Spontaneous pneumomediastinum is rare in children, mainly affecting male adolescents. It usually occurs secondary to alveloar rupture in the pulmonary interstitium, followed by dissection of gas towards the hilum and mediastinum. Many pathological and physiological events can lead to alveolar rupture, but the most common cause in children is asthma. The most frequent triggers in the pediatric age group are asthma, vomiting of any cause, situations reproducing the Valsalva maneuver (e.g., shouting, coughing), and intense sport activities. We report two cases of pneumomediastinum, occuring in a patient with vigorous coughing and pneumonia and in a patient with dyspnea and pneumonia. We describe the clinical and radiologic findings of two cases. In addition, we have made a comprehensive review of the literature on spontaneous pneumomediastinum in children.
Adolescent ; Asthma ; Child ; Cough ; Dyspnea ; Humans ; Mediastinal Emphysema* ; Mediastinum ; Pneumonia ; Rupture ; Sports ; Subcutaneous Emphysema ; Valsalva Maneuver ; Vomiting

PURPOSE: In most patients of Kawasaki disease(KD), fever subsides within 48 hours after infusion of intravenous immunoglobulin(IVIG), but in some cases, retreatment of IVIG is needed because of prolonged fever. This study was performed to findout the factors associated with the retreatment of IVIG in KD. METHODS: Patients with KD, treated with IVIG were classified into two groups : single IVIG treatment group(defeverescence within 48 hours after starting IVIG : group B) and IVIG retreatment group(retreatment with IVIG for fever over 48 hours despite the 1st infusion of IVIG; group A). We compared the clinical symptoms, laboratory findings, clinical signs and echocardiogram findings between group A and B. RESULTS: The mean CRP level of group A was higher than that of group B(P= 0.001), and the mean cholesterol level of group A was lower than that of group B(P=0.002). In CRP level is above 10 mg/dL, odds ratio for retreatment of IVIG is higher than that of level below 10 mg/dL. As cholesterol level decreased, the odds ratio for retreatment with IVIG increased. CONCLUSION: When readministration of IVIG in KD patients for prolonged fever over 48 hours, the consideration of the initial levels of relatively low serum cholesterol and high CRP is recommended.
Cholesterol ; Fever ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Mucocutaneous Lymph Node Syndrome* ; Odds Ratio ; Retreatment*

Ovarian fibroma is one of the sex cord-stromal tumor, and accounts for about 5 percent of all ovarian tumors surgically removed. This tumor is almost always unilateral and appears to affect the left ovary more often (75%) than the right. Calcification is one of the secondary changes that can take place in a fibroma of ovary. The occurrence of ossification in these calcified fibromas is rare. We experienced a case of an ovarian calcified fibroma with ossification occurring in a 19 year old, unmarried woman with a brief review of literature.
Female ; Fibroma* ; Humans ; Osteoma* ; Ovary ; Sex Cord-Gonadal Stromal Tumors ; Single Person ; Young Adult

PURPOSE: Vertigo and dizziness are not common complaints in childhood, but are present more often than formerly thought. A detailed interview and otoneurological examination are important for reaching a specific diagnosis and treatment. The purpose of our study was to obtain our own etiological, clinical and diagnostic statistics, and to review the major related pathologies. METHODS: We investigated eighty-five children who visited Dankook University Hospital with a chief complaint of vertigo. Presenting symptoms, the result of diagnostic tests, and etiologic diagnoses were evaluated. RESULTS: Benign paroxysmal vertigo in childhood was the most common etiology of childhood vertigo accounting for about 38.8%, and migrainous vertigo and post-traumatic vertigo were present in 17.6% and 12.9% respectively. In vestibular function testings, electronystagmography and rotating chair test were abnormal in 11.2% and 21.2%, and the score of sensory organization test in posturography was lower than 50 in 44.4%. Other clinical diagnostic tests were informative for elucidation of individual etiologies. CONCLUSION: Benign paroxysmal vertigo in childhood and migrainous vertigo were the most common etiologies in childhood vertigo, with the former more common in under 12 years and the latter more common in over 12 years. Vestibular function tests were not so informative in diagnostic approach of childhood vertigo.
Child ; Diagnosis ; Diagnostic Tests, Routine ; Dizziness ; Electronystagmography ; Humans ; Pathology ; Vertigo* ; Vestibular Function Tests

