PURPOSE: H. pylori infection was recently reported to be associated with unexplained iron-deficiency anemia(IDA) in children and adolescents. H. pylori-related IDA was thought to occur due to GI blood loss, scavenging of iron by H. pylori and iron malabsorption. The aim of this study was to examine how the status of H. pylori infection and age of children affected RBC indices, serum iron level and TIBC. METHODS: We performed esophagogastroduodenoscopy, and examined RBC indices, serum iron and TIBC on 178 pediatric patients with recurrent abdominal pain. H. pylori infection was assessed by CLO test and silver stain of gastric biopsy specimen. RESULTS: H. pylori infection was found in 42 of 178 patients(23.6%). In children with H. pylori infection, the prevalence of iron deficiency(ID) and IDA(39.0% and 10.3%, respectively) was higher than in children without H. pylori infection(29.6% and 4.1%, respectively), but there was no statistically significant difference. Serum iron level was lower(69.5+/-32.7 vs 77.3+/-34.1g/dL; P= 0.08) and TIBC was higher(380.8+/-50.4 vs 366.9+/-47.0g/dL; P=0.09) in children with H. pylori infection than in children without H. pylori infection. All RBC indices and iron saturation were lower in children with H. pylori infection than in children without H. pylori infection, but there was no significant difference between the two groups. In correlation analysis, serum iron, Hgb, Hct, MCV and MCH were significantly increased by age in children without H. pylori infection (P<0.05), but MCH and MCHC were decreased significantly(P<0.05) by age in children with H. pylori infection. In multiple regression analysis, the change of serum iron, MCH and MCHC by age was significantly influenced by the status of H. pylori infection(P<0.05). CONCLUSION: H. pylori infection decreases RBC indices and serum iron and increases TIBC in children. These changes become prominent as age increases. This age effect rnay be related to the duration of H. pylori infection. (J Korean Pediatr Soc 2000;43:755-762)
Abdominal Pain ; Adolescent ; Anemia, Iron-Deficiency ; Biopsy ; Child* ; Endoscopy, Digestive System ; Erythrocytes* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Iron* ; Prevalence ; Silver

PURPOSE: To evaluate the relative value of arterial, portal venous and delayed phase images of spiral CT in the detection of metastatic tumor of the liver. MATERIALS AND METHODS: Forty-three metastatic tumors in twelve patients were underwent tri-phasic spiral CT examination with injection of 120 ml ionic contrast material (36 g of iodine) at the rate of 3 ml/sec. Arterial, portal venous and delayed phase CT images were obtained 35, 65, and 360 seconds after the start of contrast injection, respectively. RESULTS: Arterial phase images detected 35(81%), portal venous phase images 43(100%), and delayed phase images 34(79%) lesions, respectively(p<0.05). All masses larger than 2cm(n=23) were detected in all three phases, whereas 60%, 100%, 55%of the masses smaller than 2cm(n=20) were detected in arterial, portal venous and delayed phase CT, respectively. The best contrast between masses and the hepatic parenchyma was in portal venous phase followed by arterial and delayed phase(p<0.01). In two hypervascular masses, the contrast was better in arterial phase. CONCLUSION: Portal venous phase of spiral CT is optimal in the detection of metastatic tumor of the liver. Arterial phase may be helpful for the detection of hypervascular metastasis. Delayed phase should be used restrictively.
Humans ; Liver* ; Neoplasm Metastasis ; Tomography, Spiral Computed*

No abstract available.
Head*

Sialadenosis, characterized by a uniform hypertrophy and hyperplasia of the acinar parenchyma of salivary glands, is associated with a variety of systemic diseases or functional disorders. The disease is associated with underlying systemic factors such as diabetes, malnutrition, alcohol abuse and drugs. So it is also referred to as nutritional mumps. Bulimia nervosa is a disorder that is defined as binge eating combined with inappropriate ways of stopping weight gain. It is significantly more common in females than in males. In the past few years, the number of reports concerning eating disorders have increased in developing countries including Korea, where economic development has also brought about rapid introduction of the Western culture. The authors have observed a rare case of sialadenosis of the submandibular gland in association with bulimia nervosa and report this with literature review.
Alcoholism ; Bulimia Nervosa* ; Bulimia* ; Developing Countries ; Feeding and Eating Disorders ; Economic Development ; Female ; Humans ; Hyperplasia ; Hypertrophy ; Korea ; Male ; Malnutrition ; Mumps ; Salivary Glands ; Sialadenitis ; Submandibular Gland ; Weight Gain

