RESUMO
BACKGROUND AND OBJECTIVES: Snoring and sleep apnea from tonsillar hypertrophy are the main problems for tonsillectomy and adenoidectomy, which are the most frequently performed surgical procedures in the pediatric population. The relative size of the palatine tonsils to the oropharynx gets smaller with increasing age, but little has been studied about the age distribution and the associated change in the clinical symptoms. We attempted to observe the incidence according to age and to determine the relationship between the tonsillar hypertrophy and snoring, and sleep apnea in obese children. MATERIALS AND METHODS: A total of 2,248 elementary school children in one district of Ansan City were entered in the study. The index of obesity, the presence and degree of tonsillar hypertrophy were determined and the symptoms due to tonsillar hypertrophy were investigated. RESULTS: The prevalence of tonsillar hypertrophy of grades 3 and 4 was 28.0% at 6yrs and 22.9% at 7yrs. The prevalence decreased dramatically after 10yrs, with the prevalence rate below 10%. The prevalence of palatine tonsillar hypertrophy was significantly higher in obese children than in non-obese children. The most common clinical symptoms determined from questionnaires were sore throat. Although snoring decreased with increasing age, sore throat accompanied by fever was more common with increasing age. CONCLUSION: The prevalence of palatine tonsillar hypertrophy rapidly decreased after the age of 10. Therefore, we believe that when making a decision to perform a tonsillectomy, the change in size of palatine tonsils with increasing age should be an important factor to consider along with clinical symptoms.
Assuntos
Criança , Humanos , Adenoidectomia , Distribuição por Idade , Febre , Hipertrofia , Incidência , Obesidade , Orofaringe , Tonsila Palatina , Faringite , Prevalência , Inquéritos e Questionários , Síndromes da Apneia do Sono , Ronco , TonsilectomiaRESUMO
PURPOSE: To determine clinical outcome in cases of traumatic intraventricular hemorrhage(TIVH) according to the mechanisms and amount of hemorrhage seen on initial CT. MATERIALS AND METHODS: We retrospectively reviewed the initial CT findings of 61 patients with TIVH. The mechanisms of TIVH were analyzed on the basis of the following CT findings: Type I; large intracerebral hematoma extending to adjacent ventricle; Type II: hemorrhagic and/or non-hemorrhagic diffuse axonal injury in the thalamus and basal ganglia; Type III: multiple small hemorrhagic lesions in the septum pellucidum, fornix, corpus callosum, and periventricular region, which may be due to inner cerebral trauma, Type IV: evidence of hypoxic brain injury, and Type V: TIVH with contusion and small subdural or epidural hematomas. The amount of TIVH was classified according to the Graeb score. We analyzed these mechanisms on the basis of CT findings, and for prognosis, correlated these with clinical outcomes and the Glasgow coma score. RESULTS: Prognosis was good in types V and III and poor in type I and II(p=0.001). In patients with a Graeb score of 4 or less, the clinical outcome was better than in those with a Graeb score above 5(p=0.03). Patients with a lower initial Glasgow coma score had poor outcomes(p=0.001). CONCLUSION: The hemorrhage mechanism in patients with TIVH could be important for estimating clinical outcome, especially during the early phase. In patients with type V or III TIVH, clinical outcome was better than in those with type I or II.
Assuntos
Humanos , Gânglios da Base , Lesões Encefálicas , Classificação , Coma , Contusões , Corpo Caloso , Lesão Axonal Difusa , Hematoma , Hemorragia , Prognóstico , Estudos Retrospectivos , Septo Pelúcido , TálamoRESUMO
PURPOSE: To evaluate the effectiveness of percutaneous transluminal angioplasty(PTA) and to determine thefactors affecting the long-term patency rate in the management of insufficient hemodialytic arteriovenousfistula(AVF). MATERIALS AND METHODS: Forty-nine cases of insufficient hemodialytic AVF were treated in 44patients(native AVF:20, graft AVF:29, M:17, F:27, Age:22-70 years). In 28 thrombus patients, thrombolysis wasperformed with urokinase, and was followed by PTA. The initial success rate and complications of PTA wereevaluated. According to the site and length of the stenosis, type and age of the AVF, the presence or abscence of thrombus, a history of diabetic mellitus, the patient 's age, and the duration of renal failure, patency rateswere compared within each subgroup using the Kaplan-Meier logrank test. RESULTS: The initial success rate of PTAfor insufficient hemodialytic AVF was 88%(43/49), the patency rate of PTA was 67% at 6 months, and 50% at 12months. The initial success rate of thrombolysis was 89%(25/28). The complication rate of PTA was 12%(6/49), ofwhich five cases were vein rupture, and one was subcutaneous hematoma. Statistically, the patency rates in theabove mentioned subgroups were not significantly different. CONCLUSION: PTA with or without thrombolysis offerssafe and effective management of insufficient hemodialytic AVF.