Decreased Calbindin-immunoreactive Renshaw Cells (RCs) in the Lumbar Spinal Cord of the Ataxic Pogo Mice / 대한해부학회지

Calbindin D-28K (CALB) is one of the calcium-binding proteins which is assumed to be buffering, transport of Ca2+, and regulation of various enzyme systems. In the spinal cord, a subpopulation of calbindin-immunoreactive neurons located in the ventral portion of lamina VII, medial to the motoneuron column, has recently been proposed to be Renshaw cells (RCs), that mediate recurrent inhibition of spinal alpha-motoneurons, based on the anatomical location. In this study, we have performed to investigate the correlation between RCs containing high levels of CALB and motoneurons in the ventral horn of lumbar spinal cord of the ataxic pogo mice, that characterized by a failures of interlimb coordination, and prolonged excessive tone of hindlimb extensor muscles. We have shown that CALB immunoreactive RCs was significantly decreased in the ventral horn of lumbar spinal cord of the ataxic pogo mice (p.0.05), when compared with the control mice. Whereas, CALB immunoreactivity expression levels were no difference in the dorsal horn. Furthermore, CALB protein was significantly decreased in the lumbar spinal cord of the ataxic pogo mice (p.0.01). However, there were no difference in the cervical and thoracic spinal cord of the between control and pogo mice. These results suggest that motoneurons of ventral horn of the lumbar spinal cord might be more excited state, results in the decreased CALB immunoreactive RCs have not mediated a motoneuron excitability, in the atxic mice, pogo.

Voltage-dependent Calcium Channel (VDCC) alpha(1A) Subunit Expression in the Ataxic Mutant, Pogo Mice Cerebellum / 대한해부학회지

The pogo mouse is a new ataxic mutant derived from a Korean wild mouse. The pogo mutation is inherited as an autosomal recessive trait on chromosome 8. Mutations in gene coding for the alpha(1A)subunit of voltagegated P/Q-type Ca(2+) channel have been shown to cause phenotypes in humans and mice, i.e., tottering, leaner, rolling mouse mouse Nagoya. Using immunohistochemistry, the expression of the alpha(1A)subunit of voltage-gated P/Q-type Ca(2+) channel was examined in pogo mice cerebellum including deep cerebellar nuclei (DCN). We observed alpha(1A)immunoreactivity in the cerebellar cortex (Purkinje cell and granule cell) and DCN of ataxic pogo mice and heterozygote control mice. There was no difference in cerebellar cortical alpha(1A)immunoreactivity between ataxic pogo mice and heterozygous littermate controls (pogo/+). However, we observed alpha(1A)immunoreactivity in the Purkinje cells of control and ataxic pogo mice cerebellum and DCN. We found a significant difference between pogo and heterozygous controls in terms of alpha(1A)immunoreactivities in the DCN. alpha(1A)immunoreactivity in this nucleus in pogo was much higher than in heterozygous littermate controls. No significant differences were observed in the interposed nucleus between pogo and heterozygous controls, but we found that the alpha(1A)subunits were clearer and more abundant in the lateral and medial regions of pogo than in control mice in these regions, where only weak immunoreactivity was observed. This elevated expression of the alpha(1A)subunit in deep cerebellar neurons of pogo might be a compensation for the altered function of P/Q type calcium channel and be related with the induction of the ataxic phenotype in pogo mice.

A Study of the Survival Rate of Childhood Cancer in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: It is known that the prognosis of childhood cancer is relatively good, however actual representative nationwide data on childhood cancer, particularly of survival rate, are rare. In this study we attempted to establish the overall survival rate of major childhood cancer. MATERIALS AND METHODS: The primary source of data of childhood cancer under 15 years of age were the registry files of the Central Cancer Registry Report (Ministry of Health & Welfare) from 1993 to 1997. The above data was compared to death case data files of the same period obtained from the Korea National Statistical Office using the personal identification code. We calculated the 1, 3, and 5 year survival rates using the life table of SPSS and Kaplan-Meier method and compared the survival rate of disease according to prognostic factors. RESULTS: A total of 6,720 cases of pediatric cancer from the Central Cancer Registry files were computerized and sorted by personal identification (ID) code to extract duplicated cases as well as cases with incomplete data. The final number of cases entered in this study was 4,983. 1) The number of confirmed death cases was 1,448 (29.1%). 2) The disease distribution showed that the most common pediatric cancer was leukemia (1,468/4,983, 29%), followed by brain tumors (503/4,983, 10%), lymphoma (315/4,983, 6%), Wilms tumor (165/4,983, 3%), etc. in order by number of patients. 3) The 5 year survival rate of disease was as follows: overall 62%, acute lymphocytic leukemia 61%, acute non-lymphocytic leukemia 32%, malignant lymphoma 72%, neuroblastoma 47%, medulloblastoma 51%, Astrocytoma 66%, Wilms tumor 83%, etc. CONCLUSION: We analyzed and report the 5 year survival rate of overall childhood cancer and of each of the twelve major childhood cancers from in Korea 1993 to 1997 to provide basic data on childhood cancer statistics.

