Impact on Bisphosphonate Persistence and Compliance: Daily Postprandial Administration

BACKGROUND: Bisphosphonate (BP) is an effective drug for the prevention and treatment of osteoporosis. However, gastrointestinal distress caused by BP is a well-known side effect for low compliance. The aim of our study was to compare the 1-year persistence, compliance and T-scores between the aperitif medication group and the postprandial medication group. METHODS: Three hundred patients were included in this study to determine their persistence and compliance with the prescribed daily BP (Maxmarvil®, alendronate 5 mg and calcitriol 0.5 µg; YuYu Pharm) following distal radius fractures. Patients in Group 1 (aperitif medication) were asked to adhere to the general guidelines for BPs before breakfast. Patients in Group 2 (postprandial medication) were recommended medication after breakfast. We compared the persistence and compliance of this daily BP therapy using the medication possession ratio (MPR) and T-scores between the 2 groups after 1 year. RESULTS: Bone mineral density in hip and lumbar spine was improved significantly in 2 groups (P < 0.001). Significant differences existed between 2 groups, including 73 of 150 patients (48.7%) in Group 1, and 111 of 150 patients (73.3%) in Group 2 for 1-year persistence (P=0.001). The mean MPR is 0.66 in Group 1 (range, 0.50–0.86) and 0.71 in Group 2 (range, 0.54–0.87). A significant difference was detected between the 2 groups (P=0.002). CONCLUSIONS: Postprandial administration improved persistence and compliance with daily BP therapy, resulting in better clinical outcomes.

Relationship between Dietary Intake and Depression in Metabolic Syndroem among Korean Adults: Korea National Health and Nutrition Examination Survey 2014 / 農村醫學 地域保健

OBJECTIVES: Metabolic syndrome and depression are interconnected disorders. Although many studies have assessed the association between dietary intake and each disorder independently, few studies have examined the association between depression and dietary intake in patients with metabolic syndrome. Our study examined the association between depression and dietary intake in adults with metabolic syndrome. METHODS: We analyzed the second data set (2014) from the sixth KNHNES. Of the patients with metabolic syndrome, the final study population comprised 1,334 patients, aged 20 to 60 years, with metabolic syndrome as defined by KNHNES and depression diagnosed by a physician. We examined the patients??dietary intake obtained using the 24-h recollection method in KNHNES. RESULTS: Depression group had a lower niacin dietary intake than those without depression in both male and female (male P=0.047, female P=0.025). None of the other components had any association between depression group and those without depression group in both male and female. CONCLUSIONS: This study demonstrates that a low dietary intake of niacin may be related to the depression in patients with metabolic syndrome. The results indicate that it is worthwhile to evaluate the nutritional status in patients who have been diagnosed with both metabolic syndrome and depression.

Relationship between diet and prevalence of depression among Korean adults: Korea National Health and Nutrition Examination Survey 2010 / 農村醫學 地域保健

BACKGROUND: Many studies focus on the causes of depression, but few assess the dietary intake. This study investigated the relationship between diet and prevalence of depression. METHODS: This study used the data from the Korea National Health and Nutrition Examination Survey 2010. A total of 734 persons aged 20-65 years old in whom the presence or absence of depression was confirmed by doctor were analyzed. We analyzed associations between prevalence of depression and diet based on carbohydrate, fiber, calcium, iron, sodium, potassium, vitamin A, thiamine, riboflavin, niacin and vitamin C intakes for male and female groups. RESULTS: There was no association between diet and prevalence of depression in the male group. For the female group, as fiber intake was increased, the prevalence of depression significantly decreased (odds ratio=0.923, 95% confidence interval=0.850-0.986), but there was no association between the other dietary intakes and prevalence of depression. CONCLUSIONS: The fiber intake and prevalence of depression are negatively correlated in women aged 20-65 years. A diet therapy including fiber may decrease the prevalence of depression.

A Case with Emanuel Syndrome Resulting from a Maternal Balanced Translocation

Emanuel syndrome is a rare genomic syndrome which is characterized by multiple congenital anomalies and developmental disability. This syndrome is related to the presence of the supernumerary derivative chromosome originating from both chromosome 11 and 22. In most cases, one of the parents is a balanced carrier of a translocation. Our case results from 3:1 meiotic segregation of the maternal translocation carrier and is a rare case in Korea confirmed by genetic analysis.

Asthma predictive index in children with recurrent wheezing / 소아과

PURPOSE: We compared the asthma predictive index(API) and the modified asthma predictive index (mAPI) of the Tuscon Children's Respiratory Study Group in Korean children with recurrent wheezing. We investigated the atopic profiles and presence of allergen sensitization of each risk group, and ascertained the significant clinical risk factors. METHODS: Two hundred and sixty two children, who visited for recurrent wheezing from 1998 to 2005, were enrolled and divided into groups by API and mAPI. We investigated the history of the patients and their families, atopic profiles, and sensitization to aeroallergen and food allergens. Twenty nine children were followed up to 6 years of age and we evaluated the sensitivity, specificity and positive and negative predictive value of both indices. RESULTS: The high risk group of API were of older age, were more likely to be sensitized to aeroallergen(P=0.001) and food allergen(P=0.034) and had higher levels of total eosinophil count, eosinophil percent, serum ECP, total IgE, and D.p-, D.f-specific IgE. High risk group of mAPI showed higher levels of atopic markers such as egg-, milk-, D.p- and D.f-specific IgE. Even though API did not include allergen sensitization, the high risk group was more significantly sensitized to common allergens than the low risk group. Twenty nine children were followed up until 6 years of age; therefore 15 children were diagnosed as asthma, clinically. The sensitivity, specificity, positive and negative predictive values of mAPI were higher than API. CONCLUSION: Both high risk groups of API and mAPI had higher levels of atopic markers and were more sensitized to common allergens. These findings suggest that sensitization to aeroallergens and food allergens are more objective markers as asthma predictive indices. In addition, mAPI is a more reliable index in predicting asthma in Korean children with recurrent wheezing than is API. But only 29 patients were followed until the age of 6, so we need to include more children with long term follow up for future study.

Airway Expandible Metallic Stent Implantation in Children with Tracheal or Bronchial Stenosis / 소아과

PURPOSE: In adults, endoscopic tracheobronchial balloon dilatation and stenting have become valuable methods to establish and maintain an adequate airway lumen when tracheomalacia or neoplastic growth compromise the airways. But in children, only a few cases were reported due to technical problems. We report six children who were treated with stent implantation and describe the use and safety of airway stents. METHODS: Six patients with severe airway obstruction were treated. We investigated the underlying medical problems, stenotic site, symptomatic improvement and complications, and the size and location of stent. RESULTS: The median age of the six patients was 21 months. Three of them were mechanically ventilated and one had an endotracheal tube to maintain the patency of airway. Diagnoses were:congenital tracheal stenosis with or without bronchomalacia, granulation tissue formation after right upper lobectomy by bronchial carcinoid or after prolonged intubation, endobronchial tuberculosis, and airway compression by mediastinal undifferentiated sarcoma. Nitinol stents were implanted in the airway guided by bronchoscopy and fluoroscopy simultaneously. Three cases were placed in trachea, the others were in the bronchus. After stent implantation, all patients showed marked improvements of their airway obstructive symptoms. Four patients are doing well, although two expired due to underlying diseases. Four patients had granulation tissue formation around stents, but that was tolerable after removing the stent. CONCLUSION: We suggest that the use of expandible metallic stent implantation can offer safe therapeutic option even in extremely severe, life threatening and inoperable airway stenosis in children.

