Coiling of intracranial aneurysms is a generally safe treatment. However, despite increasing clinical experience and technological improvements, endovascular treatment still has inherent risks of morbidity and mortality. Recently, we have experienced two cases of delayed complications that developed after uneventful coil embolization of unruptured aneurysms.
Aneurysm ; Intracranial Aneurysm

PURPOSE: This study was performed to characterize sepsis with thrombocytopenia in premature infants to determine if thrombocytopenia is a prognostic factor in sepsis in premature infants. METHODS: We retrospectively analyzed the medical records of sepsis in premature infants admitted to the neonatal intensive care unit(N=41) at the Hallym University Sacred Heart Hospital from January 1999 to December 2002. The incidence, risk factors, symptoms, hematologic and bacteriologic findings were analyzed during episodes of sepsis. RESULTS: Of the 41 cases, 29(72%) were associated with thrombocytopenia. The ratio of male to female was 1.2 : 1. The vast majority(98%) were late-onset sepsis. The risk factors of the thrombocytopenic group were low birth weight and low gestational age. Major symptoms were poor activity (72%), apnea/tachypnea(52%), but were not significantly different between two groups. In the thrombocytopenic group(N=29), low total WBC count and high CRP level were discovered(P=0.03, P<0.01). The mean platelet count was 70.17(x103/mm3) at diagnosis of sepsis, and a mean platelet nadir was 43.10(x103/mm3). The severe thrombocytopenia(below 50x103/mm3) in the thrombocytopenic group was discovered in 69% and the duration of thrombocytopenia was about eight days. The majority of pathogens were gram-negative bacteria and candida. The thrombocytopenic group showed a pro longed length of stay and a high mortality rate. According to comparisons between the survived and expired groups, low birth weight, low gestational age, neutropenia and thrombocytopenia were significantly correlated with mortality(P<0.05). CONCLUSION: The sepsis with thrombocytopenia in premature infants showed late-onset sepsis and high morbidity and mortality, although differences were not significant statistically. Especially, low birth weight and low gestational aged infants should be cautiously treated and monitored.
Blood Platelets ; Candida ; Diagnosis ; Female ; Gestational Age ; Gram-Negative Bacteria ; Heart ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Length of Stay ; Male ; Medical Records ; Mortality ; Neutropenia ; Platelet Count ; Retrospective Studies ; Risk Factors ; Sepsis* ; Thrombocytopenia*

PURPOSE: Children with acute colonic diverticulitis(ACD), can be misdiagnosed with acute appendicitis. METHODS: We reviewed 15 cases of ACD during five years, from January 1998 to June 2002 retro spectively. RESULTS: Most patients(80%) with ACD in children presented with right lower quadrant pain. The primary diagnosis on admission was mostly acute appendicitis(87%), and all ACD in children occurred in the right colon. Fourteen patients were managed by conservative treatment including antibiotics. A follow-up study was performed in 15 patients. There were symptomatic recurrences in two patients, but no significant complication was noted. The frequency of ACD was 11.7 per 1000 acute appendicitis. CONCLUSION: ACD in children can mostly be cured by conservative treatment. It is prudent to choose the management through the diagnostic work up, including abdominal sonography and computed tomography, because there was no significant difference of clinical findings between ACD and acute appendicitis.
Anti-Bacterial Agents ; Appendicitis ; Child* ; Colon* ; Diagnosis ; Diverticulitis ; Diverticulitis, Colonic* ; Follow-Up Studies ; Humans ; Recurrence

