Multicenter Adherence Study of Asthma Medication for Children in Korea

PURPOSE: Adherence is a major component of successful medical treatment. However, non-adherence remains a barrier to effective delivery of healthcare worldwide. METHODS: Twenty healthcare facilities (secondary or tertiary hospitals) belonging to the Korean Academy of Pediatric Allergy and Respiratory Diseases (KAPARD) participated. Questionnaires were given to patients currently receiving treatment in the form of inhalant useor oral intake or transdermal patch for mild to moderate asthma. RESULTS: A total of 1,838 patients responded to the questionnaire. Mean age was 5.98 ± 3.79 years (range: 0-18 years). With help from their caregivers, the percentage of patients that answered “taking as prescribed” was 38.04% for inhalant users, 50.09% for oral medication users and 67.42% for transdermal users. Transdermal patch users had significantly greater adherence compared to the other 2 groups (P < 0.001). The 34.15% of inhalant users, 70.33% of oral medication users and 93.00% of transdermal patch users felt that their medication delivery system was “Easy” or “Very easy” to use (P < 0.001). “Method of administration” was deemed to be the most difficult part of the treatment regimen to follow, and 76.7% of patients preferred once-daily administration (i.e., “Frequency of administration”). CONCLUSIONS: Asthma medication adherence in young children was found to be better in the transdermal patch group. This may be due to requiring fewer doses and easy to follow instructions. From an adherence point of view, the transdermal patch seems more useful for long-term asthma control in children compared to oral or inhaled medicine.

Large Coronary Artery Aneurysm with Thrombotic Coronary Occlusion Resulting in ST-Elevation Myocardial Infarction after Warfarin Interruption

A 44-year-old man, who had a history of myocardial infarction (MI) due to thrombotic occlusion of right coronary artery (RCA) aneurysm, visited emergency department presenting with ST-segment elevation myocardial infarction (STEMI). The patient had been on oral anticoagulant therapy (warfarin) from the first thrombotic event, but the medication had been recently changed to aspirin 4 months before the second event. Emergent coronary angiography revealed thrombotic total occlusion of RCA with heavy thrombotic burden from middle RCA to the ostium of the posterior descending branch. Combination pharmacotherapy was performed with anticoagulants (heparin), fibrinolytics (urokinase), and Glycoprotein IIb/IIIa antagonists (abciximab), in addition to mechanical thrombosuction. However, on hospital day 2, the patient complained recurrent chest pain and again underwent coronary angiography, which revealed distal embolization of large thrombus to the posterior lateral branch. Coronary flow was recovered after repeated mechanical thrombosuction was performed. This case has shown the importance of aggressive combination drug therapy, accompanied by mechanical thrombosuction in patient with myocardial infarction due to thrombotic occlusion of coronary artery aneurysm and the importance of unceasing life-long anticoagulant therapy in those particular patients.

Endovascular Management of Spontaneous Superficial Femoral Artery Pseudoaneurysm in a Renal Allograft Patient

We report a case of a superficial femoral artery pseudoaneurysm in 52-year old patient with a history of having renal allograft. The pseudoaneurysm spontaneously developed while standing up from squatting position after defecation, and it was successfully managed by an endovascular repair with an endograft. This case suggests that an atherosclerotic superficial femoral artery is vulnerable to torsion and tension movement during changing position from squatting to standing, which is repeatedly practiced by the people using the Korean traditional toilet. The endovascular therapy is also recommended for elderly patients with poor clinical conditions such as having a renal allograft and diffuse atherosclerosis of peripheral arteries.

