The authors evaluated the clinical significance of the bilirubin values as screening test means for predicting the occurrence of neonatal jaundice earlier after birth, by using the transcutaneous bilirubinometry which is known to measure the bilirubin values in a noninvasive, accurate and simple way. The results obtained were as follows: 1. In comparison between the test group(showing the symptom of a jaundice within 72 hours after birth) and the control group, there were found no statistically significant differences in terms of sex, delivery type, birth weight, gestational age and mother's age, while being found statistically significant differences in terms of transcutaneous bilirubin at birth(TcBbirth), transcutaneous bilirubin at 24 hours after birth(TcB24hr), increase in transcutaneous bilirubin per hour during the first 24 hours after birth(TcBin/hr) and transcutaneous bilirubin at 72 hours after birth(TcB72hr)(p<0,05). 2. The correlation test using the Pearson's coefficient produced statistically significant correlationship between each transcutaneous bilirubin index (TcBbirth, TcB24hr, TcBin/hr and TcB72hr) and serum bilirubin concentration at 72 hours after birth(B72hr)(p<0.05), while the result of the correlation test using the Spearman's roh showed statistically significant correlationship only between TcB24hr or TcB72hr and B72hr(p<0.05). As it was, the correlationship between TcB72hr and B72hr was highest in both Pearsons coefficient and Spearman's roh tests, followed by that between TcB24hr and B72hr. 3. In view of the ROC graph, the most effective means of predicting the occurrence of the neonatal jaundice was TcB72hr followed by TcB24hr, TcBbirth and TcBin/hr in their order. In particular, TcB24hr was conceived to be useful as screening test for determining an early discharge from the nursery within 48 hours. On the other hand, since the negative predictive value of TcBbirth, and TcB24hr is higher, the possibility that those infants showing a lower value of these indices may well be free later from a serious neonatal jaundice even if they should be discharged earlier from the nursery. In conclusion, those four indices predicting the neonatal jaundice in a simple, quick and noninvasive manner using the transcutaneous bilirubinometry were considered to be effective screening test means whereby any serious neonatal jaundice developed earlier after delivery can be successfully predicted.
Bilirubin ; Birth Weight ; Gestational Age ; Hand ; Humans ; Infant ; Infant, Newborn ; Jaundice ; Jaundice, Neonatal* ; Mass Screening* ; Nurseries ; Parturition

Protein-losing enteropathy (PLE) is a syndrome characterized by excessive gastrointestinal protein loss, resulting in hypoproteinemia and edema. A variety of benign and malignant conditions can be associated with PLE and acute leukemia is a very rare cause of PLE. We report a case of PLE associated with acute lymphoblastic leukemia. A 27-year-old man was admitted due to watery diarrhea, epigastric pain and bilateral leg edema. Laboratory findings showed hypoproteinemia and polycythemia. The diagnosis of PLE and acute lymphoblastic leukemia were confirmed on the measurement of fecal alpha1-antitrypsin clearance and bone marrow examination. After systemic chemotherapy and autologous stem cell transplantation, his clinical symptoms and abnormal laboratory findings were gradually improved.
Adult ; Bone Marrow Cells/pathology ; Endoscopy, Gastrointestinal ; Humans ; Magnetic Resonance Imaging ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/*diagnosis/genetics ; Protein-Losing Enteropathies/complications/*diagnosis ; Thoracic Vertebrae/radiography ; Tomography, X-Ray Computed ; Translocation, Genetic ; alpha 1-Antitrypsin/analysis

Renal cell carcinoma is well known for its tendency to metastasize early to the lung, bone, and liver, but skeletal muscle is an extremely unusual site of metastasis. We report here on an unusual case with numerous skeletal muscle metastases in the posterior abdominal wall and buttock 2 years after radical nephrectomy for renal cell carcinoma.
Abdominal Wall ; Buttocks ; Carcinoma, Renal Cell* ; Liver ; Lung ; Muscle, Skeletal* ; Neoplasm Metastasis* ; Nephrectomy*

