Immunogenicity and Safety of Oral Live Attenuated Salmonella typhi Vaccine / 감염과화학요법

BACKGROUND: This study is aimed at evaluating immunogenicity by measuring immunoglobulin A (IgA) seroconversion rate through common mucosal immune system and adverse reactions after vaccination of oral live attenuated Salmonella typhi (S. typhi) Ty21a vaccine in Korean population. METHODS: A commercially available oral live attenuated vaccine of S. typhi strain Ty21a (Zerotyph(r) capsule, Boryung Biopharma Co., Seoul, Korea) was given to volunteers; children above 6 years, adolescents, and adults who have never infected with S. typhi nor received S. typhi vaccination. The vaccines were given in three doses, with two day interval between the doses. Seroconversion was determined by ELISPOT (enzyme-linked immunospot) assay. Adverse reactions after vaccination were evaluated in 12 institutions by direct interviewing with vaccinees. RESULTS: A total of 93 volunteers for evaluation of seroconversion were enrolled. Seroconversion rate in the the below 16 year-old group was 73.8% (31/42) and that of over 16 year-old group was 86.3% (44/51), which was not statistically different. Adverse reaction were found in 8.6% (40/465). Gastrointestinal symptoms were most common (6.5%, 30/465). Adverse reactions were found in 5.2% (24/465) after 1st administration, 4.5% (21/462) after 2nd, and 2.6% (12/461) after 3rd. Frequency of adverse reactions was significantly higher after 1st administration (P<0.05). CONCLUSION: Oral live attenuated S. typhi vaccine, Zerotyph(r) capsule, had good immnuogenicity and safety through intestinal immune system.

Immunogenicity and Safety of Oral Live Attenuated Salmonella typhi Vaccine / 감염과화학요법

BACKGROUND: This study is aimed at evaluating immunogenicity by measuring immunoglobulin A (IgA) seroconversion rate through common mucosal immune system and adverse reactions after vaccination of oral live attenuated Salmonella typhi (S. typhi) Ty21a vaccine in Korean population. METHODS: A commercially available oral live attenuated vaccine of S. typhi strain Ty21a (Zerotyph(r) capsule, Boryung Biopharma Co., Seoul, Korea) was given to volunteers; children above 6 years, adolescents, and adults who have never infected with S. typhi nor received S. typhi vaccination. The vaccines were given in three doses, with two day interval between the doses. Seroconversion was determined by ELISPOT (enzyme-linked immunospot) assay. Adverse reactions after vaccination were evaluated in 12 institutions by direct interviewing with vaccinees. RESULTS: A total of 93 volunteers for evaluation of seroconversion were enrolled. Seroconversion rate in the the below 16 year-old group was 73.8% (31/42) and that of over 16 year-old group was 86.3% (44/51), which was not statistically different. Adverse reaction were found in 8.6% (40/465). Gastrointestinal symptoms were most common (6.5%, 30/465). Adverse reactions were found in 5.2% (24/465) after 1st administration, 4.5% (21/462) after 2nd, and 2.6% (12/461) after 3rd. Frequency of adverse reactions was significantly higher after 1st administration (P<0.05). CONCLUSION: Oral live attenuated S. typhi vaccine, Zerotyph(r) capsule, had good immnuogenicity and safety through intestinal immune system.

Efficacy of Antiepileptic Drug on the Benign Childhood Epilepsy with Centro-Temporal Spikes

PURPOSE: Benign childhood epilepsy with centrotemporal spikes(BECT) is characterized by an excellent prognosis. Therefore, the necessity for the use of antiepileptic drugs is controversial. The object of this study is to know about the long-term follow-up of BECT, comparing daily treatment with antiepileptic drug(AED) versus no medication. METHODS: We retrospectively studied 56 cases of BECTs, examined at Pediatric Neurology Clinic, Korea University Medical Center as reference study time, August 2002. Thirty-eight patients didn't have mediation(group I), while eighteen patients received one or two AED(group II). We evaluated demographics, clinical manifestations at diagnosis, EEG findings and clinical courses in groups I & II. RESULTS: There was no significant differences of sex, age, seizure frequency, seizure type, seizure onset time, family history and EEG findings between group I & II. The reasons to start AED were: parents' anxiety(three cases), frequent seizure(12 cases) and daytime seizure(three cases). There was no evolution of status epilepticus and no difficulty in school performance. CONCLUSION: AED treatment was of no advantage and long-term prognosis was good regardless of treatment strategy. So it is advisable not to choose AED as the first line of therapy, provided that the patient himself/herself or the family understands the benign nature of BECT.

