About the new edition of child and adolescent health record book / 소아과

Recently we published new edition of 'child & Adolescent health record book' considering easy usability and introduction of new vaccines. This record book has essential and important contents for caring our children and adolescents. Currently many people use various vaccination record books with wrong and poor contents. We suggest the campaign that every pediatrician must give our well made record book to these people. This campaign can give their children an opportunity for proper vaccination and medical checkup. Ultimately through this campaign, the role and importance of pediatrician in the fields of vaccination and bring up children and adolescents will be recognized. We trust that the better record book can be made with continuous interest and active advice of all Korean Pediatric Society members about the contents and usability of this book.

About the new edition of child and adolescent health record book / 소아과

Recently we published new edition of 'child & Adolescent health record book' considering easy usability and introduction of new vaccines. This record book has essential and important contents for caring our children and adolescents. Currently many people use various vaccination record books with wrong and poor contents. We suggest the campaign that every pediatrician must give our well made record book to these people. This campaign can give their children an opportunity for proper vaccination and medical checkup. Ultimately through this campaign, the role and importance of pediatrician in the fields of vaccination and bring up children and adolescents will be recognized. We trust that the better record book can be made with continuous interest and active advice of all Korean Pediatric Society members about the contents and usability of this book.

Immunogenicity and Safety of Oral Live Attenuated Salmonella typhi Vaccine

BACKGROUND: This study is aimed at evaluating immunogenicity by measuring immunoglobulin A (IgA) seroconversion rate through common mucosal immune system and adverse reactions after vaccination of oral live attenuated Salmonella typhi (S. typhi) Ty21a vaccine in Korean population. METHODS: A commercially available oral live attenuated vaccine of S. typhi strain Ty21a (Zerotyph(r) capsule, Boryung Biopharma Co., Seoul, Korea) was given to volunteers; children above 6 years, adolescents, and adults who have never infected with S. typhi nor received S. typhi vaccination. The vaccines were given in three doses, with two day interval between the doses. Seroconversion was determined by ELISPOT (enzyme-linked immunospot) assay. Adverse reactions after vaccination were evaluated in 12 institutions by direct interviewing with vaccinees. RESULTS: A total of 93 volunteers for evaluation of seroconversion were enrolled. Seroconversion rate in the the below 16 year-old group was 73.8% (31/42) and that of over 16 year-old group was 86.3% (44/51), which was not statistically different. Adverse reaction were found in 8.6% (40/465). Gastrointestinal symptoms were most common (6.5%, 30/465). Adverse reactions were found in 5.2% (24/465) after 1st administration, 4.5% (21/462) after 2nd, and 2.6% (12/461) after 3rd. Frequency of adverse reactions was significantly higher after 1st administration (P<0.05). CONCLUSION: Oral live attenuated S. typhi vaccine, Zerotyph(r) capsule, had good immnuogenicity and safety through intestinal immune system.

Immunogenicity and Safety of Oral Live Attenuated Salmonella typhi Vaccine

BACKGROUND: This study is aimed at evaluating immunogenicity by measuring immunoglobulin A (IgA) seroconversion rate through common mucosal immune system and adverse reactions after vaccination of oral live attenuated Salmonella typhi (S. typhi) Ty21a vaccine in Korean population. METHODS: A commercially available oral live attenuated vaccine of S. typhi strain Ty21a (Zerotyph(r) capsule, Boryung Biopharma Co., Seoul, Korea) was given to volunteers; children above 6 years, adolescents, and adults who have never infected with S. typhi nor received S. typhi vaccination. The vaccines were given in three doses, with two day interval between the doses. Seroconversion was determined by ELISPOT (enzyme-linked immunospot) assay. Adverse reactions after vaccination were evaluated in 12 institutions by direct interviewing with vaccinees. RESULTS: A total of 93 volunteers for evaluation of seroconversion were enrolled. Seroconversion rate in the the below 16 year-old group was 73.8% (31/42) and that of over 16 year-old group was 86.3% (44/51), which was not statistically different. Adverse reaction were found in 8.6% (40/465). Gastrointestinal symptoms were most common (6.5%, 30/465). Adverse reactions were found in 5.2% (24/465) after 1st administration, 4.5% (21/462) after 2nd, and 2.6% (12/461) after 3rd. Frequency of adverse reactions was significantly higher after 1st administration (P<0.05). CONCLUSION: Oral live attenuated S. typhi vaccine, Zerotyph(r) capsule, had good immnuogenicity and safety through intestinal immune system.

