Hypernatremia and Intraventricular Hemorrhage in Very Low Birth Weight Infants (<1,250 g)

PURPOSE: Hypernatremia most frequently occurs in the immature newborn and be severe in association with intraventricular hemorrhage (IVH). This study examined the frequency, onset and risk factors of hypernatremia, and the relationship between hypernatremia and IVH in very low birth weight (VLBW; or =150 mEq/L) and nonhypernatremia group, and were compared. RESULTS: Incidence of hypernatremia in the VLBW infants was 52.7%, and mean starting time of hypernatremia was 2.8+/-1.3 days. There were no differences in the sodium and fluid intake between the two groups. Weight loss at day 3 after birth was significantly higher in the hypernatremia compared to the nonhypernatremia group (P<0.05); thereafter weight loss was non-significantly higher. The incidence of IVH in VLBW infants was 38.2%, and the difference between the two groups was not significant. CONCLUSION: Hypernatremia occurs commonly in VLBW infants and is most commonly caused by weight loss in the early days after birth. Incidence of IVH is not likely influenced by hypernatremia with marginally elevated sodium concentration.

Retroperitoneoscopic Nephrectomy for a Horseshoe Kidney with Unilateral Severe Hydronephrosis and Ureteral Hypoplasia

A horseshoe kidney is the most common renal fusion anomaly. It is well known that horseshoe kidneys may be associated with many urological problems, including calculi, vesicoureteral reflux, and ureteropelvic junction obstruction. However, a horseshoe kidney with unilateral severe hydronephrosis and ureteral hypoplasia is very rare. We report an 11-year-old female who underwent a retroperitoneoscopic nephrectomy for a horseshoe kidney with severe hydronephrosis and unilateral ureteral hypoplasia.

Retroperitoneoscopic Nephrectomy for a Horseshoe Kidney with Unilateral Severe Hydronephrosis and Ureteral Hypoplasia

A horseshoe kidney is the most common renal fusion anomaly. It is well known that horseshoe kidneys may be associated with many urological problems, including calculi, vesicoureteral reflux, and ureteropelvic junction obstruction. However, a horseshoe kidney with unilateral severe hydronephrosis and ureteral hypoplasia is very rare. We report an 11-year-old female who underwent a retroperitoneoscopic nephrectomy for a horseshoe kidney with severe hydronephrosis and unilateral ureteral hypoplasia.

Reticulocyte hemoglobin content for the diagnosis of iron deficiency in young children with acute infection / 소아과

PURPOSE: Early identification of iron deficiency in young children is essential to prevent damaging long-term consequences. It is often difficult for the pediatrician to know which indices should be used when diagnosing these conditions especially in hospitalized young children. This study investigated the clinical significances of reticulocyte hemoglobin content in young children with acute infection. METHODS: We studied 69 young children aged from 6 to 24 months admitted with acute infection in a single center. Venous blood was drawn to determine hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), hemoglobin content (CH), reticulocyte hemoglobin content (CHr), and red blood cell distribution width (RDW) using ADVIA 120 (Bayer Diagnostics, NY, USA). For evaluating iron status, iron, total iron binding capacity, ferritin and transferrin saturation (Tfsat) were determined. Iron deficiency was defined as Tfsat less than 20%, and iron deficiency anemia as Tfsat less than 20% and Hb level less than 11 g/dL. RESULTS: In all, 47 were iron deficient; 17 of these had iron deficiency anemia. CHr was the only significant predictor of iron deficiency (likelihood ratio test=71.25; odds ratio=0.67; P<0.05). Plasma ferritin level had no predictive value (P=0.519). Subjects with CHr less than 27.4 pg had lower Hb level, MCH, CH, Tfsat, and iron levels than those with CHr 27.4 pg or more (P<0.05 for all). CONCLUSION: CHr level was a sensitive screening tool and the strongest predictor of iron deficiency in hospitalized infants with acute infection; it was cost saving and avoiding additional sampling. However its reference range should be established.

