PURPOSE: Febrile convulsions are the most common form of childhood seizures, appearing between in children 3 months and 5 years of age and are predominantly of benign nature. Febrile convulsions occurring after 5 years of age might be estimated as epilepsy. Most data for these disorders are from mainly epilepsy populations and might not be relevant to these children, and the requirement of any specific treatment or workup is not yet established either. Thus we tried to obtain a unique perspective. METHODS: Clinical data for episodes of febrile convulsions were collected in Eulji hospital in Deajeon. These were obtained from anonymised copies of a standardised admission note, emergency, nursing, and intensive care unit notes and interviews with parents, medical, nursing, and paramedic staff. RESULTS: Finding of 259 episodes of febrile seizure in over 5 year olds. 121(46.7%) were confirmed epilepsy or afebrile seizure in under 5 year olds, 13(5.0%) were caused by infection, metabolic disorder, leukemia and so on, and 23(8.9%) had previous neurological defect. Lastly, 102(39.4%) were included to febrile convulsion in over 5 year olds. 28(27.5%) of the subjects had their initial febrile convulsions in children over 5 year olds while 74(72.5%) of the subjects were under 5 years of age. The male to female ratio of the seizure group was 2:1. In the duration and type of convulsions, generalized convulsions occurred predominantly within 15mins in both of them. 5(17.9%) of group A and 16(21.6%) of group B showed electroencephalogram abnormality. The most common causes of seizure were common colds. Most of the convulsions occurred less than 24hrs after fever but, there were no abnormal findings in lumbar puncture and brain MRI. CONCLUSION: Febrile seizure in over 5 year olds without organic problems has similar characteristics to febrile convulsion in under 5 year olds. In light of these findings, lumbar puncture and brain MRI do not require a routine checkup for the evaluation of febrile seizure in over 5 year olds. However, encephalography needs to be examined.
Allied Health Personnel ; Brain ; Child ; Coat Protein Complex I ; Common Cold ; Electroencephalography ; Emergencies ; Epilepsy ; Female ; Fever ; Humans ; Intensive Care Units ; Leukemia ; Light ; Male ; Parents ; Seizures ; Seizures, Febrile ; Spinal Puncture

BACKGROUND: Corticosteroids and intravenous immunoglobulin (IV-Ig) have been used asfirst line treatments for acute idiopathic thrombocytopenic purpura (AITP) in children. High dose dexamethasone (HD) has been reported to be effective for chronic refractory ITP and for the initial treatment of AITP in adults. There has been no report about HD as the initial treatment for childhood AITP. We assessed the effectiveness of HD for the initial treatment of childhood AITP, as compared to IV-Ig. METHODS: 25 Patients with newly diagnosed AITP were enrolled. We conducted a prospective, randomized study to compare the two treatment options. 11 patients were treated with IV-Ig and 14 patients were treated with HD. The platelet counts were assessed at 3, 5, 7, 14 and 21 days after the beginning of the treatment. The adverse effects were noted, and the patients were followed for more than 6 months. RESULTS: Both the IV-Ig and HD groups showed a rapid rise of the platelet counts and the platelet counts were maintained at 3, 5, 7, 14 and 21 days. The difference of platelet counts between the two groups was significant at day 5 (P<0.05). During the follow-up period, 5 patients had a recurrence: 2 in IV-Ig group and 3 in HD group. All 5 patients were re-treated with HD and they had a good response. One of the recurred patients in the IV-Ig group had chronic ITP. Some side effects were observed, but they were not severe enough to necessitate the discontinuation of treatment. CONCLUSION: We conclude that HD is as effective and safe as high dose IV-Ig for the initial treatment of childhood AITP. The choice between these treatment options can be made according to the cost-effectiveness and the therapy-related risks.
Adrenal Cortex Hormones ; Adult ; Child ; Dexamethasone ; Follow-Up Studies ; Humans ; Immunoglobulins ; Platelet Count ; Prospective Studies ; Purpura, Thrombocytopenic, Idiopathic

