Clinical Experiences with Febrile Infants, Younger than Three Months, with Urinary Tract Infection in a Single Center for Four Years: Incidence, Pathogens and Viral Co-infections

PURPOSE: The aim of this study was to analyze the incidence and microbiological characteristics of urinary tract infection in infants aged younger three months and to compare with other infection with positive urine culture. METHODS: We retrospectively reviewed the medical records of 425 infants with a tympanic temperature >37.6℃, aged younger than three months, who were admitted to Cheil General Hospital in Seoul, Korea, from January 2013 to December 2016. Demographic and clinical features, laboratory findings, respiratory virus PCR and the pathogens of a urine culture were analyzed. RESULTS: A total of 88 infants (63 males, 25 females) had urinary pathogens detected in the urine culture test. The incidence of UTI in febrile infants aged younger 3 months was 11%. The most common pathogen which causes UTI was E. coli as same as in previous studies. They were divided into a UTI group (n=48) and a non-UTI group (n=40). In comparison of both group, leukocytosis, C-reactive protein level, Absolute neutrophil count level, peak temperature is statistically significant. In both group, there were co-infections with viral pathogens in some cases, and the odd ratio of non-UTI group with viral infection was 3.28. CONCLUSION: The study determined the incidence and pathogen of UTI in febrile infants, aged younger three months. E. coli was responsible for the majority UTI. There were some viral co-infections in febrile infants with bacteriuria and incidence was higher in non-UTI group. WBC count, ANC count and CRP level were the differentiating factors of UTI from non-UTI group.

Clinical Experiences with Febrile Infants, Younger than Three Months, with Urinary Tract Infection in a Single Center for Four Years: Incidence, Pathogens and Viral Co-infections

PURPOSE: The aim of this study was to analyze the incidence and microbiological characteristics of urinary tract infection in infants aged younger three months and to compare with other infection with positive urine culture. METHODS: We retrospectively reviewed the medical records of 425 infants with a tympanic temperature >37.6℃, aged younger than three months, who were admitted to Cheil General Hospital in Seoul, Korea, from January 2013 to December 2016. Demographic and clinical features, laboratory findings, respiratory virus PCR and the pathogens of a urine culture were analyzed. RESULTS: A total of 88 infants (63 males, 25 females) had urinary pathogens detected in the urine culture test. The incidence of UTI in febrile infants aged younger 3 months was 11%. The most common pathogen which causes UTI was E. coli as same as in previous studies. They were divided into a UTI group (n=48) and a non-UTI group (n=40). In comparison of both group, leukocytosis, C-reactive protein level, Absolute neutrophil count level, peak temperature is statistically significant. In both group, there were co-infections with viral pathogens in some cases, and the odd ratio of non-UTI group with viral infection was 3.28. CONCLUSION: The study determined the incidence and pathogen of UTI in febrile infants, aged younger three months. E. coli was responsible for the majority UTI. There were some viral co-infections in febrile infants with bacteriuria and incidence was higher in non-UTI group. WBC count, ANC count and CRP level were the differentiating factors of UTI from non-UTI group.

A 12-Year Retrospective Study of Survival Rates and Outcomes of Very Low Birth Weight Infants in a Single Center

PURPOSE: To investigate the outcomes and survival rates of very low birth weight infants (VLBWI) born over a 12-year period in a single center. METHODS: A retrospective review of 613 VLBWI born from January 2000 to December 2011 was performed. We compared the incidence, survival rate, and morbidity of infants classified according to their birth weight or gestational age for the following periods: Period I (2000-2002), Period II (2003-2005), Period III (2006-2008), and Period IV (2009-2011). RESULTS: The incidence of VLBWI was 0.7%, while the overall survival rate was 94.9%. The survival rates were 92.8%, 92.9%, 95.9%, and 97.5% for periods I, II, III and IV, respectively; the rates improved significantly over time (P or =grade III), 8.5%; sepsis, 6.5%; cystic periventricular leukomalacia, 3.8%; necrotizing enterocolitis (> or =grade II), 3.4%; and intraventricular hemorrhage (> or =grade III), 2.3%. A significant decrease was seen in some clinical parameters: the time to start feeding, duration of parenteral nutrition, and duration required to reach full enteral feeding in every successive three-year period (P<0.01). CONCLUSION: The overall survival rate of VLBWI born between January 2000 and December 2011 was 94.9%. This survival rate was found to increase significantly in each successive three-year period starting January 2000.

Inflammatory Pseudotumor in the Mediastinum: Imaging with 18F-Fluorodeoxyglucose PET/CT

Mediastinal inflammatory pseudotumor is a rare benign disease with its capability for local invasion and rapid growth. We present a case of middle-mediastinal inflammatory pseudotumor and report its contrast-enhanced chest computed tomography, 18F-fluorodeoxyglucose positron emission tomography/computed tomography and pathologic findings.

