Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. We report a case of KD with acute respiratory distress syndrome (ARDS) after intravenous immunoglobulin (IVIG) infusion. Lung manifestations associated with KD have previously been reported in the literature. Although IVIG infusion is an effective therapy for acute KD, there are some reported complications related to IVIG infusion: hypotension, aseptic meningitis, acute renal failure, hemolytic anemia, etc. The case of KD reported here was treated with IVIG and aspirin. A few days after recovery from KD, the patient developed fever and maculopapular rash. A diagnosis of relapse KD was made and retreated with IVIG infusion. However, the patient developed ARDS four days after the second IVIG infusion. The patient recovered from ARDS after nine days of ICU care, which included high frequency oscillation ventilation with inhaled nitric oxide, steroid treatment and other supportive care.
Acute Kidney Injury ; Anemia, Hemolytic ; Aspirin ; Diagnosis ; Exanthema ; Fever ; High-Frequency Ventilation ; Humans ; Hypotension ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Lung ; Meningitis, Aseptic ; Mucocutaneous Lymph Node Syndrome* ; Nitric Oxide ; Recurrence ; Respiratory Distress Syndrome, Adult* ; Systemic Vasculitis

No abstract available.

OBJECTIVE: To evaluate common symptoms and severities of swallowing disorders in pediatric patients with a central nervous system disorder. METHOD: Twenty six pediatric patients with age ranging from 1 month to 3 years who had complained feeding and swallowing difficulties were studied. The subjects were divided into two groups according to the presence or absence of a central nervous system disorder. After taking the history and physical examination, a bedside swallowing test and a videofluoroscopic swallowing study were done. The parameters of oral preparatory phase, oral phase and pharyngeal phase were evaluated. RESULTS: In the bedside swallowing test, the patients with a central nervous system disorder showed a significantly higher incidence of decreased swallowing reflex, postural abnormality, tendency of poor secretion control and absent gag reflex. In the videofluoroscopic swallowing study, patients with a central nervous system disorder showed delayed oral transport time, poor oral control, pharyngeal triggering, aspiration, nasal regurgitation and esophageal reflux. Compared to the patients without a central nervous system disorder, the patients with a central nervous system disorder showed a significantly higher incidence of decreased pharyngeal peristalsis and delayed pharyngeal triggering. The patients with a central nervous system disorder also showed a more profound swallowing disorder than that of the patients without a central nervous system disorder, having more chances of a non-oral feeding than those without a central nervous system disorder. CONCLUSION: The children with a swallowing disorder and central nervous system disordershowed the different features from those without a central nervous system disorder in the bedside swallowing test and videofluoroscopic swallowing study. So that a complete swallowing evaluation including the videofluoroscopic a swallowing study will be helpful to children with swallowing disorder and central nervous system disorder for the evaluation and treatment of pharyngeal stage swallowing dysfunction.
Central Nervous System Diseases* ; Central Nervous System* ; Child ; Deglutition Disorders* ; Deglutition* ; Gastroesophageal Reflux ; Humans ; Incidence ; Peristalsis ; Physical Examination ; Reflex

PURPOSE: In the era of shock wave lithotripsy (SWL) and ureteroscopy, the majority of ureter stones are successfully managed with these less invasive treatment modalities. However, open ureterolithotomy still has a role in special situations. The efficacy of a laparoscopic retroperitoneal ureterolithotomy for large impacted ureter stones indicated for open ureterolithotomy is reported. MATERIALS AND MTHODS: Between February 1998 and December 1999, laparoscopic retroperitoneal ureterolithotomy for proximal ureter stones was performed in 5 patients who required an open ureterolithotomy. The mean size of the stones was 15mm, all of which were tightly impacted in the ureteral lumen and were associated with marked hydronephrosis. RESULTS: All but the initial operation was performed successfully via the retroperitoneal approach. Open conversion was needed in the first patient because of inexperience and the lack of anatomic perception. The mean operation time and estimated blood loss was 122 minutes and < or =50ml, respectively. A transfusion was not needed in any of the patients. Postoperative pain was well controlled with 175mg of Ketoprofen. The mean postoperative length of hospital stay was 6.3 days. There were no significant intraoperative or postoperative complications. CONCLUSIONS: A laparoscopic retroperitoneal ureterolithotomy can be considered as an alternative to conventional ureterolithotomy when open surgery is indicated.
Humans ; Hydronephrosis ; Ketoprofen ; Laparoscopy ; Length of Stay ; Lithotripsy ; Pain, Postoperative ; Postoperative Complications ; Shock ; Ureter ; Ureteroscopy

