PURPOSE: To determine the clinical and demographic factors associated with long-term remission of valproate(VPA) therapy in childhood absence epilepsy. METHODS: Fifty-six cases of childhood and juvenile absence epilepsy were identified by reviewing of Electroencephalographic records and medical charts. Thirty-six cases were initially treated with VPA. Factor associated with responsiveness were identified by uni- and mutivariate logistic regression. RESULTS: Twenty-seven patient achieved long-term remission(75%). Failure to achieve remission was more likely if the initial treatment of VPA had failed than if it was successful(53% versus 90.4%, P<0.02) was also associated with failure of long-term remission. Lamotrigine was more efficacious add-on drug than Ethosuximide(63.6% vs 25% P=0.04). CONCLUSION: Long-term seizure remission was related to the patient's initial response to VPA.
Demography ; Epilepsy ; Epilepsy, Absence ; Humans ; Logistic Models ; Seizures ; Triazines ; Valproic Acid

BACKGROUND: The infrarenal abdominal aorta and the iliac arteries are the most common sites of chronic atherosclerosis in patients with symptomatic occlusive disease of the lower extremities. Direct anatomic reconstruction is the standard surgical treatment for a patient with aortoiliac occlusive disease, but extraanatomic bypass is used in patients with high cardiac or other risks. The purpose of this study was to compare the operative results of direct anatomic reconstruction with those an extraanatomic bypass and to select the optimal surgical treatment according to the preoperative risk. METHOD: The cases of 40 patients who received vascular reconstruction for aortoiliac occlusive disease between January 1995 and October 1997 were reviewed. The patients were classified in two groups: a direct anatomic reconstruction group and an extraanatomic bypass group. Operative risks were analyzed by the scoring system recommended by the Subcommittee on Reporting Standards for Lower Extremity Ischemia of International Society for Cardiovascular Surgery (ISCVS). Graft patency, operative mortality, and morbidity were also analyzed for the two groups. RESULT: There was no significant difference in operative risk (p>0.05) between the two groups, but the result of graft patency was better and the postoperative morbidity was less in direct anatomic reconstruction group. There was no postoperative mortality in either group. CONCLUSION: According to this study, direct anatomical reconstruction was superior to extraanatomic bypass inspite of same operative risks.
Aorta, Abdominal ; Atherosclerosis ; Humans ; Iliac Artery ; Ischemia ; Lower Extremity ; Mortality ; Transplants

PURPOSE: Moyamoya disease is a chronic cerebrovascular illness characterized by bilateral stenoses or occlusions of the arteries around the circle of Willis with prominent collateral circulation. We studied 36 children and adolescents with Moyamoya disease to evaluate the clinical features and outcomes. METHODS: Records were reviewed of 36 pediatric patients admitted at the Busan Paik Hospital for Moyamoya disease between January 2000 and July 2007. The clinical records were reviewed in terms of the patient profiles, imaging findings, surgical techniques, and pathologic findings. RESULTS: Overall clinical features, responses to treatment and outcome were nearly same as those of other previous reports in Korea as well as the other countries. The mean age of onset was 8 years and 5 months and the ratio of male to female was 1:1.2. Ischemia was more often than infarction(5.6: 1). Half of the patients had conservative therapy and 17 cases(47%) were treated with EDAS. CONCLUSION: The clinical features of childhood Moyamoya disease are similar to the result from other studies in Korea.
Adolescent* ; Age of Onset ; Arteries ; Busan ; Child* ; Circle of Willis ; Collateral Circulation ; Constriction, Pathologic ; Female ; Humans ; Ischemia ; Korea ; Male ; Moyamoya Disease*

The association between blood lead children and Intelligent Quotient(IQ) was investigated in a sample of l00 boys and girls aged 6-8 years from one primary school within an industrial area of Pusan. The trained undergraduates in school of public health administered an I.Q. test one by one. Parents answered a questionnaire on demographic, perinatal and socioeconomic variables. Atomic Absorbtion spectrophotometer was used to determine blood lead levels. The geometric mean of blood lead value was 7.99 microgram/dl. In total children, there was no significant relationship between blood lead level and I.Q. But in the children who were born of gestational age of less than 38 weeks, children with higher levels of blood lead performed more poorly on I.Q. test with correlation coefficient from -0.68 to -0.71. But, the children who were born of gestational age of 38 weeks and more were same as total children. These results suggest that exposure to low levels of lead in the children who were born premature probably may result in impaired intelligent development. But, we think that more profound study should be performed with sufficient numbers of subjects.
Busan ; Child* ; Female ; Gestational Age ; Humans ; Intelligence* ; Parents ; Public Health ; Surveys and Questionnaires

