Causative Organisms of Community Acquired Urinary Tract Infection and Their Antibiotic Susceptibility at a Secondary hospital in Korea / 소아감염

PURPOSE: We investigated the causative organism and its antibiotic susceptibility of community acquired urinary tract infection (UTI) in children at a secondary hospital to test the adequacy of the current guidelines. METHODS: Children diagnosed with UTI at the Department of Pediatrics, Kwandong University Myongji Hospital by pyuria and bacterial growth of greater than 1.0x10(5) CFU/mL on clean catch midstream urine from January 2005 to December 2008 were studied retrospectively. The epidemiologic data, causative organism, and the antibiotic susceptibility were analyzed. RESULTS: Sixty two children were diagnosed with sixty four cases of UTI's. Two bacteria were isolated in one case and thus data on 65 urine cultures were analyzed. The male:female ratio was 1.6:1 and 78.1% were less than 12 months of age. Escherichia coli was the predominant cause consisting of 53 cases (82.8%) of the cases. K. pneumoniae (5), Enterobacter (4), Enterococcus (1), beta-streptococcus (1), Diphtheroides (1) were isolated. The antibiotic resistance of E. coli were as follows; ampicillin 69.8%, cefotaxime 1.9%, gentamicin 15.1%, amikacin 0.0%, levofloxacin 1.9%, and trimethoprim/sulfamethoxazole 26.4%. Only one case of the E. coli was extended spectrum beta-lactamase (ESBL) positive. CONCLUSION: Compared to prior reports from other tertiary hospitals in Korea, E. coli was the predominant cause in childhood UTI and the rate of ESBL positivity was low. The antibiotic resistance was also different compared to prior reports. We conclude that a difference in the cause and antibiotic resistance of childhood UTI exists between centers and this should be taken into consideration when prescribing antibiotics for childhood UTIs.

Myocardial Function in Infant Kawasaki Disease with Tissue Doppler Imaging

PURPOSE: The purpose of this study is to assess myocardial function in infant Kawasaki disease, with strain and tissue Doppler imaging, in addition to conventional echocardiographic measures. METHODS: Strain and tissue Doppler imaging were performed in 20 patients with infant Kawasaki disease. Peak velocities of systolic and early, late diastolic pulsed tissue Doppler velocities, strain, and time to peak strain values were measured at ventricular septal annulus from apical view. The data set were obtained at both acute period and convalescent period. RESULTS: All patients represents coronary arteriopathy. Measures of Systolic peak velocity (S') of pulsed wave tissue Doppler value and strain decreased in convalescent phase, and time to peak strain was delayed (P<0.01). Meanwhile, the diastolic measures (E' and A') demonstrated no significant differences between acute and convalescent phases using tissue Doppler velocity data. CONCLUSION: In convalescent phase, myocardial systolic function may not be completely improved yet. After convalescent period, continuous myocardial assessment should be followed.

A Case of Focal Segmental Membranoproliferative Glomerulonephritis in a 5 Years Old Girl

=Abstract= Membranoproliferative glomerulonephritis (MPGN) is a progressive primary glomerulonephritis characterized by mesangial proliferation with increased mesangial matrix, subendothelial immune deposits, mesangial interposition and a double contour feature of the glomerular basement membrane. The glomerular involvement in MPGN is usually diffuse; however, cases of focal or segmental MPGN have been reported by several authors. We report a case of focal segmental MPGN with prolonged hypocomplementemia for 3 years in a 5 years old girl.

Left ventricular function after mitral valve operation in congenital mitral regurgitation

