Chronic Urticaria in Childhood: Etiology and Outcome / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to evaluate the etiology and outcome of chronic urticaria (CU) in childhood. METHODS: We reviewed retrospectively the clinical manifestations and laboratory findings of the thirty-nine patients with urticaria and/or angioedema for more than 6 weeks. We also invested the clinical parameters affecting the remission. Positive autologous serum skin test (ASST) results were compared with CU remission. RESULTS: Male occupied about 56.4% of patients (n=22). Age at first outpatient clinic visit was from 12 month to 13 years 9 month. Duration of symptoms before visit were from 6 weeks to 6 months. Among the etiologic causes, 35.9% (n=14) of patients had physical urticaria, concretely, 17.9% (n=7) of patients had cold urticaria, 12.8% (n=5) of patients had symptomatic dermographism, 5.1% (n=2) of patients had cholinergic urticaria. Sinusitis was associated with CU in 5.1% (n=2) of patients. Unknown causes were 59.9% (n=23) of patients, and among them, 34.8% (n=8) of patients had positive ASST. Disease remission was observed in 56.4% (n=22), but non-remission was observed in 43.6% (n=17). Remission of CU was not associated with age, gender, etiology, and ASST. The remission rate of ASST negative group was higher than the ASST positive group, but it was not significant statistically. CONCLUSION: Etiologies of CU were variable and physical urticaria should be evaluated first. Unknown etiology were 59.9% and of them, correlation positive ASST with disease remission rate should be evaluated later with further study.

A Case of Renal abscess in Neonate

The renal abscess is a rare disease in neonate. The clinical findings consist of non- specific symptoms such as fever, lethargy, flank mass and laboratory abnormalities including leukocytosis, elevated CRP, ESR and pyuria. The diagnosis can be made with ultrasonography, CT scan and DMSA. The renal abscess involving corticomedullary region is known to be frequently associated with urologic abnormality and can progress into perirenal abscess which has been reported to have a poor prognosis. The treatments include antibiotic therapy, drainage of abscess and surgical intervention. We report a neonate with bilateral renal abscesses with underlying vesicoureteral reflux grade V which was successfully treated with antibiotic therapy and drainage of abscess.

A Case of Choledochal Cyst Complicated by Liver Cirrhosis on Pathology in a 20-Month-Old-Girl / 소아과

Choledochal cyst is considered to be congenital anomalies of the biliary tract, characterized by varying degrees of cystic dilatation at various segments of the biliary tract. A 20-month-old girl was admitted to Eul-Ji general hospital because of abdominal distension. Physical examination revealed marked splenomegaly and hepatomegaly with nodular surface and hard consistency. Laboratory examination showed elevated transaminase level, alkaline phosphatase level and gamma glutamyltranspeptidase level without evidence of cholestasis. Diagnostic imaging study revealed choledochal cyst with Todani classification type 1. Cholecystectomy and Roux-en-Y choledochojejunostomy was performed, and wedge liver biopsy showed diffuse periportal fibrosis with cirrhotic change and ductular proliferation in the portal area. After operation, hepatosplenomegaly and abnormal laboratory examinations improved rapidly, and in 9 months, the liver and spleen became not palpable. We experienced a case of choledochal cyst complicated by liver cirrhosis on pathology in a 20 month-old girl, and removal of choledochal cyst improved clinical manifestations rapidly.

A Clinical Study of Chronic Functional Constipation in Children Treated for more than Five Months / 소아과

