Tubulointerstitial nephritis and uveitis (TINU) syndrome is defined as the occurrence of tubulointerstitial nephritis and uveitis in the absence of other systemic diseases. Three pediatric cases have been reported in the Republic of Korea, and we now report a fourth case. A 15-year-old girl presented to the ophthalmology department with a 1-week history of bilateral ocular discomfort that worsened on the day of presentation with redness and pain in both eyes. She was diagnosed with bilateral uveitis, and her baseline examination revealed moderate renal dysfunction and mild proteinuria. A renal biopsy was performed and confirmed the diagnosis of TINU syndrome. She was started on steroid eye drops and a 12-week course of oral steroids at a dose of 40 mg/m2/day, which completely resolved the proteinuria and mild renal function to an estimated glomerular filtration rate of 60 mL/min/1.73 m2. However, the uveitis did not improve, and despite the addition of oral methotrexate as a second-line treatment, the uveitis remains unresponsive to treatment over 21 months. Further evaluation and treatment are ongoing, and active therapeutic intervention is suggested even at a pediatric age, considering the lack of improvement in renal function and uveitis to date.

BACKGROUND: Accurate recognition of stroke victims by ambulance paramedics is necessary to ensure the rapid transfer of these patients to the hospital. We carried out a prospective study to characterize the cause of prehospital delays after stroke by the emergency medical service (EMS) and to determine the accuracy of identifying acute stroke by paramedics. METHODS: All paramedics in the Busan Metropolitan 119 EMS were asked to record the clinical presentations and time intervals from symptom onset to various points along the patients' prehospital course on the ambulance admission sheets for suspected stroke patients during a month (February 1, 2010 to February 28, 2010). Neurologists in twenty four hospitals reviewed the hospital records for the patients who were given a diagnosis of stroke or transient ischemic attack by the paramedics. RESULTS: Of the EMS on-scene evaluations, the diagnosis of stroke by ambulance paramedics was correct for 79 of the 186 (43%) patients. Positive predictive values for main suspected stroke symptoms were 95% in hemiparesis, 88% in speech disturbance and 44% in impaired consciousness. The prehospital personnel transferred the suspected stroke patients to each hospital at a mean of 25 minutes after the emergency 119 call. However, only 62% of the stroke patients called EMS within the first 2 hours of stroke. CONCLUSIONS: Public education for the need to seek EMS promptly after stroke as a medical emergency, and strokespecific training for EMS personnel are essential so that stroke patients receive effective acute treatment.
Allied Health Personnel ; Ambulances ; Consciousness ; Dietary Sucrose ; Emergencies ; Emergency Medical Services ; Hospital Records ; Humans ; Ischemic Attack, Transient ; Paresis ; Prospective Studies ; Stroke

BACKGROUND: Although idiopathic cardiomyopathies(i-CMP) are very important in all age groups, the epidemiology of i-CMP in children has not been well defined. A retrospective study in Korean children was performed in 1998 to obtain basic data on i-CMP. MATERIAL AND METHOD: The medical records of all patients aged birth to 15 years from the hospitals where pediatric cardiologists worked were reviewed to obtain information on i-CMP. Pediatric cardiologists from a total of 22 hospitals were participated in reviewing the medical records of their patients and filling up the protocol. The data were pooled to the study committee and reviewed. RESULTS: Of the 278 cases with i-CMP, there were dilated cardiomyopathy (d-CMP) in 182 (65.4%): hypertrophic cardiomyopathy (h-CMP) in 74 (26.6%): restrictive cardiomyopathy (r-CMP) and unclassified in 17 (6.1%) and 5 (1.9%) each. The average annual occurrence of new cases as a whole was 2.65 per 100,000 (95% CI: 1.5-3.7): d-CMP, 1.73/100,000/year (95% CI: 0.73-2.73): h-CMP, 0.71/100,000/year (95% CI: 0.35-1.07): r-CMP, 0.16/100,000/year (95% CI: 0.02-0.3). The median age at the time of diagnosis was 11 months in d-CMP: 3.0 years in h-CMP: 6.9 years in r-CMP. The survival rate in d-CMP was 76% at 1 year, 72.5% at 2 year, 70% at 5 year. There was no difference in survival rate according to age (in d-CMP, between children less than 2 years of age and over 2 years of age (74% vs. 79% at 1 year: 67% vs. 76% at 5 year, p=NS): in h-CMP, between children less than 1 year of age and over 1 year of age (84% vs. 96% at 1 year: 63% vs. 81% at 5 year, p=NS)). R-CMP showed the worst survival rate (72% at 1 year, 30.2% at 5 year). CONCLUSION: In spite of the inherent defects of retrospective analysis, this study provides the useful epidemiological data in children with i-CMP. However, more systemic approach is needed to define the nature of the i-CMP in children.
Cardiomyopathies* ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Cardiomyopathy, Restrictive ; Child* ; Diagnosis ; Epidemiology ; Humans ; Medical Records ; Parturition ; Retrospective Studies ; Survival Rate

