PURPOSE: Congenital hypothyroidism(CH) is not uncommon disorder, leading to retardation of mental development and growth, if not treated early. The aim of this study is to determine the factors influencing IQ of children with CH, diagnosed after 1 month of life. METHODS : Thirteen children with CH were included. They had intelligence test by KEDI-WISC(Korean Educational Development Institute-Wechsler Intelligence Scale for Children) and their medical records were reviewed. Their T4, TSH, height, age at diagnosis were investigated retrospectively. To evaluate the influence of T4, TSH, height, age at diagnosis on IQ, children were divided into three groups ; athyroid(n=8), sublingual(n=3), inborn errors of thyroid hormone synthesis(n=2) according to the result of thyroid scan. Results : In athyroid group, IQ closely correlated to VIQ and PIQ and had close relationship to T4 at diagnosis(.p=0.0086, r=0.8427), but no relation to TSH. There was no difference in height, T4 TSH, and IQ between athyroid and sublingual group. CONCLUSION : The results suggest that intellectual function in children with CH, diagnosed after 1 month of life depends on serum level of T4 at diagnosis. Further study is mandatory to elucidate the relationship between final IQ and factors, including thyroid function, age at diagnosis, adequacy of treatment, etc.
Child* ; Congenital Hypothyroidism* ; Diagnosis ; Growth and Development ; Humans ; Intelligence ; Intelligence Tests ; Medical Records ; Retrospective Studies ; Thyroid Gland

We report a rare case of an extremely large right ventricular myxoma involving the ventricular side of the tricuspid valve. The tumor was excised along with the entire posterior leaflet and part of the anterior leaflet. The tricuspid valve was repaired by sliding valvuloplasty combined with ring annuloplasty.
Heart Ventricles ; Myxoma* ; Tricuspid Valve*

OBJECTIVE: This consecutive retrospective study was designed to analyze and to compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using a fibular and femur allograft with anterior cervical plating. METHODS: A total of 88 consecutive patients suffering from cervical degenerative disc disease (DDD) who were treated with ACDF from September 2007 to August 2010 were enrolled in this study. Thirty-seven patients (58 segments) underwent anterior interbody fusion with a femur allograft, and 51 patients (64 segments) were treated with a fibular allograft. The mean follow-up period was 16.0 (range, 12-25) months in the femur group and 19.5 (range, 14-39) months in the fibular group. Cage fracture and breakage, subsidence rate, fusion rate, segmental angle and height and disc height were assessed by using radiography. Clinical outcomes were assessed using a visual analog scale and neck disability index. RESULTS: At 12 months postoperatively, cage fracture and breakage had occurred in 3.4% (2/58) and 7.4% (4/58) of the patients in the femur group, respectively, and 21.9% (14/64) and 31.3% (20/64) of the patients in the fibular group, respectively (p<0.05). Subsidence was noted in 43.1% (25/58) of the femur group and in 50.5% (32/64) of the fibular group. No difference in improvements in the clinical outcome between the two groups was observed. CONCLUSION: The femur allograft showed good results in subsidence and radiologic parameters, and sustained the original cage shape more effectively than the fibular allograft. The present study suggests that the femur allograft may be a good choice as a fusion substitute for the treatment of cervical DDD.
Dichlorodiphenyldichloroethane ; Diskectomy ; Femur ; Follow-Up Studies ; Humans ; Neck ; Retrospective Studies ; Stress, Psychological ; Transplantation, Homologous

