We report a case of a large peritoneal loose body diagnosed on computed tomography. The most common causes of a peritoneal loose body are thought to be torsion and separation of the appendices epiploicae. Peritoneal loose bodies are usually small, 0.5 to 2.5 cm in diameter. However, "giant" peritoneal loose bodies, larger than 4 cm in diameter, are an uncommon disease and present with various symptoms, and are difficult to diagnose preoperatively. Especially, abdominal large peritoneal loose bodies are frequently misdiagnosed as tumorous disease preoperatively. In our case, the loose body appeared as a round pelvic mass with central calcifications and a distinct fat plane separating it from adjacent organs. Preoperatively, we suspected a tumorous lesion from the wall of the upper rectum; however, at laparoscopy, a large peritoneal loose body was detected. An extraction of the giant peritoneal loose body was performed laparoscopically.
Laparoscopy

PURPOSE: This study was undertaken to eveluate the early results of the laparoscopic suture rectopexy in the treatment of rectal prolapse. METHODS: From May 1999 to July 2001, laparoscopic suture rectopexy (LSR) was successfully performed in 26 patients and the results were compared to those of 5 patients with open suture rectopexy (OSR) and 6 patients with open resection rectopexy (ORR). Preoperative and postoperative functional assessment included Wexner's incontinence score, constipation score, and anorectal manometry. RESULTS: Immediate postoperative morbidity was minimal in all groups. Bowel function was resumed significantly sooner (P=0.001), the numbers of the analgesics injection were significantly fewer (P<0.001) and postoperative hospital stay was significantly shorter (P<0.001) in the LSR than in the open groups. Postoperatively, the anal resting and squeezing pressures increased slightly and Wexner's incontinence score decreased significantly in all groups of patients. Constipation score decreased slightly in all groups of patients after surgery. There was one mucosal prolapse recurrence after surgery in the LSR. CONCLUSIONS: Laparoscopic suture rectopexy for rectal prolapse can be performed safely. Recovery is uneventful and of shorter duration after the laparoscopic than after the open approach. Functional results are obtained similarly with both approaches.
Analgesics ; Constipation ; Humans ; Length of Stay ; Manometry ; Prolapse ; Rectal Prolapse* ; Recurrence ; Sutures*

PURPOSE: We investigated incidence of feeding intolerance and time when normal enteral feeding can be established in full term neonates with hypoxic-ischemic encephalopathy (HIE). METHODS: We reviewed medical records of 61 full term infants with HIE who were admitted to St. Paul's Hospital from Jan. 1996 to Dec. 2001. The incidence of feeding intolerance, day of first feeding, and day of full enteral feeding were studied in respective to Sarnat stages. RESULTS: Among the full term with HIE, 32 were classified into stage I, 20 into stage II, and 9 into stage III. The incidence of feeding intolerance was 6%, 30%, and 89% for stages I, II and III, respectively. There was only one case of necrotizing enterocolitis among infants of stage III HIE. Feeding first began on 0.13+/-0.01 postnatal day (PND) in normal infants compared to 0.15+/-0.03 PND in infants of stage I, 3.24+/-1.82 PND in stage II and 5.58+/-2.50 PND in stage III. The incidence of feeding intolerance, day of first feeding, and day of normal enteral feeding achieved in infants with stage I were not different from those of normal infants but significantly higher and delayed in infants with more severe degrees of encephalopathy. CONCLUSION: The first feeding should vary according to severity of encephalopathy so as to lower the incidence of feeding intolerance and the risk of necrotizing enterocolitis. We suggest that infants of stageIencephalopathy be first fed as same as normal infants, but precaution is in order when deciding an appropriate time to start feeding in infants of stage II, III encephalopathy.
Enteral Nutrition ; Enterocolitis, Necrotizing ; Humans ; Hypoxia-Ischemia, Brain* ; Incidence* ; Infant ; Infant, Newborn* ; Medical Records

