Skin atrophy is one of the most common side effects of topical steroid use and results from decreased skin proalphaI collagen mRNA production due to specific alterations in collagen gene transcription or from reduced collagen mRNA stability. This report describes a case of a 8 year-old-girl who visited our hospital with a complaint of ambiguous genitalia. She was observed to have atrophic labia majora and atrophic striae resembling scrotal rugae. However, her serum levels of FSH, LH, 17-KS, 17-OHCS, 5-DHT, DHT and DHEA-S were all in normal range and her karyotype was 46,XX. Abdominal and pelvic ultrasonogram showed a normal uterus and ovaries. Careful history taking revealed frequent use of steroid ointment due to vulvar pruritus for 2 years and she was finally diagnosed to have atrophy of external genitalia induced by long-term use of topical steroid.
Atrophy* ; Collagen ; Disorders of Sex Development ; Female ; Genitalia* ; Karyotype ; Ovary ; Pruritus ; Reference Values ; RNA Stability ; RNA, Messenger ; Skin ; Ultrasonography ; Uterus

The finding of extraluminal gas on plain abdominal radiogram is usually associated with a perforated viscus, and an emergency laparatomy is indicated. But we report herein an immature neonate with spontaneous pneumoperitoneum that was treated successfully with conservative management, although this infant she showed positive result in stool occult blood test. As this case shows, the finding of pneumoperitoneum is not of a surgical emergency, because there are many benign explanations for pneumoperitoneum. A through history taking and physical examination are most important in differentiating between surgical and nonsurgical pneumoperitonium.
Emergencies ; Humans ; Infant ; Infant, Newborn* ; Occult Blood ; Peritonitis ; Physical Examination ; Pneumoperitoneum*

OBJECTIVES: The purpose of this study was to explore insomniac demographic characteristics and the type of consultation provided to hospitalized patients asked to the Department of Psychiatry for insomnia and to compare patient insomnia characteristics by consultation type. METHODS: We performed a retrospective chart review of 4,966 patients who were hospitalized from August 1, 2005 to December 31, 2011 that received consultation in the Department of Psychiatry. Among them, 236 patients were referred for insomnia. We compared the differences in demographic characteristics and types of consultation between the insomnia patient group and other patient group. We also compared the difference between demographic characteristics and type of consultation by dividing total subjects into ‘with reconsultation’ and ‘without reconsultation’ groups. RESULTS: Our results came from the analysis of 9,689 consecutive consultation requests. There were 4,966 patients that participated in the study over 6 years and 6 months. The overall consultation rate was 3.3% of all admissions and insomnia patients comprised 4.8% of those. The ratio of re-consultation for insomnia was 27.5%. There was no significant difference in mean age between the insomnia ‘with reconsultation group’ and the insomnia ‘without reconsultation group’, but the ‘with reconsultation’ group had significantly more male patients and medical patients than the ‘without re-consultation’ group. For insomnia patients, consultation types were in the order of Mending request (51.3%), Paralle request (36.6%), Complementary request (9.0%) and this composition differed from that of total admission patients. CONCLUSION: Hospitalized patients referred for insomnia showed a higher proportion of male patients, lower rates of re-consultation compared with other patients, and most of these were for secondary insomnia. Each doctor should be aware of the possibility of inpatient insomnia, conduct positive assessments and referrals as necessary, and psychiatrists who might be asked for consultation need to prepare an active intervention with initial diagnosis and treatment, as well as recommendations for the timing of reconsultation.
Diagnosis ; Humans ; Inpatients ; Male ; Psychiatry ; Referral and Consultation ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders

Maternal diabetes is known to have teratogenic effects which increase the risk for congenital anomalies, such as caudal dysplasia, cardiac defects, hydronephrosis, and small left colon syndrome. Infants of diabetic mothers have a 10-fold higher frequency of anomalies in the central nervous system and a 5-fold higher frequency of congenital heart defects. However, jejunal atresia combined with multiple anomalies of the face, ears, and hands has rarely been reported. Herein we report a neonate born to a diabetic mother, who had hemifacial microsomia, displacement of the lacrimal ducts, polydactyly of the right hand, microtia of the right ear and proximal jejunal atresia presenting as bile regurgitation on the 1st day of life.
Bile ; Central Nervous System ; Colon ; Congenital Abnormalities ; Diabetes, Gestational ; Displacement (Psychology) ; Ear ; Facial Asymmetry ; Female ; Hand ; Heart Defects, Congenital ; Humans ; Hydronephrosis ; Infant ; Infant, Newborn ; Intestinal Atresia ; Mothers ; Polydactyly ; Pregnancy

The Committee of Education of the Korean Diabetes Association discussed the need to develop the Diabetes Education Recognition Program. In 2011, the current certification program was reviewed and a survey was conducted to improve the Diabetes Education Recognition Program. This improved program will be a standard for qualified diabetes education for diabetes educators and institutes, and will ultimately become a national standard for diabetes education.
Academies and Institutes ; Certification ; Diabetes Mellitus ; Patient Education as Topic

We experienced a case, which showed the sudden drop of arterial oxygen saturation and capnographic score in a femur surgery patient under general anesthesia. We installed a transesophageal echocardiography probe in the patient and detected free-floating emboli in the right atrium, enlargement of the right atrium and the right ventricle, and global hypokinesia of the right ventricle. Because the patient's vital sign was so unstable, emergent cardiac and pulmonary embolectomy was performed with the use of cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged without any neurologic sequale. We concluded that transesophageal echocardiography was a useful device for the diagnosis of intraoperative massive pulmonary thromboembolism.
Anesthesia, General ; Cardiopulmonary Bypass ; Echocardiography, Transesophageal ; Embolectomy ; Femur ; Heart Atria ; Heart Ventricles ; Humans ; Hypokinesia ; Oxygen ; Pulmonary Embolism ; Vital Signs

BACKGROUND: InBody 4.0, a bioelectrical impedance analyser (BIA) has an automatic function of printing out the measurement data of visceral fat area. The purpose of this study was to assess the usefulness of the visceral obesity measured by the InBody 4.0 and the waist circumference METHODS: A total of 124 participants who visited an obesity clinic in a university hospital were measured their waist circumference, height, weight and the visceral fat area by the InBody 4.0 and CT scan. The mean difference and agreement between the two visceral fat areas by the two methods had been analyzed according to sex, age and BMI groups. The accuracy of the visceral obesity by the BIA and the waist circumference was respectively compared with the visceral obesity by the CT scan. RESULTS: There was no significant difference between visceral fat area measured by the CT and the BIA in women participants under 46 years of age and below BMI 30. When comparing visceral fat area obtained from the CT with those obtained from the BIA, the 95% confidence interval for the limit agreement was higher in male subjects than in females. The waist circumference was the more sensitive method to diagnose visceral obesity than the BIA (91.80% vs. 77.94%), but the BIA method showed a higher specificity than the waist circumference (76.79% vs 52.38%). CONCLUSION: Waist circumference turned out to be more useful than the BIA as a screening tool for visceral obesity. In the group of males, BMI of over 30, or the age over 46 years, it is recommended that the CT rather than the BIA for measurement of visceral fat area be utiliged.
Electric Impedance ; Female ; Humans ; Intra-Abdominal Fat ; Male ; Mass Screening ; Obesity ; Obesity, Abdominal* ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Waist Circumference*

OBJECTIVE: This study is to report our experience of 40 cases of spinal schwannoma. METHODS: From 1995 to 2006, medical records were retrospectively reviewed in 40 cases of spinal schwannoma. RESULTS:We treated 40 spinal schwannomas in 38 (22 male and 16 female) patients. The mean age was 50.2. Four cases were sited in the cervical spine, 11 cases in the thoracic spine, and 25 cases in the lumbar spine. Two patients showed recurrences. Thirty-eight cases were intradural-extramedullary type and 2 cases were extradural. Two cases (5%) including 1 recurred case had no postoperative motor improvement. Ninety-five percents of patients improved on postoperative motor grade. CONCLUSION: Spinal schwannoma is mostly benign and extramedullary tumor. There were 2 recurred cases (5%) that had history of previous subtotal removal at first operation and had shown worse prognosis compared with the cases without recurrence. To reduce the recurrence of spinal schannoma, total excision of tumor mass should be done.
Humans ; Male ; Medical Records ; Neurilemmoma ; Prognosis ; Recurrence ; Retrospective Studies ; Spine

BACKGROUND: We attempted to see if acute MRI can expand the time window of thrombolytic therapy in acute stroke. METHODS: We performed MRI protocol including diffusion-weighted image (DWI) and MR angiogram (MRA) for patients with stroke within 6 hours after symptom onset. We selected 58 patients who had occlusion of middle cerebral artery (MCA) on the initial MRA. Thrombolytic therapy was done only when the patients showed more severe neurological deficits than expected with DWI findings. We analyzed demographic features, initial and follow-up NIH stroke scale scores, recanalization, and hemorrhagic transformation after thrombolytic therapy in 2 groups which were classified according to time to check MRI (within or beyond 3 hours). We measured the initial and follow-up lesion volume detected by DWI. RESULTS: Thrombolytic therapy was done in 38 patients. Twenty-four patients underwent MRI within 3 hours, and 14 patients underwent MRI between 3 and 6 hours. There were no significant differences in baseline characteristics, recanalization rate, ratio of marked clinical improvement, and hemorrhagic transformation rate between 2 groups. Young age was a significant predictable factor for good clinical outcome (p<0.05), but the interval from onset to imaging time and treatment modalities were not. CONCLUSIONS: It is suggested that patients' age and DWI findings are more appropriate factors affecting the clinical outcome after thrombolytic therapy than time interval itself at least when the therapy is considered within 6 hours.
Diffusion Magnetic Resonance Imaging ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Middle Cerebral Artery ; Stroke* ; Thrombolytic Therapy*

PURPOSE: The purpose of this study was to analyze the therapeutic effect of plasmapheresis in various pediatric diseases. METHODS: Therapeutic plasmapheresis was performed by COBE Spectra centrifugation. Nine cases were included in this study. The number and method of plasmapheresis, together with the progress and prognosis of each case were retrospectively reviewed. RESULTS: The patients' ages ranged from 26 months to 16 years of age, and the mean age was 9.9 years. There were 5 males and 4 females. The underlying diseases requiring plasmapheresis included 2 cases of hemolytic uremic syndrome(HUS), 1 case of lupus nephritis, 2 cases of rapidly progressive glomerulonephritis(RPGN), 1 case of focal segmental glomerulosclerosis(FSGS), 1 case of systemic vasculitis after pulmonary hemorrhage, 1 case of acute renal failure associated with pulmonary hemorrhage, and 1 case of acute rejection after renal transplantation. The average number of plasmapheresis performed was 6.2 times with a range of 3 to 13 times. The patients with HUS, lupus nephritis, ANCA positive systemic vasculitis induced by pulmonary hemorrhage and ARF-associated pulmonary hemorrhage showed a good response to therapeutic plasmapheresis, but the patients with RPGN, refractory FSGS, and acute rejection after renal transplantation were not responsive to treatment. The most common side effect was hypocalcemia which was rarely symptomatic. Vital signs were not compromised. CONCLUSION: Although it is presumptuous to generalize the therapeutic effects of plasmapheresis in different diseases due to the small number of study subjects, this study shows that plasmapheresis may be an effective therapeutic modality in various pediatrics diseases and should be considered as a therapeutic option.
Acute Kidney Injury ; Antibodies, Antineutrophil Cytoplasmic ; Centrifugation ; Child ; Female ; Hemorrhage ; Humans ; Hypocalcemia ; Kidney Transplantation ; Lupus Nephritis ; Male ; Pediatrics ; Plasma Exchange* ; Plasma* ; Plasmapheresis ; Prognosis ; Renal Insufficiency ; Retrospective Studies ; Systemic Vasculitis ; Vital Signs