Paradoxical Response to Chemotherapy in Tuberculous Pleural Effusion / 소아알레르기및호흡기학회지

It is defined as the paradoxical response when the clinical or radiologic worsening of old lesions or the development of new lesion occur in spite of appropriate antituberculous therapy. The paradoxical response can occur as an intracranial tuberculoma, pleurisy, pericarditis and contralateral new parenchymal lesions. However, poor compliance with therapy, drug resistance, non-tuberculous mycobacterium, or another underlying condition as lung cancer should be ruled out before concluding that the treatment is the cause of the exacerbation. The case reports of paradoxical response have been mainly reported in adults, but extremely rare in children. We report a case of paradoxical response in which a new parenchymal lung lesion developed during antituberculous therapy in a 14-year-old female patient with tuberculous pleurisy. She experienced clinical improvement with steroid therapy in addition to antituberculous therapy.

Severity Scoring of Atopic Dermatitis in Children: Study for Usefulness of Three Item Severity Score / 소아알레르기및호흡기학회지

PURPOSE: Many different scoring systems have been proposed for assessing the severity of atopic dermatitis. The SCORAD (SCORing Atopic Dermatitis) is one of the best validated systems, but is too complicated and time-consuming for routine clinical use. The aim of this study is to evaluate the Three Item Severity (TIS) score in routine clinical practice and to investigate the correlation with SCORAD and quality of life. METHODS: The study was done on 69 cases of atopic dermatitis randomly selected by SCORAD severity in Kangdong Sacred Heart Hospital pediatric allergy clinic from March 2003 to August 2003. Patients were from three months old to 15 years old. A trained pediatrician assessed the TIS score and simultaneous 10 item questionnaire about quality of life (QOL) was checked. RESULTS: According to the SCORAD, there were 21 (30.4%) mild cases, 26 (37.7%) moderate cases and 22 (31.9%) severe cases out of total 69 patients. According to the TIS score, 21 (30.4%) cases were 0-2 point, 16 (23.2%) were 3 point, 11 (16.0%) were 4-5 point and include 21 (30.3%) were 6-9 point. In QOL score, 21-30 points were most common (36.2%). There was significant positive correlation between TIS score and SCORAD (Spearman's rs= 0.86, P< 0.01). There was significant positive correlation between TIS score and QOL (Spearman's rs=0.89, P< 0.01). CONCLUSION: The TIS score is a reliable and simple scoring system for atopic dermatitis. It is particularly suitable in general practice, for routine clinical use.

Correlation between Body Fat Percent Estimated by Bioelectrical Impedance Analysis and Other Variable Methods

PURPOSE: Obesity is a significant health problem with medical and psychological consequences for children and adolescents. The purpose of this study was to assess the correlation between body fat percent using bioelectrical impedance(BI) and other variable methods. METHODS: We measured height, weight, body mass index(BMI) and body fat percent by skinfold thickness(ST) and BI in 1,035(496 male; 539 female) children from seven to 18 years of age. The correlation coefficients between BI and each of the other different methods were obtained. The sensitivity and specificity to predict obesity by these several methods were studied. RESULTS: Fat percent estimated by BI analysis and BMI showed a strong correlation(r=0.749). Fat percent estimated by BI analysis and ST showed a very strong correlation(r=0.835). At the 95th percentile cut-off point for BI, ST showed a sensitivity of 57.7%, and a specificity of 97.6% for estimating body fat. At the 95th percentile cut-off point for BI, BMI showed a sensitivity of 84.9%, and a specificity of 99.3% for estimating body fat. CONCLUSION: The fat percent estimated by BI analysis correlated strongly with ST or BMI. BI analysis is an objective and accurate method for estimating body fat in childhood obesity.