PURPOSE: We aimed to assess the influence of perinatal factors on intra-arterial mean blood pressures of very low birth weight infants during the first seven days of life and the association of intra-arterial mean blood pressures on the common morbidities and neonatal death of very low birth weight infants. METHODS: The retrospective study on intra-arterial mean blood pressures over the first seven days of life in 103 very low birth weight infants who admitted to the neonatal intensive care unit at the Dankook University Hospital from Jan. 1996 to Dec. 2000 was done. Trend data for each infants were assessed in 9 time periods until seven days of age. Perinatal factors that might influence intra-arterial mean blood pressures and the association of intra-arterial mean blood pressures on neonatal death and common morbidities were assessed. RESULTS: Intra-arterial mean blood pressures of very low birth weight infants increased with birth weight and gestational age (P<0.05), and significantly increased with postnatal age over the seven day periods from 35.0+/-4.9 mmHg (period 1) to 44.2+/-6.5 mmHg (period 9). Intra-arterial mean blood pressures of infants weighing less than 1,000 g were significantly lower than infants weighing 1,000 to 1,499 g at all each time periods (P< 0.05). Intra-arterial mean blood pressures were found to correlate significantly with antenatal steroid (P<0.005), and correlate inversely with PDA (P<0.001), pulmonary hemorrhage (P<0.005) and ROP (P<0.05). CONCLUSION: Intra-arterial mean blood pressures in very low birth weight infants during the first seven days were found to correlate significantly with postnatal age, gestational age, birth weight and antenatal steroid and probably correlate with some common morbidities of very low birth weight infants. It is therefore important to maintain adequate blood pressure ranges during the first seven days of life that are the most critical periods of illness for the majority of very low birth weight infants.
Birth Weight ; Blood Pressure* ; Critical Period (Psychology) ; Gestational Age ; Hemorrhage ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Retrospective Studies

Meningioma is relatively common, benign, and extra-axial tumor accounting for about 20% of primary brain and spinal cord tumors. The World Health Organization (WHO) classified these tumors into Grade I (benign), Grade II (atypical), and Grade III (anaplastic) meningioma. Grade I meningioma which is slowly growing tumor and have some rare subtypes. Among them, metaplastic subtype is defined as a tumor containing focal or widespread mesenchymal components including osseous, cartilaginous, lipomatous, myxoid or xanthomatous tissue, singly or in combinations. We report a rare metaplastic meningioma overspreading nearly whole cerebral convexity from main extra-axial tumor bulk in the parietal lobe.
Brain ; Brain Neoplasms ; Meningioma* ; Parietal Lobe ; Pathology ; Spinal Cord Neoplasms ; World Health Organization

BACKGROUND/AIM: Sedated endoscopy performed for higher compliance requires close monitoring and long recovery time. In addition, several side effects including even mortality could occur. This study was performed to evaluate the usefulness of unsedated 6.5 mm endoscopy compared with sedated standard endoscopy. METHODS: One hundred eight patients were randomized into 2 groups (unsedated or sedated); unsedated endoscopy with 6.5 mm endoscope (58 patients); sedated endoscopy with standard endoscope (50 patients). Vital sign, time to recover walking ability and degree of amnesia were evaluated. The endoscopists' and patients' satisfaction and complication were estimated in terms of endoscopic score, visual analogue scale and complication score. RESULT: Oxygen saturation during the procedure significantly decreased in the sedated group. No difference was noted in endoscopists' and patients' satisfaction, but complication score was significantly decreased in the 6.5 mm scope group. The time for the induction of sedation was 3.4 minutes and the time to recover through walking ability was 36 minutes. CONCLUSION: From these results, there was no difference in either the endoscopists' or the patients' satisfaction between two groups, but complication and recovery time were significantly reduced in 6.5 mm group. Unsedated 6.5 mm endoscopy could be considered as a substitution for the sedated standard endoscopy.
Mortality