BACKGROUND/AIMS: It has been recently reported that celiac ganglia can be identified by linear-array endoscopic ultrasonography (EUS). Still, there has been no report on the detection rate of celiac ganglia with radial scanning EUS. The aim of this study was to evaluate the detection rate of celiac ganglia by radial scanning echoendoscopy during a routine examination. METHODS: We prospectively enrolled 57 consecutive patients (23 men, 34 women; mean age 54 years, range 21-78 years) who were referred for EUS examination from September 2006 to December 2006. EUS was performed using a radial scanning echoendoscope. The size, location and EUS appearance of the celiac ganglia were recorded for each patient. RESULTS: Celiac ganglia were identified in 51 out of 57 patients (89.4%). They were identified at the left side of the celiac trunk and aorta and between the celiac artery and the left adrenal gland. They appeared as hypoechoic, oblong or lobulated structures, often with an irregular edge, and they often contained a hyperechoic focus or strand. The mean size was 18 mm by 4 mm. Structures corresponding to the visualized celiac ganglia were retrospectively identified on CT scans in 33 among the 37 patients (89.2%). CONCLUSIONS: The results of this study showed that celiac ganglia could be identified, with radial scanning EUS, in the majority of subjects.
Adult ; Aged ; Endosonography/*methods ; Female ; Ganglia, Sympathetic/radiography/*ultrasonography ; Humans ; Male ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; Tomography, X-Ray Computed

PURPOSE: To review the clinical and laboratory features of patients with Wilson disease at diagnosis. METHODS: In this retrospective study, records of all 20 patients, who were diagnosed as having Wilson disease at the Paik hospital in Busan from 1990 to 2000, were reviewed. RESULTS: Out of 20 patients, 12 pateints (60%) have hepatic presentation alone, 2 patients (10%) have neurologic presentation, 4 patients (20%) have hepatic and neuropsychiatric presentation, and one patient (5%) has hematologic presentation at diagnosis. One patient (5%) has neither symptom nor laboratory finding of Wilson disease except very low serum ceruloplasmin level and positive family history. Family screening test revealed 3 cases of Wilson disease. 12 patients were revealed to be combined with liver cirrhosis at diagnosis. CONCLUSION: Early diagnosis and treatment is very important in patients with Wilson disease. Children or adolescents who manifest symptoms of hepatitis, who has prolonged elevation of liver enzymes, and has family history of hapatitis of unknown origin, with mild hematologic or urinary abnormalities must be suspected to have Wilson disease. Also, in adolescents with extrapyramidal symptoms or other neuropsychiatric symptoms, liver function test should be done.
Adolescent ; Busan ; Ceruloplasmin ; Child ; Diagnosis ; Early Diagnosis ; Hepatitis ; Hepatolenticular Degeneration* ; Humans ; Liver ; Liver Cirrhosis ; Liver Function Tests ; Mass Screening ; Retrospective Studies

PURPOSE: An anastomotic leak after resection of rectal cancer is a omnious complication. The diverting stoma is performed to avoid this serious complication. However, a diverting stoma and a stoma reversal are associated with significant morbidity and a small mortality. As stoma-related complications are associated with a delay of adjuvant therapy for advanced rectal cancer, minimal stoma-related morbidity is mandatory for rectal cancer patients. A safe and simple dissection of the stoma is known to be associated with less morbidity at stoma closure. Since in a loop colostomy of a not everted fashion, it is easy to construct and dissect the peristomal site at colostomy reversal, this study evaluated the usefulness of a protective loop colostomy of a not everted fashion in rectal cancer. METHODS: We reviewed the clinical records of 71 cases of loop colostomy closure for rectal cancer between January 1996 and December 2004. The clinical data, including indications for the stoma, the clinicopathologic features of the patients and their general conditions, the data for patients receiving adjuvant therapy, stoma-related morbidity, stoma-closure-related morbidity, and perioperative data were examined. RESULTS: Indications for stoma creation are the discretion of the surgeon (n=22), poor bowel preparation (n=21), unstable anastomosis (n=16), bowel obstruction (n=6), and anastomotic leakage (n=6). The stoma-related morbidity rate for a non-eversion colostomy was 5.6%. Morbidity events were peristomal erythema (n=2), prolapse (n=1), and parastomal hernia (n=1) requiring surgery. The stoma-closure-related morbidity rates was 9.9%. In the 45 patients undergoing adjuvant therapy, colostomy closure was performed during adjuvant therapy in 39 patients. Major complications, such as anastomotic leakage or abscess following reversal of the non-eversion colostomy, occurred in 1 of the 71 patients (1.4%). The average operating time and the blood loss for clostomy closure were 89.5 minutes and 202.3 ml, respectively. A simple closure of the loop colostomy was performed in 51 patients (71.8%). CONCLUSIONS: Based on our results, a non-eversion colostomy may be considered due to the ease of construction and reversal if a temporary diverting stoma for rectal cancer is indicated.
Abscess ; Anastomotic Leak ; Colostomy* ; Erythema ; Hernia ; Humans ; Mortality ; Prolapse ; Rectal Neoplasms*

