Cerebral Venous Sinus Thrombosis (CVST) in children is rare and its cause is multifactorial. The clinical manifestations of CVST vary and may cause long-term neurological sequelae and even death on rare occasion. In this case, a 15 year old boy presented with severe headache and vomiting for 1 day. Brain MRI with venography revealed multiple lesions of CVST in superior sagittal sinus and the left transverse sinus. Anticoagulation therapy was performed for 3 months, which led to the complete resolution in superior sagittal sinus and partial resolution in left transverse sinus.
Adolescent ; Brain ; Child ; Headache ; Humans ; Phlebography ; Sinus Thrombosis, Intracranial ; Superior Sagittal Sinus ; Vomiting

Background and Objectives: The aim of this study was to determine the clinical effectiveness of parotid gland (PG) massage for the prevention of PG dysfunction after administration of radioiodine (I-131) therapy for treatment of differentiated thyroid cancer (DTC). Materials and Methods: One hundred patients with DTC with planned high-dose I-131 therapy were enrolled in the clinical trial and randomized into two groups (massage and non-massage group). Serum amylase values were obtained before and 24 h after I-131 therapy, and salivary gland scintigraphy (SGS) were taken before and at eight months after the I-131 therapy. Additional SGS (addSGS) were taken when the patients complained symptoms related to salivary gland dysfunction. Questionnaire surveys were performed before and until two years after I-131 therapy. Results Ninety-five of 100 patients finished the study protocol. Changes in survey scores tended to be higher in the non-massage group. The non-massage group had more severe symptoms related to salivary gland dysfunction. Among 32 patients who underwent addSGS, 27 had normal 8-month SGS. Of these 27 patients, 18 (66.7%) had salivary gland dysfunction on the addSGS. Amylase values were significantly increased in patients with normal 8-month SGS but abnormal addSGS, as compared to patients who were normal on both 8-month SGS and addSGS (p=0.046). Amylase difference values were a significant predictor of abnormal addSGS (p=0.002). Conclusion: PG massage reduced symptoms related to salivary gland dysfunction. The PG massage may be helpful in preventing damage to salivary glands caused by I-131 therapy.

Background and Objectives: The aim of this study was to determine the clinical effectiveness of parotid gland (PG) massage for the prevention of PG dysfunction after administration of radioiodine (I-131) therapy for treatment of differentiated thyroid cancer (DTC). Materials and Methods: One hundred patients with DTC with planned high-dose I-131 therapy were enrolled in the clinical trial and randomized into two groups (massage and non-massage group). Serum amylase values were obtained before and 24 h after I-131 therapy, and salivary gland scintigraphy (SGS) were taken before and at eight months after the I-131 therapy. Additional SGS (addSGS) were taken when the patients complained symptoms related to salivary gland dysfunction. Questionnaire surveys were performed before and until two years after I-131 therapy. Results Ninety-five of 100 patients finished the study protocol. Changes in survey scores tended to be higher in the non-massage group. The non-massage group had more severe symptoms related to salivary gland dysfunction. Among 32 patients who underwent addSGS, 27 had normal 8-month SGS. Of these 27 patients, 18 (66.7%) had salivary gland dysfunction on the addSGS. Amylase values were significantly increased in patients with normal 8-month SGS but abnormal addSGS, as compared to patients who were normal on both 8-month SGS and addSGS (p=0.046). Amylase difference values were a significant predictor of abnormal addSGS (p=0.002). Conclusion: PG massage reduced symptoms related to salivary gland dysfunction. The PG massage may be helpful in preventing damage to salivary glands caused by I-131 therapy.

OBJECTIVES: To compare the mortality rate of children under ages five from different countries by their causes and to explore the cause of death that is relatively higher in South Korea and came up with measures for resolution. METHODS: The statistics were based from section ICD(International Classification of Diseases)-10 of WHO(World Health Organization) Mortality Database. Among the OECD(Organization for Economic Cooperation and Development) countries, 15 countries with higher GDP(Gross Domestic Product) than South Korea were studied by the mortality rate from 2005 to 2010 sorted into two groups: 0 year group and 1-4 years group. Then the cause of death investigated in detail. RESULTS: Among the 15 countries, average mortality of 0 year group in Korea ranked 8th and the average mortality of 1-4 years group ranked 4th out of 15. There were no significance in the mortality of 0 year group caused by any specific disease, but unnatural death was ranked 2nd after the United States. The natural death of 1-4 years group was ranked 6th, and the unnatural death was ranked 2nd after the Unites States. Among the natural deaths of 1-4 years group, the cause of death significantly higher was found to be disease G(nervous system disease). Among the subgroups of disease G, the orders went epilepsy, cerebral palsy, paralysis, and inflammatory disease. CONCLUSIONS: We have identified major causes of death of children under age 5. The highest proportion of cause of death in 1-4 years group was nervous system disease and we have proposed resolution. Henceforth, this data will be used as a foundational data for formulating policies relation to the Mother-Child Health.
Cause of Death ; Cerebral Palsy ; Child ; Child Mortality ; Classification ; Epilepsy ; Humans ; Korea ; Mortality ; Nervous System Diseases* ; Paralysis ; United States ; World Health Organization

