• Pediatric Infection and Vaccine
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• v.21 no.2
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• pp.129-138
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• 2014

Purpose: Streptococcus pyogenes is an important cause of invasive diseases in children. We aimed to describe the clinical characteristics of invasive infections due to S. pyogenes in children in Korea. Methods: A retrospective study of children under 18 years of age with invasive infections due to S. pyogenes at Seoul National University Children's Hospital between March 1992 and December 2012, and Seoul National University Bundang Hospital between March 2003 and December 2012 was conducted. Demographic factors, clinical characteristics, laboratory findings, treatment, mortality and morbidity of all patients were reviewed. Results: A total of 30 among 36 cases identified as invasive disease due to S. pyogenes were available for review. There was a predominance for male subjects (male:female=2.75:1). The median age was 50 months (range 12 days to 15 years) and 53.3% were under 5 years of age. Skin and soft tissue infections (9/30, 30.0%), bacteremia without identified focus (4/30, 13.3%) and bone and joint infections (6/30, 20.0%) were the most frequent clinical presentations. Streptococcal toxic shock syndrome (3/30, 10.0%) pulmonary, abdomen and central nervous system infections (2/30, 6.7%) were also seen. There was a peak in number of patients in year 2012 (9/30, 30.0%). There were no cases of mortality. Erythromycin and clindamycin resistance rates were low by 3.8% and 7.5%, respectively. Conclusion: We studied the clinical presentations of invasive infections due to S. pyogenes during the past 20 years in Korean children. The findings of this study help us understand the characteristics of the disease, enhancing early recognition and prompting adequate antibiotic therapy which is important in reducing morbidity and mortality.

• Journal of Veterinary Clinics
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• v.21 no.1
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• pp.7-14
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• 2004

Bacteria that are resistant to several different groups of antibiotics have increased during the past few years. The importance of surveillance of antimicrobial resistance is now widely recognized. Unfortunately, this development has not been documented continuously in veterinary medicine in Korea. Therefore, the clinical prevalence and trend of antimicrobial susceptibility of aerobic isolates were investigated in this study. Total 121 isolates of aerobic bacteria were isolated from clinical specimens of dogs and cats at Veterinary Medical Teaching Hospital of Seoul National University from May 2001 to October 2002. Among them, the most common isolated species was Staphylococcus spp. (48 isolates), followed by E.coli (26 isolates), Enterococcus spp. (21 isolates), Klebsiella pneumoniae (9 isolates), Streptococcus spp. (6 isolates), Enterobacter cloacae (3 isolates), Pseudomonas aeruginosa (3 isolates), Corynebacterium xerosis (2 isolates), Chryseomonas spp. (2 isolates), and Providencia stuartii (1 isolate). The susceptibility of isolates to antibiotics was determined by the disk diffusion method. Gram-positive bacterial isolates were showed high susceptibilities to amikacin, amoxacillin/clavulanate, ceftazidime, and oxacillin, while Gram-negative bacterial isolates were showed high susceptibilities to amikacin and ceftazidime. Staphylococcus spp. were showed high susceptibilities to amikacin, amoxicillin/clavulanate, ceftazidime, cephalothin, and oxacillin. Streptococcus spp. and E.coli were showed high susceptibilities to amikacin and ceftazidime. Of the 48 staphylococci, seven Methicillin Resistant staphylococci were observed (14.6%), distributed among S. auricularis (1), S. hemolyticus (2), S. sciuri (1), S. saprophyticus (1), S. warneri (2) isolates. One strain of E.coli and one strain of Corynebacterium xerosis were resistant to all antibiotics tested. And, resistance trends between the you 2000 (from July 1999 to September 2000) and 2002 (from May 2001 to October 2002) were compared. Resistance to antibiotics was increased in both Gram-positive and Gram-negative bacterial isolates (p＜ 0.05). The resistance rates of Staphylococcus spp., E.coli and Klebsiella pneumoniae to all antibiotics tested were also increased (p＜0.05). This study investigated increasing resistance between the year 2000 and 2002 in Veterinary Medical Teaching Hospital of Seoul National University. Surveillance resistance is helpful to alert to veterinarian and select of appropriate therapy. Antimicrobial susceptibility surveillance of isolates should urgently be continued in veterinary medicine.

