A Case of Cervical Disc Herniation with Paresthesia in Both Arms and Tic Mimicking Motions

Intervertebral disc herniation is rare in children and is reportedly related with disc calcification and traumatic injury. We report an 8 years old girl, who complained of tingling sensation in both arms and intentional tic like neck stretching for about 1 month. She had got unnoticed whiplash Injury 2 weeks before symptoms. She also had been taking lessons for taekwondo for one and half year. Physical examination was unremarkable. Her symptoms got aggravated over the next 4 weeks. Plain vertebral x-ray showed no abnormalities, but cervical spinal MRI revealed disc central herniations at C 5-6 and C 6-7 levels. We concluded that her paresthesia and tic like motion were related with cervical disc herniation from hyperflexion neck injury.

Use of Inhaled Iloprost in an Infant With Bronchopulmonary Dysplasia and Pulmonary Artery Hypertension

Pulmonary artery hypertension is a common cardiovascular complication in preterm infants with bronchopulmonary dysplasia which is associated with increased morbidity and mortality. Inhaled iloprost is used as a therapeutic option in pulmonary hypertension, especially in adults. There have been but a few reports on the use of iloprost for neonates and infants. We report the case of a 5 month-old-male infant who received neonatal intensive care for 4 months due to respiratory distress syndrome and prematurity, during which he developed bronchopulmonary dysplasia. Echocardiography showed severe pulmonary hypertension. The initial treatment included respiratory support with high frequency oscillatory ventilation (HFOV); however, his clinical condition did not improve. Inhaled iloprost with sildenafil, an oral phosphodiesterase-5 inhibitor, was thus used. With the administration of iloprost and sildenafil, his condition improved and he was weaned from oxygen. Our clinical experience suggests that iloprost is a promising therapy for pulmonary hypertension, especially when inhaled nitric oxide is unavailable.

Measuring depth of anesthesia with EEG and ECG in children / 대한마취과학회지

BACKGROUND: Heart rate is tightly controlled by brain. If activity of brain and electroencephalograph (EEG) are changed by anesthetics, electrocardiograph (ECG) might be changed. We investigated whether there is a correlation between EEG and ECG, ECG could replace EEG as a monitor for depth of anesthesia. METHODS: We recruited 50 patients, aged 2-8 years. Inspired and expired end-tidal sevoflurane concentrations were held constant at 1.0 or 2.5 vol%, after which ECG and EEG were obtained for 15 minutes. Total power (TP), low-frequency power (LFP), high-frequency power (HFP), approximate entropy (ApEn), and Hurst exponent (H) were calculated from the ECG. The relationship between EEG and ECG indices at the two sevoflurane concentrations was measured by Pearson's correlation coefficient. RESULTS: As anesthesia deepened, ApEn, H of ECG and beta wave decreased and those of delta and theta increased in 4 channels. In FP2, changes of beta and theta wave were negatively correlated with ApEn and H of ECG (P < 0.05), and changes of delta wave was positively correlated with ApEn (P < 0.05) and H (P < 0.01). In F8, changes of beta and theta wave were negatively correlated with ApEn (P < 0.05) and only theta wave was negatively correlated with H (P < 0.05). In C4, change of delta wave was positively correlated with ApEn (P < 0.001) and H (P < 0.05). CONCLUSIONS: EEG and ECG indices are correlated during sevoflurane anesthesia in children, and ECG-derived indices could possibly be used to monitor depth of anesthesia.

Effect of Horizontal Eye Movements on the Heart Rate Variability after Exposure to a Fear-Inducing Film Clip

OBJECTIVES: There has been a continued debate regarding the role of eye movements in Eye Movement Desensitization and Reprocessing(EMDR). This study examined the possible autonomic effect of horizontal eye movements after being exposed to fearful stimuli. METHODS: Fifty two healthy adult women were randomly allocated to eye movement or eye fixed groups after watching a five minute fear-inducing film clip. ECG was recorded during the resting state, after watching the clip, and the treatment. A spectral power analysis of the heart rate variability was performed. As the variables violated the rule of normal distribution and the number in each group is small the non-parametric test was used. RESULTS: Overall, we did not find the differences between the groups in both time and frequency domains. Some minor differences found were not consistent with results from previous studies. CONCLUSIONS: Effect of eye movement on autonomic nervous system during fear desensitization was not supported in this experiment. Further study with other psychophysiological measures is needed to understand the role of eye movements in treatment of traumatic memory.

