Community-acquired pneumonia is the leading cause of pediatric morbidity and mortality. However, there is a lack of data on the epidemiology of pneumonia in Korean children. In this review, we aimed to summarize pneumonia studies in Korea and suggest diagnostic methods and treatment for Korean children who were referred based on the foreign guidelines for pediatric community-acquired pneumonia. A Korean guideline for pediatric pneumonia in tune with domestic circumstances is needed.
Child* ; Epidemiology ; Humans ; Korea ; Mortality ; Pneumonia*

Atopic dermatitis is the most common chronic inflammatory skin disease in children. It usually develops in infancy and early childhood and is an entry point of ‘atopic march’, which may progress to other allergic diseases, including allergic rhinitis and asthma. Although there is no disagreement on the importance of early treatment of atopic dermatitis, it is difficult to treat children with moderate to severe atopic dermatitis due to concerns about treatment-related side effects and age restrictions for effective drugs in real world. As recent researches have extend our understanding of pathogenesis, new agents targeted key pathologic mechanisms have been developed. Therefore, it is time to establish a new paradigm of treatment for children with atopic dermatitis since new biologics have been demonstrated to be effective and safe in children. The objective of this article is to review the clinical characteristics, severity classification, pathogenesis, and treatment, in particular, biologics already approved/undergoing clinical trials for children with atopic dermatitis.

PURPOSE: Infantile atopic dermatitis (AD) is one of the most important risk factors for development of childhood asthma. Those with persistent wheezing with atopy had a great risk of declining lung function. Our study was designed to find out the risk factors for wheezing in infants who has AD, therefore early detection of risk factors for developing wheezing. METHODS: Three hundreds forty seven infants with AD who visited on our Pediatric Allergy Respiratory Center in Soonchunhyang University Hospital from January 2002 to December 2005 were enrolled and they were followed up till July 2006. We obtained familial allergy history and laboratory data such as serum total IgE, specific IgE and blood eosinophil count. We analyzed the factors affecting recurrent wheezing and persistent wheezing after 3 years old in children who had AD during infancy. RESULTS: One-hundred ninety-four children (55.9%) developed wheezing. Male sex (adjusted odds ratio (aOR) 1.7, 95% CI 1.1-2.7) and asthma history of parents or siblings (aOR 4.7, 95% CI 1.7-12.5) were the significant risk factors for development of wheezing. Serum total IgE (aOR 5.1 95% CI 1.1-22.5) and house dust mite sensitization (aOR 9.0, 95% CI 0.9-89.4) were significant risk factors for persistent wheezing after first three years of life. CONCLUSION: We should be alert for asthma in cases of infantile AD especially in male sex or with familial asthma history. And we propose early identification and intervention for asthma in infantile AD with increased total IgE and with house dust mite sensitization.
Asthma ; Child ; Child, Preschool ; Dermatitis, Atopic* ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Infant* ; Lung ; Male ; Odds Ratio ; Parents ; Pyroglyphidae ; Respiratory Center ; Respiratory Sounds* ; Risk Factors* ; Siblings

Chylothorax, defined as escape of chyle from the thoracic duct into the thoracic cavity, is the most common cause of pleural effusion during the neonatal period. The use of octreotide, a synthetic analogue of the somatostatin, for the treatment of congenital idiopathic chylothorax, has not been previously reported in Korea. We report here a case of idiopathic congenital chylothrax successfully treated with octreotide in a premature infant who showed no response to conservative therapies.
Chyle ; Chylothorax* ; Humans ; Infant, Newborn ; Infant, Premature* ; Korea ; Octreotide* ; Pleural Effusion ; Somatostatin ; Thoracic Cavity ; Thoracic Duct ; United Nations

