Decreased heart sound in a healthy newborn: Spontaneous multiseptated cystic pneumomediastinum with delayed respiratory distress / 소아과

Spontaneous pneumomediastinum in the absence of predisposing risk factors has been rarely observed in full-term neonates. A 3-day-old neonate, delivered vaginally at term without any perinatal complications or signs of respiratory difficulty, was referred to the Seoul National University Children's Hospital because of reduced heart sound detected during routine neonatal examination. Chest computed tomography (CT) showed air collection in the anterior mediastinum. The baby developed respiratory distress on the fourth day and required supplemental oxygen. On the seventh day, there was no sign of respiratory difficulty, and x-ray examination showed no demonstrable pneumomediastinum. Hence, careful neonatal physical examination is essential during the postnatal assessment of newborns, and spontaneous pneumomediastinum should be considered when a healthy newborn presents with reduced heart sound.

Granulocytic Sarcoma in the Head and Neck: CT and MR Imaging Findings

OBJECTIVES: To evaluate characteristic computed tomography (CT) and magnetic resonance (MR) imaging findings of granulocytic sarcomas of the head and neck. METHODS: The CT (n=11) and MR (n=1) images obtained from 11 patients (7 males and 4 females; mean age, 23.5 yr; age range, 1 to 69 yr) with histologically-proven granulocytic sarcomas of the head and neck were retrospectively reviewed. Histological confirmation was done by bone marrow biopsy in 9 patients, and/or local biopsy in 4 patients. The imaging findings were analyzed with particular attention to location, size, shape, margin, bone destruction, internal architecture, pattern and degree of enhancement, and multiplicity of the lesions. RESULTS: The masses were most commonly located in the orbital cavity (n=8); other locations included lymph nodes (n=5) and palatine/pharyngeal/lingual tonsils (n=3). The mass sizes varied from a mean diameter of 1.3 to 5.8 cm (average, 2.6 cm). Multiple lesions were found in 6 patients. The shapes of the tumors were ovoid in 12 patients and irregular in 4 patients. Most lesions had poorly-defined margins (13/16) and invaded adjacent bony structures (5/16). On the pre-contrast CT images, the masses were iso- (5/8) or low-density (3/8) in comparison with muscle. The MRI, which was obtained in one patient in this study, showed that the mass was iso-signal intensity on T1-weighted images and iso-signal intensity on T2-weighted images compared to the gray matter of the brain. On the post-contrast CT images, there was homogenesous (n=12) or heterogeneous (n=4) enhancement, with mild (n=10), moderate (n=4), and marked (n=2) enhancement in the solid portions of the lesions. CONCLUSION: Although rare, granulocytic sarcomas arise in various locations in the head and neck area (most commonly in the orbit) in the form of well-demarcated, and mildly- and homogenously-enhancing masses with adjacent bony invasion.

A Case of Metastatic Signet Ring Cell Carcinoma ofthe Colon in a Child / 대한소아소화기영양학회지

Colorectal carcinomas are extremely rare in childhood and adolescence; however, the colon is the most common site of a gastrointestinal carcinoma. Mucin secreting adenocarcinomas with signet ring formation is the most common type of colon cancer identified in children. An 11-year-old boy had abdominal pain and weight loss for three months, back pain and left thigh pain for two months, and hematochezia for four days. Colonoscopy showed an annular mass in the sigmoid colon and the histopathology revealed a signet ring cell carcinoma. A metastatic signet ring cell carcinoma was suspected from the findings of the bone scan, and confirmed later by a left scalp mass incisional biopsy and a bone marrow biopsy. We report a case of a metastatic signet ring cell carcinoma of the colon in a child.

Serologic and Genetic Characterization of Hantavirus from Apodemus Mice Captured in Kyonggi - do and Gangwon - do , 2001

Hantaan virus is widely distributed in Korea and has been known to cause hemorrhagic fever with renal syndrome (HFRS). Hantaviruses are carried by numerous rodent species throughout the world. Especially, the striped field mice, Apodemus agrarius, is natural host for Hantaan virus in Korea. In this study, a total 105 wild rodents of 3 species (101 of Apodemus agrarius, 2 of Eothenomys regulus, and 2 of Mus musculus) were trapped in Kyonggi and Gangwon provinces for April to June, 2001 to study serologic and genetic characterization. 8 Apodemus agrarius (7.9%) were immunofluorescent antibody (IFA) positive against Hantaan virus and Hantaan virus genome was found in 5 among 8 seropositive rodents. S gene of isolated Hantaan virus genome was amplified and directly sequenced. Based on 917 bases of S gene (411-1327 bases), 2001 Korean isolates showed 94.8% to 95.5% nucleotide homologies in comparison with prototype Hantaan virus 76-118 which was isolated from Apodemus agrarius in Korea, 1976. The partial M gene (1969-2240 bases) showed 94.1% to 100.0% nucleotide homologies in comparison with 76-118 strain. In phylogenetic analysis, 2001 Korean isolates made the distinct cluster. Therefore, Hantaan viruses isolated in 2001 were not significantly chinged in genetic level comparison with previous isolate from Korea.

High-Resolution Computed Tomography(HRCT)Findings of the Lung in Asthmatic Children and Their Correlation with Clinical Characteristics

PURPOSE: The purposes of this study were to determine the abnormal high-resolution computed tomography(HRCT) findings of the lung in uncomplicated asthmatic children, to compare the clinical characteristics between normal and abnormal HRCT finding groups and to correlate abnormal HRCT findings with clinical characteristics, especially FEV1 and PC20. METHODS: Forty asthmatic children were studied. Inspiratory and expiratory HRCT scans were performed on all patients. Pulmonary function tests and methacholine challenge tests were done and total eosinophil counts and total IgE level were checked during the symptom-free period. According to the presence of abnormality in HRCT findings, the subjects were divided into two groups : Normal and abnormal HRCT finding group. Clinical characteristics, severity of asthma, FEV1 and PC20 were compared between the two groups. RESULTS: Abnormal HRCT findings were air trapping, fibrosis, bronchial dilatation, and bronchial wall thickening. Air trapping was the most prevalent finding(50%). Significant differences in total IgE level(P< 0.05), severity of asthma(P< 0.05), FEV1(P< 0.05) and PC20(P< 0.05) were found between patients with abnormal HRCT findings and those with normal HRCT findings. Air trapping scores were significantly correlated with FEV1(r=-0.469, P< 0.05) and PC20(r=-0.315, P< 0.05). CONCLUSION: Air trapping was detected in 50% of uncomplicated asthmatic children and air trapping scores were correlated well with the extent of airflow obstruction and the degree of airway hyperresponsiveness. Our data suggest that the extent of air trapping found on HRCT scans reflects the severity of asthma and airway hyperresponsiveness in asthmatic patients.