Association Between Receipt of General Anesthesia During Childhood and Attention Deficit Hyperactive Disorder and Neurodevelopment

Background@#There are inconsistent reports regarding the association between general anesthesia and adverse neurodevelopmental and behavioral disorders in children. @*Methods@#This nationwide administrative cohort study included children born in Korea between 2008 and 2009, and followed until December 31, 2017. The cohort included 93,717 participants who received general anesthesia with endotracheal intubation (ETI) who were matched to unexposed subjects in a 1:1 ratio. General anesthesia was defined by National Health Insurance Service treatment codes with intratracheal anesthesia, and the index date was the first event of general anesthesia. The primary outcome was attention deficit hyperactive disorder (ADHD), which was defined as at least a principal diagnosis of 10th revision of the International Classification of Diseases code F90.X after the age of 72 months.Neurodevelopment, which was assessed using a developmental screening test (Korean-Ages and Stages Questionnaire [K-ASQ]), was a secondary outcome. The K-ASQ is performed annually from 1 to 6 years of age and consists of 5 domains. The association between general anesthesia and ADHD was estimated using a Cox hazard model, and its association with neurodevelopment was estimated using a generalized estimation equation, with control for multiple risk factors beyond 1 year after the index date. @*Results@#The median age at the index date was 3.8 (95% confidence interval [CI], 1.7–5.8) years, and there were 57,625 (61.5%) men. During a mean follow-up period of 5 years, the incidence rate of ADHD was 42.6 and 27.7 per 10,000 person-years (PY) in the exposed and unexposed groups, respectively (absolute rate difference 14.9 [95% CI, 12.5–17.3] per 10,000 PY). Compared to the unexposed group, the exposed group had an increased risk of ADHD (adjusted hazard ratio, 1.41 [95% CI, 1.30–1.52]). In addition, a longer duration of anesthesia with ETI and more general anesthesia procedures with ETI were associated with greater risk of ADHD. General anesthesia with ETI was also associated with poorer results in the K-ASQ. @*Conclusion@#Administration of general anesthesia with ETI to children is associated with an increased risk of ADHD and poor results in a neurodevelopmental screening test.

Analysis of variations in anesthesia cost according to severity of physical status and cancer stage in colorectal cancer patients

BACKGROUND: Since the late 2000s, the number of anesthesia performed has increased yearly. However, there has not been research into the appropriate cost of anesthesia based on the difficulty of anesthesia performed, the number of medical personnel participated, and materials administered for anesthesia. The purpose of this study was to analyze the variations in anesthesia cost according to severity of their physical status and cancer stage in patients who had undertaken colorectal cancer surgeries. METHODS: In order to analyze the cost of anesthesia for colorectal cancer surgery, we used Electronic Data Interchange data from 2011 to 2012 of the three superior general hospitals in Seoul. Colorectal cancer codes were limited to seven codes included in the cancer screening statistics of the Health Insurance Review and Assessment Service. Based on these data, a frequency analysis and a multiple linear regression analysis were performed. RESULTS: There was no variation in the cost of anesthesia according to gender and age. However, the ASA physical status (PS) class and the cancer stage variables were confirmed to modify the anesthesia cost. CONCLUSIONS: These study imply that there is a difference in the technology used for anesthesia by medical personnel as well as the anesthesia related materials used according to the ASA PS and the cancer stage among patients having the same disease.

Characteristics and prognosis of hepatic cytomegalovirus infection in children: 10 years of experience at a university hospital in Korea / 소아과

