CHA Bundang Medical Center Research Articles

Mass-forming Eosinophilic Infiltration Involving the Central Airway: A Case Report of Endobronchial Involvement of Eosinophilic Inflammation Mimicking Bronchogenic Malignancy

Correspondence to Hye-Cheol Jeong, M.D. Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea Tel: +82-31-780-6142, Fax: +82-31-780-2992, E-mail: jhcmd@hanmail.net Copyrightc 2014 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 호산구성 염증을 동반한 기관지 협착이 폐암으로 오인된 증례 1예

5,10-Methylenetetrahydrofolate reductase 677C>T polymorphism and microsatellite instability in sporadic colorectal cancer

Purpose: Hypermethylation of human mut L homologue 1 (hMLH1) promoter region is known to cause sporadic microsatellite instability (MSI) colorectal cancers. 5,10-methylenetetrahydrofolate reductase (MTHFR) is the key enzyme in folate metabolism, acting as a methyl donor for DNA methylation. In this study, we investigate whether the polymorphism of MTHFR 677C>T plays a role in the alteration of the promoter-specific hypermethylation, predisposing to MSI colorectal cancers. Methods: Total of 487 sporadic colorectal cancer patients in CHA Bundang Medical Center were collected. MSI was identified when two or more are positive among five microsatellite markers (BAT25, BAT26, D17S250, D5S346, D2S123). The others were classified as microsatellite stable (MSS). Polymorphism of MTHFR 677C>T was genotyped by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: MSI was observed in 65 of 487 patients (12.73%). MSI colorectal cancers showed similar clinicopathological features with previously reported; younger age onset, right-sided preponderance, mucinous and poorly differentiated histology, lower stage, fewer lymph node metastases than MSS tumors (each P Conclusion: This study demonstrated higher frequency of MTHFR 677TT genotype in MSI colorectal cancers. Furthermore, individuals with MTHFR 677CT+TT variant type might potentially develop MSI rather than MSS colorectal cancers.

Clinical Manifestations of Salmonellosis in Children during the last 12 Years: A Single Institution Experience

Purpose:The purpose of this study is to investigate the clinical manifestations and antibiotic resistance of salmonellosis in children. Methods:We reviewed medical records and investigated the clinical characteristics of culture-proven childhood salmonel- losis from January 2000 through December 2011 at the CHA Bundang Medical center. Results:We assessed 53 patients. The median age was 3-years-old (minimum 12 days, maximum 18-years-old) and the number of male patients was 33 (62.3%). It occurred most frequently in the summer (39%) and in 2001 (11 cases) however there was no case in 2009 and 2010. Salmonella typhi was isolated in 3 cases with septicemia. Antibiotic resistance to ampicillin was most frequently presented (30.2%) and 63.6%in serogroup B. No antibiotics resistance strains were cultured in patients with positive Salmonella typhi. Admitted patients from 2000 to 2011 were divided into 2 groups; group 1 from 2000 to 2005 and group 2 from 2006 to 2011. 40 cases belonged to group 1 and 13 cases were in the group 2. Group 2 showed more resistance to ampicillin than group 1 but without any statistical significance(25% vs. 38.5%, P=0.349). In group 1, the most common serotype was group D and in group 2, the most common serotype were group C and D. Conclusion:Salmonellosis in children was frequently occurred from 2000 to 2003 but decreased after 2004. There was no difference in clinical manifestations, serotypes and antibiotic resistances between the years. (Korean J Pediatr Infect Dis 2013;20:1-8)

Analysis of Stromal Vascular Fraction from Lipoaspirates: Our Institute's Experiences

Today, adipose tissue derived mesenchymal stem cells (ADSC) have gained a great interest in various medical fields due to the characteristics of its self-renewal and multilineage differentiation capacity. The stromal vascular fraction (SVF) of adipose tissue is known to contain mesenchymal stem cells and it is obtained by processing the lipoaspirate which is usually collected from tumescent liposuction. In this study, we reviewed the records of patient epidemiology and results of SVF isolation. 30 patients (8 males and 22 females) had been underwent tumescent liposuction between April 2012 and January 2013, and the collected lipoaspirates were processed to isolate SVF in GMP facility in CHA Bundang Medical Center. The average stem cell count per 1 cc of lipoaspirate was 52,252 ± 26,704 and cell count including red blood cells per 1cc of lipoaspirate was 970,607 ± 873,436. The stem cell viability was proven to be 84 ± 4%. Bacteria were not detected in all the SVF samples. Compared to previous reports concerning the yield of SVF, our results coincide well with the results of previous studies. Because there were no domestic report about the yield and viability of SVF, this report may provide a reference value of the Korean SVF for the clinicians who want to use SVF as a therapeutic purpose.

