Effects of Nebulized Budesonide in the Treatment of Patients with Mild to Moderate Croup

PURPOSE: Dexamethasone intramuscular injection and oral prednisolone have been known to be effective in the treatment of croup. The aim of this study was to determine whether nebulized budesonide leads to clinically important improvement in respiratory symptoms within four hours for child with mild to moderate croup. METHODS: Patients with croup visited to the department of Pediatrics, Han Il General Hospital from March 1995 to June 1996 were enrolled in this study. Patients were eligible if their age was between six months and six years, their total croup score was higher than 2 after breathing humidified air for at least 15 minutes. 28 patients were treated with 2mg (8ml) of nebulized budesonide and 8 patients with 8ml of normal saline as control group over the 30 minutes. Croup score, heart rate and respiratory rate were then assessed hourly for up to four hours. Side effects were also observed. RESULTS: 1) The croup score was improved from 3.6+/-0.8 to 1.9+/-0.9 at 4 hours after the nebulized budesonide treatment. 2) No significant differences in changes in heart rate were observed until 4 hours after both the nebulized budesonide group and control group. 3) Significant decrease in respiratory rate was observed at 4 hours after the nebulized budesonide group. 4) No specific side effects were noted during and 4 hours after the nebulized budesonide treatment. CONCLUSIONS: We concluded that nebulized budesonide leads to a prompt and important clinical improvement in children with mild to moderate croup without any specific side effects.

A Case of Intestinal Amebiasis with Protein Losing Enteropathy

Amebiasis is an infectious disease caused by Entameba histolytica. Amebiasis remains an extremely important consideration in the differential diagnosis of diarrhea, especially when there is associated bleeding. It is imperative that appropriate studies to establish or exclude the diagnosis of amebiasis be carried out in all patients who present with a clinical and sigmoidoscopic picture of colitis, and that patients treated with metronidazole for amebiasis have adequate clinical and parasitological follow-up. We have experienced one case of intestinal amebiasis with protein losing enteropathy in 30month-old boy whose chief complaint was mild fever, vomiting and blood tinged diarrhea. His laboratory findings were compatible with protein losing enteropathy. The diagnosis of amebiasis is confirmed by observation of trophozoite of E. histolytica in the stools. A brief review with related literatures is also presented.

A Case of 17alpha-Hydroxylase Deficiency

A 12-year-old girl with hypertension, hypokalemia, cystic ovaries and absence of secondary sexual development is presented. Hormonal study revealed very low levels of cortisol, testosterone, estrogen, and high levels of progesterone, deoxycorticosterone, corticosterone, FSH and ACTH. Following treatment with dexamethasone and estrogen, the levels of the latter group remarkably decreased. Serum potassium level and blood pressure also became normal. With all the above hormonal profile and clinical findings, we reached the diagnosis of 17alpha-hydroxylase deficiency and report this case with the review of literature.