• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.600-612
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• 1996

Background : Recent studies deported that untreated patients with obstructive sleep apnea syndrome had high long-term mortality rates, and cardiovascular complications of these patients clad a major effect on mortality. Several data indicates that obstructive sheep apnea syndrome contributes to the development of diurnal systemic hypertension. But the pathophysiological mechanism of the development of systemic hypertension in these patients is still uncertain. This study was performed to evaluate the possible role of sympathetic nervous system activity for the development of systemic hypertension in patients with obstructive sleep apnea syndrome. Method : 35 patients with obstructive sleep apnea syndrome(OSAS) and 13 Control subjects(control) were included in this study. 21 patients of OSAS were normotensives(OSAS-NBP), and 14 patients of OSAS were hypertensives(OSAS-HBP). Full night polysomnography was undertaken to all subjects. We measured plasma norepinephrine(NE) and epinephrine(EP) concentrations during waking and sleep, using high performance liquid chromatography, in all patients and control subjects. Results : In OSAS, OSAS-NBP and control, plasma NE and EP concentrations during sleep were lowed than during waking(p<0.01). But, in OSAS-HBP, these was no difference between during waking and sleep. Plasma NE concentrations during sleep of OSAS, OSAS-NBP and OSAS-HBP were higher than Control(p<0.05). In OSAS-HBP, daytime systolic blood pressure correlated with plasma NE concentration during sleep(r=0.7415, p<0.01), arid correlated inversely with mean arterial oxygen saturation(r=-0.6465, p<0.05) or arterial oxygen saturation nadir(r=-0.6) 14, p<0.05) during sleep. Conclusion : The sympathetic activity during sleep of obstructive sleep apnea syndrome patients was higher than control subjects. In obstructive sleep apnea syndrome patients with systemic hypertension, there was no diurnal variation of sympathetic activity, and there was correlation between daytime systolic blood pressure and sympathetic activity during sleep. These data suggests that chronic hyperactivity of sympathetic nervous system may contribute to the development of diurnal systemic hypertension in patients with obstructive sleep apnea syndrome.

• Pediatric Infection and Vaccine
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• v.26 no.2
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• pp.112-117
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• 2019

Eikenella corrodens rarely causes invasive head and neck infections in immunocompetent children. We report a case of epidural abscess caused by E. corrodens in a previously healthy 13-year-old boy who presented with fever, headache, and vomiting. On physical examination upon admission, there was no neck stiffness, but discharge from the right ear was observed. Brain magnetic resonance imaging (MRI) revealed approximately 4.5-cm-sized epidural empyema on the right temporal lobe as well as bilateral ethmoid and sphenoid sinusitis, right mastoiditis, and right otitis media. During treatment with vancomycin and cefotaxime, purulent ear discharge aggravated, and on follow-up brain MRI, the empyema size increased to $5.6{\times}3.4cm$ with interval development of an abscess at the right sphenoid sinus. Burr hole trephination was performed, and foul-smelling pus was aspirated from the epidural abscess near the right temporal lobe. Pus culture yielded E. corrodens. Endoscopic sphenoidotomy was also performed with massive pus drainage, and the same organism was grown. The patient was treated with intravenous cefotaxime for 3 weeks and recovered well with no other complications. Therefore, E. corrodens can cause serious complications in children with untreated sinusitis.

• Journal of the korean academy of Pediatric Dentistry
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• v.37 no.2
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• pp.207-212
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• 2010

Protein C deficiency increases the risk of thrombosis due to the lack of anticoagulant factor protein C. Among the numerous congenital protein C deficiencies, homozygous protein C deficiency has an especially low protein C activity level, that it is almost undetectable. It is a rare disease with a probability of 1:250000~500000. The signs and symptoms of homozygous protein C deficiency include purpuric, necrotic dermatosis, ecchymosis, blindness, and thrombosis in central nervous system. A 4-year-old girl was brought to the clinic with a chief complaint of extensive caries. The child was under warfarin medication in order to prevent possible complications during dental treatment. We consulted the pediatric department. Without warfarin intake, serious complications may occur due to thrombosis during dental treatment. Therefore, certain warfarin dosage (INR 3~5) and fresh frozen plasma as a backup for excessive hemorrhage were recommended. This child was a severely disabled child with the loss of vision, and it was difficult to manage her behavior effectively. Thus, dental treatment was carried out under general anesthesia, where bleeding control would be also easier to achieve.This report presents the case of a 4-year-old girl with protein C deficiency, who has received dental treatment for extensive caries under general anesthesia.

