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: The aim of this study was to evaluate the data of 11 patients who had excessive drooling attributable to various diseases such as hypoxic ischemic encephalopathy, spinal muscular atrophy, and esophageal stricture treated with the injection of botulinum toxin A. METHODS: Eleven children with excessive drooling were enrolled in a retrospective clinical evaluation. Eighty to a hundred units of botulinum toxin A were injected into the patients' parotids, submandibular glands under sonographic guide. Subjective measures including Teacher Drooling Scale(TDS) by the patients' parents or caregivers were used to determine the effect of botulinum toxin A on drooling and to document the severity and frequency of children's drooling. RESULTS: The TDS and number of suctions per day demonstrated a significant reduction at 1 week, 1 month, and 3 months in most of the patients. We defined a 2 point decrease on the TDS as "success to therapy". Five of the eleven patients(45.5%) responded to botulinum toxin A injections. Of children who responded, the definite reduction of drooling was noticed at 4 weeks after the injections in three children, at 12 weeks in one, and at 1 week in the other. No adverse effects were observed during and after the injections in this study. CONCLUSION: Parotid and submandibular botulinum toxin A injection is an effective method for the reduction of excessive drooling, demonstrating a high response rate up to 12 weeks. The procedure is simple to perform, and safe when ultrasonographic guidance is used.
Botulinum Toxins ; Caregivers ; Cerebral Palsy ; Child ; Esophageal Stenosis ; Humans ; Hypoxia-Ischemia, Brain ; Muscular Atrophy, Spinal ; Parents ; Retrospective Studies ; Sialorrhea ; Sorbitol ; Submandibular Gland ; Suction ; Tyramine

Anti-N-methyl D-aspartate receptor (anti-NMDAR) encephalitis, recently recognized as a form of paraneoplastic encephalitis, is characterized by a prodromal phase of unspecific illness with fever that resembles a viral disease. The prodromal phase is followed by seizures, disturbed consciousness, psychiatric features, prominent abnormal movements, and autonomic imbalance. Here, we report a case of anti-NMDAR encephalitis with initial symptoms of epilepsia partialis continua in the absence of tumor. Briefly, a 3-year-old girl was admitted to the hospital due to right-sided, complex partial seizures without preceding febrile illness. The seizures evolved into epilepsia partialis continua and were accompanied by epileptiform discharges from the left frontal area. Three weeks after admission, the patient's seizures were reduced with antiepileptic drugs; however, she developed sleep disturbances, cognitive decline, noticeable oro-lingual-facial dyskinesia, and choreoathetoid movements. Anti-NMDAR encephalitis was confirmed by positive detection of NMDAR antibodies in the patient's serum and cerebrospinal fluid, and her condition slowly improved with immunoglobulin, methylprednisolone, and rituximab. At present, the patient is no longer taking multiple antiepileptic or antihypertensive drugs. Moreover, the patient showed gradual improvement of motor and cognitive function. This case serves as an example that a diagnosis of anti-NMDAR encephalitis should be considered when children with uncontrolled seizures develop dyskinesias without evidence of malignant tumor. In these cases, aggressive immunotherapies are needed to improve the outcome of anti-NMDAR encephalitis.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis* ; Antibodies ; Anticonvulsants ; Antihypertensive Agents ; Cerebrospinal Fluid ; Child* ; Child, Preschool ; Cognition ; Consciousness ; D-Aspartic Acid ; Diagnosis ; Dyskinesias ; Encephalitis ; Epilepsia Partialis Continua* ; Female ; Fever ; Humans ; Immunoglobulins ; Immunotherapy ; Korea* ; Methylprednisolone ; Rituximab ; Seizures ; Virus Diseases

Hemimegalencephaly and tuberous sclerosis complex are distinct and rare conditions which are characterized by malformations of cortical developments. Hemimegalencephaly is a cerebral malformation of unknown pathophysiology characterized by asymmetry of the hemispheres and cortical dysplasia. Tuberous sclerosis complex(TSC) is an autosomal dominant neurocutaneous disorder characterized by the formation of hamartomatous lesion in multiple organ systems. While they are currently thought to be unrelated, there are similar cases in the literature and it is conceivable that an abnormality in early cortical development could lead to both conditions in an individual. We report here a first Korean case of unusual association of hemimegalencephaly and tuberous sclerosis complex with mutation in the TSC2 gene, who presented initially frequent partial seizures and infantile spasms.
Epilepsy ; Malformations of Cortical Development ; Neurocutaneous Syndromes ; Seizures ; Tuberous Sclerosis

BACKGROUND: It is well known that the prone position affects hemodynamics. In this study, we investigate whether the prone position will affect the heart rate variability compared with the supine position. METHODS: Sixty five pediatric patients were assigned to supine group (n = 36) and prone group (n = 29) according to position during surgery. The patients were induced with thiopental and vecuronium and maintained with O2-enflurane-N2O. ECG data was collected for 15 minutes after saturation at the end tidal concentration of the inhalent agent. From the ECG data, power spectral analysis was performed and approximate entropy was calculated. RESULTS: In the prone group, low frequency power and ratio of low to high frequency power were lower and approximate entropy was higher than those in the supine group. Mean heart rate and blood pressure were no different between the two groups. CONCLUSIONS: In the prone position, sympathetic autonomic activity and balance of the autonomic nervous system decreased. However the complexity of regulation of heart rate variability was maintained in the prone position.
Anesthesia, General* ; Autonomic Nervous System ; Blood Pressure ; Child* ; Electrocardiography ; Entropy ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Prone Position* ; Supine Position ; Thiopental ; Vecuronium Bromide