Giant Brain Abscess in a Neonate: Good Outcome with Single Transfontanelle Aspiration and Antibiotic Therapy

Brain abscesses in neonates are extremely rare and usually occur in patients with certain risk factors. A 1-month-old boy presented at the hospital with fever and irritability. As a result of preterm delivery and low birth weight, he had a history of admission to the neonatal intensive care unit. Neuroimaging revealed a large, space-occupying lesion in both frontal lobes, which was suspected to be an abscess with the midline shifting to the right. With a single aspiration and abscess drainage along with concurrent prolonged parenteral antibiotic therapy, the patient showed an excellent treatment outcome with normal development. The focus will be placed on minimally invasive surgical management as well as positive outcomes.

Four Children with Multidrug-resistant Acinetobactor baumanii Infections in the Intensive Care Units of a University Hospital / 소아감염

The Multidrug-resistant Acinetobactor baumanii (MDRAB) is an opportunistic pathogen. Patients with long periods of hospital stay and/or under intensive care unit (ICU) receiving invasive management are more susceptible to this pathogen. In this report, four children with MDRAB infection are reviewed and described their clinical characteristics. There had been concurrent outbreaks of MDRAB infection in adult patients in the ICU at this period of time. The first child had received a craniotomy and epidural hematoma evacuation. The second child was admitted for status epilepticus with hydrocephalus. The third child had pneumonia with status epilepticus with hydrocephalus. The fourth child had poor activity due to hypoxic ischemic encephalopathy and convulsive disorder. Except the fourth child, all had not been exposed to carbapenem prior to infection of MDRAB. That imply the cause of MDRAB infections may be associated with invasive management and prolonged hospitalization together with the previous exposure to carbapenem in our cases. We would like to emphasize the importance and minimizing the spread of hospital infection in patients under prolonged intensive care management regardless of the use of carbapenem.

Age and Dosage-related Longitudinal Changes in Body Mass Index on Epileptic Children Treated with Topiramate / 대한소아신경학회지

PURPOSE: The objective of this prospective study is to assess changes in body mass index(BMI, weight in kilograms/height in meters2) according to age and dosage on epileptic children treated with topiramate. METHODS: From January 2006 to December 2008, prospective studies have been performed on 63 children with epilepsy aged below 15 old who had been treated with topiramate. Patients were classified into 3 groups according to age: 2-5 years as a group 1; 6-10 years as a group 2; 11-15 years as a group 3;, and classified into 2 groups according to dosage: from 2 to 5 mg/kg/day as group A, more than 5 mg/kg/day to 8 mg/kg/day as group B. We have checked BMI of patients four times and evaluated the changes in BMI of each group. RESULTS: BMI at initial presentation and follow-up periods of 6, 12, and 24 months is as follows: 16.3+/-1.25, 14.3+/-1.8, 14.2+/-2.4, and 15.7+/-2.1 in the group 1, 18.5+/-1.23, 15.2+/-1.24, 14.8+/-2.27, and 16.8+/-2.5 in the group 2, 21.6+/-2.31, 16.5+/-2.17, 15.4+/-2.56, and 15.1+/-1.3 in the group 3. Comparing with group A and B is as follows: 19.3+/-2.35 and 18.1+/-1.89 at initial presentation, 15.5+/-2.45 and 15.1+/-1.15 at 6 months, 14.9+/-2.15 and 14.7+/-1.91 at 12 months, 15.9+/-1.28 and 16.0+/-1.12 at 24 months. CONCLUSION: The effect of topiramate on changes of BMI shows difference according to age. In groups of 2-10 years old, BMI was rebounded from lowest value after 12 months, however, in the group of 11-15 years old, BMI kept decreasing at 24 months. And dosage of topiramate does not affect to BMI significantly.

