The Management of Three Infants with Critical Valvular Aortic Stenosis by Transcarotid Balloon Aortic Valvuloplasty

Critical valvular aortic stenosis(AS) is a life threatening congenital heart anomaly in neonates or infants. The main cause of death is rapidly progressing left ventricular failure. The treatment goal of critical AS is to save left ventricular function early. Before the 1980s, the preferred treatment was surgical valvotomy, however, that operative method had a high mortality rate and risk of re- procedure. These surgical problems encouraged balloon aortic valvuloplasty technique for initial life saving. There were some vascular approaches for balloon aortic valvuloplasty(e.g. femoral artery and vein, umbilical artery and vein, carotid artery). Each approach has some advantages and disadvantages. Balloon aortic valvuloplasty through the right carotid artery makes access to the aortic valve easy, has less vascular complication, and short procedure time and effect of saving femoral artery for reballooning. We had three cases of transcarotid balloon aortic valvuloplasty in infants with critical AS. In our long-term follow up, we had good results, except carotid artery thrombosis in one case. We report the first three Korean cases of balloon aortic valvuloplasty though carotid artery cutdown procedure for critical AS with a brief review of literatures. (J Korean Pediatr Soc 2000;43:820-827)

Atrial Rhythms in Patients with Left Atrial Isomerism

PURPOSE: Histologic studies have revealed ectopic location and hypoplasia of sinus nodal tissue in left atrial isomerism. The purpose of this study is to characterize the atrial rhythms corresponding to these histologic abnormalities in left atrial isomerism. Electrocardiograms in left atrial isomerism are characterized by multiple atrial rhythms with abnormal P-wave axes, but the complex nature of atrial rhythms in left atrial isomerism remains to be clarified. METHODS: Surface electrocardiograms and Holter recordings of 16 patients with left atrial isomerism were retrospectively reviewed. For comparison, atrial rhythms in 8 patients with right atrial isomerism were studied with the same study protocol. RESULTS: In left atrial isomerism, atrial rhythm with abnormal superior P-wave axis was the most frequent in 69% of patients and multiple atrial rhythms were observed in 37% in surface electrocardiograms. In Holter recordings, transient or persistent slow atrial rhythms with or without visible P waves associated with junctional escape were documented in 9 out of 16(56%) patients. In comparison, multiple atrial rhythms were as frequent as in left atrial isomerism, but slow atrial rhythm with junctional escape was not present in 8 patients with right atrial isomerism. CONCLUSION: It is concluded that transient or persistent slow atrial rhythms associated with junctional escape, suggestive of atrial nodal dysfunction, are characteristic and helpful in the diagnosis of left atrial isomerism.

Clinical and MRI Findings of Acute Disseminated Encephalomyelitis Associated with Preceding Infections Confirmed Serologically

PURPOSE: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system. The pathogenesis is not well known, but it is thought to be an immune-mediated disease and may follow a viral infection or vaccinations. MRI demonstrates decreased signal on T1 weighting and increased signal on T2-weighted image. We report clinical features and characteristic MRI findings in seven patients with ADEM who confirmed the preceding infections serologically. METHODS: Patients admitted to the Department of Pediatrics at Asan Medical Center as having ADEM were evaluated for the preceding infections : CSF findings, MRI findings, effects of high-dose steroids and follow-up on changes of neurological symtoms and MRI findings. RESULTS: The onset of neurological symptoms from preceding infection was between 1-3 weeks. The etiologies were Epstein-Barr virus in two, mycoplasma pneumoniae in three, and measles virus in two cases. All lesions found in MRI were cerebral white matter lesions of which there were subcortical white matter in three, corpus callosum in three, deep white matter in two, periventricular white matter in one, internal capsule in one, and cerebral peduncle in one case. There were a total of 3 cases with gray matter lesions. Two cases were treated with high- dose methyl prednisolone, one which showed a good clinical response with much improved lesions on follow-up T2-weighted image, but no clinical response in the other with aggravated MRI lesions. There was 1 patient with gadolinium enhancement lesion in acute phase and the lesion was completely resolved after steroid treatment. CONCLUSION: MRI shows various features in ADEM and may be useful in diagnosis and evaluation of clinical course.

