Lead is one of the most widespread environmental toxins and its poisoning in children was considered a rarity, usually resulting from unique circumstances such as inappropriate use of leadbased body cosmetics or direct administration of lead-containing folk medicines. The increasing concern about children with lower levels of lead exposure has developed, but there are no data regarding the mean blood lead levels and the incidence of symptomatic or asymptomatic lead poisoning in Korean children. We analyzed the zinc protoporphyrine (ZPP) values and blood lead concentrations in 163 pediatric inpatients for a prospective study of lead exposure. The blood lead concentrations in all 163 children were 15~54 g/dl, of whom 111 children (68.1%) were 25~54 g/dl which needs decision to chelate based on the EDTA provocation test. Among 111 children whose blood lead concentrations are 25~54 g/dl, 59 children(53.2%) were between 7 months and 3 years of age, which revealed no significant higher incidence of lead exposure than any other age group. The ZPP values in 126 children (77.3%) were above 35 g/dl. The mean blood lead concentration and ZPP values are 27.8 g/dl and 48.8 g/dl, respectively. We conclude that there are many asymptomatic children with increased absorption of lead in the urban area of Korea, and we need further studies regarding lead poisoning. It is important that there must be a national counterplan and that pediatricians continue to pay attention to lead posioning in children.
Absorption ; Child ; Edetic Acid ; Humans ; Incidence ; Inpatients* ; Korea ; Lead Poisoning ; Poisoning ; Prospective Studies ; Zinc

Eosinophilia is a common finding in premature babies during the neonatal period. Serial eosinophil counts were determined in 94 hospitalized, appropriately grown premature in fants whose gestational ages ranged form 28 to 36 weeks. The incidence, severity and etiologic factors of eosinophilia were retrospectively studied in premature infants, who were divided into three groups according to their gestational age. The results were as follows: 1) Absolute eosinophilia (>700/mm3)was documented in 46.8%(44/94). 2) The duration of TRN and antibiotics was cignificantly higher in infants with eosinophilia than withour eosinophilia (p<0.05). The gestational age of the infants with eosinophilia was significantly shorter than that of the infants without eosinophilia (p<0.05). The infants with eosinophilia started with bottle feeding significantly earlier than the infants without eosinophilia (p<0.05). 3) The infants younger than 30 weeks of gestational age have greater incidence of eosinophilia (75%) than the infant with the gestational age between 34 and 36 weeks (34.3%)(p<0.05). 4) The incidence of mild eosinophilia was higher in the group with gewtational age 30 weeks or below(37.5%)than in the group with gestational age between 34 and 36 weeks(17.1%)(p<0.05).Also, the incidence of severe eosinophilia was significantly higher in the group with gestational age 30 weeks or below(37.5%)than in the group with gestational age between 34 and 36 weeks(17.1%)(p<0.05). 5) Eosinophilia was more prevalent in the infants who received parenteral nutrition composed of glucose, amino acid and lipid(77.8%) than the infants who received only glucose(34.1%)(p<0.05). 6) Gestational age and birth weight were significantly lower in infants with severe eosinopilia than those of mild or moderate eosinophilia. The duration of TRN and antibiotics were significantly longer in infants with severe eosinophilia than those of mild or moderate eosinophilia (p<0.05). 7) The peak eosinophil count was observed significantly later in severe eosinophilic group (26.5 13.1 days)than in non-eosinophilic group(14.4 9.0 days)(p<0.05). The above results suggest that eosinophilia in premature infants may be the effecto of immature immunologic responses to the intravenous administration of extemal antigens like amino acid, lipid and antibiotics.
Administration, Intravenous ; Anti-Bacterial Agents ; Birth Weight ; Bottle Feeding ; Eosinophilia* ; Eosinophils ; Gestational Age ; Glucose ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Parenteral Nutrition ; Retrospective Studies

No abstract available.
Tuberculosis, Pulmonary*

Vascular leak syndrome(VLS) is characterized by endothelial damage, which causes extravasation of plasma proteins and fluid from capillaries into the extravascular space. It has been suggested that the increased vascular permeability is the result of an IL-2-induced suppression of endothelin-1 secretion by endothelial cells, an IL-2-induced activation of the complement cascade or TNF-alpha release from IL-2-activated T-cells. A 13-year-old male patient visited our hospital with abdominal pain. He was diagnosed with acute lymphoblastic leukemia(T cell type) by bone marrow study on his 2 nd day in hospital. On the 3 rd day of induction chemotherapy(prednisone, L-asparaginase, vincristine, intrathecal methotrexate), pulmonary edema and pleural effusion, ascites and generalized edema developed and lasted for 53 days without responding to supportive care. The laboratoy finding was that TNF-alpha was increased without evidence of infection and hypoalbuminemia was noted. It was suggested that the patient's clinical feature was induced by VLS.
Abdominal Pain ; Adolescent ; Ascites ; Blood Proteins ; Bone Marrow ; Capillaries ; Capillary Permeability ; Complement System Proteins ; Edema ; Endothelial Cells ; Endothelin-1 ; Humans ; Hypoalbuminemia ; Induction Chemotherapy* ; Male ; Pleural Effusion ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Pulmonary Edema ; T-Lymphocytes ; Tumor Necrosis Factor-alpha ; Vincristine