BACKGROUND: Although a magnetic resonance imaging (MRI) is highly sensitive for changes associated with ischemic stroke, the detection of an acute ischemic lesion is usually impossible within 6 hours of the stroke onset on a conventional MRI. The perfusion MRI is a new imaging technique for diagnosing acute ischemic stroke. We evaluate the clinical usefulness of the perfusion MRI in predicting the final infarct extent in 18 patients with acute middle cerebral artery (MCA) territory ischemic stroke. METHOD: The perfusion MRI was performed within 6 hours after the stroke onset in all patients with a single-section dynamic contrast-enhanced T2*-weighted imaging in conjunction with a conventional routine MRI and MR angiography. Time-concentration curves and cerebral blood volume (CBV) maps were calculated from the dynamic MR imaging data by using numerical integration techniques. We compared findings of CBV maps with infarction on a follow-up CT or MRI. RESULTS: In 14 of 18 patients, the CBV in the occluded MCA territory were decreased. In the remaining 4 patients with a reversible ischemic neurologic deficit (RIND) or transient ischemic attack (TIA), the CBV were increased in 3 and normal in 1. Out of 14 patients with a decreased CBV, two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. The regions of increased or decreased CBV were eventually converted to infarction on follow-up images in all 14 patients. Out of 4 patients with RIND or TIA, one showed focal infarction in centrum semiovale on a follow-up image. CONCLUSIONS: The perfusion MRI was useful for the assessment of hemodynamic change about cerebral perfusion and may predict the extent of final infarction in acute MCA territory ischemic stroke. These results suggest that the perfusion MRI may play an important role in the diagnosis and management of acute ischemic stroke.
Angiography ; Blood Volume ; Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Hyperemia ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Neurologic Manifestations ; Perfusion* ; Reperfusion ; Stroke*

PURPOSE: The purpose of our study was to investigate the risk factors in developing persistent wheezing in infants with recurrent wheezing. METHODS: Two hundred thirty two infants with recurrent wheezing under two years old visited to Pediatric Allergy and Respiratory Center in Soonchunhyang University Hospital from August 1998 to May 2002 were enrolled and investigated until May 2006, retrospectively. The patients were divided into two groups; persistent wheezer group (PW) who had recurrent wheezing until six years old and transient wheezer group (TW) who didn't have wheezing after three years old. The patients' demographics and laboratory data such as serum total IgE, specific IgE (Dp, Df, dog hair, egg white, milk, soy) and peripheral blood eosinophil count at the first visit were analysed to investigate the risk factors for developing persistent wheezing. RESULTS: PW was 115 (49.5%) and TW was 117 (50.5%) out of 232 infants with recurrent wheezing. In comparison analysis between PW and TW, there were no significant differences in age (months), serum total IgE, peripheral blood eosinophil (P=0.319), birth weight, and gestational age. However, increased serum total IgE (OR 1.72; 95% CI 1.01-2.90), sensitization to Dp (3.6, 1.14-11.39) and egg white (2.96, 1.49-5.89), family history of allergic diseases (2.35, 1.33-4.13), personal history of atopic dermatitis (2.08, 1.11-3.89), and not having older siblings (2.93, 1.64-5.24) had statistic significance. Among these results, not having older sibling (adjusted OR 2.74, 1.46-5.13) and having family history of allergic diseases (adjusted OR 2.69, 1.39-5.18) had strong significance by regnession a nalysis. CONCLUSION: Early intervention of infants with high risk factors for developing persistent wheezing may improve their outcome. Therefore early intervention of infants with high risk factors will be necessary for preventing develop childhood asthma.
Animals ; Asthma ; Birth Weight ; Demography ; Dermatitis, Atopic ; Dogs ; Early Intervention (Education) ; Egg White ; Eosinophils ; Gestational Age ; Hair ; Humans ; Hypersensitivity ; Immunoglobulin E ; Infant* ; Milk ; Respiratory Center ; Respiratory Sounds* ; Retrospective Studies ; Risk Factors* ; Siblings

PURPOSE: Some studies report a role of leukotrienes in the pathogenesis of atopic dermatitis and suggest a rationale for the use of leukotriene receptor antagonist (LTRA) in the treatment of atopic dermatitis. This study aimed to evaluate the treatment effectiveness of montelukast in children with atopic dermatitis. METHODS: Fifty-four children between the ages of 2 and 6 years with moderate to severe atopic dermatitis were enrolled. Group A received montelukast for 8 weeks, followed by a crossover to 8 weeks of placebo after a 2-week washout period. Group B reversed the administration according to a randomized, double-blind, placebo-controlled, crossover design. The SCORing atopic dermatitis (SCORAD) index, urinary leukotriene E4 (LTE4), and eosinophil-derived neurotoxin (EDN) were assessed at every visit. RESULTS: Forty-three patients (21 males) completed the study. Although the SCORAD index was decreased in both groups, there was no statistically significant difference between montelukast and placebo (-3.0±11.2 vs -5.7±11.3, P=0.43). The level of urinary LTE4 was decreased after taking montelukast when compared to placebo, but there was no statistically significant difference (-65.9±556.2 vs 87.7±618.3, P=0.26). The changes in urinary EDN after taking montelukast and placebo had no significant difference (37.0±1,008.6 vs -195.8±916.7, P=0.10). When analyzing SCORAD indices, urinary LTE4, and EDN, we could not prove the effectiveness of montelukast in the atopic, non-atopic or high ECP (ECP ≥15 µg/L) subgroups. CONCLUSIONS: There was no statistically significant difference in clinical improvement or biomarkers between montelukast and placebo treatment. Therefore, conventional treatments with skin care and infection control might be more important strategies in the treatment of atopic dermatitis.
Biological Markers ; Child* ; Cross-Over Studies* ; Dermatitis, Atopic* ; Eosinophil-Derived Neurotoxin ; Humans ; Infection Control ; Leukotriene E4 ; Leukotrienes ; Receptors, Leukotriene ; Skin Care ; Treatment Outcome

