The control of invasive Candida infection in very low birth weight infants by reduction in the use of 3rd generation cephalosporin / 소아과

PURPOSE: To evaluate the effectiveness of new management policies on the incidence of invasive Candida infections METHODS: This observational study involved a retrospective analysis of the patients' medical records. In total, 99 very low birth weight infants, who were admitted to the neonatal intensive care unit at Ajou University Hospital from January 2010 to December 2011, were enrolled for the study. Period I, defined as the period before the revision of management policies, comprised 57 infants; whereas, period II, defined as the period after the implementation of new management policies, comprised 42 infants. The new management policies entailed a reduction in antibiotic and histamine type 2 receptor blocker (H2 blocker) use, duration of central venous catheterization, and duration of endotracheal intubation. RESULTS: There was a significant overall decrease in the use of antibiotics including 3rd generation cephalosporin and H2 blockers (P<0.05), and a significantly lower incidence of invasive Candida infections in period II as compared to period I (0/42 vs. 6/57, respectively; P=0.037). Comparison between infants with invasive Candida infections (n=6) and those without (n=93) showed that gestational age (odds ratio [OR], 0.909; 95% confidence interval [CI], 0.829 to 0.996; P=0.042) and the duration of 3rd generation cephalosporin use (OR, 1.093; 95% CI, 1.009 to 1.183; P=0.029) were statistically significant risk factors. CONCLUSION: The new management policies effectively decreased overall use of antibiotics, especially 3rd generation cephalosporin, and H2 blockers, which led to a significantly lower incidence of invasive Candida infections.

Natural History of Treated New-Onset Epilepsy in Children: A Long-term Follow-up Cohort Study in a Single Center / 대한소아신경학회지

PURPOSE: Seizure outcomes are more complicated in terms of repeated remission and relapse in the course of epilepsy. We aim to investigate the different patterns of evolution in new-onset pediatric epilepsy and the seizure outcome of different types of epilepsy syndromes. METHODS: We examined the evolution pattern of remission and relapse in the course of epilepsy in 326 children who were less than 15 years of age, with new-onset epilepsy. Different remission-relapse patterns were determined in each patient and according to epilepsy syndromes. The probability of repeated remission and relapse were analyzed with Markov process. RESULTS: During follow-up (mean+/-SD: 79+/-25 months) of 326 patients, early remission, defined as remission within the first year of treatment, was seen in 288 patients (88.4%), and late remission was achieved in 21 patients (6.4%). 17 patients (5.2%) never achieved remission. 94.8% of the cohort experienced at least one remission, with first relapse, second relapse, and third relapse occurring in 115 patients (35.3%), 61 patients (18.7%), and 28 patients (8.6%), respectively. At the end of follow-up period, 281 patients (86.2%) were in terminal remission. 194 patients (59.6%) showed a continuous remitting course, and 87 patients (26.7%) showed a remitting-relapse course. 45 patients (13.8%), including worsening courses in 28 patients (8.6%) and drug resistant courses in 17 patients (5.2%), did not show terminal remission. Markov process disclosed that children with epileptic encephalopathy and symptomatic partial epilepsy were less likely to show remission than children with idiopathic partial or generalized epilepsy (P<0.001). CONCLUSION: Only 13.8% of children with new-onset epilepsy have poor seizure outcome in terms of never achieving remission or persistent seizure after achieving at least one remission. The etiology of epilepsy syndrome is an important factor determining seizure outcome.

Life Threatening Upper Gastrointestinal Bleeding in Neonate: A Report of Two Cases

Neonatal upper gastrointestinal bleeding is rare in healthy full term infants and is known to be caused by stress ulcer, intracranial hemorrhage, increased intracranial pressure, congenital heart disease, perinatal asphyxia, respiratory distress, hypoglycemia and use of drugs such as steroids. Mallory-Weiss syndrome and hemorrhagic gastritis can cause life threatening upper gastrointestinal bleeding and are rarely reported in neonates and young infants. The authors experienced a case of Mallory-Weiss syndrome in a full term infant without particular perinatal history and a case of acute hemorrhagic gastritis in a preterm infant born at 33 weeks of gestation and 2,260 g of birth weight, both showed life threatening upper gastrointestinal bleeding. We report these two cases with a review of current literature.

