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Clinical experience with amitriptyline for management of children with cyclic vomiting syndrome (주기성 구토 증후군 소아에서 구토 예방을 위한 amitriptyline의 임상 경험)

  • Sim, Ye-Jee;Kim, Jung-Mi;Kwon, Soonhak;Choe, Byung-Ho
    • Clinical and Experimental Pediatrics
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    • v.52 no.5
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    • pp.538-543
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    • 2009
  • Purpose : To report the clinical experience with amitriptyline for managing children with cyclic vomiting syndrome (CVS). Methods : Totally, eleven children (eight males) were diagnosed with CVS. Of these, medical records were reviewed for eight children treated with amitriptyline; three children were not treated because one was not followed up and two were kept under observation to study the natural course without medication, because the frequency of vomiting had recently decreased to less than one episode per year. The eight amitriptyline-treated children were divided into three groups by the therapeutic response: (1) complete remission (CR), with no recurrence of symptoms after treatment; 2) partial remission (PR), in which the frequency of symptoms decreased by almost 50% after treatment; and (3) no response. Results : For the eight amitriptyline-treated children, the mean age of symptom onset was 4.7 (0.3-7) yr and mean age at diagnosis was 8.9 (6.0-11.3) yr. The mean number of vomiting episodes was 8.8 (2-25) per year, and the duration of vomiting in each episode ranged from 3 hours to 5 days. CR was achieved in five (62.5%) of the eight amitriptyline-treated children (0.2-0.8 mg/kg/day orally, at night) and PR was achieved in three children (37.5%). Two children relapsed on discontinuation of amitriptyline by their parents decision but showed improvement on remedication. No adverse effects were noted throughout the study period. Conclusion : Amitriptyline can be used in long-term prophylaxis for the management of children with CVS aged over 6 yr. However, a large-scale study is needed to ascertain its effects.

Surgical outcome of severe pulmonary arterial hypertension secondary to left-to-right shunt lesions (심한 폐동맥 고혈압을 동반한 좌우 단락 질환 환자의 수술 후 경과)

  • Lee, Cha Gon;Jeong, Su-In;Huh, June;Kang, I-Seok;Lee, Heung Jae;Yang, Ji-Hyuk;Jun, Tae Gook
    • Clinical and Experimental Pediatrics
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    • v.53 no.2
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    • pp.195-202
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    • 2010
  • Purpose : Despite recent advances in pulmonary hypertension management and surgery, appropriate guidelines remain to be developed for operability in congenital heart disease with pulmonary artery hypertension (PAH). Our aim was to evaluate clinical outcomes of patients with severe PAH who underwent surgical closure of left-to-right shunt lesions (LRSL) on the basis of pulmonary reactivity. Methods : We retrospectively reviewed 21 patients who underwent surgical closure of LRSL with severe PAH (${\geq}8$ Wood unit) from January 1995 to April 2009. The median age at operation was 26 years. Atrial septal defect, ventricular septal defect (VSD), VSD and patent ductus arteriosus (PDA), and PDA was present in 11, 4, 4, and 2 patients, respectively. Results : Operability was based on vasoreactivity of PAH. Of the 21 patients, 5 showed response to pulmonary vasodilator therapy and 8 showed vasoreactivity after balloon occlusion of defects. The remaining 8 patients were considered operable because of significant left-to-right shunt (Qp/Qs ${\geq}1.5$). Five patients underwent total closure of defects and 16 were left with small residual shunts. The median follow-up duration was 32 months. There was no significant postoperative mortality or morbidity. Systolic pulmonary artery pressure (PAP) decreased in all but 2 patients. All patients except 1 showed improvement of New York Heart Association functional class. Conclusion : Closure of LRSL in patients with severe PAH on the basis of pulmonary vasoreactivity seems reasonable. PAP and clinical symptoms improved in most patients. Further research is needed for the evaluation of long-term results.

Eight cases of incidentally diagnosed as subclinical rickets (우연히 발견된 무증상 구루병 8예)

