The clincal experience of thirteen patients with proven acute osteomyelitis under twelve years of age treated by surgical exprolation such as immediate decompression followed by continuous suction-irrigation. Five patients of them who had short duration from the onset improved while three patients who had long duration from the onset had persisting inflammatory change of the bone in spite of the regimen. The causating organisms were mostly staphylococcus aureus in bacterial cultures. The combination of gentamycin, minocin and penclox were the antibiotics of choice. Early diagnosis and early operation is advocated to attain good results in the treatment of acute osteomyelitis in the children.
Anti-Bacterial Agents ; Child ; Decompression ; Early Diagnosis ; Gentamicins ; Humans ; Minocycline ; Osteomyelitis ; Staphylococcus aureus

Bacterial infection has been implicated in premature labor in human. But it is impossible to undergo human study of bacteria-induced preterm delivery. If we carry out animal experiment which simulate human preterm delivery induced by bacteria, studies for mechanism, diagnosis, and treatment of preterm delivery will be progressed rapidly. To elucidate mechanisms and potential intervention strategies in preterm pregnancy loss, we observed bacteria-induced preterm labor and the protecting effect of administration of antibiotics with hysteroscopy-guided intracervical inoculation of Escherichia coli. Sterile saline solution(group I, n=5) or 2x10(7)cfu (colony-forming units) of E. coli bilaterally in the cervix of pregnant New Zealand White rabbits on day 20 or 21(70% of gestation) by hysteroscopy was inoculated and rabbits were assinged to ampicillin-sulbactam therapy beginning at 0hr(group II, n=4), 2 hr(group III, n=4), 4 hr(group IV, n=2), and 16 hr(group V, n=2) after inoculation with E. coli, or to no antibiotic therapy(group VI, n=3). Unasyn(ampicillin-sulbactam) was used and its daily dosage was 100 mg/kg/day. The occurrence of vaginal bleeding or preterm birth was observed every two hours. If one rabbit fetus was found to be delivered, exploratory laparotomy was done. Amniotic fluid culture on each sac, decidual culture on each uterine cavity, and pathologic examinations on each placenta were done. The results of experiments are as follows. In control group(0.2cc sterile saline inoculation only), there was no preterm labor and no bacterial growth in culture. In all three rabbits in group VI, preterm delivery occurred and the culture results were all positive in maternal blood, decidua, and amniotic sacs. Preterm delivery also occurred in group V, but results of maternal blood culture were all negative. Increased trend in the occurrence of preterm delivery was statistically significant in the order(p < 0.05) : group I(0/5), group II(0/4), group III(0/4), group IV(0/2), group V(2/2), and group VI(3/3). Pregnancy outcomes on the basis of the number of living fetus, dead fetus, and macerated fetus, have significant trend in the above order. Amniotic fluid culture results also had significant relationship(p < 0.05) : group I(0.20), group II(20/26), group III(18/30), group IV(10/11), and group VI(7/7). In group V, amniotic fluid fail to be obtained due to severe oligohydramnios. Decidual culture results also had an increased trend; group I(0/32), group II(21/29), group III(20/30), gorup IV(16/16), gorup V(11/11), and group VI(25/25). It is statistically significant(p < 0.05) Incidence of histologic chorioamnionitis was also significantly increased from group I to VI. These results indicate that E. coli inoculation has induced preterm delivery and antibiotic therapy has somewhat prevented preterm birth, amniotic fluid infection, decidual infection, and histologic chorioamnionits. Antibiotic effects were attenuated in cases of delayed antibiotic administration.
Amniotic Fluid ; Animal Experimentation ; Anti-Bacterial Agents* ; Bacteria ; Bacterial Infections ; Cervix Uteri ; Chorioamnionitis ; Decidua ; Diagnosis ; Escherichia coli ; Female ; Fetus ; Humans ; Hysteroscopy ; Incidence ; Laparotomy ; Models, Animal ; Obstetric Labor, Premature ; Oligohydramnios ; Placenta ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Prognosis* ; Rabbits ; Uterine Hemorrhage

