Sick sinus syndrome (SSS) is a disorder characterized by sinus node dysfunction. Although the condition is most common in the elderly, it can occur in children including neonates and its recognition and treatment are important. The diagnosis of SSS is based on the presence of sinus bradycardia, sinus arrest or exit block, combinations of sinoatrial and atrioventricular nodal conduction disturbances, and atrial tachyarrhythmias documented in the Holter recordings. In most children with SSS, previous history of congenital heart malformation or cardiac surgery is noted. SSS is also seen in the children including neonates without heart disease or other contributing factors, however SSS is most often idiopathic. The treatment of SSS depends on the basic rhythm problem, but generally involves the placement of a cardiac pacemaker. We report a case of SSS in extremely low birth weight infant without congenital heart disease and suggest that the treatment system is necessary for preterm infants with SSS.
Aged ; Arrhythmias, Cardiac ; Bradycardia ; Child ; Heart ; Heart Diseases ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Pancreas ; Pancreatic Diseases ; Premature Birth ; Sick Sinus Syndrome ; Tachycardia ; Thoracic Surgery

PURPOSE: The objective of this study was to evaluate the effect of gonadotropin releasing hormone analog (GnRHa) treatment on bone mineral density (BMD) in girls with central precocious puberty (CPP). Further we investigated the differences in the effect on BMD by using the GnRHa leuprolide-acetate and triptorelin. METHODS: Sixty-one females with CPP were enrolled in the study, the lumbar spine BMD was measured by dual energy x-ray absorptiometry before treatment, after one year (n = 61) and after two years (n = 24) of treatment. Lumbar spine BMD standard deviation scores (SDS) were compared according to chronological age (CA) and bone age (BA) for the whole group, as well as for the group A, treated with leuprolide-acetate (n = 40), and the group B, treated with triptorelin (n = 21). RESULTS: All subjects showed significant increment in BMD during treatment (P < 0.05). Lumbar spine BMD SDS for CA and BA showed no significant changes before and during treatment. Group A and group B, within each group, showed no significant changes in lumbar spine BMD SDS for CA and BA during treatment. CONCLUSION: Our study suggests that lumbar spine BMD was not impaired in girls treated with GnRHa for CPP and both leuprolide-acetate and triptorelin showed comparable effects on lumbar spine BMD during treatment.
Absorptiometry, Photon ; Bone Density ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Leuprolide ; Piperazines ; Puberty, Precocious ; Spine ; Triptorelin Pamoate

Secondary brain tumors after cranial irradiation have been reported in survivors of childhood acute lymphoblastic leukemia (ALL). We report a case of secondary oligodendroglioma, occurring in a 19-year-old male, 12 years after the diagnosis of ALL. He was treated with vincristine, asparaginase, doxorubicin, methotrexate, prednisone, 6-mercaptopurine and cytarabine followed by prophylactic cranial irradiation at the age of 7 years. After treatment of ALL was completed at the age of 10 years, he showed symptoms of seizure, headache and decreased visual acuity at the age of 19 years. Magnetic resonance imaging (MRI) of the brain showed a mass lesion which was revealed as low-grade oligodendroglioma by stereotactic biopsy. He was treated with cranial radiotherapy, followed by 4 cycles of chemotherapy composed of PCV (procarbazine, methyl-1-(2-chloroethyl)-1-nitrosourea (CCNU), and vincristine) for oligodendroglioma, and sodium valproate for seizure control. The patient showed stable disease and no recurrence of seizure 8 months after treatment.
6-Mercaptopurine ; Asparaginase ; Biopsy ; Brain ; Brain Neoplasms ; Cranial Irradiation ; Cytarabine ; Doxorubicin ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Methotrexate ; Oligodendroglioma ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prednisone ; Recurrence ; Seizures ; Survivors ; Valproic Acid ; Vincristine ; Visual Acuity ; Young Adult

