• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.257-262
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• 2005

Clinical findings in neonates and infants with cholestasis characteristically include prolonged jaundice, acholic stool, pruritus and failure to thrive. We report two cases of cholestasis presenting with spontaneous bleeding due to vitamin K deficiency. Laboratory studies on admission revealed moderate liver dysfunction and a bleeding tendency due to vitamin K deficiency. After administration of vitamin K, the bleeding tendency disappeared. Vitamin K deficiency was resulting from a combination of cholestasis-induced fat malabsorption and low vitamin K supplementation due to breast-milk feeding. Cholestasis should be considered in neonate and infant with a bleeding tendency.

• Pediatric Infection and Vaccine
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• v.8 no.1
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• pp.107-113
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• 2001

Spinal epidural abscess(SEA) is a rare condition in children. Classic symptoms are spinal ache, root pain, weakness and paralysis. The earliest symptoms of SEA in the pediatric age group are nonspecific and variable. Early diagnosis may be almost impossible when local spinal pain is inconspicuous or absent, when toxic epiphenomena divert attention from subtle signs of neurologic dysfunction and when the patient is an acutely distressed and uncooperative child. Failure to diagnosis and treat condition on a timely basis may lead to permanent neurolgic dysfunction or even death. This infection, usually located in the dorsal epidural space of the mid thoracic or lower lumbar regions, is the result of hematogenous dissemination of bacteria, usually Staphylococci, from foci of infection in the skin, or respiratory or urinary tracts. MRI was the diagnostic method of choice. A combination of antibiotics and surgical drainage remains the treatment of choice. Prognosis is excellent if surgery is performed before the development of neurologic deficit. We report a case of SEA in a child whose first presenting symptom was abdominal pain rather than spinal pain. A case is diagnosed by MRI and successfully treated with laminectomy and drainage and antibiotics.

• Journal of Korean Neurosurgical Society
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• v.42 no.2
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• pp.83-88
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• 2007

Objective : Pituitary apoplexy, resulting from an acute infarction or hemorrhage mainly in pituitary adenomas, is a rare yet major clinical event with neurological, ophthalmological and hormonal emergent consequences. The authors review our surgical experience with a series of 16 cases of pituitary apoplexy. Methods : The cases of pituitary apoplexy, operated via trans-sphenoidal approach in our hospital between 1998-2005, were retrospectively analyzed in terms of their clinicoradiological features, pathological findings and surgical outcomes. Results : The mean age of patients (9 male and 7 female) was 47.1 years. The average time of presentation after onset of symptom was 8.9 days. Pituitary apoplexy occurred as an initial manifestation of pituitary adenoma in all patients. Headache was the most common presenting symptom (94%). Visual disturbance was found in 56% of patients. Thirty-one percent of the patients had hypopituitarism. On magnetic resonance imaging, this entire catastrophic event accompanied with macroadenoma in a mean size of 22.5 mm. Only four patients needed postoperative hormone replacement therapy. Three of them showed preoperative hypopituitary function, and one patient in normal pituitary function. There was no specific complication in any of these patients. Conclusion : Early trans-sphenoidal decompression with high-dose corticosteroid replacement showed good outcomes of pituitary apoplexy.

• Archives of Plastic Surgery
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• v.40 no.4
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• pp.392-396
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• 2013

Background The typical clinical symptoms of glomus tumors are pain, tenderness, and sensitivity to temperature change, and the presence of these clinical findings is helpful in diagnosis. However, the tumors often pose diagnostic difficulty because of variations in presentation and the nonspecific symptoms of glomus tumors. To the best of our knowledge, few studies have reported on the usefulness of magnetic resonance imaging (MRI) in diagnosing glomus tumors in patients with unspecific symptoms. Methods The inclusion criteria of this study were: having undergone surgery for subungual glomus tumor of the hand, histopathologic confirmation of glomus tumor, and having undergone preoperative MRI. Twenty-one patients were enrolled. The characteristics of the tumors and the presenting symptoms including pain, tenderness, and sensitivity to temperature change were retrospectively reviewed. Results Five out of 21 patients (23%) did not show the typical glomus tumor symptom triad because they did not complain of pain provoked by coldness. Nevertheless, preoperative MRI showed well-defined small soft-tissue lesions on T1- and T2-weighted images, which are typical findings of glomus tumors. The tumors were completely resected and confirmed as glomus tumor histopathologically. Conclusions Early occult lesions of glomus tumor in the hand may not be revealed by physical examination because of their barely detectable symptoms. Moreover, subungual lesions may be particularly difficult to evaluate on physical examination. Our cases showed that MRI offers excellent diagnostic information in clinically undiagnosed or misdiagnosed patients. Preoperative MRI can accurately define the character and extent of glomus tumor, even though it is impalpable and invisible.

