No abstract available.
Gestational Sac* ; Ultrasonography*

Crohns disease is a granulomatous isease of the gastrointetin 1 tract, especially terminal ileum, but may involve the lip, mouth, anus, skin, liver and bone. The skin is a common site of extraintestinal involvement in Crohns disease, with the perianil, perineal, and peristomal areas most frequently affected. Vulvar involvement, however, is an uncommon extraintestinal manifestantion of Crohns disease. We report a case of a 16-year-old girl with Crohns disease of the vulva and perianal region. A histopathologic study of the descending colon and vulvar skin showed noncaseating granulomatous reactions composed of lymphocytes, epithelioidell and giant cells. We were able to make the diagnosis of Crohns disease of the vulvar and the patient was treated with prednisolone and metronidazole.
Adolescent ; Anal Canal ; Colon, Descending ; Crohn Disease* ; Diagnosis ; Female ; Giant Cells ; Humans ; Ileum ; Lip ; Liver ; Lymphocytes ; Metronidazole ; Mouth ; Prednisolone ; Skin ; Vulva*

PURPOSE: The object of this study is to evaluate bone metabolism in healthy adolescents according to the progression of puberty. METHODS: Forty boys(13.9+/-1.7 years) and 42 girls(12.1+/-1.6 years) were classified by Tanner stage (TS) and bone age. Serum levels of osteocalcin(OC) and bone specific alkaline phosphatase(BALP) were measured as bone formation markers. Serum level of C-terminal telopeptide of type I collagen (ICTP) and urinary N-terminal telopeptide of type I collagen(NTx) concentrations adjusted by creatinine concentrations were measured as bone resorption markers. Serum or urine levels of bone turnover markers in each pubertal development group and bone age group were analysed. RESULTS: In boys, BALP and OC levels increased to peak levels significantly(P<0.05), and decreased significantly(P<0.05) from the peak levels to the levels at TS 5. ICTP and NTx levels seemed to increase to peak levels and to decrease from the peak levels to the levels at TS 5. But there were no significant differences except decreasing NTx levels. All showed peak levels between 13 and 15 years of bone age. In comparison with each TS group, BALP and OC levels were significantly different(P<0.05) between each TS group, but ICTP and NTx were not. In girls, the levels of all bone markers seemed to increase to peak levels without significance, and then decrease significantly(P< 0.05). All showed peak levels between 11 and 13 years of bone age. All except ICTP level were significantly different between each TS group(P<0.05). CONCLUSION: The bone metabolism seems to increase as progression of puberty, and to decrease during late puberty. Bone formation markers levels change more actively, rather than bone resorption markers levels during puberty. And the increment of bone formation in early puberty is more significant in boys rather than in girls.
Adolescent ; Bone Resorption ; Collagen Type I ; Creatinine ; Female ; Humans ; Metabolism* ; Osteogenesis ; Puberty*

Recently, we have experienced a case of von Hippel-Lindau's disease. The patient was a 16 years old Korean girl who visited to our hospital because of visual impairment in both eyes since childhood, mental retardation, dysarthria and gait disturbance. On the eye examination, visual acuity of both eyes were 0.04, incorrectable, funduscopy revealed optic atrophy and typical angiomatosis retinae in the right eye and optic atrophy associated with retinal detachment in the left eye. The cerebral angiography showed a space occupying mass in the left cerebellum. Thus this case was presented as a complete form of von Hippel-Lindau's disease, and a brief review of literatures was also discussed.
Adolescent ; Cerebellum ; Cerebral Angiography ; Dysarthria ; Female ; Gait ; Humans ; Intellectual Disability ; Optic Atrophy ; Retinal Detachment ; Vision Disorders ; Visual Acuity ; von Hippel-Lindau Disease*

