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Short Bowel Syndrome as the Leading Cause of Intestinal Failure in Early Life: Some Insights into the Management

  • Goulet, Olivier;Nader, Elie Abi;Pigneur, Benedicte;Lambe, Cecile
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.22 no.4
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    • pp.303-329
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    • 2019
  • Intestinal failure (IF) is the critical reduction of the gut mass or its function below the minimum needed to absorb nutrients and fluids required for adequate growth in children. Severe IF requires parenteral nutrition (PN). Pediatric IF is most commonly due to congenital or neonatal intestinal diseases or malformations divided into 3 groups: 1) reduced intestinal length and consequently reduced absorptive surface, such as in short bowel syndrome (SBS) or extensive aganglionosis; 2) abnormal development of the intestinal mucosa such as congenital diseases of enterocyte development; 3) extensive motility dysfunction such as chronic intestinal pseudo-obstruction syndromes. The leading cause of IF in childhood is the SBS. In clinical practice the degree of IF may be indirectly measured by the level of PN required for normal or catch up growth. Other indicators such as serum citrulline have not proven to be highly reliable prognostic factors in children. The last decades have allowed the development of highly sophisticated nutrient solutions consisting of optimal combinations of macronutrients and micronutrients as well as guidelines, promoting PN as a safe and efficient feeding technique. However, IF that requires long-term PN may be associated with various complications including infections, growth failure, metabolic disorders, and bone disease. IF Associated Liver Disease may be a limiting factor. However, changes in the global management of IF pediatric patients, especially since the setup of intestinal rehabilitation centres did change the prognosis thus limiting "nutritional failure" which is considered as a major indication for intestinal transplantation (ITx) or combined liver-ITx.

An Analysis of Morphological Variation in Abies koreana Wilson and A. nephrolepis (Traut.) Maxim. of Korea (Pinaceae) and Their Phylogenetic Problems (한국산(韓國産) 분비나무와 구상나무의 형질분석(形質分析)과 종간유연관계(種間類緣關係))

  • Chang, Chin-Sung;Jeon, Jeong Ill;Hyun, Jung Oh
    • Journal of Korean Society of Forest Science
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    • v.86 no.3
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    • pp.378-390
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    • 1997
  • Ten total populations of Korean fir (Abies koreana Wilson) and Manshurian fir [A. nephrolepis (Traut.) Maxim.] were sampled from south Korea to investigate patterns of intraspecific variation in these species and to evaluate a recognition of the two species. Principal components analysis and cluster analysis were performed both on seed-cone data and on needle morphology data. The characters that contributed most to the separation between A. koreana and A. nephrolepis along three principal components axis were leaf width, length of seed, width of seed wing, length of seed wing, cone width, width of scale, and length of bract tip, but these characters were not diagnostic because of overlap in reality. Therefore, all these characters were not reliable in distinguishing these two taxa including bract position (exerted and recurved vs. exerted and straight). The individuals of A. koreana from Mt. Chi-ri appeared quite unique probably on account of its larger cone size and longer scale tip, while those from Mt. Hal-la of A. koreana were generally distinct from others in terms of their larger seed and seed wing and longer scale width. The Mt. Duk-yu specimens of A. korecana appeared somewhat smaller but more data were needed due to the small sampling size. Generally, the gradual clinal geographic trends made evident by the position of resin ducts in leaves of A. koreana can be detected. The southern populations, Mt. Hal-la (an insular population) were generally distinct from the northern populations (Mt. Chi-ri, Mt. Ga-ya and Mt. Duk-yu) in terms of their position of resin duct (medial, within mesophyll vs marginal, close to epidermis : 100% vs 75 or 50%). Although no sharp boundary separating these two species could be detected based on cone and needle morphology, the observed clinal pattern was distinct in northern populations of A. koreana and southern population of A. nephrnlepis. In a preceding study of the flavonoids variation of 20 species in eastern Asia, flavanone (5-deoxyflavanone) was found to be characteristic of A. faxoniana Rehder et Wilson, A. georgei Orr of China and A. koreana of Korea. A. faxoniana, which is assumed to be primitive species, has position of resin duct relative to both the medial and the marginal, while A. georgei and A. koreana are identified by marginal position of resin duct. With respect of foliar flavonoids chemistry, A. koreana was distinct from A. nephrolepis : the southmost samples (Mt. Hal-la and Mt. Chi-ri) contained additional flavonoids derivatives (mainly flavanone) that were not found in the northmost samples of A. nephrolepis except a few individuals from Mts. Seo-rak and Tae-bak populations of Kwang-won province. The presence of A. koreana type flavonoids in two Chinese species suggested that position of resin duct may be a phyletic character. Abies koreana including two Chinese taxa, exhibited the most elaborate and specialized flavonoids profile within the Abies in eastern Asia. Contrary to our initial expectations, the apparent intermediates between A. nephrolepis and A. koreana in Duk-yu and Ga-ya mountains were found. The pattern of variation on position of resin duct and flavonoids chemistry in these populations of A. kareana suggested that genetic interchange or natural hybridization had occurred between these two species. The evidence needed to resolve the status of this taxon is still inconclusive in our opinion until intermediate individuals from Mts. Duk-yu and Ga-ya show indication of hybridization between the two species.

