Rosácea Granulomatosa: una variante infrecuente en la infancia / Granulomatous Rosacea: A variant infrequent in childhood

RESUMEN La rosácea es una dermatosis inflamatoria crónica de la piel, caracterizada por la presencia de eritema, telangiectasias, pápulas y pústulas en la región centro facial. Dentro de sus variantes, la forma granulomatosa es un cuadro clínico comunicado con escasa frecuencia en la infancia. Se presenta una paciente de sexo femenino, de 9 años de edad, quien presenta enrojecimiento facial y lesiones quísticas de tamañosvariables. Se decide realizar biopsia cutánea profunda, en la que se observó en lámina histológica, con técnica de H-E, al 40X: infiltrado inflamatorio severo perivascular superficial y profundo, a predominio linfo-plasmocitario, leucocitos polimorfonucleares e histiocitos, formando granulomas. Se instaura tratamiento tópico y sistémico, con resolución satisfactoria del cuadro clínico, con lo que mejora su calidad de vida.

ABSTRACT Rosacea is a chronic inflammatory dermatosis of the skin, characterized by the presence of erythema, telangiectasias, papules and pustules in the central facial region. Among its variants, the granulomatous form is a clinical picture rarely reported in childhood. A 9-year-old female patient is presented, who presents facial redness and cystic lesions of variable sizes, it was decided to perform a deep skin biopsy where it was observed in histological plate, with the H-E technique, at 40X; Superficial and deep perivascular severe inflammatory infiltrate, predominantly lymphoplasmacytic, polymorphonuclear leukocytes, and histiocytes, forming granulomas. Topical and systemic treatment was established with satisfactory resolution of the clinical picture, improving their quality of life.

Neoplasia papilar intraductal de la vía biliar / Intraductal papillary neoplasm of the bile duct / Neoplasia papilar intraductal da via biliar

La neoplasia papilar intraductal de la vía biliar (NPIVB) es una entidad infrecuente caracterizada por el crecimiento exofítico papilar del epitelio biliar hacia la luz ductal. Previamente incluida en el grupo de tumores del mismo nombre de localización pancreática, presenta diferencias evidentes con ellos y desde 2010 se considera una entidad propia con demostrado potencial de malignización hacia colangiocarcinoma.

Papillary intraductal neoplasia of the bile duct (NPIVB) is a rare entity characterized by exophytic papillary growth of the biliary epithelium towards the ductal lumen. Previously included in the group of tumors of the same name in pancreatic location, it presents obvious differences with them and since 2010 it has been considered a separate entity with demonstrated potential for malignancy towards cholangiocarcinoma.

O neoplasma papilar intraductal da via biliar (NPIVB) é uma entidade infrequente por el creciento exofítico papilar do epitélio biliar hacia la luz ductal. Obviamente incluído no grupo de tumores do mismo nombre de localização pancreática, apresenta diferenças evidentes com ellos e desde 2010 se considerar uma entidade propia com potencial demonstrado de malignización hacia cholangiocarcinoma.

Prevalence of Different Clinical Variants of Nephrotic Syndrome in Children 1–18 Years of Age in Tertiary Care Hospital of North India

