PURPOSE: There are few rigorous studies about the side effects of antiepileptic drugs(AEDs) according to age. This study is to analyze differences of the side effects of AEDs in epileptic children according to age. METHODS: Sample are 368 children who had received AEDs for at least 1 month during January 1995 to June 1999. We reviewed their medical records including age, sex, AEDs and side effects, and analyzed these data by X2-test. RESULTS: Side effects were observed in 86(23.4%) of 368 patients. There was no difference in the frequency of overall side effects according to age. But significant differences existed in each side effect(p<0.05). The most common side effect according to age were hematologic side effect(75.0%) under 2 months, gastro intestinal side effect(41.7%) between 2 months and 1 year, CNS side effect(42.1%) between 1 year and 5 years, CNS side effect(41.5%) over 5 years. Hepatotoxicity, the increase of AST/ALT due to valproate, occurred significantly more frequently in children younger than 2 years(p<0.05). Drug eruption and post-carbamazepine leukopenia had no differences according to age. Under 1 year, valproate group had significantly more side effects in CNS. But carbamazepine, phenobarbital, and vigabatrin groups had no differences. CONCLUSION: There was significant difference in the side effects of AEDs among each system according to age. It is recommended to use valproate as monotherapy in children younger than 2 years, and pay more attention to CNS side effect in children older than 1 year.
Anticonvulsants* ; Carbamazepine ; Child* ; Drug Eruptions ; Humans ; Leukopenia ; Medical Records ; Phenobarbital ; Valproic Acid ; Vigabatrin

PURPOSE: The purpose of this study is to estimate the side effects of antiepileptic drug(AED) in children. METHODS: Subjects were 267 children who had received AED for at least 1 month during January 1995 to July 1998. We reviewed their sex, age at start of seizure onset, age at medication, class and number of AED, developmental delay, type and cause of seizure according to the presence of side effect. We analyzed data using Student's t-test and X2-test. RESULTS: Side effects were observed in 61 of 267(22.8%) patients. There were no significant differences in their characteristics according to the presence of side effect. There were 112 episodes of complications in 61 patients. In decreasing order, CNS(38.4%) > digestive(25.9%) > hematologic(22.3%) > skin and connective tissue(7.1%) > others(6.3%). There were 12 episodes in 11 patients who should have been taken off AED due to drug eruption, drowsiness, nausea and so on. Side effects were observed in 16 of 123(6.0%) patients in monotherapy compared with 45 of 144(16.8%) patients in polytherapy, which showed significantly fewer side effects in monotherapy(P<0.05). In monotherapy, mean age at seizure onset and medication start were older(4.63+/-3.83, 5.85+/-3.86 years, respectively) than in polytherapy(2.69+/-3.06, 3.69+/-3.58 years, respectively) (P<0.05). CONCLUSION: In the data, CNS is the most common side effect(43 episodes, 38.4%) and there were significantly fewer side effects in monotherapy compared with polytherapy. Accordingly, we concluded that monotherapy is preferred over polytherapy in reducing the side effects of AED.
Child* ; Drug Eruptions ; Humans ; Nausea ; Seizures ; Skin ; Sleep Stages

BACKGROUND: Control of seizure inducing factors (SIFs) is essential in the management of epilepsy. We suggest that avoiding of SIFs may prevent first attak of seizure in patients with risk factors or family history of epilepsy. We observed SIFs, clinical features associated with SIFs on their first seizure attack in patients diagnosed as epilepsy to help the prevention or management of the childhood epilepsy. SUBJECTS AND METHODS: A retrospective study was undertaken the analysis of 339 epileptic children visited to the pediatric Department of Pusan National University hospital from November, 1992 to July, 1998. RESULTS: 1) The 168 of 339 patients (49.5%) are associated with SIFs on first seizure attack. 2) Mean Age on their first seizure attack in the group with SIFs is 4.08+/-3.63 year-old and without SIFs is 2.80+/-3.34 year-old.3) The factors were febrile state (32.7%), sleepy state (29.0%), acute illness (8.3%), emotional stress (5.8%), fatigue (5.3%), hypoxia (4.7%), during watching TV or playing game (3.5%), head trauma (3.5%), bathing (2.8%), infection of central nervous system (2.3%), sleep deprivation (1.1%), vaccination (0.5%), hyperventilation(0.5%). 4) The types of seizure in patients with SIFs were as following : generalized tonic, clonic, tonic-clonic seiuzre was 140(90.9%), partial seiuzre 14(9.1%). 5) The family history of seizure disorders were not associated with SIFs. And 14(8.3%) of patients with SIFs had developmental delay, 24 (14.0%) of patients without SIFs. 6. Mean duration of control seizure was 1.52+/-2.65 years in the group with SIFs, 0.84+/-1.30 years in the group without SIFs. CONCLUSION: Early detection and education of the possible SIFs in each epileptic patients is considered as an important therapeutic modality in managing the epileptic patients in childhood.
Anoxia ; Baths ; Busan ; Central Nervous System ; Child ; Craniocerebral Trauma ; Education ; Epilepsy* ; Fatigue ; Humans ; Precipitating Factors* ; Retrospective Studies ; Risk Factors ; Seizures* ; Sleep Deprivation ; Stress, Psychological ; Vaccination

