A 13-year-old boy was admitted via emergency room with dyspnea after vigorous coughing. Subcutaneous emphysema was palpated on both eyelids and around the neck. Breathing sound was slightly wheezy. On initial chest roentgenogram no parenchymal lesion or pneumothorax except subcutaneous emphysema on the thoracic wall was found. On the second day of hospitalization he showed agitation much more severe than the roentgenographic findings on the chest. Diffuse severe subcutaneous emphysema, pneumomediastinum, pneumopericardium, retroperitoneal pneumoperitoneum and epidural emphysema were found on computed tomography. He did not showed neurologic deterioration or respiratory difficulty demanding mechanical ventilation. He was treated with oxygen, bronchodilator and corticosteroids. After four days of hospitalization, tension pneumothorax finally developed which was successfully treated by closed thoracic tube drainage with water sealed bottle. The patient recovered without any sequelae after conservative care. On the follow up computed tomography no underlying pathologic lesion or residual emphysema was found.

Congenital nasolacrimal duct cyst is an uncommon anomaly of nasolacrimal duct obstruction in the newborn. It is cystic dilation of the lower end of the unperforated nasolacrimal duct with intranasal extension. In such cases, the bluish-gray cyst arises beneath the inferior turbinate on nasal endoscopy. A large nasolacrimal duct cyst can fill the nasal cavity and lead to nasal obstruction. Neonates are obligate nasal breathers at birth and require several weeks to learn to breathe through the mouth. Consequently this nasal obstruction can cause significant respiratory distress. We experienced a case of bilateral nasolacrimal duct cyst presenting as neonatal respiratory distress. Diagnosis was confirmed by nasal endoscopy and CT scan. After endoscopic marsupialization of the cysts , symptom and sign of respiratory distress were rapidly resolved.
Diagnosis ; Endoscopy ; Humans ; Infant, Newborn ; Mouth ; Nasal Cavity ; Nasal Obstruction ; Nasolacrimal Duct* ; Parturition ; Tomography, X-Ray Computed ; Turbinates

PURPOSE: This study was undertaken to evaluate the immunogenicity and reactogenicity of Td booster immunization in early preadolescents of Korea. METHODS: Healthy preadolescents, who had been vaccinated with 4 or 5 doses of DTaP vaccines until 6 years old age, were enrolled in this study from August 2006 to April 2007 . Diphtheria and tetanus anti-toxoid antibodies in sera were measured by ELISA just before vaccination and 4 weeks after vaccination to evaluate immunogenicity. Local and systemic adverse reactions observed for 4 weeks after vaccination to access reactogenicity. RESULTS: 183 preadolescents were enrolled and mean age was 11.40+/-0.51 years old. All subjects achieved seroprotective diphtheria and tetanus anti-toxoid antibodies (titers > or =0.1 IU/mL) after Td booster vaccination. Among 183 vaccinees, 73.8% showed local adverse reactions and 37.2% systemic adverse reactions. Pain at injection site (66.1%) was the most common local reaction, and the most commonly shown systemic reaction was myalgia (17.5%). The adverse reactions were spontaneously relieved within three days after vaccination. CONCLUSION: Td vaccine in this study was high immunogenic and showed an acceptable tolerance in Korean preadolescents. Td booster vaccination at 11 -12 years old is the most effective method to increase compliance of the vaccination and to decrease the incidence of diphtheria and tetanus.
Aged ; Antibodies ; Compliance ; Diphtheria ; Diphtheria-Tetanus Vaccine ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunization ; Immunization, Secondary ; Incidence ; Korea ; Tetanus ; Vaccination

PURPOSE: While pediatric observation units (POU) have become a common practice in hospitals throughout developed countries, there has been no report about POUs in Korea so far. The aims of this study were to analyze our one-year's experience of the POU and to decide which disease entities are suitable for the POU. METHODS: All children admitted from March 2006 to February 2007 to the POU at the Department of Pediatrics in Our Lady of Mercy Hospital were included in this study. Data were collected from retrospective reviews of their medical records. RESULTS: There were a total of 1,076 POU admissions. Median age of patients was 2.4 years and median length of hospital stay 14.0 hours. The most common diagnoses were gastroenteritis (42.7%), pharyngotonsillitis (19.1%), bronchiolitis (7.8%), pneumonia (5.5%) and febrile seizure (5.2%). Overall, 7.5% of the POU patients required subsequent inpatient admissions due to hospital stays of longer than 48 hours. The disease entities that were most likely to require inpatient admission were pneumonia (17.0%), febrile seizure (12.5%) and asthma (11.5%). Diseases that allowed successful discharge from the POU were gastroenteritis (4.6%), upper respiratory tract infection (5.8%), such as otitis media and pharygnotonsillitis and seizure disorder (6.4%). Compared with the previous year when the POU was not in operation, there was a statistically significant reduction in the average length of hospital stays (from 4.69 to 3.75 days), as well as a rise in the bed turnover rate (from 78.8 to 98.2 patients/ bed). CONCLUSION: Our study shows that the POU is efficient for the management of children with certain acute illnesses. Based on this study, we suggest that the POU be used as a new modality which links between the outpatient, inpatient, and emergency departments in the field of pediatrics in Korea.
Asthma ; Bronchiolitis ; Child ; Day Care, Medical ; Developed Countries ; Diagnosis ; Emergency Service, Hospital ; Epilepsy ; Gastroenteritis ; Humans ; Inpatients ; Korea* ; Length of Stay ; Medical Records ; Otitis Media ; Outpatients ; Pediatrics ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies ; Seizures, Febrile