PURPOSE: Population-based studies have shown positive associations between migraine and irritable bowel syndrome, colitis and peptic ulcer and migraine prevalence was higher among patients with dysmotility-like dyspepsia or nausea/vomiting. The aim of this study was to investigate clinical manifestation between primary headache with epigastric pain or tenderness(EPT) and primary headache without EPT. METHODS: We retrospectively reviewed the medical records of 58 patients who were diagnosed primary headache[by ICHD-II(2004)] at Incheon St. Mary Hospital from January, 2006 to December, 2007. Their clinical characteristics such as age, sex, frequency & severity of headache and associated symptoms & signs were analysed. RESULTS: The rate of headache associated with EPT were 36% of migraine cases, 50% of tension-type headache cases, and 100% of unclassified headache cases. Headache with EPT were at a high rate in female. Headache with EPT were more severe than one without EPT. Regulation of behavior, diet and sleep pattern had improved severity of headache in 71% of migraine without EPT and 94% of tension-type headache without EPT, but in 12% of migraine with EPT and 18% of tension-type headache with EPT. Headache disappeared in 64% of migraine with EPT and 53% of tension-type headache by additional regular antiacid medication. CONCLUSION: Our study supports any specific correlation between headache and EPT, but further studies are needed.
Abdominal Pain ; Child ; Colitis ; Diet ; Dyspepsia ; Female ; Gastrointestinal Diseases ; Headache ; Humans ; Irritable Bowel Syndrome ; Medical Records ; Migraine Disorders ; Nausea ; Peptic Ulcer ; Prevalence ; Retrospective Studies ; Tension-Type Headache ; Vomiting

PURPOSE: We evaluated the differences between radiologically measured size and pathologic size of renal tumors. MATERIALS AND METHODS: The data from 171 patients who underwent radical or partial nephrectomy for a renal tumor at Ajou University Hospital were reviewed. Radiologic tumor size, which was defined as the largest diameter on a computed tomographic scan, was compared with pathologic tumor size, which was defined as the largest diameter on gross pathologic examination. RESULTS: Mean radiologic size was significantly larger than mean pathologic size for all tumors (p=0.019). When stratified according to radiologic size range, mean radiologic size was significantly larger than mean pathologic size for tumors <4 cm (p=0.003), but there was no significant difference between the sizes for tumors 4-7 cm and >7 cm. When classified according to histologic subtype, mean radiologic size was significantly larger than mean pathologic size only in clear cell renal cell carcinomas (p=0.002). When classified according to tumor location, mean radiologic size was significantly larger than mean pathologic size in endophytic tumors (p=0.043) but not in exophytic tumors. When endophytic tumors were stratified according to radiologic size range, there was a significant difference between the mean radiologic and pathologic sizes for tumors <4 cm (p=0.001) but not for tumors 4-7 cm (p=0.073) and >7 cm (p=0.603). CONCLUSIONS: Our results suggest that in planning a nephron-sparing surgery for renal tumors, especially for endophytic tumors of less than 4 cm, the tumor size measured on a computed tomography scan should be readjusted to get a more precise estimate of the tumor size.
Carcinoma, Renal Cell ; Humans ; Kidney ; Nephrectomy

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*

No abstract available.
Leukemia, Myeloid, Acute*

PURPOSE: We investigated the effects of pretransplant-transfusion on engraftment, graft versus host disease (GVHD) and graft rejection after bone marrow transplantation (BMT) in children with severe aplastic anemia who had HLA-identical sibling donor. METHODS: We reviewed retrospectively the medical records of 47 children with severe aplastic anemia who received grafts from HLA-matched sibling donor using same conditioning regimen (procarbazine, antithymocyte globulin, and cyclophosphamide) from September 1986 to May 2001. GVHD prophylaxis consisted of cyclosporine and short-term methotrexate. Patients receiving multiple transfusion more than 40 transfused units in total before BMT were defined as high-risk group (HRG) and those with less than 40 transfused units were as standard-risk group (SRG). RESULTS: Among 47 patients, 30 patients were classified into SRG and remaining 17 were into HRG. The median time from diagnosis to transplant was 4 (range, 1~14) months in SRG and 36 (range, 3~360) months in HRG. Primary engraftment was achieved in all patients. Acute GVHD (> or =grade II) in HRG (13.3%) was comparable with in SRG (5.9%) (P=0.221), meanwhile corresponding fugures for chronic GVHD was 1 (3.3%) and 2 (11.8%). All of these patients have experienced complete resolution of GVHD and are no longer receiving immunosuppressive therapy. Booster stem cell infusion was needed for poor graft function (n=3) in SRG and also for poor graft function (n=1) or progressive rejection (n=3) in HRG. Five-year disease free survival rate was 100% in SRG and 94.1 6% in HRG (P=0.18). CONCLUSION: These findings suggest that multiple transfusion may be not a risk factor for rejection or poor outcome. Progressive rejection was observed only in patients with multiple transfusion but did not affect the survival.
Anemia, Aplastic* ; Antilymphocyte Serum ; Bone Marrow Transplantation* ; Bone Marrow* ; Child ; Cyclosporine ; Diagnosis ; Disease-Free Survival ; Graft Rejection ; Graft vs Host Disease ; Humans ; Medical Records ; Methotrexate ; Retrospective Studies ; Risk Factors ; Siblings* ; Stem Cells ; Tissue Donors* ; Transplants

