PURPOSE: Although breast milk is considered the best source of nutrition for infants because of its superiority over powdered milk, there are circumstances when breast milk is unavailable. Committee on Nutrition of the Korean Pediatric Society conducted an investigation into the current status of formula feeding in Korea. METHODS: This investigation was conducted using questionnaires produced by our committee and distributed to mothers of children under the age of two who were using formula feeding at 10 university hospitals and 22 public health centers nationwide between March 1999 to September 1999. A comparative analysis according to location, birth order, mother's occupation, education, housing tenure and normal birth status was performed on all 2696 questionnaires using the chi-square test. RESULTS: Formula feeding was found in 49.4% and formula feeding combined with breast milk were 21.5% of the respondents. The percentage of formula feeding was higher in working mothers who underwent a Cesarean section in metropolitan areas. The inadequacy of breast milk was the most common reason for feeding powdered rnilk followed by the unhealthy condition of the mother and mother's return to work. Of those investigated, 94.9% said that they changed products at each stage as recommended by the manufacturer. Promotions for special formulas were more active in metropolitan areas than other areas, and 57.7M said that they used special formulas based on recornmendations by the doctor and acquaintances(15.5%) or after seeing an advertisement(14.0%). CONCLUSION: This investigation revealed that many rnothers were misinformed concerning formula feeding and pediatricians should provide mothers with education, shedding light on proper feeding methods.
Birth Order ; Cesarean Section ; Child ; Surveys and Questionnaires ; Education ; Feeding Methods ; Female ; Hospitals, University ; Housing ; Humans ; Infant* ; Korea ; Milk ; Milk, Human ; Mothers ; Occupations ; Parturition ; Pregnancy ; Public Health ; Return to Work

PURPOSE: Body mass index(BMI), skinfold thickness and arm circumference are commonly used to evaluate obesity in children. There is a need for new standards of these items on Korean children. We performed this study to provide up-to-date reference percentile values and percentile charts for these three items. METHODS: Standardized measurements of height, weight, skinfold thickness(triceps, subscapular) and arm circumference on a total of 31,188 infants and children from age 1 to 18 years during January to December 1998 were used to calculate percentile values and to develop smoothed percentile charts. RESULTS: The mean BMI increased with age and showed similar values in both sexes, but 95th percentile values were slightly higher for boys than girls. The percentile values of BMI were consistently higher than those reported previously in Korea, particularly for the 95th percetile values. Triceps and subscapular skinfold thickness showed significant increase compared with previous studies and significantly higher for females than males. Arm circumference also showed significant increase compared with the previous studies. It was significantly higher for males than females. BMI was more closely related with arm circumference than skinfold thickness. CONCLUSION: The percentile values and percentile charts of BMI, skinfold thickness and arm circumference will allow pediatricians to evaluate obesity in Korean children.
Arm* ; Body Mass Index* ; Child* ; Female ; Humans ; Infant ; Korea ; Male ; Obesity ; Skinfold Thickness*

No abstract available.

Pulmonary cryptococcosis is rare in immunocompetent subjects. Here, we present the case of a 16-year-old boy who was referred to our pediatric department for the management of multiple consolidations detected on chest radiography, which was routinely performed when the patient was being evaluated for an ankle fracture. Fine needle aspiration biopsy was performed, and the definitive diagnosis was established as cryptococcal pneumonia. After 8 weeks of antifungal treatment, the pulmonary nodules on the chest radiographs disappeared.
Adolescent ; Animals ; Ankle ; Biopsy ; Biopsy, Fine-Needle ; Child ; Cryptococcosis ; Humans ; Multiple Pulmonary Nodules ; Pneumonia ; Thorax

