Transcatheter Closure of Atrial Septal Defect Using Amplatzer Septal Occluder

BACKGROUND AND OBJECTIVES: Transcatheter occlusion (TCO) may be an alternative method for the surgical closure of a secundum atrial septal defect (ASD) below 20 mm in diameter. We performed this study in order to evaluate the safety and feasibility of an Amplatzer septal occluder for closing ASD bigger than 20 mm in diameter percutaneously. SUBJECTS AND METHODS: Thirty three of 39 patients presenting with ASD were included in this study (3 patients with a large defect over 32mm and 3 with multiple defects were excluded). The median age was 8.6 years (2.2 - 54) and median weight was 27 kg (10.7 - 85). The mean defect size was 15+/-3 mm as measured by transthoracic echocardiogram, 17+/-5 mm by transesophageal echocardiogram, and 21+/-6 (11 - 32) mm by balloon stretched diameter. The balloon stretched diameter was larger than 20 mm in 20 of 33 patients. The mean Qp/Qs was 2.3+/-0.7. The mean device size was 22+/-6 mm and the mean fluoroscopic time was 13+/-7 min. RESULTS: The device was successfully implanted in 29 of 33 patients. The 4 patients in which implantation failed showed a left disc protrusion into the right atrium. Three of these patients were treated surgically, and one underwent a successful second attempt of TCO 12 months after the first trial. Complete closure was obtained in 30 patients in follow-up. The complications encountered included;cobra-shaped deformity of the device (3), transient AV block (Wenckebach) (1), embolization of the radioopaque marker into the left atrial appendage (1), failure in the first device (1), and mild mitral regurgitation at 3 months follow-up due to device protrusion into the mitral valve (1). CONCLUSION: The Amplatzer septal occluder appears to be a promising device for TCO of ASD up to 32 mm in diameter, however, long-term follow-up in a large number of patients is warranted.

Study for Balloon Aortic Valvuloplasty in Congenital Aortic Stenosis

PURPOSE: The aims of this study are to investigate the results of balloon aortic valvuloplasty (BAV) in congenital aortic stenosis(CAS) and, especially, to compare the results between BAV performed before two months of age(Group A) and BAV after two month of age(Group B). METHODS: From January 1993 to June 2000, 14 patients who were diagnosed as CAS were treated with BAV. Indications for BAV were 1) critical aortic stenosis and 2) a peak-to-peak systolic pressure gradient in excess of 50mmHg or a gradient > OR =40mmHg with either symptoms or EKG changes. RESULTS: In Group A, the procedures were performed through femoral artery, carotid, or femoral vein approach. In Group B, however, all procedures were performed through femoral artery approach. After the BAV, a peak-to-peak systolic pressure gradient was reduced from 66.5+/-31.3 mmHg to 30.1+/-15.5mmHg(Group A; from 42.3+/-23.8mmHg to 22.0+/-15.3mmHg, Group B; from 88.9+/-16.8mmHg to 38.1+/-11.5mmHg). Repeated BAV were tried in 3 of these cases. There were 3 mortality cases in Group A. One of them was related with the procedure. CONCLUSION: The result of BAV after 2 months of age is acceptable, but that before 2 months of age is not satisfactory. However this result of BAV on early infants is thought to be mainly related to the poor pre-BAV conditions. So BAV may still be considered as a first intervention for CAS in this period. In such cases, other approachs rather than femoral artery should be considered.

