PURPOSE: Chronic administration of anticonvulsants for children with epilepsy may cause multiple abnormalities in bone metabolism. The aim of this study was to evaluate the effects of anticonvulsants on bone mineral density(BMD) in children with epilepsy. METHODS: Seventy patients with epilepsy were enrolled in this study. All subjects had taken anticonvulsants for at least 1 year or more. Subjects were classified into three groups according to age(5-7 yrs, 8-11 yrs, >12 yrs). BMD was measured by Dual-energy X-ray Absorptiometry(DXA) on the lumbar spine and whole body. Statistical analysis for BMD of anticonvulsants-treated subjects were compared to results with the published data. RESULTS: BMD was significantly decreased in the anticonvulsants-treated group as compared with the control group of all age groups(P<0.05). But BMD among groups according to anticonvulsants was not significantly different(P>0.05). CONCLUSION: Because chronic administration of anticonvulsants for growing children leads to a decrease in BMD, early detection and management of abnormal BMD is important in monitoring of children with epilepsy.
Child ; Male ; Female ; Humans

This study utilized the Community Multiscale Air Quality model to simulate the spatial distribution of benzene, toluene, and xylene (BTX) concentrations from large national industrial complexes (IC) located in the Ulsan metropolitan region (UMR). Through controlling pollutant emissions from major IC, this study performed a quantitative analysis of the influence of pollutant emissions on BTX concentrations in surrounding urban areas. The results showed that approximately 40% of the annual average BTX concentrations in nearby urban grids were directly influenced by pollutant emissions from the IC. Seasonal modeling results indicated that average BTX concentrations were high around petrochemical complexes, with higher concentrations in the surrounding urban areas during the summer (July). All three of the BTX pollutants showed similar seasonal differences. Daily contributions differed significantly throughout the modeling period, with some values reaching a maximum of 80% during July. Overall, when urban areas were located downwind of the IC, contributions rose. Moreover, this study compared the differences in BTX contributions at each measurement point within the IC and urban areas, which showed that the influence of the IC emissions decreased significantly with distance. The spatial distribution and direct influence of the IC on BTX concentrations in the UMR identified through this study could be used to provide input data in environmental epidemiological studies.
Benzene ; Epidemiologic Studies ; Seasons ; Toluene ; Ulsan ; Xylenes

Background: The reliability and validity of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans (K-HADS-A) has not been studied in Korean surgical patients. This study aimed to validate the usefulness of K-HADS-A for measuring preoperative anxiety in Korean surgical patients. Additionally, the effect of preoperative anxiety on postoperative quality of recovery was evaluated. Methods: Preoperative anxiety in 126 inpatients with planned elective surgery was measured using the K-HADS-A. The postoperative quality of recovery was measured using the Korean version of the Quality of Recovery-15. The validity and reliability of the K-HADS-A were evaluated. The differences in quality of recovery on the first and seventh day postoperatively were then compared between the anxious and non-anxious groups. Results: There was a statistical correlation between the K-HADS-A and Anxiety Likert Scale. The goodness-of-fit indices of the structural equation model showed how well the data from the K-HADS-A match their concept. The Kaiser-Meyer-Olkin value was 0.848, and the P value of Bartlett’s test of sphericity was < 0.001. Cronbach’s alpha was high at 0.872. The K-HADS-A had an acceptable level of validity and reliability. Postoperative quality of recovery was significantly lower in the anxious group (postoperative day 1: t = 2.058, P = 0.042; postoperative day 7: t = 3.430, P = 0.002). Conclusions The K-HADS-A is an acceptable tool for appropriately assessing preoperative anxiety in Korean surgical patients. Assessing preoperative anxiety is valuable, because preoperative anxiety affects the postoperative quality of mental and physical recovery.

