PURPOSE: We compared the clinical manifestations of patients with tsutsugamushi disease between children and adults. METHODS: From January 2003 to December 2012, 768 patients diagnosed with tsutsugamushi disease were retrospectively reviewed, and the clinical characteristics, laboratory findings, and complications were compared between children and adults. RESULTS: No patterns of annual increases in the number of patients were noted in both children and adults. The higher incidences occurred in October and November respectively. By gender, male outnumbered female in children, but the opposite trend was seen in adults. By residential area, the urban distribution of children was higher than that of adults. Rashes (P=0.001) and eschar (P=0.004) were more common in children, while myalgia was more common in adults. Children had a high prevalence of anemia (P=0.041), and low incidence rates of thrombocytopenia, abnormal liver and renal function. Children yielded better results in the duration of their hospital stay and the incidence of complications (P<0.001). A comparison of the therapeutic effects of doxycycline and macrolide antibiotics, which was performed only on the children, did not reveal any significant differences. CONCLUSION: Compared to adults, children had higher incidence rates of male patients and more often suffered from rashes and eschar. Children yielded better results in the laboratory findings and duration of the hospital stay and complications. Therefore, when children are suspected to have tsutsugamushi disease, especially during its peak occurrence period, detailed physical examination and serological test should be performed to ensure a prompt diagnosis, and the use of macrolide antibiotics, which have fewer side effects, is expected to yield the same therapeutic effects.
Adult* ; Anemia ; Anti-Bacterial Agents ; Child* ; Diagnosis ; Doxycycline ; Exanthema ; Female ; Humans ; Incidence ; Length of Stay ; Liver ; Male ; Myalgia ; Physical Examination ; Prevalence ; Retrospective Studies ; Scrub Typhus* ; Serologic Tests ; Thrombocytopenia

Incontinentia pigmenti (IP), also known as Bloch-Sulzberger syndrome, is a rare X-linked dominant disorder that is generally lethal to males and almost always leads to death in utero. This disorder is a genodermatosis with characteristic cutaneous lesions and manifestations affecting the eyes, teeth, hair, and central nervous system. Genodermatosis is a hereditary disease caused by mutations in the nuclear factor-kappa B essential modulator gene mapped to chromosome Xq28. This gene encodes a variety of cytokines and chemokine regulators and is indispensable for protecting cells from tumor necrosis factor-induced apoptosis. Here we describe a case of male newborn with vesiculobullous cutaneous lesions over the left thigh and leg. We first considered the cutaneous lesions a skin infection, as they improved with intravenous antibiotics. However, recurrence and the need for repeated hospitali zations made us consider the differential diagnosis of IP, for which we performed a skin biopsy and chromosome analysis. The histology results were compatible with IP, that is, eosinophilic infiltration in the dermis and epidermis, and individual cell dyskeratinization. The chromosome analysis result was a normal 46, XY karyotype.Here we report the case of a male newborn with IP that manifested as multiple vesiculobullous skin lesions and was initially misdiagnosed as a recurrent skin infection.

This study was conducted to establish the control program for preventing unfavorable health effects of nitrogen dioxide(NO2) exposure in homes by preparing the fundamental data for evaluation of relationships between NO2 levels and influencing factors through measurements of indoor-outdoor NO2 levels and personal NO2 exposures for housewives with questionnaire survey on 172 homes in Pusan area from April to June, 1987. NO2 measurements were made by using diffusion tube samplers(Palmes tube NO2 sampler) for one week at 4 sites in homes ; kitchen(KIT), bedroom(BED), living room(LIV), outdoor(OUT) and near the collar housewives(personal exposure livel, PNO). The details of questionnaire were number of household members(FAM), number of regular smokers(SMOKER), daily number of meals eaten(MEAL), type of housing units(HOUSE), location of house with distance from the heavy traffic roads as walking time(DIST), and of kitchen(KAREA), kind of cooking fuels(FUEL), cooking time of each meal(CTIME), usage of kitchen fan for cooking(FAN), type of heating facilities(HEAT) and so on of subject homes. The obtained results were as follows : 1) The mean NO2 level was significantly higher at indoors than outdoors(p<0.01) and the kitchen NO2 level was the highest with 33.7+/-13.6ppb(9.5-81.5ppb). The mean personal exposure level of NO2 for housewives was 20.6+/-8.8ppb(3.1-46.9ppb). 2) The mean indoor NO2 level was significantly higher in the group of household members above 5 than below 4(p<0.05), in detached dwellings than apartments(p<0.001), within 5 minutes of distance than over 5 minutes(p<0.001), in the group of unusing fan(p<0.001), in the group of longer cooking time(p<0.001), and it was in order of coal briquette, gas, electricity and oil by kind of cooking fuels(p<0.05). 3) Variables showing significant correlation(p<0.001) with indoor NO2 level were kitchen NO2 level(r=0.8677), cooking time(r=0.5921), outdoor NO2 exposure level(r=0.4615), usage of kitchen fan(r=0.3573) and location of house(r=-0.2988). 4) As a result of multiple regression analysis, the most significant influencing variable to the kitchen NO2 level was cooking time [KIT=-0.378+/-11.772(CRIME)+0.298(OUT)+3.102(FAN)], it was kitchen NO2 level to the indoor NO2 level [IND = 6.996+0.458 (KIT) + 0.230 (OUT) - 1.127 (KAREA)], and it was indoor NO2 level to the personal NO2 exposure level [PNO=15.562+0.729(IND)-4.542(DIST)-0.200(KIT)]. 5) It was recognized that artificial ventilation in the kitchen, suppression of unnecessary combustion and replacement of cooking fuel, as much as possible, were effective means for decreasing indoor NO2 levels in homes.
Busan ; Coal ; Cooking ; Diffusion ; Electricity ; Family Characteristics ; Heating ; Hot Temperature ; Housing ; Humans ; Meals ; Nitrogen ; Surveys and Questionnaires ; Ventilation ; Walking

