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2009 H1N1 influenza virus infection and necrotizing pneumonia treated with extracorporeal membrane oxygenation.

Suntae JI ; Ok Jeong LEE ; Ji Hyuk YANG ; Kangmo AHN ; Joongbum CHO ; Soo In JEONG ; Woo sik HAN ; Yae Jean KIM

Korean Journal of Pediatrics.2011;54(8):345-349. doi:10.3345/kjp.2011.54.8.345

A 3-year-old girl with acute respiratory distress syndrome due to a H1N1 2009 influenza virus infection was complicated by necrotizing pneumonia was successfully treated with extracorporeal membrane oxygenation (ECMO). This is the first reported case in which a pediatric patient was rescued with ECMO during the H1N1 influenza epidemic in Korea in 2009.
Child ; Extracorporeal Membrane Oxygenation ; Humans ; Influenza, Human ; Korea ; Orthomyxoviridae ; Pneumonia ; Preschool Child ; Respiratory Distress Syndrome, Adult

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Log-transformed plasma level of brain natriuretic peptide during the acute phase of Kawasaki disease is quantitatively associated with myocardial dysfunction.

Sunhee BANG ; Jeong Jin YU ; Myung Ki HAN ; Hong Ki KO ; Sail CHUN ; Hyung Soon CHOI ; Young Hwue KIM ; Jae Kon KO ; In Sook PARK

Korean Journal of Pediatrics.2011;54(8):340-344. doi:10.3345/kjp.2011.54.8.340

PURPOSE: Brain natriuretic peptide (BNP) has been considered a biochemical marker for myocarditis in Kawasaki disease. We performed this study to determine its quantitative significance. METHODS: We attempted to correlate log-transformed BNP concentrations (log-BNP) and clinical, laboratory, and echocardiographic variables in 81 children with Kawasaki disease. Stepwise multiple linear regression analysis was used to determine the variables independently associated with log-BNP concentration. RESULTS: Serum C-reactive protein level (P<0.0001), serum alanine aminotransferase concentration (P=0.0032), white blood cell count (P=0.0030), and left ventricular mass index (P=0.0024) were positively related with log-BNP, and hemoglobin level (P<0.0001), serum albumin level (P<0.0001), Na+ concentrations (P<0.0001), left ventricular fractional shortening (P=0.0080), and peak early diastolic tissue velocity of the left ventricular basal lateral segment (P=0.0045) were negatively related to the log-BNP concentration. Multiple regression analysis showed that serum albumin concentration (R2=0.31, P=0.0098) and left ventricular mass index (R2=0.09, P=0.0004) were significantly associated with the log-BNP concentration. CONCLUSION: Elevated BNP levels during the acute phase of Kawasaki disease may be attributable to cardiac dysfunction associated with the increase in left ventricular mass, and log-BNP concentration may be a quantitative biochemical marker of myocarditis in Kawasaki disease.
Alanine Transaminase ; Biomarkers ; Brain ; C-Reactive Protein ; Child ; Hemoglobins ; Humans ; Leukocyte Count ; Linear Models ; Mucocutaneous Lymph Node Syndrome ; Myocarditis ; Natriuretic Peptide, Brain ; Plasma ; Serum Albumin

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Polymorphisms of methylenetetrahydrofolate reductase are not a risk factor for Kawasaki disease in the Korean population.

Kyung Lim YOON ; Jin Hee KO ; Kye Shik SHIM ; Mi Young HAN ; Sung Ho CHA ; Su Kang KIM ; Joo Ho JUNG

