The purpose of this study was to standardize ingredients used by school foodservices. This study analyzed the current notation of ingredients in used by used in school foodservices through the NEIS system employed by school foodservices of elementary schools through high schools in South Korea. Specifically, this study suggests systemized standardization of ingredient classification and quality attributes of at school foodservices by applying a case study analysis. The findings from the case analysis of the Electronic Procurement System operator are as follows. Classifications for ingredients of the NEIS system used by school food services consisted of included food group, food name, detailed food name, and description. Classification was not clearly divided between the classification scheme and the attribute system. Therefore, food group, food name, and product information of each food should be categorized as the classification scheme, whereas the detailed food name (excluding product information) and description should be standardized as the attribute system, which is composed of required attributes, recommended attributes, and other attributes. This study suggests that system standardization should be carried out in the field of school foodservices, as advancements between distributors and school food service providers could affect food ingredient quality. Thus, standardization can influence purchase and distribution in many ways.
Classification* ; Food Services ; Humans ; Korea

Veno-occlusive disease of the liver was first reported by Chiari in 1899. Pyrrolizidine-containing substances, chemotherapeutics and hepatic radiation injury can cause this disorder. Bone marrow and renal allograft recipients are at risk for the development of veno-occlusive lesions. Veno-occlusive disease produces a syndrome of painful hepatomegaly, jaundice and fluid accumulation. The disease affects central vein and zone 3 of the liver acinus. We discuss a patient with tender hepatomegaly and high fever due to veno-occlusive lesion. We mis-diagnosed this case as acute cholecystitis because of clinical symptoms and radiological findings of GB wall thickening. During the laparotomy, she was found to have a congested liver and dilatation of superficial lymphatics of the liver surface. The Liver biopsy showed centrilobular congestion and hepatocyte necrosis in acinar zone 3. We could not determine the etiological factor in this patient. We considered that she suffered a mild form of veno-occlusive disease and recovered spontaneously within 1 month.
Allografts ; Biopsy ; Bone Marrow ; Cholecystitis, Acute ; Dilatation ; Estrogens, Conjugated (USP) ; Fever ; Hepatic Veno-Occlusive Disease* ; Hepatocytes ; Hepatomegaly ; Humans ; Jaundice ; Laparotomy ; Liver ; Necrosis ; Radiation Injuries ; Veins

BACKGROUND AND OBJECTIVES: Although the standard management of an abdominal aortic aneurysm (AAA) is surgery, endovascular stent-graft treatment is more attractive for patients with significant co-morbid conditions. We evaluated the immediate and mid-term outcomes for the endovascular treatment of AAA. SUBJECTS AND METHODS: Between November 1996 and August 2004, 59 patients with an AAA (53 males, mean age 68.0+/-9.6 years, 3 cases with ruptured AAA) underwent an endovascular stent-graft repair at our institute. All patients were evaluated by an angiography, taken just after the completion of the procedure and at followed up with computed tomography (CT) at 1, 3, 6 and 12 months, and yearly thereafter. RESULTS: Technical success was achieved in 54 of the 59 patients (91.5%). The periprocedural mortality rate was 3.4% (2 of the 59 patients). A primary endoleak was found in 12 patients (20.3%)(type I; 9 patients, type II; 2 patients, type III; 1 patient), 2 of which required subsequent surgical conversion. Spontaneous resolution of an endoleak was seen in 4 patients (33.3%). The average follow-up period of 57 patients was 27.5 months (range from 72 days to 2581 days). In 8 patients (14.0%), a newly developed secondary endoleak was documented. A total 14 patients (23.7%) died during the follow-up period (rupture; 3, operation-related sepsis; 3, unrelated causes; 3, cardiac arrest; 1, unknown causes; 4). The cumulative survival rates at 30 days and at 1 and 2 years were found to be 93.0, and 85.7 and 76.3%, respectively, using Kaplan-Meier methods. Secondary intervention was required in 12 patients (21.8%), and surgical conversion in 4 (6.8%), with 2 (3.4%) requiring conversion to open surgery immediately after the intervention. In those with technical success, without endoleaks and graft failure, the survival rate during follow-up was higher (97.1%; rate with the exception of unrelated cause of death) than that of all the patients. CONCLUSION: The immediate and mid-term results suggest that the endovascular treatment of an AAA is technically feasible and effective. There was higher mortality and morbidity in primary and newly developed endoleak cases; therefore, proper selection of cases, according to the anatomical and clinical criteria, is essential, with meticulous regular follow-ups being critical for the optimal endovascular treatment of an AAA.
Angiography ; Aortic Aneurysm, Abdominal* ; Conversion to Open Surgery ; Endoleak ; Follow-Up Studies ; Heart Arrest ; Humans ; Male ; Mortality ; Sepsis ; Survival Rate ; Transplants ; Treatment Outcome

