Pulmonary arteriovenous malformations (PAVMs) are direct communications between pulmonary arteries and pulmonary veins, resulting in right-to-left shunts that may cause cyanosis, dyspnea, and digital clubbing. Neurological complications such as intrace rebral hemorrhage or brain abscess may result from cerebral thrombosis or emboli. In most cases, they remain unrecognized until the late te enage years. Here, we report a case of a 6-year-old boy who presented with perioral cyanosis, digital clubbing, and dyspnea on exertion. A plain chest X-ray showed a focal nodular opacity in the right lower lobe (RLL), and a diagnosis of a large PAVM in the RLL was confirmed by chest computed tomography. A right lower lobe ctomy was successfully performed without any complications. Although their incidence in children is low, PAVMs should be suspected as a possible cause of cyanosis and dyspnea of non-cardiac origin, and should be treated promptly to prevent further neurological complications.
Arteriovenous Malformations ; Brain Abscess ; Child ; Cyanosis ; Dyspnea ; Hemorrhage ; Humans ; Incidence ; Intracranial Thrombosis ; Pulmonary Artery ; Pulmonary Veins ; Thorax

PURPOSE: The aim of this study was to determine the potential usefulness of uterine artery embolization (UAE) for the management of uterine leiomyoma. MATERIALS AND METHODS: Sixty nine patients (mean age; 40.3 years, age range; 31-52 years) who underwent UAE for symptomatic fibroids (with menorrhagia, dysmenorrhea and bulk-related symptoms) from January 2000 to December 2000 were retrospectively analyzed. The mean follow-up period was 3.5 months (range: 1-8 months). The fibroids ranged in size from 2.0 cm to 13.2 cm with a mean size of 5.8 cm. We performed embolization using polyvinyl alcohol particles (250-710microgram). The improvement of the clinical symptoms was analyzed. Reduction of the uterine and predominant fibroid volumes was assessed using MRI. RESULTS: Symptom improvement for the menorrhagia (87.5%), dysmenorrhea (83.3%) and the bulk-related symptoms (79.2%) was reported. Complications included ovarian failure in four patients (5.8% of the total patients, mean age: 43.3 yrs) and infection in three patients (4.3% of the total patients) who underwent conservative management with intravenous antibiotics and analgesics. The volume reduction rate of the uterus and the predominant fibroids after uterine artery embolization were 36.3% and 56.6%, respectively. CONCLUSION: UAE is a promising new treatment for symptomatic fibroids and may be a valuable alternative to hysterectomy.
Analgesics ; Anti-Bacterial Agents ; Dysmenorrhea ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Leiomyoma* ; Magnetic Resonance Imaging ; Menorrhagia ; Polyvinyl Alcohol ; Retrospective Studies ; Uterine Artery Embolization* ; Uterine Artery* ; Uterus

PURPOSE: The results of the bronchial provocation test were different by the method of inhalation, but there was no data in children. We performed the provocation test by 2 different methods such as two-minute tidal breathing versus five vital capacity breathing and compared the datas. METHODS: Methacholine inhalation test was performed for the In 17 patients with suspected bronchial hyperresponsiveness in Pocheon university Bundang Cha hospital, under identical conditions, except for the method of inhalation. All the patients were performed two-minute tidal breathing (2 min-TB) in one test and five vital capacity breathing (5VCB) with interval 1 to 7 days. Baseline and postsaline FEV1 were also measured to compare effects by two inhalation methods. Methacholine PC20 was calculated by linear interpolation between the last two data parts on the dose-response curve, and the cut off value of bronchial asthma was 8 mg/mL. RESULTS: The rate of positive brochial provaction test in 5VCB was 88.24% which was not significantly lower than 70.59% in 2 min-TB. In 12 patients with positive bronchial provocation test in both inhalation methods, the mean PC20 in 5VCB (5VC-PC20) was 4.40 mg/mL, being significantly higher than 1.02 mg/mL in 2 min-TB (2 min-PC20) (P< 0.05). There was a significant positive correlation between 5VC-PC20 and 2 min-PC20 (R=0.76, P< 0.001). CONCLUSION: We conclude from this study that the results of bronchial provocation test in children are different according to methods of inhalation in using the same nebulizer. Therefore, when we analyze the result of bronchial provocation test, we need attention to factors which are nebulizer output and method of inhalation to influence the response to the test.
Asthma ; Bronchial Provocation Tests* ; Child* ; Humans ; Inhalation ; Methacholine Chloride ; Nebulizers and Vaporizers ; Respiration* ; Vital Capacity*

