PURPOSE: To evaluate the clinical characteristics, treatments and outcome of patients with hemorrhagic shock and encephalopathy(HSE) syndrome. METHODS: We performed a clinical study on 14 patients who were diagnosed as hemorrhagic shock and having encephalopathy syndrome in the Department of Pediatrics, from 1984 to 1998. Age, sex, clinical symptoms and physical findings at admission, the most deranged laboratory findings, radiologic findings, treatments and outcome were analyzed. RESULTS: The age of onset was 1.0+/-0.9 years and the male to female ratio was 1: 1.8. At admission, clinical findings included dehydration in 85.7%, shock in 85.7%, fever in 71.4%, vomiting in 71.4%, diarrhea in 64.3%, GI bleeding in 50%, convulsion in 42.9%, and edema in 35.7%. Altered mental state was found in 100%, hepatomegaly in 64.3%, and splenomegaly in 21.4%. Laboratory findings revealed D-dimer positive in 92.9%, the mean hemoglobin level 8.2+/-2.1g/dL, BUN 35.7+/-24.0mg/dL, creatinine 1.9+/-1.5mg/dL, AST 561.0+/-1,412.1IU/L, ALT 858.9+/-1,649.8IU/L, blood glucose 229.5+/-197.4mg/dL, ammonia 195.4+/-129.7pg/dL, and total bilirubin 4.9+/-8.2mg/dL. On serologic tests, rotavirus and Epstein-Barr virus was found in 1 patient(7.1%), respectively. The mortality rate was 78.6%. CONCLUSION: We found that shock and disseminated intravascular coagulation(DIC) played important roles in the pathogensis of HSE syndrome, and encephalopathy, hepatic and renal insufficiency, and respiratory failure were secondary complications resulting from shock and DIC. Despite vigorous treatment, the prognosis was very poor. We feel more efforts should be focused on investigating the etiology and pathophysiology of HSE to prevent as well as develop a specific therapy. (J Korean Pediatr Soc 2000;43:814-819)
Age of Onset ; Ammonia ; Bilirubin ; Blood Glucose ; Creatinine ; Dacarbazine ; Death, Sudden* ; Dehydration ; Diarrhea ; Edema ; Female ; Fever ; Hemorrhage ; Hepatic Encephalopathy ; Hepatomegaly ; Herpesvirus 4, Human ; Humans ; Infant* ; Male ; Mortality ; Pediatrics ; Prognosis ; Renal Insufficiency ; Respiratory Insufficiency ; Rotavirus ; Seizures ; Serologic Tests ; Shock ; Shock, Hemorrhagic* ; Splenomegaly ; Vomiting

PURPOSE: H. pylori infection was recently reported to be associated with unexplained iron-deficiency anemia(IDA) in children and adolescents. H. pylori-related IDA was thought to occur due to GI blood loss, scavenging of iron by H. pylori and iron malabsorption. The aim of this study was to examine how the status of H. pylori infection and age of children affected RBC indices, serum iron level and TIBC. METHODS: We performed esophagogastroduodenoscopy, and examined RBC indices, serum iron and TIBC on 178 pediatric patients with recurrent abdominal pain. H. pylori infection was assessed by CLO test and silver stain of gastric biopsy specimen. RESULTS: H. pylori infection was found in 42 of 178 patients(23.6%). In children with H. pylori infection, the prevalence of iron deficiency(ID) and IDA(39.0% and 10.3%, respectively) was higher than in children without H. pylori infection(29.6% and 4.1%, respectively), but there was no statistically significant difference. Serum iron level was lower(69.5+/-32.7 vs 77.3+/-34.1g/dL; P= 0.08) and TIBC was higher(380.8+/-50.4 vs 366.9+/-47.0g/dL; P=0.09) in children with H. pylori infection than in children without H. pylori infection. All RBC indices and iron saturation were lower in children with H. pylori infection than in children without H. pylori infection, but there was no significant difference between the two groups. In correlation analysis, serum iron, Hgb, Hct, MCV and MCH were significantly increased by age in children without H. pylori infection (P<0.05), but MCH and MCHC were decreased significantly(P<0.05) by age in children with H. pylori infection. In multiple regression analysis, the change of serum iron, MCH and MCHC by age was significantly influenced by the status of H. pylori infection(P<0.05). CONCLUSION: H. pylori infection decreases RBC indices and serum iron and increases TIBC in children. These changes become prominent as age increases. This age effect rnay be related to the duration of H. pylori infection. (J Korean Pediatr Soc 2000;43:755-762)
Abdominal Pain ; Adolescent ; Anemia, Iron-Deficiency ; Biopsy ; Child* ; Endoscopy, Digestive System ; Erythrocytes* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Iron* ; Prevalence ; Silver

