A Case of Diffuse Panbronchiolitis Developing in Childhood / 소아과

Diffuse panbronchiolitis(DPB) is a chronic inflammatory airway disease predominantly affecting respiratory bronchioles, with distinct clinicopathological profiles. It was first described in 1966 by Yamanaka et al. The etiology of DPB is not yet clear, and the natural history of the disease is respiratory failure leading to cor pulmonale and ultimately death. But the long-term use of low-dose macrolide has proven to be highly effective in treating patients with DPB. Usual age at diagnosis is over 40. A few cases of DPB have been reported in Korea since 1992 but there have been no reports in children. We experienced a case of DPB in a 12-year-old girl. Therefore, we report the case with a brief review of the related literature.

A Case of Meningococcal Meningitis with Complement 9 Deficiency / 소아과

Meningococcal disease is not rarely associated with abnormalities of the complement system. We experienced a case of C9 deficiency with meningococcal meningitis from a 12-year-old girl. Identification of complement deficiency has implications for management, including family studies, prophylaxis, vaccination, and altered threshold for infection screening and treatment.

Clinico-epidemiologic Study of Mycoplasma pneumoniae Pneumonia(1993 through 2003) / 소아과

PURPOSE: We evaluated the epidemiologic and clinical characteristics of mycoplasma pneumonia. METHODS: A total of 559 medical records of children with mycoplasma pneumonia admitted to The Catholic University of Korea, Daejeon St. Mary's Hospital, were retrospectively analyzed. RESULTS: The mean annual number of cases was 51. There was a higher occurrence in autumn (September-November, 41.7%) and in winter(26.7%). Outbreaks of mycoplasma pneumonia were noted in 1993-94, 1997, 2001, and 2003. The age distribution showed a peak frequency of 5-6 years of age and 68.2 percent of patients were in 3-8 years of age. The male-to-female ratio was 1.2:1. In comparison between 1994 and 2003, there was a difference in age distribution with a peak frequency of 5-6 years of age in 1994, and of 3-4 years of age in 2003. There were outbreaks during autumn and winter in 1993-94, and during summer and autumn in 2003. CONCLUSION: Outbreaks of mycoplasma pneumonia occurred every 2-4 years in Daejeon in accordance with nationwide epidemics during 1993-2003. The peak incidence of age in the recent outbreak was younger than in the outbreak which occurred 10 years ago, and in outbreaks in Western countries.

A Case of Atypical Kawasaki Disease with Autoimmune Hemolytic Anemia

Kawasaki disease(KD) is an acute febrile vasculitis with various clinical manifestations and the most common cause of acquired coronary arterial lesion in pediatric population. Occasionally, KD can be presented with some kind of unusual associations. of these, cases associated with autoimmune hemolytic anemia(AIHA) have been rarely reported worldwide. We report a case of KD associated with AIHA in the acute stage of disease and Parvovirus B19 infection, in a 4-month-old infant.

Epidemiologic Study of Aseptic Meningitis in Daejeon, Korea(1987 through 2003) / 소아과

PURPOSE: To evaluate the epidemiologic characteristics of aseptic meningitis in Daejeon, Korea from 1987 to 2003. METHODS: A total of 2201 medical records of children with aseptic meningitis admitted to the Catholic University of Korea, Daejeon St. Mary's Hospital, was retrospectively analyzed. RESULTS: The mean annual number of cases was 129, with a higher rate of occurrence in the summer season(May to August, 74.1%). Outbreaks of aseptic meningitis were noted in the years 1990, 1993, 1996, 1997, 2001, and 2002. The age distribution was relatively even, with higher incidences in the 4-7 years group and in the under one year old group. The male-to-female ratio was 2 : 1. Comparing the epidemics of 1997 and 2002, there were no marked differences in age distribution, except in the less than 1 year old age group(11.8% vs. 4.4%), nor in the monthly incidence. Neurologic complications were found in 0.7% of the patients. CONCLUSION: Outbreaks of aseptic meningitis occurred every one to three years in Daejeon, reflecting typical nationwide epidemics that occurred from 1987 to 2003. The incidence of disease in the less than 1 year age group during each epidemic may reflect the herd immunity of the maternal generation.

