Clinical Analysis of Pediatric Death in Emergency Room

PURPOSE: Sudden, unexpected pediatric death triggers acute grief in most survivors. In this study, we analyzed the pediatric death in emergency room in order to find out the factors for minimized unexpected pediatric death and increase awareness of these conditions. METHODS: We performed a review on the records of 63 patients under the age of 16 years who died before and after admission to the emergency room of Yeungnam University Hospital during a 5 year period from January 1996 to December 2000. RESULTS: Among the total of 63 patients who died, 33 were male(52.4%) and 30 were female (47.6%). The most prevalent age group was between 1 month and 1 year of age(38%). We classified 3 categories by the direct cause of death, disease 21 cases(33%), accident 19 cases(30%), unknown 23 cases(37%) respectively. Among 23 cases of unknown cause of death, 13 cases(56.5 %) had been placed under medical attention for underlying diseases : these were 7 cases of neurologic disorder(30.4%) 5 cases of congenital heart disease 5 cases(21.7%) and 1 case of metabolic disease(4.4%). The most common types of accident were traffic accident(10 cases; 52.6%) and the next were drowning(4 cases; 21%), asphyxia(3 cases; 15.8%). CONCLUSION: In unexpected pediatric death, among unknown causes of death, the number of patients who had an underlying disease was greater than these patients who did not. We conclude, more attention needs to be paid to underlying disease, especially congenital heart disease and neurologic disease. A parents teaching program is necessary emergency for situations. This would decrease cases of unexpected pediatric death.

The Changes of Production of RANTES and Gro-alpha in Kawasaki Disease

PURPOSE: Kawasaki disease is probably driven by abnormalities of the immune system after infectious insult. In this report, a clinical review with laboratory parameters and the changes of the plasma levels of chemokines(RANTES and Gro-alpha was undertaken according to the clinical stage of Kawasaki disease. METHODS: This investigation included 74 samples from 21 patients(10 boys, 11 girls; mean age, 27.8 months) with Kawasaki disease who met the revised diagnostic guidelines and 5 samples from healthy children. The plasma levels of RANTES and Gro-alpha were measured by enzyme- linked immuno-sorbent assay(ELISA). To analyze the pattern of the gene expression of chemokine mRNA for lymphotactin(Ltn), RANTES, IP-10, MIP-1 beta, MIP-1 alpha MCP-1, IL-8 and I-309 in the peripheral blood monocyte, ribonuclease protection assays(RPA) were performed in 3 patients whose plasma levels of RANTES were very low and not significantly changed after intravenous immunoglobulin(IVIG) treatment. RESULTS: The production of RANTES and Gro-alpha were markedly elevated during the acute and subacute phases of Kawasaki disease compared to those of the normal control. In addition, interestingly, the changing patterns of plasma level of chemokines were not consistent(biphasic) after IVIG treatment. According to the RPA, the expression of RANTES was the most prominent among 8 kinds of chemokines and elevated in all phases of Kawasaki disease. But, there was no ovious relation between clinical characteristics of the disease including the coronary artery dilatation and the level of RANTES. CONCLUSION: These finding suggested that RANTES and Gro-alpha may play an important role in pathophysiology of the Kawasaki disease. Longer follow-up and more case studies will be needed to clearly establish the significance of the changes of RANTES and Gro-alpha in the pathophysiology of Kawasaki disease.

Foreign Body in the Gastrointestinal Tract in Children / 영남의대학술지

BACKGROUND: The accidental swallowing of foreign body is a common problem in the children. Ingested foreign bodies may be managed by endoscopy, observation, or surgery. So we analyzed the methods of removal, type, location and complications of foreign bodies. MATERIALS AND METHODS: This report reviewed 37 cases of ingested foreign body in the gastrointestinal tract at the Department of Pediatrics, Yeungnam University Hospital between January 1997 and April 2001. RESULTS: The age ranged from 8 months to 8 years. The most prevalent age group was between 1 year and 2 years of age(19%). The male to female ratio was 2.1:1 with 25 male and 12 female patients. The type of foreign bodies were coins in 20 cases(54%), nail in 4 cases(11%), key in 4 cases(11%), pin in 2 cases(5.5%), necklace in 2 cases(5.5%) and others. The locations of foreign bodies were upper esophagus in 12 cases(32.5%), lower esophagus in 4 cases(10.8%), stomach in 16 cases(43.2%), small bowel in 5 cases(13.5%). 4. Presenting symptoms were variable with asymptomatic (59. 4%) , vomiting (19. 0%) , epigastric pain (8.1%), dysphagia (5. 4%) and others. The methods for removal of foreign bodies included 20 cases of endoscopic removal(54.0%), 3 cases of spontaneous removal(8.1%) and there was no surgical removal. 14 cases(37.9%) did not confirmed removal of foreign body because of no revisit of our hospital. Endoscopic finding of patients were normal(15 cases), ulceration(2 cases), erosion(1 case), inflammation(l case), mucosal scratch(l case). CONCLUSION: It appears that the endoscopic approach is the preferable method for the removal of upper gastrointestinal foreign bodies in the children.