Clinical features of respiratory adenovirus infections in pediatric inpatients in a single medical center

PURPOSE: The purpose of this study is to identify the epidemiologic and clinical characteristics of respiratory adenovirus infections in children, and to investigate the difference in the clinical features between single adenovirus infection and coinfection with adenovirus and other respiratory viruses. METHODS: A retrospective study was performed in 470 children hospitalized with respiratory adenovirus infections in Gwangmyeong Sungae Hospital between January 2013 and December 2013. RESULTS: The mean age of the patients was 46.2 months and the peak incidence was in the 12- to 24-month age group. The mean duration of hospitalization and fever were 4.5+/-1.1 and 4.5+/-9.2 days, respectively. Seasonally it had occurred throughout the year, but showed the highest prevalence in August and high prevalence in July, September, and October. The frequency of viral coinfection with other respiratory viruses was 39.6%. The age was significantly younger in coinfection group than in the single adenovirus infection group (P<0.001). The prevalence rates of bronchiolitis (P<0.001) and pneumonia (P=0.042) were significantly higher in the respiratory syncytial virus coinfection group. The coinfection rate was significantly higher in children aged less than 2 years (P<0.001), and the prevalence rates of bronchiolitis (P<0.001) and pneumonia (P<0.001) were also higher in the group aged less than 2 years than other age groups. CONCLUSION: Adenovirus is an important viral agent in hospitalized children with acute respiratory tract infection. Lower respiratory tract infections, such as bronchiolitis and pneumonia, and coinfection with other respiratory viruses were more frequently occurred in patients under 2 years of age. Further studies are needed to clarify whether coinfection with other respiratory viruses would increase the rate of lower respiratory tract infections in patients with respiratory adenoviral infections.

Long-term Follow-up of Metaphyseal Sclerotic Lines in Children Treated with Pamidronate

PURPOSE: Bisphosphonates are widely used for the management steroid-induced osteoporosis (SIO) in children. With the increasing use of bisphosphonates, there have been reports of abnormal radiological findings in the growing skeleton. Therefore, their use in pediatric patients remains controversial. The present study was conducted to evaluate the long-term follow-up radiographic features, particularly metaphyseal sclerotic lines, in children who receive pamidronate therapy for nephropathy. METHODS: Twenty-four children with nephropathy treated with oral calcium and pamidronate (mean duration, 9 months; dose, 100 mg daily), were evaluated retrospectively. All patients had SIO secondary to chronic glucocorticoid therapy for treating nephropathy. Long bone radiographic imaging was performed before treatment with pamidronate, and at follow-up, several years later. Physeal growth rates were estimated by measuring the distance that the sclerotic lines moved on the radiographs during the corresponding time intervals. RESULTS: The mean follow-up period was 138 months. Long bone radiographs showed well-defined sclerotic lines at the metaphyseal ends, progressively moving from the physeal plate to the diaphysis, in all patients. The mean rate of movement of the sclerotic line was 6.21 mm per year. In 12 patients, the lines disappeared. The mean rate of growth in height was 7.33 cm per year. CONCLUSIONS: Results of long-term follow-up suggest that the metaphyseal sclerotic lines associated with pamidronate treatment tend to disappear without affecting overall skeletal growth. Bisphosphonate treatment for SIO in children with nephropathy seems to be safe, although further studies in larger number of patients are needed.

Transforming growth factor beta receptor II polymorphisms are associated with Kawasaki disease / 소아과

PURPOSE: Transforming growth factor beta receptor 2 (TGFBR2) is a tumor suppressor gene that plays a role in the differentiation of striated cells and remodeling of coronary arteries. Single nucleotide polymorphisms (SNPs) of this gene are associated with Marfan syndrome and sudden death in patients with coronary artery disease. Cardiovascular remodeling and T cell activation of TGFBR2 gene suggest that the TGFBR2 gene SNPs are related to the pathogenesis of Kawasaki disease (KD) and coronary artery lesion (CAL). METHODS: The subjects were 105 patients with KD and 500 healthy adults as controls. Mean age of KD group was 32 months age and 26.6% of those had CAL. We selected TGFBR2 gene SNPs from serum and performed direct sequencing. RESULTS: The sequences of the eleven SNPs in the TGFBR2 gene were compared between the KD group and controls. Three SNPs (rs1495592, rs6550004, rs795430) were associated with development of KD (P=0.019, P=0.026, P=0.016, respectively). One SNP (rs1495592) was associated with CAL in KD group (P=0.022). CONCLUSION: Eleven SNPs in TGFBR2 gene were identified at that time the genome wide association. But, with the change of the data base, only six SNPs remained associated with the TGFBR2 gene. One of the six SNPs (rs6550004) was associated with development of KD. One SNP associated with CAL (rs1495592) was disassociated from the TGFBR2 gene. The other five SNPs were not functionally identified, but these SNPs are notable because the data base is changing. Further studies involving larger group of patients with KD are needed.

Two cases of female hydrocele of the canal of nuck / 소아과

The processus vaginalis within the inguinal canal forms the canal of Nuck, which is a homolog of the processus vaginalis in women. Incomplete obliteration of the processus vaginalis causes indirect inguinal hernia or hydrocele of the canal of Nuck, a very rare condition in women. Here, we report 2 cases of hydrocele of the canal of Nuck that were diagnosed with ultrasonography in both cases and magnetic resonance imaging in 1 case to confirm the sonographic diagnosis. High ligation and hydrocelectomy were conducted in both patients. In 1 patient, 14 months later, the occurrence of contralateral inguinal hernia was suspected, but did not require surgery. The other patient had a history of surgery for left inguinal hernia 11 months before the occurrence of right hydrocele of the canal of Nuck. In both cases, the occurrence of an inguinal hernia on the contralateral side was noted.

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.