Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea, we report one case of RSV pneumonia that developed in an infant with acute lymphoblastic leukemia (ALL). Despite administration of oral ribavirin and intravenous immunoglobulin, the patient's respiratory distress worsened and admission to an intensive care unit was necessary. Chest x-ray showed multifocal consolidation, pneumothorax, and pneumomediastinum. Treatment with aerosolized ribavirin led to significant clinical improvement. The role of aerosolized ribavirin is still controversial, but it might have a therapeutic potential for severe RSV pneumonia in children with leukemia.
Child ; Humans ; Immunocompromised Host ; Immunoglobulins ; Infant ; Intensive Care Units ; Korea ; Leukemia ; Mediastinal Emphysema ; Pneumonia ; Pneumothorax ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Ribavirin ; Thorax

This was a clinical trial study to aid the recovery of elderly female alcoholic liver disease patients by providing a balanced nutritional supplement comprising soymilk. All patients gave their consent before enrolling. The average demographics of the subjects were age 81.57 years, height 150.43 cm, weight 52.67 kg, and body mass index 24.15 kg/m2 . An increase in the daily consumption of fruits and fruit juice was observed after the patients had started taking the balanced meal as compared to before. Intakes of vitamin A, vitamin C, vitamin E, and cholesterol decreased after consuming soymilk, whereas vitamin B 12, niacin, folic acid, and dietary fiber significantly increased (P<0.05). Blood cholesterol and BUN levels showed a decreasing tendency.Our results indicate that consuming soymilk in a balanced diet for female patients afflicted with alcoholic liver disease helps improve their nutritional status by increasing the nutrients lacking in the body.

The aim of this study was to investigate the diphtheria-tetanus-pertussis antibody titers after antineoplastic treatment and to suggest an appropriate vaccination approach for pediatric hemato-oncologic patients. A total of 146 children with either malignancy in remission after cessation of therapy or bone marrow failure were recruited. All children had received routine immunization including diphtheria-tetanus-acellular pertussis vaccination before diagnosis of cancer. The serologic immunity to diphtheria, tetanus and pertussis was classified as: completely protective, partially protective, or non-protective. Non-protective serum antibody titer for diphtheria, tetanus and pertussis was detected in 6.2%, 11.6%, and 62.3% of patients, respectively, and partial protective serum antibody titer for diphtheria, tetanus and pertussis was seen in 37%, 28.1%, and 8.9% of patients. There was no significant correlation between the severity of immune defect and age, gender or underlying disease. Revaccination after antineoplastic therapy showed significantly higher levels of antibody for each vaccine antigen. Our data indicates that a large proportion of children lacked protective serum concentrations of antibodies against diphtheria, tetanus, and pertussis. This suggests that reimmunization of these patients is necessary after completion of antineoplastic treatment. Also, prospective studies should be undertaken with the aim of devising a common strategy of revaccination.
Adolescent ; Age Factors ; Antibodies, Bacterial/blood/immunology ; Antineoplastic Agents/therapeutic use ; Child ; Child, Preschool ; Diphtheria/immunology/prevention & control ; Diphtheria-Tetanus-acellular Pertussis Vaccines/*immunology ; Female ; Hematologic Neoplasms/*diagnosis/drug therapy ; Humans ; Immunization, Secondary ; Lymphoma/diagnosis/drug therapy ; Male ; Neuroblastoma/diagnosis/drug therapy ; Sex Factors ; Tetanus/immunology/prevention & control ; Whooping Cough/immunology/prevention & control

Foreign body ingestion is a common problem among paediatric populations. Most of the ingested foreign bodies spontaneously pass through the gastrointestinal tract, but approximately less then 10% of them remain without being discharged, and trigger complications. Therefore, proper evaluation and treatment according to the situation is required. In this study, clinical progress and complications were analyzed according to the clinical features and treatment in children who ingested foreign bodies. Among pediatric patients under 18 who were admitted to Chonnam National University Hospital after ingesting foreign bodies between January 2008 to June 2012, only the patients who had their foreign body in the gastrointestinal tract were included in this study. Based on medical records, age, type of foreign body, time spent till admission, and whether the endoscopy was done or not, complication were researched retrospectively. According to symptoms and plain abdomen X-ray findings, treatment was chosen and conducted among endoscopy, observation and emergency operation. Among 273 patients, 9 (3.3%) of them had surgical removal. Seven (2.6%) of them had an emergency operation on the day of admission, and the rest 2 (0.7%) had operation during observation. Removal through initial endoscopic approach was tried in 157 (57.5%) patients. Eleven (70.8%) of them had their foreign body removed at the initial trial, and 5 (4.9%) of them at the second trial. Among 109, who were on observation status, 9 (8.3%) of them needed endoscopic removal, and 2 (1.8%) of them suffered from surgical removal. It is thought to be better to approach slowly considering the type, size and symptoms in foreign body ingestion of pediatric patients, rather than immediate and invasive removal.
Abdomen ; Child* ; Eating ; Emergencies ; Endoscopy ; Foreign Bodies* ; Gastrointestinal Tract* ; Humans ; Jeollanam-do ; Medical Records ; Retrospective Studies