PURPOSE: Clinical and laboratory findings predict a severe outcome for mucocutaneous lymph node syndrome. This study aimed to define the clinical characteristics of Kawasaki disease (KD) patients with hyponatremia and to determine the factors associated with its development. METHODS: Retrospective studies were performed on 114 KD patients who received an initial high-dose intravenous immunoglobulin (IVIG, single 2 g/kg/dose) within 10 days of fever onset from January 2006 to February 2008. These patients were divided into 2 groups. Group 1 consisted of 30 (26.3%) patients with hyponatremia, and group 2 consisted of 84 (73.6%) patients without hyponatremia. Clinical manifestations, laboratory results, and echocardiographic findings were compared between the groups. RESULTS: Group 1 patients were more likely to have a coronary artery lesion (53.3% versus 20.2%, P=0.005) and suffered from diarrhea (41.3% versus 14.1%, P=0.007). There was a higher incidence of cardiovascular involvement in group 1 patients, including coronary dilatation (46.6%), valvular regurgitation (13.3%), pericardial effusion (6.7%) and medium-sized aneurysm (6.7%). There were no coronary aneurysms in group 2 patients. Serum C-reactive protein (CRP) was significantly higher in patients with hyponatremia (12.2+/-7.79 mg/ dL versus 7.3+/-4.7 mg/dL, P=0.003) and IVIG-resistant patients were more common in group 1 (13.3% versus 3.6%). CONCLUSION: These results indicate that hyponatremia in KD occurs in patients exhibiting severe inflammation and was significantly associated with the development of coronary disease. Further studies will be necessary to confirm the pathogenic mechanisms of hyponatremia in KD patients.
Aneurysm ; C-Reactive Protein ; Coronary Aneurysm ; Coronary Disease ; Coronary Vessels ; Diarrhea ; Dilatation ; Fever ; Humans ; Hyponatremia ; Immunoglobulins ; Incidence ; Inflammation ; Mucocutaneous Lymph Node Syndrome ; Pericardial Effusion ; Retrospective Studies

PURPOSE: To assess wall motion of the left ventricle in the various forms of congenital heart disease and to select appropriate methods by which to gauge left ventricular wall motion. METHODS: We evaluated left ventricular function, including volume, global ejection fraction, and regional wall motion(Centerline method, Local Ejection Fraction, Curved Perimeter method and Radial method). The evaluation was done on review mode of 30-degree elongated right anterior oblique projection of left ventriculogram by using cardiac analysis program of the DXC Hiline Digital System(GER, USA) in 53 pediatric patients undergoing diagnostic(or therapeutic) cardiac catheterization from June 1995 to July 1996 at Kyung-pook National University Hospital. RESULTS: Cardiac indices calculated by Dodge's and Simpson's methods were 5.76+/-2.13 L/min/ m2, 5.86+/-2.31 L/min/m2 respectively with significant correlation to each other(r=0.99, P<0.01). Global ejection fractions using both methods were 69.81+/-8.33%, and 69.69+/-8.20%, respectively (r=0.99, P<0.01). After dividing the left ventricular outline contour into five regions such as posterobasal, diaphragmatic, apical, anterolateral and anterobasal portions, all four models could ascertain regional wall motion abnormalities well(P<0.01). And among them, the Centerline method and the Curved Perimeter method correlated well in assessing wall motion(for each portion r=0.67, 0.84, 0.94, 0.91 and 0.61 respectively, P<0.01). CONCLUSION: In conclusion, we confirmed regional wall motion abnormalities in the various forms of congenital heart disease in spite of normal global ejection fractions, showing that the Centerline and Curved Perimeter methods are preferable methods in the assessment of wall motion in patiens with congenital heart disease.
Cardiac Catheterization ; Cardiac Catheters ; Child* ; Heart Defects, Congenital* ; Heart Ventricles* ; Humans ; Ventricular Function, Left

