PURPOSE: The importance of trace elements in their effect on the physiology and pathology of the central nervous system is well recognized. Changes in the concentrations of these elements in the brain could take place in pathological states. Recently, a greater emphasis has been given to the role of trace elements in the function of the nervous system both in normal and pathological conditions. The past experiments from animal demonstrate that Na+-K+-ATPase inhibition, particularly in the hippocampus, is involved in epileptogenicity. Zinc is the most potent inhibitor of Na+-K+-ATPase followed closely by copper. Zinc modulates the activity of glutamic acid decarboxylase, the rate limiting enzyme in the synthesis of -aminobutyric acid (GABA), which is a major inhibitory neurotransmitter. There are few reports of zinc and copper concentrations in normal CSF and in CSF from patients with neurological diseases. The aim of this study was designed to determine the zinc and copper concentrations and their correlation with protein in CSF of pediatric patients with neurologic disorders. METHODS: The study population was 43 patients who had admitted to Kang Nam Sacred Heart Hospital of Hallym University from March to June, 1996 due to high fever, headache, vomiting, and seizure. All patients were examined CSF study, 32 patients (group I) were showed abnormal CSF and seizure disorders including febrile convulsion and 11 patients (group II) were showed normal CSF and clinical symptoms of febrile illness. Zinc and copper concentrations in CSF were determined with flame atomic absorption spectrophotometry. In addition, CSF zinc and copper concentrations in normal CSF proteingroup (group A) and in increased CSF protein group (group B) were determined to investigate probability that the damaged blood-brain-barrier permits the passage of zinc and copper into the subarachnoid space. RESULTS: 1) The CSF zinc concentrations in group I and II were 9.40+/-6.18 and 7.39+/-5.48microgram/dl, and the CSF copper concentrations in group I and II were 4.86+/-7.07 and 2.93+/-1.45microgram/dl, respectively. There was no statistically significant difference in the CSF zinc and copper concentrations between the two groups. 2) The CSF zinc concentrations in group A and B were 7.21+/-4.96 and 11.24+/-7.32microgram/ dl, and the copper concentrations in group A and B were 3.31+/-2.15 and 5.59+/-9.46microgram/dl, respectively. There was no statistically significant difference in the CSF zinc and copper concentrations between the two groups. 3) There was a significant positive correlation between the CSF zinc and copper concentrations as well as between the CSF zinc and protein concentrations. But there was no significant correlation between the CSF copper and protein concentrations. CONCLUSIONS: There was no statiscally significant defference in the CSF zinc and copper concentrations between neurologic disorders and febrile diseases. Increased CSF zinc and copper concentrations in increased CSF protein groups were not found. But there were some correlation between zinc, copper, protein levels in CSF. These results do not support assumption that damaged BBB permits the passage of the zinc, copper into the subarachnoid space.
Animals ; Brain ; Central Nervous System ; Cerebrospinal Fluid* ; Child* ; Copper* ; Epilepsy ; Fever ; Glutamate Decarboxylase ; Headache ; Heart ; Hippocampus ; Humans ; Nervous System ; Nervous System Diseases* ; Neurotransmitter Agents ; Pathology ; Physiology ; Seizures ; Seizures, Febrile ; Spectrophotometry, Atomic ; Subarachnoid Space ; Trace Elements ; Vomiting ; Zinc*

The discovery of C-T scan have facilitated the detection of post-traumatic hydrocephalus cases. Of those, 6 cases of hydrocephalus of non-parenchymatous in origin, in other words, normal pressure hydrocephalus were presented. They were diagnosed by repeated brain C-T and cisternography with Iodine 131-labeled human serum albumin. The symptomatology, diagnosis procedure and surgical results were discussed. Followings are the results. 1) The RIHSA cisternogram taken after 6 hrs, 12 hrs, 24 hrs and 48 hrs from lumbar injection showed abnormal features in all cases. 2) Surgical results were thought that there is much correlation with the age and improvement of mental impairments were seen, more or less, in all cases and improvement of gait disturbance and incontinence were seen in 5 cases and 4 cases respectively. 3) In those who sustained severe head injury with delayed recovery, the authors think, repeated check of brain C-T and cisternography is necessitated to perform the V-P shunt or V-A shunt to relieve the symptomatology of normal pressure hydrocephalus.
Brain ; Cerebrospinal Fluid Pressure ; Craniocerebral Trauma ; Diagnosis ; Gait ; Humans ; Hydrocephalus ; Hydrocephalus, Normal Pressure* ; Iodine ; Serum Albumin ; Ventriculoperitoneal Shunt