Korean Journal of Pediatrics.2011;54(8):335-339. doi:10.3345/kjp.2011.54.8.335

PURPOSE: Hyperhomocysteinemia is known as a risk factor for atherosclerosis. Preclinical arteriosclerosis is noted and premature atherosclerosis is known to be accelerated in Kawasaki disease (KD) patients. Genetic polymorphisms in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene result in elevated plasma homocysteine concentrations and are known to be associated with the development of coronary artery disease. Our hypothesis is that single nucleotide polymorphisms (SNPs) of the MTHFR gene are related to the development of KD and coronary artery lesions (CALs). METHODS: For this study, we selected 3 candidate single nucleotide polymorphisms (SNPs) (rs2274976, rs1801131, and rs1801133) of MTHFR. These SNPs are located on chromosome 1p36.3. We included 101 KD patients and 306 healthy adults as controls in this study. CALs were seen in 38 patients. Genotypes of the selected SNPs were determined by direct sequencing and analyzed with SNPAlyze. RESULTS: The genetic distribution and allelic frequency of the 3 MTHFR SNPs (rs2274976, rs1801131, and rs1801133) were not significantly different in patients with KD compared to the control group (P=0.71, 0.17, and 0.96, respectively). There was no difference in the genetic distribution of the MTHFR SNPs between the normal control group and the CAL group (P=0.43, 0.39, 0.52 respectively). CONCLUSION: The genetic distribution of the MTHFR SNPs (rs2274976, rs1801131, and rs1801133) was not different in the KD group compared to the control group. In addition, the genetic distribution of these SNPs was not different in the CAL group compared to the control group in the Korean population.
Adult ; Arteriosclerosis ; Atherosclerosis ; Coronary Artery Disease ; Coronary Vessels ; Genotype ; Homocysteine ; Humans ; Hyperhomocysteinemia ; Methylenetetrahydrofolate Reductase (NADPH2) ; Mucocutaneous Lymph Node Syndrome ; Oxidoreductases ; Plasma ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Risk Factors ; Tetrahydrofolates

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Clinical characteristics and outcomes among pediatric patients hospitalized with pandemic influenza A/H1N1 2009 infection.

Eun LEE ; Ju Hee SEO ; Hyung Young KIM ; Shin NA ; Sung Han KIM ; Ji Won KWON ; Byoung Ju KIM ; Soo Jong HONG

Korean Journal of Pediatrics.2011;54(8):329-334. doi:10.3345/kjp.2011.54.8.329

PURPOSE: The purpose of this article is to describe the clinical and epidemiologic features and outcomes among children hospitalized with pandemic influenza A/H1N1 2009 infection. METHODS: We retrospectively reviewed the charts of hospitalized pediatric patients (<18 years) diagnosed with pandemic influenza A/H1N1 2009 infection by reverse-transcriptase polymerase chain reaction at a tertiary hospital in Seoul, Korea, between September 2009 and February 2010. RESULTS: A total of 72 children were hospitalized with pandemic influenza A/H1N1 2009 infection (median age, 6.0 years; range, 2 months to 18 years). A total of 40% had at least 1 underlying medical condition, including asthma (17%), malignancies (19%), and heart diseases (17%). Of the 72 patients, 54 (76%) children admitted with H1N1 infection showed radiographic alterations compatible with pneumonia. There was no significant difference in pre-existing conditions between pandemic influenza A/H1N1 infected patients with or without pneumonia. Children with pandemic influenza A/H1N1 pneumonia were more likely to have a lower lymphocyte ratio (P=0.02), higher platelet count (P=0.02), and higher level of serum glucose (P=0.003), and more commonly presented with dyspnea than did those without pneumonia (P=0.04). CONCLUSION: No significant differences in age, sex, or presence of preexisting conditions were found between children hospitalized with pandemic influenza A/H1N1 H1N1 influenza infection with pneumonia and those without pneumonia. Higher leukocyte count, higher glucose level, and a lower lymphocyte ratio were associated with the development of pandemic A/H1N1 2009 influenza pneumonia.
Asthma ; Child ; Dyspnea ; Glucose ; Heart Diseases ; Hospitalization ; Humans ; Influenza, Human ; Korea ; Leukocyte Count ; Lymphocytes ; Pandemics ; Platelet Count ; Pneumonia ; Polymerase Chain Reaction ; Retrospective Studies ; Tertiary Care Centers

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Complications of nephrotic syndrome.

