Enteral nutrition (EN) formulas are foods that are used to improve the nutritional status of patients and these foods' safety and quality must be ensured. Therefore, EN formulas in other countries are managed differently from that of general foods. We investigated the direction of development of the relevant laws regulations and guidelines pertaining to EN formulas and we compared these laws regulations and guidelines from different countries, including Korea. The United States and Europe manage EN formulas as foods, but they are managed differently compared to general foods because of separate laws or programs pertaining to EN foods. In addition, the use of the formulas does not necessarily require a prescription, but when used by prescription, then medical insurance covers them. In Japan, there are two types of EN formulas, food and drug, and there are differences for their management and insurance coverage. In the case of Korea, EN formulas are classified as food and drug, and different management and insurance are applied in each case, which inhibits their systematic management and industrial development. Integration of a management system and establishment of a legal foundation is necessary for the systematic management and development of EN formula in Korea.
Enteral Nutrition ; Europe ; Humans ; Industrial Development ; Insurance ; Insurance Coverage ; Japan ; Jurisprudence ; Korea ; Nutritional Status ; Prescriptions ; Social Control, Formal ; United States

No abstract available.
Colorectal Neoplasms, Hereditary Nonpolyposis*

No abstract available.
Esophageal Atresia

No abstract available.
Colorectal Neoplasms, Hereditary Nonpolyposis*

No abstract available.

This study evaluated the nutrition intake and changes in laboratory data of surgery patients with hypermetabolic severity on nutrition support. From January 2002 to September 2002, 66 hospitalized surgery patients who had received enteral nutrition (EN, n=19) and total parenteral nutrition (TPN, n=47) for more than 7 days were prospectively and retrospectively recruited. The laboratory data was examined pre-operatively, and on the post-operative 1, 3, 7 day and at the time of discharge. The characteristics of the patients were examined for the hypermetabolic severity, The hypermetabolic scores were determined by high fever (> 38 degrees C), rapid breathing (> 30 breaths/min), rapid pulse rate (> 100 beats/min), leukocytosis (WBC>12,000/microliter), leukocytopenia (WBC<3,000/microliter), status of infection, inflammatory bowel disease, surgery and trauma. The scores for the hypermetabolic status were divided into three groups (mild 0-10, moderate 11-40, severe>41). According to the results of the study, 38.3% (n=23), 45.4% (n=30) and 19.6% (n=13) were in the mild, moderate, and severe groups, respectively. There was a decrease in the serum albumin level and weight loss according to the hypermetabolic severity. However, the white blood cells (WBC), fasting blood sugar (FBS), c-reactive protein (CRP), total bilirubin, GOT, and GPT increased. The nutritional intake was TPN (32.5 kcal/kg, protein 1.2 g/kg, fat 0.25 g/kg), EN (28.1 kcal/kg, protein 1.0 g/kg, fat 1.01 g/kg). The serum albumin, hemoglobin and cholesterol were higher in the EN group than in the TPN group. But the FBS, total bilirubin, GOT and GPT were higher in the TPN group than the EN group. In conclusion, there was a negative correlation between the changes in the laboratory data and the hypermetabolic severity. There was an increase in the number of metabolic complications in the TPN group.
Bilirubin ; Blood Glucose ; C-Reactive Protein ; Cholesterol ; Enteral Nutrition* ; Fasting ; Fever ; Heart Rate ; Humans ; Inflammatory Bowel Diseases ; Leukocytes ; Leukocytosis ; Leukopenia ; Malnutrition ; Parenteral Nutrition, Total* ; Prospective Studies ; Respiration ; Retrospective Studies ; Serum Albumin ; Weight Loss

No abstract available.
Gardner Syndrome*

The aim of this study is to evaluate the clinical outcome. Between January 1, 2002 to September 30, 2002, we prospectively and retrospectively recruited 111 hospitalized patients who received Enteral Nutrition (ENgroup n = 52) and Total Parenteral Nutrition (TPNgroup n = 59) for more than seven days. The factors of clinical outcomes are costs, incidences of in-fection, lengths of hospital stay, and changes in weight. The characteristics of patients were investigated, which included nutritional status, disease severity (APACHE III score) and hypermetabolic severity (hypermetabolic score). Hypermeta-bolic scores were determined by high fever (>38 degrees C), rapid breathing (>30 breaths/min), rapid pulse rate (>100 beats/min), leukocytosis (WBC > 12000 mm3), leukocytopenia (WBC < 3000 mm3), status of infection, inflammatory bowel disease, surgery and trauma. There was a positive correlation between hypermetabolic score and length of hospital stay (ICU), medical cost, weight loss, antibiotics adjusted by age while APACHE III score did not show correlation to clinical outcome. Medical cost was higher by 18.2% in the TPN group than the EN group. In conclusion, there was a strong negative correlation between the clinical outcome (cost, incidence of infection, hospital stay) and hypermetabolic score. Higher metabolic stress caused more malnutrition and complications. For nutritional management of patients with malnutrition, multiple factors, including nutritional assessment, and evaluation of hypermetabolic severity are needed to provide nutritional support for critically ill patients.
Anti-Bacterial Agents ; APACHE* ; Critical Illness ; Cross Infection ; Enteral Nutrition* ; Fever ; Heart Rate ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Length of Stay ; Leukocytosis ; Leukopenia ; Malnutrition ; Nutrition Assessment ; Nutritional Status* ; Nutritional Support ; Parenteral Nutrition, Total* ; Prospective Studies ; Respiration ; Retrospective Studies ; Stress, Physiological ; Weight Loss

No abstract available.
Canada* ; Gastrointestinal Tract*

PURPOSE: Medullary thyroid carcinoma (MTC) is an uncommon thyroid tumor. Calcitonin (CT) is a very specific marker of this cancer and has a major place in the postoperative follow-up. The aim of this study was to evaluate the outcome of surgical treatment for MTC and to identify the prognostic factors for the normalization of CT after surgery. METHODS: Retrospective analysis of 29 patients with MTC from 1994 to 2002 in Samsung Medical Center was carried out. RESULTS: 22 female and 7 male were identified and their mean age was 46.9 years. Mean follow-up was 42.7 months. 5 patients had MEN2a; all had pheochromocytoma and 2 among them had hyperplasia of parathyroid gland. The majority of patients (86.2%) presented with a palpable neck mass and 23 patients were diagnosed with MTC preoperatively. Total thyroidectomy with or without neck dissection was performed in all patients. Cervical lymph node involvement was detected in 34.5% of these patients. Basal CT levels were found to be normal in 15 patients (51.7%) postoperatively. 1 distant metastasis, 6 loco-regional metastases and 1 death were observed during follow-up period. Overall survival rate was 94.7% and disease-free survival rate was 62.9% at 5 years. Univariate analysis showed that extra-thyroidal invasion and involvement of lymph node were significant prognostic factors for normalization of CT after surgery. CONCLUSION: Considering the high recurrence rate in the thyroid bed and cervical lymph node, more extensive and thorough neck dissection is needed for the treatment of MTC.
Calcitonin ; Carcinoma, Medullary* ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Hyperplasia ; Lymph Nodes ; Male ; Multiple Endocrine Neoplasia Type 2a ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Parathyroid Glands ; Pheochromocytoma ; Recurrence ; Retrospective Studies ; Survival Rate ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy