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OBJECTIVE: Mycoplasma pneumoniae infection is known as one of the frequent causes of exacerbation of bronchial asthma and it can also be a trigger for the initiation of asthma. However, little is known about the pathogenesis of respiratory M. pneumoniae infection. Furthermore, there is little data on human cytokine production and its involvement in the pathogenesis of M. pneumoniae infection. In order to investigate the immunopathogenesis of M. pneumoniae infection, we investigated the cytokine production in the bronchoalveolar lavage ( BAL ) fluid of patients with M. pneumoniae pneumonia and viral pneumonia, and compared the results with those of control subjects. SUBJECT AND METHOD: BAL was performed with fiberoptic bronchoscopy in patients with M. pneumoniae pneumonia( n=9 ), viral pneumonia( n=9 ), and control subjects( n=6 ) aged 3 years to 9 years. M. pneumoniae pneumonia was documented by polymerase chain reaction and serologic analysis. Four respiratory viruses ( adenovirus, influenza A, influenza B, parainfluenza ) were detected by culture method. Cell pellets and supernatants were separated by centrifugation and Interleukin( IL ) - 2, Interferon( IFN )-r, IL-4, and IL-5 levels were measured in concentrated BAL supernatants by ELISA. RESULTS: Analysis of cytokines revealed significantly increased production of IL-4 ( p< 0.0001 ) and IL-2 ( p< 0.0001 ), in patients with M. pneumoniae pneumonia and significantly increased production of IL-2 (p <0.0001) in patients with viral pneumonia compared with those of the control subjects. Ratio of IL-4/IFN-r was significantly increased in patients with M. pneumoniae pneumonia ( p< 0.005 ) but not in patients with viral pneumonia compared with that of the control subjects. CONCLUSION: IL-4 production and IL-4/IFN-r ratio were increased in the BAL fluid of patients with M. pneumoniae infection. These findings suggest that predominant Th2 immune response could play an important role in the pathogenesis of M. pneumoniae infection.
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Humanos , Adenoviridae , Asma , Líquido del Lavado Bronquioalveolar , Lavado Broncoalveolar , Broncoscopía , Centrifugación , Citocinas , Ensayo de Inmunoadsorción Enzimática , Gripe Humana , Interleucina-2 , Interleucina-4 , Interleucina-5 , Mycoplasma pneumoniae , Mycoplasma , Infecciones por Paramyxoviridae , Neumonía , Neumonía por Mycoplasma , Neumonía Viral , Reacción en Cadena de la PolimerasaRESUMEN
PURPOSE: The purpose of the study was to evaluate serum magnesium(Mg) concentration in very low birth weight(VLBW) infants during the first three weeks of life and to assess its relation to diseases of prematurity. METHODS: We measured serum Mg level at 0, 1, 2, and 3weeks of life in VLBW infants and analyzed its correlations with diseases of prematurity. Ninety-five VLBW infants(mean gestational age 30.4wks, birth wt 1304gm) who survived 30days were selected. Seven infants who had been treated with magnesium sulfate prenatally were excluded. RESULTS: Serum Mg level decreased linearly during the first three weeks of life(P=0.03). Serum Mg level at birth had no significant relation to gestational age, birth weight and serum calcium concentration. Serum Mg level at birth were higher within normal range in infants with respiratory distress syndrome(n=20, 2.6mg/dl vs. n=68, 2.2mg/dl, P=0.036), patent ductus arteriosus (n= 19, 2.5mg/dl vs. n=69, 2.2mg/dl, P=0.035) and bronchopulmonary dysplasia(BPD)(n=15, 2.6mg/dl. vs. n=73, 2.2mg/dl, P=0.01) than in infants without them. Serum Mg level at first week of life were similar(2.3mg/dl. vs. 2.2mg/dl, P=0.51) and serum Mg level at second and third weeks of life were significantly lower in infants with BPD than in control(1.9mg/dl vs. 2.2mg/dl, P=0.002 and 1.6mg/dl vs. 2.2mg/dl, P=0.001, respectively). CONCLUSION: Serum Mg level during the first three weeks of life decreased linearly. Serum Mg level of infants with BPD at birth was higher within normal variation than in infants without BPD. And serum Mg level of infants with BPD at second and third weeks of life were lower than control. Thus, we suggest that Mg deficiency during the first three weeks of life might play a role in the pathogenesis of BPD.
