BACKGROUND: Acute idiopathic thrombocytopenic purpura(ITP) in children has a low morbidity and mortality, and most of cases are self limited illness. But some of them are not responsive to treatment and finally progress to chronic disease. The purpose of this study is to evaluate the factors which influence the outcome in childhood idiopathic thrombocytopenic purpura. METHOD: From January 1990 to December 1995, patients with ITP who were admitted to the Pediatric department of Pusan National University Hospital were divided into acute and chronic form depending on whether the platelet count had returned to normal(150 x 10(9)/1) by six months after diagnosis. Between two groups, the clinical and laboratory characteristics, response to treatment were compared. RESULT: 1) Out of 55 patients with ITP, 36 cases(65.5%) were acute and 19 cases(34.5%) were chronic ITP. 2) Sex, previous viral infection history, clinical manifestations were not significantly different between two groups, but the chronic ITP was rare in less than 1 year of age. 3) The duration of symptoms over >2 weeks at presentation was strongly predictive of chronic ITP. 4) Most of chronic disease (87.5%) showed platelet counts below 150 x 10(9)/1 at 28 days after diagnosis as compared with acute disease(25.0%). 5) Among 19 cases of chronic disease, 6 cases responded completely to treatment, but 11 cases(57.9%) did not respond to any treatments, 2 cases improved spontaneously. CONCLUSION: A history of symptoms over 2 weeks at presentation and platelet counts below 150 x 10(9)/1 at 28 days after diagnosis were strong predictors of chronic ITP in children.
Busan ; Child ; Chronic Disease ; Diagnosis ; Humans ; Mortality ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic*

Atrial septal defect is one of the most common congenital heart diseases in adult, of which absolute causes is not confirmed, but explained by multifactorial inheritance. In Korea, there has been no case report of atrial septal defect in identical twins in spite of some reports of atrial septal defect in relatives and twins in other countries. We present a first case of atrial septal defect in identical twins whose mother had no infection or medication history during pregnancy.
Adult ; Heart Diseases ; Heart Septal Defects, Atrial* ; Humans ; Korea ; Mothers ; Multifactorial Inheritance ; Pregnancy ; Twins ; Twins, Monozygotic*

The authors accessed the effects of heart rate and age to echocardiographic right ventricular systolic time intervals in 27 cases with normal pulmonary artery pressure and correlation of pulmonary hemodynamic parameters with echocardiographic right ventricular systolic time intervals in 76 cases with congenital and acquired valvular heart diseases. The results were as follows; 1) As heart rate increased there was a diminution of the length of right ventricular ejection time(RVET)(r=0.642), but no significant changes in the length of right ventricular pre-ejection period(RVPEP) and the ratio of RVPEP/RVET were found. 2) As age increased there was an increase in the ratio of RVPEP/RVET(r=0.46), but no significant changes in the length of RVPEP and RVEF were found. 3) In patients with the RVPEP/RVET of 0.3 or more this ratio can predict that pulmonary artery systolic pressure is >30mmHg(sensitivity : 83%, specificity : 96%, accuracy 88%), pulmonary artery mean pressure >20mmHg(sensitivity : 87%, specificity : 96%, accuracy 90%), and pulmonary artery diastolic pressure >15mmHg(sensitivity : 86%, specificity : 90%, accuracy : 88%). 4) In patients with the RVPEP/RVET of 0.4 or more this ratio can predict that pulmonary artery systolic pressure is >50 mmHg(sensitivity : 75%, specificity : 98%, accuracy : 92%), pulmonary artery mean pressure >40mmhg(sensitivity : 93%, specificity : 96%, accuracy : 96%), pulmonary artery diastolic pressure >25mmHg(sensitivity : 75%, specificity : 98%, accuracy : 92%), pulmonary vascular resistance >6 units(sensitivity : 70%, specificity : 96%, accuracy : 89%), and Rp/Rs >0.25(sensitivity : 86%, specificity : 95%, accuracy : 93%). In conclusion, pulmonary hypertension, increased pulmonary vascular resistance and pulmonary arteriolar obstructive disease can be predicted by echocardiographic measurement of RVPEP/RVET.
Blood Pressure ; Echocardiography* ; Heart Rate ; Heart Valve Diseases ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Pulmonary Artery* ; Sensitivity and Specificity ; Systole ; Vascular Resistance*

Reconstruction of a injured digit needs good aesthetic result as well as functional recovery. Since Honda deported the first clinical application in 1984, the venous flap has been used increasingly for skin and soft tissue defects of the fingers and hands. From november 1992 to december 1995, 12 single-pedicled venous island flaps from hand dorsum were used for coverage of soft tissue defects of fingers over exposed bone, tendon, or joint. The pedicle of the flap included one superfitial dorsal vein of hand and its perivenous areolar tissue. Eight of twelve flaps survived completely and four necrosed partially possibly due to excessively long pedicle and poor perivenous areolar tissue. All donor sites were closed directly. Most patients were satisfied with postoperative result cosmetically and functionally. This method has several advantages : easy versatility and operability with superficial location of numerous dorsal vein, making good contour owing to proper thickness of flap, minimal donor site morbidity, and short operation time. We consider that the pedicled venous island flap is another reliable and useful method for reconstruction or finger defects as long as the pedicle length is not long and the perivenous areolar tissue is enough.
Fingers* ; Hand ; Humans ; Joints ; Skin ; Surgical Flaps ; Tendons ; Tissue Donors ; Veins