Total Anomalous Pulmonary Venous Connection: The Results of 23 Consecutive Patients

PURPOSE: Surgical risk of total anomalous pulmonary venous connection (TAPVC) is high, especially in patients with early presentation resulting from pulmonary venous obstruction or with advanced pulmonary vascular obstructive disease (PVOD). We reviewed our experience of primary correction of TAPVC and examined the surgical outcome and risk factors. METHODS: From June 1991 to Sept. 1996, 23 neonates or infants who were diagnosed simple TAPVC and underwent primary correction at Asan Medical Center were included. They were 16 males and 7 females. We analyzed clinical records, operative records, preoperative and postoperative echocardiographic findings or cardiac catheterization angiographic data and follow-up data and analyzed risk factors for late death. RESULTS: Age at operation ranged from 1 week to 9 months (mean 66 days). 11 cases (49%) were less than 1 month and 19 cases (83%) were less than 3 months. Weight at operation ranged from 2.2kg to 6.4kg (mean 4.0 +/- 1.3kg). The anatomical types of TAPVC was supracardiac in 17, infracardiac in 4, cardiac in 1, mixed type in 1. There were 10 preoperative pulmonary venous obstructions. There were 2 cases of hospital death; one died of persistent low cardiac output from postoperative complete AV block, the other died unsuspectedly. Late death were 5 cases (23.8%). Anastomotic stenosis was suspected in 4 cases on postoperative echocardiography (1 case was confirmed by cardiac catheterization and angiography). one case died of progressive PVOD. Risk factor analysis revealed that only anastomotic stenosis was related to late death (P=0.005). CONCLUSION: From our series, we concluded that earlier surgical intervention is important to prevent PVOD especially in cases with pulmonary hypertension preoperatively and we are alert to the development of late pulmonary venous stenosis especially in cases with intimal irregularity at operative field or vague symptoms postoperatively. Finally prompt reintervention is necessary in cases with correctable pulmonary venous stenosis to decrease late death.

Tachycardia Induced Cariomyopathy in Childhood

PURPOSE: Dilated cardiomyopathy in children is usually progressive and leads to death in several years. Chronic tachyarrhythmia has been shown to cause dilated cardiomyopathy in human and animals and this ventricular dysfuntion is usually reversible after control of the arrhythmia. The uncontrolled chronic tachycardia may be a curable cause of dilated cardiomyopathy in some patients. We describe six children who had persistent chronic tachycardia and ventricular dysfunction that improve significantly after control of the arrhythmia. METHODS: We retrosepctively reveiwed the medical records, electrocardiograms, Holter recordings, Echcardiographic reports of 6 children with the tachycardia induced ventricular dysfunction who have been managed at Sejong general hospital and Asan medical center from January 1992 to June 1995. RESULTS: 1) The causes of referral were dilated cardiomyopathy in 2 and tachyarrhythmia in 4. The age at diagnosis was 4 to 36 months old and follow-up period was 6 to 29 months. The symptoms of congestive heart failure were seen in 3 children. 2) The mechanisms of thachyarrhythmia causing cardiomyopathy were atrial ectopic tachycardia in 2, chaotic atrial rhythm in 3 and junctional ectopic tachycardia in 1. Atrial ectopic tachycardia has improved after combined treatment with amidarone and atenonl. One case of chaotic atrial rhythm has improved spontaneously and other 2 cases of chaotic arial rthythm have improved after treatment with digoxin or after combined therapy with amidarone and digoxin. Junctional ectopic tachycardia is partially controlled with mexiletine. 3) The shortening fractions of left ventricle at diagnosis were 14-21% and improved to over 30% in all after 2 to 9 months of follow-up. CONCLUSIONS: We have shown that control of persistent tachycardia resolved the left ventricular dysfunction. We suggest that patients with dilated cardiomyopathy be carefully screened for tachyarrhythmia as a curable cause of ventricular dysfunction and that left ventricular function be assessed in the asymptomatic patients with persistent tachycardia.

