Perforation of azygos vein and right-sided hydrothorax caused by peripherally inserted central catheter in extremely low birth weight infant / 소아과

We report a case in which routine chest roentgenograms of an 840 g infant led to the belief that the peripherally inserted central catheter (PICC) was appropriately positioned within the superior vena cava when, in actuality, it was within the azygous arch. Although many cases of pleural effusions have been reported to be caused by a central venous catheter, a right-sided hydrothorax caused by azygous vein rupture from the use of a PICC is an extremely rare complication. Sudden changes in the condition of a preterm infant with PICC should raise the suspicion of a catheter- related problem.

Two Cases of Atypical Optic Neuritis

Optic neuritis refers to any inflammatory disorder of optic nerves, but it usually denotes an acute or subacute disease of optic nerves attributed to inflammation associated with demyelination. The diagnosis of optic neuritis is usually made on a clinical ground. The condition usually presents as a painful subacute unilateral loss of vision, which progresses over a few days to 2 weeks. The pain varies in severity, although it typically does not interfere with sleep. We report 2 cases of atypical optic neuritis rapidly recovered by the administration of high doses of steroid that presented with severe eyeball pain accompanied by vague visual loss and painlessly insidious onset of visual loss respectively, with normal findings in fundoscopic examinations, visual evoked potentials and orbital MRIs.

Usefulness of modified ambu(R) in patients who need artificial ventilation / 소아과

PURPOSE: The comatose mentality can be catastrophic, especially if the condition is severe or the duration is prolonged. Therefore, delayed diagnosis can result in a poor outcome or death. The best radiologic modality to differentiate from cerebral lesions in patients suffering from cerebral diseases is magnetic resonance imaging (MRI) rather than computed tomography (CT). Special apparatuses with metal materials such as ventilators, and cardiac pacemakers belonging to patients cannot be located in the magnetic field. We aimed to exhibit the possibility of examining MRI, maintaining ventilation at a relative long distance by means of modified Ambu(R). METHODS: Self-inflating bags as a sort of a manual ventilator, connected with relatively long extension tubes instead of mechanical ventilators, were adopted to obtain MRI. PVC (polyvinyl chloride) extension tubes had different lengths and diameters. Lengths were 1, 2, and 3 cm and diameters were 15, and 25 mm. The work of breathing and expiratory changes of expiratory tidal volume (TVe), minute volume of expiration (MVe), peak inspiratory pressure (PIP) were measured by use of the mechanical ventilator, Servoi(R), as the alteration of TVi (inspiratory tidal volume), extension tube lengths and diameters with other values fixed. RESULTS: Measured TVe and MVe by ventilator were the same values with control at every TVi, regardless of extension tube lengths and diameters, but PIP were increased with the rise of TVi, tube lengths, with decline of tube diameters, these were statistically significant. CONCLUSION: MRI examination can be carried out with a self-inflating bag connected with an extension tube at a long distance in patients who need artificial ventilation.

Usefulness of Korean Infant Developmental Screening Test in Premature Infants / 소아과

PURPOSE: This study aimed to evaluate the usefulness of Korean Infant Development Screening Test in predicting delayed development in premature infants. METHODS: A total of 74 children with histories of prematurity, who visited the pediatric neurology clinic of Korean University Ansan Hospital from August, 2002 to July, 2004, were examined, using the Korean Infant Development Screening Test. They were divided into two groups; a normal group and a patient (neurologically compromised) group. RESULTS: At 7 months of conceptional age, the normal and patient groups differed significantly in the fine motor, cognitive-adaptive sections. At 12 months of conceptional age both group, differed significantly in the gross motor, fine motor, personal-social, language and cognitive-adaptive sections. At 18-24 months, the group, differed significantly in gross motor, fine motor, personal-social, language and cognitive-adaptive sections. CONCLUSION: The Korean Developmental Screening Test was useful in predicting developmental delay in premature infants.

