The exact etiologies and mechanisms of ischemia in avascular necrosis of femoral head are still under investigation. But this condition seems to be increasing during a few decades with increasing use of steroid and alcohol abuse in Korea. The treatment modalities have been based on the stages of the disease by simple radiographic findings that do not describe the accurate pathological extent or localization. Therefore more sophisticated study is needed to treat the AVN of the femoral head well. Magnetic resonance images, simple radiographs, scintigraphs of 13 patients(22 femoral heads), who were admitted and treated at Seoul National University Hospital from April, 1989 to December, 1989 were correlated, to characterize the type of AVN by extent and location regardless of its stage and reveal the relationship between types and stages. It is the result of this study that the type of AVN as well as stage should be considered in determining the treatment modality.
Alcoholism ; Classification ; Head ; Ischemia ; Korea ; Magnetic Resonance Imaging ; Necrosis ; Seoul

Bruising and bleeding are common events in children. The pediatrician must be able to determine whether a child's symptoms are normal or perhaps indicative of hemorrhagic disorders. A thorough medical history and physical examination should enable the pediatricians to identify those patients warranting further evaluation. This review describes the characteristics of the medical history, physical examination, and clinical laboratory testing that are important in recognizing clinically significant bleeding disorders. This review will help the pediatrician to perform the initial laboratory evaluation, differentiate for patients with bleeding tendency and make the correct diagnosis for a variety of cases.
Child ; Diagnosis ; Diagnosis, Differential* ; Hemorrhage ; Hemorrhagic Disorders* ; Humans ; Physical Examination

No abstract available.

Iron deficiency anemia (IDA) frequently occurs in infants and adolescents. IDA is the result of an interplay between increased host requirements, limited external supply, and increased blood loss. In outpatient clinics, we often see children with iron deficiency anemia. Most cases in children are caused by incomplete nutrient supplements and growth spurts. However, we can occasionally see patients with poor response despite iron supplementation. Failure of iron therapy occurs when a child does not receive the prescribed medication, when iron is given in a form that is poorly absorbed, or when there is a continuing unrecognized blood loss such as intestinal or pulmonary loss, or loss with menstrual periods. In addition, the therapeutic failure of iron medication may indicate that the original diagnosis of nutritional iron deficiency was incorrect. In this situation, we have to evaluate other etiologies of anemia. Recently, many cases relating H.pylori infection to iron deficiency anemia have been described in the literature and H.pylori infection has emerged as a cause of refractory iron deficiency anemia that is unresponsive to oral iron therapy. Also, iron deficiency anemia induced by athletics in adolescent females has been reported several times. In this article, the author reviews various etiologies of childhood iron deficiency anemia. The most important consideration in treatment of iron deficiency anemia is disclosure of the underlying cause and its recovery. Dietary habits should also be corrected. To supplement iron, 6 mg/kg of oral iron supplements (elemental iron) is recommended in ferrous salt form. If oral administration is not feasible, intravenous supplementation is recommended using forms such as iron dextran, iron gluconate, or iron sucrose.
Administration, Oral ; Adolescent ; Ambulatory Care Facilities ; Anemia ; Anemia, Iron-Deficiency ; Child ; Dextrans ; Disclosure ; Female ; Ferric Compounds ; Food Habits ; Glucaric Acid ; Gluconates ; Humans ; Infant ; Iron ; Sports ; Sucrose

When pulmonary nodules are detected in children receiving chemotherapy for osteosarcoma, it is often assumed that they have metastatic disease. However, these pulmonary nodules do not always represent metastatic disease. There are considerable similarities in the computed tomography (CT) images of benign pulmonary nodules and those of malignant nodules. Therefore, we have to be careful when diagnosing pulmonary metastases based on chest CT scan alone. We report a case of benign multiple pulmonary nodules in a patient with osteosarcoma.
Child ; Humans ; Multiple Pulmonary Nodules ; Neoplasm Metastasis ; Osteosarcoma ; Thorax

The histiocytosis is rare disorder characterized by the accumulation of macrophages, dendritic cells, or monocyte-derived cells in various tissues and organs of children and adults. Classifying histiocytic disorders is difficult and has changed over time as an understanding of the biology of these cells has evolved. The most recently revised 2016 WHO classification of histiocytosis and neoplasms of the macrophagedendritic cell lineages has proposed grouping this diverse group of over 100 clinical entities into five main groups based on clinical, histologic, and molecular relevance. Comprehensive genomic studies for histiocytosis have been described and our understanding of the pathogenesis and biology has increased over the past decade. These advances will be able to make precision medicine and targeted therapy possible in patients with histiocytosis. Among the histiocytosis, this review mainly focuses on the updated diagnosis and treatment of Langerhans cell histiocytosis (LCH) and hemophagocytic lymphohistiocytosis (HLH) in children.

