Paradoxical Response to Chemotherapy in Tuberculous Pleural Effusion / 소아알레르기및호흡기학회지

It is defined as the paradoxical response when the clinical or radiologic worsening of old lesions or the development of new lesion occur in spite of appropriate antituberculous therapy. The paradoxical response can occur as an intracranial tuberculoma, pleurisy, pericarditis and contralateral new parenchymal lesions. However, poor compliance with therapy, drug resistance, non-tuberculous mycobacterium, or another underlying condition as lung cancer should be ruled out before concluding that the treatment is the cause of the exacerbation. The case reports of paradoxical response have been mainly reported in adults, but extremely rare in children. We report a case of paradoxical response in which a new parenchymal lung lesion developed during antituberculous therapy in a 14-year-old female patient with tuberculous pleurisy. She experienced clinical improvement with steroid therapy in addition to antituberculous therapy.

Correlation between Body Fat Percent Estimated by Bioelectrical Impedance Analysis and Other Variable Methods

PURPOSE: Obesity is a significant health problem with medical and psychological consequences for children and adolescents. The purpose of this study was to assess the correlation between body fat percent using bioelectrical impedance(BI) and other variable methods. METHODS: We measured height, weight, body mass index(BMI) and body fat percent by skinfold thickness(ST) and BI in 1,035(496 male; 539 female) children from seven to 18 years of age. The correlation coefficients between BI and each of the other different methods were obtained. The sensitivity and specificity to predict obesity by these several methods were studied. RESULTS: Fat percent estimated by BI analysis and BMI showed a strong correlation(r=0.749). Fat percent estimated by BI analysis and ST showed a very strong correlation(r=0.835). At the 95th percentile cut-off point for BI, ST showed a sensitivity of 57.7%, and a specificity of 97.6% for estimating body fat. At the 95th percentile cut-off point for BI, BMI showed a sensitivity of 84.9%, and a specificity of 99.3% for estimating body fat. CONCLUSION: The fat percent estimated by BI analysis correlated strongly with ST or BMI. BI analysis is an objective and accurate method for estimating body fat in childhood obesity.

Serogroup and Antimicrobial Resistance of Streptococcus pneumoniae Isolated from Oropharynx in Children Attending Day Care Center

PURPOSE: Penicillin- and multidrug-resistant S. pneumoniae poses a serious threat to clinicians because the rate of resistance of S. pneumoniae to penicillin in Korea has surged up to the world's highest level. This study was performed to assess the carriage rate, serogroups and antimicrobial susceptibility of S. pneumoniae isolated from oropharynx in children. METHODS: From March to July 1998, 209 children under 5 years of age were recruited from five day care centers. The carriage rate for pneumococci was obtained. Antimicrobial susceptibilities were determined with the E-test and agar dilution methods. Serogrouping was performed on 48 of the pneumococcal isolates by the Quellung reaction. RESULTS: The carriage rate of S. pneumoniae was 30.1%. Antimicrobial susceptibility profiles were available for 59 of the isolates. Sixty-six percent of isolates were not susceptible to penicillin, and multidrug-resistance was observed in 76.3% of the isolates. A high proportion of the penicillin-resistant strains showed associated resistance to trimethoprim-sulfamethoxazole, tetracycline, erythromycin, and oxacillin. The most prevalent oropharyngeal serogroups were 19, 6, 3, 23, and 29. Resistance of the pneumococcal isolates to penicillin was different according to the serogroups. All of the strains of serogroup 19, 23, and 29 was resistant to penicillin but 87.5% of serogroup 3 strains were susceptible to penicillin. CONCLUSION: The resistance rate of S. pneumoniae isolated from oropharynx in children was very high to penicillin and other antimicrobial agents. For the reduction of the drug-resistant rate of S. pneumoniae, clinicians should be required to be more judicious in their use of antimicrobial agents.

Body Composition by Bioelectrical Impedance Analysis in Obese Children

PURPOSE: Body composition by bioelectrical impedance analysis(BIA) is a very useful method of analysing body composition in many diseases. BIA is a simple, rapid, non-invasive and reproducible technique. There was no comparative analysis between obese and healthy children. A comparative analysis between obese and healthy children is needed to assess the effect of excercise and other interventions in the management of childhood obesity. This study is designed to analyze and compare the body composition and body fat percent measured by BIA in healthy and obese children. METHODS: Height and weight were measured. BIA was done in healthy and obese children. Body compositions were analyzed with fat mass, lean body mass, body fat percent, protein, mineral, intracellular fluid(ICF), and extracellular fluid(ECF). RESULTS: Fat mass, fat percent, ICF, and ECF were significantly higher in the obese group. Resistances were significantly lower in the obese group. The amounts of ICF and ECF were significantly higher in obese group. Fat mass showed more significant correlation with ICF and ECF than body mass index. CONCLUSION: Body composition analysis using bioelectrical impedance(BI) is considered as very useful diagnostic method in the evaluation and treatment in childhood obesity. Epidemiologic study will be needed to determine the diagnostic criteria of obesity by BI.

