Purpose: To determine predictive factors for detecting renal parenchymal damages (RPDs) in infants with recurrent febrile urinary tract infection (fUTI). Methods: From January 2015 to December 2021, 102 infants with recurrent fUTI and who underwent 99mTc-dimercaptosuccinic acid (DMSA) renal scan in our hospital were included in this study. Controls included infants with normal DMSA results performed 3 months apart from the 2nd episode of fUTI. DMSA-positive group included infants with positive DMSA results performed 3 months apart from the 2nd episode of fUTI or at the 3rd episode of fUTI. The recurrence rate, causative bacteria, renal size discrepancy of both kidneys, and laboratory findings including C-reactive protein (CRP) and spot urine sodium-to-potassium ratio (uNa/K) were compared between both groups. Results: Only 3.8% of 79 infants with a 2nd episode of fUTI showed positive DMSA results. fUTI recurred more frequently within 12 months of follow-up in the DMSA-positive group than in the control group (69% vs. 13%, P=0.00). CRP values were significantly higher in the DMSA-positive group than in the control group (7.3 mg/dL vs. 3.7 mg/dL, P=0.00). Spot uNa/K were significantly lower in the DMSA-positive group than in the control group (0.6 vs. 1.1, P=0.00). Conclusions Congenital renal scar and RPDs on the DMSA scan were more frequently found in infants with recurrent fUTI than those in the control group. High CRP values and low spot uNa/K in acute infections were helpful in predicting the presence of RPD in infants with recurrent fUTI.

No Abstract Available.
Knee* ; Synovitis, Pigmented Villonodular*

BACKGROUND: Automated border detection(ABD) is a new echocardiographic modality providing continuous on-line measurements of left ventricular(LV) cavitary ares, volume, and ejection fraction(EF) throughout the cardiac cycle. Previous study showed that LV volume and EF measurements with ABD system approximate manually traced LV volume and EF obtained with conventional 2-dimensional echocardiography. But further clinical validation needs a comparison of LV function between the ABD system and established methods. The purpose of this study is to compare EF, peak ejection rate(PER) and peak filling rate(PFR) between on-line ABD system and the gated cardiac blood pool scinitigraphy. METHOD: 27 patients with an apical 4 chamber view of LV in which at least 75% of the endocardium was clearly seen were selected for this study. They had a normal sinus rhythm and underwent echocardiographic study on the same day of or one day before gated cardiac blood pool scintigraphic study. The off-line estimation of LV volume was performed by the method of disc, after manually tracing the endocardial border on the apical 4 chamber view and EFoff was calculated. Also on that view the ABD system was turned on, and EFABD, PEABD, PEABD were calculated automatically from LV volume curve. They were compared with EFRI, PERRI, and PERRI obtained by the gated cardiac blood pool scintigraphy. RESULTS: 1) EFoff and EFABD were highly correlated with EFRI(r=0.78, 0.90 respectively : p<0.001). The mean difference between EFRI and EFoff was 4+/-9%, and the limits of agreement between EFRI and EFoff were -16~22%, EFoff were less than EFRI(p<0.05). The mean difference between EFRI and EFABD was 5+/-7%, and the limits of agreement between EFRI and EFoff were -9~+19%. EFABD was also less than EFRI(p<0.05). 2) PERABD and PERABD were highly correlated with PERRI and PERRI(r=0.74, 0.60, respectively ; p<0.001). The mean difference between PERRI and PERABD was -0.1+/-0.7EDV(enddiastolic volume)/sec, and the limits of agreement were -1.5~+1.3EDV/sec. PEABD was slightly greater than PERRI(p>0.05). The mean difference between PERRI and PEABD was -0.8+/-0.8EDV/sec, and the limits of agreement were -2.4~+0.8EDV/sec. PEABD were greater than PERRI(p<0.01). CONCLUSION: EF, PER, PER measurements by the ABD system and the gated cardiac blood pool scintigraphy have significant correlations. Thus ABD echocardiography is a useful method for assessement of LV function.
Echocardiography* ; Endocardium ; Gated Blood-Pool Imaging* ; Humans ; Ventricular Function, Left*

