Staphylococcus epidermidis is a normal inhabitant of skin, throat, mouth, vagina, and urethra. It is not usually pathogenic, particularly in immunocompetent hosts. This report describes a case of a pyogenic liver abscess caused by Staphylococcus epidermidis in a healthy 12-year-old boy. He was admitted to Seoul St. Mary's Hospital with intermittent fever for 6 days. Findings on abdominal computed tomography (CT) showed a mass measuring 7.0x6.5 cm in the right hepatic lobe. Culture of the abscess resulted in growth of Staphylococcus epidermidis as a causative organism. The patient was successfully treated with intravenous administration of antibiotics and percutaneous drainage of the abscess.
Abscess ; Administration, Intravenous ; Anti-Bacterial Agents ; Child ; Drainage ; Fever ; Humans ; Liver Abscess ; Liver Abscess, Pyogenic ; Mouth ; Pharynx ; Skin ; Staphylococcus ; Staphylococcus epidermidis ; Urethra ; Vagina

PURPOSE: This paper evaluate and classified the risk factors that could possibly cause ischemic stroke in children, and investigate whether TOAST classification could be applied to the ischemic stroke in children. METHODS: From March 1995 to February 2002, we retrospectively reviewed the medical record of 87 patients under the age 16 who had been registered to the Ajou Stroke Registry. We evaluated the risk factors of ischemic stroke according to the Ajou Stroke Registry Protocol, and classified the risk factors into 6 main subgroups. In addition, the risk factors were investigated according to the age distribution. TOAST classification had been applied to children with ischemic stroke. RESULTS: There was 64 ischemic stroke(73.6%) and 23 hemorrhagic stroke(26.4%) among the 87 patients. In children with ischemic stroke, there was three major peak age; 13 patients younger than 1 year old(15.3%), 26 patients in age 5 to 8 years old(40.6 %), 22 patients in 9 to 12 years old(34.3%). Vasculopathy(48.6%) was the most common risk factor of the ischemic stroke in this study. Other important risk factors in order of frequency were hypertensive encephalopathy(12.5%), infectious disease(7.8%), metabolic disease(7.8%), and hematologic disease(6.2%). Moyamoya disease was the most common cause of ischemic stroke due to vasculopathy. If we analyze the risk factors according to the age at the presentation of ischemic stroke, 90% of the ischemic stroke due to vasculopathy had been developed after 5 years of age. However, ischemic stroke due to infectious disease had been developed less than 4 years of age. Major stroke was the most common subtype of the ischemic stroke in children, but TIA had been found in 80% of the patients with ischemic stroke due to moyamoya disease. TOAST classification determined the subtype of the ischemic stroke only in 2 children. Risk factors of ischemic stroke in the remained 62 patients were extremely variable, and could not be applicable to the TOAST classification. CONCLUSION: Risk factor of ischemic stroke were found in the 90% of patients. Although risk factors of ischemic stroke were extremely variable in children, cerebral vasculopathy including moyamoya disease was the most common. However, inherited metabolic disorder, coagulopathy, and hypertensive encephalopathy were also relatively common risk factors of ischemic stroke especially in children older than 5 years old. Therefore, we must extensively evaluate all the possible risk factors of ischemic stroke in children. TOAST classification could not be applicable in children because the risk factors of ischemic stroke were extremely variable.
Age Distribution ; Child* ; Child, Preschool ; Classification ; Communicable Diseases ; Humans ; Hypertensive Encephalopathy ; Medical Records ; Moyamoya Disease ; Retrospective Studies ; Risk Factors* ; Stroke*

We evaluated the degree and mechanism of regression after laser in situ keratomileusis[LASIK]on moderate to highly myopic eyes during the first postopserative 6 months. Betwwen January 1997 and October 1998, 61 eyes operated on with LASIK for myopia, with 2 diopter or more myopic regres-sion occuring during than first 6 months were included in this study. And 79 eyes in control group with less than 1 diopter were included. The attemped correction for refractive error was determined by cycloplegic refraction. We evaluated the changes of refractive error, uncorrected visual acuity, best corrected visual acuity, corneal topography, corneal thickness and keratometry before operation, one day, one week, two months and six months after operation. In regression group, corneal thickness was significantly incresed from 0.425 +/-0.048millimeter at postoperative 1 week to 0.444 +/-0.050millimeter postoperative 6 month[p=0.003]and central corneal power was significantly increased from 36.45 +/-2.03 dopter at 1 week to 37.45 +/-5.52 diopter.[p<0.01]The larger sperical equivalent and cylinder were, the more amount myopic regression was in contrast with control group. Early regression of refractive effect after LASIK appears to be a consequence of an increase in corneal thickness associated with central corneal steepening.
Corneal Topography ; Keratomileusis, Laser In Situ* ; Myopia ; Refractive Errors ; Visual Acuity

