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Objectives: This study aimed to determine whether Korean medicine could improve unilateral testicular pain caused by recurrent varicocele without unfavorable side effects.Methods: A 46-year-old man diagnosed with varicocele, identified with a scrotal ultrasound scan, had right-side testicular pain. We administered Banchong-san and Eunhoebanchong-san to observe changes in the degree of pain.Results: After one month of taking Banchong-san and Eunhoebanchong-san, testicular pain improved.Conclusion: This study suggests that Korean medicine might be effective for managing testicular pain caused by varicocele.

Background Respiratory infection in children is a major disease that ranks high in outpatient and inpatient cases. In particular, the causes of community acquired pneumonia (CAP) vary depending on the individual susceptibility, epidemiological characteristics of the community, and season, and it is difficult to obtain samples for microbiological diagnosis. This study analysis that laboratory surveillance network of pathogen for pediatric CAP by linking the national community-based hospital and clinics and the Centers for Disease Control and Prevention (KCDC) to identify the distribution trend and prevalence of causative pathogens and to prevent antibiotic resistance of bacterial pathogens. Method The monitoring network was composed of the 28 secondary and tertiary medical institutions based on the national community, and the 24-month prospective study operated a community monitoring network for CAP in children. Results A total of 1023 cases were registered for nasopharyngeal aspirate or sputum in patients with CAP, and 711 cases (69.5%) were isolated by culture, S. aureus 131 cases (12.8%), S. pneumonia 92 cases (9%), H. influenzae 20 cases (2%). PCR of atypical pneumonia revealed 422 cases of M. pneumoniae (41.3%), 5 cases of C. pneumonia (0.5%), and 5 case (0.5%) of B. pertussis. Respiratory virus multiplex PCR test showed positive rates in 65.7%, human rhinovirus 312 (30.5%), RSV(A+B) 212 (20.7%), Adenovirus 123 (12%), Influenza (A+B) 53 (7.8%), CoV (OC43+NL63+229E) 69 (6.7%), HMPV 81 (7.9%), HBoV 51 (5%), PIV (1+2+3+4) 65 (6.4%) and HEV 30 (2.9%) Conclusion It will identify the pathogens that cause respiratory infections, and analyze the current status of antibiotic resistance to provide scientific evidence for management policies of domestic respiratory infection. Also, in preparation for the new epidemic, including COVID19, monitoring of respiratory infections in children and adolescents, especially community pneumonia, has become more important, and research should be continuously conducted in the future. The location and extent of involvement in the medulla were the most important factors associated with the severity of dysphagia after LMI.

Purpose This study aimed to investigate the clinical and socioenvironmental characteristics of sudden cardiorespiratory arrest after venipuncture in children. Methods We conducted a retrospective email-based survey of all members of the Korean Pediatric Society. The questionnaire included items on patient demographics, socioenvironmental circumstances of the venipuncture, type of cardiorespiratory arrest, symptoms and signs, treatment, prognosis, and presumed cause of the arrest. Results Fourteen patients were identified. Of these, 13 were young children (

Purpose To investigate the frequency of childhood sleep problems at pediatric clinics in Seoul and Gyeonggi provinces. Methods Children (n=936) and their parents who visited 5 primary and 1 secondary pediatric outpatient clinics were invited to complete a Pediatric Sleep Questionnaire. Results Among patients, 901 (96.3%) answered questionnaires in sufficient detail for evaluation. The participant's mean age was 4.35±3.02 years (range, 0–18 years). The male to female ratio was 1:0.93 (466 boys, 435 girls). Habitual snoring (>3 day/week) was reported in 16.9% of the participants. The prevalence of habitual snoring in children 2 years. Insomnia was reported in 13.2% of children. The prevalence of sleepwalking, night terrors, and bruxism, is 1.6%, 19%, and 21.1%, respectively. Snoring was associated with increased incidence of sleepwalking, night terrors, and bruxism. Age was associated with insomnia and habitual snoring (P