Increasing Rates of Community Associated Methicillin-ResistantStaphylococcus aureusin Children with Muscular-Skeletal Infections in Korea: A Single Center Experience from 2000 to 2012

Purpose : This study aimed to explore how prevalent the community-related methicillin-resistant Staphylococcus aureus (CA-MRSA) was in children with muscular-skeletal infections. Methods : We retrospectively reviewed the medical records of patients of 18 years or under who were diagnosed with suppurative arthritis or osteomyelitis and S. aureus from September 2000 through August 2012 at the CHA Bundang Medical center. Results : Thirty-one cases of suppurative arthritis or osteomyelitis were identified. The patients were between 17 days old and 18 years old with an average age of 7. Eleven cases (33.5%) of suppurative arthritis and 16 cases (51.6%) of osteomyelitis were observed. Five cases were accompanied by the two diseases. Methicillin sensitive S. aureus (MSSA) was isolated in 25 cases (80.6%) and methicillin resistant S. aureus (MRSA) was isolated in 6 cases (19.4%). Multidrug resistant strains were not observed. MRSA was not found from 2000 through 2005. All patients were treated with antibiotics and the duration of antibiotics treatment was days. Vancomycin was used as the initial antibiotic treatment in 4 cases (12.9%) and vancomycin was used as the definitive antibiotics in the 10 cases (32.3%). Conclusions : The result of this study showed that methicillin resistance rate of S. aureus from muscular-skeletal infections was concentrated in the latter half of the 12 year period.

Two Cases of Hodgkin's Lymphoma after Allogeneic Hematopoietic Cell Transplantation

Correspondence to So Young Chong, M.D. Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea Tel: +82-31-780-5154, Fax: +82-31-780-5208, E-mail: sychong@cha.ac.kr Copyrightc 2013 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 급성골수성 백혈병으로 조혈모세포 이식 후 발생한 호지킨림프종 2예

Angular Positioning of Stent Increases Bowel Perforation after Self-Expandable Metal Stent Placement for Malignant Colorectal Obstruction

Background/AimsSome factors like stent wires, balloon dilatation and use of guide wires seems to increase perforation after self-expandable metal stent (SEMS) placement, but few studies mentioned about the relationship between angulation of malignant stricture and perforation. The present study aimed to confirm that more angular positioning of stents increases perforation.MethodsThis study was conducted with retrospectively evaluation at Digestive Disease Center, CHA Bundang Medical Center, CHA University. Between January 2002 and August 2011, SEMS was inserted in 130 patients with malignant colorectal obstruction. We studied the difference in the angle of stenosis between perforation and non-perforation groups using fluorography images.ResultsSEMS insertion was performed in 130 cases of obstruction due to colon cancer. Perforation occurred in eight patients (6.2%) of them. Thirteen cases were excluded from the analysis due to poor fluoroscopic images. Among the eight patients with perforation, the mean stenosis angle was 109.9° compared to 153.1° in the nonperforation group, indicating that the angle was more acute in the perforation group (p=0.016).ConclusionsThis study shows that more angular positioning of stent increases bowel perforation after SEMS placement for malignant colorectal obstruction.

Prevalence of Occult Hepatitis B Virus Infection in Hemodialysis Patients

The prevalence of occult HBV infection depends on the prevalence of HBV infection in the general population. Hemodialysis patients are at increased risk for HBV infection. The aim of this study was to determine the prevalence of occult HBV infection in hemodialysis patients. Total of 98 patients undergoing hemodialysis in CHA Bundang Medical Center (Seongnam, Korea) were included. Liver function tests and analysis of HBsAg, anti-HBs, anti-HBc and anti-HCV were performed. HBV DNA testing was conducted by using two specific quantitative methods. HBsAg was detected in 4 of 98 patients (4.1%), and they were excluded. Among 94 patients with HBsAg negative and anti-HCV negative, one (1.1%) patient with the TaqMan PCR test and 3 (3.2%) patients with the COBAS Amplicor HBV test were positive for HBV DNA. One patient was positive in both methods. Two patients were positive for both anti-HBs and anti-HBc and one patient was negative for both anti-HBs and anti-HBc. The present study showed the prevalence of occult HBV infection in HBsAg negative and anti-HCV negative patients on hemodialysis at our center was 3.2%. Because there is possibility of HBV transmission in HBsAg negative patients on hemodialysis, more attention should be given to prevent HBV transmission.