A Clinical Observation of Newborns of Unmarried Mothers

PURPOSE: The purpose of this study was to assess the importance of prenatal care of the unmarried mothers. METHODS: Clinical characteristics of 131 newborn babies of unmarried mothers who were hospitalized at National Medical Center from April, 1998 to August, 1999 were compared to 131 newborn babies of married mothers who were also hospitalized at National Medical Center from June, 1999 to August, 1999 by reviewing their medical records retrospectively. RESULTS: Average age of mothers were 20.1+/-4.0 years in unmarried group and 28.8+/-4.4 years in married group, which was statistically significant. In unmarried group, the highest rate of maternal age (55.8%) was below 20 years of age, which showed increased tendency compared to previous report. In cesarean section rate, there was significant difference; 11.4% in unmarried group and 48.1% in married group. In the birth order, the first baby was most frequent in both groups. The sex ratio showed 1.78 : 1 with male preponderance in unmarried group and 1 : 1.02 with slight female preponderance in married group. In average gestational age, birth weight, height, head circumference, chest circumference, 5 minutes Apgar score, and admission rate, there was no significant difference. The unmarried group had more babies in postmaturity and meconium-stained condition. CONCLUSION: There was no significant difference in growth and morbidity rate between newborn babies from unmarried mothers who had prenatal care and those from married mothers.

Three Cases of Subacute Necrotizing Lymphadenitis in Childhood

Subacute necrotizing lymphadenitis was first reported by Kikuchi and Fujimoto in 1972. Young females no more than 30 years of age are mainly affected. It usually manifests as fever and cervical lymphadenopathy. We experienced three cases of subacute necrotizing lymphadenitis in an 11-year-old boy, a 12- year-old boy and an 11-year-old girl. Symptoms presented were URI signs, diarrhea, headache and weight loss along with fever and cervical lymphadenopathy. Fever persisted from 9 to 30 days and did not respond to antibiotics. We performed aspiration biopsy of cervical lymph node which was consistent with subacute necrotizing lymphadenitis in all cases. We used oral steroid in one case. Fever and lymphadenopathy subsided spontaneously within one month. There were no other complications.

Three Cases of Subacute Necrotizing Lymphadenitis in Childhood

Subacute necrotizing lymphadenitis was first reported by Kikuchi and Fujimoto in 1972. Young females no more than 30 years of age are mainly affected. It usually manifests as fever and cervical lymphadenopathy. We experienced three cases of subacute necrotizing lymphadenitis in an 11-year-old boy, a 12- year-old boy and an 11-year-old girl. Symptoms presented were URI signs, diarrhea, headache and weight loss along with fever and cervical lymphadenopathy. Fever persisted from 9 to 30 days and did not respond to antibiotics. We performed aspiration biopsy of cervical lymph node which was consistent with subacute necrotizing lymphadenitis in all cases. We used oral steroid in one case. Fever and lymphadenopathy subsided spontaneously within one month. There were no other complications.

Clinical Trends in Acute Rheumatic Fever in Korean Children: Mailed Questionnaire Survey from 1988 to 1997(Compared with 1978-1987)

