PURPOSE: Neurofibromatosis 1 (NF1) is an autosomal dominant condition caused by an NF1 gene mutation. NF1 is also a multisystem disorder that primarily affects the skin and nervous system. The goal of this study was to delineate the phenotypic characterization and assess the NF1 mutational spectrum in patients with NF1. METHODS: A total of 42 patients, 14 females and 28 males, were enrolled in this study. Clinical manifestations and results of the genetic study were retrospectively reviewed. RESULTS: Age of the patients at the time of NF1 diagnosis was 15.8+/-14.6 years (range, 1-62 years). Twelve patients (28.6%) had a family history of NF1. Among the 42 patients, Cafe-au-lait spots were shown in 42 (100%), neurofibroma in 31 (73.8%), freckling in 22 (52.4%), and Lisch nodules in seven (16.7%). The most common abnormal finding in the brain was hamartoma (20%). Mental retardation was observed in five patients (11.9%), seizures in one patient (2.4%), and plexiform neurofibromas (PNFs) in four patients (9.5%). One patient with PNFs died due to a malignant peripheral nerve sheath tumor in the chest cavity. Genetic analysis of seven patients identified six single base substitutions (three missense and three nonsense) and one small deletion. Among these mutations, five (71.4%) were novel (two missense mutations: p.Leu1773Pro, p.His1170Leu; two nonsense mutations: p.Arg2517*, p.Cys2371*; one small deletion: p.Leu1944Phefs*6). CONCLUSION: The clinical characteristics of 42 Korean patients with NF1 were extremely variable and the mutations of the NF1 gene were genetically heterogeneous with a high mutation-detection rate.
Brain ; Cafe-au-Lait Spots ; Codon, Nonsense ; Diagnosis ; Female ; Genes, Neurofibromatosis 1 ; Hamartoma ; Humans ; Intellectual Disability ; Korea ; Male ; Mutation, Missense ; Nervous System ; Neurofibroma ; Neurofibroma, Plexiform ; Neurofibromatosis 1* ; Peripheral Nerves ; Retrospective Studies ; Seizures ; Skin ; Thorax

The incidence of type 1 diabetes mellitus (T1DM) in children and adolescents is increasing worldwide. Combined effects of genetic and environmental factors cause T1DM, which make it difficult to predict whether an individual will inherit the disease. Due to the level of self-care necessary in T1DM maintenance, it is crucial for pediatric settings to support achieving optimal glucose control, especially when adolescents are beginning to take more responsibility for their own health. Innovative insulin delivery systems, such as continuous subcutaneous insulin infusion (CSII), and noninvasive glucose monitoring systems, such as continuous glucose monitoring (CGM), allow patients with T1DM to achieve a normal and flexible lifestyle. However, there are still challenges in achieving optimal glucose control despite advanced technology in T1DM administration. In this article, disease prediction and current management of T1DM are reviewed with special emphasis on biomarkers of pancreatic β-cell stress, CSII, glucose monitoring, and several other adjunctive therapies.
Adolescent ; Biomarkers ; Child ; Diabetes Mellitus, Type 1* ; Glucose ; Humans ; Incidence ; Insulin ; Life Style ; Self Care

