Risk Factors of Failure of Ibuprofen Treatment in Preterm Infants with Hemodynamically Significant Patent Ductus Arteriosus / 대한주산의학회잡지

PURPOSE: In this study, the risk factors of failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA) were investigated. METHODS: Among 403 preterm infants (<32 weeks gestation) born between January 2010 and December 2012, 125 infants treated with ibuprofen for hsPDA were retrospectively reviewed. The preterm infants were divided into the following groups according to their response to the 1st and 2nd cycles of ibuprofen treatment: responder groups I and II, closure of the ductus arteriosus after the 1st and 2nd cycles of ibuprofen treatment; and non-responder groups I and II, persistency of hsPDA after the 1st and 2nd cycles of ibuprofen treatment. RESULTS: One hundred twenty five infants were enrolled in the study: 74 in responder group I, 51 in non-responder group I, 14 in responder group II, and 22 in non-responder group II. In non-responder group I, the gestational age and birth weight were smaller, the postnatal steroid treatment was more frequent, and the duration of mechanical ventilation and the days spent in the hospital were prolonged.I n non-responder group II, the gestational age and birth weight were smaller, the diameters of the ductus arteriosus were larger, and the inotropics use was more frequent. CONCLUSION: Failure of ibuprofen treatment of hsPDA is associated with the diameter of the ductus arteriosus and with inotropics use. Obtaining data regarding these is expected to help in determining if early direct surgical ligation is needed.

Vertically Transmitted Severe Coxsackievirus B Infection in Four Preterm Twins Presented / 대한주산의학회잡지

During summer and fall months (from June to November), enteroviral infection is more common than group B streptococcal infection or herpes simplex viral infection in neonates. Enteroviruses are divided into polioviruses, coxsackieviruses A, coxsackieviruses B, and echoviruses. Enteroviruses can cause a wide spectrum of acute illnesses ranging from non-specific febrile illness, upper respiratory tract infection or gastroenteritis, to severe diseases such as myocarditis, and encephalitis. Coxsackieviruses B are important neonatal pathogens, which can cause meningoencephalitis, disseminated intravascular coagulopathy, and cardiomyopathy. Transplacental transmission of coxsackievirus or perinatal transmission by inhalation or swallowing of cervical secretion or feces during delivery causes more severe diseases than postnatal transmission by horizontal transmission in nursery or neonatal intensive care unit, due to larger load of viruses. Four preterm infants had severe coxsackieviral B infection with thrombocytopenia, meningitis, disseminated intravascular coagulopathy, and myocarditis within seven days of age during this June. Coxsackieviruses B were detected from their feces, cerebrospinal fluid, and blood. Viruses might be transmitted prenatally through placenta from mother to fetus, which caused severe disease. Coxsackieviruses B infections have to be considered in the neonates with sepsis-like illness during summer and fall months, or enteroviral seasons.

Clinical Manifestations and Characteristics in Patients with Horseshoe Kidney

PURPOSE: We aimed to investigate the clinical characteristics and associated diseases in children with a horseshoe kidney and compared these data between children and adults. METHODS: We performed a retrospective analysis of the medical records and radiological findings of 43 patients diagnosed with a horseshoe kidney in the Busan Paik Hospital. The subjects were divided into the children's group (14 cases, age or =18 years). RESULTS: The study group consisted of 17 males and 26 females with a median age of 34 years. In the children's group (14 cases), 5 subjects were male and 9 were female, with a mean age of 6.7+/-6.2 years. Most of the subjects were asymptomatic and were incidentally diagnosed with horseshoe kidney during their evaluation for another disease. Among the associated diseases in the children's group, Turner syndrome was the most common (5 cases), whereas ureteropelvic junction (UPJ) stricture was observed in 2 cases (14.2%). None of the children exhibited abnormal renal function during the follow-up period. In the adult group (29 cases), 12 subjects were male and 17 were female, with a mean age of 48 years. Eighteen patients were incidentally diagnosed with horseshoe kidney during their evaluation for another disease, and 11 patients had hematuria or abdominal pain due to renal stones. Among the associated diseases in the adult group, Turner syndrome was the most common (5 cases), and UPJ stricture was observed in 5 cases; the other accompanying diseases included hydronephrosis and overactive bladder. Six patients exhibited decreased renal function (serum creatinine level >1.5) during the follow-up period. CONCLUSION: Horseshoe kidney is usually diagnosed incidentally in both children and adults. In the present study, we noted that Turner syndrome was the most common associated disease in children. In addition, most children were asymptomatic but had a high risk of urologic complications after the transition to adulthood. Therefore, children with horseshoe kidney require continuous follow-up.