Tachycardia Induced Cariomyopathy in Childhood

PURPOSE: Dilated cardiomyopathy in children is usually progressive and leads to death in several years. Chronic tachyarrhythmia has been shown to cause dilated cardiomyopathy in human and animals and this ventricular dysfuntion is usually reversible after control of the arrhythmia. The uncontrolled chronic tachycardia may be a curable cause of dilated cardiomyopathy in some patients. We describe six children who had persistent chronic tachycardia and ventricular dysfunction that improve significantly after control of the arrhythmia. METHODS: We retrosepctively reveiwed the medical records, electrocardiograms, Holter recordings, Echcardiographic reports of 6 children with the tachycardia induced ventricular dysfunction who have been managed at Sejong general hospital and Asan medical center from January 1992 to June 1995. RESULTS: 1) The causes of referral were dilated cardiomyopathy in 2 and tachyarrhythmia in 4. The age at diagnosis was 4 to 36 months old and follow-up period was 6 to 29 months. The symptoms of congestive heart failure were seen in 3 children. 2) The mechanisms of thachyarrhythmia causing cardiomyopathy were atrial ectopic tachycardia in 2, chaotic atrial rhythm in 3 and junctional ectopic tachycardia in 1. Atrial ectopic tachycardia has improved after combined treatment with amidarone and atenonl. One case of chaotic atrial rhythm has improved spontaneously and other 2 cases of chaotic arial rthythm have improved after treatment with digoxin or after combined therapy with amidarone and digoxin. Junctional ectopic tachycardia is partially controlled with mexiletine. 3) The shortening fractions of left ventricle at diagnosis were 14-21% and improved to over 30% in all after 2 to 9 months of follow-up. CONCLUSIONS: We have shown that control of persistent tachycardia resolved the left ventricular dysfunction. We suggest that patients with dilated cardiomyopathy be carefully screened for tachyarrhythmia as a curable cause of ventricular dysfunction and that left ventricular function be assessed in the asymptomatic patients with persistent tachycardia.

Counter-Current Aortography Using Peripheral Arteries in Small Infants and Neonates with Aortic Arch Obstruction

BACKGROUND: Diagnosis of aortic arch obstruction can be made with two-dimensional and Doppler echocardiography in most cases.However,not infrequently,clear imaging of the aortic arch can not be obtained,particularly in sick neonates and young infants from a number of reasons and heart catheterization and angiography carries significant risk in sick babies.Therefore it is the purpose of this study to assess the feasibility and safety of counter-current aortography through a peripheral artery in young infants and neotates with suspected aortic arch obstruction. METHOD: We studied 56 patients with suspected aortic arch anomaly at Asian Medical Center from Feburary 1990 to April 1997.First choice for the peripheral artery was radial artery on the same side as the aortic arch,followed by brachial artery and axillary artery.Small 24 gauge plastic cannula was inserted and special attention was given to ensure that the peripheral artery,plastic cannula,and a syringe containing contrast material are all in the same plane.1ml/kg of contrast material was injected by rapid hand injection and biplane cineangiograms were taken at 60 frame/second. RESULTS: Fifty six patients underwent 58 angiograms.Age ranged from 5-255 days(median 30 days) and body weight nanged from 2.1-5.4kg(mean3.4kg).There were 27 males and 29 females.Arteries used were:Radial artery in 37,brachal artery in 19,and axillary artery in 2 cases.Peripheral arteries were ipsilateral side as the aortic arch in 54,contralateral side in 2 and bilateral in 2 cases.In 8 patients heart catheterization was done because of inadequate visualization of aortic arch anatomy and/or need for evaluating other defects.In 48 patients who had periperal angiography only,fluoroscopic time ranged from 0.6 to 3.5 minutes and total procedure time ranged from 10 to 15 minutes.Among these 48 patients,only 11 patients(23%) were given intraveous sedation and 37 patients(77%) did not recieve any sedation.Diagnosis of aortic arch anomaly was aortic coarctation in 38,aortic interruption in 10 and nomal aortic arch in 8 patients.Aortic arch anatomy was well demonstrated in all cases where injected artery was on the same side as the aortic arch.In patients who had angiograms through peripheral arteries contralateral to the side of the aortic arch did not haveadequate visualization of the arch.Compression of the carotid artery did not enhance the imaging of the arch.Simultanous bilateral angiography did not improve the imaging quality as compared to ipsilateral artery angiography.Transient complication,related to cannulation,e.g.,prolonged bleeding was seen in only one patient with aortic interruption.Circulation on the upper extremities was normal after angiography in all patients. CONCLUSION: Counter-current aortography using 24 gauge plastic cannular through peripheral artery is feasible,rapid,safe,economic and relatevely non-invasive procedure and provides adquate imaging of aortic arch obstruction in infants and neonates without risk of heart catheterization and angiography.We,therefore,recommend this procedure in selected patients in whom echocardiographic imaging alone is not conclusive for planning corrective sursery.

