BACKGROUND: To evaluate serological typing of T(epidemiologic marker) and M protein(major virulence antigen) is important to understand pathogenesis and epidemiology of streptococcal infection. The purpose of this study is to find out whether there were major difference in distribution of serotypes isolated from healthy school children and patients with pharyngotonsillitis, and to characterize the geographical differences in distribution of the serotypes. METHOD: Twenty-three strains of group A streptococci were isolated from healthy school children in two different areas(Dongdaemun-Ku and Kangsuh-Ku) in Seoul in April and July 1996. 23 strains came from patients living in Dongjak-Ku with pharyngotonsillitis in April 1996. All isolated were serotyped by T agglutination, M precipitation and opacity factor at the WHO Collaborative Center for Reference and Research on Streptococci, University of Minnesota, Minneapolis. RESULTS: 89.1% of the strains were typable by T agglutination, 56.5% by M precipitation, and 52.2% were positive in opacity factor. T types 1, 25, 4, and 12 accounted for 65.2% of patients with pharyngotonsillitis, T types 12, and 25 accounted for 71.5% of healthy children in Dongdaemun-Ku, and T types 28, 6, and 3 accounted for 62.6% of healthy children in Kangsuh-Ku. T types 1, 25, 28, 12, 4 and M types 1, 75, 28, 4, 12 were typed in decreasing order. CONCLUSION: We characterized the differences in serotypes of group A streptocpcci between healthy children and patients. The periodic and seasonal serotyping analysis is important in monitoring and understanding of the epidemiologic patterns of group A streptococci.
Agglutination ; Child* ; Epidemiology ; Humans ; Minnesota ; Seasons ; Seoul ; Serotyping* ; Streptococcal Infections ; Virulence

Objective: To investigate esophageal motility disorders in patients with esophageal residual barium on chest x-rays after videofluoroscopic swallowing studies (VFSS) through high-resolution esophageal manometry (HREM). Methods: We reviewed the records of 432 patients who underwent VFSS from September 2019 to May 2021, and 85 patients (19.7%) with large residual barium (diameter ≥1 cm) were included. As a result of HREM, motility disorders were classified as major or minor motility disorders according. Esophagogastroduodenoscopy and chest computed tomography results available were also reviewed. Results: Among 85 patients with large residual barium in the esophagus, 16 patients (18.8%) underwent HREM. Abnormal esophageal motilities were identified in 68.8% patient: three patients (18.8%) had major motility disorders—achalasia (n=1), esophagogastric junction (EGJ) outflow obstruction (n=2)—and eight patients (50%) had minor motility disorders—ineffective esophageal motility (n=7), fragmented peristalsis (n=1). In those with normal esophageal motility, three patients of esophageal structure disorders (18.8%)—esophageal cancer (n=1), cardiogenic dysphagia (n=1), slight narrowing without obstruction of EGJ (n=1)—and two patients (12.5%) with chronic atrophic gastritis (n=2) were confirmed. Conclusion Esophageal motility disorders were identified in 68.8% of 16 patients with large esophageal residual barium with three patients in the major and eight patients in the minor categories. Residual barium in the esophagus was not rare and can be a sign of significant esophageal motility disorders.

Cardiogenic dysphagia is a rare type of esophageal dysphagia caused by external compression of the esophagus by an enlarged left atrium. Long-term comparisons between the degree of cardiogenic dysphagia and heart failure have not been reported due to its low incidence. We hereby report the case of a 74-year-old woman with valvular heart disease, suspected of having oropharyngeal dysphagia following a recent intracerebral hemorrhage, who performed a swallowing function test. Videofluoroscopic swallowing study (VFSS) revealed a supraglottic penetration, confirming the oropharyngeal dysphagia. Furthermore, post-VFSS chest radiograph revealed esophageal residual barium, suggestive of reduced esophageal food transition secondary to external compression, at the level of the T6 vertebral body. Chest computed tomography showed mid-esophageal compression caused by left atrial enlargement. She had pulmonary edema which was managed with diuretics. Post-VFSS chest radiographs also revealed a direct association between the diameter of the esophageal barium residue and body weight. A reduction in body weight led to the resolution of the barium residue and vice versa. Development of cardiac dysphagia may be one of the signs of acute exacerbation of heart failure.

