No abstract available.
Child* ; Down Syndrome* ; Humans

No abstract available.
Anesthesia, Local* ; Arthroscopy* ; Knee*

OBJECTIVES: The multiple sleep latency test (MSLT) is commonly used as a valid objective measure of sleepiness. The procedure of MSLT is well standardized but the sleep onset criterion is somewhat variable. One epoch of stage 1 sleep is the most commonly used criterion, and the criterion of three epochs of stage 1 sleep is also used. The purpose of this study was to compare the two criteria used to determine sleep onset. METHODS: We retrospectively analyzed 60 consecutive MSLT that were performed according to a standaridized protocol. We scored each test using the two different criteria for sleep onset and then statistically analyed the results. RESULTS: Using the different criteria, 20 patients among 60 showed changes in mean sleep latency (33.3%). The extent of change ranged from 1.3% to 38.5% (mean 15.9%). Non-narcoleptic patients showed a significantly higher incidence of change than other sleep disorder patients. CONCLUSION: Changes in mean sleep latency occurred according to the different criteria of sleep onset. But the difference arising from different criteria was statistically not significant in patients with moderate to severe sleepiness. Considering that 1 epoch criterion for sleep onset is more sensitive in detecting clinically significant sleepiness, the authors suggest that the 1 epoch criterion is more reliable than the 3 epochs criterion.
Humans ; Incidence ; Retrospective Studies

PURPOSE: Gamma-globulin is effective in preventing coronary aneurysm, the primary complication of Kawasaki disease(KD). However, in order to predict high-risk cases which absolutely require gamma-globulin, because of its high expenses, Harada score(HS) was introduced in Japan in 1990. We attempted to compare HS scoring with the health insurance criteria currently used in Korea. METHODS: Retrospective studies were performed on 123 cases who did not receive gamma-globulin among 283 KD patients who had been treated in this hospital from 1990 to 1997. Chi-square analyses were used. RESULTS: Of the 123 subjects, 91(74%) had HS scores higher than 4, and 32(26%) had HS less than 4, whereas 56(45.5%) belonged to the high-risk group and 67(54.5%) to the low-risk group according to the insurance criteria, with both methods differing significantly(P<0.001). Of 18 cases with the coronary complications only 2 cases had an HS<4, whereas 4 patients belonged to the low-risk group. Even though both methods did not differ significantly in discriminating risky cases, twice as many patients may have been denied adequate treatment if the insurance criteria had been applied. Of various factors, the age and albumin level were found relevant to the coronary complication. CONCLUSION: No statistically significant difference was found between HS and the insurance criteria in predicting the incidence of coronary complications in 123 KD patients. But a less lenient criteria used in the current health insurance policy may result in more cases with coronary complications.
Coronary Aneurysm* ; gamma-Globulins ; Humans ; Incidence ; Insurance ; Insurance, Health ; Japan ; Korea ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies

A clinical study was carried out on patients with tuberculous meningitis who were admitted to the Department of Pediatrics, Kwangju Christian Hospital during a 9 year period from January, 1971 to December, 1979. The following results were obtained. 1) About 3/4 of all cases were under the age of 6, the majority being between the age of one and three. The male-to-female ratio was 1.3:1. 2) Seasonal incidence was in the order of spring, summer, winter and autumn, but no sign ificant differences were noted. 3) A family history of tuberculosis was found in 41.5%, usually in one of the parents. 4) A history of B.C.G. vaccination was found in 16.7% of tuberculous meningitis cases. The tuberculin test was positive in 28.9%. 5) The most frequent symptoms on admission were vomiting, fever, convulsion and headache, in that order. 6) The major neurologic findings were unconsciousness(34.0%), neck stiffness(76.4%), and positive Kernig's sign(63.2%). 7) Leukocytes in the C.S.F. on admission were generally elevated, but below the range of 500/mm3 in 74.5% of cases, and the mean count was 278.7/mm3 with 66.7% lymphocytes. Mean protein level in the C.S.F. was 162.5mg/dl, and 94.3% of all cases were over 50mg/dl. Sugar in the C.S.F. was definitely reduced to less than 120 mEq/L in 78.3%, with the mean level being 112.8mEq/L. 8) Chest X-ray revealed tuberculous lesions in 69.8% and miliary tuberculosis was found in 36.8% of cases. 9) The highest mortality was seen in young infants. Among 26 patients of clinical stage I on admission, 21(80.3%) recovered, and 35(79.5%) of 44 patients of stage II recovered, whereas only 13(36.1%) out of 36 patients of stage III were cured. Over-all mortality rate was 5.7% of those followed.
Fever ; Gwangju ; Headache ; Humans ; Incidence ; Infant ; Leukocytes ; Lymphocytes ; Mortality ; Neck ; Neurologic Manifestations ; Parents ; Pediatrics ; Seasons ; Seizures ; Thorax ; Tuberculin Test ; Tuberculosis ; Tuberculosis, Meningeal* ; Tuberculosis, Miliary ; Vaccination ; Vomiting

