The authors determined the value of performing urine microscopy on biochemically negative urine sepcimens in a pediatric population. The 746 urine specimens of patients who were either visited or admitted to the Department of Pediatrics, National Police Hospital, from March 1991 to July 1992 were reviewed on the basis of comparative evaluation of biochemical and microscopic urine analysis. Eight reactions of Clinitek(r) 200 were used as biochemical indicators, namely, pH, nitrite, albumin, glucose, ketone, urobilinogen, bilirubin, and blood. Out of 746 urine specimens studied, 186 were true positive. Thirty-six specimens reacted biochemically in the absence of positive microscopic findings (false postive), 492 specimens were true negatives. Thirty-two specimens had negative biochemical indicators, in spite of positive microscopy. The sensitivity of the biochemical parameters for predicting significant microscopy of urinary sediment is 85% and the specificity is 99%. The positive predictive value is 69.7% and the negative predictive value is 99.3%. The sensitivity of blood for RBC is 94%. and the specificity is 99%. The predictive value of a positive result is 84.6% and that of a negative result is 99.7%. We therefore conclude that urine microscopy is less necessary in biochemically negative urine specimens from asymptomatic pediatric patients, with hopefully resultant time and cost effectiveness.
Bilirubin ; Cost-Benefit Analysis ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Microscopy ; Pediatrics ; Police ; Sensitivity and Specificity ; Urinalysis* ; Urobilinogen

In complication of infective endocaditis splenomegaly and splenic infarction are not uncommon but splenic rupture is very rare. We report a case of splenic rupture complicated by infective endocarditis in 1 71-yr-old man who had been suffered from rheumatic heart disease (aortic regurgitation and stenosis and mitral regurgitation). The patient was admitted to mild fever and generalized weakness for 20 days. Diagnosis of infective endocarditis due to Staphylococcus epidermidis was made by clinical manifestaions and blood culture study.On 34th day of admissionthe patient suddenly displayed the symptoms and signs of massive intraperitoneal hemorrhage. Splenic rupture was revealed by paracentesis and radiologic studies. Rupture of spleen is an uncommon and usually fatal complication of infective endocarditis. Therefore early diagnosis and prompt treatment must be performed.
Constriction, Pathologic ; Diagnosis ; Early Diagnosis ; Endocarditis* ; Fever ; Hemorrhage ; Humans ; Paracentesis ; Rheumatic Heart Disease ; Rupture ; Spleen ; Splenic Infarction ; Splenic Rupture* ; Splenomegaly ; Staphylococcus epidermidis

No abstract available.
Cell Line* ; Humans*

The efficacy of acetaminophen, sponging plus acetaminophen, and sponging alone as method of lowering body temperature was compared in 108 children aged 8 weeks to 5 years who presented with an axillary temperature of 38.5degrees C or greater during the period from January 1993 to April 1993. The following results were obtained. 1) The male to female ratio was 2.5:1 and clinical diagnosis in the order of frequency were upper respiratory infection, gastroenteritis, pneumonia, urinary tract infection, cellulitis, chickenpox and hand-foot-mouth disease. 2) At thirty minutes after treatment, there was no significant difference on the decrement of temperature among the three groups. 3) At sixty minutes, the temperature decrement was the greatest in the group of sponging plus acetaminophen and that was statistically significant (P<0.01). But there was no significant difference between the group of acetaminophen and that of sponging.
Acetaminophen ; Body Temperature ; Cellulitis ; Chickenpox ; Child* ; Diagnosis ; Female ; Fever* ; Gastroenteritis ; Humans ; Male ; Pneumonia ; Urinary Tract Infections

No abstract available.
Mesenteric Lymphadenitis*

BACKGROUND: The dipyridamole and dobutamine stress echocardiography have been studied as a non-invasive diagnostic test in coronary artery disease. Recently, some authors have extended the usefulness of these tests to predicting the prognosis of myocardial infarction patients. But as far as we know, there was no literature which tried boh tests to the same infarcted patients group. So, we performed both tests in the 23 infarcted patients to compare and evaluate both tests as predicting the prognosis in myocardial infarction. METHODS: Patients underwent (1) two-dimensional echocardiography under basal condition and after dipyridamole infusion for 4 minites at the dose of 0.14mg/kg/min, (2) another two dimensional echocardiography under basal and during dobutamine infusion at each dose of 5 to a maximum of 20microg/kg/min at 1 or 2 days after dipyridamole stress echocardiography, and (3) coronary and left ventricular angiography. Preinfusion and peak infusion images were analyzed independently by two different observers using Nova Micro Sonic soft were(DataVueII and ColorVue II analysis system). The segmental wall motions were scored as follows ; hyperkinetic : 1, normal : 2, hypokinetic : 3, akinetic : 4. THe test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during drug infusion at the vascular distributions except the akinetic infarcted segment identified during basal condition. The coronary angiography was analyzed by measuring the maximal luminal diameter stenosis with caliper and 50% or greater diameter narrowing was considered significant. The sensitivity and specificity were calculated by comparing echocardiographic prediction and angiographic findings. RESULTS: 1) Among 22 patients with sufficient image in dipyridamole stress echocardiography, 13 patients have myltivessel coronary disease without resting akinesia of non-infarcted segments. Only 5 patients showed positive findings in dipyridamole stress echocardiography(sensitivity, 38.4%). Among 9 patients who has single or minimal disease, 9 patients were negative finding(specificity, 100%). 2) Among 21 patients with sufficient image in dobutamine stress echocardiography, 12 patients have multivessel coronary disease without resting akinesia of non-infarcted segments. 7 patients showed positive finding in dobutamine stress echocardiography(sensitivity, 58.3%). Among 9 patients who has single or minimal disease, 8 patients showed negative finding(specificity, 88.8%). 3) In hemodynamic changes, dipyridamole stress echocardiography showed significant changes in heart rates and double products and dobutamine stress echocardiography showed significant changes in heart rates, systolic blood pressure and double products. 4) There was no significant side effect during both stress tests inacute and old myocardial infarction patients. CONCLUSION: 1) The dobutamine and dipyridamole stress echocardiography are safe and easy test for myocardial infarction patients. 2) The dobutamine stress echocardiography has higher sensitivity than dipyrdamole stress echocardiography for identifying multivessel coronary disease in myocardial infarction patients but the dose of both drugs were relatively small to get the adequate results. So the high dose of drugs must be tried in feature study.
Angiography ; Blood Pressure ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Diagnostic Tests, Routine ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Exercise Test ; Heart Rate ; Hemodynamics ; Humans ; Myocardial Infarction* ; Phenobarbital ; Prognosis ; Sensitivity and Specificity