Pulmonary Features of Hyperimmunoglobulin E (Job's)syndrome / 결핵

Hyperimmunoglobulin E syndrome, otherwise known as Job's syndrome, is an immune disorder characterized by an abnormal elevation of the circulating immunoglobulin E level, and recurrent infections of the skin and sinopulmo nar tract. The syndrome has various ppulmonary featurea, e.g., pneumonia, pneumatocele, pneumothorax, lung abscesses and empyema. We report a case of hyperimmunoglobulin E syndrome, with various respiratory clinical manifestation. Medical therapy, including prophylactic antibiotics, has been the cornerstone for the treatment of hyperimmunoglobulin E syndrome. Even if surgical intervention is required, minimal pulmonary parenchymal resection is recommended.

The Characteristics of the 2000-2001 Measles Epidemic in the Seoul Metropolitan Area

PURPOSE: To assess the clinical characteristics of the 2000-2001 measles outbreak in the Seoul metropolitan area, Korea, the clinical data of measles inpatients were analyzed. METHODS: Three hundred and five children diagnosed with measles by clinical manifestation from July, 2000 to February, 2001, in Seoul, Ilsan and Ansan City were grouped according to their age and investigated for clinical manifestations, vaccination history and measles-specific IgM/IgG antibody positivity. RESULTS: Thirty eight point seven percent of the subjects were less than 12 months of age, 27.5 % were 12-47 months of age and 33.8% were 48 months of age or older. There was no significant sexual difference(male : female=1.2 : 1). This epidemic started in June, 2000 and the number of patients increased abruptly in October, peaked in December and finally decreased after February, 2001. It started from the older age group and moved to the younger. Sixty five point two percent had a history of more than 1-dose vaccination and 13.6% of the patients equal or more than 48 months of age had a history of 2-dose vaccination. Primary vaccine failure rate was 59.4%(107/ 180) and secondary vaccine failure rate was 3.9%(7/180) in 1 dose vaccinees. Sixty one point six percent showed more than one complication and 38.4% had no complication. The most common complication was pneumonia(31.8 %), followed by bronchitis(11.5%) and acute otitis media(4.6%). Vaccination and dose were not related significantly with the occurrence of complications. CONCLUSION: Compared with previous outbreaks in Korea, clinical features showed no specific change in the 2000-2001 measles epidemic. However, primary vaccine failure rate was so high that the second vaccination at four to six years of age must be emphasized in Korea.

The Trend for Diagnosis and Treatment of Childhood Asthma in Korean Pediatricians / 소아알레르기및호흡기학회지

PURPOSE: Korean Academy of Pediatric Allergy and Respiratory Disease suggested Korea Guideline for Diagnosis and Management of Childhood Asthma(KGDMCA) in 1994 and updated it in 1999. This survey was performed to evaluate the practical efficacy of KGDMCA and to develop appropriate educational interventions of childhood asthma for the Korean Pediatricians. METHODS: One thousand and two hundreds pediatricians were chosen randomly from the address book of Korean Pediatric Society. A questionnaire consisted of 22 multiple choices about childhood asthma and personal data was mailed to each pediatrician. RESULTS: Two hundred and thirty-eight pediatricians(19.8%) completed and returned the questionnaires. History of recurrent wheezing(24.9%) and improvement of wheezing after using bronchodilator(13.1%) were considered as the most important factors for the asthma diagnosis. 65.1% of the respondents used inhaled bronchodilator for the treatment, and 64.0% of users thought it efficient. 46.3% of the respondents used the inhaled corticosteroid. The younger the respondents are, the more they use the inhaled corticosteroid and inhaled bronchodilator(P<0.01). 66.4% of the respondents was already aware of the KGDMCA. 20% of them followed KGDMCA and 72.0% of them used personal guidelines modified from KGDMCA. KGDMCA was significantly preferred in younger pediatricians(4-5th decades, P<0.01). CONCLUSION: Many Korean pediatricians used KGDMCA-modified personal guidelines, but older pediatricians were less familiar with KGDMCA. It is necessary to identify specific areas of misunderstanding about the diagnosis and treatment of asthma, and the continuous, eager education about KGDMCA must be emphasized.

