Chromobacterium violaceum is a gram negative straight rod, 0.8-1.2 by 2.5 to 6.0 m, which is motile by one polar flagella and one to four lateral flagella. The organism inhabits soil and water and is often found in semitropical and tropical climates. Infections in humans are rare. We report a case of infection caused by strains of C. violaceum. A 38-year-old male patient was admitted to KyungHee University Hospital, Seoul, Korea on July 28th, 2003, after a car accident. The patient had multiple trauma and lacerations. He had an open wound in the left tibial area from which C. violaceum was isolated. The strain was resistant to ampicillin, tobramycin, ampicillin/sulbactam, ceftriaxone and cefepime, but was susceptible to amikacin, gentamicin, ciprofloxacin, levofloxacin, trimethoprim/sulfamethoxazole and piperacillin/tazobactam. The patient was treated successfully by debridement, cephapirin sodium and astromicine sulfate.
Wound Infection/*etiology ; Male ; Humans ; Gram-Negative Bacterial Infections/*etiology ; Chromobacterium/*isolation & purification ; Adult ; *Accidents, Traffic

PURPOSE: To evaluate MRI findings of spinal cord according to mechanism in acute cervical spinal injury. MATERIALS AND METHODS: 25 patients under went MRI within 1 month after acute cervical trauma. Axial T1WI (TR/TE :500/20), gradient-echo (TR/TE :300/14), sagittal T1WI (TR/TE:500/20), proton (TR/TE :2000. 20 msec), T2WI (TR/TE :2000/80) were performed. In 11 pateints, post-enhancement T1WI was done. Change of spinal cord signal intensity on MRI in addition to the presence of abnormal changes of vertebral body, intervertebral disc and paraspinal soft tissue were evaluated. RESULTS: 15 patients had flexion injury, seven had extension injury and three had injury of unknon mechanism. Twelve patients showed /so-signal intensity on T1WI and high signal intensity on T2WI. Three patients showed low signal intensity on T1WI and high signal intensity on T2WI. Spinal cord hemorrhage occured in 10 patients. We found cord swelling in nine patients and cord compression in 12 patients. In nine patients with cord swelling, extent of cord injury was more than one segment of vertebral body. Ligamentous injury, disc injury, soft tissue injury occurred in 16(64%), 17(68%), 15(60%) patients respectively. Vertebral body fracture was found in 17 patients (68%). The levels of fracture were C6(eight patients) and C5(five patients). CONCLUSION: MRI is valuable in exaluetion of the spinal cord, intervertebral disc, and soft tissue lesions in acute cervical spinal injury. Prognosis is worse in flexion injury than in extension injury, and is well correlated with cord hemorrhage and lesion extent.
Hemorrhage ; Humans ; Intervertebral Disc ; Ligaments ; Magnetic Resonance Imaging ; Neurologic Manifestations* ; Prognosis ; Protons ; Soft Tissue Injuries ; Spinal Cord ; Spinal Injuries

Leiomyoma is the most common benign tumor of the esophagus, but it still occurs rarely, as compared with the incidence of cacinoma. There are no geographic or racial differences and manifestations are unusual and inconsistent. About 97% of the esophageal leiomyoma may oecur in intramural type and 1 of the tumor may be polypoid type. Considerable diagnostic problems may arise as well as problems of proper surgical management. We experienced a case of a 47-year old female with esophageal leiomyoma in the mid- point of the esophagus. The patient complained of substernal discomfort for 1 month and routine examinatian and gastrofiberscope were performed. The gastrofiberscopic finding was asmoothly protruded, round bean-sized polypoid mass in the midpoint of the esophagus which was removed by polypectomy. There were no other complications. So we reported this case with review of literature.
Esophagus ; Female ; Humans ; Incidence ; Leiomyoma* ; Middle Aged

Rumination syndrome is defined as a regurgitation of recently ingested food into the mouth with subsequent remastication and reswallowing or spitting out, and absence of structural disease. This is infrequent in adults of normal mental capacity. The true prevalence of rumination syndrome is unknown because few people have medical attention and most of physicians do not recognize this syndrome as a disease. Upper gastrointestinal manometry has been reported to show a characteristic pattern that confirms the diagnosis, namely, the occurrence of synchronous pressure spikes termed "R waves" at all levels in the stomach and small intestine. We assessed a 49-year-old male patient who complained of frequent effortless regurgitation of food. Ambulatory short-segment antroduodenal manometry with pH-metry showed simultaneous repeatetive contractions in all segments associated with regurgitation.
Adult ; Diagnosis ; Humans ; Intestine, Small ; Male ; Manometry* ; Middle Aged ; Mouth ; Prevalence ; Stomach