Introduction: Childhood nephrotic syndrome has an incidence of 90–100 per million population of India. This study was conducted with the primary objective of studying the prevalence of different clinical variants of childhood nephrotic syndrome (new-onset steroid-sensitive nephrotic syndrome/infrequent relapsing nephrotic syndrome [IFRNS]/frequently relapsing nephrotic syndrome [FRNS]/steroid-dependent nephrotic syndrome [SDNS]/steroid-resistant nephrotic syndrome [SRNS]), while the secondary objectives were to estimate the prevalence of use of steroid-sparing drugs in those with FRNS and SDNS. Materials and Methods: A retrospective study of all patients referred to renal diseases clinic at Government Medical College, Jammu, was done. Records of 61 children of 1–18 years of age fulfilling the International Study of Kidney Disease in Children criteria for nephrotic syndrome attending to our nephrology clinic were reviewed over 1 year period. Standard definitions for new-onset nephrotic syndrome, IFRNS, FRNS, SDNS, and SRNS were used. Steroid-sparing drugs used were levamisole in FRNS and low-dose SDNS whereas cyclophosphamide, mycophenolate mofetil (MMF), and tacrolimus in high-dose SDNS. Results: Among nephrotic syndrome, patients mean age of presentation was 5.95 years, with M: F ratio of 1.77:1. Infrequent relapsers (27.9%) were the most prevalent clinical variant followed by steroid-dependent nephrotic syndrome (24.6%) and new-onset nephrotic syndrome (21.3%). Prednisolone alone was successful in achieving remission in 50.8% of total cases and less commonly involving use of other immunosuppressants with prednisolone such as levamisole (23%), cyclophosphamide (9.8%), and tacrolimus in (3.3%). However, prednisolone in combination with cyclophosphamide and then MMF was used in 14 (23%) in an aim to achieve full remission, but full remission was achieved in 48 (78.7%). Conclusion: In the present study, clinical profile of children with nephrotic syndrome was concordant with typical nephrotic syndrome in children. Pattern of nephrotic syndrome differs in our population in terms of increased number with SDNS and response to treatment did not differ significantly from other studies.

Effect of Serum IgE Level between Frequent Relapse and Infrequent Relapse Nephrotic Syndrome in Children

Objective: In this study our main objective is to evaluate effectof serum IgE level between frequent relapse and infrequentrelapse nephrotic syndrome in children.Methodology: This Cross-sectional comparative studyconducted at the Department of Paediatric Nephrology,Bangabandhu Sheikh Mujib Medical University (BSMMU) andDepartment of Paediatrics, Dhaka Medical College Hospital,Dhaka from February 1, 2010 to October 1, 2010. During thestudy, 60 children were included in the study according tojudgmental or purposive sampling method and they weregrouped as follows: Group A (n = 30): Frequent RelapseNephrotic Syndrome (FRNS), Group B (n= 30): InfrequentRelapse Nephrotic Syndrome (IFRNS).Results: During the study, majority (60%) were of age groupA, 2-5. On the other hand in group-B, majority (66.8%) were ofage groups 2-5 years followed by (16.7%) were of age group 6-9 years and 5 (16.6%) were of age group 10-15 years. Duringrelapse of the disease serum immunoglobulin E (IgE) level wasapproximately 3.5 times higher in group A than that of group Bwhich was 1573.60IU/ml (SD ±197.01) vs. 438.46IU/ml (SD±51.6).Conclusion: From our study we can conclude that, that serumIgE level in frequent relapse nephrotic syndrome wassignificantly higher (P < 0.001) in comparison to infrequentrelapse nephrotic syndrome in children during both relapse andremission irrespective of history of atopy. So serum IgE levelmight have an influence for the occurrence of relapse inchildhood idiopathic nephrotic syndrome

Study of risk factors for relapse in frequently versus infrequently relapsing nephrotic syndrome in 1-18 year age group: a combined prospective retrospective cohort analytical observational study

Background: Early prediction and prevention of risk factors is the key to successful management of childhood nephrotic syndrome. This study was carried out to find the risk factors of relapse which will help in early prediction and reduce the risk of relapse in childhood nephrotic syndrome.Methods: It was a combined prospective-retrospective cohort analytical observational study of duration 18 months with sample size of 80 patients of age group 1-18 years who fulfilled the inclusion and exclusion criteria. The variables taken into account for the present study were demographic and disease related.Results: In the present study, 67.7% of patients with ?6 year of age at first onset were frequent relapsers while 60% of patients with >6 year of age at first onset were infrequent relapsers. A 77.1% of patients belonging to lower socioeconomic strata and 60% of patients belonging to lower-middle socioeconomic strata were frequent relapsers. 100% of patients having ? 4 relapses within the 1st year after diagnosis were frequent relapsers while 73.2% of patients having ?3 relapses within the same period were infrequent relapsers. In present study, out of 38 patients who had received 8 weeks of steroid therapy 92.1% were frequently relapsing while out of 42 patients who received 12 weeks of steroid therapy 64.3% were found to be infrequently relapsing.Conclusions: Younger age at first onset, higher number of relapses in first year and lower socio-economic strata is associated with frequently relapsing nephrotic syndrome. Longer duration of steroid therapy (12 weeks) lowers the chance of frequent relapses.