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Humanos , Lactante , Recién Nacido , Peso al Nacer , Displasia Broncopulmonar , Calcio , Conducto Arterioso Permeable , Edad Gestacional , Recién Nacido de muy Bajo Peso , Sulfato de Magnesio , Magnesio , Parto , Valores de ReferenciaRESUMEN
PURPOSE: Vasodilator therapy in infants with persistent pulmonary hypertension of the newborn(PPHN) frequently causes systemic hypotension due to non-selectivity for pulmonary vessels. Blood pressure(BP) cuffs can increase systemic vascular resistance around which they are applied without affecting pulmonary vessels. We studied the effects of BP cuffs on the circulatory and respiratory status of infants with PPHN receiving vasodilator therapy. METHODS: Mechanically ventilated 16 term infants(gestational age of 39.9+ 1.3 weeks and birth weight of 3,533+/-318 gm with PPHN who had right to left shunt on echocardiogram and survived over 5 days were included for the study. All infants received vasodilator(tolazoline)therapy. We applied BP cuffs for neonatal use to four extremities of study infants(n=8) and inflated them to systolic pressure. Those who received vasodilator therapy alone served as control(n=8). We analyzed systolic and mean BP, respiratory parameters, presence of right to left shunt an clinical outcome at 1, 2, 6, 12, 24, 48, 72hr after initiation of vasodilator therapy. RESULTS: Systolic BP increased significantly in study group(from 37+/-11 to 46+/-13 mmHg) from 6 hours after BP cuff application compared to control group(from 39+/-8 to 40+/-13 mmHg), and this effect persisted up to 72 hour(52+/-18 vs. 46+/-16 mmHg)(P<0.05). Mean BP also increased significantly in study group(30 +/-10 to 38+/-12 mmHg) from 6 hours compared to control group(32+/-11 to 33 15 mmHg) and maintained up to 72 hour occurred(43+17 vs. 3715 mmHg)(P<0.05). Reversal of right to left shunt occurred significantly earlier in study group than control group(30+/-10 vs. 52+/-18 hr)(P<0.01). Respiratory parameters such as mean airway pressure, oxygenation index and duration of ventilator care and hospitalization were not different. Four of five infants in the study group and five of eight in control group survived. CONCLUSION: Application of BP cuffs to the infants with PPHN treated with vasodilator resulted in increase innd mean BP and early reversal of right to left shunt. We suggest that application of BP cuffs can play a useful role in the management of infants with PPHN.
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Humanos , Lactante , Recién Nacido , Peso al Nacer , Presión Sanguínea , Extremidades , Hospitalización , Hipertensión , Hipertensión Pulmonar , Hipotensión , Oxígeno , Resistencia Vascular , Ventiladores MecánicosRESUMEN
Endoscopic balloon dilatation has provided a non-operative means of managing obstructive lesions in the gastrointestinal tract. In an infant with idiopathic hypertrophic pyloric stenosis(IHPS), the stenosis was successfully dilated with endoscopic balloon dilatation. Endoscopic balloon dilatation was performed using a 9mm endoscope and through-the-scope(TTS) balloon catheter (diameter 10 to 12mm). Dilatation was performed two times for 5 minutes. The 9mm endoscope then passed through the pylorus. There were no complications. The treatment was followed by immediate symptomatic relief. Endoscopic balloon dilatation may become a valid alternative to surgical procedures for the treatment of IHPS if good results can be confirmed in further studies.
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Humanos , Lactante , Catéteres , Constricción Patológica , Dilatación , Endoscopios , Tracto Gastrointestinal , Estenosis Hipertrófica del Piloro , PíloroRESUMEN
PURPOSE: Flexible bronchoscopy is an important diagnostic and sometimes therapeutic tool that can be used on infants and children using light sedation and local anaesthesia. The purpose of this study is to evaluate the contribution of the flexible bronchoscopy to clinical diagnosis and therapy in children. METHODS: We examined the first 100 consecutive flexible bronchoscopies performed in children under 15 years of age(median age, 7 years). RESULTS: Indications for bronchoscopy were bronchoalveolar lavage(39.3%), wheezing(12.5%), stridor/noisy breathing(10.7%), recurrent/persistent pneumonia(8.0%), atelectasis or bronchial toilet (7.1%), equivocal airway foreign body(6.3%), hemoptysis(4.5%), and miscellaneous other reasons (11.6%). Inspection was abnormal in 79.0% of all investigations and made a clinically meaningful contribution to diagnosis in 79.0%. Bronchoalveolar lavage cytology was abnormal in 77.3% of the 44 lavages. Viruses and bacteria were isolated in 33.3% of the 48 specimens cultured. Meaningful therapeutic result was obtained in 81.3% of the 16 therapeutic bronchoscopies including bronchial toilet and persistent atelectasis. CONCLUSION: A high yield of meaningful diagnostic information and therapeutic goal can be expected from flexible bronchoscopy in children.