A Three-year Follow-up of D.f- and D.p-Specific Conventional Immunotherapy in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE: Immunotherapy (IT) with Dermatophagoides farinae (D.f) or Dermatophagoides pteronyssinus (D.p) has proven to be clinically effective treatment for patients with asthma, but the mechanism and prognostic index of IT are not completely understood. We evaluated the long-term effect of conventional IT with D.f or D.p, and also investigated whether IT could prevent new sensitizations to other new allergens. METHODS: The patient group included 23 asthmatic patients with D.f- and D.p-sensitivities who visited Asan Medical Center and were treated with conventional IT (Allergopharma, Germany). The control group contained 27 asthmatic patients with D.f- and D.p-sensitivities who were not treated with IT. We compared skin test reactivity, total IgE, specific IgE, total eosinophil counts, eosinophils fraction and bronchial hyperreactivity before and three years after IT. RESULTS: The skin test reactivity to D.p and total eosinophil counts were decreased significantly three years after IT. But total IgE, D.f- and D.p-specific IgE, and eosinophils fraction were not changed three years after IT. The bronchial hyperreactivity by methacholine was decreased in both groups after three years. In addition, development of sensitization to new allergens happened in 13.0 percent of the IT group and 22.2 percent of the control group, but did not reach statistical significance. CONCLUSION: The conventional IT with D.f and D.p could change the allergic responsiveness of the target organs, such as skin, but it could not prevent the development of new sensitizations in asthmatic children.

Familial Interstitial Lung Disease in Two Young Korean Sisters

Most of the interstitial lung diseases are rare, chronic, progressive and fatal disorders, especially in familial form. The etiology of the majority of interstitial lung disease is still unknown. Host susceptibility, genetic and environmental factors may influence clinical expression of each disease. With familial interstitial lung diseases, mutations of surfactant protein B and surfactant protein C or other additional genetic mechanisms (e.g. mutation of the gene for ATP-binding cassette transporter A3) could be associated. We found a 21 month-old girl with respiratory symptoms, abnormal radiographic findings and abnormal open lung biopsy findings compatible with nonspecific interstitial pneumonitis that is similar to those of her older sister died from this disease. We performed genetic studies of the patient and her parents, but we could not find any mutation in our case. High-dose intravenous methylprednisolone and oral hydroxychloroquine were administered and she is still alive without progression during 21 months of follow-up.

A Case of Pulmonary Septic Emboli after Removal of BCGoma / 소아알레르기및호흡기학회지

Septic pulmonary emboli occur when thrombi contain organisms such as bacteria, fungi, or parasites. The septic emboli reach the lung from a variety of sources, including infected venous catheter or pacemaker wires, right-sided bacterial endocarditis, sepsis, septic thrombophlebitis, osteomyelitis, peritonsillar and subcutaneous abscess. Early clinical detection, along with prompt administration of broad-spectrum antibiotics, is an important factor in the prognosis of patients, but unfortunately initial clinical diagnosis is often difficult because of nonspecific findings in clinical, laboratory data. But recently, the characteristic chest computed tormography (CT) and chest radiographic findings of septic emboli have been helpful in non-invasive diagnostic method of early detection. Especially, chest CT is an important method for confirming the presence of septic pulmonary emboli. We experienced a case of septic pulmonary embolism in a 5-month-old infant with fever and intermittent cough after removal of BCGoma. The diagnosis was made on the basis of a chest x-ray and a chest CT. The CT revealed the presence of multiple subpleural nodules, cavitation of nodules and feeding vessel signs. Methicillin resistant staphylococcus aureus was cultured in the wound swab culture on left axillary area. After administration of broad spectrum antibiotics, clinical and radiologic improvements were achieved.

