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.

Eosinophils in the Sputum

The sputum eosinophilia has been observed in various allergic disease of respiratory tract, even non allergic disease, and as well as malignant disease of respiratory tract by several authors in adult patient. This studies were undertaken to evaluate sputum eosinphils in normal and in acute respi ratory tract infection in children. Sputum eosinophils were studied in 10 cases of normal child and in 30 cases of acute respiratory infection. Sputum was liquified by trypsin for 2 hours at 37degrees C in incubator and stained sputum eosinophils with Hinkelman's solution specifically. The stained eosinophils in 1mm3 of sputum were counted by hemocytometer. The results were as follows : 1. Average sputum eosinophil counts in normal child were 120+316 cell/mm3. 2. Average sputum eosinophil counts in acute respiratory tract infection were 10597+/-13207 cell/mm3, which was significantly increased than normal child(p<0.005). 3. Average sptum eosinophil counts in acute bronchitis and bronchiolitis were 10417+/-9295 cell/mm3, 7724+/-6136 cell/mm3 in acute pnemonia, 800 cell/mm3 in bronchial asthma, and 1945+/-2468 cell/mm3 in pulmonary tuberculosis. There were no significant differences of sputum eosinophils between acute respiratory infections. 4. Average sputum eosinophils in acute respiratory infection by different age group were 11178+9632 cell/mm3 below 1 year of age, 8816+/-8933 cell/mm3 in 1~6 years of age, 18798+/-29847 cell/mm3 in 6~10 years of age, and 1400+/-1697 cell/mm3 above 10 years of age. Average sputum eosinophil counts in male patient were 8428+/-9067 cell/mm3, 10597+/-13207 cells/mm3 in female patient. There were no significant differences of sputum eosinophils by age and sex in acute respiratory infection.

Plasma Fibronectin Concentration in the Neonate

PURPOSE: Plasma fibronectin is thought to have important role in the inflammatory response and host defense. We performed this study to evaluate concentration in the full-term, healthy preterm, asphyxia and respiratory distress syndrome and how that correlated with gestational age and birth weight. METHODS: We evaluate 51 neonates who were delivered at Korea University Hospital from Jan. 1992 to Jul. 1992. In order to evaluate concentration of plasma fibronectin according to gestational age and birth weight in 51 neonates, we measured plasma fibronectin in healthy premature and term infants and investigated the alteration in plasma values in infants with perinatal asphyxia and respiratory distress syndrome. RESULTS: 1) The concentration of plasma fibronectin was lower in preterm infants(123+/-30ug/dl) than in term infants(151+/-26ug/dl). 2) There was a significant correlation between the plasma fibronectin concentration and both gestational age and weight (p<0.01). 3) The infant with perinatal asphyxia and respiratory distress syndrome had lower plasma fibronectin concentration than those in age matched healthy infant. CONCLUSIONS: This results shows that the plasma fibronectin correlate with gestational age and birth weight and suggests that deficiency of plasma fibronectin correlate with reticuloendothelial system hypofunction in infants with complicated birth.

Serum Lipids in Children and Adolescents with Family History of Coronary Artery Diseases

PURPOSE: Atherosclerotic change begins in childhood, elevated blood lipid levels and a family history of premature coronary vascular diseases are important risk factors for coronary artery disease. Identification, follow-up and treatment of children at high risk of cardiovascular diseases are very effective and important for prevention of future coronary artery diseases. The purpose of this study is to determine the relation between parental history coronary artery disease and lipid levels of children in Korea. METHODS: As a cross sectional study, lipids and apolipoproteins were measured in 94 off-spring of patients diagnosed by coronary angiography as a myocardial infarction and an angina pectoris before the age of 55 years, the results were compared with those of 98 controls without family history of coronary artery diseases. RESULTS: The mean levels of total cholesterol, LDL-cholesterol, Apolipprotein B and Lipoprotein(a)(Lp(a)) were significantly higher in study group than in control group(p<0.01). The mean level of HDL-cholesterol was significantly lower in study group than in control group(p<0.05). Also, the percentage of children having abnormal lipid values(total cholesterol < or =200mg/dl, LDL-cholesterol < or =130mg/dl, Lp(a) < or =30mg/dl) were significantly higher in study group than in control group. CONCLUSIONS: The children and adolescents whose parents suffered from early onset coronary heart diseases should be evaluated for lipids and lipoprotein levels to identify and to manage the high risk group for coronary artery disease.