PURPOSE: To determine whether febrile seizure enhances neuroexcitability by altering synaptic transmission and whether febrile seizure-induced hyperexcitability leads to long-lasting neuronal death. METHODS: We investigated the expression of synaptic and postsynaptic proteins and the apoptosis of neuronal cells in rat pup hippocampus after hyperthermic seizure using immunoblotting and confocal microscopy. RESULTS: Hyperthermic seizure enhanced the long-term expressions of presynaptic proteins such as syntaxin, VAMP, SNAP-25 and nSec1, whereas that of NSF was decreased. The expressions of postsynaptic NMDA receptors 1, 2a and 2b were up-regulated. The expression of postsynaptic AMPA glutamate receptors 1 month after hyperthermic seizures altered by way of increasing the ratio of GluR1 to GluR2 and decreasing NSF-GluR2 interaction, which leads to the formation of Ca2+permeable AMPA receptors and enhanced toxicity. However, in spite of enhanced neuroexcitability, there was a transient increase of neuronal death in hipocampus one week after hyperthermic seizure, but returned to baseline one month later. CONCLUSION: These results demonstrate both presynaptic and postsynaptic forms of long-term enhancement of glutamate synaptic transmission after hyperthermic seizure and support the idea that early-life febrile seizure might have persistent effects on neuronal excitability in the hippocampus.
Rats ; Animals

PURPOSE: It had been suggested that pain arising from deep somatic body regions influences neural activity within periaqueductal gray(PAG) of midbrain via distinct spinal pathways. Aspirin is one of the popular non-steroidal anti-inflammatory drugs used in the management of pain. Fos expression was used as a marker for neuronal activity throughout central neurons following painful peripheral stimulation. This study was prepared to investigate changes of c-Fos immunoreactivity in midbrain by deep pain and effects of aspirin. METHODS: Male Sprague-Dawley rats were injected with 0.1 mL of 5% formalin in the plantar muscle of the right hindpaw. For experimental group II, aspirin was injected intravenously before injection of formalin. An aspirin-untreated group was utilized as group I. Rats were sacrificed at 0.5, 1, 2, 6 and 24 hours after formalin injection. Rat's brains were removed and sliced in rat brain matrix. Brain slices were coronally sectioned at interaural 1.00-1.36 mm. Serial sections were immunohistochemically reacted with polyclonal c-Fos antibody. The numbers of c-Fos protein immunoreactive neurons in ventrolateral periaqueductal gray(VLPAG) and dorsomedial periaqueductal gray(DMPAG) were counted and analyzed statistically with Mann-Whitney U tests. RESULTS: Higher numbers of c-Fos protein immunoreactive neurons were found in VLPAG. In both VLPAG and DMPAG of formalin-treated group, the numbers of c-Fos protein immunoreactive neurons were significantly higher at all time points than the formalin-untreated group, which peaked at two hours. The numbers of c-Fos immunoreactive neuron of the aspirin-treated group were less compared to the aspirin-untreated group at each time point. CONCLUSION: These results provide some basic knowledge in understanding the mechanism of formalin-induced deep somatic pain and the effects of aspirin.
Animals ; Aspirin* ; Body Regions ; Brain ; Formaldehyde ; Humans ; Male ; Mesencephalon* ; Neurons ; Nociceptive Pain ; Rats ; Rats, Sprague-Dawley

STUDY DESIGN: Infectious spondylitis patients were classified according to their cause in pyogenic and tuberculous and compared by each. SUMMARY OF LITERATURE REVIEW: Tuberculous spondylitis shows chronic clinical course and disc space sparing with much pus formation in radiologic finding compared to pyogenic spondylits. PURPOSE: To compare pyogenic and tuberculous spondylitis in clinical, radiological, pathological difference for appropriate management of infectious spondylitis. MATERIALS AND METHODS: We reviewed sixty two cases of infectious spondylitis confirmed by culture and pathologic findings of specimens which obtained by surgical method at the orthopaedic department of the Dong-A university hospital between June 1990 and November 1998. RESULTS: There were 18 cases of pyogenic and 44 cases of tuberculous spondylitis, and combined infection case was absent. Average period between beginning of symptom and diagnosis was 6.4 months in pyogenic spondylitis(4-11 months), 3.9 months in tuberculous spondylitis(3-39 months). The average number of affected vertebra was 2.3 in pyogenic spondylitis and 3.9 in tuberculous spondylitis. 6 cases of pyogenic spondylitis(33%) showed high fever(above 38degree C) which not presented in tuberculous spondylitis. We could not find considerable difference in leukocyte count, ESR, CRP level and simple radiologic finding, MRI finding between pyogenic and tuberculous spondylitis. CONCLUSIONS: In our study, most pyogenic spondylitis shows chronic and inactive feature, so clinical, radiological, laboratory findings are not appropriate guide to differentiate between pyogenic and tuberculous spondylitis. Culture growth of infecting agent and histologic examination are reliable and essential diagnostic method for pyogenic and tuberculous spondylitis.
Diagnosis ; Humans ; Leukocyte Count ; Magnetic Resonance Imaging ; Spine ; Spondylitis* ; Suppuration

