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Clinical Outcome and Prognostic Factors of Acute Respiratory Distress Syndrome in Children.

Jung Min KO ; Eun Ju HA ; Eun Hee LEE ; So Youn LEE ; Hyo Bin KIM ; Soo Jong HONG ; Seong Jong PARK

Korean Journal of Pediatrics.2005;48(6):599-605.

PURPOSE: The purpose of this study was to examine the causes, clinical courses and outcomes in children with acute respiratory distress syndrome (ARDS), and evaluate the physiologic variables as prognostic factors in the patients. METHODS: Retrograde medical chart review was carried out in 24 patients who were diagnosed with ARDS at the pediatric intensive care unit (PICU) during 20-month period. RESULTS: The incidence of ARDS among all PICU admission was 3.7 percent and the mortality rate was 37.5 percent, which was 14.8 percent of overall deaths in PICU. The most common causes of ARDS were pneumonia and sepsis. We found significant differences between survivors and non- survivors in PaO2/FiO2 ratio (P/F ratio), alveolar arterial oxygen gradient and oxygenation index (OI) on the second day from the onset of ARDS. Therapies for ARDS such as high frequency oscillator ventilation (HFOV), recruitment maneuver and low dose corticosteroid improved the P/F ratio and OI, especially in survivors CONCLUSION: The mortality rate of children with ARDS was 37.5 percent; an important cause of death in PICU. HFOV, recruitment maneuver and low dose corticosteroid seemed to be effective in pediatric ARDS. The P/F ratio, alveolar arterial oxygen gradient and OI on the second day from the onset of ARDS may be useful as prognostic factors.
Cause of Death ; Child* ; Humans ; Incidence ; Intensive Care Units ; Mortality ; Oxygen ; Pneumonia ; Respiratory Distress Syndrome, Adult* ; Sepsis ; Survivors ; Ventilation

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Comparison of Efficacy of Steroid Oint with Different Potency in Phimosis.

In Ok HWANG ; Eun Sil LEE ; Yong Hoon PARK

Korean Journal of Pediatrics.2005;48(6):594-598.

PURPOSE: Phimosis is the inability to retract the foreskin of the penis over the glans of the penis. Even though phimosis is not pathogenic, the presence of phimosis is known to increase the risk of urinary tract infection in infancy. The use of topical steroids has been advocated as a safe and economical alternative to surgical intervention. The purpose of the study was to assess the effectiveness of topical steroids for the treatment of phimosis in young boys. METHODS: A total of 53 boys with phimosis were divided into two groups to distinguish between the efficacy of low-potency topical steroid (group 1, 27 cases) and of high-potency topical steroid (group 2, 26 cases). RESULTS: The success rate increased in the process of time. After 6 weeks, the success rate was 21 cases in group 1 and 22 cases in group 2. There was no significant differences in treatment outcomes between the two groups. The age of the boys, the appearance of prepuce prior to treatment, and the presence of previous symptoms, including symptoms of UTI, and ballooning of the prepuce at micturation had no significant difference on treatment outcomes. CONCLUSION: Topical steroid was effective in treatment of phimosis in boys younger than 4 years old. Although treatment outcomes between low- and high-potency topical steroids were not significantly different, those treated with a high-potency steroid cream showed more fast improvement. Further studies are necessary to assess systemic side effects of steroid treatment, duration of treatment and prevention of genitourinary tract infection in male infants.
Child, Preschool ; Female ; Foreskin ; Humans ; Infant ; Male ; Penis ; Phimosis* ; Steroids ; Urinary Tract Infections

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Pulmonary Function Test and Body Composition Analysis in Obese Children.

Jee Seon SHIN ; Ji Hye PARK ; Ji Young KIM ; Su Jung KIM ; Young Mi HONG

Korean Journal of Pediatrics.2005;48(6):588-593.

