Recurrent Plastic Bronchitis in a Child with 2009 Influenza A (H1N1) and Influenza B Virus Infection

Plastic bronchitis is an uncommon disorder characterized by the formation of bronchial casts. It is associated with congenital heart disease or pulmonary disease. In children with underlying conditions such as allergy or asthma, influenza can cause severe plastic bronchitis resulting in respiratory failure. A review of the literature showed nine cases of plastic bronchitis with H1N1 including this case. We report a case of a child with recurrent plastic bronchitis with eosinophilic cast associated with influenza B infection, who had recovered from plastic bronchitis associated with an influenza A (H1N1) virus infection 5 months previously. To the best of our knowledge, this is the first case of recurrent plastic bronchitis related to influenza viral infection. If patients with influenza virus infection manifest acute respiratory distress with total lung atelectasis, clinicians should consider plastic bronchitis and early bronchoscopy should be intervened. In addition, management for underlying disease may prevent from recurrence of plastic bronchitis.

A study for post-diagnostic lumbar puncture headache in children / 소아과

PURPOSE: Post-lumbar puncture headache is common complaint. A study of post-diagnostic lumbar puncture headache in children is rare. Various factors that might influence the occurrence of post- diagnostic lumbar puncture headache in children exist. The purpose of this prospective study was to assess the frequency and risk factors for post-diagnostic lumbar puncture headache in children. METHODS: From March 2005 to February 2006, 44 patients with suspected meningitis were enrolled. Patients were received diagnostic lumbar puncture at the Chosun University Hospital, Gwangju, Korea. We evaluated age, sex, previous headache history, number of puncture attempts, volume of cerebrospinal fluid (CSF), pressure of CSF, cell count in CSF, final diagnosis, and the frequency and duration of headaches. RESULTS: Of the 44 patients (mean age 7.36+/-2.04, range 4-13 years), 16 patients (36.4%, male 13/33, 39.4%, female 3/11, 27.2%) had headache. The frequency of headaches was significantly higher in patients with previous headache history compare to those without previous headache history (P= 0.037). The mean of cell count of CSF was significantly higher in patients with post-lumbar puncture headache (P=0.012). The other factors did not influence the post-diagnostic lumbar puncture headache. CONCLUSION: Post-diagnostic lumbar puncture headache in children was more common than other studies. The factors that influence post-diagnostic lumbar puncture headache in children are previous headache history and cell count in CSF.

A Case of Intussusception Secondary to Ileocecal MALT Lymphoma / 대한소아소화기영양학회지

The gastrointestinal (GI) tract is the extranodal location most frequently involved in MALT lymphomas, and although MALT lymphomas can be found in the small intestine, most MALT lymphomas of the GI tract occur in the stomach. In addition, MALT lymphoma occurs predominantly in adults; however, a ten-year old female that was admitted to our hospital due to Rt. lower quadrant abdominal pain 1 month ago,was diagnosed with intussusception secondary to ileocecal MALT lymphoma. A biopsy specimen confirmed lymphocyte infiltration with lymphoepithelial lesions, suggesting a low grade MALT lymphoma. Therefore, we report a case of low-grade MALT lymphoma occurring in a ten-year-old female who presented with ileocecal intussusception.

A Case of Intussusception Secondary to Ileocecal MALT Lymphoma / 대한소아소화기영양학회지

The gastrointestinal (GI) tract is the extranodal location most frequently involved in MALT lymphomas, and although MALT lymphomas can be found in the small intestine, most MALT lymphomas of the GI tract occur in the stomach. In addition, MALT lymphoma occurs predominantly in adults; however, a ten-year old female that was admitted to our hospital due to Rt. lower quadrant abdominal pain 1 month ago,was diagnosed with intussusception secondary to ileocecal MALT lymphoma. A biopsy specimen confirmed lymphocyte infiltration with lymphoepithelial lesions, suggesting a low grade MALT lymphoma. Therefore, we report a case of low-grade MALT lymphoma occurring in a ten-year-old female who presented with ileocecal intussusception.