No abstract available.

BACKGROUND: To secure a rapid and safe approach which is at the same time cosmetically appealing, we employed the right anterolateral thoracotomy incision for repair of atrial septal defects and valvular heart diseases in the adult. MATERIAL AND METHOD: Between October 1989 and June 1998, 44 adult patients underwent open heart surgery through right anterolateral thoracotomy at our institution. Operative time, cardiopulmonary bypass time, aortic cross clamp time, blood loss until chest tube removal, length of ICU stay, days to discharge, and survival were compared with those that received cardiac surgery via conventional sternotomy. RESULT: No significant differences were observed between the two groups. There was no death and no additional morbidity directly related to this approach. Cosmetically satisfying results were obtained with safety using the right anterolateral thoracotomy approach. CONCLUSION: Our data show that the right anterolateral thoracotomy approach is a safe alternative to conventional median sternotomy as it offers excellent exposure and aesthetically more acceptable wounds while not adding on to the operative risks.
Adult* ; Cardiopulmonary Bypass ; Chest Tubes ; Heart Septal Defects, Atrial ; Heart Valve Diseases ; Humans ; Operative Time ; Sternotomy ; Thoracic Surgery* ; Thoracotomy* ; Wounds and Injuries

Ophthalmoplegia without ataxia has various etiologies. An atypical Miller Fisher syndrome implies an ophthalmoplegia without ataxia, areflexia or both. The presence of anti-GQ1b antibody supports the diagnosis of an atypical Miller Fisher syndrome. A 4-year-old Russian girl visited our hospital because of acute bilateral abducens nerve palsy and mydriasis. Although the muscle power of extremities was normal and she didn't show an ataxia, the deep tendon reflex of both knees and ankles was absent. The results of nerve conduction study and cerebrospinal fluid analysis were normal. Magnetic resonance imaging (MRI) showed an enhancement of the bilateral abducens nerve. The anti-Gq1b antibody titer was elevated. The diagnosis of atypical Miller Fisher syndrome was made and a therapy with intravenous immunoglobulins led to the clinical recovery. We report a girl with atypical Miller Fisher syndrome with acute bilateral abducens nerve palsy and mydriasis, diagnosed by of anti-GQ1b antibody positivity.
Abducens Nerve ; Abducens Nerve Diseases* ; Ankle ; Ataxia ; Cerebrospinal Fluid ; Child, Preschool ; Diagnosis ; Extremities ; Female ; Humans ; Immunoglobulins, Intravenous ; Knee ; Magnetic Resonance Imaging ; Miller Fisher Syndrome ; Mydriasis* ; Neural Conduction ; Ophthalmoplegia ; Reflex, Stretch

Duchenne muscular dystrophy (DMD) is the most common and severe form of childhood muscular dystrophy. Females are affected in rare cases because of its' X-linked, recessive inheritance. A small number of female DMD carriers have muscle weakness to some extent. A healthy 8-month-old girl was brought to our tertiary center because of the elevated serum liver enzyme (aspartate aminotransferase (AST): 986 IU/mL, alanine aminotransferase (ALT): 1,126 IU/mL), that was first noted 1 month ago when she was hospitalized for an acute respiratory infection. Follow-up her serum liver enzyme, AST and ALT level remained increased to 613 and 1,049 IU/mL, respectively without serologic evidence of viral hepatitis. Serum creatinine kinase (CK) level was highly elevated to 5,245 U/L. She showed normal development. Pseudohypertrophy of bilateral calf muscle was not observed, and Gowers' sign was not seen because of her young age. Electromyography and cardiac echocardiography showed no abnormal findings. A multiplex ligation-dependent probe amplification confirmed the heterozygote deletion mutation of DMD gene in exon 10-17. The result of karyotyping was normal 46,XX. She was diagnosed as an asymptomatic DMD carrier. Female carriers are usually asymptomatic but may have an elevated serum CK and/or mild calf hypertrophy. A girl with persistent elevated liver enzyme and CK level should be evaluated for the neuromuscular disease including DMD, despite her normal motor activity.
Alanine Transaminase ; Creatinine ; Echocardiography ; Electromyography ; Exons ; Female ; Follow-Up Studies ; Hepatitis ; Heterozygote ; Humans ; Hypertrophy ; Infant* ; Karyotyping ; Liver ; Motor Activity ; Multiplex Polymerase Chain Reaction ; Muscle Weakness ; Muscular Dystrophies ; Muscular Dystrophy, Duchenne* ; Neuromuscular Diseases ; Phosphotransferases ; Sequence Deletion ; Wills

