Frequency of Self-Monitoring of Blood Glucose during the School Day Is Associated with the Optimal Glycemic Control among Korean Adolescents with Type 1 Diabetes

BACKGROUND: This study aimed to evaluate the relationship between the frequency of self-monitoring of blood glucose (SMBG) and glycosylated hemoglobin (HbA1c) levels among Korean adolescents with type 1 diabetes mellitus (T1DM). Factors affecting the SMBG frequency were analyzed in order to improve their glycemic control. METHODS: Sixty-one adolescents aged 13 to 18 years with T1DM were included from one tertiary center. Clinical and biochemical variables were recorded. Factors associated with SMBG frequency were assessed using structured self-reported questionnaires. RESULTS: Average total daily SMBG frequency was 3.8±2.1 and frequency during the school day was 1.3±1.2. The mean HbA1c level was 8.6%±1.4%. As the daily SMBG frequency increased, HbA1c levels declined (P=0.001). The adjusted odds of achieving the target HbA1c in participants who performed daily SMBG ≥5 significantly increased 9.87 folds (95% confidence interval [CI], 1.58 to 61.70) compared with those performed SMBG four times a day. In the subjects whose SMBG frequency < 1/day during the school day, an 80% reduction in the adjusted odds ratio 0.2 (95% CI, 0.05 to 0.86) showed compared to the group with performing two SMBG measurements in the school setting. The number of SMBG testing performed at school was significantly high for individuals assisted by their friends (P=0.031) and for those who did SMBG in the classrooms (P=0.039). CONCLUSION: Higher SMBG frequency was significantly associated with lower HbA1c in Korean adolescents with T1DM. It would be necessary to establish the school environments that can facilitate adequate glycemic control, including frequent SMBG.

Acute Scrotum in an Infant with Kawasaki Disease

Kawasaki disease (KD) is a systemic vasculitis that occurs predominantly in infants and young children. The etiology of KD is unknown and coronary heart disease is a major complication of KD. Acute scrotum is a rare complication of acute KD, and not as well recognized as other manifestations of the disease. We report a 2-month-old boy with acute scrotum in the acute phase of KD. He was treated with intravenous immunoglobulin (total 2 g/kg) and aspirin (50 mg/kg/day). The treatment was effective in resolving his fever and other clinical symptoms, but 2 days after starting treatment he experienced scrotal swelling. Scrotal ultrasound and transillumination were used in the diagnosis of acute scrotum. After 2 months, a follow-up testicular ultrasound revealed a remission of the acute scrotum. Subsequently, he has been followed up for KD.

Iron deficiency anemia in infants and toddlers

BACKGROUND: In Korea, the prevalence of anemia and iron deficiency anemia (IDA) among older infants and young children remains high. To detect IDA early and to reduce its adverse impact, we assessed the characteristics of infants and young children who had IDA or were at risk of developing IDA, or who exhibited characteristics associated with severe anemia. METHODS: Among the 1,782 IDA-affected children aged 6 months to 18 years who visited the hospital, we retrospectively analyzed the medical records and laboratory data of 1,330 IDA-affected children aged 6–23 months who were diagnosed between 1996 and 2013. We excluded patients with a C-reactive protein level ≥5 mg/dL. RESULTS: IDA was predominant in boys (2.14:1) during infancy and early childhood. The peak IDA incidence was noted among infants aged 9–12 months. Only 7% patients exhibited symptoms of IDA, while 23.6% patients with severe IDA demonstrated classic symptoms/signs of IDA. Low birth weight (LBW) infants with IDA demonstrated low adherence to iron supplementation. In a multivariate analysis, prolonged breastfeeding without iron fortification (odds ratio [OR] 5.70), and a LBW (OR 6.49) were identified as risk factors of severe anemia. CONCLUSION: LBW infants need more attention in order to increase their adherence to iron supplementation. For the early detection of IDA, nutritional status of all infants, and iron batteries of high-risk infants (LBW infants, infants with prolonged breastfeeding, picky eaters, and/or infants with the presence of IDA symptoms) should be evaluated at their health screening visits.

