Yeong-Seng Yuh

Intravenous Gamma-Globulin Therapy in Myocarditis Complicated with Complete Heart Block: Report of One Case

Myocarditis complicated with complete heart block is rare in childhood. We report a case of 4-year-old child presented with complete heart block which may have been caused by Mycoplasma pneumoniae. Under emergent temporal pacing, patient experienced cardiogenic shock with pulmonary edema eventually. The cardiopulmonary function was improved with atrial rhythm at the 6th hour later after intravenous infusion with high-dose gamma-globulin (IVIG). The IVIG therapy may have immunomodulatory effects and serve as a potential adjunctive therapy for fulminant myocarditis.

Xanthoma of Bone in a Normolipidemic Child: Report of One Case

Xanthoma invasion of the bone is a very rare disease especially in normolipidemic children. Bone erosion can be found in patients with this disease. However, due to the similarity of the symptoms of xanthoma with many other diseases including malignancy, the other diseases may initially be to be suggested and xanthoma may not even be considered. In this paper, we present an 8-year-old normolipidemic male child with a parietal bone xanthoma proved using tissue diagnosis. The clinical, radiographic and histological findings are also reviewed.

Subglottic hemangioma associated with cutaneous and cerebellar hemangiomas detected by MRI: report of one case.

Subglottic hemangioma (SGH) is a benign neoplasm that may cause severe and life-threatening respiratory obstruction in infants. However, patients usually present with inspiratory stridor in the first few months of life and may be mistakenly diagnosed as recurrent or persistent croup. Definitive diagnosis is made by image studies, endoscopic examination and biopsy or all. We report a 2-month-old female infant of SGH with initial clinical manifestations of dyspnea and inspiratory stridor co-existing with cutaneous and cerebellar hemangiomas. Clinicians must be alert the possibility of SGH when associated with cutaneous hemangioma. This patient has received oral steroid treatment for more than two months with improvement of the airway obstruction. Although purplish patch lesions over left side of face, eyelid, cheek, and peri-oral regions regressed, the size of the SGH on the followed MRI was slightly enlarged. The diagnosis and various treatments of SGH are discussed and reviewed in this paper.

Reevaluating reference ranges of oxygen saturation for healthy full-term neonates using pulse oximetry.

BACKGROUND We compared our clinical experience with currently available reference oxygen saturation level (SpO(2)) values from the American Academy of Pediatrics/American Heart Association (AAP/AHA) neonatal resuscitation program guidelines. METHODS We enrolled 145 healthy full-term neonates; infants showing respiratory distress and those with serious congenital anomalies were excluded. SpO(2) values at every 1 minute until 10 minutes after birth were measured and recorded. Infants were classified into the cesarean section (CS) and normal spontaneous delivery (NSD) groups for evaluating differences. The 10(th) percentiles of SpO(2) at each minute were used as the lower limits of normal oxygen saturation, and these were compared with the lowest target values recommended in the AAP/AHA guidelines. RESULTS Overall, 130 vigorous full-term neonates (median gestational age: 38 5/7 weeks; body weight at birth: 2405-3960 g) were analyzed. The median SpO(2) were 67% and 89% at the 1(st) and 4(th) minute, respectively. On average, SpO(2) values reached >90% at the 5(th) minute. No statistical differences were noted in the SpO(2) values between the CS and NSD groups after 5 minutes; however, a trend of higher SpO(2) was observed in the NSD group. We noted a gradually increasing trend for SpO(2) values over time, similar to that noted in the AAP/AHA guidelines. However, SpO(2) values at the 10(th) percentiles of each minute within the first 5 minutes in our study were equal to or significantly lower than those in the AAP/AHA guidelines; moreover, at the 10(th) minute, SpO(2) values at the 10(th) percentiles were significantly higher than those in the guidelines. CONCLUSION The delivery modes did not affect the SpO(2) values of full-term healthy neonates. Discrepancies in SpO(2) changes in full-term neonates not requiring resuscitation between this study and the AAP/AHA guidelines were significant. SpO(2) ranges for each time point within the first 10 minutes after birth should therefore be reevaluated locally.

Exhaled Nitric Oxide in Airway Diseases of Children

The measurement of exhaled nitric oxide (ENO) is a simple and noninvasive approach for assessing airway inflammation. The purpose of this study was to investigate whether ENO levels were different in children with various types of airway diseases. We recruited 100 consecutive patients with different airway diseases and 42 healthy control subjects for the study. Allergic asthmatic patients with high specific immunoglobulin E (IgE) level to Dermatophagoides pteronyssinus (Der p) tended to have the highest specific ENO levels (48.28 ± 16.63 ppb; n = 24). Perennial allergic rhinitis patients with high specific IgE level to Der p had intermediate levels of ENO (20.81 ± 9.56 ppb; n = 40). Patients with interstitial pneumonia induced by Mycoplasma pneumoniae (9.44 ± 3.97 ppb; n = 12) or with simple upper respiratory tract infections (10.51 ± 4.19 ppb; n = 24) had ENO levels similar to those of the healthy control subjects (8.80 ± 3.03 ppb; n = 42). Increased ENO in asthmatic patients and perennial allergic rhini...

Acute Respiratory Distress Syndrome in a Full-Term Newborn: Report of One Case

Respiratory distress syndrome, previously called hyaline membrane disease, is a common cause of morbidity and mortality associated with premature delivery. The incidence and severity of respiratory distress syndrome generally increase with decreasing gestational age at birth, and its occurrence in the at-term baby is rare. We report a male newborn who was born via elective cesarean section at 38 4/7 weeks gestation. After birth, he subsequently had severe respiratory distress typical of surfactant deficiency severe enough to be managed with ventilator support. He showed no evidence of intrapartum infection or aspiration. After two doses of surfactant were instilled via endotracheal tube, his respiratory condition showed dramatic improvement and recovered fully without complication before discharge. We report this case to emphasize the possibility that a term baby may develop surfactant-deficient respiratory failure and to suggest that elective delivery before 39 weeks gestation should be undertaken only for good medical reasons. In addition, the pathogenesis of acute respiratory distress syndrome in full-term neonates is discussed.

Moyamoya Disease Initially Mimicking MELAS Syndrome in a 14-Month-Old Child

Moyamoya disease is a neurological disease rarely seen in children outside Japan. It is difficult to differentiate moyamoya disease in its early stage from mitochondrial disorders in children when nontraumatic ischemic stroke is considered. We present a 14-month-old Taiwanese female child who had suffered from sudden onset of nontraumatic seizure attack, after which progressive left limb weakness was noted. Initial brain imaging and a series of laboratory studies were performed which suggested mitochondrial disorders, especially mitochondrial encephalopathy, lactic acidosis, and strokelike episodes (MELAS) syndrome. The patient underwent an oral glucose lactate stimulation test (OGLST), and mitochondrial disorders were not favored. MR angiography of the circle of Willis showed moyamoya disease. The patient then underwent an encephalo-duro-arterio-myo-synangiosis (EDAMS) operation. Evaluation of the neurodevelopmental and intelligence outcome required close long-term follow-up.