Change in Severity and Clinical Manifestation of MIS-C Over SARSCoV-2 Variant Outbreaks in Korea

Background@#There is difference in the incidence of multi-system inflammatory syndrome in children (MIS-C) in patients with different variants of severe acute respiratory syndrome coronavirus 2, however, little is known about the epidemiology in Asian countries. We investigated and compared the epidemiology of the MIS-C during omicron-dominant period with that of previous periods in South Korea. @*Methods@#We obtained clinical, epidemiological and laboratory data on MIS-C cases from national MIS-C surveillance in South Korea. We defined pre-delta period as January 2020–May 2021; delta period as June 2021–December 2021; and omicron period as January 2022–April 2022. We describe the clinical characteristics and outcomes of MIS-C patients by period. @*Results@#A total of 91 cases were assessed to be MIS-C cases. Number of MIS-C cases have increased from six cases during pre-delta period to 66 cases during omicron period, while the incidence rate (the number of MIS-C cases per 100,000 cases of reported coronavirus disease 2019) has decreased from 38.5 cases per 100,000 (95% confidence interval [CI], 14.1–83.9) during pre-delta period to 1.6 cases per 100,000 (95% CI, 1.2–2.0) during omicron periods. During pre-delta period, 66.7% and 100% had hypotension and gastrointestinal involvement, respectively; while during omicron period, 12.1% and 6.1% had such clinical manifestations. Fifty percent of pre-delta MIS-C patients were taken intensive care unit (ICU) cares, while 10.6% of patients during omicron periods were in ICUs. @*Conclusion@#Omicron period were associated with less severe clinical manifestation compared to pre-delta and delta periods. Although incidence rate of MIS-C was lower for the omicron period than pre-delta and delta periods, number of patients reported with MIS-C may pose a substantial clinical burden.

Influence of Food Waste Compost on the Yield and Mineral Content of Ganoderma lucidum, Lentinula edodes, and Pholiota adipose Fruiting Bodies

The objectives of this study were to evaluate applicability of food waste compost (FWC) as a substrate for cultivation of Ganoderma lucidum, Lentinula edodes, and Pholiota adipose, and to determine contents of Ca, Mg, Na, and K in fruiting bodies (FB). FB yield per substrate in FWC-free controls was 53 +/- 4 g/kg for G. lucidum, 270 +/- 90 g/kg for L. edodes, and 1,430 +/- 355 g/kg for P. adipose. Substrates supplemented with FWC showed the highest FB production at FWC content of 10% for G. lucidum (64 +/- 6 g/kg), and 13% for L. edodes (665 +/- 110 g/kg) and P. adipose (2,345 +/- 395 g/kg), which were 1.2~2.5 times higher than the values for the controls. P. adipose contained higher amounts of mineral elements than the other species. Ca, Mg, Na, and K content in FB did not show a significant relation to FWC content.

Effectiveness of Medium-Dose Intravenous Immunoglobulin (1 g/kg) in the Treatment of Kawasaki Disease

BACKGROUND AND OBJECTIVES: High-dose intravenous immunoglobulin (IVIG) (2 g/kg) is usually given in the treatment of Kawasaki disease (KD). According to the authors' experience, however, medium-dose immunoglobulin (1 g/kg) was also effective in the majority of patients. We performed a retrospective clinical study to validate effectiveness of the medium-dose regimen in treatment of KD. SUBJECTS AND METHODS: A total of 274 patients with KD who were treated with medium-dose immunoglobulin at Bundang Jesaeng General Hospital from July 1998 to October 2007 were enrolled. RESULTS: Medium-dose immunoglobulin was given once in 220 patients (group A; 80.3%) and twice or more in 54 patients (group B; 19.7%). Age and gender distributions, duration of fever before treatment, hemoglobin concentrations, and white blood cell and platelet counts did not differ significantly between the two groups (p>0.05). Concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase, and bilirubin were significantly higher in group B (p<0.005). Coronary arterial lesions (CAL) were found in 51 patients (23.2%) in group A and in 26 patients (48.1%) in group B during the acute stage, and in 14 patients (6.4%) in group A and in 11 patients (20.4%) in group B during the convalescent stage (p<0.005, respectively). A giant aneurysm was found in one patient in each group (0.5% in group A and 1.9% in group B; p<0.005) during the follow-up period. CONCLUSION: A single infusion of medium-dose immunoglobulin was effective in 80% of patients with KD. About 20% of patients required two or more infusions of medium-dose immunoglobulin, who had higher concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase and bilirubin. The authors think that the medium-dose regimen proffers an advantage over the high-dose regimen in view of cost-effectiveness.