PURPOSE: Traumatic extrusion of the eyeball is rare. We experienced and successfully reconstructed a case of the eyeball extrusion with complete avulsion of the optic nerve, and complex, comminuted fractures of medial and inferior orbital walls. METHODS: A 27-year-old man presented with the ocular pain and eyeball extrusion of the right eye after the trauma. There were multiple lacerations of the eyelid and the conjunctiva of the right eye, the complete avulsion of the optic nerve and the avulsion of extraocular muscles except the lateral rectus muscle, and the eyeball extrusion of the right eye. We performed the enucleation with Medpor(R) sphere implantation and the reconstruction of the inferior and medial walls with Medpor(R) one channel and sheet implant. RESULTS: At one-year follow-up, there were no implant exposure and infection, and good cosmetic result was seen without enophthalmos. CONCLUSIONS: In a case of eyeball extrusion with complex, comminuted fractures after trauma, we could reconstruct these successfully with enucleation with Medpor(R) sphere implantation, and repair of fractures with Medpor(R) channel and sheet implant.
Adult ; Conjunctiva ; Enophthalmos ; Eyelids ; Follow-Up Studies ; Fractures, Comminuted* ; Humans ; Lacerations ; Muscles ; Optic Nerve ; Orbit

PURPOSE: We have evaluated the results of laser in situ keratomileuresis (LASIK) for high myopia above -15D over the follow-up periods of three years. METHODS: Twenty-two eyes from 15 LASIK patients were analyzed (10 eyes from 6 males and 12 eyes from 9 females). The average age was 30+/-6.7 years (20~42 years). The follow-up evaluations were performed at 6 months, 1 year and 3 years. RESULTS: The preoperative spherical equivalent ranged from -15.00D to -37.00D (average: -20.38+/-5.06D) and the mean postoperative spherical equivalents -2.07+/-3.43D at 6 months, -3.01+/-2.88D at 1 year, -3.05+/-2.86D at 3 years. Myopic regression continued during three-year follow-up, but, was not statistically significant (p>0.05). The incidence of increased BCVA 2 lines or more was 64% at 3 years and the case of decreased BCVA 2 lines or more was not found. The mean preoperative astigmatism was -2.93+/-2.11D and the mean postoperative astigmatisms were -0.81+/-0.81D at 6 months, -1.06+/-1.07D at 1 year and -1.16+/-1.44D at 3 years. It was significantly decreased (p<0.05). The intraoperative complications were not found. The postoperative complications after 3 years were myopic regression in 8 eyes, night glare in 8 eyes, decentration in 7 eyes and the foreign bodies in the border of the flap in 1 eye and there was no corneal haze. CONCLUSIONS: LASIK for high myopia above -15D is relatively safe. Howerver it needs further longterm evaluation.
Astigmatism ; Follow-Up Studies ; Foreign Bodies ; Glare ; Humans ; Incidence ; Intraoperative Complications ; Keratomileusis, Laser In Situ* ; Male ; Myopia* ; Postoperative Complications

PURPOSE: Acute lympholastic leukemia is common in children but, rare in adults. Authors experienced a case of acute lympholastic leukemia with orbital relapse in adult, and we report this case with literature review. METHODS: A fifty-year-old woman complained of left eye pain and proptosis for 7 days. The superio-lateral subconjunctival mass excision and biopsy were performed and evisceration was done. The pathologic findings showed the lymphoblastic leukemia. Immunohistochemistry showed the original precursor T-lineage acute lymphoblastic leukemia. RESULTS: The mass was enlarged 40 days after surgery with pain, and subsided after radiation therapy. We recommended systemic chemotherapy, but she refused the therapy. She died 6months after surgery with systemic relapse.
Adult ; Biopsy ; Child ; Drug Therapy ; Exophthalmos ; Eye Pain ; Female ; Humans ; Immunohistochemistry ; Leukemia ; Orbit* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence*

