Tibial Torsion in Children of the Jeju Area / 소아과

PURPOSE: Internal tibial torsion is prevalent in East Asian countries such as Korea and Japan, where sitting on the floor is common behavior. Internal tibial torsion or excessive lateral tibial torsion may cause esthetical, functional, or psychological problems and also may induce degenerative arthritis in older age. The purpose of this study is to measure the tibial torsion in children of the Jeju area. METHODS: Tibial torsion was measured in 1,042 lower extremities of 521 children from one to 12 years of age. The values of transmalleolar angles were analyzed for each age group divided by 6 months. Quadratic and linear regression models were used to fit patterns of changes in mean values of transmalleolar angles. The age at seven, which provides the highest coefficient of determination for quadratic regression analysis, was used as a cut-off point to fit different statistical models. RESULTS: The mean transmalleolar angle was 0.10+/-5.79degrees in all children, 0.90+/-5.49degrees in males, and -0.80+/-5.97degrees in females. The value was 4.25+/-4.04 in 1 year of age, gradually decreased to the lowest level of -1.98degrees in four years and seven months of age, increased again with age until it reached 0.67+/-1.10degrees at seven years of age, and stayed at that level thereafter. CONCLUSION: Internal tibial torsion in infancy is known to correct spontaneously in the normal developing process. But in this study, the mean transmalleolar angle in children of Jeju area annually decreased after one year of age; to the lowest angle at four years and seven months of age; increased again gradually to the age of seven; and persisted in that level, about 10degrees less than western children, not correcting further thereafter. These findings suggest tibial torsion might be caused by lifestyle, especially sitting on feet. To prevent abnormalities of joints and gaits, early diagnosis of tibial torsion in childhood and posture correction or early treatment when needed, seems to be necessary.

Serum Lipids of School Children and Adolescence in Urban and Rural Area / 소아과

PURPOSES: A cross-sectional study on serum lipids in school children and adolescents was carried out in two different areas in 2002. We studied to determine of the difference in lipids level of children between urban and rural areas and changes of cholesterol levels compared to those of early- 1990 studies. METHODS: A cross-sectional study on serum lipids in school children and adolescents was carried out in two different areas, Ansan and Paju. The number of children in Ansan was 835, that in Paju was 233. After fasting for 12 hours, serum total choleterol, high density lipoprotein(HDL) cholesterol, low density lipoprotein(LDL) cholsterol, triglyceride were measured. RESULTS: The mean of total serum cholesterol level was 176.48+/-27.70 mg/dL. The mean of HDL cholesterol was 61.42+/-12.38 mg/dL, LDL cholesterol was 94.14+/-24.45 mg/dL, and triglyceride was 93.09+/-45.96 mg/dL. The means of total serum total cholesterol and lipoproteins of children and adolescents were not different significantly in Ansan and Paju. The prevalences of children and adolescence with abnormal high cholesterol level(> or =200 mg/dL) and abnormal LDL cholesterol level(> or =130 mg/dL) were also not different in two areas. CONCLUSION: Our results suggest that there were no significant differences in serum lipid level and the prevalence of school children and adolescence with hyperlipidemia between urban and rural area and mean lipid levels of school children and adolescence were increased during the past decade.

Overnight Growth Hormone Secretions and Sleep Patterns in Idiopathic Short Stature Children

PURPOSE: Pharmacologic provocation test of growth hormone(GH) is a non-physiologic method and has several limitations for diagnosing growth hormone(GH) deficiency. Spontaneous GH release studies could be important in understanding the pathophysiology of children with poor growth but normal responses to GH provocation tests. Also, the relationship between nocturnal GH secretions and sleep patterns in short stature children is poorly understood. The aim of this study is to determine whether there are differences in sleep patterns and nocturnal GH secretory profiles between idiopathic short stature children and a normal stature group. METHODS: Spontaneous nocturnal GH secretions and sleep patterns were evaluated in 12 prepubertal idiopathic short stature children with normal responses to provocation tests and 9 normal stature controls. Blood samples were taken every 30 minutes from 22:00-06:30 and sleep patterns were analyzed by polysomnography. RESULTS: The mean GH level during sleep was significantly lower in short stature children than in controls. The peak GH level after sleep, coincident with the first slow wave sleep, was lower in the short stature group. The slow wave sleep times of short stature children were decreased compared with those of normal subjects. CONCLUSION: These results suggest that overnight serial GH sampling is helpful to identify short stature children with subnormal GH secretions, and sleep structure differences may be associated with decreased overnight GH secretions in short stature children.

