Nowadays, to evaluate growth hormone(GH) deficiency-suspicious short stature, we usually use more than two kinds of provocative tests using various pharmacologic agents such as clonodine, L-dopa, insulin, etc. However, the importance of physiologic natural secretion of GH was recently approved. In the past, diagnosis of GH neurosecretory dysfunction was made by studying the 24-hour spantaneous GH secretion profile. But, because it is very clinically difficult, and so we measured and evaluated the mean GH concentrations of blood samples, obtained every 30 minutes during the first 3 hours' nocturnal sleep, instead of that. At the department of Pediatrics, Hanyang University Hospital from November, 1992 to February, 1994, we selected 34 GH deficiency-suspected children on the base of their growth data and bone age, etc. After GH stimulation with clonidine(100-150 ug/m2) and L-dopa(200-250 mg/m2), we measured their peak GH values by the immunoradiometric assay(IRMA) kit. And, we measured the mean GH concentrations of blood samples, obtained every 30 minutes during the first 3 hours noctumal sleep(22:OOPM-1:OOAM). RESULTS: 1. We analyzed the relationship between the mean of 3-hours' physiologic night-time surge of GH(X) and the phamacologically stimulated peak GH level(Y), except for the two neurosecretory dysfunction suspicious children. And so, for the 32 children, the relationship was Y=1.806X+ 3.177, r= 0.794, p<0.01. However, for all the tested children(34), the relationship is Y=1.709X+ 4.06, r=0.737, p<0.01. 2. We analyzed the relationship between the peak of 3-hours' physiologic night-time surge of GH(X) and the phamacologicaUy stimulated peak GH level(Y), except for the two neurosecretory dysfunction suspieious children. And so, for the 32 children, the relationship was Y=0.683X+ 3.686, r=737, p<0.01. CONCLUSION: For all the tested children(34), the relationship between the mean 3hr physiologic GH night time surge and stimulated peak GH value is Y=1.709X+4.06, r=0.737, p<0.01. The percentage of GH neurosecretory dysfunction is 5.8%(2/34). And, except for the two childrren, the relationship is more good, Y=1.806X+3.177, r=0,794, p<0.01. On the above relationship, the 3-hour GH night time-surge test might to give us some helpful information for the diagnosis of neurosecretory dysfunction.
Child* ; Diagnosis ; Growth Hormone* ; Humans ; Insulin ; Levodopa ; Pediatrics

Intrathecal administration of methotrexate(IT-MTX) has constituted the standard approach to prophylaxis and treatment of central nevous system(CNS) leukemia. We experienced a quadriplegia and motor aphasia in a 14-year-old boy following repeated IT-MTX for the prophylaxis of meningeal leukemia. He was diagnosed as ALL without CNS involvement and treated by CCG- 1882 protocol. IT-MTX was administered for CNS prophylaxis. The patient began complaining of urinary incontinence, motor aphasia and weakness in his right leg from 12 days after the 5th dose of the IT-MTX therapy. Even though the IT-MTX was discontinued, loss of muscle power progressed upward resulting in quadriplegia. The patient showed slow and partial recovery on right extremities over 3 months. We report this case with brief review of literature.
Adolescent ; Aphasia, Broca* ; Extremities ; Humans ; Leg ; Leukemia ; Male ; Methotrexate* ; Quadriplegia* ; Urinary Incontinence

