• Clinical and Experimental Pediatrics
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• v.46 no.8
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• pp.803-810
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• 2003

Purpose : The purpose of this study was to evaluate the factors affecting the final adult height and total height gain in idiopathic and organic growth hormone deficient(GHD) children after growth hormone(GH) treatment. Methods : Thirteen patients with idiopathic GHD and 22 patients with organic GHD who had been treated with GH and attained adult final height were included in this study. Factors which could affect the final adult height(FAH) and total height gain, were evaluated. Results : Height SDS(standard deviation score) at initial GH treatment in idiopathic GHD was significantly shorter than that in organic GHD($-4.13{\pm}1.28$ vs $-1.66{\pm}1.06$, P<0.001). Growth velocity during the first year of GH treatment was $9.69{\pm}3.19cm$(idiopathic GHD) and $7.87{\pm}3.65cm$(organic GHD). Height(SDS) at puberty in organic GHD was significantly greater than in idiopathic GHD ($-0.55{\pm}1.25$ vs $-2.28{\pm}0.95$, P<0.001). Final adult height(SDS) was significantly greater in organic GHD than in idiopathic GHD($0.22{\pm}1.06$ vs $-1.44{\pm}0.84$, P<0.001). In idiopathic GHD, total height gain (SDS) was most significantly correlated with midparental height minus initial height(MPH-IH)(SDS) (r=0.886, P<0.001). Total height gain(SDS) was more significantly correlated with MPH-IH(SDS) and prepubertal height gain(SDS) in idiopathic GHD(r=0.640, P=0.01, r=0.801, P<0.001). Conclusion : Final adult height was greater in organic GHD than in idiopathic GHD patients. While total height gain(SDS) was more pronounced in children with lower initial height compared to MPH, absolute final adult height was influenced by height at puberty. To improve the final adult height in children with GHD, height at onset of puberty must be increased by early diagnosis and continuous treatment with optimal doses of GH. There results should be evaluated with more patients.

• Journal of Yeungnam Medical Science
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• v.13 no.2
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• pp.211-224
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• 1996

The patients of developmental dislocation of the hip(DDH) are almost found after walking age because of early diagnosis of DDH in younger children is not easy. A controversy still exists as to the relative value of closed and operative management in the treatment of a child who has reached walking age. This study is a report of the results of 16 patients(17 cases) in developmental dislocation of the hip who have visited our hospital at the age of 9 months to 3 years old, and have been followed more than 12 months (12-112 months) on review of plain radiographs and arthrograms. The results were as follows : 1. The age at diagnosis was 16.4 months(9-31 months) in average. The methods of treatment were conservative for 8 cases, and operation for 4 cases and secondary operation for 5 cases who were failed with conservative therapy. 2. By Severin's radiologic grade, the result was good in 4 cases, fair in 3 cases and poor in 1 case in conservative treatment. In operative treatment, fair was in 2 cases and poor in 2 cases. In secondary operative patients who were failed with conservative therapy, good was in 2 cases, fair in 2 cases and poor in 1 case. 3. Avascular necrosis of femoral head was developed in 3 cases. 4. In the good reduction as determined by arthrogram according to Race and Herring, we can get a favorable result in conservative treatment, and in the poor reduction as determined by arthrogram, the better result in operative treatment can be expected.

• Clinical and Experimental Pediatrics
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• v.49 no.1
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• pp.71-75
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• 2006

