We report a case of pneumonia in 36 year-old male patient who presented acute respiratory failure and associated radiologic findings of bilateral ground-glass opacity with focal cystic changes, showing rapidly aggravating course and was diagnosed as concomitant Pneumocystis carinii and Cytomegalovirus pneumonia accompanied by acquired immunodeficiency syndrome through antemortem open lung biopsy.
Acquired Immunodeficiency Syndrome ; Biopsy ; Cytomegalovirus ; Humans ; Lung ; Male ; Pneumocystis carinii ; Pneumonia ; Respiratory Insufficiency*

Purpose: Hypothalamic damage may increase the risk of adulthood obesity and cardiovascular disease in patients with craniopharyngioma. We evaluated the effects of hypothalamic involvement (HI) and growth hormone (GH) discontinuation on cardiovascular risk factors during the transition period in patients with childhood-onset craniopharyngioma. Methods: Thirty-three patients (17 males, 16 females) underwent retesting for adult GH deficiency (GHD) between 2005 and 2020 at Seoul National University Children's Hospital. Postoperative HI was graded by Puget's criteria and data regarding GH replacement were collected. At retesting, body mass index (BMI), fasting blood glucose, insulin, high-density lipoprotein cholesterol (HDL-C), triglycerides, and blood pressure were assessed. Results: The mean age of commencement and discontinuation of GH replacement for childhood GHD was 10.0±3.6 and 15.3±3.1 years, respectively. The mean age at retesting for adult GHD was 17.7±2.5 years. When patients were categorized by post-GH discontinuation duration, those with durations >6 months (n=27) showed lower HDL-C levels than those with <6 months (P=0.037). Patients with extensive HI (n=16) had higher BMI z-scores than did those with no HI or mild HI (P=0.020). Both the extent of HI and longer post-GH discontinuation duration were significantly predictive for decreased HDL-C levels (P<0.05, for both). Conclusion The extent of HI and GH discontinuation duration during the transition period can increase cardiovascular risks in patients with childhood-onset craniopharyngioma.

The authors experienced a case of myoglobinuria accompanied by generalized myalgia and mild fever that developed 3 hours 30 minutes after general anesthesia. Tracheal intubation was done smoothly 5 minutes after injection of thiopental sodium(275 mg) and pancuronium bromide(6 mg), and anesthesia was maintained with ethrane/N2O/O2(1.5-2%/21/21/min). There was no specific event except tachycardia and fluctuation of blood pressure throughout operation. In this case, we assume that the myoglobinuria is a presentation of the sign of an abortive type of malignant hyperthermia. However, it was not confirmed. We had good patient outeome with the supportive measures of hydration and diuresis. The patient was discharged twenty three days after operation without any complication.
Anesthesia ; Anesthesia, General* ; Blood Pressure ; Diuresis ; Fever ; Humans ; Intubation ; Malignant Hyperthermia ; Myalgia ; Myoglobinuria* ; Pancuronium ; Tachycardia ; Thiopental

