To analyse the clinical characteristics of children with atrial flutter(AF1), we reviewed(the medical records of the children who had been admitted and diagnosed as AF1 or 12 leads surface ECG during the period between February, 1986 and Octobe, 1990. The onset age of 25 children was evenly distributed between gestational period and upto 14 years of age. The sex ratio between boys and girls was 11:14. The cardiac abnormalities were detected in 21 children(dilated cardiomyopathy in 3, congenital heart defect in 18). In 4 children, AF1 occured in apparently normal heart. In 9 children, AF1 developed without relation to cardiac surgery(4 in normal heart, 3 in dilated cardiomyopathy, 2 in preoperative CHD). AF1 developed in 9 children within 30 days postoperatively(group A) and in 7, after 30 days postoperatively(group B). In group A, various types of operation were done. In 2 of them, AF1 persisted beyond the immediate postoperative period and 1 died of cardiac decompensation 3 months postoperatively. In group B, operative procedures before AF1 were Senning operation in 2, Fontan operation in 2, operation for tetralogy of Fallot, ventricular septal defect with severe tricuspid regurgitation, endocardial cushion defect in 1 each. Five children in group B( except 1 Senning operation and 1 Fontan operation) had significant residual atrioventricular regurgitation. The associated rhythm disturbance besides AF1 could be determined in 23 children. The sinus node dysfunction was associated in 8 ; the supraventricular dysrhythmia in 10; the ventricular dysrhythmia in 6; the atrioventricular conduction disturbance in 3, and no other associated rhythm disturbance in 6. The efficacy of various methods in conversion of AF1 to sinus rhythm were 57.1%(4/7) with DC cardioversion, 38.5%(5/13) with digoxin and other antiarrhythmic drug(amiodarone, beta blocker, quinidine, verapamil, flecainide), 25%(5/20) with pacing in esophagus or endocardium. The follow-up evaluation was possible in 24 children. Eight children were dead : 5 due to chronic decompensation, 2 due to sudden cardiac arrest, and 1 due to sepsis. Of the 16 alive children, 14 had recovered the normal sinus rhythm and the other 2 had persistent AF1. Twelve children without AF1 and 1 with persistent AF1 were on medication, Although there were none cardiac death in children without persistent AF1, 7 out of 9 children with persistent AF1 were dead. Of the 7 children with significant atrioventricular regurgitation, corrective procedures were done in 4. There were no death in these 4 children, despite of 2 cardiac death out of 3 children on whom corrective procedure were not done. In conclusion, the atrioventricular regurgitation was a significant factor in relation to the occurrence and persistence of AF1 and the prognosis was bad in children with persistent AF1. It is recommended to trat the children with AF1 associated with atrioventricular regurgitation promptly and more aggressively.
Age of Onset ; Atrial Flutter* ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Child* ; Death ; Death, Sudden, Cardiac ; Digoxin ; Electric Countershock ; Electrocardiography ; Endocardial Cushion Defects ; Endocardium ; Esophagus ; Female ; Follow-Up Studies ; Fontan Procedure ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Humans ; Medical Records ; Postoperative Period ; Prognosis ; Quinidine ; Sepsis ; Sex Ratio ; Sick Sinus Syndrome ; Surgical Procedures, Operative ; Tetralogy of Fallot ; Tricuspid Valve Insufficiency ; Verapamil

No abstract available.
Ductus Arteriosus, Patent*

PURPOSE: We analyzed the RESULTS of the GnRH stimulation test to assess its usefulness as a predictor for testicular dysfunction in adolescent varicocele. MATERIALS AND METHODS: We studied 20 adolescents with unilateral varicocele from January 1998 to January 2001. Eight patients were grade II and 12 were grade III. Testicular volume was measured using an orchidometer. The responses of the gonadotropins to GnRH stimulus were compared between grade II and III patients. All patients had varicocelectomy and 7 were followed up. RESULTS: After GnRH stimulus, all patients except one showed excessive response in LH and FSH. LH response(8-fold greater than the baseline) was more exaggerated than that of FSH(1.8-fold greater than the baseline). The 12 patients of grade III varicocele presented greater excessive responses in LH and FSH to GnRH stimulus than those of grade II(p>0.05). After surgical treatment, the exaggerated gonadotropin response to GnRH was not normalized. But the response was less exaggerated, suggesting an improvement of testicular dysfunction. CONCLUSIONS: In this study, the grade of the varicocele was correlated with the excessive responses of the gonadotropins to the GnRH stimulus. Nevertheless, we suggest that the deterioration of the testicular function in adolescents with varicocele was a progressive phenomenon. We think that the GnRH stimulation test could be useful in assessing the testicular dysfunction in adolescent varicocele patients.
Adolescent* ; Gonadotropin-Releasing Hormone* ; Gonadotropins ; Humans ; Varicocele*

