• Journal of Chest Surgery
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• v.42 no.6
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• pp.792-795
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• 2009

Pulmonary sequestration is a relatively rare malformation. Infection with common pyogenes is a frequent complication in this disease. We report here on a case of intralobar sequestration that was infected with Mycobacterium tuberculosis in the absence of any other site of tuberculous infection. A 40-year man presented with a small amount of hemoptysis, and the man had been previously diagnosed with bronchiectasis 3 years ago. Chest computerized tomography revealed bronchiectasis with pneumonia in the left lower lobe and there was a large feeding artery from the thoracic aorta. A lobectomy of the left lower lobe was conducted via thoracotomy and the final pathologic examination confirmed pulmonary tuberculosis limited to the intralobar sequestrated lung. The patient underwent anti-tuberculous chemotherapy from the postoperative $7^{th}$ day and he was discharged without any adverse event.

• Journal of Chest Surgery
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• v.38 no.9 s.254
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• pp.656-659
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• 2005

Pulmonary mucormycosis is very rare but has a devastating opportunistic fungal infection in immunocompromised hosts. The infection usually occurs in patients with hematologic malignancy, chronic renal failure, diabetes mellitus, or in solid organ transplant recipients. We experienced a case of pulmonary mucormycosis associated with renal cadeveric allograft recipient who had uncontrolled diabetes mellitus. The patient was successfully treated by surgical resection with Amphotericin B therapy.

• Clinical and Experimental Pediatrics
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• v.48 no.11
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• pp.1193-1200
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• 2005

Purpose : Invasive bacterial infection is a major cause of morbidity and mortality in children. Previously, we reported etiology of invasive infections in healthy children in 1985-1995. This study was performed to update etiology of invasive bacterial infections in the previously healthy children. Methods : We reviewed medical records of 98 episodes of invasive bacterial infections in immunocompetent children at the Seoul National University Children's Hospital in 1996-2004. Results : The frequent pathogens identified over all age groups were Streptococcus pneumoniae (33%) and Staphylococcus aureus(33%). The proportion of Salmonella species and Haemophilus influenzae has been declined to 4% each from 23% and 14%, respectively, compared to previous study. S. agalactiae was the most common isolate in the infants ${\leq}3$ months. Among the infants and children aged 3 months to 2 years and children of 2-5 years, S. pneumoniae(57%, 52%, respectively, in each group) was the most common isolates followed by S. aureus(17% and 24%, respectively). S. aureus was the most common isolates(73%) in children >5 years. Primary bacteremia was the most common clinical diagnosis(27%). S. pneumoniae was responsible for 42% of primary bacteremia, 50% of meningitis, and 69% of bacteremic pneumonia and empyema. S. aureus accounted for 80% of bone and joint infections. The case fatality rate was 8.1% for all invasive infections. Conclusion : We reviewed frequency of bacterial agents of invasive infections in children. The data may be useful for pediatricians to select adequate empirical antibiotics in the management of invasive bacterial infections.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.123-126
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• 2009

Cryptococcosis is a subacute or chronic inflammation that's caused by infection from cryptococcus neoformans in the soil or dust that's contaminated by pigeon droppings. Pulmonary cryptococcosis occurs in immunocompromised patients, and particularly in HIV positive patients, but it rarely occurs in immunocompetent individuals. It is most often detected as asymptomatic single or multiple nodules that are found by chest X-ray examination. In these situations, the diagnosis for most cases is made by the histology of the resected lesion. We report here on a case of solitary nodular pulmonary cryptococcosis that occurred in a 32 years old female patient who underwent thyroidectomy for treating her thyroid cancer.

• Childhood Kidney Diseases
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• v.6 no.2
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• pp.237-242
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• 2002

Hemolytic Uremic Syndrome (HUS) is the most common cause of acute renal failure in children and is comprised of the combination of hemolytic anemia, thrombocytopenia, and acute renal failure. Atypical HUS, rare in childhood, has worse prognosis than that of typical HUS and is associated with chemotherapy drug, other bacterial (especially Streptococcus pneumoniae) or viral infections, and so on. We report a case of HUS caused by pneumococcal infection in 4-year-old boy. While he was admitted with pneumonia and pleural effusion, pneumococcal infection could be revealed. Although HUS progressed rapidly, he immediately received 3-time hemodialysis and recovered completely after two weeks.

