BACKGROUND: Generalization of standardized surgical techniques to treat aortic valve (AV) and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR). METHODS: We retrospectively reviewed 66 patients (36 male; mean age, 44.5±9.5 years) who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. RESULTS: Emergency surgeries comprised 43.9% (n=29). Indications for the redo-ARR were aneurysm (n=12), pseudoaneurysm (n=1), or dissection (n=6) of the residual native aortic sinus in 19 patients (28.8%), native AV dysfunction in 8 patients (12.1%), structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%), and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%). There were 3 early deaths (4.5%). During follow-up (median, 54.65 months; quartile 1–3, 17.93 to 95.71 months), there were 14 late deaths (21.2%), and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were 81.5%±5.1% and 76.4%±5.4%, respectively. CONCLUSION: Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients.
Aneurysm ; Aneurysm, False ; Aorta ; Aorta, Thoracic ; Aortic Valve* ; Disease-Free Survival ; Emergencies ; Endocarditis ; Follow-Up Studies ; Generalization (Psychology) ; Humans ; Male ; Reoperation ; Retrospective Studies ; Sinus of Valsalva ; Surgeons ; Transplants

BACKGROUND/AIMS: To prevent the transmission of pathogens by endoscopes, following established reprocessing guidelines is critical. An ideal reprocessing step is simple, fast, and inexpensive. Here, we evaluated and compared the efficacy and safety of two disinfectants, a tertiary amine compound (TAC) and ortho-phthalaldehyde (OPA). METHODS: A total of 100 colonoscopes were randomly reprocessed using two same automated endoscope reprocessors, according to disinfectant. The exposure time was 10 minutes for 0.55% OPA (Cidex® OPA, Johnson & Johnson) and 5 minutes for 4% TAC (Sencron2®, Bab Gencel Pharma & Chemical Ind. Co.). Three culture samples were obtained from each colonoscope after reprocessing. RESULTS: A total of nine samples were positive among the 300 culture samples. The positive culture rate was not statistically different between the two groups (4% for OPA and 2% for TAC, P=0.501). There were no incidents related to safety during the study period. CONCLUSIONS: TAC was non-inferior in terms of reprocessing efficacy to OPA and was safe to use. Therefore, TAC seems to be a good alternative disinfectant with a relatively short exposure time and is also less expensive than OPA.
Colonoscopes* ; Disinfectants* ; Endoscopes* ; o-Phthalaldehyde*

During the 2015 outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in Korea, 186 persons were infected, resulting in 38 fatalities. We isolated MERS-CoV from the oropharyngeal sample obtained from a patient of the outbreak. Cytopathic effects showing detachment and rounding of cells were observed in Vero cell cultures 3 days after inoculation of the sample. Spherical virus particles were observed by transmission electron microscopy. Full-length genome sequence of the virus isolate was obtained and phylogenetic analyses showed that it clustered with clade B of MERS-CoV.
Animals ; Cercopithecus aethiops ; Coronavirus Infections/*diagnosis/epidemiology/*virology ; Disease Outbreaks ; Humans ; Microscopy, Electron ; Middle East Respiratory Syndrome Coronavirus/classification/genetics/*isolation & purification/ultrastructure ; Phylogeny ; Polymerase Chain Reaction ; RNA, Viral/analysis/chemistry/metabolism ; Republic of Korea/epidemiology ; Sequence Analysis, RNA ; Vero Cells

