Background: The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods: This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results: Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53%) and infection (44%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

BACKGROUND: Viridans streptococci is a major pathogen of infective endocarditis. This study was conducted in order to investigate the factors associated with infective endocarditis and predictors for three-month mortality among patients with viridans streptococcal bacteremia (VSB). MATERIALS AND METHODS: In this study, among 261 eligible patients diagnosed as VSB from January 2000 through June 2011 in a university-affiliated hospital, a retrospective analysis of 197 patients was conducted. All patients with VSB were classified into two groups according to sites of bacteremia; infective endocarditis and other infections. Demographic and clinical characteristics were reviewed through electronic medical records factors associated with infective endocarditis and predictors of three-month mortality in VSB patients were evaluated. RESULTS: Of the 197 patients, 37 (18.8%) patients had viridans streptococcal infective endocarditis (VSIE) and 160 (81.2%) patients had VSB due to other infection. In logistic regression analysis, underlying valvular heart disease (odds ratio [OR], 48.43; 95% confidence interval [CI], 5.77-406.38) and persistent bacteremia (OR, 46.32; 95% CI, 7.18-299.01) showed an independent association with VSIE. Three-month mortality rate was 21.7% in patients with VSB. In logistic regression analysis, previous steroid use (OR, 9.31; 95% CI, 1.34-64.52), previous immunosuppressive therapy (OR, 9.50; 95% CI, 2.13-42.30), hypotension at onset of bacteremia (OR, 7.72, 95% CI, 2.45-24.33), and Charlson comorbidity score > or =3 (OR, 4.53, 95% CI, 1.55-13.28) showed an independent association with three-month mortality in patients with VSB. CONCLUSIONS: VSB patients who have valvular heart disease or persistent bacteremia routinely require echocardiography. Previous steroid use, immunosuppressive therapy, hypotension, and higher Charlson comorbidity score suggested poor prognosis in patients with VSB.
Bacteremia ; Comorbidity ; Echocardiography ; Electronic Health Records ; Endocarditis ; Heart Valve Diseases ; Humans ; Hypotension ; Logistic Models ; Prognosis ; Retrospective Studies ; Viridans Streptococci

Streptococcal toxic shock syndrome (STSS) is an acute, progressive illness that manifests with fever, hypotension, and accelerated multi-organ failure. It is usually caused by Group A Streptococcus (Streptococcus pyogenes). STSS due to non-group A streptococci is rare, but its incidence has recently increased. We report here on two cases of STSS caused by Group B Streptococcus (Streptococcus agalactiae) and Group G Streptococcus (Streptococcus dysagalactiae).
Fever ; Hypotension ; Incidence ; Shock, Septic ; Streptococcus ; Streptococcus agalactiae

BACKGROUND AND PURPOSE: Low-dose topiramate (TPM) monotherapy has recently been found effective for seizure control in newly diagnosed epilepsy. In higher dosages, TPM has been associated with relatively high rates of adverse cognitive effects; similar side effects have been seen after rapid titration or polytherapy. However, its cognitive effects during low-dose monotherapy have not been established. We evaluated the cognitive effects of low-dose TPM compared with oxcarbazepine (OXC), a drug that does not appear to affect cognitive function. METHODS: Cognitive tests and subjective complaints of 30 patients with low-dose TPM monotherapy (50-200 mg/day) were retrospectively compared with those of 30 patients with OXC monotherapy at 1 year of medication. The two groups did not differ with respect to epilepsy-relevant variables, nor on baseline neuropsychological tests. RESULTS: The TPM group showed a significant difference in the performance of delayed word recall (P<0.05), backward digit span (P<0.01), and verbal fluency (P<0.05) compared with the OXC group. The TPM group showed worse performances of digit span and verbal fluency. The OXC group showed better performances of delayed word recall. The incidence of cognitive complaints was higher in the TPM group (50%) than in the OXC group (20%) (P<0.05). These cognitive effects shown in the TPM group were dose-related. The cognitive dysfunction was trivial with patients taking 50 mg/day TPM. CONCLUSIONS: Even at low-dose, TPM has a negative effect on working memory and verbal fluency compared with OXC. It can be demonstrated at 1 year of treatment.
Cognition ; Epilepsy* ; Humans ; Incidence ; Memory, Short-Term ; Neuropsychological Tests ; Retrospective Studies ; Seizures

