Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes. The lifetime prevalence of DPN is thought to be >50%, and 15%–25% of patients with diabetes experience neuropathic pain, referred to as “painful DPN.” Appropriate treatment of painful DPN is important because this pain contributes to a poor quality of life by causing sleep disturbance, anxiety, and depression. The basic principle for the management of painful DPN is to control hyperglycemia and other modifiable risk factors, but these may be insufficient for preventing or improving DPN. Because there is no promising diseasemodifying medication for DPN, the pain itself needs to be managed when treating painful DPN. Drugs for neuropathic pain, such as gabapentinoids, serotonin–norepinephrine reuptake inhibitors, tricyclic antidepressants, alpha-lipoic acid, sodium channel blockers, and topical capsaicin, are used for the management of painful DPN. The U.S. Food and Drug Administration (FDA) has approved pregabalin, duloxetine, tapentadol, and the 8% capsaicin patch as drugs for the treatment of painful DPN. Recently, spinal cord stimulation using electrical stimulation is approved by the FDA for the treatment for painful DPN. This review describes the currently available pharmacological and nonpharmacological treatments for painful DPN.

Spinal epidural hematoma (SEH) is a rare neurosurgical emergency in which pressure on the spinal cord leads to acute neurological deficits, and is a rare complication in children with hemophilia. We report three cases of SEH in severe hemophilia A. An 8-month-old boy who presented with non-traumatic acute-onset irritability was found to have SEH and was later diagnosed with hemophilia. The two other patients presented with neck pain and magnetic resonance imaging confirmed the diagnosis of SEH. Two patients who received conservative management fully recovered, however the patient who presented with progressive neurological abnormalities at the time of diagnosis, received surgery but later developed breathing difficulties and quadriplegia. Early diagnosis and immediate, aggressive, clotting factor replacement therapy are crucial when managing SEH in children with hemophilia. Immediate and aggressive factor replacement, accompanied by both neurological monitoring and early imaging, are essential for hemophiliac with suspected SEH.
Child* ; Diagnosis ; Early Diagnosis ; Emergencies ; Hematoma ; Hematoma, Epidural, Spinal* ; Hemophilia A* ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Neck Pain ; Quadriplegia ; Respiration ; Spinal Cord

Background: We investigated the prevalence of diabetic retinopathy (DR) in patients with undiagnosed diabetes through a nationwide survey, compared to those with known diabetes. Methods: Among the participants of the Korean National Health and Nutrition Examination Surveys (KNHANES) from 2017 to 2018, individuals aged ≥40 years with diabetes and fundus exam results were enrolled. Sampling weights were applied to represent the entire Korean population. Newly detected diabetes patients through KNHANES were classified under “undiagnosed diabetes.” Results: Among a total of 9,108 participants aged ≥40 years, 951 were selected for analysis. Of them, 31.3% (standard error, ±2.0%) were classified under “undiagnosed diabetes.” The prevalence of DR in patients with known and undiagnosed diabetes was 24.5%±2.0% and 10.7%±2.2%, respectively (P<0.001). The DR prevalence increased with rising glycosylated hemoglobin (HbA1c) levels in patients with known and undiagnosed diabetes (P for trend=0.001 in both). Among those with undiagnosed diabetes, the prevalence of DR was 6.9%±2.1%, 8.0%±3.4%, 5.6%±5.7%, 16.7%±9.4%, and 42.6%±14.8% for HbA1c levels of <7.0%, 7.0%–7.9%, 8.0%–8.9%, 9.0%–9.9%, and ≥10.0% respectively. There was no difference in the prevalence of hypertension, dyslipidemia, hypertriglyceridemia, or obesity according to the presence or absence of DR. Conclusion About one-third of patients with diabetes were unaware of their diabetes, and 10% of them have already developed DR. Considering increasing the prevalence of DR according to HbA1c level was found in patients with undiagnosed diabetes like those with known diabetes, screening and early detection of diabetes and DR are important.

