Ileocolic Intussusception Accompanied with Inflamed Appendix: 2 Case Reports

Intussusception and acute appendicitis are common emergency conditions in children. They should be promptly differentiated in pediatric patients presenting with suggestive symptoms.However, both diseases may occur simultaneously. Herein, we present two cases of intussusception of the appendix accompanied with appendicitis.

Ileocolic Intussusception Accompanied with Inflamed Appendix: 2 Case Reports

Intussusception and acute appendicitis are common emergency conditions in children. They should be promptly differentiated in pediatric patients presenting with suggestive symptoms.However, both diseases may occur simultaneously. Herein, we present two cases of intussusception of the appendix accompanied with appendicitis.

Etiology and Clinical Characteristics of Pediatric Dizziness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dizziness is not uncommon in children. The etiology of dizziness varies according to different studies due to different methods of examination or characteristics of the dizziness center. To assess meaningful causes of dizziness in children, a multidisciplinary approach would be needed. The purpose of this study was to analyze the main pathologies associated with vertigo and dizziness in children, paying particular attention to recent diagnostic advances with a multidisciplinary approach. SUBJECTS AND METHOD: A total of 73 children, aged between 4-18 years, who visited the Pediatric Dizziness Clinic of the University Hospital from January 2016 to June 2016 were included in this study. Medical records were reviewed retrospectively. All of the subjects were examined by history, questionnaires, physical examinations, electrocardiogram, hematologic tests, brain MRI scan, audiogram and vestibular function tests. Patients who had orthostatic symptoms additionally underwent a tilt table test, and in selective cases, a caloric and vestibular evoked myogenic potential tests as well. RESULTS: Vestibular migraine (VM) and benign paroxysmal vertigo of childhood (BPVC) were found in 35.6% and 27.4% of the children with dizziness, respectively. The incidence of orthostatic hypotension and postural orthostatic tachycardia syndrome were 12.3% each, both of which are higher than other previous reports. Other causes were Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis and so on. CONCLUSION: VM and BPVC were the most common causes of pediatric dizziness. Also, the incidence of orthostatic dizziness was rather high in pediatric population. The evaluation of dizziness in children should include a thorough check of history (questionnaire), neurotological examination, vestibular function tests and a tilt table test.

Current usage and effects of steroids in the management of childhood mycoplasma pneumonia in a secondary hospital

PURPOSE: Steroids can be used as an adjuvant therapy in the management of mycoplasma pneumonia, but no definite guidelines for the use of steroids have been established. The purpose of this study was to analyze the current usage and effects of steroids in the management of childhood mycoplasma pneumonia in a secondary hospital in Korea. METHODS: We retrospectively reviewed the medical records of 152 patients who were admitted due to mycoplasma pneumonia. The patients were divided into 3 groups as follows: those who did not use steroids (81 patients, 53%), those who used steroids after their fever subsided (42 patients, 28%) and those who used steroids during fever (29 patients, 19%). RESULTS: In decreasing order of values, the duration of fever during hospitalization (60.0±40.2 hours vs. 37.3±28.5 hours vs. 29.7±29.5 hours, P=0.006) and duration of hospitalization (5.9±1.7 days vs. 5.0±1.4 days vs. 4.0±1.5 days, P < 0.001) were reported in the group which received steroids during fever, the group which received steroids after the fever subsided and the group which did not receive steroids. In the group which received steroids during fever, patients with early steroid use (within 24 hours) had a shorter fever duration in the hospital (12.0 hours vs. 73.5 hours, P < 0.001) and a hospitalization duration (5.0 days vs. 6.5 days, P=0.007) than those with late steroid use (after 24 hours). CONCLUSION: Steroids were used in 47% of patients with mycoplasma pneumonia. The patients who received early steroids had a shorter fever duration and a shorter hospital stay than those who received late steroids.

