Relationships Between Exhaled Nitric Oxide and Atopy Profiles in Children With Asthma

PURPOSE: We examined whether fractional exhaled nitric oxide (FeNO) levels are associated with atopy profiles in terms of mono-sensitization and poly-sensitization in asthmatic children. METHODS: A total of 119 children underwent an assessment that included FeNO measurements, spirometry, methacholine challenge, and measurement of blood eosinophil count, serum total IgE, and serum eosinophil cationic protein (ECP). We also examined sensitization to five classes of aeroallergens (house dust mites, animal danders, pollens, molds, and cockroach) using skin prick testing. The children were divided into three groups according to their sensitization profiles to these aeroallergens (non-sensitized, mono-sensitized, and poly-sensitized). RESULTS: The geometric means (range of 1 SD) of FeNO were significantly different between the three groups (non-sensitized, 18.6 ppb [10.0-34.7 ppb]; mono-sensitized, 28.8 ppb [16.6-50.1 ppb]; and poly-sensitized, 44.7 ppb [24.5-81.3 ppb], P=0.001). FeNO levels were correlated with serum total IgE concentrations, peripheral blood eosinophilia, and serum ECP levels to different degrees. CONCLUSIONS: FeNO levels vary according to the profile of atopy, as determined by positive skin prick test results to various classes of aeroallergens. FeNO is also moderately correlated with serum total IgE, blood eosinophilia, and serum ECP. These results suggest that poly-sensitized asthmatic children may have the highest risk of airway inflammation.

Characteristics of Methicillin-resistant Staphylococcus aureus Nasal Colonization Among Neonatal Unit Staffs and Infection Control Measures / 소아감염

PURPOSE: In February 2007, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections occurred in two newborns in the neonatal unit of Sahmyook Seoul Hospital. We performed this study to investigate the characteristics of MRSA nasal carriage among neonatal unit staffs and the effective infection control measures. METHODS: Nasal swab specimens were obtained from the neonatal unit staff for the presence of MRSA. MRSA-colonized staffs were offered decolonization therapy with oral trimethoprim-sulfamethoxazole or 2% mupirocin ointment. Every 2-4 months after decolonizaton, repeat nasal swab specimens were obtained. Also, samples from the neonatal unit environment and room air were collected. RESULTS: Successful decolonization was achieved in 92% of the cases in 2 weeks after decolonization therapy, but most of the staffs were recolonized after several months. The nature of antibiotic susceptibility was changed from multi-drug- susceptible to multi-drug-resistant. The most frequently contaminated objects were dressing carts, computer keyboards, bassinets and washbowls. In environmental cultures using the settle microbe count method, the colony counts were decreased significantly at the last study period compared with the first study period in the neonatal room, breastfeeding room, service room, and dressing room (P<0.05). CONCLUSION: Effective control of sustained MRSA transmission within an institution may require prompt identification, treatment, and monitoring of colonized and/or infected staffs. However, nasal decolonization therapy may induce multi-drug- resistant MRSA infection and had no effect on decreasing the MRSA nasal carriage rate in our study. Other factors might be more important, such as improving staff education, increasing hand hygiene practices, and environmental sterilization for controlling MRSA infections.

Escherichia coli Susceptibility to Antimicrobials in Children with Urinary Tract Infection

PURPOSE: This study was performed to identify longitudinal changes in the prevalence of organisms isolated from urinary tract infection(UTI) and in the pattern of Escherichia coli susceptibility to antibiotics during the past 10 years in children with UTI. METHODS: We performed a retrospective study of a total of 192 urine cultures from children with UTI in the Department of Pediatrics, Seoul Adventist Hospital over two periods(1st: 1995-2000, 2nd:2001-2005). Antimicrobial susceptibility of the isolates was compared between the two groups. RESULTS: The pathogens of UTI in the two groups were similar. In the first period, E. coli was the leading uropathogen(66.2%) followed by Klebsiella pneumoniae(7.8%), Enterobacter cloacae(6.5%), and others(19.5%). In the second period, E. coli was the leading uropathogen (67%) followed by K. pneumoniae(12.2%), E. cloacae(3.5%), Enterobacter aerogenes(3.5%), and others(13.8%). The susceptibility pattern of E. coli to amoxicillin/clavulanate(87.5%, 81.0 %) did not present any statistically significant difference between the two periods(P>0.05). The susceptibility of E. coli to TMP/SMX(52.4%, 50.0%) was still low with no significant difference between the two periods(P>0.05). CONCLUSION: Our results suggest that the use of amoxicillin/clavulanate is still an excellent therapeutic option in children with UTI. The low rate of susceptibility to TMP/SMX against uropathogens suggest that TMP/SMX may be reevaluated as the first-line therapeutic drug for UTI.