Correlation between BIS and layered behavior of heart rate in children under general anesthesia

BACKGROUND: The bispectral index (BIS) is based on changes in the electroencephalogram, and is commonly used to monitor depth of anesthesia. The central nervous system (CNS) controls heart rate variability (HRV). The purpose of this study was to examine the relationship between heart rate variability and changes in BIS. METHODS: We recruited 33 patients, aged 2-12 years. On arrival at the operating room, electrocardiograph (ECG), SpO2, noninvasive blood pressure, and BIS were monitored. After induction and intubation, patients were ventilated with sevoflurane in 35% oxygen in air. At a tidal volume of 7 ml/kg, the respiratory rate was adjusted to maintain an end-tidal CO2 of 35-40 mmHg. Inspired and expired end-tidal sevoflurane concentrations were held constant at 1.0 or 2.5 vol% for more than 10 minutes, after which ECG and BIS data were obtained for 15 minutes. Low-frequency power (LFP), highfrequency power (HFP), approximate entropy (ApEn), maximum layered behavior indices (MaxLI), and mean layered behavior indices (MeanLI) were calculated from the ECG. The relationship between mean BIS and variability indices at the two sevoflurane concentrations was measured by Pearson's correlation coefficient. RESULTS: MaxLI and MeanLI were positively correlated to BIS; whereas LFP, HFP, and ApEn were not. CONCLUSIONS: BIS and ECG indices are correlated during sevoflurane anesthesia in children, and thus ECG-derived indices could be used to monitor depth of anesthesia.

A Case of Jarcho-Levin Syndrome with Fusion of Both Kidneys in a Newborn Infant

The Jarcho-Levin syndrome is a rare genetic disorder characterized by a short neck, short trunk, and a constricted thorax, and is due to multiple vertebral and rib defects. The small size of the thorax frequently leads to respiratory insufficiency and death in neonates or infants. This syndrome also combines with various kinds of anomalies, especially renal anomalies. We report an infant with Jarcho-Levin syndrome combined with fusion of both kidneys who was referred from a local obstetric clinic for cyanosis and respiratory difficulty.

A Pilot Study of Comparisons Between 1999 and 2007 Data on Childhood Asthma Caregiver's Quality of Life Questionnaire / 소아알레르기및호흡기학회지

PURPOSE: Childhood asthma is one of the most frequent chronic inflammatory diseases of the respiratory tract and can have profound effects on emotional, and economical aspects not only for childhood asthma patients, but also the patient's caregivers. It was also performed has been done in Korea in 1999 under the supervision of The Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD). We compared and evaluated the data from the questionnaire between 1999 and 2007 in order to obtain the pilot data for a nation-wide study on the life quality of childhood asthma caregivers. METHODS: We selected childhood asthma patients at the Department of Pediatrics, Hanyang University Seoul Hospital and Guri Hospital. The contents and categories of the questionnaire were identical with the one developed by KAPARD, the questionnaire were filled up twice at first & second visit, divided into emotion and activity domains. All items were rated on a 5 scores from 1 to 5: 1, a lower quality of life; and 5, a satisfactory quality of life. For the validity of the study, the caregivers filled up the first and the second questionnaire at least at 1-week intervals the measurement of forced expiratory volume 1 (FEV1) at each time and also added an item in the second questionnaire which compared the difference between 2 visits, subsequently scoring +5 for the most improved state, -5 for the most aggravated state and 0 for the stationary state. RESULTS: In this study, may higher scores in the second visit suggested successful management of asthma may contribute to the improvement in the caregiver's quality of life. Particularly, items such as "Frustration", "Embarrassment", "Worry about daily works" and "Concern about side effect of medicine" have been improved in the emotion domain, and "sleepless", "Night awakening", and "Disturbance of housework" in the activity domain. Between 1999 and 2007, "Concerning", and "Concern about ordinary works" has been improved in the first visit, and "Disturbance of houseworks", "Worry about daily works" and "Concern about side effects of medicine" in the second visit. CONCLUSION: The results of this study suggest that there may be no significant different items regarding the quality of life between the stable and changed groups, suggesting that our questionnaire can be applicable to clinical practice.

