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Clinical Analysis of Intussusception Delayed in the Final Diagnosis (발병 초기에 진단하지 못한 장중첩증에 관한 고찰)

  • Kim, Eo Jin;Lee, Min Hae;Lee, Hae Young;Kim, Jum Su;Seo, Ji Hyun;Lim, Jae Young;Choi, Myoung Bum;Park, Chan Hoo;Woo, Hyang Ok;Youn, Hee Shang
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.7 no.1
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    • pp.16-23
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    • 2004
  • Purpose: In this study, we tried to evaluate the clinical characteristics or circumstances that lead to unintentionally the delay in the diagnosis of intussusception or to the wrong direction that prevent the proper management early. Methods: All the patients of intussusception with delayed diagnosis in the department of pediatrics or emergency room at Gyeongsang National University Hospital from 1990 to 2003 were enrolled and reviewed retrospectively. Results: There were 8 boys and 6 girls and their median age was 8 months (range 2 months to 10 years). Their initial symptoms and signs were vomiting, seizure, diarrhea, lethargy, irritability, bloody stool, palpable abdominal mass, foul odor of urine and tachycardia. Clinical diagnosis or impressions at admission consisted of acute gastroenteritis, shigellosis and toxic encephalopathy, convulsive disorders, urinary tract infections, sepsis, abdominal mass and intestinal obstruction. Eight patients were luckily diagnosed due to the delayed manifestations of cyclic irritability or currant jelly stool. Six patients were not paid attentions for the possibilities of intussusception and diagnosed serendipitiously by the abdominal sonography or CT during the evaluation of the abdominal mass or distension. Only five of 14 cases (35.7%) were successfully managed by barium or air reductions. The other 9 cases needed surgical operations. Conclusion: Delayed diagnosis of intussusception arise when doctors initially diagnose the patients incorrectly due to the unusual presentations or when they overlook the newly arising symptoms or signs suggestive intussusception after the admission because they are ardently attached to the first impressions or initial clinical diagnosis.

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A Clinical Observation on Children with Transient Small Bowel Intussusception (일과성 소장형 장중첩증의 임상적 고찰)

  • Hur, Nam-Jin;Ryu, Min-Hyuk;Lee, Dong-Jin;Kwon, Jung-Hyeok
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.3 no.2
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    • pp.160-168
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    • 2000
  • Purpose: The purpose of this study was to evaluate the clinical and abdominal ultrasonogra- phic(US) features of spontaneously reduced transient small bowel intussusception in chlidren. Methods: We retrospectively reviewed the clinical and US findings of 98 children with intussusception who were admitted to the Pediatric Department of Ulsan Dong-Kang General Hospital from Mar. 1999 to Feb. 2000. Results: 1) Among 98 cases, there were 12 cases (12.3%) of transient small bowel intussusception(TSBI) and 86 cases (87.7%) of classic intussusception (CI). 2) The peak incidence of age in TSBI was over 3 years, which was older than that in CI. With regard to sex distribution, male predominated in both type. 3) Clinical symptoms and signs including cyclic irritability, vomiting, bloody stool, and abdominal mass in TSBI group were less common than those in CI group (41.7%, 33.4%, 0.0%, 0.0% vs 91.9%, 59.3%, 41.9%, 26.7%, respectively) but persistent abdominal pain was more common in TSBI group than in CI group (58.5% vs 11.2%). 4) The size of total target sign and surrounding peripheral hypoechoic rim of TSBI group on US were smaller than those of CI group ($11.95{\pm}2.61$ mm, $2.08{\pm}1.15$ mm vs $26.91{\pm}5.98$ mm, $7.86{\pm}2.77$ mm, respectively). 5) Concomittant illness was found more frequently in TSBI group than in CI group (66.7% vs 26.7%). 6) All case of TSBI group were reduced spontaneouly, which were confirmed by US, but none of CI group. Conclusion: Transient small bowel intussusception is probably more common than generally thought and its clinical and US findings is quite different from classical obstructing intussus-ception. Because all of our cases resulted in spontaneous reduction, we recommend careful observation and repeat examination rather than an immediate operation in transient small bowel intussusception.

