A Case of Successful Management of Hypertrophic Pyloric Stenosis with Endoscopic Balloon Dilatation

Endoscopic balloon dilatation has provided a non-operative means of managing obstructive lesions in the gastrointestinal tract. In an infant with idiopathic hypertrophic pyloric stenosis(IHPS), the stenosis was successfully dilated with endoscopic balloon dilatation. Endoscopic balloon dilatation was performed using a 9mm endoscope and through-the-scope(TTS) balloon catheter (diameter 10 to 12mm). Dilatation was performed two times for 5 minutes. The 9mm endoscope then passed through the pylorus. There were no complications. The treatment was followed by immediate symptomatic relief. Endoscopic balloon dilatation may become a valid alternative to surgical procedures for the treatment of IHPS if good results can be confirmed in further studies.

Effects of Blood Pressure Cuffs on the Circulatory and Respiratory Status of Infants with Persistent Pulonary Hypertension of the Newborn

PURPOSE: Vasodilator therapy in infants with persistent pulmonary hypertension of the newborn(PPHN) frequently causes systemic hypotension due to non-selectivity for pulmonary vessels. Blood pressure(BP) cuffs can increase systemic vascular resistance around which they are applied without affecting pulmonary vessels. We studied the effects of BP cuffs on the circulatory and respiratory status of infants with PPHN receiving vasodilator therapy. METHODS: Mechanically ventilated 16 term infants(gestational age of 39.9+ 1.3 weeks and birth weight of 3,533+/-318 gm with PPHN who had right to left shunt on echocardiogram and survived over 5 days were included for the study. All infants received vasodilator(tolazoline)therapy. We applied BP cuffs for neonatal use to four extremities of study infants(n=8) and inflated them to systolic pressure. Those who received vasodilator therapy alone served as control(n=8). We analyzed systolic and mean BP, respiratory parameters, presence of right to left shunt an clinical outcome at 1, 2, 6, 12, 24, 48, 72hr after initiation of vasodilator therapy. RESULTS: Systolic BP increased significantly in study group(from 37+/-11 to 46+/-13 mmHg) from 6 hours after BP cuff application compared to control group(from 39+/-8 to 40+/-13 mmHg), and this effect persisted up to 72 hour(52+/-18 vs. 46+/-16 mmHg)(P<0.05). Mean BP also increased significantly in study group(30 +/-10 to 38+/-12 mmHg) from 6 hours compared to control group(32+/-11 to 33 15 mmHg) and maintained up to 72 hour occurred(43+17 vs. 3715 mmHg)(P<0.05). Reversal of right to left shunt occurred significantly earlier in study group than control group(30+/-10 vs. 52+/-18 hr)(P<0.01). Respiratory parameters such as mean airway pressure, oxygenation index and duration of ventilator care and hospitalization were not different. Four of five infants in the study group and five of eight in control group survived. CONCLUSION: Application of BP cuffs to the infants with PPHN treated with vasodilator resulted in increase innd mean BP and early reversal of right to left shunt. We suggest that application of BP cuffs can play a useful role in the management of infants with PPHN.

A Case of Toxic Epidermal Necrolysis in Early Infancy

Toxic epidermal necrolysis(TEN) is a bullous disorder affecting mainly basal layers of epidermis by hypersensitive reaction. It is rarely reported in infants under six months of age. It can be developed by drug, infection, and vaccination, which makes it difficult to differentiate from staphylococcal scalded skin syndrome(SSSS) especially in early infancy. We report a case of TEN in a 6-week-old infant with short bowel syndrome receiving total parenteral nutrition. A male infant(birth weight 2,570gm at 37 weeks) whose mother had polyhydramnios with bilous vomiting at birth was evaluated. Barium and histologic study showed total aganglionosis. Surgical resection was performed at 3 days of life and subsequently short bowel syndrome developed. Total parenteral nutrition via central venous catheter was done due to feeding intolerance. Staphylococcus aureus was cultured from blood at 37days of life, and we administered vancomycin. As multiple scaly eruption and fever developed at 47days of life, we were suspicious of SSSS. Blood culture done at 47days of life revealed Pseudomonas aeruginosa and skin biopsy showed the split at dermoepidermal junction at light microcopy and confirmed the diagnosis of TEN. Despite discontinuation of antibiotics, the infant did not improve and died due to shock at 54days of life. We emphasized that in case of acute, severe exfoliative disease in early infancy, the diagnosis of TEN should be considered and that skin biopsy should be performed to make the correct diagnosis.

