• Title/Summary/Keyword: Transmission of pain

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Clinical review of Typhoid Fever Patients (장티브스에 관한 임상적 관찰)

  • 최정신
    • Journal of Korean Academy of Nursing
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    • v.6 no.1
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    • pp.60-71
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    • 1976
  • The author reviewed the medical records of 96 typhoid fever patients who were diagnosed, admitted, and treated at Sea grave Memorial Hospital from January 1 , 1973 through August 31, 1975. Diagnosis was determined by clinical observation, aerology and bacteriology, eighty patients were treated medically, the remaining 16 patients required surgical intervention. The following results were obtained: 1) The age distribution of the patients revealed that 33.3% wert between 10 and 19 years old 21.9% were between 20 and 29, and 19.8% were between 30 and 39. The majority of patients were from these more active age groups. Male to female sex ratio was 1.3 : 1 2) Seasonal distribution was observed. Most illness occurred in the summer and autumn month 5. 3) 84. 3%of the patients came from farm families. 4) Duration between onset and admission averaged 16.0 days. The group without compilations was admitted after an average of 15. 1 days; The group with complications was ad-matted after an average of 19.4 days. 5) Methods of treatment before admission were as follows: 10.4% at medical clinics, 61, 5% at pharmacies (antibiotics 47.9%, other. drugs 13.5%), 7.3% by herb medications, 20.8% had no treatment. 6) Main clinical symptoms were as follows: fever 93.8%, headache 47.9%, abdominal pain 47.9%, chills 38.5%, cough 36.5%, general weakness 26.0%, nausea e vomiting 24.0% and generalized pain 21.9%. 7) Temperature of patients on admission: 22.9% were 39f or more, 67.6% were between 37℃ and 38℃, and 9.4% were 37℃ or less. 8) Occurrence of intensional bleeding after onset of disease averaged 9.3 days; perforation occurred at an average of 19. 1 days. 9) Interval between onset of major complication and surgical intervention averaged 2.8 days. 10) Among the 68 patients who underwent the bacteriological test the positive rate was 44.1% (30). The positive ,ales to, each separate culture method were as follows: 20.4% in the blood culture, 40.4% in the stool culture and 6.7% in the urine culture. Among these bacteriological positive patients 15 patients had a negative results or less than 160 titer of vidal reaction. 11) The initial vidal test of the total group showed a counts of 160 titer or more in 60.4% and less than 160 titer in 39.6%, 12) W. B. C. Counts in the uncomplicated group indicated that 32.5% were 6,000/㎣ or less, 47.5% were between 6,000 and 10,000, arid 20.0% were 10,000/㎣ or more. In the complicated group, 37.6% were 6,000/㎣ or less, 25,0% were 6,000-10,000/㎣ and 37.6% were 10,000/㎣ or more. 13) Duration of hospital stay of the patients averaged 6.4 days in the uncomplicated group and 12.7 days in the complicated group. 14) Subdiaphragmatic free air simple X-ray was found in 91.7% of the perforated cases. 15) Duration of antibiotic therapy until an febrile state was attained averaged 4.8 days in the uncomplicated group and 6.5 days in the complicated group. 16) Operative procedures were as follows: one layer simple closure of their perforation with or without debasement in 56.3%, drainage only in 6.3%, small bowel resection with primary anastomosis in 18.8% , externalization in 6.3%, cholecystectomy in 6.3%, The clinical findings of this study suggest the following recommendations. According to Top's report; 1% of typhoid fever patients treated with chlorarnphenicol and 2% of patients treated with other drugs become chronic carriers. Therefore, importance should be given to the strict control of these carriers. Immunization, improvement of sanitation and living standards are all needed for the prevention and treatment of disease, but a more serious problem is a lack of knowledge on the part of patients and their families. Thus it is most urgent to enlighten the citizens about the transmission and hygiene related to contagious disease. Legal restriction of sale of antibiotics at drug stores without a physician's prescription is an urgent matter for public health administrators. An even more important nursing responsibility is the reemphasis on health education both in the clinical setting and in the home.