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Niño , Humanos , Lactante , Bacterias , Lavado Broncoalveolar , Broncoscopía , Diagnóstico , Atelectasia Pulmonar , Irrigación TerapéuticaRESUMEN
While the frequency of primary carcinoma of the lung has recently increased in adults, it is rare in the pediatric age group. The various adult types of bronchogenic carcinoma such as squamous cell, small cell, large cell, and adenocarcinoma, are extremely rare in children. Twenty to 30 cases of primary bronchogenic carcinoma of the lung in children under 15 years of age have been reported in the English-language literature. We have experienced a small cell bronchogenic carcinoma detected by fiberoptic bronchoscopy with bronchial biopsy in a 14-year-old boy with chief complaint of hemoptysis, lung mass and persistent pneumonitis. To the best of our knowledge, this is the first reported case of primary small cell bronchogenic carcinoma in childhood under 15 years of age. We report this case with a brief review of related literatures.
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Adolescente , Adulto , Niño , Humanos , Masculino , Adenocarcinoma , Biopsia , Broncoscopía , Carcinoma Broncogénico , Hemoptisis , Pulmón , NeumoníaRESUMEN
Toxic epidermal necrolysis(TEN) is a bullous disorder affecting mainly basal layers of epidermis by hypersensitive reaction. It is rarely reported in infants under six months of age. It can be developed by drug, infection, and vaccination, which makes it difficult to differentiate from staphylococcal scalded skin syndrome(SSSS) especially in early infancy. We report a case of TEN in a 6-week-old infant with short bowel syndrome receiving total parenteral nutrition. A male infant(birth weight 2,570gm at 37 weeks) whose mother had polyhydramnios with bilous vomiting at birth was evaluated. Barium and histologic study showed total aganglionosis. Surgical resection was performed at 3 days of life and subsequently short bowel syndrome developed. Total parenteral nutrition via central venous catheter was done due to feeding intolerance. Staphylococcus aureus was cultured from blood at 37days of life, and we administered vancomycin. As multiple scaly eruption and fever developed at 47days of life, we were suspicious of SSSS. Blood culture done at 47days of life revealed Pseudomonas aeruginosa and skin biopsy showed the split at dermoepidermal junction at light microcopy and confirmed the diagnosis of TEN. Despite discontinuation of antibiotics, the infant did not improve and died due to shock at 54days of life. We emphasized that in case of acute, severe exfoliative disease in early infancy, the diagnosis of TEN should be considered and that skin biopsy should be performed to make the correct diagnosis.
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Humanos , Lactante , Masculino , Antibacterianos , Bario , Biopsia , Catéteres Venosos Centrales , Diagnóstico , Epidermis , Fiebre , Madres , Nutrición Parenteral Total , Parto , Polihidramnios , Pseudomonas aeruginosa , Choque , Síndrome del Intestino Corto , Piel , Staphylococcus aureus , Síndrome de Stevens-Johnson , Vacunación , Vancomicina , VómitosRESUMEN
PURPOSE: Multiple allergosorbent test-chemiluminescent assay(MAST-CLA) is a semiquantitative method for detecting total IgE and specific IgE in serum. The purposes of this study are to investigate the correlation between MAST-CLA and Paper radioimmunosorbent test(PRIST), and to find out whether MAST-CLA can replace PRIST in measuring of serum total IgE. METHODS: Data of 162 subjects were analyzed by linear regression analysis for MAST-CLA (MAST class) and PRIST(PRIST IgE, PRIST class, PRIST log10 IgE). Diagnostic sensitivity, specificity, efficiency, positive and negative predictive values were calculated by standard methods. RESULTS: The sensitivity of MAST-CLA was 64.0%, specificity was 56.0%, efficiency was 56.0%, positive predictive value was 87.2% and negative predictive value was 21.8%. The overall correlation coefficiency(r) of total IgE between MAST class vs PRIST IgE was 0.176(P<0.05), MAST class vs PRIST class was 0.308(P<0.001), MAST class vs PRIST log10 IgE was 0.301(P<0.001). According to age classification, good correlation was obtained in the 3-6 yr age group(MAST class vs PRIST IgE : r=0.283, P<0.01, MAST class vs PRIST log10 IgE : r=0.377, P<0.001), but there were no significant correlation in the 7-10 yr age group and in the 11-15 yr age group. CONCLUSION: A different correlation was observed between the two tests according to age, so we suggest that simultaneous use of PRIST should be performed considering the age when MAST-CLA is used as an atopy screening.