PURPOSE: Febrile seizures (FSs) are the most common type of seizure in the first 5 years of life and are frequently associated with viral infections. Influenza infection is associated with a variety of neurological conditions, including FSs. The purpose of this study was to evaluate the clinical implications of influenza infection in FSs. METHODS: In total, 388 children with FS were divided into two groups: FS with influenza infection (n=75) and FSs without influenza infection (n=313). Their medical records, including seizure type, frequency, duration, and familial history of FSs or epilepsy, were retrospectively reviewed and the clinical characteristics of the two groups were compared. RESULTS: In total, 75 of the 388 children (19.3%) had FSs associated with influenza infection; such children were significantly older than those with FSs without influenza infection (34.9±22.3 months vs. 24.4±14.2 months; P < 0.001). The children who had more than two febrile seizures episodes were more prevalent in children with FS with influenza infection [40/75 (53.3%) vs. 92/313 (29.4%); P < 0.01]. Children older than 60 months were more likely to have influenza infection compared to those aged less than 60 months [11/22 (50%) vs. 64/366 (17.5%); P=0.001]. CONCLUSION: Influenza infection may be associated with FSs in older children, and with recurrence of FSs. Its role in the development of afebrile seizures or subsequent epilepsy requires further investigation with long-term follow-up.
Child ; Epilepsy ; Follow-Up Studies ; Humans ; Influenza, Human* ; Medical Records ; Recurrence ; Retrospective Studies ; Seizures ; Seizures, Febrile*

Differentiating between nocturnal seizures and sleep-related behaviors is challenging; a detailed history and careful examination are imperative. There have been some case reports of patients who were comorbid with nocturnal seizures and obstructive sleep apnea (OSA). Here, we report a case of an overweight 12-year-old boy diagnosed with sleep-related epilepsy and comorbid OSA. We were able to make these two diagnoses by performing polysomnography with full extended electroencephalography on our patient, who complained of recurrent nocturnal choking episodes during sleep. What differentiates our case is that after further evaluation, the cause of our patient’s OSA was ultimately determined to be laryngeal lymphoid hyperplasia.

Behcet's disease is a multisystem autoimmune disease with vasculitic features, and major vascular involvement occurs in 7.7-60% of patients. Venous lesions are more common than arterial lesions and arterial thrombotic events are relatively rare. We report a patient with Behcet's disease who developed a splenic infarct associated with splenic thrombotic arteritis. A 44-year-old man who had been diagnosed with Behcet's disease 5 years earlier presented with left flank pain lasting for 5 days. Laboratory tests revealed an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Computed tomography (CT) and three-dimensional CT showed a wedge-shaped splenic infarct and thrombus in the splenic artery. We treated him with low-molecular-weight heparin and prednisolone. The symptoms improved within 6 days of hospitalization, after which we stopped the heparin and added methotrexate and azathioprine. Splenic infarct should be ruled out if patients with Behcet's disease complain of new left-sided abdominal pain.
Abdominal Pain ; Adult ; Arteritis ; Autoimmune Diseases ; Azathioprine ; Blood Sedimentation ; C-Reactive Protein ; Flank Pain ; Heparin ; Heparin, Low-Molecular-Weight ; Hospitalization ; Humans ; Methotrexate ; Prednisolone ; Splenic Artery ; Splenic Infarction ; Thrombosis

Behcet's disease is a multisystem autoimmune disease with vasculitic features, and major vascular involvement occurs in 7.7-60% of patients. Venous lesions are more common than arterial lesions and arterial thrombotic events are relatively rare. We report a patient with Behcet's disease who developed a splenic infarct associated with splenic thrombotic arteritis. A 44-year-old man who had been diagnosed with Behcet's disease 5 years earlier presented with left flank pain lasting for 5 days. Laboratory tests revealed an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Computed tomography (CT) and three-dimensional CT showed a wedge-shaped splenic infarct and thrombus in the splenic artery. We treated him with low-molecular-weight heparin and prednisolone. The symptoms improved within 6 days of hospitalization, after which we stopped the heparin and added methotrexate and azathioprine. Splenic infarct should be ruled out if patients with Behcet's disease complain of new left-sided abdominal pain.
Abdominal Pain ; Adult ; Arteritis ; Autoimmune Diseases ; Azathioprine ; Blood Sedimentation ; C-Reactive Protein ; Flank Pain ; Heparin ; Heparin, Low-Molecular-Weight ; Hospitalization ; Humans ; Methotrexate ; Prednisolone ; Splenic Artery ; Splenic Infarction ; Thrombosis

This study was conducted to establish accurate baseline values of clinical laboratory data with regard to age-related changes in the Oriental white stork (Ciconia boyciana). In addition, the availability of an automated hematological cell counter was evaluated. A total of 94 clinically normal storks, including 64 young storks (<1 year old; 30 male and 34 female) and 30 adults (> 1 year old; 17 male and 13 female) were included. Hematological assays were performed using manual and automated cell counters and serum biochemistry profiles were examined using an automated analyzer. There were no significant differences in any parameters between male and female storks, while 16 parameters were significantly different between young and adult storks. Of these 16 parameters, total protein, albumin, aspartate aminotransferase, alanine aminotransferase, creatinine, triglyceride, total bilirubin, potassium, white blood cell count, packed cell volume, mean cell volume and hemoglobin levels were higher in adult storks than in young storks, while the latter showed higher glucose, uric acid and alkaline phosphatase levels, as well as a higher sodium/potassium ratio. The results presented herein will aid researchers who work for the conservation and rehabilitation of this endangered species.
Adult ; Alanine Transaminase ; Alkaline Phosphatase ; Aspartate Aminotransferases ; Bilirubin ; Biochemistry ; Cell Count ; Cell Size ; Creatinine ; Endangered Species ; Erythrocyte Indices ; Female ; Glucose ; Hematology ; Humans ; Leukocyte Count ; Male ; Potassium ; Rehabilitation ; Triglycerides ; Uric Acid