PURPOSE: In the era of shock wave lithotripsy (SWL) and ureteroscopy, the majority of ureter stones are successfully managed with these less invasive treatment modalities. However, open ureterolithotomy still has a role in special situations. The efficacy of a laparoscopic retroperitoneal ureterolithotomy for large impacted ureter stones indicated for open ureterolithotomy is reported. MATERIALS AND MTHODS: Between February 1998 and December 1999, laparoscopic retroperitoneal ureterolithotomy for proximal ureter stones was performed in 5 patients who required an open ureterolithotomy. The mean size of the stones was 15mm, all of which were tightly impacted in the ureteral lumen and were associated with marked hydronephrosis. RESULTS: All but the initial operation was performed successfully via the retroperitoneal approach. Open conversion was needed in the first patient because of inexperience and the lack of anatomic perception. The mean operation time and estimated blood loss was 122 minutes and < or =50ml, respectively. A transfusion was not needed in any of the patients. Postoperative pain was well controlled with 175mg of Ketoprofen. The mean postoperative length of hospital stay was 6.3 days. There were no significant intraoperative or postoperative complications. CONCLUSIONS: A laparoscopic retroperitoneal ureterolithotomy can be considered as an alternative to conventional ureterolithotomy when open surgery is indicated.
Humans ; Hydronephrosis ; Ketoprofen ; Laparoscopy ; Length of Stay ; Lithotripsy ; Pain, Postoperative ; Postoperative Complications ; Shock ; Ureter ; Ureteroscopy

PURPOSE: We report our experience using flexible ureteroscopy in diagnosing and treating upper urinary tract diseases. MATERIALS AND METHODS: Fifty six patients (male 35; female 21) who underwent flexible ureteroscopy for diagnostic purposes (n=24) or treatment (n=32) of upper urinary tract diseases from January 2000 to November 2001 were enrolled in this study. The primary indications for the ureteroscopy included stones (32), filling defects (10), stricture (8) and hematuria (6). A 7.5Fr flexible ureteroscope was used for observation and either an electrohydraulic lithotriptor (EHL) or Ho: YAG laser were used to remove the stones. RESULTS: The ureteroscopic procedures were performed under local (n=46) or general anesthesia (n=10). As a diagnostic procedure (n=24), clear underlying causes were found in 19 patients. As therapeutic purposes, the flexible ureteroscopic procedures were applied to 32 patients with urolithiasis (renal calyx, 14; renal pelvis, 6; proximal ureter, 7; and middle ureter, 5). Among them, an advancement in flexible ureteroscopy was possible in 24 patients. Of these, the stones in 20 (83%) had completely fragmented by the EHL or Ho: YAG laser lithotriptor without further treatment. In 4 patients (17%) who had residual stones, the adjuvant procedures including extracorporeal shock wave lithotripsy or a subsequent endoscopic procedure were performed for successful fragmentation. CONCLUSIONS: The flexible ureteroscopic procedure is one of the more effective and minimally traumatic diagnostic and therapeutic modalities for upper urinary tract diseases.
Anesthesia, General ; Constriction, Pathologic ; Female ; Hematuria ; Humans ; Kidney Pelvis ; Lasers, Solid-State ; Lithotripsy ; Shock ; Ureter ; Ureteroscopes ; Ureteroscopy ; Urinary Tract* ; Urolithiasis ; Urologic Diseases*

OBJECTIVE: To evaluate the pattern of developmental delay of language and to correlate the language with other developmental areas in cerebral palsy children. METHOD: Sequenced Inventory of Communication Development (SICD) was studied in 31 children with cerebral palsy of age ranging from 11 months to 48 months. Korean Denver Developmental Screening Test (DDST) was also performed in 18 children simultaneously. RESULTS: On SICD, 10 children (32.3%) showed the receptive language delay and 13 children (41.9%) showed the expressive language delay. Among 15 spastic quadriplegic children, 40% showed the delay of receptive language development, 53.3% showed the delay in expressive language development. Among 10 spastic diplegic children, 30% showed the delay of both receptive and expressive language development. One spastic right hemiplegic child showed a delay of expressive language development, but 4 left hemiplegic children showed the normal language development. One hypotonic cerebral palsy child showed a delay of both receptive and expressive language development. The expressive language was delayed more than the receptive language. SICD correlated highly with the language sector of DDST. And both SICD and DDST language sectors correlated with the other sectors of DDST (personal-social, fine motor-adaptive, gross motor), especially with the fine motor sector (r=0.912, 0.918, 0.976, p<0.001). CONCLUSION: There is a considerably high incidence of developmental delay of language in cerebral palsy children, especially among spastic quadriplegic children. The early evaluation and treatment for the developmental delay of language need to be included in a general rehabilitation program for the cerebral palsy children.
Cerebral Palsy* ; Child* ; Humans ; Incidence ; Language Development ; Language Development Disorders ; Mass Screening ; Muscle Spasticity ; Rehabilitation

