Clinical Characteristics of Pandemic Influenza A (H1N1) 2009 Pediatric Infection in Busan and Gyeongsangnam-do: One Institution / 결핵및호흡기질환

BACKGROUND: This study investigated the clinical characteristics and risk factors of the severity of pandemic influenza A (H1N1) 2009 infection in pediatric patients in Busan and Gyeongsangnam-do. METHODS: Cases of influenza A (H1N1) 2009 in patients under the age of 18 years, confirmed by reverse transcription polymerase chain reaction, at Pusan National University Hospital and Pusan National University Yangsan Hospital from the last week of August 2009 through the last week of February 2010 were retrospectively analyzed. RESULTS: Of the 3,777 confirmed cases of influenza A (H1N1) 2009, 2,200 (58.2%) were male and 1,577 (41.8%) were female. The average age of the patients was 8.4+/-4.8 years. The total cases peaked during 44th to 46th week. Most of the patients were in the 5- to 9-year-old age group. Oseltamivir was administered to 2,959 (78.3%) of the patients. 221 patients (5.9%) were hospitalized, age an average of 6.7+/-4.5 years. The average duration of hospitalization was 7.4+/-5.6 days. One hundred cases (45.2%) had pneumonia. Risk factors for hospitalization included male gender, <2 years of age, and underlying disease. Children with asthma were at very high risk of hospitalization, over 20 times the non-asthmatic children (odds ratio [OR], 21.684; confidence interval [CI], 13.295~39.791). Likewise the children with neurologic deficits faced a 16 times higher risk (OR, 15.738; CI, 7.961~31.111). Ten of the patients (4.5%) were admitted to the intensive care unit, and eight (3.6%) required mechanical ventilation. CONCLUSION: Of the pediatric patients with pandemic influenza A (H1N1) 2009, most of the patients were in the 5- to 9-year-old age group. Risk factors for hospitalization included male gender, <2 years of age, and underlying disease. The most common complication was pneumonia. The very high risk of severe morbidity in children with asthma or neurologic disease shows the critical importance of targeted vaccine coverage, special awareness and swift care by both guardians and primary care providers.

A case of paraneoplastic limbic encephalitis due to ovarian mature teratoma / 소아과

Paraneoplastic limbic encephalitis, a remote effect of cancer without nervous system metastasis, is rare, especially in childhood. Here, we report a case of paraneoplastic limbic encephalitis associated with an ovarian mature teratoma in an adolescent girl. The 15-year-old girl developed neuropsychiatric symptoms, memory loss, seizures, and unconsciousness. Cerebrospinal fluid analysis and brain magnetic resonance imaging (MRI) findings were normal, while single photon emission computed tomography imaging showed hypoperfusion in both temporal lobes. Ultrasound and MRI of the abdomen revealed a left ovarian cystic mass. The patient experienced a significant recovery of cognitive function after surgical resection of the tumor, which was pathologically identified as a mature ovarian teratoma, and treatment with intravenous immunoglobulin.

The Role of an Upper Gastrointestinal Endoscopy in the Diagnosis of Congenital Hypertrophic Pyloric Stenosis / 대한소화기내시경학회지

BACKGROUND/AIMS: In 1977, Teele and Smith reported their positive experience using an ultrasonographic in the evaluation of Congenital Hypertrophic Pyloric Stenosis (CHPS). Since that time, ultrasonography has been advocated by some as the diagnostic procedure of choice, although a number of false-negative cases have been encountered at any rate, in 1994, Becker reported that an endoscopy was far more accurate than an ultrasonography, the diagnosis being made in 97% and 81% of the cases. Therefore, we performed a prospective study to evaluate the diagnostic value of an upper gastrointestinal endoscopy in CHPS patients. METHODS: We reviewed the clinical records of 12 pediatric patients experiencing vomiting, who had visited Pusan National University Hospital from January 1993 to March 1997. We performed on upper gastrointestinal endoscopy and abdominal ultrasonography simultaneously in order to evaluate the diagnostic value of an upper gastrointestinal endoscopy in CHPS patients. RESULTS: The male to female ratio was 11: 1. In 7 of 12 patients, 58%, vomited within 4 weeks after birth. Diagnostic sensitivity by abdominal ultrasonography was about 75%, and by upper GI endoscopy, almost 100%. Associated lesions were discovered in 5 cases, 3 esophagitis and 2 gastritis in the upper GI endoscopy. CONCLUSIONS: The upper GI endoscopy was more accurate in the diagnosis of CHPS than the ultrasonography, and was more effective in the diagnosis of associated lesions.