Identification of a Calcium-activated Potassium Channel Gene Expressed in Rat Cardiac Myocytes

PURPOSE: Calcium-activated potassium channels(KCa) may be involved in the transient outward current of the first phase of cardiac action potential. But it is still not clear whether cardiac myocytes express any Kca. We try to identify here the types of Kc, expressed in rat caridac myocytes. METHODS: We isolated total heart RNA from 50 rats(Spague-Dawley) and performed reverse transcription-polymerase chain reaction(RT-PCR) using specifically designed synthetic oligonucleotide primer sets. From the pure culture of cardiac myocyte, Kc, gene expression was detected by Southern blot analysis. RESULTS: RT-PCR revealed expressions of BKca(large-conductance Kca, rSlo) and S&,(small-conductance Kca, rSK1). We prepared cardiac myocytes pure culture(>9596 pure myocyte) using pure culture technique. RT-PCR and Southern blot analysis of rat cardiac myocyte showed only rSK1-specific band, but no rSlo-specific was detected. CONCLUSION: The expressions of more than one type of Kca are detected from rat heart. A sub-type of SKcrSK1, was expressed in cardiac myocyte, while the main subunit of BKca(rSlo) was found in cells other than myocytes, most likely in the smooth muscle of cardiac blood vessels.

A Case of Transcatheter Occlusion of Aortopulmonary Window(APW) after PAW Banding

Aortopulrnonary window is an uncommon cardiac anomaly accounting for approximately 0.2-0.6% of all congenital cardiac anomalies in which there is a connection between the ascending aorta and pulmonary trunk. Since the first report of successful surgical repair, many investigators have advocated surgical closure of all types of aortopulmonary windows using different technique. The majority of aortopulmonary windows require surgical therapy due to extensive size or location. A few cases of interventional closure of APW with double umbrella and buttoned device are reported, but Gianturco coil has not been used previously. A case is described in an infant with a small aortopulmonary window which was closed by Gianturco coil after APW banding. He did not receive corrective operation because his parents who are Jehovahs Witnesses refused transfusion. Complete occlusion of the defect was achieved without complications. Transcatheter coil closure of a small aortopulmonary window is feasible in infancy and the technique is likely to be applicable in a few cases.

Early Results of Stent Implantation in Branch Pulmonary Artery Stenosis after Tetralogy of Fallot Repair

PURPOSE: Pulmonary artery stenosis is mainly complicated by aortopulmonary shunt or total correction of tetralogy of Fallot(TOF). Results of surgical angioplasty are poor and the success rate of balloon angioplasty is 53-72%. Endovascular stents have been applied to these lesions. The purpose of this study is to evaluate the early results of stent implantation in postoperative pulmonary artery stenosis in TOF. METHODS: Nineteen children with postoperative pulmonary artery stenosis were selected and balloon-expandable stent implantation was attempted between May 1994 and Feb 2000. For assessment of the results of stent implantation, the intraluminal diameter and the pressure gradient across the narrowest point were measured, as were the ratio of a right ventricle and aorta pressure, and a radionuclide lung perfusion scan was done before and after the procedure. RESULTS: Nineteen stents were implanted in 19 children, aged 2.3 years to 25,5 years. The increase of vessel diarneter ranged from 5.0+/-1.4mm to 10.7+/-2.1mm, pulmonary perfusion ratio from 16.7+/-5.3% to 29.2+/-10.0% and pressure gradients from 28.0+/-18.0 to 11.0+/-11.0mmHg with stent implantation. The systolic pressure ratio of the right ventricle and aorta decreased from 0.55+/-0.16 to 0.45+/-0.14. All above changes were statistically significant. Implantation failure occurred in 1 case and complications arose in 4 cases. CONCLUSIONS: The success rate of stent implantation is 94.296. Stent implantation is an effective and safe treatment method for postoperative pulmonary artery stenosis of TOF in short-term follow-up.