A Case of Idiopathic CD4+ T-lymphocytopenia Associated with Autoimmune Hemolytic Anemia

Idiopathic CD4+ T-lymphocytopenia (ICL) is defined by the CDC as depressed numbers of circulating CD4+ T-lymphocytes (<300 cells/microliter or <20% of the total T cells) on more than one determination, with the absence of HIV infection and other known causes of immunodeficiency. The clinical spectrum of ICL ranges from asymptomatic laboratory abnormalities to severe opportunistic infections that mimic the clinical course of human immunodeficiency virus (HIV) infected patients. There are a few reports of ICL associated with different diseases such as Sjogren's syndrome, pulmonary sarcoidosis, Down syndrome or non-Hodgkin's lymphoma. We describe here a 5-year-old male patient with a three-year history of recurrent otitis media and pulmonary infection, and he was without any risk factors for HIV infection; this patient presented with autoimmune hemolytic anemia and was ultimately found to have idiopathic CD4+ T-lymphocytopenia.

UDP-glucuronosyltransferase 1A1 Gene Polymorphism in Severe Neonatal Hyperbilirubinemia

PURPOSE: TATA box mutation/polymorphism in the promoter region of the bilirubin uridinediphosphoglucuronate glucuronosyltransferase 1A1 (UGT-1A1) gene is known to be an etiology of hyperbilirubinemia. This study examined if a TATA box mutation/polymorphism in UGT-1A1 gene promoter could be associated with the development of severe early neonatal jaundice in Korean infants. METHODS: Thirty-nine neonatal jaundice patients and 40 controlled infants were analyzed for UGT-1A1 promoter genotypes by using DNA sequencing. RESULTS: The homozygote for (TA)7TAA mutation was not found in this study. Comparison of the prevalence of UGT-1A1 promoter (TA)7TAA heterozygotes revealed no difference between the group with jaundice and the controlled group (15.4% vs. 10%). The peak bilirubin level was higher and the onset of jaundice was earlier in the jaundice group with (TA)7TAA heterozygote compared to the jaundice group without (TA)7TAA heterozygote (23.2+/-1.0 mg/dL vs. 19.7+/-2.4 mg/dL, P=0.004, 5.0+/-1.5 days vs. 8.3+/-4.1 days, P= 0.057). CONCLUSION: The results of this study showed that TATA box polymorphism in UGT-1A1 gene promoter did not increase the prevalence of severe early neonatal jaundice in Korean infants.

Usefulness of echocardiographic findings in the early diagnosis of Kawasaki disease / 소아과

PURPOSE: The early diagnosis of Kawasaki disease (KD) is difficult sometimes, especially in atypical or incomplete cases presenting 4 or less principal clinical features without coronary arterial lesions (coronary arterial ectasia or aneurysm). The authors investigated the incidence of echocardiographic abnormalities in patients with KD to discover whether abnormal echocardiographic findings might be helpful in the early diagnosis of KD. METHODS: Echocardiography was done in the acute stage of 103 patients with KD (Kawasaki group) and 40 patients with other acute febrile illnesses (control group). Abnormal echocardiographic findings were classified into 4 categories and defined as follows; 1) significant pericardial effusion, 2) significant valvular dysfunctions, 3) left ventricular systolic dysfunction, 4) coronary arterial ectasia or aneurysm. RESULTS: In the Kawasaki group, significant pericardial effusion was present in 24 patients (23.3 percent), significant valvular dysfunctions in 30 patients (29.1 percent), left ventricular systolic dysfunction in 10 patients (9.7 percent), and coronary arterial lesions in 27 patients (26.2 percent). In the control group, significant pericardial effusion was present in only one patient (2.5 percent). The number of patients with any one of echocardiographic abnormalities was 57 (55.3 percent) in Kawasaki group and one (2.5 percent) in control group. The sensitivity of echocardiography in the diagnosis of KD was 55.3 percent, the specificity 97.5 percent, the positive predictive value 98.3 percent, and the negative predictive value 45.9 percent. CONCLUSION: If abnormal echocardiographic findings, even if other than coronary arterial lesions, are confirmed in patients in whom KD is suspected, it seems desirable to inifiate specific treatment for KD.