Transcatheter Closure of Moderate-to-Large Patent Ductus Arteriosus

PURPOSE: Transcatheter closure of the patent ductus arteriosus (PDA) is a well established alternative to surgical treatment. The aim of this study was to analyze safety, efficacy and follow up results of percutaneous closure of a moderate-to-large sized PDA. METHODS: Between November 1999 and October 2004, eighty-two patients underwent attempted transcatheter closure of a moderate to-large sized PDA. Age at intervention ranged from 9 months to 68 years (18.4+/-18.3 years). Body weight ranged from 7.8 kg to 74 kg (34.0+/-21.3 kg). RESULTS: The mean PDA diameter was 4.5+/-1.3 mm. The type of PDA was conical (72 patients), tubular (9 patients), other (1 patient, dumbbell shape). The devices used were Amplatzer Ductal Occluder (ADO(R), 64 cases), Detachable Coil (14 cases), and Duct Occlud (3 cases). Total complete closure rate was 93%. Complete closure was achieved in 58 patients (78%) at the end of procedure, 8 patients (11%) at 1week, 4 patients (5%) at 1 month, and 4 patients (5%) at 1 year, respectively. A residual shunt was present in three patients (4%). Complications occurred in eight patients: stenosis of left pulmonary artery (4 patients), hemolytic anemia (2 patients), infective endocarditis (1 patient), and device embolization (1 patient). CONCLUSION: Transcatheter closure of a moderate to-large sized PDA using the device is a safe and effective treatment with a favorable short and mid-term results. For optimal results, appropriate devices should be selected in relevance to PDA morphology and diameter, age, body weight, and +++economical factor.

Usefulness of Plasma B-type Natriuretic Peptide Assay as a Screening Tool for Infants with Suspected Congenital Heart Disease

PURPOSE: B-type natriuretic peptide (BNP) is a cardiac neurohormone secreted predominantly from the ventricle in response to increased left and right ventricular pressure loads as well as volume loads. The aim of our study is to investigate the usefulness of plasma BNP assay as a screening tool for infants with suspected congenital heart disease (CHD). METHODS: Ninety-five infants less than 3 months of age with suspected CHD were enrolled and divided into a healthy control group (n=40) and a CHD group (n=50) according to physical examination, chest X-ray, electrocardiography and echocardiography. The CHD group was divided into the treatment group (n=15), requiring urgent treatment and the observation group (n=35), not requiring any treatment. Plasma BNP concentrations were measured using a commercial kit, Triage BNP(R) test kit. RESULTS: The mean BNP concentration of the CHD group was higher than that of the control group (639+/-1, 147 pg/mL versus 26+/-25 pg/mL, P<0.001). The mean BNP concentration of the treatment group was significantly higher than that of the observation group (1, 732+/-1, 629 pg/mL versus 171+/-229 pg/mL, P<0.001). The area under the Receiver Operating Characteristic curve for the detection of CHD was high: 0.821 (95% CI, 0.737-0.905, P<0.001). The best cut-off value of BNP concentration for the screening of CHD requiring urgent treatment was determined to be 282 pg/mL (sensitivity: 100%, negative predictive value: 100%). CONCLUSION: In infants, the plasma BNP measurement is useful and objective in screening the CHD infant without any specific professional skills. Especially in the outpatient department, it is very helpful to determine CHD infant requiring urgent treatment and thus an efficient consultation can be made to the pediatric cardiologist.