• Pediatric Infection and Vaccine
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• v.8 no.1
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• pp.94-100
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• 2001

Purpose : Enterovirus is a common cause of aseptic meningitis and nonspecific febrile illness in young children. During the summer and fall months, enterovirus-infected young children are frequently admitted and evaluated to rule out bacterial sepsis and/or meningitis. The purpose of this study was to evaluate the relationship between nonpolio enterovirus infection and febrile illness in infants under 3 months of age during the summer, fall months by using a stool culture to identify the presence of enterovirus. Methods : Patients included febrile infants under 3 months of age admitted to Masan Fatima Hospital for sepsis evaluation from May 1999 to September 1999. Cultures were performed from stool and Cerebrospinal fluid samples and then were tested for enterovirus infection. Viral isolation and serotype identification were performed by cell culture and immunofluorescent testing. Enteroviruses not typed by immunofluorescent testing were confirmed by reverse transcription-polymerase chain reaction. Results : A total of 44 febrile infants were enrolled; of those, 20(45%) were positive for enterovirus. Two enterovirus culture-positive infants had concomitant urinary tract infection and one had Kawasaki disease. All infants infected with an enterovirus recovered without complications. Serotype of 20 enteroviruses were isolated from stool, 3 of echovirus type 9, 1 of echovirus type 11, 1 Coxsachievirus type B4, 15 of untyped enteroviruses. One untyped enterovirus was isolated in the CSF. Conclusion : Nonpolio enterovirus infections are associated with nonspecific febrile illnesses in infants under 3 months of age.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.10 no.1
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• pp.11-19
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• 2007

Purpose: Henoch-Sch$\"{o}$nlein purpura (HSP) is a systemic vasculitis involving the skin, joints, gastrointestinal tract, and kidney. Although the pathogenesis of HSP is still unclear, tumor necrosis factor (TNF-${\alpha}$) is regarded as an important cytokine contributing to the disease. The goal of this study was to determine the role of TNF-${\alpha}$ in the pathogenesis of HSP, and to evaluate the TNF-${\alpha}$ polymorphism for genetic susceptibility to HSP. Methods: From March 2004 to November 2005, 40 children with HSP and 32 healthy controls were included. Serum TNF-${\alpha}$ levels were measured using the ELISA method during the acute and convalescent phase of HSP. The genotypic and allelic frequencies of the TNF-${\alpha}$ gene polymorphisms at positions -308 and -238 were evaluated in patients and controls. Results: Serum TNF-${\alpha}$ levels were $23.17{\pm}11.31$ pg/mL in the acute phase of children with HSP and $10.56{\pm}5.59$ pg/mL in the convalescent phase (p=0.000). There was no significant correlation between the serum TNF-${\alpha}$ levels and the clinical scores of HSP (r=0.310, p=0.070). The genotypic frequency of the TNF-${\alpha}$ -308 polymorphism in children with HSP was not significantly different compared to healthy controls (GG 80%, GA 20% vs. GG 93.8%, GA 6.2%; p=0.094). The genotypic frequency of the TNF-${\alpha}$ -238 polymorphism in children with HSP was not significantly different (GG 97.5%, GA 2.5% vs. GG 93.8%, GA 6.3%; p=0.429). Conclusion: TNF-${\alpha}$ is assumed to be the main cytokine associated with the pathogenesis of HSP during the acute phase. However, the presence of TNF-${\alpha}$ gene polymorphisms at positions -308 and -238 did not distinguish children with HSP from normal controls.

• Proceedings of the Korea Contents Association Conference
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• 2015.05a
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• pp.173-174
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• 2015

간에서 발생하는 악성종양과 양성종양의 대표적 질환 으로는 간세포암(Hepatocelluar carci- noma, HCC)과 간혈관종(Hepatic hemangioma, HH)이다. CT검사를 이용한 진단에 있어서 두 질환은 시간변화에 따른 조영증강양상 차이가 나타난다. Liver 3-phase computed tomography검사를 시행하여 시간별 조영증강 양상을 알아보았다. 본 연구는 조영제 주입전, 동맥기(35sec), 문맥기(70sec), 지연기(180sec)에 대한 Enhan -cement Pattern 변화와 HU(Hounsfield unit)값 변화, pixel값 변화의 관찰로서 검증하였다. 실험결과 HU를 사용한 방법에서 의미있게 구분되었고 임상적용 시 판독에 도움을 줄 것으로 생각한다.

