A Case of Solid and Papillary Epithelial Neoplasm in Head of Pancreas in a 11-year-old Female / 대한소아소화기영양학회지

Solid and Papillary epithelial neoplasm of pancreas is a rare and low grade malignant tumor. It develops in 2nd or 3rd decades of young female and located in tail of pancreas predominantly. Prognosis is good despite its various histologic features, which suggest a malignant appearance. We report one case of solid and papillary epithelial neoplasm in head of pancreas in a 11-year-old girl who had been suffered from vomiting and right upper abdominal pain for 3 weeks.

Clinical Evaluation of Diagnostic Criteria for Early Prediction of Bacterial Infection in Febrile Neonates

PURPOSE: A retrospective study was undertaken to test the hypothesis that febrile neonates, who have bacterial infections, can be accurately predicted early by diagnostic criteria. METHODS: We conducted a retrospective study of 152 infants, 28 days or less of age, whose rectal temperature was at least 38degrees C. Past history, family history, finding on physical examinations and results of CBC, urinalysis, lumbar puncture, CRP, and cultures of blood, urine and CSF were recorded. The diagnostic criteria for bacterial infection were : presence of identifiable fever focus(skin, soft tissue, bone, joint, eyes, ears), presence of maternal risk factors(malnutrition, fever, infection, premature rupture of membrane) & neonatal risk factors(prematurity, SGA), unhealthy condition at physical examinations, neutrophil index(immature neutrophil count/total neutrophil count ratio)> OR =0.15 and CRP> OR =2.0mg/dL, urinalysis-> OR =5 WBC/high-power field, absence of upper respiratory tract illness in parent and contact people. Febrile neonates who meet any of the diagnostic criteria were considered as high risk for bacterial infection. RESULTS: The overall incidence of bacterial infections in the 152 febrile neonates was 13.8%(21 neonates) with urinary tract infections in 8 neonates, bacteremia in 8 neonates and meningitis in 5 neonates. Only 1 neonate, who was classified as low risk for bacterial infection, was identified with a bacterial urinary tract infection. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic criteria were 95.2, 92.4, 66.7 and 99.2%, respectively. CONCLUSION: These data show the ability of diagnostic criteria to identify neonates with bacterial infection. Febrile neonates who meet the diagnostic criteria must be treated intensively and those who do not meet the diagnostic criteria can be carefully managed as inpatients or outpatients without administering antimicrobial agents, avoiding iatrogenic complications.

Clinical Evaluation of Diagnostic Criteria for Early Prediction of Bacterial Infection in Febrile Neonates

PURPOSE: A retrospective study was undertaken to test the hypothesis that febrile neonates, who have bacterial infections, can be accurately predicted early by diagnostic criteria. METHODS: We conducted a retrospective study of 152 infants, 28 days or less of age, whose rectal temperature was at least 38degrees C. Past history, family history, finding on physical examinations and results of CBC, urinalysis, lumbar puncture, CRP, and cultures of blood, urine and CSF were recorded. The diagnostic criteria for bacterial infection were : presence of identifiable fever focus(skin, soft tissue, bone, joint, eyes, ears), presence of maternal risk factors(malnutrition, fever, infection, premature rupture of membrane) & neonatal risk factors(prematurity, SGA), unhealthy condition at physical examinations, neutrophil index(immature neutrophil count/total neutrophil count ratio)> OR =0.15 and CRP> OR =2.0mg/dL, urinalysis-> OR =5 WBC/high-power field, absence of upper respiratory tract illness in parent and contact people. Febrile neonates who meet any of the diagnostic criteria were considered as high risk for bacterial infection. RESULTS: The overall incidence of bacterial infections in the 152 febrile neonates was 13.8%(21 neonates) with urinary tract infections in 8 neonates, bacteremia in 8 neonates and meningitis in 5 neonates. Only 1 neonate, who was classified as low risk for bacterial infection, was identified with a bacterial urinary tract infection. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic criteria were 95.2, 92.4, 66.7 and 99.2%, respectively. CONCLUSION: These data show the ability of diagnostic criteria to identify neonates with bacterial infection. Febrile neonates who meet the diagnostic criteria must be treated intensively and those who do not meet the diagnostic criteria can be carefully managed as inpatients or outpatients without administering antimicrobial agents, avoiding iatrogenic complications.