PURPOSE: Obesity is associated with disturbances of ventilatory functions in adults. But few studies have evaluated the pulmonary complications of obesity in the pediatric population. The purpose of this study is to clarify the effects of obesity on pulmonary function and body composition in obese children. METHODS: Forty seven obese children whose ages ranged from nine to twelve years were evaluated for their body composition (intracellular fluid, extracellular fluid, protein mass, mineral mass, soft lean mass, fat mass, percent body fat, fat distribution) by bioelectrical impedance analysis. Hemoglobin, serum glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol and triglycerides were measured. Pulmonary function test was performed by spirometer. RESULTS: Intracellular fluid, protein mass, fat mass, percent body fat and fat distribution were significantly higher in severely obese children with an obesity index of more than 150 percent compared with those with an index of less than 150 percent. Peak expiratory flow rate (PEFR) was significantly lower in severely obese children with obesity index of more than 150 percent compared with those with less than 150 percent (241.7+/-14.6 L/sec vs 276.8+/-64.3 L/sec). PEFR, forced expiratory flow 25 percent (FEF25), mid expiratory flow rate (MEFR), forced expiratory flow 50 percent (FEF50), forced expiratory volume in 1st second (FEV1) and forced vital capacity (FVC) were decreased in 37.0 percent, 14.8 percent, 14.8 percent, 11.1 percent, 3.7 percent and 3.7 percent of obese children, respectively. CONCLUSION: PEFR was significantly decreased in obese children. Pulmonary function test must be performed in severely obese children and more extended study is needed in other age groups.
Adipose Tissue ; Adult ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Glucose ; Body Composition* ; Child* ; Cholesterol ; Electric Impedance ; Extracellular Fluid ; Forced Expiratory Volume ; Humans ; Intracellular Fluid ; Obesity ; Peak Expiratory Flow Rate ; Respiratory Function Tests* ; Triglycerides ; Vital Capacity

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Proliferative and Synthetic Responses of Airway Smooth Muscle in Asthma.

Jung Yeon SHIM

Korean Journal of Pediatrics.2005;48(6):580-587.

New evidence is emerging that airway smooth muscle (ASM) may act as an immunomodulatory cell by providing pro-inflammatory cytokines and chemokines, polypeptide growth factors, extracellular matrix proteins, cell adhesion receptors and co-stimulatory molecules. ASM can promote the formation of the interstitial extracellular matrix, and potentially contribute to the alterations within the extracellular matrix in asthma. In addition, extracellular matrix components can alter the proliferative, survival, and cytoskeletal synthetic function of ASM cells through integrin-directed signaling. Increased ASM mass is one of the most important features of the airway wall remodeling process in asthma. Three different mechanisms may contribute to the increased ASM mass: cell proliferation, increased migration and decreased rate of apoptosis. The major signaling pathways of cell proliferation activated by ASM mitogens are those dependent on extracellular signal-regulated kinase and phosphoinositide 3'-kinase. The key signaling mechanisms of cell migration have been identified as the p38 mitogen-activated protein kinase and the p21-activated kinase 1 pathways. ASM cells contain beta2-adrenergic receptors and glucocorticoid receptors. They may represent a key target for beta2- adrenergic receptor agonist/corticosteroid interactions which have antiproliferative activity against a broad spectrum of mitogens.
Apoptosis ; Asthma* ; Cell Adhesion ; Cell Movement ; Cell Proliferation ; Chemokines ; Cytokines ; Extracellular Matrix ; Extracellular Matrix Proteins ; Intercellular Signaling Peptides and Proteins ; Mitogens ; Muscle, Smooth* ; p21-Activated Kinases ; Phosphotransferases ; Protein Kinases ; Receptors, Adrenergic ; Receptors, Glucocorticoid

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Common Urinary Symptoms in Outpatient Clinic: Voiding Dysfunction in Children.

Kee Hyuck KIM ; Young Sig KIM

Korean Journal of Pediatrics.2005;48(6):575-579.

