Coexistence of Posterior Cortical Atrophy and Parkinson’s Disease

We report a rare and unique presentation of a patient with early and levodopa-responsive Parkinson’s disease (PD) who exhibited clinical features similar to posterior cortical atrophy (PCA). The imaging evidence suggested the coexistence of PD and PCA, without the presence of amyloid pathology. Although the present case lacks pathologic evidence, this case represents a distinct manifestation of PD characterized by a combination of parkinsonism and early prominent posterior cognitive deficits, reminiscent of the visual variant of Alzheimer’s disease.

Associated Factors for Asthma Severity in Korean Children: A Korean Childhood Asthma Study

PURPOSE: Childhood asthma has a considerable social impact and economic burden, especially in severe asthma. This study aimed to identify the proportion of childhood asthma severity and to evaluate associated factors for greater asthma severity. METHODS: This study was performed on 667 children aged 5–15 years with asthma from the nationwide 19 hospitals in the Korean childhood Asthma Study (KAS). Asthma was classified as mild intermittent, mild persistent, and moderate/severe persistent groups according to the National Asthma Education and Prevention Program recommendations. Multinomial logistic regression models were used to identify the associated factors for greater asthma severity. RESULTS: Mild persistent asthma was most prevalent (39.0%), followed by mild intermittent (37.6%), moderate persistent (22.8%), and severe persistent asthma (0.6%). Onset later than 6 years of age (adjusted odds ratio [aOR], 1.69 for mild persistent asthma; aOR, 1.92 for moderate/severe persistent asthma) tended to increase asthma severity. Exposure to environmental tobacco smoke (aOR, 1.53 for mild persistent asthma; aOR, 1.85 for moderate/severe persistent asthma), and current dog ownership with sensitization to dog dander (aOR, 5.86 for mild persistent asthma; aOR, 6.90 for moderate/severe persistent asthma) showed increasing trends with greater asthma severity. Lower maternal education levels (aOR, 2.32) and no usage of an air purifier in exposure to high levels of outdoor air pollution (aOR, 1.76) were associated with moderate/severe persistent asthma. CONCLUSIONS: Modification of identified environmental factors associated with greater asthma severity might help better control childhood asthma, thereby reducing the disease burden due to childhood asthma.

Seasonal patterns and etiologies of croup in children during the period 2010–2015: A multicenter retrospective study

PURPOSE: Croup is known to have epidemics in seasonal and biennial trends, and to be strongly associated with epidemics of parainfluenza virus. However, seasonal and annual epidemics of croup have not been clearly reported in Korea. This study aimed to examine the seasonal/annual patterns and etiologies of childhood croup in Korea during a consecutive 6-year period. METHODS: Pediatric croup data were collected from 23 centers in Korea from 1 January 2010 to 31 December 2015. Electronic medical records, including multiplex reverse transcription polymerase chain reaction (RT-PCR) results, demographics and clinical information were cross-sectionally reviewed and analyzed. RESULTS: Overall, 2,598 childhood croup patients requiring hospitalization were identified during the study period. Among them, a total of 927 who underwent RT-PCR were included in the analysis. Males (61.5%) predominated, and most (63.0%) of them were younger than 2 years of age (median, 19 months; interquartile range, 11–31 months). Peak hospitalization occurred in 2010 and 2012 in even-numbered years, and parainfluenza virus (PIV, 39.7%) was the most common cause of childhood croup requiring hospitalization, followed by respiratory syncytial virus (14.9%), human rhinovirus (12.5%), Mycoplasma pneumonaie (10.6%), and human coronavirus (7.3%). CONCLUSION: It is concluded that croup hospitalization has a biennial pattern in even-numbered years. PIV may be the most common cause of childhood croup; however, croup epidemics could be attributed to other viruses.