The prevalence of vitamin D deficiency in iron-deficient and normal children under the age of 24 months

BackgroundIron and vitamin D deficiencies cause a variety of health issues in children, which might have long-lasting effects even in asymptomatic cases. The present study sought to elucidate the potential association between iron status and serum vitamin D levels in infants.MethodsWe evaluated 102 infants aged 3-24 months who visited the CHA Bundang Medical Center from August 2010 to July 2011. Questionnaire and laboratory data were collected. The infants were classified into iron deficiency anemia (IDA), iron deficiency (ID), and normal groups according to hemoglobin (Hb) and ferritin levels. They were then classified into vitamin D deficiency (VDD), vitamin D insufficiency (VDI), and vitamin D sufficiency (VDS) groups according to 25-hydroxyvitamin D [25(OH)D] levels.ResultsVDD was present in 67% of IDA, 53% of ID, and 29% of normal subjects. The proportion of breastfed infants was the highest in the IDA (97%) and VDD (96%) groups. The odds ratio for the likelihood of iron-deficient infants to have subnormal vitamin D levels was 4.115. There was a significant correlation between Hb and 25(OH)D levels. Plasma 25(OH)D levels were lower in the winter/spring. Body mass index values were higher in the IDA/ID groups. Iron, age, and season were predictors of 25(OH)D levels.ConclusionThe prevalence of iron and vitamin D deficiency was high in breastfed infants. There was also a significant association between Hb and 25(OH)D levels in infants. Since all breastfed infants should receive vitamin D supplementation, there should also be concern about concurrent deficiencies in infants with IDA.

Antibody response to pneumococcal vaccination in children with chronic or recurrent rhinosinusitis

PurposeAlthough chronic and recurrent rhinosinusitis is prevalent in children, little is known about its causes. Here, we investigated the humoral immunity in children with chronic or recurrent rhinosinusitis.MethodsWe examined 16 children attending the outpatient clinic at the CHA Bundang Medical Center including 11 boys and 5 girls, aged 3.11 years (mean age, 5.6 years), who had rhinosinusitis for >3 months or >3 times per year. The complete blood count with differential and total serum concentrations of Immunoglobulin (Ig) E, IgA, IgD, IgM, IgG, and IgG subclasses (IgG1, IgG2, IgG3, and IgG4) of all children were measured. All subjects received 23-polysaccharide pneumococcal vaccination (PPV), and the levels of antibodies to 5 serologic types (4, 6B, 14, 18C, and 23F) of pneumococcal capsular polysaccharide antigens were measured before and after vaccination. Post-PPV antibody titers ≥0.35 µg/mL or with a ≥4-fold increase were considered as positive responses.ResultsThe titers of IgG, IgA, IgD, and IgM were within normal range in all 16 children, whereas the total IgE concentration was higher than normal in 2 children. IgG1 deficiency was observed in 1 patient and IgG3 deficiency in 3. After PPV, 1 patient failed to respond to all 5 serologic types, 2 failed to respond to 4 serologic types, and 2 failed to respond to 3 serologic types.ConclusionClinicians should consider the evaluation of humoral immune functions in children with chronic or recurrent rhinosinusitis who do not respond to prolonged antibiotic treatment.