A Case of Cystathioninuria with Delayed Development / 대한소아신경학회지

Cystathionine is well-known intermediate in the metabolism of methionine. It is cleaved to cysteine and homoserine by gamma-cystathionase. This enzyme utilize pyridoxal 5'-phosphate as coenzyme. gamma-cystathionase deficiency leads to persistent excretion of large amount of cystathionine in urine, as well as to accumulation of cystathionine in body tissues and fluids. It is inherited as an autosomal recessive trait and shows wide variety of clinical manifestations. No clinical abnormality seems to be specifically associated with gamma-cystathionase deficiency. The majority of patients responded to high dose administration of pyridoxine. We report the first case of cystathioninuric patient in Korea, 19 months of female with developmental delay. In brain MRI, there was generalized mild brain atrophy. There were several times of brief paroxysmal generalized polyspike and wave discharges in electroencephalography(EEG). In amino acid analysis of urine, there was elevated level of cystathionine. She was treated with high dose of pyridoxine. In follow up analysis of urinary amino acid, the cystathionine level was markedly decreased to normal range, and EEG was normalized. Her development shows improvement.

Lung Function Reference Values in Healthy Korean Children / 소아알레르기및호흡기학회지

PURPOSE: Appropriate reference values are needed for assessment of pulmonary function during childhood. We performed pulmonary function test with simple computerized spirometry to establish reference values of air flow rates in healthy Korean children. METHODS: We examined 1,317 children aged 6 to 15 years at their schools by standardized method during May, 2001. The children with poor cooperation, respiratory symptom, and chronic disease were excluded. Regression analysis was applied for FVC, FEV1, PEF, FEF25-75% predicted from sex, age, standing height, weight, and body surface area. RESULTS: In 1,317 children(Male : 716, Female : 601), the distribution of height was from 106.7 cm to 173.5 cm, weight was from 16.5 kg to 75.5 kg. We could get regression equations and determinant coefficients between anthropometric parameters and air flow rates. In both sexes, height showed very close correlation with lung function variables, and FEV1 showed very close correlation with all anthropometric parameters. Reference values of pulmonary function test were generally higher in boys than in girls. CONCLUSION: After performing the pulmonary function test in healthy Korean children, we report their normal values of air flow rates and regression equations for the predicted values. Among anthropometric parameters, height showed most close correlation with lung function variables in both sexes.

A Case of Cerebral Abscess with Pulmonary Arteriovenous Fistula / 대한소아신경학회지

Pulmonary arteriovenous fistula is an uncommon capillary abnormality. It may be accompanied by neurological complications such as cerebral abscess and be associated with or without hemorrhagic telangiectasia. We recently experienced a case of cerebral abscess with pulmonary arteriovenous fistula(PAVF), which was not associated with hereditary hemorrhagic telangiectasia. We report this case with review of the related literature.

The Characteristics of the 2000-2001 Measles Epidemic in the Seoul Metropolitan Area

PURPOSE: To assess the clinical characteristics of the 2000-2001 measles outbreak in the Seoul metropolitan area, Korea, the clinical data of measles inpatients were analyzed. METHODS: Three hundred and five children diagnosed with measles by clinical manifestation from July, 2000 to February, 2001, in Seoul, Ilsan and Ansan City were grouped according to their age and investigated for clinical manifestations, vaccination history and measles-specific IgM/IgG antibody positivity. RESULTS: Thirty eight point seven percent of the subjects were less than 12 months of age, 27.5 % were 12-47 months of age and 33.8% were 48 months of age or older. There was no significant sexual difference(male : female=1.2 : 1). This epidemic started in June, 2000 and the number of patients increased abruptly in October, peaked in December and finally decreased after February, 2001. It started from the older age group and moved to the younger. Sixty five point two percent had a history of more than 1-dose vaccination and 13.6% of the patients equal or more than 48 months of age had a history of 2-dose vaccination. Primary vaccine failure rate was 59.4%(107/ 180) and secondary vaccine failure rate was 3.9%(7/180) in 1 dose vaccinees. Sixty one point six percent showed more than one complication and 38.4% had no complication. The most common complication was pneumonia(31.8 %), followed by bronchitis(11.5%) and acute otitis media(4.6%). Vaccination and dose were not related significantly with the occurrence of complications. CONCLUSION: Compared with previous outbreaks in Korea, clinical features showed no specific change in the 2000-2001 measles epidemic. However, primary vaccine failure rate was so high that the second vaccination at four to six years of age must be emphasized in Korea.