No abstract available.
Conjunctiva* ; Melanoma*

PURPOSE: Mycoplasma pneumoniae is a common cause of lower respiratory disease, especially in children and young adults. The diagnosis, in most cases, is confirmed by serology. M. pneumoniae is difficult to culture because of its fastidious nature, and growth is too slow for diagnostic use. In this prospective study, the sensitivity and specificity of the PCR assay was evaluated with clinical samples. METHODS: We compared the nested PCR test with serological findings for detection of M. pneumoniae in clinical samples(sputum or throat swabs), obtained from 58 pneumonic children who were admitted to the pediatric department of Chungnam National University Hospital between February and September, 1997. RESULTS: Among 28 mycoplasma antibody positive cases, the number of positive cases of cold agglutinin test were 20. So sensitivity and specificity of cold agglutinin test were 71.4% and 80.0%. Positive predictive value and negative predictive value of cold agglutinin test were of 76.9% and 75.0%. Among 28 mycoplasma antibody positive cases, the number of positive cases of M. pneumoniae nested PCR were 26 cases. So sensitivity and specificity of M. pneumoniae nested PCR were of 92.8% and 100.0%. Positive predictive value and negative predictive value were of 100.0% and 93.7%. Four cases showing negative antibody, in acute phase serum and positive in convalescent, revealed positive for nested PCR test. CONCLUSION: It is concluded that nested PCR assay is a highly sensitive, specific test and is fast enough to allow for the early application of therapy with specific antibiotics.
Anti-Bacterial Agents ; Child ; Chungcheongnam-do ; Diagnosis* ; Humans ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pharynx ; Pneumonia* ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction* ; Prospective Studies ; Sensitivity and Specificity ; Young Adult

No abstract available.
Humans ; Hyperbilirubinemia, Hereditary* ; Siblings*

No abstract available.
Salivary Glands*

Replantation of a severed limb is an elective procedure and, as such, the decision to carry it out must be assessed anew in each case. The arm is progressively more valuable from shoulder to fingers, the leg, on the contrary, is progressively of less significance. Especially, the replantation of severed hand at the level of carpal bones or wrist joint is technically more difficult than at the level of forearm or arm. We have a successful case of replanted hand at the level of intercarpal joint without bony shortening.
Arm ; Carpal Bones ; Carpal Joints ; Extremities ; Fingers ; Forearm ; Hand ; Leg ; Microsurgery ; Replantation ; Shoulder ; Wrist Joint

BACKGROUND: Epidural and intravenous administration of opioids had been commonly used for postoperative pain management in thoracoscopic surgery. Recently, interpleural analgesia was frequently used. The aim of this study was to compare the effect of an intravenous continuous infusion of fentanyl (F-IV) with interpleural bupivacaine (B-IP) using a continuous infusion system in the management of post-thoracoscopic pain. METHODS: An interpleural continuous infusion of bupivacaine (B-IP group: basal infusion 7(ng/kg/min) was compared with an intravenous continuous infusion of fentanyl (F-IV group: basal infusion 0.33ng/ kg/hr) in forty patients who had undergone elective thoracoscopic surgery. During the postoperative 48 hours, the visual analogue scale (VAS), Prince-Henry score (PHS), heart rate, respiratory rate and peripheral oxygen saturation were measured. RESULTS: The postoperative heart rate in both groups was significantly higher than the preoperative value (P < 0.05 1 h and 4 h after operation), but there were no differences in the respiratory rate and peripheral oxygen saturation between the two groups. There were significant improvement of the degree of pain in VAS and PHS after administration of the analgesic, but there was no significant differences in the two groups during 48 hours. The incidence of adverse effects such as nausea, vomiting, dizziness, urinary difficulty and respiratory depression was higher in the F-IV than the B-IP group. CONCLUSIONS: The interpleural continuous infusion of local anesthetics and intravenous continuous infusion of fentanyl provided effective analgesia in this study. The side effects were significantly lower in the interpleural continuous infusion of local anesthetics than intravenous continuous infusion of fentanyl. Therefore, interpleural continuous infusion of local anesthetics could be a useful alternative for postoperative analgesia after thoracoscopic surgery.
Administration, Intravenous ; Analgesia ; Analgesics, Opioid ; Anesthetics, Local ; Bupivacaine* ; Dizziness ; Fentanyl* ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Interpleural Analgesia ; Nausea ; Oxygen ; Pain, Postoperative ; Respiratory Insufficiency ; Respiratory Rate ; Thoracoscopy* ; Vomiting