PURPOSE: Ventriculoperitoneal (VP) shunt insertion is an important treatment modality in children with hydrocephalus. VP shunt infection is a major complication and an important factor that determines the surgery outcome. This 15-year study was performed to evaluate the epidemiology of VP shunt infections in pediatric patients treated at our center. METHODS: A retrospective review of medical records was performed in patients 18 years old or younger who underwent VP shunt insertion surgery from April 1995 to June 2010. RESULTS: Three hundred twenty-seven VP shunt surgeries were performed in a total of 190 pediatric patients (83 females, 107 males). The median age of the patients was 2.4 years (range, 0.02-17.9 years). Having a malignant brain tumor was the most frequent cause for VP shunt insertion. The shunt infection rate was 6.7% (22/327) per 100 operations and 9.5% (18/190) per 100 patients, and the incidence rate was 0.45 infection cases per 100 shunt operations-year. The most common pathogen was coagulase-negative staphylococcus (n=7) followed by methicillin resistant Staphylococcus aureus (n=1). Ten cases were treated with vancomycin and beta-lactam antibiotic (cephalosporin or carbapenem) combination therapy and 7 cases were treated with vancomycin monotherapy. The median duration of antibiotic treatment was 26 days (range, 7 to 58 days). Surgical intervention was performed in 18 cases (18/22, 81.8%). CONCLUSION: Epidemiologic information regarding VP shunt infections in pediatric patients is valuable that will help guide proper antibiotic management. Additional studies on the risk factors for developing VP shunt infections are also warranted.
Brain Neoplasms ; Child ; Epidemiologic Studies ; Female ; Humans ; Hydrocephalus ; Incidence ; Medical Records ; Methicillin Resistance ; Retrospective Studies ; Risk Factors ; Staphylococcus ; Staphylococcus aureus ; Vancomycin ; Ventriculoperitoneal Shunt

PURPOSE: The purpose of this study was to investigate the effects of an exercise program on physical function and quality of life of mastectomy patients. METHOD: This study was conducted from October, 2004 to June, 2005. The subjects consisted of 60 patients with breast cancer(30 each in the experimental and control groups). The subjects in the experimental group participated in an exercise program for 16 weeks. Evaluation was performed four times in both the experimental and control group. RESULTS: The results revealed an increase in physical function in the experimental group including wrist circumstance, function of shoulder joint, stretching, and upper endurance. Also, an increase in function scales in quality of life were significantly higher in the experimental group than the control group. In addition subjective comments on how they felt after participating in the exercise program were good in the experimental group. CONCLUSION: The 16-week exercise program showed a large positive effect on physical function and quality of life of breast cancer patients after a mastectomy.
Breast ; Breast Neoplasms ; Humans ; Mastectomy* ; Quality of Life* ; Shoulder Joint ; Weights and Measures ; Wrist

Purpose: Surgery, radiotherapy (RT), and chemotherapy have prolonged the survival of patients with anaplastic oligodendroglioma. However, whether RT induces long-term toxicity remains unknown. We analyzed the relationship between the RT dose to the fornix and symptomatic radiation necrosis (SRN). Materials and Methods: A total of 67 patients treated between 2009 and 2019 were analyzed. SRN was defined according to the following three criteria: 1) radiographic findings, 2) symptoms attributable to the lesion, and 3) treatment resulting in symptom improvement. Various contours, including the fornix, were delineated. Univariate and multivariate analyses of the relationship between RT dose and SRN, as well as receiver operating characteristic curve analysis for cut-off values, were performed. Results: The most common location was the frontal lobe (n=40, 60%). Gross total resection was performed in 38 patients (57%), and 42 patients (63%) received procarbazine, lomustine, and vincristine chemotherapy. With a median follow-up of 42 months, the median overall and progression-free survival was 74 months. Sixteen patients (24%) developed SRN. In multivariate analysis, age and maximum dose to the fornix were associated with the development of SRN. The cut-off values for the maximum dose to the fornix and age were 59 Gy (equivalent dose delivered in 2 Gy fractions) and 46 years, respectively. The rate of SRN was higher in patients whose maximum dose to the fornix was >59 Gy (13% vs. 43%, p=0.005). Conclusion The maximum dose to the fornix was a significant factor for SRN development. While fornix sparing may help maintain neurocognitive function, additional studies are needed.

