Clinical Features of Anaphylaxis in the Middle Area of South Korea / 소아알레르기및호흡기학회지

PURPOSE: Anaphylaxis is a medical emergency requiring immediate recognition and treatment. Despite the serious nature of these reactions, there is no universal agreement on the definition and there have been few epidemiologic studies of anaphylaxis in children. The purpose of the study is to investigate the causative agents, presenting signs and symptoms and course of disease in children suitable for established diagnostic criteria for anaphylaxis in the middle area of South Korea. METHODS: We identified potential episodes of anaphylaxis occuring between March 1994 and October 2007 from the university hospitals in the middle area of South Korea. We reviewed all patients' medical records diagnosed with anaphylaxis and other related diagnoses. From chart review, we retrospectively collected demographic and epidemiologic data. RESULTS: We identified 40 patients with anaphylaxis. Patients' ages ranged from 2 months to 17 years, with a mean age of 6.6 years. A causative agent was recognized in 84.5%. The inciting agent included foods in 26 cases (65%), medication in 7 cases (17.5%) and bee sting in 1 case (2.5%). Mucocutaneous manifestations were the most common, respiratory symptoms were in 35 patients, cardiovascular symptoms were in 8 patients, and gastrointestinal symptoms were in 5 patients. CONCLUSION: We found some cases of anaphylaxis which had misdiagnosed as urticaria or angioedema using the established diagnostic criteria. Therefore, clinicians must accurately know the criteria of anaphylaxis and make an effort to identify cases of anaphylaxis with a high suspicion. Also, we found the epidemiology, causative agents, and symptoms and treatments of anaphylaxis in the middle area of South Korea. Our data will be the basis for anaphylactic studies in South Korea.

Evaluation of a Rapid Antigen Test for Detection of Influenza Virus / 대한임상미생물학회지

BACKGROUND: Influenza virus is a cause of annual outbreaks of acute respiratory disease and is responsible for considerable mortality and morbidity in all age groups. To achieve maximum efficacy antiinfluenza drugs must be started within 48 h of the development of influenza symptoms. Improvements in rapid diagnosis methods are needed to identify influenza infections. The aim of this study was to compare a quick rapid antigen test with viral culture assays. METHODS: A total of 87 nasopharyngeal swab specimens were collected from symptomatic paediatric patients during March, 2004. The performance of the Quick S-Influ A/B rapid test for influenza virus detection was compared to that of the viral culture. RESULTS: The overall rate of detection for viral culture was 23.4% for influenza A virus and 13.4% for influenza B virus. The Quick S-Influ A/B assay identified 17 of 18 influenza A viruses (sensitivity, 94.4%; specificity, 96.8%; PPV, 89.5%; NPV, 98.4%), and identified 7 of 9 influenza B viruses (sensitivity, 77.8%; specificity, 98.4%; PPV, 87.5%; NPV, 96.8%). CONCLUSIONS: The Quick S-Influ A/B assay was easy to perform and showed comparable sensitivities and specificities. This rapid test kit can be an alternative tool for interventions in disease management.

Endoscopic Findings of Upper GI Bleedings in Full Term Newborn Infants / 대한소아소화기영양학회지

PURPOSE: We are going to establish the efficacy of endoscopic examinations in diagnosing and treating upper GI bleeding in full term neonates. METHODS: We retrospectively reviewed newborns who underwent endoscopic examination because of hematemesis from July 1998 to April 2001. RESULTS: Gestational ages were between 38 and 41weeks, and birth weights were between 2,730 and 3,400 gm. Total of 9 patients were reviewed. Endoscopic examination revealed gastric ulcer in 6 cases, multiple erosions in 2 cases and negative finding in 1 case. All 6 gastric ulcers were multiple and among them 2 patients endoscopic hemostatic therapy. No complication due to the procedure was noticed. Five patients recieved transfusions. All 9 cases were cured through conservative and endoscopic therapy without recurrence. CONCLUSION: The common cause of upper GI hemorrhage in newborns with no preceding disease turns out to be multiple gastric ulcers and the prognosis is good. The endoscopic approach is useful in diagnosing and treating upper GI bleeding in newborns.