Carriage and Antimicrobial Susceptibility of Haemophilus influenzae Isolated from Oropharynges of Children

PURPOSE: Haemophilus influenzae, one of the normal flora of the upper respiratory tract, can cause such infections as otitis, sinusitis, pneumonia, and meningitis in children. The oropharyngeal flora has therefore mainly been analyzed as a reservoir for pathogens. This study was performed to reveal the colonization rate of H. influenzae in the upper respiratory tract, their biotypes, their antimicrobial resistance and production of beta-lactamase in healthy children. METHODS: The specimens for H. influenzae were obtained through oropharyngeal swab from 209 healthy children, younger than 5 years of age in 4 day care centers from March 1998 to June 1998. These isolates of H. influenzae were tested for their biotypes, in vitro susceptibility to seven antimicrobial agents(ampicillin, ampicillin/sulbactam, aztreonam, chloramphenicol, cefotaxime, tetracycline and trimethoprim-sulfamedoxazole) by disc diffusion method and production of beta- lactamase. RESULTS: The carriage rate of H. influenzae in the day care center children was 13.4%(28/209). Of 24 isolates, 8 isolates(33%) were biotype II and 6 isolates(25%) were biotype I. The overall rates of resistance of 15 isolates are as follows; ampicillin 46.7%, tetracycline 28.6%, trimethop rim-sulfamedoxazole 14.3%, ampicillin/sulbactam 6.7%. The prevalence of beta-lactamase producing isolates was 65.2%. All beta-lactamase producing isolates were resistant to ampicillin. The resis tance rates of beta-lactamase producing isolates to tetracycline, trimethoprim-sulfamedoxazole, and ampicillin/sulbactam were 44.4%, 25.0%, and 11.1%, respectively. CONCLUSION: Children in day care centers in Seoul have high rates of H. influenzae carriage. The antimicrobial resistance of H. influenzae from the oropharyngeal specimens of healthy children was higher than expected.

Factors Associated with the Development of Anti-insulin Antibody in Diabetic Children / 대한소아내분비학회지

PURPOSE: Anti-insulin antibodies develop within several months of initiation of insulin therapy in most of diabetic patients. The purpose of this study is to observe the relationship between the clinical factors and development of anti-insulin antibody METHODS: Serum was collected from 116 diabetic patients and 47 nondiabetic children for the measurement of anti-insulin antibody titer by radioimmunoassay (RIA). Retrospective analysis of the medical records of clinical factors were evaluated. RESULTS: There was no relationship of anti-insulin antibody titer with age, duration, HbA1c, insulin dose, and BMI in diabetic children. There was no difference in anti-insulin antibody titer according to the sex, the presence of family history, the presence of DKA, the presence of complications, the presence of puberty, species of insulin, duration of disease in diabetic children. The titers of anti-insulin antibody were significantly higher in type 1 diabetic children(30.3+/-17.9% in type 1 and 16.5+/-7.0% in type 2, P7%. The positive rates of anti-insulin antibody were higher in male patients with diabetes(73.2% in male and 53.3% in female, P7%). CONCLUSION: The results suggests that anti-insulin antibody developed more likely in type 1 DM and less likely in DM patients whose control had been good and who used less insulin doses, which remains to be studied further with more patients for longer duation.

The Changes of Apoptosis and Viability in Stem Cells after Thawing with Lapse of the Time

PURPOSE: Thawed stem cells should be infused as early as possible because delay of infusion leads to decrease of cell viability and formation of DNA clumping. The procedure of 10% Dimethyl sulfoxide(DMSO) removal and a long distance from the thawing location to the patient are the main causes of delay of infusion that results in the loss of cell viability and apoptosis. Therefore, we investigated the changes of cell viability and apoptosis after thawing with lapse of time. METHODS: Five samples of mobilized peripheral blood were evaluated. We measured cell viability, colony forming unit(CFU) and apoptosis at 0, 1, 2, 4, and 24 hours after thawing. The state of stem cells were divided into live, apoptotic and dead with double staining using annexin V and 7-aminoactinomycin D(7-AAD) in flow cytometry. RESULTS: Viability of the total cells after thawing was 77.3(53.3-97.7)%. The percentage which recovered to initial CFU at 1, 2, 4 and 24 hours after thawing decreased to 63.9%, 50.2%, 45.8% and 11.6%, respectively. The proportion of apoptotic cells among CD34+ cells after thawing were increased from 0.2% at 0 hour to 16.5% at 1 hour, 21.9% at 2 hours, and then decreased to 15.0% at 4 hours, 2.7% at 24 hours because they were replaced by dead cells. CONCLUSION: Thawed cells changed to apoptotic and had less colony forming capacity from 1 hour after thawing, and were then replaced by dead cells from 4 hours after thawing.