The Role of ATP on Reactive Oxygen Species Generation and Cellular Proliferation in BV-2 Cells

PURPOSE: Adenosine triphosphate (ATP) evokes several cellular responses in microglia including propagation. However, the role of the purinoceptor on ROS generation in microglia is unclear. In order to determine the action of the purinoceptor in microglia, the effects of ATP on ROS generation and cellular proliferation in BV-2 murine microglial cells were evaluated. An additional aim of this study was to investigate signal transduction pathways using several inhibitors. METHODS: The [Ca2+] was measured using Ca2+ sensitive indicator, Fura-2/AM. ROS production was observed by fluorescence-confocal microscope and cell proliferation was evaluated by counting cell number. RESULTS: ATP increased the intracellular calcium levels ([Ca2+]i) in BV-2 cells in a dose-dependent manner. This increase was attenuated by pretreatment with a calcium chelator (EGTA) and a phospholipase C (PLC) inhibitor (U-73122) while the protein tyrosine kinase (PTK) inhibitor (genistein) had no inhibitory effects. To identify the effects of the nucleotides, ROS generation was observed in the nucleotide-stimulated BV-2 cells. The treatment with 100 M ATP induced ROS generation, but 100 M adenosine and 100 M UTP did not. To investigate the signal transduction pathway in ATP-induced ROS generation, several inhibitors were pretreated before adding ATP. ATP- induced ROS production was blocked by pretreatment with either 0.5 mM EGTA or 10 M U73122 while 40 M genistein had an inhibitory effect on ATP action. Correspondingly, 40 M KN62 (CaM kinase II inhibitor), 1 M sphingosine (protein kinase C inhibitor), 1 nM DPI (NADPH oxidase inhibitor) and 50 M mepacrine (phospholipase A2 inhibitor) could suppress ATP-induced ROS generation. The effects of ATP on cell proliferation was observed 3 days after ATP treatment and its peak velocity after 4 days. NF-kB activation was observed after the cells were incubated with 0.1 mM ATP. The maximal level of NF-kB activation was obtained with 0.3 mM ATP while higher concentrations were less effective. CONCLUSION: Overall, we conclude that ATP in BV-2 cells induces ROS generation and cell propagation. The signal transduction pathways including calcium, CaM kinase II, PLC, protein kinase C, phospholipase A2 and NADPH oxidase are involved in ATP-induced ROS generation.

Serogroup and Antimicrobial Resistance of Streptococcus pneumoniae Isolated from Oropharynx in Children Attending Day Care Center

PURPOSE: Penicillin- and multidrug-resistant S. pneumoniae poses a serious threat to clinicians because the rate of resistance of S. pneumoniae to penicillin in Korea has surged up to the world's highest level. This study was performed to assess the carriage rate, serogroups and antimicrobial susceptibility of S. pneumoniae isolated from oropharynx in children. METHODS: From March to July 1998, 209 children under 5 years of age were recruited from five day care centers. The carriage rate for pneumococci was obtained. Antimicrobial susceptibilities were determined with the E-test and agar dilution methods. Serogrouping was performed on 48 of the pneumococcal isolates by the Quellung reaction. RESULTS: The carriage rate of S. pneumoniae was 30.1%. Antimicrobial susceptibility profiles were available for 59 of the isolates. Sixty-six percent of isolates were not susceptible to penicillin, and multidrug-resistance was observed in 76.3% of the isolates. A high proportion of the penicillin-resistant strains showed associated resistance to trimethoprim-sulfamethoxazole, tetracycline, erythromycin, and oxacillin. The most prevalent oropharyngeal serogroups were 19, 6, 3, 23, and 29. Resistance of the pneumococcal isolates to penicillin was different according to the serogroups. All of the strains of serogroup 19, 23, and 29 was resistant to penicillin but 87.5% of serogroup 3 strains were susceptible to penicillin. CONCLUSION: The resistance rate of S. pneumoniae isolated from oropharynx in children was very high to penicillin and other antimicrobial agents. For the reduction of the drug-resistant rate of S. pneumoniae, clinicians should be required to be more judicious in their use of antimicrobial agents.

