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 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

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

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.

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

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*

PURPOSE: Stress urinary incontinence (SUI) and urge urinary incontinence (UUI) have different mechanisms of action. We believe that alteration of autonomic nervous system (ANS) activity may contribute to UUI because the lower urinary tract is regulated through the sympathetic and parasympathetic nervous systems. Heart rate variability (HRV) allows measurement of autonomic nervous function, therefore we measured and compared HRV parameters in women with urinary incontinence. METHODS: From March 2008 to March 2010, we evaluated all patients who visited 2 university hospitals for treatment of urinary incontinence. Theywere performed 3-day voiding diary, urodynamic study, physical examination and routine laboratory examination. We excluded subjects who had diabetes, cardiovascular problems, or other condition that affect ANS. Patients with mixed urinary incontinence (MUI) were also excluded. Finally 47 women with SUI (group 1) and 29 women with UUI (group 2) were enrolled according to their symptoms and voiding diary. We compared their HRV parameters. And excluding 11 patients who had detrusor underactivity, we divided them again into group A, 53 women without detrusor overactivity (DO) and group B, 12 women with DO. We compared HRV parameters between DO and non-DO group. RESULTS: Older women had a higher incidence of UUI and DO. In HRV parameters, only the ratio of low frequency (LF) and high frequency (HF) was significantly higher in group 2 than group 1 (3.5+/-3.6 vs. 1.6+/-1.1, P<0.05). Also group A had higher mean LF/HF ratio than group B (4.3+/-3.8 vs. 1.9+/-1.9, P<0.05). CONCLUSIONS: Increased LF/HF values indicate relative sympathetic hyperactivity over parasympathetic activity. Changes in ANS activity could indicate the presence of UUI and potentially DO.
Autonomic Nervous System ; Female ; Heart Rate ; Hospitals, University ; Humans ; Incidence ; Parasympathetic Nervous System ; Physical Examination ; Urinary Incontinence ; Urinary Tract ; Urodynamics

PURPOSE: The exposure to domestic animals has been increased, but there is no systematic evaluation for the clinical importance of animal antigens in Korea. The purpose of this study is to evaluate the significance of animal epithelial antigens as the causative allergens in childhood asthma and rhinitis. METHODS: In 228 children with asthma and rhinitis, allergic skin tests were done with 72 extracts, including 5 animal epithelial antigens. RESULTS: According to the results of allergy skin tests, 208 out of 228 children showed positive skin reactions to more than one antigens, and 128(61.4%) showed positive reactions to animal epithelial extracts. Among them, 17(8.1%) were mites non-sensitive to house dust and sensitive to animal epithelium. The positive reaction to each antigens were as follows:D. farinae(72.6%), D. pteronyssinus(69.7%), rabbit(40.3%), cat(33.1%), dog(24.0%), horse(16.8 %), and cow(14.9%). The degree of skin reactions to animal epithelial antigens were weaker than those to house dust mites. The positive concordance rates between skin tests and specific IgE reactions to D. pteronyssinus and cat/dog were 89.1%, and 25.9%, respectively. We experienced six patients with asthma and rhinitis who suspected animal epithelium as a causative allergen. CONCLUSION: Up to 61.4% of children with respiratory allergy showed positive reactions to animal epithelial extracts and 8.1% of them were house dust mites non-sensitive cases. Therefore, animal epithelium should be investigated as a causative allergen when skin reactions were strong and showed positive specific IgE antibodies.
Allergens ; Animals* ; Animals, Domestic ; Antibodies ; Asthma* ; Child* ; Dust ; Epithelium* ; Humans ; Hypersensitivity ; Immunoglobulin E ; Korea ; Mites ; Pyroglyphidae ; Rhinitis* ; Skin ; Skin Tests