An Analytic Study for Incidence of Childhood Leukemia in Pusan City, Korea / 대한소아혈액종양학회지

BACKGROUND: Cancer is the second cause of childhood death following accident, and leukemia is the most frequent childhood cancer in Korea. For the desirable control of childhood leukemia, of which the mortality is still high, the basic data for the incidence has a great importance. This is the second report from the data during 1991~1995 following the first one that analyzed the data from 328 cases of childhood leukemia during 1981~1990 in the same area, Pusan city, Korea. METHODS: The data were obtained from 138 new cases(84 males and 54 females from 0 to 15 years old) of childhood leukemia who had been living in the city of Pusan and were admitted to the 4 university hospitals and 11 general hospitals from 1991 to 1995. The cases were confirmed by CBC and bone marrow examination. RESULTS: The crude annual incidence rate per 100,000 population varied 1.50~5.30, 2.59~6.00 and 1.58~2.61 in the age group of 0~4 years, 5~9 years and 10~14 years, respectively. The standardized annual incidence rate per 100,000 population varied from 2.05 to 3.46(male 2.96~4.89, female 0.98~3.57). Sex ratio(male to female) was 1.58:1, 1.44:1, and 1.82:1 in total cases, ALL and AML, respectively, while incalculable in CML. By the major types of childhood leukemia, the cases were composed of 105 ALL (76.1%), 31 AML(22.5%), 2 CML(1.4%). CONCLUSION: It was concluded that the annual incidence rate of childhood leukemia per 100,000 population in Pusan city during 1991~1995 was similar to that of previous report during 1981~1990, while the proportion of ALL had tendency to increase up to that of United States, in contrast to the low proportions of ALL in the previous reports.

Optimal Number of Blood Cultures and Volume of Blood Needed to Detect Bacteremia in Children

PURPOSE: We compared pathogen recovery rates by obtaining two blood cultures instead of one blood culture containing 1ml and collecting a larger volume, 1 to 3ml. METHODS: Total of 750 blood specimens from 250 patients with fever, a temperature higher than 39degrees C and suspected bacteremia were obtained. Each patient had two samples of blood, A (1ml) and B (4ml), obtained at 30-minute interval from separate sites of extremities and B was divided into B1 (1ml) and B2 (3ml). Each sample was inoculated into aerobic culture media. Patients were excluded if two samples of blood were not obtained or if the isolate represented a contaminant. RESULTS: A pathogen was isolated in 19 (7.6%) of 250 patients and 37 (4.9%) of 750 specimens. In 7 patients, the pathogen was isolated with all the culture methods and in 12 patients, one or more of the cultures yielded no growth. The pathogen recovery rates were 53% (10/19) in A and B1, 89% (17/19) in B2 and 68% (13/19) in A+B1. No difference was detected between A or B1 and A+B1 (P>0.05) and the pathogen recovery rate for B2 was significantly greater than that for A or B1 (P<0.05), but no significant differences were found in pathogen recovery when B2 was compared with A+B1. CONCLUSION: Increasing volume of blood from 1 to 3ml inoculated into blood culture bottles improves detection of bacteremia in pediatric patients and spares patients the cost and pain of an additional venipuncture.

Optimal Number of Blood Cultures and Volume of Blood Needed to Detect Bacteremia in Children

PURPOSE: We compared pathogen recovery rates by obtaining two blood cultures instead of one blood culture containing 1ml and collecting a larger volume, 1 to 3ml. METHODS: Total of 750 blood specimens from 250 patients with fever, a temperature higher than 39degrees C and suspected bacteremia were obtained. Each patient had two samples of blood, A (1ml) and B (4ml), obtained at 30-minute interval from separate sites of extremities and B was divided into B1 (1ml) and B2 (3ml). Each sample was inoculated into aerobic culture media. Patients were excluded if two samples of blood were not obtained or if the isolate represented a contaminant. RESULTS: A pathogen was isolated in 19 (7.6%) of 250 patients and 37 (4.9%) of 750 specimens. In 7 patients, the pathogen was isolated with all the culture methods and in 12 patients, one or more of the cultures yielded no growth. The pathogen recovery rates were 53% (10/19) in A and B1, 89% (17/19) in B2 and 68% (13/19) in A+B1. No difference was detected between A or B1 and A+B1 (P>0.05) and the pathogen recovery rate for B2 was significantly greater than that for A or B1 (P<0.05), but no significant differences were found in pathogen recovery when B2 was compared with A+B1. CONCLUSION: Increasing volume of blood from 1 to 3ml inoculated into blood culture bottles improves detection of bacteremia in pediatric patients and spares patients the cost and pain of an additional venipuncture.

