Ha, Eun Sil;Kim, Hye Ok;Lee, Kyoung Ju;Lee, Eun Joo;Hur, Gyu Young;Jung, Ki Hwan;Lee, Sung Yong;Kim, Je Hyeong;Lee, Sang Yeub;Shin, Chol;Shim, Jae Jeong;Kang, Kyung Ho;Yoo, Se Hwa;In, Kwang Ho
Tuberculosis and Respiratory Diseases
/
v.67
no.6
/
pp.506-511
/
2009
Background: The smoking prevalence in asthma patients are similar to those in the general population. Asthma and active cigarette smoking can interact to create more severe symptoms, an accelerated decline in lung function and impaired therapeutic responses. Accordingly, asthmatics with a history of smoking were examined to define the clinical characteristics and lung function of smoking asthmatics. Methods: The medical records of 142 asthmatics with a known smoking history were reviewed. The patients were divided into three groups according to their smoking history - current smokers, former smokers and non-smokers. The clinical characteristics, lung function, and annual declines of the forced expiratory volume in one second ($FEV_1$) were compared. Results: Fifty-three of the 142 patients (37%) were current smokers, 24 were former smokers (17%) and 65 were non-smokers (45%). The patients with a hospital admission history during the previous year included 16 current smokers (30%), 4 former smokers (17%) and 7 non-smokers (11%) (p=0.02). The mean $FEV_1$ (% predicted) was 76.8${\pm}$19.8%, 71.6${\pm}$21.1% and 87.9${\pm}$18.7% for current smokers, former smokers and non-smokers, respectively (p< 0.001). The $FEV_1$/forced vital capacity (FVC) (ratio, %) values were 63.6${\pm}$12.6%, 59.3${\pm}$14.9% and 72.1${\pm}$11.8% in current smokers, former smokers and non-smokers, respectively (p<0.001). The corresponding mean values for the individual $FEV_1$ slopes were not significant (p=0.33). Conclusion: Asthmatic smokers demonstrated higher hospital admission rates and lower lung function. These findings suggest that the smoking history is an important predictor of a poor clinical outcome in asthma patients.
Purpose: To evaluate the clinical manifestations of various glomerular diseases in children, a clinicopathological study was performed in 52 children who had renal biopsy. The type and relative incidence of the glomerular pathologies were analyzed, and the clinical predictability and usefulness of renal biopsy in glomerular diseases were assessed. Methods: Medical records of fifty two children with renal disease who had undergone percutaneous renal biopsy under ultrasonic guidance at Chungnam University Hospital from October 1995 to August 2003 were reviewed. In addition, we compared the clinical findings before renal biopsy with the pathological diagnosis. Results: The male to female ratio was 1.6:1 and they were $9.8\pm2.6$ years old on average. The chief complaints for biopsy were hematuria in 22 cases which was the most common (42.3%), proteinuria in 16 cases(30.8%), and hematuria & proteinuria(26.9%). Among the 22 cases of hematuria, there were 15 cases of gross hematuria(68.2%) and 7 cases of microscopic hematuria(31.8%). In terms of histopathologic diagnosis, most of them were primary glomerular diseases(84.6%), which included IgA nephropathy(28.8%), thin glomerular basement membrane disease(25.0%), focal segmental glomerulosclerosis(FSGS)(11.5%), membranous proliferative glomerulonephritis(7.7%), minimal change lesion(3.8%), acute poststreptococcal glomerulonephritis(3.8%) and membranous glomerulonephritis(3.8%). The clinical manifestations and pathologic diagnosis were not correlated. Conclusion: The clinical manifestations could not predict the pathological diagnosis. Therefore, renal biopsy would be inevitable in diagnosis of glomerular diseases for effective management and assessment of prognosis.
Purpose : We evaluated the C-reactive protein(CRP), white blood cell(WBC) and neutrophil levels in the various infectious diseases in a single hospital. Methods : A total of 640 medical records of children with infectious diseases such as bacterial meningitis(19 cases), acute pyelonephritis(55 cases), measles(253 cases), chicken pox (38 cases), mycoplasma pneumonia(160 cases), tsutsugamushi disease(39 cases) and Kawasaki disease(152 cases) admitted to The Catholic University of Korea, Daejeon St. Mary's hospital from 1996 to 2002 were retrospectively analyzed. Results : The mean CRP level was $17.9{\pm}6.4mg/dL$ in bacterial meningitis, $9.1{\pm}5.6mg/dL$ in Kawasaki disease, and $8.1{\pm}3.3mg/dL$ in acute pyelonephritis. In the mycoplasma pneumonia and tsutsugamush disease group(atypical bacterial group), the CRP level was $3.2{\pm}2.5mg/dL$, and $1.0{\pm}0.8mg/dL$ in the viral diseases group(measles and chicken pox). There were also significant differences for the WBC count and neutrophil differential between the 3 infectious groups with higher level in the bacterial infections group($15,600{\pm}6,100/mm^3$, $62{\pm}21%$) than in the atypical bacterial infections and in the viral infections group($9,600{\pm}3,300mm^3$, $57{\pm}11%$ and $7,300{\pm}2,900/mm^3$, $49{\pm}16%$, respectively). The inflammatory indices in Kawasaki disease were like those of bacterial infections. There was a correlation between CRP level and WBC or neutrophil count in the bacterial infections and Kawasaki disease groups. Conclusion : The CRP, WBC and neutrophil levels showed a clear difference between the infectious diseases according to causative agents. The WBC and neutrophil level was different according to age in measles and mycoplasma pneumonia. There was a correlation between CRP level and WBC or neutrophil count in the bacterial infections and Kawasaki disease groups.