The age and dose-related hyponatremia during carbamazepine and oxcarbazepine therapy in epileptic children / 소아과

PURPOSE: To assess the prevalence of hyponatremia in epileptic children receiving carbamazepine or oxcarbazpine, we investigate serum sodium changes according to age, serum carbamazepine level, and daily oxcarbazepine dosage, and the prevalence of symptoms of hyponatremia. METHODS: We reviewed the clinical data of the 197 children receiving carbamazepine and/or oxcarbazepine with or without antiepileptic therapy. And these were classified into the carbamazepine treated patients (group I), oxcarbazepine treated patients (group II), and carbamzepine or oxcarbazepine with other antiepileptics treated patients (group III). Potentially predictive values for development of hyponatremia were examined in each group: age, plasma level of carbamazepine and daily dosage of oxcarbazepine. We assessed the symptoms of hyponatremia. RESULTS: The overall prevalence of hyponatremia was 20.8% (group I, II and III: 17.9%, 22.6%, and 21.8%, respectively), and the prevalence in groups II and III compared with controls (P<0.03) was significantly lower. The changes of serum sodium levels relation to age were not significantly different. The changes of serum sodium levels by increasing of serum levels of carbamazepine and dosage of oxcarbazepine were statistically significant (P<0.01). Among the 41 patients who had biochemical hyponatremia, the prevalence of hyponatremic symptoms was 17.1%. CONCLUSION: Hyponatremia may occur relatively more frequently with oxcarbazepine or combined other antiepileptics than carbamzepine therapy only. Age of children receiving carbamazepine or oxcarbazepine was no predictive value for occurrence of hyponatremia. The patients whose serum level were less than 125 mEq/L showed more severe clinical symptoms than any other study groups.

A Case of Multiple Cardiac Myxomas Complicating Recurrent Right Hemiparesis in a Child who had a Wrong Diagnosis of Acute Disseminated Encephalomyelitis

Multiple cardiac myxomas are rare in children. However, myxomas may be lethal because of their various manifestations such as blood flow obstruction, embolization and constitutional changes. Especially, the cerebral infarction due to tumor fragmentation are more likely to be misdiagnosed of acute disseminated encephalomyelitis. We report a case of multiple cardiac myxoma complicating recurrent right hemiparesis in a 12-year-old child who at first had a wrong diagnosis of acute disseminated encephalomyelitis (ADEM). Consequently, a child who show unrepresentative symptom of ADEM, should be examined rapidly by various tools to rule out the cerebral infarction from cardiogenic cause.

Surgical removal of a left ventricular thrombus caused by acute myocarditis / 소아과

Left ventricular thrombus is mainly caused by anterior myocardial infarction or severe cardiac wall dysfunction of the apex, and is rarely caused by a complication of acute myocarditis. A 12-year-old female who developed symptoms of motor dysphasia and incomplete hemiparesis of the right side was admitted to the hospital. The brain MRI taken on the day of her admission showed acute cerebral infarction in the left basal ganglia and the frontoparietal lobe. The echocardiogram showed a movable thrombus, which was 19x28 mm sized and located in the apex of the left ventricle. So in order to prevent further thromboembolic event we performed open cardiac surgery via the atrium and removed the thrombus of the left ventricle. After the removal of the thrombus her symptoms improved and she was discharged from the hospital. Thrombus formation in acute viral myocarditis are considered to be related with endocardial injury and blood flow stasis. Treatment with anticoagulants in left ventricular thrombosis may not be effective and may even cause a major thromboembolism. When the thrombus is laminar and fixed, one should consider anticoagulant therapy. But if the thrombus is pedunculated and movable, which means that there are higher possibilities of major embolism or there may be already one, one should consider surgical removal. We report a 12-year-old girl who required surgical removal of a left ventricular thrombus caused by acute viral myocarditis.

Clinical Analysis of Neonatal Microtia

PURPOSE: Neonatal microtia is an external ear deformity that takes various forms in degrees from minor deformity to aural atresia. Microtia causes not only simple deformity of the auricle but also the deformity of the middle ear or/and the internal ear leading to hearing loss. We intended to analyze the clinical manifestation of microtia in neonate period. METHODS: 17 neonates born with microtia who were admitted to Kyung Hee Hospital from January 1994 to June 2003 were evaluated for clinical characteristics including associated anomalies, outcomes, findings of temporal computer tomogram (CT) and auditory brainstem response test. RESULTS: The most common type of microtia was grade III (64.7%) followed by grade II (29.4%) and grade I (5.9%) according to the Marx classification. Temporal CT was carried out in 15 cases which showed external ear abnormalities in 7 cases, external and middle ear abnormalities in 5 cases, and external middle and internal ear abnormalities in 3 cases. 7/15 (46.7%) cases had partial hearing loss, followed by 4/15 (26.7%) cases of total hearing loss and 4/15 (26.7%) cases of normal hearing. Associated anomalies among 8/17 (47%) cases included congenital heart disease, celft palate and lip, microcephaly, micrognathia, CONCLUSION: Neonate born with microtia should be evaluated and followed closely for combined anomalies such as middle or internal ear deformities as these may lead to hearing loss affecting language and emotional development.

