We have experienced a case of incomplete congenital duodenal diaphragm with a foreign body (a button), which was found by endoscopy in a 13 month-old girl. She had symptoms of hematemesis, vomiting and bloody stool for a day probably due to foreign body impaction.
Diaphragm* ; Endoscopy ; Female ; Foreign Bodies ; Hematemesis* ; Humans ; Infant ; Vomiting

Transient symptomatic zinc deficiency (TSZD) is clinically similar to acrodermatitis enteropathica. The patients are experienced dermatitis on periorifice and extremities, alopecia, diarrhea, growth retardation, anemia, delayed wound healing and infection. They showed a characteristically rapid response to zinc supplement without recurrence. We report 3 cases of TSZD infants, 2 premature infants with inadequate zinc supply and 1 mature infant with chronic diarrhea.
Acrodermatitis ; Alopecia ; Anemia ; Dermatitis ; Diarrhea ; Extremities ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Recurrence ; Wound Healing ; Zinc*

BACKGROUND: Long-term administration of ethambutol (EMB) for Mycobacterium avium complex lung disease (MAC-LD) sometimes leads to permanent discontinuation of EMB due to various adverse events. This study aimed to investigate treatment outcomes after discontinuation of EMB.METHODS: Among patients diagnosed with MAC-LD between January 2001 and December 2014, 508 patients whose treatment was initiated with standard regimen until May 2018 were enrolled at a tertiary referral center in Korea. Of these 508 patients, 60 (11.8%) discontinued EMB due to various adverse effects. Among these 60 patients, treatment outcomes were analyzed for 44 patients by comparing their outcomes with those of matched subjects who received the standard treatment regimen without EMB discontinuation.RESULTS: The mean age of the 60 patients who discontinued EMB was 64.4 years. Ocular toxicity was the most common cause of discontinuation of EMB (75.0%, 45/60). The mean duration of EMB administration before its discontinuation was 7.0 ± 4.6 months. The treatment failure rate of the 44 patients with EMB discontinuation analyzed for treatment outcome was 29.6%, which was higher than that of the matched patients who received the standard regimen (18.3%), although the difference was not significant (P = 0.095). Of these 44 patients, EMB was substituted with later-generation fluoroquinolone in 23 patients, and the treatment failure rate of these 23 patients was significantly higher than that of the matched patients who received the standard regimen (39.1% vs. 19.3%, P = 0.045).CONCLUSION: These findings suggest that treatment outcomes are unsatisfactory in patients with MAC-LD who discontinue EMB owing to adverse events. Notably, there was a statistically significant high failure rate in patients who were prescribed fluoroquinolone to replace EMB.
Ethambutol ; Fluoroquinolones ; Humans ; Korea ; Lung Diseases ; Mycobacterium avium Complex ; Mycobacterium avium ; Mycobacterium ; Tertiary Care Centers ; Treatment Failure ; Treatment Outcome

BACKGROUND: Long-term administration of ethambutol (EMB) for Mycobacterium avium complex lung disease (MAC-LD) sometimes leads to permanent discontinuation of EMB due to various adverse events. This study aimed to investigate treatment outcomes after discontinuation of EMB. METHODS: Among patients diagnosed with MAC-LD between January 2001 and December 2014, 508 patients whose treatment was initiated with standard regimen until May 2018 were enrolled at a tertiary referral center in Korea. Of these 508 patients, 60 (11.8%) discontinued EMB due to various adverse effects. Among these 60 patients, treatment outcomes were analyzed for 44 patients by comparing their outcomes with those of matched subjects who received the standard treatment regimen without EMB discontinuation. RESULTS: The mean age of the 60 patients who discontinued EMB was 64.4 years. Ocular toxicity was the most common cause of discontinuation of EMB (75.0%, 45/60). The mean duration of EMB administration before its discontinuation was 7.0 ± 4.6 months. The treatment failure rate of the 44 patients with EMB discontinuation analyzed for treatment outcome was 29.6%, which was higher than that of the matched patients who received the standard regimen (18.3%), although the difference was not significant (P = 0.095). Of these 44 patients, EMB was substituted with later-generation fluoroquinolone in 23 patients, and the treatment failure rate of these 23 patients was significantly higher than that of the matched patients who received the standard regimen (39.1% vs. 19.3%, P = 0.045). CONCLUSION These findings suggest that treatment outcomes are unsatisfactory in patients with MAC-LD who discontinue EMB owing to adverse events. Notably, there was a statistically significant high failure rate in patients who were prescribed fluoroquinolone to replace EMB.