A Case of Influenza-associated Encephalopathy

Influenza-associated encephalopathy is regarded as one of the major neurologic disease entities along with those of Reye syndrome, acute necrotizing encephalopathy, and myelitis which are known to be related to influenza virus, mostly type A. And it is being actively researched in Japan as it has caused a tremendous increase in the number of deaths from 1997 to 2002, but it has not been yet reported in the Korean pediatric medical community. It attacks those previously healthy children, who have not been vaccinated. Patients start with such symptoms as fever and common respiratory problems, but within 24 to 48 hours they suffer from seizures with acute mental deterioration, become worse, and suffer multiple organ failures including marked elevated transaminase levels as well as coagulopathy. It induces deaths in a couple of days after the symptoms appear or remains a serious neurologic sequelae. Confirmative diagnosis is used to demonstrate influenza viral infection. We report here a 37 month aged boy who was admitted to our hospital during the last influenza season under the diagnosis of influenza associated encephalopathy on the basis of serologic testing by hemagglutinin inhibition(HI). This is the first report confirmed by increased antibody titer of the influenza A virus in Korea.

A Case of Protein-losing Enteropathy in Congestive Heart Failure : Resolution with Prednisolone

Protein-losing enteropathy can result from primary or secondary intestinal lymphangiectasia. Sec ondary intestinal lymphangiectasia develops as a result of lymphatic obstruction or elevated lym phatic pressure. Cardiac lesions such as constrictive pericarditis, post-Fontan procedure state, and chronic congestive heart failure increase lymphatic pressure and may cause intestinal lymphan giectasia and protein-losing enteropathy. An 11-year-old girl who underwent corrective surgery for Tetralogy of Fallot at two years of age had been suffering from chronic congestive heart failure, taking digitalis and diuretics. She was afflicted with protein-losing enteropathy nine years after surgery. Diagnosis was made by means of radioisotope scan using technetium-99m-labeled albumin. Symptoms were not improved with diet therapy, so prednisolone was given orally and remission was achieved. Although relapses occurred four times, remission was achieved with pre dnisolone at each time. Thereafter the patient remained in remission state over one year after dis continuation of prednisolone.

A Case of Systemic Fibromuscular Dysplasia with Renovascular Hypertension and Superior Mesenteric Arterial Aneurysm

No abstract available.

Epidemiologic Study of Measles Outbreak in School-Aged Children in East KyongGi-Do Area

PURPOSE: There was marked decline of measles outbreak in the world since the first measles vaccine had been introduced. Recently, however, measles outbreak in the vaccinated children have been reported worldwide, which was ascribed to the possibilities of primary or secondary vaccine failure. We investigated the incidence in the school-aged children in the Kyong-gi Do area, the larger district which covers the urban and rural area, by the questionnaire. METHODS: The questionnaires which were asked to the students' parents of 14 elementary schools in and nearest Sungnam city, Kyong-Gi Do for their present age, experience of measles attack and vaccination, and the age of measles attack. The answers of this questionnaire were analysed by SAS computer program. RESULTS: 1) Measles vaccination rate at 9 months was 70.5% and MMR vaccination rate at 15 months was 91.3%. 2) Measles attack rate among unvaccinated group was 53.8%, and 16.1% in vaccinated group. There was significant low risk of measles attack among vaccinated group than unvaccinated group(relative risk=3.35, p<0.001). 3) Vaccine efficacy of measles in this age group was 69%. 4) Age distribution of measles outbreak reveals bimodal pattern, the graph shows two peak incidence of 1 year-old and 6 years-old. 5) There were no significant differences of measles incidence in the different medical care service center that measles vaccination had been done. CONCLUSIONS: Despite high rate of measles vaccine coverage in Sungnam, the attack rate of measles in the vaccinated population was relatively high. There may be due to primary, secondary vaccine failure or the other factors. The policy of measles vaccination in Korea should be reestablished as soon as possible.

Normal Predicted Value of Airway Resistance by Flow Interrupter Technique in Korean Primary School-Aged Children