PURPOSE: Studies on cytomegalovirus (CMV) infections in immunocompetent children are lacking, and minimal information is available in the medical literature on hepatic manifestations and complications of CMV. The aims of this study were to evaluate the clinical characteristics, laboratory data, and prognosis of children with CMV hepatitis, and to investigate its prevalence at a single medical center in Korea over a 10-year period. METHODS: One hundred thirty-two children diagnosed with CMV infection based on specific markers (anti-CMV IgM, CMV polymerase chain reaction in blood and urine, or CMV culture of urine) were included in the study. Clinical and biochemical characteristics, immunological markers, and outcomes of hepatic CMV infection were determined. RESULTS: The median age of patients (n=132) was 8.5 months (range, 14 days–11.3 years). Peak total bilirubin and alanine aminotransferase levels in serum ranged from 0.11–21.97 mg/dL, and 5–1,517 IU/L, respectively. Alanine aminotransferase remained elevated from 2–48 weeks. Jaundice was the most common clinical feature of hepatic CMV infection during infancy. The hematologic findings revealed anemia, leukocytosis, and monocytosis in CMV-infected patients. All participants recovered without administration of ganciclovir. CONCLUSION: In children with CMV hepatitis, fever was the most common symptom at presentation, and jaundice was the most common clinical feature of hepatic CMV infection in infants younger than 3 months of age. Hepatic CMV infection in immunocompetent children is often a self-limited illness that does not require antiviral therapy, as most patients in this study had favorable outcomes.

Atypical Neonatal Marfan Syndrome with p.Glu1073Lys Mutation of FBN1: the First Case in Korea

Neonatal Marfan syndrome (nMFS) is considered to be on the most severe end of the spectrum of type I fibrillinopathies. The common features of nMFS include ascending aortic dilatation, severe mitral and/or tricuspid valve insufficiency, ectopia lentis, arachnodactyly, joint contractures, crumpled ear, loose skin, and pulmonary emphysema.We describe a newborn male diagnosed with nMFS. He presented several atypical features, such as diaphragmatic eventration, severe hydronephrosis with hydroureter, and dilated cisterna magna. Molecular analysis revealed a missense mutation at nucleotide 3217 (c.3217G>A) in exon 26 of the fibrillin-1 (FBN1) gene, resulting in the substitution of a glutamate for a lysine at codon 1073 (E1073K) in the 12th calcium binding epidermal growth factor-like domain of the FBN1 protein. Here we report a rare case of Nmfs with several combined atypical features, such as diaphragmatic eventration, severe hydronephrosis with hydroureter, and dilated cisterna magna. Our report is the first atypical nMFS case with p.Glu1073Lys mutation of FBN1 in Korea and may help clinicians with the diagnosis and follow-up of atypical nMFS.

Cytologic Features of Prostatic Adenocarcinoma in Urine: Comparison with Urothelial Carcinoma

BACKGROUND: Prostate adenocarcinoma (PACa) cells are rarely identified in urine cytology specimens and might be easily overlooked or misdiagnosed as urothelial neoplasm when clinically unsuspected. METHODS: We reviewed 19 urine cytology specimens obtained from 13 patients with PACa and evaluated the characteristic features discriminating PACa from urothelial carcinoma (UCa). For comparison, 27 cases of high-grade UCa (HGUCa) and 10 cases of urothelial carcinoma in situ (UCis) were also evaluated. RESULTS: The urine cytologic evaluation of PACa revealed clustered cells forming 3-dimensional syncytial fragments with occasional microacinar grouping in a clean background. Most tumor cells were small and uniform with a high nuclear-to-cytoplasmic ratio and indistinct cell borders. The nuclei were round-to-oval and the cytoplasm was scanty and thin. One or more centrally-located prominent nucleoli were characteristically noted in one half of the cases. The nucleoli had a well-defined, large, round and eosinophilic appearance. In four high-grade cases, large tumor cells were encountered and had relatively monotonous cells with smooth-outlined cell clusters, well-defined and thin cytoplasm, and round nuclei with characteristic prominent nucleoli. CONCLUSIONS: Combining the information of prostate cancer and the recognition of cytomorphologic features of PACa will help differentiate PACa from HGUCa and UCis.