Abdominoplasty may be applied to achieve aesthetic outcome and it also can be combined with other surgeries. In addition, liposuction has been offered to patients to improve contour. Liposuction combined with abdominoplasty gives us the advantage of higher patient satisfaction, better aesthetic outcome, and one-staged surgery. The authors performed a retrospective study to evaluate the outcomes. A total of 6 patients who underwent lipoabdominoplasty were included. The patients were all female and the mean age of the patients was 50.5 years old(age range, 32 to 58 years). This study surveyed lipoabdominoplasty based on the purpose of operation, type of suture, and application of quilting suture. Complication rates, patient satisfaction, and postoperative contour of the abdomen were questioned. A mild abdominal complication occurred in one patient, flap bullae, but this was healed within a week and overall flap survival was excellent with good satisfactory outcome. It appears that complication rates of simple lipoabdominoplasty group is low(1/6), and only minor complication occurs. Preservation of perforators during liposuction accounts for improved flap survival. In addition, abdominoplasty may be combined with other abdominal surgeries since other abdominal surgeries usually involve the lower abdomen, which will eventually be cut away curing the abdominoplasty stage.
Abdomen ; Abdominal Wall ; Abdominoplasty ; Adipose Tissue ; Blister ; Female ; Humans ; Imidazoles ; Lipectomy ; Nitro Compounds ; Patient Satisfaction ; Retrospective Studies ; Surgery, Plastic ; Sutures

PURPOSE: We tried to check the accuracy of references in the Journal of the Korean Pediatric Society and Journals of the Korean Pediatric Subspecialty Societies. We also wanted to know the citation patterns of authors by analyzing the frequency of cited materials. METHODS: Three journals were randomly selected from the 2000 issues of Journal of the Korean Pediatric Society and nine journals were selected mainly from the second half of 2000 issues of each Journal of the Korean Pediatric Subspecialty Societies for the study. Then the accuracy of references was checked with Medline. Journals before 1964, books, and journals which were not written in English were used only in the citation pattern analysis. RESULTS: Author errors were the most common(21.3%) among the reference elements. The next was title errors, followed by page errors, journal errors, volume errors and year errors. Total average error rate was 34.7% and we were unable to find journals in 89 cases(2.2%). The journal of the Korean Society of Neonatology had the lowest error rate(17.4%) and the journal of the Korean Pediatric Cardiology Society had the highest error rate(53.2%). The reference journals which were published and quoted in the most recent three years were only 612 cases(15%). Foreign journals were selected as reference(78.4%) more than domestic journals; The Journal of the Korean Pediatric Society was the most frequently cited reference(43.3%) among domestic journals. CONCLUSION: Authors are ultimately responsible for the accuracy of references and they should check the reference list with responsibility. Hopefully, authors also will have to use more domestic journals and recent journals.
Cardiology ; Neonatology

An 8-year-old girl visited the emergency room with perioral cyanosis and dyspnea, which had developed 20 hrs prior to the hospital visit. She had taken a Chinese herbal medication for 3 days prior to the onset of the symptoms. A co-oximeter examination revealed a methemoglobin level of 23.7%. An intravenous infusion of methylene blue was administered. Chemical analysis of the herbal medication revealed an ammonia (NH3) level of 239.41 mg/ L. More studies are needed on the correlation between methemoglobinemia and the components of Chinese herbal medicines.
Ammonia ; Asian Continental Ancestry Group ; Child ; Cyanosis ; Dyspnea ; Eating ; Emergencies ; Humans ; Infusions, Intravenous ; Methemoglobin ; Methemoglobinemia ; Methylene Blue

PURPOSE: Transrectal ultrasonography (TRUS)-guided prostate biopsy causes fear and pain in 65% to 90% of patients. This study was designed to evaluated the use of intravenous propofol anesthesia during TRUS-guided prostate biopsy. MATERIALS AND METHODS: Between January 2006 and June 2008, 195 men undergoing a transrectal prostate biopsy were divided into 2 groups according to anesthetic technique. Group A consisted of 99 patients who received intravenous propofol infusion through an 18 gauge needle during TRUS-guided prostate biopsy. Group B consisted of 96 patients who intrarectally received 10 ml of 2% lidocaine gel 10 minutes before TRUS-guided prostate biopsy. Pain scores were assessed on a visual analogue scale immediately after prostate biopsy. RESULTS: The pain score was significantly reduced in group A compared with group B. There was a significant difference in the mean pain score between the 2 groups (1.0+/-1.3 in group A versus 2.9+/-2.0 in group B; p<0.01). Also, there was a significant difference in the willingness to undergo rebiopsy between the 2 groups (83.8% in group A versus 17.7% in group B; p<0.01). However, the complication rates were not significantly different between the 2 groups. Gross hematuria was found in 14% of group A patients and 18% of group B patients. CONCLUSIONS: Our results proved the advantage of intravenous propofol anesthesia during TRUS-guided prostate biopsy. Intravenous propofol infusion can be a safe and simple technique that significantly reduces pain during TRUS-guided prostate biopsy.
Anesthesia ; Biopsy ; Hematuria ; Humans ; Imidazoles ; Lidocaine ; Male ; Needles ; Nitro Compounds ; Propofol ; Prostate

