Mollaret meningitis is a recurrent aseptic meningitis with characteristic clinical features and Mollaret cells in cerebrospinal fluid. Since Mollaret first reported Mollaret meningitis in 1944, further reports had been made mainly in Europe. The syndrome consists of brief attacks of meningitis that recur at regular intervals and alternate with a symptom-free period lasting for weeks or months. The symptoms subside as quickly as they develop, and the patient is completely asymptomatic until the next episode, without any residual neurologic abnormalities. Specific changes in the cytologic pattern of the cerebrospinal fluid occur over the course of an attack. In the early stages, polymorphonuclear leukocytes and endothelial cells appear in the cerebrospinal fluid, called Mollaret cell. We experienced a case of Mollaret meningitis in a 15-year-old female child who had 5 episodes of recurrent aseptic meningitis, always accompanied by vesicles on the face and anterior neck. We observed Mollaret cells which had faint, finely vacuolated cytoplasm, eccentrically located nuclei show on Papanicolau stain. We present a case of Mollaret meningitis with a brief review of related literatures.
Adolescent ; Cerebrospinal Fluid ; Child ; Cytoplasm ; Endothelial Cells ; Europe ; Female ; Humans ; Meningitis* ; Meningitis, Aseptic ; Neck ; Neutrophils

Mollaret meningitis is a recurrent aseptic meningitis with characteristic clinical features and Mollaret cells in cerebrospinal fluid. Since Mollaret first reported Mollaret meningitis in 1944, further reports had been made mainly in Europe. The syndrome consists of brief attacks of meningitis that recur at regular intervals and alternate with a symptom-free period lasting for weeks or months. The symptoms subside as quickly as they develop, and the patient is completely asymptomatic until the next episode, without any residual neurologic abnormalities. Specific changes in the cytologic pattern of the cerebrospinal fluid occur over the course of an attack. In the early stages, polymorphonuclear leukocytes and endothelial cells appear in the cerebrospinal fluid, called Mollaret cell. We experienced a case of Mollaret meningitis in a 15-year-old female child who had 5 episodes of recurrent aseptic meningitis, always accompanied by vesicles on the face and anterior neck. We observed Mollaret cells which had faint, finely vacuolated cytoplasm, eccentrically located nuclei show on Papanicolau stain. We present a case of Mollaret meningitis with a brief review of related literatures.
Adolescent ; Cerebrospinal Fluid ; Child ; Cytoplasm ; Endothelial Cells ; Europe ; Female ; Humans ; Meningitis* ; Meningitis, Aseptic ; Neck ; Neutrophils

PURPOSE: Continuous intravenous access is imperative in emergency situations. Ultrasound-guided internal jugular vein (IJV) catheterization was investigated in critically ill pediatric patients to assess the feasibility of the procedure. METHODS: Patients admitted to the pediatric intensive care unit between February 2011 and September 2012 were enrolled in this study. All patients received a central venous catheter from attending house staff under ultrasound guidance. Outcome measures included successful insertion of the catheter, cannulation time, number of cannulation attempts, and number and type of resulting complications. RESULTS: Forty-one central venous catheters (93.2%) were successfully inserted into 44 patients (21 males and 23 females; mean age, 6.54+/-1.06 years). Thirty-three patients (75.0%) had neurological disorders. The right IJV was used for catheter insertion in 34 cases (82.9%). The mean number of cannulation attempts and the mean cannulation time was 1.57+/-0.34 and 14.07+/-1.91 minutes, respectively, the mean catheter dwell time was 14.73+/-2.5 days. Accidental catheter removal was observed in 9 patients (22.0%). Six patients (13.6%) reported complications, the most serious being catheter-related sepsis, which affected 1 patient (2.3%). Other complications included 2 reported cases of catheter malposition (4.6%), and 1 case each of arterial puncture (2.3%), pneumothorax (2.3%), and skin infection (2.3%). CONCLUSION: The results suggest that ultrasound-guided IJV catheterization can be performed easily and without any serious complications in pediatric patients, even when performed by visiting house staff. Therefore, ultrasound-guided IJV catheterization is strongly recommended for critically ill pediatric patients.
Catheterization* ; Catheters* ; Central Venous Catheters ; Child ; Critical Illness* ; Emergencies ; Female ; Humans ; Intensive Care Units ; Internship and Residency ; Jugular Veins* ; Male ; Nervous System Diseases ; Outcome Assessment (Health Care) ; Pneumothorax ; Punctures ; Sepsis ; Skin ; Ultrasonography

