Carotid artery intima media thickness in obese children: relation with cardiovascular risk factors / 소아과

PURPOSE: The of common carotid artery intima media thickness (IMT) is an acknowledged noninvasive marker for early atherosclerotic changes. We investigate whether common carotid IMT is different between obese and normal-weight children and also evaluate the relationships IMT with cardiovascular risk factors. METHODS: We collected the clinical data (age, sex, pubertal stage, body mass index) and measured blood pressure, glucose, insulin, lipid profiles and adiponectin in 49 obese children (mean age, 12 years) and 24 nonobese children as controls. The control group was composed of 24 nonobese children of the same age, sex and pubertal stage. We measured the carotid IMT of all subjects by B-mode ultrasound with a 7.5-MHz linear transducer and analyzed. RESULTS: Obese children demonstrated a significantly thicker intima media (mean, 0.34 mm, peak, 0.42 mm) compared to the control group (mean, 0.31 mm, peak, 0.38 mm, P<0.01). IMT was significantly correlated to the BMI (r=0.431, P<0.01), age (r=0.317, P<0.01), total cholesterol (r=0.377, P<0.01), triglyceride (r=0.253, P<0.05) and low-density lipoprotein cholesterol (r=0.289, P<0.05). Serum adiponectin was significantly lower in obese children than in controls (11.2 ng/mL vs. 14.7 ng/mL, P<0.05) and negatively related with IMT (r=-0.267, P<0.05). CONCLUSION: Obesity is associated with increased carotid artery IMT in children. Our results suggest vascular changes in obesity seem to occur already in childhood and vascular ultrasonography may helpful for screening cardiovascular complications in obese children.

Carotid artery intima media thickness in obese children: relation with cardiovascular risk factors / 소아과

PURPOSE: The of common carotid artery intima media thickness (IMT) is an acknowledged noninvasive marker for early atherosclerotic changes. We investigate whether common carotid IMT is different between obese and normal-weight children and also evaluate the relationships IMT with cardiovascular risk factors. METHODS: We collected the clinical data (age, sex, pubertal stage, body mass index) and measured blood pressure, glucose, insulin, lipid profiles and adiponectin in 49 obese children (mean age, 12 years) and 24 nonobese children as controls. The control group was composed of 24 nonobese children of the same age, sex and pubertal stage. We measured the carotid IMT of all subjects by B-mode ultrasound with a 7.5-MHz linear transducer and analyzed. RESULTS: Obese children demonstrated a significantly thicker intima media (mean, 0.34 mm, peak, 0.42 mm) compared to the control group (mean, 0.31 mm, peak, 0.38 mm, P<0.01). IMT was significantly correlated to the BMI (r=0.431, P<0.01), age (r=0.317, P<0.01), total cholesterol (r=0.377, P<0.01), triglyceride (r=0.253, P<0.05) and low-density lipoprotein cholesterol (r=0.289, P<0.05). Serum adiponectin was significantly lower in obese children than in controls (11.2 ng/mL vs. 14.7 ng/mL, P<0.05) and negatively related with IMT (r=-0.267, P<0.05). CONCLUSION: Obesity is associated with increased carotid artery IMT in children. Our results suggest vascular changes in obesity seem to occur already in childhood and vascular ultrasonography may helpful for screening cardiovascular complications in obese children.

Surgical Correction of Congenital Heart Disease In 18 Trisomy / 소아과

18 trisomy(Edwards syndrome) is a fatal disease with a congenital heart anomaly. Patients usually receive less aggressive care because caregivers expect them to die very young. Although they have a very poor prognosis due to severe multi-organ dysfunction, symptomatic simple cardiac anomaly with left to right shunt can be repaired. We experienced a case of 18 trisomy with ventricular septal defect and patent ductus arteriosus. He showed prolonged dyspnea and tachypnea after the ligation of patent ductus arteriosus in a previous hospital. In our hospital, the ventricular septal defect was closed because his parents insisted on aggressive treatment. After surgery, the symptoms were relieved and he was discharged in a condition satisfactory to his parents and the medical team.

Transcatheter Closure of Atrial Septal Defect

BACKGROUND AND OBJECTIVES: We report our initial experience with percutaneous transvenous closure of atrial septal defects (ASD). MATERIALS AND METHOD: Between September 1997 and May 2000, we attempted transcatheter closure of ASD in 18 patients using CardioSEALTM (8), STARFlexTM (4) and Amplatzer septal occluder (6). The ages of patients ranged from 4.5-64.8 (mean 32.8) years, body weight ranging from 16-76 (mean 51) kg, Qp/Qs ratio from 1.3-3.4 (mean 2.2). RESULTS: Embolization of device occurred in two patients; right pulmonary artery in one and left atrium in the other. In one patient, the device slipped into the right atrium before detachment. After retrieval of the device, the defect seemed too large for transcatheter closure. There were no other complications apart from a transient aggravation of pre-existing atrial premature beats in two patients. There was no significant size difference between the data measured by transthoracic and transesophageal echocardiography. The stretched ASD diameter was larger (5.1 3.2 mm) than the size measured by transesophageal echocardiography. In the remaining 15 patients, complete closure of defects was confirmed by transthoracic echocardiography on the 1 day or 1 month follow-up. During the same period, transcatheter closure of patent foramen ovale(PFO) was also attempted in 7 patients with stroke. The guidewire could not be passed in 2 of the patients. In the other 5 patients, transcatheter closure was successfully performed without any problems. Though the follow-up period may have been short, no patients were found with further stroke attack. CONCLUSION: Transcatheter closure of ASD can be performed with high efficiency and safety if patient selection is adequate. The indication for ASD closure can be extended to patients with larger defects. Transcatheter closure of PFO is an easy and safe procedure, but the indications of PFO closure in patients with stroke is still unclear. Further evaluation is necessary for long-term results.