Primary malignant lymphoma of the central nervous system which is characterized by high radiosensitiveness is rarely reported in the literature. We have experienced a case of recurred cerebellar lymphoma whose criginal site was septal area. Though septal tumor disappeared completely after radiation, a large cerebellar tumor was found 2 years thereafter. After decompressive suboccipital craniectomy and partial tumor removal the patient's general condition improved so secondary radiation and chemotherapy were started. In the course of port-op therapy, the patient abruptly deteriorated and succumbed.
Central Nervous System ; Cerebellar Neoplasms ; Cerebellum* ; Drug Therapy ; Humans ; Lymphoma* ; Septum of Brain

PURPOSE: Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. METHODS: From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. RESULTS: Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times (P<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer (P<0.05), the mortality rate was not significantly different among the 2 groups. CONCLUSION: Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.
Accelerated Idioventricular Rhythm ; Arrhythmias, Cardiac ; Arteries ; Body Weight ; Cardiopulmonary Bypass ; Child ; Heart ; Heart Diseases ; Humans ; Incidence ; Intensive Care Units ; Medical Records ; Retrospective Studies ; Risk Factors ; Tachycardia, Ectopic Junctional ; Thoracic Surgery ; Ventilators, Mechanical

Herein, we report a rare case of hemolytic anemia with reticulocytopenia following intravenous immunoglobulin therapy in a young infant treated for Kawasaki disease. A 2-month-old boy presented with fever lasting 3 days, conjunctival injection, strawberry tongue, erythematous edema of the hands, and macular rash, symptoms and signs suggestive of incomplete Kawasaki disease. His fever resolved 8 days after treatment with aspirin and high dose infusion of intravenous immunoglobulin. The hemoglobin and hematocrit decreased from 9.7 g/dL and 27.1% to 7.4 g/dL and 21.3%, respectively. The patient had normocytic hypochromic anemia with anisocytosis, poikilocytosis, immature neutrophils, and nucleated red blood cells. The direct antiglobulin test result was positive, and the reticulocyte count was 1.39%. The patient had an uneventful recovery. However, reticulocytopenia persisted 1 month after discharge.
Anemia ; Anemia, Hemolytic* ; Anemia, Hypochromic ; Aspirin ; Coombs Test ; Edema ; Erythrocytes ; Exanthema ; Fever ; Fragaria ; Hand ; Hematocrit ; Hemolysis ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Infant* ; Male* ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Reticulocyte Count ; Reticulocytes ; Tongue

Twenty-three patients with mass in parotid gland were examined with magnetic resonance (MR) imaging. The confirmed diagnoses were pleomorphic adenoma (9 cases), primary malignant tumor (3 cases), vascular malformation (3 cases), post operative scar (3 cases), parotid glandular lymphadenopathy (2 cases), lipoma (1 case), neurofibroma (1 cases), and chronic organizing abscess (1 case). Pleomorphic adenomas appeared as well-marginated lobulating masses with multi-compartment by internal fibrous septa. Most pleomorphic adenomas showed low signal intensity on T1-weighted images, and high signal intensity on T2-weighted images. Malignant tumors showed slightly high signal intensity on T2-weighted images but were less intense in signal intensity compared with that of benign tumors. One case of chronic abscess showed MR signal intensity similar to the malignant tumor. The lesions were clearly delineated on pre-contrast T1-weighted images in all cases. Gd-DTPA enhancement was helpful in characterizing the nature of the mass, but had limited diagnostic value in delineating the lesion from the surrounding normal tissue.
Abscess ; Adenoma, Pleomorphic ; Cicatrix ; Diagnosis ; Gadolinium DTPA ; Humans ; Lipoma ; Lymphatic Diseases ; Neurofibroma ; Parotid Gland ; Vascular Malformations

