Comparison of hypertonic saline treatment in meningitis with cerebral edema / 소아과

PURPOSE: Cerebral edema in meningitis is a potentially complication. Hypertonic saline of various concentrations are frequently used to treat cerebral edemas in meningitis. We analyzed the safety and efficacy of osmotic therapy in cerebral edema by comparison of various hypertonic saline concentrations and mannitol. METHODS: The medical records of 42 patients, who were followed up in the Department of Pediatrics, Busan Medical Center, from Jan. 2002 to Oct. 2005, were analyzed retrospectively. We measured intracranial pressure, mean flow velocity, and various laboratory parameters. RESULTS: In cerebral edema developed in meningitis, intracranial pressure and symptoms were improved in treatment of hypertonic saline and mannitol. Serial bolus infusion of 3 percent hypertonic saline resulted in the best outcome. There was not a statistically considerable difference on the mean values of the intracranial pressure gap. On transcranial doppler, mean flow velocity was increased and pulsatilty index was decreased. Laboratory findings (osmolarity, Na, Cl, pH, lactic acid, Ca) were diffenent during the treatment period as opposed to K, Hb, bicarbonate, base excess. There was not a specific form of hypertonic saline used in meningitis treatment with cerebral edema. CONCLUSION: The therapy for cerebral edema in meningitis remains largely empirical. Serial bolus infusion of 3 percent hypertonic saline is better than other hypertonic salines. Various concentrations and different infusion methods of hypertonic saline statistically does not influence the result of treatment. More research aimed at improving cerebral edema treatment is needed to identify new, effective forms of treatment.

Smoking Adolescents' Acquisition of Cigarettes and Status of Proof of Age / 소아과

PURPOSE: The aim of this study is to identify where and how adolescents acquire cigarettes and how many were asked for identification while purchasing cigarettes. METHODS: This study was conducted in 2003; participants were 2,200 students in middle and high schools, aged from 13 to 18 years old(males 1,098; females 1,102) in Ansan, Korea. The questionnaire assured them of anonymity, and self-administered in school. The data was analyzed with chi- square test for trends. RESULTS: The prevalence of smoking was about 20 percent among respondents, was higher in males than in females, and in older students than in younger students(P<0.001). The most frequent source of cigarettes was purchased from a store(36.3 percent). About 29.2 percent of the students borrowed from friends or family members. By sex, the main sources of cigarettes were purchase from a store and borrowing. Younger students were borrowed more cigarettes; older students purchased more cigarettes from stores. Only 48.8 percent were asked for proof of age during their purchase. Of those asked for proof of age, about 73.3 percent answered that this made it difficult to buy cigarettes(P< 0.001), and they thought that it was more difficult when asked for a photo ID than simply being asked their age(P=0.019). CONCLUSION: So far, there has been no systemic prevention of adolescents' smoking. It is difficult for minors to purchase cigarettes if asked for proof of age, but most minors go to stores to purchase cigarettes. Therefore, prevention efforts should include educating retailers not to sell cigarettes to minors and enforcing existing laws requiring youth to provide proof of age when attempting to buy cigarettes.

Isolated Extramedullary Relapse of Acute Lymphoblastic Leukemia Presenting as an Paraspinal Mass / 대한소아혈액종양학회지

Despite improvements in therapy, cases in which relapse occurs are still common in children with acute lymphoblastic leukemia (ALL). Most relapses occur in the bone marrow, and extramedullary relapse is most commonly in the central nerve system. Soft tissue mass lesion or spinal cord involvement is extremely unusual in ALL relapse. We experienced a 13-year-old boy who presented with extremity weakness and pain. He was diagnosed with ALL 4 years ago and achieved complete remission after systemic chemotherapy. Imaging study revealed a paraspinal mass which was invading the S1-2 vertebral body. Histopathologic examination revealed infiltrates composed of immature lymphoblasts with morphology identical with that of initially diagnosed bone marrow aspiration. Studies on bone marrow were negative for disease at this time. He was treated with irradiation and intrathecal chemotherapy, in addition to systemic chemotherapy. The mass has nearly disappeared, and he is planned for allogeneic bone marrow transplantation.

The Influence of Environmental Tobacco Smoke (ETS) by Family Member on Pediatric Asthma / 소아알레르기및호흡기학회지

PURPOSE: Asthma is an important worldwide pediatric public health problem and rapidly increasing prevalence has been reported. Environmental tobacco smoke (ETS) is known to be an important aggravation factor of asthma. The aim of this study was to determine whether ETS exposure is associated with exacerbations of asthma, and therefore to define the possibility of improving illness by cessation of smoking. METHODS: One hundred one (101) asthmatic children who visited and followed up at Korea university hospital pediatric allergy clinic were enrolled. Their chart was reviewed retrospectively and their family members were also interviewed. RESULTS: Sixty nine patients were exposed to ETS and thirty two patients were not exposed. Among exposed group (n=69), fourteen patients were no longer exposed due to cessation of smoking. The difference in the number of hospital admissions between exposed group and non-exposed was statistically significant (P=0.002). But the difference in the number of emergency room visits and PFT value (FEV1, PEFR, FEF25-75%) between the two groups was statistically insignificant. Statistical relationship between the duration of ETS and number of hospital admissions was significant (Pearson Correlation Coefficient=0.243, P=0.015). Comparing current smoking group and smoking cessation group, differences in out-patient clinic follow up period, number of hospital admissions, and number of emergency room visits between the two groups were statistically insignificant. CONCLUSION: We found that ETS exposure is associated with exacerbations of asthma. Possibility of improving illness by reduction of ETS exposure indicates the significance of education for cessation of smoking.

A Case of Neonatal Transient Tricuspid Regurgitation with Cardiomegaly in Fetal Period

Tricuspid regurgitation(TR) with normal heart structure during fetal life is a frequent functional phenomenon with a prevalence of six to seven percent. Isolated severe congenital TR, however, is an uncommon cause of neonatal congestive heart failure, cyanosis and massive cardiomegaly. We experienced a case of severe transient neonatal TR presented as massive cardiomegaly during fetal life which was normalized in the postnatal period.