Rhabdomyolysis is a syndrome resulting from skeletal muscle injury with release of muscle cell contents into the plasma. It has been reported as a cause of acute renal failure(ARF), and often associated with alcohol abuse, muscle compression, infections, and generalized seizure. Rhabdomyolysis-induced ARF is rare in children. We experienced a case of rhabdomyolysis-induced ARF in a 12-year-old boy who presented with azotemia and oliguria secondary to convulsion. After the control of convulsion by antiepileptic drugs, the daily urine output gradually increased and systemic features recovered with appropriate hydration and alkalinization.
Acute Kidney Injury* ; Alcoholism ; Anticonvulsants ; Azotemia ; Child ; Humans ; Male ; Muscle Cells ; Muscle, Skeletal ; Oliguria ; Plasma ; Rhabdomyolysis* ; Seizures*

Acute interstital nephritis can occur by acetaminophen, but it is rarely presented as acute renal failure with azotemia. We report a case of acute interstitial nephritis induced by acetaminophen in a 14-year-old girl who developed non-oliguric acute renal failure. She has taken acetaminophen to control the persistent throat pain for the last two months. Renal biopsy revealed diffuse infiltration of mononuclear inflammatory cells admixed with eosinophils in the edematous interstitia. After the discontinuation of acetaminophen and the administration of corticosteroid, the serum creatinine level returned to normal.
Acetaminophen ; Acute Kidney Injury* ; Adolescent ; Azotemia ; Biopsy ; Creatinine ; Eosinophils ; Female ; Humans ; Nephritis ; Nephritis, Interstitial* ; Pharynx

PURPOSE: This study was aimed to determine the predictive risk factors for the treatment response and relapse rate in children diagnosed with idiopathic nephrotic syndrome. METHODS: We analyzed the medical records of children who were diagnosed and treated for childhood idiopathic nephrotic syndrome from November 1991 to May 2005. Variables selected in this study were age at onset, sex, laboratory data, concomitant bacterial infections, days to remission, and interval to first relapse. RESULTS: There were 46 males and 11 females, giving a male:female ratio of 4.2:1. The age(mean+/-SD) of patients was 5.8+/-4.1 years old. Of all patients who were initially given corticosteroids, complete remission(CR) was observed in 54(94.7%). Of the 54 patients who showed CR with initial treatment, 40(70.2%) showed CR within 2 weeks and 14(24.6%) showed CR after 2 weeks. The levels of serum IgG were lower in the latter group who showed CR after 2 weeks(P=0.036). Of the 54 patients who showed CR with initial treatment, 47(82.5%) relapsed. Of these patients, 35.1% were frequent relapsers and 43.9% were infrequent relapsers. There was no significant correlation between the frequency of relapse and the following variables:sex, days to remission, and laboratory data. However, age at onset and interval to first relapse had a negative correlation with the frequency of relapse (Pearson's coefficient=-0.337, -0.433, P<0.012, P<0.01). CONCLUSION: The age at onset and the interval to first relapse were found to be predictive clinical parameters for the relapse rate, while the levels of serum IgG at initial presentation were a predictive laboratory factor for treatment response in childhood idiopathic nephrotic syndrome.
Adrenal Cortex Hormones ; Bacterial Infections ; Child ; Female ; Humans ; Immunoglobulin G ; Male ; Medical Records ; Nephrotic Syndrome* ; Recurrence* ; Risk Factors

BACKGROUND: Most of nonrebreathing circuits were used for pediatrics, not for adults and the high flow of fresh gas and specially designed valve or lever should be needed. The current study was designed to compare between one corrugated tube(universal FTMcircuit) and two corrugated tube in patients with oral and maxillofacial surgery under general anesthesia. METHODS: Twenty adults undergoing oral and maxillofacial surgery were anesthetized with enflurane- N2O-fentanyl after radial arterial cannulation. Under the condition with stable vital signs, ventilator was setted with tidal volume 10ml/kg, respiratory rate 11 breaths/min using two separate limbs(expiratory and inspiratory limbs) and one corrugated tube of anesthesia machine. Mean arterial pressure, heart rate, saturated pulse oxygen, end tidal carbon dioxide, peak inspiratory oxygen, arterial blood gas analysis were measured at 15, 30min during the use of each circuit. RESULTS: There were no differences of mean arterial pressure, heart rate, end tidal carbon dioxide, saturated pulse oxygen. peak inspiratory presssure and arterial blood gas analysis between 2 circuits during mechanical ventilation. CONCLUSIONS: Universal FTMcircuit of single limb could substituted for the two corrugated tube, especially in patients with oral and maxiolofacial surgery.
Adult ; Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Blood Gas Analysis* ; Carbon Dioxide ; Catheterization ; Extremities ; Heart Rate ; Hemodynamics* ; Humans ; Oxygen ; Pediatrics ; Respiration, Artificial ; Respiratory Rate ; Surgery, Oral* ; Tidal Volume ; Ventilators, Mechanical ; Vital Signs

