No abstract available.
Meningitis* ; Meningitis, Viral*

Four newborn infants with hyperbilirubinemia, caused by ABO blood group incompatibility, were treated with high-dose intravenous immune globulin(IVIG). As soon as the diagnosis was clinically suspected, these infants received conventional treatment including phototherapy and were monitored closely for bilirubin levels. When bilirubin concentrations reached the risk point in spite of phototherapy, IVIG was given at a dose of 1g/kg for 6 hours. In all cases, bilirubin levels declined within 12 hours after LVIG therapy, and to rebound effect was seen, No side effects of IVIG treatment were observed. We suggest that high-dose IVIG therapy may be useful in the treatment of hyperbilirubinemia due to ABO incompatibility, and reduce the need for exchange transfusion.
Bilirubin ; Blood Group Incompatibility ; Diagnosis ; Humans ; Hyperbilirubinemia* ; Hyperbilirubinemia, Neonatal ; Immunoglobulins, Intravenous* ; Infant ; Infant, Newborn ; Phototherapy

Common variable immunodeficiency (CVID) is a heterogeneous collection of disorders with hypogammaglobulinemia with recurrent bacterial infections and high incidence of autoimmune disorders as its hallmark. We report a 7-year-old girl suffering from CVID with Coombs' test positive hemolytic anemia. She had been relatively well until 23-months old when she was admitted to Taejon St. Mary's Hospital with pneumonia 5 years ago. Afterwards, she had suffered from recurrent otitis media, paranasal sinusitis, bronchitis and pneumonia, experiencing 13 admissions. She was diagnosed as autoimmune hemolytic anemia at 4-years old and had been treated with prednisolone. Laboratory finidings showed hypogammaglobulinemia(gamma-globulin in immunoelectrophoresis 0.04g/dL, IgG 170mg/dL, IgA 31mg/dL, IgM 27.5mg/dL) which was previously within normal limits checked at the age of 3- and 5-years old. Isohemmagglutinins (Anti-A,-B IgM and IgG) and anti-measles IgG, anti-mumps IgG, anti-rubella IgG and anti-HBs antibody along with PPD skin test were all negative. Peripheral lymphocyte subsets revealed as follows : pan T cells (CD3+) 48.6% (normal values : 60-85%), pan B cells (CD19+) 36.7% (8-20%), CD4+ T cells 24.4% (28+/-8%), CD8+ T cells 15.3% (5+/-10%), and CD4/CD8 ratio of 1.6 (0.6-2.8). Proliferations of peripheral blood mononuclear cells induced by various T cell stimulants were all markedly depressed. Chronic paranasal sinusitis and lung parenchymal damages were revealed on computerized tomography and lung scan, and a monthly intravenous immunoglobulin therapy was started.
Agammaglobulinemia ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune* ; B-Lymphocytes ; Bacterial Infections ; Bronchitis ; Child ; Child, Preschool ; Common Variable Immunodeficiency* ; Coombs Test ; Daejeon ; Female ; Humans ; Immunization, Passive ; Immunoelectrophoresis ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Incidence ; Infant ; Ionomycin ; Lung ; Lymphocyte Subsets ; Otitis Media ; Pneumonia ; Prednisolone ; Sinusitis ; Skin Tests ; T-Lymphocytes

PURPOSE: To identify the risk factors for coronary sequelae in Kawasaki disease, we analyzed and compared the clinical features and laboratory findings of Kawasaki disease in patients younger than one year of age with those over one year of age. METHODS: A retrospective chart review was conducted of all children with Kawasaki disease who were admitted to the Catholic University Taejon St. Mary's hospital between March 1992 and December 1997. RESULTS: Of 162 patients with Kawasaki disease, 36 patients(22.2%) were less than one year of age and four(11.1%) of them had coronary artery aneurysms. On the other hand, 126 patients (77.8%) were above 12 months and 15(11.9%) of them developed coronary artery aneurysms. The Kawasaki criteria signs were not significantly prominent(P<0.05) and maximal platelet count was higher in the infant group(P<0.05) but other clinical and laboratory findings were not different between the two groups. Comparative studies revealed that maximal platelet count was higher (P<0.05), and total duration of fever was significantly longer in the patients with coronary aneurysms(19 cases, P<0.001) than those without coronary aneurysms(143 cases). CONCLUSION: We cannot find any significant clinical and laboratory differences including coronary artery involvement in Kawasaki disease between less than one year of age and over one year. The age of onset seems not to be a predictor for the risk of coronary aneurysm. The principal signs of Kawasaki disease can be less prominent in infant. For this reason, early diagnosis utilizing laboratory findings are important, especially in the course of illness with prolonged fever.
Age of Onset ; Aneurysm ; Child ; Coronary Aneurysm ; Coronary Vessels ; Daejeon ; Early Diagnosis ; Fever ; Hand ; Humans ; Infant ; Mucocutaneous Lymph Node Syndrome* ; Platelet Count ; Retrospective Studies ; Risk Factors

