Mycoplasma pneumoniae Infection Affects the Serum Levels of Vascular Endothelial Growth Factor and Interleukin-5 in Atopic Children

PURPOSE: Previous studies have outlined mechanisms by which Mycoplasma pneumonia (M. pneumonia) infection may promote allergic lung inflammation and airway remodeling, and increasing evidence from human studies suggests that atypical bacterial infections contribute to asthma exacerbation, chronic asthma, and disease severity with changes in cytokine expression. The present study evaluated changes in serum levels of vascular endothelial growth factor (VEGF) and interleukin (IL)-5 in atopic children with Mycoplasma pneumoniae pneumonia. METHODS: We recruited a total of 72 children with pneumonia. The patients were divided into 4 groups: atopic children with M. pneumonia pneumonia (group I, n=24), non-atopic children with M. pneumonia pneumonia (group II, n=23), atopic children with viral pneumonia (group III, n=13), and non-atopic children with viral pneumonia (group IV, n=12). Serum levels of IL-5, IL-13, VEGF, and tumor necrosis factor-alpha were measured at admission and at recovery using enzyme-linked immunosorbent assays. RESULTS: Serum levels of VEGF and IL-5 were elevated in group I compared with the other groups at both admission phase and clinical recovery phase. In group I, serum levels of VEGF and IL-5 were higher at recovery phase than at admission phase (VEGF: 1,102.2+/-569.4 vs. 874.9+/-589.9 pg/mL, respectively; IL-5: 150.5+/-63.9 vs. 120.2+/-46.7 pg/mL, respectively). CONCLUSIONS: The serum levels of VEGF and IL-5 were more increased in atopic children with M. pneumonia pneumonia than in the other groups. In this group, the serum levels of VEGF and IL-5 were more increased at recovery phase than at admission phase. The results of this study suggest that increases in VEGF and IL-5 may contribute to the development of hypersensitivity during M. pneumonia infection. These cytokines may act through their respective pro-inflammatory pathways to aggravate the allergic status and induce airway hypersensitivity during M. pneumonia pneumonia in atopic children.

Prevalence of Late Effects by Designed Health Promotion Program in Long-term Survivors of Childhood Cancer / 임상소아혈액종양

BACKGROUND: We prospectively investigated the incidence and features of late organ complications in long-term childhood cancer survivors (LTCCS) who took part in a specially designed health promotion program (HPP).METHODS: We developed our own HPP for LTCCS based on the Children's Oncology Group (COG) program, by modifying the adult HPP in Hanyang University Medical Center. The study included survivors who had received chemotherapy and/or radiotherapy for childhood cancer and had survived for at least 4 years after the end of treatment without evidence of recurrence.RESULTS: A total of 38 survivors were enrolled in the study. One or more abnormal findings were identified in 33 (87%) of the survivors, and two or more abnormal findings were present in 16 (42%) of the survivors. The most frequent type of abnormality was identified by thyroid ultrasonography, which detected benign nodules or cysts in 17 (45%) of the survivors. High-risk posttraumatic stress disorder needing medical treatment was detected in 1 of 17 survivors who were examined by psychological questionnaire.CONCLUSION: Most (87%) of childhood cancer survivors have at least 1 major or minor late effect. They must be continuously monitored after completion of treatment for early detection of late effects as well as cancer recurrence. Nationally integrated research is needed to provide standardized and comprehensive HPP for LTCCS considering domestic circumstances in Korea.

Prevalence of Late Effects by Designed Health Promotion Program in Long-term Survivors of Childhood Cancer / 임상소아혈액종양

BACKGROUND: We prospectively investigated the incidence and features of late organ complications in long-term childhood cancer survivors (LTCCS) who took part in a specially designed health promotion program (HPP). METHODS: We developed our own HPP for LTCCS based on the Children's Oncology Group (COG) program, by modifying the adult HPP in Hanyang University Medical Center. The study included survivors who had received chemotherapy and/or radiotherapy for childhood cancer and had survived for at least 4 years after the end of treatment without evidence of recurrence. RESULTS: A total of 38 survivors were enrolled in the study. One or more abnormal findings were identified in 33 (87%) of the survivors, and two or more abnormal findings were present in 16 (42%) of the survivors. The most frequent type of abnormality was identified by thyroid ultrasonography, which detected benign nodules or cysts in 17 (45%) of the survivors. High-risk posttraumatic stress disorder needing medical treatment was detected in 1 of 17 survivors who were examined by psychological questionnaire. CONCLUSION: Most (87%) of childhood cancer survivors have at least 1 major or minor late effect. They must be continuously monitored after completion of treatment for early detection of late effects as well as cancer recurrence. Nationally integrated research is needed to provide standardized and comprehensive HPP for LTCCS considering domestic circumstances in Korea.

