To determine the impact of intake large amount whole cow's milk (WCM) on iron status during early childhood (18~36 months), selected indices of complete blood count(CBC) and iron status were compared between the WCM large amount intake group (n=20)and small amount intake group (n=20). WCM large amount intake children's mean hemoglobin and mean hematocrit were 9.6+/-1.7 g/dL and 30.8+/-4.5% respectively. These range of peripheral blood with other indices of CBC disclosed the hypochromic microcytic anemia. WCM large amount intake children's some indices of CBC-hemoglobin, hematocrit, MCV, MCH-were significantly lower than those of small amount intake children (P<0.01). WCM large amount intake children had significantly lower mean iron, transferrin saturation and ferritin (P<0.01) and greater mean total iron binding capacity (P<0.05) than did small amount intake children. It is concluded that intake large amount of WCM for long duration impacts on the iron status of 18~36 months old children disadvantageously. It should be avoided for the protection of irreversible recognitive impairment and behavioral change.
Anemia ; Anemia, Iron-Deficiency ; Child ; Ferritins ; Hematocrit ; Humans ; Iron* ; Milk* ; Transferrin

Congenital hypertrophic pyloric stenosis is the most common intra-abdominal disease required surgery during the first few months of life. The expression of pyloric stenosis is dependent upon the genetic influence of ancestors affected with the disease, as well as unknown environmental influences in the postnatal period. Pyloric stenosis has been reported in multiple sibs in a family, which suggests the genetic influence on the expression of this disease. Until now, the genetic influence is thought a sex-modified polygenic or multifactorial background which facilitates the expression of a common dominant gene. We experienced a case of congenital hypertrophic pyloric stenosis in a two siblings. The siblings suffered projectile vomiting for 2~4 days at 16 days old of age and 15 days old of age. After we confirmed the diagnosis by upper gastrointestinal series and abdominal sonogram, the Fredet-Ramstedt pyloromyotomy was done successfully. This case suggests the genetic influence on the expression of this disease.
Diagnosis ; Genes, Dominant ; Humans ; Pyloric Stenosis ; Pyloric Stenosis, Hypertrophic* ; Siblings* ; Vomiting

No abstract available.
Thanatophoric Dysplasia*

Extra-articular tenosynovial giant cell tumor (TS-GCT) in retropharyngeal space is a rare case. We found only two case reports in the literature, in which one was located in retropharynx or prevertebral space of the cervical spine. We describe a rare case of TS-GCT in the retropharynx, which was initially misdiagnosed as oropharyngeal cancer. Furthermore, we want to assure that extraarticular diffuse type TS-GCT should be considered in the differential diagnosis of lesions showing low signal intensity in MRI scan.
Diagnosis, Differential ; Giant Cell Tumors ; Giant Cells ; Magnetic Resonance Imaging ; Oropharyngeal Neoplasms ; Spine

Purpose: The post-operative quality of life (QoL) is a significant concern for patients undergoing gastrectomy. Unlike subtotal gastrectomy, the detailed aspects of QoL involving the ability to perform everyday activities that reflect physical, psychological, and social well-being; and satisfaction with levels of functioning and control of the disease after total gastrectomy remain poorly investigated. Materials and Methods: We enrolled 170 patients who underwent total gastrectomy for gastric carcinoma and completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life questionnaires (QLQ) C30 and STO22 preoperatively and post-operatively at 1, 6, and 12 months. We investigated the QoL change in terms of the minimally important difference (MID), which refers to a score change patients would perceive as clinically important (effect size >0.5). Results: At 1-month post-surgery, MID in global health, physical, social, role, emotional, and cognitive functions was observed at 44.0%, 68.0%, 42.7%, 38.7%, 32.0%, and 16.0% respectively. Of QLQ-C30 symptoms, MID was frequently observed in appetite (52.9%). Of the QLQ-STO22 symptoms, MID was frequently observed in eating restrictions (74.1%), dysphagia (63.5%), pain (51.8%), and anxiety (50.6%). At 12 months post-surgery, MID in global health, physical, role, cognitive, social, and emotional functions was 32.9%, 58.8%, 42.4%, 40.0%, 36.5%, and 17.6%, respectively. Of QLQ-C30 symptoms, MID was frequently observed in diarrhea (52.9%). Of the QLQ-STO22 symptoms, MID was frequently observed in eating restrictions (63.5%), dysphagia (52.9%), body image (55.3%), pain (55.3%), and anxiety (51.8%). Male sex, comorbidity, D2 lymphadenectomy, and post-operative morbidity were associated with MID in global health at 12 months post-surgery. Conclusion This study provides information about the detailed aspects of impairment in various functions and symptoms of QoL after total gastrectomy. This information can be used to develop a tailor-made management plan for QoL.