Analysis of Risk Factors for Developmental Delay in Preterm Infants Using Screening Test / 대한소아신경학회지

PURPOSE: The purpose of this study was to identify the risk factors for developmental delays in preterm infants. METHODS: We studied 151 preterm infants admitted to the neonatal intensive care unit (NICU) at the Hallym University Kangnam Sacred Heart Hospital from January 2013 to November 2016. After discharge, the infants were evaluated by a pediatric neurologist via the developmental screening test K-ASQ:SE II, which consists of five domains: communication (CC), gross motor (GM), fine motor (FM), problem solving (PS), and social-emotional (SE). The subjects were divided into a normal group and an abnormal group (abnormal results on at least one of the five domains). Several variables were compared between the two groups and risk factors for developmental delays were analyzed. RESULTS: Several factors, such as birth weight (BW), gestational age (GA), Apgar score at 1 and 5 min (AS1, AS5), hospital days (HDs), respiratory distress syndrome (RDS), chronic lung diseases, intraventricular hemorrhage (IVH), early sepsis, retinopathy of prematurity (ROP), and history of management of invasive ventilators, dexamethasone, anti-hypotensive, were significantly different between the normal and abnormal groups. BW was a risk factor for developmental delay according to the binary logistic regression analysis. On individual domain analysis, risk factors were lower GA for domains CC and FM, lower AS1 for GM domain, lower BW for PS domain, and longer HDs for SE domain. CONCLUSION: In preterm infants, regular developmental screening especially follow-up observation, is important for early detection of developmental delay, considering the risk factors, such as GA (≤30 weeks), BW (≤1,500 g), low AS1, and long HDs, which may be helpful in the early diagnosis of developmental delay.

The different effects of gonadotropin-releasing hormone agonist therapy on body mass index and growth between normal-weight and overweight girls with central precocious puberty

PURPOSE: The effects of gonadotropin-releasing hormone agonist (GnRHa) treatment on body mass index (BMI) are controversial in girls with central precocious puberty (CPP). We therefore evaluated auxological parameters during GnRHa therapy in patients with CPP, specifically focusing on changes in BMI. METHODS: Seventy-seven girls with idiopathic CPP who underwent GnRHa therapy were retrospectively recruited. We investigated BMI changes during the treatment period after stratifying them according to baseline BMI status as follows: normal (BMI percentile of <85th) and overweight groups (BMI percentile of ≥85th). RESULTS: The incidence of overweight/obesity (40.3%/23.4%) was very high in the girls with CPP. In the overall study population, no significant BMI change was observed during the GnRHa treatment period. However, when stratified according to baseline BMI status, the normal-weight group showed a significant increase in BMI-standard deviation score (SDS), whereas the overweight group showed no change in BMI-SDS. Baseline BMI-SDS was an independent predictor of changes in BMI during the GnRHa treatment period. Changes in weight-SDS were similar, but changes in height-SDS were significantly greater in the overweight group than in the normal-weight group, which explains the observed difference in BMI-SDS. CONCLUSION: Our results demonstrate that the difference in the pattern of BMI changes among our CPP patients suggests that delayed puberty induced by GnRHa treatment may have different effects on linear growth according to baseline body composition. This study underscores the importance of individualized lifestyle intervention in CPP children.

Recent updates on treatment for pediatric migraine

Pediatric migraine is a disorder that significantly interferes with the everyday life and school life of approximately 8% of children and adolescents in Korea. Recently, studies on migraine have been carried out very rapidly, many drugs have been developed, and acute-phase and preventive treatments for migraine have been evaluated. Therefore, it is necessary to understand the diagnostic criteria and degree of impairment in pediatric migraine and to become familiar with up-to-date treatment methods in children. Research into the use of botulinum toxin or calcitonin gene-related peptide antagonists to treat adult migraine headaches is progressing, and we expect these therapies to be applicable to pediatric patients soon. Many students in our country are suffering from migraines in their daily life. Therefore, we need to acquire the relevant knowledge and identify practical treatment methods for pediatric migraine in children and adolescents in order to reduce their pain.

