ABSTRACT
PURPOSE: Exaggerated pro-inflammatory reactions during the acute phase of Kawasaki disease (KD) suggest the role of immune dysregulation in the pathogenesis of KD. We investigated the profiles of T regulatory cells and their correlation with the clinical course of KD. METHODS: Peripheral blood mononuclear cells were collected from 17 KD patients during acute febrile and subacute afebrile phases. T cells expressing CD4, CD25, and Foxp3 were analyzed using flow cytometry, and the results were correlated with the clinical course of KD. RESULTS: The percentage of circulating CD4+CD25highFoxp3+ T cells among CD4+ T cells was significantly higher during the subacute afebrile phase than during the acute febrile phase (1.10%+/-1.22% vs. 0.55%+/-0.53%, P=0.049). Although levels of CD4+CD25lowFoxp3+ T cells and CD4+CD25-Foxp3+ T cells were only slightly altered, the percentage of CD4+CD25+Foxp3- T cells among CD4+ T cells was significantly lower during the subacute afebrile phase than during the acute febrile phase (2.96%+/-1.95% vs. 5.64%+/-5.69%, P=0.036). Consequently, the ratio of CD25highFoxp3+ T cells to CD25+Foxp3- T cells was higher during the subacute afebrile phase than during the acute febrile phase (0.45%+/-0.57% vs. 0.13%+/-0.13%, P=0.038). CONCLUSION: Decreased CD4+CD25highFoxp3+ T cells and/or an imbalanced ratio of CD4+CD25highFoxp3+ T cells to CD4+CD25+Foxp3- T cells might play a role in KD development. Considering that all KD patients were treated with intravenous immunoglobulin (IVIG), recovery of CD4+CD25highFoxp3+ T cells during the subacute afebrile phase could be a mechanism of IVIG.
Subject(s)
Humans , Flow Cytometry , Immunoglobulins , Immunoglobulins, Intravenous , Mucocutaneous Lymph Node Syndrome , T-LymphocytesABSTRACT
PURPOSE: In recent years, Korea has showed a steady increase in the frequency of teenage births, while the overall birth rate has declined. As the teenage birth is known as a high risk pregnancy itself, we examined perinatal complications of teenage mothers and whose neonates in aspects of medical problem, and social status and support. METHODS: We examined the perinatal characteristics of teenage mothers and whose babies, who were hospitalized at Korea University Ansan Hospital from January 2004 to July 2009 using medical records retrospectively. Twenty-seven teenage mothers and their 28 babies were enrolled in this study. RESULTS: Teenage mothers were all unmarried and showed high rates of preterm labor, maternal anemia, and unexpected delivery. Among them, 11 (40.7%) were from families that were separated. Eleven mothers (40.7%) did not have any antenatal care. There were high rates of prematurity and low birth weight (60.7% and 64.3%, respectively). The complication included: respiratory distress syndrome, patent ductus arteriosus and necrotizing enterocolitis. Fourteen babies (51.9%) were not going to be brought up by their biological parents. CONCLUSION: Teenage pregnancy had high rates of preterm labor and associated complications, often caused by the lack of proper antenatal care. Babies from unmarried mothers were likely to be adopted and this could be a social burden. Therefore, to reduce unplanned teenage pregnancy and births, sex education and social supports should be provided to all teenagers.
Subject(s)
Adolescent , Female , Humans , Infant, Newborn , Pregnancy , Anemia , Birth Rate , Ductus Arteriosus, Patent , Enterocolitis, Necrotizing , Illegitimacy , Infant, Low Birth Weight , Korea , Medical Records , Mothers , Obstetric Labor, Premature , Parents , Parturition , Pregnancy in Adolescence , Pregnancy, High-Risk , Pregnancy, Unplanned , Retrospective Studies , Sex Education , Single PersonABSTRACT
No abstract available.
ABSTRACT
Tuberculosis is primarily a pulmonary disease, but extra-pulmonary manifestations are not uncommon, especially in children and adolescents. Ten percent of extra pulmonary tuberculosis localizes to the bones and joints, and 56% of such cases affect the spine. We treated a childhood case of spinal tuberculosis misdiagnosed as muscular dystrophy in a patient without specific constitutional symptoms. We report this case because the patient had an unusual presentation of spinal tuberculosis.