Neurologic Complications Associated with Respiratory Syncytial Virus Infection in Childhood

PURPOSE: Respiratory syncytial virus(RSV) mainly brings about respiratory complication, but it can also be related to neurologic complication. We have studied clinical aspect and incidence of neurologic complication associated with RSV infection. METHODS: We reviewed the medical records of 732 children with RSV infection who were admitted to the department of pediatrics, Hanyang University hospital from November 2002 to June 2007 and studied on existence of neurologic complication, age, sex, clinical symptom, characteristics of seizure, and laboratory findings. RESULTS: Neurologic complications were occurred in 52 patients(7.1%) among 732 patients. Among them, 14 patients(1.9%) had seizure and 38 patients(5.2%) had alteration of mental status such as drowsy, lethargy. Age distribution of patients with neurologic complication was from 1 month to 5 years(mean 16.4 months). There were 30 boys and 22 girls. Among 14 patients who had seizure, 2 patients had convulsion disorder, 3 patients had febrile convulsion, and 9 patients had no seizure before. Their age distribution was from 1 months to 4 years(mean 18.4 months) and there were 8 boys and 6 girls. All of 14 patients showed generalized tonic clonic seizure and durations were from 30sec to 15 min(mean 4.4 min). All of the investigations were normal. None of 52 patients had recurrence and neurologic sequelae. CONCLUSION: It is important to know that RSV can cause CNS complications because we know how many patients infected by RSV. RSV-related seizure can be considered as benign seizure which does not need any long-term antiepileptic medication.

Spontaneous Baroreflex Sensitivity and Multifractal Hurst Analysis of Heart Rate

BACKGROUND AND OBJECTIVES: This study was designed to examine whether the multifractal Hurst exponents of heart rate can estimate activating and deactivating spontaneous baroreflex sensitivity (SBRS). SUBJECTS AND METHODS: Age and sex matched 24 healthy volunteers were placed in the supine position and head-up tilt position for 30 minutes, and the systolic blood pressure and heart rate were measured in an noninvasive manner. When the RR interval (RRI) sequence and systolic pressure sequence simultaneously increased or decreased for more than three successive beats, the slope of the linear regression line of systolic blood pressure and RR interval sequence was defined as the value of spontaneous baroreflex sensitivity (SBRS). From the RR intervals, very short-term (alpha range, or =12 heartbeats), and the multrifractal Hurst exponents were calculated to determine the linear correlation.coefficients for SBRS. RESULTS: In the supine position, the linear correlation coefficients (p) of SBRS and H-5alpha, H-4alpha, H-3alpha, H-2alpha, H-1alpha, H1alpha, H2alpha, H3alpha, H4alpha, H5alpha were -0.195 (NS), -0.207 (NS), -0.232 (NS), -0.282 (NS), -0.355 (NS), -0.621 (0.003), -0.650 (0.001), -0.677 (0.001), -0.699 (0.0006) and -0.708 (0.0005), respectively. In the tilting position, the linear correlation coefficients of SBRS and H-5beta, H-4beta, H-3beta, H-2beta, H-1beta, H1beta, H2beta, H3beta, H4beta, H5beta were 0.024 (NS), 0.020 (NS), 0.010 (NS), -0.028 (NS), -0.193 (NS), -0.627 (0.0034), -0.607 (0.0045), -0.598 (0.0053), -0.572 (0.0084) and -0.539 (0.0141), respectively. CONCLUSION: Some of the very short-term and short-term generalized Hurst exponents, such as H5alpha and H1beta, can be used for the estimation of spontaneous baroreflex sensitivity during patient placement in the supine and head-up tilt position, respectively.