BACKGROUND: To determine the natural progression of conservatively treated rotator cuff tears, we evaluated changes in radiologic and clinical parameters in patients whose recalcitrant tears were neglected after conservative treatment. METHODS: A total of 73 patients with recalcitrant rotator cuff tears in spite of conservative treatment were included in this study. We measured changes in tear size and in the extent of fatty infiltration of the rotator cuff by comparing the initial and final follow-up magnetic resonance imagings (MRIs). To determine factors influencing the change in tear size, we collected the medical history of patients taken at the time of initial admission. RESULTS: The average follow-up period was 20.1 months, and the average increase in tear size across this period was 6.2 mm. In terms of steroid injection, we found that the increases in tear size of the steroid injection group (p=0.049) and of the sub-group that had received more than three steroid injections (p=0.010) were significantly greater than that of the non-steroid injection group. CONCLUSIONS: We found that the increase in cuff tear size was on average 6.2 mm across the follow-up period, indicating that neglecting cuff tears may cause them to progress into more severe tears. We also observed that a history of steroid injection might be a possible risk factor for a worse prognosis of cuff tears. Therefore, we suggest that patients with rotator cuff tears and a history of steroid injection are recommended aggressive modes of treatment such as surgery.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prognosis ; Retrospective Studies* ; Risk Factors ; Rotator Cuff* ; Tears*

PURPOSE: To investigate the characteristics of the sliding pattern of the proximal fragment (head and neck) in unstable intertrochanteric fractures, which were fixed with a dynamic hip screw (DHS) with anterior to posterior or posterior to anterior insertion angle in the axial view. MATERIALS AND METHODS: AO type A2.1 intertrochanteric fracture was reproduced in 10 proximal femur model (Synbone, Malans, Switzerland). Five fractured models were reduced and fixed using DHS with anterior to posterior insertion angle (group 1) and five models were fixed with posterior to anterior angle (group 2). Load of 500 N (30 cycles) was applied to the fracture fragment-plate complex using Instron 6022. Data on the distance of sliding and the angle of rotation of the proximal fragment were collected and analyzed. RESULTS: No significant difference was noted statistically in the distance of sliding between the two groups (p=0.92). However, the mean angle of rotation was 13.4degrees and 8.0degrees in group 1 and 2, respectively and the difference was statistically significant (p=0.012). Anterior cortical fracture of distal fragment was noted in 3 cases of group 1. There was no fracture of the anterior cortex in group 2. CONCLUSION: In unstable intertrochanteric fracture, the insertion angle of the lag screw in axial view does seem to play a role in the fate of bone-plate complex. Early eccentric contact of both fragments caused rotation of the proximal fragment in all cases and anterior cortical fracture of the distal fragment in 3 cases of group 1.
Femur ; Hip ; Hip Fractures*

OBJECTIVE: The aim of this study was to analyze the correlation between thromboembolic complications and antiplatelet drugs before and after neurointervention. METHODS: Blood samples and radiographic data of patients who received a neurointervention (coil embolization, stent placement or both) were collected prospectively. Rapid platelet function assay-aspirin (RPFA-ASA) was used to calculate aspirin resistance in aspirin reaction units (ARU). For clopidogrel resistance, a P2Y12 assay was used to analyze the percentage of platelet inhibition. ARU > 550 and platelet inhibition < 40% were defined as aspirin and clopidogrel resistance, respectively. RESULTS: Both aspirin and clopidogrel oral pills were administered in fifty-three patients before and after neurointerventional procedures. The mean resistance values of all patients were 484 ARU and < 39%. Ten (17.0%) of 53 patients showed resistance to aspirin with an average of 597 ARU, and 33 (62.3%) of 53 patients showed resistance to clopidogrel with an average of < 26%. Ten patients demonstrated resistance to both drugs, 5 of which suffered a thromboembolic complication after neurointervention (mean values : 640 ARU and platelet inhibition < 23%). Diabetic patients and patients with hypercholesterolemia displayed mean aspirin resistances of 513.7 and 501.8 ARU, and mean clopidogrel resistances of < 33.8% and < 40.7%, respectively. CONCLUSION: Identifying individuals with poor platelet inhibition using standard regimens is of great clinical importance and may help prevent cerebral ischemic events in the future. Neurointerventional research should focus on ideal doses, timing, choices, safety, and reliable measurements of antiplatelet drug therapy, as well as confirming the clinical relevance of aggregometry in cerebrovascular patients.
Aspirin ; Blood Platelets ; Drug Resistance ; Humans ; Hypercholesterolemia ; Platelet Aggregation Inhibitors ; Prospective Studies ; Stents ; Ticlopidine

