Estimation of the Possible Age for Using Various Types of Inhaler by In-Check Inspiratory Flow Meter(TM)

PURPOSE: It is important to select and use kinds of Inhaler appropriate to the age of the patient and severity of symptoms. Several kinds of Inhaler have been developed and recommended according to each inhaler's resistance and usage method. We evaluated the usable age of 4 inhalers (turbulent flow inhalers, multi unit dose inhalers, breath actuated MDI, and autohalers) by measuring peak inspiratory flow(PIF) using In-Check(TM) Inspiratory Flow Meter. METHODS: Ninety three patients aged from 3 to 7 years(mean 57+/-12.9 mo.) who had admitted to CHA hospital from July 2000 to April 2001 were enrolled. Study patients were divided into 4 groups according to age:3-4 years of age(group A, n=31), 4-5 years of age(group B, n=32), 5-6 years of age(group C, n=18), and 6-7 years of age(group D, n=12). RESULTS: Out of total 93 patients, 23(71%), 27(84%), 17(94%) patients of each group A, B, C and all 12 patients of group D could use the 4 types of inhaler through adequated education. In all four groups, height, body weight and age were significantly correlated(P<0.05). Usable age, height and weight of children who can use turbulent flow inhaler(TFI) were each 8 year 7 month old, 144 cm, 32.0 kg, and those of multi unit dose inhaler(MUD) were 2 year 10 month old, 92 cm, 12.0 kg. Also that of breath-actuated MDI were 1 yr 8 months, 83 cm, 8.5 kg and that of autohaler were 2 yr 8 months, 91 cm, 11.0 kg. CONCLUSION: We concluded that the ability to use inhalers correlated with height, weight and age of the patients. Multi unit dose inhalers, Breath actuated MDI and Autohaler are useful after 3 years of age through adequate education.

Thyroid Function in Preterm Infants with Respiratory Distress Syndrome and Bronchopulmonary Dysplasia

PURPOSE: It has been known that intrauterine thyroid hormone deficiency may be one of the factors predisposing to RDS in premature infants. The aims of the study was to predict the development of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) with the serial serum thyroid hormone concentrations in premature infants. METHODS: From April 1998 to July 1999, we measured serum T3, T4, FT4. and TSH levels at less than 24 hours, 7, and 28 days of age in 57 premature infants. Study infants were divided into 3 groups according to their respiratory disease : the healthy premature group (A), the RDS without BPD group (B), and the BPD group (C). We compared the thyroid function among these three groups. RESULTS: Out of total 57 premature infants, 11, 33, and 13 infants belong to the Group A, B, and C, respectively. In all three groups, T3 and T4 levels were slightly decreased at 7 days and then increased at 28 days of age, whereas TSH level was highest in the first day of life and progressively decreased with time. In the first day of life, T3, T4, FT4, and TSH levels were highest in group A, middle in group B, and lowest in group C. In group C, T3 and T4 levels at 24 hours and 7 days of age were significantly lower than those in group A (P<0.05). T4, FT4 levels at 24 hours of age and T3, T4 levels at 7 days of age in group C were significantly lower than those in group B (P<0.05). There were no significant differences in thyroid function between groups A and B at any ages, and among all three groups at 28 days of age. CONCLUSION: There were no differences in thyroid function between the healthy premature infants and the infants with RDS who did not develop BPD later. However, in the infants with BPD, thyroid functions within 24 hours after birth and at 7 days of age were significantly lower than those in the premature infant without BPD. These observations support that early postnatal thyroid hormone concentrations are not related to the development of RDS, but useful as a predictive factor for the development of BPD in premature infants.

A Case of Malignant Gastric Stromal Tumor / 대한소아혈액종양학회지

As leiomyosarcomas of smooth muscle origin are rare tumors found in adults, they are even more uncommon among children. Therefore, most of the existing literatures concerning pediatric leiomyosarcomas has been limited to case reports. More recently, ultrastructural and immunohistochemical studies revealed that some tumors may have properties more suggestive of nerve cells or vascular endothelial cells, rendering the gastrointestinal stromal tumor a more popular term. We experienced a 13 year old boy who was diagnosed and treated as iron deficiency anemia. Even after iron therapy, he had persistent anemia and endoscopic examination revealed a huge mass in the gastric cardia. Proximal gastrectomy was performed with margins free of tumor. The tumor cells showed high mitotic activity suggesting malignant nature. The immunohistochemical staining was positive for smooth muscle actin while negative for S-100 protein. Brief review of the literatures are presented.