PURPOSE: Diagnosis of a hemodynamically significant patent ductus arteriosus(PDA) that should be treated is difficult to determine by clinical and echocardiographic examinations. The aim of this study was to clarify the interrelationship of plasma atrial natriuretic peptide(ANP) concentrations and clinical signs or echocardiographic signs of PDA in preterm infants and use plasma ANP concentrations as a diagnostic indicator of a hemodynamically significant PDA. METHODS: Twenty-four preterm infants who were born at Guro Hospital, Korea Medical Center were evaluated on the 3rd day after birth. Clinical signs(cardiovascular dysfunction score 3) and echocardiographic signs[magnitude of left-to-right shunt across a PDA and left atrium(LA): Ao ratio] of a PDA and plasma ANP concentrations were measured. RESULTS: Plasma ANP concentrations and LA/Ao ratios of preterm infants with hemodynamically significant PDA were significantly higher than those of preterm infants without hemodynamically significant PDA. Plasma ANP concentrations were related to the magnitude of the left- to-right shunt across a PDA and LA: Ao ratio. Plasma ANP concentrations of LA/Ao of more than 1.3 were significantly higher than that of LA/Ao of less than 1.3. CONCLUSION: In preterm infants, high plasma ANP concentration may be a useful predictive indicator of a hemodynarnically significant PDA. Measurement of plasma ANP concentration may play a role in deciding the need for and timing of medical or surgical management of preterm infants with PDA.
Atrial Natriuretic Factor ; Diagnosis* ; Ductus Arteriosus, Patent* ; Echocardiography ; Humans ; Infant, Newborn ; Infant, Premature* ; Korea ; Parturition ; Plasma

Pneumoperitoneum usually indicates rupture of a hollow viscus and considered a surgical emergency. But air may also enter the peritoneum from the lung or the genital organs in female without visceral perforation. While scuba diving, the rapid ascent is usually controlled by placing in a decompression chamber and the excess gas volume is exhaled. Failure to allow this excess gas to escape will result in overdistension of air passage, which may rupture resulting in pulmonary interstitial emphysema or, if air enters the circulation, air embolus can occur. Pneumo-peritoneum is a rare complication of diving accidents. While the majority of cases are not related to an intraabdominal catastrophy, more than 20% have been the result of gastric rupture. We report a 42-yr-old male patient with massive pneumoperitoneum after scuba diving, who presented himself with dyspnea and abdominal distension. Knowledge of this rare condition and its benign course may allow the emergency physician and surgeon to order appropriate studies to help avoid unnecessary surgical treatment. It is important to determine promptly whether the air emanated from a ruptured viscus or was introduced from an extraperitoneal source. Free air in the abdomen does not always indicate a ruptured intra-abdominal viscus.
Adult ; Diving/adverse effects* ; Female ; Human ; Male ; Pneumoperitoneum/diagnosis* ; Pneumoperitoneum/etiology* ; Radiography, Abdominal ; Radiography, Thoracic

A retroperitoneal Synovial Sarcoma is defined as a tumor arising in the retroperitoneal space, with an origin of mesodermal structures. The majority of synovial sarcomas (85 to 95%) occur in the extremities, located near the large joints. They are uncommon, and usually appear as a non- specific soft tissue mass, with no specific imaging feature. However, in some cases, radiological findings and anatomic location of the tumor may help the diagnosis. On CT examination, these tumors may be shown as hypo-dense masses and have an irregular enhancement in the periphery, with a poor enhancement in the central area, reflecting the necrotic, cystic and hemorrhagic changes. Histologically, there are two types of synovial sarcoma: biphasic and monophasic. Both types have about a 40% mortality rate. The known prognostic factors are; frequent mitotic figures, extensive tumor necrosis, and poor differentiation. Surgical ablation remains the mainstay of their management. Regardless of adequate surgical and adjunctive therapies, the recurrence rate ranges from 28 to 36%. Here, we present a case of a retroperitoneal synovial sarcoma, with a review of the literature.
Diagnosis ; Extremities ; Joints ; Mesoderm ; Mortality ; Necrosis ; Recurrence ; Retroperitoneal Neoplasms ; Retroperitoneal Space ; Sarcoma, Synovial*