PURPOSE: To get the normal predicted value of airway resistance in Korean primary school-aged children by using flow interrupter technique which is simple and easy enough to be applicable even to young children. METHODS: Among all the children of one primary school, we selected 964 (Male 469, Female 495). Excluded children were out of normal range in growth with Korean standard and/or history and/or symptom and sign of airway diseases. One medical doctor, well trained to the Microlab 4000 (Micromedical Co. England) educated the children before check and carried out all the procedure. Rint (Airway resistnace by interrupter technique) was checked 5 times. After exclusion of both highest and lowest values, we got the average of remaining 3 values as Rint (in both inspiratory and expiratory phases). We got mean, standard deviation, regression equation, correlation coefficient in every age, height group, weight group, and chest circumference group in both sex. RESULTS: 1) Age ranged from 6 to 11 years. 6-year-old boys' Rint were 0.56+/-0.15 kPa.l-1.s and 0.56+/-0.15 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.55+/-0.16 kPa.l-1.s and 0.55+/-0.18 kPa.l-1.s in girls. The Rint decreased as the children getting older. 2) Height ranged from 105 to 160 cm. Rint of boys from 111 to 115 cm in height were 0.54+/-0.11 kPa.l-1.s and 0.55+/-0.15 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.56+/-0.18 kPa.l-1.s and 0.56+/-0.19 kPa.l-1.s in girls. The Rint decreased as the children getting taller. 3) Weight ranged from 16 to 57 kg. Rint of boys from 16 to 18 kg in weight were 0.52+/-0.07 kPa.l-1.s and 0.59+/-0.07 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.47+/-0.15 kPa.l-1.s and 0.43+/-0.14 kPa.l-1.s in girls. The Rint decreased as the children getting heavier. 4) Chest circumference ranged from 50 to 85 cm. Rint of boys from 50 to 55 cm in chest circumference were 0.49+/-0.12 kPa.l-1.s and 0.46+/-0.13 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.53+/-0.16 kPa.l-1.s and 0.52+/-0.17 kPa.l-1.s in girls. The Rint decreased as the children's chest circumference increase. 5) We got regression equations and correlation coefficient by age, height, weight, and chest circumference in both boys and girls and in both inspiratory and expiratory phases. Correlation was best with height but correlation coefficient was less than 0.45. CONCLUSION: We got the normal predicted value of airway resistance by flow interrupter technique. It can be used in evaluating lung condition, progression of lung disease, and effectiveness of drugs in lung disease.

Clinical Review of Recurrent Kawasaki Disease

PURPOSE: The recurrence of Kawasaki disease has not been considered significant and has not been reported on literatures in Korea. Authors reviewed cases with recurrent Kawasaki disease to get informations about recurrent Kawasaki disease and to know whether there is any factor, if present, that can predict recurrence. METHODS: We reviewed and analyzed the hospital records of patients with recurrent Kawasaki disease who had been admitted to Inha University Hospital from January 1986 through December 1994. RESULTS: The total number of cases with Kawasaki disease was 266 during that period in Inha University Hospital. Seven patients were diagnosed as having recurrent Kawasaki disease, but four of them fulfilled five or more items of the diagnostic criteria for Kawasaki disease. So the proportion of recurrent cases was 1.5%(4/259)(or 2.7% (7/259) ?). Sex ratio was M:F=3:1. The ages at the first episodes of illness were from 7 months to 3 years 2 months (median=24 months), and those of the second episodes were from 11 months to 6 years 3 months (median=4 years 3 months). The intervals between two episodes were from 4 months to 4 years 2 months (median=1 year 9 months). No special aspect could be found in the clinical and laboratory findings of primary cases, compared with other cases with kawasaki disease. The clinical manifestations and courses of recurred cases were not significantly different from those of primary cases, except one recurred case who developed coronary aneurysm. CONCLUSIONS: The recurrence rate of Kawasaki disease seems to be higher than 1.5%(or 2.7%) at least. The risk factors for recurrence could not be found, and there was no specific aspect in the clinical manifestations and courses of recurrent Kawasaki disease.

