PURPOSE: In pediatric solid organ injury, non-operative management is considered as a standard treatment when the patient is hemodynamically stable. However, treatment according to the injured organ and the depth of injury is controversial. The purpose of this study is to evaluate treatment results in the management of abdominal solid organ injuries in children. METHODS: This analysis was performed retrospectively with 57 consecutive children under 15 year of age who were diagnosed with abdominal solid organ injuries at Ewha Womans University Mokdong Hospital from January, 1999 to June, 2007. RESULTS: The major cause of pediatric solid organ injury was traffic accidents (59.6%) and the most frequently injured organ was the liver (66.7%). 54 patients (94.7%) were treated non-operatively and the success rate was 100%. There was no difference in type of management and success rate according to the depth of injury or the injured organs. The average ICU stay was 4.3 days, and the average hospital stay was 13.6 days and that was extended depending on the depth of injury. And according to the cause of injury, cases by traffic accident stayed significantly longer than cases by other causes. CONCLUSION: High grade of injury is not contraindication of nonoperative management in pediatric solid organ injury. Hemodynamic instability is the only absolute indication of operation. Therefore, if the patient is stable, non-operative management with intensive observation is the choice of treatment.
Accidents, Traffic ; Child ; Female ; Hemodynamics ; Humans ; Length of Stay ; Liver ; Retrospective Studies

BACKGROUND: There is little evidence on the prevalence of secondhand smoke (SHS) exposure among cancer patients. We aimed to investigate its prevalence, and to identify gender differences in factors associated with SHS exposure among cancer patients. METHODS: Participants were 304 patients who have been treated via either inpatient or outpatient clinics in the National Cancer Center. SHS exposure was defined as an individual's experience of SHS exposure during the past month. Gender-stratified analysis was performed by using a logistic regression analysis with potential covariates. RESULTS: SHS exposure was prevalent in 69.5% of the total participants, specifically in 57.1% of men and 62.7% of women; however, it did not differ significantly by gender. The prevalence of SHS exposure at home was significantly greater in women (20.7%) than in men (4.4%) (P=0.048). Among men, age < or =50 years (Adjusted odds ratio [OR]=3.11; confidence interval [CI]=1.05-9.24), employed status (Adjusted OR=3.15; CI=1.38-7.19), and having family smokers (Adjusted OR=0.32; CI=0.12-0.82) were significantly associated with SHS exposure. Among women, employment status (Adjusted OR=2.67; CI=1.40-5.10), good self-rated health (Adjusted OR=2.35; CI=1.20-4.61), and having family smokers (Adjusted OR=2.03; CI=1.05-3.91) were significantly associated with SHS exposure. CONCLUSIONS: Cancer patients were exposed to SHS by 69.5% during the past month. Among cancer patients, factors associated with SHS exposure differed by gender. Therefore, gender-specific strategies for preventing SHS exposure are needed for cancer patients.
Ambulatory Care Facilities ; Employment ; Female ; Humans ; Inpatients ; Logistic Models ; Male ; Odds Ratio ; Prevalence ; Tobacco Smoke Pollution*

PURPOSE & METHODS: Nonoperative reduction of childhood intussusception is the treatment of choice. However, few techniques of nonoperative reduction are available. When used, nonoperative reduction can be successfully completed by a radiologist. In this study, we analyzed 637 cases of childhood intussusception diagnosed and treated by ultrasound-guided saline enema reduction (UGSER) over nine years at Ewha Womans University Mokdong Hospital. We compared the results of 76 cases surgically treated after UGSER (US group) with 84 cases surgically treated after barium enema reduction in 1980s (BE group). RESULTS: The success rate of the saline reduction was 88.1%. The risk factors associated with surgery were the patient's age, symptom duration and the type of intussusception. The rate of bowel resection was 32.9%. Patients less than six months old and a pathologic lead point (PLP) on the US were risk factors for bowel resection. There were no significant differences in age, gender and the number of PLPs between the US and BE groups. The number of patients with a spontaneous reduction was greater in the BE group and bowel perforation occurred only in the US group. The bowel resection rate was significantly higher in the US group. However, the median hospital stay was significantly shorter in the US group. CONCLUSION: UGSER is reliable and safe in childhood intussusecption. Moreover, it has a high success rate and is easy to perform. The surgeon, without the need for a radiologist, performs this procedure from diagnosis to treatment. In addition, it might help avoid invasive surgery.
Barium ; Enema ; Female ; Humans ; Intussusception ; Length of Stay ; Risk Factors