PURPOSE: To investigate peripapillary retinal nerve fiber layer (RNFL) thickness profiles associated with myopia. METHODS: One hundred and twenty-seven normal eyes of 67 Korean adults were divided into three groups by spherical equivalent. All subjects were tested with fast RNFL scans of Stratus optical coherence tomography. The angular locations of superior and inferior maximal thickness points in relationship to a reference line drawn horizontally though the center of the scan circle were calculated from the raw data of scanned images (angle alpha, angle beta). Differences of angle alpha and angle beta were compared among the three groups. RESULTS: Angle alpha and angle beta were significantly different in three groups (ANOVA, p<0.001, respectively). Angle alpha and angle beta were also significantly different among the three groups for excluded eyes with tilted discs. CONCLUSIONS: The points of superior and inferior maximal peripapillary RNFL thickness were significantly different in three groups divided by spherical equivalent. As myopia becomes more severe, superior and inferior maximal peripapillary RNFL thickness points are located closer to the fovea.
Adult ; Eye ; Humans ; Myopia ; Nerve Fibers ; Retinaldehyde ; Tomography, Optical Coherence

PURPOSE: Methylphenidate (MPH) is one of the most commonly prescribed psychostimulants for attention deficit hyperactivity disorder (ADHD). However, there is limited research on its effects on lower urinary tract function. This study investigated changes in cystometric parameters after intragastric administration of MPH in conscious spontaneously hypertensive rats (SHRs), an animal model of ADHD. METHODS: Fourteen- to 16-week-old male SHRs (n=10), weighing between 280 and 315 g, were used. Three micturition cycles were recorded before administering MPH. One hour after each intragastric MPH injection, three cycles of cystometrogram were obtained in the awake condition. Various cystometric parameters were evaluated, including basal pressure (BP), maximal pressure (MP), threshold pressure (TP), bladder capacity (BC), micturition volume (MV), micturition interval (MI), and residual volume (RV). The data were analyzed using paired Student t-tests. RESULTS: Five SHRs were each administered a dose of 3-mg/kg MPH, and the other five received a dose of 6-mg/kg MPH. BP and MP increased significantly in the rats that received the 3-mg/kg MPH injection, but not in those that received the 6-mg/kg injection. BC, MV, and MI significantly increased in the rats that received the 6-mg/kg MPH injection, but not in those that received the 3-mg/kg injection. There were no significant changes in TP after either injection. CONCLUSIONS: Significant increases in BC, MV, and MI after the 6-mg/kg MPH injection suggest that the peripheral and the central nervous systems may play important roles in bladder function in those receiving MPH for ADHD.
Animals ; Attention Deficit Disorder with Hyperactivity ; Central Nervous System ; Humans ; Male ; Methylphenidate* ; Models, Animal ; Rats ; Rats, Inbred SHR* ; Residual Volume ; Urinary Bladder ; Urinary Tract ; Urination ; Urodynamics

PURPOSE: The clinical significance of the lateral resection margin for rectal cancer has been widely investigated. The ascending and the descending colon do not have a peritoneal covering posteriorly. Therefore, colon cancers located on their posterior side can penetrate the entire bowel wall, which is similar to mesorectal invasion in rectal cancer. However, the prognostic significance of the retroperitoneal resection margin involvement is unknown. The aim of this study is to evaluate the prognostic significance of the lateral resection margin in ascending and descending colon cancer. METHODS: A retrospective study was performed and involved 92 patients who had undergone a curative resection for right or left colon cancer with TNM stage II and III. The patients were assigned to either a lateral margin negative group (LMNG, n=73) or a lateral margin positive group (LMPG, n=19) according to the presence of a tumor or a metastatic lymph node within 1 mm of the lateral resection margin. The oncological outcomes of the LMPG were compared with those of the LMNG. RESULTS: The LMPG was younger and had higher incidences of tumors positive vascular or neural invasion and advanced T and N stages. The overall recurrence rate of the LMPG was higher than that of the LMNG (36.8% versus 16.4%) and the cumulative survival rate of the LMPG was significantly lower than that of the LMNG (35.0% versus 76.2%). High preoperative CEA, lymphatic invasion, lateral margin involvement of the tumor, N2 in nodal status were significant factors in the univariate analysis for evaluation of the prognosis, but lateral margin involvement was not a significant factor in the multivariate analysis. In the lymph-node-positive group and the CEA non-elevation group, lateral margin involvement of the tumor was revealed as a prognostic factor. CONCLUSIONS: Lateral margin involvement of ascending and descending colon cancer affects tumor recurrence and overall survival, but it is not a significant prognostic factor.
Colon* ; Colon, Descending ; Colonic Neoplasms* ; Humans ; Incidence ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Survival Rate