No abstract available.
Syringomyelia*

The lung and stomach are very unusual sites for teratoma. The histologic findings of intrapulmonary and gastric teratomas are not different from those arising in usual sites, such as the ovary or testis. However, preoperative diagnosis is sometimes difficult to make partly because of unusual location. We report here two cases of teratoma, one intrapulmonary teratoma and the other gastric. The intrapulmonary teratoma in our study had an endobronchial tumor growth, which rules out mediastinal teratoma. Meanwhile gastric teratomas usually present as a submucosal tumor and most cases are reported in infancy and childhood. Gastric teratoma in this study occurred in a 27-year-old man. To the best of our knowledge, this case of intrapulmonary teratoma is the eighth and the gastric teratoma is the first to be reported in Korea.
Adult ; Case Report ; Gastrectomy ; Human ; Lung Neoplasms/surgery ; Lung Neoplasms/radiography ; Lung Neoplasms/pathology* ; Male ; Middle Age ; Stomach Neoplasms/surgery ; Stomach Neoplasms/radiography ; Stomach Neoplasms/pathology* ; Teratoma/surgery ; Teratoma/radiography ; Teratoma/pathology* ; Tomography, X-Ray Computed

Epidemiological evidence suggests that the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is lesser and morbidity and mortality rates are lower in children than in adults. Although respiratory viral infections are major triggers of asthma exacerbations in children, the association between asthma and SARS-CoV-2 infection remains unclear. We describe a previously healthy 13-year-old male adolescent who developed severe acute asthma exacerbation following coronavirus disease 2019 (COVID-19) infection. This case report describes new-onset asthma as severe exacerbation following COVID-19 infection and highlights the importance of ongoing surveillance of the wide spectrum of COVID-19 manifestations in children.

PURPOSE: This study is aimed to evaluate the effectiveness and tolerability of rufinamide as add-on therapy in patients with intractable epilepsies. METHODS: We retrospectively reviewed the medical records of 70 patients treated with rufinamide in Asan Medical Center, children's hospital. Two cases with incomplete medical records were excluded and total sixty-eight cases were enrolled. Rufinamide was added on the existing antiepileptic drugs and the total seizure frequency at pre-medication, 3 months and 12 months were examined. RESULTS: The mean age of 68 patients (43 male) was 10.5 yrs (range, 1-24 yrs). At 3 months after rufinamide initiation, 5 patients achieved freedom from seizures and 28 (41.2%) achieved a ≥50% seizure reduction. At 12 months, 7 patients achieved seizure freedom and 29 (42.6%) achieved ≥50% seizure reduction. The retention rate was hold up to 75.0% at 3 months and 66.2% at 12 months of study. Total 29 patients reported adverse events in order of seizure aggravation, somnolence, insomnia, common cold, nausea and vomiting. CONCLUSION: In this study, rufinamide is effective and tolerable in patients with other intractable epilepsy of childhood onset as well as the patients with LGS. Further research is required to define the efficacy of rufinamide in intractable epilepsy other than LGS.
Anticonvulsants ; Chungcheongnam-do ; Common Cold ; Drug Resistant Epilepsy ; Encephalitis, Viral* ; Freedom ; Humans ; Medical Records ; Nausea ; Retrospective Studies ; Seizures ; Sleep Initiation and Maintenance Disorders ; Vomiting

PURPOSE: Most of the atopic dermatitis (AD) patients and their parents refuse topical treatment because of concern about generalized side effect due to systemic absorption of topical corticosteroids. Therefore, a large number of studies reported difficulty in properly controlling in AD. However, investigations of the percutaneous absorption of topical corticosteroids are still insufficient. METHODS: One hundred nine patients who visited our atopy clinic and diagnosed as AD by a physician from January 2005 to January 2012 were enrolled. We examined serum corticosteroid (clobetasol propionate, hydrocortisone) level by liquid chromatography (LC) coupled with a tandem mass spectrometric (MS/MS) method. RESULTS: We developed the LC-MS/MS method to determine corticosteroids (clobetasol propionate, hydrocortisone) in sera of AD patients. Also, we confirmed precision, accuracy, limit of detection, limit of quantification, absolute recovery, and relative recovery of the experimental methods. We could not detect clobetasol propionate or hydrocortisone in sera of 109 AD patients using the newly developed LC-MS/MS method. CONCLUSION: Regardless of age, the severity and illness duration of AD, clobetasol and hydrocortisone were not detected in sera. Although there are many other factors of determining systemic absorption of topical medications, our results showed that topical corticosteroids applied for several years in AD patients may be under the limit of detection in their sera by the LC-MS/MS method.
Absorption, Physiological ; Adrenal Cortex Hormones* ; Chromatography, Liquid ; Clobetasol ; Dermatitis, Atopic* ; Diethylpropion ; Humans ; Hydrocortisone ; Limit of Detection ; Methods ; Parents ; Skin Absorption

