A Superior Ulnar Collateral Artery Perforator Flap for a Large Defect on the Posterior Upper Arm

A patient underwent reconstruction of skin and soft tissue using V-Y advancement of a superior ulnar collateral artery perforator flap after resection of the scar tissue on the upper arm. Successful flap healing was observed without complications. The medial side of the upper arm is an ideal donor site because of its thin, elastic, and hairless skin, resulting in a well-hidden scar. The elasticity of the medial side of the upper arm allows primary closure after flap elevation. The superior ulnar collateral artery perforator flap is an option for reconstruction of the upper arm.

A Clinical Study of Pediatric Bacterial Meningitis in Daejeon and Chungcheong area : 2006-2010 / 대한소아신경학회지

PURPOSE: The aim of this study was to investigate the causative organisms, clinical manifestations, and prognosis of pediatric patients with bacterial meningitis in Daejeon and Chungcheong area, occurred from 2006 to 2010. METHODS: We retrospectively reviewed medical records of patients aged between 1 month and 15 years, diagnosed with bacterial meningitis at 8 university or general hospitals in Daejeon and Chungcheong area. The bacterial meningitis was defined by isolation of organism from cerebrospinal fluid(CSF). The data was collected from January 2006 to December 2010, and analyzed including patient's demographics, causative organisms, clinical presentation, laboratory findings and complications. RESULTS: During the 5-year study period, 24 patients were diagnosed with CSF culture-proven bacterial meningitis. The most common causative organism was Streptococcus pneumoniae (S. pneumoniae, 37.5%), and the others were group B streptococcus (GBS, 20.8%), Escherichia coli (E. coli, 16.7%), Neisseria meningitidis (N. meningitidis, 8.3%), Haemophilus influenzae (H. influenzae, 4.2%), respectively. They initially complained of fever (95.8%), vomiting (83.3%), anorexia (45.8%), seizure (29.2%), headache (20.8%). The leukocyte counts exceeding 1,000/mm3 in CSF was observed in 14 patients (58.3%). In 15 patients (62.5%), the glucose concentration in CSF was less than 50 mg/dL, 18 patients showed that the protein concentration in CSF was more than 100 mg/dL. Long-term neurologic sequelae were observed in 4 patients (16.7%) and described as hearing disturbance (2 patients), hemiparesis (1 patient) and endocrine dysfunction (1 patient). Ten patients (41.7%) showed abnormal neuroradiologic findings and the most common abnormalities was subdural effusion (25.0%). CONCLUSION: Compared to the previous study performed between 2001 and 2005, S. pneumonia continued to be the leading cause of the pediatric bacterial meningitis in Daejeon and Chungcheong area. The frequency of pneumococcal meningitis was not decreased, despite of the introduction of conjugated pneumococcal vaccination. On the other hand, H. influenzae meningitis was notably decreased.

The Effectiveness of a Low-dose Oral Diazepam Treatment to Prevent Recurrence of Febrile Seizures / 대한소아신경학회지

PURPOSE: This study was aimed to investigate the optimum dose of diazepam to reduce the recurrence of febrile seizures and side effects in children with febrile seizures. METHODS: The subjects of this study included 528 children with febrile seizures (3 months-5 years of age) who were admitted to Eulji University Hospital (Daejeon, Korea) from January 2008 to December 2011. The children divided into four groups according to the dose of diazepam; Group I, 121 patients, received no diazepam therapy, group II, 129 patients, received oral diazepam in a single dose of 0.1 mg/kg after the febrile seizures, group III, 127 patients, 0.2 mg/kg, and group IV, 151 patients, 0.3 mg/kg, respectively. RESULTS: Seizures recurred in 6 of 129 children (4.7%) in group II, 1of 127 children (0.8%) in group III, and none of 151 children in group IV recurred. For the 121 untreated patients, febrile seizures recurred in 20 (16.5%) children. This study revealed a significant difference in the rate of recurrence of febrile seizures between children treated with diazepam and those who were not. And the recurrence rate was decreased by the increment of the dosage of diazepam, but there was no significant difference between groups. The side effects were observed in 19.9% of children treated with diazepam, 3.9% in group II, 12.6% in group III, and 39.7% in group IV, The rate of side effect was also increased with the increment of the dosage. CONCLUSION: An oral diazepam therapy will reduce the incidence of recurrent febrile seizures during the same febrile illnesses. We think the optimum dose of diazepam is 0.1 mg/kg or 0.2 mg/kg rather than 0.3 mg/kg. However, the use of oral diazepam after a febrile seizure should be carefully considered with weighing the benefits and potential adverse effects.

