Infarction is an uncommon occurrence in healthy young patients. Despite the lower mortality rate of infarction in the pediatric patients, there is a high social impact of the disease. Recent years are represented by the increased attention that is placed on detecting risk factors of infarction. Patent foramen ovale (PFO) is attributable to the important risk factor that has been associated with cerebral infarction of unknown etiology or cryptogenic infarction. Since the treatment to prevent recurrence in infarction is percutaneous closure with permanently implanted closure devices. We present a case of fifteen-year-old male who admitted to hospital after he had paresthesia and hemiparesis. His physical, cardiologic and neurologic examinations were normal, except for the left hemiparesis and left finger paresthesia. On admission, magnetic resonance imaging and magnetic resonance imaging spectroscopy revealed multifocal hyperintense lesions consistent with acute ischemic events. Further evaluation with an aim to define the cause of infarction revealed a PFO with right-to-left shunt. He was underwent closure of the PFO using the Amplatzer occluder(R). Since one year after procedure, the patient has been visiting the out-patient department without recurrence of neurologic or cardiologic events.
Cerebral Infarction* ; Fingers ; Foramen Ovale, Patent* ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male* ; Mortality ; Neurologic Examination ; Outpatients ; Paresis ; Paresthesia ; Recurrence ; Risk Factors ; Social Change ; Spectrum Analysis

Osteopetrosis or albers-Schonberg disease is extremely rare disease. It is characterized by osteoporosis, stunted growth, deformity, increased likelihood of fractures, also patients suffers anemia, recurrent infections and hepatosplenomegaly. However, we recently came upon a 14-month-old female as the 1st child of osteopetrosis with hydrocephalus and rickets. She has the typical symptoms such as nystagmus, osteosclerosis -especially in skull. Brain Magnetic Resonance Imaging (MRI), MRI shows hydrocephalus and x-ray finding are consistent with rickets. This is the first report of osteopetrosis with hydrocephalus and rickets in Korea by pediatrician.
Anemia ; Brain ; Child ; Congenital Abnormalities ; Female ; Humans ; Hydrocephalus* ; Infant ; Korea ; Magnetic Resonance Imaging ; Osteopetrosis* ; Osteoporosis ; Osteosclerosis ; Rare Diseases ; Rickets* ; Skull

PURPOSE: This study investigated the prevalence of islet autoantibodies in children and adults with T1DM according to their age and the duration of disease. METHODS: We measured the levels of islet autoantibodies, including antiglutamic acid decarboxylase antibody (anti-GAD Ab), and combined these with anthropometric measurements and laboratory tests of 137 patients newly diagnosed with T1DM during the last 20 years. The subjects were subdivided into four groups according to their age at the onset of the disease. We then compared the prevalence of islet autoantibodies in the different age groups with the duration of disease. RESULTS: Among the 137 patients, 68.9% tested positive for islet autoantibodies (71.4% within 1 year; 67.7% after 1 year of the disease onset). Within 1 year of the onset of the disease, 66.3% of the patients were positive for the anti-GAD Ab, and 35.6% were positive for IAAs. The prevalence of islet autoantibodies was significantly higher in the prepubertal groups than in the postpubertal groups (80.0% vs. 58.3%). The rate of positive islet autoantibodies changed with the duration of disease, and it differed according to the type of autoantibody and the age of the patient. CONCLUSION: The rates of positive islet autoantibodies were significantly higher in younger than in older patients at the time of the diagnosis of the disease. The positive rates were significantly changed 1 year after the onset of the disease in the preschool and the children groups. So these findings suggest that we need to diagnose type 1B diabetes distinguished T2DM in aldolescent group, carefully.
Adult ; Autoantibodies ; Child ; Diabetes Mellitus, Type 1 ; Glutamate Decarboxylase ; Humans ; Prevalence

PURPOSE: This study investigated the prevalence of islet autoantibodies in children and adults with T1DM according to their age and the duration of disease. METHODS: We measured the levels of islet autoantibodies, including antiglutamic acid decarboxylase antibody (anti-GAD Ab), and combined these with anthropometric measurements and laboratory tests of 137 patients newly diagnosed with T1DM during the last 20 years. The subjects were subdivided into four groups according to their age at the onset of the disease. We then compared the prevalence of islet autoantibodies in the different age groups with the duration of disease. RESULTS: Among the 137 patients, 68.9% tested positive for islet autoantibodies (71.4% within 1 year; 67.7% after 1 year of the disease onset). Within 1 year of the onset of the disease, 66.3% of the patients were positive for the anti-GAD Ab, and 35.6% were positive for IAAs. The prevalence of islet autoantibodies was significantly higher in the prepubertal groups than in the postpubertal groups (80.0% vs. 58.3%). The rate of positive islet autoantibodies changed with the duration of disease, and it differed according to the type of autoantibody and the age of the patient. CONCLUSION: The rates of positive islet autoantibodies were significantly higher in younger than in older patients at the time of the diagnosis of the disease. The positive rates were significantly changed 1 year after the onset of the disease in the preschool and the children groups. So these findings suggest that we need to diagnose type 1B diabetes distinguished T2DM in aldolescent group, carefully.
Adult ; Autoantibodies ; Child ; Diabetes Mellitus, Type 1 ; Glutamate Decarboxylase ; Humans ; Prevalence

BACKGROUND AND PURPOSE: The susceptibility-weighted imaging form of brain MRI using minimum intensity projection (mIP) is useful for assessing traumatic brain injuries because it readily reveals deoxyhemoglobin or paramagnetic compounds. We investigated the efficacy of using this methodology in nontraumatic patients. METHODS: We retrospectively analyzed the asymmetric mIP findings in nontraumatic patients. Asymmetric mIP images were first verified visually and then using ImageJ software. We enrolled patients with a difference of >5% between hemispheres in ImageJ analysis. All patients underwent detailed history-taking and EEG, and asymmetric mIP findings were compared. RESULTS: The visual analysis identified 54 pediatric patients (37 males and 17 females) with asymmetric mIP findings. Ten patients were excluded because they did not meet the ImageJ verification criteria. The 44 patients with asymmetry comprised 36 with epilepsy, 6 with headache, and 2 with cerebral infarction. Thirty-one of the 36 epileptic patients showed definite partial seizure activities in semiology, while the remaining patients did not demonstrate a history of partial seizure manifestations. The MRI findings were normal in all patients except for five with periventricular leukomalacia unrelated to seizure symptoms. There was agreement between mIP images and semiology in 29 (93.5%) of the 31 epileptic patients with focal signs, while the other 2 demonstrated discordance. Twenty (64.5%) of the 31 patients showed consistent EEG abnormalities. CONCLUSIONS: Our data suggest that asymmetric mIP findings are an excellent lateralizing indicator in pediatric patients with partial epilepsy.
Brain Injuries ; Brain ; Cerebral Infarction ; Child ; Electroencephalography ; Epilepsies, Partial ; Epilepsy ; Headache ; Humans ; Infant, Newborn ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Seizures

Background: and Purpose The purpose of this study was to determine the effect of fludrocortisone in patients with pediatric vasovagal syncope (VVS). Methods: This retrospective observational single-tertiary-center study based on chart reviews included 74 patients who were newly diagnosed with VVS in the head-up tilt-table test (HUTT). Some of the patients had been treated with fludrocortisone. All patients were assessed using a brain and cardiac workup before treatment to rule out the syncope being due to other causes, which resulted in seven of them being excluded: two for epilepsy and five for brain pathologies. The remaining 67 patients were analyzed. The effect of fludrocortisone was evaluated based on the results of a follow-up HUTT, with a response to the treatment considered to be present if there was a negative change at the follow-up HUTT. Univariate logistic regression were used for statistical analyses, with the criterion for significance being p<0.05. Results: There were no significant differences in the characteristic of the patients between the no-medication (n=39) and fludrocortisone (n=28) groups, including age, sex, and duration of treatment. The recurrence rate of syncopal or presyncopal events was significantly lower in the fludrocortisone group (39.3%, 11 of 28) than in the no-medication group (64.1%, 25 of 39) (p=0.044), as was the rate of negative change at the follow-up HUTT: 57.1% (16 of 28) and 28.2% (11 of 39), respectively (p=0.017). Conclusions Our findings suggest that fludrocortisone is more effective than no medication in pediatric patients with VVS.