PURPOSE: Recently, an increase in the number of patients sensitized to rice allergen with or without clinical symptoms has been reported. This study was designed to determine the major allergens in rice and their clinical significance. METHODS: Twenty-four children (15 boys and 9 girls; mean age, 16.3 months) with allergic disease, who were sensitized to rice antigen (by UniCAP) in the Pediatric Allergy Respiratory Center at Soonchunhyang University Hospital, were enrolled in this study. The allergenicity of various types of rice (raw, cooked, and heat-treated, simulated gastric fluid [SGF], and simulated intestinal fluid [SIF]) was investigated using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoglobulin E (IgE) immunoblots. The patients' medical records, including laboratory data and allergy symptoms after ingestion of rice were reviewed. RESULTS: Patients were sensitized to an average of 13.5 food antigens and their mean total IgE was 6,888.7 kU/L. In SDS-PAGE, more than 16 protein bands were observed in the raw rice, whereas only 14-16 kDa and 31-35 kDa protein bands were observed in cooked rice. The common SDS-PAGE protein bands observed in SGF-, SIF-, and heat-treated rice were 9, 14, and 31 kDa. In a heated-rice IgE immunoblot, protein bands of 9, 14, and 31-33 kDa were found in 27.8%, 38.9%, and 38.9% of all sera, respectively, and in 50%, 50%, and 75%, of ser a from the 4 symptomatic patients, respectively. CONCLUSION: The 9-, 14-, and 31-kDa protein bands appeared to be the major allergens responsible for rice allergy symptoms.
Allergens ; Child ; Eating ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Medical Records ; Respiratory Center ; Sodium

Pompe disease is a genetic disorder caused by a deficiency of acid alpha-glucosidase (GAA). Infantile onset Pompe disease is uniformly lethal. Affected infants generally present in the first few months of life with hypotonia, generalized muscle weakness, and a hypertrophic cardiomyopathy, which is rapidly followed by death, usually by the age of one. The late-onset form is characterized less severe symptoms and prognosis. Therapy for Pompe disease is intended to directly address the underlying metabolic defect via intravenous infusions of recombinant human GAA to replace the missing enzyme. We report a case of atypical infantile-onset Pompe disease that presented symptoms in infancy but had less severe clinical manifestations and improved after GAA enzyme replacement (Myozyme(R), Genzyme Co., MA, USA) therapy. It is very important that pediatricians become aware of signs and symptoms of Pompe disease, such as a nasal voice or a waddling gait at an early stage so that these patients can benefit from appropriate GAA replacement therapy as soon as possible.
alpha-Glucosidases ; Cardiomyopathy, Hypertrophic ; Enzyme Replacement Therapy* ; Gait ; Glycogen Storage Disease Type II* ; Humans ; Infant ; Infusions, Intravenous ; Muscle Hypotonia ; Muscle Weakness ; Prognosis ; Voice

Cutaneous plasmacytosis is a rare disorder characterized by multiple red-brown plaques, mainly on the trunk, which histologically show a marked hyperplasia of mature plasma cells with no mitotic figures or cellular atypia. It is sometimes accompanied by extracutaneous symptoms like lymphadenopathy or interstitial pneumonia, but without plasma cell infiltration. Although many treatments such as corticosteroid lesional injection, cyclophosphamide, melphalan, systemic PUVA, and local tacrolimus application have been introduced for cutaneous plasmacytosis, there is no reported post-treatment data on cutaneous plasmacytosis in Korea. We report a case of a Korean male patient who was diagnosed with cutaneous plasmacytosis which was improved by PUVA therapy.
Cyclophosphamide ; Humans ; Hyperplasia ; Korea ; Lung Diseases, Interstitial ; Lymphatic Diseases ; Male ; Melphalan ; Plasma Cells ; PUVA Therapy* ; Tacrolimus