PURPOSE: We compared the therapeutic efficacy of lamivudine and alpha-interferon in children with chronic hepatitis B two years after the initiation of treatment, so that we could verify the safety and long term efficacy of lamivudine in children. METHODS: We prospectively studied 44 children(32 male and 12 female; age, 1-18 years, mean, 9 years) treated for chronic hepatitis B from September 1996 to June 2004 in Kyungpook National University Hospital in Korea. Twenty three children were treated with interferon, and 21 with lamivudine. Treatment efficacy was defined as the normalization of ALT and hepatitis B virus(HBV) DNA levels, loss of HBsAg and HBeAg seroconversion at two years after the initiation of treatment. RESULTS: Among the 23 children treated with interferon, the ALT level normalized in 10 children(43 %) and HBV DNA was undetectable in 12 children(52%). HBsAg was undetectable in one child (4 %) and HBeAg seroconversion occurred in nine children(39%) two years after the initiation of treatment. In comparison, among the 21 children treated with lamivudine, ALT normalized in 20 children (95%), HBV DNA in 19(90%), HBsAg in 5(24%), and HBeAg seroconversion occurred in 13(62%). Above all, in the lamivudine treated group under the age of seven, HBeAg and HBsAg seroconversion occurred in six(75%) and five(63%) out of the eight children respectively, which showed superior HBsAg seroconversion rate if treated in preschool aged children. CONCLUSION: We believe that the therapeutic efficacy of lamivudine in children with chronic hepatitis B could be better than interferon with fewer side effects, especially in preschool aged children.
Child* ; DNA ; Female ; Gyeongsangbuk-do ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-alpha* ; Interferons ; Korea ; Lamivudine* ; Male ; Prospective Studies ; Treatment Outcome

PURPOSE : Weight loss and malnutrition in patients undergoing radiation therapy for lung cancer are common problems. We evaluated the effect of nutritional support with administering oral high calorie, high protein liquid, Mediwell ProteinTM. MATERIALS AND METHODS : From Feb. 2007 to Aug. 2008, 21 patients with lung cancer received nutritional supplement for 4 weeks with Mediwell StandardTM (n=10) or higher protein liquid, Mediwell ProteinTM (n=11). Their nutritional statues were evaluated just before radiation therapy and after 4 weeks. RESULTS : Nutritional support with oral high calorie, high protein liquid, Mediwell ProteinTM, showed improvement of the nutritional status during radiation therapy for lung cancer, even though it was not statistically significant. CONCLUSION : Nutritional support with oral high calorie, high protein liquid was effective for maintaining the nutritional status of patients with lung cancer during radiation therapy
Humans ; Lung ; Lung Neoplasms ; Malnutrition ; Nutritional Status ; Nutritional Support ; Weight Loss

Multiple primary malignant neoplasms (MPMN) are defined by the presence of multiple primary cancers of multicentric origin and/or different tissues. The incidence of MPMN is less than 1% in Korea and recently seems to be increased due to early detection of cancer and prolonged survival of cancer patients. Previous investigations suggest that non-Hodgkin's lymphoma (NHL) may be associated with chronic liver disease and hepatocellular carcinoma (HCC). The pathogenesis of this association is thought to be due to chronic antigenic stimulation, the presence of HBsAg, and immunosuppressive therapy. We report a case of synchronous NHL and HCC in a 54-year-old man which is thought to be associated with hepatitis B virus infection. Pathological examination and immunohistochemical study of neck lymph node and liver mass biopsies showed diffuse large cell lymphoma and HCC, respectively. He was treated initially with EPOCH (etoposide, vincristine, doxorubicin, cyclophosphamide and prednisolone) chemotherapy for NHL and transarterial chemoembolization with doxorubicin, mitomycin-c, lipiodol, and gelfoam for HCC.
Biopsy ; Carcinoma, Hepatocellular* ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Early Detection of Cancer ; Ethiodized Oil ; Gelatin Sponge, Absorbable ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Incidence ; Korea ; Liver ; Liver Diseases ; Lymph Nodes ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin* ; Middle Aged ; Mitomycin ; Neck ; Vincristine

PURPOSE: The aim of this study was to compare the distribution and risk from hand positions applied at the center of the chest (CoC) versus the inter-nipple line (INL) during external chest compression by novice rescuers. METHODS: This simulation study included 105 participants. The participants were given photographs of the unexposed male chest and asked to mark a cross at the center of the chest and at the midpoint of the inter-nipple line. The range of contact with the chest was estimated by measuring the participants' palm width. The median and distribution of the two points were then compared and analyzed to determine whether the range in contact with the chest involved the xiphoid process. RESULTS: The level of the INL was approximately 0.8 cm higher at the sternum than the CoC (p<0.001), while the standard deviation of the CoC [1.8(0.6-3.8)] was higher than that of the INL [1.2(0.4-2.4)] (p<0.001). There were more cases in which the palm range involved the xiphoid process in the CoC group [15(14.3%)] than the INL group [1(0.9%)] (p<0.001). CONCLUSION: For male adult patients, chest compression at the level of the INL by novice rescuers is safer and more intensive than compression at the level of the CoC.
Adult ; Cardiopulmonary Resuscitation ; Hand ; Heart Massage ; Humans ; Male ; Nipples ; Sternum ; Thorax* ; Xiphoid Bone