Clinical and Molecular-Biologic Study of Extended Spectrum beta-lactamase Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit

PURPOSE: Extended spectrum beta-lactamase (ESBLs) producing Klebsiella pneumoniae has recently been increasingly responsible for infections. Considering the characteristics of the neonatal intensive care unit (NICU), the increase in such colonies is to be an important factor in the treatment and outcome of neonatal patients. Therefore, we performed this study in order to investigate the incidence of this colony and the clinical characteristics that are helpful in diagnosing these infections. METHODS: We performed a double disk synergy test and randomly amplified polymorphic DNA (RAPD) analysis of which 12 was resistant or intermediate to cefotaxime, and 4 colonies isolated from rectal swab taken in 14 patients between July and August, 1997. Also, we compared the annual isolation rate of K. pneumoniae, from those admitted to the Soonchunhyang University Chunan Hospital NICU from July, 1997 to June, 2000. We retrospectively studied the medical records and the clinical characteristics of those 79 cases from whom 110 colonies were isolated. RESULTS: From July to August, 1997, there was a K. pneumoniae outbreak in the NICU. Fifteen out of a total of sixteen isolates were positive in the double disk synergy test and turned out to be ESBL producing K. pneumoniae. Also the RAPD analysis of thirteen isolates which were from the NICU proved eleven isolates to have similar band pattern on RAPD typing. In those who were admitted to our NICU from July, 1997 to June, 2000, 110 colonies of K. pneumoniae resistant or intermediate to cefotaxime were isolated from 79 patients. Though patient group infected by the ESBLs producing K. pneumoniae had significantly no difference in gestational age or birth weight, they had a longer hospitalization period compared to the control group. CONCLUSION: It is possible that ESBLs producing K. pneumoniae be responsible for outbreaks in the NICU. The emerging of these can affect the morbidity in neonates and also can put great limits in the choice of antibiotics.

The Detection of Chlamydia trachomatis Using Nested PCR in Prematurity and Delivery of Low Birth Weight Infant

PURPOSE: Polymerase chain reaction(PCR) has generally been more sensitive than traditional tests for the detection of Chlamydia trachomatis which has been a leading cause of sexually transmitted disease. We performed this study to find out if there is an association between C. trachomatis infection and low birth weight(LBW) or prematurity. METHODS: The study included 98 premature or LBW infants admitted to the neonatal intensive care unit of Soonchunhyang Chunan hospital between January and July of 1999. Nasopharyngeal swab specimens were obtained from 98 neonates with a LBW or prematurity. Endotracheal secretions were obtained from 28 LBW or premature infants. Vaginal swabs were collected from 47 mothers who had given birth to LBW or premature infants. We performed the nested PCR with Chlamydia-CR kit(Bioneer, Korea). PCR products were resolved by electrophoresis on 2% agarose gel. These products were observed by their size which was 345 bp. RESULTS: C. trachomatis was not detected by the nested PCR from 98 nasopharyngeal swabs nor 28 endotracheal secretion specimens. But, C. trachomatis was detected in 2(4.2%) out of 47 vaginal swab specimens from mothers who had given birth to LBW or premature infants. CONCLUSION: The nested PCR is a relatively simple, fast and practical tool for the detection of C. trachomatis, but the positive rates of C. trachomatis were low in LBW or premature infants and also in mothers who had given birth to LBW or premature infants. We suggest two possible conclusions from our study. The first is that nasopharyngeal swabs and endotracheal secretions are improper specimens for C. trachomatis. The second is that C. trachomatis infection is lower in our study.

Clinical and Molecular-epidemiologic Analysis of A Nosocomial Outbreak of Acinetobacter baumannii in a Neonatal Intensive Care Unit

PURPOSE: Acinetobacter species are aerobic gram-negative rods that can be widely found in nature and are a part of the normal flora of humans. The most clinical isolates of A. baumannii reflect infection rather than colonization. Recent reports suggest that the organisms cause serious and often fetal nosocomial infection such as ventilator-associated pneumonia. METHODS: From March to September 1998, we experienced thirty clinical isolates of A. baumannii in fifteen patients in Sonchunhyang University Chunan Hospital neonatal intensive care unit. Clinical characteristics, bacteriologic investigation, and molecular epidemiologic investigation by randomly amplified polymorphic DNA (RAPD) method was performed. RESULTS: The number of clinical isolates of A. baumannii were thirty and the number of Acinetobacter cases were fifteen. The duration of hospitalization and ventilator support were significantly longer in the patient group than in the control group. The most common culture site of A. baumannii was the endotracheal tube (83.3%). The thirty clinical isolates showed resistance to the most commonly used antibiotics. The RAPD result of A. baumannii isolated from fifteen patients showed the same band patterns, designating they were of the same strain. Surveillance cultures of medical staffs' hands, incubators, and ventilators failed to identify the source of infections. CONCLUSOIN: It is possible to have an outbreak of A. baumannii in a neonatal intensive care unit. In A. baumannii infection, the durations of hospitalization and ventilator support were significantly longer. It is very difficult to discover the source of A. baumannii outbreak.

