PURPOSE: There are few rigorous studies about the side effects of antiepileptic drugs(AEDs) according to age. This study is to analyze differences of the side effects of AEDs in epileptic children according to age. METHODS: Sample are 368 children who had received AEDs for at least 1 month during January 1995 to June 1999. We reviewed their medical records including age, sex, AEDs and side effects, and analyzed these data by X2-test. RESULTS: Side effects were observed in 86(23.4%) of 368 patients. There was no difference in the frequency of overall side effects according to age. But significant differences existed in each side effect(p<0.05). The most common side effect according to age were hematologic side effect(75.0%) under 2 months, gastro intestinal side effect(41.7%) between 2 months and 1 year, CNS side effect(42.1%) between 1 year and 5 years, CNS side effect(41.5%) over 5 years. Hepatotoxicity, the increase of AST/ALT due to valproate, occurred significantly more frequently in children younger than 2 years(p<0.05). Drug eruption and post-carbamazepine leukopenia had no differences according to age. Under 1 year, valproate group had significantly more side effects in CNS. But carbamazepine, phenobarbital, and vigabatrin groups had no differences. CONCLUSION: There was significant difference in the side effects of AEDs among each system according to age. It is recommended to use valproate as monotherapy in children younger than 2 years, and pay more attention to CNS side effect in children older than 1 year.
Anticonvulsants* ; Carbamazepine ; Child* ; Drug Eruptions ; Humans ; Leukopenia ; Medical Records ; Phenobarbital ; Valproic Acid ; Vigabatrin

PURPOSE: Tumor lysis syndrome is characterized by hyperuricemia, hyperphosphatemia, hypetkalemia and hypocalcemia due to destruction of tumor cells. The purpose of this study is bi estimate in children the incidence, onset time, differences in outcomes between hemodialysis and conservative therapy, and predictive factor of tumor lysis syndrome before treatment with chernotherapy. METHODS: Subjects were 108 children who had received induction chemotherapy from January 1993 to December 1998. We reviewed 12 patients who developed turnor lysis syndrorne, and retrospectively analyzed their data on WBC, Hb, platelet, LDH, uric acid, phosphorus, potassiurr., calcium, BUN and creatinine. RESULTS: Tumor lysis syndrome was observed in 12(11.1%) cases. Seven out of 12 patient:; (58A%) were in the age group of 6 to 10 years. The incidence of tumor lysis syndrome was 9.4% in acute leukemia, 30.8% in malignant lymphoma and 6.5% in solid tumor. Before chemotherapy, tumor lysis syndrome occurred in 3 cases(25.0%). Nine cases(75.0%) developed after initiation of chemotherapy. LDH was significantly higher in the group with tumor lysis syndrome(2790.8+/-1882.1U/L) than the group without(777.6+/-618.5U/L)(P<0.05). Of 12 patients, there were increased levels of phosphorus and uric acid in 11 cases, creatinine in 9 cases, potassium in 6 cases, and calcium was decreased in 8 cases. There was no death during treatment. Duration of treatment until improvement was longer in the hemodialysis group(7.62.7 days) than in thi conservative therapy group(5.71.5 days). CONCLUSION: Turnor lysis syndrome occurred mostly within 24-48 hours after chernotherapy of acute lymphocytic leukemia and Burkitt's lymphoma. LDH before chemotherapy was helpful in predicting the occurrence of turnor lysis syndrome in children.
Blood Platelets ; Burkitt Lymphoma ; Calcium ; Child* ; Creatinine ; Drug Therapy ; Humans ; Hyperphosphatemia ; Hyperuricemia ; Hypocalcemia ; Incidence ; Induction Chemotherapy ; Leukemia ; Lymphoma ; Phosphorus ; Potassium ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Renal Dialysis ; Retrospective Studies ; Tumor Lysis Syndrome* ; Uric Acid

