• Clinical and Experimental Pediatrics
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• v.49 no.12
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• pp.1308-1314
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• 2006

Purpose : This study aimed to evaluate the usefulness of auditory evoked potential (AEP) in clarifying neuronal development in premature small for gestational age (SGA), and appropriate for gestational age (AGA) infants. Methods : A total of 183 premature infants who were born from August 2002 to July 2005, were examined with AEP. They were divided into three groups; AGA, symmetric-SGA and asymmetric-SGA group. Results : Statistically significant differences in the head circumference were observed in three groups. Among the risk factors, prevalence of hypoglycemia and hypoalbuminemia between AGA and asymmetric SGA infants were significantly different. V absolute peak latency (APL) in the right side of AGA infants was delayed were than that of asymmetric SGA infants. III-V interpeak latency (IPL) of asymmetric SGA infants was delayed more than that of symmetric SGA infants. Moreover, I-V IPL on both sides of symmetric SGA infants was shortened more than that of AGA infants. However, all the results of AEP were within the reference range, according to gestational age. Birth weight of, only asymmetric SGA, was related to the III APL on both sides and the III-V IPL on right side. Conclusion : This study shows that the values of APL and IPL of premature SGA infants are different than that of premature AGA infants. These data could be an indicator in evaluating the neurologic functions of small for gestational age infants.

• Clinical and Experimental Pediatrics
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• v.49 no.5
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• pp.475-481
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• 2006

Purpose : As the prevalence of childhood obesity is increasing, hypertension, hyperlipidemia, insulin resistance and diabetes mellitus have become problems. High homocysteine levels and low vitamin $B_{12}$ supplementation are acknowledged to have a role in coronary artery disease, but there are few studies on homocysteine, insulin and vitamin $B_{12}$ levels in obese children. We aimed to study whether homocysteine, insulin, vitamin $B_{12}$, folic acid levels could have any difference and relation in obese children. Methods : The disease group consisted of 27 children from 8 to 11 years old, whose obesity index was over 130. The control group consisted of 30 healthy children of the same age group. Obesity index and body mass index were calculated by height and body weight of the children, and their systolic and diastolic blood pressures at resting state were checked. Total cholesterol, triglyceride, homocysteine, insulin, vitamin $B_{12}$, folic acid levels were studied after 10 hours of fasting. Intracellular fluid, extracellular fluid, protein, mineral, muscle mass, lean body fat, fat mass and fat percentages were checked by bioelectrical impedance. Results : Homocysteine levels were higher in obese children($8.1{\pm}2.1{\mu}mol/mL$ vs. $4.9{\pm}1.0{\mu}mol/mL$). Insulin levels were also higher in obese children($26.8{\pm}11.2{\mu}IU/mL$ vs. $12.5{\pm}5.24{\mu}IUl/mL$). Vitamin $B_{12}$ was lower in obese children($798.6{\pm}174.3pg/mL$ vs. $967.8{\pm}405.0pg/mL$). But there was not a difference in the folic acid levels between the two groups. In obese children, systolic blood pressure (r=0.535), triglyceride(r=0.517), total cholesterol(r=0.408), folic acid(r=0.408), vitamin $B_{12}$(r=0.338) and abdomoanl fat %(r=0.306) had a positive correlation. Conclusion : We found definite differences of insulin, homocysteine, and vitamin $B_{12}$ plasma levels in obese children, but we need more study to use those parameters as risk factors of metabolic syndrome in pediatric obese patients.

• Clinical and Experimental Pediatrics
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• v.48 no.1
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• pp.48-54
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• 2005