Tibialis anterior muscle hernia is the most common hernia among lower extremity muscles. This condition can be diagnosed by physical examination and radiologic findings, especially by dynamic ultrasonography. There are surgical methods of treatment for muscle hernia, including direct repair, fasciotomy, fascial patch grafting using autologous fascia lata or synthetic mesh. We report a case of tibialis anterior muscle hernia treated with local periosteal rotational flap. Because there are several advantages to the local periosteal rotational flap, such as lack of donor site morbidity, lack of skin irritation, low cost, simplicity, and an easy approach, this technique could be an option for tibialis anterior muscle hernia.
Fascia Lata ; Hernia ; Humans ; Lower Extremity ; Muscle, Skeletal ; Muscles ; Physical Examination ; Skin ; Tissue Donors ; Transplants

Purpose: This study was performed to investigate the gender differences in suicide attempts in adolescents. Methods: We reviewed the medical records of adolescents (≤ 18 years) who had visited a university hospital emergency department (ED) for suicide attempts from January 2018 through December 2019. General characteristics of the adolescents, details of the attempt, and outcomes were analyzed. The characteristics were age, gender, the Korean Triage and Acuity Scale, previous attempts, and psychiatric history. The details were initial Glasgow Coma Scale, attempt-arrival time, living alone, method, place, and motivation of the attempt, and concurrent use of alcohol. The outcomes included psychiatric consultation, ED length of stay, and ED outcomes. Results: A total of 86 adolescents were included. Their age ranged from 13 to 18 years, and girls accounted for 65.1%. The girls had more frequent psychiatric history than boys (66.1% vs. 30.0%; P = 0.001) without a significant difference in previous attempts (55.4% vs. 46.7%; P = 0.442). The most common methods of the attempt in the girls and boys were poisoning and sharp objects (53.3% [16 of the 30 boys] vs. 60.7% [34 of the 56 girls]; P = 0.002), respectively. No differences were found in the other details of the attempt and in the rate of psychiatric consultation. The girls had longer ED length of stay (247.0 minutes vs. 186.5; P = 0.033), a lower rate of discharge against medical advice, and higher rates of hospitalization (discharge against medical advice, 53.6% vs. 76.7%; non-psychiatric, 23.2% vs. 3.3%; psychiatric, 12.5% vs. 0%; P = 0.003). Conclusion Girls may make suicide attempts, usually by poisoning, and undergo relevant hospitalization, more often than boys. In contrast, boys usually use sharp objects, with a higher rate of discharge against medical advice and lower rates of the attempt and hospitalization.

Purpose: This study was performed to investigate the gender differences in suicide attempts in adolescents. Methods: We reviewed the medical records of adolescents (≤ 18 years) who had visited a university hospital emergency department (ED) for suicide attempts from January 2018 through December 2019. General characteristics of the adolescents, details of the attempt, and outcomes were analyzed. The characteristics were age, gender, the Korean Triage and Acuity Scale, previous attempts, and psychiatric history. The details were initial Glasgow Coma Scale, attempt-arrival time, living alone, method, place, and motivation of the attempt, and concurrent use of alcohol. The outcomes included psychiatric consultation, ED length of stay, and ED outcomes. Results: A total of 86 adolescents were included. Their age ranged from 13 to 18 years, and girls accounted for 65.1%. The girls had more frequent psychiatric history than boys (66.1% vs. 30.0%; P = 0.001) without a significant difference in previous attempts (55.4% vs. 46.7%; P = 0.442). The most common methods of the attempt in the girls and boys were poisoning and sharp objects (53.3% [16 of the 30 boys] vs. 60.7% [34 of the 56 girls]; P = 0.002), respectively. No differences were found in the other details of the attempt and in the rate of psychiatric consultation. The girls had longer ED length of stay (247.0 minutes vs. 186.5; P = 0.033), a lower rate of discharge against medical advice, and higher rates of hospitalization (discharge against medical advice, 53.6% vs. 76.7%; non-psychiatric, 23.2% vs. 3.3%; psychiatric, 12.5% vs. 0%; P = 0.003). Conclusion Girls may make suicide attempts, usually by poisoning, and undergo relevant hospitalization, more often than boys. In contrast, boys usually use sharp objects, with a higher rate of discharge against medical advice and lower rates of the attempt and hospitalization.

