PURPOSE: The purpose of this study was to evaluate the spontaneous remission rate in children with chronic ITP. METHODS: The medical records of 21 patients diagnosed with chronic ITP and followed for at least 6 months at Hanyang University Hospital between Mar. 1985 and Feb. 1997 were reviewed. Complete remission(CR) was defined as a recovery of platelet count of more than 100x109/L and partial remission(PR) was defined as a recovery of platelet count of 50-100x109/L, maintained for at least 6 months. RESULTS: Of 21 patients, 9 boys and 12 girls, the mean age at diagnosis was 5.5 years (0.4~15.5 years). The mean platelet count at diagnosis was 26.5x109/L(2-86x109/L). Of 21 patients, 5 with persistent thrombocytopenia and severe bleeding tendency underwent splenectomy. With a median follow up of 39.5 months after splenectomy, 4 achieved CR. The time to CR of the 4 patients were 2 weeks, 13.6, 18.6, 31.0 months, respectively. Of 16 patients, excluding 5 splenectomized children, 6 achieved CR and 4 PR. With a median follow-up of 21 months, the predicted spontaneous CR and PR rate at 5 years were 37.5%, and 68.7%, respectively(The percentage of PR includes that for CR). No serious complications including ICH or death were observed. CONCLUSION: Our study indicates that many cases of chronic ITP in childhood may remit without therapy even several years from onset. Splenectomy should be delayed as long as possible and reserved for the symptomatic and severely thrombocytopenic patient.
Child ; Diagnosis ; Female ; Follow-Up Studies* ; Hemorrhage ; Humans ; Medical Records ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Remission, Spontaneous ; Splenectomy ; Thrombocytopenia

Pyogenic vertebral osteomyelitis, which is not uncommon in adults, is rare in children. Furthermore, the clinical presentation is often subtle and nonspecific. As a result, vertebral osteomyelitis is often not considered in the initial evaluation in children, resulting in a delay in diagnosis and treatment. We report a 3-year-old boy who was eventually diagnosed with pyogenic vertebral osteomyelitis and treated successfully with antibiotics. The patient initially presented himself with mild fever and abdominal pain for one week. Urinary tract infection, initially considered due to dysuria with suprapubic tenderness, was ruled out. Further investgation revealed that he had right sided suprapubic tenderness and low abdominal pain. He refused to sit or walk, and preferred a recumbent position with his knees bent. The magnetic resonance imaging study showed findings of L2-L3 vertebral osteomyelitis. With 4 weeks of intravenous cephradine treatment, the patient improved clinically and radiologically.
Abdominal Pain ; Adult ; Anti-Bacterial Agents ; Cephradine ; Child ; Child, Preschool ; Diagnosis ; Discitis ; Dysuria ; Fever ; Humans ; Knee ; Magnetic Resonance Imaging ; Male ; Osteomyelitis* ; Urinary Tract Infections

PURPOSE: Outbreaks of mumps continue to occur, even though the number of patients diagnosed of mumps has decreased considerably with the widespread use of vaccine. The accurate diagnosis of mumps is needed to understand the epidemiology of mumps and analyse the safety and effectiveness of vaccine. Therefore, we attempted to appraise the accuracy of provisional diagnosis of mumps in clinical practice by measuring mumps specific antibody. METHODS: Thirty-six patients with presumptive diagnosis of mumps were enrolled from four university hospitals. Medical history including MMR vaccination was obtained, and anti-mumps IgM antibody test(ELISA. Denka Seiken Co., Ltd., Tokyo, Japan), complete blood counts and amylase were measured. RESULTS: Among 36 patients presumptively diagnosed of mumps, anti-mumps IgM antibody was positive in 14 patients(38.8%), negative in 20(55.5%) and equivocal in 2(5.5%). In two patients who were not vaccinated against mumps, one had anti-mumps IgM antibody and the other did not. All four patients, vaccinated with MMR twice after their first birthday did not have anti-mumps IgM antibody. The sites of involved glands and the associated localized as well as systemic symptomatologies were not different between patients with anti-mumps antibody and those without. The proportion and degree of increment of serum amylase level were not different between the two groups. CONCLUSION: A significant number of patients with provisional diagnosis of mumps appear to be due to other causes. Amylase, commonly used in clinical practice, does not differentiate mumps from other illnesses involving the parotid glands. Mumps can be accurately diagnosed only by laboratory tests including anti-mumps antibody. The two-dose MMR vaccination program needs to be reinforced.
Amylases ; Blood Cell Count ; Child* ; Diagnosis ; Disease Outbreaks ; Epidemiology ; Hospitals, University ; Humans ; Immunoglobulin M* ; Mumps* ; Parotid Gland ; Vaccination