Bowel Wall Thickening on Computed Tomography in Children: A Novel Method of Measurement and Its Clinical Significance / 대한소아소화기영양학회지

Purpose@#The clinical implications of bowel wall thickening (BWT) on abdominal computed tomography (CT) among children are unknown. We aimed to suggest a new method for measuring BWT and determining its clinical significance in children. @*Methods@#We retrospectively analyzed 423 patients with acute abdomen who underwent abdominal CT; 262 were classified into the BWT group. For this group, the pediatric radiologist described the maximal bowel wall thickness (MT), normal bowel wall thickness (mm) (NT), and their ratios for each segment of the bowel wall. @*Results@#In the thickened bowel walls, the thickness differed significantly between the small bowel (6.83±2.14 mm; mean±standard deviation) and the colon (8.56±3.46 mm; p<0.001). The ratios of MT to NT in the small bowel (6.09±3.17) and the colon (7.58±3.70) were also significantly different (p<0.001). In the BWT group, 35 of 53 patients had positive fecal polymerase chain reaction results; 6 patients infected with viruses predominantly had BWT in the small intestine, while the terminal ileum and the colon were predominantly affected in 29 patients with bacterial infections. In the initially undiagnosed 158 patients with BWT, the symptoms improved spontaneously without progression to chronic gastrointestinal disease. @*Conclusion@#This study provides a clinical reference value for BWT in the small intestine and colon using a new method in children. The BWT on abdominal CT in children might indicate nonspecific findings that can be observed and followed up without additional evaluation, unlike in adults.

Bowel Wall Thickening on Computed Tomography in Children: A Novel Method of Measurement and Its Clinical Significance / 대한소아소화기영양학회지

Purpose@#The clinical implications of bowel wall thickening (BWT) on abdominal computed tomography (CT) among children are unknown. We aimed to suggest a new method for measuring BWT and determining its clinical significance in children. @*Methods@#We retrospectively analyzed 423 patients with acute abdomen who underwent abdominal CT; 262 were classified into the BWT group. For this group, the pediatric radiologist described the maximal bowel wall thickness (MT), normal bowel wall thickness (mm) (NT), and their ratios for each segment of the bowel wall. @*Results@#In the thickened bowel walls, the thickness differed significantly between the small bowel (6.83±2.14 mm; mean±standard deviation) and the colon (8.56±3.46 mm; p<0.001). The ratios of MT to NT in the small bowel (6.09±3.17) and the colon (7.58±3.70) were also significantly different (p<0.001). In the BWT group, 35 of 53 patients had positive fecal polymerase chain reaction results; 6 patients infected with viruses predominantly had BWT in the small intestine, while the terminal ileum and the colon were predominantly affected in 29 patients with bacterial infections. In the initially undiagnosed 158 patients with BWT, the symptoms improved spontaneously without progression to chronic gastrointestinal disease. @*Conclusion@#This study provides a clinical reference value for BWT in the small intestine and colon using a new method in children. The BWT on abdominal CT in children might indicate nonspecific findings that can be observed and followed up without additional evaluation, unlike in adults.

A Case of Unusual Suicide due to Overlapping Inhalation of Nitrous Oxide and Carbon Monoxide / 대한법의학회지

Nitrous oxide (N2O) is a chemical used as a medical anesthetic supplement, industrial semiconductor cleaning agent, and food additive in the manufacture of whipping cream. Nitrous oxide causes hypoxemia and suffocation during repeated inhalation. In severe cases, it causes coma and death. Some of those who are not aware of the dangers still illegally obtain and abuse nitrous oxide even with the law enforcing its use, and some people seem to have abused nitrous oxide after purchasing large amounts in small containers before the law has taken effect. Deaths from misuse of nitrous oxide are extremely rare in South Korea compared to those from other addictions such as carbon monoxide poisoning. No autopsy or follow-up blood tests were performed in this case.However, this is a unique and rare case in which carbon monoxide inhalation due to the combustion of lightning coal at the last moment overlaps with continuous inhalation of large amounts of nitrous oxide for several days beyond simple hallucination use, and is included in this report with a simple literature review.