Relationships of Serum Leptin Levels with Bone Metabolism in the Childhood Obesity / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to evaluate the influence of leptin on biochemical markers of bone metabolism in childhood obesity. METHODS: A total of 50 male children (25 obese and 25 controls) were recruited from the pediatric outpatient clinic at the Chosun University Hospital from November 1st 2005 to May 30th 2006. BMI, body fat percentage, serum leptin, bone-specific alkaline phosphatase (B-ALP), C-terminal propeptide of type 1 collagen (CICP), total deoxypyridinoline crosslinks (total DPD) were measured. The correlations of leptin with BMI, body fat percentage, B-ALP, CICP, total DPD were analyzed by Pearson's correlation. In a multiple stepwise regression analysis, leptin after correction for body weight was evaluated if there was a correlation with biochemical markers of bone formation and resorption respectively. RESULTS: The leptin levels of the obese group were significantly higher than those of the control group (p=0.012). In the obese group, the leptin level was significantly positively correlated with the BMI (r=0.551, p=0.01) and the percentage of body fat (r=0.584, p=0.018). In the obese group, of bone markers, B-ALP (r=-0.613, p=0.026) and CICP (r=-0.583, p=0.037) were negatively correlated with leptin. B-ALP (r=-0.728, p=0.007) and CICP (r=-0.684, p=0.014) were negatively correlated with leptin when corrected for body weight. In the control group, bone markers were not correlated with leptin. In the multiple stepwise regression analyses, there was a negative correlation between the leptin and B-ALP (Y=-39.653X+356.341, p=0.026), CICP (Y=-13.437X+116.013, p=0.037) respectively in the obese group. CONCLUSION: Leptin was a significant factor in the bone formation but not in bone resorption in childhood obesity.

Prevalence of Orthostatic Dysregulation in Elementary School Students and Frequency of Individual Symptoms / 소아과

PURPOSE: The purpose of the present study was to access the prevalence of orthostatic dysregulation(OD) and the frequency of each category for major and minor criteria among elementary school students using the OD questionnaire. METHODS: We carried out inquiry by questionnaire as to the frequency of OD among two elementary schools with 725 students, 10 to 12 years of age, residing in Gwangju, Korea. The questionnaire was made according to criteria proposed by the Japan OD Study Group. RESULTS: Of the 725 students(male 390; female 335) questioned, the OD was found in 338 students (53.5 percent). Prevalence of OD in males(59.2 percent) was significantly higher than in females(46.8 percent)(P<0.05). Palpitation with slight exercise(95.9 percent) was the most frequent major symptom. Headaches(85.8 percent) were the most frequent minor symptom among cases of OD. CONCLUSION: The prevalence of OD in elementary school students in this study(53.5 percent) was higher than in other studies. Contrary to studies from other countries, the male to female ratio was reversed. Because the diagnostic criteria seem to be dependent on subjective reporting of the symptoms, a newer diagnostic system based on more objective findings should be established.

Evaluation of Web Sites on Treatment of Childhood and Adolescent Obesity / 대한소아소화기영양학회지

PURPOSE: The purpose of this study was to evaluate the quality and problems of Web sites for management of childhood and adolescent obesity. METHODS: We evaluated 203 Web sites identified from the search engine, Korean Yahoo, using the word of 'childhood and adolescent obesity'. 203 Web sites were classified according to medical institutions, health information Web sites, beauty shops. etc. We surveyed whether childhood and adolescent obesity distinguished with adult obesity was considered, or not. and researched the unique managements of childhood and adolescent obesity including the cardinal treatment. RESULTS: Of the 203 Web sites, 157(77.3%) provided detailed information about treatment of obesity, 46(22.7%) provided only simple information about one. The sites providing detailed information were composed of 52.2% of oriental medicine clinics, 35.0% of clinic and hospitals including pediatric hospitals. Distribution of the sites about management of childhood and adolescent obesity distinguished with adult's one was only 23% of oriental medicine clinics, but 93% of childrens hospitals. CONCLUSION: Without considering the speciality of childhood obesity, inaccurate information are distributing on internet web sites. It is necessary for concern and development of advertizing system on the internet distributing accurate information about treatment of childhood obesity.

