Kawasaki disease is generally diagnosed base on its clinical features. Sometimes unusual or atypical presentations make the diagnosis of Kawasaki disease difficult. We experienced an unusual case of Kawasaki disease presented with unilateral parotitis in a 23-month old girl. Despite of intravenous antibiotics treatment, fever and unilateral parotid swelling persisted. Skin rashes, conjunctival injections, and coronary abnormalities showed up on the 8th day of fever. After the intravenous immunoglobulin and salicylates treatment, all symptoms disappeared. Although unilateral parotitis is very unusual presentation of Kawasaki disease, in case of no response to antibiotics, Kawasaki disease should be included in the differential diagnosis.
Anti-Bacterial Agents ; Child* ; Diagnosis ; Diagnosis, Differential ; Exanthema ; Female ; Fever ; Humans ; Immunoglobulins ; Mucocutaneous Lymph Node Syndrome* ; Parotitis* ; Salicylates

No abstract available.
Estradiol* ; Female ; Humans ; Plasma* ; Progesterone*

The object of this study was to determine the physiological range of talar tilt angle of the Korean and to establish the basis for diagnosis and treatment of the lateral instability of the ankle. The anteroposterior inversion stress view of both ankles was taken in the 108 healthy Korean who had no history of ankle injury or disease. The sagittal stress films were also performed on 96 ankles (48 cases) of these to further define the physiological limits of the sagittal mobility of the normal talus. We compared these two values of normai mobility of talus to deterrnine the significance and relationship of the rwo. The results obtained were as follows: 1) Talar tilt over 10 degrees was seen in only 6 ankles (1.9%) and most of the ankles (279 ankles, 88.4%) showed a tilt less than 5 degrees. 2) Normal talar tilt angle was increased in 30 degrees plantarflexed position than in 90 degrees neutral position of ankle. In 12 cases the value was different between the right and the left; but there was no significant difference between the sexes. 3) The anterior displacement index over 200 was seen in only 5 ankles (5.2%). 4) There was gross positive inter-relationship between physiological. range of talar tilt angle and talar sagittal mobility.
Ankle ; Ankle Injuries ; Diagnosis ; Talus

Flexor tendon grafting is a well-proved procedure for the restoration of tendon defects in the hand. The results are not entirely predictable, it offers a good expectation of successful outcome. Authors have performed the tendon graft in thirteen cases of flexor tendon injury of the hand during the period from September '79 to January '82 and evaluated the results. The followings were the results obtained. 1. Male was eleven, female was two. Age distribution is from 4 to 38 years. 2. Injured fingers were thumb 6, index 2, middle finger 4 and little finger 1 cases. The site of the primary injury was on area of Bunnell's Zone II in all cases. 3. Time interval from tendon injury to flexor tendon graft was 6 weeks to 19 months (average 5.6 months). 4. The results of tendon grafts rated as excellent 2 cases and good 3 cases in preoperative Good group; excellent 1, good 3 and fair 1 in “Scar” group; fair 1 and 1 poor in “Joint” group; fair 1 in “Salvage” group. In the thumbs, the results were better than in the fingers. 5. Degrading the postoperative results were flexion contracture in 3 cases, lack of flexion ROM in 2 cases and bowstringing in 2 cases. 6. Pinch power of the finger where tendon graft was performed was 52% of that of the opposite healthy finger. 7. As complication, bowstringing was observed in 2 cases and recurvatum deformity of the PIP joint in one case.
Age Distribution ; Congenital Abnormalities ; Contracture ; Female ; Fingers ; Hand ; Humans ; Joints ; Male ; Tendon Injuries ; Tendons ; Thumb ; Transplants