Síndrome de Sézary. Presentación de un caso / Sézary síndrome. Case presentation

RESUMEN El síndrome de Sézary constituye la fase leucémica de la micosis fungoide caracterizado por eritrodermia, adenopatías superficiales y células atípicas en sangre. Predomina en los hombres con una proporción 2/1 respecto a las mujeres, y en las edades entre los 60 y 70 años de edad. La enfermedad es de difícil tratamiento, con un pronóstico reservado por su baja supervivencia. Por ser infrecuente y su posible similitud con otras dermatosis, se presenta un caso con antecedentes de psoriasis vulgar con 5 años de evolución, que hacía aproximadamente 6 meses, se encontraba sin mejoría en brote de agudización a pesar de los tratamientos indicados (AU).

ABSTRACT Sezary syndrome is the leukemic part of the fungoid mycosis, characterized by erythroderma, surface adenopathies and atypical cells in blood. It predominates in men with a 2/1 proportion in respect to women, and in ages ranging from 60 to 70 years. It is a difficult treated disease, with a reserved prognosis because of the low survival. Due to its infrequency and possible similarity to other dermatosis, it is presented a case with antecedents of vulgar psoriasis of 5 years evolution, without improvement for around 6 months, in acute outbreak in spite of the indicated treatments (AU).

Molecular Epidemiologic Analysis of Community-Onset Extended Spectrum Beta-Lactamase (ESBL) Producing Escherichia coli Using Infrequent-Restriction-Site Polymerase Chain Reaction (IRS-PCR) with Comparison by Pulsed-Field Gel Electrophoresis (PFGE) / 감염과화학요법

BACKGROUND: We evaluated the ability of infrequent restriction site-polymerase chain reaction (IRS-PCR) to perform molecular epidemiologic analysis of Community-Onset Extended Spectrum Beta-Lactamase (ESBL) producing Escherichia coli, and also assessed the use of PFGE as an alternative method. MATERIALS AND METHODS: IRS-PCR assay was performed using combinations of adaptors for XbaI and HhaI restriction sites on clinical isolates of E. coli (n=51). We compared the discriminatory power, quality and efficiency of IRS-PCR to PFGE. RESULTS: In E. coli, PFGE discriminated 39 (76.4%) and IRS-PCR discerned 41 (80.3%) of the total 51 strains. It took much less time to complete IRS-PCR (one day) than PFGE (at least 4 days). CONCLUSIONS: IRS-PCR is a more sensitive and rapid alternative to PFGE for molecular epidemiologic analysis of E. coli.

Application of Infrequent-Restriction-Site Polymerase Reaction (IRS-PCR) to the Molecular Epidemiologic Analysis of Methicillin Resistant Staphylococcus aureus (MRSA) / 감염과화학요법

BACKGROUND: We investigated the usefulness of infrequent-restriction-site polymerase chain reaction (IRS-PCR) compared with pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) on the molecular epidemiologic analysis of methicillin-resistant Staphylococcus aureus (MRSA). MATERIALS AND METHODS: We used fifty clinical isolates of MRSA collected from 10 university hospitals located in Seoul. We performed three procedures on these isolates: PFGE using SmaI, IRS-PCR using XbaI-Hha I or EagI-Hha I, and MLST using seven house-keeping genes. We determined the clusters of molecular types by dendrogram using the unweighted pair group method with arithmetic mean (UPGMA) and Dice coefficients. RESULTS: MLST analysis showed that isolates exhibited ST1, ST5, ST72, ST89, and ST239. In PFGE, the isolates clustered into 5 major groups with 80% similarity, which subsequently became classified into 18 subgroups with 95% similarity. In IRS-PCR using EagI-HhaI restriction enzymes, there was little resolution among the patterns of isolates. However, XbaI-HhaI IRS-PCR showed 5 groups with a 90% similarity. These groups were then classified into 9 subgroups with a 95% similarity. There were no significant differences among the isolates from different hospitals. CONCLUSIONS: The XbaI-HhaI IRS-PCR method could be a useful tool in the molecular epidemiology of MRSA. Its resolution power was good enough to analyze isolates, because the patterns of IRS-PCR were closely correlated with those of MLST and showed diverse groups.