OBJECTIVE: In a rabbit model using hysteroscopy-guided inoculation of E.coli with antibiotic administration, we determine the effects of persistent intrauterine infection on perinatal outcome including fetal death, congenital sepsis, and abnormal fetal-placental growth and amniotic fluid volume in live fetuses. METHODS: Rabbits with timed pregnancies underwent hysteroscopy at 20 to 21 days of gestation(70%). Animals were inoculated with E. coli (0.2 ml containing 10 cfu/ml) and administered ampicillin-sulbactam(100 mg/kg/day; Unasyn; Pfizer) every 8 hours beginning 30 minutes after microbial inoculation until they were killed 5 days after hysteroscopy. In the first study, the following outcome parameters were evaluated between fetuses with and without pe#rsistent intrauterine infection: fetal survival, congenital sepsis, maternal morbidity, and placental pathology. In second study was performed in 16 rabbits having only both live fetuses with and without persistent intrauterine infection in a rabbit simultaneously. We evaluate the effects of persistent intrauterine infection on fetal-placental weight and amniotic fluid volume in live fetuses. RESULTS: 1) Fetuses with persistent intrauterine infection had significantly fewer live fetuses, more positive cord blood cultures than those without (live fetuses: 44% vs 82%, p<0.000001; positive cord blood cultures: 44% vs 3%, p<0.000001, respectively; Fishers exact test). However the rates of maternal morbidity and placental inflammatory lesions were similar between the two groups. 2) The placental weight and amniotic fluid volume were significantly less in live fetuses with than in those without persistent intrauterine infection. Moreover the fetal weight was decreased in live fetuses with persistent intrauterine infection, but it was not statistically significant(placental weight: p<0.05; amniotic fluid volume: p<0.05; fetal weight: p 0.051, respectively; Wilcoxon matched-pairs signed ranks test). CONCLUSION: Fetal complications including fetal death, congenital sepsis, and decreased fetal-placental weight and amniotic fluid volume wae produced in utero when pasistent intrauterine infection was present with antibiotics administration after inoculstion of E. coli. Therefore, when treating with antibiotics in intrauterine infection, it is needed to observe and monitar the presence of persistent intrauterine infection, and if it is peristent, delivery may be considered for the improvement of pregnancy outcome.
Amniotic Fluid ; Animals ; Anti-Bacterial Agents ; Female ; Fetal Blood ; Fetal Death ; Fetal Weight ; Fetus ; Hysteroscopy ; Obstetric Labor, Premature ; Pathology ; Pregnancy ; Pregnancy Outcome ; Rabbits ; Sepsis

Kawasaki disease or mucocutaneous lymph node syndrome is an acute inflammatory illness of childhood characterized by systemic panvasculitis. It presents with high fever, dramatic changes of the skin and mucous membranes, and lymphadenopathy. Adult-onset Kawasaki disease is rare and reports on coronary involvement in adult are even rarer. Herein, we report a case of adult-onset Kawasaki disease complicated by splenic infarction and development of coronary aneurysm even despite of treatment with intravenous gamma globulin. A 20-year-old man presented with fever, erytheatous rash, induration and desquamation of hands and feet, pulmonary edema and shock due to cardiomyopathy, splenic infarction, bilateral conjunctivitis, jaundice, and cervical lymphadenopathy. After Kawasaki disease was suspected, intravenous gamma globulin (2 g/kg once) and aspirin (6 g/day) were administered. On the 30th hospital day, transesophageal echocardiography showed one coronary aneurysm and coronary angiography showed three aneurysms. Eight months after the first admission, follow-up coronary angiography showed normalization of the previous coronary abnormalities.
Adult ; Aneurysm ; Aspirin ; Cardiomyopathies ; Conjunctivitis ; Coronary Aneurysm* ; Coronary Angiography ; Echocardiography, Transesophageal ; Exanthema ; Fever ; Follow-Up Studies ; Foot ; gamma-Globulins ; Hand ; Humans ; Jaundice ; Lymphatic Diseases ; Mucocutaneous Lymph Node Syndrome ; Mucous Membrane ; Pulmonary Edema ; Shock ; Skin ; Splenic Infarction* ; Young Adult

Rhabdomyosarcoma is the most frequent cancer involving the bladder, prostate, vagina and paratesticular tissues in children, and is highly malignant neoplasm with a tendency toward early infiltration of adjacent structures and metastases to regional lymph nodes and distant organs. We report a case of paratesticular embryonal rhabdomyosarcoma developed in 20-year-old male with brief review of literatures.
Child ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prostate ; Rhabdomyosarcoma ; Rhabdomyosarcoma, Embryonal* ; Urinary Bladder ; Vagina ; Young Adult

From May 1991 to December 1993, 30 male bladder cancer patients with 34 to 68 years old age (mean age 52.4 years) underwent bladder replacement with the ileocolic neobladder. A divided segment of ileum and colon was used to create a neobladder after radical cystectomy with a cecourethral anastomosis to provide volitional voiding with continence. Urodynamic studies were followed up 3, 6, l2 and 18 months postoperatively. The mean maximal reservoir capacity was 420+/-87.7, 553+/-65.3, 565+/-60.3, 563+/-53.5ml, mean maximal reservoir pressure was 33.2+/-7.5, 24.2+/-6.1, 24.0+/-5.9, 23.1+/-6.3cmH2O, mean maximal urethral closure pressure was 57.9+/-9.5, 61.3+/-7.6, 61.0+/-7.3, 61.5+/-6.9cmH2O, maximal flow rate was 23.2+/-7.2, 24.3+/-5.8, 24.0+/-6.1, 24.1+/-5.4ml/s and residual urine was 40.0+/-10.3, 35.0+/-7.8, 24.0+/-6.1, 24.1+/-5.4ml/s. The daytime continence rate was 100% and the nighttime continence rate was 93% at 6 months postoperatively. With its very good functional results and its ease of performance, ileocolic neobladder may be one of the ideal urinary diversion for bladder substitution after radical cystectomy.
Aged ; Colon ; Cystectomy ; Humans ; Ileum ; Male ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion ; Urodynamics*