Association Study of Microrna and Microrna-Biogenesis Gene Polymorphisms with Venous Thromboembolism (VTE) in Korean Population

AbstractAbstract 3395Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a public health concern in Western and Asian countries. Venous thromboembolism often complicates the course of hospitalized patients but may also affect ambulatory and otherwise healthy people. The classic risk factors for VTE are cancer, surgery, prolonged immobilization, fracture, paralysis, oral contraceptive use, and hereditary coagulopathies. In addition to these classic risk factors, microparticle containing microRNA is a known risk factor for both arterial and venous thrombosis. The aim of study was to investigate genetic association between microRNAs or microRNA-biogenesis genes and VTE. We selected 6 well-studied polymorphisms of miR-146a (rs2910164), miR-196a2 (rs11614913), miR-499 (rs3746444), DICER (rs3742330), DROSHA (rs10719), and RAN (rs14035).Patients with consecutive VTE with recent (<6 months) objective diagnosis of DVT or PE, who visited to the CHA Bundang Medical Center (Seongnam, Korea) or Keimyung University hospital (Daegu, Korea) between May 2005 and December 2009, were enrolled in the study. We enrolled the patients with symptomatic VTE and excluded the patients with asymptomatic VTE. Venous thromboembolism was defined as provoked or unprovoked, depending on the presence or absence of any of the following risk factors: recent surgery (<3 months), recent trauma/fracture (<3 months), immobilization (>7 days), malignancy, stroke, severe medical disease, autoimmune disease, pregnancy, use of oral contraceptives, and known inherited thrombophilia. Venous thromboembolism was classified as provoked in the presence of at least one of these risk factors. The control group was selected among patients visiting the CHA Bundang Health Promotion Center for periodic health examinations, who had no medical history of VTE. The Institutional Review Board of CHA Bundang Medical Center approved the research protocol and written informed consent was obtained from all participating individuals. Genotyping of microRNA and microRNA-biogenesis gene polymorphisms was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. Multivariate logistic regression was used to calculate strength of association.The genetic distributions of microRNA and microRNA-biogenesis gene polymorphisms were in Hardy-Weinberg equilibrium (Table 1). RAN rs14035 CC genotype was associated with increased VTE risk (adjusted odds ratio [AOR], 1.640; 95% confidence interval [CI], 1.106–2.432; P=0.014; Table 1). The statistical significance of RAN rs14035 CC was strengthened in unprovoked VTE patients (AOR, 2.478; 95% CI, 1.410–4.357; P=0.002; Table 2). Although other microRNA-related polymorphisms showed differences between controls and VTE patients, there were not positive statistical significances. In conclusion, RAN rs14035 CC may be a possible predisposing factor for VTE development. [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Surgical Technique of Minimal Incision Approach with CO2Laser for Congenital Cholesteatoma

Received April 13, 2012 Revised June 25, 2012 Accepted June 26, 2012 Address for correspondence Chang Ho Lee, MD, PhD Department of OtolaryngologyHead and Neck Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea Tel +82-31-780-5340 Fax +82-31-780-5347 E-mail hearwell@gmail.com Background and ObjectivesZZTranscanal antrotomy approach (TCA) enables not only good exposure but also minimal incision approach required for pediatric congenital cholesteatoma (CC). The addition of “CO2 laser enabled ablation and resection (CLEAR)” would facilitate safe and complete removal of CC from stapes. This study evaluates the clinical results of surgically removing CC through TCA with CLEAR (minimal incision approach with CO2 laser, MICL). Subjects and MethodZZThe medical records of patients who underwent endaural extended tympanostomy, MICL, or postauricular approach for CC removal from January 2009 to September 2011 were reviewed in this study. ResultsZZMICL was performed in 37 patients of Potsic I, II CC. It was effective in surgical exposure and reducing the chance of residual CC. MICL could satisfactorily avoid postauricular tympanomastoidectomy, which allowed preservation of healthy mastoid air cells for almost all Potsic III CC, including posterior CC (14 patients). MICL was also useful for 6 cases of Potsic IV CC that extended beyond the incus posterosuperiorly to the auditus ad antrum. Children were not committed to second look operation because the attic was exteriorized with-out the cavity problem and the complete removal of CC from the stapes was facilitated with CLEAR. ConclusionZZMICL enabled sufficient exposure with less invasive approach as well as complete CC removal, which reduced the postoperative complications and needs for second look operation. This surgical technique could be widely used for Potsic stage I, II, III, and some IV CC. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:422-8

