Current Characteristics of Infective Endocarditis with Congenital Heart Disease: A Retrospective Survey of 121 Cases between 1985 and 2006

BACKGROUND AND OBJECTIVES: The relative proportion of infective endocarditis (IE) with congenital heart disease (CHD) has increased because of improved survival with CHD. This may affect the current profile of IE with CHD. The aim of this study is to assess the changing profiles of IE with CHD. SUBJECTS AND METHODS: All cases diagnosed from January 1985 to May 2006 were retrospectively reviewed and were analyzed according to the diagnosed period (period I-prior to 1995, period II-after 1996). Duke criteria were used for the definition of diagnosis. RESULTS: As a whole, 121 episodes occurred (63 episodes in period I and 58 episodes in period II). Although the mean age was similar for patients diagnosed in the two periods, the proportion of younger age patients was larger during period II. During period II, the number of non-surgical ventricular septal defect (VSD) cases decreased and the number of Rastelli procedure cases increased. Negative blood cultures were similar in patients for both periods. S. viridans was the most common causative organism in patients during both periods. Post-surgical cases and IE after a dental procedure increased during period II. The in-hospital mortality rate, total complication rate, and proportion of IE requiring early surgery were not different for patients in either period. However, the interval to early surgery was shorter for patients during period II (period I 35+/-21.1 days, period II 22+/-16.5 days, p=0.041). CONCLUSION: Our study indicates that IE in CHD is still a major problem with similar clinical features exhibited during the two different periods. The presence of non-surgical VSD as a major underlying defect indicates that one needs to pay more attention to the education of the population at risk.

Insulin Resistance in Adolescence and the Related Factors: in 10th Grade High School Students in Seoul

BACKGROUND: There are some studies concerning fasting insulin and insulin resistance in normal healthy Korean adults, but none exists especially for adolescence. Therefore, we investigateck insulin resistance and its related factors in adolescence. METHODS: We analyzed 582 10th grade high school students. Height, weight, abdominal circumference, systolic and diastolic blood pressure, fasting glucose, total cholesterol, hemoglobin were measured. Fasting state and parent's and student's previous medical history were guestioned. We used Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) as an indicator of insulin resistance. RESULTS: By HOMA-IR 2.15, the subjects were divided into the insulin sensitive and the resistant groups. Two groups showed significant differences in body mass index, systolic diastolic blood pressure, fasting glucose, fasting insulin, total cholesterol and abdominal circumference (P <0.05). HOMA-IR was strongly related to the body mass index (r=0.53) and abdominal circumference (r=0.52), but weakly related to the total cholesterol (r= 0.20). According to logistic regression analysis of HOMA-IR, the odds ratio of the body mass index was 1.17 and that of abdominal circumference was 1.06 (P <0.05). CONCLUSION: HOMA-IR showed strong relationship with body mass index, abdominal circumference, but showed weak relationship with total cholesterol. There was no significant correlation with the parent's diabetic medical history. Therefore we conclude that in adolescence the body mass index or the abdominal circumference is far more important factor than the parent's diabetic history.

Transcatheter Coil Closure of a Congenital Coronary Arterial Fistula

Congenital coronary artery fistulas are rare congenital heart anomalies. Surgical closure of these fistulas was the therapy of choice till recently. The recent development of a new accurate coil-delivery system has enabled us to embolize the vessels. Percutaneous transcatheter coil embolization is a safe and effective approach to treating coronary artery fistulas and should be considered as the best treatment for coronary artery fistulas. We report the case of 5-year-old girl whose coronary artery fistula was occluded with Gianturco coils successfully.

Clinical Study of CATCH 22

No abstract available.

Double Chambered Right Ventricle-Review of Clinical Findings

No abstract available.

Clinical Study on the Dilated Cardiomyopathy in Children

No abstract available.

Clinical Observation on Factors Influencing Survival in Pediatric Acute Lymphocytic Leukemia

Sixty two properly treated acute lymphocytic leukemia cases who were diagnosed at SNUH, from 1958 to July, 1981 were studied. Among them, 20 cases had survived more than 3 years and 42 cases survived less than 3 years. The 11 cases of 20 are now alive and off theray and the remainder 9 cases were expired after survival for more than three years. The clinical features of the 11 currently living cases are as follows. The survival time of 11 cases are 3 years and 1 month - 16 years and 1 month. Except one case, first remission have continued till now. Average leukocyte count and liver size are 7,710/mm3 and 1.5 fingerbreadth respectively. The proportion of cases who showed splenomegaly, lymph node enlargement and hemorrhagic phenomena is 18.2%, 9.1% and 36.4% respectively. The clinical features of the 9 expired cases are as follows. Average leukocyte count is 7,780/mm3 and average liver size is 2.4 finger-breadth and average spleen size is 2.8 fingerbreadth. The proportion of cases who showed lymph node enlargement and hemorrhagic phenomean in 50.0% and 37.5% respectively. The clinical features of 29 cases who attained initial remission but survived less than 3 years are as follows. Average leukocyte count, liver size and spleen size 72,910/mm3, 2.8 finger-breadth and 2.0 finger-breadth respectively. The proportion of cases who showed lymph node enlargement and hemorrhagic phenomean is 52% and 75.9% respectively. The clinical features of 13 cases who died before initial remission are as follows. Average leukocyte count, liver size and spleen size are 244,570/mm3, 2.4 finger-breadth and 2.0 finger-breadth respectively. The proportion of cases who showed lymph node enlargement and hemorrhagic phenomena is 53.8% and 90.9% respectively. Various prognostic factors were related to duration of survival. The proportion of cases who were over 10 years of age at diagnosis and male to female ratio are higher in cases who survived less than 3 years. The leukocyte count, liver size, proportion of lymph node enlargement and proportion of hemorrhagic phenomeana are significantly lower in long survivors. In long survivors, spleen size in smaller but statistically not significant.

Testicular Leukemia

Leukemic infiltration of the testes has been relatively rare disease. But increased survival due to advance in the treatment of childhood leukemia has been associated with an increase in incidence of leukemic infiltration of the tests. Six of 66 male children with acute lymphocytic leukemia and 2 of 2 male children with leukemic transformation on non-Hodgkin's lymphoma, who have been admitted to our pediatric department during past 7.5 years period, from January, 1974 to June, 1981 developed testicular leukemia. This represents an incidence of 11.8% and the median age was 6.6 years(9 mo. to 14 yrs). All patients were symptom free despite testicular enlargement. Testicular enlargement was initial presenting manifestation in two patients. The enlargement was unilateral in 5 and bilateral in 3. Initial white blood cell count was greater than 100,000/mm3 in five patients and was less than 10,000/3 in other three. Microscopic findings on specimens were leukemic infiltration mainly in the interstitial spaces and atrophy of spermatogenic cells. Four patients developed testicular relapse during bone marrow remission. Hepatosplenomegaly and lymphadenopathy were present in 5 and 6, and these appeared to imply an increased risk of testicular relapse. The median duration from diagnosis to testicular relapse was 33.5 months(2 mo. to 93 mo.). Three patients developed subsequent relapses(CNS; 2, BM; 1) 1.5 to 26 months after the testicular relapse, the median interval being 14.5 months. Radiotherapy with chemotherapy has resulted clinical improvement, but only one patient showed long survival without relapse.

Clinical Studies on Total Anomalous Pulmonary Venous Connection

No abstract available.