Fasting Insulin Level in Obese Children: Relationship to Comorbidities of Childhood Obesity / 대한소아내분비학회지

PURPOSE:It is well known that childhood obesity associated with high morbidity of hyperlipidemia, hypertension, fatty liver and type 2 diabetes mellitus. Recently investigators have revealed that hyperinsulinemia in obese children is related with not only insulin resistance but also hyperlipidemia and fatty liver. We investigated the relationship between fasting insulin level and comorbidities of childhood obesity. Also we determined the prevalence of asymptomatic fatty liver and presumed nonalcoholic steatohepatitis and to assess the correlation of fatty liver with degree of obesity and serum insulin level. METHODS:We measured fasting serum insulin in 300 obese children (obesity index greater than 20 percent), from 8 to 15 years old age and blood pressure, fasting serum glucose and lipid profiles were also checked. Fatty liver was diagnosed by liver function test and abdominal ultrasonography. The correlations of insulin with BMI, blood pressure and lipid profiles were analyzed by linear regression. The prevalences of hypertension, hyperlipidemia and fatty liver were compared according to fasting insulin level. RESULTS:Mean obesity index of obese children was 35.26 (37.01 in male, 31.61 in female). Mean body mass index of obese children was 26.15 kg/m2 (26.72 kg/m2 in male, 24.98 kg/m2 in female). Among obese children, 87 children had hypercholesterolemia (>or=200 mg/dL, 28.9%), 60 children had hypertriglyceridemia (>or=150 mg/dL, 20.0%), 128 children had fatty liver (42.7%) and 139 children had hyperinsulinemia (46.6%). Serum insulin level had positive correlation with body mass index (r=0.274, P>0.01), systolic blood pressure (r=0.291, P<0.01), serum triglyceride (r=0.339, P<0.01) and not with serum total cholesterol. The prevalences of hypertriglyceridemia and fatty liver were higher in obese children with hyperinsulinemia than with normal insulin level (P<0.01). The severity of fatty liver was positively related to BMI, obesity index, triglyceride, insulin, HOMA. Fatty liver with elevated ALT was found in 40 subjects (13.3%). CONCLUSION: In this study, fasting insulin level had closely related with dyslipidemia and fatty liver in obese children. Our results suggest that monitoring of insulin level is helpful to assess the morbidities and should become a part of routine care of obese children.

Immunogenicity and Safety of Oral Live Attenuated Salmonella typhi Vaccine

BACKGROUND: This study is aimed at evaluating immunogenicity by measuring immunoglobulin A (IgA) seroconversion rate through common mucosal immune system and adverse reactions after vaccination of oral live attenuated Salmonella typhi (S. typhi) Ty21a vaccine in Korean population. METHODS: A commercially available oral live attenuated vaccine of S. typhi strain Ty21a (Zerotyph(r) capsule, Boryung Biopharma Co., Seoul, Korea) was given to volunteers; children above 6 years, adolescents, and adults who have never infected with S. typhi nor received S. typhi vaccination. The vaccines were given in three doses, with two day interval between the doses. Seroconversion was determined by ELISPOT (enzyme-linked immunospot) assay. Adverse reactions after vaccination were evaluated in 12 institutions by direct interviewing with vaccinees. RESULTS: A total of 93 volunteers for evaluation of seroconversion were enrolled. Seroconversion rate in the the below 16 year-old group was 73.8% (31/42) and that of over 16 year-old group was 86.3% (44/51), which was not statistically different. Adverse reaction were found in 8.6% (40/465). Gastrointestinal symptoms were most common (6.5%, 30/465). Adverse reactions were found in 5.2% (24/465) after 1st administration, 4.5% (21/462) after 2nd, and 2.6% (12/461) after 3rd. Frequency of adverse reactions was significantly higher after 1st administration (P<0.05). CONCLUSION: Oral live attenuated S. typhi vaccine, Zerotyph(r) capsule, had good immnuogenicity and safety through intestinal immune system.

