A Study of Clinical Aspects of Scabies in the Jeonbuk Province / 대한피부과학회지

BACKGROUND: Scabies is a contagious skin infestation primarily observed in poor or overcrowded environments. However, an individual may be affected regardless of hygiene and/or socioeconomic status, and/or age. OBJECTIVE: To investigate the characteristics and epidemiology of scabies in patients visiting a single tertiary hospital in Jeonbuk province. METHODS: We retrospectively reviewed the medical records of 194 patients with scabies who visited the Dermatology clinic at Wonkwang University Hospital between June 2015 and May 2018. RESULTS: Of the 194 patients investigated, 82 (42.3%) were men and 112 (57.7%) were women. The mean age of men was 46.3 years and that of women was 60.1 years. Scabies was diagnosed in patients most commonly in autumn. The most common symptom of scabies was the occurrence of papules (83.5%) followed by the presence of burrows (23.2%). The most common route of infection was a nursing hospital (26.3%), except unknown (29.4%). Medications used to treat scabies included 5% permethrin cream, 10% crotamiton ointment, and 1% gamma benzene hexachloride lotion. The mean duration of treatment was 33.9 days using 5% permethrin cream, 34.8 days using 10% crotamiton ointment, and 34.6 days using 1% gamma benzene hexachloride lotion. CONCLUSION: This study could help in the prevention and management of scabies, by guiding clinicians in choosing optimal therapeutic agents based on patients' condition.

Analysis of Prenatal and Postnatal Factors Associated with Complications and Prognosis in Premature Infants with Leukemoid Reaction

PURPOSE: This study determined the prenatal and postnatal factors associated with complications and prognosis in premature infants with leukemoid reaction. METHODS: We retrospectively reviewed the medical records of premature infants with gestational ages 30,000/mm3. The infants who had leukemoid reaction comprised the study group, while the remainder of infants made up the control group. The relationships between maternal and neonatal variables and ANC were studied. RESULTS: Leukemoid reaction was detected in 3.1% of the study infants (8 of 252). Factors more frequently associated with infants with leukemoid reaction were as follows: maternal chorioamnionitis, high levels of maternal and infant C-reactive protein, gestational age <37 weeks, birth weight <2,500 g, low Apgar score, prolonged ventilator support, and a high incidence of bronchopulmonary dysplasia (BPD). However, there were no significant differences with respect to the antenatal usage of steroids, the incidences of patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, and mortality between the two groups. CONCLUSION: Leukemoid reaction in premature infants was associated with chorioamnionitis and high levels of serum C-reactive protein in mothers and infants, and BPD in infants. These findings suggest that leukemoid reaction is secondary to inflammation caused by infection.

Frequency and Etiologies of Hypotension in Extremely Low Birth Weight Infants

PURPOSE:Hypotension is common in extremely low birth weight infants (ELBWI) and the treatment becomes important as the survival rate of ELBWI is increasing. This study is to investigate frequency and etiologies of hypotension in ELBWI. METHODS:40 patients admitted to the NICU of Seoul National University Children's Hospital from September 2004 to June 2006 were included retrospectively. Definition of hypotension was 1) mean arterial blood pressure below 30 mmHg or below the gestational age, 2) decreased urine output or metabolic acidosis, and 3) use of inotropics. Hydrocortisone was used for inotrope-resistant hypotension. Clinical characteristics of patients with hypotension were compared with those of others without hypotension. RESULTS:Mean gestational age and mean birth weight of 40 patients was 26(+6)+/-2(+1) weeks and 787+/-149 g. 20 patients had hypotension. 17 events were within 1 week of postnatal age, 5 from 1 to 2 weeks, and 9 after 2 weeks. The etiologies of hypotension within 1 week were PDA in 12 cases, and bleeding in 4 cases. PDA, post-operative condition, adrenocortical insufficiency, and sepsis were the probable etiologies of hypotension after 2 weeks. Among 12 patients recieved hydrocortisone, 9 responded to hydrocortisone. Patients with hypotension were significantly low in gestational age and birth weight. Incidence of IVH and ROP were significantly high in patients with hypotension. CONCLUSIONS:Hypotension was frequent in ELBWI and the etiologies of hypotension were various according to postnatal ages. Significant proportion of hypotension was inotrope-resistant in ELBWI. Further studies about etiologies are in need with reference of this study.

