PURPOSE: This study was conducted to assess the usefulness of fat-free mass index (FFMI) and fat mass index (FMI) as novel expression methods of body composition in children. METHODS: A total of 466 Second grade students-248 boys and 218 girls- from all elementary schools the Gwacheon City underwent anthropometric measures including bioelectrical impedance analysis (BIA) and biochemical tests. The correlation coefficients between obesity indices, including FMI and FFMI, and metabolic risk factors, were assessed. Metabolic risk factors of children with increased FMI were compared with those of children with normal FMI. We compared FMI and FFMI percentile distribution between this study's subjects and the subjects of the Fukuoka body composition study. RESULTS: FMI was lower and FFMI was higher in this study's subjects compared to the subjects of the Fukuoka body composition study. FMI was correlated with other obesity indices and several metabolic risk factors. Metabolic risk was higher in children with increased FMI than in children with normal FMI. CONCLUSION: FMI and FFMI were useful indicators in comparing difference of body composition among children that had different body size and growth. High FMI was related to increase of metabolic risk in children.
Body Composition* ; Body Mass Index ; Body Size ; Child ; Electric Impedance ; Gyeonggi-do ; Humans ; Obesity ; Risk Factors

PURPOSE: While pediatric observation units (POU) have become a common practice in hospitals throughout developed countries, there has been no report about POUs in Korea so far. The aims of this study were to analyze our one-year's experience of the POU and to decide which disease entities are suitable for the POU. METHODS: All children admitted from March 2006 to February 2007 to the POU at the Department of Pediatrics in Our Lady of Mercy Hospital were included in this study. Data were collected from retrospective reviews of their medical records. RESULTS: There were a total of 1,076 POU admissions. Median age of patients was 2.4 years and median length of hospital stay 14.0 hours. The most common diagnoses were gastroenteritis (42.7%), pharyngotonsillitis (19.1%), bronchiolitis (7.8%), pneumonia (5.5%) and febrile seizure (5.2%). Overall, 7.5% of the POU patients required subsequent inpatient admissions due to hospital stays of longer than 48 hours. The disease entities that were most likely to require inpatient admission were pneumonia (17.0%), febrile seizure (12.5%) and asthma (11.5%). Diseases that allowed successful discharge from the POU were gastroenteritis (4.6%), upper respiratory tract infection (5.8%), such as otitis media and pharygnotonsillitis and seizure disorder (6.4%). Compared with the previous year when the POU was not in operation, there was a statistically significant reduction in the average length of hospital stays (from 4.69 to 3.75 days), as well as a rise in the bed turnover rate (from 78.8 to 98.2 patients/ bed). CONCLUSION: Our study shows that the POU is efficient for the management of children with certain acute illnesses. Based on this study, we suggest that the POU be used as a new modality which links between the outpatient, inpatient, and emergency departments in the field of pediatrics in Korea.
Asthma ; Bronchiolitis ; Child ; Day Care, Medical ; Developed Countries ; Diagnosis ; Emergency Service, Hospital ; Epilepsy ; Gastroenteritis ; Humans ; Inpatients ; Korea* ; Length of Stay ; Medical Records ; Otitis Media ; Outpatients ; Pediatrics ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies ; Seizures, Febrile

Hematopoietic stem cell transplantation (HSCT) has expanded and evolved substantially in the last decades to treat various malignant and nonmalignant diseases. However, the conditioning regimen can lead to transplantation related death by major organ dysfunction, severe infection and bleeding. In the allogeneic setting, graft versus host disease may also develop, making post-transplant management complex. To overcome these problems, new stem cell sources, stem cell mobilizing agents and new skills, nonmyeloablative stem cell transplantation including reduced intensity stem cell transplantation has been introduced in clinical practice, but problems remained so far. Recipients of stem cell transplant may be severely immunocompromised for many months after transplantation. Furthermore, long- term complications (endocrine, metabolic, relapse, second malignancies, etc) can develop. Pediatrician is open called on to participate in the evaluation and consideration of patients for possible transplant and long-term follow-up of HSCT patients. This review is intended as a basic overview of HSCT relevant to general pediatrician.
Follow-Up Studies ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Hemorrhage ; Humans ; Neoplasms, Second Primary ; Recurrence ; Stem Cell Transplantation ; Stem Cells