The annular pancreas in adults is a rare congenital anomaly that is detected after development of complications, such as gastric outlet obstruction, recurrent pancreatitis, and peptic ulcer. Duodenal bypass is the procedure of choice for treating duodenal obstruction caused by the annular pancreas in both children and adults. Duodenoduodenostomy is routinely performed in neonates and children. In adults, duodenojejunostomy or gastrojejunostomy are recommended, because the duodenum is less mobile. We report a case of annular pancreas in a 33-year-old male that was successfully treated with laparoscopic gastrojejunostomy.
Adult ; Child ; Duodenal Obstruction ; Duodenum ; Gastric Bypass ; Gastric Outlet Obstruction ; Humans ; Infant, Newborn ; Laparoscopy ; Male ; Pancreas ; Pancreatic Diseases ; Pancreatitis ; Peptic Ulcer

No abstract available.
Arteries* ; Echocardiography ; Fetus* ; Heart ; Humans* ; Mitral Valve* ; Tricuspid Valve*

PURPOSE: The purpose of this study is to analyze left ventricular (LV) radial strain (S) and strain rate (SR) in children with dilated cardiomyopathy (DCM) and to evaluate whether the impairment of global radial wall motion correlates with global ventricular dysfunction in DCM. METHODS: In 10 DCM patients (range 0.6-15 years, median age 6.5 years, 3 females) and 17 age and sex matched normal controls (range 0.5-14 years, median age 5 years, 5 females) conventional echocardiography and real time tissue Doppler imaging analysis were performed. Using an automatic two dimensional speckle tracking imaging (STI) method radial S and SR were calculated for each LV segment in 18 segment model. To evaluate the correlation between the impairment of radial motion and LV global function, the average values of radial S and SR of each LV level were obtained, and defined as global (G) S or SR. RESULTS: LV radial S and SR were markedly heterogeneous and decreased in almost all segments of LV in DCM. Impaired radial S and SR were associated with global LV dysfunction. CONCLUSION: In DCM, decreased and disorganized radial S and SR contribute to LV dysfunction. Analysis of radial S and SR with STI method can give further information on LV function in DCM.
Cardiomyopathy, Dilated* ; Child* ; Echocardiography ; Humans ; Ventricular Dysfunction

A 45-year-old female visited our clinic due to sudden right leg weakness and sensory loss. Brain and spinal cord magnetic resonance imaging showed widespread cavernous malformations. Cavernous malformation in L1 spine area was accompanied by a subacute stage hematoma with perilesional edema. Sensory loss subsided after corticosteroid therapy. Usually, neurologic deficit by spinal cavernous malformation appears more chronically in the adults compared to children. Treatment options are difficult to establish in a case with multiple cavernous malformations. Identifying hemorrhagic lesions by extensive neuroimaging evaluation could be helpful to select the treatment target for cavernous malformation.
Adult ; Brain ; Central Nervous System* ; Child ; Edema ; Female ; Hematoma ; Hemorrhage ; Humans ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Neuroimaging ; Neurologic Manifestations* ; Spinal Cord ; Spine

Transcatheter balloon pulmonary valvuloplasty (BPV) is considered to be the treatment of choice for neonates with critical pulmonary valvar stenosis (PVS) or pulmonary valvar atresia with intact ventricular septum accompanied by reasonable right ventricular volume. The percutaneous femoral venous access is the most preferred route for BPV in most cardiac centers. We report herein the case of a newborn baby with critical PVS with inferior vena cava interruption, severe tricuspid regurgitation and a severely enlarged right atrium. We tried BPV through the transumbilical approach with difficulty, but he was successfully treated with the assistance of a coronary artery guiding catheter.
Catheterization/*methods ; Echocardiography ; Heart Defects, Congenital/surgery ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases/*surgery ; Male ; Pulmonary Atresia/*surgery ; Treatment Outcome