PURPOSE: The purpose of this study was to assess the frequency of acute rheumatic fever(ARF) among children in Korea and to describe trends in its clinical characteristics compared to data from a previous study(1978-1987). METHODS: A mailed questionnaire survey sent to the pediatric departments of 13 general hospitals in Korea requested the total number of patients with ARF and its clinical manifestations from Jan. 1988 to Dec. 1997. These data were compared with the data from a previous study (1978-1987) to evaluate the clinical trends in occurrence and clinical manifestations of ARF during the last 20 years in Korea. RESULTS: The average number of patients with ARF for the 10-year period(1988-1997) was 0.74 per 1,000 annual pediatric inward patients. There was a significant decrease in incidence during the study period. There were 115 male and 85 female patients with ARF, and 97.5% of total patients were 6 to 15 years old. 126 out of 200 patients(63.0%) had a history of preceding upper respiratory infection(URI). The percentage of major manifestations were as follows; carditis(66.5%),polyarthritis(54.0%), erythema marginatum(12.0%), chorea(7.5%) and subcutaneous nodule (6.0%). Clinical findings of carditiswere cardiac murmur(91.0%), cardiomegaly in chest PA(34.6%), congestive heart failure(15.8%). The electrocardiographic findings were PR interval prolongation (37.6%), right ventricular hypertrophy (RVH) and left ventricular hypertrophy(LVH)(15.8%), QT interval prolongation(13.5%). Doppler echocardiographic valvular lesions were mitral insufficiency(96.2 %), aortic insufficiency(39.8%). Minor and other clinical manifestations were fever(69.0%), arthralgia (56.5%), sore throat(28.5%). CONCLUSION: There was a steady decrease in the number of patients with ARF during the study period from 1988 to 1997. A sudden decrease in number of patients with ARF between the two study periods is likely due to patients with valvular heart disease, possibility of double registration, and wide spread use of echocardiography for accurate diagnosis.

Tuberculin Response in Infants after BCG Vaccination during Neonatal Stage

PURPOSE: Mantoux test was widely used to identify the tuberculosis. But no reliable method exists for distinguishing tuberculin reactions caused by previous BCG vaccination from those caused by mycobacterial infections. So we studied Mantoux response in infants who had received BCG vaccination in the first month of life. METHODS: Mantoux testing was carried out in 143 healthy infants aged from 3 to 15months who had received BCG vaccination in the first month of life. Among them, 81 received Japan 172 strain BCG vaccination with multiple puncture method and 62 Copenhagen 1331 strain with intradermal method. RESULTS: The mean Mantoux reactions in the Japan 172 strain group were as follows : 10.0mm at 3 months, 9.7mm at 4-6months, 11.4mm at 7-9months, and 10.5mm at 10-15months. The mean Mantoux reactions in the Copenhagen 1331 strain group were as follows : 7.6mm at 3 months, 7.5mm at 4-6months, 7.5mm at 7-9months, and 6.8mm at 10-15months. Infants who received Japan strain had significantly larger sized induration in all ages. About 50% of Japan strain BCG-vaccinated infants had more than 10mm of tuberculin reaction. CONCLUSION: Infants who received Japan strain had significantly larger sized tuberculin reaction in all ages. Although the size of induration is more than 10mm in Tokyo strain BCG-vaccinated child, vaccine effect should be generally considered.

The Significance of Plasma Potassium Level in Pseudohyperkalemia with Thrombocytosis / 대한소아혈액종양학회지

PURPOSE: As blood coagulates, potassium is released from cells, causing the concentration of potassium in serum to be slightly higher than that of plasma. We measured serum and plasma potassium levels simultaneously to evaluate the significance of plasma potassium especially in the patients with thrombocytosis. METHODS: The study was designed into two steps. To determine the relationship between platelet count and serum potassium level, the subjects of the first study were 140 children admitted to the National Medical Center (NMC) from January 1996 to June 1997. To determine the significance of plasma potassium level in pseudohyperkalemia with thrombocytosis, the subjects of the second study were 80 children admitted to the NMC from June 1997 to June to 1998. All of them are 1 month to 14 years old. RESULTS: 1) There was no relationship between the platelet count and serum potassium levels in the control group with platelet count from 150x109/L to 400x10(9)/L (r=0.07), but there was significant relationship in the group with platelet count above 400x10(9)/L (r=0.41, P<0.01). 2) As platelet counts increased, the differences between the serum and plasma potassium concentration increased (r=0.518, P<0.01). CONCLUSION: The clinician should pay attention to the possibility of the pseudohyperk alemia when there is thrombocytosis with hyperkalemia without specific hyperkalemic symptoms or EKG changes. Plasma potassium level will be helpful for the accurate assesment of potassium concentration.

