Allergen sensitization trajectories in children with respiratory and allergic diseases

Purpose@#There is a lack of a report about the trajectories of allergen sensitization, although it is important to understand the change of allergen sensitization to manage allergic disease. This study aimed to analyze the change and trajectories of allergen sensitization in children with respiratory and allergic diseases. @*Methods@#From 2006 to 2020, children with respiratory and allergic diseases or screened for allergic sensitization were evaluated. We visualized the alterations and the trajectories of allergen sensitization using stacked area graphs, box plots, and Sankey diagrams. @*Results@#A total of 2,804 subjects were included, and allergic rhino-conjunctivitis was diagnosed in 1,931 children (68.9%). The mean age for the first test was 4.1 years, and that for the second test was 6.5 years. Children sensitized to class 1 food allergen before age 5 showed sensitizations more for other allergens and at a younger age after age 5 than children who were not. The atopic tendency continued once it had been obtained before the early school age in the persistence or the new development of sensitization. @*Conclusion@#Allergen sensitization has changed over time and has shown different patterns according to age. Its trajectory has taken a wide variety of courses in children with respiratory and allergic diseases until the early school age. These changes reflect the allergic diseases and socio-environmental characteristics of children and adolescents.

A case of vocal cord dysfunction diagnosed in a 10-year-old girl with recurrent wheezing and dyspnea

Vocal cord dysfunction is one of the causes of dyspnea and is characterized by paradoxical closure of the vocal cords. The paradoxical movement of the vocal cords produces the limitation of airflow, resulting dyspnea, chest tightening, hoarseness, stridor, or wheezing. These findings are similar to those of other upper airway obstruction diseases or asthma; therefore, a high index of suspicion and clear differential diagnosis are required. Here, we discuss a case of vocal cord dysfunction aged 10 years that presented recurrent wheezing and dyspnea. The abnormal movement of the vocal cords was observed by fiberoptic laryngotracheobronchoscopy, which was correlated with stridor during respiration. Repeated episodic symptoms were controlled by the multidisciplinary team approach; however, surgical treatment was needed to stabilize the symptom.

Changes in allergen sensitization in children with allergic diseases in the 1980 to 2019

Purpose@#Allergen sensitization is constantly changing, and understanding these changes can help manage and prevent allergic diseases. This research analyzed and compared the changes in allergen sensitization in children diagnosed with allergic diseases using the skin test and the multiple allergen simultaneous test. @*Methods@#We retrospectively analyzed the data on children who were diagnosed with allergic diseases and received immunotherapy at Yonsei Medical Center from 1980 to 1998 and they were screened for allergen sensitization at Severance Hospital from 2005 to 2019. @*Results@#Between 1980 and 1998, and between 2005 and 2019, data on 3,205 (male, 70.3%; mean age, 7.2 ± 2.9 years) and 15,318 children (male, 62.8%; mean age, 8.8 ± 4.5 years) were analyzed. The sensitized allergens that appeared in the 1980–1998 included Dermatophagoides farinae (91.0%), Dermatophagoides pteronyssinus (76.3%), cockroach (13.5%), and Alternaria (11.5%), in order of frequency; further, the sensitized allergens that appeared in the 2005–2019 included D. farinae (45.0%), D. pteronyssinus (39.6%), cat dander (12.2%), and dog dander (9.1%), in order of frequency. D. farinae and D. pteronyssinus demonstrated the highest sensitization rates, although the rates decreased gradually. The sensitization to cat dander and dog dander showed a growing trend, and sensitization to Humulus japonicus, Candida, and cockroach decreased after 2005. @*Conclusion@#Over the past 40 years, the allergen sensitization in Korean children with allergic diseases has increased. These changes reflect lifestyle and environmental changes and influence allergic disease management approaches. Thus, changes in allergic sensitization should be monitored continuously.

