• Journal of the Korean Society of Radiology
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• v.82 no.2
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• pp.493-497
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• 2021

A malignant rhabdoid tumor is an aggressive tumor that occurs mainly in the kidney of infants and children. When it occurs in extrarenal sites, it is referred to as an extrarenal malignant rhabdoid tumor. Although a few cases of malignant rhabdoid tumor occuring in the central nervous system, liver, brain, skin, and soft tissue have been reported, it is rarely observed in the stomach. We report the imaging findings of a malignant rhabdoid tumor of the stomach that mimicked a gastric lymphoma in a patient who presented with melena.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.6 no.1
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• pp.74-89
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• 1995

Selective mutism is a childhood condition defined by persisten failure to speak in specific social situation when speaking is expected, dispite preserved ability to comprehend spoken language and speak. Present study is to investigate clinical characteristics, treatment method and outcome of 23 children who were diagnosed as selective mutism by DSM-IV criteria at the child psychiatry ouptatient department of SNUH. The results were as follows : 1) The Sex ratio was 1: 4.8, female dominant Mear age of onset was 33 years old and mean age of first referral was 7.7 years old. 2) 22% of subjects had perinatal problem such as low birth weight, preterm birth, 26% of the subjects have history of delayed language development. There are subjects who had been separated with mam caretaker before 3 years old(26%) and who experienced physical or psychological trauma before 3 years old(26%). A few subjects had enurests(30%) and encoprests(4%). 3) Many subjects(65%) had symbiotic relationship with their mother. These families consist of dominant, verbally aggressive mother and passive father. Parents of 39% of all subjects were judged to have definite psychopathology(social phobic, depression, hysterical trait or alcohol problem) 26% of all subject, were reported physically abused. 4) The personality trait of the subjects were frequently described as follows(in order of frequency) ; Shy(100%), anxious(83%), stubborn(83%)m rigid and tense posture(78%), immature(65%) overdependent(65%), irritable(52%), manipulative(39%), depressive(39%). 5) The mean performance IQ of 16 subjects by KEDI-WISC was 88.3 Among them, the subjects with IQ below 69 were seven and those with IQ above 70 were nine. When comparing these two group(Mental retardation group vs Normal IQ group), we could find some difference in language development, personality trait, family dynamics and treatment outcome. 6) Among several treatment methods for selective mutism, play therapy was the most frequently used method(65%). Other commonly used treatment methods were pharmacotherapy(21%), behavioral therapy(8%), combined therapy(play therapy+pharmacotherapy+family therapy+behavioral therapy)(12%), 7) Regarding the outcome of treatment 8.6% was evaluated as Excellent, 30.4% as Good, 52% as Fair, 8.7% as Poor at the tinic of treatment. At follow up interview 21.7% was evaluated Excellent, 13% as Good, 21.7% as Fair, 34.8% as Poor. 8) We classified all subjects by Havden's 4 subtype. Symbiotic mutism was most common(65%) and other subtypes are Speech phobic mutism(8.6), Reactive mutism(13%) and Passive-aggressive mutism(30%).

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.12 no.1
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• pp.115-124
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• 2001

Objective：The purpose of this study was to compare the clinical features of children with three subdiagnoses of tic disorder(transient tic disorder(TTD), chronic tic disorder(CTD) and Tourette’s disorder (TD)) and to exam the factors related with illness severity of them. Method：Subjects were 69 children who met DSM-IV criteria for tic disorder and 43 control children. All subjects were investigated demographic and clinical factors related to tic. The severity of tic was assessed with the Yale Global Tic Severity Scale(YGTSS) in tic disorder children. The Child Behavior Checklist(CBCL) was accomplished by parents of all subjects. Results：Children with TTD had not only shorter duration of tic symtoms but also milder tic severity and impairment than those with CTD and TD. They also had significantly lower scores on most CBCL subscales than children with CTD and TD, while they were similar with controls in all the CBCL subcale scores except aggressive behavior. Children with CTD and those with TD were similar to each other in clinical variables except number of tic symptom and scores on CBCL social problem subscale. The interference and intensity of motor tic symptoms and duration of tic symptoms were significant predictors of global impairment score on YGTSS, while the presence of comorbid ADHD was a preictor of the total behavior problem score of CBCL. Conclusion：These findings indicate that duration of tic symptoms and the presence of comorbid ADHD as well as the severity of tic symptoms strongly associated with the illness severity of children with tic disorder. These results also suggest that those clinical factors may be more important for assessing the severity of illness and determining the treatment strategy than the sub-diagnosis itself in children with tic disorder.