Usefulness of the procalcitonin test in young febrile infants between 1 and 3 months of age / 소아과

PURPOSE: To study the usefulness of the procalcitonin (PCT) test in young febrile infants between 1 and 3 months of age. METHODS: We evaluated the medical records of 336 febrile infants between 1 and 3 months of age who visited the Emergency Department or outpatient department of Samsung Changwon Hospital from May 2015 to February 2017, and analyzed the clinical characteristics between infants in the serious bacterial infection (SBI) group and non-SBI group. RESULTS: Among the 336 infants, 38 (11.3%) had definitive SBI (bacteremia, n=3; meningitis, n=1; urinary tract infection, n=34). The mean PCT (6.4±11.9 ng/mL) and C-reactive protein (CRP) level (3.8±2.6 mg/dL), and the absolute neutrophil count (ANC) (6,984±4,675) for patients in the SBI group were significantly higher than those for patients in the non-SBI group (PCT, 0.3±1.2 ng/mL; CRP, 1.3±1.6 mg/dL; ANC, 4,888±3,661). PCT had lower sensitivity (43.6%), but higher specificity (92.6%) and accuracy (86.9%) than CRP (92.3%, 25.3%, and 33.0%) for identifying SBI. The area under the receiver operating characteristic curves (AUCs) for definitive SBI were PCT 77.0%, CRP 80.8%, WBC 56.8%, ANC 67.8%, and PLT 48.1%. The AUCs for definitive SBI were PCT+CRP 85.4%, PCT+WBC 77.2%, PCT+ANC 81.3%, CRP+WBC 80.1%, and CRP+ANC 81.6%. CONCLUSION: Our results suggest that the PCT test or a combination of PCT and CRP tests is a more accurate and specific biomarker to detect and rule out SBIs.

Association between social economic status and asthma in Korean children: An analysis of the Fifth Korea National Health and Nutrition Examination Survey (2010–2012)

PURPOSE: Asthma is one of the most common chronic conditions, and its prevalence has been increasing in recent decades. Social economic status is a well-known risk factor for asthma. This study was performed to investigate the relationship between social economic status and asthma in Korean children. METHODS: Data were acquired from 4,397 children, aged under 18 years who participated in the Fifth Korea National Health and Nutrition Examination Surveys, which was conducted from 2010 to 2012. The presence of asthma was based on self-reported, physician-diagnosed asthma in the Health Interview Surveys. RESULTS: The prevalence of pediatric asthma was 5.3%, while the prevalence of atopic dermatitis in children was 14.0%. In univariate analysis, asthmatic children tended to be male, to be older, to have asthmatic mothers, to suffer from atopic dermatitis and to live in urban areas (P < 0.05). The parents' marital status, employment status, education level, and the number of household members were not associated with pediatric asthma. In logistic regression analysis, older age, male sex, maternal asthma, pediatric atopic dermatitis, and urban residence were associated with a higher prevalence of childhood asthma (P < 0.01). CONCLUSION: Socioeconomic status was not an important risk factor for asthma in Korean children in our study. It is conceivable that socioeconomic factor could affect the asthma prevalence in a different manner in each country. Further studies are warranted to explore mechanisms responsible for the association between socioeconomic status and asthma in children.

The association between smoking and asthma

Epidemiological evidence for the association between active cigarette smoking and asthma is not available. In this review, we aimed to summarize previous studies and gave some information on the association between asthma and smoking to researchers. To date, smoking is thought to be associated with asthma exacerbation, but the relationship between smoking and asthma development is still unclear. In the aspect of lung function, smoking results in a faster reduction in asthmatics and parental smoking causes a decrease in neonatal lung function.

The Association between Socioeconomic Status and Obesity in Korean Children: An Analysis of the Fifth Korea National Health and Nutrition Examination Survey (2010-2012) / 대한소아소화기영양학회지

PURPOSE: Obesity is one of the most common health problems among children and its prevalence has increased in recent decades. Socioeconomic status (SES) is a well-known risk factor for childhood obesity although the associations were different across countries. Previous studies in other countries have reported a positive association between childhood obesity and SES in developing countries, and inverse correlation has been reported in developed countries. For this reason, we wanted to investigate the relationship between SES and obesity in Korean children. METHODS: Data were acquired 3,095 boys and girls who participated in the fifth Korea National Health and Nutrition Examination Survey, which was conducted from 2010 to 2012. Body mass index was calculated from measured anthropometric data using the 2007 Korean National Growth Charts. RESULTS: Upon univariate analysis, we did not find any statistically significant differences in the parental employment status, monthly family income between children with and without obesity. Multiple logistic regression analysis showed childhood obesity was positively associated with maternal overweight (OR, 1.889; 95% CI, 1.079-3.309), maternal obesity (OR, 3.409; 95% CI, 2.228-5.215) and paternal obesity (OR, 2.135; 95% CI, 1.257-3.627). CONCLUSION: The present study showed that socioeconomic status might not an important risk factor for obesity in Korean children. These results warrant further studies to clarify the association between SES and obesity in Korean children.

