PURPOSE: The Purposes of this study are to identify the circulating etiologic viruses of acute lower respiratory tract infection in children and to understand the relation with clinical diagnosis. METHODS: We obtained a total of 418 nasopharyngeal aspirates from children admitted for their acute lower respiratory tract infections at three tertiary hospitals in Seoul from September 2008 to March 2009. We performed multiplex RT-PCR to identify 14 etiologic viruses and analyzed their emerging patterns and clinical features. RESULTS: Average age of patients was 16.4 months old and the ratio of male to female was 1.36. Viruses were detected in 56.2% of a total of 418 samples. Respiratory syncytial virus (35%) was the most frequently detected and followed by human rhinovirus (22%), human bocavirus, adenovirus, human metapneumovirus, parainfluenza virus, influenza virus and human coronavirus. Co-infection reached 21.9% of positive patients. CONCLUSION: When we manage the patients with acute lower respiratory infectious diseases, we should remind the role of various viral pathogens, which might be circulating by seasons and by local areas.
Adenoviruses, Human ; Child ; Coinfection ; Communicable Diseases ; Coronavirus ; Female ; Human bocavirus ; Humans ; Male ; Metapneumovirus ; Orthomyxoviridae ; Paramyxoviridae Infections ; Respiratory Syncytial Viruses ; Respiratory System ; Respiratory Tract Infections ; Rhinovirus ; Seasons ; Tertiary Care Centers ; Viruses

We report a case of doxycycline-induced phototoxicity in a 62-years-old male. The patient, had erythematous macules and patches on sun-exposed areas. A Phototest revealed a marked decreased minimal erythemai. dose (MED) to UVA (MED(UNA)=-10J/cm2). Photopatch tests with 1%, 5% Doxycycline ointment were negative. An oral provocation test was performed, which showed a positive result with a decrease of MED to UVA (MED(UVA)= 20J/cm2). After the cessation of doxycycline, his skin lesioris were improved markedly with complete loss of photosensitivity.
Dermatitis, Phototoxic* ; Doxycycline ; Humans ; Male ; Skin

Small cell carcinoma of the kidney is very rare, but lethal due to early metastasis and rapid progression. We report a case of the primary small cell carcinoma of the kidney with large rena1 calculus resulting in spontaneous rupture of the kidney, and was managed by total nephrectomy and evacuation of retroperitoneal hematoma and calculus. Immunohistochemical studies revealed the positive staining for cytokeratin and neuron-specific enolase, and dense-core neurosecretory granules were identified in the cytoplasm by electron microscopy. This report is the first case of the primary small cell carcinoma of the kidney resulting in spontaneous rupture of the kidney.
Calculi ; Carcinoma, Small Cell* ; Cytoplasm ; Hematoma ; Keratins ; Kidney* ; Microscopy, Electron ; Neoplasm Metastasis ; Nephrectomy ; Phosphopyruvate Hydratase ; Rupture, Spontaneous*

BACKGROUND: Bronchoscopy has been widely used for a histologic diagnosis through a transbronchial lung biopsy or for staging of patients with peripheral lung cancer. However a transthoracic needle aspiration (TTNA) has been used more widely for a histologic diagnosis in patient with a small size nodule or a nodule located in the outer portion of the lung because of the low diagnostic yield of bronchoscopy in these cases. The role of bronchoscopy for staging is not well established in patients with peripheral lung cancer diagnosed by a TTNA or patients who are undergoing surgery without a histologic diagnosis. METHOD: To evaluate the role of bronchoscopy for the staging in patients with peripheral lung cancer, who were diagnosed by TTNA, the medical records of 86 patients with peripheral lung cancer who underwent bronchoscopy at Kyungpook National University Hospital between January 1995 and May 1997 were reviewed. RESULTS: While 53 cases had normal bronchoscopic findings, 33 cases had abnormal bronchoscopic findings comprising 9 cases of tumor, 10 cases of infiltration and 14 cases of compression of which there were 25 cases of T1 and 8 T2 endoscopically. The bronchoscopic staging did not influence the changes of the clinical stage of lung cancer. The frequencies of bronchial involvement tended to increase as the sizes of the nodule increased. Among the 42 patients who underwent surgery, 9 patient staged higher after operation because of lymph node involvement in 8 patients and the involvement of the pulmonary artery in 1 patient. No case staged above after operation due to a bronchial invasion. CONCLUSION: These findings suggests that bronchoscopy is not useful for staging in patients with peripheral lung cancer diagnosed by a TTNA.
Biopsy ; Bronchoscopy* ; Diagnosis ; Gyeongsangbuk-do ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Nodes ; Medical Records ; Needles ; Pulmonary Artery

