A study for post-diagnostic lumbar puncture headache in children / 소아과

PURPOSE: Post-lumbar puncture headache is common complaint. A study of post-diagnostic lumbar puncture headache in children is rare. Various factors that might influence the occurrence of post- diagnostic lumbar puncture headache in children exist. The purpose of this prospective study was to assess the frequency and risk factors for post-diagnostic lumbar puncture headache in children. METHODS: From March 2005 to February 2006, 44 patients with suspected meningitis were enrolled. Patients were received diagnostic lumbar puncture at the Chosun University Hospital, Gwangju, Korea. We evaluated age, sex, previous headache history, number of puncture attempts, volume of cerebrospinal fluid (CSF), pressure of CSF, cell count in CSF, final diagnosis, and the frequency and duration of headaches. RESULTS: Of the 44 patients (mean age 7.36+/-2.04, range 4-13 years), 16 patients (36.4%, male 13/33, 39.4%, female 3/11, 27.2%) had headache. The frequency of headaches was significantly higher in patients with previous headache history compare to those without previous headache history (P= 0.037). The mean of cell count of CSF was significantly higher in patients with post-lumbar puncture headache (P=0.012). The other factors did not influence the post-diagnostic lumbar puncture headache. CONCLUSION: Post-diagnostic lumbar puncture headache in children was more common than other studies. The factors that influence post-diagnostic lumbar puncture headache in children are previous headache history and cell count in CSF.

Evaluation of Web Sites on Treatment of Childhood and Adolescent Obesity / 대한소아소화기영양학회지

PURPOSE: The purpose of this study was to evaluate the quality and problems of Web sites for management of childhood and adolescent obesity. METHODS: We evaluated 203 Web sites identified from the search engine, Korean Yahoo, using the word of 'childhood and adolescent obesity'. 203 Web sites were classified according to medical institutions, health information Web sites, beauty shops. etc. We surveyed whether childhood and adolescent obesity distinguished with adult obesity was considered, or not. and researched the unique managements of childhood and adolescent obesity including the cardinal treatment. RESULTS: Of the 203 Web sites, 157(77.3%) provided detailed information about treatment of obesity, 46(22.7%) provided only simple information about one. The sites providing detailed information were composed of 52.2% of oriental medicine clinics, 35.0% of clinic and hospitals including pediatric hospitals. Distribution of the sites about management of childhood and adolescent obesity distinguished with adult's one was only 23% of oriental medicine clinics, but 93% of childrens hospitals. CONCLUSION: Without considering the speciality of childhood obesity, inaccurate information are distributing on internet web sites. It is necessary for concern and development of advertizing system on the internet distributing accurate information about treatment of childhood obesity.

Prevalence of Orthostatic Dysregulation in Elementary School Students and Frequency of Individual Symptoms / 소아과

PURPOSE: The purpose of the present study was to access the prevalence of orthostatic dysregulation(OD) and the frequency of each category for major and minor criteria among elementary school students using the OD questionnaire. METHODS: We carried out inquiry by questionnaire as to the frequency of OD among two elementary schools with 725 students, 10 to 12 years of age, residing in Gwangju, Korea. The questionnaire was made according to criteria proposed by the Japan OD Study Group. RESULTS: Of the 725 students(male 390; female 335) questioned, the OD was found in 338 students (53.5 percent). Prevalence of OD in males(59.2 percent) was significantly higher than in females(46.8 percent)(P<0.05). Palpitation with slight exercise(95.9 percent) was the most frequent major symptom. Headaches(85.8 percent) were the most frequent minor symptom among cases of OD. CONCLUSION: The prevalence of OD in elementary school students in this study(53.5 percent) was higher than in other studies. Contrary to studies from other countries, the male to female ratio was reversed. Because the diagnostic criteria seem to be dependent on subjective reporting of the symptoms, a newer diagnostic system based on more objective findings should be established.

