Usefulness of a Alvarado Scoring System for the Diagnosis of Acute Appendicitis in Children / 대한소아소화기영양학회지

PURPOSE: Alvarado scoring system was evaluated regarding its usefulness for the early diagnosis of acute appendicitis in adult and in reduction of the incidence of negative appendicectomies. To evaluate the accuracy of diagnosing appendicitis using the Alvarado score in children. METHODS: Prospectively, we surveyed 122 patients (male 67, female 55) suffering from abdominal pain, who had visited to the emergency department of Chosun University Hospital from June 2002 to May 2003. The Alvarado score has been computed from the white blood cell count, neutrophil count, body temperature, resistance in the right lower quadrant, length of symptoms, nausea and vomiting. Each patient was evaluated by a pediatric resident and then by a general surgeon independently. RESULTS: Out of 170 total children who visited to the emergency department due to abdominal pain, 122 patients were associated with appendicitis. A total of 122 patients (67 male and 55 female) were visited to the emergency room with suspected appendicitis. From 105 operated patients, 92 (87.6%) were diagnosed acute appendicitis and erronous diagnostic rate was 12.4%, pathologically. Mean alvarado score of appendicitis group was 5.40+/-1.24 whereas those of non-appendicitis group was 3.73+/-1.82 (p<0.05). From 6 Alvarado score high sensitivity (86.4%) and high specificity (80.0%) were observed. Sensitivity of ultrasonography or computed tomography was 92.5%. CONCLUSION: We found that Alvarado score system is a noninvasive, safe diagnostic method, which is simple, reliable and repeatable. Alvarado score is useful system for a first, rapid and economic evaluation for the appendicitis in children.

Pulmonary Hemorrhage with Hemoptysis in Systemic Lupus Erythematosis / 소아알레르기및호흡기학회지

Pulmonary hemorrhage is a rare, but serious manifestation of systemic lupus erythematosus (SLE). In this report we describe a 13-year-old girl with pulmonary hemorrhage as the sole presenting clinical manifestation of SLE. Asymptomatic pulmonary lupus needs no treatment; however, pulmonary involvement in lupus may be life threatening, in which case prompt and aggressive treatment is mandatory. The different aspects of pulmonary lupus are demonstrated through the clinical histories of patients who suffered from pleuro-pulmonary lupus. Early diagnosis of acute pulmonary complications in systemic lupus erythematosus patients is essential to improve the chances of recovery.

A Case of Congenital Chloride Diarrhea in Premature Infant

Congenital chloride diarrhea is a serious autosomal recessive disease, and defect of intestinal electrolyte absorption that involves, specifically, Cl-/HCO3- exchange in the distal part of the ileum and colon. The clinical feature is dominated by profuse, watery diarrhea containing high concentrations of chloride(> 90 mmol/L) and sodium. The chloride loss results in severe dehydration with a hypochloremic alkalosis. The molecular pathology involves an epithelial Cl - /HCO3 - exchanger protein. Mucosal ion transport is affected to differing degrees and the severity of the disease may thus vary. Recently, a gene defect on chromosome 7 has been identified. However, there was a deficit in replacement of fluid and electrolyte, abdominal distension remained and the character of stools was watery. We report a case of congenital chloride diarrhea in a premature female who presented with watery diarrhea containing high concentrations of chloride and abdominal distension.

Relationship between Admission and Clinical Features of Children who visited the Emergency Department with Seizures

PURPOSE: To review the seizure-related complaints and analyze the relationship between admission rates and clinical features in children who had visited the emergency department with seizures. METHODS: Retrospectively, we reviewed 180 patients(male 100, female 80) suffering from seizures, who had visited to the emergency department of Chosun University Hospital from January 2000 to June 2002. We have analyzed the correlation between admission rate and clinical features such as age, seizure type, seizure duration and individual laboratory findings(CT or MRI, and CSF). RESULTS: Out of 4,865 total children who visited the emergency department, 180 patients(3.7%) were seizure related. The most common seizure type was simple febrile seizure(52.2%). The admission rate of children with seizures was 48.9%. The admission rate according to age, sex and abnormal laboratory findings revealed no significant correlations(P>0.05). There was a significant correlation between admission and both status epilepticus 82.4%(14/17) and complex febrile seizure 63.6%(14/22) (P<0.05). According to the duration of convulsions, admission rates were 41.2% when within five minutes, 60% when six-15 minutes, 58.8% when 16-30 minutes, 85.7% when 30 minutes, to one hour and 66.7% when above one hour of duration. According to the seizure frequency, admission rates of recurrent seizure patients(61.4%=43/70) was higher compared to the first time seizure patients(40.9%=45/110). CONCLUSION: We found that the admission rate of children visiting the emergency department for seizure treatment was 48.9% and significantly correlated with duration, type and frequency of seizure.

A Case of Cerebral Tuberculoma who has been Suffered from Recurrent Idiopathic Pleural Effusion / 대한소아신경학회지

Central nervous system(CNS) involvement by tuberculosis is uncommon in comparison to the involvement of other systems. Untreated tuberculous meningitis is characterized by progressive stupor and a fatal outcome within 4 to 8 weeks of the onset of symptoms. So rapid detection of Mycobacterium tuberculosis is of vital importance for these patients. In almost all patients with tuberculous meningitis, acid-fast bacteria are undetectable in the CSF. Culture techniques that permit the identification of the isolated mycobacterial species require several weeks. We report a case of tuberculous meningitis with intracranial tuberculoma in 8-year old male who experienced pleural effusion, repeatedly. CSF findings did not reveal diagnosis tuberculous meningitis. In MRI study, multiple intracranial tuberculomas were located at the cerebellum. Prolonged treatment with anti- tuberculous chemotherapy and high-dose corticosteroids led to complete recovery.