Comparison of Therapeutic Efficacy between Lamivudine and Alpha-Interferon in Korean Children with Chronic Hepatitis B at Two Years after the Initiation of Treatment / 소아과

PURPOSE: We compared the therapeutic efficacy of lamivudine and alpha-interferon in children with chronic hepatitis B two years after the initiation of treatment, so that we could verify the safety and long term efficacy of lamivudine in children. METHODS: We prospectively studied 44 children(32 male and 12 female; age, 1-18 years, mean, 9 years) treated for chronic hepatitis B from September 1996 to June 2004 in Kyungpook National University Hospital in Korea. Twenty three children were treated with interferon, and 21 with lamivudine. Treatment efficacy was defined as the normalization of ALT and hepatitis B virus(HBV) DNA levels, loss of HBsAg and HBeAg seroconversion at two years after the initiation of treatment. RESULTS: Among the 23 children treated with interferon, the ALT level normalized in 10 children(43 %) and HBV DNA was undetectable in 12 children(52%). HBsAg was undetectable in one child (4 %) and HBeAg seroconversion occurred in nine children(39%) two years after the initiation of treatment. In comparison, among the 21 children treated with lamivudine, ALT normalized in 20 children (95%), HBV DNA in 19(90%), HBsAg in 5(24%), and HBeAg seroconversion occurred in 13(62%). Above all, in the lamivudine treated group under the age of seven, HBeAg and HBsAg seroconversion occurred in six(75%) and five(63%) out of the eight children respectively, which showed superior HBsAg seroconversion rate if treated in preschool aged children. CONCLUSION: We believe that the therapeutic efficacy of lamivudine in children with chronic hepatitis B could be better than interferon with fewer side effects, especially in preschool aged children.

Henoch-Schonlein Nephritis in Korean Children: Renal Outcome and Prognostic Factors / 대한신장학회잡지

Purpose: This retrospective study has been undertaken to find out the clinical outcome of children with Henoch-Schonlein nephritis and its relationship with initial clinical presentations and/or renal pathologic findings. METHODS: Study population consisted of 54 children with HS nephritis who have been admitted to the Pediatric department of Kyungpook University Hospital from 1993 to 2003, and biopsy was done with indications of heavy proteinuria (1 g/m2/day) lasting over 1 month, nephrotic syndrome, and persistent hematuria and/or proteinuria over 1 years. Patients were clinically divided into 3 groups; isolated hematuria, hematuria with proteinuria and heavy proteinuria (including nephrotic syndrome). Biopsy findings were graded from I-VI according to International Study of Kidney Disease in Children. RESULTS: Mean age of presentation was 7.9+/-2.7 years and slight female predominance was noted (24 boys and 30 girls). Histopathologic grading showed grade I in 5, grade II in 17, grade III in 29, and grade VI in 3 cases. Clinical outcome at the follow- up period less than 4 years (45 cases) and more than 5 years (18 cases) showed normal urinalysis in 17 (38%) and 10 (56%), persistent isolated hematuria in 14 (31%) and 1 (5%), hematuria with mild proteinuria in 14 (31%) and 7 (39%), respectively. No patients persist heavy proteinuria more than 3 years. Clinical outcome according to histopathologic grading showed that normalization of urinalysis was significantly lower in grade III when compared to grade II (p<0.05). Disappearance of proteinuria takes significantly longer in children with crescent formation (p<0.05). CONCLUSION: The majority of children with mild HS nephritis had good prognosis. The severity of histopathologic grade was well correlated with improvement of urinalysis. Our study suggests that renal biopsy provides a valuable prediction of prognosis even in mild HS nephritis without renal functional impairment.

Clinical Characteristics and Prognosis of Neonatal Seizures

BACKGROUND: Seizures in the neonate are relatively common and their clinical features are different from those in children and adults. The study aimed to provide the clinical profiles of neonatal seizure in our hospital. METHODS: A total of 41 newborns with seizures were enrolled in this study over a period of three years. They were evaluated with special reference to risk factors, neurologic examinations, laboratory data, neuroimaging studies, EEG findings, seizure types, response to treatment, and prognosis, etc. RESULTS: The average age at onset of seizures was 6.1+/-4.6 days and the majority of patients(42%) had multifocal clonic seizure and 24% had subtle seizure. Factors that are known to increase risk of neonatal seizures include abnormal delivery history, birth asphyxia, and electrolyte imbalance, etc. However, they remain obscure in about 20% of cases. More than 50 percent showed abnormal lesions on neuroimaging studies such as brain hemorrhage, periventricular leukomalacia, brain infarction, cortical dysplasia, hydrocephalus, etc. and 17 out of 32 patients showed abnormal electroencephalographic patterns. Phenobarbital was tried as a first line antiepileptic drug and phenytoin was added if it failed to control seizures. The treatments were terminated in the majority of patients during the hospital stay. The overall prognosis was relatively good except for those with abnormal EEG background or congenital central nervous system malformations. CONCLUSIONS: Neonatal seizures may permanently disrupt brain development. Better understanding of their clinical profiles and appropriate management may lead to a reduction in neurological disability in later childhood.