Urinary incontinence is the most common urinary symptom in children and causes considerable anxiety in children and parents. In most cases, there is no underlying organic pathology and the long- term prognosis is excellent. Despite these reassuring facts, children with wetting problems can be a challenge for primary pediatrician. This is probably because the problem is poorly understood, there is no readily identifiable medical pathology, and because treatment is usually time consuming and arduous. There is a great demand for treatment because wetting is an unpleasant symptom that can cause a stress and anxiety in the family. There may also be other coexisting problems such as urinary tract infection, constipation, soiling, and behavioral or emotional difficulties. Despite the frequency and vexing nature of voiding dysfunction, physicians may not always obtain a careful history to identify and to treat children properly with this condition. This article addresses the comprehensive diagnostic and therapeutic approach to such children.
Ambulatory Care Facilities* ; Anxiety ; Child* ; Constipation ; Humans ; Outpatients* ; Parents ; Pathology ; Prognosis ; Soil ; Urinary Incontinence ; Urinary Tract Infections

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Small bowel obstruction caused by an anomalous congenital band in an infant.

Tae Jung SUNG ; Ji Woong CHO

Korean Journal of Pediatrics.2008;51(2):219-221. doi:10.3345/kjp.2008.51.2.219

Intestinal obstruction is not uncommon in infants. The common causes of intestinal obstruction in the neonatal period are Hirschsprung disease, intestinal atresia, meconium ileus, and intussusception. However, small bowel obstruction caused by a congenital band is very rare. We report a 27-day-old baby who was admitted with abdominal distension and fever. The abdominal X-ray revealed massive bowel dilatation and the contrast gastrografin enema suggested a distal small bowel obstruction. The explolaparotomy showed small bowel entrapment due to an unusual anomalous congenital band.
Diatrizoate Meglumine ; Dilatation ; Enema ; Fever ; Hirschsprung Disease ; Humans ; Ileus ; Infant ; Intestinal Atresia ; Intestinal Obstruction ; Intussusception ; Meconium

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Palliative effect of (131)I-MIBG in relapsed neuroblastoma after autologous peripheral blood stem cell transplantation.

Yong Jik LEE ; Jeong Ok HAH

Korean Journal of Pediatrics.2008;51(2):214-218. doi:10.3345/kjp.2008.51.2.214

Neuroblastoma is one of the most common extracranial solid tumor of childhood, and treatment of refractory neuroblastoma remains a significant clinical problem. Iodine-131-metaiodobenzylguanidine ((131)I-MIBG) therapy is an alternative approach to treat stage IV neuroblastoma. We report the palliative effect of (131)I-MIBG in three cases of relapsed neuroblastoma after autologous peripheral blood stem cell transplantation. (131)I-MIBG is an effective and relatively nontoxic palliative therapy resulting in reduction of pain and prolongation of survival.
Neuroblastoma ; Palliative Care ; Peripheral Blood Stem Cell Transplantation

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Pericardial effusion in three cases of anorexia nervosa.

Young Kuk CHO ; Su Jin YANG ; Jae Sook MA

Korean Journal of Pediatrics.2008;51(2):209-213. doi:10.3345/kjp.2008.51.2.209

In young adolescent girls, anorexia nervosa is a significant cause of weight loss, and hospital admissions among children and adolescents. Anorexia nervosa is a life-threatening disorder, with about one-third of deaths caused by cardiac complications. A high rate of pericardial effusion has been recently reported in patients with anorexia nervosa, although relatively few cases require pericardiocentesis. Here, we describe three patients with anorexia nervosa who were diagnosed with large pericardial effusions. To prevent cardiac tamponade, pericardiocentesis was performed in two girls.
Adolescent ; Anorexia ; Anorexia Nervosa ; Cardiac Tamponade ; Child ; Humans ; Pericardial Effusion ; Pericardiocentesis ; Weight Loss

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Change of neutrophil count after treatment of intravenous immunoglobulin in children with idiopathic thrombocytopenic purpura.

