Epidemiological comparison of three Mycoplasma pneumoniae pneumonia epidemics in a single hospital over 10 years / 소아과

PURPOSE: Mycoplasma pneumoniae (MP) pneumonia epidemics have occurred in 3- to 4-year cycles in Korea. We evaluated the epidemiologic characteristics of MP pneumonia in Daejeon, Korea, from 2003 to 2012. METHODS: We retrospectively analyzed 779 medical records of children (0-15 years of old) with MP pneumonia admitted to our institution and compared the data from 3 recent epidemics. RESULTS: In 779 patients, the mean age and male-to-female ratio were 5.0+/-2.2 years and 1:1, and most cases were observed in autumn. There were three epidemics during the study period, in 2003, 2006-2007, and 2011. In our comparison of the three epidemics, we found no differences in mean age, the male-to-female ratio, hospital stay, or the rate of seroconverters during hospitalization. All three epidemics began in early summer and peaked in September 2003 and 2011 and in October 2006 and then gradually decreased until the next year's spring season, although the 2006 epidemic extended further into 2007. The peak age groups in the children in 2003 and 2006 were 3-6 year-olds (57.5% and 56%, respectively), but in the 2011 epidemic, the peak group was 1-4 year-olds (46.5%). The proportion of the 10 years of age group was 5.2%, 13.8%, and 14.8% of total patients, respectively. CONCLUSION: MP pneumonia outbreaks occurred every 3-4 years. The pattern of 3 recent epidemics was similar in demographic characteristics and seasonality with some variations in each outbreak.

Esophageal pH and Combined Impedance-pH Monitoring in Children / 대한소아소화기영양학회지

Esophageal pH monitoring is considered the gold standard for the diagnosis of gastroesophageal reflux disease because of the normal ranges across the pediatric age range. However, this method can only detect acid reflux. Multichannel intraluminal impedance-pH (MII-pH) monitoring has recently been used for the detection of bolus reflux in infants and children. This method allows for the detection of liquid, gas or mixed reflux in addition to acid, weakly acidic or weakly alkaline reflux. MII-pH monitoring can record the direction of flow and the height of reflux, which are useful parameters to identify an association between symptoms and reflux. However, the technique is limited by its high cost and the lack of normative data of MII-pH in the pediatric population. Despite certain limitations, MII-pH monitoring will become more common and gradually replace pH monitoring in the future, because pH monitoring is part of MII-pH.

Early Additional Immune-Modulators for Mycoplasma pneumoniae Pneumonia in Children: An Observation Study

BACKGROUND: Mycoplasma pneumoniae (MP) pneumonia is a self-limiting disease, but some patients complain of progressive pneumonia, despite of appropriate antibiotic treatment. We aimed to introduce the role of immune-modulators (corticosteroid and/or intravenous immunoglobulin, IVIG) treatment for childhood MP pneumonia based on previous our experiences. MATERIALS AND METHODS: A retrospective case series analysis for 183 children with MP pneumonia was performed. MP pneumonia patients were diagnosed by two Immunoglobulin M (IgM) tests: the micro-particle agglutination method (> or =1:40) and the cold agglutination test (> or =1:4), and were examined twice at the initial admission and at discharge. Among 183 MP pneumonia patients, 90 patients with persistent fever for over 48 hours after admission or those with severe respiratory symptoms and signs received additional prednisolone (82 patients, 1 mg/kg/day) or intravenous methylprednisolone (8 patients, 5-10 mg/kg/day) with antibiotics. Four patients with aggravated clinical symptoms and chest radiographic findings after corticosteroid treatment received IVIG (1 g/kg/day, 1-2 doses). RESULTS: Mean age of 183 patients was 5.5 +/- 3.2 years (6 months-15 years), and the male: female ratio was 1.1:1 (96:87). Fifty-seven patients (31%) were seroconverters and 126 seropositive patients showed increased diagnostic IgM antibody titres during admission (over 4 folds). The majority of the patients who received corticosteroids (86/90 cases) showed rapid defervescence within 48 hours with improved clinical symptoms, regardless of the used antibiotics. Also, 4 patients who received additional IVIG improved both clinically and radiographically within 2 days without adverse reaction. CONCLUSIONS: In the era of macrolide-resistant MP strains, early additional immune-modulator therapy with antibiotics might prevent from the disease progression and reduce the disease morbidity without adverse reaction.

