The Dieulafoy's lesion is a rare cause of recurrent massive gastrointestinal bleeding in children. The bleeding results from an abnormally large submucosal artery that protrudes through a small mucosal defect. The lesion is commonly found on proximal stomach. Surgical intervention was believed to be the best treatment in the past, but recent advancement in endoscopy has made effective hemostasis possible. We report a case of a 9-year-old boy with underlying mycoplasma pneumonia with effusion who presented with massive upper gastrointestinal bleeding. Bleeding was controlled with endoscopic treatment by epinephrine and ethanol injection and the patient was successfully treated.
Arteries ; Child* ; Endoscopy ; Epinephrine ; Ethanol* ; Hemorrhage ; Hemostasis ; Humans ; Male ; Pneumonia, Mycoplasma ; Stomach

PURPOSE: Kawasaki disease (KD) is a systemic panvasculitis that causes coronary artery lesions. KD is accompanied by immunoregulatory abnormalities. Nitric oxide (NO) can induce relaxation of blood vessels by activating guanylate cyclase in smooth muscle cells and high levels of NO may result in coronary artery lesions. We investigated tumor necrosis factor (TNF)-alpha and NO production before and after intravenous immunoglobulin (IVIG) therapy to study the roles of NO and TNF-alpha in KD with coronary artery lesions. METHODS: Serum levels of NO and TNF-alpha were measured in 24 patients with KD (group I, eight patients with normal coronary artery; group II, 16 patients with coronary artery lesions) and 23 controls (group III, 13 afebrile controls; group IV, 10 febrile controls). Blood samples from each subject were drawn before and after IVIG therapy and in the convalescent stage. Serum concentrations of NO and TNF-alpha were measured by enzyme linked immuno sorbent assay. RESULTS: The NO levels before IVIG therapy were significantly higher in group II than in group I, group III and group IV. After IVIG therapy the levels of NO were significantly higher in group I and group II than in group III. The TNF-alpha levels before IVIG therapy were significantly higher in group I and group II than in group III. The serum TNF-alpha and NO levels were higher before IVIG therapy and decreased through the convalescent stage in KD patients. In the acute stage of KD patients with coronary artery lesions, serum NO levels significantly correlated with white blood cells (r=043, P< 0.05). CONCLUSION: The serum concentration levels of TNF-alpha and NO were abnormally high in KD patients and NO concentrations were statistically higher in the KD patients with coronary artery abnormalities than those without coronary abnormality during the early stage of the KD. These results suggest NO may be involved in the development of coronary artery lesions.
Blood Vessels ; Coronary Vessels ; Guanylate Cyclase ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Leukocytes ; Mucocutaneous Lymph Node Syndrome* ; Myocytes, Smooth Muscle ; Nitric Oxide* ; Relaxation ; Tumor Necrosis Factor-alpha*

PURPOSE: Tissue Doppler Imaging(TDI) is a modern echocardiographic technique used for quantitative assessment of myocardial tissue velocities. The purpose of this study is to estimate the left ventricular function by TDI in Kawasaki disease(KD). METHODS: TDI and conventional echocardiography were performed in 33 patients(3.2+/-2.4 years) in acute phase, 33 patients(4.2+/-4.0 years) in subacute phase of KD and 60 children(5.4+/-3.9 years) in controls. Systolic velocity, systolic integral, E' velocity, E' integral, A' velocity and A' integral at the base, mid-septum and the apex were measured. Ejection fraction(EF) and myocardial performance index(MPI) were estimated by conventional echocardiography. Myocardial function was compared in KD patients of the acute and subacute phase with controls by TDI and conventional echocardiography. RESULTS: E' integral at the base(4.59+/-3.87 cm vs 6.91+/-4.29 cm, P<0.05), mid septum(3.52+/-3.13 cm vs 5.49+/-3.47 cm, P<0.05), apex(2.52+/-2.40 cm vs 3.80+/-2.48 cm, P<0.05), A' integral at the mid septum(1.24+/-1.19 cm vs 2.11+/-1.64 cm, P<0.05) and apex(1.14+/-1.32 cm vs 1.90+/-1.59 cm, P<0.05) were lower in the acute phase patients than in the controls. Systolic integral at base, mid septum and apex were significantly lower in KD patients of the acute phase than in the controls. There was significant negative correlation with right coronary artery diameter and systolic integral, E' integral, A' integral at mid septum, E' integral, A' integral at apex in the acute phase of KD. EF and MPI were not significantly decreased in KD. CONCLUSION: Myocardial velocity was not different, but systolic and diastolic integrals at the left ventricular septum were significantly decreased in the acute phase of KD by TDI. The data will need to be compared with febrile controls.
Coronary Vessels ; Echocardiography ; Echocardiography, Doppler* ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Ventricular Function ; Ventricular Function, Left* ; Ventricular Septum

