Epstein-Barr virus (EBV) has been known to be associated with a wide variety of neoplastic conditions including nasopharyngeal carcinoma, Hodgkin's disease, and non-Hodgkin's lymphoma. Recent studies reveal the presence of EBV in certain subtypes of gastric carcinoma in which EBV appears to be pathogenetically related. To evaluate the relationship between EBV and gastric adenocarcinoma, we examined EBV DNA using direct in situ polymerase chain reaction, and expression of p53 protein and bcl-2 protein using immunohistochemical staining method on paraffin embedded tissues. The materials consisted of one hundred twenty-eight gastric adenocarcinomas and twenty benign peptic ulcers. EBV DNA was detected in 14 of 128 gastric adenocarcinomas (10.9%). p53 protein was positive in 10 of 14 EBV positive adenocarcinomas (71.4%) and in 61 of 114 EBV negative adenocarcinomas (53.5%). Bcl-2 protein was positive in 2 of 14 EBV positive adenocarcinomas (14.3%) and in 19 of 114 EBV negative adenocarcinomas (16.7%). The above results indicate that EBV is associated with gastric adenocarcinoma, and p53 protein may play a role in carcinogenesis of EBV in gastric adenocarcinoma.
Adenocarcinoma* ; Carcinogenesis ; DNA ; Herpesvirus 4, Human* ; Hodgkin Disease ; Lymphoma, Non-Hodgkin ; Paraffin ; Peptic Ulcer ; Polymerase Chain Reaction

BACKGROUND: Healthcare-associated infections (HAIs) are among the most important threats to patient safety. When hospitalized children face these threats, there is morbidity, mortality, prolonged hospitalization, and increased healthcare costs. Research on local healthcare epidemiology is necessary to enhance collective knowledge and evidence formanaging this problem. METHODS: We performed a retrospective analysis of databases of patients who were diagnosed with HAIs at Chung-Ang University Hospital (CAUH) from 2007 through 2011. Cases were selected from the microbiology registry databases. The data on prevalence of HAIs in various wards and its annual trends were compared to previously reported nationwide data. Moreover, we analyzed the patterns of antibiotic susceptibility results for HAI pathogens. RESULTS: A total of 181 HAIs were identified in 122 patients. The HAI rate among pediatric patients at CAUH was 2.4/1,000 person-hospital days. Urinary tract infections (UTIs) (53 episodes, 29.3%) were the most common, followed by pneumonia (33 episodes, 18.2%). Staphylococcus aureus was found to be the most common gram-positive organism, whereas Escherichia coli was the most common gram-negative organism. Methicillin-resistant S. aureus (MRSA) comprised 84% of the S. aureus infections. Imipenem resistance was detected in 58.8% and 55.0% of Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively. CONCLUSION: Between 2007 and 2011, UTIs were the most common type of HAIs, and MRSA was the most common pediatric HAI pathogen, both in the general ward and intensive care unit at the CAUH. Further research on the epidemiology and pathogenesis of HAIs is necessary and prevention measures should be implemented to prevent HAIs in children.
Acinetobacter baumannii ; Child ; Child, Hospitalized ; Delivery of Health Care ; Escherichia coli ; Health Care Costs ; Hospitalization ; Humans ; Imipenem ; Intensive Care Units ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Patient Safety ; Patients' Rooms ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa ; Retrospective Studies ; Staphylococcus aureus ; Urinary Tract Infections

Rhabdomyolysis has been reported as a cause of acute renal failure (ARF), and it can arise from traumatic and variable non-traumatic events. Rhabdomyolysis-induced ARF is very rare in children. We experienced a case of rhabdomyolysis-induced ARF in a 14-year-old boy who presented with generalized edema and oliguria following trauma, a compressed thigh by a cultivator. Laboratory tests showed marked elevation of muscle enzymes (aspatate aminotransferase, creatine kinase and lactate dehydrogenase), increased serum and urine myoglobin, and other laboratory abnormalities showing ARF. Ten days after continuous arteriovenous hemofiltration using catheterization of the femoral artery and vein, the daily urine output gradually increased and he recoverd. We report this case with brief review of literature.
Acute Kidney Injury* ; Adolescent ; Catheterization ; Catheters ; Child* ; Creatine Kinase ; Edema ; Femoral Artery ; Hemofiltration ; Humans ; Lactic Acid ; Male ; Myoglobin ; Oliguria ; Rhabdomyolysis ; Thigh ; Veins