Immunogenicity and Safety of Oral Live Attenuated Salmonella typhi Vaccine

BACKGROUND: This study is aimed at evaluating immunogenicity by measuring immunoglobulin A (IgA) seroconversion rate through common mucosal immune system and adverse reactions after vaccination of oral live attenuated Salmonella typhi (S. typhi) Ty21a vaccine in Korean population. METHODS: A commercially available oral live attenuated vaccine of S. typhi strain Ty21a (Zerotyph(r) capsule, Boryung Biopharma Co., Seoul, Korea) was given to volunteers; children above 6 years, adolescents, and adults who have never infected with S. typhi nor received S. typhi vaccination. The vaccines were given in three doses, with two day interval between the doses. Seroconversion was determined by ELISPOT (enzyme-linked immunospot) assay. Adverse reactions after vaccination were evaluated in 12 institutions by direct interviewing with vaccinees. RESULTS: A total of 93 volunteers for evaluation of seroconversion were enrolled. Seroconversion rate in the the below 16 year-old group was 73.8% (31/42) and that of over 16 year-old group was 86.3% (44/51), which was not statistically different. Adverse reaction were found in 8.6% (40/465). Gastrointestinal symptoms were most common (6.5%, 30/465). Adverse reactions were found in 5.2% (24/465) after 1st administration, 4.5% (21/462) after 2nd, and 2.6% (12/461) after 3rd. Frequency of adverse reactions was significantly higher after 1st administration (P<0.05). CONCLUSION: Oral live attenuated S. typhi vaccine, Zerotyph(r) capsule, had good immnuogenicity and safety through intestinal immune system.

Serum Lipids of School Children and Adolescence in Urban and Rural Area / 소아과

PURPOSES: A cross-sectional study on serum lipids in school children and adolescents was carried out in two different areas in 2002. We studied to determine of the difference in lipids level of children between urban and rural areas and changes of cholesterol levels compared to those of early- 1990 studies. METHODS: A cross-sectional study on serum lipids in school children and adolescents was carried out in two different areas, Ansan and Paju. The number of children in Ansan was 835, that in Paju was 233. After fasting for 12 hours, serum total choleterol, high density lipoprotein(HDL) cholesterol, low density lipoprotein(LDL) cholsterol, triglyceride were measured. RESULTS: The mean of total serum cholesterol level was 176.48+/-27.70 mg/dL. The mean of HDL cholesterol was 61.42+/-12.38 mg/dL, LDL cholesterol was 94.14+/-24.45 mg/dL, and triglyceride was 93.09+/-45.96 mg/dL. The means of total serum total cholesterol and lipoproteins of children and adolescents were not different significantly in Ansan and Paju. The prevalences of children and adolescence with abnormal high cholesterol level(> or =200 mg/dL) and abnormal LDL cholesterol level(> or =130 mg/dL) were also not different in two areas. CONCLUSION: Our results suggest that there were no significant differences in serum lipid level and the prevalence of school children and adolescence with hyperlipidemia between urban and rural area and mean lipid levels of school children and adolescence were increased during the past decade.

An Outbreak of Acute Gastroenteritis Presenting with Metabolic Acidosis in Many Nurseries in Gyeonggi Province, Korea

PURPOSE: The hospital-acquired outbreak of acute gastroenteritis caused by a virus is currently one of major health problems among newbron nurseries in Korea. We report an outbreak of acute gastroenteritis with metabolic acidosis over a eight-month period in many nurseries in Gyeonggi-do, Korea. METHODS: We retrospectively evaluated 73 neonates who were admitted in Ansan Hospital, Korea University Medical Center, presenting with symptoms of acute viral gastroenteritis from March, 2001 to September, 2003. Epidemiologic, clinical and laboratory data for these neonates were reviewed. Enzyme-linked immunosorbent assay (ELISA) for rotavirus and enzyme immunoassay (EIA) for astrovirus, norwalk virus and enteric adenovirus were performed in 54 and 16 neonates, respectively. RESULTS: The mean age at admission was 9.5 +/- 3.9 days. The mean body weight was significantly decreased, compared with mean birth weight. The numbers of severe dehydration were 37 (50.7%) and severe metabolic acidosis (pH < 7.2) were 40 (54.8%). Although the symptoms and laboratory findings were all compatible with acute gastroenteritis caused by a virus, the positive results for ELISA for rotavirus and EIA for astrovirus, norwalk virus and enteric adenovirus were 8 (14.8%) for 54 neonates and none for 16 neonates, respectively. CONCLUSION: Recognizing an outbreak of viral gastroenteritis necessitates notification of local health officials, collection of appropriate specimen for diagnosis and prompt institution of infection control measures.