Epidemiology and Clinical Characteristics of Childhood Acute Lymphoblastic Leukemia in Korea / 대한소아혈액종양학회지

PURPOSE: Acute lymphoblastic leukemia (ALL) accounts for approximately 75% of all cases of childhood leukemia. We investigated epidemiology, clinical and laboratory features and treatment outcome of the children with ALL in Korea during recent 5 years. METHODS: One thousand forty nine patients were enrolled between January 1994 and December 1998 from 37 major hospitals in Korea. The data regarding the clinical and laboratory features including age, WBC counts at diagnosis, immunophenotype, morphology, cytogenetics and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed. The differences between groups analyzed by log-rank test. RESULTS: There were 597 males and 452 females. The distribution between the age 2 and 5 years is most common in 46.1%. The annual incidence rate per 100,000 population varied from 1.6 to 2.2. The 5 year event free survival (EFS) rates according to good prognostic factors were as follows: 67% bet ween 1-9 year of age at diagnosis, 69% in under 10,000/mm3of initial WBC count, 74% in early pre-B cell CALLA ( ) immunophenotype, 65% in L3 morphology, 68% in no CNS invasion. Most of patients were treated by CCG treatment protocol. The 5 year EFS was 63%. Main complications were sepsis (21.8%) and hemorrhage (12.5%). The relapse rate was 15.6%. The common causes of death were sepsis, DIC, pneumonia, relapse. CONCLUSION: Our results could provide the most recent and important information about acute lymphoblastic leukemia of children in Korea.

The Effect of Massage on Premature Infants

PURPOSE: To determine the effects of massage therapy on growth, development, hormones, immune function, hepatic function, hematopoietic function and sleep pattern of preterm infants. METHODS: Thirty-one preterm infants of less than 35 weeks gestational age, who were admitted to Eulji Medical College Hospital Neonatal Intensive Care Unit between August 1998 and May 1999, and were in the state without mechanical ventilation or oxygen therapy, and hemodynamically stable with no acute disease state non congenital anomaly, and who were also fed by oral route or gastric tube, were enrolled in this study. The randomly selected massage group(15 neonates) received three 15-minute periods of tactile and kinesthetic stimulation daily for 7 days, and the control group(16 neonates) received general nursing care. We measured gastrin, thyroid function test, serum cortisol, CH50, IgG, IgM, CBC and liver function test in both groups before and after the study. During observation for 7 days, neonate behaviors were recorded every hour for 10sec using the analysis of 6 sleep-wake states. RESULTS: Although the massage group showed slight differences in blood level of Thyroid stimulating hormone, CH50, hemoglobin, hematocrit and body weight and alertness as compared with control group, there was no statistically significant difference between the two groups. CONCLUSION: Several positive effects of massage on the preterm infants that have been reported previously must be reevaluated.

Infantile Hypertrophic Pyloric Stenosis Treated with Intravenous Atropine Sulfate

PURPOSE: The pharmacologic effect of atropine on HPS can be considered to control pyloric muscle spasm. Therefore, we studied the effects of intravenous atropine sulfate on the clinical course of HPS, and periodically observed the ultrasonographic appearance of the pyloric muscles after atropine treatment. METHODS:From April 1998 to May 1999, 14 infants who were diagnosed with HPS were treated with intravenous atropine sulfate. Intravenous atropine sulfate was administered at an initial dose of 0.04mg/kg/day, which was divided into 8 equal doses. The daily dose was increased by 0.01 mg/kg/day until vomiting was controlled for an entire day while infants received unrestricted oral feeding. Ultrasonographic examinations were performed during hospitalization and repeated at least every 2 months until normalization of pyloric muscles was confirmed. RESULTS: Intravenous atropine was effective in 12 of 14 infants with HPS and the conditions of 9 of them improved. Two infants who were not free from vomiting despite a week of intravenous atropine sulfate treatment underwent pyloromyotomy. A series of ultrasonographic examinations were done after vomiting had improved with intravenous atropine sulfate. The ultrasonographic findings showed good passage of gastric contents through pyloric canals despite thickening of the pyloric muscles. CONCLUSION: Intravenous administration of atropine sulfate is an effective therapy for HPS and can be an alternative to pyloromyotomy. (J Korean Pediatr Soc 2000;43:763-768)