A Case of Craniofrontonasal Dysplasia Diagnosed at Birth

Craniofrontonasal dysplasia(CFND), a rare congenital syndrome, is characterized by varying degrees of frontonasal dysplasia, craniosynostosis, and variable extracranial abnormalities. It was first reported by Cohen in 1979. The inheritance pattern is not straightforward. Although all modes of Mendelian inheritance have been suggested, the most plausible explanation is that this is an X-linked condition with the unusual situation of complete expression in females, and minimal to no expression in males. In our case, CFND was diagnosed in a female neonate who had unilateral coronal craniosynostosis, frontal bossing, orbital hypertelorism, broad nasal root, clefting nasal tip, corpus callosum agenesis and mild extremity abnormalities.

The Long-term Follow-up Studies of Childhood Obesity after Puberty / 대한소아소화기영양학회지

PURPOSE: We studied the prevalence and long-term trend of childhood obesity after puberty to help in managing and treating obesity. METHODS: We surveyed obesity index of children at age 13 and 17 who was diagnosed as obesity at their age 7. 1,559 students consisting of 753 boys and 806 girls had followed up since 1992 until 2002. Obesity was defined as the obesity index over 20 percent. RESULTS: The prevalence of obesity was 3.1% at age 7, 7.1% at age 13 and 13.0% at age 17, which increased significantly with getting older in age in both sex. Among obese children at age 7, 67.5 percent remained obese at age 17. 66.6% of the obese boys at age 7 and 68.4% of the obese girls at age 7 remained obese at age 17. The proportion of severe obesity in obese boys was increased as they were old, but not in obese girls. The progression to moderate and severe obesity at age 17 was prominent for obese boys at age 7, compared to the obese girls. 12.7% of normal weight boys at age 7 and 9.8% of normal weight girls at age 7 became obese at age 17. CONCLUSION: We think that the prevention and treatment of obesity during puberty is as important as those in the childhood.

Relationship between Admission and Clinical Features of Children who visited the Emergency Department with Seizures

PURPOSE: To review the seizure-related complaints and analyze the relationship between admission rates and clinical features in children who had visited the emergency department with seizures. METHODS: Retrospectively, we reviewed 180 patients(male 100, female 80) suffering from seizures, who had visited to the emergency department of Chosun University Hospital from January 2000 to June 2002. We have analyzed the correlation between admission rate and clinical features such as age, seizure type, seizure duration and individual laboratory findings(CT or MRI, and CSF). RESULTS: Out of 4,865 total children who visited the emergency department, 180 patients(3.7%) were seizure related. The most common seizure type was simple febrile seizure(52.2%). The admission rate of children with seizures was 48.9%. The admission rate according to age, sex and abnormal laboratory findings revealed no significant correlations(P>0.05). There was a significant correlation between admission and both status epilepticus 82.4%(14/17) and complex febrile seizure 63.6%(14/22) (P<0.05). According to the duration of convulsions, admission rates were 41.2% when within five minutes, 60% when six-15 minutes, 58.8% when 16-30 minutes, 85.7% when 30 minutes, to one hour and 66.7% when above one hour of duration. According to the seizure frequency, admission rates of recurrent seizure patients(61.4%=43/70) was higher compared to the first time seizure patients(40.9%=45/110). CONCLUSION: We found that the admission rate of children visiting the emergency department for seizure treatment was 48.9% and significantly correlated with duration, type and frequency of seizure.

The Prevalence and Associated Factors of Constipation in the School-aged Children / 대한소아소화기영양학회지

PURPOSE: Constipation in childhood is a significant problem, however, understanding of its epidemiology has been limited in Korea. The aim of this study was to investigate the prevalence and risk factors of constipation in school-aged children, helping to manage and prevent it. METHODS: This cross-sectional, descripsive observational prevalence study included children (2 grade, 1st and 6th grade) who were attending two elementary schools in Gwangju. The prevalence of constipation, associated symptoms, and risk factors were evaluated by questionnaire. A child was considered to be constipated when he or she defecated two or less times per week. RESULTS: The prevalence of constipation was 15.4%. There is no significant difference between both sexes and grades. Of the causes of constipation, there was statistically significant difference in exercise deficiency, frequent intake of convenience food, long-time watching TV, unbalanced diet and enuresis history between constipation and normal group. Especially, long-time watching TV, exercise deficiency, and enuresis history were risk factors for development of constipation. Only 27.1% of children with constipation were treated by laxative and enema. CONCLUSION: Even though the prevalence of constipation was high, more than half of them was not treated at all. We should endeavor to educate the children and their parents to prevent constipation by evaluating the feeding and behavioral habit completely, and treating them properly.