Inflammatory Processes in Kawasaki Disease Reach their Peak at the Sixth Day of Fever Onset: Laboratory Profiles According to Duration of Fever

We evaluated the inflammatory indices according to the fever duration in children with Kawasaki disease (KD), and determined duration when the inflammatory processes in KD reach their peak. Children with KD (n=152) were classified into 7 groups according to fever duration: at the third day or earlier (n=20), fourth (n=33), fifth (n=46), sixth (n=15), seventh (n=15), eighth (n=9), and at the ninth day or later after fever onset (n= 14). The levels of various laboratory indices were determined 3 times: before, 24 hr and 7 days after intravenous immunoglobulin administration (2 g/kg). WBC and neutrophil counts, and C-reactive protein level were the highest at the sixth day. Levels of hemoglobin, albumin, and high density lipoprotein cholestrol were the lowest at the sixth day. Although these indices were not significant statistically between groups, the indices showed either bell-shaped or U-shaped distribution of which peak or trench were at the sixth day. These findiugs showed that the inflammatory processes in KD reach peak on the sixth day of fever onset. This finding is important because a higher single-dose intravenous immunoglobulin treatment before the peak day may help reduce the coronary artery lesions in KD.

The Activity of sICAM-1 and sVCAM-1 in Plasma of Preeclamptic Mother and Neonatal Cord Blood

PURPOSE: Current concepts of preeclampsia have been focused on dysfunction of the maternal vascular endothelium, a central pathogenetic feature of the disease. But it is uncertain whether maternal preeclampsia has a harmful effect on fetal or neonatal vascular endothelium. In this study, plasma levels of endothelial adhesion molecules in preeclamptic mother and cord blood were determined to delineate vascular effects of preeclampsia on neonates. METHOD: Quantitative determinations of sICAM-1 and sVCAM-1 were measured from plasma of preeclamptic mother and neonatal cord blood in pairs according to gestational age and was compared to nonpreeclamptic control groups. RESULTS: Plasma ICAM-1 level was significantly higher in the maternal groups compared to corresponding cord groups (P<0.001). Preeclamptic maternal groups showed significantly higher sICAM-1 level compared to control maternal groups (P<0.001) and preterm maternal groups showed higher levels than term maternal groups (P<0.001). The level of sICAM-1 was significantly elevated in preeclamptic preterm cord groups than other cord groups (P<0.001). In respect to plasma sVCAM-1 level, higher value was observed in the preeclamptic preterm cord groups than preeclamptic preterm maternal groups. CONCLUSIONS: Elevation of the plasma sICAM-1 level caused by factors including vascular endotherial damage in preeclamptic mothers was observed in their neonates but with much lesser degree than their mothers. Factors associated with preterm labor other than maternal preeclampsia may seem to influence vascular endothelial injury in the cord blood.

Effects of Insulin-like Growth Factor-I and 1,25-(OH)2 Vitamin D3 Concentration on Intrauterine Growth of Newborns from Mothers with Preeclampsia / 소아과

PURPOSE: This study was undertaken to observe the blood levels of IGF-I and 1,25-(OH)2 Vit. D3 in maternal and neonatal compartments and the effects of IGF-I concentration on intrauterine fetal growth and 1,25-(OH)2 Vit. D3 metabolism in the presence of preeclampsia. METHODS: Thirty-four full-term pregnant women with preeclampsia and their newborns(preeclampsia group) and 10 normotensive full-term pregnant women and their newborns(normotensive group) were observed. IGF-I and 1,25-(OH)2 Vit. D3 concentrations in maternal and umbilical cord blood were analysed. RESULTS: Maternal and umbilical cord blood levels of IGF-I and 1,25-(OH)2 Vit. D3 were significantly lower in the preeclampsia group than in the normotensive group. In the preeclampsia group, maternal and cord blood levels of IGF-I of small-for-gestational age newborns were significantly lower than those of appropriate-for-gestational age newborns. The birth weight and length of newborns correlated with IGF-I concentrations of maternal and umbilical cord blood in small-for-gestational age newborns of preeclampsia group. The correlation between IGF-I and 1,25-(OH)2 Vit. D3 was significant in the umbilical cord blood of preeclampsia group, but only in appropriate-for-gestational age newborns. CONCLUSION: It is suggested that the lower level of IGF-I is the primary factor of intrauterine growth retardation in preeclampsia, and the effect of IGF-I on the metabolism of 1,25-(OH)2 Vit. D3 is different according to the presence of preeclampsia and intrauterine fetal growth retardation.