An epidemiological study on enuresis in children of two elementary schools in Suwon / 소아과

Purpose: The purpose of this study was to investigate the prevalence of enuresis in association with voiding habits and socioeconomic status in elementary school children. Methods: A dynamic survey was done of 1,514 students from two elementary schools in Suwon, Korea in December 2006. Data regarding gender, age, height and weight, voiding habits, and monthly family incomes were gathered and analyzed to discover any correlation with the incidence of enuresis. The percentile value of height or weight was extrapolated from the standard population curve. Results: Among 1,514 children, 1,063 (70.2%) answered and returned the questionnaires. Overall, the prevalence of enuresis was 8.7% and there was no difference between the public (8.8%) and private school (8.7%). The family incomes of the students from the two schools differed greatly from each other, but there was no difference in the prevalence of enuresis between the two schools. Children with a habit of void-holding showed a higher prevalence of enuresis. No significant correlation was found between the prevalence of enuresis and the height and weight percentile of children. Experience with hospital visits was low among enuretic children (20.8%), suggesting that Korean parents tend to neglect treatment of enuresis for their children. The prevalence of enuresis decreased by 2.0% each year, as school children aged. Conclusion: The overall prevalence of enuresis among elementary school children in Suwon district was 8.7%. The 12.1% prevalence of enuresis at the seven years came down gradually, to be nil at the age of 13. Infrequent urination or void- holding was assumed to be one of the important factors causing enuresis in elementary school children.

Evaluation of Infrequent-Restriction-Site PCR for Epidemiological Typing of Candida tropicalis / 대한임상미생물학회지

BACKGROUND: We evaluated the usefulness of a newly developed molecular typing method of infrequent restriction site polymerase chain reaction (IRS-PCR) as an epidemiological DNA fingerprinting tool for Candida tropicalis. METHODS: Thirty-two strains of C. tropicalis comprising eight sporadic strains and 24 clonal strains belonging to six clones, of which clonal type were previously confirmed by pulsed-field gel electrophoresis (PFGE), were tested by IRS-PCR to evaluate the usefulness of this technique. Twenty strains of Candida species, including C. glabrata, C. krusei, C. albicans, and C. parapsilosis, were also tested to assess the ability of IRS-PCR to discriminate among species of Candida. RESULTS: Using the IRS-PCR assay, sporadic strains of C. tropicalis could not be differentiated from clonal strains. Most strains belonging to the same clones were classified as different IRS-PCR types or clusters, and some different sporadic strains were classified as the same IRS-PCR types. When pattern variation was examined for different strains of C. tropicalis using IRS-PCR, pairwise similarity measured by the Dice coefficient was 75.4~100%. In contrast, pairwise similarity among isolates of five different species of Candida was 25~69.2%. Therefore, five different species of Candida were easily differentiated. CONCLUSION: The IRS-PCR typing assay appears to be an inadequate tool for the epidemiological typing of C. tropicalis, because the typing result of IRSPCR is not comparable to that of PFGE. To our knowledge, this is the first evaluation study for IRSPCR as an epidemiological typing tool for C. tropicalis.

Nephrotic syndrome in Thai children: Nakornping Hospital experience.

