ABSTRACT
PURPOSE: This study was aimed to investigate the relationship between changes in intrapulmonary right to left shunt(QSP/QT) and improvements in oxygenation during the 2-hr study period after Surfactant-TA(S-TA) administration. METHODS: Umbilical arterial blood gases and corresponding respiratory indexes of 27 preterm neonates with respiratory distress syndrome were studied. The neonates were separated into group A(n=20) and group B(n=7) according to whether their initial QSP/QT was above or below 30 %, respectively. And the patients were studied immediately before and after endotracheal single- dose S-TA administration within 6 hours after birth. RESULTS: In the case of P(a/A)O2, group A showed a significant increase throughout the study period(P<0.01, P<0.001), whereas group B showed an initial significant increase at 2 hr(P<0.05). Significant correlations between changes in QSP/QT and improvements in P(a/A)O2 were seen in both groups(P<0.001, P<0.05). Moreover in the case of PaO2/FIO2, group A showed a significant increase throughout the study period(P<0.01, P<0.001), whereas group B showed an initial significant increase at 30 min(P<0.05). Significant correlations between changes in QSP/QT and improvements in PaO2/FIO2 were also seen in both groups(P<0.01, P<0.05). And at 2 hr, VEI and VA showed a significant increase in both groups(P<0.05, P<0.01), whereas PaCO2 showed a significant decrease in both groups(P<0.001, P<0.05). CONCLUSION: Irrespective of initial QSP/QT, immediate improvements in oxygenation following surfactant replacement were accomplished by recruiting atelectatic alveoli and stablizing underventilated alveoli(namely by decreasing QSP/QT). Moreover, the patients with more severe respiratory failure had a more rapid and sustained improvement in oxygenation.
Subject(s)
Humans , Infant, Newborn , Gases , Oxygen , Parturition , Respiratory InsufficiencyABSTRACT
PURPOSE: There were some reports that IgE-mediated food hypersensitivity is associated with subsequent development of atopic disease in wheezy infants. So we carried out this study to show whether the food specific IgE antibodies are useful to predict recurrent wheezing attack in wheezy infants. METHODS: A total of 190 children younger than 4-year-old were enrolled in this study. They were divided into 3 groups according to the number of experienced wheezing attacks as 1st, 2nd and more than 3rd attack group. There were 30 age-matched controls who had not wheezing nor family members of allergy. We measured peripheral blood eosinophil count, total serum IgE level, RAST f1(egg white), f2(milk), D1(Dp) and D2(Df) from the all participants. RESULTS: The proportion of patients having more than 250/mm3 cosinophils in each group increased as increasing wheezing attacks(P0.05). There was no significant difference in RAST f1 levels among the four groups. In contrast, the proportion of positive RAST f1 increased significantly as the number of wheezing attacks increased(P0.05). CONCLUSION: Egg white specific IgE antibody appear to be a risk factor for recurrent wheezing in infants and young child.
Subject(s)
Child , Child, Preschool , Humans , Infant , Antibodies , Asthma , Egg White , Eosinophils , Food Hypersensitivity , Hypersensitivity , Immunoglobulin E , Respiratory Sounds , Risk FactorsABSTRACT
PURPOSE: Mantoux test was widely used to identify the tuberculosis. But no reliable method exists for distinguishing tuberculin reactions caused by previous BCG vaccination from those caused by mycobacterial infections. So we studied Mantoux response in infants who had received BCG vaccination in the first month of life. METHODS: Mantoux testing was carried out in 143 healthy infants aged from 3 to 15months who had received BCG vaccination in the first month of life. Among them, 81 received Japan 172 strain BCG vaccination with multiple puncture method and 62 Copenhagen 1331 strain with intradermal method. RESULTS: The mean Mantoux reactions in the Japan 172 strain group were as follows : 10.0mm at 3 months, 9.7mm at 4-6months, 11.4mm at 7-9months, and 10.5mm at 10-15months. The mean Mantoux reactions in the Copenhagen 1331 strain group were as follows : 7.6mm at 3 months, 7.5mm at 4-6months, 7.5mm at 7-9months, and 6.8mm at 10-15months. Infants who received Japan strain had significantly larger sized induration in all ages. About 50% of Japan strain BCG-vaccinated infants had more than 10mm of tuberculin reaction. CONCLUSION: Infants who received Japan strain had significantly larger sized tuberculin reaction in all ages. Although the size of induration is more than 10mm in Tokyo strain BCG-vaccinated child, vaccine effect should be generally considered.