PURPOSE: This study was performed to investigate the prevalence of Staphylococcus aureus (S. aureus) nasal carriage in Korean children attending day care centers. METHODS: During September and October 2009, a survey for nasal carriage of S. aureus and methicillin-resistant S. aureus (MRSA) was conducted among children attending day care centers located in Seoul with questionnaire survey for evaluation of risk factors of acquisition of MRSA was obtained from their guardians. A culture of the anterior nares swabs using enrichment broth was executed for isolating S. aureus and oxacillin susceptibility was assessed by the disk diffusion method. RESULTS: Out of the 428 children enrolled whose mean age was 55 months old, 163 (38.1%) were colonized with S. aureus. Of the 163 isolates, 40 (24.5%) were MRSA. The nasal carriage rate of S. aureus showed an increasing trend with increase of age. Based on the answer to the questionnaire, 9.2% and 3.6% of children had a recent history of hospitalization and surgery, respectively, and approximately 40% of children had a history of prescription of antibiotics within 1 year prior to enrollment. Of the 428 subjects, 40 (9.3%) were MRSA nasal carriers. CONCLUSION: S. aureus and MRSA carriage rate of children attending day care center in Korea was 38.1% and 9.3%, respectively. Continued surveillance for nasal carriage rate of S. aureus and MRSA (especially community-associated MRSA) is mandatory.
Anti-Bacterial Agents ; Child ; Colon ; Day Care, Medical ; Diffusion ; Hospitalization ; Humans ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Prescriptions ; Prevalence ; Surveys and Questionnaires ; Risk Factors ; Staphylococcus ; Staphylococcus aureus

Purpose: 17β-Estradiol (E2) supplementation suppresses MC38 tumor growth by downregulating the expression of programmed death-ligand 1 (PD-L1). This study aims to figure out the gut microbiota that respond to anti–PD-L1 and/or estrogen treatment in MC38 colon cancer model. Materials and Methods: A syngeneic colon tumor model was developed by injection of MC38 cells into C57BL/6 background male and female mice. Three days before MC38 cells injection, E2 was supplemented to male mice daily for 1 week. Male and female mice with MC38 tumors (50-100 mm3) were injected with anti–PD-L1 antibody. Fresh feces were collected 26 days after injection of MC38 cells and 16S rRNA metagenomics sequencing of DNA extracted from feces was used to assess gut microbial composition. Results: At the taxonomic family level, Muribaculaceae was enriched only in the MC38 male control group. In male mice, linear discriminant analysis effect size analysis at the species level revealed that the four microorganisms were commonly regulated in single and combination treatment with anti–PD-L1 and/or E2; a decrease in PAC001068_g_uc and PAC001070_s (family Muribaculaceae) and increase in PAC001716_s and PAC001785_s (family Ruminococcaceae). Interestingly, in the anti–PD-L1 plus E2 group, a decrease in opportunistic pathogens (Enterobacteriaceae group) and an increase in commensal bacteria (Lactobacillus murinus group and Parabacteroides goldsteinii) were observed. Furthermore, the abundance of Parabacteroides goldsteinii was increased in both males and females in the anti–PD-L1 group. Conclusion Our results suggest that gut microbial changes induced by the pretreatment of estrogen before anti–PD-L1 might contribute to treatment of MC38 colon cancer.