Clinical Significance of C-reactive Protein in Measles

PURPOSE: We evaluated clinical manifestations and laboratory findings in patients with measles according to C-reactive protein(CRP) concentration. METHODS: A retrospective analysis was performed using the medical records of patients with measles at The Catholic University of Korea, Daejeon St. Mary's Hospital from October 1999 to May 2000. We divided the patients with measles into four groups according to CRP level, i.e., those with below 5 mg/L(134 patients, negative group), those with 6-19 mg/L(85 patients), those with 20-49 mg/L(27 patients), and those over 50 mg/L(7 patients). We compared clinical and laboratory characteristics among these four groups. RESULTS: The mean CRP level of all patients was 11.1+/-7.5 mg/L. No statistical differences were present between the negative group and the 6-19 mg/L group or the 20-49 mg/L group in the duration of fever, hospitalization days, complications determined with longer hospitalization for more than eight days, white blood cell count, and incidence of hepatitis. Compared with the negative group, the over 50 mg/L group showed a longer duration of fever(4.7+/-1.7 vs 7.2+/-3.9 days), duration of hospitalization(5.4+/-1.4 vs 9.4+/-4.7 days), incidence of complications(5.2% vs 42.9%) and a higher mean level of WBC count(5,900+/-2,700/mm3 vs 12,700+/-6,700/mm3). With an increasing CRP level, there was a tendency for the duration of fever, complications and WBC count to increase. However the levels of liver enzymes(AST/ALT) were not associated with CRP level. CONCLUSION: A CRP level of over 50 mg/L in measles is associated with severity and complications.

A Comparative Study of Measles According to Age

PURPOSE: We evaluated clinical manifestations and laboratory findings in patients with measles according to age distribution. METHODS: Retrospective analyses were performed using medical records of patients with measles admitted to The Catholic University of Korea, Daejon St. Mary's Hospital from October 2000 to May 2001. We divided the patients with measles into three age groups, i.e., those who were under two years of age(159 patients), those between 9-11 years of age(39 patients), and those older than 16 years of age who were hospitalized in the department of internal medicine(young adult group; 23 patients). We compared clinical and laboratory characteristics among these three groups. RESULTS: Almost all patients with measles were presented with fever, skin rash and cough. No statistical differences were present between the three groups in total fever duration, number of hospitalization days, complications determined with longer hospitalization for more than eight days, and positive values of anti-measles IgM. Patients under 2 years of age showed statistically higher levels of white bood cell and lymphocyte counts. However, neutropenia and lymphopenia were observed in all age groups compared with age-matched standard values. Campared with the other two age groups, the young adult group showed a higher mean level of liver enzymes(AST/ALT) and more patients with a level twice as high as the normal values. CONCLUSION: Clinical manifestations including complications according to age groups showed no significant differences in patients with measles. Hepatic involvement was more prevalent in the young adult group.

Laboratory Values in Patients with Kawasaki Disease after Intravenous Immunoglobulin: Comparison of Patients with Coronary Artery Lesions to those without Coronary Artery Lesions

PURPOSE: We evaluated the effects of intravenous immunoglobulin(IVIG) on level of laboratory parameters examined serially according to the existence of coronary artery lesions in children with Kawasaki disease. METHODS: Children with Kawasaki disease(n=63), treated with IVIG at a dose of 2.0 g/kg, were classified as a group with coronary artery lesions(CALs+ group, n=9) or a group without coronary artery lesions(CALs- group, n=54). Levels of various laboratory parameters were determined three times during admission; before, 24 hrs after and 7 days after IVIG administration. RESULTS: There were no significant differences in laboratory parameters performing at, before and 7 days after IVIG administration. However WBC and neutrophil counts, and CRP were significantly higher, and the level of albumin was significantly lower at 24 hrs after IVIG administration. CONCLUSION: Approximately 15% of patients with Kawasaki disease showed CALs in the acute stage. Kawasaki disease patients with CALs were associated with persistent elevated levels of inflammatory parameters including WBC count, neutrophil count and CRP examined 24 hours after IVIG administration.

Causative Organisms in Children with Bacterial Meningitis(1992-2002)

PURPOSE: This study was performed to assess the difference of organisms causing bacterial meningitis according to time. METHODS: We analyzed retrospectively 40 medical records of bacteriologically proven meningitis from 1992 to 2002. We divided them into two groups; neonate's group(14 cases), and children's group(26 cases). The results of the neonate's group were compared with those of previously reported articles in Korea, in 1970s-1980s. The causative agents of the children's group were analyzed according to the stage before and after the introduction of H. influenza type b(Hib) vaccine. RESULTS: In neonates, Group B streptococci(GBS) was the most common cause of bacterial meningitis. There was a trend in Korea that major causative agents of neonatal bacterial meningitis have changed from gram negative bacteria including E. coli to gram positive bacteria including GBS. In children, H. influenzae was isolated in six out of 11 cases(55%) in 1992-95, before the introduction of Hib vaccine, while two out of seven(29%) were isolated in 1999-2002, after the introduction of the Hib vaccine. CONCLUSION: Our study showed that the most common agent of neonatal bacterial meningitis was GBS. There was a trend that after the introduction of Hib vaccine, the incidence of H. influenza meningitis decreased in children.