No abstract available.
Coxiella burnetii ; Humans ; Korea*

Scaphoid fracture is the most common carpal bone fracture and its treatment is frequently delayed due to difficulties of diagnosis. Nonunions and avascular necrosis are commonly developed due to peculiar blood supply. Though most of the undisplaced fracture, diagnosed early, can be managed easily by plaster of Paris immobilization, many cases of delayed diagnosis, displaced fractures and nonunions are difficult to treat and its outcome is not uniform. Ruse reported good results by iliac bone graft via volar approach and several internal fixation methods are reported such as K-wire, compression screw, Herbert screws etc. Recently, many suthors advocated accurate anatomical reduction in fear of volar and dorsal intercalary segmental instability. We reviewed 30 cases of scaphoid fracture at the department of orthopedic surgery, Kyungpook national university hospital, from June, 1986 to April, 1989 and obtained the following results. l. Among 30 cases of scaphoid fractures, 27 cases(90 %) were males. 2. Twenty one cases(70%) were between second decade and third decade. 3. The fracture mechanism is hyperdorsiflexion of the wrist during slip down or fall down in 21 cases(70%). 4. Right side is 17 cases(57%) and left 13 cases. Middle 1/3 fracture occupies 24 cases(80%) in anatomical location. 5. Among 15 cases of the fresh fracture, 11 cases(93%) attained bone union by plaster pf Paris immobilization. 6. Among 18 cases of operation, 3 cases were acute transscaphoid perilunar dislocation(TSPD), 1 case was delayed TSPD, 5 were delayed unions and 9 were monunions. Operative methods were Herbert screw fixations in 8, Herbert screw fication with iliac bone graft in 4, Russe's bone grafts in 6 cases. 7. The results of the treatment were classified according to the bone union status and range of motion of the wrist. In operative treatment, excellent and good results were obtained in 6 and 11 cases respectively, poor result in 1 case. In conservative treatment, excellent and good results in 6 and 5 cases respectively, fair in 1 case.
Calcium Sulfate ; Carpal Bones ; Clothing ; Delayed Diagnosis ; Diagnosis ; Gyeongsangbuk-do ; Humans ; Immobilization ; Male ; Necrosis ; Orthopedics ; Range of Motion, Articular ; Transplants ; Wrist

Fractures of the femoral neck in children are uncommon and usually occur as a result of severe trauma due to their anatomical and physiologic characteristics. There are many difficulties during the treatment period and high incidence of complications such as avascular necrosis, coxa vara and premature epiphyseal closure. Twenty-three cases of fractures of the femoral neck in children which were treated at Kyung-Pook National University Hospital from Aug., 1980 to May, 1989 were analyzed both clinically and radiologically. The results were as follws: l. Among the 23 cases, higher incidence was in girls(13 cases, 56.5%) and the highest incidence was between the age of 11 and 13 years(8 cases, 34.8%). 2. The main cause of fracture was traffic accident(16 cases, 69.6%). 3. The most common type of fracture was the transcervical type(9 cases, 39.1%) and 17 cases (73.9%) were displaced fractures. 4. Associated injuries occurred in 13 cases(56.5%), and the common associated injuries were extremity fractures, head injuries and pelvic bone fractures. 5. Minimally displaced 7 cases(30.4%) were treated by closed reduction & internal fixation, and neglected, irreducible 15 cases(65.2%) by open reduction & internal fixation and undisplaced intertrochanteric fracture(1 case) by closed reduction & hip spica cast. 6. Twenty-three cases were followed from 8 months to 9 years and average period of follow-up studies was 28 months. The results were good in 5 cases(71.4%), fair in 2 cases (28.6%) in closed reduction & internal fixation, and good in 9 cases(60%), fair in 2 case(13.3%), poor in 4 cases(26.7%) in open reduction & internal fixation. 7. Complications were developed in 11 cases(47.8%), and premature epiphyseal closure were in 7 cases(30.4%), and avascular necrosis were in 6 cases(26.1%), and coxa vara were in 3 cases (13%), and delayed union was in 1 case and infection was in 1 case. 8. As a result, we recommend early closed reduction & internal fixation as the favorable method of treatment for the fracture of the femoral neck in children better than open reduction & internal fixation or conservative methods.
Child ; Clinical Study ; Coxa Vara ; Craniocerebral Trauma ; Extremities ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Incidence ; Methods ; Necrosis ; Pelvic Bones