Most authorities including WHO recommended immununizing infants with BCG as early as possible in areas prevalent with tuberculosis, however the optimal time for immunization has not well been characterized. Therefore the investigation was undertaken by vaccinating various infant groups of different ages with BCG and subsequently evaluating for adverse effects and tuberculin reactions, in order to contribute to undestanding the optimal time for immunization. Four hundred eighty three infants from the newborn nursery and the well baby clinic of Hanyang University Hospital who had no family history of tuberculosis were divided into three groups; group I of infants immunized within 7 days after birth, group II of infants immunized at about 1 month of age and group III of infants immunized at about 3 months of age. To each infant 0.1 ml of BCG(Institute Merieux, France) was administered intradermaly and approximately 3 months later tuberculin skin test using 5 TU PPD (NIH, Korea) was performed. Adverse reactions following BCG vaccination such as temperature elevation, induration alone or with suppuration at or near the injection site, and lymph node enlargement were also analyzed. The summary of the results is as follows. 1) Distribution of diameters of induration on tuberculin skin test illustrated incomplete bimodal configuration in all three different age groups. The means 2 standard deviations of diameters of indurations distributed on the main bells were 10.07 4.52 mm in group I, 10.65 3.82 mm in group II, and 10.83 5.08 mm in group III, and were not significantly different. 2) Criteria for positive tuberculin reaction was diameters of indurations equal to or greater than 6mm, 2 standard deviations below the mean values of diameters of indurations on the main bells. 3) The positive tuberculin reaction rates of 85.8% in group II and 88.6% in group III were significantly greater than 74.1% in group I. 4) Incidence of complications following BCG vaccination including temperature elevation, induration with suppuration, and localized lymphadenopathy was not different among three groups and the serious complications such as temperature elevation and lymphadenopathy were minimal. The data indicate that it is appropriate to immunize infants with BCG at about one month of age and the incidence of complications following BCG vaccination was not different among three infant groups of different ages.
Humans ; Immunization ; Incidence ; Infant* ; Infant, Newborn ; Lymph Nodes ; Lymphatic Diseases ; Mycobacterium bovis* ; Nurseries ; Parturition ; Skin Tests* ; Skin* ; Suppuration ; Tuberculin Test ; Tuberculin* ; Tuberculosis ; Vaccination*

Hemorrhagic fever with renal syndrome (HIFRS), scrub typhus, murine typhus and leptospirosis have been the principal acute febrile diseases in Korea. To evaluate the seroepidemiologic patterns of acute febrile illness, sera collected from 2,423 patients in 1996 were examined for antibodies against Hantaan virus, Orientia tsutsugamushi, Rickettsia typhi, and Borrelia burgdorferi by indirect immunofluorescent antibody technique (IFA) and macroscopic agglutination test for Leptospira interogans. Seropositive cases against O. tsutsugamushi, Rickettsia typhi, Leptispira interogans and Hantaan virus were 192 (7.9%), 193 (8.0%), 12 (0.5%) and 324 (13.4%), respectively. Male was more affected in HFRS and murine typhus contrasting to scrub typhus and leptospirosis in female. Most positive cases occurred during October and November for scrub typhus, and during November and December for HFRS. These results showed similar patterns with previous epidemical data for recent couple of years, and possibly implied no significant changes occurred in ecologic situations for acute febrile diseases in Korea.
Agglutination Tests ; Antibodies ; Borrelia burgdorferi ; Female ; Hantaan virus ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Korea* ; Leptospira ; Leptospirosis ; Male ; Orientia tsutsugamushi ; Rickettsia typhi ; Scrub Typhus ; Typhus, Endemic Flea-Borne

PURPOSE: Recent studies have reported on application of fibrin glue composed of fibrinogen and thrombin to nerve anastomosis, which can be another candidate for vessel anastomosis. However, no research regarding the risk and effectiveness of thrombin in microvascular free tissue transfer has been reported. Therefore, the aim of study is to determine the risk and effectiveness of thrombin on microvascular free tissue transfer through clinical cases. MATERIALS AND METHODS: Twenty-five patients underwent free flap reconstruction for soft tissue defect or bone exposure in our institute from March 2011 to February 2014. In the group using thrombin, dissolved powder thrombin (5,000 IU/amp) was mixed with 10 mL normal saline. Saline mixed with thrombin was applied on the flap, recipient, and around vessel anastomosis. In the control group, free flap was performed using the same method, except using thrombin. We analyzed the results between the two groups. RESULTS: All flaps survived. The group using thrombin included 14 patients and the control group included 11 patients. Hematoma was found in two cases, respectively, in each group. The group using thrombin showed lower incidence of hematoma than the control group. No difference in survival rate of the flap was observed between the thrombin group and the control group. CONCLUSION: Results of this study showed that use of saline mixed with thrombin in free tissue transfer may be safe and effective for prevention of hematoma formation in the recipient site.
Fibrin Tissue Adhesive ; Fibrinogen ; Free Tissue Flaps ; Hematoma ; Humans ; Incidence ; Survival Rate ; Thrombin*