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ULTRASTRUCTURAL ANALYSIS OF TOOTH PULP AFFERENTS TERMINALS IN THE MEDULLARY DORSAL HORN OF THE RAT (치수유래 구심성 신경섬유의 삼차신경 감각핵군에서의 연접특성)

  • Bae, Yong-Chul;Lee, Eun-Hee;Choy, Min-Ki;Hong, Su-Hyung;Kim, Hyun-Jung;Na, Soon-Hyeun;Kim, Young-Jin
    • Journal of the korean academy of Pediatric Dentistry
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    • v.28 no.2
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    • pp.219-227
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    • 2001
  • Little is known about processing mechanism of pain sensation of the oral cavity at the 1st synapse of trigeminal sensory nuclei. Serial ultrathin sections of tooth pulp afferent terminals, identified by the transganglionic transport of 1% wheatgerm agglutinin conjugated horseradish peroxidase, were investigated with electron microscope. Quantitative ultrastructural analysis was performed on digitizing tablet connected to Macintoshi personal computer (software; NIH Image 1.60, NIH, Bethesda, MD). Labeled boutons could be classified into two types by the shapes of containing vesicles : S bouton, which contained mainly spherical vesicles (Dia. 45-55 nm) and few large dense cored vesicles (Dia, 80-120nm), and LDCV bouton, which contained spherical vesicles as well as large number of large dense cored vesicles. Most of the parameters on the ultrastructural characteristic and synaptic organization of labeled boutons were similar between S and LDCV boutons, except shapes of containing vesicles. Majority of the labeled boutons showed simple synaptic arrangement. The labeled boutons were frequency presynaptic to dendritic spine, and to a lesser extent, dendritic shaft. They rarely synapsed with soma and adjacent proximal dendrite. A small proportion of labeled boutons made synaptic contacts with presynaptic, pleomorphic vesicles containing endings and synaptic triad. Morphometric parameters of labeled boutons including volume and surface area, total apposed area, mitochondrial volume, active zone area, vesicle number and density showed wide variation and these were not significantly different between S and LDCV boutons. The present study revealed characteristic features on ultrastructure and synaptic connection of pulpal afferents which may involved in transmission of oral pain sensation.

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Synaptic Organization of Vibrissa Afferent Terminals in the Trigeminal Interpolar Nucleus (삼차신경중간핵에서 저역치기계자극수용기 유래 들신경섬유 종말의 연접양상)

  • Ahn, Hyoung-Joon;Paik, Sang-Kyoo;Bae, Yong-Chul;Choi, Jong-Hoon;Kim, Chong-Youl
    • Journal of Oral Medicine and Pain
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    • v.30 no.1
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    • pp.87-106
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    • 2005
  • In order to evaluate the mechanism of transmission as well as processing of sensory information originating from low-threshold mechanoreceptor in oral and maxillofacial region at primary synaptic region of trigeminal nervous system, vibrissa afferent fibers of adult cat were labeled with intra-axonal HRP injection. Serial sections containing labeled boutons were obtained from the piece of trigeminal interpolar nucleus. Under electron microscope, total 30 labeled boutons were observed, and ultrastructural characteristics, frequency of occurence, synaptic organizations of vibrissa afferent terminals were analysed. The results were as follows: 1. Labeled boutons contained clear, spherical synaptic vesicles with diameter of 45$\sim$55nm. They formed asymmetrical synapse with dendrites showing definite postsynaptic density, larger synaptic cleft, multiple synaptic structures at various regions. With unlabeled axon terminals(p-ending) containing polymorphic synaptic vesicles, they formed symmetrical synapse showing indefinite postsynaptic density and narrower synaptic area. 2. Each labeled bouton formed 1 to 15 synapses, the average of 4.77$\pm$3.37 contacts per labeled bouton, with adjacent neuronal profiles. Relatively complex synaptic organization, which formed synapses with more than 5 neuronal profiles, was observed in a large number(46.7%, n=14) of labeled boutons. 3. Axo-somatic synapse was not observed. The number of axo-dendritic synapse was 1.83$\pm$1.37 per labeled bouton. Majority(85.0%) of axo-dendritic synapses were formed with dendritic shafts, nonprimary dendrites(n=47, 1.57$\pm$1.38/1 bouton), however, synapses formed with primary dendrites(n=6, 0.20$\pm$0.41/1 bouton) or dendritic spines(n=2, 0.07$\pm$0.25/1 bouton) were rare. 4. 76.7%(n=23) of labeled boutons formed axo-axonic synapse (2.93$\pm$2.36/1 bouton) with p-endings containing pleomorphic vesicles. Synaptic triad, in which p-endings formed synapses with labeled boutons and dendrites adjacent to the labeled boutons simultaneoulsy, were also observed in 60.0%(n=18) of labeled boutons. From the above results, vibrissa afferent terminals of adult cat showed distinctive synaptic organization in the trigeminal interpolar nucleus, thus, suggests their correlation with the function of the trigeminal interpolaris nucleus, which participates in processing of complex sensory information such as two-point discrimination and motivational-affective action. Further studies on physiologic functions such as quantitative analysis on ultrastructures of afferent terminals and nerve transmitters participating in presynaptic inhibition are required.

