The Effectiveness of High Dose Dexamethasone for the Initial Treatment of Childhood Acute Idiopathic Thrombocytopenic Purpura / 대한혈액학회지

BACKGROUND: Corticosteroids and intravenous immunoglobulin (IV-Ig) have been used asfirst line treatments for acute idiopathic thrombocytopenic purpura (AITP) in children. High dose dexamethasone (HD) has been reported to be effective for chronic refractory ITP and for the initial treatment of AITP in adults. There has been no report about HD as the initial treatment for childhood AITP. We assessed the effectiveness of HD for the initial treatment of childhood AITP, as compared to IV-Ig. METHODS: 25 Patients with newly diagnosed AITP were enrolled. We conducted a prospective, randomized study to compare the two treatment options. 11 patients were treated with IV-Ig and 14 patients were treated with HD. The platelet counts were assessed at 3, 5, 7, 14 and 21 days after the beginning of the treatment. The adverse effects were noted, and the patients were followed for more than 6 months. RESULTS: Both the IV-Ig and HD groups showed a rapid rise of the platelet counts and the platelet counts were maintained at 3, 5, 7, 14 and 21 days. The difference of platelet counts between the two groups was significant at day 5 (P<0.05). During the follow-up period, 5 patients had a recurrence: 2 in IV-Ig group and 3 in HD group. All 5 patients were re-treated with HD and they had a good response. One of the recurred patients in the IV-Ig group had chronic ITP. Some side effects were observed, but they were not severe enough to necessitate the discontinuation of treatment. CONCLUSION: We conclude that HD is as effective and safe as high dose IV-Ig for the initial treatment of childhood AITP. The choice between these treatment options can be made according to the cost-effectiveness and the therapy-related risks.

A Clinical Study of Febrile Convulsions in Children Over 5 Year Olds without Organic Problems

PURPOSE: Febrile convulsions are the most common form of childhood seizures, appearing between in children 3 months and 5 years of age and are predominantly of benign nature. Febrile convulsions occurring after 5 years of age might be estimated as epilepsy. Most data for these disorders are from mainly epilepsy populations and might not be relevant to these children, and the requirement of any specific treatment or workup is not yet established either. Thus we tried to obtain a unique perspective. METHODS: Clinical data for episodes of febrile convulsions were collected in Eulji hospital in Deajeon. These were obtained from anonymised copies of a standardised admission note, emergency, nursing, and intensive care unit notes and interviews with parents, medical, nursing, and paramedic staff. RESULTS: Finding of 259 episodes of febrile seizure in over 5 year olds. 121(46.7%) were confirmed epilepsy or afebrile seizure in under 5 year olds, 13(5.0%) were caused by infection, metabolic disorder, leukemia and so on, and 23(8.9%) had previous neurological defect. Lastly, 102(39.4%) were included to febrile convulsion in over 5 year olds. 28(27.5%) of the subjects had their initial febrile convulsions in children over 5 year olds while 74(72.5%) of the subjects were under 5 years of age. The male to female ratio of the seizure group was 2:1. In the duration and type of convulsions, generalized convulsions occurred predominantly within 15mins in both of them. 5(17.9%) of group A and 16(21.6%) of group B showed electroencephalogram abnormality. The most common causes of seizure were common colds. Most of the convulsions occurred less than 24hrs after fever but, there were no abnormal findings in lumbar puncture and brain MRI. CONCLUSION: Febrile seizure in over 5 year olds without organic problems has similar characteristics to febrile convulsion in under 5 year olds. In light of these findings, lumbar puncture and brain MRI do not require a routine checkup for the evaluation of febrile seizure in over 5 year olds. However, encephalography needs to be examined.

