BACKGROUND: Patients with bronchial asthma frequently have exercise-induced bronchocon striction. Exercise-induced bronchoconstriction limits the activities important for physical and social development in children. Leukotriene receptor antagonist has been shown to protect against exercise-induced bronchoconstriction. The purpose of this study is to determine the effect of montelukast in protecting or controlling exercise-induced asthma. METHOD: 22 patients were enrolled and received montelukast(5 mg/day) for 2 months. Exercise challenges were performed before and after treatment and medication was not given for at least 48 hours before follow-up test. The form of exercise was free running for 8 minutes. The respiratory symptom scores, maximum percent fall in FEV1 from pre-exercise baseline and time to recovery of FEV1 to within 10% of pre-exercise baseline were evaluated. RESULTS: The respiratory symptoms score was siginificantly improved after 2 months of therapy(p<0.05). The maximum percent fall in FEV1 after exercise and the time from maximum percent fall in FEV1 to return to within 10 precent of pre-exercise FEV1 were also siginificantly improved after 2 months of therapy(p<0.05). In 3 patients with exercise-induced asthma, the maximum percent fall in FEV1 was decreased after 2 months of therapy, but was increased after follow-up 2 months without therapy. CONCLUSION: Montelukast, a leukotriene-receptor antagonist, is effective for protection and control of exercise-induced asthma in children.
Asthma ; Asthma, Exercise-Induced* ; Bronchoconstriction ; Child ; Follow-Up Studies ; Humans ; Receptors, Leukotriene ; Running ; Social Change

BACKGROUND: Minimally invasive surgery is currently popular, but this has been applied very sparingly to cardiac surgery because of some limitations. Our study evaluated the safety and efficacy of atrial septal defect (ASD) closure through a video-assisted mini-thoracotomy. MATERIAL AND METHOD: Fifteen patients were analyzed. Their mean age was 31+/-6 years. The mean ASD size was 24+/-5 mm and there were 3 cases of significant tricuspid regurgitation. The working window was made through the right 4th intercostal space via a 4~5 cm inframammary skin incision. CPB was conducted with performing peripheral cannulation. After cardioplegic arrest, the ASDs were closed with a patch (n=11) or direct sutures (n=4), and the procedures were assisted by using a thoracoscope. There were 3 cases of tricuspid repair and 1 case of mitral valve repair. The mean CPB time and aortic occlusion time were 160+/-47 and 70+/-26 minutes, respectively. RESULT: There was no mortality, but there were 3 minor complications (one pneumothorax, one wound dehiscence and one arrhythmia). The mean hospital stay was 5.9+/-1.8 days. The mean follow-up duration was 10.7+/-6.4 months. The follow-up echocardiogram noted no residual ASD or significant tricuspid regurgitation. Three patients suffered from pain or numbness. CONCLUSION: This study showed satisfactory clinical and cosmetic results. Although the operative time is still too long, more experience and specialized equipment would make this technique a good option for treating ASD.
Catheterization ; Cosmetics ; Follow-Up Studies ; Heart Septal Defects, Atrial ; Humans ; Hypesthesia ; Length of Stay ; Mitral Valve ; Operative Time ; Pneumothorax ; Skin ; Sutures ; Thoracic Surgery ; Thoracoscopes ; Thoracoscopy ; Tricuspid Valve Insufficiency

Although surgical closure is the standard approach for a muscular ventricular septal defect, the procedure may be complicated by poor visualization and the need for incision on the ventricle. Another approach is catheter-based intervention. However, it also has limitations. A hybrid procedure, the intraoperative combined use of an interventional device may reduce the procedure's invasiveness. We successfully managed two cases of muscular ventricular septal defect with a hybrid procedure. We report here on these 2 cases along with a review of the literature.
Chimera ; Heart Septal Defects, Ventricular

PURPOSE: As diagnostic tools for Hirschsprung's disease (HD), barium enema and rectal biopsy have radiation exposure and invasiveness respectively; however anorectal manometry does not have these disadvantages. We therefore performed this study to evaluate the diagnostic efficacy of anorectal manometry. METHODS: We reviewed medical records of infants with one or two symptoms of vomiting, abdominal distension, chronic diarrhea or constipation who had a anorectal manometry followed by barium enema and/or biopsy from July 1995 to May 2002. We evaluated the sensitivity, specificity and predictive value of anorectal manometry and barium enema for diagnosis of HD. We also measured sphincter length, median value of balloon volume at which rectoanal inhibitory reflex (RAIR) occurred. RESULTS: All 61 patients received anorectal manometry, 33 of 61 received barium enema. 18 of 61 were diagnosed as HD according to histology and 43 of 61 were evaluated as a control. The sensitivity, specificity, positive predictive value, negative predictive value of anorectal manometry and barium enema for diagnosis of HD were 1.00, 0.91, 0.82, 1.00 and 0.93, 0.67, 0.70, 0.92 respectively. The mean value of sphincter length in control was 1.68+/-0.67 cm and correlated with age, weight and significantly longitudinal length. The median value of balloon volume at which RAIR occurred was 10 mL and did not correlated with age, weight and longitudinal length. CONCLUSION: This study suggests that anorectal manometry is an excellent initial screening test for Hirschsprung's disease because of its safety and accuracy.
Barium ; Biopsy ; Constipation ; Diagnosis* ; Diarrhea ; Enema ; Hirschsprung Disease* ; Humans ; Infant ; Manometry* ; Mass Screening ; Medical Records ; Reflex ; Sensitivity and Specificity ; Vomiting

PURPOSE: To examine various neonatal outcomes and perinatal factors resulting from assisted reproduction compared to that of spontaneous conception. METHODS: This is a retrospective study. The control cases were all twins of spontaneous conception born between periods from January 1995 to June 2000. The study cases were identified from twins conceived by assisted reproduction in the same time peried. A total of 460 sets of twins consisted of 250 twins of spontaneous conception and 156 twins of assisted reproduction were studied. The primary outcomes were neonatal morbidity and mortality and the secondary outcomes were perinatal factors including number, length and cost of hospitalization for the delivery. RESULTS: No differences were seen in various neontal factors including gestational age, birth weight and incidences of respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, hyperbilirubinemia, sepsis, intraventricular hemorrhage and the length of hospitalizations. Lower one minute and five minute Apgar scores and frequently encountered electrolyte abnormalities were observed in neonates of assisted reproduction. In general, the second twin of assisted reproduction had increased incidences of respiratory distress syndrome, sepsis and necrotizing enterocolitis than the first twin. Increased frequencies of preterm labor, hospitalization and elective cesarean section were seen among mothers who underwent artifical conception. However, overall hospital costs in terms of mothers hospitalization for the delivery and neonates hospitalization did not show differences. CONCLUSION: Assisted reproduction twins had similar neonatal morbidities, mortalities and perinatal morbidities compared to those born by spontaneous conception.
Birth Weight ; Cesarean Section ; Ductus Arteriosus, Patent ; Embryo Transfer* ; Embryonic Structures* ; Enterocolitis, Necrotizing ; Female ; Fertilization ; Fertilization in Vitro* ; Gestational Age ; Hemorrhage ; Hospital Costs ; Hospitalization ; Humans ; Hyperbilirubinemia ; Incidence ; Infant, Newborn ; Mortality ; Mothers ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy, Twin* ; Reproduction ; Retrospective Studies ; Sepsis ; Systemic Inflammatory Response Syndrome