Changes of Plasma Brain Natriuretic Peptide According to the Changes of Ductal Shunt in Healthy Preterm Infants

PURPOSE: The purpose of this study is to clarify the effect of hemodynamic changes of ductal shunt on brain natriuretic peptide(BNP) secretion and to investigate the value of plasma BNP level as a predictor of spontaneous closure of ductus arteriosus(DA) in healthy preterm infants. METHODS: 24 preterm infants were enrolled. Echocardiographic examinations and blood samplings of BNP were carried out in 24 hours, 72 hours and on 5th days after birth. The magnitudes of ductal shunts were estimated using ductal color Doppler flow pattern, left atrial/aortic root ratio(LA/Ao ratio) and antegrade peak diastolic flow velocity(APDFV) in left pulmonary artery. RESULTS: DA in healthy preterm infants were closed spontaneously within 5 days of birth. Plasma BNP levels in infants with ductal shunt were higher than that of infants without shunt in 24 hours and then significantly decreased within 72 hours of birth according to the decreases of flow in ductal shunts. BNP levels of all infants with ductal shunt were significantly correlated with LA/Ao ratio and APDFV. CONCLUSION: Reduction of BNP levels may serve as an indicator of spontaneous closure of DA in healthy preterm infants. Its levels show significant correlations with the magnitudes of ductal shunt. Therefore BNP levels may be used in determining the necessity of and the optimal time to initiating medical and surgical management of preterm infants with significant PDA.

Epidemiologic Study of Kawasaki Disease in Korea, 1997-1999: Comparison with Previous Studies During 1991-1996

We performed a retrospective epidemiologic survey on Kawasaki disease (KD) from 1997 to 1999 in Korea. We sent a questionnaire to 111 training hospitals, and summarized the data from 50 hospitals that responded. Data from a total of 3,862 cases were collected, which showed no difference in annual incidence and a seasonal predilection for summer. The male-to-female ratio was 1.51:1, and the mean age was 29.7 months. The prevalence of sibling cases was 0.26%, and the rate of recurrent cases was 2.3%. The proportion of patients with KD among total hospitalized pediatric patients was 1.19% in average, showing a significant difference according to the regions. Coronary arterial (CA) abnormalities were detected by echocardiography in 19.8% of cases (737/3,723) including dilatations in 601 cases (16.1%) and aneurysms in 191 cases (5.1%). Data from total 8,251 cases in the 1990s including the cases in the present study, in Korea showed a mean age of patients 28.9 months, male-to-female ratio 1.6:1, seasonal predilection for summer, prevalence of sibling cases 0.24%, rate of recurrent cases 2.3%, incidence of CA abnormalities 21.0%, and incidence of CA aneurysms 5.2%, with statistically significant decreasing trends in the male-to-female ratio and the rate of CA abnormalities.

Transplacental transfer and age-related levels of serum IgG antibodies to the capsular polysaccharides of Streptococcus pneumoniae types 14 and 19 in Korea

Little is known about the prevalence of naturally acquired IgG antibodies to the capsular polysaccharides of Streptococcus pneumoniae (pneumococcal IgG) in Korea. In the present study, we investigated transplacental transfer and age-related levels of pneumococcal IgG to provide background seroepidemiologic data for S. pneumoniae in Korea. One hundred thirty eight sera were assayed by ELISA for IgG to pneumococcal polysaccharide capsular serotypes 14 and 19, the predominant serotypes for under 15 yr of age in Korea. The subjects were divided into 7 subgroups according to age. The cord/maternal geometric mean titer of pneumococcal were 4.47+/-5.88/5.21 +/- 5.88 for serotype 14, and 4.68 +/- 5.55/6.55 +/- 6.92 for serotype 1 9 (mean +/- standard deviation, microg/mL). After birth, the geometric mean titers of pneumococcal IgG for serotypes 14 and 19 expressed in microg/mL were 1.18+/-2.12 and 1.41+/-2.17 in the 0-6 months group, 0.27+/-0.19 and 0.69+/-0.93 in 7-12 months, 0.21+/-0.22 and 0.64+/-1.32 in 1-2 yr, 0.69+/-0.78 and 2.65+/-2.46 in 3-6 yr, 2.52+/-2.72 and 8.29+/-4.24 in 7-10 yr, respectively. In conclusion, reduced transplacental transfer and very low serum concentrations of pneumococcal IgG may contribute to the susceptibility of neonates, infants, and young children to S. pneumoniae infection.