The Evaluation of Attenuation Difference and SUV According to Arm Position in Whole Body PET/CT (전신 PET/CT 검사에서 팔의 위치에 따른 감약 정도와 SUV 변화 평가)

  • Kwak, In-Suk;Lee, Hyuk;Choi, Sung-Wook;Suk, Jae-Dong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.2
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    • pp.21-25
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    • 2010
  • Purpose: For better PET imaging with accuracy the transmission scanning is inevitably required for attenuation correction. The attenuation is affected by condition of acquisition and patient position, consequently quantitative accuracy may be decreased in emission scan imaging. In this paper, the present study aims at providing the measurement for attenuation varying with the positions of the patient's arm in whole body PET/CT, further performing the comparative analysis over its SUV changes. Materials and Methods: NEMA 1994 PET phantom was filled with $^{18}F$-FDG and the concentration ratio of insert cylinder and background water fit to 4:1. Phantom images were acquired through emission scanning for 4min after conducting transmission scanning by using CT. In an attempt to acquire image at the state that the arm of the patient was positioned at the lower of ahead, image was acquired in away that two pieces of Teflon inserts were used additionally by fixing phantoms at both sides of phantom. The acquired imaged at a were reconstructed by applying the iterative reconstruction method (iteration: 2, subset: 28) as well as attenuation correction using the CT, and then VOI was drawn on each image plane so as to measure CT number and SUV and comparatively analyze axial uniformity (A.U=Standard deviation/Average SUV) of PET images. Results: It was found from the above phantom test that, when comparing two cases of whether Teflon insert was fixed or removed, the CT number of cylinder increased from -5.76 HU to 0 HU, while SUV decreased from 24.64 to 24.29 and A.U from 0.064 to 0.052. And the CT number of background water was identified to increase from -6.14 HU to -0.43 HU, whereas SUV decreased from 6.3 to 5.6 and A.U also decreased from 0.12 to 0.10. In addition, as for the patient image, CT number was verified to increase from 53.09 HU to 58.31 HU and SUV decreased from 24.96 to 21.81 when the patient's arm was positioned over the head rather than when it was lowered. Conclusion: When arms up protocol was applied, the SUV of phantom and patient image was decreased by 1.4% and 9.2% respectively. With the present study it was concluded that in case of PET/CT scanning against the whole body of a patient the position of patient's arm was not so much significant. Especially, the scanning under the condition that the arm is raised over to the head gives rise to more probability that the patient is likely to move due to long scanning time that causes the increase of uptake of $^{18}F$-FDG of brown fat at the shoulder part together with increased pain imposing to the shoulder and discomfort to a patient. As regarding consideration all of such factors, it could be rationally drawn that PET/CT scanning could be made with the arm of the subject lowered.

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Epidemiologic Investigation of an Outbreak of Shigellosis in Kyongju, Korea (1998년 경주시 한 초등학교 학생과 인근 주민에서 발생한 세균성이질)

