Purpura fuIminans is a rare form of nonthrombocytapenic purpura characterized by sudden onset, fever, prostration, anemia and symmetrical massive ecchymoses, usually of the lower extremities, and hypotension associated with disseminated intravascular coagulation (DIC). A 18 years old female patieat with characteristic clinical manifestations of purpura fulminans was seen at the department of Dermatology, St. Pauls Hospital. With intensive systemic corticasteroid and heparin treatmemts, the ecchymoses and necrosis began to heal, leaving multiple, thick esehar formation from 8th day, Although purpura fulminana has been known to attack mainly children, this case was of adolescent age.
Adolescent ; Anemia ; Child ; Dermatology ; Disseminated Intravascular Coagulation ; Ecchymosis ; Female ; Fever ; Heparin ; Humans ; Hypotension ; Lower Extremity ; Necrosis ; Purpura Fulminans* ; Purpura*

PURPOSE: We compared clinical findings of headaches to find out important characteristics for the differential diagnosis of headaches. We tried to find out specific electroencephalogram (EEG) findings according to the types of primary headache and the relationship between clinical characteristics and EEG findings by analyzing EEGs of migraine. METHOD: We conducted a retrospective analysis by reviewing medical records of 275 patients who visited the Department of Pediatrics of Korea University Guro Hospital from November 2010 to October 2013. The headaches were classified according to the International Classification of Headache Disorders-II (ICHD-II). EEG was analyzed in relation to the type of headache. RESULTS: 245 (89.1%) were primary headache patients, and 30 (10.9%) were secondary headache patients.There were no differences in the frequencies of abnormal EEG findings according to the type of primary headache (P=0.855), and epileptiform discharge was most common abnormal EEG finding in the primary headache. Comparing the patients with epileptiform discharges to the patients with normal EEG finding in migraine, the patients showing epileptiform discharge were younger (P=0.035) and presented with occipital and atypical (i.e., not pulsating or pressing) headache (P=0.005). CONCLUSION: History and physical examination are the most important in the diagnosis of headache in children. There were no significant differences in EEG findings among the different types of primary headaches.However,we could find a relationship between clinical features of the migraine and its epileptiform discharge, so more studies correlating EEG findings to clinical features are needed in the future.
Child* ; Classification ; Diagnosis ; Diagnosis, Differential ; Electroencephalography* ; Headache* ; Humans ; Korea ; Medical Records ; Migraine Disorders ; Pediatrics ; Physical Examination ; Retrospective Studies ; Tension-Type Headache

Gastroesophageal reflux disorder (GERD) is the most common esophageal disorder in children. Achalasia occurs less commonly but has similar symptoms to GERD. A nine-year old boy presented with vomiting, heartburn, and nocturnal cough. The esophageal impedance-pH monitor revealed nonacidic GERD (all-refluxate clearance percent time of 20.9%). His symptoms persisted despite medical treatment for GERD, and he was lost to follow up. Four years later, he presented with heartburn, solid-food dysphagia, daily post-prandial vomiting, and failure to thrive. Endoscopy showed a severely dilated esophagus with candidiasis. High-resolution manometry was performed, and he was diagnosed with classic achalasia (also known as type I). His symptoms resolved after two pneumatic dilatation procedures, and his weight and height began to catch up to his peers. Clinicians might consider using high-resolution manometry in children with atypical GERD even after evaluation with an impedance-pH monitor.
Candidiasis ; Child* ; Cough ; Deglutition Disorders ; Dilatation ; Electric Impedance ; Endoscopy ; Esophageal Achalasia* ; Esophageal pH Monitoring ; Esophagus ; Failure to Thrive ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Lost to Follow-Up ; Male ; Manometry* ; Vomiting

Eosinophilic gastroenteritis is a rare disease characterized by prominent eosinophilic tissue infiltration of the gastrointestinal tract. Here, we report a case of eosinophilic gastroenteritis in an 18-year-old patient with prolonged nephrotic syndrome who presented with abdominal pain and peripheral hypereosinophilia. During the previous 2 years, he had visited local Emergency Department several times because of epigastric pain and nausea. He had been treated with steroid-dependent nephrotic syndrome since 3 years of age. Tests ruled out allergic and parasitic disease etiologies. Gastroduodenoscopy with biopsy revealed marked eosinophilic infiltration in the duodenum. Renal biopsy findings indicated minimal change disease spectrum without eosinophilic infiltration. The oral deflazacort dosage was increased, and the patient was discharged after abdominal pain resolved. To our knowledge, this is the first report of eosinophilic gastroenteritis in a patient with minimal change disease.
Abdominal Pain ; Adolescent* ; Biopsy ; Duodenum ; Emergency Service, Hospital ; Eosinophilia ; Eosinophils* ; Gastroenteritis* ; Gastrointestinal Tract ; Humans ; Male* ; Nausea ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Parasitic Diseases ; Rare Diseases

No abstract available.
Antibodies, Antineutrophil Cytoplasmic ; Fever* ; Ulcer ; Wegener Granulomatosis