Subject(s)
Child , Humans , Infant , BCG Vaccine , Japan , Mycobacterium bovis , Punctures , Tuberculin Test , Tuberculin , Tuberculosis , VaccinationABSTRACT
PURPOSE: There are many methods to interpret the skin prick test which has been commonly used to find out the causative allergen in allergic disease. Among them two are most frequently used. One is to measure the absolute size of wheal which is caused by the allergen and the other is to compare the size of wheal for allergen with that of positive control. However the wheal is smaller than erythema at the same dosage of allergen and changes less with according to the allergen dosage. So we investigated the feasibility of the size of erythema as one of the index in the interpretation of skin prick test. METHODS: We carried out skin prick tests on various allergens, including Dermatophagoides pteronyssinus (Dp), Dermatophgoides farinae (Df), and house dust (HD) in 220 patients who visited the pediatric allergy clinic at Inha Hospital from January 1990 to January 1996. RESULTS: Among the 220 patients studied, 120 children (55%) showed positive skin test. There was significant correlation between wheal and erythema (P<0.0001 for Dp, P<0.0001 for Df, and P<0.0001 for HD). There was a significant statistical correlation (P<0.0001) between the allergen/histamine wheal ratio (A/HW ratio) and the size of erythema for Dp, P<0.0001 for Df, and P<0.0001 for HD. There was a significant statistical difference in the wheal size, A/HW ratio, and erythema size, allergen/histamine erythema ratio (A/HE ratio) for Dp, Df, HD between positve and negative group of RAST. As the RAST class increases, the erythema size and A/HE ratio for Dp, Df, and HD showed a tendency to increase. Sensitivity and specificity of skin test with cut off value of 20mm for erythema were 87.9%, 58.3% in Dp, 85.2%, 66.6% in Df, 61.4%, 71.9% in HD and 25mm were 75.9%, 83.3% in Dp, 67.6%, 91.6% in Df and 40.9%, 100% in HD. CONCLUSION: We conclude that erythema size can be used as one of the interpreting index of skin prick test. We also recommand more than 25mm as a cut off value for positive reaction for Dp, Df and more than 20mm for HD in bronchial asthma.
Subject(s)
Child , Humans , Allergens , Asthma , Dermatophagoides pteronyssinus , Dust , Erythema , Hypersensitivity , Sensitivity and Specificity , Skin Tests , SkinABSTRACT
PURPOSE: There are many methods to interpret the skin prick test which has been commonly used to find out the causative allergen in allergic disease. Among them two are most frequently used. One is to measure the absolute size of wheal which is caused by the allergen and the other is to compare the size of wheal for allergen with that of positive control. However the wheal is smaller than erythema at the same dosage of allergen and changes less with according to the allergen dosage. So we investigated the feasibility of the size of erythema as one of the index in the interpretation of skin prick test. METHODS: We carried out skin prick tests on various allergens, including Dermatophagoides pteronyssinus (Dp), Dermatophgoides farinae (Df), and house dust (HD) in 220 patients who visited the pediatric allergy clinic at Inha Hospital from January 1990 to January 1996. RESULTS: Among the 220 patients studied, 120 children (55%) showed positive skin test. There was significant correlation between wheal and erythema (P<0.0001 for Dp, P<0.0001 for Df, and P<0.0001 for HD). There was a significant statistical correlation (P<0.0001) between the allergen/histamine wheal ratio (A/HW ratio) and the size of erythema for Dp, P<0.0001 for Df, and P<0.0001 for HD. There was a significant statistical difference in the wheal size, A/HW ratio, and erythema size, allergen/histamine erythema ratio (A/HE ratio) for Dp, Df, HD between positve and negative group of RAST. As the RAST class increases, the erythema size and A/HE ratio for Dp, Df, and HD showed a tendency to increase. Sensitivity and specificity of skin test with cut off value of 20mm for erythema were 87.9%, 58.3% in Dp, 85.2%, 66.6% in Df, 61.4%, 71.9% in HD and 25mm were 75.9%, 83.3% in Dp, 67.6%, 91.6% in Df and 40.9%, 100% in HD. CONCLUSION: We conclude that erythema size can be used as one of the interpreting index of skin prick test. We also recommand more than 25mm as a cut off value for positive reaction for Dp, Df and more than 20mm for HD in bronchial asthma.
