Following chemotherapy for acute myelomoncytic leukemia, an 3-year-old boy developed several painful erythematous indurated patches at previous sampling sites and at the site where an arm board and adhesive tape were used in securing an intravenous infusion set. The lesions rapidly progressed to ulcers with central black eschars. Biopsies and cultures demonstrated a fungus, Aspergillus flavs, as the etiologic agent, without evidence of systemic dissemination. Local care, including s irgical debridement, were performed. The patient also received treatment with intravenous; amphotericin B followed by oral itraconazole. Six months later, the skin lesions had healed, leaving some scar and deformities.
Adhesives ; Amphotericin B ; Arm ; Aspergillosis* ; Aspergillus ; Biopsy ; Child* ; Child, Preschool ; Cicatrix ; Congenital Abnormalities ; Debridement ; Drug Therapy ; Fungi ; Humans ; Infusions, Intravenous ; Itraconazole ; Leukemia* ; Male ; Skin ; Ulcer

This study was performed in order to recognize the identifications of the glycoproteins containing oligosaccharides in human gingiva. After made paraffin sections of human gingiva at 4µm, the sections were incubated with 7 lectins (UEA-I, BS-I, SBA, DBA, WGA, PNA, PNA after neuraminidase treated, Con-A). In order to increase specificity of reactions, the sections were applicated with ABC system. And then the sections were incubated with DAB and were counterstained with hematoxylin. Using the same sections, the sections were done H-E and PAS stains. In WGA, DBA and Con-A, plasma membranes of the layers of all epithelium and connective tissue were stained. In BS-I ; In the epithelium of marginal gingiva, plasma membranes of upper layer of the spinous cell layer and granular cell layer were stained. And in epithelium of sulcular gingiva, plasma membranes of the all spinous cell layer and granular cell layer were stained. In SBA ; Plasma membranes of the granular cell layer were stained. In PNA ; In the epithelium of marginal gingiva, plasma membranes of the basal cell layer and lower layer of spinous cell layer were stained. But lectin reactions were not occurred in thc sulcular gingiva. In PNA treated neuraminidase, plasma membranes of the all epithelial layer except basal cell layer membranes especially cytoplasms of upper layer at the sulcular gingiva and connective tissue were reacted. 1. By the above results, authors could know the identification of oligosaccharides existing g1ycoproteins in the human gingiva. 1) All epithelial layer ; α-D-N-Acetyl-Galactosamine, Sialic acid, D-Glucosamine, α-D-Mannose 2) Basal cell layer ; Galactose-β-(1-3)-N-Acetyl-Galactosamine 3) Spinous cell layer ; α-D-Galactose, Galactose-β-(1-3)-N-Acetyl-Galactosamine 4) Granular cell layer ; α-D-Galactose 5) Connective tissue ; α-D-N-Acetyl-Galactosamine, Siallic acid, β-(1-4)-D-Acetyl-Glucosamine, α-D-Glucosamine, α-D-Mannose 2. The Galactose-β-(1-3)-N-Acetyl-Galactosamine was not existed in the basal cell layer and spinous cell layer in the sulcular gingiva.
Cell Membrane ; Classification* ; Coloring Agents ; Connective Tissue ; Cytoplasm ; Dronabinol ; Epithelium ; Gingiva* ; Glycoconjugates ; Glycoproteins ; Hematoxylin ; Humans* ; Lectins ; Membranes ; N-Acetylneuraminic Acid ; Neuraminidase ; Oligosaccharides ; Paraffin ; Periodic Acid-Schiff Reaction* ; Sensitivity and Specificity

