OBJECTIVE: Schizophrenia and bipolar disorder are characterized by the presence of neurocognitive impairments on the psychosis continuum. The present study aimed to explore the shared and distinct endophenotypes between these disorders. METHODS: The study included 34 probands with remitted schizophrenia and 34 probands with euthymic bipolar disorder who had a history of psychotic symptoms that met the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria, unaffected first-degree relatives of probands (31 relatives of probands with schizophrenia and 29 relatives of probands with bipolar disorder), and 34 healthy controls. Cognitive assessments were performed using the digit span, continuous performance, Rey auditory and visual learning, complex figure, verbal fluency, Wisconsin card sorting, and finger tapping tests. RESULTS: Probands with schizophrenia showed the most generalized and severe cognitive deficits across cognitive domains (working memory, verbal learning and memory, visual memory, verbal fluency, and executive function). Some domains of cognitive function (working memory, verbal learning, and memory) were also impaired in probands with bipolar disorder, but to a lesser degree than in probands with schizophrenia. All probands and relatives showed a common deficit in working memory compared to healthy controls. Relatives of probands with schizophrenia also showed verbal fluency dysfunction. Cognitive performance of all relatives was intermediate to the performance of both patients and healthy controls. CONCLUSION: These findings suggest that a deficit in working memory could be a shared endophenotype of genetic vulnerability to schizophrenia and psychotic bipolar disorder, and verbal fluency could be a candidate endophenotype for schizophrenia specifically.
Bipolar Disorder* ; Cognition ; Diagnostic and Statistical Manual of Mental Disorders ; Endophenotypes* ; Fingers ; Humans ; Learning ; Memory ; Memory, Short-Term ; Psychotic Disorders ; Schizophrenia* ; Verbal Learning ; Wisconsin

Hickman catheters are tunneled central venous catheters used for long-term venous access in children with malignancies. The appropriate management for various kinds of catheter related complications has become a major issue. We retrospectively analyzed the clinical, demographic, and surgical characteristics in 154 pediatric hemato-oncology patients who underwent Hickman catheter insertion between January 2005 and December 2009. There were 92 boys and 62 girls. The mean age at surgery was 7.6+/-5.1 years old. The mean operation time was 67.4+/-21.3 minutes and C-arm fluoroscopy was used in 47(30.5%). The causes of Hickman catheter removal were termination of use in 82 (57.3%), catheter related bloodstream infection in 44(30.8%), mechanical malfunction in 11(7.7%), and accidents in 6(4.2%). Univariate and multivariate analysis for associated factors with catheter related bloodstream infection showed that there were no statistically significant associated factors with catheter related infection complications. All cases except two showed clinical improvement with catheter removal and relevant antibiotics treatment. The mean catheter maintenance period in patients of catheter removal without complications was 214.9+/-140.2 days. And, The mean catheter maintenance period in patients of late catheter related bloodstream infection was 198.0+/-116.0 days. These data suggest that it is important to remove Hickman catheter as soon as possible after the termination of use. When symptoms and signs of complications were noticed, prompt diagnostic approach and management can lead to clinical improvements.
Anti-Bacterial Agents ; Catheters ; Central Venous Catheters ; Child ; Fluoroscopy ; Humans ; Multivariate Analysis ; Retrospective Studies

PURPOSE: When flexor tendons are injuried in children, the management is difficult. There are needs to determine the periods of postoperative immobilization. MATERIALS AND METHODS: From April 1994 to March 1998, 40 patients younger than 16 years who had sustained flexor tendon lacerations in zone I or zone II of 52 digits were available for critical evaluation. The average postoperative follow-up period was 24 (range, 3-48) months. RESULTS: All profundus repairs in zone I achieved excellent or good function. Isolated profundus and combined profundus and superficialis repairs in zone II achieved comparable results which managed with a passive motion program immediately after operation (TAM=82%) or motion following immobilization for 3 weeks (TAM =79%) or 4 weeks (TAM=78%) . Immobilization for longer than 4 weeks which resulted in an appreciable deterioration of funtion (5 weeks: TAM=64%, 6 weeks: TAM=61%) . Digital motion following flexor tendon injuries treated with less than 4 weeks of immobilization or early motion was not significantly different. CONCLUSION: We could find no benefits of early mobilization protocols in children. Howerver, it does appear that it is important that postoperative immobilization not be continued beyond 4 weeks.
Child* ; Early Ambulation ; Follow-Up Studies ; Hand* ; Humans ; Immobilization ; Lacerations ; Tendon Injuries ; Tendons*