Purpose : Despite the seriousness of bacterial meningitis in children, there is little information on the incidence, causative organisms, mortality rate and age distribution. We studied the frequency by age group and causal pathogens, and clinical characteristics in children with bacterial meningitis in the private sector in Korea. Methods : The medical records containing the data on bacterial meningitis patients under 18 years of age confirmed by cerebrospinal fluid (CSF) findings were retrospectively analyzed from September, 1993 to August, 2006 at Ewha Womans University Mokdong Hospital. Results : Eighty-one cases of bacterial meningitis were observed. Overall the most common organism was Streptococcus agalactiae (group B streptococcus, GBS) (30 cases, 37.0%) followed by Haemophilus influenzae (22 cases, 27.2%), Streptococcus pneumoniae (12 cases, 14.8%), Escherichia coli (3 cases, 3.7%), Neisseria meningitidis (1 case, 1.2%) and others (13 cases, 16.0%). In neonates and young infants under 2 months, the most common organism was GBS. In children between 3 months, and 5 years, the most common organism was H. influenzae. S. pneumoniae was the most common organism in children over 5 years of age. Thirty-one patients (38.3%) had complications. Of all ages, the mortality rate of bacterial meningitis markedly decreased compared with the previously reported rate. Conclusion : In neonates, GBS meningitis was most common. The frequency of H. influenzae meningitis decreased after the introduction of H. influenzae type b vaccination. A strategy for the prevention of GBS meningitis in neonates should be established. The influence of the pneumococcal conjugate vaccine on S. pneumoniae meningitis should be studied.
Choi, Jin Hyoung;Choe, Young June;Hong, Ki Bae;Lee, Jina;Yoo, Won Joon;Kim, Han Soo;Park, Moon Seok;Cho, Tae Joon;Chung, Chin Youb;Lee, Hoan Jong;Choi, In Ho;Choi, Eun Hwa
Pediatric Infection and Vaccine
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v.18
no.1
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pp.31-39
/
2011
Purpose : This study was performed for the purpose of finding causative organisms and clinical features of septic arthritis or acute osteomyelitis in children. Methods : The study involved a retrospective review of the medical records of 63 microbiologically confirmed cases of acute pyogenic arthritis and osteomyelitis. All of the cases were brought about by community-associated infections and managed at the Seoul National University Children's Hospital or Seoul National University Bundang Hospital from June 2003 to July 2009. Results : The median age of all cases was 60 months and there were 35 males and 28 females. Major involved joints included the hip joint (15 cases), knee joint (7 cases), shoulder joint (4 cases), and elbow joint (4 cases). Also, major involved bones included the femur (20 cases), tibia (13 cases), humerus (7 cases), and radius (7 cases). Staphylococcus aureus was the most commonly identified causative organism, accounting for 49 cases (77.8%). Of the 49 isolates of S. aureus, methicillin-resistant S. aureus (MRSA) accounted for 8 cases (16.3%). Group B streptococcus spp. (GBS) and Salmonella spp. accounted for 3 cases, respectively. Nafcillin or cefazolin was often prescribed as an initial empirical antibiotic. There were 9 cases that were managed by a regimen that included vancomycin as the first choice. Fifty four cases (85.7%) recovered without any complications. Methicillin-sensitive S. aureus (MSSA), responsible for 41 cases, caused chronic complications in 3 cases. Of 8 cases caused by MRSA, 1 case showed chronic complication. There were no fatal cases. Conclusion : S. aureus remains the most common organism causing acute pyogenic arthritis and osteomyelitis of childhood acquired in the community. The high prevalence of methicillin resistance among S. aureus should be considered carefully in the selection of initial empirical antibiotics.
Objective: It has been recently reported that very small stem cells with pluripotency are detected in murine and human. The purposes of this study are to confirm whether very small putative stem cells (VSPSCs), which have the proper characteristics of stem cells as well as the expression of stem cell markers, are detected in human endometrium. Methods: The endometrial cells of 5 women, which were obtained by endometrial biopsy, were cultured for 2 weeks and were confirmed for the expressions of alkaline phosphatase, OCT-4 and CXCR4 by immunochemistry. Subsequently VSPSCs were separated by percoll density gradient method and were cultured. Also VSPSCs and their derived cells were confirmed for the expressions of OCT-4 and CXCR4. Results: The colonies, which is composed with VSPSCs less than 3 ${\mu}m$ and the 5~15 ${\mu}m$ sized hyperchromatic round cells, were detected in the endometrium of all of women and showed the strong expressions of alkaline phosphatase, OCT-4 and CXCR4. In culture after the separation of VSPSCs by percoll, these cells showed the morphological and functional characteristics of stem cells; self-renewal, colony formation, embryoid body-like formation and differential plasticity. VSPSCs formed gradually the 5~15 ${\mu}m$ sized hyperchromatic round cells and the 10~20 ${\mu}m$ sized sphere-shaped cells by cell-to-cell aggregation or cell fusion. Then these cells differentiated the various cells including fibroblast-like cells, nerve-like cells and endothelium-like cells. VSPSCs and their derived cells often showed the strong expressions of OCT-4 and CXCR4. Conclusion: VSPSCs less than 3 ${\mu}m$ and their derived cells are detected in human endometrium and these cells have the proper characteristics of stem cells and the expressions of stem cell markers as alkaline phosphatase, OCT-4 and CXCR4.