• Korean Journal of Acupuncture
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• v.23 no.1
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• pp.111-118
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• 2006

Objectives : To test the therapeutic efficacy of acupuncture applied to PC6 and ST36 for the relief of fullness of epigastrium or epigastric pain. Subjects and Methods : We enrolled fifty patients in a case series study The patients were mainly female (94 %) with an average age of 55 years $({\pm}15.0)$; the average age of the male patients was 51 years $({\pm}20.0)$. Twenty four percent of patients were in acute phase which epigastric pain had lasted below 1 month. Twenty eight percent of patients were in chronic phase which the pain had lasted over 6 month. The rest were in subacute phase. Acupuncture needles were inserted into PC6 and ST36 bilaterally. The acupuncture treatments were performed 2 times a week for 4 weeks. One treat session was lasted for 30 min. At each visit, overall symptomatic improvement, frequency and intensity of symptoms were checked on a 4 scaled questionnaire. Results : After acupuncture treatment, a progressive improvement of pain intensity was reported in 46 of the 50 patients, including 23 of excellent and 23 of good. The progress of symptom was more superior in subacute phase to acute or chronic phase. The symptom of 22 of 24 patients in subacute phase was improved. No patient experienced minor side-effects during acupuncture treatment. Conclusion : These preliminary data suggest the acupuncture treatment provides good pain relief for most patients presenting with epigastric pain. Randomized trials with appropriate control groups are needed to validate the effectiveness of this therapy in the treatment of epigastric pain.

• Tuberculosis and Respiratory Diseases
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• v.64 no.1
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• pp.52-56
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• 2008

A pheochromocytoma is a neuroectodermal tumor that originates from the chromaffin cells of the sympathetic system. Typical symptoms or signs are periodic attacks of paroxysmal hypertension, spell, palpitation, headache and sweating. However, the clinical presentation is quite variable. Therefore, an atypical clinical presentation sometimes makes a diagnosis difficult. Hemoptysis as a presenting symptom is very rare in pheochromocytoma. We recently experienced a patient with diffuse alveolar hemorrhage due to pheochromocytoma. A chest PA showed diffuse consolidation and ground glass opacities in both lungs. A chest CT showed diffuse consolidation and ground glass opacities in the central, middle and lower portion predominance of the lungs, sparing the costophrenic angles and apices of the lungs. In Korea, a case of pheochromocytoma that presented initially as massive hemoptysis due to diffuse alveolar hemorrhage has not been previously reported. We report the case with a review of the literature.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.1
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• pp.70-74
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• 2008

Herpes simplex virus has rarely been identified as a cause of esophagitis in immunocompetent children. This virus affects predominantly males presenting with symptoms of fever, odynophagia, dysphagia, and retrosternal pain of acute onset. Esophagoscopy typically reveals exudative well-circumscribed ulcerations of the distal and/or mid-esophagus. Further investigations using biopsy, viral culture, polymerase chain reaction (PCR), and seroconversion of antibodies to Herpes simplex are recommended to assist with a definitive diagnosis. This esophagitis is often a self-limited infection in immunocompetent children. Nevertheless, antiviral treatment may expedite symptom relief with Herpes simplex virus infection. It is imperative to document herpes esophagitis in cases with subsequent severe odynophagia in immunocompetent children. Here we present the case of a 12-year-old immunocompetent boy with herpes esophagitis.

• Annals of Clinical Neurophysiology
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• v.17 no.1
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• pp.24-27
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• 2015

Amyloidosis is a systemic disorder associated with clonal plasma cell dyscrasia. Nephrotic syndrome, congestive heart failure, autonomic and peripheral neuropathy is often associated features in amyloidosis. Early diagnosis is most important because of different prognosis by stage. The diagnosis can be delayed since symptoms of amyloidosis may vary or nonspecific. We describe a patient of myeloma-associated amyloidosis, who showed orthostatic intolerance as the first symptom of the disease.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.379-382
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• 2014

A case of intractable hiccup developed by cavernous hemangioma in the medulla oblongata is reported. There have been only five previously reported cases of medullary cavernoma that triggered intractable hiccup. The patient was a 28-year-old man who was presented with intractable hiccup for 15 days. It developed suddenly, then aggravated progressively and did not respond to any types of medication. On magnetic resonance images, a well-demarcated and non-enhancing mass with hemorrhagic changes was noted in the left medulla oblongata. Intraoperative findings showed that the lesion was fully embedded within the brain stem and pathology confirmed the diagnosis of cavernous hemangioma. The hiccup resolved completely after the operation. Based on the presumption that the medullary cavernoma may trigger intractable hiccup by displacing or compression the hiccup arc of the dorsolateral medulla, surgical excision can eliminate the symptoms, even in the case totally buried in brainstem.

• Child Health Nursing Research
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• v.22 no.4
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• pp.370-378
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• 2016

Purpose: The purpose of this study was to examine current status of somatic symptoms of late school-aged children using the school health clinic and to investigate the influence of perceived attachment security and social support on their somatic symptoms. Methods: For this descriptive study, self-report questionnaires were completed by fifth and sixth graders attending 'A' elementary school in Gyeonggi-do. Data from 216 students were included. Data analysis included descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and multiple regression analysis. Results: Most frequent somatic symptoms were headache, fainting, backache, numbness in a body part, and muscle ache in that order. More frequent somatic symptoms were reported by girls, students who recognized their family SES as low, students who used school health clinic often and students who were dissatisfied with school life. Somatic symptom showed negative correlations with attachment stability and perceived social support from family and teachers. In the regression analysis, the variables; low attachment stability, female gender, and low satisfaction with school affected more frequent somatic symptoms. Conclusion: Careful monitoring of late school-aged children expressing frequent somatic symptoms is required. Intervention programs to improve attachment security and satisfaction with school should be developed for school children, especially girls, presenting with somatic symptoms.