Histomorphometric Evaluation of Onlay Freeze-Dried Block Bone and Deproteinized Bovine Bone with Collagen in Rat

The aim of this study was to evaluate the effect of human freeze-dried bone block (FDBB) and deproteinized bovine bone with collagen (DBBC) on bone formation when applied as an onlay graft in rat calvariums. Thirty male Sprague-Dawley rats received collagen sponge (control), FDBB, or DBBC onlay grafts trimmed into 8-mm disks measuring 4-mm height. Each graft was secured onto the calvarium surface using horizontal mattress sutures. Rats in each group were killed at 2 (n=5) or 8 (n=5) weeks postoperatively for histologic and histomorphometric analysis. The total augmented area (mm²), new bone area (mm²), and bone density (%) were measured. The FDBB and DBBC groups showed significantly more new bone formation and bone density than the control group at 2 and 8 weeks. The increased new bone area was significantly greater in the FDBB group than in the DBBC group (p<0.05). The total augmented area was significantly higher in the FDBB and DBBC groups at 2 and 8 weeks than in the control group (p<0.05), and at 8 weeks, the area was significantly decreased in the DBBC group compared to that in the FDBB group and the area at 2 weeks (p<0.05). Within the limitations of the present study, we concluded that onlay FDBB and DBBC grafts caused new bone formation through an osteoconductive mechanism. In addition, compared to FDBB, DBBC had less capacity to form new bone and maintain the space.

Cerebro-oculo-facio-skeletal syndrome: A case report / 소아과

The Cerebro-oculo-facio-skeletal (COFS) syndrome is a rare autosomal recessive disorder characterized by multiple abnormalities that involve the brain, face, eyes, and extremities. COFS syndrome is regarded as a degenerative disorder of the brain and spinal cord caused by a mutation of the DNA repair genes. We report on an 8-month-old girl with COFS syndrome who exhibited growth and developmental delay, hypotonia, microcephaly, nystagmus, cleft palate, widely separated nipples, inguinal hernia, camptodactyly, and rocker-bottom feet with vertical talus.

A case of lung abscess caused by Burkholderia cepacia in healthy child / 소아과

Burkholderia cepacia is a Gram-negative aerobic bacillus known to cause opportunistic infections in the immune-compromised hosts. This microorganism is strongly virulent and causes a necrotising invasive infection that may lead to death. As B. cepacia is highly resistant to various antimicrobials, combination antimicrobial therapy must be used instead of monotherapy. We report a successful treatment of lung abscess that was naturally caused by B. cepacia in a healthy child, through combination antimicrobial therapy of meropenem and trimethoprim/sulfamethoxazole and operative management.

Clinical Characteristics of Extended-spectrum beta-lactamase Producing Shigella sonnei Infection Outbreaked in Chungju Area / 대한진단검사의학회지

BACKGROUND: An outbreak of extended-spectrum-lactamase (ESBL)-producing Shigella sonnei enteritis, especially in pediatric populations, was unprecedented not only in Korea, but also throughout the world in the past. This study was intended to devise a management guideline for shigellosis caused by an ESBL-producing strain based on analysis of the clinical manifestations and response to therapy. METHODS: We examined 24 strains of S. sonnei isolated from stool cultures of patients with acute enteritis, between November 2004 and February 2005, for antimicrobial susceptibility and ESBL production, and we also performed DNA sequencing with PCR for the typing of ESBL genes. In addition, we retrospectively analyzed the clinical characteristics, laboratory results, and therapeutic responses to antibiotics of the 103 patients who grew S. sonnei on stool cultures. RESULTS: All 24 isolates showed a very similar antibiotic sensitivity pattern and were ESBL gene type of CTX-M-14. The most frequent clinical symptom in the 103 patients was a fever, followed by diarrhea, abdominal pain, headache, vomiting, and nausea. Leukocytosis and CRP were positive in 53.4% and 78.6% of the patients, respectively. On stool direct smears, 11.7% showed more than 50 WBCs per HPF and 71% were positive on stool occult blood. Microbiological eradication rates were as follows: azithromycin and ciprofloxacin, 100%; imipenem-cilastatin, 68.8%; ampicillin-sulbactam, 42.9%; amoxicillin-clavulanic acid, 20%; ceftizoxime, 12.5%; cefdinir, 6.9%; and ceftriaxone and trimethoprim-sulfamethoxazole, 0%. CONCLUSIONS: We presumed that, given its cost-effectiveness and safety, azithromycin can be an attractive option for the treatment of ESBL-producing S. sonnei enteritis in pediatric populations. Although ciprofloxacin is another cost-effective agent, its use in pediatric populations is not recommended.