PURPOSE: Obesity is associated with disturbances of ventilatory functions in adults. But few studies have evaluated the pulmonary complications of obesity in the pediatric population. The purpose of this study is to clarify the effects of obesity on pulmonary function and body composition in obese children. METHODS: Forty seven obese children whose ages ranged from nine to twelve years were evaluated for their body composition (intracellular fluid, extracellular fluid, protein mass, mineral mass, soft lean mass, fat mass, percent body fat, fat distribution) by bioelectrical impedance analysis. Hemoglobin, serum glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol and triglycerides were measured. Pulmonary function test was performed by spirometer. RESULTS: Intracellular fluid, protein mass, fat mass, percent body fat and fat distribution were significantly higher in severely obese children with an obesity index of more than 150 percent compared with those with an index of less than 150 percent. Peak expiratory flow rate (PEFR) was significantly lower in severely obese children with obesity index of more than 150 percent compared with those with less than 150 percent (241.7+/-14.6 L/sec vs 276.8+/-64.3 L/sec). PEFR, forced expiratory flow 25 percent (FEF25), mid expiratory flow rate (MEFR), forced expiratory flow 50 percent (FEF50), forced expiratory volume in 1st second (FEV1) and forced vital capacity (FVC) were decreased in 37.0 percent, 14.8 percent, 14.8 percent, 11.1 percent, 3.7 percent and 3.7 percent of obese children, respectively. CONCLUSION: PEFR was significantly decreased in obese children. Pulmonary function test must be performed in severely obese children and more extended study is needed in other age groups.
Adipose Tissue ; Adult ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Glucose ; Body Composition* ; Child* ; Cholesterol ; Electric Impedance ; Extracellular Fluid ; Forced Expiratory Volume ; Humans ; Intracellular Fluid ; Obesity ; Peak Expiratory Flow Rate ; Respiratory Function Tests* ; Triglycerides ; Vital Capacity

PURPOSE: The construction worker has diverse harmful factors such as noise, dust, and dealing with chemicals. Therefore this research aimed to examine the necessity of appointing a health manager in the construction industry by examining the cost-benefit analysis when the construction industry appoints a health manager. METHODS: In order to calculate the healthcare staff employment cost and the benefits from their activities in 1,425 construction companies with the staff of 300 or more people during 2011, this study analyzed existing data and existing research data, as well as national data. RESULTS: Total annual costs were 99,920,070,900 won and total annual benefits were 324,807,182,625 won. Benefits were found to be 224,887,111,725 won exceeding costs. Benefit/cost ratio resulting from appointing a health manager in the construction industry workplaces was 3.25 times. CONCLUSION: The findings of this research can be used as the base data to make rational decision to positively encourage the employment of healthcare staff in construction companies pursuant to relevant laws.
Construction Industry* ; Cost-Benefit Analysis* ; Delivery of Health Care* ; Dust ; Employment ; Jurisprudence ; Noise

In published article by Li et al., an author's name was misspelled.

BACKGROUND: Quantitative susceptibility mapping (QSM) has been used to measure iron accumulation in the deep nuclei of patients with Parkinson's disease (PD). This study examined the relationship between non-motor symptoms (NMSs) and iron accumulation in the deep nuclei of patients with PD. METHODS: The QSM data were acquired from 3-Tesla magnetic resonance imaging (MRI) in 29 patients with early PD and 19 normal controls. The Korean version of the NMS scale (K-NMSS) was used for evaluation of NMSs in patients. The patients were divided into high NMS and low NMS groups. The region-of-interest analyses were performed in the following deep nuclei: red nucleus, substantia nigra pars compacta, substantia nigra pars reticulata, dentate nucleus, globus pallidus, putamen, and head of the caudate nucleus. RESULTS: Thirteen patients had high NMS scores (total K-NMSS score, mean = 32.1), and 16 had low NMS scores (10.6). The QSM values in the deep were not different among the patients with high NMS scores, low NMS scores, and controls. The QSM values were not correlated linearly with K-NMSS total score after adjusting the age at acquisition of brain MRI. CONCLUSION: The study demonstrated that the NMS burdens are not associated with iron accumulation in the deep nuclei of patients with PD. These results suggest that future neuroimaging studies on the pathology of NMSs in PD should use more specific and detailed clinical tools and recruit PD patients with severe NMSs.
Basal Ganglia ; Brain ; Caudate Nucleus ; Cerebellar Nuclei ; Globus Pallidus ; Head ; Humans ; Iron* ; Magnetic Resonance Imaging ; Neuroimaging ; Parkinson Disease* ; Pars Compacta ; Pars Reticulata ; Pathology ; Putamen ; Red Nucleus

