PURPOSE: To quantify the incidence of asymptomatic incidental trochlear calcifications and to describe their clinical features. METHODS: We retrospectively reviewed orbital computed tomography (CT) scans of 216 patients to identify the presence of trochlear calcifications. We analyzed the prevalence, age distribution, and gender preponderance of trochlear calcifications. We also examined age-specific prevalence rates for trochlear calcifications, as well as their relationship to systemic disease. RESULTS: The mean age of patients was 26.8 years. Trochlear calcifications were observed in 35 (16%) of the 216 patients, and 18 of the 35 patients had bilateral calcifications. The rate of trochlear calcification was higher in males; 32 (20.9%) of 153 male patients had trochlear calcifications, compared with 3 (4.8%) of 63 female patients. Age, hypertension, diabetes mellitus, and thyroid disease were not significantly associated with the incidence of trochlear calcifications. CONCLUSIONS: Incidental asymptomatic orbital calcification is more commonly observed on CT images than we expected and occurs predominantly in male patients. Understanding this to be a relatively common, benign finding may help us to rule out foreign bodies and other pathologic conditions.
Adult ; Calcinosis/*epidemiology/radiography ; Female ; Humans ; Incidence ; Male ; Orbital Diseases/*epidemiology/radiography ; Republic of Korea/epidemiology ; Retrospective Studies ; Sex Distribution ; Tomography, X-Ray Computed

PURPOSE: To evaluate the clinical course of visual acuity and foveal thickness in the idiopathic epiretinal membrane (ERM) after a vitrectomy with the use of triamcinolone. METHODS: We retrospectively reviewed the records of 30 patients (30 eyes) with ERM that were treated by vitrectomy from 2004 to 2008. Visual acuity and foveal thickness from optical coherence tomography imaging was obtained preoperatively and at every postoperative follow-up visit. RESULTS: Visual acuity improved by two or more lines of vision in 30%, 50%, 60%, and 70%, and stayed the same within +/-1 line in 47%, 50%, 40%, and 30% at one month, three months, five months, and seven months after surgery. Twenty-three percents of the subjects deteriorated by two or more lines of vision within one month after surgery. None of the subjects had reduced vision three months after surgery. Foveal thickness decreased significantly after surgery. The mean thickness was 409.7+/-107.9 microm before surgery and 288.6+/-66.1 microm seven months after surgery. Parameters which were significantly correlated with the final visual acuity included preoperative visual acuity (0.683), preoperative foveal thickness (0.544), and final foveal thickness (0.643) (p<0.005). CONCLUSIONS: Foveal thickness and visual acuity improved until seven months after the vitrectomy in patients with idiopathic ERM. Preoperative visual acuity, foveal thickness, and final foveal thickness had a significant correlation with the final visual acuity.
Aged ; Epiretinal Membrane/pathology/*surgery ; Female ; Follow-Up Studies ; Fovea Centralis/*pathology ; Humans ; Male ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

Objectives: This study examined the level of depression and anxiety and the related factors, especially the knowledge and attitudes towards dementia, of people caring for a family member with dementia. Methods: Data on the demographics, care burdens, and clinical characteristics of dementia patients and their family caregivers were collected. The Center for Epidemiologic Studies Depression Scale (CES-D) and Korean Screening Tool for Anxiety disorders (K-ANX), Dementia Knowledge Scale (DKS), and Dementia Attitudes Scale (DAS) were performed. This study investigated whether depression and anxiety of caregivers differed according to the caregivers, patients, and the burden of caregivers. Multiple regression analysis was performed to investigate the potential factors that may influence the psychological symptoms in family caregivers. Results: There were 135 respondents. The scores of CES-D and K-ANX were 19.18±12.05 (probable depression) and 11.48±8.88 (mild anxiety), respectively. There was a significant difference in the degree of depression according to the level of education (F=4.14, p<0.05), the severity of dementia (F=3.63, p<0.05), and cohabitation with patients with dementia (t=2.07, p<0.05). On the other hand, the difference in the degree of anxiety was not significant depending on the stratified potential factors. The degree of depression in caregivers was positively associated with severe dementia (β=0.252, p<0.01) and negatively associated with the DAS score (β= -0.392, p<0.001). Anxiety was only inversely affected by the DAS score (β=-0.369, p<0.001). Conclusion This study shows that family caregivers of people with dementia experience high levels of depression and anxiety, which are influenced by the patient’s severity of dementia and the caregiver’s attitude toward dementia.