A Case of Primary Small Cell Bronchogenic Carcinoma Detected by Bronchoscopy in a Child

While the frequency of primary carcinoma of the lung has recently increased in adults, it is rare in the pediatric age group. The various adult types of bronchogenic carcinoma such as squamous cell, small cell, large cell, and adenocarcinoma, are extremely rare in children. Twenty to 30 cases of primary bronchogenic carcinoma of the lung in children under 15 years of age have been reported in the English-language literature. We have experienced a small cell bronchogenic carcinoma detected by fiberoptic bronchoscopy with bronchial biopsy in a 14-year-old boy with chief complaint of hemoptysis, lung mass and persistent pneumonitis. To the best of our knowledge, this is the first reported case of primary small cell bronchogenic carcinoma in childhood under 15 years of age. We report this case with a brief review of related literatures.

A Case of Allergic Bronchopulmonary Aspergillosis During Childhood

Allergic bronchopulmonary aspergillosis(ABPA) is an inflammatory disease which causes a hypersensitivity to Aspergillus spores growing in the bronchi. The clinical syndrome is characterized by asthma, recurrent pulmonary infiltrations or mucoid impaction, eosinophilia, and central bronchiectasis. A 12-year-old boy was admitted to our hospital because of right lower chest pain and cystic mass-like shadows on a chest X-ray film. He had asthma as an infant, but had no asthmatic symptoms on admission. Chest CT scan showed low density cystic mass of the right lower lobe. The total eosinophil count and IgE level were abnormally high. Test for immediate skin reaction to Aspergillus fumigatus was positive but precipitating antibody to Aspergillus antigen was negative. After steroid treatment, he became asymptomatic. Radiologic abnormalities including mass-like shadows were resolved by two months after the start of treatment and a follow-up high resolution CT scan obtained after clinical improvement revealed central saccular bronchiectasis. We report one case of ABPA with review of literature.

Correlation of Serum Magnesium Concentrations and Diseases of Prematurity in Very Low Birth Weight Infants

PURPOSE: The purpose of the study was to evaluate serum magnesium(Mg) concentration in very low birth weight(VLBW) infants during the first three weeks of life and to assess its relation to diseases of prematurity. METHODS: We measured serum Mg level at 0, 1, 2, and 3weeks of life in VLBW infants and analyzed its correlations with diseases of prematurity. Ninety-five VLBW infants(mean gestational age 30.4wks, birth wt 1304gm) who survived 30days were selected. Seven infants who had been treated with magnesium sulfate prenatally were excluded. RESULTS: Serum Mg level decreased linearly during the first three weeks of life(P=0.03). Serum Mg level at birth had no significant relation to gestational age, birth weight and serum calcium concentration. Serum Mg level at birth were higher within normal range in infants with respiratory distress syndrome(n=20, 2.6mg/dl vs. n=68, 2.2mg/dl, P=0.036), patent ductus arteriosus (n= 19, 2.5mg/dl vs. n=69, 2.2mg/dl, P=0.035) and bronchopulmonary dysplasia(BPD)(n=15, 2.6mg/dl. vs. n=73, 2.2mg/dl, P=0.01) than in infants without them. Serum Mg level at first week of life were similar(2.3mg/dl. vs. 2.2mg/dl, P=0.51) and serum Mg level at second and third weeks of life were significantly lower in infants with BPD than in control(1.9mg/dl vs. 2.2mg/dl, P=0.002 and 1.6mg/dl vs. 2.2mg/dl, P=0.001, respectively). CONCLUSION: Serum Mg level during the first three weeks of life decreased linearly. Serum Mg level of infants with BPD at birth was higher within normal variation than in infants without BPD. And serum Mg level of infants with BPD at second and third weeks of life were lower than control. Thus, we suggest that Mg deficiency during the first three weeks of life might play a role in the pathogenesis of BPD.

