Tonsillar tuberculosis is uncommon and is almost secondary to pulmonary tuberculosis. Primary tonsillar tuberculosis is very rare, especially in children. The incidence of tuberculosis has been greatly reduced with chemotherapy, although it has not been eradicated. Recently, we experienced one case of pediatric primary tonsillar tuberculosis of left palatine tonsil. It was diagnosed pathologically after tonsillectomy and adenoidectomy. The purpose of this report is to point out that primary tonsillar tuberculosis still exists and to draw attention to the differential diagnosis in children.
Adenoidectomy ; Child* ; Diagnosis, Differential ; Drug Therapy ; Humans ; Incidence ; Palatine Tonsil* ; Tonsillectomy ; Tuberculosis* ; Tuberculosis, Pulmonary

BACKGROUND: Glomerular filtration rate(GFR) is an important parameter for the evaluation and monitoring of renal function. The aim of this study was to investigate the correlation between the relative 1 hour uptake of (99m)Tc-DMSA renal scan(DMSA- %uptake, TRUR) and GFR which was estimated by (99m)Tc-DTPA, serum creatinine and 24 hour-urinary creatinine excretion. METHODS: Between January 1998 and March 2001, 65 patients had undergone (99m)Tc-DMSA renal scan, (99m)Tc-DTPA renal scan, serum creatinine and 24 hour-urinary creatinine excretion. Of them, 42 patients had moderately or severely reduced renal function(DTPA-GFR 0.05). In group B, TRUR (mean+/-S.D. 16.3+/-7.4%) was significantly correlated with DTPA-GFR(r=0.731, p < 0.01). In both group, serum creatinine, Ccr and C and G Ccr were significantly correlated with TRUR. CONCLUSION: Although the relative 1 hour uptake of the (99m)Tc-DMSA renal scan, as a method of renal cortical image could not estimate the true GFR, it showed a good correlation with GFR in patients with moderately reduced renal function. (99m)Tc-DMSA renal scan seems to be helpful to evaluate the renal function in patients with moderately reduced renal function.
Creatinine ; Filtration ; Glomerular Filtration Rate* ; Humans ; Male

The nutcracker syndrome refers to compression of the left renal vein between the aorta and the superior mesenteric artery, which results in renal vein and left gonadal vein varices. This is an unusual, but well accepted cause of hematuria. We report a case of the nutcracker syndrome which is diagnosed by CT angiography before venography and pressure measurement of the left renal vein and managed by intravascular stent placement. A 47-year-old female patient was presented with gross hematuria. Urinalysis revealed hematuria with only 1% of dysmorphism. Abdominal spiral CT and 3D CT angiography revealed compression of the left renal vein between the aorta and superior mesenteric artery because of an acute branching angle of superior mesenteric artery from the aorta. Renal venography showed compression of the left renal vein and collateral circulations to the left ovarian vein and lumbar vein. The pressure gradient between the left renal vein and inferior vena cava was 4 mmHg. Intravascular stent was placed in this patient. We conclude that in patients with the nutcracker syndrome, CT angiography could be considered before venography and venous pressure measurements. When this syndrome leads to clinical symptoms, Intravascular stent placement should be considered. Well designed stent offers minimal invasiveness and physiologic relief as in the present case.
Angiography ; Aorta ; Collateral Circulation ; Female ; Gonads ; Hematuria ; Humans ; Mesenteric Artery, Superior ; Middle Aged ; Phlebography ; Renal Veins ; Stents* ; Tomography, Spiral Computed ; Urinalysis ; Varicose Veins ; Veins ; Vena Cava, Inferior ; Venous Pressure

BACKGROUND: Diabetic nephropathy is one of the major causes of end-stage renal disease. Microalbuminuria predicts not only progressive renal disease, but also increased cardiovascular morbidity and mortality. But, the relationship between urinary albumin excretion rate (UAER) and glomerular filtration rate (GFR) remains an unresolved issue. In order to investigate the early renal function abnormalities, UAER and GFR were assessed and their relationship was examined in normotensive patients with type 2 diabetes mellitus (DM). METHODS: Between January 1997 and June 2001, in a cross sectional study of 112 normotensive patients with type 2 DM not showing overt proteinuria and thirty healthy subjects served as control group. According to UAER, type 2 DM patients were divided into normoalbuminuria group and microalbuminuria group. The GFR was measured using 99mTc-DTPA renal scan. Clinical values in type 2 DM patients and control subjects were compared using one-way analysis of variance (ANOVA) with Scheffe's F test. In type 2 DM patients, Univariate Chi-square analysis was used to evaluate the prevalence of diabetic retinopathy and the differences in anti-diabetic treatment. Pearson correlation coefficients were used to demonstrate a strength of an association between UAER and other variables including GFR. RESULTS: Three groups were well matched with regard to gender, age and body mass index. There were no significant differences in disease duration and anti-diabetic treatment in type 2 DM patients. The GFR in microalbuminuric patients was significantly higher than in normoalbuminuric patients (124.0 17.6 vs 102.9+/-15.5 mL/min/1.73 m2, p<0.05). The prevalence of diabetic retinopathy in microalbuminuric patients was significantly higher than in normoalbuminuric patients (53.8% vs 24.7%, p<0.05). Only there was significant positive correlation between log UAER and GFR (r=0.303, p<0.05). CONCLUSION: As in type 1 DM patients, there was a significant relationship between UAER and GFR in normotensive type 2 DM patients without overt proteinuria.
Body Mass Index ; Diabetes Mellitus, Type 2* ; Diabetic Nephropathies ; Diabetic Retinopathy ; Glomerular Filtration Rate* ; Humans ; Kidney Failure, Chronic ; Mortality ; Prevalence ; Proteinuria

