• Title/Summary/Keyword: 위험감소

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Effects of Rye Silage on Growth Performance, Blood Characteristics, and Carcass Quality in Finishing Pigs (호맥 사일리지의 급여기간이 비육돈의 생산성, 혈액 성상 및 도체특성에 미치는 영향)

  • Shin, Seung-Oh;Han, Young-Keun;Cho, Jin-Ho;Kim, Hae-Jin;Chen, Ying-Jie;Yoo, Jong-Sang;Whang, Kwang-Youn;Kim, Jung-Woo;Kim, In-Ho
    • Food Science of Animal Resources
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    • v.27 no.4
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    • pp.392-400
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    • 2007
  • This experiment was conducted to evaluate effects of various periods of rye silage feeding on the growth performance, blood characteristics, and carcass quality of finishing pigs. A total of sixteen [($Landrace{\times}Yorkshire{\times}Duroc$)] pigs (90.26 kg in average initial body weight) were tested in individual cages for a 30 day period. Dietary treatments included 1) CON (basal diet), 2) S10 (basal diet for 20 days and 3% rye silage for 10 days) 3) S20 (basal diet for 10 days and 3% rye silage for 20 days) and 4) S30 (3% rye silage for 30 days). There were no significant differences in the ADG and gain/feed ratio among the treatments(p>0.05), however the ADFI was higher in pigs fed the CON diet than with pigs fed diets with rye silage (p<0.05). The DM digestibility was higher with the S20 diet than with the S30 diet (p<0.05). With regard to blood characteristics, pigs fed rye silage had a significantly reduced cortisol concentration compared to pigs fed the CON diet (p<0.05). The backfat thickness was higher with the CON diet than with the S20 or S30 diets (p<0.05). Regarding the fatty acid contents of the leans, the C18:0 and total SFA were significantly higher with the CON diet than with the other diets (p<0.05). However, the C18:1n9, total MUFA and UFA/SFA levels were significantly lower with the CON diet than the other diets (p<0.05). Regarding the fatty acid contents of fat, the levels of C18:1n9 and MUFA were similar with the S20 and S30 diets, however, these levels were higher than with the CON or S10 diets (p<0.05). In conclusion, feed intake and DM digestibility were affected by rye silage, and the cortisol concentration, backfat thickness and fatty acid composition of pork were positively affected by feeding pigs rye silage.

School Dietitians' Perceptions and Intake of Healthy Functional Foods in Jeonbuk Province (전북지역 일부 학교 영양사의 건강기능식품 인식 및 이용실태)

  • Kang, Young-Ja;Jung, Su-Jin;Yang, Ji-Ae;Cha, Youn-Soo
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.36 no.9
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    • pp.1172-1181
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    • 2007
  • This research involved 226 Jeonbuk Province school dietitians as subjects to investigate intake and perceptions of the healthy functional foods. Sixty nine percent of the school dietitians didn't even know about the law enforcement concerning the health functional foods. Although 68.1% of the respondents said that they slightly knew about health functional foods, only 25% knew exactly what it was. As shown in the survey, most didn't have the cognitive understanding did not understand which should be obtained by education. Sixty two percent of the answerers said they had experience of taking health various functional food products of various kinds such as supplements (57.9%), red ginseng products (52.9%), and chlorella products (30.0%). The motive of intake was in the order of fatigue restoration (25.7%), sickness prevention (22.9%), and nutrient replenishment (22.9%). A fascinating fact from this study was that the reason for healthy functional product intake was different between groups that was primarily interested in the products and those that was not. For those who had interest, the reason for intake was for sickness prevention. On the other hand, for those who didn't have any interest, the reasons was primarily for fatigue restoration and they were mostly persuaded by close friends and relatives. Main concerns were in the order of side effects (4.72), efficacy after intake (4.59), cleanliness (4.51), reliability of the company (4.29), and price (4.23). In view of the study, it is clear that a lot of people are showing interest in healthy functional food products. However, dietitians who are experts in food and nutrition lacked knowledge and information on healthy functional food.

