PURPOSE: Febrile seizure affects 2 to 5% of children, but 30 to 40% of the children who already had febrile seizure experience another febrile seizure. We researched to define a high risk group of recurrent febrile seizures through investigating several risk factors. METHODS: We evaluated 342 patients who were admitted to our hospital or treated in the emergency room for their first febrile seizure from March, 1995 to August, 2001. We assessed various risk factors, such as age, the type of seizure, body temperature, serum sodium concentration, sex, neurologic abnormalities, and family history of febrile seizure or epilepsy. RESULTS: Age at the first febrile seizure(< or =18 months) and family history of febrile seizure were significant risk factors for recurrence of febrile seizure. The study showed that 21.9% of the children who had none of these risk factors, 36.4% of the children who had one, and 57.1% of the children who had both factors had recurrent febrile seizures. Thus, the recurrence rates clearly increase as the number of these factors increase. CONCLUSION: Two major risk factors for recurrent febrile seizures were identified:early onset(< or =18 months) and family history of febrile seizure. The risk of recurrent febrile seizures increased with the number of these risk factors increased. Consequently, children with both risk factors were considered to belong to a high risk group of recurrent febrile seizures.
Body Temperature ; Child ; Emergency Service, Hospital ; Epilepsy ; Humans ; Recurrence ; Risk Factors* ; Seizures ; Seizures, Febrile* ; Sodium

BACKGROUND: Cardiovascular injury is a potentially fatal complication of blunt chest trauma. The diagnosis of cardiovascular injury in blunt chest trauma is not easy because of concomittent injuries of thoracic cage or lungs and early death from cardiovascular injury. Diagnostic tools such as electrocardiography or cardiac enzyme studies are not specific to cardiovascular injury. Two-demensional echocardiography can visualize anatomic and functional disturbances from cardiovascular injuries in patients with blunt chest trauma. Purpose: This study was designed to evaluate the usefulness of echocardiography in detecting cardiovascular injury of patients with blunt chest trauma. METHODS: We performed echocardiography for detecting cardiovascular injury in 151 patients with significant blunt chest trauma including sternal fracture, multiple rib fractures or pulmonary contusion. Echocardiography was performed within 6 hours since patient arrived emergency department. Electrocardiography was traced on arrival and 24 hours after admission. Serial determinations of cardiac enzymes including MB fraction of creatinine phosphokinase were also performed every 8 hours after admission. RESULTS: 37(25%) patients had echocardiographic evidences of cardiovascular injury. Abnormal echocardiographic findings were 10 pericardial effusion, 9 regional wall motion abnormality(RWMA) outright ventricle, 5 aortic injuries, 4 reduced left ventricular ejection fraction, 3 RWMA of left ventricle, 2 right ventricular dilatation, 2 valve injuries, and 2 other cardiovascular injuries. Electrocardiographic abnormalities were associated with echocardiographic findings. However, CK-MB/CK ratio was not associated with echocardiographic findings. Significant proportion(65%) of patients with abnormal echocardiographic findings needed cardiovascular management during hospital stay. CONCLUSION: Two-dimensional echocardiography is useful for detecting cardiovascular injury. Echocardiographic abnormality in blunt chest trauma is associated with high probability of need of cardiovascular management.
Contusions ; Creatinine ; Diagnosis* ; Dilatation ; Echocardiography* ; Electrocardiography ; Emergency Service, Hospital ; Heart Ventricles ; Humans ; Length of Stay ; Lung ; Pericardial Effusion ; Rib Fractures ; Stroke Volume ; Thorax*

PURPOSE: To compare the change in corneal sensitivity after temporal and superior clear corneal incisions in cataract surgery. METHODS: We measured and compared the change in corneal sensitivity in senile cataract patients who had received phacoemulsification using temporal clear corneal incision (group 1) and superior clear corneal incision (group 2). The changes were measured at 1 week, 1 month, and 3 months after surgery using Cochet-Bonnet esthesiometer. RESULTS: There were 25 eyes (20 patients) in group 1 and 25 eyes (23 patients) in group 2. The mean age for each group was 67.2 +/- 8.6 years and 63.0 +/- 6.6 years, respectively. At 1 week after surgery, the sensitivity at the corneal center had a tendency to be decreased in both groups (Group 1: P=0.057, Group 2: P=0.043). No significant changes were observed during the subsequent follow-up period. There were significant decreases in the sensitivity at the incision site in both groups. At 3 months after surgery, the corneal sensitivity was nearly recovered to preoperative values. The postoperative change in corneal sensitivity showed similar patterns in both groups, and group 1 showed a larger decrease. CONCLUSIONS: Postoperative change in corneal sensitivity occurs mainly around the incision site and is recovered to preoperative values within 3 months after surgery.
Cataract Extraction ; Cataract* ; Follow-Up Studies ; Humans ; Phacoemulsification