Symptomatic pacing lead-associated thrombosis is very uncommon occurring in 0.5-3.5% of pacemaker implants. Especially thrombisis-induced total occlusion occures almost in late stage over several months to years but acute thrombosis occurring several days after venous pacing has not been reported. In this case, We performed upper limb venography in the patient who presented edema and pain of neck, left upper limb and headache as well as intermittent cough occurring in bending forward. A venogram confirmed acute thrombus completely occluding the left brachiocephalic vein and the patient received intravenous heparin and was maintained on warfarin. Repeated veno- graphy after treatment for 30 days revealed persistent thrombus with total occlusion which not be improved signi- ficantly copmpared to previous venogram and collateral veins diverting the blood to the contralateral side and into the superior vena cava was developed. The patient's symptoms resolved almost and that is likely to be due to the development of collateral venous channels.
Brachiocephalic Veins* ; Cough ; Edema ; Headache ; Heparin ; Humans ; Neck ; Phlebography ; Thrombosis* ; Upper Extremity ; Veins ; Vena Cava, Superior ; Warfarin

PURPOSE: We evaluated the epidemiologic characteristics and incidence of coronary artery sequele of children with KD according to treatment. METHODS: We retrospectively analyzed 506 medical records of children with KD, who were admitted at Daejeon St. Mary's Hospital from Jan. 1987 to Dec. 2000. RESULTS: The mean annual incidence was 36.1+/-11.1 cases per year. There was a slightly higher occurrence in summer with no significant difference in monthly incidence. The mean age was 2.4+1.7 years and 450 children(88.9%) were below four years of age. The male to female ratio was 1.7 : 1. When the 345 cases between 1987 and 1994 were divided into three groups according to treatment, incidences of the coronary abnormality(above grade II) of aspirin-treated(54 cases; 15.6%), divided-intravenous immunoglobulin(IVIG) treated(400-500 mg/dayX4-5 days, 224 cases; 64.9%), and one-dose IVIG treated(2.0 g/day, 67 cases; 19.5%) groups were 8.3%, 6.0%, and 7.5%, respectively. Between 1995 and 2000, 143 cases were treated with only one-dose IVIG and 21 cases(14.7%) showed coronary artery abnormalities(grade I, 15 cases; grade II, two cases; and grade III, four cases). Among the 143 cases, 22 cases(15.1%) were retreated with IVIG and/or steroid pulse therapy. The incidence of coronary artery abnormality in this group was 50.0%. Incidences of cases in recurrence and among siblings were 0.6% and 0.4% respectively. There was no fatal case. CONCLUSION: In Daejeon, Korea, the epidemiologic feature of KD showed slight annual variations without monthly differences. The incidence of coronary abnormality with one-dose IVIG therapy was 14.7%. The nonresponse of this therapy was 15.1% with a coronary abnormality of 50.0%.
Child ; Coronary Vessels* ; Epidemiologic Studies* ; Epidemiology ; Female ; Humans ; Immunoglobulins, Intravenous ; Incidence* ; Korea ; Male ; Medical Records ; Mucocutaneous Lymph Node Syndrome ; Recurrence ; Retrospective Studies ; Siblings

Drug-induced agranulocytosis is a potentially lethal disorder characterized by selective neutropenia. G-CSF has been utilized for its treatment. We report a case of acute agranulocytosis probably associated with injection of sulpyrine(dipyrone). A three-year old girl was admitted to Taejon St. Mary's Hospital following five days of fever and two days of chills and prostration. During this period, she had been treated at local clinics with oral acetaminophen, ibuprofen, and miokamycin. Two days before admission, she was administered an intramuscular injection of dipyrone as antipyretics. She had a past history of previous sensitization of dipyrone. CBC revealed profound netropenia(total WBC 900/mm3, with 1% neutrophils, 88% lymphocytes, 10% atypical lymphocytes, 1% monocytes), but normal RBC and platelet count. Bone marrow examination showed hypocellularity(20%), decreased myeloid precusors, and M:E ratio of 1 : 2.5. The girl received subcutaneous G-CSF once daily for 3 days. G-CSF therapy resulted in a steep increase of neutrophil count, which was faster than the spontaneous recovery reported in the literature. G-CSF may be considered useful in the management of drug-induced agranulocytosis.
Acetaminophen ; Agranulocytosis* ; Antipyretics ; Bone Marrow Examination ; Chills ; Daejeon ; Dipyrone ; Female ; Fever ; Granulocyte Colony-Stimulating Factor ; Granulocytes* ; Humans ; Ibuprofen ; Injections, Intramuscular ; Lymphocytes ; Miocamycin ; Neutropenia ; Neutrophils ; Platelet Count