Subject(s)
Adolescent , Child , Humans , Joints , Lung Diseases , Muscular Dystrophies , Neurologic Manifestations , Spine , Tuberculosis , Tuberculosis, Pulmonary , Tuberculosis, SpinalABSTRACT
PURPOSE: Intussusceptions are one of the most common causes of intestinal obstruction in infants and young children. Although it is easily treated by non-operative reduction using barium, water or air, this treatment is very stressful for young patients and may cause bowel perforation, peritonitis and shock. In this study, we identified the risk factors associated with the failure of non-operative reduction, to identify a group of children that would benefit from the procedure and those who would not. METHODS: We reviewed the medical records of patients with intussusception who were treated at the Korea University Medical Center Ansan hospital from March 1998 to July 2006. Three hundred fourteen children with intussusception were identified. Among them, non-operative reductions were performed in three hundred. Clinical and radiological variables were compared according to the failure or success of the non-operative reduction. RESULTS: Non-operative reductions were successful in 243 (81%) and failed in 57 (19%). The group that had failed procedures had a younger age (12.3+/-17.2 months vs. 18.0+/-15.8 months, p=0.03), longer symptom duration before reduction (33.6+/-29.0 hr vs. 21.5+/-20.3 hr, p<0.01), more vomiting and lethargy (p<0.01), but less abdominal pain and irritability (p<0.01), compared with the group that had a successful procedure. Logistic regression analysis showed that the factors associated with the failure of non-operative reductions were a younger age, less than 6 months of age (odds ratio: 2.5, 95% confidence interval: 1.2~5.2, p=0.01), duration of symptoms, longer than 24 hrs before reduction (odds ratio: 2.1, 95% confidence interval: 1.2~4.2, p=0.03), bloody stool (odds ratio: 4.8, 95% confidence interval: 1.9~12.2, p<0.01), lethargy (odds ratio: 3.4, 95% confidence interval: 1.1~10.4, p=0.04), and abdominal pain or irritability (odds ratio: 0.2, 95% confidence interval: 0.1~0.4, p<0.01). CONCLUSION: For children with intussusception, an age younger than 6 months, and duration of symptoms more than 24 hrs before reduction, as well as the presence of bloody stools, lethargy and abdominal pain or irritability were variables associated with failure of a non-operative reduction. Knowledge of these variables should be considered in making clinical decisions for therapeutic interventions.
Subject(s)
Child , Humans , Infant , Abdominal Pain , Academic Medical Centers , Barium , Intestinal Obstruction , Intussusception , Korea , Lethargy , Logistic Models , Medical Records , Peritonitis , Risk Factors , Shock , VomitingABSTRACT
Autoimmune hemolytic anemia (AIHA) is characterized by the production of antibodies directed against red blood cells (RBCs). It is usually accompanied by normal white blood cell (WBC) and platelet counts. Severe leukocytosis and thrombocytosis in AIHA are rare. Here, we report a 3-year-old female child who showed AIHA by warm antibody testing with both leukocytosis and thrombocytosis. The patient was treated with oral steroids for 5 days. During treatment, the leukocytosis was noted on hospital day 3 and was up to 60.87 x 10(9)/L. In addition, the thrombocytosis persisted at up to 725 x 10(9)/L. After day 7, the WBC and platelet counts returned to the normal range. The clinical condition and vital signs improved. The patient was discharged on day 12. This case demonstrated that patients with primary AIHA, may also have leukocytosis and thrombocytosis.
Subject(s)
Child , Child, Preschool , Female , Humans , Anemia, Hemolytic, Autoimmune , Antibodies , Erythrocytes , Leukocytes , Leukocytosis , Platelet Count , Reference Values , Steroids , Thrombocytosis , Vital SignsABSTRACT
A 3-year-old girl presented with polydipsia, polyuria, hyponatremia, hypertension and congestive heart failure. Her polyuria was unresponsive to water restriction and vasopressin challenge tests, and her blood pressure was not effectively controlled by antihypertensive drugs. Radiologic examinations revealed a Wilms' tumor in the right kidney. Her plasma renin activity and aldosterone concentration were greatly increased. After surgical removal of the tumor, the congestive heart failure disappeared. Congestive heart failure due to Wilms' tumor is very rare and we report here on such a case, with a brief review of the literature.