Analysis and Evaluation of the Reliability of Medical Information on Food Allergies on the Internet / 소아과

PURPOSE: The information in the internet is increasing and the number of people using the Internet to obtain medical information is increasing rapidly too. But, compared to the amount of information, the quality of information is extremely variable. To assess the accuracy of medical information on the Internet, the quality of information about food allergies available on the internet examined. METHODS: Online searches using the phrase "food allergy" were conducted on five major Internet search engines. The first 50 web pages generated by each engine were examined. Making an exception of the web pages which were inaccessible, irrelevant, and duplicated, sixty out of two hundred and fifty web pages were evaluated. Information scores were developed from 1(no statement) to 4 (sufficient) and designed to assess how well the web pages mentioned the summary, symptom, diagnosis, treatment, and education of the patients, and emergent management. RESULTS: When classified by ownership, there were six(10%) oriental clinics, twelve(20%) hospitals, twenty one(35%) profit-making institutions, fourteen(23%) non-profit institutions and seven others (12%). The mean information score(IS) was 10.7. Summary got the highest IS(2.25) and the education for patients and supporters got the lowest IS(1.33). Medical institutions such as hospital and clinic got 12.33 and non-medical institutions got 10.25. But there were no statistically significant differences between these two institutions(P=0.107). CONCLUSION: Overall, the quality of information on food allergy through the Internet was poor. The main reasons are unlimited listings of related information on the Internet and an absence of a reviewing process of the information. Therefore, people should not entirely rely on the Internet for medical information and medical-related institutions such as hospitals, schools, clinics and relevant academic associations should develop an Internet system to improve the quality of information.

Combined Modality Therapy of Ewing Sarcoma / 대한소아혈액종양학회지

PURPOSE: Ewing sarcoma (ES) occurs mainly in the pediatric and adolescent population. We evaluated the clinical characteristics and the efficacy of treatment on ES in children who were treated at Seoul National University Children's Hospital. METHODS: We undertook a retrospective analysis of 12 patients diagnosed as ES between March, 1986 and December, 2002. Systemic chemotherapyregimens were as follows: CCG 731 (Vincristine, Adriamycin, Methotrexate, Actinomycin D, Cyclophosphamide; N=6), CCG 7881B (Ifosfamide, Etoposide, Vincristine, Adriamycin, Cyclophosphamide; N=2), POG-ICE (Ifosfamide, Etoposide, Carboplatin; N=1), CCG 7881B and BCD (Bleomycin, Cyclophosphamide, Actinomycin D; N=1), CCG 7881B, POG-ICE and VEC (Vincristine, Etoposide, Carboplatin; N=1). One case received CCG 7881B and autologous peripheral blood stem cell transplantation (PBSCT). RESULTS: Among the 12 patients, 8 patients were male and the others were female. The patients median age was 7 years 10 months. The primary tumors occurred in femur (N=4), pubis (N=2), vertebra (N=2) and clavicle, humerus, rib, phalanx one each. All patients were treated with systemic chemotherapy and the duration was median 13 months. Eight patients received radical surgery and nine patients received radiotherapy. Overall 5 years survival rate was 33.3% and one patient who received systemic chemotherapy and PBSCT is alive disease-free for more than 5 years. Eight patients who had more than one poor prognostic factor died. CONCLUSION: Though recent therapeutic trials led to improvement of survival in patients with ES, the prognosis for patient with high-risk disease remain poor and the treatment related toxicities are problem to solve. For the advanced or recurrent cases more intensive therapeutic modality such as autologous bone mallow transplantation or PBSCT should be considered.

Reliability of Diastolic Flow Velocity of the Left Pulmonary Artery for the Diagnosis of Patent Ductus Arteriosus in Preterm Infants

