Lead is one of the most widespread environmental toxins and its poisoning in children was considered a rarity, usually resulting from unique circumstances such as inappropriate use of leadbased body cosmetics or direct administration of lead-containing folk medicines. The increasing concern about children with lower levels of lead exposure has developed, but there are no data regarding the mean blood lead levels and the incidence of symptomatic or asymptomatic lead poisoning in Korean children. We analyzed the zinc protoporphyrine (ZPP) values and blood lead concentrations in 163 pediatric inpatients for a prospective study of lead exposure. The blood lead concentrations in all 163 children were 15~54 g/dl, of whom 111 children (68.1%) were 25~54 g/dl which needs decision to chelate based on the EDTA provocation test. Among 111 children whose blood lead concentrations are 25~54 g/dl, 59 children(53.2%) were between 7 months and 3 years of age, which revealed no significant higher incidence of lead exposure than any other age group. The ZPP values in 126 children (77.3%) were above 35 g/dl. The mean blood lead concentration and ZPP values are 27.8 g/dl and 48.8 g/dl, respectively. We conclude that there are many asymptomatic children with increased absorption of lead in the urban area of Korea, and we need further studies regarding lead poisoning. It is important that there must be a national counterplan and that pediatricians continue to pay attention to lead posioning in children.
Absorption ; Child ; Edetic Acid ; Humans ; Incidence ; Inpatients* ; Korea ; Lead Poisoning ; Poisoning ; Prospective Studies ; Zinc

1) The patient was a male aged 20 years who has an intermittent exophthalmos of the left eye when he bend a head forward. 2) Exophthalmometry reveals OD: 11 mm OS: 17.5 mm by Hertel method base 96 in bend forward position. 3) The disc of the left eye was a slight discoloration and no changes whether protrusion of the eye or not. 4) It may be caused by varix of the left orbital vein examined by skull X-ray, optic foramen, Water's view and carotid angiography. 5) Vision OD: 1.0 OS: 0.4.
Angiography ; Exophthalmos* ; Head ; Humans ; Male ; Orbit ; Skull ; Varicose Veins ; Veins

Vascular leak syndrome(VLS) is characterized by endothelial damage, which causes extravasation of plasma proteins and fluid from capillaries into the extravascular space. It has been suggested that the increased vascular permeability is the result of an IL-2-induced suppression of endothelin-1 secretion by endothelial cells, an IL-2-induced activation of the complement cascade or TNF-alpha release from IL-2-activated T-cells. A 13-year-old male patient visited our hospital with abdominal pain. He was diagnosed with acute lymphoblastic leukemia(T cell type) by bone marrow study on his 2 nd day in hospital. On the 3 rd day of induction chemotherapy(prednisone, L-asparaginase, vincristine, intrathecal methotrexate), pulmonary edema and pleural effusion, ascites and generalized edema developed and lasted for 53 days without responding to supportive care. The laboratoy finding was that TNF-alpha was increased without evidence of infection and hypoalbuminemia was noted. It was suggested that the patient's clinical feature was induced by VLS.
Abdominal Pain ; Adolescent ; Ascites ; Blood Proteins ; Bone Marrow ; Capillaries ; Capillary Permeability ; Complement System Proteins ; Edema ; Endothelial Cells ; Endothelin-1 ; Humans ; Hypoalbuminemia ; Induction Chemotherapy* ; Male ; Pleural Effusion ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Pulmonary Edema ; T-Lymphocytes ; Tumor Necrosis Factor-alpha ; Vincristine

No abstract available.
Leukemia, Myelogenous, Chronic, BCR-ABL Positive*

In the published article by Choi et al., a part of expression of the Abstract and the Conclusion section in the main body text have been corrected. Underlined text should be read carefully.

We have experienced 20 cases of the cerebral rete mirabile from 1969 to 1975. All were proved by bilateral carotid angiography, and clinical assessment and angiographical analysis were attempted. The results were summarized as follows: 1. Age distribution was ranged from 5 to 55. The majority of 20 cases were age over 20 as 15 cases who were distributed evenly in each decade and 5 cases were age below 20. 12 cases were male and 8 female. 2. Authors classified the cases as the group of subarachnoid hemorrhage and non-subarachnoid hemorrhage conveniently. All cases of age below 20 comprised in the group of non-subarachnoid hemorrhage while majority of subarachnoid hemorrhage group were age over 20. 3. There were no contributory factors to cerebral rete mirabile with regard to past history and family background. 4. There were considerable differences in the symptoms and signs between the groups of subarachnoid hemorrhage and non-subarachnoid hemorrhage. Clinical manifestations were mainly headache and impairment of consciousness with meningeal sign in the group of subarachnoid hemorrhage. On the other hand, motor disturbance such as hemiparesis or monoparesis was occurred in the majority of non-subarachnoid hemorrhage and the minority showed speech impairment, seizure and choreiform movement. 5. All cases showed the characteristic angiographic findings of cerebral rete mirabile, which are occlusion or stenosis at the supraclinoid portion of internal carotid artery with abnormal fine vascular network around the base of brain and poor or non-visualizing anterior cerebral and middle cerebral arteries. The interesting picture was rete formation of ophthalmic artery in the orbit of 2 cases. There were no abnormal angiographic findings on the vertebral angiogram except retrograde filling to anterior cerebral and middle cerebral arteries through collateral channel from the posterior cerebral artery. 6. The prognosis of the cerebral rete mirabile seem to be favorable with regard to mortality. There were no death in our 20 cases during the period of observation.
Age Distribution ; Angiography ; Brain ; Carotid Artery, Internal ; Chorea ; Consciousness ; Constriction, Pathologic ; Female ; Hand ; Headache ; Hemorrhage ; Humans ; Male ; Middle Cerebral Artery ; Mortality ; Ophthalmic Artery ; Orbit ; Paresis ; Posterior Cerebral Artery ; Prognosis ; Seizures ; Subarachnoid Hemorrhage