No abstract available.
Child* ; Humans ; Leukemia, Myeloid, Acute* ; Typhlitis*

We experienced 3 cases of Candida esophagitis in infancy which were diagnosed by esophageal endoscopy. First case, 10 month-old boy with combined immune deficiency had suffered from oral thrush and poor feeding for more than 4 months. Esophageal endoscopy revealed multiple whitish creamy patches on the friable erythematous and necrotic mucosa of the esophagus. He was firstly treated with amphotericin-B but in vain. Then he was treated with fluconazole (5 mg/kg/day) and in a few days oral thrush nearly disappeared and endoscopy after 2 weeks revealed complete healing of the esophagitis. Second case, 6 month-old boy with some cellular immue defect also suffered from oral thrush, poor feeding and intermittent fever. He was treated with fluconazole and oral thrush was imporved. He was discharged without follow up endoscopy. Third case, 4 month-old girl with liver cirrhosis due to infantile cholestasis had Candida sepsis. Esophagitis was found incidentally during the endoscopic examination of esophageal varix. First 2 cases showed multiple small filling defects and decreased motility on esophagography. Candida antigen was not detected in the sera of all 3 cases of candidiasis. We conclude that Candidia esophagitis should be suspected when an infant has been suffering from long-term treatmet-resistant oral thrush and poor feeding and that esophageal endoscopy can be easily performed in infants also and useful in diagnosing esophagitis and assessing the outcome of treatment.
Candida* ; Candidiasis ; Candidiasis, Oral ; Cholestasis ; Endoscopy ; Esophageal and Gastric Varices ; Esophagitis* ; Esophagus ; Female ; Fever ; Fluconazole ; Humans ; Infant ; Liver Cirrhosis ; Male ; Mucous Membrane ; Sepsis

This study aimed to describe the differences in vaccination coverage between National Immunization Program (NIP) vaccines and non-NIP vaccines in Korea and to identify factors affecting the difference. Nationwide face-to-face interview-based questionnaire survey among randomly selected 4,374 participants aged 7-83 months was conducted. Vaccination coverage analyzed according to the birth cohorts, geographic areas, and socio-demographic characteristics. We found that NIP vaccines recorded higher primary vaccination coverage compared to non-NIP vaccines (95.9%-100% vs 30.7%-85.4%). The highest rate was Haemophilus influenzae type b (Hib) vaccine (85.4%), which was introduced in 1996, and the lowest rate was rotavirus vaccine (30.7%), which was introduced recently. On multivariate analysis, having a sibling were significantly associated with lower uptake of Hib vaccine, pneumococcal conjugate vaccine (PCV), and rotavirus vaccine; while, older mother's age and attendance to daycare center were significantly associated with lower uptake of PCV and rotavirus vaccine (P < 0.001). We found differences in the vaccine coverage rate between NIP vaccines and non-NIP vaccines; and the data suggests potential disparity in accessing non-NIP vaccines in Korea. Expansion of NIP to include non-NIP vaccines can provide better protection against the diseases through increased coverage.
Adult ; Asian Continental Ancestry Group ; Child ; Child Day Care Centers ; Child, Preschool ; Cohort Studies ; Demography ; Female ; Haemophilus Infections/prevention & control ; Humans ; *Immunization Programs ; Infant ; Interviews as Topic ; Male ; Multivariate Analysis ; Pneumococcal Infections/prevention & control ; Questionnaires ; Republic of Korea ; Rotavirus Infections/prevention & control ; Socioeconomic Factors ; *Vaccination

PURPOSE: Although many strides have been made in the radiological and laboratory diagnosis, the liver biopsy is still considered an important tool for the diagnosis of liver disease. We report our experience that histologic investigation of the liver was essential searching for the etiologic diagnosis in eight children with fever of unknowm origin and hepatosplenomegaly, who's diagnosis were not documented by other diagnostic studies. METHODS: Histologic investigation of the liver including Percutanous liver biopsy, open surgical biopsy, necropsy or autopsy was taken at Seoul national university of children's hospital between 1985 and 1995 in twelve children with fever of unknown origin and hepatosplenomegaly. We performed light and electron microscopic examination, culture and PCR of the tissue obtained by liver biopsy. RESULTS: 1) The etiologic diagnoses were possible by histologic investigation of the liver in 9 of 12 Cases; Nine cases were congenital tuberculosis, cryptococcosis, hepatic capillariasis, candidiasis, amoebiasis, neonatal herpes hepatitis, Escherichia. coli abscess and two cases of cytomegalovirus hepatitis. Three cases in which organisms could not be found in tissue obtained from biopsy were suspected clinically as liver abscess and parasite infestation. 2) Three cases were males and 6 were females, ranging in age from 1 days to 6 years; mean age 23.6 months. 3) Clinical manifestations were fever of unknown origin(9 Cases), hepatomegaly(9 Cases), splenomegaly(5 Cases), skin lesions(2 Cases) and jaundice(3 Cases). 4) Laboratory findings were increased AST/ALT(7 Cases), hyperbilirubinemia(3 Cases), leukocytosis(5 Cases), eosinophilia(2 Cases), increased CRP(9 Cases) and increased ESR(5 Cases). 5) In four children, there were underlying diseases which were acute lymphoblastic leukemia, acute myeloid leukemia and two cases of prematures. CONCLUSIONS: In children with fever of unknown origin and hepatosplenomegaly, we recommend liver biopsy for early diagnosis and apropriate management.
Abscess ; Amebiasis ; Autopsy ; Biopsy* ; Candidiasis ; Child* ; Clinical Laboratory Techniques ; Cryptococcosis ; Cytomegalovirus ; Diagnosis ; Early Diagnosis ; Escherichia ; Female ; Fever of Unknown Origin* ; Fever* ; Hepatitis ; Humans ; Leukemia, Myeloid, Acute ; Liver Abscess ; Liver Diseases ; Liver* ; Male ; Parasites ; Polymerase Chain Reaction ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Seoul ; Skin ; Tuberculosis