The Improvement of Cell Viability due to Dilution and Removal of DMSO in Thawing of Stem Cells

PURPOSE: Cryopreserved stem cells from cord blood are usually infused with Dimethyl Sulfoxide (DMSO) immediately after thawing. However, this process may cause cell damage due to osmotic shock, and the administration of DMSO may also cause toxic effects. We studied a new method of increasing cell viability by stabilizing osmolarity by adding dextran 40 and washing out DMSO. METHODS: Thirty-five samples of cord blood were studied. RBCs were removed in 10% pentastarch. The cells were mixed with DMSO of 5, 10 and 20% each, and stored at -80 degree C. Cryopreserved cells were thawed and then diluted with dextran 40. DMSO was removed afterwards. The cell viability, osmolarity and colony forming capacity in this new thawing method were compared with the control group done by conventional methods. RESULTS: The recovery rate of WBC after RBCs separation was 92.06% but the contamination rate of RBC was still high(29.90%). The concentration of DMSO significantly affected the survival of WBCs(P<0.05). The osmolarity was 330+/-17.7mOsm/L before freezing, 1,457+/-508.7mOsm/L after thawing prior to dilution and 811+/-199.6mOsm/L after dilution, suggesting that the dilution process was effective in reducing osmolarity. The number of viable cells increased from 6.01+/-1.61(x103/L) to 7.16+/-1.48(x103/L) after dilution but was not significant. The number of CFU-C was increased from 5.82+/-4.19(/105) to 7.58+/-3.16(/105) after dilution but was not significant. CONCLUSION: Our method of removing DMSO during the thawing process yields a higher cell survival rate and less DMSO toxicities compared with the conventional method of direct injection with DMSO after thawing.

Percent of Body Fat by Bioelectrical Impedance Analysis in Healthy Children

PURPOSE: Obesity is a frequent nutritional disorder in children and adolescent and its prevalence is increasing. Bioelectrical impedance analysis is a simple, rapid, non-invasive and reproducible technique. The aim of this study was to measure percent of body fat using bioelectrical impedance in healthy children. METHODS: We measured height, weight and bioelectrical impedance in 1035 children aged 7-18 years(496 males and 539 females). RESULTS: Percent of body fat was decreased in male children, but it was increased during the pubertal period in female. 95th percentiles of percent of body fat by bioelectrical impedance was 32.9% in 7 year olds, 31.6% in 8, 34.7% in 9, 35.1% in 10, 35.8% in 11, 33.1% in 12, 36.1% in 13, 38.2% in 14, 33.3% in 15, 28.3% in 16, 32.8% in 17 and 32.2% in 18 year olds for males. 95th percentiles of percent of body fat by bioelectrical impedance was 25.1% in 7 year olds, 29.6% in 8, 30.5% in 9, 35.6% in 10, 34.5% in 11, 36.5% in 12, 39.1% in 13, 34.1% in 14, 33.7% in 15, 32.8% in 16, 34.5% in 17 and 35.1% in 18 year olds for females. Intraobserver reliability coefficient of bioelectrical impedance analysis was 0.995 and intraobserver reliability of BI(Bioelectrical impedance) analysis was significantly high. CONCLUSION: To measure body fat percentage using bioelectrical impedance analysis in healthy children provides objective data in diagnosing obesity.

Nesidioblastosis in Neonate with Persistent Hyperinsulinemic Hypoglycemia / 대한소아내분비학회지

Nesidioblastosis, also known as persistent hyperinsulinemic hypoglycemia of infancy(PHHI) or familial hyperinsulinsm, is the most common cause of recurrent severe hypoglycemia in infancy. It is an autosomal recessive disorder characterized by irregular insulin secretion leading to inappropriately raised plasma insulin concentration compared to blood glucose levels. Recently, mutations in the sulfonylurea receptor(SUR) have been described in association with PHHI. The mainstay of medical treatment is glucose infusion and diazoxide or long acting somatostatin. If medical treatment fails in preventing hypoglycemia, near total pancreatectomy is recommended. We report one case of nesidioblastosis cured by near total pancreatectomy with brief review of literatures.