PURPOSE: The purpose of the study is to investigate the relationship between total serum bilirubin(TSB) and transcutaneous bilirubinometry(TcB) in neonates with jaundice. METHOD: TcB from various sites(forehead, sternum, abdomen, buttock, hand, dorsalis-pedia) was measured using a JM-102 in a total of 102 neonate, 42 female and 60 male, with the mean 37.5 gestational week and the mean 2,903 gram of birth weight, as well as TSB from capillary punctures. RESULT: The mean bilirubin was 11.73 in serum, 20.55 on the forehead, 17.23 on the sternum, 16.19 on the abdomen, 18.22 on the buttock, 15.83 on the hand and 15.49 on the dorsalis-pedia. The relationship between TSB and TcBs were formulated by simple regression with 0.406 < r < 0.668(p < .000). A higher relationship was revealed between TSB and TCB at the forehead in infants of full-term, ABO incompatibility, and Hb greater than 16 mg/dl(r = 0.725, 0.790, and 0.717, retrospectively). Phototherapy altered the measurement of TcB per site. CONCLUSION: TcB on the forehead is a reliable, noninvasive and convenient measurement of TSB in normal infants(Institutions need to establish quantitative equations representing the specific relationship between TSB and TCB according to the hemodynamic problems of infants such as ABO incompatibility, or low Hb).

No abstract available.
Carcinoma, Small Cell* ; Prognosis*

Phytolacca americana poisoning is a benign plant intoxication that causes gastrointestinal symptoms, including abdominal cramps, vomiting, diarrhea, and gastrointestinal bleeding. Other signs and symptoms include diaphoresis, salivation, visual disturbance, and seizures or mental changes. We report two cases of patients who experienced confusion and abdominal pain, vomiting, and hematemesis after oral ingestion of pokeweed. A 60-year-old female with confusion and a 67-year-old female with abdominal pain, vomiting, and diarrhea were admitted to the emergency department after pokeweed poisoning. After supportive treatment of hydration and gastrointestinal medication, the two patients showed full recovery within 24 h and were discharged from the hospital.
Abdominal Pain ; Aged ; Colic ; Diarrhea ; Eating ; Emergencies ; Female ; Hematemesis ; Hemorrhage ; Humans ; Middle Aged ; Phytolacca ; Phytolacca americana ; Plant Poisoning ; Plants ; Salivation ; Seizures ; Vomiting

PURPOSE: Procalcitonin (PCT) is a newly introduced marker of systemic bacterial infection. The MEDS (Mortality in Emergency Department Sepsis) scoring system has proven to be the most useful and appropriate clinical prediction tool in cases of systemic bacterial infection in the emergency department. There have been no studies comparing the PCT assay with the abbreviated MEDS scoring system (without neutrophil bands). This study aimed to determine the efficacy of quantitative PCT assay and the abbreviated MEDS score in predicting the 28-day mortality and intensive care unit (ICU) admission in emergency department patients with systemic inflammatory response syndrome (SIRS). METHODS: This study was carried out prospectively on 212 patients >18-years-of-age with the criteria of SIRS who had visited to the emergency department. They were included if they had an emergency department diagnosis of sepsis, two or more SIRS criteria. We checked the initial PCT concentration and calculated abbreviated MEDS score. The primary outcome was 28-day mortality and ICU admission. We evaluated the predictive abilities of the initial PCT assay and abbreviated MEDS score. Receiver operating characteristic (ROC) curves were used to identify the value of PCT and abbreviated MEDS scoring system that maximized the sum sensitivity and specificity. RESULTS: Among the 212 patients included in this study, the mortality rate was 21%(45 of 212 patients) and the ICU admission rate was 33%(70 of 212 patients). Non-survivor group had a significantly higher PCT concentration (median, interquartile range (IQR), 12.23 ng/mL, 2.33-39.77 vs. 0.58 ng/mL, 0.10-3.60, p=0.05) and a higher abbreviated MEDS score (12.62+/-4.33 vs. 5.53+/-3.57, p<0.05) than the survival group. ICU admission patients had a significantly higher PCT concentration (median, IQR, 7.75 ng/mL, 1.43-36.85 vs. 0.55 ng/mL, 0.08-3.03 p<0.05) and a higher abbreviated MEDS score (10.90+/-4.60 vs. 5.13+/-3.48, p<0.05) than general ward admission patients. ROC analysis showed the discriminative power of the abbreviated MEDS score and PCT assay in predicting ICU admission and 28-day mortality. For ICU admission, areas of under the curves (AUC) of abbreviated MEDS score and PCT were 0.842 and 0.749, respectively (p<0.05). For PCT, AUC of abbreviated MEDS and PCT were 0.888 and 0.784, respectively (p<0.05). The optimal PCT threshold in predicting ICU admission was 1.22 ng/mL (odds ratio (OR), 6.92; 95% confidence interval (CI), 3.51-13.63; p<0.05) and 1.90 ng/mL in predicting 28-day mortality (OR, 11.90; 95% CI, 4.76-29.74). The optimal threshold of abbreviated MEDS score in predicting ICU admission was 8 (OR, 10.95; 95% CI, 5.47-21.90; p<0.05) and 9 in predicting 28 day mortality (OR, 19.03; 95% CI, 8.28-43.78; p<0.05). CONCLUSION: Both abbreviated MEDS scoring system and single plasma PCT assays can be used as a useful marker in rapidly and accurately predicting poor prognosis in emergency department patients with sepsis.
Area Under Curve ; Bacterial Infections ; Calcitonin ; Emergencies ; Humans ; Intensive Care Units ; Neutrophils ; Patients' Rooms ; Plasma ; Prognosis ; Prospective Studies ; Protein Precursors ; ROC Curve ; Sepsis ; Systemic Inflammatory Response Syndrome