PURPOSE: Liver function test abnormalities have been reported frequently in patients receiving total parenteral nutrition (TPN). In adults, it is known that liver complications decrease with the use of cyclic parenteral nutrition (CPN), especially if the shift to cycling was not too late. However, there are few studies about the effects of cycling on liver injury in children beyond the neonatal period. The aim of this study is to evaluate the effect of the early use of CPN on total parenteral nutrition induced hepatic dysfunction. METHODS: Twelve sets of CPN in 11 children (2 months to 17 years) were included in this study. Data on underlying diseases, age, length of time on TPN, macronutrient intake, complications, and biochemical parameters were collected from clinical records. All children had received CPN in the early period of persistent transaminase elevation or cholestasis complicated by previous continuous PN. The duration of infusion off-time in CPN was 2 hours in patients less than 3 months of age and 4 hours in the older children. RESULTS: All 12 cases showed elevated aminotransferase and 5 of them also showed cholestasis. Serum total bilirubin concentration was normalized in all 5 cases with median periods of 8 days (p<0.05) after initiation of CPN. ALT either decreased significantly or was normalized in all cases with median periods of 30 days (p<0.05) on CPN. The CPN was well tolerated without significant complication except for one case of hyperglycemia. CONCLUSION: The early use of cyclic parenteral nutrition had a beneficial effect in improving hepatic dysfunction complicated by TPN in children.
Adult ; Bilirubin ; Child ; Cholestasis ; Humans ; Hyperglycemia ; Liver ; Liver Function Tests ; Parenteral Nutrition* ; Parenteral Nutrition, Total*

PURPOSE: A prospective, controlled trial was conducted to evaluate growth, bone mineralization, and nutritional status receiving preterm human milk supplemented with a newly formulated Maeil human milk fortifier. METHODS: Twenty five fortified human milk-fed and preterm formula-fed infants with a birth weight < 1, 800 g and gestational age <35 weeks, who were born at Ajou University Hospital from March, 2003 through August, 2004 were studied. Growth, biochemical indices of bone mineralization, feeding tolerance, morbidity and wrist X-ray were assessed serially. Total body bone mineral density was measured by dual energy X-ray absorptiometry at 2 and 5months of age. RESULTS: There were no differences in growth, including weight, height and head circumference, between two groups. Serum Ca, P, ALP and other biochemical indices were similar. Although low grade rickets (grade I and II) were occasionally found on wrist X-ray, the rate of occurrence and severity were similar. The bone mineral densities of both group showed no difference. CONCLUSION: The fortified human milk-fed infants and preterm formula-fed infants showed no difference in growth, and bone mineralization. This newly formulated Maeil human milk fortifier can be safely used in preterm infants.
Absorptiometry, Photon ; Birth Weight ; Bone Density ; Calcification, Physiologic* ; Gestational Age ; Head ; Humans* ; Infant ; Infant, Newborn ; Infant, Premature* ; Milk, Human* ; Nutritional Status ; Prospective Studies ; Rickets ; Wrist

PURPOSE: To evaluate the efficacy of transcatheter arterial embolization(TAE) in children with blunt splenicinjury. MATERIALS AND METHODS: The results of transcatheter splenic arterial embolization in nine children whosuffered splenic injury after blunt abdominal trauma were retrospectively studied. This injury was demonstrated byCT, and the findings were evaluated according to the classification of Mirvis et al. ; two patients were grade 3and seven were grade 4. All were carefully observed in intensive care before embolization. TAE was performed if apatient satisfied the following criteria : (1) transfusion and/or fluid replacement required to maintainhemodynamic stability ; or (2) rapid Hb/Hct decrease ; or (3) both. Splenic function was subsequently estimatedaccording to the results of 99mTc-sulfur colloid scintigraphy and/or CT scanning. RESULT: TAE was suscessful inall nine children. Two were embolized with a coil only, three with gelfoam, and four with gelfoam and a coil.Seven were embolized in the main trunk of the splenic artery and others in both the main trunk and its branches.Splenic function was preserved in all nine children, during follow-up, none suffered rebleeding. CONCLUSION: TAEof the splenic artery can be a safe and effective nonsurgical approach to the management of blunt splenic injuryin children, and can preserve splenic function.
Child* ; Classification ; Colloids ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Humans ; Critical Care ; Radionuclide Imaging ; Retrospective Studies ; Splenic Artery ; Tomography, X-Ray Computed

We describe a case with acute myelogenous leukemia (AML; M2) who developed prolonged marrow hypoplasia with residual leukemic blasts and recurrent infections after induction chemotherapy. He was treated successfully with a sequential treatment of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) and low-dose cytosine arabinoside (LD AraC). To the best of our knowledge this is the first reported case of a successful treatment of a patient with AML, who showed prolonged markedly hypocellular bone marrow with significant residual leukemic cells after induction chemotherapy, with a sequential treatment of GM-CSF and LD AraC.
Bone Marrow Diseases/chemically induced/*drug therapy ; Case Report ; Cytarabine/*administration & dosage ; Granulocyte-Macrophage Colony-Stimulating Factor/*therapeutic use ; Human ; Leukemia, Myelocytic, Acute/*drug therapy/pathology ; Male ; Middle Age

