• Clinical and Experimental Pediatrics
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• v.52 no.5
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• pp.538-543
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• 2009

Purpose : To report the clinical experience with amitriptyline for managing children with cyclic vomiting syndrome (CVS). Methods : Totally, eleven children (eight males) were diagnosed with CVS. Of these, medical records were reviewed for eight children treated with amitriptyline; three children were not treated because one was not followed up and two were kept under observation to study the natural course without medication, because the frequency of vomiting had recently decreased to less than one episode per year. The eight amitriptyline-treated children were divided into three groups by the therapeutic response: (1) complete remission (CR), with no recurrence of symptoms after treatment; 2) partial remission (PR), in which the frequency of symptoms decreased by almost 50% after treatment; and (3) no response. Results : For the eight amitriptyline-treated children, the mean age of symptom onset was 4.7 (0.3-7) yr and mean age at diagnosis was 8.9 (6.0-11.3) yr. The mean number of vomiting episodes was 8.8 (2-25) per year, and the duration of vomiting in each episode ranged from 3 hours to 5 days. CR was achieved in five (62.5%) of the eight amitriptyline-treated children (0.2-0.8 mg/kg/day orally, at night) and PR was achieved in three children (37.5%). Two children relapsed on discontinuation of amitriptyline by their parents decision but showed improvement on remedication. No adverse effects were noted throughout the study period. Conclusion : Amitriptyline can be used in long-term prophylaxis for the management of children with CVS aged over 6 yr. However, a large-scale study is needed to ascertain its effects.

• Pediatric Infection and Vaccine
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• v.14 no.2
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• pp.145-154
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• 2007

Purpose : Rotavirus is one of the most important etiologic agents of nosocomial infections among the neonates. This study was designed to investigate nosocomial rotavirus infection in neonates who were admitted to a postpartum-care center after birth. Methods : From March 2005 to September 2006, 957 healthy neonates were examined for rotavirus antigen in stool by immunochromatographic method and 216 neonates were rotavirus antigen positive within 24 hours after admitted to a postpartum-care center. We reviewed the nursing charts retrospectively such as characteristics, monthly distribution, birth hospitals, delivery methods, feeding types and clinical manifestations. Results : Among 957 neonates, 216 neonates (22.6%) were rotavirus antigen positive and there were no differences in sex, birth weight, gestational age. Monthly positive rate of rotavirus antigen showed diversity from 10% to 36%. According to birth hospitals, positive rate showed diversity from 3.5% to 53.6%. Out of 957 neonates, 655 cases (68.4%) were born of vaginal delivery and mean hospitalized duration was 2.4 days, 302 cases (31.6%) were born of cesarean section and mean hospitalized duration was 5.7 days. 17.6% of vaginal delivery and 33.4% of cesarean section were rotavirus antigen positive. The positive rate was higher in neonates by cesarean section than vaginal delivery (P<0.001). According to feeding types, positive rate of rotavirus antigen was lower in breast-fed group than formula-fed group (P<0.001). Proportion of symptomatic case among rotavirus antigen positive was 34.7%. Most common clinical manifestation was diarrhea (61.3%), following poor feeding (45.3%), fever (40.0%), vomiting (25.3%), delayed weight gain (12.0%), and decreased urine amount (5.3%). Conclusion : Some neonates were already infected before admission to a postpartum-care center. Without meticulous management, nosocomial rotavirus infection would transmit rapidly in a postpartum-care center spreading to the community. Recommendation of breast-feeding, routine rotavirus screeing test with or without symptom, and isolation of all rotavirus antigen positive neonates in a postpartum-care center seem to be necessary. Also attentive hygiene education and further investigations of rotavirus infection in a postpartum-care center would be needed.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.4
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• pp.323-329
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• 2009