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Recurrence Analysis after Video-assisted Thoracic Surgery for the Treatment of Spontaneous Pneumothorax (자연기흉의 비디오흉강경수술 후 재발에 대한 분석)

  • Kim, Sung-Wan;Kim, Duk-Sil;Lim, Chang-Young;Lee, Hyeon-Jae;Lee, Gun;Kong, Joon-Hyuk
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.710-715
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    • 2010
  • Background: Video-assisted thoracic surgery (VATS) became common in the treatment of spontaneous pneumothorax (SP). Therefor we've reviewed the recurrence rate after VATS and analysed the factors affecting recurrent pneumothorax after VATS on this study. Material and Method: This retrospective analysis was performed on 321 patients of SP who had undergone VATS from Jan. 2001 to Dec. 2008. The two groups were divided as follow: group A, non-recurrent group (298 patients: 93%); and group B, recurrent group (26 patients: 7%); the two groups were analysed retrospectively. Result: The average age of the study groups were $20.9{\pm}4.3$ years old in recurrent group vs. $25.9{\pm}11.7$ years old in non-recurrent group with statistical significance (p < 0.05). There were no statistical significance in male to female ratio, height/weight ratio, location of pneumothorax, smoking history, operative time, duration of drain, hospital stay, indication of opertion and incidence rate. Average length of duration in recurrence was 12.9 months. There was 22 (95.7%) recurrent patients after VATS within 4 year period among recurrent group. Treatment methods in 23 of recurrent patients were, 8 (VATS), 2 (Axillary thoracotomy) with 15% or more in amount of pneumothorax and 7 (7 Fr. chest tube), 6 (nasal 02) with 15% or less in amount of pneumothorax. Among 10 cases of reoperation, there were 3 cases of over looking type and 7 cases of new growing type. There was no additional recurrence after these procedures were given. Conclusion: There was higher recurrence rate in younger age after VATS thus for those under 20 yrs old, detailed and possible preoperative warning for recurrence is warranted. Most recurrence occured within 4 year period, thus for this reason, regular interval based follow up with chest x-ray study is suggested during this period.