• Clinical and Experimental Pediatrics
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• v.51 no.2
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• pp.156-161
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• 2008

Purpose : Neutropenic enterocolitis is an acute, life-threatening inflammation of the small and large bowel, often seen in children with malignancies during periods of prolonged or severe neutropenia. The optimal management for typhlitis in pediatric oncology patients has been debateful between operative and nonoperative approaches. The purpose of this study was to review the outcome of medical management of patients who were diagnosed as typhlitis. Methods : The records of 207 pediatric cancer patients who were diagnosed and treated at the pediatric department of Yeungnam University Hospital for cancer between August, 2002 and July, 2007 were reviewed. Results : Among 207 patients, 12 (5.7%) children aged 9 to 14 years, were diagnosed clinically to have typhlitis. Clinical symptoms and signs of patients were fever, abdominal pain and tenderness, diarrhea, vomiting and rebound tenderness. Bowel-wall thickening (> 4mm) was seen on CT or ultrasonography. All patients were treated with antibiotics combinations of teicoplanin, carbapenem, aminoglycoside, or other third generation cephalosporin and metronidazole or clindamycin. Eight patients were treated with additional antifungal agents. Other supportive management included bowel rest, total parenteral nutrition, and G-CSF administration. All patients recovered completely and did not need any surgical management. Conclusion : Early diagnosis and aggressive supportive treatment appears to be important for complete recovery and survival of typhlitis.

• Journal of The Korean Association of Information Education
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• v.9 no.3
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• pp.417-438
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• 2005

The purpose of this study was to find out the relations between elementary children's game addition, aggression, and personality, by making a survey with 360 children of 5th and 6th grade in the Metropolitan are. The results were made as follows: First, as it examined the real condition of computer addition, it presented a low level of addiction. There was a meaningful difference according to their gender, however no meaningful differences were found between the grades. It found that the more they had game experience, game frequency, game concentration, the more they were addicted. Second, there were significant differences when investigated the relations of game addiction and aggression, students who were in severe addicted group showed more aggressive attitudes. Aggression in general, seemed less related to the gender, but related to the level of addiction, showing higher level of physical, linguistic, negative, indirect aggression in the more addicted group. Third, when it compared the difference between the general personality by the level of game addiction, there was a meaningful difference statistically in the addicted level of p<0.01. In detail, more addicted children showed low level of sociality, achievement, mobility, stability, and they showed lower figures in comparison with normal user group. It is interpreted that they dislike to get along with friends, and unstable emotionally.

• Journal of the Korean Society of Child Welfare
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• no.56
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• pp.253-281
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• 2016

The purpose of this study was to verify the clinical utility of th Korea Child Behavior Checklist 16-18(K-CBCL 6-18) in diagnosing ADHD among children with psychological disorders in child welfare institutions. The participants were 509 elementary school children(309 boys and 200 girls) who lived in child welfare institutions. They were assessed using the Korean ADHD Rating Scale(K-ARS) and K-CBCL 6-18. Only five scales of the K-CBCL 6-18 related with attention were used for analysis: syndrom total, externalizing total, aggressive behavior, attention problems and DSM-oriented ADHD scales. The results were as follows. First, K-ARS and K-CBCL 6-18 had significantly positive correlations with all five scales. Second, as a result of a t-test on the ADHD and the non-ADHD groups, which were divided using K-ARS, the mean scores of ADHD group were significantly higher than the non-ADHD group for all five scales of the K-CBCL 6-18. The hit rate of all five scales of the K-CBCL 6-18 was 60 to 70 percent. The syndrom total and externalizing total scales had high sensitivity, whereas the aggressive behavior, attention problems, and the DSM-oriented ADHD scales had high specificity. In addition, all scales had high positive predictive values. Third, as the result of a t-test on the ADHD group and the emotional disorder group, there were significant difference in the mean scores of the attention problems and the DSM-oriented ADHD scales. The attention problems and the DSM-oriented ADHD scales had a similar percentage of hit rate, high specificity and low sensitivity. Especially, the DSM-oriented ADHD scale revealed higher specificity than the attention problems scale. The results of this study suggested that the five scales related to attention of the K-CBCL 6-18 are useful in diagnosing ADHD in child welfare institutions.

