Protective Field Efficacy Study of Influenza Vaccines for Korean Children and Adolescent in 2010-2011 Season / 소아감염

PURPOSE: We conducted a prospective comparative clinical study to determine the field efficacy of the 2010-2011 influenza vaccines [Influenza virus strains; A/California/7/2009 (H1N1), A/Perth/16/2009 (H3N2), B/Brisbane/60/2008] in healthy Korean children under 18 years of age. METHODS: In this study, we enrolled subjects aged between 6 months and 18 years and divided them into 2 study groups: a group who received the influenza vaccines (407 subjects), and a control group who did not receive the influenza vaccines (230 subjects). Ours was a multicenter study that involved 7 hospitals, including the Korea Cancer Center Hospital. The study was conducted between September 2010 and February 2011. We collected nasal wash or throat swab samples from subjects who presented with acute febrile respiratory or influenza-like illnesses at the hospital. We used PCR to confirm the presence of the influenza virus in the respiratory samples and characterize the virus type. RESULTS: In this study, we collected 22 respiratory samples from the influenza-vaccinated group and found 3 cases of influenza virus infection. Similarly, we collected 21 samples from the control group and found 12 cases of influenza virus infection among 10 subjects during the study period. We determined the field efficacy of the 2010-2011 seasonal influenza vaccines to be 83.2% in healthy Korean children and adolescents. CONCLUSION: In this study, we determined the field efficacy of the 2010-2011 seasonal influenza vaccines in healthy Korean children and adolescents. We found that the field efficacy of 2010-2011 seasonal influenza vaccines was adequate.

Evaluation of immunogenicity of the 2008-2009 seasonal influenza vaccines by microneutralization test / 소아과

PURPOSE: For evaluating the immunogenicity of an influenza vaccine, the microneutralization (MN) test has a higher sensitivity and specificity as compared to the hemagglutination inhibition (HI) test. However, the MN test is more time consuming and is difficult to standardize. We performed the MN test to determine its usefulness as an alternative or complementary test to the HI test for evaluating the immunogenicity of influenza vaccines. METHODS: We compared the MN test with the HI test using 50 paired samples taken from a previous clinical study (2008-2009) in Korean children under 18 years of age. RESULTS: The linear correlation coefficients of the 2 tests for H3N2, H1N1, and influenza B were 0.69, 0.70, and 0.66, respectively. We identified a high index of coincidence between the 2 tests. For an influenza vaccine, the postvaccination seroprotection rates and seroconversion rates determined by the MN test were 78.0% and 96.0%, 90% and 42.0%, and 42.0% and 48.0% for H3N2, H1N1, and influenza B, respectively. Geometric mean titer fold increases of H3N2, H1N1, and influenza B were 2.89, 5.04, and 4.29, respectively, and were 2.5-fold higher. We obtained good results in the evaluation of the immunogenicity of the 2008-2009 seasonal influenza vaccines. CONCLUSION: We found that the MN test was as effective as the HI test. Therefore, we suggest that the MN test can be used as an alternative or complementary test to the HI test for evaluating the immunogenicity of influenza vaccines.

Bone Mineral Density Reference of 10-20 year-old Korean Children and Adolescents: Based on Hologic DXA from the Korean National Health and Nutrition Examination Surveys / 대한소아내분비학회지

PURPOSE: To obtain normative data on bone mineral density of each region of interest (ROI) measured by Hologic model dual-energy x-ray absorptiometry (DXA) of children and adolescents. METHODS: Cross sectional results from 723 healthy Korean children and adolescents (10-20 years of age) in the Korean National Health and Nutrition Examination Surveys were analyzed. We used age- and sex-specific reference data for bone mineral density (BMD) of the lumbar spine, femur neck, and total body except head from Hologic DXA device as recommended by the International Society for Clinical Densitometry. RESULTS: The bone mineral density of each ROI increased with age in both boys and girls. Maximal increase in the lumbar BMD occurred between ages 11 and 12 in girls and between ages 12 and 14 in boys. However, the increases of BMD in each ROI were different. The plateaus of the lumbar spine and whole body except head BMD in girls occurred at ages 15 and 17, respectively. The plateaus of BMD in each ROI occurred at age 17 in boys. CONCLUSION: Most of the skeletal mass, including lumbar spine and total body except head, is reached before the end of the second decade. This study provides reference values for bone density of each ROI measured with DXA for children and adolescents.

Candida tropicalis arthritis of the elbow in a patient with Ewing's sarcoma that successfully responded to itraconazole / 소아과

Fungal infections are rarely responsible for arthritis. Few cases of fungal arthritis have been reported, even in immunocompromised hosts susceptible to low-virulence organisms. Herein, the authors report the first case of Candida tropicalis arthritis in a child with a solid tumor. A 13-year-old boy with Ewing's sarcoma developed arthritis in his elbow during the neutropenic period after chemotherapy. Despite treatment with broad-spectrum antibiotics, his condition did not improve and serial blood cultures failed to reveal any causative organisms. After surgical drainage, culture of the joint fluid revealed the presence of C. tropicalis. Itraconazole treatment was started and after 3 months of therapy, the patient completely recovered full elbow function.

