Relationship between methacholine PC20 level and asthma control status among pediatric patients with atopic asthma

PURPOSE: Although methacholine PC20 helps clinicians to identify asthma, there are practical limitations in using methacholine PC20 to assess asthma control. We assessed the relationship between methacholine PC20 levels and asthma control status in child patients with atopic asthma. METHODS: We enrolled 153 children of 8 to 15 years of age with atopic asthma and measured methacholine PC20 of these children when their asthma was controlled. We followed up these patients for more than 2 years with measurements of asthma control score, lung function, bronchodilator response (BDR), and fractional exhaled nitric oxide (FeNO). RESULTS: The geometric mean of methacholine PC20 in the study population was 2.81 mg/mL. Lower methacholine PC20 was found to be associated with lower lung function, higher rate of BDR greater than 12%, higher level of BDR, higher rate of FeNO levels greater than 23 ppb, higher FeNO, higher numbers of asthma aggravation per year, and higher rate of asthma control test scores of 19 or less. CONCLUSION: These data provide evidences that the degree of methacholine PC20 is linked to disease severity in children with atopic asthma. Thus, regular and close monitoring of asthma control should be required for patients with lower levels of methacholine PC20.

Fractional exhaled nitric oxide and forced expiratory flow between 25% and 75% of vital capacity in children with controlled asthma / 소아과

PURPOSE: Fractional exhaled nitric oxide (FeNO) and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) are not included in routine monitoring of asthma control. We observed changes in FeNO level and FEF25-75 after FeNO-based treatment with inhaled corticosteroid (ICS) in children with controlled asthma (CA). METHODS: We recruited 148 children with asthma (age, 8 to 16 years) who had maintained asthma control and normal forced expiratory volume in the first second (FEV1) without control medication for > or =3 months. Patients with FeNO levels >25 ppb were allocated to the ICS-treated (FeNO-based management) or untreated group (guideline-based management). Changes in spirometric values and FeNO levels from baseline were evaluated after 6 weeks. RESULTS: Ninety-three patients had FeNO levels >25 ppb. These patients had lower FEF25-75% predicted values than those with FeNO levels 25 ppb.

Clinical Study and Review of Articles (Korean) about Retrorectal Developmental Cysts in Adults

PURPOSE: A retrorectal developmental cyst (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) is very rare disease, and the symptoms are not characteristic so that sometimes this disease is still misdiagnosed as a supralevator abscess or a complex anal fistula. We would like to present a clinical approach to this disease. METHODS: We retrospectively examined the charts of 15 patients who were treated for retrorectal cysts from January 2001 to November 2009. RESULTS: All 15 patients were female. The average age was 41 years (range, 21 to 60 years). Fourteen patients (93.3%) were symptomatic, and the most common symptom was anal pain or discomfort. Nine patients (60%) had more than one previous operation (range, 1 to 9 times) for a supralevator abscess, an anal fistula, etc. In 12 patients (80%), the diagnosis could be made by using the medical history and physical examination. Thirteen cysts (80%) were excised completely through the posterior approach. The average diameter of the cysts was 4.8 cm (range, 2 to 10 cm). Pathologic diagnoses were 8 tailgut cysts (53.3%), 5 epidermoid cysts (33.3%) and 2 dermoid cysts (13.3%). The average follow-up period was 18.3 months (range, 1 to 64 months). CONCLUSION: In our experience, high suspicion and physical examination are the most important diagnostic methods. If a female patient has a history of multiple perianal operations, a retrorectal bulging soft mass, a posterior anal dimple, and no conventional creamy foul odorous pus in drainage, the possibility of a retrorectal developmental cyst must be considered.