Background: Teicoplanin is used to treat serious gram-positive infections. Optimal teicoplanin trough levels are considered to be ≥ 10 μg/mL. Despite its wide use in various clinical settings, data on teicoplanin trough level in pediatric patients are limited. Therefore, the aim of this study was to investigate the therapeutic drug level monitoring of teicoplanin in Korean pediatric patients, including those with impaired renal function. Methods: A retrospective study was performed in pediatric patients (age ≤ 18 years old) who received teicoplanin from September 2014 to April 2018. The regimen included a loading dose of 10 mg/kg/dose at 12 hours' interval three times in a row, and a maintenance dose of 10 mg/kg/dose commenced at 24 hours of interval after the loading dose, with a maximum of 400 mg/dose, respectively. The first therapeutic drug levels were measured. Distribution and characteristics of trough levels in patients with decreased renal function and those with bacteremia were also assessed. Results: A total of 187 trough levels were collected from 143 patients. Hematologic and oncologic diseases were the most common underlying diseases (83.2%, n = 119). One hundred eighty trough levels were first measured, and their median value was 16.2 μg/mL (range, 2.3–100 μg/mL) and the median interval between initial teicoplanin injection and 1st trough level was 96.5 hours (range 47.6–179.3 hours). Lower steady-state levels were observed in younger age group (median, 13.5 vs. 18.0 μg/mL, P = 0.038). Median trough levels were higher in patients with decreased renal functions (P < 0.001). In addition, among eight with gram-positive bacteremia, seven of them had a favorable outcome. Conclusion This study provides additive information on trough level monitoring of teicoplanin in children with impaired renal function and treatment effect in patients with gram-positive bacteremia. Careful monitoring for steady state trough levels of teicoplanin is warranted.

BACKGROUND: The increasing prevalence of type 2 diabetes mellitus (T2DM) is associated with the rapid spread of obesity. Obesity induces insulin resistance, resulting in beta-cell dysfunction and thus T2DM. Green tea extract (GTE) has been known to prevent obesity and T2DM, but this effect is still being debated. Our previous results suggested that circulating green tea gallated catechins (GCs) hinders postprandial blood glucose lowering, regardless of reducing glucose and cholesterol absorption when GCs are present in the intestinal lumen. This study aimed to compare the effect of GTE with that of GTE coadministered with poly-gamma-glutamic acid (gamma-PGA), which is likely to inhibit the intestinal absorption of GCs. METHODS: The db/db mice and age-matched nondiabetic mice were provided with normal chow diet containing GTE (1%), gamma-PGA (0.1%), or GTE+gamma-PGA (1%:0.1%) for 4 weeks. RESULTS: In nondiabetic mice, none of the drugs showed any effects after 4 weeks. In db/db mice, however, weight gain and body fat gain were significantly reduced in the GTE+gamma-PGA group compared to nondrug-treated db/db control mice without the corresponding changes in food intake and appetite. Glucose intolerance was also ameliorated in the GTE+gamma-PGA group. Histopathological analyses showed that GTE+gamma-PGA-treated db/db mice had a significantly reduced incidence of fatty liver and decreased pancreatic islet size. Neither GTE nor gamma-PGA treatment showed any significant results. CONCLUSION: These results suggest that GTE+gamma-PGA treatment than GTE or gamma-PGA alone may be a useful tool for preventing both obesity and obesity-induced T2DM.
Absorption ; Adipose Tissue ; Animals ; Appetite ; Blood Glucose ; Catechin ; Cholesterol ; Diabetes Mellitus, Type 2 ; Diet ; Eating ; Fatty Liver ; Glucose ; Glucose Intolerance ; Incidence ; Insulin Resistance ; Intestinal Absorption ; Islets of Langerhans ; Mice ; Obesity ; Polyglutamic Acid ; Prevalence ; Tea ; Weight Gain

The digastric muscle is located in the suprahyoid region which consists of anterior belly, intermediate tendon and posterior belly. This muscle is an important landmark when performing an operation of submental and upper neck region. Previous researches have reported about variations of the anterior and posterior belly of digastric muscle. However, there are few studies about the general morphology of the digastric muscle and the relationship with surrounding muscles. The purpose of this study was to analyze the morphology of the anterior belly of digastric muscle and confirm the topographic relationship between the digastric muscle and the stylohyoid muscle of Korean. Thirty-four cadavers (21 males, 13 females; mean age 65 years; range 24~89 years) were used in this study. The skin, subcutaneous tissues, superficial fascia and platysma were removed and a detailed dissection was performed, with extreme care being taken not to damage underlying the muscles of submental and upper neck region. After the dissections, all specimens were sketched and photographed. In 8 specimens, we observed the accessory bellies of the anterior belly of digastric muscle. We classified the accessory bellies into the crossover type (five specimens, 14.7%) that cross the mandibular raphe and unilateral type (three specimens, 8.82%). The findings resulting from observation of the anatomical relationship between the posterior belly of digastric and stylohyoid muscles, the posterior belly of digastric muscle perforated the stylohyoid muscle in 32 cases (65%) out of 49 sides. This case was subdivided into the belly of the stylohyoid muscle lean to the lateral (twenty-one specimens, 42.9%) or medial side (eleven specimens, 22.4%) of the posterior belly of digastric muscle. In 17 specimens (35%), the stylohyoid muscle existed on the medial side of the posterior belly of digastric muscle.
Anatomic Variation ; Cadaver ; Humans ; Male ; Muscles ; Neck ; Skin ; Subcutaneous Tissue ; Tendons