Four Cases of Pulmonary Artery Sling with Bridging Bronchus

Pulmonary artery sling with bridging bronchus is not only rare but also difficult to diagnose unless specially sought. When young infant suffers from prolonged or recurrent wheezing, possibility of underlying anomalies of the tracheobronchial trees or great vessels should be considered, even though bronchiolitis and gastroesophageal reflux are the most common causes. We experienced four cases of pulmonary artery sling with bridging bronchus who presented with dyspnea and recurrent wheezing since infancy. Diagnosis was made using bronchoscopy, three dimensional computed tomography, echocardiography and angiography. Bridging bronchus of three patients (case 1, 2, 3) correspond to type IIA and one patient (case 4) to type IIB by Wells classification. Bronchoscopic examinations on 3 patients showed segmental bronchomalacia and near complete obstruction of bronchus by the posterior left pulmonary artery. These congenital bronchial anormalies should be included in differential diagnosis in pediatric patients with unexplained persistent and recurrent wheezing, or emphysema of unknown etiology on plain chest X-ray.

Early Results of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Children

PURPOSE: Although the data of radiofrequency catheter ablation (RFCA) of supraventricular tachycardia in adults has been accumulated in several centers in Korea, few data are available on its efficacy and safety in pediatric ages. We reviewed the data in young patients who underwent this procedure in a pediatric cardiology center, to evaluate the indications, early results, complications, and short-term follow-up data. METHODS: We retrospectively reviewed the medical records and RFCA procedure reports of 17 children who underwent this procedure in pediatric cardiology center, Asan Medical Center, Seoul, Korea from January 1992 to July 1996. The mean follow-up periods was 17.8 months. RESULTS: 1) The median age of the patients was 12.3 years and all of them except two patients had structurally normal hearts. The indications of RFCA were preoperative open heart surgery in a patient, drug refractory tachycardia in 4 patients and patient's choice in other 12 patients. 2) The mechanisms of supraventricular tachycardia were 9 atrioventricular reentrant tachycardia, 6 atrioventricular nodal reentrant tachycardia (AVNRT), 1 atrial flutter and 1 atrial ectopic tachycardia (AET). Among accessory pathways, preexcitation was in 6 patients and accessory pathway located in the right side in 7 patients. In all patient with AVNRT except one, slow pathway was ablated. In the case of AET, ectopic focus located in the left atrium near the orifice of right lower pulmonary vein. 3) 16 of 18 procedures (88.9%) were successful and in 2 occasions with right sided accessory pathway and AET, the procedure failed. Ectopic focus was successfully ablated at the second attempt. The mean total procedure time was 2.7 hours (n=16) and the mean fluoroscopic time was 45.3 minutes (n=12). The average number of RF application was 11 times. There was no significant complications related with procedures. 4) There were 5 recurrences (29.4%), in 2 patients with accessory pathway and 2 patients with AVNRT. Most recurrences occured in 6 weeks after procedure. CONCLUSIONS: RFCA is a good alternative for the treatment of supraventricular tachycardia also in young patients as in adults. Early results of RFCA shows resonably good success rate but somewhat higher rate of recurrence in our center. We expect the results of RFCA in children will be improved in near future after some period of learning curve.

