To estimate the child and infant mortality rates among Korean children, a mortality survey was carried out in the province of Kyongsangnam,buk-do. The study population are the beneficiaries of Korea Medical Insurance Coorporation (KMIC), Kyongsangnam,buk-do area, among which the 3,867 and 1767 deaths occurred from January, 1989 to December, 1990 in Kyongsangnam-do area and from January, 1991 to December, 1991 in Kyongsangbuk-do area respectively. We reviewed the data to confirm the causes of death. These were based on the death certificates and medical utilization records before dying which were available through the computerized databases on medical care utility of KMIC. The survey conducted along three steps. At first, the death certificates were examined, as a second step, medical utilization records were reviewed, and finally direct contacts to the family members of the deceased were done. As a result, 115 deaths were found under 20 years of age. Using them, age specific mortalities and causes of death were estimated. Mortality rate in this area was estimated 129 per 100,000 person-years during 1 month to 11 months of age, 67 during 1 year to 4 years of age, 23 during 5 years to 9 years of age, 10 during 10 years to 14 years of age, and 29 during 15 years to 19 years of age, respectively. And the frequent causes of death were congenital anomalies, central nervous system (CNS) diseases, certain condition originating from perinatal period during 1 months of age; accidents, congenital anomalies, malignancies, CNS diseases, and pneumonia or bronchiolitis during 1 to 4 years of age; accidents, malignancies, CNS diseases, and congenital anomalies during 5 to 14 years of age; and accidents, suicide, malignancies, and CNS diseases during 15 to 19 years of age.
Bronchiolitis ; Cause of Death ; Central Nervous System ; Central Nervous System Diseases ; Child ; Child Mortality* ; Child* ; Death Certificates ; Gyeongsangbuk-do ; Gyeongsangnam-do ; Humans ; Infant ; Infant Mortality ; Insurance ; Korea ; Mortality ; Pneumonia ; Suicide

OBJECTIVES: Several studies have shown that administration of antibiotics decreased sleep amount as well as bacterial colony numbers in rats. It is well known that antidepressants decrease rapid eye movement(REM) sleep and increase slow wave sleep(SWS) in both human and animal studies. However, little is known to date about the effects of antidepressant on antibiotic induced insomnia in rats. Therefore the authors studied the effects of amitriptyline on chloramphenicol induced insomnia in rats. METHODS: The Sprague-Dawley strain rats were divided into control(N=6) and experimental group (N=5). The sleep-wake activity was recorded continuously for consecutive three days(baseline, day 1 and day 2). On day 1 both groups were intraperitoneally injected with chloramphenicol 150mg/kg. On day 2 the control group was intraperitoneally injected with chloramphenicol 150mg/kg only, whereas experimental group was injected with amitriptyline 12mg/kg and chloramphenicol 150mg/kg. RESULTS: 1) Chloramphenicol administration decreased dark period SWS and total REM sleep. 2) Amitriptyline administration increased total SWS and dark period SWS as well as decreased total wakefulness and dark period wakefulness. There was a decrease of REM sleep in the first 3 hours of light period, whereas a tendency of increase of REM sleep around the end of dark period. CONCLUSION: From the above results, it is concluded that amitriptyline may be effective to reverse chloramphenicol induced insomnia in rats. Furthermore, chloramphenicol induced insomnia in rat could be a useful model for insomnia studies in the future.
Amitriptyline* ; Animals ; Anti-Bacterial Agents ; Antidepressive Agents ; Chloramphenicol* ; Humans ; Rats* ; Rats, Sprague-Dawley ; Sleep Initiation and Maintenance Disorders* ; Sleep, REM ; Wakefulness

While endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal tumors, it is rarely used for subepithelial tumors (SETs) originating from the muscularis propria of the esophagus and gastric cardia because of the risk of perforation and problems with inadequate space and field of view during procedures. Submucosal tunneling endoscopic resection (STER) is a new therapeutic method for treating SETs in specific locations in the esophagus and stomach. This technique is highly skill-dependent, using a mucosal flap that covers a deeper part of the gut wall, but is safe and minimally invasive compared with conventional endoscopic approaches such as ESD in SETs originating from the muscularis propria.We report a patient who underwent STER to remove a SET located at the gastric cardia. The patient recovered without any complications. We believe that our case shows the efficacy and safety of the STER technique for patients with a SET originating from the muscularis propria.
Cardia/pathology/surgery ; Endosonography ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Leiomyoma/*diagnosis/surgery ; Male ; Middle Aged ; Stomach Neoplasms/*diagnosis/surgery