IL-4/IL-13 Cytokine and Receptor in Asthma / 소아알레르기및호흡기학회지

Asthma is a chronic allergic inflammatory disease of lung. The initiation and progression of asthma is dependent on the cytokines interleukin (IL) -4 and IL-13 acting through related receptor complexes. Disease pathogenesis is effected by intracellular signaling pathways that couple primarily to specific motifs within the intracellular domain of the IL-4 receptor alpha chain (IL-4R alpha), a subunit that is common to the IL-4 and IL-13 receptor complexes. Neutralizing anti-cytokine strategies have proven to be highly successful on dissecting relevant effector pathways in experimental allergic disease, and are now entering clinical trials in human allergic disorders. Although there have been only a few clinical studies on the effects of cytokine modulators in asthma, this line of research and development appears promising.

Pulmonary Hemorrhage with Hemoptysis in Systemic Lupus Erythematosis / 소아알레르기및호흡기학회지

Pulmonary hemorrhage is a rare, but serious manifestation of systemic lupus erythematosus (SLE). In this report we describe a 13-year-old girl with pulmonary hemorrhage as the sole presenting clinical manifestation of SLE. Asymptomatic pulmonary lupus needs no treatment; however, pulmonary involvement in lupus may be life threatening, in which case prompt and aggressive treatment is mandatory. The different aspects of pulmonary lupus are demonstrated through the clinical histories of patients who suffered from pleuro-pulmonary lupus. Early diagnosis of acute pulmonary complications in systemic lupus erythematosus patients is essential to improve the chances of recovery.

Usefulness of a Alvarado Scoring System for the Diagnosis of Acute Appendicitis in Children / 대한소아소화기영양학회지

PURPOSE: Alvarado scoring system was evaluated regarding its usefulness for the early diagnosis of acute appendicitis in adult and in reduction of the incidence of negative appendicectomies. To evaluate the accuracy of diagnosing appendicitis using the Alvarado score in children. METHODS: Prospectively, we surveyed 122 patients (male 67, female 55) suffering from abdominal pain, who had visited to the emergency department of Chosun University Hospital from June 2002 to May 2003. The Alvarado score has been computed from the white blood cell count, neutrophil count, body temperature, resistance in the right lower quadrant, length of symptoms, nausea and vomiting. Each patient was evaluated by a pediatric resident and then by a general surgeon independently. RESULTS: Out of 170 total children who visited to the emergency department due to abdominal pain, 122 patients were associated with appendicitis. A total of 122 patients (67 male and 55 female) were visited to the emergency room with suspected appendicitis. From 105 operated patients, 92 (87.6%) were diagnosed acute appendicitis and erronous diagnostic rate was 12.4%, pathologically. Mean alvarado score of appendicitis group was 5.40+/-1.24 whereas those of non-appendicitis group was 3.73+/-1.82 (p<0.05). From 6 Alvarado score high sensitivity (86.4%) and high specificity (80.0%) were observed. Sensitivity of ultrasonography or computed tomography was 92.5%. CONCLUSION: We found that Alvarado score system is a noninvasive, safe diagnostic method, which is simple, reliable and repeatable. Alvarado score is useful system for a first, rapid and economic evaluation for the appendicitis in children.

Successful Treatment with Partial Splenic Embolization in a Case of Post-transplantations Lymphoproliferative Disease with Persistent Hypersplenism / 대한소아소화기영양학회지

Posttranplantations lymphoproliferative disease (PTLD) is a common and life-threatening complication for soid organ transplantation associated with the use of chronic immunosuppression and Epstein-Barr virus. There is no standardized treatment algorithm, but numerous management strategies are vaiable. Partial splenic embolization (PSE) had been demonstrated to be an effetive alternatie to splenectomy for patients hypersplenism and portal hypertension. PSE has the advantages of non-invasive intervention and resolution of the complications of hypersplenism. We report the effect of the PSE in a 6-year old male liver transplantation recepient with PTLD who has undergone persistent hypersplenism post-transplant. We reduced immunosuppression agent, started antiviral agent. We started with interferon and IV globulin one month after admission. Hepatosplenomegaly and cervical lymphadenopathy were improved. But fever was not subside. We selectively embolized the lower pole of the spleen to achieve a 50~60% reduction in flow as determined by angiography. After embolization, fever subside and peripheral blood findings were improved. Follow up abdominal CT revealed reduced volume of spleen due to ischemic change and there was no multiple enlarged mesenteric lymphnode compared to preembolization state. We thick that PSE is a safe an effetive treatment modality of PTLD with persistent hypersplenism in patients twho failed to medical treatment.

