Intussusception in adult is a rare disease and laparotomy is usually considered because of the probability of malignancy. Especially with obstruction symptom or sign, it might be needed emergency operation. This case was a simultaneous development of small bowel intussusception and acute hepatitis A. The patient had abdominal pain and vomiting. Intitial laboratory examination with elevated aminotransferase revealed that the diagnosis was acute hepatitis. As managing acute hepatitis, the abdominal pain was not improved and the patient had tenderness on periumbilical area on physical examination. A jejunal intussusception with a lead point was proved on the abdominal computed tomography scan. Fortunately, symptom of intussusception was relieved while nulli per os (NPO) and intravenous hydration. After recovery of acute hepatitis, laparotomy was done. The lead point was 2.5x3.0 cm sized hamartoma. This was the case that the symptom of intussusception was confused with that of acute hepatitis.
Abdominal Pain ; Adult ; Emergencies ; Hamartoma ; Hepatitis ; Hepatitis A ; Humans ; Intussusception ; Laparotomy ; Physical Examination ; Rare Diseases ; Vomiting

A 60-year-old man undergoing maintenance hemodialysis presented with periodic fever, which resembled Pel-Ebstein fever of Hodgkin's lymphoma. Despite scores of diagnostic evaluations, origin of the fever remained obscure. On positron emission tomography/computed tomography scan, focal hot uptakes were seen in the mediastinum and mediastinoscopic biopsy showed many acid-fast bacilli with chronic granulomatous inflammation and necrosis. After a week of anti-tuberculosis medication, the patient remained afebrile without recourse to antipyretics.
Antipyretics ; Biopsy ; Electrons ; Fever ; Fever of Unknown Origin ; Hodgkin Disease ; Humans ; Inflammation ; Mediastinum ; Middle Aged ; Necrosis ; Renal Dialysis ; Tuberculosis, Lymph Node

A 60-year-old man undergoing maintenance hemodialysis presented with periodic fever, which resembled Pel-Ebstein fever of Hodgkin's lymphoma. Despite scores of diagnostic evaluations, origin of the fever remained obscure. On positron emission tomography/computed tomography scan, focal hot uptakes were seen in the mediastinum and mediastinoscopic biopsy showed many acid-fast bacilli with chronic granulomatous inflammation and necrosis. After a week of anti-tuberculosis medication, the patient remained afebrile without recourse to antipyretics.
Antipyretics ; Biopsy ; Electrons ; Fever ; Fever of Unknown Origin ; Hodgkin Disease ; Humans ; Inflammation ; Mediastinum ; Middle Aged ; Necrosis ; Renal Dialysis ; Tuberculosis, Lymph Node

BACKGROUND: There has been a lack of study on the structural changes of serum albumin in patients with minimal change disease (MCD). To determine whether glycation and/or conformational transitions of albumin are involved in the pathogenesis of albuminuria, nine patients with MCD were enrolled in a prospective follow-up study for comparison of these parameters in serum albumin during the remission and relapse of nephrotic syndrome. METHODS: Circular dichroism measurements were made with purified albumin. Ellipticities at each wavelength were transformed to mean residue ellipticity. Monosaccharide composition was analyzed by high-pH anion-exchange chromatography with pulsed amperometric detection. RESULTS: There was no difference in the proportions of alpha-helix, beta-conformation, and beta-turn of albumin between the sera of control patients and those with nephrotic syndrome. However, the proportion of the random configuration was slightly higher in the plasma albumin of patients in relapse than in those in remission. The proportion of the random configuration was lower in the albumin of the serum than in the urine of patients with nephrotic syndrome, but there was no difference in the proportions of alpha-helix, beta-conformation, and beta-turn of albumin between their plasma and urine. CONCLUSION: Our results suggest that conformational changes in albumin are involved in albuminuria in patients with MCD.
Adult ; Albuminuria/urine ; Case-Control Studies ; Female ; Follow-Up Studies ; Glycosylation ; Humans ; Male ; Middle Aged ; Nephrosis, Lipoid/*blood/urine ; Nephrotic Syndrome/blood/urine ; Prospective Studies ; Research Support, Non-U.S. Gov't ; Serum Albumin/*chemistry