Diagnostic Availability of PCR in the Mycoplasma pneumoniae Pneumonia of Children / 소아알레르기및호흡기학회지

PURPOSE: Mycoplasma pneumoniae is one of the most common causes of pneumonia in children and adolescents. Though cold agglutinin test and specific antibody test are used in the diagnosis of mycoplasma pneumonia, there are some limitations in early diagnosis. In this study, we evaluated the availability and usefulness of polymerase chain reaction (PCR) in the diagnosis of M. pneumoniae pneumonia and compared it with serologic test. METHODS: One hundred twenty four children who were clinically diagnosed with pneumonia and admitted to Kyunghee Hospital from January 1998 to March 2001 were enrolled. Mycoplasma specific antibody test using commercial kit (Serodia-MYCO II, Fusirebio Inc., Tokyo, Japan) and PCR using mycoplasma DNA obtained from throat swabs were done. The sensitivity and specificity of PCR were evaluated. RESULTS: M. pneumoniae pneumonia was diagnosed when the mycoplasma specific antibody titer was over 1: 160 or when the titer increased more than fourfold during follow-up period. The specificity, sensitivity, false-positive rate and false-negative rates of PCR were 93.0%, 58.3%, 33.3%. and 9.7%, respectively. CONCLUSION: PCR has shown high specificity. But, the positive result in PCR don't correlate with the disease activity and PCR does not have high sensitivity. So PCR must be used alongside with serologic test in the diagnosis of pneumonia. But, it seems possible to improve sensitivity by delicate handling of samples and by improving PCR technology, and PCR will possibly be used in the diagnosis of early infections of M. pneumoniae pneumonia and in the evaluation of treatments in the future.

Common Pediatric Neurological Diseases at Pediatric Outpatient Clinics

According to the domestic as well as foreign reports, pediatric neurological diseases might be misunderstood as those of the distant and rare illnesses to primary physicians, however, they account for 3~4% of pediatric outpatients visit, which means pediatric neurological diseases are not uncommon. The most leading neurological cause of pediatric clinic visits is convulsive disorder, followed by head trauma, behavioral problems and psychosomatic disorders, congenital anomalies with neurological manifestations, developmental delay including cerebral palsy, CNS infections, perinatal neurologic disorders, cerebral degenerative diseases, and so on. Because these statistical results excluded neurological diseases detected at personal or collective medical checkup and nursing-health consultation, the neurological diseases actually account for over 4% of pediatric outpatient visits. The need for improvement both in range and quality of primary care, and of early diagnosis and prevention of chronic disease is increasing, gradually outdating disease-oriented medical approach in the past. The patients and their families should have preliminary knowledge on their particular diseases since the medical expertise is spreading along the advance of mass media and information technology. Therefore, they are hardly satisfied if primary physician simply explains that 'seizure due to fever' is called 'febrile convulsion', or 'children with subnormal intelligence' are regarded as 'mental retardation'. Therefore, physicians should illustrate the cause of illnesses, the extent of symptoms, differential diagnoses, complications, prognoses, as well as sequelae. Here the author briefly describes the differential diagnoses of the most common symptoms-seizure, developmental delay and headache.

The Effects of Soy-Based Infant Formula on Growth and Development, and the Isoflavone Concentration of Plasma and Urine in Full-Term Infants