A Study on the Construction Methods and the Distribution of Proper Spatial Function for Restoring Urban Streams into Close-to-Nature Streams - A Case Study of Hongjecheon(Stream) in Seodaemun-Gu, Seoul - (도시 내 자연형 하천 조성을 위한 적정 공간기능 배분과 조성방안 연구 - 서울시 서대문구 홍제천을 사례로 -)

  • Jung, Tae-Jun;Lee, Kyong-Jae;Han, Bong-Ho
    • Journal of the Korean Institute of Landscape Architecture
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    • v.41 no.3
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    • pp.43-55
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    • 2013
  • The purpose of this study is to propose a plan that properly organizes urban close-to-nature streams by evaluating the city park functions, ecological functions and landscape functions required for urban stream and setting up space function suitable for the space. The site of this study is Hongjecheon located in Seodaemun gu of Seoul City, whose length of channel spans 6.12km in total. The plan for the construction of close-to-nature streams had been established from late 2003, and the construction was completed. Evaluation Categories and indications were deduced from 4 stages. First, based on theoretical examination, we made a list of stream and park evaluation categories and added Category about Characteristic of urban streams. Next, we set Final Evaluation Categories and indications through the process of goal-relevance, indication verification, merging similar category. Final Evaluation Categories were deduced such as usage demand, usability(city park functions), biodiversity, inhabitation potential, rarity(ecological functions), historical cultural elements, and landscape Quality(landscape functions). As a result of allotting space functions, zones 1 through 4, got high grades at usage demand, was classified as a civic resort district; zones 5 through 6, close to major green area and remained original landscape, as ecological conservation and restoration district; zones 7 through 8, get high grades at usage demand and usability, as environmentally-friendly use district; and zones 9 through 10, many historical cultural elements and view points, and high green possession rate, as stream scenic district. In addition, detail space function and construction plan for each zones were proposed. As a result of this study, proposed space function assignment considering natural characteristics, humanities and social characteristics and landscape characteristics and is expected to be utilized at reasonable spatial planning considering various functions required for urban stream.

The effects of selenium on fetal growth and development in CD-1 mice exposed with mercury for the gestation period (임신 중 수은을 섭취한 CD-1 마우스 태아의 성장발육과 기형발생에 미친 셀레늄의 효과)

  • Kim, Jin-suk;Lee, Sang-mok;Choi, Seok-wha;Lee, Won-chang
    • Korean Journal of Veterinary Research
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    • v.34 no.2
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    • pp.361-368
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    • 1994
  • Teratogenic and embryotoxic effects of mercury have been reported, however, there is little information about possible antidotes against mercury exposure during gestation. In order to evaluate therapeutic effects of selenium as an antidote against mercury poisoning, pregnant CD-1 mice were exposed to methylmercury chloride(20ppm) through the drinking water with treatment of sodium selenite (1.0mg, 2.0mg or 3.0mg/kg b.w., subcutaneously) or BAL(5.0mg/kg b.w., subcutaneously) under the single or combination base as the therapeutic agents from day 6 to 15 of gestation. Fetal growth parameters such as body weight and crown-rump length in the mice exposed to mercury, were reduced as was placental weight compared to those in the control. Treatment of selenium(alone, combination with BAL) reduced the harmful effects induced by mercury on the fetal growth parameters even though no specific relationship between dose and therapeutic effect. The incidence of dead fetuses/resorptions and malformed fetuses(especially cleft palate) was also increased in the mercury only treated group. Selenium treatment demonostrated reduced the incidence of abnormal fetuses under the exposure of mercury. Relative maternal organ weights(liver, kidney, spleen) were increased significantly but relative brain weight was decreased as evidenced by decreased in the mercury treated mice compared to that in the control. A subtle indication of maternal mercury toxicity evidenced by changes of relative maternal organ weights, decreased water and feed consumption were also prevented efficiently by selenium treatment. The present study suggests that methylmercuric chloride is embrytoxic and teratogenic in CD-1 mice when exposured during organogenesis and that selenium administration may have therapeutic application for the treatment of mercury poisoning although more applicable study in human should be performed with caution in the future.