Confocal Microscopic and Histopathologic Changes in Corneal Morphology Under Corneal Scraped Injury in Rabbit

PURPOSE: To investigate that the effects of early wound healing stage after corneal epithelial scrape injury. METHODS: We studied the change of scraped corneal wound like corneal cells, corneal thickness, acelluar zone, and celluar morphology occurring at the time points of 1, 4, 12, 24, 48, 72 hours, and 7 days after corneal epithelial scrape injury by the confocal microscopy and EM findings in 4 each group rabbits. RESULTS: By normal confocal microscopy, the mean cell density was 891 cells/mm2 in the anterior stroma and decreased to 814 cells/mm2 in the middle stroma, 731 cells/mm2 in the posterior stroma, and the endothelial density was 3236 cells/mm2. The change in the morphology of the keratocyte nuclei from an elliptical shape anteriorly, to a more elongated shape posteriorly. Apoptosis revealed like as condensation or fragmentation of chromatin and nuclei, vesicle formation, apoptotic bodies after corneal scraped injury by EM findings. The mean thickness of normal cornea was as follow; 47 micrometer in the epithelium, 334 micrometer in the stroma, and 392 micrometer in total cornea. The thickness of postoperative cornea including stromal thickness and total thickness increased at the early wound healing stage, and then decreased to the postoperative 48 hours(P<0.001). Mean range of acellular zone in the stroma increased at the early wound healing, but significantly decreased at the postoperative 48 hours, 79 micrometer(P<0.001). CONCLUSIONS: Keratocyte cell density and corneal thickness at the three portions of cornea, the thickness of stromal acelluar zone, and the changes of cellular morphology were related with a kind of the early post-inflammatory reaction, especially 24 hours, of corneal scraped injury. It should be needed more studies concerned with control of early post-inflammatory reaction.

Laminin B1 mRNA expression in squamous cell carcinoma of the skin / 대한피부과학회지

BACKGROUND: Laminin, which is present in all basement membrane, is a multifunctional glycoprotein with diverse biological activities. Like fibronectin, it can influence cell adhesion, growth, morphology, differentiation, and migration as well as the assembly of the extracellular matrix. Laminin primarily affects cells of epithelial origin, and response varies depending on the cells. OBJECTIVE: Studies about the relationship of laminin and the pathogenesis or metastasis of squamous cell carcinoma(SCC). MEHTODS: In this study, we have examined the laminin B1 mRNA expression and localizing pattern of laminin in SCC, using Northern and slot-blot hybridization, in situ hybridization and immunoperoxidase stain. RESULTS: In Northern blot hybridization, 5.6Kb mRNA transcript was detected in control and SCC specimens. Slot-blot hybridization indicated theat amounts of laminin B1 mRNA expression in SCC was 677.0+/-268.5 densitometer absorbance unit, in control was 228.0+/-16.37 unit respectively. There is a 3-fold increase in SCC compared to control. In in situ hybridization, 35S-labeled laminin B1 cDNA-mRNA hybrid granules were detected along the basement membrane and adjacent cells of SCC. In immunoperoxidase stain, laminin has stained strongly and continuously along the basement membrane of the tumor nest in well differentiated SCC, and weakly and interrupted in poorly differentiated SCC. CONCLUSION: These results suggested that laminin might be related to the pathogenesisand metastasis of squamous cell carcinomas.

Painful ophthalmoplegia secondary to nasopharyngeal carcinoma: a case report

A case of painful ophthalmoplegia with unilateral ocular pain, fixed eyeball to all directions of gaze, and loss of vision is presented. After intensive steroid therapy, conjunctival chemosis subsided markedly, but no improvement was seen in other clinical signs. We took a CT scan of orbit brain and performed nasopharyngeal biopsy and open biopsy through craniectomy. Based on the results of clinical features and findings of the CT scan and tissues, we diagnosed painful ophthalmoplegia secondary to nasopharyngeal carcinoma metastasized to orbital apex and brain.

Prophylaxis of Retinal Detachment

Sixty-four eyes in 65 patients received prophylactic treatment for retinal break and predisposing degeneration. During the follow-up period of 6 months or more, rhegmatogenous retinal detachment occurred in 2 eyes(3.0%). In one aphakic eye, new tear was responsible for the subsequent formation of retinal detachment but in the other eye, retinal detachment resulted from inadequate reaction around the treated retinal tear. One patient with bilateral multiple tears developed new retinal tear without detachment. Except these cases, no intra-or permanent post-operative complications were noticed.