• Journal of agricultural medicine and community health
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• v.3 no.1
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• pp.5-9
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• 1978

이제까지 알려진 바에 의(依)하면 우리 나라에서 간(肝) 및 폐(肺)디스토마 분포양상(分布樣相)은 강원도지역(江原道地域)이 가장 저율(低率)로 나타난 것을 볼 수 있다. 그 이유(理由)로서는 이들 양흡충은 반드시 제(第)1 및 제(第)2중간숙주(中間宿主)를 통한 生活環(생활환)이 완성(完成)되어야만 하는데, 이들 중간숙주분포(中間宿主分布)가 강원도지역(江原道地域)이 낮은 까닭인듯 하다. 우연(偶然)한 기회(機會)에 저자(著者)는 강원도(江原道)의 일부지역(一部地域)은 폐(肺)디스토마의 감염(感染)이 적지 않다는 정보(情報)를 입수(入手)하고 이에 흥미(興味)를 갖게 되었으며, 특(特)히 농후감염지역(濃厚感染地域)으로 예상(豫想)되는 횡성군(橫城郡)의 일부지역(一部地域), 폐(肺), 청일면(廳日面) 신대리(里) 일대(一帶)와 서원면(面) 유현리(里)에서의 간(肝) 및 폐(肺)디스토마의 감염상(感染相)을 파악(把握)할 목적(目的)으로 본(本) 조사(調査)를 전도(全圖)하였다. 검사방법(檢査方法)으로는 일단(一旦) 간(肝) 및 폐(肺)디스토마의 VBS 항원(抗原)으로 피내반응검사(皮內反應檢査)를 실시(實施)하여 간(肝)디스토마 피내반응검사(皮內反應檢査)에 대(對)해서는 객담검사(喀痰檢査)와 면역혈청반응으로 보체결합반응(補體結合反應), 간접형광항체반응(間接螢光抗體反應) 및 Ouchterlony 반응(反應)을 하여 좀더 정확(正確)한 감염상황(感染狀況)을 파악(把握)하고저 하였다. 그 결과(結果)의 개요(槪要)는 아래와 같다. 1. 횡성군(橫城群) 신대리(里)와 우현리(里)의 주민(住民) 680명(名)에 대(對)한 폐(肺)디스토마의 VBS항원(抗原)에 의(依)한 피내반응양성율(皮內反應陽性率)은 12.4%이었고 간(肝)디스토마의 피내반응양성율(皮內反應陽性率)은 12.5%이었다. 2. 성별(性別)에 따른 피내반응양성율(皮內反應陽性率)의 차이(差異)는 간(肝)디스토마의 경우, 여자(女子) 7.4%에 비(比)하여 남자(男子)가 17.1%이었고, 폐(肺)디스토마의 경우는 여자(女子)가 20.7%인데 반(反)하여 남자(男子)가 42.9%로서 2배(倍) 이상(以上)의 고율(高率)이었다. 3. 연령별(年令別)로 보면, 간(肝)디스토마 피내반응양성율(皮內反應陽性率)은 31~40재(才)가 22.1%로 가장 고율(高率)이었고, 폐(肺)디스토마 양성율(陽性率)은 21~30재(才) 사이가 58.5%로서 가장 높았다. 4. 폐(肺)디스토마 피내반응양성자(皮內反應陽性者)에 대(對)하여 객담검사(喀痰檢査)를 실시(實施)한 바 105명(名) 중 11명(名)(10.5%)의 충란검출자(蟲卵檢出者)를 볼 수 있었다. 또 이들에 대(對)한 면역혈청반응(免疫血淸反應)으로 보체결합반응(補體結合反應), 간접형광항체반응(間接螢光抗體反應) 및 Ouchterlony 반응(反應)을 실시(實施)한 바, 각각 42.5%, 50.3% 및 45.8%로서 거의 일치(一致)된 성적(成績)을 나타내어 피내반응양성자(皮內反應陽性者)의 약반수(約半數)에서 이들 혈청반응(血淸反應)이 양성(陽性)으로 나타났다.

• Tuberculosis and Respiratory Diseases
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• v.49 no.2
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• pp.207-216
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• 2000

Background : The occurrence of lung complications after allogenic bone marrow transplantation(BMT) has been reported as 40-60 percent. The risk factors for lung complications are whole body irradiation, high dose chemotherapy, graft versus host disease, old age and CMV infection. The prevalence of graft versus host disease is less in Korea than in Western countries, but frequency of CMV infection is higher. Therefore, the pattern of lung complications may be different in Korea from those in Western countries. Methods : A retrospective cohort study was performed on one hundred consecutive adult patients who underwent allogenic bone marrow transplantation from December, 1993 to May, 1999 at Asan Medical Center. Lung complications were divided into two groups by the time of development, within 30days (pre-engraftment) and beyond 30 days (post-engraftment), and then subdivided into infectious and non-infectious complication. Infectious complications were defined as having the organism in blood, BAL fluid, pleural fluid or sputum, or compatible clinical findings in patients, which improved with antibiotics or an anti-fungal therapy. Result: 1) Eighty three episodes of lung complications had occurred in 54 patients. 2) Within thirty days after BMT, non-infectious complications were more common than infections, but this pattern was reversed after 30 days. After one year post-BMT, there was no infectious complication except in cases of recurrence of underlying disease or development of chronic GVHD. 3) Among the non-infectious complications, pleural effusion (27 episodes) was most common, followed by pulmonary edema (8 episodes), bronchiolitis obliterans(2 episodes), diffuse alveolar hemorrhage (1 episode) and bronchiloitis obliterans with organizing pneumonia (1 episode). 4) The infectious complications were pneumonia (bacterial: 9 episodes, viral: 4 episodes, fungal : 5 episodes, pneumocystis carinii : 1 episode), pulmonary tuberculosis(3 episodes) and tuberculous pleurisy (3 episodes). 5) Lung complications were more frequent in CMV positive patients and in patients with delayed recovery of neutrophil count. 6) The mortality was higher in the patients with lung complications. Conclusion : Lung complications developed in 54% after allogenic BMT and were associated with higher mortality.

