No abstract available.
Amitriptyline* ; Humans

An international outbreak of severe acute respiratory syndrome (SARS), a recently recognized syndrome caused by the newly identified severe acute respiratory syndrome-associated coronavirus (SARS-CoV), began in November 2002 and ended in July 2003. Coronavirus is a family of enveloped, single stranded-RNA viruses causing disease in humans and animals, but the other known coronaviruses that affect humans cause only the common cold. The number of SARS cases in 2003 was approximately 8000 across the world. Many recent studies have reinforced initial impressions that SARS-CoV is primarily transported via contact and/or droplets and that the combination of standard, contact, and droplet precautions is generally effective for its control. Active surveillance for clusters of cases of severe respiratory disease must be a first priority, especially among health care workers. Such surveillance should include the rapid diagnosis and prevention of other respiratory viruses that cause outbreaks of febrile respiratory disease-notably, influenza. Surveillance on the part of clinicians is the key to the early detection of any reemergence before it regains a foothold in the community. During the outbreak of SARS, ribavirin, steroids, interferon, convalescent plasma, and lopinavir/itonavir were used in varying doses and combinations in different regions of the world. At present no definitive conclusions regarding the efficacy of any of these treatments can be drawn. New findings regarding SARS are continuing to be discovered at an unprecedented pace, permitting a better understanding of the disease and enabling better preparation for its possible returns.
Animals ; Common Cold ; Coronavirus ; Delivery of Health Care ; Diagnosis ; Disease Outbreaks ; Humans ; Influenza, Human ; Interferons ; Plasma ; Ribavirin ; SARS Virus ; Severe Acute Respiratory Syndrome* ; Steroids

PURPOSE: Vesicoureteral reflux (VUR) is the major cause of urinary tract infection (UTI) in children. Prolonged untreated UTI associated with VUR may result in serious complications, such as renal scarring, renal atropy, and decreased renal function. Therefore, follow up must be continued until UTI is cured completely, to prevent of serious complication. The authors conducted this study to evaluate results of the follow-up of UTI associated with VUR. METHODS: During the period from March 1991 to July 1996, we had 47 children with urinary tract infection associated with vesicoureteral reflux who were admitted to the Department of Pediatrics and Urology, Presbyterian Medical Center. The patients were managed medically or surgically. RESULTS: 1) There were no differences in sex distribution in the 47 cases with VUR. The intensity of 67 refluxing ureters, classified by the International Reflux Study Committee, grade I, 10 cases; grade II, 11 cases; grade III, 20 cases; grade IV, 17 cases; grade V, 9 cases. 2) The most common causative agent in UTI was E. coli. Fourty-six cases underwent ultrasonography and 24 showed abnormal findings. Fourty-four cases underwent a 99mTc-DMSA renal scan, and 25 showed abnormal findings. The incidence of renal scarring showed a direct correlation with the severity of VUR. 3) The incidence of urinary tract infection during follow-up did not differ between the groups medical management versus surgical management. 4) Fourty-four refluxing ureters were treated primary medically and 38 of them were followed up. Twenty-five of the 38 ureters were disappeared or improved, and 9 persisted. The rest showed aggravation of reflux. Twenty-five of the 32 refluxing ureters showed disappearance or improvement of reflux before 5 years of age, The spontaneous cure rate of vesicoureral reflux seemed to be higher in the cases with a milder grade of reflux. 5) Although refluxing ureter disappeared completely on VCUG, we found that follow-up is continued until the disappearance of reflux is confirmed on two serial VCUG. 6) Thirty-three refluxing ureters were treated surgically and one of them was stationary on follow-up VCUG, while the others were cleared. CONCLUSIONS: As a result of follow-up the 47 patients with VUR, the incidence of urinary tract infection did not differ between the groups medical versus surgical management. Rates of disappearance of VUR in medical and surgical management were 66%, 97%, respectively. The spontaneous cure rate of VUR seemed to be higher in the cases with a milder grade of reflux and before 5 years of age. We found that follow-up is continued until the disappearance of reflux is confirmed on two serial VCUG.
Child ; Cicatrix ; Follow-Up Studies* ; Humans ; Incidence ; Pediatrics ; Protestantism ; Sex Distribution ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Ureter ; Urinary Tract Infections* ; Urinary Tract* ; Urology ; Vesico-Ureteral Reflux*