Subject(s)
Child , Humans , Allergens , Asthma , Dermatophagoides pteronyssinus , Dust , Erythema , Hypersensitivity , Sensitivity and Specificity , Skin Tests , SkinABSTRACT
Idiopathic pulmonary hemosiderosis (IPH), a rare disease of unknown etiology, is characterized by iron deficiency anemia and chronic recurrent pulmonary symptoms such as cough, hemoptysis, and dyspnea. Recurrent intra-alveolar hemorrhage resulting in hemosiderin accumulation and progressive fibrosis often leads to death. We experienced a case of IPH in a two-year-old male who was presented with cough, dyspnea, hemoptysis and anemia. The diagnosis was confirmed by hemosiderin-laden macrophages in a gastric aspirate. He was initially treated with oral iron and prednisolone for one year. But pulmonary symptoms such as cough and hemoptysis recurred five times while he was on oral prednisolone and the side effects of moon face and truncal obesity developed. So inhaled steroid (budesonide) was administered for 18 months, with improvement of pulmonary symptoms. This suggests that early treatment with inhaled steroids may work in IPH without the serious side effects of systemic steroid. The effect of inhaled steroid should be evaluated as the initial treatment of IPH.
Subject(s)
Child , Humans , Male , Anemia , Anemia, Iron-Deficiency , Cough , Diagnosis , Dyspnea , Fibrosis , Hemoptysis , Hemorrhage , Hemosiderin , Hemosiderosis , Inhalation , Iron , Macrophages , Obesity , Prednisolone , Rare Diseases , SteroidsABSTRACT
Idiopathic pulmonary hemosiderosis (IPH), a rare disease of unknown etiology, is characterized by iron deficiency anemia and chronic recurrent pulmonary symptoms such as cough, hemoptysis, and dyspnea. Recurrent intra-alveolar hemorrhage resulting in hemosiderin accumulation and progressive fibrosis often leads to death. We experienced a case of IPH in a two-year-old male who was presented with cough, dyspnea, hemoptysis and anemia. The diagnosis was confirmed by hemosiderin-laden macrophages in a gastric aspirate. He was initially treated with oral iron and prednisolone for one year. But pulmonary symptoms such as cough and hemoptysis recurred five times while he was on oral prednisolone and the side effects of moon face and truncal obesity developed. So inhaled steroid (budesonide) was administered for 18 months, with improvement of pulmonary symptoms. This suggests that early treatment with inhaled steroids may work in IPH without the serious side effects of systemic steroid. The effect of inhaled steroid should be evaluated as the initial treatment of IPH.
Subject(s)
Child , Humans , Male , Anemia , Anemia, Iron-Deficiency , Cough , Diagnosis , Dyspnea , Fibrosis , Hemoptysis , Hemorrhage , Hemosiderin , Hemosiderosis , Inhalation , Iron , Macrophages , Obesity , Prednisolone , Rare Diseases , SteroidsABSTRACT
PURPOSE: We investigated what kind of factors are the most stable among hemoglobin (Hb), hematocrit (Hct), MCV, MCH and RDW as a marker of discriminating anemia due to an acute inflammation from anemia of different origins. METHODS: We evaluated 141 patients with Kawasaki disease who had been admitted to the Department of Pediatrics, Inha hospital from 1990 to 1995. We analyzed their blood four times each week. RESULTS: Of the patients, 132 cases (93.6%) were less than 5 years of age and the median age was 2 years 3 months. After one week of hospitalization, Hb dropped a mean of 0.6g/dl compared to when first admitted. After three weeks of hospitalization, Hb increased a mean of 1.1g/dl compared to when first admitted. Coefficient of variation (CV) mean was Hct>Hb>RDW>MCH>MCV. The CV mean of Hb, Hct, MCV, MCH and RDW showed a significant difference (P=0.0001). In groups, there was an insignificant difference between Hb and Hct, there was a significant difference among the Hb-Hct group and MCV, MCH and RDW. Except for MCV, every RBC indices were changed in accordance with the measured time. But only MCV was relatively unchanged as time went by (P<0.5). CONCLUSION: Our finding indicate that MCV, MCH and RDW can be used as a useful marker for discriminating temporary anemia of acute inflammation from the other anemia of different origins, because MCV, MCH and RDW showed little change in measured values in comparison with the change of Hb and Hct in Kawasaki disease. The MCV is an useful factor among factors.