A Case of Congenital Hyperextension of the Knee

Congenital dislocation of the knee is a very rare condition and was first described by Chatelaine in 1822. The etiology of this condition is unknown. It is generally subclassified as simple hyperextension, subluxation, and dislocation, depending on the degree of the joint displacement and the severity of disease. There are a large of associated conditions that have been described, the most common of which are congenital dislocation of the hip, club foot, arthrogryposis, and Larsen's syndrome. The mainstay of treatment is early serial rnanipulation and splinting. Operative treatment was indicated whenever conservative treatment did not lead to satisfactory reduction. The authors experienced a case of congenital hyperextension of left knee associated with the calcaneovalgus deformity of both foot. Early closed treatment obtanied a successful reduction and satisfactory knee motion.

A Case of Hematemesis Due to Errosive Gastritis and Reflux Esophagitis in a 1 Day of Life

Hematemesis is not infrequent occurences in the neonatal period. Physician's first task is to determine whether this blood is maternal in origin or whether the infant is bleeding internally. Fetal blood indicates one of a variety of lesions and its source may be difficult to determine. The causes are esophagitis, peptic ulcer of the stomach or duodernum, hemorrhagic disease and pulmonary hemorrhage etc. We have experienced a case of massive hematemesis that occured in a 1 day of life. we conducted 24 hour pH monitoring, upper gastrointestinal barium series, and endoscopy with biopsy. this case showed esophagitis due to gastroesohageal reflux and errosive gastritis by above procedures. If there is hematemesis during the neonatal period, the esophagitis and gastritis should be considered.

Two Cases of Congenital Atrichia Associated with the Gastrointestinal Anomaly in Siblings

Congenital atrichia is an anomaly characterized by congenital absence of hair in varying degrees as well as the ypopigmentation & poor development of the abnormal residual hair on the scalp, eyebrows, eyelashes & body. Two cases of congenital atrichia in siblings were reviewed. The first case was associated with congenital megacolon and skin biopsy of scalp (esp. parietal region) was non-specific. The second case was associated with bilateral inguinal hernia. Congenital atrichia is inherited by autosomal dominant or recessive. Acording to the limited pedigree data, our cases were X-linked recessive inheritance We report these cases with a review of related literatures.

Two Cases of Congenital Atrichia Associated with the Gastrointestinal Anomaly in Siblings

Congenital atrichia is an anomaly characterized by congenital absence of hair in varying degrees as well as the ypopigmentation & poor development of the abnormal residual hair on the scalp, eyebrows, eyelashes & body. Two cases of congenital atrichia in siblings were reviewed. The first case was associated with congenital megacolon and skin biopsy of scalp (esp. parietal region) was non-specific. The second case was associated with bilateral inguinal hernia. Congenital atrichia is inherited by autosomal dominant or recessive. Acording to the limited pedigree data, our cases were X-linked recessive inheritance We report these cases with a review of related literatures.

Clinical Study of Mother's Awareness Related to the Treatment of Febrile Convulsion

We carried out survey on difference in awareness by age bracked and educational level of 182 mothers including their family history for the treatment of febrile convulsion, who had visited the emergency room and OPD of pediatrics, Dae Dong Hospital in Pusan, Korea, during the period from January, 1992, to December, 1992. The results were as follows: 1) The proportion of male and famale febrile convulsion patients was 1.5:1, and the distribution of patients in order of age was in the following; 81 cases(44.5%) of patients having the highest proportion between 1 to 2 years, 41 cases(22.5%) under 1 year, 35 cases (19.3%) between 3 to 5 year and 25 cases(13.7%) over 5 years. 2) The number of 110 cases(60.4%) were carries out by folk remedy, and 72 cases(39.6%) by medical treatment, for the method of treating febrile convulsion, thus folk remedial method being higher than medical treatment. Folk remedy was in the order of "needle picking", "massage", "acupuncturing" and "visit to herb store", and medical treatment was in the order of "visit to hospital", "taking of antipyretics", and "cold compress pad". 3) In comparison of treatment method according to age bracket of mothers of the patients, as the age of mothers of febrile convulsion patients become lower, patients were treated by folk remedy(p0.05). 5)In comparison of treatment method according to family history of mothers of the patients, no proportional difference in folk remedy and medical treatment was found(p>0.05).

Comparison of Therapeutic Result of Oral Corticosteroid Versus Intravenous Gammaglobulin in Childhood Acute ITP

A clinical study was conducted to compare effectiveness of IV Globulin with that of steriod in childhood acute ITP. We carried out an experiment to 36 patients of acute ITP who recovered over 50.000/mm(3) of platelet count and not to recur in 6 months. Study group consist of 10 children who were treated with steriod only (Group A), 13 children who were treated with IV Globulin (0.4g/kg/d, 5 days, Group B), and 13 children combined with steroid (Group C) Study period was from January 1988 to December 1992, folllowing results were obtained. 1) There were no significant difference in sex ratio. age distribution, pretreatment hemoglobin level, platelet count and prolonged bleeding time among study groups. 2) The days which platelet count reached to 50.000/mm(3), 100,000/mm(3) were 3.7 days (Group A), 2.1 days (Group B), and 2.3 days (Group C), respectively (p<0.05). 3) Complete response rates within 4 weeks did not show significant difference (90% in Group A, 84.6% in Group B, 92.3% in Group C), the complete response rate within 1 week were significantly different among three group (44.4% in Group A, 90.9% in Group B, 83.3% in Group C)(p<0.05). In conclusion, it is more desirable for early treatment of a childhood ITP because IV Globulin is easy to normalize platelet count in a short time.