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Filtering Rate with Effect of Water Temperature and Size of Two Farming Ascidians Styela clava and S. plicata, and a Farming Mussel Mytilus edulis (수온과 개체크기에 따른 양식산 미더덕, 흰멍게, 진주담치의 여수율)

  • KIM Yong Sool;Moon Tae Seok
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.31 no.2
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    • pp.272-277
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    • 1998
  • Filtering rates of two farming ascidians Styela clava and S. plicata, and of a farming mussel Mytilus edulis were experimentally investigated with reference to effects of water temperature and size. Absorptiometric determinations of filtering rates were carried out in a closed system with experimental animals being decreased indicate dyes neutral red. Optical density (OD) of 440 nm in path length 22 mm cell used as the indication of food particles absorption was appeared directly in proportion with the concentration of neutral red dyes. The filtering rate F is calculated by Kim's equation $F\;=\;V(1-e^{-z})$, where V is the water volume ($\ell$) in the experimental jar, and Z is the decreasing coefficient of OD as meaning of instantaneous removal speed as In $C_t\;=\;In\;C_{o}-Z{\cdot}t$, in this formula $C_t$ is OD at the time t. Filtering rate of S. clava increased as exponential function with increasing temperature while not over critical limit, and the critical temperature for filtering rate was assumed to be between $28^{\circ}C$ and $29^{\circ}C$. In case of S. plicata, the critical temperature was to be below $13^{\circ}C$, and through the temperature range $15\~25^{\circ}C$ appeared a little difference in level even though with significant. M. edulis was not appear any significant effects by water temperature less than $29^{\circ}C$. The model formula derived from the results is as below, where F is filtering rate (${\ell}/hr/animal$), T is water temperature ($^{\circ}C$), and DW is dry meat weight (g) of experimental animal. $$S.\;Clava;\;F\;=\;e xp\;(0.119\;T-4.540)\;(DW)^{0.6745},\;T<29^{\circ}C$$) $$S.\;plicata;\;F\;=\;e xp\;(A_t)\;(DW)^{0.5675},\;(13^{\circ}C $$[A_t =-8.56+0.6805\;T-0.0153\;T^2]$$ $$M.\;edulis;\;F\;=\;0.3844\;(DW)^{0.4952},\;<29^{\circ}C$$)

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An Analysis of Major Trail Deterioration in Urban Natural Park - A Focus on Apsan Park in Daegu Metropolitan City - (도시자연공원의 주요 등산로 훼손실태 분석 - 대구광역시 앞산공원을 대상으로 -)

  • Park, In-Hwan;Lee, Hea-Young;Cho, Kwang-Jin;Jang, Gab-Sue
    • Journal of the Korean Institute of Landscape Architecture
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    • v.38 no.3
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    • pp.33-40
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    • 2010
  • Many trails have been built and utilized in each sub-basin of Apsan Park. This study focused on the conditions and the present flora of several overused trails within three basins called Kun-Gol, Anjiroung-Gol, and Meaja-Gol in Apsan Park. There are two purposes for this study. The first is to make a plan for restoration by classifying the type of damage to these overused trails. The second is to provide preliminary data for reestablishing a more pleasant urban nature park. As a result of the survey, the average length of these trails is 9.0km and mean width is 2.0 to 2.6m. 2,108m of the sections studied(23.4% of the total) had exposed root, 3,199m of the sections studied (35.5% of the total) had exposed rock, 3,270m of the sections studied(36.6% of the total) displayed damaged pathways, and 4,841m of the sections studied (53.8% of the total) had higher soil hardness. Eighty-three areas of deterioration were found and there has been extensive property destruction. As an indication of human disturbances, the Naturalization Index and Urbanization Index appeared as: Kun-Gol, 7.0%, 5.5%; Anjiroung-Gol, 8.3%, 4.5%; Meaja-Gol 8.6%, 6.2%; in total, 7.8%, 8.3%. As a method of checking the level and extent of the damage process, an impact rating classification was used at each point on the trails. Kun-Gol had the highest rating and Anjiroung-Gol had the lowest rating in impact rating classification. With the impact rating classification, it was found that each trail would continue to worsen, meaning that roots and rocks are more likely to be further exposed and the trail width will continue to widen through overuse. An actual plan for reparations and restoration of the trails is needed through further study.