Purpose : The pathologic mechanisms of central nervous system(CNS) injuries in human meningitis are not yet completely understood. Recent studies indicate that the host inflammatory responses are as important in brain damage as the infecting organisms and toxins. There have been some reports on the relationship of nitric oxide(NO), macrophage inflammatory protein-$1{\alpha}$(MIP-$1{\alpha}$), and lactoferrin in bacterial meningitis, but few reports in aseptic meningitis. Thus, we investigated the concentrations of NO, MIP-$1{\alpha}$ and lactoferrin in cerebrospinal fluid(CSF) and serum of patients with aseptic meningitis and control subjects and evaluated their relationship with other parameters of meningitis. Methods : CSF and blood were obtained from 25 subjects with aseptic meningitis and 15 control subjects. After centrifugation, supernatants were stored at $-70^{\circ}C$ and we assayed the concentrations of NO, MIP-$1{\alpha}$ and lactoferrin with the ELISA method. There were no patients with neurologic sequelae after being recovered from aseptic meningitis. Results : Concentrations of CSF and serum NO, MIP-$1{\alpha}$ were not increased in aseptic meningitis subjects compared to control subjects. Concentration of CSF lactoferrin was significantly elevated in patients with aseptic meningitis and concentration of serum lactoferrin was significantly decreased in patients with aseptic meningitis compared with those in control subjects(P<0.05). CSF lactoferrin level was positively correlated with CSF WBC counts($r_s=0.449$, P=0.007), especially with neutrophil counts($r_s=0.574$, P<0.001) and CSF protein level($r_s=0.508$, P=0.002). Conclusion : Lactoferrin plays an important role in aseptic meningitis and may be released from neutrophils recruited from blood to the CSF through breakdown of blood-brain barrier. NO and MIP-$1{\alpha}$ may not be important factors in the pathogenesis of aseptic meningitis without neurologic sequelae.

• Clinical and Experimental Pediatrics
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• v.49 no.12
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• pp.1296-1300
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• 2006

Purpose : We studied the usefulness of transcutaneous bilirubinometers in follow-up of bilirubin levels during phototherapy in neonatal jaundice patients. Methods : Transcutaneous bilirubin (TcB) was measured twice per day on 90 neonatal jaundice patients without risk factors of jaundice by transcutaneous bilirubinometer JM-103(Minolta/Hill-Rom Air-shields, Japan). TcB was measured simultaneously on the patched-forehead (TcB-PF), patchedchest(TcB-PC), unpatched-forehead (TcB-UF) and unpatched-chest (TcB-UC) of infants with neonatal jaundice. Plasma bilirubin (PB) was measured by American Optical bilirubinometer (American Optical Co, Buffalo, USA) within 30 minutes after transcutaneous bilirubinometer measurement. Each TcB was compared with PB. Results : In the study group, the mean gestational age was $38.6{\pm}1.3wk$, the mean birthweight was $3,207.0{\pm}472.1g$, the mean age at start of phototherapy was $4.9{\pm}0.9days$ and the mean duration of phototherapy was $1.3{\pm}0.6days$. The correlation between TcB and PB level was observed. The correlation between TcB of the patched part (TcB-PF, TcB-PC) and PB was more significant than that of the unpatched part (TcB-UF, TcB-UC) and PB. The most significant correlation was between PB and TcB-PC. Conclusion : TcB was useful in the follow-up of jaundice during phototherapy as well the screening of jaundice in neonatal jaundice patients. TcB of patched-chest area was the most reliable site in transcutaneous bilirubinometer examination in neonatal jaundice patients.

• Clinical and Experimental Pediatrics
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• v.52 no.8
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• pp.875-880
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• 2009

Purpose : Iron-deficiency anemia remains the most common nutritional deficiency in young infants. This study aimed to survey the actual condition of feeding patterns and weaning diet and to study the association between these factors and the prevalence of anemia in infants aged over 9 months. Methods : We studied 171 infants aged 9-24 months who were hospitalized in the general ward with mild to moderate acute illnesses. The mothers answered a questionnaire about the feeding patterns and the status of the weaning diet of their infants. The infants were divided into three groups: infants who were exclusively breast-fed, those who had been given mixed feeding, and artificial milk feeders. Results : The incidence of anemia was significantly higher in exclusively breast-fed infants (23/68, 33.8%) than in the infants with mixed feeding (11/62, 17.7%) and artificial milk feeders (5/41, 12.1%). The mothers' awareness about the state of their infants󰡑 weaning diet was not related to the presence of anemia in the exclusively breast-fed infants. About 70% of the infants had started the weaning diet before age 6 months in all three groups, without any difference according to feeding patterns. Conclusion : The incidence of anemia was significantly higher in the breast-fed group than in the other infants. Many mothers of breast-fed infants with anemia also believed that their infants were taking sufficient weaning foods. Therefore, further education of the mothers about iron-rich weaning foods and the importance of iron intake during infancy is needed to prevent anemia, especially in breast-fed infants.