Pasteurella multocida, a Gram-negative coccobacillus, is part of the normal oral flora of many types of animals, including domestic dogs and cats. It is the etiologic agent of a variety of infectious diseases, such as hemorrhagic septicemia in cattle or fowl cholera in chiken. Although this is a primary pathogen in the animal world, infection due to Pasteurella multocida in man has been described with increasing frequency recently. The majority of individuals with pasteurella multocida pulmonary infection possess some underlying pulmonary diseases, most commonly bronchiectasis or COPD. With review of literature, We report a young man who developed the empyema caused by Pasteurella multocida.
Animals ; Bronchiectasis ; Cats ; Cattle ; Cholera ; Communicable Diseases ; Dogs ; Empyema ; Empyema, Pleural* ; Hemorrhagic Septicemia ; Lung Diseases ; Pasteurella multocida* ; Pasteurella* ; Pulmonary Disease, Chronic Obstructive

Purpose: Long-term culture- initiating cells(LTC-IC) are stem cells that have the capacities of long-term engraftment and helping to establish hematopoietic microenvironment. For evaluation of the LTC-IC, we measured the counts and function with multidimentional flowcytometry in long-term culture media. METHODS: Samples were obtained from umbilical cord blood, leukapheresis products and bone marrow(BM). LTC-IC were counted with flowcytometric analysis using anti- CD34, anti-CD38, and anti-HLA-DR antibodies at 0, 5, and 8 weeks. Cell adhesion molecule related with stem cell were evaluated with flowcytometric analysis also using anti-VCAM-1(CD106) and anti-VLA-4(CD49d) at 0 and 8 weeks. RESULTS: The proportion of CD34+/CD38- cell from fractionated mononuclear cells at 0 week were 0.46%, 0.044%, and 0.038% for BM, leukapheresis products, and umbilical cord blood respectively and then rapidly decreased at 5 weeks, but still persisted at 8 weeks in all three groups. The proportion of CD34+/HLA-DR- cells was the same tendency to CD34+/CD38-. VCAM+ expression rate from fractionated CD34+ cells at 0 and 8 weeks were 67.3% and 40.2% for BM and 64.1% 44.2% for umbilical cord blood but it was very low 31.2% and 5.1% for leukapheresis products. VLA-4+ expression rate for fractionated CD34+ cells at 0 and 8 weeks were similar tendency to VCAM+ cells. CONCLUSION: This study suggest that the count of LTC-IC decreased with time but still persisted until 8 weeks. Umbilical cord blood including BM help to establish the hematopoietic microenvironments.
Antibodies ; Cell Adhesion ; Culture Media ; Fetal Blood ; Leukapheresis ; Stem Cells

BACKGROUND: The study was designed to compare neonatal outcome biochemically and clinically. We examined the administration of sevoflurane below 1.0% with 50% oxygen and 50% nitrous oxide and spinal anesthesia during elective cesarean section. METHODS: The study examined 60 parturients, who were planned after 36 weeks gestation, ASA I-II, at term undergoing elective cesarean section, and who were allocated to receive 1.0% sevoflurane with 50% oxygen and 50% nitrous oxide (n = 30), and spinal anesthesia (n = 30). General anesthesia was induced with thiopental 5 mg/kg followed by succinylcholine 1.0 mg/kg to facilitate tracheal intubation. Parturients received sevoflurane given in a 50 : 50 oxygen and nitrous oxide mixture, using 0.5-1.0% progressive incremental dosing up to 1.5-2.0 MAC. Spinal anesthesia involving a spinal injection of 8 mg hyperbaric (plain) bupivacaine 0.5% with 20microgram fentanyl was added. A systolic blood pressure of less than 90 mmHg or a reduction in the systolic pressure of greater than 20% from baseline was considered as hypotension and treated with a bolus of 5 mg of intravenous ephedrine. We studied neonatal data including umbilical artery gas analysis results and Apgar scores at 1 and 5 min. RESULTS: Comparing the general and the spinal anesthetic groups, no significant differences could be detected in neonatal outcome biochemically or clinically. CONCLUSIONS: Anesthesia type does not seem to influence the biochemical or clinical results of the neonates delivered by elective cesarean section. We believe that both general anesthesia with sevoflurane and spinal anesthesia could be performed in elective term cesarean sections without risk to neonates.
Anesthesia ; Anesthesia, General* ; Anesthesia, Spinal* ; Blood Pressure ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Female ; Fentanyl ; Humans ; Hypotension ; Infant, Newborn ; Injections, Spinal ; Intubation ; Nitrous Oxide ; Oxygen ; Pregnancy ; Succinylcholine ; Thiopental ; Umbilical Arteries