No abstract available.
Osteoarthropathy, Primary Hypertrophic*

BACKGROUND AND PURPOSE: The purpose of this study is to compare two clinical predictive rules, the pre-arrestmorbidity(PAM) index and the prognosis-after-resuscitation(PAR) score, which predict failure to survive following in-hospital cardiopulmonary resuscitation(CPR). METHOD: The study population consisted of 162 consecutive adult patients who underwent CPR at Wonju Christian Hospital over a year period. The PAM index and PAR score were calculated from the most recent data available for each variable prior to cardiac arrest. Each predictive tool was compared between the group of discharge alive and the group of in-hospital mortality. Performance of the predictive scores was also compared by receiver-operating characteristic(ROC) curves where appropriate. RESULTS: PAM index of study population was 4.39+/-2.69 and PAR score was 2.99+/-3.36. PAM index in the group of discharge alive was 1.87+/-2.79, and PAM index in the group of ih-hospital mortality was 4.51+/-2.62. PAR score in the group of discharge alive was 0.75+/-1.75, and PAR score in the group of in-hospital mortality was 3.1+/-3.4. The PAM index identified 15 patients with a score>8, while the PAR score identified 39 patients with a score>4, none of whom survived. The sensitivity of the PAR score for the prediction of failure to survive was 25%, while that of the PAM index was 10%; neither index incorrectly identified a patient as a non-survivor who eventually survived. Both of predictive methods were not significantly different in the ROC curve. CONCLUSION: Although further confirmation is necessary, PAM index and PAR score may provide useful prognostic information to physicians and patients involved with decisions about do-no- resuscitate orders.
Adult ; Cardiopulmonary Resuscitation* ; Gangwon-do ; Heart Arrest ; Hospital Mortality ; Humans ; Mortality ; ROC Curve

Purpose: The author hypothesizes that exogenously injected BMP, which is mixed with fibrin glue, can accelerate the healing of a bone-tendon junction injury and increase its holding strength during the early regeneration period. Materials and Methods: A direct injury model of the bone-tendon junction was made using the Achilles tendon-calcaneus bone of 54 rabbits: and the transected Achilles tendon was repaired to its original insertion site using the Krackow method. In Group 1, no additional manipulation was performed. In Group 2, only fibrin glue was injected into the junction between the Achilles tendon and the calcaneus in order to exclude the effect of the fibrin glue. In Group 3, BMP-2 incorporated into the fibrin glue was injected into the junction. The results were evaluated by histological analysis and biomechanical tests at 2, 4, and 8 weeks after surgery. The Kruskal-Wallis test was used for a statistical evaluation. Results: Histological analysis revealed the early appearance of fibrocartilage at 2 weeks in Group 3: the area of the fibrocartilage expanded with time. The biomechanical tests showed significant differences in the maximum stress between Groups 1 and 3, and between Groups 2 and 3, at 2, 4, and 8 weeks. 74.4% of the normal maximum stress was recovered at 8 weeks in Group 3. Conclusion: The combined use of BMP-2 and the fibrin glue can accelerate the healing of an injury of the bone-tendon junction.
Achilles Tendon ; Calcaneus ; Fibrin Tissue Adhesive* ; Fibrin* ; Fibrocartilage ; Rabbits ; Regeneration

BACKGROUND: In the idiopathic interstitial pneumonia (IIP), it has been known that imbalance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) is important factor for abnormal remodeling of lung parenchyme. This study was performed to compare the expression of MMPs and TIMPs in the normal subjects and patients with IIP. METHODS: Seventeen patients were diagnosed as IIP by open lung biopsy (male: female 7:10) and four patients as normal control were diagnosed as lung cancer and treated by lobectomy or pneumonectomy from March, 1999 to August 2001 at Gil medical center. IIP group divided into UIP (n=10) and NSIP (n=7). MMP-1 and TIMP-2 of their lung tissue were stained by immunohistochemical method and were graded 4 levels (grage 0-3) following stained status. RESULTS: MMP-1 was stained more strongly in the IIP than normal. But it had no differences between UIP and NSIP. TIMP-1 and-2 were stained more strongly in the UIP than NSIP but not stained in the normal. In the UIP, TIMP-2 was stained strongly in fibroblast foci. CONCLUSION: These results suggst that imbalance between MMPs and TIMPs may be important factor of pathogenesis of pulmonary fibrosis in the IIP. It is thought that major site of TIMP-2 is myofibroblast in the fibroblast foci.
Biopsy ; Female ; Fibroblasts ; Humans ; Idiopathic Interstitial Pneumonias* ; Lung ; Lung Neoplasms ; Matrix Metalloproteinase 1* ; Matrix Metalloproteinases ; Metalloproteases ; Myofibroblasts ; Pneumonectomy ; Pulmonary Fibrosis ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2