PURPOSE: We examined whether fractional exhaled nitric oxide (FeNO) levels are associated with atopy profiles in terms of mono-sensitization and poly-sensitization in asthmatic children. METHODS: A total of 119 children underwent an assessment that included FeNO measurements, spirometry, methacholine challenge, and measurement of blood eosinophil count, serum total IgE, and serum eosinophil cationic protein (ECP). We also examined sensitization to five classes of aeroallergens (house dust mites, animal danders, pollens, molds, and cockroach) using skin prick testing. The children were divided into three groups according to their sensitization profiles to these aeroallergens (non-sensitized, mono-sensitized, and poly-sensitized). RESULTS: The geometric means (range of 1 SD) of FeNO were significantly different between the three groups (non-sensitized, 18.6 ppb [10.0-34.7 ppb]; mono-sensitized, 28.8 ppb [16.6-50.1 ppb]; and poly-sensitized, 44.7 ppb [24.5-81.3 ppb], P=0.001). FeNO levels were correlated with serum total IgE concentrations, peripheral blood eosinophilia, and serum ECP levels to different degrees. CONCLUSIONS: FeNO levels vary according to the profile of atopy, as determined by positive skin prick test results to various classes of aeroallergens. FeNO is also moderately correlated with serum total IgE, blood eosinophilia, and serum ECP. These results suggest that poly-sensitized asthmatic children may have the highest risk of airway inflammation.
Animals ; Asthma ; Child ; Dust ; Eosinophil Cationic Protein ; Eosinophilia ; Eosinophils ; Fungi ; Humans ; Immunoglobulin E ; Inflammation ; Methacholine Chloride ; Mites ; Nitric Oxide ; Pollen ; Skin ; Spirometry

PURPOSE: The measurement of fraction of nitric oxide (FeNO) is a noticeable tool that reflects airway inflammation in asthmatic patients. We wanted to find out the relationship between pulmonary function, bronchial hyperresponsiveness (AHR), blood eosinophilic inflammatory markers and FeNO level before and after methacholine bronchoprovocation test in asthmatic patients. METHODS: Fifty-five children, who visited the Allergy Clinic of Korea University Anam Hospital from March 2011 to February 2012, due to asthmatic symptoms, such as history of episodic wheezing or dyspnea during the previous year and resolved after using bronchodilators, were enrolled. We performed the baseline pulmonary function and methacholine bronchoprovocation test in the enrolled patients. Blood eosinophil counts and blood eosinophil cationic protein (ECP) were measured. FeNO levels were measured before and after the methacholine bronchoprovocation test. RESULTS: The mean FeNO levels (36.3 ppb) fell after methacholine bronchoprovocation test (25.7 ppb). Forced expiratory volume in one second (FEV1) %pred inversely correlated both with FeNO level before (R2=0.07, P=0.029) and after (R2=0.059, P=0.01) methacholine bronchoprovocation test. The provocative concentration, causing a 20% decrease in FEV1 to methacholine (methacholine PC20) inversely correlated both with FeNO levels before (R2=0.086, P=0.001) and after (R2=0.141, P=0.001) the challenge. FeNO level measured at bronchoconstriction state significantly correlated with blood eosinophil counts (R2=0.112, P=0.028). Serum ECP levels correlated FeNO level, neither before nor after bronchoprovocation. CONCLUSION: The baseline FeNO levels were higher in asthmatic children. However, FeNO levels rather decreased after methacholine induced bronchoconstriction. Repeated spirometry maneuver was considered to have an effect on reducing FeNO levels. FeNO correlated with pulmonary function, airway AHR and blood eosinophil counts.
Asthma ; Bronchoconstriction ; Bronchodilator Agents ; Child ; Dyspnea ; Eosinophil Cationic Protein ; Eosinophils ; Forced Expiratory Volume ; Humans ; Hypersensitivity ; Inflammation ; Korea ; Methacholine Chloride ; Nitric Oxide ; Respiratory Sounds ; Spirometry