BACKGROUND: With the improvement of sanitary conditions, epidemiologic features and relative frequency of serogroups of salmonella have changed in developed countries. Also there are increasing reports on occurrence of multidrug-resistant salmonella infections. To investigate such changes in Korean children, we retrospectively evaluated epidemiologic features of salmonellosis and antibiotic resistance pattern. METHODS: Medical records of patients, whose blood or stool culture yielded Salmonella sp. were reviewed. Then serogroup, monthly occurrence, clinical syndromes, and antibiotic resistance were evaluated. RESULTS: During the period from January 1986 to December 1995, 166 cases of salmonellosis had been admitted to the Seoul National University Children's Hospital. Group B salmonella was most frequently isolated (48.8%), followed by non-typhoidal group D, group C, and Salmonella typhi. S. typhi was frequently isolated from blood, in contrast with other serogroups from stool. The isolation of S. typhi has been decreasing, while that of non-typhoidal group D and group B has been increasing in the nineties. Forty-two percent were isolated from July to September. Group B was responsible for 54% of the gastroenteritis cases. Among the cases presenting with fever without a primary focus, S. typhi was isolated from blood in 16 cases and group B from blood or stool in 10 cases. Sixty- eight percent of gastroenteritis occurred in children of 2 years or below in age, while most cases of enteric fever occurred in school-age children. Group D strains including S. typhi were susceptible to most antibiotics, such as ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol, ciprofloxacin, and ceftriaxone, but more than half of group B strains were resistant to ampicillin and chloramphenicol. CONCLUSION: The occurrence of typhoid fever has been decreasing markedly, but salmonella gastroenteritis by group B and non-typhoidal group D has been increasing in the nineties. Resistance to the primary antibiotics used for the treatment of salmonellosis was observed in the group B strains.
Ampicillin ; Anti-Bacterial Agents ; Ceftriaxone ; Child* ; Chloramphenicol ; Ciprofloxacin ; Developed Countries ; Drug Resistance, Microbial ; Fever ; Gastroenteritis ; Humans ; Medical Records ; Retrospective Studies ; Salmonella ; Salmonella Infections* ; Salmonella typhi ; Seoul ; Trimethoprim, Sulfamethoxazole Drug Combination ; Typhoid Fever

