Kawasaki disease (KD) is an immune-mediated disease which is a leading cause of acquired cardiovascular disease in developed country. Recently, tumor necrosis factor-alpha (TNF-alpha) blocker, infliximab has been considered a promising option for patients with refractory KD. Although chronic use of a TNF-alpha blocker could increase risk of opportunistic infections, a few studies have documented that use of infliximab was safe without serious adverse effects in patients with KD. We observed serious bacterial infection after infliximab treatment in an infant with refractory KD. Our patient was a 5-month-old male infant diagnosed with KD who did not respond to repeated doses of intravenous immunoglobulin. We effectively treated him with a single infusion of infliximab (5 mg/kg), but gram-negative (Acinetobacter lwoffii) septicemia developed after infliximab infusion. Therefore, we report a case of serious septicemia after treatment with infliximab, and suggest considering the risk of severe infection when deciding whether to prescribe infliximab to an infant with refractory KD.
Bacterial Infections ; Cardiovascular Diseases ; Developed Countries ; Humans ; Immunoglobulins ; Infant* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Opportunistic Infections ; Sepsis* ; Tumor Necrosis Factor-alpha ; Infliximab

Background: A clinician reported unusually high incidence of A. xylosoxidans isolation from aspirated tissues in outpatient clinic. Methods: A. xylosoxidans isolates from January 2002 to June 2002 were investigated. The infection control nurse reviewed medical records and observed the procedures of tissue aspiration and culture at the clinical microbiology laboratory. Specimens were obtained for investigational cultures from dye, aspiration gun, slide alcohol sponge, tray, sink. water of sink, buffer solution, microscope, computer, and telephone. Results: A. xyloxosidans was isolated from twenty-four patients during 6 months. None of 24 cases had any typical signs or symptoms of infections by A. xylosoxidans. Observation of tissue aspiration and culture procedure revealed that buffer solution was used for prevention of specimen drying after tissue aspiration. Culture of the buffer solution yielded a heavy growth of A. xylosoxidans from four out of ten specimens. A. xylosoxidans was not isolated from any other investigational specimens. Conclusions: This was supposed to represent pseudoepidemic. Contaminated buffer solution was documented as the cause of this pseudoepidemic. The usage of buffer solution was stopped. During the follow-up period of 2 months, no additional A. Xylosoxidans was cultured from aspirated tissues.
Alcaligenes* ; Ambulatory Care Facilities ; Follow-Up Studies ; Humans ; Incidence ; Infection Control ; Medical Records ; Methods ; Porifera ; Telephone ; Water

PURPOSE: High-Sensitivity C-reactive protein(hs-CRP) has been recognized as a very useful and sensitive predictor of the future risk of myocardial infarction. But the clinical significance of hs-CRP in children remains uncertain. To confirm the existence of obesity-induced vascular inflammation and the association between metabolic syndromes and elevation of CRP in children, we investigated the relationship among CRP, obesity, blood pressure(BP), and serum lipids in schoolboys. METHODS: Twenty-eight obese(BMI 29.61+/-3.29 kg/m2) and 93 non-obese(BMI 18.99+/-2.21 kg/m2) boys aged 14 years were examined. Serum CRP levels was measured by the high sensitive latex turbidimetric immunoassay and subjects with CRP levels below 0.3 mg/dL were adopted to avoid the influence of acute infection. RESULTS: Obese children had significantly higher hs-CRP levels than their non-obese group(0.104+/-0.075 vs. 0.054+/-0.005 mg/dL). In the obese group, BMI, systolic blood pressure, diastolic blood pressure, apolipoprotein B, atherogenic index, and triglyceride were significantly higher than in non-obese. The BMI, diastolic blood pressure, apolipoprotein E, atherognic index, and triglyceride showed positive correlation with log CRP by simple regression. Multiple regression analysis indicated that BMI and apolipoprotein E were strongly related to CRP. CONCLUSION: This study revealed that obese children tended to have higher levels of serum hs-CRP, BP elevation and dyslipidemia than the control group and that BMI and apolipoprotein E were strongly related to CRP. These results indicate that obesity related metabolic syndrome can be developed in children.
Apolipoproteins ; Blood Pressure ; C-Reactive Protein* ; Child ; Dyslipidemias ; Humans ; Immunoassay ; Inflammation ; Latex ; Myocardial Infarction ; Obesity ; Triglycerides

