Three Cases of Double Hanging in Korea from 2008 to 2018 / 대한법의학회지

Hanging is the most common form of suicide, but the use of a single ligature in a suicide pact is very rare. The authors identified three cases of double hanging through the National Police Agency's Scientific Crime Analysis System over 11 years in Korea, from 2008 to 2018. Of the six deaths, all but one were suicides; one was a victim of murder (suicide after murder). A couple was found hanging by a single ligature over a beam, wherein a man hanged himself using the weight of the woman he had strangled to death. A mother and her daughter used a chest of drawers as a fulcrum off which they hanged themselves, with one on each side of the drawers, using a single rope. Two lovers were found sitting at each end of the rope, using a single ligature, with a tree branch as an abutment. Each of these cases is discussed and reported along with a brief literature review. In a double hanging case, investigators should be cautious in determining the manner of death by distinguishing between a suicide pact from a homicide-suicide.

Non-Responders to Intravenous Immunoglobulin and Coronary Artery Dilatation in Kawasaki Disease: Predictive Parameters in Korean Children

BACKGROUND AND OBJECTIVES: In Kawasaki disease (KD), high dose intravenous immunoglobulin (IVIG) significantly lowers the coronary complications. However, some patients either do not respond to initial therapy or develop coronary complications. We aimed to identify the predictive factors for unresponsiveness to initial IVIG therapy and coronary artery dilatation (CAD; defined by Z-score≥2.5) in the acute phase and convalescent phase. SUBJECTS AND METHODS: A retrospective review was conducted of 703 patients with KD, admitted to Gachon University Gil Medical Center between January 2005 and June 2013. The patients were divided into two groups-IVIG responders vs. non-responders-based on the IVIG treatments, and presence of fever after treatment. Further, these groups were divided into two subgroups based on their CAD. RESULTS: Among the 703 patients with KD, the rate of non-responders to initial IVIG was 16.8%. Serum total bilirubin, platelet count, and neutrophil proportion were independent predictive parameters of unresponsiveness (p<0.05). CAD was found in 234 patients (33.3%) in the acute phase, and in 32 patients (4.6%) in the convalescent phase. Male gender, fever duration, serum C-reactive protein, and white blood cell count were related to CAD (p<0.05). CAD was detected more frequently in non-responders than in the responders (47.5% vs. 31.5%, p=0.001). Kobayashi, Egami, and Sano scoring systems applied to our study population reflected low sensitivities (28.0-33.9%). CONCLUSION: Several independent parameters were related to unresponsiveness to the initial IVIG or CAD. These parameters might be helpful in establishing more focused and careful monitoring of high-risk KD patients in Korea.

Clinical feasibility and nutritional effects of early oral feeding after pancreaticoduodenectomy

BACKGROUNDS/AIMS: Pancreaticoduodenctomy (PD) is associated with high rates of postoperative morbidity and mortality. Although many studies have shown that early postoperative enteral nutrition improves postoperative outcomes, limited clinical information is available on postoperative early oral feeding (EOF) after PD. The aim of this study was to evaluate the clinical feasibility, safety, and nutritional effects of EOF after PD. METHODS: Clinical outcomes were investigated in 131 patients who underwent PD between 2003 and 2013, including 81 whose oral feeding was commenced within 48 hours (EOF group) and 50 whose oral feeding was commenced after resumption of bowel movements (traditional oral feeding [TOF] group). Postoperative complications, energy intake, and length of stay (LOS) were reviewed. RESULTS: Demographic factors were similar in the two groups. The EOF group had a significantly shorter LOS (25.9+/-8.5 days vs. 32.3+/-16.3 days; p=0.01) than the TOF group. The rates of anastomotic leak (1.2% vs. 16%, p=0.00) and reoperation (3.7% vs. 20%, p=0.01) were significantly lower in the EOF group. In the clinically acute phase from postoperative day 1 to day 5, the mean daily calorie intake (847.0 kcal vs. 745.6 kcal; p=0.04) and mean daily protein intake (42.2 g vs. 31.9 g; p=0.00) in the EOF group were significantly higher than that in the TOF group. CONCLUSIONS: Postoperative EOF is a clinically safe, feasible, and effective method of nutritional support after PD.

