Comparative Analysis of Handedness and Footedness in Children with Epilepsy

PURPOSE: Studies for handedness and footedness of patients with epilepsy are rare. Some studies suggest that left handedness is more common in children with injury in the left hemisphere, mental retardation and epilepsy. We analysed the correlation of handedness and footedness with epilepsy according to the cause of epilepsy and the site of brain lesion by comparing with a control group. METHODS: Subjects were 130 epileptic patients who visited the pediatric out-patient clinic of Pusan National University Hospital from June 2001 to August 2001. A control group was composed of 130 children without history of convulsion or neurologic problems. We let them carry out 10 items or answer the questions on the use of hands and feet. We defined handedness and footedness based on the number of the items carried out dominantly. We analyzed age, type of seizure, cause of epilepsy and site of brain lesions in the symptomatic group by reviewing their medical records. RESULTS: In 130 epileptic patients, left handedness and left footedness were 20.0% and 16.0%, respectively which are higher than 4.6% and 5.4% of the control group(P<0.05). There was statistically no difference between the idiopathic epilepsy group and the control group such as 8.9% and 8.9%. But left handedness in the symptomatic epilepsy group was 45.0% and left footedenss was 31.4%, which were significantly higher than those of the control group(P<0.05). According to the site of brain lesions in the symptomatic group, all the patients with abnormalities in the left hemisphere showed left handedness and 57.1% of the patients showed left footedenss. In cases of abnormalities in both hemispheres or diffuse brain lesions, left handedness was 25.9% and left footedness was 26.9%. The concordance rate of left handedness and left footedness was 66.7% (4/6) in the control group, 50.0%(4/8) in the idiopathic epilepsy group and 71.4%(10/14) in the symptomatic epilepsy group. CONCLUSION: Left handedness and footedness are more common in the epileptic patients than the control group. This is due to the high proportion of left handedness and left footedness in the symptomatic epileptic patients. Left handedness and footedness in children with epilepsy are much more related to the left side of brain lesions.

A Case of Chylothorax Controlled by Radiotherapy on Lymphangiomatosis of Thorax / 소아알레르기및호흡기학회지

The causes of the chylothorax can be classified to the congenital cases, such as the atresia of thoracic duct and thoracic duct-pleura fistula, and the acquired ones, such as thoracic surgery, trauma, malignant disease, venous thrombosis, infection and so on. We experienced a case of left chylothorax in a 10-year-old girl with a lymphangiomatosis of left thorax extending from axillar to buttock. She first received the two weeks of conservative management, which was unsuccessful to subside the chylothorax. Then she was taken the partial pleurectomy and chemical pleurodesis under the thoracoscopy as a surgical intervention, but this is also insufficient to reduce the chylous effusion. Finally she received 10 times of radiotherapy on left thorax, then the chylothorax is controlled completely.

Clinical Features of Patients with Measles during 2000-2001

PURPOSE: Although the number of patients with measles have dramatically decreased since the introduction of measles vaccines in 1965, measles outbreaks have occurred periodically every 4-6 years during the 1990s(1989-1990 and 1993-1994). During 2000-2001, measles prevailed all over the country again. A characteristic of current epidemics is that the majority of affected population was infants and school-aged children. This study was designed to analyze the epidemic and clinical features of measles prevalence during 2000-2001 and to find ways to overcome vaccination failure. METHODS: We reviewed the records of 59 patients with mealses admitted in the Pediatric Department of Pusan National University Hospital from January 2000 to October 2001 for patient's age, month of admission, history of vaccination, clinical features and complications. Antibody titers of measles-specific IgM and IgG were measured by enzyme immunoassay. RESULTS: The epidemic show two peaks in the age distribution. Forty three patients(72.9%) were under 2-years of age and 14 patients(23.7%) were over 5-years of age. Outbreaks had high incidence in July to August, 2000 and March to April, 2001, then faded away after July, 2001. Vaccinated group comprised 30.5% and unvaccinated group comprised 69.5% and their mean age was 9.25+/-4.27 years old and 0.95+/-0.30 years old respectively. Positive rate of IgM was 86.7% in vaccinated group and 90.3% in unvaccinated group. This means there was primary vaccine failure; 13 cases of 15 vaccinated patients were positive in IgM antibody. During the prevalence, two patients died with mealses complication. One of them was immunocompromised. CONCLUSION: To prevent another prevalence of measles in the future, we must enhance revaccination at ages 4-6 and check vaccination status when children enter elementary school. These will produce over 95% of herd immunity, with catch-up MMR vaccination which has been completed already.

