Tuberculous Empyema Necessitatis with Osteomyelitis, a Rare Case in the 21st Century / 소아감염

Empyema necessitatis refers to empyema that extends into the extrapleural space through a defect in the pleural surface. Tuberculous empyema necessitatis is a rare complication of tuberculosis. We experienced a 21-month-old boy with tuberculous empyema necessitatis with osteomyelitis in the right 7th rib. He presented with a mass on the right lateral chest wall, which was soft and nontender, enlarging for one month. He also had mild fever. The plain radiograph of his chest revealed soft tissue swelling and calcified lymph node on the left axilla, and his PPD skin test was positive. CT scan of the chest showed empyema necessitatis at the right lower chest and upper abdominal walls with osteomyelitis of the right 7th rib. He did not have concurrent pulmonary tuberculosis. Surgery was performed for diagnosis and treatment. In histopathologic findings, chronic granulomatous inflammation with caseation necrosis was shown and was positive for acid fast bacilli stain. In addition, M. tuberculosis complex was found as etiology by polymerase chain reaction. The patient has been treated with anti-tuberculous medication without any specific complication.

Effects of a 12-week, school-based obesity management program on obese primary school children / 소아과

PURPOSE: This study was designed to determine the effects of a school-based obesity-management program on obese primary school children. METHODS: A total of 995 children (6-12 years old) in a primary school were screened in March 2008, and of those, 101 obese students (44 boys and 57 girls, body mass index (BMI) > or = 95 percentile) were enrolled for a study group. The school-based, obesity management program, which includes physical exercise and nutritional education, was conducted as part of an extracurricular program for 12 weeks. The measurement of height, weight, waist circumference, blood pressure (BP), and bioelectrical impedance analysis (BIA) was performed before and after the program. RESULTS: Height and weight increased significantly (P<0.05). The BMI and obesity index decreased significantly (P<0.01). Systolic and diastolic BP decreased significantly (P<0.01). BMI decreased in 61.4% of boys and 66.7% of girls. Protein and basal metabolic rate (BMR) increased significantly on the BIA (P<0.01). Fat decreased significantly (P<0.05). The total body water (TBW) and percent body fat (PBF) decreased significantly (P<0.01). The changes in protein, fat, TBW, PBF, and BMR significantly correlated to the change in BMI (P<0.05). In a multiple logistic regression analysis, BMI change was significantly correlated to the changes in protein and fat content (P<0.01). CONCLUSION: The school-based obesity management program is a very effective way to manage obesity for obese primary school children.

Hyponatremia and Syndrome of Inappropriate Antidiuretic Hormone Secretion in Kawasaki Disease

BACKGROUND AND OBJECTIVES: The pathogenesis of hyponatremia (serum sodium <135 mEq/L) in Kawasaki disease (KD) remains unclear. We investigated the clinical significance of hyponatremia, and the role of interleukin (IL)-6 and IL-1beta in the development of hyponatremia and syndrome of inappropriate antidiuretic hormone secretion (SIADH) in KD. SUBJECTS AND METHODS: Fifty KD patients were prospectively enrolled and analyzed for clinical and laboratory variables according to the presence of hyponatremia or SIADH. RESULTS: Thirteen KD patients (26%) had hyponatremia and 6 of these had SIADH. In patients with hyponatremia, the percentage of neutrophils (% neutrophils), C-reactive protein (CRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were higher than in those without hyponatremia, while serum triiodothyronine (T3) and albumin were lower. Patients with hyponatremia had a higher incidence of intravenous immunoglobulin-resistance but this was not statistically significant. No differences existed between patients with and without SIADH with regard to clinical or laboratory variables and the incidence of IVIG-resistance. Serum sodium inversely correlated with % neutrophils, CRP, and NT-proBNP, and positively correlated with T3 and albumin. Serum IL-6 and IL-1beta levels increased in KD patients and were higher in patients with hyponatremia. Plasma antidiuretic hormone increased in patients with SIADH, which tended to positively correlate with IL-6 and IL-1beta levels. CONCLUSION: Hyponatremia occurs in KD patients with severe inflammation, while increased IL-6 and IL-1beta may activate ADH secretion, leading to SIADH and hyponatremia in KD.