Clinical characteristics of acute viral lower respiratory tract infections in hospitalized children in Seoul, 1996-1998

This study was performed to investigate the etiologic agents, age distribution, clinical manifestations and seasonal occurrence of acute viral lower respiratory tract infections in children. We confirmed viral etiologies using nasopharyngeal aspirates in 237 patients of the ages of 15 years or younger who were hospitalized for acute lower respiratory tract infection (ALRI) from March 1996 to February 1998 at Samsung Seoul Hospital, Seoul, Korea. The overall isolation rate was 22.1%. The viral pathogens identified were adenovirus (12.7%), influenza virus type A (21.1%), -type B (13.9%), parainfluenza virus type 1 (13.5%), -type 2 (1.3%), -type 3 (16.0%) and respiratory syncytial virus (21.5%). The occurrence of ALRIs was highest in the first year of life, although parainfluenza virus type 1 infection occurred predominantly in the second year of life and influenza virus caused illnesses in all age groups. The specific viruses are frequently associated with specific clinical syndromes of ALRI. The respiratory agents and associated syndromes frequently have characteristic seasonal patterns. This study will help us to estimate the etiologic agents of ALRI, and establish a program for the prevention and treatment. An annual nationwide survey is necessary to understand the viral epidemiology associated with respiratory illnesses in Korea.

Changing Social Background Pattern of Children in Adoption Institutions(the 4th Report)

PURPOSE: A study was undertaken to assess the social background of abandoning children at adoption institutions. The results were compared to those of three previous reports from the institution. METHODS: A total of 536 children who had been admitted to the institution during the period of 1993 to 1996 were subjected to the study. The medical records were reviewed retrospectively. RESULTS: The sex ratio of male to female was 1 : 0.9, which was opposite compared to previous studies. Mean birth weight was 2.76+/-0.58kg. The proportion of prematurity was 27.2% and their mean gestational age was 34.0+/-2.25 weeks. The academic background of the mother was mainly high school, comprising 58.4%. The highest rate of maternal age(75.9%) was between 16 to 25 years of age. Maternal age below 15 years was 2.8%, which showed increased in tendency compared to previous studies. Classifying the mother's occupation, they were unemployed(19.4%), office workers(16.8%), store clerks(15.9%), students(13.6%), factory workers(12.3%) and waitresses (5.6%) in this order of frequency. The order of birth showed that the first baby was 89.4%. The reasons for putting their baby up for adoption were they were unmarried(83.2%), poor(8.6%), extramarital birth(3.2%), divorce(2.9%) and death of parents(0.4%) in this order of frequency, showing a significant increased in the rate of unmarried mothers. Only 38.4% of mothers had taken antenatal care. Most of the children (90.8%) were adopted by parents in foreign countries. CONCLUSION: The main reason for adoption was the mothers were unmarried and the maternal age tended to be younger. The rate of foreign adoption was still high.

Changing Social Background Pattern of Children in Adoption Institutions(the 4th Report)

PURPOSE: A study was undertaken to assess the social background of abandoning children at adoption institutions. The results were compared to those of three previous reports from the institution. METHODS: A total of 536 children who had been admitted to the institution during the period of 1993 to 1996 were subjected to the study. The medical records were reviewed retrospectively. RESULTS: The sex ratio of male to female was 1 : 0.9, which was opposite compared to previous studies. Mean birth weight was 2.76+/-0.58kg. The proportion of prematurity was 27.2% and their mean gestational age was 34.0+/-2.25 weeks. The academic background of the mother was mainly high school, comprising 58.4%. The highest rate of maternal age(75.9%) was between 16 to 25 years of age. Maternal age below 15 years was 2.8%, which showed increased in tendency compared to previous studies. Classifying the mother's occupation, they were unemployed(19.4%), office workers(16.8%), store clerks(15.9%), students(13.6%), factory workers(12.3%) and waitresses (5.6%) in this order of frequency. The order of birth showed that the first baby was 89.4%. The reasons for putting their baby up for adoption were they were unmarried(83.2%), poor(8.6%), extramarital birth(3.2%), divorce(2.9%) and death of parents(0.4%) in this order of frequency, showing a significant increased in the rate of unmarried mothers. Only 38.4% of mothers had taken antenatal care. Most of the children (90.8%) were adopted by parents in foreign countries. CONCLUSION: The main reason for adoption was the mothers were unmarried and the maternal age tended to be younger. The rate of foreign adoption was still high.

A Case of Achalasia Managed by Balloon Dilatation

An 8-year-old male was admitted because of dysphagia and substernal pain suffered while eating followed by postprandial vomiting for 2 years. He was always hungry due to postprandial vomiting and willing to eat again just after vomiting. After this meals, he used to jump up and down to shake off the substernal discomfort. A narrowing of the gastroesophageal junction was noted by esophagogram. Manometry revealed high Lower esophageal sphincter (LES) pressure (51.6mmHg), incomplete LES relaxation during swallowing, loss of esophageal peristalsis and a positive pressure of the esophageal body compared to intragastric pressure. After the 1st balloon dilatation, symptoms were much improved even though LES pressure still remained high (37.2mmHg). About 2 months after the 1st balloon dilatation, symptoms relapsed and we managed him with a 2nd balloon dilatation. Symptoms were more improved than after the 1st dilatation and LES pressure normalized as well. Since the 2nd dilatation, symptoms have not recurred for 3 years. We present an 8-year-old boy with achalasia successfully managed by the use balloon dilatation.