A Case of Melkersson-Rosenthal Syndrome

Melkersson-Rosenthal syndrome(MRS) is a rare disorder, having a symptom triad of recurrent facial palsy, orofacial swelling and fissured tongue(lingua plicata). This disorder is usually recurrent or progressive, and monosymptomatic or oligosymptomatic forms have been reported to be more common than classic forms. Generally, MRS occurs in young adults at the end of the second decade of life and incidence of the disease in childhood is known to be very low. Although the clinical manifestation of MRS in children is similar to that in adults, early diagnosis and management is essential to avoid long-lasting functional disorders and psychological problems. We experienced MRS in a 13 year old boy with a history of recurrent facial palsy. We report this case with review of related literature.

A Study of Menarche and Dysfunctional Uterine Bleeding in Adolescent School Girls in Ansan City

PURPOSE: We investigated the menstrual features of adolescent school girls to know the characteristics of menarche and dysfunctional uterine bleeding in adolescents. METHODS: In March, 2001, 1,434 primary and middle school girls(10-15 years of age) in Ansan City were investigated for the menacheal age and several aspects of menstruation through questionnaire. RESULTS: Mean age of the total subjects were 13.0+/-1.2 years of age, and 68.4% of them experienced menarche. 32.2% experienced menarche after age 12, but 82.9% experienced it after age 13. Mixed type(regular and irregular) menstrual cycle was the most common(35.3%), and changing type(irregular to regular) was 27.6%. In changing type, the mean duration of cycle stabilization was 6.6+/-4.9 months. The most common menstrual cycle was 'within 26-30 days'(31.4%). Abnormal cycles such as 'equal or less than 20 days' and 'equal or more than 41 days' were 17.2% and 2.0%, respectively. The most common menstrual duration was '5-6 days'(44.7%). 7.6% of the subjects experienced short or long menstrual duration. Among the subjects, only 4.0% visited the hospital with menstrual problems. The visiting reasons were 'irregular menstrual cycles'(38.5%), 'dysmenorrhea'(28.2%), 'menorrhagia'(12.8%), and 'hypermenorrhea'(28.2%). CONCLUSION: Most adolescent girls in our study experienced menarche until 13 years of age and some of them got early menarche at the age of 9. Many of them had irregular or unstable menstrual cycles after menarche at any age, but only few of them visited a health care provider. We suggest the careful attention of pediatricians, parents and teachers to the early detection and proper treatment of menstrual problems in adolescent girls.

Myeloperoxidase Assay on Hypoxic-Ischemic Brain Injury in Immature Rats / 대한소아신경학회지

