No abstract available.
Asthma* ; Cough*

PURPOSE: It has been suggested that immunologic abnormalities play a role in the pathogenesis of vascular injury in Kawasaki disease and the immunologic abnormalities could be regulated by high-dose intravenous immunoglobulin(IVIG). We investigated the peripheral blood lymphocyte subsets, the serum levels of interleukin-6(IL-6) and tumor necrosis factor-alpha(TNF-alpha) and the effect of high- dose IVIG(400 mg/kg/day for 5 days) on these factors during acute stage of Kawasaki disease. METHODS: Thirty patients, aged 4 months to 5 years, who met the diagnostic criteria for Kawasaki disease were enrolled in this study. Patients were divided into two groups, Kawasaki disease with coronary vascular lesion(KD-CVL) and without coronary vascular lesion (KD-NCVL). Percentages of peripheral blood lymphocyte subsets were measured by flow-cytometry and the serum levels of IL-6 and TNF-alpha were measured by ELISA on 1 day before and 1 day after IVIG administration and compared with normal control group(n=15). RESULTS: The results were as follows 1) Before IVIG administration, the percentages of CD3+ lymphocyte and CD8+ lymphocyte in both KD-CVL and KD-NCVL were significantly lower than those in control group. The percentages of CD19+ lymphocyte and CD4+/CD8+ ratio in both groups were significantly higher than those in control group. There was no significant differences between the percentages of CD4+ lymphocyte in both groups and that in control group. 2) After IVIG administration, the percentages of CD3+ lymphocyte and CD8+ lymphocyte in both KD-CVL and KD-NCVL were significantly increased. The percentages of CD19+ lymphocyte and CD4+/CD8+ ratio in both KD-CVL and KD-NCVL were significantly decreased. The percentages of CD4+ lymphocyte were not changed. 3) Before IVIG administration, the detection rate of serum IL-6 and TNF-alpha in both groups was significantly higher than that in control group. After IVIG administration, the detection rate of serum IL-6 in both groups was still higher than that in control group. In KD-CVL, the detection rate of serum TNF-alpha was still higher than that in control group but there was no significant difference between the detection rate of TNF-alpha in KD-NCVL and that in control group. 4) Before IVIG administration, the serum levels of IL-6 in Kawasaki disease were significantly higher than that in control group but there was no significant difference between those in KD-CVL and KD-NCVL. After IVIG administration, the serum level of IL-6 in KD-CVL was not decreased. In KD-NCVL, it was decreased significantly but it was still higher than that in control group after IVIG administration. Before IVIG administration, the serum levels of TNF-alpha in Kawasaki diseases were significantly higher than that in control group and that in KD-CVL was significantly higher than that in KD-NCVL. After IVIG administration, the serum level of TNF-alpha in KD-CVL was not decreased but in KD-NCVL, it was decreased significantly to the level of control group. CONCLUSIONS: Immunologic abnormalities including decreased percentage of CD3+ lymphocyte, CD8+ lymphocyte, increased percentage of CD19+ lymphocyte and CD4+/ CD8+ ratio and increased levels of IL-6 and TNF-alpha were noted in the acute stage of Kawasaki diseases. But there were no difference of above immunologic abnormalities between KD-CVL and KD-NCVL. After IVIG administration, the abnormal percentages of peripheral blood lymphocyte subsets were changed to normal but in the cases of IL-6 and TNF-alpha, the levels were continuously elevated except TNF-alpha in KD-NCVL. Therefore the immunologic abnormalities including abnormal percentages of peripheral blood lymphocyte subsets and increased production of IL-6 and TNF-alpha might be involved in the pathogenesis of Kawasaki disease. And IVIG has some effects on the change of these kinds of immunologic abnormalities.
Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Interleukin-6 ; Lymphocyte Subsets ; Lymphocytes ; Mucocutaneous Lymph Node Syndrome* ; Necrosis ; Tumor Necrosis Factor-alpha ; Vascular System Injuries

Chronic cough is a symptom frequently encountered by the pediatrician. Although most coughs are self-limited, chronic cough often proves to be a frustrating problem. This study was performed at Kangnam St. Mary's Hospital from January 1, 1992 to December 31, 1992, and 83 children with chronic cough persisting for longer than 3 weeks was evaluated. We categorized these patients into 5 age groups (1. Infant: uner 12 months of age, 2. Toddler: above age 1~below age 3, 3. Preschool: above age 3~below age 6,4. School: above age 6~below age 6~below age 12, 5. Adolecent: above age 12). The most common cause of chronic cough was the reactive airway disease (71.1%) such as asthma with or without sinusitis (56.6%) and bronchiolitis-reactive (14.5%). In infant age group, the most frequent causes of chronic cough were reactive airway disease(52.4%)such as bronchiolitis-reactive (28.6%) and infantile asthma (23.8%). The second and third common causes were congenital anomalies(23.8%) and bronchiolitis-nonreactive (23.8%). In toddler age, the most common cause was the reactive airway disease such as infantile asthma (10 cases: 50%) and bronchiolitis reactive (6cases; 30%) and congenital anomalies were the second common causes of chronic cough. In preschool, school and adolescent age group, asthma and sinusitis were the main causes of chronic cough. In the groups above age 3,73.2% of chronic cough were associated with sinusitis. Therefore, in the diagnostic and therapeutic approach of chronic cough, it should be considered that the cause of cough is either reactive airway disease with or without sinusitis or not. In infant and toddler age, congenital anomaly should be considered.
Adolescent ; Asthma ; Bronchiolitis ; Child* ; Cough* ; Humans ; Infant ; Sinusitis