The effect of YB-1 antisense oligonucleotides on tumor cell growth / 대한내과학회지

BACKGROUND: Human YB-1 is a transcription factor that binds to the inverted CCAAT box in the promoter region of a variety of genes such as PCNA, DNA polymerase and MDR. In this study we evaluated the effect of YB-1 antisense oligonucleotides on tumor cell growth. METHODS: Chang liver, HepG2 and CT-26 cells were cultured as immortalized cell lines. The MTT (3-[4,5-dimethylthiazol-2-yl] 2,5-diphenyltetrazolium bromide) assay, Northern blot and flow cytometric analyses were used to determine cell growth, gene expression and cell cycle changes. In an animal model, CT-26 cells were injected into Balb/c mice to induce tumor; YB-1 antisense oligonucleotides were injected into the tail vein or tumor tissue of the mice; change of tumor size was then measured. RESULTS: Phosphorothioated YB-1 antisense oligonucleotides suppressed the proliferation of the immortalized liver cells (Chang liver cells) and a variety of cancer cells (HepG2 and CT-26 cells); however, it did not inhibit normal cell growth. The DOTAP/antisense oligonucleotide mixture showed stronger effects on cell proliferation than did the antisense oligonucleotide alone. The YB-1 antisense oligonucleotide decreased specific expression of the YB-1 mRNA in the immortalized cancer cell lines. Flow cytometric analysis revealed that the inhibition of cell proliferation might have been due to a decrease in the S phase of the cell cycle. We found that in an animal tumor model, the administration of the YB-1 antisense oligonucleotide, in the vein or tumor tissues, decreased the tumor size significantly. CONCLUSIONS: These results suggest that the YB-1 antisense oligonucleotide may inhibit growth of a variety of cancer cells.

Genotypes and Clinical Characteristics of BK Virus in Kidney Transplant Recipients / 대한신장학회잡지

BACKGOUND: BK virus has emerged as a major cause of allograft loss in kidney transplant recipients over the past decade. The presence of BK virus in urine or blood indicates reactivation of the virus not necessarily accompanied by BK virus associated nephropathy. BK virus genotypes have been described based on the DNA sequence of VP1 region, and no data have been published on BK virus genotypes in Korea. In this study, we sought to determine BK virus genotypes and clinical characteristics associated with BK virus reactivation. METHODS: We isolated BK virus DNA from urine and blood of 103 kidney transplant recipients, and amplified VP1 region using polymerase chain reaction (PCR). The PCR products were sequenced and genotypes of BK virus (I-IV) were determined based on the nucleotide sequence 1744-1812 of the VP1 region. In addition, the clinical characteristics of the patients were analyzed to determine the risk factors of BK virus reactivation. RESULTS: Of 103 patients examined, 16 and 5 patients were shown to have BK viruria and viremia, respectively. Eight viral strains were demonstrated to be genotype I, but the other 8 strains neither matched with the genotypes from I to IV, nor did they fit into any other variants identified in the Western countries. Of note, 3 of these 8 unclassified strains were shown to have the same type of mutations. With respect to the risk factors of BK virus, tacrolimus and mycophenolate mofetil when combined with tacrolimus were found to be significantly associated with BK viruria and viremia. CONCLUSION: It appears that different variants of BK virus are prevalent in Korea compared with the Western countries, and that the reactivation of BK virus is significantly associated with tacrolimus.

Quantitative Viral Load Monitoring and Cidofovir Therapy in BK Virus Nephropathy / 대한신장학회잡지

BACKGROUND: BK virus nephropathy (BKVN) has been increasingly recognized as an important cause of renal transplant dysfunction, but no specific antiviral therapy is currently available. Furthermore, a method evaluating the degree of viral infection has not been developed yet. Recently, there have been several case reports in which BKVN was successfully treated with cidofovir injection. In the current study, we report a case with BKVN successfully treated with cidofovir injection. In addition, we assessed the usefulness of quantitative viral load monitoring using a competitive polymerase chain reaction (PCR) in the treatment of BKVN. METHODS: A renal allograft recipient with BKVN was injected with cidofovir. To monitor BK viral load in urine and plasma, we developed a competitive PCR assay and followed the patient prospectively. RESULTS: A 49 year old renal transplant recipient developed a progressive rise in serum creatinine reaching 1.9 mg/dL at 15 months post-transplantation. Subsequently, the patient was diagnosed as BKVAN by allograft biopsy. At this time, BKV DNA was detected in plasma and urine. Despite a reduction of the dose of mycophenolate mofetil, serum creatinine continued to rise, which prompted the initiation of cidofovir trial. The patient was given intravenous cidofovir. After cidofovir treatment, BK virus associated findings disappeared on repeat biopsy, and BK virus in plasma was decreased to the undetectable level. For 7 months after cidofovir treatment, her renal function remained stable. CONCLUSION: Cidofovir therapy may be effective in the treatment for BKVN. Viral load in plasma reflected well the clinical and pathological course of the BK virus infection.