Background: The importance of establishing a regional stroke safety net for the treatment of acute stroke is increasingly emphasized. In this study, we analyzed effectiveness of transferring the suspected acute ischemic stroke (AIS) patients through the 1899-0215 hotline system from 119 ambulances and nearby hospitals. Methods: From July 2015 to July 2022, we analyzed data from 632 suspected acute stroke patients through the hotline. Furthermore, we investigated the proportion of patients in the target population who were eligible for reperfusion therapy and compared cases transferred by 119 emergency services (EMS) with those transferred from nearby hospitals. Results: Six hundred thirty-two suspected acute stroke patients were transferred to our stroke center through the 1899-0215 hotline system. The accuracy of diagnosing acute stroke among transferred patients is 81.0% for 119 EMS and 80.5% for cases transferred from nearby hospitals. Of the 200 patients transferred from hospitals, they were transferred from 47 nearby hospitals with an average transfer distance of 38.2 km and an average transfer time of 65 minutes. Among 291 patients diagnosed with AIS, The onset-to-door time was significantly shorter (p<0.01) for patients transferred by 119 EMS. The proportion of patients who received reperfusion therapy was significantly higher (p<0.01) for those transferred by 119 EMS. Conclusions The hotline service will become a useful tool for establishing a regional stroke network in the Busan area, and its effectiveness will be particularly useful for 119 EMS. Measures are needed in the Busan metropolitan region to ensure the speediness of transferring acute stroke patients between hospitals.

No abstract available.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Lacrimal Apparatus*

urpose: Misonidazole is a radiosensitizer that binds in hypoxic cells. The purpose of this study was to find out the feasibility of I-131-Iodomisonidazole (IMISO) for imaging of tumor hypoxia. MATERIALS AND METHODS: Tosyl precursor was dissolved in acetonitrile and I-131-NaI was added to synthesize IMISO. Balb/c mice inoculated with CT-26 adenocarcinoma were injected with IMISO. Mice were sacrificed at 1,2,4,24 hr and % of injected dose per gram of tissue (%ID/g) was determined. For scintigraphy and MRI, mouse bearing CT-26 adenocarcinoma was administered with IMISO and imaging was performed 4 hr after. Then, mouse body was fixed and microtomized slice was placed on radiographic film for autoradiography. RESULTS: %ID/g of tumor was 1.64 (1h), 0.98 (2h), 0.85 (4h) and 0.20 (24h), respectively. At 24h, %ID/g of tumor was higher than that of all other tissues except thyroid. Tumor to muscle ratio increased with time and tumor to blood ratio also increased with time and reached 1.53 at 24 hr. On autoradiogram, tumor was well visualized as an increased activity in central hypoxic area of the tumor which corresponds to the area of high signal intensity on T2-weighted MR image. On scintigraphy, tumor uptake was visualized. CONCLUSION:: This RESULTS suggest that IMISO may have a potential for tumor hypoxia imaging in mouse model. However, further study is needed to improve it's localization in tumor tissue and to achieve acceptable images of tumor hypoxia.
Adenocarcinoma* ; Animals ; Anoxia* ; Autoradiography ; Magnetic Resonance Imaging ; Mice* ; Misonidazole ; Radionuclide Imaging ; Thyroid Gland ; X-Ray Film

Hypoglycemia due to non-islet cell tumor is usually associated with hypersecretion of big insulin-like growth factor II (IGF-II). This big IGF-II cannot form ternary IGF complex, and is biologically more active in peripheral tissue, inducing increased glucose utilization and hypoglycemia. A 57-year-old man developed severe hypoglycemia due to hepatocellular carcinoma. To control hypoglycemia, the patient required continuous glucose infusion. The circulating levels of cortisol and free T4 were in the normal range. The plasma levels of insulin, C-peptide, IGF-I, IGF binding protein-3 (IGFBP-3), and total IGF-II levels were decreased. Radioimmunoassay of IGF-II revealed that big IGF-II immunoreactivity markedly increased compared to that of normal control. In this patient, it was strongly suggested that big IGF-II might be a cause of severe intractable hypoglycemia.
C-Peptide ; Carcinoma, Hepatocellular ; Glucose ; Humans ; Hydrocortisone ; Hypoglycemia* ; Insulin ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II* ; Middle Aged ; Plasma ; Radioimmunoassay ; Reference Values