We report a rare case of intrathoracic lymphangiomatosis associated with chylothorax in a 3-year-old boy. The patient had been healthy until he had chickenpox followed by continued dyspnea. The biopsy specimen showed proliferating lymphatic channels & spindle cells in the lung tissue. The boy died of respiratory failure despite conservative treatment and surgical treatment with pleurodesis. An autopsy was performed. Pleura and pericardium showed severe adhesion to the right lung parenchyma. The cut surface of lung showed thickened interlobular septum with honeycomb-appearance. Histologically, extensive intercommunicating and anastomosing endothelial-lined lymphatic channels were noted along the visceral and parietal pleura, pericardium, around the great vessels, and in the anterior mediastinum over the thymus. These lymphatic channels infiltrated into the pulmonary parenchyme along the bronchovascular bundles. There were scattered areas of spindle cell proliferation with extravasation of RBCs mimicking Kaposi's sarcoma. Histologic diagnosis and differential diagnosis on biopsy materials can be difficult to establish but awareness of the intrathoracic lymphangiomatosis and its various clinical presentation may be helpful for diagnosis.
Autopsy* ; Biopsy ; Cell Proliferation ; Chickenpox ; Child, Preschool ; Chylothorax ; Diagnosis ; Diagnosis, Differential ; Dyspnea ; Humans ; Lung ; Male ; Mediastinum ; Pericardium ; Pleura ; Pleurodesis ; Respiratory Insufficiency ; Sarcoma, Kaposi ; Thymus Gland

To identify the factors related to the readmission and ambulatory visit we analyzed the data in discharge abstract DB(DADB) and outpatient database(OPDB) for 19,983 patients discharged in 1990 from an university hospital(S Hospital) in Seoul. The target patients were limited to those who didn' t have previous episode of discharge in that hospital. Readmission data for 10 years(1990-1999) and ambulatory visit data for 5 years(1995-1999) were analyzed by using x2 test and multiple logistic regression analysis. The main results of this study is as follows. 1) As the number of readmission was increased, readmission rate(RR) was also increased while the average length of stay(ALOS) was decreased. 2) RR was higher in male, transferred from other health care facilities, with consultation, biopsy, ICU care episode during hospitalization. 3) In logistic regression, RR of patients living close to S Hospital hospital was higher than the others wh?n other variables were adjusted. 4) RR of the patients with the diagnosis(Dx) of cancer or cancer related condition was the highest(47.6%), and the consistency rate (CR) of principal Dx group with that of previous admission was also the highest in cancer patients. As the number of readmission was increased the CR of Dx group was also increased. 5) 23.4%(4866) of the target patients had episode of visiting outpatient dispensary(OPD) for between 1995-1999 and the average number of visit was 13.6 times. Patients with the Dx of heart disease showed the highest proportion in ambulatory visit.
Biopsy ; Delivery of Health Care ; Episode of Care ; Heart Diseases ; Hospitalization ; Humans ; Logistic Models ; Male ; Outpatients ; Patient Care* ; Seoul

Cavernous angiomas are being increasingly well recognized throughout the central nervous system due to the widespread use of magnetic resonance imaging(MRI). However, these malformations are uncommon in the spinal column and rarely occur in the spinal cord. Here, we report a case of a cervical cord intramedullary cavernous angioma in a 49-year-old man. The patient had complained of left upper extremity paresthesia and weakness in the left hand for 5 days prior to admission. A neurological examination showed a left C-6 dermatome paresthesia and a weakness in the left hand grasping power. A MRI demonstrated a mixed signal intensity core at the C-5 level and a surrounding edema on the T-2 weighted image. Conservatively, a laminectomy was performed and slightly hard and well demarcated intramedullary mass was removed. A histological examination confirmed the diagnosis of a cavernous angioma.
Central Nervous System ; Diagnosis ; Edema ; Hand ; Hand Strength ; Hemangioma, Cavernous* ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Paresthesia ; Spinal Cord* ; Spine ; Upper Extremity