PURPOSE: Insulinomas are a rare disease, which can be cured by surgical management if diagnosed early. However, diagnosis and localization are difficult, due to their small size and varied clinical manifestations. We analyzed the clinicopathological features, diagnosis and surgical management of insulinomas. METHODS: We retrospectively analyzed 12 insulinoma patients who had undergone pancreatic surgery, between 1988 and 2001, at the Department of Surgery, College of Medicine, The Catholic University of Korea. RESULTS: The male to female ratio of the insulinoma patients was 1: 1 with a mean age of 37.9 years, ranging from 20 to 65. The clinical manifestations were loss of consciousness, weakness, confusion and dizziness, and all the patients had findings compatible with Whipple's triad. The median duration of symptoms before surgery was 16.8 months, ranging from 1 to 48 months. Hyperinsulinemic hypoglycemia was confirmed, during prolonged fasting, when the concomitant fasting blood sugar level was 42.4mg/dl and insulin level was 25.2 microU/ml (8.1~61.8 microU/ml). The insulinoma can be localized in 11 patients (91.7%) preoperatively. For the preoperative localization, a transhepatic portal vein sample (THPVS), selective angiography and a CT scan were good diagnostic methods. Intraoperative ultrasonography was the most useful localization tool during the operation. For treating the insulinoma, an enucleation, a distal pancreatectomy, and a pylorus preserving pancreaticoduodenectomy were performed in 5, 6 and 1 patients, respectively. An enucleation case was diagnosed as nesidioblastosis after surgery, thus needing a near total pancreatectomy. One patient with a multiple endocrine neoplasia (MEN), subtype I, needed a thyroidectomy and an adrenalectomy. All cases were single, benign tumors within the pancreas. The symptoms of hypoglycemia and the laboratory values were normal in all patients after surgery. CONCLUSION: We experienced 12 insulinoma patients, where preoperative suspicions, proper utilization of diagnostic tools, and prudent intraoperative diagnostic procedures enhanced the diagnostic accuracy of the insulinoma, and led to better treatment strategies.
Insulinoma* ; Pancreas*

Eosinophilic cystitis is an uncommon disease which is characterized by eosinophilic infiltration into all layers of bladder. It was first described in 1959 by Brown and 50 cases have been reported in the literature. The presenting symptoms are frequency, urgency, dysuria and hematuria. It is chronic disease with remission and exacerbation and mimics other forms of chronic cystitis, such as interstitial cystitis, tuberculosis and bladder neoplasm. Diagnosis is made by biopsy. Treatment consists of removal of inciting allergens, corticosteroids, antihistamines, and antibiotics for secondary bacterial infection. Most women and children with eosinophilic cystitis had the history of allergic disease or asthma and most male patients had bladder or prostatic disorders, such as benign prostatic hypertrophy, bladder carcinoma, and congenital anomalies. But eosinophilic cystitis has not been found in diabetic patients yet. We report a case of eosinophilic cystitis in a 59- year-old diabetic patient with brief review of the literature.
Adrenal Cortex Hormones ; Allergens ; Anti-Bacterial Agents ; Asthma ; Bacterial Infections ; Biopsy ; Child ; Chronic Disease ; Cystitis* ; Cystitis, Interstitial ; Diabetes Mellitus* ; Diagnosis ; Dysuria ; Eosinophils* ; Female ; Hematuria ; Histamine Antagonists ; Humans ; Male ; Prostatic Hyperplasia ; Tuberculosis ; Urinary Bladder ; Urinary Bladder Neoplasms

PURPOSE: This study compared the postoperative outcomes and complications between laparoscopic totally extraperitoneal (TEP) hernia repair and open Lichtenstein hernia repair. METHODS: A total of 64 cases (30 cases by the TEP method and 34 cases by Lichtenstein repair) were enrolled in this study. The operative time, the hospital stay, the VAS score, the amount of analgesic used, the postoperative complications and recurrence were compared between the 2 methods. RESULTS: The mean operative time was 71 min for the TEP group, which was not significantly longer than that for the Lichtenstein group (66 min). The mean postoperative hospital stay was 3.7 days for the TEP group, which was significantly shorter than that for the Lichtenstein group (4.2) (p=0.035). The mean postoperative analgesic dose was 0.9+/-0.7 and 1.1+/-1.0 within 24 hours and 0.2+/-0.5 and 0.7+/-0.8 after 24 hours, respectively. The dose of analgesic after 24 hours was significantly lower for the TEP group (p=0.011), but the dose within 24 hours and the total dose was not significantly different. The VAS score was 2.3+/-1.0 and 2.6+/-0.9 at 12 hrs and 1.2+/-0.8 and 1.7+/-0.8 at 48 hrs, respectively. The VAS score was significantly lower for TEP group than that for the Lichtenstein group at 48 hrs (p=0.011), but there was no significant difference between the groups at 12 hrs. There was one recurrence in the TEP group. CONCLUSION: For the TEP group, the hospital stay was significantly shorter than that for the Lichtenstein group and this is maybe because the postoperative pain after 24 hours from the operation was less for the TEP group. Laparoscopic TEP repair may be performed efficiently with an acceptable operating time and a shorter hospital stay, as compared to open Lichtenstein hernia repair.
Hernia ; Herniorrhaphy ; Length of Stay ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Pyrazines ; Recurrence