Purpose : This study evaluated the clinical characteristics of brain tumors in children according to their location, the parental delay and the doctor's delay between the onset of symptoms and the diagnosis of a pediatric brain tumor. In addition, this study compared the relationship between the pre-diagnostic symptomatic interval and the tumor location. Methods : A retrospective study was undertaken of 45 children with primary brain tumors admitted to Inha Hospital from July, 1986 to June, 2004. A diagnosis of the tumor location was made using brain MRI. Results : The male to female ratio was 1 : 0.67. The median age at diagnosis was 6.0 years in supratentorial tumors, 7.0 years in infratentorial tumors. Twenty four cases(53.3 percent) were located in the supratentorial area, 21 cases(46.6 percent) were located in the infratentorial area. The distribution of supratentorial tumors were 14(58.3 percent) in the cerebral hemisphere and temporal lobe, seven (29.1 percent) in the suprasellar area, and three(12.5 percent) in the pineal gland and posterial lateral ventricle. The distributions of the infratentorial tumors were 12(57.1 percent) in the cerebellar vermis and fourth ventricle, four(19.1 percent) in the brain stem, and five(23.8 percent) in the cerebellar hemisphere. The most common initial symptom was seizure(37.5 percent) in the supratentorial tumor and headache(38.0 percent) in infratentorial tumors. The median pre-diagnostic symptomatic interval (PSI) was 21 days(range 0-240 days). The median PSI with a parental delay in supratentorial tumor was six days(range 1-240 days), and 30 days(range 1-40 days) in the infratentorial tumor. We immediately diagnosed most cases after visiting the hospital. There was no significant relationship between the tumor location and the pre-diagnostic symptomatic interval. Conclusion : The most common symptom of supratentorial tumors and infratentorial tumors was seizure and headache, respectively. Although, the median pre-diagnostic symptomatic interval was shorter than in previous studies, a detailed medical history and a correctly interpreted neurological examination should lead to an earlier diagnosis of pediatric brain tumors.
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.
Lee, Soon Min;Kim, He Min;Jeon, Ji Hyun;Park, Min Soo;Park, Kook In;Namgung, Ran;Lee, Chul
Clinical and Experimental Pediatrics
/
v.51
no.4
/
pp.367-371
/
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.
Purpose: This study was designed to investigate whether nutritional supply influences biochemical markers and clinical outcomes in patients who received continuous renal replacement therapy (CRRT) by evaluating adequacy of nutritional supply for patients. Methods: From January 2012 to December 2013, 239 adult patients who received CRRT in the intensive care unit for more than 3 days were included. General information from electronic medical records and nutritional status related biochemical data and clinical outcomes on the first day of CRRT and 2 weeks after CRRT were collected. Results: The rate of delivered energy and protein was 68.06% and 43.13% which was much lower than energy and protein supply based on their requirement. When the patients were divided into two groups according to 70% of energy received rate and 50% of protein received rate, the group with more than 70% of energy received rate showed significant decrease of length of hospital stay (p = 0.007), length of stay in intensive care unit (ICU) (p = 0.008), duration of CRRT (p < 0.001), and APACHE II score (p < 0.001) compared to less than 70% of energy received rate after adjusting for age. In addition, the group with more than 50% of protein received rate showed decreased mortality (p = 0.031), length of hospital stay (p = 0.008), length of ICU stay (p = 0.035), duration of CRRT (p < 0.001), and APACHE II score (p < 0.001) after adjusting for age. We found that the level of hematocrit (p = 0.006) was significantly improved in the group with more than 70% of energy received rate, and the level of TLC (p = 0.049), hematocrit (p = 0.041) was significantly improved in the group with more than 50% of protein received rate. We also found that energy delivery was negatively correlated with length of stay in ICU (p = 0.049) and positively correlated with level of calcium (p = 0.037). In addition, protein delivery was correlated with the levels of serum total protein (p = 0.021), serum albumin (p = 0.048), hematocrit (p = 0.009), and total cholesterol (p = 0.021) when dead patients were included, but was correlated with the levels of hematocrit (p = 0.034) and calcium (p = 0.024) when dead patients were excluded. Conclusion: Proper nutritional delivery may help patients' clinical outcomes for patients receiving CRRT. However, their actual intakes of energy and protein were not adequate for their requirements. Identification of patients with malnutrition is necessary and a multidisciplinary approach for systemic management is also required.
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