The Characteristics of IgA Nephropathy when Detected early in Mass School Urine Screening

PURPOSE: IgA nephropathy (IgAN) is one of the major causes of end-stage renal disease. Mass school urine screening (SUS) has been performed to enable early detection of chronic renal diseases, including IgAN. We wanted to evaluate the patients with IgAN, including those diagnosed through SUS. METHODS: Between 1998 and 2010, 64 children were diagnosed with IgAN based on renal biopsy results obtained at the Pediatric Nephrology Department, OO University Hospital. We divided these patients into the SUS group (37 cases), diagnosed through SUS, and the symptomatic (Sx) group (27 cases), diagnosed clinically. The medical records of both groups were analyzed retrospectively. RESULTS: The mean age of the SUS and Sx groups was 10.8+/-2.7 and 9.5+/-3.4 years (P>0.05), respectively. Both groups had a higher proportion of male patients. The time from the notification of an abnormal urinary finding to a hospital visit or renal biopsy was shorter in the Sx group than in the SUS group. Regarding clinical manifestations, there were fewer cases with gross hematuria (P<0.001) and edema (P=0.008) in the SUS group, but there were no differences in terms of the therapeutic regimen and treatment duration. Regarding laboratory parameters, the Sx group had a higher white blood cell count (P=0.007) and lower hemoglobin (P=0.007) and albumin (P=0.000) levels. There were no differences in the renal biopsy findings in both groups, based on the history of gross hematuria or the severity of proteinuria. However, in all 64 patients with IgAN, the light microscopy findings (Hass classification) were related to a history of gross hematuria or the severity of proteinuria. CONCLUSION: There were no significant clinical and histological differences between the groups, as both had early stage IgAN. Although SUS facilitates the early detection of IgAN, long-term, large-scale prospective controlled studies are needed to assess the benefits of early diagnosis and treatment in chronic renal disease progression.

Significance of Electron Dense Deposits in Patients with Minimal Change Nephrotic Syndrome

BACKGROUND: Minimal change nephritic syndrome (MCNS) is characterized by a lack of obvious abnormalities on light microscopy, but its electron microscopic findings include the negative immunofluorescence findings and the diffuse effacement of the epithelial cell foot processes. Rarely the presence of electron dense deposits (EDDs) has been reported, but its clinical significance remains obscure. METHODS: Eleven patients with MCNS who had the EDD deposited were enrolled in the current study. We compared the clinical characteristics, laboratory results and response to steroid treatment between the two group: the EDD group (n=11; the male-to-female ratio, 8:3) and the non-EDD group (n=13, 8:5). RESULTS: There were no significant differences in most of the laboratory results or response to steroid treatment between the two groups. The frequency of relapses per year was significantly higher in the EDD group (1.1+/-0.7 times vs. 0.5+/-0.6 times; p=0.023). These EDDs were found in the mesangium or paramesangium. With no respect to the characteristics of EDDs, our results showed that they did not cause poor treatment outcomes except for the annual frequency of relapse. CONCLUSIONS: Further large-scale studies are warrented to determine the immunologic and prognostic significance of EDDs in patients with MCNS.

Management of Urinary Tract Infections in Children: A Survey of Pediatricians in Daegu City

PURPOSE: Recently, many evidence-based guidelines for the management of urinary tract infection (UTI) have been developed because of the importance of proper management. However, there is a lack of data regarding how pediatricians manage UTIs in Korea. Therefore, we surveyed pediatricians to determine whether they manage UTIs in an appropriate manner. METHODS: A postal questionnaire survey of 78 pediatricians practicing in Daegu city was performed. Subjects were asked about diagnosis, imaging studies, treatment, and prevention of UTIs. RESULTS: Most of the respondents (94.8%) performed urinalysis to diagnose UTI in febrile children with an unknown fever focus. However, many preferred inaccurate collection methods, such as bagged urine collection, and did not obtain urine cultures. The most frequently performed imaging modality was renal-bladder ultrasonogram. Orally administered antibiotics were preferred unless admission was needed. After diagnosis of UTI, the pediatricians usually provided information to caregivers about the disease itself and supplementary treatment. Of the respondents, only 28.6% had their own guidelines for management of vesicoureteral reflux. CONCLUSION: Most pediatricians suspected UTI in febrile children with an unknown focus appropriately. Nevertheless, the fact that many pediatricians preferred inaccurate urine collection methods and did not perform sufficient imaging studies to detect associated abnormalities likely resulted in overtreatment due to false-positive diagnosis of UTI and a low probability of ruling out genitourinary anatomical problems. To improve the quality of management of UTI, pediatricians should follow scientific and evidence-based guidelines.