Effect of renin inhibition on an experimental glomerulonephritis - a preliminary report / 소아과

PURPOSE: We performed this study in order to investigate the effect of direct renin inhibition on an experimental animal model with nephrotoxic serum nephritis and tried to give useful information for clinical research and renin inhibitor treatment. METHODS: Thirty BALB/c 6-week-old male mice were divided into 4 groups: control group (CO, n=5), control-treatment group with aliskiren (CT, n=5), disease group (DO, n=10), and disease treatment group with aliskiren (DT, n=10). Nephritis was induced by an intravenous injection of 0.25 mg/g weight of rabbit anti-GBM immunoglobulin G. Model 2002 Alzet mini-osmotic pumps (Durect Corp.) for aliskiren infusion were implanted into CT and DT. Each group strain was sacrificed serially one at a time on day 14. We estimated the protein-creatinine ratio in 12-hour-collected urine (UP/Cr) and measured the mesangial matrix score in the PAS-stained kidney of each strain. RESULTS: One strain at CT and DT died on day 6 and 7, respectively. Each group strain was sacrificed serially at a time on day 10 because DO were seriously ill. The UP/Cr of each group is as follows: CO, 31.24+/-6.54 mg/mg, CT, 23.38+/-13.60 mg/mg, DO, 112.72+/-10.97 mg/mg, DT 114.07+/-32.30 mg/mg. There was no significant difference between DO and DT. The mesangial matrix score of each group was CO, 0.23+/-0.10; CT, 0.13+/-0.03; DO, 1.90+/-0.48; and DT, 1.28+/-0.41, respectively, and there was a significant difference between DO and DT in the extent of mesangial matrix expansion (P=0.008). CONCLUSION: We found that renin inhibition was able to suppress the mesangial matrix expansion in experimental mice with acute nephritis, although there were no significant differences in UP/Cr.

Clinical factors causing hyponatremia in patients with mucocutaneous lymph node syndrome / 소아과

PURPOSE: Clinical and laboratory findings predict a severe outcome for mucocutaneous lymph node syndrome. This study aimed to define the clinical characteristics of Kawasaki disease (KD) patients with hyponatremia and to determine the factors associated with its development. METHODS: Retrospective studies were performed on 114 KD patients who received an initial high-dose intravenous immunoglobulin (IVIG, single 2 g/kg/dose) within 10 days of fever onset from January 2006 to February 2008. These patients were divided into 2 groups. Group 1 consisted of 30 (26.3%) patients with hyponatremia, and group 2 consisted of 84 (73.6%) patients without hyponatremia. Clinical manifestations, laboratory results, and echocardiographic findings were compared between the groups. RESULTS: Group 1 patients were more likely to have a coronary artery lesion (53.3% versus 20.2%, P=0.005) and suffered from diarrhea (41.3% versus 14.1%, P=0.007). There was a higher incidence of cardiovascular involvement in group 1 patients, including coronary dilatation (46.6%), valvular regurgitation (13.3%), pericardial effusion (6.7%) and medium-sized aneurysm (6.7%). There were no coronary aneurysms in group 2 patients. Serum C-reactive protein (CRP) was significantly higher in patients with hyponatremia (12.2+/-7.79 mg/ dL versus 7.3+/-4.7 mg/dL, P=0.003) and IVIG-resistant patients were more common in group 1 (13.3% versus 3.6%). CONCLUSION: These results indicate that hyponatremia in KD occurs in patients exhibiting severe inflammation and was significantly associated with the development of coronary disease. Further studies will be necessary to confirm the pathogenic mechanisms of hyponatremia in KD patients.

The Role of TNF-alpha in Eosinophilic Inflammation of RSV Bronchiolitis / 소아알레르기및호흡기학회지

PURPOSE: Tumor necrosis factor (TNF)-alpha and eosinophilic inflammation have their role in asthma, but there were no studies on respiratory syncytial virus (RSV) bronchiolitis. The aim of our study was to investigate whether TNF-alpha has a role in eosinophilic inflammation of lower respiratory tract infections with RSV and has the correlation with other cytokines. METHODS: Fifty children with first RSV bronchiolitis (RSV group) and 18 healthy children without any respiratory symptom and sign (control group) were enrolled. Clinical data, such as eosinophil-derived neurotoxin (EDN), eosinophil cationic protein (ECP), were analyzed. We measured interleukin (IL)-5, IL-8, TNF-alpha, granulocyte macrophage-colony stimulating factor (GM-CSF), interferon (IFN)-gamma, eotaxin, and regulated on activation, normal T cell expressed and secreted (RANTES) in nasal lavage fluid in both groups. RESULTS: Eotaxin, GM-CSF, IL-8, IFN-gamma and TNF-alpha were higher in the RSV group than the control group. TNF-alpha correlated with an eosinophil-active cytokine, GM-CSF (r=0.86, P<0.0001), IFN-gamma (r=0.90, P<0.0001), and with eosinophil-active C-C chemokines such as eotaxin (r=0.50, P<0.0001). TNF-alpha also correlated with proinflammatory cytokines such as IL-8 (r= 0.81, P<0.0001). CONCLUSION: TNF-alpha correlated with eosinophil-active chemokines and cytokines. Therefore, TNF-alpha may have a role in eosinophilic inflammation in children with RSV bronchiolitis.

