Clinical Analysis of Childhood Vertigo / 대한소아신경학회지

PURPOSE: Vertigo and dizziness are not common complaints in childhood, but are present more often than formerly thought. A detailed interview and otoneurological examination are important for reaching a specific diagnosis and treatment. The purpose of our study was to obtain our own etiological, clinical and diagnostic statistics, and to review the major related pathologies. METHODS: We investigated eighty-five children who visited Dankook University Hospital with a chief complaint of vertigo. Presenting symptoms, the result of diagnostic tests, and etiologic diagnoses were evaluated. RESULTS: Benign paroxysmal vertigo in childhood was the most common etiology of childhood vertigo accounting for about 38.8%, and migrainous vertigo and post-traumatic vertigo were present in 17.6% and 12.9% respectively. In vestibular function testings, electronystagmography and rotating chair test were abnormal in 11.2% and 21.2%, and the score of sensory organization test in posturography was lower than 50 in 44.4%. Other clinical diagnostic tests were informative for elucidation of individual etiologies. CONCLUSION: Benign paroxysmal vertigo in childhood and migrainous vertigo were the most common etiologies in childhood vertigo, with the former more common in under 12 years and the latter more common in over 12 years. Vestibular function tests were not so informative in diagnostic approach of childhood vertigo.

Factors Associated with Retreatment of Intravenous Gamma-Glubulin in Kawasaki Disease / 소아알레르기및호흡기학회지

PURPOSE: In most patients of Kawasaki disease(KD), fever subsides within 48 hours after infusion of intravenous immunoglobulin(IVIG), but in some cases, retreatment of IVIG is needed because of prolonged fever. This study was performed to findout the factors associated with the retreatment of IVIG in KD. METHODS: Patients with KD, treated with IVIG were classified into two groups : single IVIG treatment group(defeverescence within 48 hours after starting IVIG : group B) and IVIG retreatment group(retreatment with IVIG for fever over 48 hours despite the 1st infusion of IVIG; group A). We compared the clinical symptoms, laboratory findings, clinical signs and echocardiogram findings between group A and B. RESULTS: The mean CRP level of group A was higher than that of group B(P= 0.001), and the mean cholesterol level of group A was lower than that of group B(P=0.002). In CRP level is above 10 mg/dL, odds ratio for retreatment of IVIG is higher than that of level below 10 mg/dL. As cholesterol level decreased, the odds ratio for retreatment with IVIG increased. CONCLUSION: When readministration of IVIG in KD patients for prolonged fever over 48 hours, the consideration of the initial levels of relatively low serum cholesterol and high CRP is recommended.

Intra-arterial Blood Pressure Changes in Very Low Birth Weight Infants During the First Seven Days of Life

PURPOSE: We aimed to assess the influence of perinatal factors on intra-arterial mean blood pressures of very low birth weight infants during the first seven days of life and the association of intra-arterial mean blood pressures on the common morbidities and neonatal death of very low birth weight infants. METHODS: The retrospective study on intra-arterial mean blood pressures over the first seven days of life in 103 very low birth weight infants who admitted to the neonatal intensive care unit at the Dankook University Hospital from Jan. 1996 to Dec. 2000 was done. Trend data for each infants were assessed in 9 time periods until seven days of age. Perinatal factors that might influence intra-arterial mean blood pressures and the association of intra-arterial mean blood pressures on neonatal death and common morbidities were assessed. RESULTS: Intra-arterial mean blood pressures of very low birth weight infants increased with birth weight and gestational age (P<0.05), and significantly increased with postnatal age over the seven day periods from 35.0+/-4.9 mmHg (period 1) to 44.2+/-6.5 mmHg (period 9). Intra-arterial mean blood pressures of infants weighing less than 1,000 g were significantly lower than infants weighing 1,000 to 1,499 g at all each time periods (P< 0.05). Intra-arterial mean blood pressures were found to correlate significantly with antenatal steroid (P<0.005), and correlate inversely with PDA (P<0.001), pulmonary hemorrhage (P<0.005) and ROP (P<0.05). CONCLUSION: Intra-arterial mean blood pressures in very low birth weight infants during the first seven days were found to correlate significantly with postnatal age, gestational age, birth weight and antenatal steroid and probably correlate with some common morbidities of very low birth weight infants. It is therefore important to maintain adequate blood pressure ranges during the first seven days of life that are the most critical periods of illness for the majority of very low birth weight infants.

A Case of Adams-Oliver Syndrome which was Observed in Two Brothers

Adams-Oliver syndrome is characterized by the presence of scalp aplasia cutis congenita with distal limb anomalies. Cutis mammorata and dilated scalp veins are additional frequent manifestations of the condition. In almost all reported patients with Adams- Oliver syndrome, the trait of inheritance was autosomal dominant. Only three reports suggested autosomal recessive inheritance characterized by multiple affected offsprings in unaffected parents. But a number of sporadic cases have been described. We have experienced a boy with this syndrome, who showed large congenital scalp defect with exposed dural membrane and bony defect beneath it, cutis mammorata on whole body, equinovarus, and no metatarsal ossification center of left foot. His brother also had these symptoms, but their parents were not affected. He was complicated by bacterial meningitis, and cured with antibiotics. The skin defect was closed spontaneously with atrophic scar. We report this case with the brief review of literature.

Two Cases of Cervical and Mediastinal Emphysema / 소아알레르기및호흡기학회지

Spontaneous pneumomediastinum is rare in children, mainly affecting male adolescents. It usually occurs secondary to alveloar rupture in the pulmonary interstitium, followed by dissection of gas towards the hilum and mediastinum. Many pathological and physiological events can lead to alveolar rupture, but the most common cause in children is asthma. The most frequent triggers in the pediatric age group are asthma, vomiting of any cause, situations reproducing the Valsalva maneuver (e.g., shouting, coughing), and intense sport activities. We report two cases of pneumomediastinum, occuring in a patient with vigorous coughing and pneumonia and in a patient with dyspnea and pneumonia. We describe the clinical and radiologic findings of two cases. In addition, we have made a comprehensive review of the literature on spontaneous pneumomediastinum in children.