The Change in Intestinal Lactobacillus Count among Healthy Neonates / 소아과

PURPOSE: Enhancing overall health by preventive and therapeutic use of probiotics has shown great promise on inflammatory, infectious, neoplastic disorders, allergies, et al. To attain preliminary data for the use of probiotics, we have studied the change in intestinal flora, Lactobacillus count among healthy, full term neonates. METHODS: Fresh stool samples were collected on the 2nd or 5th day of life in forty healthy full term neonates born at Ewha Womans University Hospital. Geographic factors, feeding type and gastrointestinal manifestations such as vomiting or diarrhea were recorded. Stool samples were innoculated for 48 hours in a Lactobacillus selective media in anaerobic conditions at 37degrees C, and the Lactobacillus colonies were counted. RESULTS: The lactobacillus colony count(LCC) was significantly higher in the exclusively breast milk fed neonates than those fed with a mixture of breast milk and formula(P=0.0017). LCC was significantly higher in the stool samples collected on the 5th postnatal day than the 2nd postnatal day(P= 0.0059). There were no significant differences in the LCC by sex or delivery type, and there were no significant correlations in the LCC according to the gestational age, birth weight, frequency of breast feeding, amount of milk feeding or frequency of defecation. CONCLUSION: These results suggest that breast feeding provides a more favorable environment than mixed feeding with formula for the Lactobacillus growth, and LCC increases with time after birth. Considering the fact that one of the main causes of necrotizing enterocolitis is the disruption of intestinal normal flora, the result of this study can be used as a preliminary data for investigating the effect of probiotics in neonates.

The Diagnostic Value of 99mTc DMSA Renal Scan SPECT Images in Addition to Planar Image in Children with Urinary Tract Infection

PURPOSE : 99mTc DMSA renal scan have been widely used not only for the evaluation of renal scars but also for the diagnosis of acute pyelonephritis. Recent studies have shown SPECT images have higher accuracy than the planar images with some controversy. We evaluated the availability of the SPECT images adding to planar images for the diagnosis of acute pyelonephritis(APN) and renal scar in children with urinary tract infection (UTI). METHODS : 130 children with UTI (260 kidney units) and 22 follow-up children (44 kidney units) were included between January 1, 1997 and July 31, 1999 at Ewha University Mokdong Hospital. Planar Anterior and posterior images and SPECT axial and coronal images of 99mTc DMSA renal scan were obtained with Starcam 4000-i U.S.A. GE at 3 hours after 99mTc DMSA I.V. injection. The data were analyzed by Chi square test after Yates's correction. RESULTS : The detection rate of the acute pyelonephritis by SPECT images was 12.3% higher than that of planar images (47.7% vs 35.4%) by the patient and 6.9% higher also (31.9% vs 25.4%) by the kidney unit. 18 kidney units with negative planar images had focal defect in 10 kidney units (3.8%) and multifocal defect in 8 kidney units (3.1%) on SPECT images, but 1 kidney unit with positive planar image had negative SPECT image. SPECT images were superior to the planar images in 17.3%, identical in 82.3% and inferior in 0.4% to planar image. The detection rate of the renal scars by SPECT images was 13.7% higher than planar images by the patient (68.2% vs 54.5%) and 6.8% higher also (43.2% vs 36.4%) by the kidney unit. SPECT images were superior to the planar images in 17.3% and identical in 82.3% to planar image. CONCLUSION : SPECT images had shown higher detection rate and better image than planar images for the diagnosis of the acute pyelonephritis and the evaluation of the renal scars.

Infantile hemangioendothelioma treated with high dose methylprednisolone pulse therapy

Infantile hemangioendothelioma is a severe disease with a high mortality. It is characterized by multiple hemangioma affecting the skin and visceral organs. We report that high doses of methylprednisolone pulse therapy improved symptoms and signs of infantile hemangioendothelioma in a male neonate, and completely resolved the hepatic and cutaneous hemangioendothelioma on follow up.

Risk Factors of Primary Nocturnal Enuresis

Urinary cytology has become an essential element in the diagnosis and management of transitional cell carcinoma(TCC) of the urinary tract. It has the advantage of being noninvasive, inexpensive, and easily accessible. Besides that it can even detect malignancy when unsuspected at cystoscopy. We report a retrospective review of urine cytology in the diagnosis of 83 TCC cases that underwent 295 cytologic evaluation. All patients had biopsy-proven TCC of the bladder, ureter and renal pelvis. The overall inci- dence of the positive cytology cases was 66.2%. To define the cytologic features of tumor cells, we tried to use three cytologic gradings such as "grade 1", "grade 2", and "grade 3" according to the cytologic degree of anaplastic neoplastic cells. These cytologic gades of TCC were relatively well correlated with the histologic grade and tumor invasiveness. This result suggests that the recognition of characteristic cellular features of TCC can suspect the histologic grade and tumor stage. The false negative TCC cases were 78.9%. They showed severe inflammatory or bloody background and a few neoplastic cells. Therefore, a cautious approach for accurate interpretation, personal experience, and proper fixation and processing could expand the role of urinary cytology.