Molecular Epidemiology of Human Astrovirus Infection in Hospitalized Children with Acute Gastroenteritis / 대한소아소화기영양학회지

PURPOSE: Human astrovirus (HAstV) is known to be an important etiologic agent of acute gastroenteritis in infants worldwide. However, the prevalence of HAstV infection varies according to geographic region and patient age. The purpose of our study was to investigate the incidence of HAstV infection among hospitalized children at a tertiary hospital in Seoul. METHODS: Fecal samples were collected from hospitalized children up to five years of age with acute gastroenteritis. A total of 812 fecal samples were collected from hospitalized children with acute gastroenteritis between February 2004 and January 2005. Fecal specimens were screened for rotavirus, enteric adenovirus and norovirus by enzyme immunoassay (EIA) or reverse transcriptase polymerase chain reaction (RT-PCR). HAstV positive samples were characterized by RT-PCR. RESULTS: Rotavirus was detected in 16.9% (138/812), norovirus in 11.6% (94/812), and adenovirus in 4.0% (33/812) of the study population. HAstV was detected in 4.0% (33/812) samples by RT- PCR. The age distribution of HAstV positive patients was as follows: <12 month old, 82.0% (27/ 33); 1~2 years old, 6.0% (2/33); 2~5 years old, 12.0% (4/33). The seasonal distribution of HAstV positive samples was as follows; April (3), May (5), June (4), August (12), September (4), October (2), November (2), and December (1). The peak rate of HAstV infection was observed during the summer season, 2004. A mixed infection of viral agents was confirmed in 2.7% (22 /812) of the study population, most commonly with rotavirus and norovirus, and with rotavirus and HAstV. Genotype 1 was the predominant type (91%, 20/22) and genotype 8 was detected in two cases. CONCLUSION: The prevalence of HAstV infection was 4.0% in hospitalized children with acute gastroenteritis, and was especially high in infants. HAstV can be considered as an important etiologic agent of gastroenteritis in children.

The Effects of Succinylcholine on Mivacurium: induced Neuromuscular Blockade and its Reversal in Cats / 대한마취과학회지

BACKGROUND: Previous studies examining the pharmacodynamic effects of succinylcholine(SCC) on subsequent doses of nondepolarizing muscle relaxants showed potentiation with resultant prolonged respiratory depression or no interaction at all. The interaction between SCC and mivacurium especially has not been investigated in animal and other clinical studies. METHODS: The pharmacodynamic effects of SCC on mivacurium-induced neuromuscular blockade and its reversal were investigated in 10 cats of either sex using the anterior tibialis muscle-sciatic nerve preparation. RESULTS: There was no significant difference at the onset of mivacurium neummuscular blockade between the control group(1.81+/-0.48 min) and SCC-pretreated group(1.86+/-1.04 min). However the duration of action of mivacurium neuromuscular blockade was significantly longer in the SCC-pretreated group(33.08+/-19.13 min) than that of the control group(10.65+/-2.45 min). In the control group recovery indices(RI) were 2.35+/-1.01 min and 0.68+/-0.30 min at spontaneous recovery and antagonism with neostigmine, respectively and in the SCC-pretreated group they were 6.88+/-2.42 min and 1.90+/-0.64 min. RI were significantly shortened by antagonism with neostigmine whether or not SCC was pretreated. In the SCC-pretreated group, RI were significantly longer than in the control group at spontaneous recovery and antagonism with neostigmine. But the maximal recovery and antagonism effect were 100% in all cases. There was no sigriificant difference in the train-of-four ratios measured after antagonism with neostigmine between the control group(0.91+/-0.01) and the SCC-pretreated group(0.93+/-0.06). CONCLUSIONS: The prior administration of SCC prolonged the duration of mivacurium-induced neuromuscular blockade and delayed recovery but had no influence in antagonism with neostigmine in cats.