BACKGROUND: Automated border detection (ABD) echocardiography is a convenient and objective tool in the estimation of left atrial (LA) area and function when compared to the off-line, two-dimensional echocardiographic method that requires manual tracing of the endocardial border. In addition, the applicability of the ABD system to instantaneously derive LA area and function may provide a noninvasive method to assess the diastolic interaction between the left ventricle and the left atrium. METHOD: 53 patients with a normal sinus rhythm and an apical four chamber view of LA area (in which at least 75% of the endocardium was clearly visible) were selected for this study. The on-line echocardiographic assessment of LA areas and function with automated boundary detection was performed and compared with the off-line estimation. From the instantaneous cavity area displayed by the ABD system, the extents of left atrial area decrease resulting from rapid ventricular filling (D) and atrial contraction (AC) were measured. The D/AC ratio was compared with the transmitral Doppler flow velocity E/A ratio. RESULTS: 1) The end-systolic area (ESA) and the end-diastolic area (EDA) of the left atrium, diastolic atrial emptying index (AEMI) and the systolic atrial expansion index (AEXI) with the ABD system were not different from those with the off-line, manually trace method. 2) ESA, EDA, AEMI and AEXI determined by the ABD system and the off-line method showed strong correlations (r=0.87, 0.79, 0.52 and 0.49 respectively). 3) D/AC ratio with the ABD system correlated significantly with the transmitral Doppler velocity E/A ratio (r=0.70). CONCLUSION: The ABD system may be used in the assessment of LA area and LA function and the diastolic interaction between the left atrium and the left ventricle.
Echocardiography* ; Endocardium ; Heart Atria ; Heart Ventricles ; Humans

Angiomyolipomas are hamartomatous lesions consisting of smooth muscle bundles, thick-walled blood vessels, and mature adipocytes. They are usually found in the kidneys of tuberous sclerosis patients and more rarely in other organs, such as the liver, the oral cavity, the sinonasal tract, the heart, the large intestines, the lungs, and the skin. Cutaneous angiomyolipoma has shown to be very rare and generally occurs at the ends of the digits, the elbows, the ears, and the nose. Herein, we report the first documented case of angiomyolipoma of the glabellar region.
Adipocytes ; Angiomyolipoma* ; Blood Vessels ; Ear ; Elbow ; Heart ; Humans ; Intestines ; Kidney ; Liver ; Lung ; Mouth ; Muscle, Smooth ; Nose ; Perivascular Epithelioid Cell Neoplasms ; Skin ; Tuberous Sclerosis

PURPOSE: To evaluate the accuracy and safety of ultrasound-guided biopsy of the thickened peritoneal reflections and to determine the efficacy and diagnostic role of this procedure in the differential diagnosis of peritoneal tuberculosis and peritoneal carcinomatosis. MATERIALS AND METHODS: Twenty-seven patients with only mildly thickened (25 mm or less) peritoneal reflections without apparent mass formations, and in whom imaging findings were not diagnostic, underwent ultra-sound-guided biopsy. Five-MHz linear or convex linear array transducers were used for ultrasound guidance,and an automated gun with 18-gauge (n = 23) or 20-gauge (n = 4) needles for tissue sampling. Biopsies were performed on the thickened parietal peritoneum (n = 9), greater omentum (n = 11), and small bowel mesentery (n = 7), and the results were compared with the final diagnosis determined by adiologic/clinical follow-up (n = 17) or laparoscopic biopsy (n = 10). Complications and changes in hemoglobin and hematocrit levels after the procedure were evaluated. RESULTS: Specimens adequate for pathologic examination were obtained in all 27 patients. The histopathologic results were metastatic carcinomatosis (n = 15), peritoneal tuberculosis (n = 8), and chronic granulomatous inflammation (n = 4). Specific pathologic diagnosis was obtained in all patients except the four with chronic granulomatous inflammation. Differentiation between benignancy and malignancy was possible in all patients and the histopathologic specific accuracy rate was 100%. No clinically significant complications were observed. In 24 patients with ascites at the site of the biopsy, transient bleeding was observed immediately after the procedure, but this stopped spontaneously within a few minutes. Post-procedural hemoglobin and hematocrit levels were only minimally lower (mean values of 0.9g/dL and 3.0%, respectively) than pre-procedurally. CONCLUSION: Ultrasound-guided biopsy of thickened peritoneal reflections is a safe and effective diagnostic procedure and is useful in the differential diagnosis of peritoneal tuberculosis and peritoneal carcinomatosis.
Ascites ; Biopsy* ; Carcinoma* ; Diagnosis ; Diagnosis, Differential* ; Follow-Up Studies ; Hematocrit ; Hemorrhage ; Humans ; Inflammation ; Mesentery ; Needles ; Omentum ; Peritoneum ; Peritonitis, Tuberculous* ; Transducers ; Tuberculosis ; Ultrasonography

