Kawasaki disease (KD) is an immune-mediated disease which is a leading cause of acquired cardiovascular disease in developed country. Recently, tumor necrosis factor-alpha (TNF-alpha) blocker, infliximab has been considered a promising option for patients with refractory KD. Although chronic use of a TNF-alpha blocker could increase risk of opportunistic infections, a few studies have documented that use of infliximab was safe without serious adverse effects in patients with KD. We observed serious bacterial infection after infliximab treatment in an infant with refractory KD. Our patient was a 5-month-old male infant diagnosed with KD who did not respond to repeated doses of intravenous immunoglobulin. We effectively treated him with a single infusion of infliximab (5 mg/kg), but gram-negative (Acinetobacter lwoffii) septicemia developed after infliximab infusion. Therefore, we report a case of serious septicemia after treatment with infliximab, and suggest considering the risk of severe infection when deciding whether to prescribe infliximab to an infant with refractory KD.
Bacterial Infections ; Cardiovascular Diseases ; Developed Countries ; Humans ; Immunoglobulins ; Infant* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Opportunistic Infections ; Sepsis* ; Tumor Necrosis Factor-alpha ; Infliximab

No abstract available.
Child ; Health Promotion ; Humans ; Immunization* ; Child Health

BACKGROUND: Chronic cough is a common clinical problem to which various etiologies are attributable; postnasal drip, asthma, gastroesophageal reflux (GER) and chronic bronchitis, However, in some cases, no particular etiology can be confirmed. OBJECTIVE: This study was aimed to evaluate cough sensitivity and the clinical manifestations of patients with idiopathic chronic cough. MATERIALS AND METHODS: We recruited 70 non-smoking patients who had been coughing for more than 3 weeks without any history, symptoms or signs of rhinitis, sinusitis, typical asthma, GER or recent upper respiratory infection episodes. Nineteen healthy controls were also enrolled. Bronchial provocation tests with methacholine, capsaicin and distilled water (DW) were performed. RESULTS: Thirteen patients were positive to rnethacholine test (PC20 < 25mg/ml) and defined as cough variant asthma. The others are classified into idiopathic chronic cough. By capsaicin and DW challenge tests, idiopathic cough patients could be divided into two groups, i.e., increased cough sensitivity (ICS) and normal cough sensitivity (NCS) groups. DW- induced cough counts were negatively correlated with C7 (lowest capsaicin concentration inducing continuous 7 or more coughs) (r=-0.739, p<0.001). No difference was found in clinical features such as age, sex, atopy, or peripheral eosinophil counts between these two groups but cough counts per cough burst were significantly higher in the ICS group. CONCLUSION: The heterogeneity in cough sensitivity of idiopathic chronic cough patients may refiect different pathophysiologic mechanisms. It is unclear whether patients with NCS merely have habitual or psychogenic cough or not. These suggest that different therapentic strategies should be established on idiopathic chronic cough patients according to cough sensitivity.
Asthma ; Bronchial Provocation Tests ; Bronchitis, Chronic ; Capsaicin ; Cough* ; Eosinophils ; Gastroesophageal Reflux ; Humans ; Methacholine Chloride ; Population Characteristics ; Rhinitis ; Sinusitis ; Water

Congenital absence of the gall bladder without extrahepatic biliary atresia is an extremely rare congenital malformation with a reported incidence ranging between 0.01 and 0.02%. It is thought to be occurred from failure of the gallbladder bud to develop in utero and frequent association with other malformations. Agenesis can be randomly discovered at autopsy or operations for symptoms suggestive of biliary tract disease. The authors report a case of agenesis of the gallbladder without extrahepatic biliary atresia in a neonate which was incidentally found at laparotomy for presumed duodenal obstruction, with a review of the literature.
Autopsy ; Biliary Atresia* ; Biliary Tract Diseases ; Duodenal Obstruction ; Gallbladder* ; Humans ; Incidence ; Infant, Newborn ; Laparotomy ; Urinary Bladder