Usefulness of the Flexible Bronchoscopy for Pediatric Respiratory Diseases

PURPOSE: Flexible bronchoscopy is an important diagnostic and sometimes therapeutic tool that can be used on infants and children using light sedation and local anaesthesia. The purpose of this study is to evaluate the contribution of the flexible bronchoscopy to clinical diagnosis and therapy in children. METHODS: We examined the first 100 consecutive flexible bronchoscopies performed in children under 15 years of age(median age, 7 years). RESULTS: Indications for bronchoscopy were bronchoalveolar lavage(39.3%), wheezing(12.5%), stridor/noisy breathing(10.7%), recurrent/persistent pneumonia(8.0%), atelectasis or bronchial toilet (7.1%), equivocal airway foreign body(6.3%), hemoptysis(4.5%), and miscellaneous other reasons (11.6%). Inspection was abnormal in 79.0% of all investigations and made a clinically meaningful contribution to diagnosis in 79.0%. Bronchoalveolar lavage cytology was abnormal in 77.3% of the 44 lavages. Viruses and bacteria were isolated in 33.3% of the 48 specimens cultured. Meaningful therapeutic result was obtained in 81.3% of the 16 therapeutic bronchoscopies including bronchial toilet and persistent atelectasis. CONCLUSION: A high yield of meaningful diagnostic information and therapeutic goal can be expected from flexible bronchoscopy in children.

Predominant Th2 type immune response in bronchoalveolar lavage fluid of patients with Mycoplasma pneumoniae pneumonia / 천식및알레르기

OBJECTIVE: Mycoplasma pneumoniae infection is known as one of the frequent causes of exacerbation of bronchial asthma and it can also be a trigger for the initiation of asthma. However, little is known about the pathogenesis of respiratory M. pneumoniae infection. Furthermore, there is little data on human cytokine production and its involvement in the pathogenesis of M. pneumoniae infection. In order to investigate the immunopathogenesis of M. pneumoniae infection, we investigated the cytokine production in the bronchoalveolar lavage ( BAL ) fluid of patients with M. pneumoniae pneumonia and viral pneumonia, and compared the results with those of control subjects. SUBJECT AND METHOD: BAL was performed with fiberoptic bronchoscopy in patients with M. pneumoniae pneumonia( n=9 ), viral pneumonia( n=9 ), and control subjects( n=6 ) aged 3 years to 9 years. M. pneumoniae pneumonia was documented by polymerase chain reaction and serologic analysis. Four respiratory viruses ( adenovirus, influenza A, influenza B, parainfluenza ) were detected by culture method. Cell pellets and supernatants were separated by centrifugation and Interleukin( IL ) - 2, Interferon( IFN )-r, IL-4, and IL-5 levels were measured in concentrated BAL supernatants by ELISA. RESULTS: Analysis of cytokines revealed significantly increased production of IL-4 ( p< 0.0001 ) and IL-2 ( p< 0.0001 ), in patients with M. pneumoniae pneumonia and significantly increased production of IL-2 (p <0.0001) in patients with viral pneumonia compared with those of the control subjects. Ratio of IL-4/IFN-r was significantly increased in patients with M. pneumoniae pneumonia ( p< 0.005 ) but not in patients with viral pneumonia compared with that of the control subjects. CONCLUSION: IL-4 production and IL-4/IFN-r ratio were increased in the BAL fluid of patients with M. pneumoniae infection. These findings suggest that predominant Th2 immune response could play an important role in the pathogenesis of M. pneumoniae infection.

