No abstract available.
Wilms Tumor*

No abstract available.
Failure to Thrive*

BACKGROUND: Acute idiopathic thrombocytopenic purpura(ITP) in children has a low morbidity and mortality, and most of cases are self limited illness. But some of them are not responsive to treatment and finally progress to chronic disease. The purpose of this study is to evaluate the factors which influence the outcome in childhood idiopathic thrombocytopenic purpura. METHOD: From January 1990 to December 1995, patients with ITP who were admitted to the Pediatric department of Pusan National University Hospital were divided into acute and chronic form depending on whether the platelet count had returned to normal(150 x 10(9)/1) by six months after diagnosis. Between two groups, the clinical and laboratory characteristics, response to treatment were compared. RESULT: 1) Out of 55 patients with ITP, 36 cases(65.5%) were acute and 19 cases(34.5%) were chronic ITP. 2) Sex, previous viral infection history, clinical manifestations were not significantly different between two groups, but the chronic ITP was rare in less than 1 year of age. 3) The duration of symptoms over >2 weeks at presentation was strongly predictive of chronic ITP. 4) Most of chronic disease (87.5%) showed platelet counts below 150 x 10(9)/1 at 28 days after diagnosis as compared with acute disease(25.0%). 5) Among 19 cases of chronic disease, 6 cases responded completely to treatment, but 11 cases(57.9%) did not respond to any treatments, 2 cases improved spontaneously. CONCLUSION: A history of symptoms over 2 weeks at presentation and platelet counts below 150 x 10(9)/1 at 28 days after diagnosis were strong predictors of chronic ITP in children.
Busan ; Child ; Chronic Disease ; Diagnosis ; Humans ; Mortality ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic*

PURPOSE: Tumor lysis syndrome is characterized by hyperuricemia, hyperphosphatemia, hypetkalemia and hypocalcemia due to destruction of tumor cells. The purpose of this study is bi estimate in children the incidence, onset time, differences in outcomes between hemodialysis and conservative therapy, and predictive factor of tumor lysis syndrome before treatment with chernotherapy. METHODS: Subjects were 108 children who had received induction chemotherapy from January 1993 to December 1998. We reviewed 12 patients who developed turnor lysis syndrorne, and retrospectively analyzed their data on WBC, Hb, platelet, LDH, uric acid, phosphorus, potassiurr., calcium, BUN and creatinine. RESULTS: Tumor lysis syndrome was observed in 12(11.1%) cases. Seven out of 12 patient:; (58A%) were in the age group of 6 to 10 years. The incidence of tumor lysis syndrome was 9.4% in acute leukemia, 30.8% in malignant lymphoma and 6.5% in solid tumor. Before chemotherapy, tumor lysis syndrome occurred in 3 cases(25.0%). Nine cases(75.0%) developed after initiation of chemotherapy. LDH was significantly higher in the group with tumor lysis syndrome(2790.8+/-1882.1U/L) than the group without(777.6+/-618.5U/L)(P<0.05). Of 12 patients, there were increased levels of phosphorus and uric acid in 11 cases, creatinine in 9 cases, potassium in 6 cases, and calcium was decreased in 8 cases. There was no death during treatment. Duration of treatment until improvement was longer in the hemodialysis group(7.62.7 days) than in thi conservative therapy group(5.71.5 days). CONCLUSION: Turnor lysis syndrome occurred mostly within 24-48 hours after chernotherapy of acute lymphocytic leukemia and Burkitt's lymphoma. LDH before chemotherapy was helpful in predicting the occurrence of turnor lysis syndrome in children.
Blood Platelets ; Burkitt Lymphoma ; Calcium ; Child* ; Creatinine ; Drug Therapy ; Humans ; Hyperphosphatemia ; Hyperuricemia ; Hypocalcemia ; Incidence ; Induction Chemotherapy ; Leukemia ; Lymphoma ; Phosphorus ; Potassium ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Renal Dialysis ; Retrospective Studies ; Tumor Lysis Syndrome* ; Uric Acid

No abstract available.
Diagnosis* ; Evoked Potentials, Somatosensory* ; Trigeminal Nerve Injuries* ; Trigeminal Nerve*