Testicular torsion in neonates is a urologic emergency with an incidence of 6.1 per 100,000 live births. Incarcerated inguinal hernia is also an emergency with an incidence of approximately 6% to 31% in children with inguinal hernia. Functional testicular torsion from an incarcerated inguinal hernia is a rare event in children, often not considered in the initial evaluation. A 19-day-old newborn boy was admitted to our neonatal intensive care unit after visiting a primary clinic. He presented with inconsolable crying and right scrotal swelling. Upon initial physical examination, a hard palpable mass and swelling was found in the inguinoscrotal region, accompanied with redness and warmth of the scrotum. Scrotal ultrasound with color Doppler showed inguinal hernia with strangulation and scanty blood flow to the testis. The patient underwent a right orchiectomy and partial resection of the affected small bowel. Surgical findings confirmed a testicular torsion and incarcerated inguinal hernia with testis with small bowel necrosis. Here, we report a rare case of a newborn with functional testicular torsion as a result of prolonged spermatic cord compression due to incarcerated inguinal hernia.

No abstract available.
Short Rib-Polydactyly Syndrome*

We studied the relationship among hypertension and retinal and retinal vessel change of 200 hypertensive out and in patients in Seoul Red Cross Hospital. The results are: 1) About 50% of hypertensive patients fall in 2nd stage hypertensive retinopathy. Systolic blood pressure is proportion to hypertensive retinopathy. 2) Generalized narrowing accounts for 86% of retinal vessel change, focal constriction 36.5% and increased central reflex accounts for 68%. 3) Concealment account for 57.5% of A-V crossing sign and anterior displacement accounts for 34%. 4) The commonest site of A-V crossing is inferior-temporal branch and superior-temporal branch come after. The former accounts for 45.3% of A-V crossing and the latter accounts for 36.8%. 5) In grade m retinal changes, puntate hemorrhage accounts for 30. 6% of retinal hemorrhages, flame shaped hemorrhages 32.1% punctate exudates 32.1% and cotton-wool patches accounts for 39%.
Blood Pressure ; Constriction ; Exudates and Transudates ; Hemorrhage ; Humans ; Hypertension* ; Hypertensive Retinopathy ; Red Cross ; Reflex ; Retinal Hemorrhage ; Retinal Vessels ; Retinaldehyde ; Seoul

Neuromyelitis Optica(Devic's Disease) is characterized by a disease process that is relatively afebrile and strictly limited to the spinal cord and optic nerves. We experienced a case of neuromyelitis optica characterized by binocular blindness and paresthesia below the umbilicus level with paraplegia of both lower legs associated with urinary incontinence and defication difficulty. We report above case with brief review of literatures.
Blindness ; Leg ; Neuromyelitis Optica* ; Optic Nerve ; Paraplegia ; Paresthesia ; Spinal Cord ; Telescopes ; Umbilicus ; Urinary Incontinence

