Plastic bronchitis is a rare disorder characterized by the formation of extensive, obstructing endobronchial casts. It is associated with asthma and complex cardiac defects such as those requiring the Fontan procedure. The treatment of plastic bronchitis comprises conventional therapy involving spontaneous expectoration and bronchoscopic removal and specific therapy with several new drugs. Herein, we describe the cases of 2 patients diagnosed with plastic bronchitis accompanied with a different underlying disease, which were treated with inhaled corticosteroid and low-dose oral clarithromycin.
Asthma ; Bronchitis ; Bronchoscopes ; Child ; Clarithromycin ; Fontan Procedure ; Humans ; Plastics

PURPOSE: Despite the appropriate antibiotic therapy, some patients with pneumonia do not show a significant clinical improvement. One of the important factors associated with the aggravation of pneumonia is the inflammatory response of the patient. The use of intravenous immunoglobulin (IVIG) to regulate inflammation in severe pneumonia may be beneficial. We evaluated the therapeutic effect of IVIG as an add-on therapy in patients whose pneumonia did not respond to the initial antibiotic therapy. METHODS: This study was conducted from January 2006 to March 2009 on 14 patients admitted with pneumonia who showed persistent fever and progressive worsening of radiographic findings in spite of appropriate empirical antibiotic therapy. Immunoglobulin was administrated on the 3rd to 10th admission days (6th days on average). RESULTS: The median age was 67 months (range 16-102 months), and 8 were female. All children received ampicillin+sulbactam+macrolide, or cefotaxime+macrolide. Acute Mycoplasma infection occurred in 64% (9/14) of the patients. The collapse and/or consolidation of the lobe was found in 50% (7/14) of the patients on chest radiograph. After IVIG administration, all patients became afebrile within 24 hrs, and their C-reactive protein and radiographic findings showed a significant improvement in several days. CONCLUSION: Prompt IVIG therapy may be beneficial to patients with pneumonia who did not respond to the initial antibiotic therapy, especially when the use of corticosteroids is contraindicated.
Adrenal Cortex Hormones ; C-Reactive Protein ; Child ; Female ; Fever ; Humans ; Immunoglobulin A ; Immunoglobulins ; Immunoglobulins, Intravenous ; Inflammation ; Mycoplasma Infections ; Pneumonia ; Thorax

BACKGROUND AND OBJECTIVES: We checked traditional and high-level precordial electrocardiogram (ECG) leads in patients who had undergone right ventricular outlet obstruction (RVOT) reconstruction surgery and evaluated the effect of ECG lead position on their QRS duration. SUBJECTS AND METHODS: We enrolled 34 patients who had undergone surgery for congenital heart disease with RVOT obstruction and who had received followed up care that included recorded ECG at a pediatric cardiac out-patient clinic. The control group included 29 patients who did not have hemodynamically significant intracardiac abnormality. We recorded traditional standard 12-leads ECG from the 4th intercostals space, and moved the precordial leads to the 3rd and 2nd intercostals spaces, and recorded ECGs repeatedly. RESULTS: In all groups, there was no significant difference of mean QRS duration and QTc interval between traditional standard 12-leads ECGs and ECGs at higher intercostals spaces. There was no significant difference of ECG parameters between groups. In the control group, the degree of the change between the 4th intercostals space (ICS) QRS and 3rd ICS QRS was significant (p=0.031), and although, it was insignificant, ECGs at the 3rd ICS showed decreased QRS duration in group 1 (V1: 3rd ICS 119.21+/-21.53 msec vs. 4th ICS 122.80+/-31.78 msec. V2: 3rd ICS 113.68+/-19.43 msec vs. 4th ICS 118.24+/-19.16 msec). CONCLUSION: Although the positional change of ECG leads did not result in a significant effect on measuring QRS duration after surgery, ECG leads at the 3rd ICS rather than at the 4th ICS may cause alteration of ECG readings. Therefore, we suggest that ECGs should be recorded in as accurate a position as possible.
Child ; Electrocardiography ; Heart Diseases ; Heart Ventricles ; Humans ; Outpatients ; Reading ; Thoracic Surgery

PURPOSE: We evaluated the characteristics of patients with Kawasaki disease (KD) who presented with only fever and cervical lymphadenopathy on admission, and compared them with the characteristics of those who presented with typical features but no cervical lymphadenopathy. METHODS: We enrolled 98 patients diagnosed with KD. Thirteen patients had only fever and cervical lymphadenopathy on the day of admission (group 1), 31 had typical features with cervical lymphadenopathy (group 2), and 54 had typical features without cervical lymphadenopathy (group 3). RESULTS: The mean age (4.3+/-2.1 years) and duration of fever (7.5+/-3.6 days) before the first intravenous immunoglobulin (IVIG) administration were highest in group 1 (P=0.001). Moreover, this group showed higher white blood cell and neutrophil counts, and lower lymphocyte counts after the first IVIG administration as compared to the other groups (P=0.001, P=0.001, and P=0.003, respectively). Group 1 also had a longer duration of hospitalization and higher frequency of second-line treatment as compared to groups 2 and 3 (group 1 vs. group 2, P=0.000 and P=0.024; group 1 vs. group 3, P=0.000 and P=0.007). A coronary artery z score of >2.5 was frequently observed in group 1 than in group 3 (P=0.008). CONCLUSION: KD should be suspected in children who are unresponsive to antibiotics and have prolonged fever and cervical lymphadenopathy, which indicates that KD is associated with the likelihood of requiring second-line treatment and risk of developing coronary artery dilatation.
Anti-Bacterial Agents ; Child ; Coronary Vessels ; Dilatation ; Fever ; Hospitalization ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Leukocytes ; Lymphatic Diseases* ; Lymphocyte Count ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils

No abstract available.
Humans ; Twins*

No abstract available.
Vesico-Ureteral Reflux*

The emergency arteriography have been performed in a total of 13 patiens with extermity trauma, including 9fractures, 3 blunting traumas, and 1 penetrating injury. over 17 months period. The indications were as follows:absent or diminishe pulse, swelling, sensory or motor deficit , and hypotension. Patients with an absent pulse,the most reliable indication of arterial injury, should have immediate arteriography. The superficial femoralartery was commonly injured especially with distal femoral shaft fracture. The most common arteriographic findingswas arterial occlusion.
Angiography ; Emergencies ; Extremities ; Humans ; Hypotension

Cowden syndrome (CS), also known as multiple hamartomas syndrome, is a rare hereditary autosomal dominant disorder caused by a germline mutation in the phosphatase and tensin homolog (PTEN) gene mapped on chromosome 10. The clinical features of CS are variable, primarily presenting as mucocutaneous lesions (99%). A mucocutaneous lesion, such as trichilemmoma of the face or keratosis of the extremities, is an important diagnostic marker for CS. CS has been reported to increase the incidence of benign and malignant neoplasms in the breast, thyroid, and gastrointestinal tract. The risk of developing malignancy in individuals with CS is up to 10 times higher than general population throughout an entire life time.
Breast Neoplasms* ; Breast* ; Chromosomes, Human, Pair 10 ; Extremities ; Gastrointestinal Tract ; Germ-Line Mutation ; Hamartoma ; Hamartoma Syndrome, Multiple* ; Humans ; Incidence ; Keratosis ; Thyroid Gland

Objectives: Few studies have reported long-term follow-up after treatment of gastric mucosaassociated lymphoid tissue (MALT) lymphoma. In this single-center study, we investigated longterm treatment outcomes in patients diagnosed with gastric MALT lymphoma. Methods: The study included 80 patients diagnosed with gastric MALT lymphoma, who were followed up at a single center between January 2005 and December 2019 after Helicobacter pylori eradication therapy, radiotherapy, or chemotherapy. We evaluated complete remission, improvement, or recurrence of the lesion. Follow-up over >60 months was classified as long-term follow-up, and the progression-free survival rate was recorded. Results: Following H. pylori eradication treatment, complete remission occurred in 85.9% (55/64) of H. pylori-positive and 50.0% (3/6) of H. pylori-negative patients. All patients with gastric MALT lymphoma who did not respond to H. pylori eradication therapy (100.0% [6/6]) achieved complete remission following administration of local radiotherapy. We observed no deaths on long-term follow-up (>60 months), and the progression-free survival was 101 months. Conclusions In this study, patients with gastric MALT lymphoma showed excellent survival rates, progression-free survival, and prognosis on long-term follow-up. Prospective studies are warranted to determine the long-term prognosis of gastric MALT lymphoma after treatment.

OBJECTIVE: To assess head posture using cervical spine X-rays to find out whether forward head posture is related to myofascial pain syndrome (MPS) in neck and shoulder. METHODS: Eighty-eight participants who were diagnosed with MPS in neck and shoulder were evaluated in this study. Four parameters (distance among head, cervical spines, and shoulder, and cervical angle) were measured from lateral view of cervical spine X-ray. The location and number of trigger points in the neck and shoulder and symptom duration were evaluated for each patient. RESULTS: Both horizontal distances between C1 vertebral body and C7 spinous process and between the earhole and C7 vertebral body were negatively correlated with cervical angle reflecting cervical lordosis (p<0.05). Younger patients had significantly (p<0.05) less cervical angle with more forward head posture. There was no relationship between MPS (presence, location, and number of trigger points) and radiologic assessments (distance parameters and the cervical angle). CONCLUSION: Forward head posture and reduced cervical lordosis were seen more in younger patients with spontaneous neck pain. However, these abnormalities did not correlate with the location or the number of MPS. Further studies are needed to delineate the mechanism of neck pain in patients with forward head posture.
Animals ; Cervical Vertebrae ; Female ; Head* ; Humans ; Lordosis ; Myofascial Pain Syndromes* ; Neck ; Neck Pain ; Posture* ; Shoulder ; Spine ; Trigger Points