A Clinical Study of Group B Streptococcal Infection: Five Years Experience

PURPOSE: To evaluate clinical characteristics associated with group B streptococcal (GBS) infection in infants less than 3 months. METHOD: Medical records of patients (< = or90 days of age) who were confirmed to have GBS infection were reviewed during five year study period. Data for onset of age, clinical manifestations, risk factors, clinical course, antibiotics used, results of sensitivity of antibiograms and complications were collected. RESULTS: The episodes of GBS infection were found in 38 patients. The incidence of early-onset disease was 15.7% and male to female ratio was 1.2: 1. The associated obstetric factors included prematurity, twin, meconium staining and abortion. Fever, poor oral intake, lethargy, irritability, seizure and respiratory distress were common clinical presentations for diagnosis of sepsis and meningitis. GBS was isolated from 25 among 28 cases of cerebrospinal fluids and its sensitivity to penicillin and 3rd generation cephalosporins were 56% and 60%, respectively. The initial antibiotics used included ampicillin and gentamicin in 12 cases, 3rd generation cephalosporins and gentamicin in 11 cases. Subdural effusion and hygroma, hydrocephalus, ventriculitis, infarction, leukoencephalomalacia and basal ganglia hemorrhage were complications of meningitis caused by GBS. CONCLUSION: The early diagnosis and appropriate choice of antibiotics in treatment of patients with GBS infection is very important in respect to increased incidences of resistance to penicillins and to decrease mortalities and morbidites associated with GBS infection.

A Case of Neonatal Submandibular Abscess

Suppurative sialadenitis is rare in the neonate and usually involves the parotid glands. Isolated suppurative submandibular sialadenitis in the neonatal population is extremely rare. There are only 11 cases found in the literature of suppurative submandibular sialadenitis occurring as an isolated lesion. We describe a case of isolated submandibular sialadenitis progressing to submandibular abscess requiring incision and drainage in a term neonate. Pus culture yielded methicillin-resistant Staphylococcus aureus (MRSA). A brief review of literature is included.

An Epidemiologic Study of Kawasaki Disease(1987-2000): Incidence of Coronary Artery Complication in the Acute Stage

PURPOSE: We evaluated the epidemiologic characteristics and incidence of coronary artery sequele of children with KD according to treatment. METHODS: We retrospectively analyzed 506 medical records of children with KD, who were admitted at Daejeon St. Mary's Hospital from Jan. 1987 to Dec. 2000. RESULTS: The mean annual incidence was 36.1+/-11.1 cases per year. There was a slightly higher occurrence in summer with no significant difference in monthly incidence. The mean age was 2.4+1.7 years and 450 children(88.9%) were below four years of age. The male to female ratio was 1.7 : 1. When the 345 cases between 1987 and 1994 were divided into three groups according to treatment, incidences of the coronary abnormality(above grade II) of aspirin-treated(54 cases; 15.6%), divided-intravenous immunoglobulin(IVIG) treated(400-500 mg/dayX4-5 days, 224 cases; 64.9%), and one-dose IVIG treated(2.0 g/day, 67 cases; 19.5%) groups were 8.3%, 6.0%, and 7.5%, respectively. Between 1995 and 2000, 143 cases were treated with only one-dose IVIG and 21 cases(14.7%) showed coronary artery abnormalities(grade I, 15 cases; grade II, two cases; and grade III, four cases). Among the 143 cases, 22 cases(15.1%) were retreated with IVIG and/or steroid pulse therapy. The incidence of coronary artery abnormality in this group was 50.0%. Incidences of cases in recurrence and among siblings were 0.6% and 0.4% respectively. There was no fatal case. CONCLUSION: In Daejeon, Korea, the epidemiologic feature of KD showed slight annual variations without monthly differences. The incidence of coronary abnormality with one-dose IVIG therapy was 14.7%. The nonresponse of this therapy was 15.1% with a coronary abnormality of 50.0%.

