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.

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

Rett syndrome (RTT) is an X-linked dominant neurodevelopmental disorder affecting 1 per 10,000- 15,000 female births worldwide. The disease-causing gene has been identified as MECP2 (methyl- CpG-binding protein 2). In this study, we performed diagnostic mutational analysis of the MECP2 gene in RTT patients. Four exons and a putative promoter of the MECP2 gene were analyzed from the peripheral blood of 43 Korean patients with Rett syndrome by PCR-RFLP and direct sequencing. Mutations were detected in the MECP2 gene in approximately 60.5% of patients (26 cases/43 cases). The mutations consisted of 14 different types, including 9 missense mutations, 4 nonsense mutations and 1 frameshift mutation. Of these, three mutations (G161E, T311M, p385fsX409) were newly identified and were determined to be disease-causing mutations by PCR- RFLP and direct sequencing analysis. Most of the mutations were located within MBD (42.3%) and TRD (50%). T158M, R270X, and R306C mutations were identified at a high frequency. Additionally, an intronic SNP (IVS3+23C>G) was newly identified in three of the patients. IVS3+23C>G may be a disease-related and Korea-specific SNP for RTT. L100V and A201V are apparently disease-causing mutations in Korean RTT, contrary to previous studies. Disease-causing mutations and polymorphisms are important tools for diagnosing RTT in Koreans. The experimental procedures used in this study should be considered for clinical molecular biologic diagnosis.
Rett Syndrome/diagnosis/*genetics ; Polymorphism, Single Nucleotide ; Polymorphism, Restriction Fragment Length ; Polymerase Chain Reaction ; *Mutation ; Molecular Sequence Data ; Methyl-CpG-Binding Protein 2/*genetics ; Male ; Korea ; Humans ; Female ; DNA Mutational Analysis ; Base Sequence

BACKGROUND AND OBJECTIVES: The level of thyroid-stimulating hormone (TSH)-stimulated thyroglobulin (Tg) after thyroid hormone withdrawal (THW) is the most sensitive marker for detecting recurrence of differentiated thyroid cancer (DTC). In DTC, Tg production is regulated by TSH; however, TSH values after THW are never identical, even in the same patient. The objective of this study was to evaluate the influence of TSH on Tg levels after THW. MATERIALS AND METHODS: TSH and Tg concentrations were measured twice at 2 and 3 weeks after THW in 309 patients with DTC. TSH and Tg levels at these time points were compared. The percent change in TSH (ΔTSH) and change in Tg level (%ΔTg) from 2 to 3 weeks after THW were calculated, and Pearson's correlation coefficients were calculated to determine whether ΔTSH could affect %ΔTg. Tg cutoff value for diagnostic imaging was 2 ng/mL. RESULTS: The TSH and Tg values at 3 weeks were significantly higher than those at 2 weeks after THW. Tg values increased significantly to >2 ng/mL after 1 week in 38.5% of the patients with Tg values of 0.2-2 ng/mL at 2 weeks after THW. In patients with Tg values ≥2 ng/mL at 2 weeks after THW, Tg values increased significantly after an additional week of THW. ΔTSH correlated significantly with %ΔTg. CONCLUSION: TSH values differed according to time after THW, and Tg values differed significantly according to TSH values. Therefore, TSH values should be considered carefully when interpreting the meaning of Tg levels in patients with DTC.
Diagnostic Imaging ; Humans ; Recurrence ; Thyroglobulin* ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyrotropin*

PURPOSE: In this study, doctors were surveyed with a questionnaire to determine whether they performed simultaneous vaccination and whether there were any concerns about safety or anxiety. The purpose of this study was to determine any problems associated with doctors readily performing simultaneous vaccination. METHODS: A trained surveyor visited 241 doctors from every institution registered with the National Immunization Program (NIP) located within six districts (gu) in the City of Busan (Dongnae-gu, Geumjeong-gu, Yeonje-gu, Suyeong-gu, Busanjin-gu, Haeundae-gu); a total of 155 (64%) valid responses were obtained. RESULTS: Of the 155 respondents, 144 (93%) were already performing simultaneous immunizations and 141 (91%) had a positive view of the practice. However, among the 144 doctors performing simultaneous immunizations, 67 (47%) were not confident about its safety; side effects were seen after simultaneous immunization by 86 doctors, 35 (41%) of whom believed that the frequency or possibility of side effects in simultaneous immunizations was higher than that in sequential immunizations. CONCLUSIONS: The use of simultaneous immunization is expanding quickly. However, among the doctors performing simultaneous immunizations, a high percentage had concerns over its unproven safety and potential side effects, indicating the need for academic societies or government institutions to present evidence to address such concerns.
Anxiety ; Busan ; Surveys and Questionnaires ; Immunization ; Immunization Programs ; Vaccination*

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

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