The patent urachus results from failure of luminal closure of the urachus. Embryologically, the urachus represents the vestigial remnant of the allantois which, in the fetus, communicates with the cloaca. The authors report a case of congenital patent urachus with review of some literatures.
Allantois ; Cloaca ; Fetus ; Phenobarbital ; Urachus*

BACKGROUND: Several automated and nonautomated systems have been developed and are commercially available for the identification of gram-negative bacilli. EASY 24E+ kit was recently developed as Korean kit for identification of gram-negative bacilli. So we evaluated the accuracy and clinical utility of EASY 24E+ compared with API 20E and VITEK GNI+. METHODS: The 221 clinical isolates of Enterobacteriaceae, including 17 C. freundii, 20 E. cloacae, 31 E. coli, 6 E. aerogenes, 29 K. pneumoniae, 3 K. oxytoca, 11 M. morganii, 13 P. mirabilis, 16 Salmonella spp., 20 S. marcescens, 9 Shigella spp., 22 S. sonnei, 16 S. typhi, 8 Y. pseudotuberculosis and 10 control strains were identified by API 20E, EASY 24E+, and VITEK GNI+. Discrepant strains were performed repeat identifications and we evaluated overall accuracy. RESULTS: All of control strains were correctly identified by three systems. The overall correct results at species level and at the genus level for 221 clinical isolates, were 96.8% and 99.1% by the VITEK GNI+, 97.7% and 97.7% by the EASY 24+ and 99.1% and 100% by the API 20E. All of Salmonella spp., S. typhi and Shigella spp. were correctly identified by all three systems and the discrepant identifications of species were 2 Y. pseudotuberculosis, 3 K. pneumoniae and 2 K. oxytoca by VITEK GNI+, 4 C. freundii and 1 P. mirabilis by EASY 24+, and 2 S. marcescens by API 20E. CONCLUSIONS: All three identification systems are accurate methods for the identification of Enterobacteriaceae, and EASY 24+ is comparable with API 20E and VITEK GNI+.
Cloaca ; Enterobacteriaceae* ; Mirabilis ; Pneumonia ; Salmonella ; Shigella

Urachal anomalies are very rare. The umbilicus and the structures which lead to its formation rarely cause trouble except in patients with an error. Embryologically, the urachus represents the vestigial remnant of the allantois which, in the fetus, communicates with the cloaca. The patent urachus results from failure of luminal closure of the urachus Herein a case of congenital patent urachus reported with a brief review of literatures.
Allantois ; Cloaca ; Fetus ; Humans ; Phenobarbital ; Umbilicus ; Urachus*

Plasmid-mediated quinolone resistance (PMQR) genes: qnr, aac(6')-Ib-cr, and qepA were investigated among 153 armA and 51 rmtB-positive transconjugants and their 204 clinical isolates of Enterobacteriaceae. Overall, qnrB4 and aac(6')-Ib-cr genes were identified in 52.3% (63 K. pneumoniae, 10 E. coli, 4 E. cloacae, and 3 E. aerogenes) and 24.8% (16 K. pneumoniae, 8 E. coli, 6 S. marcescens, 4 E. cloacae, 3 C. freundii and 1 K. oxytoca) of 153 armA-positive isolates, respectively. Four isolates of K. pneumoniae and two isolates of E. coli positive for armA co-harbored both qnrB4 and aac(6')-Ib-cr. The qepA gene was detected in 11.8% (5 E. coli and 1 K. pneumoniae) of 51 rmtB-positive clinical isolates and their transconjugants. Southern hybridization confirmed the co-localization of qepA and rmtB on a large conjugative plasmid of size between 90 to 170 kb. Inc replicon typing showed that qnrB4/6, aac(6')-Ib-cr, and qepA genes were principally disseminated by IncFIIAs, IncL/M, and IncF plasmids, respectively. This study constitutes the first report of the three known PMQR genes among the 16S rRNA methylase producing Enterobacteriaceae isolates of human origin from Korea.
Chimera ; Cloaca ; Enterobacteriaceae ; Humans ; Korea ; Methyltransferases ; Plasmids ; Pneumonia ; Replicon

Persistent cloaca in a female newborn is one of the most complex and challenging developmental malformations. The incidence is about 10% of all anorectal anomalies. Treatment of cloacal malformations has evolved during the past 40 years; however, it still remains one of the most difficult operations. In 1997, Pe a reported that a new technical variant called "Total urogenital mobilization" We also repaired cloacal anomaly using "Total urogenital mobilization" in 3 patients. The operations were performed between age 15- and 28-month. The length of the common channels was 2.5-3.0 cm. Two cases had double vaginas and one of them also had double uterus. The operation time was 4-5 hours and no major complications occurred. A satisfactory functional and cosmetic results were obtained.
Cloaca ; Female ; Humans ; Incidence ; Infant, Newborn ; Uterus ; Vagina

Diphallus is a rare congenital anomaly and is frequently associated with duplication of the urinary tract and rectosigmoid, and commonly associated with vertebral anomalies. Remzi reported less than 100 cases of duplication of all or a portion of the penis, but about 10 cases of complete diphallus with exstrophy of cloaca was reported, and a case of complete diphallus associated with hingut duplication was reported, and complete diphallus with displacement of bladder associated hindgut duplication and imperforate anus was not reported in Korea. We experienced a case of the complete diphallus associated with displacement of bladder, hindgut duplication, and imperforate anus as a variant of cloacal exstrophy. A review of published cases suggests that this may be the first example of a complete dip hall us with displacement of bladder coexisting with the hindgut duplication and imperforate anus.
Anus, Imperforate ; Cloaca ; Korea ; Male ; Penis ; Urinary Bladder ; Urinary Tract