Congenital Cystic Adenomatoid Malformation of the Lung: Analysis of 17 Cases / 소아알레르기및호흡기학회지

PURPOSE: Congenital cystic adenomatoid malformation of the lung(CCAM) is characterized by an excessive overgrowth of terminal bronchiolar-type structures with a lack of mature alveoli. This study was performed to evaluate the manifestation among different pathologic classification. METHODS: Seventeen patients admitted to the Samsung Medical Center from January 1995 to June 2000, were investigated for their clinical characteristics, radiologic findings, timing of treatment and post-operative outcome in each type. RESULTS: 1) Seven patients have type 1, while 9 cases were type 2. One case was diagnosed as having mixed type. Mean ages at diagnosis are 7 years 4 months. 2) 4 cases had experienced respiratory diseases that are pneumonia(3 cases), empyema(2 cases) and lung abscess(2 cases). 3) The most common clinical manifestations are fever and cough, followed by chest pain, dyspnea, cyanosis, weak crying and moaning. 4) The left lung(10 cases), especially left lower lobe(8 cases) is involved more frequently than right lung. 5) Associated anomalies are pulmonary sequestration, pectus excavatum, diaphragmatic hernia. 6) All lesions were surgically removed and all of patients survived. In our cases, there was no difference in outcome by age at operation. CONCLUSION: In this study, CCAM show various clinical manifestations, and the outcome is good irrespective of their pathologic type and age at operation. Probably this is due to few associated anomalies in our cases, but it is not clear whether this is common finding in Korea. Our findings suggest that CCAM is treated successfully by surgical removal which can be delayed unless respiratory symptoms are evident.

A longitudinal study on the interrelation between pubertal growth and sexual maturity in malocclusion / 대한치과교정학회지

To study the sexual maturity at puberty and interrelation between pubertal growth peak and sexual maturity, 68 malocclusions (female 44, male 24) were longitudinally studied for 4 years and cross-sectional samples of 210 malocclusions were studied together. The pubertal growth peak was determined by stature increment and sexual maturity was studied using developmental stages of pubic hair and breast, menarche in female and those of pubic hair in male. The following results were obtained. 1. Mean age at menarche was 12.8 years and it was 11.8 months later than PHV. 2. At pubertal growth peak, developmental stage 2 (54.2%) and 3 (29.2%) of pubic hair were most in male, and stage 1 (72.7%) and 2 (20.5%) were most in female. 3. At pubertal growth peak, the developmental stage 2 (50%) of breast was most and the stage 3 (43.2%) was next. 4. In interrelation between skeletal growth and sexual maturity, PHV had most high correlation with menarche and stage 3 of breast, and menarche had most high correlation with stage 3 of breast. 5. Appearance of remarkable sexual maturity suggested that the PHV was passed already.

A clinical study of the effects of orthodontic appliances on the gingival tissue / 대한치과교정학회지

Fifty subjects who were to be treated with fixed orthodontic appliances by light wire edgewise technique were selected. Bands with different marginal depth were made in first molar and direct bonding brackets were bonded in second premolar. For determining the effects of fixed orthodontic appliance on the gingivel tissue, the changes of chnical crown length, periodintal pocket depth, gingival sulcus fluid were checked. The results were as follows. 1. Gingival condition was deteriorated after wearing the fixed orthodontic appliance, and the deteriorative rate was decreased gradually. 2. The greatest gingival change was occurred in the maxillary first morlar among the experimental teeth. 3. The gingival change of maxillary teeth was treater than that of mandibular teeth.(p< or =0.01) 4. The greater gingival change was occurred around subgingivally located band than around supragingivally located band. 5. Comparing the gingival changes of banded teeth with them of bonded teeth, the gingival tissue was more effected by oral hygiene than by type of appliances. 6. In the quantitive changes of gingival crevicular fluid, there was no exact relationship with gingival inflammation.

