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Case Report
Neurology
A pediatric case of idiopathic Harlequin syndrome
Ju Young Kim, Moon Souk Lee, Seung Yeon Kim, Hyun Jung Kim, Soo Jin Lee, Chur Woo You, Jon Soo Kim, Ju Hyung Kang
Clin Exp Pediatr. 2016;59(Suppl 1):S125-S128.   Published online November 30, 2016

Harlequin syndrome, which is a rare disorder caused by dysfunction of the autonomic system, manifests as asymmetric facial flushing and sweating in response to heat, exercise, or emotional factors. The syndrome may be primary (idiopathic) with a benign course, or can occur secondary to structural abnormalities or iatrogenic factors. The precise mechanism underlying idiopathic harlequin syndrome remains unclear. Here, we...

Cardiology
Idiopathic midaortic syndrome with malignant hypertension in 3-year-old boy
Kyung Jin Ahn, Ja Kyoung Yoon, Gi Beom Kim, Bo Sang Kwon, Eun Jung Bae, Chung Il Noh
Clin Exp Pediatr. 2016;59(Suppl 1):S84-S87.   Published online November 30, 2016

Midaortic syndrome (MAS) is a rare vascular disease that commonly causes renovascular hypertension. The lumen of the abdominal aorta narrows and the ostia of the branches show stenosis. MAS is associated with diminished pulses in the lower extremities compared with the upper extremities, severe hypertension with higher blood pressure in the upper rather than lower extremities, and an abdominal bruit....

Gastroenterology
Acute gastritis associated with Epstein-Barr virus infection in a child
Ji Mok Kim, Chun Woo Song, Kyu Sang Song, Jae Young Kim
Clin Exp Pediatr. 2016;59(Suppl 1):S68-S71.   Published online November 30, 2016

Infectious mononucleosis is Epstein-Barr virus (EBV) inducing a self-limiting clinical syndrome characterized by fever, sore throat, hepatosplenomegaly, and generalized lymphadenopathy. Gastrointestinal symptoms of EBV infection are nonspecific and occur rarely. EBV inducing acute gastrointestinal pathology is poorly recognized without suspicion. Careful consideration is needed to diagnose gastric involvement of EBV infection including gastric lymphoma, gastric cancer, and gastritis. A few...

Rheumatology
Recurrent macrophage activation syndrome since toddler age in an adolescent boy with HLA B27 positive juvenile ankylosing spondylitis
Joon Hyeong Park, Yu Mi Seo, Seung Beom Han, Ki Hwan Kim, Jung Woo Rhim, Nack Gyun Chung, Myung Shin Kim, Jin Han Kang, Dae Chul Jeong
Clin Exp Pediatr. 2016;59(10):421-424.   Published online October 17, 2016

Recurrent macrophage activation syndrome (MAS) is very rare. We present the case of an adolescent boy with human leukocyte antigen (HLA) B27-positive ankylosing spondylitis (AS), who experienced episodes of recurrent MAS since he was a toddler. A 16-year-old boy was admitted because of remittent fever with pancytopenia and splenomegaly after surgical intervention for an intractable perianal abscess. He had been...

Original Article
Oncology
Metformin displays in vitro and in vivo antitumor effect against osteosarcoma
Yunmi Ko, Aery Choi, Minyoung Lee, Jun Ah Lee
Clin Exp Pediatr. 2016;59(9):374-380.   Published online September 21, 2016
Purpose

Patients with unresectable, relapsed, or refractory osteosarcoma need a novel therapeutic agent. Metformin is a biguanide derivative used in the treatment of type II diabetes, and is recently gaining attention in cancer research.

Methods

We evaluated the effect of metformin against human osteosarcoma. Four osteosarcoma cell lines (KHOS/NP, HOS, MG-63, U-2 OS) were treated with metformin and cell proliferation was evaluated using...

Gastroenterology
Risk factors of delayed diagnosis of acute appendicitis in children: for early detection of acute appendicitis
Jea Yeon Choi, Eell Ryoo, Jeong Hyun Jo, Tchah Hann, Seong Min Kim
Clin Exp Pediatr. 2016;59(9):368-373.   Published online September 21, 2016
Purpose

This study examined the risk factors of a delayed diagnosis of acute appendicitis in children undergoing an appendectomy.