Relationship Among Total Kidney Volume, Renal Function and Age

We measured kidney volume using software and investigated the relationship between kidney volume and renal function. Age, gender, height, body weight, body mass index, body surface area and serum creatinine were recorded for 539 normal individuals. A tissue segmentation tool program was used to measure kidney volume from computerized tomography images. The glomerular filtration rate was calculated using the Cockcroft-Gault equation and an abbreviated modification of diet in renal disease equation. We looked for correlations of renal parenchymal volume with age and anthropometric measurements. We also tested for a correlation between kidney volume and renal function using the glomerular filtration rate according to the Cockcroft-Gault and modification of diet in renal disease equations. Mean kidney volume in all participants was 261.3 ± 58.1 ml. Mean volume in men was approximately 14 ml greater than in women (266.1 vs 251.8 ml, p = 0.004). Kidney volume correlated significantly with height (r = 0.344, p <0.001), body weight (r = 0.343, p <0.001), body mass index (r = 0.177, p <0.001), body surface area (r = 0.371, p <0.001) and age (r = -0.418, p <0.001). Kidney volume also correlated with the glomerular filtration rate according to the Cockcroft-Gault and modification of diet in renal disease equations (p <0.001, r = 0.615 and p <0.001, r = 0.432, respectively). Kidney volume and the glomerular filtration rate decreased in parallel with increasing age. Kidney volume correlates well with renal function and anthropometric measurements. Knowledge of these relationships will be valuable in clinical urology and nephrology.

A Case of Massive Portal Venous Gas Caused by Fatal Intestinal Infarction

Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏 Hepatic portal venous gas (HPVG), a rare radiologic finding, is associated in some cases with severe or lethal conditions requiring urgent surgical intervention. Computed tomography has recently demonstrated a wider range of clinical conditions associated with HPVG, some of which are benign and do not necessarily require surgery. However, HPVG remains an ominous sign in cases of bowel ischemia or necrosis. We report on a case of massive HPVG caused by a fatal intestinal infarction, which showed rapid disease progression, eventually resulting in death due to septic shock. The HPVG in this case was huge and could therefore be confused with an air-biliarygram. (Intest Res 2011;9:153-157) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Successful management of abdominal pregnancy implanted on posterior cul-de-sac with postoperative selective transcatheter artery embolization: A case report

812 SUCCESSFUL MANAGEMENT OF ABDOMINAL PREGNANCY IMPLANTED ON POSTERIOR CUL-DE-SAC WITH POSTOPERATIVE SELECTIVE TRANSCATHETER ARTERY EMBOLIZATION: A CASE REPORT Young-Ran Kim, MD, Gyeong-Sik Jeon, MD, Young-Ju Jeong, MD, Jeong-Heon Lee, MD, Dong-Hyu Cho, MD Departments of Obstetrics and Gynecology, Radiology, CHA Bundang Medical Center, CHA University, Seongnam; Department of Obstetrics and Gynecology, Chonbuk National University Medical School, Jeonju, Korea

A Case of Idiopathic Spontaneous Tonsillar Hemorrhage

Received November 5, 2010 Revised December 1, 2010 Accepted December 29, 2010 Address for correspondence Chan Kee Yoo, MD, PhD Department of OtolaryngologyHead and Neck Surgery, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Seongnam 463-712, Korea Tel +82-31-780-5340 Fax +82-31-780-5347 E-mail yoochankee@empal.com Spontaneous tonsillar hemorrhage (STH) is an extremely rare event. Usually, the causes of STH are ascribed to vessel wall erosion secondary to bacterial or viral infection of tonsils. Other causes include vascular or tumorous lesions around tonsil, coagulation disorders and idiopathic one. On one hand, the total number of reported STH has slightly increased because STH is defined as all forms of “bleeding tonsils”, including even minor bleeding. On the other hand, the portion of the total STH that is life-threatening has become relatively few. Management of STH involves the use of antibiotics, and early tonsillectomy is recommended. We have experienced a case of a 29 year-old female with tonsillar hemorrhage in the absence of any identifiable cause. We report the case with a review of the related literatures. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:344-6 Key WordsZZTonsil ᆞHemorrhage.

