Brachial plexus injury is regarded as one of the most devastating injuries of the upper extremity. Accurate diagnosis is important to obtain the successful results. Basic preoperative evaluation includes simple radiography, cervical myelography. Magnetic resonance imaging, angiography, electrophysiologic studies and intraoperative studies. Furthermore, proper timing of surgery, surgical indication, plan and sufficient understanding of patients about the prognosis are the key for the satisfactory outcomes. This article provides an overview of the evaluation, diagnosis, intraoperative monitoring, and proper surgical planning for the treatment of posttraumatic brachial plexus injuries.
Angiography ; Brachial Plexus* ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Monitoring, Intraoperative ; Myelography ; Prognosis ; Radiography ; Upper Extremity

OBJECTIVE: It is difficult to make a distinction between acute pyelonephritis and lower urinary tract infection due to nonspecific clinical symptoms and laboratory findings. We measured the spot urine beta2-microglobulin in children with urinary tract infection (UTI) to distinguish between acute pyelonephritis and lower UTI. We compared the accuracy of urine beta2-microglobulin measurement with other inflammatory markers. METHODS: We studied 83 children (mean, 86+/-44.9 months) who suspected of having UTI. Leukocyte counts, erythrocyte sedimentation rates (ESR) and C-reactive protein (CRP), beta2-microglobulin were measured. Renal parenchymal involvement was evaluated by 99mTc dimercaptosuccinic acid scintigraphy in the first 7 days after admission. beta2-microglobulin was measured by radioimmunoassay. RESULTS: Urine beta2-microglobulin values were correlated with the presence of renal defects in children with UTI (n=22) (0.98+/-0.24 microg/mL, P<0.05). Using a cutoff of 0.4 microg/mL for spot urine beta2-microglobulin and 20 mm/hr for ESR, 2.6 mg/L for CRP, sensitivity and specificity between UTI with and without renal involvement were 78.7% and 90.1% for spot urine beta2-microglobulin, 77.2% and 90.1% for spot urine beta2-microglobulin/creatinine (Cr), 77.2%, 68.8% for ESR, 86.3%, 68.8% for CRP, respectively. Positive and negative predictive values were 72.7%, 90.1% for spot urine beta2-microglobulin, 73.9% and 91.6% for spot urine beta2-microglobulin/Cr, and 57.5%, 94% for CRP, respectively. CONCLUSION: In febrile UTI, spot urine beta2-microglobulin and beta2-microglobulin/Cr values were more specific than CRP, ESR, and leukocyte count for determine the renal defects.
beta 2-Microglobulin ; Blood Sedimentation ; C-Reactive Protein ; Child ; Humans ; Leukocyte Count ; Pediatrics ; Pyelonephritis ; Sensitivity and Specificity ; Technetium Tc 99m Dimercaptosuccinic Acid ; Urinary Tract Infections

OBJECTIVE: Necrotizing pneumonia (NP) is a severe complication of lobar pneumonia caused by various pathogens. The immunopathogenesis and clinical characteristics of NP in children are not clearly understood. We wanted to evaluate the clinical characteristics and suggest in part the immunopathogenesis of NP. METHODS: We reviewed retrospectively the medical charts and radiographic materials of eight patients with NP, who were diagnosed by chest radiography and chest computed tomography at the Department of Pediatrics, Soonchunhyang University Hospitals at Cheonan and Bucheon from January 2002 to December 2011. RESULTS: They were previously healthy, 2.1 to 4.6 years of ages (mean, 2.8+/-1.0 years) and three boys and five girls. All of them had pleural effusion. Five patients had pneumonic consolidations in right upper lung field. Three patients had pneumatocele. They developed leukocytosis (mean, 19,400+/-6,400/mm3), higher C-reactive protein level (mean, 25.1+/-8.0 mg/dL). The etiologic agents were revealed in two patients; Streptococcus pneumonia (S. pneumonia) was revealed in one patient and S. pneumonia and Mycoplasma pneumonia in the other patient. Three patients were treated with additional intravenous immunoglobulin. Clinical improvement was prolonged: fever lasted 10 to 23 days, and length of hospitalization was 15 to 36 days. NP or pneumatocele were completely resolved on the follow-up radiographic studies in all of the patients. CONCLUSION: Although the previously healthy young children with NP had protracted clinical course, they recovered without any problematic sequelae. Our results suggest that the immunopathogenesis of NP in children may be associated with the exaggerated immune reaction of the host to insults from initial bacterial infections, rather than the pathogen-induced cytopathies.
Bacterial Infections ; C-Reactive Protein ; Child* ; Chungcheongnam-do ; Female ; Fever ; Follow-Up Studies ; Gyeonggi-do ; Hospitalization ; Hospitals, University ; Humans ; Immunoglobulins ; Leukocytosis ; Lung ; Pediatrics ; Pleural Effusion ; Pneumonia* ; Pneumonia, Mycoplasma ; Radiography ; Retrospective Studies ; Streptococcus ; Thorax

