Renal infarction is a condition caused by sudden disturbance of renal arterial blood flow, which occurs frequently in cardioembolic disease, renal artery injury (trauma, Marfan syndrome, rarely Ehlers-Danlos syndrome), and in association with a hypercoagulable state. Ehlers-Danlos syndrome is a rare hereditary connective tissue disease characterized by skin fragility, hyperelasticity, hypermobility of small joints, and easy bruising. Among the subtypes, vascular Ehlers-Danlos syndrome is a very rare genetic disease caused by a mutation in the COL3A1 gene. As blood vessels are fragile due dysfunctional collagen synthesis, complications of bleeding due to arterial dissection or rupture are common in patients with this disease. Here, we report a case of vascular Ehlers-Danlos syndrome diagnosed based on a renal infarction caused by thrombus and renal artery injury; we also present a review of the relevant literature.

Food allergy is an immune-mediated adverse reaction that occurs mainly by food ingestion. Some children with food allergies manifest fatal symptoms like anaphylaxis. Oral immunotherapy (OIT) may offer an effective therapeutic modality for persistent and severe forms of food allergies. We report our experience with OIT in 3 patients with IgE-mediated hen’s egg allergy. Our treatment strategy consists of 1–3 days of initial escalation, 47 to 65 weeks of build-up phase, and 1 year of maintenance phase. Lactobacillus plantarum CJLP133, 1×1010 colony-forming unit/day was taken during OIT. As a result, 1 patient achieved successful desensitization, and 1 patient reached maintenance therapy, but did not obtain desensitization. In addition, 1 patient withdrew from treatment due to anxiety symptoms. Despite the limited number of patients, we experienced and herein presented 3 cases of OIT in egg allergy. More trials of OIT need to be performed as a treatment option in Korean children with food allergies.

Diffusion tensor imaging (DTI) has a diagnostic value in cervical myelopathy. The usefulness of diffusion metrics as a potential prognostic biomarker was assessed in this review. Various diffusion metrics, such as fractional anisotropy, mean diffusivity, apparent diffusion coefficient, and radial diffusivity, were significant in correlation with functional recovery after surgery. Changes in diffusion metrics not only at the compression level, but also above and below the compression level were confirmed. However, it was difficult to confirm the results owing to the diversity of studies. Further efforts to make a consensus on spinal cord DTI are needed.
Anisotropy ; Consensus ; Diffusion Tensor Imaging ; Diffusion ; Recovery of Function ; Spinal Cord ; Spinal Cord Diseases

PURPOSE: This study aimed to examine the perception of food allergy among parents and school health instructors in Korea. METHODS: A nationwide epidemiological survey in Korea was conducted in September 2015. From 17 cities and provinces, a total of 1,000 elementary, middle and high schools were selected by stratified random sampling. Parents and school health instructors were surveyed using a questionnaire on the perception of food allergy. RESULTS: The prevalence of food-induced anaphylaxis was 22.3%. Of 252 children with anaphylaxis, 47.6% were prescribed epinephrine auto-injector (EAI). Forty-three parents (37.7%) were educated about the use of EAI. Parents carrying their own EAI at all times or keeping them at schools were 5.6% and 3.8%, respectively. For the food allergen-labeling system, 42.1% of parents read food labels, and 32.1% were satisfied with the system. Only 35.2% of school health instructors received education on food allergy and anaphylaxis, and 42.5% of them knew how to use EAI. There were 70 children (9.4%) with anaphylaxis in school, and 75.9% of schools had the emergency management system. CONCLUSION: The awareness of Korean parents and school health instructors on food allergy is still low, and many parents are dissatisfied with the food allergen labeling system. Many school health instructors have difficulty in using EAI in case of anaphylaxis and are insufficiently educated about food allergy. Therefore, it is necessary to establish more systematic food allergy management plans by providing high-quality education to parents and school health instructors and by utilizing legal systems.
Anaphylaxis ; Child ; Education ; Emergencies ; Epinephrine ; Food Hypersensitivity* ; Humans ; Korea ; Parents* ; Prevalence ; School Health Services*