Repair of Corrected Transposition of the Great Arteries

PURPOSE: To assess the clinical characteristics and surgical approaches in different anatomical and hemodynamic types of corrected transposition of great arteries(TGA) and learn the surgical results of those patients. METHODS: All 52 patients who were diagnosed as corrected TGA between December 1987 and November 1999 and their medical records were reviewed. Three groups were identified according to associated anomalies', Group 1: TGA with intact ventricular septum(n=7), Group 2: TGA with ventricular septal defect(n=6), Group 3: TGA with ventricular septal defect and pulmonary stenosis(n=39). RESULTS: The clinical manifestations and managements according to associated anomalies were different. The average ages at operation were 190, 8.8 and 47 months in Groups 1, 2, and 3, respectively. The five patients underwent double switch operation and the remainder were managed conventionally without correcting discordant connection. Four patients died and 5 patients were re-operated. Eleven patients developed complete heart block, and 7 of them had permanent pacemakers. Progressive systemic tricuspid valve regurgitation developed in 15 patients and progressive systemic right ventricle dysfunction developed in 3 patients. CONCLUSION: The results of conventional management were disappointing, with significant morbidity of tricuspid failure, right ventricle failure and conduction system failure. Anatomical repair of corrected TGA can be achieved with favorable immediate surgical results but long-term follow up will be necessary.

Management of Post-operative Pulmonary Artery Stenosis in Tetralogy of Fallot

PURPOSE: Pulmonary artery stenosis is a common finding in post-operative tetralogy of Fallot (TOF), and it is one of the most frequent indication of reoperation. The objective of this study was to determine the procedural success rate of balloon angioplasty(BAP), endovascular stent, and reoperation for pulmonary artery stenosis in terms of its clinical impact on the subsequent management of these patients. METHODS: Hemodynamic and angiographic data from 71 patients who underwent balloon dilatation, stent implantation and reoperation for pulmonary artery stenosis between Jan. 1984 and Nov. 1999 were reviewed, retrospectively. The 71 patients had 94 vessels dilated by BAP. Criteria of BAP and stent implantation for success were > or =50% increase in vessel diameter or > or =20% decrease in right ventricular to aortic pressure ratio. Stent implantation was attempted in 16 patients and reoperation was performed in 11 patients. RESULTS: Of the 94 balloon angioplasty, 70(74%) were successfully dilated. In 16 patients, balloon angioplasty was ineffective for stenosis relief, thus endovascular stent implantation was attempted. All cases of endovascular stent were successfully implanted except one case which was dislodged. Reoperation was attempted in 11 patients in who balloon angioplasty failed or had ineffective results. CONCLUSION: BAP is beneficial for pulmonary artery stenosis. Left pulmonary artery kinking should be suspected at long-term follow up after tetralogy repair in patients with significant pulmonary regurgitation and right-side dilatation. Stent implantation or reoperation is considered when aneurysmal dilatation of pulmonary trunk, kinking components are suspected.

Open Heart Surgery in Infants Weighing Less than 3kg / 대한흉부외과학회지

BACKGROUND: There are well-known problems in the management of low weight neonates or infants with congenital heart defects. In the past, because of a perceived high risk of operations using cardiopulmonary bypass(CPB) in these patients, there was a tendency for staged palliation without the use of CPB. However, the recent trend has been toward early reparative surgery using CPB, with acceptable mortality and good long-term survival. Therefore we reviewed our results of the operations in infants weighing less than 3kg and considered the technical aspect of conducting the CPB including myocardial protection. MATERIAL AND METHOD: Between Jan. 1995 and Jul. 1998, 28 infants weighing less than 3kg underwent open heart surgery for many cardiac anomalies with a mean body weight of 2.7kg(range; 1.9-3.0kg) and a mean age of 41days(range; 4-110days). Preoperative management in the intensive care unit was needed in 20 infants and preoperative ventilator support therapy in 11. Total correction was performed in 23 infants and the palliative procedure in 5. Total circulatory arrest was needed in 11 infants(39%). There were seven hospital deaths(25%) caused by myocardial failure(n=3), surgical failure(n=2), multiorgan failure(n=1), and sudden death(n=1). The median duration of hospital stay and intensive care unit stay were 13days(range; 6-93days) and 6days(range; 2-77days) respectively. The follow-up was achieved in 21 patients and showed three cases of late mortality(15%) and a one-year survival rate of 62%. No neurologic complications such as clinical seizure and intracranial bleeding were noticed immediately after surgery and during follow-up. CONCLUSION: The early and late mortality rate of open heart surgery in our infants weighing less than 3 kg stood relatively high, but the improved outcomes are expected by means of the delicate conduct of cardiopulmonary bypass including myocardial protection as well as the adequate perioperative management. Also, the longer follow-up for the neurologic development and complications are needed in infants undergoing circulatory arrest and continuous low flow CPB.