A Study of Menarche and Dysfunctional Uterine Bleeding in Adolescent School Girls in Ansan City

PURPOSE: We investigated the menstrual features of adolescent school girls to know the characteristics of menarche and dysfunctional uterine bleeding in adolescents. METHODS: In March, 2001, 1,434 primary and middle school girls(10-15 years of age) in Ansan City were investigated for the menacheal age and several aspects of menstruation through questionnaire. RESULTS: Mean age of the total subjects were 13.0+/-1.2 years of age, and 68.4% of them experienced menarche. 32.2% experienced menarche after age 12, but 82.9% experienced it after age 13. Mixed type(regular and irregular) menstrual cycle was the most common(35.3%), and changing type(irregular to regular) was 27.6%. In changing type, the mean duration of cycle stabilization was 6.6+/-4.9 months. The most common menstrual cycle was 'within 26-30 days'(31.4%). Abnormal cycles such as 'equal or less than 20 days' and 'equal or more than 41 days' were 17.2% and 2.0%, respectively. The most common menstrual duration was '5-6 days'(44.7%). 7.6% of the subjects experienced short or long menstrual duration. Among the subjects, only 4.0% visited the hospital with menstrual problems. The visiting reasons were 'irregular menstrual cycles'(38.5%), 'dysmenorrhea'(28.2%), 'menorrhagia'(12.8%), and 'hypermenorrhea'(28.2%). CONCLUSION: Most adolescent girls in our study experienced menarche until 13 years of age and some of them got early menarche at the age of 9. Many of them had irregular or unstable menstrual cycles after menarche at any age, but only few of them visited a health care provider. We suggest the careful attention of pediatricians, parents and teachers to the early detection and proper treatment of menstrual problems in adolescent girls.

Predisposing Factors of Risk Taking Behaviors in Korean Adolescents

PURPOSE: Risk-taking behaviors are defined as patterns of behavior initiated during adolescence which are responsible for the majority of negative health outcomes occurring during the rest of the life. The study was to explore the relationship between the risk-taking behaviors and their predisposing factors among adolescents. METHODS: The study used a survey design with an anonymous self-report questionnaire administered to 1,076 students from first year of middle school to first year of high school in Ansan City. The questions were constructed from nine risk-taking behaviors of independent variables including smoking, alcohol, drug abuse, adaptation at school, use of computer, sexual behavior, vehicle use, suicide, school violence and eight predisposing factors of school grade, gender, academic ranking, academic achievement of the mother, socioeconomic status, living with both parents, religion of the student and the mother. The data was analysed by the statistical methods of X(2) test and Fisher's exact test. RESULTS: The study revealed that the combination of the independent variables of the risk-taking behaviors to have a close association(P<0.05) with the predisposing factors. CONCLUSION: School grades, socioeconomic status, academic rankings, final educational level of the mother and living with both parents were factors strongly correlating with risky behaviors. The role of the clinician to identify those at risk is fundamental for health maintenance long after adolescence.

A Case of Measles Encephalopathy with Thalamic Lesion on Magnetic Resonance Imaging

We experienced a case of measles encephalopathy with thalamic lesion on magnetic resonance imaging(MRI) in a 12 year old boy. Measles symptoms such as fever, erythematous maculopapular rashes on whole body and cough with sputum appeared 4 days before neurologic signs such as agitation and drowsy-to-confused mentality. He showed remarkable motor dysfunction without evidence of sensory loss. MRI showed bilateral symmetrical T2/FLAIR hyper-intensities in both thalami, posterior putamina and brainstem. It also showed inhomogenous Gadolinium(Gd) enhancement. In his electroencephalogram(EEG), there was nonspecific cortical dysfunction. After 20 days of supportive care, his motor dysfunction improved to near-normal and follow-up MRI revealed nearly normalized thalamic region. Over this period, no sensory loss was noted. We report this case with review of related literatures.

