As a preliminary step to determine if we can perform methacholine challenge test in young children, We investigated the feasibility of modified technique of methacholine challenge test in which tidal breathing and chest auscultation were used instead of dosimeter and measurement of lung function in older children. The results are as follows: 1) Values of PC20 measured by the tidal breathing method correlated significantly with those of PC20 measured by dosimeter 2) Ratio of values (PC20) obtained wth both methods was not related to age. 3) The minimal concentration of methacholine which caused wheezing on chest ausculation (PCW) correlated closely with PC20, but was 44% greater on average. 4) Expiratory wheezing is associated with greater fall of FEVI from baseline than inspiratory wheezing. Thus wheezing on chest auscultation can be used to detect bronchial obstruction at the end point for bronchial provocation testing in older children during the quiet tidal inhalation of methacholine. This may be applied to measurement of airway reactivity in young children who are unable to perform routine pulmonary function tests.
Auscultation* ; Bronchial Provocation Tests ; Child ; Humans ; Inhalation ; Lung ; Methacholine Chloride ; Respiration* ; Respiratory Function Tests ; Respiratory Sounds ; Thorax*

No abstract available.
Muscular Atrophy*

PURPOSE: It has been known for a long time that infants of insulin dependent diabetic mothers are prone to develop macrosornia, organomegaly, hyperbilirubinemia, respiratory distress syndrome, hypoglycemia, hypocalcemia, septicemia and congenital anomalies in the neonatal period. And echocardiographic asymmetrical- ventricular septal hyper- trophy(ASH) has been observed in the newborn infants of diabetic mothers. The etiology of the ASH remains unknown, although fetal hyperglycemia and subsequent glycogen deposits have been postulated as contributing factors. Therefore, we have studied whether large for gestational age(LGA) has played an important role of developing ASH. METHODS: We compared echocardiographic findings in neonates of LGA and appro- priate for gestational age(AGA), who were admitted to the Department of Pediatrics, Chung Ang University Hospital from April 1994 to March 1997. RESULTS: 1) Mean LVED in LGA and AGA were 1.96+0.06cm and 1.94+0.04cm, respectively. 2) Mean LVPW in LGA and AGA were 0.37+0.05cm and 0.370.05cm, respectively. 3) Mean IVS in LGA and AGA were 0.400.09cm and 0.380.09cm, respectively. 4) Mean IVS/ LVPW in LGA and AGA were 1.09+0.12 and 1.040.17, respectively. There was no statistical significance between two groups in echocardiographic findings. CONCLUSION: There is no relation between LGA and ASH in the neonate. According- ly, we may not need to perform echocardiography LGA routinely.
Echocardiography ; Gestational Age* ; Glycogen ; Humans ; Hyperbilirubinemia ; Hyperglycemia ; Hypertrophy* ; Hypocalcemia ; Hypoglycemia ; Infant ; Infant, Newborn* ; Insulin ; Mothers ; Pediatrics ; Sepsis

Headache is a common complaint in pediatric office practices as well as in children presenting to emergency departments. Children who complain of headache usually are brought to medical attention by their parents, who seek reassurance that the headaches are not a sign of a serious illness. The etiologies of headache range from school problems to brain tumors. A history taking, physical examination, and appropriate diagnostic testing will enable to distinguish primary headaches from those of a secondary etiology. The clinical, neuroimaging, and laboratory evaluation of the child with headache are reviewed here.
Brain Neoplasms ; Child ; Diagnostic Tests, Routine ; Emergency Service, Hospital ; Headache* ; Humans ; Neuroimaging ; Parents ; Physical Examination

Zonisamide was administered to 20 patients with refractory epileptic seizures. The mean duration of the administration was 6 months, and the mean dosage was 7.2 mg/kg/day. The efficacy of zonisamide was rated remarkable in 15% of the cases, improvement in 40%, and no change in 45%. The response rates of zonisamide were 62.5% for myoclonic seizures, 50% for tonic-clonic seizures, 80% for atonic seizures and 33.3% for atypical absence seizures. There was no correlation between the clinical response and dose or serum concentration of the drug. The adverse effects were observed in 35% of the cases which were drowsiness, dizziness, ataxia, nausea, and vomiting. In all cases, however, the administration of zonisamide could be continued.
Ataxia ; Child* ; Dizziness ; Epilepsy* ; Epilepsy, Absence ; Humans ; Nausea ; Seizures ; Sleep Stages ; Vomiting

The diagnosis of a Battered Child Syndrome is made by the pediatrician, surgeon and the radiologist because almost parents deny the diagnosis or refuse to answer the doctor's questions. The imaging modalities play a key role in the investigation and documentation of the battered child syndrome, because of the high frequency of the typical skeletal lesion. Although physical abuse is denied by parents, the recognition of this entity is possible by the primary diagnostic imaging study in the suspected child abuse. The imaging studies are either a bone scan and x-ray series or a complete radiolographic skeletal survey by X-ray series. In an expected intracranial injury, a CT scan of the head is mandatory We experienced a case of Battered Child Syndrome in a 6 month-old male infant who had subdural hemorrhage and fractures of skull and ribs in different stages of healing and repair. The brief review of the literature was made.
Battered Child Syndrome* ; Child ; Child Abuse ; Diagnosis ; Diagnostic Imaging ; Head ; Hematoma, Subdural* ; Humans ; Infant ; Male ; Parents ; Ribs ; Skull ; Tomography, X-Ray Computed