The Comparison of Interferon-alpha Treatment by Dosages and Retreatment for Chronic Hepatitis B in Children / 대한소아소화기영양학회지

PURPOSE: We compared the therapeutic efficacy of low dose with that of standard dose of interferon (IFN) treatment and also compared the first IFN treatment with retreatment. METHODS: We have studied 51 children (age, 2~14) treated for chronic hepatitis B from March 1990 to August 1999. Twenty seven children had been treated with 3 MU/m2 (2.66+/-0.66 MU/m2) of IFN-alpha three times a week for 6 months (range, 6~12 months), whereas 24 children with 6 MU/m2 (4.45+/-0.94 MU/m2). There was no significant difference in gender, age, initial ALT and HBV DNA levels between each comparative group. RESULTS: Among the 27 children treated with 3 MU/m2 of IFN, ALT level had normalized in 11 children (41%) and anti-HBe seroconversion occurred in 9 children (33%) one year after the initiation of treatment. In comparison, among the 24 children treated with 6 MU/m2 of IFN, ALT normalized in 12 children (50%) and anti-HBe seroconversion occurred in 7 children (29%). In comparing the first treatment group to retreatment group, ALT level had normalized in 23 children (45%) and anti-HBe seroconversion occurred in 16 children (31%) among the 51 children treated with the first course of IFN treatment. In comparison, ALT normalized and anti-HBe seroconversion occurred in 3 children (25%) among the retreated 12 children. CONCLUSION: There was no significant difference in the therapeutic efficacies between 3 MU/m2 and 6 MU/m2 dose of IFN treated groups in ALT normalization and anti-HBe seroconversion. The retreatment efficacy of IFN-alpha was as effective as the first treatment.

Clinical Features and ECG Findings of Supraventricular Tachycardia in Pediatric Patients

PURPOSE: Supraventricular tachycardia(SVT) is the most frequent symptomatic arrhythmia in children. We performed this study to disover the SVT mechanisms, age at SVT onset, symptoms and ECG findings of SVT and effect of adenosine on SVT. METHODS: We studied 57 patients(male : 30, female : 27, age : 1 day-15.8 years) who had been admitted or transferred due to SVT from January, 1997 to March, 2001. Retrospectively we reviewed their medical records, ECG and electrophysiologic study findings. RESULTS: Of the total 57 patients, the mechanisms of SVT(including atrial flutter) were atrioventricular reentrant tachycardia(AVRT) in 36(63%) patients, atrioventricular node reentrant tachycardia(AVNRT) in 9(16%) patients, ectopic atrial tachycardia(EAT) in 6(11%) patients, multifocal atrial tachycardia(MAT) in 3(5%) patients and atrial flutter(AF) in 3(5%) patients. Of the 12 primary atrial tachycardias(including EAT, MAT and AF), 11 tachycardias began before 1 year of age. The SVT occured before 1 year of age in 21(37%) patients, at 1 to 5 years of age in 7(12 %) patients, at 5 to 10 years of age in 19(33%) patients and after 10 years of age in 10(18%) patients. In symptomatic SVT, the frequent symptoms were palpitation, chest discomfort and chest pain, gastrointestinal symptoms including nausea and abdominal pain, dizziness and dyspnea in decreasing frequency. P wave was discernible in 31(86%) of the 36 AVRT patients and 5(56%) of the 9 AVNRT patients. Adenosine was effective in 19(91%) of 21 AVRT or AVNRT patients. No significant side effect resulted from was occured by rapid bolus intravenous injection of adenosine. CONCLUSION: AVRT was most frequent in pediatric SVT patients. SVT frequently occured before 1 year of age and at 5 to 10 years of age. Primary atrial tachycardia mainly occured before 1 year of age.