STUDY DESIGN: Literature review. OBJECTIVES: To present updated information on the relationship of the pelvis and lumbar degenerative disease (LDD) patients and to emphasize the importance of the pelvis in sagittal alignment of LDD patients. SUMMARY OF LITERATURE REVIEW: Although the relationship of the pelvis and sagittal alignment of LDD patients is controversial, many authors have reported a significant impact of the pelvis on LDD sagittal alignment. MATERIALS AND METHODS: The authors identified references through a literature search on the pelvis and LDD and continuous monitoring of the literature during the past 30 years. RESULTS: The pelvis and lumbar levels were related to whole-body sagittal alignment. The pelvis is also closely related to sagittal alignment of LDD patients. Therefore, the entire area should be regarded as a lumbopelvic complex. CONCLUSIONS: We need to consider the concept of a lumbopelvic joint and lumbopelvic lordosis, not a lumbosacral joint and lumbar lordosis. We must also evaluate the lumbopelvic complex to assess whole-body sagittal alignment and dynamic balance.
Animals ; Humans ; Joints ; Lordosis ; Pelvis*

PURPOSE: To assess the usefulness of (99m)Tc-DISIDA scanning in the early evaluation of neonatal cholestasis and to verify the diagnostic value of this test in the differential diagnosis of biliary atresia. METHODS: DISIDA scannings were performed and analyzed in 87 children(58 males and 29 females; age, 18-139 days, mean, 59.1 days) with neonatal cholestasis. Five groups according to the final diagnosis and the results of DISIDA scanning were analyzed by scatter plots using the parameters of age and the level of liver function tests(direct bilirubin, AST, ALT, ALP, GGT). The diagnostic sensitivity, specificity and accuracy of DISIDA scanning in the diagnosis of biliary atresia were compared between a higher bilirubin group and a lower bilirubin group(direct bilirubin level >5 mg/dL vs. <5 mg/dL) decided by the pattern of scatter plots. RESULTS: DISIDA scannings in the diagnosis of biliary atresia were analyzed by high sensitivity(100 percent, 16/16) but lower specificity(70.4 percent, 50/71) and accuracy(75.9 percent, 66/87). False positivity(29.6 percent, 21/71) was higher in patients with a higher direct bilirubin level(42.5 percent for >5 mg/dL vs. 9.7 percent for <5 mg/dL, P<0.01). The age and the level of liver function tests(AST, ALT, ALP, GGT) analyzed by scatter plots revealed neither diagnostic value in predicting final diagnosis nor estimated the accuracy rate of DISIDA scanning in the evaluation of neonatal cholestasis. CONCLUSION: We suggest that DISIDA scannings should not be routinely used in evaluating neonatal cholestasis with elevated direct bilirubin level(>5 mg/dL), especially if it delays early diagnosis and surgical intervention.
Biliary Atresia ; Bilirubin ; Cholestasis* ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Female ; Hepatitis ; Humans ; Infant, Newborn ; Liver ; Male ; Sensitivity and Specificity

Meningeal carcinomatosis in patients with prostate cancer is very rare. Recently, we experienced a case of meningeal carcinomatosis in a patient with prostate cancer. He had undergone a radical prostatectomy 11 years before presentation and had undergone chemotherapy 4 years before presentation due to bone metastases. This time, he visited the emergency department because of a seizure. Although cerebrospinal fluid (CSF) examinations did not reveal malignant cells, we diagnosed meningeal carcinomatosis based on positive CSF prostate-specific antigen and magnetic resonance imaging (MRI) findings. The diagnosis was confirmed pathologically. We treated the patient with whole brain radiotherapy and intrathecal chemotherapy. We report a case of prostate cancer with meningeal carcinomatosis with a literature review.
Brain ; Emergencies ; Humans ; Magnetic Resonance Imaging ; Meningeal Carcinomatosis ; Neoplasm Metastasis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Seizures