Successful and safe treatment of hemangioma with oral propranolol in a single institution / 소아과

PURPOSE: Dramatic improvement of hemangioma to propranolol has been recently reported; however, details on dose and duration of treatment, potential risks, and monitoring have not been determined. The objective of this study is to describe and analyze the use of propranolol as a first-line treatment or as a single therapy in management of complicated hemangioma. METHODS: A retrospective chart review of eight patients diagnosed with hemangioma and treated with propranolol in Kangbuk Samsung Hospital from February 2010 to April 2011 was performed. RESULTS: Eight patients with hemangioma with functional impairment, cosmetic disfigurement, or rapid growth were treated with propranolol. Five patients had solitary facial hemangioma. The mean age of symptoms at onset was 5 weeks. The median age for starting propranolol treatment was 5.5 months. Propranolol at 2 mg/kg/day was finally administered in divided doses with a gradual increase. Significant regression was observed in seven patients, and shrinkage in size, softening in consistency, and decrease in redness were evident within 4 weeks. Among them, six patients were still taking propranolol, and one patient had stopped after 12 months. Other one patient did not show significant improvement with satisfactory result after 3 months of propranolol use. Treatment with propranolol was well tolerated and had few side effects. No rebound growth was observed in any of the patients. CONCLUSION: We observed that use of propranolol was very effective in treatment of hemangioma without obvious adverse effects or relapse.

Clinical Features and Treatment Outcomes of Hemangioma in a Single Institution / 임상소아혈액종양

BACKGROUND: Hemangiomas are the most common benign tumor of childhood. Uncertainties regarding their diagnosis or management often prompt life- or function-threatening complications or unnecessary treatment. The objective of this study is to analyze and understand the clinical features and treatment outcomes of hemangiomas for accurate diagnosis and treatment.METHODS: A retrospective chart review of 60 patients diagnosed as hemangioma in Kangbuk Samsung Hospital from January 2001 to January 2011 was performed.RESULTS: Hemangiomas were observed predominantly in female with the sex ratio of 1:2.2. They were present at birth in 32%, and within 2 months of age in 22% of the patients. In 45% of the patients, hemangiomas occurred on the head and neck, which were the most commonly involved site. 27% of the cases were clinically diagnosed, 40% of the cases were diagnosed after imaging studies, and 37% of cases were confirmed by histopathology. 40% of the patients were observed without treatment. 57% of the patients were treated with surgical excision, corticosteroid, interferon or propranolol. Eight patients were treated with oral propranolol, and seven of them demonstrated regression without major side effects.CONCLUSION: We confirmed that hemangiomas were preponderant in female and usually appeared in first 2 months of life, and the head and neck were the most favored site. We observed that propranolol was effective and safe for treating problematic infantile hemangiomas.

Clinical Features and Treatment Outcomes of Hemangioma in a Single Institution / 임상소아혈액종양

BACKGROUND: Hemangiomas are the most common benign tumor of childhood. Uncertainties regarding their diagnosis or management often prompt life- or function-threatening complications or unnecessary treatment. The objective of this study is to analyze and understand the clinical features and treatment outcomes of hemangiomas for accurate diagnosis and treatment. METHODS: A retrospective chart review of 60 patients diagnosed as hemangioma in Kangbuk Samsung Hospital from January 2001 to January 2011 was performed. RESULTS: Hemangiomas were observed predominantly in female with the sex ratio of 1:2.2. They were present at birth in 32%, and within 2 months of age in 22% of the patients. In 45% of the patients, hemangiomas occurred on the head and neck, which were the most commonly involved site. 27% of the cases were clinically diagnosed, 40% of the cases were diagnosed after imaging studies, and 37% of cases were confirmed by histopathology. 40% of the patients were observed without treatment. 57% of the patients were treated with surgical excision, corticosteroid, interferon or propranolol. Eight patients were treated with oral propranolol, and seven of them demonstrated regression without major side effects. CONCLUSION: We confirmed that hemangiomas were preponderant in female and usually appeared in first 2 months of life, and the head and neck were the most favored site. We observed that propranolol was effective and safe for treating problematic infantile hemangiomas.