Optimal Duration of Medical Treatment in Superior Mesenteric Artery Syndrome in Children

The aim of this study was to investigate the outcome, and optimal duration of medical treatment in children with superior mesenteric artery syndrome (SMAS). Eighteen children with SMAS were retrospectively studied. The data reviewed included demographics, presenting symptoms, co-morbid conditions, clinical courses, nutritional status, treatments, and outcomes. The three most common symptoms were postprandial discomfort (67.7%), abdominal pain (61.1%), and early satiety (50%). The median duration of symptoms before diagnosis was 68 days. The most common co-morbid condition was weight loss (50%), followed by growth spurt (22.2%) and bile reflux gastropathy (16.7%). Body mass index (BMI) was normal in 72.2% of the patients. Medical management was successful in 13 patients (72.2%). The median duration of treatment was 45 days. Nine patients (50%) had good outcomes without recurrence, 5 patients (27.8%) had moderate outcomes, and 4 patients (22.2%) had poor outcomes. A time limit of >6 weeks for the duration of medical management tended to be associated with worse outcomes (P=0.018). SMAS often developed in patients with normal BMI or no weight loss. Medical treatment has a high success rate, and children with SMAS should be treated medically for at least 6 weeks before surgical treatment is considered.

Sandwich Graft using Ear Cartilage and Inferior Turbinate Mucoperiosteal Free Graft Via Open Rhinoplasty Approach for Repair of Nasal Septal Perforation

Repair of nasal septal perforation is a challenging problem to surgeons. Many surgical techniques which were reported through many literatures did not show high success rate constantly. The aim of this study was to examine the surgical technique of sandwich graft using inferior turbinate mucoperiosteal free graft and ear cartilage via open rhinoplasty approach. MATERIAL & METHODS: From May 2008 to December 2010, 7 patients who were suffered from nasal septal perforation underwent sandwich graft using ear cartilage and inferior turbinate mucoperiosteal free graft via open rhinoplasty approach. RESULTS: Mean age was 45+/-10.1 years (28~60 years old). We followed up 7 patients for 2 months after the surgery. Six of the 7 patients had a complete closure and one patient achieved incomplete closure. One patient who had incomplete closure was treated by primary closure again. CONCLUSIONS: Sandwich graft of inferior turbinate mucoperiosteal free graft and ear cartilage via open rhinoplasty approach showed high success rate and relatively easy surgical technique.

A Case of Adenoid Cystic Carcinoma of the Nasal Septum Misdiagnosed as Pleomorphic Adenoma / 대한이비인후과학회지

Adenoid cystic carcinoma is one of the most common minor salivary gland malignancies of the paranasal sinuses and nasal cavity and has a propensity for frequent local recurrencesand distant metastasis. It sometimes has variable histopathologic patterns in the same tumor, which makes diagnosis difficult. A very rare case of adenoid cystic carcinoma of the nasal septum, initially thought to be pleomorphic adenoma, is presented along with a review of the literature.

Correction of Saddle Nose Deformity using Autogenous Cartilage Graft

PURPOSE: Correction of saddle nose remains problematic both in the technique of reconstruction and in the choice of implant material for nasal augmentation. A large variety of graft materials have been used for the reconstruction of the saddle nose deformity. The purpose of this study is to determinate an algorithm for deciding alternative graft materials used in correction of saddle nose deformity. METHODS: Six patients with saddle nose who were corrected using by auricular cartilage and costal cartilage at Chosun university hospital were analyzed. RESULTS: After a mean interval of 12 months, all patients were satisfied with the esthetic and functional result. CONCLUSION: Auricular cartilage is an excellent graft material for esthetic and functional reconstruction of mild to moderate saddle nose deformity.