Prevalence and Associated Factors of Snoring in School-Aged Children

PURPOSE: We studied the prevalence of snoring and its association with diseases, obesity and environmental factors, as well as sleep disturbance arising from snoring, in school-aged children. METHODS: The survey was performed by a special questionnaire on 1,707 children at elementary schools from 1 to 30 July 2001 in Gwangju City. The prevalence of snoring, associated factors, and sleep disturbance were evaluated. RESULTS: 266(16.5%) of the children snored at least once a week. 73(4.3%) of the children snored almost every day. Regarding the associated factors of snoring : There was a statistically significant difference between snoring and nonsnoring groups due to gender, obesity, sinusitis, tonsillar hypertrophy, bronchial asthma and allergic rhinitis. Of them, male gender, tonsillar hypertrophy, and obesity were significant risk factors for development of snoring. Especially, the odds ratio increased to 1.048(CI, 1.004-1.659), 1.748(CI, 1.175-2.599), and 2.266(CI, 1.300-3.950) in children with an obesity index of 20-29%, 30-49%, >or=50%, respectively. There was a statistically significant association of snoring with decreased sleep duration, sleep talking, and drowsiness during the day as a result of sleep disturbance. CONCLUSION: 16.5% of school-aged children snored at least once a week. The association of snoring with tonsillar hypertrophy, obesity and gender as risk factors was demonstrated in this study.

Clinical Significance of Repeated Delayed Air Reduction in Unsuccessful Initial Reduction of Intussusception / 대한소아소화기영양학회지

PURPOSE: The advantages of air reduction are the ease of performing the procedure, reduced radiation time and lower morbidity rate if perforation occurs. But, patients who fail air reduction undergo a laparotomy at which 10% have spontaneously reduced. The first enema decreases the edema and venous congestion of bowel wall, thus repeated reduction may succeed. The aim of this study is to evaluate the efficacy of delayed repeated pneumatic reduction of intussusception in patients with failure of an initial attempt. METHODS: Between January 1998 and December 1999, 21 patients with proven intussusception received repeated delayed reduction 1 to 3 hours following the first failed attempt. These patients were in stable condition and did not have peritonitis, shock or toxic sign. RESULTS: Before reduction, the patients had symptoms and signs for 6 to 48 hours (median 24 hr). The interval from the first reduction to the repeated was 1 to 3 hours (median 2.2 hr). The success rate of repeated reductions was 76.2% (16 of 21 patients), and 23.8% (5 of 21 patients) required surgery. Four of 5 patients requiring surgery were manually reduced and 1 spontaneously reduced in the operating room. CONCLUSION: We recommended a repeated reduction in patients with intussusception who are in stable clinical condition after an unsuccessful initial reduction attempt.

Prevalence and Epidemiologic Charicteristics of Chronic Recurrent Headache in Primary School Children

PURPOSE: The purpose of the study was to determine the prevalence of chronic recurrent headache and the factors associated with it among primary school children. METHODS: The survey was performed by a special questionnaire on one thousand and eleven children in grades 4 to 6 at primary schools from 1 to 30 June 1999 in Gwangju city. RESULTS: Prevalence of chronic recurrent headaches was 17.5%(17.1% among males, 18% among girls). Over forty two point seven percent(42.7%) of the children had headache 4-6 times a month. Age at onset of headache was more predominant at 7-10 years of age. Headache most frequently occured before school(30.7%), during school(29%), and before awaking in the morning(16.5%). The highest incidence rate of chronic recurrent headache was observed on Monday(23.5%), and the lowest on Saturday(5.3%). Risk factors of chronic recurrent headaches were stress(26.1%), fatigue, poor sleep(25.1%), weather change(18.3%) and anxiety(18.2%). Of 177 cases with chronic recurrent headaches, 62 cases(35%) had family history. Among them, 50.0% of the patients had history in their mothers, 24.2% in the fathers, 17.7% in the brothers and sisters. Of 177 cases with chronic recurrent headaches, 122 cases(69%) were treated at the pharmacy(35%), hospital(23%), and herb medicine(11%). CONCLUSION: This study finds a high overall prevalence(17.5%) of chronic recurrent headache on primary school children. And among many causative factors, stress schools is most common. In conclusion, while evaluating chronic headache in children, environmental and emotional factors associated with school should be considered as well as organic causes.