BACKGROUND: The emergence of non-typhoidal Salmonella (NTS) with decreased susceptibilities to fluoroquinolone, ampicillin, or ceftriaxone has been reported worldwide. However, current surveillance studies of resistance among NTS in Korea are limited. Thus, the antimicrobial susceptibilities; resistance mechanisms such as extended-spectrum beta-lactamase (ESBL), plasmid-mediated AmpC beta-lactamase (PABL), and plasmid-mediated quinolone resistance (PMQR); and molecular epidemiologic characteristics were investigated in the present study. METHODS: National Institute of Health and National Veterinary Research and Quarantine Service collected NTS strains from 219 clinical and 293 non-clinical specimens from 2006 to 2008. The antimicrobial susceptibilities were determined using the Clinical and Laboratory Standards Institute disk diffusion test. ESBL, PABL, and qnr genotyping were performed using PCR and nucleotide sequencing. Pulsed-field gel electrophoresis was used for the molecular epidemiologic study. RESULTS: The resistance to ampicillin in clinical and non-clinical NTS was 49% and 18 to 47%, respectively. The resistance rates to trimethoprim-sulfamethoxazole in clinical and non-clinical NTS were 8% and 0 to 41%, respectively. The rates to extended-spectrum cephalosporin were 0 to 1%. One CTX-M-15-producing isolate and four CMY-2-producing isolates were detected. Notably, PFGE analysis showed four isolates carrying bla CMY-2, including one non-clinical strain had high clonality. Although the rate of ciprofloxacin resistance was very low, two qnrS1-carrying NTS strains were detected in non-clinical specimens. CONCLUSION: The resistance rates to ampicillin in both clinical and non-clinical NTS were high, while those to trimethoprim-sulfamethoxazole varied depending on the specimen. NTS strains harboring CTX-M-15-type ESBL or CMY-2-type PABL were detected even though the resistance rates to cephalosporins were very low. Four NTS strains carrying the blaCMY-2-gene implied zoonotic infection. Continuous effort to minimize transfer of resistance genes in NTS is necessary.
Ampicillin ; Animals ; Bacterial Proteins ; beta-Lactamases ; Ceftriaxone ; Cephalosporins ; Ciprofloxacin ; Diffusion ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Korea ; Lifting ; Polymerase Chain Reaction ; Quarantine ; Salmonella ; Sprains and Strains ; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND: Insulin resistance is an integral feature of metabolic syndromes, including obesity, hyperglycemia, and hyperlipidemia. In this study, we evaluated whether the aloe component could reduce obesity-induced inflammation and the occurrence of metabolic disorders such as blood glucose and insulin resistance. METHODS: Male C57BL/6 obese mice fed a high-fat diet for 54 days received a supplement of aloe formula (PAG, ALS, Aloe QDM, and Aloe QDM complex) or pioglitazone (PGZ) and were compared with unsupplemented controls (high-fat diet; HFD) or mice fed a regular diet (RD). RT-PCR and western blot analysis were used to quantify the expression of obesity-induced inflammation. RESULTS: Aloe QDM lowered fasting blood glucose and plasma insulin compared with HFD. Obesity-induced inflammatory cytokine (IL-1beta, -6, -12, TNF-alpha) and chemokine (CX3CL1, CCL5) mRNA and protein were decreased markedly, as was macrophage infiltration and hepatic triglycerides by Aloe QDM. At the same time, Aloe QDM decreased the mRNA and protein of PPARgamma/LXRalpha and 11beta-HSD1 both in the liver and WAT. CONCLUSION: Dietary aloe formula reduces obesity-induced glucose tolerance not only by suppressing inflammatory responses but also by inducing anti-inflammatory cytokines in the WAT and liver, both of which are important peripheral tissues affecting insulin resistance. The effect of Aloe QDM complex in the WAT and liver are related to its dual action on PPARgamma and 11beta-HSD1 expression and its use as a nutritional intervention against T2D and obesity-related inflammation is suggested.
11-beta-Hydroxysteroid Dehydrogenase Type 1 ; Aloe ; Animals ; Blood Glucose ; Blotting, Western ; Cytokines ; Diabetes Mellitus, Type 2 ; Diet ; Diet, High-Fat ; Fasting ; Glucose ; Humans ; Hyperglycemia ; Hyperlipidemias ; Inflammation ; Insulin ; Insulin Resistance ; Liver ; Macrophages ; Male ; Mice ; Mice, Obese ; Obesity ; Plasma ; PPAR gamma ; RNA, Messenger ; Thiazolidinediones ; Triglycerides

