No abstract available.
Aneurysm* ; Aorta*

PURPOSE: In this study, we aimed to find useful methods for diagnosis and treatment of hyperthyrotropinemia in neonates showing normal T4 and elevated TSH levels in neonatal screening test. METHODS: We retrospectively reviewed the medical records of 16 male and 26 female neonates whose T4 were normal and TSH were elevated in the neonatal screening test from 1994 to 2006. The clinical data, including perinatal history, thyroid function test and radionuclide scannig was analysed. RESULTS: Of the forty-two patients, male was 38.1% and female was 61.9%. Mean T4 and TSH level were 8.61+/-1.55 ug/dL, 49.66+/-36.56 uU/mL respectively. At the recheck, when recalled, TSH were normalized in 8 patients (19.1%), still elevated in 34 patients (80.9%). (99m)TC thyroid scan was performed in 36 cases. The results were normal in 18 cases (50.0%), diffuse enlargement in 11 cases (30.5%), ectopic thyroid, poor visualization, hypoplasia respectly in 11.2%, 5.5%, 2.8%. Fourteen patients (33.3%) had histories of povidone use for umbilical care. Of the 42 patients, 27 (64.0%) cases were treated by thyroid hormone, 15 cases (36.0%) were followed up without treatment. Among 15 cases without treatment, 8 patients showed TSH normalization at 1.5 months, 5 patients at 3 months, one patient at 6 months and one patient at 9 months. Among 27 cases with treatment, 18 cases (66.7%) are being treated, 5 cases (18.6%) are being treated more than 3 years, the 3-years treatment was ended in 6 cases (22.2%), follow up loss was 3 cases (11.1%). CONCLUSION: At long term follow up, TSH was normalized in many patients who showed normal T4 and elevated TSH levels in neonatal screening test. Imaging study such as (99m)TC thyroid scanning was helpful to decide whether to treat with thyroid hormone replacement. To predict longer term prognosis of cases without thyroid hormone replacement, long term follow up of large number of patients is needed.
Diagnosis ; Female ; Follow-Up Studies* ; Humans ; Infant, Newborn* ; Male ; Medical Records ; Neonatal Screening ; Povidone ; Prognosis ; Retrospective Studies ; Thyroid Dysgenesis ; Thyroid Function Tests ; Thyroid Gland

PURPOSE: Headache is a frequent symptom in pediatric practice, but the prevalence of chronic recurrent headache was estimated in several studies with wide variations, because of inadequate expression and differences in case definition in children. Headache classification of International Headache Society is usually used in adults, but the application of it to children is uncommon, so we tried to diagnosis children with headache by using International Headache Society Classification. METHODS: We analyzed the clinical pictures, physical examinations including neurologic examination, PNS series, EEG and CT or MRI in 53 children with nonprogressing recurrent headache over than one month, who visited to pediatric department of Dong-A University hospital from January, 1995 to Feburary, 1996 and diagnosed them by using International Headache Society Classification. RESULTS: 1) The sex ratio between male and female was 1:1.2. 2) Diagnosed groups consisted of children with migraines in 22 cases(41.5%), tension-type headache in 19 cases(35.9%), coexisting migraine and tension-type headaches in 5 cases(9.4%), miscellaneous headaches not associated with structual lesion in 1 case(1.9%), headache associated with vascular disorders in 2 cases(3.8%), headache associated with nonvascular intracranial disorder in 1 case(1.9%), headache due to facial pain in 3 cases(5.6%). 3) Of 22 migraine cases, 13 cases(59.1%) had migraine with aura, 8 cases(40.9%) have migraine without aura and of 19 tension-type headache cases, 8 cases(42.1%) have episodic type, 11(57.9%) cases have chronic type. 4) Of 53 cases with recurrent headache, 3 cases(6%) had abnormal findings in CT or MRI. 5) Of 53 cases with recurrent headache, 9 cases(17%) had abnormal findings in EEG. CONCLUSIONS: International Headache Society Classifications are useful, but the diagnostic criteria are too strict for children, especially in migraine and tension type headache.
Adult ; Child* ; Classification* ; Diagnosis ; Electroencephalography ; Facial Pain ; Female ; Headache* ; Humans ; Magnetic Resonance Imaging ; Male ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Neurologic Examination ; Physical Examination ; Prevalence ; Sex Ratio ; Tension-Type Headache