  • Jung, Cheol;Bae, Geun-Ryang;Hur, Yeong-Joo;Lee, Sang-Won;Jeong, Eun-Kyeong;Lim, Hyun-Sul
    • Journal of Preventive Medicine and Public Health
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    • v.33 no.1
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    • pp.1-9
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    • 2000
  • Objectives : This study was carried out to investigate the sources of infection and modes of transmission of an outbreak of shigellosis that occurred among pupils of 'M' primary school and residents near the school in Kyongju from Sept. 24 to Oct. 24, 1998. Methods : The subjects who completed a questionnaire and a rectal swab for microbiologic examinations were 1,534 persons (781 males, 753 females), including 469 pupils of 'M' primary school (268 males, 201 females). Bacteriological examinations of underground water and simple piped water were done. Results : The attack rate of diarrhea was 28.7% in the subjects from Sept.24 to Oct. 24, 1958. There was no difference in attack rate of diarrhea by gender, but it was significantly higher in the pupils of 'M' primary school than others (p<0.01). The attack rate of diarrhea by resident areas was no different to the pupils of 'M' primary school, but was significantly higher in the residents of Mohwa 2 Ri except pupils that 'M' primary school is located in (p<0.01). The distribution of date of onset revealed the exposure date to be Sept, 22 and 23 in consideration of incubation periods and common source outbreak followed propagative spread in the epidemic curve. The major characteristics of diarrhea were watery (89.1%) in nature, $1\sim3$ days (72.5%) in duration, $2\sim3$ times (63.9%) in frequency. The clinical symptoms among the diarrheal cases included abdominal pain (74.1%), fever (56.4%), headache (55.9%), chill (40.4%) and tenesmus (31.4%). Conclusions : The source of infection was estimated to be contaminated underground water and simple piped water caused by leakage from the cess pool. It is highly necessary that the management of drinking water and cess fools should be done thoroughly.

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Clinical Characteristics of Adult Patients with Acute Hepatitis A (성인 급성 A형 간염 환자들의 임상 양상)

  • Eun, Jong-Ryul;Lee, Heon-Ju;Kim, Tae-Nyeun;Jang, Byung-Ik;Moon, Hee-Jung
    • Journal of Yeungnam Medical Science
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    • v.24 no.2
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    • pp.170-178
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    • 2007
  • Background : The incidence of acute hepatitis A in adults has recently been increasing. This study was conducted to investigate the epidemiology and clinical characteristics of acute hepatitis A in Daegu province over the past 10 years. Materials and Methods : We reviewed the medical records of 55 patients (male/female: 34/21), who were diagnosed with acute hepatitis A by confirmation of the IgM anti-HAV between January 1998 and June 2007. Results : The mean age was $29.7{\pm}10.3$ years (range; 17-65 years). The incidence was most common between March and June (56.1%), in the third and fourth decades of life (78.2%) and 90.9% (50/55) of the patients were diagnosed from 2003 to present. The common symptoms included anorexia, nausea or vomiting (69.1%), fever and chills (49.1%), myalgia (47.3%), weight loss (47.3%), fatigue (40.0%), abdominal pain (36.4%), diarrhea (9.1%) and pruritus (5.5%). The mean duration of hospital stay was $8.6{\pm}3.4$ days (range; 3-20 days). The route of transmission was identified in only 11 patients (20.0%); 7 patients (12.7%) traveled (abroad or domestic), 2 patients (3.6%) ingested raw food and 2 patients (3.6%) had friends with acute hepatitis A. Fifty four patients recovered without complication; one patient developed fulminant hepatitis and recovered after a liver transplantation. Conclusion : The incidence of acute hepatitis A in adults is increasing. Because of the cost of treatment and potential for serious disease, persons, under 40 are recommened to have hepatitis A vaccination and confirmation of IgG anti-HAV.

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Changes in CGRP-immunoreactive Nerve Fibers during Expansion of Midpalatal Suture of the Rat (백서 정중구개봉합 확대후의 CGRP 면역반응 신경섬유의 변화)

  • Kim, Bo-Kyung;Park, Kuk-Pil;Kyung, Hee-Moon;Kwon, Oh-Won;Sung, Jae-Hyun
    • The korean journal of orthodontics
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    • v.29 no.1 s.72
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    • pp.73-81
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    • 1999
  • Midpalatal suture expansion is often used for patients haying narrow maxillary arch, cleft palate, respiratory handicap with narrow nasal cavity. CGRP has been known as a modulator of pain transmission in central nervous system and a local effector to peripheral tissue causing vasodilation, increase of blood flow, modulation of immune system, regulation of macrophagic function and stimulation of bone formation. To investigate changes of CGRP-immunoreactive nerve fibers in midpalatal suture during the expansion, immunohistochemical study was performed by using rats. Experimental rats (10 weeks, 250 gm) were divided into five groups (control, 1, 4, 7, 14 days group (each n=4) and applied orthodontic force (approximately 200gm) to upper anterior incisors. Frozen sections of midpalatal suture area were immunostained by using rabbit antisera. The results were as follows. ${\cdot}$ The CGRP-immunoreactive nerve fibers were hardly observed in control group. ${\cdot}$ In 1 day group, the CGRP-immunoreactive nerve fibers were more increased around the vessels than control group. ${\cdot}$ In 4 days group, the CGRP-immunoreactive nerve fibers were more increased than control group, but not more increased than 1 day group. Vascular diameter was more enlarged. ${\cdot}$ In 7 days group, especially, hematoxilin affinity of cells was remarkable and cells were arranged along the bone margin. The CGRP-immunoreactive nerve fibers were more reduced than 4 days group and vascular diameter was also reduced. ${\cdot}$ In 14 days group, the CGRP-immunoreactive nerve fibers were similar to those of 7 days group and the irregularity of bone margin was almost recoverd. In Conclusion, the CGRP-immunoreactive nerve fibers nay be related to initial neurogenic inflammatory reaction in expanding mid-palatal suture.

