We report a case of solitary congenital calcified nodule of the ear in a 1-year-old female. The lesion was a 2 X 2mm-sized, elevated, slightly erythematous and whitish-centered nodule located since birth on the superior helical rim of her left ear. Histopathological findings fram the totally excised lesion showed calcium deposits as amorphous, basophilic masses in the upper dermis and focal discharge of calcium by means of transepidermal elimination. Surrounding the calcium deposits, lymphohistiocytic infiltrations were present.
Basophils ; Calcium ; Dermis ; Ear* ; Female ; Humans ; Parturition

PURPOSE: This study was performed to elucidate the clinical pictures of acute focal bacterial nephritis(nephronia) in children. METHODS: We reviewed 9 children with nephronia diagnosed by ultrasonography or computed tomography of kidneys from September 1994 to August 2004. RESULTS: The overall male to female ratio was 2:1, and the age distribution ranged from 0.1 to 6 years(mean 2.8+/-2.2). The cardinal symptoms were fever, chills, abdominal pain and dysuria/frequency. The initial leukocyte count was 21,000+/-5,600/uL; ESR, 60+/-23 mm/hr; CRP, 17+/-10 mg/dl. Pyuria was noted in every patient and persisted for 10.5+/-7.8 days after antimicrobial treatment. Abdominal sonography demonstrated focal lesion of ill-defined margin and low echogenicity in 5 of 9 patients(55.6%), while computed tomography revealed nonenhancing low density area in all patients(100%). Three of 9 patients(33.3%) had vesicoureteral reflux, greater than grade III. The initial (99m)Tc-DMSA scan showed one or multiple cortical defects in every patient, and improvements were noted in 2(33.3%) of 6 patients who received follow up scan after 4 months. Intravenous antibiotics was given in every patient under admission. Total febrile period was 11.8+/-6.3 days(pre-admission, 4.0+/-3.0; post-admission, 7.8+/-5.5 days) and the patients needed hospitalization for 17.2+/-8.1 days. CONCLUSION: For the early diagnosis of 'acute focal bacterial nephritis' we should perform renal computed tomography first rather than ultrasonography, when the child has toxic symptoms and severe inflammatory responses in blood and urine.
Abdominal Pain ; Age Distribution ; Anti-Bacterial Agents ; Child* ; Chills ; Early Diagnosis ; Female ; Fever ; Follow-Up Studies ; Hospitalization ; Humans ; Kidney ; Leukocyte Count ; Male ; Nephritis* ; Pyuria ; Ultrasonography ; Vesico-Ureteral Reflux

Eosinophilic panniculitis is characterized by a prominent infiltration of numerous eosinophils in subcutaneous fat, and has been identified in patients with a variety of associated clinical conditions. A case of eosinophilic panniculitis in a 20-year-old woman with a history of atopic dermatitis is reported. She later developed superior sagittal sinus thrombosis, and we stress the importance of systemic evaluations in patients with eosinophilic panniculitis.
Dermatitis, Atopic ; Eosinophils* ; Female ; Humans ; Panniculitis* ; Subcutaneous Fat ; Superior Sagittal Sinus* ; Thrombosis* ; Young Adult

The hyperimmunoglobulin E syndrome is a primary immunodificiency disorder characterized by recurrent staphylococcal infections and markedly elevated serum IgE level. Clinical features are coarse face and severe infections of the skin-furunculosis or chronically pruritic dermatitis and sinopulmonary tract infection from infancy by coagulase positive Staphylococcus aureus, or Candida albicans etc. The patients's serum IgE level is elevated but the basic immunologic pathogenesis not fully understood. We have experienced a case of hyperimmunoglobulin E syndrome in a 26/12-year-old who had suffered from recurrent staphylococcal pneumonias and abscesses and chronically pruritic dermatitis from 1 month of age with elevated serum IgE level. A brief review of the related literature is presented.
Abscess ; Candida albicans ; Coagulase ; Dermatitis ; Immunoglobulin E ; Pneumonia, Staphylococcal ; Staphylococcal Infections ; Staphylococcus aureus