Evaluation of the Modified Hybrid-VMAT for multiple bone metastatic cancer (다중표적 뼈 전이암의 하이브리드 세기변조(modified hybrid-VMAT) 방사선치료계획 유용성 평가)

  • Jung, Il Hun;Cho, Yoon Jin;Chang, Won Suk;Kim, Sei Joon;Ha, Jin Sook;Jeon, Mi Jin;Jung, In Ho;Kim, Jong Dea;Shin, Dong Bong;Lee, Ik Jae
    • The Journal of Korean Society for Radiation Therapy
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    • v.30 no.1_2
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    • pp.161-167
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    • 2018
  • Purpose : This study evaluates the usefulness of the Modified Hybrid-VMAT scheme with consideration of background radiation when establishing a treatment plan for multiple bone metastatic cancer including multiple tumors on the same axis. Materials and Methods : The subjects of this study consisted of five patients with multiple bone metastatic cancer on the same axis. The planning target volume(PTV) prescription dose was 30 Gy, and the treatment plan was established using Ray Station(Ray station, 5.0.2.35, Sweden). In the treatment plan for each patient, two or more tumors were set as one isocenter. A volumetric modulated arc therapy(VMAT) plan, a hybrid VMAT(h) plan with no consideration of background radiation, and a modified hybrid VMAT(mh) with consideration of background radiation were established. Then, using each dose volume histogram(DVH), the PTV maximum dose($D_{max}$), mean dose($D_{mean}$), conformity index(CI), and homogeneity index(HI) were compared among the plans. In addition, the organ at risk(OAR) of each treatment site was evaluated, and the total MU(Monitor Unit) and treatment time were also analyzed. Results : The PTV $D_{max}$ values of VMAT, VMAT(h) and VMAT(mh) were 3188.33 cGy, 3526 cGy, and 3285.67 cGy, the $D_{mean}$ values were 3081 cGy, 3252 cGy, and 3094 cGy; the CI values were $1.35{\pm}0.19$, $1.43{\pm}0.12$, and $1.30{\pm}0.06$; the HI values were $1.06{\pm}0.01$, $1.14{\pm}0.06$, and $1.09{\pm}0.02$; and the VMAT(h) OAR value was increased 3 %, and VMAT(mh) OAR value was decreased 18 %, respectively. Furthermore, the mean MU values were 904.90, 911.73, and 1202.13, and the mean beam on times were $128.67{\pm}10.97$, $167.33{\pm}7.57$, and $190.33{\pm}4.51$ respectively. Conclusions : Applying Modified Hybrid-VMAT when treating multiple targets can prevent overdose by correcting the overlapping of doses. Furthermore, it is possible to establish a treatment plan that can protect surrounding normal organs more effectively while satisfying the inclusion of PTV dose. Long-term follow-up of many patients is necessary to confirm the clinical efficacy of Modified Hybrid-VMAT.

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Feasibility of Mixed-Energy Partial Arc VMAT Plan with Avoidance Sector for Prostate Cancer (전립선암 방사선치료 시 회피 영역을 적용한 혼합 에너지 VMAT 치료 계획의 평가)