Vascularized Bipedicled Pericranial Flaps for Reconstruction of Chronic Scalp Ulcer Occurring after Cranioplasty

BACKGROUND: Intractable chronic scalp ulcers with cranial bone exposure can occur along the incision after cranioplasty, posing challenges for clinicians. They occur as a result of severe scarring, poor blood circulation of the scalp, and focal osteomyelitis. We successfully repaired these scalp ulcers using a vascularized bipedicled pericranial flap after complete debridement. METHODS: Six patients who underwent cranioplasty had chronic ulcers where the cranial bone, with or without the metal plate, was exposed along the incision line. After completely excising the ulcer and the adjacent scar tissue, subgaleal dissection was performed. We removed the osteomyelitic calvarial bone, the exposed metal plate, and granulation tissue. A bipedicled pericranial flap was elevated to cover the defect between the bone graft or prosthesis and the normal cranial bone. It was transposed to the defect site and fixed using an absorbable suture. Scalp flaps were bilaterally advanced after relaxation incisions on the galea, and were closed without tension. RESULTS: All the surgical wounds were completely healed with an improved aesthetic outcome, and there were no notable complications during a mean follow-up period of seven months. CONCLUSIONS: A bipedicled pericranial flap is vascularized, prompting wound healing without donor site morbidity. This may be an effective modality for treating chronic scalp ulcer accompanied by the exposure of the cranial bone after cranioplasty.

A Case of Escherichia coli O157 Hemorrhagic Colitis / 대한임상미생물학회지

Escherichia coli O157 is an important serotype of enterohemorrhagic E. coli that causes hemorrhagic colitis worldwide. Outbreaks of E. coli O157 have been assocoated with contaminated food like meat, raw milk, and water, but recently vegetables and fruits have accounted for a growing number of recognized outbreaks. We isolated verotoxin producing E. coli O157 from the stool of a 3 year-old female with bloody diarrhea and abdominal pain. The child had been eating salad with vegetables and fruits frequently.

Anomaly of the Inferior Vena Cava

PURPOSE: Anomalies of the inferior vena cava (IVC) and its tributaries develop due to embryonic error during the process involving the formation of several anastomoses between three paired embryonic veins. These anomalies have become more commonly recognized in surgical patients due to performing preoperative computed tomography (CT) scanning. The aim of this study was to report on 7 patients with various types of IVC anomaly. METHOD: Between 1996 and 2006, we encountered 7 patients with IVC anomalies at Hanil General Hospital and Samsung Medical Center. The medical records and CT scans were retrospectively reviewed. RESULT: The mean age of the patients was 56.0 years. Five patients were male and 2 patients were female. The types of IVC anomalies were left IVC in 2 patients, double IVC in 2 patients, an absent infrarenal IVC in 2 patients, and a retroaortic left renal vein in 1 patient, respectively. The associated problems were abdominal aortic aneurysm, deep vein thrombosis, aortoiliac occlusive disease, venous ulcer, retroperitoneal mass, traffic accident and renal cell carcinoma. There were no surgical complications. CONCLUSION: IVC anomalies can have significant clinical implications. Preoperative recognition of these anomalies could reduce the complication rate during surgery.

Anomaly of the Inferior Vena Cava

PURPOSE: Anomalies of the inferior vena cava (IVC) and its tributaries develop due to embryonic error during the process involving the formation of several anastomoses between three paired embryonic veins. These anomalies have become more commonly recognized in surgical patients due to performing preoperative computed tomography (CT) scanning. The aim of this study was to report on 7 patients with various types of IVC anomaly. METHOD: Between 1996 and 2006, we encountered 7 patients with IVC anomalies at Hanil General Hospital and Samsung Medical Center. The medical records and CT scans were retrospectively reviewed. RESULT: The mean age of the patients was 56.0 years. Five patients were male and 2 patients were female. The types of IVC anomalies were left IVC in 2 patients, double IVC in 2 patients, an absent infrarenal IVC in 2 patients, and a retroaortic left renal vein in 1 patient, respectively. The associated problems were abdominal aortic aneurysm, deep vein thrombosis, aortoiliac occlusive disease, venous ulcer, retroperitoneal mass, traffic accident and renal cell carcinoma. There were no surgical complications. CONCLUSION: IVC anomalies can have significant clinical implications. Preoperative recognition of these anomalies could reduce the complication rate during surgery.

The Relationship between Change of Cardiac Function and Systemic Oxygen Consumption according to the Dose of Dopamine in the Rabbit

PURPOSE: We'd like to know the relationship between the changes of cardiac function and systemic O2 consumption according to the increasing dose of dopamine. METHODS: Ten rabbits(from 2kg to 2.8kg) were used in this experiment. Anesthesia was induced with intraperitoneal pentobarbital sodium(35mg/kg) and tracheostomy was done. It was maintained by ventilation with a mixture of 1-3% halothane and 67-69% oxygen. Polyvinyl catheters were inserted into the femoral artery and vein and to check blood pressure and arterial blood gas analysis during the surgical procedure. Two other catheters were inserted into the internal carotid artery and external jugular vein and advanced into left ventricle and right atrium to check the pressure of each chamber, LV maximal dP/dt and to obtain blood samples of each chamber. Thoracotomy was done to expose aorta and coronary artery to check the cardiac output and coronary blood flow. We injected dopamine every 10 minutes according to the scheduled dose through external jugular vein and recorded heart rate, cardiac output, aortic pressure, maximal dP/dt, coronary blood flow by computer. Systemic O2 consumption was calculated by Fick method RESULTS: The heart rate and mean aortic pressure increased slowly according to the dose of dopamine from 20 microgram/kg/min. The cardiac otuput the maximal dP/dt and coronary blood flow was not changed until 5 microgram/kg/min, but from 7.5microgram/kg/min, it increased according to the dose of dopamine. CONCLUSION: Dopamine was a powerful inotrophic agent without increasing the systemic O2 consumption until 20microgram/kg/min, but systemic O2 consumption increased markedly at more than 20 microgram/kg/min of dopamine.