• Title/Summary/Keyword: Congenital disorder

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Newborn screening of inherited metabolic disease in Korea (유전성 대사질환의 신생아 스크리닝)

  • Lee, Dong Hwan
    • Clinical and Experimental Pediatrics
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    • v.49 no.11
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    • pp.1125-1139
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    • 2006
  • In 1991, the Ministry of Health & Social affairs adopted a nationwide service program for neonatal screening of phenylketonuria, galactosemia, maple syrup urine disease, homocystinuria, histidinemia & congenital hypothyroidism for newborns delivered from low class pregnant women registered in health centers. Government decreased the test items from six to two, PKU & congenital hypothyroidism to increase test numbers with same budget from 1995. Government decided to test PKU & hypothyroidism for all newborns from 1997. 78 laboratories wanted to participate for neonatal screening test in 1999. Government didn't decide laboratory center for a certain district and placed responsibility on free competition. Government are planning to test 573,000 newborns from 1998, Government decided to screen 6 items PKU, congenital hypothyroidism, maple syrup urine disese, homocystinuria, galactosemia and congenital adrenal hyperplasia from 2006. 17 laboratores are participating now. The cost of screening test is supported by both the federal government and local government on a 40-60 basis. In case a patient with an inherited metabolic disease is diagnosed by screening of government program, special milk is provided at government's expense. Interlaboratory quality control was started 6 times a year from 1994. According to the government project, 3,707,773 newborns were screened. 86 PKU, 718 congenital hypothyroidism were detected. So incidence of PKU is 1/43,114 and congenital hypothyroidism is 1/4,612. Maeil dairy company produced new special formula for PKU, MMA and PA, MSUD, urea cycle disorder, homocystinuria, isovaleric acidemia from Oct. 1999. The cost benefit of performing screening procedures coupled with treatment has been estimated to be as high as 1.77 times in PKU, 11.11 times in congenital hypothyroidism than cost without screening. We are trying to increase the budget to test all newborns for Tandem mass sereening & Wilson disease from 2008. Now it is a very important problem to decrease laboratory numbers of neonatal screening in Korea. So we are considering 4-5 central laboratories which cover all newborns and are equipped with tandem mass spectrometer & enzyme immunoassay for TSH, 17OHP & enzyme colorimetric assay for galactose.

Congenital LQT Syndromes: From Gene to Torsade de Pointes

  • Carmeliet, Edward
    • The Korean Journal of Physiology and Pharmacology
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    • v.6 no.1
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    • pp.1-7
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    • 2002
  • Congenital Long QT syndrome (LQTs) is a relatively rare pathologic disorder but results frequently in sudden cardiac death. Of the six LQTs that have been clinically described, five have been worked out for their genetic and biophysical profile. Most are generated by mutations which cause a loss of function in two delayed $K^+$ currents, $i_{Ks}\;and\;i_{Kr}.$ One syndrome is generated by mutations in the $Na^+$ channel which causes essentially a gain of function in the channel. Clinically the syndromes are characterized by slowed repolarization of the cardiac ventricular action potential and the occurrence of typical arrhythmias with undulating peaks in the electrocardiogram, called Torsade de Pointes. Arrhythmias are initiated by early or delayed afterdepolarizations and continue as reentry. Triggers for cardiac events are exercise (swimming; LQT1), emotion (arousal; LQT2) and rest/sleep (LQT3). ${\beta}-blockers$ have a high efficacy in the treatment of LQT1 and LQT2. In LQT3 their use is questionable. The study of congenital LQTsyndromes is a remarkable example of how basic and clinical science converge and take profit of each other's contribution.

Snapping Scapula with Congenital Bilateral Elbow Fusion (선천성 양측성 주관절 유합에 동반된 발음성 견갑골 - 증례 보고 -)

  • Choi Chang-Hyuk;Koh Sang-Bong;Kim Tae-Hoon
    • Clinics in Shoulder and Elbow
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    • v.7 no.1
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    • pp.46-50
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    • 2004
  • The snapping scapula is a relatively uncommon phenomenon occuring as a consequence of some anomalous conditioin existing between the thoracic wall and the undersurface of the scapula. It may present in several ways like crepitus, pain during scapular movement and limitation of scapular motion. The causes of snapping scapula are changes in the intervening soft tissues, the muscles, or the bursae between the scapula and the chest wall; and changes in the congruence between the anterior scapular surface and the underlying chest wall. The congenital elbow fusion or humeroradioulnar synostosis is an extremely rare inheritable disorder that previously described just a few reports. Recently we experienced a case of snapping scapular with congenital bilateral elbow fusion treated by arthroscopic scapulothoracic bursectomy and consequent open superomedial scapulectomy. We would describe the clinical feature of a snapping scapula and result of treatment with literature review.