Prevalence of Obesity and Its Relationship to Diet on Elementary Students / 대한소아소화기영양학회지

PURPOSE: The purpose of our study is to provide useful information for the prevalence of obesity by the standard weight for height and the relationship of the body image to dieting methods for weight control in children. METHODS: The survey was performed by an anthropometry and a special questionnaire on children in grades 5 to 6 at elementary schools from May to June 1997 in Kwangju city. RESULTS: 1) Selected individuals were categorized into obese, normal, thin by the standard weight for height and body image. The prevalence of obesity by the standard weight for height was 19.5%, normal was 70.5%, thin was 10.1% in males and respectively 10.5%, 66.3%, 23.1% in females. The prevalence of obesity in regards to body image was 18.4%, normal was 58.4%, thin was 23.2% in males and respectively 24.5%, 58.6%, 16.9% in females. 2) The obese body image was 6.8% in normal and thin groups in males and 19.4% in females. The body image of obese children who do not perceive themselves as obese was 32.6% in males and 28.7% in females. 3) The standard body image was 88.8% as realized by themselves, 77.9% when they compared themselves to friends, 62.7% as told by parents, 56.8% as told by friends, and 29.9% when they compared themselves to celebrities. 4) The source of information for dieting treatment was 44% from radio and television, 30% from books, newspapers, magazines, 17% from family and 9% from friends and seniors. 5) The prevalence of dieting according to the standard weight for height was 18.0% in thin, 18.7% in normal and 36.7% in obese group in males and respectively 17.8%, 22.4%, 46.3% in females. There was a statistically significant correlation between males and females (p < 0.0005). 6) The prevalence of dieting up to 2 weeks in the thin and normal groups as recognized by weight centile was 17.3% according to body image. The prevalence of dieting up to 2 weeks in the obese groups was 37.2% according to body image (p < 0.001). CONCLUSION: We suggest that many students perceived their body size incorrectly and tried weight control. The incorrect perception of body size seems to cause the problem of failure to thrive, malnutrition etc. It is necessary for further study to find and prevent side effects by unnecessary weight control and to provide proper health education and management about obesity.

A Study of The Relationship Between Headache and Depressive Trends in Elementary School Children / 대한소아신경학회지

PURPOSE: The purpose of our study is to determine the relationship between the level of depression and characteristics of headache in elementary school children. METHODS: A self-administered questionnaire was completed by one thousand and eleven children (510 boys and 501 girls) of grades 4 to 6 in Gwangju city during the period from June 1 to June 30 1999. The relationship between headaches and depressive trends was investigated with the Kovasc & Beck Children's Depression Inventory modified for Korean. Result : The prevalence of headache was 17.5% (17.1% among males, 18% among girls). The mean depressive scores in the headache group was higher than those in control group, but the difference was not statistically significant. The depression scores did not differ significantly depending on sex, and family history of headache. The depression scores did not correlate with the onset, location, severity, frequency, duration, and onset pattern of headache. The mean scores of depression in the dull and tightness pattern (17.46+/-7.18) were significantly higher than those of pulsatile and other patterns. The mean scores of depression in the onset time of occurrence of headache were significantly high before school (24.33+/-5.69), at school (15.66+/-6.32, P<0.05). The mean score of depression in the aura was significantly high "inaudible (22.00+/-9.49)" and in the trigger factors was significantly high weather change (16.18+/-6.85, P<0.05). CONCLUSION: Based on our analysis, there is a correlation between depressive trends and characteristics of headache in elementary school children. So, we suggested that depressive trends should be evaluated in children with headache.