  • Hwang, Se Ha;NA, Kyoung Su;Lee, Je Hee
    • The Journal of Korean Society for Radiation Therapy
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    • v.32
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    • pp.17-29
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    • 2020
  • Purpose: The purpose of this work was to investigate the dosimetric impact of mixed energy partial arc technique on prostate cancer VMAT. Materials and Methods: This study involved prostate only patients planned with 70Gy in 30 fractions to the planning target volume (PTV). Femoral heads, Bladder and Rectum were considered as oragan at risk (OARs). For this study, mixed energy partial arcs (MEPA) were generated with gantry angle set to 180°~230°, 310°~50° for 6MV arc and 130°~50°, 310°~230° for 15MV arc. Each arc set the avoidance sector which is gantry angle 230°~310°, 50°~130° at first arc and 50°~310° at second arc. After that, two plans were summed and were analyzed the dosimetry parameter of each structure such as Maximum dose, Mean dose, D2%, Homogeneity index (HI) and Conformity Index (CI) for PTV and Maximum dose, Mean dose, V70Gy, V50Gy, V30Gy, and V20Gy for OARs and Monitor Unit (MU) with 6MV 1 ARC, 6MV, 10MV, 15MV 2 ARC plan. Results: In MEPA, the maximum dose, mean dose and D2% were lower than 6MV 1 ARC plan(p<0.0005). However, the average difference of maximum dose was 0.24%, 0.39%, 0.60% (p<0.450, 0.321, 0.139) higher than 6MV, 10MV, 15MV 2 ARC plan, respectively and D2% was 0.42%, 0.49%, 0.59% (p<0.073, 0.087, 0.033) higher than compared plans. The average difference of mean dose was 0.09% lower than 10MV 2 ARC plan, but it is 0.27%, 0.12% (p<0.184, 0.521) higher than 6MV 2 ARC, 15MV 2 ARC plan, respectively. HI was 0.064±0.006 which is the lowest value (p<0.005, 0.357, 0.273, 0.801) among the all plans. For CI, there was no significant differences which were 1.12±0.038 in MEPA, 1.12±0.036, 1.11±0.024, 1.11±0.030, 1.12±0.027 in 6MV 1 ARC, 6MV, 10MV, 15MV 2 ARC, respectively. MEPA produced significantly lower rectum dose. Especially, V70Gy, V50Gy, V30Gy, V20Gy were 3.40, 16.79, 37.86, 48.09 that were lower than other plans. For bladder dose, V30Gy, V20Gy were lower than other plans. However, the mean dose of both femoral head were 9.69±2.93, 9.88±2.5 which were 2.8Gy~3.28Gy higher than other plans. The mean MU of MEPA were 19.53% lower than 6MV 1 ARC, 5.7% lower than 10MV 2 ARC respectively. Conclusion: This study for prostate radiotherapy demonstrated that a choice of MEPA VMAT has the potential to minimize doses to OARs and improve homogeneity to PTV at the expense of a moderate increase in maximum and mean dose to the femoral heads.

A Study on Profitability of the Allianced Discount Program with Credit Cards and Loyalty Cards in Food & Beverage Industry (제휴카드 할인프로그램이 외식업의 수익성에 미치는 영향)

  • Shin, Young Sik;Cha, Kyoung Cheon
    • Asia Marketing Journal
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    • v.12 no.4
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    • pp.55-78
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    • 2011
  • Recently strategic alliance between business firms has become prevalent to overcome increasing competitive threats and to supplement resource limitation of individual firms. As one of allianced sales promotion activities, a new type of discount program, so called "Alliance Card Discount", is introduced with the partnership of credit cards and loyalty cards. The program mainly pursues short-term sales growth by larger discount scheme while spends less through cost share among alliance partners. Thus this program can be regarded as cost efficient discount promotion. But because there is no solid evidence that it can really deliver profitable sales growth, an empirical study for its effects on sales and profit should be conducted. This study has two basic research questions concerning the effects of allianced discount program ; 1)the possibility of sales increase 2) the profitability of the discount driven sales. In F&B industry, sales increase mainly comes from increased guest count. Especially in family restaurants, to increase the number of guests we need to enlarge the size of visitor group (number of visitors for one group) because customers visit by group in a special occasion. And because they pay the bill by group(table), the increase of sales per table is a key measure for sales improvement. The past researches for price & discount sensitivity and reference discount rate explain that price sensitive consumers have narrow reference discount zone and make rational purchase decision. Differently from all time discount scheme of regular sales promotions, the alliance card discount program only provides the right to get discount like discount coupon. And because it is usually once a month opportunity given by the past month usage level, customers tend to perceive alliance card discount as a rare chance to get. So that we can expect customers try to maximize the discount effect when they use the limited discount opportunity. Considering group visiting practice and low visit frequency of family restaurants, the way to maximize discount effect should be the increase the size of visit group. And their sensitivity to discount and rational consumption behavior defer the additional spending for ordering high price menu, even though they get considerable amount of savings from the discount. From the analysis of sales data paid by alliance discount cards for four months, we found the below. 1) The relation between discount rate and number of guest per table is positive : 25% discount results one additional guest 2) The relation between discount rate and the spending per guest is negative. 3) However, total profit amount per table is increased when discount rate is increased. 4) Reward point accumulation & redemption did not show any significant relationship with the increase of number of guests. These results suggest that the allianced discount program substantially contributes to sales increase and profit improvement by increasing the number of guests per table. Though the spending per guest is decreased by discount rate increase, the total amount of profit per table is improved. It seems the incremental profit by increased guest count offsets the profit decrease. Additional intriguing finding is the point reward system does not have any significant impact on the increase of number of guest, even if the point accumulation & redemption of loyalty program are usually regarded as another saving offers by customers. In sum, because it is proved that allianced discount program with credit cards and loyalty cards is effective to both sales drive and profit increase, the alliance card program could be recommended as strategically buyable program.

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An Analysis of the Research Trends in Safety Education for Home Economics Education (가정과 안전교육의 연구 동향 분석)

  • Kim, Nam Eun
    • Journal of Korean Home Economics Education Association
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    • v.28 no.3
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    • pp.47-63
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    • 2016
  • The purpose of this study is to suggest the basic information for diverse and balanced research and development in this field with understanding research trends related to safety education in home economics. In order to so, this study makes population and sampling by targeting cases which refer to 'safety' on 15 papers of academic journals related to home economics registered in the National Research Foundation from 2001 to 2015, 244 papers related to safety education area and 179 master doctorate thesis by searching keyword as 'safety'. Analysis contents are research trends of papers related to safety education by year and by subject and research trends of safety education by area and by research method. As a result of the study, first, the number of research papers related to safety education by year on home economics curriculum repeated increase and decrease and there have been consistent studies conducted on safety education with 14-52 papers per every year and yearly average 28.2 papers. On the other hand, the most number of studies conducted in 2015 with 52 papers which are twice as much of 26 papers in 2014. This seems to be affected by the announcement of safety comprehensive countermeasures from government and the emphasis of safety subject on 2015 curriculum revision of the Ministry of Education. Second, with regards to research trends by topic, 137 papers are related to safety education (29%), 336 papers are related to safety actual condition (71%). Accidents and recognition had a greater percentage in a paper before 2009 (74.4%) and studies are increased after 2009 (from 21 papers to 53 papers) in terms of development or evaluation of safety education program, development of education materials, development of education method etc. Subject area dealt with the most on the research of safety actual condition is regarding safety accidents or effective variables (23.2%). Subject regarding the variables are researches related to factors influencing family violence, internet addiction, spouse violence, willingness to purchase unsafe food, age harassment, or suicidal attempt etc. Next, researches related to safety recognition (13.9%), safety knowledge and attitude (7.4%), safety behaviors (6.3%), safety consciousness (2.3%) show in sequence. Subject area dealt with the most on the researches regarding safety education is development and evaluation of safety education program (11%) and this appears the most in 2015 by year (21.5%). Third, with regards to eight areas of safety education, there are 143 papers regarding public safety (33.8%), 106 papers regarding violence and personal safety (25.1%), 93 papers regarding general subject on safety or whole safety area (22%) and 58 papers regarding drug and internet addiction (13.7%) in sequence. And there is no paper related to first aid and 1 paper is related to occupational safety (0.2%). Occupational safety area is less researched nevertheless its included in home economic curriculum as relative chapter. First aid does not directly correlate with home economics curriculum but should be studied in preparation for accident which could happen in practical class. Forth, with regards to research trends by research method, quantitative research (89.1%) is mostly used and both research study (70.4%) and experimental research (18.7%) are used the most frequently. In particular, researches on the actual condition of safety education and experimental studies for effectiveness verification take most of research method. As qualitative studies, there are phenomenological study (3.1%) and case study (3.1%) related to actual conditions of safety accidents. 10 papers (2.4%) are mixture of quantitative and qualitative research and some research conducted research study and experimental research at the same time (0.9%). With regards to subject of study, human environments (87.5%) are more than physical environments (12.5) and students (48.4%) are more than teachers and school parents (20.6%). As the subject of physical environments, school (6.5%) is the most but home environment is none. As a result of the study, research for the development of evaluation tool for evaluating safety education, occupational safety and lifelong education should be conducted from this time forward. In addition, the object of study shall be expanded to both human environments in terms of entire life and physical environments for home. An in-depth qualitative research should be needed by observing and meeting with each student.