Comparative study of therapeutic effects according to duration of medium-dose aspirin therapy at the acute stage of Kawasaki disease / 소아과

PURPOSE: This study was performed to compare the therapeutic effects according to duration of medium-dose aspirin(50-60 mg/kg/day) therapy at the acute stage of Kawasaki disease(KD). METHODS: Total 87 patients with KD were enrolled in this study. We performed retrospective analysis of clinical characteristics and echocardiographic findings based on medical records. Patient were randomly divided into 2 groups according to the duration of aspirin therapy at the acute stage of KD. Long-term group(LG, n=55) was administered medium-dose aspirin for 2 weeks after diagnosis of KD, and short-term group(SG, n=32) for 48 hours after intravenous immunoglobulin(IVIG) administration. The parameters of therapeutic effects were duration of fever after IVIG administration, incidence of unresponsive patients to single administration of IVIG, and development of transient dilatation or aneurysm of coronary arteries. RESULTS: There was no significant difference in the duration of fever after IVIG between the both group(LG 1.7+/-1.1 days, SG 1.8+/-1.1 days; P=0.588). The incidences of unresponsive patient to the single administration of IVIG were 5.5 percent, 6.3 percent in the each group. Transient dilatation of coronary arteries occurred at 18.2 percent(10/55) in the LG, and 15.6 percent(5/32) in the SG(P= 0.761). Prevalence of coronary aneurysm after subacute stage were 7.3 percent(4/55) in the LG, and 9.4 percent(3/32) in the SG(P=0.728). CONCLUSION: There was no significant difference in the therapeutic effects between long-term(2 weeks) and short-term(48 hours) administration of medium-dose aspirin at the acute stage of KD.

A Domestic Outbreak of Bacterial Dysentery Caused by Extended-Spectrum beta-Lactamase (ESBL) -producing Shigella sonnei / 소아과

PURPOSE: An outbreak of ESBL-producing Shigella sonnei enteritis was unprecedented not only in Korea but throughout the world in the past. We intended to devise a management guideline for ESBL-producing shigellosis based on analysis of clinical manifestations and response to therapy. METHODS: We analyzed 103 patients who were admitted to the hospital with acute GI symptoms and were shown positive result for S. sonnei on stool culture. We performed sensitivity test to the antibiotics and DNA sequencing of ESBL gene in the isolated S. sonnei colonies. In addition, we retrospectively analyzed their clinical characteristics, laboratory results, and clinical and microbiological responses to the antibiotics. RESULTS: Among the clinical manifestations, fever was the most frequent (96.1%), followed by diarrhea (93.2%), abdominal pain (76.7%), headache (71.8%), vomiting (65.0%), and nausea (41.7%). The fever was sustained for average of 2.0 days and diarrhea for 3.9 days. Watery diarrhea was the most common (69%) followed by mucoid (26%), and bloody stool (5%). On peripheral blood smear, leukocytosis was noted in 53.4% of patients, and 78.6% of patients tested positive for serum CRP response. On stool direct smear, 11.7% of patients showed more than 50 WBCs/HPF, and 9.7% of patients between 5 to 20 WBCs/HPF. Stool occult blood was positive in 71% of patients. Production of CTX-M-14 type ESBL was reported for all S. sonnei strains isolated from this outbreak. Microbiological eradication rates to various antibiotics were as follows: 100% (9/9) to ciprofloxacin, 100% 5/5) to azithromycin, 6.9% (5/72) to cefdinir, 0% (0/8) to ceftriaxone, 12.5% (1/8) to ceftizoxime, 0% (0/ 8) to TMP/SMX, 42.9% (3/7) to ampicillin/sulbactam, 20% (1/5) to amoxicillin/clavulanic acid, and 68.8 % (11/16) to imipenem/cilastatin. CONCLUSION: It is presumed that azithromycin can be an attractive option for the treatment of ESBL-producing S. sonnei enteritis in pediatric population, given its cost-effectiveness and safety. Although ciprofloxacin is another cost-effective agent, its use in pediatric population may be a bit too premature.