PURPOSE: Procalcitonin (PCT) is a newly introduced marker of systemic bacterial infection. The MEDS (Mortality in Emergency Department Sepsis) scoring system has proven to be the most useful and appropriate clinical prediction tool in cases of systemic bacterial infection in the emergency department. There have been no studies comparing the PCT assay with the abbreviated MEDS scoring system (without neutrophil bands). This study aimed to determine the efficacy of quantitative PCT assay and the abbreviated MEDS score in predicting the 28-day mortality and intensive care unit (ICU) admission in emergency department patients with systemic inflammatory response syndrome (SIRS). METHODS: This study was carried out prospectively on 212 patients >18-years-of-age with the criteria of SIRS who had visited to the emergency department. They were included if they had an emergency department diagnosis of sepsis, two or more SIRS criteria. We checked the initial PCT concentration and calculated abbreviated MEDS score. The primary outcome was 28-day mortality and ICU admission. We evaluated the predictive abilities of the initial PCT assay and abbreviated MEDS score. Receiver operating characteristic (ROC) curves were used to identify the value of PCT and abbreviated MEDS scoring system that maximized the sum sensitivity and specificity. RESULTS: Among the 212 patients included in this study, the mortality rate was 21%(45 of 212 patients) and the ICU admission rate was 33%(70 of 212 patients). Non-survivor group had a significantly higher PCT concentration (median, interquartile range (IQR), 12.23 ng/mL, 2.33-39.77 vs. 0.58 ng/mL, 0.10-3.60, p=0.05) and a higher abbreviated MEDS score (12.62+/-4.33 vs. 5.53+/-3.57, p<0.05) than the survival group. ICU admission patients had a significantly higher PCT concentration (median, IQR, 7.75 ng/mL, 1.43-36.85 vs. 0.55 ng/mL, 0.08-3.03 p<0.05) and a higher abbreviated MEDS score (10.90+/-4.60 vs. 5.13+/-3.48, p<0.05) than general ward admission patients. ROC analysis showed the discriminative power of the abbreviated MEDS score and PCT assay in predicting ICU admission and 28-day mortality. For ICU admission, areas of under the curves (AUC) of abbreviated MEDS score and PCT were 0.842 and 0.749, respectively (p<0.05). For PCT, AUC of abbreviated MEDS and PCT were 0.888 and 0.784, respectively (p<0.05). The optimal PCT threshold in predicting ICU admission was 1.22 ng/mL (odds ratio (OR), 6.92; 95% confidence interval (CI), 3.51-13.63; p<0.05) and 1.90 ng/mL in predicting 28-day mortality (OR, 11.90; 95% CI, 4.76-29.74). The optimal threshold of abbreviated MEDS score in predicting ICU admission was 8 (OR, 10.95; 95% CI, 5.47-21.90; p<0.05) and 9 in predicting 28 day mortality (OR, 19.03; 95% CI, 8.28-43.78; p<0.05). CONCLUSION: Both abbreviated MEDS scoring system and single plasma PCT assays can be used as a useful marker in rapidly and accurately predicting poor prognosis in emergency department patients with sepsis.
Area Under Curve ; Bacterial Infections ; Calcitonin ; Emergencies ; Humans ; Intensive Care Units ; Neutrophils ; Patients' Rooms ; Plasma ; Prognosis ; Prospective Studies ; Protein Precursors ; ROC Curve ; Sepsis ; Systemic Inflammatory Response Syndrome