Clinical characteristics of Epstein-Barr virus infection detected by polymerase chain reaction in children less than 15 years old / 소아과

PURPOSE: Previously, Epstein-Barr virus (EBV) infection was diagnosed by serological examination; currently, many EBV antigen detection methods have been developed and applied clinically for diagnosing EBV infection. To delineate the clinical characteristics of EBV infection, clinical and laboratory findings were evaluated for patients who tested positive in EBV polymerase chain reaction (PCR). METHODS: EBV PCR was conducted in 352 patients admitted to the pediatric ward from January 2004 to December 2006, with more than 2 clinical signs such as fever (> or =37.5degrees C), exudative throat infection, lymphadenopathy, hepatitis of unknown etiology, and splenomegaly. The EBV viral gene was detected by PCR in 115 patients (32%), and the clinical characteristics of these patients were evaluated. Laboratory findings such as leukocytosis, thrombocytopenia, atypical lymphocyte, and alteration in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in peripheral blood were examined. The EBV-specific immunoglobulin M antibody (EBV-IgM Ab) was also tested. RESULTS: Most of the children were younger than 8 years (89%), and the male to female ratio was 1.3:1. Exudative throat infection and fever (> or =37.5degrees C) were observed in all patients. Cervical lymph node enlargement was seen in 36 patients (31%); leukocytosis (WBC> or =10,000/mm3), in 54 patients (47%); and atypical lymphocyte (> or =20%), in 28 patients (24%). EBV-IgM Ab was positive in 33 patients (29%). The younger patients had higher ALT levels and higher incidence of positive EBV-IgM Ab than the older patients. CONCLUSION: The cumulative number of patients diagnosed to have EBV infection by PCR increased markedly for those under 8 years. ALT was higher and EBV-IgM Ab was detected more in younger patients with EBV infection.

Platelet count and mean platelet volume in low birth weight infants (< or =2,000 g) with sepsis / 소아과

PURPOSE: Sepsis is a common complication in Neonatal Intensive Care Units (NICU), seen especially in low birth weight (LBW) infants. A recent study showed that fungal or gram-negative sepsis is associated with a greater degree of thrombocytopenia than is seen with gram-positive sepsis. So, this study was undertaken to examine the platelet counts and platelet indices in LBW infants during episodes of sepsis. METHODS: We analyzed 36 cases with culture-proven sepsis on chart review in LBW infants admitted to the NICU at Wonkwang University Hospital from January 2001 to June 2006. RESULTS: Patients were grouped by organism type: gram-positive bacteria (1,521+/-309 g, 31.3+/-2.9 wk, 15/36), gram-negative bacteria (1,467+/-290 g, 30.6+/-3.6 wk, 17/36), and fungi (1,287+/-205 g, 30.0+/-3.9 wk, 4/36). The most common organism was Staphylococcus epidermis and the incidence of thrombocytopenia was 88.9%. When compared with infants with gram-positive sepsis, those with gram- negative sepsis had significantly higher incidences of thrombocytopenia, lower initial platelet count, lower platelet nadir, and greater mean percentage decrease in platelet count from before the onset of sepsis. Those with fungal infections were similar to gram-negative sepsis, but they were not significant because of the small number of patients. And mean platelet volume (MPV) in sepsis was increased more significantly in time of platelet nadir than before the onset of sepsis. CONCLUSION: We conclude that decrease in platelet count was significantly greater in gram-negative sepsis than gram-positive sepsis, and also greater than fungal sepsis-which was insignificant because of the small number of patients-in LBW infants. And elevation in MPV will be helpful in the diagnosis and treatment of sepsis in LBW infants.

A Case of Suspected Fumarase Deficiency Presenting with Persistent Mild Metabolic Acidosis in Newborn Infant / 대한소아신경학회지

Fumaric aciduria(fumarase deficiency) is a rare inborn error of metabolism resulted from a deficiency of fumarase, one of the constituent enzymes of the Krebs tricarboxylic acid cycle. Enzyme deficiency causes excessive urinary excretion of fumaric acid due to a defective conversion of fumaric acid to malic acid. It usually presents early in infancy with a severe encephalopathy including hypotonia, developmental retardation and frequent seizures. We report a case of suspected fumarase deficiency presenting with persistent mild metabolic acidosis associated with moderate hydrocephalus in a newborn infant.

Clinical Investigation of Benign Afebrile Seizure with Gastroenteritis / 대한소아신경학회지

PURPOSE: The aim of this study is to characterize detailed clinical features of benign afebrile seizure with gastroenteritis. METHODS: We retrospectively investigated the medical records of 52 patients with benign afebrile seizure and gastroenteritis, who were admitted to the Department of Pediatrics Eulji University Hospital, between February 1996 and January 2005. RESULTS: There were 52 patients with benign afebrile seizure and gastroenteritis:18 boys and 34 girls. Most of the patients(86.5%) were from 12 to 23 months of age. In the monthly distribution, 71.1% were admitted between November and March. Most of the seizures(98.0%) were generalized and 53.9% of those were generalized tonic and clonic. The durations of the seizures were mostly within 5 minutes. 40 patients(76.9%) had 2 or more seizures. The interval between the onset of gastroenteritis and seizures was mostly from 2 to 4 days. Fifteen out of 32 patients were rotazyme positive. Chi-square test was performed to identify if there was any association between rotavirus and afebrile seizure. Rotavirus gastroenteritis has a stastically significant association with afebrile seizure compared to non-rotavirus gastroenteritis(P<0.01). The relative risk between rotavirus and non-rotavirus gastroenteritis was 3.35. However, there were no significant differences in clinical features between two groups. Cerebrospinal fluid was normal and cell counts, glucose and protein levels in all the patients examined. Either brain CT or MRI was performed in 9 patients and demonstrated no neuroradiological abnormalities. Electroencephalography was performed in 47 patients, of whom 43 patients(92.3%) showed normal electroencephalographic patterns. CONCLUSION: Benign afebrile seizure is characterized by the onset age between 12 months and 23 months, multiple episodes of seizure, short duration, generalized type, high incidence between November and March, and rotavirus as a major pathogen.

