Patients with atypical or incomplete Kawasaki disease are at same risk for development of coronary artery complications as typical Kawasaki disease. In this communication we report six patients with unusual presentation of Kawasaki disease complicated by coronary artery aneurysms, in whom correct diagnosis were not made in time for proper treatment. One of these patients died from massive myocardial ischemia due to giant aneurysms along the entire coronary artery system. These patients had either less than enough number of diagnostic criteria at initial presentation or diagnostic signs which occurred over an extended period of time, resulting in difficulty in diagnosis during the acute phase. As a result, none of these patients received intravenous gamma globulin treatment. Thus strict adherence to currently accepted criteria for diagnosis of Kawasaki disease may lead to failure to recognize atypical form of this illness with potential sequelae of myocardial ischemia or sudden death. We would like to emphasize from this experience that clinicians must be aware of the wide variations in clinical presentation of Kawasaki disease and take an aggressive approach in making correct diagnosis by obtaining early cardiac evaluation in order to initiate prompt treatment with intravenous gamma globulin.
Aneurysm ; Coronary Aneurysm* ; Coronary Vessels ; Death, Sudden ; Diagnosis ; gamma-Globulins ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Ischemia

Necrobiotic xanthogranuloma(NXG) is a characteristic cutaneous manifestation associated with paraproteinemia. A case of NXG associated with an IgG (lambda) monoclonal gammopathy occurred in a 48-year-old man. Skin lesions were dome-shaped, hard palpable nodules, 2x3 cm to 4x4 cm sized, on both arms and forearms. They were arranged in a linear pattern. Also, hard palpable tumors, 1x2 cm to 2x3 cm in size, were present on the left leg and the dorsum of the left foot. They were violaceous, slightly protruded, and hard on palpation. Histologically, the lesion was characterized by inflammatory xanthogranuloma with broad hands of hyaline necrobiosis. Many foreign body type of bizarre giant cells, Touton type of giant cells and foamy histiocytes were infiltrated into the dermis and subcutaneous fat tissue. Three days after medication with ledercort and immuran, the cutaneous masses decreased in size and became soft.

Rett syndrome is progressive neurodegenerative disorder in female patients, characterized by autistic behavior, mental retardation, loss of purposeful hand skills, stereotypic hand movement, breathing dysfunction, severely impaired language, ataxia, and seizure. The diagnosis of Rett syndrome is based on its characteristic clinical manifestation and course. The electroencephalographic (EEG) findings of Rett syndrome are nonspecific, but a progressive deterioration in the EEG, characterized by a slowing of background activity and spike sharp wave discharges, may be observed. We experienced one case of Rett syndrome in a 5 year old girl having mental retardation, loss of purposeful hand skills, stereotypic hand movements (clapping, washing, hand-to-mouth), breathing dysfunction (hyperventilation/apnea). Her EEG findings on Video-EEG monitoring are excessive slowing waves during awake state and frequent spike discharges from left or centrotemporal area during sleeping. We report a case of Rett syndrome with brief review of related literatures.
Ataxia ; Child, Preschool ; Diagnosis ; Electroencephalography ; Female ; Hand ; Humans ; Intellectual Disability ; Neurodegenerative Diseases ; Respiration ; Rett Syndrome* ; Seizures

No abstract available.
Child* ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-alpha*

Adding either macrolide or fluoroquinolone (FQ) to β-lactam has been recommended for patients with severe community-acquired pneumonia (CAP). However, due to the limited evidence available, there is a question as to the superiority of the two combination therapies. The MEDLINE, EMBASE, Cochrane Central Register, Scopus, and Web of Science databases were searched for systematic review and meta-analysis. A total of eight trials were analyzed. The total number of patients in the β-lactam plus macrolide (BL-M) and β-lactam plus fluoroquinolone (BL-F) groups was 2,273 and 1,600, respectively. Overall mortality of the BL-M group was lower than that of the BL-F group (19.4% vs. 26.8%), which showed statistical significance (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.49 to 0.94; P = 0.02). Length of hospital stay was reduced in the BL-M group compared to the BL-F group (mean difference, −3.05 days; 95% CI, −6.01 to −0.09; P = 0.04). However, there was no significant difference in length of intensive care unit (ICU) stay between the two groups. Among patients with severe CAP, BL-M therapy may better reduce overall mortality and length of hospital stay than BL-F therapy. However, we could not elicit strong conclusions from the available trials due to high risk of bias and methodological limitations.
Bias (Epidemiology) ; Humans ; Intensive Care Units ; Length of Stay ; Macrolides ; Mortality ; Pneumonia*