Ultrasound measurement of pediatric visceral fat thickness: correlations with metabolic and liver profiles

PURPOSE: Abdominal obesity is a fundamental factor underlying the development of metabolic syndrome. Because of radiation exposure and cost, computed tomography or dual-energy X-ray absorptiometry to evaluate abdominal adiposity are not appropriate in children. Authors evaluated whether ultrasound results could be an indicator of insulin resistance and nonalcoholic fatty liver disease (NAFLD). METHODS: We enrolled 73 subjects (aged 6-16 years) who were evaluated abdominal adiposity by ultrasound. Subcutaneous fat thickness was defined as the measurement from the skin-fat interface to the linea alba, and visceral fat thickness (VFT) was defined as the thickness from the linea alba to the aorta. Anthropometric and biochemical metabolic parameters were also collected and compared. The subjects who met 2 criteria, radiologic confirmed fatty liver and alanine aminotransferase >40, were diagnosed with NAFLD. RESULTS: There was a strong positive correlation between VFT and obesity. VFT was highly correlated with the homeostasis model assessment for insulin resistance score (r=0.403, P<0.001). The area under the curve for VFT as a predictor of NAFLD was 0.875 (95% confidence interval [CI], 0.787-0.964). VFT of 34.3 mm was found to be the discriminating cutoff for NAFLD (sensitivity, 84.6%; specificity, 71.2%, respectively). CONCLUSION: Ultrasound could be useful in measuring VFT and assessing abdominal adiposity in children. Moreover, increased VFT might be an appropriate prognostic factor for insulin resistance and NAFLD.

Ultrasound measurement of pediatric visceral fat thickness: correlations with metabolic and liver profiles

PURPOSE: Abdominal obesity is a fundamental factor underlying the development of metabolic syndrome. Because of radiation exposure and cost, computed tomography or dual-energy X-ray absorptiometry to evaluate abdominal adiposity are not appropriate in children. Authors evaluated whether ultrasound results could be an indicator of insulin resistance and nonalcoholic fatty liver disease (NAFLD). METHODS: We enrolled 73 subjects (aged 6-16 years) who were evaluated abdominal adiposity by ultrasound. Subcutaneous fat thickness was defined as the measurement from the skin-fat interface to the linea alba, and visceral fat thickness (VFT) was defined as the thickness from the linea alba to the aorta. Anthropometric and biochemical metabolic parameters were also collected and compared. The subjects who met 2 criteria, radiologic confirmed fatty liver and alanine aminotransferase >40, were diagnosed with NAFLD. RESULTS: There was a strong positive correlation between VFT and obesity. VFT was highly correlated with the homeostasis model assessment for insulin resistance score (r=0.403, P<0.001). The area under the curve for VFT as a predictor of NAFLD was 0.875 (95% confidence interval [CI], 0.787-0.964). VFT of 34.3 mm was found to be the discriminating cutoff for NAFLD (sensitivity, 84.6%; specificity, 71.2%, respectively). CONCLUSION: Ultrasound could be useful in measuring VFT and assessing abdominal adiposity in children. Moreover, increased VFT might be an appropriate prognostic factor for insulin resistance and NAFLD.

Extracorporeal membrane oxygenation treatment in peanut aspiration with complications

Foreign body aspiration commonly occurs, especially among children younger than 3 years of age. Most endobronchial foreign bodies may be easily removed by bronchoscopy and have a good prognosis. Despite advances in bronchoscopic procedures, difficulties in management of and complications from foreign body aspiration are still noted. We present a foreign body aspiration case with acute respiratory distress syndrome caused aspiration pneumonia, which was successfully treated by bronchoscopy under extracorporeal membrane oxygenation (ECMO). ECMO can be an effective and potentially life-saving method in complicated foreign body aspiration with uncompensated respiratory failure.

Clinical Effect of Left Ventricular Dysfunction in Patients with Mitral Stenosis after Mitral Valve Replacement

BACKGROUND: Mitral stenosis (MS) remains one of the important heart diseases. There are many factors that influence the clinical outcomes, and little is known about how left ventricular (LV) dysfunction clinically affects the prognosis of the patient with MS after mitral valve replacement (MVR). We reviewed our clinical experiences of MVR in patients with MS who had LV dysfunction. METHODS: Between January 1991 and January 2013, 110 patients with MS who underwent MVR were analyzed and divided into two groups according to ejection fraction (EF). Group 1 (EF≤45%) included 13 patients and group 2 (EF>45%) included 97 patients. RESULTS: Thromboembolism occurred in 8 patients after MVR (group 1: n=3, 23.1%; group 2: n=5, 5.2%) and its incidence was significantly higher in group 1 than in group 2 (p=0.014). There were 3 deaths each in groups 1 and 2 during follow-up. The overall rate of cardiac-related death in group 1 was significantly higher than in group 2 (group 1: n=3, 23.1%; group 2: n=3, 3.1%; p=0.007). The cumulative survival rate at 1 and 15 years was 83.9% and 69.9% in group 1 and 97.9% and 96.3% in group 2 (p=0.004). The Cox regression analysis revealed that survival was significantly associated with postoperative stroke (p=0.011, odds ratio=10.304). CONCLUSION: This study identified postoperative stroke as an adverse prognostic factor in patients with MS after MVR, and as more prevalent in patients with LV dysfunction. Postoperative stroke should be reduced to improve clinical outcomes for patients. Preventive care should be made in multiple ways, such as management of LV dysfunction, atrial fibrillation, and anticoagulation.