Body Composition by Bioelectrical Impedance Analysis in Obese Children

PURPOSE: Body composition by bioelectrical impedance analysis(BIA) is a very useful method of analysing body composition in many diseases. BIA is a simple, rapid, non-invasive and reproducible technique. There was no comparative analysis between obese and healthy children. A comparative analysis between obese and healthy children is needed to assess the effect of excercise and other interventions in the management of childhood obesity. This study is designed to analyze and compare the body composition and body fat percent measured by BIA in healthy and obese children. METHODS: Height and weight were measured. BIA was done in healthy and obese children. Body compositions were analyzed with fat mass, lean body mass, body fat percent, protein, mineral, intracellular fluid(ICF), and extracellular fluid(ECF). RESULTS: Fat mass, fat percent, ICF, and ECF were significantly higher in the obese group. Resistances were significantly lower in the obese group. The amounts of ICF and ECF were significantly higher in obese group. Fat mass showed more significant correlation with ICF and ECF than body mass index. CONCLUSION: Body composition analysis using bioelectrical impedance(BI) is considered as very useful diagnostic method in the evaluation and treatment in childhood obesity. Epidemiologic study will be needed to determine the diagnostic criteria of obesity by BI.

Varying Effects of Intravenous Immunoglobulin on Mononuclear Cell Proliferation In Vitro

Intravenous immunoglobulin (IVIG) is being increasingly used to treat numerous immune-mediated diseases. However, there is a paucity of knowledge on the specific mode of action of IVIG in vivo. In this study, the in vitro effects of IVIG on peripheral blood mononuclear cell (PBMC) proliferation using phytohemagglutinin (PHA), anti-CD3 monoclonal antibody (MAb), phorbol myristate acetate (PMA), or purified protein derivatives (PPD) have been analyzed. The PBMCs were obtained from more than 10 individual donors. In all cases, IVIG almost completely inhibited PBMC proliferation at concentration above 20 mg/mL except when used in conjunction with PMA. PHA-induced proliferation of PBMCs at concentrations ranging from 1 to 15 mg/mL did not show significant differences. Anti-CD3 MAb-induced proliferation showed dose-dependent inhibition at concentrations ranging from 1 to 10 mg/mL. Interestingly, PMA-induced proliferation of PBMCs showed a dose-dependent increase at the same concentration range. PPD-induced proliferation of PBMC at concentrations ranging from 1 to 10 mg/mL did not show any statistically significant differences. These results suggest that high dose IVIG may be necessary to immune modulation in vivo and IVIG has various effects on PBMCs proliferation in limited concentration in vitro.

Effects of Vigabatrin on Pilocarpine-Induced Seizures in Immature Rats

PURPOSE: Vigabatrin is a widely used antiepileptic drug that greatly increases whole brain gamma- aminobutyric acid(GABA). But little is known about the anticonvulsant effect of vigabatrin on pilocarpine-induced seizures in the immature rats. This study was conducted to determine the effects of vigabatrin on pilocarpine-induced seizures in the immature rats. METHODS: Six to eight day old Sprague-Dawley rats were classified into control(n=5) and vigabatrin-treated(n=5) groups that were pretreated with 30mg/kg of vigabatrin. Animals received vigabatrin or saline, intraperitonealy, for 6 days, once a day. And on the 5th day, right and left cortical electrodes were placed in 10-14 day old animals using stereotaxic instrument. The following day 2.5-hour EEG recordings were obtained to monitor the latency to first electrographic seizures and to first status epilepticus induced by intraperitoneal injection of pilocarpine(200mg/kg). Data were analyzed using the log-rank test. RESULTS: Electrographic seizures and status epilepticus were seen in 80% of vigabatrin-treated group, and in 100% of control group rats. And the latency to first seizure was 8.8+/-2.0 minutes in control group and 20.5+/-5.2 minutes in vigabatrin-treated animals(P<0.02), and to status epilepticus was 12.2+/-1.2 minutes in control group and 29.3+/-6.3 minutes in vigabatrin-treated group(P<0.03). CONCLUSION: It was confirmed that 30mg/kg of vigabatrin administration for 6 days did not affect the body weight gain and behavior of immature rats and had an anticonvulsant effect. These findings might demonstrate that the prolonged latency to seizure, and to status epilepticus, was a time to reduce GABA that was elevated in the brain by vigabatrin administration below the seizure threshold, by pilocarpine.