PURPOSE: This study examined the outcomes of children with chronic immune thrombocytopenia (ITP). MATERIALS AND METHODS: We retrospectively analyzed the medical records of all patients diagnosed with ITP from January 1992 to December 2011 at our institution. RESULTS: A total of 128 patients (64%) satisfied the criteria for newly diagnosed ITP, 31 (15%) for persistent ITP, and 41 (21%) for chronic ITP. The median age at diagnosis was 4.5 years (range, 1 month to 18 years). The median platelet count at diagnosis was 32x109/L. A comparison of the initial treatment data from 2001 to 2011 with those from 1992 to 2000 showed that the number of bone marrow examinations decreased, whereas observation increased. Chronic ITP presented at an older age than newly diagnosed and persistent ITP (6.6 years vs. 3.8 years vs. 4.1 years, respectively); however, the difference did not reach statistical significance (p=0.17). The probability of complete remission of chronic ITP was 50% and 76% at 2 and 5 years after diagnosis, respectively. Patients aged <1 year at diagnosis had a significantly better prognosis than did older patients (hazard ratio, 3.86; p=0.02). CONCLUSION: Children with chronic ITP showed a high remission rate after long-term follow-up. This study suggests that invasive treatments such as splenectomy in children with chronic ITP can be delayed for 4 to 5 years if thrombocytopenia and therapeutic medication do not affect the quality of life.
Adolescent ; Child ; Child, Preschool ; Chronic Disease ; Female ; Follow-Up Studies ; Humans ; Male ; Platelet Count ; Prognosis ; Purpura, Thrombocytopenic, Idiopathic/*diagnosis/drug therapy ; *Quality of Life ; Remission Induction ; Retrospective Studies ; Treatment Outcome

No abstract available.
Hip* ; Humans ; Renal Insufficiency, Chronic*

PURPOSE: The purpose of this study was to evaluate whether the symptoms of migraine and car sickness coexist or not. In addition, we tried to elucidate whether the car sickness can be a clinical indicator of diagnosing migraine in children. METHODS: A total of 166 children and adolescents who had newly diagnosed migraine and followed up for more than 2 years after the termination of treatment were involved in the study. The co-morbidity or co-existence of symptoms between two conditions in the clinical course was investigated. RESULTS: Sixty three of 124 who had car sickness as well as migraine recovered from migraine. Among these 63 patients, the car sickness disappeared in 44 (69.8%), decreased in 7 (11.1%) and persisted in 12 (19.0%). On the other hand, 23 of those 124 migraineurs continued to have migraine. In these patients, car sickness disappeared in 4 (17.4%), decreased in 5 (21.7%) and persisted in 14 (60.9%). The freedom or alleviation of car sickness is more common in children free from migraine than in children with persistent migraine (P<0.001). CONCLUSION: The results suggest that migraine is closely related to car sickness in children and the clinical course of migraine generally overlaps those of car sickness. We therefore believe that car sickness can be a clinical indicator in the diagnosis of migraine.
Adolescent ; Child ; Freedom ; Hand ; Humans ; Migraine Disorders ; Motion Sickness

Biotherapy, often called biological therapy or immunotherapy, aims at supporting and helping in the treatment of human disease without chemical drugs and invasive therapies, by restoring the natural immune system. It is also used to reduce certain side effects that may be caused by some treatments against cancer, autoimmune diseases, or other diseases. Biotherapy employs substances called biological response modifiers (BRMs). The term BRM is often used synonymously with the terms immunomodulator and immunostimulant. BRMs are agents that modify the host's response to pathogens with resultant beneficial prophylactic or therapeutic effects. The use of BRMs had rapidly expanded since the introduction of the first diagnostic antibodies. They are now employed in oncology, autoimmune diseases, inflammatory diseases, and transplantation medicine. BRMs used in biological therapy include interferones, interleukins, colony-stimulating factors, monoclonal antibodies, differentiation agents, tyrosine kinase inhibitor, tumor necrosis factor, vaccines, and nonspecific immunomodulating agents. BRMs are widely accepted in the treatment of certain types of cancer and rheumatoid arthritis, while others are being tested in research studies. This article reviewed the clinical use and side effects of BRMs in cancer and other diseases.
Antibodies ; Antibodies, Monoclonal ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Biological Therapy ; Colony-Stimulating Factors ; Humans ; Immune System ; Immunologic Factors ; Immunotherapy ; Interferons ; Interleukins ; Protein-Tyrosine Kinases ; Rheumatic Diseases ; Transplants ; Tumor Necrosis Factor-alpha ; Vaccines