Efficacy of Dextranomer/Hyaluronic Acid Copolymer (Deflux(R)) Injection for Vesicoureteral Reflux in Children

PURPOSE: The aim of this study was evaluating the efficacy of endoscopic Deflux(R) submucosal injection in children with primary vesicoureteral reflux (VUR). METHODS: Retrospective analysis of medical record was conducted on 38 children (59 ureters) who underwent endoscopic Deflux(R) injection due to primary VUR. Data were collected from March 2000 to February 2006. Mean infused amount of Deflux(R) was 0.77 cc. After Deflux(R) injection, patients were reassessed by voiding cystourethrogram (VCUG) 6 months later. RESULTS: The success rate of endoscopic Deflux(R) submucosal injection 6 months later by VCUG was 100% for grade 1 VUR, 87.5% for grade 2, 60% for grade 3, 26.6% for grade 4, 16.6% for grade 5, respectively and there was negatively significant correlation between success rate and grade of VUR (P<0.01). Degree of improvement of VUR by endoscopic Deflux(R) submucosal injection was not related to age at diagnosis, time to operation, existence of voiding dysfunction or constipation and infused amount of Deflux(R). However, group with anticholinergics medication had significantly lower success rate than non-medication group (P<0.047). CONCLUSION: Endoscopic Deflux(R) submucosal injection is effective therapy in patient with primary VUR, especially low grade VUR. It can be not only a useful substitute for prophylaxis with antibiotics, but also an effective management prior to ureteroneocystostomy in children with primary VUR.

Clinical Characteristics and Laboratory Findings of Children who were Newly Diagnosed with Diabetes Mellitus (From 2001 to 2008) / 대한소아내분비학회지

PURPOSE: The incidence of type 2 diabetes mellitus is increasing worldwide because of the increase in the incidence of obesity. We performed this study to determine the type of diabetes and the clinical characteristics and laboratory data of the children who were newly diagnosed with diabetes mellitus (DM). METHOD: We reviewed the medical data of 75 children (35 boys and 40 girls) who were diagnosed with DM at Kyungpook National University Hospital between January 2001 and June 2008. RESULTS: Sixty patients (80%) were diagnosed with type 1 DM and 15 (20%) with type 2 DM. Approximately 70% of the study subjects developed DM in spring and winter. Further, 38% and 60% of the patients had a family history of type 1 and type 2 DM, respectively. The average age of the patients with type 1 DM was 10.6+/-2.6 years. Diabetic ketoacidosis was the first symptom in 15% of these patients. The average body mass index of these patients was 18.2+/-4.5 kg/m2. At least one of autoantibodies against pancreas was positive in 69%. The average age of the patients with type 2 DM was 13.4+/-1.2 years. Fifty-three percent of these patients was diagnosed without any symptom. Fatty liver and hypertension were diagnosed in 20% of the patients. Fifty-three percent of these patients were obese or overweight. CONCLUSION: Twenty percent of the children who were newly diagnosed with diabetes at our institute had type 2 DM. Since the incidence of type 2 DM in children appears to be increasing with an increase in the occurrence of childhood obesity, special attention should be provided to obese children.

Two Cases of Slipped Capital Femoral Epiphysis in Children Receiving Growth Hormone Therapy / 대한소아내분비학회지

Slipped capital femoral epiphysis is a rare hip disorder that mainly occurs in pubertal children. Although the exact cause of this disorder is unknown, it is known to be associated with obesity, trauma, delayed sexual development, delayed bone maturation, chronic renal failure, genetic diseases, endocrine disorders (growth hormone deficiency, hypothyroidism, hypogonadism), growth hormone therapy, and gonadotropin releasing hormone agonist (GnRH agonist) therapy. We report 2 cases of slipped capital femoral epiphysis in adolescent females who were receiving growth hormone therapy. The first case is of a 16 year-old-girl with chronic renal failure and renal osteodystrophy. The second case is of an 11 year-old-girl with idiopathic precocious puberty who had received GnRH agonist and growth hormone therapy. Unilateral or bilateral slipped capital femoral epiphysis developed at 1 year 3 months after treatment in both the cases. The chief complaints were pain in the hip joint and lower extremities. Growth hormone and/or GnRH agonist therapy was stopped, and in situ screw fixations of the involved hip epiphyses were performed.