Hyperplasia of Brunner's glands is considered an uncommon finding; its wide range of morphological variation has led to confusing identifying terminology which includes: hyperplasia, adenoma, and hamartoma. Some investigators have suggested that hyperplasia of Brunner's glands is hamartomatous in nature, whereas others have favored a causative relationship that results from gastric acid hypersecretion. Although most commonly an incidental finding, that appears as multiple small submucosal sessile nodules, usually located in the duodenal bulb, it can lead to clinically significant symptoms including gastrointestinal bleeding, abdominal pain, and intestinal obstruction. Here, we report a case of hyperplasia of multiple cystic Brunner's glands on the duodenal bulb in a patient with acute pancreatitis; they were discovered incidentally on abdominal CT and duodenoscopy. This is the first report of hyperplasia of Brunner's glands with these morphological characteristics.
Abdominal Pain ; Adenoma ; Brunner Glands ; Duodenoscopy ; Gastric Acid ; Hamartoma ; Hemorrhage ; Humans ; Hyperplasia* ; Incidental Findings ; Intestinal Obstruction ; Pancreatitis ; Research Personnel ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Endoscopic exploration of the common bile duct (CBD) is difficult and dangerous in patients with Billroth II gastrectomy (B-II). Endoscopic papillary balloon dilation (EPBD) via a cap-fitted forward-viewing endoscope has been reported to be an effective and safe procedure. We analyzed the technical success and complications of EPBD in patients who underwent B-II. METHODS: Thirty-six consecutive patients with B-II were enrolled from among 2,378 patients who had undergone endoscopic retrograde cholangiopancreatography in a single institute in the last 4 years. The EPBD procedure was carried out using a cap-fitted forward-viewing endoscope with 8-mm balloon catheters for 60 seconds. We analyzed the rates of CBD exploration, technical success, and complications. RESULTS: Afferent loop intubation was performed in all patients and selective cannulation of the bile duct was performed in 32 patients (88.9%). Complications such as transient hypoxia were observed in two patients (5.6%) and perforation, in three patients (9.7%). The perforation sites were ductal injury in two patients and one patient showed retroperitoneal air alone without symptoms. Three patients manifested different clinical courses of severe acute pancreatitis and peritonitis, transient abdominal pain, and retroperitoneal air alone. The condition of one patient improved with surgery and that of the other two patients, with conservative management. CONCLUSIONS: Patients with perforation during EPBD in B-II showed different clinical courses. Tailored treatment strategies are necessary for improving the clinical outcomes.
Abdominal Pain ; Anoxia ; Bile Ducts ; Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Endoscopes* ; Gastrectomy* ; Gastroenterostomy* ; Humans ; Intubation ; Pancreatitis ; Peritonitis