A 16p13.3 duplication syndrome has been recently suggested to be a novel recognizable syndrome as a reciprocal microduplication disease of Rubinstein–Taybi syndrome. The CREBBP gene is believed to be the dosage-sensitive critical gene responsible for the reciprocal duplication and deletion syndrome. Descriptions so far have been de novo. Here, we report a very rare case of a maternally inherited a −1 Mb sized duplication on 16p13.3 identified by SNP array testing. The patient showed moderate intellectual disability, normal growth, and characteristic facial features. The patient's mother also had mild intellectual disability, normal growth, camptodactyly, proximally implanted small thumbs, and distinctive facial features. The study provides additional information that furthers the understanding and delineation of 16p13.3 duplication syndrome.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Background Bronchiectasis is a chronic pulmonary disease characterized by progressive and irreversible bronchial dilatation. The aim of the present study was to investigate the etiologies and clinical features of bronchiectasis in Korean children. Methods We performed a retrospective review of the medical records for children diagnosed with bronchiectasis between 2000 and 2017 at 28 secondary or tertiary hospitals in South Korea. Results A total of 387 cases were enrolled. The mean age at diagnosis was 9.2 ± 5.1 years and 53.5% of the patients were boys. The most common underlying cause of bronchiectasis was preexisting respiratory infection (55.3%), post-infectious bronchiolitis obliterans (14.3%), pulmonary tuberculosis (12.3%), and heart diseases (5.6%). Common initial presenting symptoms included chronic cough (68.0%), recurrent pneumonia (36.4%), fever (31.1%), and dyspnea (19.7%). The most predominantly involved lesions were left lower lobe (53.9%), right lower lobe (47.1%) and right middle lobe (40.2%). No significant difference was observed in the distribution of these involved lesions by etiology. The forced expiratory volume in 1 s (FEV1) levels were lowest in cases with interstitial lung disease-associated bronchiectasis, followed by those with recurrent aspiration and primary immunodeficiency. Conclusions Bronchiectasis should be strongly considered in children with chronic cough and recurrent pneumonia. Long-term follow-up studies on pediatric bronchiectasis are needed to further clarify the prognosis and reduce the disease burden in these patients.

The aim of this study was to examine the effects of acupuncture on urinary incontinence and to discuss why these acupoints were selected. Seven databases were searched for any randomized controlled trials (RCTs) that investigated the use of acupuncture or acupressure as a treatment for urinary incontinence, and the Cochrane risk of bias tool was utilized to evaluate the risk of bias in each study. Four RCTs met all the inclusion criteria. The results from the selected RCTs failed to demonstrate any statistically significant improvements in urinary incontinence, although acupuncture or acupressure did exhibit favorable effects on overactive bladder symptoms and quality of life, in comparison with other conventional therapies. There have been limited results supporting acupuncture or acupressure as an effective treatment method for urinary incontinence; therefore, further RCTs are required to confirm the effectiveness of acupuncture or acupressure in the treatment of urinary incontinence.

Serum thyroid-stimulating hormone screening of asymptomatic individuals to diagnose subclinical hypothyroidism remains controversial. We evaluated the potential role of Sasang constitutional discrimination and ryodoraku testing as an alternative and complementary diagnostic tool for subclinical hypothyroidism. Among 1,105 potential subjects, 1,073 were included in this study. Of these, 134 subjects had subclinical hypothyroidism (SCH) and 939 were healthy (euthyroid; EU) control subjects. Blood parameters, including serum thyroid hormone levels, were measured. We classified the participants into the four Sasang constitutional types, Taeyang-type individuals, Taeeum-type individuals, Soyang-type individuals and Soeum-type individuals, and measured their ryodoraku scores (RS). The mean levels of free thyroxine (FT4), glucose, red blood cells and hematocrit in the SCH group were significantly lower compared to those in the EU group (p

Objectives: The symptoms of hypothyroidism are fatigue, cold intolerance, arthralgia, muscle cramps, dry skin and etc. Although hypothyroidism is a relatively common endocrinical disease, we do have many difficulties treating it effectively. The symptoms of hypothyroidism are similar to those of Yang-deficiency in Oriental medicine. Epimedii Herba is a popular herb that has the effect of tonifying the kidney and strengthening Yang in Oriental medicine. In this study, we investigated the therapeutic effects of Epimedii Herba on a hypothyroidism rat model induced by PTU(6-Propyl, 2-thiouracil). Methods: 24 two-month-old Spargue-Dawley(SD) rats were divided into 4 groups: 1) normal(n=6), 2) PTU-induced hypothyroidism control(n=6), 3) hypothyroidism rat treated with Epimedii Herba(n=6), 4) hypothyroidism rat treated with levothyroxine(n=6). PTU was administered for 4 weeks, Epimedii Herba and levothyroxine was administered for 2 weeks after PTU was initiated for a total duration of 2 week. At the end of the experiment, blood samples from all the rats were taken from their hearts and were analyzed. Results: In comparison with normal group, the PTU-induced control group significantly showed hypothyroidism with low T3, T4 and high TSH. In Epimedii Herba group, T4 was significantly increased(p