PURPOSE: Diagnosis of a hemodynamically significant patent ductus arteriosus (PDA) that should be treated is difficult to determine by clinical and echocardiographic examination. The purpose of this study is to clarify the usefulness of diastolic flow velocity (DFV) of the left pulmonary artery (LPA) determined by echocardiography in the assessment of significant PDA in preterm infants. METHODS: Clinical and echocardiographic findings, including DFV in LPA, of PDA were evaluated at 24 hours, 48-72 hours of age and after indomethacin treatment in thirty-nine infants ranging from 25 to 34 gestational weeks of age. DFVs of the study group (N=13) with significant PDA were compared with those of healthy control group (N=26) without significant PDA. RESULTS: DFVs in healthy preterm infants were high in the first few days and were significantly decreased after spontaneous ductal closure. DFVs in preterm infants with significant PDA who underwent indomethacin treatment were significantly higher than that of healthy control infants. After indomethacin treatment, DFVs in this study group remained high with continuing significant PDA and markedly decreased with disappearance of significant PDA. Until ductus arteriosus closed, DFVs showed a significant correlation with the magnitudes of ductal shunt. A cutoff value for DFV of 30 cm/sec showed a sensitivity of 77% and a specificity of 92% as a predictor of significnat PDA in preterm infants. CONCLUSION: Measurement of DFV in LPA by echocardiography is a useful method for assessing the significnat PDA which may require treatment in preterm infants.

Urinalysis and Analysis and Imaging Studies in Children with Urinary Tract Infecion

The columnar cell variant of papillary carcinoma is a rare tumor of the thyroid, associated with aggressive behavior, early metastasis, and a rapidly fatal course. We present the fine needle aspiration cytologic(FNAC) findings of columnar cell variant of papillary carcinoma with cytohistologic correlation. In the smears, the tumor fragments showed mainly papillary pattern and a few scattered individual cells were present around the papillary fragments. The tumor cells were columnar or cuboidal and exhibited pseudostratification of the nuclei. The nuclei were oval to elongated with finely stippled chromatin and inconspicous nucleoli. Neither nuclear grooves nor intracytoplasmic inclusion was found. The FNAC diagnosis was consistent with papillary carcinoma. Total thyroidectomy was done and the histologic finding of the mass showed a predominantly papillary and focal solid proliferation of columar cells with marked nuclear pseudostratification. The unique histopathologic features and highly aggressive nature of columnar cell variant of papillary carcinoma require that this variant should be differeniated from common papillary carcinoma of the thyroid.

Comparison of Plain X-rays and OMU (Osteo-Meatal-Unit) CT Scans in Children with Chronic Sinusitis / 소아알레르기및호흡기학회지

PURPOSE: In general, sinusitis in children is diagnosed by clinical symptom and paranasal sinus x-ray. Sinus plain x-rays in children is simple, inexpensive, and speedy. However, it requires proper interpretative techniques, because different development of each sinus, soft tissues overlying sinuses and bony structure require precise diagnosis. This study was conducted to compare plain x-rays with OMU CT scans. METHODS: From September 1996 through August 1997, thirty nine patients who were diagnosed as sinusitis based on clinical symptoms and plain x-rays at the pediatric department of Seoul Adventist Hospital were studied. Water's view, Caldwell's view and lateral view were taken for the plain x-rays with concurrent OMU CT scans prior to treatments. RESULTS: Ten cases (25.6%) out of 39 patients showed posterior nasal drip and fourteen cases (35.9%) showed nasal obstruction. Twelve cases (30.8%) were related to allergic diseases and seven cases (58.3%) among these 12 cases were bronchial asthma. Sensitivity of plain x-ray were 88.5+/-12.9% for maxillary sinuses, and 59.9+/-13.65% for ethmoidal sinuses. CONCLUSION: When maxillary sinusitis is suspected, plain X-ray for maxillary sinuses is enough to diagnose sinusitis, but for ethmoidal sinuses it may be underestimated or overestimated in comparison with OMU CT scan. Ethmoidal sinusitis requires careful diagnosis and follow-up because it plays important roll for chronic sinusitis due to its structure. Therefore, we recommends OMU CT scan to diagnose paranasal sinusitis of children with plain X-ray.

A case of Infantile Digital Fibromatosis Locaated on Hypothenar Area Showing Spontaneous Regression

Infantile digital fibromatosis(IDF) is a rare, benign fibrous tumor, first described in 1965 by Reye. IDF may occur single or multiple lesions exclusively on the fingers or toes, rare occurrence outside the digit have been reported. This tumor grow slowly and may adhere to the deeper tissue, and may lead to deformity of the digit, but do not distant metastasis or dissemination. There is a marked tendency for recurrence after surgical excision. Up to now, only 6 cases have been reported in the literature showing spontaneous regression. We experienced a case of infantile digital fibromatosis located on hypothenar area at birth. Also that spontaneous regressed at 13 months of age. We reported a case of IDF showing spontaneous regression with brief review of related literature.