PURPOSE: We tried to find the relationships between the fetal beta-cell function and neonatal birth weight, anthropometric measures, and maternal characteristics, and to observe role of insulin as fetal growth factor in offsprings of mothers who have normal glucose metabolism. METHODS: We measured umbilical cord blood insulin and C-peptide concentrations in 236 neonates delivered at Cheil General Hospital from Jan. 1 to Jan. 31 1994. Their mothers had normal glucose metabolism during pregnancy. The birth weight and other anthropometric measures were performed within 24 hours after birth by same pediatrician. RESULTS: 1) The mean gestational age was 39.5+/--0.1 wk and mean birth weight was 3.3+/--0.2 Kg. According to birth weight percentile, the numbers of small for gestational age(SGA), adequete for gesational(AGA), and large for gestational age(LGA) infans were 3(1.3%), 178(75.4%), and 55(23.3%), respectively. There were no differences in gestational age, birth weight, length, head circumference, chest circumference, Ponderal index, and symmerty index between male and female infants. 2) The maternal weight gain during pregnancy was related to neonatal birth weight, length, and head circumference, but not to Ponderal index and symmetry index. 3) The mean cord blood insulin and C-peptide concentrations were 5.1+/--0.1uU/ml and 1.3+/--0.1 ng/ml. There was a significant positive correlation between insulin and C-peptide concentrations. 4) There were no significant differences in cord blood insulin and C-peptide concentrations among the SGA, AGA, and LGA group. 5) The cord blood insulin and C-peptide concentrations had weak positive correlations with neonatal birth weight, obesity, and gestational age, but nor with maternal weight gain during pregnancy. CONCLUSIONS: Although insulin has a significant role in fetal growth in diabetic pregnancy or intrauterine growth retardation(IUGR), our results suggest that it does not have a significant effect on fetal growth in offsprings of mothers who have normal glucose metabolism.
Birth Weight ; C-Peptide ; Female ; Fetal Blood* ; Fetal Development ; Gestational Age ; Glucose* ; Head ; Hospitals, General ; Humans ; Infant ; Infant, Newborn ; Insulin ; Male ; Metabolism* ; Mothers* ; Obesity ; Parturition ; Pregnancy ; Thorax ; Umbilical Cord* ; Weight Gain

PURPOSE: To evaluate the clinical outcomes and prognostic factors in retroperitoneal soft tissue sarcomas treated by postoperative radiotherapy. MATERIALS AND METHODS: The records of 23 patients with retroperitoneal soft tissue sarcomas, who underwent postoperative radiotherapy between 1985 and 2003, were analyzed. The median follow-up period was 77 months (range, 8~240 months). A total of 21 patients presented with primary disease, and two patients presented with recurrent disease. Liposarcomas and leiomyosarcomas represented 78% of the diagnosed tumor cases. Moreover, 17 cases were of high grade (grade 2 or 3). The median tumor size was 13 cm (range, 3~50 cm). Complete excision was achieved in 65% of patients. The median radiation dose was 50.4 Gy (range, 45.0 to 59.4 Gy), with conventional fractionation. RESULTS: The 5-year overall, local recurrence-free, and distant metastasis-free survival rates were 68%, 58%, and 71%, respectively. Eleven patients experienced local recurrence, while 9 patients experienced distant metastasis. The most common site for distant metastasis was the liver. A univariate analysis revealed that adjacent organ invasion and age (> 60 years) as the significant risk factors contributing to the prediction of poor overall survival. Moreover, multivariate analyses indicated that adjacent organ invasion remained significantly associated with a higher risk of death. In addition, patient age (> 60 years) was the other identified risk factor for local recurrence by univariate and multivariate analyses. Except for one case of grade 3 diarrhea, no patient suffered grade 3 or higher complications. CONCLUSION: Our results were comparable to previous reports in that adjacent organ invasion and patient age (> 60 years) were significant predictors of poor survival and tumor recurrence, respectively.
Risk Factors ; Neoplasm Metastasis