Familial adenomatous polyposis (FAP) is an hereditary autosomal dominant disease characterized by development of hundreds to thousands of adenomatous polyps in the colon and rectum. The common symptoms are bloody stool, diarrhea, and abdominal pain. The average age at onset of symptoms is 33 years. Because of inevitable progression to malignancy, it is necessary to remove the entire colonic and rectal mucosa. Current surgical options are total proctocolectomy with permanent ileostomy, trans-abdominal colectomy with ileorectal anastomosis (IRA), and restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Recently IPAA can give optimum control of colorectal polyposis in FAP patients with an acceptable incidence of postoperative complications and satisfactory functional results. We experienced one case of FAP who had malignacy in the remained rectum after subtotal colectomy. IPAA was done and the result was satisfactory.
Abdominal Pain ; Adenomatous Polyposis Coli* ; Adenomatous Polyps ; Colectomy* ; Colon ; Diarrhea ; Humans ; Ileostomy ; Incidence ; Mucous Membrane ; Postoperative Complications ; Proctocolectomy, Restorative ; Rectum*

Contrast sensitivity measurements were obtained from 45 patients with noninsulin dependent diabetes mellitus(NIDDM) who had normal Snellen acuity and minimal or no visible diabetic retinopathy. Contrast sensitivity thresholds were determined with a convenient microcomputer driven display system developed by the members of Department of Ophthalmology, Yonsei University College of Medicine. The data obtained from each diabetic. patients were compared with the normal contrast sensitivity of Korean(Lee et al, 1984). We found that, 1) The patients with NIDDM and no retinopathy had abnormal contrast sensitivity at two spatial frequencies (0.4 and 27.4 LP/D). 2) The patients with NIDDM and background retinopathy had abnormal contrast sensitivity at nearly all spatial frequencies tested. We also found a dissociation of Snellen acuity and contrast sensitivity and that contrast sensitivity can be used as an early index of changes in the retina not demonstrated by measurements of visual acuity.
Contrast Sensitivity* ; Diabetes Mellitus, Type 2 ; Diabetic Retinopathy ; Humans ; Microcomputers ; Ophthalmology ; Retina ; Visual Acuity

There are many unknown factors in the surgical treatment of congenital cataract such as time of surgery, surgical problems, and aphakic visual correction. Recently, the advancement of microsurgical technique and visual rehabilitation have reduced the rate of postoperative complications and visual losses. We have studied 81 eyes of 55 patients who had recieved cataract surgery from January 1994 to January 1998 at the department of ophthalmology, Yonsei University College of Medicine. These eyes have been categorized by age into three groups : Group l (0~1 year), Group ll (2~5 years), and Group lll(6~10 years). Cataract extraction was done in all eyes and posterior chamber intraocular lens implantation was performed in groups ll and lllfor aphakic visual correction and the followings were investigated : preoperative vision; surgical method; postoperative vision; refractive error;and complications. Improvements in surgical procedures such as lens aspiration, posterior continuous circular capsulorhexis, anterior vitrectomy, intraocular lens implantation, and intraocular lens capture (Group ll) have brought better visual outcomes in groups II and III as well as decreased incidence of after-cataract. Thus, intraocular lens implantation in congenital cataract of 1year and older should actively be considered.
Capsulorhexis ; Cataract Extraction ; Cataract* ; Humans ; Incidence ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Ophthalmology ; Postoperative Complications ; Rehabilitation ; Vitrectomy

134 cases of Diabetes Mellitus were classified by the National Diabetes Data Group: Type I (Insulin dependent type), Type II (Noninsulin dependent type, II a: Obese type, II b: Konobese type). They were observed by fluorescein angiography and analysed according to variable factors such as sex, age, diabetic maculopathy, visual acuity and duration in each type of Diabetes Mellitus. The results were as follows: 1. Among 134 diabetic patients, incidence of diabetic retinopathy was 48%. Incidence of background retinopathy was 38% and proliferative retinopathy 10%. 2. Type I was more common in younger age, whereas Type II more in over middle age(p<0.05). 3. Diabetic maculopathy was more prevalent in Type II than Type I. 4. Diabetic retinopathy was prevalent in in worsened visual acuity(p<0.005). 5. Incidence of background retinopathy was found to be concerned with duration of Diabetes Mellitus not in Type I, but in Type II(p<0.05). 6. In proliferative retinopathy, duration of Diabetes Mellitus was shorter in Type I but longer in Type II(p<0.05).
Diabetes Mellitus* ; Diabetic Retinopathy* ; Fluorescein Angiography ; Humans ; Incidence ; Visual Acuity