We describe herein four cases of childhood dermatomysitis of Brunsting type. The ages of these patients were between 7 to 10 years at the time of the disease. All four patients had pathognomOnic cutaneous changes, such as heliotrope erythema and Gottron's papules, which are not seen frequently in adult type dermatomyositis. These patients did not show any marked serologic abnormalities suggestive of having other connective tissue diseases or autoimmune diseases. All patients were initially treated with prednisolone and chloroquine, and have been under control with low dose prednisolone, or chloroquine alone.
Autoimmune Diseases ; Chloroquine ; Connective Tissue Diseases ; Dermatomyositis* ; Erythema ; Humans ; Prednisolone

INTRODUCTION: The fixation strength of transpedicular screw system in the vertebral hody relied on bone quality and anatomical characteristics of vertebral pedicle, designs of screw and types of connection(rod or plate) with screw. The purpose of this study is to verify the biomechanical nature of the transpedicular fixation in spine under various conditions with porcine vertebrae. MATERIAL AND METHOD: Fresh porcine vertebrae and the custom-made screws were used in this experiment. To reduce the errors caused by vertebral bodies of different size and quality, vertebral bodies having regular range of pedicular width(10.0 to 11.5mm) and hone density(more than 1.0 gm/cm2) were used. The pedicle screws were inserted in the same procedure and axial pull out test was performed with using the Material Testing System(lntron8511, Canton, USA). The experiments were performed in four types to assess the difference of strength accroding to designs of the screw hy using two group of screws. The first group of screw was designed according to the outer and inner diameter and the second group was designed according to the shape, pitch, and thread profile of screw. Experiment I was perfomed to evaluate the effect of screw diameters on the biomechanical pull-out strength hy using the first group of custom-made pedicle screw which fixed all other factors except the diameter of screw. Experiment I was to verify the effect of screw shape, experiment III to verify the effect of pitch and experiment IV to verify the effect of thread profile. RESULTS: The results of experiments were summarized as follows: Experiment I showed that the screw of larger outer diameter had greater holding strength. Experiment II showed that the holding strength of cylindrical shaped screw is superior to that of conical shaped screw. Experiment III showed that there is no statistical significance between different modes of pitch. Experiment IV showed that the holding strength of buttress shape of thread profile is superior to that of V-shape. CONCLUSION: It seemed that the fixation strength of the screw was more powerful with 1 mm increment of outer diameter in 4-7mm of outer diameter, 3mm of pitch and buttress shape of thread of the screw with the same operation technique.
Spine

PURPOSE: Cognitive researchers assume that learning strategies are related to three types of learning processes: 'surface learning,' 'strategy learning,' and 'deep learning.' A 'deep learning' approach is widely accepted to be associated with long-term success in medical school, contributing to the development of doctors who take desirable approaches to self-directed learning and studying in medical practice. Therefore, this study measured how medical students learn and determined whether the use of learning strategies differs between high and low academic performers. In addition, we compared medical college students with graduate medical school students with regard to the use of learning strategies. METHODS: To explore the learning strategies of students and their relation to academic achievement, we performed LIST (Learning Strategies in Higher Education Inventory) in a sample of 111 Year 1 medical students. RESULTS: Medical students with high academic performance scored higher in most learning strategies than low performers. Additionally, learning strategies were used more frequently by graduate medical school students than medical students, specifically with regard to organization, elaboration, critical thinking, and time management. CONCLUSION: We conclude that learning strategy instruments provide information that enables medical students to optimize their study. To foster deep learning and intrinsic motivation in students, it might also be necessary to adopt more changes in teaching and assessment in medical schools.
Achievement ; Humans ; Learning ; Motivation ; Schools, Medical ; Students, Medical ; Thinking ; Time Management

Histoplasmosis is particularly virulent in infants, the elderly and immunocompromised individuals. Recently the authors experienced a case of histoplasmosis diagnosed on peripheral blood smear in a newborn. So the authors report a case with brief review of literature.
Aged ; Histoplasmosis* ; Humans ; Infant ; Infant, Newborn

