PURPOSE: Data regarding out-of-hospital pediatric cardiopulmonary arrest have been limited to the retrospective study. This study was performed to analyze the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest(CPA) with the international consensus in a single hospital. METHODS: Children less than 15 years old who entered emergency department with CPA, between 1st March 2004 and 31st July 2007, were included this study. Data were recorded prospectively following Utstein's template. The characteristics and outcomes of patients were analyzed. RESULTS: Cardiopulmonary arrests occurredin total of 37 of 21,339 children presented to emergency department during 41 months study period. 15 out of 37 with CPA had return of spontaneous circulation (ROSC) after resuscitation, 4 survived to be discharged from the hospital. The rate of ROSC in the respiratory arrest is higher than the cardiac arrest. Trauma was the most common cause of out-of-hospital pediatric cardiopulmonary arrest. No children who had more 20 minutes of cardiopulmonary resuscitation (CPR) or took more than 3 doses of epinephrine survived. CONCLUSIONS: The 10.4% survival rate after out-of-hospital pediatric CPA is poor. The respiratory arrest is more favorable. Education of basic life support for publics is needed to increase the rate of ROSC and survival from out-of-hospital pediatric cardiopulmonary arrest.
Adolescent ; Cardiopulmonary Resuscitation ; Child ; Consensus ; Education ; Emergency Service, Hospital ; Epidemiology* ; Epinephrine ; Heart Arrest* ; Humans ; Prospective Studies* ; Resuscitation ; Survival Rate

In order to simulate the hemorrhagic detachment stage of disciform macular degeneration, fresh blood was injected into the subretinal space of albino rabbits. In control group, the natural course of subretinal hemorrhage was studied with the ophthalmoscope and by electron microscopy. In experimental group, to study the effect of surgical intervention of the subretinal hemorrhage, a retinotomy was performed at the edge of the detached retina and the subretinal blood was removed by aspiration. And then the histopathologic change of the retina was exam ined by electron microscopy in both groups preceded by the ophthalmoscopic examination. In control group, between 12 hours and 4 days, there was partial damage of the photoreceptor cells characterized by destruction of the outer segment and swelling of mitochondria of the inner segment. In seven days after injection, irreversible retinal destruction was observed. In experimental group, two days after removal of subretinal hemorrhage in two hours following subretinal injection of blood, the outer segment was lost and destructed. Two days after removal of subretinal hemorrhage in five days following subretinal injection of blood, hydropic swelling and vacuolization of visual cells were characteristic. However there was no significant difference in the histopathologic change of retina between two groups.
Hemorrhage* ; Macular Degeneration ; Microscopy, Electron ; Mitochondria ; Ophthalmoscopes ; Photoreceptor Cells ; Rabbits ; Retina ; Retinaldehyde

In evaluating the early state of shock patients and their response to treatment, generally vital signs or additional hemodynamic values were used. Vital signs are easily obtained and repetitious values or continous monitoring is possible, whereas it cannot evaluate the patient's status properly nor is it a good prognostic factor. Meanwhile, additional hemodynamic values are obtained from pulmonary artery catheterization. But this procedure is difficult to proceed in the emergency room. Since central venous oxygen saturation has the advantage of being easily obtained and acts as a good prognostic factor for shock patients, we intended to prove its efficacy. From 1997 May to October, 50 patients admitted to Yonsei University Young Dong Severance Hospital in shock state, with systolic blood pressure below 90mmHg, were evaluated. Central venous catheter was inserted to obtain central venous oxygen saturation, serum lactate, base excess value, and its' initial value compared with the prognosis. The central venous oxygen saturation and base excess were low, while serum lactate value was high in the nonsurvival group. And in ROC(relative operating characteristic) curve, the AUC(area under curve) of central venous oxygen saturation was larger than the others. In comparing the MOF(multi-organ failure) group with the non-MOF group, the MOF group had a lower central venous oxygen saturation and base excess, and a higher serum lactate level, whereas in ROC curve, the AUC of base excess was larger than the others. Therefore, in estimating the prognosis of shock patients, the early central venous oxygen saturation proved to be a good prognostic factor.
Area Under Curve ; Blood Pressure ; Catheterization, Swan-Ganz ; Central Venous Catheters ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Lactic Acid ; Oxygen* ; Prognosis ; ROC Curve ; Shock* ; Vital Signs