Soy-based formula has been used for centuries in Korea. Soybeans contain phytochemicals with a biochemically active component, isoflavone. Isoflavone is a kind of phytoestrogens, structurally and functionally similar to estrogen. This study was conducted to investigate the effects of soy-based infant formula on growth, development, and isoflavone concentration in the plasma and urine. Thirty-nine healthy infants who were delivered at K university medical center were recruited. Experimental groups were the breast milk group (n = 15, BM) who were fed breast milk, soy-based formula group (n = 10, SBF) who were fed soy-based infant formula, and the casein-based formula group (n = 14, CBF) who were fed casein-based infant formula for 4 months. HPLC analysis was used to measure the concentration of isoflavones. The measurements of infant weight, length, head circumference and chest circumference were all in the normal growth range and were similar among the experimental groups. No significant differences were found in the scores of total mean of infant development test (Development Quotient, DQ) among the experimental groups. The isoflavone content of soy-based formula was significantly higher than. that of breast milk and casein-based formula. Plasma concentration of daidzein and genistein in the infants fed soy-based formula (daidzein : 264.1 ng/ml, genistein : 392.1 ng/ml) was significantly higher (p<.0001) than that in infants fed breast milk (daidzein : 3.4 ng/ml, genistein : 3.8 ng/ml) and casein-based formula (daidzein: 8.1 ng/ml, genistein: 9.3 ng/ml). Also, urinary daidzein and genistein concentrations in infants fed soy-based formula (daidzein: 19.82 microgram/ml, genistein : 17.89 microgram/ml) were significantly higher (p<.001) than those in infants fed breast milk (daidzein: 0.28 microgram/ml, genistein : 0.22 microgram/ml) and casein-based formula (daidzein : 0.45 microgram/ml, genistein : 0.33 microgram/ml).

Assessment of the Relationship between Vigabatrin and Visual Field Defect in Children

PURPOSE: The authors carried out this study to determine the relationship between vigabatrin (VGB) and visual field defect. METHODS: Seventy eight patients older than 8 years who had epilepsy which had developed and been diagnosed, and were receiving add-on therapy, were the subjects of this study. If suspicious results were obtained from the initial test with the Humphrey automatic perimeter, the patient was tested again with the Goldman perimeter. Follow-up examinations were performed on these patients after 6 months. RESULTS: In this study, five of the 78 patients had suspicious primary test results, but upon the second examination they were all found to be normal. Thus there were no patients with visual field defects. CONCLUSIONS: VGB is a drug which may cause visual field defects, but in this study no patients presented with this symptom. Instead of limiting the use of VGB due to the adverse effect of visual field defect in the initial treatment of partial seizure and infantile spasm untreatable with other medication, if used with care it may not cause serious problems. Screening for visual defect is recommended, and in patients taking VGB regular examination is necessary.

A Follow-Up Study after Discontinuation of Antiepileptic Drug Therapy in Children with Well-Controlled Epilepsy: The Factors that Influence Recurrence

PURPOSE: There has been no exact answer to the question of when to discontinue antiepileptic drugs(AEDs) in children with well-controlled epilepsy for a long period. This study is about the risk factors of relapse after withdrawal of AEDs in seizure(Sz)-free patients to show a guideline for discontinuation of AEDs. METHODS: One hundred and sixty-nine children were diagnosed as epileptic at the Pediatric Dept.of Kyung-Hee Univ. between 1993 to 1998, in whom AEDs had been withdrawn after at least two years of Sz-free period. Univariate analysis using Kaplan-Meier survival analysis and multivariate analysis using Cox-proportional hazard model were performed for sixteen risk factors. RESULTS: Forty-nine of the 169 patients(28.9%) had recurrence of Szs. The mean follow-up after withdrawal of AEDs was 4.1 years, mean treatment period was 4.1 years, and the mean Sz-free period was 3.3 years. Factors associated with an increased risk of relapse were young age at onset, symptomatic Sz, Sz type in West and Lennox-Gastaut syndrome, neurologic deficit, longer Sz-controlling period, shorter total treatment period, number of AEDs used(more than one drug), age at withdrawal of AEDs, and Sz-free period less than two years in univariate analysis using Kaplan-Meier mothod. From multivariate analysis, the factors indicating a significantly higher relapse risk were pre-treatment period after first Sz attack, Sz-controlling period, Sz-free period, number of AEDs used, neurologic abnormalities. CONCLUSIONS: For epileptic children who were Sz-free for more than two years, and were more than six-years-old, the discontinuation of AEDs should be considered positively, according to age of onset, Sz type, age at withdrawal of AEDs, total treatment period, Sz-controlling period, number of AEDs used, etiology, neurologic deficit, and the wishes of the patients and the their parents.

Developmental Test in Children

No abstract available.

Classification of Epileptic Seizures and Syndromes: Historical Review and Changes in Terms and Concepts / 대한소아신경학회지

No abstract available.