  • Seo, Ji-Young;Kim, Curie;Lee, Hee-Woo;Ahn, Young-Min
    • Clinical and Experimental Pediatrics
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    • v.51 no.8
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    • pp.812-819
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    • 2008
  • Purpose : Vitamin D plays a key role in bone mineralization of the skeleton and vitamin D deficiency can lead to rickets. It is well known that vitamin D deficiency is common in breast fed infants. Of these patients, clinically, some have no signs of rickets, but laboratory and radiographic findings are diagnostic for vitamin D deficiency rickets (subclinical vitamin D deficiency rickets). The purpose of this study is to clarify current causes and ways to prevent this disease. Methods : We reviewed the clinical and laboratory characteristics of children who were incidentally diagnosed as subclinical rickets during treatment of other disease such as pneumonia, gastroenteritis, urinary tract infection at Eulji Hospital, Seoul, Korea from March, 2003 to July 2007. Results : Eight patients (six boys and two girls) were diagnosed with subclinical vitamin D deficiency rickets. The mean age of the patients was $12.6{\pm}5.8months$, and they were diagnosed from January to July. The associated diseases were pneumonia, urinary tract infection, acute gastroenteritis, and iron deficiency anemia. All patients were breast-fed. Two showed growth failure. The mean serum alkaline phosphatase was $1995.8{\pm}739.5IU/L$, the mean calcium count was $9.5{\pm}0.6mg/dL$, and the mean phosphorus content was $3.6{\pm}1.5mg/dL$. The mean intact parathyroid hormone was $214.8{\pm}155.9pg/mL$ (reference range, 9-65), the mean 1,25-dihydroxyvitamin D was $82.4{\pm}49.3pg/mL$ (reference range, 2070), and the mean 25-hydroxyvitamin D was $29.6{\pm}10.6ng/mL$ (reference range, 1030). A radiographic examination showed cupping, fraying, and flaring of metaphyses in all patients. Six patients were administered calcitriol (400 IU/day) for three months. A consequent radiographic and laboratory examination showed improvement. The first two patients were initially diagnosed with metaphyseal dysplasia, without the detection of vitamin D deficiency and they spontaneously improved without vitamin D supplements. However, two years later, they showed mild scoliosis and metaphyseal dysplasia, respectively. Conclusion : Breast-feeding without supplementation involves high risk of vitamin D deficiency. Some infants may also develop rickets; therefore, such groups should be considered for vitamin D supplementation.

A Study on Seasonal Variations of Food Consumption of Korean Farmers (한국농촌주민(韓國農村住民)의 계절별(季節別) 식품섭취조사연구(食品攝取調査硏究))

  • Park, Michael Myung-Yun
    • Journal of Nutrition and Health
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    • v.9 no.1
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    • pp.43-50
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    • 1976
  • This is the report of a food consumption survey of 193 members of 30 farm families in three rural villages of Korea. From a total of 188 households of the three villages, namely Wolgok in Kyunggi Do Province, Wachon in Kangwon Do Province, and Sobong in Cholla Namdo Province, 30 households were chosen for the survey. Four consecutive seasonal surveys, beginning in the autumn, November 1974 and finishing with the summer, August 1975, were made and each survey covered three consecutive days. The Precise Weighing Method was used in evaluating the kinds of food and nutrient intakes of the subjects. This method entails the accurate weighing of all foods by the investigator just prior to their consumption by the subjects under investigation. This survey was male to determine the actual food eaten by the members of these farm families at each season of the year, and to note any special differences in the foods consumed. The results obtained are summarized as follows: Food Intake The traditional ordinary diet of Korean farmers consists mainly of rice and other cereals as staple foods, and simple subsidary foods. The nutritional shortcomings of rice as a staple food are evident in the subclinical status of nutritional deficiencies. The mean consumption of cereals and their products was very high and it was more than half of the daily total food intake throughout all the seasons. The consumption of animal food, fruits, and fat by the farmers was very low. Fruit intake during winter and spring was almost nil. One of the special foods in the Korean dietary pattern is Kim-chi, a variety of pickled and fermented vegetables. The mean intake of Kim-chi during autumn and winter was very much higher than the other seasons. Korean farmers have difficulties in balanced year-round supply of food due to seasonality of food production and lack of food preservation. As nutrition problems of Korean farmers are highly influenced by seasonal variations, the expansion of an appropriate food preservation and storage programme should be encouraged. Special consideration should be given to new methods of preservation, the types of foods preserved, and production and consumption of nutritionally valuable foods for the improvement of the nutritional status in rural communities. Nutrient Intake Average adult rates for calorie and protein in the three study areas were 0.80 and 0.87 respectively, with little variations by villages. The adult caloric intake in averaged 2,928 kcal for autumn, 2,662 for winter, 2,673 for spring, and 2,760 for summer. Cereals contributed most of the total calories. In terms of the recommended daily dietary allowances for the Korean given by the Korea FAO Association, the diets in this survey were adequate except in the winter and spring. The protein intake averaged from 76.4 grams in autumn to 83.4 grams in summer and was near the recommended allowance, but a relatively large proportion of the total protein came from cereals and their products. The fat intake was unsatisfactory, ranging from 19.2 grams to 29.3 grams for the four seasons, and the consumption during farming season was higher than other seasons. It is apparent that the diet of the Korean farmers should be supplemented by calcium during autumn and winter. The highest calcium intake, with a mean of 583.5 milligrams, was recorded in summer. The mean intake of iron ranged from a low of 9.2 milligrams in the autumn to a high of 15.0 milligrams in the spring and it was satisfactory for all seasons. Among the vitamin group, the daily average intakes of vitamin A, thiamine, riboflavin, and ascorbic acid were lower than the desired intake throughout all the seasons. The mean vitamin A intake as ${\beta}-carotene$ ranged from a low of 2,807.8 IU to a high of 5,221.0 IU. The thiamine intake ranged from 0.98 milligrams to 1.19 milligrams, while mean riboflavin intake ranged from 0.92 milligrams to 1.13 milligrams. Ascorbic acid intake was 37.3 milligrams, the lowest, and the highest 47.8 milligrams. Niacin intake among Korean farmers was higher than the recommended allowance throughout all the seasons, and the mean intake ranged from 18.3 milligrams to 25.8 milligrams. The main character of the Korean farmers' diet has been found low in quality of protein and high in carbohydrate. Attention should be paid to the low intake of vitamin A, thiamine, riboflavin, and ascorbic acid among Korean farmers.

