No abstract available.
Child* ; Humans

We described the clinical manifestation of herpes zoster in thirteen children with underlying malignancies. Among the associated malignancies, hematologic malignancy including acute lymphotytic leukemia was the commonest and CNS tumors were also frequently associated. Pain was mild, and some showed high fever and abnormal liver function test results. Recurrent attacks were observed in 3 cases(23%). Thoracic segment and trigeminal nerve were commonly affected. In most cases, herpes zoster developed within two years after the diagnosis of the malignancy.
Child* ; Diagnosis ; Fever ; Hematologic Neoplasms ; Herpes Zoster* ; Humans ; Leukemia ; Liver Function Tests ; Trigeminal Nerve

A new hypolipidemic agent, lovastatin, hydroxy-methyl-gultaryl coenzyme A reductase inhibitor was administred to 25 patients with primary hyperlipidemia 20 to 40 mg daily for 12 weeks and sequential changes of serum lipid profile were analysed as follow. 1) Mean average at baseline period of serum total cholesterol, triglyceride, HDL and low desity lipoprotein cholesterol were 271, 179, 51 and 185 mg/dl respectively. 2) Total cholesterol showed 20% decrease at 4th week and 23% decrease at the end of 12th week while low density lipoprotein cholesterol decreased 31% and 33% respectively. 3) Triglyceride dropped 7% at 8th week and 3% at 12th week. High density lipoprotein cholesterol increased 4% at 4th week and showed 2% decrease at the end of study. 4) Only one patient complained of moderate abdominal pain, which subsided after 2 weeks drug withdrawal. In conclusion, lovastatin was well tolerated and effective, in the treatment of primary hyperlipidemia.
Abdominal Pain ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Coenzyme A ; Humans ; Hyperlipidemias* ; Lipoproteins ; Lovastatin ; Oxidoreductases ; Triglycerides

Topiramate is an antiepileptic drug effective for multiple types of seizure and is also used to prevent migraine attack. Several side effects have been reported, such as metabolic acidosis, nephrolithiasis, anorexia, weight reduction, drowsiness, glaucoma, hyperthermia, and cognitive dysfunction, whereas skin manifestationis were rarely reported. We report a case of a 12-year-old girl on medication of topiramate for 8 months due to focal epilepsy. She had fever, sore throat, burning sense in the vaginal area, and then flaccid bullae and erythematous patches proceeded to the whole bodyskin and mucosa including the conjunctiva, oral cavity, and genital areas. She was diagnosed with toxic epidermal necrolysis (TEN) and improved after the discontinuation of topiramate and with administration of high-dose intravenous steroid and immunoglobulin. We, herein, report a girl who developed severe side effects on the skin, TEN, due to topiramate.

Purpose: This descriptive study investigated the effects of nurses’ knowledge of withdrawalof life-sustaining treatment, death anxiety, and perceptions of hospice care on their attitudes toward withdrawal of life-sustaining treatment. Methods: Data were collected from 262 nurses at tertiary hospitals, general hospitals, or primary hospitals in Busan, Korea, and statistically analyzed using the t-test, analysis of variance, the Scheffé test, Pearson correlation coefficients, and hierarchical regression analysis. Results: The participants’ scores were 3.68±0.45 (out of 5) for attitudes toward withdrawal of life-sustaining treatment, 0.65± 0.15 (out of 1) for knowledge of withdrawal of life-sustaining treatment, 2.61±0.26 (out of 4) for death anxiety, and 4.06±0.43 (out of 5) for perceptions of hospice care. Furthermore, knowledge of withdrawal of life-sustaining treatment and perceptions of hospice care showed positive correlations with attitudes toward withdrawal of life-sustaining treatment, while death anxiety showed a negative correlation. The most significant factors influencing attitudes toward withdrawal of life-sustaining treatment were perceptions of hospice care, followed by having experienced caring for patients who withdrew life-sustaining treatment, death anxiety, having a spouse, and ethical values, and the overall explanatory power was 43.0%. Conclusion This study showed that perceptions of hospice were an important fac-tor influencing nurses’ attitudes toward withdrawal of life-sustaining treatment. Therefore,it is necessary to develop and validate educational intervention programs that can improve perceptions of hospice care.

