Serial MRI, SPECT and FDG-PET Findings in a Case of Herpes Simplex Encephalitis / 대한간질학회지

Herpes Simplex Encephalitis is associated with a high mortality rate and a high probability of neurological sequelae. Good results are obtained when Herpes Simplex Encephalitis is promptly diagnosed and treated with antiviral agents. We reported a case of Herpes Simplex Encephalitis in which Magnetic Resonance Imaging (MRI), Single Photon Emission Computed Tomography (SPECT) and Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) were performed sequentially. Imaging studies are valuable tools for early detection and diagnosis of Herpes Simplex Encephalitis. And particularly FDG-PET represents functional anatomy through diffuse decline of glucose metabolism better than other imaging studies.

Impact of Device Evolution in Transcatheter Closure of Patent Ductus Arteriosus Using Duct-Occlud Coils: Comparison of Mid-term Results / 소아과

PURPOSE: We reviewed the therapeutic results of various Duct-Occlud coils(pfm AG, Koln, Germany) to evaluate the efficacy of the most-recently modified Duct-Occlud coil(Nit-Occlud) in the transcatheter closure of patent ductus arteriosus(PDA), including large defects more than 4 mm in diameter. METHODS: Two hundred and five patients who underwent percutaneous PDA occlusion using Duct- Occlud devices from March 1996 to December 2003 were enrolled and four types of Duct-Occlud [Standard(S), Reinforced(R), Reinforced reverse cone(RR) and Nit-Occlud(N)] were used in this study. The patients were followed up by echocardiogram and physical examination before discharge, one month, six months and 12 months after the procedure. RESULTS: The rate of residual shunt according to the type of Duct-Occlud were as follows: S-54%, R-72%, RR-50%, N-14%(P4 mm). CONCLUSION: The transcatheter closure of PDA using Duct-Occlud was an effective treatment and our study revealed that a Nit-Occlud coil which showed higher rate of occlusion even in PDA with large diameters over than 4 mm, was a more effective modality compared to previous devices.

The Effect of Obesity on Serum Growth Factors, and Insulin-like Growth Factor Binding Protein-3 Proteolysis in Children with Simple Obesity / 대한소아내분비학회지

PURPOSE: In children with simple obesity, spontaneous and stimulated growth hormone (GH) secretion are diminished, but their heights usually are normal or even taller for their age and sex. The exact mechanism to explain the discrepancy between impaired GH secretion and normal height velocity has not been elucidated. In this study, we aimed to determine the level of serum growth factors, and the degree of insulin-like growth factor binding protein (IGFBP)-3 proteolysis, and to assess the alteration of the IGF system associated with accelerated or normal growth in simple obesity. METHODS: We evaluated serum growth factors, and IGFBP-3 proteolysis in 27 obese, 25 obesity risk group, and 28 age-matched control group. We measured serum levels of insulin-like growth factor (IGF)-I, IGFBP-1, -3, and free IGF-I by immuno-radiometric assay and IGFBP-3 fragment by Western immunoblotting. RESULTS: The height was taller in obese children than in lean control group. The results showed no significant difference in the level of serum total IGF-1 and IGFBP-3 between obese and normal control group. Although there was no significant difference in other components, serum free IGF-I levels were significantly increased (P<0.05) and showed positive correlation with their height in obese children (r=0.25, P<0.05). The degree of IGFBP-3 proteolysis was increased in obesity and obesity risk group compared to control group. The densities of the IGFBP-3 proteolytic fragment approximate 18 kDa also showed positive correlation with levels of free IGF-I (r=0.23, P<0.05) and height (r=0.19, P<0.05). CONCLUSION: These findings may suggest that elevated levels of serum IGFBP-3 proteolytic fragments showing decreased affinity to IGF-I result in the increase of biologically active free IGF-I, thereby maintain normal growth in the obese children.

Food Sensitization in Infants and Young Children with Atopic Dermatitis

Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease. Children with AD tend to have a higher prevalence of food allergies. This study investigated the clinical significance of food sensitization in AD patients. A total of 266 AD patients participated in this study. The prevalence of food sensitization and clinically relevant sensitization were compared in the subjects according to their age and AD severity. Sera from all patients were analyzed for food-specific IgE levels using the Pharmacia CAP System FEIA. The serum specific IgE levels for egg, milk, peanut and soybean were measured. Patients were regarded as sensitized to the food if their food-specific IgE levels were above 0.35 kUA/L. Also the food-specific IgE levels, the so-called diagnostic decision point, which is recommended as the clinically relevant level, for clinical food allergy, as suggested by Sampson et al, was used as an alternative method. From the measurement of food-specific IgE antibodies of the four foods, egg was the most highly sensitized and the main causative allergenic food in children with AD. The positive rates of specific IgE to the four major food allergens, and the prevalences of clinically relevant food sensitization, were higher for all foods tested in the group less than 1 year of age, and were significantly higher in moderate to severe AD compared to mild AD in infants and young children. In summary, presence of food specific IgE is prevalent in infants and young children with AD, and clinically relevant food sensitization is important in Korean infants and children with moderate to severe AD.