Renal Toxicity of High-dose Intravenous Immunoglobulin in Children with Kawasaki Disease and Idiopathic Thrombocytopenic Purpura

We describe a case of fine needle aspiration cytology of metastatic nasopharyngeal carcinoma in the lymph node of the neck presenting a predominantly spindle cell pattern. A 36 year-old male patient complained of dysesthesia on the right face and a palpable neck mass. Fine needle aspiration was done on the neck mass. Tumor cells were present in syncytial groups or singly with mainly spindle shaped nuclei, vesicular chromatin, thin and regular nuclear membrane, occasional prominent nucleoli and a few foci of cellular cohesiveness. The cytoplasm was scant and pale with ill-defined borders. Mature lymphocytes were present in the background of aspirates and within the tumor cell clusters. Histologically, the tumor of nasopharynx showed several areas of spindle cell pattern. Because the tumor cells showed a predominantly spindle shape with vesicular nuclear chromatin, the differential diagnosis of spindle cell sarcoma or granuloma of epithelioid cells were considered, but the characteristic morphology of the nuclei with vesicular chromatin and prominent nucleoli, and cellular cohesiveness were important in making the diagnosis of nasopharyngeal carcinoma. The possibility of metastatic carcinoma should always be considered in fine needle aspiration cytology of the lymph node in the neck because the incidence of metastatic carcinoma, particularly of the nasopharyngeal carcinoma in the lymph nodes of the neck is relatively high.

Diagnostic Value of Dipstick Urinalysis (Leukocyte Esterase and Nitrite) as a Screening Test for Urinary Tract Infection in Acute Febrile Children

Fine-needle aspiration (FNA) biopsy has become the procedure of choice for initial diagnosis of adrenal masses. However, there have been relatively few reports discussing the FNA cytologic features of adrenal cortical carcinoma. Recently, we experienced a case of FNA cytology of bilateral adrenal cortical carcinoma in a 61-year old man. The smear revealed loosely cohesive pleomorphic tumor cells with hemorrhagic and necrotic background. The tumor cells showed oval to spindle hyperchromatic nuclei and prominent nucleoli with frequent mitotic figures. The cytoplasm of tumor cells was relatively abundant and sometimes vacuolated. These cytologic findings were interpreted as an adrenal cortical carcinoma, undifferentiated pattern.

The Diagnostic Value of CSF Tumor Necrosis Factor-alpha for Early Diagnosis of Bacterial Meningitis

PURPOSE: During the course of bacterial meningitis, TNF-alpha produced by macrophages and monocytes in response to LPS and other inflammatory and immune stimulation, is now recognized as a primary mediator in the pathogenesis of infection, injury and inflammation and in the process of host defence. TNF-alpha was increased vascular permeability by inducing morphologic and structural changes of endothelial cells by a direct toxic effect. The authers observed the concentration of CSF TNF-alpha, which was useful or not to differentiate bacterial meningitis from viral meningitis. METHODS: In 57 children with meningitis (10 bacterial meningitis, 47 viral meningitis) were studied, at Ewha Womans University Hospital from Jan. 1995 to Oct. 1995. In the time of diagnosis, chemistry, smear, culture, latex agglutination test, TNF-alpha of CSF were checked. In bacterial meningitis, Follow up spinal tapping was performed 48 hours, 1 week after treatement, in viral meningitis, follow up was performed 2 to 7 days after treatement. RESULTS: The positive rate of CSF TNF-alpha and mean concentration of CSF TNF-alpha were significantly different between two groups (bacterial meningitis : 90% (9/10), 1026 +/- 390.1pg/mL vs. viral meningitis : 6.3% (3/47), 12.6 +/- 61.9pg/mL) (P<0.01). Positive rate of the concentration of CSF TNF-alpha in the group of bacterial meningitis was changed 90% at pretreatement period, 80% at 48 hours after treatement, 10% at 7days after treatement. Changing of positive rate by the diagnositic method, the positive rate of culture of CSF was 10%, gram smear was 40%, latex agglutination was 50% at 48 hours after treatement. CONCLUSION: The concentration of CSF TNF-alpha was rapid and sensitive method of differentiation between bacterial meningitis and viral meningitis, which was reduced the use of excessive antivbiotics.

