Lung Abscess and Bacteremia Caused by Neisseria flavescens and Streptococcus sanguis in Patient with Idiopathic Hypereosinophilic Syndrome / 대한임상미생물학회지

Neisseria flavescens has been rarely reported as a pathogen in the literature. We experienced a case of N. flavescens bacteremia and lung abscess co-infected with Streptococcus sanguis in patient with idiopathic hypereosinophilic syndrome. A 15-year-old boy was diagnosed with idiopathic hypereosinophilic syndrome complicated with pulmonary thromboembolism. He was given systemic steroids and thrombolytics. After 8 weeks of therapy, a lung abscess appeared on the plain chest radiograph. We treated him with empirical antibiotics and carried out surgical drainage. Two types of microorganisms were cultured from both blood and pus samples, obtained in the first day of hospitalization. Pus was aspirated from the lung abscess with an aseptic technique. Neisseria species and S. sanguis were identified using traditional methods. To confirm the identity of the Neisseria species, we conducted further testing using 16S ribosomal ribonucleic acid sequencing whereupon N. flavescens was identified. This is the first case report of pulmonary infection caused by N. flavescens. We suggest that N. flavescens may act as a pathogen.

Acute Hyponatremia in Pneumonia and CNS Infections of Children

PURPOSE: The option of selecting isotonic rather than hypotonic fluids for maintenance fluid in children has been advocated by some authors. Pneumonia and CNS infections are frequent clinical settings for acute hyponatremia because of nonosmotic anti-diuretic hormone stimuli in children. We conducted the present study to identify the incidence of hyponatremia in pneumonia and CNS infection of children and to determine the importance of maintenance intravenous fluid therapy regimen and other related factors. METHODS: The study included 1,992 patients admitted to the Department of Pediatrics at Pusan National University Children's Hospital between November 2008 and August 2011, who were diagnosed with pneumonia or CNS infections and checked for serum sodium concentration. Their clinical data including laboratory findings were reviewed retrospectively. RESULTS: During the study period, 218 patients were identified to have acute hyponatremia among 1,992 patients. The overall incidence of hyponatremia was 10.9%. The incidence of hyponatremia in encephalitis (37.3%) was highest and the incidence in bacterial meningitis (27.4%), viral meningitis (20.0%), bacterial pneumonia (11.1%), mycoplasma pneumonia (9.2%), and viral pneumonia (6.8%) were in descending order. The mean age was higher in hyponatremic patients than in isonatremic patients. The incidence of hyponatremia was higher in who had 0.18% NaCl in 5% dextrose (D5 0.18% NS) than 0.45% NaCl in 5% dextrose infusion (D5 1/2NS) (9.0% vs. 2.2%). SIADH was identified in 20.5% among hospital acquired hyponatremic patients after adequate evaluation for SIADH. CONCLUSION: We recommend D5 1/2NS rather than D5 0.18% NS as the maintenance fluid given to children with pneumonia or infectious CNS diseases.

Juvenile Polyp and Colonoscopic Polypectomy in Childhood / 대한소아소화기영양학회지

PURPOSE: This study aimed to evaluate the clinical features of juvenile polyp and the usefulness of polypectomy with entire colonoscopy in children. METHODS: We retrospectively reviewed the medical records of 83 children who were diagnosed with having juvenile polyps. RESULTS: The mean age of the patients was 6.5+/-3.7 (range 1.3-14.5 years) years. The male to female ratio was 2.1 : 1. Eighty one patients (97.6%) had hematochezia, of which the observed characteristics included red stool (74.1%), blood on wipe (13.6%). The time interval between the 1st episode of hematochezia and colonoscopy was 8.9+/-20.4 (ranged 0.1-48.0) months. The most proximal regions of colonoscopic approach were terminal ileum (96.4%). Sixty three patients (75.9%) had a solitary polyp and 20 patients (24.1%) had multiple polyps. The sites of the polyps were rectum (61.4%), sigmoid colon (23.5%). Eighteen polyps (15.1%) were found more proximal locations than rectosigmoid. The polyp size ranged from 0.3 to 5 cm. After the polypectomy, hematochezia recurred in 9 patients. Endoscopic hemostasis was performed in 2 patients due to severe bleeding. All procedures were carried out without using general anesthesia. CONCLUSION: Juvenile polyp occurred in a wide range locations and had variable sizes and numbers, suggesting that colonoscopy on the entire colon is necessary. Colonoscopic polypectomy is a simple and useful therapeutic method in children with juvenile polyp.

