PURPOSE: The recurrence of Kawasaki disease has not been considered significant and has not been reported on literatures in Korea. Authors reviewed cases with recurrent Kawasaki disease to get informations about recurrent Kawasaki disease and to know whether there is any factor, if present, that can predict recurrence. METHODS: We reviewed and analyzed the hospital records of patients with recurrent Kawasaki disease who had been admitted to Inha University Hospital from January 1986 through December 1994. RESULTS: The total number of cases with Kawasaki disease was 266 during that period in Inha University Hospital. Seven patients were diagnosed as having recurrent Kawasaki disease, but four of them fulfilled five or more items of the diagnostic criteria for Kawasaki disease. So the proportion of recurrent cases was 1.5%(4/259)(or 2.7% (7/259) ?). Sex ratio was M:F=3:1. The ages at the first episodes of illness were from 7 months to 3 years 2 months (median=24 months), and those of the second episodes were from 11 months to 6 years 3 months (median=4 years 3 months). The intervals between two episodes were from 4 months to 4 years 2 months (median=1 year 9 months). No special aspect could be found in the clinical and laboratory findings of primary cases, compared with other cases with kawasaki disease. The clinical manifestations and courses of recurred cases were not significantly different from those of primary cases, except one recurred case who developed coronary aneurysm. CONCLUSIONS: The recurrence rate of Kawasaki disease seems to be higher than 1.5%(or 2.7%) at least. The risk factors for recurrence could not be found, and there was no specific aspect in the clinical manifestations and courses of recurrent Kawasaki disease.
Coronary Aneurysm ; Hospital Records ; Humans ; Korea ; Mucocutaneous Lymph Node Syndrome* ; Recurrence ; Risk Factors ; Sex Ratio

No abstract available.
Arteries*

Pulmonary function test is one of the most important tools in the management of patients with respiratory tract diseases and allergic diseases. As with the difficulties in performing the test, it has been seldom used in pediatric field. But with the advent of simple, computerized tools, pediatric pulmonologist and allergist try to manage the patients using PFT. Still the normal predicted values are variable among the reports. So it is important to have normal predicted value in Korean children. From April to July 1992, pulmonary function test was performed in 965(male: 490, female: 475) primary school-aged children except <3 or >97 percentile of Korean-children Physical developemental standards with history of allergic diseases and respiratory tract diseases ay SungNam, KyongKiDo. We evaluated the predicted normal values of the FEV1.0, FVC and PEFR and logarithmic regression equation setting the predicted values by using the microspirometer of Micromedical Ltd. England that could that could be easily applied to children. 1) Predicted values of pulmonary function test items were generally higher in boys than those of girls. 2) Correlation coefficient to the parameters examined was the highest in height 0.78, then age 0.75, weight 0.70 and chest circumference 0.61.
Child* ; England ; Female ; Gyeonggi-do ; Humans ; Peak Expiratory Flow Rate ; Reference Values ; Respiratory Function Tests* ; Respiratory Tract Diseases ; Thorax

Idiopathic myelofibrosis (IMF), which is characterized by marrow fibrosis, leukoerythroblastic anemia, teardrop poikilocytosis and splenomegaly due to extrumedullary hematopoiesis, has known to have no form of therapy. On the ground of the possibility of reversing collagen deposion in IMF using 1, 25dihydroxycholecalciferol [1, 25(OH)2D3], we report here our observations of 5 patients (M:F=1:4) with IMF before and after treatment with 0.5 microgram/day of alfacalcidol, precursor of 1, 25(OH)2D3. In 3 fo 5 patients the hemoglobin rose and in 4 of 5 the platelet count increased. Follow-up marrow examination revealed that marrow trephine reticulin fibrosis decreased according as the amelioration of clinical and laboratory findings. But these did not persist except one patient in spite of the sustained use of alfacalcidol. Our results suggest that alfacalcidol may have a therapeutic role in some patients with IMF. More extensive studies will be clarify the action of alfacalcidol in IMF.
Anemia, Myelophthisic ; Bone Marrow ; Child* ; Collagen ; Fibrosis ; Follow-Up Studies ; Hematopoiesis ; Humans ; Platelet Count ; Primary Myelofibrosis* ; Reticulin ; Splenomegaly