The Diagnostic Value of CSF Tumor Necrosis Factor-alpha for Early Diagnosis of Bacterial Meningitis

PURPOSE: During the course of bacterial meningitis, TNF-alpha produced by macrophages and monocytes in response to LPS and other inflammatory and immune stimulation, is now recognized as a primary mediator in the pathogenesis of infection, injury and inflammation and in the process of host defence. TNF-alpha was increased vascular permeability by inducing morphologic and structural changes of endothelial cells by a direct toxic effect. The authers observed the concentration of CSF TNF-alpha, which was useful or not to differentiate bacterial meningitis from viral meningitis. METHODS: In 57 children with meningitis (10 bacterial meningitis, 47 viral meningitis) were studied, at Ewha Womans University Hospital from Jan. 1995 to Oct. 1995. In the time of diagnosis, chemistry, smear, culture, latex agglutination test, TNF-alpha of CSF were checked. In bacterial meningitis, Follow up spinal tapping was performed 48 hours, 1 week after treatement, in viral meningitis, follow up was performed 2 to 7 days after treatement. RESULTS: The positive rate of CSF TNF-alpha and mean concentration of CSF TNF-alpha were significantly different between two groups (bacterial meningitis : 90% (9/10), 1026 +/- 390.1pg/mL vs. viral meningitis : 6.3% (3/47), 12.6 +/- 61.9pg/mL) (P<0.01). Positive rate of the concentration of CSF TNF-alpha in the group of bacterial meningitis was changed 90% at pretreatement period, 80% at 48 hours after treatement, 10% at 7days after treatement. Changing of positive rate by the diagnositic method, the positive rate of culture of CSF was 10%, gram smear was 40%, latex agglutination was 50% at 48 hours after treatement. CONCLUSION: The concentration of CSF TNF-alpha was rapid and sensitive method of differentiation between bacterial meningitis and viral meningitis, which was reduced the use of excessive antivbiotics.

Comparison of Diagnosteic Value between the Absolute and Relative Uptake Rates on 99mTc- DMSA Renal Scan of Chhildren with Febrile Urinary Tract Infection

The fluoroscopy-guided fine needle aspiration biopsy has been gaining widespread acceptance as a rapid and effective method to make a pre-operative diagnosis of mediastinal tumors including thymoma, malignant lymphoma, and metastatic carcinoma. Although thymoma is a most common tumor of the superior mediastinum, most cytopathologists are not experted in cytologic diagnosis of this tumor because of limited experience. In order to define the diagnostic cytologic features of thymoma, we have retrospectively reviewed imprinting smears and corresponding tissue sections from four cases of this tumor. All cases revealed an apparent biphasic pattern of epithelial cell clusters and lymphocytes with occasional branching capillary fronds extending from three dimensional epithelial cell clusters. Epithelial cell clusters predominated in one case and lymphocytes in two cases. Mixed epithelial cell and lymphocyte type represented in one of four cases. In the lymphocyte predominant type, the presence of epithelial cell clusters and small mature lymphocytes are helpful features to differentiate from a malignant lymphoma.

Arterial Oxygen Desaturation after Salbutamol Nebulization in Wheezy Infants and Children

PURPOSE: Nebulized selective beta2-adrenoreceptor agonists have been widely used in acute asthma and selectively in acute bronchiolitis. However, nebulized salbutamol have been reported to cause arterial oxygen desaturation in some of the acute bronchiolitis and severe asthma patients. This may be the results of a paradoxical bronchoconstriction linked to acidic and hyper-osmolar nebulized salbutamol solution and etc. We assessed the changes in arterial oxygen saturation by percutaneous pulse oxymeter during and after nebulization of salbutamol solution and compared the effect of 100% oxygen with the compressed air as a driving gas. METHODS: This study was performed in 80 mild to moderate wheezy children(bronchiolitis 51, asthma 29) who were admitted to Pediatrics department of of EWHA from January 1992 to October 1993. The study children are randomly assigned to be nebulized by compressed air or 6l/min of 100% oxygen as a driving gas. The arterial oxygen saturation, wheeze score, retraction score, and heart rate were recorded before nebulization, post-nebulization, 5, 10, 15 and 30minutes. RESULTS: 1) Arterial oxygen saturation decreased significantly at post-nebulization five minutes only in bronchiolitis, treated with salbutamol nebulization without oxygen(p0.05). 2) Wheeze score decreased significantly at post-nebulization 5-30minutes in asthma but not in bronchiolitis whether nebulized salbutamol with or without oxygen(p0.05). CONCLUSIONS: Significant fall in arterial oxygen saturation was noted only in bronchiolitis treated with salbutamol nebulization without oxygen. In bronchiolitis, oxygen (6l/min) is better than compressed air as a driving gas during salbutamol nebulization to prevent hypoxemia.

Two Cases of Pseudohypoaldosteronism Type I

Pseudohypoaldosteronism type 1 is a genetic renal tubular disease of salt wasting, presenting in young infants. Tubular unresponsiveness to elevated endogenous and exogenous aldosterone is the suggested pathogenetic mechanism. Oral sodium chloride supplementation relieve the clinical symptoms and electrolyte distrubances. We experienced 2 cases of PHA type 1 in 38-day and 45-day old male infants who were presented with failure to thrive, vomiting and/or dehydration. Laboratory data showed hyponatremia, hyperkalemia, hypochloremia and metabolic acidosis. Renal and adrenal functions were normal. Plasma renin activity and plasma aldosterone concentration were markedly elevated. Under the diagnosis of pseudohypoaldosteronism type 1, oral supplementation of NaCl and/or kayexalate improved the clinical states of the patients.