PURPOSE: The purpose of this study is to estimate the side effects of antiepileptic drug(AED) in children. METHODS: Subjects were 267 children who had received AED for at least 1 month during January 1995 to July 1998. We reviewed their sex, age at start of seizure onset, age at medication, class and number of AED, developmental delay, type and cause of seizure according to the presence of side effect. We analyzed data using Student's t-test and X2-test. RESULTS: Side effects were observed in 61 of 267(22.8%) patients. There were no significant differences in their characteristics according to the presence of side effect. There were 112 episodes of complications in 61 patients. In decreasing order, CNS(38.4%) > digestive(25.9%) > hematologic(22.3%) > skin and connective tissue(7.1%) > others(6.3%). There were 12 episodes in 11 patients who should have been taken off AED due to drug eruption, drowsiness, nausea and so on. Side effects were observed in 16 of 123(6.0%) patients in monotherapy compared with 45 of 144(16.8%) patients in polytherapy, which showed significantly fewer side effects in monotherapy(P<0.05). In monotherapy, mean age at seizure onset and medication start were older(4.63+/-3.83, 5.85+/-3.86 years, respectively) than in polytherapy(2.69+/-3.06, 3.69+/-3.58 years, respectively) (P<0.05). CONCLUSION: In the data, CNS is the most common side effect(43 episodes, 38.4%) and there were significantly fewer side effects in monotherapy compared with polytherapy. Accordingly, we concluded that monotherapy is preferred over polytherapy in reducing the side effects of AED.
Child* ; Drug Eruptions ; Humans ; Nausea ; Seizures ; Skin ; Sleep Stages

PURPOSE: Neonatal hyperbilirubinemia has benign courses in most cases, but the possibility of toxicity of hyperbilirubinemia required courses examination of every newborn infant to identify the severity of hyperbilirubinemia progress. This study aims to see how the body surface area of newborns influences the decline rate of serum bilirubin level in conventional phototherapy. METHODS: Based on the charts of the Pediatrics Department, Dae-Dong Hospital from January 2003 to December 2006, we analyzed 168 neonates diagnosed as neonatal hyperbilirubinemia (serum bilirubin > or =15 mg/dL) in retrospective way. We excluded newborn infants under 37 weeks of gestation and under 2,500 g birth weight and classified neonates into four groups by the calculation results of body surface area:males above 75 percentile (group A), males below 25 (group B), females above 75 (group C), and females below 25 (group D). RESULTS: Out of 168 samples, the number of group A, B, C, D was 30, 20, 20, 15 respectively. In conventional phototherapy, the mean decline rates of serum bilirubin of group B and D recording 2.09 mg/dL/day and 1.77 mg/dL/day, were significantly faster than those of group A and C recording 1.63 mg/dL/day and 1.41 mg/dL/day (P<0.01). No significant differences were found in different duration of phototherapy between groups below 25 percentile and those above 75 in both genders. CONCLUSION: In conclusion, body surface area influences of infants the decline rate of serum bilirubin level in conventional phototherapy.
Bilirubin* ; Birth Weight ; Body Surface Area* ; Female ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn ; Male ; Pediatrics ; Phototherapy* ; Pregnancy ; Retrospective Studies

Primary gastric lymphorna represents one to 7% of all gastric cancer and is the most common type of extranodal lymphoma. In attempt to evaluate the endoscopic characteristics, we analysed clinical and endoscopic findings in 35 patients with primary gastric lymphoma between January 1980 and August 1994 at the Yonsei Medical Center. The results were as follows: 1) The mean age of patients was 47.1 years with male to female ratio of 1.5: l. 2) Gastroscopy was performed in all 35 patienits, which revealed polypoid lesion in one case(2.9%), ulcerative lesion in 15 cases(42.9%), ulcero-infiltrative lesion in 6 cases(17.1%) and diffuse infiltrative lesion in 2 cases(5.7%). Gastric lymphoma was suggested in 6 cases, advanced gastric cancer in 21 cases, early gastric cancer in 5 cases and benign gastric ulcer in 3 cases. Pathologic diagnosis of biopsy specimens were gastric lymphoma in 24 cases, adenocarcinoma in 5 cases and chronic superficial gastritis in one case. 3) The characteristics of the endoscopic findings in gastric lymphoma were intractable or recurrent ulcer in 10 cases, thickened and mounded ulcer margin in 9 cases, multiple ulcers in 9 cases, giant rugae in 7 cases and polypoid or depressed lesion with central ulceration in 4 cases. In conclusion, recognition of specific endoscopic findings such as intractable or recurrent ulcer, volcano-like ulcer, multiple ulcers, giant rugae and combined lesion, the possibility of a lymphoma should be considered and vigorous biopsy attempts should be carried out. Then if the first microscopic report does not suggest this diagnosis, a second investigation including jumbo biopsies, perhaps by diathermy, should be undertaken.
Adenocarcinoma ; Biopsy ; Diagnosis* ; Diathermy ; Female ; Gastritis ; Gastroscopy ; Humans ; Lymphoma ; Male ; Stomach Neoplasms ; Stomach Ulcer ; Ulcer