PURPOSE: The objectives of this study was to evaluate the correlations between the indices of insulin sensitivity using fasting glucose and insulin level, and the body fat mass measured by bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DEXA), and to determine the clinical usefulness of insulin sensitivity indices when obese children were followed up. METHODS: In this study, 28 simple obese children and adolescents were included. Anthropometric data including body weight, height, obesity degree (OD), body mass index (BMI), and waist-to-hip ratio were collected and then body fat mass was measured by using BIA and DEXA. For metabolic data, 12 hour fasting serum glucose, insulin and lipid profiles were measured and indices for insulin sensitivity (G/I ratio, loginsulin, HOMA-IR, logHOMA-IR, QUICKI) were calculated. RESULTS: BMI had a higher correlation with insulin sensitivity indices than OD (G/I ratio, -0.463 vs -0.209; loginsulin, 0.417 vs 0.196; HOMA-IR, 0.301 vs 0.238; logHOMA-IR, 0.403 vs 0.198; QUICKI, -0.451 vs -0.224). But OD had a higher correlation with body fat mass measured by BIA and DEXA than BMI (BIA, 0.612 vs 0.316; DEXA, 0.667 vs 0.512). The G/I ratio was correlated with body fat mass in BIA (r=-0.420, P< 0.05) and DEXA (r=-0.512, P< 0.01), percentage of body fat (percentage of fat) in BIA (r=-0.366, P< 0.05) and DEXA (r=-0.449, P< 0.01). HOMA-IR was only correlated with body fat mass in DEXA (r=0.341, P< 0.05). CONCLUSION: This study revealed that G/I ratios had a statistically significant correlation with anthropometric obesity indices (OD and BMI) and also had a correlation with both body fat mass and percentage of fat. These results suggest that G/I ratios could be used as useful index when obese children and adolescence are followed up.
Absorptiometry, Photon* ; Adipose Tissue* ; Adolescent ; Blood Glucose ; Body Mass Index ; Body Weight ; Child ; Electric Impedance* ; Fasting ; Glucose ; Humans ; Insulin Resistance* ; Insulin* ; Obesity ; Waist-Hip Ratio

PURPOSE: The presence and degree of fever in children is a useful indicator of illness. This project aimed to assess the accuracy and usefulness of infrared tympanic membrane (TM) & forehead feverscan thermometers for measuring children's temperatures. METHODS: Data were obtained from 1, 050 children with a median age of 4.5 years. They visited the pediatric clinics at Chung-Ang University Yongsan Hospital from January 2004 to December 2004. We measured body temperatures at axilla by mercury thermometer, at ear by infrared TM thermometer and at forehead by feverscan. Then we analyzed the correlation between these data. RESULTS: Mercury and TM thermometer, and Mercury and forehead feverscan thermometer very well correlated with each others (P< 0.05). And the sensitivity of infrared TM thermometer (right and left) to correctly identify febrile children was 81.1 percent and 82.4 percent, the positive predictive value to detect a fever was 81.8 percent and 73.6 percent. The sensitivity of forehead feverscan was 83.3 percent and the positive predictive value was 74.4 percent. CONCLUSION: The tympanic membrane temperature measured by the BRAUN IRT 3020 (R) and forehead arterial temperature measured by the HubDIC DOTORY (R) feverscan accurately reflects mercury axillary temperature, validly assesses the presence of fever in children, and is easy to use. The Braun IRT 3020 (R) & HubDIC DOTORY (R) therefore is an adequate tool to assess fever and may be used both in a clinical setting and for research purposes.
Axilla ; Body Temperature ; Child ; Ear ; Fever ; Forehead* ; Humans ; Thermometers* ; Tympanic Membrane*

BACKGROUND/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine. METHODS: We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention. RESULTS: The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups. CONCLUSIONS: Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.
Analgesia ; Anesthesia, Caudal* ; Anesthetics ; Bupivacaine* ; Humans ; Mepivacaine* ; Morphine* ; Pain, Postoperative ; Urinary Retention

BACKGROUND: Healthcare-associated infections (HAIs) are among the most important threats to patient safety. When hospitalized children face these threats, there is morbidity, mortality, prolonged hospitalization, and increased healthcare costs. Research on local healthcare epidemiology is necessary to enhance collective knowledge and evidence formanaging this problem. METHODS: We performed a retrospective analysis of databases of patients who were diagnosed with HAIs at Chung-Ang University Hospital (CAUH) from 2007 through 2011. Cases were selected from the microbiology registry databases. The data on prevalence of HAIs in various wards and its annual trends were compared to previously reported nationwide data. Moreover, we analyzed the patterns of antibiotic susceptibility results for HAI pathogens. RESULTS: A total of 181 HAIs were identified in 122 patients. The HAI rate among pediatric patients at CAUH was 2.4/1,000 person-hospital days. Urinary tract infections (UTIs) (53 episodes, 29.3%) were the most common, followed by pneumonia (33 episodes, 18.2%). Staphylococcus aureus was found to be the most common gram-positive organism, whereas Escherichia coli was the most common gram-negative organism. Methicillin-resistant S. aureus (MRSA) comprised 84% of the S. aureus infections. Imipenem resistance was detected in 58.8% and 55.0% of Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively. CONCLUSION: Between 2007 and 2011, UTIs were the most common type of HAIs, and MRSA was the most common pediatric HAI pathogen, both in the general ward and intensive care unit at the CAUH. Further research on the epidemiology and pathogenesis of HAIs is necessary and prevention measures should be implemented to prevent HAIs in children.
Acinetobacter baumannii ; Child ; Child, Hospitalized ; Delivery of Health Care ; Escherichia coli ; Health Care Costs ; Hospitalization ; Humans ; Imipenem ; Intensive Care Units ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Patient Safety ; Patients' Rooms ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa ; Retrospective Studies ; Staphylococcus aureus ; Urinary Tract Infections

