bacilli; Escherichia coli, Alkaligenes fecalis, Aerobacder aerogenes and paracolon group. Fungi and cocci were not observed. 3. In the immobilization test using immune rabbit sera immunized with a 48-hour-culture of E. histolytica, the highest immobilization reaction occurred 45-105 minutes after the beginning of the test and remobilization of the parasite took place gradually. Immobilization of ameba continued for more hours and at higher rate in the inactivated rabbit sera group, and the differences among ameba strains were not remarkable. In human amebiasis sera, the highest peak of immobilization reaction occurred at 45-90 minutes after testing with the parasite. 4. Positive rates for the immobilization test according to clinical feature were 83.3-100% in liver abscess cases, 83.3-90.7% in hepatomegaly cases, 45.4% in asymptomatic cyst-passers and 31.5% in healthy controls. 5. For 56 patients who showed a high rate of immobilization, the follow-up positive rate after treatment for amebiasis was markedly reduced in 2-3 months.
Adolescent ; Adult ; Animals ; Child ; Entamoeba histolytica/isolation & purification ; Female ; Human ; Korea ; Liver Abscess/*microbiology ; Liver Abscess, Amebic/immunology/*microbiology ; Male ; Middle Aged ; Serologic Tests