No abstract available.
Lung* ; Tracheoesophageal Fistula*

The paramount importance of breast feeding for the health of the infants has been recognized by untritionists and physicians. Although many advantages of the breast feedng, exclusive breast feeding without weaning diet or supplement food during prolonged perind in infants may produce iron deficiencyh anemia. This study was conducted to find out the hematologic state in exclusively prolonged breast-fed infants among these anemic patients and the way of thinking about their baby's feeding method in their mothers. Mothers of the anemic patients has been surveyed with questionare. The results and problems obtained from this study are summerized as follows. 1) Among 40 patients of this study, 27 were male (67.5%) and 13 were female (32.5%). Mean age was 12.6+/-2.7 month and 9 & 11 month of age were the most common, respectively (15.0%). 2) Mean age of mothers was 29.5 year. The 25 34 year-old group was most common. 3) Education levels of mothers were primary 10%, middle 10%, high 60%, and college graduate 20%. 4) In motivatins of breast feeding. Persuasion of husband or the parent of husband' 19(47.5%). 'Convenience for use' 12 (30.0%), and 'Through mass media or public information' 9 (22.5%). 5) In the causes of prolonged breast feeding, 'Think that satisfactory nutrition for baby is possible with breast milk alone' 4(10.0%), 'Due to persuasion of husband or the parents of husband' 11 (27.5%), 'Baby did no suck milk bottle or eat other diet except breast milk' 25 (62.5%). 6) In whether or not acknowledgment of the necessity of weaning diet, 'Know it but not consider so important 22 (55.0)%, 'Do not know at all) 15 (37.5%), and 'Breast milk, that will do' 3(7.5%). 7) Hb level in patient group, from 6 to 6.9g/dl was 2 (50.0%), from 7 to 7.9g/dl was 3 (7.5%), from 8 to 8.9%g/dl was 15 (37.5%), and from 9 to 10 g/dl was 20 (50.0%). From 9 to 10g/dl was the most common. Hematologic findings were Hb 8.8+/-0.9g/dl, Hct 28.8+/-3.0%, MCV 64.7+/-6.7 fl, MCH 20.0+/-2.5pg, MCHC 30.8+/-1.5g/dl. Platelet 452.5+/-142.9x103/mm3, Reticulocyte count 1.4+/-0.6%, Fe 28.6+/-14.1 g/dl, TIBC 446.7+/-66.2 g/dl, Ferritin 10.5+/-7.0ng/ml. Transferrin saturation 6.6+/-3.5%. 8) In association with duration of breast milk feeding and hematologic findings, as duration was prolonged, Hb, Hct, MCV & MCH were significantly decreased (p<0.01).
Adult ; Anemia* ; Blood Platelets ; Breast Feeding* ; Breast* ; Diet* ; Education ; Feeding Methods ; Female ; Ferritins ; Humans ; Infant ; Iron ; Male ; Mass Media ; Milk ; Milk, Human ; Mothers ; Parents ; Persuasive Communication ; Reticulocyte Count ; Spouses ; Thinking ; Transferrin ; Weaning*

PURPOSE: This study was designed to establish standard guidelines to meet the growing health care needs of adolescents by direct assessment of pediatricians' current practices, attitude and obstacles to the primary care of adolescents. MEHTODS: A questionnaire consisting of 9 questions, including personal characteristics of respondents, current health care practice of adolescents, attitude, obstacles to providing adolescent care, interest in further training, roles of Korean Pediatric Society for adolescent medicine, etc., was completed by 214 pediatricians. RESULTS: Among the respondents, 87.4% were in the 4th or 5th decade of age, and 88.8% of respondents were working for private clicins. More than 60% of respondents were managing patients without age limits. Most of the respondents were interested in adolescent medicine. However, approximately one half of all respondents answered that they could not currently provide satisfactory care to their adolescent patients. Obstacles to providing adolescent care include : their image as "baby doctors", lack of knowledge and skills in adolescent medicine, lack of separate hours for adolescents and concern that parents would object to certain types of care. Among respondents who wanted to further training, many were interested in Continuing Medical Education(CME) course, lecture series, introducing reading lists and publishing textbooks, while others expressed their interest in a newsletter and mini-fellowship. Respondents expected the Korean Pediatric Society to play a role in activating the adolescent medicine as a field for pediatric practice through educating adolescents, pediatricians and advertising via mass media. CONCLUSION: Future policy decisions and medical education must respond to these realities in pediatric practice.
Adolescent Medicine ; Adolescent* ; Surveys and Questionnaires ; Delivery of Health Care* ; Education, Medical ; Humans ; Mass Media ; Parents ; Periodicals as Topic ; Primary Health Care

PURPOSE: This study was to evaluate the relationship of 25(OH)D3 levels with anticonvulsant use and other possible factors in epileptic children and adolescents. MATERIALS AND METHODS: We studied 143 patients with epilepsy (90 boys, 53 girls; 11.21+/-4.49 years), who had been treated with anticonvulsants for more than 1 year. Patients who had taken multiple vitamins before the blood test and those who have the limitation of physical activity (wheelchair-bound) were excluded from the study. We evaluated the difference in vitamin D status according to the type and number of anticonvulsants taken and other factors such as gender, age, intelligence and seizure variables. RESULTS: For patients with mental retardation or developmental delay, 25(OH)D3 levels were lower than the levels in patients with normal intelligence quotient levels (p=0.03). 25(OH)D3 levels were lower in patients who had taken anticonvulsants for more than 2 years as compared to those who had taken them for less than 2 years (p=0.03). Those taking oxcarbazepine had significantly lower vitamin D levels than patients taking valproic acid (p=0.01). However, no effects of number of anticonvulsants taken were detectable. More than two-thirds of the patients were diagnosed with osteopenia or osteoporosis in patients showing either vitamin D insufficiency or deficiency. CONCLUSION: The possibility of vitamin D deficiency can be considered in pediatric patients taking anticonvulsants if they have mental retardation or developmental delay or if they have been taking anticonvulsants for more than 2 years or taking hepatic enzyme inducing drugs.
Adolescent* ; Anticonvulsants ; Bone Diseases, Metabolic ; Child* ; Developmental Disabilities ; Epilepsy ; Female ; Hematologic Tests ; Humans ; Intellectual Disability ; Intelligence ; Methods ; Motor Activity ; Osteoporosis ; Seizures ; Valproic Acid ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

PURPOSE: There is a paucity of evidence about prognosis after a first febrile seizure in older children. We investigated the prognosis and potential risk factors associated with subsequent unprovoked seizures in children who had experienced a first febrile seizure over 6 years of age, which we termed as late-onset febrile seizure. METHODS: We included all patients six years or older who presented to the emergency department with a febrile seizure between 2009 and 2015. Clinical data was collected by chart review and parents were contacted for information on seizure progress. We used the Cox proportional-hazards model and Kaplan-Meier analysis for evaluating the risk factors for subsequent unprovoked seizures. RESULTS: Of 247 patients, we excluded 168 children who had a history of epilepsy, unprovoked, or febrile seizure and who were followed-up for period less than six months. Overall, 79 patients were classified as having had a first late-onset febrile seizure. During follow-up of 34.9±25.7(mean±SD) months, unprovoked seizure recurred in 7 of 79 patients (9%). The cumulative probability of seizure recurrence was 4% at 6 months, 6% at 1 year and 9% at 2 years. Clinical variables predictive of subsequent unprovoked seizures were not proved. CONCLUSION: This is the first multicenter study focusing on prognosis after a late-onset febrile seizure in children six years or older. The percentage of subsequent unprovoked seizure in patients with late-onset febrile seizure was 9% at 2 years of follow-up. Prospective follow-up study with longer duration is warranted.
Child ; Emergency Service, Hospital ; Epilepsy ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Parents ; Prognosis* ; Prospective Studies ; Recurrence ; Risk Factors ; Seizures ; Seizures, Febrile*