A Case of Chylous Mesenteric Cyst in a Neonate / 소아과

Mesenteric cysts are one of the least common intraabdominal lesions, which are very rare in neonates. Among mesenteric cysts, a chylous cyst is the rarest one of all. This entity can be found anywhere in the gastrointestinal tract from the duodenum to the rectum. Mesenteric cysts may be asymptomatic and found on routine examinations, or can present with symptoms such as abdominal pain, palpable mass, abdominal distension and intestinal obstruction. We report a rare case of chylous mesenteric cyst in a neonate, who presented with symptoms of the intestinal obstruction along with the review of the literature.

Wilson-Mikity Syndrome in a Newborn: Findings of Initial and Follow-up High-Resolution CT

Wilson-Mikity Syndrome, a form of chronic lung disease, is rarely developed with the widespread use of mechanical ventilaton. There has always been difficulty distinguishing it from bronchopulmonary dysplasia. The etiology and pathogenesis of this disease are still unknown. There are no reports in Korean literature about high-resolution (HR) CT follow-up of this disease. Diffuse interstitial thickening, which was noted on the initial examination, decreased, but some focal hyperinflations remained on follow-up HRCT. Further studies with HRCT will help to understand the progression of the disease, and will help to develop treatment and management programs.

Solitary Juvenile Polyp with Adenomatous Change Presenting as Colonic Intussusception / 대한소화기내시경학회지

Solitary juvenile polyps are the most common benign hamartomatous polyps in childhood presenting with painless rectal bleeding. It is rare in solitary juvenile polyps with adenomatous change which is associated with increased risk for gastrointestinal cancer. We report a rare case of a solitary juvenile polyp with adenomatous change and causing colonic intussussection in a 6 year old girl, who presented symptoms of lower abdominal pain, vomiting, and hematochezia. The colonic intussussception was reduced during the colon barium study and a polypoid round mass shadow at the splenic flexure was formed. On colonoscopy, it was seen as a single huge polyp impacted to the splenic flexure lumen. Endoscopic polypectomy was performed. The histologic evaluation revealed the characteristic features of a juvenile poloyps with adenomatous change.

Detection of Recurrence with FDG-PET Scan in Patients with Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the feasibility of 2-[18F]-fluoro-2-deoxy-D-glucose-Positron emission tomography (FDG-PET) scan for detecting early recurrence in patients with endometrial cancer who showed no evidence of the disease after primary treatment. METHODS: A total of 14 patients, diagnosed and treated for endometrial cancer with surgery and/or subsequent radiotherapy, were included. Whole-body FDG-PET scanning was performed on 14 patients. PET images were interpreted was suspicious for malignancy in areas of localized FDG uptake compared to the surrounding tissues. computed tomography (CT) or magnetic resonance imaging (MRI) and/or fine needle biopsy were performed to evaluate positive FDG uptakes, and all patients were closely followed up at least for 6 months. RESULTS: Of the 14 patients, 2 recurrences were detected by FDG-PET scan. One of these two patients had increased FDG uptake in abdomen, which was negative on CT, and was confirmed to be recurrent 3 month later on follow-up CT. The other patient had a single focus of hypermetabolic activity in right upper quadrant of abdomen, which was correspondent to 5 cm sized hypodense mass along the right anterior segment of the liver on CT scan, and was confirmed to have adenocarcinoma cell on a needle biopsy. CONCLUSION: These preliminary data demonstrate the feasibility of FDG-PET imaging in detection of early recurrence in patients with endometrial cancer. Further prospective evaluation of FDG-PET in larger numbers of patients with endometrial cancer is warranted to more precisely define its accuracy.