Cloacal malformations are characterized by the confluence of the lower urinary tract, the female reproductive tract, and the rectum to create a common channel with a single opening on the perineum. The presence of a cloaca is a normal phase of early human embryological development. Between the 4^th and 7^th weeks of gestation, the cloaca undergoes subdivision to form the hindgut and urogenital sinus. Failure of this process results in the congenital anomaly termed persistent cloaca (PC). The term urorectal septum malformation sequence (URSMS) is also used to describe this anomaly. The classic description of this process which is still cited in many standard textbooks dates from the 19^th century. However, this has been increasingly called into question by the findings of studies using modern scientific methodology. Urogenital sinus anomalies are defined by the confluence of the urethra and vagina to form a common channel of varying length with a single perineal opening. In this condition, the anorectal canal opens separately on the perineum. The presence of a urogenital sinus represents a transient phase of the normal development of the lower genital tract in the female fetus. However, the form of urogenital sinus most commonly encountered in the developed world is a feature of disordered sexual differentiation and does not arise simply from the persistence of the anatomical structure which is a feature of normal fetal development.
Cloaca/embryology* ; Female ; Humans ; Urogenital Abnormalities/embryology* ; Vagina/embryology*

We report here the short-term results of 3 cases of cloacal and bladder exstrophy that underwent complete primary exstrophy repair. One case was diagnosed as bladder exstrophy and the others were diagnosed as cloacal exstrophy. Complete primary exstrophy repair for all 3 cases was carried out within 24 hours after birth. There was no wound dehiscence within the follow-up period of 12 months. The complete primary exstrophy repair with positioning the bladder neck and urethra in the deep pelvic cavity achieves a satisfactory short-term result.
Bladder Exstrophy* ; Cloaca ; Follow-Up Studies ; Neck ; Parturition ; Reconstructive Surgical Procedures ; Urethra ; Urinary Bladder* ; Wounds and Injuries

BACKGROUND: Clinical isolates of AmpC beta-lactamase- producing Enterobacteriaceae were evaluated to determine the prevalence of CTX-M extended-spectrum beta-lactamases (ESBLs) and their genetic environments. METHODS: A total of 250 non-duplicate isolates of Eneterobacter aerogenes, E. cloacae, Citrobacter freundii, Serratia marcescens and Morganella morganii were collected at a Korean hospital. ESBL production was determined by double disk synergy test. For ESBL producers, bla genes were sequenced and blaCTX-M environment was characterized by PCR mapping and sequencing. RESULTS: Among the 250 isolates 29 (11.6%) produced ESBL, and 14 of the 29 isolates produced CTX-M ESBLs, including CTX-M-9 by 8 isolates, CTX-M-3 by 4 isolates, CTX-M-12 by 1 isolate, and CTX-M-14 by 1 isolate. ISEcp1 was present upstream of blaCTX-M-3, 12, and 14. Three of the four CTX- M-3 producers had the same genetic environment (pemK-ISEcp1-blaCTX-M-3-orf477-mucA). An IS903-like element was found downstream of blaCTX-M-14. ISCR1 was identified upstream of blaCTX-M-9 and ISCR1 and blaCTX-M-9 were located on sul1-type class 1 integron. The variable region between the 5'-CS and the first 3'-CS contained dfrA16 and aadA2. Its structure was similar to that of In60, but our isolates did not have IS3000 or second 3'-CS. CONCLUSION: CXT-M type ESBL was prevalent in AmpC beta-lactamase-producing Enterobacteriaceae, particularly E. cloacae. blaCTX-M genes were associated with ISEcp1 or ISCR1. This is the first report on the genetic environment of blaCTX-M in Korean isolates.
beta-Lactamases ; Citrobacter freundii ; Cloaca ; Enterobacteriaceae ; Integrons ; Korea ; Morganella morganii ; Polymerase Chain Reaction ; Prevalence ; Serratia marcescens

PURPOSE: To investigate the distribution of bacterial keratitis isolates and the shifting trends of in vitro antibiotic susceptibility of the isolates for inpatients with bacterial keratitis. METHODS: Three hundred ninety-two bacterial isolates with 366 positive culture cases from consecutive corneal scrapes of 988 clinically diagnosed bacterial keratitis inpatients hospitalized at Yeungnam University Hospital between January 1998 and December 2009 were retrospectively reviewed. The bacteriological profiles and in vitro resistance were evaluated in the first and second six-year periods. RESULTS: The percentage of positive cultures was 37.0% (366/988). The commonly isolated Gram-positive and Gram-negative organisms were S. epidermidis (98; 25.0%) and P. aeruginosa (41; 10.5%), respectively. The ratio of Gram-positive to Gram-negative isolates was 1.24:1. The Gram-positive isolates significantly decreased compared to the Gram-negative isolates in the last six-year period (45.3% versus 54.7%, respectively) relative to those in the first six-year period (66.1% versus 33.9%, respectively). S. epidermidis and S. aureus decreased, and E. cloacae, S. marcescens, and S. maltophilia increased in the last six-year period. The resistance of fluoroquinolone to the Gram-positive isolates, though not statistically significant, tended to increase to 34.1% from 21.5% (p=0.061), and the methicillin-resistant S. aureus tended to increase to 54.2% from 30.0% (p=0.055). CONCLUSIONS: S. epidermidis and P. aeruginosa were the most common bacterial keratitis isolates in Gram-positive and Gram-negative isolates. The Gram-positive isolates tended to decrease, though the Gram-negative organisms tended to increase in the last six-year period compared to the first six-year period. Empirical antibiotic selection should be based on local susceptibility patterns and distribution of bacterial isolates.
Cloaca ; Drug Resistance, Microbial ; Humans ; Inpatients ; Keratitis ; Methicillin Resistance ; Retrospective Studies