Surgical correction of total anomalous pulmonary venous connection (총폐정맥 이상환류증의 수술요)

  • Kim, Gi-Bong;No, Jun-Ryang
    • Journal of Chest Surgery
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    • v.17 no.1
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    • pp.48-52
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    • 1984
  • Total anomalous pulmonary venous connection [TAPVC] defines a group of congenital heart disease which have in common the entire pulmonary venous drainage returning directly or indirectly to the right atrium instead of to the left atrium. Although this disorder represents only 1.3% of cases of congenital heart disease, if untreated the resultant mortality is greater than 80% in the 1st year of life. And since there is no satisfactory palliative treatment, correction of TAPVC Is high on the list of indications for open heart surgery in the 1st year of life. This paper describes 10 patients who underwent surgical correction of this disorder at SNUH between 1978 and 1983. 1. 7 were males and 3 females, with ages ranging from 5 months to 24 years. 2. 7 were supracardiac type, 2 cardiac type, and 1 mixed type TAPVC. We didnt experience infracardiac type. 3. All showed some degree of pulmonary hypertension preoperatively. 4. In 4 cases of supracardiac type, total circulatory arrest was used in brief period during anastomosis between common pulmonary venous trunk and left atrium. In the other cases, usual cardiopulmonary bypass with moderate to deep hyperthermia was used. 5. There were 2 cases of mortality; 1 died at operation, and the other at 4 months due to congestive heart failure. 6. Mortality seemed not closely related to age, body weight, or severity of pulmonary hypertension.

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IMPLANTS IN PSYCHIATRIC PATIENTS (정신장애 환자의 임프란트 치료)

  • Moon, Sung-Yong;Kim, Su-Gwan
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.3 no.1
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    • pp.1-5
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    • 2007
  • Patients of mental disorder have more missing teeth than general population because of the difficulty of oral hygiene management. In addition, especially Down syndrome patients etc., congenital dental problems develop more frequently. Therefore, prosthetic rehabilitation treatments for missing teeth in mental disorder patients are required more urgently. In other words, a removable partial denture may be very difficult for such patients to wear and manage. So in this review article we reviewed implant therapeutic modes for mental disorder patients based on previous reports. It should be understood that implant treatments are not impossible for mental disorder patients, and if implants could be a good method that could provide them good quality care, so implant should be included in treatment plans before surgery. Before surgery it should be evaluated that patients ability to manage themselves their ability to manage themselves should be evaluated and also should be evaluated whether general anesthesia or sedative treatment is required for the treatment, and whether their cooperation is good enough.

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A Review of Macrodystrophia Lipomatosa: Revisitation

  • Prasetyono, Theddeus OH;Hanafi, Enjeline;Astriana, Windi
    • Archives of Plastic Surgery
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    • v.42 no.4
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    • pp.391-406
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    • 2015
  • Macrodystrophia lipomatosa (MDL) is a rare congenital non-hereditary disorder that has significant impact on patient morbidity. This study provides a comprehensive review of the natural history, diagnosis, management, and outcomes of the disorder. A literature search in PubMed was conducted to identify cases of MDL from January 1950 to 14 February 2014. After ruling out articles without information related to the management of the disorder, a summary of 32 studies was performed. An additional three cases from the authors are also presented. Based on 57 journal articles and three additional cases from the authors, around 108 cases of MDL were reviewed. Most patients were males who were admitted to a treatment clinic in the first four years of life. The lower extremities were more frequently affected, with unilateral presentation being most common. They commonly underwent a single-staged surgical procedure with follow-up periods ranging from more than one year up to 21 years. Out of 43 cases that underwent surgical procedures, 13 reported no complications, and there were seven cases of esthetic satisfaction and 15 cases of significant functional improvement. Depending on the severity of a patient's condition, the use of non-invasive diagnostic tools should be carefully considered. Surgery might be a better choice of management than observation, taking into account possible future complications in the absence of surgery and the beneficial outcomes of surgical procedures.