A Case of Ankyloblepharon-Ectodermal Defect-Cleft Lip and/or Palate (AEC) Syndrome with Missense Mutation in TP63 1657(th)

Ankyloblepharon-ectodermal defects-cleft lip and/or palate (AEC) syndrome, also known as Hay-Wells syndrome, is a rare autosomal dominant disorder characterized by congenital ectodermal dysplasia. It is caused by mutations in p63 gene. Six isoforms are generated from the TP63 gene mutation and the main isoform expressed in postnatal skin is Np63a, which functions as a key regulator of epidermal integrity. We have experienced a 1-day-old female baby with skin erosions, ankyloblepharosis, and cleft palate that require treatment for skin care and feeding difficulties. Missense mutation in TP63 1657(th) T → A transition was found in the genetic test performed in the patient, and this genotype has not been reported in a previously variant. The patient was found dead at 91days of birth and the cause of death was estimated by aspiration.

Behavioral characteristics and parental stress in elementary school children with bronchial asthma and allergic rhinitis

PURPOSE: The aim of this study was to investigate the differences in behavioral characteristics and parental stress between allergic and nonallergic elementary school children. METHODS: Ninety-one elementary school children who had allergic disease were enrolled (asthma, n=27; allergic rhinitis, n=35; combined, n=29). Also one hundred six nonallergic elementary school children were enrolled for the control group. The Korean Child Behavior Check List (K-CBCL) and Korean Parenting Stress Index-Short Form (K-PSI-SF) were completed by their mothers. RESULTS: According to the analysis of K-CBCL, the score for Internalizing, anxious/depressed and somatic complaints were significantly higher in the combined group than in the control group. The score for Diagnostic and Statistical Manual of Mental Disorders (DSM)-affective problems in the combined group and DSM-somatic problems were significantly higher in the asthma group than in the control group. According to the analysis of K-PSI-SF, the score for parental distress was significantly higher in the allergic rhinitis group than in the control group. The scores for behavioral problems and parental stress were significantly correlated to allergic disease groups. CONCLUSION: Behavioral problems and parental stress were significantly associated with asthma and allergic rhinitis. The results of this study suggest the importance of psychosocial support for mothers and children with allergic diseases.

Association between social economic status and atopic dermatitis in Korean adult: an analysis of the Fifth Korea National Health and Nutrition Examination Survey (2010-2012)

PURPOSE: Atopic dermatitis is one of the most common allergic diseases, and its prevalence has been increasing in recent decades. Social economic status is a well-known risk factor for allergic disease. This study was performed to investigate the relationship between social economic status and atopic dermatitis in Korean adults. METHODS: Data were acquired from 18,066 men and women aged older than 19 years who participated in the Fifth Korea National Health and Nutrition Examination Surveys (KNHANES), which was conducted from 2010 to 2012. The presence of atopic dermatitis was based on self-reported physician diagnosis of atopic dermatitis in the Health Interview Surveys. RESULTS: The prevalence of atopic dermatitis was 2.3%, which decreased with age. In univariate analysis, adults with atopic dermatitis were younger, well-educated, had higher monthly family income, had more household members, and lived in the urban area (P<0.05), whereas sex, residential type, or smoking status was not associated with the presence of atopic dermatitis. The prevalence of hypertension, diabetes mellitus, and obesity were lower in atopic dermatitis subjects, while asthma was higher (P<0.05). Binary logistic regression analysis showed that younger age and the presence of asthma were associated with higher prevalence of atopic dermatitis (P<0.01). CONCLUSION: The results of this study suggest that younger age and the prevalence of asthma may be important risk factors for the prevalence of atopic dermatitis in Korean adults. These results warrant future studies to explore mechanisms underlying the association between social economic status and atopic dermatitis.