Malignant ovarian tumors in children are very rare, and consist of about 1% of all childhood malignant tumors. The purpose of this study is to examine the clinical characteristics, treatment, and prognosis for children with malignant ovarian tumors. We retrospectively reviewed the medical records of children under 15 years of age with malignant ovarian tumors who had been treated surgically at Asan Medical Center between 1989 and March 2009. There were 32 patients, ranged in age at surgery from 2 to 15 years (mean; 10.4 years). The median follow-up period was 64.7 months (from 1 month to 188 months). Pathologic diagnosis were; immature teratoma (n=10), mixed germ cell tumor (n=10), and dysgerminoma (n=6). Tumor stage was classified by the staging system of the International Federation of Gynecology and Obstetrics (FIGO). The number of patients in stage I, II, III, and IV were 24 (75%), 2 (6.2%), 4 (12.5%), and 2 (6.1%), respectively. The tumor recurred in 4 patients. Seven patients of group 1 did not receive postoperative adjuvant chemotherapy, and in three of them, the tumor recurred. Twenty-five patients (group 2) underwent postoperative adjuvant chemotherapy, and there was only one recurrence. One patient who did not receive postoperative adjuvant chemotherapy and expired 10 months after operation because of tumor recurrence and distant metastasis. The overall 5-year event free survival (EFS) was 84.2%: group 1 in 44.4%, and group 2 in 95.7%. Tumor recurrence was related to the postoperative adjuvant chemotherapy (p=0.004). In conclusion, proper surgical procedures with relevant postoperative adjuvant chemotherapy might improve clinical results in children with malignant ovarian tumors.
Chemotherapy, Adjuvant ; Child ; Disease-Free Survival ; Dysgerminoma ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Medical Records ; Neoplasm Metastasis ; Neoplasms, Germ Cell and Embryonal ; Obstetrics ; Ovary ; Prognosis ; Recurrence ; Retrospective Studies ; Teratoma

Meckel's diverticulum (MD) has various clinical presentations and due to the limitation of imaging studies, pre-operative diagnosis is a challenge in pediatric patients. Recently, laparoscopic exploration has been suggested as a favorable method for the diagnosis and treatment of complicated MD. We investigated the results of laparoscopic-assisted surgery compared with open technique. We retrospectively studied patients who underwent resection of complicated MD at our institute from 1997 to 2010 and compared 11 treated by laparoscopic-assisted diverticulectomy (LD) with 11 treated by open diverticulectomy (OD) for complicated MD. Operation time was not significantly different in the two groups. Hospital stay and time to diet were not significantly different. Two patients were re-admitted due to mechanical ileus in the LD group. None of patients in either group needed re-operation. Considering the possibility of false-positive results with imaging studies and the cosmetic benefit, laparoscopic-assisted surgery is a safe and effective treatment modality to diagnose and treat complicated Meckel's diverticulum.
Cosmetics ; Diet ; Humans ; Ileus ; Laparotomy ; Length of Stay ; Meckel Diverticulum ; Retrospective Studies

OBJECTIVES: This study compares single and repeat suicide attempts, and evaluates the risk factors associated with suicide re-attempts. METHODS: Two hundred and seventy-nine patients admitted to emergency rooms in four university hospitals in Daegu after suicide attempt were included in this study (n=179 single suicide attempters, n=100 repeated attempters). A structured interview focused on demographic, clinical, suicidal and psychological characteristics was administered to these patients after recovery from physical and psychological impairments. RESULTS: Individuals with repeated suicide attempts were younger, more highly educated, had more history of psychiatric treatments, took more psychiatric medications, and had more sustained suicidal ideations, bipolar disorders and personality disorders than individuals with single suicide attempt. Individuals with repeated suicide attempts marked significantly higher scores in the Childhood Trauma Questionnaire, Patient Health Questionnaire-9, and the Barratt Impulsiveness Scale. Multivariate logistic regression showed that below the sixties, history of psychiatric treatments, personality disorders, substance use disorders and sustained suicidal ideations were significantly associated with predictive factors for subsequent suicide attempt. CONCLUSION: Our findings suggest that repeat suicide attempters have different clinical characteristics from single suicide attempters, and some risk factors raise the risk of further suicide attempts. It is necessary for suicidal prevention program planners to be aware of these risk factors, especially for first-time suicide attempters.
Bipolar Disorder ; Daegu ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, University ; Humans ; Logistic Models ; Personality Disorders ; Risk Factors ; Substance-Related Disorders ; Suicidal Ideation ; Suicide*