Hepatitis B virus (HBV) is one of the major causative agents of chronic liver diseases in Korea. HBV has been classified into 8 genotypes by a divergence of >8% in the entire genomic sequence, and have distinct geographic distributions. There are limited data on the relevance between HBV genotypes and clinical outcomes in Korea. To investigate the clinical feature relating to HBV genotype in Korea, a total 120 serum samples with HBsAg (65 from Seoul and 55 from the other city in Korea) were obtained from each 30 chronic HBV carriers with asymptomatic carrier (ASC), chronic hepatitis (CH), liver cirrhosis (LC) and hepatocellular carcinoma (HCC). HBV genotype was determined by either enzyme-linked immunosorbent assay (ELISA) using monoclonal antibodies against genotype-specific epitopes in the preS2-region or the direct sequencing of small S gene. HBV genotypes were determined in 105 (87.5%) of 120 samples. HBV genotype C was identified in all HBV carriers with ASC, CH, LC, and HCC. Genotypes A, B, D, E, F and G were not detected in any of them. Genotype C HBV prevails predominantly among chronic carriers of the virus in Korea, irrespective of their clinical stages of liver disease and geographic origin.
Carrier State/*epidemiology/*virology ; Comorbidity ; Female ; Genotype ; Hepatitis B virus/*genetics/isolation and purification ; Hepatitis B, Chronic/*epidemiology/*virology ; Humans ; Korea/epidemiology ; Liver Diseases/*epidemiology/*virology ; Male ; Middle Aged ; Prevalence ; Research Support, Non-U.S. Gov't ; Risk Assessment/methods ; Risk Factors

BACKGROUND AND OBJECTIVES:There are several methods to improve voice quality in the patients with paralyzed vocal cord, such as thyroplasty type I, injection, arytenoid adduction. The goal of surgical medialization of the paralyzed vocal fold is to attain complete glottic closure. The purpose of this study is to evaluate the effectiveness of thyroplasty type I through qualifying the vocal function and glottal gap. MATERIALS & METHODS: We experienced 20 cases of unilateral vocal fold paralysis who underwent thyroplasty type I. We performed preoperative and postoperative videoimage analysis (normalized glottal gap area) and computer-assisted voice analysis in all patients. RESULTS: The glottal gap was significantly reduced after thyroplasty type I. Postoperative voice quality was characterized by an improved pitch and amplitude perturbation (jitter and shimmer), maximum phonation time and subglottic pressure . But noise to harmonic ratio was not improved. CONCLUSION: Thyroplasty type I is an effective method in the point of regaining glottal closure and vocal function.
Humans ; Laryngoplasty* ; Noise ; Paralysis* ; Phonation ; Vocal Cord Paralysis ; Vocal Cords ; Voice Quality ; Voice*

Colonic lipomas represent mesenchymal origin tumors that are second most common benign colonic tumor after hyperplastic polyps and adenomatous polyps. The patho-genesis of them is not clear. Most patients are asymptomatic and the lesion is often detected incidentally at colonoscopy, operation, and autopsy. According to the size and the location of lipoma, it may cause intestinal obstruction, perforation, intussusception, and life-threatening bleeding. There have been many reports of small colonic lipomas removed by endoscopic resection. Giant lipoma which is greater than 2 cm in size has been associated with higher risk of perforation, thus it has been removed by surgery until now. We report a case of colonic giant lipoma inducing intussusception which could be removed by endoscopic resection.
Adenomatous Polyps ; Autopsy ; Colon* ; Colonoscopy ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intussusception ; Lipoma* ; Polyps