BACKGROUND: Early failure of vascular access for hemodialysis is not uncommon. It has been known that DM, hypertension, age, sex and some abnormal laboratory findings at the surgery are the risk factors. We designed this study to analyze the risk factors for the early access failure of arteriovenous fistula (AVF). METHODS: Among 111 patients who underwent vascular access surgery and hemodialysis at KHMC from 2000 to 2004, 106 patients with AVF were enrolled. The rate of early access failure of AVF was evaluated. Histories of DM, hypertension, cardiovascular disease, and ipsilateral central venous catheterization, medication and laboratory findings were investigated through the medical records, retrospectively and statistically analyzed. RESULTS: The rate of early access failure of AVF was 21.3%, higher than that of AV grafts. The number of patients older than 50 years of age was greater in early access failure group. Early access failure group showed higher incidence of cardiovascular disease. Early access failure group showed higher incidence of ipsilateral central venous catheterization. Early access failure group also showed higher level of hemoglobin and hematocrit. Logistic regression analysis showed that higher hemoglobin and history of ipsilateral central venous catheterization are independent risk factors for early access failure of AVF. CONCLUSION: Older age at the time of surgery, history of ipsilateral central venous catheterization or cardiovascular disease and higher level of hemoglobin were associated with early access failure of AVF. History of ipsilateral central venous catheterization and higher level of hemoglobin are independent risk factors.
Arteriovenous Fistula* ; Cardiovascular Diseases ; Catheterization, Central Venous ; Central Venous Catheters ; Hematocrit ; Humans ; Hypertension ; Incidence ; Logistic Models ; Medical Records ; Renal Dialysis* ; Retrospective Studies ; Risk Factors* ; Transplants

Globally, there have been a small number of donor cell leukemia cases reported but, to our knowledge, none have been reported in Korea until now. Donor cell leukemia is a rare though well-recognized complication that occurs after allogenic hematopoietic stem cell transplantation (allo-HSCT). Herein, we report the case of an 18-year-old woman who developed acute lymphoblastic leukemia originating from donor cells after allo-HSCT.
Adolescent ; Anemia, Aplastic* ; Bone Marrow Transplantation* ; Bone Marrow* ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Korea ; Leukemia* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Tissue Donors*

BACKGROUND: There are many causes for the failure of aspirin therapy in patients with acute ischemic stroke. Laboratory aspirin resistance (AR) might be involved in clinical aspirin non-response. The PFA-100 is a laboratory method to evaluate AR in the clinical setting. However, there has been limited data regarding concordance with optical platelet aggregometry, which is considered the gold standard for detecting AR. We retrospectively analyzed platelet function tests using the PFA-100 and an optical platelet aggregometer in 86 patients with acute ischemic stroke. METHODS: Eighty six patients were enrolled in the study and were evaluated the platelet function test by optical aggregometer and a PFA-100. We determined the variability in the prevalence of AR and the kappa value between the two tests in patients with acute ischemic stroke. RESULTS: Among 86 patients, 27 (31.4%) were detected as AR by the optical aggregometer and 31 (36.0%) by the PFA-100. There were 13 cases of AR (15.1%) in both laboratory methods. The optical platelet aggregometer results showed that female gender (P=0.03), aspirin monotherapy (P =0.05), and NIHSS at baseline (P=0.04) were related with AR in acute ischemic stroke. Multiple logistic regression analysis showed that NIHSS was independently associated with AR of the optical platelet aggregometer (OR=1.12 95%, CI: 1.00-1.25, P=0.05). CONCLUSION: The prevalence of AR was similar between the PFA-100 and the optical platelet aggregometer in patients with acute ischemic stroke. However, the concordance rate of these two tools is low.
Aspirin ; Blood Platelets ; Female ; Humans ; Logistic Models ; Platelet Aggregation ; Platelet Function Tests ; Prevalence ; Retrospective Studies ; Stroke