The Diagnostic Value of Pelvic Ultrasound in Girls with Central Precocious Puberty / 전남의대학술지

The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for differentiating central precocious puberty (CPP) from exaggerated thelarche (ET). Because of this test's limitations, previous studies have clarified the clinical and laboratory factors that predict CPP. The present study investigated the early diagnostic significance of pelvic ultrasound in girls with CPP. The GnRH stimulation test and pelvic ultrasound were performed between March 2007 and February 2015 in 192 girls (aged <8 years) with signs of early puberty and advanced bone age. Ninety-three of 192 patients (48.4%) were diagnosed as having CPP and the others (51.6%) as having ET. The CPP group had higher uterine volumes (4.31+/-2.79 mL) than did the ET group (3.05+/-1.97 mL, p=0.03). No significant differences were found in other ultrasonographic parameters. By use of receiver operating characteristic curve analysis, the most predictive parameter for CPP was a uterine volume of least 3.30 mL, with an area under the curve of 0.659 (95% confidence interval: 0.576-0.736). The CPP group had significantly higher uterine volumes than did the ET group, but there were no reliable cutoff values in pelvic ultrasound for differentiating between CPP and ET. Pelvic ultrasound should be combined with clinical and laboratory tests to maximize its diagnostic value for CPP.

The Diagnostic Value of Pelvic Ultrasound in Girls with Central Precocious Puberty / 전남의대학술지

The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for differentiating central precocious puberty (CPP) from exaggerated thelarche (ET). Because of this test's limitations, previous studies have clarified the clinical and laboratory factors that predict CPP. The present study investigated the early diagnostic significance of pelvic ultrasound in girls with CPP. The GnRH stimulation test and pelvic ultrasound were performed between March 2007 and February 2015 in 192 girls (aged <8 years) with signs of early puberty and advanced bone age. Ninety-three of 192 patients (48.4%) were diagnosed as having CPP and the others (51.6%) as having ET. The CPP group had higher uterine volumes (4.31+/-2.79 mL) than did the ET group (3.05+/-1.97 mL, p=0.03). No significant differences were found in other ultrasonographic parameters. By use of receiver operating characteristic curve analysis, the most predictive parameter for CPP was a uterine volume of least 3.30 mL, with an area under the curve of 0.659 (95% confidence interval: 0.576-0.736). The CPP group had significantly higher uterine volumes than did the ET group, but there were no reliable cutoff values in pelvic ultrasound for differentiating between CPP and ET. Pelvic ultrasound should be combined with clinical and laboratory tests to maximize its diagnostic value for CPP.

A Novel Balloon-Inflatable Catheter for Percutaneous Epidural Adhesiolysis and Decompression

Epidural adhesions cause pain by interfering with the free movement of the spinal nerves and increasing neural sensitivity as a consequence of neural compression. To remove adhesions and deliver injected drugs to target sites, percutaneous epidural adhesiolysis (PEA) is performed in patients who are unresponsive to conservative treatments. We describe four patients who were treated with a newly developed inflatable balloon catheter for more effective PEA and relief of stenosis. In the present patients, treatments with repetitive epidural steroid injection and/or PEA with the Racz catheter or the NaviCath did not yield long-lasting effects or functional improvements. However, PEA and decompression with the inflatable balloon catheter led to maintenance of pain relief for more than seven months and improvements in the functional status with increases in the walking distance. The present case series suggests that the inflatable balloon catheter may be an effective alternative to performing PEA when conventional methods fail to remove adhesions or sufficiently relieve stenosis.

Radiofrequency thermocoagulation of the thoracic splanchnic nerve in functional abdominal pain syndrome: A case report / 대한마취과학회지

The thoracic splanchnic nerve block has been used in managing abdominal pain, especially for pains arising from abdominal cancers. A 27-year-old male patient who had a constant abdominal pain was referred to our clinic for pain management but had no organic disease. The numeric rating scale (NRS) for pain scored 7/10. We applied a diagnostic thoracic splanchnic nerve block under the diagnosis of functional abdominal pain syndrome. Since the block reduced the pain, we applied a radiofrequency thermocoagulation at the T11 and T12 vertebral level. Thereafter, his symptoms improved markedly with pain decreasing to an NRS score of 2-3/10. Hereby, we report a successful management of functional abdominal pain via radiofrequency thermocoagulation of the thoracic splanchnic nerves.

Abnormal Fractal Correlation of Heart Rate in Children with Neurocardiogenic Syncope

PURPOSE: The purposes of this study were to determine short- and long-term fractal correlation behavior of heart rates during daily activity in patients with neurocardiogenic syncope. METHODS: Twenty five patients with histories of neurocardiogenic syncope episodes were included. Their analogue 24h ambulatory Holter electrocardiograms were analyzed. The tape was digitized and the digitized electrocardiograms were partioned into sections of one hour. Then their RR intervals were measured and 20,000 points of RRI were used. To quantify the fractal correlation behavior, we employed the detrended fluctuation analysis, and short-term(n16, alpha2) fractal scaling exponents were calculated. RESULTS: When compared to control, 24-hour average values of alpha1 and all alpha1 values at quarters of each day were significantly higher in patients with syncope. On the contrary, their 24-hour average value of alpha2 and all alpha2 values at quarters of each day were lower in patients with syncope. However, statistical significances were found in 24-hour average value of alpha2 and in alpha2 value at MN-6AM. CONCLUSION: In the syncope patients with neurocardiogenic syncope, short-term fractal scaling exponents of RR interval was significantly high throughout the day. Therefore, their RR intervals were smoother in the short term scale and had a tendency to continue in the same direction of increase or decrease, which may contribute to persistent decrease in heart rate during a syncopal attack.