Carriage and Antimicrobial Susceptibility of Haemophilus influenzae Isolated from Oropharynges of Children

PURPOSE: Haemophilus influenzae, one of the normal flora of the upper respiratory tract, can cause such infections as otitis, sinusitis, pneumonia, and meningitis in children. The oropharyngeal flora has therefore mainly been analyzed as a reservoir for pathogens. This study was performed to reveal the colonization rate of H. influenzae in the upper respiratory tract, their biotypes, their antimicrobial resistance and production of beta-lactamase in healthy children. METHODS: The specimens for H. influenzae were obtained through oropharyngeal swab from 209 healthy children, younger than 5 years of age in 4 day care centers from March 1998 to June 1998. These isolates of H. influenzae were tested for their biotypes, in vitro susceptibility to seven antimicrobial agents(ampicillin, ampicillin/sulbactam, aztreonam, chloramphenicol, cefotaxime, tetracycline and trimethoprim-sulfamedoxazole) by disc diffusion method and production of beta- lactamase. RESULTS: The carriage rate of H. influenzae in the day care center children was 13.4%(28/209). Of 24 isolates, 8 isolates(33%) were biotype II and 6 isolates(25%) were biotype I. The overall rates of resistance of 15 isolates are as follows; ampicillin 46.7%, tetracycline 28.6%, trimethop rim-sulfamedoxazole 14.3%, ampicillin/sulbactam 6.7%. The prevalence of beta-lactamase producing isolates was 65.2%. All beta-lactamase producing isolates were resistant to ampicillin. The resis tance rates of beta-lactamase producing isolates to tetracycline, trimethoprim-sulfamedoxazole, and ampicillin/sulbactam were 44.4%, 25.0%, and 11.1%, respectively. CONCLUSION: Children in day care centers in Seoul have high rates of H. influenzae carriage. The antimicrobial resistance of H. influenzae from the oropharyngeal specimens of healthy children was higher than expected.

A Case of Common Variable Immunodeficiency with Autoimmune Hemolytic Anemia

Common variable immunodeficiency (CVID) is a heterogeneous collection of disorders with hypogammaglobulinemia with recurrent bacterial infections and high incidence of autoimmune disorders as its hallmark. We report a 7-year-old girl suffering from CVID with Coombs' test positive hemolytic anemia. She had been relatively well until 23-months old when she was admitted to Taejon St. Mary's Hospital with pneumonia 5 years ago. Afterwards, she had suffered from recurrent otitis media, paranasal sinusitis, bronchitis and pneumonia, experiencing 13 admissions. She was diagnosed as autoimmune hemolytic anemia at 4-years old and had been treated with prednisolone. Laboratory finidings showed hypogammaglobulinemia(gamma-globulin in immunoelectrophoresis 0.04g/dL, IgG 170mg/dL, IgA 31mg/dL, IgM 27.5mg/dL) which was previously within normal limits checked at the age of 3- and 5-years old. Isohemmagglutinins (Anti-A,-B IgM and IgG) and anti-measles IgG, anti-mumps IgG, anti-rubella IgG and anti-HBs antibody along with PPD skin test were all negative. Peripheral lymphocyte subsets revealed as follows : pan T cells (CD3+) 48.6% (normal values : 60-85%), pan B cells (CD19+) 36.7% (8-20%), CD4+ T cells 24.4% (28+/-8%), CD8+ T cells 15.3% (5+/-10%), and CD4/CD8 ratio of 1.6 (0.6-2.8). Proliferations of peripheral blood mononuclear cells induced by various T cell stimulants were all markedly depressed. Chronic paranasal sinusitis and lung parenchymal damages were revealed on computerized tomography and lung scan, and a monthly intravenous immunoglobulin therapy was started.