A Case of Combined Congenital Deficiency of Factor V and Factor VIII

Hemorrhagic disease of newborn by combined blood clotting factor deficiencies is very rare. Combined deficiency of factor V and factor VIII is the most common form among these cases, and inherited by autosomal recessive trait. Clinical findings are easy bruising, post-traumatic bleeding and bleeding after tooth extractions, and the main laboratory findings are prolonged partial thromboplastin time (PTT) and prothrombin time (PT) that are different from hemophilia A only with prolonged PTT. We experienced a case of combined congenital deficiency of factor V and factor VIII in a 1-day-old boy. We report the case with brief review of literature.

Availability of IgE MAST for Diagnosis of Asthmatic Children

PURPOSE: The Skin prick test is simple and cheap in diagnosis of allergic diseases. So the skin prick test has been widely used as the initial diagnostic method of IgE-mediated allergic diseases with the merit of fast detection of causative allergens. But the skin test has some difficulties in application for the infants and young children. IgE MAST(multiple antigen simultaneous test) and IgE RAST(radioallergosorbent test) are representative in vitro diagnostic tests in allergic diseases. IgE MAST has several merits, such as cheap price, simultaneous detection of many allergens, and needlessness of gamma counter, but it has been known to have less sensitivity and specificity. We performed this study to know the differences between the availability of IgE MAST and that of IgE RAST in allergic patients who were diagnosed by clinical findings and skin prick test. METHODS: We have studied 35 asthmatic children (over 3 years of age) who visited allergy clinic from September 1993 to May 1995. All of them were positive in skin prick test on one more allergens among 6 allergens(D.p, D.f, house dust, dog, egg, ragweed). IgE MAST and IgE RAST were evaluated simultaneously. RESULTS: The results were as follows 1) Sensitivity of RAST was 87.1% in D.p, 87.1% in D.f, 68% in house dust and the specificity of RAST was 94.1%, 97.1% and 87.5% respectively. 2) Sensitivity of MAST was 90.3% in D.p, 93.5% in D.f, 80% in house dust and the specificity of MAST was 94.1%, 94.1% and 85% respectively. 3) Total sensitivity of RAST was 70.5% and that of MAST was 73.2%, but there were no significant differences between them(p>0.05). 4) Total specificity of RAST was 91.4% and that of MAST was 89.9%, but there were no significant differences between them(p>0.05). 5) The stronger positive skin reaction, the higher sensitivity and specificity of the two in vitro tests. CONCLUSIONS: There was no significant differences between the two in vitro tests for the diagnosis of asthmatic children, and the both test results correlated well. IgE MAST system is easier, faster and has more cost benefit than IgE RAST. So we conclude that the MAST system is available as a screening test in the diagnosis of allergic diseases.

Comparison of The Efficacy of the Fiberoptic Phototherapy and Conventional Phototherapy for Neonatal Hyperbilirubinemia