Comparison of the portion sizes of Korean adults across eating places:Korea National Health and Nutrition Examination Survey (2012–2016) / 한국영양학회지

Purpose@#The purpose of this study was to investigate the differences in portion size of 11 types of foods that Korean adults frequently consume, based on the parameters of eating place, gender, and age using the Korea National Health and Nutrition Examination Survey (KNHANES) data. @*Methods@#The dietary survey data from 2012–2016 KNHANES was used. A total of 19,779 subjects (8,034 male [40.6%], 11,745 female [59.4%]) were classified based on gender, three age groups (19–29 years old [15.7%], 30–49 years old [46.9%], 50–64 years old [37.4%]) and three eating places (home, institution, and restaurants/convenient stores etc.). @*Results@#The portion sizes according to the eating places were calculated as per the median intake of Korean adults. Foods that showed the highest median intake in restaurants/ convenience stores were boiled rice and kimchi stew. The median intake quantity of kimchi stew was the highest in restaurants/convenience stores in men across most age groups.Women in 30–49 years age group also consumed a lot of kimchi stew in restaurants/ convenience stores. Men in the age groups 30–49 and 50–64 years consumed soybean paste stew the most in institutions compared to home and restaurants/convenient stores. Stir-fried pork was consumed the most at institutional meal places across all age groups. @*Conclusion@#The portion sizes of kimchi stew and boiled rice were the highest in restaurants/ convenience stores. As kimchi stew and soybean paste stew is high in sodium, the intake should be reduced in institutions and restaurants/convenience stores. Furthermore, it is necessary to reduce sodium intake through consumer nutrition education and the development of low-salt standard recipes for restaurants.

Comparison of the portion sizes of Korean adults across eating places:Korea National Health and Nutrition Examination Survey (2012–2016) / 한국영양학회지

Purpose@#The purpose of this study was to investigate the differences in portion size of 11 types of foods that Korean adults frequently consume, based on the parameters of eating place, gender, and age using the Korea National Health and Nutrition Examination Survey (KNHANES) data. @*Methods@#The dietary survey data from 2012–2016 KNHANES was used. A total of 19,779 subjects (8,034 male [40.6%], 11,745 female [59.4%]) were classified based on gender, three age groups (19–29 years old [15.7%], 30–49 years old [46.9%], 50–64 years old [37.4%]) and three eating places (home, institution, and restaurants/convenient stores etc.). @*Results@#The portion sizes according to the eating places were calculated as per the median intake of Korean adults. Foods that showed the highest median intake in restaurants/ convenience stores were boiled rice and kimchi stew. The median intake quantity of kimchi stew was the highest in restaurants/convenience stores in men across most age groups.Women in 30–49 years age group also consumed a lot of kimchi stew in restaurants/ convenience stores. Men in the age groups 30–49 and 50–64 years consumed soybean paste stew the most in institutions compared to home and restaurants/convenient stores. Stir-fried pork was consumed the most at institutional meal places across all age groups. @*Conclusion@#The portion sizes of kimchi stew and boiled rice were the highest in restaurants/ convenience stores. As kimchi stew and soybean paste stew is high in sodium, the intake should be reduced in institutions and restaurants/convenience stores. Furthermore, it is necessary to reduce sodium intake through consumer nutrition education and the development of low-salt standard recipes for restaurants.

The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method

PURPOSE: The purpose of this study was to investigate whether surgical experience could improve surgical competency in medial open wedge high tibial osteotomy (MOWHTO). MATERIALS AND METHODS: One hundred consecutive cases of MOWHTO were performed with preoperative planning using the Miniaci method. Surgical errors were defined as under- or overcorrection, excessive posterior slope change, or the presence of a lateral hinge fracture. Each of these treatment failures was separately evaluated using the cumulative summation test for learning curve (LC-CUSUM). RESULTS: The LC-CUSUM showed competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture after 27, 47, and 42 procedures, respectively. However, the LC-CUSUM did not signal achievement of competency in prevention of overcorrection after 100 procedures. Furthermore, the failure rate for overcorrection showed an increasing tendency as surgical experience increased. CONCLUSIONS: Surgical experience may improve the surgeon’s competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture. However, it may not help reduce the incidence of overcorrection even after performance of 100 cases of MOWHTO over a period of 6 years.

Comparison of gastric and other bowel perforations in preterm infants: a review of 20 years' experience in a single institution / 소아과

PURPOSE: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. METHODS: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. RESULTS: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4+/-1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. CONCLUSION: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

Comparison of Anaphylaxis and Angioedema with Oral Mucosal Involvement in a Single Pediatric Emergency Department / 이화의대지