Anaphylaxis to Curry Powder in Childhood / 소아알레르기및호흡기학회지

A 15-year old boy visited Samsung Medical Center complaining that when he ate curry and rice two months ago, he developed immediate palatal itching, generalized urticaria, headache and dyspnea. His chest radiographs were normal. He had no history of allergy, but a methacholine provocation challenge test revealed positive findings (PC20 3.62 mg/mL). Skin prick tests revealed positive findings to asparagus, house dust mites (Dp, Df), flower pollens (aster, chrysanthemum, golden rod), weed pollens (mugwort, ragweed, dandelion, short ragweed) and crude extract of curry powder. Specific IgE to Dp, Df and soy bean were positive (6.52, 31.2 and 1.91 kU/L) and total IgE was 1, 207 kU/L by the Pharmacia UniCAP- FEIA. After receiving parental consent, we performed an oral provocation test to confirm the relationship between his symptoms and curry powder. He ingested a small amount of curry powder with pure water, which was increased every 1 hour. We then measured his PEFR every 10 minutes after each subsequent curry powder ingestion. After he ate 20 gm of curry powder in one time, he exhibited profuse sweating, skin rash and dyspnea. When we treated him with epinephrine and bronchodilator, his symptoms improved. He developed the same symptoms 2 hours later, but these symptoms were brought under control by the same medication.

Increased Cutaneous Lymphocyte Antigen (CLA) +T Cells in the Peripheral Blood of Children with Severe Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: Skin-homing T cells expressing cutaneous lymphocyte antigen (CLA) are known to be important in the pathogenesis of atopic dermatitis (AD). So far, there have been few reports on the peripheral lymphocyte subpopulations expressing CLA, especially in children with AD. METHODS: We investigated the peripheral blood lymphocyte subpopulations expressing CLA in children with severe AD andcontrol subjects to identify which proportions of circulating CLA+ T cells were expanded in atopic dermatitis. We assayed the peripheral blood lymphocyte subpopulation with flow cytometry in 15 children with severe chronic lichenified skin lesions and 12 control subjects who had no symptoms of atopic dermatitis. The expressions of peripheral blood CD4+CLA+ T cells and CD3+CLA+ T cells were significantly increased in children with AD compared with those in control subjects, whereas there was no significant difference of CD8+CLA+ T cells between the two groups. RESULTS: The expressions of CD3+ T cells, CD4+ T cells, and CD8+ T cells showed no significant differences between children with AD and control subjects. CONCLUSION: These findings suggest that circulating CD4+CLA+ T cells play an important role in the pathogenesis of chronic severe AD in children.

Changes in Peripheral Blood T Cells after Treatment of Cyclosporine in Children with Severe Atopic Dermatitis / 소아알레르기및호흡기학회지

BACKGROUND: Skin-homing T cells expressing cutaneous lymphocyte antigen (CLA) are known to be important in the pathogenesis of atopic dermatitis (AD). Cyclosporine is known as an effective treatment for severe atopic dermatitis, which controls the cytokine production from T cells and regulates the activation of T cells. There have been no reports about the changes of circulating CLA+ T cells after the treatment of cyclosporine in AD. The aim of this study was to evaluate the clinical outcome and the changes of CLA+ T cells after treatment of cyclosporine in childhood AD. METHODS: Ten children with severe AD were treated with cyclosporine (5 mg/kg/day) for six weeks. Clinical outcome was monitored by the SCORAD index. We assayed the peripheral blood T lymphocyte subpopulation including CLA+ T cells with flow cytometry. RESULTS: The SCORAD index decreased significantly after treatment (P< 0.05). CD4+CLA+ T cells and CD3+CLA+ T cells were significantly decreased after the treatment of cyclosporine. (P< 0.05) But CD3+ T cells, CD4+ T cells and CD8+ T cells were not changed. CONCLUSION: Cyclosporine is effective to control severe AD in children and decreases CD4+CLA+ T cells, which may be important in the pathogenesis of AD.

Perioperative Respiratory Problems Associated with Congenital Heart Disease

No Abstract available.