A Case of Congenital Complete Heart Block

In complete heart block(CHB), there is a complete failure of the atrial impulse leading into a ventricular response, the atria and ventricles beat independently, with the latter having a slower rate. Approximately one-third of infants with congenital CHB have associated structural heart disease such as corrected transposition of the great arteries, single ventricle, and the heterotaxy syndrome. For those patients without associated anomalies in whom bradycardia causes heart failure unresponsive to drugs, a pacemaker is necessary. We report a case of congenital complete heart block showing a ventricular beat of 57 /min despite atrial beat of 125/min. The mother of the baby was asymptomatic but her serologic tests were positive for connective tissue disease. The patient had positive serologic tests for anti-Ro antibody and anti-La antibody but associated structural heart anomalies were not found. He remained well without signs and symptoms of heart failure and no treatment was required except 02 supply.

A Study on Epidemiologic Characteristics of Recurrent Abdominal Pain in Elementary School Children / 대한소아소화기영양학회지

PURPOSE: The aims of this study are to examine clinical characteristics, patterns of medical care utilization, and factors which determine medical care utilization of elementary school children with recurrent abdominal pain (RAP), to find possible factors influencing the onset and the course of the disorder. METHOD: We performed questionnaires in Kwangju on children from two primary schools from June, 1 1998 to June 30 and carried out statistical analysis. RESULT: 1) Total number of questionnaires were 1417. 715 were male and 702 were female and the ratio of male to female was 1.02 : 1. Average age was 10.3 years. 2) 268 children had RAP (18.9%), boys 132 (18.4%), girls136 (19.2%). 3) The duration of the pain within 10 minutes was 68.5%. 178 children with RAP (66.3%) visited the doctor, The utilization pattern of medical facilities of the pupils with RAP; the most frequently utilized medical facility was pediatrics (35.2%) and the order ran as infernal medicine (31.5%), and pharmacy (29.25). The utilization pattern of medical facilities for the older students; the utilization rate of pediatrics decreased, but internal medicine increased. The major factors affecting the selection of the medical facility were geographic accessibility, kindness of the personnel, good results and traffic convenience. 4) Symptoms which were accompanied with abdominal pain were headache (44.5%), chest pain (28.2%), dizziness (26.6%), vomiting (9%), and 119 children (44.5%) had no accompanied symptoms. 5) In 95 children (35.3%) abdominal pain, occured at postprandial time, in 55 children (20.5%) before meal and in 39 children (14.7%) at school. The highest incidence rate of RAP was observed on Monday (21.4%), and the lowest on Saturday (8.7%). 6) The most frequent involved part of the abdomen was periumbrical area (38%) and the order ran as epigastrium and suprapubic area. The most frequent characteristics of abdominal pain were burning pain (36.9%) and the order ran as dull, cramping and colicky pain. CONCLUSION: RAP is a frequent disease entitiy in children. Too many times children with RAP are treated by other departments instead of Pediatrics. A child has a peculiar growth and development which is different to those from an adult with advancing years. So, it is necessary to choose special medical care and an adequate medical facility.

A Case of Catel Manzke Syndrome

Catel Manzke syndrome is characterized by hyperphalangy of the index fingers associated with Robin malformation sequence. The etiology of Catel Manzke syndrome is still uncertain, with the majority of cases being sporadic. Careful observation to recognize upper airway obstruction secondary to the Robin sequence should be made a part of routine care for newborns with this disorder. Failure to thrive is related to respiratory or cardiac problems. The vast majority of case have normal intelligence. With advancing age, the accessory bone fuses to the proximal phalangeal epiphysis. We report a neonate with the Pierre Robin triad, accessory bone between the second metacarpal and its proximal phalanx of the Rt hand, camptodactyly, coarctation of aorta and hydronephrosis of Lt kidney.

