OBJECTIVE: In addition to obliterating the aneurysm using clipping or coiling, decompressive surgery for control of rising intracranial pressure (ICP) is thought to be crucial to prevention of adverse outcomes in patients with poor grade aneurysmal subarachnoid hemorrhage (aSAH). We evaluated the clinical characteristics of patients with poor-grade aSAH, and compared outcomes of aneurysmal clipping with simultaneous decompressive surgery to those of coil embolization followed by decompression. MATERIALS AND METHODS: In 591 patients with aSAH, 70 patients with H-H grade IV and V underwent decompressive surgery including craniectomy, lobectomy, and hematoma removal. We divided the patients into two groups according to clipping vs. coil embolization (clip group vs. coil group), and analyzed outcomes and mortality. RESULTS: Aneurysmal clipping was performed in 40 patients and coil embolization was performed in 30 patients. No significant differences in demographics were observed between the two groups. Middle cerebral artery and posterior circulation aneurysms were more frequent in the clip group. Among 70 patients, mortality occurred in 29 patients (41.4%) and 61 patients (87.1%) had a poor score on the Glasgow outcome scale (scores I-III). No significant difference in mortality was observed between the two groups, but a favorable outcome was more frequent in the coil group (p < 0.05). CONCLUSION: In this study, despite aggressive surgical and endovascular management for elevated ICP, there were high rates of adverse outcomes and mortality in poor-grade aSAH. Despite poor outcomes overall, early coil embolization followed by decompression surgery could lead to more favorable outcomes in patients with poor-grade aSAH.
Aneurysm ; Decompression* ; Decompressive Craniectomy ; Demography ; Embolization, Therapeutic* ; Glasgow Outcome Scale ; Hematoma ; Humans ; Intracranial Aneurysm ; Intracranial Hypertension ; Intracranial Pressure ; Microsurgery ; Middle Cerebral Artery ; Mortality ; Subarachnoid Hemorrhage*

Solitary fibrous tumor is rare benign mesenchymal neoplasm. The spinal solitary fibrous tumor is extremely rare. The authors experienced a case of intramedullary solitary fibrous tumor of cervicothoracic spinal cord in a 48-year-old man with right lower extremity sensory disturbance. Spinal MRI showed intradural mass lesion in the level of C7-T1, the margin between the spinal cord and tumor was not clear on MRI. A Left unilateral laminectomy and mass removal was performed. Intra operative finding, the tumor boundary was unclear from spinal cord and it had intramedullary and extramedullary portion. After surgery, patient had good recovery and had uneventful prognosis. Follow up spinal MRI showed no recurrence of tumor.
Follow-Up Studies ; Humans ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Prognosis ; Recurrence ; Solitary Fibrous Tumors* ; Spinal Cord* ; Spine

Solitary fibrous tumor is rare benign mesenchymal neoplasm. The spinal solitary fibrous tumor is extremely rare. The authors experienced a case of intramedullary solitary fibrous tumor of cervicothoracic spinal cord in a 48-year-old man with right lower extremity sensory disturbance. Spinal MRI showed intradural mass lesion in the level of C7-T1, the margin between the spinal cord and tumor was not clear on MRI. A Left unilateral laminectomy and mass removal was performed. Intra operative finding, the tumor boundary was unclear from spinal cord and it had intramedullary and extramedullary portion. After surgery, patient had good recovery and had uneventful prognosis. Follow up spinal MRI showed no recurrence of tumor.
Follow-Up Studies ; Humans ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Prognosis ; Recurrence ; Solitary Fibrous Tumors* ; Spinal Cord* ; Spine

Epiploic appendagitis is an inflammation of the epiploic appendage in which the small sacs projecting from the serosal layer of the colon are positioned longitudinally from the caecum to the rectosigmoid area. Epiploic appendagitis is rare and self-limiting; however, it can cause sudden abdominal pain in children. Epiploic appendagitis does not typically accompany other gastrointestinal diseases. Here, we report on a healthy eight-year-old girl who presented with abdominal pain, fever, vomiting, and diarrhea. Based on these symptoms, she was diagnosed with acute gastroenteritis, but epiploic appendagitis in the ascending colon was revealed in contrast computed tomography (CT). The patient was treated successfully with conservative management. CT is beneficial in diagnosis and further assessment of epiploic appendagitis. Pediatricians need to be aware of this self-limiting disease and consider it as a possible alternate diagnosis in cases of acute abdominal pain.
Abdominal Pain ; Child ; Colon ; Colon, Ascending ; Diagnosis ; Diarrhea ; Female ; Fever ; Gastroenteritis* ; Gastrointestinal Diseases ; Humans ; Inflammation ; Vomiting

Autosomal polycystic kidney disease is responsible for about 10% of the cases of end stage renal disease. The increase in kidney size is usually proportional to the degree of deterioration in renal function. At the time of transplantation, these nonfunctional kidneys can be massively enlarged and nephrectomy is required before renal transplantation. However, pretransplantation nephrectomy of polycystic kidneys has the potential risk of surgical complications, including ileus, hernias, infection, excessive bleeding and/or intestinal injury. We report here on two cases successful renal transplantation in patients with polycystic kidneys after renal contraction by renal artery embolization and without nephrectomy. The volume reduction was evaluated by CT before and 3 months after renal artery embolization and the reduction in volume was 48% and 44% in each case, respectively. The embolization was well tolerated in both cases without immediate or delayed complications except for fever and lumbar flank pain. Four months after renal artery embolization, both of the patients successfully received a transplant from living donors.
Contracts ; Fever ; Flank Pain ; Hemorrhage ; Hernia ; Humans ; Ileus ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Living Donors ; Nephrectomy ; Polycystic Kidney Diseases ; Polycystic Kidney, Autosomal Dominant ; Renal Artery ; Transplants

PURPOSE: While pediatric observation units (POU) have become a common practice in hospitals throughout developed countries, there has been no report about POUs in Korea so far. The aims of this study were to analyze our one-year's experience of the POU and to decide which disease entities are suitable for the POU. METHODS: All children admitted from March 2006 to February 2007 to the POU at the Department of Pediatrics in Our Lady of Mercy Hospital were included in this study. Data were collected from retrospective reviews of their medical records. RESULTS: There were a total of 1,076 POU admissions. Median age of patients was 2.4 years and median length of hospital stay 14.0 hours. The most common diagnoses were gastroenteritis (42.7%), pharyngotonsillitis (19.1%), bronchiolitis (7.8%), pneumonia (5.5%) and febrile seizure (5.2%). Overall, 7.5% of the POU patients required subsequent inpatient admissions due to hospital stays of longer than 48 hours. The disease entities that were most likely to require inpatient admission were pneumonia (17.0%), febrile seizure (12.5%) and asthma (11.5%). Diseases that allowed successful discharge from the POU were gastroenteritis (4.6%), upper respiratory tract infection (5.8%), such as otitis media and pharygnotonsillitis and seizure disorder (6.4%). Compared with the previous year when the POU was not in operation, there was a statistically significant reduction in the average length of hospital stays (from 4.69 to 3.75 days), as well as a rise in the bed turnover rate (from 78.8 to 98.2 patients/ bed). CONCLUSION: Our study shows that the POU is efficient for the management of children with certain acute illnesses. Based on this study, we suggest that the POU be used as a new modality which links between the outpatient, inpatient, and emergency departments in the field of pediatrics in Korea.
Asthma ; Bronchiolitis ; Child ; Day Care, Medical ; Developed Countries ; Diagnosis ; Emergency Service, Hospital ; Epilepsy ; Gastroenteritis ; Humans ; Inpatients ; Korea* ; Length of Stay ; Medical Records ; Otitis Media ; Outpatients ; Pediatrics ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies ; Seizures, Febrile