BACKGROUND: There have been several studies showing that the angiotensin II and angiotensin converting enzyme(ACE) contributes to the apoptosis of alveolar epithelial cells in idiopathic interstitial pneumonia and the activation of fibroblasts during the process of pulmonary fibrosis. These results suggest that the pulmonary fibrosis can be inhibited by the angiotensin II receptor antagonist(AGIIRA). This study was performed to identify the therapeutic effect of AGIIRA in idiopathic pulmonary fibrosis(IPF). METHOD: Thirteen patients with IPF, who were diagnosed with an open lung biopsy(6 patients) and furfilling the ATS criteria(7 patients) between March 1999 and October 2001 at the Gachon medical center, were enrolled in this study. Of these patients, eight patients were treated with a regimen including AGIIRA(AT group), and five were treated without AGIIRA(NT group). The pulmonary function tests and dyspnea(ATS scale) were measured at diagnosis and 1 year after treatment. All the data was collected to analyze the therapeutic effect of AGIIRA on the patients with IPF. RESULTS: The AT group contained 8 patients(M:F=4:4) and the NT group contained 5 patients (M:F=3:2). There was no significant difference in the serum angiotensin II level between the two groups(202.5+/-58.5 vs 163.7+/-47.3pg/ml, p>0.05). The AT group showed an upward trend in TLC(+3%), FVC(+4%), FEV1(+3%) and DLco(+2%) compared to the NT group(TLC(-14%), FVC(-3%), FEV1(-4%) except for DLco(+5%)). The dyspnea score in the AT group improved significantly but not in the NT group. CONCLUSION: These results suggest that the angiotensin II receptor antagonist may have an effect on stabilizing IPF.
Angiotensin II* ; Angiotensins* ; Apoptosis ; Diagnosis ; Dyspnea ; Epithelial Cells ; Fibroblasts ; Humans ; Idiopathic Interstitial Pneumonias ; Idiopathic Pulmonary Fibrosis* ; Lung ; Pulmonary Fibrosis ; Receptors, Angiotensin* ; Respiratory Function Tests

Spontaneous intramuscular hematoma of the abdominal wall is a rare condition characterized by acute abdominal pain. It is often misdiagnosed as a surgical condition. It used to be associated with risk factors such as coughing, pregnancy, and anticoagulant therapy. Most cases of abdominal wall hematomas were rectus sheath hematomas caused by the rupture of either the superior or inferior epigastric artery, but spontaneous internal oblique hematoma was extremely rare. In this report, we present a case of spontaneous internal oblique hematoma in a 69-year-old man with non-dialysis chronic kidney disease who was taking cilostazol. The patient complained of abrupt abdominal pain with a painful palpable lateral abdominal mass while sleeping. The abdominal computed tomography showed an 8 cm-sized mass in the patient's left internal oblique muscle. The administration of cilostazol was immediately stopped, and the intramuscular hematoma of the lateral oblique muscle disappeared with conservative management.
Abdominal Muscles ; Abdominal Pain ; Abdominal Wall ; Aged ; Cough ; Epigastric Arteries ; Hematoma* ; Humans ; Pregnancy ; Renal Insufficiency, Chronic* ; Risk Factors ; Rupture

PURPOSE: To assess the success rate and efficacy of US-guided hydrostatic reduction in children with intussusception. MATERIALS and METHODS: We retrospectively evaluated the ultrasonographic findings and clinical features of 121 children (M:F=80:41, mean age= 18 months) who underwent US-guided hydrostatic reduction between November, 2002 and February, 2007 for the diagnosis and treatment of intussusception. RESULTS: The 121 patients underwent 147 procedures, including recurred cases. Successful reduction was achieved in 132 cases (89.8% success rate), as confirmed by post-procedure ultrasonography and clinical findings. Emergency operations were performed in the 10 (6.8%) cases of irreducible intussusceptions, 8 of ileocolic type and 2 of ileoileal type. Perforation occurred in 4 cases (2.7%), and seizure in 1 case during the procedure (0.7%). CONCLUSION: US-guided hydrostatic reduction is a safe and effective tool for the diagnosis and treatment of pediatric intussusception.
Child* ; Diagnosis ; Emergencies ; Gastrointestinal Tract ; Humans ; Intussusception* ; Retrospective Studies ; Seizures ; Ultrasonography