Radiation therapy is one of the cardial therapeutic modality on breast cancer. Three decades ago, the heart was considered to be radioresistant, but now it is generally recognized that the heart is also radiosensitive. The most common clinical syndromes after irradiation are pericarditis in acute and chronic forms, cardiomyopathy, valvular disease and, to a lesser degree, complete atrioventricular block. However, lesions of coronary vessels had been considered exceptionally rare and even questionable. And then there have been a few case reports for acute myocardial infartion after irradiation for left sided breast cancer and it may be considered that radiation therpy can injure endothelium of coronary artery and cause ischemic coronary artery disease. We report the case of a 38 years old women who developed acute anterior wall myocardial infarction after irradiation for left sided breast cancer.
Adult ; Anterior Wall Myocardial Infarction ; Atrioventricular Block ; Breast Neoplasms* ; Breast* ; Cardiomyopathies ; Coronary Artery Disease ; Coronary Vessels ; Endothelium ; Female ; Heart ; Humans ; Myocardial Infarction* ; Pericarditis

BACKGROUND: This study aimed to evaluate the quality of surgical antibiotic prophylaxis (SAP) in a tertiary hospital. METHODS: Medical, anesthetic, and nursing records from the 27,320 procedures conducted in a tertiary hospital during 2012 were retrospectively reviewed. Three clinical performance indicators of SAP (selection of antibiotic, timing of the first administration, duration of prophylaxis) were included as part of the National Hospital Evaluation Program (NHEP) of the Health Insurance Review and Assessment Service. In addition, 2 other parameters were assessed according to recent guidelines (weight-based initial dosing for obesity, intraoperative re-dosing for excessive blood loss, and prolonged duration of procedures). RESULTS: Prophylactic antibiotics were administered in 19,637 (71.8%) of 27,320 total procedures. Quality of the 3 performance indicators was higher in the types of operations included in NHEP than in other procedures. However, additional doses were administered in 15 (1.2%) of 1,299 surgical procedures that lasted more than twice the half-life of the antibiotic used, and in 9 (3.3%) of 273 procedures with excessive blood loss greater than 1,500 mL. NHEP and non-NHEP results did not differ significantly. CONCLUSION: Three SAP quality indicators showed more improvement in NHEP surgical procedures than in non-NHEP, but the other parameters did not perform well regardless of NHEP assessment. Therefore, more measures to improve the appropriateness of SAP should be developed.
Anti-Bacterial Agents ; Antibiotic Prophylaxis* ; Half-Life ; Insurance, Health ; Nursing Records ; Obesity ; Quality Indicators, Health Care ; Retrospective Studies ; Tertiary Care Centers*