PURPOSE: We performed this study in order to compare the feasibility and efficacy of the fiberoptic phototherapy with conventional phototherapy and double phototherapy with single phototherapy for the treatment of neonatal hyperbilirubinemia while watching for any possible side effects of the system. METHODS: During the period of February 1994 till June 1995, randomized controlled study was performed. 130 healthy term infants with non-hemolytic hyperbilirubinemia were enrolled, 45 patients received fiberoptic phototherapy, 40 patients received conventional phototherapy and 45 patients received double phototherapy. Criteria for inclusion in the study were 1) after 37 weeks of gestation 2) negative result of a direct coombs test 3) normal hemoglobin and hematocrit 4) no Rh or ABO incompatibility 5) plasma total bilirubin concentration exceed 10mg/dl during the first 3 days of life. RESULTS: 1) The mean total bilirubin decline level after 24 hours was 0.03 2.03mg/dl and the mean indirect bilirubin decline level after 24 hours was 0.12+/-1.35mg/dl in conventional phototherapy group(p0.01). 2) The mean total bilirubin decline level after 48 hours was 1.25 2.71mg/dl and the mean indirect bilirubin decline level was 1.17+/-1.52mg/dl in conventional phototherapy group (p0.01). 3) The mean decline levels of 24 hours-total and indirect bilirubin were 0.01+/-1.23mg/dl and 0.09+/-1.13mg/dl, and the mean decline levels of 48hours-total and indirect bilirubin were 0.92+/-1.85mg/dl and 0.99+/-1.08mg/dl (p0.01) or diarrhea(p>0.01) among three groups. CONCLUSIONS: We conclude that fiberoptic phototherapy has less efficacy comparable to that of conventional phototherapy and double phototherapy has no significant differences in effectiveness compared with conventional phototherapy. So we hope further studies on the effects of the fiberoptic phototherapy in preterm infants and in after 48 hours will be done.

Two Cases of Conjoined Twins

No abstract available.

Analysis of Radiologic Findings in Children with Urinary Tract Infection

No abstract available.

A case of agnogenic myeloid metaplasia

Agnogenic myeloid metaplasia (AMM) is a myeloproliferative disorder characterized by leukoerythroblastosis, tear-drop erythrocytes, extramedullary hematopoiesis with hepatosplenomegaly, and varying degrees of myelofibrosis. The mean age at presentation is about 60 years, and pediatric cases are rare. We experienced a case of AMM in a 9 months old female who was presented with pallor, huge splenomegaly and intermittent fever. Peripheral blood showed leukoerythroblastosis poikilocytosis, and tear drop cells. Bone marrow was difficult to aspirate, and biopsy specimen showed increased reticulin with decreased cellularity, which was compatible with myelofibrosis. We presented a case of AMM with brief review of the literatures.

Clinical consideration between the type of pneumonia and cold agglutinin titer, and mycoplasma antibody titer caused by mycoplasma pneumonia in children

The authors analysed 261 cases of mycoplasmal pneumonia in children who were admitted to the pediatric department of Seoul Adventist Hospital between July 1986 and June 1991. The result obtained were as follows; 1) Yearly distribution of the cases showed high in 1987 and 1991, but no significant difference was noted in seasonally or monthly distribution. 2) The peak incidence of age was between 2 and 6 years of age, and the sex ratio of boy to girl was 1.1:1. 3) pulmonary manifestations were asthma in 21 cases (8.0%), atelectasis in 5 cases (1.9%), emphysema in 3 cases (1.2%), pleural effusion in 16 cases (6.1%), otitis media in 4 cases (1.2%) and sinusitis in 9 cases (3.4%). 4) Extrapulmonary complication were hepatitis in 53 cases (20.3%), skin rash in 9 cases (2.4%), proteinuria in 6 cases (2.3%), and hematuria in 4 cases (1.5%). 5) On the chest X-ray examination, the most common type of pneumonia was interstitial pneumonia (94 cases, 39.8%), and unilateral involvement was common (85.6%), and the most common involvement was right lower lobe (83 cases, 41.4%). 6) The relationship between the type of pneumonia and cold agglutinini titer, and between the type of pneumonia and Mycoplasma antibody titer were not found (P>0.05). 7) In the 16 cases of pleural effusion, The type of pneumonia was lobar, lobular (9 cases), bronchopneumonia (7 cases), and interstitial type was not present. The site of pneumonia was left (6 cases), right (9 cases), and 1 case showed bilatrality. The extent of pleural effusion was mild (10 cases), moderate (3 cases), and severe (3 cases). The result of pleural fluid exam in severe cases was all exudate. 8) The mean duration of admission was most common from 6 to 10 days. the mean duration of admission by the type of pneumonia was lobar, lobar (10.71+/-3.40), interstitial (8.78+/-2.14), and bronchopneumonia (8.83+/-2.47). 9) Both mycoplasma antibody test and cold agglutinin test were carried out in 185 cases and sensitivity of mycoplasma antibody test was 55.1%.

A case of Addison's disease

No abstract available.

A case of 7q-syndrome

No abstract available.