• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1050-1054
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• 2000

Objective : The incidence of head injury has been increasing in the rural area. The author investigated the clinical features and difficulties in care of the acute head-injured patients in this area. Method and Material : The authors performed a retrospective review of radiological data and clinical records in patients with mild to moderate head injury. Cause, type of craniocerebral injury, delayed intracranial lesions, complications, its relation to alcohol abuse, and outcome were analyzed. Results : In total of 68 cases, 20(29.4%) victims were associated with acute alcohol intoxication. Motor vehicle accident was the leading cause of head injury and the most common craniocerebral lesion was basilar skull fracture. Eight(11.8%) patients showed delayed radiological and clinical deterioration and 40(58.8%) were followed-up regularly after discharge. The subdural hygroma was commonly noted in the elderly and alcoholics. Causes of thirty events that resulted in an atypical and difficult neurosurgical practice were as follows : delayed admission, premature discharge against doctor's request, refusal of radiological studies and admission, misunderstanding of disease entity, and unreasonable desire of transfer to tertiary hospitals. Inaccurate initial diagnoses were made by emergency doctors in twenty patients. During the course of treatment, there were a few complications such as alcohol withdrawal, acute otitis media, cerebrospinal fistula, facial weakness, and posttraumatic seizure. Outcome was good in 60(88.2%) patients. Conclusion : Most of minor head trauma patients in this series have shown good results, but we have to consider some possible complications and delayed intracranial lesions in these patients that should be managed with special cautions with various kinds of treatment difficulties.

• Clinical and Experimental Pediatrics
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• 제51권10호
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• pp.1031-1037
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• 2008

Macrolide antimicrobial agents including erythromycin, roxithromycin, clarithromycin, and azithromycin are commonly used in the treatment of respiratory tract infections in children. Newer macrolides that have structural modifications of older drug erythromycin show improved change in the spectrum of activity, dosing, and administration. However, recent studies reported that increasing use of macrolide antibiotics is the main force driving the development of macrolide resistance in streptococci. In particular, azithromycin use is more likely to select for macrolide resistance with Streptococcus pneumoniae than is clarithromycin use, a possible reflection of its much longer half life. Recently, erythromycin resistance rates of S. pneumoniae and Streptococcus pyogenes are rapidly increasing in Korea. Two main mechanisms of acquired macrolide resistance have been described, altered binding site on the bacterial ribosome encoded by the ermB gene and active macrolide efflux pump encoded by the mef gene. Relationship between the susceptibility of S. pneumoniae and the response to macrolides has been shown in studies of acute otitis media, but less clear in cases of pneumonia. This article reviews the spectrum of activity, pharmacokinetic properties, mechanisms of action and resistance, and clinical implication of resistance on the treatment of respiratory tract infections in children.

• Clinical and Experimental Pediatrics
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• 제57권2호
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• pp.55-66
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• 2014

The 7-valent pneumococcal protein conjugate vaccine (PCV7) has been shown to be highly efficacious against invasive pneumococcal diseases and effective against pneumonia and in reducing otitis media. The introduction of PCV7 has resulted in major changes in the epidemiology of pneumococcal diseases. However, pneumococcal vaccines induce serotype-specific immunity, and a relative increase in non-vaccine serotypes has been reported following the widespread use of PCV7, leading to a need for extended serotype coverage for protection. PCV10 and PCV13 have been licensed on the basis of noninferiority of immunogenicity compared to a licensed conjugate vaccine. In this article, we aimed to review important data regarding the efficacy and effectiveness of the extended-coverage PCVs published or reported thus far and to discuss future implications for pneumococcal vaccines in Korea. After the introduction of PCV10 and PCV13, within a short period of time, evidence of protection conferred by these vaccines against invasive and mucosal infections caused by most of the serotypes included in the vaccines is accumulating. The choice of vaccine should be based on the changes in the dynamics of pneumococcal serotype distribution and diseases in the region where the vaccines are to be used. Continuous surveillance is essential for the appropriate use of pneumococcal vaccines and evaluation of the impact of PCVs on pneumococcal diseases.