A Case of Acute Respiratory Distress Syndrome Occurred after Pulmonary Edema in a Fullterm Newborn

Acute respiratory distress syndrome (ARDS) is a syndrome identified as acute respiratory failure and is characterized by wide spread infiltrates on chest radiograph, impaired oxygenation, and noncardiogenic pulmonary edema. This syndrome is identified very uncommonly during neonatal period. We experienced a case of ARDS in a 3-day old fullterm neonate who had had the sign of pulmonary edema. He was improved with the treatment of mechanical ventilation, but pulmonary interstitial emphysema and periventricular leukomalacia were complicated.

A Case of Crescentic Glomerulonephritis Associated with Bacterial Endocarditis / 대한신장학회잡지

A 25-year-old male presented with mitral insufficiency, perimembranous type of ventricular septal defect, pulmonary edema and renal insufficiency. The initial serum creatinine level was 16.2mg/dl. Blood cultures were positive for Streptococcus viridans and appropriate antibiotic therapy was initiated. Renal biopsy revealed diffuse proliferative glomerulonephritis with crescents involving all of the glomeruli. Even after adequate duration of treatment with antibiotics, surgical therapy, and high dose steroid therapy, renal function did not recover and the patient ended up with continuous ambulatory peritoneal dialysis. We present a case of crescentic glomerulonephritis associated with bacterial endocarditis with a review of the literature.

Incidence of Congenital Heart Disease in Neonate by Color Doppler Echocardiography

PURPOSE: Many reports exist about the frequency of congenital heart disease (CHD) in the world, but according to the definition of CHD and subjects of study group, many differences existed between the reports. We conducted this study to evaluate the incidence and frequency of CHD by color Doppler echocardiography in neonate, and to suggest a preliminary model of incidence of neonatal CHD in Korea. METHODS: During July 1992 to June 1995, we conducted echocardiography in 285 babies who were suspected as having a CHD. RESULTS: Among the 16,672 neonate born alive at Dong San Hospital, 121 patients with CHD were identified by color Doppler echocardiography (7.26/1,000 live birth). The incidence of CHD of neonate born at our hospital were as follows: Among 121 cases, ventricualr septal defect 37.2%, atrial septal defect 17.4%, patent ductus arteriosus 12.4%, tetraology of Fallot 4.1%, transposition of great artery 4.1%. The incidence of CHD of neonate born at another hospital were as follow: Among 169 cases, ventricular septal defect 53.8%, atrial septal defect 14.2%, tetralogy of Fallot 7.7%. pulmonary stenosis 5.3%, transposition of great artery4.1%. The incidence of isolated ventricular septal defect were as follow: Perimembranous defect 79.4%, muscular defect 14.7%, subpulmonic defect 5.9%. CONCLUSION: In this study, the incidence of CHD was 7.26 per 1000 live births. The incidence of tetralogy of Fallot in neonate was less than that of in children. and among VSD, the incidence of muscular type was relatively high.