PURPOSE: In general, genetic disorders have the numerical or structural abnormalities of chromosome. There are clinically two different disorders, Prader-Willi syndrome(PWS) and Angelman syndrome(AS), which have the deletion of specific region of 15 chromosome originated from father or mother by genetic imprinting phenomenon. We reported the results of genetic study including DNA methylation analysis and fluorescence in situ hybridization(FISH), in addition to clinical findings. METHODS: We studied 20 patients of PWS and AS diagnosed in pediatric department of Asan Medical Center from 1992 Feb. to 2001 Apr., retrospectively. We analyzed the clinical manifestations of the disorders and performed cytogenetic studies from the peripheral blood. And we the methylation pattern and FISH, using the probe for single nucleotide ribonucleoprotein N(SNRPN) locus within the Prader-Willi/Angelman region (15q11-q13). RESULTS: Among 16 patients of PWS, the age at initial visit was from 3 days to 12 years and the male to female ratio was 1.67:1. Seven patients had the history of intrauterine growth retardation or fetal distress. The chief complaints at initial presentation were classified on age. Under 3 years(n=10), there were hypotonia(4), development delay (3), feeding difficulties(2), and tachycardia(1). Above 3 years(n=6), we found short stature(2), respiratory difficulty(1), seizure(1), obesity(1), and undescended testes(1). DNA methylation study showed the methylation of 15 chromosome originated from paternal chromosome and the microdeletion by FISH was detected in all 12 among 12 patients (100%). In AS(n=4), the sex ratio(M:F) was 3:1 and age at presentation was from 15 months to 6 years. The important sign was severe developmental delay in all patients, combined with mental retardation in one case. Other clinical manifestations were depigmentation of skin and hair(4), prognathism(3), seizure(3), frequent laughing(2), undescended testes(1), hypotonia(1), and hyperactivity(1). FISH study was performed and showed the microdeletion of 15 chromosome in all 4 patients. CONCLUSION: We studied the clinically two different disorders, PWS and AS, with the deletion of same region of 15 chromosome and reported the results of the clinical and genetic analysis based on clinical findings and DNA analysis and FISH study, respectively.
Angelman Syndrome* ; Chungcheongnam-do ; Cytogenetics ; DNA ; DNA Methylation ; Fathers ; Female ; Fetal Distress ; Fetal Growth Retardation ; Fluorescence ; Genomic Imprinting ; Humans ; Intellectual Disability ; Male ; Methylation ; Mothers ; Prader-Willi Syndrome* ; Retrospective Studies ; Ribonucleoproteins ; Skin ; snRNP Core Proteins

OBJECTIVE: With the increasing popularity of pedicle screw fixation devices for several indications, the safety and reliability of screw insertion in the small pedicle has become a major issue. Many studies have investigated the accuracy of screw placement after pedicle screw fixation using various method. The reported displacement rates have been very different. The purpose of the study is to investigate the proper placement of pedicle screw insertion in the lumbar spine on 26 consecutive patients. METHODS: Between September and December 2003, 26 consecutive patients (16women and 10men) were analyzed after transpedicular screw fixation of the lumbar and lumbosacral spine. After pedicle screw fixation in this study, 2-mm slices of CT scan were performed in all patients to detect caudal and cranial deviation of screw and medial and lateral deviation. Pedcile screw placement related complication was evaluted clinically. RESULTS: A total of 144 inserted pedicle were analyzed in 26patients, and 58pedicle screws (40.3%) were detected to be improper placement. There were 14level (9.0%) of caudal or cranial deviation and 44level (30.6%) of medial or lateral deviation to the pedicle. Extra-pedicle placement was found on 4levels (2.7%) with only 1case of neurologic injury. CONCLUSION: Proper screw placement, though complication rate is low, is important not only for clinical symptom but also for biomechanics. Further study for screw placement related biomechanical changes is needed.
Humans ; Spine ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to evaluate the efficacy and histologic changes of interferon-alfa therapy on chronic hepatitis B virus infection in children. PATIENTS AND METHODS: Thirty five children aged 3~16 years who were seropositive for HBV DNA, HBsAg and HBeAg were enrolled. Interferon-alfa 2a (3.4 MU/m(2)) were given for 6 months. Serologic markers of viral replication was evaluated 1 year after therapy. Post treatment liver biopsy was performed in 18 patients who showed serologic response. RESULTS: Serum HBeAg and viral DNA became negative in 22 (63%) of treated children at 12 months after therapy. Serum aminotransferase levels normalized in all of the responders and HBsAg became negative in one responder. Horizontal transmission, serum aminotransferase levels more than twice normal, and active inflammation on liver biopsy were predictive factors for response to interferon therapy. Periportal piecemeal necrosis, lobular activity, portal inflammation, fibrosis, and total histologic activity index were reduced in responders. CONCLUSION: In children with chronic hepatitis B, interferon alfa promotes loss of viral replication and improves aminotransferase. Serologic response is associated with improvement in hepatic histology.
Biopsy ; Child* ; DNA ; DNA, Viral ; Fibrosis ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Inflammation ; Interferon-alpha* ; Interferons* ; Liver ; Necrosis