Follow up of Patients with Total Anomalous Pulmonary Venous Return in Right Atrial Isomerism

PURPOSE: Total anomalous venous return(TAPVR) is associated in more than 60Yo of patients with right isomerism and can significantly complicate the management of single ventricle patients at any stage of management. We studied the results of management and sought to determine factors that may influence survival in patients with TAPVR in right atrial isomerism. METHODS: Between February 1991 and July 1999, 14 patients with TAPVR in right atrial isomerism underwent operations,' we reviewed our experience after performing single ventricle palliation RESULTS: Seven patients were of the obstructive type TAPVR and seven patients were of the non-obstructive type TAPVR. The mean age at operation was 17 months and mean body weight at operation was 7.3kg. Direct surgical repair for the pulmonary vein was performed in seven patients and in the others, TAPVR could be satisfactorily managed by the use of bilateral cavopulrnonary anastomosis(BCPS) to exclude the distal superior vena cava(SVC). At a mean follow-up of 27 months, there were five deaths, arid pulrnonary vein restenosis developed in four patients in the direct surgical repair group. In the other group, there was neither mortality nor morbidity. Also, the presence of pulmonary venous obstruction was associated with high mortality. CONCLUSION: According to our study, TAPVR can be satisfactorily managed by the use of BCPS to exclude the distal SVC in the non-obstructive type. But further evaluation of surgical methods about other types of TAPVR are warranted, because TAPVR not requiring intervention includes any low supracardiac and some mixed types.

Study of Congenital Mitral Stenosis Cases Requiring Surgical Correction in the First 2-Years of Life

PURPOSE: Congenital mitral stenosis(CMS) is a rare anomaly accounting for 0.4-0.5% of total heart disease. CMS which cases needed surgical correction in infancy are even rare. In this study, we analyzed 11CMS patients of less than 2 year of age who needed surgical corrections, in order to find out their diagnoses, the characteristics, the results of operation and prognoses, and the progress of disease without surgical correction. METHODS: Retrospective studies were performed on eleven CMS patients of less than 2 years of age admitted to Sejong General Hospital between Jan. 1989 and Aug. 1999. RESULTS: The surgeries were performed on 9 out of 11 enrolled patients. The median age was 8(3-20) months and the median weight was 5(4-9)kg. The mitral valves of the patients were classified anatomically as supramitral ring(4), parachute mitral valve(3), "typical" symmetric hypoplastic mitral valve(2) and asymmetric hypoplastic mitral valve(2). Three patients died after the surgical correction. Among them, fibroelastosis of left ventricle was found during the surgery in two cases, and the other case was considered to be in Eisenmenger state. 5. Reoperations were performed on 3 out of 6 surviving patients. While one case was an early reoperation, two case were late ones. CONCLUSION: The patients with severe CMS under the age of two can be surgically corrected with an acceptable success rate. Poor results were observed, however, if the decisions for surgical intervention were delayed.

Treatment of a Coronary Arterial Stenosis in a Child with Kawasaki Disease by Percutaneous Transluminal Coronary Angioplasty: Case Report and Literature Review

Percutaneous transluminal coronary angioplasty(PTCA) is rarely performed on patients with coronary arterial stenosis that resulted from Kawasaki disease. We experienced a 3 year 10-month-old male with a history of Kawasaki disease who developed a few numbers of fusiform aneurysm on the right and left coronary artery. We examined and followed up the patient for 21 months using eletrocardiography, echocardiography, scintigraphy, and coronary angiography. The angiography was performed at 4 months initially and repeated 21 months after the onset because of a perfusion defect at scintigraphy. A significant stenotic lesion was found on the right coronary artery. Twenty-one months after the onset, the stenotic lesion was successfully dilated after percutaneous transluminal coronary angioplasty and luminal patency was maintained for over 1 year. We report this case and a review of literatures.