PURPOSE: This study was performed to report the diagnosis and treatment of nephrotic syndrome manifesting in the first year of life. METHODS: We retrospectively reviewed the clinical data with chart review in 7 patients who were diagnosed as nephrotic syndrome manifesting in the first year of life from 1996 to 2007. RESULTS: Three patients had congenital nephrotic syndrome, the other 4 patients had infantile nephrotic syndrome. Their ages ranged from birth to 11 months and male to female ratio was 1 to 6. Renal biopsies were done in 6 patients. One patient had Finnish type congenital nephrotic syndrome, 2 patients had diffuse mesangial sclerosis, 2 patients had focal segmental glomerulosclerosis and 1 patient had minimal change disease. Genetic analyses of NPHS2, PLCE1, and WT1 were done in 4 patients and 2 of them had WT1 mutation. Among 3 patients with congenital nephrotic syndrome, 1 patient was diagnosed as congenital nephrotic syndrome of Finnish type and the other 2 patients were diagnosed as Denys-Drash syndrome. All of the patients with congenital nephrotic syndrome died due to sepsis. Among 4 patients with infantile nephrotic syndrome, 2 patients died and 1 had remission, another patient progressed to end stage renal disease. CONCLUSION: Most of nephrotic syndrome manifesting in the first year was hereditary renal disease. Patients with nephrotic syndrome manifesting in the 3 month of life had poorer prognosis and needed more aggressive management including early dialysis and renal transplantation might be considered compared with infantile nephrotic syndrome. Further genotype-phenotype correlation studies are needed.
Biopsy ; Denys-Drash Syndrome ; Dialysis ; Female ; Genetic Association Studies ; Glomerulosclerosis, Focal Segmental ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Parturition ; Prognosis ; Retrospective Studies ; Sclerosis ; Sepsis

Here we report two cases of isolated diffuse mesangial sclerosis (IDMS) with early onset end-stage renal failure. These female patients did not show abnormalities of the gonads or external genitalia. Direct sequencing of WT1 PCR products from genomic DNA identified WT1 mutations in exons 8 (366 Arg>His) and 9 (396 Asp>Tyr). These mutations have been reported previously in association with Denys-Drash syndrome (DDS) with early onset renal failure. Therefore we suggest that, at least in part, IDMS is a variant of DDS and that investigations for the WT1 mutations should be performed in IDMS patients. In cases with identified WT1 mutations, the same attention to tumor development should be required as in DDS patients, and karyotyping and serial abdominal ultrasonograms to evaluate the gonads and kidney are warranted.
Base Sequence ; DNA/chemistry/genetics ; DNA Mutational Analysis ; Fatal Outcome ; Female ; Glomerular Mesangium/*pathology ; Humans ; Infant ; Infant, Newborn ; *Mutation ; Nephrosclerosis/*genetics ; WT1 Proteins/*genetics

OBJECTIVE: A purpose of this study was developing the Decision-Support Patient affairs management and building of Data-mart for individually specified department. Because it had a OLTP system where we were researching the hospital. It can not be analyzied variously because the data for the management, accounts, patient affairs and medical record were changing monthly/annually in conditions. also it can not have the specificity of the hospital management information. METHODS: The Data Set that used for analysis process was examined with the patient's Database for a year. They were in hospital where locates in Sun Cheon. For developing patient affairs management program, The Microsoft Visual Basic 6.0 was used. and A analysis method of ROLAP which is based on Oracle relation Database was used for general analysis of required works. RESULTS: The patient affairs Data-mart and Decision-Support System was built with the main results of the study. Those took advantage of the analysis for the each department's revenue and doctor's actual results, it also can compare the patient's hospital using frequency. With the analyzied results, each department can have their own special marketing. They can offer to the resistants a lecture, consultant and free service for the health. CONCLUSION: The management, the accounts, patient affairs and the medical record can have been analyzied various changing through the study. The host System had enormous volume, so it takes lots of times what they want to inquire. The host system usually took at night because of low transaction occurrence. The new system which was built with Data-mart had been improved the problem a lot.
Consultants ; Dataset ; Humans ; Marketing ; Medical Records ; Sensitivity and Specificity ; Solar System