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Sandstone Diagenesis of the Lower Permian Jangseong Formation, Jangseong Area, Samcheog Coalfield (삼척탄전 장성일대에 분포하는 하부페름기 장성층 사암의 속성작용)

  • 박현미;유인창;김형식
    • The Journal of the Petrological Society of Korea
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    • v.7 no.2
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    • pp.132-145
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    • 1998
  • The coal-bearing siliciclastic rocks of the Lower Permian Jangseong Formation, Samcheog coalfield, represent a megacyclothem which shows cyclic repetitions of sandstone, shale, coaly shale, and coals. Petrographic, geochemical, and SEM studies for sandstone samples, and XRD analysis for clay minerals were carried out to understand diagenesis in the sandstones of the Jangseong Formation. The Jangseong sandstones are composed of 60% quartz (mainly monocrystalline quartz) and 36% clay matrix and cement with minor amounts of feldspar, lithic fragments and accessory minerals (less than 4%). Jangseong sandstones are classified mostly as quartzwackes and partly as lithic graywackes according to the scheme of Dott(1964). The textural relationships between authigenic minerals and cements in thin sections and SEM photomicrographs suggest the paragenetic sequence as follows; (1) mechanical compaction, (2) cementation by quartz overgrowth, (3) formation of authigenic clay minerals (illite, kaolinite), (4) dissolution of framework grains and development of secondary porosity, and (5) later-stage pore-filling by pyrophyllite. We propose that these diagenetic processes might be due to organic-inorganic interaction between the dominant framework grains and the formation water. The Al, Si ions and organic acid, derived from dewatering of interbedded organic-rich shale and coals, were transported into the Jangseong sandstones. This caused changes in the chemistry of the formation water of the sandstones, and resulted in overgrowth of quartz and precipitation of authigenic clay minerals of kaolinite and illite. The secondary pores, produced during dissolution of clay and framework grains by organic acid and $CO_2$ gas, were conduit for silica-rich solution into the Jangseong sandstones and the influx of silica-rich solution produced the late-stage pyrophyllite after the expanse of kaolinite. The origin of the solution that formed pyrophyllite is not likely to be the organic-rich formation water based on the observation of fracture-filling pyrophyllite in the Jangseong sandstones, but the process of pyrophyllite pore-filling was indirectly related to organic-inorganic interaction.

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Expression and Localization of ATF4 Gene on Oxidative Stress in Preimplantation Mouse Embryo (생쥐 착상전 배아에서 산화적 스트레스에 의한 ATF4 유전자의 발현과 존재 부위)

  • Na, Won-Heum;Kang, Han-Seung;Eo, Jin-Won;Gye, Myung-Chan;Kim, Moon-Kyoo
    • Development and Reproduction
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    • v.10 no.2
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    • pp.105-113
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    • 2006
  • Reactive oxygen species(ROS) generated in cellular metabolism have an effect on cell maturation and development. In human reproductive tract, oxidative injury by ROS may induce female infertility. Also, oxidative injury may be responsible for developmental retardation and arrest of mammalian preimplantation embryos. Activating transcription factor 4(ATF4) is a member of the cyclic-AMP response element-binding(CREB) familiy of basic region- leucine zipper(bZip). ATF4 is known to regulate stress response to protect cell from various stress factors and inducer of apoptisis. The purpose of this study was to investigate whether ATF4 is involved in the defensive mechanism in oxidative stress condition during the development of mouse preimplantation embryos. To verify the expression of ATF4 in oxidative stress condition, 2-cell stage embryos were cultured in HTF media containing 0.1mM, 0.5mM or 1mM hydrogen peroxide($H_2O_2$) for 1hr(2-cell), 8hr(4-cell), 17hr(8-cell), 24hr(morula), 48hr(early blastocyst) or 64hr(late blastocyst). The developmental rate decreased in the 0.1mM $H_2O_2$ treated group compared with control group. In embryos treated with 0.5mM and 1mM $H_2O_2$ showed 2-cell block. As a results of the semi-quantitative RT-PCR analysis of SOD1, ATF4 and Bax gene expression, SOD1, ATF4 and Bax genes were increased in 0.1mM, 0.5mM, 1mM $H_2O_2$ treated groups compared with control group. In 2-cell embryos, expression of SOD1, ATF4 and Bax genes were notably increased in 0.1mM, 0.5mM, 1mM $H_2O_2$ treated groups compared with control group. Immunofluorescence analysis showed that ATF4 protein was localized at the cytoplasm of preimplantation embryos. The increase in ATF4 immunoreactivety was observed in the 0.1mM, 0.5mM, 1mM $H_2O_2$ treated groups compared with control group. It suggests that oxidative stress by $H_2O_2$ induces expression of ATF4 and may be involved in protection mechanism in preimplantation embryos from oxidative injury.

