The most common cause of obstructive sleep apnea syndrome (OSAS) in childhood is adenotonsillar hypertrophy. Adenotonsillectomy improves the symptoms quite well in most cases. However, some patients could experience the OSAS again after adenotonsillectomy, who might have several risk factors such as incomplete operation, misdiagnosis, combined anatomical malformation, sinusitis or chronic allergic rhinitis, obesity, initial severe OSAS, and early onset OSAS. We report a case of 11-year-old obese boy who presented with snoring for several years. He was obese with body mass index (BMI) of 26.3 kg/m2 and also found to have fatty liver by ultrasonogram. Initial polysomnography (PSG) showed that he met the criteria of severe OSAS with the apnea-hypopnea index (AHI) of 70.5. He underwent adenotonsillectomy and symptoms improved immediately. Four months later symptoms were relieved with AHI of 0, but 1 year after the adenotonsillectomy he started to complain snoring again and the subsequent PSG results showed that OSAS has relapsed with AHI of 43. Paranasal sinus X-ray and physical examination showed sinusitis and re-growth of adenoid. Obesity was proved not to be a contributing factor because his BMI decreased to normal range (23.1 kg/m2) after diet control and regular exercise. Also, liver transaminase was normalized and fatty liver was disappeared on follow-up abdominal ultrasonogram. After treatment of sinusitis, symptoms were relieved with decreased AHI (8.5). This case suggests that simple adenotonsillectomy might not be the end of OSAS treatment in childhood. Patients who had adenotonsillectomy should be followed by subsequent PSG if symptoms recur. It is also important to be aware of risk factors in the recurrent OSAS for the proper intervention according to the cause.
Adenoids ; Body Mass Index ; Child ; Diagnostic Errors ; Diet ; Fatty Liver ; Follow-Up Studies ; Humans ; Hypertrophy ; Liver ; Obesity ; Physical Examination ; Polysomnography ; Reference Values ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors ; Sinusitis ; Sleep Apnea, Obstructive ; Snoring

OBJECTIVE: We undertook this study to find out clinical characteristics and prognostic factors of neonatal survival in nonimmune hydrops fetalis (NIHF). METHODS: From Oct. 1988 to Feb. 2001, 54 cases of nonimmune hydrops fetalis diagnosed at Seoul National University Hospital (SNUH) were included in our study. The incidence and perinatal mortality were investigated. The diagnostic work-up for associated conditions (or etiology) included detailed ultrasonography, karyotyping, fetal echocardiography, infection work-up (TORCH, parvovirus), and autopsy (if fetus was dead). Among 54 cases, 20 cases of liveborns were divided into two groups. Group I survived beyond neonatal period (survived>28 days) and group II did not (expired3 (OR=21, CI 1.77, 248.1; p<0.05), and 5-min AS>3 (p<0.01). CONCLUSION: Over 3 of 1-min and 5-min AS were meaningful factors for neonatal survival in NIHF.
Apgar Score ; Autopsy ; Echocardiography ; Female ; Fetofetal Transfusion ; Fetus ; Gestational Age ; Hydrops Fetalis* ; Incidence ; Karyotyping ; Parturition ; Perinatal Mortality ; Pleural Effusion ; Polyhydramnios ; Pregnancy ; Seoul ; Ultrasonography

PURPOSE: To determine whether primary snoring could be distinguished from obstructive sleep apnea syndrome (OSAS) by clinical evaluation and symptom scores. METHODS: 56 snoring and 20 asymptomatic subjects were recruited and polysomnography was used to confirm that there were 39 OSAS, 17 primary snoring, and 20 control subjects. We evaluated the size of the childrens adenoids and tonsils. Parents completed sleep disordered breathing scale (SDBS) and obstructive sleep apnea 18 (OSA-18) questionnaires for use as symptom scores, as well as an attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV). RESULTS: There were no differences between primary snoring and OSAS in terms of tonsil and adenoid size, SDBS (9.4+/-4.6 vs 10.8+/-4.5), and OSA-18 score (61.1+/-25.1 vs 71.2+/-8.4). The patients with OSAS (15.8+/-7.9) and PS (22.2+/-9.4) had a higher ADHD RS-IV score than the control subjects (2.9+/-3.3). There was no difference in the ADHD RS-IV scores of patients with primary snoring and OSAS. CONCLUSION: We confirmed that clinical evaluation could not distinguish OSAS and primary snoring. In addition, our study suggests that primary snoring as well as OSAS is associated with attention deficit hyperactivity disorder.
Adenoids ; Attention Deficit Disorder with Hyperactivity ; Child ; Discrimination (Psychology) ; Humans ; Palatine Tonsil ; Parents ; Polysomnography ; Surveys and Questionnaires ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring

Although congenital syphilis can be prevented with prenatal screening, the disease remains problematic. Currently, there are no cases that describe hematuria and pneumonia related to congenital syphilis. We report a case of congenital syphilis that involved nephrotic syndrome and pneumonia alba in a 22-day-old male infant whose mother did not receive adequate prenatal care. The congenital syphilis diagnosis was confirmed with a serologic test and the patient recovered with penicillin treatment. Clinical findings may be subtle in neonates and delayed recognition occurs frequently, thus complete prenatal screening is critical for congenital syphilis prevention. Immediate serologic testing should be performed to obtain a differential diagnosis if an infant is delivered by a mother that has not received appropriate prenatal examinations.
Diagnosis ; Diagnosis, Differential ; Exanthema* ; Hematuria* ; Humans ; Infant ; Infant, Newborn ; Male ; Mothers ; Nephrotic Syndrome ; Penicillins ; Pneumonia* ; Prenatal Care ; Prenatal Diagnosis ; Serologic Tests ; Syphilis, Congenital*

OBJECTIVE: To examine if amniotic fluid (AF) monocyte chemotactic protein-1 (MCP-1) concentrations are useful in the identification of intrauterine infection and pregnancy outcomes in preterm labor with intact membranes. METHODS: The study population consists of 65 patients who received amniocentesis for preterm labor with intact membranes. Amniotic fluid was cultured for aerobic and anaerobic bacteria, as well as mycoplasmas. MCP-1 was determined by a sensitive and specific immunoassay. Fisher's exact test, Mann-Whitney U test, receiver operating characteristic curve, survival techniques, logistic regression, and Spearman correlation were used for statistical analysis. RESULTS: (1) Patients with a positive amniotic fluid culture had a significantly higher median AF MCP-1 concentration than those with negative results (median, 9.0 ng/mL; range, 0.45-40.5 ng/mL; vs median, 0.82 ng/mL; range, 0.06-30.1 ng/mL; P<.01). (2) Patients with AF MCP-1 concentration of >1.9 ng/mL had a significantly shorter median interval to delivery, the higher rate of histologic chorioamnionitis, preterm delivery within 2 and 5 days, and the occurrence of congenital proven or suspected sepsis than did those with AF MCP-1 concentration of <1.9 ng/mL after adjustment for gestational age (P<.05). (3) There was strong correlation between AF MCP-1 concentrations and AF interleukin-6 concentrations (r=.881, P<.001). CONCLUSION: AF MCP-1 determinations are useful in the identification of intrauterine infection, preterm delivery, and neonatal infectious complication in preterm labor with intact membranes.
Amniocentesis ; Amniotic Fluid* ; Bacteria, Anaerobic ; Chemokine CCL2* ; Chorioamnionitis ; Female ; Gestational Age ; Humans ; Immunoassay ; Interleukin-6 ; Logistic Models ; Membranes ; Monocytes* ; Mycoplasma ; Obstetric Labor, Premature* ; Pregnancy ; Pregnancy Outcome ; ROC Curve ; Sepsis

BACKGROUND AND OBJECTIVES: Postnasal drip is a common presentation to the medical practitioner. It is a result of disturbance to the normal drainage or an increase in secretion of the paranasal sinuses. However, sometimes no underlying cause can be found and the patient has to be reassured, and that they may just have to live with it. The aim of this study is to evaluate the clinical manifestations of patients with postnasal drip. MATERIAL AND METHOD: There were 90 patients complaining with postnasal drip. We performed a prospective study about accompanying symptoms and physical and psychiatric evaluation. CONCLUSION: Postnasal drip is more common in females over 30 years and the duration of symptoms is usually long. Anatomical nasal abnormality and sinusitis are common. There is no correlation with postnasal drip and psychiatric problems. But several items are concerned with postnasal drip. So we need detailed history taking and physical examination on patients who complained of postnasal drip.
Drainage ; Female ; Humans ; Paranasal Sinuses ; Physical Examination ; Prospective Studies ; Sinusitis