Detection of Recurrence with FDG-PET Scan in Patients with Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the feasibility of 2-[18F]-fluoro-2-deoxy-D-glucose-Positron emission tomography (FDG-PET) scan for detecting early recurrence in patients with endometrial cancer who showed no evidence of the disease after primary treatment. METHODS: A total of 14 patients, diagnosed and treated for endometrial cancer with surgery and/or subsequent radiotherapy, were included. Whole-body FDG-PET scanning was performed on 14 patients. PET images were interpreted was suspicious for malignancy in areas of localized FDG uptake compared to the surrounding tissues. computed tomography (CT) or magnetic resonance imaging (MRI) and/or fine needle biopsy were performed to evaluate positive FDG uptakes, and all patients were closely followed up at least for 6 months. RESULTS: Of the 14 patients, 2 recurrences were detected by FDG-PET scan. One of these two patients had increased FDG uptake in abdomen, which was negative on CT, and was confirmed to be recurrent 3 month later on follow-up CT. The other patient had a single focus of hypermetabolic activity in right upper quadrant of abdomen, which was correspondent to 5 cm sized hypodense mass along the right anterior segment of the liver on CT scan, and was confirmed to have adenocarcinoma cell on a needle biopsy. CONCLUSION: These preliminary data demonstrate the feasibility of FDG-PET imaging in detection of early recurrence in patients with endometrial cancer. Further prospective evaluation of FDG-PET in larger numbers of patients with endometrial cancer is warranted to more precisely define its accuracy.

Disorders of Mineral Metabolism & Acid-Base Balance / 소아과

No abstract available.

Evaluation of Growth Status Using Serum IGF-I and IGFBP-3 in Children with Mild Asthma / 대한소아내분비학회지

pose:Growth delay in asthmatic children has been reported, but the causes are unclear. In this study, we analyzed growth status in children with mild asthma and measured serum insulin-like growth factor (IGF)-I and insulin-like growth factor binding protein (IGFBP)-3 to evaluate the relationship between the growth status and growth factors. We also evaluated the difference in the relationship of height standard deviation score (HTSDS) according to weight standard deviation score (WTSDS) between children with asthma and controls. METHODS:58 children between the age of 9 months and 12 years, who visited Konkuk University Hospital between July 2002 to June 2003, with wheeze and responded to bronchodilators were enrolled as asthma group. 59 children between the age of 6 months and 14 years without any medical problem were enrolled as controls. Height and weight were measured for both groups and their standard deviation scores were calculated respectively. Blood samples were collected for serum IGF-I, IGFBP-3 levels and IGF-I/IGFBP-3 ratio were calculated from those values. The relationships between each growth status and growth factors were analyzed. RESULTS:The HTSDS and WTSDS were 0.17+/-.00, 0.38+/-.23 respectively for the asthma group; the HTSDS and WTSDS were 0.05+/-.95, 0.08+/-.06 respectively for the controls. IGF-I was 169.6+/-0.7 ng/mL, IGFBP-3 was 2146.0+/-36.5 ng/mL, and IGF-I/IGFBP-3 ratio was 0.08+/-.03 for the asthma group; IGF-I was 422.6+/-70.3 ng/mL, IGFBP-3 was 3409.6+/-61.1 ng/mL, and IGF-I/IGFBP-3 ratio was 0.12+/-.05 for the controls. In both groups, the concentration of IGF-I, IGFBP-3 and IGF-I/ IGFBP-3 ratio showed significant correlation with the age (P<0.01). In both groups, the correlation coefficient for WTSDS and HTSDS were 0.39 and 0.64, which were statistically significant. In the asthma group, the height gain was significantly smaller than the weight gain compared with controls (P<0.05). CONCLUSION: We concluded that in children with mild asthma the increment in HTSDS according to WTSDS is less than that of controls.