PURPOSE: To evaluate the impact of temporary internal ureteral stents on the surgical outcomes of dismembered pyeloplasty in children. MATERIALS AND METHODS: The medical records of 70 children (76 renal units) who underwent dismembered pyeloplasty for ureteropelvic junction (UPJ) obstruction at at Asan Medical Center between January 2005 and December 2010 were retrospectively reviewed. We classified the renal units into the stented group (22 renal units) and the nonstented group (54 renal units). Fifty-four of 70 patients were male and their mean age was 2.2+/-3.8 years old. The mean follow-up period was 29.6+/-16.8 months. RESULTS: Sixty-four children had unilateral UPJ obstruction. The mean stent duration was 31.9 days. As shown by evaluation of radiologic images, there were no significant differences between the stented group and the nonstented group during the follow-up period (p>0.05). The mean preoperative and postoperative anteroposterior pelvic diameters (APPDs) of the nonstented group were 31.3 mm and 15.1 mm, respectively (p<0.001). The preoperative and postoperative grades of hydronephrosis were 3.9 and 2.9, respectively (p=0.037). The mean preoperative and postoperative APPDs of the stented group were 36.4 mm and 15.6 mm, respectively (p<0.001). The preoperative and postoperative grades of hydronephrosis were 4 and 3.1, respectively (p<0.001). Repeat obstruction was shown in 4 subjects as a postoperative complication (5.7%). Two children from each group had recurrent UPJ obstruction, with percentages of 3.7% and 9%, respectively (p=0.575). CONCLUSIONS: In a comparison of nonstented and stented groups during pediatric dismembered pyeloplasty for UPJ obstruction, no significant differences were found in the resolution of hydronephrosis or overall postoperative complications.
Child ; Follow-Up Studies ; Humans ; Hydronephrosis ; Male ; Medical Records ; Postoperative Complications ; Retrospective Studies ; Stents ; Ureter ; Ureteral Obstruction

PURPOSE: This study aimed to determine the exact characteristics of bacterial colonization after a ureteral stent indwelling. MATERIALS AND MTHODS: The natural history of bacterial colonization on the stent itself and urine samples after different periods of stent indwelling was examined. A total of 57 double-J stents from 52 patients (21 male; 31 female) with mean age of 52 (range 20-79) years were examined. In all patients, short-term (for 2-3 days) antimicrobial therapy was done at the time of stenting. Regular urinalysis and urine culture were performed until the stent was removed. The stents were removed under aseptic conditions and the proximal and distal tip segments were obtained. Three culture specimens were acquired from each stent segments (inner surface washing suspension, outer surface washing suspension and the stent tip itself). RESULTS: Bacterial colonies were found in 44% (25/57). Multiple pathogens were identified, and Enterococcus species (6/25) was the most common pathogen followed by E. coli (5/25). The bacteria did not colonize within the first 2 weeks of indwelling. However, the colonization rate increased, as the duration of the indwelling was further increased. Colonization in the stent was followed by the colonization in the urine. CONCLUSIONS: Bacterial colonization does not occur during the initial 2 weeks after stent indwelling. This suggests that antibiotics for short-term indwelling of ureteral stents are not necessary.
Anti-Bacterial Agents ; Bacteria ; Bacterial Adhesion ; Colon* ; Enterococcus ; Humans ; Male ; Natural History ; Stents* ; Ureter* ; Urinalysis ; Urinary Tract Infections* ; Urinary Tract*

PURPOSE: This study aimed to determine the exact characteristics of bacterial colonization after a ureteral stent indwelling. MATERIALS AND MTHODS: The natural history of bacterial colonization on the stent itself and urine samples after different periods of stent indwelling was examined. A total of 57 double-J stents from 52 patients (21 male; 31 female) with mean age of 52 (range 20-79) years were examined. In all patients, short-term (for 2-3 days) antimicrobial therapy was done at the time of stenting. Regular urinalysis and urine culture were performed until the stent was removed. The stents were removed under aseptic conditions and the proximal and distal tip segments were obtained. Three culture specimens were acquired from each stent segments (inner surface washing suspension, outer surface washing suspension and the stent tip itself). RESULTS: Bacterial colonies were found in 44% (25/57). Multiple pathogens were identified, and Enterococcus species (6/25) was the most common pathogen followed by E. coli (5/25). The bacteria did not colonize within the first 2 weeks of indwelling. However, the colonization rate increased, as the duration of the indwelling was further increased. Colonization in the stent was followed by the colonization in the urine. CONCLUSIONS: Bacterial colonization does not occur during the initial 2 weeks after stent indwelling. This suggests that antibiotics for short-term indwelling of ureteral stents are not necessary.
Anti-Bacterial Agents ; Bacteria ; Bacterial Adhesion ; Colon* ; Enterococcus ; Humans ; Male ; Natural History ; Stents* ; Ureter* ; Urinalysis ; Urinary Tract Infections* ; Urinary Tract*