The outcome of percutaneous stent implantation in congenital heart disease: experience of a single institute / 소아과

PURPOSE: The efficacy of percutaneous stent implantation for congenital heart disease (CHD) in Korea, where stent availability is limited, has not been determined. This study evaluated the acute and midterm results of stent implantation in different CHD subgroups. METHODS: Stents were implanted in 75 patients with 81 lesions: (1) pulmonary artery stenosis (PAS) group, 56 lesions in 51 patients; (2) coarctation of the aorta (CoA) group, 5 lesions in 5 patients; (3) Fontan group, 13 lesions in 12 patients; (4) ductal stent group, 3 lesions in 3 patients; and (5) other CHD group, 4 lesions in 4 patients. Mean follow-up duration was 2.1 years (0.1–4 years). Medical records were reviewed retrospectively. RESULTS: The minimum lumen diameter (MLD) in PAS and CoA increased from 5.0±1.9 mm and 8.4±1.6 mm to 10.1±3.6 mm and 12.3±2.5 mm, respectively (P<0.01). In the PAS group, pressure gradient decreased from 25.7±15.6 mmHg to 10.4±10.1 mmHg, and right ventricular to aortic pressure ratio from 0.56±0.21 to 0.46±0.19. In the CoA group, the pressure gradient decreased from 50±33 mmHg to 17±8 mmHg. In the ductal stent group, the MLD of the ductus increased from 2.3 mm to 4.3 mm and arterial oxygen saturation from 40%–70% to 90%. No deaths were associated with stent implantation. Stent migration occurred in 3 patients, but repositioning was successful in all. Stent redilation was performed successfully in 26 cases after 29±12 months. CONCLUSION: Percutaneous stent implantation was safe and effective, with acceptable short and mid-term outcomes in Korean CHD patients.

Infective Endocarditis Caused by Neisseria cinerea in a 7-Year-Old Girl Who Had Undergone Surgical Pulmonary Valve Replacement / 이화의대지

A 7-year-old girl was admitted to the emergency department with a 2-week history of fever and general weakness. She had been diagnosed with tetralogy of Fallot and received surgical repair. Pulmonary prosthetic valve replacement was performed in January 2014 because of severe pulmonary regurgitation and moderate right ventricle dilatation. Echocardiography revealed suspicious vegetation around the prosthetic pulmonary valve. Neisseria cinerea was confirmed in blood culture. We diagnosed with bacterial infective endocarditis, and administered empirical intravenous antibiotics for endocarditis. However, the fever and general weakness continued, with mild muscle aches and coughing. Thus, we performed a chest radiography and pneumonia workup. Therefore, she was diagnosed with mycoplasma pneumonia and given oral clarithromycin twice daily for 2 weeks. She was successfully treated with antibiotics for 46 days. We report the first case of infective endocarditis caused by N. cinerea in Korea.

Short-Term Change of Exercise Capacity in Patients with Pulmonary Valve Replacement after Tetralogy of Fallot Repair

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effect of pulmonary valve replacement (PVR) on exercise capacity and determine cardiopulmonary exercise (CPEX) parameters associated with improvement in right ventricle (RV) function. SUBJECTS AND METHODS: We retrospectively analyzed CPEX and magnetic resonance imaging parameters in a total of 245 patients who underwent PVR from January 1998 to October 2015. In addition, we analyzed the characteristics of the patients who showed improved exercise capacity after PVR. RESULTS: Twenty-eight patients met the inclusion criteria for the study. CPEX parameters after PVR showed no significant changes in all patients. However, baseline predicted peak oxygen uptake (VO2(peak)) (%) value was significantly lower in patients with significant improvement in exercise capacity after PVR, as compared to patients who showed decreased exercise capacity after PVR (60.83±10.28 vs. 75.81±13.83) (p=0.003). In addition, patients with improved exercise capacity showed a positive correlation between the change of right ventricular ejection fraction (RVEF) (%) and the change of anaerobic threshold (r=0.733, p=0.007); whereas, patients with decreased exercise capacity showed a negative correlation between the change of RVEF (%) and the change of predicted VO2(peak) (%) (r=−0.575, p=0.020). CONCLUSION: The importance of predicted VO2(peak) (%) in evaluating exercise capacity differentiated from other CPEX variables. The change of anaerobic threshold and predicted VO2(peak) (%) might be a useful predictor of the change in RV function after PVR.