Novel influenza A (H1N1) 2009 infection in the pediatric patients with hematologic and oncologic diseases in the Yeungnam region / 소아과

PURPOSE: Natural history and consequences of the novel 2009 influenza A H1N1 (2009 H1N1) infection in immunocompromised pediatric patients are not yet fully understood. In this study, we investigated the clinical features and outcomes of the 2009 H1N1 infection in pediatric patients with hematological and oncological diseases. METHODS: We retrospectively reviewed the medical records of 528 patients who had hematological and oncological diseases and who were treated at 7 referral centers located in the Yeungnam region. Among the 528 patients, 27 with definite diagnosis of 2009 H1N1 infection were the subjects of this study. All patients were divided into the following 3 groups: patients who were receiving chemotherapy (group 1), patients who were immunosuppressed due to a non-malignant hematological disease (group 2), and patients who were off chemotherapy and had undergone their last chemotherapy course within 2 years from the influenza A pandemic (group 3). RESULTS: All 28 episodes of 2009 H1N1 infection were treated with the antiviral agent oseltamivir (Tamiflu(R)), and 20 episodes were treated after hospitalization. Group 1 patients had higher frequencies of lower respiratory tract infection and longer durations of fever and hospitalization as compared to those in group 2. Ultimately, all episodes resolved completely with no complications. CONCLUSION: These results suggest that early antiviral therapy did not influence the morbidity or mortality of pediatric patients with hematological and oncological diseases in the Yeungnam region of Korea after the 2009 H1N1 infection. However, no definite conclusions can be drawn because of the small sample size.

A Case of Left Ureteral Obstruction due to Acute Appendicitis / 영남의대학술지

Appendicitis is a common cause of acute abdomen in pediatrics. Periappendiceal abscesses are frequently found in the pediatric population. Acute appendicitis in children can, at times, be a difficult clinical diagnosis because of its highly variable history? and physical manifestations and its unpredictable course. Despite the uncertainty of the diagnosis, appendicitis demands prompt treatment because of the risk of perforation, which occurs in approximately one third of cases. Urological manifestations of appendicitis and appendiceal abscess can vary. Acute appendicitis presenting with ureteral stenosis and hydronephrosis is very rare. Here, we report a case of acute appendicitis with perforation and left hydronephrosis in a 3-year-old female. This case presents a 3-year-old girl with dysuria having hydronephrosis that originated from a perforated appendix.

Early assessment of atherosclerosis in children with type 1 diabetes / 소아과

PURPOSE: Diabetes mellitus is a major risk factor for the development of cardiovascular disease. Early atherosclerotic changes in the arterial walls begin in adolescence and the risk factors are associated with its development. To assess the usefulness of carotid artery intima-media thickness (IMT), as a marker of early atherosclerosis, we evaluated the structural and functional characteristics of the carotid artery and investigated their relationshop with the metabolic and anthropometric parameters in children and adolescents with type 1 diabetes. METHODS: For this study, we enrolled 23 children with type 1 diabet and 19 age and sex-equivalent healthy children as the control group. Metabolic and anthropometric parameters such as serum lipid levels, plasma glycated hemoglobin (HbA1c), and body mass index were measured after a 12-h fasting period. The carotid artery IMT was measured by a high- quality ultrasound system, and compliance, and distensibility were calculated by an equation. RESULTS: There were no significant differences between the 2 groups with regard to the sex ratio, age, blood pressure and serum cholesterol levels' however, HbA1c levels were significantly higher in the diabetic children (8.5+/-1.8 vs. 5.0+/-0.2, P= 0.001). Ultrasonographic findings showed that compared with the control group, the diabetic group had higher IMT (0.45+/-0.06 mm vs. 0.41+/-0.04 mm, P=0.04), but there were no significant differences in compliance and distensibility. The HbA1c (P=0.002) and high-density lipoprotein cholesterol (P=0.026) levels were independent IMT predictors in the diabetic group. CONCLUSION: Here, the carotid artery IMT was higher in the diabetic group, and it is correlated with atherosclerotic risk factor. Thus, carotid IMT could be evaluated as a marker of early atherosclerosis in diabetic children.

Pediatric Crohn's Disease presenting as Severe Constipation and Abdominal Distension / 영남의대학술지

Crohn's disease is a chronic inflammatory bowel disease that mainly affects children and young adults. Its cause remains unknown. The incidence of pediatric Crohn's disease is increasing, so it is important for clinicians to be aware of the presentation of this disease in the pediatric population. The majority of patients complain of abdominal pain (72%), with only 25% presenting with the 'classical triad' of abdominal pain, weight loss, and diarrhea. Many children with Crohn's disease present in a 'non-classical' manner, with vague complaints such as lethargy or anorexia, which may be associated with only mild abdominal discomfort. Other symptoms include fever, nausea, vomiting, growth retardation, malnutrition, delayed puberty, psychiatric symptoms, arthropathy, and erythema nodosum. Severe constipation and abdominal distension are uncommon symptoms at diagnosis. We report a case of pediatric Crohn's disease, which was diagnosed after the patient presented with severe constipation and abdominal distension.