BACKGROUND/AIMS: Various magnifying endoscopic classifications have been introduced in esophageal and gastric lesions. However, studies on an agreement between observers according to the form classification of magnifiying endoscopic findings have not been performed yet. The aim of this study was to determine the interobserver agreement for magnifying endoscopic classifications. METHODS: The patients were divided into 3 groups. The first group of patients had post-EMR ulcer scar (50 cases), the second group, elevated gastric lesion (38 cases), and the third group, gastritis (43 cases). Two mucosal patterns were used in the post-EMR ulcer scar group, 6 mucosal patterns in the elevated gastric lesion group, and 3 patterns of the collecting venule in the gastritis group. Three experienced observers (A, B, C) blinded to the patients' data participated in this study. The agreement between observers was evaluated by calculated kappa. The kappa value of 0.75 or greater was rated excellent, 0.4~0.74, fair to good, and 0.4 or less, poor. RESULTS: Regarding 2 mucosal pattern in post-EMR ulcer scar, agreements between A and B, A and C, and B and C were 0.896, 0.793, and 0.901, respectively (p<0.01). Regarding 6 mucosal patterns in elevated gastric lesion, agreements between A and B, A and C, and B and C were 0.607, 0.458, and 0.557, respectively (p<0.01). Regarding 3 collecting venule pattern in gastritis, agreements between A and B, A and C, and B and C were 0.822, 0.823, and 0.751, respectively (p<0.01). CONCLUSIONS: Interobserver agreement is good to excellent in mucosal pattern and collecting venule by magnifying endoscopy. However magnifying endoscopic classification needs to be refinded in order to improve an agreement between observers.
Cicatrix ; Classification ; Endoscopy* ; Gastritis ; Humans ; Ulcer ; Venules

BACKGROUND/AIMS: Although photodynamic therapy (PDT) has been used for the endoscopic treatment of digestive cancer, its curative efficacy remains uncertain. This study evaluated the curative role of PDT in superficial gastrointestinal cancer. METHODS: Fifteen lesions in 14 patients with a histologically proven carcinoma (early esophageal cancer 6, early gastric cancer 8, ampulla of Vater cancer 1) were injected with an intravenous hematoporphyrin derivative (2 mg/kg), and PDT was performed 48 hours later. The response to treatment was assessed by gastroscopy with biopsies. RESULTS: The median follow-up time was 273 days (42~1,030 days). According to the TNM stage of endoscopic ultrasonography, there were 14 T1 cases and 1 T2 case. Complete remission was observed in 13 cases after the initial and consecutive PDT. There were 2 cases of failure. The recurrence rate was 15.4% (2/13), and the median time from the initial PDT to recurrence was 349 days. CONCLUSIONS: PDT using a hematoporphyrin derivative as a photosensitizer is a safe and efficient method for treating early cancer. However, a long-term follow up period using a large population sample will be needed for confirmation.
Ampulla of Vater ; Biopsy ; Endosonography ; Esophageal Neoplasms ; Follow-Up Studies ; Gastrointestinal Neoplasms ; Gastroscopy ; Hematoporphyrin Derivative ; Humans ; Photochemotherapy* ; Recurrence ; Stomach Neoplasms

BACKGROUND/AIMS: This is the study to find diagnostic possibility of the H. pylori induced gastritis by using the magnifying endoscope. METHODS: The objectives were 144 pathologies from 48 patients with gastritis. The three sites of gastric mucosa have been magnified up to 80 times by using the magnifying endoscope. According to the patterns of the collecting venule, they have been classified into 3 patterns; regular (R), irregular (I) and disappearance (D) pattern and biopsy of each part has been performed. Each tissue has been evaluated into five kinds of morphological index (point: 0~3) by using an updated Sydney system. RESULTS: In 144 collecting venule, R, I and D-pattern was 19, 67, 58, respectively. Regarding the total score of morphologic points, the point of R-pattern was less than that of D-pattern (p<0.05). Regarding the infection of H. pyrori, the infection rate was 0%, 53.7%, and 60.3% in each pattern, and infection rate of R-pattern was less than other two patterns (p<0.05). Regarding the activity of neutrophile, R-pattern was less than those of I and D-pattern (p<0.05). CONCLUSIONS: Observance of the collecting venule of the gastric mucosa by magnifying endoscopy is considered to be useful when estimating the inflammation degree and H. pylori infection.
Biopsy ; Endoscopes ; Endoscopy* ; Gastric Mucosa ; Gastritis* ; Humans ; Inflammation ; Neutrophils ; Pathology ; Venules