Pyogenic vertebral osteomyelitis, which is not uncommon in adults, is rare in children. Furthermore, the clinical presentation is often subtle and nonspecific. As a result, vertebral osteomyelitis is often not considered in the initial evaluation in children, resulting in a delay in diagnosis and treatment. We report a 3-year-old boy who was eventually diagnosed with pyogenic vertebral osteomyelitis and treated successfully with antibiotics. The patient initially presented himself with mild fever and abdominal pain for one week. Urinary tract infection, initially considered due to dysuria with suprapubic tenderness, was ruled out. Further investgation revealed that he had right sided suprapubic tenderness and low abdominal pain. He refused to sit or walk, and preferred a recumbent position with his knees bent. The magnetic resonance imaging study showed findings of L2-L3 vertebral osteomyelitis. With 4 weeks of intravenous cephradine treatment, the patient improved clinically and radiologically.
Abdominal Pain ; Adult ; Anti-Bacterial Agents ; Cephradine ; Child ; Child, Preschool ; Diagnosis ; Discitis ; Dysuria ; Fever ; Humans ; Knee ; Magnetic Resonance Imaging ; Male ; Osteomyelitis* ; Urinary Tract Infections

BACKGROUND: Defensins are small (3.5~5 kDa) cationic antimicrobial peptides that have a broad spectrum of activity that includes gram-negative bacterias, yeasts and enveloped viruses. The defensins contain six cysteine residues forming three disulfide bridges depending on the spacing of the cysteine residues and the connectivity of the disulfide bridge, defensins are classified into two families, the alpha-defensins (HNP) and beta-defensins (HBD). Recently two human epithelial beta defensins, HBD-1 and HBD-2 have been identified. HBD-1 has been detected in a number of normal mucosal sites, but HBD-2 is highly restricted in its expression by inflammatory stimulations. we invesigated the expression of hunam beta defensin in human male urogenital organs. METHODS: Specimens of normal human male testis, epididymis, prostate, seminal vesicles, vas deferens, urethra, bladder, ureter, kidney, pyelonephritis, epididymitis, clear renal cell carcinoma and transitional cell carcinoma of bladder were obtained as discarded material from urological surgery. Each sample was stored at snap frozen in liquid nitrogen subsequent to RNA extraction. Reverse transcription polymerase chain reaction (RT-PCR) was used to semiquantitate HBD-1 and HBD-2 mRNA using the housekeeping gene beta-actin as an internal control. Southern blotting and sequencing showed HBD-1, 2 expressions in male urogenital organs. RESULTS: We checked the expression of HBD-1, 2 mRNA in all specimen of normal human male urogenital organ, pyelonephritis, epididymitis, clear renal cell carcinoma and transitional cell carcinoma of bladder by RT-PCR and southern blotting analysis. We checked the homolgy of HBD-1, 2 by bands sequencing. CONCLUSION: Our study indicated that the normal male urogenital organs, infection and neoplasm in male urogenital organs expresses antimicrobial peptides. These may play an important role in the prevention of infections by bacterias, antimicrobial effects in infection and anticancer effects in neoplasm of male urogenital organs. These natural endogenous antibiotic peptides could be developed as novel therapeutic agents for fighting infections and neoplasms of the human male urogenital organs.
Actins ; alpha-Defensins ; Antimicrobial Cationic Peptides ; Bacteria ; beta-Defensins ; Blotting, Southern ; Carcinoma, Renal Cell ; Carcinoma, Transitional Cell ; Cysteine ; Defensins ; Epididymis ; Epididymitis ; Genes, Essential ; Gram-Negative Bacteria ; Humans* ; Kidney ; Male* ; Nitrogen ; Peptides ; Polymerase Chain Reaction ; Prostate ; Pyelonephritis ; Reverse Transcription ; RNA ; RNA, Messenger ; Seminal Vesicles ; Testis ; Ureter ; Urethra ; Urinary Bladder ; Vas Deferens ; Yeasts