Obstructive sleep apnea (OSA) in children is a frequent disease for which optimal diagnostic methods are still being defined. Treatment of OSA in children should include providing space, improving craniofacial growth, resolving all symptoms, and preventing the development of the disease in the adult years. Adenotonsillectomy (T&A) has been the treatment of choice and thought to solve young patient's OSA problem, which is not the case for most adults. Recent reports showed success rates that vary from 27.2% to 82.9%. Children snoring regularly generally have a narrow maxilla compared to children who do not snore. The impairment of nasal breathing with increased nasal resistance has a well-documented negative impact on early childhood maxilla-mandibular development, making the upper airway smaller and might lead to adult OSA. Surgery in young children should be performed as early as possible to prevent the resulting morphologic changes and neurobehavioral, cardiovascular, endocrine, and metabolic complications. Close postoperative follow-up to monitor for residual disease is equally important. As the proportion of obese children has been increasing recently, parents should be informed about the weight gain after T&A. Multidisciplinary evaluation of the anatomic abnormalities in children with OSA leads to better overall treatment outcome.

Purpose: Obstructive sleep apnea syndrome (OSAS) in young children is frequently caused by adenoid and/or tonsillar hypertro phy. Adenoidectomy is the first operative method for childhood chronic rhinosinusitis (CRS). We investigated factors associated with recurrent rhinosinusitis in preschool aged children with OSAS to determine the association of 2 common diseases. Methods: One hundred forty-six children aged 2-5 years who were diagnosed as having OSAS after polysomnography between December 2003 and April 2016 were enrolled in this study. Children were divided into 2 groups with and without CRS. The 2 groups were compared in the severity of OSAS and allergy diseases and were evaluated for recurrent rhinosinusitis during the follow-up period, 1 year after diagnosis. Results: Among 108 patients with OSAS who were followed up, 81 patients (75%) were diagnosed with CRS. There were no signifi cant difference clinical and allergic characteristics between groups with and without CRS. However, bronchial asthma and otitis me dia was significantly more prevalent in patients with CRS than in those without (P=0.045 and P=0.000, respectively). Bronchial asthma and adenotonsillectomy was significantly associated with recurrent rhinosinusitis (P=0.005 and P=0.04, respectively) dur ing the 1-year follow-up. Conclusion: Approximately 75% of preschool children with OSAS have suffered from CRS. Bronchial asthma is associated with CRS among OSAS children. Recurrent rhinosinusitis is decreased after adenotonsillectomy, and bronchial asthma is an associated factor for recurrent rhinosinusitis after a follow-up. This close relationship childhood OSAS and recurrent rhinosinusitis/bronchial asthma needs further studies to investigate their role in the association. (Allergy Asthma Respir Dis 2018;6:168-173)

Background Nodule-in-nodule-type hepatocellular carcinoma (NIN-HCC) is a useful model to illustrate the multi-step nature of hepatocarcinogenesis. To identify large-scale molecular change in early hepatocarcinogenesis, the expression profile of NIN-HCC was compared with those from three sets of individual high-grade dysplastic nodules (HGDN) and grade 1 hepatocellular carcinomas. Methods We compared expression profiles of inner grade 1 hepatocellular carcinoma nodules and peripheral HGDN in one case of NIN-HCC using spotted-oligonucleotide DNA microarray. The relevant outlier genes assumed to associate with early carcinogenesis in hepatocellular carcinoma were identified by comparative analysis of NIN-HCC and individual cases of HGDN and grade 1 hepatocellular carcinoma, respectively. Results From this analysis we extracted a total of 40 genes, consisting of 28 up-regulated genes and 12 downregulated genes, and more than a two-fold change in grade 1 hepatocellular carcinoma compared with HGDN. Conclusion We assessed the expression profiles of pre-neoplastic lesions and grade 1 hepatocellular carcinoma using oligonucleotide microarray analysis and found high stringent outlier genes that are presumably directly involved in the transition from dysplastic nodule to the early stage of hepatocellular carcinoma by utilizing NIN-HCC.

