PURPOSE: As morbidity and mortality resulting from physical trauma have significantly increased, the importance of trauma concerning medical, legal, and socioeconomic issues has been widely documented. Studies of post-traumatic seizure after head trauma have been reported, but mostly in adults. So this study was performed to analyse clinical findings on head trauma patients under 20 years of age. METHODS: The medical records of 230 patients under 20 years of age, who were admitted as head trauma to Chung Ang University hospital from January 1993 till May 1997, were reviewed. RESULTS: The overall incidence of Post-traumatic seizure was 32 of 230 patients in this study. The incidence per age was 16.7% in less than 5 year, 12.2% in 6-10 year, 11.4% in 11-15 year, and 14.9% in 16-20 year. We found incidences of Post-traumatic seizure in cases with depressed skull fracture(44.4%), subdural hematoma(28.6%), subarachnoid hemorrhage(28.6%) and intracerebral hemorrhage(21.1%). Of the 230 patients with head trauma, 2.2% had an immediate-onset seizure, 2.6% an early-onset seizure and 9.1% a late-onset seizure. Of the patients with post-traumatic seizure, abnormal EEG findings were found in 50%. EEG abnormalities were slowing (46.2%) and spike(3.8%). Recurrence rate of post-traumatic seizure was 21.9% in this study. We found a high incidence of recurrence in cases of depressed skull fracture, subdural hematoma and epidural hematoma. CONCLUSION: Considering the great influence of seizure on a child's development and long-term prognosis, prevention based on post-traumatic seizure risk assessment is important and antiepileptic prophylaxis should be considered as disk factors.
Adolescent* ; Adult ; Craniocerebral Trauma ; Electroencephalography ; Hematoma ; Hematoma, Subdural ; Humans ; Incidence ; Medical Records ; Mortality ; Prognosis ; Recurrence ; Risk Assessment ; Seizures* ; Skull ; Skull Fracture, Depressed

Behcet's disease is a recurrent and multisystemic disorder which usually persists over many years and is classified under vasculitic syndrome. A classic triad in this disorder is composed of a recurrent oral ulcer, genital ulceration and uveitis. While intestinal Behcet's disease most commonly affects the ileoecal region, dysphagia associated with esophageal ulceration is very uncommon. A 34-year-old-female patient visited our hospital because of dysphagia, epigastric pain and fever. The patient had ulcers on the oral mucosa, soft palate and extemal genitalia. Multiple irregularly marginated ulcers surrounded with hyperemic edematous mucosa were found on the middle and distal esophagus and lesser curvature of the stomach by an esophagogastroduodenoscopic examination. The pathologic findings were non-specific ulcers with necrotizing vasculitis in the vulva and with suspicious vasculitis in the esophagus. So she was diagnosed to have a Behcets disease and was treated with steroid and sulfasalazine. In this study we report a case of esophageal involvement of Behcet's disease with a review of the literature.
Deglutition Disorders ; Esophagus ; Fever ; Genitalia ; Humans ; Mouth Mucosa ; Mucous Membrane ; Oral Ulcer ; Palate, Soft ; Stomach ; Sulfasalazine ; Ulcer ; Uveitis ; Vasculitis ; Vulva

PURPOSE: Pneumonia is one of the most common respiratory diseases in hospitalized children, and often recurs. It has been reported that asthma is one of the significant contributing factors to recurrent pneumonia. On the basis of similarities between asthma and recurrent pneumonia, we intended to evaluate the influence of allergy on recurrent pneumonia. METHODS: Seventy one children with recurrent pneumonia were defined as recurrent group(RG) and twenty one children with first episodes of pneumonia were defined as control group(CG). WBC, total eosinophil count, Eosinophilic Cationic Protein(ECP), serum total IgE and specific IgE for eleven common allergens using the CAP system were measured and compared. Recurrent pneumonia was defined as at least two pneumonia episodes in a year, or at least three episodes from birth to the time of our study. Children with previous allergic disorders were excluded. RESULTS: There were no statistical differences in WBC, total IgE, and ECP between the two groups. Total eosinophil count in RG was significantly higher than CG(P=0.021), significantly correlating with ECP(r=0.755, P<0.05) and total IgE(r=0.354, P<0.05). When the cut-off value was 0.35 kU/L in CAP test, positive prevalence of CAP in RG was significantly higher than CG(P=0.009). Also, the positive prevalence of house dust mites group, especially Dermatophagoides farinae(D.f.), was significantly higher in RG(P=0.019, 0.025, respectively). When the cut-off value was 0.7 kU/L in CAP test, only a positive prevalence of house dust mites group was significantly higher in RG than CG (P=0.042). The quantitative levels of specific IgE for Dermatophagoides pteronyssinus(D.p.) and D.f. were very high in RG(P=0.018, 0.028, respectively), significantly correlating with each other(r=0.639, P<0.05). CONCLUSION: Allergic sensitization, especially to house dust mites, is one important contributable factor in recurrent pneumonia in children. Further study, such as bronchial hyperresponsiveness, is needed in children who were sensitized by D.p. or D.f..
Allergens ; Asthma ; Child* ; Child, Hospitalized ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Eosinophils ; Humans ; Hypersensitivity* ; Immunoglobulin E ; Parturition ; Pneumonia* ; Prevalence ; Pyroglyphidae

