The difference between the two methods for myocardial performance index in children / 소아과

PURPOSE: The object of this study was to determine the difference between two methods for myocardial performance index(MPI) in children, using the conventional and pulsed Doppler echocardiography. METHODS: A total of 27 children with anatomically normal hearts were enrolled for the study. all were examined by conventional and pulsed Doppler echocardiography at Gangneung Asan Hospital between December, 2005 and February, 2006. First, we measured the time interval(a1) between the mitral inflows from apical 4-chamber view, and the ejection time(ET1) from apical 5-chamber view. And then, we calculated MPI1, isovolumic contraction time(ICT1) and isovolumic relaxation time (IRT1). Secondly, we measured ICT2, ET2 and IRT2 from apical 5-chamber view with a Dopper signal placed at just below junction between mitral and aortic valve at the same cardiac cycle. And then, we calculated MPI2. We compared MPI1 to MPI2. All MPIs were calculated by using the formula, MPI=(ICT+IRT)/ET. RESULTS: The mean age was 5.7+/-2.2 years old(M:F=15:12). The MPI2 was higher than MPI1: 0.277+/-0.083 vs. 0.428+/-0.081(MPI1 vs MPI2, P=0.000). Also, the ICT2 was higher than ICT1: 56+/-15 msec vs 97+/-18 msec(ICT1 vs ICT2, P=0.000) and the IRT2 was higher than IRT1: 42+/-8 msec vs 53+/-9 msec(IRT1 vs IRT2, P=0.000). But, the ET2 was lower than ET1: 260+/-16 msec vs 254+/-14 msec (ET1 vs ET2, P=0.01). There was, as well, positive linear correlation between MPI1 and MPI2. CONCLUSION: This study showed that there is a difference between MPI1 and MPI2 in connection with estimating methods. However, the two MPIs had a positive linear correlation. Judging from our results, the MPI of the new method might be a useful index of venticular global function in children.

A Case of Respiratory Distress associated with Congenital Bilateral Nasolacrimal Duct Mucoceles / 대한주산의학회잡지

Congenital obstruction of the nasolacrimal drainage system commonly occurs, but rarely causes significant symptoms. A congenital nasolacrimal duct mucocele (NLDM) is an uncommon condition due to a distal and proximal obstruction of the nasolacrimal drainage system. It may presents an asymptomatic medial canthal mass, epiphora, dacryocystitis, periorbital cellulitis, sepsis and nasal obstruction. It is a rarely reported cause of respiratory distress in the newborn. Bilateral NLDSMs may cause severe respiratory distress in the newborn and must be required surgical intervention to relieve the obstruction. Nasal endoscopy, CT scan and MRI scan are used in the diagnostic work-ups to evaluate the condition. We report a case of bilateral nasolacrimal duct mucoceles which presented with respiratory distress in newborn.

A Case of Right Diaphragmatic Eventration Initially Diagnosed as Congenital Diaphragmatic Hernia / 대한주산의학회잡지

Diaphragmatic eventration is an abnormal elevation of an intact diaphragm into the thoracic cavity as a result of paralysis, aplasia or atrophy of muscular fibers, which accounts for 5~10% of all diaphragmatic disorders. Congenital eventration result from a incomplete muscularization of the pleuroperitoneal membranes at 8~10 weeks' menstrual age, the cause of this failure is not known. Although some patients are asymptomatic and find out incidentally, significant compression of the affected chest contents can result in severe respiratory distress. The differentiation between congenital diaphragmatic eventration and congenital diaphragmatic hernia by sonography may be difficult, but important because of a significant differences in postnatal management and prognosis. We experienced a case of right congenital diaphragmatic eventration with severe respiratory distress during immediate postnatal period, who was initially diagnosed as congenital diaphragmatic hernia and performed plication at 18 hours after birth. So we report this case with review of literatures.

Clinical Aspects and Prognostic Factors of Near Drowning Children / 대한소아신경학회지

PURPOSE: We intended to find out clinical aspects and prognostic factors of near drowning children in this study. METHODS: We conducted a retrospective study on twenty eight near-drowning children, who were admitted to Gangneung Asan Hospital from March, 1996 to March, 2002. We investigated their clinical aspects and the differences between two groups, namely a good prognosis group and a poor prognosis group. Those in the good prognosis group had no neurologic impairments and were fully recovered while those in the poor prognosis group died or fell into vegetative states. RESULTS: Out of 28 patients, there were 18 males(64.3%) and 10 females(35.7%). Age distribution was < or =4 years in 10 cases, 5 to 8 years in 7 cases, 9 to 12 years in 8 cases, and 13 to 16 years in 3 cases. Seasonal distribution was summer in 18 cases, spring in 6 cases, autumn in 3 cases, and winter in 1 case. Submersion time was < or =5 minutes in 15 cases, 5 to 10 minutes in 7 cases, and unknown in 7 cases. Initial blood glucose level was 175.2+/-88.0 mg/dL and initial arterial blood pH was 7.24+/-0.21. Good prognosis group had 23 out of 28 cases(82.1%) while poor prognosis group had 5 out of 28 cases(17.9%) which included 4 deaths and 1 vegetative case. Between the two groups there were no significant differences in the distributions of sex, age, season, submersion place, transfer time to hospital and resuscitation time. However, submersion time, mechanical ventilation need, initial blood glucose level and initial arterial pH were significantly different between the two groups. CONCLUSION: We found out that poor prognosis is expected for near-drowning children of submersion time over 10 minutes, applied mechanical ventilation, high initial blood glucose level, and low initial arterial blood pH.