Characterization and Predictors of Headache-Related Disability among School Children: A Population-Based Study

PURPOSE: Headache is a frequent neurological symptom in school aged individuals and recurrent headache has significant disabling effects among children and adolescents that manifest as school absenteeism, decreased extracurricular activities, and poor academic performance, as shown in previous studies. In Korea, there has not yet been a population-based study of headache-related disability in children and adolescents. We sought to estimate headache-related disability and investigate relevant predictors of disability due to headaches among schoolchildren in South Korea. METHODS: This was a cross-sectional school-based study. We surveyed 5,039 (boys 2,405, girls 2,634) students aged 6-18 years. Among 1,465 students with headache, six hundred sixty-six schoolchildren (225 boys, 441 girls) completed all questionnaires. The questionnaires collected demographic data, in addition to headache specific questions consistent with International Classification of Headache Disorder criteria, 2nd edition. Disability was evaluated using the 6-question Pediatric Migraine Disability Assessment (PedMIDAS). RESULTS: Six hundred sixty six school children and adolescents (225 boys, 441 girls) among 1,465 students with headaches completed all questionnaires. The percentage of headache sufferers with grade I disability was 88.6%. The mean (±standard deviation) PedMIDAS score was 5.11±11.17. There was a trend towards more severe disability in the older age groups, particularly among the 16 to18 year-olds. Students with migraine had the highest PedMIDAS scores (6.69±10.66) whereas students reporting other types of headache had the lowest scores (3.81±7.52). The predictors of headache-related disability were intensity (P=0.028), frequent headache (P=0.003), and longer duration of symptoms prior to presentation (P=0.008). CONCLUSION: A trend towards a more severe disability was observed in the older age group. Schoolchildren with migraine had the most headache-related disability. The predictors for headache-related disability were intensity, frequent headache, and longer duration of symptoms prior to presentation.

Characterization and Predictors of Headache-Related Disability among School Children: A Population-Based Study

PURPOSE: Headache is a frequent neurological symptom in school aged individuals and recurrent headache has significant disabling effects among children and adolescents that manifest as school absenteeism, decreased extracurricular activities, and poor academic performance, as shown in previous studies. In Korea, there has not yet been a population-based study of headache-related disability in children and adolescents. We sought to estimate headache-related disability and investigate relevant predictors of disability due to headaches among schoolchildren in South Korea. METHODS: This was a cross-sectional school-based study. We surveyed 5,039 (boys 2,405, girls 2,634) students aged 6-18 years. Among 1,465 students with headache, six hundred sixty-six schoolchildren (225 boys, 441 girls) completed all questionnaires. The questionnaires collected demographic data, in addition to headache specific questions consistent with International Classification of Headache Disorder criteria, 2nd edition. Disability was evaluated using the 6-question Pediatric Migraine Disability Assessment (PedMIDAS). RESULTS: Six hundred sixty six school children and adolescents (225 boys, 441 girls) among 1,465 students with headaches completed all questionnaires. The percentage of headache sufferers with grade I disability was 88.6%. The mean (±standard deviation) PedMIDAS score was 5.11±11.17. There was a trend towards more severe disability in the older age groups, particularly among the 16 to18 year-olds. Students with migraine had the highest PedMIDAS scores (6.69±10.66) whereas students reporting other types of headache had the lowest scores (3.81±7.52). The predictors of headache-related disability were intensity (P=0.028), frequent headache (P=0.003), and longer duration of symptoms prior to presentation (P=0.008). CONCLUSION: A trend towards a more severe disability was observed in the older age group. Schoolchildren with migraine had the most headache-related disability. The predictors for headache-related disability were intensity, frequent headache, and longer duration of symptoms prior to presentation.

Posterior Reversible Encephalopathy Syndrome Accompanied by a Cerebral Hemorrhage and Restricted Diffusion in a Child with Uncontrolled Nephrotic Syndrome

Posterior reversible encephalopathy syndrome (PRES) is a rare clinico-radiological syndrome that is characterized by an acute onset of headache, vomiting, visual abnormalities, confusion, and/or seizures and is typically accompanied with edema of predominantly posterior portions of the cerebral hemispheres. Here, we report a case of PRES with cerebral hemorrhage that occurred in a female pediatric patient with uncontrolled nephrotic syndrome. The patient's magnetic resonance imaging (MRI) studies showed asymmetric white matter abnormalities, cerebral hemorrhage, and restricted diffusion. After controlling her hypertension and nephrotic syndrome, her neurologic symptoms improved, and follow-up MRI findings revealed interval resolving of the white matter lesions.