• Korean Journal of Rural Living Science
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• v.7 no.2
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• pp.189-194
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• 1996

포괄적 의료서비스를 제공하는 가정의에게 농촌지역의 질병 양상 및 실태에 대한 파악은 중요하고 지역사회를 이해하는데 도움이 될 것이다. 하지만 노령화된 농촌지역의 만성질환의 유병율 및 실태에 대한최근의 연구는 많지 않을 것 같다. 본 연구를 위 한 진료활동은 농촌지 역의 2개면에서 가정의학과, 내과, 정형외과, 흉부외과 전문의에 의해 행해졌고 흉부 방사선 촬영 및 CBC, LFT, 요 검사, B형간염항원, 항체 등의 임상병리 검사를 병행하였다. 본 연구의 조사대상은 479명으로 성별로는 남자가 194명 (40.5%), 여자가 285명 (59.5%)였고 연령별로는 60세가 남녀에서 가장 높았다. 조사 대상자의 만성질환 유병율은 66.2%였고 남녀에서 비슷한 수준이였고 질병의 빈도는 근 골격계 질환이 40.9%로 가장 높았고 순환기 질환, 소화기 질환, 호흡기 질환, 내분비 질환의 순서로 많았다. 농촌사회는 과거에 비해 더욱 고령화되고 만성질환의 유병율은 더욱 증가하고 있다. 농촌에 대한 보건복지정책의 수립과 더불어 지속적, 총체적, 포괄적인 의료서비스를 지향하는 가정의는 더욱 많은 관심과 연구를 지속적으로 하여야 할 것이다.

• Pediatric Infection and Vaccine
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• v.11 no.1
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• pp.81-89
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• 2004

Purpose : Retropharyngeal and parapharyngeal abscesses are often distinguishable from other head and neck abscesses on clinical grounds, but these infections can combine and the presentations are similar to one another. Because of the advances of antibiotic therapy, the frequency of the diseases decreased considerably, but recently the incidence of neck abscesses has increased. We sought to describe the clinical presentation of patients with deep neck abscess, and implications on management. Methods : For 10 year periods, 94 cases of charts were reviewed retrospectively, who were diagnosed as neck abscesses aged below 16 years old(between January 1993 to August 2003) in 4 hospitals. Deep neck abscesses were diagnosed by surgical pus drainage, neck CT (homogenous, hypodense area with ring enhancement) and neck sono findings. Results : The annual incidence of deep neck abscess has been increased since 2000. The median age of the patients was 4 years(range, 26 days~15 years); 63% of the patients were younger than 5 years. Abscesses in the submandibular space(34%) were most common, followed by peritonsillar space(29.7%), retropharyngeal space(11.7%), combined(10.8%), parotid space(7.4%) and parapharyngeal space(6.4%). Fever(73.4%), sore throat(37.2%), decreased oral intake(34%) and neck pain(27.7%) were the most common symptoms. In 6 children(6.4%), there was refusal to move neck, in 6(6.4%) headache, and in 4(4.3%) torticollis. Respiratory distress was observed in only 1 patient(2.1%) and stridor in 1 other(2.1%). The most common physical examinations were neck swelling/mass(67%), pharyngitis(46.8%), tonsillitis(36.2 %), and cervical lymphadenopathy(28.7%). Neck stiffness was observed in 4 patients(4.3%). Total 35 organisms were isolated in 33 patients. The most common organisms cultured by patients' blood or pus were S. aureus(34%) and S. pyogenes(28.6%). Most organisms were gram positive, and had sensitivities in vancomycin(96.4%), cefotaxime(88.9%), cephalothin (86.4%), trimethoprime-sulfamethoxazole(83.3%), and clindamycin(77.8%). 77 patients(81.9%) underwent surgery plus antibiotics; 17 patients(18.1%) were treated with antibiotics only. There is no significant differences between two groups. In duration of admission, fever after admission, and antibiotic treatment. Conclusion : The incidence of deep neck abscess has increased recently and the major symptoms have been changed. The incidence of respiratory distress or stridor is decreasing, while the incidence of abnormal head and neck symptoms and signs like headache, neck stiffness, refusal to move neck, or torticollis are increasing. Gram positive organisms are predominant, S. aureus is the most common followed by S. pyogenes. 1st generation cephalosporin has high sensitivity on gram positive organisms. Treatment with surgery plus antibiotics dose not significantly decrease total duration of antibiotic treatment or admission compared to treatment with antibiotics alone.