Numerous devices and techniques have been devised to facillitate the difficult endotracheal intubation. Percutaneous retrograde intubation was first described by Waters, who used a Tuohy needle to puncture the cricothyroid membrane and an epidural catheter as a guideline in 1963 and many variations on the technique have been described. Failure to intubate 2 male adult patients were planned retrograde tracheal intubation using the cricothyroid membrane. While the patients were awake, and after adequate local anesthesia was obtained, a 16G Medicut was punctured through cricothyroid membrane. After confirmation of the intratracheal position by aspiration of air into syringe, the opening of the Medicut was directed upward foward the larynx and the epidural catheter was inserted through it and advanced retrograde between the vocal cords and into mouth. The epidural catheter tip was passed through the Murphy's eye from outside to inside and out of the tracheal tube. By keeping the catheter taut and coincidently pulling back, the tube was advanced into trachea. Correct positioning of the tracheal tube inside the trachea was confirmed by end-tidal carbon dioxide monitoring and auscultation. Another 2 male adult patients were intubated by using cricotracheal retrograde approach method. We experienced successful retrograde tracheal intubation without significant complications using an epidural catheter through cricothyroid membrane and cricotracheal ligament in 4 male adult patients who were predicted impossibility of simple orotracheal intubation. (Korean J Anesthesiol 1995; 29: 304~309)
Adult ; Anesthesia, Local ; Auscultation ; Carbon Dioxide ; Catheters ; Humans ; Intubation* ; Intubation, Intratracheal ; Larynx ; Ligaments* ; Male ; Membranes* ; Mouth ; Needles ; Punctures ; Syringes ; Trachea ; Vocal Cords

It is challenging to treat ventriculitis with parenteral treatment alone in some cases because of the difficulty involved in maintaining an appropriate level of antibiotics in cerebrospinal fluid (CSF). We report two cases of ventriculitis who did not respond to intravenous (IV) antibiotics but were successfully treated with intraventricular antibiotics using IV agents. The first case was a four-month-old male patient with X-linked hydrocephalus.He showed ventriculitis due to Klebsiella pneumoniae not producing extended-spectrum β-lactamase and susceptible to third-generation cephalosporins and gentamicin, following ventriculoperitoneal (VP) shunt. His condition did not improve during the 47 days of treatment with IV cefotaxime and meropenem. We achieved improvement in clinical presentation and CSF profile after three times of intraventricular gentamicin injection. The patient was discharged from the hospital with antiepileptic drugs. The second case was a six-month-old female patient with a history of neonatal meningitis complicated with hydrocephalus at one month of age, VP shunt at two months of age, followed by a methicillinresistant coagulase-negative staphylococci (CoNS) shunt infection with ventriculitis after the shunt operation. CoNS ventriculitis recurred four weeks later. We failed to treat intractable methicillin-resistant CoNS ventriculitis with IV vancomycin for ten days, and thus intraventricular antimicrobial treatment was considered. Five times of intraventricular vancomycin administration led to improvement in clinical parameters. There were only neurological sequelae of delayed language development but no other major complications. Patients in these two cases responded well to intraventricular antibiotics, with negative CSF culture results, and were successfully treated for ventriculitis without serious complications.

PURPOSE: We wanted to analyze the clinical outcomes of prospectively randomized surgeries between internal fixation and hemiarthroplasty for treating unstable intertrochanteric hip fracture in elderly patients. MATERIALS AND METHODS: From January, 2004 to December, 2007, 62 cases of unstable intertrochanteric fracture that underwent internal fixation or hemiarthroplasty were analyzed retrospectively for the clinical outcomes with using the SF-36. Thirty cases were treated with internal fixation and 32 cases were treated with hemiarthroplasty. The clinical outcomes, as assessed by using the SF-36, were statistically analyzed with using SPSS for Windows. RESULTS: Hemiarthroplasty show a better result than internal fixation for pain, limping and the support scales in the 70~79 years old group, and the limping scale was also better in the over 80 years old group (P<0.05). There were no differences between the two groups according to age. Four cases of internal fixation failed due to loss of fixation (3)and nonunion (1), and 4 cases of hemiarthroplasty failed due to infection (2) and revision for dislocation (2). CONCLUSION: Primary hemiarthroplasty should be more beneficial than osteosynthesis, such as performing internal fixation, for treating unstable intertrochanteric fracture in elderly patients because of the reduced pain and early ambulation that are due to the early stabilization.
Aged ; Dislocations ; Early Ambulation ; Hemiarthroplasty ; Hip ; Humans ; Retrospective Studies ; Weights and Measures