The Relationship between the Perception of Height and Self-Esteem in Children / 소아과

PURPOSE: The aim of this study was to evaluate the behavioral and affective characteristics of children who thought they were short. METHODS: Fifteen hundred and twenty-two students of four elementary and middle schools in Gwangju City completed a battery of questionnaires asking about stature-related stress, self-esteem, and personality characteristics. The children were divided into three groups and compared according to their answers: group I(who thought they were short, n=466), group II(who thought their heights were normal, n=802), and group III(who thought they were tall, n=254). The degree of depression was calculated using Korean Kovasc's Children's Depression Inventory. RESULTS: Four hundred and sixty-six children(30%) thought they were short. Thirty-two percent of children in group I thought that they were short although their heights were above 50 percentile. Only two percent of children that thought themselves to be short answered that they compared their height with the standard value. Twenty-seven percent of children were not satisfied with their height. No statistically significant difference of depression score was found between males and females. There were statistically significant differences of the depression score according to age(P< 0.05). The average depression scores of the three groups were 15.7+/-6.4, 13.6+/-6.8, and 12.6+/-6.3 respectively(P<0.05). In group I, no significant differences were found in depression score between the subgroups classified according to the standard height distribution. The depression score in the group of those dissatisfied with their height was significantly high(P<0.05). CONCLUSION: Correct perceptions of their height are needed for children's psychiatric healthcare. Continuous medical and psychological guidance is therefore recommended.

Continuous Distal Ileostomy Drip Feeding with the Secretion of the Proximal Stoma in a Neonate with IIIa Ileal Atresia / 대한소아소화기영양학회지

Short-bowel syndrome is functionally defined as a state of malabsorption following loss of small bowel, which comprises the sequelae of nutrient, fluid, and weight loss. The proximal segment of the bowel of a patient with intestinal atresia is usually grossly distended and atonic. In contrast, distal segment is smaller. For this reason, anastomosis of the proximal and the distal segment is technically difficult and may cause no propulsion even when they are anastomosed. We experienced that continuous drip ileostomy feeding with the secretions from the proximal stoma stimulated the distal bowel to accommodate and resolved many sequelae following loss of small bowel in a patient with short-bowel syndrome due to IIIa ileal atresia.

A Case of Beriberi Because of Continuous Rice-soup Feeding during One and Half Years / 대한소아소화기영양학회지

Beriberi, which is caused by thiamin deficiency, is a rare disease in recent years. But it has been described in the Eastern literature as far back as the 17th century. Early symptoms are fatigue, apathy, irritability, drowsiness, anorexia, nausea, vomiting and abdominal pain. Signs and symptoms of progression are peripheral neuritis, paresthesia, decreased tendon reflex and congestive heart failure. Thiamin deficiency remains as an important health care issue in many world population, specially in AIDS, pregnancy women and TPN associated patients. The best diagnostic test is assessing clinical response to administration of thiamin. We have experienced a case of Beriberi caused by continuous rice-soup feeding during one and half years in a 7-year-old boy.

