A study of neuropeptides related to headaches in children with meningeal irritation signs / 소아과

PURPOSE: The headache, one of the symptoms of meningitis, is related to abrupt elevation of intracranial pressure(ICP) or stimulation of intracranial nociceptive structure. However, in cases of mild elevation of ICP or normal findings of cerebrospinal fluid(CSF) analysis, patients sometimes complain of headaches. Therefore, other pathways may contribute to the occurrence of headaches in aseptic meningitis or meningismus. We intend to investigate the role of substance P(SP) and calcitonin gene-related peptide(CGRP) in aseptic meningitis or meningismus. METHODS: We measured leukocyte count, the concentration of protein and glucose in CSF and ICP of patients with meningeal irritation sign. We also measured SP and CGRP levels by using immunoassay. We analyzed the relationship between the presence of headache and the value of SP and CGRP. RESULTS: The concentrations of CGRP(18.8+/-10.5 ng/mL) in CSF and ICP(14.8+/-4.5 cmH2O) in aseptic meningitis group were significantly higher than in those(14.1+/-7.4 ng/mL and 12.0+/-5.1 cmH2O, respectively) of the meningismus group(P<0.05). There was no significant difference in the SP levels between the two groups. In the aseptic meningitis group, the concentrations of SP and CGRP were significantly higher in the normal ICP group than in the elevated ICP group(P<0.05). CONCLUSION: Headaches in children with aseptic meningitis or meningismus is considered to be related to the elevation of the CSF levels of SP and CGRP.

Dexamethasone Attenuates PDGF- and TGF-beta-enhanced Vascular Endothelial Growth Factor Production in Cultured Human Bronchial Smooth Muscle Cells / 소아알레르기및호흡기학회지

PURPOSE: Human bronchial smooth muscle cell(HBSMC) plays an important role in the remodeling of the airways in asthma. Vascular endothelial growth factor(VEGF) is a multifunctional cytokine, which induces edema, angiogenesis, vascular remodeling, mucus metaplasia, subepithelial fibrosis, and antigen-induced Th2 inflammation. Transforming growth factor-beta(TGF-beta) is a growth modulator of HBSMC and an important cytokine in airway remodeling. We investigated the effect of dexamethasone on the release of VEGF from HBSMC stimulated with platelet-derived growth factor(PDGF) and TGF-beta. METHODS: HBSMC cultured in 10 percent FCS-DMEM media was growth-arrested in serum-deprived medium for 48 hours. Dexamethasone and TGF-beta were added and incubated for 16 hours before stimulation with PDGF. After 24 hours of stimulation, culture medium was harvested and stored at -80 degrees C until ELISA for VEGF was performed. RESULTS: The release of VEGF was significantly increased after stimulation with PDGF (P<0.01). The production of VEGF pretreated with TGF-beta before stimulation with PDGF was higher than those without TGF-beta pretreatment(P<0.01). Dexamethasone suppressed the release of VEGF in HBSMC stimulated with PDGF(P<0.01), TGF-beta and PDGF(P<0.01). CONCLUSION: PDGF and TGF-beta may be one of the key mediators in inducing airway remodeling and glucocorticoid, and can be used as useful therapies to prevent airway vascular remodeling by modulating the VEGF on airway smooth muscle cells.

A clinical study of migraines without aura in children: based on revised international headache society criteria / 소아과

PURPOSE: Because migraine in children has different characteristics from that in adults, it is inappropriate to apply migraine criteria for adults to children. Recently, the International Headache Society(IHS) revised criteria regarding children's characteristics. Therefore, we reviewed the characteristics of childhood migraines without auras based on the revised criteria and compared the data with the findings of childhood migraine by the previous criteria. METHODS: Among 102 children who visited the outpatient clinic of Kangbuk Samsung Hospital for the chief complaint of headache, we analyzed the clinical findings of 34 patients, who were diagnosed as migraine without aura, and probable migraine based on the revised criteria. RESULTS: Migraines without aura were diagnosed in 27 patients(26.5 percent) and probable migraines were observed in seven patients(6.8 percent). The usual duration of headache attacks over 2 hours was observed in 12 patients(44.4 percent). On the contrary, 15 patients(55.6 percent) usually experienced headaches for one to two hours. According to the location of headaches, there were temporal areas in 14 cases, frontal areas in nine cases, occipital areas in two cases and diffuse areas in two cases. The striking point in probable migraines is that the length of headache was below one hour in five patients. Nine patients were diagnosed as migraine without aura, when the first edition criteria was applied to same patients. CONCLUSION: We found that the prevalence of migraine without aura increased by the revision of IHS criteria. We hope that migraines in children will be diagnosed correctly by the new IHS criteria.