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Humanos , Clasificación , Inmunoglobulina E , Modelos Lineales , Tamizaje Masivo , Sensibilidad y EspecificidadRESUMEN
Allergic bronchopulmonary aspergillosis(ABPA) is an inflammatory disease which causes a hypersensitivity to Aspergillus spores growing in the bronchi. The clinical syndrome is characterized by asthma, recurrent pulmonary infiltrations or mucoid impaction, eosinophilia, and central bronchiectasis. A 12-year-old boy was admitted to our hospital because of right lower chest pain and cystic mass-like shadows on a chest X-ray film. He had asthma as an infant, but had no asthmatic symptoms on admission. Chest CT scan showed low density cystic mass of the right lower lobe. The total eosinophil count and IgE level were abnormally high. Test for immediate skin reaction to Aspergillus fumigatus was positive but precipitating antibody to Aspergillus antigen was negative. After steroid treatment, he became asymptomatic. Radiologic abnormalities including mass-like shadows were resolved by two months after the start of treatment and a follow-up high resolution CT scan obtained after clinical improvement revealed central saccular bronchiectasis. We report one case of ABPA with review of literature.
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Niño , Humanos , Lactante , Masculino , Aspergilosis Broncopulmonar Alérgica , Aspergillus , Aspergillus fumigatus , Asma , Bronquios , Bronquiectasia , Dolor en el Pecho , Eosinofilia , Eosinófilos , Estudios de Seguimiento , Hipersensibilidad , Inmunoglobulina E , Piel , Esporas , Tórax , Tomografía Computarizada por Rayos X , Película para Rayos XRESUMEN
It is generally agreed that theophylline preparations and steroids should be given intravenously for status asthmaticus. Theophylline can potentially have adverse gastrointestinal effects including abdominal pain, nausea, vomiting, and hematemesis. Upper gastrointestinal bleeding in patients treated with corticosteroids without a past history of upper gastrointestinal bleeding has been reported rarely. But the etiologic significance of the stress of status asthmaticus, administration of theophylline or corticosteroids in the development of ulcer has been open to question. We report a case of 8-year-old boy with status asthmaticus treated with these medications and later found to have a bleeding duodenal ulcer for which emergency surgery was necessary.
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Niño , Humanos , Masculino , Dolor Abdominal , Corticoesteroides , Úlcera Duodenal , Urgencias Médicas , Hematemesis , Hemorragia , Náusea , Estado Asmático , Esteroides , Teofilina , Úlcera , VómitosRESUMEN
PURPOSE: Early intervention is needed to treat patent ductus arteriosus (PDA) as it is a major cause of increased mortality in preterm infants. However, it is uncertain which is better, medical versus surgical management. We reviewed medical records to compare the treatment course and outcome between medically and surgically treated preterm PDA infants. METHODS: Thirth-two Mechanically ventilated pretem infants (gestational age<34 wks, birth weight<2,000gm) who survived beyond 30 days were studied. Treatment course and outcome were compared between indomethacin-treated (INDO, n=15) and surgically treated who have not responded to indomethacin (Surg, n=17). RESULTS: Volume of administered fluid and urine output during the first five days of life were similar, however, initial weight loss were lower in the SURG group than INDO group (p=0.031). Size of PDA on the echocardiogram were larger in SURG group (mean 3.4 mm) than INDO group (mean 2.5 mm) (p=0.046). Duration of hospitalization was longer in the SURG group (mean 46 days) than INDO group (mean 72 days) (p=0.033), however, time to start feeding, ventilator duration and weaning time were similar in both groups. Incidence of intraventricular hemorrhage was lower in the SURG group (47%) than INDO group (6%) (p=0.009). CONCLUSION: Preterm infants with poor initial weight loss and large size of PDA were likely to become surgical candidates and required longer periods of hospitalization and showed increased incidence of IVH. Although surgical treatment of PDA in preterm infants is definitive, fluid restriction and medical management at early postnatal period is recommended.