PURPOSE: Recently, there has been a marked increase in childhood obesity, and that has aroused social concern. Obesity increases several metabolic disease such as hypertension, diabetes, fatty liver, heart disease and the mortality rate. Complications of obesity are more closely related with the accumulation of visceral fat. Therefore, fundamental treatment of obesity Should be the reduction of body fat. Exercise is the best way to reduce body fat, especially to consume the free fatty acid released from adipocytes. However, it is anticipated that children's response to exercise could differ from adult's. This research was done to find the difference adaptations of energy metabolisms in exercises between children and adults. METHODS: Sprague-Dawley male rats were divided into a young group(two-three months old), adult group(six months old) and an old group(fifteen months old). At fed ad libitum, O2 consumption and CO2 production were measured before and after the exercise. Before and after fasting for 24 hours, O2 consumption and CO2 production were measured. After fasting for 24 hours, the blood was taken to analyse the plasma glucose and free fatty acid. RESULTS: The fasting oxygen consumption decreased only in young rats compared with that of the fed state. The fasting respiratory quotient was decreased in the young and adult rats compared with those of the fed state. The post exercise oxygen consumption was increased in the young and adult rats but not in the old rats. The post-exercise respiratory quotient was decreased only in the young rats. There was no significant change of plasma glucose and free fatty acid between fed and fasting state in the young rats, while the fasting glucose levels were increased in the adult and old rats. CONCLUSION: These results mean that the responses to fasting and exercise differ among rats of different age groups and young rats can burn fat more easily during exercise and fasting than those of the adult and old rats because of the better metabolic flexibility of young rats.
Adipocytes ; Adipose Tissue ; Adult ; Animals ; Blood Glucose ; Burns ; Child ; Energy Metabolism ; Exercise ; Fasting* ; Fatty Liver ; Glucose ; Heart Diseases ; Humans ; Hypertension ; Intra-Abdominal Fat ; Male ; Metabolic Diseases ; Mortality ; Obesity ; Oxygen Consumption ; Pediatric Obesity ; Pliability ; Rats* ; Rats, Sprague-Dawley

As the associations between pediatric overweight/obesity and bone health remain controversial, we investigated the effects of overweight/obesity as well as lean mass (LM) and fat mass (FM) on bone parameters in adolescents. Bone parameters were evaluated using dual-energy X-ray absorptiometry (DXA) data of 982 adolescents (aged 12–19 years) from the Korea National Health and Nutrition Examination Survey (2009–2010). Z-scores for LM, FM, bone mass, bone mineral density (BMD), and bone mineral apparent density (BMAD) using Korean pediatric reference values were used for analysis. Adolescents with overweight/obesity had significantly higher bone mass and density of the total-body-less-head (TBLH), lumbar spine, and femur neck than underweight or normal-weight adolescents (P < 0.001) after adjusting for vitamin D deficiency, calcium intake, and insulin resistance in both sexes. LM was positively associated with bone parameters at all skeletal sites in both sexes (P < 0.001). FM was negatively related to TBLH BMD in boys (P = 0.018) but was positively associated to BMD and BMAD of the lumbar spine and femur neck in girls. In conclusion, overweight/obesity and LM play a positive role in bone health in adolescents. The effect of FM on bone parameters is sex- and site-specific.
Absorptiometry, Photon ; Adolescent* ; Body Composition ; Bone Density ; Calcium ; Female ; Femur Neck ; Humans ; Insulin Resistance ; Korea ; Miners ; Nutrition Surveys ; Obesity* ; Overweight* ; Pediatric Obesity ; Reference Values ; Spine ; Thinness ; Vitamin D Deficiency

We herein report two patients with epidermolysis bullosa acquisita(EBA), who had showed the atypical clinical features. A 25-year-old male presented with multiple pruritic vesicles, erosion and crusts which occurred more severely on the face than any other sites of the skin and healed with atrophic scar formation. Histopathologically, there was a subepidermal neutrophilic blister with moderate perivascular lymphohistiocytic infiltrates in the dermis, and the diagnosis of EBA was confirmed by means of direct immunofluorescence and salt-split direct immunofluorescence test performed on the perilesional skin. The other patient was a 24-year-old female who had had multiple painful ulcerative lesions on the oral mucosa for 4 months. After then, vesicles and bullae developed to progressively generalize to the anterior neck, chest and lower leg. Histolopathologic examination of peribullous skin showed a subepidermal bulla with neutrophils and eosinophils. The salt-split skin direct immunofluence test showed IgG and IgM binding to the dermal side only. We diagnosed this patient as nonscarring inflammatory EBA. Both patients were treated with prednisolone, colchicine, and dapsone resulting in clinical improvement, but their skin lesions recurred several months after discontinuing medication.
Adult ; Blister ; Cicatrix ; Colchicine ; Dapsone ; Dermis ; Diagnosis ; Eosinophils ; Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Female ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Leg ; Male ; Mouth Mucosa ; Neck ; Neutrophils ; Prednisolone ; Skin ; Thorax ; Ulcer ; Young Adult