Clincal Trial of Percutaneous Central Vein Catherization Via Great Saphenous Vein

PURPOSE: We performed a comparative study on clinical impacts in the neonatas in the neonatal intensive care unit (NICU), who received vascular access through percutaneous central venous catheterization (PCVC), between one group via vessels of upper extremity, and the other group via the great saphenous vein. METHODS: We evaluated a total of 158 PCVC cases performed in the NICU of Soonchunhyang Chunan Hospital over 1 year 8 months from January, 1997 to September, 1998. The 134 cases of PCVC were performed via veins located on upper extremity and 34 cases of this procedures were performed via veins located on the great saphenous vein. We have compared success rates, clinical characteristics, indwelling time, causes of removal of the catheters, and associated complication between both upper extremity group and the great saphenous vein group retrospectively. RESULTS: There were no significant differences in the mean gestational age, birth weight, weight at the time of insertion between two groups. There were no significant differences in indwelling time between two groups, 20.0+/-12.8 days in upper extremity group, and 13.1+/-4.4 days in great saphenous vein group respectively (P<0.1). The overall success rate of insertions was 94.9% (150/158), the success rate of upper extremity group was 96.3% (129/134) and great saphenous vein group was 87.5% (21/24) and there were no significant differences. The most common site of tip of catheter was right atrium in both groups, that was confirmed by radiologic evaluation after venous access. The common cause of removal of the catheter was elective in both groups. Another secondary common cause of removal was mechanical complication, the rate of which was 17.1% in upper extremity group, 33.3% in great saphenous vein group. CONCLUSION: We found that there were no significant differences on success rate of insertion of central venous catheter between two groups and the rate of removal of catheter from mechanical complication caused by obstruction of it were higher in great saphenous vein group, than upper extremity group in comparison. Accordingly, further study should be performed about handling and management of central venous catheter after catherization via great saphenous vein.

A Case of Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects(OEIS syndrome)

Omphalocele-exstrophy-imperforate anus-spinal defects(OEIS Syndrome) is a single defect in early mesoderm, and its incidence is about one in 250,000. If was first described by Littre in 1709. The characteristics of this disorder is omphalocele, extrpohy of bladder, imperforate anus and spina bifida. There have been reports of longtime survival made possible by several operations, but for most cases normal life is impossible due to the deformities. We report a case of OEIS complex who had omphalocele, exstrophy of bladder, imperforate anus and spina bifida from birth.

A Case of Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects(OEIS syndrome)

Omphalocele-exstrophy-imperforate anus-spinal defects(OEIS Syndrome) is a single defect in early mesoderm, and its incidence is about one in 250,000. If was first described by Littre in 1709. The characteristics of this disorder is omphalocele, extrpohy of bladder, imperforate anus and spina bifida. There have been reports of longtime survival made possible by several operations, but for most cases normal life is impossible due to the deformities. We report a case of OEIS complex who had omphalocele, exstrophy of bladder, imperforate anus and spina bifida from birth.

A Study on Subtypes of Thyroid Disorders Detected by Neonatal Screening Test / 대한소아내분비학회지

