Candidiasis of the central nervous system (CNS) is a rare condition and like other opportunistic fungal infections, most commonly occurs in immune-compromised patients. Because of the increasing use of antibiotics and the improving survival rate of premature infants requiring intensive care, the incidence of fungal infections in the brain has increased. We report the findings of ultrasonography and MR imaging in two cases of candidiasis of the CNS in premature infants.
Anti-Bacterial Agents ; Brain ; Candidiasis* ; Central Nervous System ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature* ; Critical Care ; Magnetic Resonance Imaging* ; Nervous System* ; Survival Rate ; Ultrasonography

PURPOSE: Urinary tract infection(UTI) in children may be cause of end stage renal failure and hypertension. So, early detection of renal scar, vesicoureteral reflux(VUR) and anomaly, and proper management are important. We carried this study to observe the significance of 24 hours urine beta2-microglobulin(beta2-MG) for predicting renal injury and correlation of beta2-MG with the grade of VUR. METHODS: We evaluated 52 patients with UTI who were admitted to the department of Pediatrics, Sung-Ae General Hospital from April 1994 to December 1994. All patients were evaluated with 99mTc-2,3-dimercaptosuccinic acid (DMSA) renal scan, voiding cystourethrogram(VCUG) and 24 hours urine beta2-MG. We divided them into 3 groups, group A; renal scarring in DMSA scan and no reflux in VCUG(14 patients), group B; renal scarring and reflux (10 patients), and group C; no renal scarring and reflux (24 patients). RESULTS: 1) Among 52 patients, 31 patients(59.6%) were less than 1 year of age and 21 patients(40.4%) were older than 1 year. The sex ratio of male to female was 1.6:1. 2) Among 24 patients with renal scarring, 15 patients(63%) were less than 1 year of age, and vesicoureteral reflux was observed in 10 patients (41.6%). 3) Vesicoureteral reflux was seen in 14 patients (26.9%): one with grade I, four with grade II, six with grade III, one with grade IV, and two with grade V. 4) The values of 24 hours urine beta2-MG in group A and B were 3.94+/-6.13mg /g Cr and 3.72+/-5.38mg/g Cr respectively, while 0.85+/-0.63mg/g Cr in group C, showing significant difference between group A and group C(p<0.05). However, there was no significant difference between group A and B(p>0.05). The grade of vesicoureteral reflux was also significantly correlated with the level of 24 hours urine beta2-MG. 5) 24 hours urine beta2-MG was significantly decreased with improvement of renal scarring after successful treatment of urinary tract infection. CONCLUSIONS: Measurement of 24 hours urine beta2-MG can be used as a sensitive marker of the severity of UTI and also useful for the evaluation of successful treatment and prognosis of patients with urinary tract infection.
beta 2-Microglobulin ; Child ; Cicatrix ; Female ; Hospitals, General ; Humans ; Hypertension ; Male ; Pediatrics ; Prognosis ; Renal Insufficiency ; Sex Ratio ; Succimer ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

A 30-year-old female patient presented with a progressive gait disturbance, who had been previously diagnosed for cataract and ovarian failure. Brain magnetic resonance imaging showed a high signal intensity of white matter in fluid attenuated inversion recovery and low signal intensity in brain volume imaging, suggesting demyelinating leukodystrophy. Genetic analysis confirmed the pathogenic homozygous mutations c.245T>A in the EIF2B2 gene, which is associated with vanishing white matter disease.

A pontine intracranial hemorrhage (ICH) evokes several neurological symptoms, due to the various nuclei and nerve fibers; however, hearing loss from a pontine ICH is rare. We have experienced a non-traumatic pontine ICH patient, with hearing loss. A 43-year-old male patient had a massive pontine hemorrhage; his brain magnetic resonance imaging revealed the hemorrhage on the bilateral dorsal pons, with the involvement of the trapezoid body. Also, profound hearing loss on the pure-tone audiogram and abnormal brainstem auditory evoked potential were noticed. Fifty-two months of long-term follow-up did not reveal any definite improvement on the patient's hearing ability.
Adult ; Brain ; Evoked Potentials, Auditory, Brain Stem ; Follow-Up Studies* ; Hearing Loss* ; Hearing* ; Hemorrhage* ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Male ; Nerve Fibers ; Pons

