Lymphomatoid granulomatosis (LYG) is an Epstein-Barr virus (EBV)-associated lymphoproliferative disease. It is considered a rare entity in pediatric patients. An adolescent male with lobar consolidation suspected of having pneumonia was resistant to antibiotics and had persistently abnormal radiographs with chest pain. The patient was diagnosed with pulmonary LYG through video-assisted thoracoscopic surgery (VATS) lung biopsy. He received eight cycles of rituximab, vincristine, cyclophosphamide, and prednisolone (R-CVP) but had progressive disease. As the patient developed hypogammaglobulinemia after eight courses of rituximab, he received intravenous gamma globulin (IVIG) at regular interval. With immune augmentation effect of IVIG and immune modulation treatment with prednisolone, the patient has shown no aggravation of the lung lesions. Considering its rarity, high mortality, and frequent relapses, diagnostic methods investigating the radiologic abnormalities can help in early treatment initiation.

BACKGROUND: Nasopharyngeal aspirate (NPA) is known as the best specimen for accurate diagnosis of viral respiratory infections in pediatric patients, but the procedure is very annoying. Recently introduced flocked swabs have been reported to be easy to obtain a good quality specimen and comfortable to patients. The purpose of this study was to compare the sensitivities between NPA and nasopharyngeal flocked swabs (NPFS) for detection of respiratory viruses in children. METHODS: For this study, 111 hospitalized children with acute respiratory tract infections were recruited. NPA and NPFS were performed in parallel from each patient. NPFS were always collected after NPA. Specimens were tested for six common respiratory viruses in triplicate using indirect immunofluorescence (IIF), viral cultures, and multiplex reverse transcription PCR (RT-PCR). RESULTS: The proportion of specimens inadequate for IIF was higher in NPA (23.4%) than NPFS (5.4%). According to the consensus positive, the positive rates of NPFS were higher than those of NPA when using IIF (45.7% and 30.6%, P=0.048) and culture (38.7% and 27.9%, P=0.004). However, the false-positive rates of NPFS were higher than those of NPA when using IIF (12.4% and 1.2%, P=0.004). The positive rates of NPFS and those of NPA were not different in multiplex RT-PCR (67.6% and 55.9%, P=0.055). CONCLUSION: The higher sensitivity of IIF for NPFS specimens and of culture for respiratory viruses and the similar sensitivities in multiplex PCR could make them an alternative to NPA samples, especially in physician clinics or emergency rooms.
Child ; Child, Hospitalized ; Consensus ; Diagnosis ; Emergency Service, Hospital ; Fluorescent Antibody Technique, Indirect ; Humans ; Multiplex Polymerase Chain Reaction ; Nasopharynx ; Polymerase Chain Reaction ; Respiratory Tract Infections ; Reverse Transcription ; Specimen Handling

PURPOSE: Demand of specialized maternity ward is increasing as national income level rises. However, the National Health Insurance limits the number of hospital's non-standard room to less than 50% of total hospital beds. Therefore, this research was performed to investigate the utilization rate of non-standard room among the Korean women who recently delivered baby in medical facilities in order to examine the factors affecting their selection. METHODS: One hundred sixty six medical facilities which deliver a minimum of ten cases in 2011 were selected and categorized by type, region, and size. A cross-sectional survey was done in November 2012 by a professional research survey company. Eight hundred and two pregnant women answered the questionnaire through a face-to-face interview. RESULTS: Of the 802 expecting mothers, 690 (86%) occupied non-standard room and 684 (85.2%) preferred non-standard room to the standard room. Satisfaction levels were significantly higher in mothers occupying non-standard room [5.9+/-1.0 vs. 5.4+/-1.2 (0-7 scale), P<0.01] and high-income families used non-standard room more often. Reasons for using non-standard room included adequate convalescence (78%), separate place for breastfeeding (6.1%), and convenience on receiving visitors (5.4%). Preference for non-standard room on next visit was higher in case of delivery compared to other cause of hospitalization (81.8% vs. 44.9%, P<0.001). CONCLUSIONS: Preference and actual use of non-standard room after delivery were significant. In spite of concrete preference, there was certain barrier in use of non-standard room according to the income and types of hospitals. Therefore, changes of policy such as insurance support for room charge may be needed in case of delivery.
Breast Feeding ; Convalescence ; Cross-Sectional Studies ; Female ; Hospitalization ; Humans ; Insurance ; Maternal Health Services ; Mothers* ; National Health Programs ; Patients' Rooms ; Postpartum Period ; Pregnant Women ; Surveys and Questionnaires ; Maternal Health

