PURPOSE: The prevalence of obesity in children and adolescents has been rising rapidly in Korea because of changes of diet and lifestyle. As with adults, obesity in children and adolescents can cause diabetes mellitus, hyperlipidemia, cardiovascular diseases and renal diseases. The aim of the present study is to examine the relation of obesity, glomerular filtration rate (GFR) and serum cystatin C concentration in children and adolescents. METHODS: Data of 115 children and adolescents aged between 6 years and 20 years without clinical evidence of renal diseases were included in the study. From May 2004 to December 2004, blood samples were collected from children and adolescents who were seen at the Department of Pediatrics at Chungang University Yongsan Hospital. Obesity degrees and body mass indices (BMI) were measured, and GFRs were estimated from Schwartz's formula. Serum cystatin C was measured by particle enhanced nephelometric immunoassay using Behring Nephelometer II. RESULTS: GFRs were significantly different between the obese group (BMI > 95 percentile, 145.79+/-23.10 mL/min) and the non-obese group (BMI < 95 percentile, 134.61+/-26.19 mL/min) divided by BMI (P=0.031). GFRs were not significantly different between the obese group (obesity degree > 120 percent, 144.29+/-23.08 mL/min) and the non-obese group (obesity degree < 120 percent, 134.54+/-26.57 mL/ min) divided by obesity degree (P=0.051), but were significantly different between severe obese group (obesity degree > 150 percent, 155.55+/-20.40 mL/min) and the non-obese group (P=0.004). GFRs were correlated positively with BMI (r2=0.037, P=0.039), but were not correlated significantly with obesity degree (r2=0.030, P=0.066). Serum cystatin C concentrations were not significantly different between the obese group and the non-obese group, divided by BMI as well as by obesity degree (P> 0.05). CONCLUSION: Obesity may lead to an alteration of renal hemodynamics such as hyperfiltration, appropriate control and management for obesity is necessary.
Child ; Adolescent ; Adult ; Male ; Female ; Humans

The scalp is the thickest skin in the body and protects the intracranial structures. The coverage of a large scalp defect is a difficult surgical procedure, the full details of which must be considered prior to the procedure, such as defect size and depth, and various factors related to the patient’s general condition. Although a free flap is the recommended surgical procedure to cover large scalp defects, it is a high-risk operation that is not appropriate for all patients. As such, other surgical options must be explored. We present the case of a patient with an ulcer on the scalp after wide excision and split-thickness skin graft for squamous cell cancer. We successfully performed a reverse temporalis muscle flap for this patient.

Objective: To investigate the usefulness of goal attainment scaling (GAS) in intensive stroke rehabilitation during the subacute stage. Methods: Medical records of subacute post-stroke patients who had undergone intensive rehabilitation under hospitalization, before and after the application of GAS, were collected. GAS was conducted at the initial evaluation of each patient. Specific goals were suggested by physical and occupational therapists and were determined by the responsible physiatrist. A 5-point scale was used for the GAS score after 4 weeks of rehabilitation according to the preset criteria of each goal. To evaluate the influence of GAS in rehabilitation practice, functional improvements were compared between two patient groups before (n=121) and after (n=141) GAS. To assess progress in GAS practice, the standard GAS score was calculated, and the changes were observed over a 3-year period. The standard GAS score converged to 50 points when the goal was achieved. The therapists who used GAS also completed a survey regarding its usefulness. Results: There were no statistical differences in the motor and cognitive outcomes of the patient groups before and after applying GAS scoring. Successive yearly changes in the standard GAS scores showed progressive convergence to 50 points, signaling that the patient’s goal-setting abilities improved. According to the survey, most therapists felt that GAS enhanced the quality of therapies (84.6%). Conclusion GAS improved goal-setting for the rehabilitation of subacute post-stroke patients and might have a positive effect on rehabilitation.

