No abstract available.
Edema* ; Hydrops Fetalis*

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode (MELAS) syndrome is a maternally inherited mitochondrial disorder that usually affects the cerebral cortex and prevents high-energy demands from being met. Herein, we present the case of a male patient who rapidly developed multiple seizures, headaches, and altered mentality accompanied by severe metabolic acidosis and lactic acidosis. Initially, a brain imaging study confirmed stroke-like lesions (SLLs) only in the cerebellum. During follow-up, newly developed SLLs with lactic acidosis were observed in the basal ganglia (BG), cerebellum, and occipital lobe. The m.3243A>G variant had been found in the patient and MELAS was diagnosed, despite the BG and cerebellum being atypical locations for SLLs in MELAS. Since most cases of m.3243A>G variant MELAS show SLLs in the cerebral cortex, this case is unusual considering the location of the lesion. We emphasize that in the case of lactic acidosis accompanied by neurological symptoms, such as seizures, as in this case, MELAS should be included in the differential diagnosis, even if SLLs are observed in areas other than the cerebral cortex.

Drowning is the second most common cause of accidental death of children in Korea. But the study of near-drowning is very rare in Korea. The purpose of our study is to determine the factors that may influence survival on the basis of submersion time, consciousness state upon admission to hospital, the kinds of water, laboratory findings and neurological outcomes. The survey was performed by a retrospective cohort study on 28 near drowning victims of less than 15 years of age who were admitted to the emergency room in the Chosun University Hospital between May 1988 & May 1997. The results were as follows 1) Sex distribution was 22 males and 6 females. 2) Submersion time was (5 minutes in 9 cases, 5-9 minutes in 6 cases,10-14 minutes in 5 cases,15-19 minutes in 3 cases, > or =20 minutes in 5 cases. 3) Comatose patients upon arrival were 6/7 cases in the death group(86%) and 2/21 cases in the improved group(10%). they had unfavorable outcomes(P<0.05). 4) The first pH value was mean 7.02)0.12 in the death group and mean 7.31 +/-0.13 in the improved group. there was a statistically significant difference between the death and the improved group(P<0.05). 5) The patients who had increased blood glucose concentration were all 7 cases in the death group and 12/22 cases in the improved group(54%). The mean blood glucose concentration was mean 424.7235.6mg/dl in the death group and mean 140.182.7mg/dl in the improved group. There was a statistically significant difference between the death and the improved group(P<0.05). 6) The patients who had pulmonary edema upon arrival were all 7 cases in the death group and 1/21 cases in the improved group(18%). They had unfavorable outcomes(P<0.05). 7) The patients who had been submerged more than 15 minutes were all 7 cases in the death group and 6/21 cases in the improved group(5%). They had unfavorable outcomes(P<0.05). We conclude that pediatric victims of near-drowning can be assigned to high or low likelihoods of unfavorable outcomes with the use of five variables, comatose mentation upon arrival, decreased initial blood pH, increased initial blood glucose concentration, pulmonary edema, and maximum submersion time estimated longer than fifteen minutes. This prediction rule may be useful if it can be validated in another cohort.
Blood Glucose ; Child* ; Cohort Studies ; Coma ; Consciousness ; Drowning ; Emergency Service, Hospital ; Female ; Humans ; Hydrogen-Ion Concentration ; Immersion ; Korea ; Male ; Near Drowning ; Pulmonary Edema ; Retrospective Studies ; Sex Distribution

PURPOSE: Our examination was designed to determine the diagnostic properties of the cutoff point for the prediction of bacteremia in febrile children less than 3 years of age. Cutoff point is the value that simultaneously maximizes both sensitivity and specificity. METHODS: We conducted a retrospective study of febrile children, less than 3 years of age, who clinically have no identifiable source of fever. Peripheral blood leukocyte count(WBC), absolute neutrophil count(ANC), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were measured at the same time. All patients received blood culture, urine culture and/or CSF culture. Bacterial infection was defined as single pathogen isolated from the CSF or blood or a urinary tract infection (UTI). Patients were dichotomized into two groups: those with bacterial infection and no bacterial infection. We analyzed the characteristics of the children in the two groups. RESULTS: Seventy-one patients(44 males; 27 females) were enrolled in the study. Twenty patients (28%) had a serious bacterial infection(twelve urinary tract infection, five bacteremia, three meningitis) and fifty-one(72%) had no serious bacterial infection. WBC, ESR and CRP were significantly different between the two groups(P<0.05). The cutoff point of WBC, ESR and CRP were 20,000/mm3, 30 mm/hr and 3.0 mg/dL, respectively. The sensitivity and specificity of each cutoff point were WBC(75%, 75%), ESR(79%, 68%) and CRP(83%, 77%), respectively. CONCLUSION: These data show the ability of predictors to identify febrile children less than 3 years of age with bacterial infection. Febrile children who reach the cutoff point must be treated intensively and those who do not reach the cutoff point can be carefully managed without administering antimicrobial agents.
Anti-Infective Agents ; Bacteremia ; Bacterial Infections* ; Blood Sedimentation ; Child* ; Fever ; Humans ; Leukocytes ; Male ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity ; Urinary Tract Infections