PURPOSE: Cough and wheezing are the most common respiratory symptoms in children. Recently, the cough-holter monitoring has been used to estimate the frequency and intensity of cough and wheezing, objectively. In this study, we aimed to evaluate the validity of cough-holter monitoring for the objective assessment of cough and wheezing in the hospitalized children with respiratory symptoms. METHODS: Cough-holter monitoring was performed in 59 children who suffered from cough and/or wheezing. We obtained the information on the frequency and intensity of cough and wheezing from the parents, a pediatrician, and cough-holter monitoring. Visual Analogue Scale (VAS) scores were taken by parents, and the pediatrician estimated the wheezing score by using a stethoscope. We assessed a relationship between the VAS scores, wheezing score, and cough-holter monitoring data. RESULTS: The frequencies and intensities of cough correlated positively with the VAS scores (r=0.301, P=0.032; and r=0.540, P=0.001, respectively) and the frequencies and intensities of wheezing also correlated positively with the Wheezing scores. (r=0.335, P=0.011; and r=0.457, P=0.001, respectively) The wheezing intensity did not correlate with the Wheezing score in wheezing children. (r=0.321, P=0.089) CONCLUSION: Cough-holter monitoring correlated positively with the VAS scores and the wheezing scores. Cough-holter monitoring appears to be a useful objective assessment tool for the children who have suffered from cough and/or wheezing.
Child ; Child, Hospitalized ; Cough ; Humans ; Parents ; Respiratory Sounds ; Stethoscopes

PURPOSE: This study was conducted to investigate the immune responses of children with moderate and severe novel influenza A virus (H1N1) pneumonia, and to compare their clinical and immunological findings with those of control subjects. METHODS: Thirty-two admitted patients with H1N1 pneumonia were enrolled in the study. The clinical profiles, humoral and cell-mediated immune responses of the 16 H1N1 pneumonia patients who were admitted to the pediatric intensive care unit (severe pneumonia group), 16 H1N1 pneumonia patients admitted to the pediatric general ward (moderate pneumonia group) and 13 control subjects (control group) were measured. RESULTS: Total lymphocyte counts were significantly lower in patients with H1N1 pneumonia than in the control group (P=0.02). The number of CD4+ T lymphocytes was significantly lower in the severe pneumonia group (411.5+/-253.5/microL) than in the moderate pneumonia (644.9+/-291.1/microL, P=0.04) and control (902.5+/-461.2/microL, P=0.01) groups. However, the number of CD8+ T lymphocytes was significantly higher in the severe pneumonia group (684.2+/-420.8/microL) than in the moderate pneumonia (319.7+/-176.6/microL, P=0.02) and control (407.2+/-309.3/microL, P=0.03) groups. The CD4+/CD8+ T lymphocytes ratio was significantly lower in the severe pneumonia group (0.86+/-0.24) than in the moderate pneumonia (1.57+/-0.41, P=0.01) and control (1.61+/-0.49, P=0.01) groups. The serum levels of IgG, IgM and IgE were significantly higher in the severe pneumonia group than in the 2 other groups. CONCLUSION: The results of this study suggest that increased humoral immune responses and the differences in the CD4+ and CD8+ T lymphocyte profiles, and imbalance of their ratios may be related to the severity of H1N1 pneumonia in children.
Child ; Humans ; Immunity, Humoral ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulin M ; Influenza A virus ; Influenza, Human ; Intensive Care Units ; Lymphocyte Count ; Lymphocytes ; Pandemics ; Patients' Rooms ; Pneumonia ; T-Lymphocytes

PURPOSE: Viral infection is known as one of the dominant risk factors for wheezing in children hospitalized before 2 years of age. Although the major viral pathogen associated with wheezing is respiratory syncytial virus (RSV), the mechanisms of wheezing remain unclear. Vascular endothelial growth factor (VEGF) is a major mediator of angiogenesis and vascular permeability. The aim of this study was to evaluate the relationship between VEGF concentration and wheezing in children with acute RSV bronchiolitis. METHODS: Ninety-four children with acute bronchiolitis who were admitted to Korea University Anam Hospital were enrolled in this study. Based on the proven viral agents, children with bronchiolitis were divided into 2 groups: those who were infected with RSV (RSV (+) group, n=51) and those who were not (RSV (-) group, n=43). A complete history taking, physical examination and routine laboratory tests were performed on all children. VEGF levels in serum and nasopharyngeal aspirates (NPA) were determined by ELISA. RESULTS: NPA VEGF levels were significantly higher in the RSV (+) group than in the RSV (-) group (331.8+/-197.8 vs. 204.5+/-97.0 pg/mL, P=0.002). The duration of wheezing is significantly longer in the RSV (+) group than in the RSV (-) group (3.8+/-2.7 days vs. 2.4+/-1.8 days, P=0.037). CONCLUSION: The results of this study suggest that children with RSV bronchiolitis may have significantly higher NPA VEGF levels than those without, which may be associated with a longer duration of wheezing in those with RSV bronchiolitis.
Bronchiolitis ; Capillary Permeability ; Child ; Enzyme-Linked Immunosorbent Assay ; Humans ; Korea ; Physical Examination ; Respiratory Sounds ; Respiratory Syncytial Viruses ; Risk Factors ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors

Pulmonary cryptococcosis is rare in immunocompetent subjects. Here, we present the case of a 16-year-old boy who was referred to our pediatric department for the management of multiple consolidations detected on chest radiography, which was routinely performed when the patient was being evaluated for an ankle fracture. Fine needle aspiration biopsy was performed, and the definitive diagnosis was established as cryptococcal pneumonia. After 8 weeks of antifungal treatment, the pulmonary nodules on the chest radiographs disappeared.
Adolescent ; Animals ; Ankle ; Biopsy ; Biopsy, Fine-Needle ; Child ; Cryptococcosis ; Humans ; Multiple Pulmonary Nodules ; Pneumonia ; Thorax

PURPOSE: The aim of this study was to investigate bronchodilator responsiveness (BDR) following methacholine-induced bronchoconstriction and to determine differences in BDR according to clinical parameters in children with asthma. METHODS: The methacholine challenge test was performed in 145 children with mild to moderate asthma, and the provocative concentration causing a 20% decline in FEV1 (PC20) was determined. Immediately after the challenge test, patients were asked to inhale short-acting beta2-agonists (SABAs) to achieve BDR, which was assessed as the change in FEV1% predictedx100/post-methacholine FEV1% predicted. For each subject, the asthma medication, blood eosinophil count, serum total IgE, serum eosinophil cationic protein level, and skin prick test result were assessed. RESULTS: The FEV1 (mean+/-SD) values of the 145 patients were 90.5+/-10.9% predicted, 64.2+/-11.5% predicted, and 86.2+/-11.2% predicted before and after methacholine inhalation, and following the administration of a SABA, respectively. The BDR did not differ significantly according to asthma medication, age, or gender. However, BDR in the atopy group (37.4+/-17.7%) was significantly higher than that in the non-atopy group (30.5+/-10.7%; P=0.037). Patients with blood eosinophilia (38.6+/-18.1%) displayed increased BDR compared with patients without eosinophilia (32.0+/-13.8%; P=0.037). CONCLUSIONS: In children with mild to moderate asthma, the responsiveness to short-acting bronchodilators after methacholine-induced bronchoconstriction was not related to asthma medication, but was higher in children with atopy and/or peripheral blood eosinophilia.
Adrenergic beta-Agonists ; Asthma ; Azides ; Bronchoconstriction ; Bronchodilator Agents ; Child ; Eosinophil Cationic Protein ; Eosinophilia ; Eosinophils ; Humans ; Immunoglobulin E ; Inhalation ; Methacholine Chloride ; Serotonin ; Skin