PURPOSE: Non-accidental intracranial hemorrhage in children is not low in incidence and results in high mortality and serious sequelae. So, the authors have researched the distribution of sex and age, causes, symptoms and signs, hemorrhagic types, mortality rate and sequelae of the patients hospitalized with non-accidental intracranial hemorrhage at Hallym University Sacred Heart Hospital. METHODS: The medical records of twenty patients, aged 15 or younger, and excluding neonatal patients, were analyzed retrospectively. The patients in this study were admitted with non-accidental intracranial hemorrhage from January 1999 to June 2002. RESULTS: Of the twenty cases, the ratio of male to female was 1 : 0.8. The patients aged one or less and between 11 and 15 were discovered to be the most frequent cases. Shaken baby syndrome and arteriovenous malformation were found to be the most frequent causes. Seizure was most frequently found to be a symptom and a sign. Hemorrhagic type was classified into subdural hemorrhage eight, intracerebral hemorrhage five. There were three mortal cases. Twelve surviving patients, excluding five not-followed ones, were reclassified into six cases of complete recovery and six of sequalae. CONCLUSION: Non-accidental intracranial hemorrhage in children is not low in incidence, with a high mortality rate and a high incidence of serious sequelae after survival. Consequently, early diagnosis and appropriate treatment are required. In addition, appropriate rehabilitation after treatment is needed because the high survival rate due to advanced medical treatment results in an increasing number of neurologic sequelae.
Arteriovenous Malformations ; Cerebral Hemorrhage ; Child* ; Early Diagnosis ; Female ; Heart ; Hematoma, Subdural ; Humans ; Incidence ; Intracranial Hemorrhages* ; Male ; Medical Records ; Mortality ; Rehabilitation ; Retrospective Studies ; Seizures ; Shaken Baby Syndrome ; Survival Rate

PURPOSE: The present study was designated to sex, age, etiology of acute symptomatic seizures, which refer to the seizure caused by specific and transient pathophysiologic abnormalities in the central nervous system and other systems, and furthermore to analyze the incidence of acute symptomatic seizures before and during hospitalization. METHODS: The medical records of six hundred and ten convulsive children under fifteen years of age, who visited the Hallym University Sacred Heart Hospital from January 1999 to May 2001, were reviewed. One hundred and fourteen cases out of them were analyzed, and febrile seizures and unprovoked seizures were excluded. RESULTS: Among six hundred and ten children who had seizure during hospitalization, one hundred and fourteen(18.7%) had acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures. The ratio of male to female was 1:2.1 and the peak age was three or less, accounting for 93.9%. Acute symptomatic seizures were caused by acute gastroenteritis(42.0%), metabolic/toxic disturbances(34.1%), cerebrovascular diseases(8.8%), CNS infections(8.0%), hypoxemia(4.4%), brain tumors(1.8%), and others(0.9 %). Remarkably, hypocalcemia and shaken baby syndrom were up to 82.1% of metabolic/ toxic distubances and 30.0% of cerebrovascular diseases, respectively. Among the one hundred and fourteen patients, 41.2% suffered from seizures before and during hospitalization and 11.4% did not before but did during hospitalization. CONCLUSION: Eighteen point seven percent of the cases of convulsions reviewed were classified into acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures with the male to female ratio of 1:2.1 and high incidence age of three or less years. The leading causes of acute symtomatic seizures were acute gastroenteritis and hypocalcemia, comprising 70%. Shaken baby syrome and hyponatremia due to water intoxication can be prevented by public education about the danger, and central nervous system infection can be reduced by vaccine development and nationwide vaccination against the bacteria causing the central nervous system infection. In addition, appropriate prevention and management of seizure attacks are required for the patients with acute symptomatic seizures during hospitalization.
Bacteria ; Brain ; Central Nervous System ; Central Nervous System Infections ; Child* ; Education ; Female ; Gastroenteritis ; Heart ; Hospitalization ; Humans ; Hypocalcemia ; Hyponatremia ; Incidence ; Male ; Medical Records ; Seizures* ; Seizures, Febrile ; Vaccination ; Water Intoxication