The present case first describes the spontaneous thigh hematoma induced by enoxaparin in a hemodialysis patient. A 64- year-old woman on a hemodialysis therapy was diagnosed with acute coronary syndrome, and treated with enoxaparin. Ten days after enoxaparin administration, diffuse swelling and pain developed suddenly in the right thigh without a history of trauma. There was a weak arterial pulse below the knee with an abrupt decrease of hemoglobin level. There were no significant abnormalities in the coagulation tests including the platelet count, prothrombin time, and activated partial thromboplastin time. Computed tomographic (CT) angiography and lower extremity arteriography were performed, which showed several bleeding foci involving branches of the right deep femoral artery. She was treated successfully by embolization at the bleeding sites, along with a transfusion.
Acute Coronary Syndrome ; Angiography ; Enoxaparin ; Female ; Femoral Artery ; Hematoma ; Hemoglobins ; Hemorrhage ; Humans ; Knee ; Lower Extremity ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Renal Dialysis ; Thigh

BACKGROUND/AIMS: To compare treatment outcome of hepatocellular carcinoma(HCC) under the size of 5 cm in relation to underlying liver function and treatment modalities, analysis of data from 145 patients was performed. METHODS: In this study, the records of 145 patients with small HCC (< 5 cm in diameter determined by hepatic angiography) were reviewed. Clinical parameters were analyzed and survival rate, recurrence rate were calculated. RESULTS: There were 107(73.8%) men and 38 women. Mean age at diagnosis was 55.1(range .' 25 83 year-old). HBsAg was detected in 97(66.9%) patients. Seventy two(50.0%) patients showed markedly elevated(>40 ng/mL) serum alpha-fetoprotein(AFP) level. Liver cirrhosis was associated in 109(75.2%) patients. Sixty five(44.8%) patients underwent surge, 63(43.5%) underwent transarterial therapy(TAT), 8(5.5%) underwent other modalities of therapy and the remaining 9(6.2% ) patients did not receive any specific treatment for HCC. In relation to the underlying liver function, 119(82.1% ) patients belonged to the non-cirrhotic or Child-Pugh class A, 20(13.8%) to class B and 6(4.1%) to class C. The median follow-up duration was 21 months. When analyzed with respect to treatment modalities alone, median survival was 43 months for all patients, 60 months for surgery, 29 months for TAT, 20 months for other treatment and 18 months for patients who received no specific treatment. Without considering liver function, cumulative 3 year survival rate was 68.6% for surgery, 43.9% for TAT, 29.2% for other treatment and 0% for no treatment. The survival rate for the patients who underwent surgery was significantly higher than for any other treatment modalities without considering the underlying liver function or in the non-cirrhotic/Child-Pugh class A(p<0.001). In patients whose tumor size was equal to or less than 3 cm, there was no difference in survival rate in relation to the treatment modalities when not considering the underlying liver function of each patient(p>0.05). But in patients classified as the non-cirrhotic/Child-Pugh class A, better survival was observed in the surgep group than the TAT group(p<0.05). The only factor influencing survival was the pre-treatment serum AFP level(p<0.05). The overall recurrence rate was 30.3%. For the entire patients, the factor significantly influencing the recurrence rate was the presence of underlying cirrhosis. When considering only the patients in the surgery group, the different types of surgical procedures significantly influenced the recurrence rate. CONCLUSION: Surgery is the treatment of choice for patients with HCC equal to or smaller than 5 cm. But for those patients whose tumor size is less than 3 cm, TAT may be a reasonable alternative to surgep when the liver function is not adequate for hepatic resection. Because overall recurrence rate exceeded 30% and median time of recurrence was only 9.5 months after definitive treatment, careful follow-up is required for all patients who undergo treatment for small HCC.
Carcinoma, Hepatocellular* ; Diagnosis ; Female ; Fibrosis ; Follow-Up Studies ; Hepatitis B Surface Antigens ; Humans ; Liver Cirrhosis ; Liver* ; Male ; Recurrence ; Survival Rate ; Treatment Outcome*