The Correlation between Acholic Stool and the Result of Tc(99m) DISIDA Hepatobiliary Scintigraphy and Biochemical Test in Neonatal Cholestasis / 대한소아소화기영양학회지

PURPOSE: The most common causes of neonatal cholestasis are neonatal hepatitis (NH) and extrahepatic biliary atresia (EHBA). Since neonatal cholestasis presents with variable expression of same pathologic process and has similar clinical, biochemical, and histologic features between EHBA and idiopathic neonatal hepatitis (NH), differential diagnosis is often difficult. We reviewed the differences of clinical characteristics and laboratory data to find out any correlation between the results of Tc(99m) DISIDA scan and presence of acholic stool. METHODS: Between June 1993 and January 2001, total 29 infants younger than 4 month-old underwent Tc(99m) DISIDA scan. Their biochemical tests and clinical course were reviewed retrospectively. RESULTS: Patients who had negative intestinal activity on Tc(99m) DISIDA scan showed acholic stool and revealed higher serum direct bilirubin and urine bilirubin level. 18.2% of patients with acholic stool showed intestinal activity on Tc(99m) DISIDA scan and 81.8% of them did not. All the patients without acholic stool showed positive intestinal activity on Tc(99m) DISIDA scan. The result of Tc(99m) DISIDA scan and the presence of acholic stool showed high negative correlation (r :-0.858). Patients with acholic stool and negative intestinal activity on Tc(99m) DISIDA scan showed higher serum total bilirubin level. Patients without acholic stool and positive intestinal activity on Tc(99m) DISIDA scan showed higher serum level of ALT. CONCLUSION: Patients with acholic stool and negative intestinal activity showed high correlation, but 18.2% of patients with acholic stool showed positive intestinal activity. So operative cholangiogram or transcutaneous liver biopsy should be performed for confirmation.

A Case of Multicentric Infantile Myofibromatosis / 대한소아혈액종양학회지

Infantile myofibromatosis is one of the most common fibrous proliferation of infancy, characterized by the development of non-tender, firm, discrete, flesh-colored to purple nodules in skin, muscle, bone, and subcutaneous tissues. Three distinct subtypes are recognized-solitary, multicentric and generalized subtype. In solitary and multicentric subtypes, the prognosis is excellent with expected spontaneous regression of nodules in 1 to 2 years. But the prognosis of generalized subtype is poor with 75% of patients dying within the first few months of life secondary to cardiopulmonary or gastrointestinal complications. We report a case of multicentric infantile myofibromatosis in a 4-year-old boy presenting with multiple, asymptomatic, fixed and protruding masses on the posterior occiput, shoulders, upper and lower back and right lateral chest wall. Over the subsequent 20 monthes, the child developed limitation of motion of back and shoulder with the repeated formation and disappearance of myofibromatosis of the skin and musculature, but without visceral involvement.

Evaluation of Therapeutic Effect of Acoustic Schwannoma After Gamma-Knife Radiosurgery using Follow-up MRI

PURPOSE: To evaluate, using short-term follow-up MR imagings, the usefulness of gamma-knife radiosurgery in patients with acoustic schwannoma. MATERIALS AND METHODS: In 34 patients (M:F=11:23, aged 11 -69 years) with acoustic schwannoma, eleven of whom had undergone microsurgical resection prior to gamma-knife radiosurgery, we retrospectively reviewed the serial MR imaging findings obtained before and after this procedure. Analysis focused on post-surgical changes in tumor volume and intratumoral enhancement, and the follow-up period ranged from 3 to 44 months. RESULTS: Follow-up imaging revealed that after radiosurgery, tumor size had decreased in 17 cases (50%), was unchanged in 14 (41.2%), and had increased in three (8.8%). Local tumor control was achieved in 31 of 34 cases (91.2%). Objectively defined tumor shrinkage was seen within 3 to 24 (median, 12) months of treatment, the rate of shrinkage increasing with longer follow-up. Three to 16 (median, 6) months after treatment, loss of central tumor enhancement was evident in 28 cases(82.4%). In 25 of 28 patients with intratumoral necrosis (89.3%), tumors were either smaller of their size was unchanged. Three to six (mean, 3.6) months after treatment, five cases demonstrated a transient size increase. CONCLUSION: Gamma-knife radiosurgery effectively controlled the growth of acoustic schwannoma, and intra-tumoral necrosis appears to be a predictable sign for decreased tumor size.