Changes of Clinical Findings of Acute Poststreptococcal Glomerulonephritis

PURPOSE: Several studies have reported the recent increase in the incidence of acute poststreptococcal glomerulonephritis(APSGN). The objective of this study is to see changes of clinical findings/manifwstation in children with APSGN. METHODS: Medical records of 63 children who were diagnosed with APSGN in the deparment of Pediatrics, Kyungpook National University Hospital, between January 1992 and December 2006 were reviewed retrospectively. We analyzed various clinical characteristics such as age, sex, degrees of proteinuria, degrees of hematuria, and presence or absence of histories of systemic antibiotic use in children with APSGN, and compared the children with APSGN who were diagnosed between 1992 and 2000 to those who were diagnosed between 2001 and 2006. RESULTS: Age of the patients ranged from 2-14 years(median 7.11 years) at the time of disease onset. Study patients consisted of 41 boys and 22 girls. APSGN followed infection of the throat in 87% of cases. Patient developed an acute nephritic syndrome 12 days after an antecedent streptococcal pharyngitis. Forty patients presented with gross hematuria. Fortyone patients had hypertension at the time of diagnosis. Hypertension disappeared within 7.8+/-8.2 days, gross hematuria within 11.3+/-17.2 days and microscopic hematuria within 3.5+/-3.9 months from the disease onset. Patients in 2001-2006 had significantly higher increase of antistreptolysin O(ASO) titer. However, no significant differences in clinical characteristics were observed. Age, sex, severity of proteinuria, gross or microscopic hematuria, antibiotic therapy did not affect the clinical manifestations of glomerulonephritis. In other words, hypertension, duration of hematuria, recovery of serum C3 level are not different between the two time periods. CONCLUSION: Our data indicates that patients in 2001-2006 had significantly higher level of ASO titer. However, they did not show significant clinical differences. To evaluate the causes of the resurgence of APSGN, a national epidemic is needed.

Prognostic Value of Electrophysiologic Tests in Children with Facial Nerve Palsy / 대한소아신경학회지

PURPOSE: This study was aimed to evaluate the value of electrophysiologic tests for determining prognosis in children with facial nerve palsy. METHODS: We retrospectively analyzed 37 children diagnosed as the facial nerve palsy at the pediatric neurology clinic, Kyungpook National University Hospital from January 1, 2000 to March 31, 2007. RESULTS: A total of thirty seven children were involved in the study(male to female 21:16, and the mean age 87.5 months). Among those twenty one had electrophysiologic tests. As compared with the normal values, the amplitude decreased by 54.5%(0.6+/-0.5 mV) and the latency was prolonged by 11.0%(3.6+/-0.5 msec) in electroneurography(ENoG). Early response(R1) was absent in 15 out of 21(71.4%) and ipsilateral response(R2) was absent in 19 children(90.5%). As compared with the children who had the decrease of amplitude 90% or less in ENoG, the children with the decrease of amplitude greater than 90% showed poor recovery(100% vs 60%, P<0.05) and longer duration of follow-up(43.7+/-30.0 days vs 184.00+/-196.8 days, P<0.05). All children who had R1 and R2 responses in the Blink test were completely recovered from the illness, but they were not statistically different from the other groups. CONCLUSION: Decrease of amplitude in ENoG and responsiveness in the Blink test can be important prognostic determinants in children with facial nerve palsy, but further studies are needed.