The authors evaluated the clinical significance of the bilirubin values as screening test means for predicting the occurrence of neonatal jaundice earlier after birth, by using the transcutaneous bilirubinometry which is known to measure the bilirubin values in a noninvasive, accurate and simple way. The results obtained were as follows: 1. In comparison between the test group(showing the symptom of a jaundice within 72 hours after birth) and the control group, there were found no statistically significant differences in terms of sex, delivery type, birth weight, gestational age and mother's age, while being found statistically significant differences in terms of transcutaneous bilirubin at birth(TcBbirth), transcutaneous bilirubin at 24 hours after birth(TcB24hr), increase in transcutaneous bilirubin per hour during the first 24 hours after birth(TcBin/hr) and transcutaneous bilirubin at 72 hours after birth(TcB72hr)(p<0,05). 2. The correlation test using the Pearson's coefficient produced statistically significant correlationship between each transcutaneous bilirubin index (TcBbirth, TcB24hr, TcBin/hr and TcB72hr) and serum bilirubin concentration at 72 hours after birth(B72hr)(p<0.05), while the result of the correlation test using the Spearman's roh showed statistically significant correlationship only between TcB24hr or TcB72hr and B72hr(p<0.05). As it was, the correlationship between TcB72hr and B72hr was highest in both Pearsons coefficient and Spearman's roh tests, followed by that between TcB24hr and B72hr. 3. In view of the ROC graph, the most effective means of predicting the occurrence of the neonatal jaundice was TcB72hr followed by TcB24hr, TcBbirth and TcBin/hr in their order. In particular, TcB24hr was conceived to be useful as screening test for determining an early discharge from the nursery within 48 hours. On the other hand, since the negative predictive value of TcBbirth, and TcB24hr is higher, the possibility that those infants showing a lower value of these indices may well be free later from a serious neonatal jaundice even if they should be discharged earlier from the nursery. In conclusion, those four indices predicting the neonatal jaundice in a simple, quick and noninvasive manner using the transcutaneous bilirubinometry were considered to be effective screening test means whereby any serious neonatal jaundice developed earlier after delivery can be successfully predicted.
Bilirubin ; Birth Weight ; Gestational Age ; Hand ; Humans ; Infant ; Infant, Newborn ; Jaundice ; Jaundice, Neonatal* ; Mass Screening* ; Nurseries ; Parturition

This investigation was designed to categorize Angle's class III malocclusion groups through analyzing horizontal and vertical components of craniofacial skeleton in Angle's class III malocclusion. The material selected for this study consisted in standard lateral cephalogram of one hundred and fifty five children, seventy four boys and eighty one girls, aged 6 through 15 years, having Angle's class III malocclusion. On the basis of findings of this study, the following results were obtained. 1. In horizontal skeletal classifications, 16 groups were classified FMN-A-B, SE-FMN-A according to the Ba-SE-Me, Ba-SE/R. 2. The sequences that have relatively high frequency are as follow; a) Horizontal Group 1 b) Horizontal Group 3 c) Horizontal Group 5 d) Horizontal Group 9 e) Horizontal Group 4 3. In vertical skeletal classification, 8 groups were classified according to the PMV/PP, PMV/OP, PMV/MP. 4. The sequences that relatively high are as follows; a) Vertical Group 1 b) Vertical Group 3 c) Vertical Group 4 d) Vertical Group 8
Child ; Classification ; Female ; Humans ; Malocclusion* ; Skeleton*

PURPOSE: We conducted this study to find factors related to clinical aspects of patients with histiocytosis syndrome. METHODS: We performed a retrospective clinical study with chart review in twenty patients with histiocytosis syndrome from January 1987 to June 1997. RESULTS: The sex incidence revealed female predominance with a ratio of 1.2 : 1. Of twenty cases, fifteen were classified as class l, three cases as class ll, and two cases as class lll. The mean age of symptom onset was 7 and 9/12 years. Common clinical symptoms and signs at diagnosis were fever, mass, headache, pain on lower extremities, skin rashes and weight loss. The most common involved organ was the skeleton. Abnormal hematologic findings (hemoglobin;<10g/dL and/or white blood cell<4,000/mm3 and/or platelet<150,000/mm3) were found in four cases. Common findings on tissue biopsies were histiocytic proliferation and infiltration. Two patients with malignant histiocytosis (MH) and one patient of eosinophilic granuloma (EG) received chemotherapy. Among three patients who started chemotherapy, one patient was discharged freely, one patient died because of recurrence, and one patient had been treated with a maintenance regimen until now. CONCLUSION: The survival rate depends mainly on onset age, severity, Lahey's organ dysfunction score, histologic findings and sites of involved organs. But most patients had nonspecific symptoms before diagnosis. Therefore, early recognition and aggressive medical treatment before development of serious symptoms improved the prognosis.
Age of Onset ; Biopsy ; Diagnosis ; Drug Therapy ; Eosinophilic Granuloma ; Exanthema ; Female ; Fever ; Headache ; Histiocytic Sarcoma ; Histiocytosis* ; Humans ; Incidence ; Lower Extremity ; Organ Dysfunction Scores ; Prognosis ; Recurrence ; Retrospective Studies ; Skeleton ; Survival Rate ; Weight Loss

