The Clinical Experience of Pediatric Flexible Bronchoscopy at a Single Institution / 소아알레르기및호흡기학회지

PURPOSE: This study was performed to investigate the indications, bronchoscopic findings, results of bronchoalveolar lavage, and complications and to report the clinical features of using flexible bronchoscopy for respiratory diseases in children. METHODS: We studied 105 patients who underwent flexible bronchoscopy at the Department of Pediatrics, Dong-A University Medical Center from June 2001 to June 2008. A bronchoalveolar lavage (BAL) was performed if need, and the BAL fluid was cultured for bacteria and fungi. We performed an acid-fast bacilli (AFB) smear and culture. RESULTS: The most common indication for flexible bronchoscopy was suspected pulmonary tuberculosis (37 cases, 35.2%). The most common abnormal finding was excessive secretion, which was found in 53 cases (50.4%). BAL bacterial cultures were performed in 10 of 38 cases, and Hemophilus influenza was the most common organism and was found in three cases (7.8%). There were 17 AFB culture-positive cases (49.3%) among the 37 suspected pulmonary tuberculosis cases. Among these 17, the Tb-polymerase chain reaction (Tb-PCR) was conducted for four cases (23.5%) but only two cases (50%) were positive. TB-specific antigen-induced interferon-gamma was performed in four cases (23.5%), and all four cases (100%) were positive. CONCLUSION: Pediatric flexible bronchoscopy has made it possible to vary the indication and subjects. It was also safe and effective if used carefully. Further study should be conducted to develop safe and useful technology to overcome the limitations.

Effect of Gestational Exposure to Bisphenol A on Neuronal Stem Cell Differentiation in the Neonatal Rat Hippocampus / 대한소아신경학회지

PURPOSE: Neurogenesis in neonatal period after birth occurs consequently through a series of neuronal stem/progenitor cell proliferation and differentiation. This stage is critical for determining of normal development and maturation of the brain throughout the life. Therefore, exposure to a certain physical or chemical factor(s) during pregnancy can result in serious damage in the developing brain. Bisphenol A (BPA), a plasticizer, is generally known as an endocrine disruptor exhibiting adverse effects when exposed to animals under experimental conditions. The purpose of this study was to investigate the changes in neuronal stem cell proliferation and differentiation during neonatal brain development in BPA-exposed pregnant rats. METHODS: After exposure of BPA to pregnant rats, infant brains were excised at days 3, 7, and 14 after birth, and tissues were processed for histological and biochemical analyses. RESULTS: Proliferating cell nuclear antigen (PCNA) immunostaining showed that whereas cells in the hippocampus at days 3 and 7 after birth were highly proliferating, the cells at day 14 divided less often. Immunohistochemical staining for nestin in the control group revealed that nestin-positive cells were only observed at day 3 after birth, but the immunoreactivity was not observed at day 14. In addition, glial fibrillary acidic protein (GFAP) immunoreactive cells were observed from days 7 to 14 in control tissues. However, in the BPA-exposed groups, 1) the number of PCNA-positive cells in the BPA-exposed groups at days 3 and 7 were higher than those of the control, 2) nestin-positive cells were observed at day 3 which is earlier than that of control, and 3) GFAP-positive cells were detected in the hippocampus tissue from day 3. Furthermore, western blotting showed that exposure to BPA in pregnant rats resulted in earlier expression of nestin in the neuronal rat brain compared to the controls. CONCLUSION: Taken together, it is assumed that precocious neurogenesis in the infant rat hippocampus might be due to BPA exposure during the gestational period. Further studies on adult brain perinatally exposed to BPA are needed to evaluate the pathological status of the hippocampus.

Correlation between prognosis of pediatric medulloblastoma and its relevant clinical factors / 中华神经医学杂志

Objective To analyze the correlation between the prognosis of pediatric medulloblastoma (MB) and its relevant clinical factors. Methods Forty-seven children with MB,admitted to our hospital from November 2001 to July 2010, were chosen;a retrospective analysis, using Kaplan-Meier survival tested by log-rank and Cox proportional hazards regression model, was performed to identify the correlation between the prognosis of pediatric MB and relevant clinical factors which included age, gender, course of disease, tumor location, pathological subtype, preoperative metastasis,extent of tumor resection, interval between surgery and radiation, brainstem invasion and chemotherapy.Results The 2-year survival rate of these patients was 91.4%, and 5-year survival rate 50%.Kaplan-Meier curves indicated that patients with total or subtotal tumor resection had a significantly higher survival rate than those with partial resection (P<0.05);patients without preoperative metastasis had a significantly higher survival rate than those with preoperative metastasis (P<0.05);and patients with interval between surgery and radiation≤42 d had a significantly higher survival rate than those with interval between surgery and radiation >42 d (P<0.05). Cox proportional hazards regression analysis indicated that preoperative metastasis (RR, 6.808;95%CI, 1.844 to 25.113;P<0.05) and interval between surgery and radiation (RR, 5.642;95% CI, 2.042 to 15.587;P<0.05) were the influencing factors for prognosis of MB. Patients without preoperative metastasis and with interval between surgery and radiation ≤42 d enjoyed good prognosis results. Conclusion Both preoperative metastasis and interval between surgery and radiation are independent factors for prognosis of pediatric MB.

