PURPOSE: The prevalence of developmental delay is 5-10% of the total pediatric population and early diagnosis and proper intervention are essential but a challenge for clinicians. We performed this study for several purposes. First is to know the distribution & characteristics of developmental disorders in Korea. Second is to identify all possible causes of these disorders through a multidisciplinary diagnostic approach, and thus to find out the clinical variables that are helpful in finding the etiology. And finally to develop a useful protocol that eliminates the cost of unnecessary tests and raises the diagnostic rate of the cause. METHODS: 518 patients(M 349, F 169) were studied who visited Ilsan Hospital Developmental Disorder Clinic(DDC) for the evaluation of developmental delay from April 2001 to Jan 2005. RESULTS: The mean age was 51.5+/-32.9 months, ranging from 2 months to 16.0 years of age with a majority of the preschool children(<6 yr)(79.3%). Phenomenological diagnosis consisted of 133 cases of mental retardation, 122 cases of autistic disorders, 101 cases of delayed language disorders, 27 cases of cerebral palsies, and 91 cases labeled as simple developmental delay requiring follow up due to age less than 2 years of age. Etiologic diagnosis was obtained in 119 cases(22.9%) out the 518 cases of developmental delays. 37 cases of chromosomal anomalies, 23 cases of Periventricular leukomalacia and hypoxic ischemic encephalopathy, 21 cases of syndromes, 7 cases of malformation of cortical development, 4 cases of myopathies, 4 cases of neuropathies, and 4 cases of cerebral infarctions were found. Among the clinical variables, low birth weight, facial dysmorphism, hypotonia, focal neurologic signs, and abnormalities in MRI, chromosome, EEG and EMG studies contributed to the yields of etiologic diagnosis significantly. CONCLUSION: Possible etiology was determined in about 23% of the subjects. The most important part of the assessment for the identification of etiology is thorough history taking, physical and neurologic examination. Neuroimaging study is useful in case of micro or macrocephaly, focal neurologic signs. Genetic studies increasingly produce a yield, when there is family history of inherited disorder and there are dysmorphic features. Routine metabolic screening test has limited utility. Development of a useful screening protocol adequate for Korean situation is required.
Cerebral Infarction ; Diagnosis ; Early Diagnosis ; Electroencephalography ; Follow-Up Studies ; Humans ; Hypoxia-Ischemia, Brain ; Infant, Low Birth Weight ; Infant, Newborn ; Intellectual Disability ; Korea ; Language Disorders ; Leukomalacia, Periventricular ; Macrocephaly ; Magnetic Resonance Imaging ; Mass Screening ; Muscle Hypotonia ; Muscular Diseases ; Neuroimaging ; Neurologic Examination ; Neurologic Manifestations ; Paralysis ; Prevalence

This study investigated the method to adjust acquisition time(a) and injection dose(i) to make the best basal and subtraction images in consecutive SPECT. Image quality was assumed to be mainly affected by signal to noise ratio(S/N). Basal image was subtracted from the second image consecutively acquired at the same position. We calculated S/N ratio in basal SPECT images(S1/N1) and subtraction SPECT images(Ss/Ns) to find a(time) and i(dose) to maximize S/N of both images at the same time. From phantom images, we drew the relation of image counts and a(time) and i(dose) in our system using fanbeam-high-resolution collimated triple head SPECT. Noise by imaging process depended on Poisson distribution. We took maximum tolerable duration of consecutive acquisition as 30 minutes and maximum injectible dose as 1,850MBq(50 mCi)(sum of two injections) per study. Counts of second-acquired image(S2), counts(Ss) and noise(Ns) of subtraction SPECT were as follows. C1 was the coefficient of measurement with our system.
Acetazolamide* ; Brain* ; Head ; Noise ; Perfusion* ; Signal-To-Noise Ratio ; Tomography, Emission-Computed, Single-Photon*