• Clinical and Experimental Pediatrics
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• v.51 no.3
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• pp.299-306
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• 2008

Purpose : Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal disorder characterized by fever, splenomegaly, pancytopenia, and hemophagocytosis in the bone marrow and other tissues. In this study, we investigated the clinical manifestations and prognostic factors in patients with HLH. Methods : We retrospectively analyzed the data from 29 patients who were diagnosed whit HLH in the Severance Children's Hospital from Jan. 1996 to Feb. 2007. Results : The median age at diagnosis was 3.8 years (range 0.1-12.2). The ratio of male to female patients was 1.1:1. The 5-year overall survival rate was 55.2% with a median follow-up duration of 32 months. In a multivariate analysis, the duration of fever before admission (survival vs. non-survival, 6.5 days vs. 14 days, P=0.010), the interval from the day of fever onset to the day of initiation of etoposide (survival vs. non-survival, 10 days vs. 35 days, P=0.002) and the presence of neurologic symptoms (survival vs. non-survival, 1 case vs. 7 cases, P=0.010) were independent, poor prognostic factors of HLH. EBV infection, gender, and the level of serum ferritin had no relations to the poor prognosis of the disease. Conclusion : This study showed that the presence of neurologic symptoms and a longer duration of fever were related to a poor prognosis. Therefore, if a patient develops neurologic symptoms and the duration of fever is prolonged, a prompt diagnostic approach and aggressive treatment for HLH are necessary.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.269-274
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• 2006

Background: Tetralogy of Fallot (TOF) with pulmonary atresia and major aortopulmonary collateral arteries (MAPCAS) is complex lesion with marked heterogeneity of pulmonary blood supply and arborization anomalies. Patients with TOF with PA and MAPCAS have traditionally required multiple staged unifocalization of pulmonary blood supply before undergoing complete repair. In this report, we describe recent change of strategy and the results in our institution. Material and Method: We established surgical stratagies: early correction, central mediastinal approach, initial RV-PA conduit interposition, and aggressive intervention. Between July 1998 and August 2004, 23 patients were surgically treated at our institution. We divided them into 3 groups by initial operation method; group I: one stage total correction, group II: RV-PA conduit and unifocalization, group III: RV-PA conduit interposition only. Result: Mean ages at initial operation in each group were $13.9{\pm}16.0$ months (group 1), $10.4{\pm}15.6$ months (group II), and $7.9{\pm}7.7$ months (group III). True pulmonary arteries were not present in f patient and the pulmonary arteries were confluent in 22 patients. The balloon angioplasty was done in average 1.3 times (range: $1{\sim}6$). There were 4 early deaths relating initial operation, and 1 late death due to incracranial hemorrhage after definitive repair. The operative mortalities of initial procedures in each group were 25.0% (1/4: group I), 20.0% (2/10: group II), and 12.2% (1/9: group III). The causes of operative mortality were hypoxia (2), low cardiac output (1) and sudden cardiac arrest (1). Definitive repair rates in each group were 75% (3/4) in group I, 20% (2/10, fenestration: 2) in group II, and 55.0% (5/9, fenestration: 1) in group III. Conclusion: In patients of TOF with PA and MAPCAS, RV-PA connection as a initial procedure could be performed with relatively low risk, and high rate of definitive repair can be obtained in the help of balloon pulmonary angioplasty. One stage RV-PA connection and unifocalization appeared to be successful in selected patients.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.292-298
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• 2009

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 ($2.2{\pm}2.1$ vs. $0.7{\pm}2.3$, 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 reguration. 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.

• Pediatric Infection and Vaccine
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• v.17 no.2
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• pp.83-90
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• 2010

Purpose : Although the incidence of polymicrobial bloodstream infection (PBSI) has increased, only a few studies have so far focused on children. Therefore, in an effort to prevent more serious situations in pediatric patients, we analyzed the clinical features, organisms, and laboratory results of PBSI. Methods : We performed a retrospective review of the case records of 97 patients with polymicrobial bloodstream infection in the Severance hospital, from 2001 to 2008. Using t-test and chi-square test, we analyzed the underlying medical conditions, clinical characteristics, organisms, and laboratory results of those patients. Results : Annual incidence of polymicrobial bloodstream infection increased from 1.4 % in 2001 to 10.9% in 2008 in pediatric patients. Immunocompromised hemato-oncological malignancy was found in 31 (31.9%) patients, and was the most common underlying medical condition; cardiovascular disease was found in 15 patients (15.4%), neurologic disease in 10 patients (10.3%), and so on. Gram positive organisms were recovered in 143 cases and gram negative organisms were recovered in 101 cases of PBSI. Staphylococcus epidermidis was the most common organism. Factors affecting mortality included underlying medical disease, immune status, nosocomial infection, and central catheter-related infection, for which the rate of mortality showed a greater increase (P<0.05). Conclusion : Due to the close connection between PBSI and fatal conditions or high mortality, it requires more aggressive management. Compared with previous studies, we discovered that immunocompromised hemato-oncological malignancy was the most common underlying medical condition and that frequency of gram-positive bacteria and fungus isolated has increased.