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Changes of CGRP immunoreactivity in rat trigeminal ganglion neurons during tooth movement (백서 삼차신경절내 신경세포체의 치아이동에 따른 CGRP 면역염색성의 변화)

  • Park, Chyo-Sang;Park, Guk-Phil;Sung, Jae-Hyun
    • The korean journal of orthodontics
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    • v.27 no.4 s.63
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    • pp.607-621
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    • 1997
  • GRP was known as the modulator of Pain transmission in central nervous system and local effector to peripheral tissue causing vasodilation, increased blood flow, modulation of immune sysem, stimulation of endothelial cell proliferation, and stimulation of bone formation. Numerous study, therefore, were done to elucidate involvement of CGRP to tooth movement. To investgate the response of CGRP immunoreactive nerve cells according to cell size in trigeminal ganglion during tooth movement, immunohistochemical study was performed using rat. Experimental rats(9 weeks old, 210 gm) were divided as six groups(normal(n=6), 3 hour group(n=5), 12 hour group(n=4), 1 day group(n=5), 3 day group(n=5), 7 day group(n=5)), and were applied orthodontic force (approximately 30 gm) to upper right maxillary molar. After frozen sections of trigeminal ganglions were immunostained using rabbit antisera, the changes of CGRP immunoreactive cells in regard to cell size distribution(small cell(upto $20{\mu}m$), medium cell($20-35{\mu}m$), large cell(above $35{\mu}m$)) were observed. The results were as follows 1. The percentage of CGRP immunoreactive cells to all nerve cells in trigeminal ganglion was 33.0% in normal control group, was decreased to 24.5% in 1 day group, and was increased to 41.8% in 7 day group. 2. The percentage of small, medium, and large cells expressing CGRP immunoreactivity in normal trigeminal ganglion to all CGRP immunoreactive cells were 51.3%, 44.0%, 4.7%, respectively. 3. The percentage of small cells with CGRP immunoreactivity to all CGRP immunopositive cells was increased in 3 hour and 12 hour groups. 4. The percentage of medium cells with CGRP immunoreactivity was increaed in 3 day and 7 day groups. 5. The percentage of large cells with CGRP immunoreactivity was increaed in 7 day group. Conclusively, the small cells with CGRP immunoreactivity in trigeminal ganglion respond to orthodontic force during initial phase of tooth movement, and later the medium and large cells with CGRP immunoreactivity respond

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Outbreak of Shigellosis Occurred in a Preschool and Two Elemetary Schools in Mapo-Gu, Seoul (서울시 마포구 관내 어린이집 및 초등학교에서 집단 발병한 세균성 이질)