Familial juvenile polyposis (FJP) is a rare autosomal dominant hereditary disorder that is characterized by the development of multiple distinct juvenile polyps in the gastrointestinal tract and an increased risk of cancer. Recently, germline mutations, including mutations in the SMAD4, BMPR1A, PTEN and, possibly, ENG genes, have been found in patients with juvenile polyps. We herein report a family with juvenile polyposis syndrome (JPS) with a novel germline mutation in the SMAD4 gene. A 21-year-old man presented with rectal bleeding and was found to have multiple polyps in his stomach, small bowel, and colon. His mother had a history of gastrectomy for multiple gastric polyps with anemia and a history of colectomy for colon cancer. A review of the histology of the polyps revealed juvenile polyps in both patients. Subsequently, mutation screening in DNA samples from the patients revealed a germline mutation in the SMAD4 gene. The pair had a novel mutation in exon 10 (stop codon at tyrosine 413). To our knowledge, this mutation has not been previously described. Careful family history collection and genetic screening in JPS patients are needed to identify FJP, and regular surveillance is recommended.
Exons ; Female ; Gastrointestinal Neoplasms/*genetics/pathology ; Germ-Line Mutation ; Humans ; Intestinal Polyposis/*congenital/genetics/pathology ; Male ; Middle Aged ; Neoplastic Syndromes, Hereditary/*genetics/pathology ; Smad4 Protein/*genetics ; Young Adult

Calbindin-D9k (CaBP-9k) is a cytosolic calcium-binding protein expressed in tissues in the intestine, uterus, placenta, kidney, pituitary gland and bone. Its exact function is unknown, but it is considered to regulate intracytoplasmic concentration and transport of free ions (Ca2+). CaBP-9k protein is involved in intestinal calcium absorption in the intestine and in the regulation of myometrial activity by intracellular calcium in the uterus. Renal CaBP-9k protein is expressed at the site of calcium re-absorption in the kidney and expressed in distal convoluted tubules, where it is thought to facilitate calcium re-absorption. Expression of the CaBP-9k gene has been explored in most mammalians except in a canine model. Presently, we elucidated the expression of CaBP-9k mRNA and protein in the duodenum, kidney and uterus in a canine model involving two adult (2.5-year-old) female beagles. To collect tissues, the dogs were euthanized and then the abdominal cavity was exposed by midline incision. The proximal duodenum, cortex of kidney and uterine horn were collected. Expression of CaBP-9k mRNA was confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and real-time PCR. CaBP-9k protein expression and localization were ascertained by Western blot analysis and immunohistochemistry, respectively. CaBP-9k mRNA was detected in the duodenum, but not in the kidney and uterus. Its protein was expressed only in the enterocytes of the duodenum. Taken together, the results indicate that CaBP-9k mRNA and protein are highly expressed in the enterocytes of the duodenum of a canine model, consistent with findings in other mammalian species.
Animals ; Blotting, Western/veterinary ; Calcium-Binding Protein, Vitamin D-Dependent/*biosynthesis/genetics ; Dogs/*physiology ; Duodenum/*physiology ; Female ; Immunohistochemistry/veterinary ; Kidney/*physiology ; RNA, Messenger/biosynthesis/genetics ; Reverse Transcriptase Polymerase Chain Reaction/veterinary ; Transcription, Genetic ; Uterus/*physiology

