Childhood epilepsy which has high prevalence rate and inception rate is one of the commonest problem encountered in pediatrician. In contrast with epilepsy of adult, in childhood epilepsy, more variable and varying manifestations are found because the factors of age, growth and development exert their influences in the manifestations and the courses of childhood epilepsy. Moreover epilepsy children have associated problems such as physical and mental handicaps, psychological disorders and learning disability. For these reasons pediatrician who deals with epileptic children experiences difficulties in making diagnosis and managing them. In order to improve understanding and management of childhood epilepsy, authors reviewed 103 cases of epileptic patients seen at pediatric department of Yeungnam University Hospital retrospectively. The patients were classified according to the type of epileptic seizure. Suspected causes of epilepsy, associated conditions of epileptic patients, age incidence and the findings of brain CT were reviewed. Large numbers of epileptic patients (61.2%) developed their first seizures under the age of 5. The most frequent type of epileptic seizure was generalized tonic-clonic, tonic, clonic seizure (49.5%), followed by simple partial seizure with secondary generalization (17.5%), simple partial seizure (7.8%), atypical absence (5.8%) and unclassified seizure (5.8%). In 83.5% of patients, we could not find specific cause of it, but in 16.5% of cases, history of neonatal hypoxia (4.9%), meningitis (3.9%), prematurity (1.9%), small for gestational age (1.0%), CO poisoning (1.0%), encephalopathy (1.0%) were found. 30 cases of patients had associated diseases such as mental retardation, hyperactivity, delayed motor milestones or their combinations. The major abnormal findings of brain CT performed in 42 cases were cortical atrophy, cerebral infarction, hydrocephalus and brain swelling. This review stressed better designed classification of epilepsy is needed and with promotion of medical care, prevention of epilepsy is possible in some cases. Also it is stressed that childhood epilepsy requires multidisciplinary therapy and brain CT is helpful in the evaluation of epilepsy with limitation in therapeutic aspects.
Adult ; Anoxia ; Atrophy ; Brain ; Brain Diseases ; Brain Edema ; Cerebral Infarction ; Child ; Classification ; Diagnosis ; Epilepsy* ; Generalization (Psychology) ; Gestational Age ; Growth and Development ; Humans ; Hydrocephalus ; Incidence ; Intellectual Disability ; Learning Disorders ; Meningitis ; Poisoning ; Prevalence ; Retrospective Studies ; Seizures

We studied the effects of the acute intermittent peritoneal dialysis in severe acute renal failure of 1 newborn infant and 2 young infants during 18 months period from February 1985 to April 1986. The predisposing illnesses were severe acute gastroenteritis with dehydration. Reye's syndrome, and bilateral nephrolithiasis with hyperuricemia. The concomitant illnesses were severe hypernatremia, hyponatremia, hyperkalemia, hypocalcemia, hypoglycemia, DIC (disseminated intravascular coagulopathy). Paralytic ileus, metabolic acidosis and gastrointestinal bleeding. As a dialysate, Imperinol solutionR, 1.5% was used in all cases. The cycles of dialysis were 8, 16, and 41 times in each cases. Observed complications during dialysis were leakage, and abdominal wall and scrotal swelling in 2 cases, hyperglycemia in 1 case, and peritonitis in 1 case. Acinetobacter calcoaceticus was cultured in peritoneal fluid of peritonitis. These complications were treated by stopping dialysis in leakage and abdominal wall swelling, insulin therapy in hyperglycemia, and intraperitoneal and systemic antibiotics therapy in peritonitis. We experienced improvements of severe acute renal failure with variable concomitant illnesses by acute intermittent peritoneal dialysis despite of the treatable complications of dialysis in all cases.
Abdominal Wall ; Acidosis ; Acinetobacter calcoaceticus ; Acute Kidney Injury* ; Anti-Bacterial Agents ; Ascitic Fluid ; Dacarbazine ; Dehydration ; Dialysis ; Gastroenteritis ; Hemorrhage ; Humans ; Hyperglycemia ; Hyperkalemia ; Hypernatremia ; Hyperuricemia ; Hypocalcemia ; Hypoglycemia ; Hyponatremia ; Infant* ; Infant, Newborn* ; Insulin ; Intestinal Pseudo-Obstruction ; Nephrolithiasis ; Peritoneal Dialysis* ; Peritonitis ; Reye Syndrome