PURPOSE: Neutrophils found around an infarcted area in the brain was once considered as only the physiologic response following the brain injury, but recent studies have shown that inflammatory responses by neutrophils play an important role in the reperfusion injury. The presence of polymorphonuclear leukocytes(PML) is proven by biochemical assay of myeloperoxidase(MPO) secreted in the cytoplasmic granules. We observed the process of PML infiltration on hypoxic-ischemic brain injury of immature rats by the assay of MPO activity and changes of the MPO activity after the administration of fucoidin, inhibitor of P- and L-selectin. METHODS: We used a well characterized model of the brains of 7 day-old-rats, which had unilateral hypoxic and ischemic injuries(HI). Those injuries were induced by unilateral carotid artery ligation followed by timed exposure to hypoxic inspiratory gas mixture(8% O2). MPO activity was measured in the brain tissue homogenates of HI rats(n=18) at 0, 2, 8, 24 and 48 hrs and in rats that received fucoidin immediately before and again after hypoxia(50 mg/kg, n=6) at 8 and 24 hrs. Controls(n=2) were rats with neither hypoxia nor ischemia. The brain samples were homogenized in 20 mM potassium phosphate buffer(pH 7.4) for 50 secs. The homogenate was centrifuged at 14,000 g at 4degrees C for 15 mins and the supernatant was discarded. The tissue was pulverized, weighed, and suspended in 1 mL of 50 mM potassium phosphate buffer solution(pH 6.0) containing 0.5% cetylditrimethylammonium bromide(wt/vol). The tissue was sonicated and centrifuged at 10,000 g for 15 mins. 200 micro L of the supernatant was mixed with 1 mL of 50 mM potassium phosphate buffer solution(pH 6.0) containing 10 micro L of 1.325 mM o-dianisidine hydrochloride and 170 micro L of 3% hydrogen peroxide(vol/vol). Changes in absorbance at 460 nm were measured for 5 mins by using microplate reader. One unit of MPO activity was defined as that degrading 1 micro mol peroxide/min at 25degrees C, and the result was expressed as units of MPO/100 mg tissue. RESULTS: In HI rats, MPO activity increased at 2 hrs after HI and peaked at 24 hrs in the right hemisphere. In rats with fucoidin treatment immediately before and again after hypoxia, the MPO activity significantly decreased in both hemispheres compared with HI rats(P<0.05). MPO activity in the tissue of control rats was insignificant. CONCLUSION: The dynamic changes of the MPO activity suggest the important role of PMN on hypoxic-ischemic brain injuries in immature rats. MPO activity could be used as an index of the severity of injuries of hypoxic-ischemic brains.

A Case of Measles Encephalopathy with Thalamic Lesion on Magnetic Resonance Imaging

We experienced a case of measles encephalopathy with thalamic lesion on magnetic resonance imaging(MRI) in a 12 year old boy. Measles symptoms such as fever, erythematous maculopapular rashes on whole body and cough with sputum appeared 4 days before neurologic signs such as agitation and drowsy-to-confused mentality. He showed remarkable motor dysfunction without evidence of sensory loss. MRI showed bilateral symmetrical T2/FLAIR hyper-intensities in both thalami, posterior putamina and brainstem. It also showed inhomogenous Gadolinium(Gd) enhancement. In his electroencephalogram(EEG), there was nonspecific cortical dysfunction. After 20 days of supportive care, his motor dysfunction improved to near-normal and follow-up MRI revealed nearly normalized thalamic region. Over this period, no sensory loss was noted. We report this case with review of related literatures.

Expression of P-selectin mRNA and Protein on Hypoxic-Ischemic Brain Injury in Neonatal Rat / 대한소아신경학회지

PURPOSE: The selectin family of adhesion molecules plays a role in the initiation of endothelium-leukocyte interaction of inflammation and ischemia-reperfusion. P-selectin, a rapidly expressed endothelial cell adhesion molecule, is essential for both neutrophil rolling after endothelial stimulation and neutrophil transmigration. P-selectins were expressed after brain injury and could play an important role in the pathogenesis of ischemic brain injury in adult animal. However, the mechanisms leading to post-hypoxic-ischemic injury in immature brain are unknown yet. We hypothesize that P-selectin might mediate post-hypoxic-ischemic injury in immature rat brain. We evaluated the expression of mRNA and protein of P-selectin in post-hypoxic-ischemic immature rat brain. METHODS: In isoflurane-anesthetized P7(Postnatal day 7) Sprague-Dawley rats(n=81), the right carotid artery was isolated and coagulated. 1-2 h later animals were exposed to 8% oxygen(balanced with nitrogen) for 2 h in glass chambers, in a warm air incubator (temperature maintained at 36.5 degrees C). Control included carotid artery coagulation alone, hypoxia alone, and normal(neither hypoxia nor coagulation). For RNA extraction, the rats were decapitated at 0, 2, 4, 8, 12, 24 and 48 h after hypoxic-ischemic injury. For Western blot analyses with P-selectin, rats were decapitated at 0, 15, 30 min, 1, 2, 4, 8, 12, 24 and 48 h after hypoxic-ischemic injury. Control or hypoxia alone rats were sacrificed 8 h after the respective intervention. RESULTS: There was no expression of P-selectin mRNA in control groups(carotid artery coagulation alone, hypoxia alone, or normal). P-selectin mRNA expression in the ipsilateral(right) hemisphere reached a peak at 8 h after hypoxia-ischemia and then barely detected after 24 h. Expression of P-selectin protein was not observed in brain tissue of control rats. P-selectin protein was detected as early as 15 min and 30 min at both hemisphere in experimental rats and decreased at 1 h. P-selectin protein increased in right hemisphere at 4 h post-hypoxia-ischemia, peaked at 8 h and no longer detectable at 24 h. CONCLUSION: Hypoxic-ischemic injury leads to P-selectin expression in neonatal rats brain. The temporal profiles of post-hypoxic-ischemic P-selectin mRNA and protein expression are consistent with a role in the evolution of subsequent brain injury.