PURPOSE: Enteroviruses (EVs) are commonly known to cause infection, especially in infants and children. This report presents an overview of enterovirus epidemiology in central Korea. METHODS: From the spring of 2005 to the autumn of 2006, we collected the cerebrospinal fluid (CSF) and stool samples from the pediatric patients with a febrile illness or suspected meningitis who were admitted to hospitals in central Korea. In order to test for EVs, cell lines were derived from pretreated susceptible specimen, and the cytopathic effects were observed. Seminested real time-polymerase chain reaction (RT-PCR) and direct sequencing were performed for genotypic and phylogenetic analyses. RESULTS: Of the 305 patients examined, 51 (16.7%) tested positive for EV. Of these 51 patients, 44 showed the following serotypes: Echovirus (ECV) 18 (18 cases, 35.2%), Coxsackievirus B (CVB) 5 (13 cases, 25.4%), ECV25 (5 cases, 9.8%), ECV9 (4 cases, 7.8%), ECV5 (3 cases, 5.8%), and EV74 (1 case, 1.9%). In 2005, between June and August, ECV18 and CVB5 were mostly responsible for the enteroviral infections among the patients in central Korea. In 2006, between July and August, ECV25 was mostly the cause of enteroviral infection. Conclusions: There is a need for continuous surveillance of enteroviral infection and its clinical manifestations, particularly for EV74, which was first identified in Korea.
Cell Line ; Child ; Enterovirus ; Enterovirus B, Human ; Humans ; Infant ; Korea ; Meningitis

PURPOSE: Enteroviruses (EVs) are commonly known to cause infection, especially in infants and children. This report presents an overview of enterovirus epidemiology in central Korea. METHODS: From the spring of 2005 to the autumn of 2006, we collected the cerebrospinal fluid (CSF) and stool samples from the pediatric patients with a febrile illness or suspected meningitis who were admitted to hospitals in central Korea. In order to test for EVs, cell lines were derived from pretreated susceptible specimen, and the cytopathic effects were observed. Seminested real time-polymerase chain reaction (RT-PCR) and direct sequencing were performed for genotypic and phylogenetic analyses. RESULTS: Of the 305 patients examined, 51 (16.7%) tested positive for EV. Of these 51 patients, 44 showed the following serotypes: Echovirus (ECV) 18 (18 cases, 35.2%), Coxsackievirus B (CVB) 5 (13 cases, 25.4%), ECV25 (5 cases, 9.8%), ECV9 (4 cases, 7.8%), ECV5 (3 cases, 5.8%), and EV74 (1 case, 1.9%). In 2005, between June and August, ECV18 and CVB5 were mostly responsible for the enteroviral infections among the patients in central Korea. In 2006, between July and August, ECV25 was mostly the cause of enteroviral infection. Conclusions: There is a need for continuous surveillance of enteroviral infection and its clinical manifestations, particularly for EV74, which was first identified in Korea.
Cell Line ; Child ; Enterovirus ; Enterovirus B, Human ; Humans ; Infant ; Korea ; Meningitis

Fixed drug eruption (FDE) is an eruption, which recurs at the same site or sites on each administration of the causative drug, and heals with residual hyperpigmentation. FDE is caused by many drugs, barbiturates, tetracyclines, sulfonamide, and phenolphthalein. Salicylate and nonsteroidal anti-inflammatory drugs (NSAIDs) also cause FDE, but acetaminophen does so only rarely. A 9-year-old girl presented with a 3-year-history of symptomatic pigmented macules on her face, abdomen, and extremities. The eruption was first appeared three years ago, which was when she took medicine after she was discharged following suspicions of Kawasaki disease. Thereafter, she had the same eruption on the same sites when she took medicine for common colds including acetaminophen and ibuprofen. The oral challenge provocation test for ibuprofen was negative, whereas for acetaminophen it was positive. We report a rare case of FDE due to acetaminophen with clinical findings and results of oral challenge test.
Abdomen ; Acetaminophen* ; Barbiturates ; Child* ; Common Cold ; Drug Eruptions* ; Extremities ; Female ; Humans ; Hyperpigmentation ; Ibuprofen ; Mucocutaneous Lymph Node Syndrome ; Phenolphthalein ; Tetracyclines