PURPOSE: This study aimed to determine the prevalence of immediate-type food allergy (FA) among schoolchildren in Korea. METHODS: A nationwide, cross-sectional study was performed in September 2015. A stratified random sample of 50,000 participants was selected from children and adolescents aged 6-7 years (n=17,500), 9-10 years (n=17,500), 12-13 years (n=7,500), and 15-16 years (n=7,500). Parents were asked to complete a questionnaire on the detailed history of immediate-type FA. RESULTS: A total of 32,001 (64.0%) responded to the questionnaire survey, and 29,842 children (59.7%) were analyzed after adjusting for missing data. The number of the cases in each age group was 9,671 (6-7 years), 9,756 (9-10 years), 5,169 (12-13 years), and 5,246 (15-16 years). The prevalence of lifetime perceived FA was 15.82%. The prevalence of current immediate-type FA was 4.06% in total, with 3.15% in 6- to 7-year-olds, 4.51% in 9- to 10-year-olds, 4.01% in 12- to 13-year-olds, and 4.49% in 15- to 16-year-olds. Among individual food items, peanut (0.22%) was the most frequent causative food, followed by hen's egg (0.21%), cow's milk (0.18%), and buckwheat (0.13%). Among the food groups, fruits (1.41%), crustaceans (0.84%), tree nuts (0.32%), and fish (0.32%) were the most common offending foods. The prevalence of food-induced anaphylaxis was 0.97%. The most frequent causative food of anaphylaxis was peanut (0.08%), followed by cow's milk (0.07%), buckwheat (0.06%), and hen's egg (0.06%), while fruits (0.28%), crustaceans (0.18%), tree nuts (0.12%), and fish (0.09%) were the most commonly responsible food groups. CONCLUSIONS: The prevalence of current immediate-type FA and food-induced anaphylaxis in Korean schoolchildren in 2015 was 4.06% and 0.97%, respectively. Peanuts, cow's milk, hen's egg, fruits, crustaceans, and tree nuts are common allergens.
Adolescent ; Allergens ; Anaphylaxis ; Arachis ; Child ; Cross-Sectional Studies ; Fagopyrum ; Food Hypersensitivity* ; Fruit ; Humans ; Korea ; Milk ; Nuts ; Ovum ; Parents ; Prevalence* ; Trees

PURPOSE: The aim of this study was to evaluate the details of the clinical characteristics and food exposure types at the first symptom onset in immediate-type cow's milk allergy (CMA) and egg white allergy (EWA) in Korean children. METHODS: This study included children with immediate-type CMA (n=288) or EWA (n=233) with symptom onset time of 2 hours or less, who visited Samsung Medical Center, Ajou University Hospital, and Soonchunhyang University Seoul Hospital between September 2014 and August 2015. The details of clinical features and food exposure types at the first symptom onset were evaluated by retrospective medical record review using a standardized case report form. RESULTS: The median ages of first symptom onset were 10 months in CMA and 12 months in EWA. The most common types of exposure at the first symptom in CMA were formula milk (29.5%) and milk (29.5%), followed by cheese (17.7%) and yogurt (14.2%). The most common type of exposure in EWA was boiled eggs (35.6%), followed by rice/porridge/soup containing eggs (27.5%), pan-fried eggs (17.6%), and baked goods (9.9%). Cutaneous symptoms were most common in both CMA and EWA, and anaphylaxis was noticed in 36.1% and 30.3%, respectively. Baked goods containing milk or eggs also induced anaphylaxis. The symptom onset time was less than 30 minutes in the majority of patients and the most common place of occurrence was home in both CMA and EWA. CONCLUSION: This study provides comprehensive information on CMA and EWA, and therefore helps clinicians diagnose and guide appropriate food restriction in children with CMA and EWA.
Anaphylaxis ; Cheese ; Child* ; Egg Hypersensitivity ; Egg White* ; Eggs ; Humans ; Hypersensitivity* ; Hypersensitivity, Immediate ; Medical Records ; Milk Hypersensitivity ; Milk* ; Ovum* ; Retrospective Studies ; Seoul ; Yogurt

Hypersensitivity reactions to antituberculosis medicine are obstacles to the treatment of tuberculosis. However, rapid drug desensitization can secure successful treatment with essential antituberculosis medicines in pediatric patients. A 17-year-old boy with active pulmonary tuberculosis complained of generalized erythematous rashes, pruritus on the 11th day of tuberculosis treatment. He was diagnosed with hypersensitivity reactions to isoniazid and rifampin by the oral provocation test. After desensitization, the patient continued to take antituberculosis treatment with isoniazid, rifampin, pyrazinamide, and ethambutol. We report here a case of successful desensitization in an adolescent with hypersensitivity to isoniazid and rifampin.
Adolescent* ; Antitubercular Agents ; Desensitization, Immunologic ; Drug Hypersensitivity ; Ethambutol ; Exanthema ; Humans ; Hypersensitivity ; Isoniazid* ; Male ; Pruritus ; Pyrazinamide ; Rifampin* ; Tuberculosis ; Tuberculosis, Pulmonary*