BACKGROUND/AIMS: Endoscopic resection (ER) procedure has been performed widely to treat gastric neoplasms. Here, we compared the long-term prognosis based on the clinical features of three types of recurred gastric neoplasms after ER, including low-grade dysplasia (LGD), high-grade dysplasia (HGD), and early gastric carcinoma (EGC). METHODS: Between 2003 and 2014, subjects who were diagnosed with gastric neoplasm during screening endoscopy were included. The baseline clinicopathologic and tumor recurrence were analyzed. RESULTS: Of the 316 patients enrolled, 170 patients (53.8%) were categorized into the LGD group, 34 patients (10.8%) into the HGD group, and 112 patients (35.4%) into the EGC group. The median follow-up duration was 4.2 years. Among the total, 14 patients experienced a development of metachronous gastric cancer; 4 patients (2.3%) in the LGD group, 3 patients (8.3%) in the HGD group, and 7 patients (6.1%) in the EGC group. Metachronous gastric neoplasm had developed in 17 LGD patients (10.0%), 5 HGD patients (14.7%), and 14 EGC patients (12.5%). There was no significant difference in the incidence of metachronous gastric cancer and neoplasm among the three groups (p=0.15 and p=0.72, respectively). CONCLUSIONS: We identified that the incidence rates of gastric neoplasm and cancer after endoscopic treatment were not significantly different between the LGD, HGD, and EGC groups.
Adenoma ; Endoscopy ; Follow-Up Studies ; Humans ; Incidence ; Mass Screening ; Prognosis ; Recurrence ; Stomach Neoplasms*

PURPOSE: After the first umbilical cord blood transplantation was reported in 1988, the use of cord blood as a source of hematopoietic stem cell instead of allogeneic bone marrow increased surprisingly and currently in the worldwide, more than 1,000 cases of cord blood transplantation were reported. We, herein, report the nine cases of cord blood transplants in Korea (Jul. 1996 - Jan. 1999). METHODS: The study of childhood cord blood transplantation from July 1996 to January 1999 were analyzed. 1. Patient population 1) Diseases on patients receiving umbilical cord blood transplantation included 3 aplastic anemia (1 Fanconi's anemia), 3 acute myelogenous leukemia, 1 acute lymphoblastic leukemia, 1 chronic myelogenous leukemia and 1 Gaucher disease. 2) Patients included 5 males and 4 females and were aged a range of 1~15 years (median 5 years), and a range of body weight at transplantation was 10 kg~50 kg (median 20 kg). 3) Four cases were used related cord blood as a source of stem cells for the transplant and 5 cases were used unrelated cord blood. In unrelated cord blood transplantation, cord blood was provided by Catholic Cord Blood Bank in 4 cases and by Samsung Medical Center in 1 case. 4) Only one case had a HLA-compatible cord blood graft. Two cases had 1 HLA antigen disparate grafts, 4 cases had 2 HLA antigen disparate grafts and 2 cases had 3 HLA antigen disparate grafts. 2. Transplantation Procedures 1) The total number of nucleated cells infused was 0.2+/-13x107/kg (median number 4.4x107/kg) and the number of CD34+ cells was 0.4+/-9.4x105/kg (median number 3.3x105/kg). 2) Patients received a variety of preparative regimens that varied with the disease and disease state at time of transplantation. All patients received ATG as a part of preparation. 3) While several regimens were used for prophylaxis of GVHD, 3 patients received cyclosporine A and methylprednisolone, 3 patients received cyclosporine and methotrexate, 2 patients received cyclosporine A alone and 1 patients received cyclosporine A, methtrexate and prednisolone. RESULTS: 1. The 6 cases of total 9 cases have successed to engraft persistently and the rate of engraftment was 67%. Two of 3 cases in severe aplastic anemia failed to engraft, 1 case failed to transplant due to rejection of grafts. All 5 cases in leukemia have successed to engraft. 2. On 6 cases of engraftment, the time to achieve an absolute neutrophil count (ANC)> or =0.5x109/L, > or = 1.0x109 /L was 10~37 days (median 13 days) and 11~40 days (median 14 days), respectively, and platelet count > or = 30x109/ L was 15~114 days (19.5 days). 3. Two of evaluable 7 cases had grade II acute GVHD and cured by steroid. 4. Seven of 9 cases (77.8%) survive (2~32 months; median 11 months) after transplantation. Five of 7 surviving cases (55.6%) live with disease-free (2~11 months; median 5 months). Four of 5 patients with leukemia (80%) live without relapse (2~11 months (median 5months). 5. The complications associated with cord blood transplantation were 2 sepsis, 2 CMV infections, 1 hemorrhagic cystitis and venoocclusive disease. 6. Two of 9 patients died of 1 graft failure and 1 venoocclusive disease. CONCLUSION: Cord blood transplantation is curative strategy for the treatment of children with malignant disease and inborn error of metabolism. For aplastic anemia and myelodysplastic syndrome, the role of cord blood transplantation would be investigated.
Anemia, Aplastic ; Body Weight ; Bone Marrow ; Child ; Cord Blood Stem Cell Transplantation* ; Cyclosporine ; Cystitis ; Female ; Fetal Blood* ; Gaucher Disease ; Hematopoietic Stem Cells ; Humans ; Korea ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Male ; Metabolism ; Methotrexate ; Methylprednisolone ; Myelodysplastic Syndromes ; Neutrophils ; Platelet Count ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prednisolone ; Recurrence ; Sepsis ; Stem Cells ; Transplantation ; Transplants ; Umbilical Cord*

