Paradoxical Response to Chemotherapy in Tuberculous Pleural Effusion / 소아알레르기및호흡기학회지

It is defined as the paradoxical response when the clinical or radiologic worsening of old lesions or the development of new lesion occur in spite of appropriate antituberculous therapy. The paradoxical response can occur as an intracranial tuberculoma, pleurisy, pericarditis and contralateral new parenchymal lesions. However, poor compliance with therapy, drug resistance, non-tuberculous mycobacterium, or another underlying condition as lung cancer should be ruled out before concluding that the treatment is the cause of the exacerbation. The case reports of paradoxical response have been mainly reported in adults, but extremely rare in children. We report a case of paradoxical response in which a new parenchymal lung lesion developed during antituberculous therapy in a 14-year-old female patient with tuberculous pleurisy. She experienced clinical improvement with steroid therapy in addition to antituberculous therapy.

Catch up growth in children born small for gestational age by corrected growth curve / 소아과

PURPOSE: Being small for gestational age (SGA) is a risk factor of short stature in children. Genetic background such as mid-parental height (MPH) is known to influence growth of children born SGA. We studied the relationship between growth of children born SGA and MPH and studied the effects of insulin-like growth factor (IGF-I) and insulin-like growth factor binding protein 3 (IGFBP-3) on postnatal growth in children born SGA according to MPH. METHODS: Forty-nine neonates born SGA were included in this study. We defined corrected height standard deviation score (cHtSDS) by modified height SDS (HtSDS) based on their MPH. We categorized subjects into group 1 consisting of children with cHtSDS > or =0 (n=35) and group 2 consisting of children with cHtSDS <0 (n=14), and compared IGF-I and IGFBP-3 between the two groups. RESULTS: The HtSDSs and cHtSDSs in groups 1 and 2 were 0.06+/-1.05 vs. -0.95+/-0.85 (P=0.000) and 0.78+/-0.93 vs. -0.46+/-0.67 (P=0.000), respectively. IGF-I SDS was higher in group 1 than in group 2 (2.82+/-3.69 vs. 0.23+/-2.42, P=0.012). Total cHtSDS (0.42+/-1.03) was significantly higher than HtSDS (-0.22+/-1.10) (P=0.000). CONCLUSION: Our results show that cHtSDS differs significantly from HtSDS. Growth assessment by standardized growth curve does not uniformly show effects of genetic factors. A more accurate assessment of growth uses a personalized corrected growth curve that considers the genetic factor measured by MPH.

Catch up growth in children born small for gestational age by corrected growth curve / 소아과

PURPOSE: Being small for gestational age (SGA) is a risk factor of short stature in children. Genetic background such as mid-parental height (MPH) is known to influence growth of children born SGA. We studied the relationship between growth of children born SGA and MPH and studied the effects of insulin-like growth factor (IGF-I) and insulin-like growth factor binding protein 3 (IGFBP-3) on postnatal growth in children born SGA according to MPH. METHODS: Forty-nine neonates born SGA were included in this study. We defined corrected height standard deviation score (cHtSDS) by modified height SDS (HtSDS) based on their MPH. We categorized subjects into group 1 consisting of children with cHtSDS > or =0 (n=35) and group 2 consisting of children with cHtSDS <0 (n=14), and compared IGF-I and IGFBP-3 between the two groups. RESULTS: The HtSDSs and cHtSDSs in groups 1 and 2 were 0.06+/-1.05 vs. -0.95+/-0.85 (P=0.000) and 0.78+/-0.93 vs. -0.46+/-0.67 (P=0.000), respectively. IGF-I SDS was higher in group 1 than in group 2 (2.82+/-3.69 vs. 0.23+/-2.42, P=0.012). Total cHtSDS (0.42+/-1.03) was significantly higher than HtSDS (-0.22+/-1.10) (P=0.000). CONCLUSION: Our results show that cHtSDS differs significantly from HtSDS. Growth assessment by standardized growth curve does not uniformly show effects of genetic factors. A more accurate assessment of growth uses a personalized corrected growth curve that considers the genetic factor measured by MPH.

Insulin Resistance in Children and Adolescents Born Small for Gestational Age / 대한소아내분비학회지

PURPOSE: The aim of this study was to determine whether insulin resistance may be present and to analyze factors affecting the development of insulin resistance in children and adolescents born small for gestational age (SGA). METHODS: This study includes 24 children and 18 SGA adolescents and 13 children and 14 control adolescents. All patients underwent a standard, 2-hour oral glucose tolerance test (OGTT). Serum levels of fasting blood sugar, insulin, leptin, adiponectin, homeostasis model assessment-insulin resistance (HOMA- IR), quantitative insulin sensitivity check index (QUICKI), insulin sensitivity index (ISI), mean serum insulin (MSI) and mean serum glucose (MSG) were evaluated. RESULTS: The insulin responses at 30 min and 120 min after glucose load were significantly higher in pubertal SGA than control groups (P<0.05). Impaired glucose tolerance was found from 2 subjects (8.7 %) in prepubertal SGA group and from 3 subjects (15.0%) in pubertal SGA group. None of the patients had developed type 2 diabetes. MSI levels during OGTT were higher in pubertal SGA than in control. Pubertal SGA group had a significantly lower mean serum adiponectin level than control group (9.04+/-4.51 vs. 18.83+/-11.65 microgram/mL, P<0.05). Adiponectin level was correlated with HOMA-IR, QUICKI and ISI (r=-0.37, r=0.32, r=0.51, respectively, P<0.05). CONCLUSION: Adiponectin level was correlated with HOMA-IR, QUICKI and ISI. Pubertal SGA group had a significantly lower mean serum adiponectin level than control group. We suggest the check of insulin resistance using HOMA-IR, QUICKI, ISI and adiponectin is important for the prevention of metabolic syndrome (MS) in adolescents born SGA.