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Studies on the Dietary Self-selection by Egg-type Layers (난용계(卵用鷄) 산란기(産卵期)의 선택채식(選擇採食)에 관(關)한 연구(硏究))

  • Lee, K.H.;Lee, D.S.
    • Korean Journal of Poultry Science
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    • v.21 no.1
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    • pp.41-48
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    • 1994
  • In order to get information for the improvement of feeding systems of egg-type layers, a dietary self-selection study was conducted. Corn diet, soybean meal diet, wheat bran diet, soybean meal+fish meal diet, and limestone diet were individually prepared for self-selection regime. Forty brown layers were offered either a control laying diet (C) or one of the 3 self-selection regime consisted of corn-soybean meal-limestone diet ($T_1$), corn-soybean meal-wheat bran-limestone diet ($T_2$) and corn-soybean meal+fish meal-wheat bran-limestone diet ($T_3$) for one wk each at 31 wk and 41 wk of age. In all dietary treatments, most of the eggs were laid from 0700 h 1300 h and hens consumed more feed, energy and protein on egg forming days than on non-forming days. On egg forming days, hens fed self-selection regime consumed less energy and protein than those fed control diet. On egg forming days, the consumption of feed, energy and protein increased continuously from 1000 h 2200 h in the control diet group but they decreased during the last 3 hours from 1900 h to 2200 h in self-selection regime groups. Up to 1600 h, calcium intake of the self-selection regime groups were much less than that of the control group but after that time, they increased markedly and were much more than that of the control group. The results of the study suggest that the practical self-selection regime for layers should be developed to meet the daily cyclic requirement for nutrients without consuming an excess energy and protein at certain times of the day.

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The Change of Vascular Reactivity in Rat Thoracic Aorta 3 Days after Acute Myocardial Infarction (흰쥐에서 급성심근경색 3일 후 흉부 대동맥 혈관 반응성의 변화)

  • Lee, Sub;Roh, Woon-Seok;Jang, Jae-Seok;Bae, Chi-Hoon;Park, Ki-Sung;Lee, Jong-Tae
    • Journal of Chest Surgery
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    • v.42 no.5
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    • pp.576-587
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    • 2009
  • Background: The up-regulation of the nitric oxide (NO)-cGMP pathway might be involved in the change of vascular reactivity in rats 3 days after they suffer acute myocardial infarction. However, the underlying mechanism for this has not been clarified. Material and Method: Acute myocardial infarction (AMI) was induced by occluding the left anterior descending coronary artery (LAD) for 30 min (Group AMI), whereas the sham-operated control rats were treated similarly without LAD occlusion (Group SHAM), The concentration-response relationships for phenylephrine (PE), KCl, acetylcholine (Ach) and sodium nitroprusside (SNP) were determined in the endothelium intact E(+) and endothelium denuded E(-) thoracic aortic rings from the rats 3 days after AMI or a SHAM operation. The concentration-response relationships of PE in the E(+) rings from the AMI rats were compared with those relationships in the rings pretreated with nitric oxide synthase (NOS) inhibitor $N{\omega}$-nitro-L-arginine methyl ester (L-NAME) or the cyclooxygenase inhibitor indomethacin. The plasma nitrite/nitrate concentrations were checked via a Griess reaction. The cyclic GMP content in the thoracic aortic rings was measured by radioimmunoassay and the endothelial nitric oxide synthase (eNOS) mRNA expression was assessed by real time PCR. Result: The mean infarct size (%) in the rats with AMI was $21.3{\pm}0.62%$. The heart rate and the systolic and diastolic blood pressure were not significantly changed in the AMI rats. The sensitivity of the contractile response to PE and KCl was significantly decreased in both the E(+) and E(-) aortic rings of the AMI group (p<0.05). L-NAME completely reversed these contractile responses whereas indomethacin did not (p<0.05). Moreover, the sensitivity of the relaxation response to Ach was also significantly decreased in the AMI group (p<0.05). The plasma nitrite and nitrate content (p<0.05), the basal cGMP content (p<0.05) and the eNOS mRNA expression (p=0.056) in the AMI rats were increased as compared with the SHAM group. Conclusion: Our findings indicate that the increased eNOS activity and the up-regulation of the NO-cGMP pathway can be attributed to the decreased contractile or relaxation response in the rat thoracic aorta 3 days after AMI.

