BACKGROUND: The determination of serotype of enteroviruses is useful for the discrimination between sporadic and epidemic infections. The conventional serotyping method is time-consuming and labor-intensive. Recently, molecular method was introduced for the serotyping of enteroviruses. The aim of this study was to establish a method to isolate and analyze enteroviruses from various specimens utilizing molecular biological techniques and to determine which strains were phylogenetically related to clinical samples. METHODS: Clinical samples in this study included 164 cerebrospinal fluid (CSF), 136 stool, 15 sera, 6 throat swab, 5 urine, and 4 sputa, which were obtained from hospitalized patients, primarily infants or children presenting symptoms of aseptic meningitis in 1998. RD cells were used for enterovirus isolation. RT-PCR was performed with RD cell lysate showing CPE. The primers 011 and 012 were used for the VP1 region, and the primers EN1 and EN2 for 5'-UTR. The nucleotide sequences of VP1 region were determined and analyzed with BLAST program. RESULTS: Among 333 samples, only 23 samples produced CPE: 17 samples at first and six samples at the second blind passage. Fifteen isolates were related to coxsackievirus B2 two to echovirus 4, three to echovirus 6, and three to echovirus 18. All 23 viral isolates displayed a nucleotide sequence identity of 80-95%, compared with the reference serotypes. However, the identity was increased up to 93-100% when the VP1 region was translated into amino acids CONCLUSIONS: Since CB2 type was 55% among enteroviral isolates, the CB2 was determined as the major causative serotype of enteroviral meningitis in 1998. CB2 type was emerged between June and July, EC4 and EC6 was limited to July, and EC18 was in August.
Amino Acids ; Base Sequence ; Cerebrospinal Fluid ; Child ; Discrimination (Psychology) ; Echovirus 6, Human ; Enterovirus B, Human ; Enterovirus* ; Humans ; Infant ; Meningitis* ; Meningitis, Aseptic ; Pharynx ; Serotyping*

BACKGROUND: The determination of serotype of enteroviruses is useful for the discrimination between sporadic and epidemic infections. The conventional serotyping method is time-consuming and labor-intensive. Recently, molecular method was introduced for the serotyping of enteroviruses. The aim of this study was to establish a method to isolate and analyze enteroviruses from various specimens utilizing molecular biological techniques and to determine which strains were phylogenetically related to clinical samples. METHODS: Clinical samples in this study included 164 cerebrospinal fluid (CSF), 136 stool, 15 sera, 6 throat swab, 5 urine, and 4 sputa, which were obtained from hospitalized patients, primarily infants or children presenting symptoms of aseptic meningitis in 1998. RD cells were used for enterovirus isolation. RT-PCR was performed with RD cell lysate showing CPE. The primers 011 and 012 were used for the VP1 region, and the primers EN1 and EN2 for 5'-UTR. The nucleotide sequences of VP1 region were determined and analyzed with BLAST program. RESULTS: Among 333 samples, only 23 samples produced CPE: 17 samples at first and six samples at the second blind passage. Fifteen isolates were related to coxsackievirus B2 two to echovirus 4, three to echovirus 6, and three to echovirus 18. All 23 viral isolates displayed a nucleotide sequence identity of 80-95%, compared with the reference serotypes. However, the identity was increased up to 93-100% when the VP1 region was translated into amino acids CONCLUSIONS: Since CB2 type was 55% among enteroviral isolates, the CB2 was determined as the major causative serotype of enteroviral meningitis in 1998. CB2 type was emerged between June and July, EC4 and EC6 was limited to July, and EC18 was in August.
Amino Acids ; Base Sequence ; Cerebrospinal Fluid ; Child ; Discrimination (Psychology) ; Echovirus 6, Human ; Enterovirus B, Human ; Enterovirus* ; Humans ; Infant ; Meningitis* ; Meningitis, Aseptic ; Pharynx ; Serotyping*

PURPOSE: Cough variant asthma may be defined as a presentation of asthma that fulfills all the criteria of asthma, inflammatory process of the airways and airway hyperresponsiveness. Because of the cough is only the manifestation in cough variant asthma especially in children, it may be very difficult to assess by the physical examination and routine spirometry. Airway function may be further evaluated by bronchial provocation, usually with methacholine or exercise, to supprot or exclude the diagnosis of asthma. In children too young to perform pulmonary function tests, a therapeutic trial can serve as a diagnostic tool. In this study we evaluate the effectiveness of inhaled bronchodilator and corticosteroid treatment to the children with cough variant asthma. METHODS: Forth-eight children who visited to our pediatric allergy clinic having a chronic cough more than 3 weeks were enrolled to our study. We defined a children who showed bronchial hyperresponsiveness after exercise challenge as a cough variant asthma. We analyzed the changes of PEFR before and after exercise and treatment for 4 weeks. RESULTS: 1) All the patients with cough variant asthma or sinobronchitis have a night aggravating cough as a sole manifestation. 2) The baseline % predicted PEFR showed within normal range in the study subjects. But there was significant decrease of % perdicted PEFR after execise challenge in the patients with cough variant asthma. 3) There was significant increase of % predicted PEFR after treatment with inhaled bronchodilator and corticosteroid in the patients with cough vatiant asthma. Also it is noted in the patients with sinobronchitis treated with antibiotics. CONCLUSION: We can find significant improvement of clinical manifestation and pulmonary function in the patients with cough variant asthma who treated with inhaled bronchodilator and corticosteoid. Because of many children suffering from chronic cough may have a cough variant asthma, we emphasized that inhaled bron-chodilator and corticosteroid treatment is effective for long-term control of cough variant asthma.
Anti-Bacterial Agents ; Asthma* ; Child ; Cough* ; Diagnosis ; Humans ; Hypersensitivity ; Inhalation* ; Methacholine Chloride ; Peak Expiratory Flow Rate ; Physical Examination ; Reference Values ; Respiratory Function Tests ; Respiratory Therapy* ; Spirometry

Pseudohypoaldosteronism is a disorder in which synthesis of aldosterone is normal but unresponsiveness of the target to the aldosterone activates angiotensin-renin system which in turn elevates levels of renin and aldosterone. This salt-losing syndrome causes life-threatening hyponatremia and hyperkalemia. Despite of the normal renal and adrenal function, due to deficiency of aldosterone function, reabsorption of sodium and excretion of potassium in the kidney is impaired. Sodium loss not only from the kidney but also from sweat gland, salivary gland and colon may occur in some cases. We experienced two cases of pseudohypoaldosteronism in a 3-day-old male and 6-month-old female. The hyponatremia, hyperkalemia, elevation of plasma renin activity and aldosterone concentration were observed without renal and adrenal dysfunction. Brief review and related literatures were also presented.
Aldosterone ; Colon ; Female ; Humans ; Hyperkalemia ; Hyponatremia ; Infant ; Kidney ; Male ; Plasma ; Potassium ; Pseudohypoaldosteronism* ; Renin ; Salivary Glands ; Sodium ; Sweat Glands

Congenital middle ear cholesteatoma is a keratinizing squamous epithelial cyst that classically presents as a white "pearl" in either the anterosuperior or posterosuperior quadrants behind an intact tympanic membrane. The presenting features of congenital cholesteatoma depend upon the initial site of the disease. The most common presentation of this disease is a conductive hearing loss or a facial palsy of gradual onset. Other presentations include incapacitating vertigo with nystagmus, a feeling of fullness in the ear, frequent otalgia, an abnormal eardrum noted at physical examination for an unrelated condition and meningitis. Recently, we experienced a case of congenital cholesteatoma that was presented as a post-auricular fistula. In considering the management of such a fistula, it would be important to recognize the possibility that the disease may present in this way.
Cholesteatoma* ; Cholesteatoma, Middle Ear ; Ear ; Earache ; Facial Paralysis ; Fistula* ; Hearing Loss, Conductive ; Meningitis ; Physical Examination ; Tympanic Membrane ; Vertigo

An intravenous pyogenic granuloma is a rare, benign, intravascular tumor, which arises from the vein wall and protrudes into the lumen. This is characterized by a lobular proliferation of capillaries similar to the more common cutaneous pyogenic granulomas. We report a case of intravenous pyogenic granuloma which showed lobular capillary proliferation in the perivenous connective tissue.
Capillaries ; Connective Tissue ; Granuloma, Pyogenic* ; Veins

BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) was found in several serotypes of E coli including 0157 serotype. Sorbitol-MacConkey agar: may be useful for the detection of E. coli 0157, but is not helpful for the detection of sorbitol-fermenting STEC other than 0157. Moreover, some strains of E. colt 0157 can ferment sorbitol. In this study, in situ hybridization using DNA probe of shiga toxin was used for the isolation of STEC from the PCR-positive stool and -Sequenbe analysis of a part of shiga toxin gene was performed. METHODS: The stool was incubated in LB broth overnight and DNA was extracted from the culture fluid. Multiplex PCR was performed with primers for stxl and stx2 genes. Specimen showed PCR-positive was incubated on MacConkey agar and colonies were blotted with nitrocellulose membrane. Digoxigenin-labelled DNA probe for shiga toxin was made by PCR and the positive colonies were detected with anti-digoxigenin-alkaline phosphatase conjugate and nitroblue tetrazolium. Agglutination test with antisera was performed for the serotying and VTEC-RPLA kit was used for the toxin production. Sequence analysis of PCR products was performed with automatic sequence analyser. RESULTS: An stxl-negative, but stx2-positive PCR was observed in a three-year-old girl, who visited Kumi Hospital on July 19, 1999 complaining of vomiting and diarrhea. The positive colonies were isolated by in situ hybridization using stx2-specific DNA probe. The titers of stxl and stx2 by VTEC-RPLA test were negative and 1:64, respectively. Agglutination for the serotyping was not observed with all of the 0 antisera. 160-nucleotide sequence of stx2 of this isolate was identical with bacteriophage 933W (GenBank X07865), except for the change (T-C) of 957th nucleotide and amino acid sequence was identical each other. CONCLUSIONS: For the sensitive detection of STEC from the stool of patients with diarrhea, multiplex PCR is recommended with stxl- and stx2-specific primers. And in situ hybridization should be performed in PCR-positive specimen for the isolation of STEC. This method may be helpful for the detection of STEC as the causative microorganisms in food-borne outbreak.
Agar ; Agglutination ; Agglutination Tests ; Amino Acid Sequence ; Bacteriophages ; Collodion ; Diarrhea ; DNA ; Escherichia coli ; Female ; Gyeongsangbuk-do ; Humans ; Immune Sera ; In Situ Hybridization ; Membranes ; Multiplex Polymerase Chain Reaction ; Nitroblue Tetrazolium ; Polymerase Chain Reaction ; Sequence Analysis* ; Serotyping ; Shiga Toxin ; Shiga-Toxigenic Escherichia coli* ; Sorbitol ; Vomiting

BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) was found in several serotypes of E coli including 0157 serotype. Sorbitol-MacConkey agar: may be useful for the detection of E. coli 0157, but is not helpful for the detection of sorbitol-fermenting STEC other than 0157. Moreover, some strains of E. colt 0157 can ferment sorbitol. In this study, in situ hybridization using DNA probe of shiga toxin was used for the isolation of STEC from the PCR-positive stool and -Sequenbe analysis of a part of shiga toxin gene was performed. METHODS: The stool was incubated in LB broth overnight and DNA was extracted from the culture fluid. Multiplex PCR was performed with primers for stxl and stx2 genes. Specimen showed PCR-positive was incubated on MacConkey agar and colonies were blotted with nitrocellulose membrane. Digoxigenin-labelled DNA probe for shiga toxin was made by PCR and the positive colonies were detected with anti-digoxigenin-alkaline phosphatase conjugate and nitroblue tetrazolium. Agglutination test with antisera was performed for the serotying and VTEC-RPLA kit was used for the toxin production. Sequence analysis of PCR products was performed with automatic sequence analyser. RESULTS: An stxl-negative, but stx2-positive PCR was observed in a three-year-old girl, who visited Kumi Hospital on July 19, 1999 complaining of vomiting and diarrhea. The positive colonies were isolated by in situ hybridization using stx2-specific DNA probe. The titers of stxl and stx2 by VTEC-RPLA test were negative and 1:64, respectively. Agglutination for the serotyping was not observed with all of the 0 antisera. 160-nucleotide sequence of stx2 of this isolate was identical with bacteriophage 933W (GenBank X07865), except for the change (T-C) of 957th nucleotide and amino acid sequence was identical each other. CONCLUSIONS: For the sensitive detection of STEC from the stool of patients with diarrhea, multiplex PCR is recommended with stxl- and stx2-specific primers. And in situ hybridization should be performed in PCR-positive specimen for the isolation of STEC. This method may be helpful for the detection of STEC as the causative microorganisms in food-borne outbreak.
Agar ; Agglutination ; Agglutination Tests ; Amino Acid Sequence ; Bacteriophages ; Collodion ; Diarrhea ; DNA ; Escherichia coli ; Female ; Gyeongsangbuk-do ; Humans ; Immune Sera ; In Situ Hybridization ; Membranes ; Multiplex Polymerase Chain Reaction ; Nitroblue Tetrazolium ; Polymerase Chain Reaction ; Sequence Analysis* ; Serotyping ; Shiga Toxin ; Shiga-Toxigenic Escherichia coli* ; Sorbitol ; Vomiting

