BACKGROUND AND OBJECTIVES: A treatment gap for dyslipidemia can occur during the early phase of acute myocardial infarction (AMI) because the baseline low density lipoprotein-cholesterol (LDL-C) level during this period rapidly decreases physiologically. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of the patients who were admitted with AMI from December 2004 to July 2007 and their baseline LDL-C levels were less than 100 mg/dL. We analyzed the baseline lipid profiles and its serial changes in these patients. The initial LDL-C value, which can be expected to increase to over 100 mg/dL of LDL-C after discharge, was estimated statistically. RESULTS: Among the 298 AMI patients, 94 (31.5%) patients showed a LDL-C level below 100 mg/dL. The LDL-C level increases between baseline and within 2 weeks, 2-6 weeks and 6 weeks after discharge were 11.8+/-22.5, 24.4+/-23.8 and 26.6+/-16.6 mg/dL, respectively. We made a receiver operating characteristics (ROC) curve of the LDL-C level at baseline and within 2 weeks after discharge for predicting the increment of the LDL-C level. Using the cutoff value 74 mg/dL for the initial LDL-C level, the sensitivity and specificity were 83% and 50%, respectively. With using an 81 mg/dL cutoff value at 2 weeks, the sensitivity and specificity were 83% and 62%, respectively. CONCLUSION: A significant portion of AMI patients with an LDL-C level less than 100 mg/dL and who were not prescribed statin in the early phase of infarction showed an elevated LDL-C level over 100 mg/dL at 2 weeks after the infarction. The early administration of statin should be considered for treating an LDL-C=74 mg/dL during the initial period of AMI or an LDL-C=81 mg/dL at 2 weeks after AMI because their LDL-C level will increase to over 100 mg/dL during the subsequent follow-up period.
Dyslipidemias ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Infarction ; Medical Records ; Myocardial Infarction ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

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

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

We evaluated the inflammatory indices according to the fever duration in children with Kawasaki disease (KD), and determined duration when the inflammatory processes in KD reach their peak. Children with KD (n=152) were classified into 7 groups according to fever duration: at the third day or earlier (n=20), fourth (n=33), fifth (n=46), sixth (n=15), seventh (n=15), eighth (n=9), and at the ninth day or later after fever onset (n= 14). The levels of various laboratory indices were determined 3 times: before, 24 hr and 7 days after intravenous immunoglobulin administration (2 g/kg). WBC and neutrophil counts, and C-reactive protein level were the highest at the sixth day. Levels of hemoglobin, albumin, and high density lipoprotein cholestrol were the lowest at the sixth day. Although these indices were not significant statistically between groups, the indices showed either bell-shaped or U-shaped distribution of which peak or trench were at the sixth day. These findiugs showed that the inflammatory processes in KD reach peak on the sixth day of fever onset. This finding is important because a higher single-dose intravenous immunoglobulin treatment before the peak day may help reduce the coronary artery lesions in KD.
Child, Preschool ; Coronary Vessels/pathology ; Female ; *Fever/blood ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Infant ; *Inflammation/blood/immunology ; Male ; *Mucocutaneous Lymph Node Syndrome/blood/immunology/pathology/therapy ; Time Factors

PURPOSE: We evaluated the effects of intravenous immunoglobulin(IVIG) on level of laboratory parameters examined serially according to the existence of coronary artery lesions in children with Kawasaki disease. METHODS: Children with Kawasaki disease(n=63), treated with IVIG at a dose of 2.0 g/kg, were classified as a group with coronary artery lesions(CALs+ group, n=9) or a group without coronary artery lesions(CALs- group, n=54). Levels of various laboratory parameters were determined three times during admission; before, 24 hrs after and 7 days after IVIG administration. RESULTS: There were no significant differences in laboratory parameters performing at, before and 7 days after IVIG administration. However WBC and neutrophil counts, and CRP were significantly higher, and the level of albumin was significantly lower at 24 hrs after IVIG administration. CONCLUSION: Approximately 15% of patients with Kawasaki disease showed CALs in the acute stage. Kawasaki disease patients with CALs were associated with persistent elevated levels of inflammatory parameters including WBC count, neutrophil count and CRP examined 24 hours after IVIG administration.
Child ; Coronary Vessels* ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils

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

Intravenous immunoglobulin (IVIG) therapy is associated with a number of complications, including rare acute renal failure (ARF). Although the cause of IVIG-associated ARF is unknown, it may be related to the stabilizing agent used in IVIG preparations. ARF following IVIG infusion has not been previously described in children. We report a 4-year-old girl with Kawasaki disease who suffered from ARF following IVIG containing maltose. The previously healthy child had no underlying renal disease. She was given a 2g/kg body weight of IVIG (I.V.-Globulin S, Green Cross, IgG:maltose=1:2) for 10 hours. From the second day of IVIG administration, a gradual reduction of daily urine output was observed with an increase of BUN and creatinine levels, which by the fourth day of treatment reached 43.8mg/dL and 4.7mg/dL, respectively. A conservative ARF treatment resulted in a gradual increase in urine output, together with a decrease in BUN and creatinine levels, which after 7 days returned to normal levels. In view of the increasing use of IVIG in medicine, it is imperative that clinicians be aware of this unusual form of renal injury.
Acute Kidney Injury* ; Body Weight ; Child* ; Child, Preschool ; Creatinine ; Female ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Maltose ; Mucocutaneous Lymph Node Syndrome

PURPOSE: Recurrent parotitis is defined as a recurrent parotid inflammation, generally associated with sialectasis of the parotid gland. It can often be misdiagnosed as recurrent mumps. We studied the clinical and laboratory features of recurrent parotitis. METHODS: Outpatient clinical records of 23 cases were analyzed retrospectively between April 1993 and March 1999. Follow-up after the last outpatient clinic visit was carried out by telephone interview. RESULTS: Mean age of onset was 3.7+/-2.1 yr with 16 cases (69.6%) of 2-4 yr being predominant. Males (56.5%) were affected more than females. Mean number of recurrence per year for patients who recurred more than 3 times was 1.8/yr. Most parotid swellings subsided within 3-7 days. Laboratory findings at first visits were as follows:WBC 14,100+/-7,660/mm3 (neutrophil 56.6+/-18.9%, lymphocyte 35.5+/-17.6%), ESR 19.3+/-7.6mm/hr in males and 24.7+/-6.8 mm/hr in females and amylase 407.4+/-391.8IU/L. An eosinophil count over 250/mm3 was found in 6 out of 23 cases and IgE levels over 150IU/ml was found in 3 out of 14 cases. Anti-mumps IgG was positive in 10 out of 16 cases but anti-mumps IgM was all negative. CONCLUSION: Recurrent parotitis is not uncommon in childhood. Careful history taking and follow-up observation are important for the diagnosis of recurrent parotitis. The clinicians should reassure patients and their parents of the benign disease process.
Age of Onset ; Ambulatory Care Facilities ; Amylases ; Child* ; Diagnosis ; Eosinophils ; Female ; Follow-Up Studies ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulin M ; Inflammation ; Interviews as Topic ; Lymphocytes ; Male ; Mumps ; Outpatients ; Parents ; Parotid Gland ; Parotitis* ; Recurrence ; Retrospective Studies

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

Solid and papillary epithelial neoplasm of the pancreas is an uncommon low-grade malignant tumor found predominantly in young females. It is rare in childhood. The origin of the tumor is probably from a multipotential stem cell of the pancreas. Neoplasm usually behave like a very low grade malignancy, so that complete removal is the treatment of choice for the tumor arising anywhere in the pancreas. We report a case of solid and papillary epithelial neoplasm of the pancreas in a 14 year-old girl who presented with intermittent abdominal pain and abdominal mass. CT scan shows a large, about 7×6 cm sized, well-marginated hypodense round mass in the head of the pancreas with some ill defined enhancing solid internal portion. She had taken complete excision of the pancereatic mass and Roux-en-Y pancreaticojejunostomy and histologically comfirmed solid and papillary epithelial neoplasm of the pancreas. A brief review of literature was made.
Abdominal Pain ; Female ; Head ; Humans ; Neoplasms, Glandular and Epithelial ; Pancreas ; Pancreaticojejunostomy ; Stem Cells ; Tomography, X-Ray Computed