Subject(s)
Child, Preschool , Female , Humans , Aldosterone , Antihypertensive Agents , Blood Pressure , Estrogens, Conjugated (USP) , Heart Failure , Hypertension , Hyponatremia , Kidney , Plasma , Polydipsia , Polyuria , Renin , Vasopressins , Water , Wilms TumorABSTRACT
PURPOSE: Reactive oxygen species have been recognized as a common signaling mediator in diverse stimuli-induced apoptosis and hydrogen peroxide is a natural one of those reactive oxygen species. This study was performed to investigate the role of caspases in hydrogen peroxide-induced apoptosis of HL 60 cells. METHODS: Apoptosis was induced in HL 60 cells by treating 50microM hydrogen peroxide for 2, 4, and 6 hrs and induction of apoptosis was confirmed by flow cytometry and DNA fragmentation analysis. Caspase substrate assay was used to show the activity of caspases and then protein levels of caspase and its substrate were analyzed using immunoblotting. RESULTS: During the apoptosis, caspase substrates assay showed the increased activity of caspase-3, -7, -10, but not that of caspase-8 nor caspase-9, and immunoblotting analysis showed decreasing procaspase-3 protein with the progression of apoptosis. Furthermore, with progression of apoptosis, analysis of caspase substrates showed retinoblastoma protein decreased while cleaved 89kD fragment of poly (ADP-ribosyl) polymerase protein increased. CONCLUSION: These results suggest that hydrogen peroxide-induced apoptosis in HL 60 cells is not associated with the activation of caspase-8 nor caspase-9. Rather, caspase-3 is directly activated and responsible for hydrogen peroxide-induced apoptosis of HL 60 cells.
Subject(s)
Humans , Apoptosis , Caspase 3 , Caspase 8 , Caspase 9 , Caspases , DNA Fragmentation , Flow Cytometry , HL-60 Cells , Hydrogen Peroxide , Hydrogen , Immunoblotting , Leukemia , Reactive Oxygen Species , Retinoblastoma ProteinABSTRACT
PURPOSE: Acute lymphoblastic leukemia (ALL) accounts for approximately 75% of all cases of childhood leukemia. We investigated epidemiology, clinical and laboratory features and treatment outcome of the children with ALL in Korea during recent 5 years. METHODS: One thousand forty nine patients were enrolled between January 1994 and December 1998 from 37 major hospitals in Korea. The data regarding the clinical and laboratory features including age, WBC counts at diagnosis, immunophenotype, morphology, cytogenetics and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed. The differences between groups analyzed by log-rank test. RESULTS: There were 597 males and 452 females. The distribution between the age 2 and 5 years is most common in 46.1%. The annual incidence rate per 100,000 population varied from 1.6 to 2.2. The 5 year event free survival (EFS) rates according to good prognostic factors were as follows: 67% bet ween 1-9 year of age at diagnosis, 69% in under 10,000/mm3of initial WBC count, 74% in early pre-B cell CALLA ( ) immunophenotype, 65% in L3 morphology, 68% in no CNS invasion. Most of patients were treated by CCG treatment protocol. The 5 year EFS was 63%. Main complications were sepsis (21.8%) and hemorrhage (12.5%). The relapse rate was 15.6%. The common causes of death were sepsis, DIC, pneumonia, relapse. CONCLUSION: Our results could provide the most recent and important information about acute lymphoblastic leukemia of children in Korea.
