PURPOSE: We compared the clinical manifestations of patients with tsutsugamushi disease between children and adults. METHODS: From January 2003 to December 2012, 768 patients diagnosed with tsutsugamushi disease were retrospectively reviewed, and the clinical characteristics, laboratory findings, and complications were compared between children and adults. RESULTS: No patterns of annual increases in the number of patients were noted in both children and adults. The higher incidences occurred in October and November respectively. By gender, male outnumbered female in children, but the opposite trend was seen in adults. By residential area, the urban distribution of children was higher than that of adults. Rashes (P=0.001) and eschar (P=0.004) were more common in children, while myalgia was more common in adults. Children had a high prevalence of anemia (P=0.041), and low incidence rates of thrombocytopenia, abnormal liver and renal function. Children yielded better results in the duration of their hospital stay and the incidence of complications (P<0.001). A comparison of the therapeutic effects of doxycycline and macrolide antibiotics, which was performed only on the children, did not reveal any significant differences. CONCLUSION: Compared to adults, children had higher incidence rates of male patients and more often suffered from rashes and eschar. Children yielded better results in the laboratory findings and duration of the hospital stay and complications. Therefore, when children are suspected to have tsutsugamushi disease, especially during its peak occurrence period, detailed physical examination and serological test should be performed to ensure a prompt diagnosis, and the use of macrolide antibiotics, which have fewer side effects, is expected to yield the same therapeutic effects.
Adult* ; Anemia ; Anti-Bacterial Agents ; Child* ; Diagnosis ; Doxycycline ; Exanthema ; Female ; Humans ; Incidence ; Length of Stay ; Liver ; Male ; Myalgia ; Physical Examination ; Prevalence ; Retrospective Studies ; Scrub Typhus* ; Serologic Tests ; Thrombocytopenia

PURPOSE: Nowadays, concern about the care of one's offspring has been increasing due to increased active participation of wornen in society and having fewer children than in the past. Therefore, we performed a study to evaluate the rnajor fields of child care counselling and establish effective child care counselling. METHODS: We retrospectively analyzed 2,754 cases of child care counselling about sex ratio, distribution of age, major fields of concern and major questions of each field using personal computer communication from April 1994 to March 1999. RESULTS: Sex distribution was usually unknown. The most frequent questions concerned the infantile period, especially less than 6 months of age. Nutrition, digestive system, development and psychology were the major fields of child care counsellng. CONCLUSION: We conclude that the major period of child care counselling was during the infantile period, and there was a major concern about nutrition, development and psychology. But, more efforts and studies are needed to establish effective child care counselling.
Child ; Child Care* ; Child* ; Digestive System ; Humans ; Microcomputers* ; Psychology ; Retrospective Studies ; Sex Distribution ; Sex Ratio

Serial neurosonographic examinations are routinely performed at frequent intervals during nursery course of all preterm infants of very low-birth-weight who are admitted to the intensive care nursery of Presbyterian Medical Center from November 1, 1990 to July 30, 1992. After discharge, the following survivors who had received periodic, serial scanning by meas of cranial ultrasonography were longitudinally observed in an interdisciplinary neurodevelopmental follow-up program to a mean corrected age of 13 months. Neurodevelopmental outcome was assessed by means of Vojta's postural reaction and other neurological examinations. The results are as follows: 1) The incidence of PV-IVH in the study was 79%. 2) According to Papile's grading system of PV-IVH, gradel was 20%, gradell was 46%, gradelll was 19%, and grade IV was 13%. 3) The risk factors associated with PV-IVH were birth weight, gestational age, apgar score, ventilator care, RDS, and sepsis. 4) The mortality of PV-IVH was 20% for gradel, 19% for gradell, 44% for gradelll, and 67% for grade lV. 5) According to relationship between PV-IVH and neurodevelopmental outcome, in two of the four subjects with grade lll PV-IVH, moderate/severe CCD was developed. 6) According to relationship between PVE with cysts and nuerodevelopmental outcome, moderate/severe PVE with periventricular cysts larger than 3mm in diameter was associated with development of severe CCD.
Apgar Score ; Birth Weight ; Follow-Up Studies ; Gestational Age ; Hemorrhage* ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature* ; Critical Care ; Mortality ; Neurologic Examination ; Nurseries ; Protestantism ; Risk Factors ; Sepsis ; Survivors ; Ultrasonography ; Ventilators, Mechanical

No abstract available.

Cerebral amyloid angiopathy (C.A.A) is characterized by the extracellular amyloid protein deposition in the vessel walls of the brain and meninges. It has been estimated to account for 5 to 10% of all primary, nontraumatic brain hemorrhage. We report two cases of C.A.A causing nontraumatic intracerebral hemorrhage in the frontal lobe. The first case was a 60-year-old female who was admitted for the left hemiplegia and dysarthralgia. Brain CT revealed right frontal lobe hemorrhage. The second case was a 72-year-old male who was admitted for amnesia and gait disturbance. Clinical impression was Alzheimer's disease. Brain MRI revealed multifocal small hemorrhage in the right frontal lobe. Microscopically, both cases showed dilated small arteries of superficial cortex and meninges with hyalinization. Some vessels showed microaneurysm and fibriniod necrosis. Congo-red stain also exhibited birefringence under polarized light. There was no evidence of Alzheimer's disease.
Aged ; Alzheimer Disease ; Amnesia ; Amyloid ; Arteries ; Birefringence ; Brain ; Cerebral Amyloid Angiopathy* ; Cerebral Hemorrhage ; Female ; Frontal Lobe ; Gait ; Hemiplegia ; Hemorrhage ; Humans ; Hyalin ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Male ; Meninges ; Middle Aged ; Necrosis

PURPOSE: Our goals were to determine the frequency of headaches and backaches occurring as a side effect following lumbar puncture in children, and to investigate various factors that might influence the frequency of headaches and backaches. METHODS: From October 2004 to February 2006, we enrolled 148 patients aged 2 to 15 years who received diagnostic lumbar puncture at the Presbyterian Medical Center, Chonju, Korea. Patient data were collected for age, sex, number of puncture attempts, volume of cerebrospinal fluid(CSF), bevel orientation of puncture needle, cell count in CSF, periods of absolute bed rest, and the frequency and duration of headaches and backaches. RESULTS: Headaches occurred in 8 patients and backaches occurred in 40 patients. Headaches were found both to occur significantly more frequently in patients over age 10 and to last longer when the bevel orientation of the puncture needle was inserted toward the cranium rather than laterally. Backaches lasted longer in males than in females. The other factors evaluated showed no relationship at all to the frequency and duration of headaches and backaches. CONCLUSION: Following lumbar puncture, headaches were common in patients over age 10, and lasted longer when the bevel orientation was toward the cranium. Backaches lasted longer in males than in females. In light of these findings, we recommend taking special care when performing lumbar puncture for CSF examination in patients over age 10.
Back Pain* ; Bed Rest ; Cell Count ; Child* ; Female ; Headache* ; Humans ; Jeollabuk-do ; Korea ; Male ; Needles ; Protestantism ; Punctures ; Skull ; Spinal Puncture*

The effects of epidural fentanyl in combination with 0.5% bupivacaine were observed in randomized 60 patients undergoing lower abdominal surgery. The time of onset, segmental spread and duration of analgesia, changes in arterial blood pressure and heart rate and the incidence of side effects were observed after epidural injection of the drugs. The patients were divided into three groups; Group I: 0.9% NaCl 2 ml combined with 20ml of 0.5% bupivacaine, Group II: 0.9% NaCl 1ml and fentanyl 50ug (1 ml) combined with 20 ml of 0.5% bupivacaine, Group III: fentanyl 100 ug (2ml) combined with 20 ml of 0.5% bupivacaine. The results were as follows. 1) The time of onset was significantly short in group III (P < 0.01) 2) The level of sensory blockade 30 minutes after epidural injection in group III was 2-3 segments higher than group I. 3) The mean duration of analgesia was significantly long in group III compared to groups I and II (P<0.01). 4) The cardiovascular changes were not significantly different among the patients of the three groups.6) The side effects including mild hypotension, nausea and vomiting, voiding difficulty, itching and backache were not significantly different in the occurrence among the patients of the three groups. From the above results, it is suggested that fentanyl 100ug combined with 0.5% bupivacaine for epidural anesthesia has some benefits in its onset, spread and postoperative analgesia.
Analgesia ; Anesthesia, Epidural ; Arterial Pressure ; Back Pain ; Bupivacaine* ; Fentanyl* ; Heart Rate ; Humans ; Hypotension ; Incidence ; Injections, Epidural ; Nausea ; Pruritus ; Vomiting

The effects of epidural fentanyl in combination with 0.5% bupivacaine were observed in randomized 60 patients undergoing lower abdominal surgery. The time of onset, segmental spread and duration of analgesia, changes in arterial blood pressure and heart rate and the incidence of side effects were observed after epidural injection of the drugs. The patients were divided into three groups; Group I: 0.9% NaCl 2 ml combined with 20ml of 0.5% bupivacaine, Group II: 0.9% NaCl 1ml and fentanyl 50ug (1 ml) combined with 20 ml of 0.5% bupivacaine, Group III: fentanyl 100 ug (2ml) combined with 20 ml of 0.5% bupivacaine. The results were as follows. 1) The time of onset was significantly short in group III (P < 0.01) 2) The level of sensory blockade 30 minutes after epidural injection in group III was 2-3 segments higher than group I. 3) The mean duration of analgesia was significantly long in group III compared to groups I and II (P<0.01). 4) The cardiovascular changes were not significantly different among the patients of the three groups.6) The side effects including mild hypotension, nausea and vomiting, voiding difficulty, itching and backache were not significantly different in the occurrence among the patients of the three groups. From the above results, it is suggested that fentanyl 100ug combined with 0.5% bupivacaine for epidural anesthesia has some benefits in its onset, spread and postoperative analgesia.
Analgesia ; Anesthesia, Epidural ; Arterial Pressure ; Back Pain ; Bupivacaine* ; Fentanyl* ; Heart Rate ; Humans ; Hypotension ; Incidence ; Injections, Epidural ; Nausea ; Pruritus ; Vomiting

PURPOSE: This study was launched to classify subjects of the CSF examination and improve early diagnosis of meningitis and its treatment in children who have had a first febrile seizure. METHODS: From March 1995 to September 2003, children aged 3 months to 5 years who had had treatment for febrile seizure were analyzed as to their age at first seizure, type of seizure, CSF examination, and prevalence of meningitis. RESULTS:The largest age group distribution among the 780 children was 356(45.6%) children who were under 18 months. One hundred ninteen(15.3%) patients received the CSF examination, and out of those 68(19.1%) were less than 18 months old. Twenty five(3.2%) children were diagnosed with meningitis; those less than 18 months old were 15(4.2%). Two(0.2%) were diagnosed as bacterial meningitis. Out of 780 patients 599(76.8%) were simple febrile seizure patients. Out of 32(5.3%) who received the CSF examination, nine were diagnosed as meningitis. In complex febrile seizure, 86(52.1 %) out of 165(21.2%) received CSF examinations and 16(9.7%) of those were diagnosed as meningitis. Thus, there was a higher prevalence of meningitis in children presenting complex febrile seizure. CONCLUSION: To diagnose meningitis with the CSF examination in the first febrile seizure, the patient's general condition, such as clinical symptoms and types of seizure, are more important than the ages of the patients. We suggest that experienced physicians should be concerned with doing an early diagnosis of meningitis and thus reduce the number of CSF examinations of children with febrile seizures.
Cerebrospinal Fluid ; Child ; Early Diagnosis ; Humans ; Infant ; Meningitis ; Meningitis, Bacterial ; Prevalence ; Seizures ; Seizures, Febrile*

PURPOSE:The purpose of this study was to identify useful predictors for diagnosing bacterial meningitis and performing CSF studies in febrile infants three months or younger. METHODS:Six hundred and fifty two febrile infants with a rectal temperature > or =38.0 degreesC presented from January 2003 to April 2008 and were retrospectively studied. The total white blood cell count (WBC), band count, absolute neutrophil count (ANC), quantitative C-reactive protein (CRP) and blood cultures were performed on admission. The clinical variables associated with bacterial meningitis were analyzed. RESULTS:In patients with bacterial meningitis, the clinical variables including CRP (P= 0.036), band count (P=0.037), ANC (P=0.036) and age (P=0.001) were significantly different. The area under the receiver-operating characteristic curve was 0.969 for CRP, 0.946 for the band count, 0.765 for the ANC and 0.235 for age. A CRP cutoff point of 8 mg/dL was determined to maximize both the sensitivity and specificity (sensitivity 83%, specificity 95%, likelihood ratio 16.6). A CRP concentration of <7 mg/dL "ruled-out" bacterial meningitis, with a likelihood ratio of 0.17, a posttest probability of <0.1% and negative predictive value 91%. A CRP concentration greater than 9 mg/dL had a much higher likelihood ratio (20.1) than the band count (16.6) and ANC (2.2). CONCLUSION:The CRP concentration was a useful laboratory test for the differential diagnosis of bacterial meningitis among febrile infants three months of age or younger. A CRP concentration of<7 mg/dL effectively ruled out bacterial meningitis; a value > or =9 mg/dL increased the clinical suspicion of bacterial meningitis and the need for CSF evaluation.
Aged ; C-Reactive Protein ; Diagnosis, Differential ; Fever ; Humans ; Infant ; Leukocyte Count ; Meningitis ; Meningitis, Bacterial ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity