PURPOSE: Endoscopic variceal sclerotherapy(EVS) has been considered the mainstay therapy for bleeding esophageal varices in adults. However, recent data have shown that endoscopic variceal ligation is just as efficacious and has fewer complications than EVS. Although there are many reports concerning EVL in adults, only a few studies have been done of children. METHODS: We performed EVL in 9 children under 6 years of age(mear age, 2.5 year) with esophageal varices. Outcome was assessed with respect to survival, rebleeding, and complications. RESULTS: The causes of portal hypertension were 3 cases of congenital hepatic fibrosis, 3 cases of biliary atresia, 2 cases of portal vein thrornbosis, and one case of portal vein fibromuscular dysplasia. The age at diagnosis ranged from 10 months to 6 years. The patients underwent a mean of 2.6+/- 0.7 sessions of EVL(ranging from two to four). The numbers of bands per person were 5.6+/-1.8, and the numbers of bands per session were 2.2+/-1.0 Two complications of esophageal rebleeding were noted, and none of the cases experienced symptoms of esophageal stenosis, nor gastroesophageal reflux. CONCLUSION: EVL is safe and effective in controlling variceal hemorrhage in children with portal hypertension, regardless of etiology. The cornplication rate is low and EVL is an acceptable and perhaps preferable altemative to EVS in children with esophageal varices. But regular periodic examination for recurrence of varices after eradication should be required.
Adult ; Biliary Atresia ; Child* ; Diagnosis ; Esophageal and Gastric Varices* ; Esophageal Stenosis ; Fibromuscular Dysplasia ; Fibrosis ; Gastroesophageal Reflux ; Hemorrhage ; Humans ; Hypertension, Portal ; Ligation* ; Portal Vein ; Recurrence ; Varicose Veins

PURPOSE: To investigate the effect of 21-aminosteroid U74389G (U) on the extent of brain damage and edema formation in the newborn rats with hypoxic ischemic (HI) brain injury. METHODS: This is a randomized, placebo-controlled, experimental study. The subjects were 113 seven-days-old rats with HI injury. Pups were treated with 3, 10, or 20 mg/ kg of U intraperitoneally 30 minutes before hypoxia (Group 1, 2, 3: n=10, 13, 11), 10 mg/kg of U immediately after hypoxia (n=11) (Group 4), 10 mg/kg of U 30 minutes before and after hypoxia (n=n=13) (Group 5), or vehicle (n=12) (Group C). We expressed the degree of brain infarction and brain edema in % atrophy (Left hemisphere-Right hemisphere/Left hemispherex100) and water content % (wet weight-dry weight/wet weightx100) RESULTS: There were significant reductions in the diameters of right hemisphere compared with those of left hemisphere in vehicle and U treated animals (P<0.05). As to the cortical thickness, group 2, 3 and 5 pups showed no significant reductions in the right side compared with the left side implicating that U treatment in these groups was of benefit in attenuating HI cortical injury, while there was significant difference between the right and left side in group 1, 4 and C animals (P<0.001). There was a significant difference (P< 0.01) in % atrophy of group 2, 3, 5 versus group C, but the mean % atrophy was similar in groups 1, 4 and C. There was a significant (P<0.05) increase of water content in right hemisphere compared with left hemisphere both in U and vehicle treated groups. CONCLUSION: Pre-treatment and prepost-treatment at moderate doses (10 or more mg/kg) of 21-aminosteroid U74389G reduced the extent of perinatal hypoxic-ischemic brain damages, especially in the cortex, but do not affect the extent of brain edema.
Animals ; Anoxia ; Atrophy ; Brain Edema ; Brain Infarction ; Brain Injuries ; Brain* ; Edema* ; Humans ; Infant, Newborn* ; Lipid Peroxidation ; Rats*

Salmonella meningitis is rare yet poses causes significant neurological morbidity in children. Infants, especially those under 3 months of age, and those with immunocompromised states, such as malignancy, malaria, and human immunodeficiency virus infection, are at increased risk for developing Salmonella meningitis. Herein, we describe a case of Salmonella meningitis in a previous healthy 8-year-old girl who presented with high fever, vomiting, and altered mental status. Group D Salmonella species were isolated in cerebrospinal fluid culture, and no abnormal findings were noted in brain magnetic resonance imaging. Immunoglobulin levels and lymphocyte subset counts were within the normal ranges, and no genetic mutation responsible for primary immunodeficiency disease was detected by next-generation sequencing. The patient’s condition improved rapidly with third-generation cephalosporin, and no complications or sequalae developed. Nontyphoidal Salmonella can cause meningitis in immunocompetent children and can be successfully treated with early administration of antibiotics.

Ocular contrapulsion refers to a syndrome of static ocular deviation and saccadic hypermetria toward the intact side, and saccadic hypometria and impaired smooth pursuit toward the lesion side. It has been reported in patients with lesions in the rostral cerebellum and caudal medullary hemorrhge. We report a 60-year-old man who showed ocular contrapulsion with unilateral upper medial medullary infarction. Ocular contrapulsion may be a sign of medial medullary infarction. In our patient, the climbing fibers may be damaged before crossing the midline in the upper medulla.
Cerebellar Ataxia ; Cerebellum ; Humans ; Infarction* ; Middle Aged ; Pursuit, Smooth

PURPOSE: Recently, clinical trials of steroid add-on therapy were reported with variable results in Kawasaki disease. We analyzed the clinical outcomes of patients at high risk of with Kawasaki disease(> or = 4 points of Harada score) treated by three commonly used different treatment regimens, with or without corticosteroids. METHODS: Medical records of 96 children with Kawasaki disease treated with one of the threee regimens were reviewed retrospectively. Regimen 1 was aspirin(100 mg/kg/day) plus intravenous gamma globulin 2 g/kg single dose; regimen 2, aspirin(100 mg/kg/day) plus intravenous gamma globulin 1 g/kg single dose; regimen 3, regimen 2 plus prednisolone(2 mg/kg/day), followed by tapering two weeks and pulse therapy of methyl prednisolone performed in cases of retreatment. Also low dose aspirin was given in all three regimens for eight weeks after the acute phase. The cardiovascular and laboratory evaluations were performed on acute phase, immediate after acute phase, and subacute phase, eight weeks after treatment. RESULTS: The frequency of coronary artery lesions and laboratory findings in the three different regimens were similar. The more rapid control of fever after treatment was noted in regimen 3. Furthermore the frequency of retreatment was decreased in regimen 3 compared to the other two regimens. CONCLUSIONS: Steroid add-on therapy showed some beneficial outcome compared to conventional treatment regimens. The role of steroid in the treatment of Kawasaki disease should be reassessed in systemic manner.
Adrenal Cortex Hormones* ; Aspirin ; Child ; Coronary Vessels ; Fever ; gamma-Globulins ; Humans ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Prednisolone ; Retreatment ; Retrospective Studies

PURPOSE: This study aimed to uncover the fundamental nature of living alone in female elderly. METHODS: The phenomenological research approach developed by van Manen was adopted. RESULTS: The theme was 'taking a firm stand alone on the edges of life'. The composition elements of living alone experienced by elderly women were as follows: 1) Corporeality: participants perceived their bodies by their health status. Unhealthy participants were suffering with diseases and dependant on other persons, while healthy participants were free from family responsibility and kept on moving. 2) Spatiality: participants felt both freedom and loneliness while they stayed home. 3) Relationality: participants felt pity and yearning for their bereaved husband and sometimes talked to his picture. According to their children's filial piety, participants were pleased or displeased. However, they incessantly devoted themselves to their children. 4) Temporality: participants considered the rest of their life as extra-time which was proceeding to death, and tried to keep themselves busy before they died. CONCLUSION: A nurse should understand the multifarious aspects of elderly women's life, and then intervene to consolidate their strengths for self-supporting the final years of life.
Adaptation, Psychological ; Aged ; Aged, 80 and over ; Attitude to Death ; Family ; Female ; Health Status ; Humans ; Interviews as Topic ; Life Style ; Loneliness ; *Quality of Life ; Widowhood/*psychology