Analysis of predictive factors in the Assessment of Mear-drowning in Children

Drowning is the second most common cause of accidental death of children in Korea. But the study of near-drowning is very rare in Korea. The purpose of our study is to determine the factors that may influence survival on the basis of submersion time, consciousness state upon admission to hospital, the kinds of water, laboratory findings and neurological outcomes. The survey was performed by a retrospective cohort study on 28 near drowning victims of less than 15 years of age who were admitted to the emergency room in the Chosun University Hospital between May 1988 & May 1997. The results were as follows 1) Sex distribution was 22 males and 6 females. 2) Submersion time was (5 minutes in 9 cases, 5-9 minutes in 6 cases,10-14 minutes in 5 cases,15-19 minutes in 3 cases, > or =20 minutes in 5 cases. 3) Comatose patients upon arrival were 6/7 cases in the death group(86%) and 2/21 cases in the improved group(10%). they had unfavorable outcomes(P<0.05). 4) The first pH value was mean 7.02)0.12 in the death group and mean 7.31 +/-0.13 in the improved group. there was a statistically significant difference between the death and the improved group(P<0.05). 5) The patients who had increased blood glucose concentration were all 7 cases in the death group and 12/22 cases in the improved group(54%). The mean blood glucose concentration was mean 424.7235.6mg/dl in the death group and mean 140.182.7mg/dl in the improved group. There was a statistically significant difference between the death and the improved group(P<0.05). 6) The patients who had pulmonary edema upon arrival were all 7 cases in the death group and 1/21 cases in the improved group(18%). They had unfavorable outcomes(P<0.05). 7) The patients who had been submerged more than 15 minutes were all 7 cases in the death group and 6/21 cases in the improved group(5%). They had unfavorable outcomes(P<0.05). We conclude that pediatric victims of near-drowning can be assigned to high or low likelihoods of unfavorable outcomes with the use of five variables, comatose mentation upon arrival, decreased initial blood pH, increased initial blood glucose concentration, pulmonary edema, and maximum submersion time estimated longer than fifteen minutes. This prediction rule may be useful if it can be validated in another cohort.

Prevelance and Associated Factors of Childhood Obesity on the Elementary Students in Kwangju City

No abstract available.

A Case of the Non-rhizomelic Chondrodysplasia Punctata

No abstract available.

A Case of EIEE (Early Infantile Epileptic Encephalopathy)

The EIEE is defined by very early onest, within the first few months of life. Frequent tonic spasms, and suppression burst of EEG pattern in both waking and sleeping state. Its etiology and underlying pathology are obscure. The prognosis is usually grave with severe psychomotor retardation and intractable seizures. Occassionaly it may evolve into the West syndrome. We report a case of 3-month-old female delivered by Casesarean section, who showed typical features of EIEE disorder, with the review of literatures.

Effects of equiseti herba water-heating extract on the kidney and liver of rats

The effects of Equiseti Herba Water-heating extract on the kidey & liver of rats were studied in 25 male Sprague-Dawley rats evenly divided into five groups, i.e., 5 rats each. The group I, which served as control and the group II, III, IV, were fed 300 mg/kg, 1000 mg/kg of Eqiseti Herba water-heating extract daily for one week, respectively. The group V was fed 1000 mg/kg of Equiseti Herba extract daily for two weeks. The effect of Equiseti Herba on the kidney and liver were determined by the measurements of the serum levels of BUN, creatinine, calcium, phosporus, sodium and potassium, total protein, albumin, transaminase (GOT & GPT) and cholesterol and 24hrs urine volume and GFR(ml/min), as well as by light microscopic and ultrastructural examinations of kidney and light microscopic examinations of liver in rats. The results were as follows; The groups II, III, IV were slightly higher than the control group on serum creatinine and potassium levels, but the group V was declined on serum creatinine and potassium levels, and 24hrs urine volume in spite of increased GFR. Histologically there was no remarkable changes in groups compared with the group I, except mild vacuolization of proximal convoluted tubule in group IV and V. These results suggested that equiseti Herba water-heating extract in rats induced reversible tubular changes on the kidney of rats. But the groups administrated by Equiseti Herba water-heating extract were not significantly higher than the control group on liver function test. Histologically there was no remarkable changes in groups II, III, IV & V compared with the group I.