BACKGROUND: Clostridium difficile is the most common pathogen of antibiotic-associated diarrhea. Toxigenic strains produce toxin A and toxin B. The pathogenicity of C. difficile is due to the production of these two exotoxins. This study aimed to evaluate diagnostic value of two enzyme immunoassay by comparison of concordance rate to diagnose C. difficile-associated infection. METHODS: C. DIFF QUIK CHEK (TECHLAB, USA) that detect glutamate dehydrogenase antigen and VIDAS C. difficile Toxin A&B (BioMerieux, France) that detect toxin A and toxin B were done in 122 fecal specimens to detect C. difficile. RESULTS: In the total 122 stool specimens, 17 cases showed positive results in both tests. One specimen showed discrepancy that positive result in VIDAS C. difficile Toxin A&B (relative fluorescence value, RFV=2.93) but negative result in C. DIFF QUIK CHEK. Therefore, the concordance rate between two tests was 95.1% (116/122). Both anaerobic culture and in-house PCR for toxin B were negative in the discrepant fecal specimen and there was no clinical evidence that support C. difficile-associated diarrhea, so we concluded result in VIDAS C. difficile Toxin A&B as false positive. CONCLUSIONS: Although these two enzyme immunoassays targeted different antigen, they showed high concordance rate. The discrepant case was concluded to false positive in VIDAS C. difficile Toxin A&B test because it showed negative results in culture and PCR for toxin B and there were no clinical evidences of C. difficile-associated infection. It could be needed for analysis about conditions that cause false positive result in enzyme immunoassays to detect C. difficile toxin.
Azure Stains ; Clostridium difficile ; Diarrhea ; Exotoxins ; Fluorescence ; Glutamate Dehydrogenase ; Immunoenzyme Techniques ; Methylene Blue ; Polymerase Chain Reaction ; Xanthenes

PURPOSE: We investigated the clinical presentation of febrile pediatric patients with acute pyelonephritis (APN) with a mixed urine culture from an aseptic urine sample, and compared with that of those with a single culture. METHODS: We retrospectively reviewed the medical charts of 95 patients diagnosed as APN with fever between January 2008 and October 2010 at Korea University Medical Center. We classified the patients with APN into two groups with a positive single culture (S group) and a positive mixed culture (M group) from an aseptic urine sample of suprapubic bladder aspiration or urethral catheterization and compared the fever duration, laboratory markers such as serum white blood cell (WBC) counts and C-reactive protein (CRP) values in peripheral blood, and the presence of hydronephrosis, renal scar and vesicoureteral reflux (VUR) between the two groups (If presence of hydronephrosis, scar and VUR=1 and no=0). RESULTS: Total pediatric patients with febrile APN were 95 patients, a positive S group was 89 patients and a positive M group was 6 patients. Fever duration (S vs. M, 4.7+/-3.1 vs. 6+/-5.7 days), serum WBC (S vs. M, 18,630+/-6,483 vs. 20,153+/-7,660/microL) and CRP (S vs. M, 100.6+/-2.46 vs. 81.1+/-0.09 mg/L) values, and the presence of hydronephrosis, renal scar and VUR were not different between the two groups. CONCLUSION: Our data shows that there were no specific differences of clinical manifestation between a positive single urine culture and a positive mixed urine culture in pediatric APN. A mixed urine culture from an aseptic urine sample should be interpreted cautiously.
Academic Medical Centers ; Bacteriuria ; Biomarkers ; C-Reactive Protein ; Cicatrix ; Coinfection ; Fever ; Humans ; Hydronephrosis ; Korea ; Leukocytes ; Pyelonephritis ; Retrospective Studies ; Urinary Bladder ; Urinary Catheterization ; Urinary Catheters ; Vesico-Ureteral Reflux

BACKGROUND AND OBJECTIVES: Treatment of head and neck cancer with cisplatin-based combination chemotherapy has yielded increased complete response rates. In spite of the initial good response, recurrent cancer after chemotherapy does not respond to cisplatin based chemotherapy. In recent years, the analogues of taxol have used in a new chemotherapy treatments for head and neck cancer. The purpose of this study was to develop the acquired resistance to cisplatin in head and neck cancer cell line and to study the cross-resistance of docetaxel and 5-fluorouracil (5-FU) as compared to the parental cells in vitro. SUBJECTS AND METHOD: Two different human head and neck cancer cell lines (PNUH-12, SNU-899) were studied. We developed two cisplatin resistant cell lines (PNUH-12 R1, SNU-899 R1) by exposing them to near continuous increasing concentration of cisplatin. The morphology, growth curve of resistant cell lines were studied and the resistance of these cell lines to the cisplatin, docetaxel and 5-FU were compared to that of parental cells by MTT assay. RESULTS: The pattern of growth and shape of PNUH-12 R1 and SNU 899 R1 cell lines showed similarity to their parent cell lines. The growth curve of these cell lines were suppressed when compared with the parental cells. When compared to the parental cells, PNUH-12 R1 cells were 2.0-fold, 3.8-fold, and 1.4-fold resistant, and SNU 899 R1 cells 3.5-fold, 6.7-fold, and 15.0-fold resistant to cisplatin, docetaxel and 5-FU, respectively. CONCLUSION: In our study, cisplatin resistant cell lines of head and neck cancer have strong cross-resistance to docetaxel. However, there was difference in cross-resistance to 5-FU between these cell lines.
Cell Line* ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination ; Fluorouracil ; Head and Neck Neoplasms* ; Head* ; Humans ; Paclitaxel ; Parents

