Pediatric Acute Confusional Migraine / 계명의대학술지

Acute confusional migraine (ACM) is a rare type of migraine variant. It is primary seen in adolescent with migraine history. The specific symptom is an acute confusional mental change after acute onset headache. Symptoms include decreased alertness, disorientation, speech disturbance, agitation, difficulty in recognizing family and familiar locations, and amnesia. Patients mainly visit to emergency department due to acute mental problems. But there are no specific findings in neuroradiologic examinations and laboratory tests in ACM patients. And ACM is not widely known disease to physicians. So it takes long time to exclude other disorders and dysfunctions until to reach the diagnosis. Patient’s history of migraine, family history, and spontaneous relief of symptoms after deep sleep without medication can be helpful in diagnosis. We experienced a rare case of ACM of 13-year-old male patient, therefore we report the case with literature review.

Pediatric Acute Confusional Migraine / 계명의대학술지

Acute confusional migraine (ACM) is a rare type of migraine variant. It is primary seen in adolescent with migraine history. The specific symptom is an acute confusional mental change after acute onset headache. Symptoms include decreased alertness, disorientation, speech disturbance, agitation, difficulty in recognizing family and familiar locations, and amnesia. Patients mainly visit to emergency department due to acute mental problems. But there are no specific findings in neuroradiologic examinations and laboratory tests in ACM patients. And ACM is not widely known disease to physicians. So it takes long time to exclude other disorders and dysfunctions until to reach the diagnosis. Patient’s history of migraine, family history, and spontaneous relief of symptoms after deep sleep without medication can be helpful in diagnosis. We experienced a rare case of ACM of 13-year-old male patient, therefore we report the case with literature review.

The Study in Vitamin D Concentration in the Blood for Infants with High Level of Alkaline Phosphatase / 고신대학교의과대학학술지

OBJECTIVES: Nowadays most infants on exclusively breast feeding have vitamin D deficiency due to the increase of breast feeding. However, domestic research lacks appropriate materials. Therefore, we researched practical clinical aspects of vitamin D deficiency related to breast milk feeding for infants who have a high amount of alkaline phosphatase (> 500 IU/L). METHODS: The subjects of the study were 31 infants with high alkaline phosphatase level. We tested with 25-hydroxycholecalciferol (25-OHD3), parathyroid hormone, calcium, ionized calcium, phosphorus in their blood and with a wrist x-ray. Then, we divided them into two groups of breast feeding and formula feeding and compared the results. RESULTS: Eighteen infants (58%) out of 31 infants that have high alkaline phosphatase were vitamin D insufficiency or deficiency, and 16 (100%) breast feeding infants of them showed vitamin D deficiency or insufficiency. However, only 2 (13%) of 15 formula feeding infants were at insufficiency. There was a correlation between alkaline phosphatase and 25-OHD3 concentration in multiple regression analysis, but no correlation in other variables was found in group of breast milk feeding infants. There was neither correlation between vitamin D concentration and alkaline phosphatase nor other correlated variables in the group of formula milk feeding infants. CONCLUSIONS: In this study, there was a high probability of vitamin D deficiency in the breast feeding infants with a high alkaline phosphatase level. Therefore, it is considered to be worth utilizing alkaline phosphatase as a screening test for vitamin D deficiency or rickets for breast feeding infants.

Clinical Review of Children Diagnosed as Specific Language Impairment

PURPOSE: The purpose of this study was to evaluate the clinical characteristics of children who had been diagnosed as specific language impairment as outpatients. METHODS: One hundred twenty-five speech- or language-delayed patients were enrolled in Dae-Dong Hospital from July 2007 to June 2008. Fifty-one of 125 children were diagnosed as specific language impairment in whom clinical factors such as duration of therapy and progress after therapy were evaluated. Data were obtained from telephone or direct personal interviews. RESULTS: Among 51 children diagnosed as specific language impairment, 39 (76.5%) had mixed receptive-expressive-type language disorder and 12 (23.5%) had expressive-type language disorder. Thirty children in total were studied as ten children were unavailable for follow-up and eleven dropped out during treatment. The final 30 children consisting of 23 with mixed receptive-expressive type language disorder and seven children with expressive-type language disorder were treated after diagnosis. Total average treatment duration of children with mixed receptive-expressive-type and expressive-type language disorder were 18.1 months and 8.6 months, respectively, a statistically significant difference (P = 0.014). Thirteen (57%) of 23 children with mixed receptive-expressive-type language disorder and all (100%) seven children with expressive-type language disorder completed speech therapy with an average treatment duration of 12.2 and 8.6 months, respectively; however, this difference was not statistically significant(P = 0.287). CONCLUSION: Classifying patients with specific language impairments into mixed receptive-expressive-type and expressive-type language disorder in an outpatient department can be useful for predicting duration of and prognostic effects of language therapy, as our study and other previous articles have shown. More attention is needed from pediatricians to ensure the effective assessment and management of specific language impairment.