Two Cases of Urticaria Developed by Antianemics which Contain Cow's Milk Protein (casein) or Egg White Protein (ovalbumin) / 소아알레르기및호흡기학회지

Hemo-Q (R) and Albumax (R) solution are widely used antianemics. Hemo-Q (R) contains cow's milk protein (casein) and Albumax (R) contains egg white protein (ovalbumin). Cow's milk protein and egg protein can cause common allergic diseases in infants and young children. We reported two cases of young children with milk and egg allergy who presented skin symptoms after ingestion or cutaneous contact with Hemo-Q (R) or Albumax (R) solution. When Hemo-Q (R) or Albumax (R) solution was taken or rubbed on, erythematous papules and wheals were developed in 10-20 minutes, but other antianemics which don't contain milk or egg protein contents didn't show skin manifestations.

A Case of Neonate Born of Mother Diagnosed with Adult Onset Still's Disease Shortly before Delivery / 대한주산의학회잡지

Up to date, symptomatic neonate who needed treatments due to mother's AOSD has not been reported. We experienced a neonate born of mother diagnosed with AOSD a week before delivery. Despite treatment, the mother's symptoms had not been improved until delivery. Our patient was affected by her mother's condition, and exhibited several symptoms (fever over one week, poor activity, poor feeding) since 5 days of age, with thrombocytopenia, negative results on viral and bacterial studies, and elevation of CRP, OT/PT and ferritin. Treatment with steroid, NSAID and IV immunoglobulin was started on 14 days of age under the impression of possible maternal effects from uncontrolled AOSD of mother. The symptoms were gradually improved. Ferritin level was decreased, others were normal on 29 days of age. We present this case for the first time as effects of maternal AOSD on newborn, with review of literature.

A Study of Serum Total and House Dust Mite-Specific IgE, and ECP Levels in Healthy Korean Children Under 7 Years of Age / 소아알레르기및호흡기학회지

PURPUSE: Serum IgE have been shown to be related to allergic disease and used for an initial diagnosis of allergic diseases. House dust mite such as Dermatophagoides pteronyssinus(Dp) and D. farinae(Df) is very important for inhalant allergens, which may be a cause and/or triggering factor of atopic diseases. On the other hand, eosinophil cationic protein (ECP) causes epithelial damages of the airway, and bronchial hyperresponsiveness has been used as a useful indication of allergic inflammation. To date, there are few studies on the longitudinal patterns of total and inhalant allergen-specific IgE, and ECP in normal children in Korea. The present study was performed to determine the reference levels of serum total and Dp- and Df-specific IgE and ECP in healthy children under 7 years of age by the groups of different age and gender. METHODS: Total, and Dp- and Df-specific IgE and ECP concentrations were measured by fluoroimmunoassay(UniCAP, Pharmacia-UpJohn, Sweden) in serum from 449 healthy children under 7 years of age by using a population-based cohort followed from 1996 through 1997. All subjects were enrolled from eight large health organizations in geographically defined area such as Seoul and four local cities. RESULTS: Serum total IgE concentration showed steady increase with age from birth to 4 years, and a plateau. In contrast, Dp- and Df-IgE levels showed apparently continuous increments after 4 years of age. ECP showed variable increase until 4 years of age and slow decrease afterwards. There were no statistically significant differences in those results by gender and/or the living area, but much higher increments of Dp- and Df-IgE of boys from 3 years of age through 6 years were found. CONCLUSION: We found feasible results of total, Dp- and Df-specific IgE, and ECP in serum from healthy children under seven years of age, which may be useful for a reference.

Occult Mediastinal Ganglioneuroblastoma Presenting with Myoclonic Encephalopathy as Paraneoplastic Syndrome

