Mycoplasma pneumoniae Infection Affects the Serum Levels of Vascular Endothelial Growth Factor and Interleukin-5 in Atopic Children

PURPOSE: Previous studies have outlined mechanisms by which Mycoplasma pneumonia (M. pneumonia) infection may promote allergic lung inflammation and airway remodeling, and increasing evidence from human studies suggests that atypical bacterial infections contribute to asthma exacerbation, chronic asthma, and disease severity with changes in cytokine expression. The present study evaluated changes in serum levels of vascular endothelial growth factor (VEGF) and interleukin (IL)-5 in atopic children with Mycoplasma pneumoniae pneumonia. METHODS: We recruited a total of 72 children with pneumonia. The patients were divided into 4 groups: atopic children with M. pneumonia pneumonia (group I, n=24), non-atopic children with M. pneumonia pneumonia (group II, n=23), atopic children with viral pneumonia (group III, n=13), and non-atopic children with viral pneumonia (group IV, n=12). Serum levels of IL-5, IL-13, VEGF, and tumor necrosis factor-alpha were measured at admission and at recovery using enzyme-linked immunosorbent assays. RESULTS: Serum levels of VEGF and IL-5 were elevated in group I compared with the other groups at both admission phase and clinical recovery phase. In group I, serum levels of VEGF and IL-5 were higher at recovery phase than at admission phase (VEGF: 1,102.2+/-569.4 vs. 874.9+/-589.9 pg/mL, respectively; IL-5: 150.5+/-63.9 vs. 120.2+/-46.7 pg/mL, respectively). CONCLUSIONS: The serum levels of VEGF and IL-5 were more increased in atopic children with M. pneumonia pneumonia than in the other groups. In this group, the serum levels of VEGF and IL-5 were more increased at recovery phase than at admission phase. The results of this study suggest that increases in VEGF and IL-5 may contribute to the development of hypersensitivity during M. pneumonia infection. These cytokines may act through their respective pro-inflammatory pathways to aggravate the allergic status and induce airway hypersensitivity during M. pneumonia pneumonia in atopic children.

New clinical score for disease activity at diagnosis in Langerhans cell histiocytosis

BACKGROUND: The clinical presentation and course of Langerhans cell histiocytosis (LCH) are variable, ranging from an isolated, spontaneously remitting bone lesion to multisystem disease with risk organ involvement. Treatment of LCH ranges from a wait-and-see attitude to intensive multidrug therapy and, in some cases, bone marrow transplantation. It is necessary to develop an objective score for assessing disease activity in patients with LCH. We propose a new clinical scoring system to evaluate disease activity at diagnosis that can predict the clinical outcomes of LCH and correlate it with clinical courses. METHODS: Clinical data, obtained from children diagnosed with LCH at Asan Medical Center and Hanyang University Hospital between March 1998 and February 2009, were studied retrospectively. The scoring system was developed according to the basic biological data, radiological findings, and physical findings and applied to a database containing information on 133 patients. RESULTS: The median age of the 133 patients (74 male, 59 female) was 52 months (range, 0.6-178 months), and LCH was diagnosed based on CD1a positivity. At diagnosis, the score distributions were highly asymmetrical: the score was between 1 and 2 in 75.9% of cases, 3-6 in 15.8%, and greater than 6 in 8.3%. Initial scores above 6 were highly predictive of reactivation and late complications. CONCLUSION: This new LCH disease activity score provides an objective tool for assessing disease severity, both at diagnosis and during follow-up.

The Environmental and Educational Management Effects of Atopic Dermatitis in a Seoul Elementary School / 소아알레르기및호흡기학회지

PURPOSE: This study was conducted to address a school-based program to properly manage atopic dermatitis in school children. METHODS: A modified Korean version of written questionnaires from the International Study of Asthma and Allergies in Childhood was completed by the parents of 125 first-grade children. Skin prick tests (SPTs) for nine common inhalants and food allergens were performed. Air cleaners, HEPA vacuum cleaners, wet blackboards, and wet towels were used to clean the floor in the classroom. Students and their parents participated in school-based educational programs about atopic dermatitis. A follow-up questionnaire and SPTs were performed at 6 months after improving the classroom conditions. Indoor air quality was measured at the 3 months interval in July and September of the same year after the school-based program. RESULTS: The prevalence of "itchy eczema ever" and a "diagnosis of atopic dermatitis, within the last 12 months" was 26.4% and 12.0%, respectively. Eleven students (34.4%) showed positive results among 32 students who were examined with SPTs. All children who showed positive results were sensitized with house dust mites. After the environmental change, the prevalence of "itchy eczema within the last 6 months" and "diagnosis of atopic dermatitis within the last 6 months" was 14.7% and 7.8%, respectively. Skin reactivity assessed by mean wheal diameter decreased. Measured indoor air quality values improved in all classrooms by September. CONCLUSION: School-based environmental changes and educational programs including a partnership among home, school, society, and the public health care center could be applied to better manage atopic dermatitis in school children.

CT and MR Imaging Findings of Subdural Dermoid Cyst Extending into the Right Foramen Ovale: A Case Report

Intracranial dermoid cyst is a rare congenital benign disease, representing less than 0.5% of primary brain tumors. Nevertheless, if ruptured spontaneously or during surgery, it has a poor prognosis due to chemical meningitis. Therefore, it is essential to perform accurate diagnosis and proper treatment. We report an intracranial subdural dermoid cyst that may be misdiagnosed as extracranial or epidural lesion because of extension into the right foramen ovale, and describe the CT and MR imaging findings.