Mucormycosis (formerly known as zygomycosis) is a life-threatening opportunistic mycosis that infects a broad range of hosts with qualitative or quantitative defects in innate immunity. The overall mortality rate of pulmonary mucormycosis is above 70%. The prognosis and outcome of pulmonary mucormycosis have not improved significantly over the last decade, mainly because of difficulty in early diagnosis and the limited activity of current antifungal agents against members of the order Mucorales. We report a case of pulmonary mucormycosis treated successfully with posaconazole as salvage therapy. We suggest that posaconazole may be considered as an alternative therapeutic approach in patients with invasive pulmonary mucormycosis who are unable to tolerate surgical treatment.
Antifungal Agents ; Early Diagnosis ; Humans ; Immunity, Innate ; Mortality ; Mucorales ; Mucormycosis* ; Prognosis ; Salvage Therapy*

BACKGROUND: In patients with chronic renal failure, infection is caused by altered host defense mechanism, and contributes significantly to their morbidities and mortalities. Especially, urinary tract infection often occurs in patients with chronic renal failure and is due to azotemia, infrequent voiding, low urinary flow rate and urinary concentration defects. This study was designed to compare the incidence of asymptomatic bacteriuria with chronic renal failure with that of normal control group. We also investigated whether risk factors for urinary tract infections in patients with chronic renal failure are similar to those in normal control groups. METHODS: 34 patients (M : F=13 : 21) with chronic renal failure and 30 normal control groups (M : F= 11 : 19) were evaluated in the Pusan National University Hospital from January 2001 through December 2001. Etiology of chronic renal failure included diabetes mellitus (n=16, 47.1%), hypertension (n=14, 41.2%) and glomerular diseases (n=4, 11.7%). 25 patients were treated with hemodialysis and 5 patients were treated with peritoneal dialysis. Others (n=4) were not treated with dialysis. Clean-catch, first voided urine was collected in the morning and examined by routine urinalysis and urine culture. RESULTS: 7 of 34 (20.6%) patients with chronic renal failure were positive in urine cultures and only one of 30 (3.3%) from the normal control group were positive. E. coli (n=2), Acinetobacter baumanii (n=2), Enterococcus spp. (n=2), S. aureus (n=1), P. aeruginosa (n=1), S. epidermidis (n=1) and Str. viridans (n=1) are cultured from urine specimens. There was a significant difference between the incidence of asymptomatic bacteriuria in patients with chronic renal failure and that of normal control group. But there was no significant difference in the presence of bacteriuria according to sex, age, etiology of renal failure, dialysis modality and pyuria. CONCLUSION: Patients with chronic renal failure have higher frequency of asymptomatic bacteriuria and pyuria than healthy subjects and tend to lead to symptomatic urinary tract infections.
Acinetobacter ; Azotemia ; Bacteriuria* ; Busan ; Diabetes Mellitus ; Dialysis ; Enterococcus ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic* ; Mortality ; Peritoneal Dialysis ; Pyuria ; Renal Dialysis ; Renal Insufficiency ; Risk Factors ; Urinalysis ; Urinary Tract Infections

PURPOSE: There was a global increase in the prevalence of oseltamivir-resistant influenza viruses during the 2007-2008 influenza season. This study was conducted to investigate the occurrence and characteristics of oseltamivir-resistant influenza viruses during the 2007-2008 and 2008-2009 influenza seasons among patients who were treated with oseltamivir (group A) and those that did not receive oseltamivir (group B). METHODS: A prospective study was conducted on 321 pediatric patients who were hospitalized because of influenza during the 2007-2008 and 2008-2009 influenza seasons. Drug resistance tests were conducted on influenza viruses isolated from 91 patients. RESULTS: There was no significant difference between the clinical characteristics of groups A and B during both seasons. Influenza A/H1N1, isolated from both groups A and B during the 2007-2008 and 2008-2009 periods, was not resistant to zanamivir. However, phenotypic analysis of the virus revealed a high oseltamivir IC50 range and that H275Y substitution of the neuraminidase (NA) gene and partial variation of the hemagglutinin (HA) gene did not affect its antigenicity to the HA vaccine even though group A had a shorter hospitalization duration and fewer lower respiratory tract complications than group B. In addition, there was no significant difference in the clinical manifestations between oseltamivir-susceptible and oseltamivir-resistant strains of influenza A/H1N1. CONCLUSION: Establishment of guidelines to efficiently treat influenza with oseltamivir, a commonly used drug for treating influenza in Korean pediatric patients, and a treatment strategy with a new therapeutic agent is required.
Child ; Drug Resistance ; Hemagglutinins ; Hospitalization ; Humans ; Influenza, Human ; Inhibitory Concentration 50 ; Neuraminidase ; Orthomyxoviridae ; Oseltamivir ; Prevalence ; Prospective Studies ; Respiratory System ; Seasons ; Viruses ; Zanamivir

