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: 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

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

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

PURPOSE: The aim of this study was to identify usefulness of simple oral and gastric pH measurement using pH paper on detection of symptomatic gastroesophageal reflux in neonates. METHODS: This prospective study included a total of 66 neonates born at Konyang University Hospital from June 2004 to June 2005. Each neonate's oral and gastric pH levels measured with pH paper at 6 hourly intervals. Suspected gastroesophageal refluex neonates were studied 24-hr lower esophageal pH monitoring or upper GI series and confirmed. We compared oral and gastric pH between symptomatic gastroesophageal reflux (GER) group and asymptomatic (control) group. RESULTS: GER group consist of 12 neonates and control group consist of 54 neonates. Oral and gastric pH were 5.4+/-0.6, 2.9+/-0.5 in GER group, 6.0+/-0.3, 3.9+/-0.9 in control group, the differences between two groups were significant (P<0.05). All neonates of GER group were corfirmed gastroesophageal reflux by 24-hr lower esophageal pH monitoring or upper GI series studies. Our data indicate as a predictor for significantly symptomatic gastroesophageal reflux, at oral pH 5.75, has a sensitivity 92%, specificity 89%, positive predictive value of 65%, and negative predictive value of 98%. The difference between oral and gastric pH (oral pH-gastric pH) was not significant in each group. CONCLUSION: In neonates with symptomatic gastroesophageal reflux oral and gastric pH were significantly lower than asymptomatic neonates. Oral and gastric pH were related with clinically significant symptoms of gastroesophageal reflux. We suggest that pH measurement could be a possible simple screening test of symptomatic gastroesophageal reflux.
Esophageal pH Monitoring ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn* ; Mass Screening ; Prospective Studies ; Sensitivity and Specificity

PURPOSE: We performed to reveal the association between the Helicobacter pylori infection and body weight among children. METHODS: Out retrospective study included patients who underwent the H. pylori immunoglobulin G testing at Konyang University Hospital between March 2011 and June 2014. These patients were classified as seropositive (28 boys, 27 girls; mean age: 9.89±3.28 years) or seronegative (55 boys, 54 girls; mean age: 9.84±3.02 years). Next, we compared various characteristics between the seropositive and negative groups, as well as between obese children (body weight ≥90th percentile) and non-obese children (body weight <90th percentile). Furthermore, we compared the change in body weight after 2 months of treatment with amoxicillin, clarithromycin and omeprazole among the 55 seropositive children (14 treated children and 41 non-treated children). RESULTS: There were no differences in the weights and laboratory data for the 55 seropositive children and 109 seronegative children (weight; 40.96±18.11 kg vs. 36.85±13.72 kg, respectively; p=0.14). And, there was no difference in the prevalence of H. pylori infection among the 29 obese and 135 non-obese children (p=0.581). However, after 2 months of eradication, the 14 treated patients exhibited a significant weight gain (+0.91±0.52 kg), compared to the 41 non-treated patients (-0.29±1.16 kg, p=0.025). CONCLUSION: Our findings present that obesity was not associated with the H. pylori infection, although H. pylori eradication led to significant increase in body weight.
Amoxicillin ; Body Weight* ; Child* ; Clarithromycin ; Disease Eradication ; Female ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Obesity ; Omeprazole ; Prevalence ; Retrospective Studies ; Weight Gain ; Weights and Measures

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