Carcinoembryonic antigen(CEA) was measured in the serum and urine of 46 patients with bladder cancer and 15 patients with non-cancer disease as control group at the Paik Hospital. Pusan during the period from January, 1986 to June, 1988. The following results were obtained. 1. The upper limits of normal serum and urinary CEA levels in non tumor control group were 3.7 ng/ml and 2.3 ng/ml. Mean and positive rate of serum and urinary CEA levels in bladder cancer group were 4.40 ng/ml(37.0%) and 21.52ng/ml(65.2%). 2. Mean urinary CEA level was correlated significantly with the stage, grade and size of bladder cancer but no significance was seen in serum CEA. In the advanced cases(Stage C, D), serum CEA levels were elevated. 3. The diagnostic rate was not elevated in spite of urinary CEA determination combined with urinary cytology. After transurethral resection of cancer mass and radiation therapy, urinary CEA level decreased. As a result, serum and urinary CEA determinations in bladder cancer have no diagnostic value, but it will be useful in the study of the extent of cancer, effect of therapy, recurrence and prognosis.
Busan ; Carcinoembryonic Antigen ; Humans ; Prognosis ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

A 21-year-old man presented with a 7 days history of fever. Careful clinical examination led to the discovery of left supraclavicular lymphadenopathy without hepatosplenomegaly. Serologic tests for Ebstein-Barr virus, HIV, hepatitis type B & C, syphilis and typhoid fever were negative. Blood, urine, and stool cultures yielded no growth. Histologically, the process mainly involved the connective tissue framework of the lymph node, sharing the features of inflammatory pseudotmor(IPT) of other organs: a storiform growth pattern, increased vascularity with associated vascular lesions, and a polymorphous inflammatory infiltrate in a collagen-rich stroma. Immunohistochemical study for spindle cells showed positive reaction for actin and vimentin but not for desmin, and lymphoid cells revealed polyclonality. Characteristics of mass formation, and the inflammatory nautre of the process enabled us adopt the term IPT which should be differentiated from hematolymphoid proliferative disorder or mesenchymal neoplasia.
Male ; Humans

In spite of vigorous efforts to enhance appropriateness of blood usage in surgery, it is recognized that there are still not a few overuse and misuse of blood products in Korean hospitals. To assure appropriate use of blood, continuous monitoring and controlfling blood orders, particularly for surgical operations, should be implemented. The indicator of 'ratio of crossmatching to transfusion' (C/T ratio) has been focalized on in this regard. The authors investigated C/T ratio for eight hospitals, evenly distributed in their geographical location as well as size. Only elective surgeries operated from March 1 to May 31, 1995 were included for analysis. Standardized survey format was distributed, and retrospective reviews of medical records were performed by volunteer surveyors from each hospital after two sessions of pre- survey education. The results were as follows. Average C/T ratio, for all hospitals and all surgeries, was 1.76. Differences in C/T ratio by sex, months, clinical departments, blood components were not significant. However, the ratio showed increasing tendency with ages. The C/T ratio on the average was not higher, compared with the recommended guideline. However, due to study' s limitations ini standardization of survey method and verification of data, we could not conclude that current status of appropriateness of blood use is satisfactory. In addition, to pervasively use the C/T ratio as a quality indicator for blood use management, supplementary measures, such as standardization of data, should be adopted.
Surveys and Questionnaires ; Education ; Medical Records ; Quality Indicators, Health Care* ; Retrospective Studies ; Volunteers