The general intensive care unit of Presbyterian Medical Centar was opened in 1965 with 3 beds and expanded to 17 heds in 1981. Generally, the type of I.C.U. is multidisciplinary and intensive care often means a combination of recovery room service and intensive therapy. Here, we have analyzed clinically 4, 986 LC.U. patients admitted between Jan. 1986 and Dec. 1990. to obtain a better guide and management in the I.C.U.. The results were as follows I) Total number of patients for 5 years was 4,986; 1,071 patients in 1986, 1,102 patients in 1987, 1,012 patients in 1988, 952 patients in 1989, 849 patients in 1990. The ratio of male to female patients was almost 2: 1. 2) Total admission days in the I.C.U. was 26,892 days and average patient stay being 5.5 days. The average age for 5 years was 50.9 year-old-age. 3) The majority of the patients(3,526 cases, 70%) stayed in the I.C.U. less than 5 days The number of patients staying more than 9 days increased from 127 cases(12%) in 1986 to 155 cases (18%) in 1990 4) The group representing the highest number of patients admitted was in the 50 to 59 year-old-age group. About 60% of the patients admitted were in the 40 to 69 year-old-age groups and the highest mortality rate occurred in the 70 to 79 year-old-age group(24.4%). 5) The number of the patients admitted to the department of internal medicine, which was the highest among all departments, was 3,564 caaes. Mortality rate was highest in the department of pediatric. 6) During 5 years, overall mortality rate was 21.9%(1,091 cases) inclusive of the hopeless-dis-charged patients. 7) Liver cirrhosis & variceal rupture of esophagus was the commonest disease. Mortality rate WS8 highest in leukemia(50%) & lymyhoma(50%) and lowest in acute renal failure(0%). 8) After putting into operation of nation-wide medical. insurance scheme, average patient stay and average age were increased. From the above results, it can be concluded that average admission days, average age and patients staying more than 9 days in the I.C.U. increased annually.
Esophagus ; Female ; Humans ; Insurance ; Intensive Care Units* ; Critical Care* ; Internal Medicine ; Liver Cirrhosis ; Male ; Mortality ; Protestantism ; Recovery Room ; Rupture

A Clinical study was made of 88 pediatric patients with miliary tuberculosis, who were admitted to the Pediatric Department of Kwangju Christian Hospital during the period of January, 1971 through December, 1980. 1) The incidence of miliary tuberculosis in children was 0.6%(88 cases) of the total pediatric admission cases(13969), and 12.5% (88 cases) of the total pediatric tuberculous patiens(705). 2) The highest incidence was found in those under the age of 3 years, comprising 63.7%(56 cases) of all cases. The sex ratio of male to female was 1.5:1, which is not significant. 3) The most prevalent season was Spring, with 34.1% (30 cases). 4) The source of infection was found within their family in 36.3% (32cases). 5) Only 14.8% (13 cases) had received BCG innoculation. 6) Predisposing factors were found in 24.9% (21 cases) and these were measles, chicken pox, pertussis, typhoid fever in decreasing order of frequency. 7) Chief complaints on admission in the order of frequency were:fever (72.7%), coughing (68.2%), general weakeness (37.5%), vomiting (35.2%). 8) Principal clinical features on admission were marked adnormal auscltatory findings (68.2%), emaciation (54.5%), adnormal neurologic sings (42.0%), cervical lymphaderopathy (39.8%) and hepatosplenmegaly (22.7%). 9) Tuberculin skin test was done in 55 cases and positive reaction was obtained in 21.8% (12 cases). 10) Hematologic findings revealed a mild degree of anemia in 52.3% of all patients and leukocytosis in 75.0%. 11) AFB smear was positive in only 19.3% (17 cases/88), and the highest positive rate was found in sputum (40.0%). 12) Tuberculous meningitis was the most most common disease associated with miliary tuberculosis. 40.9% (36 cases( of all miliary tuberculosis cases were complicated by tuberculous meningitis, with the highest incidence of 72.2% (56 cases) under the age of 3 years. 13) The usual treatment was the triple regimen of INH, PAS and SM, though PAS was replaced by EMB or Rifampin in recent cases, Corticosteroids were added in complicated cases. 14) In 21.6% (19 cases) of total cases, the clinical symptoms and the miliary density on X-ray disappeared after 3 months of treatment. 15) The mortality rate was 10.2% (9 cases/88).
Adrenal Cortex Hormones ; Anemia ; Causality ; Chickenpox ; Child* ; Cough ; Emaciation ; Female ; Gwangju ; Humans ; Incidence ; Leukocytosis ; Male ; Measles ; Mortality ; Mycobacterium bovis ; Rifampin ; Seasons ; Sex Ratio ; Skin Tests ; Sputum ; Tuberculin ; Tuberculosis, Meningeal ; Tuberculosis, Miliary* ; Typhoid Fever ; Vomiting ; Whooping Cough