Utilization Patterns of Medical Care of Elementary School Children after the Implementation of Medical Reform: Comparison with a Previous Study in 1998 / 소아과

OBJECTIVE: The purpose of this study was to assess the patterns of medical care utilization and factors which determine medical care utilization of elementary school children after the implementation of medical reform. METHODS: We performed the questionnaires on 1,031 children from two elementary schools in Gwangju city from June 1 to 30 June, 2001. These data were compared with data from a previous study in 1988 to evaluate the changes in medical care utilization after the implementation of medical reform. RESULTS: The prevalence rate of illness was 52.2%. The rate of persons who received medical treatment when they were sick, was 53.6%. The reasons for not treating illness were mild symptoms (84.7%), no time and too busy(4.3%), and economic causes(9.3%). The selection distribution among various medical facilities was pediatric hospital(47.2%), otolaryngologic hospital(25.8%), internal medicine(11.2%), family medicine(4.9%) and pharmacy(4.6%). The most frequently utilized medical facility for respiratory and gastrointestinal symptoms was a pediatric hospital. The major factors influencing the selection of a medical facility were geographic accessibility and good results. The most common reason for the first visit to pediatric hospital, otolaryngologic hospital or internal medicine department was geographic accessibility. CONCLUSION: Compared with a previous study in 1998, this data showed a decreased treatment rate in spite of an increased prevalence rate. The useage of pharmacies markedly decreased but visits to pediatric hospitals did not increase.

Relationship between Admission and Clinical Features of Children who visited the Emergency Department with Seizures

PURPOSE: To review the seizure-related complaints and analyze the relationship between admission rates and clinical features in children who had visited the emergency department with seizures. METHODS: Retrospectively, we reviewed 180 patients(male 100, female 80) suffering from seizures, who had visited to the emergency department of Chosun University Hospital from January 2000 to June 2002. We have analyzed the correlation between admission rate and clinical features such as age, seizure type, seizure duration and individual laboratory findings(CT or MRI, and CSF). RESULTS: Out of 4,865 total children who visited the emergency department, 180 patients(3.7%) were seizure related. The most common seizure type was simple febrile seizure(52.2%). The admission rate of children with seizures was 48.9%. The admission rate according to age, sex and abnormal laboratory findings revealed no significant correlations(P>0.05). There was a significant correlation between admission and both status epilepticus 82.4%(14/17) and complex febrile seizure 63.6%(14/22) (P<0.05). According to the duration of convulsions, admission rates were 41.2% when within five minutes, 60% when six-15 minutes, 58.8% when 16-30 minutes, 85.7% when 30 minutes, to one hour and 66.7% when above one hour of duration. According to the seizure frequency, admission rates of recurrent seizure patients(61.4%=43/70) was higher compared to the first time seizure patients(40.9%=45/110). CONCLUSION: We found that the admission rate of children visiting the emergency department for seizure treatment was 48.9% and significantly correlated with duration, type and frequency of seizure.

Eating Habits of Children Under 4 Years with Poor-Feeding / 대한소아소화기영양학회지

PURPOSE: To find out the differences in eating habits between poor feeding and non-poor feeding children. METHODS: We performed questionnaires on 504 children under four years of age who visited hospitals in Gwangju city and JaollaNamdo from May to August, 2002. RESULTS: 138 (27.4%) children were included in poor feeding group, and 366 (72.%) children were in non-poor feeding group. Breast feeding rate was 18.8% in the poor feeding group and 20.3% in the non-poor feeding group. Duration of breast feeding for less than six months were noted in 70.5% of poor feeding group, and 58.5% of non-poor feeding group. The time at starting solid food in the poor feeding group was as follows; 15.9% of infants started on solid food when they were 2~4 months old, 32.7% during 4~6 months, 38.1% during 6~8 months and 18.8% over one year of age. Solid food was given in wrongly manners in both groups by nursing bottles, including 80.4% in poor feeding group and 66.6% in non-poor feeding group. CONCLUSION: This study demonstrated close relationships among poor feeding children under four years of age with history of low rate and short duration of breast feeding, inappropriate time to start on solid food, less interest in food during mealtime, and unbalanced diet. Pediatricians should make an effort to play an important role in nutritional education and treatment in children.