PURPOSE: The purpose of this trial was to determine whether salbtamol and budesonide combined inhalation therapy is more efficacious than conservative treatment for admitted infants with bronchiolitis in early phase. METHODS: The study subjects were 72 infants admitted to Sun Hospital in Taejeon from July 1994 to June 1995, whose age from 1 month to 12 months with clinical diagnosis of bronchiolitis. Infants were randomly assigned to different three treatment groups as follw: Group C: 21 infants who received conservative treatment with oxygen (4liter/min); Group A: 23 infants who received salbutamol (0.1mg/kg) inhalation therapy using ultrasonic nebulizer at 6 hours interval add to conservative therapy; Group B: 28 infants who received budesonide (0.1mg/kg) inhalation therapy with above mentioned treatment at 12 hours interval. Then, infants were analyzed by comparison of clinical score, repiratory rate at time order of entry, 12 hours, 24 hours, 48 hours, 72 hours, and 5 days after treatment. We also compared ABGA of admission time to 24 hours after treatment of all groups and appreciate total hospital days of three groups. On follow up, same analyzing methods of comparison were used on 42 non-recurrent wheezing infants. RESULTS: The mean values of clinical score and respiratory rate were significantly improved in salbutamol and budesonide inhalation treatment group at 24 hours from medium of 6.1 60.7/min to 2.4, 42.3/min respectly. This effect was sustained thereafter. On the while, salbutamol inhalation group was significantly improved the clinical score and respiratory reate at 12 hours after therapy, but thereafter there was no obvious difference to conservative treatment. After then we exclude the recurrent infants and analyzed above mentioned items retrospectively. The improvement of clinical score and respiratory rate of salbutamol and budesonide inhalation therapy group was significant. Oxygenation was improved after 24hours of salbutamol and budesonide inhalation therapy. Total hospital stay was significantly reduced in salbutamol and budesonide inhalation group, and slightly reduced inthe salbutamol inhalation group. CONCLUSION: Infants with bronchiolitis treated with salbutamol and budesonide inhalation achieved better results in clinical score, repiratory rate PO2, and hospital days than no inhalation therapy. No reapiratory failure was occurred. So, this trial as treatment of bronchiolitis may be useful and effective therapy in those infants.
Albuterol* ; Bronchiolitis* ; Budesonide* ; Daejeon ; Diagnosis ; Follow-Up Studies ; Humans ; Infant* ; Inhalation* ; Length of Stay ; Nebulizers and Vaporizers ; Oxygen ; Respiratory Rate ; Respiratory Sounds ; Respiratory Therapy* ; Retrospective Studies ; Solar System ; Ultrasonics