Objective: The purposes of this study are to determine the incidence, age of onset, gender, initial presentations, predictive parameters of frequent relapsers/steroid dependence and steroid resistance, results of disease course, growth retardation and complications of long term prednisolone therapy. Methods: A retrospective descriptive study was done in 37 pediatric patients with their first episode of primary nephrotic syndrome admitted at Nakornping Hospital during 1 October 2002 to 30 September 2005. The data in medical records were analyzed by using descriptive statistics. This study used percentage, mean, median and standard deviation for basic data. Statistical analyses were done by Student’s t – test, Fisher’s exact test and Chi-square test for testing of statistically significant differences. Results: The average age of patients was 7.7 years (male 7.7 years, female 7.7 years). The estimated annual incidence of nephrotic syndrome in healthy children in Chiang Mai was at least 3.48 new cases per 100,000 children younger than 15 years of age with the average of treatment period 19.2 months (2-36 months). Initial presentations consisted of generalized edema (86.4%), renal insufficiency (48.6%), fever (37.8%), hypertension (32.4%), gross hematuria (21.65%), and microscopic hematuria (21.6%). Initial therapy consisted of 60 mg/m2/day prednisolone daily for 4 weeks followed by 40 mg/m2 on alternate days for 4 weeks, thereafter decreasing alternate-day therapy every month by 25% over the next 4 months. Thirty-one patients (83.8%) were steroid-responsive, 6 patients (16.2%) were steroid-resistant. Of the 31 initial responders, 4 patients were excluded because of short follow-up period. Of the remaining 27 patients, 16 patients (59.2%) were nonrelapsers, 4 patients (14.85%) were infrequent relapsers, 6 patients (22.2%) were frequent relapsers/steroid dependence and one (3.7%) subsequently became steroid-resistant. The average of initial remission time (protein-free urine) was 16.4 days (15.2 days in nonrelapsers and infrequent relapsers, 21days in frequent relapsers/steroid-dependent patients). The study for predictive parameters predicting the response of steroid therapy found that a group of the frequent relapsers/steroid-dependent and steroid-resistant patients had ascites, pulmonary edema/plural effusion, moderate renal insufficiency (GFR <60 ml/min/1.73m2 ), and gross hematuria more frequent than a group of the nonrelapsers and infrequent relapsers. But mild renal insufficiency (GFR 60-89 ml/min/1.73m2) was found less than the latter group. Only moderate renal insufficiency was statistically different in both groups. Six frequent relapsers/steroid-dependent patients had average occurrence of 2.83 relapses. All had complete remission. Three patients who used cyclophosphamide had longer complete remission than nonuser group (17 months versus 3.6 months). Seven steroid-resistant patients were treated with cyclophosphamide, 2 patients (28.56%) had complete remission for 25 months, the other two patients had complete remission for 1.5 and 3 months, respectively. Three patients were still depended on steroid. BMI and height for age in all patients were normal except one patient with BMI> 25. Conclusion: The increasing average age of first diagnosis of primary NS may indicate that there are more frequent relapsers/steroid-dependent and steroid-resistant patients than the past. The frequent initial presentations are generalized edema, renal insufficiency, hematuria, fever, and hypertension. The initial parameters that can predict the frequent relapsers/steroid dependence and steroid resistance are moderate renal insufficiency, gross hematuria, pulmonary edema/pleural effusion, and ascites. The frequent relapsers/steroid dependence and steroid resistance had more severe degree of renal insufficiency. The longer duration of treatment until the patient’s urine became protein-free may be a predictor of frequent relapsers/steroid dependence. The long regimen of steroid therapy for the initial episode may result in sustained complete remission and reduce frequency of relapses with few complications and growth retardation. The treatment of frequent relapsers/steroid dependence with cyclophosphamide may result in longer complete remission. Failure of cyclophosphamide therapy in steroid resistance indicates a consideration of other drugs. Therefore, this study indicates the benefits of completed information collection which may improve the outcome of treatment and encourage the physicians to study further for more completed outcomes.

Molecular Epidemiologic Analysis of Legionella pneumophila by Infrequent-Restriction-Site Polymerase Chain Reaction / 대한임상미생물학회지

BACKGROUND: The frequent outbreak of legionellosis makes it critical to identify infection sources for the prevention and blockade of transmission of the disease. METHODS: Thirty-one strains of Legionella pneumophila isolated from the cooling towers of big buildings in Busan and Gyungsangnamdo Province areas, 12 strains of L. pneumophila from patients in Japan, and one type strain (L. pneumophila ATCC 33152) were used for molecular strain typing by using an infrequent-restriction-site polymerase chain reaction (IRS-PCR). RESULTS: Each strain revealed to have 7-16 bands of 200-1000 bp size. All 44 strains showed band patterns different from each other, except two strains sharing 90% homology. CONCLUSION: The molecular typing of Legionellaby IRS-PCR is an excellent and rapid method for discriminating strains; therefore, it should be useful in demonstrating the identity of possible outbreak strains.