A Study of the School-based Adolescent Violence

PURPOSE: School-based violence among adolescents is a serious public health problem. Recently, it seems to spread and intensify. We were trying to investigate the information about adolescent's experience, witness and perception in violence, thus to offer the data for appropriate violence prevention methods on our circumstance. METHODS: During July, 1996, 3,794 middle or high school students in the metropolitan area of Korea were surveyed. The self-administered questionnaires made with multiple choice system were given and writing names was not required. From the questionnaire, we obtained the information of violence experience, witness, frequency, time, place, kind, assailant, counselor, outcome, feeling, preparation, cause, motive and prevention. RESULTS: 1) Reports show that at least one in four students have been a victim of violence in or around school. Twenty-five percent has been a victim of repeated violence. One in three students has witnessed violence. Generally boys experienced and witnessed more than girls. Middle school students experienced more than high school students. 2) The characteristics of school-based violence in the metropolian area of Korea-after school, on the street-by the students of other school whom they don't know-to be stolen money-no serious outcome-to feel like revenge after violence -to counsel with friends - to work with other friends for prevention of violence. 3) The perception of the actual state of school-based violence was- it is serious. - the most common motive was to feel like to have money or things. - the common fundamental causes were the wrong educational system and the parent's indifference. - the preventive methods were to change the wrong educational system and parent's positive interest. 4) A lot of repeated school-based violence were occurred in the school. The more frequent violence was, the more severe physical and psychological injury was and the more active preventive methods were. CONCLUSIONS: School-based violence among adolescents in the metropolitan area of Korea spreads widely and intensifies more. Thus, immediately the concrete countermeasure for school-based violence is necessary.

The Hematologic Effect of Antiepileptic Drugs

PURPOSE: There have been controversies on the hematologic effects of antiepileptic drugs according to the mono or combined antiepileptic therapy. We evaluated the hematologic changes of the patients who have been taking antiepileptic drugs for more than 4 months and compared the changes of these values according to the mono or combined therapy. METHODS: From May, 1989 to April, 1995, we had examined the blood samples of 89 patients 1) when they were diagnosed as the convulsive disorder and 2) when they had taken antiepileptic drugs for more than 4 months so that their serum drug concentration was enough to be effective for the seizure control. We classified these patients as 4 groups according to the drugs they had taken; 1st group: population treated with valproic acid, 2nd group: population treated with carbamazepine, 3rd group: population treated with phenobarbital and 4th group: population treated with combined antiepileptic drugs (mostly valproic acid with other antiepileptic drugs). We examined and compared their hematologic values such as counts of white blood cell (WBC), red blood cell (RBC), platelet and hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC). RESULTS: 1) Mean age of the patients was 6.9+/-4.1 year and the mean duration of antiepileptic medication was 3.5+/-1.2 years. Age and the duration of medication had no influence on the study. 2) No significant differences were found on the WBC, RBC, Hb, Hct and MCHC before and after the medication in all the groups. 3) Statistically significant changes were found on MCV and MCH values before and after the medication in the 1st and 4th group (p<0.05, each group). CONCLUSIONS: We observed the significant increases on MCV and MCH in the patients who had taken valproic acid singly or combined with other antiepileptic drugs. It is necessary to take periodic CBC follow up to evaluate the changes of MCV and MCH in these patients. Additional investigation is needed to obtain the hamatologic side effects according to the various dosing regimens and durations of drug administration.