The Utilities of Lung Biopsy in Pediatric Lung Disease

PURPOSE: The aim of this study is to evaluate the value of lung biopsies for the management of children with lung disease. METHODS: We retrospectively reviewed 19 lung biopsies done at Asan Medical Center, Seoul between 1993 and 2001. Data gathered included demographic information, underlying conditions, diagnosis before biopsy, final diagnosis, change in therapy, morbidity and mortality. RESULTS: Nineteen patients underwent lung biopsy. Among them, 13 patients were male and six patients were female; the median age was 3.6 years(0.8 to 8.6 years). Twelve patients underwent open lung biopsies and seven patients had thoracoscopic biopsies. The overall diagnosis rate was 95 %. The most common diagnosis was interstitial lung disease(12 patients, 64%) and infection was detected in four patients(21%). The biopsy-proven bronchiolitis obliterance was confirmed in two of seven patients suspected by CT findings. Specific treatment was changed after biopsy in 16 patients (85%). The morbidity & overall mortality rates of the patients were 5%(one patient) and 21%(four patients) respectively. Only one complication was seen: empyema. The causes of death were acute respiratory distress syndrome(one patient), respiratory failure(two patients), and septicemia(one patient). CONCLUSIONS: The lung biopsy is a safe procedure and it contributes to more accurate diagnosis and proper management of pediatric lung diseases. We recommend lung biopsies should be considered more positively in the diagnosis of pediatric lung diseases.

Influence of Conventional Immunotherapy with D.f and D.p on Eosinophil, Specific IgE, Skin Test Reactivity, and Airway Hyperreactivity in House Dust Mite Sensitive Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE: Immunotherapy (IT) with house dust mite may be effective to treat house dust mite allergic disease, but the mechanism and prognostic index of IT are not completely understood. Generally allergen specific-IgE antibody significantly initially increases, then gradually declines, but there is no consistent data about the changes of allergen-specific IgE. Also there is some controversies for skin test reactivity and bronchial hyperreactivity after IT. To understand the mechanism and find the prognostic index after conventional IT, we compared the clinical and laboratory parameters before and after IT between patients with IT and patients without IT. METHODS: The IT group included 24 patients with D.f and D.p-sensitized asthmatic children who had received conventional IT. The control group included 22 D.f and D.p-sensitized asthmatic children who had not received IT. The symptom scores of asthma, methacholine challenge test (PC20), skin reactivity to D.f and D.p (allergen/histamine ratio), total eosinophil counts, the changes of D.f- and D.p-specific IgE, were compared before, 4 and 9 month after IT in two groups. RESULTS: The symptom scores and the skin reactivity to D.p were decreased significantly 9 month after IT. The eosinophil count in peripheral blood was decreased 9 month after IT. But D.p-specific IgE level was not changed 9 month after IT in either two groups. The bronchial hyperreactivity was not changed 9 month after IT. CONCLUSION: These findings suggest that the changes of effector cells such as skin mast cell may be induced after the result of IT regardless of the changes of serum IgE and bronchial hyperreactivity.

A Case of Coil Embolization in a 15-year-old Child with Pulmonary Sequestration

Pulmonary sequestration is a rare congenital mass of nonfunctional pulmonary tissue that lacks a normal-connection with the bronchial tree or the pulmonary arteries. It is clinically asymptomatic but when it is complicated with recurrent infection, it needs to be treated. Conventionally, surgical removal was recommended, but these days we are trying new and less invasive techniques, such as arterial embolization. There were several reports about successful cases of pulmonary sequestration treated by embolization, but mostly all of them were done to newborns or infants. We report a case of a 15-year-old boy with an asymptomatic pulmonary sequestration on whom was performed coil embolization, and in the follow-up computed tomography(CT), the size of the lesion was decreased. He did not suffer severe respiratory symptoms.