Predicting Factors for Difficult Endotracheal Intubation A Prospective Study / 대한마취과학회지

BACKGROUND: Unexpected difficult intubation is probably the result of inadequate preoperative examinations of the airway. The purpose of this study is to indicate that the oropharyngeal classification (OPC) and several tests may be predict difficult intubation in Korean. METHODS: In each of 462 adults the OPC was determined in sitting position. In supine position, hyomental distance (HD) and sternomental distance (SMD) with head in neutral, and thyromenal distance (TD), SMD and inter-incisors distance (DI) on mouth opening with the head fully extended were measured. The laryngoscopic grades were determined at the time of induction. We defined the cases of intubation trials > or = 3 times in patients with laryngoscopic grade 3 and 4 as difficult intubation. The datas were analyzed with Mann-Whitney and Kruskal-Wallis test. RESULTS: 14 patients had difficulty in intubating (3.03%) and 1 of 14 was failed to intubate (0.22 %). Assignment to either OPC > or = 3 and DI or = 3 and HD < or = 5.5 cm had high sensitivity, specificity, and NPV. When DI and HD < or = 4 cm were employed, combination of OPC and HD/DI resulted in increasing sensitivity and positive predictive value (PPV). CONCLUSIONS: Based on the results and performance indexes of patients in this study, we concluded that assignment to OPC, DI and HD, consider either alone or combinations, be valuable tests to predict difficult intubation before anesthesia in Korean.

The Factors Influencing the Clinical Course of Acute Cerebral Infarctions: Cortical Versus Lacunar Infarction

We think that the clinical courses of lacurlar infarctions are somewhat different from those of cortical ones, because the ischemic penumbra, a keystone of acute infarct recovery, of the former is rnore limitted than that of the latter. Therefore, we analyzed the selected data, 38 cortical and 33 lacunar infarct patients, from Severance Stroke Registry which were recorded from May, 1989 to April, 1990, to demonstrate and compare the differences of the clinical courses and its influencing factors between the cortical and lacunar infarcts. Our results suggested as follows first, the initial neurologic deficits of cortical infarctions are rnore serious than those of lacunar infarctions, but with the better short-term improvements of tbe former, the short-term motor outcome between the two types of infarcts are not significantly different second, whiIe the short-term improvernent of cortical infarcs is influenced by initial hematocrit level, the short-term motor outcome and the degree of improvement of lacunar infarcts are influenced by the patient's age.

Two cases of anterior choroidal artery territory infarction

Occlusion of the anterior choroidal artery (AChA) can cause infarction in the posterior limb of the internal capsule. Infarction is less frequently observed in the thalamus, midbrain, temporal lobe, and lateral geniculate body (LGB) territories of the AChA. The most common clinical finding is hemiparesis. Hemianesthesia may be severe at onset but is usually transient. Homonymous hemianopia, upper-quadrant anopia, or upper- and lower-quadrant sector anopia can be present. Occasionally these patients are reported to have transient abnormalities of higher cortical function. The most common stroke mechanism is known to be small-vessel occlusive disease, predominantly found in hypertensive and diabetic patients. Vasospasm due to ruptured aneurysm or intraoperative mechanical manipulation, and cardiac origin the AChA territory. The infarct lesion is usually recognized and diagnosed by computed tomography. The best treatment is still unknown.

Retroperitoneal Malignant Fibrous Histiocytoma: Report of a Case / 대한비뇨기과학회지

Malignant fibrous histiocytoma is an uncommon pleomorphic tumor of the soft tissues possibly arising from the histiocyte. A case of huge malignant fibrous histiocytoma weighing 10.2kg in the retroperitoneal space is reported with brief review of literatures.

A Case of Retroperitoneal Neurilemmoma / 대한비뇨기과학회지

Neurilemmoma is a relatively rare, which was first described by Stout in 1935. Neurilemmoma is a neoplasm arising from Schwann cells. It is usually solitary and may be benign or malignant, solid or cystic, encapsulated or diffuse. We report one case of retroperitoneal neurilemmoma with review of literature.