PURPOSE: This study aimed to determine the optimal initial vancomycin dose to achieve appropriate trough levels in pediatric patients. METHODS: We analyzed clinical data for 309 children treated with intravenous vancomycin between 2004 and 2009 at 2 different hospitals in South Korea. The patients were 1-16 years old and exhibited normal renal function. Patient data, including reason for treatment and initial dosing regimen, were reviewed. Two subgroups were identified and compared according to initial vancomycin dose: 40 (35-45) mg/kg/day and 60 (55-65) mg/kg/day. Trough levels were obtained at steady state after at least 4 doses of vancomycin. RESULTS: Patients who received vancomycin had post-operation or wound-related infections (37.2%), localized infection (12.9%), catheter-related infections (9.4%), meningitis (8.7%), or endocarditis (6.8%). Pathogens were confirmed in 79 cases: 28 cases of methicillin-resistant Staphylococcus epidermidis (35.4%) and 25 of methicillin-resistant Staphylococcus aureus (31.6%). Out of the 309 patients, 201 (65%) received vancomycin at 40 mg/kg/day and 108 (35%) at 60 mg/kg/day. Average trough concentrations were significantly different between the groups (P<0.001). Trough levels over 10 mg/L were less likely to be achieved in the 40 mg/kg/day group (14%) than in the 60 mg/kg/day group (49%) (P<0.001). There were no differences in renal function deterioration between the groups. CONCLUSION: A common vancomycin dosing regimen, 40 mg/kg/day, was not high enough to achieve trough levels of over 10 mg/L in pediatric patients. Careful drug monitoring must be performed, and increasing initial dose of vancomycin should be considered in pediatric patients.
Catheter-Related Infections ; Child ; Drug Monitoring ; Endocarditis ; Humans ; Meningitis ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Republic of Korea ; Staphylococcus epidermidis ; Vancomycin

In an effort to improve the blood safety management system, Korea Centers for Disease Control and Prevention visited the national agencies and blood centers of foreign countries. In Japan, the management system for Human T-lymphotropic virus positive donors is operated. In Germany, Red Cross Blood Centers provide 75~80% of national blood consumption, and hospital blood centers provided 15~20%. In addition, the Paul Ehrlich Institut is engaged in blood center management and blood product safety, and the Robert Koch Institut manages transfusion-transmitted infection. The standard temperature of RBC transport is 1~10degrees C. In Austria, haemovigilance is operated by the National Blood Authority and adverse reactions following transfusion are investigated by Blood Centers. In Britain, blood is provided by National Health Service Blood and Transplant, and the Serious Hazards of Transfusion, haemovigilance system is operated. Universal leukoreduction has been performed since 1999 in order to prevent transmission of variant Creutzfeldt-Jakob disease.
Austria ; Blood Safety* ; Centers for Disease Control and Prevention (U.S.) ; Creutzfeldt-Jakob Syndrome ; Germany ; Humans ; Japan ; Korea ; National Health Programs ; Red Cross ; Tissue Donors ; Viruses

PURPOSE:This study was performed to investigate the serotype distribution of group B streptococcus (GBS) isolated from pregnant Korean women using molecular methods. METHODS:The study materials included 42 GBS isolates obtained from the vagina and anorectum of pregnant women in Seoul, Korea between 2005 and 2006. Four clinical isolates with known serotypes (Ia, Ib, III, and V) were used for validation of molecular serotyping. We used serotype-specific primers for identification of the serotypes (Ia, Ib, III, V, and VI). To determine the ambiguous serotypes by serotype-specific PCR, sequence analysis of the PCR amplicons which had been amplified with GBS-common primers was used. RESULTS:The serotypes determined by the molecular methods agreed with the previously known 4 serotypes (Ia, Ib, III, and V). The serotypes of all 42 isolates were successfully determined by molecular methods. The distribution of the GBS serotype was as follows in order of frequency: serotype III was found in 12 isolates (28.6%), serotype V was found in 11 isolates (26.2%), serotype Ia was found in 11 isolates (26.2%), serotype VI was found in 4 isolates (9.5%), serotype Ib was found in 2 isolates (4.8%), and serotype II was found in 2 isolates (4.8%). CONCLUSION:Serotypes III, V, and Ia were the most frequently identified serotypes in pregnant Korean women. Molecular serotyping is useful for surveillance of the serotype distribution of GBS in colonized pregnant women and GBS diseases of neonates.
Colon ; Female ; Humans ; Korea ; Polymerase Chain Reaction ; Pregnant Women ; Sequence Analysis ; Serotyping ; Streptococcus ; Vagina