BACKGROUND: Respiratory viruses (RV) are important pathogen in both children and immunocompromised hosts. Rapid diagnosis of RV is important to manage patients and to implement infection control measures. To investigate the testing situation in Korea, we performed surveillance for the 95 medical institutions. Due to the paucity of long-term, multi-center data on RV epidemiology in Korea, we analyzed data from 5 university hospitals. METHODS: Surveillance questionnaires were sent to 95 members of the Korean Society for Clinical Microbiology. The RV data from 5 university hospitals, 2001 through 2005, were collected retrospectively and analyzed for the isolation rate of each virus. RESULTS: Among the 63 institutions, who replied, 49% performed RV testing and 84% of the testing institutes were university hospitals. A hundred percent institutes tested for respiratory syncytial virus (RSV), whereas 81% tested for influenza virus (Flu), 74% for parainfluenza virus (PIV) and adenovirus each, 32% for rhinovirus, 23% for coronavirus, and 36% for metapneumovirus. PCR and/or culture were employed in 42% of the institutes, immunochromatography 29%, immunofluorescent assay 23%, and enzyme immunoassay 7%. Among the total 11,131 specimens received, virus was detected in 22%, ranging from 12% to 28% by hospital. The most frequently detected virus was RSV (54%) and followed by PIV (18%), Flu (15%), and adenovirus (13%). But species distributions of these viruses were quite different by hospital or by year. CONCLUSION: It is necessary for more active implementation of the RV testing because only 55% of university hospitals and 17% of general hospitals performed this test.
Academies and Institutes ; Adenoviridae ; Child ; Coronavirus ; Diagnosis ; Epidemiology* ; Hospitals, General ; Hospitals, University* ; Humans ; Immunochromatography ; Immunocompromised Host ; Immunoenzyme Techniques ; Infection Control ; Korea* ; Metapneumovirus ; Orthomyxoviridae ; Paramyxoviridae Infections ; Polymerase Chain Reaction ; Republic of Korea ; Respiratory Syncytial Viruses ; Retrospective Studies ; Rhinovirus ; Surveys and Questionnaires

OBJECTIVE: Regulatory T cells, which expressing CD4 and CD25, have a crucial role in suppressing immune systems to self-antigens and preventing autoimmune diseases. This study aims to evaluate the role of regulatory T cells in maternal tolerance to the fetus by comparing the proportion of regulatory T cells in peripheral blood of pregnant and non-pregnant women with those in umbilical cord blood. Also we analyze the changes of proportions of regulatory T cells of umbilical cord blood according to ex vivo expansion. METHODS: An immunophenotypic study on 10 peripheral blood of pregnant and non-pregnant women and 10 cord blood was performed by means of FACSort flow cytometry using anti-CD4, anti-CD25 and anti-CD152 antibodies. Fresh cord blood mononuclear cells (MNCs) were isolated by Ficoll-Hypaque density centrifugation. The MNCs were cultured in anti-CD3 Ab-coated flasks for 4 days. The cells were then transferred to non-coated flasks with IL-2 175 U/mL and were cultured for another 17 days. The expression of CD4, CD25, CD152 and FoxP3 PCR were analyzed in accordance with days in culture. We also performed FoxP3 PCR in isolated CD25+ and CD25- T cells using MACSTM kit. RESULTS: Umbilical cord blood had a higher proportion of CD4+CD25++ regulatory T cells than adults, and term-pregnant women had a lower proportion than non-pregnant women (p<0.05). After ex vivo expansion in anti-CD3 Ab coated flask with IL-2, we observed a significantly increased expression of CD4, CD25, CD152 at 4th day after culture and decrease thereafter. The result was the same as the expression of FoxP3 PCR. CONCLUSION: Umbilical cord blood contained a high proportion of CD4+CD25++ regulatory T cells and regulatory T cells increased on culture day 4 and declined thereafter. Umbilical cord blood may serve as a readily available source of regulatory T cells for immunotherapy.
Adult ; Antibodies ; Autoantigens ; Autoimmune Diseases ; Centrifugation ; Female ; Fetal Blood* ; Fetus ; Flow Cytometry ; Humans* ; Immune System ; Immunotherapy ; Interleukin-2 ; Polymerase Chain Reaction ; T-Lymphocytes ; T-Lymphocytes, Regulatory* ; Umbilical Cord*