PURPOSES: To investigate the viral etiology of community-acquired pneumonia in Korean adults, we have detected respiratory viruses (Respiatory syncytial virus, adenovirus, influenza virus and parainfluenza virus) in the way of prospective, multi-center study. METHODS: From July 1997 to April 2000, nasal aspirates or sputum were obtained from adults patients with community pneumonia admitted to the participating hospitals and transferred immediately to the central laboratory in the Seoul National University Children's Hospital. The specimens were divided into three parts. One part was used for indirect immunofluorescent test for respiratory viruses, the other part for the culture of RSV and adenovirus in HEp-2 cell monolayer. Another part was used for the culture of influenza virus and parainfluenza virus in MDCK or LLC- MK2 cell monolayers. RESULTS: Of 317 samples, 32 (10.1%) specimens were positive for viral isolation by indirect IF staining or culture, including one dual-infected specimen (adenovirus and parainfluenza virus). Influenza virus was most commonly detected (16 specimens). Parainfluenza virus, adenovirus and RSV were detected in 10, 4 and 3 patients, respectively. All isolated influenza viruses were type A (H3N2 in 9 patients, H1N1 in 2 and unspecified in 5), and 8 out of 10 parainfluenza virus isolates were type 3. CONCLUSION: Similar to previous foreign reports, a significant portion of community-acquired pneumonia in Korean adult is caused by respiratory viruses. Our data empathized the need of referral system for viral diagnosis and of nationwide investigation on respiratory virus infections.
Adenoviridae ; Adult* ; Diagnosis ; Humans ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pneumonia* ; Prospective Studies ; Referral and Consultation ; Seoul ; Sputum

The mammalian ovary has been known as receiving its innervation by sympathetic and sensory neurons of the peripheral nervous system from the brain. Recently, there were several functional reports that the vagus nerves were also regulating the ovarian function, but the vagus nerve had not been identified by clear morphological evidence. A viral transneuronal tracing technique has been used to demonstrate the morphological evidence for the central vagal involvement in ovarian innervation in brain areas. Bartha strain of pseudorabies virus injection was made into the ovary of Sprague Dawley rats. In experimental group, the vagus nerve of the same injection side was removed right after ovarian injection. At five days after initial injection, all the rats were sacrificed and brains were processed for immunohistochemistry. Several central nuclei including hypothalamic paraventricular nucleus showed strong bilateral positive labelings after unilateral injection in control rats, but the positive labelings were disappeared or decreased in several hypothalamic nuclei and nuclei of the vagus nerve. In conclusion, these results provide the morphological evidence that vagus nerve has neural connection to ovary and by which the central nervous system may maintains the state of ovulation and reproduction as a possible parasympathetic routes in mammals.
Animals ; Brain ; Central Nervous System ; Female ; Herpesvirus 1, Suid ; Immunohistochemistry ; Mammals ; Ovary ; Ovulation ; Paraventricular Hypothalamic Nucleus ; Peripheral Nervous System ; Rats* ; Rats, Sprague-Dawley ; Reproduction ; Sensory Receptor Cells ; Vagus Nerve

Neurofibromatosis is a rare systemic disease, and genitourinary tract involvement is especially uncommon. Bladder is the most frequently involved organ in the genitourinary tract. Bladder neurofibromatosis may present as a diffuse infiltrative process or an isolated neurofibroma. The symptoms vary, ranging from urinary incontinence to retention. Treatment is usually conservative. The patient should be worked up to rule out other manifestation of tumor enlargement and followed to evaluate the development of new lesion. We report a case of the development of invasion of bladder in a patient with neurofibromatosis.
Humans ; Neurofibroma ; Neurofibromatoses ; Neurofibromatosis 1 ; Retention (Psychology) ; Urinary Bladder ; Urinary Incontinence ; Urinary Retention

Acute pyelonephritis (APN) is a relatively common bacterial infection in children. In previously healthy children, acute kidney injury (AKI) is very rare in the course of APN without urinary tract obstruction, renal hypoperfusion due to hypotension or exposure to nephrotoxic agents. We describe a case of AKI secondary to APN and renal abscess in a child with vesicoureteral reflux. With antibiotic treatment and adequate hydration, the patient was improved. APN should be included in the differential diagnosis of AKI and adequate treatment by proper antibiotics is crucial for full recovery of renal function.
Abscess ; Acute Kidney Injury ; Anti-Bacterial Agents ; Bacterial Infections ; Child ; Diagnosis, Differential ; Humans ; Hypotension ; Pyelonephritis ; Urinary Tract ; Vesico-Ureteral Reflux