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Humanos , Lactante , Recién Nacido , Conducto Arterioso Permeable , Intervención Educativa Precoz , Hemorragia , Hospitalización , Incidencia , Indometacina , Recien Nacido Prematuro , Registros Médicos , Mortalidad , Parto , Ventiladores Mecánicos , Destete , Pérdida de PesoRESUMEN
PURPOSE: Many young children with no other asthma features have episodic wheezing that is triggered solely by viral respiratory infections. We investigated the differential cytology in an effort to determine whether significant differences in bronchoalveolar lavage(BAL) cellularity to the pathophysiology of wheezing exist between classic astham(CA) and viral associated wheeze(VAW) in children. METHODS: Bronchoscopy with BAL was performed on 44 children, 6 months and 15 years old: 12 CA, 13 VAW. 13 viral pneumonia(VP), and 6 control cases. Viral cultures were carried out. Differential cell counts were determined on cytospin slide stained with May Grunwald Giensu. RESULTS: Total BAL fluid recovered was similar in all group(37+/-2.5%, mean+/-SEM) No significant differences in the total cell counts were observed among the four groups. Compared with the control, newtrophil percentages of VAW and VP(38.6+/-7.1% and 42.4+/-6.9%, respectively) were significantly(P<0.05) elevated than those of VAW and VP(2.0+/-0.1% and 0.4+/-0.3%, respectively). All cell types did not differ significantly between VAW and VP. The blood totol cosinophil counts were correlated with the BAL eosinophil percentage levels(r-0.795, P=0.0000). CONCLUSIONS: In conclusion, neutrophils were prominent in children with viral associated wheeze, as eosinophils in those with classic asthma. Thses findings suggest that there are different implications of cell types for the pathophysiology in these two diseases.
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Adolescente , Niño , Humanos , Asma , Lavado Broncoalveolar , Broncoscopía , Recuento de Células , Eosinófilos , Neutrófilos , Ruidos Respiratorios , Infecciones del Sistema RespiratorioRESUMEN
PURPOSE: Leptin is a protein encoded by the ob gene that is expressed in adipocytes. It regulates eating behavior by the action to the satiety centers in the hypothalamus. In ob/ob mouse, adipocytes can not produce leptin because of a mutation in the ob gene which results in obesity. Whereas, leptin concentrations were elevated in obese adults, and leptin levels in obese children has not been studied much until now. The purpose of this study is to evaluate leptin concentrations in obese children and to find out correlating factors with leptin. METHODS: Thirty-six obese childrens whose weight is above 97 percentile of korean weight standard and 39 children with average weight were included. Height, weight, waist to hip ratio, fat weight and lean body mass were measured. The serum levels of leptin, insulin, cholesterol and triglyceride were measured. RESULTS: Mean age was 10.8 +/- 2.5 years in obese group and 10.6 +/- 2.6 years in control group. Obesity percent was 51.6 +/- 18.8% in obese and 8.8 +/- 10.2% in control group. Body mass index (BMI) was 26.3 +/- 5.8kg/m2 in obese group and 17.3 +/- 1.9kg/m2 in control group. Leptin levels of obese group (13.7 +/- 5.4ng/ml) were significantly higher than that of the control group (3.6 +/- 3.3ng/ ml). Leptin levels showed no significant difference by gender and by pubertal development. Leptin levels significantly correlated with BMI, obesity percent, fat weight, and serum cholesterol level but showed no significant correlation with lean body mass, serum fasting insulin and triglyceride levels. CONCLUSION: Serum leptin levels of obesity group were significantly higher than that of the control group, and they were correlated with BMI, obesity percent and fat weight. Additional research is necessary to assess the mechanism of leptin resistance in obese children.
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Adulto , Animales , Niño , Humanos , Ratones , Adipocitos , Índice de Masa Corporal , Colesterol , Ayuno , Conducta Alimentaria , Hipotálamo , Insulina , Leptina , Obesidad , Triglicéridos , Relación Cintura-CaderaRESUMEN
PURPOSE: Leptin is a protein encoded by the ob gene that is expressed in adipocytes. It regulates eating behavior by the action to the satiety centers in the hypothalamus. In ob/ob mouse, adipocytes can not produce leptin because of a mutation in the ob gene which results in obesity. Whereas, leptin concentrations were elevated in obese adults, and leptin levels in obese children has not been studied much until now. The purpose of this study is to evaluate leptin concentrations in obese children and to find out correlating factors with leptin. METHODS: Thirty-six obese childrens whose weight is above 97 percentile of korean weight standard and 39 children with average weight were included. Height, weight, waist to hip ratio, fat weight and lean body mass were measured. The serum levels of leptin, insulin, cholesterol and triglyceride were measured. RESULTS: Mean age was 10.8 +/- 2.5 years in obese group and 10.6 +/- 2.6 years in control group. Obesity percent was 51.6 +/- 18.8% in obese and 8.8 +/- 10.2% in control group. Body mass index (BMI) was 26.3 +/- 5.8kg/m2 in obese group and 17.3 +/- 1.9kg/m2 in control group. Leptin levels of obese group (13.7 +/- 5.4ng/ml) were significantly higher than that of the control group (3.6 +/- 3.3ng/ ml). Leptin levels showed no significant difference by gender and by pubertal development. Leptin levels significantly correlated with BMI, obesity percent, fat weight, and serum cholesterol level but showed no significant correlation with lean body mass, serum fasting insulin and triglyceride levels. CONCLUSION: Serum leptin levels of obesity group were significantly higher than that of the control group, and they were correlated with BMI, obesity percent and fat weight. Additional research is necessary to assess the mechanism of leptin resistance in obese children.