We studied the effect of LASIK(laser in situ keratomileusis) on the correction of astigmatism for patients with simple myopia & compound myopic astigmatism. LASIK was performed on 147 eyes of 108 patients using VISX STAR. All the cases were divided into two groups by the amount of underlying astigmatism: 64 eyes for simple myopic group(equal or less than 0.5D) and 83 eyes for compound myopic astigmatism group(more than 0.75D). The attemped correction for refractive error was determind by cycloplegic refraction. We evaluated the changes of refractive error, uncorrected visual acuity, best corrected visual acuity, corneal topography, corneal thickness and keratometry before operation, one day, one week,two months and six months after operation. Uncorrected visual acuity improved from 0.062+/-0.056 before operation to 0.821+/-0.215 at six months after operation in simple myopic group and from 0.069+/-0.068 to 0.735+/-0.224 in compound myopic group. Spherical equivalent was reduced from -8.135+/-2.096D before operation to -0.765+/-1.186D at six months after operation in simple myopic group and from -9.498+/-3.181D to -1.022+/-1.504D in compound myopic astigmatic group. Mean astigmatism increased from -0.300+/-0.205D before operation to -0.703+/-0.553D at six months after operation in simple myopic group and was reduced from -1.640+/-1.047D to -1.075+/-0.811D in compound myopic astigmatic group. Decentration of ablation from the pupil center was ranged between 0.00 and 1.42mm(mean 0.449+/-0.341mm) in all the patients by corneal topography. It was 0.446+/-0.333mm in simple myopic group and 0.452+/-0.353mm in compound myopic astigmatic group respectively. The patients with a decentration more than 1.00mm showed a statistically significant astigmatism than those with a decentration equal or less than 1.00mm.With these results it is suggested that LASIK with VISX STAR would be effective in correction of astigmatism equal or more than 0.75D. In contrast, it is not effective in correction of astigmatism equal or less than 0.5D.
Astigmatism ; Corneal Topography ; Humans ; Keratomileusis, Laser In Situ ; Myopia ; Pupil ; Refractive Errors ; Visual Acuity

PURPOSE: We report a case of orbital abscess secondary to acute dacryocystitis in which the patient had been cared for chronic dacryocystitis. METHODS: A 59-year-old woman presented to our clinic with a history of chronic sinusitis from childhood and right chronic dacryocystitis treated for 6 years. She had sufferred from influenza 2 weeks previously and complained of painful lid swelling, limitation of ocular movement, exophthalmos, chemosis, and decreased vision of the right eye for 2 weeks. An orbital CT scan was taken and bacterial culture and sensitivity tests were done from the discharge. RESULTS: CT scan showed inflammation and abscess formation around the right nasolacrimal duct orifice which was swollen and widened. Some of the inflammation tissues extended into the retrobulbar portion. Streptococcus pyogenous was cultured. Lid swelling, pain, exophthalmos, and visual acuity improved after external dacryocystorhinostomy, and surgical drainage. CONCLUSIONS: We should be careful in a case of acute dacryocystitis underlying chronic dacryocystitis as it easily causes complications, and in such a case early surgical management as well as antibiotics therapy is more effective.
Abscess* ; Anti-Bacterial Agents ; Dacryocystitis* ; Dacryocystorhinostomy ; Drainage ; Exophthalmos ; Female ; Humans ; Inflammation ; Influenza, Human ; Middle Aged ; Nasolacrimal Duct ; Orbit* ; Sinusitis ; Streptococcus ; Tomography, X-Ray Computed ; Visual Acuity

To restore a tooth with a fracture line extending below the marginal bone level, a surgical crown lengthening procedure accompanied by ostectomy could be considered to expose the fracture line and reestablish the biologic width. However, this procedure could lead to esthetic failure, especially in the anterior teeth. Therefore, orthodontic extrusion, which elevates the fracture line from within the alveolar socket without sacrificing the supporting bone and gingiva, is recommended. This technique allows for the proper placement of the crown on a sound tooth structure, with the reestablishment of the biologic width.Alternatively, surgical extrusion is an one-step procedure that is simpler and less time-consuming than orthodontic extrusion; placing and adjusting the orthodontic appliance does not require multiple visits. This study presents successful restoration in 2 cases with a crown-tooth root fracture of the maxillary central incisor treated using a multidisciplinary approach through orthodontic extrusion or surgical extrusion followed by successful restoration.