A Correlation Analysis between Febrile Seizures and Viral Infections / 대한소아신경학회지

PURPOSE: Viral infections are common in children,. This study was aimed to identify the correlation between febrile seizures and virus infections, to reduce the use of antibiotics and to help the normal development. METHODS: We studied 114 children with the chief complaint of febrile seizures who visited Eulji Medical University Hospital for from September, 2009 to August, 2010. Data included clinical findings, signs, routine laboratory testing and chest x-ray. Viral and bacterial studies, neuroimagings, electroencephalograms and cerebrospinal fluid studies were performed if clinically indicated. RESULTS: A total of 114 patients were enrolled in the study. The male to female ratio was 2.3:1. The mean age was 27.1 months and incidence was high in patients from 18 to 24 months of age. Generalized seizure was 97.4% and partial seizure was 2.6% in seizure type. Seizures lasted from 1 to less than 5 min in 81 patients (71.1%); within 1 min in 19 (16.7%); from 5 to less than 15 min in 11 (9.6%); and 15 min or more in 3 (2.6%). The etiologies of fever were listed as follows; unknown in 41 patients (36.0%), URI in 27 (23.7%), gastroenteritis in 16 (14.0%), bronchiolitis in 15 (13.2%), pneumonia in 10 (8.9%), croup in 4 (3.5%) and UTI in 1 (0.1%). Among 74 patients in which viral studies performed, 36 patients were positive ; RSV (7), Rhinovirus (6), Parainfluenza virus (4), Adenovirus (3), Influenza A virus (2), Influenza B virus (1), Coronavirus (2), Metapneumovirus (1), Rotavirus (6) and Enterovirus (4). Bacterial cultures were negative in 98.2% but antibiotics were prescribed in 74.5%. Abnormal findings in electroencephalograms were 2. CONCLUSION: The main cause of infection in children with febrile seizure was viral. Therefore a rapid viral testing would lead to an early diagnosis, less invasive investigations and a reduction in empiric antibacterial treatment.

The concept of medical professionalism as for self-employed physicians in Korea

Medical professionalism in Korea is underdeveloped because of a strong state that has been in place for the past one hundred years. If the government actively controls policies and regulates the professional associations under state corporatism, deterioration of professionalism is inevitable. The current medical insurance in Korea is unified as a monopsony, but it is not the 'bipartite corporatism' between the government and the medical profession such as the National Health Services (NHS) in Britain. All insurance matters related to a physician's practice, including standards of treatment and the physician's reimbursement, are handled by the government. Therefore, the authority of medical expertise is subordinate to the authority of the government agency, and physicians are forced to follow the goals and policies that are set by the government. Physicians' professional ethics are the core of their occupational control. The declaration of "Codes of Ethics" by the Korean Medical Association, before it was revised in April 2006, defined a "sincere fulfillment in practicing medicine" as a full duty of the physician's life. If this declaration was intended to be interpreted literally, all physicians in Korea could be asked to pursue identical lives with the same goals as their professional life as a physician. If it was not intended to be interpreted literally, then physicians may develop their own ethical approaches according to their individual perspectives on life. The former case is an unethical form of state control while; the latter case would make legitimate occupational regulation impossible. The ideal of medical service is an institutional attribute of an occupation and not a duty of an individual's life. Therefore, it should be possible for physicians to work under an occupational control that requires specific standards for the members of the profession and embodies their professional values.

Risk Factors of Nosocomial Sepsis in Very Low Birth Weight Infants

PURPOSE: This study was performed to estimate the incidence of nosocomial sepsis and to identify the most relevant risk factors for nosocomial sepsis in high-risk very low birth weight (VLBW) infants. METHODS: A retrospective review of 341 VLBW infants, admitted to the Neonatal Intensive Care Unit of the Eulji University Hospital (Daejeon & Seoul) between January 2002 and June 2009, who survived more than 72 hours was performed. The incidence, causative organisms, risk factors and prognosis of nosocomial sepsis in VLBW infants were analyzed. RESULTS: The incidence of nosocomial sepsis was 16.1% and the onset date of nosocomial sepsis was 21.5+/-15.9 days (mean+/-SD) after delivery. Staphylococcus aureus (21.3%) was the most common organism in the patients with nosocomial sepsis in VLBW infants. The multiple logistic regression analysis showed that, gestational age [odds ratio (OR), 0.87; 95% CI, 0.83-0.91], umbilical artery catheter use for more than 5 days (OR, 2.2; 95% CI, 1.15-4.46), umbilical venous catheter use for more than 5 days (OR, 2.1; 95% CI, 1.11-4.16), peripheral arterial line use (OR, 2.1; 95% CI, 1.14-4.04) and intravenous intralipids (OR, 4.3; 95% CI, 1.13-14.32) were identified as risk factors. CONCLUSION: The limited usage of intravascular catheter related procedures and the short providence of intravenous nutrition may decrease the incidence of nosocomial sepsis in VLBW infants.