PURPOSE: This study aimed to verify the safety of low-dose topiramate on language development in pediatric patients with migraine. METHODS: Thirty newly diagnosed pediatric patients with migraine who needed topiramate were enrolled and assessed twice with standard language tests, including the Test of Language Problem Solving Abilities (TOPs), Receptive and Expressive Vocabulary Test, Urimal Test of Articulation and Phonology, and computerized speech laboratory analysis. Data were collected before treatment, and topiramate as monotherapy was sustained for at least 3 months. The mean follow-up period was 4.3±2.7 months. The mean topiramate dosage was 0.9 mg/kg/day. RESULTS: The patient's mean age was 144.1±42.3 months (male-to-female ratio, 9:21). The values of all the language parameters of the TOPs were not changed significantly after the topiramate treatment as follows: Determine cause, from 15.0±4.4 to 15.4±4.8 (P>0.05); making inference, from 17.6±5.6 to 17.5±6.6 (P>0.05); predicting, from 11.5±4.5 to 12.3±4.0 (P>0.05); and total TOPs score, from 44.1± 13.4 to 45.3±13.6 (P>0.05). The total mean length of utterance in words during the test decreased from 44.1±13.4 to 45.3±13.6 (P<0.05). The Receptive and Expressive Vocabulary Test results decreased from 97.7±22.1 to 96.3±19.9 months, and from 81.8±23.4 to 82.3±25.4 months, respectively (P>0.05). In the articulation and phonology validation in both groups, speech pitch and energy were not significant, and all the vowel test results showed no other significant values. CONCLUSION: No significant difference was found in the language-speaking ability between the patients; however, the number of vocabularies used decreased. Therefore, topiramate should be used cautiously for children with migraine.
Child* ; Follow-Up Studies ; Humans ; Language Development ; Language Tests ; Migraine Disorders* ; Problem Solving ; Vocabulary

Behcet's disease consists of a triad of relapsing inflammatory disease of the eye (iridocyclitis) with painful and recurrent oral and genital ulcerations. Arthritis, thrombophlebitis, neurologic abnormalities, fever, and colitis are associated clinical manifestations. The disease affects predominantly young adults and is very rare in children, especially those under 10 years of age. The proportion of Behcet's colitis in Behcet's disease is about 12%. Ulcerations are localized or diffuse, with the majority occuring in the ileocecal region. Extension to the serosal surface may result in perforation. The frequent complaints are abdominal pain, nausea, vomiting, diarrhea, hematochezia, loss of appetite, loss of weight gain, distention and palpable abdominal mass. The disease is complicated by intestinal obstruction, perforation, fistula formation, abscess formation and hemorrhage. We experienced a case of Behcet's colitis in a 9-year-old boy showing symptoms of abdominal pain, tenderness, and diarrhea. Thus, we report a case of Behcet's colitis with brief review of related literatures.
Abdominal Pain ; Abscess ; Appetite ; Arthritis ; Child* ; Colitis* ; Diarrhea ; Fever ; Fistula ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Intestinal Obstruction ; Male ; Nausea ; Thrombophlebitis ; Ulcer ; Vomiting ; Weight Gain ; Young Adult

PURPOSE: The purpose of this study was to investigate the effects of lamotrigine for the treatment of attention-deficit hyperactivity disorder (ADHD) symptoms in children with epilepsy. METHODS: Pediatric patients newly diagnosed with epilepsy (n=90 [61 boys and 29 girls]; mean age, 9.1±3.4 years) were enrolled. All patients were evaluated with the Korean ADHD rating scale (K-ARS)-IV before treatment with lamotrigine and after doses had been administered. The mean interval of ADHD testing was approximately 12.3 months. The initial dosage of lamotrigine was 1 mg/kg/day (maximum 25 mg/day for the first 2 weeks), and increased by 1 mg/kg every 2 weeks until titrated up to 7 mg/kg/day (or maximum 200 mg/day). RESULTS: The mean ADHD test score of the 90 subjects was 17.0±1.8 at baseline. It was slightly reduced to 15.6±1.7 after lamotrigine monotherapy (P >0.01). Prior to treatment, a total of 31 patients (34.4%) met the diagnostic criteria for ADHD according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, Of these 31 patients, 27 (87.1%) had significantly improved ADHD scores with lamotrigine monotherapy (28.0±1.6 reduced to 18.1±2.6, P<0.001). Among these 27 patients, 25 (92.6%) showed normalized electroencephalogram (EEG) and 26 (96.3%) achieved total freedom from seizures within 12 months of the initiation of lamotrigine monotherapy. CONCLUSION: The results from our study show that lamotrigine had a positive effect in pediatric epilepsy patients by reducing ADHD symptoms, preventing seizures, and normalizing EEG. However, further research is required to determine whether lamotrigine is efficacious against ADHD symptoms independent of its effects on epileptic seizures.
Anticonvulsants ; Child ; Diagnostic and Statistical Manual of Mental Disorders ; Electroencephalography ; Epilepsy* ; Freedom ; Humans ; Seizures