Hemodynamic effects of acute carbon monoxide poisoning were studied in mongrel dogs. In this study dogs were divided into two groups, namely the control and the experimental. Carbon monoxide poisoning in the experimental group was induced by the breathing of about 2% CO gas mixture for 15 minutes, and this group was further divided into two, in which the arterial CO saturation was below 50%, 30 minutes after the CO gas breathing for 15 minutes (group I) and above 50% (group II). The heart rate was markedly decreased in the both experimental groups, particularly in the group I. The cardiac index showed a relative increase in the group II compared to that of the control, and the stroke volume also showed a relative increase in the both experimental groups, being more marked in the group II. Thus the increase in the cardiac output in the group II was caused mainly by the increase in the stroke volume. The femoral artery mean pressure was decreased both in the control and the experimental groups, being more marked in the group II. There was no appreciable difference in the femoral venous pressure between the control and the experimental groups. The total peripheral resistance was decreased 30 minutes after CO gas breathing in both experimental groups, particularly in the Group II. The pulmonary artery mean pressure showed a decrease in the control and the experimental groups, and there was no prarticular difference between these two groups. The changes in the total pulmonary resistance were rather similar to those of the total peripheral resistance.
Animals ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Cardiac Output ; Dogs ; Femoral Artery ; Heart Rate ; Hemodynamics* ; Pulmonary Artery ; Respiration ; Stroke Volume ; Vascular Resistance ; Venous Pressure

OBJECTIVE: Estrogen is a major regulator/modulator of bone metabolism, and bone loss in estrogen deficiency is associated with increased bone turnover, But the mechanism for estrogen action on bone metabolism is still unknown. Recent studies have suggested that the increase in bone loss induced by estrogen deficiency is mediated by increased paracrine production of bone resorbing cytokines. Among cytokines, 1nterleukin-6(IL-6) is released from osteoblasts in estrogen deficiency and increases bone resorption by stimulation of osteoclastic activities and recruitment. Thus we performed this study to evaluate the effect of ovariectomies on bone mineral density and IL-6 in cultured monocytes of peripheral blood and bone marrow. METHODS: The experimental animals were 13 female Sprague-Dawley rats that were 8 weeks of age and weighed an average of 188.5 gram at the beginning of the study. Bilateral ovariectomies were performed in all rats from a ventral approach. Bone mineral density(BMD) of the total body, spine and level of IL-6 of cultured monocytes of peripheral blood and bone marrow were measured before and 8 weeks after ovariectomy. RESULTS: 1) BMD of total body and spine were lower after ovariectomy(0.257+/-0.069g/cm2, 0,208+/-0.005g/cm2) than before ovariectomy (0.276+/-0.005g/cm2, 0.229+/-0.011g/cm2), respectively (P<0.01). 2) Although IL-6 level of cultured monocytes in peripheral blood tended to be higher after ovariectomy than before ovariectomy, this difference was not statistically significant (P>0.05). 3) IL-6 level of cultured monocytes in bone marrow was higher after ovariectomy(82.78+/-4.99pg/ml) than before ovariectomy(48.85+/-2.42pg/ml)(P<0.05). CONCLUSION: It is possible that increased production of IL-6 in estrogen deficiency induced by ovariectomy occurs in the local environment of bone or bone marrow rather than in the pheripheral blood and stimulates bone resorption.
Animals ; Bone Density* ; Bone Marrow ; Bone Resorption ; Cytokines ; Estrogens ; Female ; Humans ; Interleukin-6* ; Metabolism ; Monocytes ; Osteoblasts ; Osteoclasts ; Ovariectomy* ; Rats* ; Rats, Sprague-Dawley ; Spine