PURPOSE: To determine the prevalence of malnutrition in hospitalized elderly Korean patients using Mini Nutritional Assessment-Short Form (MNA-SF) in Korea. METHODS: A cross-sectional, multi-center study was performed. We enrolled 300 patients aged > or =65 years from 10 hospitals. We collected subjects' general characteristics, including age, sex, height, weight, and diagnosis. Patients' nutritional status was assessed using MNA-SF within 48 hours since hospital admission. RESULTS: The subjects were 74.2+/-6.3 years old, and 155 patients were male (51.7%). Cancer was the most common diagnosis (26.3%), followed by musculoskeletal (11.3%), neuromuscular (10.3%), pulmonary (9.0%), and cardiovascular disease (8.7%). The length of hospital stay was 8.7+/-5.9 days. According to MNA-SF, 99 patients (33.0%) were at risk of malnutrition, and 51 patients (17.0%) were malnourished. MNA-SF score showed negative correlations with age (r=-0.259, P<0.001) and hospital stay (r=-0.168, P=0.006). Patients in the malnourished or at risk of malnutrition groups were more likely to be admitted to and stayed longer in the intensive care unit (ICU) than those of normal nutritional status (8.7% vs. 17.3%, P=0.026; 1.6+/-1.0 days vs. 3.7+/-3.2 days, P=0.033). The patients who were malnourished or at risk of malnutrition were hospitalized significantly longer than those of normal nutritional status (9.8+/-6.2 vs. 7.7.+/-5.4 days, P=0.004). After adjusting for age and ICU admission, nutritional status by MNA-SF was the only risk factor for prolonged hospitalization (beta=1.384, P=0.005). CONCLUSION: About half of hospitalized elderly patients were at risk of malnutrition or malnutrition status at admission, and nutritional status was the only risk factor for longer hospital stay. Thus, more attention should be paid to the nutritional care of elderly patients to improve clinical outcomes.
Aged* ; Cardiovascular Diseases ; Diagnosis ; Hospitalization ; Humans ; Intensive Care Units ; Korea ; Length of Stay ; Male ; Malnutrition* ; Nutritional Status ; Prevalence* ; Risk Factors

OBJECTIVES: We evaluated the effect of the aircraft noise on the behavior and affect status of the local elementary school students. METHODS: The daytime noise levels of the exposed and control areas were compared and the self answered questionnaires from 272 students and their parents of the exposed area and 91 of the control area were collected. The questionnaires are regarding the noise sensitivity and the psychosocial status of the students, noise sensitivity of the parents and the parents' behavioral evaluation for their children. RESULTS: The mean noise level of the exposed area (67.6 dB(A)) showed higher level than the control area (57.1 dB(A), 58.2 dB(A), 60.2 dB(A)) and it was statistically significant. The mean score for noise sensitivity and the mean score for brief mental exam. in the exposed students were lower than the mean scores in the control group but they were not statistically significant (p=0.056 & 0.165). The mean score for behavioral evaluation of students by their parents in the exposed area(15.5) was higher than the mean score in the control group(13.2) and it was statistically significant(p=0.043). The mean score for noise sensitivity in the exposed parent(27.5) was higher than the mean score in the control group(24.1) and it was statistically significant(p=0.045). CONCLUSIONS: This study revealed that the noise sensitivity of the parents affected the behavioral evaluation of the students than noise-exposure itself. The further study is needed to evaluate relationship between aircraft noise and it's effect on children's health.
Aircraft ; Child ; Humans ; Noise ; Parents ; Surveys and Questionnaires