OBJECTIVES: Rapidly progres s ive glomerulonephritis (RPGN) is a clinico- pathologic entity characterized by extens ive crescent formation(usually involving 50% or more of glomeruli) as the principal his tologic finding and a rapid deterioration of kidney function, which can lead to end s tage renal disease within a few weeks. T he etiology and incidence of RPGN has been well defined in Europe and North America, however, there has been no report of a large series in Korea. T he aim of the present s tudy was to analyze the etiology and clinico- pathologic features of 26 patients with RPGN, seen during 1983-1997. METHODS: T wenty-six patients with RPGN(crescents in > 50% of glomeruli) were obs erved during a period of las t 14 years. Male to female ratio was 1:1.4, and the mean age was 30(6-75) years. Mean time from the initial symptoms to the ESRD was 3.1 months . RESULTS: The incidence of RPGN in our series was 2.1% of primary glomerulonephritis. Immunecomplex mediated disease was presented in 14 cases (54%), including 6 sys temic lupus erythematos us, 3 post- streptococcal glomerulonephritis, 3 Henoch- Schonlein purpura, and 2 IgA nephropathy. Pauci- immune disease was presented in 12 cases (46%), including 3 Wegener' s granulomatos is, one necrotizing crescentic glomerulonephritis, and 8 idiopathic crescentic glomerulonephritis. However, there was none of anti-GBM- mediated disease in our s tudy. ANCA were found in 6 patients. All 3 patients with WG were C- ANCA pos itive, whereas one patient with PSGN, necrotizing cres centic GN, and idiopathic crescentic GN were P- ANCA pos itive, respectively. Initial clinical and laboratory features included edema(80%), hypertens ion(72%), oliguria(68%), a decreased renal function(serum creatinine > 5mg/dL, 35%), and gros s hematuria(36%). Renal biopsy showed large crescents more than 80% of the glomeruli in 14 cases (54%) which were predominantly fibrocellular. Fifteen patients (58%) were treated with prednis olone alone, and 12 of them received puls e doses of corticosteroids. Five patients were treated with prednisolone and cyclophos phamide IV pulse. Two cases received plasma exchange. During the mean follow-up of 31+/-37 months, 18 patients (69%) developed inexorable progression of renal failure, three(12%) showed recovery of renal function, and two(8%) showed partial improvement, which is followed by varying degrees of renal insufficiency. During follow-up, three patients died : two from res piratory failure with severe pulmonary hemorrhage and one from opportunistic pulmonary infection during immunosuppressive therapy. Poor prognos is is as sociated with hypertension, increased serum creatinine level at the time of diagnosis, large crescents more than 85% of glomeruli, and glomerular scleros is . CONCLUSION: We conclude that an earlier diagnos is including kidney biopsy and the more aggressive treatment are essential in the management of RPGN.
Adrenal Cortex Hormones ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Creatinine ; Diagnosis ; Europe ; Female ; Follow-Up Studies ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Hemorrhage ; Humans ; Hypertension ; Immune System Diseases ; Incidence ; Kidney ; Kidney Failure, Chronic ; Korea ; Male ; North America ; Plasma Exchange ; Prednisolone ; Purpura ; Renal Insufficiency ; Systemic Vasculitis

No abstract available.

No abstract available.
Pulmonary Artery*

Osteopontin, a secreted, arginine-glycin-asparate (RGD)-containing phosphoprotein is up-regulated in renal cortex in many experimental models of tubu- lointerstitial fibrosis. Osteopontine gene seems to be induced predominantly in chronic and progressive glomerulosclerosis. To examine the effects of enala-pril and lovastatin alone or in combination on osteopontin, TGF- 8, endothelin- 1, procollagen a 1(I) at an early phase of chronic renal failure in 5/6 nephrectomized rats, randomly assigned 4 groups [untreated 5/6 nephrectomy(group Nx), treated with enalapril(group E) or lovastatin(group L) alone and in combination(group EL)(each group n=6)] were sacrificed at 8 weeks. Four rats were served as normal control ones. Systolic blood pressure, 24 hour urine protein excretion, serum chemistry were mea- sured. mRNA levels of renal cortical osteopontin, TGF- , endothelin-l, procollagen a 1(I) were measured by Northern hybridization. Eight week after nephrectomy untreated neph- rectomized rats had higher systemic blood pressure (157 3 vs. 140 1mmHg, p<0.05) with increasing proteinuria(32.9 11 vs. 1.2 0.2, p<0.05) than normal con- trol rats. mRNA expression of osteopontin(12.5 folds, p<0.05) and endothelin-l(1.6 folds, p<0.05) in renal cortex were elevated, but mRNA expression of TGF- 0 and procollagen a 1(I) were not. The treatment with enalapril or lovastatin alone prevented a further rise in proteinuria and significantly reduced renal cortical osteopontin mRNA expression at 8 weeks. Enalapril reversed systemic hypertension but lovastatin not. Both drugs had no effect on renal cortical endothelin-1 mRNA expression. The treatment with combined enalapril and lovastatin reduced renal cortical osteopontin mRNA expression more and showed trend to reduce proteinuria compared to treatment with each drug alone. The results of the present study indicate that the treatment with enalapril or lovastatin reduces proteinuria and renal cortical osteopontin mRNA expression which are occurred at early phase of chronic renal failure in 5/6 nephrectomized rat model and combined treatment appears to be more effective.
Animals ; Blood Pressure ; Chemistry ; Enalapril* ; Endothelin-1 ; Fibrosis ; Gene Expression* ; Hypertension ; Kidney Failure, Chronic ; Lovastatin* ; Models, Animal ; Models, Theoretical ; Nephrectomy ; Osteopontin* ; Procollagen ; Proteinuria ; Rats* ; RNA, Messenger