Correction of Saddle Nose Deformity using Autogenous Cartilage Graft

PURPOSE: Correction of saddle nose remains problematic both in the technique of reconstruction and in the choice of implant material for nasal augmentation. A large variety of graft materials have been used for the reconstruction of the saddle nose deformity. The purpose of this study is to determinate an algorithm for deciding alternative graft materials used in correction of saddle nose deformity. METHODS: Six patients with saddle nose who were corrected using by auricular cartilage and costal cartilage at Chosun university hospital were analyzed. RESULTS: After a mean interval of 12 months, all patients were satisfied with the esthetic and functional result. CONCLUSION: Auricular cartilage is an excellent graft material for esthetic and functional reconstruction of mild to moderate saddle nose deformity.

Mucosa-Associated Lymphoid Tissue Lymphoma Arising from the Nasal Mucosa: A Case Report and Review of the Literature / 대한이비인후과학회지

Most extranodal lymphomas arise in the gastrointestinal tract, but the other mucosal organs are rarely involved. We report a case of primary mucosa-associated lymphoid tissue (MALT) lymphoma of the nasal cavity. A 65-year-old woman was refered to our hospital with a history of prolonged epiphora in the left eye. Although nasal examination suggested normal except marked mucosal thickening of the inferior turbinate, partial inferior turbinectomy and biopsy revealed subepithelial infiltration of atypical lymphoid cells that stained for CD20, CD79a, and BCL-2 ; stained weakly for CD43, and this patient was finally diagnosed as having primary MALT lymphoma of the nasal cavity. This patient achieved complete remission after radiation therapy, and she remains free of disease for 6 months.

A Scoring System to Predict the Outcomes in Neonatal Seizures

PURPOSE: This study was designed to compare the follow up results with clinical and laboratory findings in patients with seizures in the neonatal period. Also, it was aimed to evaluate the usefulness of scoring prognostic factors and its efficacy as a prognostic index. METHODS: The subjects are 67 neonates who were admitted to Chungnam National University Hospital from January 1999 to April 2005 for seizures which occurred within 28 days of birth. These patients were investigated retrospectively from the hospital records. We scored clinical manifestations including gestational age, birth weight, Apgar score at 5 min, etiology, type, onset, duration, and frequency of seizures, neurologic examination results, EEG background activities, and treatment responses. Follow-up examinations were done to analyze the presence of epilepsy and neurologic deficits. A sum of the factors associated with outcomes regarded as a prognostic index, were studied. RESULTS: 50 cases(74.6%) showed normal outcomes, while 7 cases(10.4%) had unfavorable neurologic outcomes and 4 cases(6.0%) favorable neurologic outcomes with epilepsy. 6 cases(9.0%) showed unfavorable neurologic outcomes with epilepsy. All of the data including gestational age, Apgar score at 5 min, etiology, type, duration, and frequency of seizures, neurologic examination results, EEG background activities, and treatment responses were used as a prognostic index by a scoring system. When the cut-off point was 7, sensitivity, specificity, positive predictive value and negative predictive value were 76.5%, 78.0%, 54.2%, and 90.7% respectively. CONCLUSION: A scoring system for neonatal seizures earned high scores in sensitivity, specificity and negative predictive value, so that it seems to be useful as a predicitive prognostic index.

The diagnostic significance of serum bile acid on total parenteral nutrition induced cholestasis in premature infants / 소아과