OBJECTIVES: We aimed to compare and distinguish the characteristics of anaphylaxis and angioedema, especially with oral mucosal involvement and treatment of patients who visited the Pediatric Emergency Department. METHODS: We retrospectively analyzed patients under age 18-year-old who were diagnosed with anaphylaxis and angioedema with oral mucosal involvement and treated with epinephrine from May 2008 to May 2013 in a single Pediatric Emergency Department in Seoul, Korea. We evaluated their past history, possible triggering causes, symptoms, vital signs and treatment and discharge with education. RESULTS: During the study period the total cases of anaphylaxis were 79 and angioedema with oral mucosal involvement were 218. The age of patients with anaphylaxis was significantly higher (6.6+/-4.9 years vs. 4.1+/-3.3 years). The heart rate relative to age was significantly higher in the anaphylaxis group (49.4% vs. 36.2%). After discharge from the Emergency Center, 3.8% of anaphylaxis patients were prescribed an epinephrine injection. Education to avoid the triggering factor was provided in 32.9% of anaphylaxis group and 17.4% in the angioedema group. CONCLUSION: Besides blood pressure, we should pay attention to the heart rate in pediatric patients with severe allergic reactions. More active follow-up of anaphylaxis and angioedema with oral mucosal involvement is needed to educate parents and prescribe emergency medication.

Clinical characteristics and serum N-terminal pro-brain natriuretic peptide as a diagnostic marker of Kawasaki disease in infants younger than 3 months of age / 소아과

PURPOSE: The incidence of Kawasaki disease (KD) is rare in young infants (less than 3 months of age), who present with only a few symptoms that fulfill the clinical diagnostic criteria. The diagnosis for KD can therefore be delayed, leading to a high risk of cardiac complications. We examined the clinical characteristics and measured the serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels of these patients for assessing its value in the early detection of KD. METHODS: We retrospectively reviewed the data of young infants diagnosed with KD from 2004 to 2012. The control group included 20 hospitalized febrile patients. Laboratory data, including NT-proBNP were obtained for each patient in both groups. RESULTS: Incomplete KD was observed in 21/24 patients (87.5%). The mean fever duration on admission was 1.36+/-1.0 days in the KD group. Common symptoms included erythema at the site of Bacille Calmette-Guerin inoculation (70.8%), skin rash (50.0%), changes of oropharyngeal mucosa (29.1%), and cervical lymphadenopathy (20.8%). The mean number of major diagnostic criteria fulfilled was 2.8+/-1.4. Five KD patients (20.8%) had only one symptom matching these criteria. The incidence of coronary artery complications was 12.5%. The mean serum NT-proBNP level in the acute phase, in the KD and control groups, were 4,159+/-3,714 pg/mL and 957+/-902 pg/mL, respectively, which decreased significantly in the convalescent phase. CONCLUSION: Incomplete KD was observed in 87.5% patients. Serum NT-proBNP might be a valuable biomarker for the early detection of KD in febrile infants aged <3 months.

Clinical experience with 18F-fluorodeoxyglucose positron emission tomography and 123I-metaiodobenzylguanine scintigraphy in pediatric neuroblastoma: complementary roles in follow-up of patients / 소아과

PURPOSE: To evaluate the potential utility of 123I-metaiodobenzylguanine (123I-MIBG) scintigraphy and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for the detection of primary and metastatic lesions in pediatric neuroblastoma (NBL) patients, and to determine whether 18F-FDG PET is as beneficial as 123I-MIBG imaging. METHODS: We selected 8 NBL patients with significant residual mass after operation and who had paired 123I-MIBG and 18F-FDG PET images that were obtained during the follow-up. We retrospectively reviewed the clinical charts and the findings of 45 paired scans. RESULTS: Both scans correlated relatively well with the disease status as determined by standard imaging modalities during follow-up; the overall concordance rates were 32/45 (71.1%) for primary tumor sites and 33/45 (73.3%) for bone-bone marrow (BM) metastatic sites. In detecting primary tumor sites, 123I-MIBG might be superior to 18F-FDG PET. The sensitivity of 123I-MIBG and 18F-FDG PET were 96.7% and 70.9%, respectively, and their specificity were 85.7% and 92.8%, respectively. 18F-FDG PET failed to detect 9 true NBL lesions in 45 follow-up scans (false negative rate, 29%) with positive 123I-MIBG. For bone-BM metastatic sites, the sensitivity of 123I-MIBG and 18F-FDG PET were 72.7% and 81.8%, respectively, and the specificity were 79.1% and 100%, respectively. 123I-MIBG scan showed higher false positivity (20.8%) than 18F-FDG PET (0%). CONCLUSION: 123I-MIBG is superior for delineating primary tumor sites, and 18F-FDG PET could aid in discriminating inconclusive findings on bony metastatic NBL. Both scans can be complementarily used to clearly determine discrepancies or inconclusive findings on primary or bone-BM metastatic NBL during follow-up.