The kidney size is of special interest during the diagnostic work up of acute lymphocytic leukemia. But is still uncertain whether a finding of kidney enlargement at presentation has long-term prognostic value. We therefore reviewed the kidney size in children with acute lymphocytic leukemia by abdominal ultrasonograms at the time of diagnosis (n=54) and exmined if there was any statistical significance between the kidney size and prognostic parameters and later outcome. The following results were obtained 1) Among the patients whose kidney size was enlarged over 4SD from the normal, hepatomegaly in 3 cases (20%), splenomegaly in 3 cases (20%), mediastinal widening in 2 cases (13%) were noted. The interrelation between kidney size and infiltration of extramedullary system had no statistical significance. 2) Among the patients whose kidney size was enlarged over 4SD from the normal, patients under age 2 and over age 10 in 5 cases (33%), male in 8 cases (53%), involvement of central nervous system in 1 cases (7%), WBC count over 100x10E9/L in 3 cases (20%), Hb over 10 g/dl in 3 cases (20%) and platelet count below 100x10E9/L in 3 cases (20%) were noted. There was no statistical significance between kidney size and infiltration of extramedullary system. 3) Two Year survival rate based upon kidney size was; 95% in the group below 2SD, 79% between 2SD and 4SD, 59% over 4SD. And 2 Year event free survival rate was 71%, 56% and 58 respectively. In conclusion, the kidney size in childhood acute lymphocytic leukemia at the time of diagnosis influences the late outcome, but it is not a meaningful prognostic parameters.
Central Nervous System ; Child ; Diagnosis ; Disease-Free Survival ; Hepatomegaly ; Humans ; Kidney ; Male ; Platelet Count ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Splenomegaly ; Survival Rate ; Ultrasonography

BACKGROUND: Modern intensive chemotherapy has dramatically improved the prognosis of acute lymphoblastic leukemia in children. However, quality of life and even survival may be threatened by infection. Immunosuppression is experted due to disease itself or therapy, and sometimes, immunosuppression itself may lead to reactivation of latent viral infections in these patients. Often the viruses involved in the most severe infections suggest that patients suffer from defect in the cellular immunity. The principal defects that predispose leukemia patients to infection are defects of T cell, B cell, stem cell, complement, and macrophage. These contributing factors interact in a complex manner resulting in spectrum of problems. But these may result from a T cell defect and, in this study, 7 cell responsiveness of patients at diagnosis, remission induction, maintenance chemotherapy and after chemotherapy for leukemia has been investigated. Studies of the immune competence of patients undergoing chemotherapy for leukemia is in progress, but results are different from each other. METHOD: Between July 1994 and May 1996, seventy patients with childhood ALL were enrolled in this study. In order to expect frequency and depth of infection and prognosis, we investigated concentrations of immunoglobulins G, A, M, peripheral total lymphocyte count, 7 cell subsets, phytohemmaglutinin responsiveness, interleukln-2(IL-2), gamma-interferon(gamma-INF), and natural killer cell activity. RESULTS: 1) IgA concentrations were often markedly raised at diagnosis, and IgG, IgM concentrations both were within normal limits. During and after chemotherapy, IgA had fallen significantly but IgG, IgM are within normal limits. 2) Total lymphocyte count had fallen during chemotherapy, and returned to normal levels after chemotherapy. CD4+ T cell were markedly decresed at diagnosis, during chemotherapy and returned to normal levels after chemotherapy. 3) In vitro proliferative response of peripheral blood lymphocytes to the T cell mitogen phytohenagglutinin were impaired at diagnosis, during chemotherapy but did not returned to normal levels. 4) Interlekin-2, gamma interferon were normal levels at diagnosis, and had fallen in the induction of remission and quickly returned to normal levels with the swish to maintenance chemotherapy. But Interleukin-2 had fallen during and after chemotherapy. Natural killer cell activity had fallen at diagnosis, during chemotherapy and returned to normal levels after chemotherapy. CONCLUSION: It is assumed that evidence of impaired T cell responses is somewhat definite. These observations suggest that proliferative responses to phytohemagglutinin, CD4+ T cell, natural killer cell activity defects are due to leukemia itself but others more likely are generalizable defects caused by chemotherapy. Further investigations, however, have suggested a persisting defect in IgA, proliferative reponses to phytohemagglutinin, and interleukln-2. Our observations also show that despite normal immunoglobulin levels, most of these children have nonprotective levels for common childhood bacterial or viral disease. These results support to the praxis to withdraw prophylactic antibiotics after discontinuation of intensive chemotherapy and to start the immunization. It is expect to try to use cytokine on treatment and to improve mortality and morbidity for children of acute leukemia also.
Anti-Bacterial Agents ; Child* ; Complement System Proteins ; Diagnosis ; Drug Therapy* ; Humans ; Immunity, Cellular ; Immunization ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Immunosuppression ; Interferons ; Interleukin-2 ; Killer Cells, Natural ; Leukemia ; Lymphocyte Count ; Lymphocytes ; Macrophages ; Maintenance Chemotherapy ; Mental Competency ; Mortality ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prognosis ; Quality of Life ; Remission Induction ; Stem Cells ; Virus Diseases

No abstract available.
Neuroblastoma*