The purpose of this study was to explore the difference of defense mechanisms between medicine and surgery groups, and between residents and specialists who were professors of a medical school. The author evaluated the defense mechanisms by using Ewha Defense Mechanisms Test. The author compared the defense mechanisms of medicine and surgery specialist groups who are employed by Soonchunhyang university hospital as professors in 2000, and of medicine and surgery resident groups in 1999. First, there were significant differences in mean scores of the defense mechanisms ratings. In surgery specialist group, the rate of using projection and show-off were significantly higher than those of medicine group. In resident group, show-off, passive-aggression, dissociation, somatization, acting-out and regression were significantly higher than those of specialist group. In medicine group, residents were higher than specialists in show-off, passive-aggression, acting-out and regression. But for the specialist group, the score on anticipation was higher than in the resident group. In surgery group, residents were higher than specialists in identification, rationalization and regression. In the interaction, analysis by hierarchy and field anticipation and altruism have a significant interaction effect. Second, in comparison of maturity level between the field of speciality and level of hierarchies, surgery group used more neurotic and narcissistic defense than medicine group significantly. For the level of hierarchies, residents used more immature and neurotic defense than specialists. In medicine group, residents used immature defense more than specialists, but more mature defenses were used in specialists than residents significantly. In surgery group, residents used more immature and neurotic defenses than specialists. Mature defenses have more interaction effect. This results may reflect the fact that discipline in surgery have characteristic apprentices system and more dramatical therapeutic approach. The results seem to be useful in understanding the optimal character for each speciality. In the process of selecting spescialities evaluating one's defenses and matching with the characteristics and coping mechanisms of each specialty group can be helpful.
Altruism ; Defense Mechanisms ; Rationalization ; Schools, Medical ; Specialization

PURPOSE: The purpose of the present study was to access the prevalence of orthostatic dysregulation(OD) and the frequency of each category for major and minor criteria among elementary school students using the OD questionnaire. METHODS: We carried out inquiry by questionnaire as to the frequency of OD among two elementary schools with 725 students, 10 to 12 years of age, residing in Gwangju, Korea. The questionnaire was made according to criteria proposed by the Japan OD Study Group. RESULTS: Of the 725 students(male 390; female 335) questioned, the OD was found in 338 students (53.5 percent). Prevalence of OD in males(59.2 percent) was significantly higher than in females(46.8 percent)(P<0.05). Palpitation with slight exercise(95.9 percent) was the most frequent major symptom. Headaches(85.8 percent) were the most frequent minor symptom among cases of OD. CONCLUSION: The prevalence of OD in elementary school students in this study(53.5 percent) was higher than in other studies. Contrary to studies from other countries, the male to female ratio was reversed. Because the diagnostic criteria seem to be dependent on subjective reporting of the symptoms, a newer diagnostic system based on more objective findings should be established.
Child ; Female ; Gwangju ; Humans ; Japan ; Korea ; Male ; Prevalence* ; Surveys and Questionnaires

BACKGROUND: In febrile convulsions, glucose concentrations are known to increase both in the blood and cerebrospinal fluid(CSF). The reason behind this increase is, however, not completely understood. We have studied the effects of convulsion and fever on the CSF and blood concentrations in four different groups of children: convulsive and non- convulsive children, with and without fever. METHODS: This study was retrospectively undertaken to review medical records of 167 children who had lumbar puncture at Chosun University Hospital during 2 years from January 1994 to December 1996. The blood samples for glucose determinations were taken just before the lumbar puncture. The effects of several variables (body temperature, duration of fever, convulsions) were analysed on glucose concentrations in the CSF and blood between the groups. RESULTS: 1) The concentration of glucose in the CSF was significantly higher in convulsive children with(90.9+/-24.Smg/dl) and without fever(105+/-29.7mg/dl) than in non-convulsive children with(68.4+/-12.3mg/dl) and without fever(67.5+/-13.3mg/dl). 2) The concentration of glucose in the blood was not significant in the different groups. 3) There was no correlation between the body temperature and the concentration of glucose in the CSF(r=0.09, p>0.05).4) A negative correlation between the duration of the fever and the concentration of glucose in the CSF was found in febrile chi1dren (r=-0.26, p<0.05). CONCLUSIONS: Our results show that an increase in the CSF glucose concentration in convulsive children may be influenced more by a stress reaction, evoked by the seizure than increased body temperature.
Body Temperature ; Cerebrospinal Fluid* ; Child* ; Fever ; Glucose* ; Humans ; Medical Records ; Retrospective Studies ; Seizures* ; Seizures, Febrile ; Spinal Puncture