Loss of Y Chromosome in the Malignant Peripheral Nerve Sheet Tumor of a Patient with Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is one of the most commonly inherited autosomal dominant disorders. In order to determine whether genomic alterations and/or chromosomal aberrations involved in the malignant progression of NF1 were present in a Korean patient with NF1, molecular and cytogenetic analyses were performed on the pathologically normal, benign, and malignant tissues and primary cells cultured from those tissues of the patient. The comparative genomic hybridization (CGH) array revealed a Y chromosome loss in the malignant peripheral nerve sheet tumor (MPNST) tissue. G-banding analysis of 50 metaphase cells showed normal chromosomal patterns in the histopathologically normal and benign cultured cells, but a mosaic Y chromosome loss in the malignant cells. The final karyotype for the malignant cells from MPNST tissue was 45,X,-Y[28]/46,XY[22]. The data suggest that the somatic Y chromosome loss may be involved in the transformation of benign tumors to MPNSTs.

A Clinical Study of Febrile Convulsions in Children Over 5 Year Olds without Organic Problems / 대한소아신경학회지

PURPOSE: Febrile convulsions are the most common form of childhood seizures, appearing between in children 3 months and 5 years of age and are predominantly of benign nature. Febrile convulsions occurring after 5 years of age might be estimated as epilepsy. Most data for these disorders are from mainly epilepsy populations and might not be relevant to these children, and the requirement of any specific treatment or workup is not yet established either. Thus we tried to obtain a unique perspective. METHODS: Clinical data for episodes of febrile convulsions were collected in Eulji hospital in Deajeon. These were obtained from anonymised copies of a standardised admission note, emergency, nursing, and intensive care unit notes and interviews with parents, medical, nursing, and paramedic staff. RESULTS: Finding of 259 episodes of febrile seizure in over 5 year olds. 121(46.7%) were confirmed epilepsy or afebrile seizure in under 5 year olds, 13(5.0%) were caused by infection, metabolic disorder, leukemia and so on, and 23(8.9%) had previous neurological defect. Lastly, 102(39.4%) were included to febrile convulsion in over 5 year olds. 28(27.5%) of the subjects had their initial febrile convulsions in children over 5 year olds while 74(72.5%) of the subjects were under 5 years of age. The male to female ratio of the seizure group was 2:1. In the duration and type of convulsions, generalized convulsions occurred predominantly within 15mins in both of them. 5(17.9%) of group A and 16(21.6%) of group B showed electroencephalogram abnormality. The most common causes of seizure were common colds. Most of the convulsions occurred less than 24hrs after fever but, there were no abnormal findings in lumbar puncture and brain MRI. CONCLUSION: Febrile seizure in over 5 year olds without organic problems has similar characteristics to febrile convulsion in under 5 year olds. In light of these findings, lumbar puncture and brain MRI do not require a routine checkup for the evaluation of febrile seizure in over 5 year olds. However, encephalography needs to be examined.

Changes in Pathogens and Antibiotic Sensitivities in very Low Birth Weight Infants with Neonatal Sepsis

PURPOSE: To set up an appropriate treatment plan for neonatal sepsis by investigating changes in pathogens and antibiotic sensitivities. METHODS: The medical records of very low birth weight infants (VLBWI) admitted to the neonatal intensive care unit (NICU) of the Eulji University Hospital between January 2000 and June 2006 were retrospectively reviewed. The culture reports were analyzed for causative microorganisms and antibiotic sensitivities. RESULTS: Among 164 neonates, 19 neonates (11.6%) had 26 episodes of culture-proven sepsis. Very late onset sepsis was the most common type. The dominant pathogens of sepsis included Klebsiella pneumoniae, Streptococcus spp., coagulase negative Staphylococcus and Enterobacter spp., and were mostly multi-drug resistant. CONCLUSION: For the appropriate treatment of neonatal sepsis, proper use of antibiotics through the periodic review and understanding of changes of the microorganisms and antimicrobial sensitivities is necessary to prevent multi-drug resistant microorganisms and to avoid excessive use of broad-spectrum empiric antibiotics.