A Case of Congenital Bilateral Choanal Atresia associated with Athelia in Neonate

Choanal atresia is the congenital failure of one or both posterior nasal apertures to communicate with the nasopharynx. Coexisting congenital anomalies are 20% to 50% of patients. Bilateral choanal atresia almost always presents respiratory distress, sucking difficulty and cyanosis relieved by crying in the newborn. Bilateral choanal atresia in newborns and infants carries significant morbidity and mortality, therefore, prompt correction is required. Athelia is the absence of the nipple-areola complex. It is a rare entity that can be either congenital or acquired. Congenital athelia is always associated with amastia and a syndrome. We report a case of choanal atresia associated athelia, in term baby.

Factors Associated with Care-giver Burden of Pediatric Epilepsy Patients

BACKGROUND: Pediatric epilepsy can result in a heavy burden of illness for the family and the role of family caregivers is becoming more important for the management of the disease. However, there are only few studies about care-giver burden of pediatric epilepsy. This study examined the factors which may influence care-giver burden of pediatric epilepsy patients METHODS: We surveyed 87 care-givers of pediatric epilepsy patients. The demographic and social data of the care-givers, along with the social and clinical data of the patients were obtained. The Korean version of the Burden Interview (KBI) and the Korean version of the Beck Depression Inventory (KBDI) were used. The relationship between the demographic and social data of care-givers, the clinical factors of the patients and KBI score were evaluated. RESULTS: Of the 87 participants, sixty-nine (79.3%) were the mothers. The mean age of caregivers was 41.3 years and the mean score on the KBI was 20.2 (+/-16.8) points. The mean age of the patients was 11.1 years and 48 patients (55.8%) were male. The number of antiepileptic drugs prescribed, severity of the disease and school record had a significant correlation with KBI in a multivariate linear regression analysis. CONCLUSIONS: We suggest that in addition to the strict control of the seizure, that the consideration for the academic functions of pediatric patients is also important for reducing care-giver burden in the treatment of pediatric epilepsy.

A Case of Hydromyelia with Erythematous Depressed Patch on Low Back in Newborn Infant

The hydromyelia is one kind of four types of syringomyelia, chronic progressive and degenerative disorder, which develops pathological cavity or syrinx within spinal cord. It is rare and comprises dilated spinal syrinx. Its clinical manifestations include muscle weakness without pain in arm and hand, dissociated segmental dysesthesia, and loss of pain and temperature sensation. It is also frequently associated with hydrocephalus. We report a case of hydromyelia with erythematous depressed patch on low back in term neonate.

Study on the Prognosis According to Clinical Patterns and Laboratory Findings in Children with Acute Encephalopathy

PURPOSE:Acute encephalopathy is defined as diffuse interference of brain functions due to neuronal dysfunction by generalized or multifocal insults. In this study, we investigated the relationship between the prognosis and other factors such as clinical patterns, laboratory findings, electroencephalographic and radiologic findings in children with acute encephalopahty. METHODS:We carried out a retrospective review on the medical records of 43 patients who were initially diagnosed as encephalopathy from January 1995 to June 2004. We excluded the patients diagnosed as mumps meningitis, Reye syndome and neonatal hypoxic ischemic encephalopathy. RESULTS: 1) The morality rate was 50% in the patients below 1 year old at the admission, but all the patients above 10 years old were survived. 2) The morality rate was 40% in the patients with alert mental status at the admission and one patient with comatous mental status died. 3) The morality rate of the patients without seizures at the admission(35.7%) was higher than that of the patients with seizures(10.3%). But there was no statistical significance. 4) In the patients with abnormal liver function tests, the mortality rate(40%) was singnificantly higher than that of the patients with normal liver functions(7.1%, P value <0.05) 5) Only 5 patients(20%) among 25 patients who took both EEG's and imaging studies were taken showed abnormalities at the same locations in both studies. But there was no significant relationship between the mortality rate and EEG and the radiologic findings. CONCLUSION:In this study, we could not find out the statistically significant relationship between the prognosis and other factors such as age, consciousness levels, the presence of seizures at the admission, and electroencephalographic and radiologic abnormalities. But the patients with abnormal liver functions at the admission showed statistically significant higher mortality rates than patients with normal liver function.

