A Clinical Study of Shigellosis Epidemics over 10 Years in the Kyung Nam Area

PURPOSE: The occurrence of shigellosis patients has increased radically in 2 recent years. For this, the authors investigated the epidemic aspect of shigellosis by regional groups to know whether the epidemic aspect of shigellosis is a general situation which occurs identically in various areas of Kyung Nam. METHODS: We reviewed pediatric patients who were hospitalized in Ulsan(eastern), in Masan(cen tral), in Chinju(western) of Kyung Nam from January, 1988 to April, 1999. RESULTS: A total of 54 cases of shigellosis were noted from Ulsan(12), Masan(21) and Chinju(21) over ten years. The number of patients was 1 each in 1991 and 1993, 5 each in 1998 and 1999 at Ulasan, 9 in 1988, 8 between 1990 and 1995, 3 in 1998, 1 in 1999 at Masan, 1 each in 1990, 1991, 1994, 4 in 1998, 14 in 1999 at Chinju. The shigellosis patients increased from 1998, especially in Chinju. S. flexneri was reported in Masan(AMP)(R)5, AMP+TMP/SMX(R)4) before 1990, in Masan (2) between 1990 and 1995 and in Chinju(AMP(R)7, AMP+MP/SMX(R)1) in 1999. S. sonnei was reported in Ulsan(AMP(R)1, TMP/SMX(R)1), in Masan(6) and in Chinju(AMP(R)2, TMP/SMX(R) 1) between 1990 and 1995 and in Ulsan(TMP/SMX(R)9, AMP+TMP/SMX(S)1), in Masan(TMP/ SMX(R)2, AMP+TMP/SMX(R)1+(S)1) and in Chinju(TMP/SMX(R)6) between 1998 and 1999. CONCLUSION: Independent of the past, shigellosis patients occurred by regional groups in three parts of Kyung Nam. The present epidemic aspect of the eastern area is similar to that of the central area, but is partially similar to that of western Kyung Nam.

Changes in Incidence of Infantile Transient Methemoglobinemia Associated with Infectious Diarrhea during 1989-1999 in Kyungnam Province

PURPOSE: Infantile transient methemoglobinemia(ITM) may develop in association with infectious diarrhea without exposure to any toxic oxidizing agents. We observed that the number of ITM associated with infectious diarrhea have increased at the Gyeongsang National University Hospital (GNUH), located in the western area of Kyungnam province during the last 4 years. To determine whether this phenomenon was similarily observed in the rest of Kyungnam province, we studied the incidence of ITM associated with infectious diarrhea over the last 10 years in Kyungnam Provine. METHODS: All cases with ITM associated with infectious diarrhea were enrolled for this study from Ulsan Donggang Hospital(UDH), Masan Samsung Hospital(MSH), and GNUH over the last 10 years. Their medical records were reviewed retrospectively. RESULTS: Six and twelve cases were identified at UDH and GNUH, respectively, while none were identified at MSH. All the infants were less than 2 months of age and prosented with severe mucoid diarrhea with metabolic acidosis, high C-reactive protein(CRP) concentrations and/or leukocytosis with shift to left. Twelve cases were identified to reveal stool leukocytosis at UGH and GNUH. Eight cases had histories of ingestion of well water. Nine cases occurred in the spring season (May, April, March). Before 1996, a total of six cases occurred at UDH. But one case in 1990 and eleven cases occurred during 1996-99 at GNUH. The increase in the incidence of ITM associated with infectious diarrhea paralleled the increase in the infectious diarrhea in infants during 1996-99 at GNUH. CONCLUSION: The increased in the incidence of ITM associated with infectious diarrhea during the last4 years at GNUH was not observed in other parts of Kyungnam province. Infectious diarrhea, severe acidosis, severe dehydration, cow milk feeding, the spring season and ingestion of well water were considered to be important associateion factors of ITM.