Se Jin PARK ; Jae Il SHIN

Korean Journal of Pediatrics.2011;54(8):322-328. doi:10.3345/kjp.2011.54.8.322

Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.
Abdominal Pain ; Acute Kidney Injury ; Adrenal Cortex Hormones ; Alkylating Agents ; Anemia ; Blood Proteins ; Bone Diseases ; Cellulitis ; Chickens ; Child ; Cyclosporine ; Cytotoxins ; Glomerulosclerosis, Focal Segmental ; Humans ; Hypocalcemia ; Hypothyroidism ; Hypovolemia ; Mycophenolic Acid ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Peritonitis ; Proteinuria ; Sepsis ; Tachycardia ; Thromboembolism ; Venous Thromboembolism

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Treatment of steroid-resistant pediatric nephrotic syndrome.

Hee Gyung KANG

Korean Journal of Pediatrics.2011;54(8):317-321. doi:10.3345/kjp.2011.54.8.317

Children who suffer from steroid-resistant nephrotic syndrome (SRNS) require aggressive treatment to achieve remission. When intravenous high-dose methylprednisolone fails, calcineurin inhibitors, such as cyclosporine and tacrolimus, are used as the first line of treatment. A significant number of patients with SRNS progress to end-stage renal disease if remission is not achieved. For these children, renal replacement therapy can also be problematic; peritoneal dialysis may be accompanied by significant protein loss through the peritoneal membrane, and kidney allograft transplantation may be complicated by recurrence of SRNS. Plasmapheresis and rituximab were initially used for treatment of recurrent SRNS after transplantation; these are now under consideration as rescue therapies for refractory SRNS. Although the prognosis of SRNS is complicated and unfavorable, intensive treatment in the early stages of the disease may achieve remission in more than half of the patients. Therefore, timely referral of pediatric SRNS patients to pediatric nephrology specialists for histological and genetic diagnosis and treatment is highly recommended.
Antibodies, Monoclonal, Murine-Derived ; Calcineurin ; Child ; Cyclosporine ; Humans ; Kidney ; Kidney Failure, Chronic ; Membranes ; Methylprednisolone ; Nephrology ; Nephrotic Syndrome ; Peritoneal Dialysis ; Plasmapheresis ; Prognosis ; Recurrence ; Referral and Consultation ; Renal Replacement Therapy ; Specialization ; Tacrolimus ; Transplantation, Homologous ; Transplants ; Rituximab

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Kawasaki disease presenting as retropharyngeal abscess.

Sung Yoon CHO ; Hye Kyung CHO ; Ky Young CHO ; Hae Soon KIM ; Sejung SOHN

Korean Journal of Pediatrics.2008;51(9):1023-1027. doi:10.3345/kjp.2008.51.9.1023

A group of patients with Kawasaki disease (KD) initially present with cervical lymphadenitis or deep neck infection. These unusual KD presentations lead to unnecessary antibiotic therapy or surgical intervention, thereby delaying intravenous immunoglobulin treatment and increasing the risk of coronary artery damage. We present four KD patients whose initial presentations mimicked a retropharyngeal abscess. Nonsuppurative cervical lymphadenitis or suspected neck abscess unresponsive to intravenous antibiotics could signal the possibility of KD.
Abscess ; Anti-Bacterial Agents ; Coronary Vessels ; Humans ; Immunoglobulins ; Lymphadenitis ; Mucocutaneous Lymph Node Syndrome ; Neck ; Retropharyngeal Abscess

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A case of testicular adrenal rest tumor in a male child with congenital adrenal hyperplasia.