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Adulto , Animales , Niño , Humanos , Ratones , Adipocitos , Índice de Masa Corporal , Colesterol , Ayuno , Conducta Alimentaria , Hipotálamo , Insulina , Leptina , Obesidad , Triglicéridos , Relación Cintura-CaderaRESUMEN
The aims of this study were to document bronchiolitis obliterans(BO), the long term pulmonary sequelae after mycoplasma pneumonia, and to evaluate the difference of development of BO according to antibody titer and X-ray pattern. Twenty five subjects who had mycoplasma pneumonia underwent high resolution CT(HRCT) 1.3 years(1.0-2.0 years) after the initial infection. Fifteen boys and 10 girls, with mean age of 6.3 years(3-15 year) at the time of the infection, were included. The clinical diagnosis of Mycoplasma pneumoniae(M. pneumoniae) pneumonia was confirmed by a fourfold or higher rise in the antibody titers between acute and convalescent phase or a single very high titers(> or = 1:640) and abnormal chest radiographs. The subjects were divided into two groups as high titer group(antibody titer 1:5120 1:20480, n=15) and low titer group(antibody titer 1:640-1:2560, n=10). Nine of 25 subjects(36.0%) demonstrated BO findings on HRCT which included mosaic perfusion in 8 of 9 subjects(88.9%), bronchiectasis in 6(66.7%), mosaic perfusion associated with bronchiectasis in 6(66.7%), bronchial wall thickening in two(22.2%), and decreased pulmonary vascularity in one(11.1%). Those findings were more commonly seen in high titer group compared to low titer group[53.3%(8/15) vs 10.0%(1/10), P<0.05] and lobar type compared to linear type[58.0%(7/12) vs 15.4% (2/13), P<0.05]. The involved areas on HRCT exactly corresponded with initially involved area on chest radiographs in 8 of 9 subjects (88.9%). The development of BO was closely related to the M. pneumoniae pneumonia and was noted significantly in individuals with high antibody titer and lobar type x-ray pattern. We suggest that it is necessary to pay attention to the development of BO after M. pneumoniae pneumonia with high antibody titer and lobar type x-ray pattern.
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Femenino , Humanos , Bronquiectasia , Bronquiolitis Obliterante , Bronquiolitis , Diagnóstico , Mycoplasma pneumoniae , Mycoplasma , Perfusión , Neumonía , Neumonía por Mycoplasma , Radiografía TorácicaRESUMEN
PURPOSE: Helicobacter pylori (H. pylori) is recognized as the cause of primary or unexplained gastrointestinal diseases in children as well as in adults. However, it is unclear whether H. pylori causes specific clinical symptoms or diseases. Therefore, we studied the clinical manifestations associated with H. pylori infection in consecutive symptomatic children undergoing diagnostic endoscopy. METHODS: This study included 42 patients with H. pylori infection, confirmed by ELISA test, CLO test, or Warthin Starry stain of a gastric mucosa biopsy specimen. The presenting symptoms, associated disease, endoscopic findings, and hematologic features were studied in the patients retrospectively. RESULTS: The positivity of H. pylori was 15%, and increased with age. The average age of infected children was 11 years. The presenting symptoms of H. pylori infection were chronic abdominal pain (57.1%), acute abdominal pain (14.3%), pallor (11.9%), hematemesis (9.5%), and nausea/ vomiting (7.1%). The endoscopic findings were nodular gastritis (54.8%), nodular duodenitis (35.7%), duodenal ulcer (14.3%), hemorrhagic erosive duodenitis (2.4%), and normal finding (19%). The associated diseases were chronic recurrent abdominal pain (57.1%), acute gastritis (16.7%), duodenal ulcer (14.3%), and iron deficiency anemia (9.5%). CONCLUSION: H. pylori infection was associated with recurrent chronic abdominal pain, acute gastritis, duodenal ulcer, and iron deficiency anemia in children. Therefore, in patients with several gastrointestinal symptoms and iron deficiency anemia, the diagnostic and therapeutic approach of H. pylori infection is warranted.