Neonatal hydrometrocolpos is the cystic dilatation of the vagina and uterus, which is caused by the combination of vaginal obstruction such as imperforate hymen, transverse vaginal septum, or vaginal atresia, and glandular secretion by maternal estrogenic stimulation. Although hydrometrocolpos is a rare congenital abnormality unlike pubertal hematocolpos, it is one of the relatively common abdominal masses in neonates. In typical cases the diagnosis may be determined easily by the combination of a pelvic mass, upper urinary tract dilatation and a bulging membrane in the vaginal introitus. The presense of a lower abdominal mass in a female infant should always arouse suspicion of hydrometrocolpos and lead to careful examination of the vagina. We report a case of neonatal hydrometrocolpos due to imperforate hymen which was initially presented as a large abdominal mass and a bulging membrane in the vaginal introitus. For 72 hrs, the abdominal mass increased rapidly, accompanied by urinary tract obstruction. It was relieved by a simple incision of the imperforate hymen and drainage of 300 cc of whitish mucoid vaginal fluid, and by Foley catheter drainage of 750 cc urine. No other anomaly was observed.
Catheters ; Congenital Abnormalities ; Diagnosis ; Dilatation ; Drainage ; Estrogens ; Female ; Hematocolpos ; Humans ; Hymen ; Infant ; Infant, Newborn ; Membranes ; Urinary Tract* ; Uterus ; Vagina

PURPOSE: To raise awareness of the clinical importance of, and the need for proper management of acute focal bacterial nephritis(AFBN), we analyzed 22 AFBN patients and 22 other upper urinary tract infection patients by use of comparative studies. METHODS: From January 2000 to May 2002, 22 AFBN patients aged from 1 month to 12 months were selected. As a control group, 22 UTI patients with no radiologic abnormalities were selected and matched by age and sex. RESULTS: The incidence of AFBN was more common in boys than in girls. Since both groups had similar symptoms, it was difficult to diagnose AFBN by clinical presentations alone. ESR and CRP were significantly higher in AFBN patients. The most common causative organism was E. coli in both groups. On the sonographic findings, the most lesions were seen on the upper lobe of the kidney; more frequently, on left kidney. The lesions showed globular or wedge-shaped increased echogenecity. 99mTc-DMSA scan showed the complete coincidence of the location, size and shape in all cases compared to the findings of renal sonography. CONCLUSION: The roles of renal sonography and DMSA scan were very important, and ultrasonography was an excellent initial tool in diagnosing AFBN. Since the degree of infection in AFBN is more severe than other urinary tract infections and evollution into a renal abscess is possible, early diagnosis and appropriate antibiotics therapy is essential.
Abscess ; Anti-Bacterial Agents ; Child* ; Early Diagnosis ; Female ; Humans ; Incidence ; Kidney ; Nephritis* ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Urinary Tract Infections