The Relationship between Atopic Dermatitis, Thymus and Activation-Regulated Chemokine/CCL17, Quality of Life, and Attention Deficit-Hyperactivity Disorder in Preschool Children / 소아알레르기및호흡기학회지

PURPOSE: Atopic dermatitis may impair quality of life and lead to attention deficit-hyperactivity disorder (ADHD). Thymus and activation-regulated chemokine (TARC)/CCL17 may serve as a new biomarker for atopic dermatitis. We investigated the relationship between TARC and the severity of atopic dermatitis, quality of life, and ADHD. METHODS: A total of 249 preschool children who had atopic dermatitis were enrolled. Parents of the patients filled out a questionnaire on the past history of allergic diseases, quality of life, and ADHD. In each patient, total immunoglobulin (Ig) E and specific IgE to nine foods and inhalant allergens, total eosinophil counts, and TARC levels were measured. We evaluated the severity of atopic dermatitis by using the scoring atopic dermatitis (SCORAD) score and divided the patients into three groups; mild (40). RESULTS: In a total of 249 children, 222 children (89.2%) had a history of atopic dermatitis. Children with allergic sensitization had a higher SCORAD score, total IgE levels, and total eosinophil counts, but not TARC levels. Three groups by the SCORAD score showed significant differences in quality of life index and TARC levels but not in ADHD index. TARC level was correlated with the SCORAD score, but not with the quality of life index and ADHD index. The SCORAD score was correlated with the quality of life index but not with the ADHD index. CONCLUSION: Serum TARC levels may be associated with the severity of atopic dermatitis but not with the degree of quality of life and ADHD. Disease severity of atopic dermatitis in preschool children may be associated with the degree of quality of life but not with the level of ADHD.

Impact of Environmental Tobacco Smoke Exposure and Home Environment on Asthma and Wheeze in School Children / 소아알레르기및호흡기학회지

PURPOSE: Environmental factors may increase risk for childhood asthma. The objective of this study was to investigate the association of environmental tobacco smoke (ETS) exposure and home environment with the development of wheeze and asthma. METHODS: We conducted a cross-sectional survey of 969 elementary school students. Data included questions about asthma and wheeze symptoms, exposure to tobacco smoke, and home environment including history of moving into a new house within 1 year of age after birth, use of fragrance at home, recent purchase of new furniture. Logistic regression and Pearson chi statistics were used to estimate these associations. RESULTS: ETS exposure was associated with current wheeze and nocturnal sleep disturbance. Paternal smoking over 20 cigarettes per day was associated with 4 or more episodes of wheeze during the past 1 year. However, there were no significant differences in pulmonary function, serum total IgE levels, blood eosinophil counts, and atopy between children with ETS exposure and non-exposure. Moving into a new house within 1 year of birth was associated with current asthma or wheeze. Use of fragrance at home and purchase of new furniture during the past 1 year were associated with current wheeze, current physician-diagnosed asthma, and nocturnal cough. CONCLUSION: Exposure to ETS, moving into a new house after birth, and indoor fragrance are risk factors for wheeze and asthma in schoolchildren.

A Study on Weight-Control Experience, Eating Disorder and Nutrient Intake of College Students Attending Web Class via the Internet / 대한지역사회영양학회지

This study was to investigate weight-control experience disorder and nutrient intake of college student attending web class via the internet. The subject were 1200 college students(392 male, 808 female) attending web class concerned with nutrition and weight control. This cross-sectional survey was conducted by self-administered questionnaire and data were analyzed by Students t-test and chi2-test. Nutrient intake collected from 3 day-recalls were analyzed by the Computer Aided Nutritional Analysis Program. Mean height, weight and RBW(relative body weight) of the male college students were 174.7 cm, 68.0 kg and 101.2%, respectively. Mean height, weight and RBW of the female college students were 162.3% cm, 52.7% kg and 95.3% respectively. Among the male college students, low weight were 1.0%, underweight were 12.8%, overweight were 12.5%, obese were 6.9% by RBW standard. Among the female college students, low weight were 5.1%, underweight 30.2%, overweight were 5.2%, obese were 1.5% by RBW standard. Percentages of weight control experience were 21.7% and 67.0% in the male and female college students, respectively. According to RBW, 22.4% of the weight control experience group were low weight or underweight in the female college students but none of weight control experience group were low weight or underweight in the male college students. Percentage of eating disorder were 6.8%(2.8%, male, 8.7% female) in the college students. Among the female college students, most nutrient intakes were significantly lower in the weight-control experienced group compared to the weight-control nonexperienced group. Among the male college students, there was a tendency that the intake of nutrients, except carbohydrate, calcium and vitamin A was higher in the eating disorder group compared to the non-eating disorder group. However, among the female college students, there was a tendency that the intake of nutrients, except calcium and thiamin was lower in the eating disorder group compared to the non-eating disorder group. Therefore, nutrition education via the internet is required for college students to know proper weight loss methods, desirable eating habits and eating disorder problem well.

Nephrogenic Adenoma Arising from the Urinary Bladder: A Case Report

Nephrogenic adenoma is a benign metaplastic lesion of the urinary tract occurring most frequently at the urinary bladder. It is very rare, especially in children. We describe the US, CT and MRI findings of nephrogenic adenoma arising from the urinary bladder in an 8-year-old girl who suffered rupture of the bladder, ure-thra and vagina after a traffic accident and whose condition was complicated by urethral stricture and vesi-coureteral reflux.

