The sella turcica is often the key to intracranial diseases and some endocrine disorders. It is significanly enlarged in hypothyroidism, pituitary tumors, some types of increased intracranial pressure and decreased in size in hypopituitarism. Estimation of the sellar size by naked eye is not scientific and moreover very difficult, especially in the borderline sella, an everyday problem of radiologist and pediatrician. It would be very convenient in evaluating the size of the sellar turcica if there are reliable standards. However normal values of the sella turcica for children have not been published in Korea yet. Means+/-2 S.D. of the area and volume of the sella turcica were obtained from skull films taken antero-posterior and lateral projections with focus-film distance of 36 inches in 517 Korean children(Boys, 293; Girls, 224). The area was calculated using the formula : A=LxD, and the volume was studied using the formula : V=1/2 (LxDxW) where A is area ; V, volume ; L, length ; D, depth and W, width of the sella turcica (Fig. 1,2,3). The results obtained are presented in Tables 2~5 and Figures 4~7. By the data, sella turcica area above 70mm2 in infants (0~1 year of age), 90mm2 in preschool children(2~5 years of age), 100mm2 in schoolchildren (6~11 years of age) and 140mm2 in adolescents(12~14 years of age) and/or sellar turcica volume above 450mm2 in infants, 600mm2 in preschool children, 700mm2 in school children and 1,000mm2 in adolescents can be regarded abnormally large sella whereas sella turcica area below 10mm2 in infants, 30mm2 in preschool children, 40mm2 in school children and 50mm2 in adolescents and/or sella turcica volume below 60mm2 in infants, 150mm2 in preschool children, 300mm2 in schoolchildren and 450mm2 in adolescents can be said abnormally small sella. Separate plottings of the volume of the sella turcica for boys and girls show a rapid increase in size during the first two years of life, gradual deceleration in growth rate thereafter and pre-pubertal acceleration of growth in girls by 12 years of age and in boys by 14 years of age. The sella turcica of boys tends to be larger than that of girls from the infancy to 10 years and girls tend to be larger than that of boys between the ages of 11 and 14 years because of the earlier pre-adolescent growth acceleration in girls compared with boys(Fig. 8). An application of these normal values for the sella turcica should help the pediatrician, radiologist, neurologist and neurosurgeon in judging the size of the sellar turcica for children.
Acceleration ; Adolescent ; Child* ; Child, Preschool ; Deceleration ; Female ; Humans ; Hypopituitarism ; Hypothyroidism ; Infant ; Intracranial Pressure ; Korea ; Pituitary Neoplasms ; Reference Values ; Sella Turcica* ; Skull

No abstract available.
Humans ; Neurogenic Bowel* ; Spinal Cord Injuries*

Hereditary fructose intolerance (HFI) is a carbohydrate metabolic disease of autosomal recessive inheritance. The basic deficit is deficiency of aldolase B, the enzyme catalyzing catabolism of fructose-1-phosphate, which is found only in intestinal mucosa, liver and kidney. Its main symptoms are abdominal pain, vomiting, hypoglycemia, and severe liver disease following the ingestion of fructose. Neurologic impairment is not typical in HFI, but it can occur in the acute phase of the disease. Neurologic impairment is related to the acute hepatic toxicity of fructose (hypoglycemia, abnormal coagulation, cardiovascular collapse). The 7 year-old German girl admitted because of generalized tonic clonic seizure. She had the first seizure at the age of 2, and was diagnosed as Lennox-Gastaut syndrome. Thereafter, frequent morning and midnight seizures were developed following indigestion of milk, sweety cake and cookies. Her family history was unknown because she was adopted from India at the 4 months of age. She showed developmental delay. After the ingestion of fructose, the patient experienced hypoglycemic episode within 60-90 minutes of the intake. Based on this finding, she was diagnosed as HFI. With fructose free diet, the patient became free of seizure even without the anticonvulsant, and improved in growth and development.
Abdominal Pain ; Child ; Diet ; Dyspepsia ; Eating ; Female ; Fructose ; Fructose Intolerance* ; Fructose-Bisphosphate Aldolase ; Growth and Development ; Humans ; Hypoglycemia ; India ; Intestinal Mucosa ; Kidney ; Liver ; Liver Diseases ; Metabolic Diseases ; Metabolism ; Milk ; Seizures ; Vomiting ; Wills

Fifteen patients, 15 eyes with medically uncontrollable glaucomas and poor surgical prognoses underwent one-stage, single plate Molteno implatation without postoperative adjunctive systemic antifibrosis therapy. The Molteno implant procedures were successful in 12 (80%) of the 15 eyes. The visual acuity was improved in 2 eyes (13%), but worsened in 2 eyes (13%). Complications included hyphema in 5 eyes (33%), choroidal detachment in 4 eyes (26%), shallow anterior chamber in 3 eyes (20%), tube-iris touch in one eye (6%).
Anterior Chamber ; Choroid ; Glaucoma* ; Humans ; Hyphema ; Prognosis ; Visual Acuity