PURPOSE: This study was performed to investigate the indications, yield, and complications of flexible bronchoscopy for respiratory disease in children compared to earlier domestic studies and to examine if any differences existed in comparison to international studies. METHODS: The medical records of 100 cases of flexible bronchoscopy that were performed in 76 patients at the Department of Pediatrics of The Catholic University of Korea, Seoul St. Mary's Hospital from June 16, 2010 to August 6, 2013 were reviewed. RESULTS: A total of 76 patients (50 males and 26 females) were included in the study. The most common indication of flexible bronchoscopy was persistent pneumonia or pneumonia in immunocompromised patients (53 cases). The object of flexible bronchoscopy was accomplished in 65 of 100 cases, and, the treatment was changed in 24 of 65 cases. The most common abnormal finding was tracheomalacia that was found in 18 cases. In 67 cases where bronchoalveolar lavage was performed, bacteria were identified in 47 cases, fungi in 9 cases, and viruses in 22 cases. Complications occurred in 8 cases. CONCLUSION: Compared to earlier domestic studies, there was no significant change in diagnostic approaches and therapeutic improvement. However, this study showed that flexible bronchoscopy appears to be safe in patients with hemato-oncologic disease. Compared to international studies, the occurrence of complications due to flexible bronchoscopy was relatively low.
Bacteria ; Bronchoalveolar Lavage ; Bronchoscopy* ; Child* ; Fungi ; Humans ; Immunocompromised Host ; Korea ; Male ; Medical Records ; Pediatrics ; Pneumonia ; Seoul ; Tracheomalacia

Various benign and malignant conditions can cause biliary obstruction. We present a rare case of obstructive jaundice due to the compression of the common hepatic duct by the anteriorly overriding right hepatic artery. This case was also associated with the absence of the lateral segment of the left hepatic lobe. The patient was a 39 year-old housewife with a 4-day history of jaundice and occasional febrile sensation. An abdominal computed tomography showed absence of the lateral segment of the left hepatic lobe and a percutaneous transhepatic cholangiography showed a band-like filling defect of 2 mm width at the level of the upper common hepatic duct. The anteriorly overriding right hepatic artery compressing the common hepatic duct and the absence of the lateral segment of the left hepatic lobe were confirmed by operation.
Adult ; Bile Duct Diseases/complications ; Case Report ; Cholestasis/*etiology ; Female ; *Hepatic Artery ; *Hepatic Duct, Common ; Human ; Liver/*abnormalities

PURPOSE: Human metapneumovirus (hMPV) is known to result in clinical manifestation similar to respiratory syncytial virus (RSV) in children. But some recent studies showed different features. This study compared the clinical manifestation of respiratory disease between hMPV and RSV. METHODS: A total of 801 children who admitted to Seoul St. Mary's Hospital for respiratory infection from January to June, 2012 were enrolled. Respiratory viral polymerase chain reaction (PCR) using nasopharyngeal swab was performed in all children. We grouped hMPV positive children and RSV positive children and compared clinical features between them by retrospective chart review. RESULTS: Among 801 children, 365 showed one virus PCR positive with 44 showing hMPV and 41 showing RSV. Respiratory diseases were upper respiratory infection, acute bronchitis, acute bronchiolitis and pneumonia. The peak season was March and April for hMPV and February and March for RSV. Fever incidence, fever duration and neutrophil percent of complete blood cell count were higher in hMPV group than RSV group (P<0.05). The mean age of hMPV group was higher than RSV group (P<0.05). But in acute bronchiolitis children, there was no mean age difference between two group. Acute bronchiolitis incidence declined with increased age for both group (P<0.05). The hMPV group showed relatively lower bronchiolitis and higher pneumonia incidence than RSV group, suggesting relation with age. CONCLUSION: Respiratory infection by hMPV developed at late winter and spring, slightly later than RSV and at older age. The lower incidence of acute bronchiolitis for hMPV infection than RSV is maybe due to older age than RSV.
Blood Cell Count ; Bronchiolitis ; Bronchitis ; Child ; Fever ; Humans ; Incidence ; Metapneumovirus ; Neutrophils ; Pneumonia ; Polymerase Chain Reaction ; Respiratory Syncytial Viruses ; Retrospective Studies ; Seasons ; Viruses