OBJECTIVE: The vasoconstrictor peptide endothelin-1 (ET-1) produces narrowing of cerebral arteries and has been implicated in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage. Little is known, however, regarding the physiological consequences of prolonged exposure of arterial wall to ET-1. METHODS: In 30 rats, normal saline or 10 -8 mol/h of ET-1 was continuously applied for 3 or 5 days to the adventitial surface of the femoral artery in a Silastic cuff via an osmotic infusion pump. Vessels were examined for histopathological changes and luminal narrowing during ET-1 infusion (3 or 5 d) or at intervals from 2 to 9 days after infusion was stopped. RESULTS: Marked arterial constriction (30-40% arterial diameter reduction) was present during continuous ET-1 infusion for 3 or 5 days. For both 3- and 5-day ET-1 infusions, significant reduction in arterial cross sectional area persisted up to 4 days after cessation of infusion, after which normal caliber returned. In arteries with persistent luminal narrowing after cessation of ET-1 infusion, light microscopic findings revealed morphological changes in the vessel wall similar to those observed in cerebral vasospasm after subarachnoid hemorrhage, with apparent increased collagen deposition in media and adventitia. CONCLUSION: Continuous infusion of ET-1 produces reversible arterial narrowing that persists beyond the usual interval of physiological effect for this agent. Prolonged arterial constriction may produce physiological changes in arterial wall that act to maintain a narrowed lumen.

Background Serum levels of eosinophil cationic protein are an indirect measure of airway inflammation in asthma. It is proposed that the extent to which bronchoconstriction or airway inflammation contributes to airflow obstruction in acute asthma may determine responsiveness to bronchodilator therapy. Objective To test the hypothesis that subjects with acute asthma exacerbations who respond poorly to inhaled bronchodilator treatment may have more marked airway inflammation than those who respond well to identical therapy. Methods Forty-eight asthmatic children who visited the emergency room due to acute exacerbations were studied. Serum levels of eosinophil cationic protein were measured at the time of acute exacerbations and of clinical remissions at acute exacerbation, FEV 1 was assessed before and after the administration of aerosolized salbutamol. Results The mean serum level of eosinophil cationic protein at acute exacerbation (41.1 ± 12.8 microgram/L) was significantly higher ( P .01) than that at clinical remission (30.0 ± 8.5 microgram/L) in the study population. The level at acute exacerbation was even higher in group A (n = 18: postbronchodilator FEV 1 1 >/= 75% predicted), whereas both groups showed similar levels at clinical remission. The level at acute exacerbation correlated positively with severity of exacerbation (r = .47, P .01) and negatively with bronchodilator responses (r = −.56, P .01). This negative correlation was valid among subjects with a similar degree of exacerbation. Conclusion A higher level of eosinophil cationic protein at acute asthma exacerbation was associated not only with more severe exacerbation but also with a lower degree of bronchodilator responsiveness. This suggests that degree of airway inflammation may be one determinant of degree of responsiveness to initial bronchodilatory therapy at acute asthma exacerbation.

Background: The objective of this study was to assess the prevalence of education about sleep and sleep disorders in pediatric residency programs and to identify barriers to providing such education. Methods: Surveys were completed by directors of 152 pediatric residency programs across 10 countries (Hong Kong, India, Indonesia, Japan, Singapore, South Korea, Thailand, United States-Canada, and Vietnam). Results: Overall, the average amount of time spent on sleep education is 4.4 hours (median = 2.0 hours), with 23% responding that their pediatric residency program provides no sleep education. Almost all programs (94.8%) offer less than 10 hours of instruction. The predominant topics covered include sleep-related development, as well as normal sleep, sleep-related breathing disorders, parasomnias, and behavioral insomnia of childhood. Conclusions: These results indicate that there is still a need for more efforts to include sleep-related education in all pediatric residency programs, as well as coverage of the breadth of sleep-related topics. Such education would be consistent with the increased recognition of the importance of sleep and under-diagnosis of sleep disorders in children and adolescents.