PURPOSE: Recent progress in neonatal intensive care has led to increased survival of infants weighing less than 1500 gm. Many studies to declining sequelae of intensive care, addition to increasing survival, were made. So, we investigated particulary the relationship between survival and birth weight, gestational age, and factors associated with morbidities. METHOD: The retrospecitve review of medical records was analyzed for 92 VLBW infants(birth weight <1,500gm) who were admitted to the neonatal intensive care unit of Samsung seoul hosptial from 1994 to 1996. We compared the outcomes of 32 VLBW infants between October 1994 and September 1995 (period I), with the outcomes of 60 VLBW infants between October 1995 and September 1996 (period II). RESULTS: 1) The incidence of VLBW infants was 1.01% in period I and 1.55% in period II. The overall survival rate increased to 76.7% in period II, compared with 71.9% in period I. 2) By birth weight, the highest survival rate was 100% at 750gm in peeriod I, and 86.4% at 1000 to 1249gm in period II. The survival rate at birth weight 1000 to 1249 gm increased significantly in period II. According to gestational age, the highest was at 31-32 weeks(85.7%) in period I, and at 29-30 weeks(88.9%) in period II. 3) The male : female ratio was 1:1 in period I versus 1:1.07 in period II. There was no significant difference in sex and mode of delivery. 4) The most common major morbidity occurred in VLBW infants was respiratory distress syndrome (65.6% in period I, 53.3% in period II). 5) There was no difference of neonatal death rate during period I, while 2-3 days after birth was the highest(30.0%) during period II. Major causes of death, during both periods, were infection and respiratory distress syndrome and/or its sequelae. CONCLUSION: This report demonstrates marked increased survival rate than previous other reports and especially during period II. With increasing survival, more attention to neonatal sequelae, including chronic lung disease and neurodevelopmental delay, is required.
Birth Weight ; Cause of Death ; Female ; Gestational Age ; Humans ; Incidence ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Critical Care* ; Intensive Care, Neonatal ; Lung Diseases ; Male ; Medical Records ; Mortality ; Parturition ; Seoul ; Survival Rate

PURPOSE: The outcomes of infants weighing less than 1,500 gm(very low birth weight infant : VLBWI) reflect recent progress in neonatal intensive care. In this study, we analyzed changes over time in survival rate and morbidity of VLBWIs during the past seven years. METHODS: A retrospective review of medical records was analyzed for VLBWIs admitted to the neonatal intensive care unit of Samsung Medical Center within three days from birth. We compared the outcomes of previous corresponding data(period I : Oct. 1994 to Sept. 1996), with the outcomes of period II(Oct. 1996 to Dec. 1998) and period III(Jan. 1999 to Dec. 2000). RESULTS: As shown in Tables 1 and 3, the distribution of birth weight, gestational age(GA), gender, and inborn admissions did not change during the 7-year study. The overall survival rate of VLBWI increased significantly over time(period I : 72% vs period III : 88.3%, P<0.05). Between period I and period II, the birth weight-specific survival rate increased by 23.6%(75% vs 92.7%, P<0.05) for infants 1,000 to 1,249 gm. Between period II and period III, the birth weight-specific survival rate increased three times(20% vs 66.7%, P<0.05) for infants <750 gm. The survivors of lowest birth weight included infants at 624 gm(GA : 26(+5) weeks), 667 gm(GA : 25(+6) weeks) and 480 gm(GA : 26(+2) weeks) in each period. The gestational age-specific survival rate in period III increased significantly in GA 25-26 weeks and 29-30 weeks(vs period I and period II, P<0.05). The survivors of lowest gestational age included infants at GA 26 weeks(970 gm), GA 23(+5) weeks(791 gm) and GA 24(+1) weeks(740 gm) in each period. The incidence of severe IVH(grade III, IV) and the early death rate(I; P<0.05), reflecting improve-ments in neonatal intensive care. CONCLUSION: The survival rate of VLBWI continues to increase, particularly for BW <750 gm, GA <26 weeks. This increase in survival is not associated by any increase in major morbidities.
Birth Weight ; Gestational Age ; Humans ; Incidence ; Infant* ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Critical Care ; Intensive Care, Neonatal ; Medical Records ; Parturition ; Retrospective Studies ; Survival Rate ; Survivors