Comparison of the Therapeutic Effects of Curosurf(R) and Newfactan(R) in Respiratory Distress Syndrome

PURPOSE: The aim of this study was to compare the clinical effects of modified porcine (Curosurf(R)) and bovine (Newfactan(R)) surfactants in the treatment of neonatal respiratory distress syndrome. METHODS: Between April 2004 and December 2006, 65 neonates (birth weight < or =2,500 g and gestational age < or =35 weeks) with neonatal respiratory distress syndrome were treated in our neonatal intensive care unit with surfactant. Thirty-one neonates received Curosurf(R) and 34 neonates received Newfactan(R). The neonates were not enrolled if they had major congenital anomalies or meconium aspiration syndrome. We compared the changes in respiratory parameters after surfactant instillation, the incidences of acute and chronic complications, and the mortality between the two treatment groups. RESULTS: Neonatal and maternal demographic characteristics were not different between the groups. The patterns of change in the respiratory parameters after surfactant instillation were not statistically different between the groups. The incidences of surfactant reinstillation and acute complications, such as pneumothorax, patent ductus arteriosus, pulmonary hemorrhage, and grade 3-4 intraventricular hemorrhage, were not different between the neonates who received Curosurf(R) and the neonates who received Newfactan(R). There were no statistically significant differences in the duration of mechanical ventilation, oxygen therapy, hospitalization, prevalence of bronchopulmonary dysplasia, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, and mortality between the groups. CONCLUSION: In the present comparative study, no significant differences in the clinical effects of Curosurf(R) and Newfactan(R) were observed.

Abnormal Visual Evoked Potential Response from Hypoglycemic Encephalopathy in Two Neonates

Although neonatal hypoglycemia is a common metabolic abnormality in newborn infants, brain injuries resulting from isolated neonatal hypoglycemia are rare. Many infants who are hypoglycemic do not exhibit clinical manifestations, while other infants are symptomatic and at risk for permanent brain damage. There is no disagreement that hypoglycemia can cause neonatal encephalopathy and result in permanent brain injury. Occipital brain injury associated with neonatal hypoglycemia can result in long-term disability, epilepsy, and visual impairment. Infants should receive ongoing developmental and visual surveillance for late- onset epilepsy, and visual or cognitive impairment. We report two cases of newborn infants with abnormal visual evoked potentials (VEP) caused by neonatal hypoglycemic encephalopathy.

A clinical study of child bacterial meningitis in Daejeon and Chungcheong area : 2001-2005 / 소아과

PURPOSE: The purpose of this study was to analyze the epidemiology, causative organism, clinical manifestation and prognosis of bacterial meningitis for children after the introduction of Haemophilus influenzae type b (Hib) vaccine in Daejeon and Chungcheong area. METHODS: We analyzed retrospectively 53 medical records who had been diagnosed with bacterial meningitis at 10 general or university hospitals in Daejeon and Chungcheong area. All patients aged 1 month-14 years admitted between January 2001 through December 2005. RESULTS: During the 5-year study period, 40 of all cases were positive for bacterial growth. Of the 40 cases that were CSF culture-proven bacterial meningitis, Streptococcus peumoniae was the most common bacteria for 17 (32.1%) of all cases, followed by H. influenzae for 10 (18.9%), Neisseria meningitidis for 3 (5.7%). In this study, the most common clinical manifestation is fever, accompanied by all cases. CSF leukocyte count was more than 100/mm3 in 45 (84.1%) cases. CSF glucose concentration was less than 50 mg/dL in 42 (79.2%) cases and protein concentration was more than 45 mg/ dL in 49 (92.5%) cases. 45 of all cases made a recovery after treatment and were discharged. Most common complication after treatment is subdural effusion (19.0%) and hearing disturbance (9.4%). CONCLUSION: The most common organism of culture-proven bacterial meningitis in the children beyond neonatal period was S. pneumoniae. Continued surveillance studies were demanded to know the altered incidence of bacterial meningitis, because we expect the incidence of S. pneumoniae meninigitis will be on the decrease after more active innoculation of pneumococcal protein conjugate vaccine.