Purpose : Because migraine in children has different characteristics from that in adults, it is inappropriate to apply migraine criteria for adults to children. Recently, the International Headache Society(IHS) revised criteria regarding children's characteristics. Therefore, we reviewed the characteristics of childhood migraines without auras based on the revised criteria and compared the data with the findings of childhood migraine by the previous criteria. Methods : Among 102 children who visited the outpatient clinic of Kangbuk Samsung Hospital for the chief complaint of headache, we analyzed the clinical findings of 34 patients, who were diagnosed as migraine without aura, and probable migraine based on the revised criteria. Results : Migraines without aura were diagnosed in 27 patients(26.5 percent) and probable migraines were observed in seven patients(6.8 percent). The usual duration of headache attacks over 2 hours was observed in 12 patients(44.4 percent). On the contrary, 15 patients(55.6 percent) usually experienced headaches for one to two hours. According to the location of headaches, there were temporal areas in 14 cases, frontal areas in nine cases, occipital areas in two cases and diffuse areas in two cases. The striking point in probable migraines is that the length of headache was below one hour in five patients. Nine patients were diagnosed as migraine without aura, when the first edition criteria was applied to same patients. Conclusion : We found that the prevalence of migraine without aura increased by the revision of IHS criteria. We hope that migraines in children will be diagnosed correctly by the new IHS criteria.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.656-662
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• 1997

Aortic valvuloplasty has recently gained attention as an attractive alternative procedure for aortic valvular disease. Between March 1995 to August 1996, 14 patients with pure aortic regurgitation(AR) underwent aortic alvuloplasty using leaflet extension with glutaraldehydepreserved autologous pericardium. There were 11 males and 3 females, and the mean age was 34.8 $\pm$ 15.3 years. Preoperative echocardiography and cardiac catheterization revealed that the degree of AR was mean 3.4$\pm$0.65, and more than moderate degree of mitral regurgitation(MR) were detected in 4 patients. In 12 patients, 3 leaflets were extended and in another 2 patients only one deformed leaflet was extended. Concomitant mitral valvuloplasty (MVP) was performed in 4 patients. The competency of the aortic valve after completion of repair was evaluated by the transesophageal echocardiography in operating theater, and there was no aortic and mitral stenosis or regurgitation. In an early postoperative echocardiography, trivial AR was detected in 3 patients and mild MR in 1 patient. The end-systolic and end-diastolic dimensions of the left ventricle were decreased significantly(p<0.05) as compared with those of preoperative values. T ere was no mortality and no significant postoperative complication encountered. Late complication developed in 2 patients during the follow-up period(mean 7.9$\pm$ 5.9 months). One patient underwent AVR on postoperative 7th month due to endocarditis, and the another patient with Behcet's disease underwent Ross operation at postoperative 4th month. In conclusion, AVP of leaflet extension technique offers an excellent early clinical result and represents a good alterna!ivy surgical treatment for the pure AR especially in young age group, although long-term follow-up is necessary to determine the durability of glutaraldehyde-preserved autologous pericardium as a valve leaflet.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.559-569
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• 2004

The CarboMedics mechanical valve has been reported to show acceptable valve-related complication rates. The aim of this study is to evaluate our clinical experience with the CarboMedics valve. Material and Method: Between August 1988 and September 1999, we implanted 1,144 CarboMedics valves in 850 patients (aortic 179; mitral 385; double-valve 234; tricuspid 52). The mean age was 44.5 $\pm$ 12.5 years. Follow-up was completed in 95.2% and median follow-up period was 7.9 years (6753 patient-years). Result: The overall hospital mortality rate was 3.4% and the mortality rate for each group was 1.7% for aortic group, 2.6% for mitral group, 4.7% for double-valve group, and 9.6% for tricuspid group, Tricuspid group showed significantly higher mortality rate than aortic and mitral group (p〈0.05). The actuarial survival at 10 years was 87.1 $\pm$ 2.6%, 88.9 $\pm$ 1.7%, 82.4 $\pm$ 2.9%, and 77.5 $\pm$ 7.0% for aortic, mitral, double, and tricuspid valve group, respectively. Age and tricuspid valve replacement were significant risk factors for long-term survival in multivariate analysis (p 〈 0.05). Freedom from valve thrombosis at 10 years was 99.4 $\pm$ 0.6%, 98.2 $\pm$ 0.8%, 99.2 $\pm$ 0.8%, and 87.6 $\pm$ 0.5% for aortic, mitral, double and tricuspid valve group. Tricuspid valve group showed significantly higher rate of valve thrombosis (p 〈 0.05). Conclusion: Long-term results of our experience demonstrated that CarboMedics valve showed acceptable incidence of valve-related complications. However, tricuspid valve replacement showed higher rate of early mortality and valve thrombosis than other valve replacement groups.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.613-618
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• 2005

