Ultrasonography (US) is being used increasingly to guide diagnostic and therapeutic musculoskeletal injections. Intra-articular injection is an important mainstay in the treatment of joint diseases, including rheumatoid arthritis (RA) and osteoarthritis (OA). However, blind or palpation-based injection can result in inaccurate needle placement and can be challenging for small joints or difficult-to-access joints such as the hip joint. The correct position of the needle with guidance in the target area would improve the efficacy of the procedure and greatly improve the outcome. Compared to conventional fluoroscopic guidance, the advantages of US are that it avoids radiation exposure and the equipment is readily available and less expensive. Knowledge of anatomy and probe positioning, as well as the ability to coordinate the probe and needle are necessary when injecting patients under US guidance. This review describes the general considerations for intra-articular injections under US guidance and includes practical suggestions for the injection of individual joints.
Arthritis, Rheumatoid ; Hip Joint ; Humans ; Injections, Intra-Articular* ; Joint Diseases ; Joints ; Needles ; Osteoarthritis ; Ultrasonography

Wilson's Disease is a rare familial disorder of abnomalities in hepatic copper metabolism usually presenting with neuropsychiatric or hepatic manifestation. Hemolytic anemia is known as one of its initial clinical manifestation, but that with fulminant hepatitis is a rare presentation of Wilson's disease and so fatal leading always to death, to our best knowledge. This 16-year-old woman was transferred to our hospital with problems of acute Coombs' negative hemolytic anemia and unknown fulminant hepatitis features. She was early diagnosed as complications of Wilson's disease by slit-lamp examination of characteristic Kayser-Fleischer ring and later confirmed by raised serum free copper (55.9microgram/dL, control;< 15 microgram/dL) and 24h urine copper (1,546 microgram/dL, control; 38~70 microgram/dL). She was soon treated with D-penicillamine and pyridoxine with the plan of early liver transplantation. She was fortunately recovered with conservative treatment alone but did have active cirrhosis on consequent liver biopsy. She has been followed up for 7months. Wilson's disease should always be thought in childhood or adolescent patient with Coombs' negative hemolytic anemia and unknown fulminant hepatitis.
Adolescent ; Anemia, Hemolytic* ; Biopsy ; Copper ; Female ; Fibrosis ; Hepatitis* ; Hepatolenticular Degeneration* ; Humans ; Liver ; Liver Transplantation ; Metabolism ; Penicillamine ; Pyridoxine

Purpose: To compare the effects of orthokeratology lens (Ortho‐K lens) and topical cyclopentolate on myopia progression in children. Methods: This retrospective study analyzed the medical records of 36 children who received Ortho‐K lens and 28 who received cyclopentolate (i.e., total of 64 eyes). The following data were recorded: sex, age, age at first intervention, follow‐up duration, and visual acuity and axial length (AL) at the time of first treatment and after 6, 12, and 24 months of treatment. Results: In the Ortho‐K group, the changes of AL significantly decreased by 0.3 ± 0.25 mm at 12 months and 0.52 ± 0.34 mm at 24 months (p for trend < 0.001). In the cyclopentolate group, the changes of AL significantly decreased by 0.36 ± 0.17 mm at 12 months and 0.62 ± 0.29 mm at 24 months (p for trend = 0.022). Compared to the use of cyclopentolate, the use of Ortho‐K lens resulted in smaller changes in AL during follow‐up (p = 0.038). Conclusions In myopic children, Ortho‐K reduced myopia progression, whereas cyclopentolate significantly less affect myopia progression than Ortho‐K lens.

PURPOSE: We tried to evaluate the effect of prophylactic treatment with short-term intermittent diazepam or long-term continuous valproate in prenventing the recurrence febrile seizures and compare the efficacy of both drugs. METHODS: Eighty six children who were admitted to the Kwangju Christian Hospital from March, 1997 to July, 1999 with more than three febrile seizures and more than one risk factor were enrolled in our study and followed up for one year. Among them, sixteen belonged to an oral diazepam group and twelve to a valproate group while fifty eight to a control group. We investigated the recurrence rate of each group for the period of a year. RESULTS: In the diazepam group, diazepam(0.3 mg/kg/dose) was administered orally every eight hours during the first febrile day and the recurrence rate was 6.2%. The recurrence rate of the valproate group(17 mg/kg/day, bid) was 25%. Those treatments significantly reduced the recurrence rates of febrile convulsions compared to the untreated control group(74.1%), but no significant differences were found between the two treatment groups in the respect of recurrence rates of febrile seizures. CONCLUSION: Both intermittent diazepam and continuous valproate treatment were equally effective in preventing the recurrence of febrile seizures.
Child* ; Diazepam* ; Gwangju ; Humans ; Recurrence ; Risk Factors ; Seizures, Febrile* ; Valproic Acid*