PURPOSE: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) and pulsed-spraypharmacomechanical thrombolysis (PSPMT) using urokinase for the management of insufficient hemodialysis access. MATERIALS AND METHODS: Between September 1996 and May 1998, 21 insufficient hemodialysis accesses were treated in16 patients (3 artificial arteriovenous fistulae, AVF ; and 13 arteriovenous graft, AVG). PTA and PSPMT were performed in 6 and 15 and 15 cases, respectively, and success and long-term patency rates were evaluated. RESULTS: The overall success rate of PTA and PSPMT for insufficient hemodialysis access was 76.2%(16/21). The success rates of PTA and PSPMT were 83.3%(5/6) and 73.3%(11/15), respectively. the primary patency rates of PSPMT were 69+/-12.8% at 6 months and 38+/-18.6% at 12 months. One of the two initially successful PTAs had been patent for 7months, and the second PTA was performed at that time due to venous stenosis. The other was patent for 15 months throughout the follow-up period. CONCLUSION: PTA and PSPMT are effective primary methods for the treatment of insufficient hemodialysis access ; success and patency rates were high, and the procedures can be performed repeatedly.
Angioplasty* ; Arteriovenous Fistula* ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Renal Dialysis* ; Transplants* ; Urokinase-Type Plasminogen Activator*

BACKGROUND: Transbronchial lung biopsy (TBLB) is a valuable diagnostic tool for peripheral pulmonary lesions. The diagnostic yield of TBLB reportedly ranges from 41%-60%. Many studies demonstrated the various factors that influence the yield of TBLB, including size, location, and distance from the carina or pleura. However, no study has evaluated the effects of the bronchoscope diameter. We evaluated whether the bronchoscope diameter affected the diagnostic yield of TBLB. METHODS: We reviewed records from 178 patients who underwent TBLB using bronchoscopes of two different diameters (5.7 mm, thick outer diameter, Olympus BF-200; 4.9 mm, thin, BF-260). The fluoroscopic guidance rates, yield of TBLB and flexible bronchoscopy (FB) were compared between the two groups. Additionally, we compared the results of the procedures with respect to diagnosis, distance from the pleura, and size of the lesion. RESULTS: The results of fluoroscopic guidance, TBLB, and FB yield using thin diameter bronchoscope were significantly better than those obtained with a thick diameter bronchoscope (p=0.021, p=0.036, and p=0.010, respectively). Particularly, when the distance from the pleura was < or = 10 mm, success rates for fluoroscopic guidance and FB with thin bronchoscope were higher (p=0.013 and p=0.033, respectively), as compared to with thick bronchoscope. CONCLUSION: A thinner diameter bronchoscope increased the yield of bronchoscopy, and bronchial washing in conjunction with TBLB was useful in the diagnosis of peripheral pulmonary nodules.
Biopsy* ; Biopsy, Fine-Needle ; Bronchoscopes* ; Bronchoscopy ; Diagnosis ; Humans ; Lung Neoplasms ; Lung* ; Pleura

Pulmonary Langerhans cell histiocytosis is an uncommon diffuse cystic lung disease in adults. In rare cases, it can involve extrapulmonary organs and lead to endocrine abnormalities such as central diabetes insipidus. A 42-year-old man presented with polyphagia and polydipsia, as well as a dry cough and dyspnea on exertion. Magnetic resonance imaging of the hypothalamic-pituitary system failed to show the posterior pituitary, which is a typical finding in patients with central diabetes insipidus. This condition was confirmed by a water deprivation test, and the patient was also found to have type 2 diabetes mellitus. Computed tomographic scanning of the lungs revealed multiple, irregularly shaped cystic lesions and small nodules bilaterally, with sparing of the costophrenic angles. Lung biopsy through video-assisted thoracoscopic surgery revealed pulmonary Langerhans cell histiocytosis. On a follow-up visit, only 1 year after the patient had quit smoking, clinical and radiological improvement was significant. Here, we report an uncommon case of pulmonary Langerhans cell histiocytosis that simultaneously presented with diabetes insipidus and diabetes mellitus.
Adult* ; Biopsy ; Cough ; Diabetes Insipidus ; Diabetes Insipidus, Neurogenic* ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Dyspnea ; Follow-Up Studies ; Histiocytosis, Langerhans-Cell* ; Humans ; Lung ; Lung Diseases ; Magnetic Resonance Imaging ; Male* ; Polydipsia ; Smoke ; Smoking ; Smoking Cessation ; Thoracic Surgery, Video-Assisted ; Water Deprivation