Paradoxical Response to Chemotherapy in Tuberculous Pleural Effusion / 소아알레르기및호흡기학회지

It is defined as the paradoxical response when the clinical or radiologic worsening of old lesions or the development of new lesion occur in spite of appropriate antituberculous therapy. The paradoxical response can occur as an intracranial tuberculoma, pleurisy, pericarditis and contralateral new parenchymal lesions. However, poor compliance with therapy, drug resistance, non-tuberculous mycobacterium, or another underlying condition as lung cancer should be ruled out before concluding that the treatment is the cause of the exacerbation. The case reports of paradoxical response have been mainly reported in adults, but extremely rare in children. We report a case of paradoxical response in which a new parenchymal lung lesion developed during antituberculous therapy in a 14-year-old female patient with tuberculous pleurisy. She experienced clinical improvement with steroid therapy in addition to antituberculous therapy.

Insulin Resistance in Children and Adolescents Born Small for Gestational Age / 대한소아내분비학회지

PURPOSE: The aim of this study was to determine whether insulin resistance may be present and to analyze factors affecting the development of insulin resistance in children and adolescents born small for gestational age (SGA). METHODS: This study includes 24 children and 18 SGA adolescents and 13 children and 14 control adolescents. All patients underwent a standard, 2-hour oral glucose tolerance test (OGTT). Serum levels of fasting blood sugar, insulin, leptin, adiponectin, homeostasis model assessment-insulin resistance (HOMA- IR), quantitative insulin sensitivity check index (QUICKI), insulin sensitivity index (ISI), mean serum insulin (MSI) and mean serum glucose (MSG) were evaluated. RESULTS: The insulin responses at 30 min and 120 min after glucose load were significantly higher in pubertal SGA than control groups (P<0.05). Impaired glucose tolerance was found from 2 subjects (8.7 %) in prepubertal SGA group and from 3 subjects (15.0%) in pubertal SGA group. None of the patients had developed type 2 diabetes. MSI levels during OGTT were higher in pubertal SGA than in control. Pubertal SGA group had a significantly lower mean serum adiponectin level than control group (9.04+/-4.51 vs. 18.83+/-11.65 microgram/mL, P<0.05). Adiponectin level was correlated with HOMA-IR, QUICKI and ISI (r=-0.37, r=0.32, r=0.51, respectively, P<0.05). CONCLUSION: Adiponectin level was correlated with HOMA-IR, QUICKI and ISI. Pubertal SGA group had a significantly lower mean serum adiponectin level than control group. We suggest the check of insulin resistance using HOMA-IR, QUICKI, ISI and adiponectin is important for the prevention of metabolic syndrome (MS) in adolescents born SGA.

The usefulness of skin test in evaluation of immunity to varicella / 소아과

PURPOSE: The aim of this study is to assess the usefulness of skin test by an inactivated, 1/50 diluted solution of attenuated varicella vaccine in evaluating the immune status to varicella. METHODS: Total 41 subjects (22 males, 19 females, aged 1-32 years) were enrolled from July to August, 2005. Past medical history including varicella infection, varicella vaccination were investigated through questionnaires. The skin test solution was prepared from solution of attenuated varicella vaccine(Oka strain) which was inactivated by exposure to room temperature for 10 days and diluted at 1/50 with normal saline. Skin test was done by injecting 0.1 mL of the solution intradermally into the volar surface of the right forearm and sterile normal saline was used as a control on the left forearm. Positive reaction was defined when the transverse diameter of the induration was 5 mm or more. Serum varicella zoster virus specific IgG antibody test by ELISA (enzyme-linked immunosorbent assay) was done. RESULTS: In adults, the sensitivity of the varicella zoster virus skin test compared to ELISA was 94.7% and the positive predictive value was 100%. In children, both the positive predictive value and specificity were 100% but the sensitivity and the negative predictive value were 50% and 30.7% respectively. Children showed smaller skin test reactivity compared to adults. CONCLUSION: The varicella zoster virus skin test using inactivated, 1/50 diluted solution of attenuated varicella vaccine was proved as one of the useful tools for evaluating the immunity and susceptibility of the varicella zoster virus.