PURPOSE: The purpose of this trial was to determine whether salbtamol and budesonide combined inhalation therapy is more efficacious than conservative treatment for admitted infants with bronchiolitis in early phase. METHODS: The study subjects were 72 infants admitted to Sun Hospital in Taejeon from July 1994 to June 1995, whose age from 1 month to 12 months with clinical diagnosis of bronchiolitis. Infants were randomly assigned to different three treatment groups as follw: Group C: 21 infants who received conservative treatment with oxygen (4liter/min); Group A: 23 infants who received salbutamol (0.1mg/kg) inhalation therapy using ultrasonic nebulizer at 6 hours interval add to conservative therapy; Group B: 28 infants who received budesonide (0.1mg/kg) inhalation therapy with above mentioned treatment at 12 hours interval. Then, infants were analyzed by comparison of clinical score, repiratory rate at time order of entry, 12 hours, 24 hours, 48 hours, 72 hours, and 5 days after treatment. We also compared ABGA of admission time to 24 hours after treatment of all groups and appreciate total hospital days of three groups. On follow up, same analyzing methods of comparison were used on 42 non-recurrent wheezing infants. RESULTS: The mean values of clinical score and respiratory rate were significantly improved in salbutamol and budesonide inhalation treatment group at 24 hours from medium of 6.1 60.7/min to 2.4, 42.3/min respectly. This effect was sustained thereafter. On the while, salbutamol inhalation group was significantly improved the clinical score and respiratory reate at 12 hours after therapy, but thereafter there was no obvious difference to conservative treatment. After then we exclude the recurrent infants and analyzed above mentioned items retrospectively. The improvement of clinical score and respiratory rate of salbutamol and budesonide inhalation therapy group was significant. Oxygenation was improved after 24hours of salbutamol and budesonide inhalation therapy. Total hospital stay was significantly reduced in salbutamol and budesonide inhalation group, and slightly reduced inthe salbutamol inhalation group. CONCLUSION: Infants with bronchiolitis treated with salbutamol and budesonide inhalation achieved better results in clinical score, repiratory rate PO2, and hospital days than no inhalation therapy. No reapiratory failure was occurred. So, this trial as treatment of bronchiolitis may be useful and effective therapy in those infants.
Albuterol* ; Bronchiolitis* ; Budesonide* ; Daejeon ; Diagnosis ; Follow-Up Studies ; Humans ; Infant* ; Inhalation* ; Length of Stay ; Nebulizers and Vaporizers ; Oxygen ; Respiratory Rate ; Respiratory Sounds ; Respiratory Therapy* ; Retrospective Studies ; Solar System ; Ultrasonics

PURPOSE: The aim of this study was to investigate the pathophysiologic role of serum E-selectin, vascular endothelial growth factor(VEGF)-induced cell adhesion mollecule in Kawasaki disease(KD) and to look for the evidence of direct relationship between the plasma levels of soluble E-selectin and the incidence of coronary artery lesion(CAL). METHODS: Changes in plasma levels of sE-selectin(n=98) over time were measured by enzyme-linked immunosorbent assay(ELISA) in 23 patients with acute KD and 25 age-matched febrile children. RESULTS: Compared with control values, the peak levels of plasma sE-selectin were significantly elevated(mean+/-S.E.:22.89+/-12.53 ng/mL vs 10.65+/-3.42 ng/mL, P=0.01) in KD. 5 patients with CAL, plasma sE-selectin levels before treatment were higher than in 18 patients without CAL(mean+/-S.E.:39.43+/-15.08 ng/mL and 19.00+/-8.32 ng/mL, respectively; P=0.01). Plasma sE-selectin declined rapidly in the majority of KD patients regardless of the presence of CAL. Plasma sE-selectin levels after treatment and convalesent period were similar in KD patients with and without CAL. The plasma levels sE-selectin were correlated with those of white blood cell count(r=0.299, P<0.05), CRP(r=0.430, P<0.05), serum albumin(r=-0.483, P<0.05), serum protein(r=-0.502, P<0.05) and hemoglobin(r=-0.372, P<0.05) not with those of ESR, platelet, or duration of fever. There were significant differences in the initial level of serum sE-selectin between KD with and without CAL(mean+/-S.E.:39.44+/-15.08 ng/mL vs. 19.00+/-17.18 ng/mL) in multivariated linear tests. CONCLUSION: Plasma sE-selectin levels were significantly higher in KD than in other febrile illness. Higher plamsa levels of sE-selectin may have potential as a predictor of CAL in patients with KD.
Blood Platelets ; Cell Adhesion ; Child ; Coronary Vessels ; E-Selectin* ; Fever ; Humans ; Incidence ; Leukocytes ; Mucocutaneous Lymph Node Syndrome* ; Plasma