No abstract available.

We performed clinical and virological studies on 79 children with hand, foot and mouth disease (HFMD) who had been admitted or visited to the department of Pediatrics, Asan Medical Center from February to August, 1990. The results were as follows; 1) There were total of 79 cases with hand, foot and mouth disease during this period. The aseptic meningitis was combined in 18 cases (22.8%). 2) The male-to-female ratio of HFMD was 2.03 to 1, but that of aseptic meningitis was 8 to 1. 3) Hand, foot and mouth disease occurred more frequently in under the age of 5 years, and the aseptic meningitis in under the age of 1 year. 4) Hand, foot and mouth disease and the aseptic meningitis occurred mostly in May and June. 5) In addition to the skin manifestations characteristic in hand, foot and mouth disease, some of the patients with aseptic meningitis had the following symptoms: change of consiousness, seizure, monoparesis in the upper extremity, paraparesis in the lower extremity. 6) The causative agent of hand, foot and mouth disease associated with the aseptic meningitis in Seoul in 1990 seemed to be enterovirus 71 according to the serologic study.
Animals ; Child ; Chungcheongnam-do ; Enterovirus ; Foot-and-Mouth Disease ; Hand* ; Hand, Foot and Mouth Disease* ; Humans ; Lower Extremity ; Meningitis, Aseptic* ; Paraparesis ; Paresis ; Pediatrics ; Seizures ; Seoul* ; Skin Manifestations ; Upper Extremity

TO know the causative agent of asptic meningitis. we performed and cerebrospinal fluid study on 24 children who had been admitted to the department of Pediatrics.. Asam Medical Center form Jume. 1991 to July 1991. In the 10 cases of them. CSF virus culture was done Special Reference Laboratory, Japan The most of the patients were young infants, and 15 cases of them were under 3 months of age. The male to female ratio was 1:1.4 We observed the main symptoms as fever 100%. irritability 67%, vomiting 17%. poor feeding 13%, seizure 8%. In the 4 cases among the 10 cases with virus culture, Coxsackievirus B5 was cultured. We concluded that the causative agent of this epidemic aseptic meningitis in 1991 was Coxsakievirus B5.
Cerebrospinal Fluid ; Child ; Female ; Fever ; Humans ; Infant ; Japan ; Male ; Meningitis ; Meningitis, Aseptic* ; Pediatrics ; Seizures ; Vomiting

No abstract available.
Child* ; Fistula* ; Humans

PURPOSE: The purposes of this study is to develop an educational program to prevent sexual abuse of children and to improve the physical and mental health of children by providing a rape-free environment and safety education. This program will provide parents and children with information on how to prevent sexual abuse in children. Children learn specific methods to avoid being victimized both at home and outside the home through a learning game and simulation, which is based on problem solving. METHOD: This program was developed based on a literature reviews, surveys and negotiation process. School- aged-children, parents, and teachers were interviewed to reveal their educational needs based on their experiences related to sexual abuse. RESULT: This program includes useful subjects such as safety education, early detection of sexual abuse, crisis management, resource persons, and phone numbers of available hospital. Counseling is provided by researcher or by a pediatric psychiatrist if needed. CONCLUSION: This program could be adequately utilized for prevention of sexual abuse of children. It also will provide an intervention strategy for abused children. This educational program was distributed to all of the elementary school through the Ministry of Education and Human Resources Development.