The Usefulness of Serum Total IgE Test by Multiple Allergosorbent Test-Chemiluminescent Assay(MAST-CLA): Comparison with Paper Radioimmunosorbent Test(PRIST)

PURPOSE: Multiple allergosorbent test-chemiluminescent assay(MAST-CLA) is a semiquantitative method for detecting total IgE and specific IgE in serum. The purposes of this study are to investigate the correlation between MAST-CLA and Paper radioimmunosorbent test(PRIST), and to find out whether MAST-CLA can replace PRIST in measuring of serum total IgE. METHODS: Data of 162 subjects were analyzed by linear regression analysis for MAST-CLA (MAST class) and PRIST(PRIST IgE, PRIST class, PRIST log10 IgE). Diagnostic sensitivity, specificity, efficiency, positive and negative predictive values were calculated by standard methods. RESULTS: The sensitivity of MAST-CLA was 64.0%, specificity was 56.0%, efficiency was 56.0%, positive predictive value was 87.2% and negative predictive value was 21.8%. The overall correlation coefficiency(r) of total IgE between MAST class vs PRIST IgE was 0.176(P<0.05), MAST class vs PRIST class was 0.308(P<0.001), MAST class vs PRIST log10 IgE was 0.301(P<0.001). According to age classification, good correlation was obtained in the 3-6 yr age group(MAST class vs PRIST IgE : r=0.283, P<0.01, MAST class vs PRIST log10 IgE : r=0.377, P<0.001), but there were no significant correlation in the 7-10 yr age group and in the 11-15 yr age group. CONCLUSION: A different correlation was observed between the two tests according to age, so we suggest that simultaneous use of PRIST should be performed considering the age when MAST-CLA is used as an atopy screening.

Comparison of Treatment Course and Outcome between Medically and Surgically Treated Patent Ductus Arteriosus in Preterm Infants

PURPOSE: Early intervention is needed to treat patent ductus arteriosus (PDA) as it is a major cause of increased mortality in preterm infants. However, it is uncertain which is better, medical versus surgical management. We reviewed medical records to compare the treatment course and outcome between medically and surgically treated preterm PDA infants. METHODS: Thirth-two Mechanically ventilated pretem infants (gestational age<34 wks, birth weight<2,000gm) who survived beyond 30 days were studied. Treatment course and outcome were compared between indomethacin-treated (INDO, n=15) and surgically treated who have not responded to indomethacin (Surg, n=17). RESULTS: Volume of administered fluid and urine output during the first five days of life were similar, however, initial weight loss were lower in the SURG group than INDO group (p=0.031). Size of PDA on the echocardiogram were larger in SURG group (mean 3.4 mm) than INDO group (mean 2.5 mm) (p=0.046). Duration of hospitalization was longer in the SURG group (mean 46 days) than INDO group (mean 72 days) (p=0.033), however, time to start feeding, ventilator duration and weaning time were similar in both groups. Incidence of intraventricular hemorrhage was lower in the SURG group (47%) than INDO group (6%) (p=0.009). CONCLUSION: Preterm infants with poor initial weight loss and large size of PDA were likely to become surgical candidates and required longer periods of hospitalization and showed increased incidence of IVH. Although surgical treatment of PDA in preterm infants is definitive, fluid restriction and medical management at early postnatal period is recommended.