BACKGROUND AND OBJECTIVES: The ethmoidal infundibulum is a cleft-like space situated like a funnel before the maxillary ostium. In this cleft, unilateral inflammations and benign diseases occur sometimes. In this study, we are trying to evaluate benign diseases widening the unilateral ethmoidal infundibulum and their chief complaints, and to identify the radiologic patterns of them in contrast-enhanced computerized tomography (CT) and magnetic resonance imaging (MRI). SUBJECTS AND METHODS: Sixty eight cases with unilateral ethmoidal infundibular widening on contrast enhanced CT were evaluated with MRI between Jan, 1995 and Dec, 1999. Fifty- six cases of pathologically proved inflammatory or benign diseases were analyzed prospectively by medical records, CT and MRI. RESULTS: Benign diseases widening the unilateral ethmoidal infundibulum included antrochoanal polyp, maxillary sinus mucocele, prolapsed antral mucosa (a variant of maxillary sinus mucocele), noninvasive fungal sinusitis, nasal polyp with sinusitis and inverted papilloma. They showed soft tissue density in the unilateral maxillary sinus and infundibulum with uncinate process erosion on CT. They were differentiated by the signal intensity on T2 weighted MRI and enhancement patterns on T1 weighted MRI. CONCLUSION: The preoperative diagnosis of benign diseases widening the unilateral ethmoidal infundibulum depends on endoscopic biopsy generally, but MR imaging may be helpful for differential diagnosis of them.
Biopsy ; Diagnosis ; Diagnosis, Differential ; Inflammation ; Magnetic Resonance Imaging ; Maxillary Sinus ; Medical Records ; Mucocele ; Mucous Membrane ; Nasal Polyps ; Papilloma, Inverted ; Polyps ; Prospective Studies ; Sinusitis

BACKGROUND AND OBJECTIVES: The ethmoidal infundibulum is a cleft-like space situated like a funnel before the maxillary ostium. In this cleft, unilateral inflammations and benign diseases occur sometimes. In this study, we are trying to evaluate benign diseases widening the unilateral ethmoidal infundibulum and their chief complaints, and to identify the radiologic patterns of them in contrast-enhanced computerized tomography (CT) and magnetic resonance imaging (MRI). SUBJECTS AND METHODS: Sixty eight cases with unilateral ethmoidal infundibular widening on contrast enhanced CT were evaluated with MRI between Jan, 1995 and Dec, 1999. Fifty- six cases of pathologically proved inflammatory or benign diseases were analyzed prospectively by medical records, CT and MRI. RESULTS: Benign diseases widening the unilateral ethmoidal infundibulum included antrochoanal polyp, maxillary sinus mucocele, prolapsed antral mucosa (a variant of maxillary sinus mucocele), noninvasive fungal sinusitis, nasal polyp with sinusitis and inverted papilloma. They showed soft tissue density in the unilateral maxillary sinus and infundibulum with uncinate process erosion on CT. They were differentiated by the signal intensity on T2 weighted MRI and enhancement patterns on T1 weighted MRI. CONCLUSION: The preoperative diagnosis of benign diseases widening the unilateral ethmoidal infundibulum depends on endoscopic biopsy generally, but MR imaging may be helpful for differential diagnosis of them.
Biopsy ; Diagnosis ; Diagnosis, Differential ; Inflammation ; Magnetic Resonance Imaging ; Maxillary Sinus ; Medical Records ; Mucocele ; Mucous Membrane ; Nasal Polyps ; Papilloma, Inverted ; Polyps ; Prospective Studies ; Sinusitis