• Pediatric Infection and Vaccine
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• v.18 no.2
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• pp.109-116
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• 2011

Purpose : Pneumococcus is one of the most important causes of invasive infection through the childhood period. In January 2008, the Clinical and Laboratory Standards Institute (CLSI) published revised penicillin breakpoints for Streptococcus pneumoniae and penicillin susceptibility rates of S. pneumoniae increased in Korea. This study was performed to determine the probability of oral amoxicillin for the empirical treatment achieving bactericidal exposure against pneumococcus using pharmacodynamics model. Methods : Twenty-three isolates of pneumococci were subjected to determine minimum inhibitory concentration (MIC) for ${\beta}$-lactams and macrolide. For the ${\beta}$-lactams, exposure of fT >MIC (time that free drug concentrations remain above the MIC) for 50% of the administration interval have determined the probability of target attainment (PTA), and regimens that had a PTA >90% were considered optimal. An analysis was performed by applying MIC of 23 isolates to a 5000-patient Monte Carlo simulation model. Results : Among 23 isolates from healthy children, 7 (30.4%) isolates were MIC ${\leq}$1.0 ${\mu}g$/mL and 19 (82.6%) were MIC ${\leq}$2 ${\mu}g$/mL for amoxicillin. Amoxicillin 40 mg/kg/day achieved PTA >90% at MIC ${\leq}$1.0 ${\mu}g$/mL but PTA decreased to 52% at MIC 2 ${\mu}g$/mL, whereas amoxicillin 90 mg/kg/day can predict 97% of PTA at MIC 2 ${\mu}g$/mL. Overall, oral amoxicillin 90 mg/ kg/day for the empirical treatment against pneumococcus can expect more successful response in Korean children. Conclusion : Considering the resistantce pattern of pneumococci in Korean children, we estimate that oral amoxicillin 90 mg/kg/day will provide a pharmacodynamic advantage for the empirical treatment against pneumococcus. And low dose amoxicillin or macrolide are expected to have higher chance of treatment failure than high dose oral amoxicillin.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1102-1105
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• 1998

Chronic granulomatous disease in childhood is a rare inheritable disorder of phagocytic cells in which defective production of the reactive intermediates of oxygen predisposes the patient to severe recuring pyogenic infections. The lung is the most common site of infection and pulmonary disease is the primary cause of death for greater than 50% of children with chronic granulomatous disease. Although the role of surgery in management of this disease remains undefined, rapid diagnosis of the underlying pulmonary problem is crucial to determine the most appropriate antimicrobial therapy and surgical techniques such as lobectomy of involved areas lead to more rapid recovery and thus allow the antibiotics to be more efficacious in these cases. We have treated a one month old male baby who had the chronic granulomatous disease with pulmonary infection. Wide surgical resection of the affected lobe and use of antibiotics and antifungals were carried out with good clinical results. He was well after the operation.

• Clinical and Experimental Pediatrics
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• v.46 no.9
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• pp.846-853
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• 2003

Purpose : Pneumoccocus is one of the most important causes of invasive infection through the childhood period and the prevelance of antibiotics resistance of pneumococcus is increasing worldwide. A 7-valent conjugate vaccine has been developed. It is important to know the prevalence of each serotype of pneumococci in the countries where the vaccine is used to estimate the coverage rate by the vaccine. Methods : One hundred and twenty seven strains of clinical isolates and 72 strains from healthy carriers recovered from Korean children during the period from 1997 to 2002 were subjected to determination of serotype by Quellung reaction and penicillin susceptibility with oxacillin disc diffusion test. Results : Forty-three per cent of clinical isolates were obtained from children under two years of age. Thirty strains(24%) were isolated from normally sterile body fluids. The frequent serotypes were 19F, 19A, 23F, 6A, 6B and 9V. Fifty-six per cent of the clinical isolates were represented in the current 7-valent protein conjugate pneumococccal vaccine, and 84% when the cross-reactive serotypes were included. Frequent serotypes of strains isolated from one to five year-old healthy children were 19F, 14, 11A, 23F, 18C, and 19A. Seventy-one per cent of the carrier strains were included in the 7-valent vaccine. Ninety-three per cent of the clinical isolates and 86% of carrier strains were not susceptible to penicilline. Conclusion : Fifty-six to 84% of pneumococci recovered from Korean children are covered by the current 7-valent protein conjugate pneumococcal vaccine and the prevalence of penicillin resistance was very high.