BACKGROUND: Recently, patients' demands for emergency medicine are increasing, and most of prehospital medical care, including basic life support, cardiopulmonary resuscitation and triage, are provided by paramedics or emergency medical technicians. Evaluation of the adequacy of prehospital management and triage has become important for improving the quality and the effectiveness of the emergency medical system. METHODS: The 202 patients who were transferred by ambulance with paramedics, nurses, or emergency medical technicians to the Emergency Department in Gil Medical Center from July 1, 1999, to September 31, 1999, were enrolled. This study was conducted prospectively by using the emergency physician's log and newly devised protocols recorded by paramedics or nurses. RESULTS: 1) Male to female ratio was 1:0.8, and the peak age of the patients were the 4th(18.8%) and 6th decade(15.3%). 2) Of the 202 patients, 84 patients were transferred for trauma and 118 for medical problems. The mean transfer time was 6+/-1.73 minutes. 3) The validities of prehospital triage and decisions using the trauma severity measure and the disease severity measure, were 33.3% in trauma patients and 57.6% in medical patients. 4) The results for the adequacy rate in prehospital management analyzed by using the rate of necessity of treatment, performance of treatment, and adequate treatment were as follows: oxygen supply, 38.1/41.6/93.8; wound dressing, 19.3/71.8/92.9; immobilization of the cervical spine, 15.8/56.3/92.9; application of a spinal board, 12.9/42.3/72.7; application of a splint, 9.9/50.0/60.0; manual maintenance of an airway, 9.9/55.0/63.6; and CPR, 4.5/66.7/0.5) Kind of ALS(Advanced Life Support) were not conducted(peripheral IV, EKG, intubation medical administration, defibrillation, pacing). The rates of necessity of treatment were as follows: peripheral IV, 40.6%; ECG monitoring, 23.3%; endotracheal intubation, 8.9%; medical administration, 8.9%; defibrillation, 3.5%; and pacing, 1.5%. CONCLUSION: The adequacy of prehospital triage and decisions using trauma and disease severity measures was relatively low. To improve the adequacy of BLS(Basic Life Support) and to increase the performance of ALS(Advanced Life Support), we must create challenges to develop new protocols and to supplement new equipment.
Allied Health Personnel ; Ambulances ; Bandages ; Cardiopulmonary Resuscitation ; Electrocardiography ; Emergencies ; Emergency Medical Technicians ; Emergency Medicine ; Emergency Service, Hospital ; Female ; Humans ; Immobilization ; Intubation ; Intubation, Intratracheal ; Male ; Oxygen ; Prospective Studies ; Spine ; Splints ; Triage* ; Wounds and Injuries

PURPOSE: The identification of specific behaviors conducive to overeating or inactivity is the cornerstone of obesity management. The Committee on Nutrition of the Korean Pediatric Society developed parent and self-reporting questionnaires about eating behavior and physical activity in 2006. The aim of this study was to evaluate the usefulness of the questionnaires in assessing modifiable lifestyle factors related to obesity. METHODS: A retrospective chart review was performed for 177 children (6-11 years old) and 134 adolescents (12-16 years old) from 10 hospitals between May 2006 and January 2007 who had completed parent or self-reporting questionnaires. Cases were divided into normal and overweight groups at or above the age-gender-specific 85th percentile based on 2007 Korean national growth charts. RESULTS: Compared to children, the adolescents tended to have a significantly more sedentary lifestvle and inappropriate dietary behaviors significantly (P<.05). Overweight mothers were significantly associated with overweight children and adolescents (P<.05). Being overweight was significantly associated with a family history of adult diseases for children and adolescents (P<.05). Inappropriate eating behaviors (strong appetite, eating fast, eating until they were full, binge eating, favoring greasy foods) were associated with being overweight in children and adolescents. Sedentary activity such as TV viewing and using a computer were significantly associated with overweight in children and adolescents (P<.05). CONCLUSION: Intervention to modify obesity-related lifestyle factors is needed before adolescence. These questionnaires are useful in identifying modifiable lifestyle factors and in individual counseling for overweight children and adolescents in pediatric clinics.
Adolescent ; Adult ; Appetite ; Bulimia ; Child ; Counseling ; Eating ; Feeding Behavior ; Growth Charts ; Humans ; Hyperphagia ; Life Style ; Mothers ; Motor Activity ; Obesity ; Overweight ; Parents ; Surveys and Questionnaires ; Retrospective Studies