Purpose: We aimed to investigate the clinical characteristics and their relationship with the onset age of wheeze in school-age children and adolescents with asthma. Methods: Three hundred twenty-six patients, aged 6 to 19 years, diagnosed with asthma at 6 hospitals from Seoul, Gyeonggi, Daegu, and Busan were enrolled. They were categorized into 3 groups by the onset age of wheeze: group A, early onset (age

The hygiene hypothesis postulates that infections early in life might influence the development of asthma later in childhood. However, this hypothesis is controversial. The objective of this study was to determine whether there is a relationship between infection-related risk factors during infancy and development of asthma later in childhood.Data were obtained by a nationwide, population-based, cross-sectional study of 26,400 children, 7 to 12 years of age. Parents completed a questionnaire on symptoms of and risk factors for asthma, including the number of fever episodes, acute gastroenteritis, use of antibiotics, and immunization during infancy. The presence of asthma was defined by parental report of "wheeze in the last 12 months" or "asthma ever." Data were analyzed by logistic regression analysis.The occurrence of fever during infancy was weakly associated with the development of asthma (P0.05). A higher frequency of episodes of fever was associated with a higher risk of development of asthma. The relationship between antibiotic use during infancy and development of asthma was also significant (P0.0001). The adjusted odds ratios of childhood asthma increased in proportion to the number of antibiotic courses during infancy. A history of acute gastroenteritis during infancy increased the risk of developing asthma in later life (P0.001). In contrast, immunization in infancy was not related to development of asthma in childhood (P0.05).These data suggest that the development of childhood asthma is associated with episodes of fever, antibiotic use, and acute gastroenteritis during infancy.

Purpose: Hereditary angioedema is a familial disease which is caused by a genetic deficiency or functional defect of the C1 inhibitor, and it features episodic swelling that can affect any part of the body. A great number of patients are estimated not to have an accu - rate diagnosis after the onset of symptoms, and close attention is required because sudden hereditary angioedema attacks can re- sult in even death. Methods: We sent an e-mail questionnaire to 975 members of the Korean Academy of Asthma, Allergy and Clinical Immunology. A total of 82 members replied. The questionnaire, including 15 questions about the diagnosis and management of hereditary angio- edema, was developed by the anaphylaxis/urticaria, angioedema workgroup of the Korean Academy of Asthma, Allergy and Clini- cal Immunology. Results: Forty-two percent of the respondents had experience with treatment of a suspected case of hereditary angioedema, and 15.9% made a confirmed diagnosis of hereditary angioedema. When the respondents suspected of cases, 91.4% of them performed tests for C3 and C4 concentrations and C1 inhibitor level. For maintenance treatment, most of the respondents used androgen, and only 22% found that C1 inhibitor concentrates can be prescribed through the Korea Orphan Drug Center in Korea. Conclusion: Allergy physicians in Korea substantially recognized the correct diagnosis and treatment of hereditary angioedema. However, there was a lack of awareness for the latest treatments, such as C1 inhibitor concentrates. Education of doctors and the public is needed. (Allergy Asthma Respir Dis 2014;2:277-284)

The advantages of sublingual immunotherapy (SLIT) are its friendly route of administration and less frequent occurrence of severe side-effects. The most frequently reported events were irritation of the throat and oral itching. According to the recent data, the number of side effects seems to be dose-dependent. We report on one case of anaphylaxis after the first dose of SLIT with house dust mite drop. A 10-year-old girl suffered from severe allergic rhinitis with perennial symptoms and asthma for which a low dose inhaled corticosteroid was used. Her allergy workup disclosed a positive skin prick test to Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, hazel tree, alder, dog, cat, platane, and acacia pollens. We started SLIT (Pangramin SLIT, ALKAbello, Madrid, Spain) with D. pteronyssinus and D. farinae. Fifteen minutes after the first dose taken at home, she experienced local irritation, lip swelling, facial rash, rhinorrhea and cough. Provocation test was performed in the clinic with the same drug (0.00015 µg/drop, 1.6 STU/mL of D. pteronyssinus and D. farinae, respectively). After twenty minutes, she reported lip swelling, perioral wheals, rash and cough. Wheezing was aggravated, and peak expiratory flow rate (PEFR) dropped by 13% compared to prechallenge PEFR. We stress to have the first dose of SLIT taken in the clinic with an observation period. [Pediatr Allergy Respir Dis(Korea) 2011;21:238-241]

We present a 22-day-old infant with extensive subcutaneous calcifications due to subcutaneous fat necrosis caused by prolonged exposure to cold.

