The authors report two cases of suddenly deteriorated accommodative esotropia with amblyopia during part-time occlusion therapy. A 7-year-old girl with right accommodative esotropia, which was well controlled, showed marked increase in esodeviation after part-time occlusion and regained orthophoria without occlusion. This phenomenon was repeated. Recession of both medial recti was performed and orthophoria was well maintained at both distant and near targets. Accommodative esotropia of a 9-year-old boy with glasses also showed a striking increase in esodeviation after part-time occlusion. The authors recommended wearing only glasses without occlusion or surgery and he recovered fusion. Three months later, orthophoria was maintained at distant target, with 8PD esophoria at near target with glasses. Although this complication should be considered before occlusion therapy, it must be taken continuously if needed, because an increase of the deviation size with occlusion may simply reflect a true deviation and may not be a poor prognostic sign.
*Accommodation, Ocular ; Amblyopia/physiopathology/therapy ; Child ; Esotropia/*etiology/physiopathology ; Eyeglasses ; Female ; Humans ; Male ; *Sensory Deprivation

Purpose: To evaluate serum 25(OH) vitamin D levels in patients with low-energy hip fractures. Materials and Methods: Among 983 patients who underwent hip fracture surgery between August 2013 and March 2019, 732 patients were evaluated. The remaining patients were excluded due to the presence of one or more of the following: metastatic bone tumor, metabolic bone disease other than osteoporosis, fracture due to high-energy injury, atypical femoral fracture, and no blood test. We collected patient’s data about age, sex male female, date of injury, a place of residence, fracture type, preinjury ambulation ability according to their Koval score, and their serum level of 25(OH) vitamin D. The mean age was 79.3 years (60-104 years). The sample was comprised of 530 female and 202 male, of which 342 had femoral neck fractures and 390 had trochanteric fractures. Results: Of the total 732 patients, 346 patients (47.3%) had a 25(OH) vitamin D level of less than 10 ng/mL, 264 patients (36.1%) had scores of 10-19.9 ng/mL, 87 patients (11.9%) had scores of 20-29.9 ng/mL, and 35 patients (4.8%) had a level higher than 30 ng/mL. Vitamin D deficiency (less than 20 ng/mL) was present in 610 patients (83.3%), insufficiency (20-29.9 ng/mL) was found in 87 patients (11.9%), and 35 patients (4.8%) had normal vitamin D levels. The differences in vitamin D concentration based on season and fracture type were statistically significant. Conclusion Vitamin D deficiency and inadequacy were high in patients with low-energy hip fractures, with only 4.9% of patients had normal vitamin D levels. These findings suggest that efforts should be made to maintain proper vitamin D concentration.

OBJECTIVES: As a preliminary study on the prevalence of mental disorders in Korean children and adolescents, we investigated the diagnosis distribution of mental disorders in people under 19 years of age using the health insurance data. METHODS: From the 2011 health insurance data of 1,375,842 people, the data of 286,465 people under 19 years old were extracted. Among them, we selected 10,778 with psychiatric diagnoses; male 6,453 (59.9%) and female 4,325 (40.1%). The frequency of psychiatric diagnoses in the males was 10,140 (62.7%) cases, which was significantly higher than that (6,031; 37.3%) in the females. We categorized the groups into 3 year intervals. RESULTS: In the males under 3 years old, F80 was the most prevalent diagnosis, followed by F98. F90 and F41 were the most prevalent in the 4-15 and above 16 years old groups, respectively. In the females, F98 was the most prevalent in the children up to 3 years old, while F80 was the second most prevalent. In the 4-6 years of age group, F98 was the most prevalent, followed by F93. F90 and F41 were predominant in the 7-12 and above 12 years old groups, respectively. CONCLUSION: In the analysis of the frequency of diagnosis of mental disorders in the population under 19 years old, there were significant differences in the distribution based on age and gender.
Adolescent ; Child ; Diagnosis ; Female ; Humans ; Insurance* ; Insurance, Health ; Male ; Mental Disorders ; Prevalence

Background: Plate fixation for atypical femoral fractures has shown high failure rates compared to intramedullary nail fixation. The aim of this study was to evaluate the radiological results of patients treated with a plate and screws for atypical fractures of the femoral diaphysis. Methods: This study was conducted retrospectively on 16 patients who had undergone internal fixation using plates for treatment of atypical femoral complete fractures from 2007 to 2015. Nine patients were treated with lag screws and short plates while 7 patients were treated with position screws and long plates, which covered the whole femur. Radiologic evaluation was performed on all patients. Complications were also evaluated. Results: Bone union was achieved in all patients and the average bone union time was 17.7 weeks (range, 14–28 weeks). There was no correlation between the preoperative use of a bisphosphonate, plate length, postoperative teriparatide use, and the time to bone union. Regarding complications, 2 cases of complete fractures and 1 impending fracture occurred at the end of short plates. Conclusions Satisfactory results were obtained with use of plates for patients with atypical femoral complete diaphyseal fractures, in whom intramedullary nails could not be applied due to severe bowing. In particular, it seemed advantageous compared with intramedullary nail fixation in that it could maintain the leg length through anatomical reduction and prevent iatrogenic fracture.