The Effect of Extracorporeal Shock Wave Therapy on Lower Limb Spasticity in Subacute Stroke Patients

OBJECTIVE: To evaluate the effect of extracorporeal shock wave therapy (ESWT) on lower limb spasticity in subacute stroke patients. METHODS: We studied thirty hemiplegic subacute stroke patients with ankle plantar flexor spasticity. ESWT was applied for 1 session/week, with a total of 3 sessions at the musculotendinous junction of medial and lateral gastrocnemius muscles. Patients were evaluated both clinically and biomechanically at baseline, after sham stimulation, and at immediately 1 week and 4 weeks after ESWT. For clinical assessment, Modified Ashworth Scale (MAS), clonus score, passive range of motion of ankle, and Fugl-Myer Assessment for the lower extremity were used. A biomechanical assessment of spasticity was conducted by an isokinetic dynamometer. Two parameters, peak eccentric torque (PET) and torque threshold angle (TTA), were analyzed at the velocities of 60degrees/sec, 180degrees/sec, and 240degrees/sec. RESULTS: After sham stimulation, there were no significant changes between each assessment. MAS and PET (180degrees/sec and 240degrees/sec) were significantly improved immediately and 1 week after ESWT. However, these changes were not significant at 4 weeks after ESWT. PET (60degrees/sec) and TTA (60degrees/sec, 180degrees/sec, and 240degrees/sec) were significantly improved immediately after ESWT. Yet, these changes were not significant at 1 week and 4 weeks after ESWT as well. CONCLUSION: Lower limb spasticity in subacute stroke patients was significantly improved immediately after ESWT. Although the therapeutic effect of ESWT reduced with time and therefore was not significant at 4 weeks after ESWT, the degree of spasticity was lower than that of the baseline. Future studies with a larger sample of patients are warranted in order to verify the protocols which can optimize the effect of ESWT on spasticity.

Medial Antebrachial Cutaneous Nerve Injury After Brachial Plexus Block: Two Case Reports

Medial antebrachial cutaneous (MABC) nerve injury associated with iatrogenic causes has been rarely reported. Local anesthesia may be implicated in the etiology of such injury, but has not been reported. Two patients with numbness and painful paresthesia over the medial aspect of the unilateral forearm were referred for electrodiagnostic study, which revealed MABC nerve lesion in each case. The highly selective nature of the MABC nerve injuries strongly suggested that they were the result of direct nerve injury by an injection needle during previous brachial plexus block procedures. Electrodiagnostic studies can be helpful in evaluating cases of sensory disturbance after local anesthesia. To our knowledge, these are the first documented cases of isolated MABC nerve injury following ultrasound-guided axillary brachial plexus block.

Reliability of the Pinch Strength with Digitalized Pinch Dynamometer

OBJECTIVE: To examine the intra-rater, inter-rater, and inter-instrumental reliability of the digitalized pinch muscle strength dynamometer. METHOD: Thirty normal subjects were examined for pinch strength, using both the Preston pinch gauge and the digitalized pinch dynamometer. The participants performed all pinch strength tests in the seated position as recommended by the American Society of Hand Therapists (ASHT). Three successive measurements were taken for each hand. The mean of the three trials was used for data analysis. The pinch strength tests performed used a repeated measure design and measurements were taken by each rater. RESULTS: The relationship between the Preston pinch gauge and the digitalized pinch dynamometer in pinch strength was reliable (the ICC were 0.821 and 0.785 in rater 1 and rater 2 respectively). The relationship between the first session and second session in pinch strength using the digitalized pinch dynamometer was reliable (the ICC were 0.872 and 0.886 in rater A and rater B respectively). The relationship between rater A and rater B in pinch strength using the digitalized pinch dynamometer was reliable (the ICC was 0.754). CONCLUSION: The pinch strength measurement using the digitalized pinch dynamometer is reliable within the rater and between raters. Thus, the Preston pinch gauge and the digitalized dynamometer measure grip strength equivalently, and can be used interchangeably.