PURPOSE:The project of the neonatal mass screening test for inborn errors of metabolism are just at the beginning in Korea and there was a few reports about the overall incidence and subtypes of congenital hypothyroidism. METHODS:In this study, we analysed the 97 cases of newborns with hyperthyrotropinemia who were detected by neonatal screening test to identify the incidence and early clinical manifestations of each subtypes of congenital hypothyroidism. Thyroid function were measured by thyrotropin(TSH) level, T4, T3, Free T4, Free T3, thyroglobulin, T3 resin uptake, TBII, TBG in serum, thyroid ultrasonography and 99mTc thyroid scan. We reanalysed the thyroid functions 1 week after discontinuance of L-thyroxine treatment for 1 year. RESULTS: 1) The time of neonatal screening test were between 3 and 7 days after birth in 46 cases(47.4%) and 8 and 14 days after birth in 35 cases(36.1%). Two cases (2.1%) were done neonatal screening test at the age of 2 days old. 2) The major cause of thyroid disorders were primary hypothyroidism in 45 cases of the total due to thyroid aplasia(7 cases), thyroid hypoplasia(17 cases), ectopic thyroid gland(12 cases) and dyshormonogenesis(9 cases). Other causes of thyroid disorders were TBG deficiency(11 cases), TBG dysfuction(1 case), transient hyperthyrotropinemia(28 cases) and transient hypothyroidism(12 cases). 3) Serum level of thyrotropin(TSH) at diagnosis were 223.5+/-229.6microU/ml in thyroid aplasia, 41.6+/-42.9microU/ml in thyroid hypoplasia, 52.4+/-55.6microU/ml in ectopic thyroid gland. TSH levels were significantly high in thyroid aplasia. T4 levels in thyroid aplasia are 1.7+/-2.0microg/dl and this is significantly lower than other types of thyroid disorders. T3 levels were within normal range except in thyroid aplasia and TBG deficiency. 4) Prolongation of physiologic jaundice was the most common clinical manifestation(33.3%) in patients with primary hypothyroidism and macroglossia, hypothermia, umbilical hernia and cold skin were the next commom clinical manifestations in order to present. 5) Osseous development was normal in 57 cases(82.6%) out of 69 cases who accomplished roentgenographic examination of knees. Only 12 cases(17.4%) showed retardation of osseous development, but there was no significant differences between types of thyroid disorders. 6) Most of the newborn(93.3%) with primary hypothyroidism started to treatment within 8 weeks of age. 7) Initial dosage of L-thyroxine was 10microg/kg/day and decreased 6 to 12 months after treatment. 8) There was significantly decreased thyroid uptake of 99mTc after 1 year follow-up in 5 cases of dyshormonogenesis. 9) The serum TSH levels returned to normal ranges within 6 month after treatment in transient hypothyroidism and transient hyperthyrotropinemia. CONCLUSIONS:Special attention should be paid to transient hyperthyrotropinemia and transient hypothyroidism because many of the congenital thyroid disorders showed transient type and it is necessary to establish the diagnostic guideline to early detect these transient types of congenital thyroid disorders.

Surgical Treatment of the Acute Anterior Cruciate Ligament Injuries / 대한정형외과학회잡지

The anterior cruciate ligament(ACL) is one of the major stabilizers of knee motion. The ACL does not heal once torn, unlike many other biological tissues. Its absence can lead to severe joint instability which can lead to disruptions of secondary restraints around the knee and then progress to degenerative joint disease. Thus many authors advocate surgical intervention for a torn ACL in order to restore stability to the joint. Yet, there is still controversy as to best treatment for the ACL injuries. It is desirable to be considered for the patients age, the severity of the injury, and the future activity level of the patient to decide treatment. We analyzed thirty ACL acute injuries of twenty seven patients who had an ACL injury and treated surgically between Apr. 1986 and Dec. 1991 at St. Pauls Hospital. The results were as follows: 1. There were twenty five males and two females. The mean age was 33.4 years ranged, 15 to 52 years. 2. The anterior cruciate ligaments were torn at proximal portion in twenty two cases, at midportion and distal portion in four, respectively. 3. Two knees had isolated ACL injuries and twenty eight had combined injuries. 4. Twenty one out of twenty six cases treated with primary repair, and three out of four cases treated with reconstruction had good-excellent results.

Treatment for posterior cruciate ligament injury / 대한정형외과학회잡지

No abstract available.

Transpubic Urethroplasty / 대한비뇨기과학회지

Urethroplasty was done in 6 patients with posterior urethral disruption with pubectomy and end to end anastomosis or full thickness tube graft of the urethra. The following results were obtained. 1. Transpubic approach provided excellent access to posterior urethra in every case. 2. Immediate cystostomy was done in all cases and reconstruction of the urethra later. 3. One of two tube graft and three of four end to end anastomosis were successful. 4. There were no orthopedic problem, incontinence or sexual impotency.

Clinical Observation on In-patient of Genitourinary Tract Tuberculosis / 대한비뇨기과학회지

A clinical observation was made on 60 cases of genitourinary tract tuberculosis who were admitted to National Medical Center during the period from January 1976 through December 1980. Following results were obtained 1. Incidence of genitourinary tract tuberculosis was 6% of all in patients. 2. Most frequent symptoms was those of vesical symptoms such as frequency (53.3%), hematuria (55%) and dysuria (28.3%). 3. Tuberculosis in other combined with genitourinary tract tuberculosis were such as pulmonary tuberculosis (38.3%), pleurisy (5%), spine tuberculosis (3.3%) and tuberculous intestinal fistula (3.3%). 4. Tuberculous epididymitis without radiographic evidence of tuberculous invasion were 12 cases among the patients. 5. The most frequent finding of urine was pyuria (45%) , hematuria (45%) and proteinuria (33.3%). 6. Tubercle bacilli were demonstrated by staining in 26.6%. 7. Excretory urographic findings in 60 cases of renal tuberculosis were non visualization (50%). calyectasis (26.6%). delayed visualization (21.6%), ureteral abnormality (21%) and contracted bladder (15%). 8. Patients were managed by chemotherapy only in 20%, chemotherapy with nephrectomy in 38.3% and chemotherapy with reconstructive surgery in 20%.