Although variation is the rule with pancreatic duct morphology, certain variants occur as a result of altered embroological development. These ductal configurations, most striking deviations from the normal configuration, may be classfied according to alterations of embryological development. These congenital variants of pancreatic duct may be important for several reasons. First, the pseudomass effect of ductal anomalies can be mistaken for carcinoma by the inexperienced radiologists. Second, whether or not the anomaly is important, it is present in many patients with recurrent pacreatitis. Original descriptions were based on small sampling of postmortem studies and surgical specimen, but more recently the advent of endoscopic retrograde cholangiopancreatography(ERCP) has confirmed of the work of early anastomists and increased awareness of these variants. To evalute of frequency, characteristics of associated disease and clinical significance of pancreatic anomalies, we have reviewed of 5330 case of ERCP filmes which were undertaken between July, 1973 and August, 1993. Having reviewed of ERCP filmes, we found out 9 case of pancreatic duct variants. Among them, 7 cases were classified as ductal duplication anomalies, 4 cases of number variation, most, bifuricaiton and 3 cases of form variation, which were composed of loop, spiral and terminal N. Three cases of fusion anomalies were also noted, which were 2 cases of panceratic divisum and 1 case of incomplete pancreatic divisum. The associated diseases were 6 cases of bile duct and galbladder stones and 3 cases of pancreatic cancer. We could not find out the case of congenital anomalies as cause of obstructive pain and pseudomass effect.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Humans ; Pancreatic Ducts* ; Pancreatic Neoplasms ; Pancrelipase ; Strikes, Employee

BACKGROUND AND SIGNIFICANCE: Neck manipulation or trauma uncommonly be associated with serious and even fatal vascular complications. We presented the clinical and radiologic findings in 3 patients of brainstem and/or cerebellar infarct with basilar artery occlusion and extracranial vertebral artery stenosis or occlusion,. Cases : In the patient 1, the infarction of pons and lsft cerebellar hemisphere outbroke just after being seized by the collar. The angiographic findings were complete occlusion of basilar artery and left vertebral artery on C1 level and vertebrobasilar junctional occlusion of right vertebral artery. In the patient 2, extensive infarction of pons and left cerebellar hemisphere developed just after chiropractic manipulation of the neck. The angiographic findings were occlusions of left vertebral artery and distal portion of the basilar artery. In the patient 3, right cerebellar and medullary infarction of posteroinferior cerebellar artery territory occurred just after autobicycle accident. The angiographic finding was complete occlusion of left vertebral artery on C1 lever. They had not another risk factor of the stroke. CONCLUSIONS: We experienced and presented 3 cases of posterior circulation infarctio with vertebrobasilar stenoocclusion just following cervical manipulation or neck trauma.
Arteries ; Basilar Artery ; Brain Stem ; Humans ; Infarction* ; Manipulation, Chiropractic ; Manipulation, Spinal* ; Neck ; Pons ; Risk Factors ; Stroke ; Vertebral Artery ; Vertebrobasilar Insufficiency

No abstract available.
Abscess* ; Technetium Tc 99m Exametazime*

A technique for Thallium-201 imaging after two separate injections of the tracer, which took less than I hour, was performed to evaluate if this technique could be used clinically as a noninvasive screening test of angina pectoris. 29 patients who complained of chest pain were included in this study: 18 patients were proven to have coronary artery disease by coronary angiography and 11 patients had normal coronary arteries. With the patient supine at rest, 1.0 mCi of Thallium was injected intravenously and imaging was performed in the anterior and 50degrees left anterior oblique projections for a preset time according to Okada's protocol. Immediately after acquisition of the rest images, without moving the camera head, an infusion of dipyridamole was done at the rate of 0.14 mg/Kg/min for 4 minutes. Two minutes after stopping the infusion, 1.0 mCi of Thallium was injected intravenously and 50degrees left anterior oblique and anterior projection images were acquired. Images of the same projection were realigned using computer image registration approach (PDP-11/34 computer of DEC company). The rest image was then subtracted from the realigned dipyridamole image to produce an image representing perfusion during dipyridamole induced hyperemia (subtraction image). The results were as follows; 1) All of the subtraction images were of adequate quality for interpretation. 2) 16 cases in 18 patients of angina pectoris and 1 case in 11 normal control showed perfusion defects, so the over all sensitivity and specificity of the subtraction versus rest Thallium image technique for diagnosis of angina pectoris were 89% and 91%, respectively. 3) All patients (8 cases) whose left ventriculography revealed abnormality of regional wall motion showed perfusion defects in corresponding segments. But qualitative analysis of Thallium image could not predict if the patient whose Thallium image revealed perfusion defect has abnormality of regional wall motion. 4) segmental analysis was performed to know the association between the site of coronary artery stenosis and the perfusion defects in Thallium scan, which revealed the sensitivities for detecting stenosis of LCX, LAD & RCA were 50-60% in range and the range of specificities were 89-92%. 5) Adverse effects of dipyridamole were headache (2 cases) and chest pain (4 cases) but aminophylline was not needed in any case. In conclusion, split dose Thallium dipyridamole scan can be used as a noninvasive screening test of angina pectoris reducing the total duration of imaging to less than one hour. Futher applications of this technique may include the assessment of myocardial perfusion before and immediately after coronary angioplasty and coronary artery bypass graft and the evaluation of the impact of pharmacotheraphy on regional myocardial perfusion.
Aminophylline ; Angina Pectoris* ; Angioplasty ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Diagnosis* ; Dipyridamole* ; Head ; Headache ; Humans ; Hyperemia ; Mass Screening ; Perfusion ; Sensitivity and Specificity ; Thallium ; Transplants