PURPOSE: Puberty is a rapid changing periods of body composition and endocrine system. Already leptin was known to be closely related to body composition and was known to change according to Tanner stage. Ghrelin, a natural GH secretagogue, was also known to be related with weight change, fat utilization, insulin secretion, and influenced by sex steroid. But the relationship between ghrelin and other parameter according to pubertal development is not established yet. METHODS: Cross-sectional study of 101 peripubertal children (54 males and 47 females) aged 8.5 to 17.0 years. We examined body composition (free fat mass, fat mass, % body fat) by bioelectric impendence measurements. Total ghrelin, leptin, insulin was measured by radioimmunoassay (RIA). Relationship between ghrelin, leptin, insulin and body composition data was analysed according to Tanner stage controlling gender using SPSS ver 11.0. RESULTS: Ghrelin concentration is only correlated with Tanner stage (r=-0.21, P<0.05) and GIR (r=0.29, P<0.01). When we divided subjects by sex, even though there was no difference of ghrelin level between both sex, only male is correlated with Tanner stage (r=-0.28, P<0.05) and GIR (r=0.36, P<0.01). There was no difference of ghrelin level between each Tanner stage and no correlation was observed with other body composition and endocrine parameter including leptin. CONCLUSION: These data suggest that Ghrelin levels decrease during puberty at least in boys as pubertal development proceeds but it is minimal. During puberty, ghrelin levels are stable. Ghrelin may have no relationship with other pubertal change. The relation of ghrelin and insulin sensitivity need to be further investigated.
Adolescent ; Body Composition ; Child ; Cross-Sectional Studies ; Endocrine System ; Ghrelin* ; Humans ; Insulin ; Insulin Resistance ; Leptin ; Male ; Puberty* ; Radioimmunoassay

PURPOSE: The incidence of type 2 diabetes in children and adolescents has been reported to increase recently. The aim of this study is to investigate the clinical features of type 2 diabetes developing during childhood and adolescent period. METHODS: The medical records of 33 patients with type 2 diabetes were reviewed. We analysed clinical manifestations, demographic data, and modes and responses of treatment. RESULTS: Age at diagnosis was 13.4+/-1.8 years. Seventy percent of patients revealed pubertal signs at diagnosis. Half of the patients had BMI more than 25 kg/m2. Seventy-three percent of patients had family history of type 2 diabetes. Acanthosis nigricans were found in 18% of patients. Nineteen(57.6%) patients were diagnosed incidentally by random urine or blood glucose test without any typical diabetic symptom or sign. The modes of therapy to control hyperglycemia were insulin alone(75.8%), oral hypoglycemic agents alone(9.1%), insulin and oral hypoglycemia agents(9.1%), and only diet with exercise(6%). At the time of investigation, 45.5% of patients were not using insulin. The typical diabetic symptoms at diagnosis were more prevalent in patients who required insulin for more than two years than patients who did not(P<0.05). CONCLUSION: The development of type 2 diabetes in children and adolescents is possibly related to puberty, obesity, family history, and defects in insulin secretion rather than insulin resistance. Many children and adolescents with type 2 diabetes required insulin initially and some of them could discontinue. More than half of the patients were diagnosed as diabetes without any typical symptom or sign, which might be one of the predictive factors of the prolonged insulin requirement.
Acanthosis Nigricans ; Adolescent* ; Blood Glucose ; Child* ; Diagnosis ; Diet ; Humans ; Hyperglycemia ; Hypoglycemia ; Hypoglycemic Agents ; Incidence ; Insulin ; Insulin Resistance ; Medical Records ; Obesity ; Puberty

PURPOSE: The aim of this study was to determine whether there is a feedback relationship between pituitary growth hormone (GH) and gastric ghrelin. METHODS: We intravenously administered 10 microgram of either rat ghrelin or normal saline to adult male Sprague-Dawley rats and then measured the plasma GH levels and the mRNA expression levels of pituitary GH mRNA and hypothalamic GH-releasing hormone (GHRH) mRNA. Human GH (500 microgram/kg, twice a day) or normal saline was subcutaneously administered to rats with or without food for 3 days. Thereafter, the plasma ghrelin levels and the ghrelin mRNA levels in the stomach were measured. RESULTS: The plasma GH levels increased more significantly in rats that were administered ghrelin than in controls (P<0.05). The mRNA levels of pituitary GH and hypothalamic GHRH were similar in the 2 groups. The plasma ghrelin levels and the stomach ghrelin mRNA levels were not affected by GH administration. Fasting significantly increased plasma ghrelin levels (P<0.05) and stomach ghrelin mRNA levels (P<0.05). CONCLUSION: Exogenous ghrelin administration only stimulated GH secretion without stimulating the synthesis of GH and GHRH. The synthesis and secretion of ghrelin were not suppressed by exogenous GH administration. These findings indicate that there is no feedback relationship between pituitary GH and gastric ghrelin.
Adult ; Animals ; Fasting ; Ghrelin ; Growth Hormone ; Growth Hormone-Releasing Hormone ; Humans ; Male ; Plasma ; Rats ; Rats, Sprague-Dawley ; RNA, Messenger ; Stomach