Clinical Observation on Giant Hydronephrosis / 대한비뇨기과학회지

A clinical observation was made on five cases of giant hydronephrosis during recent 5 years. The results were as follows: 1. The most common cause of giant hydronephrosis was congenital ureterovesical juncture stricture (3 cases). 2. The male and female ratio was 3 : 2 and age incidence was predominated in children. 3. Positive urinary bacterial culture was obtained in 2 patients among the 5 patients but no growth was observed in the culture of hydronephrotic content in all cases. 4. Operative procedure was nephroureterctomy in all cases and no complication accompanied.

Management of Ureteral Stones / 대한비뇨기과학회지

During 5 years, from January 1976 to December 1980, clinical observation on management of ureteral stones was made on 169 admitted patients with ureter stones. Following results were obtained. 1) Among total 1054 in-patients, 169 cases (16.0%) had ureteral stones, and male to female ratio was 2 : 1. 2) Patients with 20-40 of his age was half. 3) On seasonal distribution, it was most prevalent on Summer. 4) 113 cases were located on lower ureter, and laterality was even. 5) Most common symptoms were renal colic and hematuria (91.8%) 6) Ureterolithotomy was done in 127 cases. In 86 cases of lower ureter stones, less than 1cm in size. conservative fluid therapy and cystoscopic extraction was successful in 44 cases. 7) Post-operative complications were urinary leaking (16 cages), wound infection(12 cases), hematuria (3 cases), ureteral stricture (1 case), and pyelonephritis (1 case).

Urinary Diversion Using the Intestinal Segments / 대한비뇨기과학회지

A clinical observation on 18 cases of urinary diversion using the intestinal segment was made on who had been admitted to the Department of Urology from January. 1972 to December, 1979. 1) of 18 cases of urinary diversion, 15 were ureteroileocutaneostomy with total cystectomy and 3 were ureterosigmoidostomy. 2) 55 percent was fifth and sixth decades of age and the male to female ratio was two to one 3) The most common underlying disease was bladder cancer (89 percent) 4) Improvement was shown 66 percent of the cases in renal function and 50 percent in intravenous pyelographic finding, deterioration was shown 33 percent of the cases in renal function and 20 percent in intravenous pyelographic finding. 5) Major complications were wound infection, intestinal obstruction, acute pyelonephritis, ureteroileal obstruction, wound dehiscence, acute renal failure and pneumonia in order. 6) 6 cases were died from cancer recurrence within 4 years.

Clinical Observation on the Hypospadias / 대한비뇨기과학회지

A clinical observation was done on 24 cases of hypospadias during the past 5 years from January 1975 to December 1979. 1. The hypospadia had high incidence rate among the anomalies of G-U tract (22.5%). 2. Of 24 hypospadias, 16 cases(66,7%) were penoscrotal, 5 cases (20.8%) were perineal and 3 cases (12.5%) were penile. 3. Cryptorchism was the most common associated anomaly and it occupied 33.3% of 15 associated anomalies. 4. Of 20 urethroplasty, 10 cases (71.1%) were successed by buried skin tube method and over-all success rate was 60%.

Radionuclide Evaluation of Renal Function / 대한비뇨기과학회지

The Radionuclide study provides reproducible information about total and differential renal function quickly and easily. The major limitation of radionuclide examination is that it does not provide a sensitive and accurate illustration of the anatomic change of the kidney but the excretory urogram provides an excellent evaluation of anatomic change in the kidney, but is a poor indicator of renal function. Therefore, the excretory urogram and renal radionuclide (rectilinear renal scanning and renogram) renal function evaluation and to discuss the result of its use comparing to 34 cases of severe abnormal anatomic change in excretory urogram. 1. The urolithiasis was 12 cases (50%) and renal tuberculosis was 7 cases (21%). 2. 18 cases (53%) was non visualization in IVP and 5 cases (28%) was maintained the renal function. The most common causes of non visualization were urolithiasis (5 cases) and renal tuberculosis (5 cases). 3. 12 cases were hydronephrosis and 6 (50%) cases were maintained good function in radionuclide study.

Leiomyoma of the Urinary Bladder: A Case Report / 대한비뇨기과학회지

A case of leiomyoma of the urinary bladder is presented.