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Menu pattern and food diversity of snack menus provided by Child Care Information Centers in Seoul (서울시 소재 육아종합지원센터에서 제공하는 어린이집 간식식단의 유형 및 식품 다양성)

  • Yeoh, Yoonjae;Kwon, Sooyoun;Lee, Youngmi
    • Journal of Nutrition and Health
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    • v.47 no.6
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    • pp.443-451
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    • 2014
  • Purpose: This study was conducted for analysis of menu pattern and food diversity of snack menus of child care centers in order to provide preliminary data for establishment of related guidelines for snack menus for child care centers. Methods: Data from 630 snack menus (350 for morning snacks and 280 for afternoon snacks) of March, 2013 from 14 Child Care Information Centers in Seoul provided for child care centers were analyzed. In addition, the menu pattern and food diversity of morning snack menus were compared with those of afternoon snack menus. Results: Differences in menu pattern and food diversity were observed between morning and afternoon snack menus. The majority of snack menus (66.8%) included two menu items and the numbers of menu items of afternoon snack menus were significantly larger than those of morning snack menus. The percentages of "Grains (G)" and "Grains (G) + Milk (D)" patterns were higher in snack menu (G: 18.9%, G+D: 17.1%). Approximately one third of snack menus were composed of only one food group. In addition, 45.6 % of all snack menus comprised milk and only 23.0% included fruits. Conclusion: These results demonstrated the need for improvement in food composition and diversity of snack menus provided by Child Care Information Centers for child care centers. Therefore, to ensure children's intake of nutritionally balanced snacks, it will be necessary to establish more detailed guidelines for the menu pattern and food composition in snack menus for child care centers.

Effects of nutrition education on nutrition-related knowledge, dietary habits, and nutrient intakes of alcoholic patients (영양교육이 알코올중독자의 영양지식, 식습관 및 영양섭취상태에 미치는 효과)

  • Kim, An Na;Lim, Hyeon-Sook
    • Journal of Nutrition and Health
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    • v.47 no.4
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    • pp.277-286
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    • 2014
  • Purpose: The aim of this study was to examine the characteristics of nutrition-related knowledge, dietary habits, and nutrient intakes of alcoholic patients and how nutrition education affects these nutritional behaviors. Methods: Subjects included 37 adult male alcoholic patients who were hospitalized. The nutrition education program consisted of five lessons over a five-week period. An each 80-minute nutrition education program per week was implemented for the alcoholic patients over a five-week period. Both before and after the implementation of nutrition education, their nutrition-related knowledge and dietary habits were assessed and nutrient intakes were investigated. Results: The subjects showed drinking habits of considerably high frequency, a large quantity of alcohol consumption, and preference for soju (a liquor) over beer. They had proper weight, height, and BMI, and came from relatively poor socioeconomic backgrounds with a low-level of self-rated health status and a comparatively high rate of suffering from disease. Mean score of their nutrition-related knowledge and dietary habits was quite low. They consumed less energy, dietary fiber, vitamin C, thiamin, riboflavin, folic acid, Ca, and K, but more Na compared to each Dietary Reference Intake (DRI). After implementing the nutrition education, mean score of nutrition-related knowledge and dietary habits showed significant improvement. In addition, the meeting rate of each DRI of several nutrients was increased significantly, including energy, carbohydrate, dietary fiber, vitamins A, C, and $B_6$, thiamin, riboflavin, niacin, pyridoxine, folic acid, Ca, P, K, Fe, and Zn, while that of Na decreased. Conclusion: The findings of this study indicate that alcoholic patients had various nutritional problems, such as lack of nutrition-related knowledge, bad dietary habits, and insufficient nutrient intakes, however, these problems can be positively modified by implementation of a relatively short-term nutrition education program.