PURPOSE: The aim of this study was to investigate the pathophysiologic role of serum E-selectin, vascular endothelial growth factor(VEGF)-induced cell adhesion mollecule in Kawasaki disease(KD) and to look for the evidence of direct relationship between the plasma levels of soluble E-selectin and the incidence of coronary artery lesion(CAL). METHODS: Changes in plasma levels of sE-selectin(n=98) over time were measured by enzyme-linked immunosorbent assay(ELISA) in 23 patients with acute KD and 25 age-matched febrile children. RESULTS: Compared with control values, the peak levels of plasma sE-selectin were significantly elevated(mean+/-S.E.:22.89+/-12.53 ng/mL vs 10.65+/-3.42 ng/mL, P=0.01) in KD. 5 patients with CAL, plasma sE-selectin levels before treatment were higher than in 18 patients without CAL(mean+/-S.E.:39.43+/-15.08 ng/mL and 19.00+/-8.32 ng/mL, respectively; P=0.01). Plasma sE-selectin declined rapidly in the majority of KD patients regardless of the presence of CAL. Plasma sE-selectin levels after treatment and convalesent period were similar in KD patients with and without CAL. The plasma levels sE-selectin were correlated with those of white blood cell count(r=0.299, P<0.05), CRP(r=0.430, P<0.05), serum albumin(r=-0.483, P<0.05), serum protein(r=-0.502, P<0.05) and hemoglobin(r=-0.372, P<0.05) not with those of ESR, platelet, or duration of fever. There were significant differences in the initial level of serum sE-selectin between KD with and without CAL(mean+/-S.E.:39.44+/-15.08 ng/mL vs. 19.00+/-17.18 ng/mL) in multivariated linear tests. CONCLUSION: Plasma sE-selectin levels were significantly higher in KD than in other febrile illness. Higher plamsa levels of sE-selectin may have potential as a predictor of CAL in patients with KD.
Blood Platelets ; Cell Adhesion ; Child ; Coronary Vessels ; E-Selectin* ; Fever ; Humans ; Incidence ; Leukocytes ; Mucocutaneous Lymph Node Syndrome* ; Plasma

We report a case of thymic hyperplasia accompanied by pericardial lipomatosis and right facial hemihypertrophy in an 8-year-old boy. On imaging studies, the hyperplastic thymus had prominent curvilinear and nodular fatty areas simulating a fat-containing anterior mediastinal mass, which is an unusual finding in children. To our knowledge, this is the first report on a child with a combination of thymic hyperplasia, pericardial lipomatosis, and right facial hemihypertrophy. The radiologic findings are presented with a brief discussion.
Child ; Diagnosis, Differential ; Facial Asymmetry/complications/*diagnosis ; Heart Diseases/complications/*diagnosis/surgery ; Humans ; Hypertrophy/pathology ; Lipomatosis/complications/*diagnosis/surgery ; Magnetic Resonance Imaging ; Male ; Pericardium/*pathology ; Thymus Hyperplasia/complications/*diagnosis/surgery ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to evaluate the prevalence of increased aminotransferase levels and to identify associated factors in children admitted to hospital with urinary tract infections (UTIs). METHODS: The study included children with a diagnosis of UTI who were admitted to the Konyang University Hospital from January 2007 to May 2011. The total number of patients was 249 and the mean age was 15.88+/-28.21 months. UTI was defined as a positive urine culture (>105/colony forming unit [CFU]) with pyrexia. Patients were treated by intravenous antibiotics, such as ampicillin/sulbactam, aminoglycoside, cephalosporins or vancomycin. Patients with neonatal jaundice or other liver disease were excluded. We investigated the relationship of aminotransferase levels with the type of antibiotic, degree of vesicoureteral reflux (VUR), and causative organisms. RESULTS: Children with increased aminotransferase levels were younger than those with normal levels (p=0.001), but white blood cell count, platelet count, causative organisms, type of antibiotics and presence of VUR were not associated with aminotransferase levels. Aminotransferase levels became normal within 1 month after discharge without special measures, except in 1 case. CONCLUSION: We found that many children with UTI have abnormal aminotransferase levels. In most cases, this change is mild and self-limiting. We conclude that increased aminotransferase level increase during UTI do not require unnecessary tests and excessive treatment.
Anti-Bacterial Agents ; Cephalosporins ; Child ; Fever ; Humans ; Infant, Newborn ; Jaundice, Neonatal ; Leukocyte Count ; Liver Diseases ; Liver Function Tests ; Platelet Count ; Prevalence ; Sepsis ; Urinary Tract ; Urinary Tract Infections ; Vancomycin ; Vesico-Ureteral Reflux