Ganglioneruroblastoma and neuroblastoma are among commonest types of childhood malignancy and a number of unique paraneoplastic syndromes have associated with both localized and disseminated neuroblastoma. The coincidence of neuroblastoma and myoclonic encephalopathy or other paraneoplastic syndromes occurs relatively rare, and therefore, failure to recognize this association could result in delays in both diagnosis and treatment, and the result could prove to be unfortunately fatal. The mechanism which underlies the remote damaging effect of neural crest tumor, especially neuroblastoma, on the nervous system resulting in myoclonic encephalopathy is by no means clear. In addition the nature and the extent of the pathologic lesion are inconsistent. We experienced a case of myoclonic encephalopathy associated with an occult mediastinal ganglioneuroblastoma in a 22-month-old girl who was hospitalized for inability to walk without support and tilting of the head to the left side. She became increasingly ataxic, and during the hospitalization myoclonic jerks of upper extremities and head along with chaotic, rapidly flickering, multidirectional spontaneous eye movements, were noted. Laboratory data included normal complete blood count, urinalysis, BUN and creatinine, electrolytes and bone marrow. Chest X-ray and chest CT revealed a relatively well marginated right posterior mediastinal mass. In a 24 hours urine excretion test, VMA and catecholamines were increased. Over the next 2 weeks, a surgical exploration revealed a right posterior mediastinal mass. Microscopically the mass proved to be a ganglioneuroblastoma, extending to right innominate artery and right axillary lymph nodes. Within 2 weeks after the surgery, radiotherapy (2,400 rads) and chemotherapy (CTX, DTIC, VCR) were started, but corticosteroid was not used. She has been free of tumor and abnormal neurological systemic symptoms and signs for 1 1/2 year since the completion of chemotherapy. In the 3 1/2 years follow-up period, her neurologic symptoms has completely resolved by the completion of 2 years chemotherapy. We report a case of mycoclonic encephalopathy associated with hidden ganglioneuroblastoma in 22-month-old girl.

A Case of Severe Pituitary Dwarfism due to Agenesis of Anterior Pituitary Gland with Pituitary Stalk Transection

We experienced one case of severe pituitary dwarfism in a 10 years old female girl. Magnetic resonance image (MRI) revealed transection of the pituitary stalk stalk with the formation of high intensity ectopic posterior lobe located at the median eminence and agenesis of an anterior lobe of pituitary gland. The serum growth Hormone (GH) response to clonidine and L-dopa revealed severe GH deficiency. The patient had responses to TRH, normal TSH and partial prolactin response, respectively. There was not response LH and FSH to GnRH. The morning cortisol concentration and serum T4 concentration were decreased below the normal range. These findings and no hyperprolactinemia suggested the presence of a vascular connection between the pituitary gland and hypothalamus, which is not visible on MRI. Sofar, the primary cause of idiopathic pituitary dwarfism in many patients is injury to hypothalamus by perinatal insults. In this patient, there was no history of perinatal insults and postnatal head trauma but transection of the pituitary stalk. We report a case of severe pituitary dwarfism due to agenesis with brief review of related litereature.

Comparison of tuberculin skin test results and adverse reactions following BCG vaccination in various infant groups of different ages

Most authorities including WHO recommended immununizing infants with BCG as early as possible in areas prevalent with tuberculosis, however the optimal time for immunization has not well been characterized. Therefore the investigation was undertaken by vaccinating various infant groups of different ages with BCG and subsequently evaluating for adverse effects and tuberculin reactions, in order to contribute to undestanding the optimal time for immunization. Four hundred eighty three infants from the newborn nursery and the well baby clinic of Hanyang University Hospital who had no family history of tuberculosis were divided into three groups; group I of infants immunized within 7 days after birth, group II of infants immunized at about 1 month of age and group III of infants immunized at about 3 months of age. To each infant 0.1 ml of BCG(Institute Merieux, France) was administered intradermaly and approximately 3 months later tuberculin skin test using 5 TU PPD (NIH, Korea) was performed. Adverse reactions following BCG vaccination such as temperature elevation, induration alone or with suppuration at or near the injection site, and lymph node enlargement were also analyzed. The summary of the results is as follows. 1) Distribution of diameters of induration on tuberculin skin test illustrated incomplete bimodal configuration in all three different age groups. The means 2 standard deviations of diameters of indurations distributed on the main bells were 10.07 4.52 mm in group I, 10.65 3.82 mm in group II, and 10.83 5.08 mm in group III, and were not significantly different. 2) Criteria for positive tuberculin reaction was diameters of indurations equal to or greater than 6mm, 2 standard deviations below the mean values of diameters of indurations on the main bells. 3) The positive tuberculin reaction rates of 85.8% in group II and 88.6% in group III were significantly greater than 74.1% in group I. 4) Incidence of complications following BCG vaccination including temperature elevation, induration with suppuration, and localized lymphadenopathy was not different among three groups and the serious complications such as temperature elevation and lymphadenopathy were minimal. The data indicate that it is appropriate to immunize infants with BCG at about one month of age and the incidence of complications following BCG vaccination was not different among three infant groups of different ages.

Median sternotomy for simultaneous bilateral bullectomy / 대한흉부외과학회지

No abstract available.

Arterial complication of percutaneous transluminal angioplasty: a report of case / 대한흉부외과학회지

No abstract available.