Expression of P-selectin mRNA and Protein on Hypoxic-Ischemic Brain Injury in Neonatal Rat / 대한소아신경학회지

PURPOSE: The selectin family of adhesion molecules plays a role in the initiation of endothelium-leukocyte interaction of inflammation and ischemia-reperfusion. P-selectin, a rapidly expressed endothelial cell adhesion molecule, is essential for both neutrophil rolling after endothelial stimulation and neutrophil transmigration. P-selectins were expressed after brain injury and could play an important role in the pathogenesis of ischemic brain injury in adult animal. However, the mechanisms leading to post-hypoxic-ischemic injury in immature brain are unknown yet. We hypothesize that P-selectin might mediate post-hypoxic-ischemic injury in immature rat brain. We evaluated the expression of mRNA and protein of P-selectin in post-hypoxic-ischemic immature rat brain. METHODS: In isoflurane-anesthetized P7(Postnatal day 7) Sprague-Dawley rats(n=81), the right carotid artery was isolated and coagulated. 1-2 h later animals were exposed to 8% oxygen(balanced with nitrogen) for 2 h in glass chambers, in a warm air incubator (temperature maintained at 36.5 degrees C). Control included carotid artery coagulation alone, hypoxia alone, and normal(neither hypoxia nor coagulation). For RNA extraction, the rats were decapitated at 0, 2, 4, 8, 12, 24 and 48 h after hypoxic-ischemic injury. For Western blot analyses with P-selectin, rats were decapitated at 0, 15, 30 min, 1, 2, 4, 8, 12, 24 and 48 h after hypoxic-ischemic injury. Control or hypoxia alone rats were sacrificed 8 h after the respective intervention. RESULTS: There was no expression of P-selectin mRNA in control groups(carotid artery coagulation alone, hypoxia alone, or normal). P-selectin mRNA expression in the ipsilateral(right) hemisphere reached a peak at 8 h after hypoxia-ischemia and then barely detected after 24 h. Expression of P-selectin protein was not observed in brain tissue of control rats. P-selectin protein was detected as early as 15 min and 30 min at both hemisphere in experimental rats and decreased at 1 h. P-selectin protein increased in right hemisphere at 4 h post-hypoxia-ischemia, peaked at 8 h and no longer detectable at 24 h. CONCLUSION: Hypoxic-ischemic injury leads to P-selectin expression in neonatal rats brain. The temporal profiles of post-hypoxic-ischemic P-selectin mRNA and protein expression are consistent with a role in the evolution of subsequent brain injury.

Dexamethasone Induced Cardiac Hypertrophy in Preterm Infants hypertrophy, Hypertrophic Cardiomyopathy

PURPOSE: Dexamethasone is a well-known treatment for preterm infants with bronchopulmonary dysplasia. However, serious side effects have been identified, including hypertension, and cardiac hypertrophy. This study was undertaken to examine whether dexamethasone induced cardiac hypertrophy in preterm infants with bronchopulmonary dysplasia. METHODS: We retrospectively reviewed 12 infants with bronchopulmonary dysplasia treated with dexamethasone at Korea University Hospital from August 1995 to February 1999. Serial two-dimensional and M-mode echocardiographic measurements were taken before treatment and at 1,2,3,4,5 weeks after the start of dexamethasone therapy. RESULTS: Patients receiving dexamethasone had a significantly increase in interventricular septal thickness and left ventricular posterior wall thickness. These effects were transient, reached their maximal degree by the third week of treatment, and approached pretreatment conditions by the fifth week of treatment. Heart rate was increased but statistically not significant. The fractional shortening, systolic and diastolic arterial pressure were transiently increased during dexamethasone therapy. CONCLUSION: We conclude that a transient myocardial hypertrophy is associated with dexamethasone therapy in infants with bronchopulmonary dysplasia. Follow up of careful echocardiac monitoring should be considered in infants with dexamethasone therapy.