Purpose: Radioimmunoassay (RIA) was usually performed by the batch assay. To improve the efficiency of RIA without increase of the cost and time, random assay could be a choice. We investigated the possibility of the random assay using automatic dispenser by assessing the agreement between batch assay and random assay. Materials and Methods: The experiments were performed with four items; Triiodothyronine (T3), free thyroxine (fT4), Prostate specific antigen (PSA), Carcinoembryonic antigen (CEA). In each item, the sera of twenty patients, the standard, and the control samples were used. The measurements were done 4 times with 3 hour time intervals by random assay and batch assay. The coefficient of variation (CV) of the standard samples and patients' data in T3, fT4, PSA, and CEA were assessed. ICC (Intraclass correlation coefficient) and coefficient of correlation were measured to assessing the agreement between two methods. Results: The CVs (%) of T3, fT4, PSA, and CEA measured by batch assay were 3.2$\pm$1.7%, 3.9$\pm$2.1%, 7.1$\pm$6.2%, 11.2$\pm$7.2%. The CVs by random assay were 2.1$\pm$1.7%, 4.8$\pm$3.1%, 3.6$\pm$4.8%, and 7.4$\pm$6.2%. The ICC between the batch assay and random assay were 0.9968 (T3), 0.9973 (fT4), 0.9996 (PSA), and 0.9901 (CEA). The coefficient of correlation between the batch assay and random assay were 0.9924(T3), 0.9974 (fT4), 0.9994 (PSA), and 0.9989 (CEA) (p<0.05). Conclusion: The results of random assay showed strong agreement with the batch assay in a day. These results suggest that random assay using automatic dispenser could be used in radioimmunoassay.

• Childhood Kidney Diseases
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• v.3 no.1
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• pp.64-71
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• 1999

Purpose : The protective effects of dietary protein on the progression of renal failure were studied in subtotally nephrectomized rats. Methods : Treatment groups were as follows; 5/6 nephrectomy and a normal protein ($18.5\%$) diet (NP); 5/6 nephrectomy and a low protein ($6\%$) diet (LP): 5/6 nephrectomy, a normal protein diet and converting enzyme inhibitor, enalapril (NPE): 5/6 nephrectomy, a low protein diet and enalapril (LPE). Both diets were isocaloric and had the same phosphorus content. Proteinuria, remnant kidney weight, mesangial matrix expansion score and glomerular volume were assessed at 4, 12 and 16 weeks after renal ablation. Results : LP and NP developed progressive hypertension. Eight weeks after surgery, LPE and NPE controlled hypertension. LP, LPE, and NPE had significantly less proteinuria than NP at 16 weeks (P<0.05). Kidney weight in LP were markedly less enlarged than NP (P<0.05). There was no difference in kidney weight between LPE and NPE. At 12 and 16 weeks the mesangial matrix expansion score was significantly less in LP, LPE, and NPE compared to NP (P<0.05). At 12 and 16 weeks mean glomerular volume was significantly less in LP compared to NP (P<0.05). At 12 and 16 weeks mean glomerular volume in LPE was significantly less compared to NPE. Conclusion : Dietary protein restriction afforded considerable protection from renal injury in the rat remnant kidney model. During the enalapril treatment, there was no additional protective effect of dietary protein restriction against the development of renal lesions.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.4
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• pp.365-373
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• 2016

Composites are the most useful restorative material. However, composites have some disadvantages such as polymerization shrinkage, long working time, and susceptibility to water and contamination, which are stood out more especially when treating children. To solve these problems, bulk-fill composites have been developed. The aim of this study is to compare mechanical properties of bulk-fill and conventional composites. Bulk-fill composites (SureFil SDR flow (SDR), Tetric N-Ceram bulk fill (TBF)) and conventional composites (Filtek Z-350 (Z-350), Unifil Flow (UF), Unifil Loflo Plus (UL)) were used. The Vickers hardness tester was used to measure the microhardness of materials, and Fourier transform infrared spectroscopy was used to measure the degree of conversion. Polymerization shrinkage was measured by using a linometer. Flexural and compressive properties were measured by using the universal testing machine. Data were statistically analyzed by ANOVA and Scheffe's post hoc test. The level of significance was set to p < 0.05. Most conventional composites showed higher microhardness than bulk-fill composites. However, bulk-fill composites showed a higher top/bottom microhardness ratio than conventional composites. Bulk-fill composites showed a higher top/bottom degree of conversion ratio than conventional composites. The polymerization shrinkage was highest in UL and lowest in Z-350. The polymerization shrinkage of flowable composites was higher than that of non flowable composites. The compressive properties were highest in Z-350 and lowest in SDR and UL. In terms of flexural properties, Z-350 was the highest. However, none of the bulk-fill composites exhibited mechanical properties as good as those of conventional composites. Nonetheless, the ratio of microhardness and degree of conversion, which are important properties of bulk filling, were higher in bulk-fill composites. Therefore, the bulk-fill composites might be considered suitable restorative materials in pediatric dentistry.

