PURPOSE: We compared the clinical manifestations of patients with tsutsugamushi disease between children and adults. METHODS: From January 2003 to December 2012, 768 patients diagnosed with tsutsugamushi disease were retrospectively reviewed, and the clinical characteristics, laboratory findings, and complications were compared between children and adults. RESULTS: No patterns of annual increases in the number of patients were noted in both children and adults. The higher incidences occurred in October and November respectively. By gender, male outnumbered female in children, but the opposite trend was seen in adults. By residential area, the urban distribution of children was higher than that of adults. Rashes (P=0.001) and eschar (P=0.004) were more common in children, while myalgia was more common in adults. Children had a high prevalence of anemia (P=0.041), and low incidence rates of thrombocytopenia, abnormal liver and renal function. Children yielded better results in the duration of their hospital stay and the incidence of complications (P<0.001). A comparison of the therapeutic effects of doxycycline and macrolide antibiotics, which was performed only on the children, did not reveal any significant differences. CONCLUSION: Compared to adults, children had higher incidence rates of male patients and more often suffered from rashes and eschar. Children yielded better results in the laboratory findings and duration of the hospital stay and complications. Therefore, when children are suspected to have tsutsugamushi disease, especially during its peak occurrence period, detailed physical examination and serological test should be performed to ensure a prompt diagnosis, and the use of macrolide antibiotics, which have fewer side effects, is expected to yield the same therapeutic effects.
Adult* ; Anemia ; Anti-Bacterial Agents ; Child* ; Diagnosis ; Doxycycline ; Exanthema ; Female ; Humans ; Incidence ; Length of Stay ; Liver ; Male ; Myalgia ; Physical Examination ; Prevalence ; Retrospective Studies ; Scrub Typhus* ; Serologic Tests ; Thrombocytopenia

We report a case of giant M llerian duct cyst in a 6 month-old-boy with urinary tract infection. A mass displacing the bladder and prostatic urethra anteriorly was found on the voiding cystourethrogram, and it was a oval shaped retrovesical anechoic cyst on the abdominal ultrasonogram. On MRi, it was a tear-drop shaped cyst of isosignal intensity with a projection toward the prostatic urethra and located in the midline of vesicorectal space. Grossly, the cyst had communication with prostatic urethra and both vas deferenses were drained to the cyst. Pathologically it was confirmed as a M~'llerrian duct cyst lined with squamous epithelium.
Epithelium ; Magnetic Resonance Imaging ; Ultrasonography ; Urethra ; Urinary Bladder ; Urinary Tract Infections ; Vas Deferens

No abstract available in English.
Osteosarcoma

Norfloxacin is a new broad spectrum of antibacterial activity against both Gram-positive and Gram. negative bacteria. After oral administration of Norfloxacin, it produces high concentrations in the urine, so it has the excellent effect for the treatment of urinary tract infection. Norfloxacin was studied with respect to clinical effect in 115 patients with the urinary tract infection and the following results were obtained. 1. Excellent efficacy was 53% and efficacy rate was 90% in upper urinary tract infection(UTI). Efficacy rate for 20 patients with upper UTI without the underlying disease was 100%, and in 29 patients with underlying disease efficacy rate was 83%. 2. In upper UTI resistant for other antibiotics, efficacy rate was 78%. 3. In lower UTI excellent efficacy rate was 36% and efficacy rate was 71%. In gonococcal urethritis excellent efficacy rate was 76% and efficacy rate was 88%. 4. Eliminated rate of bacteria on culture findings were E. coli 93%, pseudononas 89%, proteus 100%, klebsiella 80%, gonococcus 88% and staphylococcus 80%. 5. Mild side effects such as epigastric pain, nausea, dizziness and itching sensation were seen in 5 cases. We consider Neutam-400 is one of the most effective agents in urinary tract infection.
Administration, Oral ; Anti-Bacterial Agents ; Bacteria ; Dizziness ; Humans ; Klebsiella ; Nausea ; Neisseria gonorrhoeae ; Norfloxacin ; Proteus ; Pruritus ; Sensation ; Staphylococcus ; Urethritis ; Urinary Tract Infections* ; Urinary Tract*

No abstract available.
Mouth Floor*

Incontinentia pigmenti (IP), also known as Bloch-Sulzberger syndrome, is a rare X-linked dominant disorder that is generally lethal to males and almost always leads to death in utero. This disorder is a genodermatosis with characteristic cutaneous lesions and manifestations affecting the eyes, teeth, hair, and central nervous system. Genodermatosis is a hereditary disease caused by mutations in the nuclear factor-kappa B essential modulator gene mapped to chromosome Xq28. This gene encodes a variety of cytokines and chemokine regulators and is indispensable for protecting cells from tumor necrosis factor-induced apoptosis. Here we describe a case of male newborn with vesiculobullous cutaneous lesions over the left thigh and leg. We first considered the cutaneous lesions a skin infection, as they improved with intravenous antibiotics. However, recurrence and the need for repeated hospitali zations made us consider the differential diagnosis of IP, for which we performed a skin biopsy and chromosome analysis. The histology results were compatible with IP, that is, eosinophilic infiltration in the dermis and epidermis, and individual cell dyskeratinization. The chromosome analysis result was a normal 46, XY karyotype.Here we report the case of a male newborn with IP that manifested as multiple vesiculobullous skin lesions and was initially misdiagnosed as a recurrent skin infection.