Changes in the Outcomes of Very Low Birth Weight Infants in Busan Area

PURPOSE: To evaluate mortality and morbidity of very low birth weight infants(VLBW infants) born in the Busan area from 1996 to 2005. METHODS: A total of eight neonatal intensive care units (4 university hospitals and 4 general hospitals) in Busan participated in this study. A total of 1,414 VLBW infants were divided into three groups: period I, 1996 to 2000; period II, 1999 to 2002; period III, 2003 to 2005, based on date of birth. We performed a retrospective review of medical records of VLBWinfants and compared the survival rate, morbidity and mortality over the three periods. RESULT: The number of VLBW infants admitted to 8 NICUs in 1996-2005 was a total of 1,414 (1.3% incidence, mean gestational age 29.1+/-2.7 wk, mean birth weight 1158+/-235 g), including 361 (24.7%) extremely low birth weight infants (ELVW infants) who were less than 1,000 g at birth weight. Overall survival rate of VLBW infants was 66.1%. The survival rate of VLBW infants increased significantly over the three periods (period I:57.6%, period II:67.8%, period III:75.7%, P<0.01). Overall survival rate of ELBW infants was 33.8%, and increased from 26.4% in period I to 44.2% in period III (P<0.01). The incidence of respiratory distress syndrome was 45.1%; patent ductus arteriosus, 16.4%; bronchopulmonary dysplasia, 13.1%; blood culture positive sepsis, 12.7%; necrotizing enterocolitis, 6.6%; severe intracranial hemorrhage, 6.5%; and severe retinopathy of prematurity, 5.9%. The main causes of death were respiratory distress syndrome and sepsis. CONCLUSION: Overall survival rate of very low birth weight infant in Busan area during the last 10 years was 66.1%, and increased significantly over the three periods.

A case of congenital ductus arteriosus aneurysm / 소아과

Aneurysmal dilatation of the ductus arteriosis has been considered a rare but potentially fatal abnormality. The mechanism of ductal aneurysmal formation remains uncertain. Plain chest radiography has proven helpful in the diagnosis of ductus arteriosus aneurysm (DAA), before the application of transthoracic echocardiography. The transthoracic echocardiography is an important tool for the diagnosis and follow-up of DAA. We present a case of congenital ductus arteriosus aneurysm in a newborn, that was an incidental discovery. The diagnosis was made by echocardiography, three-dimensional surface rendering computed tomography (CT), and spontaneous regression after four weeks of follow-up.

Early and mid-term results of pulmonary valve reconstruction in surgical repair of tetralogy of Fallot; comparison with other techniques of right ventricular outflow reconstruction / 소아과

PURPOSE: The purpose of this study is to determine whether the new pulmonary valve reconstruction technique prevents short-term postoperative pulmonary regurgitation and improves early and mid-term clinical outcome. METHODS: We reviewed postoperative echocardiographic variables and chest X-ray films from 31 patients who had undergone valve reconstruction(pulmonary valve reconstruction group:PVR) for the repair of TOF between April 2000 and August 2004. We compared the clinical data of these patients with those from 47 patients who had right ventricular outflow tract reconstruction with a monocusp valve(monocusp ventricular outflow patch group:MVOP) and 22 patients who had a transannular patch repair without a monocusp valve(transannular patch group:TAP). RESULTS: In the PVR group, 25 patients(81 percent) had trivial or mild pulmonary regurgitation in their early post operative echocardiogram. Only 12 patients(26 percent) in the MVOP group had mild pulmonary regurgitation; and no patient in the TAP group had it. Pulmonary valve function was good in 96 percent of the PVR group, 36 percent of the MVOP group, and none in the TAP group in early post-operative echocardiogram. Follow-up echocardiogram(1, 2, 3, 4 years later) of the MVOP and TAP groups showed moderate pulmonary regurgitation and severely decreased valve function in almost all cases. However, in the PVR group 54 percent(16/28), 50 percent(14/28), 37 percent(9/24), and 31 percent(5/16) of the patients had trivial or mild pulmonary regurgitation 1, 2, 3 and 4 years after operation, respectively. The valve function remained good in 80 percent(24/30), 64 percent(18/28), 57 percent(12/21), and 31 percent(5/16) of the patients 1, 2, 3 and 4 years after operation respectively. CONCLUSION: Pulmonary valve reconstruction is effective in reducing pulmonary regurgitation and right ventricular dilatation in the repair of TOF, even though regurgitation increases with time. Further study is needed to determine long-term results.