• Clinical and Experimental Pediatrics
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• v.50 no.12
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• pp.1241-1246
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• 2007

Purpose : Recently, there has been several studies to clarify the pathogenesis of Kawasaki disease (KD) and the relations of VEGF and endostatin that act on vascular endothelial cells to the coronary artery complications. In this report, we measured serum levels of VEGF and endostatin in acute and subacute phases of KD to assess the change of these levels and the relations to the development of coronary artery lesions (CAL). Methods : Twenty six patients were diagnosed and treated for KD between January, 2001 and July, 2005 at Kangnam St. Mary's Hospital, the Catholic University of Korea. They were divided into those with and without CAL. Serum levels of VEGF and endostatin were measured during acute and subacute phases and compared to those measured in healthy and disease control groups. Results : Serum levels of VEGF were increased in KD but no differences were noted in KD with and without CAL. Serum levels of endostatin were decreased in the acute phase of KD, however they were recovered in the subacute phase of KD, regardless of CAL. The VEGF/endostatin ratio was increased in KD. KD without CAL showed a relative decrease in this ratio during the subacute phase. Significant positive correlations were found between serum VEGF and WBC count, VEGF and ESR, VEGF/endostatin ratio and ESR in the acute phase of KD. Conclusion : Analysis of factors influencing the vascular endothelium such as VEGF and endostatin will help to clarify the etiology of KD and the pathogenesis of CAL.

• Clinical and Experimental Pediatrics
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• v.51 no.7
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• pp.747-753
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• 2008

Purpose : Diabetes mellitus is a major risk factor for the development of cardiovascular disease. Early atherosclerotic changes in the arterial walls begin in adolescence and the risk factors are associated with its development. To assess the usefulness of carotid artery intima-media thickness (IMT), as a marker of early atherosclerosis, we evaluated the structural and functional characteristics of the carotid artery and investigated their relationshop with the metabolic and anthropometric parameters in children and adolescents with type 1 diabetes. Methods : For this study, we enrolled 23 children with type 1 diabet and 19 age and sex-equivalent healthy children as the control group. Metabolic and anthropometric parameters such as serum lipid levels, plasma glycated hemoglobin (HbA1c), and body mass index were measured after a 12-h fasting period. The carotid artery IMT was measured by a high-quality ultrasound system, and compliance, and distensibility were calculated by an equation. Results : There were no significant differences between the 2 groups with regard to the sex ratio, age, blood pressure and serum cholesterol levels' however, HbA1c levels were significantly higher in the diabetic children ($8.5{\pm}1.8$ vs. $5.0{\pm}0.2$, P=0.001). Ultrasonographic findings showed that compared with the control group, the diabetic group had higher IMT ($0.45{\pm}0.06mm$ vs. $0.41{\pm}0.04mm$, P=0.04), but there were no significant differences in compliance and distensibility. The HbA1c (P=0.002) and high-density lipoprotein cholesterol (P=0.026) levels were independent IMT predictors in the diabetic group. Conclusion : Here, the carotid artery IMT was higher in the diabetic group, and it is correlated with atherosclerotic risk factor. Thus, carotid IMT could be evaluated as a marker of early atherosclerosis in diabetic children.