Idiopathic Left Ventricular Tachycardia in Childhood

BACKGROUND: Idiopathic left ventricular tachycardia with a QRS pattern of right bundle branch block and left axis deviation that is sensitive to verapamil is electrophysiologically distinct arrhythmia entity but descriptions in pediatric ages are infrequent. This study attempted to describe the clinical presentation and dignostic clues from the surface ECG in children with idiopathic left venteicular tachycardia. METHODS: We retrospectively reviewed the medical records, electrocardiograms, Holter recordings, echocardiographic reports of 10 children with idiopathic left ventricular tachycardia who have been managed at Sejong General Hospital and Asan Medical Center, Seoul, Korea from January 1991 to July 1996. Follow-up periods are 2 months to 5 years(mean=26 months). RESULTS: 1) Age of tachycardia onset was 8 months to 14 years(median=4.3 years). In 3 children tachycardia began from infancy. The main complaint in older children was palpitation and chest discomfort but young childen complained abdominal pain during tachycardia attack. Tachycardia was paroxysmal and sustained. Tachycardia responded to intravenous use of verapamil in 9 patients and was controlled by chronic verapamil medication in 6 patients. 2 patients were well without medication. Radiofrequency catheter ablation was done in an adolescent patient successfully. 2) In sinus rhythm, surface ECG showed normal QRS axis and normal QRS morphologies in all patients. During ventricular tachycardia, the heart rate was 183 to 270 beats/min. The taxhycardia of RBBB morphology was observed in all patients. The mean QRS duration was 109+-12ms and the QRS axis was -50* to -90*. Themean RS interval was 60+-12ms. AVdissociation was found on surface RCG in all patients and confirmed in 4 patients by transesophageal ECG. We tried rapid transesophageal atrial pacing in 3 patients and could induce and terminate the ventricular tachycardia. CONCLUSIONS: Idiopathic left ventricular tachycaedia is rare in childhood and is seen from infancy. Idiopathic left ventricular tachycardia is generally benign but occasionally causesmyocardial dysfunction. Idiopathic ventricular tachycardia with a QRS pattern of right bundle branch block amd left axis deviation that is sensitive to verapamil in children should not be confused with supraventricular tachycardia with aberrancy and most helpful diagnostic clue is AV dissociation in surface ECG.

A Case Report: Ganciclovir Therapy of Cytomegalovirus Pneumonitis

Ganciclovir is an antiviral agent that is effective for cytomegalovirus (CMV) infection in immunocompromised hosts. But the benefits of treatment for the congenital CMV diseases are still controversial. Cytomegalovirus pneumonitis is very rare. And so, a few cases of ganciclovir therapy in CMV pneumonitis were reported. We experienced a case of a 7 month-old male infant with prolonged pneumonitis and respiratory difficulty which were not improved with steroid and antibiotic therapy for 2 months. He was born at gestational age of 32 weeks and received oxygen therapy with mask for 2 days only. On physical examination, tachypnea, chest retracion, inspiratory wheezing and rales were present. PaCO2 was 84.0 mmHg on blood gas analysis and the anti-CMV-IgM, -IgG antibodies were positive. But anti-CMV-IgM, -IgG antibodies of his mother were negative. The open lung biopsy revealed CMV inclusion in alveolar interstitium. CMV shell vial assay of patient's urine and tracheal aspirate were positive. Ganciclovir (5-10 mg/kg, 10weeks) had been given without any significant complications. After treatment of ganciclovir for 4 weeks, shell vial assay of tracheal aspirate for CMV showed negative conversion and anti-CMV-IgM antibody was converted negatively. CMV pneumonitis of this patient had the possibility of secondary infection associated with immunosuppressive status after long-term steroid therapy or with blood transfusion. We report a first case of ganciclovir therapy of CMV pneumonitis with review of related literatures.