Masticatory function following implants replacing a second molar

PURPOSE: The aim of this study was to obtain objective and standardized information on masticatory function and patient satisfaction following second molar single implant therapy. METHODS: Twenty adult patients, who had restored second molar single implants more than 1 month before the study, were enrolled in this study. All patients received a chewing test using peanuts before and after insertion of the implant prosthesis, with a questionnaire and visual analogue scale (VAS) to evaluate the effect of second molar single implant therapy. RESULTS: This study obtained standardized information on the masticatory function objectively (e.g., P, R, X50) before (Pre-insertion) and after insertion (Post-insertion) of the implant prosthesis. Masticatory performance (P) after insertion of the implant prosthesis significantly increased from 67.8+/-9.9 to 84.3+/-8.5% (P<0.0001). With the implant prosthesis, the P value increased by 24%. The masticatory efficiency index (R) of Post-insertion is higher than that of Pre-insertion (P<0.0001). With the implant prosthesis, the R value increased by 29%. The median particle size (X50) of Post-insertion is lower than that of Pre-insertion (P<0.0001). More than 90% of the patients were satisfied with the second molar single implant therapy from a functional point of view. CONCLUSIONS: These findings indicate that a second molar single implant can increase masticatory function.

Clinical Characteristics of Intracranial Germ Cell Tumors in Children / 임상소아혈액종양

BACKGROUND: Intracranial germ cell tumors are higher in the East Asia such as Korea and Japan than any other Western countries. By analyzing common clinical features of intracranial germ cell tumors in children, we will prevent from misdiagnosing and delaying in the establishment of diagnosis. Furthermore, we can choose appropriate therapeutic plans to improve patient's prognosis.METHODS: We retrospectively reviewed the medical records of 68 patients to investigate and analyze clinical characteristics of intracranial germ cell tumors in children.RESULTS: The average age of 68 patients was 14.8 years old, and the male to female ratio in all patients was 3:1. The most common symptom presented by 30 patients was headache regarded as a nonspecific symptom in brain tumors. Sixty four patients were diagnosed by histologic method called biopsy and most of them were come out into germinoma. Thirty five patients were included in low-risk group and 30 patients were in high-risk group. Intracranial germ cell tumors in this study were most commonly located in the pineal gland.CONCLUSION: There are a variety of types in intracranial germ cell tumors, and they have been accurately diagnosed by radiologic, histologic methods and elevated tumor markers. We concluded that it is necessary for early diagnosis to evaluate exhaustively in patients suspected of brain tumors.

Clinical Characteristics of Intracranial Germ Cell Tumors in Children / 임상소아혈액종양

BACKGROUND: Intracranial germ cell tumors are higher in the East Asia such as Korea and Japan than any other Western countries. By analyzing common clinical features of intracranial germ cell tumors in children, we will prevent from misdiagnosing and delaying in the establishment of diagnosis. Furthermore, we can choose appropriate therapeutic plans to improve patient's prognosis. METHODS: We retrospectively reviewed the medical records of 68 patients to investigate and analyze clinical characteristics of intracranial germ cell tumors in children. RESULTS: The average age of 68 patients was 14.8 years old, and the male to female ratio in all patients was 3:1. The most common symptom presented by 30 patients was headache regarded as a nonspecific symptom in brain tumors. Sixty four patients were diagnosed by histologic method called biopsy and most of them were come out into germinoma. Thirty five patients were included in low-risk group and 30 patients were in high-risk group. Intracranial germ cell tumors in this study were most commonly located in the pineal gland. CONCLUSION: There are a variety of types in intracranial germ cell tumors, and they have been accurately diagnosed by radiologic, histologic methods and elevated tumor markers. We concluded that it is necessary for early diagnosis to evaluate exhaustively in patients suspected of brain tumors.

The neuroprotective effect of recombinant human erythropoietin via an antiapoptotic mechanism on hypoxic-ischemic brain injury in neonatal rats / 소아과

PURPOSE: The neuroprotective effects of erythropoietin (EPO) have been recently shown in many animal models of brain injury, including hypoxic-ischemic (HI) encephalopathy, trauma, and excitotoxicity; however, limited data are available for such effects during the neonatal periods. Therefore, we investigated whether recombinant human EPO (rHuEPO) can protect against perinatal HI brain injury via an antiapoptotic mechanism. METHODS: The left carotid artery was ligated in 7-day-old Sprague-Dawley (SD) rat pups (in vivo model). The animals were divided into 6 groups: normoxia control (NC), normoxia sham-operated (NS), hypoxia only (H), hypoxia+vehicle (HV), hypoxia+rHuEPO before a hypoxic insult (HE-B), and hypoxia+rHuEPO after a hypoxic insult (HE-A). Embryonic cortical neuronal cell culture of SD rats at 18 days gestation (in vitro model) was performed. The cultured cells were divided into 5 groups: normoxia (N), hypoxia (H), and 1, 10, and 100 IU/mL rHuEPO-treated groups. RESULTS: In the in vivo model, Bcl-2 expressions in the H and HV groups were lower than those in the NC and NS groups, whereas those in the HE-A and HE-B groups were greater than those of the H and HV groups. The expressions of Bax and caspase-3 and the ratio of Bax/Bcl-2 were in contrast to those of Bcl-2. In the in vitro model, the patterns of Bcl-2, Bax, and caspase-3 expression and Bax/Bcl-2 ratio were similar to the results obtained in the in vivo model. CONCLUSION: rHuEPO exerts neuroprotective effect against perinatal HI brain injury via an antiapoptotic mechanism.