Inflammatory Reponse of the Lung to Hypothermia and Fluid Therapy after Hemorrhagic Shock in Rats (흰쥐에서 출혈성 쇼크 후 회복 시 저체온법 및 수액 치료에 따른 폐장의 염증성 변화)

  • Jang, Won-Chae;Beom, Min-Sun;Jeong, In-Seok;Hong, Young-Ju;Oh, Bong-Suk
    • Journal of Chest Surgery
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    • v.39 no.12 s.269
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    • pp.879-890
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    • 2006
  • Background: The dysfunction of multiple organs is found to be caused by reactive oxygen species as a major modulator of microvascular injury after hemorrhagic shock. Hemorrhagic shock, one of many causes inducing acute lung injury, is associated with increase in alveolocapillary permeability and characterized by edema, neutrophil infiltration, and hemorrhage in the interstitial and alveolar space. Aggressive and rapid fluid resuscitation potentially might increased the risk of pulmonary dysfunction by the interstitial edema. Therefore, in order to improve the pulmonary dysfunction induced by hemorrhagic shock, the present study was attempted to investigate how to reduce the inflammatory responses and edema in lung. Material and Method: Male Sprague-Dawley rats, weight 300 to 350 gm were anesthetized with ketamine(7 mg/kg) intramuscular Hemorrhagic Shock(HS) was induced by withdrawal of 3 mL/100 g over 10 min. through right jugular vein. Mean arterial pressure was then maintained at $35{\sim}40$ mmHg by further blood withdrawal. At 60 min. after HS, the shed blood and Ringer's solution or 5% albumin was infused to restore mean carotid arterial pressure over 80 mmHg. Rats were divided into three groups according to rectal temperature level($37^{\circ}C$[normothermia] vs $33^{\circ}C$[mild hypothermia]) and resuscitation fluid(lactate Ringer's solution vs 5% albumin solution). Group I consisted of rats with the normothermia and lactate Ringer's solution infusion. Group II consisted of rats with the systemic hypothermia and lactate Ringer's solution infusion. Group III consisted of rats with the systemic hypothermia and 5% albumin solution infusion. Hemodynamic parameters(heart rate, mean carotid arterial pressure), metabolism, and pulmonary tissue damage were observed for 4 hours. Result: In all experimental groups including 6 rats in group I, totally 26 rats were alive in 3rd stage. However, bleeding volume of group I in first stage was $3.2{\pm}0.5$ mL/100 g less than those of group II($3.9{\pm}0.8$ mL/100 g) and group III($4.1{\pm}0.7$ mL/100 g). Fluid volume infused in 2nd stage was $28.6{\pm}6.0$ mL(group I), $20.6{\pm}4.0$ mL(group II) and $14.7{\pm}2.7$ mL(group III), retrospectively in which there was statistically a significance between all groups(p<0.05). Plasma potassium level was markedly elevated in comparison with other groups(II and III), whereas glucose level was obviously reduced in 2nd stage of group I. Level of interleukine-8 in group I was obviously higher than that of group II or III(p<0.05). They were $1.834{\pm}437$ pg/mL(group I), $1,006{\pm}532$ pg/mL(group II), and $764{\pm}302$ pg/mL(group III), retrospectively. In histologic score, the score of group III($1.6{\pm}0.6$) was significantly lower than that of group I($2.8{\pm}1.2$)(p<0.05). Conclusion: In pressure-controlled hemorrhagic shock model, it is suggested that hypothermia might inhibit the direct damage of ischemic tissue through reduction of basic metabolic rate in shock state compared to normothermia. It seems that hypothermia should be benefit to recovery pulmonary function by reducing replaced fluid volume, inhibiting anti-inflammatory agent(IL-8) and leukocyte infiltration in state of ischemia-reperfusion injury. However, if is considered that other changes in pulmonary damage and inflammatory responses might induce by not only kinds of fluid solutions but also hypothermia, and that the detailed evaluation should be study.