To investigate the toxic effects of cheonggukjang (CKJ) manufactured using mixed cultures of Bacillus subtilis MC31 and Lactobacillus sakei 383 on the liver and kidney of ICR mice, an alteration on the related markers including body weight, organ weight, urine composition, liver pathology and kidney pathology were analyzed after oral administration at dosage of 25, 50 and 100 mg/kg body weight/day of CKJ for 14 days. Any significant toxicity was not observed on the body and organ weight, clinical phenotypes, urine parameters and mortality in the CKJ-treated group compared with the vehicle-treated group. Also, liver toxicity analysis revealed no significant increase in alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) or lactate dehydrogenase (LDH) in response to CKJ. Additionally, the specific pathological features induced by most toxic compounds were not observed upon liver histological analysis. Furthermore, kidney toxicological analysis revealed that blood urea nitrogen (BUN) and the serum creatinine (Cr) levels and pathological features on histological sections did not differ significantly between the vehicle- and CKJ-treated groups. Overall, these results suggest that CKJ does not induce any specific toxicity in liver and kidney organs of ICR at dose of 100 mg/kg body weight/day as no observed adverse effect level (NOAEL).
Administration, Oral ; Alanine Transaminase ; Alkaline Phosphatase ; Animals ; Aspartate Aminotransferases ; Bacillus subtilis* ; Blood Urea Nitrogen ; Body Weight ; Creatinine ; Kidney* ; L-Lactate Dehydrogenase ; Lactobacillus* ; Liver* ; Mice ; Mice, Inbred ICR* ; Mortality ; No-Observed-Adverse-Effect Level ; Organ Size ; Pathology ; Phenotype ; Soybeans*

Streptococcus salivarius meningitis is very uncommon, and most cases are iatrogenic, occurring after invasive procedures such as spinal anesthesia or lumbar puncture etc.. Post-traumatic occurrence of this infection is especially rare. A 20-year-old man with a previous history of skull base fracture was seen at the emergency department with signs of acute bacterial meningitis. The CSF had a few gram positive cocci with neutrophilic pleocytosis, which were identified as S. salivarius by the Vitek system (bioMerioux, Inc., Hazelwood, MO, USA), rapid ID 32 Strep (bioMerieux, Marcy-l'Etoile, France) and 16S rRNA sequencing. The microorganism showed intermediate resistance to penicillin (MIC=0.25 microg/mL) but was susceptible to cefotaxime (MIC=0.25 microg/mL) and vancomycin (MIC= 0.75 microg/mL). The patient was treated with ceftriaxone and vancomycin. He also had his CSF leakage repaired by an endoscopic approach. To our knowledge, this is the first case of S. salivarius meningitis reported in Korea.
Anesthesia, Spinal ; Cefotaxime ; Ceftriaxone ; Cerebrospinal Fluid Rhinorrhea ; Emergencies ; Gram-Positive Cocci ; Humans ; Korea ; Leukocytosis ; Meningitis ; Meningitis, Bacterial ; Neutrophils ; Penicillins ; Skull ; Skull Base ; Skull Fractures ; Spinal Puncture ; Streptococcus ; Vancomycin ; Young Adult