Two Cases of Kabuki Make-up Syndrome Including One Case Associated with Xq Isochromosome

Kabuki make-up syndrome(KMS) is characterized by mental and developmental retardation and peculiar facial features including long palpebral fissures with eversion of the lateral portion of lower eyelid and arching of eyebrows, resembling the actors in Japanese Kabuki. In addition, dermatoglyphic and skeletal abnormalities are commonly associated. Although most karyotypes of KMS are shown to be normal, there have been some reports suggesting the involvement of X chrornosome in KMS. We report here two children showing the main features of KMS, one of whom has a mosaic Turner karyotype of 45,X/46,Xi(Xq). We reviewed KMS and its association with abnormalities of X chromosome.

Postnatal Changes in Left Ventricular Performance in Early Neonatal Life

PURPOSE: This study was undertaken to investigate changes in cardiac performance in early neo-natal life by observing the changes of left ventricular(LV) function and volume according to the size of ductus arteriosus. METHODS: The study group consisted of 21 full-term Cesarean section neonates who were admitted to the nursery of Korea University Hospital. We serially investigated the patency and size of the ductus at 2, 24, 120 hours after birth by two-dimensional echocardiography. The standard two-dimensional tracings of LV volume were obtained under the guidance of apical two- and four-chamber views. LV end-diastolic and end-systolic volumes were calculated using a biplanar Simpson's method. RESULTS: LV end-diastolic volume was highest(3.44>0.4mm) at 2 hours of age(P<0.01), being constant from 24 to 120 hours. LV contractility, indicated by the mean normalized systolic ejection rate, remained constant during the whole period of investigation. The size of the ductus arteriosus was maximal at 2 hours after birth, and decreased significantly at 24 hours of age (P<0.01). The size of ductus arteriosus demonstrated a close linear correlation with the left ventricular end-diastolic volume(y=0.17x+2.92, r=0.59: P<0.01). CONCLUSION: Changes in LV end-diastolic volume soon after birth depend on changes in ductus arteriosus flow, which in turn is affected by ductal diameter. Upon patency of the ductus arteriosus, the newborn left ventricle operates at maximal performance with only a limited capacity to increase contractility.

Regulation of bcl-2 family in hydrogen peroxide-induced apoptosis in human leukemia HL-60 cells

Numerous types of cells have been shown to undergo apoptosis when exposed to oxidant agent such as hydrogen peroxide. In order to understand the functional relationship between the anti- and pro-apoptotic regulatory proteins in the cells under oxidant stress, we have studied the level of expression of apoptosis regulatory proteins, bcl-2 and bax, in human leukemia HL-60 cells. The exposure of HL-60 cells to different concentrations of H2O2 for 6 h resulted in a typical apoptosis of the cells as characterized by flow cytometry, cell cycle analysis, and DNA fragmantation. There was a block in G1 to S transition and apoptotic cells were mainly derived from S and G2 cells. Kinetic study demonstrated that the levels of both bcl-2-mRNA and -protein expression were decreased with the progression of cellular apoptosis whereas the level of bax-mRNA was unchanged but the expressed bax-protein was not detectable. Cycloheximide, a nonspecific translation inhibitor, did not prevent the hydrogen peroxide-mediated apoptosis in HL-60 cells. These results suggest that the regulation of bcl-2, but not of bax are important factor in the oxidative stress-induced apoptosis in HL-60 cells.

A Case of Dissolution of Barium-impaction by Gastrografin / 대한소아소화기영양학회지

Ileus caused by impaction of hardened residual barium stagnated in the colon, a rare complication of barium-enema examination, constitutes a particularly serious problem when it occurs in congenital megacolon patients. The administration of gastrografin in such case has proven efficacy in dissolution of impacted barium refratory to routine means of evacuation. We experienced a case of barium-impaction occurred in 6-months old male who had congenital megacolon. Gastrografin enema was a safe and simple method used in the management of this case.