An experimental study in vitro using piezoelectric extracorporeal shock wave lithotriptor(EDAP LT-01) and urinary stones removed from the patients by surgical method has been performed. The purposes were 1) to correlate the stone components and sizes with the storage of complete fragmentation, 2) to examine the screening effect and 3) to observe the stone fracture mechanism in urinary stones. The following results were obtained. 1. Tribasic calcium phosphate stone, magnesium ammonium phosphate stone and uric acid stone fractured more easily than calcium oxalate stone. In the case of small stones(diameter 0.5 cm), all stones fractured at relatively low storage. Large stones (diameter 1.5 cm) fractured at high storage with wide variations according to components. 2. Magnesium ammonium phosphate stones tested to observe for screening effect showed that a high storage was needed for complete fragmentation(about 2 times) when the stone debris was not removed. 3. Urinary stones fractured first on the front surface. When the stones showed lamellae, which were separated first by shock wave, thereafter each lamella was broken.
Ammonium Compounds ; Calcium ; Calcium Oxalate ; Humans ; Magnesium ; Mass Screening ; Shock* ; Uric Acid ; Urinary Calculi

Achalasia is very uncommon in children, and cases accompanied with alacrima and adrenal insufficiency is even more uncommon. When these three disorders are seen altogether, it is called triple A syndrome. It is inherited in an autosomal recessive manner and has potentially life-threatening sequelae. So, pediatricians should always consider the possibility of triple A syndrome when seeing children with achalasia. Neurological abnormalities such as autonomic neuropathy, peripheral neuropathy, sensory impairment and mental retardation occasionally accompany. We report a 2-year-old girl who presented with repeated vomiting, short stature and alacrima. Diagnosis of achalasia was made after perfoming esophagogram and endoscopy and was confirmed with esophageal manometry. After pneumatic dilatation, she became asymptomatic.
Adrenal Insufficiency ; Child ; Child, Preschool ; Diagnosis ; Dilatation ; Endoscopy ; Esophageal Achalasia ; Female ; Humans ; Intellectual Disability ; Manometry ; Peripheral Nervous System Diseases ; Vomiting

Hydrops fetalis is diagnosed when abnormal fluid collections are manifest in two or more fetal compartments, including abdominal ascites, pleural effusions, pericardial effusions, skin edema, polyhydroamniosis and placental edema. Although fetal hydrops was hystorically most commonly associated with Rh blood group isoimmunization, the availability of Rh immunoglobulin has increased the proportion of fetuses affected due to nonimmune etiologies. We have experienced a case of nonimmune hydrops fetalis at 32 weeks of gestation in a 27-year-old woman and reported that with brief review of related literatures.
Adult ; Ascites ; Edema ; Female ; Fetus ; Humans ; Hydrops Fetalis* ; Immunoglobulins ; Pericardial Effusion ; Pleural Effusion ; Pregnancy ; Skin

BACKGROUND: Cardiac myxomas are rare benign tumors of the heart. Although cardiac myxomas are histologically benign, they may be lethal because of their strategic position. Most cases are sporadic, but rare familial occurrence has been described. PATIENTS AND RESULTS: The left atrial myxoma with cerebral embolism was diagnosed in the 21 year old female and the left atrial myxoma with acromegaly due to pituirary adenoma was subsequently diagnosed in her 19 year old male sibling. The myxoma in the male patient was successfully excised. CONCLUSION: Echocardiography can be used effectively in the diagnosis of atrial myxoma, detection of its possible recurrence, and screening other members of the family.
Acromegaly ; Adenoma ; Diagnosis ; Echocardiography ; Female ; Heart ; Humans ; Intracranial Embolism ; Male ; Mass Screening ; Myxoma* ; Recurrence ; Siblings ; Young Adult

The renal oncocytoma is a rare benign tumor arising from the proximal tubular cells and has recently become a recognized clinical and pathologic entity. The feature of this tumor includes the tendency to (1) be incidental finding, (2) be large in size, (3) have well defined borders, (4) exhibit benign clinical behaviors. Here, we report a case of renal oncocytoma which was found incidentally due to pelvic inflammatory disease of a 37-years-old woman, who was treated with the radical nephrectomy.
Adenoma, Oxyphilic* ; Female ; Humans ; Incidental Findings ; Kidney ; Nephrectomy ; Pelvic Inflammatory Disease