Clinical Study of Effectiveness Topiramate in Children with Intractable Epilepsy

PURPOSE: Topiramate(TPM) is a new anticonvulsant with multiple action mechanisms which should theoretically represent a wide therapeutic spectrum. However, there is still little clinical experience of its use in Asian children with epilepsy. METHODS: The patients were total 96 children who were treated with more than 2 anticonvulsants but poorly controlled seizure activity. TPM was given as add-on therapy and evaluated the efficacy and adverse events prospectively. This study consisted of 8 weeks of baseline phase, 10- 16 weeks titration phase, and 8 weeks of stabilization phase. Clinical efficacy was classified into 4 groups : disappearance, marked improvement, improvement, no improvement. RESULTS: When TPM was prescribed, a response of >50% reductions in seizure attacks was seen in 90.6% of cases(95.5% of partial type epilepsy) and disappearance was seen in 67.7% of cases (83.3% of generalized type epilepsy). Concommitent with the larger number of anticonvulsants a longer duration of epilepsy and more frequent seizure attack was showed more lower disappearance rate of seizure attack. Adverse event weight loss(9.4%), somnolence(7.3%), dizziness(5.2%), skin rash, decreased cognitive function, nocturia(3.1%) and headache(2.1%) were noted, but were mostly not serious. CONCLUSION: TPM seems to be a promising new broad-spectrum anticonvulsant, which is efficacious and safe in children with intractable epilepsy.

Clinical Review of the Development Epilepsy in Patients with Febrile Seizure / 대한소아신경학회지

PURPOSE: Febrile seizure is a common neurological disorder in children and it has been reported that it may progress to epilepsy in a few cases. We have set forth to carry out a prospective study of patients who developed epilepsy after febrile seizures to determine their clinical characteristics. METHODS: The subjects of this research were 104 patients who met WHO's definition of epilepsy after at least 6 months had passed since their first seizure of the 612 patients admitted to the pediatrics department of Kyung-hee Medical Center during 5 years from January of 1993 to January of 1998 for their first febrile seizure. Epilepsy was categorized as epileptic seizure according to ILAE(1981). RESULTS: 1) The incidence of epilepsy was highest in children from 3 years to 5 years. 2) Of 104 children who developed epilepsy, 60 children were males and 44 were females. 3) Of children who eventually developed epilepsy, 37% of them had the family history of seizure. 4) Of 612 cases of first attack febile seizure, generalized tonic-clonic type was the most frequent type and at the time of diagnosis of epilepsy, generalized tonic-clonic type was also the most frequent type. 5) The abnormal EEG findings are found in 95% of children who developed epilepsy. CONCLUSIONS: We observed the clinical characteristics of patients who developed epilepsy after febrile seizures, but we feel that continuous research is necessary in establishing a correlation between the two disorders.

Analysis of Risk Factors of Readmission to Hospital for Pediatric Asthma

PURPOSE: The admission rates for pediatric asthma are increasing annually and are partially responsible for the increased rates of readmission. Selections of children with a high-risk of readmission and aggressive treatments of them may improve treatment outcome and cost- effectiveness. The purpose of this study is to evaluate the risk factors affecting readmission in cases of bronchial asthma in children. METHODS: We reviewed the medical records of 95 cases under 14 years of age who were admitted to the Department of Pediatrics, Kyung-Hee University, from March 1996 to February 1997 and divided them into readmission and first admission group. RESULTS: Readmission cases were 52 (55%). Age, sex, duration of admission, duration of oxygen therapy, serum IgE concentration, duration of symptoms prior to admission and severity of asthma were not statistically significant compared with those of the control group (t-test) (P>0.05). Use of prophylactic agents, family history of allergic diseases and past history of bronchiolitis were significant (P0.05) as independent risk factors. CONCLUSION: Age under 4 years, past history of bronchiolitis, and history of previous hospital admission for asthma were significant risk factors for hospital readmission. Further study needs to be done to decrease the readmission rates.

