Clinical Characteristics and Neurophysiologic Findings of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients

PURPOSE: No domestic report has been published on postural orthostatic tachycardia syndrome (POTS) in adolescents, although it has been increasingly studied in adolescents since first reported in 1999. This study analyzed the clinical characteristics and neurophysiologic findings of POTS in Korean pediatric patients. METHODS: We reviewed the medical records of pediatric patients (<18 years) with POTS who visited Gyeongsang National University Hospital in Jinju between January 2008 and March 2010. All patients underwent tilt-table and autonomic function tests. RESULTS: We identified 18 patients (72.2% male, mean age 13.6 +/- 2.1 years). The mean orthostatic heart rate increment was 43.0 +/- 9.1 beats/min. Most patients (83.3%) had mild autonomic dysfunction, and three (16.6%) had moderate autonomic dysfunction. Half of patients had sudomotor abnormalities in the lower limbs, implying peripheral postganglionic sympathetic denervation in the legs. Of these patients, 66.6% also had adrenergic impairment. The degree of autonomic dysfunction correlated with the orthostatic heart rate increment (P=0.047). Patients needing pharmacologic treatment had a higher orthostatic heart rate increment (P=0.017), composite autonomic severity score (P=0.002), and sudomotor score (P=0.006), compared with non-pharmacologically treated patients. CONCLUSION: Autonomic dysfunction or autonomic neuropathy seems to be the main pathophysiology of POTS in pediatric patients, especially adolescents. Further, the degree of autonomic dysfunction influenced the prognosis of POTS. Additionally, unlike previous adult series, most of our patients were male. This male predominance in adolescents suggests that the growth spurt is an important factor triggering POTS at this age.

Successful treatment by exchange transfusion of a young infant with sodium nitroprusside poisoning / 소아과

Although sodium nitroprusside (SNP) is often used in pediatric intensive care units, cyanide toxicity can occur after SNP treatment. To treat SNP-induced cyanide poisoning, antidotes such as amyl nitrite, sodium nitrite, sodium thiosulfate, and hydroxycobalamin should be administered immediately after diagnosis. Here, we report the first case of a very young infant whose SNP-induced cyanide poisoning was successfully treated by exchange transfusion. The success of this alternative method may be related to the fact that exchange transfusion not only removes the cyanide from the blood but also activates detoxification systems by supplying sulfur-rich plasma. Moreover, exchange transfusion replaces cyanide-contaminated erythrocytes with fresh erythrocytes, thereby improving the blood's oxygen carrying capacity more rapidly than antidote therapy. Therefore, we believe that exchange transfusion might be an effective therapeutic modality for critical cases of cyanide poisoning.

A Case of Obstructive Jaundice Secondary to Traumatic Pancreatitis Treated with Percutaneous Transhepatic Biliary Drainage / 대한소아소화기영양학회지

Isolated pancreatic trauma and secondary obstructive jaundice in the pediatric population is unusual. Biliary tract obstruction can be a major cause of acute pancreatitis. We report a case of obstructive jaundice secondary to isolated traumatic acute pancreatitis in a previously healthy 32-month-old girl. In our case, secondary obstructive jaundice aggravated the pancreatic inflammation and was successfully treated with percutaneous transhepatic biliary drainage (PTBD).

A Case of Obstructive Jaundice Secondary to Traumatic Pancreatitis Treated with Percutaneous Transhepatic Biliary Drainage / 대한소아소화기영양학회지

Isolated pancreatic trauma and secondary obstructive jaundice in the pediatric population is unusual. Biliary tract obstruction can be a major cause of acute pancreatitis. We report a case of obstructive jaundice secondary to isolated traumatic acute pancreatitis in a previously healthy 32-month-old girl. In our case, secondary obstructive jaundice aggravated the pancreatic inflammation and was successfully treated with percutaneous transhepatic biliary drainage (PTBD).

A Case of Encephalitis Caused by Epstein-Barr Virus Infection

An 11-year-old girl was diagnosed with encephalitis due to Epstein-Barr virus(EBV). She was admitted to our hospital due to convulsion and decreased consciousness after several days of fever, sore throat and headache. Cerebrospinal fluid analysis showed lymphocyte-dominant pleocytosis and markedly elevated levels of protein. Magnetic resonance imaging(MRI) finding was normal, except for marked leptomeningeal enhancement. Even though she had signs and symptoms of infectious mononucleosis, EBV infection could not be considered as the underlying cause of the encephalitis until IgM for the viral capsid antigen of EBV had been detected in her blood. After treatment with acyclovir, a high dose of methylprednisolone and intravenous immunoglobulin, the neurological symptoms improved rapidly. She has not suffered from any neurological complications in the four months since being discharged. EBV infection should be considered as the main etiology in cases of childhood encephalitis, although there is no evidence of infectious mononucleosis existed.

Kawasaki Disease Presenting as Parotitis in a 3-Month-Old Infant

A male infant aged 3 months and 1 week had persistently high fever with parotitis that was unresponsive to antibiotics. Mumps was identified by serologic study, but he was finally diagnosed by clinical features as having Kawasaki disease and echocardiographic findings on the 9th day of fever. Parotitis, which is unresponsive to antibiotics, should be considered Kawasaki disease even though typical symptoms are not present.