PURPOSE: To identify relationship of behavioral problems, parenting practice and school life in children with atopic dermatitis. METHODS: The participants were parents of 102 school-aged children with atopic dermatitis. The instruments used were a self-reported questionnaire on K-CBCL, Childrearing Behavior Questionnaire, and measurements of relationship with friends and teachers. Descriptive, Pearson correlation and multiple regression analyses were performed. RESULTS: There was no statistically significant relationship between behavior problems for gender, age, parent's age, parent's educational level, family structure, academic achievement, and duration and severity of illness. There were significant differences in internalizing (F=3.471, P<0.05) and externalizing problems (F=3.227, P<0.05) according to economic status. In bivariate analysis, rejection-nonintervention maternal parenting practice (r=0.293, P<0.05), the relationship with friends (r=-0.297, P<0.05) and the relationship with teachers (r=-0.252, P<0.05) were significantly correlated with internalizing problems and rejection-nonintervention maternal parenting practice (r=0.257, P<0.05), rejection-nonintervention paternal parenting practice (r=0.274, P< 0.05), the relationship with friends (r=-0.275, P<0.05) and the relationship with teachers (r= -0.263, P<0.05) were significantly correlated with externalizing problems. However, the results of multiple regression analysis showed that only the relationship with friends (beta=-1.412, P<0.05) was significantly associated with internalizing problems and rejection-nonintervention maternal parenting practice (beta=-0.458, P<0.05), the relationship with friends (beta=0.402, P<0.05) were significantly associated with externalizing problems. CONCLUSION: School-aged children with atopic dermatitis who reported lower socioeconomic status, reported higher rejection-nonintervention parenting practice and had a poor relationship with friends and teachers showed higher internalizing and externalizing problems. A comprehensive intervention program for children with atopic dermatitis is recommended to promote the development of positive relationships with parents, friend and teachers.
Achievement ; Child ; Dermatitis, Atopic ; Friends ; Humans ; Parenting ; Parents ; Surveys and Questionnaires ; Social Class

OBJECTIVE: Angiogenesis, the formation of blood vessels by sprouting from pre-existing ones, is essential for the growth of solid tumors beyond 2-3mm in diameter and for tumor metastasis. Vascular endothelial growth factor (VEGF), is known as vascular permeability factor(VPF) and mediates vascularization and tumor-induced angiogenesis. This study examined the potential of growth, invasion, and metastasis of uterine cervical carcinomas associated with neovascularization. METHODS: From January 1996 to December 1999, at the Department of Obstetrics and Gynecology, Kyung-Hee University Hospital, 37 uterine cervical carcinomas and 7 normal cervical tissues were obtained and the samples were immediately frozen and stored at -70 degrees C. Immunohistochemical staining for VEGF was carried out to study VEGF localization, and the levels of VEGF subtype mRNAs were determined by quantitative RT-PCR in specimens. The relation between VEGF subtypes expression of cervical cancers was analysed. RESULTS: The positive staining for VEGF is seen dominantly in the cytoplasm of the cancer cells, and faintly in interstitial cells. The intensity of staining was stronger in squamous carcinomas than in adenocrcinomas, but there was no significant difference (p>0.05). Quantitative RT-PCR analysis demonstrated significantly increased VEGF121/VEGF165 mRNA expression levels (>0.56 / >0.72) in 21 (56.8%) and 15 (40.5%) of 37 cervical carcinomas comparing to control groups (mean: 0.28 / 0.36). There was no obvious relationship between VEGF121/VEGF165 mRNA expression levels and the clinical parameters examined including age, pathology, differentiation, tumor size, lymphovascular space invasion, LN involvement and invasion depth except clinical stage (p<0.05). CONCLUSIONS: The overexpression of VEGF mRNA may be an important contributing factor in cervical carcinomas. There is no significant differenece of VEGF mRNAs levels according to clinical parameters, so it seems that the expression of VEGF is involved in the promotion of angiogenesis on cervical cancer and plays an important role in early invasion.
Blood Vessels ; Capillary Permeability ; Carcinoma, Squamous Cell ; Cytoplasm ; Gynecology ; Neoplasm Metastasis ; Obstetrics ; Pathology ; RNA, Messenger* ; Uterine Cervical Neoplasms ; Vascular Endothelial Growth Factor A*