BACKGROUND: The aim of this study was to describe the structure, organization, management, and staffing of pediatric critical care (PCC) in Korea. METHODS: We directed a questionnaire survey for all Upper Grade General Hospitals (n = 43) in Korea in 2015. The first questionnaire was mainly about structure, organization, and staffing and responses were obtained from 32 hospitals. The second questionnaire was mainly about patients and management. Responses to second questionnaire were obtained from 18 hospitals. RESULTS: Twelve from 32 Upper Grade General Hospitals had pediatric intensive care units (PICUs) and 11 of them had the PICU which was exclusive for children. Total number of PICU beds in Korea was 113. The ratio of the number of PICU beds to the number of children was 1:77,460 in Korea and this ratio is lower than that of other developed countries. The mean number of beds in the PICUs was 9.4 ± 9.3 (range, 2–30). There were 16 medical doctors who were assigned for PCC and only 5 of them were full time pediatric intensivists. In the 18 Upper Grade General Hospitals that responded to the second questionnaire survey, there were 97 patients in the PICUs with an average number of 5.7 ± 7.2 (range, 0–22) on the survey day. The mean age of the patients was 3.4 ± 5.6 years. The mean length of hospital stay was 82 ± 271 days. The mean Pediatric Risk of Mortality score III was 9.4 ± 7.8 at the time of admission to the PICUs. CONCLUSION: There is a considerable shortage of PICU beds compared to those in developed countries. In addition, the proportion of PICUs with PCC specialists is much lower than those in the US and European countries.
Child ; Critical Care* ; Developed Countries ; Hospitals, General ; Humans ; Intensive Care Units, Pediatric ; Korea* ; Length of Stay ; Mortality ; Specialization

The secondary amyloidosis (AA type), a complication of inflammation or infection, is caused by the deposition of serum amyloid protein A in various organs. The clinical manifestations of amyloidosis are various according to involved organs. The gastrointestinal tract is one of the commonly affected organs. However, the endoscopic findings of gastrointestinal amyloidosis are nonspecific, and symptoms are diverse. Hepatic involvement of amyloidosis rarely leads to hepatic dysfunction, threfore is not a clinical concern. We report a 54-year-old women with intestinal tuberculosis whose major symptom was watery diarrhea lasting several months. The amyloid deposits were histologically proven in the rectum of which mucosa showed redness and swelling endoscopically and hepatic involvement of amyloidosis was suspected on abdominopelvic CT scan. After anti-tuberculosis medication for 6 months, abdominopelvic CT scan showed resolution of hepatic involvement and colonoscopy revealed improvement of redness and loss of vascularity of the rectum.
Amyloidosis* ; Colonoscopy ; Diarrhea ; Female ; Gastrointestinal Tract ; Humans ; Inflammation ; Middle Aged ; Mucous Membrane ; Plaque, Amyloid ; Rectum ; Serum Amyloid A Protein ; Tomography, X-Ray Computed ; Tuberculosis*

The secondary amyloidosis (AA type), a complication of inflammation or infection, is caused by the deposition of serum amyloid protein A in various organs. The clinical manifestations of amyloidosis are various according to involved organs. The gastrointestinal tract is one of the commonly affected organs. However, the endoscopic findings of gastrointestinal amyloidosis are nonspecific, and symptoms are diverse. Hepatic involvement of amyloidosis rarely leads to hepatic dysfunction, threfore is not a clinical concern. We report a 54-year-old women with intestinal tuberculosis whose major symptom was watery diarrhea lasting several months. The amyloid deposits were histologically proven in the rectum of which mucosa showed redness and swelling endoscopically and hepatic involvement of amyloidosis was suspected on abdominopelvic CT scan. After anti-tuberculosis medication for 6 months, abdominopelvic CT scan showed resolution of hepatic involvement and colonoscopy revealed improvement of redness and loss of vascularity of the rectum.
Amyloidosis* ; Colonoscopy ; Diarrhea ; Female ; Gastrointestinal Tract ; Humans ; Inflammation ; Middle Aged ; Mucous Membrane ; Plaque, Amyloid ; Rectum ; Serum Amyloid A Protein ; Tomography, X-Ray Computed ; Tuberculosis*