• Clinical and Experimental Pediatrics
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• v.46 no.6
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• pp.566-571
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• 2003

Purpose : Leukoencephalopathy(LE) is one of the most serious complications in children with hematologic malignancies during the course of treatment. Early recognition is important to reduce the impact and sequelae from LE. We therefore investigated the clinical features of LE following central nervous system(CNS) prophylaxis in children with hematologic malignancies and evaluated the significance of regular check-ups of brain MRI. Methods : We retrospectively reviewed children with hematologic malignancies who had CNS prophylaxis including intrathecal(IT) methotrexate(MTX) and/or cranial irradiation at the Department of Pediatrics, Kyungpook National University Hospital from Oct. 1995 to May 2002. Fifteen cases of acute leukemia and one case of lymphoma who experienced LE following CNS prophylaxis were included in the study. Clinical data were analyzed from the medical records and brain MRIs were reviewed by neuroradiologists. Results : The ages ranged from 1 to 13 years(median age=5.2 years), and the male to female ratio was 3 : 1. The time interval from the beginning of chemotherapy to the time of diagnosis of LE ranged from 2 to 17 months. They all had IT MTX two to 15 times and ten underwent cranial irradiation(1,800 rads). At the time of diagnosis, ten of them had neuropsychiatric symptoms including seizures, personality changes, headache, etc. After the change of treatment modality, four cases showed significant improvement on follow-up MRIs, six cases had no significant changes and two had worsening of LE. Four patients died of infection and bone marrow relapse. Conclusion : CNS prophylaxis with IT therapy and cranial irradiation may cause leukoencephalopathy during the course of treatment. As a result, regular brain MRI check-up is recommended for the early detection and reducing the incidence of LE, along with changes in the treatment modality.

• Clinical and Experimental Pediatrics
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• v.46 no.9
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• pp.903-908
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• 2003

Purpose : Kawasaki disease is notorious for coronary arterial complication which is usually developed as a febrile disease in early childhood. Increased polymorphonucleus(PMN) cell levels in acute phases may be associated with the pathophysiology of Kawasaki disease. We studied the relationship between coronary arterial dilatation and elastase activity which was excreted from PMN cell and roles as an important factor for vasculitis. Methods : Ten patients diagnosed with Kawasaki disease in Yonsei University Medical Center were examined between November, 2001 and January, 2002. In addition, 15 patients with other febrile diseases were also examined. Echocardiography was done in patients with Kawasaki disease on the first day of admission and four weeks after the onset of the disease. At each time, venous samples were drawn and separated into plasma and leukocytes. In patients with other febrile disease, samples were drawn on admission. Elastase activities in plasma and neutrophil extracts were measured. Results : The significant increased plasma elastase activity, $6.19{\pm}0.74U/mL$, found in Kawasaki disease patients compared with the other febrile disease patients, $4.86{\pm}1.17U/mL$(P<0.05). And there was no significance between the above two diseases in terms of the elastase activity in neutrophil extracts. The relationship between initial elastase activity and the coronary arterial complication which was shown in subacute phase wasn't significant. Conclusion : Plasma elastase activity was increased in Kawasaki disease significantly, but the initial plasma elastase activity in the acute phase could not reflect the range of coronary arterial complication.

• Clinical and Experimental Pediatrics
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• v.46 no.3
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• pp.284-290
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• 2003

Purpose : A new airway inflammatory marker, exhaled nitric oxide(ENO) has been reported to correlate with bronchial hyperresponsiveness(BHR) and atopy. The purpose of this study was to analyze the relationship of ENO with BHR or atopy in patients with asthma and with allergic rhinitis. Methods : The subjects consisted of 55 children with asthma, 17 with allergic rhinitis, and 14 healthy controls. The asthma group was subdivided into the atopic asthma group(n=37) and the nonatopic asthma group(n=18) and the allergic rhinitis group into BHR group(n=7) and non-BHR group(n=10). All were investigated with spirometry and measurements of ENO concentration. The correlations between ENO concentration and both methacholine $PC_{20}$(provocative concentration causing a 20% decrease in forced expiratory volume in one second) and the number of allergen skin test positivity were analyzed. Results : ENO concentrations of both asthma and allergic rhinitis groups were significantly greater than that of control(P<0.01). ENO concentration of atopic asthma was significantly greater than that of nonatopic asthma(P<0.01). In allergic rhinitis, ENO concentration did not differ according to the presence or absence of BHR(P=0.50). ENO concentrations correlated significantly with the number of skin test positivity(r=0.32, P=0.02) or methacholine $PC_{20}$(r=-0.38, P<0.01) in asthma group, but not in the allergic rhinitis group(r=0.42, P=0.09; r=-0.06, P=0.83). Conclusion : In asthma patients, some pathogenetic mechanisms associated with atopy and BHR seem to influence ENO concentration. In allergic rhinitis patients, some factors other than BHR may be important in determining ENO concentration.