Clinical Course and Management of Chaotic Atrial Rhythm in Childhood

BACKGROUND: Chaotic atrial rhythm (CAR) is characterized by the presence of three or more P-wave morphologic features on the surface electrogram, absence of a dominant atrial pacemaker, and variable P-P, R-R, and P-R intervals with an atrial rate of over 100 beats/min. CAR is infrequently seen in pediatric ages and its clinical course, management and underlying mechanism are uncertain. We report our recent experience with 11 infants with CAR and describe their clinical characteristics and reponse to treatment. METHODS: We retrospectively reveiwed the medical records, electrocardiograms, Holter recordings, echocrdiographic reports of 11 cases of CAR managed at Sejong general hospital and Asan medical center from January 1991 to June 1995. RESULTS: 1) All patients were < or =6 months old and 5 of 11 patients had symptoms at neonatal period. The duration of follow-up was 3-42 months(mean : 18 months). 2 patients had structural heart disease and 3 patients showed signs of ventricular dysfunction. In 10 of 11 patients tachycardia was sustained or recurrent. 1 patient died of severe congestive heart failure due to incessant rapid tachycardia. 2) 3 of 10 patients took digoxin only and others took more than 2 medications. Full control within 1 month after medication was in 2 patients, with digoxin only in one and digoxin and amiodarone in another patient. At discharge, state of arrhythmia control in 8 patients with medications were full control in 2, good control in 3, and partial control in 3. At last follow-up, full control in 5, good control in 1 were confirmed through Holter recordings and the other 4 patients showed sinus rhythm in surface electrocardiograms. The total duration of medications were < or =1 year except 1 patient. 3) In 3 patients with ventricular dysfunction, ventricular function was normalized after restoration of sinus rhythm. CONCLUSION: CAR in children usually occurs in the first month of life and genenally takes benign course, but sometimes it causes severe congestive heart failure or ventricular dysfunction. Frequently, the patients remain asymptomatic despite persistence of the tachycardia for weeks or months. CAR is difficult to convert to sinus rhythm with medications but tends to resolve spontaneously within 1 year. We think treatment is necessary only in the symptomatic patients with rapid ventricular response and it is enough to control the ventricular rate with antiarrhythmic agents.

Catheter Ablation of Atrial Flutter Using Radiofrequency Energy in a Child: A Case Report

Atrial flutter is a potentially life threatening complication of repair or palliation of congenital heart disease and is frequently drug resistant. Recent studies in human have demonstrated that common type atrial flutter is due to macro-reentry in the right atrium and that the reentrant circuit may involve slow conduction in the low posteroseptal area of the right atrium. Catheter ablation of atrial flutter has been successful using radiofrequency energy. Application of radiofrequency energy at the isthmus between the inferior vena cava and tricuspid ring was effective in preventing recurrence of atrial flutter in a 6 year old boy after open heart surgery of common atrium. Despite concerns regarding ablation scar in growing children and persistence of underlying structural abnormalities in postoperative patients, radiofrequency ablation of atrial flutter appears to be another useful therapeutic option in management of this not so rare but potentially malignant and often resistant arrhythmia.

Neurologic Complications Associated with Mycoplasma pneumoniae Infection

PURPOSE: Mycoplasma pneumoniae is known to be a common respiratory pathogen in children and cause neurologic complications in some patients. The clinical spectrum of the neurologic complications is wide, ranging from mild meningeal signs to severe neurologic symptoms with poor outcomes. The overall mortality in patients with neurologic complications has been approximated upto 10% and significant residual deficits could develop in about one third of the patients. This study was done to recognize the neurologic complications associated with M. pneumoniae and possibly to improve therapy and outcome. METHODS: We reviewed retrospectively the medical records of 8 patients with neurologic complications associated with M. pneumoniae infection in the department of Pediatrics, Asan Medical Center, during the period of 6 months from October,1993 to March, 1994. And we compared these cases with total 165 patients diagnosed as M. pneumoniae infection during the same period. RESULTS: 1) Neurologic complications were seen in 8 children among 165 patients with M. pneumoniae infection. 2) Among 8 patients, 4 patients were diagnosed as meningitis, 2 patients as Guillain-Barr syndrome, and 2 patients as ADEM. 3) 4 patients with meningitis were treated by erythromycin and 2 Guillain-Barr syndrome patients by IV gamma globulin and plasmapheresis, and 2 ADEM patients by methylprednisone pulse therapy and supportive therapy, respectively. 4) All patients improved without any neurological sequelae. CONCLUSIONS: Although M. pneumoniae is a common and usually self-limited pathogen in children, various neurologic complications can occur in a small proportion of patients. Therefore, M. pnuemoniae is to be considered as one of the etiologic agents of neurologic diseases in children.

