A Case of Extensive Cerebral Venous Thrombosis in Childhood Nephrotic Syndrome

Nephrotic syndrome in childhood is known to be associated with a hypercoagulable state and thromboembolic complications, among which cerebral venous thrombosis is a very rare and serious one, with only a few isolated reports in the literature. A 9-year-old boy with known nephrotic syndrome was admitted due to a relapse with massive proteinuria and generalized edema. He complained of a prolonged frontal headache. The enhanced brain magnetic resonance imaging(MRI) showed a high signal in the region of the superior sagittal sinus and right transverse sinus consistent with a thrombus. He was managed with steroids, cyclosporine and warfarin. His headache subsided 2 weeks later and proteinuria resolved 1 month later. An MRI 2 months later was normal. We describe this case and review the literature to emphasize the importance of recognizing this potentially life threatening complication and initiating anticoagulation therapy.

Clinical Course and Outcome of Thyroid Carcinoma in Childhood / 대한소아내분비학회지

PURPOSE: Thyroid carcinoma is rarely occurred in childhood and has a good prognosis despite high incidence of relapse. This study was undertaken to investigate clinical, histological characteristics and prognosis of thyroid carcinoma in childhood. METHODS: Eleven patients (6 males and 5 females) less than 21 years of age were enrolled in this study. They have been followed up for a mean duration of 6 years, ranging from 0.4 to 11 years. Clinical characteristics including age at diagnosis, sex, histological type, tumor size, metastasis, staging, treatment modality, outcome and prognosis with thyroid carcinoma in childhood were reviewed retrospectively. RESULTS: The mean age at diagnosis was 11.6+/-2.84 years. The predominant type of histology was papillary carcinoma (82%). Serum thyroglobulin levels were elevated up to 203.6+/-151.17 ng/mL in all patients at diagnosis. A thyroid scan using 99mTc-pertechnetate revealed cold (64%), warm (9%) and hot (18%) nodules. Seven patients (64%) had lymph node metastases, and five patients (45%) had pulmonary metastases at diagnosis. Total or near total thyroidectomy was performed in seven (64%) patients with local or distant metastases. Unilateral lobectomy was performed in four (36%) patients without metastases. Seven (64%) patients with local or distant metastatic lesions have been under radioiodine (131I) ablation therapy. Four (57%) out of seven patients improved, and three (43%) patients were persistent. CONCLUSIONS: Prognosis of thyroid carcinoma in childhood was good despite high incidence of local or distant metastasis. Patients with thyroid carcinoma should be diagnosed early because different treatment modalities and prognosis of patients with thyroid carcinoma could be determined by the presence of metastatic lesion and histological type.

Microarray Analysis of Gene Expression in Rat Hippocampus of Maternal Social Separation Model

OBJECTIVES: Alteration of hippocampus was demonstrated in the maternal social separation(MSS) pups, separated from dams on postnatal day(pnd) 14 and placed alone. Therefore, to understand the molecular events involved in the MSS, we have initiated a search for gene profiles that are up or down-regulated in the hippocampus of MSS pups. METHODS: Analysis of cDNA microarray was performed by using total RNA extracted from the hippocampus of control and MSS pups on pnd 17. Also, passive-avoidance test was demonstrated on pnd 35. RESULTS: Up-regulation of Nedd4a was observed in the hippocampus of MSS pups. Also, MSS rats showed less elongation of latency in passive avoidance test. CONCLUSION: We suggest that environmental effects of MSS may be altered the neural and/or glial differentiation and synapse formation-related genes which may lead cognitive alterations in MSS rats.

National Questionnaire Survey on Managing Patients with Severe Acute Respiratory Syndrome, 2003

BACKGROUND: There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. RESULTS:Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. RESULTS: The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. CONCLUSIONS: The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

National Questionnaire Survey on Managing Patients with Severe Acute Respiratory Syndrome, 2003

BACKGROUND: There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. RESULTS:Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. RESULTS: The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. CONCLUSIONS: The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

Central Vein Catheterization with an Electrocardiogram

PURPOSE: This study analyzed the value of an electrocardiogram (ECG) using an arterial pulsator in central vein catheterization (CVC). METHODS: In 442 patients who underwent CVC with an ECG and an arterial pulsator, this study evaluated the rates of change in the P wave and the QRS wave at the limb lead II before and after insertion. After insertion, a plain chest X-ray was checked in order to locate the catheter tip. RESULTS: After catheterization, the P wave and the QRS wave increased together at 97% but the P wave (change rate: 0.5~21.0) was more sensitive than the QRS wave (change rate: 0.5~5.8). For an abnormal location (3%), the rate of change in the P wave was 2.0 were 95% and 100%, and those of the QRS wave >1.4 were 90% and 100%. CONCLUSION: In central vein catheterization, an electrocardiogram with an arterial pulsator can be a useful method, and the normal position of the catheter tip can be estimated by using a rate of change in the P wave >2.0 or a rate of change in QRS wave >1.4.

Perforated Afferent Loop Syndrome in a Patient with Recurrent Gastric Cancer: Non-Surgical Treatment with Percutaneous Transhepatic Duodenal Drainage and Endoscopic Stent

Surgical treatment for afferent loop syndrome (ALS) in patients with recurrent gastric cancer is usually not feasible because of the recurrent tumor mass at the anastomosis site and/or extensive carcinomatosis resulting in bowel loop fixation. Furthermore, ALS usually makes oral intake impossible, resulting in a rapid deterioration in general condition. In this situation, gastroscopic stenting at the anastomotic site and/or percutaneous external drainage may be a more feasible alternative for palliation. We herein report a recurrent gastric cancer whose ALS was successfully treated with internal and external drainage procedures.

A Case of Vocal Cord Dysfunction / 소아과

Vocal cord dysfunction is a recently described entity in which paradoxical adduction of the vocal cords produces airflow obstruction at the level of the larynx. Recurrent wheezing results, which may imitate asthma. Inspiratory closure of the cords can also cause stridor, commonly misdiagnosed as an upper airway obstruction of undefined cause. The acute presentation is often dramatic and has led to inappropriate treatment, including intubation, tracheotomy, or high doses of steroids. We present the case of a 9 yr old boy with allergic rhinitis who was referred to us for the evaluation of wheezing and dyspnea which did not respond to asthma management. Pulmonary function tests had abnormal inspiratory phases and laryngoscopy revealed typical adduction of the vocal cord during inspiration. Psychological tests suggested anxiety and tension with repressed aggression. There have been no further episodes, possibly due to counseling and education of relaxed throat breathing as well as avoidance of inhaled medication.