Joo Hwa KIM ; Kyong Ah YUN ; Choong Ho SHIN ; Sei Won YANG

Korean Journal of Pediatrics.2008;51(9):1018-1022. doi:10.3345/kjp.2008.51.9.1018

Testicular adrenal rest tumors are a well-known complication in male patients with congenital adrenal hyperplasia. Corticosteroid suppressive therapy usually results in the regression of these tumors. We describe a patient with 21-hydroxylase deficiency who developed bilateral testicular masses. Despite steroid suppressive therapy, the tumors did not regress and hormonal control was poor. Consequently, bilateral partial orchiectomies were performed.
Adrenal Hyperplasia, Congenital ; Adrenal Rest Tumor ; Child ; Humans ; Male ; Orchiectomy ; Steroid 21-Hydroxylase ; Testicular Neoplasms

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Clinical significance of the mechanical properties of the abdominal aorta in Kawasaki disease.

Mi Jin KIM ; Sang Yun LEE ; Yong Bum KIM ; Hong Ryang KIL

Korean Journal of Pediatrics.2008;51(9):1012-1017. doi:10.3345/kjp.2008.51.9.1012

PURPOSE: This study aimed to assess the mechanical properties of the abdominal aorta in school-aged patients treated for Kawasaki disease and in normal, healthy children. METHODS: This study examined 28 children with Kawasaki disease who had been followed up on and 30 healthy subjects of the same age and gender. We recorded systolic (Ps) and diastolic (Pd) blood pressure values and the aortic diameter at both minimum diastolic (Dd) and maximum systolic (Ds) expansion using two-dimensional echocardiography. These measurements were used to determine 1) aortic strain: S=(Ds-Dd)/Dd; 2) pressure strain elastic modulus: Ep=(Ps-Pd)/S; and 3) normalized Ep: Ep*=Ep/Pd. RESULTS: Ep (P=0.008) and Ep* (P=0.043) of the Kawasaki disease group were relatively high compared to those of the control group. Ep (P=0.002) and Ep* (P=0.015) of patients with coronary aneurysm were also relatively high compared with those of patients without coronary aneurysm, but lipid profiles did not differ, except for homocysteine (P=0.008). Therefore, in patients with coronary aneurysm, aortic stiffness was higher, compared to not only the control group but also patients without coronary aneurysm. However, in patients without coronary aneurysm, aortic stiffness was not significant, different compared to the control group. CONCLUSION: Measuring aortic distensibility may be helpful in assessing the risk of early atheroscletic change in the long-term management of Kawasaki disease.
Aorta, Abdominal ; Blood Pressure ; Child ; Coronary Aneurysm ; Echocardiography ; Homocysteine ; Humans ; Mucocutaneous Lymph Node Syndrome ; Sprains and Strains ; Vascular Stiffness

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Polymorphisms of interleukin-1beta promoter in simple febrile seizures.

Jang Won YOON ; Eun Jung CHOEN ; Young Hyuk LEE

Korean Journal of Pediatrics.2008;51(9):1007-1011. doi:10.3345/kjp.2008.51.9.1007

PURPOSE: Febrile seizure (FS) is the most common type of seizure. The role of genetic factors in FSs has long been recognized. A positive family history can be elicited in 25-40% of patients with FSs; nonetheless, the genes responsible for FSs in the majority of the population remain unknown. Interleukin-1beta (IL-1beta) is a pro-inflammatory cytokine that acts as an endogenous pyrogen. Thus, IL-1beta could be involved in the pathophysiology of FSs. METHODS: To determine whether or not single nucleotide polymorphisms of the IL-1beta gene are associated with susceptibility to simple FSs, IL-1beta promoter -31 and -511 genotyping was performed by means of polymerase chain reaction-restriction fragment (PCR-RF) length polymorphism in 40 FS patients (20 sporadic and 20 familial FS patients) and 33 controls. RESULTS: There were no significant differences in the frequencies of -31 C/T and -511 C/T in the IL-1beta promoter gene, between simple FS patients and controls. CONCLUSION: The frequency of CT/CT increased relatively in familial FS patients. A study examining a larger number of FS patients is needed.
Humans ; Interleukin-1 ; Interleukin-1beta ; Polymorphism, Single Nucleotide ; Seizures ; Seizures, Febrile

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