PURPOSE: The purpose of this study is to find out the diagnostic significance of serum bile acid on total parenteral nutrition induced cholestasis in premature infants. METHODS: Infants without cholestasis were classified into postnatal days and each change of serum bile acid was measured and analyzed. Also, the serum direct bilirubin, serum bile acid, gamma-glutamic acid transferase, and alkaline phosphatase of premature infants with total parenteral nutrition induced cholestasis were measured for comparison and analysis of their correlation. RESULTS: Changes of serum bile acid analysis after birth showed no significant difference between boys and girls, between premature infants and term infants without cholestasis. Serum bile acid levels are constant after two weeks after birth in neonates without cholestasis. In premature infants with total parenteral nutrition induced cholestasis, the increase of serum direct bilirubin over 2 mg/ dL was 34.9+/-18.3 days after birth, and the increase of serum bile acid was 28.1+/-18.3 days. Its increase was about 1 week faster than serum direct bilirubin, however, there was no statistical significance(P=0.114). Comparing analysis of serum bile acid, gamma-glutamic acid transferase, and alkaline phosphatase, serum bile acid showed the highest correlation to serum direct bilirubin(r=0.487, P= 0.000). CONCLUSION: Serum bile acid is an important parameter of total parenteral nutrition induced cholestasis in premature infants and will be useful for early diagnosis and treatment.

Acute Torsion of a Wandering Spleen Managed by Splenopexy / 대한혈액학회지

Torsion of the spleen is a rare cause of abdominal pain in children and it may occur in conjunction with wandering spleen. Wandering spleen is the presence of the spleen in a location other than the left upper quadrant, and it is secondary to the congenital or functional absence of splenic ligaments. The occurrence of wandering spleen is rare in adults and it's even less common in children. The most common presentation is acute abdominal pain, although the signs and symptoms vary widely. Due to the risk of splenic infarction, making a rapid and accurate diagnosis is essential. When a wandering spleen is diagnosed, the treatment of choice is splenopexy, even if the patient is asymptomatic. If splenic necrosis is present, then splenectomy is usually required. We describe here a 4-year-old girl with torsion of a wandering spleen that was managed by splenopexy.

Brain Magnetic Resonance Imaging in Children with CNS Manifestations

PURPOSE: This study is to examine the relationship between clinical manifestations and MRI findings of children with CNS symptoms and signs. METHODS: A total of 447 inpatients with CNS symptoms and signs took brain MRI's at the Department of Pediatrics of Chungnam National University Hospital from July 2001 to June 2004. The results were retrospectively evaluated in terms of age, gender, chief complaints, and the findings of MRI and EEG based on the medical records. RESULTS: The overall incidence of abnormal MRI findings was 30.4%, of whom 44.7% were aged from one month to one year. The MRI findings were markedly different between under and over 6 years olds. In the former group, hydrocephalus, periventricular leukomalacia and hemorrhage were common while vascular malformation and brain tumor were more common in the latter group. Periventricular leukomalacia and hydrocephalus were shown to be the most frequent abnormal findings. 42.9% of those with seizures had abnormal MRI findings. Headache was common with 10.5% low incidence rate of abnormalies in MRI. The EEG findings were normal in 33.9% of the patients and there were not any articular correlations between EEG and MRI findings. CONCLUSION: MRI is important in the diagnosis of neurological disorders. However, caution should be taken in selecting patients since the MRI findings were normal in 69.6 % of the children with CNS symptoms and signs. This is the reason why more detailed standards of MRI for CNS manifestations are required.

A Case of Mesenteric Castleman's Disease with Systemic Involvement / 대한소아혈액종양학회지

Castleman's disease (CD) is a lymphoproliferative disorder of unknown origin and rarely occurs in children. It has been further classified into two major subgroups: solitary or localized and multicentric CD. Furthermore, there are two main histological variants: hyaline-vascular, plasma cell types. Clinically, hyaline-vascular type is rarely associated with systemic symptoms, but the plasma cell type is frequently associated with the constitutional symptoms of fever, malaise, night sweat and the abnormal laboratory markers. Surgical excision of the affected lymph node plays an important role in the treatment of this disease. We encountered a case of the hyaline-vascular type CD located in the mesentery with systemic involvement. The clinical and biochemical abnormal findings improved after surgical resection of the involved lymph node.