No abstract available.
Polyarteritis Nodosa*

PURPOSE: Transcranial electromagnetic stimulation(TMS) is a noninvasive method which stimulates the central nervous system through pulsed magnetic fields without direct effect on the neurons. Although the neurobiologic mechanisms of magnetic stimulation are unknown, the effects on the brain are variable according to the diverse stimulation protocols. This study aims to observe the effect of the magnetic stimulation with two different stimulation methods on the cultured hippocampal slices. METHODS: We obtained brains from 8-days-old Spague-Dawley rats and dissected the hippocampal tissue under the microscope. Then we chopped the tissue into 450 micrometer thickness slices and cultured the hippocampal tissue by Stoppini's method. We divided the inserts, which contained five healthy cultured hippocampal slices respectively, into magnetic stimulation groups and a control group. To compare the different effects according to the frequency of magnetic stimulation, stimulation was done every three days from five days in vitro at 0.67 Hz in the low stimulation group and at 50 Hz in the high stimulation group. After N-methyl-D-aspartate exposure to the hippocampal slices at 14 days in vitro, magnetic stimulation was done every three days in one and was not done in another group. To evaluate the neuronal activity after magnetic stimulation, the NeuN/beta-actin ratio was calculated after western blotting in each group. RESULTS: The expression of NeuN in the magnetic stimulation group was stronger than that of the control group, especially in the high frequency stimulation group. After N-methyl-D-aspartate exposure to hippocampal slices, the expression of NeuN in the magnetic stimulation group was similar to that of the control group, whereas the expression in the magnetic non-stimulation group was lower than that of the control group. CONCLUSION: We suggest that magnetic stimulation increases the neuronal activity in cultured hippocamal slices, in proportion to the stimulating frequency, and has a neuroprotective effect on neuronal damage.
Animals ; Blotting, Western ; Brain ; Central Nervous System ; Magnetic Fields ; Magnets* ; N-Methylaspartate ; Neurogenesis* ; Neurons* ; Neuroprotective Agents ; Rats*

Neonatal cerebral sinovenous thrombosis (CSVT) is a rare disease with severe neurological sequelae. Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme in the folate cycle, and mutations in MTHFR are associated with vascular diseases. Here, we report the case of a newborn with MTHFR mutation-associated CSVT. Analysis of MTHFR in the patient detected heterozygous C677T (677CT) and A1298C (1298AC) mutations. Analysis of MTHFR in the patient's mother did not detect a C677T (677CC) mutation but detected a homozygous A1298C (1298CC) mutation. Our results suggest that the presence of heterozygous MTHFR C677T and A1298C mutations affect thrombophilic activity in the neonate, resulting in the development of refractory seizure and CSVT. Moreover, presence of the homozygous MTHFR A1298C mutation in the patient's mother, who did not show any symptoms associated with thrombophilic activity, and conditions during gestation may have affected the patient's condition.
Cerebral Infarction ; Folic Acid ; Humans ; Infant, Newborn ; Methylenetetrahydrofolate Reductase (NADPH2) ; Mothers ; Pregnancy ; Rare Diseases ; Seizures ; Stroke ; Thrombosis* ; Vascular Diseases

PURPOSE: Antiepileptic drug (AED) therapy has been reported to induce immunological alterations in epileptic patients. However, despite extensive studies, the accumulated data are not consistent and there is still confusion and controversy over the effects of AEDs on the immune system. This study tries to elucidate the effects of anticonvulsant on some immune parameters, and serum concentration of IgA, IgG, IgM. METHODS: Thirty pediatric epileptic patients[Group A (n=12) : patients on carbamazepine, Group B (n=10) : patients on valproic acid and Group C (n=8) : patients on carbamazepine and valproic acid] were enrolled in this study and the levels of IgA, IgG, and IgM were determined before treatment and after 10 months of anticonvulsant therapy. Paired t-test was used to evaluate the data. p values<0.05 were considered significant. RESULTS: The mean serum concentratrions of IgG was elevated in patients receiving anticonvulsants (p<0.05) but mean concentrations of IgA and IgM were not different significantly. CONCLUSION: Our results demonstrate that anticonvulsants elevate the serum concentrations of IgG level, suggesting that anticonvulsants may increase humoral immunity and decrease the opportunity of infectious disease, thus decreasing the convulsion.
Anticonvulsants ; Carbamazepine* ; Child* ; Communicable Diseases ; Humans ; Immune System ; Immunity, Humoral ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Seizures ; Valproic Acid*