Purpose: To report a case of bilateral papilledema and visual field defect in pediatric idiopathic intracranial hypertension. Case summary: The 5-year-old female patient was admitted to the hospital, complaining of headache and vomiting of 3 weeks duration. After admission, she complained of diplopia. The uncorrected visual acuity was 0.3 in the right eye and 0.8 in the left. An alternative prism cover test showed approximately 35 PD esotropia, with a -2 abduction limitation of both eyes. Fundus examination showed bilateral papilledema and peripapillary retinal hemorrhages. No abnormality was found in the MRI and CT, symptoms of headache, vomiting, bilateral papilledema, and esotropia with normal neurologic examination. Therefore, she was diagnosed with pediatric idiopathic intracranial hypertension. In Humphrey visual field test, MD was -14.15 dB in right and -16.58 dB in the left eye. Also, the general sensitivity of visual field decreased. Acetazolamide (Diamox) was given orally for 30 days. Forty-four days after the initial visit, peripapillary retinal hemorrhages and vessel tortuosity decreased. Furthermore, visual acuity improved to 1.0 in the right eye and 0.9 in the left. The esotropia reduced to 5 PD, and MD improved to -4.83 dB in the right eye and -5.24 dB in the left.

We report clinical, cytogenetic, and fluorescence in situ hybridization (FISH) studies of a patient with ring chromosome 9. She presented with failure to thrive, facial dysmorphysm and mild psychomotor development delay in the absence of major malformations. Peripheral blood karyotype of the patient was 46,XX,r(9)(p24q34). G-band analysis suggested no loss of material in the ring chromosomes. FISH analysis using the subtelomere-specific sequences on chromosome 9p and 9q, revealed 46,XX,r(9)(p24q34),ish r(9)(D9S913-,D9S325+). Failure to detect any hybridization of a probe for the subtelomeric sequences in the ring 9p terminal suggested that this ring arose from breakage in the distal short arm. The cytogenetic and FISH data in our case provided further evidence for the existence of a "complete ring" phenotype with incomplete subtelomeric sequences.

Purpose : To determine whether primary snoring could be distinguished from obstructive sleep apnea syndrome (OSAS) by clinical evaluation and symptom scores. Methods : 56 snoring and 20 asymptomatic subjects were recruited and polysomnography was used to confirm that there were 39 OSAS, 17 primary snoring, and 20 control subjects. We evaluated the size of the childrens adenoids and tonsils. Parents completed sleep disordered breathing scale (SDBS) and obstructive sleep apnea 18 (OSA-18) questionnaires for use as symptom scores, as well as an attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV). Results : There were no differences between primary snoring and OSAS in terms of tonsil and adenoid size, SDBS (9.4±4.6 vs 10.8±4.5), and OSA-18 score (61.1±25.1 vs 71.2±8.4). The patients with OSAS (15.8±7.9) and PS (22.2±9.4) had a higher ADHD RS-IV score than the control subjects (2.9±3.3). There was no difference in the ADHD RS-IV scores of patients with primary snoring and OSAS. Conclusion : We confirmed that clinical evaluation could not distinguish OSAS and primary snoring. In addition, our study suggests that primary snoring as well as OSAS is associated with attention deficit hyperactivity disorder.

Purpose : The most common causes of acute viral gastroenteritis in newborn period are rotavirus, astrovirus, norovirus and enteric adenovirus. This study was designed to investigate the clinical characteristics, clinical symptoms, isolation rate and distribution of these viruses in full-term neonates during neonatal period. We also studied the influence on the viral isolation rate by postnatal care place and feeding type. Methods : We evaluated 112 healthy full-term neonates who were admitted to Eulji hospital, presenting with symptoms of acute viral gastroenteritis from September 2004 to August 2005. Epidemiologic, clinical and laboratory data were reviewed. Enzyme-linked immunosorbent assay (ELISA) for rotavirus, astrovirus and norovirus and RT-PCR for enteric adenovirus were performed in study subjects.Results : The mean age at the admission was 11.4±5.4 days, mean weight loss was 5.9±5.1%, mean hospitalization duration was 6.3±3.4 days. Moderate and severe weight loss were expressed in 51.7% and metabolic acidosis was in 13.4%. The percent of living in postnatal care facility (PCF) was 74.1 % and the percent of mixed feeding was 64.3%. Isolation rate of virus was 33%. The most prevalent virus was rotavirus (59.5%), followed by astrovirus (29.7%) and norovirus (10.8%). There was no differences in virus isolation rate by postnatal care place and by feeding type. The rotavirus was main virus in both home group and PCF group. But astrovirus was more detected in PCF and norovirus was more detected in home (P