The Results of Transcatheter Occlusion of Patent Ductus Arteriosus: Success Rate and Complications Over 12 Years in a Single Center

BACKGROUND AND OBJECTIVES: Percutaneous occlusion of patent ductus arteriosus (PDA) has become increasingly attractive with the evolution of devices and techniques. We reviewed results for percutaneous occlusion of PDA using various devices in a single center. SUBJECTS AND METHODS: A retrospective review was done for 118 consecutive procedures performed in 111 patients with PDA between January 1996 and December 2007. RESULTS: The median age of the patients was 4.5 years (0.9 to 60.3 years); body weight was 16.9 kg (6.8 to 74.7 kg). The median PDA diameter at the pulmonic end was 3.8 mm (0.7 to 10 mm); mean pulmonary artery pressure was 21.0 mmHg (7 to 60 mmHg). Complete occlusion occurred in 76/111 (68.4%) immediately after implantation and in 100/111 (90.0%) at one year of follow-up. Second procedures for residual shunts were done in 7 patients. After the year 2001, the complete closure rate was 95.2% compared to 71.4% before 2001. Complications associated with the procedure were left pulmonary artery narrowing (all <20 mmHg) in 14, arrhythmia in 2, and death in 1. CONCLUSION: Evolution of devices, cumulative experience, and health insurance covering the cost of devices have contributed to good outcomes in our center for percutaneous occlusion of PDA. Our results have improved over the years, particularly with the use of the Amplatzer duct occluder.

Predictive indicators of coronary artery complications in Kawasaki disease / 소아과

PURPOSE: Kawasaki disease-the most common cause of acquired heart disease in children-incidence is increasing yearly. Therefore, we evaluated the predictive indicators of coronary complications of Kawasaki disease based on clinical and laboratory data. METHODS: Between January 2005 and March 2008, of the 201 children with Kawasaki disease treated at the Gil Hospital of Gachon University of Medicine and Science, 51 had coronary artery lesions (Group II) and 150 had no lesions (Group I). The reasons for coronary artery lesions were deduced from the clinical and laboratory data. RESULTS: Analysis of the 2 groups revealed that fever duration and days of fever after and before initial intravenous gammaglobulin (IVIG) treatment were significantly longer in Group 2 than in Group I. IVIG infusions were statistically higher in Group II than in Group I. As per the laboratory data, C-reactive protein (CRP) value was significantly higher in Group II. Collectively, >10 days of fever duration, >48 h of fever duration after, and >10 days of fever before IVIG treatment increased the risk of coronary artery lesions 6-, 5-, and 3.5-fold, respectively. Furthermore, additional IVIG courses and higher CRP level increased the risk of coronary artery lesions 4-fold and 2.3-fold, respectively. CONCLUSION: The following 3 factors were responsible for increased risk of coronary artery lesions in children with Kawasaki disease: fever duration and days of fever after and before IVIG treatment. To identifythe predictive indicators of coronary complications, it is necessary to further elucidate the relationship between well-known forecasting factors.

Mitral Valve Repair for Congenital Mitral Regurgitation in Children / 대한흉부외과학회지

BACKGROUND: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. MATERIAL AND METHOD: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. RESULT: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value (2.2+/-.1 vs. 0.7+/-.3, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral regurgitation. CONCLUSION: Our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques.

Perivascular Delivery of Rapamycin in Pluronic Gel Inhibits Neointimal Hyperplasia in a Rat Carotid Artery Injury Model, and the Complementary Role of Carotid Arteriography