• Journal of Life Science
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• v.17 no.11
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• pp.1464-1471
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• 2007

Diabetes mellitus is a chronic metabolic disorder, leading to many complications including cognitive deficit. Regular exercise has often been recommended as a therapeutic maneuver to the diabetic patients for the prevention of secondary complications. In the present study, the effects of treadmill exercise on memory and brain-derived neurotrophic factor (BDNF) in the hippocampus of streptozotocin (STZ)-induced diabetic rats were investigated. Male SD rats, aged 6 weeks, were randomly assigned to the following three groups: control group(n=8), STZ-induced diabetic group(n=8), and STZ-induced diabetes and exercise group(n=8). Diabetes was induced by a single injection of STZ (50 mg/kg body weight). Treadmill running was conducted with duration and frequency of 30 minutes and 5 times per week, respectively, for 8 weeks. Memories were tested in the Morris water maze. Western blotting was performed to detect BDNF expression in the hippocampus. In this study, we found that compared to the control group, the STZ-induced diabetes group had a significantly impaired cognitive performance along with suppressed BDNF expression in the hippocampus and the exercise group had a higher cognitive function in diabetic rats. Therefore, the current findings of the study show that a treadmill running exercise can improve diabetes-induced impairment of cognitive function. And the improved cognitive function appears to be related to an alleviation in diabetes-induced BDNF expression in hippocampus.

• Pediatric Infection and Vaccine
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• v.28 no.2
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• pp.66-81
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• 2021

The coronavirus disease 2019 pandemic has been continuously spreading throughout the world. As of July 15, 2021, there have been more than 188 million confirmed cases and more than 4.06 million deaths. Although the incidence of severe infections is relatively low in children and adolescents compared to adults, a complication called multisystem inflammatory syndrome in children (MIS-C) may occur in some cases at approximately 2-6 weeks after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. MIS-C can be seen in patients of various ages, from young infants to adolescents, and may present with diverse clinical manifestations. While fever present in a great majority of patients, symptoms suggesting the involvement of the digestive or nervous system and the skin and mucous membranes (Kawasaki disease-like symptoms) also appear in many cases. Cardiac involvement may also be observed, including left ventricular dysfunction, myocarditis, coronary artery dilatation, and coronary aneurysm. In some cases, hypotension or shock can occur, and mechanical ventilation or treatment in the intensive care unit may be necessary. Fortunately, recovery is generally reported after appropriate treatment. MIS-C is a rare but important complication of SARS-CoV-2 infection in children and adolescents. As such, it is important to recognize the clinical symptoms and provide appropriate treatment at an early stage. In this review, the epidemiology, clinical symptoms, suggested pathophysiology, diagnostic approach, and treatment of MIS-C will be discussed.

• Pediatric Infection and Vaccine
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• v.22 no.1
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• pp.40-44
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• 2015

Cases of incomplete Kawasaki disease (KD), wherein the patient does not fulfill the full diagnostic criteria for KD, are often detected in infants younger than 6 months of age. The clinical manifestations in infants with incomplete KD may resemble other infectious diseases, including meningitis. For this reason, clinicians may have difficulty differentiating incomplete KD from other infectious diseases in this population. Various neurological features are associated with KD, including aseptic meningitis, subdural effusion, facial nerve palsy, cerebral infarction, encephalopathy, and reversible corpus callosum splenial lesions on magnetic resonance imaging. We report a case of a 5-month-old girl with incomplete KD, associated with cerebrospinal fluid pleocytosis and an epidural fluid collection. Echocardiography indicated dilatation of the main coronary arteries. The girl made a complete recovery, with resolution of both the epidural fluid collection and coronary artery aneurysms. In this case, the child is well, and showed normal developmental milestones at the 7-month follow-up.

• Korean Journal of Head & Neck Oncology
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• v.15 no.2
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• pp.200-204
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• 1999

Objectives: Injuries of neurologic structures during parotid surgery are sometimes unavoidable even in benign tumors. Since the major postoperative neurologic complications such as facial nerve palsy and Frey's syndrome give a serious and heavy burden to both patients and surgeons, it is very important to know detailed information concerning risk factors, the incidence of complication, possibility of recovery, and the term before complete recovery. Materials and Methods: This report was based on 95 patients with parotid gland tumor who had been treated and followed up over 1 year at department of surgery and otolaryngology, chonnam university hospital. Results: 1) Among total 95 cases, the facial nerve palsy developed in 18 cases(l8.9%) and Frey's syndrome in 6 cases(6,3%). 2) The incidence of facial nerve palsy increased in cases with large tumor size, and in those operated with bipolar method. However, we didn't find out relationships between the incidence of facial palsy, localization, and histologic type. 3) The incidence of Frey's syndrome showed an increasing tendency in the cases with large tumor size, benign nature, and in those underwent superficial lobectomy with posterior approach, without a statistical significance. Conclusions: Risk of facial nerve palsy, especially a transient form, seems to be related to tumor size and bipolar coagulation method. Although Frey's syndrome tends to develop easily in the cases treated with superficial lobectomy under the diagnosis of benign tumor, a futhermore study is suggested to obtain a statistical significance.