Joubert syndrome is a rare autosomal recessive disorder characterized by cerebellar vermian hypoplasia, hypotonia, developmental delay, abnormal respiratory patterns and abnormal eye movements. It is usually diagnosed during infancy or thereafter by hypotonia and developmental delay. We experienced a case of Joubert syndrome presenting in newborn period manifesting as unexplainable episodic hyperpnea and apnea.
Apnea ; Eye Movements ; Humans ; Infant, Newborn ; Muscle Hypotonia

OBJECTIVE: To establish intrauterine growth curve for the birth weight of twins on the basis of gestational age. METHODS: The medical records of twin gestations delivered between 1980 and 2001 were reviewed. 610 Twin pairs (1,220 infants) were comprised our study population. The newborns were grouped according to gestational age and the median, 10th, 50th, and 90th percentile birth weight for each gestational week were calculated. Intrauterine growth curve of twins was compared with that of singletons of Wonju Christian Hospital. We studied the differences of birth weights of twins as sex, parity, chorionicity in twins. RESULTS: The birth weights of twins fall below that of singleton after 32-33 weeks. The 50th percentile for twins falls below the 10th percentile for singleton after 37 weeks, and 90th percentile for twins falls below the 50th percentile for singleton. The mean birth weight in male twin infant was heavier than in female twin infant through all gestational week. The mean brith weight in multiparity was heavier than in nulliparity through all gestational week. The mean birth weight in dichorionic twins was heavier than in monochorionic twins through all gestational week. CONCLUSION: We presented twin specific birthweight curve on the basis of gestational age. The growth pattern of twins was different from that of singleton. We recommend the twin specific birthweight curve in the management of twin gestations.
Birth Weight* ; Chorion ; Female ; Gangwon-do ; Gestational Age* ; Humans ; Infant ; Infant, Newborn ; Male ; Medical Records ; Parity ; Parturition* ; Twins*

Enterohemorrhagic Escherichia coli (EHEC) is an important cause of bloody diarrhea in children, but is considered to be rare in infants. Herein, a case of infant hemorrhagic colitis of verotoxin-producing E. coli O157:H7 diagnosed by multiplex PCR is reported. A nine-month-old boy was admitted to our hospital with bloody diarrhea for the previous two days. Multiplex PCR using Seeplex(R) Diarrhea ACE Detection Kit (Seegene, Seoul, Korea) was directly applied to the stool specimens. Amplified bands specific for verotoxin, O157, and H7 indicated the presence of O157:H7 EHEC. The stool specimens were inoculated on sorbitol-MacConkey agar (SMA) and tryptic soy broth containing mitomycin C (TSB-M). Colorless colonies on sorbitol-MacConkey agar were O157-positive. TSB-M enrichment cultures of the stool specimen and the isolates were positive for verotoxin according to an enzyme immunoassay (EIA). The prepared ingredients of baby foods for the patient including ground meat, chopped carrot, chopped cabbage, and white rice porridge showed no EHEC on TSB-M and SMA. The patient's parents and three-year-old sister did not recently have any gastrointestinal symptoms. Cefdinir was administered for one day and was ceased after diagnosis of EHEC colitis. The stool culture and verotoxin assay were negative on the second day of hospitalization. Application of multiplex PCR and verotoxin EIA directly to diarrheal stool warrants the rapid diagnosis and appropriate treatment of EHEC colitis.
Agar ; Brassica ; Caseins ; Cephalosporins ; Child ; Colitis ; Daucus carota ; Diarrhea ; Enterohemorrhagic Escherichia coli ; European Continental Ancestry Group ; Hospitalization ; Humans ; Immunoenzyme Techniques ; Infant ; Meat ; Mitomycin ; Multiplex Polymerase Chain Reaction ; Parents ; Protein Hydrolysates ; Shiga Toxins ; Shiga-Toxigenic Escherichia coli ; Siblings

No abstract available.
Hip ; Hip Joint ; Osteoma, Osteoid

The long-term clinical issues in Kawasaki disease are concerned with the coronary artery lesions that result in aneurysmal formation, thrombotic occlusion, progression to ischemic heart disease, and premature atherosclerosis. We here report a 3 month old infant with Kawasaki disease complicated by giant coronary aneurysm with thrombosis. After urokinase(10,000 IU/kg) and heparin(400 IU/kg) were injected for two days as thrombolytic agents, thrombi were successfully dissolved. Even though long-term oral anticoagulation with low-dose aspirin, dipyridamole and coumadin were administered, thrombosis of the left main coronary artery was slowly increased. five years later, coronary angiography showed nearly total occlusion of the left anterior descending artery and collaterals from the right posterior branch and radionuclide scan demonstrated complete reversible perfusion defect of several portions of the left ventricle.
Aneurysm ; Arteries ; Aspirin ; Atherosclerosis ; Child* ; Coronary Aneurysm* ; Coronary Angiography ; Coronary Vessels ; Dipyridamole ; Fibrinolytic Agents ; Follow-Up Studies* ; Heart Ventricles ; Humans ; Infant ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Ischemia ; Perfusion ; Thrombolytic Therapy* ; Thrombosis* ; Warfarin