Epidemiological studies have demonstrated an increased risk for cardiovascular events in relation to both short- and long-term exposure to ambient particulate matter (PM). Several plausible mechanistic pathways have been described, including an enhanced propensity for arrhythmias, systemic inflammatory responses, and the chronic promotion of atherosclerosis. On the basis of this review, several new findings were reached, including the following: exposure to PM including PM <2.5 microm in diameter can trigger cardiovascular disease-related mortality; longer-term exposure (e.g., a few years) increases the risk for cardiovascular mortality; reductions in PM levels are associated with decreases in cardiovascular mortality within a period as short as a few years; and many credible pathological mechanisms have been elucidated that lend biological plausibility to these findings. It is the opinion of the writing group that the overall evidence is consistent with a causal relationship between PM exposure and cardiovascular morbidity and mortality. Finally, PM exposure is deemed a modifiable factor that contributes to cardiovascular morbidity and mortality. The purpose of this statement is to develop evidence-based practical guidelines for healthcare professionals and regulatory agencies with a comprehensive review of the literature on air pollution and cardiovascular disease and a specific focus on the clinical implications.
Air Pollution ; Arrhythmias, Cardiac ; Atherosclerosis ; Cardiovascular Diseases* ; Delivery of Health Care ; Dust* ; Epidemiologic Studies ; Mortality ; Particulate Matter ; Writing

Stenosis of extracranial vertebral artery (VA) is not an infrequent lesion, and it can pose a significant clinical problem. However, the standard treatment for a significant VA stenosis has still not been established. Here in this study, we report our experiences of VA stenting in 25 patients (age 56.2 +/-15.2 years, male 76%). The patients had comorbidities as follows: DM (36%), hypertension (64%), Takayasu's (12%) and Behcet's diseases (4%). There were combined involvement of other vessels such as the coronary artery (72%), carotid artery (36%), subclavian artery (32%) and the contralateral vertebral artery (24%). Indications for stenting were prior stroke or symptoms related to vertebrobasilar ischemia in 11 patients, and an asymptomatic but angiographically significant stenosis (> 70% stenosis) in 14 patients. Twenty-three balloon-expandable stents and two self-expandable stents were deployed. A drug-eluting coronary stent and distal balloon protection device were each used in one case. A technically successful procedure was achieved in all patients. The baseline reference diameter was 4.7 +/-1.3 mm, minimal luminal diameter (MLD) 1.0 +/-0.6 mm (diameter stenosis 77.8 +/-12.5%) and lesion length 6.4 +/-3.9 mm. After stenting and adjuvant dilation, the MLD was increased to 4.5 +/-0.9 mm (diameter stenosis 3.1 +/-17.9%). There were no procedure-related complications. During the further follow-up period of 25 (3-49) months, no stroke or death occurred. Restenosis was observed in 4 (30.8%) of 13 eligible patients. In conclusion, VA stenting is feasible with a high degree of technical success, and this treatment is associated with a relatively low incidence of procedure-related complications. However, a relative high rate of in-stent restenosis remains as a problem to be resolved.
Adult ; Aged ; Angiography ; *Angioplasty, Balloon ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; *Stents ; Treatment Outcome ; Vertebrobasilar Insufficiency/diagnosis/*therapy