OBJECTIVES: The purposes of this study were 1) to correlate the carotid intima-medial thickness (IMT) with risk factors of atherosclerosis, 2) to demonstrate the standarized methods of B-mode ultrasound (US) scanning of carotid artery and IMT measurement. MATERIALS AND METHODS: Bilateral carotid arteries of 95 adult volunteers were scanned using 12 MHz linear probe. The mean of bilateral IMT was regarded as the volunteer's IMT, which was measured on the far wall of distal common carotid artery. The normality test for measured IMT and correlation tests between IMT and various known risk factors of atherosclerosis including age, end-systolic blood pressure, end-diastolic blood pressure, fasting blood glucose level, body mass index, life-style data and lipid profiles were performed. Inter-observer and intra-observer variability were evaluated through correlation tests on 20 randomly sampled data. RESULTS: The measured IMT showed normal distribution (mean=0.673 mm, SD=+/-0.1, p=0.494) and the 95th percentile was 0.830 mm. The systolic blood pressure (r=0.101) and body mass index (r=0.200) showed positive correlation but they did not show statistically significant relationships with IMT (p>0.05). The age showed statistically significant correlation (r=0.585, p<0.001), but the other risk factors did not show statistically significant correlation with IMT. The correlation coefficients of inter-observer and intra-observer variability on IMT measurement were 0.8770 and 0.9213, respectively. CONCLUSION: The diagnostic criteria for early carotid atherosclerosis using B-mode US could be estimated from our data. Our measurement protocols showed high reproducibility. The associations between most risk factors that did not show statistically significant correlation in our study and IMT should be confirmed in a population-based study.
Adult* ; Atherosclerosis ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Artery, Common ; Fasting ; Humans ; Observer Variation ; Risk Factors ; Ultrasonics ; Ultrasonography* ; Volunteers*

No abstract available.

Amyloidosis comprises a diverse group of systemic and local diseases characterized by organ involvement by the extracellular deposition of fibrils composed of subunits of a variety of normal serum proteins. Secondary amyloidosis is caused by the deposition of amyloid A(AA) protein in chronic inflammatory disease. Juvenile rheumatoid arthritis(JRA) has been known to be the most common cause of secondary amyloidosis. We experienced one case of secondary renal amyloidosis in a 12-year-old girl who had suffered from JRA for several years who had visited our renal clinic to evaluate the proteinuria with microscopic hematuria which was detected by chance at school urine screening examination. Apple green birefringence was observed under polarized light with Congo red stain and characteristic electron microscopic findings was also noted in renal tissues which was obtained by percutaneous renal biopsy. In our knowledge, this is the first case report of secondary renal amyloidosis developed in pediatric age in Korea.
Amyloid ; Amyloidosis* ; Arthritis, Juvenile* ; Biopsy ; Birefringence ; Blood Proteins ; Child* ; Congo Red ; Female ; Hematuria ; Humans ; Korea ; Mass Screening ; Proteinuria

Tumarkin's otolithic crisis refers to drop attacks of vestibular origins. It usually occurs without warning in patients with late or end-stage endolymphatic hydrops. However, drop attacks of vestibular origins may occur in patients without otologic deficit. We report a patient with Tumarkin's otolithic crisis from delayed endolymphatic hydrops. The careful delineation of drop attacks in patients with vertigo can provide appropriate therapeutic options for patients with this potentially dangerous condition.
Endolymphatic Hydrops ; Humans ; Otolithic Membrane* ; Syncope ; Vertigo