A Study on Assessment of CAPs (Client Assessment Protocols) using MDS-HC 2.0 on City Elderly

BACKGROUND: This study used MDS-HC 2.0 (Minimum Data Set-Home Care) to analyze the health and the state of function of the traveling health objects. This study was intended to make use of it with the basic materials for providing them with traveling health service suited for the requirement on the health of the traveling health objects. METHODS: The subjects of this study were 1160 people (over 65 years) living under management control of local Health Center from September 7th to October 3th, 2006. This study was analyzed with inter RAI program & SPSS/WIN 10.0, chi-square -test, t-test, and ANOVA. RESULTS: The result showed that 8.97 CAPs per an elderly person was identified and the subjects over 60% had an injury problem from a fall, health prevention service, vision, IADL, pain, and cognition. The number of CAPs in general was high in higher age and the less educated, and those without a job. But, in subjects that had a life partner and a spouse, the number of CAPs was low. In CAPs by the distinction of sex, CAPs which was much more in man than women in statistics were the improvement of health, the abuse of alcohol and drinking wine, bedsore, and the weak supply system. CAPs which women had much more were the function of the heart and the lungs, pain, the performance of the doctor's advice, health prevention service, and incontinence of urine and insertion of catheter. According to the results comparing CAPs by the level of the ADL, the number of CAPs was shown that the group of ADL 2 was higher than group ADL 1. The matter in which the traveling health service had to be applied in all both ADL1 and ADL2 was injury from a fall, health prevention service, and vision. Conculsion: MDS-HC is applicable to decide the care needs for health and social service supplies. The results can be further applicable for careplan, and referral criteria in continuum of care service over long-term care spectrums.

The Role of Neoadjuvant Chemotherapy for Advanced Stage Wilms Tumor

PURPOSE: This study was designed to exclude radiation in advanced(stage 3, 4) Wilms tumor (WT) by increasing the chance of complete surgical removal with preceding neoadjuvant chemotherapy, thereby reducing the incidence of late effects. METHODS: Between December 1998 and July 2002, we conducted neoadjuvant chemotherapy after needle aspiration biopsy on patients who had advanced WT. If needle biopsy was accessible, we conducted neoadjuvant chemotherapy(vincristine, adriamycin, dactinomycin) for 12 weeks and then performed surgical removal, excluded radiation therapy and conducted postoperative chemotherapy (vincristine, dactinomycin+/-adriamycin). In other cases, we firstly conducted the operation and then performed radiation and postoperative chemotherapy. RESULTS: Of the 17 patients diagnosed as WT, 12 patients had an advanced stage of disease. In two of the 12 patients, initial surgical removal was conducted. The median age of patients was 21 months(5-103 months). Of the 10 the patients who received neoadjuvant chemotherapy, eight patients were stage 1, one patient was stage 2, and the other was stage 3 at operation. In nine patients except one with stage 3 disease, we could perform complete surgical resection and there fore could omit radiation. In four cases we could also exclude adriamycin after operation. All but one patient was alive, disease-free, for a median follow-up of 21 months(9-43 months). CONCLUSIONS: After neoadjuvant chemotherapy, we could increase the chance of complete tumor resection, exclude radiation and decrease the intensity of postoperative chemotherapy in selected cases. Long term follow-up is needed to determine whether our method would significantly decrease late effects.

The Changes of Incidence of Nosocomial Sepsis, and Risk Factors in Extremely Low Birth Weight Infants

PURPOSE: To know whether the changes in the risk factors of nosocomial sepsis had an impact on the occurrence of nosocomial sepsis (NS) in extremely low birth weight infants (ELBW I). METHODS: ELBW I who were admitted to the NICU at Samsung Medical Center from October 1994 to December 2000 were devided into three groups according to periods (period I:1994.10-1996.9, period II:1996.10-1998.12, period III:1999.1-2000.12), and charts were reviewed retrospectively for demographic profile, incidence of NS, and changing patterns of risk factors of NS. RESULTS: Gestational age and birth weight of ELBW I decreased and the incidence of NS increased significantly during third period. However, cumulative incidence of NS corrected by hospital days was not changed irrespective of periods. Among the risk factors of NS in 3rd period, use of antibiotics in the 1st day, postnatal dexamethasone and use and duration of indwelling umbilical catheters decreased significantly and the use of nasal continuous positive airway pressure increased significantly especially, in ELBW I under 800 g of birth weight. In the ELBW I under 800 g of birth weight, cumulative incidence of NS and mortality among the infants who suffered from NS decreased significantly in 3rd period. CONCLUSION: Efforts to decrease the risk factors of NS can prevent the increase in incidence of NS in ELBW I.