Objective: To evaluate the therapeutic outcomes of no-touch radiofrequency ablation (NT-RFA) using twin cooled wet (TCW) electrodes in patients experiencing recurrent hepatocellular carcinoma (HCC) after undergoing locoregional treatments. Materials and Methods: We conducted a prospective, single-arm study of NT-RFA involving 102 patients, with a total of 112 recurrent HCCs (each ≤ 3 cm). NT-RFA with TCW electrodes was implemented under the guidance of ultrasonography (US)-MR/CT fusion imaging. If NT-RFA application proved technically challenging, conversion to conventional tumor puncture RFA was permitted. The primary metric for evaluation was the mid-term cumulative incidence of local tumor progression (LTP) observed post-RFA. Cumulative LTP rates were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard regression was used to explore factors associated with LTP. Considering conversion cases from NT-RFA to conventional RFA, intention-to-treat (ITT; including all patients) and per-protocol (PP; including patients not requiring conversion to conventional RFA alone) analyses were performed. Results: Conversion from NT-RFA to conventional RFA was necessary for 24 (21.4%) out of 112 tumors. Successful treatment was noted in 111 (99.1%) out of them. No major complications were reported among the patients. According to ITT analysis, the estimated cumulative incidences of LTP were 1.9%, 6.0%, and 6.0% at 1, 2, and 3 years post-RFA, respectively. In PP analysis, the cumulative incidence of LTP was 0.0%, 1.3%, and 1.3% at 1, 2, and 3 years, respectively. The number of previous locoregional HCC treatments (adjusted hazard ratio [aHR], 1.265 per 1 treatment increase; P = 0.004), total bilirubin (aHR, 7.477 per 1 mg/dL increase; P = 0.012), and safety margin ≤ 5 mm (aHR, 9.029; P = 0.016) were independently associated with LTP in ITT analysis. Conclusion NT-RFA using TCW electrodes is a safe and effective treatment for recurrent HCC, with 6.0% (ITT analysis) and 1.3% (PP analysis) cumulative incidence of LTP at 2 and 3-year follow-ups.

PURPOSE: The number of geriatric patients admitted to the emergency department (ED) is growing as the elderly population grows. The altered mental status of the elderly is more difficult to evaluate and manage than others. The purpose of this study was to determine the etiologies of altered mental status in elderly patients visiting the ED. METHODS: A retrospective study was made of 119 patients who visited the ED of Kyungpook National University Hospital for altered mental status from January 2001 to June 2002. RESULTS: The results of this study showed that extracranial causes (67.8%) were more than intracranial causes (31.9%): metabolic (35.3%), cerebrovascular (29.4%), extracranial infection (16.0%), cardiovascular (8.4%), drugs/toxins (8.4%), and intracranial infection (2.5%). The group with underlying disease or with brain imaging done showed more intracranial causes than extracranial causes. The results showed that the age, the initial Glasgow coma scale (GCS) score, a new positive finding on a brain image, and the causes of the mental change had significant influence on improvement of the mental status and on the survival rate (p < 0.05). CONCLUSION: Initial evaluation of the underlying disease, the GCS score, an early study of brain imaging, and a search for possible metabolic causes, as well as others should be done simultaneously to deliver high quality care to elderly patient. Knowledge of the most frequent causes of altered mental status in elderly patients may assist the emergency physician in the approaching these potentially ill patients and managing their care.
Aged* ; Brain ; Emergencies* ; Emergency Service, Hospital* ; Glasgow Coma Scale ; Gyeongsangbuk-do ; Humans ; Neuroimaging ; Retrospective Studies ; Survival Rate

PURPOSE: Although the Injury Severity Score (ISS) has certain predictive limitations and difficulties in calculation, the ISS has been widely used as a predictor of serious injury. The objective of this study was to determine the correlations of the serum lactate and base deficit levels to injury severity and to determine the value of using serum lactate and base deficit measurements as prognostic tools in the emergency department. METHODS: This study was a retrospective analysis of data collected from March 2001 to February 2002, and two hundred seventeen trauma patients who were admitted to the Emergency Department (ED) of Kyungpook National University Hospital during that period were included in this study. Patients who received a transfusion, bicarbonate, or vasopressor or who had no ISS score were excluded from this study. RESULTS: The serum lactate and the base deficit, as well as the ISS, showed a significant value for predicting the seriousness of injury in trauma patients. Because gamma(Pearson's correlation coefficient) between ISS and serum lactate levels is 0.890, it showed strong association. Especially, in multiple injury patients, the serum lactate level had predictive value in revealing hidden injuries that could lead to possible death. Logistic regression showed a strong association between the serum lactate and base deficit levels and mortality rate. CONCLUSION: The serum lactate and the base deficit levels at admission to the ED are useful tools in predicting the outcome in severe trauma patients, and they can be used adjunct to previous injury scoring systems.
Emergency Service, Hospital ; Gyeongsangbuk-do ; Humans ; Injury Severity Score ; Lactic Acid* ; Logistic Models ; Mortality ; Multiple Trauma ; Retrospective Studies