Serum Carbohydrate Antigen 19-9 as an Indicator of Liver Metastasis in Colorectal Carcinoma Cases

  • Dong, Hang;Tang, Jie;Li, Long-Hao;Ge, Jun;Chen, Xin;Ding, Jing;Men, Hai-Tao;Luo, Wu-Xia;Du, Yang;Li, Cong;Zhao, Feng;Chen, Ye;Cheng, Ke;Liu, Ji-Yan
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.2
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    • pp.909-913
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    • 2013
  • Purpose: The liver is the organ to which colorectal carcinomas (CRCs) most commonly metastasize, and surgical resection has been established as the most effective and potentially curative treatment for CRC with liver metastasis (LM). Therefore, surveillance of LM is vital for improvement of prognosis of CRC patients. In this study, we aimed to explore the potential value of carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), and marker enzymes in indicating LM with CRC. Methods: Three groups of eligible patients with metastatic cancers were retrospectively included: CRC patients with LM (CRC-LM) or without LM (CRC-NLM), and non-CRC patients with LM (NCRC-LM). All metastatic lesions were identified by CT or MRI. Data on characteristics of the patients, the primary site, the locations of metastasis, CA 19-9, CEA, and biochemical parameters were collected for analysis. Results: A total of 493 patients were retrospectively included. More alcohol consumption was found in CRC-LM than CRC-NLM. Some biochemical enzymes were found to be significantly higher in groups with LM than without (CRC-LM or NCRC-LM v.s CRC-NLM). Both CEA and CA 19-9 were much higher in CRC-LM than CRC-NLM or NCRC-LM. For CRC patients, CA 19-9, ${\gamma}$-glutamyl transpeptidase, CEA and alcohol consumption were identified as independent factors associated with LM. Conclusion: Our analysis suggested the CA 19-9 might be a potential valuable indicator for LM of CRC in the clinic.

Results of Arthroscopic-assisted Minimally Invasive Removal of a Lateral Periarticular Plate used for the Treatment of AO Type-C Distal Femoral Fractures (AO C-형 원위 대퇴골 골절의 치료로 삽입된 관외측 금속판의 절경 보조하 최소 침습적 제거의 결과)

  • Kim, Young-Mo;Lee, June-Kyu;Yang, Jae-Hoon;Kim, Bo-Kun;Lee, Won-Gu
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.1
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    • pp.46-52
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    • 2009
  • Purpose: To evaluate the usefulness of minimally invasive arthroscopy-assisted plate removal of a laterally inserted periarticular distal femur plate used for the treatment of AO type-C distal femur fractures. Materials and Methods: From October 2002 to November 2005, we evaluated 17 patients whose plates were removed through minimally invasive arthroscopy-assisted plate-removal technique and 15 patients who got their plates removed through conventional method without using arthroscopy, 32 patients in total. All these patients included in this study initially underwent open reduction and internal fixation of the distal femoral fractures with a lateral plate, and complained of continued pain over the lateral femoral condyle after the fracture fixation. The average age was 42.6 (ranges: 20~66) and initial fracture types included 16 cases of C1, 11 cases of C2, and 5 cases of C3 following AO/ASIF classification guidelines. Measured outcomes included: associated intra-articular pathologies, time needed to return to activities of daily living, patients' overall satisfaction, complications following the removal of hardware, and pain before and 6 months after the operation. Results: The distal-most end of the plate was placed in the knee joint in all cases and damage of the lateral articular capsule was found in 23 cases. Continuous wound discharge after surgery was found in one case who underwent arthroscopy-assisted plate removal, and it was treated by irrigation and re-suture. Average time needed to return to activities of daily living was 7 days in arthroscopy assisted group and 7.6 days in conventionally removed group. Fourteen patients (82.4%) who underwent arthroscopyassisted plate-removal reported above 'fair' satisfaction and the Visual analog scale pain score decreased from 4.9 to 1.9, six months after the plate removal. Thirteen patients(86.7%) who underwent conventional plate removal reported above 'fair' satisfaction and the Visual analog scale pain score decreased from 5.2 to 2.5, six months after the operation. Conclusion: Through minimally invasive arthroscopic-assisted plate removal, intrarticular pathology of the knee joint was able to be simultaneously identified and treated at the time of hardware removal. Damage of lateral capsule of the knee joint caused by the inserted plate for the treatment of type C distal femoral fracture was very frequently found and following the plate removal, patients experienced an improvement in pain score. We therefore recommend routine lateral distal femoral plate removal if the bony union is attained in such cases as type C distal femoral fractures whose distal most end of the plates are located in the joint.