Genotype of rotavirus isolated from patients with rotaviral enteritis and neurological complications / 소아과

PURPOSE: This study was undertaken to determine the differences in genotypes of rotavirus and their incidence between patients with acute rotaviral enteritis who suffered neurologic complications and those who did not suffer neurologic complications. METHODS: Among the 82 patients with rotaviral enteritis whose genotype was analyzed, 71 patients were not associated with neurologic complications(neurology(-) group), and eleven patients were associated with neurologic complications(neurology(+) group). Four G genotypes and four P genotypes were determined by reverse trans cription and multiplex polymerase chain reaction. RESULTS: In the neurology(-) group, the number of G4, G3, G2 and G1 was 24(35.3 percent), 23 (33.8 percent), 17(25.0 percent) and 4(5.6 percent), respectively and the number of P6, P4, P8 and P9 was 26(36.1 percent), 23(31.9 percent), 22(30.6 percent) and 1(1.4 percent), respectively. G2P4, and G4P6 were the most frequently found com bination genotypes, respectively. In the neurology(+) group, the number of G2, G3 and G4 was 9(75.0 percent), 2(16.7 percent) and 1(8.3 percent), respectively and the number of P4, P6, P8 and P9 was 8(66.7 percent), 2(16.7 percent), 1(8.3 percent) and 1(8.3 percent), respectively. G2P4 was the most frequently found combination genotype. The incidence of each of the G2, P4 and G2P4 was significantly higher in the neurology(+) group when compared to that of each of the G2, P4, and G2P4 in the neurology(-) group. CONCLUSION: In the patients with acute rotavirus gastroenteritis associated with neurologic complications, the G1 genotype was not found and genotypes of the G2, P4, and G2P4 were more frequently found.

The Different Abnormalities of Autonomic Nervous Modulation and Instability of Fetal Heart Rate According to Different Etiologies of Intrauterine Growth Restriction

BACKGROUND AND OBJECTIVES: The purpose of this study was to examine whether the different etiologies of intrauterine growth restriction (IUGR) produce different autonomic nervous modulation and instability of the fetal heart rate (FHR) regulation. SUBJECTS AND METHODS: We investigated the frequency-domain variability and instability in the FHR from 150 uneventful pregnancies (control group), 47 pregnancies with idiopathic IUGR (iIUGR group) and 48 with IUGR associated with severe pre-eclampsia of the mother (PEIUGR group). The FHR was analyzed for the power spectrum and very short-term intermittency (C1alpha), which are used to quantify the instability in FHR. RESULTS: Compared to the control group, the iIUGR group showed significantly increased low- and high-frequency powers (LFP and HFP, respectively). In contrast, the PEIUGR group showed significantly decreased LFP and LFP/HFP ratio, but significantly increased C1alpha compared to the control and iIUGR groups. CONCLUSION: The IUGR of an idiopathic cause produces abnormally increased the autonomic modulation of the FHR. In contrast, the IUGR due to pre-eclampsia abnormally decreased the autonomic modulation in the low-frequency range, but increased the instability of the fetal heart rate regulation.

Teratogenic Effect of X-ray on Cardiovascular System of Chick Embryo

BACKGROUND AND OBJECTIVES: Laboratory research was carried out to investigate the teratogenic effect of X-ray on chick embryos, especially with regard to cardiovascular malformation. MATERIALS AND METHODS: The chick embryos, 242, 242 and 215 eggs, were irradiated with X-ray at the dose of 500, 750 and 1000 cGy, respectively, during the incubation period between 0 and 9 days. A control group of 90 eggs received no irradiation. After 2 weeks of incubation, the embryos were sacrificed and examined. RESULTS: The survival rate of irradiated group was significantly lower than that of control group (62.5 vs. 87.8%, p<0.0001). The incidence rate of cardiovascular malformation was significantly higher in the irradiated than the control group (16.2 vs. 2.5%, p<0.005). The rate of cardiovascular malformation in the irradiated group increased from 9.4% with 500 cGy to 24.5% with 1000 cGy (p<0.05). There were a total of 33 cases of cardiac malformation, of which 24 were ventricular septal defects and 9 were complex congenital heart diseases. The higher the administered dose of radiation, the higher the observed incidence rate of cardiac malformation and the more complex the cardiac anomaly. Also, the rates of exocardia, exencephaly, beak anomalies and anopia were all increased in the irradiated group. CONCLUSION: X-ray irradiation of chick embryos increased the rates of death and cardiovascular malformation. The highest dose resulted in greater complexity of the cardiovascular malformation.