BACKGROUND: This study was to evaluate a nationwide nosocomial infection rate and antimicrobial resistance in intensive care units(ICUs) in Korea. METHODS: The study was carried out at 16 university-affiliated teaching hospitals from July through October 2004. We performed a prospective multicenter study to investigate nosocomial infection rates, device-associated infection rated, and causative pathogens and their antimicrobial resistance. RESULTS: The urinary tract was the most commonly involved site. Nosocomial infection rate was 12.48 in medical. ICU (MICU), 9.59 in medical surgical ICU (MSICU), 14.76 in surgical ICU (MSICU), and 11.60 in other lCU. Device-associated infection rates were as follow: 1) rates of urinary catheter-associated urinary tract infection were 4.26 in MICU, 3.17 in SICU, 4.88 in MSICU, and 5.87 in other ICU; 2) rates of central line-associated bloodstream infection were 3.24 in MICU, 1.56 in SlCU, 2.36 in MSICU, and 1.78 in other ICU; 3) rates of ventilator-associated pneumonia were 3.61 in MlCU, 13.05 in SICU, 1.68 in MSICU, and 4.84 in other lCU. Staphylococcus aureus was the most frequently identified microorganism in this study; 93% of S. aurues were resistant to methicillin; 17% of Pseudomonas aeruginosa isolated were resistant to imipenem; 11% of Enterococcus faecium and 18% of Enterococcus faecalis showed resistance to vancomycin. Over a half of Acinetobacter spp, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Escherichia coli showed resistant to fluoroquinolone. Conclusion: This study shows the seriousness of antimicrobial resistance and the importance of infection control in the lCU in Korea. This study should provide a theoretical strategy to enforce the infection control.
Acinetobacter ; Cross Infection* ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Hospitals, Teaching ; Hospitals, University* ; Imipenem ; Infection Control ; Intensive Care Units* ; Critical Care* ; Klebsiella pneumoniae ; Korea* ; Methicillin ; Pneumonia, Ventilator-Associated ; Prospective Studies ; Pseudomonas aeruginosa ; Staphylococcus aureus ; Stenotrophomonas maltophilia ; Urinary Tract ; Urinary Tract Infections ; Vancomycin

BACKGROUND: Chronic liver disease is a common cause of metabolic neurologic deterioration. We analyzed the clinical features and MRI findings of patients with liver cirrhosis who showed rapidly progressing cerebral dysfunction. METHODS: From August 2001 to July 2003, we had 9 liver cirrhosis patients hospitalized due to acutely developed and rapidly progressed neurologic symptoms that were caused not by other metabolic disturbances. Blood tests and liver ultrasonography were performed to assess the severity of liver cirrhosis. A brain MRI study was done in all patients. RESULTS: The causes of liver cirrhosis were viral hepatitis (n=6), chronic alcoholism (n=2), and autoimmune disease (n=1). Serum ammonia and electrolyte levels were within the normal range. Truncal or limbs ataxia and dysarthria were the most common symptoms. The corpus callosum and dentate nucleus of the cerebellum were commonly involved on diffusion- and T2-weighted MRI. In spite of intensive investigation and treatment, all patients had a rapidly deteriorating course with the appearance of uncontrolled abnormal movements and a decreased consciousness level. Their deaths occured within 1 month of the onset of symptoms. CONCLUSIONS: We present nine liver cirrhosis patients with characteristic clinical features and diffusion- and T2-weighted MRI findings for the first time. It is assumed that some neurologic circuit plays a role in pathogenesis.
Alcoholism ; Ammonia ; Ataxia ; Autoimmune Diseases ; Brain Diseases, Metabolic* ; Brain* ; Cerebellar Nuclei ; Cerebellum ; Consciousness ; Corpus Callosum ; Dysarthria ; Dyskinesias ; Extremities ; Hematologic Tests ; Hepatitis ; Hepatolenticular Degeneration ; Humans ; Liver Cirrhosis ; Liver Diseases ; Liver* ; Magnetic Resonance Imaging* ; Neurologic Manifestations ; Reference Values ; Ultrasonography