PURPOSE: In a preliminary series of 36 eyes with partial nasolacrimal duct obstruction, the types of dacryoscintigraphy result were classified and the results of silicone tube intubation were analysed. METHODS: The results of dacryoscintigraphy, performed in 36 eyes of 29 patients with partial nasolacrimal duct obstruction, were classified into the following 3 types: pre-lacrimal sac type, proximal nasolacrimal duct type and distal nasolacrimal duct type. Punctoplasty accompanied by silicone tube intubation was conducted selectively. RESULTS: In dacryoscintigraphy, symptoms improved in 6 eyes among 6 in distal nasolacrimal duct type (100%), 14 eyes among 18 in proximal nasolacrimal duct type (77.8%) and 8 eyes among 12 in pre-lacrimal sac type (66.7%). CONCLUSIONS: We conclude that dacryoscintigraphy predicts the results of silicone tube intubation. Furthermore, silicone tube intubation was effective in proximal nasolacrimal duct type and distal nasolacrimal duct type, but less effective in pre-lacrimal sac type of partial nasolacrimal duct obstruction.
Humans ; Intubation* ; Nasolacrimal Duct* ; Silicones*

The development of renal glomerular lesions secondary to severe visceral infection (pulmonary, pleural, retroperitoneal or hepatic abscess) is not generally appreciated. Such patients resemble those with infective endocarditis. The suggested pathogenetic mechanisms by which infection can cause glomerular damage are immunologic interaction, direct toxicity of a bacterial products, and some other triggering factors; However, direct correlation between the infectious and immunologic events has not been demonstrated. The histopathologic findings of infectious glomerulonephritis are variable, and these findings, as well as the clinical abnormalities, may resolve with effective antimicrobial therapy or abscess drainage. We experienced a case of glomerulonephritis and acute renal failure due to staphylococcal retroperitoneal abscess. The patient was a 58-year-old man who presented with abdominal and back pain. We performed an abdominal CT scan which showed a retroperitoneal abscess which was proven to be a staphylococcal infection upon percutaneous abscess drainage. Furthermore, we performed a renal biopsy in order to investigate hematuria, RBC casts, and proteinuria. Pathologic findings revealed postinfectious glomerulonephritis. Abscess drainage and sensitive antibiotics were administered, after which his symptoms and urinary abnormalities disappeared, and the retroperitoneal abscess subsided. Here, we report a case of a staphylococcal retroperitoneal abscess which led to postinfectious glomerulonephritis and acute renal failure along with a brief review of the literatures.
Abscess* ; Acute Kidney Injury ; Anti-Bacterial Agents ; Back Pain ; Biopsy ; Drainage ; Endocarditis ; Glomerulonephritis* ; Hematuria ; Humans ; Middle Aged ; Proteinuria ; Staphylococcal Infections ; Tomography, X-Ray Computed

Mediastinal fibrosis is pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. Mediastinal fibrosis is local expression of a family of systemic fibrosing syndroms. This can result in compression of adjacent mediastinal structures. Idiopathic fibrosing syndromes include retroperitoneal fibrosis, sclerosing cholangitis of the orbit and fibrosis of the thyroid gland(Riedel's struma). The cause of these disorders is obscure, in some instance there is an underlying malignancy, infection, history of drug ingestion, or trauma with retoperitoneal bleeding. Treatment of mediastinal fibrosis depends on structures involved by the fibrotic process. The disease is self limited in most case or improved by steroids uses. We experienced a case of idopathic solerosing mediastinitis with orbital fibrous dysplasia of unknown cause, which was confirmed by open lung biopsy, so reported it with a review of literature.
Biopsy ; Cholangitis, Sclerosing ; Eating ; Fibrosis* ; Hemorrhage ; Humans ; Inflammation ; Lung ; Mediastinitis ; Orbit ; Retroperitoneal Fibrosis ; Steroids ; Thyroid Gland

C-T guided stereotactic early burr hole aspirations performed on 106 spontaneous deep intracerebral hematoma patients in the Department of Neurosurgery, Kyungpook University Hospital, between January 1992 and December 1993. For average five days following the operation, continual urokinase(UK) irrigation was done for complete removal of the remaining hematoma. Of the patients, 73 who were operated on within three days of bleeding ictus were chosen for analyses and evaluation by factors believed to affect the final results. Eighty six percent was found to have hypertension as it's cause. The hematoma was removed completely in 13.7% of all the patients on post operation 1st day and 45% within 7 days by urokinase irrigation. The site of hematoma in thalamocapsulo-lenticular area showed a rather poor remission rate compared with those in other locations along with a higher mortality rate. By comparison between the time of admission and discharge, the state of consciousness of patients showed much improvement with 440% of the number of alert patients on discharge:motor function also showed significant improvement with 450% good patients number. In case of poor state of consciousness or motor function on admission, the mortality rate was higher. Rebleeding after aspiration was found in 6.8% and in all the cases except one the operation was done within 24 hours of bleeding, which resulted in poor postoperative outcome without improvement. Pneumonia was most common complication during admission followed by hydrocephalus. Mortality rate was 8.2%, most of which resulted from direct brain damage through bleeding. This surgical method is simple, safe and efficient in treating spontaneous deep intracerebral hematoma with no significant outcome difference when compared with early craniotomy.
Aspirations (Psychology) ; Brain ; Cerebral Hemorrhage* ; Consciousness ; Craniotomy ; Gyeongsangbuk-do ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Mortality ; Neurosurgery ; Pneumonia ; Urokinase-Type Plasminogen Activator*