Influence of Implant Fixture-Abutment Connection and Abutment Design on Mechanical Strength (임플란트 고정체-지대주 연결부 및 지대주 디자인이 기계적 강도에 미치는 영향)

  • Chun, Mi-Hyun;Jeong, Chang-Mo;Jeon, Young-Chan;Eom, Tae-Gwan;Yoon, Ji-Hoon
    • Journal of Dental Rehabilitation and Applied Science
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    • v.24 no.3
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    • pp.269-281
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    • 2008
  • Fatigue or overload can result in mechanical problems of implant components. The mechanical strength in the implant system is dependent on several factors, such as screw and fixture diameters, material, and design of the fixture-abutment connection and abutment. In these factors, the last rules the strength and stability of the fixture-abutment assembly. There have been some previous reports on the mechanical strength of the fixture-abutment assembly with the compressive bending test or short-term cyclic loading test. However, it is restrictive to predict the long-term stability of the implant system with them. The purpose of this study was to evaluate the influence of the design of the fixture-abutment connection and abutment on the mechanical strength and failure mode by conducting the endurance limit test as well as the compressive bending strength test. Tests were performed according to a specified test(ISO/FDIS 14801) in 4 fixture-abutment assemblies of the Osstem implant system: an external butt joint with Cemented abutment (group BJT), an external butt joint with Safe abutment (group BJS), an internal conical joint with Solid abutment (group CJO), and an internal conical joint with ComOcta abutment (group CJT). The following conclusions were drawn within the limitation of this study. Compressive bending strengths were decreased in order of group BJS(1392.0N), group CJO(1261.8N), group BJT(1153.2N), and group CJT(1110.2N). There were no significant differences in compressive bending strengths between group BJT and group CJT(P>.05). Endurance limits were decreased in order of group CJO(600N), group CJT(453N), group BJS(360N), and group BJT(300N). 3. Compressive bending strengths were influenced by the connection and abutment design of the implant system, however endurance limits were affected more considerably by the connection design.

Dynamics of Temperature and Humidity Changes in Lentinula edodes Sawdust Cultivation Sheds (표고 톱밥재배사의 溫-濕度 變化 動態)

  • Koo, Chang-Duck;Kim, Je-Su;Lee, Hwa-Yong;You, Sung-Ryul;You, Chang-Hyun
    • Journal of Korean Society of Forest Science
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    • v.98 no.6
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    • pp.748-756
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    • 2009
  • The key for cultivating Lentinula edodes in sawdust bags with an appropriate strain and medium is to encourage the mushroom growth, while discouraging contaminating fungi by controlling environment, especially temperature and relative humidity (RH). To investigate the daily and seasonal fluctuation of temperature and RH in two L. edodes cultivation sheds types, HOBO data loggers was set and the collected data were analyzed. In a Taiwan type L. edodes cultivation shed, temperature and humidity changes were divided into five characteristic periods: mycelium growing winter, mushroom fruiting spring, mushroom fruiting early summer, mushroom nonfruiting summer and mushroom fruiting autumn. First, the mycelium growing winter was December to early March with daily mean temperature of $-1{\sim}8^{\circ}C$. Second, mushroom fruiting spring was mid March to late May with daily mean temperature of $8{\sim}21^{\circ}C$ and day-night temperature difference of $15^{\circ}C$. Third, the Mushroom fruiting early summer was early June to early July with 17 to $25^{\circ}C$. Fourth, nonfruiting summer was mid July to mid August with daily mean temperature of $25{\sim}28^{\circ}C$. Lastly, mushroom fruiting autumn was late August to October with daily mean temperature of $10{\sim}23^{\circ}C$ and with cyclic temperature change by $7^{\circ}C$ decrease and 5 increase every 5 to 7 days. In a Chinese type shed, temperature ranged $-1.9{\sim}5.0^{\circ}C$ during winter and $15{\sim}32^{\circ}C$ during June to October. Temperature and relative humidity changed $12{\sim}30^{\circ}C$ and 40~100%, respectively, depending on 0~150 cm shelf heights of by positions in the shed. In conclusion, to grow L. edodes but to discourage contaminating fungi, that is, not to be too high in temperature and RH, the growers changed temperature and RH by adjusting shading, aeration and insulation in the shed.