A 50-year-old man presented bilateral hypesthesia on and below the T6 dermatome and paresthesia. Magnetic resonance imaging (MRI) showed an intraspinal extradural tumor, which located from the 6th thoracic vertebral body to the upper margin of the 7th vertebral body, continuing dumbbell-like through the intervertebral foramen into the right middle thorax suggesting a neurogenic tumor (neurofibroma or neurilemmoma). With the patient in a prone position, we exposed and excised the tumor via a one stage posterior approach through a hemi-laminictomy of T6. Histologic examination showed a grade 1 meningothelial meningioma, according to the World Health Organization classification. Initially, we assumed the mass was a schwannoma because of its location and dumbbell shape. However, the tumor was actually a meningioma. Postoperatively, hypesthesia resolved completely and motor power of the leg gradually full recovered. A postoperative MRI revealed no evidence of residual tumor.
Classification ; Humans ; Hypesthesia ; Leg ; Magnetic Resonance Imaging ; Meningioma* ; Middle Aged ; Neoplasm, Residual ; Neurilemmoma* ; Paresthesia ; Prone Position ; Spinal Neoplasms ; Spine* ; Thorax ; World Health Organization

OBJECTIVE: This study aimed to show the possibility of neural canal enlargement and restoration of bony fragments through laminectomy and minimal facetectomy without pediculectomy or an anterior approach, and also to prove the adequacy of posterior stabilization of vertebral deformities after thoracolumbar bursting fracture. METHODS: From January 2003 to June 2009, we experienced 45 patients with thoracolumbar burst fractures. All patients enrolled were presented with either a neural canal compromise of more than 40% with a Benzel-Larson Grade of VI, or more than 30% compromise with less than a Benzel-Larson Grade of V. Most important characteristic of our surgical procedure was repositioning retropulsed bone fragments using custom-designed instruments via laminectomy and minimal facetectomy without removing the fractured bone fragments. Beneath the dural sac, these custom-designed instruments could push the retropulsed bone fragments within the neural canal after the decompression and bone fragment repositioning. RESULTS: The mean kyphotic deformities measured preoperatively and at follow-up within 12 months were 17.7 degrees (+/-6.4 degrees) and 9.6 degrees (+/-5.2 degrees), respectively. The mean midsagittal diameter improved from 8.8 mm (+/-2.8 mm) before surgery to 14.2 mm (+/-1.6 mm) at follow-up. The mean traumatic vertebral body height before surgery was 41.3% (+/-12.6%). At follow-up assessment within 12 months, this score showed a statistically significant increase to 68.3% (+/-12.8%). Neurological improvement occurred in all patients. CONCLUSION: Though controversy exists in the treatment of severe thoracolumbar burst fracture, we achieved effective radiological and clinical results in the cases of burst fractures causing severe canal compromise and spinal deformity by using this novel custom-designed instruments, via posterior approach alone.
Body Height ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Humans ; Laminectomy* ; Neural Tube ; Spinal Fractures ; Spinal Fusion ; Surgical Fixation Devices ; Surgical Instruments

Epidermal cysts slowly growing, intradermal or subcutaneous tumors that usually cease growing after having reached 1 to 5 cm in diameter. We report a case of giant epidermal cyst on the scapular region with the appearance of well delineated huge mass measured 19×17×14cm in size. Its clinical and surgical management are illustrated.
Epidermal Cyst

Huntington's disease(HD), an autosomal dominant disorder, is characterized by progressive involuntary choreiform movement, psychiatric symptoms, and dementia. We experienced a 44-year-old male HD patient with prominent family history of the disease who showed dementia and involuntary movements including chorea. The diagnosis was made by clinical symptoms, family history of the disease, and brain MRI findings to show bicaudate atrophy and diffuse cortical atrophy with marked ventricualr dilatation. Interestingly, the patient frequently exhibited generalized tonic-clonic seizures. The seizures first appeared about 3 to 4 years after the onset of HD and were controlled with valproic acid. To our knowledge, this may be the first case of lateonset HD accompanied by generalized seizures and we report this case with literature review.
Adult ; Atrophy ; Brain ; Chorea ; Dementia ; Diagnosis ; Dilatation ; Dyskinesias ; Humans ; Huntington Disease* ; Magnetic Resonance Imaging ; Male ; Seizures* ; Valproic Acid