PURPOSE: To compare fMRIs of visual and auditory word generation tasks, and to evaluate the difference of its activated areas and lateralization according to the mode of stimuli. MATERIALS AND METHODS: Eight male normal volunteers were included and all were right handed. Functional maps were obtained during auditory and visual word generation tasks in all. Normalized group analysis were performed in each task and the threshold for significance was set at p<0.05. Activated areas in each task were compared visually and statistically. RESULTS: In both tasks, left dominant activations were demonstrated and were more lateralized in visual task. Both frontal lobes (Broca's area, premotor area, and SMA) and left posterior middle temporal gyrus were activated in both tasks. Extensive bilateral temporal activations were noted in auditory task. Both occipital and parietal activations were demonstrated in visual task. CONCLUSION: Modality independent areas could be interpreted as a core area of language function. Modality specific areas may be associated with processing of stimuli. Visual task induced more lateralized activation and could be a more useful in language study than auditory task.
Brain ; Frontal Lobe ; Hand ; Humans ; Magnetic Resonance Imaging ; Male

PURPOSE: Children visit the emergency department (ED) with more severe abdominal pain, nausea, and vomiting without specific cause than any other outpatients, and many have recurrent abdominal pain (RAP). For that reason, we examined the correlation between Helicobacter pylori (H. pylori) infection and these symptoms. METHODS: From August 2001 to January 2002, serum samples of H. pylori IgG were collected prospectively from 90 children under 17-years old who had visited our ED with the above symptoms. Of these, 40 children satisfying Apley 's criteria were researched. H. pylori infection was defined as a positive result on a CLO test or a C13-Urea Breath test or a modified Giemsa stain. RESULTS: The male-to-female ratio was 1.5 : 1, and the mean age was 8.6 +/- 3.9 years old. The mean value of the IgG level was 16.1 +/- 22.2 U/mL. Seropositive patients accounted for 11 cases (28%). Of the 30 children who had undergone upper endoscopy, 15 children were confirmed as having an H. pylori infection. The sensitivity and the specificity of H. pylori IgG were 47% and 73%. In the school-age group (>or=8 years old), the rates of IgG positivity and infection were 42% (10/24) and 70% (14/20), compared with the preschool age group value of 6% (1/16) and 10% (1/10). The most common upper endoscopy findings was nodular gastritis in 23 patients. CONCLUSION: The rate of H. pylori infection in children visiting the ED with unknown causes of above symptoms was higher than it was in a recent study. In the ED, H. pylori IgG may be required as a screening test in such children.
Abdominal Pain ; Adolescent ; Azure Stains ; Breath Tests ; Child* ; Emergencies* ; Emergency Service, Hospital* ; Endoscopy ; Gastritis ; Helicobacter pylori ; Humans ; Immunoglobulin G* ; Mass Screening ; Nausea ; Outpatients ; Prospective Studies ; Sensitivity and Specificity ; Vomiting

OBJECTIVE: The aim of this study was to investigate the relationship between the diffusion and perfusion parameters in hyperacute infarction, and we wanted to determine the viability threshold for the ischemic penumbra using diffusion- and perfusion-weighted imaging (DWI and PWI, respectively). MATERIALS AND METHODS: Both DWI and PWI were performed within six hours from the onset of symptoms for 12 patients who had suffered from acute stroke. Three regions of interest (ROIs) were identified: ROI 1 was the initial lesion on DWI; ROI 2 was the DWI/PWI mismatch area (the penumbra) that progressed onward to the infarct; and ROI 3 was the mismatch area that recovered to normal on the follow-up scans. The ratios of apparent diffusion coefficient (ADC), the relative cerebral blood volume (rCBV), and the time to peak (TTP) were calculated as the lesions' ROIs divided by the contralateral mirror ROIs, and these values were then correlated with each other. The viability threshold was determined by using the receiver operating characteristic (ROC) curves. RESULTS: For all three ROIs, the ADC ratios had significant linear correlation with the TTP ratios (p < 0.001), but not with the rCBV ratios (p = 0.280). There was no significant difference for the ADC and rCBV ratios within the ROIs. The mean TTP ratio/TTP delay between the penumbras' two ROIs showed a significant statistical difference (p < 0.001). The cutoff value between ROI 2 and ROI 3, as the viability threshold, was a TTP ratio of 1.29 (with a sensitivity and specificity of 86% and 73%, respectively) and a TTP delay of 7.8 sec (with a sensitivity and specificity of 84% and 72%, respectively). CONCLUSION: Determining the viability thresholds for the TTP ratio/delay on the PWI may be helpful for selecting those patients who would benefit from the various therapeutic interventions that can be used during the acute phase of ischemic stroke.
Acute Disease ; Aged ; Cerebrovascular Accident/*diagnosis ; Female ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Sensitivity and Specificity ; Tissue Survival/*physiology