Colon Perforation during Air Enema Reduction of Intussusception (소아 장중첩증에서 공기 주입 정복술 시행 도중 발생한 장천공)

  • Kim, Yong Kuk;Im, Hae Ra;Lee, Gwang Hoon;Han, Soo Jin;Sun, Yong Han;Ryoo, Eell;Cho, Kang Ho;Tchah, Hann;Lee, Hak Soo
    • Clinical and Experimental Pediatrics
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    • v.46 no.1
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    • pp.37-41
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    • 2003
  • Purpose : Although air enema reduction has been known as a good method of diagnosis and treatment of intussusception, it could develop colon perforation. However, there have been few studies about this complication. So we analyzed the risk factors of colon perforation during air enema reduction in patients with intussusception. Methods : We reviewed the charts of 12 colon perforation patients during air enema reduction of intussusception, who were admitted to Gil Medical Center from Jan. 1990 to Dec. 2001. Their age, sex, major symptoms, length of time till hospital visit, types of intussusception, operative findings and pathologic reports were reviewed. Results : Among 657 cases, 596 patients(90.7%) were successfully treated, but 12 patients(1.83%) failed in air enema reduction and had colon perforation. In patients with colon perforation the male to female ratio was 11 : 1, and average age was 5.3 months. The most common symptom at the time of hospital visit was vomiting(91.7%). Cyclic irritability(75.0%), bloody stool(75.0%) and abdominal mass(41.7%) were also noted. The average length of time between symptom onset and hospital visit was 44.7 hours. Types of intussusception were predominantly ileocolic, ileocecal, and ileoileocolic. The site of perforation was most commonly found at the proximal part of intussusception including ascending colon(50%) and transverse colon(50%). Most cases were uncomplicated, and had a single perforation. Pathologic reports showed hemorrhagic necrosis and mesenteric laceration at the site of colon perforation. Complications of colon perforation were tension pneumoperitonium(58.3%), requiring immediate decompression. Conclusion : The chance of colon perforation during air enema reduction increases in cases with small bowel obstruction on simple abdominal x-ray of a patient younger than 6 months, delay in time till hospital visit and higher air pressure during reduction. Therefore more careful investigation is needed in these cases.

Effect of Reused Cocopeat Substrate on Growth and Yield of Summer-cultivated Paprika in EC-based Recycling Hydroponic Cultivation (EC기준 순환식 수경재배에서 코크피트배지 재사용이 여름작형 파프리카의 생육 및 수량에 미치는 영향)

  • Jang, Dong-Cheol;Choi, Ki-Young;Yeo, Kyung-Hwan;Kim, II-Seop
    • Journal of Bio-Environment Control
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    • v.26 no.2
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    • pp.100-107
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    • 2017
  • This experiment was carried out to analyze the effects of substrate reuse on the growth and yield of summer paprika in cyclic hydroponics. The test group was divided into a new coco slab, one year reused coco slab two year reused coco slab based on 30% nutrient solution reuse, and was performed from April 18 to November 31, 2016 for 30 weeks. As a result, plant height of early growth was that the 2 year reused slab was longer than the new slab but the final growth period was 56.58 cm shorter. First group flower position was that reused slab was shorter by 2.92 cm than the new slab and the second group flower position was 0.31 cm long. The relative internode length of early growth, when the reused slab was used, the imbalance in the late growth stage was increased compared with the use of the new slab. The number of growth nodes in the 1 and 2 year reused slab was the smallest with 27.4 nodes. However, the number of harvested nodes did not show the difference in the test group, and the ratio of harvested that the 2 year reused slab was the highest at 26.8%. The ratio of unmarketable fruit tended to increase as the growth progressed. Fresh weight was 227.7g for new slab, 219.2g for 2 year reused slab and 21.2g for 1 year reused slab. The dry weight of the new slab increased with the reuse of the slab. It was 17.13g for new slab, 18.26g for 1 year reused, and 19.28g for 2 year reused. The average water content of the entire growth period was smaller as the slab was reused, and the 1 year reused slab was about 20g less than the 2 year reused slab. This trend was steadily occurring throughout the entire growing season. Especially, the reused slab for 1 year was less than 60g after 3 groups compared to other test groups. In conclusion, If will control seriously occurrence of unmarketable fruits by weakening after medium growth in summer-cultivated paprika in EC-based recycling hydroponic cultivation with reused cocopeat substrate, It is not what I have to worry that decrease of the yield and deterioration of the quality due to the change of physical and chemical properties of the slab and the pathogenic bacteria infection.