We report a case of perforated jejunal diverticulitis in a 68-year-old man with iatrogenic Cushing's syndrome. The patient presented with right upper abdominal pain. Ultrasonography showed a hypoechoic structure connected to a small bowel loop, and subsequent CT examination showed multiple diverticula in proximal jejunal loops with free air trapped within the mesenteric leaf. Segmental resection of the jejunal loop confirmed jejunal diverticulitis with perforation.
Abdominal Pain ; Aged ; Cushing Syndrome ; Diverticulitis* ; Diverticulum ; Humans ; Ultrasonography

PURPOSE: Continuous intravenous access is imperative in emergency situations. Ultrasound-guided internal jugular vein (IJV) catheterization was investigated in critically ill pediatric patients to assess the feasibility of the procedure. METHODS: Patients admitted to the pediatric intensive care unit between February 2011 and September 2012 were enrolled in this study. All patients received a central venous catheter from attending house staff under ultrasound guidance. Outcome measures included successful insertion of the catheter, cannulation time, number of cannulation attempts, and number and type of resulting complications. RESULTS: Forty-one central venous catheters (93.2%) were successfully inserted into 44 patients (21 males and 23 females; mean age, 6.54+/-1.06 years). Thirty-three patients (75.0%) had neurological disorders. The right IJV was used for catheter insertion in 34 cases (82.9%). The mean number of cannulation attempts and the mean cannulation time was 1.57+/-0.34 and 14.07+/-1.91 minutes, respectively, the mean catheter dwell time was 14.73+/-2.5 days. Accidental catheter removal was observed in 9 patients (22.0%). Six patients (13.6%) reported complications, the most serious being catheter-related sepsis, which affected 1 patient (2.3%). Other complications included 2 reported cases of catheter malposition (4.6%), and 1 case each of arterial puncture (2.3%), pneumothorax (2.3%), and skin infection (2.3%). CONCLUSION: The results suggest that ultrasound-guided IJV catheterization can be performed easily and without any serious complications in pediatric patients, even when performed by visiting house staff. Therefore, ultrasound-guided IJV catheterization is strongly recommended for critically ill pediatric patients.
Catheterization* ; Catheters* ; Central Venous Catheters ; Child ; Critical Illness* ; Emergencies ; Female ; Humans ; Intensive Care Units ; Internship and Residency ; Jugular Veins* ; Male ; Nervous System Diseases ; Outcome Assessment (Health Care) ; Pneumothorax ; Punctures ; Sepsis ; Skin ; Ultrasonography

PURPOSE: Pulmonary hypertension is a known risk factor for mortality in preterm infants with bronchopulmonary dysplasia. However, mortality in patients with bronchopulmonary dysplasia and congenital heart disease has been poorly investigated. Therefore, we conducted an investigation into the mortality and risk factors in these patients. METHODS: We reviewed the records of 45 preterm infants who were diagnosed with bronchopulmonary dysplasia and congenital heart disease from 2010 to 2013. Their survival was compared with that of a group of control individuals who did not have congenital heart disease. A variety of factors associated with survival were examined. RESULTS: Although initial pulmonary hypertension was more frequent in the patient group, no significant differences were found between the patients and the control subjects with respect to cumulative mortality. The log-rank test indicated that many factors, including follow-up pulmonary hypertension, the use of pulmonary vasodilators, and aggravated oxygen demand, but not the congenital heart disease type, impacted upon survival in the patient group. Aggravated oxygen demand was the only factor that was determined to be associated with mortality in the multivariate analysis. CONCLUSION: There was no significant difference between the patient and the control groups with respect to cumulative survival. Of the three factors that affected survival within the patient group, aggravated oxygen demand was the only risk factor that was associated with mortality.
Bronchopulmonary Dysplasia* ; Follow-Up Studies ; Heart Defects, Congenital* ; Humans ; Hypertension, Pulmonary ; Infant* ; Infant, Newborn ; Infant, Premature ; Mortality ; Multivariate Analysis ; Oxygen ; Risk Factors ; Vasodilator Agents

A santorinicele is a cystic dilatation of the dorsal pancreatic duct at the minor papilla, and has been reported in patients with pancreas divisum and pancreatitis. Santorinicele without pancreas divisum is extremely rare, with only one case being previously reported. We present here a case of santorinicele that was observed as a cystic dilatation of the distal dorsal pancreatic duct at MCDT, and had communication between the ventral and dorsal pancreatic ducts. Additionally, MRCP and ERCP firmly confirmed the presence of a santorinicele.
Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis* ; Dilatation ; Humans ; Pancreas* ; Pancreatic Ducts ; Pancreatitis