Genetic Heterogeneity of Borrelia burgdorferi Sensu Lato Isolated in Chungju, Korea, by ospC Gene Sequence Analysis

Eight Borrelia burgdorferi strains, which had been isolated from Ixodes nipponensis and Apodemus agrarius captured in the Chungju area of Korea, were characterized by ospC gene sequence analysis. Nucleotide sequence similarity among the Chungju strains ranged from 83.6 to 100%. Deduced amino acid sequence similarity of the Chungju strains ranged from 75.4 to 100%. In a molecular phylogenetic analysis, the Chungju strains were separated from B. burgdorferi and B. garinii reference strains, and formed a cluster with B. afzelii reference strains. Three (KK2, KM4, and KK5), two (CJ2 and CJ21), and one (CJ3) Chungju strains formed clusters with OspC serotype 5, OspC serotype 8, and OspC serotype 7 reference strains, respectively. However, two Chungju strains (KK1 and KM10) formed a distinctive cluster that was separated from other strains of B. afzelii reference strains. These results suggest that Chungju strains are very heterogeneous in clonality.

A Case of Impetigo Herpetiformis during Pregnancy / 대한산부인과학회잡지

Impetigo herpetiformis is a rare pustular eruption that may be seen in late pregnancy. It is associated with severe maternal and fetal complications in case of misdiagnosis and delayed treatment. The patient was a 25-years-old multigravida with psoriasis in her past history. At 20weeks gestation, she had been developed erythematous scaly annular patchs with papules and pustules on inner thigh. At 37weeks' gestation, the patient was suffered from a severely pruritic pustular rash with fever and leukocytosis. The skin of the affected areas was biopsied and showed intraepidermal pustular abscess with a neutrophilic infiltrate. Treatment commenced with intravenous fluids, antibiotics, systemic prednisone, steroid creams, and phototherapy(UVB) under the careful fetal well being monitoring. Cesarean section was done due to fetal distress, and a normal healthy male infant was delivered, following which the patient's condition improved rapidly.

Gastric Duplication in the Newborn

Duplications of the stomach account for only 3.8% of gastrointestinal duplication, mainly discovered during first year of life. Etiopathogenesis is unknown. The most widely accepted theory is recannalization with fusion of longitudinal epithelial fold. The most frequent presented symptoms and signs include gastric outlet obstruction with vomiting, and palpable mass in the epigatric area. An upper gatrointestinal series usually reveals evidence of extrinsic mass effect of intramural lesion. An abdominal ultrasonographic finding is cystic mass lesion with double layer. Histologically, the wall of intramural cyst is composed of orderly layers of alimentary mucosa, submucosa, and muscle fibers. Recommended management is complete excision & simple closure of duplication without violation of the gastric lumen. In this case, 3-day old male newborn suffered from symptoms of gastric outlet obstruction, multiple gastric duplication cysts were found in pyloric canal and greater curvature. The cystic wall was composed with typical 3 layers of gastric mucosa, submucosa, and muscle fibers. The cystic wall was composed with typical 3 layers of gastric mucosa, submucosa, and muscle fibers. Surgical excision was successfully done.

Congenital Partial Left Pericardial Defect

Congenital pericardial defect is relatively rare and two different types, partial and complete, of different clinical significance have been recognized. Most reported defects are complete type and left-sided lesion. Most patients are asymptomatic or complain of vague chest pain. Partial pericardial defect can be potentially fatal due to cardiac herniation and strangulation or coronary insufficiency. Plain chest reontgenography shows abnormal prominence along the cardiac border. 2-D echocardiography demonstrates a drop-off of pericardial echo and protruding cardiac chamber through the defect. Because of the potential fatality, surgical repair is recommended for the partial pericardial defect. We report a case of congenital partial left pericardial defect, which was diagnosed by plain chest reontgenography and 2-D echocardiography, with related literatures.