PURPOSE: To promote awareness and efforts by pediatricians to identity and prevent child abuse by investigation of characteristics of victim and types of injury caused by abuse. METHODS: A retrospective study was performed with 20 patients who had been diagnosed or suspected as child abuse at Hallym University Hospital from January 1999 to December 2005. The medical records, radiologic documents, and social worker's notes were reviewed to investigate age, sex, visiting time, form of abuse, perpetrator, risk factor, and type of injury. RESULTS: The mean age of the subjects was 2.8 years. Fourteen patients were between 0-1 years old, 2 patients between 1-6 years old, 3 patients between 7-12 years old, and 1 case over 13 years old. The ratio of male to female was 1:1. The majority of these patients (70%) visited via emergency department. Eight five percent of these patients reported with physical abuse, 5% psychological abuse, 5% sexual abuse, and 5% neglect respectively. The suspected perpetrator was the biological father in six cases, the biological mother in three cases, the stepmother in two cases, caregiver in one case, relatives in one case and "unknown" in six cases. Bruise and hematoma (80%) were the most common physical findings. Skull fractures were diagnosed in six cases, long bone fractures in two cases, hemoperitoneum in two cases, subdural hemorrhage in 10 cases, epidural hemorrhages in two cases, subarachnoidal hemorrhages in two cases, and retinal hemorrhages in five cases respectively. Seventeen cases required hospitalization and surgical operations performed were in nine cases. Four patients died and three patients had sequalae such as developmental delay and quadriplegia. CONCLUSION: Child abuse results in high mortality and morbidity in victims. Therefore early recognition and prevention is very important. Pediatricians should always suspect the possibilities of abuse in cases of fracture, intracranial hemorrhage, abdominal injury, or even any injury to the body. We recommend that the clinical investigation of suspicious children should include a full multidisciplinary social assessment, a skeletal survey and CT or MRI.
Abdominal Injuries ; Adolescent ; Caregivers ; Child ; Child Abuse* ; Child* ; Contusions ; Emergency Service, Hospital ; Fathers ; Female ; Fractures, Bone ; Hematoma ; Hematoma, Subdural ; Hemoperitoneum ; Hemorrhage ; Hospitalization ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Male ; Medical Records ; Mortality ; Mothers ; Quadriplegia ; Retinal Hemorrhage ; Retrospective Studies ; Risk Factors ; Sex Offenses ; Skull Fractures

PURPOSE: The present study was designated to sex, age, etiology of acute symptomatic seizures, which refer to the seizure caused by specific and transient pathophysiologic abnormalities in the central nervous system and other systems, and furthermore to analyze the incidence of acute symptomatic seizures before and during hospitalization. METHODS: The medical records of six hundred and ten convulsive children under fifteen years of age, who visited the Hallym University Sacred Heart Hospital from January 1999 to May 2001, were reviewed. One hundred and fourteen cases out of them were analyzed, and febrile seizures and unprovoked seizures were excluded. RESULTS: Among six hundred and ten children who had seizure during hospitalization, one hundred and fourteen(18.7%) had acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures. The ratio of male to female was 1:2.1 and the peak age was three or less, accounting for 93.9%. Acute symptomatic seizures were caused by acute gastroenteritis(42.0%), metabolic/toxic disturbances(34.1%), cerebrovascular diseases(8.8%), CNS infections(8.0%), hypoxemia(4.4%), brain tumors(1.8%), and others(0.9 %). Remarkably, hypocalcemia and shaken baby syndrom were up to 82.1% of metabolic/ toxic distubances and 30.0% of cerebrovascular diseases, respectively. Among the one hundred and fourteen patients, 41.2% suffered from seizures before and during hospitalization and 11.4% did not before but did during hospitalization. CONCLUSION: Eighteen point seven percent of the cases of convulsions reviewed were classified into acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures with the male to female ratio of 1:2.1 and high incidence age of three or less years. The leading causes of acute symtomatic seizures were acute gastroenteritis and hypocalcemia, comprising 70%. Shaken baby syrome and hyponatremia due to water intoxication can be prevented by public education about the danger, and central nervous system infection can be reduced by vaccine development and nationwide vaccination against the bacteria causing the central nervous system infection. In addition, appropriate prevention and management of seizure attacks are required for the patients with acute symptomatic seizures during hospitalization.
Bacteria ; Brain ; Central Nervous System ; Central Nervous System Infections ; Child* ; Education ; Female ; Gastroenteritis ; Heart ; Hospitalization ; Humans ; Hypocalcemia ; Hyponatremia ; Incidence ; Male ; Medical Records ; Seizures* ; Seizures, Febrile ; Vaccination ; Water Intoxication