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Adulto , Niño , Humanos , Dolor Abdominal , Anemia Ferropénica , Biopsia , Úlcera Duodenal , Duodenitis , Endoscopía , Ensayo de Inmunoadsorción Enzimática , Mucosa Gástrica , Gastritis , Enfermedades Gastrointestinales , Helicobacter pylori , Helicobacter , Hematemesis , Palidez , Estudios Retrospectivos , VómitosRESUMEN
The incidence of Hypertrophic pyloric stenosis (HPS) in premature infants is rare, the presentation is not typical, and the diagnosis delayed due to uncertain diagnostic criteria in abdominal ultrasonography (US). We report two premature infants with HPS diagnosed by US and upper gastrointestinal (UGI) contrast study. Patient 1. A premature female infant (birth weight 1950 gm at 34 week's gestation) with the onset of intermittent vomiting at 9 days of age was evaluated. US was normal at 13 days of life, however, abnormal at 41 days of life (pyloric muscle length 16.5 mm). Patient 2. A premature male infant (birth weight 1470 gm at 29 week's gestation) with the onset of intermittent vomiting at 10 days of age was evaluated. US showed pylorospasm at 11 days of life, however, findings compatible with HPS at 57 days of life (pyloric muscle thickness 11 mm).UGI contrast study at 48 days of life showed similar findings in both cases. Both patients had undergone pyloromyotomy. In conclusion, the diagnosis of HPS in premature infants requires careful follow-up by US and UGI contrast study.
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Femenino , Humanos , Lactante , Recién Nacido , Masculino , Diagnóstico , Estudios de Seguimiento , Incidencia , Recien Nacido Prematuro , Estenosis Pilórica , Estenosis Hipertrófica del Piloro , Ultrasonografía , VómitosRESUMEN
PURPOSE:The incidence of congenital adrenal hyperplasia(CAH) is 1/5,000- 1/20,000 births and thus the importance of the neonatal screening test is being emphasized. However, the reference value for the term and preterm infants has not yet been established and false positive values are frequent due the immature hypothalamic-adrenal axis of the preterm infants or the stress-induced adrenal dysfunction. Therefore, we analyzed the 17-hydroxyprogesterone(17-OHP) concentration in terms of gestational age, birth weight, and postnatal state to establish the reference range for the Korean term and preterm infants. METHODS:We analyzed the results of the CAH screening test retrospectively, which was performed on 737 neonates(624 fullterm neonates, 113 premature neonates) born between January 1998 through July 1998 in Inje University College of Medicine Sanggye Paik Hospital. Mean gestational age and birth weight of infants were 38.2+/-2.6 weeks and 3,116+/-674kg respectively. 17-OHP screening test was performed on 4.9+/-3.8days after birth by obtaining blood samples from the heelstick of neonates. 17-OHP concentration was measured by the ELISA kit(ICN Co.) and repeated the procedure if the result was higher than 35ng/ml. RESULTS: 1) 17-OHP concentration of the preterm infants was significantly higher than that of the fullterm infants(19.1+/-12.3ng/ml vs 11.7+/-7.8ng/ml, P=0.001). 17-OHP concentration was inversely proportional to gestational age. 2)17-OHP concentration was inversely proportional to birth weight(r=0.22, P>0.01). 17-OHP concentration according to birth weight was as follows.:below 1,500g was 26.7+/-11.7ng/ml, 1,500 to 2,000g was 18.0+/-13.9ng/ml, 2,001 to 2,500g was 17.9+/-10.5ng/ml, 2,501 to 3,000g was 12.1+/-7.9ng/ml, 3,001 to 3,500g was 11.5+/-8.1ng/ml, above 3,500g was 11.4+/-7.5ng/ml. There was a significant decline in the 17-OHP concentration as the birth weight increased. 3) 17-OHP concentration was gradually decreased as sampling date increased. 4) The gender of the infants did not influence the 17-OHP concentration(male 13.0+/-9.1 vs female 12.7+/-9.0). 5)17-OHP concentration were significantly higher in sick preterm infants than healthy preterm infants. 6)Six cases, whose 17-OHP concentration were greater than 35ng/ml, were all preterm and low birth weight infants. Reexamination after one week showed the value within normal range. No CAH cases were diagnosed in the study. CONCLUSION: 17-OHP concentration was inversely proportional to gestational age and birth weight. Therefore, reference ranges of 17-OHP concentration should be subdivided according to gestational age and birth weight. Further research about perinatal risk factors affecting the 17-OHP concentration will be required.