Jun Young PARK ; Ji Ae PARK ; Seong Shik PARK ; Young Tak LIM

Korean Journal of Pediatrics.2008;51(2):204-208. doi:10.3345/kjp.2008.51.2.204

PURPOSE: The aim of this study was to investigate the incidence and course of neutropenia following intravenous immunoglobulin (IVIG) therapy in children with idiopathic thrombocytopenic purpura (ITP). METHODS: From January 2001 to June 2006, fifty-four patients with ITP were enrolled in this study. Forty-two of 54 patients were treated with IVIG, while the other 12 were treated with anti-D immunoglobulin (Anti-D Ig). Post-treatment absolute neutrophil counts (ANC) were compared between patients who received IVIG and those who received Anti-D Ig. Comparison of post-treatment ANC between patients who treated with two different IVIG regimens (400 mg/kg/day for 5 days and 1 g/kg/day for 2 days) was also performed. RESULTS: Pretreatment ANC were not significantly different between the two treatment groups. After treatment with IVIG, 32 out of 42 patients (76.2%) showed more than 50% decrease of ANC from the baseline. On the other hand, only 2 out of 12 patients (16.7%) showed more than 50% decrease of ANC from the baseline after treatment Anti-D Ig. No significant difference was observed in the decline of ANC between the first IVIG treatment (42 patients) and repeated IVIG treatment groups (7 patients). There was no statistical difference in post-treatment ANC between patients who treated with two different IVIG regimens. The neutropenia induced by IVIG had resolved spontaneously in 38 out of 39 patients (97%) after several days. CONCLUSION: Neutropenia following IVIG administration may not be an uncommon finding in children with ITP. It seems to be transient and self limited.
Child ; Hand ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Isoantibodies ; Neutropenia ; Neutrophils ; Purpura, Thrombocytopenic, Idiopathic

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Chest X-ray Findings and Serum Tumor Necrosis Factor-alpha Levels in Patients with Kawasaki Disease.

Ji Young KIM ; Jung Hyun KWON ; Kyung Hyo KIM ; Jung Hyun YU ; Young Mi HONG

Korean Journal of Pediatrics.2005;48(5):534-538.

PURPOSE: Kawasaki disease(KD) is a multisystemic inflammatory vasculitis of unknown etiology. Many complications other than cardiovascular involvement have been recognized in KD. However, there have been few reports published concerning involvement of the lungs in this disease. The purpose of this study was to examine the relationship between serum TNF-alpha, the degree of coronary artery dilatation and chest X-ray(CXR) findings. In addition, we have investigated serum anti-Mycoplasma antibody(AMA) titers in patients with KD who have abnormal CXR findings. METHODS: Eighty four patients with KD were included in this study(group I; 41 patients with normal CXR fndings, group II; 43 patients with abnormal CXR findings). Serum levels of TNF-alpha and AMA titer were measured. RESULTS: We reviewed the CXR findings and clinical courses of 84 patients with Kawasaki disease and found abnormal CXR findings in 43 patients(51.2 percent). Peribronchial cuffing was the most frequent abnormality(22.4 percent). In the group with abnormal CXR findings(group II), a statistical difference was not noted in age, sex, duration of fever, hemoglobin, WBC, platelet, ESR, and CRP levels and incidence of coronary arterial lesions as compared with the group having normal CXR findings(group I). No difference was noted in serum TNF-alpha level between group I and group II. 2 patients(12.5 percent) of 16 KD patients with abnormal CXR findings have positive AMA titer(above 1:320). CONCLUSION: Most of the abnormal CXR findings in KD patients were peribronchial cuffing. The abnormal CXR findings in KD patients did not mean severe inflammations. It is difficult to consider that CXR abnormalities are related to coronary arterial lesions. In addition, further study on the relationship between Mycoplasma infection and Kawasaki disease is needed
Blood Platelets ; Coronary Vessels ; Cytokines ; Dilatation ; Fever ; Humans ; Incidence ; Inflammation ; Lung ; Mucocutaneous Lymph Node Syndrome* ; Mycoplasma Infections ; Thorax* ; Tumor Necrosis Factor-alpha* ; Vasculitis

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