The records of 255 cyanide poisoning deaths obtained from National Forensic Service (NFS) headquarters, located in Seoul of Korea, from 2005 to 2010 were retrospectively reviewed. The mean age was 41.88 +/- 13.09 and range was 6~80 years (unknown in seven cases). The number of deaths of males and females were 200 and 53, respectively (unknown in two cases). The largest number of cases occurred in people aged 40-49 years (81 cases, 31.8%), followed by the age groups 30~39 years (51 cases, 20%), 50~59 years (44 cases, 17.2%) and 20~29 years (43 cases, 16.9%). The total number of deaths among other age groups (below 10, 10~19, 60~69, 70~79, over 80 years and unknown) were 36, representing only 14.1%. Of all cyanide poisoning deaths, 97.3% were due to suicide, and 14.5% of the total number who died received medical treatment. The most frequent site for ingestion was the person's own residence (120 cases, 47.1%) and the route of administration was mainly oral (252, 98.8%). From the total of 255 cyanide poisoning cases, white powders were submitted for analysis in 92 cases. Potassium cyanide and sodium cyanide occupied 51 and 41 cases, respectively. This study showed that poisoning deaths due to cyanide are one of the continuously reported public health problems in Korea. Enforcement of regulations and safety education to prevent cyanide poisoning should be carried out by the government.
Aged ; Eating ; Female ; Humans ; Korea ; Male ; Potassium Cyanide ; Powders ; Public Health ; Retrospective Studies ; Social Control, Formal ; Sodium Cyanide ; Suicide

Lymphocytic interstitial pneumonitis (LIP) is characterized by diffuse bilateral pulmonary infiltrations in both lower lobes. Pleomorphic lymphohistiocytes including mature lymphocytes, variable admixture of plasma cells and other mononuclear cells infiltrate within the pulmonary interstitium, ranging from widened septa to confluent masses. We report a case of LIP associated with Epstein-Barr virus in a patient with SLE and Sj gren's syndrome. A 50-year-old woman was admitted with insidious onset of progressive dyspnea for 20 days. She suffered from arthritis 10 years earlier without specific diagnosis. A radiography of chest has showed bilateral consolidative infiltrations with pleural effusion in both lower lung fields. Open lung biopsy documented lymphocytic interstitial pneumonitis which expressed Epstein-Barr virus genome in situ hybridization study. Following corticosteroid and cyclophosphamide therapy, clinical symptoms and radiologic infiltrations gradually remitted.
Case Report ; Cyclophosphamide/therapeutic use ; Female ; Glucocorticoids, Synthetic/therapeutic use ; Herpesviridae Infections/*complications ; *Herpesvirus 4, Human ; Human ; Immunosuppressive Agents/therapeutic use ; Lung Diseases, Interstitial/*complications/drug therapy ; Lupus Erythematosus, Systemic/*complications ; Middle Age ; Prednisone/therapeutic use ; Sjogren's Syndrome/*complications

Respiratory syncytial virus (RSV) is an extremely common cause of childhood respiratory infection resulting in significant morbidity and mortality especially in young infants and premature babies. There have been a few reports about seizures or encephalopathy in children with RSV infection. We describe here refractory status epilepticus in two preterm babies with severe respiratory illness by RSV infection. The seizures were refractory to phenobarbital and diphenylhydantoin, but ceased by continuous midazolam infusion. After several days with clinical improvement of respiratory illness, their seizures were stable on phenobarbital maintenance only. Although rare, status epilepticus can be a form of neurologic manifestation of severe RSV infection in preterm baby. We must be aware of their neurological manifestations; continuous EEG monitoring is helpful for the diagnosis of the status epilepticus in infants.
Child ; Electroencephalography ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Midazolam ; Neurologic Manifestations ; Phenobarbital ; Phenytoin ; Respiratory Syncytial Viruses ; Seizures ; Status Epilepticus