Subject(s)
Humans , Anemia , Hematocrit , Hospitalization , Inflammation , Mucocutaneous Lymph Node Syndrome , PediatricsABSTRACT
PURPOSE: We are inclined to analyze the relationship between the intrapulmonary right-to-left shunt and the PaO2/PaCO2 after endotracheal single-dose surfactant instillation to premature neonates with respiratory distress syndrome within 6 hours after birth. METHODS: From Jan. 1993 to Jun. 1995, we have conducted a clinical trial of surfactant replacement therapy to the premature neonates with respiratory distress syndrome at the neonatal intensive care unit of InHa University Hospital. The surfactant group (n=17) was given Surfactant-TA and mechanical ventilator care, but the control group (n=22) was treated with only mechanical ventilator. We analyzed umbilical arterial blood gases and estimated respiratoy indexes before and after treatment. RESULTS: 1) The QSP/QT decreased initially in the surfactant group, but significantly increased 24 hours after treatment in the control group (40.6+/-4.7%, P0.5) resulted in a decrease in PaO2 and also a significant relationship was found between the QSP/QT and the PaO2. However, there was no significant relationship between the QSP/QT and the PaCO2.
Subject(s)
Humans , Infant, Newborn , Capillaries , Gases , Hypocapnia , Intensive Care, Neonatal , Parturition , Pulmonary Surfactants , Ventilators, MechanicalABSTRACT
Although basic mechanisms of atopic dermatitis remain largely speculative, many studies on pathogenesis suggest the importance of food and inhalent allergens. To evaluate the frequency of food and house dust mite hypersensitivity and differences in this frequency according to ages, we measured the levels of specific IgE antibodies to egg white, egg yolk, milk, soy, and house dust mites in 119 children with atopic dermatitis. The results showed that 53% of patients had positive RAST to any one kind of allergens. The frequency of food and house dust mite hypersensitivity were 34.5%, 30.3 %, respectively. Among allergens, house dust mites and egg white are the most prevalent allergens in all atopic dermatitis patients. The Prevalence of egg white is most common under the age of 2 years, but those of house dust mites are the dust mites are the highest in the ages of 5-12 years. In conclusion, we recommend an egg restriction diet in atopic dermatitis patients who are less than 2 years old when their symptoms do not improve with general skin care.
Subject(s)
Child , Child, Preschool , Humans , Allergens , Antibodies , Antigens, Dermatophagoides , Dermatitis, Atopic , Diet , Dust , Egg White , Egg Yolk , Hypersensitivity , Immunoglobulin E , Mites , Ovum , Prevalence , Pyroglyphidae , Skin Care , Soy MilkABSTRACT
PURPOSE: There are some disagreements about the optimal dosages of intravenous gammaglobulin(IVGG) and oral aspirin(ASA) in the treatment of Kawasaki disease. So authors performed a prospective clinical study to evaluate the efficacy of IVGG 1g/kg plus ASA 50mg/kg/day. METHODS: We treated 29 patients who were admitted to Inha University Hospital from June 1993 through May 1994 with IVGG 1g/kg plus ASA 50mg/kg/d. We compared the outcomes of above patients with those of two other groups of patients, group A and B in authors' previous study. Group A(20 patients) had been treated with IVGG 2g/kg plus ASA 50mg/kg/d and group B(19 patients) with IVGG 2g/kg plus ASA 100mg/kg/d. The outcomes had been similar in group A and B, which was published on this journal in 1995 (vol. 38:378-385). RESULTS: 1) Twenty five patients(86.2%; group C) were given only one dose of IVGG 1g/kg, and remaining 4 patients(13.8%; group D) were given two doses of IVGG 1g/kg because of persistent high fever. 2) The age and sex distributions, durations of fever before treatment, and durations of ASA therapy in group C were not significantly different from those in group A and B (p>0.05). 