BACKGROUND: A US Food and Drug Administration (FDA)-approved drug methacholine chloride (Provocholine®) was recently introduced to Korea where it is now widely used in clinical practice. We aimed to evaluate the prevalence, risk factors and cutoff value of bronchial hyperresponsiveness (BHR) to Provocholine in 7-year-old children. METHODS: Six hundred and thirty-three children from the Panel Study on Korean Children who visited 16 regional hospitals were evaluated. Skin prick tests, spirometry and bronchial provocation tests for Provocholine as well as a detailed history and physical examinations were performed. The bronchial provocation test was reliably performed on 559 of these children. RESULTS: The prevalence of ever-diagnosed asthma via medical records was 7.7%, and that of current asthma (wheezy episode in the last 12 months + diagnosed asthma by physicians) was 3.2%. The prevalence of BHR to Provocholine was 17.2% and 25.8%, respectively, for a PC20 < 8 and < 16 mg/mL. The risk factors for BHR (PC20 < 16 mg/mL) were atopic dermatitis diagnosis and current dog ownership, whereas those for current asthma were allergy rhinitis diagnosis, a history of bronchiolitis before the age of 3, recent use of analgesics/antipyretics and maternal history of asthma. The BHR prevalence trend showed an increase along with the increased immunoglobulin E (IgE) quartile. The cutoff value of PC20 for the diagnosis of current asthma in children at age 7 was 5.8 mg/mL (sensitivity: 47.1%, specificity: 87.4%). CONCLUSIONS: BHR to Provocholine (PC20 < 8 mg/mL) was observed in 17.2% of 7-year-olds children from the general population and the cutoff value of PC20 for the diagnosis of current asthma was 5.8 mg/mL in this age group. The risk factors for BHR and current asthma showed discrepancies suggesting different underlying mechanisms. Bronchial provocation testing with Provocholine will be a useful clinical tool in the future.
Animals ; Asthma ; Bronchial Hyperreactivity ; Bronchial Provocation Tests ; Bronchiolitis ; Child* ; Dermatitis, Atopic ; Diagnosis ; Dogs ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Korea ; Medical Records ; Methacholine Chloride* ; Ownership ; Physical Examination ; Prevalence* ; Rhinitis ; Risk Factors* ; ROC Curve ; Sensitivity and Specificity ; Skin ; Spirometry ; United States Food and Drug Administration

PURPOSE: It is controversial whether indoor pet exposure is either a risk or protective factor developing sensitization to pet allergens or asthma. Therefore, we investigated whether indoor pet ownership entails a risk for the development of asthma and sensitization in childhood. METHODS: The Panel Study of Korean Children (PSKC) is a general-population-based birth cohort study that recruited 2,078 mother-baby dyads in Korea between April and July of 2008. Among 1,577 children who were followed up in 2015, 559 underwent skin prick tests, spirometry and bronchial provocation tests using Provocholine. Having a cat or a dog and the prevalence of asthma were evaluated by using self-reported questionnaires and physicians’ medical records. RESULTS: During infancy, the rate of dog ownership was 4.5% (71 of 1,574) and that of cat ownership was 0.5% (8 of 1,574). Of the subjects, 7.9% (n=109) currently had at least 1 dog and 2.5% (n=34) had at least 1 cat. Pet ownership during infancy was associated with sensitization to cats or dogs (adjusted odds ratio [aOR], 4.24; 95% confidence interval [CI], 1.29–13.98), wheezing within 12 months (aOR, 5.56; 95% CI, 1.65–18.75) and current asthma (wheezing episode in the last 12 months+diagnosed asthma by physicians) (aOR, 6.36; 95% CI, 1.54–26.28). In contrast, pet ownership during the last 12 months was not associated with sensitization to cats or dogs or current asthma. CONCLUSION: Indoor pet exposure during infancy can be critical for developing sensitization to cats or dogs and asthma in childhood. Avoidance of pet exposure in early life may reduce sensitization to cats or dogs and development of asthma.
Allergens ; Animals ; Asthma ; Bronchial Provocation Tests ; Cats ; Child ; Cohort Studies ; Dogs ; Humans ; Infant ; Korea ; Medical Records ; Methacholine Chloride ; Odds Ratio ; Ownership ; Parturition ; Pets ; Prevalence ; Protective Factors ; Respiratory Sounds ; Risk Factors ; Skin ; Spirometry