Factors Associated with the Development of Anti-insulin Antibody in Diabetic Children / 대한소아내분비학회지

PURPOSE: Anti-insulin antibodies develop within several months of initiation of insulin therapy in most of diabetic patients. The purpose of this study is to observe the relationship between the clinical factors and development of anti-insulin antibody METHODS: Serum was collected from 116 diabetic patients and 47 nondiabetic children for the measurement of anti-insulin antibody titer by radioimmunoassay (RIA). Retrospective analysis of the medical records of clinical factors were evaluated. RESULTS: There was no relationship of anti-insulin antibody titer with age, duration, HbA1c, insulin dose, and BMI in diabetic children. There was no difference in anti-insulin antibody titer according to the sex, the presence of family history, the presence of DKA, the presence of complications, the presence of puberty, species of insulin, duration of disease in diabetic children. The titers of anti-insulin antibody were significantly higher in type 1 diabetic children(30.3+/-17.9% in type 1 and 16.5+/-7.0% in type 2, P7%. The positive rates of anti-insulin antibody were higher in male patients with diabetes(73.2% in male and 53.3% in female, P7%). CONCLUSION: The results suggests that anti-insulin antibody developed more likely in type 1 DM and less likely in DM patients whose control had been good and who used less insulin doses, which remains to be studied further with more patients for longer duation.

The Changes of Apoptosis and Viability in Stem Cells after Thawing with Lapse of the Time

PURPOSE: Thawed stem cells should be infused as early as possible because delay of infusion leads to decrease of cell viability and formation of DNA clumping. The procedure of 10% Dimethyl sulfoxide(DMSO) removal and a long distance from the thawing location to the patient are the main causes of delay of infusion that results in the loss of cell viability and apoptosis. Therefore, we investigated the changes of cell viability and apoptosis after thawing with lapse of time. METHODS: Five samples of mobilized peripheral blood were evaluated. We measured cell viability, colony forming unit(CFU) and apoptosis at 0, 1, 2, 4, and 24 hours after thawing. The state of stem cells were divided into live, apoptotic and dead with double staining using annexin V and 7-aminoactinomycin D(7-AAD) in flow cytometry. RESULTS: Viability of the total cells after thawing was 77.3(53.3-97.7)%. The percentage which recovered to initial CFU at 1, 2, 4 and 24 hours after thawing decreased to 63.9%, 50.2%, 45.8% and 11.6%, respectively. The proportion of apoptotic cells among CD34+ cells after thawing were increased from 0.2% at 0 hour to 16.5% at 1 hour, 21.9% at 2 hours, and then decreased to 15.0% at 4 hours, 2.7% at 24 hours because they were replaced by dead cells. CONCLUSION: Thawed cells changed to apoptotic and had less colony forming capacity from 1 hour after thawing, and were then replaced by dead cells from 4 hours after thawing.

The Improvement of Cell Viability due to Dilution and Removal of DMSO in Thawing of Stem Cells

PURPOSE: Cryopreserved stem cells from cord blood are usually infused with Dimethyl Sulfoxide (DMSO) immediately after thawing. However, this process may cause cell damage due to osmotic shock, and the administration of DMSO may also cause toxic effects. We studied a new method of increasing cell viability by stabilizing osmolarity by adding dextran 40 and washing out DMSO. METHODS: Thirty-five samples of cord blood were studied. RBCs were removed in 10% pentastarch. The cells were mixed with DMSO of 5, 10 and 20% each, and stored at -80 degree C. Cryopreserved cells were thawed and then diluted with dextran 40. DMSO was removed afterwards. The cell viability, osmolarity and colony forming capacity in this new thawing method were compared with the control group done by conventional methods. RESULTS: The recovery rate of WBC after RBCs separation was 92.06% but the contamination rate of RBC was still high(29.90%). The concentration of DMSO significantly affected the survival of WBCs(P<0.05). The osmolarity was 330+/-17.7mOsm/L before freezing, 1,457+/-508.7mOsm/L after thawing prior to dilution and 811+/-199.6mOsm/L after dilution, suggesting that the dilution process was effective in reducing osmolarity. The number of viable cells increased from 6.01+/-1.61(x103/L) to 7.16+/-1.48(x103/L) after dilution but was not significant. The number of CFU-C was increased from 5.82+/-4.19(/105) to 7.58+/-3.16(/105) after dilution but was not significant. CONCLUSION: Our method of removing DMSO during the thawing process yields a higher cell survival rate and less DMSO toxicities compared with the conventional method of direct injection with DMSO after thawing.