Neonatal Gaves disease is a relatively rare condition due to transplacental passage of Thyroid-stimulating antibody(TSAb) from a mother with active or inactive Graveses disease or autoimmune thyroiditis. A 11-day-old female newborn was referred to our department of pediatrics from a local clinic because of low level T4(3.55microg/dl) concurrent with high level TSH (501.74uIU/ml) on the 5th day neonatal metabolic screening. But, our repeated laboratory data showed very high serum T4(59.6microg/dl), T3(1,600ng/dl), suppressed TSH(0.43uIU/ml), and the presence of TSH receptor antibody. Her mother was treated with propylthiouracil(PTU) for Graves disease during pregnancy. Therefore, we thought it was a delayed-onset neonatal hyperthyroidism, because the fetal thyroid gland was initially suppressed by antithyroid drug taken during pregnancy. After initiating antithyroid drug therapy for the hyperthyroid nature, TSH levels became elevated again, while thyroid hormone levels decreased. Maternal and infant blood samples at the 23th day after birth were examined for serum autoantibodies directed towards the TSH receptor(Thyrotropin-binding inhibitory immunoglobulin:TBII, Thyroid-stimulating antibody:TSAb, Thyroid-stimulating blocking antibody:TSBAb) and high levels of TBII and TSAb were detected. About 2 months after birth, TBII and TSAb decreased within normal limit, and then we could stop antithyroid medication in safety. We report here a case of neonatal Graveses disease with very high level of T4 and T3, but firstly presented as hypothyroid nature on neonatal screening because of the maternally transferred antithyroid drug, PTU.
Autoantibodies ; Drug Therapy ; Female ; Graves Disease ; Humans ; Hyperthyroidism ; Infant ; Infant, Newborn ; Mass Screening ; Mothers ; Neonatal Screening ; Parturition ; Pediatrics ; Pregnancy ; Receptors, Thyrotropin ; Thyroid Gland ; Thyroiditis, Autoimmune

Acute focal bacterial nephritis(AFBN) is an unusual form of localized renal infection, which has various imaging findings and should be distinguished from abscess or other renal masses. Clinical symptoms are similar to other urinary tract infections but the diagnosis needs a CT or sonographic confirmation. Treatment, which is nonoperative, consists of intensive antibiotic therapy. We report three cases of AFBN with urinary tract infection in an 11-month-old, 9-month-old female and 8-month-old male patients, respectively. The confirmative diagnosis was done by localized intrarenal solid mass lesion by sonography. They were treated with intravenous and oral antibiotics for 6, 4 and 2weeks, respectively. Follow-up urinalysis, urine culture and sonographic finding were normal after treatment.
Abscess ; Anti-Bacterial Agents ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Nephritis* ; Ultrasonography ; Urinalysis ; Urinary Tract Infections