IgG4-related disease (IgG4-RD) is characterized by a systemic involvement of tumor-like lesions with IgG4-positive plasmacytes. We experienced a case of IgG4-RD developed in a patient with bronchial asthma (BA) and chronic rhinosinusitis (CRS). A 55-yr-old female patient with BA and CRS complained of both eyes and neck swelling as well as a recurrent upper respiratory infection in recent 1 yr. The serum levels of IgG4, creatinine, and pancreatic enzymes were elevated. A biopsy of the submandibular gland showed an abundant infiltration of IgG4-positive plasmacytes. Her symptoms remarkably improved after the treatment of a systemic steroid that has been maintained without recurrence. We report a rare case of IgG4-RD developed in a patient with BA and CRS.
Asthma/complications/*diagnosis ; Chronic Disease ; Creatinine/blood ; Female ; Humans ; Immunoglobulin G/*blood ; Middle Aged ; Pancreas/enzymology ; Plasma Cells/physiology ; Prednisolone/therapeutic use ; Republic of Korea ; Rhinitis/complications/*diagnosis/drug therapy ; Sinusitis/complications/*diagnosis/drug therapy ; Submandibular Gland/pathology ; Tomography, X-Ray Computed

Objective: To compare the diagnostic performance and interobserver agreement between contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CE-MRI) with magnetic resonance cholangiopancreatography (MRCP) for evaluating the resectability in patients with extrahepatic cholangiocarcinoma (eCCA). Materials and Methods: This retrospective study included treatment-naïve patients with pathologically confirmed eCCA, who underwent both CECT and CE-MRI with MRCP using extracellular contrast media between January 2015 and December 2020.Among the 214 patients (146 males; mean age ± standard deviation, 68 ± 9 years) included, 121 (56.5%) had perihilar cholangiocarcinoma. R0 resection was achieved in 108 of the 153 (70.6%) patients who underwent curative-intent surgery. Four fellowship-trained radiologists independently reviewed the findings of both CECT and CE-MRI with MRCP to assess the local tumor extent and distant metastasis for determining resectability. The pooled area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of CECT and CE-MRI with MRCP were compared using clinical, surgical, and pathological findings as reference standards. The interobserver agreement of resectability was evaluated using Fleiss kappa (κ). Results: No significant differences were observed between CECT and CE-MRI with MRCP in the pooled AUC (0.753 vs. 0.767), sensitivity (84.7% [366/432] vs. 90.3% [390/432]), and specificity (52.6% [223/424] vs. 51.4% [218/424]) (P > 0.05 for all).The AUC for determining resectability was higher when CECT and CE-MRI with MRCP were reviewed together than when CECT was reviewed alone in patients with discrepancies between the imaging modalities or with indeterminate resectability (0.798 [0.754–0.841] vs. 0.753 [0.697–0.808], P = 0.014). The interobserver agreement for overall resectability was fair for both CECT (κ = 0.323) and CE-MRI with MRCP (κ = 0.320), without a significant difference (P = 0.884). Conclusion CECT and CE-MRI with MRCP showed no significant differences in the diagnostic performance and interobserver agreement in determining the resectability in patients with eCCA.

Purpose: The purpose of this study was to evaluate the intra-observer reproducibility of ultrasound attenuation imaging (ATI) for the noninvasive assessment of hepatic steatosis in patients with suspected hepatic steatosis and the inter-observer reproducibility in asymptomatic volunteers. Methods: This prospective study was approved by our institutional review board and informed consent was obtained from all patients. In group 1, composed of patients with suspected hepatic steatosis (n=143), one abdominal radiologist performed gray-scale ultrasonography and two sessions of ATI. In group 2, composed of healthy volunteers (n=18), three independent sessions of ATI were performed by three abdominal radiologists. The visual degree of hepatic steatosis in all study subjects was graded on a 4-point scale by two independent reviewers using gray-scale ultrasonography. Thereafter, the attenuation coefficient (AC) was correlated with the degree of hepatic steatosis using Spearman rank correlation analysis. Intra-class correlation coefficients (ICCs) were used to assess the intra-observer (group 1) and inter-observer reproducibility (group 2) of ATI measurements. Results: For the intra-observer reproducibility of ATI, the ICC was 0.929 (95% confidence interval [CI], 0.901 to 0.949), and the coefficient of variation was 7.1%. Inter-observer reproducibility of ATI measurements showed an ICC of 0.792 (95% CI, 0.549 to 0.916). The AC showed a significant correlation with the visual grade of hepatic steatosis for both reviewers (rho, 0.780 and 0.695; P<0.001, respectively). Conclusion ATI showed high intra- and inter-observer reproducibility in the assessment of hepatic steatosis.

