As dyslipidemia at a young age is a risk factor for cardiovascular disease in adulthood, the screening and management of dyslipidemia in children and adolescents might be an important health issue. This review deals with issues related to the prevalence, diagnosis, screening, and treatment of pediatric dyslipidemia.Current Concepts: In Korea, the prevalence of pediatric dyslipidemia was 19.7% between 2007 and 2009. Dyslipidemia was defined according to the guidelines of the Korean Society of Pediatric Endocrinology: total cholesterol ≥200 mg/dL, low-density lipoprotein cholesterol ≥130 mg/dL, triglycerides ≥130 mg/dL, high-density lipoprotein cholesterol <40 mg/dL, or non-high-density lipoprotein cholesterol ≥145 mg/dL.Discussion and Conclusion: We recommend universal screening tests for dyslipidemia at ages 9–11 years and 17–21 years. Diet and lifestyle modifications are essential in the treatment of dyslipidemia. In children aged ≥10 years with a poor response to lifestyle modification, drug therapy is recommended. Pediatric dyslipidemia should be diagnosed and treated properly to reduce adult cardiovascular diseases and improve quality of life in this age group.

As dyslipidemia at a young age is a risk factor for cardiovascular disease in adulthood, the screening and management of dyslipidemia in children and adolescents might be an important health issue. This review deals with issues related to the prevalence, diagnosis, screening, and treatment of pediatric dyslipidemia.Current Concepts: In Korea, the prevalence of pediatric dyslipidemia was 19.7% between 2007 and 2009. Dyslipidemia was defined according to the guidelines of the Korean Society of Pediatric Endocrinology: total cholesterol ≥200 mg/dL, low-density lipoprotein cholesterol ≥130 mg/dL, triglycerides ≥130 mg/dL, high-density lipoprotein cholesterol <40 mg/dL, or non-high-density lipoprotein cholesterol ≥145 mg/dL.Discussion and Conclusion: We recommend universal screening tests for dyslipidemia at ages 9–11 years and 17–21 years. Diet and lifestyle modifications are essential in the treatment of dyslipidemia. In children aged ≥10 years with a poor response to lifestyle modification, drug therapy is recommended. Pediatric dyslipidemia should be diagnosed and treated properly to reduce adult cardiovascular diseases and improve quality of life in this age group.

A notable secular trend in early puberty onset has been described over the past few decades. Also, the prevalence and incidence of precocious puberty is increasing not only in Korea, but also around the world. The manifestation of secondary sex characteristics before 8 years in girls and 9 years in boys is defined as precious puberty. The causes of precocious puberty can be classified as gonadotropin releasing hormone (GnRH)-dependent, also known as central precocious puberty (CPP), or GnRH-independent. Evaluation of patient with precocity requires detailed examination of the clinical manifestation, GnRH stimulation test, and imaging of the central nervous system if indicated. The standard treatment for CPP is GnRH agonist, which is beneficial for adequate pubertal development and preservation of final adult height. In this paper, we investigate the diagnosis and adequate treatment of CPP.

Spontaneous osteonecrosis of the knee (SPONK) is rare disease and most common in the medial femoral condyle. This condition presents with acute onset of pain in elderly patients, usually without a history of trauma. The exact etiology of SPONK is still debated. There are several options for the treatment according to the size, progression and site of the osteonecrosis. SPONK usually occurs in one knee. The spontaneous osteonecrosis of the medial tibial plateau is less recognized than osteonecrosis of the medial femoral condyle. And, in this case, SPONK in the medial tibial plateau of the contralateral knee followed SPONK in the medial femoral condyle, and bony destruction extended to the lateral aspect of the lateral tibial eminence from the medial tibial plateau. The best treatment has not yet been defined. This condition of the tibial side has been managed by total knee replacement resulting in a satisfactory outcome.
Aged ; Arthroplasty, Replacement, Knee ; Humans ; Knee ; Osteonecrosis ; Rare Diseases