PURPOSE: Irreparable massive rotator cuff tears pose a distinct clinical challenge for the orthopaedist and non-surgical treatment has had inconsistent results and proven unsuccessful for chronic symptoms, while surgery, including debridement and partial and complete repairs have had varying degrees of success. MATERIALS AND METHODS: For rotator cuff tears that are deemed irreparable, treatment options are limited. RESULTS AND CONCLUSION: The use of tendon transfers (latissimus dorsi for posterosuperior type cuff defects and pectoralis major for subscapularis defects) in younger patients to reconstruct rotator cuffs and re-establish function and restore shoulder kinematics can be useful in solving this difficult problem.
Biomechanics ; Debridement ; Humans ; Rotator Cuff ; Shoulder ; Tendon Transfer ; Tendons

PURPOSE: To evaluate the usefulness of interlocking intramedullary nailing for operative treatment of forearm shaft fractures in adults. MATERIALS AND METHODS: Thirteen forearm shaft fractures in 12 patients were fixated with 13 Acumed forearm intramedullary rods (ulna: 8, radius: 5). The average age was 36.7 years and mean follow-up period was 15.2 months. The union time was measured when there was no tenderness over the fracture site and the bridging callus was evident in at least two sides of the cortex. The range of motion of the joint and the rotation of the forearm was measured and the functional results were evaluated with Grace and Eversmann's rating system. RESULTS: Radiologic union was observed at 11.8 weeks postoperatively in 11 cases out of 13. No limitation of motion was observed. Nine had excellent or good functional results. In one Galeazzi fracture, radial shaft became displaced after nailing and should be re-stabilized with plate. Proximal interlocking screws were improperly inserted in one ulnar nail. Implants were removed in 7 cases. Removal guide screw was broken while removing the intramedullary nail in one case of ulnar shaft fracture. CONCLUSION: Interlocking intramedullay nailing might be a treatment option for the middle 1/3 shaft fractures of the adult forearm bone with favorable results.
Adult ; Bony Callus ; Follow-Up Studies ; Forearm ; Fracture Fixation, Intramedullary ; Humans ; Joints ; Nails ; Range of Motion, Articular

PURPOSE: This study compared the efficacy and tolerability of intravenous (i.v.) phenobarbital (PHB) and i.v. levetiracetam (LEV) in children with status epilepticus (SE) or acute repetitive seizure (ARS). METHODS: The medical records of children (age range, 1 month to 15 years) treated with i.v. PHB or LEV for SE or ARS at our single tertiary center were retrospectively reviewed. Seizure termination was defined as seizure cessation within 30 minutes of infusion completion and no recurrence within 24 hours. Information on the demographic variables, electroencephalography and magnetic resonance imaging findings, previous antiepileptic medications, and adverse events after drug infusion was obtained. RESULTS: The records of 88 patients with SE or ARS (median age, 18 months; 50 treated with PHB and 38 with LEV) were reviewed. The median initial dose of i.v. PHB was 20 mg/kg (range, 10-20 mg/kg) and that of i.v. LEV was 30 mg/kg (range, 20-30 mg/kg). Seizure termination occurred in 57.9% of patients treated with i.v. LEV (22 of 38) and 74.0% treated with i.v. PHB (37 of 50) (P=0.111). The factor associated with seizure termination was the type of event (SE vs. ARS) in each group. Adverse effects were reported in 13.2% of patients treated with i.v. LEV (5 of 38; n=4, aggressive behavior and n=1, vomiting), and 28.0% of patients treated with i.v. PHB (14 of 50). CONCLUSION: Intravenous LEV was efficacious and safe in children with ARS or SE. Further evaluation is needed to determine the most effective and best-tolerated loading dose of i.v. LEV.
Child* ; Electroencephalography ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Phenobarbital* ; Recurrence ; Retrospective Studies ; Seizures* ; Status Epilepticus*