VURD syndrome is a disorder characterized by a posterior urethral valve, unilateral reflux, and ipsilateral renal dysplasia. This syndrome is not uncommon, with an incidence in the range of 15 to 20% in patients with posterior urethral valve. Etiology is not clear, but there are a few reports that renal dysplasia is either a result of hydrostatic pressure transmitted to the developing kidney or a common teratogenic factor resulting in urethral obstruction, renal dysplasia, and vesicoureteral reflux. Infants with posterior urethral valves and persistent unilateral reflux after valve resection often have an associated nonfunctioning, dysplastic kidney. Misinterpretation of initial radiographic studies performed without coinciding bladder drainage results in a missed diagnosis of this syndrome and misguided surgical management. Functional assessment by a renal scan with bladder catheter drainage will avoid unnecessary staged or reconstructive procedures. Nephoureterectomy is recommended at about 1 year of age to improve voiding dynamics and to avoid infection. We experienced a case of VURD syndrome, first presenting bilateral hydronephrosis by ultrasonography during the prenatal period. Voiding cystourethrography revealed dilated posterior urethra and left vesicoureteral reflux, and DMSA scan showed a nonfunctioning left kidney.
Catheters ; Diagnosis ; Drainage ; Humans ; Hydronephrosis ; Hydrostatic Pressure ; Incidence ; Infant ; Kidney ; Succimer ; Ultrasonography ; Urethra ; Urethral Obstruction ; Urinary Bladder ; Vesico-Ureteral Reflux

Internal myiasis is a rare disease, which has not been reported in Korea, yet. This case report describes a patient with pneumonia associated with internal myiasis. She was 84-year old female who was admitted to the emergency department, Konyang University Hospital as a result of dyspnea and fever and a drowsy mental state. Approximately twenty fly maggots continuously crawled out from the nose at the third hospital day in the intensive care unit. These maggots were almost 7.2mm long and were identified as the genus lucilia belonging to the family Calliphoridae. In addition, a bronchial washing study showed eggs of the dipterous larvae. A lesion of this myiasis case might have been located in the respiratory system of patient. This case is the first internal myiasis of the respiratory system reported in Korea. This cases is discussed with a review of the relevant literature.
Aged, 80 and over ; Diptera ; Dyspnea ; Eggs ; Emergency Service, Hospital ; Female ; Fever ; Humans ; Intensive Care Units ; Korea ; Larva ; Myiasis* ; Nose ; Ovum ; Pneumonia* ; Rare Diseases ; Respiratory System

Congenital thoracic ectopic kidney is a very rare developmental disorder and the rarest type of ectopic kidney. This condition is usually asymptomatic and detected incidentally on routine chest radiography. Most cases of thoracic ectopic kidney develop in adulthood and during the neonatal period, and congenital thoracic ectopic kidney rarely develops in children. Most patients are asymptomatic, and the treatment depends on the diagnosis. Herein, we report a rare case of ectopic thoracic kidney associated with a diaphragmatic hernia in a 15-month-old male infant, who presented with periodic severe irritability. The thoracic ectopic kidney was detected as a mass in the right base of the chest on routine chest radiography.
Child ; Diagnosis ; Hernia, Diaphragmatic* ; Humans ; Infant* ; Kidney* ; Male ; Radiography ; Thorax

In northern China, annual epidemics of acute-onset flaccid paralysis diagnosed clinically Guillain-Barre syndrome have been observed for at least 20 years. These patients had a distinctive pattern that shares clinical and cerebrospinal fluid findings with demyelinating Guillain-Barr syndrome. But it was different from Guillain-Barr syndrome physiologically and pathologically. Electrodiagnostic studies showed normal motor distal latencies and limb conduction velocity, but reduced compound muscle action potential amplitude. When sensory nerve action potentials are elicitable, F waves are within the range of normal. This disorder was named acute motor axonal neuropathy characterized pathologically by motor nerve fiber degeneration of variable severity and by sparing of sensory fibers. Recovery is usually complete. We experienced a case of acute axonal motor neuropathy, and reported the case with a review of literature.
Action Potentials ; Axons* ; Cerebrospinal Fluid ; China ; Extremities ; Guillain-Barre Syndrome ; Humans ; Nerve Fibers ; Paralysis