The Optimal Dosages of Gammaglobulin and Aspirin in Treating Kawasaki Disease

PURPOSE: There are some disagreements about the optimal dosages of intravenous gammaglobulin(IVGG) and oral aspirin(ASA) in the treatment of Kawasaki disease. So authors performed a prospective clinical study to evaluate the efficacy of IVGG 1g/kg plus ASA 50mg/kg/day. METHODS: We treated 29 patients who were admitted to Inha University Hospital from June 1993 through May 1994 with IVGG 1g/kg plus ASA 50mg/kg/d. We compared the outcomes of above patients with those of two other groups of patients, group A and B in authors' previous study. Group A(20 patients) had been treated with IVGG 2g/kg plus ASA 50mg/kg/d and group B(19 patients) with IVGG 2g/kg plus ASA 100mg/kg/d. The outcomes had been similar in group A and B, which was published on this journal in 1995 (vol. 38:378-385). RESULTS: 1) Twenty five patients(86.2%; group C) were given only one dose of IVGG 1g/kg, and remaining 4 patients(13.8%; group D) were given two doses of IVGG 1g/kg because of persistent high fever. 2) The age and sex distributions, durations of fever before treatment, and durations of ASA therapy in group C were not significantly different from those in group A and B (p>0.05). 3) Laboratory findings on admission in group C were not significantly different from those in group A and B, except that the mean ESR was lower in group C than in group A and B (35.1+/-19.8 vs 55.5+/-5.95 & 50.2+/-11.4mm/hr; p0.05, respectively). 5) In group C, the mean hemoglobin concentration at the 3rd week of illness was higher than in group A (11.1+/-0.98 vs 10.1+/-1.24g/dl; p0.05, respectively). In follow-up examinations, coronary aneurysm was observed in only one(1/23; 4.3%) in group C, which was similar to group A(1/18; 5.5%) and B(1/19; 5.2%) (p>0.05, respectively). Giant aneurysm was not observed in any patients. 7) Four patients(group D) were given one more dose of IVGG 1g/kg because high fever persisted 48 hours after injection of the first dose of IVGG. Afterthen fever subsided within 1 to 7 days. Echocardiography revealed mild coronary arterial dilation in two patients initially, but follow-up examinations revealed no coronary aneurysm. CONCLUSIONS: The medium-dose combined regimen with IVGG 1g/kg plus ASA 50mg/kg/d seems to be more cost-effective than the high-dose regimen with IVGG 2g/kg plus ASA 50-100mg/kg/d. If high fever persists 48 hours or more after the first dose of IVGG 1g/kg, it is desirable to give one more dose of IVGG 1g/kg.

Epidemiologic Study during 1993 Measles Outbreaks in Seongnam Area

PURPOSE: Although remarkable progress has been made in efforts to control measles since measles vaccines became available for use, the longterm success of their vaccination programmes has been questioned, with the worldwide resurgence of the disease. This resurgence has increased attention on the inadequacy of current immunization programmes. In 1993 there have been measles outbreaks in Seong-nam city located near the sourthern Seoul, Korea. To characterize further the epidemiology of measles in Seong-nam city, we analysed demographic characteristics of measles cases reported for the year 1993. METHODS: With the cooperation of the nurse teacher in elimentary school, the data of measles cases were collected and each case was confirmed at local clinics, hospital or general hospital, including inha General Hospital. RESULTS: 1) Out of 645 cases(male: female = 1.08:1) the children above 5 yrs of age were 586 cases of which 529 cases(90.3%) were vaccinated on after 15 months of age. After the survey, measles occurred in 1.9% of the 11 elementary school students. Children with past MMR vaccination history showed milder course of measles than those without the vaccination history. 2) Out of 87 patients who had been brought to Inha General Hospital, 55%(n=48) was 6 to 1 5 months of age, 13%(n=11) was 15 months to 4 years of age, and 32%(n=28) was 5 to 14 years of age, which showed two major outbreaks: those in which of the cases occurred below 16 months of age and those in which considerable cases occurred among school-age persons. 3) Below 15 months of age, most of the cause of the unvaccination were inadequate access to medical care and lack of public awareness in some communities, with the resulting lack of d emand for immunization services. The causes of unvaccination above 15 months of age were neglect or oblivion in 35%(n=2 0), mild acute illness not contraindicated to vaccine use in 21%(n=12), economic difficulty in 8. 8%(n=5), vaccine omission after natural measles before 12 months of age in 7%(n=4). CONCLUSIONS: Despite the high uptake of measles vaccine there is currently a nationwide e pidemic of measles, especially among the school-age groups. Secondary vaccine failure is also thought to be important cause of measles ortbreak as well as primary vaccine failure. A booster dose of measles vaccine may be necessary to reduce the measles outbreak to allow the goal of measles elimination to be achieved, with the reinforcement of age-appropriate Immunization.

A Case of Burkitt's Lymphoma with Bilateral Renal Enlargement

Burkitt's lymphoma is a distinct pathologic entity characterized as a diffuse undifferentiated malignant lymphoma of B-lymphocyte origin. We experienced a case of Burkitt's lymphoma with bilateral renal enlargement in which a 3year-old male patient was admitted with complaints of abdominal distention and facial edema. Laboratory examination revealed positivity for CD 19, CD 10, CD 20 and c-myc on flow cytometry, bilateral renal enlargement(10x12cm in longitudinal length) on abdominal ultrasonogram and CT, malignant lymphoma of Buritt's type with prominent nucleoli and cytospin of cerebrospinal fluid. Initially he showed tumor lysis syndrome and clinical stage D by Zigler(stage IV by Murphy) with CNS involvement. After initial management with hydration, urine alkalinization and allopurinol, combination chemotherapy had been applied with the craniospinal radiotherapy according to the CCG 503 II regimane, with achievement of complete remission. Thus we report a case of Burkitt's lymphoma with bilateral renal enlargement with a biref review of literatures.