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.711-715
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• 2005

Purpose : With the recent improved survival of extremely low birth weight infants(ELBWI), enteral feeding has become a major issue. This study investigates the effects of early enteral feeding in ELBWI on their morbidity, duration of hospitalization, and mortality. Methods : ELBWI admitted to the neonatal intensive care unit at Samsung Medical Center from November 1994 to April 2004 who survived more than 14 days were enrolled. ELBWI were divided into two groups : an early feeding group(EF), in which enteral feeding was started within 3 days after birth; and a late feeding group(LF), in which enteral feeding was started beyond 3 days after birth. 80 ELBWI came under EF, and 131 ELBWI under LF. Results : Birth weight and gestational age did not differ between the two groups. In EF, the time to achieve full enteral feeding and the duration of parenteral nutrition were significantly shorter than in LF. The incidence of bronchopulmonary dysplasia was significantly lower in EF, but the incidences of sepsis, necrotizing enterocolitis, and cholestasis were not different between the two groups. There was no difference in the survival rate between the two groups, but the duration of hospitalization was significantly shorter in EF. Conclusion : Early enteral feeding in ELBWI did not increase the incidence of necrotizing enterocolitis and sepsis, but rather decreased the incidence of bronchopulmonary dysplasia and shortened the duration of hospitalization.

• Clinical and Experimental Pediatrics
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• v.48 no.9
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• pp.991-997
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• 2005

Purpose : Cow's milk protein-induced enterocolitis(CMPIE) is a symptom complex of vomiting and/or diarrhea caused by delayed hypersensitivity and may result in serious complications. This study was undertaken to identify high risk factors to facilitate the early recognition of CMPIE. Methods : We reviewed the data of 101 patients, aged 15 to 45 days, admitted due to vomiting and/or diarrhea between 2003 and 2004. After excluding 13 patients absolutely breast-fed and 2 patients transferred from other hospitals with the impression of CMPIE, the 86 study subjects were divided into three groups based on the underlying etiologies; CMPIE, infectious and non-infectious group. Results : CMPIE was diagnosed in 11 patients(12.8%). On admission, failure to gain weight(P=0.003), hypoalbuminemia(P=0.003), peripheral leukocytosis(P=0.015), and metabolic acidosis(P=0.014) were more significant in the CMPIE group than in the others. Multiple logistic regression analysis showed that the independent predictors of high risks for CMPIE were failure to gain weight <10 g/day(OR, 10.25[95% CI, 1.62-65.06]) and serum hypoalbuminemia <3.5 g/dL(OR, 9.18[95% CI, 1.69-49.74]). Cow's milk challenges were performed in the 11 CMPIE patients; vomiting(81.8%), abnormal stool test(80.0%), peripheral leukocyte count and absolute neutrophil count(ANC) increase(100.0%) (P<0.05), and enteropathy(100.0%). Conclusion : CMPIE is not a rare clinical disease in early infancy. The high risk factors of CMPIE were identified as follow : failure to gain weight below 10 g/day, hypoalbuminemia on admission and a rapid decrease during admission. Cow's milk challenge test with endoscopic duodenal biopsy was helpful to confirm CMPIE.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1096-1101
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• 2005