No abstract available.
Heart Rate* ; Heart* ; Shock, Hemorrhagic*

Testicular microlithiasis is a rare cause of testicular enlargement. An 8.5-year-old boy presented with bilateral testicular enlargement accompanied by no other pubertal signs. His bone age was 8.5 years and serum levels of luteinizing hormone and follicle-stimulating hormone after gonadotropin-releasing hormone stimulation were within prepubertal limits. Scrotal ultrasonography showed multiple echogenic microcalcifications that are indicative of microlithiasis in both testes. During 2-year follow-up, he developed clinical manifestations of early puberty between 9.5 and 10.5 years of age. Testicular microlithiasis should be considered when boys show bilateral testicular enlargement without other findings of puberty.
Calculi ; Follicle Stimulating Hormone ; Follow-Up Studies ; Gonadotropin-Releasing Hormone ; Hypertrophy ; Luteinizing Hormone ; Puberty ; Testicular Diseases ; Testis

BACKGROUND: This study was conducted to verify the hypothesis that the suppression of lipid peroxidation with the antioxidant, U-74389G, could improve the survivability of paraquat intoxicated rats. METHODS: First, we obtained the 24-h mortality by using several paraquat dosages and calculated the 24-h LD50 in 24 male Wistar rats(250~350g). To examine the effect of U-74389G, we divided the rats in 4 groups: a control group and U-74389G only group, a paraquat only group, and a paraquat plus U-74389G group(n=10 each). Paraquat, 35mg/kg, was injected intraperitoneally at 0 h. U-74389G, 10mg/kg, was administered intraperitoneally at 0, 12 h or at 1, 12 h in the respective groups. The rats were observed for 24 hours. At 24 h, plasma and lung, liver, and kidney tissues were obtained after sacrificing the surviving rats to determine the degree of lipid peroxidation by using a thiobarbituric acid reactive substances(TBARS) quantitative analysis. RESULTS: The 24-h LD50 of paraquat was calculated as 40mg/kg in our rats. The 24-h mortality was as follows: control group and U-74389G group 0%, paraquat group 30%, and paraquat plus U-74389G group 10%. The TBARS analysis showed no differences between the U-74389G and the control groups. The paraquat group showed significantly increased TBARS levels in the serum and in the kidney and lung tissue compared to the control group(p<0.05). With U-74389G, the increased TBARS levels were significantly decreased in the plasma, kidney, and lung tissues compared to the paraquat group(p<0.05). However, in the liver tissue, there were no significant differences among the groups. CONCLUSION: A 21-aminosteroid antioxidant, U-74389G, improved the survivablity of paraquat-intoxicated rats through the suppression of lipid peroxidation. Our result suggests the possibility of clinical application of this drug as an antidote for paraquat poisoning.
Animals ; Humans ; Kidney ; Lethal Dose 50 ; Lipid Peroxidation ; Liver ; Lung ; Male ; Mortality ; Paraquat ; Plasma ; Poisoning ; Rats* ; Thiobarbituric Acid Reactive Substances

PURPOSE: The Epstein-Barr virus(EBV), gamma herpesvirus, is an important pathogen that is widespread around the world. The EBV causes various diseases depending on the geographic location, and on the immunity or the premorbid condition of the person exposed to EBV. To evaluate EBV typing may be the most important step to figure out the pathogenesis of EBV associated diseases, and we need to re-evaluate the pathologic role of human leukocyte antigen(HLA) in developing Epstein-Barr virus associated acute infectious mononucleosis by using newly developed methods. METHODS: This study included 24 children(age range : 6 to 13 years), serologically confirmed with acute infectious mononucleosis. The control group for the HLA type consisted of 200 age-matched healthy children. To classify HLA I, modified ARMs-PCR was used, while modified PCR-SSOP was utilized in typing of HLA II. Also, we performed EBV typing in study patients by using a one-step PCR. RESULTS: The results of HLA types : In HLA class I, HLA-A24 was positive in 69 of 200 healthy children and positive in 14 of 24 patients in the study group(relative risk : 3.5724, chi-square; 5.26, P<0.05). In HLA class II, HLA-DRB1*07 was detected in 18 of 200 healthy children, and eight of 24 patients in the study group(relative risk; 506173, chi-square; 9.73, P<0.01). The results of EBV types : In the research group, 20(83.8%) of 24 patients were shedding type A virus, while 4(16.7%) were type B. CONCLUSION: We conclude that development of infectious mononucleosis may be associated with HLA types, and these results suggest that acute infectious mononucleosis could have hereditary traits. And we confirm that type A EBV is highly prevalent in patients with acute infectious mononucleosis in Korea. Also, our results suggest that further large scale studies, including adult groups, regarding the association between pathogenesis of EBV with HLA-DP or HLA-DQ will be warranted.
Adult ; Child* ; Herpesvirus 4, Human* ; HLA-A24 Antigen ; HLA-DP Antigens ; HLA-DQ Antigens ; Humans* ; Infectious Mononucleosis* ; Korea ; Leukocytes* ; Polymerase Chain Reaction