Intrahepatic stones are frequently associated with recurrent pyogenic cholangiohepatitis and complete surgical removal of the stones is almost always difficult because of the large number of stones and associated bile duct strictures. One hundred and seventy-nine patients with retained intrahepatic stones underwent percuttaneous stone removal utilizing a preshaped angulated catheter and a Dormia basket under fluoroscopy with a combination of techniques including irrigation-suction. crushing of large stones. balloon dilatation of strictures and extracorporenal shock wave lithotripsy. The procedure was performed through a mature T-tube tract (177 patients) and a mature transhepatic tube tract (two patients). Stones were exclusively intrahepatic in 130 patients. whereas 49 patients also had stones in the common bile duct. In 91 (50.8%) of 179 patients. the stones were completely removed and in 36 (20.1%) patients most of the stones were removed. The overall success rate was 70.9% ngulation deformity. stricture of bile ducts and impacted stones were the factor most often responsible for failure, No significant complications were observed. Fluoroscopicalyy-guided percutaneous interventional procedures with a preshaped angulated catheter is an useful complementary procedure to surgery for patients with intrahepatic stones. the major benefits of an individually fitted angulated catheter are its safety and easy access to small peripheral bile ducts.
Bile Ducts ; Catheters* ; Common Bile Duct ; Congenital Abnormalities ; Constriction, Pathologic ; Dilatation ; Fluoroscopy ; Humans ; Lithotripsy ; Shock

Megacalicosis is a primary disease of renal calyces which were dilated without evidence of obstruction. Since its first description by Puigvert in 1963, megacalicosis has been described in many literatures. Recently we experienced a case of bilateral congenital megacalicosis with right lower ureteral obstruction. Herein we report our case with brief review of literatures.
Ureteral Obstruction

Graves' disease, the main cause of hyperthyroidism in the pediatric age group, is very rare in children younger than 4 years old but can seriously interfere with growth and development if not recognized and treated. Here we report a case of a 3-year-old girl with Graves' disease who presented with goiter, exophthalmos, heat intolerance, and hyperactivity. At her first visit, her serum concentrations of triiodothyronine (T3) and free thyroxine (free T4) were normal, whereas that of thyroid-stimulating hormone (TSH) was decreased. Antimicrosomal antibody was 7,053.94 IU/mL, and TSH-binding inhibitory immunoglobulin was 31.62%. A thyroid scan showed diffuse enlargement with markedly increased uptake of both thyroid glands. Although T3 and free T4 levels were initially normal, she developed hyperthyroidism 3 months later. She was finally diagnosed with Graves' disease and treated with methimazole for 6 months. This is the first report of Graves' disease in children younger than 4 years old in Korea.
Child ; Child, Preschool* ; Exophthalmos ; Female ; Goiter ; Graves Disease* ; Growth and Development ; Hot Temperature ; Humans ; Hyperthyroidism ; Immunoglobulins ; Korea ; Methimazole ; Thyroid Gland ; Thyrotropin ; Thyroxine ; Triiodothyronine

BACKGROUND: Angiogenesis is essential for tumor growth and metastasis. Vascular endothelial growth factor(VEGF), also known as vascular permeability factor(VPF), is an angiogenic factor that plays important roles in tumor growth. Angiogenesis studies on VEGF deal with various types of malignant tumors, but little is known about the role or significance of VEGF in human thyroid neoplasms. Therefore, this study was performed to determine whether the VEGF expression in different histological types of thyroid tumors is altered and to see if there was a relationship between the expression of VEGF and either metastasis or the invasiveness of thyroid carcinomas. METHODS: Forty-two cases that underwent thyroidectomy at Kosin Medical Center, between March, 1999 and February, 2000, were included in this study. Of the 42 cases, 27 were malignant(26 papillary carcinoma, 1 Hurthle cell carcinoma) and 15 were benign lesions. The expression of VEGF was determined by immunohistochemistry using paraffin embedded thyroid tissue blocks, and was quantified as negative(absent), +(1~24%), ++(25~49%), +++(50~74%) and ++++(> or =75%), according to the extent of positive cells. RESULTS: VEGF was stained with red-brown colored granules in the cytoplasm of the thyroid tumor epithelium and was expressed in 27 of the 42 cases(+1, ++8, +++5, ++++13). Most malignant tumors(24 of 27 cases) were stained with VEGF, but only 3 of the 15 benign tumors cases were stained(P<0.001). When the VEGF expression was divided into ++ or below and +++ or above groups, the expression of VEGF was much more extensive in the malignant than benign tumors(P<0.001). Of the 27 malignant tumors cases, lymph node metastasis and/or invasion was noted in 13. VEGF expression was more extensive in malignant tumors with lymph node metastasis and/or invasion than in those without(P<0.001). CONCLUSION: In this study, the rate and extent of VEGF expression were greater in the malignant than the benign thyroid tumors, and also the extent of VEGF expression was the extent of VEGF greater in the malignant tumors with lymph node metastasis and/or invasion than those without
Angiogenesis Inducing Agents ; Capillary Permeability ; Carcinoma, Papillary ; Cytoplasm ; Epithelium ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Vascular Endothelial Growth Factor A*