Methods

This retrospective study involved children aged below 18 years, who underwent an appendectomy. After dividing them into a delayed diagnosis group and nondelayed diagnosis group according to the time interval between the initial hospital visit and final diagnosis, the risk factors of delayed...

Neurology
Clinical importance of F-waves as a prognostic factor in Guillain-Barré syndrome in children
Eung-Bin Lee, Yun Young Lee, Jae Min Lee, Su Min Son, Su-Kyeong Hwang, Soonhak Kwon, Sae Yoon Kim
Clin Exp Pediatr. 2016;59(6):271-275.   Published online June 30, 2016
Purpose

A limited number of studies have examined the link between F-wave abnormalities and clinical presentation in pediatric Guillain-Barré syndrome (GBS). Therefore, this study examined the importance of F-wave abnormalities as a prognostic factor in pediatric GBS patients.

Methods

The records and electrodiagnostic studies (EDS) of 70 GBS patients were retrospectively evaluated, and divided into 2 groups according to the results of EDS....

Infection
Usefulness of interferon-γ release assay for the diagnosis of latent tuberculosis infection in young children
Ki Wook Yun, Young Kwang Kim, Hae Ryun Kim, Mi Kyung Lee, In Seok Lim
Clin Exp Pediatr. 2016;59(6):256-261.   Published online June 30, 2016
Purpose

Latent tuberculosis infection (LTBI) in young children may progress to severe active tuberculosis (TB) disease and serve as a reservoir for future transmission of TB disease. There are limited data on interferon-γ release assay (IGRA) performance in young children, which our research aims to address by investigating the usefulness of IGRA for the diagnosis of LTBI.

Methods

We performed a tuberculin skin...

Cardiology
Subclinical left ventricular dysfunction in children after hematopoietic stem cell transplantation for severe aplastic anemia: a case control study using speckle tracking echocardiography
Beom Joon Kim, Kyung Pil Moon, Ji-Hong Yoon, Eun-Jung Lee, Jae Young Lee, Seong Koo Kim, Jae Wook Lee, Nack Gyun Chung, Bin Cho, Hack Ki Kim
Clin Exp Pediatr. 2016;59(4):190-195.   Published online April 30, 2016
Purpose

Severe aplastic anemia (SAA), a fatal disease, requires multiple transfusion, immunosuppressive therapy, and finally, hematopoietic stem cell transplantation (HSCT) as the definitive treatment. We hypothesized that iron overloading associated with multiple transfusions and HSCTrelated complications may adversely affect cardiac function. Left ventricular (LV) function was assessed in children after HSCT for SAA.

Methods

Forty-six consecutive patients with a median age of 9.8...

Correlation of B-type natriuretic peptide levels and echocardiographic parameters in preterm infants with patent ductus arteriosus
Hyun Ah Jeong, Jeonghee Shin, Eunji Kim, Eun Hee Lee, Byung Min Choi, Chang Sung Son, Joo Won Lee
Clin Exp Pediatr. 2016;59(4):183-189.   Published online April 30, 2016
Purpose

This study aimed to evaluate the correlation, according to postnatal age, between plasma B-type natriuretic peptide (BNP) levels and echocardiographic parameters for the assessment of patent ductus arteriosus (PDA) in preterm infants with respiratory distress.

Methods

We enrolled 42 preterm infants with respiratory distress who underwent serial echocardiographic evaluation with simultaneous plasma BNP measurements until ductal closure. The correlations between BNP levels...

Neonatology (Perinatology)
Modification of nutrition strategy for improvement of postnatal growth in very low birth weight infants
Ah Young Choi, Yong Wook Lee, Mea-young Chang
Clin Exp Pediatr. 2016;59(4):165-173.   Published online April 30, 2016
Purpose

To identify the effects of modified parenteral nutrition (PN) and enteral nutrition (EN) regimens on the growth of very low birth weight (VLBW) infants.

Methods

The study included VLBW infants weighing <1,500 g, admitted to Chungnam National University Hospital between October 2010 and April 2014, who were alive at the time of discharge. Subjects were divided according to 3 periods: period 1...