BACKGROUND: The use of osteoanabolic agents to facilitate fracture healing has been of heightened interest to the field of orthopaedic trauma. This study aimed to evaluate the evidence of teriparatide for fracture healing and functional recovery in osteoporotic patients. METHODS: We performed a literature search in PubMed, EMBASE, Web of Science, and the Cochrane Library using terms including “Fracture” [tiab] AND “Teriparatide [tiab] OR “PTH” [tiab]. RESULTS: This systematic review included 6 randomized clinical trials, 4 well-controlled retrospective studies, and 1 retrospective post hoc subgroup analysis. Fracture location was 2 in pelvis, 3 in proximal femur, 1 in distal femur, 1 in shoulder, 2 in wrist and 2 in spine. The use of teriparatide yielded positive effects on radiographic bone healing in 6 studies, but was not associated with better radiographic outcome in 3. In terms of functional recovery, teriparatide injection was related with decrease in pain or shorter time to mobilization in 6 studies, but not related with pain numerical scale and mobility in 3. CONCLUSIONS: Our findings suggest that teriparatide provide selective advantages to fracture healing or functional recovery in the management of osteoporotic fractures. A better understanding of the role of teriparatide on osteoporotic fractures requires greater evidences from large volume prospective trials.
Femur ; Fracture Healing* ; Humans ; Osteoporosis ; Osteoporotic Fractures ; Parathyroid Hormone ; Pelvis ; Prospective Studies ; Retrospective Studies ; Shoulder ; Spine ; Teriparatide* ; Wrist

PURPOSE:We compared anthropomorphic measures and hormone levels in girls with atypical thelarche (AT) and central precocious puberty (CPP) and tried to find out factors discriminating AT from CPP. METHODS:We analyzed clinical and laboratory data of 62 girls with precocious breast development from May 2004 to May 2008 at Kangnam St. Marys Hospital. Immunoradiometeric assay (IRMA) was used to estimate gonadotropins and growth related hormones. CPP was diagnosed if peak luteinizing hormone (LH) level was >6.9 IU/L after gonadotropin hormone releasing hormone (GnRH) stimulation test. A multiple logistic regression analysis and the area under the receiver operating characteristics curve (AUC) were used to analyse the prediction capacity of variable factors to diagnose CPP. RESULT:The basal LH levels (P=0.001), IGF-I levels (P=0.049) and the peak LH levels (P<0.001) in GnRH-stimulation test in girls with CPP were higher than those with AT. Girls with AT had a lower degree of breast maturation than girls with CPP (P=0.001). A multivariate logistic regression model including the basal LH levels and IGF-I levels revealed a strong relation of the basal LH levels to CPP [OR:2.7, 95% confidence interval (CI): 1.1-6.7, P=0.035]. The AUC for basal LH levels showed prediction capacity of basal LH levels to diagnose CPP [AUC: 0.70, 95% CI: 0.57-0.81, P=0.009]. The statistically ideal cut-off value of basal LH levels to discriminate CPP from AT was 2.66 IU/L (sensitivity 40%, specificity 98%) and the clinically meaningful cut-off value was 1.86 IU/L (sensitivity 70%, specificity 62%). CONCLUSION:These results suggest that the basal LH level using IRMA could be a useful parameter discriminating AT from CPP. Further study with larger number of subjects will be needed.
Area Under Curve ; Breast ; Gonadotropins ; Insulin-Like Growth Factor I ; Logistic Models ; Luteinizing Hormone ; Piperazines ; Puberty, Precocious ; ROC Curve ; Sensitivity and Specificity

Epiploic appendagitis is an inflammation of the epiploic appendage in which the small sacs projecting from the serosal layer of the colon are positioned longitudinally from the caecum to the rectosigmoid area. Epiploic appendagitis is rare and self-limiting; however, it can cause sudden abdominal pain in children. Epiploic appendagitis does not typically accompany other gastrointestinal diseases. Here, we report on a healthy eight-year-old girl who presented with abdominal pain, fever, vomiting, and diarrhea. Based on these symptoms, she was diagnosed with acute gastroenteritis, but epiploic appendagitis in the ascending colon was revealed in contrast computed tomography (CT). The patient was treated successfully with conservative management. CT is beneficial in diagnosis and further assessment of epiploic appendagitis. Pediatricians need to be aware of this self-limiting disease and consider it as a possible alternate diagnosis in cases of acute abdominal pain.
Abdominal Pain ; Child ; Colon ; Colon, Ascending ; Diagnosis ; Diarrhea ; Female ; Fever ; Gastroenteritis* ; Gastrointestinal Diseases ; Humans ; Inflammation ; Vomiting