Relationship between serum 25-hydroxyvitamin D and lung function among Korean adults

PURPOSE: The relationship between vitamin D status and pulmonary function has been investigated in several studies. But previous study results are controversial. We want to know the relationship between vitamin D status and pulmonary function in Korean adults in small regional area. METHODS: The medical records of 3,253 subjects were reviewed retrospectively, those visited for routine health examination in Samsung Changwon Hospital between January and December 2013. All of them were workers in one company and lived in one island ('Geojedo'). RESULTS: Vitamin D deficiency group (serum 25-hydroxyvitamin D [25(OH)D]<20 ng/mL) showed lowed % forced vital capacity in one second (%FEV1; P<0.01), forced vital capacity (FVC; P<0.01) and higher FEV1/FVC (P<0.01). Serum 25(OH)D was positively correlated with %FEV1 (R=0.035, P<0.05), %FVC (R=0.081, P<0.01), FVC (R=0.125, P<0.01) and negatively with FEV1/FVC (R=-0.083, P<0.01). After adjustment for smoking history, we found serum 25(OH)D level was positively correlated with %FVC (R=0.058, P<0.01), FVC (R=0.093, P<0.01) and negatively with FEV1/FVC (R=-0.055, P<0.01). After adjustment for smoking and asthma history, we found serum 25(OH)D level was positive correlated with %FVC (R=0.103, P<0.01) and negatively with FEV1/FVC (R=-0.119, P<0.01). CONCLUSION: Serum 25(OH)D level was associated with pulmonary function.

Association between asthma and depression in Korean adults

PURPOSE: Asthma is one of the most common allergic diseases in which depression is an important comorbidity. However, little is known about the prevalence of depression in Korean adult asthmatics. This study was performed to evaluate the association between asthma and depression and to investigate the clinical characteristics of Korean adult asthmatics with depression. METHODS: Data were acquired from 18,066 men and women, aged older than 19 years who participated in the Fifth Korea National Health and Nutrition Examination Surveys, which was conducted from 2010 to 2012. The presence of asthma was based on self-reported physician diagnosis of asthma in the Health Interview Surveys. RESULTS: The prevalence of asthma was 3.2%, and that of depression was 4.2%. In univariate analysis, adults with asthma were old age, marital status, unemployment, low education, low monthly family income, low number of household members, obesity (P<0.05) were significantly associated with asthma, but sex, residence area, and smoking status were not associated with asthma. The prevalence of hypertension and depression were higher in asthmatics (P<0.05), while diabetes mellitus was not associated with asthma. After adjustment for age, marital status, number of household members, monthly family income, body mass index, hypertension, unemployment, low educated status, and depression were associated with the higher prevalence of asthma (P<0.01). Depression was associated with female sex, unemployment, while it was not associated with lung function in asthmatics. CONCLUSION: The results of this study show that depression may be an important risk factor for asthma in Korean adults. Further studies are needed to explore mechanisms responsible for the association between depression and asthma.

The association between maternal depression and childhood allergic diseases: an analysis of the Fifth Korea National Health and Nutrition Examination Survey (2010-2012)

PURPOSE: Asthma and atopic dermatitis are common chronic diseases and depression is an important comorbidity in allergic diseases. However, the association between maternal depression and child allergic diseases is little known. This study was performed to find out the association between maternal depression and child allergic diseases. METHODS: Data were acquired from 2,737 families who participated in the Fifth Korea National Health and Nutrition Examination Surveys, which was conducted from 2010 through 2012. RESULTS: The prevalence of childhood asthma was 5.3% and that of childhood atopic dermatitis was 14.1%. The prevalence of maternal depression was 3.9%. In univariate analysis, maternal depressions was associated with maternal smoking, lower education level, lower economic state, lower number of household members, maternal asthma, children's asthma (P<0.05), but marital status, maternal employment status, maternal atopic dermatitis, children's sex, children's age, children's atopic dermatitis, residence area were not related to maternal depression. After adjustment, maternal depression was associated with lower house income, maternal asthma, and children's asthma (P<0.05). CONCLUSION: The present study shows that maternal depression may be associated with childhood asthma, but not childhood atopic dermatitis. These results warrant future studies to explore the mechanisms responsible for the association between maternal depression and childhood asthma.