PURPOSE: It has been a common medical practice to use prophylactic antibiotics to prevent recurrent urinary tract infections (UTI) in high risk situations such as urinary tract obstruction, vesicoureteral reflux, neurogenic bladder, or urinary stones. But sometimes, we meet difficult situation of breakthrough infections (BI) which might cause new or progressive renal scarring. The clinical characteristics of children contracting breakthrough UTI experienced in a single center were studied. METHODS: The study was done retrospectively through medical records of 150 pediatric patients who had been cared in pediatric and urologic clinics of Pusan National University Hospital from Jan. 2001 till June 2006 and had prophylactic antibiotics to prevent recurrent UTI. RESULTS: The starting age of prophylactic antibiotics of 150 patient was 1-76 months, and median age was 5 months. The BI developed 61 times in 43 patients (28.7%), 1.5 times per 100 patient-months. The BI occurred more frequently in patients with higher grade of VUR, and in the cases with abnormal DMSA scan. Co-trimoxazole was more effective than 2nd and 3rd generation cephalosporins to prevent UTI. The distribution of causative organisms was more diverse than usual UTI. The causative organisms were sensitive to the antibiotics used for prophylaxis in 29.5%, and resistant in 59.1%. After experience of BI, 40 percents of patients went to the surgical treatment including endoscopic injection of Deflux, 35% to new antibiotics for prophylaxis, 26% remain on the same antibiotics as the previous one. CONCLUSION: Based on our study results, preexisting renal scar might be one of the factors which should be considered in favor of early surgical interventions of VUR. Poor compliance and wrong selection of antibiotics such as cephalosporins are important underlying causes of breakthrough UTIs.
Anti-Bacterial Agents ; Cephalosporins ; Child ; Cicatrix ; Compliance ; Contracts ; Dextrans ; Humans ; Hyaluronic Acid ; Medical Records ; Retrospective Studies ; Succimer ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Bladder, Neurogenic ; Urinary Calculi ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux

Hemolytic uremic syndrome is an unusual and uncommon disease in adults but more common in children, which is defined by the triad of acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia. We report a 64-year-old man who developed hemolytic uremic syndrome after esophagectomy and esophagogastrostomy due to esophageal cancer. We treated him using continuous renal replacement therapy and plasmapheresis with large volume fresh frozen plasma transfusion for 9 days. We could not find the cause of hemolytic uremic syndrome, and so finally concluded that it is idiopathic. Bleeding continuously without a particular reason after an operation, it needs an early diagnosis and treatment with considering a possibility of the hemolytic uremic syndrome.
Acute Kidney Injury ; Adult ; Anemia, Hemolytic ; Child ; Early Diagnosis ; Esophageal Neoplasms ; Esophagectomy* ; Hemolytic-Uremic Syndrome* ; Hemorrhage ; Humans ; Middle Aged ; Plasma ; Plasmapheresis ; Renal Replacement Therapy ; Thrombocytopenia

Fibromuscular dysplasia is the single leading etiology of renovascular hypertension in children. We report an eight-year-old girl who was admitted for generalized tonic seizure with fibromuscular dysplasia of right renal artery. On admission, she presented hypertension and altered mentality. She had suffered from intermittent severe headache for the past year. Renal angiography of right renal artery showed stenosis, beaded pattern and aneurysms. Brain MRI showed multifocal lesions in parietooccipital, periventricular and external capsular area. She was diagnosed as hypertensive encephalopathy due to fibromuscular dysplasia of renal the artery. Renal angioplasty with ballooning catheter was performed. Successful renal angioplasty dropped her blood pressure to normal level and no more headaches has occurred for more than a year after discharge.
Aneurysm ; Angiography ; Angioplasty ; Arteries ; Blood Pressure ; Brain ; Catheters ; Child ; Constriction, Pathologic ; Female ; Fibromuscular Dysplasia* ; Headache ; Humans ; Hypertension ; Hypertension, Renovascular ; Hypertensive Encephalopathy* ; Magnetic Resonance Imaging ; Renal Artery ; Seizures