Subject(s)
Child , Female , Humans , Male , Cause of Death , Clinical Protocols , Cytogenetics , Dacarbazine , Diagnosis , Disease-Free Survival , Epidemiology , Hemorrhage , Incidence , Kaplan-Meier Estimate , Korea , Leukemia , Medical Records , Pneumonia , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Precursor Cells, B-Lymphoid , Recurrence , Retrospective Studies , Sepsis , Treatment OutcomeABSTRACT
PURPOSE: This study was undertaken to investigate changes in cardiac performance in early neo-natal life by observing the changes of left ventricular(LV) function and volume according to the size of ductus arteriosus. METHODS: The study group consisted of 21 full-term Cesarean section neonates who were admitted to the nursery of Korea University Hospital. We serially investigated the patency and size of the ductus at 2, 24, 120 hours after birth by two-dimensional echocardiography. The standard two-dimensional tracings of LV volume were obtained under the guidance of apical two- and four-chamber views. LV end-diastolic and end-systolic volumes were calculated using a biplanar Simpson's method. RESULTS: LV end-diastolic volume was highest(3.44>0.4mm) at 2 hours of age(P<0.01), being constant from 24 to 120 hours. LV contractility, indicated by the mean normalized systolic ejection rate, remained constant during the whole period of investigation. The size of the ductus arteriosus was maximal at 2 hours after birth, and decreased significantly at 24 hours of age (P<0.01). The size of ductus arteriosus demonstrated a close linear correlation with the left ventricular end-diastolic volume(y=0.17x+2.92, r=0.59: P<0.01). CONCLUSION: Changes in LV end-diastolic volume soon after birth depend on changes in ductus arteriosus flow, which in turn is affected by ductal diameter. Upon patency of the ductus arteriosus, the newborn left ventricle operates at maximal performance with only a limited capacity to increase contractility.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Cesarean Section , Ductus Arteriosus , Ductus Arteriosus, Patent , Echocardiography , Heart Ventricles , Korea , Nurseries, Infant , Parturition , Ventricular Function, LeftABSTRACT
PURPOSE: The necessity of recombinant human erythropoietin (rhEpo) as a therapeutic agent in pediatric cancer patients has been challenged. Before clinical trials of the rhEpo, we evaluated the relationship of endogenous eythropoietin (Epo) level and hemoglobin (Hgb) in childhood acute lymphoblastic leukemia (ALL) and solid tumors. METHODS: Twenty eight children (20 ALL and 8 solid tumor) were involved in this study in Korea University Medical Center from January 1999 to June 1999. Epo and Hgb were measured simultaneously several times in the course of their diseases, and a simple regression analysis was performed to describe the Epo-Hgb relationship. RESULTS: 1) There was no inverse linear relationship between Log10Epo (LogEpo) and the variable Hgb of the control group (n=7). 2) There was a significant inverse linear relationship between LogEpo and the variable Hgb at the induction and consolidation phase of the childhood ALL patients (n=14) (r=0.73, P<0.05). 3) There was a significant inverse linear relationship between LogEpo and the variable Hgb at the reinduction phase of the childhood ALL patients (n=15) (r= 0.72, P<0.05). 4) There was a significant inverse linear relationship between LogEpo and the variable Hgb at the maintenance phase of the childhood ALL patients (n=19) (r= 0.74, P<0.05). 5) There was a significant inverse linear relationship between LogEpo and the variable Hgb during the chemotherapy of the childhood solid tumors patients (n=15) (r= 0.76, P<0.05). CONCLUSION: There was a significant inverse relationship between Epo and Hgb in pediatric cancer patients, suggesting that the negative feedback mechanism for endogenous production of Epo is intact.