Acyclovir Resistance of Herpes Simplex Virus

No abstract available.

A Case of Bilateral Tubo-Ovarian Abscesses in a One-and-Half Year-Old Girl

Tubo-ovarian abscess is an end-stage disease of acute pelvic inflammatory disease (PID). Since most cases of PID are caused by sexually transmitted microorganisms, this is very rare in children. Here, we report an 1 1/2-year-old girl with bilateral tubo-ovarian abscesses. She was admitted to our Department with chief complaints of fever, vomiting and diarrhea. Abdominal ultrasonography and CT scanning of the patient showed solid and cystic masses in pelvic cavity. It was very difficult to differentiate the lesions from abscess and tumor. In addition, intravenous pyelography (IVP) and abdominal CT scanning of the patient showed both hydronephrosis and ureteral dilatation. Because of severe visceral adhesions, we could not perform laparoscopic examination of the pelvic masses. By exploratory operation and frozen biopsy, the masses were confirmed as tubo-ovarian abscesses and they were drained. In the bacterial culture, K. pneumoniae and E. coli were grown. The patient was treated with sensitive antibiotics and recovered from her disease. After 4 weeks of operation, IVP showed no abnormal findings and voiding cystourethrography (VCUG) showed grade I vesicoureteral reflux of the left side. It was suggested the hydronephroses were developed by the ureteral obstruction of tubo-ovarian abscesses.

Serum Leptin Levels in Children according to Pubertal Stage / 대한소아내분비학회지

PURPOSE: Leptin is a hormone, encoded by ob gene in adipocytes and regulates food intake and energy expenditure. The serum concentration of leptin is known to be proportional to the amount of body fat but the regulation of leptin for growth and development in childhood is not clear. The purpose of this study is to evaluate the correlation of serum leptin levels to gender, pubertal development and sex steroid in children. METHODS: Serum leptin levels were measured by RIA in 145 Korean children of both sexes, age 8-16yr, and were compared according to body mass index, gender and pubertal stage. The correlations of leptin with testosterone and estradiol were also analized. RESULTS: A positive relationship was observed for leptin levels with body mass index(in male:r=0.63, P<0.001, in female:r=0.80, P<0.001). The mean leptin level of girls was higher than that of boys(7.50+/-.83ng/mL vs 4.11+/-.72ng/mL, P<0.05) in lean children but there was no significant difference in obese group. An analysis according to the pubertal development showed an increase of leptin level in girls while leptin decreased in boys at overt puberty. Serum leptin levels of boys in puberty correlated inversely with testosterone(r=-0.52, P<0.001) but leptin of girls did not have significant correlation with estradiol. CONCLUSION: Serum leptin level increases in girls and decreases in boys as the pubertal development proceeds. The relationships between leptin level and pubertal developement show gender difference and it might be explained in part by suppressive effects of androgen in male.

A Case of Bilateral Tubo-Ovarian Abscesses in a One-and-Half Year-Old Girl

Tubo-ovarian abscess is an end-stage disease of acute pelvic inflammatory disease (PID). Since most cases of PID are caused by sexually transmitted microorganisms, this is very rare in children. Here, we report an 1 1/2-year-old girl with bilateral tubo-ovarian abscesses. She was admitted to our Department with chief complaints of fever, vomiting and diarrhea. Abdominal ultrasonography and CT scanning of the patient showed solid and cystic masses in pelvic cavity. It was very difficult to differentiate the lesions from abscess and tumor. In addition, intravenous pyelography (IVP) and abdominal CT scanning of the patient showed both hydronephrosis and ureteral dilatation. Because of severe visceral adhesions, we could not perform laparoscopic examination of the pelvic masses. By exploratory operation and frozen biopsy, the masses were confirmed as tubo-ovarian abscesses and they were drained. In the bacterial culture, K. pneumoniae and E. coli were grown. The patient was treated with sensitive antibiotics and recovered from her disease. After 4 weeks of operation, IVP showed no abnormal findings and voiding cystourethrography (VCUG) showed grade I vesicoureteral reflux of the left side. It was suggested the hydronephroses were developed by the ureteral obstruction of tubo-ovarian abscesses.

