PURPOSE: This study aimed to examine the development of socializing and emotional expressions through vocalizations and joint attention (JA) behaviors in Korean-speaking children with autism spectrum disorder (ASD), compared to those with developmental delay (DD). MATERIALS AND METHODS: Video samples were collected from 28 toddlers with ASD and 18 age-matched toddlers with DD, and vocalizations were each coded in detail for the purpose of this retrospective research. In addition to some statistical analysis, Computerized Language Analysis was conducted to obtain the final results. RESULTS: Although they produced a higher number of vocalizations than the DD group, the ASD group did not engage in emotional or social interactions with their caretakers, whereas the DD group did. The children with ASD used more atypical vocalizations and socially unengaged vocalizations than the children with DD did. JA using vocalizations in the ASD group, in particular, was largely dyadic, with triadic types occurring at a significantly lower frequency than those in the DD group. CONCLUSION: Results from this study indicate the importance of assessing early vocalizations in toddlers with ASD, suggesting that some common symptoms of ASD, such as lack of typical, emotional, and social functions in early vocalizations, could be used to develop screening and intervention programs related to ASD.
Autism Spectrum Disorder* ; Autistic Disorder* ; Child ; Child Behavior ; Communication Disorders ; Developmental Disabilities ; Humans ; Interpersonal Relations ; Joints ; Mass Screening ; Mother-Child Relations ; Retrospective Studies

PURPOSE: This study was performed to evaluate the availability of classification of lacunar syndrome and of diffusion weighted MRI as initial diagnostic tools for patients with lacunar syndrome. METHODS: From January 1 to October 31, 2001, we prospectively studied patients presenting with lacunar syndrome. All patients were scanned using diffusion-weighted MRI and were then classified into categories based on the diagnosis pure motor stroke and ataxic hemiparesis, sensory motor stroke, pure sensory stroke, dysarthria-clumsy hand syndrome, and others. RESULTS: The total number of patents was 72 ; 60 cases of lacunar infarcts and 12 cases of lacunar hemorrhage. There were 42 cases of pure motor stroke and ataxic hemiparesis, 17 cases of sensory motor stroke, 8 cases of dysarthria-clumsy hand syndrome, 3 cases of pure sensory stroke, 2 cases of others. Lacunar syndrome can be caused by lesions in a variety of locations, and specific location can cause a variety of lacunar syndromes. With diffusion-weighted MRI, lacunar syndromes were visible in 91.7% of the patients (66/72) and lacunar infarcts were visible in 90% (54/60). The mean size of the lacunar infarcts was 11.90+/-5.04 mm and the mean volume of lacunar hemorrhages was 4.70+/-2.08 ml. CONCLUSION: This study showed that the classification of lacunar syndrome was of little benefit in the diagnosis and treatment of a lacunar infarct. Diffusion-weighted MRI, however, was a good initial diagnostic tool in cases of lacunar infarcts. An additional study of the availability of diffusion weighted MRI for use in cases of hemorrhagic lesions is needed.
Classification* ; Diagnosis ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Hand ; Hemorrhage ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Paresis ; Prospective Studies ; Stroke ; Stroke, Lacunar*

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been known as a method of local treatment for early gastric cancer (EGC) or gastric adenoma. The purpose of this study was to identify the factors affecting complete resection rate (CRR) of EMR and to identify histological discrepancy between endoscopic biopsy and the resected specimen obtained by EMR. METHODS: Forty four gastric adenomas and twenty seven EGCs in 63 patients were treated by EMR from January, 1999 until August, 2002. We analysed the factors affecting CRR on the basis of location, macroscopic type, size, piecemeal resection, and EMR methods. RESULTS: The CRR in antrum was 72%. The CRR of the method using endoscopic resection with hypertonic saline-epinephrine solution, injection, precutting and snaring (ER-HSE) was 78%. The CRR according to en bloc resection was 77%. Sixty six percents of histological coincidence was noted between the endoscopic biopsy and the resected specimen of gastric adenoma. CONCLUSIONS: In this study, the CRR of the ER-HSE method and the lesion located in antrum is higher than that other groups. Gastric adenoma should be removed by EMR because of histologic discrepancy between the endoscopic biopsy and the resected specimen.
Adenoma* ; Biopsy* ; Humans ; SNARE Proteins ; Stomach Neoplasms*