Bisphosphonates are widely used to treat osteoporosis, hypercalcemia of malignant tumor. Despite their clinical benefit, bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a newly documented complication to patients receiving these drugs and first recognized by Marx in 2003. Thus, consideration of prevention and needs regarding unequivocal treatment regimen have emerged. Recently, several authors emphasized reports on appropriate clinical availability of surgical approach. It serves to concern about guideline for surgical and conservative treatment modalities. So, it is the purpose of this paper to review the current literatures about treatment regimens of BRONJ.
Bisphosphonate-Associated Osteonecrosis of the Jaw ; Diphosphonates ; Humans ; Hypercalcemia ; Osteonecrosis ; Osteoporosis

BACKGROUND: The aim of this study was to clarify the incidence and role of microsatellite instability (MSI) in sporadic ovarian epithelial cancers (OEC). We investigated the MSI status and mismatch repair (MMR) protein expression in OEC. METHODS: MSI was examined by fluorescence- based polymerase chain reaction using five NCI panel markers (BAT25, BAT26, D2S123, D5S346 and D17S250) in 46 cases of OEC. Immunohistochemistry (IHC) for hMLH1 and hMSH2 was performed. RESULTS: Seven cases (15.2%) exhibited high-frequency MSI (MSIH), one exhibited low-frequency MSI (MSI-L), and the remaining 38 demonstrated microsatellite stability (MSS). MSI-H in OEC was not associated with histologic grade, FIGO stage, tumor size, mitoses or histologic type. Loss of expression of either hMLH1 or hMSH2 was observed in 4 of the 7 (59.3%) MSI-H cases, whereas 4 of the 39 (10.3%) MSI-L or MSS tumors revealed loss of expression of MMR proteins. The sensitivity and specificity of immunohistochemistry for hMLH1 and hMSH2 were 57.1% and 89.7%. CONCLUSIONS: Our data suggest that a genetic defect in the MMR system might play a role in the carcinogenesis of a minor subset of sporadic OEC however, immunohistochemical testing for hMLH1 and hMSH2 cannot accurately determine microsatellite instability status in OEC.
Carcinogenesis ; DNA Mismatch Repair ; Immunohistochemistry ; Incidence ; Microsatellite Instability* ; Microsatellite Repeats* ; Mitosis ; Ovarian Neoplasms ; Polymerase Chain Reaction ; Sensitivity and Specificity

OBJECTIVE: To report our clinical experience with 763 cases of laparoscopic assisted vaginal hysterectomy (LAVH) and to evaluate the efficacy and advantage of LAVH. METHODS: From Jan. 2000 to Feb. 2006, 763 cases of LAVH were performed at the Department of Obstetrics and Gynecology. we analyzed the results regard to the age, parity, surgical indication, previous abdominal surgery, operation time, weight of uterus, change of hemoglobin, hospital stay, concomitant procedures, and complication. RESULTS: The mean age was 45.7+/-7.1 years. The mean parity was 2.5+/-1.2. The average weight of patients was 58.59+/-9.5 kg. Leiomyoma was the most common surgical indication. Tubal ligation was the most common previous surgery. The mean operation time was 87.5+/-45.7 minutes. The mean hemoglobin change was 1.1+/-0.7 g/dL. The mean uterine weight was 251.34+/-131.5 gm. The mean hospital stay was 6.15+/-0.94 days. The complication rate was 3.4% (26 cases); bladder injury (7 cases), ureter injury (3 cases), vault bleeding (3 cases), trochar site bleeding (13 cases). CONCLUSIONS: LAVH is safe and effective surgical procedure for hysterectomy. The improvement of surgical skill and laparoscopic instrument can make more replace Total abdominal hysterectomy with LAVH.
Female ; Gynecology ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Leiomyoma ; Length of Stay ; Obstetrics ; Parity ; Sterilization, Tubal ; Ureter ; Urinary Bladder ; Uterus