A Validation Study for the Korean Version of Chronic Obstructive Pulmonary Disease Assessment Test (CAT) / 결핵및호흡기질환

BACKGROUND: Health status measure is not only important for clinical research studies but also for clinical practices of chronic obstructive pulmonary disease (COPD) patients. The objective of this study is to evaluate the validity of the Korean Version of COPD Assessment Test (CAT) in primary care clinics as well as in referral hospitals. METHODS: Smokers or ex-smokers, aged 40 years or older, with a smoking history of >10 pack-years; and a COPD diagnosis in the past 6 months or more, were recruited from 4 primary care clinics and 2 referral hospitals. Demographic, medical, and spirometry data was collected from patients who completed the CAT and St. George Respiratory Questionnaire (SGRQ), and had their dyspnea been assessed. The primary endpoint was the correlation between of the Korean version of CAT with SGRQ in patients with COPD. RESULTS: A total 100 patients were enrolled. The mean age and smoking amounts were 69.2+/-8.4 years and 40.6+/-22.3 pack-years, respectively. Sixty-seven percent of the patients reported at least one exacerbation in the past year. The mean CAT score was 16.9+/-8.0. The internal consistency assessed by Cronbach's alpha was 0.85. The CAT score was positively correlated with the SGRQ score (r=0.76, p<0.0001) and each component of SGRQ: symptoms, activity and impacts; r=0.68, r=0.61, and r=0.72, respectively (all p<0.0001). These positive correlations were preserved in the different groups (r=0.86, p<0.0001 in primary care clinic group; r=0.69, p<0.0001 in hospital group). The CAT score was also positively correlated to the Medical Research Council dyspnoea scale (r=0.46, p<0.0001). CONCLUSION: The Korean version of CAT had good internal consistency and showed good correlations with SGRQ. It can be used for assessing the impacts of COPD on the patient's health including primary care setting.

Churg-Strauss Syndrome: The Clinical Features and Long-term Follow-up of 17 Patients

Churg-Strauss syndrome (CSS) is a rare multi-system vasculitis; some cases have been reported in Korea. The aim of this study is to describe the clinical features, treatment outcome, and long-term follow-up of CSS from a single Korean medical center. Between 1995 and 2004, seventeen patients were diagnosed with CSS at the Department of Medicine of the Samsung Medical Center, Sungkyunkwan University School of Medicine. The diagnosis of CSS is based on the classification criteria of the American Collage of Rheumatology. All patients had asthma. As in other case series, the lung, peripheral nervous system, and skin were the most commonly involved organs. During the active stage of the disease, most of the patients exhibited peripheral blood eosinophilia and an elevated serum eosinophil cationic protein level. Ten patients were treated with pulses of methylprednisolone followed by tapering and cyclophosphamide, and the others were treated with corticosteroids alone. The outcomes after long-term follow-up were generally good. One patient who was refractory to initial treatment died of heart failure during the follow-up period. CSS was highly variable in its presentation and course. The manifestations may range from mild symptoms to life-threatening conditions. The outcome after long-term follow-up was as good as that of previous studies.

Chronic cough of unknown causes and gastroesophageal reflux disease: the incidence and treatment response / 대한내과학회지

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common cause of chronic cough. Nevertheless the incidence of GERD is low in Korea. We evaluated the necessity of tests for GERD as a cause of chronic cough and treatment responses to proton pump inhibitors. METHODS: Patients with cough for more than three weeks were enrolled. Patients who were diagnosed as bronchial asthma, eosinophilic bronchitis, and posterior nasal drip were differentiated. Twenty four hour ambulatory esophageal pH monitoring was performed in patients with chronic cough of unknown causes or gastroesophageal reflux symptoms. Patients were diagnosed as GERD when DeMeester composite score was over 14.7 or symptom sensitivity index was over 10 percent. We prescribed proton pump inhibitors for patients diagnosed as GERD. RESULTS: Sixty seven of 531 patients supposedly needed 24-hour ambulatory esophageal pH monitoring. 24-hour ambulatory esophageal pH monitoring was performed in 34 patients and eight patients were diagnosed as GERD. Symptoms improved in 5 patients on taking omeprazole 20~40 mg/day single or combined with prokinetic agents. CONCLUSIONS: Among patients with chronic cough, not many cases needed to take 24-hour ambulatory esophageal pH monitoring. The incidence of GERD, diagnosed by 24-hour ambulatory esophageal pH monitoring, in chronic cough of unknown causes was low. The effect of omeprazole was similar to the previous reports.

