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*

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

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 is to identify the effects of telephonic counseling on burnout, depression, life satisfaction, and perceived physical health among family caregivers of older adults with dementia. METHOD: Subjects were randomly assigned into telephonic counseling group (n=21) and the comparison group (n=32). A weekly telephone counseling was conducted by research assistants for 12 weeks. T-test were used to answer the research questions. RESULT: 1) There were no significant differences between the two groups on the level of burnout, depression, life satisfaction, and perceived physical health after telephone counseling. 2) Spouse caregivers under the telephone counseling tended to report higher perceived physical health than comparison group at the post-test (t=-1.88, p=.08). Spouse caregivers under the telephone counseling tended to report higher emotional exhaustion and lower feeling of self achievement. 3) Daughter-in-law caregivers under telephone counseling showed increased feeling of self achievement, improved physical health condition, and decreased depression. CONCLUSION: This study showed potential effects of the problem-solving telephone counseling to improve perceived physical health and to reduce the level of burnout and depression. The findings suggest the necessity of screening most vulnerable subgroups of caregivers to increase the effectiveness of nursing intervention such as telephone counseling.
Adult* ; Caregivers* ; Counseling* ; Dementia* ; Depression* ; Humans ; Mass Screening ; Nursing ; Telephone*

The uptake of glucose for metabolism and growth is essential to most animal cells and is mediated by glucose-transporter (GLUT) proteins. The aim of this study was to determine which class of glucose transporter molecules was responsible for uptake of glucose in the mouse early embryo and at which stage the corresponding genes were expressed. In addition, co-culture system with vero cell was used to investigate the effect of the system on GLUT expression. Two-cell stage embryos were collected from the superovulated ICR female and divided into 3 groups. As a control, embryos were cultured in 0.4% BSA-T6 medium which includes glucose. For the experimental groups, embryos were cultured in either co-culture system with vero cells or glucose-free 76 medium supplemented with 0.4% BSA and pyruvate as an energy substrate. 2-cell to blastocyst stage embryos in those groups were respectively collected into microtubes (50 embryos/tube). Total RNA was extracted and RT-PCR was performed. The products were analysed after staining ethidium bromide by 2% agarose gel electrophoresis. Blastocysts were collected from each group at 120hr after hCG injection. They were fixed in 2.5% glutaraldehyde, stained with hoechst, and mounted for observation. In control, GLUT1 was expressed from 4-cell to blastocyst. GLUT2 and GLUT3 were expressed in morula and blastocyst. GLUT4 was expressed in all stages. When embryos were cultured in glucose-free medium, no significant difference was shown in the expression of GLUTI1, 2 and 3, compared to control. However GLUT4 was not expressed until morular stage. When embryos were co-cultured with vero cell, there was no significant difference in the expression of GLUT1, 2, 3 and 4 compared to control. To determine cell growth of embryos, the average cell number of blastocyst was counted. The cell number of co-culture (93.8+/-3.1, n=35) is significantly higher than that of control and glucose-free group (76.6 +/- 3.8, n=35 and 68.2+/-4.3, n=30). This study shows that the GLUT genes are expressed differently according to embryo stage. GLUTs were detectable throughout mouse preimplantation development in control and co-culture groups. However, GLUT4 was not detected from 2- to 8-cell stage but detected from morula stage in glucose-free medium, suggested that GLUT genes are expressed autocrinally in the embryo regardless of the presence of glucose as an energy substrate. In addition, co-culture system can increase the cell count of blastocyst but not improve the expression of GLUT. In conclusion, expression of GLUT is dependent on embryo stage in preimplantation embryo development.
Animals ; Blastocyst ; Cell Count ; Coculture Techniques ; Electrophoresis, Agar Gel ; Embryonic Development ; Embryonic Structures* ; Ethidium ; Female ; Glucose Transport Proteins, Facilitative* ; Glucose* ; Glutaral ; Humans ; Metabolism ; Mice* ; Morula ; Pregnancy ; Pyruvic Acid ; RNA ; Vero Cells