Neonatal Sepsis Caused by Multi-Resistant Streptococcus Mitis

PURPOSE: Streptococcus mitis, one of the Viridans streptococci, is a normal female genital tract flora. It is known as a common cause of chorioamnionitis and subsequent abortions in perinatal period. Although it has been suggested to be less virulent they can cause severe neonatal infections. In this study, we focused on the clinical presentations of neonatal septicemia and the antibiotic susceptibilities of Streptococcus mitis. METHODS: Nine newborns for whom Streptococcus mitis was isolated from normally sterile sites were seen in the NICU of Eulji University Hospital from Jan. 1 to Dec. 31 2005. Medical records were reviewed for the perinatal risk factors, maternal clinical manifestations, obstetric complications and the placental pathologic findings. We also observed the neonatal clinical courses and antibiotic susceptibilities of Streptococcus mitis. RESULTS: All nine infants were high-risk newborns because of prematurity, low birth weight and/or co-morbid diseases. Clinical manifestations varied from asymptomatic to severe neonatal sepsis. Six cases resistant to ampicillin were all sensitive to vancomycin. Five among them had clinical sepsis, and one infant was asymptomatic. Three cases were sensitive to ampicillin, two of them were asymptomatic and one infant with sepsis was successfully treated with ampicillin and aminoglycoside. CONCLUSION: Streptococci mitis should not be overlooked as a contaminant when isolated from normally sterile sites. If Streptococci mitis or Viridans streptococci are recovered from a high-risk newborn showing no clinical response to penicillin, it would be better to switch antibiotics to vancomycin until the susceptibility results available.

Specific Prenatal Histories and Associated Congenital Anomalies Related to Hydronephrosis in Newborn Infants

PURPOSE: Ultrasonography is being widely used as a standard test in obstetric care, studies on congenital hydronephrosis. Focusing on specific prenatal history and frequently associated anomalies in newborn infants with hydronephrosis, this investigation was intended to suggest particulars that need to be considered in making an accurate diagnosis of fetal hydronephrosis. METHODS: From May 2000 to May 2005, retrospective study was conducted on 67 patients (93 kidney) who had been diagnosed by renal ultrasonography during neonatal periods. Hydronephrosis was defined as having a pelvic diameter more than 5 mm, and was classified into three groups according to their severity;mild (grade I, II), moderate (grade III) and severe (grade IV). RESULTS: This study included 67 cases with 54 male and 13 female infants. There were 35 cases with a specific prenatal history in 22 infants such as oligohydramnios, intrauterine growth retardation, preeclampsia and others. 33 cases in 23 infants had associated anomalies such as urogenital anomalies, cardiac anomalies. Of these 67 infants (97 kidneys), 49.5% was mild, 30.1% moderate, 20.4% severe hydronephrosis. Infants with moderate hydronephrosis had more specific prenatal history and associated anomaly than the mild hydronephrosis did (68.2% vs 31.8%, P<0.001 73.7% vs 26.3%, P<0.001). CONCLUSION: Particular attention should be paid for cases with congenital hydronephrosis with a specific prenatal history to find out any associated congenital anomalies (such as urogenital or cardiac anomalies). This will enable clinicians to establish a more appropriate treatment and postnatal care.

Motor delay: cerebral palsy / 소아과

Motor delay, when present, is usually the first concern brought by the parents of children with developmental delay. Cerebral palsy that is the most common motor delay, is a nonspecific, descriptive term pertaining to disordered motor function that is evident in early infancy and is characterized by changes in muscle tone, muscle weakness, involuntary movements, ataxia, or a combination of these abnormalities. A wide range of causative disorders and risk factors have been identified for cerebral palsy, and broadly classified into 5 groups; perinatal brain injury, brain injury related to prematurity, developmental abnormalities, prenatal risk factors, and postnatal brain injury. Delay in attaining developmental milestones is the most distinctive presenting complaint in children with cerebral palsy. A detailed history and thorough physical and neurologic examinations are crucial in the diagnostic process. The clinician should be cautious about diagnostic pronouncement unless the findings are unequivocal. Several serial examinations and history review are necessary. All children with cerebral palsy should undergo a neuroimaging study, preferably MRI, because an abnormality is documented on head MRI(89%) and CT(77%). The high incidence rates for mental retardation, epilepsy, ophthalmologic defects, speech and language disorders and hearing impairment make it imperative that all children with cerebral palsy be screened for mental retardation, ophthalmologic and hearing impairments, and speech and language disorders; nutrition, growth, and swallowing also should be closely monitored.