Transient tachypnea of the newborn(TTN) is a benign self-limited disease characterized by early onset and rapid recovery of tachypnea although it may occasionally have a more prolonged and protracted course. A retrospective clinical study was mad on 29 neonates with TTN admitted to NICU of Pohang St. Mary's Hospital from January 1992 to June 1993. The results were as follows: 1) TTN(36.2%) was the most common cause of respiratory distress in the neonate followed by idiopathic respiratory distress syndrome(23.8%), pneumonia(18.8%), meconium aspiration syndrome(6.2%), perinatal asphyxia(6.2%), polycythemia(3.8%), anemia(1.2%), persistent fetal circulation(1.2%), paroxysmal supraventricular tachycardia(1.2%) and tracheoesophageal fistula(1.2%) 2) TTN was more frequent in the male term infants but can occur in premature(41.4%) and low birth weight infants(34.5%). 3) The associated perinatal conditions were oxytocin-induction(8 cases, 27.6%), Cesarean delivery(10 cases, 34.5%) and asphyxia(7 cases, 24.2%) 4) Arterial blood gas analysis showed respiratory acidosis in 3 cases and metabolic acidosis in 3 cases but none of TTN showed hypoxia unresponsive to oxygen 5) Chest X-ray showed hyperaeration in 10 cases(34.5%), increased pulmonary vascularity in 8 cases(27.6%), hyperaeration and increased pulmonary vascularity in 6 cases(20.6%) and cardiomegaly in 12 cases(53%). 6) Tachypnea usually appeared within 6hours and abated by 48-72hours but sustained more than 73hours in 7 cases(24.1%) 7) In majority of cases, maximal respiratory rates were below 100 rates/min and administered oxygen concentrations were 20-40%, and their mean values were 81 rates/min, 37.6% respectively. 8) TTN with more prolonged course(> or=48hours) was associated with low birth weight infants, prematurity and higher respiratory rates(> or=100 breaths a minute)(p<0.05).
Acidosis ; Acidosis, Respiratory ; Anoxia ; Blood Gas Analysis ; Cardiomegaly ; Gyeongsangbuk-do ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Male ; Meconium Aspiration Syndrome ; Oxygen ; Respiratory Rate ; Retrospective Studies ; Tachypnea ; Thorax ; Transient Tachypnea of the Newborn*

Transient tachypnea of the newborn(TTN) is a benign self-limited disease characterized by early onset and rapid recovery of tachypnea although it may occasionally have a more prolonged and protracted course. A retrospective clinical study was mad on 29 neonates with TTN admitted to NICU of Pohang St. Mary's Hospital from January 1992 to June 1993. The results were as follows: 1) TTN(36.2%) was the most common cause of respiratory distress in the neonate followed by idiopathic respiratory distress syndrome(23.8%), pneumonia(18.8%), meconium aspiration syndrome(6.2%), perinatal asphyxia(6.2%), polycythemia(3.8%), anemia(1.2%), persistent fetal circulation(1.2%), paroxysmal supraventricular tachycardia(1.2%) and tracheoesophageal fistula(1.2%) 2) TTN was more frequent in the male term infants but can occur in premature(41.4%) and low birth weight infants(34.5%). 3) The associated perinatal conditions were oxytocin-induction(8 cases, 27.6%), Cesarean delivery(10 cases, 34.5%) and asphyxia(7 cases, 24.2%) 4) Arterial blood gas analysis showed respiratory acidosis in 3 cases and metabolic acidosis in 3 cases but none of TTN showed hypoxia unresponsive to oxygen 5) Chest X-ray showed hyperaeration in 10 cases(34.5%), increased pulmonary vascularity in 8 cases(27.6%), hyperaeration and increased pulmonary vascularity in 6 cases(20.6%) and cardiomegaly in 12 cases(53%). 6) Tachypnea usually appeared within 6hours and abated by 48-72hours but sustained more than 73hours in 7 cases(24.1%) 7) In majority of cases, maximal respiratory rates were below 100 rates/min and administered oxygen concentrations were 20-40%, and their mean values were 81 rates/min, 37.6% respectively. 8) TTN with more prolonged course(> or=48hours) was associated with low birth weight infants, prematurity and higher respiratory rates(> or=100 breaths a minute)(p<0.05).
Acidosis ; Acidosis, Respiratory ; Anoxia ; Blood Gas Analysis ; Cardiomegaly ; Gyeongsangbuk-do ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Male ; Meconium Aspiration Syndrome ; Oxygen ; Respiratory Rate ; Retrospective Studies ; Tachypnea ; Thorax ; Transient Tachypnea of the Newborn*