PURPOSE: Ethosuximide (ESX) is currently not available due to various reasons in Korea. The aim of this study is to compare the efficacy of valproate (VPA) and lamotrigine (LTG) when ESX monotherapy was replaced by VPA or LTG. METHODS: A retrospective study was done for a total of 34 patients treated with ESX in 5 different hospitals affiliated with Catholic University of Korea from January, 2010 to December, 2012. They all were initially treated with ESX, but later switched to VPA or LTG. The subjects were selected based on clinical symptoms and electroencephalography findings. RESULTS: Among 34 patients, VPA was prescribed to 17 patients (50.0%) and LTG to 17 patients (50.0%). Twenty patients (58.8%) achieved the seizure freedom after 3 months of the treatments, 13 patients (76.5%) by VPA and 7 (41.2%) by LTG respectively. Four patients (23.5%) with VPA and 10 (58.8%) with LTG were replaced by other anticonvulsants due to ineffectiveness and/or side effects of medication. When we compare the efficacy of seizure reduction between VPA and LTG after 3 month period of the treatment, the efficacy of VPA was better than that of LTG (P=0.04). CONCLUSION: The results of this study suggest that the VPA is a better alternative anticonvulsant than LTG for the patients with absence epilepsy who are unable to continue ESX.
Anticonvulsants ; Child ; Electroencephalography ; Epilepsy ; Epilepsy, Absence* ; Ethosuximide ; Freedom ; Humans ; Korea ; Retrospective Studies ; Seizures ; Valproic Acid*

PURPOSE: The study was performed to assess the distribution of the diseases associated with nonspecific reactive hepatitis (NRH) for the past 10 years and to evaluate the change in the level of AST and ALT, and the difference by several variable factors. METHODS: From January 1997 to December 2006, 646 patients had elevated liver enzymes among 22,763 patients admitted to the Holy Family Hospital. We analyzed the difference in the age distribution, the period of elevated levels of AST and ALT, the resolution period, the peak value, the daily resolution value of AST and ALT, the sexual differences and the difference in several disease entities. One hundred and ninety-seven patients not confirmed as NRH or lost during follow-up were excluded. RESULTS: The prevalence rate of NRH was 2.84%. When compared to AST, ALT showed longer period of morbidity and resolution and the peak value was also higher in ALT. The male and female ratio showed significant value of 1.63:1. The morbid and resolution periods of AST and ALT between males and females were longer periods in males. The most prevalent disease entities were respiratory and gastrointestinal infections. Between the respiratory and the gastrointestinal diseases, the highest level of AST and ALT was observed in the respiratory disease. CONCLUSION: NRH is a common disease that occurs in 2.84% of the admitted pediatric patients. However, the pathogenesis and the progress of the disease have not been well known due to the lack of generalized information. Further research is necessary in the future.
Age Distribution ; Alanine Transaminase ; Aspartate Aminotransferases ; Female ; Follow-Up Studies ; Gastrointestinal Diseases ; Hepatitis ; Humans ; Liver ; Male ; Prevalence

BACKGROUND: Recently isolates of S. aureus with intermediate (VISA) and heterogeneous resistance (hetero-VRSA) to vancomycin, which has been the only effective against MRSA infections, were identified. Several infections due to these isolates did not respond to adequate antibiotic treatments. In Japan, the prevalences of hetero-VRSA ranged from 0 to 48%. The aim of this study was to determine the prevalence of S. aureus heterogenously resistant to vancomycin and VISA. METHODS: The isolates were collected at Seoul National University Hospital from April 1998 to August 1999. To detect S. aureus with reduced susceptibility to vancomycin, brain heart infusion (BHI) agar with 4 mg/L of vancomycin and Mu-3 agar were used. Analysis of resistant subpopulations of bacteria (population analysis) was done. Minimum inhibitory concentration (MIC) for vancomycin was determined by microbroth and agar dilution methods, respectively according to NCCLS and Hiramatsu's recommendation. Coagulase type was determined with type I-VIII antisera. RESULTS: Total 235 MRSA, including 88 isolates from blood and 147 from other specimens, were collected. After 88 blood isolates were inoculated on BHI agar with 4 mg/L of vancomycin, 14 isolates (16 %) grew in variable colonies. But there were no subclones with vancomycin MIC > or =8 mg/L on population analysis and no isolates which grew confluently on Mu-3 agar with beta-lactam disks. In addition, 147 isolates from other specimens did not grow confluently on Mu-3 agar. Among 64 MRSA and 32 MSSA isolates, coagulase type II (49, 77%) and Vll(8, 25%) were respectively the most common types. CONCLUSION: In our tertiary-care hospital, there were no MRSA isolates with reduced susceptibilities to vancomycin.
Agar ; Bacteria ; Brain ; Coagulase ; Heart ; Immune Sera ; Japan ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Prevalence* ; Seoul ; Staphylococcus aureus* ; Staphylococcus* ; Tertiary Care Centers* ; Vancomycin*