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Early Changes of Left Ventricular Geometry and Function after Surgical Ventricular Restoration and Mitral Valve Annuloplasty: Magnetic Resonance Imaging (외과적 심실 복원과 승모판 고리성형 후 좌심실 형태와 기능의 초기 변화: 자기공명영상)

  • Choi, Byoung-Wook;Chang, Byung-Chul;Kim, Young-Jin;Hur, Jin;Lee, Hye-Jeong;Kim, Tae-Hoon;Choe, Kyu-Ok
    • Investigative Magnetic Resonance Imaging
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    • v.12 no.1
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    • pp.40-48
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    • 2008
  • Purpose : We sought to determine the early change of ventricular geometry and function after concomitant surgeries of modified Dor procedure and mitral valve annuloplasty by using magnetic resonance imaging. Materials and Methods : We enrolled 21 patients with dilated heart failure who underwent modified Dor procedure (n=8), mitral valve annuloplasty (n=6), or both surgeries (n=7). Cine MRI was used to assess left ventricular dimensions and function before and after surgery. We measured the left ventricular end-diastolic and end-systolic volumes and the dimensions of the left ventricular long-axis and short-axis. Left ventricular stroke volume, ejection fraction, and sphericity index were calculated from these measurements. These parameters were analyzed and compared between three different surgery groups to explain the combined effect of the concomitant surgeries. Results : MRI was performed within average $12\;{\pm}\;15$ days (range 1-58 days) before and $38\;{\pm}\;50$ days (range 7- 231 days) after the surgery. The patients who underwent concomitant surgeries had more profound enlargement of left ventricle and decreased contractility prior to surgery than those in the patients who underwent single surgical procedure. Left ventricular end-diastolic volume and endsystolic volume significantly decreased in all patients regardless of surgery type after surgery. Ejection fraction significantly increased only in the patients who got modified Dor procedure without mitral valve annuloplasty (25.4% to 40.7%). Sphericity index increased in patients with modified Dor procedure but decreased in patients with mitral valve annuloplasty (0.65 to 0.78 vs. 0.75 to 0.65). In the patients who underwent concomitant surgeries showed no significant change in sphericity index after surgery. Conclusion : The early change of the left ventricular geometry and function after the concomitant surgeries with modified Dor procedure and mitral valve annuloplasty in patients with dilated heart failure includes a marked reduction in left ventricular volume and in stroke volume. The shape of the left ventricle does not change because the effect of sphericity index decrease from mitral valve annuloplasty is counteracted by the effect of sphericity index increase from modified Dor procedure. Improvement of left ventricular ejection fraction is not the early change after the concomitant surgeries.

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Noise-robust electrocardiogram R-peak detection with adaptive filter and variable threshold (적응형 필터와 가변 임계값을 적용하여 잡음에 강인한 심전도 R-피크 검출)

  • Rahman, MD Saifur;Choi, Chul-Hyung;Kim, Si-Kyung;Park, In-Deok;Kim, Young-Pil
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.12
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    • pp.126-134
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    • 2017
  • There have been numerous studies on extracting the R-peak from electrocardiogram (ECG) signals. However, most of the detection methods are complicated to implement in a real-time portable electrocardiograph device and have the disadvantage of requiring a large amount of calculations. R-peak detection requires pre-processing and post-processing related to baseline drift and the removal of noise from the commercial power supply for ECG data. An adaptive filter technique is widely used for R-peak detection, but the R-peak value cannot be detected when the input is lower than a threshold value. Moreover, there is a problem in detecting the P-peak and T-peak values due to the derivation of an erroneous threshold value as a result of noise. We propose a robust R-peak detection algorithm with low complexity and simple computation to solve these problems. The proposed scheme removes the baseline drift in ECG signals using an adaptive filter to solve the problems involved in threshold extraction. We also propose a technique to extract the appropriate threshold value automatically using the minimum and maximum values of the filtered ECG signal. To detect the R-peak from the ECG signal, we propose a threshold neighborhood search technique. Through experiments, we confirmed the improvement of the R-peak detection accuracy of the proposed method and achieved a detection speed that is suitable for a mobile system by reducing the amount of calculation. The experimental results show that the heart rate detection accuracy and sensitivity were very high (about 100%).