Perinatal Outcome in Preterm Infants with Abnormal Umbilical Artery Doppler Results : Emphasizing on Early Onset Thrombocytopenia and its Risk Factors

PURPOSE:Umbilical artery Doppler study is a commonly used non-invasive tool in high risk pregnancies because of its good correlation with the degree of placental insufficiency. We analyzed hematologic profiles and perinatal outcome of preterm infants with abnormal umbilical artery Doppler results and the risk factors of early onset thrombocytopenia. METHODS:We retrospectively reviewed the medical records of preterm infants under 35 weeks of gestational age at birth who were admitted to the neonatal intensive care unit of Seoul National University Children's Hospital from January 1, 2002 through December 31, 2004, and whose mothers had undergone umbilical artery Doppler studies within 5 days before delivery. Sixty two neonates were divided into three groups; the 1st group was defined as the patients with normal umbilical artery (UA) systolic/diastolic (S/D) ratio, the 2nd group, with increased UA S/D ratio above 95 percentile, and the 3rd, with absent or reversed end-diastolic flow (AREDF). RESULTS:Mean nucleated red blood cell (nRBC) counts per 100 white blood cells (WBCs) were 14.2 (0-150), 91.0 (0-262), 301.4 (6-884) (P<0.001), mean WBC counts were 10.8 (0- 34.1), 9.2(3.4-23.9), 5.9(0.5-15.2) (x1,000/mm(3)) (P=0.007), and mean platelet counts were 215.5+/-69.2, 185.9+/-96.7, 100.2+/-50.3 (x1,000/mL) (

A case of gastrointestinal stromal tumor of the stomach showing exophytic growth / 대한내과학회지

Gastroinstestinal stromal tumors (GISTs) are defined as a group of KIT (CD117) positive mesenchymal tumors. Approximately 70% of those tumors are found in the stomach followed in order by the small bowel, colon and rectum, esophagus. The common clinical presentation of GISTs varies according to the size and location of the tumors, ranging from massive gastrointestinal bleeding to vague abdominal pain. We detected a GIST of the stomach incidentally during chest-computed tomography examination of a 68-year-old-woman. Esophagogastroduodenoscopy showed an 8 cm sized protruded lesion with normal mucosal covering on the posterior wall of the gastric body, and endoscopic ultrasonography showed a cystic mass originating in the fourth layer of the stomach. The patient was treated with a subtotal gastrectomy. Immunohistochemical studies on the surgical resection specimen showed CD117(+) and CD34(+). The final diagnosis was a GIST of the stomach showing exophytic growth.

Recent outcome of extremely low birth weight infants: The use of CRIB(clinical risk index for babies) II score for analyzing the survival rate / 소아과

PURPOSE: The survival rate of infants weighing less than 1,000 g at birth(extremely low birth weight infants, ELBWI) has increased due to recent advances in perinatal and neonatal intensive care. The purpose of this study was to evaluate the survival rates of ELBWI born at Seoul National University Hospital during the last six years. METHODS: A total of 99 infants were divided into three groups(period I : 2000 to 2001, period II: 2002 to 2003, period III: 2004 to 2005) based on date of birth. We compared the survival rate of ELBWI over the three periods, using CRIB II score for adjustment for clinical severity. RESULTS: Overall survival rate of ELBWI was 74.7 percent. The survival rate of ELBWI increased over the three periods(period I: 60.7 percent, period II : 73.3 percent, period III: 85.3 percent). The threshold of viability(defined as survival of at least 50 percent of infants) was 25 weeks of gestation and 600 g at birth. The birth weight-specific survival rates increased considerably over the three periods for infants < 750 g at birth(period I: 10 percent, period II: 46.2 percent, period III: 70.6 percent). The survival rates of ELBWI over the three periods increased much remarkably after adjustment for clinical severity by CRIB II score. CONCLUSION: In our institution, survival rates of ELBWI during the last six years continued to improve, particularly for infants weighing < 750 g at birth. This increase in survival rates was not associated with the clinical severity of ELBWI.