BACKGROUND: We evaluated the antihypertensive effect, safety and effect on serum lipids of terazosin, second generation alpha1-blocker. METHODS: Terazosin 1-4mg was adminstered once daily in 20 patients for 12 weeks with dose titration every 2 weeks. RESULTS: 1) The systolic and diastolic blood pressure were decreased from 170.0+/-13.0/104.0+/-6.0mmHg to 144.0+/-13.3/88.0+/-5.6mmHg(p<0.01), but the heart rate and body weight were independant of terazosin administration. 2) Total cholesterol was decreased significantly from 209.9+/-33.5mg/dL to 194.6+/-30.1mg/dL after 12 weeks treatment(p<0.05), triglyceride was decreased significantly from 185.4+/-37.0mg/dL to 168.9+/-35.0mg/dL(p<0.05). and LDL-cholesterol was decreased significantly from 134.5+/-31.9mg/dL to 122.7+/-29.9mg/dL(p<0.05), but HDL-cholesterol was increased significantly from 37.8+/-5.6mg/dL to 40.6+/-5.5mg/dL(p<0.05). 3) The adverse effects of terazosin were dizziness in 2, headache in 2, asthenia in 1, peripheral edema in 1 and skin rash in 1 patient, but were not troublesome enough to stop medication. CONCLUSIONS: Terazosin 1-4mg once daily regimen was effective and safe as an antihypertensive agent, and moreover terazosin has favorable effects on serum lipids.
Asthenia ; Blood Pressure* ; Body Weight ; Cholesterol ; Dizziness ; Edema ; Exanthema ; Headache ; Heart Rate ; Humans ; Hypertension* ; Triglycerides

BACKGROUND: Low flow anesthesia provides many advantages, including reduced cost, conservation of body heat and airway humidity. This study was performed to compare low flow anesthesia with high flow anesthesia and to investigate whether the advantages of low flow anesthesia during positive pressure ventilation can be combined with the laryngeal mask airway in paralyzed pediatric patients. METHODS: Thirty-one pediatric patients of ASA physical status 1 or 2 were studied and divided into two groups according to the fresh gas flow (FGF) in the breathing system; low flow group (FGF approximation 1 L/min, n = 17) or high flow group (FGF approximation 4 L/min, n = 14). Each respiratory parameter was measured when a steady state was reached at 20 min after induction. RESULTS: There were no significant differences of respiratory data between the two groups except that the inspired oxygen concentration was lower in the low flow group than in the high flow group. Hemodynamic changes with the laryngeal mask airway insertion were not statistically significant. CONCLUSIONS: A laryngeal mask airway is an effective airway device for low flow anesthesia as well as for high flow anesthesia in paralyzed pediatric patients.
Anesthesia* ; Hemodynamics ; Hot Temperature ; Humans ; Humidity ; Laryngeal Masks* ; Oxygen ; Pediatrics* ; Positive-Pressure Respiration* ; Respiration

PURPOSE: This study was carried out to survey the serum anti-PRP titers after the completion of a primary series with 3 doses of the PRP-T conjugate vaccine(ACT-HIBTM), to evaluate the necessity of booster vaccination. METHODS: One hundred twenty healthy infants who went for consultations at Moon Hwa hospital between December 1999 to May 2001 were vaccinated at two, four and six months after birth. The serum antibody levels were measured at 7-8 months and 19-20 months of age by the "Farr" type of radioimmunological method at Aventis Pasteur International in France. RESULTS: The geometric mean of Anti-PRP titers were 24.6 microgram/mL at 7-8 months and then fell to 2.10 microgram/mL at 19-20 months. Minimum Anti-PRP titer was 0.75 microgram/mL at 7-8 months, and 0.1 microgram/mL at 19-20 months. Maximum Anti- PRP titer was 99.2 microgram/mL at 7-8 months, and 9.1 microgram/mL at 19-20 months. Subjects of Anti-PRP titers more than 0.15 microgram/mL were 100% at 7-8 months, and 97.0% at 19-20 months, and subjects of Anti-PRP titers more than 1.0 microgram/mL were 98.3% at 7-8 months, and 61.6% at 19-20 months. CONCLUSION: The Anti-PRP titers at 7-8 months were very high but rapidly decreased at 19-20 months of age, so the necessity of booster vaccination could be considered in Korean children.
Child ; France ; Haemophilus influenzae* ; Haemophilus* ; Humans ; Infant ; Parturition ; Referral and Consultation ; Vaccination*