The Changes of Skin Temperature and Sympathetic Skin Response after Thoracic Sympathectomy in Patients with Palmar Hyperhidrosis

OBJECTIVE: The purposes of these study were to evaluate the changes of temperature and sympathetic skin response (SSR) before and after sympathectomy in patients with palmar hyperhidrosis and to quantify long standing effect of sympathectomy. METHOD: The SSR and skin temperature were measured before, one day and 30 days after thoracoscopic sympathectomy. SSR was recorded from palm and sole bilaterally. Temperature was recorded on 9 sites of each hand and 11 site of each sole. Patient's satisfaction with operation was assessed by 10-point scale. RESULTS: One day after sympathectomy, the amplitude of SSR was significantly decreased and latency of SSR was delayed in all cases on bilateral palm and sole. However, after sympathectomy 30 days, the amplitude of SSR was normalized in all cases on bilateral sole. All patients who had undergone sympathectomy showed significant clinical improvement. The temperature increased dramatically over 3degrees C on postoperation 1 day and maintained 1.72degrees C higher in post-operation 30 days than pre-operation on both hands. There was no significant difference of temperature among pre-operation and post-operation 1 day and post-operation 30 days on sole. CONCLUSION: Our study proved effect of thoracoscopic sympathectomy to the patients with palmar hyperhidrosis objectively and quantified the decrement of sympathetic tone. Further study is needed for long term follow up over 2 months or more.

Evaluation of Peripheral Polyneuropathy in Patients with Diabetes Mellitus Using Quantitative Sensory Test

OBJECTIVE: The purpose of this study was to determine whether quantitative sensory test can be used as a screening test of peripheral polyneuropathy in patients with diabetes mellitus, and to evaluate the severity of peripheral polyneuropathy in patients with diabetes mellitus using quantitative sensory test. METHOD: We performed nerve conduction study to right upper and left lower extremity of the patients. Quantitative sensory test was performed using TSA-2001 thermal sensory analyser on right thenar and left foot dorsum in both diabetic and control groups. RESULTS: 1) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than age-matched control group (p<0.05). 2) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than young-aged control group (p<0.05). 3) As nerve conduction study results were severe, the cold sense threshold in right thenar were decreased (p<0.05). CONCLUSION: Quantitative sensory study in patients with diabetes mellitus are sensitive to identify neuropathic change; thus, they would be used as the screening method of diabetic peripheral polyneuropathy.

Diagnosis of Osteoporosis of the Foot in Patients with Diabetes Mellitus Using Bone Densitometry

OBJECTIVE: The purpose of this study was to evaluate the severity and frequency of osteoporosis of the foot in patients with diabetes mellitus using bone densitometry, and to determine whether plain radiologic evaluation can be used as a cheap and reliable screening of osteoporosis. METHOD: We studied plain X-ray including AP and lateral views of the feet of the patients. Bone densitometry studies were performed on the feet of both diabetic and age-matched control groups. RESULTS: Forefoot bone densitometry scores were significantly lower in the male diabetic group compared to the control group (p<0.05). Furthermore, the female diabetics had significantly lower bone densitometry scores for forefoot and hindfoot than the control group (p<0.05). Bone densitometric evaluation of the diabetic patients' feet revealed scores significantly lower than those of the controls in cases which the radiologist interpreted as normal finding in plain roentgenogram alone (p<0.05). CONCLUSION: Plain radiologic studies of the feet in patients with diabetes mellitus are not effective in identifying osteoporotic change; thus, they should not be used as the screening method of diabetic foot lesions.

Correlation between P300 Latency and Cognitive Capacity Screening Examination in Patients with Brain Lesion

OBJECTIVE: To verify the correlation between auditory event-related potential and Cognitive Capacity Screening Examination (CCSE) in patients with brain lesion. METHOD: P300 study using an auditory paradigm was performed in thirty patients with brain lesion, age ranged from thirteen to seventy-three years-old, and then was compared with the score of CCSE. RESULTS: The mean latency of P300 was 383.07+/-50.63 msec. The mean score of CCSE was 17.10+/-8.62. There was no significant difference in P300 latency and score of CCSE between male and female, and among the types of brain lesion. There was significant negative correlation between P300 latency and score of CCSE (p<0.05, r= 0.686), between score of CCSE and age (p<0.05, r= 0.364). There was significantly high intra-rater reliability in P300 latency study (alpha=0.9771). CONCLUSION: We conclude that P300 electrodiagnostic study is useful for reflection of cognitive function in patients with brain lesion.

A Usefulness of Pudendal Nerve Block in the Dorsal Approach under EMG Monitoring: A case report

This study was designed to evaluate the usefulness of pudendal nerve block in the dorsal approach under EMG monitoring. The patient is placed in the prone position. The location of pudendal nerve is identified using the both ischial tuberosities and greater trochanter. We have performed the pudenal nerve block with 5% phenol solution, under the EMG monitoring. The patient was able to void with percussion method. There has been no impairment in urinary continence. We experienced an excellent effect of bilateral pudendal nerve block in the dorsal approach, under EMG montoring, using 5% phenol solution in detrusor sphincter dyssynergia of neurogenic bladder.