BACKGROUND: Benign pathologic findings are shown in 800% of thyroid nodules by fine needle aspiration cytology (FNAC) or needle biopsy. About half of these benign nodules are follicular lesions which are presented only as thyroid follicles or thyroid cell clumps. Differential diagnosis of follicular adenoma, follicular carcinoma and adenomatous goiter is impossible by FNAC or needle biopsy. Thyroxine suppression therapy has been performed traditionally in order to discriminate malignant nodules, but few studies are available which confirmed the efficacy of thyroxine suppression therapy in thyroid nodules of those the initial pathologic findings were follicular lesions. So we tried to evaluate the efficacy of thyroxine suppression therapy in benign thyroid nodules and also the incidence of thyroid cancer of the thyroid nosules which were not decreased on thyroxine suppression therapy after surgical resection. METHODS: Total 1027 patients with thyroid nodules were evaluated by FNAC or needle biopsy at Soonchunhyang university hospital from 1990 to 1996. Among 1027 patients, 507 patients showed follicular lesions in FNAC or needle biopsy and they received thyroxine suppression therapy. Thyroid nodule volume was measured before and after thyroxine suppression therapy using ultrasonography. We studied 184 patients who were followed up for more than 1 year. Serial changes of thyroid function tests, thyroid nodule volume, serum thyroglubulin (Tg) level before and after therapy were analyzed. RESULTS: l. In 80 (43.5%) of the 184 patients, nodule volumes decreased more than 50 percent after thyroxine suppression therapy. 2. There was no significant difference in serum T3, T4, TSH levels before and after thyroxine suppression therapy between group I (nodule volume decreased less than 50%) and group II (nodule volume decreased more than 50%). 3. In group II patients, thyroid nodule volumes were decreased continuously at 12 month, 18 month and 30 month after thyroxine suppression (p<0.05). 4. There was no significant difference between the group I and group II in the frequency of multiple thyroid nodules on ultrasonography. 5. Among 37 patients who underwent thyroidectomy, 19 cases (51.4%) were revealed as malignant thyroid nodules (papillary cancer 4 cases, follicular cancer 15 cases). Eighteen cases (48.6%) were revealed as benign thyroid nodules (follicular adenoma 10 cases, adenomatous goiter 8 cases). 6. There was no significant difference in the frequency of multiple nodules on ultrasonography between benign and malignant nodules. CONCLUSION: Our data suggested thyroxine suppression therapy was effective in discriminating malignant thyroid nodules from benign nodules, especially in selecting follicular carcinoma from follicular lesion by FNAC or biopsy.
Adenoma ; Biopsy ; Biopsy, Fine-Needle ; Biopsy, Needle ; Diagnosis, Differential ; Goiter ; Humans ; Incidence ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Thyroidectomy ; Thyroxine* ; Ultrasonography

Varicella during pregnancy is a threat to both mother and fetus because of disseminated infection, varicella pneumonia and meningitis etc. And about 10% of babies acquire intrauterine infection, as indicated by the congenital varicella syndrome, neonatal varicella or zoster during infancy. We report a case of varicella in a 30-year-old, 39 weeks and 3 days' gestational age, full-term pregnant woman presented with generalized erythematous papules, vesicles, pustules and umbilicated pustules on the whole body. She was ordered absolute bed rest for delaying the delivery and treated with acyclovir and varicella-zoster immune globulin. However, she delivered a healthy baby which weighed 3,350 gm the next early morning. In our investigation of cord blood after delivery, varicella-zoster IgG and IgM by ELIZA method were negative and varicella-zoster virus DNA by polymerase chain reaction was also negative. The newborn revealed no clinical evidence of skin lesions and anomalies of varicella. So we supposed there was no intrauterine varicella infection.
Acyclovir ; Adult ; Bed Rest ; Chickenpox* ; DNA ; Female ; Fetal Blood ; Fetus ; Gestational Age ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Infant, Newborn ; Meningitis ; Mothers ; Pneumonia ; Polymerase Chain Reaction ; Pregnancy ; Pregnant Women* ; Skin