• Clinical and Experimental Pediatrics
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• v.52 no.2
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• pp.176-180
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• 2009

Purpose : The objective of this study was to establish the serum IGF-1 level in newborn infants, and investigate its association with growth and diseases. Methods : In a retrospective study, serum IGF-1 levels were measured for newborn infants admitted to NICU at Kyungpook University Hospital from March 2007 to July 2007. Birth data, disease history, and hospital course were obtained from medical records. Results : Of 52 blood samples obtained at birth, serum IGF-l levels in 30 preterm infants ($31.6{\pm}27.3$ ng/mL) were lower than in 22 full-term infants ($53.4{\pm}40.0$ ng/mL; P<0.05). In sick full-term infants, serum IGF-1 levels ($46.0{\pm}40.2$ ng/mL) were lower than in healthy full-term infants ($64.1{\pm}39.5$ ng/mL; P<0.05). In preterm infants, there were no differences in IGF-1 levels between healthy ($33.2{\pm}23.3$ ng/mL) and sick infants ($30.6{\pm}30.4$ ng/mL); however, IGF-1 levels in both sick and healthy preterm infants were lower than in healthy full-term infants. Among infants admitted after 8 days of life, serum IGF-1 levels were higher in infants who gained weight ($70.8{\pm}36.2$ ng/mL) than in infants who lost weight ($13.3{\pm}19.9$ ng/mL; P<0.01); however IGF-1 levels showed no difference between gender or method of delivery. Conclusion : The study showed lower IGF-l levels in preterm infants than in full-term infants. Additionally, the IGF-l level in infants with weight loss was lower than in infants with weight gain. These results indicate that serum IGF-1 is associated with gestational age and postnatal growth.

• Clinical and Experimental Pediatrics
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• v.52 no.2
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• pp.205-212
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• 2009

Purpose : Chronic urticaria is a disorder characterized by the appearance of wheals for more than 6 weeks; in most cases, the etiology is unknown. This study was aimed to discover the clinical aspects, the etiologic factors, and the course of chronic urticaria. Methods : 51 children who were diagnosed with chronic urticaria in the past 4 years, and who had had follow-ups more than 6 months after diagnosis in the pediatric department of Soonchunhyang University Hospital in Bucheon, were enrolled in the study. The laboratory findings, clinical aspects, and courses were retrospectively investigated by medical record review and telephone interview. Results : The median age of children with chronic urticaria was 4 years (8 months to 16 years) and the ratio of male to female was 1.4:1. Of the total, 39.2% of patients had a history of atopy. Angioedema occurred concurrently with urticaria in 11.8% of patients, and dermographism was seen in 41.2%. Results of thyroid function tests were normal and thyroid autoantibodies were absent in all cases. Regarding etiology, most cases (74.5%) were forms of idiopathic urticaria. Urticaria was induced by physical factors in 19.6% of patients. Open challenge tests revealed that 3 patients were allergic to food additives (glutamate 2, glutamate, and sulfite 1). In this study, most of the patients reported good response after medication of 1st- or 2nd-generation antihistamines alone. Follow-up at 6 months revealed that 70.6% of patients had experienced remission, and 84.8% of children who had follow-up at 1 year presented remission. Conclusion : Chronic urticaria in most patients was idiopathic. Remission occurred within 1 year of diagnosis, in most cases so chronic urticaria in children seems to have good prognosis.

• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.377-382
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• 2008

Purpose : The aim of this study is to assess the usefulness of skin test by an inactivated, 1/50 diluted solution of attenuated varicella vaccine in evaluating the immune status to varicella. Methods : Total 41 subjects (22 males, 19 females, aged 1-32 years) were enrolled from July to August, 2005. Past medical history including varicella infection, varicella vaccination were investigated through questionnaires. The skin test solution was prepared from solution of attenuated varicella vaccine(Oka strain) which was inactivated by exposure to room temperature for 10 days and diluted at 1/50 with normal saline. Skin test was done by injecting 0.1 mL of the solution intradermally into the volar surface of the right forearm and sterile normal saline was used as a control on the left forearm. Positive reaction was defined when the transverse diameter of the induration was 5 mm or more. Serum varicella zoster virus specific IgG antibody test by ELISA (enzyme-linked immunosorbent assay) was done. Results : In adults, the sensitivity of the varicella zoster virus skin test compared to ELISA was 94.7% and the positive predictive value was 100%. In children, both the positive predictive value and specificity were 100% but the sensitivity and the negative predictive value were 50% and 30.7% respectively. Children showed smaller skin test reactivity compared to adults. Conclusion : The varicella zoster virus skin test using inactivated, 1/50 diluted solution of attenuated varicella vaccine was proved as one of the useful tools for evaluating the immunity and susceptibility of the varicella zoster virus.

• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.367-371
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• 2008

Purpose : The surfactant dysfunction may play an important role in meconium aspiration syndrome (MAS). We aim to evaluate the effect of surfactant lavage in the treatment of term infants with MAS. Methods : The medical records of 15 neonates with severe MAS admitted at Yongdong Severance Hospital from 2005 to 2007 were reviewed and analyzed. Seven infants with severe MAS necessitating mechanical ventilation underwent tracheobronchial lavage with 20 mL/kg of diluted (5.3 mg phospholipid/mL) surfactant saline suspension ($Newfactan^{(R)}$). Data regarding clinical outcomes was assessed by comparison with 8 control infants with equally severe MAS retrospectively. Results : In the lavage group, radiological improvement was evident after 6 hours of treatment. The duration of artificial ventilation and duration of hospital day were also significantly shorten in the lavage group compared with the control group. The mean oxygen index, mean ventilation index improved significantly within the first 6 hours after treatment. No differences were found in the incidence of major complications and mortality between the two groups. Conclusion : The surfactant lavage seems to be an effective and safe method for treatment of severe MAS. A multicenter, large scaled randomized controlled trial is needed for further study.

• Pediatric Infection and Vaccine
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• v.7 no.1
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• pp.143-151
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• 2000

Purpose : The accuracy of bacteriologic diagnosis of beta-hemolytic streptococcal pharyngotonsillitis depends on the degree of carrier rate in that area where the throat swabs are obtained and the evaluation of serological T typing as an epidemiologic marker is important to understand epidemiology of streptococcal infection. The purpose of this study is to know the carrier rates of group A streptococcus in normal children form four different areas and to find out the epidemiologic characteristic in distribution of the serotypes for 3 years. Method : Throat swabs were obtained from the tonsillar fossa of normal school children in four different areas(Uljin, Seoul, Osan, Kunsan) from March to May 1996, in Uljin in April 1997, and in Uljin in April 1998. The samples were plated on a 5% sheep blood agar plate and incubated overnight at $37^{\circ}C$ before examination for the presence of beta-hemolytic colonies. All isolated beta-hemolytic streptococcus were grouped and serotyped by T agglutination. Results : The carrier rate of beta-hemolytic streptococci and group A streptococci in 1996 were 27.6%, 18.6% at Uljin; 16.4%, 2.7% at Seoul; 33.0%, 26.0% at Osan; 20.0%, 12.3% at Kunsan, respectively. Among 1,192 normal school children from 4 different areas, we obtained 179 strains of group A streptococci. Fifty two percent of the strains were typable by T agglutination in 1996. Common T-type in 1996 were NT, T1, T3, T2 at Uljin; T12, T25 at Seoul; NT, T6, T28 at Osan; T25, T4, NT, T5 at Kunsan, in decreasing order, respectively. At Uljin, T1, T3, T25 accounted for 69% of strains in 1996, T1, T12, T25 accounted for 70% in 1997, and T12, T4 accounted for 88% in 1998. Conclusion : Higher carrier rates were found in Uljin and Osan, where there are a lower population density with scanty of medical facilities compared with another areas. We supposed that low carrier rates is likely to be related to antibiotic abuse or some epidemiologic factor. The periodic and seasonal serotyping analysis is important in monitoring and understanding the epidemiologic patterns of group A streptococci.