The Anterior Chamber Angle Deformities in Traumatic Hyphema

The contusive anterior chamber angle deformities after traumatic hyphema probably were related to the late onset of glaucoma but have been overlooked easily. Authors analysed clinically the angle deformities of 53 patients with traumatic hyphema at the Department of Ophthalmology, Pusan National University from May 1983 to April 1986 by gonioscopic findings. The results were as follows: 1. Male to female ratio of 53 patients was 7.8:1, The average age was 23.7 years. 2. The traumatic hyphema was caused by missile injuries(58.5%) and blunt traumas(41.5%). 3. Of the 53 patients with traumatic hyphema, 42(79.2%) patients had angle recession and 9 patients had normal angle. 4. The degree of angle recession consisted of Grade I, 19.0%(8 cases), Grade II, 38.1%(16 cases), and Grade III, 42.9%(18 cases). The circumferential extent of angle recession increased proportionally with the degree of angle recession. 5. The circumferential extent of angle recession in the range of 271 degrees ~ 360 degrees was 57.1%, 181 degrees ~ 270 degrees was 23.8%, 91 degrees ~ 180 degrees was 11.9% and under 90 degrees was 7.1% of the patients. 6. There was no significant correlation between the amount of hyphema and the extent and degree of angle recession. 7. The distribution of angle recession was noted 42 cases in superonasal quadrant, 34 cases in superotemporal quadrant, 29 cases in inferotemporal quadrant and 23 cases in infercnasal quadrant and was not correlative to the amount of hyphema. 8. Of the 42 patients with angle recession, 35 patients developed peripheral anterior synechiae, its average extent was under 50 degrees, mostly being at the lower half of anterior chamber angle. 9. The relationship between the intraocular pressure and the degree of angle recession was not significant. 10. Associated ocular abnormalities other than angle abnormalities were iris damage(32.1%), chorioretinal damage(17.0%) and lens damage(7.5%). 11. The chorioretinal damage was the major cause of decreased visual acuity. 12. The chronic simple glaucoma was developed in 2(4.8%) of 42 patients with angle recession.

The Anterior Chamber Angle Deformities in Traumatic Hyphema

The contusive anterior chamber angle deformities after traumatic hyphema probably were related to the late onset of glaucoma but have been overlooked easily. Authors analysed clinically the angle deformities of 53 patients with traumatic hyphema at the Department of Ophthalmology, Pusan National University from May 1983 to April 1986 by gonioscopic findings. The results were as follows: 1. Male to female ratio of 53 patients was 7.8:1, The average age was 23.7 years. 2. The traumatic hyphema was caused by missile injuries(58.5%) and blunt traumas(41.5%). 3. Of the 53 patients with traumatic hyphema, 42(79.2%) patients had angle recession and 9 patients had normal angle. 4. The degree of angle recession consisted of Grade I, 19.0%(8 cases), Grade II, 38.1%(16 cases), and Grade III, 42.9%(18 cases). The circumferential extent of angle recession increased proportionally with the degree of angle recession. 5. The circumferential extent of angle recession in the range of 271 degrees ~ 360 degrees was 57.1%, 181 degrees ~ 270 degrees was 23.8%, 91 degrees ~ 180 degrees was 11.9% and under 90 degrees was 7.1% of the patients. 6. There was no significant correlation between the amount of hyphema and the extent and degree of angle recession. 7. The distribution of angle recession was noted 42 cases in superonasal quadrant, 34 cases in superotemporal quadrant, 29 cases in inferotemporal quadrant and 23 cases in infercnasal quadrant and was not correlative to the amount of hyphema. 8. Of the 42 patients with angle recession, 35 patients developed peripheral anterior synechiae, its average extent was under 50 degrees, mostly being at the lower half of anterior chamber angle. 9. The relationship between the intraocular pressure and the degree of angle recession was not significant. 10. Associated ocular abnormalities other than angle abnormalities were iris damage(32.1%), chorioretinal damage(17.0%) and lens damage(7.5%). 11. The chorioretinal damage was the major cause of decreased visual acuity. 12. The chronic simple glaucoma was developed in 2(4.8%) of 42 patients with angle recession.