The sieving coefficient(S) representing convective transport of glucose during peritoneal dialysis(PD) with glucose containing dialysis solution has been reported to be anomalous, lower than 0 or higher than 1. During peritoneal dialysis using glucose containing dialysis solution, diffusive transport of glucose is from dialysate to blood, and convective transport in the opposite direction i.e., from blood to dialysate. Glucose intolerance and hyperinsulinemia are well known adverse effects of PD using glucose containing dialysis solutions. Insulin is required for glucose transport from extracelluar fluid to intracelluar fluid in adipocytes and muscell cells. Hyperinsulinemia in PD may alter peritoneal glucose transport. If extra to intracellular glucose transport mediated by insulin is involved in the peritoneal glucose transport during PD with conventional glucose containing dialysis solutions, the diffusive and convective transport characteristics for glucose calculated using membrane model between two well-mixed compartments may not represent true values. S can be calculated best when diffusion is minimized. Male Sprague-Dawley rats were used. To minimize the diffusive transport the glucose isochratic solutions containing approximately the same concentration as in serum were used. To maximize ultrafiltration 3.86% mannitol was used as an osmotic agent. To evaluate the effect of insulin on glucose transport two different glucose concentrations, 100mg/dl(NI) and 300mg/dl(HI), were used. During the dialysis with HI solution glucose clamp technique was performed to keep blood glucose level approximately 300mg/dl. A 2 hour peritoneal dialysis was performed in 13 rats(7 Nl and 6 Hl). Serum and dialysate insulin levels were measured in 3rats in Nl, 2 rats in Hl, and 4 rats without dialysis(NC). Intraperitoneal volume(VD) was calculated using volume marker, RISA, dilution method. The diffusive mass transport coefficient(KBD) and S for urea and glucose were calculated using the modified Babb- Randerson-Farrell model. D/P glucose in Nl was 0.61+/-0.05 due to high blood glucose level 187.2+/-17.9mg/dl vs. 114.3+/-7.6 mg/dl in dialysate and 0.99+/-0.26 in Hl(360.6+/-55.6mg/dl in blood vs. 345.0+/-55.6mg/dl in dialysate). VD did not differ between the two groups. KBD for urea and glucose, and S for urea did not differ between the two groups. S for glucose in Hl was negative value and significantly lower than that in Nl(-0.903+/-0.960 vs. 1.036+/-0.137, P<0.001). Plasma insulin level was significantly higher in Hl compared with values in Nl and NC. Dialysate insulin level was similar in Nl and Hl. Dialysate insulin level in Nl was higher than plasma insulin level. The present result that S for glucose at hyperinsulinemic condition was anomalous indicates that not only simple passive transport but also other transport mechanisms mediated by insulin such as glucose influx into cells may be involved in peritoneal glucose transport. The finding of dialysate insulin level higher than plasma concentration in Nl may suggest direct leakage of insulin from pancreas or portal vein into the peritoneal cavity.
Adipocytes ; Animals ; Blood Glucose ; Dialysis ; Dialysis Solutions ; Diffusion ; Glucose Clamp Technique ; Glucose Intolerance ; Glucose* ; Humans ; Hyperinsulinism ; Insulin ; Male ; Mannitol ; Membranes ; Pancreas ; Peritoneal Cavity ; Peritoneal Dialysis* ; Plasma ; Portal Vein ; Rats ; Rats, Sprague-Dawley ; Ultrafiltration ; Urea

Nasopharyngeal carcinoma(NPC) is highly prevalent among southeastern Chinese,and not rare in Korea. Due to NPC usually spreads submucosally and complexity of anatomy in the nasopharynx, we have difficulty in determining the exact extent of tumor. If we know the parameters that represent tumor burden and prognosis, it is very helpful to decide planning of treatment. NPC is etiologically related to Epstein Barr Virus(EBV), and many studies have been reported dealing with EBV and its relationships to the clinical course of NPC. Interleukin 2 receptor(IL-2R) are released from activated human T lymphocyte and marked elevated levels of serum IL-2R have been reported in patients with lymphoproliferative disorders such as leukemia,lymphoma. Histologicallly NPC is associated with T lymphocyte infiltration and it was also reported that the serum levels of IL-2R represents a good marker of tumor burden in NPC. The purpose of this papers was to detect the levels of IL-2R , viral capsid antigen(VCA) IgA and early antigen(EA) IgG in the serum of 19 NPC patients and analyzed the relationships those values and clinical courses, for its usefulness in estimating the tumor burden and predicting the response to therapy and prognosis, who diagnosed as NPC in Kang Nam St. Mary Hospital from June 1993 to November 1995. The results were as follows. 1) Serum IL-2R levels of NPC was not higher than that of controls and showed no relationships with the stage of the NPC. 2) Serum IL-2R levels of recurrent group were higher than that of remission groups(p=0.019). 3) Titers of VCA(IgA), EA(IgG) were higher than that of controls(p=0.0009) and showed no relatiohships with the stage of NPC. 4) There is no differences in the titer of antibodies to EBV according to histological types of NPC. 5) The titers of EA(IgA) had relationship to clinical results(p=0.0286). Above results suggested that higher levels of IL-2R and titers of EBV antibody after therapy, detailed examination should be done for the detection of possible recurrent and remained disease with close follow up.
Antibodies ; Capsid ; Follow-Up Studies ; Herpesvirus 4, Human* ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Interleukin-2* ; Interleukins* ; Korea ; Lymphocytes ; Lymphoproliferative Disorders ; Nasopharynx ; Prognosis ; Receptors, Interleukin-2* ; Tumor Burden