PURPOSE: It has been a common medical practice to use prophylactic antibiotics to prevent recurrent urinary tract infections (UTI) in high risk situations such as urinary tract obstruction, vesicoureteral reflux, neurogenic bladder, or urinary stones. But sometimes, we meet difficult situation of breakthrough infections (BI) which might cause new or progressive renal scarring. The clinical characteristics of children contracting breakthrough UTI experienced in a single center were studied. METHODS: The study was done retrospectively through medical records of 150 pediatric patients who had been cared in pediatric and urologic clinics of Pusan National University Hospital from Jan. 2001 till June 2006 and had prophylactic antibiotics to prevent recurrent UTI. RESULTS: The starting age of prophylactic antibiotics of 150 patient was 1-76 months, and median age was 5 months. The BI developed 61 times in 43 patients (28.7%), 1.5 times per 100 patient-months. The BI occurred more frequently in patients with higher grade of VUR, and in the cases with abnormal DMSA scan. Co-trimoxazole was more effective than 2nd and 3rd generation cephalosporins to prevent UTI. The distribution of causative organisms was more diverse than usual UTI. The causative organisms were sensitive to the antibiotics used for prophylaxis in 29.5%, and resistant in 59.1%. After experience of BI, 40 percents of patients went to the surgical treatment including endoscopic injection of Deflux, 35% to new antibiotics for prophylaxis, 26% remain on the same antibiotics as the previous one. CONCLUSION: Based on our study results, preexisting renal scar might be one of the factors which should be considered in favor of early surgical interventions of VUR. Poor compliance and wrong selection of antibiotics such as cephalosporins are important underlying causes of breakthrough UTIs.
Anti-Bacterial Agents ; Cephalosporins ; Child ; Cicatrix ; Compliance ; Contracts ; Dextrans ; Humans ; Hyaluronic Acid ; Medical Records ; Retrospective Studies ; Succimer ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Bladder, Neurogenic ; Urinary Calculi ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: There has been several studies about pathological findings of the asymptomatic urinary abnormalities (AUA) in children. But most of them are based on collaboratively collected data. That kinds of studies might have some bias due to different criteria for renal biopsy. We analyzed histopathological findings of AUA patients experienced in a single hospital and analyzed the efficacy of renal biopsy according to the clinical findings. METHODS: We reviewed the pathological reports and clinical data of 171 patients with AUA who had renal biopsies for the last 20 years. Patient were divided into 3 groups based on the urinalysis: hematuria group, proteinuria group, combined hematuria and proteinuria group. To analyze the efficacy of renal biopsy, we defined "modifiable diseases" as those diseases of which early treatment can alter the prognosis, including IgA nephropathy, membranoproliferative glomerulonephritis, membranous glomerulonephritis and focal segmental glomerulosclerosis. RESULTS: Male to female ratio was 2.2 to 1, and the highest incidence was in the age group of 6 to 10 years. IgA nephropathy (49%) was the most frequent pathological diagnosis. The incidence of "modifiable diseases" were higher in the group of combined proteinuria and hematuria, compared to isolated hematuria or proteinuria group. CONCLUSION: IgA nephropathy was most frequent pathological diagnostic entity in AUA. The efficacy of renal biopsy, which can be defined as the possibility of diagnosing "modifiable disease" by renal biopsy, is greater in the combined hematuria and proteinuria group than hematuria or proteinuria group.
Bias (Epidemiology) ; Biopsy ; Child ; Female ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hematuria ; Humans ; Incidence ; Male ; Prognosis ; Proteinuria

Moyamoya disease is a cerebrovascular condition that results in the narrowing of the vessels of the circle of Willis and collateral vessel formation at the base of the brain. Although relationships between Graves' disease and cerebrovascular accidents in Moyamoya disease are obscure, the coexistence of the two diseases is noteworthy. Moyamoya disease has been rarely reported in adolescent patients with thyrotoxicosis. Recently, we encountered two adolescent Korean patients with Moyamoya disease associated with Graves' disease who presented with episodic right-sided hemiparesis and syncope. These two girls who had Graves' disease had no history of other diseases or head trauma. A thyroid function test revealed a euthyroid state and a high thyroid-stimulating hormone (TSH) receptor antibody titer at that time. The patients were diagnosed with Moyamoya disease based on brain magnetic resonance angiography and cerebral four-vessel angiography. The patients underwent cranial revascularization by encephalo-duroarterio-synangiosis as soon as a diagnosis was made, which resulted in successful symptom resolution. They fared well and had no additional neurological symptoms as of their last follow-up visits. Here, we report these two cases of confirmed Moyamoya disease complicated by Graves' disease with a review of the literature, and discuss the possible association between the two diseases. To our knowledge, this is the first report in South Korea on Moyamoya disease associated with Graves' disease in adolescents with a euthyroid.
Adolescent* ; Angiography ; Brain ; Circle of Willis ; Craniocerebral Trauma ; Diagnosis ; Female ; Follow-Up Studies ; Graves Disease* ; Humans ; Hyperthyroidism ; Korea ; Magnetic Resonance Angiography ; Moyamoya Disease* ; Paresis ; Stroke ; Syncope ; Thyroid Function Tests ; Thyrotoxicosis ; Thyrotropin