A Clinical Study on Infantile Asthma / 소아알레르기및호흡기학회지

PURPOSE: Early diagnosis and treatment of infantile asthma is very important because early treatment might influence the long term outcome. Tabachnik and Levison proposed in 1981 that "any infant with three or more episodes of wheezing should be considered as having asthma, regardless of the age of onset, evidence of atopy, apparent precipitating cause of wheeze." So we conducted clinical study in infants (less than 2 yr of age) with three or more episodes of wheezing. Method : 69 infants less than 2 yr of age with three or more episodes of wheezing admitted to the Department of Pediatrics, Keimyung University, Dongsan Medical Center from January, 1993 to December, 1994 were investigated for their chief complaint, allergic history, physical examination, serum IgE, MAST(multiple antigen simultaneous test), severity of asthma, response to bronchodilator and outcome after 3 yrs. RESULTS: The male to female ratio was 3.6:1. In age distribution, 60.8% of infants with asthma was less than 12 month. The Serum level of total eosinophil count and total IgE was mostly within normal limit, and only 5 of 30 cases performed MAST were positive. In chest radiologic finding, hyperinflation was most common(65.2%) and increased bronchovascular marking, pneumonia in orders. In the severity of asthmatic attack according to age on diagnosis, infants with asthma less than 12 month of age showed more severe than over than 13 month of age. In the responsiveness to bronchodilator therapy, infants with asthma less than 12 month of age showed poorer response than over than 13 month of age. In the outcome of 69 infantile asthma after 3 yrs, the patients of infantile asthma with atopy showed poorer prognosis than without atopy. CONCLUSIONS: In the diagnosis of infantile asthma, three or more episodes of wheezing and/or allergic history was more important than laboratory and allergic test. Because infants with asthma less than 12 month of age showed more severe asthmatic attack and poorer response to bronchodilator therapy than over than 13 month of age, it is very important to apply nebulized corticosteroid to them earlier. In the outcome of 69 infantile asthma after 3 yrs, the patients of infantile asthma with atopy showed poorer prognosis than without atopy.

Change of Thyroid Function during Chemotherapy in Chilolren with Acute Leukemia / 대한소아혈액종양학회지

BACKGROUND: The overall prognosis of acute leukemia has dramatically improved in the past 20 years, primarily due to the use of intensive multiagent chemotherapy in combination with CNS prophylaxis. However, increased aggressiveness of treatment protocols was entailed a great risk of various toxic effects. Endocrine function was also affected. The aim of this study is to compare the effect of chemotherapy on thyroid function in children with acute leukemia. METHOD: Parameters of thyroid function during chemotherapy were measured in 11 children with acute leukemia. Level of the serum 73,74 and TSH were determined before therapy, 7th day and 30th day of chemotherapy. Determination of serum 73, 74 and TSH were performed by conventional radioimmunoassay technique. Statistical analysis was done using SAS software. RESULT: 1) Level of level 73 was normal in 7 cases before therapy and decreased in 9 cases on 7th day of remission induction therapy. On 30th day, 73 level was increased to normal value. 2) Level of 74 was normal before therapy and decreased on 7th day of therapy. On 30th day of therapy 74 level showed various change. Three of them showed sustained low level of 74 on 7th and 30th day. 3) Level of TSH were normal before therapy and decreased on 7th day of therapy, followed achievement of normal level after completion of induction therapy. CONCLUSION: We conclude that during induction chemotherapy in childhood acute leukemia, thyroid function was impaired which was reversible.

A Case of Ectopia Cordis

Ectopia cordis is a very rare cardiac anomaly that the heart is partially or totally outside the thorax, and it was classified anatomically as 5 types-cervical, thoracocervical, thoracic (most common type), thoracoabdominal, abdominal types. We experienced a case of ectopia cordis (thoracic type) in a newborn who had the symptom of generalized cyanosis since birth, and expired during operation due to recurrent bradycardia and hypotension. The brief review of literature was made

Normal Values of Left Ventricular Mass by Echocardiography in Korean Children

PURPOSE: Determination of left ventricular myocardial mass with echocardiography is feasible and validated. American Society of Echocardiography(ASE) issued recommendations for the quantitation of the left ventricle by M-mode echocardiography. The purpose of this study is to determine the mean value of left ventricular mass in Korean children. METHODS: We measured left ventricular mass in 498 subjects(male 289, female 209) using ASE cube method with correction in M-mode method. RESULTS: 1) The mean value of left ventricular mass corrected by body surface area are respectively: 54.87+/-27.45 gm/m2 in Korean male children, and 49.57+/-23.16 gm/m2 in Korean female children, by echocardiography in accordance with the ASE convention. 2) The left ventricular mass correlated well with the left ventricular end-diastolic dimension, interventricular septal thickness, left ventricular posterior wall thickness, and left ventricular end-diastolic volume. CONCLUSIONS: These normal values shoud provide a valuable database for further studies of the development of left ventricular mass in patients with various cardiac abnormalities.