BACKGROUND: Living related liver transplantation (LRLT) was developed to alleviate the mortality resulting from the scarcity of suitable cadevaric grafts. The purpose of this study is to review 30 cases of pediatric living-related liver transplantation, and to find the proper anesthetic management for this operation. METHODS: We retrospectively analyzed the medical records of 23 cases (body weight < 15 kg) of liver transplantation from living related donors between August 1995 and May 1998. RESULTS: Mean age and body weight were 14 (range; 6-29) months, 8.7 (range: 5.4-12.2) kg, respectively. The most common cause of end stage liver disease was biliary atresia. After reperfusion there were significant decreases of mean arterial pressure and body temperature, and increases of central venous pressure (P< 0.05), whereas the change of heart rate was not significant. The incidence of postreperfusion syndrome was 26%. Serum Na levels increased significantly (P< 0.05) from 133 3 to 144+/-3 mEq/L, and K level decreased from 4.1+/-0.7 to 3.2+/-0.5 mEq/L during surgery. Hematocrit was 26+/-3.5%, platelet 10.3+/-7.2 x 104/mm3 at the time of peritoneal closure. Wide inter-individual RBC and FFP requirements were observed, 43+/-40 (range: 5-133) mL/kg, 108+/-82 (range: 22-300) mL/kg, respectively. CONCLUSIONS: We conclude that anesthetic management for pediatric LRLT and LRLT in recipients less than 15 kg in body weight can be carrid out, through with some precautions.
Arterial Pressure ; Biliary Atresia ; Blood Platelets ; Body Temperature ; Body Weight ; Central Venous Pressure ; End Stage Liver Disease ; Heart Rate ; Hematocrit ; Humans ; Incidence ; Liver Transplantation* ; Liver* ; Medical Records ; Mortality ; Reperfusion ; Retrospective Studies ; Tissue Donors ; Transplants

Background: The purpose of the current study was to evaluate and compare the effectiveness of a cryopneumatic compression device with that of standard ice packs following arthroscopic anterior cruciate ligament (ACL) reconstruction, with a primary focus on early postoperative pain. Methods: Participants were divided into two groups: cryopneumatic compression device group (CC group) and standard ice pack group (IP group). Patients in the CC Group (28 patients) received a cryopneumatic compression device (CTC-7, Daesung Maref) treatment, while patients in the IP group (28 patients) received standard ice pack cryotherapy postoperatively. All cryotherapy was applied three times (every 8 hours) per day for 20 minutes until discharge (postoperative day 7). Pain scores were assessed preoperatively and at 4, 7, and 14 days after surgery, and the primary outcome for analysis was pain at postoperative day 4 assessed using a visual analog scale (VAS). Other variables were opioid and rescue medication use, knee and thigh circumferences, postoperative drainage, and joint effusion quantified by a three-dimensional magnetic resonance imaging (MRI) reconstruction model. Results: The mean pain VAS score and difference in VAS relative to the preoperative measurements for postoperative day 4 were significantly lower in the CC group than in the IP group (p = 0.001 and p = 0.007, respectively). The sum of postoperative drainage and effusion quantified by MRI showed a significant reduction of postoperative effusion in the CC group compared to the IP group (p = 0.015). The average total rescue medication consumption was comparable between the two groups. Circumferential measurements at days 7 and 14 postoperatively relative to those at day 4 (index day) demonstrated no significant differences between the groups. Conclusions Compared to standard ice packs, application of cryopneumatic compression was associated with a significant reduction in VAS pain scores and joint effusion during the early postoperative period following ACL reconstruction.

Facioscapulohumeral muscular dystrophy (FSHD) is a genetically trarlsmitted benign muscular dystrophy which has autosomal dominant inheritance pattern. It starts anytime within the first 30 years of life, and usually involves the face and shoulder girdle, and finally the pelvic muscles with very slow progression. Authors-report a fanily consisting of a father, two sons and one daughter, who had suffered from exertional dyspnea, weakness of facial muscle and winged scapulae, all wlth a slow progressive course. Two of these patients were biopsied arld confirmed light microscopically and electron microsopically.
Dyspnea ; Facial Muscles ; Fathers ; Humans ; Inheritance Patterns ; Muscles ; Muscular Dystrophies ; Muscular Dystrophy, Facioscapulohumeral* ; Nuclear Family ; Scapula ; Shoulder