BACKGROUND: The North Korean defectors are suffering from multiple psychologic and physical health problems. However, because of their emotional maladaptation, noncooperation and suspiciousness and distrust toward others, it is difficult for South Korean doctors to build effective therapeutic relationships with them. Therefore, we made efforts to clarify the characteristics of North Korean defectors in symptom expressions and illness behaviors which would help South Korean doctors to gain rapport. METHODS: We performed qualitative study with focus group interview. Three focus groups were composed of 14 North Korean defectors and group interviews were performed twice for each group. The contents of each interview were analyzed and conclusions were drawn by extracting and arranging significant findings. RESULTS: The North Korean defectors showed psychologic symptoms such as anxiety, depression and various somatic symptoms. Among them, 'Laeng-Dol ('cold mass) and 'Jeog' mean subjective mass-feeling, such as globus sensation. And 'Tag-Gi-Byeong ('chicken heart disease')' means recurrent chest pain. These expressions reflect their anxious, depressive, and somatizing tendency. Among illness concept, 'Laeng-Byeong' ('cold related disease') means that they consider the cold weather to be the cause of various somatic symptoms. Characteristic illness behaviors include continuous complaining of recurrent symptoms, distrusting medical staffs and institutions, self-diagnosis, self- prescription, and reliance upon folk remedies. These illness behaviors were precipitated by the current breakdown of health-care system and economic crisis of the North Korea. CONCLUSION: South Korean doctors should be able to understand these characteristics of the North Korean defectors in order to build effective therapeutic relationship with them.
Anxiety ; Chest Pain ; Democratic People's Republic of Korea ; Depression ; Focus Groups ; Heart ; Humans ; Illness Behavior* ; Interviews as Topic ; Medical Staff ; Medicine, Traditional ; Prescriptions ; Sensation ; Weather

BACKGROUND: The North Korean defectors are suffering from multiple psychologic and physical health problems. However, because of their emotional maladaptation, noncooperation and suspiciousness and distrust toward others, it is difficult for South Korean doctors to build effective therapeutic relationships with them. Therefore, we made efforts to clarify the characteristics of North Korean defectors in symptom expressions and illness behaviors which would help South Korean doctors to gain rapport. METHODS: We performed qualitative study with focus group interview. Three focus groups were composed of 14 North Korean defectors and group interviews were performed twice for each group. The contents of each interview were analyzed and conclusions were drawn by extracting and arranging significant findings. RESULTS: The North Korean defectors showed psychologic symptoms such as anxiety, depression and various somatic symptoms. Among them, 'Laeng-Dol ('cold mass) and 'Jeog' mean subjective mass-feeling, such as globus sensation. And 'Tag-Gi-Byeong ('chicken heart disease')' means recurrent chest pain. These expressions reflect their anxious, depressive, and somatizing tendency. Among illness concept, 'Laeng-Byeong' ('cold related disease') means that they consider the cold weather to be the cause of various somatic symptoms. Characteristic illness behaviors include continuous complaining of recurrent symptoms, distrusting medical staffs and institutions, self-diagnosis, self- prescription, and reliance upon folk remedies. These illness behaviors were precipitated by the current breakdown of health-care system and economic crisis of the North Korea. CONCLUSION: South Korean doctors should be able to understand these characteristics of the North Korean defectors in order to build effective therapeutic relationship with them.
Anxiety ; Chest Pain ; Democratic People's Republic of Korea ; Depression ; Focus Groups ; Heart ; Humans ; Illness Behavior* ; Interviews as Topic ; Medical Staff ; Medicine, Traditional ; Prescriptions ; Sensation ; Weather

BACKGROUND AND OBJECTIVES: While the off-label use of implantable medical devices for treating congenital heart disease is not uncommon, the present conditions and outcomes of their off-label use have rarely been described. Therefore, this study evaluated the prevalence and results of using implantable devices off-label to treat congenital heart disease at a single institute. SUBJECTS AND METHODS: This was a retrospective study based on the medical records of catheter-based interventions for congenital heart disease performed from July 1, 1995 to June 1, 2015. The inclusion criterion was the off-label use of an implantable device. Patient demographic data, procedural success, and follow-up status regarding late complications were investigated, and the results of the off-label use of each device were compared. RESULTS: Off-label use occurred in 144 of 1730 interventions with device implantation, accounting for 8.3% of the interventions. The median patient age and mean body weight were 51.0 months and 16.3 kg, respectively. Immediate and late failures were found in 9 cases, and 3 cases of mortality were not directly related to the devices used. The overall success rate was 93.8%. There were no long-term complications of the off-label use of occlusion devices. No procedural failures resulted from stent implantation, but one case of stent malposition and two cases of stent fracture were identified after procedure completion. CONCLUSION: In general, the off-label use of implantable devices for treating congenital heart disease is safe and effective.
Body Weight ; Follow-Up Studies ; Heart Defects, Congenital* ; Humans ; Medical Records ; Mortality ; Off-Label Use* ; Prevalence ; Retrospective Studies ; Stents