Multiple Insufficient Fractures in a Woman Who Failed to Achieve Peak Bone Mass after Cancer Therapy in Adolescence / 대한소아내분비학회지

A 23-year-old female was brought to our pediatric clinic complainting arm and back pain. The pain developed suddenly while she was on a roller coaster and she denied any history of injuries. At First, she visited local orthopedics, and a simple X-ray showed fracture in her left forearm. She received a cast therapy, and and after several months, the fracture lesion of forearm was improved. But the pain in her arm and back still remained. Eight years ago, she was diagnosed with rhabdomyosarcoma of the left forearm and received a combination of chemotherapy and radiotherapy. She was slightly built and became increasingly thinner over the course of, chemotherapy. After completing chemotherapy, she was evaluated for bone mineral density (BMD) and was found to be osteoporotic. She was advised to take calcium supplements and exercise regular, and was assesse for BMD annually, using a duel energy X-ray absorpometry (DXA). However, her BMD did not improve and she never achieved an adequate peak bone mass. This case showed that failure to gain adequate peak bone mass during growth did not result in a later increase in bone mass in the young adult period, and finally caused multiple insufficient fractures.

Comparative study of newborns of Asian immigrant and Korean women / 소아과

PURPOSE: This study compares the maternal characteristics and birth outcomes of infants of Asian immigrant mothers from developing countries with those of the infants of Korean mothers. METHODS: In this multicenter and retrospective study, Asian immigrant women who had delivered between January 2005 and June 2008 were enrolled from9 Medical Centers. In all, 333 births to Asian immigrant women from developing countries (Asian-Korean infants) were included in this study. In addition, sex-, birth year-, and gestational age-matched 333 neonates born to Korean mothers were selected as the control group (Korean infants). On the basis of the hospital data, we investigated the nationality, age, and medical history of the mothers and compared the incidence of congenital infection, Apgar score, weight, height, and head circumference of Asian-Korean infants with those of the Korean infants. RESULTS: The average maternal age of Asian women from developing countries at birth term was 26.7 years, which was significantly lower than that of Korean women (30.8 years, P<0.05). The birth weight of Asian-Korean infants (2,869 g) was significantly smaller than that of Korean infants (2,995 g, P<0.05). There was a significant difference in the incidence of congenital syphilis infection between the Asian-Korean infants and Korean infants (5 cases vs. 0 case, P<0.05). CONCLUSION: There were significant differences in the perinatal outcomes between the Korean and Asian-Korean infants. A multicenter large-scaled study should be performed to analyze the perinatal outcomes of Asian-Korean infants.

Theory of Mind Deficits in Schizophrenia Patients and Their First-Degree Relatives / 신경정신의학

OBJECTIVES : Theory of mind (ToM) is the ability to conceptualize other people's mental states in order to explain their behavior. This study compared the ToM ability of schizophrenia patients, their first-degree biological relatives, and healthy controls. METHODS : ToM animation test was administered to schizophrenia patients (N=28), their healthy first-degree relatives (N=26), and healthy controls (N=28). The Korean version of schizotypal personality questionnaire (SPQ) was used to assess the schizotypal personality trait of all three groups. RESULTS : Schizophrenia patients and their first-degree relatives showed decreased accuracy on ToM animation test compared to healthy controls [F(2,78)=29.75, p<.001]. Additionally, first-degree relatives performed worse than the control group and better than schizophrenia patients. First-degree relatives had similar SPQ scores compared to healthy controls but showed decreased ToM accuracy compared to healthy controls. CONCLUSION : ToM deficits in schizophrenia patients are apparent. The ToM deficit in first-degree relatives of schizophrenia patients raises the possibility that ToM deficit may be a endophenotype for schizophrenia pathology.

Relationship between blood leptin and non-alcoholic fatty liver in obese male adolescent / 대한내과학회지

BACKGROUND: The non-alcoholic fatty liver is characterised by accumulation of triglycerides within liver parenchymal cells without intake of alcohol. Leptin is produced by peripheral adipose cells and it's blood concentrations are positively correlated with blood insulin levels, independent of body mass index. Non-alcoholic fatty liver is associated with insulin resistance and hyperinsulinemia even in lean subjects. Therefore, we aimed to elucidate whether hyperleptinemia is associated with non-alcoholic fatty liver, independent of age and obesity. METHODS: The age, weight, BMI and blood laboratory data such as LFT, lipid profiles, insulin, and leptin were analyzed on 26 control subjects and 30 non-alcoholic fatty liver subjects with BMI above 25 kg/m2 in male adults. RESULTS: There was no significant difference in their age, height, weight, and BMI between normal control group and non-alcoholic fatty liver group. But, blood triglyceride, leptin, and insulin level of patients with non-alcoholic fatty liver were significantly higher than those of normal control group. CONCLUSION: Blood leptin levels of non-alcoholic fatty liver group were significantly higher than that of control group. Thus, high circulating leptin concentrations may play a role in the pathogenesis of non-alcoholic fatty liver, regardless of age and obesity.