Clinical Studies of Sinus Headache in Children / 소아과

PURPOSE: Headache is a common reason for children to seek medical care. There are many causes of headaches in children, such as migraine and its variants, tension, intracranial masses, and sinusitis. A high frequency of diagnosis of sinus headache, which specialists consider to be relatively rare, raises the possibility that migraine and other headache types are sometimes mistaken for sinus headache. This report studied the clinical characteristics of sinus headache in the pediatric population. METHODS: We analyzed the clinical manifestations of 25 patients who had sinusitis in 97 children whose chief complain was headache. The clinical manifestation involved location, type, frequency and associated symptoms of headache, frequency of upper respiratory tract infection(URI), and family history of migraine. RESULTS: There were eight cases of organic headaches, which were two cases of brain tumor, two cases of arachnoid cyst, one case of Moyamoya disease, one case of brain abscess and two cases of eye problems. The mean age of patients who had sinus headaches was 8.2 years. The most common age group was between 6 and 11 years(76%). The most common location of sinus headache was the frontal area in 10 cases(40%). And the most common pattern of headache was dull and steady pain in 16 cases(64%). The most common associate symptom of headache were gastrointestinal symptoms such as nausea, vomiting and abdominal pain in 13 cases(52%). There were 13(52%) of patients who had no history of frequent URI. There were also seven(28%) patients who had a family history of migraines. CONCLUSION: Considered in aggregate, the data show that the occurrence of sinus inflammation associated with a headache should neither trigger a diagnosis of sinus disease nor exclude a diagnosis of migraine. It should prompt diagnostic consideration of both conditions.

Clinical Studies of Aseptic Meningitis in Daejeon Area between 2000 and 2003 / 대한소아신경학회지

PURPOSE: Since 1990, several epidemics of aseptic meningitis have been reported in Korea. We report 327 children with aseptic meningitis in Daejeon for 4 years from 2000 to 2003. And the clinical features and laboratory data were compared between the positive enterovirus PCR group and the negative enterovirus PCR group. METHODS: We reviewed the clinical records of 327 aseptic meningitis children who were admitted to the Department of Pediatrics of Eulji University Hospital from 2000 to 2003. We described their age, sex, annual and monthly incidence rates, clinical manifestations and laboratory data. Reverse transcription-polymerase chain reaction(RT-PCR) method was used to identify enterovirus RNA in the cerebrospinal fluid. RESULTS: The male to female ratio was 2 : 1 and most of them were 5 to 9 years old. Meningitis occurred mostly from May to July. In the positive PCR group, a peak incidence was noticed in July with most of the cases from May to September. The patients showed symptoms of fever, vomiting, and headache with a wide range of WBC counts from 3,520 to 32,330(mean 9,470)/mm3 and relatively normal ranges of ESR and CRP. In the cerebrospinal fluids, leukocytes were in a range of 5-5,400(mean 270)/mm3, proteins 11-180 (mean 37.7) mg/dL and glucose 22-95(mean 55.86) mg/dL. The examination of the cerebrospinal fluids with RT-PCR for enterovirus showed positive in 103 out of 204 patients. There were not any statistically significant differences in the clinical features between the positive result group and the negative result group. However, the proportion of polymorphonuclear leukocytes in the peripheral blood and the leukocyte counts in the cerebrospinal fluids were higher in the positive result group. CONCLUSION: Aseptic meningitis was prevalent in Daejeon between 2001 and 2002. The clinical manifestations and the laboratory findings of the patients were compatible with those of previous reports. There were no statistically significant differences in the clinical features and the laboratory data between the positive enterovirus PCR group and the negative enterovirus PCR group except the proportion of polymorphonuclear leukocytes in the peripheral blood and the leukocyte counts in the cerebrospinal fluids.