Bronchiolitis Obliterans in Children: A Single Institution Experience / 소아알레르기및호흡기학회지

PURPOSE: Although bronchiolitis obliterans (BO) most often occurs after infection, the incidence of post-transplant BO has recently increased due to the increase of organ and bone marrow transplantation. However, there is limited data on the responses to treatment using measurements of pulmonary function in patients with BO. This study aimed to describe clinical characteristics and pulmonary function in children with BO from a single institute and to compare the responses according to treatment modalities in children with post-infectious BO. METHODS: This study was conducted on 22 children who were diagnosed with BO from January 2005 to December 2010. Based on the medical chart, treatment courses and prognosis of the patients were examined retrospectively. The severity of clinical symptoms was determined by the Denver symptom score, basal pulmonary function, and responses to bronchodilators; all parameters were measured and compared between the time of diagnoses and follow-up six months later. RESULTS: The mean age of the patients when diagnosed with BO was 8.3+/-6.6 years; of those patients, sixteen were boys and six were girls. Nineteen cases of BO were associated with acute infection, and the most common cause of those cases was adenovirus. Three cases of BO occurred following allogeneic bone marrow transplantation for acute myelogenous leukemia. The Denver symptom scores at the time of diagnosis were averaged to 3.95+/-0.63, and the average symptom score after follow-up of six months was 2.15+/-0.73. The averages of the % forced vital capacity (FVC), % forced expiratory volume in 1 second (FEV1), and % forced expiratory flow, midexpiratory phase (FEF25-75%) at the time of diagnosis were 69+/-13%, 40.5+/-12.7%, and 17.6+/-7.8%, respectively, and FEV1/FVC was 56.7+/-10.9%. The averages of %FVC, % FEV1, and %FEF25-75% six months after diagnosis were 78+/-17.3%, 62.5+/-16.5%, and 35.6+/-9.5%, respectively, and FEV1/FVC was improved to 70.7+/-18.9%. Symptom scores of the group treated with high dose systemic steroids decreased significantly compared to those of the group treated with inhaled corticosteroids (P<0.05). Likewise, improvement of FEV1/FVC after treatment was greater in the group treated with high dose systemic steroids than in the group treated with inhaled corticosteroids (P<0.05). CONCLUSION: Infections are the more frequent causes of BO in our institute, and adenovirus ismost common. Six-month follow-up study results suggest high dose systemic steroids could lead to better improvement of clinical symptoms and pulmonary function in children with post-infectious BO.

The Morris Water Maze Performance in Androgenized Female Rats: Sexual Dimorphisms in Spatial Memory and Effects of Testosterone / 신경정신의학

OBJECTIVES: It is widely accepted that gonadal steroids are involved in organization and activation of sexual dimorphism in the brain areas related with spatial learning. This study aimed to test the following hypothesis: 1) spatial memory is affected by sex, 2) this difference is related with brain differentiation by exposure to testosterone in the neonatal period, and/or 3) the sexual difference of spatial memory is the result of the interaction between organization of sexual dimorphism in the brain and the circulating testosterone after growing up. METHODS: Testosterone enanthate 100 microgram ('androgenized') or vehicle ('control') was randomly administered to 28 female and 25 male rat pups within 24 hour of birth. The escape latencies (EL) in Morris water maze were measured in 15 and 16 week of age with vehicle ('baseline') and with 10 micromol/kg of testosterone ('with testosterone'), respectively. Each session consisted of 10 trials, and means of the last 5 trials were analyzed. RESULTS: The baseline EL of the males were significantly shorter than females regardless of neonatal exposure to testosterone. With testosterone, EL of the androgenized females were significantly shorter than control females and comparable to those of males. CONCLUSION: Neonatal exposure to testosterone in female rats may develop a tesosterone-dependent male-like spatial learning system.