El deterioro cognitivo: una mirada previsora / Cognitive deterioration: a foresighted look

El deterioro cognitivo constituye un frecuente motivo de consulta. Estaremos en disposición de poder diagnosticarlo tras la integración de los datos obtenidos en la entrevista clínica (anamnesis tests psicométricos). Ante su sospecha es obligatorio realizar una correcta valoración del estado mental de la persona que incluirá la evaluación de las capacidades cognitivas y de la función ejecutiva, así como la valoración de su estado emocional. Se valorará conjuntamente el estado funcional del individuo que abarcará la personalidad y su conducta, además del grado de afectación de las actividades instrumentales y básicas de la vida diaria. La implicación real de la APS en la detección y manejo de los problemas cognitivos es escasa. En nuestro medio la exploración del estado mental no constituye una práctica sistemática, por lo que persiste un grado no despreciable de subregistro para dicho diagnóstico.

Cognitive deterioration is a frequent reason to seek medical attention. We will be able to diagnose it after the integration of the data obtained in the clinical interview (anamnesis + psychometric tests). In case of suspicion, it is compulsory to carry out a correct evaluation of the mental status of the person, including the assessment of the cognitive capacities, of the executive function and of his emotional state. The functional state of the individual will be evaluated as a whole, taking into consideration the personality and his behavior, in addition to the degree of affectation of the instrumental and basic activities of daily life. The real implication of PHC in the detection and management of the cognitive problems is infrequent. In our setting, the exploration of the mental status is not a systematic practice, and that's why there is a nondespicable degree of subregister for this diagnosis.

Genomic analysis of Vibrio vulnificus by Infrequent Restriction Site-Polymerase Chain Reaction / 대한임상미생물학회지

BACKGROUND: Vibrio vulnificus sepsis is one of the notifiable disease(Class 3) in Korea. It is usually acquired through the consumption of raw or undercooked seafood in summer. We studied the clinical findings of V. vulnificus septicemia and the genomic patterns of V. vulnificus isolates. METHODS: Seven patients with V. vulnificus septicemia were admitted to Hanyang University hospital from 1998 to 2002. We analysed the clinical findings and the genomic patterns by infrequent restriction site-polymerase chain reaction(IRS-PCR). RESULTS: All patients were over forty years old, and five were male. The patients had underlying diseases;five with liver cirrhosis, two with DM, and four patients with heavy alcoholism. Five of seven patients had history of ingesting raw fish and four had tissue necrosis with bullae or vesicles in their extremities. Four patients who died showed disseminated intravascular coagulation symptoms. We applied IRS-PCR to 6 isolates from blood and 2 isolates from wound. The six isolates from blood showed various genomic patterns that were all different from one another, while the two isolates from wound showed IRS-PCR patterns that were identical to the blood isolates of the same patients. CONCLUSIONS: The genomic patterns of IRS-PCR are quite different in 6 cases of V. vulnificus isolates in Korea.

Application of Infrequent-Restriction-Site Amplification for Genotyping of Mycobacterium tuberculosis and non-tuberculous Mycobacterium

Infrequent restriction site amplification (IRS-PCR) is a method of amplifying DNA sequences, which flank an infrequent restriction site, and produces a strain-specific electrophoretic pattern. We studied the use of IRS-PCR to characterize Mycobacterium tuberculosis and non-tuberculous mycobactria (NTM). One-hundred and sixteen M. tuberculosis and nine NTM isolated at Hanyang University Hospital in Seoul, Korea were used in this study. IRS-PCR using AH1 and PX-G primers produced unique patterns for reference strains, M. tuberculosis H37Rv, M. bovis BCG, M. kansasii, M. scrofulaceum, M. szulgai, M. gordonae, M. avium, M. intracellulae, M. fortuitum, and M. chelonae, respectively. Reference strains M. tuberculosis H37Rv, M. bovis, M. africanum, and all isolates of M. tuberculosis showed similar IRS-PCR patterns. The IRS-PCR patterns generated with multiple isolates of M. tuberculosis from the same patients were essentially identical. IRS-PCR revealed the greatest difference between electrophoretic DNA patterns from M. avium, M. intracellulae, and M. fortuitum that differed from each other and from the reference strains. We concluded that IRS-PCR is a useful tool for strain typing of NTM, but not for M. tuberculosis.