Effect of Recombinant Human Erythropoietin on the Anemia of Premature Infants

PURPOSE: To determine whether the prophylactic treatment with recombinant human erythropoietin(rHuEPO) for the anemia of prematurity would reduce the need for blood transfusions. METHODS: We randomly assigned 17 premature infants to the rHuEPO group and the control group. For the rHuEPO group (n=9, birth weight=1210+/-156 g, gestational age=31.7+/-1.9 wk), rHuEPO (400 U/kg) was given three times a week for 4 weeks, plus iron (8 mg/kg/day) and vitamin E (25 IU/day). The same amount of vitamin E was only given for the control group (n=8, birth weight=1266+/-204 g, gestational age=30.0+/-1.9 wk). RESULTS: Reticulocyte counts and hematocrit values were higher in the rHuEPO group than the control group at the 4 week of study (10.0+/-1.5 % vs. 5.5+/-2.1 % : p<0.05 and 25.6+/-4.0 % vs.31.0+/-1.5 % : p<0.05). Also, hemoglobin F were higher in the rHuEPO group than the control group at the 4 week of study (76.2+/-8.1 % vs.27.2+/-33.3 % : p<0.05). The rHuEPO treatment group required fewer blood transfusions during the study period (1.25 vs. 0.11 : p<0.05). And the complications such as leukopenia, thrombocytosis and infection did not develop during the study period. There was no evidence of iron deficiency state in the both groups. CONCLUSIONS: The rHuEPO treatment, in combination with iron supplementation, prevented the anemia of prematurity and reduced the need for blood transfusion in the premature infants.

The Study of Distribution of HI Antibody Titers Aganist Japanese Encephalitis Virus Among Children in Seoul

PURPOSE: Incidence of Japanese encephalitis has been markedly decreased, but this disease is known to be high and lethal in the young age group. This study was designed to find out the HI antibody titers and associated factors of Japanese encephalitis of children in Seoul, and to establish the plan of vaccination. METHODS: The survey was conducted from the end of May to the beginning of June, 1992. Serum of total 862 children aging from 4 year to 15 year in the Kangseo-ku and Songpa-ku, Seoul wre obtained. And we analyzed the HI antibody titers to Japanese encephalitis virus. RESULTS: 1) The percentage of childrens with the antibody titer higher than 1:20 was 34.5%. 2) The protective HI antibody to Japanese encephalitis virus by sex revealed that the percentage of males was 47% while that of females was 29.2% 3) The protective HI antibody titer to Japanese encephalitis was higher in the younger age than older age. 4) The comparative studies on HI antibody titer of Japanese encephalitis virus by vaccination types revealed that the percentage of children without vaccination was 0%, the percentage of children with single vaccination at 2 years ago was 9.7%, single vaccination at 1 year ago 31.6%, and single vaccination at this year 39.1%. According to serial vaccination at 1990 and 1991, 1991 and 1992, the percentage of protective HI antibody titer to Japanese encephalitis virus was 22.4%, 44.8%, respectively. 5) The factors influenced on protective antibody titer to Japanese encephalitis virus were age and vacciantion history at 1991 and 1992. CONCLUSIONS: Effective antibody titers to Japanese encephalitis virus of children in Seoul were low and the important factors to maintain protective HI antibody titers were age and recent vaccination history. Therefore regular vaccination of Japanese encephlitis virus is thought to be important in preventing the Japanese encephalitis.

Clinical and Histologic Changes in Children with Chronic Hepatitis B Virus Infection after Alpha Interferon Therapy

No abstract available.