To assess the early results, risk factors and optimal timing for coronary artery bypass graft surgery(CABG) after an acute myocardial infarction(AMI), we reviewed our 19 patients who underwent CABG within 30 days after AMI, between June 1994 and October 1996. This study excluded 1 patient whose diagnosis was AMI with ventricular septal rupture. 14 of the patients were male and 5 were female. Their ages ranged from 41 to 77 years(mean age, 60.6+/-10.4 years), and the amount of time between AMI and CABG ranged from 8 hours to 24 days(mean time, 10.6+/-6.4 days). There were 11 anteroseptal infarctions and 8 inferior wall infarctions. 11 patients had transmural infarctions and 8 had subendocardial infarctions. Indications of operations were primary revascularization and postinfarction angina. Three patients required preoperative intra-aortic balloon pump(IABP) support, and 4 additional patients required IABP to be separated from cardiopulmonary bypass. An average of 3.6+/-0.6 vessels per patient were bypassed. The early mortality rate for these 19 patients was 5.3% and late mortality rate was 5.5%, 1-year and 2-year actuarial survival rates were 89.5%. Univariate analysis of mortality showed that an ejection fraction less than 30% and intraopretative IABP supports were associated with risk factors(p value=0.018 and 0.015 respectively). Age, sex, time to CABG, emergency operations, types and locations of infarctions were not significant. Although our studies have weak points in that there was only a small number of patients and the lack of long-term results, we could conclude that early myocardial revascularization is relatively safe after AMI for those individuals with an ejection fraction greater than 30%.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Diagnosis ; Emergencies ; Female ; Humans ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Myocardial Revascularization ; Risk Factors ; Survival Rate ; Transplants ; Ventricular Septal Rupture

PURPOSE: Kawasaki disease is a systemic vasculitis, leading cause of pediatric acquired heart disease. Vascular endothelial growth factor (VEGF) has functions as vascular permeability factor, plays an important role in coronary artery lesion (CAL). We studied the clinical significance of serum VEGF in Kawasaki disease. METHODS: Kawasaki group was 49 patients, and control group was 15 patients. Diagnosis followed AHA (American Heart Association) diagnostic criteria, with blood sampling in acute, subacute, and convalescent phase. Echocardiographic abnormalities were defined and the definition of intravenous gamma globulin (IVGG)-responsive and IVGG-resistant was determined. RESULTS: Serum VEGF of Kawasaki group was significantly higher than of control group. Comparison of serum VEGF between CAL and non-CAL group, between carditis group and non-carditis group showed no significant differences. Subacute serum VEGF was statistically higher in IVGG-resistant group than in IVGG-responsive group, and serum VEGF of IVGG-resistant group in subacute phase was statistically higher than in the other phases. Serum VEGF of convalescent CAL and non-CAL group in acute and subacute phase had meaningful differences. Total fever duration and subacute serum VEGF had positive correlation. Acute serum VEGF had positive correlation with ESR and CRP, all phases serum VEGF had also positive correlation with WBC. Acute and subacute serum VEGF had negative correlations with hemoglobin and albumin. CONCLUSION: Serum VEGF can help to determine the severity of Kawasaki disease, especially subacute serum VEGF seems to be used as a prognostic factor of coronary complication. Afterward, further studies needed with more strict diagnostic criteria and more study groups.
Coronary Vessels ; Diagnosis ; Echocardiography ; Fever ; gamma-Globulins ; Heart ; Heart Diseases ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Myocarditis ; Systemic Vasculitis ; Vascular Endothelial Growth Factor A*

Herpes zoster in infancy is very rare but can be developed following intrauterine or postnatal exposure to varicella zoster virus. We report a case of herpes zoster in a 4-month-old male infant. He had no prior history of primary varicella or varicella vaccination. His mother had no history of varicella infection and no contact history with varicella during pregnancy. He had a history of exposure to his father with herpes zoster 3 months ago, and to his cousin with convalescent chickenpox 2 months ago. Multinucleated, giant cells were shown on a Tzanck smear. He was treated with acyclovir and first generation cephalosporin for herpes zoster with Staphylococcal skin infection, with complete resolution without sequelae.
Acyclovir ; Chickenpox ; Fathers ; Giant Cells ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Infant ; Male ; Mothers ; Pregnancy ; Staphylococcal Skin Infections ; Vaccination