PURPOSE: The purpose of this study was to evaluate the clinical features and the courses and effects of long-term treatment, and to analyze the association between clinical features and duration of therapy in chronic functional constipation in children. METHODS: This study enrolled 57 children with chronic functional constipation who were treated in the Eulji Hospital for more than five months between May, 2000 and February, 2004. We analyzed the clinical features and the courses and results of the phase of disimpaction, maintenance, weaning retrospectively. RESULTS: Mean age at diagnosis was 3.3+/-2.3 years and the male to female ratio was 24:33. The mean duration of symptoms was 12.5+/-13.9 months in 49 patients. Mean defecation frequency per week was 5.7+/-4.0 and hard stools were seen in 59.7% of patients. The clinical presentations were as follows : abdominal pain(45.6%), rectal blood loss(28.1%), vomiting(19.3%). Fifty-four patients had successful disimpaction with lactulose+bisacodyl/glycerine enema or only lactulose, except for three patients with polyethylene glycol(PEG) solution. After a maintenance phase with lactulose or lactulose+mineral oil, a significant increase in defecation frequency per week was observed(5.7+/-4.0 to 6.3+/-1.8(P<0.05)), discomfort in defecation was not observed in all patients and hard stools were not observed except in four patients. The mean duration of the maintenance phase was 5.5+/-4.3 months and mean duration of total therapy was 10.8+/-3.8 months in 42 patients who finished the weaning phase. Duration of the maintenance phase and of total therapy had no statistical correlation with age, duration of symptoms and frequency of stools, and had no association with clinical presentations. CONCLUSION: Long-term treatment is necessary for effective treatment of chronic functional constipation in children. Further long-term follow up would have to be perfomed to evaluate successful treatment.

A Case of Intestinal Tuberculosis Complicated with Pulmonary Tuberculosis in a Young Adolescent with Cerebral Palsy / 대한소아소화기영양학회지

About 20% of intestinal tuberculosis have active pulmonary tuberculosis. Intestinal tuberculosis can develop by swallowing sputum which have active pulmonary tuberculosis and by ingestion of contagious milk. We report a case of intestinal tuberculosis complicated with pulmonary tuberculosis in a 15-year old adolescent who could not cough out sputum because of known cerebral palsy. He was admitted because of 3 day history of fever and bloody stool. Chest PA showed both upper lobe consolidation. AFB stain and AFB PCR was positive for tuberculosis. Colon study showed abscence of haustral marking and lead pipe appearance due to stenosis of ascending colon and mucosal edema. Abdominal CT scan showed mild wall thickening in ascending colon. Despite the anti-tuberculosis therapy with first line drugs, fever accompanying pleural effusion developed. Second line drug with Isoniazid and Rifampin improved clinical manifestation. After the report on sensitivity, we readjusted the regimen, and clinical manifestations improved gradually.

A Case of Giant Sertoli-Leydig Cell Tumor of the Ovary with Masculinization / 대한부인종양콜포스코피학회잡지

Sertoli-Leydig cell tumor is a rare sex-cord stromal tumor of the ovary and accounts for less than 0.5% of all ovarian tumors. It is among the most fascinating from pathologic and clinical viewpoints in masculinization. We experience an unusual case of a poorly differentiated Sertoli-Leydig cell tumor in 60-year-old woman who showed masculinization and present it with brief review of literature.

A case of disruption of symphysis pubis diagnosed after delivery of a primigravida / 대한산부인과학회잡지

Peripartum pubic symphysis separation is a recognized complication of delivery with incidence ranging 1:300 to 1:30,0002,4-6. The underlying etiology of symptomatic symphyseal separation has not fully elucidated. Diagnosis is mostly based on clinical findings. Complete recovery was made only by analgesics and physical therapy. The occurrence of symphyseal separation does not necessitate an alteration in the management of subsequent pregnancy7. We have experienced a case of disruption of symphysis pubis during labor supposed to be caused by too rapid labor course. Details regarding this case and a review of the literature are presented.

3 Cases of Monozygotic Twin Pregnancy after IVF-ET / 대한불임학회지

OBJECTIVE: To report three cases of monozygotic twinning after IVF-ET transfer. METHODS: Private practice in two different assisted reproductive technology clinics. RESULTS: Three intrauterine monozygotic twin pregnancies occurred after IVF-ET. One of them was complicated by cord entanglement, another is progressing normal pregnancy without complication and the other was had a normal pregnancy without complication and delivered twin by cesarean section. CONCLUSION: The reported prevalence of multiple gestations in IVF-ET is a approximately 30%, and it is only 2.7% to be monozygotic twinning in IVF-ET. We report three cases of monozygotic twining after IVF-ET.