BACKGROUND: Malnutrition is a frequent nutritional problem among ICU patients, and their nutritional status is known to affect clinical prognosis. We conducted this study to examine nutritional status and actual nutrition delivery in the ICU patients and its relations to clinical outcomes. METHODS: This study was a multicenter retrospective observational study based on the medical records of 163 patients admitted to ICU of tertiary teaching hospitals in Korea. We included the patients who were treated with mechanical ventilation for 3 or more days and received enteral or parenteral nutrition. RESULTS: According to albumin and total lymphocyte count levels, 54.6% of the subjects were moderately or severely malnourished. Mean percentage of calorie and protein delivery to estimated needs for 10 days were 55.8 +/- 29.3% and 46.1 +/- 30.1%, respectively. While parenteral nutrition (PN) started at 1.6 +/- 1.4 days after admission, enteral nutrition (EN) did at 3.6 +/- 2.1 days. Days to PN and EN start, the calorie and protein amount via EN or PN were significantly different among 6 hospitals. No clinical outcomes differed by the levels of calorie or protein delivery. In-hospital mortality was significantly higher in the severely malnourished group at admission as compared to the other 2 groups (54.3% vs. 31.2% vs. 27.7%, p < 0.05) CONCLUSIONS: Malnutrition prevalence is high among Korean intensive care unit patients, but current nutritional therapy practice is inconsistent across institutions and far below the international guidelines. Systematic efforts should be made to develop nutritional support guidelines for Korean ICU patients.
Critical Illness ; Enteral Nutrition ; Hospital Mortality ; Hospitals, Teaching ; Humans ; Critical Care ; Intensive Care Units ; Korea ; Lymphocyte Count ; Malnutrition ; Medical Records ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition ; Prevalence ; Prognosis ; Respiration, Artificial ; Retrospective Studies

Neurofibromatosis type 1 is characterized by cutaneous neurofibromas and pigmented lesions of the skin called cafe au lait spots. Although neurofibromatosis type 1 represents a major risk factor for the development of malignancy, especially of nervous system tumors, malignant lymphoma rarely occurs in a patients with neurofibromatosis type 1. Recently, a 77-year-old woman with neurofibromatosis type 1 was diagnosed as non-Hodgkin's Lymphoma (diffuse large B cell). She had multiple cafe au lait spots, neurofibromas and right axillary lymph node enlargement. An abdominal CT scan demonstrated a left pelvic mass and para-aortic lymphadenopathy. Because non-Hodgkin's Lymphoma in a neurofibromatosis patient has never been reported in Korea, herein, we describe this case and include a review of the literature.
Aged ; Cafe-au-Lait Spots/complications/pathology ; Female ; Human ; Lung Neoplasms/*complications/pathology/radiography ; Lymphoma, Non-Hodgkin/*complications/pathology/radiography ; Neurofibromatosis 1/*complications/pathology/radiography ; Tomography, X-Ray Computed

In the current years, it has now become necessary to establish standards for micronutrient intake based on scientific evidence. This review discusses issues related to the development of the 2020 Dietary Reference Intakes for Koreans (KDRI) for magnesium (Mg), zinc (Zn), and copper (Cu), and future research directions. Following issues were encountered when establishing the KDRI for these minerals. First, characteristics of Korean subjects need to be applied to estimate nutrient requirements. When calculating the estimated average requirement (EAR), the KDRI used the results of balance studies for Mg absorption and factorial analysis for Zn, which is defined as the minimum amount to offset endogenous losses for Zn and Mg. For Cu, a combination of indicators, such as depletion/repletion studies, were applied, wherein all reference values were based on data obtained from other countries. Second, there was a limitation in that it was difficult to determine whether reference values of Mg, Zn, and Cu intakes in the 2020 KDRI were achievable. This might be due to the lack of representative previous studies on intakes of these nutrients, and an insufficient database for Mg, Zn, and Cu contents in foods. This lack of database for mineral content in food poses a problem when evaluating the appropriateness of intake. Third, data was insufficient to assess the adequacy of Mg, Zn, and Cu intakes from supplements when calculating reference values, considering the rise in both demand and intake of mineral supplements. Mg is more likely to be consumed as a multi-nutrient supplement in combination with other minerals than as a single supplement. Moreover, Zn-Cu interactions in the body need to be considered when determining the reference intake values of Zn and Cu. It is recommended to discuss these issues present in the 2020 KDRI development for Mg, Zn, and Cu intakes in a systematic way, and to find relevant solutions.