Serum Lipids in Children and Adolescents with Family History of Coronary Artery Diseases

PURPOSE: Atherosclerotic change begins in childhood, elevated blood lipid levels and a family history of premature coronary vascular diseases are important risk factors for coronary artery disease. Identification, follow-up and treatment of children at high risk of cardiovascular diseases are very effective and important for prevention of future coronary artery diseases. The purpose of this study is to determine the relation between parental history coronary artery disease and lipid levels of children in Korea. METHODS: As a cross sectional study, lipids and apolipoproteins were measured in 94 off-spring of patients diagnosed by coronary angiography as a myocardial infarction and an angina pectoris before the age of 55 years, the results were compared with those of 98 controls without family history of coronary artery diseases. RESULTS: The mean levels of total cholesterol, LDL-cholesterol, Apolipprotein B and Lipoprotein(a)(Lp(a)) were significantly higher in study group than in control group(p<0.01). The mean level of HDL-cholesterol was significantly lower in study group than in control group(p<0.05). Also, the percentage of children having abnormal lipid values(total cholesterol < or =200mg/dl, LDL-cholesterol < or =130mg/dl, Lp(a) < or =30mg/dl) were significantly higher in study group than in control group. CONCLUSIONS: The children and adolescents whose parents suffered from early onset coronary heart diseases should be evaluated for lipids and lipoprotein levels to identify and to manage the high risk group for coronary artery disease.

The effect of prostaglandin E1 infusion for papillation of ductus dependent cyanotic congenital heart disease in neonates

No abstract available.

Changes of Measles Specific IgG after Active Immunization of Measles in Korean Children

PURPOSE: Despite preventive measures, measles outbreaks ocurred in 1989, 1990 and 1994 in Korea. Especially, the proportion of immunized school aged children and adolescents was increased, and the reason was, in our opinion, primary and secondary vaccine failure after measles immunization. In this context, we attempted to evaluate the changes of measles specific IgG levels in various age groups of immunized children. METHODS: From Jun. 1. 1994 to Mar. 31. 1995, the sera were collected from immunized children aged 1.5 to 12 years who had no history of natural measles. We measured the measles specific IgG using enzyme linked immunosorbent assay (ELISA: SIATM Measles IgG Kit, SIGMA Co. St Louis, Mo). RESULTS: The seropositivity of immunized children aged 1.5 to 12 years was 86.1% and 11 year old age group showed lowest level, 66.0%. As children were getting older, the measles antibody level decreased significantly( r=-0.2264, p<0.001 ). CONCLUSIONS: Above results partially explain the reasons for recent measles occurrences in immunized children and suggest that it is necessary to modify the current immunization schedule of measles in Korea.

A Case of Familial Hypercholesterolemia with Diabetes Mellitus

Familial Hypercholesterolemia is the most common hyperlipoproteinemia during the childhood, which occurs from the mutation of genes that regulates low-density lipoproteins (LDL), and is classified into two types, the homozygote presented abnormal genes from both parents and the heterozygote presented an abnormal gene from each parent. Type IIa familial hypercholesterolemia is characterized by, especially, increased level of LDL which is common type and normal level of high-density lipoproteins. The clinical signs are arterosclerosis, xanthoma of the Achilles tendons and the arcus cornea. The treatments are dietary and drug therapy. This report is a case of familial hypercholesterolemia diagnosed as type IIa hyperlipoproteinnemia with Insulin Dependent Diabetes Mellitus.

A Case of Takayasu's Disease

Takayasu's disease is characterized by absent upper extremity pulses and ophthalmological finding of secreased visions and catract formation. Clinical features of Takayasu's disease are attributed to an obstructive arteritis of the large vessels criginating from aortic arch and other aortic segments. This dissease most frequently has been reported from Orient, and has affected primarily young females. This is a report of a 10 years old girl who developed the typical clinical and pathophysiological manifestation of Takayasu's disease and we also made brief review of literature.

Comparison of Measles Specific IgG in the Sera of Infants and Children after Vaccination of Measles

PURPOSE: After recent epidemics of measles in Korea, Korean Pediatric Society recommended 2 dose measles vaccination schedule instead of 1 dose since 1991. However, the studies that supported the modification of vaccination schedule were insufficient yet. This study was performed to evaluate the vaccination efficacy of 1 dose and 2 dose vaccination. METHODS: One dose vaccination group consisted of 19 infants(mean: 13.5 months of age) and two dose vaccination group consisted of 17 infants(mean: 20.4 months of age). We measured the serum level of measles specific IgG antibody in vaccinated infants during 2 to 8month after vaccination using enzyme linked immunosorbent assay(ELISA). RESULTS: 1) There was no significant difference between one dose and two dose vaccination group in measles specific IgG antibody level(479+/-203AU/ml vs. 442+/-119AU/ml). 2) There was no significant difference between one dose and two dose vaccination in seropositivity of measles specific IgG antibody(94.7% vs. 88.2%). 3) Seropositivity of measles specific IgG antibody in all subjects has gradually decreased after vaccination and it was not related to the dose of vaccination. CONCLUSIONS: These results suggest that two dose vaccination of measles is not effective than one dose. Therefore, to confirm the current vaccination schedule of measles in Korea, more studies about effective method of vaccination should be performed.