Spontaneous Chylothorax in Children / 소아알레르기및호흡기학회지

PURPOSE: The purpose of this study was to review the cases of spontaneous chylothorax and its diagnosis, treatment, outcome, and complications. METHODS: We retrospectively reviewed the medical records of 10 patients who were diagnosed as spontaneous chylothorax in Seoul National University Children's Hospital between January 1990 and August 2001. We reviewed demographic data, pleural fluid analysis, treatment modalities, complications, and outcomes. RESULTS: Spontaneous chylothorax was identified in 10 patients including 5 infants with congenital origin. Chylothorax was noted in left(3 cases), right(2 cases) and bilatelly in five cases. Three of five infants with congenital chylothorax were born with hydrops fetalis and two were born prematurely. Pleural fluid laboratory findings were as follows: WBC>1,000/microliter, lymphocytes 92.8+/-9.9%, protein 3.9+/-2.7 g/dL, triglyceride 994+/-825 mg/dL, cholesterol 46.6+/-26.7 mg/dL. All cases were treated initially with a combination of repeated thoracenteses and/or pleural drains, total parenteral nutrition, medium-chain triglyceride based formula or low fat diet. Seven cases responded to conservative treatment. One infant underwent successful thoracic duct ligation. Chylothorax persisted in 2 cases. There was an initial response to steroid treatment in 1 infant who was considered Noonan syndrome, but chylous effusion increased during the tapering of steroid. CONCLUSION: Conservative treatment was successful in 70% of the patients. A precise diagnosis, proper treatment, and prevention and treatment of complications are important in the management of chylothorax. Familiarity with the therapeutic options and appropriate timing for surgical intervention will be required.

Safety of Neonatal Surgery in Neonatal Intensive Care Unit Versus Operating Room

PURPOSE: A transport of a critically ill infant, especially preterm infant, to an operating room (OR) from a neonatal intensive care unit (NICU) has special dangers like incidental removal of an intravenous line or a chest tube, extubation, stopping of vital sign monitoring, hypothermia and postanesthetic apnea, which could be fatal to the infant. An operation in a NICU, however, has high risk of sepsis and shortage of specialized staffs and equipments. Thus, it is generally favored so far to perform a surgery in an OR. We assessed the safety of surgery in a NICU. METHODS: 66 infants underwent operation in the NICU of Seoul National University Children's Hospital from January of 1995 to April of 2001. There were 30 cases of cryotherapy or laser photocoagulation for retinopathy of prematurity (ROP), 17 of peritoneal drainage catheter insertion, 10 of patent ductus arteriosus (PDA) ligation, 8 of extraventricular drainage, and 1 of laparotomy and peritoneal lavage. This study was conducted focusing on ROP and PDA patients. 28 cases of photocoagulation and 10 cases of PDA ligation conducted in the NICU were compared each other with 10 cases of photocoagulation and 10 cases of PDA ligation in the OR about surgical outcome and complications using retrospective medical record inspection. RESULTS: Regarding ROP, there was no big difference between the two groups in light of the clinical factors and the status of an infant before and after an operation except that inspiratory fraction of oxygen (FiO2) before an operation in the NICU group was higher than that of the other group. A total operation time was longer and there were more variations of weight, body temperature and blood pressure in the OR group. A higher rise of the mean airway pressure (MAP) and higher frequency of intraoperative hypothermia were found in the OR group and there was 1 case of extubation during an operation. The postoperative retinal detachment and the postanesthetic apnea were more frequent in the OR group. Regarding PDA, no big difference was found between the two groups in light of the clinical factors and the status of an infant except that the gestational age at birth was smaller and cardiac failure was more frequent in the NICU group. The total operation time was longer and the rises of FiO2 and MAP were higher in the OR group. There was no significant difference in operation results and postoperative complications. CONCLUSION: In light of the safety, the results, and the complications of an operation, no significant difference was found between the two groups. Accordingly, in case of ROP and PDA of a premature baby, We came to a conclusion that a NICU could be used as safe an operation place as an OR.