A Case of Hemimegalencephaly with Focal Seizure

Hemimegalencephaly is a rare brain malformation characterized by congenital hypertrophy of one cerebral hemisphere, ipsilateral ventriculomegaly, hemiparesis, intractable epilepsy, and mental retardation, which often results in early death. We reported a case of hemimegalencephaly in a 1-month-old male with the chief complaint of intractable focal seizure.

A Case of Glucose-6-phosphate dehydrogenase Riley Causing Hemolytic Anemia / 대한혈액학회지

A glucose-6-phoshate dehydrogenase variant called G6PD Riley was detected in an Korean boy with nonspherocytic hemolytic anemia. Using polymerase chain reaction based single-strand conformation polymorphism (PCR-SSCP) followed by DNA sequence analysis, we found mutation T to C at nucleotide 1139 in exon 10, resulting in a substitution of 380th amino acid isoleucine to threonine. The patient's mother was confirmed to be a heterozygote.

Percent of Body Fat by Bioelectrical Impedance Analysis in Healthy Children

PURPOSE: Obesity is a frequent nutritional disorder in children and adolescent and its prevalence is increasing. Bioelectrical impedance analysis is a simple, rapid, non-invasive and reproducible technique. The aim of this study was to measure percent of body fat using bioelectrical impedance in healthy children. METHODS: We measured height, weight and bioelectrical impedance in 1035 children aged 7-18 years(496 males and 539 females). RESULTS: Percent of body fat was decreased in male children, but it was increased during the pubertal period in female. 95th percentiles of percent of body fat by bioelectrical impedance was 32.9% in 7 year olds, 31.6% in 8, 34.7% in 9, 35.1% in 10, 35.8% in 11, 33.1% in 12, 36.1% in 13, 38.2% in 14, 33.3% in 15, 28.3% in 16, 32.8% in 17 and 32.2% in 18 year olds for males. 95th percentiles of percent of body fat by bioelectrical impedance was 25.1% in 7 year olds, 29.6% in 8, 30.5% in 9, 35.6% in 10, 34.5% in 11, 36.5% in 12, 39.1% in 13, 34.1% in 14, 33.7% in 15, 32.8% in 16, 34.5% in 17 and 35.1% in 18 year olds for females. Intraobserver reliability coefficient of bioelectrical impedance analysis was 0.995 and intraobserver reliability of BI(Bioelectrical impedance) analysis was significantly high. CONCLUSION: To measure body fat percentage using bioelectrical impedance analysis in healthy children provides objective data in diagnosing obesity.

A Case of Acute Drug-Induced Agranulocytosis Treated with Recombinant Granulocyte Colony-Stimulating Factor(G-CSF)

