Bone Mineral Density and Bone Markers in the Children with Epilepsy Taking on Chronic Anticonvulsants / 소아과

PURPOSE: Long-term administration of anticonvulsants in children with epilepsy may cause short stature, hypocalcemia and low bone mineral density. This study was performed for the early detection of abnormal bone metabolism in children with epilepsy on taking anticonvulsants. METHODS: Thirty children aged 5 to 16 years who were diagnosed with epilepsy were enrolled in this study. All had taken anticonvulsants for more than one year. Bone mineral density of lumbar vertebra was measured by dual-energy X-ray absorptiometry. Serum calcium, phosphorous, alkaline phosphatase, 25-hydroxycholecalciferol[25(OH)D3], parathyroid hormone, and urine deoxypyridinoline were measured as biochemical bone markers. Bone age and body mass index were also calculated. RESULTS: Bone minreal density, body mass index, bone age, and height were significantly decreased in two female patients who had taken two antiepileptic drugs for more than four years and they also had chronic diseases such as cerebral palsy with microcephaly, encephalomalacia, and microcephaly with atrial septal defect. Bone mineral density had significant positive correlations with body mass index(P<0.01) and bone age(P<0.01). CONCLUSION: This study showed chronic medication of anticonvulsants in children may cause low bone mineral density and short stature. Bone age and body mass index could be the important surrogate markers to find the population at risk. More studies, including a large study population and long term cohort study, will be required.

A Case of Mycoplasma pneumoniae Pneumonia Complicated with Guillain-Barre Syndrome and Encephalitis / 소아과

The most common pathogen of respiratory tract infection among school-age children and adolescents is Mycoplasma pneumoniae, which causes clinical manifestations of pneumonia, acute asthmatic attack, pharygitis, and tonsilitis. It can also cause extrapulmonary infections that involves skin, the nervous system, the digestive system, the cardiovascular system, and the hematopoietic system. It is reported that the central nervous system symptoms may occur in 0.1% to 7% of patients hospitalized with Mycoplasma pneumoniae infection. Direct invasion, toxin, immune-mediated, and vascular phenomenon have been proposed for the etiology of the neurological manifestations. We have experienced a six-year-old male patient with Mycoplasma pneumoniae pneumonia who had complained of both leg pains and immobility two weeks after the onset of pneumonia, which was confirmed as peripheral neuropathy of Guillain-Barr syndrome. Three weeks after the disease-onset, altered consciousness and seizure attacks developed and intravenous immunoglobulins infused under the impression of encephalitis induced by Mycoplasma pneumoniae infection. He showed complete recovery of running and mentality five months after the disease-onset. We herein report a case of Mycoplasma pneumoniae pneumonia complicated with Guillain-Barr Syndrome and encephalitis about 2 or 3 weeks after the disease onset with a review of literatures.

Possible Neuroprotective Role of Exogenous Growth Hormone on Hypoxic-Ischemic Brain Injury in Neonatal Rats / 소아과

PURPOSE: This study was performed to evaluate the possible neuroprotective effect of exogenous growth hormone on hypoxic-ischemic brain injury in neonatal rats. METHODS: After ligation of the right common carotid artery, seven-day old Sprague-Dawley rats(n= 75) were exposed to 8% oxygen for two hours. In a growth hormone(GH)-treated group(n=25), each animal was subcutanously injected by GH(50 mg/kg, Grotrpin, Dong-Ah Pharmacy Co. KOREA) just before exposing to 8% oxygen, and then injected for the next two consecutive days by the same method. In a saline-treated group(n=25), the same amounts of saline were injected instead of GH. Other twenty five animals were sham-operated without hypoxia as a sham control group. The gross morphologic changes of extracted brains at three and seven days after injury were observed, and the ratios of wet and dry weight of each cerebral hemisphere ipsilateral and contralateral to hy poxic-ischemic injury were compared among three groups for evaluating the severity of brain edema. Also, the microscopic changes of cerebral cortex on coronal sections of paraffin-embedded brains were observed at three days after injury by light microscopy. RESULTS: The GH injection reduced the severities of gross changes at seven days after HI injury. The brain edemas of ipsilateral cerebral hemispheres to the site of ligation of the right common carotid artery were significantly decreased in GH-treated animals at three days after HI injury, compared to those in saline-treated animals(P<0.05). On light microscopic examination, neurons with pyknosis of nucleus were remarkably reduced on cerebral cortex at three days after hypoxic-ischemic injury by GH treatment. CONCLUSION: Exogenous GH might have a some neuroprotective role in hypoxic-ischemic brain injury of newborn rats.