PURPOSE: We investigated the change of bone mineral density (BMD) one year after renal transplantation, and examined the risk factors that affect the BMD by performing the dual energy X-ray absorptiometry in Korean adults renal transplants. METHODS: The results of pre-transplant and post-transplant BMD of 99 patients were analyzed in respect to sex, age, method and duration of dialysis before transplantation, immunosuppressive methods, history of previous graft and episode of acute rejection. Alfacalcidol or biphosphonate was not used postoperatively. Data were expressed as T-score and calculated percentage. Uni-variate analysis, T-test and ANOVA were used for the statistical analysis. P values less than 0.05 were considered significant. RESULTS: There were 66 male and 33 female patients. Change of T-score (and percentage) of lumbar vertebra and average of femur area in male were -0.353 (-2.3%) and -0.059 (-1.2%), respectively. Those of female patients were -0.483 (-5.2%) and 0.115 (-1.7%), respectively. The significant loss of BMD in the female lumbar spine was evident. Patients in 20's showed the largest loss of BMD [lumbar spine: -0.739 (-2.3%), femur: -0.206 (-3.1%), compared to other age groups. There were no significant differences by the mode and duration of dialysis, presence of diabetes, degree of HLA matching, history of previous graft, immunosuppression methods, and number of acute rejection episode. However we could accept the positive trend of BMD loss related to the kind of immunosuppression methods and number of acute rejection. CONCLUSION: There was significantly different loss of BMD after renal transplantation by the age and sex of the recipients. Although statistically not significant, kinds of immunosuppression and episode of acute rejection are likely to affect the BMD loss one year after renal transplantation.
Absorptiometry, Photon ; Adult ; Bone Density* ; Dialysis ; Female ; Femur ; Humans ; Immunosuppression ; Kidney Transplantation* ; Male ; Risk Factors* ; Spine ; Transplants

Background: Colorectal cancer is one of the most common cancers worldwide. Colorectal cancer that has recurred and metastasized to other organs also has a very poor prognosis. According to recent studies, the long interspersed element-1 (LINE-1) retrotransposon open reading frame (ORF) is located in the intron of the c-Met proto-oncogene, which is involved in cancer progression and metastasis, and regulates its expression. However, no study has compared the expression patterns of LINE-1 ORF1 and c-Met, which are closely related to cancer progression and metastasis, and their correlation in primary and recurrent cancers. Methods: In the present study, we compared the expression patterns of LINE-1 ORF1 and c-Met in both primary and recurrent colorectal cancer tissues from 10 patients. Expression patterns and correlations between LINE-1 ORF1 and c-Met proto-oncogene proteins were analyzed by immunofluorescence staining using both LINE-1 ORF1 and c-Met antibodies. Results: The expression patterns of LINE-1 ORF1 and c-Met showed significant individual differences, and the expression of both proteins was correlated in all colorectal cancer patients. However, the expression levels of LINE-1 ORF1 and c-Met were not significantly different between primary and recurrent colorectal cancers. Conclusions The protein expression levels of LINE-1 ORF1 and c-Met were correlated, but did not change significantly in cases of recurrent colorectal cancer in the same patient.

PURPOSE: Adverse drug events (ADEs) are associated with high health and financial costs and have increased as more elderly patients treated with multiple medications emerge in an aging society. It has thus become challenging for physicians to identify drugs causing adverse events. This study proposes a novel approach that can improve clinical decision making with recommendations on ADE causative drugs based on patient information, drug information, and previous ADE cases. MATERIALS AND METHODS: We introduce a personalized and learning approach for detecting drugs with a specific adverse event, where recommendations tailored to each patient are generated using data mining techniques. Recommendations could be improved by learning the associations of patients and ADEs as more ADE cases are accumulated through iterations. After consulting the system-generated recommendations, a physician can alter prescriptions accordingly and report feedback, enabling the system to evolve with actual causal relationships. RESULTS: A prototype system is developed using ADE cases reported over 1.5 years and recommendations obtained from decision tree analysis are validated by physicians. Two representative cases demonstrate that the personalized recommendations could contribute to more prompt and accurate responses to ADEs. CONCLUSION: The current system where the information of individual drugs exists but is not organized in such a way that facilitates the extraction of relevant information together can be complemented with the proposed approach to enhance the treatment of patients with ADEs. Our illustrative results show the promise of the proposed system and further studies are expected to validate its performance with quantitative measures.
Aged ; Aging ; Clinical Decision-Making ; Complement System Proteins ; Data Mining ; Decision Trees ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Learning* ; Prescriptions