Since the introduction of chemotherapy for the treatment of childhood leukemia more than 50 years ago, the results of childhood cancer have improved dramatically. The 5-year survival rate of disease, many of which were uniformly fatal in the prechemotherapy era, reached to more than 75%. This remarkable improvement in survival is a direct result of the incorporation of chemotherapeutics into treatment regimens that previously relied only on surgery or radiotherapy for the primary tumor. The multimodality approach, which integrates surgery and radiotherapy to control local disease with chemotherapy to eradicate systemic or metastatic disease, has become the standard approach to treating most childhood cancers. The overall improvement in outcomes in childhood solid tumors has been related to the development of multidisplinary cooperative studies that has permitted the development of well-designed tumor treatment protocols characterized by uniform staging criteria, sharing informations in pathologic classification, uniform methods for tumor markers, oncogenes, and other biologic and genetic factors. Important advances in the biologic study of cancer and its genetic basis led to a number of observations that impact directly on the management of childhood solid tumors. Identification of specific genes, oncogenes, tumor markers, and other biologic and pathologic factors plays an important role in both staging and clarifying the risk categorization of individual patients. Treatment of the patient is influenced by the recognition of specific risk factors. This knowledge has resulted in a change in the approach to care based not only on staging criteria, but also on risk-based management. This concept uses various risk factors of outcomes. Risk-based management allows for each patient to maximize survival, minimize long-term morbidity and improve the quality of life, especially for children's growth and development.
Classification ; Clinical Protocols ; Drug Therapy ; Growth and Development ; Humans ; Leukemia ; Oncogenes ; Quality of Life ; Radiotherapy ; Risk Factors ; Survival Rate ; Biomarkers, Tumor

The cure rate of acute lymphoblastic leukemia (ALL) in children dramatically improved over past 5 decades from zero to about 80%. The main cause of improvement is owing to the development of chemotherapy by multicenter clinical trial of large study groups with the understanding of leukemia biology. Recently, pediatric ALL protocols were applied to the treatment of adolescent and even adult ALL patients. For nearly 30 years, clinical factors have been used to risk-stratify therapy for children with ALL, so that the most intensive therapies are reserved for those patients at the highest risk of relapse. The risk groups of ALL are divided as standard- (low- plus intermediate-), high- and very high-risk group according to the prognostic factors, and treatment results improved by this risk based treatment. The factors used to risk-stratify therapy include age, gender, presenting leukocyte count, immunophenotype, cytogenetic aberrations including ploidy and translocations, and initial response after 1 to 2 weeks of therapy. But treatment efficacy is the most important determinant and can abolish the clinical significance of most, if at all, prognostic factors. Today, in the era of intensive, multiagent regimens, there is increasing evidence that we have reached the limits of prognostic significance of currently applied clinical risk factors in childhood ALL. As the cure rate of ALL is about 80%, introducing new prognostic factors such as new molecular prognostic markers, new methods of assessment about minimal residual disease, and pharmacogenetic study, with the development of stem cell transplantation and molecular targeted therapy are needed to cure residual 20% of childhood ALL patients without short and long term complications.
Adolescent ; Adult ; Biology ; Child* ; Chromosome Aberrations ; Drug Therapy ; Humans ; Leukemia ; Leukocyte Count ; Molecular Targeted Therapy ; Neoplasm, Residual ; Ploidies ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence ; Risk Factors ; Stem Cell Transplantation ; Treatment Outcome

18 trisomy(Edwards syndrome) is a fatal disease with a congenital heart anomaly. Patients usually receive less aggressive care because caregivers expect them to die very young. Although they have a very poor prognosis due to severe multi-organ dysfunction, symptomatic simple cardiac anomaly with left to right shunt can be repaired. We experienced a case of 18 trisomy with ventricular septal defect and patent ductus arteriosus. He showed prolonged dyspnea and tachypnea after the ligation of patent ductus arteriosus in a previous hospital. In our hospital, the ventricular septal defect was closed because his parents insisted on aggressive treatment. After surgery, the symptoms were relieved and he was discharged in a condition satisfactory to his parents and the medical team.
Caregivers ; Ductus Arteriosus, Patent ; Dyspnea ; Heart ; Heart Defects, Congenital* ; Heart Septal Defects, Ventricular ; Humans ; Ligation ; Parents ; Prognosis ; Tachypnea ; Trisomy*