PURPOSE: Recently islets transplantation has been become a hot issue in insulin dependant diabetes mellitus. This study is aimed to review the technical method of islet isolation, pruification, and microencapsulation in animal model and to study the actual ability of transplated islets on controlling hyperglycemia. Finally, we want to know whether hollow fiber model for immunoislation in islet transplantation is effective in diabetic nude mouse. Method: We use 5-6 weeks old Spregue-Dawley rats as donor. After midline incision, collagenase was infused to proximal common bile duct and pancreas was extracted. With HBSS treatment and discontinuous density gradient centrifugation, islets were isolated. From 500-1,000 numbers of islets were transplanted to 6 strepozotocin-induced nude mice via upper pole of spleen and serial blood glucose level of nude mice were checked from conjunctival veins. Also, we examined transplanted-islets in spleen histologically with light and electron microscopy. Finally, after impregnation of 500 to 1,000 numbers of islets to 2-4 hollow fibers(Amicon R, H1P30-43 type, M.W:30,000) for immunoisolation, we inserted hollow fiber into peritoneum of 3 streptozotocin-induced nude mice and checked blood glucose level serially. Results: 1) Isolation of islets from rats was done successfully and we could calculate the number of islets under microscopy. 2) In 3 diabetic nude mice without islet transplantation(control group), all of them revealed hyperglycemia above 200mg/dL after 5days from strptozotocin injection. After then, blood glucose level was ranged from 300 to 500mg/dL persistently and all of them were died after 120 days. 3) We could observe the transplabted-islets in spleen with microscopy. Blood glucose level began to be controlled after 5 days from transplantation in 3 diabetic nude mice and all of 6 diabetic nude mouses revealed normoglycemia after 25 days from transplantation. 4) Islets transplantation with holler fibers into peritoneum of diabetic nude mice was not satisfactory. Although no technical difficulty was occured, persistent hyperglycemia was observed and all of 3 diabetic nude mice were died. CONCLUSION: Though islet transplantation through spleen was sucessful in diabetic nude mouse, further study is needed to clear the cause of failure of hollow fiber model in islets transplantation.
Animals ; Blood Glucose ; Centrifugation, Density Gradient ; Collagenases ; Common Bile Duct ; Diabetes Mellitus ; Drug Compounding ; Humans ; Hyperglycemia ; Insulin ; Islets of Langerhans Transplantation* ; Islets of Langerhans* ; Mice ; Mice, Nude* ; Microscopy ; Microscopy, Electron ; Models, Animal ; Pancreas ; Peritoneum* ; Rats ; Spleen ; Tissue Donors ; Veins

A 47-day-old male infant presented with fever, poor oral intake, irritability, and right-sided bluish buccal swelling. Contrast-enhanced computed tomography of the neck showed a round mass lesion of about 2.0x1.5 cm that suggested abscess formation in the right masticator space. Ultrasound-guided extraoral aspiration of the abscess at the right masseter muscle was successful. Staphylococcus aureus was identified in the culture from the aspirated pus and blood. Appropriate antibiotics were given and the patient recovered. The patient underwent follow-up ultrasonography that showed an improved state of the previously observed right masseter muscle swelling at about 1 month after hospital discharge. A masticator space abscess usually originates from an odontogenic infection in adults. We report a case of masticator space abscess in a 47-day-old infant in whom septicemia without odontogenic infection was suspected.
Abscess ; Adult ; Anti-Bacterial Agents ; Bacteremia ; Fever ; Follow-Up Studies ; Humans ; Infant ; Male ; Masseter Muscle ; Neck ; Sepsis ; Staphylococcus aureus ; Suppuration

PURPOSE: The purpose of this study was to review our recent experiences with deep neck abscesses in children and adolescents and to provide helpful information in treatment and diagnosis by comparing them with those in other available literatures. METHODS: Medical records of 36 children and adolescents admitted for deep neck abscess at two hospitals from January 2000 to October 2010 were reviewed retrospectively. RESULTS: Male to female ratio was 1.4 : 1 and the mean age was 6.5 years. Painful neck swelling and fever were the most frequent symptoms in patients under thirteen years of age whereas trismus and headache were frequent symptoms in patients over fourteen years of age. Submandibular space was the most common site of deep neck abscess in patients under thirteen years of age, whereas peritonsillar space was the most common site in patients over fourteen years of age. The results of bacterial cultures were positive in 61.5% of drained cases. Staphylococcus aureus was the most commonly identified bacteria in 6 patients (37.5%) and 5 of them were under 2 years of age. Twenty six patients received surgical drainage while the others were treated with antibiotics only. There were no statistically significant differences in the durations of admission, fever after admission, and antibiotic treatment between surgical and medical treatment groups. CONCLUSION: The common sites of deep neck abscess, associated symptoms, and causative organisms were different between children and adolescents. As there were no differences in durations of admission, fever, or antibiotics treatments between surgical and medical treatment groups, surgical drainage may be avoided by early recognition and suspicion. However, if there is no improvement of symptoms or size of abscesses within 48-72 hours of antibiotic treatment, surgical drainage should be considered.
Abscess ; Adolescent ; Anti-Bacterial Agents ; Bacteria ; Child ; Drainage ; Female ; Fever ; Headache ; Hospitals, General ; Humans ; Male ; Medical Records ; Neck ; Staphylococcus aureus ; Trismus