The Effect of ACTH on Mouse Heart

No abstract available.

Detection of Mycoplasma pneumoriae in Clinical Samples from Pediatric Patients by Polymerase Chain Reaction

No abstract available.

Plasma immunoreactive endothlin-1, creatine kinase and CK isoenzyme and its relation to neonate with asphyxia

Endotheline-1 (ET-1) is a potent vasoconstrictor peptide with 21 amino acid residues. ET-1 is thought to have a key role in vasoconstriction, and cardiac, renal, and endocrine actions of the peptide. Creatine Kinase(CK), also referred to as ATP-creatine-N-phosphotransferase, consists of either the B or M type. CK is found almost exclusively in muscle(MM), myocardium(MB), and brain(BB). It is to be an almost specific index of injury of myocardium and brain in hypoxic damage. I measured the ET-1, CK isoenzyme in neonates among asphyxia group (14 cases), as a control devide into two group. 1st group(birth weight (2500 g, n=9) and 2nd group (body weight 2500g, n=11). 1) There was no significant difference between asphyxia and control 1st, 2nd group during postnatal 24 hrs include cord blood on irET-1(p< 0.05). 2) There was significant difference between asphyxia and control 1 st, 2nd group during postnatal 24 hrs include cord blood on CK and CK and CK isoenzyme (p<0.001). 3) There was significant difference between asphyxia and control 1st, 2nd group on CK-MB and CK-BB proportion (p< 0.001). 4) There was significant difference between cord blood and postnatal 24 hrs on total CK level (P< 0.001).

Changein Regional Cerebral Blood Flow Velocity in Premature Infant

No abstract available.

Two Cases of The Salt-losing Congenital Adrenal Hyperplasia

No abstract available.

Measles Specific IgG Antibody Level of Term Pregnant Women and Neonatal Umbilical Cords

PURPOSE: Despite appropriate preventive measures, measles outbreaks occurred in the year of 1989-1990 and 1994 in Korea. Especially, the ratio of young infantile patients below 15 months old was high in those outbreaks, and the reason was, we thought, low serum level of measles specific IgG antibody in pregnant women and low transplacental transfer rate of measles specific IgG antibody to neonate. This study was performed to evaluate the serum level of measles specific IgG antibody in term pregnant women- neonate pairs. METHODS: During Oct. 1. 1994 to Mar. 31. 1995, we collected the 44 paired sera of term pregnant women and their neonate(umbilical cord) in Anam hospital of Korea university medical center and then we measured the measles specific IgG antibody using enzyme linked immunosorbent assay(ELISA: Sigma Diagnostics, SIATM Measles IgG Kit). RESULTS: 1) There was close relationship between maternal and neonatal umbilical cord sera in the level of measles specific IgG antibody(r=0.9288, p<0.001). 2) The mean antibody level of neonates was higher than that of mothers by 1.4 times (p<0.05). 3) The seropositivity of measles specific IgG antibody in term pregnant women was 45.5%(20/44) and that of neonatal umbilical cord was 56.8%(25/44). CONCLUSIONS: Above results demonstrates that the seropositivities and levels of measles specific IgG antibody in term pregnant women and neonates were lower than expected value and partially explain the reasons for the recent measles epidemic in Korea.

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.

A case of fetal atrial flutter with hydrops fetalis

Fetal hydrops is often serious and associated with a high perinatal motality rate. Cardiac causes of fetal hydrops include congenital heart diseases and rhythm disturbances. An irregular fetal heart rate may indicate atrial fibrillation and atrial flutter with variable AV conduction. Fetal atrial flutter is characterized by the pressence of flutter waves which are regular sawtooth undulations in the baseline that are larger than p waves. Authors experienced a case of fetal atrial flutter with hydrops fetalis at 30 week's gestation which was confirmed by fetal M-mode echocardiogram and electrocardiography. A new born infant had shown to have atrial flutter in utero and after delivery was successfully converted to normal sinus rhythm with digoxin and quinidene.

A Case of Chronic Pancreatitis with Pancreatic Stones in Childhood

No abstract available.