Objective: To determine whether Sonazoid-enhanced ultrasound (SZUS) was noninferior to SonoVue-enhanced ultrasound (SVUS) in diagnosing hepatocellular carcinoma (HCC) using the same diagnostic criteria. Materials and Methods: This prospective, single-center, noninferiority study (NCT04847726) enrolled 105 at-risk participants (71 male; mean age ± standard deviation, 63 ± 11 years; range, 26–86 years) with treatment-naïve solid hepatic nodules (≥ 1 cm). All participants underwent same-day SZUS (experimental method) and SVUS (control method) for one representative nodule per participant. Images were interpreted by three readers (the operator and two independent readers). All malignancies were diagnosed histopathologically, while the benignity of other lesions was confirmed by follow-up stability or pathology. The primary endpoint was per-lesion diagnostic accuracy for HCC pooled across three readers using the conventional contrast-enhanced ultrasound diagnostic criteria, including arterial phase hyperenhancement followed by mild (assessed within 2 minutes after contrast injection) and late (≥ 60 seconds with a delay of 5 minutes) washout. The noninferiority delta was -10%p. Furthermore, different time delays were compared as washout criteria in SZUS, including delays of 2, 5, and > 10 minutes. Results: A total of 105 lesions (HCCs [n = 61], non-HCC malignancies [n = 19], and benign [n = 25]) were evaluated. Using the 5-minutes washout criterion, per-lesion accuracy of SZUS pooled across the three readers (72.4%; 95% confidence interval [CI], 64.1%–79.3%) was noninferior to that of SVUS (71.4%; 95% CI, 63.1%–78.6%), meeting the statistical criterion for non-inferiority (difference of 0.95%p; 95% CI, -3.8%p–5.7%p). The arterial phase hyperenhancement combined with the 5-minutes washout criterion showed the same sensitivity as that of the > 10-minutes criterion (59.0% vs. 59.0%, p = 0.989), and the specificities were not significantly different (90.9% vs. 86.4%, p = 0.072). Conclusion SZUS was noninferior to SVUS for diagnosing HCC in at-risk patients using the same diagnostic criteria. No significant improvement in HCC diagnosis was observed by extending the washout time delay from 5 to 10 minutes.

PURPOSE: We aimed to evaluate the influence of family environment, parenting behavior, and psychological characteristics on metabolic control in children with type 1 diabetes mellitus (DM). METHODS: We performed a statistical survey among Korean children (adolescents; age, 11-17 years) undergoing treatment for type 1 DM for more than a year and the parents of these children. We obtained the glycosylated hemoglobin (HbA1c) levels; children's depression inventory (CDI) scores; family affection, partnership, growth, adaptation, resolve (APGAR) scores; parenting behavior inventory (PBI) scores; and scores of the Korean version of family environment scale (FES-K) for these families. The results of the survey were collected and analyzed using statistical methods. RESULTS: We found a statistically significant evidence of a positive relationship between HbA1c levels and depressive symptoms (r=0.43, P=0.001). However, there was no relationship between HbA1c levels and family APGAR scores. FES-cohesion scale (beta=-0.422, P=0.005), achievement orientation scale (beta=-0.323, P=0.013), and control scale (beta=0.356, P=0.009)-were significant predictors of HbA1c levels. In the family APGAR index, low CDI score (P=0.001) were indicative of a highly functional family. Furthermore, the family APGAR scale showed a statistically significant association with the reasoning and affection subscales of the PBI scale and inverse association with the inconsistency subscale of the PBI scale. Multiple-regression analysis of the data revealed that the monitoring (beta=-0.325, P=0.045) and reasoning (beta=-0.507, P=0.011) variables of the paternal and maternal PBI scale, respectively, were significant predictors of a child's depressive symptoms. CONCLUSION: Improvements in family environment and parenting behavior may help improve metabolic control and reduce depressive symptoms in children with type 1 DM.
Achievement ; Child ; Depression ; Diabetes Mellitus, Type 1 ; Family Relations ; Hemoglobin A, Glycosylated ; Humans ; Orientation ; Parenting ; Parents ; Social Environment