A Case of Partial Trisomy 9 by Balanced Maternal Translocation

Trisomy 9p syndrome was first described by Rethore et al in 1970 and about 100 cases have been reported since. The phenotypic spectrum of this syndrome is characterized by craniofacial malformation, facial deformity, skeletal and dermatoglyphic anomalies with variable degrees of mental retardation. We experienced a case of partial trisomy 9 syndrome in a 15-month-old female who had multiple congenital anomalies of frontal bossing, oblique antimongoloid palpebral fissures, enophthalmos, hypertelorism, globular prominent nose, down-turned mouth, prominent low-set ears, simian creases of both hands, clinodactyly and single crease of 5th finger, congenital dislocation of both knees and mental retardation. In cytogenetic studies using G banding technique and fluorescent in situ hybridization(FISH), she presented with an extra derivative chromosome No. 9. The karyotype of the patient was confirmed as 47,XX,+der (9),t (6:9) (q27;q21.2) mat. We report the case with the review of the associated literatures.

Dysmenorrhea and Premenstrual Syndrome of School Girls in Ansan

PURPOSE: Menstrual disorders are very common problems in adolescence. Most of them are minor, including mild dysmenorrhea, premenstrual syndrome(PMS) and minor variations in cycle, length, or amount of flow. Dysmenorrhea is the most prevalent among them while PMS is a nebulous condition characterized by a broad spectrum of symptoms. The purpose of this study is to investigate the correlation between dysmenorrhea and PMS in adolescents. METHODS: This cross sectional study on dysmenorrhea and PMS was performed in 1153 junior high school girls in Ansan. We researched the clinical aspects of PMS and investigated the correlation between menstrual characteristics and PMS in adolescents. RESULTS: The results are as follows : The incidence of PMS is 66.3%. The correlation of menstrual characteristics and severity of PMS was as follows : intensity of menstrual flow(P<0.01), duration of menstrual flow(P<0.05). The correlation of severity between dysmenorrhea and PMS is found(P<0.01). CONCLUSION: Korean adolescents have many problems related to dysmenorrhea and PMS. This study indicates that Korean adolescents need to be educated on the matter and treatment of their menstrual disorders are also needed.

Role of Inappropriate Antidiuretic Hormone Secretion in Hyponatremia associated with Febrile Convulsions

PURPOSE: Febrile convulsion is a common clinical problem in young children. In spite of their frequent occurrence, there is little information available about the value of investigation with febrile convulsion. Recent studies found a correlation between low serum sodium levels and risk of febrile convulsions. We carried out a study to evaluate the role of inappropriate ADH secretion in hyponatremia in relation to febrile convulsions. METHODS: This study used seventy cases(46 boys, 24 girls) with febrile convulsion, that were treated at the pediatric department of Korea University Medical Center Ansan hospital from Jan. 1998 to Aug. 1999. During the same period, thirty one cases(19 boys, 12 girls) with fever but without convulsion(control group I) and twenty four cases(16 boys, 8 girls) with convulsion but without fever(control group II) were evaluated in comparison with febrile convulsion group. Serum sodium, osmolality, vasopressin and urine osmolality of each group were measured on admission and analyzed by ANOVA. RESULTS: The mean serum sodium concentration of febrile convulsion group, control group I and control group II were 134.3+/-2.4mmol/L, 136.4+/-2.0mmol/L, and 136.0+/-2.2 mmol/L respectively. The serum sodium level of patient group was significantly lower than those of control group I and II(P<0.05). The case of the serum levels less than 135mmol/L was 54.3%(38/70) in patient group, 16.1%(5/31) in control group I and 12.5% (3/24) in control group II. Serum osmolality, uine osmolality of patients group were not significantly different from those of each control group. Vasopressin level of febrile convulsion group was higher than that of each control group. The risk of recurrent convulsion approaches 60%(15/25) of cases with hyponatremia less than 135mmol/L. CONCLUSION: We conclude that febrile convulsions are not mediated by hyponatremia but induce the changes in serum vasopressin and sodium level.