A Case of Typhoid Fever Complicated with Meningitis, Cervical Spondylitis and Epidural Abscess / 감염과화학요법

Typhoid fever still steadily occurrs, although its incidence decreased in Korea. Even though the clinical manifestations of typhoid fever are varied, there has been no reported case complicated with meningitis, cervical spondylitis and epidural abscess simultaneously. We experienced a case of typhoid fever in an immunocompetent patient complicated with meningitis, cervical spondylitis and cervical epidural abscess. A 55-year old woman was admitted because of fever and neck pain. The finding of her lumbar puncture was compatable with bacterial meningitis, and Salmonella enterica Typhi was found in blood cultures. Despite of medical treatment, neck pain, radiating to upper extremities, was aggravated. Cervical MRI revealed an anterior epidural abscess with spondylitis and discitis at the level of the 5th and 6th cervical vertebral bodies. Removal of epidural abscess and laminectomy were performed for cervical spinal cord compression. Ciprofloxacin was intravenously given for up to one month and was then switched to oral formula. She was cured without neurologic sequelae and has had no relapse for 1 year follow-up.

A Case of Typhoid Fever Complicated with Meningitis, Cervical Spondylitis and Epidural Abscess / 감염과화학요법

Typhoid fever still steadily occurrs, although its incidence decreased in Korea. Even though the clinical manifestations of typhoid fever are varied, there has been no reported case complicated with meningitis, cervical spondylitis and epidural abscess simultaneously. We experienced a case of typhoid fever in an immunocompetent patient complicated with meningitis, cervical spondylitis and cervical epidural abscess. A 55-year old woman was admitted because of fever and neck pain. The finding of her lumbar puncture was compatable with bacterial meningitis, and Salmonella enterica Typhi was found in blood cultures. Despite of medical treatment, neck pain, radiating to upper extremities, was aggravated. Cervical MRI revealed an anterior epidural abscess with spondylitis and discitis at the level of the 5th and 6th cervical vertebral bodies. Removal of epidural abscess and laminectomy were performed for cervical spinal cord compression. Ciprofloxacin was intravenously given for up to one month and was then switched to oral formula. She was cured without neurologic sequelae and has had no relapse for 1 year follow-up.

A case of eosinophilic cellulitis associated with angioedema and eosinophilia / 천식및알레르기

Eosinophilic cellulitis was first described by Wells, which is characterized by cellulitis like skin lesion, eosinophilic infiltration of dermis and subcutaneous fat with characteristic flame figure appearance of chollagen bundles. Peripheral eosinophilia is not necessary for the diagnosis of eosinophilic cellulitis, but association with hypereosinophilic syndrome was reported. Episodic angioedema associated with eosinophilia was first described by Gleich et al. as recurrent attack of angioedema; peripheral eosinophilia; and body weight gain; they described this as separate disease entity rather than variant of the hypereosinophilic syndrome. Both angioedema associated with eosinophilia and eosinophilic cellulitis were reportedly associated with hypereosinophilic syndrome, and we believe both diseases are variants of idiopathic hypereosinophilic syndrome. We experienced a patient with eosinophilic cellulitis who has expressed skin lesion resembling angioedema associated with eosinophilia, and who also has involvement of pleura and gastrointestinal tract. We speculate that this patient represents an overlap syndrome of idiopathic hypereosinophilic syndrome, eosinophilic cellulitis and angioedema associated with eosinophilia.

A Case of Granular Cell Tumor in the Rectum / 대한소화기내시경학회지

Granular cell tumor (GCT), first described by Abrikossoff in 1926, is relatively uncommon, usually benign and solitary neoplasm. The most frequently involved organs include the tongue, skin, breast, and digestive tract. Until now, less than 200 cases of GCTs of the digestive tract have been reported in the esophagus, and less than 50 cases in the large intestine, stomach, biliary tract in the world. Only less than 20 cases of GCT of the rectum have been reported in the world. It is believed that there have been no reported cases of GCT of the rectum in Korea. Recently, the incidence of granular cell tumor has been slowly rising since endoscopy has been used more commonly as a diagnostic tool. We report a case of granular cell tumor in the rectum in a 49-year-old male patient, which was confirmed by microscopic examination after colonoscopic polypectomy.

Occupational asthma induced by cephalosporin precursor / 천식및알레르기

A 41-year-old male pharmaceutical worker developed dyspnea and wheezing 10 years after beginning the work. He had handled powder of cephalosporin precursor, 7-aminocephalosporanic acid (7-ACA). He had suffered from dyspnea, chest tightness and wheezing in the workplace for the last three years. Recently, these symptoms were aggravated. His pulmonary function test showed severe obstructive pattern and PC(20) was 0.06 mg/ml on MBPT(methacholine bronchial provocation test). Skin prick test and intradermal test showed positive reactions to ceftriaxone, cefazolin, etc. During the skin test, he suffered from an asthmatic attack and anaphylactic shock. Bronchial provocation test with cefotiam elicited a dual asthmatic reaction. We presumed that IgE-mediated mechanism may be mainly involved in the pathogenesis of cephalosporin induced occupational asthma, in addition to other immunologic or non-immunologic mechanisms. Further studies will be necessary to investigate the pathogenesis of this disease.