• Pediatric Infection and Vaccine
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• v.31 no.1
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• pp.140-146
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• 2024

Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of coronavirus disease 2019 (COVID-19), causing multi-organ damage affecting the heart, lungs, kidneys, digestive tract, and nervous system. As the cases of MIS-C have been increasing following the COVID-19 pandemic, the importance of appropriate management for MIS-C is becoming increasingly apparent. Immunomodulating agents such as anakinra, infliximab, and steroids are regarded as supplementary therapy to the first-line treatment with intravenous immunoglobulin. However, these immunomodulating therapies can potentially precipitate opportunistic infections, including those caused by cytomegalovirus (CMV), Epstein-Barr virus, and tuberculosis, or increase the risk of co-infections. Herein, we report a case of a 3-year-old boy who was treated with immunoglobulin, infliximab, and high-dose methylprednisolone for MIS-C, and subsequently developed a persistent fever lasting 32 days caused by a CMV infection.

• Clinical and Experimental Pediatrics
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• v.45 no.11
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• pp.1373-1380
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• 2002

Purpose : Acute measles encephalitis(ME) is characterized by an abrupt onset of fever and obtundation, frequently accompanied by seizures and multifocal neurological signs. The aim of this study was to clarify the clinical manifestation, progression and the brain SPECT patterns in patients with acute ME. Methods : This study included 11 children with acute ME admitted to Chonbuk National University Hospital. Ten patients received a first dose of measles vaccine, one patient did not receive a first dose, and no patients received a second dose. ME was diagnosed based on characteristic clinical pictures, measles antibodies by ELISA and abnormal CSF findings. Brain MRI and brain SPECT were performed in 11 patients with acute ME. Results : There were four males and seven females whose ages at onset ranged between 18 months and 14 years(mean : 10.5 years). The main clinical neurologic pictures were loss of consciousness( 10) and seizure(five). The titer of IgG and IgM antimeasles antibodies in serum were positive in 10 patients. In CSF, nine patients had IgG antibodies and one patient had IgM antibodies. The concentration of protein(mean : $124{\pm}60mg/dL$) and WBC counts(mean : $158{\pm}157/{\mu}L$) in CSF were elevated in all patients. In electroencephalographic examination, nine patients showed increased slow waves. Seven of 11 patients(63.6%) revealed high signal intensity on the brain MRI. In contrast, all patients showed hypoperfusion in brain SPECT examination. According to brain SPECT, the perfusion deficits were frequently observed in the frontal lobe(nine), temporal (nine), parietal(eight) and thalamus(eight). Conclusion : Brain SPECT is more sensitive than MRI for the evaluation of brain damage in early stages of acute ME.

• Journal of Chest Surgery
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• v.38 no.7 s.252
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• pp.489-495
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• 2005

In the surgical treatment of aortic dissection, aortic arch replacement under total circulatory arrest is often performed after careful inspection to determine the severity of disease progression. Under circulatory arrest, antegrade or retrograde cerebral perfusion is required for brain protection. Recently, antegrade cerebral perfusion has been used more, because of the limitation of retrograde cerebral perfusion. This study is to compare these two methods especially in the respect to neurological complications. Material and Method: Forty patients with aortic dissection involving aortic arch from May 2000 to May 2004 were enrolled in this study, and the methods of operation, clinical recovery, and neurological complications were retrospectively reviewed. Result: In the ACP (antegrade cerebral perfusion) group, axillary artery cannulation was performed in 10 out of 15 cases. In the RCP (retrograde cerebral perfusion) group, femoral artery Cannulation was performed in 24 out of 25 cases. The average esophageal and rectal temperature under total circulatory arrest was $17.2^{\circ}C\;and\;22.8^{\circ}C$ in the group A, and $16.0^{\circ}C\;and\;19.7^{\circ}C$ in the group B, respectively. Higher temperature in the ACP group may have brought the shorter operation and cardiopulmonary bypass time. However, the length of period for postoperative clinical recovery and admission duration did not show any statistically significant differences. Eleven out of the total 15 cases in the ACP group and thirteen out of the total 25 cases in the RCP group showed neurological complication but did not show statistically significant difference. In each group, there were 5 cases with permanent neurological complications. All 5 cases in the ACP group showed some improvements that enabled routine exercise. However all 5 cases in RCP group did not show significant improvements. Conclusion: The Antegrade, cerebral perfusion, which maintains orthordromic circulation, brings moderate degree of hypothermia and, therefore, shortens the operation time and cardiopulmonary bypass time. We concluded that Antegrade cerebral perfusion is safe and can be used widely under total circulatory arrest.