Role of Polymorphism in HLA DQ-alpha and -beta Chain Loci in the Pathophysiology of Autoimmune Thyroid Disease in Children with and without Turner Syndrome

PURPOSE: About 10% of girls with Turner syndrome may have autoimmune thyroid disease(AIT), but the disease's pathophysiology has not yet been elucidated. Accordingly, this study was performed to observe whether the pathogenesis of AIT in children with Turner syndrome and without Turner syndrome correlate with special loci of DQ and chain in HLA. METHODS: Blood samples were drawn from children with and without Turner syndrome. Thyroid antibodies(anti-thyroglobulin and anti-microsomal antibody) were measured from the samples to determine AIT. DNAs were extracted with the DNA extraction kit and processed in PCR reaction for amplification of exon 2 region of HLA-DQA1 and -DQB1, and then eluted again. The eluted PCR products were sequenced directly with an automatic sequencer. The sequences were compared with those of normal control. RESULTS: There was a signficant increase in frequencies of HLA DQA1*0301(P<0.05) and HLA DQB1*0601 but without statistical significance(P=0.06) in normal children with AIT, compared with those in control group. There was signficantly but slightly increased frequency of HLA DQA1*0104, 0105 and DQB1*0202 in the group of children with Turner syndrome who had AIT than in control group. The frequency of the marker chromosome(45,X/46,XX+mar) increased in children with Turner syndrome who had AIT, compared with these in children with Turner syndrome who did not have AIT. Children with Turner syndrome who had spontaneous puberty had higher a incidence rate of AIT than those who did not have spontaneous puberty(P<0.01). CONCLUSION: The results suggest that HLA DQA1*0301 and HLA DQB1*0601 play a role in the pathogenesis of AIT in children without Turner syndrome, but not in children with Turner syndrome. Additionally, there seem to be other factors participating in the pathogenesis of AIT in children with Turner syndrome, such as chromosomal karyotype and spontaneous puberty. Therefore, the factors participitating in the pathogenesis of AIT in children with Turner syndrome remain to be elucidated with further study.

A Clinical Study on Infantile Spasms with Vigabatrin Therapy

PURPOSE: Infantile spasms are considered an age-specific and malignant epilepsy. It is not controlled easily by general anticonvulsants. Therefore, this study aimed to assess vigabatrin(VGT) efficacy in infantile spasms. METHODS: From January 1992 to December 1995, 35 children with infantile spasms, who were diagnosed at Kyung Hee University Hospital and treated vigabatrin, were analyzed retrospectively. RESULTS: The ratio of male to female was 1.7 : 1.2. Mean age at onset of infantile spasms was 7.6+/-3.4 months old and mean duration from onset of the disease to the beginning of the treatment was 2.4 months. Mean duration of vigabatrin treatment was 24.2 months. The most common type of infantile spasms was the flexion type with 26 cases(74.3%). Cryptogenic group had 13 cases and symptomatic group 22 cases. The most common causes were tuberous sclerosis, agyria-pachygyria, brain atrophy and hygroma(each are 4 cases). Among vigabatrin monotherapy(15 cases), complete cessation of seizure were 2 cases and 99-75% seizure reduction was 6 cases and among vigabatrin add-on therapy(20 cases), complete cessation was 4 cases and 99-75% seizure reduction was 6 cases. The most common combined anticonvulsant used was prednisolone. CONCLUSION: The effectiveness of vigabatrin in infantile spasms was good due to more than 75% reduction in seizure frequency in 51.4% of cases. Vigabatrin should be used in refractory infantile spasms.

Comparison of Mini-Wright Peak Flow Meter and Microplus Pocket Spirometer in Measuring Peak Expiratory Flow Rate / 소아알레르기및호흡기학회지

PURPOSE: Peak expiratory flow rate (PEFR) monitoring plays an important role in the diagnosis of airway obstruction and management of patients with bronchial asthma. This study compared the PEFR taken by a Microplus pocket spirometer and mini-Wright peak flow meter by assessing the extent of agreement between the instruments and the repeatability of measurements with each instrument. METHODS: Eighty healthy children (age 11-12 years, 43 females, 37 males) performed three PEFR maneuvers on the Microplus pocket spirometer and on the mini-Wright peak flow meter in a random order. Agreement and reproducibility between the two instruments were assessed by the statistical methods proposed by Bland and Altman. RESULTS: Seventy six (95%) of the PEFR taken by the mini-Wright peak flow meter were higher than that of Microplus pocket spirometer. The 95% limits of agreements (mean difference+/-2SD) between each instrument were very wide (2.7 to 144.3 L/min). The repeatability coefficient for the mini-Wright peak flow meter was 27 L/min and for the Microplus pocket spirometer was 33.5 L/min. Analysis by sex and order of usage did not show any significant differences. CONCLUSION: The limit of agreement between the Microplus pocket spirometers and the mini-Wright peak flow meter was too wide to use interchangeably.