A Case of Wolf-Hirschhorn Syndrome with Periventricular Nodular Heterotopia Presenting with Status Epilepticus

Wolf-Hirschhorn syndrome is a congenital disorder associated with partial deletion of the short arm of chromosome 4. The majority of patients showed characteristic facial anomalies - so called "Greek-Helmet" appearances - mental retardation, growth retardation, and developmental delay. Here we report the case of a 3-year-old girl who was diagnosed as having Wolf-Hirschhorn syndrome immediately at birth with distinct facial anomalies and an abnormal chromosomal karyotype [46,XX,del(4)(p14)]. The patient later presented with status epilepticus and magnetic resonance imaging showed periventricular nodular heterotopia.

Risk factors of allergic sensitization in preschool children with chronic cough

PURPOSE: Chronic cough is one of the major symptoms of asthma and allergic sensitization and may appear prior to the onset of asthma. The object of this study was to investigate the risk of allergic sensitization in preschool children with chronic cough. METHODS: We reviewed the medical records of 99 preschool children presenting with chronic cough but not with allergic rhinitis, atopic dermatitis, recurrent wheezing, or lower respiratory tract infection between November 2011 and July 2013. RESULTS: Fifty-four children (55%) were sensitized at least one of the following inhalant allergens: Dermatophagoides pteronyssinus, Dermatophagoides farinae, cockroach, Alternaria alternata, dog dander, and cat epithelium. Children with allergic sensitization had a higher blood total IgE levels transformed by common logarithm (1.9+/-0.6 IU/mL vs. 1.3+/-0.5 IU/mL, P<0.001) and eosinophils (3.7%+/-2.5% vs. 2.7%+/-2.0%, P=0.043), more frequent parental history of allergy (68% vs. 48%, P=0.044) and less frequent history of breast milk feeding (68% vs. 86%, P=0.041) than those without. CONCLUSION: These results suggest that the ratio of allergic sensitization may be 50% or more in preschool children with chronic cough and that parental history of allergy and formula milk feeding may be associated with allergic sensitization.

Neonatal Outcomes of Premature Infants Who Were Delivered from Mother with Hypertensive Disorders of Pregnancy and Effects of Antihypertensive Drugs and MgSO4 / 대한주산의학회잡지

PURPOSE: Hypertensive disorders of pregnancy increase morbidity and mortality of fetus and neonates. Recently some studies revealed that antihypertensive agents affected the neonatal outcomes. The aim of this study was to investigate the prognosis of preterm infants delivered from the mothers with hypertensive disorders who were treated with antihypertensive agents and magnesium sulfate. METHODS: This retrospective study was conducted on preterm infants who were delivered from normotensive mother (control, n=436) and antihypertensive drugs +/- magnesium sulfate treated mother (study, n=150) between January 2009 and December 2013. Study group were divided into two groups based on whether they received antihypertensive drugs only (n=110) and additional magnesium sulfate (n=40). We compared the characteristics of mothers and neonatal outcomes. RESULTS: Study group had shorter gestational age (32.2+/-3.5 weeks vs. 33.7+/-3.0 weeks, P=0.000) and lower birth weight (1,810.5 +/- 689.2 g, 2,212.1 +/- 604.9 g, P=0.000), and higher rate of small for gestational age infants (22% vs 11%, P=0.000). One minute and 5 minutes Apgar score were lower, but duration of hospital days, oxygen supplement and mechanical ventilation were longer in study group. Respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, intraventricular hemorrhage occurred more in study group than control. The group treated with magnesium sulfate together with antihypertensive agent had lower 1 minute and 5 minutes Apgar score than the group taken antihypertensive agent only. CONCLUSIONS: Mothers with hypertensive disorders have increased the risk of preterm delivery, low birth weight, and high neonatal morbidity rate. Therefore it is important to predict and manage possible complication. Moreover, if magnesium sulfate is taken, careful neonatal monitoring is needed because of possible low Apgar score.