BACKGROUND AND OBJECTIVES: Rapamycin has been shown to inhibit the vascular smooth muscle cell migration and proliferation that contributes to neointimal formation. We investigated whether the perivascular delivery of rapamycin in Pluronic gel could inhibit neointimal hyperplasia in a rat carotid artery model, and we tested the usefulness of carotid arteriography. MATERIALS AND METHODS: To assess the kinetics of rapamycin's release from Pluronic gel, a [3H] thymidine incorporation assay was performed with using the media exposed to rapamycin in Pluronic gel for 10, 20, 60 and 120 min. We applied 100 microgram of rapamycin in Pluronic gel to the perivascular space of the carotid artery after the balloon injury (n=9), whereas only gel was applied in a control group (n=9). We performed the carotid arteriography and the morphometric analysis 14 days after injury. RESULTS: The [3H] thymidine incorporation assay showed a reduction of uptake in a time-dependent manner (86%, 48%, 45% and 40% of the control, respectively, at 10, 20, 60 and 120 minutes). The inhibiting effect of rapamycin on neointimal hyperplasia was identified on the carotid arteriography (mean luminal diameter; 0.75+/-0.11 vs. 0.60+/-0.12 arbitrary units, respectively, p< 0.05) and on the morphometric analysis (neointima area: 0.09+/-0.03 vs. 0.17+/-0.06 mm(2), respectively, p< 0.05). CONCLUSION: This study demonstrated that perivascular delivery of rapamycin in Pluronic gel inhibits neointimal hyperplasia in a rat carotid injury model. This animal model combined with arteriography can be used for developing new drugs to treat restenosis. In addition, this technique might be useful for vascular surgery such as coronary artery bypass grafting, arteriovenous fistula formation and peripheral vascular bypass graft insertion.

Closure of secundum atrial septal defect: comparison between percutaneous and surgical occlusion / 소아과

PURPOSE: This study was performed to compare the safety, efficacy and clinical results of the Amplatzer septal occluder (ASO) for closure of secundum atrial septal defect (ASD) with surgery. METHODS: One hundred fifteen patients diagnosed as isolated secundum ASD in Gil Medical Center, Gachon University of Medicine from January 2000 to July 2006 were included. Seventy patients underwent surgical repair of ostium secundum ASD. Forty-five consecutive patients were treated with percutaneous closure using ASO. We compared the mortality, morbidity, hospital stay, and efficacy between two groups. RESULTS: Male to female ratio was 1:2.4. The mean age and the size of defects were not statistically different. No mortality occurred in either group. The success rate was 97.8% in the device group and 100% in the surgical group. The overall rate of complications was higher in the surgical group than in the device group (64.0 vs. 15.6%, P<0.05). Hospital stay was shorter in the device group than in the surgical group (4.2+/-1.2 vs. 12.4+/-4.7 days, P<0.0001). Residual shunt rates were more frequent in the device group (8.9%) than in the surgical group (4.3%) at discharge. All residual shunts disappeared at 3 months follow-up. CONCLUSION: Percutaneous closure of ASD using ASO is a safe and effective alternative to surgical repair. The indications of percutaneous ASD closure with ASO would be expanded by accumulation of experiences and evolutions of device.

Comparison of Efficacy of Transcatheter Closure of Atrial Septal Defect with Amplatzer Septal Occluder between Children and Adult

PURPOSE: This study sought to analyze the safety, efficacy, and follow-up results of percutaneous closure with Amplatzer septal occulder (ASO) for secundum atrial septal defect (ASD) in less than 10 years old by comparing to those of adult. METHODS: We divided 49 enrolled subjects to two groups as childhood group (25 patients, 10 years). We evaluated hemodynamic changes, including Qp/Qs, systolic right ventricular pressure, pulmonary artery pressure in pre- and post-treatment. The residual shunt rate and complications were investigated. Then, we compared the results between two groups. RESULTS: The success rate of two groups was not statistically different (100% vs 95.8%). The hemodynamic changes, including Qp/Qs, systolic right ventricular pressure, pulmonary artery pressure were statistically significant between pre- and post-treatment (all P0.2). The residual shunt rate and complications occurrence rate were not statistically significant between two groups. CONCLUSION: The cure rate and complications by percutaneous closure of ASD with ASO were not different between in children and in adult. This procedure was an effective treatment modality for ASD in children like in adult.