Survival Rate in Very Low Birth Weight Infants / 소아과

PURPOSE: We observed changes in the outcome of very low birth weight infants(VLBWI) admitted to the neonatal intensive care unit(NICU) of Dankook University Hospital(DKUH) in the last six years. METHODS: The distribution of birth weight and gestational age, survival rate, neonatal complications, and causes of death for 228 VLBWI who had been admitted to DKUH from 1st January 1997 to 31th December 2002, were observed by retrospective review of medical records. We compared the above variables between period I(1997-1999) and period II(2000-2002). RESULTS: The mean birth weight, mean gestational age, gender ratio, rate of inborn infants, and other perinatal and obstetric variables were not significantly different between the two periods, except for the rate of infants with Apgar scores less than 4 at 5 min. The survival rate of VLBWI significantly increased from period I(81.0%) to period II(85.4%)(P<0.05). Major neonatal complications of VLBWI were respiratory distress syndrome, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, periventricular leukomalasia and intraventricular hemorrhage. The most common cause of death in VLBWI was pulmonary hemorrhage, and the age of death was mostly less than seven days after birth. CONCLUSION: The survival rate of VLBWI who had been admitted to the NICU of DKUH was increased without any increase in major complications, and this increase(4.4%) in survival rate was mainly from the increase in survival rate of infants with birth weights of less than 1,000 gm and gestational ages of less than 28 weeks.

Hydroxyl Radical Production after Intrastriatal Injection of Dopamine and the Effect of Growth Hormone on the Apoptosis of Striatal Neurons Injured by Hypoxia-ischemia in Newborn Rat Brain / 대한소아내분비학회지

PURPOSE:We investigated the production of oxygen hydroxyl radicals in the striatum of neonatal rat brain after intrastriatal injection of dopamine (DA) and the effect of growth hormone (GH) on the apoptosis of striatal neurons injured by hypoxia-ischemia. METHODS:The extracellular striatal levels of 2,3-dihydroxybenzoic acid (DHBA) and 2,5-DHBA as indicators of hydroxyl radical(OH-) production were measured by in vivo microdialysis in the striatums of 7 day-old newborn rats (n=10) after direct intrastriatal infusion of dopamine hydrochloride (1.0 micromol/microL). The samples of perfused artificial cerebrospinal fluid (CSF) were collected every 10 minutes interval. The levels of DA, 2,3-DHBA and 2,5-DHBA of CSF were analysed by HPLC (high performance liquid chromatography). Also, the brains were removed at 24 hour after hypoxic-ischemic injury by Rice-Vannucci method. The coronal sections (12 micrometer) of paraffin-fixed brains were stained by TUNEL (terminal transferase-mediated dUTP nick-end-labelling) technique, and the neuronal cells undergoing apoptosis in the striatum were observed by fluorescent microscopy and compared between GH-treated (50 mg/kg, Dong-Ah Pharmacy Co.) and saline-treated rats. RESULTS:The extracellualr striatal levels of 2,3-DHBA and 2,5-DHBA increased abruptly in the first 10 minutes samples after intrastriatal injection of DA. After then, the levels declined slowely. The levels of striatal extracelluar 2.3-DHBA increased up to 621.8+/-508.7% of basal levels (P<0.05), and the levels of 2.5-DHBA increased up to 262.8+/-198.1% of basal levels (P<0.05). GH reduced markedly the number of apoptotic neuronal cells in the striatum after hypoxic-ischemic brain injury. CONCLUSION: The level of hydroxyl radicals increased abruptly after intrastriatal injection of DA and GH reduced markedly the number of apoptotic neuronal cells in the striatum after hypoxic-ischemic brain injury.