Midgut volvulus is commonly complicated with malrotation, and develops mainly in infants before 1 year old, especially in neonate. Intrauterine midgut volvulus is an extremely rare disease therefore is difficult to diagnose. Furthermore unless the fetus has malrotation, symptoms and results of tests suspicious of fetal midgut volvulus are nonspecific. There are some reports that meconium ileus could be a cause of intrauterine midgut volvulus from foreign countries, however has never been reported in Korea. So we report a case of prematurity born with bowel perforation and gangrene due to intrauterine midgut volvulus caused by meconium ileus.
Fetus ; Gangrene ; Humans ; Ileus ; Infant ; Infant, Newborn ; Intestinal Volvulus ; Korea ; Meconium ; Rare Diseases

Teratoma originate from one or more germ cell layer and commonly arise from sacrococcygeal area in neonate. Teratoma arising from the oropharyngeal cavity is called "epignathus tumor" and is extremely rare in neonate. Clinical manifestation of epignathus tumor vary from asymptomatic to severe respiratory distress symptom. It is reported that most of the tumor are benign in nature. Large teratoma can be diagnosed by prenatal ultrasonography, but most cases were diagnosed with computed tomography or magnetic resonance image after birth. Prognosis is determined by the need for neonatal resuscitation for respiratory distress at the time of birth and the extent of tumor, involving large vessles, skull base or communication with the brain. We experienced a case of epignathus tumor in a neonate with severe respiratory distress immediately after birth, so that reported with review of the literature.
Brain ; Germ Cells ; Humans ; Infant, Newborn ; Magnetic Resonance Spectroscopy ; Parturition ; Prognosis ; Resuscitation ; Skull Base ; Teratoma ; Ultrasonography, Prenatal

Between June 1994 to August 1996, 13 patients underwent emergency coronary artery bypass operations. There were 3 males and 10 females and ages ranged from 56 to 80 years with the mean of 65.5 years. The indications for emergency operations were cardiogenic shock in 12 cases and intractable polymorphic VT(ventricular tachycardia) in 1 case. The causes of cardiogenic shock were acute evolving infarction in 6 cases, PTCA failure in 4 cases, acute myocardial infarction in 1 case, and post-AMI VSR(ventricular septal rupture) in 1 case. Five out of 13 patients could go to operating room within 2 hours. However, the operations were delayed from 3 to 10 hours in 8 patients due to non-medical causes. In 12 patients, 37 distal anastomoses were constructed with only 3 LITA's(left internal thoracic arteries) and 34 saphenous veins. In a patient with post-AMI VSR, VSR repair was added. In a patient with intractable VT and critical stenosis limited to left main coronary artery, left main coronary angioplasty was performed. Five patients died after operation with the operative mortality of 38.5%. Three patients died in the operating room due to LV pump failure, one patient died due to intractable ventricular tachycardia on postoperative second day, and one patient died on postoperative 7th day due to multi-organ failure with complications of mediastinal bleeding, low cardiac output syndrome, ARF, and lower extremity ischemia due to IABP. In 8 survived patients, 3 major complications (mediastinitis, PMI, UGI bleeding) developed but eventually recovered. We think that the aggressive approach to critically ill patients will salvage some of such patients and the most important factor for patient salvage is early surgical intervention before irreversible damage occurs.
Angioplasty ; Cardiac Output, Low ; Constriction, Pathologic ; Coronary Artery Bypass* ; Coronary Vessels* ; Critical Illness ; Emergencies* ; Female ; Hemorrhage ; Humans ; Infarction ; Ischemia ; Lower Extremity ; Male ; Mortality ; Myocardial Infarction ; Operating Rooms ; Saphenous Vein ; Shock ; Shock, Cardiogenic* ; Tachycardia, Ventricular

Kawasaki diseases occur frequently in children beyond the age of 4 years, but classic Kawasaki disease in newborns are rare and have not been reported in Korea yet. We report a case of classic Kawasaki disease in neonate who is 21 days old girl and has no response to gamma-globulin although early diagnosis and treatment. Her clinical features met typical Kawasaki disease, but unusually she had a non suppurative labia major erythema and severe edema instead of cervical lymphadenitis. She had persistent fever and progressive carditis with coronary dilatation in spite of 3 doses of gamma globulin. Her fever was subsided after 3 doses of intravenous methyl prednisolone. In the subacute stage her other symptoms subsided and appeared typical desquamation of fingers and toe. Finally she had mild mitral regurgitation and diffuse coronary dilatation when she was discharged. Since one year follow up, with continuous aspirin medication, now she is very healthy, and her coronary dilatation was normalized and not any more valvular regurgitation.
Aspirin ; Child ; Dilatation ; Early Diagnosis ; Edema* ; Erythema* ; Female ; Fever ; Fingers ; Follow-Up Studies ; gamma-Globulins ; Humans ; Infant, Newborn* ; Korea ; Lymphadenitis ; Mitral Valve Insufficiency ; Mucocutaneous Lymph Node Syndrome* ; Myocarditis ; Prednisolone ; Toes