In this paper, a new superimposition scheme using a computer vision system was proposed with pairs of skull and ante-mortem photographs, which were already identified through other tests and DNA fingerprints at the Korea National Institute of Scientific Investigation. In this computer vision system, an unidentified skull was caught by video-camcoder with the MPEG and the other ante-mortem photograph was scanned by scanner. These two images were processed and superimposed using pixel processing. This recognition of individual identifications by anatomical references can be performed on the two superimposed images for many big cases like as Guam KAL accident in 1997.
Artificial Intelligence ; DNA Fingerprinting ; Guam ; Korea ; Skull

PURPOSE: Lumbar puncture is an essential and commonly practiced diagnostic tool and post-lumbar puncture headache and post-lumbar puncture back pain are common neurological complications. The aim of this study is to identify the factors that might cause post-lumbar puncture back pain and to reduce those complaints by eliminating the causes. METHODS: From June 5, 2013 to July 29, 2013, we studied 155 patients, male and female between the age 1 and 18,who received diagnostic or therapeutic lumbar puncture at Pusan National University Hospital and Pusan National University Yangsan Hospital. We collected data of variable aspects that may influence post-lumbar puncture back pain, by reviewing the medical records retrospectively. The independent variables were sex, age, symptoms, diagnosis, number of trials to successful lumbar puncture, year of the resident who carried out the procedure, opening pressure of cerebrospinal fluid(CSF), spinal level of punctured site, duration of strict bed rest, and use of sedatives for the procedure. RESULTS: Among the 155 patients whounderwent lumbar puncture, 36 (23.2%) experienced back pain after the procedure. Back pain subsided within 48hours in 24 ofthe 36 patients. Only one patient suffered from post-lumbar puncture back pain for more than 5days. There is no clear causality between the occurrence rate of post-lumbar puncture back pain and the independent variables which includeage, sex, duration of bed rest, symptoms, diagnosis, number of trials, skill, opening pressure, anatomic location, and use of sedatives. CONCLUSION: Back pain was a frequent complication of lumbar puncture. Various factors we expected to influence on the incidence of post-lumbar puncture back pain had no statistical significance. Further studies should be performed to investigate the causes and risk factors of post-lumbar puncture back pain.
Back Pain* ; Bed Rest ; Busan ; Child* ; Diagnosis ; Female ; Gyeongsangnam-do ; Humans ; Hypnotics and Sedatives ; Incidence ; Male ; Medical Records ; Post-Dural Puncture Headache ; Punctures* ; Retrospective Studies ; Risk Factors ; Spinal Puncture

Central pontine myelinolysis(CPM) is rare, with fewer than 30 cases reported in children. It is characterized by demylinated regions throughout the brain and which are most prominent in the pons. The original patients studied were all chronic alcholics, but subsequently the condition has been found in children and in other patients with electrolyte abnormalities, most notably hyponatremia which had been corrected rapidly. CPM symptoms include spastic quadriparesis, pseudobulbar palsy, and acute changes in mental status leading to altered levels of consciousness, coma, or death. This condition was originally thought to be uniformly fatal, but there have been recent reports of survival accompanied by varying degrees of residual neurologic deficit. We experienced a case of central pontine myelinolysis in a 1-year-old girl in 1998. On admission, she had right hemiphegia and developmental delay. She suffered from hyponatremia a year prior to admission. We performed brain MRI and other studies. She was diagnosed with CPM though brain MRI.
Brain ; Child ; Coma ; Consciousness ; Female ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Muscle Spasticity ; Myelinolysis, Central Pontine* ; Neurologic Manifestations ; Pons ; Pseudobulbar Palsy ; Quadriplegia