A Childhood Case of Nephrotic Syndrome Complicated with Cerebral Venous Sinus Thrombosis Followed by Left Popliteal Artery Thrombosis

We report a 10-year-old male with steroid-responsive nephrotic syndrome which was complicated by cerebral venous sinus thrombosis including superior sagittal sinus and left popliteal artery thrombosis following 5 months later. At each thrombotic episode, he suffered from relapse of massive proteinuria with hypovolemic crisis, and from hemoconcentration with dehydration due to vomiting or diarrhea. Brain MR angiography confirmed thromboses of superior sagittal sinus, straight sinus, vein of Galen and occipital sinus. Diagnosis of left popliteal artery thrombosis was made according to the clinical observations including pulseless left dorsalis pedis artery, pain and coldness of left lower leg, and reperfusion injury of calf muscle after heparinization. Each thrombotic episode was successfully managed with heparinization, oral warfarin therapy and fresh frozen plasma for the antithrombin III replacement.

Whole Blood and Plasma Vitamin C Level in Healthy Middle and High School Students in Chinju

PURPOSE: Recommended dietary allowance of vitamin C was determined without considering the important function of vitamin C as a first-line antioxidant. We measured the whole blood and plasma vitamin C concentrations of healthy middle and high school students in Chinju to assess the optimal daily vitamin C requirement in these age groups. METHODS: Whole blood and plasma vitamin C concentrations were measured by the 2, 4-dinitrophenylhydrazine method in 780 students from 1st to 3rd grade of at a middle school and high school in Chinju during June 1996. RESULTS: Whole blood and plasma vitamin C concentrations were 1.42+/-0.40mg/dL and 0.92+/-0.40 mg/dL, respectively. Whole blood and plasma vitamin C concentrations decreased as the school grade became higher. Whole blood and plasma vitamin C concentrations did not differ between females and males in the middle school. However, female high school students had a significantly higher whole blood and plasma vitamin C concentrations than male high school students(P<0.001). Fourteen of 390 middle school students(3.4%) and 23 of 390 high school students(5.9%) had whole blood vitamin C concentrations of less than 0.8mg/dL. Forty-six of 390 middle school students (11.7%) and 113 of 390 high school students(29.0%) had plasma vitamin C concentrations less than 0.6mg/dL. Especially, 45.2% of male high school students had plasma vitamin C concentrations of less than 0.6mg/dL. CONCLUSION: Some adolescents, especially almost half the male high school students, didn't have satisfactory plasma vitamin C levels.

Two Childhood Cases of Heat Stroke with Rhabdomyolysis and Multiorgan Failure

Heat stroke occurs when body thermal regulation is upset and unable to dissipate adequate amounts of heat with rise in body temperature. Thus heat stroke may result in rhabdomyolysis and multiorgan failure. We observed two childhood cases of heat stroke with rhabdomyolysis and multiorgan failure. One case was caused by accidentally being left in a car trunk for 3 hours on a sunny afternoon in late spring and the other case occurred climbing a mountain on a hot summer day during a school trip for improving individual self-control. The first case, a boy almost 5 years old, displayed thetypical clinical features of heat stroke including hyperpyrexia, CNS disturbance, hot dry skin, acute liver failure, rhabdomyolysis, oligo- anuric acute renal failure, and disseminated intravascular coagulopathy. He was treated with general supportive care and daily hemodialysis. Despite the aggressive management, he died of shock on the sixteenth day of admission day. The second case, a 14-year-old middle school boy, displayed similiar features of the first case but showed milder symptoms. He was also treated with general supportive care and daily hemodialysis for 10 days. He recovered completely and was discharged in good condition. The public including medical and paramedical personnels should be warned of the dangers of childhood heat stroke, which is potentially lethal, but preventable.

Two Cases of Factor XI Deficiency in Sisters

We experienced two cases of factor XI deficiency in a 5 yearr 7 month-old girl, whose chief complaint was coke-colored gross hematuria, and her 9-year-old elder sister. The laboratory findings were prolonged aPTT and prominent deficiency of factor XI. The gross hematuria of the index case was identified due to acute poststreptococcal glomerulonephritis. So we report two cases of factor XI deficiency with a brief review of the related literature.

A Case of Adrenal Aplasia

Major known causes of neonatal adrenal insufficiency are prolonged maternalsteroid use, adrenal hemorrhage from the perinatal stress and adrenogenital syndrome. Theoretically adrenal aplasia might be a cause of neonatal adrenal insufficiency but it has not been reported yet. We had experienced a case of adrenal aplasia in a 5 day-old male neonate whose chief complaint was hyperpigmentation. His laboratory findings were compatible with adrenal insufficiency and adrenal gland was not detected by the ultrasonography and thin section abdominal CT. We reported a case of adrenal aplasia with a brief review of the related literature.