Role of Polymorphism in HLA DQ-alpha and -beta Chain Loci in the Pathophysiology of Autoimmune Thyroid Disease in Children with and without Turner Syndrome

PURPOSE: About 10% of girls with Turner syndrome may have autoimmune thyroid disease(AIT), but the disease's pathophysiology has not yet been elucidated. Accordingly, this study was performed to observe whether the pathogenesis of AIT in children with Turner syndrome and without Turner syndrome correlate with special loci of DQ and chain in HLA. METHODS: Blood samples were drawn from children with and without Turner syndrome. Thyroid antibodies(anti-thyroglobulin and anti-microsomal antibody) were measured from the samples to determine AIT. DNAs were extracted with the DNA extraction kit and processed in PCR reaction for amplification of exon 2 region of HLA-DQA1 and -DQB1, and then eluted again. The eluted PCR products were sequenced directly with an automatic sequencer. The sequences were compared with those of normal control. RESULTS: There was a signficant increase in frequencies of HLA DQA1*0301(P<0.05) and HLA DQB1*0601 but without statistical significance(P=0.06) in normal children with AIT, compared with those in control group. There was signficantly but slightly increased frequency of HLA DQA1*0104, 0105 and DQB1*0202 in the group of children with Turner syndrome who had AIT than in control group. The frequency of the marker chromosome(45,X/46,XX+mar) increased in children with Turner syndrome who had AIT, compared with these in children with Turner syndrome who did not have AIT. Children with Turner syndrome who had spontaneous puberty had higher a incidence rate of AIT than those who did not have spontaneous puberty(P<0.01). CONCLUSION: The results suggest that HLA DQA1*0301 and HLA DQB1*0601 play a role in the pathogenesis of AIT in children without Turner syndrome, but not in children with Turner syndrome. Additionally, there seem to be other factors participating in the pathogenesis of AIT in children with Turner syndrome, such as chromosomal karyotype and spontaneous puberty. Therefore, the factors participitating in the pathogenesis of AIT in children with Turner syndrome remain to be elucidated with further study.

Plasma Lipid Alteration in Leukemia and Solid Tumor

PURPOSE: A sensitive, specific blood test to detect cancer would be of great value but the search for such a test has been fruitless so far. In actual practice, there is often a considerable interval between the point at which a tumor could have been detected and the point at which it produces symptoms as a result of tumor growth. The research has been largely directed toward the identification of tumor-specific subtances that are liberated into body fluid. These tumor markers will not only indicate the presence of a cancer but also identify its site of origin and morphology. The available tumor markers, including the oncofetal antigen, placental hormones and enzymes, do not have enough tumor specificity or sensitivity to be used in diagnosis, but they do have a selective role monitoring the progression of tumor growth and assessing the response to treatment. Plasma lipid abnormality occurs regularly in many experimental animal tumor system. In some cases, their pattern and pathogenesis as well as their correlation with tumor volume and histologic features have been well characterized. Since both in vivo and in vitro celluar lipid alterations have been studied most intensively and found most commonly in lymphoproliferative and myeloproliferative disease, these form a particularly interesting group of malignancies for further investigation. In this study, we prospectively evaluated 26 patients with leukemia and 10 patients with solid tumor with full plasma lipid profiles. METHODS: Plasma lipids and lipoproteins were studied in 36 patients with acute leukemia and solid tumor at initial presentation or relapse and lipid studies were regularly repeated during a period of clinical remission. Patients were admitted to the department of pediatrics Eulji general hospital between March 1988 and June 1992 and they had no drugs known to alter lipid metabolism. No patient had a history of thyroid disease or diabetes and none had evidence of hepatic or renal dysfunction. Full serum chemistry analysis was performed utilizing Automated Analyzer and total serum lactic acid dehydrogenase was used as an additional parameter of tumor burden in all patients. Lipoprotein concentrations in plasma were measured b electrophoresis, and total lipid, phospholipid and free fatty acid by enzyme immunoassay. RESULTS: A consistent and predictable pattern of alterations in plasma lipid and lipoproteins were found. This pattern consisted of a marked decrease in aloha-lipoprotein(p=0.0001) and total cholesterol(p=0.0066), and increase in beta-lipoprotein(p=0.0001). Changes in triglyceride, phospholipid, free fatty acid and pre-beta-lipoprotein levels were net significant. The degree of lipid abnormality was directly related to the underlying tumor burden in leukemia. Among the lipid and lipoprotein alteration, aloha-lipoprotein appeared to be most sensitive indicator for the presence of tumor. CONCLUSIONS: The result suggest that an abnormality in systemic lipid metabolism, possibly in cholesterol clearance, is present in cancer patient. There appeared to be a direct relationship between magnitude of lipid abnormality and the amount of tumor burden but at the present time the exact mechanism of tumor-host interaction and its possible clinical implications remain to be determined.