  • Park, Tae Su;Lee, Ho Jun;Kim, Su Yeon;Lee, Dong Woo;Kim, Jae Yoon;Baik, Ji Na;Park, Yu Mi;Park, Mi Sun;Lee, Bok Kwon
    • Pediatric Infection and Vaccine
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    • v.13 no.1
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    • pp.71-77
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    • 2006
  • Purpose : Shigellosis is still an important cause of acute food-borne diarrheal diseases throughout the world. We investigated the transmission routes and clinical course through the outbreak of shigellosis in Mapo-Gu, Seoul. Methods : From October 7th to November 19th in 2005, Mapo-Gu public health center had referred 32 patients with confirmed or suspected shigellosis to the National Medical Center. We had investigated source of infection, epidemiology, laboratory findings, and clinical course of the cases occurred during this outbreak. Results : Among 32 patients, 24 patients had been confirmed with shigellosis, 8 patients had been diagnosed with suspected shigellosis. They ranged in age from 5 months to 12 years old and their mean age was 6.5 years. The clinical manifestations were as follows; diarrhea, fever, abdominal pain and asymptomatic condition. Symptoms had sustained for 3.7 days on the average. S. sonnei were cultured by rectal swab and founded to be resistant to ampicillin and TMP/SMX except to 3rd generation cephalosporin. After treatment with antibiotics such as cefixime and ceftriaxone or imipenem and conservative treatment with electrolyte and fluid replacement for 5~7 days, Stool cultures of the rectal swab grew no Shigella in these cases except 3 cases. Conclusion : An outbreak of shigellosis had occurred in a preschool and elementary school children. From the same results of antimicrobial susceptibility and pulsed-field gel electrophoresis patterns in this study, we suggest that the outbreak of shigellosis in this report had been originated from a single strain. According to all negative results about suspected food and water cultures, we couldn't find out source of infection. Through materials offerred by Mapo-Gu Public Health Center, we presumed the trasmission routes probably were person-to-person.

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Epidemiological Changes and Clinical Features of Hepatitis A in Children, Living in Kyung-gi Province, Since 1988 to 1998 (최근 10년간(1988~1998) 경기지역 소아에서 A형 간염의 역학적 변화 및 임상에 관한 연구)

  • Kim, Hyun;Kim, Jong Hyun;Kim, Dong Un;Hur, Je Kyun;Lee, Won Bae;Seo, Byung Kyeu;Kang, Jin-Han
    • Pediatric Infection and Vaccine
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    • v.5 no.2
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    • pp.230-238
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    • 1998
  • Purpose : Worldwidely, the incidence of the hepatitis A has been markedly decreased in the past years. Also in Korea, there has been only a few sporadic cases without evidence of epidemics since the mid 1980s. However, the incidence of the hepatitis A in young adults and childen has been in trends of increasing since 1996. So, we retrospectively performed the study on the epidemiolgical changes and the clinical feature of hepatitis A in childen, living in Kyung-gi province, since 1988 to 1998. Methods : The four affiliated hospitals of the Catholic University of Korea, Our lady of Mercy's hospital, Holy family hospital, Eui-Jung-bu St. Mary's hospital, and St. Vincent hospital, were enrolled in this study. We conducted statistical analysis on the incidence of hepatitis A since 1988 to 1998, concerning with the period (monthly, annually), age, sex and related epidemiological property, by reviewing the hospital records of the patients with hepatitis A. We simultaneously performed the study concerning with the clinical characteristics of hepatitis A. Results : 1) During the study period, 46 children was diagnosed as hepatitis A, and among them 28 children (60.1%) developed sporadically in the 1998. And sex ratio was 1.2(male):1(female). 2) Most of the patients developed between March and July, and hepatitits A were mainly developed in the patients above the 10 year old ages(37 patients; 80.4%). 3) The socioeconomic and educational status of the patient's parents was almostly below the middle and low class. Although, we could not find the etiological factors in most cases, but we found the evidence of interfamilial transmission in one family. 4) The patients complained the symptoms of nausea and vomiting, jaundice, poor appetite, mild fever, fatigueness, abdominal pain, URI symptom, dyspepsia, dark urine, headache and diarrhea in order, and findings of jaundice, hepatomegaly, RUQ tenderness, splenomegaly and LLQ tenderness in order were seen. 5) All patients showed abnormal findings of the liver function tests, and the pattern of cholestatic hepatitis were seen in most cases, but these findings were normalized within the 2~4 weeks. The findings of the gall bladder wall thickening, hepatomegaly, splenomegaly and ascites were seen on abodominal sonogram. 6) The prognosis of all patients were good without complications, except in one case who had the episode of transient recuurence. And the mean hospitalization dates were 11.1 days. Conclusion : We found that the incidence of hepatitis A showed the increasing trend, and peaked in the 1998 in Kyung-gi province children. And hepatitis A mainly developed in children above the 10 year old ages. The scioeconomic and educational status of patient's family was almostly below the middle class. All of them showed abnormal liver function, and clinically cholestatic hepatitis features were seen in most cases. But, the prognosis was excellent without complication in all cases.

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