Clinical Study of Childhood Accidents from a Hospital Over Ten Years with Regard to Foreign Body Aspiration

PURPOSE: Childhood accidents have been increasing recently. Accidents rank as the leading cause of childhood mortality and morbidity. We performed this study to evaluate the causes of childhood accidents. METHODS: The authors analysed retrospectively the medical records of 6,410 cases of childhood accidental injuries who visited the emergency room of Asan Medical Center from January 1990 to December 1999. RESULTS: The most common type of accidents was trauma which accounted for 5,038 cases of the total accidents, followed by falls, burns, foreign body aspiration, and poisoning. The most common age of foreign body aspiration was under two years old and the male to female ratio was 2 to 1. The most common site of foreign body aspiration was the esophagus and the stomach, followed by the respiratory tract. In airways, the right and left main bronchus were the most common site for foreign body aspiration and were accompanied by the highest mortality. The most common foreign body in the gastrointestinal tract and respiratory tract were coins and peanuts, respectively. CONCLUSION: The most common cause of accidents was trauma, followed by falls, burns, foreign body aspiration, and poisoning. The incidence of foreign body aspiration and poisoning is increasing in infants. In cases of foreign bodies in airways, proper management is needed because of the high mortality rate.

A Case of Alport Syndrome Associated with Diffuse Esophageal Leiomyomatosis

We report a case of Alport syndrome associated with esophageal leiomyomatosis, presenting as recurrent pneumonia. A 5-year old girl who had a history of cataract visited the out patient clinic with a complaint of recurrent wheezing and respiratory difficulty which had started five months previously. Chest magnetic resonance image(MRI) and esophagography, checked on the suspicion of achalasia, revealed esophageal leiomyomatosis and renal biopsy revealed Alport syndrome. In the pediatric population, this tumor is a rare cause of dysphagia and is often misdiagnosed as an esophageal motility disorder. Although a number of Alport syndrome associated with leiomyomatosis were reported in the literature, this is a second case report presented with recurrent pneumonia in Korea.

A Case of Mucoepidermoid Carcinoma of Bronchus / 소아알레르기및호흡기학회지

Primary bronchial neoplasms in children, especially malignant lesions, are extremely rare. We report a case of a 10-year old boy with intermediate-grade mucoepidermoid carcinoma of the right intermediate bronchus, presenting as collapse and bronchiectasis after pneumonia. He was diagnosed by bronchoscopic biopsy. The lobectomy was performed. The patient is in good condition 1 year after operation. All reported cases of bronchial mucoepidermoid tumors in children had histologically low or intermediate grade(well differentiated) variety with a benign clinical course. The optimal surgical therapy for bronchial mucoepidermoid tumors is identical. There must be total removal of either mass with the sacrifice of as little normal lung as possible.

Analysis of Etiology and Prognosis of Pulmonary Complications in Children with Hematological or Oncological Disorders in Pediatric Intensive Care Unit

PURPOSE: In the course of treatment, patients with hematological or oncological disorders often develop pulmonary complication. The patients who develop a severe pulmonary complication have a poor outlook. The causes of pulmonary complication are either infectious or non-infectious in origin. We have analyzed the etiology and outcome of these patients admitted to the pediatric intensive care unit of Asan Medical Center. METHODS: Medical records of 95 patients on Pediatric oncology service who were admitted to pediatric intensive care unit(PICU) of Asan Medical Center from Jan 1997 to May 2000 were retrospectively reviewed. RESULTS: The mean age of the patients was 8.5 years(2 months-18 years). The underlying malignancies of these 95 patients were as following; acute lymphoblastic leukemia(31 cases), lymphoma (11 cases), acute myeloid leukemia(nine cases), brain tumor(eight cases) and other solid tumors(25 cases). Pulmonary complications included pneumonia, acute respiratory failure, pneumothorax and pleural effusion. The most common cause of pulmonary complication was infection(88%) in etiology. The overall mortality rate was 56.8%. Pulmonary complications in these patients carried high rates of mortality regardless of whether they were immune compromised(76%) or not(69%). Even without pulmonary complications, the hematological or oncological patients admitted to PICU had high mortality rates of 43%. CONCLUSION: Pulmonary complications are frequent finding in the hematological or oncological patients admitted to Intensive Care Unit. The main etiology of these pulmonary complications was infection, which carried a high mortality rate regardless of their immune status at the time when they were admitted to PICU