Case Report
Neurology
Complete occlusion of the right middle cerebral artery associated with Mycoplasma pneumoniae pneumonia
Ben Kang, Dong Hyun Kim, Young Jin Hong, Byong Kwan Son, Myung Kwan Lim, Yon Ho Choe, Young Se Kwon
Clin Exp Pediatr. 2016;59(3):149-152.   Published online March 31, 2016

We report a case of a 5-year-old girl who developed left hemiparesis and left facial palsy, 6 days after the initiation of fever and respiratory symptoms due to pneumonia. Chest radiography, conducted upon admission, showed pneumonic infiltration and pleural effusion in the left lung field. Brain magnetic resonance imaging showed acute ischemic infarction in the right middle cerebral artery territory....

Original Article
Nephrology (Genitourinary)
Acute tubular necrosis as a part of vancomycin induced drug rash with eosinophilia and systemic symptoms syndrome with coincident postinfectious glomerulonephritis
Kyung Min Kim, Kyoung Sung, Hea Koung Yang, Seong Heon Kim, Hye Young Kim, Gil Ho Ban, Su Eun Park, Hyoung Doo Lee, Su Young Kim
Clin Exp Pediatr. 2016;59(3):145-148.   Published online March 31, 2016

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal condition characterized by skin rash, fever, eosinophilia, and multiorgan involvement. Various drugs may be associated with this syndrome including carbamazepine, allopurinol, and sulfasalazine. Renal involvement in DRESS syndrome most commonly presents as acute kidney injury due to interstitial nephritis. An 11-year-old boy was referred to...

Usefulness of neutrophil-lymphocyte ratio in young children with febrile urinary tract infection
Song Yi Han, I Re Lee, Se Jin Park, Ji Hong Kim, Jae Il Shin
Clin Exp Pediatr. 2016;59(3):139-144.   Published online March 31, 2016
Purpose

Acute pyelonephritis (APN) is a serious bacterial infection that can cause renal scarring in children. Early identification of APN is critical to improve treatment outcomes. The neutrophil-lymphocyte ratio (NLR) is a prognostic marker of many diseases, but it has not yet been established in urinary tract infection (UTI). The aim of this study was to determine whether NLR is a...

Gastroenterology
Diagnostic value of the Vesikari Scoring System for predicting the viral or bacterial pathogens in pediatric gastroenteritis
Dong Ho Shim, Dong Yeon Kim, Ky Young Cho
Clin Exp Pediatr. 2016;59(3):126-131.   Published online March 31, 2016
Purpose

To evaluate the diagnostic value of the Vesikari Scoring System (VSS) as an early predictor of pathogens in children with acute gastroenteritis (AG).

Methods

In this retrospective study, the VSS score, absolute neutrophil count (ANC), and C-reactive protein (CRP) levels were analyzed in 107 hospitalized children with AG, aged 6 months to 17 years. Patients were divided into nonspecific, viral, and bacterial...

Recent viral pathogen in acute gastroenteritis: a retrospective study at a tertiary hospital for 1 year
Hye Il Jin, Yoo Mi Lee, You Jin Choi, Su Jin Jeong
Clin Exp Pediatr. 2016;59(3):120-125.   Published online March 31, 2016
Purpose

Viral gastroenteritis among children is mainly caused by rotavirus, norovirus, astrovirus, or adenovirus strains. However, changing socioeconomic conditions and a rotavirus vaccination program may be affecting the prevalence of these viral infections. Therefore, we aimed to elucidate the season-specific trends in viral infections for facilitating prophylaxis and surveillance in our region.

Methods

We evaluated 345 pediatric patients (203 males, 142 females; age,...

Review Article
Hematology
Diffuse alveolar hemorrhage and recombinant factor VIIa treatment in pediatric patients
Jeong A Park
Clin Exp Pediatr. 2016;59(3):105-113.   Published online March 31, 2016

Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary complication in patients with hematologic malignancies or autoimmune disorders. The current treatment options, which include corticosteroids, transfusions, extracorporeal membrane oxygenation (ECMO), and immunosuppressants, have been limited and largely unsuccessful. Recombinant activated factor VII (rFVIIa) has been successfully administered, either systemically or bronchoscopically, to adults for the treatment of DAH, but there are...