BACKGROUND/AIMS: Urocortin 1, a corticotropin-releasing factor related peptide, increases colonic motility under stressful conditions. We investigated the effect of urocortin 1 on colonic motility using an experimental model with isolated rat colon in which the blood flow and intestinal nerves were preserved. Furthermore, we assessed whether this effect was mediated by adrenergic or cholinergic nerves. METHODS: Colonic motility was measured in the proximal and distal parts of resected rat colon. The colon resected from the peritoneum was stabilized, and then urocortin 1 (13.8, 138, 277, and 1,388 pM) was administered via a blood vessel. Motility index was measured in the last 5 min of the 15 min administration of urocortin 1 and expressed as percentage change from baseline. Subsequently, the change in motility was measured by perfusing urocortin 1 in colons pretreated with phentolamine, propranolol, hexamethonium, atropine, or tetrodotoxin. RESULTS: At concentrations of 13.8, 138, 277, and 1,388 pM, urocortin 1 increased the motility of proximal colon (20.4+/-7.2%, 48.4+/-20.9%, 67.0+/-25.8%, and 64.2+/-20.9%, respectively) and the motility of distal colon (3.3+/-3.3%, 7.8+/-7.8%, 71.1+/-28.6%, and 87.4+/-32.5%, respectively). The motility induced by urocortin 1 was significantly decreased by atropine to 2.4+/-2.4% in proximal colon and 3.4+/-3.4% in distal colon (p<0.05). However, tetrodotoxin, propranolol, phentolamine, and hexamethonium did not inhibit motility. CONCLUSIONS: Urocortin 1 increased colonic motility and it is considered that this effect was directly mediated by local muscarinic cholinergic receptors.
Animals ; Colon/*drug effects/physiology ; Injections, Intravenous ; Male ; Muscle Contraction/drug effects ; Neurotransmitter Agents/pharmacology ; Rats ; Rats, Sprague-Dawley ; Receptors, Cholinergic/chemistry/metabolism ; Urocortins/isolation & purification/*pharmacology

BACKGROUND AND OBJECTIVES: Carotid artery stenting (CAS) is emerging as a reasonable alternative to carotid endarterectomy, and especially for those patients with comorbidities. However, this endovascular approach has acute complications related to distal embolization. Therefore, the use of protection devices is expected to reduce the risk of embolic strokes during this procedure and to deliver more favorable outcomes. We report here on our early experiences with balloon occlusion and filter type distal protection devices that were used for CAS. SUBJECTS AND METHODS: CAS was performed on 92 lesions of 73 patients (age:61.0 +/-1 2.7 years, males:71.2%). Of these patients, 16 patients with 17 carotid lesions underwent CAS using distal protection devices. A balloon occlusion type protection device, PercuSurge GuardWire system, was used for 8 lesions and a filter type, FilterWire EX system, was used for 9 lesions. Procedural and early clinical outcomes including complications were compared between the two groups of patients who underwent CAS with the distal protection (group I) and without the distal protection (group II). RESULTS: Carotid angioplasty and stenting was performed successfully in all the patients. Successful deployment of the protection devices was possible in all 17 carotid lesions. Among the 75 carotid lesions treated without protection device, there were two fatal strokes, one non-fatal major stroke, one minor stroke and five transient ischemic attacks (TIA), whereas one TIA and one non-neurologic death occurred among the 17 lesions treated with the protection device (p=ns). CONCLUSION: CAS with use of the distal protection device can be performed successfully and safely. Despite the limited experience with the protection devices, our results suggest the use of distal protection device for carotid intervention may reduce acute complications related to distal embolization during the procedure.
Angioplasty ; Balloon Occlusion ; Carotid Arteries* ; Carotid Stenosis ; Comorbidity ; Endarterectomy, Carotid ; Humans ; Ischemic Attack, Transient ; Protective Devices ; Stents* ; Stroke

Benign schwannomas arise in neural crest-derived Schwann cells. They can occur almost anywhere in the body, but their most common locations are the central nervous system, extremities, neck, mediastinum, and retroperitoneum. Schwannomas occurring in the biliary tract are extremely rare and mostly present with obstructive jaundice. We recently experienced a case of extrahepatic biliary schwannomas in a 64-yr-old female patient who presented with intra- and extrahepatic bile duct and gallbladder stones during a screening program. To the best of our knowledge, extrahepatic biliary schwannomas associated with bile duct stones have not been reported previously in the literature.
Adult ; Bile Ducts/pathology ; Bile Ducts, Extrahepatic/*metabolism/*pathology ; Central Nervous System/pathology ; Cholangiography/methods ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Neurilemmoma/*diagnosis/*pathology ; Tomography, X-Ray Computed