Dysmenorrhea and Premenstrual Syndrome of School Girls in Ansan

PURPOSE: Menstrual disorders are very common problems in adolescence. Most of them are minor, including mild dysmenorrhea, premenstrual syndrome(PMS) and minor variations in cycle, length, or amount of flow. Dysmenorrhea is the most prevalent among them while PMS is a nebulous condition characterized by a broad spectrum of symptoms. The purpose of this study is to investigate the correlation between dysmenorrhea and PMS in adolescents. METHODS: This cross sectional study on dysmenorrhea and PMS was performed in 1153 junior high school girls in Ansan. We researched the clinical aspects of PMS and investigated the correlation between menstrual characteristics and PMS in adolescents. RESULTS: The results are as follows : The incidence of PMS is 66.3%. The correlation of menstrual characteristics and severity of PMS was as follows : intensity of menstrual flow(P<0.01), duration of menstrual flow(P<0.05). The correlation of severity between dysmenorrhea and PMS is found(P<0.01). CONCLUSION: Korean adolescents have many problems related to dysmenorrhea and PMS. This study indicates that Korean adolescents need to be educated on the matter and treatment of their menstrual disorders are also needed.

Clinical Trends in Acute Rheumatic Fever in Korean Children: Mailed Questionnaire Survey from 1988 to 1997(Compared with 1978-1987)

PURPOSE: The purpose of this study was to assess the frequency of acute rheumatic fever(ARF) among children in Korea and to describe trends in its clinical characteristics compared to data from a previous study(1978-1987). METHODS: A mailed questionnaire survey sent to the pediatric departments of 13 general hospitals in Korea requested the total number of patients with ARF and its clinical manifestations from Jan. 1988 to Dec. 1997. These data were compared with the data from a previous study (1978-1987) to evaluate the clinical trends in occurrence and clinical manifestations of ARF during the last 20 years in Korea. RESULTS: The average number of patients with ARF for the 10-year period(1988-1997) was 0.74 per 1,000 annual pediatric inward patients. There was a significant decrease in incidence during the study period. There were 115 male and 85 female patients with ARF, and 97.5% of total patients were 6 to 15 years old. 126 out of 200 patients(63.0%) had a history of preceding upper respiratory infection(URI). The percentage of major manifestations were as follows; carditis(66.5%),polyarthritis(54.0%), erythema marginatum(12.0%), chorea(7.5%) and subcutaneous nodule (6.0%). Clinical findings of carditiswere cardiac murmur(91.0%), cardiomegaly in chest PA(34.6%), congestive heart failure(15.8%). The electrocardiographic findings were PR interval prolongation (37.6%), right ventricular hypertrophy (RVH) and left ventricular hypertrophy(LVH)(15.8%), QT interval prolongation(13.5%). Doppler echocardiographic valvular lesions were mitral insufficiency(96.2 %), aortic insufficiency(39.8%). Minor and other clinical manifestations were fever(69.0%), arthralgia (56.5%), sore throat(28.5%). CONCLUSION: There was a steady decrease in the number of patients with ARF during the study period from 1988 to 1997. A sudden decrease in number of patients with ARF between the two study periods is likely due to patients with valvular heart disease, possibility of double registration, and wide spread use of echocardiography for accurate diagnosis.

Epidemiologic Study of Kawasaki Disease in Korea, 1994-1996: Comparison of Previous Study in 1991-1993