Graves' disease, the main cause of hyperthyroidism in the pediatric age group, is very rare in children younger than 4 years old but can seriously interfere with growth and development if not recognized and treated. Here we report a case of a 3-year-old girl with Graves' disease who presented with goiter, exophthalmos, heat intolerance, and hyperactivity. At her first visit, her serum concentrations of triiodothyronine (T3) and free thyroxine (free T4) were normal, whereas that of thyroid-stimulating hormone (TSH) was decreased. Antimicrosomal antibody was 7,053.94 IU/mL, and TSH-binding inhibitory immunoglobulin was 31.62%. A thyroid scan showed diffuse enlargement with markedly increased uptake of both thyroid glands. Although T3 and free T4 levels were initially normal, she developed hyperthyroidism 3 months later. She was finally diagnosed with Graves' disease and treated with methimazole for 6 months. This is the first report of Graves' disease in children younger than 4 years old in Korea.
Child ; Child, Preschool* ; Exophthalmos ; Female ; Goiter ; Graves Disease* ; Growth and Development ; Hot Temperature ; Humans ; Hyperthyroidism ; Immunoglobulins ; Korea ; Methimazole ; Thyroid Gland ; Thyrotropin ; Thyroxine ; Triiodothyronine

Objective and METHOD: In order to identify the aggravating agents for intrinsic asthma, we performed ASA- and food additive-challenge tests on 182 subjects diagnosed as having intrinsic asthma. The following tests were performed: Lysine-aspirin bronchoprovocation test to confirm aspirin-sensitivity, sodium bi-sulfite (40-200mg) oral provocation test for sulfite sensitivity, tartrazine oral provocation test (50mg) for tartrazine sensitivity, and sodium benzoate (400mg) oral provocation test for sodium benzoate sensitivity. Positive reaction was defined as decrease in FEV, by more than 20% from the baseline value after the provocation. RESULT: Seventy-five (41.2%) of 182 subjects showed positive responses to more than one agent among the aspirin and three food additives challenged. The prevalence of aspirin-sensitivity was the highest (22.5%), followed by sulfite-sensitivity (8.8%), and then concurrent sensitivity to both aspirin and sulfite (6.0% ), to both aspirin and tartrazine (1.6% ), to aspirin, sulfite and tartrazine (1.1%) and to aspirin, sulfite and sodium benzoate (0.5%). Rhino-sinusitis was noted in 62.5% of aspirin-sensitive asthmatic subjects, 60% of sulfite-sensitive ones, and 80% of tartrazine-sensitive ones. Urticaria was noted in 21.4% of aspirin-sensitive asthmatic subjects, 16.6% of sulfite-sensitive ones and 6.3% of tartrazine-sensitive ones. Thirty-seven to 83% of positive responders had no adverse reaction history. CONCLUSION: These findings suggest that ASA and food additive challenge tests should be considered as a screening test to evaluate any aggravating factors in subjects with intrinsic asthma, even though they may not have experienced any adverse reactions.
Aspirin* ; Asthma* ; Food Additives* ; Mass Screening ; Prevalence ; Sodium ; Sodium Benzoate ; Tartrazine ; Urticaria

BACKGROUND AND OBJECTIVES: Despite the fact that the rate of complications is constantly decreasing, the immediate and severe complications of thyroid surgery emphasize the need for precise surgical techniques and to provide patients with the most benefical treatment that results in lower morbidity. To clarify the safety of thyroid surgery, 147 thyroidectomy cases were reviewed. MATERIALS AND METHODS: From April 1998 through March 2000, 147 thyroidectomies were performed at the otolaryngologic department. The risk of recurrent laryngeal nerve lesion is based on the number of nerves at risk, and the risk of hypocalcemia is based on the number of patients undergoing bilateral procedures, or contralateral surgery in patients previously operated on. The risk of superior laryngeal nerve injury is based on the number of all thyroidectomies. RESULTS: The number of nerves at risk was 210. The rate of postoperative permanent recurrent laryngeal nerve palsy was 1.4% (3/210), which is iatrogenic. Four recurrent nerves (1.9%) invaded by cancer were sacrificed intentionally. Transient paralysis was found in 1.4% of the cases (3/210). Transient superior laryngeal nerve injury was found in 0.7% (1/147), all within one month of recovery. Of 89 patients undergoing dissection of both thyroid lobes, 1.1% (1/89) developed postoperative permanent hypocalcemia. Transient postoperative hypocalcemia was found in 7 patients (7.9%), with a recovery period ranging from one to two weeks. Postoperative bleeding, infection, and seroma were not noted in this study. CONCLUSION: The data strongly indicate that careful surgical techniques, understanding of anatomic variation and surgical experiences hold the clue for a low rate of complications following thyroid surgery.
Anatomic Variation ; Hemorrhage ; Humans ; Hypocalcemia ; Hypoparathyroidism ; Intention ; Laryngeal Nerves ; Paralysis ; Recurrent Laryngeal Nerve ; Seroma ; Thyroid Gland* ; Thyroidectomy ; Vocal Cord Paralysis