Correlation between Serum Estrogen and Spatial Memory in Peripartal Rats / 신경정신의학

OBJECTIVES: This study was designed to find possible effect of pregnancy and parturition on spatial memory, especially in relation to levels of estrogen during the third trimester and postpartal period in rats. METHODS: 25 female Sprague Dawley rats were divided into pregnant group (N=14) and control group (N=11). Changes in spatial memory during 6 weeks including third trimester and postpartal period were measured using Morris water maze. Time to reach the platform in the maze was indicator of spatial memory. Serum estrogen level was measured on 1 week before delivery, postpartal day 1, and day 14. RESULTS: Both groups showed gradual improvement in performance by trial days and weeks, but no significant difference was found between the two groups. However in the third trimester, pregnant group showed a trend of less achievement on 3 days of learning than control group. Serum estrogen levels did not differ significantly between groups over the 6 weeks of period. However there was positive correlation between serum estrogen level on postpartum day 1 and time to reach platform on postpartum week 2, and negative correlation between estrogen level on postpartum day 14 and latency to the platform on postpartum week 5. CONCLUSION: These results imply that changes in the serum estrogen level may have dual effects on the spatial learning in peripartal period. It is suggested that decline in cognitive function might occur either by failure of rapid decrease of estrogen, immediately after parturition, or retarded restoration of estrogen in later postpartal period.

Effect of Naltrexone on Acute Alcohol Response in Social Drinker / 신경정신의학

OBJECTIVES: We investigated the effects of naltrexone on acute alcohol response, stimulant and sedative, in healthy social drinkers using two doses of alcohol intake. METHODS : Twenty four healthy male medical students were voluntarily participated. The experimental method was crossover design. Subjects received 25 mg/day or 50 mg/day of naltrexone on the experimental days. Biphasic Alcohol Effects Scale (BAES), alcohol craving, and blood alcohol concentration (BAC) were measured before drinking and at 15, 30, 45, 60, 90, and 120 min after drinking. RESULTS : 1) Group of 0.6 mg/kg of alcohol intake. When the scores of stimulative subscale of BAES were compared between the naltrexone and control group, the scores were significantly lower in the naltrexone group at 15 and 90 min after drinking. Alcohol induced sedative effect was significantly higher in the naltrexone group at 90 min after drinking. The alcohol induced alcohol craving at 45 and 60 min after drinking was significantly lower in the naltrexone group as compared to the control. 2) Group of 0.3 mg/kg of alcohol intake. The alcohol induced stimulative effect evident in the control group seen in the time span of 15 to 45 min after drinking was not seen in the naltrexone group. The increase of alcohol induced alcohol craving noticed at 30 min after drinking in the control group was not seen in the naltrexone group. BAC at 15 min after drinking was lower in the naltrexone group compared to the control. CONCLUSION : Naltrexone is suggested to attenuate stimulative effect, to intensify sedative effect, and to block alcohol induced alcohol craving. These triple actions might be utilized for treatment and prevention of relapse of alcohol dependence.

Extracardiac Aneurysm of the Sinus of Valsalva: A Case Report / 대한흉부외과학회지

Aneurysm of the sinus of Valsalva on mostly congenital disease that develops more frequently in Orientals, is very low in incidence. In most cases, aneurysm of the sinus of Valsalva extends to intracardiac and results in ruptures into the right ventricle or atrium. The likelihood of extracardiac aneurysm of the sinus of Valsalva is very low. Cases of extracardiac aneurysm are usually accompanied by aortic regurgitation and can cause right ventricle outflow tract obstruction, myocardial ischemia, and myocardial infarction due to compression by aneurysm. Since the aneurysm can rupture in the intrapericardium and cause cardiogenic shock or sudden death, definite diagnosis and management are important. If confirmed, it is preferable operform a surgical correction. We report here, with a literature review, a case where myocardial ischemia and aortic egurgitation caused by aneurysm developed in the left coronary and noncoronary sinus, and were surgically corrected with satisfactory esults.

Clinical Results of Mitral Valve Replacement with St. Jude Medical Valve / 대한흉부외과학회지

A total of 172 cases of MVR using the St. Jude Medical valve was conducted in the period from August 1986 to May 1996. The hospital mortality rate was 3.5% (n=6) and the late mortality rate was 3.3% (n=5). According to the follow-up of 161 surviving patients, the average length of survival was 50.23+/-0.27 months. Three cases of prosthetic valve related complication deaths were identified. Two cases could be ascribed to left atrial thrombi and resulting cerebral infarction, and one case was prosthetic valve endocarditis. Two cases were caused by hemorrhagic complications that we presume to have been accompanied by anti-coagulation therapy. The actuarial survival rate of all cases at 10 years was 92.3%. We conclude that good clinical results and a low complication rate could be achieved through mitral valve replacement with the St. Jude Medical valve. We also conclude that mid-term and long-term follow-ups were instrumental and necessary.