PURPOSE: To determine the epidemiology and rate of cardiac sequelae of Kawasaki disease in Korea. METHODS: On behalf of the Korean Pediatric Cardiology Society, we sent a questionnaire to 107 training hospitals two times; first period(Jan. 94-Sep. 95) and second period(Oct. 95-Dec. 96), and summarized the data of the survey from 58 hospitals which responded. RESULTS: The total number of patients was 2,680 cases, with male to female ratio and mean age 1.6 and 28.9+/-20.0 months, respectively. The total number of cases of 19 hospitals which participated in the first and second periods was 1,045, including 354 in 1994, 315 in 1995, and 376 in 1996, which showed no difference in annual incidence and higher incidence in Jan., May, June and July. The proportions of sibling cases was 0.26%(7/2,680) and rate of recurrent cases was 1.7% (46/2,680), and the proportion of patients with Kawasaki disease among total hospitalized pediatric patients was 1.13% in average, showing no significant difference according to regions. Echocardiogram was done in 93.5% of patients(2,507/2,680), and coronary abnormalities occurred in 20.1% of cases (505/2,507) including 16.8% of dilatations and 5.4% of aneurysms. CONCLUSION: Compared with a previous study in 1991-1993, this data showed somewhat increased mean age, increased recurrence rate and decreased incidence of coronary arterial abnormalities statistically. Studies like this needs to be continued in the future to determine the epidemiologic trends of Kawasaki disease in Korea.

Atypical pulmonary artery sling with diffuse-type pulmonary arteriovenous fistula

The case of a cyanotic infant with a rare combination of atypical pulmonary artery sling, imperforate anus, absence of the left kidney, interruption of the inferior vena cava, left side hemihypertrophy and diffuse-type pulmonary arteriovenous fistula is described. The clinical features were confusing, because of compounding abnormalities involving the respiratory tract and pulmonary circulation. The diagnostic approach to the etiology of cyanosis is discussed and the embryonic origin of pulmonary artery sling is reviewed.

Role of Inappropriate Antidiuretic Hormone Secretion in Hyponatremia associated with Febrile Convulsions / 대한소아신경학회지

PURPOSE: Febrile convulsion is a common clinical problem in young children. In spite of their frequent occurrence, there is little information available about the value of investigation with febrile convulsion. Recent studies found a correlation between low serum sodium levels and risk of febrile convulsions. We carried out a study to evaluate the role of inappropriate ADH secretion in hyponatremia in relation to febrile convulsions. METHODS: This study used seventy cases(46 boys, 24 girls) with febrile convulsion, that were treated at the pediatric department of Korea University Medical Center Ansan hospital from Jan. 1998 to Aug. 1999. During the same period, thirty one cases(19 boys, 12 girls) with fever but without convulsion(control group I) and twenty four cases(16 boys, 8 girls) with convulsion but without fever(control group II) were evaluated in comparison with febrile convulsion group. Serum sodium, osmolality, vasopressin and urine osmolality of each group were measured on admission and analyzed by ANOVA. RESULTS: The mean serum sodium concentration of febrile convulsion group, control group I and control group II were 134.3+/-2.4mmol/L, 136.4+/-2.0mmol/L, and 136.0+/-2.2 mmol/L respectively. The serum sodium level of patient group was significantly lower than those of control group I and II(P<0.05). The case of the serum levels less than 135mmol/L was 54.3%(38/70) in patient group, 16.1%(5/31) in control group I and 12.5% (3/24) in control group II. Serum osmolality, uine osmolality of patients group were not significantly different from those of each control group. Vasopressin level of febrile convulsion group was higher than that of each control group. The risk of recurrent convulsion approaches 60%(15/25) of cases with hyponatremia less than 135mmol/L. CONCLUSION: We conclude that febrile convulsions are not mediated by hyponatremia but induce the changes in serum vasopressin and sodium level.

Mumps and Rubella-Specific IgG Levels of Term Pregnant Women and Their Neonates

PURPOSE: This study was performed to evaluate seropositivities in term pregnant women and their neonates, and the transplacental transfer rate of maternal mumps and rubella- specific IgG from term pregnant women to their neonates. METHODS: During Jun. 1, 1994 to Mar. 31. 1995, we collected 44 pairs of sera from pregnant women and their neonates in Anam Hospital of Korea University Medical Center. The serum levels of mumps and rubella-specific IgG was measured using the ELISA method. RESULTS: The seropositivities of Mumps-specific IgG were 84.1% in mothers and 90.9% in neonates. There was significant correlation of mumps-specific IgG levels between maternal sera and neonatal umbilical cord sera (correlation coefficient r=0.856, P<0.001). The mean antibody level of neonates was 1.2 times higher than that of the mothers (P<0.05). The seropositivities of rubella- specific IgG were 38.6% in mothers and 38.6% in neonates. There was significant correlation of rubella-specific IgG levels between maternal sera and neonatal umbilical cord sera (correlation coefficient r=0.8370, P<0.001). There was no significant difference of the mean antibody levels between mothers and neonates. CONCLUSION: The transplacental transport rate and the seropositivities of mumps-specific IgG of mother and neonates were appropriate for expected values, but those of the rubella-specific IgG were lower than expected values. The above results suggest re-evaluating the current vaccination schedules of mumps and rubella in Korea.