PURPOSE: A prospective study was performed to evaluate the efficacies of two different dosages of aspirin(ASA) in treating Kawasaki disease(KD). METHODS: Thirty-nine children with KD were admitted to this hospital from July, 1992 to May, 1993, and were assigned randomly into 2 groups. Group A(medium-dose group, 20 patients) was given 50mg/kg/d(# 4), and group B(high-dose gorup, 19 patients) was given 100mg/kg/d(# 4) of ASA. Intravenous gammaglobulin(2g/kg) was given to all patients. RESULTS: 1) There were no significant differences in ages, sex ratios, durations of fever before treatment, and laboratory findings on admission between two groups. 2) The durations of ASA administration were similar in 2 groups(group A, 10.1+/-2.77 ; group B, 10.6+/-3.37 days ;?p>0.1). 3) The durations of fever after onset of treatment were not different significantly (group A, 2.65+/-3.28 ; group B, 1.74+/-1.52 days ; p>0.1). 4) There were no significant differences in laboratory findings after treatment between two groups, except hemoglobin(Hgb) and ESR examined in the 3 rd week of illness (Hgb: group A (N=15), 10.1+/-1.24 ; group B(n=14), 11.1+/-0.92g/dl ; p<0.05) (ESR: group A(n=14), 47.7+/-13.0 ; group B(n=14), 37.1+/-13.6mm/hr ; p<0.05). 5) Serum concentrations of ASA were examined 3 to 5 days after onset of treatment in 31 patients(group A, 17 ; group B, 14). Mean concentrations before the lst dose of the day were 3.28+/-3.01mg/dl in group A and 12.6+/-6.22mg/dl in group B(p<0.001). Mean concentrations before the 3 rd dose of the day were 3.58+/-2.36mg/dl in group A and 13.7+/-6.32mg/dl in group B(p<0.001). 6) EKG was examined 2 and 4 weeks after onset of illness. There were no abnormalities in EKG except sinus tachycardia in both groups. 7) Echocardiography was done 2 and 4 weeks after onset of illness. Coronary artery dilatation was observed in 40% of group A (8/20) and 31.6% of group B(6/19) at the lst examination (p>0.1), and in 25% of group A(5/20) and 10.5% of group B(2/19) at the 2 nd examination (p>0.1). In long-term follow-up, only 1 patient in each group showed coronary aneurysm respectively. CONCLUSIONS: Although serum concentrations of ASA were different significantly, there were no significant differences in recovery from KD and incidences of coronary artery lesions between two grous. So we think medium-dose aspirin therapy is safe and effective in the treatment of Kawasaki disease.
Aspirin* ; Child ; Coronary Aneurysm ; Coronary Vessels ; Dilatation ; Echocardiography ; Electrocardiography ; Fever ; Follow-Up Studies ; Humans ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Prospective Studies ; Sex Ratio ; Tachycardia, Sinus