BACKGROUND: Cytomegalovirus(CMV) disease is an important opportunistic infection and contributes to significant morbidity and mortality in immunocompromised hosts. To determine predisposing conditions to CMV disease and its prognosis, the authors reviewed the clinical courses of patients with CMV disease. METHODS: We reviewed medical records of 23 patients with CMV disease diagnosed at Seoul National University Hospital from 1987 to 1997. RESULTS: CMV pneumonia was diagnosed in 8 patients. Underlying conditions of the patients were allogeneic bone marrow transplant(BMT) in 4 patients, lupus nephritis in 1, dermatomyositis in 1, and renal transplantation recipient in 1. The cumulative dose of corticosteroid given to the BMT recipients before the development of CMV pneumonia ranged between 1,000 and 4,700 mg, whereas that to the non-BMT patients ranged between 2,100 and 6,000 mg. Of the 8 patients with CMV pneumonia, five patients(75%) died. Of the 15 CMV gastroenteritis, two had CMV gastric ulcers. The gastric ulcers showed clinical and endoscopic improvement with systemic ganciclovir therapy. Among 13 patients with CMV enterocolitis, nine had preceding GI diseases, and nine had received systemic corticosteroids. Five patients died. The mortality was lower in patients with underlying bowel diseases than in those without ones(22% vs. 75%, respectively). CONCLUSION: The mortality of CMV disease was 62.5%, 0%, and 38% in patients with CMV pneumonia, gastric ulcer, and enterocolitis, respectively. GVHD, systemic corticosteroid and/or immunosuppressive therapy were major risk factors of CMV diseases.
Adrenal Cortex Hormones ; Bone Marrow ; Cytomegalovirus* ; Dermatomyositis ; Enterocolitis ; Ganciclovir ; Gastroenteritis ; Humans ; Immunocompromised Host ; Kidney Transplantation ; Lupus Nephritis ; Medical Records ; Mortality ; Opportunistic Infections ; Pneumonia ; Prognosis ; Risk Factors ; Seoul ; Stomach Ulcer

Painful Hashimoto thyroiditis (HT) is a rare pediatric condition. Because of the rarity of painful HT, it can be misdiagnosed as other thyroid diseases, and there is limited evidence regarding its clinical course and treatment. A 7-year-old girl presented to the emergency room with neck pain. A physical examination revealed diffusely enlarged thyroid gland with firm consistency and without tenderness. Her serum free thyroxine level was decreased and levels of thyroid-stimulating hormone, thyroglobulin antibody, and thyroid-stimulating antibody were elevated. The ultrasonography revealed a diffusely enlarged thyroid gland with homogeneously hypoechoic parenchyma and lobulated contours. She was diagnosed with painful HT based on the clinical presentations, laboratory tests, and ultrasonography findings, and was treated with a steroid, levothyroxine, and nonsteroidal anti-inflammatory drugs, after which her clinical symptoms improved dramatically. We should consider the possibility of painful HT in children with neck pain; HT could be treated with medical treatment.

Painful Hashimoto thyroiditis (HT) is a rare pediatric condition. Because of the rarity of painful HT, it can be misdiagnosed as other thyroid diseases, and there is limited evidence regarding its clinical course and treatment. A 7-year-old girl presented to the emergency room with neck pain. A physical examination revealed diffusely enlarged thyroid gland with firm consistency and without tenderness. Her serum free thyroxine level was decreased and levels of thyroid-stimulating hormone, thyroglobulin antibody, and thyroid-stimulating antibody were elevated. The ultrasonography revealed a diffusely enlarged thyroid gland with homogeneously hypoechoic parenchyma and lobulated contours. She was diagnosed with painful HT based on the clinical presentations, laboratory tests, and ultrasonography findings, and was treated with a steroid, levothyroxine, and nonsteroidal anti-inflammatory drugs, after which her clinical symptoms improved dramatically. We should consider the possibility of painful HT in children with neck pain; HT could be treated with medical treatment.

BACKGROUNG AND OBJECTIVES: The aim of this study was to analyze the influence of changes in ventricular preload and afterload, atrial and ventricular pacing on the coronary flow reserve (CFR). METHOD: Five open chest anesthetized dogs were studied in five sequential stages:baseline, saline solution volume loading (293.8+/-29.2 ml for 10 min), atrial and ventricular pacing (120, 140, and 160 bpm), and aortic clamp. Coronary blood flow (CBF) was measured with electro-magnetic flowmeter. CFR was defined as the ratio of hyperemic CBF (hCBF) to resting CBF (rCBF). Hyperemia was induced by IV adenosine infusion (1 mg/kg/min). RESULTS: 1)After volume loading wtih saline solution, CFR significantly decreased (p<0.05) because rCBF was increased while hCBF remained unchanged. 2)Atrial pacing produced increase in rCBF but did not change hCBF. Consequently CFR singificantly reduced when heart rate (HR) increased from sinus rhythm to 120, 140, and 160 bpm (p<0.01). 3)Ventricular pacing produced decrease in hCBF but did not change rCBF. Consequently CFR significantly reduced as HR increased from sinus rhythm to 120 (p<0.05) , 140 (p<0.01), and 160 (p<0.01) bpm. 4)After aortic clamp, CFR significantly decreased (p<0.01) because rCBF increased while hCBF remained unchanged. CONCLUSION: We found that CFR is dependent on the changes in volume loading, HR, and ventricular afterload that may commonly occur in clinical situations.
Adenosine ; Animals ; Dogs* ; Flowmeters ; Heart Rate ; Hyperemia ; Sodium Chloride ; Thorax