Evaluation of Therapeutic Effect of Acoustic Schwannoma After Gamma-Knife Radiosurgery using Follow-up MRI

PURPOSE: To evaluate, using short-term follow-up MR imagings, the usefulness of gamma-knife radiosurgery in patients with acoustic schwannoma. MATERIALS AND METHODS: In 34 patients (M:F=11:23, aged 11 -69 years) with acoustic schwannoma, eleven of whom had undergone microsurgical resection prior to gamma-knife radiosurgery, we retrospectively reviewed the serial MR imaging findings obtained before and after this procedure. Analysis focused on post-surgical changes in tumor volume and intratumoral enhancement, and the follow-up period ranged from 3 to 44 months. RESULTS: Follow-up imaging revealed that after radiosurgery, tumor size had decreased in 17 cases (50%), was unchanged in 14 (41.2%), and had increased in three (8.8%). Local tumor control was achieved in 31 of 34 cases (91.2%). Objectively defined tumor shrinkage was seen within 3 to 24 (median, 12) months of treatment, the rate of shrinkage increasing with longer follow-up. Three to 16 (median, 6) months after treatment, loss of central tumor enhancement was evident in 28 cases(82.4%). In 25 of 28 patients with intratumoral necrosis (89.3%), tumors were either smaller of their size was unchanged. Three to six (mean, 3.6) months after treatment, five cases demonstrated a transient size increase. CONCLUSION: Gamma-knife radiosurgery effectively controlled the growth of acoustic schwannoma, and intra-tumoral necrosis appears to be a predictable sign for decreased tumor size.

MR Imaging of Articular Cartilage: Comparison of Magnetization Transfer Contrast and Fat - Suppression inMultiplanar and 3D Gradient-Echo, Spin-Echo, Turbo Spin-Echo Techniques

PURPOSE: The purpose of this study was to evaluate the effects of magnetization transfer contrast(MTC) andfat-suppression(FS) in variable spin-echo and gradient-echo sequences for articular cartilage imaging and todetermine the optimal pulse sequences. MATERIALS AND METHODS: Using variable 7-pulse sequences, the knees of 15pigs were imaged Axial images were obtained using proton density and T2-weighted spin-echo (PDWSE and T2WSE),turbo spin-echo (TSE), multiplanar gradient-echo (MPGR), and 3D steady-state gradient-echo (3DGRE) sequences, andthe same pulse sequences were then repeated using MTC. Also T1-weighted spin-echo(T1WSE) and 3D spoiledgradient-echo(3DSPGR) images of knees were also acquired, and the procedure was repeated using FS. For each knee,a total of 14 axial images were acquired, and using a 6-band scoring system, the visibility of and thevisibilities of the the articular cartilage was analyzed. The visual effect of MTC and FS was scored using a4-band scale. For each image, the signal intensities of articular cartilage, subchondral bone, muscles, and salinewere measured, and signal-to-noise ratios(SNR) and contrast-to-noise ratios(CNR) were also calculated. RESULTS: Visibility of the cartilage was best when 3DSPGR and T1WSE sequences were used. MTC imaging increased the negativecontrast between cartilage and saline, but FS imaging provided more positive contrast. CNR between cartilage andsaline was highest when using TSE with FS(-3 5 1 . 1 +/-15.3), though CNR between cartilage and bone then fell to-1 4 . 7 +/-10.8. In MTC imaging using MPGR showed the greatest increase of negative contrast between cartilage andsaline(CNR change=-74.7); the next highest was when 3DGRE was used(CNR change=-34.3). CNR between cartilage andbone was highest with MPGR(161.9 +/-17.7), but with MTC, the greatest CNR decrease(-81.8) was observed. Thegreatest CNR increase between cartilage and bone was noted in T1WSE with FS. In all scans, FS provided acartilage-only positive contrast image, though the absolute value of CNR was lower than that of MTC imaging. CONCLUSION: The most prominent effects of MTC and FS were seen in MPGR and T1WSE, respectively, though forcartilage, optimal high signal intensity and contrast can be achieved using 3DGRE with MTC, and 3DSPGR with FS.