Comparisons of the Left Ventricular Ejection Fraction Between M-Mode, Two-Dimension Echocardiographic Studies and Digital Cardiac Imaging(DCI) System in Ventricular Septal Defects*

BACKGROUND: Left ventricular performance is one of the most important factors for the prognosis of congenital and acquired heart diseases. Measure of left ventricular performance such as chamber volume and ejection fraction are usually deemed most reiable when derived from cardiac catheterization data. Measurement of ventricular volume and ejection fraction by M-mode echocardiography may be compromised by segmental dysfunction or paradoxical septal motion. We compared ejection fraction derived from M-mode and two-dimensional echocardiographic methods to those derived from newly developed DCI (Digital Cardiac Imaging) system to determine the most accurate noninvasive technique for prediction these variables in children. METHODS: The ejection fraction measured by M-mode, Two-dimensional echocardiography was compared with the ejection fraction by DCI system in 22 patients who were admitted to the department of Pediatrics, Dong San Hospital during the period of 8 months from November 1992 to June 1993 for the evaluation of ventricular septal defect. RESULTS: M-mode measured ejection fraction correlated with Two-dimensional echocardiography measured ejection fraction(gamma=0.54). M-mode measuredd ejection fraction correlated with the DCI system measured ejection fraction(gamma=0.52). Two-dimensional echocardiography measured ejection fraction correlated well with the DCI system measured ejection fraction(gamma=0.88). CONCLUSION: 1) For ejection fraction, the best correlation with DCI was achieved by two-dimensional Simpson's method. 2) Two-dimensional Simpson's method appeared a safe and useful noninvasive method of evaluation left ventricular ejection fraction.

Urinary Red Cell Volume in the Diagnosis of Glomerular and Non-Glomerular Hematuria in Children

Hematuria is a important clinical sign that is a consequence of significant fenal. urologic or sytemic disease. Recently the morphology of the red cell in hematuria has been used to indicate a renal or non-renal source and also the measurement of red cell volume by red cell analyzer has been used to distinguish glomerular from non-glomerular hematuria. In this study. the MCV(mean corpsular red cell voume). RDW(red cell distribution width) and HDW (hemoglobin distribution width) were measured using H-1 system in57 children with hematuria to assess the diagnostic usefulness of the urinary red cell analyzer in the differentation of glomerular and non-glomerular hematuria. The patients were divided into two groups as glomerular diseases(40cases)and non-glomerular diseases(17 cases)and the location of the bleeding was confirmed by renal biopsy, radiology and the clinical findings. The results were as follows. 1) The urinary red cell MCV waslower in patients with glomerular diseases than that in patients with non-glomerular diseases (79.89 +/- 12.0fl vs. 90.93 +/- 9.71fl vs. 90.93+/-9.71 fL; p<0.01) 2) The urinary RDW and HDW were significantly higher in glomerular diseases than those in non-glomerular diseases (RDW; 19.86 +/- 11.28% vs 11.34+/-5.88%, HDW; 3.37+/-2.07 gm vs. 1.86+/-1.43gm). 3) The urinary red cell MCV was correlated well with the RDW and HDW while there was no correlation between the urinary red cell MCV and the urinary SG or pH. 4) The sensitivity, specificity and positive predictability of the urinsary MCV were 37.8%, 94.1% and 93.7% and those of RDW were 62.5%, 82.3% and 89.2% 5) The sensitivity, specificity and positive predictability of the urinary HDW were 42.5%, 88.2% and 89.4% We concluded from above date that the measurment of the urinary MCV, RDW and HDW would be useful as a primary non-invasive screening test in differentation of glomerular and non-glomerular hematuria in children.

Incidence of tricuspid regurgitation in children with heart disease

No abstract available.