Resolution of Menetrier's Disease after Helicobacter pylori Eradication / 대한소화기학회지

No abstract availble.

Anticancer effect of tamoxifen in oral cancer cell

Tamoxifen is an selective estrogen receptor antagonist widely used in the management of patients with breast cancer for more than 30 years. It was thought to act primarily through occupying the estrogen receptor sites in ER positive breast cancer cells and directly on cancer cell proper. These inhibitory effects, which have been shown to be independent of the ER, highlight new mechanism of therapeutic action of tamoxifen. The purposes of this study were to identify ER in oral carcinoma cell lines and to evaluate ER independent cytotoxic effect of tamoxifen. KB(SCC), HSC-3(SCC) and A253(ACC) cell line were used and capacity of cell proliferation, apoptosis, in vitro invasion and gelatin zymography were tested. ER expression of each cell line were detected by RT-PCR and immunocytochemistry. Dose dependent inhibition of cell proliferation and inhibition of gelatinolytic activity were observed in all oral carcinoma cell lines and significant difference of apoptotic index were observed in A253 and KB. Tamoxifen inhibited in vitro invasion in all experimental groups. ER expression was detected in KB and A253. These data suggest that tamoxifen may play a role in management of oral carcinoma by independent cytotoxic effect and more advanced research must processed confirming ER-dependent cytotoxicity.

A Case Report of Esophageal and Ileocecal Valve Involvement in Behcet's Disease / 대한소화기내시경학회지

Behcet's disease characterized by recurrent oral and genital ulceration and ocular inflammation has been recognized as a multi-system disorder with numerous manifestations including gastrointestinal tract. Terminal ileum and cecum are the most frequently involved portions of the gastrointestinal tract in Behcet's disease and esophageal involvement is very uncommon. We experienced a case of Behcet's disease involved esophageal and ileocecal region which had been diagnosed by endoscopy. A 20-year-old male was admitted by dysphagia and substernal discomfort. There was a history of recurrent aphthous stomatitis and genital ulcers. The large geographic ulcers surrounded with edematous mucosa were found at mid esophagus and the huge ulcer with exudate was noted on ileocecal valve area in endoscopic examination. The microscopic finding of endoscopic biopsy showed chronic nonspecific inflammation with necrotic inflammatory exudate. Pathergy test was positive. So he was diagnosed as Behcet's disease, and his symptoms and signs were resolved after steroid treatment.

Clinical observation of acute glyphosate intoxication / 대한내과학회지

BACKGROUND: Although glyphosate, organophosphorus herbicide, has been used extensively in agricultural area, no clinical data of acute poisoning have been reported in Korea. The current study evaluated clinical characteristics of acute intoxication by glyphosate. METHODS: We retrospectively collect and analysed the clinical data of 16 acute glyphosate poisoned patients admitted to the department of internal medicine, Soonchunhyang University Chunan hospital from January 1999 through June 2000. RESULTS: 1) Thirteen of sixteen poisoning were male and mean age was 44.2 year-old. 2) The main cause of glyphosate ingestion was suicide intent (12 cases, 75%), and clinical severity was divided into 3 categories : mild (14 cases), moderate (1 case) and severe (1 case). 3) Nausea and vomiting were the most frequent clinical features (each 6 cases) and dyspnea (4 cases), cough (3 cases), sputum (3 cases) and sore throat (3 cases) were followed. Leucocytosis, hepatotoxicity, anemia, hypoxia and renal toxicity were observed in 9,8,5,6 and 3 cases, respectively. 4) No fatal case and severe complication, except 1 aspiration pneumonia and 1 acute respiratory failure, were observed in acute glyphosate poisonings. CONCLUSION: Our data supported that acute glyphosate poisoning dose not result in fatal in humans even after intentional ingestion of glyphosate.