Systemic lupus erythematosus (SLE) is an autoimmune disorder involving multiple organs. Neuropsychiatric symptoms are frequently associated in SLE, which is referred to as neuropsychiatric SLE (NPSLE). NPSLE contains both central and peripheral nervous systems, which includes transverse myelitis, and Guillain-Barre syndrome (GBS). We report our experience of concurrent manifestation of transverse myelitis and GBS as an initial presentation of SLE, which suggests the common immune-mediated mechanisms of diseases. We here report the case of a 14-year-old boy with SLE who first presented with features of GBS. The patient developed ascending weakness starting from low extremities, experienced difficulty voiding, and had a facial rash. An initial diagnosis of GBS was made on the basis of clinical findings and nerve conduction studies. But he did not respond to intravenous immunoglobulin therapy and following spine MRI displayed T2 weighted high signal intensities from the cervical to thoracic region of the spinal cord, and serological analysis revealed the presence of anti-dsDNA, anti-smAb, anti nuclear antibody with decreased level of complements. The diagnosis was revised to GBS and acute transverse myelitis resulting from SLE. Additional methylprednisolone pulse therapy led to rapid clinical improvement. This was followed by oral prednisolone and cyclophosphamide pulse therapy. This is the first case of concurrent manifestation of GBS and transverse myelitis as initial presentation of SLE. The cross-reactivity of autoantibodies and increased susceptibility to infection owing to immunologic changes associated with lupus may form the basis of the association. Clinicians should consider a diagnosis of SLE as an etiology of GBS or transverse myelitis.
Adolescent ; Autoantibodies ; Complement System Proteins ; Cyclophosphamide ; Exanthema ; Extremities ; Guillain-Barre Syndrome ; Humans ; Immunization, Passive ; Lupus Erythematosus, Systemic ; Methylprednisolone ; Myelitis, Transverse ; Neural Conduction ; Peripheral Nervous System ; Prednisolone ; Spinal Cord ; Spine

Neuromyelitis optica(NMO) or Devic's syndrome is an uncommon clinical syndrome associating with unilateral or bilateral optic neuritis and transverse myelitis. It is rarely found in children and usually reported in adults with serious neurologic manifestations. We report a case of an 8-year-old girl with neuromyelitis optica whose first clinical manifestation was acute visual loss of both eyes. Initially the patient had been diagnosed with central retinal artery occlusion and optic neuritis by ophthalmologic examination, a brain magnetic resonance imaging, and cerebrospinal fluid findings. She was treated with intravenous methylprednisolone pulse therapy and heparinization. Then the treatments were replaced with oral prednisolone and warfarin. At the fifteenth day after the start of oral prednisolone tapering, she visited our emergency room for voiding difficulty and paresthesia on both legs. A spinal magnetic resonance imaging revealed increased signal intensity in T2-weighted images from cervical to lumbar level, and neuromyelitis optica- IgG(NMO-IgG) was detected in the patient's serum. After we diagnosed her as having neuromyelitis optica, intravenous methylprednisolone and nine courses of daily plasmapheresis were tried. However, the patient still had visual loss, pain, and sensory loss below the sixth thoracic dermatome, and we tried maintenance therapy with intravenous rituximab. We report our case with reviews of the related literatures.
Adult ; Antibodies, Monoclonal, Murine-Derived ; Brain ; Child ; Emergencies ; Eye ; Heparin ; Humans ; Leg ; Magnetic Resonance Imaging ; Methylprednisolone ; Myelitis, Transverse ; Neurologic Manifestations ; Neuromyelitis Optica ; Optic Neuritis ; Paresthesia ; Plasmapheresis ; Prednisolone ; Retinal Artery ; Retinal Artery Occlusion ; Warfarin ; Rituximab