A case of aplasia cutis congenita associated with epidermolysis bullosa

Alpasia cutis congenita is an anomaly characterized by absence of localized areas of the integument. The most common type of aplasia cutis congenita is Aplasia cutis congenita limited to the scalp, although other areas of the body may also be involved. We experienced a case of aplasia cutis congenita in a male newborn infant. The skin defects were extensive with symmetrical involvement of lower extremities. The multiple bullae were found on the both fingers and toes. No similar conditions and other associated congeital anomalies were found in the family membes of this particular case. The light microscopic examinaton of the denuded skin areas how absence of epidemis and the demis contain atrophic and hypoplastic adnexa. The bullae have a split within the dermis below lamina densa on electron microscopy. The skin defects were healed by supportive therapy for 4weeks.

A study of serum transaminase level and it's correlation with several symptoms in children with HRV gastroenteritis

The retrospective study was taken to study the serum transaminase level and it's correlation with several symptoms in human rotavirus gastroenteritis. 494 children, who admitted to the Department of Pediatrics in Dae Dong Hospital from January 1991 to December 1991 with chief complaints of waterdy diarrhea were included in studies. The 1st stool specimen on admission was tested for rotavirus Ag by ELLSA method. and than serum transaminase were checked. The results are as follows: 1) The peak incidence being between 6 months to 2 years in both group, but higher incidence was noted in Non-HRV group. Males are more common than females by ratio of about 2:1. 2) The major symptoms in order of frequency was diarrhea>dehydration>vomiting>coughing>fever in HRV group, diarrhea>dehydration=vomiting>fever>coughing in Non-HRV group. The incidence of dehydration and coughing in HRV group were higher than in Non-HRV group. 3) AST & ALT elevation above the normal value were 83.2% (213/256), 52.0% (133/256) in HRV group and 45.3% (116/238), 22.3% (57/238) in Non-HRV group. AST & ALT were significantly increased in HRV group than Non-HRV group (AST: p0.05, Non-HRV group: p>0.05). 6) Duration of diarrhea for 4-5 days & 1-3 days were relatively more common in HRV group than Non-HRV group. The frequency were 36.3% (93/256) in HRV group and 34.9% (83/268) in Non-HRV group. The degree of diarrhea were not correlated with serum transaminase level at each group (HRV group: p>0.05, Non-HRV group: p>0.05). 7) No fever or duration of fever for 1-2 days were relatively more common in both group. The frequency were 39.9% (102/256), 37.5% (96/256) in HRV group and 38.2% (91/238), 42.5% (101/238) in Non-HRV group. The degree of fever was not correlated with serum transaminase level in HRV group, but correlated with Non-HRV group (HRV group: p>0.05, Non-HRV group: p<0.05).

A clinical and statistical analysis on acute appendicitis in children

No abstract available.

Morphological Observations on the Hair Development of Human Fetal Skin

The developing process of the hair of the fetal skin was studied. The ages of 103 human embryos and fetuses ranged from 4 to 40 gestation weeks. Ten different sites were selected, i.e., scalp, forehead, cheek, chest, abdomen, back, palm, sole, finger and toe. For the embryos 3 sites were studied, i.e., cephalic, trunk, and caudal portions. Following results were made: 1) The primitive hair germ was first noted the 10th week in the face skin as nubbins of mesenchymal cells beneath discrete foci of crowdes, elongated germinative epithelial cells. The developing hair germs and hair pegs were observes at the cephalic portion by 11 weeks. At 15 weeks the hair pegs including hair germs were noted in the trunk skin. The bulbous hair peg stage started at the 16th week in the cephalic portion and at the 18th week in the trunk. 2) Relative number of fetal hairs progressively increase up to 20 weeks of gestation but, thereafter decreased although it was different by the site of the body. 3) The diameter of fetal hair follicles increased with fetal age to the term with slight difference by the portion of body. 4) The developmental process of hair was more rapid in the cephalic portion than the trunk in views of morphologic changes of the hair structures, number and diameter of hair follicles.