BACKGROUND: Waon therapy has beneficial effects on chronic heart failure (CHF), peripheral arterial disease, and other various diseases. This was to assess the safety and effect of Waon therapy by echocardiography for the first time in Korea. METHODS: Ten patients with CHF were enrolled. The patients with a light gown were placed in a sitting-position in an evenly maintained 60degrees C dry sauna system for 15 minutes, and then after leaving the sauna, they underwent bed rest with a blanket to keep them warm for an additional 30 minutes. Waon therapy was performed once a day, 5 days a week. RESULTS: Four of the 5 patients who had been treated for more than 2 weeks as protocol noted improvement of heart failure (HF) symptoms and decrease in left ventricular (LV) volume. There were trends in improvement of LV ejection fraction and parameters of diastolic function after the therapy although statistical significance was lack. No one complained of worsening of HF symptoms. In each session, body weight (61.8+/-10.2 kg vs. 61.6+/-10.3 kg, p=0.008) and blood pressure (systolic, 119+/-28 vs. 111+/-27 mmHg, p=0.005; diastolic, 69+/-12 mmHg vs. 63+/-10 mmHg, p=0.005) were significantly decreased, oral temperature (35.9+/-0.4degrees C vs. 37.0+/-0.9degrees C, p=0.017) was increased by 1.0degrees C at the end of sauna bathing, but the heart rate (71+/-10/min vs. 72+/-8/min, p=0.8) was not changed. CONCLUSION: We have experienced Waon therapy which was safe and well tolerated and some beneficial effects for patients with CHF. Large scale randomized study is needed to apply Waon therapy as a promising therapy in Korean HF patients.
Baths ; Bed Rest ; Blood Pressure ; Body Weight ; Echocardiography ; Heart Failure ; Heart Rate ; Humans ; Korea ; Light ; Peripheral Arterial Disease ; Steam Bath

BACKGROUND/AIMS: Microsatellite instability (MSI) is associated with mutations in the DNA mismatch repair system and accounts for 10-15% of all cases of sporadic colorectal cancer (CRC). However, the characteristics and role of MSI as a marker for predicting the prognosis and therapeutic effect on CRC remain unclear. METHODS: Between June 2003 and December 2007, 259 patients (males, 159 [61%]; age, 63 [+/-11] years) who underwent surgery for CRC were retrospectively enrolled. The clinicopathologic characteristics of patients with high-frequency MSI (MSI-H) CRC were reviewed and compared to patients with low-frequency MSI or microsatellite stable CRC. The patient characteristics and MSI-related data were recorded for the following variables: gender, age, clinicopathologic findings, chemotherapy response, recurrence, and survival. RESULTS: MSI-H CRC was diagnosed in 30 patients (12%), low-frequency MSI CRC was diagnosed in 10 patients (4%), and microsatellite stable CRC in was diagnosed in 219 patients (84%). The MSI-H group exhibited the following characteristics: large size, right colon location, positive response to chemotherapy, low recurrence, longer survival, less neural invasion, poor differentiation, diffuse lymphoid reaction, and mucin pool formation. However, in the chemotherapy group (n=180), MSI-H was not a marker of longer survival. Based on Cox-regression analysis, stage IV CRC (OR=6.66; 95% CI, 2.24-53.00), MSI-H (OR=0.17; 95% CI, 0.04-0.73), and a positive response to chemotherapy (OR=0.02; 95% CI, 0.01-0.11) were related to mortality. CONCLUSIONS: MSI-H CRC had less neural invasion and diffuse lymphoid reaction. Further studies regarding the relationship between those pathologic findings and survival are needed.
Colon ; Colorectal Neoplasms ; DNA Mismatch Repair ; Humans ; Microsatellite Instability ; Microsatellite Repeats ; Mucins ; Prognosis ; Recurrence ; Retrospective Studies ; Succinimides

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent dermatology pathogens in hospitals and increasingly recognized in communities. We determined PFGE pattern of SmaI-restricted genomic DNA, coagulase type, and antimicrobial susceptibility of MRSA isolated in 2008 from dermatology inpatients and healthy hospital employees in A Hospital and from primary school children in Iksan city, Korea. Overall, the isolation rate of MRSA was 3.8% from the 788 normal persons: 4.9% from hospital employees and 1.1% from primary school children. MRSA was isolated in six of 13 (46.2%) family members of four school children with MRSA. The most prevalent coagulase serotype was II from patients and V from healthy individuals. Ten of twenty and six of twenty MRSA isolates from patients and from healthy personnel, respectively, had identical PFGE patterns, suggesting that these are originated from identical clones. Against MRSA from patients, only vancomycin was the most active (MIC range < or =2 microg/ml), whereas the resistance rates were 35% to rifampin and 65% to mupirocin. The resistance rates of patient isolates were > or =90% to amikacin, clindamycin, ciprofloxacin, erythromycin, fusidic acid, gentamicin and tetracycline. In conclusion, the MRSA carriage rates of healthy hospital workers were relatively high, 2.3~7.7%, depending on groups. Family members of a few primary school children with MRSA showed a high carriage rate, suggesting that intrafamily transmission occurred. MRSAs isolated from dermatology inpatients were relatively more resistant to various antimicrobial agents, including mupirocin, but all isolates were susceptibility to vancomycin.
Amikacin ; Anti-Infective Agents ; Child ; Ciprofloxacin ; Clindamycin ; Clone Cells ; Coagulase ; Dermatology ; DNA ; Erythromycin ; Fusidic Acid ; Genotype ; Gentamicins ; Humans ; Inpatients ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin ; Rifampin ; Tetracycline ; Vancomycin ; Natural Resources

Thymomas are associated with different paraneoplastic syndromes, with the most clinically important association being with myasthenia gravis, hypogammaglobulinemia, and pure red cell aplasia (PRCA). The optimal therapy for PRCA that complicates a thymoma is unknown, given the rarity of the clinical situation. It has been suggested that remission following surgery alone is uncommon and most patients will require some other form of therapy. We report a case of PRCA with a thymoma in a 59-year-old man who remained in complete remission of the PRCA after surgical resection of the thymoma.
Agammaglobulinemia ; Humans ; Middle Aged ; Myasthenia Gravis ; Paraneoplastic Syndromes ; Red-Cell Aplasia, Pure* ; Thymoma*

Multiple bilobar liver metastases (MBLM) are the main cause of low resectability in the colon cancer liver metastases. The authors experienced one case of initially non-resectable colon cancer liver metastases. He was curatively and safely treated with a two-stage hepatectomy using the new method of future remnant liver volume growing. A 54-year-old man was referred to our department with the sigmoid colon cancer combined with MBLM, which were checked in two small metastatic lesions in the left lobe and five large sized lesions in the right lobe in the computed tomogram (CT). At first, a laparoscopy-assisted anterior resection was performed. We performed the 1st stage hepatectomy 3 weeks after the colon resection. Intra-operative Ultrasonogram (US) found 9 small superficial metastatic lesions in the left lobe. All that lesions were completely removed by non-anatomical wedge resection. An occlusion balloon catheter was placed in the right portal vein through a small branch of the inferior mesenteric vein at that time. The future remnant liver volume was sufficiently increased 3 weeks after the 1st hepatectomy. A right hepatectomy was safely performed 22 days after the 1st hepatectomy. The patient had received a regional chemotherapy (interleukin2 based immuno-chemotherapy through hepatic artery) for 6 months, then has been receiving a systemic chemotherapy (biweekly Oxaliplatin, leucovorin, plus 5-fluorouracil) without any recurrence evidence.
Catheters ; Colon* ; Colonic Neoplasms* ; Drug Therapy ; Hepatectomy ; Humans ; Leucovorin ; Liver* ; Mesenteric Veins ; Middle Aged ; Neoplasm Metastasis* ; Portal Vein ; Recurrence ; Sigmoid Neoplasms ; Ultrasonography