IGF-I on the Expression of Gene Associated with Hypoxic Ischemic Brain Injury in the Neonatal Rats

PURPOSE: To investigate the effect of intraperitoneal injection of IGF-I after hypoxic ischemic brain injury on neuronal cell necrosis, apoptosis and expression of proapoptotic and antiapoptotic proteins bax and bcl-2, respectively. METHODS: The right carotid artery was cut between the double ligation. Then allowed to recover for 30 minutes followed by exposure to 8% oxygen at 37degree C for 2 hours. Devided 2 groups, control group(N=30) and IGF-I treated group(N=30). IGF-I treated group received IGF-I 20 microg 2 hours after hypoxic ischemic injury intraperitoneally. Rates were decapitated at 24 hours and 72 hours following hypoxic ischemic brain injury. After then, right hippocampal CA1 and CA3 neuronsof rat brains were examined. RESULTS: The apoptosis and necrosis was significantly less in IGF-I treated group than control group and necrosis was more prominent in CA1 neurons than CA3 neurons. Necrosis was slightly decreased at 72 hours in both groups(P<0.05). The apoptosis was more prominent at 24 hours than 72 hours after hypoxic ischemic injury(P<0.05). Bax protein expression was prominent in control group, especially at 72 hours(P<0.05) and less in the IGF-I treated group than control group. Bcl-2 protein expression was not detected in both group. CONCLUSION: The results from this study suggest that exogenous systemic IGF-I had a neuroprotective effect by inhibition of up-regulation of bax protein expression after hypoxic ischemic brain injury.

The Usefulness of 99mTc-DMSA Scan in Acute Pyelonephritis and Vesicoureteral Reflux in Children / 대한신장학회잡지

During a 4 year period, 118 children(62 boys) below 14 years of age(median 2.9+/-2.7 years) with symptomatic urinary tract infection were studied by 99mTc-dimercaptosuccinc acid scintigraphy(DMSA scan), ultrasonography and voiding cystoureterography(VCUG). The male to female ratio was 1.1 : 1, and 2.4 : 1 under 1 year of age, and 0.54 : 1 above 1 year age, respectively. Forty-seven patients presented with positive urine cultures and 71 were negative. DMSA scan was performed in 108 patients, and showed abnormalities in 50(46.3%) of them. Renal scars were observed in 24(51.0%) of 47 patients with positive urine culture and 26(42.6%) of 61 patients with negative urine culture, however there was no statistical difference between the two groups. Of the 118 patients VCUG was performed in 92 patients. Vesicoureteral reflux was found in 29(31.5%) of them. VURs were found in 25(50.0%) of 50 patients with positive and 4(9.6%) of 42 patients with negative findings in DMSA scan. Also, DMSA scan demonstrated scarring in 11(64.7%) of 17 renal units with grade I-II, 12(92.3%) of 13 renal units with grade III, and 9(90.0%) of 10 renal units with grade IV-V. The incidence of positive findings in DMSA scan was higher above grade III. VURs were found in 21 (52.5%) of 40 patients with abnormal findings in ultrasonography and 8(15.3%) of 52 patients with normal findings. Ultrasonographic findings were abnormal in 29(58.0%) of 50 patients with positive findings in DMSA scan and were normal in 47(81.0%) of 58 patients with negative findings. Our study shows that DMSA scan is useful in the diagnosis of acute pyelonephritis and detection of VUR. It is advisable that DMSA scan should be included as an initial evaluation tool for symptomatic urinary tract infection in children and used as a follow-up tool.

A Fatal Case oh Hemorrhagic Disease of the Newborn with a Massive Cephalhematoma / 대한주산의학회잡지

No abstract available.

A Case of Solid and Papillary Epithelial Neoplasm of the Pancreas / 대한소아소화기영양학회지

Solid and papillary epithelial neoplasm of the pancreas is an uncommon low-grade malignant tumor found predominantly in young females. It is rare in childhood. The origin of the tumor is probably from a multipotential stem cell of the pancreas. Neoplasm usually behave like a very low grade malignancy, so that complete removal is the treatment of choice for the tumor arising anywhere in the pancreas. We report a case of solid and papillary epithelial neoplasm of the pancreas in a 14 year-old girl who presented with intermittent abdominal pain and abdominal mass. CT scan shows a large, about 7×6 cm sized, well-marginated hypodense round mass in the head of the pancreas with some ill defined enhancing solid internal portion. She had taken complete excision of the pancereatic mass and Roux-en-Y pancreaticojejunostomy and histologically comfirmed solid and papillary epithelial neoplasm of the pancreas. A brief review of literature was made.