PURPOSE: Since a significant number of patients with locally invasive bladder tumor(T3a/T3b) subsequently develop distant metastases, there have been lots of controversies in deciding treatment modalities. In the past decade, progress has been made in the development of effective chemotherapy for the treatment of advanced transitional cell carcinoma of the urothelium. Thus, we reviewed the effectiveness of the M-VAC(methotrexate, vinblastine, adriamycin, and cisplatin) chemotherapy for locally invasive transitional cell carcinoma (TCC) of the bladder. MATERIALS AND METHODS: We reviewed 36 patients who were diagnosed as T3a/T3b TCC and treated with aggressive transurethral resection of the bladder tumor(TURBt) and M-VAC chemotherapy Remission was defined in case of complete disappearance of the tumor or downstaging, and progression was defined in case of persistent disease or upstaging. RESULTS: Mean age of the patients was 60.4 years old(33 males; 3 females), and mean follow up was 12.2 +/- 8.9 months. Response rate considering loss of follow up according to the Kaplan-Meyer's method, was 79, 49, 44, 37% at 6, 12, 18, 24th month, respectively. Disease progressions were found in 19 patients during follow up, and the mean duration to progression was 9.2 +/- 5.0(1-19)months. 79% of the patients with disease progression showed progression within 12 months. Lymph node metastases or distant metastases were confirmed in 68% of progressed patients. CONCLUSIONS: M-VAC chemotherapy after aggressive TURBt is limited, but erective treatment modality, and it is also useful in deciding the prognosis of cancer with its responsiveness.
Carcinoma, Transitional Cell* ; Disease Progression ; Doxorubicin* ; Drug Therapy* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prognosis ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urothelium ; Vinblastine*

Recently, laser treatment of benign prostatic hyperplasia (BPH) is considered as a promising alternative to traditional transurethral resection of the prostate (TURP). To evaluate the effectiveness and safety of laser therapy on BPH, we compared the results of transurethral balloon laser thermotherapy (TUBALT, n=13) and Hybrid laser prostatectomy (HLP, n=21) with those of TURP (n=25) in 58 patients with mild and moderate BPH. Following data were evaluated at postoperative 1, 3 and 6 months : AUA symptom score (SS), maximal flow rate (Qmax), subjective symptom improvement (SI), postoperative complications. All 3 groups show significant improvement after treatment in the Qmax values. Among 3 groups, the Qmax value was lower in TUBALT group (12.9+/-3.3 ml/sec) than those in HLP group (15.5+/-5.2 ml/sec) and TURP group (18.7+/-5.3 ml/sec) on postoperative 6 months. The Qmax values were not significantly different between HLP and TURP groups. In the SS values, all 3 groups show significant improvement after treatment and, TUBALT (9.9+/-9.7) and HLP (10.3+/-9.4) group were comparable to TURP group (5.2+/-4.2) on postoperative 6 months. In global assessment of SI, both HLP (87.5%) and TUBALT (75%) group were also comparable to TURP (90%) group on postoperative 3 months. but TUBALT group showed delayed symptom improvement compared to TURP group. Postoperative complications were minimal both in HLP and TUBALT groups, compared to TURP group. These results suggest that both HLP and TUBALT are effective in mild and moderate BPH, Further more, HLP treatment could be considered a promising alternative to TURP.
Humans ; Hyperthermia, Induced* ; Laser Therapy ; Postoperative Complications ; Prostate ; Prostatectomy* ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate

OBJECTIVE: To evaluate the incidence, the time of detection, classification, and risk factors of thyroid dysfunction in very low birth weight (VLBW) and sick infants in order to help with the diagnosis and treatment of thyroid dysfunction in the neonatal intensive care unit (NICU). METHODS: We reviewed the medical records of 78 infants, who were admitted for more than 1 month in the NICU at Chungbuk National University Hospital from July 2004 through June 2006. In these infants, at least to 2 thyroid function tests were performed, a initial screening whthin 2 weeks of age and a repeated thyroid function test after 2 weeks of age. RESULTS: 1) The study infants were divided into 2 groups, VLBW (birth weight < 1,500 g) and NVLBW (birth weight > or =1,500 g). 2) In the VLBW groups (n=48), 24 infants (50%) showed thyroid dysfunction. Six infants (12.5%) were detected at initial screening test and all had transient hypothyroxinemia. The remaining 18 infants (37.5%) were detected at repeated tests, most commonly detected at 4~8 weeks of age (n=8). Their types of thyroid dysfunction were primary hypothyroidism (PH) with a delayed marked TSH rise (n=3), PH with a delayed mild TSH rise (n= 7), euthyroid sick syndrome (ESS, n=8), and central hypopituitary hypothyroidism (HH, n=1). 3) In the NVLBW groups (n=30), 11 infants (36.7%) showed thyroid dysfunction. Three infants (10%) were detected at initial screening test, while 8 (26.7%) were detected at repeated tests. Their types of thyroid dysfunction were PH (n=5), ESS (n=3), transient hyperthyrotropinemia (n=2), and HH (n=1). 4) Among 35 infants with thyroid dysfunction, 20 infants (57.1%) were treated with thyroxine. CONCLUSION: Thyroid dysfunction was very common in sick infants in the neonatal intensive care unit, especially in the very low birth weight infants. Often, they were not detected at the initial screening test, but detected at later repeated tests. The repeated thyroid function test need to be performed in infants at risk for late detection of thyroid dysfunction after 2~4 weeks of age.
Chungcheongbuk-do ; Classification ; Diagnosis ; Euthyroid Sick Syndromes ; Humans ; Hydrogen-Ion Concentration ; Hypothyroidism ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Mass Screening ; Medical Records ; Risk Factors ; Thyroid Function Tests ; Thyroid Gland* ; Thyroxine

The sparsity of publication concerning CT findings of tuberculous arthritis prompted authors to retrospectively evaluate 12 patients with tuberculous arthritis for characteristic CT findings. In each patient, the diagnosis of tuberculous arthritis was confirmed by surgery or biopsy. The CT examinations were evaluated by two radiologists retrospectively. Involved joints were the hip joint in seven patients, the sacroiliac joint in three parients, and the shoulder and ankle joint in one patients each. CT features included subchondral bony erosion(12 patients), soft tissue mass in the joint space(nine), widenining of the joint space(eight), ipsilateral muscle atrophy(eight), thickening of the joint capsule(seven), intra-articular effusion(six), soft tissue abscess(five),and bony sclerosis(four). In seven patients with the duration of symptoms less than 1 year, thickening of joint capsule and intra-articular effusion were the predominent findings, while bony sclerosis, gross bone destruction, and soft tissue mass in joint space were seen in five patients with the duration of symptoms longer than 1 year. Our results indicate that CT is useful in the diagnosis of tuberculous arthritis by demonstrating characteristic pathologic changes of the joint space, soft tissue abnormality and bony involvement.
Ankle Joint ; Arthritis* ; Biopsy ; Diagnosis ; Hip Joint ; Humans ; Joint Capsule ; Joints ; Publications ; Retrospective Studies ; Sacroiliac Joint ; Sclerosis ; Shoulder

Primary fetal hydrothorax presents a wide spectrum of severity ranging from small harmless effusions to life-threatening thoracic compression. Management of this condition is controversial. We experienced a case of non-chylous primary fetal hydrothorax not associated with hydrops or other malformations. A predominantly unilateral hydrothorax in a fetus was diagnosed by sonography at 31 weeks gestation. Repeated ultrasonographic examinations to detect development of hydrops or progression of intrapleural effusion were used to evaluate the need for intrauterine thoracentesis and to decide the optimal time for delivery. Two thoracenteses were performed. The baby was delivered at 34 weeks. Postnatal intubation was carried out in the baby, and then chest tube placement was performed and resulted in the collection of 805ml of serous fluid. Sustained intubation was necessary for 16 days because of developing respiratory distress as a result of prematurity and recurrent pleural fluid accumulation. The baby did well after postnatal evacuation of the intrapleural fluid. Pre and postnatal investigation to find the pathophysiological mechanism leading to hydrothorax were negative. We conclude that non-chylous primary fetal hydrothorax is generally associated with a favorable outcome.
Chest Tubes ; Edema ; Fetus ; Hydrothorax ; Intubation ; Pregnancy

Fractures, Comminuted ; Humans ; Incidence ; Mandible ; Mandibular Fractures ; Osteomyelitis ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome