Two patients with cutaneous leishmaniasis were treated with itraconazole. One patient was a 24-year-old man who had several erythematous papulonodules on the extremities for 1 month, which revealed cutaneous leishmaniasis, histopathologically. He was treated with itraconazole (200 mg/day) for 2 months. After treatment he showed clinical healing and the biopsy specimens no longer showed leishmania organisms. The other patient was a 27-year-old female who had several erythematous papulonodules on the face and neck for 3 months. The skin lesions revealed leishmania organisms in the tissue sections and culture media. She was also treated with itraconazole (200 mg/day) for 2 months. After treatment she also showed satisfying clinical healing and the biopsy specimens revealed no leishmania organisms. No specific side effects were encountered in both patients during the treatment. From these results, itraconazole is considered to be one of the promising anti-leishmanial drugs.
Adult ; Biopsy ; Culture Media ; Extremities ; Female ; Humans ; Itraconazole* ; Leishmania ; Leishmaniasis, Cutaneous* ; Neck ; Skin ; Young Adult

BACKGROUND: This study was intended to present the importance of insight status concerning the abstinence of alcoholics. METHODS: The 214 subjects, who participated in insight improving programs during hospitalization in an alcohol treatment center, were followed up for their abstinent status during the 12 month period after discharge. The relation between their abstinence results and insight status was investigated. To find out the influence of other factors upon abstinence, stepwise multiple regression was performed over variables including disease severity, sociodemographic, therapeutic and familial features. RESULTS: The 73 individuals (34.1%) had 'no remission', 110 (51.4%) 'early full remission', and 31 (14.5%) 'sustained full remission'. The insight degree was significantly correlated with both 'initial consecutive months of sobriety'(IMS) after discharge and 'total months of sobriety'(TMS) during the follow up. The 153 subjects (71.5%) relapsed within four months after discharge, and the rate of continuous abstinence at each month differed significantly among three insight groups. On the inter group shifts during hospitalization, the abstinent months were greater in the group whose insight changed from 'poor ' to 'good insight' than the one from 'fair ' to 'good insight'. By stepwise multiple regression analysis, the higher insight scores, older age and shorter hospital days, in a decreasing order of association, the longer IMS and TMS, while absence of religion and lower MAST scores was associated only with IMS, with their overall R2 value of 18.5% and 20.8%, respectively. CONCLUSION: The insight degree was related to the length of abstinence and thus it is necessary to develop insight improving programs which can be of help to recovering patients.
Alcoholics ; Alcoholism ; Follow-Up Studies ; Hospitalization ; Humans ; Prognosis

PURPOSE: To reconstruct soft tissue defect on lower extremity especially combined with osteomyelitis, free flap with enough blood supplies is required. There are some instance when patients have inadequate recipient vessels for microanastomosis. Anastomosis with harvested vein graft can solve the problem. It may be more problematic or even increase recipient site complication. Cross leg free flaps using contra-lateral vessel can be a solution. METHODS: From 2005 to 2008, 12 cases of cross leg free flap were done for 12 patients(9 male, 3 female). External fixators used in all cases. The free flaps used were laissmus dorsi muscle flap(n=5), anterolateral thigh flap(n=4), gracilis muscle flap(n=2) and medial plantar artery fasciotaneous flap(n=1). In all cases, contralateral posterior tibial artery and vein were used as recipient pedicle. RESULTS: All flaps survived without additional operative procedures. There happened no complications such as hematoma or Infection. Sometimes patients needed further therapeutic exercise for fast movement recovery. CONCLUSION: Although cross leg free flaps require long period of bed resting and rehabilitation after pedicle cutting, It can be a practical alternative for soft tissue defect on lower distal extremity with inadequate recipient vessels for free flap on affected leg.
Arteries ; Bed Rest ; Equipment and Supplies ; External Fixators ; Extremities ; Free Tissue Flaps ; Glycosaminoglycans ; Hematoma ; Humans ; Leg ; Lower Extremity ; Male ; Muscles ; Osteomyelitis ; Surgical Procedures, Operative ; Thigh ; Tibial Arteries ; Transplants ; Veins

BACKGROUND: Alterations in blood cell count are well recognized features of bacteremia. The study objective was to determine the hematologic changes predictive of bacteremia. METHODS: We retrospectively studied febrile adult patients with neutrophilia and included patients were either bacteriologically proven cases or those who had clinically suspected bacterial infections. Hematologic findings derived from basic hematologic tests were compared between patients with and those without bacteremia. RESULTS: Of the 624 patients, 143 (22.9%) had significant bacteremia. The following items were significantly different between patients with and those without bacteremia by univariate analysis: absolute neutrophil count, neutrophil differential, absolute lymphocyte count, lymphocyte differential, platelet count and band-associated parameters such as absolute band neutrophil count (ABC). Multivariate analysis revealed platelet count, lymphocyte differential and ABC as independent predictors (P<0.0001, each). Platelet count, the most potent predictor of bacteremia, showed area under the curve (AUC) of 0.685. Analysis according to the primary diagnosis indicated that the most potent predictors of bacteremia in patients with respiratory tract, urinary tract and hepatobiliary system infections were platelet count (P=0.002, AUC=0.697), ABC (P=0.002, AUC=0.681) and neutrophil differential (P=0.0001, AUC=0.822), respectively. CONCLUSIONS: Simple variables obtained from basic hematologic tests were associated with bacteremia even in febrile patients with neutrophilia. In particular, very high neutrophil differential was highly predictive of bacteremia in patients with hepatobiliary system infections and its clinical usefulness needs to be elucidated in a prospective study.
Adult ; Bacteremia ; Bacterial Infections ; Blood Cell Count ; Hematologic Tests ; Humans ; Lymphocyte Count ; Lymphocytes ; Multivariate Analysis ; Neutrophils ; Platelet Count ; Respiratory System ; Retrospective Studies ; Urinary Tract

Severe fever with thrombocytopenia syndrome virus (SFTSV) is a zoonotic, tick-borne RNA virus of the genus Bandavirus (Family Phenuiviridae), mainly reported in China, Japan, and the Republic of Korea (Korea). For the purpose of this study, a total of 3,898 adult and nymphal ticks of species Haemaphysalis longicornis (94.2%), Haemaphysalis flava (5.0%), Ixodes nipponensis (0.8%), and 1 specimen of Ixodes ovatus, were collected from the Deogyusan National Park, Korea, between April 2016 and June 2018. A single-step reverse transcriptase–nested PCR was performed, targeting the S segment of the SFTSV RNA. Total infection rate (IR) of SFTSV in individual ticks was found to be 6.0%. Based on developmental stages, IR was 5.3% in adults and 6.0% in nymphs. The S segment sequences obtained from PCR were divided into 17 haplotypes. All haplotypes were phylogenetically clustered into clades B-2 and B-3, with 92.7% sequences in B-2 and 7.3% in B-3. These observations indicate that the Korean SFTSV strains were closer to the Japanese than the Chinese strains. Further epidemiological studies are necessary to better understand the characteristics of the Korean SFTSV and its transmission cycle in the ecosystem.

BACKGROUND: Although rheumatic mitral stenosis is still a prevalent and clinically significant valvular heart disease in Korea, the natural history of rheumatic mitral stenosis has not been clearly determined yet. The present study aimed to evaluate the clinical and echocardiographic changes in patients with rheumatic mitral stenosis according to different therapeutic modalities. METHODS: A total of 91 patients (66 women; mean age, 50.9+/-12 years) with dominant rheumatic mitral stenosis and mitral valve area of less than 1.5 cm2 who were followed for more than 3 years (mean: 5.1 years) were included in this study. The subjects were divided into 3 groups according to the therapeutic modalities for mitral stenosis (A: medical therapy (n=31), B: percutaneous mitral valvuloplasty (n=30), C: mitral valve replacement (n=30)). Clinical and echocardiographic follow-up was performed before and immediately after therapeutic intervention such as percutaneous mitral valvuloplasty (PMV) and mitral valve replacement (MVR) and every year thereafter. Clinical symptoms and echocardiographic findings were compared between 3 groups. RESULTS: The patients of group B consisted of less females and more younger (p=NS). Clinical symptom of dyspnea was more severe in group B and C initially (A: 1.8+/-0.8, B: 2.5+/-0.8, C: 2.9+/-0.7; A vs. B, A vs. C, p<0.05) but more improved in group B and C (A: 1.6+/-0.5, B: 1.3+/-1.0, C: 1.6+/-0.5; A vs B, A vs. C, p<0.05) during the follow-up. The prevalence of atrial fibrillation did not change significantly during follow-up. Mitral valve area decreased significantly in A group from 1.1+/-0.4 to 0.9+/-0.3 cm2 (p<0.05), but, no significant change was observed in group B and C. No significant changes were observed in the left ventricular end-diastolic, end-systolic dimensions, and ejection fraction during the follow-up period. No clinically significant aggravations of associated valvular regurgitations and systolic pulmonary artery pressure were observed. CONCLUSION: In patients with mitral stenosis more than moderate severity, PMV or MVR is superior to medical therapy for controlling clinical symptoms and maintaining the mitral valve area. Therapeutic modality does not influence the change in the dimension and systolic function of the left ventricle. Accompanied other valvular regurgitation does not change significantly regardless of therapeutic modality, indicating that any additional therapy for associated valvular regurgitation is unnecessary.
Atrial Fibrillation ; Dyspnea ; Echocardiography* ; Female ; Follow-Up Studies ; Heart Valve Diseases ; Heart Ventricles ; Humans ; Korea ; Mitral Valve ; Mitral Valve Stenosis* ; Natural History ; Prevalence ; Pulmonary Artery

BACKGROUND: Real-time PCR for quantification of JAK2 V617F has recently been introduced and used to evaluate the importance of mutant allele burden in both diagnosis and disease progression in myeloproliferative diseases (MPDs). We evaluated the usefulness of JAK2 MutaScreen(TM) kit that uses a real-time semiquantitative PCR method and has been designed to screen JAK2 V617F mutant allele burden. METHODS: Forty MPD patients were included in this study. We screened JAK2 V617F and determined the mutant allele burden using JAK2 MutaScreen(TM) kit. The mutant allele burden was estimated by six-scaled standards of JAK2 V617F mutant allele (2%, 5%, 12.5%, 31%, 50%, and 78%). For evaluation of test performance, an allele-specific PCR (AS-PCR) was carried out in all samples by using Seeplex JAK2 Genotyping kit. We assessed the clinical differences in distinct disease entities of MPDs according to JAK2 V617F mutant allele burden. RESULTS: JAK2 V617F mutation was detected in 30 cases, including 10 of 11 cases (91%) of polycythemia vera (PV), 13 of 20 cases (65%) of essential thrombocythemia (ET), and 2 of 3 cases (67%) of chronic idiopathic myelofibrosis (CIMF). The concordance rate between the two tests was 95% (38/40). JAK2 V617F mutant allele burden was greater than 50% in 17 cases, and 10 of them (59%) were PV. In contrast, mutant allele burden was less than 50% in 13 cases and 11 of them (85%) were ET. CONCLUSIONS: JAK2 MutaScreen(TM) kit that utilizes a real-time semi-quantitative PCR method is a useful tool for diagnosing MPDs precisely. It can be used to assess the grade of mutant allele burden as well as to screen JAK2 V617F simultaneously.
Adult ; Aged ; *Alleles ; Amino Acid Substitution ; DNA Mutational Analysis ; Disease Progression ; Female ; Humans ; Janus Kinase 2/*genetics ; Male ; Middle Aged ; Mutation ; Myeloproliferative Disorders/*diagnosis/genetics ; Polymerase Chain Reaction/*methods ; Reagent Kits, Diagnostic

The population of the elderly and neuropsychiatric elderly patients increases radically, but realistic management in the welfare and medical dimensions are not adequate. Especially, the treatment and care for the neuropsychiatric geriatric patients have not been achieved properly for the lack of good medical facilities and heavy economic burden. Therefore, this paper will propose a model of specialized neuropsychiatric geriatric hospital suited to our reality for the welfare of the elderly themselves and their families. For this, we investigated the needs of medical consumers through surveys. Our subjects are 41 families of neuropsychiatric elderly patients in admission and 51 caregivers. In these surveys, patrons expect the establishment of specialized geriatric hospital proper to the characteristics of neuropsychiatric elderly patients. In addition, they hope patients adminssion fee to be reduced as difficulty and specialty of neuropsychiatric geriatric patient treatment are actively applied to the medical insurance fee and national support system. According to our examination of the caregeivers for the neuropsychiatric elderly patients, caregivers didn't receive systematized training, but only brief care-giving education. Their status is also unstable and their pay is low. These issues are very important for the quality of care-giving work. Therefore, specialized neuropsychiatric geriatric hospitals should be established properly to our social reality and request, and national and social supports for the training and education of medical staffs and quite necessary.
Aged* ; Caregivers ; Education ; Fees and Charges ; Hope ; Humans ; Insurance ; Medical Staff

There have been a few reports of hemophagocytic lymphohistiocytosis (HLH) with chromosomal abnormalities. Clonal chromosomal abnormalities in HLH patients are usually found in association with hematologic malignancies and rarely with epstein-barr virus (EBV) infection. Here, we report a fatal case of HLH with clonal karyotype abnormalities. A 75-yr-old man was admitted with persistent anorexia and high fever. Laboratory data revealed pancytopenia, hypofibrinogenemia, hyperferritinemia, prolonged prothrombin time and activated partial thromboplastin time, and marked elevated level of serum transaminases. In real time-PCR using whole blood, EBV DNA was not detected but cytomegalovirus (CMV) DNA was detected. The bone marrow aspiration smear showed hyperplasia of mature histiocytes with prominent hemophagocytosis. In chromosomal analysis of bone marrow aspirates, complex chromosomal abnormalities were found. In spite of steroid pulse therapy and antibiotic treatment, he died of disseminated intravascular coagulopathy.
Anorexia ; Bone Marrow ; Chromosome Aberrations ; Cytomegalovirus ; DNA ; Fever ; Hematologic Neoplasms ; Herpesvirus 4, Human ; Histiocytes ; Humans ; Hyperplasia ; Karyotype ; Lymphohistiocytosis, Hemophagocytic ; Pancytopenia ; Partial Thromboplastin Time ; Prothrombin Time ; Transaminases

OBJECTIVES: The aging process can influence sexual functions by physiological, pathological, behavioral and psychosocial changes. Studies on sex among elderly are scarce. However, sexual activities remain throughout life in different forms. The aim of this study was to identify sexual problems and dysfunctions among dementia patients and compare with healthy aged persons. METHODS: The sexual problems and affecting factors were evaluated by structured interview and sexual problem screening instruments for 46 dementia patients according to DSM-IV and 60 healthy Koreans aged over 60. RESULTS: 1) Frequency of erection was less than once a day in 68.0% of controls, while more than once a day in 47.6% of dementia. Trouble in attaining erection was found in 50.0% of dementia as compared with 65.4% of controls. Awake with erection was less than once a week in 37.8% of controls, while less than once a week in 22.2% and more than once a week in 10.0% of dementia. Maintaining erection was better in controls (92.0%) as compared with dementia (55.0%)(p<0.01). Number of sex partner was one in 75.0% and none in 25.0% of controls, while one in 80.0%, none in 16.0% and more than one in 4.0% of dementia. Pain during with intercourse was less in dementia (22.7%) than controls (73.2%)(p<0.001). Frequency of ejaculation and masturbation, frequency of intercourse, thoughts and dreams of sex, feeling of desire was higher in dementia than controls (p<0.05). In 41.7% of dementia patients, sexual activity cf. sexual desire was less(desired>activity). Satisfaction in sex life (41.7%), partner's satisfaction (31.8%), satisfaction with partner (45.5%) and men's interest in sex decline with age (54.5%) were higher in dementia (p<0.001, respectively). 2) The recognition of sexual problems was higher in healthy elderly (74.1%). Most of sexual dysfunctions except sexual desire disorder (83.3% in controls vs 40.0% in dementia) was higher in demetia, that is, erectile disorder (30.0%), premature ejaculation (20.0%), and orgasmic disorder (10.0%). The duration over 5 years of sexual problems was the most in both (46.7% in controls vs 53.3% in dementia). 3) Problematic sexual behaviors seen among dementia patients were obscene remarks/sexual hallucination (30.8%, respectively), public exposure (15.4%), inappropriate contact/physical contact with others/sexual seduction toward other patients (1.7%, respectively) in that order. Appea-rance time of sexual problems was over 1 year of dementia (50.0%), within 1 year of dementia (32.4%), and with the initiation of dementia (17.6%). The frequency was more than once a week in 60.0% and less than once a week in 40.0% of dementia. Place of sexual misbehavior was one's own room (68.6%), other place (22.9%), toilet (5.7%), activity therapy room (2.9%) in that order. Targets of sexual misbehavior were other patients (40.0%), caregivers (31.4%), medical personnel/others (14.3%, respectively) in that order. For the management of sexual misbehavior, most of the doctors chose non-pharmacological methods (83.9%). CONCLUSION: The sexual activity among Korean elderly with age over 60 was more active in healty controls than dementic patients, while sexual dysfunction except sexual desire disorder was more in dementic patients than healthy controls. Therefore, special interest and proper management was needed toward hypersexuality as well as sexual hypoactivity, and most of all, conceptual changes of doctors and caregivers toward sexual problems in the elderly must be preceded.
Aged* ; Aging ; Caregivers ; Dementia ; Diagnostic and Statistical Manual of Mental Disorders ; Dreams ; Ejaculation ; Hallucinations ; Humans ; Korea* ; Male ; Mass Screening ; Masturbation ; Premature Ejaculation ; Sexual Behavior ; Sexual Dysfunctions, Psychological