Food and house dust mite allergens in children with atopic dermatitis / 알레르기

Although basic mechanisms of atopic dermatitis remain largely speculative, many studies on pathogenesis suggest the importance of food and inhalent allergens. To evaluate the frequency of food and house dust mite hypersensitivity and differences in this frequency according to ages, we measured the levels of specific IgE antibodies to egg white, egg yolk, milk, soy, and house dust mites in 119 children with atopic dermatitis. The results showed that 53% of patients had positive RAST to any one kind of allergens. The frequency of food and house dust mite hypersensitivity were 34.5%, 30.3 %, respectively. Among allergens, house dust mites and egg white are the most prevalent allergens in all atopic dermatitis patients. The Prevalence of egg white is most common under the age of 2 years, but those of house dust mites are the dust mites are the highest in the ages of 5-12 years. In conclusion, we recommend an egg restriction diet in atopic dermatitis patients who are less than 2 years old when their symptoms do not improve with general skin care.

Clinical observation of neonatal sepsis

Ninety two cases of culture proved neonatal sepsis who had been admitted to pediatric department, National medical Center, during 7 years from Jan. 1984 to Dec. 1990 were reviewed clinically and the following results were obtained. 1) The frequency of neonatal sepsis was 3.1% and male to female sex ratio was 1.9:1, Sepsis was more prevalent in premature infants (9.9%) than in full term infants (1.9%). 2) The seasonal incidence was more prevalent in summer (32.6%). 3) The weight distribution showed 50 cases with the weight less than 2500 gram and 42 cases more than 2500 gram. 4) In 76 cases the onset was before 7 days old and in 16 cases were developed after 7 days old. 5) The major associated perinatal conditions in neonatal sepsis were institutional baby (23.9%), premature rupture of membranes (11.9%) and placenta previa (4.3%) in the order of frequency. The clinical manifestations on admission were jaundice (50.0%), poor activity (46.7%), respiratory difficulty (35.9%), poor feeding (22.8%), cyanosis (22.7%), gastrointestional symptoms (21.5%), fever (15.2%) and convulsion (13.0%) in the order of frequency. 6) The associated diseases were urinary tract infection (31.5%), hyaline membrane disease (19.6%), congenital disorder (18.5%), pneumonia (15.2%), anemia (13.0%), meningitis (9.8%), omphalitis (7.6%), DIC (6.5%), necrotizing enterocolitis (5.4%) and intracranial hemorrhage (5.4%) in the order of frequency. 7) Causative organisms were gram positive organisms in 27 cases (25.7%) and gram negative organisms in 79 cases (74.3%). The main organisms were Serratia marcescens (18.5%). Enterobacter spp (17.4%), Klebsiella pneumoniae (12.0%), Staphylococcus aureus (10.9%), Acinetobactor calcoaceticus (8.7%), Coagulase (-) staphylococcus (8.7%), E. coli (8.7%), Enterococcus (6.5%), Group B beta-hemolytic streptococcus (5.4%) and Pseudomonas (5.4%) in the order of frequency. The sensitivity to antibiotics were: Serratia marcescens: 70.6% sensitive to Amikacin 58. 9% sensitive to Cefotaxime 59. Enterobacter spp: 87.5% sensitive to Amikacin 68.8% sensitive to Cefotaxime Klebsiella pneumoniae: 100% sensitive to Amikacin 91. 0% sensitive to Cefotaxime Staphylococcus aureus: 100% sensitive to Cefazolin 90. 0% sensitive to Cefotaxime Acinetobacter calcoaceticus: 88.9% sensitive to Amikacin Coagulase (-) Staphylococcus: 100% sensitive to Amikacin 87. 5% sensitive to Cefotaxime E. coli: 100% sensitive to Amikacin, Cefotaxime Enterococcus: 50% sensitive to Gentamicin, Ampicillin, Amikacin Group B beta-hemolytie Streptococcus: 100% sensitive to Ampicillin, Penicillin Pseudomonas: 100% sensitive to Amikacin, Gentamicin, Tobarmycin 8) Mortality cases were 32 cases (34.8%).