Epidemiology and Clinical Characteristics of Childhood Acute Lymphoblastic Leukemia in Korea / 대한소아혈액종양학회지

PURPOSE: Acute lymphoblastic leukemia (ALL) accounts for approximately 75% of all cases of childhood leukemia. We investigated epidemiology, clinical and laboratory features and treatment outcome of the children with ALL in Korea during recent 5 years. METHODS: One thousand forty nine patients were enrolled between January 1994 and December 1998 from 37 major hospitals in Korea. The data regarding the clinical and laboratory features including age, WBC counts at diagnosis, immunophenotype, morphology, cytogenetics and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed. The differences between groups analyzed by log-rank test. RESULTS: There were 597 males and 452 females. The distribution between the age 2 and 5 years is most common in 46.1%. The annual incidence rate per 100,000 population varied from 1.6 to 2.2. The 5 year event free survival (EFS) rates according to good prognostic factors were as follows: 67% bet ween 1-9 year of age at diagnosis, 69% in under 10,000/mm3of initial WBC count, 74% in early pre-B cell CALLA ( ) immunophenotype, 65% in L3 morphology, 68% in no CNS invasion. Most of patients were treated by CCG treatment protocol. The 5 year EFS was 63%. Main complications were sepsis (21.8%) and hemorrhage (12.5%). The relapse rate was 15.6%. The common causes of death were sepsis, DIC, pneumonia, relapse. CONCLUSION: Our results could provide the most recent and important information about acute lymphoblastic leukemia of children in Korea.

Usefulness of Voice Handicap Index in Patients with Hoarseness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Voice Handicap Index (VHI) was developed to assess patients' perception on the severity of their voice disorders. The purpose of this study was to determine the severity of handicap expressed by patients with various voice disorders, and to help clinicians in making future treatment plan. VHI may also be used as a guideline in making diagnosis according to different factors of voice quality. SUBJECTS AND METHOD: The people who had visited the Asan Medical Center with hoarseness from August 2000 to August 2001 were studied. They filled out the questionnaire composed of 30 questions about their voice disorders. The subjects were consisted of 6 groups; 50 patients with vocal cord nodule, 43 patients with laryngitis, 42 patients with vocal cord polyp, 25 patients with glottic cancer and 14 patients with unilateral vocal cord paralysis. Descriptive statistics were used to analyze the data and mean value of VHI scores. RESULTS: The mean score of VHI was found to be statistically higher in the subjects with the history of voice abuse (p<0.002). Overall, the group with unilateral vocal cord paralysis showed the highest VHI score that was statistically significant (p<0.001). When the functional factor is considered, groups with unilateral vocal cord paralysis and glottic cancer had shown higher scores compared to the other groups. When the physical factor is considered, groups with unilateral vocal cord paralysis and vocal cord polyp had shown higher scores. When the emotional factor is considered, groups with unilateral vocal cord paralysis had shown higher scores. CONCLUSION: Measurement of VHI in patients with voice disorders provides a measure of self-perception on the severity of the problems that cannot be assessed through visual perception or objective acoustic and aerodynamic measures. In addition, the measurement of VHI score was easy to perform, non-invasive, and inexpensive. In using this method, we expect to reveal the efficacy of the treatment for voice disorders.

Clinical Study of Sarcomas in Head and Neck / 대한이비인후과학회지

BACKGROUNDS: Head and neck sarcomas constitute a heterogenous group of rare malignant tumors occurring at rare sites. The purpose of this retrospective study is to evaluate the pathologic features, treatment modalities, outcome, patterns of failure, survival, and other prognostic factors. MATERIALS AND METHOD: The medical records of 33 patients whose tumors were diagnosed as head and neck sarcomas and treated at the department of otolaryngology in Asan Medical Center between 1990 to 2001 were reviewed. Potential prognostic factors including age, tumor size, histology, and adjuvant treatment were evlauated. RESULTS: All 33 of histologic classification consist of : rhabdomyosarcoma (10), angiosarcoma (4), spindle cell sarcoma (4), osteosarcoma (3), follicular dendritic cell sarcoma (2), synovial sarcoma (2), chondrosarcoma (2), malignant fibrous histiocytoma (2), hemangiopericytoma (1), leiomyosarcoma (1), unclassified (2). The ratio of male to female was 1.2 : 1 (19 : 14). The median age was 42 years (range 4-78 years). The mean follow-up period was 24.7 months. At 3 years, the disease-specific survival rates for patients with rhabdomyosarcoma were 100% and patients with other types of sarcoma had 78.0% mean survival. Twenty-three patients (70%) had undergone surgical approach with adjuvant chemotherapy or radiotherapy. Five patients had undergone surgical treatment only. The univariate analysis showed that tumor size is one of the most important prognostic factors for the survival. CONCLUSION: The rhabdomyosarcoma showed a better survival rate than other sarcomas of head and neck. Tumor size more or less than 5 cm was important prognostic factor for survival. We could not find the proven treatment guidelines, but surgery may be essential to the treatment for head and neck sarcomas.

