Congenital Cystic Adenomatoid Malformation of the Lung: Analysis of 17 Cases / 소아알레르기및호흡기학회지

PURPOSE: Congenital cystic adenomatoid malformation of the lung(CCAM) is characterized by an excessive overgrowth of terminal bronchiolar-type structures with a lack of mature alveoli. This study was performed to evaluate the manifestation among different pathologic classification. METHODS: Seventeen patients admitted to the Samsung Medical Center from January 1995 to June 2000, were investigated for their clinical characteristics, radiologic findings, timing of treatment and post-operative outcome in each type. RESULTS: 1) Seven patients have type 1, while 9 cases were type 2. One case was diagnosed as having mixed type. Mean ages at diagnosis are 7 years 4 months. 2) 4 cases had experienced respiratory diseases that are pneumonia(3 cases), empyema(2 cases) and lung abscess(2 cases). 3) The most common clinical manifestations are fever and cough, followed by chest pain, dyspnea, cyanosis, weak crying and moaning. 4) The left lung(10 cases), especially left lower lobe(8 cases) is involved more frequently than right lung. 5) Associated anomalies are pulmonary sequestration, pectus excavatum, diaphragmatic hernia. 6) All lesions were surgically removed and all of patients survived. In our cases, there was no difference in outcome by age at operation. CONCLUSION: In this study, CCAM show various clinical manifestations, and the outcome is good irrespective of their pathologic type and age at operation. Probably this is due to few associated anomalies in our cases, but it is not clear whether this is common finding in Korea. Our findings suggest that CCAM is treated successfully by surgical removal which can be delayed unless respiratory symptoms are evident.

The sensitization rates to egg, milk, soy bean in children with atopic dermatitis and acute urticaria / 천식및알레르기

BACKGROUND: Atopic dermatitis(AD) and urticaria(UR) are common allergic diseases associated with various food allergens. We evaluated possible differences of sensitization rates to egg, milk, and soy bean according to the age in children with AD and UR. MATERIALS AND METHOD: One hundred and thirty-six patients(n=100 in AD, n=36 in UR) who had visited Samsung Medical Center from January 1998 to February 2000 were enrolled and divided into 3 groups by age: gruop I, children under 1year of age (45 in AD, 17 in UR); group II, between 1 and 3 years of age (32 in AD, 12 in UR); and group III, children over 3 years of age (23 in AD, 7 in UR). Total and specific IgE to cow milk, a-lactalbumin(a-LA), beta-lactoglobulin(beta-LG), casein, soy, egg white(EW) and egg yolk(EY) were measured by RAST or CAP system. RESULTS: Total IgE was highest in group III of AD patients(p0.05). The most common allergen among AD patients was EW(54%) for all age groups (51.1% in group I, 56.3% in group II, 56.5% in group III), while among UR patients, beta-LG(22.2%) was the most common food allergen, especially beta-LG(35.3%) in Group I, CM/casein(27.3%) in Group II, and CM/alpha-LA/casein/EW(12.5%) in Group III. Sensitization rate to EW, EY and soy bean were higher in AD than in UR(p<0.05). CONCLUSION: Sensitization rate to egg was higher in patients with AD than in those with UR. Restriction of eggs maybe helpful in management of infants with a family history of AD.

Airway obstruction by congenital cardiovascular anomaly / 소아알레르기및호흡기학회지

PURPOSE: This study was performed to review the clinical presentation, diagnostic methods, treatments and prognosis of children with vascular rings. METHOD: We reviewed the medical records of 7 patients with vascular ring who were admitted in Samsung medical center between 1996 and 2000 retrospectively. RESULT: Pulmonary artery sling was noted in 4 cases. Two cases had double aortic arch, and 1 case had right aortic arch with left ligamentum arteriosus and aberrant left subclavian artery. The mean age at onset of symptoms was 3.2 months(from birth to 11 months). The mean age at diagnosis was 7.0 months(from 6 weeks to 15 months). Presenting symptoms and signs were respiratory difficulty, stridor, chest retraction, coughing, grunting, wheezing, sputum, cyanosis, choking, dysphagia, and poor feeding. All patients with pulmonary artery sling had tacheobronchial and/or pulmonary anomalies and cardiac defects were associated in two of them. Surgical repair was done successfully for the patients with double aortic arch or right aortic arch, but three deaths occurred to the patients with pulmonary artery sling combined with bronchial anomaly. CONCLUSION: Vascular ring should be considered especially for infants with respiratory distress or chronic respiratory symptoms. Associated anomalies are likely to affect the prognosis in these patients.

Measles, Mumps, and Rubella Immunization in Children with Egg Allergies

PURPOSE: The safety of MMR(Measles, Mumps, and Rubella) immunization to children with egg allergies has been debated for decades because the live attenuated virus used in the vaccine is grown in cultured chick-embryo fibroblasts. Many studies that investigated adverse reactions to MMR vaccine have been reported abroad, but there has been no report in Korean children. So, this study is aimed at determining the prevalence of positive reactions to skin test with the diluted MMR vaccine and the safety of MMR immunization in Korean children with egg allergies. METHODS: Twenty children who have atopic dermatitis or urticaria associated with egg allergies in Samsung Medical Center underwent prick and intradermal tests with diluted MMR vaccine. Then, we administered the vaccine to the children subcutaneously. RESULTS: One patient(5.0%) had a positive result on the prick test and five(25.0%) on the intradermal test. Urticaria was elicited after MMR immunization in two children(10%) who had past illness of urticaria. One of them had a positive result on the prick and intradermal tests, but the other had negative results on both tests. CONCLUSION: Although anaphylaxis did not appear in our study, adverse reactions to MMR vaccination can occur in children with egg allergies, regardless of skin test result to MMR vaccine, prick or intradermal. Thus, in children with a history of severe systemic allergic reaction to egg, it is safe to perform MMR vaccination in a tertiary medical center where emergency care can be taken appropriately.