Despite the relatively high prevalence (5~10%) of developmental disability, the early identification for such problems remains difficult. Doctors who care children with developmental delay tried to find out these disorders as early as possible in order to apply an early intervention and reduce the long-term disabilities among them. Identification of a delayed young child by routine out-patient's clinic mandates a careful search for an underlying etiology. This article discusses the available approaches for the infants and young children with various kinds of developmental disabilities, according to the parent's chief complaints including 'unable to walk', 'unable to speak', 'unable to control temper', and 'unable to contact his or her eyes'.
Cerebral Palsy ; Child ; Developmental Disabilities ; Early Intervention (Education) ; Humans ; Infant ; Language Development Disorders ; Mental Disorders ; Prevalence

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Dipyridamole* ; Perfusion*

No abstract available.
Brain* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: Current evidence of the benefits of early intensive behavioral intervention (EIBI) in children with autism spectrum disorders(ASD) is increasing. In order to get the benefits from EIBI, early identification of ASD is essential but a challenge for clinicians. Therefore, we designed this study to know what differs from other developmental disorders in terms of early developmental patterns and clinical and laboratory characteristics. METHODS: Among 518 children diagnosed developmental delay in Ilsan Hospital Developmental Disorder Clinic from April 2001 to January 2005, we analyzed 122 ASD patients as a study group, and 133 mentally retarded(MR) and 101 specific language impaired(SLI) patients as control groups. We used a questionnaire survey to assess past and family history. We performed various kinds of tools for the evaluation of the development, and cognitive and speech functions according to the patients' age. MRI, SPECT, EEG, genetic and metabolic studies were performed as optional tests. RESULTS: The mean age of ASD was 55.9+/-30.7 months and male was predominant in ASD(male:female ratio was 3.2:1). In early developmental history, motor functions are relatively well preserved in ASD(P<0.05). In speech and social milestones, single word speech was noticeably delayed in all the 3 groups. However, there was no appreciable difference in stranger anxiety among the 3 groups. In the developmental evaluation, speech and social functions were most significantly delayed in ASD(P<0.05). There was a significant motor delay in ASD and MR than SLI(P<0.05). In physical examination, a raised rate of macrocedphaly in ASD was not noted. Abnormal EEG findings were significantly noted in ASD and MR than in SLI and MRI abnormalities were least found in these groups. The etiologic diagnosis was much less identified in ASD than MR. CONCLUSION: In an early stage, absence of stranger anxiety was not statistically significant. However, this seems to be an important risk factor for predicting ASD. Motor functions were relatively well preserved in ASD in an early stage. In the developmental evaluation, social and language areas were the most significantly delayed domains in ASD and motor functions were most delayed in MR. Routine MRI studies are not indicated for identifying the etiology in ASD. It was harder to find out the etiology in ASD than MR.
Anxiety ; Autistic Disorder* ; Child ; Autism Spectrum Disorder* ; Diagnosis ; Electroencephalography ; Humans ; Magnetic Resonance Imaging ; Male ; Physical Examination ; Surveys and Questionnaires ; Risk Factors ; Tomography, Emission-Computed, Single-Photon