V. fluvialis is a gram-negative, oxidase-producing, halophilic bacterium. It is normally found in coastal waters and seafoods. There have been a few reports on Vibrio fluvialis gastroenteritis in other countries, whereas there has been no previous report of V. fluvialis infections in Korea. Reports from other countries showed that V. fluvialis was isolated mostly from infants and children. We experienced a rare case of gastroenteritis due to V. fluvialis in a 55-year-old man with liver cirrhosis who ate an ark shell. He was admitted due to mild abdominal pain and severe watery diarrhea followed by rapidly progressive dehydration, electrolyte imbalance, and hepatorenal syndrome for a week. This patient was not improved by intensive care and antibiotic therapy.
Abdominal Pain ; Arcidae ; Child ; Dehydration ; Diarrhea ; Gastroenteritis* ; Hepatorenal Syndrome ; Humans ; Infant ; Critical Care ; Korea ; Liver Cirrhosis ; Middle Aged ; Seafood ; Vibrio*

PURPOSE: In Korea, tree pollens are known to be prevalent in spring, grass pollens in summer and weed pollens in autumn. However, few studies have revealed their seasonal specificity for allergic rhinitis symptoms. An ARIA (Allergic Rhinitis and its Impact on Asthma) classification of allergic rhinitis was recently introduced and its clinical validation has not been well proved. The aim of this study was to evaluate the seasonal specificity of seasonal allergens and to validate the ARIA classification with the conventional seasonal and perennial allergic rhinitis (SAR/PAR) classification. METHODS: Two hundred twenty six patients with allergic rhinitis were included in this study. The patients were classified according to the sensitized allergens and the ARIA classifications. A questionnaire survey was performed and the data on the seasonal symptom score, the severity of symptoms and the SNOT (sinonasal outcome test)-20 score was obtained and the data was analyzed and compared between the conventional SAR/PAR classification and the ARIA classification. RESULTS: Seasonal pollens (tree, grass, weed) were not specific to the pollen peak season and the patients' symptoms were severe during spring and autumn regardless of the offending pollens. More than 60% of the patients with SAR showed persistent symptoms and 33% of the patients with perennial allergic rhinitis (PAR) had intermittent symptoms, showing the lack of association between the SAR/PAR/PAR+SAR classification and the ARIA classification. The ARIA classification showed better association not only with the symptomatic score, but also with the SNOT-20 score, which showed better validity than the conventional SAR/PAR classifications. CONCLUSIONS: Seasonal pollens were not specific to their season of prevalence in terms of the severity of symptoms, and the ARIA classification showed better representation of allergic symptoms and quality of life (SNOT-20 score) than did the SAR/PAR classification.
Allergens ; Humans ; Korea ; Poaceae ; Pollen ; Prevalence ; Quality of Life ; Rhinitis ; Rhinitis, Allergic, Perennial ; Rhinitis, Allergic, Seasonal ; Seasons ; Sensitivity and Specificity* ; Surveys and Questionnaires