• Progress in Medical Physics
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• v.9 no.3
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• pp.163-173
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• 1998

Nuclear medicine emission computed tomography(ECT) can be very useful to diagnose early stage of neuronal diseases and to measure theraputic results objectively, if we can quantitate energy metabolism, blood flow, biochemical processes, or dopamine receptor and transporter using ECT. However, physical factors including attenuation, scatter, partial volume effect, noise, and reconstruction algorithm make it very difficult to quantitate independent of type of SPECT. In this study, we quantitated the effects of attenuation and scatter using brain SPECT and three-dimensional brain phantom with and without applying their correction methods. Dual energy window method was applied for scatter correction. The photopeak energy window and scatter energy window were set to 140ke${\pm}$10% and 119ke${\pm}$6% and 100% of scatter window data were subtracted from the photopeak window prior to reconstruction. The projection data were reconstructed using Butterworth filter with cutoff frequency of 0.95cycles/cm and order of 10. Attenuation correction was done by Chang's method with attenuation coefficients of 0.12/cm and 0.15/cm for the reconstruction data without scatter correction and with scatter correction, respectively. For quantitation, regions of interest (ROIs) were drawn on the three slices selected at the level of the basal ganglia. Without scatter correction, the ratios of ROI average values between basal ganglia and background with attenuation correction and without attenuation correction were 2.2 and 2.1, respectively. However, the ratios between basal ganglia and background were very similar for with and without attenuation correction. With scatter correction, the ratios of ROI average values between basal ganglia and background with attenuation correction and without attenuation correction were 2.69 and 2.64, respectively. These results indicate that the attenuation correction is necessary for the quantitation. When true ratios between basal ganglia and background were 6.58, 4.68, 1.86, the measured ratios with scatter and attenuation correction were 76%, 80%, 82% of their true ratios, respectively. The approximate 20% underestimation could be partially due to the effect of partial volume and reconstruction algorithm which we have not investigated in this study, and partially due to imperfect scatter and attenuation correction methods that we have applied in consideration of clinical applications.

• Radiation Oncology Journal
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• v.8 no.2
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• pp.219-223
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• 1990

This is a retrospective review of 33 patients with large cell lung carcinoma treated at Yonsei University Cancer Center between Jan.1985 and Dec.1989. Of the thirty-three patients, twenty eight were men and five women. Median age was 59 years. Large cell undifferentiated carcinoma was the most common pathologic type, $78.8\%$. Twenty one of thirty three patients had far advanced diseases, stage IIIB-IV at the time of initial diagnosis. Pleural effusion was initially presented in 12 patients, and SVC syndrome appeared in 5 patients. As to location of the primary tumor,19($57.6\%$) appeared in the right lung and 14 ($42.4\%$) in the left. Patients with a centrally located primary tumor mass were nearly the same as those peripherally located (17 vs.16). Fifteen of thirty three patients developed metastasis involving not only bone, brain, the opposite lung, adrenal gland but also soft tissue, skin, pancreas and appendix. Treatment was individualized with 19 treated radically and 14 palliatively. After treatment, only two patients showed a complete response. Long term survival was observed in 4 patients: 1 (24 mo.),2 (41 mo.) and 1 (54 mo.). The overall 2 year survival rate was $14.3\%$ while the median survival time was 6.0 months. Through the analysis of the various factors affecting survival, we observed that pleural effusion-absent group and complete response group had a statistical significant better survival rate (p<0.01).

• Radiation Oncology Journal
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• v.6 no.2
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• pp.269-276
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• 1988

Eight patients with intracranial tumors or arteriovenous malformation (AVM)s which were less than 3 cm in diameter were treated by a technique of stereotactic radiotherapy during the 4months period from July 1988 through October 1988 at the Division of Radiation Therapy, Kang-Nam St. Mary's Hospital, Catholic University Medical College. The patients were diagnosed as AVMs in 3 cases, acoustic neurinoma, craniopharyngiom (recurrent), hemangioblastoma, pineocytoma, and pituitary microadenoma in each case. There are several important factors in this procedure, such as localization system, portal, field size, radiation dose, and perioperative supportive care. It is suggested that stereotactic radiotherapy may be peformed safely with a radiation dose of 12-30 Gy. So this nonivasive procedure can be used to treat unresectable intracranial tumors or AVMs. Of these, clinical symptoms had been regressed in AVMs in 2 cases at 3 months and 2 months after Stereotactic radiotherapy, one of whom was confirmed slightly regressed on the follow-up angiogram. And also craniopharyngioma and pineocytoma was minimally regressed on 3 month follow-up CT.