A Study on the Status of Utilization and Criteria for Selection of Medical Care Facilities of Elementary School Children

PURPOSE: The aim of this study is to find out the distribution of illness, patterns of medical care utilization and factors determining medical care utilization in elementary school children. METHODS: We performed the questionnaires in Gwangju city on 2,036 children of two elementary schools from June 1 to June 30, 1998. RESULTS: The prevalence rate of illness was 32.3%. The distribution of illness was respiratory disease(64.7%), gastrointestinal disease(12.8%), injury & poisoning. The rate of persons having received medical treatment when they were sick, was 89.8%. The selection distribution among various medical facilities was pediatric hospital(46.7%), otolaryngologic hospital(19.8%), pharmacy (13.2%) and internal medicine in the decreasing frequency sequence. The major factors influencing the selection of medical facility were geographic accessibility and good results. The most common reason for the first visit to the pediatric hospital was geographic accessibility. The most common reason for a visit and to otolaryngologic hospital was a good result. The most frequently utilized medical facility for respiratory symptoms and gastrointestinal symptoms was pediatric hospital. The persons influencing the selection of medical facility in the children were mother(73.3%), father(10.8%), doctor and others in decreasing sequence. The persons answering the questionaire thought that the optimal age of pediatric care was from 0 to 12 years(47.8%), to 10 years(22.4%) and to 15 years(18.5%) in decreasing rate. CONCLUSION: Other departments instead of pediatrics have treated children. Children have particular growth and development process, which is different to those of adults. So, it is necessary to choose special medical care and adequate medical facilities for children.

Six Year Follow-up of Childhood Obesity

PURPOSE: To examine the prevalence of obesity in elementary school-aged children in Gwangju, and long term courses of those obese children. METHODS: We examined children aged 7 to 12 in the total number of 3,028 elementary school students consisting of 1,579 boys and 1,449 girls between 1994 and 1999. Obesity was defined as weight that exceeded the standard weight for height and sex by more than 20%(relative weight >120%). RESULTS: The prevalence of obesity was 3.4% at age 7 and 6.2% at age 12. The prevalence of obesity increased with age in both sexes. In boys, 5.7% of normal weight children at age 7 became obese at age 12. Sixty percent of mild obese children and sixty four point three percent of moderately obese children at age 7 remained obese at age 12. One hundred percent of severely obese children at age 7 remained obese at age 12. In girls, 3.1% of normal weight children at age 7 became obese at age 12. Forty seven percent of mildly obese children and fifty six point three percent of moderately obese children at age 7 remained obese at age 12. Sixty six point seven percent of severely obese children at age 7 remained obese at age 12. Above half of the obese children at age 7 remained obese at age 12. CONCLUSION: Our results suggest that prevention and treatment of obesity in elementary school children is required as early as possible.

Prevalence and Epidemiologic Charicteristics of Chronic Recurrent Headache in Primary School Children

PURPOSE: The purpose of the study was to determine the prevalence of chronic recurrent headache and the factors associated with it among primary school children. METHODS: The survey was performed by a special questionnaire on one thousand and eleven children in grades 4 to 6 at primary schools from 1 to 30 June 1999 in Gwangju city. RESULTS: Prevalence of chronic recurrent headaches was 17.5%(17.1% among males, 18% among girls). Over forty two point seven percent(42.7%) of the children had headache 4-6 times a month. Age at onset of headache was more predominant at 7-10 years of age. Headache most frequently occured before school(30.7%), during school(29%), and before awaking in the morning(16.5%). The highest incidence rate of chronic recurrent headache was observed on Monday(23.5%), and the lowest on Saturday(5.3%). Risk factors of chronic recurrent headaches were stress(26.1%), fatigue, poor sleep(25.1%), weather change(18.3%) and anxiety(18.2%). Of 177 cases with chronic recurrent headaches, 62 cases(35%) had family history. Among them, 50.0% of the patients had history in their mothers, 24.2% in the fathers, 17.7% in the brothers and sisters. Of 177 cases with chronic recurrent headaches, 122 cases(69%) were treated at the pharmacy(35%), hospital(23%), and herb medicine(11%). CONCLUSION: This study finds a high overall prevalence(17.5%) of chronic recurrent headache on primary school children. And among many causative factors, stress schools is most common. In conclusion, while evaluating chronic headache in children, environmental and emotional factors associated with school should be considered as well as organic causes.