BACKGROUND: Pressure-controlled intermittent coronary sinus occlusion(PICSO) as well as synchronized retrograde perfusion(SRP) have emerged as a new technique that can redirect blood through the coronary sinus to nourish ischemic myocardium beyond a coronary occlusion. Also, coronary sinus occlusion pressure(CSOP) can be measured during application of PICSO. This experimental study was to determine the characteristics of CSOP and the effects of PICSO on the reduction of infarct size in experimentally induced acute myocardial infarction. METHOD: 22 dogs were included in this study, 9 in control group and 13 in PICSO group. Thirty minutes after experimental ligation of proximal left anterior descending artery, PICSO device was applied to PICSO group for 4 hours. Systolic and end-diastolic pressure of CSOP, LVEDP(left ventricular end-diastolic pressure), LVSP and aortic pressure with heart rate were measured every 1 hour. After 4 hours, heart was excised and 1% TTC(triphenyl tetrazolium cholride) solution was perfused distal to left anterior descending(LAD) coronary artery to measure the area of viable myocardium in LAD territory. 'The area at risk(LAD territory/LV surface area)' and 'the area of necrosis(necrosis area/LAD territory)' were calculated with cut surface of LV using planimetry. RESULTS: 1) End-diastolic pressure of CSOP and left ventricular end-diastolic pressure(LVEDP) were closely equalized and significantly correlated each other(p<0.001). 2) Aortic pressure profiles, left ventricular pressure profiles and heart rate during coronary occlusion did not differ significantly from the control group. Aortic and left ventricular systolic and mean pressures declined significantly after 1 hour of coronary occlusion. Also LVEDP increased significantly after 1 hour of coronary occlusion(p<0.01). 3) The area of myocardium at risk was similar in both groups(control 12.0+/-2.1 %, PICSO 11.5+/-1.2%). But the results of the area of necrosis within the area of risk showed that PICSO significantly reduces myocardial infarct size(control 79.1+/-4%, PICSO 25.3+/-5%). CONCLUSION: PICSO can be indicated in acute coronary syndrome to reduce the myocardial necrosis especially in LAD territory. In addition, PICSO can be used to evaluated LVEDP by measuring CSOP,especially in patients with severe aortic valvular stenosis. Further study is needed upon the effectiveness of PICSO on clinical situations and precise metabolic effects of PICSO on myocardium.
Acute Coronary Syndrome ; Animals ; Arterial Pressure ; Arteries ; Constriction, Pathologic ; Coronary Occlusion ; Coronary Sinus* ; Coronary Vessels ; Dogs ; Heart ; Heart Rate ; Humans ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Ventricular Pressure