No abstract available.
Dermoscopy* ; Diagnosis

PURPOSE:Idiopathic ketotic hypoglycemia (IKH) is an important cause of hypoglycemia in children. The purpose of this study was to determine the prevalence of ketotic hypoglycemia and to describe the clinical manifestation. METHODS:We conducted a retrospective chart review of children presenting hypoglycemia to the emergency department (ED) of Ewha Womans University Hospital between January 1995 and June 2004. Information recorded for subject included age, gender, weight, time of presentation, presenting symptoms, and laboratory data. RESULTS:Eighty two children were identified for hypoglycemia during the study period. IKH was the ultimate diagnosis for 66 patients (80.5%). Other diagnoses included hyperinsulinism (2.4%), drug adverse event (1.2%), sepsis (1.2%), and other disorder. The mean age for presentation of IKH was 37.9+/-18.6 months. Thirty eight boys and twenty eight girls were identified. The median time of presentation was 9:48 a.m. Of the 66 subjects, body weight of 46.9% patients was below 25th percentile for age. The average blood glucose was 41.4+/-14.2 mg/dL. Symptoms at presentation included lethargy (24.2%), mental change (16.7%) and vomiting (16.7%). 49 patients (74.2%) were described as having a concomitant illness. CONCLUSION: IKH was responsible for 80.4% of cases of hypoglycemia in pediatric ED and it had usually concomitant intercurrent illness which resulting in poor oral intake. Awareness of IKH, and its presenting characteristics, will be helpful in the ED when taking care of hypoglycemic children.
Blood Glucose ; Body Weight ; Child ; Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Hyperinsulinism ; Hypoglycemia* ; Lethargy ; Prevalence* ; Retrospective Studies ; Sepsis ; Vomiting

Purpose: This report describes a case of recurrent ophthalmoplegia associated with hyperhomocysteinemia due to methylenetetrahydrofolate reductase (MTHFR) gene polymorphism.Case summary: A 40‐year‐old healthy man presented with acute diplopia. He had a history of diplopia due to left sixth nerve palsy 2 years ago. Prism and alternate cover tests revealed left hypertropia in the primary position. Examination of ductions and versions showed mild elevation of the left eye on adduction. Brain and orbit magnetic resonance imaging were normal. Laboratory studies revealed an elevated level of erythrocyte sedimentation rate (ESR) and homocysteine. A diagnosis of left fourth nerve palsy associated with hyperhomocysteinemia was made. Symptoms were completely resolved within 2 weeks. Two years later, the patient again had diplopia associated with esotropia and limited abduction of the right eye. ESR and homocysteine level were normal. Analysis for MTHFR gene polymorphisms, which contribute to variable hyperhomocysteinemia, revealed 677TT homozygote variant. A diagnosis of recurrent paralytic strabismus associated with hyperhomocysteinemia, caused by MTHFR gene polymorphism, was made. Symptoms resolved within 1 month, and the patient did not have any further recurrence in 6 months. Conclusions Patients with hyperhomocysteinemia may present with ophthalmoplegia. An analysis for MTHFR gene polymorphisms is needed to diagnose hyperhomocysteinemia.

No abstract available.
B-Lymphocytes* ; Lymphoma, B-Cell* ; Waldenstrom Macroglobulinemia*

BACKGROUND: Skin thickness for parameter of skin aging has been analysed with various methods. Skin thickness variations between the young and the old has been studied with various methods such as biopsies, calipers, micrometers, computer tomography, ultrsonography. But none of these methods evaluates skin thickness exactly. OBJECTIVE: For the evaluation of age-dependent skin thickness changes, we compared the skin thickness of an old-aged group and a young group with 20MHz-ultrasonography. METHODS: In order to identify the skin thickness variation between different age groups, 60 subjects, 30 aged 23-33, and 30 over 60, were studied with 20MHz-high frequency ultrasonogrphy (Dermascan C, Cortex Technology, Hadsund, Denmark) on fourteen skin sites. This machine was designed to measure the thickness from the top of the epidermis to the bottom of the dermis. After storage of cross-sectional skin imaging, skin thickness was calculated with a computer assisted image-analysis program. Skin thickness of the old was analysed by age, sex, height and weight.
Biopsy ; Dermis ; Epidermis ; Humans ; Skin Aging ; Skin* ; Ultrasonography*

No abstract available.
Dermatitis, Contact*

The caudal epidural anesthesia has been popular due to the postoperative pain relief and the reduction of the amount of general anesthetics. It is also technically simple and safe both for inpatients and outpatients under the age of 7 Year. The aim of this study was to determine the adequate dosage and degree of postoperative pain relief according to the different local anesthetics. We have performed the caudal anesthesia in 60 patients from the age of 10 month to 7 year. All caudal blocks were performed under light general anesthesia in order to relief the fear and anxiety of operation. The patients were divided by 4 groups of each 15 children. Group 1 (control group) for 1% lidocaine 1 ml/kg, Group 2 for 1% lidocaine 0.8 ml/kg, Group 3 for 0.25% bupivacaine 0.8 ml/kg, Group 4 for 0.25% bupivacaine 0.6 ml/kg. All groups were given 1:200,000 epinephrine. The overall success rate of caudal blocks was 98%. Complication was 3 cases. As the result of this study, Group 1 (control group): There was sensory block over T4 (20%). The degree of motor block was very high(73.3%). Group 2 and 3: There was no sensory block over T4. Duration of postoperative analgesia was long enough compared to the control group (p<0.05). The degree of motor block was less than the control group. Group 4: The height of most sensory block was below T8 (80%). The degree of motor block was very low (p<0.05) and duration of postoperative analgesia was short compared to the control group (p<0.001). Therefore it is considered that caudal blocks in Group 2 & 3 were adequate dosage for the pediatric operation.
Analgesia ; Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics, General ; Anesthetics, Local ; Anxiety ; Bupivacaine ; Child ; Epinephrine ; Humans ; Inpatients ; Lidocaine ; Outpatients ; Pain, Postoperative*

PURPOSE: The purpose of this study was to examine the effects of parental stress, social support, and coping behavior on burnout among mothers caring for children with cerebral palsy. METHODS: Participants in this cross-sectional, descriptive study were 185 mothers who completed a self-report structured questionnaire. The data were analyzed using descriptive statistics, t-test, one-way ANOVA, correlation and multiple linear regression analyses with IBM SPSS Win 22 program. RESULTS: Parental stress and coping behavior were strong predictors of burnout among mothers of children with cerebral palsy. These variables explained 50.0% of the variance in burnout. Social support was not a predictor of burnout. A higher level of burnout was associated with higher levels of parental stress and lower levels of social support and coping behavior. CONCLUSION: Mothers of children with cerebral palsy are vulnerable to burnout. These results show that effective strategies for reducing parental stress and improving positive coping behavior are needed to reduce burnout in these mothers.
Adaptation, Psychological ; Cerebral Palsy* ; Child* ; Humans ; Linear Models ; Mothers* ; Parenting ; Parents ; Stress, Psychological

BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
Anesthesia ; Body Mass Index ; Catheterization ; Humans ; Jugular Veins* ; Observational Study ; Palpation ; Prospective Studies ; Skin ; Ultrasonography ; Valsalva Maneuver* ; Veins

No abstract available.
Carcinoma, Basal Cell* ; Nevus*