Experience of Milrinone Treatment for Persistent Pulmonary Hypertension of the Newborn

PURPOSE:Persistent pulmonary hypertension of the newborn (PPHN) is life threatening neonatal disease. Nitric oxide (NO) has been proven to improve oxygenation, however its usage is limited and 30% of patients with PPHN are NO nonresponders. Milrinone decreases right ventricular afterload and has selective pulmonary vasodilator effect. We studied the effects of milrinone on neonates with respiratory failure originated in PPHN. METHODS:Six neonates, who had oxygen index above 20 and responded poorly to other management, were treated with intravenous milrinone after confirming pulmonary hypertension with echocardiography. We reviewed their medical records retrospectively. Intravenous milrinone was started at a dose of 0.375 microgram/kg/min. Respiratory indices (Oxygenation index [OI], ventilation settings, and arterial blood gas) and cardiovascular stability (mean arterial pressure and heart rate) were documented just before; and at 6, 12, 24, 36, 48, and 72 hours after commencement of milrinone therapy. The primary outcome was the effect of milrinone on oxygenation, which was 40% reduction in OI. RESULTS:Primary cause of PPHN was meconium aspiration syndrome in three infants, respiratory distress syndrome (RDS) in the other three. Milrinone was commenced at a median age of 22.3+/-6.1 hours with a dose of 0.375 microgram/kg/min except one infant (0.5 microgram/kg/min) and infants were treated for median 58.3+/-16.7 hours. OI of all infants showed 40% reduction within 24 hours. There were no mortality, and no infants with hypotension, and intraventricular hemorrhage. CONCLUSION:Milrinone proved to be effective for PPHN by improving oxygenation. It did not cause any complications in clinical trials for newborns. It is suggested that Milrinone can replace NO or can be used as adjunct to NO in the treatment of PPHN.

A Case of Empyema Necessitatis in a Child / 소아알레르기및호흡기학회지

Empyema necessitatis, which is a rare complications of empyema especially in immunocompromised conditions, extends pus from the thoracic cavity into surrounding soft tissues. The causes of empyema necessitatis are fungal infection, pulmonary tuberculosis and various types of pneumonia. A 9-year-old boy presented with a 7 day history of anterior chest pain and a coin sized palpable mass. Physical examination revealed a papable egg sized erythematous mass above the areola of the left chest. Laboratory data revealed acute inflammation. CT scans of chest demonstrated acute inflammation from the left anterior chest to the mediastinum and pericardium. He underwent sono guided thoracentesis and percutaneous aspiration of the mass and no organisms grew in a culture of pleural fluid and percutaneous aspiration. Tuberculin skin test was negative. The child was treated with antibiotics. Then, pain and the size of the mass decreased, follow up results of CT were resolved and he was discharged with oral antibiotics. We experienced a rare case of empyema necessitatis in 9-year-old child who was immunocompetent.

Congenital Pulmonary Vein Stenosis with Normal Anatomical Connection: One case report / 대한흉부외과학회지

Congenital pulmonary vein stenosis is a rare anomaly and related to high mortality due to progressive pulmonary hypertension and heart failure in infancy. Aggressive anti-failure medication and surgical treatment is recommended. Surgical options are balloon dilatation, endovascular stent, pneumonectomy, lung transplantation, patch grafting, and sutureless repair. We report a case of congenital pulmonary vein stenosis with normal anatomical connection successfully treated with sutureless technique and using pulmonary vasodilators, such as Sildenafil, Iloprost and iNO postoperatively.

A Case of CATCH22 Syndrome with First Attack of Hypocalcemic Seizure at 13 Years of Age / 소아과

The acronym 'CATCH22' is characterized by many clinical manifestations such as cardiac defects, abnormal face, thymic and parathyroid hypoplasia, cleft palate and hypocalcaemia. It is now known to arise from chromosome 22q11.2 microdeletion, and it is also called 22q11.2 deletion syndrome. Hypocalcemia occurs in more than 50% cases of this syndrome, most frequently in neonatal periods, with some exceptions. Our patient was not diagnosed until age 13, although he had a cleft palate and presented with nasal speech and learning disturbances. He had no clinical manifestations of hypocalcemia until age 13, when he developed generalized tonic-clonic convulsions several times in that year. Laboratory tests showed hypocalcemia, hyperphosphatemia, with normo-to-low parathyroid hormone levels in the serum. Chromosome analysis with FISH revealed a deletion on the proximal portion of the long arm of chromosome 22(22q11.2). The authors herein report a case of CATCH22 syndrome who showed hypocalcemic convulsions in late childhood with a review of the literature.