• Child Health Nursing Research
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• v.8 no.1
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• pp.32-43
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• 2002

The purpose of this study was to provide basic data on elementary school children's lifestyle and to contribute to developing on the health education program in elementary schools. The subjects were 1,412 children in 4 elementary schools in Gangwon-Do and Chonrabuk-Do area. Data collection was done from September to November 2001 by questionnaire and school health documents. The questionnaire corrected for the purpose of this study which had been developed by Bronson School of Nursing(1991), 'Lifestyle Questionnaire for School-age Children'. The questionnaire consists of 3 categories; 'Activities that promote health', 'Injury prevention', 'Feeling'. Cronbach coefficient alpha for the 29 items was .68. The data analyzed to obtain frequency, mean, percentage, t-test, ANOVA and Pearson correlation coefficient by SPSS Win program. The results of this study were as follows. 1. Females(50.2%) of gender, 6th grade(24.2%) of grade, nuclear family(82.0%) of family type, beyond college graduate(54.5%) of father's school career, under high school graduate(58.1%) of mother's school career, first of birth order(47.1%) were majority. Mean of father's age was 41.2 and mother's age was 38.1. 2. The mean of lifestyle was 66.4, feeling was 73.3, activities that promote health was 60.3 and injury prevention was 64.0. The highest degree of activities that promote health was 「I eat fruits」and injury prevention was 「I look both ways when crossing streets」and feeling was 「I enjoy my family」. The lowest degree of activities that promote health was 「I visit the dentist every tear」 and injury prevention was 「I wear a helmet when I go on bike trips」 and feeling was 「I think it is okay to cry」. 3. There were significant differences in lifestyle of gender(t=4.309, p=.000), grade(F=6.299, p=.000), father's age(t=2.534, p=.011), father's education(t=-4.933, p=.000), mother's education(t=-3.360, p=.001), birth order (t=5.363, p=.000). There were significant differences in activities that promote health of gender(t=-2.462, P=.014), grade(F=4.893, p=.000), father's education(t=-4.480, p=.000), birth order(t=4.343, p=.000), in injury prevention of gender(t=-4.452, p=.000), grade(F=8.636, p=.000), father's age(t=3.386, p=.001), mother's age(t=2.059, p=.040), father's education(t=-6.051, p=.000), mother's education(t=-5.173, p=.000), birth order(t=4.417, p=.000) and in feeling of gender (t=-3.285, p=.001), grade(F=7.526, p=.000), mother's age(t=-3.268, p=.001). 4. Activities that promote health was positively correlated with injury prevention(r=.432, p=.000), feeling(r=.210, p=.000), lifestyle (r=.785, p=.000). Injury prevention was positively correlated with feeling(r=.256, p=.000), lifestyle(r=.854, p=.000) also feeling was positively correlated with lifestyle(r=.504, p=.000). These findings suggest the need to develop nursing strategy to promote elementary school children's health. Because helmet use score in injury prevention marked the lowest score, it is necessary to encourage helmet use when planning injury prevention and health promotion.

• Tuberculosis and Respiratory Diseases
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• v.39 no.1
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• pp.35-41
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• 1992

Background: Massive hemoptysis is a major clinical and surgical problem related to high motality. Bronchial and nonbronchial systemic arteries are considered to be the main source of hemoptysis. Embolization of these arteries has become an accepted treatment in the management of massive hemoptysis. Herein we evaluate the effect of arterial embolization in immediate control of massive hemoptysis and investigate the clinical and angiographic characteristics and the course of patients with recurrent hemoptysis after initial successful embolization. Method: 21 patients (15 men & women, aged 21 to 74 years) underwent transcatheter arterial embolization for the treatment of life-threatening massive hemoptysis from Jan 1988 to July 1991. Seven patients had inactive residual pulmonary tuberculosis, 5 cases aspergilloma, 4 cases active pulmonary tuberculosis, 3 cases bronchiectasis and 2 case lung cancer. Arteriography was done by percutaneous catheterization via the femoral artery, and at the same time, arterial embolization was done with gelfoam particle. Result: Immediate control of massive hemoptysis was achieved in all 21 cases by arterial embolization. Hemoptysis recurred in nine of 21 patients. Four cases were aspergilloma, two inactive tuberculosis, two lung cancer, and one bronchiectasis. The initial angiographic findings revealed that nonbronchial systemic arterial supply, bronchial-pulmonary arterial shunt, and marked vascularity were more frequently, but statistically insignificant, in recurred patients. The following complications occured: fever, chest pain, cough, voiding difficulty, paralytic ileus, paraplegia, and splenic infarction. The course of the recurred patients was as follows: Three patients were died due to recurred massive hemoptysis. one was aspergilloma and two lung cancer. Surgical resection could be performed successfully in two patient with relatively good lung function, one aspergilloma and the other inactive tuberculosis. In 4 patients with poor lung function, repeated embolization or medical conservative treatment was continued. Conclusion: Arterial embolization as initial treatment of massive hemoptysis is most useful and relatively safe, although this is a palliative procedure and the potentiality for recurrence exists. Repeated embolization in inoperable patient with recurrent bleeding may improve the lengthening of life.