• 여성건강간호학회지
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• 제11권1호
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• pp.5-11
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• 2005

Breast feeding can play a very important role in the development of strong, healthy children. Many studies over the years have shown that breast milk provides defense against common ailments of childhood such as otitis media, gastrointestinal distress, and atopic diseases (allergies). For these reasons the American Academy of Pediatrics recommends breast feeding for at least the first twelve months of an infant's life. Goals of the Health People 2010 Initiative include that at least 75% of mothers will be breast feeding upon discharge from the hospital and at least 50% will be still nursing at six months post-partum. Currently, about 60% of new mothers initiate breast feeding and about 26% are still breast feeding at six months. However, research has shown that breast feeding trends are below these averages in rural areas of the United States. This may be due in part to lack of breast feeding knowledge and teaching in rural areas. Rural hospitals and birthing centers have not initiated many of the breast feeding promotional programs, such as the Baby Friendly Hospital Initiative and Best Start, that have been successful in improving breast feeding trends in urban areas. Often new mothers who live in rural areas do not have access to a lactation consultant to help them with proper follow up. This paper will examine these concerns and propose recommendations to improve breast feeding in rural areas.

• Advances in pediatric surgery
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• 제13권1호
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• pp.81-86
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• 2007

A 3-year-old boy with purulent otitis media received a chest radiograph as the part of a routine work up. The patient was normal appearing, in no acute distress. The patient's lung and heart sounds were clear and normal. The patient's abdomen was soft, non-distended, and non-tender. An anterior cardiophrenic mass was incidentally identified on the lateral chest radiograph. A computed tomography scan demonstrated a diaphragmatic hernia with bowel loops in the retrosternal space. An exploratory operation revealed a diaphragmatic defect (4 cm in diameter) on the left side of the falciform ligament, through which transverse colon was protruded. There was no hernia sac, and the defect was closed with interrupted No. 2 silk sutures. The child was discharged on the 8th postoperative day without any complications. During 6 months of follow-up period, recurrence was not noticed.

• Journal of Yeungnam Medical Science
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• 제29권1호
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• pp.1-8
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• 2012

Streptococcus pneumonia is a very important pathogen for children and elderly people. Two types of pneumococcal vaccines are available in the market: pneumococcal polysaccharide vaccine (PPSV) and pneumococcal conjugate vaccine (PCV). PPSVs have been used for more than 30 years, and PCVs for about 10 years. There have been many reports concerning the evaluation of the vaccines' efficacies in preventing pneumococcal diseases such as meningitis, pneumonia, and otitis media and bacteremia, but the clinical trials had been performed with different conditions, such as diverse vaccine valencies, age groups, races, target outcomes, immunological cut-off values, and follow-up periods. PPSV is recommended for elderly people and chronic disease patients such as asthma, diabetes mellitus, chronic renal failure, and hyposplenic patients. According to the data from several systemic reviews and population-based surveillances, PPSV is effective for pneumococcal pneumonia and vaccine-type bacteremia among healthy adults. Until now, however, there is insufficient evidence of the effectiveness of PPSV among high-risk adults. PCV is very effective in preventing vaccine-type invasive pneumococcal disease (IPD) among children, but its efficacy for pneumonia is very low among children. The incidence of vaccine-related or non-vaccine-type IPDs is increasing after the introduction of 7-valent PCV (PCV7) as a routine immunization for children. Recently, 10- and 13-valent PCVs have been used for children, instead of PCV7. Therefore, continuous surveillance for serotype change among pneumococcal diseases is necessary to evaluate the vaccines' efficacy.