OBJECTIVE: We aim to statistically analyze the variables affecting FHR using principal component analysis and multiple regression analysis. It is tried to find which variables significantly affect FHR. Thus, it would help further work of building objective decision basis to analyze variables affecting FHR. METHODS: The samples are chosen from pregnant women who took a NST at Hanyang University Hospital. It consists of 5,314 data which have been collected from 1989 to 1997. For collection of data and values of each variable, our own FHR interpretation softwares, HYFM-I (DOS version, since 1989) and HYFM-II (Windows version, since 1998) were used. Then, the principal component analysis is performed to find significant variable and multiple regression analysis is performed using these variables. RESULTS: The mean baseline FHR is not influenced by a specific factor in abnormal group. The gestational week, loss of signal, variability, and 5 minutes Apgar score are chosen as main effects through principal component analysis. From the results of regression analysis, it is noticed that 5 minutes Apgar score which is one of neonate prognosis after birth causes an increase of estimated FHR score (EFS), whereas the loss of signal causes a decrease of EFS. The variability in normal group is more active increasing factor of EFS than abnormal group. CONCLUSIONS: Based on gestational week, 5 minutes Apgar score is highly related with fetal maturity in both normal and abnormal groups. Also, it is found that different patterns of each variable by groups are due to delay of fetal growth that is caused by disease of a pregnant women. Thus, the further studies to build objective decision basis are need.
Apgar Score ; Female ; Fetal Development ; Fetal Heart* ; Heart Rate, Fetal* ; Humans ; Infant, Newborn ; Multivariate Analysis* ; Parturition ; Pregnancy ; Pregnant Women ; Principal Component Analysis ; Prognosis

Galeazzi fractures in child is rare and seldom necessary of operative treatment because the result of conservative treatment is good. We present the patient who was a 11-year-old male and fell onto his both hands during a hundred-meter dash. His diagnosis was bilateral Galeazzi fractures and limited open reduction and internal fixation with Kirschner pins was initial treatment at local hospital. After 4 weeks postoperatively, Kirschner pins were removed and rehabilitating exercise was started. After 4 months postoperatively, he was transferred to our hospital due to malunion with severe angular deformities and distal radioulnar joint (DRUJ) dislocation. He was treated with corrective osteotomy. Thus, as in this case, we suggest more careful treatment and observation if conservative method of Galeazzi fracture in child is chosen and consider operative method as treatment according to age and pattern of fracture.
Child ; Congenital Abnormalities ; Dislocations ; Hand ; Humans ; Joints ; Male ; Osteotomy

We report a premature neonate who suffered from bronchial foreign body. The neonate was delivered at 34 weeks of gestational age, 1,850 g of birth weight, through Cesarean section. After birth the baby showed respiratory distress and received surfactant therapy on the first hospital day. After extubation on the 10th hospital day, the baby experienced 2 episodes of pneumonia in the right upper lung field. On the 27th day after birth, a chest X-ray revealed a feeding tube-shaped foreign body which was located from right main bronchus to trachea, about 4.5 cm long and 2.0 mm wide. The patient was too small to remove the foreign body by even the smallest-diametered fibroptic bronchoscopy. We rotated the baby to a nearly 90 degree head-down position and percussed on the back. After confirming the movement of foreign body in to the trachea, we intubated 3.0 Fr. endotracheal tube under fluoroscopic observation. We found that a tip of foreign body was inserted into the ET tube innerside. We sucked out the foreign body by mechanical suction with central-holed rubber suction tip. Forced expiration with cough reflex and intubation with mechanical suction allowed for the successful removal of the foreign body.
Birth Weight ; Bronchi ; Bronchoscopy ; Cesarean Section ; Cough ; Female ; Foreign Bodies* ; Gestational Age ; Humans ; Infant, Newborn* ; Intubation ; Lung ; Parturition ; Pneumonia ; Pregnancy ; Reflex ; Rubber ; Suction ; Thorax ; Trachea

PURPOSE: Hearing loss can lead to a number of disabilities and can reduce quality of life. Noise-induced hearing losses have become more common among adolescents due to increased exposure to personal music players. We, therefore, investigated the use of personal music player among Korean adolescents and the relationship between hearing threshold and usage pattern of portable music players. MATERIALS AND METHODS: A total of 490 adolescents were interviewed personally regarding their use of portable music players, including the time and type of player and the type of headphone used. Pure tone audiometry was performed in each subject. RESULTS: Of the 490 subjects, 462 (94.3%) used personal music players and most of them have used the personal music player for 1-3 hours per day during 1-3 years. The most common type of portable music player was the MP3 player, and the most common type of headphone was the earphone (insert type). Significant elevations of hearing threshold were observed in males, in adolescents who had used portable music players for over 5 years, for those over 15 years in cumulative period and in those who had used earphones. CONCLUSION: Portable music players can have a deleterious effect on hearing threshold in adolescents. To preserve hearing, adolescents should avoid using portable music players for long periods of time and should avoid using earphones.
Adolescent ; Age Distribution ; *Audiovisual Aids ; Auditory Threshold ; Female ; Hearing Loss, Noise-Induced/*epidemiology ; Humans ; Korea/epidemiology ; Male ; *Music ; Sex Distribution