A Study about Optimal Dose of Aspirin in Treating Kawasaki Disease

PURPOSE: A prospective study was performed to evaluate the efficacies of two different dosages of aspirin(ASA) in treating Kawasaki disease(KD). METHODS: Thirty-nine children with KD were admitted to this hospital from July, 1992 to May, 1993, and were assigned randomly into 2 groups. Group A(medium-dose group, 20 patients) was given 50mg/kg/d(# 4), and group B(high-dose gorup, 19 patients) was given 100mg/kg/d(# 4) of ASA. Intravenous gammaglobulin(2g/kg) was given to all patients. RESULTS: 1) There were no significant differences in ages, sex ratios, durations of fever before treatment, and laboratory findings on admission between two groups. 2) The durations of ASA administration were similar in 2 groups(group A, 10.1+/-2.77 ; group B, 10.6+/-3.37 days ;?p>0.1). 3) The durations of fever after onset of treatment were not different significantly (group A, 2.65+/-3.28 ; group B, 1.74+/-1.52 days ; p>0.1). 4) There were no significant differences in laboratory findings after treatment between two groups, except hemoglobin(Hgb) and ESR examined in the 3 rd week of illness (Hgb: group A (N=15), 10.1+/-1.24 ; group B(n=14), 11.1+/-0.92g/dl ; p0.1), and in 25% of group A(5/20) and 10.5% of group B(2/19) at the 2 nd examination (p>0.1). In long-term follow-up, only 1 patient in each group showed coronary aneurysm respectively. CONCLUSIONS: Although serum concentrations of ASA were different significantly, there were no significant differences in recovery from KD and incidences of coronary artery lesions between two grous. So we think medium-dose aspirin therapy is safe and effective in the treatment of Kawasaki disease.

Normal Predicted values of Pulmonary function Test in Korean Primary School-Aged Children

Pulmonary function test is one of the most important tools in the management of patients with respiratory tract diseases and allergic diseases. As with the difficulties in performing the test, it has been seldom used in pediatric field. But with the advent of simple, computerized tools, pediatric pulmonologist and allergist try to manage the patients using PFT. Still the normal predicted values are variable among the reports. So it is important to have normal predicted value in Korean children. From April to July 1992, pulmonary function test was performed in 965(male: 490, female: 475) primary school-aged children except 97 percentile of Korean-children Physical developemental standards with history of allergic diseases and respiratory tract diseases ay SungNam, KyongKiDo. We evaluated the predicted normal values of the FEV1.0, FVC and PEFR and logarithmic regression equation setting the predicted values by using the microspirometer of Micromedical Ltd. England that could that could be easily applied to children. 1) Predicted values of pulmonary function test items were generally higher in boys than those of girls. 2) Correlation coefficient to the parameters examined was the highest in height 0.78, then age 0.75, weight 0.70 and chest circumference 0.61.

The Effect of Alfacalcidol in the Treatment of Idiopathic Myelofibrosis in Children

Idiopathic myelofibrosis (IMF), which is characterized by marrow fibrosis, leukoerythroblastic anemia, teardrop poikilocytosis and splenomegaly due to extrumedullary hematopoiesis, has known to have no form of therapy. On the ground of the possibility of reversing collagen deposion in IMF using 1, 25dihydroxycholecalciferol [1, 25(OH)2D3], we report here our observations of 5 patients (M:F=1:4) with IMF before and after treatment with 0.5 microgram/day of alfacalcidol, precursor of 1, 25(OH)2D3. In 3 fo 5 patients the hemoglobin rose and in 4 of 5 the platelet count increased. Follow-up marrow examination revealed that marrow trephine reticulin fibrosis decreased according as the amelioration of clinical and laboratory findings. But these did not persist except one patient in spite of the sustained use of alfacalcidol. Our results suggest that alfacalcidol may have a therapeutic role in some patients with IMF. More extensive studies will be clarify the action of alfacalcidol in IMF.

Adrenogenital Syndrome Combined with Congenital Hypothyroidism

No abstract available.

Ebstein's anomaly in a 75-year-old female

No abstract available.