Comparison of Endoscopic Removal of Disk Batteries in Children / 대한소아소화기영양학회지

PURPOSE: Any battery impacted in the esophagus must be removed urgently because of the possibility of serious complications such as perforation, fistula, and mediastinitis. The use of endoscopic procedures was compared to find the most rapid, effective, and safe method to remove disk batteries. METHODS: The cases of 24 children (9 males, mean age, 1.5 years) that had accidentally ingested disk batteries were reviewed. The patients had visited the Department of Pediatrics, Kyungpook National University Hospital from July 1997 to June 2007 for the removal of disk batteries. Endoscopic removal was attempted using a retrieval net or a magnetic extractor with a balloon (condom). The procedure times for removing the ingested battery were compared. RESULTS: Children that ingested batteries with a larger diameter (20 mm) had a greater chance to have esophageal impaction with serious injury, such as esophageal mucosal necrosis or ulcers, as compared to the ingestion of smaller diameter batteries (10 mm) (p<0.01). Endoscopic removal of disk batteries was attempted either using a retrieval net in 10 children or by using a magnetic extractor with a balloon in 6 children. Endoscopic removal using a retrieval net was more effective (mean procedure time: 1.5 min) as compared to using a magnetic extractor with a balloon (mean procedure time: 3.3 min) (p<0.05). CONCLUSION: Both procedures, either using a retrieval net or a magnetic extractor with a balloon were effective in removing ingested disk batteries. Based on our experience, an endoscopic procedure using a retrieval net was a more effective method for foreign body removal.

Comparison of Endoscopic Removal of Disk Batteries in Children / 대한소아소화기영양학회지

PURPOSE: Any battery impacted in the esophagus must be removed urgently because of the possibility of serious complications such as perforation, fistula, and mediastinitis. The use of endoscopic procedures was compared to find the most rapid, effective, and safe method to remove disk batteries. METHODS: The cases of 24 children (9 males, mean age, 1.5 years) that had accidentally ingested disk batteries were reviewed. The patients had visited the Department of Pediatrics, Kyungpook National University Hospital from July 1997 to June 2007 for the removal of disk batteries. Endoscopic removal was attempted using a retrieval net or a magnetic extractor with a balloon (condom). The procedure times for removing the ingested battery were compared. RESULTS: Children that ingested batteries with a larger diameter (20 mm) had a greater chance to have esophageal impaction with serious injury, such as esophageal mucosal necrosis or ulcers, as compared to the ingestion of smaller diameter batteries (10 mm) (p<0.01). Endoscopic removal of disk batteries was attempted either using a retrieval net in 10 children or by using a magnetic extractor with a balloon in 6 children. Endoscopic removal using a retrieval net was more effective (mean procedure time: 1.5 min) as compared to using a magnetic extractor with a balloon (mean procedure time: 3.3 min) (p<0.05). CONCLUSION: Both procedures, either using a retrieval net or a magnetic extractor with a balloon were effective in removing ingested disk batteries. Based on our experience, an endoscopic procedure using a retrieval net was a more effective method for foreign body removal.

Changes of Bone Mineral Densities in Children with Idiopathic Hypercalciuria / 대한신장학회지

PURPOSE: Idiopathic hypercalciuria is a common clinical disorder in children with hematuria or nephrolithiasis. Recently, it has been reported that idiopathic hypercalciuria may disturb the metabolism of bone and induce its loss. We measured the biochemical markers of bone metabolism and bone mineral densities (BMD) by dual energy X-ray absorptiometry (DEXA) in children with idiopathic hypercalciuria to elucidate the prevalence and clinical significance of osteopenia. METHODS: From 1997 to 2005, 52 children with idiopathic hypercalciuria were included in this study. The biochemical markers of bone metabolism were measured in all 52 patients. BMD was measured in 21 patients initially and additional 6 patients during the follow-up. RESULTS: Mean age of patients was 6 years 7 months, and the male to female ratio was 1.26:1. BMD Z-scores were less than -1 in 10 of initial 21 patients (osteopenia), and -2.5 in 2 of 10 osteopenic patients (osteoporosis). There was a negative correlation between BMD Z-score and the level of osteocalcin. However, there were no significant differences in BMD Z-scores and other biochemical markers of bone metabolism among groups divided by sex, the type of idiopathic hypercalciuria, and the presence of urinary stone. CONCLUSION: Idiopathic hypercalciuria can be not only the cause of hematuria, but also of osteopenia in children. We suggest that the measurement of BMD in children with idiopathic hypercalciuria should be performed routinely with regular follow-up.