Changes in the thyroid hormone profiles in children with nephrotic syndrome / 소아과

PURPOSE: We compared thyroid hormone profiles in children with nephrotic syndrome (NS) during the nephrotic phase and after remission. METHODS: This study included 31 pediatric NS patients. The thyroid hormone profiles included serum levels of triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and free T4. RESULTS: Of the 31 patients, 16 (51.6%) showed abnormal thyroid hormone profiles: 6 had overt hypothyroidism, 8 had subclinical hypothyroidism, and 2 had low T3 syndrome. The mean serum T3, T4, and free T4 levels in the nephrotic phase and after remission were 82.37±23.64 and 117.88±29.49 ng/dL, 5.47±1.14 and 7.91±1.56 µg/dL, and 1.02±0.26 and 1.38±0.23 ng/dL, respectively; the levels were significantly lower in the NS nephrotic phase (P=0.0007, P<0.0001, and P=0.0002). The mean serum TSH levels during the nephrotic phase and after remission were 8.05±3.53 and 4.08±2.05 µIU/ mL, respectively; they were significantly higher in the nephrotic phase (P=0.0005). The urinary protein/ creatinine ratio during the nephrotic phase was significantly correlated with serum T3, T4, and free T4 levels (r=-0.5995, P=0.0032; r=-0.5797, P=0.0047; r=-0.5513, P=0.0078) as well as with TSH levels (r=0.5022, P=0.0172). A significant correlation was found between serum albumin and serum T3 levels during the nephrotic phase (r=0.5385, P=0.0018) but not between serum albumin and T4, TSH, or free T4 levels. These significant correlations all disappeared after remission. CONCLUSION: Abnormal thyroid hormone profile findings were observed in 51.6% of pediatric patients with NS. Thyroid hormone levels normalized after remission, regardless of levothyroxine therapy.

Nursing Tasks and Practice Environment for Nursing Work Perceived by Nurses Working on Comprehensive Wards versus General Wards / 간호행정학회지

PURPOSE: This study was performed to measure the level of nursing tasks and practice environment of nursing work (PENW) perceived by nurses working on comprehensive wards or general wards, and to investigate the relationship between these two variables. METHODS: This study was a cross-sectional survey. Participants were 97 nurses working on comprehensive or general wards of one general hospital in Gyeonggido, Korea. Data were collected from October 17 to 21, 2016 using the structured questionnaires and analyzed with SPSS/PC ver 18.0 programs. RESULTS: The scores for nursing tasks (performance, importance, and knowledge) perceived by nurses working on comprehensive wards were higher than nurses on general wards. The score for PENW perceived by nurses working on comprehensive wards was significantly higher than that of nurses on general wards. For comprehensive ward nurses, there was a relationship between nursing tasks and PENW, but no relationship was found for general ward nurses. CONCLUSION: This findings show that nurses working on comprehensive wards evaluate nursing tasks and PENW higher than nurses working on general wards indicating that nursing managers should work to raise the perception of general ward nursing tasks and PENW.

The influence of gonadotropin releasing hormone agonist treatment on the body weight and body mass index in girls with idiopathic precocious puberty and early puberty

PURPOSE: This study aimed to investigate the influence of gonadotropin releasing hormone agonist (GnRHa) treatment on the weight and body mass index (BMI) of girls who were diagnosed with idiopathic central precocious puberty (CPP) or early puberty (EP). METHODS: Patients who were younger than 8 years of age at diagnosis were classified as CPP and patients aged between 8 and 9 years at diagnosis were classified as EP. Of 129 patients, 34 were diagnosed with CPP and 95 were diagnosed with EP. The patients were divided according to pretreatment weight status into normal weight group, an overweight group, or an obese group. RESULTS: No significant changes were observed with respect to the weight standard deviation score (SDS) before and after 1 year, 2 years of treatment, respectively (P>0.05, P>0.05) in all patient groups. No significant changes were observed in relation to the BMI SDS before and after 1 year, 2 years of treatment, respectively (P>0.05, P>0.05) in all patient group. Depending on the degree of obesity, differences with respect to the weight SDS and BMI SDS were observed. CONCLUSION: BMI SDS increased in the GnRHa-treated patients as a whole group, but was not statistically significant. But BMI SDS increased significantly in the normal weight group after 2 years of GnRHa treatment. So, GnRHa treatment may affect the change of BMI SDS depending on degree of obesity.