Balloon Valvuloplasty of Pulmonary Stenosis in Patients Younger than 6 Months of Age

PURPOSE: Balloon valvuloplasty(BVP) is the treatment of choice for valvular pulmonary stenosis (PS). However, this procedure was usually performed in children older than 2 years. The purpose of the present study was to assess the safety and efficacy of BVP in young infants. METHODS: Retrospective analysis of the medical records of 25 infants younger than 6 months of age who received BVP for PS including critical PS between July 1991 and September 1997 were evaluated. RESULTS: The arterial oxygen saturation before and after procedure was 76.7% and 90.0%, respectively(P<0.001). Transvalvar pressure gradients measured with continuous wave Doppler echocardiography changed from 103.2+/-27.1mmHg to 34.8+/-14.4mmHg(P<0.001) and 29.3+/-15.9 mmHg after 6 months(P=0.075). The systolic pressure ratio of right and left ventricle before and after procedure was decreased from 1.40+/-0.4 to 0.74+/-0.3(P<0.001). Successful gradient relief was achieved with initial BVP in 21 out of 25 infants. There was one procedural death and one emergency surgery after BVP. Four of the 23 remaining patients required repeated BVP. CONCLUSION: Balloon valvuloplasty in young infants is a safe and effective procedure. In patients with symptomatic severe PS, balloon valvuloplasty should be recommended at an early age.

Treatment of Pulmonary Atresia, Ventricular Septal Defect and Diminutive Pulmonary Arteries Comparing First Palliative Management Schemes

PURPOSE: This report reviews an 8-year treatment of pulmonary atresia, ventricular septal defect and diminutive pulmonary arteries, comparing first palliative management schemes. METHODS: Between January 1989 and March 1997, patients had their pulmonary artery anatomy evaluated before any surgical managements. Twenty-two patients had diminutive pulmonary arteries(Nakata index<90). Clinical records, hemodynamic data, and cineangiograms were examined in these patients. RESULTS: The median age of patients were 14 months and the mean Nakata index were 54.7+/-18.2(24.3-88.9). The cases were classified into 3 different groups according to different first palliative strategies. Group I(n=18) was treated by a right ventricular outflow tract reconstruction. Group II(n=2) was treated by unifocalization and Blalock-Taussig shunt, and Group III(n=2) by a central shunt. The mean Nakata index of Group I was 68.0+/-29.6 and Group II and III showed 71.9+/-13.1 and 41.0+/-13.1, respectively. The total correction was performed in 14 cases (77.8%) of Group I and in 1 case (50%) of Group II. Group Ihad 3 deaths. Coil embolization was performed in 6 cases before total correction, and balloon angioplasty was performed in 3 and 5 cases, before and after the total correction, respectively. After total correction, the peak systolic pressure ratio of the right ventricle to the aorta was 0.80+/-0.08 in 11 cases. 5 cases of those indicated that balloon angioplasty reduced the ratio from 0.89 to 0.78. CONCLUSION: These results of first palliative surgery on the right ventricular outflow tract reconstruction compared favorably with previous reports of disease's history and survival after complete repair.

A Case of Aplastic Anemia Spontaneously Recovered after Delivery / 대한혈액학회지

A 26-year-old female was admitted for the evaluation of thrombocytopenia, who complained easy bruisy and multiple petechiae at 22 weeks of gestation. Bone marrow examination was recommended, but refused. Steroid therapy was tried under the impression of idiopathic thrombocytopenic purpura. But pancytopenia developed at 37 weeks of gestation. Considering aplastic anemia associated with pregnanacy, Caesarian section with supplementation of platelet rich plasma and packed red blood cells was done in order to terminate pregnancy. Bone marrow findings at 1 week after delivery were compatible with aplastic anemia. At 8 weeks after delivery, recovery of pancytopenia was noticed with normalization of bone marrow cellularity and maturation of hematopoietic cells.