BACKGROUND: Despite the use of antibiotics and cardiac surgery, infective endocarditis, remains a life-threatening disease. Unfortunately, diagnosis and treatment may be delayed. This is due, in part, to the vague and, at times, baffling clinical picture of this disease and to the frequency with which antibiotics were administered prior to obtaining a microbiological diagnosis. We conducted this study to improve the suspicion index from difficult diagnostic process of this serious disease. METHODS: We retrospectively reviewed the medical records of 39 patients admitted to the Gangneung Asan Hospital in Gangwon-do with infective endocarditis from December 1996 to July 2004. We evaluated initial chief complaints and presumed diagnosis on first visit to medical care facilities, duration of referral from primary care to our hospital, the time period to confirm the diagnosis, treatment modality, and survival rate. RESULTS: Among the total, 23 out of 39 patients fulfilled the criteria for definite infective endocarditis, whereas the others (16 patients) were for possible group in Duke criteria. In 79.5%, infective endocarditis was the first clinical presentation without medical history of any cardiac disease. Most frequent initial presenting symptoms and signs were fever and chills (56.4%), abnormal neurologic deficit (12.8%), and myalgia (7.6%). The most common initial diagnosis at first medical facilities was common cold. The mean duration of referral from primary care to our hospital was 9.5 days. The mean duration of symptoms before the definite diagnosis was 20.3 days. The most frequent etiologic microorganisms were streptococcus and staphylococcus. Blood culture negative infective endocarditis was found in 35.9% of cases. Almost all patients were treated with 3rd generation cephalosporins. Among the total, 71.6% patients were treated with medical treatment only, and 28.2% patients required surgical intervention. The mortality rate was 20.5% with the major cause of death being sepsis. CONCLUSION: Since the symptoms and signs of infective endocarditis are nonspecific, it is difficult to suspect and reach to correct diagnosis of infective endocarditis in primary care, requiring prolonged duration of 3 weeks to reach diagnosis. The consequences can result in higher rate of systemic complications and mortality.
Anti-Bacterial Agents ; Cause of Death ; Cephalosporins ; Chills ; Common Cold ; Endocarditis ; Fever ; Heart Diseases ; Humans ; Medical Records ; Neurologic Manifestations ; Primary Health Care ; Referral and Consultation ; Retrospective Studies ; Staphylococcus ; Streptococcus ; Thoracic Surgery

BACKGROUND: Present limitations to monopolar RF include the small lesion size, difficulties in targeting, and questions about the reliability.In contrast with monopolar RF, bipolar RF create larger, more predictable, and more extensive ablative lesion. This study documents the optimal spacing of two needles, temperature, and time required to produce bipolar RF lesions. METHODS: Two 20-gauge 5 mm active tip needles and 10 mm active tip needles were secured in a parallel position 6, 8, and 10 mm apart and submerged in egg white that would allow visualization of the size and shape of the lesion.RF lesions were produced at 70, 80, and 90degrees C.At each temperature, photographs were taken at 30, 60, 90, and 120 seconds. RESULTS: When the 5 mm active tips with 6 mm distance were above 60 s and with 8, 10 mm distance above 120 s, continuous strip lesions were produced.10 mm active tips with 120 s were produced too.The others had discrete unipolar lesions around each cannula.The lesion size increased with a higher temperature and time.But time was the more important factor in determining lesion size. CONCLUSIONS: A continuous strip lesion was produced even though the electrode spaced 10 mm apart.And spacing the electrode 6 mm apart with 5 mm active tip and 8 mm apart with 10 mm active tip at 90degrees C for 90 s maximize the surface area of the lesions.
Egg White ; Electrocoagulation ; Electrodes ; Needles

The purpose of the study was to examine the current status of nutritional management at elderly nursing homes. A survey was performed of 83 nursing homes from January 5, 2011 to January 21, 2011 via mail. A total of 34 nursing homes responded to the survey and 149 elderly subjects were analyzed according to the presence of a dietitian. Among the 34 nursing homes, 70.6% had a dietitian on duty. All of the facilities with a dietitian had the dietitian making the meal plan, whereas 70% of the facilities without dietitian served meals planned by a non-professional person. Overall, however, a low proportion of nursing homes implemented dietetic treatments for residents with diseases. For the nutritional assessment of these residents, a mini nutritional assessment (MNA) was performed. MNA scores were significantly associated with body mass index (BMI), mid-arm circumference (MAC), calf circumference (CC), ingestion problems, and weight loss during the last 3 months (P<0.001). Among the elderly studied, 5.4% were malnourished, and 36.9% were at risk for malnutrition by MNA score. The results of this survey show that the current management of nutrition at nursing homes is insufficient because the elderly who needed dietetic treatment did not receive proper care. Dietetic management is the most important service in all nursing homes. Therefore, to improve the nutritional status of elderly residents in nursing homes, systematic nutrition management by nutrition experts should be implemented.
Aged* ; Body Mass Index ; Eating ; Humans ; Insurance, Long-Term Care ; Malnutrition ; Meals ; Nursing Homes* ; Nursing* ; Nutrition Assessment ; Nutritional Status ; Postal Service ; Weight Loss