Influence of Neonatal Body Surface Area on Decline Rate of Serum Bilirubin Level in Conventional Phototherapy -Neonatal Body Surface Area and the Decline Rate of Serum Bilirubin Level-

PURPOSE: Neonatal hyperbilirubinemia has benign courses in most cases, but the possibility of toxicity of hyperbilirubinemia required courses examination of every newborn infant to identify the severity of hyperbilirubinemia progress. This study aims to see how the body surface area of newborns influences the decline rate of serum bilirubin level in conventional phototherapy. METHODS: Based on the charts of the Pediatrics Department, Dae-Dong Hospital from January 2003 to December 2006, we analyzed 168 neonates diagnosed as neonatal hyperbilirubinemia (serum bilirubin > or =15 mg/dL) in retrospective way. We excluded newborn infants under 37 weeks of gestation and under 2,500 g birth weight and classified neonates into four groups by the calculation results of body surface area:males above 75 percentile (group A), males below 25 (group B), females above 75 (group C), and females below 25 (group D). RESULTS: Out of 168 samples, the number of group A, B, C, D was 30, 20, 20, 15 respectively. In conventional phototherapy, the mean decline rates of serum bilirubin of group B and D recording 2.09 mg/dL/day and 1.77 mg/dL/day, were significantly faster than those of group A and C recording 1.63 mg/dL/day and 1.41 mg/dL/day (P<0.01). No significant differences were found in different duration of phototherapy between groups below 25 percentile and those above 75 in both genders. CONCLUSION: In conclusion, body surface area influences of infants the decline rate of serum bilirubin level in conventional phototherapy.

A Study of Clinical Features of Acute Tumor Lysis Syndrome in Children

PURPOSE: Tumor lysis syndrome is characterized by hyperuricemia, hyperphosphatemia, hypetkalemia and hypocalcemia due to destruction of tumor cells. The purpose of this study is bi estimate in children the incidence, onset time, differences in outcomes between hemodialysis and conservative therapy, and predictive factor of tumor lysis syndrome before treatment with chernotherapy. METHODS: Subjects were 108 children who had received induction chemotherapy from January 1993 to December 1998. We reviewed 12 patients who developed turnor lysis syndrorne, and retrospectively analyzed their data on WBC, Hb, platelet, LDH, uric acid, phosphorus, potassiurr., calcium, BUN and creatinine. RESULTS: Tumor lysis syndrome was observed in 12(11.1%) cases. Seven out of 12 patient:; (58A%) were in the age group of 6 to 10 years. The incidence of tumor lysis syndrome was 9.4% in acute leukemia, 30.8% in malignant lymphoma and 6.5% in solid tumor. Before chemotherapy, tumor lysis syndrome occurred in 3 cases(25.0%). Nine cases(75.0%) developed after initiation of chemotherapy. LDH was significantly higher in the group with tumor lysis syndrome(2790.8+/-1882.1U/L) than the group without(777.6+/-618.5U/L)(P<0.05). Of 12 patients, there were increased levels of phosphorus and uric acid in 11 cases, creatinine in 9 cases, potassium in 6 cases, and calcium was decreased in 8 cases. There was no death during treatment. Duration of treatment until improvement was longer in the hemodialysis group(7.62.7 days) than in thi conservative therapy group(5.71.5 days). CONCLUSION: Turnor lysis syndrome occurred mostly within 24-48 hours after chernotherapy of acute lymphocytic leukemia and Burkitt's lymphoma. LDH before chemotherapy was helpful in predicting the occurrence of turnor lysis syndrome in children.

Comparison of Side Effects of Antiepileptic Drugs in Children according to Age

PURPOSE: There are few rigorous studies about the side effects of antiepileptic drugs(AEDs) according to age. This study is to analyze differences of the side effects of AEDs in epileptic children according to age. METHODS: Sample are 368 children who had received AEDs for at least 1 month during January 1995 to June 1999. We reviewed their medical records including age, sex, AEDs and side effects, and analyzed these data by X2-test. RESULTS: Side effects were observed in 86(23.4%) of 368 patients. There was no difference in the frequency of overall side effects according to age. But significant differences existed in each side effect(p<0.05). The most common side effect according to age were hematologic side effect(75.0%) under 2 months, gastro intestinal side effect(41.7%) between 2 months and 1 year, CNS side effect(42.1%) between 1 year and 5 years, CNS side effect(41.5%) over 5 years. Hepatotoxicity, the increase of AST/ALT due to valproate, occurred significantly more frequently in children younger than 2 years(p<0.05). Drug eruption and post-carbamazepine leukopenia had no differences according to age. Under 1 year, valproate group had significantly more side effects in CNS. But carbamazepine, phenobarbital, and vigabatrin groups had no differences. CONCLUSION: There was significant difference in the side effects of AEDs among each system according to age. It is recommended to use valproate as monotherapy in children younger than 2 years, and pay more attention to CNS side effect in children older than 1 year.