Optimum Radiotherapy Schedule for Uterine Cervical Cancer based-on the Detailed Information of Dose Fractionation and Radiotherapy Technique (처방선량 및 치료기법별 치료성적 분석 결과에 기반한 자궁경부암 환자의 최적 방사선치료 스케줄)

  • Cho, Jae-Ho;Kim, Hyun-Chang;Suh, Chang-Ok;Lee, Chang-Geol;Keum, Ki-Chang;Cho, Nam-Hoon;Lee, Ik-Jae;Shim, Su-Jung;Suh, Yang-Kwon;Seong, Jinsil;Kim, Gwi-Eon
    • Radiation Oncology Journal
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    • v.23 no.3
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    • pp.143-156
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    • 2005
  • Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.

The Three Types of Clinical Manifestation of Cow's Milk Allergy with Predominantly Intestinal Symptoms (위장관 증세 위주로 발현하는 영유아기 우유 알레르기 질환의 3가지 임상 유형에 관한 고찰)

  • Lee, Jeong-Jin;Lee, Eun-Joo;Kim, Hyun-Hee;Choi, Eun-Jin;Hwang, Jin-Bok;Han, Chang-Ho;Chung, Hai-Lee;Kwon, Young-Dae;Kim, Yong-Jin
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.3 no.1
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    • pp.30-40
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    • 2000
  • Purpose: During the first year of life, cow's milk protein is the major offender causing food allergy. Cow's milk allergy (CMA) affects 2~7% of infants, of which approximately one-half show predominantly gastrointestinal symptoms. We studied the clinical types of cow's milk allergy with predominantly gastrointestinal symptoms (CMA-GI) of childhood. Methods: The retrospective study was performed on 30 (male 22, female 8) patients who had diagnosed as CMA-GI during 2 years and 3 months from March 1995 to June 1997. Results: 1) Children with CMA-GI presented in the three types of clinical manifestation on the basis of time to reaction to milk ingestion: Quick (Q) onset (5 cases), Slow (S) onset (20 cases), Quick & Slow (Q&S) (5 cases). 2) Age on admission of the three groups was significantly different (p<0.05): (Q onset: $81.4{\pm}67.1$ days, S onset: $31.9{\pm}12.7$ days, Q&S: $366.0{\pm}65.0$ days). Although the body weight at birth was 10~95 percentile in all patients, body weight on admission was different: (Q onset: 10~50 percentile, S onset: below 10 percentile, Q&S: 10~25 percentile). S onset group was significantly different compared with other groups (p<0.05) and 90% of this one was failure to thrive below 3 percentile. 3) Peripheral leukocyte counts were as followings: (Q onset: $5,700{\sim}12,300/mm^3$, S onset: $10,000{\sim}33,400/mm^3$, Q&S: $5,200{\sim}14,900/mm^3$). Slow onset group was significantly different compared with other groups (p<0.05). Serum albumin levels on admission were as followings: (Q onset: $4.2{\pm}0.4\;g/dl$, S onset: $3.0{\pm}0.3\;g/dl$, Q&S: $4.0{\pm}0.3\;g/dl$). S onset group was significantly different compared with other groups (p<0.05) and 85% of this one was below 3.5 g/dl. 4) Although morphometrical analysis on small intestinal mucosa did not show enteropathy in Q onset and Q&S groups, all cases of S onset revealed enteropathy: 45% of this one showed subtotal villous atrophy, 55 % showed partial villous atrophy. 5) Allergic reaction test to other foods was not performed in S onset group because of ethical problem and high risk in general condition. In Q onset group, allergic reaction to one or two other foods: soy formula, weaning formula and eggs. Q&S goup revealed allergic reactions to several foods or to most of all foods except protein hydrolysate formula: eggs, potatos, some kinds of sea food, apples, carrots, beef and chicken. 6) Serum IgE level, peripheral eosinophil counts, milk RAST, soy RAST, skin test were not significantly different among groups. Conclusion: CMA-GI may present in three clinical ways on the basis of time to reaction to milk ingestion, typical clinical findings and morphologic changes in the small bowel mucosal biopsy specimens. This clinical subdivision might be helpful in diagnostic and therapeutic approaches in CMA-GI. Early suspicion is mandatory especially in S onset type because of high risks with malnutrition and enteropathy.

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