Surgical Treatment of Congenital Hallux Varus

BACKGROUND: The purpose of this study was to report outcomes of congenital hallux varus deformity after surgical treatment. METHODS: We evaluated ten feet of eight patients with a congenital hallux varus deformity, including four feet combined with a longitudinal epiphyseal bracket (LEB). There were seven male patients and one female patient with a mean age of 33 months (range, 7 to 103 months) at the time of surgery. Two patients were bilaterally involved. The mean duration of follow-up was 5.9 years (range, 2.3 to 13.8 years). Clinical outcomes were assessed according to the criteria of Phelps and Grogan. Surgical procedures included the Farmer procedure, the McElvenny procedure or an osteotomy at the first metatarsal or proximal phalanx. RESULTS: The clinical results were excellent in two feet, good in six and poor in two feet. The LEB was associated with hallux varus in four feet and were treated by osteotomy alone or in conjunction with soft tissue procedure. CONCLUSIONS: Congenital hallux varus was successfully corrected by surgery with overall favorable outcome. Preoperatively, a LEB should be considered as a possible cause of the deformity in order to prevent recurrent or residual varus after surgery.

Appendicitis during Pregnancy: The Clinical Experience of a Secondary Hospital

PURPOSE: Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea. METHODS: We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals. RESULTS: The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion. CONCLUSION: Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals.

Phenotypic and genotypic characterization of Bifidobacterium isolates from healthy adult Koreans

A total of twenty-two strict anaerobic and Gram-positive Bifidobacteria, identified as B. adolescentis, B. pseudocatenulatum, or B. longum, were isolated from healthy adult Koreans. We here investigated the cell morphology, antimicrobial resistance patterns to novel antibiotics and genotypic differentiation of Bifidobacteria assessing repetitive DNA element PCR [rep-PCR] fingerprinting using the BOXA1R primer at the species level. All Bifidobacterium spp., except B. adolescentis SPM1005 and B. longum SPM1205, formed round and convex colonies. All B. adolescentis, B. pseudocatenulatum, and B. longum were opaque white glossy in colony color, and short, long, and irregular rods in morphological shape. In addition, all B. adolescentis, B. pseudocatenulatum, and B. longum formed a variety of shapes ranging from rods to Vshaped, Y-shaped, clubbed rods, or irregular. All Bifidobacterium spp., except B. adolescentis SPM0214, were sensitive to daptomycin [DAP], linezolid [LIN], and tigecycline [TIG]. B. adolescentis SPM0214 was resistant to DAP. Genomic fingerprinting patterns of B. adolescentis, B. pseudocatenulatum, and B. longum were diverse and different from those of the KCTC strain. The band size of B. adolescentis, B. pseududocatenulatum, and B. longum varied from 3.0 kb to 300 bp, 2.0 kb to 200 bp, and 2.0 kb to 500 bp, respectively. In conclusion, twenty-two strains of B. adolescentis, B. pseudocatenulatum, and B. longum isolated from healthy adult Koreans were very diverse in both phenotype and genotype. Moreover, this diversity of phenotype and genotype may support that health promoting effects of individual strain of Bifidobacterium spp. human isolates could be different and specific even within same species

Enteropathogenic Bacteria Contamination of Unchlorinated Drinking Water in Korea, 2010

OBJECTIVES: The purpose of this study was to assess the microbiological quality of unchlorinated drinking water in Korea, 2010. One hundred and eighty unchlorinated drinking water samples were collected from various sites in Seoul and Gyeonggi province. METHODS: To investigate bacterial presence, the pour plate method was used with cultures grown on selective media for total bacteria, total coliforms, and Staphylococcus spp., respectively. RESULTS: In the 180 total bacteria investigation, 72 samples from Seoul and 33 samples from Gyeonggi province were of an unacceptable quality (>10(2) CFU/mL). Of all the samples tested, total coliforms were detected in 28 samples (15.6%) and Staphylococcus spp. in 12 samples (6.7%). Most of the coliform isolates exhibited high-level resistance to cefazolin (88.2%), cefonicid (64.7%) and ceftazidime (20.6%). In addition, Staphylococcus spp. isolates exhibited high-level resistance to mupirocin (42%). Species of Pseudomonas, Acinetobacter, Cupriavidus, Hafnia, Rahnella, Serratia, and Yersinia were isolated from the water samples. CONCLUSIONS: The results of this study suggest that consumption of unchlorinated drinking water could represent a notable risk to the health of consumers. As such, there is need for continuous monitoring of these water sources and to establish standards.