Posttranplantations lymphoproliferative disease (PTLD) is a common and life-threatening complication for soid organ transplantation associated with the use of chronic immunosuppression and Epstein-Barr virus. There is no standardized treatment algorithm, but numerous management strategies are vaiable. Partial splenic embolization (PSE) had been demonstrated to be an effetive alternatie to splenectomy for patients hypersplenism and portal hypertension. PSE has the advantages of non-invasive intervention and resolution of the complications of hypersplenism. We report the effect of the PSE in a 6-year old male liver transplantation recepient with PTLD who has undergone persistent hypersplenism post-transplant. We reduced immunosuppression agent, started antiviral agent. We started with interferon and IV globulin one month after admission. Hepatosplenomegaly and cervical lymphadenopathy were improved. But fever was not subside. We selectively embolized the lower pole of the spleen to achieve a 50~60% reduction in flow as determined by angiography. After embolization, fever subside and peripheral blood findings were improved. Follow up abdominal CT revealed reduced volume of spleen due to ischemic change and there was no multiple enlarged mesenteric lymphnode compared to preembolization state. We thick that PSE is a safe an effetive treatment modality of PTLD with persistent hypersplenism in patients twho failed to medical treatment.
Angiography ; Child ; Fever ; Follow-Up Studies ; Herpesvirus 4, Human ; Humans ; Hypersplenism* ; Hypertension, Portal ; Immunosuppression ; Interferons ; Liver Transplantation ; Lymphatic Diseases ; Male ; Organ Transplantation ; Spleen ; Splenectomy ; Tomography, X-Ray Computed ; Transplants

Short-bowel syndrome is functionally defined as a state of malabsorption following loss of small bowel, which comprises the sequelae of nutrient, fluid, and weight loss. The proximal segment of the bowel of a patient with intestinal atresia is usually grossly distended and atonic. In contrast, distal segment is smaller. For this reason, anastomosis of the proximal and the distal segment is technically difficult and may cause no propulsion even when they are anastomosed. We experienced that continuous drip ileostomy feeding with the secretions from the proximal stoma stimulated the distal bowel to accommodate and resolved many sequelae following loss of small bowel in a patient with short-bowel syndrome due to IIIa ileal atresia.
Humans ; Ileostomy* ; Infant, Newborn* ; Intestinal Atresia ; Weight Loss

PURPOSE: The purpose of the study was to determine the prevalence of chronic recurrent headache and the factors associated with it among primary school children. METHODS: The survey was performed by a special questionnaire on one thousand and eleven children in grades 4 to 6 at primary schools from 1 to 30 June 1999 in Gwangju city. RESULTS: Prevalence of chronic recurrent headaches was 17.5%(17.1% among males, 18% among girls). Over forty two point seven percent(42.7%) of the children had headache 4-6 times a month. Age at onset of headache was more predominant at 7-10 years of age. Headache most frequently occured before school(30.7%), during school(29%), and before awaking in the morning(16.5%). The highest incidence rate of chronic recurrent headache was observed on Monday(23.5%), and the lowest on Saturday(5.3%). Risk factors of chronic recurrent headaches were stress(26.1%), fatigue, poor sleep(25.1%), weather change(18.3%) and anxiety(18.2%). Of 177 cases with chronic recurrent headaches, 62 cases(35%) had family history. Among them, 50.0% of the patients had history in their mothers, 24.2% in the fathers, 17.7% in the brothers and sisters. Of 177 cases with chronic recurrent headaches, 122 cases(69%) were treated at the pharmacy(35%), hospital(23%), and herb medicine(11%). CONCLUSION: This study finds a high overall prevalence(17.5%) of chronic recurrent headache on primary school children. And among many causative factors, stress schools is most common. In conclusion, while evaluating chronic headache in children, environmental and emotional factors associated with school should be considered as well as organic causes.
Child* ; Fathers ; Fatigue ; Gwangju ; Headache Disorders ; Headache* ; Humans ; Incidence ; Male ; Mothers ; Prevalence* ; Surveys and Questionnaires ; Risk Factors ; Siblings ; Weather