PURPOSE: Vesicoureteral reflux (VUR) is the major cause of urinary tract infection (UTI) in children. Prolonged untreated UTI associated with VUR may result in serious complications, such as renal scarring, renal atropy, and decreased renal function. Therefore, follow up must be continued until UTI is cured completely, to prevent of serious complication. The authors conducted this study to evaluate results of the follow-up of UTI associated with VUR. METHODS: During the period from March 1991 to July 1996, we had 47 children with urinary tract infection associated with vesicoureteral reflux who were admitted to the Department of Pediatrics and Urology, Presbyterian Medical Center. The patients were managed medically or surgically. RESULTS: 1) There were no differences in sex distribution in the 47 cases with VUR. The intensity of 67 refluxing ureters, classified by the International Reflux Study Committee, grade I, 10 cases; grade II, 11 cases; grade III, 20 cases; grade IV, 17 cases; grade V, 9 cases. 2) The most common causative agent in UTI was E. coli. Fourty-six cases underwent ultrasonography and 24 showed abnormal findings. Fourty-four cases underwent a 99mTc-DMSA renal scan, and 25 showed abnormal findings. The incidence of renal scarring showed a direct correlation with the severity of VUR. 3) The incidence of urinary tract infection during follow-up did not differ between the groups medical management versus surgical management. 4) Fourty-four refluxing ureters were treated primary medically and 38 of them were followed up. Twenty-five of the 38 ureters were disappeared or improved, and 9 persisted. The rest showed aggravation of reflux. Twenty-five of the 32 refluxing ureters showed disappearance or improvement of reflux before 5 years of age, The spontaneous cure rate of vesicoureral reflux seemed to be higher in the cases with a milder grade of reflux. 5) Although refluxing ureter disappeared completely on VCUG, we found that follow-up is continued until the disappearance of reflux is confirmed on two serial VCUG. 6) Thirty-three refluxing ureters were treated surgically and one of them was stationary on follow-up VCUG, while the others were cleared. CONCLUSIONS: As a result of follow-up the 47 patients with VUR, the incidence of urinary tract infection did not differ between the groups medical versus surgical management. Rates of disappearance of VUR in medical and surgical management were 66%, 97%, respectively. The spontaneous cure rate of VUR seemed to be higher in the cases with a milder grade of reflux and before 5 years of age. We found that follow-up is continued until the disappearance of reflux is confirmed on two serial VCUG.
Child ; Cicatrix ; Follow-Up Studies* ; Humans ; Incidence ; Pediatrics ; Protestantism ; Sex Distribution ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Ureter ; Urinary Tract Infections* ; Urinary Tract* ; Urology ; Vesico-Ureteral Reflux*

No abstract available.
Female* ; Humans ; Kidney* ; Ureter* ; Ureterocele*

PURPOSE: To determine which perinatal risk factors influence neurodevelopmental outcome, we try to investigate which perinatal risk factors are correlated with Baley mental or psychomotor developmental index using BSID-II test (Baley Scales of Infant Development, II) in long term follow up of very low birth weight who received neonatal intensive care. METHODS: This study was performed on 56 very low birth weight infants with corrected age 24 months who were admitted to the neonatal intensive care unit. We analyzed correlation between perinatal risk factors and neurodevelopmental outcome assessed by mental and psychomotor developmental index. RESULTS: Mean birth weight was 1317.8+/-168.5g : Small for gestational age was 11 cases and appropriate for gestational age was 45 cases : Mean mental developmental index was 93.8+/-10.3 and psychomotor developmental index was 99.9+/-13.2. Mean developmental scale did not show any significant difference between perinatal risk factors, such as sex, ventilator care and its duration, hospitalization days, birth weight, small for gestational age. Mental or psychomotor developmental score was significantly delayed in the subgroup with grade III intraventricular hemorrhages and periventricular cyst. On cranial ultrasonogram, sinificantly low mental, psychomotor developmental score was found on the subgroup with grade III intraventricular hemorrhages and periventricular cyst formation larger than 3mm size (P<0.01). CONCLUSIONS: These findings suggest that grade III intraventricular hemorrhage and periventricular cyst larger than 3mm size are associated with poor prognostic risk factors regarding to low neurodevelopmental index score.
Birth Weight ; Child ; Child Development ; Follow-Up Studies ; Gestational Age ; Hemorrhage ; Hospitalization ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Risk Factors* ; Ultrasonography ; Ventilators, Mechanical ; Weights and Measures

Gastric diverticula have been considered to be rave when compored with diverticula in other sites of the gastrointestinal tract. It's prevalence is 0.043% of routine gastrointestinal radiologic examination by Palmer's extensive review. Gastric diverticula almost always occur as a single lesion and approximately 75% of gastric diverticula occur in the juxtacardiac region, high on the posterior wall of the stomach, about 2 cm below the esophagogastric junction and 3 cm from the lesser curvature. We report a case of 75-year-old male patient with multiple gastric diverlicula which was first encountered by endoscopy and confirmed by upper gastrointestinal radiologic examination.
Aged ; Diverticulum ; Diverticulum, Stomach* ; Endoscopy ; Esophagogastric Junction ; Gastrointestinal Tract ; Humans ; Male ; Prevalence ; Stomach