The effects of antlers have long been known in traditional Asian medicine. However, few studies have investigated the effects of antlers on immunity. In this study, we investigated whether fermented antler extract (FAE) has immunomodulatory effects on spleen cells. FAE enhanced the activity of spleen cells in a concentration dependent manner compared to antler extract. Interestingly, FAE significantly increased the production of interleukin-12, a representative cytokine of cell-mediated immunity, while it marginally increased that of tumor necrosis factor-alpha. Flow cytometry analysis demonstrated that FAE can protect spleen cells from spontaneous cell death without a significant proportional change in subsets, mainly lymphocytes. Taken together, the results of the present study showed that FAE has beneficial effects on spleen cells, a major type of immune cell, indicating that it can function as an immunomodulator without significant cytotoxicity. These data may broaden the use of FAE in basic research and clinical areas.
Animals ; Antlers* ; Asian Continental Ancestry Group ; Cell Death ; Flow Cytometry ; Humans ; Immunity, Cellular ; Immunomodulation ; Interleukin-12* ; Lymphocytes ; Spleen* ; Tumor Necrosis Factor-alpha

Naso-orbito-ethmoidal (NOE) fractures are complicated fractures of the mid-face. The treatment of NOE fractures is challenging and a comprehensive treatment strategy is required. We introduce a case of NOE fracture treated with open reduction and suspension sutures. A 28-year-old woman presented with a unilateral NOE fracture. To reduce the frontal process of the maxilla, a suspension suture was made by pulling the fragment using a double arm suture via a transcaruncular incision. The suture thread was placed in the horizontal plane. Another suspension suture on the inferior orbital rim assisted reduction procedure, and they passed through the overlying skin. The reduction alignment could be finely adjusted by tightening the transcutaneous suture threads while checking the degree of bone alignment through the subciliary incision. The two suture threads were suspended using a thermoplastic nasal splint. An additional skin incision on the medial canthal area, which would have resulted in a scar, could be avoided. Four months postoperatively, computed tomography showed an accurate and stable reduction. The patient was satisfied with her aesthetic appearance, and functional deficits were not present.

OBJECTIVES: Dental technicians are exposed to methyl methacrylate(MMA) and hard metal dusts while working, and several cases of hypersensitivity pneumonitis caused by the exposure have been reported. The authors experienced a case of hypersensitivity pneumonitis in a female dental technician who had 10 years' work experience and report the case with clinical evidence. METHOD: The patient's work, personal, social, and past and present medical histories were investigated based on patient questioning and medical records. Furthermore, the workplace conditions and tools and materials the patient worked with were also evaluated. Next, the pathophysiology and risk factors of pneumonitis were studied, and studies on the relationship between hypersensitivity pneumonitis and a dental technician's exposure to dust were reviewed. Any changes in the clinical course of her disease were noted for evaluation of the work-relatedness of the disease. RESULTS: The patient complained of cough and sputum for 1 year. In addition, while walking up the stairs, the patient was not able to ascend without resting due to dyspnea. She visited our emergency department due to epistaxis, and secondary hypertension was incidentally suspected. Laboratory tests including serologic, electrolyte, and endocrinologic tests and a simple chest radiograph showed no specific findings, but chest computed tomography revealed a centrilobular ground-glass pattern in both lung fields. A transbronchial biopsy was performed, and bronchoalveolar washing fluid was obtained. Among the findings of the laboratory tests, microcalcification, noncaseating granuloma containing foreign body-type giant cells, and metal particles within macrophages were identified histologically. Based on these results, hypersensitivity pneumonitis was diagnosed. The patient stopped working due to admission, and she completely quit her job within 2 months of restarting work due to reappearance of the symptoms. CONCLUSION: In this study, the patient did not have typical radiologic findings, but pathological evaluation of the lung biopsy from the bronchoscope led to the suspicion of pneumonitis. Under the microscope, the sample contained fibrotic changes in the lung, multinucleated giant cells, and particles in macrophages and was diagnosed as dental technician pneumoconiosis by the pathology. Working as a dental technician had directly exposed her to light metal dust and MMA, and her clinical symptoms and radiologic findings subsided after withdrawal from exposure to the workplace. These outcomes led to the diagnosis of hypersensitity pneumonitis due to MMA exposure and strong work-relatedness.
Alveolitis, Extrinsic Allergic* ; Biopsy ; Bronchoscopes ; Cough ; Dental Technicians* ; Diagnosis ; Dust ; Dyspnea ; Emergencies ; Epistaxis ; Female* ; Giant Cells* ; Giant Cells, Foreign-Body ; Glycogen Storage Disease Type VI ; Granuloma ; Humans ; Hypersensitivity* ; Hypertension ; Lung ; Macrophages ; Medical Records ; Pathology ; Pneumoconiosis ; Pneumonia ; Radiography, Thoracic ; Risk Factors ; Sputum ; Thorax ; Walking