Thyroid hormones are crucial for development of the central nervous system. Congenital hypothyroidism (CH) is the most common preventable disease resulting in mental retardation. A neonatal screening test (NST) can detect a mild form of CH that can be treated at an early age. Generally after 3 years of age, when most of the brain has matured, clinicians consider reevaluation of thyroid function for CH patients that have been identified with a normal thyroid gland at a normal position. This report presents three CH patients that developed normally, with persistent goiter despite thyroid hormone supplements. The patients’ initial thyroid-stimulating hormone (TSH) level after NST was 47, 157, and 57 mIU/L, respectively. Levothyroxine administration began at 1 or 2 months of age and was terminated after reevaluation at the age of 3, 15, and 5 years, respectively. However, 1 or 2 years later, they all resumed their medication due to increased TSH level coupled with newly developed or enlarged goiter. They all showed dual oxidase maturation factor 2 (DUOXA2) gene mutation: a homozygous mutation with DUOXA2 (c.413dupA; p.Tyr138*) in case 1, a presumed compound heterozygotic mutation with DUOXA2 (p.Tyr138*/p.Tyr246*) in case 2, and heterozygous mutations with DUOXA2 (c.738C>G; p.Tyr246*) and TPO (c.2268dupT; p.Glu757*) in case 3. When goiter persists or is newly developed despite a maintained euthyroid status, for those with transient CH history, follow-up to assess the thyroid function is recommended for at least 1 or 2 years, and genetic testing would be helpful. This study presents the first clinical cases of DUOXA2 mutation in Korea.

PURPOSE: We evaluated restoration of range of motion(ROM) after manipulation under intravenous anesthesia in patients whose maximum flexion was less than 90 degrees at 2 weeks after total knee arthroplasty(TKA). MATERIALS AND METHODS: 136 knees of 108 patients who received TKA between January 1996 and December 2000 and followed up for more than 2 years were analyzed. The forceful manipulation underwent for 16 knees because whose maximum flexion was less than 90 degrees after 2 weeks of TKA. Manipulation were done for 12 of 16 cases at 2 weeks after TKA and 4 cases after more than 3 months. RESULTS: 12 knees which were manipulated 2 weeks after TKA had a mean flexion 103+/-10.2 degrees , 111+/-9.6 degrees and 116+/-11.4 degrees at immediate post-operation, 3 months and 2 years after TKA. In 4 knees manipulated more than 3 months after TKA, a mean flexion was 100+/-10.4 degrees , 102+/-11.5 degrees and 96+/-11.4 degrees at immediate post-operation, 3 months after manipulation and 2 years after TKA. 120 knees with no manipulation had a mean flexion 115+/-13.7 degrees at last follow-up. There was no difference of a mean flexion at last follow-up between group manipulation within 2weeks after TKA and group with no manipulation. CONCLUSION: Manipulation under intravenous anesthesia performed 2 weeks after TKA if patients had less than 90 degrees of flexion increased flexion of the operated knee without any serious complication.
Anesthesia, Intravenous ; Arthroplasty* ; Follow-Up Studies ; Humans ; Knee*

OBJECTIVE: The purpose of our study is to evaluate the success rate and feasibility of intraoperative neuromonitoring (IONM) focusing on transcranial motor evoked potential (TcMEP) monitoring for patients with preoperative motor weakness in spine surgery. METHODS: Between November 2011 and December 2013, TcMEP and somatosensory evoked potential (SSEP) monitoring were attempted in 130 consecutive patients undergoing spine surgeries for cervical or thoracic cord lesions. Patients ranged in age from 14 to 81 years (mean±standard deviation, 56.7±14.8 years), and 84 patients were male. The success rates of both SSEP and MEPs monitoring were assessed according to the preoperative Medical Research Council (MRC) and Nurick grades. RESULTS: TcMEP was recorded successfully in 0%, 28.6%, 72.3%, and 100% of patients with MRC grades 1, 2, 3, 4, and 5, respectively. SSEP was obtained from 0%, 37.5%, 21.5%, 61.4%, and 85.4% of patients with MRC grades 1, 2, 3, 4, and 5, respectively. TcMEP was recorded successfully in 84% of patients with Nurick grades 1-3 and 26% of patients with Nurick grades 4-5. SSEPs were recorded successfully in 76.3% of patients with Nurick grades 1-3 and 24% of patients with grades 4-5. CONCLUSION: IONM during spine surgery may be useless in patients with MRC grades 1-2, applicable MRC grade 3, and useful MRC grades 4-5. MRC grade 3 is a critical point of indication for application of MEPs. In unmonitorable cases with MRC grade 3, increasing stimulus intensity or facilitation techniques may be considered to improve the usefulness of TcMEP.
Evoked Potentials, Motor ; Evoked Potentials, Somatosensory ; Humans ; Male ; Spine*