BACKGROUND: Severe bradycardia occurring in strabismus surgery is unpredictable and may lead to cardiac arrest. If we identify patients who have risk of severe bradycardia during strabismus surgery, it is helpful to provide a more meticulous anesthesia. In this study, we investigated the correlation between the degree of bradycardia and indices of power spectral analysis and nonlinear dynamic data analysis of preoperative ECG. METHODS: ECG was collected for twenty minutes from strabismus patients (n = 93). No premedicants were administered. After administration of anesthesia and traction of extraocular muscle, the lowest heart rate was recorded. We calculated the correlation coefficient between the power spectral density, approximate entropy and correlation dimension of preoperative ECG and the difference between preoperative and lowest HR. RESULTS: As the difference between the preoperative heart rate and the intraoperative bradycardia increased, the preoperative ECG showed a low total power (r = 0.27, P = 0.016), low low-frequency power (r = 0.31, P = 0.049), low high-frequency power (r = 0.30, P = 0.007) and high ratio of low to high-frequency power (r = 28, P = 0.03). There was no correlation between bradycardia and approximate entropy and correlation dimension, respectively. CONCLUSIONS: There was a correlation between indices of power spectral analysis of preoperative ECG and degree of bradycardia during strabismus surgery. Therefore we take into consideration preoperative ECG and its analytic indices in order to provide careful preparation for high risk patients who exhibit a tendency to severe bradycardia.
Anesthesia ; Bradycardia* ; Electrocardiography* ; Entropy ; Heart Arrest ; Heart Rate ; Humans ; Nonlinear Dynamics ; Reflex, Oculocardiac ; Statistics as Topic ; Strabismus* ; Traction

PURPOSE: This study was performed to investigate the change in the causative organisms of bacterial meningitis and the prevalence of bacterial meningitis caused by antibiotics resistant strains in a single Korean tertiary center. METHODS: We retrospectively analyzed medical records of patients who had been diagnosed with bacterial meningitis from March 1999 to March 2010 at the Asan Medical Center. The bacterial meningitis was defined as the correlated clinical symptoms and the isolation of organisms from the cerebrospinal fluid culture. RESULTS: During the 11-year study period, we found 81 cases of CSF-culture proven bacterial meningitis. Streptococcus agalactiae (group B streptococcus, GBS) were most common bacteria accounting for 23 (28.3%) cases, followed by Streptococcus pneumoniae with 22 (27.2%), and Haemophilus influenzae with 8 (9.9%). After introduction of the vaccination, only one case of H. influenzae meningitis was documented. Seventeen of 18 (94.4%) cases of GBS were sensitive to the penicillin, whereas 82.4% (14/17) of S. pneumoniae were resistant to penicillin. Among the 17 cases of S. pneumoniae, 11 cases (64.7%) were multi-drug resistant strains but all were susceptible to vancomycin. CONCLUSION: In spite of the introduction of the vaccination, S. pneumoniae was the most common cause of bacterial meningitis in children older than two months. For pneumococcal meningitis, careful selection of antibiotics and ongoing research about antibiotics susceptibility will be needed due to multi-drug resistance.
Accounting ; Anti-Bacterial Agents ; Bacteria ; Child ; Drug Resistance ; Drug Resistance, Multiple ; Haemophilus influenzae ; Humans ; Influenza, Human ; Medical Records ; Meningitis ; Meningitis, Bacterial ; Meningitis, Pneumococcal ; Penicillins ; Pneumonia ; Prevalence ; Retrospective Studies ; Streptococcus ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Vaccination

PURPOSE: A technique of cerclage wire fixation in comminuted fracture of the clavicle shaft is thought to interfere the fracture healing, so authors studied radiographically and clinically about the cases of cerclage wiring of the fracture fragments with the plate and screws fixation in the comminuted fracture of the shaft of the clavicle. MATERIALS AND METHODS: According to following inclusion criteria, total 18 patients (male: 15, female: 3) were investigated; Patients who visited hospital due to clavicle shaft comminuted fracture from February 2005 to April 2009, who underwent surgery utilizing more than 2 cerclage wire fixation for the fragments when open reduction and plate fixation were operated and who could be follow-up over one year. The duration for fracture union, functional outcome and complications were investigated retrospectively. RESULTS: Radiological bone union was accomplished in average 13.3 weeks (12~16 weeks) and there was no complication such as nonunion, delayed union or infection. Range of motion of ipsilateral shoulder joint was recovered in all patients except one at the final follow-up. CONCLUSION: The clinical and radiographical results of the plate and screws fixation with cerclage wiring of the fragments in comminuted clavicle shaft fracture showed that the cerclage wiring does not interfere the fracture healing, so authors think that this method is a good alternative operation if it is performed carefully to minimize soft tissue dissection.
Clavicle ; Follow-Up Studies ; Fracture Healing ; Fractures, Comminuted ; Humans ; Range of Motion, Articular ; Shoulder Joint