Breast abscess caused by Staphylococcus aureus in 2 adolescent girls with atopic dermatitis / 소아과

Atopic dermatitis (AD) is a chronic inflammatory skin disease in children. Patients with AD experience a high rate of colonization of the skin surface by Staphylococcus aureus. Because of a skin barrier defect, there is a potential risk of staphylococcal invasive infection in patients with AD. Here, we present 2 cases of breast abscess caused by S. aureus in 2 adolescent girls with severe AD. Methicillin-sensitive S. aureus was identified from the breast abscess material. They were treated with appropriate antibiotics, however surgical drainage of the abscess was needed in case 1. Identical strains were found from the breast abscess material as well as the lesional and the nonlesional skin of the patients through matrixassisted laser desorption/ionization time-of-flight analysis. We characterized the differential abundance of Firmicutes phylum in patients' skin in microbiota analysis. In particular, S. aureus, a member of Firmicutes, differed significantly between the lesional and the normal-appearing skin. Our cases demonstrate the potential severity of bacterial deep tissue infection in AD and the dysbiosis of skin microbiota may be involved in inflammation in AD.

Is Transradial Cerebral Angiography Feasible and Safe? A Single Center's Experience

OBJECTIVE: Although a transradial angiography is accepted as the gold standard for cardiovascular procedures, cerebral angiography has been performed via transfemoral approach in most institutions. The purpose of this study is to present our experience concerning the feasibility, efficacy, and safety of a transradial approach to cerebral angiography as an alternative to a transfemoral approach. METHODS: Between February 2007 and October 2009, a total of 1,240 cerebral angiographies were performed via a transradial approach in a single center. The right radial approach was used as an initial access route. The procedure continued only after the ulnar artery was proven to provide satisfactory collateral perfusion according to two tests (a modified Allen's test and forearm angiography). RESULTS: The procedural success rate was 94.8% with a mean duration of 28 minutes. All supra-aortic vessels were successfully catheterized with a success rate of 100%. The success rates of selective catheterization to the right vertebral artery, right internal carotid artery, left internal carotid artery, and left vertebral artery were 96.1%, 98.6%, 82.6% and 52.2%, respectively. The procedure was performed more than twice in 73 patients (5.9%), including up to 4 times in 2 patients. The radial artery occlusion was found in 4 patients (5.4%) on follow-up cerebral angiography, but no ischemic symptoms were observed in any of the cases. CONCLUSION: This study suggests that cerebral angiography using a transradial approach can be performed with minimal risk of morbidity. In particular, this procedure might be useful for follow-up angiographies and place less stress on patients.

Acute Aneurysmal Subdural Hematoma: Clinical and Radiological Characteristics

OBJECTIVE: Acute spontaneous subdural hematoma(SDH) secondary to a ruptured intracranial aneurysm is a rare event. The authors present nine cases with aneurysmal SDH. METHODS: We analyzed nine cases of aneurysmal SDH from 337 patients who underwent treatment for a ruptured aneurysm between January 1998 and May 2004. Clinical and radiological characteristics and postoperative course were evaluated by reviewing medical records, surgical charts and intraoperative videos. RESULTS: The nine patients comprised four males and five females with a mean age of 53years (range 15-67years). The World Federation of Neurosurgical Societies grades on admission were I in one patient, II in two patients, III in five patients and V in one patient. With respect to location, there were four internal carotid-posterior communicating artery(ICA-Pcom) aneurysms, one distal anterior cerebral artery(DACA) aneurysm, one anterior communicating artery and three middle cerebral artery aneurysms. CT scans obtained from the four patients with ICA-Pcom aneurysms revealed SDH over the convexity and along the tentorium, and two of these patients presented with pure SDH without subarachnoid hemorrhage(SAH). In three patients with ICA-Pcom aneurysm, the ruptured aneurysm domes adhered to the petroclinoid fold. In the patient with the DACA aneurysm, the domes adhered tightiy to the pia mater and the falx. CONCLUSION: Ruptured intracranial aneurysm may cause SDH with or without SAH. In the absence of trauma, the possibility of aneurysmal SDH should be considered.

The Delayed Phase of Protection in Heat-Induced Preconditioning: Role of the Heat Shock Protein associated with cytoskeleton

BACKGROUND AND OBJECTIVES: We investigated the ability of a brief heat shock on day one to provide delayed protection against lethal heat stress on day two in a rat-derived H9c2 cardiomyoblast cell line with reference to the role of heat shock protein 25/27, 70i and the p38MAPK signalling pathway. MATERIALS, METHODS AND RESULTS: Heat preconditioning(Heat P; 20min at 42+/-0.1degrees C) and adenosine(ADO) administered on day 1 protected against cell death under lethal heat challenge (75min at 42+/-0.1degrees C) on day 2 as measured by MTT test: ( % cell viability: Heat P: 79.9+/-3.23%, ADO: 71.9+/-4.10% vs. control: 52.7+/-1.65% respectively ). This protection was abolished by treatment with SB203580 or cytochalasine D prior to the protective stimulus on day 1( SB203580: 64.1+/-4.37%, cytochalasine D: 73.1+/-4.33% vs. Heat P ). Western blotting analysis indicated a significant accumulation of hsp70i in Heat P and SB203580-treated Heat P cells compared to control and adenosine-, SB203580-treated cells. Phosphorylation of hsp25 was significantly increased in Heat P cells compared to control cells. We also observed fragmentation of F-actin and formation of F-actin aggregates in cells exposed to lethal heat challenge. In contrast, the delayed cytoprotection preserved the F-actin bundles under lethal heat challenge. Hsp27-overexpressed, stable clones were more resistant to lethal heat shock when compared to control cells transfected with the vector alone. CONCLUSION: These data suggest an important role for p38MAPK/hsp25/27 pathway as a potential distal effector of heat-induced delayed protection.