It is well known that the murine T helper cell clones are divided by their lymphokine secretory activities. One is the Th-1 cell, producing IL-2 and IFN after stimulation and the other is the Th-2 cell, producing the IL-4 and IL-5. This study was undertaken to evaluate the immunomodulatory properties of the bacterial lipopolysaccharide(LPS) on the lymphokine production in vivo and in vitro. The results were as follows: There were no effects on the lymphokine secretion by the in vitro treatment of the LPS. The in vivo treatment of the LPS decreases the capability of the production of IL-2 and IFN , whereas it increases the capability of IL-4 production. The altered capacity of the lymphokine production was recovered about 2 weeks after the treatment of the LPS. There were no differences on the lymphokine production between E-coli LPS and salmonella LPS. The capacity of the lymphokine production was the same in the treatment of a non-heated LPS or heated-LPS. The lymphokine production of the mice which were desensitized by the long term treatment of the LPS was not different from the control mice. The in vitro treatment of RU486 can block the alterations of the lymphokine production after the treatment of the LPS. In summary, one can tell that the LPS increases the secretion of the IL-4 through the endogenous secretion of the glucocorticoids.
Animals ; Clone Cells ; Glucocorticoids ; Interleukin-2 ; Interleukin-4 ; Interleukin-5 ; Mice ; Mifepristone ; Salmonella ; T-Lymphocytes* ; T-Lymphocytes, Helper-Inducer

PURPOSE: Escherichia coli sequence type (ST) 131, a multidrug-resistant clone causing extraintestinal infections, has rapidly become prevalent worldwide. However, the epidemiological and clinical features of pediatric infections are poorly understood. We aimed to explore the characteristics of ST131 Escherichia coli isolated from Korean children with urinary tract infections. METHODS: We examined 114 uropathogenic E. coli (UPEC) isolates from children hospitalized at Chung-Ang University Hospital between 2011 and 2014. Bacterial strains were classified into STs by partial sequencing of seven housekeeping genes (adk, fumC, gyrB, icd, mdh, purA, and recA). Clinical characteristics and antimicrobial susceptibility were compared between ST131 and non-ST131 UPEC isolates. RESULTS: Sixteen UPEC isolates (14.0%) were extended-spectrum β-lactamase (ESBL)-producers; 50.0% of ESBL-producers were ST131 isolates. Of all the isolates tested, 13.2% (15 of 114) were classified as ST131. There were no statistically significant associations between ST131 and age, sex, or clinical characteristics, including fever, white blood cell counts in urine and serum, C-reactive protein, radiologic abnormalities, and clinical outcome. However, ST131 isolates showed significantly lower rates of susceptibility to cefazolin (26.7%), cefotaxime (40.0%), cefepime (40.0%), and ciprofloxacin (53.3%) than non-ST131 isolates (65.7%, 91.9%, 92.9%, and 87.9%, respectively; P<0.001 for all). ESBL was more frequently produced in ST131 (53.3%) than in non-ST131 (8.1%) isolates (P<0.01). CONCLUSION: ST131 E. coli isolates were prevalent uropathogens in children at a single medical center in Korea between 2011 and 2014. Although ST131 isolates showed higher rates of antimicrobial resistance, clinical presentation and outcomes of patients were similar to those of patients infected with non-ST131 isolates.
C-Reactive Protein ; Cefazolin ; Cefotaxime ; Child* ; Ciprofloxacin ; Clone Cells ; Escherichia coli ; Fever ; Genes, Essential ; Humans ; Korea ; Leukocyte Count ; Multilocus Sequence Typing ; Urinary Tract Infections* ; Urinary Tract* ; Uropathogenic Escherichia coli*