BACKGROUND: Severe mitral regurgitation is a common clinical entity that can lead to progressive, irreversible left ventricular dysfunction, and thus should be corrected in proper stage of life. Authors have conducted this investigation to assess left ventricular function after mitral valve operation and to determine the predicting factors. METHODS AND RESULTS: The echocardiographic parameters, specifically left ventricular ejection fraction, shortening fraction, end-systolic dimension and volume, and end-diastolic dimension and volume were measured in preoperative and postoperative period of congenital mitral regurgitation patients (n=60), between March 1992 and March 1998. After correction of severe mitral regurgitaion, left ventricular ejection fraction and shortening fraction decreased significantly (p<0.001 and p<0.05 respectively). Furtheremore, after reoperation of recurred mitral regurgitation, left ventricular ejection fraction and shortening fraction decreased significantly (p<0.05). Left ventricular ejection fraction and shortening fraction in mitral valve reoperation group (n=23) is significantly lower than those in non-reoperation group (n=37) in both preoperative and postoperative period (p<0.05). Left ventricular ejection fraction and shortening fraction is also significantly lower in mitral valve replacement group (n=20) than in mitral valvuloplasty group (n=40)(p<0.05). Severe postoperative left ventricular dysfunction led to dilated cardiomyopathy in 5 patients. Postoperative left ventricular end systolic dimension increased significantly in reoperation group and DCMP group respectively (p<0.05). CONCLUSION: After surgical correction of mitral regurgitation, left ventricular dysfunction is frequent and carries a poor prognosis. Postoperative left ventricular dysfunction can be predicted by preoperative ejection fraction, shortening fraction and systolic diameter. Therefore surgical therapy before the onset of left ventricular dysfunction is recommended.

Surgical Repair of Isolated Ventricular Septal Defect in Infancy Guided by Echocardiography

BACKGROUND: Echocardiographic examination is universally considered as an established method for the diagnosis of congenital heart disease, and as a result of many technological advancements in information processing, its utility is being emphasized much more. Cardiac catheterization, by comparison, is usually performed in the past for the purpose of diagnosis and preoperative assessment of infants with isolated ventricular septal defect (VSD), and the risks and complications of cardiac catheterization have been more frequent in the younger ages. Accordingly, we present in this study the effectiveness and safety of echocardiography on the diagnosis and treatment of infants who met the indications of early correction and underwent operations. METHODS: Between May 1994 and April 1997, 66 infants with isolated VSD were submitted for primary correction in the Yonsei Cardiovascular Center. Among the 66 infants (36 males and 30 females), 33 (group 1) underwent surgery on the basis of echocardiography alone and another 33 (group 2), on the basis of cardiac catheterization in addition to echocardiography. The two groups were compared for the diagnostic sensitivity, specificity, complication after surgical correction and frequency of re-operation. RESULTS: 1) The average age was 5.4+/-3.3 months in group 1 and 5.7+/-2.2 months in group 2. 2) There was no significant difference between the two groups in terms of the sensitivity and specificity of diagnostic tools. 3) There was no post-operative death in either group and no significant difference in postoperative hospital stay between the two groups. 4) There was no significant difference between the two groups in complications such as sepsis, pneumonia after surgical correction. CONCLUSION: We concluded that after an accurate selection, most infants with isolated VSD can safely undergo primary repair on the basis of echocardiography alone.

Urinary Stone in Childen

Herpes simplex virus type 1 and 2 (HSV-1, HSV-2) are the ubiquitous human pathogens responsible for a variety of afflictions. HSV-2 is one of the viruses that were suspected of promoting carcinogenesis in the uterine cervix. Certainly, there is a need for the more sensitive and accurate laboratory techniques for HSV detection. We examined total 80 cases of smears including 17 Tzanck smears of skin and 63 cases of Papanicolaou smears from total 77 patients with clinical impression of herpetic infections, from September, 1985 through August, 1989. Immunohistochemical typings for HSV-1 and HSV-2 were performed together with routine cytologic findings and compared. The results are as follows ; 1) Patients were 9 males and 33 females, and age distribution was between 5 and 71 years 2) Subjective symptoms such as ulceration, vesicle, vaginal discharge, pruritus, and pain were complained in 36 patients and 38 cases were genital herpes. Recurrence was noted in 11 cases. 3) Positive results were obtained in 42 among 80 cases. 4) Both routine cytology and immunohistochemical staining were positive in 13 cases and in 24 cases only immunohistochemical staining were positive. 5 cases were positive only in routine cytologic smears. 5) The cases that immunocytochemical stain had been performed were 37 cases, which were all positive in type 2. Among the above 37 cases, type 1 also were positive in 5 cases. The results show that the immunoperoxidase technique is one of the rapid and reliable method to confirm the herpetic when suspected and that it is particularly useful when the Papanicolaou smear findings are equivocal.