PURPOSE: This study was designed to evaluate the safety and efficacy of early cessation of antibiotic treatment regardless of absolute neutrophil count in children with febrile neutropenia and no identifiable infectious source. METHODS: A prospective randomized clinical trial was performed in 93 episodes of fever in 37 neutropenic children with cancer, who were admitted to the Department of Pediatrics, Pusan National University Hospital from January 1996 to June 1997. RESULTS: Thirty-seven patients represented 93 febrile neutropenic episodes after chemotheraphy. Among them, 63 febrile episodes had no focus of fever, and there were 10 episodes of bacteremia. Of 63 febrile episodes who weren't identified focus of fever, only 47 febrile episodes had early cessation of antibiotics. During 47 febrile episodes, only 4 episodes (8.5%) had recurrent fever after early cessation of empirical antibiotic therapy. Between patients with recurrent fever and without recurrent fever, there were no significant difference in absolute neutrophil count (ANC) and CRP at admission, high body temperature before admission and duration of antibiotics. Recurrent rate of fever was high in patients who declined in absolute neutrophil count (ANC) and less than 25% increase in absolute phagocyte count (APC) at the stop of antibiotics. CONCLUSION: We suggest that early cessation of antibiotics regardless of absolute neutrophil count (ANC) is safe in the case of febrile neutropenia without an identifiable source of infection.
Anti-Bacterial Agents* ; Bacteremia ; Body Temperature ; Busan ; Child ; Febrile Neutropenia* ; Fever ; Humans ; Neutrophils ; Pediatrics ; Phagocytes ; Prospective Studies

Anemia can be defined as a reduction in blood hemoglobin concentration or red cell mass relative to age matched normal values. Clinical presentation may range from obviously pale and lethargy to an incidental finding during screening of an otherwise well appearing child. The differential diagnosis of anemia in each instance is broad with numerous possible etiologies. A careful history and physical examination as well as complete blood count, peripheral blood smear and additional laboratory tests are necessary in defining underlying cause of the anemia and guide in further treatment plans. In addition, Iron deficiency anemia and anemia of inflammation are common causes of mild to moderate anemia in children, but most pediatricians have some confusions to differentiate these two entities.
Anemia* ; Anemia, Iron-Deficiency ; Blood Cell Count ; Child* ; Diagnosis, Differential* ; Erythrocyte Volume ; Humans ; Incidental Findings ; Inflammation ; Lethargy ; Mass Screening ; Physical Examination ; Reference Values

PURPOSE: We evaluated plasma coagulation parameters sequentially and the influence of antithrombin III adjuvant treatment in children with acute lymphoblastic leukemia. METHODS: Twenty-nine cases with acute lymhoblastic leukemia who had been treated with L-asparaginase at Pusan National University Hospital were enrolled in this study. The coagulation parameters were checked before and on every week of L-asparaginase administration. The patients whose level of antithrombin III was below normal range were given antithrombin III done adjuvant treatment. RESULTS: In the twenty-nine cycles of chemotherapies, nine cycles were treated with antithrombin III adjuvant therapy and others were not treated with the therapy. The PT and aPTT levels showed no changes during L-asparaginase treatment. After one week of L-asparaginase treatment, the fibrinogen and antithrombin III levels were decreased markedly. Antithrombin III level in patients under antithrombin III adjuvant treatment had increased significantly. On the other hand, antithrombin III level in patients not on antithrombin III adjuvant treatment showed low levels until finishing L-asparaginase. We observed only one case of sudden cerebral thrombosis in the non-antithrombin III adjuvant treatment. CONCLUSION: Antithrombin III adjuvant treatment can correct hemostatic parameters partially and may prevent thromboembolic events in patients with L-asparaginase.
Antithrombin III* ; Busan ; Child* ; Drug Therapy ; Fibrinogen ; Hand ; Humans ; Intracranial Thrombosis ; Leukemia ; Plasma ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Reference Values

No abstract available.
Neoplasm Metastasis* ; Peptide Hydrolases*

Granulocytic sarcoma is an uncommon extramedullary localized tumor composed of granulocytic precursor cells. The majority of cases have been reported in association with acute myeloid leukemia(AML) especially in children, but infrequently may occur in patients with myeloproliferative disorders or myelodysplastic syndromes. Most common sites of involvement were bone, soft tissue, lymph nodes and skin, but gastrointestinal tract, testis, central nervous system are also involved rarely. We present an unusual case of granulocytic sarcoma of the intracranium and the retro-orbital soft tissue occurring in a patient with concurrent myelodysplastic syndrome, diagnosed by brain magnetic resonance images and ultrasound guided needle biopsy.
Biopsy, Needle ; Brain ; Central Nervous System ; Child ; Gastrointestinal Tract ; Granulocyte Precursor Cells ; Humans ; Lymph Nodes ; Myelodysplastic Syndromes* ; Myeloproliferative Disorders ; Sarcoma, Myeloid* ; Skin ; Testis ; Ultrasonography