Ferrocholinate, choline citrate iron salt is a new chelate iron which is synthesized by reacting ferric hydroxide with choline dihydrogen citrate. Ferrocholinate is used in the prevention and treatment of microcytic, hypochromic anemias due to iron deficiency. Ferrocholinate does not release high concentrations of free ionic iron in the gastrointestinal tract and clinical reports, although limited, seem to indicate that this drug is better tolerarated than is ferrous sulfate or ferrous gluconate. Ferrocholinate : syrup was administered to 19 patients of iron deficiency anemia. Ferrocholinate was administered orally. Therapeutic dosage was 1.2cc/kg (elementary iron 6mg/kg) divided three times daily. The results were obtained as follows. (Table 1) 1) In this clinical trials, the over-all effective rate was 84.2% 2) There was no effect on 3 cases who have combined with severe infection and congenital heart disease. 3) Of the 19 patients, 2 patients complained transient nausea and 1 patient mild diarrhea. These symptoms, however, disappeared along with continued therapy.
Anemia, Hypochromic ; Anemia, Iron-Deficiency* ; Child* ; Choline ; Citric Acid ; Diarrhea ; Gastrointestinal Tract ; Heart Defects, Congenital ; Humans ; Iron* ; Nausea

PURPOSE: Retrospective studies were carried out to clarify the incidence of contralateral occurrence after unilateral repair of hydrocele in children and the role of ultrasonography in preoperative recognition of asymptomatic hydrocele. MATERIALS AND METHODS: 452 patients of under 14 years old who underwent unilateral hydrocele repairs between January, 1990 and December, 1997 were reviewed. Patients with contralateral occurrence were defined as those who had previous unilateral hydrocele repairs and no clinical or historical evidence of contralateral hydrocele at the time of the initial repair Patients with simultaneous presence of bilateral hydrocele on their initial visit were excluded from this study. 36 patients who visited lately underwent ultrasonographic examination of both side of the groin and scrotum prior to surgery to identify asymptomatic contralateral hydrocele. RESULTS: The incidence of contralateral occurrence after unilateral hydrocele repairs was 5.4%(24 patients). When the left side was repaired initially, 13(7.4%) patients showed contralateral occurrence and when the right side was repaired initially, 11 (4.0%) patients showed contralateral occurrence. In the 36 patients who underwent ultrasonography, 2 patients(5.6%) had asymptomatic contralateral hydrocele and exploration revealed the presence of a patent processus vaginalis. On the other hand, 2 patients(5.6%) with negative ultrasonographic findings had contralateral repairs 1 month after clinically apparent hydrocele repair. CONCLUSIONS: Although the incidence was low, contralateral occurrence after unilateral repair of hydrocele in children was noted. Therefore, preoperative thorough history taking and physical examination in unilateral hydrocele patients should be performed. Also, in suspicious cases, inguinal or scrotal ultrasonography is helpful for the detection of the clinically occult contralateral hydrocele in children.
Adolescent ; Child* ; Groin ; Hand ; Humans ; Incidence ; Physical Examination ; Retrospective Studies ; Scrotum ; Ultrasonography

This study was designed to reveal the correlationship between the internal derangement state of TMJ and clinical characteristics including pain and mandibular dusfuntion. One hundred and twenty five subjects with TMJ signs and symptoms were chosen for two years. The level of pain and mandibular dysfuntion were evaluated by Visual Analog Scale(VAS) and Craniomandibular Index(CMI). The diagnostic categories of TMJ internal derangement were determined by arthrography and they included normal disc position, anterior disc displacement with reduction(ADDR), rotational disc displacement with reduction(RDDR), andterior disc displacement without reduction(ADDNR), and rotational disc displacement without reduction(RDDNR). Also disc perforation was used as a criteria to divide the diagnostic subgroups. The obtained results were as follows ; 1. The patient distribution of each group was 5 in normal disc position(4%), 40 in ADDR(32%), 30 in RDDR(24%), 34 in ADDNR(27%), and 16 in RDDNR(13%). 2. Perforation was observed in 8% of ADDR, 10% of RDDR, 32% of ADDNR, and 19% of RDDNR. 3. CMI of perforation group was higher than that of reduction or normal group(P<0.005), but vas showed no significant difference. 4. CMI of non-reduction group was higher than that of non-perforation group in reduction group(P<0.05). 5. There were no significant differences of CMI and VAS between anterior disc displacement group and rotational disc displacement group in both reduction and non-reduction group. 6. CMI of RDDNR group was higher than that of RDDR group(P<0.05). 7. There were no significant difference of CMI and VAS between bilateral involvement group and unilateral involvement group(p>0.05).
Arthrography ; Humans ; Temporomandibular Joint*