• Childhood Kidney Diseases
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• v.4 no.2
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• pp.120-126
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• 2000

Purpose : This retrospective study has been undertaken to find out the clinical outcome of children with HS nephntis and its relationship with initial clinical presentation and/or renal pathologic finding. Patients and methods : Study population consisted of 59 children with HS nephritis who have been admitted to the Pediatric department of Kyungpook University Hospital from 1987 to 1999, and biopsy was done with indications of heavy proteinuria (> 1 g/m2/day) lasting over 1 month, nephrotic syndrome, and persistent hematuria and/or proteinuria over 1 year. Patients were divided clinically into 3 groups ; isolated hematuria, hematuria with proteinuria and heavy proteinuria (including nephrotic syndrome). Biopsy findings ore graded from I-V according to International Study of Kidney Disease in Children (ISKDC). Results : Mean age of presentation was $8.1{\pm}3.0$ years and slight male preponderance m noted (33 boys md 26 girls). Histopathologic grading showed Grade I ; 2, Grade II ; 44, and Grade III ; 13 cases. Clinical outcome at the follow-up period of 1-2 year (49 cases) and 3-4 years (30 cases) shooed normal urinalysis in 75 (30.6$\%$) and 18 cases (60.0$\%$), persistent isolated hematuria in 20 (40.8$\%$) and 2 cases (6.7$\%$), hematuria with proteinuria in 11 (22.5$\%$) and 8 cases (26.6$\%$), and persistent heavy proteinuria in 3 (6.1$\%$) and 2 cases (6.7$\%$) respectively. Clinical outcome according to histopathologic grading showed the frequency of normalization of urinalysis being lower in Grade III compared to grade I or II. Clinical outcome according to initial clinical presentation showed no relationship to the normalization or urinalysis at follow-up periods. However, 15-20$\%$ of children with initial heavy proteinuria showed persistent heavy proteinuria (3 out of 20 cases at 1-2 years, and 2 out of 10 case at 3-4 years of follow-up periods). Conclusion : The majority of children with HS nephritis (histopathologic grade I, II, III) improved within 3-4 years and persistent heavy proteinuria was seen only in a kw of children with initial clinical presentation of heavy proteinuria.

• Clinical and Experimental Pediatrics
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• v.45 no.4
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• pp.512-518
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• 2002

Purpose : Cerebral palsies are the most common and severe motor disabilities in childhood. There is currently increased interest in their occurrence and patterns of likely cause for a variety of reasons. Therefore, a retrospective study was carried out to understand the clinical features of cerebral palsy. Methods : A retrospective chart review was conducted of all children with cerebral palsy who were diagnosed at St. Benedict Hospital between March 1999 and March 2001. Results : Cerebral palsy patients were classified into 6 major groups. Of six groups, spastic diplegia is the most common type of cerebral palsy(55.3%). The risk factors of cerebral palsy were placenta previa(1 case), placenta abruption(1 case), cytomegalovirus infection(1 case), prematurity (53 cases), neonatal asphyxia(12 cases), dystocia(2 cases), breech delivery(1 case), multiple birth(5 cases), head trauma(3 cases), meningitis(2 cases) and unknown(26 cases). Among the 59 in the preterm group, 37 patients showed MR or CT images of periventricular leukomalacia. Among the 44 in the term group, 15 patients showed MR or CT images of atrophy. Among 103 patients, 29 patients(28.2%) had a seizure disorder. Conclusion : It is very importent to understand the clinical features and risk factors of cerebral palsy for physicians to diagnose and manage cerebral palsy patient.

• Clinical and Experimental Pediatrics
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• v.46 no.6
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• pp.591-596
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• 2003

Purpose : Kawasaki disease(KD) is rare in infants <3 months of age. In this younger group, the diagnosis may be delayed due to lack of most of the clinical criteria, resulting in a high risk of cardiac complications. We examined clinical characteristics in these patients for early recognition and treatment. Methods : We conducted a retrospective study on the infants with KD aged three months or younger treated at our hospital from January 1998 to July 2002. Results : Of a total of 291 patients treated during the study period, 11(3.8%) were three months old or younger. Of the 11 patients, 10 had atypical presentations. Infants had fewer of the accepted criteria, and the most common findings were fever(100%) and oral mucosal changes(72.7%). Erythema at the site of BCG inoculation was observed in six of the 11 patients(unknown in the remaining five). This feature proved a definite diagnostic clue in two patients in whom cardiac complications developed in the subacute phase. Cardiac complications were found in six patients(54.5%) : three had coronary dilatation, two had coronary wall irregularity, and one had mitral valve prolapse with regurgitation. Defervescence occurred within $1.1{\pm}0.3day$ in 10 of the 11 patients treated with intravenous immunoglobulin(IVIG) and one was given a second course of IVIG. Echocardiographic abnormality persisted in only one patient with mitral regurgitation at the 6-month follow-up. Conclusion : Most patients with KD younger than three months of age have atypical presentations and a high complication rate. For early diagnosis, erythema at the BCG inoculation site, if present, could be used as a valid diagnostic clue to atypical KD in this age group.