Tuberculous colitis, an important extra-pulmonary tuberculosis, is still prevalent in the developing countries and has been resurging in the Western world. The duration and dose of anti-tuberculous therapy have not yet been clarified in the tuberculous colitis. We experienced a case of tuberculous colitis, which relapsed after 9 months of therapy. A 28-year-old man presented with hematochezia and was diagnosed as tuberculous colitis on the basis of colonoscopic findings. He was treated with anti-tuberculous agents for 9 months successfully. Three months later, however, he complained of hematochezia again, suggesting the relapse of tuberculous colitis. He had taken anti-tuberculous therapy for another 15 months and showed no evidence of relapse. Although anti-tuberculous therapy is efficient for tuberculous colitis, rare cases of reactivation should be reminded.
Adult ; Colitis/*drug therapy/microbiology ; English Abstract ; Humans ; Male ; Recurrence ; Tuberculosis, Gastrointestinal/*drug therapy

It is well known that Rhododendron sclippenbashii contains the toxic material grayanotoxin. So, Koreans do not eat it, but they do eat azalea although it contains grayanotoxin. That is why there have been no reports about Rhododendron sclippenbashii intoxication after ingesting it intentionally, not accidentally. In this case, the patient was admitted to the emergency room with several toxic symptoms after intentionally consuming 50 blossoms of Rhododendron sclippenbashii to get rid of thirst. Treatment with saline infusion and atropine was successful and the outcome was favorable enough in this case to produce a complete cure without any sequelae at discharge. But toxic symptoms were seen for 24 hours, although the symptoms usually fade in 9 hours. Therefore, we should carefully treat and observe, for over 24 hours, the patient who intentionally ingests about 50 blossoms of Rhododendron sclippenbashii.
Adult ; Atropine ; Bradycardia ; Drug Combinations ; Emergencies ; Flowers ; Humans ; Intention ; Piperonyl Butoxide ; Pyrethrins ; Rhododendron ; Thirst

PURPOSE: This study compared the postoperative outcomes and complications between laparoscopic totally extraperitoneal (TEP) hernia repair and open Lichtenstein hernia repair. METHODS: A total of 64 cases (30 cases by the TEP method and 34 cases by Lichtenstein repair) were enrolled in this study. The operative time, the hospital stay, the VAS score, the amount of analgesic used, the postoperative complications and recurrence were compared between the 2 methods. RESULTS: The mean operative time was 71 min for the TEP group, which was not significantly longer than that for the Lichtenstein group (66 min). The mean postoperative hospital stay was 3.7 days for the TEP group, which was significantly shorter than that for the Lichtenstein group (4.2) (p=0.035). The mean postoperative analgesic dose was 0.9+/-0.7 and 1.1+/-1.0 within 24 hours and 0.2+/-0.5 and 0.7+/-0.8 after 24 hours, respectively. The dose of analgesic after 24 hours was significantly lower for the TEP group (p=0.011), but the dose within 24 hours and the total dose was not significantly different. The VAS score was 2.3+/-1.0 and 2.6+/-0.9 at 12 hrs and 1.2+/-0.8 and 1.7+/-0.8 at 48 hrs, respectively. The VAS score was significantly lower for TEP group than that for the Lichtenstein group at 48 hrs (p=0.011), but there was no significant difference between the groups at 12 hrs. There was one recurrence in the TEP group. CONCLUSION: For the TEP group, the hospital stay was significantly shorter than that for the Lichtenstein group and this is maybe because the postoperative pain after 24 hours from the operation was less for the TEP group. Laparoscopic TEP repair may be performed efficiently with an acceptable operating time and a shorter hospital stay, as compared to open Lichtenstein hernia repair.
Hernia ; Herniorrhaphy ; Length of Stay ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Pyrazines ; Recurrence

BACKGROUND/AIMS: De novo colorectal carcinoma shows more aggressive behavior including submucosal invasiveness. Both p53 and cyclo-oxygenase-2 (COX-2) have been shown to be involved in colon carcinogenesis, progression from adenoma to carcinoma, and submucosal invasion by tumor. We performed this study to evaluate the expression of p53 and COX-2 protein in de novo carcinoma, compared with ex-adenoma carcinoma. METHODS: Twenty three flat adenomas, 19 ex-adenoma carcinomas, 6 de novo carcinomas were included in this study. The expression of p53, COX-2 and Ki-67 were examined immunohistochemically. RESULTS: Both ex- adenoma carcinomas and de novo carcinomas showed similar size and shape. Positive staining for p53 was detected in 3 of 23 (13%) flat adenomas, in 11 of 19 (57.8%) ex-adenoma carcinomas (p<0.05), and in 1 of 6 (16.6%) de novo carcinomas. Increased numbers of COX-2 positive tumor cells were observed in 1 of 23 (4.3%) flat adenomas, in 2 of 19 (10.5%) ex-adenoma carcinomas, and in 3 of 6 (50%) de novo carcinomas. COX-2 positive expression showed increased tendency in de novo carcinoma (p=0.073). There was no correlation between COX-2, p53, and Ki-67 expression. CONCLUSION: De novo carcinoma shows increased tendency of COX-2 expression, but decreased p53 expression when compared to ex-adenoma carcinoma. These immunohistochemical findings are in accordance with the fact that de novo carcinoma has no preceding adenoma, with more frequent submucosal invasion despite the small lesion size.
Adenoma/chemistry/pathology ; Carcinoma/chemistry/pathology ; Colorectal Neoplasms/chemistry/*pathology ; Cyclooxygenase 2/*analysis ; Female ; Humans ; Immunohistochemistry ; Ki-67 Antigen/analysis ; Male ; Middle Aged ; Tumor Markers, Biological/analysis ; Tumor Suppressor Protein p53/*analysis