Purpose : Recently, early surfactant replacement and tidal volume based gentle ventilation has been a fundamental treatment of respiratory distress syndrome(RDS). The aims of this study were to survey the changes in ventilator care duration and rate of complication in RDS groups. Methods : We performed a retrospective study of 255 newborn infants less than 1,500 g admitted to the neonatal intensive care unit(NICU) and discharged from January 1999 to December 2003. 141 of 255 newborn infants were RDS groups that required invasive management, such as endotracheal intubation, surfactant replacement and assisted ventilation. We analyzed epidemiologic data to study the changes in ventilator care duration and outcome of RDS groups. Results : Of 141 RDS groups, 135 were mild to moderate RDS groups and only 6 were severe RDS groups. 24(17.8%) of 135 mild to moderate RDS groups and 3(50%) of 6 severe RDS groups were antenatal no use of maternal dexamethasone. 127(90.1%) of 141 RDS groups underwent replacement of surfactant during 3 hours after birth. 121(85.9%) weaned within 48 hours. Conclusion : Our study shows a decreased frequency of severe RDS by a antenatal use of maternal dexamethasone and decreased duration of ventilator care by early surfactant replacement and gentle ventilation.

• Tuberculosis and Respiratory Diseases
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• v.65 no.3
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• pp.198-206
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• 2008

Background: Tracheobronchial suctioning using the closed suctioning system has physiological benefits for critically ill patients. Despite these benefits, there are concerns about increased colonization of tracheobronchial tree by pathogenic organisms. The cost is another hinder to the introduction of closed suction system. The aim of this study was to evaluate the incidence of colonization and ventilator associated pneumonia and the cost-effectiveness of closed suction compared with open suction. Methods: During separated one month period, patients admitted MICU were cared by multiple-use, open suction, single-use, open suction and multiple-use, closed suction method, consecutively. Costs, colonization of tracheobronchial tree by MRSA and the incidence of ventilator-associated pneumonia (VAP) were analyzed. Results: One-hundred and six patients were enrolled. Twenty patients were treated with multiple-use, open suction, while 42 and 44 patients were cared with single-use, open catheter and multiple-use, closed catheter, respectively. Colonization by MRSA and the incidence of VAP were not different among three ways of suctioning. The overall costs per patient per day for suctioning were $10.58 for multiple-use, open suction, $28.27 for single-use, open suction and $23.76 for multiple-use, closed suction. Conclusion: Multiple-use, closed suctioning, when suction catheters were changed every 48 hrs, has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal suction.

• Tuberculosis and Respiratory Diseases
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• v.52 no.4
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• pp.367-375
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• 2002

Background : Murine typhus is a flea-borne, worldwide Rickettsial disease caused by Rickettsia typhi. Its symptoms are typically mild but sometimes can be fatal. The major clinical features include fever, rash, and headache. Recently, we experienced 6 cases of ARDS associated with a Rickettsia typhi infection. This study was aimed to analyze the attributing factors for fatal murine typhus and to review the characteristics of the patients who showed acute respiratory distress syndrome as the initial presentation. Methods : The medical records of 15 patients diagnosed as murine typhus were reviewed. The diagnosis was made by single titers of 1:512 or higher, or a 4-fold rise with compatible clinical features. Acute Respiratory Distress Syndrome (ARDS) was defined according to the American-European Consensus Conference. The Characteristics between the ARDS group and the non-ARDS group of murine typhus were compared. Results : Six patients developed ARDS as their initial presentation. Two of them were women and three of them had lived urban area. None of Them a showed skin rash. One of them expired during treatment. The time lapse until the commencement of the specific treatment, the lower serum albumin level, the higher serum total bilirubin level, the higher APACHE III score and the higher MOD score were significantly associated with the ARDS group compared to the non-ARDS group. Conclusion : Murine typhus should be considered as one of the etiologies for the ARDS of unknown cause, particularly in an endemic regions. ARDS caused by Murine typhus generally has a good prognosis.