Serum Leptin Levels in Obese Children

PURPOSE: Leptin is a protein encoded by the ob gene that is expressed in adipocytes. It regulates eating behavior by the action to the satiety centers in the hypothalamus. In ob/ob mouse, adipocytes can not produce leptin because of a mutation in the ob gene which results in obesity. Whereas, leptin concentrations were elevated in obese adults, and leptin levels in obese children has not been studied much until now. The purpose of this study is to evaluate leptin concentrations in obese children and to find out correlating factors with leptin. METHODS: Thirty-six obese childrens whose weight is above 97 percentile of korean weight standard and 39 children with average weight were included. Height, weight, waist to hip ratio, fat weight and lean body mass were measured. The serum levels of leptin, insulin, cholesterol and triglyceride were measured. RESULTS: Mean age was 10.8 +/- 2.5 years in obese group and 10.6 +/- 2.6 years in control group. Obesity percent was 51.6 +/- 18.8% in obese and 8.8 +/- 10.2% in control group. Body mass index (BMI) was 26.3 +/- 5.8kg/m2 in obese group and 17.3 +/- 1.9kg/m2 in control group. Leptin levels of obese group (13.7 +/- 5.4ng/ml) were significantly higher than that of the control group (3.6 +/- 3.3ng/ ml). Leptin levels showed no significant difference by gender and by pubertal development. Leptin levels significantly correlated with BMI, obesity percent, fat weight, and serum cholesterol level but showed no significant correlation with lean body mass, serum fasting insulin and triglyceride levels. CONCLUSION: Serum leptin levels of obesity group were significantly higher than that of the control group, and they were correlated with BMI, obesity percent and fat weight. Additional research is necessary to assess the mechanism of leptin resistance in obese children.

Serum Leptin Levels in Obese Children

PURPOSE: Leptin is a protein encoded by the ob gene that is expressed in adipocytes. It regulates eating behavior by the action to the satiety centers in the hypothalamus. In ob/ob mouse, adipocytes can not produce leptin because of a mutation in the ob gene which results in obesity. Whereas, leptin concentrations were elevated in obese adults, and leptin levels in obese children has not been studied much until now. The purpose of this study is to evaluate leptin concentrations in obese children and to find out correlating factors with leptin. METHODS: Thirty-six obese childrens whose weight is above 97 percentile of korean weight standard and 39 children with average weight were included. Height, weight, waist to hip ratio, fat weight and lean body mass were measured. The serum levels of leptin, insulin, cholesterol and triglyceride were measured. RESULTS: Mean age was 10.8 +/- 2.5 years in obese group and 10.6 +/- 2.6 years in control group. Obesity percent was 51.6 +/- 18.8% in obese and 8.8 +/- 10.2% in control group. Body mass index (BMI) was 26.3 +/- 5.8kg/m2 in obese group and 17.3 +/- 1.9kg/m2 in control group. Leptin levels of obese group (13.7 +/- 5.4ng/ml) were significantly higher than that of the control group (3.6 +/- 3.3ng/ ml). Leptin levels showed no significant difference by gender and by pubertal development. Leptin levels significantly correlated with BMI, obesity percent, fat weight, and serum cholesterol level but showed no significant correlation with lean body mass, serum fasting insulin and triglyceride levels. CONCLUSION: Serum leptin levels of obesity group were significantly higher than that of the control group, and they were correlated with BMI, obesity percent and fat weight. Additional research is necessary to assess the mechanism of leptin resistance in obese children.

The Development of Bronchiolitis obliterans after Mycoplasma pneumoniae Pneumonia: Relationship with Antibody Titer and X-ray Pattern / 소아알레르기및호흡기학회지

The aims of this study were to document bronchiolitis obliterans(BO), the long term pulmonary sequelae after mycoplasma pneumonia, and to evaluate the difference of development of BO according to antibody titer and X-ray pattern. Twenty five subjects who had mycoplasma pneumonia underwent high resolution CT(HRCT) 1.3 years(1.0-2.0 years) after the initial infection. Fifteen boys and 10 girls, with mean age of 6.3 years(3-15 year) at the time of the infection, were included. The clinical diagnosis of Mycoplasma pneumoniae(M. pneumoniae) pneumonia was confirmed by a fourfold or higher rise in the antibody titers between acute and convalescent phase or a single very high titers(> or = 1:640) and abnormal chest radiographs. The subjects were divided into two groups as high titer group(antibody titer 1:5120 1:20480, n=15) and low titer group(antibody titer 1:640-1:2560, n=10). Nine of 25 subjects(36.0%) demonstrated BO findings on HRCT which included mosaic perfusion in 8 of 9 subjects(88.9%), bronchiectasis in 6(66.7%), mosaic perfusion associated with bronchiectasis in 6(66.7%), bronchial wall thickening in two(22.2%), and decreased pulmonary vascularity in one(11.1%). Those findings were more commonly seen in high titer group compared to low titer group[53.3%(8/15) vs 10.0%(1/10), P<0.05] and lobar type compared to linear type[58.0%(7/12) vs 15.4% (2/13), P<0.05]. The involved areas on HRCT exactly corresponded with initially involved area on chest radiographs in 8 of 9 subjects (88.9%). The development of BO was closely related to the M. pneumoniae pneumonia and was noted significantly in individuals with high antibody titer and lobar type x-ray pattern. We suggest that it is necessary to pay attention to the development of BO after M. pneumoniae pneumonia with high antibody titer and lobar type x-ray pattern.