PURPOSE: We aim to compare clinical severity of atopic and non-atopic eczema in children and examine the relationship between total-IgE, eosinophil counts, Eosinophil, Eosinophil cationic protein (ECP) and clinical severity of atopic dermatitis (AD). METHODS: A total of 271 children diagnosed with AD at the Pediatric Allergy Respiratory Center in Soonchunhyang University Hospital from October 2005 to March 2008 were enrolled for this study and divided into 2 groups: atopic and non-atopic eczema. Serum concentrations of total- and specific-IgE, eosinophil counts and ECP were measured. Allergy skin tests were also performed and the SCORAD index was used to evaluate clinical severity. Comparisons the SCORAD index and serum total-IgE, eosinophil count and ECP between the 2 groups were made. RESULTS: Of the 271 patients, 162 (59.8%) were included in the atopic eczema group, while 109 (40.2%) were included in the non-atopic group according to the laboratory results. Serum total- IgE, eosinophil counts, ECP, the SCORAD index and the frequency of a family history of eczema were relatively higher in the atopic group. In the atopic group, serum total-IgE, eosinophil counts and ECP each had a statistically significant correlation with the SCORAD index with eosinophil counts showing the highest correlation. However, only eosinophil counts had a statistically significant correlation with the SCORAD index in the non-atopic group. CONCLUSION: Serum total-IgE, eosinophil counts, and ECP can be used as markers for clinical severity in patients with atopic eczema, while eosinophil counts be used as marker for clinical severity in those with non-atopic eczema.
Child ; Dermatitis, Atopic ; Eczema ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Respiratory Center ; Skin Tests

Castleman's disease is a rare lymphoproliferative disorder of uncertain etiology which most commonly occurs in the mediastinum. We describe a case of a benign Castleman 's disease of the hyaline vascular type affecting the upper extremity, an extremely rare site of the disease.
Giant Lymph Node Hyperplasia* ; Hamartoma ; Hyalin ; Lymphoproliferative Disorders ; Mediastinum ; Upper Extremity*

OBJECTIVE: To investigate the recognition about clinical application of "neurodevelopmental treatment (NDT)". METHOD: We surveyed on the recognition for Bobath and NDT concepts and its training programs provided by Korean Academy of Rehabilitation Medicine from Jan 2009 to Feb 2009. The survey was made for physiatrists and physical therapists (PTs), separately. One hundred twelve physiatrists and 322 PTs have participated. RESULTS: In physiatrist, interest in NDT was very high (98%), and the need for further knowledge of NDT was also high (95%). Though the NDT was mainly used techniques in neuro-rehabilitation setting, the expectation about effectiveness of it was moderate (56%) and the requirement of changing concepts of the NDT was very high (93%). PTs have carried out NDT most frequently with Bobath's concepts, but they also did not regard NDT as the best procedure. PTs emphasized the importance of their handling technique in NDT practices and also had high interest in the other maneuvers beside Bobath's. CONCLUSION: Physiatrists and PTs regard NDT as one of the most important treating method for patients with brain lesions, but it is not approved as the most effective method yet. Nowadays NDT is changing or adapting, with discarding some of the old Bobath's concepts and adding new modern scientific knowledge. Therefore we suggest that physiatrists to give PTs the revised NDT concepts and evidence based the other therapeutic methods. And the NDT needs to be verified its therapeutic efficacy with evidence based view points through proper studies.
Brain ; Handling (Psychology) ; Humans ; Physical Therapists

No abstract available.
Humans ; Pneumatosis Cystoides Intestinalis* ; Scleroderma, Systemic*

Idiopathic acute eosinophilic pneumonia (IAEP), characterized by acute febrile respiratory failure associated with diffuse radiographic infiltrates and pulmonary eosinophilia, is rarely reported in children. Diagnosis is based on an association of characteristic features including acute respiratory failure with fever, bilateral infiltrates on the chest X-ray, severe hypoxemia and bronchoalveolar lavage fluid >25% eosinophils or a predominant eosinophilic infiltrate in lung biopsies in the absence of any identifiable etiology. We present a 14-month-old girl who was admitted to our pediatric intensive care unit because of acute respiratory distress. She had a fever, dry cough, and progressive dyspnea for 1 day. Chest X-ray showed multifocal consolidations, increased interstitial markings, parenchymal emphysema and pneumothorax. IAEP was confirmed by marked pulmonary infiltrates of eosinophils in the lung biopsy specimen. Most known causes of acute eosinophilic pneumonia, such as exposure to causative drugs, toxins, second-hand smoking and infections were excluded. Her symptoms were resolved quickly after corticosteroid therapy.
Anoxia ; Biopsy ; Bronchoalveolar Lavage Fluid ; Child ; Cough ; Dyspnea ; Emphysema ; Eosinophils ; Fever ; Humans ; Intensive Care Units ; Lung ; Pneumothorax ; Pulmonary Eosinophilia ; Respiratory Insufficiency ; Smoke ; Smoking ; Thorax