PURPOSE: Newborn infants with diarrhea, metabolic acidosis and dehydration may develop methemoglobinemia without exposure to oxidizing agents. This study was undertaken to investigate clinical features in the development of methemoglobinemia in newborn infants with diarrhea. METHOD: This study involved 16 newborn infants with diarrhea who were admitted to NICU at Dong San Medical Center between January 1995 and June 1996. We investigated the age of onset of methemoglobinemia, sex ratio, level of methemoglobin in the blood, feeding methods, clinical manifestations, arterial blood gas findings, the results of culture findings and the response to therapy. RESULT: 1) The age of onset was beyond the second week of life in most cases, no sex predilection was noted and formula feeding was used in all cases. 2) Methemoglobin level in the blood was 10.1-20.0% in 7 cases, 20.1-30.0% in 6 cases, 30.1-40.0% in 2 cases and above 40.1% in one case. 3) Clinical rnanifestations on admission: moderate to severe dehydration developed in all patients with diarrhea along with respiratory distress in 13 cases, cyanosis in 6 cases, fever was noted in 5 cases, vomiting in 5 cases, while 2 cases presented with abdominal distention. Combined diseases included metabolic acidosis in most cases (93.8%), hypokalemia in 6, failure to thrive in 3, chronic diarrhea in 2, hyponatremia in 2, necrotizing enterocolitis in 1 and hepatitis was found in one case. 4) In all cases, there were no pathogenic organisms found in either blood or urine cultures along with similar negative findings in stool cultures, and Rotazyme test results using ELISA method were negative. 5) Rehydration and correction of acidosis with sodium bicarbonate was accomplished in all patients and 11 cases with greater than 15% methemoglobin were treated with methylene blue, 2mg/kg as a 1% solution in normal saline. Response to methylene blue was indicated in 1 to 2 hours in all cases although there was a reoccurrence of methemoglobinemia after an initial response in 2 cases, they both responded favorably with retreatment with methylene blue. CONCLUSION: In all newborn infant with diarrhea, dehydration and metabolic acidosis, screening tests for early diagnosis of methemoglobinemia should be considered with prompt fluid replacement therapy.
Acidosis ; Age of Onset ; Cyanosis ; Dehydration ; Diarrhea* ; Early Diagnosis ; Enterocolitis, Necrotizing ; Enzyme-Linked Immunosorbent Assay ; Failure to Thrive ; Feeding Methods ; Fever ; Fluid Therapy ; Hepatitis ; Humans ; Hypokalemia ; Hyponatremia ; Infant* ; Infant, Newborn* ; Mass Screening ; Methemoglobin ; Methemoglobinemia* ; Methylene Blue ; Oxidants ; Retreatment ; Sex Ratio ; Sodium Bicarbonate ; Vomiting

Vertebral hemangioma is a slow-growing tumor which involves the vertebral body only. It is usually discovered incidentally on lateral radiographs of the spine and only rarely symptomatic. Compression of the spinal cord due to vertebral hemangioma is very rare. The authors report a patient who developed a progressive paraplegia and sensory change clinically resembling an intramedullary spinal cord tumor. Simple spine film gave us a hint that there was a vertebral hemangioma at T-5, but the clinical correlation was uncertain until spinal cord compression was demonstrated by MRI and the symptoms improved with operation. Selective angiography was normal. The histologic diagnosis was a cavernous hemangiona. As there was no associated spinal cord vascular malformation visualized during operation, her clinical presentation mimicking intramedullary spinal cord tumor was atypical one of compressive extramedullary mass. Following surgical excision, the patient improved dramatically and was discharged with only a residual hyperalgesia below the T-10 dermatome.
Angiography ; Diagnosis ; Hemangioma* ; Humans ; Hyperalgesia ; Magnetic Resonance Imaging ; Paraplegia ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Neoplasms ; Spine ; Vascular Malformations

Combined spinal epidural block with use of the needle-through-needle technique has become increasingly more popular during recent years because it provides rapidity and density of spinal block, combined with the ability to extend the block and provide postoperative analgesia by use of the extradural catheter. However, the combined spinal epidural block has some disadvantages. Since the spinal needle makes a hole in the dura, the accidental migration of an extradural catheter into the dural opening made previously by the spinal needle is thought to be theoretical risk. We report a case during combined spinal epidural anesthesia for a total hip replacement in which the clear fluid in the epidural catheter was found and tested to confirm the nature of fluid and migration of catheter by the dextrostix test and the immunoelectrophoresis test(prealbumin test).
Analgesia ; Anesthesia, Epidural* ; Anesthetics, Local* ; Arthroplasty, Replacement, Hip ; Catheters ; Immunoelectrophoresis ; Needles

No abstract available.

