A Case of Paenibacillus-induced Sepsis Complicated with Pneumatocele in a Very Low Birth Weight Infant

Paenibacillus spp. are gram-positive, rod-shaped, facultative anaerobic bacteria found in nature and rarely cause diseases in humans. We report our experience with Paenibacillus-induced sepsis complicated with pneumatocele in a very low birth weight male infant with a gestational age of 29 weeks and 5 days and a birth weight of 1,380 g, who was born by cesarean section with because of preterm labor and premature rupture of membrane. On day 12 after admission, the patient presented oxygen desaturation without apnea and fever. We identified pleural effusion on chest radiography and diagnosed pneumatocele on low-dose chest computed tomography. An empirical antibiotic was administered to treat the infection. The patient's blood culture revealed gram-positive rods, and Paenibacillus spp. was identified using16s rRNA sequencing.

Sequential therapy with activated prothrombin complex concentrates and recombinant activated factor VII to treat unresponsive bleeding in patients with hemophilia and inhibitors: a single center experience

BACKGROUND: Currently, the greatest challenge in hemophilia treatment is managing hemophilia patients with inhibitors. The two main bypassing agents that are used to treat hemophilia patients with inhibitors are activated prothrombin complex concentrates (APCC) and recombinant factor VIIa (rFVIIa). Hemophilia patients with inhibitors can develop bleeding episodes, that are refractory to monotherapy with either APCC or rFVIIa and thus are often difficult to manage. METHODS: This report describes a retrospective chart review of four hospitalized patients with severe hemophilia and inhibitors who were treated with sequential therapy of APCC and rFVIIa for refractory bleeding. Sequential therapy was defined as the administration of both rFVIIa and APCC within 12 h. RESULTS: In 5 episodes experienced by 4 patients with inhibitors, bleeding was not controlled by single bypass treatment, but it was controlled when two agents were sequentially administered. Sequential therapy was administered by alternating one APCC dose to 1 to 2 rFVIIa doses, with dosing intervals ranging from 3 to 6 h. All bleeding episodes were controlled within 12 to 24 h. Sequential therapy was discontinued after 2 to 5 days. No adverse clinical events, such as thrombosis, were observed. CONCLUSION: Sequential therapy with APCC and rFVIIa was efficacious without adverse events; however, attention on thrombosis is needed. In addition, a prospective clinical trial is needed to provide further evidence for this treatment.

Early postictal electroencephalography and correlation with clinical findings in children with febrile seizures / 소아과

PURPOSE: Electroencephalography (EEG) is frequently ordered for patients with febrile seizures despite its unclear diagnostic value. We evaluated the prevalence of abnormal EEGs, the association between clinical findings and abnormal EEGs, and the predictive value of EEG for the recurrence of febrile seizures. METHODS: Data were collected on 230 children who were treated for febrile seizures at Kyung Hee University Medical Center from 2005 to 2009. EEGs were recorded after 1-2 days of hospitalization when children became afebrile. EEG patterns were categorized as normal, epileptiform, or nonspecific relative to abnormalities. The patients' medical records were reviewed, and telephone interviews with the families of the children were conducted to inquire about seizure recurrence. The relationships between clinical variables, including seizure recurrence, and EEG abnormalities were evaluated. RESULTS: Of the 131 children included, 103 had simple and 28 had complex febrile seizures. EEG abnormalities were found in 41 children (31%). EEG abnormalities were more common in children with complex than simple febrile seizures (43% vs. 28%), but the difference was not statistically significant. Logistical regression analysis showed that having multiple seizures in a 24-hour period was significantly predictive of abnormal EEG (odds ratio, 2.98; 95% confidence interval, 1.0 to 88; P=0.048). The frequency of recurrence did not differ significantly in the normal (31%) and abnormal (23%) EEG groups. CONCLUSION: Multiple seizures within 24 hours were predictive of abnormal EEG in children with febrile seizures. Abnormal EEG was not predictive of febrile seizure recurrence.

Medical papers related to keywords of vaccine and vaccination in KoreaMed database, Korea (1962-2012)

PURPOSE: To describe the present status and changing patterns of medical papers related to keywords of vaccine and vaccination published in Korea over the last 50 years, and provide basic data for future studies. MATERIALS AND METHODS: 185,603 papers are registered in the medical database KoreaMed, which is run by Korean Association of Medical Journal Editors. Among these papers, a search with the keywords vaccine or vaccination revealed a total of 1,089 articles which were published on vaccine and/or vaccination during the period of September 2, 1962 to April 30, 2012. Our study endeavors to analyze these 1,089 articles. RESULTS: Only one article published with the keywords vaccine and/or vaccination was published in the 1960s, and the number of journals steadily increased starting from the 1970s (24 articles) to 2 times, 10 times, 20 times in the 1980s, 1990s, and the 2000s (585 articles), respectively. The articles were classified into reviews (20.2%), original articles with clinical study (40.7%), original articles with experimental study (24.6%), and case reports (8.2%). The review articles mainly dealt with an overview. The original articles with clinical study were on epidemiology, effect and immunogenicity, clinical trial. Original articles with experimental study were mainly comprised of complication and overview. Articles on vaccine, pathogen or disease topics were mostly microorganisms such as bacteria or viruses, and studies on anti-cancer vaccines or vaccines of specific diseases were sparse. CONCLUSION: The above data reflects the clinical uses of vaccines in Korea and the history of vaccine studies. The number of vaccine-related articles is increasing rapidly since the first article was published in 1962. This implies that with the increase of studies of clinical trials, clinical uses and results and analyses of the results, articles relating to basic studies are also on the rise. We intend these findings to be of use to researchers in this active and expanding field.

A Case of Pulmonary Artery Sling Associated with Left Bronchial Stenosis and Patent Ductus Arteriosus

Pulmonary artery sling is a rare and potentially lethal vascular anomaly wherein the anomalous left pulmonary artery arises from the posterior aspect of the right pulmonary artery and passing to the left lung between the trachea and the esophagus which causes respiratory distress in infants and children due to the extrinsic compression of the airway by the anomalous vessel. Associated anomalies are common, particularly those of the tracheobronchial tree. The most common lesions are hypoplasia of the distal trachea and right main stem bronchus. About 50 percent of patients have cardiovascular anomalies, such as in the left superior vena cava, atrial septal defect, ventricular septal defect, patent ductus arteriosus, aortic arch anomalies, tetralogy of Fallot 1 etc. We experienced a case of a 6-year-old boy who showed dyspnea and frequent pneumonia. He was diagnosed with pulmonary artery sling associated with left bronchial stenosis, patent ductus arteriosus, and left superior vena cava which was parven by echocardiographic examinations, spiral computerized tomography of the chest and cineangiography. We report this case with related literature.