Clinical Investigation of Benign Afebrile Seizure with Gastroenteritis / 대한소아신경학회지

PURPOSE: The aim of this study is to characterize detailed clinical features of benign afebrile seizure with gastroenteritis. METHODS: We retrospectively investigated the medical records of 52 patients with benign afebrile seizure and gastroenteritis, who were admitted to the Department of Pediatrics Eulji University Hospital, between February 1996 and January 2005. RESULTS: There were 52 patients with benign afebrile seizure and gastroenteritis:18 boys and 34 girls. Most of the patients(86.5%) were from 12 to 23 months of age. In the monthly distribution, 71.1% were admitted between November and March. Most of the seizures(98.0%) were generalized and 53.9% of those were generalized tonic and clonic. The durations of the seizures were mostly within 5 minutes. 40 patients(76.9%) had 2 or more seizures. The interval between the onset of gastroenteritis and seizures was mostly from 2 to 4 days. Fifteen out of 32 patients were rotazyme positive. Chi-square test was performed to identify if there was any association between rotavirus and afebrile seizure. Rotavirus gastroenteritis has a stastically significant association with afebrile seizure compared to non-rotavirus gastroenteritis(P<0.01). The relative risk between rotavirus and non-rotavirus gastroenteritis was 3.35. However, there were no significant differences in clinical features between two groups. Cerebrospinal fluid was normal and cell counts, glucose and protein levels in all the patients examined. Either brain CT or MRI was performed in 9 patients and demonstrated no neuroradiological abnormalities. Electroencephalography was performed in 47 patients, of whom 43 patients(92.3%) showed normal electroencephalographic patterns. CONCLUSION: Benign afebrile seizure is characterized by the onset age between 12 months and 23 months, multiple episodes of seizure, short duration, generalized type, high incidence between November and March, and rotavirus as a major pathogen.

A Case of Valproic Acid Associated with Acute Pancreatitis / 대한소아신경학회지

Valproic acid is a commonly prescribed medication approved for epilepsy, migraine and bipolar disorder. The common adverse effects associated with valproic acid include nausea, vomiting, tremor and weight gain. Less common but more serious adverse effects can occur. These include irreversible hepatotoxicity and pancreatitis. We report one case of pancreatitis, an uncommon disorder in children, in an 11-year-old boy treated with valproic acid for simple partial seizure.

A Case of Hypophosphatemic Rickets associated with Epidermal Nevus Syndrome

Epidermal nevus syndrome is a rare disease consisting of epidermal nevus and multisystem pathologic conditions associated with anomalies in the central nervous system, bone, eye, heart, vasculature and genito-urinary system. Hypophosphatemic rickets has been rarely observed in association with this syndrome. We report a case of hypophosphatemic rickets associated with epidermal nevus syndrome with review of the literature.

A Case of Suspected Fumarase Deficiency Presenting with Persistent Mild Metabolic Acidosis in Newborn Infant / 대한소아신경학회지

Fumaric aciduria(fumarase deficiency) is a rare inborn error of metabolism resulted from a deficiency of fumarase, one of the constituent enzymes of the Krebs tricarboxylic acid cycle. Enzyme deficiency causes excessive urinary excretion of fumaric acid due to a defective conversion of fumaric acid to malic acid. It usually presents early in infancy with a severe encephalopathy including hypotonia, developmental retardation and frequent seizures. We report a case of suspected fumarase deficiency presenting with persistent mild metabolic acidosis associated with moderate hydrocephalus in a newborn infant.

Acute Epididymo-orchitis in Newborn Infant

Acute scrotum in newborn infants is unusual and it is even more unusual with infectious origin. The causes of acute scrotum in newborn infants include hydrocele, testicular torsion, torsion of an appendix testis, epididymo-orchitis, meconium peritonitis, testicular tumor, scrotal hematoma and reducible or incarcerated inguinal hernia. Because of lack of typical symptoms and signs, the correct diagnosis of surgical emergencies such as testicular torsion and incarcerated inguinal hernia are often delayed. Recently, color Doppler ultrasonography and testicular scans are being used for differential diagnosis of acute scrotum, although the latter is often technically unsatisfactory due to small size of the testicles in newborn infants. We report a seven day-old male infant with acute scrotum who was diagnosed as acute epididymo-orchitis by color Doppler ultrasonography, and saved from unnecessary surgical interventions. Although color Doppler ultrasonography can not give diagnostic clue for acute scrotum, it can reduce the need for explorative surgery.