PURPOSE:To identify the clinical features of human metapneumovirus (hMPV) and the respiratory syncytial virus (RSV) infection in children. METHODS:The participants of our study were 1,104 children who were admitted to Bungdang CHA hospital for lower respiratory infection from August 2006 through July 2007. Nasopharyngeal swabs were taken from the patients, and viruses were identified by RT-PCR. The clinical features of 51 patients with hMPV infection and 138 patients with RSV infection were compared by retrospective review of their medical records. RESULTS:The peak incidence of hMPV infection was noted in April, and that of RSV was noted in November. Both viruses had the highest incidence in patients age <1 year and hMPV infections occurred in 40% and 25% of patients age <6 months, respectively. In the hMPV group, 33.4% of the patients were age > or =2 years, while in the RSV group, 19% were age > or =2 years. In both groups, pneumonia was the most common clinical diagnosis, followed by acute bronchiolitis, acute bronchitis, and asthma. The white blood cell counts were higher in the RSV group, and fever was more frequent on admission in the hMPV group. CONCLUSION:hMPV was the fourth most common virus causing lower respiratory tract infections in children. The clinical features of hMPV infection were similar to those of RSV infection. This study may be helpful for the effective treatment of lower respiratory tract infection in children.
Asthma ; Bronchiolitis ; Bronchitis ; Child ; Fever ; Humans ; Incidence ; Leukocyte Count ; Metapneumovirus ; Pneumonia ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Retrospective Studies ; Viruses

PURPOSE: It is important to select and use kinds of Inhaler appropriate to the age of the patient and severity of symptoms. Several kinds of Inhaler have been developed and recommended according to each inhaler's resistance and usage method. We evaluated the usable age of 4 inhalers (turbulent flow inhalers, multi unit dose inhalers, breath actuated MDI, and autohalers) by measuring peak inspiratory flow(PIF) using In-Check(TM) Inspiratory Flow Meter. METHODS: Ninety three patients aged from 3 to 7 years(mean 57+/-12.9 mo.) who had admitted to CHA hospital from July 2000 to April 2001 were enrolled. Study patients were divided into 4 groups according to age:3-4 years of age(group A, n=31), 4-5 years of age(group B, n=32), 5-6 years of age(group C, n=18), and 6-7 years of age(group D, n=12). RESULTS: Out of total 93 patients, 23(71%), 27(84%), 17(94%) patients of each group A, B, C and all 12 patients of group D could use the 4 types of inhaler through adequated education. In all four groups, height, body weight and age were significantly correlated(P<0.05). Usable age, height and weight of children who can use turbulent flow inhaler(TFI) were each 8 year 7 month old, 144 cm, 32.0 kg, and those of multi unit dose inhaler(MUD) were 2 year 10 month old, 92 cm, 12.0 kg. Also that of breath-actuated MDI were 1 yr 8 months, 83 cm, 8.5 kg and that of autohaler were 2 yr 8 months, 91 cm, 11.0 kg. CONCLUSION: We concluded that the ability to use inhalers correlated with height, weight and age of the patients. Multi unit dose inhalers, Breath actuated MDI and Autohaler are useful after 3 years of age through adequate education.
Body Height ; Child ; Education ; Humans ; Infant ; Nebulizers and Vaporizers*

PURPOSE: Aspiration pneumonia is an important complication of drug intoxication with decreased mental status. The purpose of the study is to investigate the risk factors of aspiration pneumonia in the patients of benzodiazepine overdose with or without co-ingestion of other drugs. METHODS: A retrospective chart review of patients who visited the emergency department between January 2012 and December 2014 was conducted. Demographic data, time from ingestion to visit, initial vital signs, symptoms, mental status, medical history, laboratory results, chest radiological findings and co-ingested medications were recorded. Multiple logistic analyses were performed to verify the association between variables and the development of aspiration pneumonia. RESULTS: A total of 249 patients presented to the emergency department with benzodiazepine overdose. Aspiration pneumonia had developed in 24 patients (9.6%). Univariate analysis revealed time from ingestion to visit was longer, Glasgow coma scale score was lower, hypoxia was presented, leukocytosis was shown, types of ingested drugs was high, less activated charcoal was applied and tricyclic antidepressants was taken in patients that developed aspiration pneumonia. Time from ingestion to visit (odds ratio (OR) 1.121, 95% confidence interval (CI), 1.057-1.189, p=0.000), GCS score (OR 0.724. 95% CI, 0.624-0.839, p=0.000), oxygen saturation (OR 0.895, 95% CI, 0.835-0.959, p=0.002), and co-ingestion of TCA (OR 4.595, 95% CI, 1.169-18.063, p=0.029) were identified as risk factors of morbidity of aspiration pneumonia upon multiple logistic regression analysis. CONCLUSION: Time from ingestion to visit, low GCS score, low oxygen saturation and co-ingestion of TCA were risk factors of the development of aspiration pneumonia in benzodiazepine overdose patients.
Anoxia ; Antidepressive Agents, Tricyclic ; Benzodiazepines* ; Charcoal ; Drug Overdose ; Eating ; Emergency Service, Hospital ; Glasgow Coma Scale ; Humans ; Leukocytosis ; Logistic Models ; Oxygen ; Pneumonia ; Pneumonia, Aspiration* ; Retrospective Studies ; Risk Factors* ; Thorax ; Vital Signs