There is room for debate in appropriate diagnosis and treatment due to physiological and anatomical differences in pediatric facial bone fractures from that of adult's. The objectives of this article is to analyze for our clinical cases and to suggest the appropriate management of facial bone fracture in children. The study included 56 children who had treatment for the craniofacial fractures form March, 1990 to February, 1998. Their ages ranged from 3 to 15. There were 38 males and 18 females. Physical examination, simple x-rays, ultrasonograms and routine CT scans were used for diagnosis. Materials were classified into 28 nasal bone fractures, 4 nasoethmoidal fractures, 6 orbital fractures, 8 mandible fractures, and 10 zygoma fractures. Patients were treated with conservative treatment in 9 cases, with closed reduction in 28 cases and open reduction only, and 14 patients with open reduction and internal fixation using microplates and screws. 3 patients needed autogenous calvarial bone graft. Plates and screws were removed in postoperative 3-6 months. All patients had successful union of fractured bones without no specific complications, and normal bony growths were noticed during the 7 years follow up. We conclude that surgeons should be careful in diagnosis and management for the pediatric facial fracture due to anatomical variations and differences in fracture aspects. First, it is mandatory for surgeous to get accurate diagnosis and identify children's fracture and displacement through routine CT check up along with physical examination. Second, it is important to perform the minimally invasive technique or conservative treatment for the children with mild displacement so that it reduces the incidence of growth retardation which may be caused by extensive operation. However, application of rigid fixation is necessary in case of extensive bony displacement or bony defects because of poor coorporation in postoperative care. Third, plates and screws which were used for the internal fixation should be removed at 3-6 months after the surgery. Fourth, if bone graft is needed, it is better to use autogenous graft than allogeneous graft. Fifth, care for dentition and follow up for growth are necessary for growing children.
Child ; Dentition ; Diagnosis ; Facial Bones* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mandible ; Nasal Bone ; Orbital Fractures ; Physical Examination ; Postoperative Care ; Tomography, X-Ray Computed ; Transplants ; Ultrasonography ; Zygoma

BACKGROUND: Intravenous catheter-related complication among the hospitalized patients has been increasing recently in Korea, since many hospitals has tried to save expenses by replacing the foreign-made catheter with domestic-made intravenous catheter. We studied the incidence rate of catheter-related complication and compared the incidence of catheter-related complication between domestic-made and foreign-made ones. We also studied to elucidate whether the morphologic characteristics of the intravenous catheter will effect the incidence of catheter-related complication. METHOD: From July 1 to Sept 30, 1998, we surveyed the incidence rate of intravenous catheter-related complication among the hospitalized patients in the wards of Medicine. Surgery, Obstetric, and Neonatal Intensive Care Unit in Guro Hospital, Korea University Medical center. We also compared the incidence of complication between domestic-made catheter (catheter A) and foreign-made catheter (catheter B) of three different gages (24G, 22G and 18G). The morphologic characteristics of intravenous catheters has been studied by electron microscopy. RESULT: Complication associated with use of intravenous catheter had been occurred 263 out of 459 cases (57.3%), among those cases, non-infectious complication and infectious complication were 173 cases (37.7%) and 90 cases (19.6%), respectively. Totally, catheter A group showed higher complication than catheter B group [62.0% (160/258) vs 51.2% (103/201), P=.021]. Analysis on the incidence rate of complication according to the products did not show significant differences in the noninfectious complication in every gage groups. However the infectious complication occurred higher in the domestic-made catheter A group than among the foreign-made catheter B group [(24G: 6% vs 0%, P=.026), (22G: 25.6% vs 9.6%, P=.001), (18G: 36.8% vs 13.4%, P=.002)]. Duration of catheter life did not show the difference between catheter A group and catheter B group [48.5hrs vs 50.3hrs, P=.474]. The analysis on risk factors for complication showed that catheter A group is highly related (odd ratio 1.85). The morphologic analysis of the catheter by using electron microscopy showed that the angles in the tip of the introducing needle of catheter Aand catheter Bare 60degrees and 45degrees , respectively, and the bevel between introducing needle and catheter sheath are 50degrees and 27degrees, respectively. CONCLUSION: There was a higher incidence rate of complication related to domestic-made catheter usage, which might influence increasing the period of the hospitalization and the expenses due to the complication. The study of cost effectiveness analysis needs to be performed regarding intravenous catheter-related complication. Morphologically, catheter A showed more blunt angle in the tip and transition area of the introducing needle than the angle of catheter B, which is considered to influence the higher complication incidence. It needs to improve the quality of domestic-made intravenous catheter.
Academic Medical Centers ; Catheter-Related Infections ; Catheters ; Cost-Benefit Analysis ; Female ; Hospitalization ; Humans ; Incidence* ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Microscopy, Electron ; Needles ; Obstetric Surgical Procedures ; Prospective Studies* ; Risk Factors

No abstract available.
Ciprofloxacin* ; Mycobacterium tuberculosis* ; Mycobacterium*