Congenital Pulmonary Vein Stenosis Manifested by Severe Cyanosis in Infancy / 소아과

Congenital pulmonary vein stenosis(CPVS) with anatomically normal connection, a rare anomaly, usually leads to progressive pulmonary hypertension, cardiac failure in infancy, and death if untreated. Most are combined with other anomalies, particularly left to right shunt lesions. Very often, the detection of CPVS is overlooked on the initial cardiac echocardiogram, because it may be mild in its severity initially, but progresses over time. CPVS shows the turbulence at color Doppler echocardiogram and a pulsed-wave Doppler signal of >1.6 m/sec with loss of phase. We experienced a case showing a small sized secundum atrial septal defect and mild turbulence at the right pulmonary vein on the initial color Doppler echocardiogram, and at follow-up, severe cyanosis, pulmonary hypertension, right heart failure, and reopened ductus with bidirectional shunt. Complete examination of echocariogram must be warranted at the initial stage and follow-up, in order not to miss CPVS.

Respiratory Distress / 소아과

No abstract available.

Echocardiographic Evaluation of Left Ventricular Function in Kawasaki Disease: Effect of Immune Globulin / 소아과

PURPOSE: The purpose of this investigation was to identify the impaired myocardial function and improvement with immune globulin in Kawasaki disease. METHODS: The myocardial performance and diastolic function were evaluated in 52 patients. M-mode and Doppler echocardiography were performed before(pre) and after immune globulin treatment:two to nine days(pre), five to 15 days(period one), 14 to 35 days(period two), 49 to 77 days(period three) from onset, respectively. RESULTS: Myocardial performance of the patients compared to normal controls by fractional shortening(mean 33.6% vs 35.6%:P=0.07) and Tei index(mean 0.49 vs 0.47, P=0.1) was reduced at present, and improved after immune globulin(34.7%, 0.47 respectively), but was statistically not significant. Doppler echocardiography showed decreased isovolumic relaxation time(mean 38 ms vs 49 ms, P< 0.001), deceleration time(mean 72 ms vs 87 ms, P<0.001) and pulmonary vein S and D velocity time integral ratio(1.46 vs 1.66, P=0.1). Only IVRT showed significant differences after immune globulin (38-49-49-49 ms, P<0.001). CONCLUSION: I conclude that patients with Kawasaki disease exhibit decreased myocardial performance at present and improvement after immune globulin treatment, but it is not as peculiar as the published reports. The diastolic function assessed by Doppler echocardiography shows similar features to the restrictive pattern of diastolic dysfunction, but needs to be compared with febrile controls to determine.

Two Cases of Acquired Hypothyroidism with Severe Obesity, Short Stature and Cardiomegaly / 대한소아내분비학회지

The clinical signs of acquired hypothyroidism are usually manifested insidiously over several months to years. The incidence increases after 6 years of age and peaks at 11 to 18 years of age. The clinical symptoms and signs are fatigue, constipation, decreased growth velocity and delayed bone age, compromised intellectual performance, obesity, myxedema, hyperlipidemia, peripheral neuropathy and delayed or precocious puberty. Two children were referred to our hospital for the evaluation of severe obesity and short stature. During the evaluation we found they also had hyperlipidemia, cardiomegaly with or without pericardial effusion. Thyroid function test revealed decreased serum thyroid hormone levels with positive anti- microsome and anti-thyroglobulin antibodies consistent with long-standing acquired hypothyroidism. After the supplement of L-thyroxine, both of them showed rapid improvement of above symptoms, except for the incomplete catch-up growth. We herein report two cases of acquired hypothyroidism with severe obesity, short stature, hyperlipidemia and cardiomegaly with review of literatures.