Drug-induced agranulocytosis is a potentially lethal disorder characterized by selective neutropenia. G-CSF has been utilized for its treatment. We report a case of acute agranulocytosis probably associated with injection of sulpyrine(dipyrone). A three-year old girl was admitted to Taejon St. Mary's Hospital following five days of fever and two days of chills and prostration. During this period, she had been treated at local clinics with oral acetaminophen, ibuprofen, and miokamycin. Two days before admission, she was administered an intramuscular injection of dipyrone as antipyretics. She had a past history of previous sensitization of dipyrone. CBC revealed profound netropenia(total WBC 900/mm3, with 1% neutrophils, 88% lymphocytes, 10% atypical lymphocytes, 1% monocytes), but normal RBC and platelet count. Bone marrow examination showed hypocellularity(20%), decreased myeloid precusors, and M:E ratio of 1 : 2.5. The girl received subcutaneous G-CSF once daily for 3 days. G-CSF therapy resulted in a steep increase of neutrophil count, which was faster than the spontaneous recovery reported in the literature. G-CSF may be considered useful in the management of drug-induced agranulocytosis.

A Case of Acute Drug-Induced Agranulocytosis Treated with Recombinant Granulocyte Colony-Stimulating Factor(G-CSF)

Drug-induced agranulocytosis is a potentially lethal disorder characterized by selective neutropenia. G-CSF has been utilized for its treatment. We report a case of acute agranulocytosis probably associated with injection of sulpyrine(dipyrone). A three-year old girl was admitted to Taejon St. Mary's Hospital following five days of fever and two days of chills and prostration. During this period, she had been treated at local clinics with oral acetaminophen, ibuprofen, and miokamycin. Two days before admission, she was administered an intramuscular injection of dipyrone as antipyretics. She had a past history of previous sensitization of dipyrone. CBC revealed profound netropenia(total WBC 900/mm3, with 1% neutrophils, 88% lymphocytes, 10% atypical lymphocytes, 1% monocytes), but normal RBC and platelet count. Bone marrow examination showed hypocellularity(20%), decreased myeloid precusors, and M:E ratio of 1 : 2.5. The girl received subcutaneous G-CSF once daily for 3 days. G-CSF therapy resulted in a steep increase of neutrophil count, which was faster than the spontaneous recovery reported in the literature. G-CSF may be considered useful in the management of drug-induced agranulocytosis.

Clinical Change of Mycoplasma Pneumonia

PURPOSE: It was noted some changes of clinical manifestations of mycoplasma pneumonia. we reviewed and compared these changes and saught any clues causes for proper dignosis and treatment. METHODS: We divided patients with mycoplasma pneumonia into two groups, Group 1 (from Jan. to Dec. 1996) and Group 2 (from Jan. to Dec. 1994), and analyzed clinical, radiologic, and serologic differences. RESULTS: Mean age of onset lowered markedly from was 8.34 +/- 2.56 years to 6.91 +/- 3.28 years (P1 : 1280) were more frequently observed in group 1 and correlated with severity of clinical manifestations. In radiologic findings, alveolar consolidation were significantly prominent findings in Group (P or = 3 days) in spite of medication were more prevalent in Group 1 (P<0.05), suggesting increased cases of diminished responsiveness to treatment. CONCLUSIONS: Recently, there was some clinical changes of mycoplasma pneumonia, lowering of onset age, severe clinical symptoms, and more decreased responsiveness to antibiotic treatment. We suggest that it is to neccessary to make some efforts to prevent antibiotics abuse and to decrease the occurrence of resistant strains by introducing of new method for early diagnosis, selective identification of micro-organism and minute sensitivity test for antibiotics.

Nesidioblastosis in Neonate with Persistent Hyperinsulinemic Hypoglycemia / 대한소아내분비학회지

Nesidioblastosis, also known as persistent hyperinsulinemic hypoglycemia of infancy(PHHI) or familial hyperinsulinsm, is the most common cause of recurrent severe hypoglycemia in infancy. It is an autosomal recessive disorder characterized by irregular insulin secretion leading to inappropriately raised plasma insulin concentration compared to blood glucose levels. Recently, mutations in the sulfonylurea receptor(SUR) have been described in association with PHHI. The mainstay of medical treatment is glucose infusion and diazoxide or long acting somatostatin. If medical treatment fails in preventing hypoglycemia, near total pancreatectomy is recommended. We report one case of nesidioblastosis cured by near total pancreatectomy with brief review of literatures.