A Case of Congenital Partial Nephrogenic Diabetes Insipidus (선천성 부분 신성 요붕증 1례)

  • Mo, Eun Ha;Nam, In Hye;Chung, Min Ja;Yu, Jae Hong
    • Clinical and Experimental Pediatrics
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    • v.45 no.7
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    • pp.902-905
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    • 2002
  • The most common form of genetic nephrogenic diabetes insipidus(NDI), a rare inherited disorder, is congenital and is transmitted in an X-linked recessive mode. It is refractory to the antidiuretic effect of normal to moderately increased levels of plasma arginine vasopressin(AVP) but, in some cases, may respond to high levels of the hormone or its analogue, deamino-D-arginine vasopressin(DDAVP). X-linked congenital NDI has now been linked to over 128 different mutations in diverse coding regions of the AVP receptor 2(AVPR2) gene. The functional effects of these mutations vary from complete loss of responsiveness to a simple shift to the right in the dose response curve. We report a case of congenital partial NDI, with transversion of A to G at codon 280 of the AVPR2 gene, resulting in a subsequent change of amino acid from tyrosine to cysteine, and that has been effective with hydrochlorothiazide and high dose of DDAVP.

A Case of Becker's Type Congenital Myotonia (Becker형 선천성 근긴장증 1례)

  • Yun, Sung-Hwan;Hah, Jung-Sang;Lee, Jun
    • Journal of Yeungnam Medical Science
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    • v.16 no.1
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    • pp.125-130
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    • 1999
  • Congenital myotonia is a hereditary disorder of the skeletal muscle. The most characteristic features of the disease are myotonia and variable muscular hypertrophy. Molecular biologic investigations have revealed that mutations in the gene of the human skeletal muscle chloride ion channel protein are a cause of the disease. The Becker's type congenial myotonia is clinically similar to the autosomal dominantly inherited congenital myotonia (Thomsen's disease). Both disorders are characterized electrophysiologically by increased excitability of muscle fibers. reflected in clinical myotonia. In general, Becker's type congenital myotonia is more severe than Thomsen's disease in muscular hypertrophy and weakness. The authors recently experienced a 25-year-old female patient who has no family-related disease history and who has conspicuous muscular hypertrophy and the stiffness with muscles which occurred from the age of 3 or 4. Clinically she showed the authors a percussion myotonia. On electrophysiological study, exercise and repetitive stimulation of the abductor digiti quinti muscle disclosed a decline in the compound muscle action potential. Biopsy of biceps muscle revealed enlargement of muscle fibers with marked nuclear internalization. After the oral taking the Mexiletine, the patient showed a favorable turn a little with her stiffness of muscles. So we authors are reporting one case of Becker's type congenital myotonia with review of literatures.

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Congenital Polyvalvular Disease; Report of A Case (선천성 다발성 판막질환 1예 보고)

  • 김정원;민경석;윤태진;서동만;윤소영;김영휘;고재곤;박인숙;김규래
    • Journal of Chest Surgery
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    • v.34 no.8
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    • pp.626-629
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    • 2001
  • Congenital polyvalvular disease is a connective tissue disorder affecting more than one heart valve with variable involvement of the entire valvular and subvalvular apparatus. It is frequently associated with the Trisomy 18 and trisomy 13-15 or ventricular septal defect and patent ductus arteriosus. We present an isolated case of congenital polyvalvular disease in a new born baby with a review of the pertinent literatures, which has not been described in Korea. The mass was discovered as a right atrial mass in the prenatal ultrasonography and it was thought to be either a hematoma or a myxoma in the preoperative echocardiography. Microscopic examination of the surgically resected mass showed irregular thickening, nodulation, and additional features of calcification and ossification in the valvular connective tissue on the body of anterior and septal leaflet of tricuspid valve. Congenital polyvalvular disease should be included in the differential diagnosis in cases showing valvular calcification or ossification in the fetal echocardiography.

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Right ventricular failure in congenital heart disease

  • Cho, Young Kuk;Ma, Jae Sook
    • Clinical and Experimental Pediatrics
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    • v.56 no.3
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    • pp.101-106
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    • 2013
  • Despite developments in surgical techniques and other interventions, right ventricular (RV) failure remains an important clinical problem in several congenital heart diseases (CHD). RV function is one of the most important predictors of mortality and morbidity in patients with CHD. RV failure is a progressive disorder that begins with myocardial injury or stress, neurohormonal activation, cytokine activation, altered gene expression, and ventricular remodeling. Pressure-overload RV failure caused by RV outflow tract obstruction after total correction of tetralogy of Fallot, pulmonary stenosis, atrial switch operation for transposition of the great arteries, congenitally corrected transposition of the great arteries, and systemic RV failure after the Fontan operation. Volume-overload RV failure may be caused by atrial septal defect, pulmonary regurgitation, or tricuspid regurgitation. Although the measurement of RV function is difficult because of many reasons, the right ventricle can be evaluated using both imaging and functional modalities. In clinical practice, echocardiography is the primary mode for the evaluation of RV structure and function. Cardiac magnetic resonance imaging is increasingly used for evaluating RV structure and function. A comprehensive evaluation of RV function may lead to early and optimal management of RV failure in patients with CHD.