Tyrosinemia type 1 is an autosomal recessive disorder caused by deficiency of the enzyme fumarylacetoacetate hydrolase(FAH). The disease is characterized by hepatic dysfuntion, hepatocellular carcinomas, renal tubular dysfunction, rickets, and neurologic crises. Two forms of the disease, acute and chronic, are thought to be from the residual enzyme activity in the liver. The diagnosis of the tyrosinemia type 1 is suggested by elevated plasma tyrosine, supported by increased urinary succinylacetone, and confirmed by reduced FAH activity in cultured fibroblasts. We had a 5 month old Korean boy with acute tyrosinemia type 1 who presented with recurrent sepsis-like episodes since 2 months of age, progressive liver dysfunction, and rickets. Plasma amino acid analysis showed markedly elevated tyrosine, methionine and urine amino acid analysis was suggestive of Fanconi syndrome showing generalized aminoaciduria. Organic acid analysis by Gas Chromatography/Mass Spectrometry detected large amount of succinylacetone excreted in the urine. Delta-aminolevulinic acid was elevated as well. X-ray findings were characteristics of rickets and abdominal sonogram, CT and MRI revealed cirrhotic liver with varying size of multiple nodules. Liver transplantation was strongly recommended throughout his clinical course but refused by parents, and he died of hepatic failure at the age of 8 months. Autospy was perfomed showing macro and micronodular liver cirrhosis. Kidney was markedly enlarged, however, glomeruli and tubules were relatively unaltered. Mutation analysis is under the study.
Acute Disease ; Aminolevulinic Acid ; Carcinoma, Hepatocellular ; Diagnosis ; Fanconi Syndrome ; Fibroblasts ; Humans ; Infant* ; Kidney ; Liver ; Liver Cirrhosis ; Liver Diseases ; Liver Failure ; Liver Transplantation ; Magnetic Resonance Imaging ; Male* ; Methionine ; Parents ; Plasma ; Rickets ; Spectrum Analysis ; Tyrosine ; Tyrosinemias*

PURPOSE: Pharmacologic provocation test of growth hormone(GH) is a non-physiologic method and has several limitations for diagnosing growth hormone(GH) deficiency. Spontaneous GH release studies could be important in understanding the pathophysiology of children with poor growth but normal responses to GH provocation tests. Also, the relationship between nocturnal GH secretions and sleep patterns in short stature children is poorly understood. The aim of this study is to determine whether there are differences in sleep patterns and nocturnal GH secretory profiles between idiopathic short stature children and a normal stature group. METHODS: Spontaneous nocturnal GH secretions and sleep patterns were evaluated in 12 prepubertal idiopathic short stature children with normal responses to provocation tests and 9 normal stature controls. Blood samples were taken every 30 minutes from 22:00-06:30 and sleep patterns were analyzed by polysomnography. RESULTS: The mean GH level during sleep was significantly lower in short stature children than in controls. The peak GH level after sleep, coincident with the first slow wave sleep, was lower in the short stature group. The slow wave sleep times of short stature children were decreased compared with those of normal subjects. CONCLUSION: These results suggest that overnight serial GH sampling is helpful to identify short stature children with subnormal GH secretions, and sleep structure differences may be associated with decreased overnight GH secretions in short stature children.
Child* ; Growth Hormone* ; Humans ; Polysomnography

Background: This study analyzed the practice of dental medical dispute prevention rules of dental hygienists to present an improvement plan for improving perceived importance and practice and provide data for the development of effective medical dispute prevention programs. Methods: A self-administered questionnaire survey was conducted targeting dental hygienists who were providing assistance at dental hospitals and dental clinics in Seoul and Gyeonggi-do regions from March 22 to April 28, 2022. The questionnaire collected from 273 dental hygienists consisted of eight questions on general characteristics, 30 questions on medical dispute experience, and 14 questions on medical dispute prevention. Results: Complaints showed a high experience rate in ‘Consultation & reservation’, medical disputes in ‘Patient handling (unkind) related’, and ‘Prosthesis installation and cement removal’. In both the importance and practice of medical dispute prevention rules, Preservation of medical records and other medical-related data’ was high, and ‘Management of patients on standby for a long time’was low in terms of practice. ‘Lack of time’ and ‘Lack of manpower’ were cited as reasons for not resolving dental treatment disputes. The importance of dental dispute prevention rules was found to be significant according to age and position, and it was also found to affect the level of practice. Conclusion Seventy-six-point six percent of the respondents said that education on the prevention of medical disputes was necessary, although they lacked recognition of prevention rules compared to their perceptions and experiences. This study suggested specifying prevention rules in dental hygiene subjects and expanding education, improvement of dental treatment system, revise the law on the range of work to improve the recognition and practice of prevention rules.

Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.