OBJECTIVE: To survey the clinical features, complications, prognostic factors and Five-year survival rates of 398 patients with invasive cervical cancer(stage Ib-IIb), subjected to radical hysterectomy and bilateral pelvic lymphadenectomy. METHODS: Medical records and pathologic reports were reviewed retrospectively on 398 cases, diagnosed and operated on during the period of Jan. 1988 - Dec. 1998. Five-year survival rates were estimated by the Kaplan-Meier method, and prognostic factors were assessed using Wilcoxon test. RESULTS: Of the 398 cases, 285 were in stage Ib(71.6%), 58 in stage IIa(14.5%), and 55 in stage IIb(13.8%). The mean age of patients was 48+/-9.9 years. Neoadjuvant chemotherapy was given to 200 patients(50.2%), Adjuvnat radiotherapy in 160 patients(40.2%) postoperatively. Operative complications occured in 121 patients(30%). Massive blood loss and bladder dysfuction were frequent complications(11.3% and 10.3%, respectively). Others were urinary tract infection(9.3%), wound infection(7.5%), lymphocyst(3.5%) and urinary tract fistula(0.7%), respectively. The Five-year survival rates for stage Ib, IIa, and IIb were 84.2, 82.8%, and 75.8%, respectively. Factors that affect the Five-year survival rates were cell type(small cell Vs other, P=0.0146), tumor size(< or = 3cm Vs >3cm, P=0.0425), depth of invasion( < or = 5gm Vs >5ne, P= 0.0007), response of chemotherapy(poor response Vs other, P= 0.0001), LN metastasis(1 Vs 2 Vs more, P=0.0001). CONCLUSION: Accumulating the clinical experience, we could improve results, reduce complications and speculated that the survival rates could be improved by neoadjuvant chemotherapy and/or adjuvant postoperative radiotherpy. Prospective randomized trials are needed to evaluate our approach and to be compared with concurrent chemoradiotherapy to definite its precise role in locally advanced cervical cancer.
Chemoradiotherapy ; Drug Therapy ; Humans ; Hysterectomy* ; Lymph Node Excision ; Medical Records ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Urinary Bladder ; Urinary Tract ; Uterine Cervical Neoplasms* ; Wounds and Injuries

PURPOSE: To examine the results of macular hole surgery using pars plana vitrectomy (PPV), triamcinolone-assisted peeling of the internal limiting membrane (ILM), and intravitreous air in idiopathic stage 2 and 3 macular holes. METHODS: Thirteen eyes of 13 consecutive patients with idiopathic macular hole underwent a PPV with triamcinolone-assisted ILM peeling and intravitreous air tamponade. An air-fluid exchange was performed and the patient was asked to maintain a face-down position at home for 4 days. The follow-up period was 6 months or more in all cases. If a significant cataract was present before surgery, a combined phacoemulsification with posterior chamber lens implantation was performed at the time of the macular hole surgery. The closure of the macular hole was determined by biomicroscopy and Optical Coherence Tomography (OCT). RESULTS: The idiopathic macular hole was closed after the primary operation in all 13 patients. The postoperative visual acuities (0.1 to 0.9) significantly improved from the preoperative visual acuities (0.02 to 0.4) in all eyes. There was no recurrence of the macular hole and there were no adverse effects of the intraoperative use of triamcinolone and ILM peeling during the follow-up period. CONCLUSIONS: This study suggests that triamcinolone-assisted ILM peeling with intravitreous air may be an effective technique for stage 2 and 3 macular holes. This procedure could reduce the face-down position time and improve early visual rehabilitation by using air instead of long-acting gas tamponade.
Cataract ; Eye ; Follow-Up Studies ; Humans ; Membranes ; Phacoemulsification ; Recurrence ; Retinal Perforations ; Tomography, Optical Coherence ; Triamcinolone ; Visual Acuity ; Vitrectomy

Primary lymphoma of the kidney is rare, and in most cases is attributable to lymphomatous renal infilitration of systemic non-Hodgkin's lymphoma or an extension from an adjacent site of the disease. Since the renal parenchyma is not a lymphoid organ, the mechanism by which renal lymphoma occur remains poorly understood. We report here a case of primary bilateral B-cell renal lymphoma in 26-year-old man who was treated successfully with combination chemotherapy.
Adult ; B-Lymphocytes* ; Drug Therapy, Combination ; Humans ; Kidney ; Lymphoma* ; Lymphoma, Non-Hodgkin