A 14-year-old girl was admitted to the emergency department for excessive bile-containing vomiting and severe abdominal pain. She had been healthy until she intentionally lost 25 kg over a 6-month period. Thick, bloody bile-mixed food particles were drained from the stomach through a nasogastric tube. Abdominal computed tomography revealed huge stomach dilatation with extensive gastric pneumatosis, possible near rupture, acute pancreatitis, and a very narrow third of the duodenum, indicating superior mesenteric syndrome. Gastrofibroscopy revealed multiple hemorrhagic ulcers and numerous beadlike cystic lesions in the stomach. Laboratory examination results were notable for severe deficiencies in critical nutrients, including iron, zinc, proteins, and prealbumin, as well as undernutrition-associated endocrine complications such as hypothyroidism and hypogonadotropic hypogonadism. Excessive vomiting ceased after the endoscopic removal of stagnant gastric contents. Gastric pneumatosis improved after 3 days of supportive care.

OBJECTIVES: This study was conducted in order to develop a computerized test to measure the level of mathematic achievement and related cognitive functions in children and adolescents in South Korea. METHODS: The computerized Comprehensive Learning Test-Mathematic (CLT-M) consists of the whole number computation test, enumeration of dot group test, number line estimation test, numeral comparing test (magnitude/distance), rapid automatized naming test, digit span test, and working memory test. To obtain the necessary data and to investigate the reliability and validity of this test, 399 children and adolescents from kindergarten to middle school were recruited. RESULTS: The internal consistency reliability of the CLT-M was high (Cronbach's alpha=0.76). Four factors explained 66.4% of the cumulative variances. In addition, the data for all of the CLT-M subtests were obtained. CONCLUSION: The computerized CLT-M can be used as a reliable and valid tool to evaluate the level of mathematical achievement and associated cognitive functions in Korean children and adolescents. This test can also be helpful to detect mathematical learning disabilities, including specific learning disorder with impairment in mathematics, in Korea.
Adolescent* ; Child* ; Cognition ; Dyscalculia ; Humans ; Korea ; Learning ; Learning Disorders ; Mathematics* ; Memory, Short-Term ; Reproducibility of Results ; Specific Learning Disorder

BACKGROUND/AIMS: Blood loss and blood transfusion are extremely important determinants of morbidity and mortality following hepatic resection. This is attributed to increased risks of coagulopathy, acute respiratory distress syndrome and multiorgan failure. The hypothesis is that a low pressure in the central veins would be accompanied by a low pressure in the hepatic veins and sinusoids, thereby decreasing blood loss during hepatic resection. This study evaluates the effectiveness of continuing low central venous pressure comparing with high central venous pressure during major hepatic resection. METHODS: 20 consecutive major hepatic resections between March 2000 and August 2000 were studied prospectively concerning central venous pressure which was analysed for 10 cases with a central venous pressure less than 10 mmHg, and greater than or equal to 10 mmHg. The central venous pressure was monitored continuously using a Narkomed Anaesthetic Component Monitoring System (Drager Inc., USA). RESULTS: Low central venous pressure allowed a smaller intraoperative blood loss (<10 mmHg: 1010+/-465.3 ml vs. > or =10 mmHg: 1770+/-916.5 ml, p<0.05), a smaller perioperative transfusion (<10 mmHg: 139+/-276.2 ml vs. > or =10 mmHg: 807+/-799.2 ml, p<0.05), a lower postoperative peak AST (<10 mmHg: 167.4+/-53.2 IU/L vs. > or =10 mmHg: 293.0+/-123.2 IU/L, p<0.05), a lower postoperative peak ALT (<10 mmHg: 96.1+/-55.3 IU/L vs. > or =10 mmHg: 193.2+/-103.5 IU/L, p<0.05), and a earlier resumption of a normal hepatic enzyme (<10 mmHg: 6.4+/-0.9 days vs. > or =10 mmHg: 8.7+/-1.6 days, p<0.05) in comparison to high central venous pressure. There was no postoperative mortality in both group. CONCLUSIONS: Maintaining a low central venous pressure throughout major hepatic resection reduced blood loss, blood transfusion requirements and enzyme recovery periods. Lowering the central venous pressure is a simple and effective way during hepatic resection.
Blood Transfusion ; Central Venous Pressure* ; Hepatic Veins ; Mortality ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; Veins