BACKGROUND: Definite criteria for determining severity of organophosphate poisoning have not been made. Discovery of the third neuromuscular syndrome, the intermediate syndrome, have made it more complicating then ever. Objectives of this study is to determine early prognostic factors of outcome and development of a new treatment algorithm. METHOD: 74 patients admitted to Severance hospital with acute organophosphate poisoning during 5 years were included. We made a protocol concerning the initial consciousness level, QTc interval, PVC, serum cholinesterase, the intermediate syndrome, total hospital, ICU day, length of ventilator support, disposition and have done a study retrospectively. Multiple regression and Chi-square was used as statistical analysis. Significant statistical P-value was 0.05. RESULTS: The total hospital days were prolonged as serum cholinesterase levels were lower, the age was older and mental status graver.(p<.05) The length of ventilatory support was prolonged when patient's serum cholinesterase level was very low, they were unconscious and serum cholinesterase level not recovered to 500 IU/ml within initial 3 days. The intermediate syndrome was significantly related to the prolonged cholinesterase inhibition. CONCLUSION: As an early prognostic factor for the length of ventilatory support in organophosphate poisoning, 1) level of concsiousness and 2) serum cholinesterase level at admission, 3) recovery to more than 500 IU/ml within initial 3 days are useful. Especially when the serum cholinesterase level is not recovered to more than 500 IU/ml within initial 3 days, it is essential to observe closely for the possibility of an intermediate syndrome.
Cholinesterases ; Consciousness ; Humans ; Organophosphate Poisoning* ; Retrospective Studies ; Ventilators, Mechanical

OBJECTIVE: The purpose of the current study is to investigate the effect of the prosthetic disc nucleus replacement on the mobility and height of the intervertebral disc and adjacent segments. METHODS: Thirteen patients who underwent L4-L5 prosthetic disc nucleus replacement were included in this study. A retrospective review of clinical and radiological data was conducted. The L4-L5 disc height and sagittal rotation angle of L3-L4, L4-L5, L5-S1 were measured in the static and dynamic lateral radiographs pre- and postoperatively. RESULTS: There were seven men and six women whose mean age was 37 years(range, 24-49 years). The mean follow-up period was nine months(range, 6-14 months). In all cases the L4-L5 motion segment demonstrated angular motion between flexion and extension with a mean of 4degrees(+/-2.3degrees) of sagittal rotation angle. The disc height increased from preoperative levels by 117%. There was no difference in angular motion of adjacent segments between pre- and postoperative data. CONCLUSION: The prosthetic disc nucleus replacement after discectomy is shown to restore the disc height and maintain segmental mobility.
Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc* ; Male ; Retrospective Studies

OBJECTIVE: The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation. METHODS: Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging. RESULTS: Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups. CONCLUSION: Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation.
Back Pain ; Diskectomy ; Follow-Up Studies ; Humans ; Leg ; Length of Stay ; Magnetic Resonance Imaging ; Muscles ; Perioperative Period ; Recurrence

PURPOSE: The determination of tetanus prophylaxis according to patients' memories of past immunization is inaccurate. However, by using the Tetanos Quick Stick(R) test, it is possible to select Korean adults with low tetanus antibody titers and to perform tetanus prophylaxis in the emergency department. In 1996, Ha reported that tetanus toxoid injection into healthy Korean adults revealed significant differences between the tetanus antibody titers at the beginning and the tetanus antibody titers after 1 week. Our purpose is to determine the effect of a single tetanus toxoid in Korean adults with low tetanus antibody titers. METHODS: Blood samples were taken from 44 volunteers for a period of 6 weeks. All samples were analyzed using the Tetanus IgG ELISA (enzyme-linked immunosorbent assay) method. RESULTS: The results for tetanus antibody titers at the beginning and after 1 week, 2 weeks, 4 weeks, and 6 weeks were 0.04+/-0.05 IU/mL, 1.22+/-3.63 IU/mL, 4.99+/-7.3 6 IU/mL, 8.36+/-11.10 IU/mL and 6.59+/-9.21 IU/mL respectively. There was a statistically significant defference between the tetanus antibody titers at the beginning and the tetanus antibody titers after 2 weeks. There was no statistically significant defference between the tetanus antibody titers after 2 weeks and 6 weeks. After 4 weeks, all subjects' tetanus antibody titers were at the protective level. CONCLUSIONS: A single tetanus toxoid injection is effective in Korean adults with low tetanus antibody titers.
Adult* ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunization ; Immunoglobulin G ; Tetanus Toxoid* ; Tetanus* ; Volunteers