The Long Term Results of Ossicular Chain Reconstruction Using IONOS(R) in Chronic Otitis Media Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The goals in the surgery of chronic otitis media are to gain control of infection, closure of the tympanic membrane defects and hearing rehabilitation via ossicular chain reconstruction. Polymaleinate ionomeric cement, which has been used in dentistry as a filling and lute material for more than 15 years, has recently been used to construct total and partial ossicular prostheses. We intended to evaluate the hearing results of ossicular chain reconstruction using polymaleinate ionomeric prosthesis (IONOS(R)) in patients with chronic otitis media with the minimum 3 years postoperative follow-up periods. MATERIALS AND METHOD: Forty-four cases (30 PORP and 14 TORP), who underwent ossicular chain reconstruction using IONOS(R) in the Chonnam University Hospital from 1993 to 1996, were reviewed retrospectively. A postoperative hearing was accessed by the postoperative air-bone gap (ABG). Postoperative ABG was divided into the following three groups, ABG of or=31 dB. RESULTS: In the 44 total cases, 14 cases (31.8%) had

The Effect of Mastoid Obliteration Technique Using Superiorly Based Musculoperiosteal Flap and Autologous Conchal Cartilage / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The debate regarding the surgical technique for the management of open mastoid cavity still continues. In this study, we investigated the mastoid obliteration effect of superiorly based musculoperiosteal flap (SBF) with or without the combination of autologous conchal cartilage comparing with the well known Palva flap. MATERIAL AND METHOD: The 51 ears of 51 chronic otitis media or cholesteatoma patients who had been performed open cavity tympanomastoidectomy surgery with mastoid obliteration during the period from 1998 to 1999 were included in this study. Of the 51 ears, mastoid obliteration was performed using SBF and conchal cartilage in 25 ears, using SBF only in 18 ears and using the Palva flap in 8 ears. The duration of cavity epithelization and the increment of ear canal volume were compared among these three groups. The volume of ear canals and postoperative cavities were measured by filling the ear canals with sterile saline solution up to the cartilaginous part of the ear canal, starting at the level of tympanic membrane when the patient was lying on his side with the ear examined facing upward. RESULTS: Analysis of the data showed significant differences among the three groups in either duration of cavity epithelization (SBF & cartilage: 76+/-20 days, SBF only : 85+/-18 days and Palva flap : 106+/-21 days) and increased rate of postoperative ear canal volume (SBF & cartilage : 72%, SBF : 102% and Palva flap : 171%). CONCLUSION: The results of this study shows better outcomes in the groups of SBF & cartilge or SBF only compared with the group of Palva flap in terms of duration of cavity epithelization and increment of ear canal volume. Especially, SBF combined with autologous conchal cartilage achieves more favorable results. Thus, we suggest that the SBF & cartilage mastoid obliteration technique is one of the useful technique for the patients with open cavity tympanomastoidectomy.

Usefulness of Flexible Bronchoscopy in the Diagnosis of Tracheobronchial Foreign Bodies in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diagnosis of foreign body aspiration in children has not been satisfactory, although many methods have included history, physical examination, radiographic findings, computed tomography, magnetic resonance imaging, and lung scan. Therefore, a simple and definitive method is needed and we have studied the usefulness of flexible bronchoscopy in the diagnosis of tracheobronchial foreign bodies in children. MATERIALS AND METHOD: A retrospective review was undertaken of 67 cases referred with suspicion of foreign body aspiration. The age of patients ranged from 3 months to 192 months, with a mean age of 33.5 months. Flexible bronchoscopy was performed in 37 cases with topical-local anesthesia, because the evidence of tracheobronchial foreign body aspiration was not conclusive. RESULTS: We detected foreign bodies in 72.9% (27) and secretion suggesting foreign bodies in 18.9% (7). All of 34 children who were suspicious of having foreign bodies underwent rigid bronchoscopy and 32 had foreign bodies. Three children who had normal flexible bronchoscopic examination were discharged after improvement by medical treatment. There were no complications except transient cyanosis. CONCLUSION: We suggest that the diagnostic use of the pediatric flexible bronchoscope is safe, definitive, and cost-effective method for the identification of patients with tracheobronchial foreign bodies.