Recent Trend of Increasing Proportion of Interventional Catheterization in Congenital Heart Disease

PURPOSE: The proportion of interventional catheterization in congenital heart disease is being increased in Korea, especially in Sejong Heart Institute, so we performed statistical analysis on the cardiac catheterization cases. METHODS: Total 233 cases of congenital heart disease confirmed by cardiac catheterization at the Sejong Heart Institute between Jaunary 1995 and June 1995 were analyzed retrospectively. RESULTS: 1) The distribution of age has become more younger than that of previous reports that is, the proportion of the infant less than 1 year old was 34.8%. 2) The proportion of male sex was equal to that of female. TOF and TGA were observed predominantly in male patients, and PDA and UVH revealed female preponderance. 3) The relative frequencies of each individual congenital heart disease in order of frequency were as follows; TOF 37.3%, PDA 13.3%, VSD 8.2% and UVH 7.7%. 4) Among the 145 (62%) cases of hemodynamic study pre-operation and post-operation cases were 85 and 60 cases, respectively. The cases of interventional catheterization were 84 (36%), and those of endomyocardial biopsy were 4 (2%). 5) The frequencies of each interventional catheterization of 84 cases in order of frequency were as follows: defect closure 28 cases, balloon valvuloplasty 20 cases, balloon angioplasty 17 cases, coil embolization 15 cases, and balloon atrial septostomy 4 cases. 6) There were 2 cases of mortality associated with cardiac catheterization. CONCLUSIONS: The proportion of interventional catheterization in congenital heart disease is being increased in the Sejong Heart Institute, and this trend will spread to the other cardiac center in Korea.

The Effects of Lipo Prostaglandin E1(Eglandin ) in Patients with Ductus Dependent Congenital Heart Disease

PURPOSE: The adverse reactions of prostaglandin E1(PGE1) are troublesome in the preoperative management of critical patients with ductus dependent congenital heart disease, and a preparation with less adverse reactions is preferable. The effects of Lipo PGE1, a new preparation of PGE1 contained in lipid microspheres, were compared with those of conventional PGE1(PGE1-CD). METHODS: Lipo PGE1 was infused at a rate of 5 ng/kg/min in 19 patients, PGE1-CD at a rate between 10 and 50 ng/kg/min in 15 patients. The effects of drugs were assessed in terms of clinical response rate and overall safety. RESULTS: Clinically, both treatment were effective in relieving cyanosis and hypoxemia except in patients already having either a closed ductus or severe hypoxemia and acidosis. The increments of PaO2 1 hour after infusion were 10.9 and 6.2 mmHg (p>0.1), respectively and those 4 hours postinfusion were 16.0 and 7.8 mmHg(p0.1), the mean dose of Lipo PGE1 at appearance of response was about 1/5 of that of PGE1-CD in overall patients and also in patients with ductus dependent pulmonary circulation(6.7 vs 31.7 ng/kg/min, p<0.005). The adverse reactions occurred in 52.6% of the patients given Lipo PGE1, while it was 86.7% in those administered PGE1-CD(p<0.05). The adverse reactions in Lipo PGE1 group was much less severe than that in PGE1-CD group. There was a significant difference in overall safety between the two drugs(84.2 vs 40%, p<0.01). As the incidence of the adverse reactions increased at dose over 5 ng/kg/min, the initial dose of 5 ng/kg/min seemed to be appropriate for Lipo PGE1. CONCLUSIONS: Lipo PGE1 was effective at a lower dose than was PGE1-CD, and was associated with fewer or less severe adverse reactions, and is therefore judged to be more suitable for clinical use than conventional PGE1-CD.

