Propylthiouracil-induced Hepatic Injury: A Case Report

Propylthiouracil (PTU) is one of the most widely used drugs for the treatment of the hyperthyroidism. However the liver damage is a rare adverse effect, which can be fatal. We present a case of PTU-induced hepatitis. A 13-year-old girl was diagnosed as having Graves' disease, for which PTU was administered. Three months after commencing PTU, she developed jaundice accompanied with elevated serum transaminases and total bilirubin levels. The viral markers were all negative. The pathologic findings of the liver biopsy included necrosis of hepatocytes predominantly around the central veins (i.e., zone 3 necrosis) and moderate to severe infiltration of lymphocytes in portal areas. After withdrawal of the PTU, clinical symptoms and liver function test results were improved gradually.

Behavioral and Emotional Problems in Children with Nocturnal Enuresis: Results of a Multicenter Study / 신경정신의학

OBJECTIVES: The aim of this study was to examine the behavioral and emotional problems associated with nocturnal enuresis in Korean children. METHODS: Three hundred eighteen children with nocturnal enuresis, together with their parents, completed the Child Behavior Checklist (CBCL), Disruptive Behavior Disorder Scale according to DSM-IV (DBDS), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Piers-Harris Children's Self-Concept Scale (PHCSC). Ninety-three normal students were selected as the control group. RESULTS: Compared to the normal control group, the mean scores with regard to the withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems and total problems profiles were significantly higher in the nocturnal enuresis group according to the CBCL results. The nocturnal enuresis group also scored significantly higher in the ADHD and ODD profiles of the DBDS. The nocturnal enuresis group was more depressed and anxious than the control group according to the results of the CDI and STAI. The mean score of the PHCSC was significantly lower in the nocturnal enuresis group when compared to the normal control group. CONCLUSION: The results of this study suggest that children with nocturnal enuresis in Korea have clinically relevant behavioral and emotional problems. The findings support the link between nocturnal enuresis and psychopathology in Korean children.

Treatment of Severe Small Bowel Involvement in Henoch-Schonlein Purpura: Two Cases Report / 대한소아소화기영양학회지

Henoch-Schonlein purpura (HSP) is a vasculitis of the small vessels in skin, joints, gastrointestinal (GI) tract and kidney. GI symptoms occur in up to 85% of patients and may lead to severe problems such as intussusception, obstruction, and perforation. GI symptoms may not be easily controlled, showing refractoriness to the conventional corticosteroid therapy. Although GI involvements of HSP are acute, and self-limited in most instances, they may cause fatal results in some unusual cases. In such conditions all the possible therapeutic modalities should be considered. We report two cases of severe small bowel involvement of HSP. One case presented with severe abdominal pain showing refractoriness to corticosteroid, but improved with IV immunoglobulin therapy. In the second case, HSP with transmural infarction in the small bowel could be cured with surgical intervention.

Changes of Blood Glucose and Insulin under Different Fentanyl Dosage in Neonates and Infants Undergoing Open Heart Surgery / 대한마취과학회지

Background: Hyperglycemia during cardiopulmonary bypass may increase the incidence and severity of neurologic deficits that may result from cerebral ischemia. Moderate hyperglycemia has been noted to occur in pediatric patients undergoing cardiac surgery despite measures such as eliminating dextrose from the CPB clear pump priming solution and from the intra-operative iv fluids. To ameliorate the hormonal and hemodynamic stress responses during cardiac surgery in neonates, infants and children, high dose fentanyl anesthesia is widely used. The authors wished to determine prospectively whether fentanyl dosage is associated with reduced blood glucose or not in pediatric patients undergoing cardiac surgery. METHODS: Twenty four pediatric patients undergoing cardiac surgery were allocated randomly into 3 groups who received 25 g/kg fentanyl, 50 g/kg fentanyl or 75 g/kg fentanyl before CPB. The changes of plasma glucose and insulin levels were observed after sternotomy, on bypass, 30 min after bypass, off bypass, and the end of the operation. RESULTS: Blood glucose levels were not increased after sternotomy, but significantly increased at bypass to the end of the operation in all fentanyl dosage groups. Plasma insulin level increased, but statistically not significant. Different fentanyl dosage (25~75 g/kg) is not associated with differences in blood glucose level. CONCLUSION: At a dosage of 25~75 g/kg fentanyl anesthesia during pediatric open heart surgery were associated with no differences and below 250 mg/dl of blood glucose level and no significant changes in insulin level.

Tracheal Agenesis: Report of an autopsy case

Tracheal gaenesis is an extremely rare congenital anomaly and is characterized by totally or partially undeveloped trachea. In many instances, the lesion has been associated with malformations in other organ systems. This anomaly is classified into 3 types based on developmental period of the respiratory tract. We report a case of tracheal agenesis with tracheoesophageal fistula in a 2-hour-old male. Postmortem examination revealed that the upper and mid portion of the trachea was absent but 1 cm segment of the trachea above the carina was present. The proximal end to this trachea opened to the esophagus by a fistula, 1 cm in diameter. The well-formed larynx ended blindly in a fibrous sac at which thyroids and cartilage islands are noted. Associated anomalies were bilobed right lung and single umbilical artery.

Ketogenic Diet Trial for The Treatment of Minor Motor Seizures

A 3-years-old girl, diagnosed as infantile spasm and 5-years-old boy, diagnosed as akinetic seizure were subjected to ketogenic diet trial because of their poor responses anticonyulsant treatment After adding ketogenic diet trial, in the former infantile spasm case, her seizures were controlled satisfactorily and in the latter akinetic seizure case, the frequency of seizures decreasd fairly. It seemed to be beneficial to add kotogenic diet the anticonvulsant therapy for the treatment of minor motor seizure children. We report these results with some discussion and a brief review of related literature