Serum TSH Level in Healthy Koreans and the Association of TSH with Serum Lipid Concentration and Metabolic Syndrome

Background/AimsThe proper treatment of subclinical hypothyroidism and the normal range of serum thyroid stimulating hormone (TSH) concentration are intensely debated. However, few reports have investigated TSH concentrations in Asian ethnic groups. Therefore, the present study was designed to define the TSH reference range in a Korean population and to investigate the metabolic significance of TSH concentration.MethodsWe enrolled patients who underwent medical examination at the CHA Bundang Medical Center. Anthropometric data were evaluated, and serum TSH, free T4, and lipid profiles were assayed.ResultsA total of 7,270 subjects were included. Mean TSH concentration of the study population was 1.82 ± 0.95 mU/L, and we observed a sex-related difference in TSH concentration (male, 1.67 ± 0.87 mU/L; female, 2.02 ± 1.01 mU/L; p < 0.01). When the 2.5 and 97.5 percentiles were calculated, 95% TSH reference limits were 0.52-4.29 mU/L. TSH concentration was higher in elderly subjects, during winter, in postmenopausal women, and in obese males. Moreover, TSH showed significantly positive correlations with serum total cholesterol, triglyceride, and low density lipoprotein cholesterol regardless of sex, age, season, obesity, or menopausal status (all p < 0.01). Finally, TSH concentration was positively related to the prevalence of metabolic syndrome.ConclusionsWe demonstrated the association between TSH concentration within the normal reference range and serum lipid levels. TSH concentration varies according to sex, age, season, and body mass index (only in males). Moreover, high normal TSH levels were significantly associated with an increased prevalence of metabolic syndrome, which may be of importance when evaluating subjects with high normal TSH concentration.

A Case of Upper Gastrointestinal Hemorrhage Misdiagnosed as Post-Tonsillectomy Hemorrhage

Received November 5, 2010 Revised December 21, 2010 Accepted December 28, 2010 Address for correspondence Sang Yul Shim, MD, PhD Departments of OtolaryngologyHead & Neck Surgery, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Seongnam 463-712, Korea Tel +82-31-780-5340 Fax +82-31-780-5347 E-mail shim6103@cha.ac.kr Tonsillectomy, with or without adenoidectomy, remains the most frequently performed surgical procedure by otolaryngologists. Postoperative hemorrhage, which is classified as primary ( 24 h) hemorrhage, is recognized as a rare but potentially life-threatening complication. Although most oral bleedings occuring after tonsillectomy are considered as post-tonsillectomy hemorrhages, there could also be other origins such as gastrointestinal hemorrhage. We recently experienced a case of gastrointestinal hemorrhage that was misdiagnosed as secondary post-tonsillectomy hemorrhage. We report this case with a review of the literature. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:297-99 Key WordsZZPost-tonsillectomy hemorrhage ᆞGastrointestinal hemorrhage ᆞGastric ulcer.

Effects of single dose of esmolol on BIS and catecholamine response to tracheal intubation during desflurane anesthesia

Department of Anaesthesiology and Pain Medicine, CHA Bundang Medical Center and Yonsei University, Seoul, Korea

Risk Factors for Community-onset Urinary Tract Infections due to Extended-spectrum β-lactamase Producing Bacteria in Children

β the community. The aim of this study was to identify risk factors for community-onset urinary tract infections (UTIs) by ESBL producers in children. Materials and Methods : We analyzed 854 episodes of community-onset UTIs in children diagnosed at CHA Bundang Medical Center from January, 2004 to April, 2009. The presence of ESBL in Escherichia coli and Klebsiella spp. was screened and confirmed by VITEK ® -2 ESBL test. Controls were matched in a 2:1 ratio to case patients by age and sex. The clinical characteristics, risk factors, antimicrobial resistance, and treatment efficacy were compared with controls. Results : The most common pathogen was Escherichia coli (681 isolates), followed by Klebsiella pneumoniae (60 isolates), Enterococcus faecalis (23 isolates), etc. The number of isolated ESBL producers among the pathogens E. coli and K. pneumoniae was 25 (3.7%) and 7 isolates (11.7%), respectively. No significant differences were noted as to the UTI history prior to the present treatment, underlying urogenital anomaly, and clinical characteris - tics. Use of any antibiotics within a month ( P=0.012, Odds ratio, 6.341, 95% confidence interval, 1.492 to 26.955) was related to the increased risk of community-onset UTI by ESBL producers. Conclusions : ESBL-producing bacteria has been identified in pediatric community-onset UTI, and the use of any antibiotics within the previous month was related to the increased risk of UTI by ESBL producers. Therefore, careful selection and use of antibiotics should be recommended for community-onset UTI in children.