PURPOSE: We investigated incidence of feeding intolerance and time when normal enteral feeding can be established in full term neonates with hypoxic-ischemic encephalopathy (HIE). METHODS: We reviewed medical records of 61 full term infants with HIE who were admitted to St. Paul's Hospital from Jan. 1996 to Dec. 2001. The incidence of feeding intolerance, day of first feeding, and day of full enteral feeding were studied in respective to Sarnat stages. RESULTS: Among the full term with HIE, 32 were classified into stage I, 20 into stage II, and 9 into stage III. The incidence of feeding intolerance was 6%, 30%, and 89% for stages I, II and III, respectively. There was only one case of necrotizing enterocolitis among infants of stage III HIE. Feeding first began on 0.13+/-0.01 postnatal day (PND) in normal infants compared to 0.15+/-0.03 PND in infants of stage I, 3.24+/-1.82 PND in stage II and 5.58+/-2.50 PND in stage III. The incidence of feeding intolerance, day of first feeding, and day of normal enteral feeding achieved in infants with stage I were not different from those of normal infants but significantly higher and delayed in infants with more severe degrees of encephalopathy. CONCLUSION: The first feeding should vary according to severity of encephalopathy so as to lower the incidence of feeding intolerance and the risk of necrotizing enterocolitis. We suggest that infants of stageIencephalopathy be first fed as same as normal infants, but precaution is in order when deciding an appropriate time to start feeding in infants of stage II, III encephalopathy.
Enteral Nutrition ; Enterocolitis, Necrotizing ; Humans ; Hypoxia-Ischemia, Brain* ; Incidence* ; Infant ; Infant, Newborn* ; Medical Records

This study compares the sexual differences among rectal prolapse patients regarding the clinical and the physiologic characteristics with emphasis on males. METHODS: The clinical data, functional status and operative records of 43 patients, who had completed both clinical and functional evaluations were collected in a prospective database and were analyzed according to sex. The functional status of the patients was evaluated by Wexner's constipation score (0~30), Wexner's incontinence score (0~20), anorectal manometry, and pudendal nerve terminal motor latency (PNTML). RESULTS: The incidences of rectal prolapse in males (n=22) and in females (n=21) were similar. The age of onset for males was lower (mean standard deviation, 19.6 19.59 (50% in childhood) vs 52.0 20.75 years; p=0.001) and the duration of symptoms was longer (31.5+/-19.87 vs 12.5+/-14.31 years; p<0.001). Surgery in males was most commonly performed during the sexually active years (51.2+/-16.34 vs 64.5+/-13.19; p=0.006). The incidence of mucosal prolapse in males was higher (10/22 vs 4/17; p=0.065). The incidences and the severities of defecation difficulty in males and females were similar (n=12, mean Wexner score=8.4 vs n=12, mean Wexner score=9.9; p=NS) but, the incidences and the severities of fecal incontinence were lower in males (n=4, mean Wexner score=4.3 vs n=17, mean Wexner score= 14.2; p<0.001). The maximum resting pressure was higher in males (39.2+/-21.46 vs 26.3+/-19.98 mmHg; p=0.049), and the maximum squeezing pressure was better preserved (131.2+/-62.63 vs 67.5+/-37.99 mmHg; p<0.001). No significant difference existed in the PNTML. Female patients underwent abdominal resection rectopexy (n=6), perineal rectosigmoidectomy with lavatoroplasty (n=11), and Delorme's procedure (n=4), but all male patients preferred the perineal approach (rectosigmoidectomy with lavatoroplasty (n=8), Delorme's procedure (n=14)) for fear of sexual dysfunction after the abdominal approach. CONCLUSIONS: These findings suggest that the mechanism for developing rectal prolapse in male and female may be different and that surgical treatment should be tailored to the patient.
Age of Onset ; Constipation ; Defecation ; Fecal Incontinence ; Female ; Humans ; Incidence ; Male* ; Manometry ; Prolapse ; Prospective Studies ; Pudendal Nerve ; Rectal Prolapse*