Kabuki syndrome (KS) is a rare syndrome characterized by multiple congenital anomalies and mental retardation. Other characteristics include a peculiar facial gestalt, short stature, skeletal and visceral abnormalities, cardiac anomalies, and immunological defects. Whole exome sequencing has uncovered the genetic basis of KS. Prior to 2013, there was no molecular genetic information about KS in Korean patients. More recently, direct Sanger sequencing and exome sequencing revealed KMT2D variants in 11 Korean patients and a KDM6A variant in one Korean patient. The high detection rate of KMT2D and KDM6A mutations (92.3%) is expected owing to the strict criteria used to establish a clinical diagnosis. Increased awareness and understanding of KS among clinicians is important for diagnosis and management of KS and for primary care of KS patients. Because mutation detection rates rely on the accuracy of the clinical diagnosis and the inclusion or exclusion of atypical cases, recognition of KS will facilitate the identification of novel mutations. A brief review of KS is provided, highlighting the clinical and genetic characteristics of patients with KS.
Congenital Abnormalities ; Diagnosis ; Exome ; Humans ; Intellectual Disability ; Molecular Biology ; Primary Health Care

PURPOSE: Prader-Willi syndrome (PWS) is a complex genetic disorder that results from the lack of paternally expressed genes in the chromosome 15q11-q13 region. This study was performed to delineate the clinical features of PWS infants and toddlers and the effects of two-year growth hormone (GH) treatment according to gender and age at the start of treatment. METHODS: The clinical characteristics and the results of the GH treatment were reviewed retrospectively for 30 PWS patients diagnosed by molecular genetic testing and clinical manifestations. RESULTS: The mean age at diagnosis with PWS was 13.7 months (2-47 months of age). All patients showed the characteristics of facial dysmorphism, including brown hair and almond-shaped eyes. Most patients showed developmental delays/mental retardation (93.3%), cryptorchidism (75%), feeding problems in infancy (73.3%), and neonatal or infantile hypotonia (66.7%). Among 30 patients, 14 PWS infants and toddlers had been treated with GH for more than two years. Two years of GH treatment resulted in an improvement in head circumference-standard deviation score (HC-SDS), body weight-SDS, insulin-like growth factor-1 (IGF-1) SDS, IGF binding protein-3 (IGFBP-3) SDS, lean body mass, and bone mineral content, especially in IGFBP-3 SDS and motor development in PWS patients younger than two years of age. There was significant increase in IGF-1 SDS and IGFBP-3 SDS among male PWS patients after GH treatment. CONCLUSION: Our study showed increases in IGFBP-3 SDS and an improvement in motor development among individuals under two years of age after GH treatment, and significant difference in IGF-1 SDS and IGFBP-3 SDS by gender.
Bone Density ; Cryptorchidism ; Diagnosis ; Growth Hormone ; Hair ; Head ; Humans ; Infant ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Korea ; Male ; Molecular Biology ; Muscle Hypotonia ; Prader-Willi Syndrome* ; Retrospective Studies

No abstract available.
Adolescent* ; Humans ; Obesity* ; Overweight*

Combined oxidative phosphorylation deficiency-17 (COXPD-17) is very rare and is caused by homozygous or compound heterozygous mutations in the ELAC2 gene on chromosome 17p12. The ELAC2 gene functions as a mitochondrial tRNA processing gene, and only 4 different pathogenic mutations have been reported in ELAC2-associated mitochondrial dysfunction involving oxidative phosphorylation. Affected patients show various clinical symptoms and prognosis, depending on the genotype. We report a novel mutation in the ELAC2 gene (c.95C>G [p.Pro32Arg], het), in an infant with COXPD-17 who presented with encephalopathy including central apnea and intractable epilepsy, and growth and developmental retardation. During hospitalization, consistently elevated serum lactic acid levels were noted, indicative of mitochondrial dysfunction. The patient suddenly died of shock of unknown cause at 5 months of age. This is the first case report of COXPD-17 in Korea and was diagnosed based on clinical characteristics and genetic analysis.
Brain Diseases ; Drug Resistant Epilepsy ; Genotype ; Growth and Development ; Hospitalization ; Humans ; Hyperlactatemia ; Infant ; Korea ; Lactic Acid ; Oxidative Phosphorylation* ; Prognosis ; RNA, Transfer ; Shock ; Sleep Apnea, Central