BACKGROUND: The rate of rise of left ventricular(LV) systolic pressure, dp/kt, and the peak ejection rate(PER) of LV may be more accurate indices for assessing LV systolic function than ejection fraction(EF). Both can be easily obtained by noninvasive methods, M-mode echo/phonocardiography and automated border detection(ABD) echocardiography, respectively. Mean dp/dt by M-mode echo/phonocardiography and PER by ABD echocardiography were compared with mean dp/dt by Doppler echocardiography. METHODS: Twenty-one adult patients who had normal sinus rhythm, mitral regurgitant signals by continuous wave Doppler echocardiography and an apical 4 chamber view of LV in which at least 75% of the endocardium was clearly visualized were selected for our study. The off-line estimation of LV end-diastolic volume (1) were performed by the method of disc, after manually tracing the endocardial border on the apical 4 chamber view and EF was calculated. M-mode echocardiography of the aortive valve and phonocardiography were simultaneously recorded on the strip chart to measure the isovolumic contraction time(dtM). A blood pressure (2) and LV end-diasolic pressure(LVEDP) was assigned 20mmHg in patients with Q wave myocardial infarction or EF< or =40% and 10mmHg in others. The mean dp/dtM during isovolumic contraction time was calculated as (aortic diastolic pressure-LVEDP)/dtM and was compared with the Doppler-derived mean rate of LV pressure rise(dp/dtDoppler) over the time period between velocities of 1 and 3m/sec on the ascending slope of the Doppler velocity spectrum. ABD system was used to measure the changes in LV volume and PER on the apical four chamber view. PER was compared with mean dp/dtDoppler. RESULTS: Mean dp/dtM positively correlated with mean dp/dtDoppler(r=0.73, p<0.001), but the limits of agreement between two methods were somewhat wide(-659-937mmHg/sec). PER also positively correlated with dp/dtDoppler and EF(r=0.73, p<0.001 ; r=0.80, p<0.001). CONCLUSIONS: Mean dp/dtM by M-mode echo/phomocardiography and PER by ABD echocardiography may be useful indices for assessing LV systolic function.
Adult ; Blood Pressure ; Echocardiography* ; Echocardiography, Doppler ; Endocardium ; Humans ; Myocardial Infarction ; Phonocardiography

BACKGROUND AND PURPOSE: Hemifacial spasm(HFS) is a chronic and often progressive disorder characterized by unilateral irregular clonic and tonic contractions of one or more muscles of facial expression. Many previous electrophysiologic studies showed characteristic features of HFS differentiating from other involuntary movements of the face. However, there has been no electrophysiologic study for estimating the clinical severity of HFS. This study was prospectively designed to evaluate the relationships between electrophysiologic findings and clinical severity of HFS. METHODS: The authors performed direct facial nerve stimulation, blink reflex, and lateral spread response in 62 patients with HFS, and compared the results of affected side with those of unaffected each other. Clinical severity was graded into seven groups (0-6) by questionnaire and confirmed by a neurologist. RESULTS: The results were as following. 1) The total number of subjects were 62, the number of patients in group 2 was 3 (4.8%), group 3 was 12 (19.3%), group 4 was 25 (40.3%), group 5 was 21 (33.9%), and group 6 was 1(1.6%). 2) The mean age was 54.5+/-9.1years old, the mean duration of the illness was 6.4+/-4.9years, male was 11(17.7%) and female was 51(82.3%), and involved sites were right in 26(41.9%) and left in 36(58.1%) patients. 3) Direct stimulation of facial nerve showed no differences between affected and unaffected sides in HFS. 4) The results of blink reflex showed more increased latencies and larger amplitudes of R1 & R2 responses in affected sides than in unaffected sides of HFS, but no differences among the groups. 5) The lateral spread responses were found in 45 of 62 (72.6%) patients by stimulation of zygomatic branch and recording in mentalis muscle, 26 of 62 (41.9%) patients by stimulation of mandibular branch and recording in orbicularis oculi muscle on affected side. 6) There was a linear correlation between the presence of lateral spread response with zygomatic or mandibular stimulation and the grade of clinical severity. CONCLUSION: We suspected that the lateral spread response was a significant electrophysiological test for estimating the clinical severity of HFS.
Blinking ; Dyskinesias ; Facial Expression ; Facial Nerve ; Female ; Hemifacial Spasm* ; Humans ; Male ; Muscles ; Prospective Studies ; Surveys and Questionnaires