Safety of Neonatal Surgery in Neonatal Intensive Care Unit Versus Operating Room

PURPOSE: A transport of a critically ill infant, especially preterm infant, to an operating room (OR) from a neonatal intensive care unit (NICU) has special dangers like incidental removal of an intravenous line or a chest tube, extubation, stopping of vital sign monitoring, hypothermia and postanesthetic apnea, which could be fatal to the infant. An operation in a NICU, however, has high risk of sepsis and shortage of specialized staffs and equipments. Thus, it is generally favored so far to perform a surgery in an OR. We assessed the safety of surgery in a NICU. METHODS: 66 infants underwent operation in the NICU of Seoul National University Children's Hospital from January of 1995 to April of 2001. There were 30 cases of cryotherapy or laser photocoagulation for retinopathy of prematurity (ROP), 17 of peritoneal drainage catheter insertion, 10 of patent ductus arteriosus (PDA) ligation, 8 of extraventricular drainage, and 1 of laparotomy and peritoneal lavage. This study was conducted focusing on ROP and PDA patients. 28 cases of photocoagulation and 10 cases of PDA ligation conducted in the NICU were compared each other with 10 cases of photocoagulation and 10 cases of PDA ligation in the OR about surgical outcome and complications using retrospective medical record inspection. RESULTS: Regarding ROP, there was no big difference between the two groups in light of the clinical factors and the status of an infant before and after an operation except that inspiratory fraction of oxygen (FiO2) before an operation in the NICU group was higher than that of the other group. A total operation time was longer and there were more variations of weight, body temperature and blood pressure in the OR group. A higher rise of the mean airway pressure (MAP) and higher frequency of intraoperative hypothermia were found in the OR group and there was 1 case of extubation during an operation. The postoperative retinal detachment and the postanesthetic apnea were more frequent in the OR group. Regarding PDA, no big difference was found between the two groups in light of the clinical factors and the status of an infant except that the gestational age at birth was smaller and cardiac failure was more frequent in the NICU group. The total operation time was longer and the rises of FiO2 and MAP were higher in the OR group. There was no significant difference in operation results and postoperative complications. CONCLUSION: In light of the safety, the results, and the complications of an operation, no significant difference was found between the two groups. Accordingly, in case of ROP and PDA of a premature baby, We came to a conclusion that a NICU could be used as safe an operation place as an OR.

Systemic Candidiasis in Neonatal Intensive Care Unit : A 8-Year Experience

PURPOSE: Recently, Candida has become an increasingly significant neonatal pathogen, and may result in serious morbidity and mortality in the neonatal intensive care units. The purpose of this study was to describe and analyze our 8-year experiences with a review of the related literature, and to contribute to the improvement of the survival rate in the neonatal intensive care unit. METHODS: We retrospectively reviewed the medical records of 20 patients who were diagnosed as systemic candidiasis in the neonatal intensive care unit of Seoul National University Children's Hospital between January 1993 and December 2000. We then analyzed demographics, clinical presentations, diagnostic features, risk factors, antifungal therapy, and outcomes. RESULTS: Twenty-one systemic candidial infections occurred in 20 patients representing 0.85% of all NICU patients during the study period, among which 13 were very low birth weight (VLBW) infants (2.85% of total 456 VLBW infants). The mean gestational age and birth weight were 30.4 weeks and 1,430 gm, respectively. The common Candida species were C. albicans (61.9%), C. parapsilosis (38.1%), and the others such as C. glabrata (4.8%), C. tropicalis (4.8%), and C. famata (4.8%). The rates of culture positivity of blood, urine, and tracheal aspirates were 95.2%, 42.9%, and 9.5%, respectively. Each of candidial endocarditis, peritonitis, and renal fungus ball developed in a different patient. The most common presenting clinical signs were respiratory deterioration, abdominal distension, and apnea/bradycardia. All patients were treated with amphotericin B, alone in 9 cases or in combination with 5-flucytosine (7 cases) and with fluconazole (4 cases). Systemic candidiasis contributed to the deaths of 6 patients (30%). CONCLUSION: In the neonatal intensive care unit of Seoul National University Children's Hospital, systemic candidiasis was a serious infection associated with high mortality and the diverse clinical features. Early diagnosis and appropriate antifungal therapy, combined with the elimination of the risk factors, may guarantee lower morbidity and mortality in the neonatal systemic candidiasis.

A Case of Congenital Methemoglobinemia Due to NADH-Methemoglobin Reductase Deficiency

Congenital methemoglobinemia is caused by NADH-methemoglobin reductase deficiency in more than half of the total reported cases. NADH-methemoglobin reductase deficiency is an uncommon hereditary disorder producing methemoglobinemia and cyanosis in the homozygous subject. A majority of the patients born with these abnormalities have only a cosmetic defect-asymptomatic cyanosis. Congenital methemoglobinemia due to NADH-methemoglobin reductase deficiency is an autosomal recessive disorder and classified into 4 types according to the pathophysiology of the disorder. In type I, the deficiency of NADH-methemoglobin reductase is restricted to erythrocytes of patients with mild cyanosis, and 7 missence mutations have been reported in the case of type I. We report the first Korean pediatric case of type I congenital methemoglobinemia due to NADH- methemoglobin reductase deficiency with a review of the literature.