Pelvic actinomycosis is a rare disease and has diverse clinical manifestations and courses which make it difficult to diagnose the disease initially. Therefore the disease is still often diagnosed first at a laparotomy for a suspected malignant tumor. Since Henderson`s report (1973), the association between pelvic actinomycosis and intrauterine device has been recognized by gynecologists. IUD is thought to cause chronic intrauterine infection, tissue injury, and act as nucleus for parasitic infection. We report a case of Pelvic Actinomycosis related to IUD with brief review of concerned literatures.
Actinomycosis* ; Intrauterine Devices* ; Laparotomy ; Rare Diseases

This study was carried out to assess the present level of atmospheric metals. Five metals-lead, cadmium, chromium, manganese, vanadium-were checked on the industrial(Sasang) and residental area(Daeshindong) in the city of Pusan sampling period was the year of 1986, 1990, and 1994, and the sampling time was 2 days of each site. As the result of comparison with the atmospheric standard of ASHRAE(1980) the average concentrations of lead was above the standard, the average concentrations of chromium was around the standard, and the average concentrations of cadmium and vanadium was below the standard. The average concentrations of manganese was above the standard of industrial environment. And the average concentrations of five metals was higher in the industrial area than the residental area The average concentrations of lead cadmium and chromium showed the increase tendency by the year, and the average concentrations of vanadium showed no change, and the average concentrations of manganese showed the decrease tendency. As a result of correlation analysis, lead and cadmium(r=0.31), vanadium and manganese(r=0.24), vanadium and chromium(r=0.19) showed significance.
Busan* ; Cadmium ; Chromium ; Manganese ; Metals ; Metals, Heavy* ; Vanadium

This study examined the characteristics of biochemical parameters, bone diseases, and vascular calcification in Korean patients with chronic kidney disease (CKD) not yet on dialysis. Serum levels of fibroblast growth factor 23 (FGF23), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D3 (25D), and 1,25-dihydroxyvitamin D3 (1,25D); lumbar spine, total hip, and femur neck bone mineral densities; and brachial-to-ankle pulse wave velocity (baPWV) representing vascular calcification were measured at baseline for 2,238 CKD patients in the KoreaN Cohort Study for Outcomes in Patients With CKD (KNOW-CKD). Increases in serum FGF23 and iPTH preceded changes in serum calcium and phosphate, similar to Western populations. However, the 25D and 1,25D levels decreased earlier than serum FGF23 or iPTH increased, with a decreased estimated glomerular filtration rate (eGFR) in Korean CKD patients. Vitamin D deficiency occurred in 76.7% of patients with CKD stage 1. Bone mineral densities were lowest in CKD stage 5 (lumbar spine, −0.64 ± 1.67; total hip, −0.49 ± 1.21; femur neck, −1.02 ± 1.25). Osteoporosis was more prevalent in patients with higher CKD stages. The mean baPWV, abdominal aortic calcification (AAC), and coronary calcium score also increased, with declined eGFR. In conclusion, a decline in serum vitamin D levels was observed in early CKD stages before significant increases of FGF23 and iPTH in the Korean CKD population compared with that in Western populations. Increased bone disease and vascular calcification occurred in early-stage CKD.
Bone Density ; Bone Diseases ; Calcifediol ; Calcitriol ; Calcium ; Cohort Studies* ; Dialysis ; Femur Neck ; Fibroblast Growth Factors ; Glomerular Filtration Rate ; Hip ; Humans ; Kidney* ; Osteoporosis ; Parathyroid Hormone ; Pulse Wave Analysis ; Renal Insufficiency, Chronic* ; Spine ; Vascular Calcification ; Vitamin D ; Vitamin D Deficiency