A Case of Transient Neonatal Pustular Melanosis

Transient neonatal pustular melanosis(TNPM) is a benign, self-limited, cutaneous disorder of unknown etiology. Significant physical findings are limited to the skin. Hematologic and serological tests are normal. Cultures of blood and pustule are negative. Biopsy specimens from pustules show a intracorneal or subcorneal separation containing neutrophils and also some eosinophils. TNPM produces only cutaneous lesions and requires no treatment. So it is essential to differentiate TNPM and other neonatal skin lesions. We experienced a case of TNPM in a male newborn with generalized superficial vesicopustules which developed into pigmented macules and report this case with review of related literatures.

Neuroprotective Effects by Magnesium Sulfate Pretreatment against Hypoxia-Ischemia in the Newborn Rat: Preliminary report

PURPOSE AND BACKGROUND: Recently several clinical studies suggested that maternal treatment with magnesium sulfate had protective effects against cerebral palsy in premature infants. But previous studies with differing perinatal animal models resulted in inconclusive results with regard to magnesium neuroprotection. Our purpose was to study the neuroprotective effect of magnesium sulfate and optimal dosage on hypoxicischemic brain damage in the newborn rat. METHOD: Seven-day-old rats(n=68) underwent right carotid ligation, followed by 3 hours of hypoxia(8% oxygen in 92% nitrogen). Rats received magnesium sulfate immediately before and again after hypoxia(two doses, 150mg-600mg/kg/dose, n=39), or saline solution(n=29). Severity of injury was assessed 5 days later, by visual evaluation of ipsilateral hemisphere infarction and by measurement of bilateral hemispheric cross sectional areas. RESULTS: Magnesium sulfate pre-treatment reduced the incidence of liquefactive cerebral infarction and atrophy from 80.8% in controls to 22.2% with magnesium sulfate(450 mg/kg/dose, P<0.05). Quantitation of hemispheric areas confirmed these findings. Percent protection based on inter-hemisphere area differences by pre-treatment with magnesium sulfate 450mg/kg/dose ranged from 71.1%(hippocampus) to 90.8%(striatum). However higher dose of magnesium(600mg/kg/dose) did not attenuate hypoxic-ischemic brain injury in the newborn rat but increased mortality. CONCLUSION: Pretreatment of magnesium sulfate has neuroprotective effects against hypoxia-ischemia in the newborn rat and adequate dose of magnesium sufate is important to protect the brain. Magnesium pretreatment may be an effective strategy to decrease the severity of neonatal hypoxic-ischemic brain injury in the adequate dose.

A Case of Neonatal Alloimmune Thrombodytopenia Due to Anti - HLA Antibody

Anti-HLA antibody related neonatal thrombocytopenia is an uncommon disorder caused by platelet antigen incompatibility between mother and fetus in Korea. Mothers who lack the specific platelet antigen produce the IgG against the platelet antigen which the fetus inherits from the father. These IgG antibodies are then transported across the placenta into the fetal circulation where they lead to the destruction of fetal platelets. We report a case of neonatal alloimmune thrombocytopenia related with anti-HLA antibody in second baby of dizygotic twin who had petechia on trunk and platelet count 43,000/mm. Initially, mother and twin showed the positives in antiplatelet antibodies. In microlym- phocytotoxic test at 6 months of age, anti-HLA antibodies was negative in twins but anti-HLA A2, A24 was positive in their mother. The patient was treated with intravenous immunoglobulin and clinically improved and her platelet count was norrnalized.