Genotyping of Vibrio parahaemolyticus by Infrequent Restriction Site Polymerase Chain Reaction / 대한임상미생물학회지

BACKGROUND: Infrequent restriction site PCR (IRS-PCR) is a recently described DNA fingerprinting technique based on selective amplification of restriction endonuclease-cleaved fragments. We applied of IRS-PCR to clinical isolates of Vibrio parahaemolyticus associated with diarrhea. METHODS: IRS-PCR assay was performed with adaptors for XbaI and HhaI restriction sites. A total of 35 strains of V. parahaemolyticus which were isolated from clinical specimens of patients with diarrhea were analyzed. The isolates were collected from different geographic areas of Seoul (n=12), Incheon (n=21) and Gwangju (n=2) during 1998-2000 in Korea. RESULTS: In IRS-PCR, amplifed DNA fragments between 50 and 400 bp were found to be the most reproducible in this study. When V. parahaemolyticus isolates were amplified with AH1 and PX-G as primers, 35 isolates could be grouped into five IRS-PCR patterns: A (n=16), B (n=4), C (n=6), D (n=5) and E (n=4). The patterns were subdivided into 15 subtypes: A1, A2, B1, B2, B3, B4, C1, C2, C3, D1, D2, D3, E1, E2 and E3. The IRS-PCR patterns of V. parahaemolyticus did not show any relationship with serotype or geographic origin, but the isolates from same outbreak produced a same pattern(A1). CONCLUSION: The results provide evidence of the discriminatory power of the IRS-PCR method as it applies to V. parahaemolyticus.

Infrequent Voiding Induced Acute Pyelonephritis in a Thirteen-Year Old Girl

Infrequent voiding is defined as two or less micturitions in a day without organic causes. It can lead to bladder capacity enlargement and increase in the volume of residual urine and as a consequence it may produce recurrent urinary tract infections(UTI) and or renal damages. We report a case of acute pyelonephritis due to infrequent voiding in a 13 year old girl. The imaging studies revealed floating debris in the bladder on VCUG and dilated ureter on ultrasonography, and parenchymal defects on 99mTc DMSA scan.

Comparison of Pulsed-field Gel Electrophoresis, Amplified Fragment Length Polymorphism, and Infrequent Restriction Site-Polymerase Chain Reaction for Molecular Typing of Escherichia coli and Staphylococcus aureus Strains / 감염

BACKGROUND: Pulsed-field gel electrophoresis (PFGE) has been regarded a standard method for genotyping in epidemiologic studies. However, it is tedious and time-consuming to perform. Two alternative genotyping methods have recently been developed using the polymerase chain reaction (PCR):amplified fragment length polymorphism (AFLP) and infrequent restriction site-polymerase chain reaction (IRS-PCR). These methods have not yet been applied yet to common pathogens such as Staphylococcus aureus. The purpose of this study was to determine the applicability of AFLP and IRS-PCR for the genotyping of E. coli and S. aureus isolates. METHODS: We performed PFGE, AFLP, and IRS-PCR on clinical isolates of E. coli (n=27) and S. aureus (n=30). We assessed each method in terms of discriminatory power, quality, and efficiency. RESULTS: In E. coli, the discriminatory powers of IRS-PCR and AFLP were comparable to that of PFGE. PFGE discerned 24 (88.8%) out of 27 strains, IRS-PCR discerned 22 (81.5%) out of 27, and AFLP discerned 25 (92.6%) out of 27. In the case of S. aureus, PFGE discerned 27 (90%) out of 30 strains, while both IRA-PCR and AFLP discerned 12 (40%) out of 30. The test-ing took four days to complete with PFGE, two days with AFLP, and was completed within one day with IRS-PCR. IRS-PCR showed better resolution than both PFGE and AFLP. CONCLUSION: In cases of E. coli, AFLP and IRS-PCR could be good alternatives for epidemiologic typing, as they offer better efficiency and comparable discriminatory power to PFGE. On the other hand, IRS-PCR and AFLP do not seem to be suitable for the strain-to-strain differentiation of S. aureus.