A Case of Defecation-induced Epilepsy

Defecation induced epilepsy is a very rare form of reflex epilepsy, which has not been reported yet in Korea. We experienced a case of defecation-induced epilepsy in a 10 month old boy who has been showing seizure with every defecation since 5 months of his age. Diagnosis was made by clinical history and appearance of clinical seizure with epileptiform activities in electroencephalography after glycerine enema during recording.

Clinical observation on Guillain-Barre syndrome in children

Clinical observation was performed on 23 children with Guillain-Barre syndrome which were hospitalized at the Pediatric ward of Han Yang University Hospital, from July 1975 through May 1991.@ES The results were as follows: 1) The ratio of male patient to female was 2.8:1 and 47.8% of total GBS patients were between the ages 1 to 5 years. 2) The highest seasonal incidence of GBS was seen in summer and there was no significant variation of GBS annually.3) Preceding illness of GBS was found in 60% of the total patients, and upper respiratory infection was the most common (65%). 4) Muscular paralysis or weakness in extremities was the most common chief complaints on admission, and repiratory difficulty, vomiting, diarrhea, swallowing difficulty and myalgia were followed. 5) The sites of paralysis on admission were upper and lower extremities in 14 GBS patients (60.8%), lower extremities in 7 GBS patints (34.8%) and respiratory muscle in 4 GBS patints (17.3%), respectively. 6) The protein content of cerebrospinal fluid was elevated in 18 GBS patients of total (78.3%) on admission and remnant 5 GBS patients showed increased protein later. 7) There was a tendency that recovery time in 5 GBS patients with muscular fibrillation on E.M.G. was longer than in 4 GBS patients without muscular fibrillation. We thought further studies on critical evaluation and better treatment for GBS were needed.

Comparison of tuberculin skin test results and adverse reactions following BCG vaccination in various infant groups of different ages

Most authorities including WHO recommended immununizing infants with BCG as early as possible in areas prevalent with tuberculosis, however the optimal time for immunization has not well been characterized. Therefore the investigation was undertaken by vaccinating various infant groups of different ages with BCG and subsequently evaluating for adverse effects and tuberculin reactions, in order to contribute to undestanding the optimal time for immunization. Four hundred eighty three infants from the newborn nursery and the well baby clinic of Hanyang University Hospital who had no family history of tuberculosis were divided into three groups; group I of infants immunized within 7 days after birth, group II of infants immunized at about 1 month of age and group III of infants immunized at about 3 months of age. To each infant 0.1 ml of BCG(Institute Merieux, France) was administered intradermaly and approximately 3 months later tuberculin skin test using 5 TU PPD (NIH, Korea) was performed. Adverse reactions following BCG vaccination such as temperature elevation, induration alone or with suppuration at or near the injection site, and lymph node enlargement were also analyzed. The summary of the results is as follows. 1) Distribution of diameters of induration on tuberculin skin test illustrated incomplete bimodal configuration in all three different age groups. The means 2 standard deviations of diameters of indurations distributed on the main bells were 10.07 4.52 mm in group I, 10.65 3.82 mm in group II, and 10.83 5.08 mm in group III, and were not significantly different. 2) Criteria for positive tuberculin reaction was diameters of indurations equal to or greater than 6mm, 2 standard deviations below the mean values of diameters of indurations on the main bells. 3) The positive tuberculin reaction rates of 85.8% in group II and 88.6% in group III were significantly greater than 74.1% in group I. 4) Incidence of complications following BCG vaccination including temperature elevation, induration with suppuration, and localized lymphadenopathy was not different among three groups and the serious complications such as temperature elevation and lymphadenopathy were minimal. The data indicate that it is appropriate to immunize infants with BCG at about one month of age and the incidence of complications following BCG vaccination was not different among three infant groups of different ages.

A clinical study of mycoplasma pneumonia in children during recent 5 years

No abstract available.