• Journal of Yeungnam Medical Science
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• 제28권1호
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• pp.13-19
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• 2011

The emergence of antibiotic-resistant pathogens is a Serious clinical problem in the treatment of infectious diseases that increase mortality, morbidity, hospitalization length, and the cost of healthcare. In particular, $Streptococcus$ $pneumoniae$ is a major etiologic pathogen of pneumonia, sinusitis, otitis media, and meningitis. As the definition of penicillin resistance to $S.$ $pneumoniae$ was recently changed, macrolide-resistant $S.$ $pneumoniae$ is a major resistant pathogen in the community. Infections caused by antibiotic-resistant strains are associated with incorrect use of antibiotics and critical clinical outcomes. For the appropriate use of antibiotics to treat infections, physicians always should have up-to-date information on the current epidemiologic status of antibiotic resistance for common pathogens and their susceptibility to antimicrobials. Appropriate selection of antimicrobials, strict control of infection, vaccination, and development of a feasible national policy of infection control are important strategies for the control of antimicrobial resistance. This review article focuses on the current status of antibiotic-resistant $S.$ $pneumoniae$ in community-acquired pneumonia in Korea.

• Journal of Microbiology and Biotechnology
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• 제14권4호
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• pp.836-843
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• 2004

Nontypeable H. influenzae (NTHi), a Gram-negative obligate human pathogen, causes pneumonia, chronic bronchitis, and otitis media, and the respiratory epithelium is the first line of defense that copes with the pathogen. In an effort to identify transcriptional responses of human respiratory epithelial cells to infection with NTHi, we examined its differential gene expression using high density cDNA microarrays. BEAS-2B human bronchial epithelial cells were exposed to NTHi for 3 hand 24 h, and the alteration of mRNA expression was analyzed using microarrays consisting of 8,170 human cDNA clones. The results indicated that approximately 2.6% of the genes present on the microarrays increased in expression over 2-fold and 3.8% of the genes decreased during the 24-h infection period. Upregulated genes included cytokines (granulocyte-macrophage colony stimulating factor 2, granulocyte chemotactic protein 2, IL-6, IL-10, IL-8), transcription factors (Kruppel-like factor 7, CCAAT/enhancer binding protein $\beta$, E2F-1, NF-$\kappa$B, cell surface molecules (CD74, ICAM-1, ICAM-2, HLA class I), as well as those involved in signal transduction and cellular transport. Selected genes were further confirmed by reverse-transcription-PCR. These data expand our knowledge of host cellular responses during NTHi infection and should provide a molecular basis for the study of host-NTHi interaction.

• 대한의용생체공학회:의공학회지
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• 제32권4호
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• pp.285-288
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• 2011

In this study, we developed an optical coherence tomography(OCT) using a sweep-source laser whose center wavelength is 1310 nm and a probe of hand-held type. The developed hand-held probe targets to diagnose the middle ear, so it is miniaturized for ease and convenience of control. For the first time, we performed in-vivo clinical experiments on tympanic membrane(TM) perforation patients not reported from previous studies about OCT. The high-resolution sectional images of tympanic membrane perforation can be obtained. There aren't many studies about diagnostic instrument of the middle ear and diagnosis with sectional image of the middle ear, so the developed OCT system and hand-held probe are applicable to tympanic membrane perforation and other pathologic diagnosis in the middle ear.

• Pediatric Infection and Vaccine
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• 제2권2호
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• pp.194-199
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• 1995

Most boys afflicted with panhypogammaglobulinemia, also known as X-linked agammaglobulinemia, remain healthy during the first 6 to 12 months of life because of protection by maternally transmitted IgG antibodies. Thereafter, they repeatedly acquire infections with high-grade pathogens, such as pneumococci, streptococci, and hemophilus unless given antibiotics or immunoglobulin replacement therapy. We experienced a case of panhypogammaglobulinemia in a 4 years old boy. He had been suffered from recurrent upper respiratory tract infection, otitis media and pneumonia since late infancy. He was admitted due to right pleural effusion with pneumonia, and streptococcus pneumoniae was isolated from pleural fluid and blood cultures. His immune status revealed panhypogammaglobulinemia and deficiency in mature B lymphocyte. He was treated with appropriate antibiotics therapy, but showed poor responses. He was transferred to department of thoracic surgery, and received minithoracotomy (decortication) operation. He was successfully treated with operation, antibiotics, and IV gammaglobulin infusions. Now he is being followed with periodic IV gammaglobulin replacement therapy.