A Case of Solitary Rectal Ulcer Syndrome in a 16-year-old Girl Presented with Iron Deficiency Anemia / 임상소아혈액종양

Solitary rectal ulcer syndrome (SRUS) is a rare condition that is most commonly characterized by rectal pain and bleeding. It can be accompanied by diarrhea or constipation, tenesmus, and rectal prolapse. Considering its non-specific symptoms, it is often difficult to diagnose, particularly in children. The underlying etiology of SRUS is not fully understood; however, it may be secondary to ischemic changes in the rectum associated with paradoxical contraction of the pelvic floor and external anal sphincter muscles and rectal prolapse. The macroscopic appearance of the rectal lesion may vary from hyperemia to ulceration or a polypoid lesion that can mimic carcinoma, although the histological findings are characteristic, with fibromuscular obliteration of the lamina propria and disorientation of muscle fibers. We report an adolescent case of SRUS developed in a 16-year-old adolescent girl who presented with iron deficiency anemia.

A Case of Solitary Rectal Ulcer Syndrome in a 16-year-old Girl Presented with Iron Deficiency Anemia / 임상소아혈액종양

Solitary rectal ulcer syndrome (SRUS) is a rare condition that is most commonly characterized by rectal pain and bleeding. It can be accompanied by diarrhea or constipation, tenesmus, and rectal prolapse. Considering its non-specific symptoms, it is often difficult to diagnose, particularly in children. The underlying etiology of SRUS is not fully understood; however, it may be secondary to ischemic changes in the rectum associated with paradoxical contraction of the pelvic floor and external anal sphincter muscles and rectal prolapse. The macroscopic appearance of the rectal lesion may vary from hyperemia to ulceration or a polypoid lesion that can mimic carcinoma, although the histological findings are characteristic, with fibromuscular obliteration of the lamina propria and disorientation of muscle fibers. We report an adolescent case of SRUS developed in a 16-year-old adolescent girl who presented with iron deficiency anemia.

Effects of Diet-Induced Mild Obesity on Airway Hyperreactivity and Lung Inflammation in Mice

PURPOSE: Obesity has been suggested to be linked to asthma. However, it is not yet known whether obesity directly leads to airway hyperreactivity (AHR) or obesity-induced airway inflammation associated with asthma. We investigated obesity-related changes in adipokines, AHR, and lung inflammation in a murine model of asthma and obesity. MATERIALS AND METHODS: We developed mouse models of chronic asthma via ovalbumin (OVA)-challenge and of obesity by feeding a high-fat diet, and then performed the methacholine bronchial provocation test, and real-time PCR for leptin, leptin receptor, adiponectin, adiponectin receptor (adipor1 and 2), vascular endothelial growth factor (VEGF), transforming growth factor (TGF) beta, and tumor necrosis factor (TNF) alpha in lung tissue. We also measured cell counts in bronchoalveolar lavage fluid. RESULTS: Both obese and lean mice chronically exposed to OVA developed eosinophilic lung inflammation and AHR to methacholine. However, obese mice without OVA challenge did not develop AHR or eosinophilic inflammation in lung tissue. In obese mice, lung mRNA expressions of leptin, leptin receptor, VEGF, TGF, and TNF were enhanced, and adipor1 and 2 expressions were decreased compared to mice in the control group. On the other hand, there were no differences between obese mice with or without OVA challenge. CONCLUSION: Diet-induced mild obesity may not augment AHR or eosinophilic lung inflammation in asthma.

Increased Prevalence of H1N1-Induced Severe Lower Respiratory Tract Diseases in Children With Atopic Sensitization

PURPOSE: Viral infection is the most common aggravating factor for childhood asthma. Asthma may be a risk factor for severe respiratory symptoms in children with lower respiratory tract infections of viral etiology. Influenza A infection enhances Th2-polarization to house dust mites during the acute phase and leads to lung dysfunction in a mouse model. However, there are no data on the relationship between atopic sensitization and H1N1 (Influenza A) infection in humans. To investigate whether atopic sensitization is associated with the severity of H1N1 pneumonia, we compared clinical features and the atopic sensitization rate between children with and without H1N1 infection. METHODS: Using reverse transcription-polymerase chain reactions, we investigated H1N1 virus infection in 214 children who were hospitalized with high fever and respiratory symptoms from September 2009 to February 2010. We also performed immunoassays for total and specific IgEs to six common aeroallergens. Atopy was defined as positivity for more than one specific IgE. The clinical severity of pneumonia was evaluated based on intensive care unit admission, oxygen therapy, steroid therapy, and atelectasis. RESULTS: There were 70 H1N1-positive children, 42.9% of whom had pneumonia. Children with H1N1 infection were older and had a higher prevalence of atopic sensitization and pneumonia compared with H1N1-negative children. The rate of atelectasis was higher in children with H1N1 pneumonia than in children with non-H1N1 pneumonia. Among children with H1N1 viral infection, those with atopic sensitization had a higher prevalence of intensive care unit admission and oxygen therapy, and a longer duration of hospitalization than non-atopic children. There were no differences between atopic and non-atopic children without H1N1 viral infection. CONCLUSIONS: The prevalence of H1N1-induced severe lower respiratory tract diseases is higher in children with atopic sensitization.