Allogeneic Hematopoietic Stem Cell Transplantation in Children with Acute Lymphoblastic Leukemia: Experiences in a Single Center / 대한소아혈액종양학회지

PURPOSE: To improve survival of children with acute lymphoblastic leukemia (ALL), allogeneic hematopoietc stem cell transplantation (HSCT) was applied. METHODS: From June 1999 to May 2002, 27 children with ALL received allogeneic HSCT at Samsung Medical Center. Patients in complete remission (CR) who received HLA-matched HSCT before relapse when HSCT was indicated were assigned to standard-risk, otherwise were assigned to high-risk. Cyclophosphamide and total body irradiation was basic conditioning regimen. For prophylaxis of GVHD, cyclosporine alone in related HSCT and cyclosporine methotrexate methylprednisolone in unrelated HSCT were used. RESULTS: Fifteen patients in first CR including 6 induction failures, 3 MLL rearrangements and 2 Philadelphia chromosomes, and 3 patients in second CR were assigned to standard-risk. Thirteen related HLA-matched, 11 unrelated HLA-matched, 2 related HLA-mismatched and 1 unrelated HLA-mismatched HSCT were applied. Sixteen of 18 standard-risk patients are still alive with median follow-up of 12.5 (range: 2~37) months and 13 of them are disease-free without relapse. Event-free survival rate (EFS) in 18 standard-risk and 9 high-risk patients were 68.2% and 14.8%, respectively. Confined to standard-risk patients, EFS in related and unrelated HSCT were 75.0%, 60.0%, respectively. CONCLUSION: When allogeneic HSCT is indicated in childhood ALL with available HLA-matched donor, early transplantation before clinical aggravation seems to be necessary.

Lactoferrin Sequestration and Its Contribution to Iron Deficiency Anemia in Helicobacter pylori Infected Gastric Mucosa / 대한소아소화기영양학회지

PURPOSE: It is known that lactoferrin serves as a source of iron for H. pylori in gastric mucosa. This study was undertaken to investigate the relationship between lactoferrin and H. pylori infection coexistent with iron-deficiency anemia by determining the lactoferrin levels in gastric biopsy specimens, and by locating the major sites of lactoferrin expression, according to the presence or absence of iron-deficiency anemia. METHODS: Fifty-five adolescents that underwent gastroduodenoscopy were divided into three groups: NL (n=19) for normal controls, HP (n=15) for patients with H. pylori, and IDA (n=21) for patients with H. pylori gastritis and coexisting iron-deficiency anemia. Histopathologic features were graded from null to marked on the basis of the Updated Sydney System. The gastric mucosal levels of lactoferrin were measured by immunoassay. Immunohistochemical technique was used to allow identification of the location and quantification of the lactoferrin expression. RESULTS: Lactoferrin levels in the antrum increased significantly, in proportion to, H. pylori density, polymorphonuclear cell infiltration, and chronic inflammation in the histologic specimens. Patients in the HP and IDA groups showed significantly increased mucosal levels of lactoferrin compared with that observed in the normal group (p=0.0001). The lactoferrin level in IDA group tended to be higher than that in the HP group (p=0.2614). The major sites of lactoferrin expression by immunohistochemistry were in glands and neutrophils within epithelium. Lactoferrin was stained weakly in NL, and strongly in HP and IDA. CONCLUSION: The lactoferrin sequestration in the gastric mucosa of IDA was remarkable, and this finding seems to give a clue that leads to the clarification of the mechanism by which H. pylori infection contributes to iron-deficiency anemia.

Role of Flexible Fiberoptic Bronchoscopy in the Diagnosis of Childhood Endobronchial Tuberculosis / 소아알레르기및호흡기학회지

Endobrochial tuberculosis which may result in stenosis of the bronchus, is a rare complication of pulmonary tuberculosis in children. We recently treated three children with endobronchial tuberculosis which presented different clinical manifestations and different response to the treatments. Endoscopic examinations revealed bronchial masses, in which biopsy and polymerase chain reaction(PCR) were consistent with endobronchial tuberculosis. We reviewed the presentation and treatment of endobronchial tuberculosis in 3 children.