Neurofibromatosis type 1(NF1) is one of the most common inherited disorders, clinically characterized by cafe-au-lait spots, Lisch nodules and neurofibromas. In addition, the affected individuals usually develop benign and malignant tumors of the nervous system. One of the most common tumors is the optic nerve glioma. NF1-associated glioma, however, rarely occurs in the cerebellum. Recently, we experienced a NF1-associated cerebellar pilocytic astrocytoma in an 11 years old girl. She has a family history of NF1 and multiple cafe-au-lait spots over her whole body. We report herewith a case of NF1-associated cerebellar pilocytic astrocytoma with a brief review of related literature.
Astrocytoma* ; Cafe-au-Lait Spots ; Cerebellum ; Child ; Female ; Glioma ; Humans ; Nervous System Neoplasms ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1* ; Optic Nerve Glioma

Central diabetes insipidus is a rare disorder that can result as a consequence of diverse etiologies, including malformations, autoimmune, infiltrative(e.g. neoplastic or histiocytosis) or traumatic processes, as well as mutations in the gene encoding arginine vasopressin. Idiopathic central diabetes insipidus is a diagnosis of exclusion, one that has been made less frequently through the decades. Idiopathic central diabetes insipidus in children and adolescent requires a frequent follow-up regimen using serial brain MRI and CSF examinations especially if an isolated pituitary stalk thickening or loss of a hyperintense signal in the posterior lobe is observed. Also, so-called "idiopathic" central diabetes insipidus warrants close follow-up to determine the etiology, especially if anterior pituitary hormone deficiencies are detected. We report a case of idiopathic central diabetes insipidus with growth hormone deficiency and loss of a hyperintense signal in the posterior lobe of pituitary in the brain MRI. We followed up with serial contrast enhanced brain MRI and CSF evaluation for the early detection of an evolving occult hypothalamic-stalk lesion and finally detected a newly developed teratocarcinoma in the suprasellar region.
Adolescent ; Arginine Vasopressin ; Brain ; Child ; Diabetes Insipidus, Neurogenic* ; Diagnosis ; Follow-Up Studies ; Growth Hormone ; Humans ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Gland, Posterior ; Teratocarcinoma*

Meconium peritonitis is a rare disease in neonates, characterized by intraperitoneal calcification, numerous fibrosis with or without pseudocyst formation due to antenatal extravasation of meconium. Meconium peritonitis may result in a number of genital manifestations, including inguinal and scrotal or labial hydrocele containing meconium or calcifications. Recently, increased numbers of fetuses with meconium peritonitis have been prenatally diagnosed by ultrasonography. We report a case of meconium peritonitis in a neonate with ascites and hydrocele which was diagnosed by antenatal ultrasonography.
Ascites ; Fetus ; Fibrosis ; Humans ; Infant, Newborn ; Meconium* ; Peritonitis* ; Rare Diseases ; Ultrasonography

PURPOSE: Proliferative chondrocytes and prehypertrophic chondrocytes secrete significant amounts of type II collagen in an extracellular matrix. In contrast, hypertrophic chondrocytes secrete type X collagen. In addition, fibroblast growth factors (FGFs) and fibroblast growth factor receptors (FGFRs) also appear to play an important role during differentiation. Accordingly, the current study identified and characterized the chondrocytes and FGFR mRNA expressed at different stages of differentiation. METHODS: Chondrocytes were isolated from the caudal one-third portion (LS) of the sterna, peripheral regions (USP) and central core regions (USC) of the cephalic portion of the sterna, and the lower portion of the proximal tibial growth plate (Ti). Chondrocytes from the LS, USP, USC, and Ti of 17-day-old chick embryo sterna and tibia were cultured and type II and type X collagen mRNA and FGFR1, FGFR2, and FGFR3 mRNA were isolated and analyzed by Northern blotting. RESULTS: Generally, the cells were larger in size after two days of culture than after seven days of culture and the cells from the USC and Ti were larger and more mature than those from the LS and USP. Type II collagen genes were found to be expressed in all the chondrocyte types, while type X collagen was strongly expressed in the USC and Ti. Therefore, the LS was identified as a resting or proliferative zone, the USP as a postproliferative or prehypertrophic zone, and the USC or Ti as a hypertrophic zone. FGFR1 was expressed only in hypertrophic chondrocytes in proportion to the culture time, FGFR2 was not expressed in any of the chondrocyte types, and FGFR3 was expressed in all the chondrocyte types. CONCLUSION: As such, it is possible that the different receptors play distinct roles during chondrocyte differentiation.
Animals ; Blotting, Northern ; Chick Embryo* ; Chondrocytes* ; Collagen ; Collagen Type II ; Collagen Type X ; Extracellular Matrix ; Fibroblast Growth Factors* ; Fibroblasts* ; Growth Plate ; Receptors, Fibroblast Growth Factor* ; RNA, Messenger ; Tibia