The Efficacy of Routine Liver Function Test Follow Up in Epileptic Children

PURPOSE: Routine liver function test follow up is done in epileptic children receiving antiepileptic drugs to prevent hepatotoxicity induced by these drugs. But rarely seen are the abnormalities of liver function test, and seldomly are these abnormalities accompanied by the clinical manifestation. This study is carried out to assess the efficacy of routine liver function test follow up in epileptic children. METHODS: We determined the changes of the serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, direct bilirubin, total protein, albumin, gamma-glutamyltransferase (gamma-GT) and alkaline phosphatase before and 3, 6, 12 months and 2 years after antiepileptic drug medication in 59 epileptic children who had been receiving carbamazepine (n=16), phenobarbital (n=14), valproic acid (n=10) and combination of these (n=19) for 2 to 5 years. RESULTS: 1) The difference in liver function test follow up according to the age and sex was not found and there was no statistical correlationship between drug medication time and the serum drug level. 2) AST and ALT had been within normal range for all the study period in any group. 3) Total bilirubin had been within normal range for all the study period in any group. Direct bilirubin had decreased for the first 6 months in valproic acid group, but the changes had been within normal range for all the study period. 4) Total protein and albumin had been within normal range for all the study period in any group. 5) gamma-GT had the increasing tendency for all the study period in valproic acid group, but the values had been within normal range for all the study period. 6) Alkaline phosphatase had decreased for the first 6 months in valproic acid group, but the changes had been within normal range for all the study period. 7) No clinically significant hepatic manifestation had developed during study period in any group. CONCLUSIONS: Our data suggest that routine liver function test follow up itself can not be the indicator of hepatotoxicity and that liver function test in need when accompanied by the development of clinical hepatic manifestation is more efficacious than routine liver function test follow up.

A Study of Menstruation of School Girl in Ansan

Objective: Menstruation is a great part as the procedure for physiological, psychological development and physical growth, and menstrual disorders are very common problems in adolescence period. these problems can be resolved by interview or appropriate education of normal pubertal development. However unlike other developed countries, systematic report or appropriate education for menstruation may not be performed in our country. Therefore. our pediatric department investigated for menstruation of normal pubertal age women as an information educating adolescence. Methods: In cross-sectional study (ex, questionnaire), 4112 junior high and high school girl students (12~18 years old) in Ansan, Kyungki-do were investigated for menarcheal age, menstrual cycle, duration, amount, premenstrual syndrome, dysmenorrhea and relation to family history. Resulta: 1) Mean Menarcheal age was 12.9+/-1.2 years. According to menarcheal age by present age, menarcheal age was younger when present age was young as menarcheal age 11.8+/-0.6 years at 12 years, 13.3+/-1.1 years at 16 years, and 13.7+/-1.1 years at 18 years, respectively (p<0.001). 2) The month during which menarche occurs most frequently was August (14.7%), followed by July, December and January. 3) Considering menstrual cycle, mixed type (regular and irregular cycle) was most common (39.0%), and menstrual cycle became regular after mean 8.8+/-8.4 months. 4) In women having regular menstrual cycle, most women (53.l0%) had menstrual cycles between 26 and 30 days, next was 21~25 days and 31~35 days according to frequency. 5) Menstrual duration was 5~6 days by 49.6% of the women. 6) Premenstrual syndrome was noted in 56.0% of the women, in that 42.5% experienced occasionally and 13.5% always, respectively. 7) Dysmenorrhea was showed in 85.0% of the women. A total of 63.7% of the respondents suffered from dysmenorrhea was unaffected on daily activity as grade l and was needed no medication to relieve pain. Grade 2 (20.5%) was defined that limited daily activity and was needed medication to relieve pain. Grade 3 (0.9%) was defined that inhibited daily activity seriously, and was unimproved by analgesics. 8) The prevalence of dysmenorrhea was 78.0% at 12 years, 85.9% at 15 years and 94.0% at 18 years, respectively. Getting older, frequency of dysmenorrhea was increasing. 9) Dysmenorrhea was experienced for the first time during the first year after the menarche by 65.3% of the women. The amount of menstrual bleeding was significantly correlated to the severity of dysmenorrhea (P<0.001), and dysmenorrhea reported by the women was singificantly correlated to maternal dysmenorrhea (p<0.01) and to sisters with dysmenorrhea (p<0.001). Conclusions: We found that Korean adolescent girls had earlier menarcheal age than past period, and they had many problems for menstruation. This study suggested that it may be needed adolescent education and appropriate treatment of menstrual disorders.