A Case of Congenital Laryngeal Atresia with Single Umbilical Artery Who Required a Tracheotomy / 소아과

Congenital laryngeal atresia is a rare cause of airway obstruction that is almost always lethal within a few minutes after birth. Therefore congenital laryngeal atresia should be diagnosed in the prenatal period. If not, it should be considered in newborn infant with life-threatening symptoms at birth such as cyanosis and dyspnea that need emergent procedures like a tracheotomy. We report a case of congenital laryngeal atresia with single umbilical artery diagnosed in a one-day-old neonate who required a tracheotomy and ventilator care after intubation failure.

Medicolegal Problems in Pediatric Area / 소아과

PURPOSE: Medicolegal problems start when the patient asserts the mistake of doctor and doctor does not accept it. The purpose of this study is to assess the actual condition of medicolegal problems and to provide solutions of medicolegal problems in the pediatric field. METHODS: There is not official statistical data about medicolegal problems in our country. We gathered data of legal insurance program of Korean Medical Association (KMA) and court cases and other fragmentary data. RESULTS: Between 1981 and 1995, of total 2, 338 cases reported to legal problem insurance program of KMA, most common ones were 748 cases of obstetrics and gynecology. Pediatric case was ranked at the 5th, 74 cases (3.1%). According to analysis of 41 medicolegal cases' after 1990, maltreatment of patient had the highest incidence of 14 cases, injection and medication were related to 12 cases, misdiagnosis was 9 cases, patient management were related to 4 cases, and others were 2 cases. The trial result of the medicolegal cases was that 31 cases were compensated, and 8 cases were defeated, and 2 cases were still in the process. CONCLUSION: The aspect of medical legal problem has the tendency of radicalism and systematization. This brings an economic destitution in the patient and gives damage to a doctor. In order to reduce medicolegal problem, doctor should offer a duty of explanation and efforts to his best to satisfy patient and endeavor to make an intimate doctor-patient relationship.

Decreased Nonlinear Coupling of Peripheral Blood Volume to Heart Rate in Preterm Infants / 소아과

PURPOSE: We investigated the autonomic nervous and complex modulation of heart rate and peripheral blood volume, and linear and nonlinear coupling between heart rate and peripheral blood volume in full-term and preterm infants. METHODS: In twenty healthy preterm infants and twenty full-term infants at postconceptional age of 30-37 and 38-41 weeks each, we recorded electrocardiogram and photoplethysmogram simultaneously during sleep in the supine position. To evaluate the autonomic and complex modulation, we performed power spectral analysis and analysis of the univariate nonlinear determinism. To quantify degree of linear and nonlinear couple between heart rates and peripheral blood volume, analyses of cross spectrum and bivariate nonlinear determinism were performed respectively. RESULTS: In the analysis of heart rates, preterm infants had significantly lower normalized high-frequency power (20.3+/-7.7% vs 30.7+/-15.1%, P<0.05), higher low-to high-frequency power ratio (3.0+/-2.1 vs 1.9+/-1.6, P<0.05), and significantly lower univariate prediction error (2.9+/-1.3% vs 4.1+/- 2.8%, P<0.05) when compared to full-term infants. In the analysis of peripheral blood volume, they showed no significant differences. Cross spectrum in all frequency ranges showed no significant difference between them. But preterm infants showed a significantly higher bivariate nonlinear prediction error (4.8+/-3.8% vs 3.1+/-2.2%, P<0.05) and a lower statistical coupling index (16.6+/-10.4 vs 22.9+/-9.2, P<0.05) than full-term infants. CONCLUSION: Compared to full-term infants, the heart rates of preterm infants are less modulated by cardiac parasympathetic activity and less complex. Furthermore, their peripheral blood volume was less nonlinearly coupled to heart rate.

Heart Rate Instability and Autonomic Modulation of the Heart Rate in Fetuses Affected by Severe Preeclampsia with or without Growth Restriction

No Abstract available.