Trichomoniasis, a common and sometimes distressing condition in women, is caused by infection of the genitourinary tract by the pathogenic protozoan Trichomonris aginalis(T. vaginalis). Men may also be infected, although frequently without any symptoms, and most cases of trichomoniasis are sexually transmitted. The best evidence for an etiologic role for T. vaginalis is in nongonococcal urethritis(NGU). In epidemiologic studies, T,ginalis has been isolated from 1 to 68 percent in men with NGU. The nurnber of NGU is increasing rapidly than gonorrhea in deeloped nations, and in some developing countries, especially in Korea, In view of the difficulties in findng trichomonads by direct microsco by in men, urine culture and serodiagnosis plays an important role in the diagnostic work. Urine culture, indirect fluorescent antibody test(IFAT) and enzyme-linked immunosorbent assay (ELISA) were used to elecect T.vaginalis in 221 patients with male NGU. These patients visited the VD Clinic of ChoongKu Public Health Center in Seoul from May to August, 1989 and from March, 1990 to December, 1991. The results obtained were as follows.: 1. T. vaginalis was grown from only one of the 221 samples on TPS-1 meida. 2. In 208 NGU patients, there were 10(4.8%) positive reactions on IgG antibody in IFAT. 3. In 208 NGU patient, there were 14(6.7%) positive reactions to IgG antibody in ELISA. 4. No statistical significant correlation was found between then sults of IFAT and ELISA in individual patients. In conclusion, 1. Male trichomoniasis in patients with NGU was detected at a, significantly low rate. Due to the small number of patients in the test, further epidemiologic stidies of trichomoniasis in male NGU patient are necessary. 2. Serologic studies (IFAT and ELISA) have detected sorre trichomoniasis in male patients with NGU. These tests seem to be helpful in the diagnosis of male t-ichomoniasis.
Developing Countries ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay ; Epidemiologic Studies ; Female ; Gonorrhea ; Humans ; Immunoglobulin G ; Korea ; Male* ; Public Health ; Seoul ; Serologic Tests* ; Urethritis*

A 43-year-old man with generalized lichen planus demonstrated serum antibodies against autologous lesional skin. Indirect immunofluorescence using serum and papular lesional skin revealed a lichen planus specific antigen found only in the granular layer. The specific tissue antigen was not detected in normal skin from this patient, in normal skin from patients with skin disorders other than lichen planus or in skin from normal control persons. When titers of the serum antibodies against lichen planus antigen were examined before and after a successful therapy a positive correlation of the titer could be found in this patient.
Adult ; Antibodies/*immunology ; Antigens/*analysis ; Humans ; Lichen Planus/drug therapy/*immunology ; Male ; Skin/*immunology

No abstract available.
Cardiomyopathy, Hypertrophic* ; Humans ; Infant* ; Mothers*

BACKGROUND: Immunolcgical assays are required for the accurate diagnosis of autoimmune bullous dermatoses including pemphigus vulgaris(PV) and pemphigus foliaceus(PF). In the detection of circulating autoantibodies to pemphigus antigens(desmosomal components), the priority remains controversial between indirect immunofluorescence(IF) and immunoblot(IB) assay. OBJECTIVE: In the present study we compared the sensitivity of indirect IF and that of IB using amplified alkaline phosphatase staining system in the detection of pemphigus autoantibodies. PATIENTS: We selected eight patients with serum endpoint titer of 1:80 in preliminary study. Among these patients three were PV and five were PF. METHODS/RESULTS: The titers of IgG autoantibodies found on indirect IF were confirmed as 1: 80 in all patients, whereas the titers examined by IB assay were much higher, 1: 640 to 1: 2560. In the 3 sera of PV patients, the titers of two cases were 1: 1280 and the third case was 1: 2560. In 5 cases of PF, one was 1:640, two were 1: 1280, and two were 1:2560. CONCLUSION: This result suggests that the immunoblot examination using amplified alkaline phosphatase staining system demonstrates higher sensitivity compared with indirect IF(p=0.0003 by Mann-Whitney U test) in the detection of pemphigus autoantibodies.
Alkaline Phosphatase ; Autoantibodies* ; Diagnosis ; Fluorescent Antibody Technique, Indirect* ; Humans ; Immunoglobulin G ; Pemphigus* ; Skin Diseases, Vesiculobullous

BACKGROUND: Immunolcgical assays are required for the accurate diagnosis of autoimmune bullous dermatoses including pemphigus vulgaris(PV) and pemphigus foliaceus(PF). In the detection of circulating autoantibodies to pemphigus antigens(desmosomal components), the priority remains controversial between indirect immunofluorescence(IF) and immunoblot(IB) assay. OBJECTIVE: In the present study we compared the sensitivity of indirect IF and that of IB using amplified alkaline phosphatase staining system in the detection of pemphigus autoantibodies. PATIENTS: We selected eight patients with serum endpoint titer of 1:80 in preliminary study. Among these patients three were PV and five were PF. METHODS/RESULTS: The titers of IgG autoantibodies found on indirect IF were confirmed as 1: 80 in all patients, whereas the titers examined by IB assay were much higher, 1: 640 to 1: 2560. In the 3 sera of PV patients, the titers of two cases were 1: 1280 and the third case was 1: 2560. In 5 cases of PF, one was 1:640, two were 1: 1280, and two were 1:2560. CONCLUSION: This result suggests that the immunoblot examination using amplified alkaline phosphatase staining system demonstrates higher sensitivity compared with indirect IF(p=0.0003 by Mann-Whitney U test) in the detection of pemphigus autoantibodies.
Alkaline Phosphatase ; Autoantibodies* ; Diagnosis ; Fluorescent Antibody Technique, Indirect* ; Humans ; Immunoglobulin G ; Pemphigus* ; Skin Diseases, Vesiculobullous

No abstract available.
Child* ; Evoked Potentials, Auditory, Brain Stem* ; Humans

BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall