No abstract available.

BACKGROUND: The aim of this study is to evaluate the therapeutic effect of splenectomy in children with chronic idiopathic thrombocytopenic purpura(ITP) who do not respond to corticosteroids and intravenous immunoglobulin(IVIG). METHODS: Fifteen patients(7 boys and 8 girls) who were admitted to St. Mary's Hospital under the diagnosis of ITP from December 1990 to February 1997 were enrolled In this study. All had chronic forms(more than 6 months after diagnosis) and were refractory to corticosteroids(prednisolone 1~2mg/kg) and IVIG(400mg/kg for 5 days or 1 g/kg for 2 days). We you-finely employ pneumococcal vaccine in 13 patients before splenectomy slnce 1992. Antiplatelet antibody was examed in 10 patients. We measured platelet count at preoperative time, postoperative 1 day, 1 month, and 3 months or more. Hematologic results were analyzed according to Berchtold and McMillan's criteria (1) complete response(CR) >120 x 10(9)/l; (2) partial response(PR) >50 x 10(9)/l (3) no response(NR) < 50 x 10(9)/l. RESULTS: The median age at operation was 10 yr(6~16). The median time interval between diagnosis and splenectomy was 2 yr 2 mo(6 mo~5 yr 5 mo). Antiplatelet antibody was positive in 2 cases of 10 cases(20%). Of 15 cases, 12 cases were corticosteroid resistant and 3 cases were corticosteroid dependent. The postsplenectomy platelet count(median 407 x 10(9)/l of 1 day; 254 x 10(9)/l of 1 month; 227 x 10(9)/l of 3 months or more) was significantly higher than presplenectomy platelet count(median 9 x 10(9)/l)(P<0.05). All patients showed complete or parial response throughout the follow up period. Accessory spleen was found in 1 case and removed during operation. There were no serious complications following splenectomy except mild fever in 2 cases(14%). CONCLUSION: Splenectomy appears to be an effective and relatively safe treatment for patients with chronic ITP who have had inadequate response to conventional therapies.
Adrenal Cortex Hormones ; Blood Platelets ; Child ; Diagnosis ; Fever ; Follow-Up Studies ; Humans ; Platelet Count ; Purpura, Thrombocytopenic* ; Spleen ; Splenectomy*

PURPOSE: It has been reported that neovascularization of the optic disc (NVD) occurs in ocular ischemic syndrome, sickle cell hemoglobinopathy, ocular sarcoidosis, Eales' disease, and central retinal artery occlusion. However, NVD in acute ophthalmic artery occlusion had not been reported. Therefore, we report one unusual case of NVD in acute ophthalmic artery obstruction. METHODS: A 56 year-old man with complaint of abrupt decrease of visual acuity and periorbital discomfort underwent medical history taking, periorbital examination, fundus examination, and fluorescein angiography. He was followed up for 5 months RESULTS: Fundus examination showed segmentation of blood flow and diffuse retinal whitish opacity on the posterior pole around the center of the macula, without any cherry red spots in the perifoveal area. Fluorescein angiography showed a marked filling delay in the nasal retinal and choroidal circulations with a definite watershed zone involving the peripapillary choroid and macula. The retinal arteries filling and arteriovenous transit time were delayed. There was no light-perception vision and low intraocular pressure. Diabetes was found on systemic examination. Five weeks later, NVD and choroidal atrophy around the optic disc were detected. Panretinal photocoagulation was performed for the regression of NVD. NVD was regressed, but recurred.
Atrophy ; Choroid ; Fluorescein Angiography ; Hemoglobinopathies ; Humans ; Intraocular Pressure ; Light Coagulation ; Medical History Taking ; Middle Aged ; Ophthalmic Artery* ; Prunus ; Retinal Artery ; Retinal Artery Occlusion ; Retinaldehyde ; Sarcoidosis ; Visual Acuity