Distal renal tubular acidosis (RTA) is a biochemical syndrome as a deficiency of hydrogen in secretion by the distal tubule and collecting duct. Owing to the nature of the defect, hyperchloremic non-anion gap metabolic acidosis and high urine pH despite severe systemic acidosis is characterized. Typical manifestations of distal RTA are growth retardation, rickets, polyuria and nephrocalcinosis. We experienced a case of distal renal tubular acidosis in a 4 years old female child who complained of growth retardation and gait disturbance. She showed typical hyperchloremic non-anion gap metabolic acidosis and persistent high urine pH. In radiographic examination. we found delayed bone age and severe rachitic changes of wrist, elbow, and knee as well as nephrocalcinosis. In ammonium chloride loading test, high urine pH persisted despite the lowering blood HCO3- concentration. After alkali therapy, she is in well condition with excellent growth velocity and absence of rachitic changes.
Acidosis ; Acidosis, Renal Tubular* ; Alkalies ; Ammonium Chloride ; Child ; Child, Preschool ; Elbow ; Female ; Gait ; Humans ; Hydrogen ; Hydrogen-Ion Concentration ; Knee ; Nephrocalcinosis ; Polyuria ; Rickets ; Wrist

No abstract available.

Only a few cases of cyst related to cruciate ligament were reported in the literatrure. It is not only because of rarity but also difficulty of diagnosis by conventional method. Recentely, the precise intraarticular structure of the knee joint became to be seen by introduction of MRI and arthroscope and cycts would bave been found incidentally during the workup of the internal derangement of knee. We have experienced three cases of ganglion around the cruciate ligament in the patients whose symptom was mimic of intemal derangement of knee. We excised the ganglion with good clinical results.
Arthroscopes ; Diagnosis ; Ganglion Cysts ; Humans ; Knee Joint ; Knee ; Ligaments ; Magnetic Resonance Imaging ; Methods

For prevention of limitation of range of motion due to arthrofibrosis of the knee joint after anterior cruciate ligament reconstruction, it is accepted in general that the operation should be delayed for about three weeks after injury. We studied the duration form operation to time of full range of motion, and analized the results in forty-eight patients who had undergone arthroscopic anterior cruciate ligament recostruction using the autologous bone-patella tendon-bone graft and early CPM, range of motion exercise during Feb. 1991 and June 1994. The results were as follows: 1. The average interval from injury to operation were 1.3 weeks in acute injury group, 6 weeks in subacute injury group and 20.7 months in chronic group. The average interval from operation to full range of motion were 7.1 weeks in acute injury group, 5.7 weeks in subacute injury group and 3.0 weeks in chronic group. 2. In acute injury group, 14(93.3%) of 15 cases showed full extesion and only 1 case(6.7%) showed the limitation of extension less than 5 degrees. In subacute injury group, 6(85.7%) of 7 cases showed full extension but1 case(14.3%) showed the limitation of extension less than 5 degrees. On the other hand in the chronic injury group, all the 26 cases(100%) of the patients showed full extension. 3. In acute injury group, 14(93.3%) of 15 cases showed full flexion and only 1 cases(6.7%) showed the limitatin of flexion less than 5 degrees. In subacute injury group, 6(85.7%) of 7 cases showed full flexion but 1 case(14.3%) showed the limitation of flexion less than 5 degrees. On the other hand in the chronic injury group, 23(88.5%) of 26 cases could flex to full range of flexion, and 3 cases(11.5%) revealed limitation of flexion less than 5 degrees. 4. The limitation of ROM mainly due to arthrofibrosis can be prevented by early range of motion execise and active rehabilitation in the acute or chronic anterior cruciate ligament reconstruction using the autograft bone-patella-bone graft. Although in acute patients the interval from operation to full ROM can be prolonged, the full ROM can be achieved after all.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Autografts ; Hand ; Humans ; Knee Joint ; Patella ; Patellar Ligament ; Range of Motion, Articular ; Rehabilitation ; Transplants

No abstract available.

The idiopathic hypereosinophilic syndrome (HES) represents a heterogenous group of disorder characterized by prolonged eosinophilia of undetectable cause and multiorgan system dysfunction. Bone marrow is the most frequentry involved organ, but the most severe clinicopathologic involvement is heart. The major cause of death in patients with the HES is cardiac dysfunction especially congestive heart failure resulted from endocardial fibrosis and restrictive cardiomyopathy. We have experienced a case of DES with both cardiac and pulmonary involvements. The patient was an 18-month-old infant with poorly controlled lung abscess who complained of fever and productive cough. On the microscopic examination of pleural effusion, eosinophilic infiltration was noted. M-mode echocardiogram showed diffuse thickening of interventricular septum and left ventricular posterior wall. On the peripheral blood smear, prolonged eosinophilia was observed. We confirmed this case with bone marrow aspiration which showed eosinophilic hyperplasia.
Bone Marrow ; Cardiomyopathy, Restrictive ; Cause of Death ; Cough ; Eosinophilia ; Eosinophils ; Fever ; Fibrosis ; Heart ; Heart Failure ; Humans ; Hypereosinophilic Syndrome* ; Hyperplasia ; Infant ; Lung Abscess ; Pleural Effusion

No abstract available.
Emphysema* ; Heart Septal Defects, Ventricular*