Effect of Prophylactic Ibuprofen in Preterm Infants Less than 1,250 g in Birth Weight

PURPOSE: Ibuprofen is used for prevention and treatment of patent ductus arteriosus as an alternative drug of indomethacin in very premature infants. We aimed to determine the effect of prophylactic ibuprofen on patent ductus arteriosus and clinical outcomes in preterm infants less than 1,250 g. METHODS: A retrospective review of 39 preterm infants who were admitted to our neonatal intensive care unit from November 2009 to July 2010 was performed. Patients were divided into a prophylactic group (n=13) and a matched historical control group (n=26), where prophylactic ibuprofen were administrated within 24 hours after birth. The rate of ductal closure, side-effects of drug treatment and clinical outcomes were compared between two groups. RESULTS: Comparison of the prophylactic and control groups revealed no significant differences in the rate of ductal closure (69.2% vs 77.7%, P=0.825) and surgical ligation (23.1% vs 30.8%, P=0.719). Occurrence of bowel perforation was more frequent in the prophylactic group than the control group, but was not significant (30.8% vs 11.5%, P=0.194). The frequency of intraventricular hemorrhage (grade> or =3) and other outcomes did not differ between the groups. CONCLUSION: Ibuprofen prophylaxis in preterm infants did not decrease the rate of ductal closure, the need for surgical ligation and the incidence of intraventricular hemorrhage. Further studies are needed to investigate the beneficial effect and associated adverse events attributed to ibuprofen prophylaxis.

Langerhans Cell Histiocytosis Diagnosed at the Neonatal Period / 임상소아혈액종양

BACKGROUND: We retrospectively analyzed the clinical data to describe the characteristics of lesions, extent of disease, and outcomes in patients with neonatal presentation of Langerhans cell histiocytosis (LCH).METHODS: Clinical data obtained from neonate diagnosed with LCH at Asan Medical Center between March 1998 and May 2010 were studied. A review of the medical records, analyzing the clinical parameters such as age when signs and symptoms initially manifested, morphologic characteristics of lesions, age at diagnosis, additional organ involvement, therapy administered, course, and outcome, including delayed sequelae was done.RESULTS: Among seventy nine (36 female, 43 males) patients, 6 patients (3 female, 3 male) were presented symptoms within 4 weeks after birth and diagnosed with neonatal LCH (7.6%). Median age of the 6 patients was 11.5 (5-42) days and LCH was diagnosed based on the CD1a positivity. At diagnosis, 4 patients showed single system (SS) LCH (66.7%) whereas 2 patients had multisystem (MS) LCH (33.3%) and skin lesions were the most common initial manifestation (83.3%). The probability of event free survival at 12 years was 83.3%.CONCLUSION: Skin lesion was the most prominent manifestation of the neonatal LCH with complete spontaneous involution. A multi-organ evaluation at the time of diagnosis is important to ascertain the possibility of multisystem involvement with LCH.

Langerhans Cell Histiocytosis Diagnosed at the Neonatal Period / 임상소아혈액종양

BACKGROUND: We retrospectively analyzed the clinical data to describe the characteristics of lesions, extent of disease, and outcomes in patients with neonatal presentation of Langerhans cell histiocytosis (LCH). METHODS: Clinical data obtained from neonate diagnosed with LCH at Asan Medical Center between March 1998 and May 2010 were studied. A review of the medical records, analyzing the clinical parameters such as age when signs and symptoms initially manifested, morphologic characteristics of lesions, age at diagnosis, additional organ involvement, therapy administered, course, and outcome, including delayed sequelae was done. RESULTS: Among seventy nine (36 female, 43 males) patients, 6 patients (3 female, 3 male) were presented symptoms within 4 weeks after birth and diagnosed with neonatal LCH (7.6%). Median age of the 6 patients was 11.5 (5-42) days and LCH was diagnosed based on the CD1a positivity. At diagnosis, 4 patients showed single system (SS) LCH (66.7%) whereas 2 patients had multisystem (MS) LCH (33.3%) and skin lesions were the most common initial manifestation (83.3%). The probability of event free survival at 12 years was 83.3%. CONCLUSION: Skin lesion was the most prominent manifestation of the neonatal LCH with complete spontaneous involution. A multi-organ evaluation at the time of diagnosis is important to ascertain the possibility of multisystem involvement with LCH.