Central pontine myelinolysis(CPM) is rare, with fewer than 30 cases reported in children. It is characterized by demylinated regions throughout the brain and which are most prominent in the pons. The original patients studied were all chronic alcholics, but subsequently the condition has been found in children and in other patients with electrolyte abnormalities, most notably hyponatremia which had been corrected rapidly. CPM symptoms include spastic quadriparesis, pseudobulbar palsy, and acute changes in mental status leading to altered levels of consciousness, coma, or death. This condition was originally thought to be uniformly fatal, but there have been recent reports of survival accompanied by varying degrees of residual neurologic deficit. We experienced a case of central pontine myelinolysis in a 1-year-old girl in 1998. On admission, she had right hemiphegia and developmental delay. She suffered from hyponatremia a year prior to admission. We performed brain MRI and other studies. She was diagnosed with CPM though brain MRI.
Brain ; Child ; Coma ; Consciousness ; Female ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Muscle Spasticity ; Myelinolysis, Central Pontine* ; Neurologic Manifestations ; Pons ; Pseudobulbar Palsy ; Quadriplegia

Central pontine myelinolysis(CPM) is rare, with fewer than 30 cases reported in children. It is characterized by demylinated regions throughout the brain and which are most prominent in the pons. The original patients studied were all chronic alcholics, but subsequently the condition has been found in children and in other patients with electrolyte abnormalities, most notably hyponatremia which had been corrected rapidly. CPM symptoms include spastic quadriparesis, pseudobulbar palsy, and acute changes in mental status leading to altered levels of consciousness, coma, or death. This condition was originally thought to be uniformly fatal, but there have been recent reports of survival accompanied by varying degrees of residual neurologic deficit. We experienced a case of central pontine myelinolysis in a 1-year-old girl in 1998. On admission, she had right hemiphegia and developmental delay. She suffered from hyponatremia a year prior to admission. We performed brain MRI and other studies. She was diagnosed with CPM though brain MRI.
Brain ; Child ; Coma ; Consciousness ; Female ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Muscle Spasticity ; Myelinolysis, Central Pontine* ; Neurologic Manifestations ; Pons ; Pseudobulbar Palsy ; Quadriplegia

Behcet's disease consists of a triad of relapsing inflammatory disease of the eye (iridocyclitis) with painful and recurrent oral and genital ulcerations. Arthritis, thrombophlebitis, neurologic abnormalities, fever, and colitis are associated clinical manifestations. The disease affects predominantly young adults and is very rare in children, especially those under 10 years of age. The proportion of Behcet's colitis in Behcet's disease is about 12%. Ulcerations are localized or diffuse, with the majority occuring in the ileocecal region. Extension to the serosal surface may result in perforation. The frequent complaints are abdominal pain, nausea, vomiting, diarrhea, hematochezia, loss of appetite, loss of weight gain, distention and palpable abdominal mass. The disease is complicated by intestinal obstruction, perforation, fistula formation, abscess formation and hemorrhage. We experienced a case of Behcet's colitis in a 9-year-old boy showing symptoms of abdominal pain, tenderness, and diarrhea. Thus, we report a case of Behcet's colitis with brief review of related literatures.
Abdominal Pain ; Abscess ; Appetite ; Arthritis ; Child* ; Colitis* ; Diarrhea ; Fever ; Fistula ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Intestinal Obstruction ; Male ; Nausea ; Thrombophlebitis ; Ulcer ; Vomiting ; Weight Gain ; Young Adult

Schwannoma commonly arises from Schwann cells of the neural sheath, and is rare in the groin region. Here, we describe a vaginal schwannoma incidentally detected by magnetic resonance imaging (MRI) in a patient with thigh pain. A 43-year-old woman presented with thigh pain with burning and tingling sensations in the medial aspect of her left thigh. MRI revealed a mass lesion of heterogeneous intensity 5.2 x 5.7 cm in the left vaginal wall. The mass was resected and histology revealed schwannoma.
Adult ; Burns ; Diagnosis* ; Female ; Groin ; Humans ; Magnetic Resonance Imaging ; Neurilemmoma* ; Schwann Cells ; Sensation ; Thigh* ; Vaginal Neoplasms

Endometrial cancer is the most common malignancy of the female genital tract. The cancer spreads by direct extension, transtubal dissemination, lymphatic dissemination, and/or by hematogenous spread, usually results in lung metastasis, but may less commonly involve liver, brain, and bone. Here, we describe a patient with stage IA endometrial cancer who developed liver recurrence 17 months after surgery.
Brain ; Endometrial Neoplasms ; Female ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Recurrence