Background : Recently, medical treatment of multi-drug resistant pulmonary tuberculosis has been unsuccessful. Through analyzing the cases with surgical treatment, we hope to provide some help in treating multi-drug resistant pulmonary tuberculosis in the future. Material and Method : A retrospective review was performed with 138cases of surgical treatment of multi-drug resistant tuberculosis during 10years from January 1994 to December 2003 at National Masan Hospital. Results : The ratio of men to women, 5.1:1 indicates that there were more incidences in men. The number of the resistant drugs was 5.3 with a mean age of 42.6 years. Cavitary lesions on the plain chest X-rays were seen in 94cases (68.1%). 128cases had positive sputum culture preoperatively. Types of operations were 24 pnemonectomies, 83 lobectomies, 10 bilobectomies, 19 lobectomies with segmentectomies or wedge resections, 1 wedge resection, and 1 carvenoplasty. There was no death after operation. There were 6cases of air leakage over a week, 6cases of postoperative bleeding, 8cases of bronchopleural fistula and empyema, 16cases of dead space, 1case of atelectasis, 1case of wound infection, 1case of cyst as postoperative complication. Postoperative complication showed higher long-term negative conversion rate of 92.8%. Conclusion : There has been many discussions about operative indications, postoperative drug regimens, length of postoperative chemotherapy. In our study, we showed higher long-term success rate of postoperative chemotherapy with pulmonary resection on multi-drug resistant pulmonary tuberculosis.

• Journal of agricultural medicine and community health
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• v.24 no.1
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• pp.103-113
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• 1999

The authors surveyed the inhabitants of a rural area to assess the patterns of medical utilization on dermatoses. Seven hundred and sixty new outpatients of dermatoses were examined and surveyed with formed questionnaire from March 1997 to February 1999. The results are as follows; 1. Among 760 new outpatients, the number of male patients was 283(37.2%) and that of female patients was 477(67.3%). 2. The most common dermatoses was Tinea pedis(34.9%), and follows senile pruritus, contact dermatitis, housewife eczema, seborrheic dermatitis, numular dermatitis, atopic dermatitis, Tinea corporis, Tinea ungium, acne vulgaris, impetigo, keratolysis exfoliativa, chronic urticaria, Tinea cruris and Molluscum contagiosum in orders. 3. Drug store was the most frequent places where patients initially visited for their skin diseases(39.6%) and followed by non dermatologic clinic, dermatologic clinic and general hospital in orders. 4. One hundred and twenty one(15.9%) patients have been experienced folk treatment. It was founded that the topical vinegar application or soaking was the most common method. Many patients felt no symptom improvement after the folk treatment(48.8%). Seventeen point four percent of patient felt symptom worsened. The results of this study suggest that many of the rural inhabitants are lack of understanding on their dermatoses. So many physician who are in charge of the primary care in rural area have to pay attention to the common dermatoses and educate patients on their medical utilization.

• Advances in pediatric surgery
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• v.12 no.1
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• pp.70-85
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• 2006

A nationwide survey on necrotizing enterocolitis (NEC) was undertaken among members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and the case registration form for each patient during the three-year period from July 2001 to June 2004. Eighty one patients were included in the questionnaire, but only 71 patients were registered from 22 members in 16 hospitals. At the same time survey on focal intestinal perforation (FIP) was undertaken and 17 patients were registered from 11 members in 10 hospitals. Total 19,041 newborns were admitted to neonatal intensive care unit during the study period. Eighty one patients (17.27 %) were underwent surgery among 469 babies who were managed under the impression of NEC. The male to female ratio was 2.1:1. The premature were 60.6 %. The most common site of involvement was ileum. Overall and operation survival of NEC were 72 % and 79 %, respectively. The survival was lower in smaller babies, multiple segments involvement and involvement of both the small and large intestine. But there was no difference in survival according to sex or prematurity. The FIP showed very similarity with NEC in terms of incidence, and the age of diagnosis and operation. But the survival was much better and 100 %. The results showed the clinical characteristics of NEC and the trend of management in NEC in Korea. In the future we hope we can discuss about this topic in prospective manner.