Thyroid Function Studies in Patients Who Underwent Open Heart Surgery

PURPOSE: Alteration in the serum level of thyroid hormone can occur following open heart surgery due to major stress and hemodilution after extracorporeal circulation but these changes have been ignored. The purpose of this study is to evaluate the changes of thyroid hormone level after open heart surgery and if these changes influence the prognosis. METHODS: We evaluated 26 children who had undergone open heart surgery from Sept. 1994 to Jun. 1996 at Korea University Hospital. Five ml of blood were collected before surgery, immediately after surgery and 24 hours after surgery. The blood was centrifused and the serum stored at -40degrees C until examinations were made. Serum T3, T4, reverse T3 were measured by sensitive and specific radioimmunoassay. RESULTS: The mean T3 level was 1.49 +/- 0.50ng/ml (normal 0.08-2.0ng/ml) at pre op, 0.75 +/- 0.40ng/ ml immediately after surgery and 0.69 +/- 0.50ng/ml 24 hours after surgery. The mean T4 level was 10.73 +/- 4.40ug/dl (normal 6.1-11.8 microgram/dl) at pre op, 5.80 +/- 1.90ug/dl immediately after surgery and 5.60 +/- 2.10ug/dl 24 hours after surgery. The mean TSH level was 1.69 +/- 1.13uIU/ml (normal 0.25-4.0 uIU/ml) at pre op, 1.37 +/- 0.80uIU/ml immediately after surgery and 1.61 +/- 1.00uIU/ml 24 hours after surgery. Serum T3 and T4 levels in cardiac surgical patients were significantly reduced (P<0.01), and serum reverse T3 levels were significantly increased (P<0.05), and serum TSH levels were not significantly different in comparison with the preoperative state. CONCLUSION: We conclued that patients with congenital heart disease who underwent open heart surgery show euthyroid sick states like other severely ill patients. It is likely that reduction in T3 and T4 without increased TSH represents an adaptive response by the body to minimize catabolism when undergoing major stress.

Association of Mycoplasma pneumoniae Pneumonia and Allergy in Preschool Children / 소아알레르기및호흡기학회지

PURPOSE: To clarify whether Mycoplasma pneumoniae-induced respiratory infections are associated with allergic disorder. METHODS: We studied ninety-two preschool children with pneumonia who were hospitalized at the pediatric ward of Korea University Medical Center from December 1995 to June 1997. Patients who had evidence of Mycoplasma pneumoniae infection(Group I) were compared with non-infected group(Group II) in terms of serologic parameters, ie, eosinophil count, total IgG, IgA, IgM, IgE levels and specific IgE(MAST). RESULTS: 1) Number of Group I was 46(male 23, female 23, mean age=3.4 years old), and that of Group II was also 46(male 29, female 17, mean age=3.4 years old). There was no age difference between two groups. 2) Total eosinophil count in Group I(185.0+/-179.3/mm3) was significantly higher than that of Group II(123.3+/-148.3/mm3)(P<0.05). 3) Total IgE in Group I(245.4+/-279.2IU/mL) was significantly higher than that of Group II(135.1+/-207.8IU/mL)(P<0.05). 4) Higher levels of IgG, IgM, and IgA were observed in the group I as compared to a non-infected group, but there were no significant differences between two groups. 5) Positive rates of specific IgE(MAST) in each group were not significantly different. CONCLUSIONS: We concluded that Mycoplasma pneumoniae pneumonia in preschool children is highly associated with allergy, and follow-up studies are expected to know the occurrence rate of allergic disease in children with a previous history of Mycoplasma pneumoniae pneumonia.