3) Laboratory findings on admission in group C were not significantly different from those in group A and B, except that the mean ESR was lower in group C than in group A and B (35.1+/-19.8 vs 55.5+/-5.95 & 50.2+/-11.4mm/hr; p0.05, respectively). 5) In group C, the mean hemoglobin concentration at the 3rd week of illness was higher than in group A (11.1+/-0.98 vs 10.1+/-1.24g/dl; p0.05, respectively). In follow-up examinations, coronary aneurysm was observed in only one(1/23; 4.3%) in group C, which was similar to group A(1/18; 5.5%) and B(1/19; 5.2%) (p>0.05, respectively). Giant aneurysm was not observed in any patients. 7) Four patients(group D) were given one more dose of IVGG 1g/kg because high fever persisted 48 hours after injection of the first dose of IVGG. Afterthen fever subsided within 1 to 7 days. Echocardiography revealed mild coronary arterial dilation in two patients initially, but follow-up examinations revealed no coronary aneurysm. CONCLUSIONS: The medium-dose combined regimen with IVGG 1g/kg plus ASA 50mg/kg/d seems to be more cost-effective than the high-dose regimen with IVGG 2g/kg plus ASA 50-100mg/kg/d. If high fever persists 48 hours or more after the first dose of IVGG 1g/kg, it is desirable to give one more dose of IVGG 1g/kg.
Subject(s)
Humans , Aneurysm , Aspirin , Coronary Aneurysm , Echocardiography , Fever , Follow-Up Studies , Mucocutaneous Lymph Node Syndrome , Platelet Count , Prospective Studies , Sex DistributionABSTRACT
PURPOSE: To get the normal predicted value of airway resistance in Korean primary school-aged children by using flow interrupter technique which is simple and easy enough to be applicable even to young children. METHODS: Among all the children of one primary school, we selected 964 (Male 469, Female 495). Excluded children were out of normal range in growth with Korean standard and/or history and/or symptom and sign of airway diseases. One medical doctor, well trained to the Microlab 4000 (Micromedical Co. England) educated the children before check and carried out all the procedure. Rint (Airway resistnace by interrupter technique) was checked 5 times. After exclusion of both highest and lowest values, we got the average of remaining 3 values as Rint (in both inspiratory and expiratory phases). We got mean, standard deviation, regression equation, correlation coefficient in every age, height group, weight group, and chest circumference group in both sex. RESULTS: 1) Age ranged from 6 to 11 years. 6-year-old boys' Rint were 0.56+/-0.15 kPa.l-1.s and 0.56+/-0.15 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.55+/-0.16 kPa.l-1.s and 0.55+/-0.18 kPa.l-1.s in girls. The Rint decreased as the children getting older. 2) Height ranged from 105 to 160 cm. Rint of boys from 111 to 115 cm in height were 0.54+/-0.11 kPa.l-1.s and 0.55+/-0.15 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.56+/-0.18 kPa.l-1.s and 0.56+/-0.19 kPa.l-1.s in girls. The Rint decreased as the children getting taller. 3) Weight ranged from 16 to 57 kg. Rint of boys from 16 to 18 kg in weight were 0.52+/-0.07 kPa.l-1.s and 0.59+/-0.07 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.47+/-0.15 kPa.l-1.s and 0.43+/-0.14 kPa.l-1.s in girls. The Rint decreased as the children getting heavier. 4) Chest circumference ranged from 50 to 85 cm. Rint of boys from 50 to 55 cm in chest circumference were 0.49+/-0.12 kPa.l-1.s and 0.46+/-0.13 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.53+/-0.16 kPa.l-1.s and 0.52+/-0.17 kPa.l-1.s in girls. The Rint decreased as the children's chest circumference increase. 5) We got regression equations and correlation coefficient by age, height, weight, and chest circumference in both boys and girls and in both inspiratory and expiratory phases. Correlation was best with height but correlation coefficient was less than 0.45. CONCLUSION: We got the normal predicted value of airway resistance by flow interrupter technique. It can be used in evaluating lung condition, progression of lung disease, and effectiveness of drugs in lung disease.