Septic pulmonary emboli(SPE) is derived from a variety of sources, including infected heart valves, peripheral sites of septic thrombophlebitis and infected venous catheters or pacemaker wires. In adult intravenous drug users, the most common cause of septic emboli is tricuspid valve endocarditis, but infective endocarditis in the non-complicated ventricular septal defect is a relatively rare condition in infants and children. Early detection, along with prompt administration of broad-spectrum antibiotics, is an important factor in the prognosis of patients with SPE. Unfortunately, initial clinical diagnosis is often difficult; a heart murmur may or may not be present and blood cultures may remain negative early in the course of infection. And so characteristic chest CT and chest radiographic findings are helpful in non-invasive diagnostic method for early detection. We experienced a case of pulmonary septic emboli associated with ventricular septal defect in a 6-year-old girl. The diagnosis was made on the basis of clinical features, echocardiography, chest x-ray and chest CT. We report this case with brief review related literatures.
Adult ; Anti-Bacterial Agents ; Catheters ; Child ; Diagnosis ; Drug Users ; Echocardiography ; Endocarditis ; Female ; Heart Murmurs ; Heart Septal Defects, Ventricular* ; Heart Valves ; Humans ; Infant ; Prognosis ; Radiography, Thoracic ; Thorax ; Thrombophlebitis ; Tomography, X-Ray Computed ; Tricuspid Valve

Cerebral gigantism(Sotos syndrome) is a growth disorder that consists of large size at birth, rapid early growth rate with accompanying advanced bone age, acromegalic features, and developmental delay. Clumsiness in the absence of other abnormal neurologic findings is common. The cause is unknown. We report here a case of 238/12-year-old Sotos syndrome with final adult height above 97 percentile, abnormal brain MRI findings(large ventricles, prominent trigone, prominent occipital horn & thining of corpus callosum), clumsiness, and some behavioral problems.
Adult ; Animals ; Brain ; Growth Disorders ; Horns ; Humans ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Parturition ; Sotos Syndrome

PURPOSE: During the past two decades in Korea, the prevalence rate of childhood asthma has been increased, and also there has been a significant evolution in the management of asthma. In 1994, a guideline for the diagnosis and treatment of asthma was established. This study was designed to investigate a real picture of clinical practice in the management of childhood asthma. METHODS: This survey was conducted with data on 24 items of questionnaires from pediatricians working in private clinics, general hospitals, and university hospitals. We investigated the age distributions, severity of asthma, educational levels, management of asthma, and current trends of medication. RESULTS: 1) In age distribution, childhood asthma was most prevalent in 3-5 years old age group (30-40%), followed by 2 years old age group, and was least prevalent in 10-15 years old age group. 2) The number of patients with cough variant asthma was about 10% of all childhood asthma. 3) A period of 5-10 minutes was the most common period consumed for the explanation of child asthma during each medical practice. Cases recording symptom diary and cases monitoring PEFR (using peak flow meter) were less than 10% each. 4) With regard to the use of beta2 agonist in the treatment of acute asthmatic attack, rate of using oral drugs and nebulizer or inhalers of beta2 agonist are similar in the university hospitals, but the rate of using oral drugs was over 80% in private clinics. 5) With regard to the use of anti-inflammatory drugs in the management of chronic asthma, nebulizer or inhaler therapy was the first-line choice in the university hospitals (rate over 60-90%), oral drugs were main therapy in private clinics. The administration of anti-allergic medication as a preventive measures was recommended in about 40-50%, and ketotifen was used most frequently. 6) Immunotherapy was being performed in about 10% of childhood asthma patients. CONCLUSION: Childhood asthma was most prevalent in the age group under 5 years and severity was mostly mild. For the management of childhood asthma, the education and control for asthma are still insufficient and previously published guidelines have been inappropriately used in practical field.
Age Distribution ; Asthma* ; Child ; Child, Preschool ; Cough ; Diagnosis ; Education ; Hospitals, General ; Hospitals, University ; Humans ; Immunotherapy ; Ketotifen ; Korea ; Nebulizers and Vaporizers ; Peak Expiratory Flow Rate ; Prevalence ; Surveys and Questionnaires