OBJECTIVE: Necrotizing pneumonia (NP) is a severe complication of lobar pneumonia caused by various pathogens. The immunopathogenesis and clinical characteristics of NP in children are not clearly understood. We wanted to evaluate the clinical characteristics and suggest in part the immunopathogenesis of NP. METHODS: We reviewed retrospectively the medical charts and radiographic materials of eight patients with NP, who were diagnosed by chest radiography and chest computed tomography at the Department of Pediatrics, Soonchunhyang University Hospitals at Cheonan and Bucheon from January 2002 to December 2011. RESULTS: They were previously healthy, 2.1 to 4.6 years of ages (mean, 2.8+/-1.0 years) and three boys and five girls. All of them had pleural effusion. Five patients had pneumonic consolidations in right upper lung field. Three patients had pneumatocele. They developed leukocytosis (mean, 19,400+/-6,400/mm3), higher C-reactive protein level (mean, 25.1+/-8.0 mg/dL). The etiologic agents were revealed in two patients; Streptococcus pneumonia (S. pneumonia) was revealed in one patient and S. pneumonia and Mycoplasma pneumonia in the other patient. Three patients were treated with additional intravenous immunoglobulin. Clinical improvement was prolonged: fever lasted 10 to 23 days, and length of hospitalization was 15 to 36 days. NP or pneumatocele were completely resolved on the follow-up radiographic studies in all of the patients. CONCLUSION: Although the previously healthy young children with NP had protracted clinical course, they recovered without any problematic sequelae. Our results suggest that the immunopathogenesis of NP in children may be associated with the exaggerated immune reaction of the host to insults from initial bacterial infections, rather than the pathogen-induced cytopathies.
Bacterial Infections ; C-Reactive Protein ; Child* ; Chungcheongnam-do ; Female ; Fever ; Follow-Up Studies ; Gyeonggi-do ; Hospitalization ; Hospitals, University ; Humans ; Immunoglobulins ; Leukocytosis ; Lung ; Pediatrics ; Pleural Effusion ; Pneumonia* ; Pneumonia, Mycoplasma ; Radiography ; Retrospective Studies ; Streptococcus ; Thorax

PURPOSE: The purpose of our study is to provide useful information for diagnostic methods of fatty liver by childhood simple obesity and to provide correlation between serum alanine aminotransferase (ALT) for screening test and abdominal computerized tomography (CT) and liver biopsy for confirmative diagnostic methods of fatty liver. METHODS: Among 78 obese childrens who visited our hospital, CT was carried out in 26 childrens. Of these, liver biopsy was carried out in 15 childrens who had high obesity index or severe elevated ALT. Based on the level of serum ALT, 26 cases were classified into 3 groups, and compared with physical measurements and degree of fatty infiltration on CT and liver biopsy. RESULTS: 1) Correlation between ALT and physical measurements: Of 26 obese children, ALT was abnormally elevated (>30 IU/L) in 17 cases (67.4%) but there was no significant correlation between ALT and physical measurements (p>0.05). 2) Correlation between degree of fatty infiltration on CT and ALT: Of 26 cases, 13 cases (50%) revealed fatty liver on CT. The degree of fatty liver on CT had significant correlation with elevation of ALT (p<0.05). 3) Correlation between the degree of fatty infiltration on liver biopsy and ALT: Liver biopsy was performed in 15 cases of which 14 cases revealed fatty liver. But one case had normal hepatic histology with severe obesity and normal ALT. Fourteen fatty liver cases on liver biopsy were classified into 3 groups by the degree of fatty infiltration and analysed with obesity index and ALT. The histologic hepatic steatosis had no significant correlation with obesity index (p>0.05), but significant correlation with ALT (p<0.05). 4) Correlation between CT and liver biopsy finding: Both CT and liver biopsy were performed in 15 cases of which 6 cases revealed normal finding on CT and 9 cases manifested fatty liver. There was significant correlation between CT and liver biopsy findings (r=0.6094). CONCLUSION: The results of our study suggest that abdominal CT and liver biopsy are useful and accurate methods of estimating fatty liver in the childhood obesity. But biochemical abnormalities of routine liver function tests dot not correlate well with severity of the fatty liver and liver injury.
Alanine Transaminase ; Biopsy* ; Child* ; Diagnosis* ; Fatty Liver* ; Humans ; Liver Function Tests ; Liver* ; Mass Screening ; Obesity* ; Obesity, Morbid ; Pediatric Obesity ; Tomography, X-Ray Computed*

Renal transplantation is the optimal treatment for end stage renal disease and it has been improved through the development of operative methods and immunosuppressants. However some patients must receive dialysis or undergo retransplantation after a loss of the primary graft due to rejection or other causes. Recently the frequency of retransplantation has begun to increase gradually. Some articles have reported that retransplantation results do not significantly differ in comparison with initial transplantation results when living related donor kidneys are used. Our study focused on the outcome of 445 first transplantation and 12 retransplantation cases. The sex distribution of retransplanted patients was 11 male and 1 female. The mean age (yrs) for recipients was 32.3 at the first transplantation and 39.1 at the retransplantation. The underlying causes of end stage renal disease were presumed to be chronic glomerulonephritis in all retransplantion patients; the mean duration of graft survival (mo) for first transplantation was 77.92. The causes of previous graft failure were as follows: 10 due to chronic rejection, 1 due to recurrent glomerulonephritis, 1 resulted from a graft rupture due to a motorcar accident. The interval (mo) between graft failure and retransplantation averaged 6.7 and 9 out of 12 patients underwent regrafting within 1 year of their previous graft loss. Recipient-donor relationships in first transplantations were as follows: 9 were living related and 3 were living non-related. Recipient-donor relationships in second transplantations were as follows: 4 were living related and 8 were living non-related. Acute rejection within 1 month of transplantation occurred in 4 primary transplantation patients and 2 retransplantation patients. The incidence of acute rejection within 1 month was as follows: 23% of 445 first renal transplantation patients, 16.7% of 12 second transplantation patients. The 1 year and 2 year graft survival rate was 100% and the mean survival duration (mo) was 33 for retransp
Dialysis ; Female ; Glomerulonephritis ; Graft Survival ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney Failure, Chronic ; Kidney Transplantation ; Kidney* ; Male ; Rupture ; Sex Distribution ; Tissue Donors ; Transplants