PURPOSE: Stereotactic vacuum-assisted breast biopsy (SV AB) has recently been introduced as an alternative to the traditional surgical excisional biopsy with needle localization (NLBB). Although SVAB has excellent sensitivity and specificity with very low false negative results, patients might complain about the uncomfortable table and the painful breast compression that is done during SVAB. Furthermore, the cost of SVAB is too expensive to be widely adopted in Korea. So we developed a new technique of vacuum-assisted breast biopsy with air localization (VAB-AL) for the patients suffering with microcalcifications. METHODS: From April 2005 to Oct 2005, 10 microcalcification patients, whose lesions were difficult to be seen on breast ultrasonography, underwent vacuum-assisted breast biopsies with air localization (VAB-AL). First, classical NL was done to localize the mammographic abnormalities. Instead of insertion of the wire, 1 cc amounts of air were injected through a needle. The injected air could be easily visualized as a hyperechogenic density on breast sonography. Vacuum-assisted breast biopsy for the air-induced hyperechogenic densities was then done under sonographic guidance. The specimen radiography was performed to confirm that the lesion was removed. RESULTS: The mean age of the patients was 46 (range: 37~55). The upper-outer quadrant of the breast was the most common site of the lesions (6/10, 60%); the upper-inner quadrant (2/10, 20%), and then the lower-inner quadrant (1/10, 10%) followed. The specimen radiology for all 10 patients showed that the mammographic abnormalities were successfully removed. The most common pathologic type was fibrocystic disease (6/10, 70%); intraductal carcinoma (3/10, 30%), and then atypical ductal hyperplasia (1/10, 10%) followed. There were no major complications. CONCLUSION: Vacuum-assisted breast biopsy with air localization is a new technique that can minimize the complaints of patients with microcalcifications about the uncomfortable table, the painful breast compression and the economic burden of SVAB. This new procedure was successfully performed in our 10 patients, and we believe this procedure shows a lot of promise as one of alternatives to classical NLBB and SVAB.
Biopsy* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Hyperplasia ; Korea ; Needles ; Radiography ; Sensitivity and Specificity ; Ultrasonography ; Ultrasonography, Mammary

BACKGROUND AND OBJECTIVES: here are several reports of cardiac rehabilitation (CR) having beneficial effects on the reduction of cardiovascular mortality and in the prevention of recurrent coronary events in patient with myocardial infarction (MI). An 8-week CR program was investigated to see if it affected the prognostic factors, such as inflammatory markers, after acute MI. SUBJECTS AND METHODS: 33 male and 5 female patients, with a mean age of 55+/-10 yrs, were consecutively assigned to the CR (n=19) and the control (n=19) groups three weeks after acute MI. The 8-week CR program consisted of life style modification and aerobic exercise training. At the baseline, and after 8 weeks, the symptom limited exercise test and peripheral blood sampling were performed to measure the physiologic capacity, the serum levels of high sensitive C-reactive protein (hs-CRP) and the plasma levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha. The interval changes of each parameter were compared between the two groups. RESULTS: The interval increments of the maximal oxygen uptake (14.3% vs. 10.6%, CR vs. control group, p=0.014), anaerobic threshold (18.8% vs. 7.0%, CR vs. control group, p=0.044) and exercise duration (9.4% vs. 3.1%, CR vs. control group, p=0.009) were larger in the CR than in the control group. The magnitudes of the interval changes in hs-CRP, IL-6 and TNF-alpha, as inflammatory markers, did not differ between the two groups (p>0.05). CONCLUSION: This 8-week CR program demonstrated an improved exercise capacity for MI patients, but a larger clinical trial, with modified exercise intensity and duration, will be necessary to detect any possible effect on the inflammatory markers.
Anaerobic Threshold ; C-Reactive Protein ; Exercise ; Exercise Test ; Female ; Humans ; Interleukin-6 ; Interleukins ; Life Style ; Male ; Mortality ; Myocardial Infarction* ; Oxygen ; Plasma ; Rehabilitation* ; Tumor Necrosis Factor-alpha