Systemic Interferon-Gamma Therapy for Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: Atopic dermatitis is a chronic, inflammatory skin disease characterized by intense pruritus and an immunologic profile consistent with allergic disease. It is associated with increased eosinophil and IgE level and decreased INF-gamma production. We describe the result of a treatment with INF-gammaand assess the clinical, immunologic, and laboratory data of 12 patients with atopic dermatitis. METHODS: Twelve patients were treated for 12 weeks with 2x106 units/m2 INF-gamma by subcutaneous injection. General hematologic tests were done, and total eosinophil counts, eosinophil fractions, neutrophil fractions, and IgE levels were measured before the treatment, 2 weeks after the treatment, 12 weeks after the treatment serially. We also followed up the patients for 12 weeks after discontinuing INF-gammatherapy. RESULTS: All patients showed clinically significant improvement after 12 weeks of the systemic INF-gammatherapy. There was no clinical aggravation during the therapy period and the follow-up 4 weeks without the therapy. But the recurrence rate in the 12 weeks after discontinuing the therapy was about 40%. Eosinophil counts and eosinophil fractions were significantly decreased after the therapy. And, eosinophil counts and eosinophil fractions were increased in clinically aggravated patients during the 12 weeks of off-therapy. CONCLUSION: We conclude that INF-gammais an effective therapy in atopic dermatitis without significant side effects. The eosinophil counts and eosinophil fractions were decreased during the INF-gamma therapy, and increased in clinically aggravated patients after the off-therapy. There was no aggravation during the therapy. But 5 patients were clinically aggravated during the 12 weeks of off-therapy. Further studies for a long-term maintenance therapy and its side effect might be needed in chronic atopic dermatitis.

Correlation between proliferating index and prognostic factors in papillary cystic tumors of the pancreas

Fifteen cases of papillary cystic tumor of the pancreas (PCTP) were studied (14 female patients, one male patient; mean age: 23.5 years). Most tumors developed in the head of the pancreas as a well circumscribed large mass. The tumor had a mean diameter of 6.7 cm(range; 2 to 15 cm). Histopathologically abundant delicate papillary fragments, monomorphic tumor cells and degenerative changes of the solid area of the tumor were characteristic. All but two cases had completely circumscribed capsules. Two cases had duodenal invasion; one of all cases had cul de sac metastasis. Compared with 12 non-aggressive tumors, the aggressive cases had larger tumor size (more than 9 cm) with a thicker capsule (more than 2 mm). In studies to investigate the prognostic index using nucleolar organizing region (NOR), proliferating cell nuclear antigen (PCNA) and flow cytometry as well as nuclear grade and mitotic index, we could not find the useful parameter to detect the malignant potential of PCTP. In the flow cytometric analysis of cellular DNA contents, two invasive cases and the only one case of the male patient among the non-aggressive group were aneuploid. In conclusion, although it is hard to predict the prognosis by microscopic findings only, those with a thick capsule and aneuploidy tend to be related to malignant potential.

Immunohistochemical Study of p53 Gene Expression in Astrocytic Neoplasms

Nineteen astrocytic neoplasms, such as 9 cases of glioblastoma multiforme, 6 cases of anaplastic astrocytoma and 4 cases of low grade astrocytoma, were analysed in view of the relationship between histopathologic grade, nuclear pleomorphism, grade of mutant p53 gene expression and mean survival time after operation. The histopathologic classification by Ringertz and immunohistochemical stain for mutant p53 gene with the DO-7 anti-p53 oncoprotein mouse monoclonal antibody were applied, and the results obtained were as follows; 1) Among 19 cases, 18 cases were located in the supratentorium, where 13 cases(42%) were located in the left and 17 cases(55%) in the right. 2) The p53 gene expression was detected in 12(63.2%) of the cases, as revealed by positive nuclear staining. All cases of glioblastoma multiforme showed p53 gene expression, compared with two(33.3%) cases of anaplastic astrocytoma and one(25%) case of low grade astrocytoma. The frequency and degree of histopathologic grade(p=0.03). 3) The mean survival time after operation was 29.49+/-4.08 months in cases with p53-negative tumors and 12.93+/-3.14 months in cases with p53-positive tumors(p<0.05). 4) Both histopathological classification and p53 gene expression showed a significant influence on servival(p=0.02 and p=0.03, respectively). 5) The relative risk for survival time was the highest in p53 gene expression. In conclusion, p53 gene expression appears to be one of the recommendable prognosticators among astrocytic neoplasms.

A Case of Acyclovir Induced Acute Tubular Necrosis

No abstract available.

Therapeutic effects of plasmapheresis in Guillian-Barre syndrome

No abstract available.

A Case of Interrupted Aortic Arch

No abstract available.