Ganglioneruroblastoma and neuroblastoma are among commonest types of childhood malignancy and a number of unique paraneoplastic syndromes have associated with both localized and disseminated neuroblastoma. The coincidence of neuroblastoma and myoclonic encephalopathy or other paraneoplastic syndromes occurs relatively rare, and therefore, failure to recognize this association could result in delays in both diagnosis and treatment, and the result could prove to be unfortunately fatal. The mechanism which underlies the remote damaging effect of neural crest tumor, especially neuroblastoma, on the nervous system resulting in myoclonic encephalopathy is by no means clear. In addition the nature and the extent of the pathologic lesion are inconsistent. We experienced a case of myoclonic encephalopathy associated with an occult mediastinal ganglioneuroblastoma in a 22-month-old girl who was hospitalized for inability to walk without support and tilting of the head to the left side. She became increasingly ataxic, and during the hospitalization myoclonic jerks of upper extremities and head along with chaotic, rapidly flickering, multidirectional spontaneous eye movements, were noted. Laboratory data included normal complete blood count, urinalysis, BUN and creatinine, electrolytes and bone marrow. Chest X-ray and chest CT revealed a relatively well marginated right posterior mediastinal mass. In a 24 hours urine excretion test, VMA and catecholamines were increased. Over the next 2 weeks, a surgical exploration revealed a right posterior mediastinal mass. Microscopically the mass proved to be a ganglioneuroblastoma, extending to right innominate artery and right axillary lymph nodes. Within 2 weeks after the surgery, radiotherapy (2,400 rads) and chemotherapy (CTX, DTIC, VCR) were started, but corticosteroid was not used. She has been free of tumor and abnormal neurological systemic symptoms and signs for 1 1/2 year since the completion of chemotherapy. In the 3 1/2 years follow-up period, her neurologic symptoms has completely resolved by the completion of 2 years chemotherapy. We report a case of mycoclonic encephalopathy associated with hidden ganglioneuroblastoma in 22-month-old girl.
Blood Cell Count ; Bone Marrow ; Brachiocephalic Trunk ; Catecholamines ; Creatinine ; Dacarbazine ; Diagnosis ; Drug Therapy ; Electrolytes ; Epilepsies, Myoclonic* ; Eye Movements ; Female ; Follow-Up Studies ; Ganglioneuroblastoma* ; Head ; Hospitalization ; Humans ; Infant ; Lymph Nodes ; Myoclonus ; Nervous System ; Neural Crest ; Neuroblastoma ; Neurologic Manifestations ; Paraneoplastic Syndromes* ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed ; Upper Extremity ; Urinalysis

PURPOSE: To verify the usefulness of left portal vein angle (LPVA) on CT scan in the diagnosis of liver cirrhosis and to compare its diagnostic value with that of caudate to right lobe ratio (C/RL ratio). MATERIALS AND METHODS: LPVA, an angle formed by a vertical line and a line connecting the center of the vertebral body to the umbilical point of the left portal vein, and C/RL ratio were measured on CT scans of 100 cirrhotic and 100 normal livers. Diagnostic values of LPVA and C/RL ratio were compared statistically. RESULTS: The mean of LPVA was 18.9 degrees(SD; 7.6) for normal livers and 25.8 degreesSD; 8.4) for cirrhotic livers (P<0.001). The mean of C/RL ratio was 0.47(SD; 1.10) for normal livers and 0.58(SD;0.14) for cirrhotic livers (P<0.001). When LPVA was greater than 30 degreesliver cirrhosis was diagnosed with 36% sensitivity and 92% specificity. When C/RL ratio was greater than 0.60, the diagnose of liver cirrhosis was with 41% sensitivity and 90% specificity. There was no significant difference of the diagnostic accuracy between LPVA and C/R L ratio in ROC analysis. CONCLUSION: Both LPVA and C/RL ratio are useful diagnostic indices of liver cirrhosis on CTscan. LPVA is more convenient to measure than C/RL ratio.
Diagnosis* ; Fibrosis ; Liver Cirrhosis* ; Liver* ; Portal Vein* ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed

The incidence of thyroid cancer has been rapidly increased in Korea. Although fine needle aspiration cytology is recommended for diagnosis of cancer, there are some limitations. Patients with indeterminate or suspicious cytology category in which malignancy cannot be ruled out usually undergone a thyroidectomy, however, only 10~25% of them finally diagnosed as cancer. According to the progress in understanding molecular mechanism, some mutations or other molecular alterations have been studied for the diagnostic and prognostic markers for thyroid cancer. The majority of papillary thyroid cancers have BRAF and RAS mutations or RET/PTC rearrangement, and approximately 80% of follicular thyroid cancers harbor a RAS mutation or PAX8/PPARgamma rearrangement. These genetic alterations are mostly studied and current clinical guidelines suggested that these molecular markers may help management for patients with indeterminate cytology. In addition, recent studies demonstrated the high sensitivity and specificity of thyroid-stimulating hormone receptor mRNA in diagnosing cancer in patients with indeterminate cytology. For the detection of recurrent or residual thyroid cancer, serum thyroglobulin is the only circulating marker in clinical practice. However, it lacks sensitivity and is unreliable specifically in the presence of antibodies to thyroglobulin. Recent studies demonstrated a significant role of measuring the mRNA of thyroglobulin, thyroid peroxidase, thyroid-stimulating hormone receptor, and sodium/iodine symporter in peripheral blood for monitoring of the recurrence of thyroid cancer.
Antibodies ; Biopsy, Fine-Needle ; Humans ; Incidence ; Iodide Peroxidase ; Ion Transport ; Korea ; Recurrence ; RNA, Messenger ; Sensitivity and Specificity ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Thyrotropin