OBJECTIVE: Spontaneous intracranial hypotension(SIH) is a rare condition presented with cardinal postural headache and low CSF pressure. The authors describe the characteristic clinical features, imaging findings, and treatment methods in the patients with spontaneous intracranial hypotension. METHODS: Between May 1994 and Aug. 2001, eight patients were diagnosed with spontaneous intracranial hypotension based on characteristic radiologic and clinical findings in our department. All cases were shown diffuse meningeal enhancement(DME) on magnetic resonance(MR) image. Two cases had subdural hematoma. RESULTS: The most characteristic feature on Brain MR image is DME with/without subdural fluid collection. Radionuclide image reveals direct leaking point and rapid appearance of urinary bladder activity. Direct leaking points were detected in all four cases who performed radioisotope study. Autologous epidural blood patches were applied to four cases, and all of them were improved without complication. Among four patients treated with conservative method, three were improved, but one patient was died of spontaneous chronic subdural hematoma. CONCLUSION: We suggest that 1) meticulous studies need to be performed aggressively if SIH is diagnosed clinically and radiologically, 2) the most effective study may be radioisotope study, and 3) if leaking point is found, aggressive management such as autologous epidural blood patches is recommended.
Blood Patch, Epidural ; Brain ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Chronic ; Humans ; Intracranial Hypotension* ; Urinary Bladder

Severe symptomatic hyponatremia shows high mortality in association with cerebral edema and central nervous system dysfunction. Postoperative hyponatremia is usually attributed to administration of hypotonic fluids while antidiuretic hormone is acting. However, we experienced a severe symptomatic hyponatremia in spite of infusion of lactated Ringer's solution perioperatively in a case of 4-year-old girl's tonsillectomy. Inappropriate secretion of ADH caused by pain, stress, anxiety, nausea, vomiting. Paralytic ileus developed several hours after surgery, severe hyponatremia (Na 119 mmol/L) with convulsion notified. After prompt infusion of sodium supplement and fluid restriction, the patient recovered uneventfully.
Anxiety ; Brain Edema ; Central Nervous System ; Child, Preschool ; Humans ; Hyponatremia* ; Intestinal Pseudo-Obstruction* ; Mortality ; Nausea ; Seizures* ; Sodium ; Tonsillectomy* ; Vomiting

OBJECTIVES: Nowadays most infants on exclusively breast feeding have vitamin D deficiency due to the increase of breast feeding. However, domestic research lacks appropriate materials. Therefore, we researched practical clinical aspects of vitamin D deficiency related to breast milk feeding for infants who have a high amount of alkaline phosphatase (> 500 IU/L). METHODS: The subjects of the study were 31 infants with high alkaline phosphatase level. We tested with 25-hydroxycholecalciferol (25-OHD3), parathyroid hormone, calcium, ionized calcium, phosphorus in their blood and with a wrist x-ray. Then, we divided them into two groups of breast feeding and formula feeding and compared the results. RESULTS: Eighteen infants (58%) out of 31 infants that have high alkaline phosphatase were vitamin D insufficiency or deficiency, and 16 (100%) breast feeding infants of them showed vitamin D deficiency or insufficiency. However, only 2 (13%) of 15 formula feeding infants were at insufficiency. There was a correlation between alkaline phosphatase and 25-OHD3 concentration in multiple regression analysis, but no correlation in other variables was found in group of breast milk feeding infants. There was neither correlation between vitamin D concentration and alkaline phosphatase nor other correlated variables in the group of formula milk feeding infants. CONCLUSIONS: In this study, there was a high probability of vitamin D deficiency in the breast feeding infants with a high alkaline phosphatase level. Therefore, it is considered to be worth utilizing alkaline phosphatase as a screening test for vitamin D deficiency or rickets for breast feeding infants.
Alkaline Phosphatase ; Breast Feeding ; Calcifediol ; Calcium ; Humans ; Infant ; Mass Screening ; Milk ; Milk, Human ; Parathyroid Hormone ; Phosphorus ; Rickets ; Vitamin D ; Vitamin D Deficiency ; Vitamins ; Wrist

In 1897, Poncet described polyarthritis in patients suffering from tuberculosis which was not caused by tuberculosis infection of the joints. Poncet's disease is characterized by a polyarthritis that occurs during the acute tuberculosis infection in which no mycobacterial involvement can be found or other known cause of polyarthritis detected. It is a different entity from tuberculous arthritis, which is usually monoarticular and is caused by direct tuberculous infection. It was little known for pathogenesis of Poncet's disease, but immunologic reaction was suggested. Poncet's disease is associated with an excellent prognosis with rapid resolution on commencing therapy and no sequelae. Therefore, recognition of Poncet's disease can be important. Poncet's disease remains a diagnosis of exclusion.Recently, we experienced one case of Poncet's disease which have characterized by the clinical manifestations, and report this case with a review of the literatures.
Arthritis ; Diagnosis ; Humans ; Intestines* ; Joints ; Lymph Nodes* ; Prognosis ; Tuberculosis*