PURPOSE: Pleural effusions may develop during the course of bacterial pneumonia. The aim of this study was to evaluate the significance of the polymerase chain reaction (PCR) method for detection of Mycoplasma pneumoniae, Mycobaterium tuberculosis and Staphylococcus aureus from pleural fluid. METHODS: Total 12 samples were obtained from pleural fluid; 2 samples from children with Mycoplasma pneumonia, 5 samples from adults with tuberculous pleurisy, and 5 samples from sterile pleural fluid seeded artificially with staphylococcus aureus. The primers used for our PCR were prepared to amplify M. pneumonia-specific MP5 gene, M. tuberculosis-specific IS6110 gene, and S. aurus-specific femA and mecA gene. The amplified PCR products were detected by ethidium bromide-stained agarose gel electrophoresis. RESULTS: A total of 12 pleural fluid samples were tested by nested PCR using the specific primer set. We could amplify MP5 gene in 2 samples, IS6110 gene in 5 samples, mecA gene in 3 samples, and femA gene in 5 samples. These PCR data were correlated with serolological data, microbiological data and methicillin-sensitivity test result. There were no false-positive results due to cross-contaminating DNA between these 3 organisms. CONCLUSIONS: We conclude that enzymatic amplification of specific gene from pleural fluid might be useful to diagnose the infectious pleural effusion by Mycoplasma pneumoniae, Mycobacterum tuberculosis or Staphylococcus aureus.
Adult ; Child ; DNA ; Electrophoresis, Agar Gel ; Ethidium ; Humans ; Mycobacterium tuberculosis* ; Mycobacterium* ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pleural Effusion ; Pneumonia, Bacterial ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction* ; Staphylococcus aureus* ; Staphylococcus* ; Tuberculosis ; Tuberculosis, Pleural

Congenital self-healing reticulohistiocytosis (CSHR) is a rare variant of cutaneous reticulohistiocytosis. We report a newborn who had about 25 reddish brown papulonodular lesions on whole body at birth. No extracutaneous involvement was found. All skin lesions involuted within 4 months spontaneously. Biopsy of a skin lesion showed marked aggregated histiocytic infiltration with some eosinophils. S-100 protein and lysozyme were positive. Electron microscopy revealed numerous dense bodies, often with a myelin-like core and some Birbeck granules. We described a detailed clinical features of this case and reviewed the literatures.
Biopsy ; Eosinophils ; Humans ; Infant, Newborn ; Microscopy, Electron ; Muramidase ; Parturition ; S100 Proteins ; Skin

Dystonia has a wide range of causes, but treatment of dystonia is limited to minimizing the symptoms as there is yet no successful treatment for its cause. One of the optimal treatment methods for dystonia is chemodenervation using botulinum toxin type A (BTX-A), alcohol injection, etc., but its success depends on how precisely the dystonic muscle is selected. Here, we reported a successful experience in a 49-year-old post-stroke female patient who showed paroxysmal repetitive contractions involving the right leg, which may be of dystonic nature. BTX-A and alcohol were injected into the muscles which were identified by dynamic polyelectromyography. After injection, the dystonic muscle spasm, cramping pain, and the range of motion of the affected lower limb improved markedly, and she was able to walk independently indoors. In such a case, dynamic polyelectromyography may be a useful method for selecting the dominant dystonic muscles.
Botulinum Toxins ; Botulinum Toxins, Type A ; Dystonia* ; Electromyography ; Female ; Humans ; Leg ; Lower Extremity ; Methods ; Middle Aged ; Muscle Cramp ; Muscles ; Nerve Block ; Range of Motion, Articular ; Spasm