Purpose:The purpose of this study was to investigate the health status and nutritional condition of children living in a low-income community through anthropometric, laboratory evaluation. Methods:A community-based survey identified children below 15 years living in a low-income community. Their weight, height, visual acuity, hearing level and dental status were measured. Blood sample were obtained on June and July, 2004. Hemoglobin, serum cholesterol, Hepatitis B antigen/ antibody, AST and ALT were measured. Results:A total of 285 students(M:F=141:144) aged 6 to 14 years were included in this study. The heights and weights in some grades were smaller than controls. The prevalence of obesity was 10.6 percent in males and 10.7 percent in females. The prevalence of abnormal visual acuity, hearing impairments and dental carries were 20.5 percent, 0.3 percent and 69.4 percent. The prevalence of anemia was 10.1 percent. Serum total cholesterol was over 200 mg/dL in 7 percent. They complained of abdominal pain(22.1 percent) and headache(17.1 percent). Hyperthyroidism, cataract, neurofibromatosis, severe atopic dermatitis, ventricular septal defect, strabismus and inguinal hernia were newly diagnosed. Conclusion:Mean heights and weights of children in the low-income community were smaller than controls. The prevalence of abnormal visual acuity, hearing impairment and dental carries were higher than in the 2003 national health survey. Additional research is needed to evaluate the health status of the low-income community.

To validate the prevalence rate of symptoms of asthma produced by the phase I ISAAC (International Study of Asthma and Allergies in Childhood) study, hypertonic saline challenge test was carried out during the phase II study at a year after the phase I study. For the phase II study, six middle schools from three cities in the phase I study were selected. Finally, 499 children who responded to both studies were analyzed. All subjects were asked to complete the written questionnaire (WQ) first, followed by a video questionnaire (AVQ 3.0) during the phase I study. Of the 499 children, only 19 (3.8%) were positive to the hypertonic saline bronchial challenge test. The degree of agreement between responses to the two corresponding questions "wheezing at rest" and "nocturnal wheeze" in the AVQ 3.0 and WQ were moderate and weak with a Kappa indices of 0.45 and 0.23, respectively. The question on "severe wheeze" in the AVQ 3.0 had the highest Youden's index among the five questions related to asthma symptoms in the previous 12 months, but its specificity was low whereas its sensitivity was 1.0. There was no consistency of priority between the two questionnaires in predicting bronchial hyperreactivity in a group of Korean schoolchildren. Therefore we need to develop more appropriate WQ or AVQ to compare the prevalences of asthma to other countries.

Leigh's disease is a rare progressive neurological disorder that is characterized light microscopically by focal spongy necrosis in the brain and electron microscopically by mitochondriopathy. We report an autopsy case of Leigh's disease that showed abnormalities in the liver, kidney and skeletal muscle as well as the central nervous system. The patient was an 18-month-old girl who has carried a diagnosis of cerebral palsy ever since her birth to a 20-year-old mother. The baby was generally hypertonic and mentally retarded. She died of severe metabolic acidosis. Postmortem examination showed growth retardation, fatty liver, fatty kidney and soft brain. Brain section showed multifocal softenings in the brainstem, basal ganglia and periventricular areas. Microscopically increased capillaries with endothelial proliferation, vacuolar degeneration and mild gliosis were seen in the brain. The axons were relatively preserved. Liver and kidneys showed microvesicular fatty change. Myofiber degeneration of the skeletal muscle was also noted. Electron microscopic examination showed markedly increased mitochondria in the parenchymal cells of the brain, liver and kidney. The mitochondria showed round to ovoid ballooned appearance including electron-dense core-like structures and pseudoinclusions of glycogen granules.