Currarino syndrome is a hereditary syndrome characterized by the triad of a sacral bony defect, presacral mass and anorectal malformation. We retrospectively reviewed 13 Currarino syndrome patients who were treated in our center between 1997 and 2010. Demographic data, initial symptoms, initial diagnosis, pathologic diagnosis of presacral mass, associated anomalies and managements were analyzed. There were 8 boys and 5 girls. Four patients were diagnosed as Currarino syndrome immediately after birth with failure of passage of meconium and abdominal distension. Four patients underwent surgery for imperforate anus immediately after birth and were diagnosed as Currarino syndrome later and underwent reoperation. Three patients were diagnosed during work-up and management with of the tentative diagnosis of Hirschsprung's disease. Diagnosis of the remaining two patients was at the age of 26 months and 9 years and anorectal malformation was not associated. Twelve patients showed hemi-sacrum and one patient showed bilateral sacral subtotal agenesis. Two patients without anorectal malformation underwent presacral mass excision, untethering of spinal cord and repair of myelomeningocele. Six out of 8 patients, excluding 3 that expired or were lost to follow up, with anorectal malformation underwent colostomy, presacral mass excision, untethering of spinal cord, repair of myelomeningocele, posterior sagittal anorectoplasty and colostomy repair. One patient underwent only posterior sagittal anorectoplasty after colostomy. One waits the scheduled operation only with Hegar dilatation. Pathologic examation of presacral masses showed myelomeningoceles in 4 patients, lipomyelomeningoceles in 3 patients and dermoid cyst in one patient. Teratoma was combined in 2 patients. Eight patients needed neurosurgical operation for spinal cord problems. Seven patients had urologic anomalies and two of them underwent operation. Currarino syndrome should be considered as a differential diagnosis in pediatric patients with abdominal distension, constipation and anorectal malformation. For proper evaluation and treatment, a multi-disciplinary approach is recommended.
Anal Canal ; Anus, Imperforate ; Colostomy ; Constipation ; Dermoid Cyst ; Diagnosis, Differential ; Digestive System Abnormalities ; Dilatation ; Hirschsprung Disease ; Humans ; Lost to Follow-Up ; Meconium ; Meningomyelocele ; Parturition ; Rectum ; Reoperation ; Retrospective Studies ; Sacrum ; Spinal Cord ; Syringomyelia ; Teratoma

PURPOSE: The authors retrospectively compared single-port laparoscopic appendectomy (SPLA) with conventional laparoscopic appendectomy (CLA) in terms of the perioperative outcomes in pediatric patients. METHODS: Cases of laparoscopic appendectomy between December 2009 and July 2010 were retrospectively reviewed. The demographic data, operating time, pathology of the appendix, hospital stay and surgical morbidities were compared. RESULTS: Ten patients underwent SPLA and 57 underwent CLA. The mean age of the CLA and SPLA groups were 11.2 and 10.6 years, respectively. The pathology of the appendix showed that relatively more severe cases were included in the CLA group. There were 2 cases of a post operative intra-abdominal abscess and 2 cases of an umbilical wound infection in the SPLA group. Therefore, the SPLA group showed a significantly higher surgical morbidity rate (p=0.003) and hospital stay (p=0.05). The mean operation time of the SPLA and CLA group was 88.1+/-30.1 and 71.6+/-26.3 minutes, respectively; the mean operation time of the SPLA group was slightly longer (p=0.054). On the other hand, surgical morbidity and the mean operation time showed a decreasing tendency in the latter half of 10 cases. CONCLUSION: The initial experience of SPLA in pediatric patients shows a higher complication rate and longer hospital stay than CLA. On the other hand, the complication rates and operation time have been decreasing. The clinical outcomes are expected to improve after going through a learning curve.
Abdominal Abscess ; Appendectomy ; Appendix ; Child ; Hand ; Humans ; Learning Curve ; Length of Stay ; Retrospective Studies ; Wound Infection

Extracorporeal membrane oxygenation (ECMO) has been utilized in congenital diaphragmatic hernia (CDH) patients with severe respiratory failure unresponsive to conventional medical treatment. We retrospectively reviewed 12 CDH patients who were treated using ECMO in our center between April 2008 and February 2011. The pre ECMO and on ECMO variables analyzed included gestational age, sex, birth weight, age at the time of ECMO cannulation, arterial blood gas analysis results, CDH location, timing of CDH repair operation, complications and survival. There were 9 boys and 3 girls. All patients were prenatally diagnosed. Mean gestational age was 38.8 +/- 1.7 weeks and mean birth weight was 3031 +/- 499 gram. Mean age at the time of ECMO cannulation was 29.9 +/- 28.9 hours. There were 4 patients who survived. Survivors showed higher 5 min Apgar scores (8.25 +/- 0.96 vs. 7.00 +/- 1.20, p=0.109), higher pre ECMO mean pH (7.258 +/- 0.830 vs. 7.159 +/- 0.986, p=0.073) and lower pre ECMO PaCO2 (48.2 +/- 7.9 vs. 64.8 +/- 16.1, p=0.109) without statistical significance. The hernia was located on the left side in 10 patients and the right side in 2 patients. The time interval from ECMO placement to operative repair was about 3~4 days in 5 early cases and around 24 in the remaining cases. There were 3 cases of post operative bleeding requiring re operation and 2 cases of abdominal compartment syndrome requiring abdominal fascia reopening. ECMO catheter reposition was required in 4 cases. Three cases of arterial or venous thrombosis were detected and improved with follow up. Our data suggests that ECMO therapy could save the lives of some neonates with CDH who can not be maintained on other treatment modalities. Protocolized management and accumulation of case experience might be valuable in improving outcomes for neonates with CDH treated with ECMO.
Birth Weight ; Blood Gas Analysis ; Catheterization ; Catheters ; Extracorporeal Membrane Oxygenation ; Fascia ; Follow-Up Studies ; Gestational Age ; Hemorrhage ; Hernia ; Hernia, Diaphragmatic ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn ; Intra-Abdominal Hypertension ; Respiratory Insufficiency ; Retrospective Studies ; Survivors ; Venous Thrombosis