The Fine Scratches of the Spectacle Frames and the Allergic Contact Dermatitis

BACKGROUND: Spectacle contact allergy is not infrequent. The fine scratches on the spectacle frames which may play a role in the sensitization to the potential allergenic components have not been studied. OBJECTIVE: We sought the relationship between the scratches on the spectacle frames and the allergic contact dermatitis (ACD) in the Republic of Korea. METHODS: A total of 42 Korean patients with ACD at the spectacle contact sites were enrolled. Their spectacle frames were examined with the dimethylglyoxime (DMG) test and analyzed by the scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Patch tests (thin-layer rapid use epicutaneous test [TRUE tests]) were performed to identify the skin allergens. RESULTS: The DMG-positive spectacle frames were identified in 78.5% of the frames. The SEM results showed that there were more scratches on the skin-contacting parts of the spectacle frames than the non-skin-contacting parts of the same frames. In the EDS findings, the mean nickel content (weight, %) of the spectacle frames was 15.7+/-5.5, and the mean chromium content was 20.3+/-3.4 at the skin-contacting parts. In the TRUE tests, nickel sulphate was the most common allergen (31 cases, 73.8%), and potassium dichromate was the second (9 cases, 21.4%). Three patients presented simultaneous positive reactions with nickel sulphate and potassium dichromate. CONCLUSION: Minor visible and non-visible fine scratches on the spectacle frames may present the provocation factors of the ACD. Nickel sulphate was the most common allergen suspected of provoking the spectacle frame-induced ACD, followed by potassium dichromate.

Vitamin D and Asthma / 소아알레르기및호흡기학회지

Vitamin D deficiency and asthma are common public health problems worldwide. Recently, newer physiologic functions for vitamin D have been identified. Several studies suggest vitamin D plays a vital and complex role in immune system function and regulation. Asthma is one of the most common chronic diseases worldwide and has been increasing in prevalence over the last decades. Common risk factors for both asthma and vitamin D deficiency, such as an urbanized, westernized lifestyle and obesity have led to a hypothesized link between asthma and vitamin D. The purpose of this review is to present the evidence for a role of vitamin D in asthma.

The Evaluation of an Education Program for Using an Inhaler Devices in Childhood Asthma / 소아알레르기및호흡기학회지

PURPOSE: Asthma inhalation therapy is important for the treatment of childhood asthma. Therefore, it is necessary to educate patients on the correct inhalation techniques. The purpose of this study was to determine the effectiveness and necessity of educating patients on the correct inhalation techniques. METHODS: A total of 86 patients with bronchial asthma and who were over 7 years old were enrolled and educated on handling inhaler devices for 2 years. The inhaler devices used were the diskus (n=27), turbuhaler (n=12) and metered dose inhaler with a spacer (n=47). Trained pharmacists provided the education. Four steps (breathing out prior to inhalation, inhalation, holding the breath, exhaling slowly) that were critical for handling each device were evaluated and each step was scored as good, fair or poor. We evaluated the symptom score (daytime cough, nighttime cough, sleep disturbance and limitation of activity) and lung function before treatment and 4 weeks later. RESULTS: Over 90.0% of the diskus users performed fair to good in each step. The symptom score and lung function at 4 weeks later after education were significantly improved (P=0.000). The turbuhaler users all performed fair to good on each step. The symptom score was significantly improved (P<0.005), but the lung function was not difference. Over 95% of the users of a metered dose inhaler with a spacer performed moderate to good on each step. The symptom score and lung function were significantly improved (P<0.05). CONCLUSION: The structured, detailed education on inhaler devices by trained specialists was very important for performing correct inhalation therapy to control asthma, and repeated education might be also necessary.

Clinical review of acute seizures among children who visited the emergency room in Masan Samsung hospital from 2004 to 2006 / 소아과

PURPOSE: The purpose of this study was to evaluate acute childhood seizures, one of the most important causes of emergency room visits, to provide appropriate medical services. METHODS: We reviewed the medical records of 433 (4.6%) pediatric patients with acute seizures that visited the emergency room at Masan Samsung hospital from 2004 to 2006. RESULTS: The male to female ratio was 1.4:1 and the mean age was 40.9+/-34.9 months range. The order of geographical distribution was Masan, Changwon, Haman, and others. Fever was present in 40.6% of patients; December (14.8%) was the most frequent month for visits and generalized tonic clonic seizures (62.7%) were the most common type of seizure. The average frequency and duration of the seizure was 1.5+/-1.0 and 6.7+/-13.2 minutes respectively. Febrile seizures were present in 69.7% of patients and afebrile seizures in 30.3%. The causes of the febrile seizures were acute pharyngotonsillitis (44.6%), acute bronchitis, gastroenteritis, pneumonia, urinary tract infection, and unknown origin, in order of frequency. The most common cause of an afebrile seizure was epilepsy (71.5%) followed by a benign convulsion with mild gastroenteritis (BCwMG), sequela of a perinatal brain injury or brain malformation, and acute CNS infection. Evaluation of the causes of an acute seizure according to age showed that febrile seizures, epilepsy, and the sequela of perinatal brain injuries were more common between 2 and 6 years of age and epilepsy, febrile seizures and acute CNS infection, in order of frequency, were common between 6 and 15 years of age. Many patients, 49.4%, were discharged without admission. CONCLUSION: The common characteristics of pediatric patients presenting to the emergency room were male gender, an age between 2-6 years, presenting during the month of December, with generalized tonic clonic seizures due to acute pharyngitis. The most common presentation for the group less than 6 years of age was a febrile seizure and in the group more than 6 years of age, it was epilepsy. In many cases, the seizures stopped by the time the family presented to the emergency room.