Clinical study on 12 cases of neonatal group B ?hemolytic streptococcal meningitis

A clinical study was made on 12 cases of neonatal Group B beta-hemolytic streptococcal (=GBS) meningitis, who were admitted to the department of pediatrics, Dong-San Hospital, Keimyung University during the period of 3 years from Aug 1989 to Jul 1992. The following results were obtained: 1) GBS was cultured in 12 cases (57.1%) among 21 neonatal meningitis admitted during the same period. 2) Male and female ratio was 1.4:1, and 4 cases had early-onset and 8 cases had late-onset. 3) In 6 (50%) out of 12 cases, obstetric factors were noted, including premature rupture of membrane (2 caes), premature delivery(1 case), asphyxia (1 case), cesarean section (1 case) and maternal toxemia (1case). 4) The clinical manifestations were fever (91.7%), lethargy and poor feeding (83.3%),vomiting and irritability (50%), convulsion and bulging fontanel in order. 5) Associated diseases were GBS sepsis (8 cases), pneumonia (2 cases), hyperbilirubinemia (2 cases), etc. 6) Cerebrospinal fluid findings were increased cells(250-12600/mm3), decreased sugar (1-11), increased protim (220-678mg%) and the CBC differential ratio was less than 1.0 in all cases. 7) Overall survival rate was 83.3% with 75% in early-onset disease, and 87.5% in late-onsetdisease. 8) The acute neurologic complications were noted in 5 cases (45.5%) including subdural hemorrhage, brain swelling and cerebral infarction.

A case of bacteria associated hemophagocytic syndrome

Hemophagocytic syndrome has been identified as a benign reactive histocytic proliferation with marked hemophagocytosis and usually associated with systemic viral infection. Recently similar cases that were associated with bacteria have been described. The syndrome is clinically characterized by fever, severe constitutional symptoms, hepatosplenomegaly, lymphadenopathy and laboratory findings of pancytopenia, hemophagocytosis, abnormal liver function test and coagulopathy. The authors experienced a case of bacteria associated hemophagocytic syndrome in a 11-year old girl following Mycoplasma pneumoniae infection. The patient showed characteristic clinical features of hemophagocytic syndrome, peripheral pancytopenia and phagocytized histiocytes in bone marrow. The brief review of the literature was made.

Plasma norepinephrine levels in infants and children with congestive heart failure

To characterize the sympathetic nervous system response to congestive heart failure in infants and children, plasma norepinephrine levels were measured in 29 patients aged 4 months to 15 years undergoing routine cardiac catheterization at Dong San Hospital, Keimyung University during the period of 4 months from November 1990 to February 1991. Plasma norepinephrine levels were significantly higher in patients with heart disease and congestive heart failure than in those without congestive heart failure(P<0.001). A significant association was found between the level of plasma norepinephrine and severity of the symptoms of congestive heart failure. Plasma norepinephrine levels correlated well with size of the shunt (Qp/Qs)(gamma=0.75), degree of pulmonary arterial pressure (gamma=0.79) and degree of right ventricular pressure (gamma=0.82).

Results of Treatment in Childhood with High Hyperopic or Astigmatic Amblyopia

We analized the results of treatment in 28 children with high hyperopic amblyopia or astigmatic amblyopia among 65 amblyopic children ranging from 3 to 10 years of age from Jan. 1985 to Dec. 1989. The results are as follows: 1. The final corrected visual acuities of both eyes above 0.8, according to Han's visual acuity chart, were attained in 7 cases (50.0%) among children with high hyperopic amblyopia and 4 cases (28.6%) among children with astigmatic amblyopia. 2. As the degree of hyperopic errors increased, initial corrected visual acuity decreased (p<0.05). 3. The initial corrected visual acuity was not associated with the degree of hyperopic errors, but could be correlated with the initial visual acuity examination under 5 years of age (p<0.025). 4. The final corrected visual acuity recovered was above 0.8, (with Han's visual acuity chart) in 11 eyes (78.6%) among 14 eyes with high hyperopic amblyopia under 5 years of age However above 6 years of age, only one eye (12.5%) among 8 eys was correctable. 5. As the degree of astigmatic errors increased, the final corrected visual acuity decreased (p<0.025).