PURPOSE: The aim of this study was to determine whether the panoramic mandibular index (PMI) is useful for assessing bone mineral density. We also analyzed the potential correlations between PMI parameters and patient age. MATERIALS AND METHODS: Four observers measured the PMI of both sides of the mental foramen using a picture archiving and communication system and images in the Digital Imaging and Communications in Medicine format. They studied 300 panoramic radiographic images of patients belonging to the following age groups: 40–49 years, 50–59 years, 60–69 years, 70–79 years, and 80–89 years. The observers were allowed to zoom in or out and to adjust the contrast of the images. Further, they were instructed to record the reasons for any measurements that could not be made. Then, we conducted a reliability analysis of the measured PMI and assessed the correlations between different patient age groups and the 3 parameters used for determining the PMI from the available data. RESULTS: Among the 600 data items collected, 23 items were considered unmeasurable by at least 1 observer for the following 4 reasons: postoperative state, lesion, unidentified mental foramen, and alveolar bone loss. The intraobserver reproducibility of the measurable data was 0.611-0.752. The mandibular cortical width (MCW) decreased significantly as patient age increased. CONCLUSION: PMI had limited usability when the margin of the mental foramen was not clear. In contrast, MCW, a parameter used for determining the PMI, had fewer drawbacks than the PMI with respect to bone mineral density measurements and exhibited a significant correlation with patient age.
Alveolar Bone Loss ; Bone Density ; Humans ; Mandible ; Radiography

Shaken baby syndrome is a serious form of child abuse, mostly involving children younger than 2 years. It results from extreme rotational cranial acceleration induced by violent shaking. The characteristic injuries include subdural hemorrhage, retinal hemorrhage, and fracture of ribs or long bones. If physicians have no recognition of, or suspicion about, shaken baby syndrome, this syndome is difficult to diagnosis because of a lack of obvious external signs and failure of the abuser to admit his or her actions. In addition to the high mortality, 60% of survivors have significant long term neurologic and developmental abnormality. The authors experienced five cases of shaken baby syndrome presented with seizures or vomiting, without external signs of trauma. All of these cases had subdural hemorrhages, and four cases had retinal hemorrahges. In our follow up, two children were found to have sequelae such as quadriplegia, monoplegia, and developmental delay. We emphasize that early recognition and prompt treament are key to overall success of case management. The incidence of shaken baby syndrome can be reduced through public awareness and education of parents not to shake a babies.
Acceleration ; Case Management ; Child ; Child Abuse ; Diagnosis ; Education ; Follow-Up Studies ; Hematoma, Subdural ; Hemiplegia ; Humans ; Incidence ; Mortality ; Parents ; Quadriplegia ; Retinal Hemorrhage ; Retinaldehyde ; Ribs ; Seizures ; Shaken Baby Syndrome* ; Survivors ; Vomiting

PURPOSE: To raise awareness of the clinical importance of, and the need for proper management of acute focal bacterial nephritis(AFBN), we analyzed 22 AFBN patients and 22 other upper urinary tract infection patients by use of comparative studies. METHODS: From January 2000 to May 2002, 22 AFBN patients aged from 1 month to 12 months were selected. As a control group, 22 UTI patients with no radiologic abnormalities were selected and matched by age and sex. RESULTS: The incidence of AFBN was more common in boys than in girls. Since both groups had similar symptoms, it was difficult to diagnose AFBN by clinical presentations alone. ESR and CRP were significantly higher in AFBN patients. The most common causative organism was E. coli in both groups. On the sonographic findings, the most lesions were seen on the upper lobe of the kidney; more frequently, on left kidney. The lesions showed globular or wedge-shaped increased echogenecity. 99mTc-DMSA scan showed the complete coincidence of the location, size and shape in all cases compared to the findings of renal sonography. CONCLUSION: The roles of renal sonography and DMSA scan were very important, and ultrasonography was an excellent initial tool in diagnosing AFBN. Since the degree of infection in AFBN is more severe than other urinary tract infections and evollution into a renal abscess is possible, early diagnosis and appropriate antibiotics therapy is essential.
Abscess ; Anti-Bacterial Agents ; Child* ; Early Diagnosis ; Female ; Humans ; Incidence ; Kidney ; Nephritis* ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Urinary Tract Infections