Clinical Features and Endoscopic Findings of Helicobacter pylori Infection in Children

PURPOSE: Helicobacter pylori (H. pylori) is recognized as the cause of primary or unexplained gastrointestinal diseases in children as well as in adults. However, it is unclear whether H. pylori causes specific clinical symptoms or diseases. Therefore, we studied the clinical manifestations associated with H. pylori infection in consecutive symptomatic children undergoing diagnostic endoscopy. METHODS: This study included 42 patients with H. pylori infection, confirmed by ELISA test, CLO test, or Warthin Starry stain of a gastric mucosa biopsy specimen. The presenting symptoms, associated disease, endoscopic findings, and hematologic features were studied in the patients retrospectively. RESULTS: The positivity of H. pylori was 15%, and increased with age. The average age of infected children was 11 years. The presenting symptoms of H. pylori infection were chronic abdominal pain (57.1%), acute abdominal pain (14.3%), pallor (11.9%), hematemesis (9.5%), and nausea/ vomiting (7.1%). The endoscopic findings were nodular gastritis (54.8%), nodular duodenitis (35.7%), duodenal ulcer (14.3%), hemorrhagic erosive duodenitis (2.4%), and normal finding (19%). The associated diseases were chronic recurrent abdominal pain (57.1%), acute gastritis (16.7%), duodenal ulcer (14.3%), and iron deficiency anemia (9.5%). CONCLUSION: H. pylori infection was associated with recurrent chronic abdominal pain, acute gastritis, duodenal ulcer, and iron deficiency anemia in children. Therefore, in patients with several gastrointestinal symptoms and iron deficiency anemia, the diagnostic and therapeutic approach of H. pylori infection is warranted.

Pyloric Stenosis in Premature Infants: Report of two cases / 대한소아소화기영양학회지

The incidence of Hypertrophic pyloric stenosis (HPS) in premature infants is rare, the presentation is not typical, and the diagnosis delayed due to uncertain diagnostic criteria in abdominal ultrasonography (US). We report two premature infants with HPS diagnosed by US and upper gastrointestinal (UGI) contrast study. Patient 1. A premature female infant (birth weight 1950 gm at 34 week's gestation) with the onset of intermittent vomiting at 9 days of age was evaluated. US was normal at 13 days of life, however, abnormal at 41 days of life (pyloric muscle length 16.5 mm). Patient 2. A premature male infant (birth weight 1470 gm at 29 week's gestation) with the onset of intermittent vomiting at 10 days of age was evaluated. US showed pylorospasm at 11 days of life, however, findings compatible with HPS at 57 days of life (pyloric muscle thickness 11 mm).UGI contrast study at 48 days of life showed similar findings in both cases. Both patients had undergone pyloromyotomy. In conclusion, the diagnosis of HPS in premature infants requires careful follow-up by US and UGI contrast study.