Original Article
Cardiology
Meta-analysis of factors predicting resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease
Jin-Young Baek, Min Seob Song
Clin Exp Pediatr. 2016;59(2):80-90.   Published online February 29, 2016
Purpose

Studies have been conducted to identify predictive factors of resistance to intravenous immunoglobulin (IVIG) for Kawasaki disease (KD). However, the results are conflicting. This study aimed to identify laboratory factors predictive of resistance to high-dose IVIG for KD by performing meta-analysis of available studies using statistical techniques.

Methods

All relevant scientific publications from 2006 to 2014 were identified through PubMed searches. For...

Case Report
Infection
Tuberculosis-associated hemophagocytic lymphohistiocytosis in adolescent diagnosed by polymerase chain reaction
Ju-Hee Seo, Jun Ah Lee, Dong Ho Kim, Joongbum Cho, Jung Sub Lim
Clin Exp Pediatr. 2016;59(1):43-46.   Published online January 22, 2016

We present a case of tuberculosis-associated hemophagocytic lymphohistiocytosis in a 14-year-old girl. The patient presented with weight loss, malaise, fatigue, prolonged fever, and generalized lymphadenopathy. Laboratory investigation revealed pancytopenia (white blood cells, 2,020 cells/µL; hemoglobin, 10.2 g/dL; platelets, 52,000 cells/µL), hypertriglyceridemia (229 mg/dL), and hyperferritinemia (1,420 ng/mL). Bone marrow biopsy showed a hypocellular bone marrow with a large numbers of...

Oncology
Early onset of colorectal cancer in a 13-year-old girl with Lynch syndrome
Do Hee Ahn, Jung Hee Rho, Hann Tchah, In-Sang Jeon
Clin Exp Pediatr. 2016;59(1):40-42.   Published online January 22, 2016

Lynch syndrome is the most common inherited colon cancer syndrome. Patients with Lynch syndrome develop a range of cancers including colorectal cancer (CRC) and carry a mutation on one of the mismatched repair (MMR) genes. Although CRC usually occurs after the fourth decade in patients with Lynch syndrome harboring a heterozygous MMR gene mutation, it can occur in children with...

Giant coronary aneurysm caused by Kawasaki disease: consistency between catheter angiography and electrocardiogram gated dual-source computed tomography angiography
Eun-Ha Hwang, Jung-Ki Ju, Min-Jung Cho, Ji-Won Lee, Hyoung-Doo Lee
Clin Exp Pediatr. 2015;58(12):501-504.   Published online December 22, 2015

We present the case of a 5-year-old child with coronary complications due to Kawasaki disease; this patient unintentionally underwent both dual-source computed tomography (DSCT) coronary angiography and invasive coronary angiographic examination in 2 months. This case highlights the strong consistency of the results between DSCT coronary angiography and invasive coronary angiography. Compared to conventional invasive coronary angiography, DSCT coronary angiography...

Original Article
A prospective study to assess the efficacy and safety of oral propranolol as first-line treatment for infantile superficial hemangioma
Yeong Ju Yun, Yun Hee Gyon, Sohyoung Yang, Youn Kyung Lee, Joohyun Park, Meerim Park
Clin Exp Pediatr. 2015;58(12):484-490.   Published online December 22, 2015
Purpose

To determine the efficacy and safety of oral propranolol as a first-line treatment for superficially located infantile hemangioma (IH) and propose an assessment tool to measure treatment response.

Methods

Patients with superficial IH under 1 year of age were prospectively recruited between May 2012 and December 2013 at the Department of Pediatrics of Chungbuk National University Hospital. Propranolol was administered to 12...

Clinical characteristics of lung abscess in children: 15-year experience at two university hospitals
Mi Suk Choi, Ji Hye Chun, Kyung Suk Lee, Yeong Ho Rha, Sun Hee Choi
Clin Exp Pediatr. 2015;58(12):478-483.   Published online December 22, 2015
Purpose

Information on the clinical features of lung abscess, which is uncommon in children, at hospitalizationis helpful to anticipate the disease course and management. There is no report concerning lung abscess in Korean children. We aimed to identify the clinical characteristics of pediatric lung abscess and compare the difference between primary and secondary abscess groups.

Methods

The medical records of 11 lung abscess...

Parental satisfaction with pediatric emergency care: a nationwide, cross-sectional survey in Korea
Hye Young Jang, Young Ho Kwak, Ju Ok Park, Do Kyun Kim, Jin Hee Lee
Clin Exp Pediatr. 2015;58(12):466-471.   Published online December 22, 2015
Purpose

This study attempted to examine parental satisfaction with pediatric emergency care (PEC) in Korea and investigate the features influencing overall satisfaction.