PURPOSE: To identify the necessity of more reasonable diagnostic criteria and the possibility of early prediction of coronary involvement in the higher risk group, we investigated and compared clinical and laboratory findings in the acute phase and coronary involvements in those younger (n=17) and older(n=53) than one year of age in Kawasaki disease(KD). METHODS: Retrospective chart reviews were performed on 70 patients with KD who were admitted to the Chung-Ang University Hospital from April 1997 to May 2001. RESULTS: Male were significantly higher in the younger age group(M : F ratio 3.3 : 1 vs. 1.0 : 1, P=0.004). Fever durations before intravenous immunoglobulin(IVIG) and echocardiography were significantly shorter in the younger group(4.6+/-1.3 vs. 6.2+/-2.5, P=0.004 vs. 0.01, respectively). Cases meeting typical diagnostic criteria were significantly less in the younger group(P=0.006). In the laboratory findings, serum albumin, BUN and K+ levels in the acute febrile phase were significantly higher in the younger group(P=0.002, 0.006, <0.001, respectively) and incidences of coronary artery dilatation in the acute phase were significantly higher in the younger group(P=0.01). CONCLUSION: Although less met the typical diagnostic criteria of KD, infants younger than one year of age are more susceptible to coronary artery change in the acute febrile phase. Therefore, KD should be entertained as a diagnostic possibility in young infants with prolonged fever without distinct fever focus, and echocardiography should be considered as part of the evaluation of these patients, and then early diagnosis and prompt IVIG should be conducted.
Coronary Vessels ; Dilatation ; Early Diagnosis ; Echocardiography ; Fever ; Humans ; Immunoglobulins, Intravenous ; Incidence ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Serum Albumin

PURPOSE: To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. MATERIALS AND METHODS: Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using 192Ir between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. RESULTS: The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT +/- external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (< or =grade 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. CONCLUSION: HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.
Brachytherapy* ; Humans ; Mouth Neoplasms ; Mouth* ; Radiotherapy ; Recurrence ; Retrospective Studies

Respiratory syncytial virus pneumonia in a 6-month-old male infant progressed to acute respiratory distress syndrome. He had an acute and rapidly progressive Pulmonary disease, in association with progressive, diffuse, bilateral pulmonary infiltrates on the chest radiograph, and hypoxemia(PaO2/FiO2 ratio of 98.2 with PEEP) without evidence of cardiac disease. High frequency oscillatory ventilation(HFOV) was instituted after worsening of oxygenation with conventional ventilation. High frequency oscillatory ventilation improved oxygenation without any complications-After 8 days of HFOV, conventional ventilation was instituted with- out impairment of oxygenation-After 13 days of total mechanical ventilation, he was extubated and soon after discharged home. High frequency oscillatory ventilation provide good results of oxygenation and ventilation in infants with ARDS. Further evaluation of safety and efficacy of HFOV will Fequire carefully designed, randomized, controlled studies of patients with acute respiratory distress syndrome.
Heart Diseases ; Humans ; Infant* ; Lung Diseases ; Male ; Oxygen ; Pneumonia* ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Syncytial Viruses* ; Ventilation

PURPOSE: Apoptosis is a process of active cell death which has been suggested to be part of hippocampal cell loss caused by kainic acid (KA). Immature rats showed higher susceptibility and mortality to KA but did not develop recurrent seizure, long term behavioral or neuropathologic changes. We investigated whether this was due to age-dependent resistance, and elucidated the molecular mechanics which mediate P53-induced apoptosis, identifying bax and bcl-2 as P53 protein expressions that serve as a paradigm on how the balance of bcl-2 to bax is differentially altered by apoptotic stimuli. METHODS: Sprague-Dawley rats were classified into postnatal age (P) 10, 15, 20 and 30 days and given specific doses of i.p. KA (P10; 3mg/kg, P15; 4mg/kg, P20; 8mg/kg, P30; 10mg/kg). Only rats that achieved continuous clonic seizure were selected and decapitated at 24, 48, and 72h (n=15 each age). We analysed P53, bax and bcl-2 protein expressions by immunohistochemistry as well as apoptosis by TUNEL in each group. RESULTS: KA-induced hippocampal cell death first appeared in P20. Remarkable expressions of apoptosis, P53 and bax, while bcl-2 proteins were suppressed were observed at 48 hours following KA in P20 and the most prominently affected areas were hippocampal CA1 and CA3 neurons. Similar results were obtained in P30. CONCLUSOIN: A Induction of P53, a growth regulatory gene which has been implicated in apoptosis and the changes in bcl-2 to bax ratio may be important to KA mediated excitotoxicity of specific regions during the critical period of developing rat brain.
Animals ; Apoptosis* ; Brain ; Cell Death ; Critical Period (Psychology) ; Genes, Regulator ; Hippocampus* ; Immunohistochemistry ; In Situ Nick-End Labeling ; Kainic Acid ; Mechanics ; Mortality ; Neurons ; Rats* ; Rats, Sprague-Dawley ; Seizures*