Experimental Study on Acute Gastric Mucosal Lesion

Acute gastric mucosal lesions (AGM lesions) is a general term applied to conditions characterized by the acute development of mucosal lesions in the form of erythema, mucosal hemorrhage, erosions and ulcerations in the mucosa of the stomach and duodenum. Although the pathopphysiological events leading to the formation of these lesions remain unknown, we do know that they are after preceded by one of many situations. It has become traditional to use the term stress ulcer to describe AGM lesions proceded by a major stress such as that of an operation or of severe thermal burns or hemorrhagic shock. The silent clinical manifestation of acute gastric mucosal lesions, regardless of their cause, is bleeding. AGM lesions were experimentally produced by brain injury and administration of steroid. This experimental study was conducted in order to study the so called AGM lesions, especially on production and pathology of them. This experimental animals, normal adult rate, were divided into 4 groups the first group of brain injury, the second group of brain injury and administration of steroid, the third group of administration of steroid only, and the fourth group of normal control with administration of normal saline and normal rats. The frequency of AGM lesions was studied in relation to each experimental group, experimental period and grade of lesions. The AGM lesions were divided into 3 grades depending on the macroscopic and microscopic findings. 1. AGM lesions were observed in 34 out of 63 all experimental animals except for control group of animal. Majority of the lesions were found in the glandular portion of the stomach. 2. In the brain injured group, the lesions that was erythematous and superficial mucosal erosion were found in 3 out of 21(14.3%), which were observed only in experimental period of 3-5 days. 3. In the group with brain injury and steroid administration, the lesions were found in 16 out of 21 animals(76.2%) among them grade 1 was in 2 out of 16, grade 2 in 10 and grade 3 in 4, which observed in the period of 2-7 days. 4. In the group with administration of steroid, the lesions were found in 15 out of 21 animals(71.4%), among them grade 1 was 2 out of 15, grade 2 in 11 and grade 3 in 2, which started to be observed form 2nd day through out the experimental period. 5. No lesions were investigated in the control group. No correlation between the variety of brain injury and production of AGM lesion was studied.

A Clinical Observation on Craniocerebral Injuries in Adults: Analysis of 1547 Cases

During the five years from 1972 to 1976, 2308 cases of head injury were admitted to Han Kang Sung Shim Hospital and were treated in the department of neurosurgery. Of these, 1547 were adults aged 16 and over, and 761 were infants and children up to the age of 15. The results of clinical analysis of 761 cases of above series have been reported early in 1977. In this paper, a clinical analysis of 1547 adult cases of above series was performed and following results were obrained. 1) There were 1077 males and 470 females, and the proportion of male was much greater than female, male-female ratio was 2.3:1. 2) The age incidence was greater in the age group between 16 to 40, becoming maximal at the second decade. 3) Traffic accidents form by far the largest group (62%), and next are, in order of incidence, accidents due to blow or assault, fall from a height, simple fall, and industrial accidents. 4) Among the 1547 patients investigated, 20 of 1275 cases those conscious or confused on admission were died and 103 of 272 those semicomatose or comatose were died. 5) Skull fractures were seen in 504 cases, and nearly half of those, 242 or 48%, were linear fractures. 6) Of the 333 patients with intracranial hemorrhage or subdural hygroma, 181 were accompanied by skull fracture and epidural hematoma showed highest incidence, 80.46%. 7) Of 87 epidural hematoma, 69(79%) were found in the temporal and parietal fossae of the skulls, and of 70 subdural hematoma, 60(85.7%) were found in the parietal and temporal surface of brains. 8) Operation were carried out in 228 patients and surgical mortality was 24.5%, and subdural hematoma showed highest mortality, 40.0%. 9) Among the 228 surgical cases mortalities were 30% in those operation have been carried out within 6 hours of injury, 24% in those within hours 6 to 24, and 14% in those after 24 hours. The earlier the surgery had to be carried out, the higher operation mortality was noted. 10) The overall mortality in this series was 7.95%.

A Case of Primary Osteogenic Sarcoma of the Thoracic Spine with Paraplegia

Osteogenic sarcoma arise from primitive bone forming mesenchyme which is transformed into neoplastic osteoid and bone. Most osteogenic sarcomas originate in long bone, only rarely do they occur as primary tumor of the spine. A case is presented in which a patient who had suffered from paraplegia and self voiding difficulty. It was diagnosed as osteogenic sarcoma of the 5th thoracic spine which was operated and confirmed by microscopically, and is discussed with a brief review of the literatures.

Experimental Brain Edema

By the expansion of stalk of laminaria inserted into the right epidural space of the rabbit head, cerebral compression and edema were produced. The studies of the occurrence and changes of experimental brain edema have been observed by weighing the wet and dry brain tissue, and by calculating the percentage of water content and that of swelling, with rate of per cent water content to that of control group. The percentage of water content and swelling of cerebral gray and white matters in the compressed site showed higher values than those in control and in non-compressed groups. As compared with normal group, the rate of per cent water content of cerebral gray matter at the site of compression showed gradually increasing tendency as time elapsed by 12 hours, while that of white matter demonstrated a increase of it by 24 hours and decreased gradually thereafter. Cerebral edema induced by laminaria compression was more evident and severe in the white matter than in the gray. Oxygen and glucose that are utilized the brain are two of the most important substances and play very important roles in the brain to form high energy bond and nucleic acid. Authors have attempted to measure oxygen consumption in normal rabbit brain and diseased brain that are produced by the expansion of stalk of laminaria in the intracranial epidural space. The value of oxygen consumption of cerebral gray and white matters in the compressed hemispheres showed higher values than those in control group, and they revealed a tendency of rather rapid increases at early experimental stages, an of gradual decrease thereafter.