Atrial fibrillation (AF) is the most common form of sustained arrhythmia in elderly patients. However, AF is often detected during health screening, or accidentally during testing for other diseases; some patients lack clinical symptoms. Nevertheless, AF increases the incidence of ischemic stroke and other thrombotic events, and compromises cardiovascular prognosis in terms of heart failure, dementia, and hospitalization. Therefore, initial AF management should be performed at the point of primary care, not only in specialized medical centers. We wish to propose a five-step management protocol for AF. We review the evidence supporting integrated management by primary care physicians new to AF, and by specialized physicians who often diagnose and manage AF. Further, we also outline a structured goal-based follow-up protocol; this is an important part of integrated management.
Aged ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Dementia ; Follow-Up Studies ; Heart Failure ; Heart* ; Hospitalization ; Humans ; Incidence ; Integrative Medicine ; Mass Screening ; Physicians, Primary Care ; Primary Health Care ; Prognosis ; Stroke

Afferent loop syndrome (ALS) is a rare cause of recurrent pancreatitis. Recurrent pancreatitis in association with ALS can develop due to impaired outflow of pancreatic juice or reflux of enteric secretions caused by increased intraluminal duodenal pressure. Here, we report a case of ALS presenting as recurrent acute pancreatitis due to chronic intermittent partial obstruction of the third portion of the duodenum caused by postoperative adhesion. Interestingly, pancreatic histology showed a granulocytic epithelial lesion, which is a diagnostic feature of type 2 autoimmune pancreatitis (AIP, idiopathic duct centric chronic pancreatitis [IDCP]). From this case we learned that the diagnosis of type 2 AIP should be made in the appropriate clinical setting.
Afferent Loop Syndrome ; Diagnosis ; Duodenal Obstruction ; Duodenum ; Pancreatic Juice ; Pancreatitis ; Pancreatitis, Chronic

Afferent loop syndrome (ALS) is a rare cause of recurrent pancreatitis. Recurrent pancreatitis in association with ALS can develop due to impaired outflow of pancreatic juice or reflux of enteric secretions caused by increased intraluminal duodenal pressure. Here, we report a case of ALS presenting as recurrent acute pancreatitis due to chronic intermittent partial obstruction of the third portion of the duodenum caused by postoperative adhesion. Interestingly, pancreatic histology showed a granulocytic epithelial lesion, which is a diagnostic feature of type 2 autoimmune pancreatitis (AIP, idiopathic duct centric chronic pancreatitis [IDCP]). From this case we learned that the diagnosis of type 2 AIP should be made in the appropriate clinical setting.

PURPOSE: A brain abscess is a serious disease of the central nerve system. We conducted this study to summarize the clinical manifestations and outcomes of brain abscesses. METHODS: A retrospective chart review of pediatric patients diagnosed with brain abscesses from November 1994 to June 2009 was performed at Samsung Medical Center, Seoul, Korea. RESULTS: Twenty-five patients were included in this study. On average, 1.67 cases per year were identified and the median age was 4.3 years. The common presenting clinical manifestations were fever (18/25, 72%), seizure (12/25, 48%), altered mental status (11/25, 44%), and signs of increased intracranial pressure (9/25, 36%). A total of 14 (56%) patients had underlying illnesses, with congenital heart disease (8/25, 32%) as the most common cause. Predisposing factors were identified in 15 patients (60%). The common predisposing factors were otogenic infection (3/25, 12%) and penetrating head trauma (3/25, 12%). Causative organisms were identified in 64% of patients (16/25). The causative agents were S. intermedius (n=3), S. aureus (n=3), S. pneumoniae (n=1), Group B streptococcus (n=2), E. coli (n=1), P. aeruginosa (n=1), and suspected fungal infection (n=5). Seven patients received medical treatment only while the other 18 patients also required surgical intervention. The overall fatality rate was 16% and 20% of patients had neurologic sequelae. There was no statistical association between outcomes and the factors studied. CONCLUSION: Although uncommon, a brain abscess is a serious disease. A high level of suspicion is very important for early diagnosis and to prevent serious consequences.
Abscess ; Brain ; Brain Abscess ; Child ; Early Diagnosis ; Fever ; Head Injuries, Penetrating ; Heart Diseases ; Humans ; Intracranial Pressure ; Korea ; Pneumonia ; Retrospective Studies ; Seizures ; Streptococcus