BackgroundHyperleukocytosis caused by acute lymphoblastic leukemia (ALL) is associated with early morbidity and mortality due to hyperviscosity arising from the excessive number of leukocytes.This study was designed to assess the incidence of hyperleukocytosis, survival outcomes, and adverse features among pediatric ALL patients with hyperleukocytosis.MethodsBetween January 2001 and December 2010, 104 children with previously untreated ALL were enrolled at the Pusan National University Hospital. All of them were initially stratified based on the National Cancer Institute (NCI) risk; 48 (46.2%) were diagnosed with high-risk ALL. The medical charts of these patients were retrospectively reviewed.ResultsTwenty (19.2%) of the 104 children with ALL had initial leukocyte counts of >100×109/L, and 11 patients had a leukocyte count of >200×109/L. Male gender, T-cell phenotype, and massive splenomegaly were positively associated with hyperleukocytosis. Common early complications during induction therapy included renal dysfunction, and central nervous system hemorrhage. The complete remission (CR) rate for the pediatric ALL patients with hyperleukocytosis (94.1%) was similar to the overall CR rate (95.6%). The estimated 3-year event free survival (EFS) and overall survival of ALL children with hyperleukocytosis were 75.0% and 81.2%, respectively. However, patients with initial leukocyte counts >200×109/L had a lower EFS than those with initial leukocyte counts 100-200×109/L (63.6% vs. 100%; P=0.046).ConclusionThe outcome of pediatric ALL cases with an initial leukocyte count >200×109/L was very poor, probably due to early toxicity-related death during induction therapy.

Purpose The aims of the present study were to compare the biomechanical effects on the adjacent segments after mono-segmental floating fusion with posterior semi-rigid or rigid stabilization, and to evaluate the effect of the amount of fusion mass on the biomechanical differences. Methods A detailed, nonlinear L1-S1 finite element model had been developed and validated. Then five models were reconstructed by different fixation techniques on the L3-L4 level: rigid fixation with an interbody spacer (Ti ? IS), rigid fixation with a large interbody spacer (Ti ? IS_all), semi-rigid fixation with an interbody spacer (PEEK ? IS), semi-rigid fixation with a large interbody spacer (PEEK ? IS_all), and semi-rigid fixation only (PEEK). Analyses were conducted for the case of erect standing position, flexion, and extension motion. Results At L1-L2 and L2-L3, PEEK ? IS demonstrated less inter-segmental rotation and nucleus pressure increments from the intact model compared with Ti ? IS. The L4-L5 and L5-S1 levels showed slightly higher values with PEEK ? IS, but these differences among the instrumented models were not significant. The motion difference based on the fusion mass at the adjacent levels was at most 3 %. All instrumentation cases generated a 55 % higher facet contact force at the lower adjacent level (L4-L5) compared to that of the intact model during 26°e xtension and the largest increment was detected at the upper adjacent level (L2-L3) in the Ti ? IS. Instrumentation with Ti ? IS markedly increased the stress in the intervertebral disk at the upper adjacent level, while the stress with PEE-K ? IS appeared largest at the lower adjacent level. Conclusions Posterior instrumentation with semi-rigid rods may lower the incidence of disk and facet degeneration in the upper adjacent segment compared to rigid rods. On the other hand, the possibility of facet degeneration will be similar for all instrumentation devices in the lower adjacent segment in the long-term. The stiffness difference between rigid and semi-rigid rods on the changes in the adjacent motion segments was more crucial than amount of fusion mass.

In this study, a high occurrence rate and risk factor for C5 palsy were verified after LF. Among the various factors, C4-C5 foraminal stenosis was the only risk factor for C5 palsy. Preoperative warning for C5 palsy after LF seems to be imperatively necessary, especially in patients with C4-C5 foraminal stenosis.

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Purpose:Since there are few studies involving acute pancreatitis in children, we reviewed our experience with this medical condition to describe the clinical features. Methods: A retrospective analysis was conducted by reviewing the medical records of 41 patients with AP who were admitted to the Department of Pediatrics of Pusan National University Hospital between January 1996 and June 2007. Results: Twenty males and 21 females (mean age, 8.7±4.5 years) were included. In 22 patients (53.7%), no definitive causes were found. The most common etiologies were choledochal cysts (22.0%). Necrotizing pancreatitis was diagnosed in 5 patients (12.2%), and recurrent acute pancreatitis in 4 patients (9.8%). CT findings included pancreatic swelling (43.9%), peripancreatic fluid collection (29.3%), ascites (24.4%), and peripancreatic fat necrosis (12.2%). Serum amylase and lipase levels at diagnosis were 535.3±553.2 and 766.2±723.6 U/L, respectively, and were normalized within 1 week in 22 and 14 patients, respectively. On the basis of the Balthazar scale, 2 patients were diagnosed with severe AP. In 4 patients (9.8%), a surgical procedure was indicated. Major complications included ascites (32.3%), sepsis (16.1%), and pseudocyst and renal impairments (12.9%). Two patients died from multi-organ failure. . 하지만 최근 여러 연구들에 따르면 소아 급성 췌장염의 발생은 증가하고

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