MR Imaging of Disseminated Tuberculosis of the Brain in a Patient with Miliary Tuberculosis: Initial Findings and Changes Six Months after Antituberculous Therapy

A 23-month-old girl visited with chronic cough and her chest radiograph showed miliary tuberculosis. There was no neurological abnormality. But CSF findings showed WBC 22/mm3(lymphocyte 20%, neutrophil 80%) and positive result of polymease chain reaction(PCR) for M. tuberculosis. MR imaging showed multiple ring enhanced nodules and ovoid nonenhancing bright signal lesion on the cerebrum, cerebellar parenchyme, and left basal ganglia. Antituberculous chemotherapy was done and follow-up MR imaging was done after six months. One month after treatment, the number and size of nodules had decreased. Six months after treatment, the multiple enhanced nodules and leptomeningeal enhancement were not observed, and high signal intensity of genu portion of left internal capsule and posterior portion of putamen were decreased.

The Annual and Seasonal Changes in the Prevalence of Rotaviral Infection from: 1993 to 1998

PURPOSE: Rotavirus infection is a leading cause of severe gastroenteritis among infants and young children worldwide. In temperate regions, institutional outbreaks of the disease occur mainly in cold dry weather, whereas in tropical settings its seasonal course is less well defined. We studied the annual changes in the seasonal prevalence of rotavirus infection for 5 years. METHODS: The study was conducted on 502 patients who lived in Taejon city and its vicinity. They were diagnosed with rotavirus gastroenteritis by stool latex coagulation method in Eulji Medical College Hospital from July 1993 to June 1998. RESULTS: During the 5-years period, 502 fecal specimens were positive by rotavirus latex coagulation method. The peak of the infection occurred in 1994 (July 1994-June 1995), 152 cases (30.3%) from July 1994 to June 1995 and the next peak occurred in 111 cases (22.1%) from July 1993 to June 1994. The seasonal peaks of the infection occurred in December 1993 (17.1%) and January 1994 (21.1%) and in March 1996 (23.4%) and March 1997 (22.5%). CONCLUSOIN: We observed that the seasonal peak in rotavirus infection changed over a 5-year period. The timing of rotavirus activity peaked during December-January(1993 and 1994), Februray-March (1996), and March-April (1997).

A Case of the Esophageal Atresia with Distal Tracheoesophageal Fistula Associated with Duodenal Obstrction

The congenital esophageal atresia with distal tracheoesophageal fisula is a developmental defect due to incomplete septation of the foregut during embryonic period and is often associated with other congenital anomalies. I experienced a case of the esophageal atresia with distal tracheoesophageal fistula in one-day-old female patient. Primary repair of esophageal atresia with distal tracheoesophageal fistula was performed but abdominal distension developed. UGI series was done and showed duodenal obstruction. I report this case with brief review of the related literature.

A Case of DiGeorge Syndrome

We experienced a case of DiGeorge syndrome in a 25-day-old male infant presented with micrognathia, short neck, fish-shaped mouth and intractable seizures with a loading dose of phenobarbital & dilantin. The serum calcium level was 3.7mg/dl, ionized calcium level was 0.62mmol/L, and parathyroid hormone carboxy-terminal level was 0.01ng/ml. We treated with it calcium gluconate infusion, low phosphorous formula milk feeding, and 1,25 (OH) 2D3. The serum calcium level was normalized in 3 days but fever and diarrhea symptom continued for 3 weeks. T-cells decreased, no thymus shadow was visible in chest MRI, and no reaction to delayed hypersensitivity skin test was detected at 9 months old. He has been followed up at the outpatient department, showing normal calcium level with the supplementation of calcium gluconate and 1,25 (OH) 2D3 for 10 months. A brief review of literatures was made.

Two Cases of Neonatal Osteomyelitis due to Extended Spectrum beta-lactamase Producing Klebsiella pneumoniae

The most common etiologic agents of neonatal osteomyelitis in the last decades were Staphylococcus aureus, Group B streptococcus, and E. coli, but Klebsiella pneumoniae as a cause of neonatal osteomyelitis appears to be rare. Klebsiella pneumoniae is one of the most important organisms associated with hospital acquired infections in the neonate and outbreaks with multiresistant strains have been reported from neonatal intensive care units around the world. These multiresistant Klebsiella pneumoniae have been shown to produce tranferable plasmid mediated beta-lactamases that are able to hydrolyze oxyimmino- beta-lactamas and these confer resistance to the third generation cephalosporin and named extended spectrum beta-lactamase producing Klebsiella pneumoniae. We experienced two cases of neonatal osteomyelitis due to extended spectrum lactamase producing Klebsiella pneumoniae in our neonatal intensive care unit during the same period. To our knowledge this represents the first documented neonatal osteomyelitise to extended spectrum beta-lactamase producing Klebsiellae pneumoniae in Korea.

A Case of the Esophageal Atresia with Proximal Tracheoesophageal Fistula

The congenital esophageal atresia with proximal tracheoesophageal fistula is a developmental defect with incomplete septation of the foregut of embryonic period and is often associated with other congenital anomaly. We experienced a case of the esophageal atresia with proximal tracheoesophageal fistula in a 1-day old male patient who was transferred from an obstetric clinic due to respiratory distress soon after birth. The baby was treated not by primary anastomosis but by operation of ligation of proximal part of fistula and gastrostomy because of too long distance of 4cm between proximal and distal pouches of esophageal atresia. His weight gain has been good in the treatment of reverse gastric tube interposition for 9 months after birth. We presented the case with brief review of the related literatures.