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*

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

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.

OBJECTIVES: With the rapid increase in the prevalence of diabetes, the age groups of diabetic patients are becoming diversified. This study will examine the degree of obesity, insulin resistance, and insulin secretion ability among patients first diagnosed with diabetes according to age and gender. METHODS: The subjects of this study included 616 patients who were first diagnosed with diabetes during a routine physical examination. This sample was obtained from a total of 28,075 adults aged 19 years and older who received the examination among 33,829 participants in the Korea National Health & Nutrition Examination Survey (KNHANES) from 2007–2010. The subjects were categorized by age into young age (age: 19 – 39 years), middle age (age: 40 – 59 years), and old age (age: 60 years and older). The degree of obesity was categorized according to body mass index (BMI) into normal weight (BMI: 18.5 ~ 22.9), overweight (BMI: 23 ~ 24.9), and obesity (BMI: 25 or above). Insulin resistance was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR). RESULTS: It was found that 14.1% (n = 87) of a total of 616 subjects (324 men, 292 women) were in the young age group, 43.8% (n = 270) were in the middle age group, and 42.1% (n = 259) were in the old age group. In addition, 83.3% of men that were overweight or obesity were in the young age group, while 79.2% and 60.5% were in the middle age and old age groups, respectively. A total of 82.2% of women that were overweight or obesity were in the young age group, while 79.5% and 77% were in the middle age and old age groups, respectively. For men, the more obesity they were in all age groups, the higher their HOMA-IR. For women, the more obesity they were in the young age and middle age groups, the higher their HOMA-IR; however, women in the old age group showed the highest HOMA-IR when they were of normal weight. CONCLUSION: Among diabetic patients first diagnosed with the disease in Korea, the youth population had the highest obesity rate. Insulin resistance increases as an individual's weight increases among those patients who are first diagnosed with diabetes; the only exception noted is for elderly women.
Adolescent ; Adult ; Aged ; Bodily Secretions ; Body Mass Index ; Female ; Humans ; Insulin Resistance* ; Insulin* ; Korea* ; Male ; Middle Aged ; Obesity* ; Overweight ; Physical Examination ; Prevalence

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

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: Renal allograft mass may potentially affect long term outcome after kidney transplantation. An inadequate renal mass to metabolic demand might trigger hyperfiltration and consequently contribute to the progression of graft nephropathy and failure. METHODS: This is a prospective study with 195 cases of 2 transplant centers. The study population was restricted to live donor transplants except the cases of diabetes, ischemic injury, rejection, and any complication which might result in functional decrease of the kidney graft. Recipient's serum creatinine, 24 hours proteinuria, urine creatinine excretion and creatinine clearance were measured and calculated. Weight of donated kidney, weights and heights of both donors and recipients were recorded and the BSA, LBW, and BMI were calculated. The correlations between each variables were analyzed using Pearson's test, and P<.05 was considered significant. Significantly correlated pairs of variables were included into the linear regression for multivariate test. RESULTS: The amount of urinary excretion of protein is associated with renal mass supply rather than functional demand of recipient. The serum creatinine is associated with the functional balance between the metabolic demand of recipient and renal mass supply from donor. The amount of urinary excretion of creatinine is associated with metabolic demand of recipient rather than renal mass supply. CONCLUSION: Our findings provide direct evidence of a substantial effect of the balance between nephron supply and recipient metabolic demand on early graft function. We suggest that during donor-recipient matching, both the potential sizes of donated kidney and recipient should be considered in terms of early graft function.
Allografts ; Creatinine ; Humans ; Kidney Transplantation* ; Kidney* ; Linear Models ; Living Donors* ; Nephrons* ; Prospective Studies ; Proteinuria ; Tissue Donors ; Transplants* ; Weights and Measures