BACKGROUND: The sources of pulmonary blood flow in patients with pulmonary atresia and ventricular septal defect (PA/VSD) are very diverse, and detailed informations for the pulmonary circulation are essential for successful treatment. The purpose of this study is to examine and define the origins, distributions and characteristics of collateral circulations in patients with PA/VSD and major aortopulmonary collateral arteries (MAPCAs). METHODS: 34 patients diagnosed as PA/VSD and MAPCA were studied between May 1992 and April 1996. 85 MAPCAs were investigated for the sites of origin, distributions and characteristics by review of biplane angiograms. The characteristics of MAPCAs were examined in the aspects of anastomosis sites and sites/types of stenosis. RESULTS: 1) In 34 subjects, a total of 85 MAPCAs existed which supplied blood to 344 bronchopulmonary segments (4.1 BPS/MAPCA). 2) The origin sites of MAPCAs were the descending aorta (72%), the branch of aortic arch (16%), and the aortic arch or ascending aorta (12%). 3) The BPSs which frequently take primary blood supply from MAPCA were the 3 BPSs of upper lobe and superior / posterior basal segment of lower lobe in the right lung, and the superior / posterior basal segment of lower lobe in the left lung. 4) The BPS having apparent dual blood supply was 13.4% and the most frequent was the superior and posterior basal segment of the right lower lobe. 5) In total, 64% of MAPCA had anastomosis, and anastomosis in the lobar pulmonary artery was 48% to be the most frequent. 6) Stenosis was observed in 61% of MAPCAs. The site of stenosis was midportion (33%), originating portion (27%), multiple (26%), peripheral (14%), and the type of stenosis was focal (53%), segmental (31%), diffuse (16%), in the order of frequency. CONCLUSION: In PA/VSD and MAPCA, selective angiogram should be performed in all the different blood-supplying sources of the lung for detailed information of the pulmonary circulation. When the blood sources of the pulmonary circulation is uncertain, elaborated efforts to find the blood sources, by angiograms in the frequent locations of MAPCA, are neccessary. We believe this study to be useful for precise planning in the diagnosis and treatment of PA/VSD and MAPCA.
Angiography ; Aorta ; Aorta, Thoracic ; Arteries ; Collateral Circulation* ; Constriction, Pathologic ; Diagnosis ; Heart Septal Defects, Ventricular* ; Humans ; Lung ; Pulmonary Artery ; Pulmonary Atresia* ; Pulmonary Circulation

Creutzfeldt-Jakob disease (CJD) is presumably caused by a slow infectious pathogen or prion. The principal clinical features of Creutzfeldt-Jakob disease are dementia, pyramidal and extrapyramidal symptoms and signs, cerebellar dysfunction, and myoclonus. The patient rapidly deteriorates, declines to a vegetative state, becomes comatous, and is ultimately dead within several months. The authors present a case of Creutzfeldt-Jakob disease, proved by clinical findings, typical serial EEG, and pathologic features.
Creutzfeldt-Jakob Syndrome/*diagnosis/pathology/radiography ; Electroencephalography ; Female ; Humans ; Middle Aged ; Tomography, X-Ray Computed