BACKGROUND: Airway infiltration by inflammatory cells, particularly of eosinophils, is one of the characteristic features of asthma. Several mechanisms for the recruitment of eosinophil is focused on the CD4+ T lymphocyte for the preferential production of Th2-derived cytokines. Interleukin-10(IL-10) is identified cytokine with potent antiinflammatory activity. This molecule has been shown to inhibit the release of cytokine from inflammatory cells including Th2 cell, and also to inhibit eosinophil survival. We therefore attempted to determine whether decreased synthesis of IL-10 in the lung of bronchial asthma may contribute to inflammation that is characteristics of this dease. METHOD: Subjects were patients with bronchial asthma(n=23) and normal controls(n=11). IL-10 produced from peripheral mononuclear cell(PBMC) and in bronchoalveolar lavage(BAL) fluid was measured by ELISA method. Degree of bronchial inflammation was assessed by total cell counts and eosinophil percents in BAL fluid, eosinophil infiltration on bronchial biopsy tissue and PC20 for methacholine. RESULTS: The IL-10 level produced by PBMC and in BAL fluid from patient with bronchial asthma were not different with normal controls(respectively, 901.6+/-220.4 pg/ml, 810.9+/-290.8pg/ml for PBMC, 24.5+/-9.5pg/ml, 30.5+/-13.5 pg/ml for BAL fluid p>0.05). There were significant negative correlation between IL-10 in BAL fluid and eosinophil percents in BAL fluid or degree of eosinophil infiltration in bronchial biopsy(respectively r=-0.522, r=-0.4486 p<0.05). However there was no difference of IL-10 level according to PC20 for methacholine. There were no correlation between IL-10 production by PBMC and peripheral blood eosinophil counts or serum eosinophilic cationic protein levels(respectively r=0.1146, r=0.0769 p>0.05). CONCLUSION: These observation suggest that IL-10 may participate but not acts the crucial role in regulation of the airway inflammation in bronchial asthma.
Asthma* ; Biopsy ; Bronchoalveolar Lavage Fluid* ; Bronchoalveolar Lavage* ; Cell Count ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; Humans ; Inflammation* ; Interleukin-10* ; Lung ; Lymphocytes ; Methacholine Chloride ; Th2 Cells

Background: Recent studies suggest that acanthosis nigricans (AN) is associated with insulin resistance in obese children. However, very few studies have assessed insulin resistance and obesity according to the degree of AN. Therefore, this study aimed to investigate the correlation between the degree of obesity and insulin resistance according to the severity of AN. Methods: A total of 141 participants (83 boys and 58 girls) aged 6−17 years were recruited for the Intervention for Childhood and Adolescents obesity via Activity and Nutrition study between 2016 and 2017. The participants were categorized into four groups according to the severity of AN: grade 0 (n=69), grade 1 (n=19), grade 2–3 (n=35), and grade 4 (n=18). All participants underwent physical examination and blood tests. We compared the mean homeostatic model assessment (HOMA-IR) and body mass index Z score (BMI Z-score) in each group using ANCOVA and linear regression model. Results: The HOMA-IR, which represents insulin resistance, increased with increasing AN severity (grade 0 group: 3.25±0.070; grade 1 group: 3.97±0.103; grade 2–3 group: 4.76±0.079; AN grade 4: 6.40±0.107; P for trend<0.001). Similarly, the BMI Z-score, which represents the degree of obesity, increased with increasing AN severity (grade 0 group: 2.29±0.052; grade 1 group: 2.42±0.080; grade 2–3 group: 2.44±0.062, grade 4: 2.67±0.089; P for trend<0.001). Conclusion Insulin resistance and the degree of obesity increase with the severity of AN in Korean obese children.