Follow-up HRCT Findings of Ground-Glass Attenuation in Usual Interstitial Pneumonia

PURPOSE: To evaluate changes in lesions, as shown by follow-up high-resolution CT (HRCT) in patients withusual interstitial pneumonia (UIP), and the significance of ground-glass attenuation. MATERIALS AND METHODS: HRCTfindings in 23 patients with UIP were retrospectively reviewed. We quantitatively analysed the pattern and extentof lesions, as seen on HRCT, initially and during the most recent follow-up. We also compared pattern changesbetween group I (n=12; less than 25% of the initial extent of GGA) and group II (n=11, more than 26% of thisinitial extent). RESULTS: Initial HRCT findings included GGA and irregular linear density in all patients,honeycombing in 21 (91%), and consolidation in two patients (9%). During the most recent follow-up, HRCT showedthat the extent of GGA had decreased (p0.05). CONCLUSION: The greater extent of GGA, as seen on HRCT, of a patient with UIP shows much less fibrosison follow-up HRCT. In UIP, evaluation of the extent of GGA, as seen on initial HRCT, is a helpful indicator ofprognosis.

Radiologic Findings of Malignant Retroperitoneal Fibrosis

PURPOSE: To evaluate the radioloic findings of malignant retroperitoneal fibrosis. MATERIALS AND METHODS: Post-contrast CT (n=9) and urographic (n=7) findings of nine patients with malignant retroperitoneal fibrosis were retrospectively analyzed. Primary tumors were found to be advanced gastric cancer (n=6), early gastric cancer (n=1), breast cancer (n=1), and cervical cancer (n=1). We analyzed CT findings with regard to the site of soft tissue lesion, ureteral involvement, the presence or absence of hydronephrosis, and distant metastasis. The level and length of ureteral involvement, presence or abscence of ureteral stenosis, and ureteral displacement as seen on urography, were analyzed. RESULTS: On CT scans, enhanced soft tissue lesions (mass, 5 cases; plaque, 4 cases) encircling the abdominal aorta and IVC were noted in all cases. Thickening of the ureteral wall (n=8), hydronephrosis (n=9), and enlarged lymph node (n=5) were also seen. On urography, irregular stenosis and medial displacement of ureters from level L2 to S2 were noted in all cases. The length of ureteral involvement was 4-6.5cm. CONCLUSION: The common CT findings of malignant retroperitoneal fibrosis were enhanced soft tissue lesion encircling the abdominal aorta and IVC, hydronephrosis, and thickening of the ureteral wall. On urography, ureteral stenosis and medial displacement were seen.

Whirling Sign: An Imaging Finding Indicating Ovarian Torsion

PURPOSE: To present a diagnostic sign on MRI and US in patients with ovarian torsion. MATERIALS AND METHODS: We present characteristic imaging findings in eight patients with surgically-proven ovarian torsion. MRI was performed in four patients, CT in six and US in all patients; the procedures including eight transabdominal US(TAS) and three transvaginal US(TVS). In each study, imaging findings were analyzed for the appearance of twisted pedicle and the presence of a "whirling sign". RESULTS: The pedicle which indicates ovarian torsion was detected on MRI in all 4 patients, on TAS in 4/7, on TVS in 3/3, and on CT in 4/6. A specific "whirling sign" was detected on MRI in 2/4 patients, on TAS in 2/4, and on TVS in all three. On CT a "whirling sign" was not detected. CONCLUSION: The "whirling sign" on both MRI & US is a characteristic finding of ovarian torsion; in a patient with adnexal mass and complaining of lower abdominal pain, the presence of this sign is very useful for the diagnosis of ovarian torsion.

Whirling Sign: An Imaging Finding Indicating Ovarian Torsion

PURPOSE: To present a diagnostic sign on MRI and US in patients with ovarian torsion. MATERIALS AND METHODS: We present characteristic imaging findings in eight patients with surgically-proven ovarian torsion. MRI was performed in four patients, CT in six and US in all patients; the procedures including eight transabdominal US(TAS) and three transvaginal US(TVS). In each study, imaging findings were analyzed for the appearance of twisted pedicle and the presence of a "whirling sign". RESULTS: The pedicle which indicates ovarian torsion was detected on MRI in all 4 patients, on TAS in 4/7, on TVS in 3/3, and on CT in 4/6. A specific "whirling sign" was detected on MRI in 2/4 patients, on TAS in 2/4, and on TVS in all three. On CT a "whirling sign" was not detected. CONCLUSION: The "whirling sign" on both MRI & US is a characteristic finding of ovarian torsion; in a patient with adnexal mass and complaining of lower abdominal pain, the presence of this sign is very useful for the diagnosis of ovarian torsion.