• Tuberculosis and Respiratory Diseases
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• v.57 no.3
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• pp.234-241
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• 2004

Background : There has been a gradual increase in the number of newly diagnosed cases of Mycobacterium avium complex (MAC) pulmonary disease. However, the optimal therapeutic regimen for the disease has not yet established and there is no report about the treatment outcome of MAC pulmonary disease in Korea. This study examined the effect of clarithromycin-based regimen in patients with pulmonary MAC disease without a HIV infection. Materials and Methods : Fifty-six patients with pulmonary MAC disease were diagnosed according to the American Thoracic Society criteria from January 2000 to December 2003 at this hospital. Of these patients, 15 were treated with clarithromycin, rifampin, and ethambutol for more than 6 months, together with streptomycin initially (first 6 months) in 8 patients. Results : Six months after the treatment, the sputum cultures converted from positive to negative in 8 patients (53%) and the radiological findings improved in 10 (67%). At 12 months 4 patients (44%) achieved sputum negative conversion and 6 patients out of 9 patients (67%) who were treated for more than 12 months showed radiological improvement. Overall, the sputum findings converted to negative in nine patients (60%) who underwent medical treatment. A pulmonary resection was successfully performed in one patient. Only one patient discontinued the treatment due to side effects such as gastrointestinal intolerance and optic neuritis. Conclusion : A combined regimen containing clarithromycin is relatively safe and tolerable even in the elderly outpatients. However, the results of this combined chemotherapy were unsatisfactory and new companion drugs for MAC pulmonary disease are needed. A resection may be considered for localized disease.

• Tuberculosis and Respiratory Diseases
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• v.54 no.3
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• pp.283-294
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• 2003

Introduction : Rapidly growing nontuberculous mycobacteria (RGM) can produce numerous types of manifestations including a pulmonary infection. Managing a pulmonary infection due to RGM is unusually difficult to treat because the organism is invariably resistant to traditional antituberculous drugs and has a varying susceptibility to other antibiotics. The experiences of treatments for a RGM pulmonary infection with various antibiotics are also limited. This study evaluated the clinical manifestations, treatment, and the therapeutic outcomes of a RGM pulmonary infection. Subjects and method : Fifty-four cases with RGM from respiratory specimens were identified between November of 1996 and September of 2002 in the Asan medical center. The medical records and radiographic findings in 20 patients who fulfilled the diagnostic criteria of nontuberculous mycobacteria (NTM) pulmonary disease by ATS guidelines. The clinical, laboratory, and radiological parameters between subgroups. Results : Of the 20 patients, 15 were female. The mean age was 57.7 yrs (${\pm}7.5$), and all of the patients had a history of pulmonary tuberculosis. Most (90%) had an underlying lung disease. The majority of the isolates (80%) were M. abscessus. Chest radiography showed bilateral involvement in 80% of the patients. Bronchiectasis and multiple nodules were the main findings. Cavitation was present in 35% of the patients. Even though 70 % of the patients received antituberculous drugs prior to the correct diagnosis, all of the patients eventually received antibiotics. A mean of 3.5 antibiotics were given for an average of 439 days(${\pm}168$). After completing treatment, nine patients showed improvement after a mean 591(${\pm}311$) days of treatment, whereas the antibiotic treatment was unsuccessful in 2 patients. Conclusion : Many patients with a RGM pulmonary infection show an atypical pattern of radiological findings (bronchiectasis and multiple centrilobular nodules). It is very important to differentiate between M. tuberculosis and NTM and to identify the causative organisms among the NTM because a misdiagnosis can lead to an inappropriate and prolonged treatment. Combined antibiotic treatment yielded promising results, and is recommended for treating patients with a RGM pulmonary infection.