Methods

A nationwide, cross-sectional survey was conducted among parents who had taken their children to an Emergency Department (ED) in the three years prior to the study. A 21-item, structured questionnaire was administered to the parents through a web-based system. Participants'...

Review Article
Postinfectious bronchiolitis obliterans in children: lessons from bronchiolitis obliterans after lung transplantation and hematopoietic stem cell transplantation
Jinho Yu
Clin Exp Pediatr. 2015;58(12):459-465.   Published online December 22, 2015

Postinfectious bronchiolitis obliterans (PIBO) is an irreversible obstructive lung disease characterized by subepithelial inflammation and fibrotic narrowing of the bronchioles after lower respiratory tract infection during childhood, especially early childhood. Although diagnosis of PIBO should be confirmed by histopathology, it is generally based on history and clinical findings. Irreversible airway obstruction is demonstrated by decreased forced expiratory volume in 1...

Original Article
Analysis of clinical information and reverse transcriptase-polymerase chain reaction for early diagnosis of enteroviral meningitis
Dahee Jin, Tae Hoon Heo, Jung Hye Byeon, Gun-Ha Kim, Mi Kyung Kim, So-Hee Eun, Baik-Lin Eun
Clin Exp Pediatr. 2015;58(11):446-450.   Published online November 22, 2015
Purpose

Meningitis is among the most common infections affecting the central nervous system. It can be difficult to determine the exact pathogen responsible for the infection and patients are often treated with empiric antibiotics. This study was conducted to identify the most common clinical characteristics of enteroviral meningitis in children and evaluate the diagnostic efficacy of reverse transcriptase-polymerase chain reaction (RT-PCR)...

Evaluation of new American Academy of Pediatrics guideline for febrile urinary tract infection
Da Min Choi, Tae Hoon Heo, Hyung Eun Yim, Kee Hwan Yoo
Clin Exp Pediatr. 2015;58(9):341-346.   Published online September 21, 2015
Purpose

To evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline.

Methods

We retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture...

Case Report
Hypopituitarism and Legg-Calve-Perthes disease related to difficult delivery
Veysel Nijat Baş, Salih Uytun, Ümit Erkan Vurdem, Yasemin Altuner Torun
Clin Exp Pediatr. 2015;58(7):270-273.   Published online July 22, 2015

Legg-Calve-Perthes (LCP) disease is characterized by idiopathic avascular osteonecrosis of the epiphysis of the femur head. The main factor that plays a role in the etiology of the disease is decreased blood flow to the epiphysis. Many predisposing factors have been suggested in the etiology of LCP disease, and most have varying degrees of effects. Here we present the case...

Original Article
The strong association of left-side heart anomalies with Kabuki syndrome
Ja Kyoung Yoon, Kyung Jin Ahn, Bo Sang Kwon, Gi Beom Kim, Eun Jung Bae, Chung Il Noh, Jung Min Ko
Clin Exp Pediatr. 2015;58(7):256-262.   Published online July 22, 2015
Purpose

Kabuki syndrome is a multiple congenital malformation syndrome, with characteristic facial features, mental retardation, and skeletal and congenital heart anomalies. However, the cardiac anomalies are not well described in the Korean population. We analyzed the cardiac anomalies and clinical features of Kabuki syndrome in a single tertiary center.

Methods

A retrospective analysis was conducted for a total of 13 patients with Kabuki...

Applying the bacterial meningitis score in children with cerebrospinal fluid pleocytosis: a single center's experience
Jungpyo Lee, Hyeeun Kwon, Joon Soo Lee, Heung Dong Kim, Hoon-Chul Kang
Clin Exp Pediatr. 2015;58(7):251-255.   Published online July 22, 2015
Purpose

The widespread introduction of bacterial conjugate vaccines has decreased the risk of cerebrospinal fluid (CSF) pleocytosis due to bacterial meningitis (BM) in children. However, most patients with CSF pleocytosis are hospitalized and treated with parenteral antibiotics for several days. The bacterial meningitis score (BMS) is a validated multivariate model derived from a pediatric population in the postconjugate vaccine era and...