BACKGROUND: Korea is considered an iodine sufficient country, and several studies have been conducted regarding iodine status in healthy Korean adults, pregnant women, and preschool children. However, data on iodine status in Korean school-age children are lacking. Therefore, the iodine nutrition status of Korean school-age children was investigated by measuring urine iodine concentration (UIC). METHODS: This cross-sectional study conducted between April and September 2016 comprised 373 school-age children. UIC was determined using a modified microplate method employing ammonium persulfate digestion followed by Sandell-Kolthoff reaction. RESULTS: The median UIC was 458.2 µg/L. Excessive iodine intake (>300 µg/L) was found in 286 children (76.7%), with extremely high values exceeding 1,000 µg/L in 19.6% of subjects. Insufficient iodine intake (<100 µg/L) was observed in eight children (2.1%). UIC values were not significantly different between sexes. CONCLUSION: Korean school-age children showed excessive iodine intake. Therefore, education regarding adequate iodine intake in school-age children is needed.
Adult ; Ammonium Compounds ; Child* ; Child, Preschool ; Cross-Sectional Studies ; Digestion ; Education ; Female ; Humans ; Iodine* ; Korea* ; Methods ; Nutritional Status ; Pregnant Women

PURPOSE: The decrease in bone mineral density (BMD) is a major complication after kidney transplantation. This was reported to occur preferentially during the first 6 months. However, the treatment and prevention strategies against a decline of BMD are not yet clear. METHODS: The data on the pre-transplant baseline and post-transplant 1 year BMD were archived and retrieved in 125 renal transplant recipients. The post-transplant changes of the BMD were compared by the baseline status of the BMD and the types of anti-osteoporosis treatment either with a vitamin D agent (alfacalcidiol) (n=18) or alendronate (n=21). Anti-osteoporosis treatment began within 30 days after transplantation, with an oral administration of 0.5 mcg/day vitamin D or 70 mg/week alendronate, and maintained until 1 year after transplantation. RESULTS: Regardless the degree of baseline BMD status, each group (the control, vitamin D, or alendronate group) showed a significant and uniform decrease of BMD during the post-transplant 1 year. The mean change in the spine BMD in the control, vitamin D, and alendronate group was -7.1+/-7.5%, -3.3+/-7.4% and -2.6+/-6.5%, respectively. The femur BMD also changed -5.1+/-7.7%, 1.1+/-5.3% and -1.5+/-8.2%, respectively. The degree of BMD decrease in the treatment groups was significantly lower than that in the control (P=0.014 in spine, P=0.003 in femur). When the severely reduced baseline BMD (T-score of spine or femur < or =-1) subgroups were analysed separately, the treatment groups (-3.7+/-6.5% in vitamin D and -1.1+/-6.4% in alendronate group) showed a significantly less decrease in the spine BMD than the control (-8.2+/-6.2%)(P=0.036). The femur BMD also showed a less decrease in the BMD in the treatment group, but this was not statistically significant (P=0.234). There was no significant difference between the vitamin D and alendronate treatment groups. CONCLUSION: After renal transplantation, early administration of vitamin D or alendronate showed some benefit to reduce the post-transplant decrease of BMD in both spine and femur area.
Administration, Oral ; Alendronate* ; Bone Density* ; Femur ; Kidney Transplantation* ; Spine ; Transplantation ; Vitamin D* ; Vitamins*

PURPOSE: Currently, donor supply for transplantation is in serious shortage. In Korea, numbers of patients with end- stage renal failure have been increasing, while patients who could have a graft kidney are limited because of donor organ shortage. To alleviate this problem, donor exchange (Swap) program was launched in Korea. After the success of direct Swap program between two families, we have developed the Swap-around program to expand the donor pool by enrolling close relatives, spouses, friends of potential recipients and motivated voluntary donors. Herein, we report our results of Swap program. METHODS: Medical records of 918 renal recipients who have undertaken a transplantation surgery between January 1995 to December 2002 in our units, were retrospectively reviewed in terms of donor-recipient relationship and way of donor recruit, episode of acute rejection, and 5-year patient and graft survival. RESULTS: Transplantation was performed in 90 patients (9.8%) by way of Swap program. The percentage Swap patients among the number of unrelated donor renal transplant has been increasing: 4.2% in 1995, 10.4% in 1997, 40.0% in 2000, 44% in 2002. Five year patient/graft survival rates were 92.1%/90.6% in 90 Swap recipients, which were comparable to 94.3%/90.0% in other kinds of living unrelated recipients (n=240), and 94.5%/90.7% in HLA 1-haplotype mismatched related recipients (n=454). Among the groups, incidence of acute rejection was comparable. CONCLUSION: We could achieve some success in reducing the organ shortage with Swap program in addition to current unrelated living donor programs without jeopardizing the graft survival. Potentially exchangeable donors should undergo careful and strict medical and social evaluation as a pre-requisite to rule out the commercialism and conserve health of potential donor and recipients. Expanding Swap program to a regional or national pool could be an option to reduce donor organ shortage in the near future.
Friends ; Graft Survival ; Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Korea ; Living Donors ; Medical Records ; Renal Insufficiency ; Retrospective Studies ; Spouses ; Survival Rate ; Tissue Donors* ; Transplants ; Unrelated Donors