To develop the occupational cancer surveillance system in Korea, data linkage analysis was performed on the subjects of Health-monitoring-pocketbook (the list of subjects who were exposed to selected occupational carcinogens) and the retired workers of a cokes manufacturing factory using the Korean medical insurance data, Korean death certificate data and Korean cancer registry data. Study subjects comprised the 822 retired subjects and the 3101 present-post subjects of Health-monitoring-pocketbook and the 182 retired workers of a cokes manufacturing factory. The incidence of cancer of these study subjects was ascertained by linkage of Korean medical insurance data of year 1995-6, Korean death certificate data of year 1992-8 and Korean cancer registry data of year 1993-5. In the study subjects, Eighty seven percent were males and mean age was 39.3+/-8.9 year-old, Average work duration was 8.0+/-5.5 years. Chrome, asbestos and cokes were the most frequent exposed agents. In the study subjects, total 13 cancer cases were ascertained by data linkage analysis. In the ascertained cancer cases, 8 cases were male and 5 cases were female, and 7 cases were aged 40-49 yr, 5 cases were aged 50-59 yr and 1 cases were aged 30-39 yr. The commonest exposure agent in the ascertained cancer cases was asbestos and cokes. By the site of cancer, 3 stomach cancer cases, 2 hematopoietic cancer cases and 2 biliary tract cancer cases were ascertained. The occupational cancer surveillance system using data linkage analysis on the workers exposed to hazardous agents was the most feasible and efficient method in Korea. And to do this, establishment of occupational history information in several disease registry database is needed with the effort of estimating the proper size of workers exposed hazardous agents.
Asbestos ; Biliary Tract Neoplasms ; Coke ; Information Storage and Retrieval* ; Death Certificates ; Female ; Humans ; Incidence ; Insurance ; Korea* ; Male ; Stomach Neoplasms

Objectives: Early detection of developmental issues in infants and necessary intervention are important. To identify the comorbid conditions, a comprehensive evaluation is required. The study’s objectives were to 1) generate scale items by identifying and eliciting concepts relevant to young children (12–71 months) with developmental delays, 2) develop a comprehensive screening tool for developmental delay and comorbid conditions, and 3) assess the tool’s validity and cut-off. Methods: Multidisciplinary experts devised the “Infant Comprehensive Evaluation for Neurodevelopmental Delay (ICEND),” an assessment method that comes in two versions depending on the age of the child: 12–36 months and 37–71 months, through monthly seminars and focused group interviews. The ICEND is composed of three parts: risk factors, resilience factors, and clinical scales. In parts 1 and 2, there were 41 caretakers responded to the questionnaires. Part 3 involved clinicians evaluating ten subscales using 98 and 114 questionnaires for younger and older versions, respectively. The Child Behavior Checklist, Strengths and Difficulties Questionnaire, Infant-Toddler Social Emotional Assessment, and Korean Developmental Screening Test for Infants and Children were employed to analyze concurrent validity with the ICEND. The analyses were performed on both typical and high-risk infants to identify concurrent validity, reliability, and cut-off scores. Results: A total of 296 people participated in the study, with 57 of them being high-risk (19.2%). The Cronbach’s alpha was positive (0.533–0.928). In the majority of domains, the ICEND demonstrated a fair discriminatory ability, with a sensitivity of 0.5–0.7 and specificity 0.7–0.9. Conclusion The ICEND is reliable and valid, indicating its potential as an auxiliary tool for assessing neurodevelopmental delay and comorbid conditions in children aged 12–36 months and 37–71 months.