Volumetric Quantitation of Pulmonary Regurgitation and Right Ventricular Function in Postoperative Tetralogy of Fallot by Echocardiography and Magnetic Resonance Imaging

PURPOSE: Despite improved surgical techniques, pulmonary regurgitation is a common postoperative sequelae in patients with tetralogy of Fallot. Pulmonary regurgitation may induce deterioration of right ventricular performance, right ventricular dilatation and ventricular arrhythmia. The evaluation of the clinical significance of pulmonary regurgitation in postoperative tetralogy of Fallot has been troublesome since there was no technique that could accurately quantitate volume of pulmonary flow. Magnetic resonance imaging (MRI) with velocity mapping provided data on the volumetric quantitation of pulmonary regurgitation. The purpose of this present study was to assess right ventricular function and the severity of pulmonary regurgitation after surgical correction of tetralogy of Fallot by echocardiography and MRI. METHODS: Echocardiography and MRI were performed on nine patients with total surgical correction of tetralogy of Fallot. Quantitative volumetric assessment of pulmonary reguritation and right ventricular function was done. RESULTS: The pulmonary regurgitant volume was similar between echocardiography and MRI, and the pulmonary velocity was significantly larger by MRI in comparison with echocardiography. Right ventricular end-diastolic volume and stroke volume were similar in both two methods, but end-systolic volume was significantly larger by MRI in comparison to echocardiography. Pulmonary regurgitant volume was positively correlated with right ventricular end-systolic volume, end-diastolic volume and stroke volume. Each parameter (pulmonic velocity, pulmonary regurgitant volume, right ventricular end-diastolic volume, end-systolic volume, stroke volume) was significantly correlated linearly between echocardiography and MRI. CONCLUSION: Cine MRI with velocity mapping is an accurate method for the noninvasive, volumetric quantitation of pulmonary regurgitation after surgical correction of tetralogy of Fallot.

A Case of 5 alpha-reductase Deficiency in Infancy / 대한소아내분비학회지

5 alpha-reductase deficiency resulting in male pseudohermaphroditism is a rare disease characterized by clitoral-like phallus, bifid scrotum, urogenital sinus, testis cited in labioscrotal folds. Evaluation of plasma T/DHT ratios in infancy, particularly after hCG stimulation of the testes and elevated urinary tetrahydrocortisol (THF) to 5 alpha-tetrahydrocortisol(5 alpha-THF) ratios provide a valuable dianostic test for 5 alpha-reductase deficiency. We report one case of 5 alpha-reductase deficiency who were presented with ambiguous genitalia and elevated T/DHT ratio before and after hCG stimulation.

A Case of Pulmonary Artery Sling

Pulmonary artery sling is a rare vascular anomaly in which the left pulmonary artery arises from the right pulmonary artery and then traverses between the esophagus and the trachea toward the hilum of the left lung. Despite the availability of a corrective operation, the mortality rate remains very high due to the high incidence of associated obstructive anomalies of tracheobronchial trees. We experienced a 8 month old female infant who was admitted because of recurrent pneumonia and expiratory wheezing. She was diagnosed as pulmonary sling by esophagography, echocardiography, computed tomography. We report this with a brief review and related literature.

Comparative Study on the Allergy Skin Test and RAST in Allergic Patients

The allergic skin test and RAST are used commonly to demonstrate the presence of skin sensitizing IgE antibody in the diagnosis of allergic disease. To evaluate the agreement rate and correlation between results of skin test and RAST (radioallergosorbent test) in allergic subject, 83 allergic childhood with positive skin test (bronchial asthma: 26, allergic rhinitis: 27, atopic dermatitis and urticaria: 6 bronchial asthma and allergic rhinitis: 24) and 16 nonallergic childhood were studied. The results were as follows. 1) Peripheral eosinophil counts were significantly elevated in groups with bronchial asthma, allergic rhinitis, bronchial asthma & allergic rhinitis except atopic dermatitis & urticaria group in comparison with normal control group. 2) Serum IgE levels were significantly higher in groups with bronchial asthma, allergic rhinitis, bronchial asthma & allergic rhinitis than in normal control group except atopic dermatitis & urticaria group but there was no significant differences among study groups. 3) RAST units of D.p and D.f were significantly higher in study group except atopic dermatitis & urticaria group. RAST units of cockroach, however, were not significantly increased but in D.f, combined group of bronchial asthma & allergic rhinitis was significantly higher than bronchial asthma or allergic rhinits (p<0.05). 4) Each agreement rate between 3+ skin test and positive rate of RAST in D.p, D.f, cockroach was 37.5%, 63.6% and 12.5% respectively and 4+ skin test and positive rate of RAST was 84.0%, 89.1% and 38.4%. 5) Correlation coefficient between skin test and RAST was 0.71 in D.P, 0.59 in D.f and 0.23 in cockroach. In conclusion, there was difference in agreement rate between positive skin test and RAST to each allergen. Agreement rate between positive skin test and RAST was higher in D.p and D.f. These results suggest that RAST can be used simultaneously with skin test for detecting allergens.

A case of congenital dyserythropoietic anemia

No abstract available.