PURPOSE: Patient-centered care is one of the most important factors of high-quality medical care. Medical educators have been increasingly interested in education for patient-centered care. This study was conducted to guide such education by assessing the patient-centeredness of medical students in a real patient encounter and a standardized patient encounter on the clinical performance examination (CPX). METHODS: During the first semester of 2010 and 2011, fourth-year medical students in a clinical clerkship interviewed outpatients who visited the Department of Family Medicine. The interviews were videotaped, 25 of which were selected for study. We searched the 25 students' CPX videotapes that were recorded in the same year for comparison. The patient-centeredness of the students was assessed by measure of patient-centered communication (MPCC). RESULTS: The inter-rater reliability of the MPCC was 0.89 when measuring real patient encounters. MPCC scores of 25 students were very low for both real patients (mean, 28.8; range, 8.2~53.1) and for standardized patients (mean, 27.5; range, 8.2~52.7), and there was no significant difference between two groups. The component 1 MPCC scores were significantly higher for real patient encounters compared with those of CPX encounters (0.28 vs 0.18, p=0.0001). The component 2, 3 MPCC scores of two groups were not different each other. CONCLUSION: Medical educators must emphasize the importance of exploring a patient's illness and social background and involving them in making a diagnosis and treatment plan for patient-centered care. They should give students more opportunities to interview real patients and diversify scenarios for standardized patients.
Clinical Clerkship ; Humans ; Outpatients ; Patient-Centered Care ; Physician-Patient Relations ; Students, Medical ; Videotape Recording

PURPOSE: The aim of this study was to identify the predictive factors in the early laboratory findings for cardiac sequelae in Kawasaki disease(KD). METHODES: A retrospective review of the records was conducted of all children with KD who were admitted to the Ulsan Dongkang General Hospital, Masan Samsung Hospital, and Gyeongsang National University Hospital between January 1995 and December 1999. We analyzed and compared the early laboratory findings between the patients with and without coronary artery dilatation. RESULTS: A total of 981 patients were divided into two groups : 826 patients(84.3%) with normal coronary artery and 155 patients(15.7%) with coronary artery dilatation. Age and sex were not significantly different between the two groups. The mean serum C-reactive protein(CRP) in the coronary artery dilatation group and in the normal coronary artery group were 5.0 mg/dl(+/-5.3) and 4.1 mg/dl(+/-5.0), respectively, with a significant difference(P<0.05), whereas the other early laboratory findings had no difference between the groups. CONCLUSION: This study shows that the early serum CRP was higher in patients with KD who had coronary artery dilatation than in those with normal coronary artery. There may be a strong possibility of cardiac sequelae at a high level of serum CRP. However, the cut-off value of serum CRP could not be determined for the prediction of cardiac sequelae in patients with KD.
Child ; Coronary Vessels ; Dilatation ; Hospitals, General ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Staphylococcal Protein A* ; Ulsan

PURPOSE: The primary objective of this study was to evaluate the impact of radical retropubic prostatectomy(RRP) on lower urinary tract symptoms(LUTS) in patients with clinically localized prostate cancer. MATERIALS AND METHODS: Between 2000 and 2006, 82 men with clinically localized prostate cancer underwent RRP. The International Prostate Symptom Score(IPSS) and the IPSS quality of life(QoL) score, and uroflowmetry were administered both prior to and 1 year after RRP. RESULTS: The overall mean total IPSS, maximal flow rate, and postvoid residual volume did not change over time after RRP. Prior to and after RRP, the mean maximal flow rate and residual urine changed from 17.6ml/sec to 17.9ml/sec(p=0.566) and 16.9ml to 15.8ml(p=0.777), respectively. Total IPSS also changed after RRP, from 12.8 to 12.5(p=0.731). The reduction of the IPSS was more prominent in patients with severe symptoms(IPSS> or =20), whereas in those with moderate symptoms(8< or =IPSS<20), the score did not change significantly after RRP. Furthermore, in those patients with no or mild symptoms(IPSS<8), the score increased after RRP. CONCLUSIONS: RRP was not shown to improve uroflowmetric parameters, including maximal flow rate, postvoid residual urine, and IPSS, in cases of moderate LUTS. However, RRP may exert a beneficial effect in those patients with severe LUTS, and may also have adverse effects on some individuals with no or mild symptoms. We believe that these results might be utilized when counseling patients about treatment options for localized prostate cancer.
Counseling ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Prostatic Neoplasms ; Residual Volume ; Urinary Tract