This study aimed to evaluate the clinical profiles, antibiotic susceptibility, risk factors of multi-drug resistance (MDR) and outcomes of P. aeruginosa bacteremia in children by retrospective methods at a tertiary teaching children's hospital in Seoul, Korea during 2000-2009. A total of 62 episodes were evaluated and 59 patients (95.2%) had underlying diseases. Multivariate analysis demonstrated that an intensive care unit (ICU) stay within the previous one month was the only independent risk factor for MDR P. aeruginosa bacteremia (odds ratio [OR], 6.8; 95% confidence interval [CI], 1.3-35.8, P = 0.023). The overall fatality rate associated with P. aeruginosa bacteremia was 14.5% (9 of 62). The fatality rate in patients with MDR P. aeruginosa was 57.1%, compared with 9.1% in non-MDR patients (OR 13.3; 95% CI 2.3-77.2, P = 0.006). However, the presence of respiratory difficulty was the only independent risk factor for overall fatality associated with P. aeruginosa bacteremia according to multivariate analysis (OR 51.0; 95% CI 7.0-369.0, P < 0.001). A previous ICU stay and presentation with respiratory difficulty were associated with acquisition of MDR P. aeruginosa and a higher fatality rate, respectively. Future efforts should focus on the prevention and treatment of P. aeruginosa bacteremia in high-risk children.
Adolescent ; Bacteremia/*drug therapy/*epidemiology/microbiology ; Child ; Child, Preschool ; *Drug Resistance, Multiple, Bacterial ; Female ; Hospitals, Teaching ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric ; Male ; Microbial Sensitivity Tests ; Pseudomonas Infections/*drug therapy/*epidemiology/microbiology ; Pseudomonas aeruginosa/*drug effects ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Treatment Outcome

We investigated serotype distribution and antimicrobial resistance of pneumococcal carriage isolates from children after optional immunization with the 7-valent pneumococcal conjugate vaccine (PCV7) in Korea. From June 2009 to June 2010, 205 (16.5%) pneumococcal isolates were obtained from 1,243 nasopharyngeal aspirates of infants and children at Seoul National University Children's Hospital, Korea. Serotype was determined by Quellung reaction and antibiotic susceptibility was tested by E-test. The results were compared to previous studies done in the pre-PCV7 period. In this study, the most common serotypes were 6A (15.3%), 19A (14.7%), 19F (10.2%), 35B (7.3%), and 6D (5.6%). The proportion of PCV7 serotypes decreased from 61.9% to 23.8% (P < 0.001). The overall penicillin nonsusceptibility rate increased from 83.5% to 95.4% (P = 0.001). This study demonstrates the impact of optional PCV7 vaccination in Korea; the proportion of all PCV7 serotypes except 19F decreased while antimicrobial resistant serotypes 6A and 19A further increased.
Anti-Bacterial Agents/pharmacology ; Child, Preschool ; Drug Resistance, Bacterial/drug effects ; Humans ; Infant ; Microbial Sensitivity Tests ; Nasopharynx/*microbiology ; Pneumococcal Infections/immunology/prevention & control ; Republic of Korea ; Serotyping ; Streptococcus pneumoniae/classification/*isolation & purification ; Vaccination ; Vaccines, Conjugate/*immunology