Side Effects of Antiepileptic Drug in Children

PURPOSE: The purpose of this study is to estimate the side effects of antiepileptic drug(AED) in children. METHODS: Subjects were 267 children who had received AED for at least 1 month during January 1995 to July 1998. We reviewed their sex, age at start of seizure onset, age at medication, class and number of AED, developmental delay, type and cause of seizure according to the presence of side effect. We analyzed data using Student's t-test and X2-test. RESULTS: Side effects were observed in 61 of 267(22.8%) patients. There were no significant differences in their characteristics according to the presence of side effect. There were 112 episodes of complications in 61 patients. In decreasing order, CNS(38.4%) > digestive(25.9%) > hematologic(22.3%) > skin and connective tissue(7.1%) > others(6.3%). There were 12 episodes in 11 patients who should have been taken off AED due to drug eruption, drowsiness, nausea and so on. Side effects were observed in 16 of 123(6.0%) patients in monotherapy compared with 45 of 144(16.8%) patients in polytherapy, which showed significantly fewer side effects in monotherapy(P<0.05). In monotherapy, mean age at seizure onset and medication start were older(4.63+/-3.83, 5.85+/-3.86 years, respectively) than in polytherapy(2.69+/-3.06, 3.69+/-3.58 years, respectively) (P<0.05). CONCLUSION: In the data, CNS is the most common side effect(43 episodes, 38.4%) and there were significantly fewer side effects in monotherapy compared with polytherapy. Accordingly, we concluded that monotherapy is preferred over polytherapy in reducing the side effects of AED.

A Case of Behcet's Colitis in Children / 대한소화기내시경학회지

Behcet's disease consists of a triad of relapsing inflammatory disease of the eye (iridocyclitis) with painful and recurrent oral and genital ulcerations. Arthritis, thrombophlebitis, neurologic abnormalities, fever, and colitis are associated clinical manifestations. The disease affects predominantly young adults and is very rare in children, especially those under 10 years of age. The proportion of Behcet's colitis in Behcet's disease is about 12%. Ulcerations are localized or diffuse, with the majority occuring in the ileocecal region. Extension to the serosal surface may result in perforation. The frequent complaints are abdominal pain, nausea, vomiting, diarrhea, hematochezia, loss of appetite, loss of weight gain, distention and palpable abdominal mass. The disease is complicated by intestinal obstruction, perforation, fistula formation, abscess formation and hemorrhage. We experienced a case of Behcet's colitis in a 9-year-old boy showing symptoms of abdominal pain, tenderness, and diarrhea. Thus, we report a case of Behcet's colitis with brief review of related literatures.

A Case of Central Pontine Myelinolysis

Central pontine myelinolysis(CPM) is rare, with fewer than 30 cases reported in children. It is characterized by demylinated regions throughout the brain and which are most prominent in the pons. The original patients studied were all chronic alcholics, but subsequently the condition has been found in children and in other patients with electrolyte abnormalities, most notably hyponatremia which had been corrected rapidly. CPM symptoms include spastic quadriparesis, pseudobulbar palsy, and acute changes in mental status leading to altered levels of consciousness, coma, or death. This condition was originally thought to be uniformly fatal, but there have been recent reports of survival accompanied by varying degrees of residual neurologic deficit. We experienced a case of central pontine myelinolysis in a 1-year-old girl in 1998. On admission, she had right hemiphegia and developmental delay. She suffered from hyponatremia a year prior to admission. We performed brain MRI and other studies. She was diagnosed with CPM though brain MRI.

A Case of Central Pontine Myelinolysis

Central pontine myelinolysis(CPM) is rare, with fewer than 30 cases reported in children. It is characterized by demylinated regions throughout the brain and which are most prominent in the pons. The original patients studied were all chronic alcholics, but subsequently the condition has been found in children and in other patients with electrolyte abnormalities, most notably hyponatremia which had been corrected rapidly. CPM symptoms include spastic quadriparesis, pseudobulbar palsy, and acute changes in mental status leading to altered levels of consciousness, coma, or death. This condition was originally thought to be uniformly fatal, but there have been recent reports of survival accompanied by varying degrees of residual neurologic deficit. We experienced a case of central pontine myelinolysis in a 1-year-old girl in 1998. On admission, she had right hemiphegia and developmental delay. She suffered from hyponatremia a year prior to admission. We performed brain MRI and other studies. She was diagnosed with CPM though brain MRI.