Serum 17-Hydroxyprogesterone Levels in Term and Preterm Infants / 대한소아내분비학회지

PURPOSE:The incidence of congenital adrenal hyperplasia(CAH) is 1/5,000- 1/20,000 births and thus the importance of the neonatal screening test is being emphasized. However, the reference value for the term and preterm infants has not yet been established and false positive values are frequent due the immature hypothalamic-adrenal axis of the preterm infants or the stress-induced adrenal dysfunction. Therefore, we analyzed the 17-hydroxyprogesterone(17-OHP) concentration in terms of gestational age, birth weight, and postnatal state to establish the reference range for the Korean term and preterm infants. METHODS:We analyzed the results of the CAH screening test retrospectively, which was performed on 737 neonates(624 fullterm neonates, 113 premature neonates) born between January 1998 through July 1998 in Inje University College of Medicine Sanggye Paik Hospital. Mean gestational age and birth weight of infants were 38.2+/-2.6 weeks and 3,116+/-674kg respectively. 17-OHP screening test was performed on 4.9+/-3.8days after birth by obtaining blood samples from the heelstick of neonates. 17-OHP concentration was measured by the ELISA kit(ICN Co.) and repeated the procedure if the result was higher than 35ng/ml. RESULTS: 1) 17-OHP concentration of the preterm infants was significantly higher than that of the fullterm infants(19.1+/-12.3ng/ml vs 11.7+/-7.8ng/ml, P=0.001). 17-OHP concentration was inversely proportional to gestational age. 2)17-OHP concentration was inversely proportional to birth weight(r=0.22, P>0.01). 17-OHP concentration according to birth weight was as follows.:below 1,500g was 26.7+/-11.7ng/ml, 1,500 to 2,000g was 18.0+/-13.9ng/ml, 2,001 to 2,500g was 17.9+/-10.5ng/ml, 2,501 to 3,000g was 12.1+/-7.9ng/ml, 3,001 to 3,500g was 11.5+/-8.1ng/ml, above 3,500g was 11.4+/-7.5ng/ml. There was a significant decline in the 17-OHP concentration as the birth weight increased. 3) 17-OHP concentration was gradually decreased as sampling date increased. 4) The gender of the infants did not influence the 17-OHP concentration(male 13.0+/-9.1 vs female 12.7+/-9.0). 5)17-OHP concentration were significantly higher in sick preterm infants than healthy preterm infants. 6)Six cases, whose 17-OHP concentration were greater than 35ng/ml, were all preterm and low birth weight infants. Reexamination after one week showed the value within normal range. No CAH cases were diagnosed in the study. CONCLUSION: 17-OHP concentration was inversely proportional to gestational age and birth weight. Therefore, reference ranges of 17-OHP concentration should be subdivided according to gestational age and birth weight. Further research about perinatal risk factors affecting the 17-OHP concentration will be required.

Fatal Doudenal Ulcer Bleeding in Status Asthmaticus Treated with Theophylline and Steroids

It is generally agreed that theophylline preparations and steroids should be given intravenously for status asthmaticus. Theophylline can potentially have adverse gastrointestinal effects including abdominal pain, nausea, vomiting, and hematemesis. Upper gastrointestinal bleeding in patients treated with corticosteroids without a past history of upper gastrointestinal bleeding has been reported rarely. But the etiologic significance of the stress of status asthmaticus, administration of theophylline or corticosteroids in the development of ulcer has been open to question. We report a case of 8-year-old boy with status asthmaticus treated with these medications and later found to have a bleeding duodenal ulcer for which emergency surgery was necessary.

Bronchoalveolar Lavage Cellularity between Classic Asthma with Wheezing and Viral Associated Wheeze in Children / 소아알레르기및호흡기학회지