Clostridium sordellii is a gram-positive spore forming anaerobic bacillus, rarely encountered in human infection. It produces several exotoxins which contribute to myonecrosis, pulmonary infection, obstetric infection and bacteremia. C. sordellii bacteremia is very rare and has been reported in few patients with malignancy or immunosuppression. To date, there has been no report in Korea. Mortality is high when deep site infection exists regardless of underlying pathology and immune status. In contrast, superficial skin and subcutaneous tissue infection has a favorable prognosis. We present a case of C. sordellii bacteremia in a patient with osteosarcoma. The patient was admitted for the treatment of the infection at the ulcerative osteosarcoma lesions of the leg, and C. sordellii bacteremia was demonstrated. He was successfully treated with intravenous ampicillin/sulbactam for two weeks.
Bacillus ; Bacteremia* ; Clostridium sordellii* ; Clostridium* ; Exotoxins ; Humans ; Immunosuppression ; Korea ; Leg ; Mortality ; Osteosarcoma* ; Pathology ; Prognosis ; Skin ; Spores ; Subcutaneous Tissue ; Ulcer

Clostridium sordellii is a gram-positive spore forming anaerobic bacillus, rarely encountered in human infection. It produces several exotoxins which contribute to myonecrosis, pulmonary infection, obstetric infection and bacteremia. C. sordellii bacteremia is very rare and has been reported in few patients with malignancy or immunosuppression. To date, there has been no report in Korea. Mortality is high when deep site infection exists regardless of underlying pathology and immune status. In contrast, superficial skin and subcutaneous tissue infection has a favorable prognosis. We present a case of C. sordellii bacteremia in a patient with osteosarcoma. The patient was admitted for the treatment of the infection at the ulcerative osteosarcoma lesions of the leg, and C. sordellii bacteremia was demonstrated. He was successfully treated with intravenous ampicillin/sulbactam for two weeks.
Bacillus ; Bacteremia* ; Clostridium sordellii* ; Clostridium* ; Exotoxins ; Humans ; Immunosuppression ; Korea ; Leg ; Mortality ; Osteosarcoma* ; Pathology ; Prognosis ; Skin ; Spores ; Subcutaneous Tissue ; Ulcer

No abstract available.
Encephalomyelitis, Acute Disseminated ; Meningoencephalitis ; Orientia tsutsugamushi ; Scrub Typhus

OBJECTIVE: To evaluate the effectiveness of intensive rehabilitation to support recovery of neurological function after brain tumor surgery and assess long-term satisfaction. METHODS: This retrospective study included patients with neurological impairment after brain tumor surgery who underwent intensive rehabilitation therapy between December 2013 and May 2017. To assess effectiveness of rehabilitation, functional outcomes (motor, cognition, and activities of daily living [ADL]) were compared between brain tumor group and a control group enrolling stroke patients who received equivalent rehabilitation during the study period. Long-term satisfaction with rehabilitation was evaluated by surveying family caregivers. RESULTS: This study included 21 patients with benign brain tumor, 14 with malignant brain tumor, and 108 with stroke. Significant and similar improvement in motor, cognition, and ADL function were noted in both the brain tumor group and the stroke group. Malignancy status did not influence the extent of functional improvement. According to medical records and surveys, 9 (69.2%) patients with malignant tumor and 2 (11.8%) with benign tumor had expired by the time of the survey. Most family caregivers confirmed that rehabilitation was effective for functional improvement (>60%), expressing overall satisfaction and stating they would recommend such therapy to patients with similar conditions (approximately 70%). CONCLUSION: Intensive rehabilitation may help promote functional improvement following brain tumor surgery regardless of malignancy compared with stroke patients. Family caregivers expressed overall satisfaction with rehabilitation at long-term follow-up. These findings support the provision of intensive rehabilitation therapy for neurologic function recovery following brain tumor surgery.
Activities of Daily Living ; Brain Neoplasms ; Brain ; Caregivers ; Cognition ; Follow-Up Studies ; Humans ; Medical Records ; Neurological Rehabilitation ; Pilot Projects ; Recovery of Function ; Rehabilitation ; Retrospective Studies ; Stroke ; Treatment Outcome