Tuberculosis remains prevalent in developing countries and has recently re-emerged in the Western world. Intra-abdominal tuberculosis can mimic a variety of other abdominal disorders, and here we describe a patient with solitary tuberculous mesenteric lymphadenopathy mimicking duodenal gastrointestinal stromal tumor (GIST). A 22-year-old woman complained of epigastric discomfort and was presumed to have a duodenal GIST after an endoscopic examination and abdominal CT scan. However, exploratory laparotomy revealed an enlarged node penetrating the duodenal bulb, which was diagnosed histopathologically as tuberculous lymphadenitis. This case suggests that in regions with a high prevalence of tuberculosis, intra-abdominal tuberculosis is often mistaken as a malignant neoplasm. A high index of suspicion and the accurate nonsurgical diagnosis of intra-abdominal tuberculosis continues to be a challenge.
Abdomen ; Adult ; Diagnosis, Differential ; Duodenal Neoplasms/*diagnosis ; Female ; Gastrointestinal Stromal Tumors/*diagnosis ; Humans ; Research Support, Non-U.S. Gov't ; Tuberculosis, Lymph Node/*diagnosis

PURPOSE: To compare the sedation quality of oral chloral hydrate against intramuscular ketamine in children requiring primary repair in the emergency department. METHODS: Patients needing primary repair of lacerations (range 1.6 years of age) were blindly randomized to either chloral hydrate or ketamine groups. One group received intramuscular ketamine at 4 mg/kg and the other group received oral chloral hydrate at 50 mg/kg. Both groups received lidocaine for local anesthesia. Physiologic parameters (heart rate, blood pressure and respiratory rate), the time from sedation to recovery, and the degree of sedation as measured by the Ramsay sedation score and the Modified Aldrete recovery score were recorded during the treatment. Overall behavior and complication were assessed both at baseline and at the end of the treatment. RESULTS: Data are mean+/-SD. We enrolled 80 consecutive patients into the study; 39 received intramuscular ketamine and 41 were administered oral chloral hydrate. The two groups were similar with regard to age, sex, and body weights. No patient had a clinically significant change in vital signs and the time from sedation to recovery. Changes in the Modified Aldrete recovery score after sedation were not statistically significant. However, statistically significant differences were observed for the Ramsay sedation score at 15 minutes after sedation (4.89+/-0.32 versus 4.23+/-0.48; p=0.024). No differences at other time points achieved statistical significance in the Ramsay sedation score. CONCLUSION: Both oral chloral hydrate and intramuscular ketamine are safe and effective for the sedation of children requiring laceration repair in the emergency department.
Anesthesia, Local ; Blood Pressure ; Body Weight ; Child* ; Chloral Hydrate* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Ketamine* ; Lacerations ; Lidocaine ; Vital Signs

PURPOSE: We evaluated a method to distinguish group A (abscess) from group B (cellulitis, pharyngitis, tonsillitis, epiglottis) through clinical variables in patients with a deep neck infection. METHODS: This was a retrospective chart review study consisting of the evaluation of CT scans or surgical diagnoses on adult patients (18 or more years of age). CT scans were reviewed by a radiologist. We evaluated several clinical variables in order to distinguish group A from group B. We also evaluated the ability of these clinical variables to distinguish group A from group B by a receiver operating characteristic curve. RESULTS: Sixty-three patients were enrolled in this study. Several clinical variables (swelling, odynophagia, tenderness, trismus, age>50years) differed between group A and group B. A AUC which was obtained by adding the number of variables (swelling, odynophagia, tenderness, trismus, age>50years) was 0.87 (p<0.01). The sensitivity and specificity of these clinical variables were 0.96 and 0.6 respectively, when the cut off value for adding the number of variables was set as 1.5. When the sum of these number of variables are more than two, the sensitivity is 0.958 (95% C.I:0.901~0.987) and the specificity is 0.600 (95% C.I:0.417~0.693). CONCLUSION: Five clinical variables (age>50, swelling, odynophagia, tenderness, trismus) were able to distinguish group A from group B.
Abscess ; Adult ; Area Under Curve ; Humans ; Neck ; Palatine Tonsil ; Pharyngitis ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Soft Tissue Infections ; Tonsillitis ; Trismus