Acute lymphocytic leukemia (ALL) is uncommon lymphoid malignancy in dogs, and its diagnosis is challenging. A 14-year-old spayed female mixed breed dog was transferred to a veterinary medical teaching hospital for an immediate blood transfusion. The dog showed lethargy, pale mucous membranes, and a weak femoral pulse. Complete blood count revealed non-regenerative anemia and severe leukopenia with thrombocytopenia. ALL was tentatively diagnosed based on the predominance of immature lymphoblasts on blood film examination. For confirmation of lymphoid malignancy, PCR for antigen receptor rearrangement (PARR) on a peripheral blood sample and flow cytometry analysis were performed after blood transfusion. Flow cytometry analysis revealed that lymphocyte subsets were of normal composition, but PARR detected a T-cell malignancy. The dog was diagnosed with ALL and survived 1 wk after diagnosis. In conclusion, after blood transfusion, flow cytometry was not a reliable diagnostic method for an ALL dog, whereas PARR could detect lymphoid malignancy. Our results suggest that PARR should be the first-line diagnostic tool to detect canine lymphoid malignancy after a blood transfusion.
Adolescent ; Anemia ; Animals ; Blood Cell Count ; Blood Transfusion* ; Diagnosis* ; Dogs* ; Female ; Flow Cytometry ; Hospitals, Teaching ; Humans ; Lethargy ; Leukopenia ; Lymphocyte Subsets ; Methods ; Mucous Membrane ; Polymerase Chain Reaction* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Receptors, Antigen* ; T-Lymphocytes ; Thrombocytopenia

BACKGROUND AND OBJECTIVES: Acute heart failure (AHF) is associated with a poor prognosis and it requires repeated hospitalizations. However, there are few studies on the characteristics, treatment and prognostic factors of AHF. The aims of this study were to describe the clinical characteristics, management and outcomes of the patients hospitalized for AHF in Korea. SUBJECTS AND METHODS: We analyzed the clinical data of 3,200 hospitalization episodes that were recorded between June 2004 and April 2009 from the Korean Heart Failure (KorHF) Registry database. The mean age was 67.6+/-14.3 years and 50% of the patients were female. RESULTS: Twenty-nine point six percent (29.6%) of the patients had a history of previous HF and 52.3% of the patients had ischemic heart disease. Left ventricular ejection fraction (LVEF) was reported for 89% of the patients. The mean LVEF was 38.5+/-15.7% and 26.1% of the patients had preserved systolic function (LVEF > or =50%), which was more prevalent in the females (34.0% vs. 18.4%, respectively, p<0.001). At discharge, 58.6% of the patients received beta-blockers (BB), 53.7% received either angiotensin converting enzyme-inhibitors or angiotensin receptor blockers (ACEi/ARB), and 58.4% received both BB and ACEi/ARB. The 1-, 2-, 3- and 4-year mortality rates were 15%, 21%, 26% and 30%, respectively. Multivariate analysis revealed that advanced age {hazard ratio: 1.023 (95% confidence interval: 1.004-1.042); p=0.020}, a previous history of heart failure {1.735 (1.150-2.618); p=0.009}, anemia {1.973 (1.271-3.063); p=0.002}, hyponatremia {1.861 (1.184-2.926); p=0.007}, a high level of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) {3.152 (1.450-6.849); p=0.004} and the use of BB at discharge {0.599 (0.360-0.997); p=0.490} were significantly associated with total death. CONCLUSION: We present here the characteristics and prognosis of an unselected population of AHF patients in Korea. The long-term mortality rate was comparable to that reported in other countries. The independent clinical risk factors included age, a previous history of heart failure, anemia, hyponatremia, a high NT-proBNP level and taking BB at discharge.
Anemia ; Angiotensin Receptor Antagonists ; Angiotensins ; Female ; Heart ; Heart Failure ; Hospitalization ; Humans ; Hyponatremia ; Korea ; Multivariate Analysis ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Peptide Fragments ; Prognosis ; Registries ; Risk Factors ; Stroke Volume

BACKGROUND AND OBJECTIVES: Metabolic syndrome (MetS) increases the risk of heart failure (HF). The purpose of this study was to identify the prevalence of MetS in patients with HF and determine the syndrome's association with HF in clinical and laboratory parameters. SUBJECTS AND METHODS: A total of 3200 HF patients (67.6+/-14.5 years) enrolled in a nationwide prospective Korea HF Registry between Jan. 2005 and Oct. 2009. Patients were divided into two groups according to the presence or absence of MetS at admission: group I (presence, n=1141) and group II (absence, n=2059). RESULTS: The prevalence of MetS was 35.7% across all subjects and was higher in females (56.0%). The levels of white blood cells, platelets, creatinine, glucose, and cholesterol were significantly higher in group I than in group II. Left ventricular dimension and volume was smaller and ejection fraction was higher in group I than in group II. An ischemic cause of HF was more frequent in group I. The rates of valvular and idiopathic cause were lower in group I than in group II. The rate of mortality was lower in group I than in group II (4.9% vs. 8.3%, p<0.001). CONCLUSION: Despite the increased cardiovascular risks in MetS, MetS was found to be associated with decreased mortality in HF.
Blood Platelets ; Cholesterol ; Creatinine ; Female ; Glucose ; Heart ; Heart Failure ; Humans ; Korea ; Leukocytes ; Prevalence ; Prospective Studies