The incidence of retinopathy of prematurity(ROP) was observed in 194 infants admitted in our nursery room, who had birthweighs less than 2000 gm, or who had gestational ages less than 37 weeks and received supplemental oxygen therapy. To minimize the multiple correlation of birthweights and gestational ages with other possible risk factors of ROP, we selected a control group of normal infants whose birthweights or gestational ages were similar to ROP group, and then other risk factors were analyzed statisticully through a case-control study. Among 194 infants, 41 infants(21%) were diagnosed as ROP. The incidence of ROP was 48%(24/50) in infants with birthweights less than 1500 gm , 41%(28/68) in infants with gestational ages less than 32 weeks(p<0.001). In the case-control study, there were statistically significant differences in the duration of oxygen therapy and the maximal oxygen concentration betweenROP and control group, and long duration(>or=5 days) ahd high concentration(>or=40%) were highly associated with ROP(p<0.01). Other statistically significant risk factors included mechanical ventilation duration, 5 minutes Apgar score, apnea of prematurity, blood transfusion, anemia, asphyxia neonatorum, respiratory distress syndrome, xanthine administration, and parity, cesarean section, pregnancy induced hypertension in mother's factors(p<0.05).
Anemia ; Apgar Score ; Apnea ; Asphyxia Neonatorum ; Blood Transfusion ; Case-Control Studies ; Cesarean Section ; Female ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Incidence* ; Infant ; Infant, Newborn ; Nurseries ; Oxygen ; Parity ; Pregnancy ; Respiration, Artificial ; Retinopathy of Prematurity* ; Risk Factors* ; Xanthine

Gastritis cystica polyposa (GCP) is a lesion characterized by all the histological features described for hyperplastic polyps, And there is s marked proliferation of muscular elements and entrapment of numerous epithelial cysts. These lesions have been described at gastroenterostomy stomas, at peptic ulcer edges, and in association with carcinoma. It is rare that GCP presenting as a submucosal tumar-like lesion develops in the absence of above mentioned associated conditions. We had experienced a 69 year-old man with GCP. Barium X-ray and endoacopic findings showed submucosal tumor in antrum, and endoscopic ultrasonograpic findings showed markedly thickened mucosal layer with scattered hypoechoeic areas and the submucosal layer well preserved. GCP was confirmed by histological examination of resected stomach.
Aged ; Barium ; Gastritis* ; Gastroenterostomy ; Humans ; Peptic Ulcer ; Polyps ; Stomach

No abstract available.
Lymphadenitis*

To predict the mydriatic status of the cataract patients preoperatively, we performed maximal mydriasis test with stepwise instillations of 1% tropicamide and 2.5% phenylephrine or 10% phenylephrine to the out-patients who was scheduled to have cataract operation. Among 210 eyes of 113 patients, the pupillary size of 167 eyes was dilated to 8mm or more and the other 43 eyes were insufficiently dilated to less than 8mm diameter. In the insufficiently dilated group, we have observed the presumable causes of insufficient mydriasis as follows: posterior synechiae, diabetic autonomic pupillopathy, age-related miosis and unknown. By this test, we could predict the mydriatic status of the cataract patient preoperatively and could prepare the appropriate operative method and equipment effectively.
Cataract* ; Humans ; Miosis ; Mydriasis* ; Outpatients ; Phenylephrine ; Tropicamide

PURPOSE: It is known that single umbilical artery is frequently associated with gastrointestinal or urogenital anomaly, however, routine renal sonography has been debated in healthy neonate with isolated single umbilical artery. This study is designed to determine the usefulness of routine renal sonography in apparently healthy infants with an isolated single umbilical artery. METHODS: Thirty healthy neonates with a single umbilical artery without a major anomaly from January 1995 to July 2002 were enrolled. The authors investigated the clinical background of babies and their mothers after renal sonography after 72 hours of age. When the abnormalities were found at the first renal sonography, the severity of hydronephrosis and degree of obstruction and renal function were analyzed by follow up renal sonography, voiding cystourethrography(VCUG) and technetium-99m-dimercaptosuccinic acid(DMSA) scan or technetium-99m-mercaptoacetyl-triglycerine (MAG3) scan. RESULTS: Among the 30 healthy patients with isolated single umbilical artery, five patients(16.7%) showed abnormalities on first renal sonography with one major(3.3%) and four(13.4%) minor renal anomaly(minimal or mild hydroneohrosis). One major renal anomaly(severe hydronephrosis) showed severe decreased renal function on MAG3 scan without reflux, and the other four minor regressed spontaneously on follow up study. CONCLUSION: The value of routine early renal sonograpy for detecting renal anomaly in healthy infants with an isolated single umbilical artery remained unclear because most of the anomalies would regress spontaneously in the follow up study.
Follow-Up Studies ; Humans ; Hydronephrosis ; Infant* ; Infant, Newborn ; Mass Screening* ; Mothers ; Single Umbilical Artery*