PURPOSE: There are limited population-based data regarding herpes zoster in children. Thus we conducted a multi-institutional epidemiological analysis of herpes zoster in children and comparative analysis according to their immune status. MATERIALS AND METHODS: The study included 126 children under the age of 18 years who were hospitalized for herpes zoster at 8 hospitals in South Korea, between July 2009 and June 2015. The subjects were divided into 2 groups according to their immune status, and medical records were reviewed. RESULTS: There were 61 cases (48.4%) in the immunocompetent group and 65 cases (51.6%) in the immunocompromised group. Median age was older in immunocompromised group (11.4 vs. 8.6) (p<0.001). The mean duration of hospitalization was longer in immunocompromised group (11.0 vs. 6.6) (p<0.001). Patients were treated with oral or intravenous antiviral agents. A total of 12 in immunocompetent group were cured only by oral acyclovir. No treatment failure was found in both groups. Six immunocompromised patients had postherpetic neuralgia and 1 case was in immunocompetent group. In immunocompetent children, herpes zoster was likely caused by early varicella infection. There was no increase in progression of severity in both groups due to appropriate treatment. CONCLUSION: Early initiation of therapy is necessary for those in immunocompromised conditions. And inactivated herpes zoster vaccination may be considered in immunocompromised adolescents in the future.
Acyclovir ; Adolescent ; Antiviral Agents ; Chickenpox ; Child ; Child, Hospitalized ; Herpes Zoster ; Hospitalization ; Humans ; Immunocompromised Host ; Korea ; Medical Records ; Neuralgia, Postherpetic ; Treatment Failure ; Vaccination

PURPOSE: The locoregional recurrence (LRR) in breast cancer, without distant metastasis has traditionally been regarded as a predictor of subsequent distant metastasis. This study was designed to attain the survival rate, disease progress in patients with a LRR only and to approve a locoregional treatment able to increase the survival in specific locoregional recurrent breast cancer. METHODS: The records of 223 patients with LRR, after initial treatment at the Asan Medical Center, between 1989 and 2003, were retrospectively reviewed. The patients were classified into the LRR only and simultaneous distant metastasis groups with the LRR group subdivided into the operable and inoperable groups. The data were analyzed using SPSS 11.0. RESULTS: There were 152 and 71 patients in the LRR only and simultaneous distant metastasis groups respectively: 105 patients in the LRR only group were operable cases. The 5-year survival rate of LRR was 42.5%, but this was 50.1% in the LRR only group. The 5-year survival rates following a recurrence in the operable and inoperable groups were 66.2% and 21.1%. On multivariate analysis, age at the primary surgery, tumor size, hormone receptor status and DFI were independent prognostic factors for survival. The operable group indicated less tumor size at the primary surgery, less lymph node metastasis and more chest wall or axillary lymph node recurrences, compared to the inoperable group. CONCLUSION: In some of the LRR only cases, the survival rate was relatively good, especially in the operable group. Age at the primary surgery, tumor size, hormone receptor status and DFI were independent prognostic factors for survival. Surgical treatment could be resulted in good responses to the LRR patients with early stage or chest wall or axillary recurrences.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence* ; Retrospective Studies ; Survival Rate ; Thoracic Wall

BACKGROUND: The incidence pattern of malignancy after kidney transplantation is different from that of the general population. Because increased exposure to immunosuppressants results in an increased incidence of malignancy, institutional reports that do not consider duration of immunosuppression have limited value for providing future kidney recipients with the actual risk for malignancy or for developing a kidney allograft recipient surveillance program. Thus, we retrospectively analyzed our institutional data with regard to the duration of exposure to immunosuppressants. METHODS: A total of 757 patients who had kidney transplantation and were followed-up for at least 6 months at our hospital were reviewed retrospectively. The crude incidence rate (CI) was calculated by counting the days of exposure to immunosuppressants. RESULTS: Most malignancies after kidney transplantation were solid tumors (85.3%). The CI of malignancies was 641.1 in allograft recipients and 329.6 in the general population per 100,000 persons per year. Solid tumor cancers of the stomach, liver, lung, breast, cervix, and pancreas showed an increased CI in the allograft recipient group than the general population but cancers of the thyroid and colon did not. Based on the type of immunosuppressive agent, the CI was highest in the cyclosporine group (866/12 months/100,000 persons) than the other groups. CONCLUSIONS: We have provided the CIs of cancers after kidney transplantation at our institute. The pattern of post-transplant malignancy is different from that of western countries. Nationwide registration is needed to provide a more rational approach to post-transplant cancer surveillance in Korea.
Breast ; Cervix Uteri ; Colon ; Cyclosporine ; Female ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney ; Kidney Transplantation ; Korea ; Liver ; Lung ; Pancreas ; Postoperative Complications ; Retrospective Studies ; Stomach ; Thyroid Gland ; Transplantation, Homologous