PURPOSE: Recently, the incidence of preterm and low birth weight infants (LBWI) is increasing, even though the birth rate is continuously low in Korea. Despite that change, there continues to be a deficit of beds in the neonatal intensive care unit (NICU). This study is based on the 2009 Korean Statistical Information Service that examined the development of a Korean NICU service and the survival rate of preterm infants by regionally analyzing the rate of total live births, preterm infants, LBWI, and NICU beds in Korea. METHODS: Data were obtained from the Korean Health Insurance Review and Assessment Service and Korean Statistical Information Service. We confirmed the regional total live birth rate, number of LBWI, and preterm infants and NICU numbers, and all of the results were compared to the average value to determine deficient areas of NICU beds. RESULTS: There were 25,374 (5.7%) preterm infants and 21,954 (4.9%) LBWI in the total number of live births (444,849) in 2009, and regions of high proportion compared to the mean value were Busan, Daegu, and Ulsan. Total NICU beds totaled 1,284, and regions of high rates preterm infants and LBWI per 1 NICU bed compared to the mean value were Incheon, Daegu, Ulsan, etc. The NICU holding rate was 87.5% (1,284/1,468), which was increased from 2005. However, there were still shortages of 184 NICU beds (12.5%), especially in Gyeonggi-do, which lacked 157 beds. CONCLUSION: High risk neonates difficult to transfer, and they need immediate and continuous treatment. As a result, a foundation of well-balanced, national NICU regionalization is necessary. This study suggested that more NICU facilities must be implemented, and clinicians should realize the continuing deficiency of NICU beds in cities and provinces.
Birth Rate ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Information Services ; Insurance, Health ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Korea ; Live Birth ; Survival Rate

OBJECTIVE: Decompressive craniectomy (DC) is a useful surgical method to achieve adequate decompression in hypertensive intracranial patients. This study suggested a new skin incision for DC, and analyzed its efficacy and safety. METHODS: In the retrograde reviews, 15 patients underwent a newly suggested surgical approach using n-shape skin incision technique (Group A) and 23 patients were treated with conventional question mark skin incision technique (Group B). Two groups were compared in the terms of the decompressed area of the craniectomy, protruded brain volume out of the skull layer, the operation time from skin incision to bone flap removal, and modified Rankin Scale (mRS) which was evaluated for 3 months after surgery. RESULTS: The decompressed area of craniectomy (389.1 cm² vs. 318.7 cm², p=0.041) and the protruded brain volume (151.8 cm³ vs. 116.2 cm³, p=0.045) were significantly larger in Group A compared to the area and the volume in Group B. The time interval between skin incision and bone flap removal was much shorter in Group A (23.3 minutes vs. 29.5 minutes, p=0.013). But, the clinical results were similar between 2 groups. Group A showed more favorable outcome proportion (mRS 0-3, 6/15 patients vs. 5/23 patients, p=0.225) and lesser mortality cases proportion 1/15 patients vs. 4/23 patients, but these differences were not significantly observed (p=0.225 and 0.339). CONCLUSION: DC using n-shaped skin incision was a feasible and safe surgical technique. It may be an easier and faster method for the purpose of training neurosurgeons.
Brain ; Decompression ; Decompressive Craniectomy* ; Dermatologic Surgical Procedures ; Humans ; Methods ; Mortality ; Neurosurgeons ; Skin* ; Skull ; Surgical Flaps ; Surgical Procedures, Operative

Primary pericardial mesothelioma is a rare tumor of mesodermal origin that is infrequently diagnosed antemortem and survival is short. A 60 year old male case of pericardial mesothelioma (epitheloid type) is reported. He was admitted to Yeungnam University Hospital because of chest pain, dyspnea, orthopnea and nonproductive cough. Chest x-ray suggested pericardial effusion. 2-D echocardiography showed echo free spaces of massive pericardial effusion and areas of thick hyperrefractile echoes arising from the pericardium. Pericardiocentesis was attempted and aspirated fluid was bloody exudates. Pericardial window operation with biopsy was done. Swan-Ganz catheterization showed equalization between right atrial pressure and pulmonary capillary wedge pressure. The pathologic diagnosis was established by histologic finding at pericardial biopsy.
Atrial Pressure ; Biopsy ; Catheterization, Swan-Ganz ; Chest Pain ; Cough ; Diagnosis ; Dyspnea ; Echocardiography ; Exudates and Transudates ; Humans ; Male ; Mesoderm ; Mesothelioma* ; Pericardial Effusion ; Pericardiocentesis ; Pericardium ; Pulmonary Wedge Pressure ; Thorax