Background: Malnutrition is a well-known risk factor of falls, although studies examining the association between nutritional status and falls are rare. We aimed to investigate the association between nutritional status and falls according to gender among Korean older adults. Methods: The study included 10,675 participants (4,605 men and 6,070 women) aged 65 years and older and used data from the 2011 Survey of Living Conditions and Welfare Needs of Korean Older Persons. Nutritional status of the participants was assessed using the Nutritional Screening Initiative checklist, and the participants were categorized into the following groups: “good,” “moderate nutritional risk,” and “high nutritional risk.” Odds ratios (OR) of fall risk in the above groups based on gender were evaluated using multivariate logistic regression analyses. Results: Fallers in both genders showed significant association with older age, lower household income, inadequate exercise, and poor nutritional status compared with non-fallers. Considering the good nutritional status group as the reference group, the high nutritional risk group showed a higher risk of falls in men (OR, 1.59; 95% confidence interval [CI], 1.26–1.99); both moderate and high nutritional risk groups showed a higher risk of falls after adjusting for confounding factors in women (OR, 1.39; 95% CI, 1.19–1.62 and OR, 1.90; 95% CI, 1.61–2.24, respectively). Conclusion The risk of falls was associated with poor nutritional status, and statistical significance of the association between nutritional status and falls was stronger in women than in men.

Rifampicin is a macrocyclic antibiotic which is used extensively for treatment against Mycobacterium tuberculosis and other mycobacterial infections. Recently, a number of studies have focused on the immune-regulatory effects of rifampicin. Therefore, we hypothesized that rifampicin may influence the TLR2 expression in LPS-activated RAW 264.7 cells. In this study, we determined that rifampicin suppresses LPS-induced TLR2 mRNA expression. The down-regulation of TLR2 expression coincided with decreased production of TNF-alpha. Since NF-kappaB is a major transcription factor that regulates genes for TLR2 and TNF-alpha, we examined the effect of rifampicin on the LPS-induced NF-kappaB activation. Rifampicin inhibited NF-kappaB DNA-binding activity in LPS-activated RAW 264.7 cells, while it did not affect IKKalpha/beta activity. However, rifampicin slightly inhibited the nuclear translocation of NF-kappaB p65. In addition, rifampicin increased physical interaction between pregnane X receptor, a receptor for rifampicin, and NF-kappaB p65, suggesting pregnane X receptor interferes with NF-kappaB binding to DNA. Taken together, our results demonstrate that rifampicin inhibits LPS-induced TLR2 expression, at least in part, via the suppression of NF-kappaB DNA-binding activity in RAW 264.7 cells. Thus, the present results suggest that the rifampicin-mediated inhibition of TLR2 via the suppression of NF-kappaB DNA-binding activity may be a novel mechanism of the immune-suppressive effects of rifampicin.
DNA ; Down-Regulation ; Mycobacterium tuberculosis ; NF-kappa B ; Receptors, Steroid ; Rifampin ; RNA, Messenger ; Toll-Like Receptor 2 ; Toll-Like Receptors ; Transcription Factors ; Tumor Necrosis Factor-alpha

An outbreak of rapidly progressive renal failure was observed in Belgium in 1993 and was related to a slimming regimen involving Chinese herbs. Extensive interstitial fibrosis with atrophy and tubular loss was the major histological lesion. Aristolochic acid has been suspected to be responsible for nephrotoxicity. The use of Chinese herbal medicines is very popular in Korea. We report the presence of a nephrotoxic compound in herb medications, which led to end-stage renal failure in a patient with complete remission state of minimal change disease. The typical and sequential pathologic changes in our patient following the consumption of herbs suggest possible relationship to herbal medicines, and end-stage renal disease, despite the fact that a cause-and-effect relationship cannot be automatically inferred.
Asian Continental Ancestry Group* ; Atrophy ; Belgium ; Fibrosis ; Humans ; Kidney Failure, Chronic* ; Korea ; Nephrosis ; Nephrosis, Lipoid* ; Renal Insufficiency