Benign paroxysmal positional vertigo as a complication of sinus floor elevation

PURPOSE: Osteotome sinus floor elevation (OSFE) is an often-used technique of great utility in certain implant patients with resorbed posterior maxilla. Recently benign paroxysmal positional vertigo (BPPV) has been reported as an early postoperative complication following OSFE. Although OSFE-induced BPPV commonly resolves itself within a month without treatment, this complication can be a cause of trouble between the implant surgeon and patient. This report presents a case of BPPV following OSFE. METHODS: A 27-year-old man without any significant medical problems and missing his maxillary right first molar, was scheduled for OSFE and simultaneous implant placement. RESULTS: The patient suffered dizziness accompanied by nausea immediately after implant placement using OSFE. Following referral to the ear nose throat clinic, "right posterior canal BPPV" was diagnosed. Despite anti vertigo medication and a single episode of the Epley maneuver, the condition did not improve completely. The Epley maneuver was then applied 7 and 8 days later and the symptoms of BPPV disappeared. One year later, the patient remained symptom-free. CONCLUSIONS: Before sinus elevation with an osteotome, implant surgeons should screen out patients with a history of vertigo, to diminish the possibility of BPPV. Operators should be aware of BPPV symptoms. As the symptoms may be very incapacitating, immediate referral to an otorhinolaryngologist is recommended.

Assessment of Children with Developmental Delay: Korean-Ages & Stages Questionnaires(K-ASQ) and Bayley Scales of Infant Development test II(BSID-II)

PURPOSE: Ages & Stages Questionnaires (K-ASQ, parents report of developmental skills) was used as a screening tool for detecting infant and young children with developmental disorder in National Health Screening Program. This study was designed for validating the effectiveness of K-ASQ in the assessment of children with developmental delay. METHODS: One hundred twenty-nine children(male: 94, female: 35, age: 8-39 months) with suspected developmental delay, who visited the department of Pediatrics in Catholic University of Daegu Hospital from January 2008 to August 2009 were enrolled. They were classified into three groups according to Mental Developmental Index of Bayley Scales of Infant Development test II(BSID II)(Group I: MDI or =85: within normal range), and compared with the result of K-ASQ. RESULTS: Group I was eighty-one children. Group II was thirty-eight children. The scores of eighty children of Group I and thirty-three children of Group II fall below a given cut off score in one or more domains in K-ASQ. One child's score of group I didn't fall below a given cut off score but was adjacent to a given cut off score. Five children's scores of group II didn't fall below a given cut off score. Only three children's score of these five were adjacent to a given cut off score. CONCLUSION: There was relatively high correlation between the results of K-ASQ and BSID-II for infants and children with developmental delay. Our results suggest that the referral for further developmental evaluation is recommended if the scores showed below or adjacent to a given cut off score in any domain in K-ASQ.

A case of glycogen storage disease type Ib / 소아과

We report a case of an 18-month-old girl with glycogen storage disease type Ib (GSD Ib). Her neutrophil counts had gradually decreased to less than 500/microL by the age of 3 years. However, there were no recurrent bacterial infections. Mutation analysis of the glucose-6-phosphate translocase (G6PT) gene revealed a compound heterozygous missense mutation (Ala148Val/Gly273Asp).

Measurement of hard tissue density of head phantom based on the HU by using CBCT / 대한구강악안면방사선학회지

PURPOSE: The purpose of this study was to determine a conversion coefficient for Hounsfield Units(HU) to material density (g cm-3) obtained from cone-beam computed tomography (CBMercuRay(TM)) data and to measure the hard tissue density based on the Hounsfield scale on dental head phantom. MATERIALS AND METHODS: CT Scanner Phantom (AAPM) equipped with CT Number Insert consists of five cylindrical pins of materials with different densities and teflon ring was scanned by using the CBMercuRay(TM)(Hitachi, Tokyo, Japan) volume scanner. The raw data were converted into DICOM format and the HU of different areas of CT number insert measured by using CBWorks(TM). Linear regression analysis and Student t-test were performed statistically. RESULTS: There was no significant difference (P>0.54) between real densities and measured densities. A linear regression was performed using the density, rho (g cm-3), as the dependent variable in terms of the HU(H). The regression equation obtained was rho=0.00072H-0.01588 with an R(2) value of 0.9968. Density values based on the Hounsfield scale was 1697.1+/-24.9 HU in cortical bone, 526.5+/-44.4 HU in trabecular bone, 2639.1+/-48.7 HU in enamel, 1246.1+/-39.4 HU in dentin of dental head phantom. CONCLUSION: CBCT provides an effective option for determination of material density expressed as Hounsfield Units.