We reviewed 26 cases of cardiac rhabdomyoma in children which were diagnosed between 1986 and 1991 in Seoul National University Children's Hospital. Twenty-two cases were associated with tuberous sclerosis. Total tumor count was 58 and mean tumor count per patient was "daehakgyo".23. Their cardiac rhabdomyomas were diagnosed from fetal period through 12 years after birth. Median age was 9."uiwon" months. Fifteen patients were males and rest 11 patients were females. Cardiac symtoms and signs at initial diagnosis were present in 12 cases. They consisted of cardiac murmur in "hakgyo", arrhythmia in 8 and congestive heart failure in "daehakgyo" cases (one with murmur and the other with arrhythmia). Cardiomegaly was seen in 9 cases on chest X-ray and other "byeongwon" case showed abnormal left cardiac border. Electrocardiography and 24 hour Holter monitorings showed arrhythmia in 15 cases. Clinically significant arrhythmias were found in 7 cases on 24 hour Holter monitorings. They consisted of 1with frequent premature ventricular contractions, "daehakgyo uigwadaehak" with frequent premature atrial contractions, "daehakgyo" with atrial tachycardia and "daehakgyo uigwadaehak" with atrio-ventricular block ("daehakgyo" cases of atrio-ventricular block had other arrhythmias also). The locations of tumors were left ventricle in 21, interventricular septum in 21, right ventricle in 13 and atrium in "daehakgyo uigwadaehak" tumors. Mean tumor count per patient in fetal period and infancy was "daehakgyo".86 and it was statistically much more than that after infancy which was "byeongwon".5. Mean tumor area which was calculated on two dimensional echocardiography was larger in fetal period and infancy(128.9 +/- 38.2mm2)than that after infancy(47.8 +/- 11.2mm2). Mean relative tumor area to aortic root dimension was also significantly larger in fetal period and infancy than that after infancy ("daehakgyo".07vs 0.30). In tuberous sclerosis, mean mass area and mean relartive tumor area to aortic root dimension in fetal period and infancy was significantly larger than those in patients after infancy. Of 26 cases, tumorectomy was done in "daehakgyo uigwadaehak" cases due to hemodynamic obstruction and arrhythmia. One case died immediately after operation and the other "daehakgyo" cases are still alive with the follow up period of 30 and 44 months each. Of the 7 patients with significant arrhythmia on 24 hour Holter monitorings, pacemaker insertion was done in "byeongwon" case who received tumorectomy and other 1 case was treated with anti-arrhythmic drugs. All the other patients did not need anti-arrhythmic drugs or other management.
Arrhythmias, Cardiac ; Atrial Premature Complexes ; Cardiomegaly ; Child* ; Diagnosis ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Failure ; Heart Murmurs ; Heart Ventricles ; Hemodynamics ; Humans ; Male ; Parturition ; Rhabdomyoma* ; Seoul ; Tachycardia ; Thorax ; Tuberous Sclerosis ; Ventricular Premature Complexes

pose:Growth delay in asthmatic children has been reported, but the causes are unclear. In this study, we analyzed growth status in children with mild asthma and measured serum insulin-like growth factor (IGF)-I and insulin-like growth factor binding protein (IGFBP)-3 to evaluate the relationship between the growth status and growth factors. We also evaluated the difference in the relationship of height standard deviation score (HTSDS) according to weight standard deviation score (WTSDS) between children with asthma and controls. METHODS:58 children between the age of 9 months and 12 years, who visited Konkuk University Hospital between July 2002 to June 2003, with wheeze and responded to bronchodilators were enrolled as asthma group. 59 children between the age of 6 months and 14 years without any medical problem were enrolled as controls. Height and weight were measured for both groups and their standard deviation scores were calculated respectively. Blood samples were collected for serum IGF-I, IGFBP-3 levels and IGF-I/IGFBP-3 ratio were calculated from those values. The relationships between each growth status and growth factors were analyzed. RESULTS:The HTSDS and WTSDS were 0.17+/-.00, 0.38+/-.23 respectively for the asthma group; the HTSDS and WTSDS were 0.05+/-.95, 0.08+/-.06 respectively for the controls. IGF-I was 169.6+/-0.7 ng/mL, IGFBP-3 was 2146.0+/-36.5 ng/mL, and IGF-I/IGFBP-3 ratio was 0.08+/-.03 for the asthma group; IGF-I was 422.6+/-70.3 ng/mL, IGFBP-3 was 3409.6+/-61.1 ng/mL, and IGF-I/IGFBP-3 ratio was 0.12+/-.05 for the controls. In both groups, the concentration of IGF-I, IGFBP-3 and IGF-I/ IGFBP-3 ratio showed significant correlation with the age (P<0.01). In both groups, the correlation coefficient for WTSDS and HTSDS were 0.39 and 0.64, which were statistically significant. In the asthma group, the height gain was significantly smaller than the weight gain compared with controls (P<0.05). CONCLUSION: We concluded that in children with mild asthma the increment in HTSDS according to WTSDS is less than that of controls.
Asthma* ; Bronchodilator Agents ; Carrier Proteins ; Child* ; Humans ; Insulin-Like Growth Factor Binding Protein 3* ; Insulin-Like Growth Factor I* ; Intercellular Signaling Peptides and Proteins ; Weight Gain