The authors have recntly experienced a case of Wilson's disease which was developed Kayser-Fleischer ring. The 13 years old male patient has dysarthria, slurring speech, choreiform movement and gait disturbance about for 2 years. The treatment was performed by B.A.L. and penicillamine and the result has been excellent up to date, 31/2 months after medical treatment. Physical examination on discharge were normal mentality, absence of tremors and pale Kayser Fleischer ring.
Adolescent ; Chorea ; Dysarthria ; Gait ; Hepatolenticular Degeneration* ; Humans ; Male ; Penicillamine ; Physical Examination ; Tremor

PURPOSE: Thyroid carcinomas are rare in childhood and adolescence, and the papillary thyroid carcinoma is the most frequent hisotological type. This study was undertaken to investigate clinical characteristics of the papillary thyroid carcinoma developing in childhood and adolescence. METHODS: From 1980 to 2006, 53 children and adolescents were treated for the papillary thyroid carcinoma in our department. Clinical characteristics were reviewed retrospectively. The clinical course of 9 patients was not evaluable because of inadequate follow-up and the remaining 44 patients were included in the final survival analysis. RESULTS: The median age at diagnosis was 14.9+/-3.9 years. There were 9 males and 44 females. There was a significant female preponderance (1:7.8) (P=0.035) in pubertal age group, while there was no sexual difference in prepubertal age group (1:1.25). 33 patients (62.3%) had local invasion to the perithyroidal tissue, 38 patients (71.7%) had regional lymph node metastasis, and 12 patients (22.6%) had pulmonary metastasis. Unilateral lobectomy, subtotal or total thyroidectomy was performed in all patients. 19 patients (35.8%) with local or distant metastasis were additionally treated with radioiodine ((131)I) ablation therapy. After initial treatment, 41 patients were alive and free of thyroid carcinoma, 3 patients were alive with persistent thyroid carcinoma. At median follow-up of 9.9+/-5.8 years, 10 patients (24.4%) among 41 patients were recurred but all 44 patients were alive, 5 with disease and 39 disease-free. CONCLUSION: Childhood Papillary thyroid carcinoma was more frequent in pubertal female. And it was associated with more locally aggressive, more frequent metastasis and had higher recurrence rates.
Adolescent ; Carcinoma ; Child ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

OBJECTIVE: This study aims at evaluating the usefulness of the electrodiagnostic study (EDx) and the magnetic resonance imaging (MRI), which are performed before surgical operation of brachial plexus injury. METHOD: We reviewed 57 cases of brachial plexopathy diagnosed with surgical findings. EDx and MRI were performed to the patients before surgery. Based upon intraoperative findings, we evaluated the occurrence of preganglionic root injury and subsequently each injured spinal root level. RESULTS: EDx and MRI for preganglionic root injuries showed 92.1% and 78.9% of diagnostic sensitivity and 63.2% and 42.9% of diagnostic specificity, respectively. The followings were about each injured spinal root level. EDx showed that the sensitivities of C5, C6, C7, C8, T1 were 91.4%, 91.4%, 92.6%, 96%, 95.8%, and their specificities were 59.1%, 59.1%, 56.7%, 68.8%, 66.7%. MRI showed that the sensitivities were 47.4%, 57.9%, 58.3%, 75%, 66.7%, and their specificities were 57.1%, 71.4%, 78.6%, 85.7%, 85.7%. CONCLUSION: As for preganglionic brachial plexopathy, EDx was more useful than MRI to diagnose preganglionic root injury and determine the level of injured spinal root.
Brachial Plexus ; Brachial Plexus Neuropathies* ; Humans ; Magnetic Resonance Imaging* ; Sensitivity and Specificity ; Spinal Nerve Roots