BACKGROUND: We investigated the risk factors for the recurrence of anterior shoulder instability after arthroscopic surgery with suture anchors and the clinical outcomes after reoperation. METHODS: A total of 281 patients (February 2001 to December 2012) were enrolled into our study, and postoperative subluxation and dislocation were considered as recurrence of the condition. We analyzed radiologic results and functional outcome including the American Shoulder and Elbow Surgeons Evaluation Form, the Korean Shoulder Society Score, and the Rowe scores. RESULTS: Of the 281 patients, instability recurred in 51 patients (18.1%). Sixteen out of 51 patients (31.4%) received a reoperation. In terms of the functional outcome, we found that the intact group, comprising patients without recurrence, had a significantly better functional outcome than those in the recurrent group. The size of glenoid defect at the time of initial surgery significantly differed between intact and recurrent group (p<0.05). We found that the number of dislocations, the time from the initial presentation of symptoms to surgery, and the number of anchor points significantly differed between initial operation and revision group (p<0.05). The functional outcome after revision surgery was comparable to intact group after initial operation. CONCLUSIONS: Eighteen percent of recurrence occurred after arthroscopic instability surgery, and 5.6% received reoperation surgery. Risk factors for recurrence was the initial size of glenoid defect. In cases of revision surgery, good clinical outcomes could be achieved using additional suture anchor.
Arthroscopy* ; Dislocations ; Elbow ; Humans ; Joint Instability ; Recurrence* ; Reoperation ; Risk Factors* ; Shoulder* ; Surgeons ; Suture Anchors* ; Sutures*

Pustulotic arthro-osteitis is a rheumatic syndrome of unknovn cause, characterised by an inflammatory osteitis of the sternocostoclavicular region and pustuosis palmaris et plantaris. Although many ases of the disease have been reported in Japan, it, has not been reported in Korea so far. Three cases of pustulosis palmaris et plantaris associated i rith sternocostoclavicular hyperostosis or pustulotic arthro-osteitis are presented.
Hyperostosis, Sternocostoclavicular* ; Japan ; Korea ; Osteitis ; Psoriasis*

Homozygous Protein C deficiency is a rare genetic disease with catastrophic and fatal purpura fulminans like or thrombotic complication occurring during the neonatal period. Purpura fulminans is characterized by microvascular thrombosis in the dermis followed by perivascular hemorrhage, necrosis, and minimal inflammation. Laboratory findings are consistent with disseminated intravascular coagulopathy: We report a case of purpura fulminans in a neonate with the findings of disseminated intravascular coagulopathy and an undetectable level of protein C activity, whose parents proved to be heterozygous protein C deficiency.
Dermis ; Hemorrhage ; Humans ; Infant, Newborn ; Inflammation ; Necrosis ; Parents ; Protein C Deficiency* ; Protein C* ; Purpura Fulminans* ; Purpura* ; Thrombosis

In a conservative treatment of lumbar disc herniation, authors customarily had included the flexion exercise untill 1991. Thereafter, the extension exercise started to be included for the selected patients and this study was designed to assess the clinical outcome of the extension exercise compared to the flexion exercise in the conservative treatments of lumbar disc herniations. 55 consecutive patients (31 males and 24 females having ages ranging from 19-68 years with a mean of 37.2) were included in this prospective study. Criteria for inclusion in this group were: 1. Contained herniations of a single lumbar disc, documented by CT or MRI; 2. no other concurrent spine pathology; 3. conservative treatments with an uniform program including the extension exercise; 4. follow-up for a minimum of one year. For comparison with this prospective group, another 62 consecutive patients (36 males and 26 females having ages ranging from 17-63 years with a mean of 35.7) were selected who were treated during 1991 with flexion exercise before this study was designed and who were matched with the designed criteria except for the direction of exercise. Apart from the therapeutic exercise, the conservative treatments also included medication, physiotheraphy, epidural injection, and back school in the both groups uniformly. The clinical outcome of the extension exercise group indicated that 28 (50.9%) patients excellent, 23 (41.8%) patients good, three (5.5%) patients fair, and one (1.8%) patient failed outcomes. In the flexion exercise group, there were 23 (37.1%) excellent, 27 (43.5%) good, seven (11.3%) fair, and five (8.1%) failed outcomes. From these results, it would seem to follow that the extension exercise group had superior clinical outcome compared to the flexion exercise, i.e. higher excellent and good outcomes (92.7% vs. 80.6%) and lower poor and failed outcomes (7.3% vs. 19.4%), respectively, Moreover, the excellent outcome in terms of full recovery without any pain and disability was more common in the extension exercise group (50.9% vs. 37.1%). A better clinical outcome was obtained in the extension exercise group of patients who were younger than 40 years and who had a history of three months or less compared with those who were older and had longer history of disease. The sizes of disc protrusion did not affect the clinical outcome. In conclusion, we would recommend that the extension exercise, instead of the flexion exercise, should be included in the conservative treatment of a contained herniation of lumbar disc for a better clinical outcome.
Female ; Follow-Up Studies ; Humans ; Injections, Epidural ; Magnetic Resonance Imaging ; Male ; Pathology ; Prospective Studies ; Spine