Atopic dermatitis (AD) is an inflammatory skin disorder that is both uncomfortable and distressing to patients, and its prevalence has been steadily increasing. It is obvious that the identification of efficient markers of AD in plasma would offer the possibility of effective diagnosis, prevention, and treatment strategies. In this study, a proteomic approach was used to analyze plasma glycoproteins from both children with AD and healthy child donors. Several protein spots showing significant quantitative changes in the AD patients were identified. Through sequential studies, it was confirmed that CD5L and ApoE were significantly up-regulated or down-regulated, respectively, in the plasma from AD patients compared with that from healthy donors. In addition, we suggest that the up-regulated CD5L in AD patients causes eosinophilia by inhibiting apoptosis or promoting the proliferation of eosinophils either in combination with or without IL-5. The glycoproteomic data in this study provides clues to understanding the mechanism of atopic alterations in plasma and suggests AD-related proteins can be used as candidate markers for AD.
Apolipoproteins E/*blood ; Biological Markers/blood ; Cell Line ; Cell Proliferation ; Child ; Dermatitis, Atopic/*metabolism ; Eosinophilia/metabolism ; Eosinophils/physiology ; Female ; Glycoproteins/*blood ; Humans ; Interleukin-5/metabolism ; Male ; Proteomics ; Scavenger Receptors, Class B/*blood

PURPOSE: It is difficult to differentiate between viral and bacterial pneumonia in children and to decide antibiotic therapy. Study was conducted to investigate the clinical usefulness of antibiotic therapy based on procalcitonin (PCT) in children diagnosed with viral pneumonia. METHODS: This study included 108 patients diagnosed with viral pneumonia. Patient's age, fever duration, hospital stay, and treatment progress were noted, and laboratory study including PCT levels were tested. In addition, Polymerase chain reaction was done to test for viruses. Patients were divided into PCT and non-PCT groups according to PCT level. And their clinical patterns, treatment outcome, antibiotic use, severity of complications were compared. RESULTS: The number of patients with respiratory syncytial virus (RSV) was 35 and 50, rhinovirus was 5 and 10 in PCT and non-PCT groups, respectively. Fever duration was longer by 2.5 days in PCT group than in the non-PCT group (P<0.001), but there was no difference in the duration of hospital stay (P=0.191). White blood cell and absolute neutrophil count levels were higher in the PCT group (P=0.013 and P<0.001, respectively). Use of antibiotic therapy was performed in group was on 22% and 90% of patients in the PCT and non-PCT groups, respectively showing a significant reduction in the frequency of antibiotic therapy in PCT group, without a significant difference in treatment outcome, despite more severe clinical signs (P<0.001). CONCLUSION: Antibiotic therapy based on serum PCT levels in children admitted for pneumonia can reduce the frequency of antibiotic therapy in viral pneumonia, without causing significantly different treatment outcome or complications.
Anti-Bacterial Agents ; Child* ; Fever ; Humans ; Length of Stay ; Leukocytes ; Neutrophils ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Viral ; Polymerase Chain Reaction ; Respiratory Syncytial Viruses ; Rhinovirus ; Treatment Outcome

Hutchinson-Gilford progeria syndrome (HGPS) is a rare condition originally described by Hutchinson in 1886. Death result from cardiac complications in the majority of cases and usually occurs at average age of thirteen years. A 4-yr old boy had typical clinical findings such as short stature, craniofacial disproportion, alopecia, prominent scalp veins and sclerodermatous skin. This abnormal appearance began at age of 1 yr. On serological and hormonal evaluation, all values are within normal range. He was neurologically intact with motor and mental development. An echocardiogram showed calcification of aortic and mitral valves. Hypertrophy of internal layer at internal carotid artery suggesting atherosclerosis was found by carotid doppler sonography. He is on low dose aspirin to prevent thromboembolic episodes and on regular follow up. Gene study showed typical G608G (GGC- > GGT) point mutation at exon 11 in LMNA gene. This is a rare case of Hutchinson-Gilford progeria syndrome confirmed by genetic analysis in Korea.
Child, Preschool ; Humans ; Lamin Type A/*genetics ; Male ; Point Mutation ; Progeria/diagnosis/*genetics ; Prognosis ; Republic of Korea