Percutaneous Nephrostomy Combined with Antifungal Agent Therapy for Both Hydronephrosis and Obstructive Uropathy in VLBW Infant

With increasing survival of smaller, more immunocompromised preterm infants, the incidence of invasive fungal infection is increasing among NICU patients, with highly associated morbidity and mortality. The most common site of end organ dissemination in premature infants with fungemia is the renal system. Renal fungal infection is followed by acute pyelonephritis and renal cortical abscess, and leads to obstructive nephropathy and renal failure. We recently experienced a case of VLBW infant who was dignosed as both hydronephrosis and obstructive uropathy due to Candida albicans that was treated intravenous amphotericin B combined with direct daily irrigation into the renal pelvis via percutaneous nephrostomy catheter.

A Case of Acute Internal and External Ophthalmoplegia without Ataxia and Areflexia Associated with Anti-GQ1b Antibody

No abstract available.

A Clinical Study of Child Abuse / 소아과

PURPOSE: To promote awareness and efforts by pediatricians to identity and prevent child abuse by investigation of characteristics of victim and types of injury caused by abuse. METHODS: A retrospective study was performed with 20 patients who had been diagnosed or suspected as child abuse at Hallym University Hospital from January 1999 to December 2005. The medical records, radiologic documents, and social worker's notes were reviewed to investigate age, sex, visiting time, form of abuse, perpetrator, risk factor, and type of injury. RESULTS: The mean age of the subjects was 2.8 years. Fourteen patients were between 0-1 years old, 2 patients between 1-6 years old, 3 patients between 7-12 years old, and 1 case over 13 years old. The ratio of male to female was 1:1. The majority of these patients (70%) visited via emergency department. Eight five percent of these patients reported with physical abuse, 5% psychological abuse, 5% sexual abuse, and 5% neglect respectively. The suspected perpetrator was the biological father in six cases, the biological mother in three cases, the stepmother in two cases, caregiver in one case, relatives in one case and "unknown" in six cases. Bruise and hematoma (80%) were the most common physical findings. Skull fractures were diagnosed in six cases, long bone fractures in two cases, hemoperitoneum in two cases, subdural hemorrhage in 10 cases, epidural hemorrhages in two cases, subarachnoidal hemorrhages in two cases, and retinal hemorrhages in five cases respectively. Seventeen cases required hospitalization and surgical operations performed were in nine cases. Four patients died and three patients had sequalae such as developmental delay and quadriplegia. CONCLUSION: Child abuse results in high mortality and morbidity in victims. Therefore early recognition and prevention is very important. Pediatricians should always suspect the possibilities of abuse in cases of fracture, intracranial hemorrhage, abdominal injury, or even any injury to the body. We recommend that the clinical investigation of suspicious children should include a full multidisciplinary social assessment, a skeletal survey and CT or MRI.

A Case of Neonatal Hydrometrocolpos Accompanying Urinary Tract Obstruction / 소아과

Neonatal hydrometrocolpos is the cystic dilatation of the vagina and uterus, which is caused by the combination of vaginal obstruction such as imperforate hymen, transverse vaginal septum, or vaginal atresia, and glandular secretion by maternal estrogenic stimulation. Although hydrometrocolpos is a rare congenital abnormality unlike pubertal hematocolpos, it is one of the relatively common abdominal masses in neonates. In typical cases the diagnosis may be determined easily by the combination of a pelvic mass, upper urinary tract dilatation and a bulging membrane in the vaginal introitus. The presense of a lower abdominal mass in a female infant should always arouse suspicion of hydrometrocolpos and lead to careful examination of the vagina. We report a case of neonatal hydrometrocolpos due to imperforate hymen which was initially presented as a large abdominal mass and a bulging membrane in the vaginal introitus. For 72 hrs, the abdominal mass increased rapidly, accompanied by urinary tract obstruction. It was relieved by a simple incision of the imperforate hymen and drainage of 300 cc of whitish mucoid vaginal fluid, and by Foley catheter drainage of 750 cc urine. No other anomaly was observed.