Prevalence of Voiding Dysfunction and Constipation in Children with Attention Deficit Hyperactivity Disorder

PURPOSE: Attention deficit hyperactivity disorder (ADHD) has been associated with impairments in frontal inhibitory function and the catecholaminergic system. ADHD is diagnosed in 3-5% of children. Children with ADHD seem develop various forms of urinary problems such as nocturnal enuresis, dysfunctional voiding, and diurnal incontinence. However, no data exist to confirm the presence of these problems in Korean children with ADHD. We investigated the clinical findings of voiding dysfunction in children with ADHD. METHODS: Between October 2009 and March 2011, a total of 63 children (33 with ADHD, 30 with an upper respiratory infection, as a control group) were enrolled. ADHD was diagnosed using the diagnostic and statistical manual of mental disorders (DSM)-IV criteria. A comprehensive survey of voiding and defecation was administered. RESULTS: The patient group included 28 boys and 5 girls; the control group comprised 20 boys and 10 girls. The mean age was 9.09+/-2.8 years in the ADHD group and 8.58+/-3.1 years in the control group. Children with ADHD had a statistically significantly higher incidence of urgency (P=0.017), urge incontinence (P=0.033), and constipation (P=0.045). There was no significant difference in the incidence of straining, intermittency, holding maneuvers, or nocturnal enuresis. CONCLUSION: Children with ADHD in Korea have significantly higher rates of urgency, urge incontinence, and constipation than those without ADHD.

A Case of Herpes Simplex Virus Type 2 Encephalitis of a Newborn Delivered by a Mother without Prenatal Screening / 대한주산의학회잡지

Neonatal herpes simplex virus (HSV) encephalitis is a rare disease nowadays because of prenatal screening test and management. It shows progressive central nervous system manifestations affecting predominantly temporal and frontal lobes. Early diagnosis of HSV encephalitis is important since even with the early initiation of high-dose intravenous acyclovir therapy, it results in serious morbidity among survivors. A 14-day-old neonate with fever and poor oral intake was admitted via emergency department. The next day she had seizures and the brain was damaged with permanent sequelae despite of early administration of intravenous acyclovir on day 2 of admission. We report a serious case of HSV encephalitis diagnosed as type 2 HSV by polymerase chain reaction and culture of a newborn without proper prenatal screening test.

Psychologic Characteristics in Caregivers of Children with Attention Deficit Hyperactivity Disorder

PURPOSE: ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental disorder with three characteristics, such as impulsivity, inattention, and hyperactivity symptoms. This is a common disease that the prevalence reaches 4-7% of all children. There are a variety of hypothesis in the pathogenic mechanisms and etiology. Parental psychopathology influences directly and indirectly on the occurrence of ADHD in children. The aim of this study was to evaluate the clinical and psychological characteristics of caregiver of child with ADHD using the MMPI (Minnesota Multiphasic Personality Inventory)-2. METHODS: The subjects consisted of 35 caregivers of patients with ADHD and 34 caregivers of children without neuropsychiatric disorders who visited to the pediatric neurology clinic of Kangnam sacred heart hospital from January 2009 to June 2011. We diagnosed ADHD according to DSM(Diagnostic and Statistical Manual of Mental Disorder)-IV criteria. We compared the psychologic characteristics between ADHD group and control group using T score of MMPI-2. RESULTS: MMPI T scores of caregivers of children with ADHD were significantly higher on the depression(D), psychasthenia(Pt), schizophrenia(Sc), social introversion (Si) scales than control group and most of scales were significantly higher in restructured clinical (RC) scale and personality psychopathology five (PSY-5) scales. CONCLUSION: The results suggested that psychopathology of caregivers might induce ADHD in the children. On the contrary, ADHD symptom of children might be associated with occurrence of psychopathology in the cargiver. In order to proper treatment of ADHD patient, we need to psychologic evaluation in the caregivers of patients with ADHD.