Round ligament varicosities mimicking inguinal hernia in pregnancy / 대한외과학회지

Round ligament varicosities during pregnancy are rare, and can easily be mistaken for an inguinal hernia. On physical examination, round ligament varicosities and groin hernia are difficult to distinguish. The diagnosis of round ligament varicosities can be established on gray-scale and color Doppler sonography. We experienced a case of round ligament varicosities in which a 29-year-old woman presented symptoms at 36 weeks gestation. The patient was diagnosed using Doppler sonography, managed with conservative therapy, and had an uncomplicated vaginal delivery at 40 weeks. The symptoms were resolved completely by two weeks postpartum. We report a case of round ligament varicosities that was diagnosed at 36 weeks of gestation with a review of the literature.

Cerebral Infarction in a Young Female Patient With Renovascular Hypertension Caused by Fibromuscular Dysplasia

No abstract available.

Pathologic Gambling in Parkinson Disease

Pathologic gambling (PG) is an impulse control disorder (ICD) or dopamine dysregulation syndrome (DDS) in patients with Parkinson disease (PD). ICD/DDS is presumed to be related to dopaminergic treatment in PD. Although increasing number of patients with ICD/DDS is being reported, ICD/DDS such as PG has not been reported in Korean PD patients. We describe a PD patient who developed PG secondary to dose adjustment of levodopa and pramipexole. His symptoms was controlled by reducing the dopaminergic drugs and adding a small amount of atypical antipsychotics.

Tuberculous Sacroiliitis

Tuberculosis can affect the sacroiliac joint. The involvement has been reported in up to 10 percent of patients with osteoarticular tuberculosis. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. Lack of awareness of this presently uncommon form of infection often leads to diagnostic delay and increased morbidity. Early diagnosis and proper treatment with anti-tuberculous medication could obtain a satisfactory functional outcome. We report a case of tuberculous sacroiliitis in a 21 year-old male patient including his clinical presentation, radiographic features and outcome of medical treatment.

Gender Differences in Adult Foot Shape with 3D Foot Scanner

OBJECTIVE: To analyze gender differences in adult foot shape with 3D foot scanner METHOD: Subjects included 1,107 feet of 872 healthy volunteers (male: 325, female: 547) without foot deformity. Total 23 foot parameters (foot length, inside joint length, outside joint length, ball girth, ball width, grading point length, vamp height, vamp length, waist girth point length, waist point length, waist height, waist girth, instep girth point length, instep point length, instep height, instep girth, short heel girth, long heel girth, throat opening, vamp waist angle, waist instep angle, instep-vamp height ratio, instep- ball girth ratio) were measured with 3D foot scanner. Univariate t-test was used to assess significant differences between men and women for each foot parameter, standardized to stature and foot length. RESULTS: For a given stature, 20 of 23 foot parameters were greater in men than women (p<0.05). For a given foot length, 13 of 23 foot parameters were greater in men than women (p<0.05). CONCLUSION: This study demonstrated that female feet were different from male feet in a number of shape characteristics. These differences should be taken into account in the manufacture of women's shoes.

Clinicopathologic Features in T2 Gastric Cancer

PURPOSE: This study was done to evaluate the clinicopathologic features and survival rates for patients with T2 stage gastric cancer. METHODS: Ninety-six patients with T2 gastric cancer, were treated by radical gastrectomy (and D2 lymph node dissection) at Department of Surgery of Gospel Hospital, Kosin University College of Medicine from April 1996 to October 1998. We retrospectively analyzed age, gender, tumor site, tumor size, type of resection, histopathologic classification(WHO classification and Lauren classification), Borrmann type, TNM stage, blood type, perineural invasion, angioinvasion, lymphatic invasion and the survival rate. The survival rate was analyzed with the Kaplan-Meier method using the SPSS statistical program, and the other statistical analyses were performed using the cross table Chi-square test and the independent sample t-test. RESULTS: Lymph node metastasis was found in 39 patients (40.6%). There were no significant differences except for the Borrmann type, tumor size, angioinvasion and lymphatic invasion for the T2 gastric cancer with regard to patient age, gender, the histopathologic classification (WHO classification and Lauren classification), the type of resection, tumor site, blood type and perineural invasion. The 5 year survival rate for T2 gastric cancer patients was 82.3%. The TNM stage and angioinvasion were significant prognostic factors on the univariate analysis, but the TNM stage was a significant prognostic factor on the multivariate analysis (Relative risk; 10.943, P=0.001). CONCLUSION: The Borrmann type, tumor size, angioinvasion and lymphatic invasion were useful indicators of lymph node metastasis for T2 gastric cancer. The TNM stage was the only significant prognostic factor for T2 gastric cancer.