PURPOSE: There are few recent data regarding allergic sensitization of atopic dermatitis (AD) in Korea. The aim of this study was to investigate patterns of sensitization according to age and gender in children with AD. METHODS: This retrospective study included 4,661 children with AD from 1998 to 2014. The serum specific IgE (sIgE) levels to egg white (EW), cow's milk (CM), peanut, wheat, soybean, buckwheat, tree nuts, crustaceans, meat, and house dust mites (HDMs) were reviewed. AD was categorized into the extrinsic (ADe) and intrinsic type (ADi) according to the presence or absence of sensitization. The proportion of patients with sIgE to EW or CM greater than the previously reported diagnostic decision point (DDP) was determined. RESULTS: A total of 4,661 children (2,843 boys and 1,818 girls) were collected. We identified 1,857 of 2,663 children (69.7%) with the ADe type and 806 of 2,663 children (30.3%) with the ADi type. The sensitization rates increased with age (P<0.001). EW (59.3%) was the most commonly sensitized food, followed by CM (46.6%), peanut (32.2%), wheat (31.5%), soybean (28.1%), and buckwheat (23.7%). The most commonly sensitized food groups were tree nuts (56.7%) and crustaceans (28.3%). The rate of sensitization to HDMs was 40.1%. In addition, 11.1% and 7.5% of children had levels of sIgE to EW and CM, respectively, higher than the DDP. CONCLUSION: The incidence of ADe among children with AD was 69.7% and increased with age. The most commonly sensitized food allergen was EW, followed by CM and peanut.
Arachis ; Child* ; Dermatitis, Atopic* ; Egg White ; Fagopyrum ; Humans ; Immunoglobulin E ; Incidence ; Korea ; Meat ; Milk ; Nuts ; Pyroglyphidae ; Retrospective Studies ; Soybeans ; Trees ; Triticum

OBJECTIVE: To confirm a relationship between the pharyngeal response and bolus volume, and examine whether increasing the fluid bolus volume can improve penetration and aspiration for stroke dysphagic patients. METHODS: Ten stroke patients with a delayed pharyngeal response problem confirmed by a videofluoroscopic swallowing study (VFSS) were enrolled. Each subject completed two swallows each of 2 mL, 5 mL, and 10 mL of barium liquid thinned with water. The pharyngeal delay time (PDT) and penetration-aspiration scale (PAS) were measured and the changes among the different volumes were analyzed. RESULTS: PDTs were shortened significantly when 5 mL and 10 mL of thin barium were swallowed compared to 2 mL. However, there was no significant difference in PAS as the bolus volume increased. CONCLUSION: The increased fluid bolus volume reduced the pharyngeal delay time, but did not affect the penetration and aspiration status.
Barium ; Deglutition Disorders* ; Deglutition* ; Fluoroscopy ; Humans ; Pilot Projects* ; Reaction Time ; Respiratory Aspiration ; Stroke ; Swallows ; Water

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal condition characterized by skin rash, fever, eosinophilia, and multiorgan involvement. Various drugs may be associated with this syndrome including carbamazepine, allopurinol, and sulfasalazine. Renal involvement in DRESS syndrome most commonly presents as acute kidney injury due to interstitial nephritis. An 11-year-old boy was referred to the Children's Hospital of Pusan National University because of persistent fever, rash, abdominal distension, generalized edema, lymphadenopathy, and eosinophilia. He previously received vancomycin and ceftriaxone for 10 days at another hospital. He developed acute kidney injury with nephrotic range proteinuria and hypocomplementemia. A subsequent renal biopsy indicated the presence of acute tubular necrosis (ATN) and late exudative phase of postinfectious glomerulonephritis (PIGN). Systemic symptoms and renal function improved with corticosteroid therapy after the discontinuation of vancomycin. Here, we describe a biopsy-proven case of severe ATN that manifested as a part of vancomycin-induced DRESS syndrome with coincident PIGN. It is important for clinicians to be aware of this syndrome due to its severity and potentially fatal nature.
Acute Kidney Injury ; Allopurinol ; Biopsy ; Busan ; Carbamazepine ; Ceftriaxone ; Child ; Drug Hypersensitivity Syndrome ; Edema ; Eosinophilia* ; Exanthema* ; Fever ; Glomerulonephritis* ; Humans ; Kidney Tubular Necrosis, Acute ; Lymphatic Diseases ; Male ; Necrosis* ; Nephritis, Interstitial ; Proteinuria ; Sulfasalazine ; Vancomycin*