Relationship between Lifestyle and Headache in Korean Students

PURPOSE: Despite the high prevalence of headaches in students, their lifestyles have not been well examined. We examined correlation between lifestyle and headache in Korean students. METHODS: We conducted a cross-sectional, school-based study from a randomized and proportional sample of 5,360 male and female students. The questionnaires include demographic data, lifestyle, in addition to specific questions about headache according to International Classification of Headache Disorder II (ICHD-II) criteria. Valid questionnaires were returned by 94.1% (5,039, boys 2,405, girls 2,634) of the sample. Modified criteria changed the item 'duration' in migraine (>1 hour instead of 4 hours). We analyzed the data in terms of exercise, regular eating, sleep time, fluid intake, and caffeine intake. RESULTS: Students on regular exercise have less headache (P=0.03). Students who eat regularly have less recurrent headache (P<0.0001, odds ratio=0.5). Students sleep more have less headache (P<0.0001). Students take more fluid have less headache (P=0.0002). Students take more caffeine have more headache (P=0.0001). CONCLUSION: There seem to be a significant relationship between life style and headache in school children in South Korea. We suggest that changing the lifestyles or habits should be considered to manage and prevent headaches in school children.

Erratum: Comparison of the BACTEC Peds Plus Pediatric Blood Culture Bottle to the BacT/Alert PF Pediatric Blood Culture Bottle for Culturing Blood from Pediatric Patients / 대한임상미생물학회지

English abstract of the paper, there is an error in the following to correct it.

Clinical Characteristics of Children Diagnosed with Migraine

PURPOSE: To analyze the clinical characteristics of visual symptoms, aspects of headache, and ophthalmologic features in children diagnosed with migraine. METHODS: The medical records of 31 Korean children who had been diagnosed with migraine by pediatric neurologists were retrospectively reviewed and visual symptoms and ophthalmologic examinations were evaluated. RESULTS: The mean age of the 31 patients was 10.8 years (range, 5-17 years). The mean age of onset of headache was 9 years (range, 4-15 years). Nineteen patients (61.3%) had the associated visual aura. Visual symptoms of the 19 patients included blurred vision, unilateral vision loss, flickering lights, scotoma, and visual hallucination in descending order. However, there was no specific abnormality observed on thorough ophthalmologic examinations. CONCLUSIONS: Most of the children diagnosed with migraine did not show any ophthalmologic problems. Careful ophthalmologic examination with an understanding of migraine should be performed and reassurance to patients may be beneficial.

Clinical Characteristics and Psychological Analysis in Children with Tic Disorder

PURPOSE: Tic disorder is a neurodevelopmental disorder which begins in early childhood and continues into adolescence and adults. Tic disorder affects 1-2% of the population. In order to make a correct diagnosis and treatment of tic disorder, the clinical psychological analysis is needed because children with tic disorder tend to have higher rates of emotional and behavioral difficulties than those of the general population. The aim of this study was to evaluate the clinical and psychological characteristics of child with tic disorder. METHODS: The sample consisted of 69 patients with tic disorder who visited to the pediatric neurology clinic of Kangnam sacred heart hospital from January 2007 to June 2010. Fifty patients who visited our clinic without tic disorder were included in the control group. Patients were classified as the DSM-IV, Tourette's disorder, chronic motor or vocal tic disorder, transient tic disorder and tic disorder not otherwise specified. Korean child behavior checklist (K-CBCL), K-WISC-III, ADS, K-ARS was conducted in the tic disorder patients and T score of K-CBCL was compared with the control group. RESULTS: Male to female ratio was 2.5:1 in the study group and the mean age was 9.5+/-3.2 years old. The symptom period was 16.7+/-17.2 months at their first visit. Twelve subjects (18%) presented with Tourette syndrome, 14 subjects (20%) had multiple chronic motor or phonic tic disorder, 20 subjects (29%) had transient tic disorder and 23 subjects (33%) had tic disorder not otherwise specified. The Medications were given in 26 patients and risperidone was the primary drug for most of them. The mean T scores of K-CBCL were 55.5+/-6.1 for attention scale, 56.9+/-6.9 for anxiety-depression scale, 56.5+/-7.4 for withdrawn scale, 52.0+/-3.4 for emotional lability scale. All of them were higher than control group (P<0.05). CONCLUSION: In order to make a correct diagnosis and treatment of tic disorder, the clinical psychological assessment is mandatory due to their higher rates of emotional and behavioral difficulties.