The borderline tumor is not benign but has low malignant potential, which accounts for 10-15% of all ovarian tumors. The mucinous borderline tumors make up approximately 40% of all borderline tumors. About 5% of mature cystic teratomas of ovary include some with mucinous cystadenoma. The malignant transformation is occurred in about 1-3% of patients who have a mature cystic teratoma. There has been reported frequently about the malignant transformation of a mature cystic teratoma. After the first description of a patient with mucinous borderline tumor associated with a mature cystic teratoma in 1988, the borderline tumorous change of a mature cystic teratoma has been reported rarely. This report presents a patient with atypical proliferating mucinous tumor arising in a mature cystic teratoma.
Cystadenoma, Mucinous ; Female ; Humans ; Mucins ; Ovary ; Teratoma*

Recent studies described the epsilon 4 allele of apoE confers a two-to fourfold increased risk for late-onset Alzheimer's disease (LOAD), but LOAD pathology does not all fit neatly around apo E. Therefore, the goal of this study was to find the association between Alzheimer and apo E4 genotype in the 107 elderly between 50 to 64 years old who visited to FHWC of Sungshin Women's University. We conducted the questionnaire survey (general & 24 hr dietary recall), anthropometerics (BP, waist & BMI) and blood biochemistry (FBS & lipid profiles). LDL-c and HOMA-IR were calculated by Friedwald's and Matthew's formulas. The apo E genotyping was performed by PCR-RFLP method and subjects were divided into three allele groups (epsilon 3; wild, epsilon 2 & epsilon 4; mutants). The apo E allele frequencies were 7.0% for the epsilon 2, 83.6% for the epsilon 3 and 9.3% for the epsilon 4. In comparison with biochemistry characteristics by apo E genotype, FBS was significantly higher in epsilon 4 (129.2 +/- 6.8) than that in the others (epsilon 2: 117 +/- 7.4, epsilon 3: 107.3 +/- 2.2)(p < 0.01). More than forty percents of epsilon 4 group shown the dyslipidemia [high TG (> 150 mg/dl) & low HDL (< 40 mg/dl: male symbol or < 50 mg/dl: female symbol )]. The cytokines levels such as IL-1beta, IL-6 and TNF-alpha were not different among three apoE alleles. After the adjusting sex, age & dietary fiber, LDL-c level was significantly higher in epsilon 4 (108.3 +/- 7.7) than that in epsilon 2 (100.4 +/- 8.4)(p < 0.05). According to food intake and the recipe on the basis of 24 hr dietary recall, the elderly with epsilon 4 allele took higher intake frequency of the light -colored vegetable (radish, onion & cabbage) and pan-fried foods (sauteed beef and vegetables, stir-fried vienna with vegetables) than the others. We knew that the elderly with epsilon 4 allele had been restricted the calories intakes with high dietary fiber (33.6 + 2.5 g/d) to maintain the normal level of FBS and LDL-c. On next study, the prevalence of Alzheimer's disease in this population who has epsilon 4 allele on the condition of calories restriction will be continually follow-up.
Aged ; Alleles ; Alzheimer Disease ; Apolipoprotein E4* ; Apolipoproteins E ; Biochemistry ; Cytokines ; Dietary Fiber ; Dyslipidemias ; Eating ; Female ; Gene Frequency ; Genotype* ; Humans ; Interleukin-6 ; Male ; Middle Aged* ; Onions ; Pathology ; Prevalence ; Surveys and Questionnaires ; Tumor Necrosis Factor-alpha ; Vegetables