Relationship between total IgE and Epstein Barr virus infection during infancy and early childhood / 천식및알레르기

BACKGROUND: The 'hygiene hypothesis', the apparent inverse relationship between certain childhood infections and the subsequent development of asthma and atopy, has been gaining attention and is currently now considered one of the most plausible explanations for the cause of asthma and atopy currently. OBJECTIVE: We tried to evaluate the relationship between Epstein Barr virus infection in infancy and early childhood with total IgE, the hallmark of atopy. with these results, we observed the changing pattern of total IgE levels according to the ages that EBV infection occured. METHODS: The study population, a total of 75 patients were divided by age: under 2 years of age, under 3 years of age, under 4 years of age and then they were divided into the two groups : EBNA negative and EBNA positive groups. EBNA and IgE were measured by ELISA and CLA respectively. We analyzed the relationships between age, sex, family history, atopic predisposition, total eosinophils, log IgE, and positivity of EBNA stastically. RESULTS: Prevalence of EBNA positivity was 26% in children 1-3 years of age. Among the six variables, log IgE showed statistically significant difference in the two groups under 2 years of age and under 3 years of age. In the group of under 2 years of age, mean log IgE in EBNA positive group was 0.7 IU/mL and EBNA negative group was 1.3 IU/mL, these differences were significant statistically (p<0.05). In the group of under 3 years of age , mean log IgE in EBNA positive group was 0.8 IU/mL and EBNA negative group was 1.5 IU/mL, these differences were statistically significant(p<0.05). CONCLUSION: This study showed that Ebstein Barr virus infection before 3 years of age is associated with lower log IgE. This means that there is a possibility of a negative influence in the prevalence of allergic disease by EBV infection in children before 3 years of age.

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.

The Usefulness of Echocardiographic Severity Index for Prediction of Severity of Pulmonary Embolism

BACKGROUND: Pulmonary embolism is associated with varying degrees of pulmonary vascular obstruction. This study was undertaken to establish whether the extent of perfusion defect in lung scintigraphy can be predicted from analysis of echocardiographic measurements in patients with pulmonary embolism. METHODS: We retrospectively studied 28 patients who presented with clinical evidence of pulmonary embolism. In order to compare the extent of perfusion defect in lung scintigraphy, we devised a scoring system (echocardiographic severity index, ESI) for various echocardiographic parameters, which include right ventricle size, area, shape, systolic function, and pulmonary artery pressure. [ESI=sum of scores/number of parameters measured]. RESULTS: The mean values (+/-SD) of each parameter were as follow; right ventricular end-diastolic dimension (RVedD), 34.5+/-5.7 mm; LVedD, 40.9+/-5.2 mm; ratio of RVedD to LVedD, 0.87+/-0.2; right ventricular end-diastolic area (RVedA), 24.7+/-9.5 cm2; right ventricular end-systolic area (RVesA), 17.8+/-7.8 cm2; fractional area change, 28.8+/-9.7%; angle between IVS and RV, 96.0+/-14.8degrees; RV hypokinesia, absence or mild in 29%, moderate in 50%, severe in 21%; TR grade, absence or mild in 25%, moderate in 43%, severe in 32%; pulmonary artery systolic pressure, 50 mmHg 11% of patients. The echocardiographic severity index (ESI) in patients with pulmonary embolism was 0.52+/-0.24, and the perfusion defect score was 0.21+/-0.14. There was a close correlation between the ESI and the extent of perfusion defect (r=0.622, p<0.01). CONCLUSION: The echocardiographic severity index may reflect the extent of the perfusion defects in patients with pulmonary embolism, therefore it is potentially applicable in clinical practice for evaluating patients with pulmonary embolism and furthermore in their follow-up over a period of time.

A Case of Pheochromocytoma with Acute Myocardial Infarction / 대한내분비학회지

Pheochromocytoma, the catecholamine-producing tumor of chromaffin tissue, is associated with a curable form of hypertension. Recently we report the case of a 59 year-old male admitted for an acute myocardial infarction and who subsequently developed late recurrent severe ventricular arrhythmia coincident with transient hypertensive episodes. A pheochromocytoma was diagnosed on the basis of the urinary concentration of catecholamines and computerized tomography of the adrenal glands. After stabilization of his cardiac rhythm and blood pressure with alpha adrenergic blockade, the left adrenal gland, which contained the tumor, was subsequently resected. The diagnosis of a pheochromocytoma should be considered when recurrent ventricular arrhythmia are associated with intermittent hypertension after acute myocardial infarction.