Ki-Soo Pai

Prevalence of pediculosis capitis among Korean children

Pediculus humanus capitis is an ectoparasite, which causes scalp pruritus particularly among children. A total of 15,373 children including 8,018 boys and 7,355 girls from 26 primary schools and 15 kindergartens attached to the primary schools and a total of 33 children from an orphanage were examined for head lice infestation (HLI). The overall prevalence of HLI in this study was 4.1% including 3.7% of the urban areas and 4.7% of the rural areas. Head lice were found more frequently in girls than in boys with prevalence of 6.5% and 1.9%, respectively. The infestation rate by school grade was 3.2%, 4.7%, 4.2%, 5.0%, 4.9%, 3.8%, and 2.1% for kindergarten, first, second, third, fourth, fifth, and sixth grades, respectively. The infestation rate of the children in an orphanage was 66.7%. The prevalence of HLI has decreased especially in the rural areas. However, HLI is a still health problem of kindergarteners and primary schoolchildren in Korea.

Discordant findings on dimercaptosuccinic acid scintigraphy in children with multi-detector row computed tomography-proven acute pyelonephritis

Purpose The diagnosis of acute pyelonephritis (APN) is often difficult, as its clinical and biological manifestations are non-specific in children. If not treated quickly and adequately, however, APN may cause irreversible renal damage, possibly leading to hypertension and chronic renal failure. We were suspecting the diagnostic value of 99mTc-dimercaptosuccinic acid (DMSA) scan by experiences and so compared the results of DMSA scan to those of multi-detector row computed tomography (MDCT). Methods We retrospectively selected and analyzed 81 patients who were diagnosed as APN by MDCT during evaluation of their acute abdomen in emergency room and then received DMSA scan also for the diagnostic work-up of APN after admission. We evaluated the results of imaging studies and compared the diagnostic value of each method by age groups, <2 years (n=45) and ≥2 years (n=36). Results Among total 81 patients with MDCT-proven APN. DMSA scan was diagnostic only in 55 children (68%), while the remaining 26 children (32%) showed false negative normal findings. These 26 patients were predominantly male with average age of 21 months and most of them, 19 (73.1%) were <2 years of age. Conclusion DMSA scan has obvious limitation compared to MDCT in depicting acute inflammatory lesions of kidney in children with APN, especially in early childhood less than 2 years of age. MDCT showed hidden lesions of APN, those were undetectable through DMSA scan in children.

Congenital Cavernous Hemangioma Exhibiting Subcutaneous Fat Necrosis

time 15 seconds, partial thromboplasin 55 seconds, and fibrinogen 250 mg/dL). Culture studies including blood, urine, cerebro-spinal fluid, and wound were all negative and other laboratory studies were not remarkable. Immediate shock management and surgical hemostasis were performed. Because of continuous bleeding from the wound, an oral systemic steroid Hemangiomas are the most common benign cutaneous tumors occurring in early infancy. However, hemangiomas related to subcutaneous fat necrosis (SFN) have not been reported previously. We report a female newborn with cavernous hemangiomas located on her back, presenting with SFN, and extending to the superior mediastinum. Complete regression of the back mass was achieved after 4 weeks of systemic steroid treatment.

The link of HLA-B27 with interleukin-23/interleukin-17 axis in coexisting systemic lupus erythematosus and ankylosing spondylitis:

Sir, We read with great interest the contribution by Mrabet et al. They reported an unusual case of coexisting systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS) with positive human leukocyte antigen (HLA)-B27 but did not explicate the exact mechanisms. We would like to suggest a possible pathomechanism in the development of the two inflammatory diseases. Interleukin (IL)-23, a heterodimer composed of IL-12p40 and IL-23p19 subunits, and IL-17A, a cytokine produced by the IL-23-maintained T helper 17 (Th 17) subset, have been implicated in a number of inflammatory autoimmune diseases such as rheumatoid arthritis and SLE. Th 17 development producing the pro-inflammatory cytokine IL-17 is promoted by IL-23. Quite recently and importantly, Bowness et al. showed that H chain dimers of HLA-B27, termed HLA-B27(2)-expressing APCs which bind the killer-cell Ig-like receptor KIR3DL2 stimulate IL17 production of KIR3DL2(þ) CD4 T cells. Strikingly, KIR3DL2(þ) CD4 T cells account for the majority of peripheral blood CD4 T cell IL-23R expression and produce more IL-17 in the presence of IL-23. These findings link HLA-B27 with IL-17 production. In the previous study of Whittingham et al., there was also an increased risk of SLE with HLA-B8/B27 (relative risk1⁄4 27.6). The result suggested that susceptibility to SLE is influenced by one or more genes in linkage disequlibrium with the HLA-antigens-DR3 haplotype. AS, the most common spondyloarthritis, is genetically associated with both HLA-B27 and IL-23R polymorphisms. Wang et al. reported that the patients with AS showed elevated levels of IL-23 and IL-17 in the serum and supernatants of cultured peripheral blood mononuclear cells and speculated that these two cytokines might be responsible for the development of AS. Wendling also supported the potential central role of the IL-23/IL-17 axis in AS and speculated that p19 IL-23 blockade might be more efficacious in a new therapeutic pathway. Therefore, there is a possibility that enhanced IL23R expression and increased production of IL-17 through KIR3DL2(þ) CD4 T cells linked with positiveHLA-B27homodimersmayplay critical roles in the pathogenesis of coexisting AS and SLE. However, further studies are necessary to elucidate the exact molecular role and signaling transduction pathway of IL-23 and IL-17 during the diseases process. The role of IL-21, a member of the type I cytokine superfamily, and IL-32, originally named natural killer cell transcript 4 (NK4), in AS and SLE should also be further evaluated in the future.