Acetabular fracture is severe injury and is associated with other body injuries severely. It's complications are traumatic arthritis and avascular necrosis of femoral head which induce severe permanent disability and its treatment is equivocal. A clinical study was performed on 70 patients with 65 fresh fractures and 5 old fractures of the acetabulum, who were hospitalized and treated at Severance Hospital from January 1971 to December 1980 and following results were obtained. 1. The prevalent age distribution was between 20 and 50 years of age (75.7%), and the ratio between males and females was 2.2:1. The most common cause of injury was traffic accident (70.%). 2. 56 patients (80.0%) were associated injuries of other parts and the most common associated fracture was pelvic bone fracture and the most common associated soft tissue injury was urological injury. 3. A classification of acetabular fracture was induced from Judet and Letournel's anatomical classification; simple fracture was 45 cases (64.2%), associated fracture was 25 cases (35.8%) and most common hip dislocation was posterior dislocation (31.4%). 4. The methods of treatment were; closed management by using traction for 53 patients, surgical management by open reduction and internal fixation for 12 patients, and hip reconstructive surgery by total hip replacement(2 patients), cup arthroplasty (2 patients), acetabular roof formation by using iliac bone graft (1 patient). 5. The satisfactory result of conservative treatment was (57.8%), surgical treatment was (72.7%), hip reconstructive treatment was (80.0%). 6. The complications of the acetabular fracture were traumatic arthritis (36.1%), avascular necrosis (23.0%), myositis ossificans (6.6%), infection (3.3%). 7. Finally, the results of treatment depend largely on anatomical reduction, early joint motion.
Accidents, Traffic ; Acetabulum ; Age Distribution ; Arthritis ; Arthroplasty ; Classification ; Clinical Study ; Dislocations ; Female ; Head ; Hip ; Hip Dislocation ; Humans ; Joints ; Male ; Myositis Ossificans ; Necrosis ; Pelvic Bones ; Soft Tissue Injuries ; Traction ; Transplants

To assess the adequacy of medical manpower and medical fee for the newborn nursery care, the author visited 20 out of 24 hospitals with the pediatric training program in Youngnam area between July 29 and August 14, 1991. Total number of newborn, both normal and sick, admission and discharge in 1--30 June 1991 was obtained from the logbook of nursery. Head nurse and staff pediatrician of the nursery were interviewed to get the current staffing for the nursery and their subjective opinion on the adequacy of nursery manpower and the difficulties in recruiting manpower. Average medical fee charged for the maternity and normal newborn nursery care was obtained from the division of self-audit of medical insurance claim of each hospital. Average minimum requirement of nursing care time for one normal newborn per day was 179.5 (+/-58.6) minutes; 2023(+/-50.7) minutes for the university hospitals and 164.2(+/-60.5) minutes for the general hospitals. The ratio of minimum requirement of nursing care time and available nursing time was 1.42 on the average. Taking the additional requirement of nursing care for the sick newborns into consideration, the ratio was 2.06. The numbers of R. N. and A. N. in the nurserys of study hospitals were 31%, and 17%, respectively, of the nursing manpower for the nursery recommended by the American Academy of Pediatrics. These findings indicate that the nursing manpower in newborn nursery is in severe shortage. Ninety percent of the head nurses and 85% of the staff pediatrician stated that the newborn nursery is short of R.N. and 75% of them said that the nurse's aide is also short. Major reason for not recruiting R.N. was the financial constraint of hospital. For the recruitment of nurse's aide, short supply was the second most important reason next to the financial constraint. However, limit of quarter in T.O. was the major reason for the national university hospitals. Average total medical fee for the maternity and newborn nursery cares of a normal vaginal delivery who stayed two nights and three days at hospital was 219,430Won. Out of the total medical fee, 20,323Won(9.3%) was for the newborn nursery care. In case of C-section delivery six nights and seven days, who stayed otal medical fee was 732,578Won and out of the total fee 76,937Won (12.0%) was for the newborn care. Cost for a newborn care per day by cost accounting was 16,141Won for the tertiary care hospitals and 14,576Won for the all other hopitals. The ratio of cost and the fee schedule of the medical insurance for a newborn care per day was 5.0 for the tertiary care hospitals and 4.9 for the all other hospitals. Considering the current wage level of the medical personnel, capital investment for the hospital facilities and equipments, and the cost for hospital maintenance, it is hard to expect adequate quality care in the newborn nursery under the current medical insurance fee schedule.
Education ; Fee Schedules ; Fees and Charges ; Fees, Medical* ; Hospitals, General ; Hospitals, University ; Humans ; Infant, Newborn* ; Insurance ; Investments ; Maintenance and Engineering, Hospital ; Nurseries* ; Nursing ; Nursing Care ; Nursing, Supervisory ; Pediatrics ; Salaries and Fringe Benefits ; Tertiary Healthcare