OBJECTIVES: The aim of this study was to develop the computerized Comprehensive Learning Test-Reading (CLT-R) to evaluate the cognitive processes and achievements related to their basic reading ability and identify dyslexia in children and adolescents in South Korea. We also obtained the normative data and evaluated the reliability and validity of the test. METHODS: We developed the CLT-R, including the word attack/nonword decoding, paragraph reading, sound blending, nonword repetition, rapid automatized naming, letter-sound matching, visual attention, orthography awareness, and digit span tests, for the purpose of diagnosing dyslexia. We investigated the reliability and validity of the tests and gathered the normative data from 399 subjects (male 48.9%), aged 5-14 years, from the last grade in kindergarten to middle school, dwelling in Seoul and Gyeonggi Province, South Korea. RESULTS: No statistical differences were observed between the means of the tests and retests of the CAT. The mean of the correlation coefficient of the test-retest scores was 0.85. According to the construct validity test calculated by principal constant analysis using the oblique rotation method, 4 factors explained 70.0% of the cumulative variances. In addition, the normative data were obtained for all of the CLT-R subtests. CONCLUSION: The computerized CLT-R can be used as a reliable and valid tool to evaluate the reading achievement and reading related cognitive process in Korean children and adolescents in schools, clinics, and research institutes.
Academies and Institutes ; Adolescent* ; Animals ; Cats ; Child* ; Diagnosis* ; Dyslexia* ; Gyeonggi-do ; Humans ; Korea ; Learning* ; Methods ; Reading ; Reproducibility of Results ; Seoul

BACKGROUND: Bleeding can be a problem in wound debridement. In search for an effective hemostatic agent, we experimented with a chitosan film combined with the recombinant human epidermal growth factor (rh-EGF), hypothesizing that it would achieve effective hemostasis and simultaneously enhance arterial healing. METHODS: Forty-eight Sprague-Dawley rats were used, and 96 puncture wounds were made. The wounds were divided into the following four groups: treated with sterile gauze, treated with gelatin sponge, treated with chitosan, and treated with chitosan combined with rh-EGF. Immediate hemostasis was evaluated, and arterial healing was observed histologically. RESULTS: Groups B, C, and D showed a significant rate of immediate hemostasis as compared to group A (P<0.05), but there were no significant differences among groups B, C, and D. Histologically, only group D showed good continuity of the vessel wall after 1 week. It was the only group to show smooth muscle cell nuclei of the vessel wall. CONCLUSIONS: We observed that chitosan has an effective hemostatic potential and the mix of rh-EGF and chitosan does not interfere with chitosan's hemostatic capabilities. We also identified enhanced healing of vessel walls when rh-EGF was added to chitosan. Further research based on these positive findings is needed to evaluate the potential use of this combination on difficult wounds like chronic diabetic ulcerations.
Blood Vessels* ; Chitosan* ; Debridement ; Epidermal Growth Factor* ; Gelatin ; Hemorrhage ; Hemostasis* ; Humans ; Myocytes, Smooth Muscle ; Porifera ; Punctures ; Rats, Sprague-Dawley ; Ulcer ; Wounds and Injuries

Anaplastic carcinomas of the pancreas, also known as pleomorphic, sarcomatoid, or undifferentiated carcinomas, are in most cases variants of duct-derived carcinomas. However, their appearance is so distinctive and their behavior so aggressive that a distinction from the ordinary ductal adenocarcinoma is warranted. They comprise about 7% of all non-endocrine pancreatic malignancies. Most tumors are large and apparently more likely to involve the body or tail of the pancreas rather than the head. Most patients are above the age of 50 at the time of diagnosis, and there is a distinct male predilection. Here we report on a 50-year woman who diagnosed pathologically as a anaplastic carcinoma of the pancreas. The patient underwent Whipple's operation because of a distal common bile duct cancer 6 years ago. Distal pancreatectomy and splenectomy were performed. The patient was discharged with a good general condition.
Adenocarcinoma ; Carcinoma* ; Common Bile Duct* ; Diagnosis ; Female ; Head ; Humans ; Male ; Pancreas* ; Pancreatectomy ; Splenectomy

Background: Postoperative sore throat (POST) is a complication that decreases patient satisfaction and increases postoperative complaints. The present study was conducted to investigate effects of gargling with dexamethasone, intravenous dexamethasone injection and the combination of the two on the incidence and severity of POST. Methods: Study participants were 96 patients who had undergone laparoscopic cholecystectomy, randomly allocated into three groups. Group G gargled with 0.05% dexamethasone solution and were infused intravenous 0.9% normal saline before general anesthesia; group I gargled with 0.9% normal saline and were infused intravenous 0.1 mg/kg dexamethasone; group GI gargled with 0.05% dexamethasone solution and were infused intravenous 0.1 mg/kg dexamethasone. The incidence and severity of POST, hoarseness and cough were evaluated and recorded at 1, 6, and 24 h after the surgery. Results: There were no significant differences in the total incidence of POST up to 24 postoperative hours among Group G, Group I and Group GI (P = 0.367, Group G incidence = 34.38%, [95% confidence interval, 95% CI = 17.92–50.83], Group I incidence = 18.75%, [95% CI = 5.23–32.27], Group GI incidence = 28.13%, [95% CI = 12.55–43.70]). The other outcomes were comparable among the groups. Conclusions In patients who had undergone laparoscopic cholecystectomy, gargling with 0.05% dexamethasone solution demonstrated the same POST prevention effect as intravenous injection of 0.1 mg/kg dexamethasone. The incidence and severity of POST were not significantly different between the combination of gargling with 0.05% dexamethasone solution and intravenous injection of 0.1 mg/kg dexamethasone and use of each of the preventive methods alone.