Prediction of Neurologic Outcome of Perinatal Asphyxia by Use of CK-BB Isoenzyme Measurements

Creatine kinase (CK) isoenzyme are considered as a specific tissus injury marker. Brain type isoenzyme of CK (CK-BB) was measured in 44 healthy and 33 asphyxiated preterm and fullterm infants. Samples were drawn from periphera blood at six to ten hours after birth. There were no difference of CK-BB and CK-BB% between preterm and fullterm infants. CK-BB and CK-BB% were well correlated to the degree of hypoxic ischemic encephalopathy. Seventeen infants died in newborn period had higher CK-BB activity than 60 infants who survived at discharge. We conculuded that early CK-BB determination can be used as and indicator of neonatal brain damage and neonatal death. It is warranded to do long-term follow-up for evaluation of neurologic outcome.

Indirect measurement of blood pressure in neonates using an automatic noninvasive oscillometric monitor

The measurement of blood pressure in neonates is an important diagnostic procedure. But the measurement of blood pressure has not been performed routinely because of difficulty in measuring blood pressure and variable normal range according to measuring apparatus. Recently some accurate and convenient apparatus of measuring blood pressure have been introduced in neonatal care, so the reference values of neonatal blood pressure may be obtainable. The authors measured systolic and diastolic blood pressure using a noninvasive oscillometric monitor instrument on 1,3,6,12,24,48,72 hours of life in 200 neonates born at Eulji General Hospital, Taejon. And we analysed the results according to birth weight, gestational age, delivery type, sex, meconium stain, preeclampsia and hypocalcemia. The following results were obtained: 1) On the 1st day of life, systolic and diastolic blood pressure were 65.611.7 mmHg and 36.7+/-5.8 mmHg in the normal birth weight neonates, and 56.2+/-6.7 mmHg and 34.14.2 mmHg in the low birth weight neonates, respectively. So the blood pressure of normal birth weight neonates were higher than that of low birth weight neonates. 2) On the 1st day of life, systolic and diastolic blood pressure were 65.5+/-11.8 mmHg and 36.6+/-5.8 mmHg in the fullterm neonates, and 57.6+/-5.2 mmHg and 35.6+/-3.8 mmHg in the preterm neonates, respectively. So the blood pressure of full term neonates were higher than that of preterm neonates. 3) The difference of blood pressure in analysis according to birth weight were wider than that according to gestational age. 4) The blood pressure of neonates were lowest on the 3 hours of life and increased gradually during 72 hours of life. 5) The blood pressure of neonates did not show any significant difference in analysis according to sex. delivery type, Meconium stain, preeclampsia, and hypocalcemia.

Clinical analysis and prognostic factors in Henoch-Schonlein purpura

No abstract available.

The diagnosis of mycoplasma pneumoniae pneumonia by high density composite particles agglutinin test

No abstract available.