Subject(s)
Child , Humans , Academic Medical Centers , Anemia , Drug Therapy , Erythropoietin , Korea , Pediatrics , Precursor Cell Lymphoblastic Leukemia-LymphomaABSTRACT
PURPOSE: Epstein-Barr virus (EBV) is associated with various diseases and complications caused by the host's immune reactions. This study focuses on various clinical findings and hematologic complications in childhood EBV infection. METHODS: The study group was thirty-eight EBV infected children (Anti-EBV VCA IgM; positive) who were admitted to the Department of Pediatrics, Korea University from January 1996 to July 1997. Patients were evaluated by clinical and laboratory findings. RESULTS: The mean age was 5.1 years old and the male-female ratio was 1.2:1. Fever was the most common clinical manifestation, which was present in 30 (79%) cases. Lymphadenopathy was present in 22 (58%) cases, throat injection in 18 (47%) cases, nausea and vomiting were in 13 (34%) cases, cough in 13 (34%) cases, skin rashes in 11 (29%) cases, hepatomegaly in 10 (26%) cases. AST and/or ALT levels were elevated in 18 (45%) cases and Bilirubin level was elevated in 9 (24%) cases. Twenty cases had hematologic complications. Neutropenia was present in 6 (16%) cases, thrombocytopenia in 1 (3%) case, both anemia and neutropenia in 3 (8%) cases, both anemia and thrombocytopenia in 2 (5%) cases, both neutropenia and thrombocytopenia in 1 (3%) case, pancytopenia in 7 (18%) cases. CONCLUSION: A presumptive diagnosis of EBV infection may be made by the presence of clinical symptoms such as fever, pharyngitis, lymphadenopathy, and hematologic complications such as unknown neutropenia, anemia, thrombocytopenia, and pancytopenia. In such conditions, specific serologic studies for EBV should be performed and confirmed by specific serologic studies.
Subject(s)
Child , Humans , Anemia , Bilirubin , Cough , Diagnosis , Epstein-Barr Virus Infections , Exanthema , Fever , Hepatomegaly , Herpesvirus 4, Human , Immunoglobulin M , Korea , Lymphatic Diseases , Nausea , Neutropenia , Pancytopenia , Pediatrics , Pharyngitis , Pharynx , Thrombocytopenia , VomitingABSTRACT
BACKGROUND: Cord blood transplantation has generated much enthusiasm because of the low incidence of GVHD(graft-versus-host disease), even in HLA(Human Leukocyte Antigen) mismatched situations, owing to intrinsic defects in mature T cell functions, and human cord blood is a constantly and easily obtainable source for hematopoietic stem cell. This study was undertaken to elucidate the possible mechanisms of low GVHD incidence observed when cord blood is used for stem cell transplantation. Based on current knowledge of the phenotypic correlates with functional subtypes of peripheral blood lymphocytes, we evaluated lymphocyte subpopulation in cord blood. METHODS: The 25 cord blood and 20 peripheral blood of adult control were included in this study. Monoclonal antibodies(MAb) conjugated with fluorescein-isothiocynate(FITC), phycoerythrin(PE) were used in this study. Heparinized whole blood was stained with mAbs using the whole blood lysis method. We used FACScan flow cytometer with argon laser tuned at 488 nm. Analysis was done by either Simulset or lysis II research software. RESULT: 1) The means of WBC and lymphocyte content were higher in cord blood than in adult blood(p<0.05). 2) The overall percentages of cord blood T(CD3+) cells, B(CD19+) cells, NK(natural killer)(CD16+/CD56+) cells were not different from adult controls. 3) The CD4+ : CD8+ ratio of cord blood was higher than thar of adult controls(2.7 in cord bloods versus 1.8 in adults). 4) The majority of the cord blood cells, both CD4+ and CD8+, co-expressed the CD45RA+ (naive) molecule. 5) The CD57, an antigen present on a subpopulation of NK cells, is absent in cord blood. CONCLUSION: We determined that cord blood contained mainly naive T lymphocytes to be predominantly suppressor cells. We found reduced alloproliferative, allostimulatory and allocytotoxic capacity of cord blood lymphocytes. Therefore, the GVHD may be less readily induced in cord blood transplantation, even in the face of HLA difference.
Subject(s)
Adult , Humans , Argon , Fetal Blood , Hematopoietic Stem Cells , Heparin , Incidence , Killer Cells, Natural , Leukocytes , Lymphocyte Subsets , Lymphocytes , Phenotype , Stem Cell Transplantation , T-LymphocytesABSTRACT
The leukemia of infancy, characterized by a high leukocyte count, massive organomegaly, CNS leukemia at diagnosis, high chromosomal abnormalities and immature phenotype. This is reflected in its poor prognosis. Isolated lesions of the facial nerve have been reported in leukemia patients, but appear to be rare in infancy. We report a case of unilateral facial nerve paralysis occurred in 4-months-old male who had acute lymphoblastic leukemia with review of literature.