The comparison of recognition between non-medicated and medicated group in hypertensive patients

BACKGROUND: With proper management, hypertensive patients can maintain their health and prevent complications. But poor compliance is a main problem for management of hypertension. This study was designed to investigate the reasons among hypertensive patients who did not initiate antihypertensive medication despite recommendations. METHODS: Questionnaires were used for hypertensive patients who visited a health care center and an outpatient clinic of family medicine department in a university hospital, from March to July, 1998. The non-medicated(noncompliant)group were those who had not taken antihypertensive drug at all with high blood pressure(higher than 160mmHg at systolic, or 100mmHg at diastolic phase initially and hypertensive range on the follow up), despite doctor's recommendations. The medicated(compliant) group were those hypertensive patients who had taken antihypertensive drug well and visited the clinic regularly at least for 9 months during the recent 12 months. RESULTS: The total number of the noncompliant was 65, and the compliant 57. The mean age of the noncompliant was 50.8, and the compliant 58.0 years old. The mean blood pressure in the noncompliant was 162.6/106.6mmHg, higher than in the compliant 138.1/85.7mmHg. The main reasons refusing antihypertensive drug were fearful feeling for `lifelong medication'(47.7%), followed by complications from drugs(30.8%). The reason for delaying treatment with antihypertensive drug is that the noncompliant showed more tendency to think `It would be the same', or `better than starting medication early' than the compliant. For the complications from drugs, 59.5% of the noncompliant answered. `I'm not sure, but it'll be not good', and those who answered `it'll be not bad to have medication' seemed to be less than in the noncompliant. CONCLUSION: The patients who had been recommended but did not start on medication had less knowledge about the benefits of medication. We can assume that they are refusing antihyper-tensives because of their excessive anxiety about complications of and lifelong medication.

A Case of Teratocarcinosarcoma Involving the Maxillary and Ethmoid Sinuses / 대한이비인후과학회지

Sinonasal teratocarcinosarcoma is a very unusual malignant neoplasm. This neoplasm histologically consists of an epithelial elements and one or more mesenchymal components with immature and embryonal characteristics. These tumors, which is variously termed as malignant teratoma, blastoma, teratocarcinoma, or teratocarcinosarcoma, probably comprise a group of neoplasm by their similar characteristics of histology and biology. This is a case of teratocarcinosarcoma in a 67-year-old male, involving the right maxillary sinus and ethmoid sinus with invasion of hard palate. The tumor was totally resected via total maxillectomy, and the patient was given post-operative radiotherapy. A follow-up PNS CT after 7 months of the surgery showed no recurrence of the lesion or residual tumor. Extensive tumor necrosis, rapid growth and local destruction are the prominent features of this neoplasm. The clinical presentation, pathological features and clinical course of this unusuat malignancy are discussed with a reivew of the literature.

Habits of smoking and pulmonary function in current smokers

BACKGROUND: It is well known that there is an adverse effect of longterm cigarette smoking on pulmonary function. But there are few reports about the effect of different habits of cigarette smoking on pulmonary function. Some smokers think that different habits of cigarette smoking are more safe than athers and this can be, an obstacle to the education of smoking cessation. Therefore, we have obtained applicable basic information for education of smoking cessation by analysing the effects of different habits of cigarette smoking on pulmonary function. METHODS: We surveyed current smokers on different habits of smoking who had performed puhnonary function test at the pulmonary function laboratory of one tertiary hospital in Seoul and pulmonary function test was done as a part of comprehensive health check-up at health promotion center of one secondary hospital at Ulsan from May 1998 to July 1998. We analysed the effects of different habits of cigarette smoking on pulmonary function in 160 subjects who has no specific respiratory disease. RESULTS: The factors were age, height, weight and amount of total smoking that had effect on pulmonary function. There were six different habits of smoking that we could analyse time of first smoking after sleep, average time of one cigarette smoked, current amount of smoking, length of one cigarette smoked, effort to quit smoking, smoking with drinking and all these six habits of sking had no relationship with the results of the pulmonary function test. CONCLUSIONS: The damage in pulmonary function was not protected by different habits of smoking that were previously known to be more safe or healthy. Therefore, we concluded that smoking cessation is the only way to prevent the damage in pulmonary function from cigarette smoking.