Infectious Mononucleosis in Children

We reviewed the clinical findings of infectious mononucleosis and performed Epstein-Barr virus (EBV) serologic antibody tests in infectious mononucleosis and healthy group. One groupwas 18 cases of children, diagnosed as infectious mononucleosis who had been admitted to the department of Pediatrics, Asan Medical Center for two years and eight months, from November, 1989 to June, 1992. Another group was 20 cases of healthy 5-year old children. @ES The results wereas follows: 1) The age distributions of 18 patients with infectious mononucleosis were as follows: nine patients were less than 5 year old and nine patients (50%)were older than 5 year old. 2) The hematologic findings revealed increased atypicallymphocytes in sixteen patients (88%), leukopenia in one patient (6%), thrombocytopenia in one patient (6%). In addition, we observed transient hepatitis in eight patients (44%) and jaundice in one patient (6%). 3) Hemophagocytic sydrome wasdeveloped in one patient who expired due to meningitis. 4) The heterophil antibody tests werepositive in two cases (11%) out of eighteen infectious mononucleosis patients. 5) EBV serologic antibody tests for IgM antibody to EBV-viral capsid antigen (VCA) in 18 patients were all positive, which implies primary infection. 6) EBV serologic antibody tests for IgG antibody to EBV-VCA and antibody to Epstein-Barr nuclear antigen (EBNA) in helathy 5-year old children were negative in 3 cases (15%) out of 20 cases each other, which suggests primary infection might occur afer five years of age. 7) Recently, more cases of clinically typical infectious mononucleosis are detected and the onset of EBV primary infection is becoming late in Korea, which is thought to be due to economic developments and improvements of environmental hygine. And we recommend EBV serologic antibody test for the confirmative diagnostic test of infectious mononucleosis.

Prevalence of Epstein-Barr Virus(EBV) Antibody in Korean Children

Recently, cases with typical clinical manifestations of infectious mononucleosis are increasing in Korea. So, to evaluate the recent epidemiology of EBV infection in Korea, we performed EBV serologic antibody tests for IgG antibody to EBV-viral capsid antigen (VCA) and antibody to EBV-associated nuclear antigen (EBNA) among the 108 healthy Korean infants and children whose ages were from newborn to 15 years old. And the results were as follows; 1) The positive rates of anti-VCA IgG 100% in newborn, 90% in 2 to 6 months, 20% in 7 to 12 months, 60% in 1 to 2 years, 77.3% in 3 to 4 years, 88.5% in 5 to 6 years, 90% in 7 to 9 years, and 100% in 10 to 15 years of age, respectively. 2) The anti-VCA IgG titers ranged from 1:20 to 1:1280. 3) The positive rates of anti-EBNA were 100% in newborn, 60% in 2 6 months, 10% in 7 to 12 months, 60% in 1 to 2 years, 68.2% in 3 to 4 years, 84.5% in 5 to 6 years, 70% in 7 to 9 years, and 100% in 10 to 15 years of age, respectively. 4) The anti-EBNA titers ranged from 1:2 to 1:128. According to these data, the age of primary infection of EBV has increased compared to the previous data in Korean children.

A Case of Rett Syndrome Observed with Video-EEG Monitoring

Rett syndrome is progressive neurodegenerative disorder in female patients, characterized by autistic behavior, mental retardation, loss of purposeful hand skills, stereotypic hand movement, breathing dysfunction, severely impaired language, ataxia, and seizure. The diagnosis of Rett syndrome is based on its characteristic clinical manifestation and course. The electroencephalographic (EEG) findings of Rett syndrome are nonspecific, but a progressive deterioration in the EEG, characterized by a slowing of background activity and spike sharp wave discharges, may be observed. We experienced one case of Rett syndrome in a 5 year old girl having mental retardation, loss of purposeful hand skills, stereotypic hand movements (clapping, washing, hand-to-mouth), breathing dysfunction (hyperventilation/apnea). Her EEG findings on Video-EEG monitoring are excessive slowing waves during awake state and frequent spike discharges from left or centrotemporal area during sleeping. We report a case of Rett syndrome with brief review of related literatures.