BACKGROUND AND OBJECTIVES: Laryngopharyngeal reflux disease (LPRD) is relatively common disease. N-acetyl cysteine (NAC) has both mucolytic and antioxidant effect, also may be beneficial in inflammatory airway diseases. The purpose of this study was to evaluate the efficacy and safety of inhaled NAC therapy in LPRD. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 525 LPRD patients at 12 medical centers. Finally 401 patients subjected to inhaled NAC therapy for 2 months were enrolled in the study. We analyzed the change of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) after use of NAC for 4 weeks and 8 weeks in addition to the patient's compliance of the treatment. RESULTS: The RSI score significantly decreased from 19.87±6.34 to 12.78±6.93 after 4 weeks and to 10.65±7.47 after 8 weeks. The RFS score also significantly decreased from 9.29±3.4 to 7.17±3.41 after 4 weeks and to 6.1±3.73 after 8 weeks (p<0.05). During the treatment periods, 42 patients (10.4%) reported to have 80 episodes of discomfort. Throat discomfort (33%) and nausea (28%) were most common complaints, but the duration of discomfort was usually less than 4 weeks. CONCLUSION: Inhaled NAC treatment is highly effective for the reduction of both subjective and objective findings in LPRD patients. This study will provide the evidence of new treatment option for patients with LPRD. However, further studies will be needs to assess the real effect of inhaled NAC therapy as a standard treatment regimen of LPRD.
Antioxidants ; Compliance ; Cysteine ; Cystine ; Humans ; Inhalation ; Laryngopharyngeal Reflux ; Medical Records ; Nausea ; Pharynx ; Retrospective Studies

PURPOSE: Several treatment options have been reported for post-traumatic kyphosis (PTK) and neurologically compromised osteoporotic fractures. However, there is no ideal surgical procedure. This study evaluated the effectiveness of posterolateral decompression and anterior support with a titanium mesh in PTK by posterior surgery. MATERIALS AND METHODS: Seventeen patients with PTK and neurologically compromised osteoporotic fractures underwent a single posterior approach. During posterior decompression, a titanium mesh was inserted through the posterior approach after a transpedicular intracorporeal corpectomy. Complications, operating time and blood loss were noted, and radiographic studies and neurological status were evaluated before surgery, after surgery, and at final follow-up. RESULTS: The mean kyphosis was 35+/-9.7degrees (range; 17-58degrees) before surgery, 3.2+/-1.8degrees after surgery (correction; 90.5%) and 5.5+/-3.2degrees at the final follow-up (correction; 85.5%). There was 29.6degrees correction of the kyphosis with a 6% loss of correction. Postoperative neurological improvement using the Frankel classification was demonstrated in all patients. There was no new onset or progressive neurological deterioration, additional surgery or extrusion of mesh. Three complications were encountered: one care each of pneumonia, prolonged ventilator support and distal adjacent vertebral fracture. CONCLUSION: The posterior insertion of a titanium mesh for anterior support appears to maintain the length of the anterior column, stabilize the injured vertebra and facilitate spinal fusion. Posterolateral decompression allows as direct a decompression as the anterior approach.
Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Osteoporosis ; Osteoporotic Fractures ; Pneumonia ; Spinal Fusion ; Spine ; Titanium ; Ventilators, Mechanical

Purpose: This study aimed to compare the outcomes of primary radiotherapy (RT) versus surgery in early-stage human papilloma virus–positive oropharyngeal squamous cell carcinoma (hpv+OPC), and investigate the preoperative clinical factors that can predict the requirement for postoperative adjuvant treatment. Materials and Methods: This multicenter study included 166 patients with American Joint Committee on Cancer 8th edition-Stages I-II hpv+OPC. Sixty (36.1%) and 106 (63.9%) patients underwent primary (concurrent chemo)radiotherapy [(CC)RT] and surgery, respectively. Seventy-eight patients (73.6%) in the surgery group received postoperative (CC)RT. Results: With a median follow-up of 45.6 months for survivors, the 2-year overall survival (OS), progression-free survival (PFS), and locoregional control (LC) for RT/surgery were 97.8%/96.4%, 91.1%/92.0%, and 92.9%/93.3%, respectively. In multivariate analyses, patients with synchronous radiologic extranodal extension and conglomeration (ENEcong) of metastatic lymph nodes (LNs) showed significantly poorer OS (p=0.047), PFS (p=0.001), and LC (p=0.003). In patients undergoing primary surgery, two or more clinically positive LN metastases (odds ratio [OR], 5.15; p=0.004) and LN metastases with ENEcong (OR, 3.75; p=0.009) were predictors of postoperative chemoradiotherapy. No patient in the primary RT group demonstrated late severe toxicity whereas three (2.8%), one (0.9%), and one (0.9%) patient in the surgery group showed grade 3 dysphagia, grade 3 xerostomia, and fatal oral cavity bleeding. Conclusion We found no differences in OS, PFS, and LC between upfront RT and surgery in stage I-II hpv+OPC which warrants comparison through a prospective trial in the treatment de-escalation era. However, most early-stage hpv+OPC patients undergoing surgery received adjuvant (CC)RT. Pretreatment LN findings were prognostic and predictive for adjuvant treatment.