Correlation of Coronary Flow Reserve with Myocardial Perfusion Status and Contractility After Reperfusion of the Infarct-Related Artery in Patients with Acute Myocardial Infarction

BACKGROUND: This study was to determine whether coronary flow reserve (CFR) of infarct related artery is related to the microvascular perfusion status in the infarct zone determined by myocardial contrast echocardiography (MCE) immediately after successful revascularization in patients with acute myocardial infarction and to the presence of non-contractile myocardium at follow-up. METHODS: CFR was measured immediately after successful revascularization in 21 patients 5+/-2 days after acute myocardial infarction. Then, myocardial perfusion status was evaluated by MCE. Myocardial opacification index (MOI) was calculated as the ratio of sum of reperfusion area to total risk area of infarct-related artery. Follow-up transthoracic echocardiography was performed 1 month after infarction. RESULTS: CFR was correlated with myocardial opacification index immediately after successful revascularization (r=0.79, p0.05). CONCLUSION: CFR may be used to determine the microvascular perfusion status of the myocardium in the infarct zone. CFR immediately after successful revascularization seems to be associated more closely with myocardial perfusion status determined by MCE at that time than whether the non-contractile myocardium is presence or not after 1 month.

A case of double primary gastric adenocarcinoma and duodenal carcinoma with osteoclast-like giant cells / 대한내과학회지

Osteoclast like giant cells (OGCs) are infrequently encountered in a number of malignancies in extraosseous sites, such as the breast, pancreas, liver, stomach, thyroid gland, and other organs. Immunohistochemical stains demonstrate that the OGCs are of monocytic or histiocytic origin and probably represent a distinctive host response to the tumor. The OGCs show strong reactivity with CD68, and no reactivity with cytokeratin or polyclonal antibody to carcinoembryonic antigen (CEA). We experienced a 70 year old man who presented with epigastric pain and weight loss, and found synchronous duodenal carcinoma with OGCs and gastric adenocarcinoma. Histological examination showed an undifferentiated carcinoma with evenly scattered OGCs in the duodenum and liver metastases. OGCs were never seen to undergo mitotic division or exhibit atypia. By immunohistochemistry, neoplastic cells were diffusely positive for vimentin and focally positive for CAM 5.2 (low molecular weight cytokeratin), but OGCs were positive for only vimentin. He underwent palliative gastrojejunostomy for intestinal obstruction due to a large duodenal neoplasm. We report a case of synchronous double primary cancer of gastric adenocarcinoma and duodenal carcinoma with OGCs in a 70 year old man which was proved histopathologically.

Minimal Change Nephrotic Syndrome in a Patient with Type II Diabetic Mellitus and Review of the Literature / 대한신장학회잡지

Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria, a relentless decline in GFR and raised arterial blood pressure, and usually diagnosed on clinical grounds without a renal biopsy. Their renal injuries are irreversible and they become eventually end-stage renal disease. Recently, it has been reported that proteinuria are also induced by other causes, and some of the renal diseases was treatable. The detection of non-diabetic renal disease in diabetic patients by renal biopsy has the prognostic and therapeutic importance. We report a case of type II diabetic mellitus with minimal change nephrotic syndrome, and no evidence of diabetic glomerulosclerosis.

Bronchobiliary Fistula as a Late Complication of Hepatic Resection / 대한소화기내시경학회지

A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihepatectomy, trauma, hydatid disease, choledocholithiasis, and other causes of biliary obstruction. BBF are rare complication of hepatic resection that can present from days to years after operation. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of BBF, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical intervention via ERCP or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained. We are reporting a case of BBF secondary to hepatic resection of hepatocellular carcinoma which was managed by surgical operation.

A Case of Acquired Coronary Artery Fistula to the Left Ventricle after Acute Myocardial Infarction

Coronary artery fistula is an unusual anomaly that consists of a communication between one of the coronary arteries and a cardiac chamber or vein. It has hemodynamic significance, complicated by congestive heart failure, bacterial endocarditis, rupture or thrombosis of the fistula or an associated arterial aneurysm, myocardial ischemia, and arrhythmias. It occurs in congenital, traumatic, neoplastic, or artherosclerotic cardiac disorders. It is being diagnosed with increasing frequency with widespread use of selective coronary angiography. However, acquired coronary artery fistula after acute myocardial infarction is a rare clinical entity, and it has not been reported in Korea yet. We observed a 62-year-old male patient with intermittent chest pain at rest, in whom serial coronary angiography showed newly developed communications from the left anterior descending coronary artery to the left ventricular chamber several months after acute myocardial infarction of the anteroseptal wall. The area of communication corresponded to the site of infarction as established by contrast echocardiography.