Partial trisomy 10q syndrome is a rare chromosome anomaly characterized by severe mental and growth retardation, craniofacial dysmorphia with prominent forehead, fine arched eyebrows, deep set small eyes and micrognathia, In addition, other physical manifestations have been reported as skeletal anomaly, congenital heart disease, inguinal hernia, and so on. We report a case of partial trisomy 10q syndrorne with certain stigmata which confirmed by chromosome analysis.
Christianity ; Eyebrows ; Forehead ; Heart Defects, Congenital ; Hernia, Inguinal ; Trisomy*

PURPOSE: To cmpare the clinical results of complex tibial plateau fractures treated by hybrid external fixation and dual plate fixation. MATERIALS AND METHODS: We studied forty patients with Schatzker type V and VI fractures respectively and selected twenty seven patients who were followed at least one year between January 2000 and December 2005. We evaluated the clinical results in which fourteen fractures with hybrid external fixation were compared with thirteen fractures with dual plate fixation. The clinical results were evaluated according to Knee Society Clinical Rating System and the statistical analysis was performed by Student t-test. RESULTS: There were no significant differences in terms of bone union time (average union time: dual plate fixation 13.8 weeks, hybrid external fixation 14.2 weeks). The quality of osseous reduction was superior in the fractures with dual plate fixation than those with hybrid external fixation. There were significant differences in functional score (average functional score: dual plate fixation 73, hybrid external fixation 62), but not in average knee score. CONCLUSION: The hybrid external fixation can be a useful modality for treatment of complex proximal tibial plateau fractures. But the good quality of the fracture reduction by dual plate fixation may be a indicator for favorable prognosis for satisfactory knee function.
Chimera ; External Fixators ; Humans ; Knee ; Prognosis

BACKGROUND: Care for prehospital cardiac arrest is one of the major concerns of emergency medical services. But, in Korea, prehospital emergency medical service systems are not yet well established. We tried to offer one of the fundamental data for development of these systems. METHODS: After application of exclusion criteria, 183 patients who transferred to emergency center of our hospital after cardiac arrest in consecutive 24 months from Jan,1,1994 to Dec,31,1995 were included in this study. Retrospective review of the hospital charts of these patients was done. For statistical analysis, we divided patients to some categories. t-test or chi-square analysis was used. RESULTS: 24 patients of the 183 patients were secondary visitors(cardiac arrest was occurred during transfer from other hospitals), 159 patients were primary visitors. In the primary visitor group, only one third was ambulance visitors, and there is no statistical differences between arrest time of ambulance visitors and non-ambulance visitors(35+/-27 vs 37+/-24 min, p=NS). No organized bystander CPR was done. After arrival, 131 patients received CPR and 87 patients(66.4%) were not responded, 31 patients(23.1%) experienced transient ROSC, 13 patients(10.0%) survived until discharge, and only 2 patients(1.5%) were returned to their lives. CONCLUSION: We failed to find significant statistical survival differences between ambulance visitors and non-ambulance visitors, between presumed cardiac etiology group and non-cardiac etiology group. Survival rate was high in witnessed arrest group than unwitnessed arrest group(14.5% vs 2.1%, p=0.015).
Ambulances ; Cardiopulmonary Resuscitation ; Emergencies ; Emergency Medical Services ; Heart Arrest* ; Humans ; Korea ; Retrospective Studies ; Survival Rate

Is superselective embolization of the brain AVMs, the possibilities of adjacent normal brain tissue damage necessitates preembolic evaluation. The authors performed the Sodium Amytal test on 15 patients with brain AVMs. In the AVM patients with negative Amytal test(30 cases), all patients showed normal pattern on EEG and neurologic examinations after embolization Among the five patients with positive Amytal test, three cases showed neurologic deficit and the others two didn't. In eleven patients. Repeated embolization without the Amytal test were done. Among them, 5 cases showed neurlogic deficit and the others were quite normal. In conclusion, the Amytal test is a useful method of evaluation of the risk to damage normal brain tissue which are supplied by superselected feeding vessels. Combining the EEG with this test is a sensitive and objective method in evaluating patients following the Amytal test. And it is essential to performed the Amytal test for repeat embolization procedures.
Amobarbital* ; Arteriovenous Malformations* ; Brain* ; Electroencephalography ; Humans ; Methods ; Neurologic Examination ; Neurologic Manifestations