PURPOSE: To evaluate risk factors associated with the development of strabismus in children with organic ocular diseases. METHODS: The authors reviewed the medical records of 143 patients diagnosed with organic ocular disease between the ages of six months and 19 years from March 2000 through September 2009. The distributions of etiology, age, visual acuity and visual acuity difference between both eyes at onset of visual loss, spherical equivalent difference between both eyes, duration of visual loss, and nystagmus were analyzed to determine relationships with the development of strabismus. RESULTS: Of 143 patients, strabismus developed in 41 children (28.7%). The causative diseases were congenital cataract (73.2%), developmental cataract (7.3%), uncorrected aphakia (7.3%), retinal detachment (4.9%), lens subluxation (2.4%), optic nerve disorder (2.4%), and corneal opacity (2.4%). The incidence of strabismus increased significantly in the cases of congenital disease, those < or = five years of the age at onset of visual loss, those with < or = 20/200 visual acuity, and those with large interocular spherical equivalent difference. There was no relationship between incidence of strabismus and visual acuity difference between both eyes. However, the incidence of strabismus increased significantly when the visual acuity difference was more than three Snellen lines in congenital ocular disease. CONCLUSIONS: When ocular disease is congenital, an increased risk of onset of strabismus should be considered when the age at onset of visual loss is less than five years, when visual acuity is below 20/200, and when there is a large spherical equivalent difference between both eyes.
Adolescent ; Aphakia ; Cataract ; Child ; Corneal Opacity ; Eye ; Humans ; Incidence ; Lens Subluxation ; Medical Records ; Optic Nerve ; Retinal Detachment ; Risk Factors ; Strabismus ; Visual Acuity

No abstract available.
Blood Flow Velocity* ; Pregnancy* ; Umbilical Arteries*

Objective: . To investigate the impact of the amendment of the Korean National Health Insurance (KNHI) reimbursement criteria for anti-tumor necrosis factor-α (TNF-α) agents based on from conventional clinical and laboratory measurements to disease activity score of 28 joints (DAS28) on treatment pattern, clinical response, and persistence rate in patients with rheumatoid arthritis (RA). Methods: . This multicenter retrospective cohort study evaluated 148 RA patients eligible for the initiation of anti- TNF-α agents as the first-line biologics by either the past (n=95) or current (n=53) KNHI reimbursement criteria. Persistence was defined as the duration between the initiation and discontinuation of anti-TNFα agents. Results: . In total, 106 (71.6%), 35 (23.6%), and 7 (4.7%) RA patients started treatment with adalimumab, etanercept, and infliximab, respectively. RA patients who received anti-TNF-α agents under the current reimbursement criteria had a significantly lower mean DAS28-erythrocyte sedimentation rate (ESR) (6.02 vs. 6.95, p＜0.001) and daily prednisolone-equivalent glucocorticoid dose (4.51 vs. 6.17 mg, p＜0.001) than those who received anti-TNF-α agents under the past reimbursement criteria. No significant differences in the 1-year remission rate defined by DAS28-ESR＜2.6 (17.9% vs. 30.2%, p=0.085) and the persistence rate (p=0.703) between the past and current reimbursement criteria was observed. Conclusion . Our data suggest that less active RA patients can receive reimbursement for anti-TNF-α agents under the current criteria, and the amendment of the KNHI reimbursement criteria may improve access to anti-TNF-α agents without affecting the treatment response and persistence rate.

No abstract available.
Cytomegalovirus Infections*

There is no single characteristic clinical or radiological feature to diagnose xanthogranulomatous pyelonephritis, so it makes accurate preoperative diagnosis difficult. In our case, the renal parenchyme of affected kidney was well preserved on excretory urogram. The abnormal finding was only a filling defect within the right upper pelvocalyceal system. Herein we report a case of xanthogranulomatous pyelonephritis in a 18 years old girl which was confused with renal pelvic tumor.
Adolescent ; Diagnosis ; Female ; Humans ; Kidney ; Pyelonephritis, Xanthogranulomatous*

BACKGROUND: In the course of the study of keratin expression in the epidermis of nevus sebaceus, several cells in the epidermis of nevus sebaceus were positively stained with CAM 5.2 antibody, which is known to be specific for the lower molecular weight cytokeratin and used as a marker of Merkel cell. OBJECTIVE: This study was intended to verify that CAM 5.2 positive cells found in the epidermis of nevus sebaceus are Merkel cells and to understand the meaning of CAM 5.2 positive j cells in the epidermis of nevus sebaceus. METHODS: The immunohistochemical stainings with CAM 5.2 and antibody to epithelial membrane antigen (EMA) performed on specimens of normal skin, epidermal nevus, nevus sebaceus and some appendage tumors. In order to confirm the nature of CAM 5.2 positive cells, the distribution of those were compared to that of Merkel cells and double labeling with CAM 5.2 and neurofilament was performed. RESULTS: CAM 5.2 positive cells were also found in trichilemmoma developed associated with nevus sebaceus and the epidermis of normal paimoplantar skin. CAM 5.2 positive cells were also stained with antibody to EMA on serial sections cut from the same tissue blocks. The association of CAM 5.2 positive cell and nerve fiber was also demonstrated. CONCLUSION: CAM 5.2 positive cells are seemed to be Merkel cells and their presence in the covering epidermis of nevus sebaceus suggests to the epidermis of nevus sebaceus may not be nevoid proliferation of epidermal keratinocytes.
Epidermis* ; Intermediate Filaments ; Keratinocytes ; Keratins ; Merkel Cells ; Molecular Weight ; Mucin-1 ; Nerve Fibers ; Nevus* ; Skin