Asunto(s)
Femenino , Humanos , Lactante , Recién Nacido , 17-alfa-Hidroxiprogesterona , Vértebra Cervical Axis , Peso al Nacer , Ensayo de Inmunoadsorción Enzimática , Edad Gestacional , Incidencia , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Tamizaje Masivo , Tamizaje Neonatal , Parto , Valores de Referencia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
PURPOSE:In infants born intrauterine growth retardation(IUGR), there may be persistent short stature in childhood and adulthood, although most IUGR infants show some degree of catch-up growth. The purpose of this study was to describe the postnatal growth status in order to determine the incidence of catch-up growth. METHODS:This study was carried out with the 260 IUGR infants(birth weight<2,500gm) born at Inje University Sanggye Paik Hospital, from October 1989 to March 1995. RESULTS: 1)Mean gestational age was 38.3+/-.6weeks, mean birth weight was 2.3+/-.2kg and mean birth length was 46.1+/-.7cm. 2)Mean height standard deviation score(height SDS) was 0.02+/-.03. Height SDS was -0.002+/-.71 at 1 year of age, 0.03+/-.14 at 2 years of age, -0.03+/-.71 at 3 years of age, 0.01+/-.24 at 4 years of age, 0.16+/-.24 at 5 years of age, -0.08+/-.43 at 6 years of age. 3)Of the entire study group of the 260 children, 16 children (6%) were below 10 percentile in height. 1 of 36 (2.8%) was below 10 percentile in height at 1 year of age, 5 of 86(5.8%) at 2 years of age, none at 3 years of age, 6 of 44 (13.6%) at 4 years of age, 1 of 25 (4.0%) at 5 years of age, 3 of 17 (17.6%) at 6 years of age. 4)Height SDS significantly correlated with gestational age (r=0.57, p<0.01), birth weight (r=0.17, p<0.01) and midparental height (r=0.72, p<0.01). 5)Birth length and midparental height showed significant differences between catch-up group and non-catch-up group (p<0.01). Condusions:In summary, of the infants born IUGR, 94% showed catch-up growth. Birth length and midparental height were significantly lower in non- catch-up group.
Asunto(s)
Niño , Humanos , Lactante , Peso al Nacer , Retardo del Crecimiento Fetal , Edad Gestacional , Incidencia , PartoRESUMEN
PURPOSE:Factors influencing postnatal growth are innumerable. It is known that genetic factors such as parental height and environmental factors such as nutrition, economic status and hormonal effects are important factors. The purpose of this study was to examine the factors affecting final adult height in normal children. METHODS:753 high school students (513 boys, 240 girls) who live in Seoul were studied. Height and body weight were measured and questionaires about sexual development were examined. We included the subjects who reached fianl adult height. The criteria of final adult height was as following: ages over 17 years in the boys and over 15 years in the girls and growth velocity was less than 1 cm per year. They had no systemic diseases and height standard deviation scores were more than -2.5. RESULTS: 1)Final adult heights were 173.1+/-.1cm in boys and 160.9+/-.7cm in girls. 2)Final adult height significantly correlated with father height(r=0.13, p<0.01), mother height(r=0.25, p<0.01), midparental height(r=0.25 p<0.01) and birth weight (r=0.16, p<0.01). 3)In short final adult height groups, birth weight and midparental height were significantly lower(p<0.05), but puberty onset age, body mass index and economic status were similar to normal stature groups. 4)Final adult height significantly correlated with target height.(r=0.43, p<0.01). In boys, the final adult height was 1.7cm taller than target height on the average. In girls, final adult height was 1.6cm taller than target height on the average. 5)In the group in which final adult height is less than target height, birth weights were significantly lower than those of the groups in which final height is greater than target height. CONCLUSIONS:Among factors affecting final adult height, parent height and birth weight were important. To predict final adult height, target height can be used simply and target height showed significant correlation with final adult height. In the case of showing differences between final adult height and target height, many factors including birth weight will influence the outcome.