PURPOSE: The incidence of community-acquired urinary tract infection (UTI) due to extended-spectrum beta-lactamase producing Escherichia coli (ESBL(+) E. coli) has increased worldwide. ESBL causes resistance to various types of the newer beta-lactam antibiotics, including the expanded spectrum cephalosporins and monobactams. We aimed to investigate the severity of UTI and associated genitourinary malformations in children with febrile UTI caused by ESBL(+) E. coli. METHODS: We retrospectively reviewed the medical records of 290 patients diagnosed as febrile UTI caused by E. coli between January 2008 and October 2010 at Korea University Medical center. We classified the patients into two groups with ESBL(+) and ESBL(-) E. coli group according to the sensitivity of urine culture. Fever duration, admission period, white blood cell (WBC) counts and C-reactive protein (CRP) in peripheral blood, the presence of hydronephrosis, cortical defects, vesicoureteral reflux (VUR) and renal scar were compared between the two groups. RESULTS: Patients with ESBL(+) E. coli were 32, and those with ESBL(-) E. coli were 258. If we excluded those tested with a sterile urine bag, patients with ESBL(+) E. coli were 22, and those with ESBL(-) E. coli were 212. Whether the results of sterile urine bag tests were included or not, there was no significant difference in all parameters between the two groups statistically. CONCLUSION: Our data shows that ESBL(+) E. coli may not be related to the severity of UTI and associated genitourinary malformations.
Academic Medical Centers ; Anti-Bacterial Agents ; beta-Lactamases ; C-Reactive Protein ; Cephalosporins ; Child ; Cicatrix ; Escherichia ; Escherichia coli ; Fever ; Humans ; Hydronephrosis ; Incidence ; Korea ; Leukocytes ; Medical Records ; Monobactams ; Retrospective Studies ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux

In one-stage transanal endorectal pull-through operation (TERPT) for Hirschsprung disease, preoperative evaluation by contrast enema (CE) is important tool in aspect of planning of surgical procedure as well as diagnosis. This study was to evaluate the significance of CE for identifying the extent of aganglionic bowel. A retrospective analysis was performed in 40 patients who underwent TERPT between 2003 and 2011. The authors reviewed the CE studies and their correlation with pathologic extent of aganglionosis. Total 66 contrast enemas were performed in 40 patients. Twenty patients underwent single CE, but 20 patients required multiple CEs. In single CE group, 17 had clear radiographic transition zone, but 3 had less definite transition zone. In multiple CE group, 17 patients who had equivocal finding in first or second CE had definite radiographic transition zone, but 3 patients of this group had less definite radiographic transition zones. Overall, 34 patients (85%) had clear radiographic transition zone by single or repeated CE. One (2.9%) out of 34 patients with clear radiographic transition zone had discordance between radiographic and pathologic transition zone. In contrast 4 (66.7%) out of 6 patients with equivocal radiographic transition zone had discordance between radiographic and pathologic transition zone. Observation of clear radiographic transition zone is important in preparation of TERPT, and repeated CE is helpful to reduce the discordance between radiographic and pathologic transition zone. Awareness of the possibility of discordance is also important if radiographic transitional zone is not clear.
Enema ; Hirschsprung Disease ; Humans ; Retrospective Studies

N2O can diffuse in and/or out the middle ear cavities and it may alter the middle ear pres-sure. This study was performed to investigate the effect of N2O discontinuation on the changes in middle ear pressure during general endotracheal anesthesia. We measured middle ear pres-sures and end-tidal NO concentrations at preanesthesia, immediately after N2O discontinuation and then at every five minutes for 60 minutes under either halothane or enflurane an- esthesia in two groups(group 1=50% administration of N2O in O2; group 2=60% administration of N2O in O2). The middle ear pressures after N2O discontinuation decreased slowly but they did not returned to the preanesthetic value in both groups. The end-tidal N2O concentrations decreased rapidly until five minutes and then they decresed slowly to the zero leve1 until 30 minutes after N2O discontinuation in both groups. The expected time of the middle ear pres-sure of preanesthesia value was 89.4 minutes in group 1 and 80.9 minutes in group 2 respectively. The middle ear pressure do not return to the level of preanesthesia at 60 minutes after N2O discontinuation while the end-tidal N2O concentration decrease to the zero level via 30 minutes after its discontinuation. Thus it is recommended that N2O administration should be discontinued at least 30 minutes before an application of tympanic membrane patch on the ear drum and N2O is carefully administered in patients with middle ear and/or upper airway disesses.
Anesthesia* ; Ear ; Ear, Middle* ; Enflurane ; Halothane ; Humans ; Tympanic Membrane