A Case of Cholangiocarcinoma Arising from Type I Choledochal Cyst in a 13-year-old Girl / 대한소아소화기영양학회지

Choledochal cyst is a rare developmental malformation of the biliary tree and has serious problem of transformation to malignancy. The development of cholangiocarcinoma related to choledochal cyst increases as the age of patient increases and is more common in Orientals with female predominance of 2.5 times. Prevalence rate of cholangiocarcinoma is various from 2.5 to 15.6% in adult with choledochal cyst, but very low in children. We experienced a case of cholangiocarcinoma with multiple liver metastases arising from type I choledochal cyst in a 13-year-old girl who complained of sudden onset of right upper quadrant abdominal pain.

A Case of Cytomegalovirus Colitis which Occurred During Treatment of Hemophagocytic Syndrome

Cytomegalovirus(CMV) colitis is an important opportunistic infection in immunocompromised individuals. The clinical symptoms are abdominal pain, diarrhea, colonic hemorrhage and perforation. The endoscopic appearance shows three characteristic features with focal or diffuse inflammatory changes, submucosal hemorrhagic spots, and well demarcated ulcers. We experienced a case of CMV colitis in an 8-year-old girl presented with Stevens-Johnson syndrome, vanishing bile duct syndrome and infection-associated hemophagocytic histiocytosis, which developed during chemotherapy with etoposide and dexamethasone for hemophagocytic syndrome. The impaired immunity caused by chemotherapy is the most likely possible cause of CMV colitis in this case. We confirmed this case by endoscopic findings, the presence of cytomegalic cells on mucosal biopsy specimens, immunohistochemistry with monoclonal antibody to CMV antigen, and serologic study, and report with a brief review of the literature.

Clinical Significance of CD34 Antigen Positivity in Childhood Acute Lymphoblastic Leukemia / 대한소아혈액종양학회지

PURPOSE: CD34 antigen is an early marker of hematopoietic progenitors. CD34 expression on leukemic cells might define peculiar characteristics of immaturity. The prognostic significance of CD34 antigen expression in acute lymphoblastic leukemias (ALL), especially in children, is still not well established. To evaluate the prognostic value of CD34 expression in childhood ALL, we compared the clinical features, laboratory findings and survival rates according to the presence of CD34 antigen in patients with ALL. METHODS: We conducted retrospective reviews in 38 children with ALL who were admitted to the Department of Pediatrics in Pusan National University Hospital between July 1994 and December 1999. We analyzed and compared the clinical features, laboratory findings and survival rates of CD34 ALL with those of CD34-ALL. RESULTS: CD34 antigen was expressed more on B-lineage ALL (71.9%) than T-lineage ALL (16.7%). There was no statistical differences in age, sex, clinical manifestations (eg, hepatomegaly, splenomegaly, CNS involvement) and initial laboratory findings. In B- lineage ALL, CD34 positive group had higher complete remission rate. CD34 antigen positive group had better overall survival rate than that of CD34 negative group both in ALL and B-lineage ALL, but there was no difference in disease free survival rate between two groups. CONCLUSION: It suggests that CD34 positivity in acute lymphoblastic leukemia could be prognostic value by demonstrating higher overall survival rate than that of CD34 negative group.

A Case of Chronic Intractable Diarrhea with IgA, IgG2 and IgG4 Deficiency / 대한소아소화기영양학회지

In most cases, acute diarrhea in childhood heals spontaneously, but it may become the form of chronic diarrhea in immunodeficient children and then cause weight loss, dehydration, malabsorption and malnutrition. The immunodeficient diseases associated with chronic diarrhea include severe combined immunodeficiency syndrome, common variable immunodeficiency, acquired immunodeficiency syndrome, agammaglobulinemia or selective IgA deficiency. IgA deficiency is the most common primary immunodeficiency. Because many IgA deficient individuals seem to have compensated for their deficiency with increased IgM production and various nonimmunologic factors, the incidence of gastrointestinal involvement is not prominent. Some of those with IgA deficiency and recurrent infections have been found to also have IgG subclass deficiency. IgA deficiency with IgG2 and IgG4 subclass deficiency have high susceptability to infection and chronic diarrhea. IgG subclass deficiency, when present, is more likely to be found in association with a partial IgA deficiency rather than complete IgA deficiency. We report a 3-month-old male with intractable diarrhea accompanied by IgA, IgG2, and IgG4 deficiency.