The objective of this study was conducted to investigate growth and development status of infants fed soy-based formulas over 3 months. The height and weight were measured and Z-scores were calculated by using standard of the same age groups. Their mothers were interviewed using questionnaires including general and environmental characteristics, total food intakes, soy based formula intakes and Ewha infant development screening test. Main results were as follows: 1) Nutrient intake levels of subjects were similar to or more than the level of Korean Recommended Dietary Allowances except for intakes of vitamin E (79.89% RDA), and the average status of nutrient intakes of infants were fairly good. 2) Z-scores of height for age (HAZ) and Z-scores of weight for age (WAZ), Kaup index, WLI and Ewha Infant Developmental Screening Test score of subjects were in the normal growth range. 3) There were no significant differences among soy based formula intake percentile groups in HAZ, WAZ, Kaup index, WLI and Ewha Infant Developmental Screening Test score. 4) Total energy intake was positively correlated with HAZ (p < 0.01), WAZ (p < 0.01), and WLI (p < 0.05) in infants less than 12 month. Also, soy based formula energy intake was positively correlated with HAZ (p < 0.05) in infants less than 12 month. However, energy and soy based formula intake levels of infants over 12 month were not significant among variables. Considering results of this study, infants fed soy-based formulas over 3 months showed normal growth and development status. Further studies are needed to evaluate long-term growth and development in infants fed soy based formulas.
Child ; Child Development ; Energy Intake ; Growth and Development* ; Humans ; Infant* ; Mass Screening ; Mothers ; Recommended Dietary Allowances ; Vitamin E ; Vitamins

We investigated the vestibulo-ocular reflex which is followed by the change of angular acceleration in sinusoidal harmonic acceleration test. 20 normal volunteers with no evidence of previous otoneurologic disease were tested. The maximal slow phase eye velocity, gain and asymmetry were obtained in five different amplitudes of rotation, 30degrees, 60degrees, 90degrees, 120degrees and 150degrees with properly fixed conditions such as darkness and the frequency of rotation fixed at 0.05Hz. During each test, we asked the examinees to be alert and keep the eyes open. At least 5 minute interval was given between the tests and recalibrations were done before each test. The results of this test were as follows. 1) The maximal slow phase eye velocities were gradually increased according to the increment of the amplitudes of rotation with the statistical significances(p<0.05). 2) The gains were gradually decreased according to the increment of the amplitudes of rotation between the range of 30degrees and 90degrees with the statistical significances(p<0.05). 3) The asymmetries of each amplitude were the highest(13.6%) at 30degrees and the lowest(6.9%) at 120degrees, but there were no statistical significances(p>0.05). Therefore, from the above results, sinusoidal harmonic acceleration test with the frequency fixed at 0.05Hz, gain is higher when the amplitude of rotation is smaller and the pattern of the nystagmus is more evident when the amplitude of rotation is bigger. But The authors conclude that in order to get the results which are statistically significant, the amplitude of rotation should be lower than 90degrees.
Acceleration* ; Darkness ; Healthy Volunteers ; Reflex, Vestibulo-Ocular*