Chiari malformations are brain stem anomalies with or without spinal canal involvement. Type III is the rarest of the Chiari malformations and is characterized by a low occipital or high cervical encephalocele in combination with multiple cerebellar and brain stem anomalies. We report a case of Chiari III malformation of a newborn, who underwent repair of occipital meningoencephalocele and endoscopic third ventriculostomy. We present the case with a review of related literature.
Brain Stem ; Encephalocele ; Humans ; Infant, Newborn ; Spinal Canal ; Ventriculostomy

Laboratory information system(LIS) is a key tool for management of laboratory data and for improvement of service quality in clinical pathology. Using down-sized computer system, we have developed an information management system, for urinalysis. The hardware is organized with an IBM 486 compatible PC with 16 MB main memory, 210 MB hard disk drive, three terminals, and 24 pin dot printer. The system is interfaced with one automatic urine analyzer(Miditron-M) via RS-232C port for unidirectional data transmission form analyzer to computer. The operating system and database management system are SCO UNIX and SCO foxbase, respectively. The program was developed using Xbase language provided by SCO foxbase and C language for interface. The system is connected to our hospital information system via application program interface(API), so the informations about patients and request details are automatically transmitted to our computer. Pull-down menu makes the users to access system more easily and the urinalysis results obtaining through interface can be reviewed during microscopic examination by users. To reduce workload, the default value was assigned to urine color, turbidity and cell count. To minimize the individual difference and standardize interpretation criteria, the recording results were entered as a code originating from objective grading system. The authors suggest that this system based on down-sized computer could provide a progressive approach to total LIS based on local area network, and the implemented system could serve as a model for constructing LIS in other hospitals for routine urinalysis.
Cell Count ; Chungcheongnam-do* ; Computer Systems ; Database Management Systems ; Hospital Information Systems ; Humans ; Individuality ; Information Management ; Local Area Networks ; Memory ; Pathology, Clinical ; Urinalysis*

Backgound: The aim of this study was to compare the levels of perception of and compliance with handwashing between the groups of direct patient contact and indirect contact in a tertiary-care university hospital. METHODS: A cross-sectional study was conducted in a university hospital with 4,500 employees. A questionnaire, containing questions on demographic data and the perception of and compliance with handwashing, was distributed to and collected from a total of 1,087 employees from June 25 to July 10, 2005. RESULTS: The study subjects washed their hands an average of 11.2 times (range, 1-100) per day: nurses washed their hands more frequently than others. The average duration of handwashing by employees was 18.8 seconds. Those in the direct patient contact group scored significantly higher points than did those in the indirect contact group in both perception (P<.021) of and compliance (P<.001) with handwashing. CONCLUSION: Education for handwashing is needed direction employees who have indirect contact with patients to improve their compliance with handwashing.
Compliance* ; Cross-Sectional Studies ; Education ; Hand ; Hand Disinfection* ; Humans ; Surveys and Questionnaires

PURPOSE: Recently, incidences of chronic cough with allergic disease have been increased. The identification of specific allergens for chronically coughing children is significant for diagnosis, proper treatment and prevention. The aim of this study was to identify significant contributors for sensitization in chronically coughing children. METHODS: A total of 106 children, aged 1-6 years, visiting for chronic cough(>3 weeks), were tested for inhalant multiple allergosorbent assay(MAST), eosinophil count and total IgE. Parents completed a questionnaire on past history of atopy(infantile eczema) and bronchiolitis, family history of allergy, breastfeeding, smoking, pets and floor coverings at home. RESULTS: Significant contributors for sensitization were:age(4-6 years), infantile eczema, positive family history of allergy and smoking by family. CONCLUSION: We were able to identify significant contributors for sensitization in chronically coughing children.
Allergens ; Breast Feeding ; Bronchiolitis ; Child* ; Cough* ; Dermatitis, Atopic ; Diagnosis ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Incidence ; Parents ; Surveys and Questionnaires ; Smoke ; Smoking