Drug-induced agranulocytosis is a potentially lethal disorder characterized by selective neutropenia. G-CSF has been utilized for its treatment. We report a case of acute agranulocytosis probably associated with injection of sulpyrine(dipyrone). A three-year old girl was admitted to Taejon St. Mary's Hospital following five days of fever and two days of chills and prostration. During this period, she had been treated at local clinics with oral acetaminophen, ibuprofen, and miokamycin. Two days before admission, she was administered an intramuscular injection of dipyrone as antipyretics. She had a past history of previous sensitization of dipyrone. CBC revealed profound netropenia(total WBC 900/mm3, with 1% neutrophils, 88% lymphocytes, 10% atypical lymphocytes, 1% monocytes), but normal RBC and platelet count. Bone marrow examination showed hypocellularity(20%), decreased myeloid precusors, and M:E ratio of 1 : 2.5. The girl received subcutaneous G-CSF once daily for 3 days. G-CSF therapy resulted in a steep increase of neutrophil count, which was faster than the spontaneous recovery reported in the literature. G-CSF may be considered useful in the management of drug-induced agranulocytosis.
Acetaminophen ; Agranulocytosis* ; Antipyretics ; Bone Marrow Examination ; Chills ; Daejeon ; Dipyrone ; Female ; Fever ; Granulocyte Colony-Stimulating Factor ; Granulocytes* ; Humans ; Ibuprofen ; Injections, Intramuscular ; Lymphocytes ; Miocamycin ; Neutropenia ; Neutrophils ; Platelet Count

Mycoplasma pneumoniae is the most common etiologic agent of pneumonia in school-aged children and young adults. It involves not only the respiratory system but includes extrapulmonary complications such as exanthem, hemolysis, arthritis, hepatic dysfuction, cardiac disease, and central nervous system disease. The pathogenesis of extrapulmonary involvements may be an autoimmune phenomena. Recent studies suggest that bronchial asthma can be initiated by Mycoplasma pneumoniae infection. We experienced a five-year-old girl suffering simultaneously from Guillain-Barr syndrome and initial bronchial asthmatic attack after mycoplasma pneumonia. She was admitted with lower-leg pain and weakness for three days. Ten days before admission, she was coughing and showed on a chest X-ray, pneumonic infitrations of both subhilar peribronchial areas. The titers of anti-mycoplasma antibody and cold hemagglutinin were 1:80 and 1:32, respectively. With a progression of paralysis to the upper extremities, she showed dyspnea, dysphagia and right facial palsy on the second hospital day. We performed a tracheostomy and started artificial ventilation. Unexpectedly, she showed continuous dyspnea, poor lung aeration and revealed severe hypoxemia in serial arterial gas analysis. Intravenous theophylline, high-dose corticosteroid and intravenous immunoglobulin therapy resulted in a progressive improvement of lung condition. She recovered completely from neurologic and pulmonic complications after five weeks.
Anoxia ; Arthritis ; Asthma* ; Central Nervous System ; Child ; Cough ; Deglutition Disorders ; Dyspnea ; Exanthema ; Facial Paralysis ; Female ; Heart Diseases ; Hemagglutinins ; Hemolysis ; Humans ; Immunization, Passive ; Lung ; Mycoplasma pneumoniae ; Mycoplasma* ; Paralysis ; Pneumonia ; Pneumonia, Mycoplasma* ; Respiratory System ; Theophylline ; Thorax ; Tracheostomy ; Upper Extremity ; Ventilation ; Young Adult

The prevalent ages at onset for Kawasaki Disease (KD) and Epstein-Barr virus (EBV) infection are known to be similar in Korea and Japan. We evaluated the correlation between EBV infection and KD. The antibodies to EBV such as anti-viral capsid antigen (VCA) IgG and IgM, anti-diffuse and restricted early antigen IgG (anti-EADR IgG), and the anti-EBV determined nuclear antigen IgG (anti-EBNA IgG) were examined in 29KD patients at five separate times sequentially during a period of one year, and also in 14 other children with a past history of KD. The results of each group were compared with those of age-matched controls. The positive rates of anti-VCA IgG and IgM at presentation in the KD patients were 41.4% (12/29) and 0% (0/29), respectively. Only one patient was found to be anti-VCA IgM-positive within two months. There were no cases of anti-VCA IgG except one, anti-EADR IgG and anti-EBNA IgG positive to negative seroconversion during the year. The children with a past history of KD showed higher anti-EBNA IgG-positive rates than the controls (p=0.04). There was no difference in the seropositive rates of the antibodies to EBV, cytomegalovirus, herpes simplex virus and herpes zoster virus. In conclusion, children with KD were noted to have normal immune responses to EBV infection. Children with a past history of KD seemed to be infected with EBV at a later age than children with no history of KD.
Mucocutaneous Lymph Node Syndrome/*virology ; Male ; Korea ; Infant ; Immunoglobulins/metabolism ; Immunoglobulin M/chemistry ; Immunoglobulin G/chemistry ; Humans ; Herpesvirus 4, Human/*metabolism ; Female ; Epstein-Barr Virus Infections/*complications ; Child, Preschool ; Antibodies, Viral/*chemistry ; Age of Onset