PURPOSE: Recently, laparoscopic surgery has been performed with increasing frequency in cases of various diseases, including colorectal cancer. However, in some cases, laparoscopic surgery should be converted to open procedures because of several factors. In this study, we tried to find the causes of and the risk factors for conversion to open procedures during colorectal cancer surgery. METHODS: From June 2002 to May 2008, laparoscopic surgery in 324 patients who were diagnosed as having colorectal cancer was performed by two surgeons. Patients were divided into two groups, non-conversion and conversion groups. We investigated the differences in age, sex, presence of preoperative colonic obstruction, tumor invasion (pT stage), and so on between the two groups. RESULTS: Of the 324 patients, 20 patients experienced an open conversion: 5 of 28 patients who had a colonic obstruction and 15 of 296 patients who had no obstruction (P=0.021). The causes of conversion during the surgery were tumor invasion, peritoneal adhesion, hemorrhage, and cancer perforation. There were 8 conversions out of 92 patients from June 2002 to May 2005 and 12 out of 232 from June 2005 to May 2008 (P=0.231). In regards to the degree of tumor invasion, 9 of 32 who were stage pT4 experienced a conversion to an open procedure (P<0.001). In multivariate analysis, the presence of a colonic obstruction and pT4 stage were meaningful risk factors for conversion to an open procedure. CONCLUSION: From this study, we can predict a higher rate of conversion to an open procedure in patients with locally advanced colon cancer, especially when a colonic obstruction is present. Therefore, a careful laparoscopic approach is needed in such patients.
Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Conversion to Open Surgery ; Hemorrhage ; Humans ; Laparoscopy ; Multivariate Analysis ; Risk Factors

PURPOSE: Capecitabine (Xeloda(R)), which is a systemic prodrug of 5-fluorouracil, can be used in oral formulation for treatment of advanced colorectal cancer as a 1st line or an alternative modality to I.V. 5-fluorouracil-based chemotherapy. One of the most common side effects of this drug is hand-foot syndrome (HFS), palmar-plantar erythrodysesthesia syndrome. We planned this study to clarify the incidence and the clinical course of severe hand-foot syndrome (WHO classification, grade 3 or 4) following capecitabine monotherapy for adjuvant treatment of colorectal cancer. METHODS: From August 2006 to August 2008, 45 colorectal cancer patients were treated with capecitabine, 1,250 mg/m2, orally administered twice daily for 2 wk, followed by 1 wk of rest, given as 3-wk cycles. Seven of them discontinued the drug within 3rd cycle due to poor performance status, gastrointestinal troubles, or other causes. We retrospectively analyzed the remaining 38 patients' medical records and defined the incidence and the clinical course of HFS. RESULTS: Of the 38 patients, 17 (44.7%) suffered severe HFS after capecitabine monotherapy. Of those 17, 5 (29.4%) had severe symptoms after the 1st chemotherapy cycle, and 14 patients (82.4%) had severe symptoms within the 4th cycle. Three of the 14 female and 14 of the 24 male patients complained of severe HFS, showing a statistical male predominance (P=0.043). Eventually, we had to decrease capecitabine to 75% of the daily dose in 12 patients and to 50% in one patient, and to discontinue its use in 4 patients. CONCLUSION: Capecitabine monotherapy very frequently provokes severe HFS, especially in the early cycles of chemotherapy and in males.
Capecitabine ; Colorectal Neoplasms ; Deoxycytidine ; Female ; Fluorouracil ; Hand-Foot Syndrome ; Humans ; Incidence ; Male ; Medical Records ; Retrospective Studies

PURPOSE: Crohn's disease is an inflammatory bowel disease with various symptoms and progressions. For effective identification of various causes and follow up of patients, we used the Vienna Classification from 1998, but we started applying the Montreal Classification in 2005. In this study, our aim was to identify the clinical characteristics of Korean patients with Crohn's disease by using the Montreal Classification. METHODS: A retrospective study was carried out among 111 patients who were evaluated at KyungHee Medical Center from March 1986 through February 2008 as having Crohn's disease. RESULTS: The male-to-female ratio was 1.8:1, and the average age was 27.2+/-9.6 yr. Abdominal pain was the major symptom, and extraintestinal manifestations were seen in 16 cases. Of the Crohn's disease patients, 25.2% were initially misdiagnosed as having tuberculosis. Concerning age at diagnosis, A2 (patients 17 to 40 yr of age) was the largest group. The most common disease location was the ileocolon (L3), and a combined upper gastrointestinal lesion (L4) was most commonly seen in L3. The most common disease behaviors were nonstricturing and nonpenetrating (B1), and although perianal lesions were most common in B1, there were no statistical correlations (P=0.061). Surgical treatments were performed in 46 cases, especially in cases involving complex disease (stricturing&penetrating) (P<0.005) and ileal disease (L1) (P=0.024). CONCLUSION: According to the Montreal Classification of Korean Crohn's disease patients, a more stable manifestation was seen in the group with lower age at diagnosis. Perianal lesions did not have any correlation with the form in which the disease manifested itself. Complex disease and ileal disease required a surgical procedure the most.
Abdominal Pain ; Crohn Disease ; Follow-Up Studies ; Humans ; Ileal Diseases ; Inflammatory Bowel Diseases ; Korea ; Retrospective Studies ; Tuberculosis