ABSTRACT
PURPOSE: The purpose of this study was to investigate the clinical characteristics and outcome of febrile urinary tract infections (UTIs) caused by community-acquired extended-spectrum beta-lactamase (CA-ESBL)-producing and -nonproducing bacteria. METHODS: We analyzed febrile UTIs in children hospitalized at Gachon University Gil Medical Center from January 2011 to December 2013 through retrospective data collection from their medical records. RESULTS: Among pathogens causing 374 episodes of UTIs, the proportion of ESBL-producing bacteria was 13.1% (49/374). The proportion of ESBL-producing Escherichia coli and Klebsiella spp. was 13.6% (48/354) and 5.0% (1/20), respectively. There was no significant difference between the CA-ESBL and CA non-ESBL groups in duration of fever (4.2+/-2.7 vs.3.7+/-2.1 days, P=0.10) and bacterial eradication rate with empirical antibiotics (100% vs. 100%). The risk of cortical defects on renal scan significantly depended on existence of vesicoureteral reflux rather than ESBL production of pathogen. CONCLUSIONS: There was no significant difference between the CA-ESBL and CA non-ESBL groups in renal cortical defects and clinical outcome. Careful choice of antibiotics is important for treatment of community-acquired UTI in children.
Subject(s)
Child , Humans , Anti-Bacterial Agents , Bacteria , beta-Lactamases , Data Collection , Escherichia coli , Fever , Klebsiella , Medical Records , Retrospective Studies , Urinary Tract Infections , Vesico-Ureteral RefluxABSTRACT
Neurocutaneous melanosis is a rare non-familial congenital neurocutaneous syndrome characterized by the presence of large or multiple congenital melanocytic nevi in association with benign or malignant proliferation of melanocytes in the leptomeninges. It is believed to be an embryonic neuroectodermal dysplasia. The Dandy Walker complex is an uncommon disorder of the CNS, also. refers to a condition with a broad posterior fossa and high tentorium insertion, hypoplasia or aplasia of the cerebellar vermis and cystic dilation of the fourth ventricle communication with the posterior fossa. We report a patient with NCM associated with the DWC that was diagnosed by MRI. The patient had multiple, small to medium-sized melanocytic nevi on the scalp and back, presenting at birth. At 6 months of age, frequent daily attacks of partial seizures were noted. T1 weighted MR images showed multiple high signal lesions in the amygdala, cerebellar folia, deep nuclei, and basis pontis, compatible with intraparenchymal melanin deposits. In addition, hypoplasia of the inferior vermis and a broad posterior fossa were identified. The patient failed to respond to oxcarbazepine. The seizure frequency did not decrease for the first three months. Vomiting and mild elevation of the liver enzymes were observed after adding valproic acid. However, after topiramate was started the frequency of the seizures decreased, and the oxcarbazepine and valproic acid were discontinued. With 5 mg/kg of topiramate treatment, the patient became seizure free for 20 months; however, infrequent seizures recurred thereafter. The dosage of topiramate was increased to 13 mg/kg, and for the following 15 months, there have been no seizures. Seizures were well controlled by topiramate for four years.
Subject(s)
Humans , Amygdala , Carbamazepine , Dandy-Walker Syndrome , Fourth Ventricle , Fructose , Liver , Melanins , Melanocytes , Melanosis , Neural Plate , Neurocutaneous Syndromes , Nevus, Pigmented , Parturition , Scalp , Seizures , Valproic Acid , VomitingABSTRACT
PURPOSE: There have been a few data about esophageal length in children and previous data are improper for application to various procedures. Because of the variability in height and weight of each the individuals especially in children, measurable external parameters are needed. METHODS: We measured distance from upper incisor to esophago-gastric junction using a flexible endoscope and compared these data with age, height and weight in 262 children who underwent upper gastrointestinal endoscopy. RESULTS: The mean age was 9.0+/-3.6 year (from 2 days to 16 year of age), mean height was 132.89+/-23.49 cm and mean length from upper incisor to esophago-gastric junction was 33.34+/-5.42 cm. Correlation between distance from upper incisor to esophago-gastric junction and height was the mostly predictable indicator of the esophageal length (Pearson correlation=0.944). We propose a formula [Esophageal length=4.419+(0.218 x height)] as a indicator of the esophageal length (p=0.000, R2=0.891). CONCLUSION: The esophageal length in children and for application to various procedures can be reliably predicted by using the height.