PURPOSE: Many young children with no other asthma features have episodic wheezing that is triggered solely by viral respiratory infections. We investigated the differential cytology in an effort to determine whether significant differences in bronchoalveolar lavage(BAL) cellularity to the pathophysiology of wheezing exist between classic astham(CA) and viral associated wheeze(VAW) in children. METHODS: Bronchoscopy with BAL was performed on 44 children, 6 months and 15 years old: 12 CA, 13 VAW. 13 viral pneumonia(VP), and 6 control cases. Viral cultures were carried out. Differential cell counts were determined on cytospin slide stained with May Grunwald Giensu. RESULTS: Total BAL fluid recovered was similar in all group(37+/-2.5%, mean+/-SEM) No significant differences in the total cell counts were observed among the four groups. Compared with the control, newtrophil percentages of VAW and VP(38.6+/-7.1% and 42.4+/-6.9%, respectively) were significantly(P<0.05) elevated than those of VAW and VP(2.0+/-0.1% and 0.4+/-0.3%, respectively). All cell types did not differ significantly between VAW and VP. The blood totol cosinophil counts were correlated with the BAL eosinophil percentage levels(r-0.795, P=0.0000). CONCLUSIONS: In conclusion, neutrophils were prominent in children with viral associated wheeze, as eosinophils in those with classic asthma. Thses findings suggest that there are different implications of cell types for the pathophysiology in these two diseases.

Bronchiolitis Obliterans after Adenovirus Type 7 Pneumonia / 소아알레르기및호흡기학회지

PURPOSE: The purpose of this study was to document bronchiolitis obliterans, the long term pulmonary sequelae of adenovirus type 7 pneumonia, using High Resolution CT(HRCT) and to identify risk factors that increase the likelihood of developing bronchiolitis obliterans. METHODS: Thirty-nine children were admitted to the Inje University, Sanggye Paik Hospital in the early summer of 1996 with clinical adenoviral pnemonia. Type 7 adenovirus was isolated from 11 children. All eleven were reassessed clinically and performed HRCT in 1997, one year (12.1+/-1.9 mo) after the adenovirus type 7 pnemonia. RESULTS: Seven (64%) had HRCT findings of BO(BO group) including mosaic perfusion, attenuation of pulmonary vessel and bronchiectasis, Four(36%) had a normal HRCT finding(Non-BO group). The mean age of the children on admission was lower in BO group(15.3+/-7.1 mo) than Non-BO group(35.3+/-14.2 mo) (P<0.05). The mean duration of fever was longer in BO group(14.4+/-2.8 days) than Non-BO group(6.3+/-2.5 days)(P<0.01). The mean duration of initial hospital admission was longer in BO group(28.0+/-10.8 days) than Non-BO group (9.8+/-3.6 days)(P<0.01). But the sex ratio between the two groups was not statistically significant. Four of the seven BO group subjects had bronchial asthma, and three of the four patients had persistent wheezing . CONCLUSIONS: Adenovirus type 7 pneumonia is closely associated with bronchiolitis obliterans, the important long term pulmonary sequelae. The risk factors which increase the possibility of developing bronchiolitis obliterans are: the young age of the child, the long fever duration , and the long admission duration.

The Pathophysiology of the Transient Neonatal Tricuspid Regurgitation

PURPOSE: This study was carried out to evaluate the role of the septal leaflet of the tricuspid valve. The hypothesis was that the neonatal tricuspid regurgitation (TR) was related to a transient elevation of right ventricular pressure in the neonatal period, that deviated ventricular septum and pull the anchored septal leaflet of the tricuspid valve. The pulled septal leaflet created the incomplete coaptation between the tricuspid valves and the regurgitation. METHODS: We used cross-sectional echocardiography, Doppler and color Doppler echocardiography to measure the normalized ventricular curvature at end-systole, the angle of the septal leaflet of the tricuspid valve, the type of coaptation of the tricuspid valve, the direction of regurgitation and the peak flow rate of regurgitation in 114 normal newborn babies (87 with TR, 27 without TR). RESULTS: The normalized septal curvature ratio (p=.0113), the angle of the septal leaflet (p=.0023) and the corrected diameter of the tricuspid valve annulus (p=.0008) were related statistically to the presence of TR (not in the angle of the anterior septum). But in the TR group, right ventricular pressure (calculated through peak velocity of TR) had no correlation with the above variables except the grade of TR (p=.002). CONCLUSIONS: One of the pathophysiological aspects of the neonatal TR is mainly related to the septal leaflet of the tricuspid valve, but the exact pathophysiology of neonatal TR may also be combined with other factors.