The Efficacy of a Leukotriene Receptor Antagonist and a Second-generation Anti-histamine in the Treatment for Children with Moderate to Severe Persistent Allergic Rhinitis / 소아알레르기및호흡기학회지

PURPOSE: We evaluated the efficacy of leukotriene receptor antagonist and second generation anti-histamine in children with moderate to severe persistent allergic rhinitis. METHODS: Twenty eight patients who were treated with second generation anti-histamine for 4 weeks (Zyrtec syrup(R), Group A) and 58 patients who were treated with leukotriene receptor antagonist for 4 weeks (Singulair(R), Group B) were enrolled in this study. Control group (n=22) was received only first generation anti-histamine (Hydroxyzine) intermittently. Efficacy were evaluated by nasal scores in nasal congestion, rhinorrhea, nasal itching, sneezing and total nasal symptom score (a sum of patient ratings of nasal congestion, rhinorrhea, nasal itching, sneezing) before treatment and at 2 and 4 weeks after treatment. RESULTS: There were no difference in the total IgE and total eosinophil count of 3 groups. There were also no significant difference in the initial symptom scores. For nasal congestion, group A and B showed significant improvement at 2 and 4 weeks after treatment compared with controls (each P=0.006, P=0.000, P=0.023, P=0.001). For sneezing, group A and B showed significant improvement at 2 weeks after treatment compared with controls (each P=0.048, P=0.011) and group B also showed significant improvement at 4 weeks after treatment compared with controls (P=0.041). In total nasal symptom score (TNSS), group A and B showed significant improvement at 2 and 4 weeks after treatment compared with controls (each P=0.014, P=0.005, P=0.008, P=0.005). CONCLUSION: In the moderate to severe persistent allergic rhinitis, leukotriene receptor antagonist or second generation anti-histamine is effective in nasal congestion and sneezing.

A Case of Kawasaki Disease Resembling as Peritonsillar Abscess

Kawasaki disease is an acute febrile mucocutanenous syndrome associated with multisystemic vasculitis. The etiology of Kawasaki disease is still unknown therefore this disease can be diagnosed only based upon clinician's recognition of a symptom pattern which includes high fever, oral cavity changes, polymorphous skin rash, conjuctival injections, cervical lymphadenopathy, and swelling of peripheral extremities. Early diagnosis and treatment of Kawasaki disease is critical to reduce the risk of cardiac complications such as coronary aneurysm. However there is no specific diagnostic tools for Kawasaki disease, unusual clinical manifestation resembling infectious disease involving cervical lesion often leads to delay in appropriate diagnosis and treatment of Kawasaki disease. We report a ten-year-old girl with Kawasaki disease whose initial presentation mimicking peritonsillar abscess.

A Clinical Study on Relationship of Surgical Glove and Back Pain after Lumbar Puncture in Children / 소아과

PROPOSE: In this study, we evaluated whether powder on surgical gloves is a cause of postpuncture backpain in children. MOTHODS: In 164 children with meningitis between July and September 1997, we did not remove powder from surgical gloves. However, in 149 children with menigitis between May and October 2001 the powder was removed from the surgical gloves. RESULTS: Out of the 164 patients in 1997, 41 cases(25.00%) were found to have postdural puncture backpain. On the other hand, out of 149 patients in 2001, with whom we used gloves from which the powder was removed, we found only 8 patients(5.36%) with postdural puncture backpain. CONCLUSION: We conclude that the powder on surgical gloves is one of the main causes of postdural puncture backpain in children.