It has been reported that repetitive brief periods of ischemia and reperfusion (ischemic preconditioning, IP) cause a significant reduction in the extent of myocardial necrosis or in the incidence of reperfusion arrhythmias in rat heart. However, recent reports have stated that IP effect is diminished or lost in the canine or bovine heart if ischemia (mostly regional) is sustained for 40 min or longer. The main objective of this study is to assess whether IP provides myocardial protection in prolonged sustained ischemia under the condition of global ischemia in isolated rabbit heart. The hearts were subjected to 10-60 min sustained ischemia (SI) followed by 60 min reperfusion with (IP heart) or without IP (ISCH heart). IP was induced by 4 cycles of 5 min global ischemia and 5 min reperfusion. Left ventricular function (LVF), extent of infarction (EI) and ultrastructural changes were examined. As a whole, the LVF began to recover on reperfusion but there was no significant difference in the functional parameters. However, extracellular Ca2+ concentration was lower in the ISCH hearts (p <0.05) and the EI was significantly different between the hearts which had received 60 min SI (67% in the ISCH versus 32% in the IP heart, p <0.01). Ultrastructural changes were homogeneous in the ISCH hearts and became irreversible in accordance with increase of the duration of ischemia, while these changes were heterogeneous and restricted in the IP heart. These results suggest that IP does not attenuate the postischemic dysfunction in prolonged ischemia but it can provide an infarct size-limiting effect and delay ultrastructural changes. This cardioprotective effect may be related to calcium homeostasis.
Animal ; Arrhythmia/prevention & control ; Calcium/metabolism ; Extracellular Space/metabolism ; Female ; Heart/physiology ; Hydrogen-Ion Concentration ; Male ; Myocardial Infarction/prevention & control ; Myocardial Ischemia/metabolism/*physiopathology ; Myocardial Reperfusion Injury/*prevention & control ; Myocardium/metabolism/pathology/ultrastructure ; Necrosis ; Rabbits ; Support, Non-U.S. Gov't ; Time Factors ; Ventricular Function, Left/physiology

Fibromatosis of the breast is a rare tumor. We describe here a case of mammary fibromatosis in a 37-year-old woman. The mass from the right breast was 3 cm at the greatest dimension. The lesion was poorly circumscribed, firm and white-gray on the cut surface. Histologically, the lesion infiltrated into the lobules of the breast, and the tumor was composed of relatively uniform fibroblasts and collagen. Neither mitotic activity nor cellular atypia was seen. On the immunohistochemistry, the cells were positive for vimentin and they were focally positive for smooth muscle actin. Staining results for estrogen receptor and progesterone receptor were negative.
Actins ; Adult ; Breast Neoplasms ; Breast* ; Collagen ; Estrogens ; Female ; Fibroblasts ; Fibroma* ; Humans ; Immunohistochemistry ; Muscle, Smooth ; Receptors, Progesterone ; Vimentin

Lymphoproliferative disorders, manifesting either as a primary lesion or as part of a generalized process, rarely involve the breast. The primary malignant lymphoma of the breast is rare. The cytologic features of this neoplasm have not been reported in Korea thus far. We described a case of primary malignant lymphoma of the breast, as diagnosed by fine needle aspiration cytology (FNAC) in an 84-year-old female. FNAC smears showed high cellularity. The main cytologic feature observed was a carpeting of monotonous, atypical, enlarged lymphoid cells. These lymphocytes showed relatively round elliptical nuclei with some indentation. One or more prominent nucleoli were seen. Biopy from the breast mass revealed diagnostic features of non-Hodgkin's lymphoma, diffuse large B-cell type.
Aged, 80 and over ; B-Lymphocytes ; Biopsy, Fine-Needle* ; Breast* ; Female ; Floors and Floorcoverings ; Humans ; Korea ; Lymphocytes ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Lymphoproliferative Disorders

Verrucous carcinoma is a distinct morphologic variant of well differentiated squamous cell carcinoma that is most often seen in the oral cavity & larynx but extremely rare in the nasal cavity. This neoplasm has been characterized as a slow growing lesion in elderly smokers with poor oral hygiene. It is histologically and locally invasive but metastasis is rare. We report a case of verrucous carcinoma found in the hard palate & the nasal floor and treated by surgical excision with a review of the literature.
Aged ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous* ; Humans ; Larynx ; Mouth ; Nasal Cavity ; Neoplasm Metastasis ; Oral Hygiene ; Palate, Hard*