Burkitt's lymphoma is a distinct pathologic entity characterized as a diffuse undifferentiated malignant lymphoma of B-lymphocyte origin. We experienced a case of Burkitt's lymphoma with bilateral renal enlargement in which a 3year-old male patient was admitted with complaints of abdominal distention and facial edema. Laboratory examination revealed positivity for CD 19, CD 10, CD 20 and c-myc on flow cytometry, bilateral renal enlargement(10x12cm in longitudinal length) on abdominal ultrasonogram and CT, malignant lymphoma of Buritt's type with prominent nucleoli and cytospin of cerebrospinal fluid. Initially he showed tumor lysis syndrome and clinical stage D by Zigler(stage IV by Murphy) with CNS involvement. After initial management with hydration, urine alkalinization and allopurinol, combination chemotherapy had been applied with the craniospinal radiotherapy according to the CCG 503 II regimane, with achievement of complete remission. Thus we report a case of Burkitt's lymphoma with bilateral renal enlargement with a biref review of literatures.
Allopurinol ; B-Lymphocytes ; Burkitt Lymphoma* ; Cerebrospinal Fluid ; Drug Therapy, Combination ; Edema ; Flow Cytometry ; Humans ; Lymphoma ; Male ; Radiotherapy ; Tumor Lysis Syndrome ; Ultrasonography

PURPOSE: M. pneumoniae is knwon as a common causative agents of respiratory infection in school children. But, it tends to occur in infants and younger children recently. This study was performed to evaluate the incidence and clinical manifestations of M. pneumoniae pneumonia in infants. METHOD: A total of 142 children(33 infants{Group I : Infants group; 0-2 years} and 109 children{Group II : Children group; 3-6 years}) was admitted with M. pneumoniae pneumonia from January through December 1998. We reviewed medical records and evaluated the incidence, clinical manifestations and laboratory findings. RESULT: Number of patients with M. pneumoniae pneumonia in 0 to 2 years of age(infants group) comprised 23.2% of the total in contrast to 57.1% in 3 to 6 years of age group and 19.7% in 7 to 12 years of age group. Seasonal distribution showed the highest frequency in autumn in infant and children groups(45.5% and 39.4% respectively). The most frequent symptom was cough(90.9% and 96.3%, respectively), followed by sputum(81.8% and 90.8%, respectively), fever(72.7% and 66.0%, respectively) and rhinorrhea(72.7% and 64.0%, respectively). The common physical findings on admission were crackle(84.8% and 80.7%, respectively), wheezing(30.3% and 18.3%, respectively) and throat injection(39.4% and 35.8%, respectively). WBC count was within normal range in both groups(90.9% and 89%, respectively) and CRP was lower than 0.8 mg/dL in 63.6% of infant group and 54.1% of children group. The most common radiologic finding was bronchopneumonia in both groups (47% and 38%, respectively). CONCLUSION: Number of the patients with Mycoplasma pneumoniae pneumonia in infants age from 0 to 2 years comprised 23.2% of the total. Clinical manifestations of Mycoplasma pneumonia in infants were similar to those of older children. We recommened Mycoplasma pneumoniae should be considerd as a causative agent even in infant with respiratory infection.
Bronchopneumonia ; Child ; Humans ; Incidence ; Infant* ; Medical Records ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pharynx ; Pneumonia* ; Pneumonia, Mycoplasma* ; Reference Values ; Seasons

Immotile cilia syndrome is an inherited disorder characterized by specific ultrastructural defects of cilia and associated impairment of ciliary motion and mucociliary clearance. Disorders of ciliary structure or function result in chronic sinopulmonary diseases manifested as chronic sinusitis, bronchitis, otitis media, nasal polyposis, and ultimately bronchiectasis. In addition, situs inversus, dextrocardia, and infertility can be associated with dysfunctional ciliary activity. We experienced a case of immotile cilia syndrome presenting with recurrent bronchitis, pneumonia, chronic sinusitis, otitis media, and bronchiectasis. She was diagnosed by lack of dynein inner arm on electron microscopy. Treatment included chest percussion, bronchodilators, antibiotics, and surgical intervention. She has been followed up at regular intervals. We report this case with related literatures.
Anti-Bacterial Agents ; Arm* ; Bronchiectasis ; Bronchitis ; Bronchodilator Agents ; Cilia ; Ciliary Motility Disorders* ; Dextrocardia ; Dyneins* ; Infertility ; Microscopy, Electron* ; Mucociliary Clearance ; Otitis Media ; Percussion ; Pneumonia ; Sinusitis ; Situs Inversus ; Thorax