PURPOSE: Deep vein thrombosis (DVT) is a risk factor of pulmonary thromboembolism (PTE), however it is not clear who should be evaluated for a PTE and a DVT at the same time. The purpose of this study is to determine the clinical characteristics of PTE in patients with DVT who visited the emergency department (ED). METHODS: This was a retrospective cohort study of ED patients who visited with DVT and were simultaneously evaluated for a PTE from January 2012 to December 2013. We compared clinical characteristics between non-PTE and PTE patients with confirmed DVT in the ED. RESULTS: Of these 166 patients, 96 patients (57.8%) were confirmed PTE by computed tomography. In multivariate analysis, patients with PTE had more systemic neoplasm (OR 2.03, 95% CI 1.04-3.93, p=0.037) and right heart strain pattern in electrocardiography (OR 5.29, 95% CI 1.71-16.36, p=0.004) than patients without PTE. Femoral DVT was more likely in the non-PTE group (87.1% vs. 65.6%, p=0.002) and popliteal DVT was more likely in the PTE group (62.9% vs. 80.2%, p=0.013). However the number of DVT sites including both femoral and popliteal vein was not statistically different. CONCLUSION: In patients with systemic neoplasm or right heart strain patterns in electrocardiography, simultaneous PTE evaluation may be required in patients with DVT.
Cohort Studies ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Heart ; Humans ; Multidetector Computed Tomography ; Multivariate Analysis ; Popliteal Vein ; Pulmonary Embolism* ; Retrospective Studies ; Risk Factors ; Thromboembolism ; Venous Thrombosis*

Effective microorganism (EM) fermentation extract has been widely used for agricultural and environmental application. It has been recently revealed that EM cocktail treatment may be effective for treatment of diseases including cancer. In the present study, effectiveness of EM cocktail to control asthma was investigated using a mouse model of allergic asthma. Asthmatic mice sensitized and intranasally challenged with OVA were orally given EM fermentate (EM-1(R) during antigen challenge. Administration of EM-1(R) resulted in a significant reduction in airway hyper-reactivity (AHR) and airway recruitment of total leukocytes and eosinophils. Cytokine (IL-4, IL-5 and IFNgamma) levels in bronchoalveolar lavage fluid (BALF) and lung tissues were not altered by EM-1(R) treatment. However, IL-13 level in BALF was considerably lower in EM-1(R) treated mice than in controls. Moreover, Ag-specific IL-4, IL-5 and IL-13 production of draining lymph node cells were markedly downregulated by EM-1(R) treatment when compared to controls, whereas their IFNgamma production was not significantly different. Those data show that EM-1(R) treatment suppresses type 2 helper T (Th2), but not type 1 helper T (Th1), cell response. This finding was also supported by serum antibody data showing that IgE and IgG1 levels in EM-1(R) treated mice were significantly lower than in controls, while IgG2a level was not significantly different between two groups. In conclusion, oral administration of EM-1(R) attenuates asthmatic manifestations including AHR and airway recruitment of eosinophils in a mouse model and which possibly results from selective inhibition of Th2 cell response to allergen. Our data also suggest that EM-1(R) may be effectively applied for control of allergic asthma.
Administration, Oral ; Animals ; Asthma* ; Bronchoalveolar Lavage Fluid ; Eosinophils ; Fermentation* ; Immunoglobulin E ; Immunoglobulin G ; Inflammation ; Interleukin-13 ; Interleukin-4 ; Interleukin-5 ; Leukocytes ; Lung* ; Lymph Nodes ; Mice* ; Ovum ; Pneumonia* ; Th2 Cells