OBJECTIVE: The measurement of liver size can be used for the diagnosis of the fetal growth abnormality (FGR, macrosomia etc.). The purpose of this study was to evaluate a mathematical relationship between the fetal liver size(liver length or volume) and the gestational age in the normal pregnancies. Brief comparisons were also tried on the base of the degree of the correlation between liver length and its volume. METHODS: We collected 54 singleton pregnancies of 20 to 36weeks of gestation for measuring fetal liver length and 57 singleton pregnancies for measuring fetal liver volume. We used Combison 530 utrasonic machine(Kreztechnik AG, Zipf, Austria). RESULTS: There was significant correlation between liver size( length and volume) and gestation age. And the liver volume better correlated with gestational age than liver length(r=0.93 : r=0.78, p<0.0001, p<0.0001). CONCLUSION: Ultrasonic measurement of fetal liver size is a reliable indicator of fetal growth, especially liver volume. Therefore these data may have a potential value for the prediction of abnormal fetal growth(FGR, macrosomia).
Diagnosis ; Fetal Development ; Gestational Age* ; Liver* ; Pregnancy* ; Ultrasonics

Childhood obesity seems to contribute to the development of vascular inflammation and the progression of arterial wall changes. High-sensitivity C-reactive protein (hs-CRP) has recently emerged as a useful biomarker for vascular inflammation associated with atherosclerosis. The objectives of this study were to evaluate the association of the serum hs-CRP level with ultrasonic findings of early atherosclerosis, carotid intima-media wall thickness (IMT) and brachial flow-mediated dilation (FMD), in obese children. Thirty eight obese children and 45 sex/age-matched healthy control children were recruited. Serum CRP levels were measured by the high-sensitive latex turbidimetric immunoassay, and we measured carotid IMT and brachial FMD using high-resolution B-mode ultrasonography. Obese children had significantly higher hs-CRP levels (1.40+/-0.74 mg/L vs. 0.55+/-0.49 mg/L, p<0.01), as well as increased IMT (0.52+/-0.09 mm vs. 0.41+/-0.07 mm, p<0.01) and impaired FMD (7.35+/-7.78% vs. 20.34+/-16.81%, p<0.01) compared to healthy controls. Serum hs-CRP correlated positively with IMT (r=0.413, p<0.05) and inversely with FMD (r=-0.350, p<0.05) in the obesity group. Measurement of the serum hs-CRP level is a simple, cheap, and highly reproducible assay and correlates with IMT and FMD in obese children. Thus, it would be a useful marker for evaluating and estimating the degree of atherosclerosis in children.
Sensitivity and Specificity ; Risk Factors ; Risk Assessment/*methods ; Reproducibility of Results ; Prognosis ; Obesity/*blood/*complications/diagnosis ; Male ; Humans ; Female ; C-Reactive Protein/*analysis ; Biological Markers/blood ; Atherosclerosis/*blood/complications/*diagnosis ; Adolescent

PURPOSE: We performed to reveal the association between the Helicobacter pylori infection and body weight among children. METHODS: Out retrospective study included patients who underwent the H. pylori immunoglobulin G testing at Konyang University Hospital between March 2011 and June 2014. These patients were classified as seropositive (28 boys, 27 girls; mean age: 9.89±3.28 years) or seronegative (55 boys, 54 girls; mean age: 9.84±3.02 years). Next, we compared various characteristics between the seropositive and negative groups, as well as between obese children (body weight ≥90th percentile) and non-obese children (body weight <90th percentile). Furthermore, we compared the change in body weight after 2 months of treatment with amoxicillin, clarithromycin and omeprazole among the 55 seropositive children (14 treated children and 41 non-treated children). RESULTS: There were no differences in the weights and laboratory data for the 55 seropositive children and 109 seronegative children (weight; 40.96±18.11 kg vs. 36.85±13.72 kg, respectively; p=0.14). And, there was no difference in the prevalence of H. pylori infection among the 29 obese and 135 non-obese children (p=0.581). However, after 2 months of eradication, the 14 treated patients exhibited a significant weight gain (+0.91±0.52 kg), compared to the 41 non-treated patients (-0.29±1.16 kg, p=0.025). CONCLUSION: Our findings present that obesity was not associated with the H. pylori infection, although H. pylori eradication led to significant increase in body weight.
Amoxicillin ; Body Weight* ; Child* ; Clarithromycin ; Disease Eradication ; Female ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Obesity ; Omeprazole ; Prevalence ; Retrospective Studies ; Weight Gain ; Weights and Measures