CT and MRI Findings in Patients with Hyperglycemic Encephalopathy: Three Cases Report

We describe the distinctive brain CT and MRI findings seen in the putamen of three patients with hyperglycemia. The chief complaint of these patients was either chorea (n=1) or mental change (n=2). They showed hyperglycemia, but physical examination and laboratory data revealed no other abnormalities. In all patients, non-enhanced CT scanning revealed high-attenuated lesions in the unilateral putamen. In two of the three patients, brain MRI performed two days after the onset of symptoms showed an abnormally high signal on T1-weighted images and a low signal on T2-weighted images. One patient had a history of diabetes mellitus, and another had acute myocardiac infarction. The third had no specific history. After the correction of hyperglycemia, the patient's symptoms subsided and diabetes mellitus was diagnosed.

Sonographic Evaluation of Nasal Bone Fractures

PURPOSE: To describe the sonographic findings of nasal bone fracture and evaluate the diagnostic value of sonography (US). MATERIALS AND METHODS: Thirty-six patients with sustained nasal trauma underwent plain radiography, US and CT, and the CT findings were used as the gold standard. The sonographic findings were retrospectively reviewed and compared with those of radiography and CT. Twelve patients underwent follow-up US within 3 months of reduction. RESULTS: Sonographic findings of nasal bone fractures were irregularity (n=7), discontinuity (n=25) and dis-placement with discontinuity (n=28) of the thin smooth echogenic line formed by the ventral cortex of the nasal bone. Sixty-five nasal bone fractures (36 patients) were identified by CT; 60 of these were revealed on US but only 41 by plain radiographs. CT demonstrated unilateral involvement of nasal bone fractures in seven bones and bilateral involvement in 58, while US revealed unilateral involvement in 12 and bilateral involvement in 48. Plain radiographs, unilat-eral involvement in 21 bones and bilateral fractures in 20. Plain radiographs were more limited in detecting the location of nasal bone fractures than was US. On follow-up US in 12 patients, normal alignment without residual abnormality was observed in seven patients, residual cortical irregularities in four, and minimal cortical depression in one. CONCLUSION: The sonographic findings of nasal bone fractures were similar to those of CT in detecting the location and degree of depression or displacement of nasal bone fractures. We believe that US is very useful for the evaluation of such fractures, especially in cases in which plain radiographs reveal equivocal abnormality, or postreduction status is uncertain.

Clinical Evaluation of Continuous Axillary Bracheal Plexus Block / 대한마취과학회지

Instead of previous conventional method, we have evaluated 42 cases of anesthetic effect by means of continuous axillary bracheal plexus block performed in Nationl Medical Center from May, 1984 to Oct. 1985. Although this method has been no longer new in western countries since several years ago, our effort to increase the success rate, durations and postoperative controls of pain and spasm solely by the method, were tried. Mainly using a 23 gauge, 3cm radio opaque reflon coated intravenous cather(HAKKO SHOJI CO, LTD, Dwell cath. type 3) inserted it into the axillary sheath, pointing towards the needle which was inserted to the apex of axilla with right angle in advance, about 400 or 500mg each of lidocaine, 1.5% with or without epinephrine, 1:200,000 were injected. This technique used was safe and had a high successful rate. It is particularly useful in patients undergoing long operation and in patients in whom postoperative vasodilatation would be needed after microreplantation of the hands.

Trends of Anesthetic Management in 22 Years / 대한마취과학회지

To evaluate the historical trend of anesthetic experience for the past 22 years a total of 68,473 cases which were performed at the National Medical Center from 1959 to 1981 were studied. To simplify the analysis statistically, the author selected the anesthetic cases every other year(12 years). 1) General anesthesia was performed in more than 78% of the total cases and of this number endotracheal intubation has been used with increasing frequency(average 92.8%). 2) For intravenous induction, thiopental sodium was used as the main agent, in more than 90% since 1980. 3) Trichlorethylene, cyclopropane and ethylchloride which had been used since 1961, were abandoned from 1978 except for training purposes. Methoxyflurane was used from 1973 to 1979, but given up there after because of it's nephrotoxicity. The use of halothane has steadily increased(86% of the total inhalation anesthetics) and ethrane has also been used with increasing frequency since 1980. 4) Pancuronium has been used as a primary muscle relaxant instead of gallamine and D-tubocurarine which had been used as the main durgs from 1959 till 1979. 5) Innovar and morphine as intravenous anesthetics, have recently been with increasing grequency.