Nocardiosis is an uncommon, potentially life-threatening infectious disease caused by several species of the genus Nocardia, which are Gram-positive branched bacilli. Most infections enter through the respiratory tract and then disseminate systemically but rarely has a primary infection occurred resulting from direct inoculation. Isolation of Nocardia from clinical specimens and identification of species is difficult and require a specialized microbiologist. We report a case of primary cutaneous nocardiosis caused by N. brasiliensis in a 68-year-old man who was diagnosed by bacterial culture and 16S ribosomal RNA sequencing. The skin lesions improved with trimethoprim- sulfamethoxazole antibiotic therapy for 6 months.
Aged ; Communicable Diseases ; Humans ; Nocardia ; Nocardia Infections ; Respiratory System ; RNA, Ribosomal, 16S ; Skin ; Sulfamethoxazole

Syphilid has been called the "great imitator" of skin disease, and it can have protean clinical manifestations and it may present with unusual lesions. Annular syphilid, which can mimic sarcoid, granuloma annulare, Sweet syndrome or tinea corporis, is a rare variant of syphilid. We report here on a case of annular syphilid that mimicked tinea corporis in a 29-year-old female who showed a three month history of multiple, pruritic, well-demarcated annular scaly erythematous patches with central clearing and an elevated border on the trunk and both upper extremities. Direct mycological examination and culture did not result in finding any fungal elements, and annular syphilid was confirmed according to the histopathologic and serologic findings. She and her boyfriend were treated with benzathine penicillin G, and the skin lesions disappeared completely.
Adult ; Ethylenediamines ; Female ; Granuloma Annulare ; Humans ; Hydrazines ; Penicillin G Benzathine ; Skin ; Skin Diseases ; Sweet Syndrome ; Syphilis, Cutaneous ; Tinea ; Upper Extremity

BACKGROUND: The pericytes in the blood vessel wall have recently been identified to be important in regulating vascular formation, stabilization, remodeling, and function. We isolated and identified pericyte-like platelet-derived growth factor receptor beta-positive (PDGFRβ+) cells from the stromal vascular fraction (SVF) of adipose tissue from critical limb ischemia (CLI) patients and investigated their potential as a reliable source of stem cells for cell-based therapy. METHODS: De-identified subcutaneous fat tissues were harvested after amputation in CLI patients. Freshly isolated SVF cells and culture-expanded adipose-derived stem cells (ADSCs) were quantified using flow cytometry. A matrigel tube formation assay and multi-lineage differentiation were performed to assess pericytic and mesenchymal stem cell (MSC)-like characteristics of PDGFRβ+ ADSCs. RESULTS: PDGFRβ+ cells were located in the pericytic area of various sizes of blood vessels and coexpressed mesenchymal stem cell markers. PDGFRβ+ cells in freshly isolated SVF cells expressed a higher level of stem cell markers (CD34 and CXCR4) and mesenchymal markers (CD13, CD44, CD54, and CD90) than PDGFRβ– cells. In vitro expansion of PDGFRβ+ cells resulted in enrichment of the perivascular mesenchymal stem-like (PDGFRβ+/CD90+/CD45–/CD31–) cell fractions. The Matrigel tube formation assay revealed that PDGFRβ+ cells were located in the peritubular area. CONCLUSIONS: PDGFRβ+ ADSCs cells demonstrated a good multilineage differentiation potential. Pericyte-like PDGFRβ+ cells from the SVF of adipose tissue from CLI patients had MSC-like characteristics and could be amplified by in vitro culture with preservation of their cell characteristics. We believe PDGFRβ+ cells in the SVF of adipose tissue can be used as a reliable source of stem cells even in CLI patients.
Adipose Tissue ; Adipose Tissue, White* ; Adult Stem Cells ; Amputation ; Blood Vessels ; Extremities* ; Flow Cytometry ; Humans ; In Vitro Techniques ; Ischemia* ; Mesenchymal Stromal Cells ; Pericytes ; Platelet-Derived Growth Factor* ; Receptors, Platelet-Derived Growth Factor ; Stem Cells ; Subcutaneous Fat

Mycobacterium (M.) fortuitum is a rapidly growing mycobacterium. It is classified as Runyon's group IV with M. abcessus and M. chelonae that are mostly found in water and soil. M. fortuitum infection usually occurs after trauma, surgery or procedures such as acupuncture that cause cutaneous or soft tissue manifestations. We report a case of cutaneous infection due to M. fortuitum in a 72-year-old woman with erythematous deep-seated nodules on her left hand. She inflicted a minor injury to her left hand in a farm. Culture from skin biopsy specimens on 3% Ogawa medium yielded bacterial colonies after 5 days. The microorganism was subsequently identified as M. fortuitum by PCR-restriction fragment length polymorphism analysis. The skin lesions were improved by antibiotic therapy with clarithromycin for 6 months.
Acupuncture ; Aged ; Biopsy ; Clarithromycin ; Female ; Hand ; Humans ; Mycobacterium ; Mycobacterium fortuitum ; Skin ; Soil

BACKGROUND: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. METHODS: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. RESULTS: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. CONCLUSION: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.
Confounding Factors (Epidemiology) ; Diagnosis ; Diagnosis-Related Groups ; Humans ; Inpatients ; Korea

BACKGROUND: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. METHODS: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. RESULTS: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. CONCLUSION: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.
Confounding Factors (Epidemiology) ; Diagnosis ; Diagnosis-Related Groups ; Humans ; Inpatients ; Korea

Merkel cell carcinoma is a rare aggressive primary skin cancer which mostly occurs in the elderly on sun-exposed skin. It usually presents as a solitary dome-shaped red or purple nodule on the head, neck and extremities. The mortality rate is higher than the rate for malignant melanoma because its local recurrence is common. Agent Orange, an herbicide widely used as a defoliant in the Vietnam War, contains dioxin contaminants and can cause several dermatoses and skin cancers. We report a case of multiple Merkel cell carcinoma in a 65-year-old male with lesions on the head and neck, who had been exposed to Agent Orange during Vietnam War.
2,4,5-Trichlorophenoxyacetic Acid ; 2,4-Dichlorophenoxyacetic Acid ; Aged ; Carcinoma, Merkel Cell ; Citrus sinensis ; Extremities ; Head ; Humans ; Male ; Melanoma ; Neck ; Recurrence ; Skin ; Skin Diseases ; Skin Neoplasms ; Tetrachlorodibenzodioxin ; Veterans ; Vietnam

Estrogen replacement therapy is known to reduce the incidence of cardiovascular disease and osteoporosis in postmenopausal women. Estrogen has beneficial effect on bone density and adding progesterone to estrogen is known to have synergistic effect. However, the effect of progesterone on bone mineral density had not been precisely evaluated in Korean postmenopausal women. To evaluate the impacts of progesterone on bone mineral density during estrogen replacement therapy, we conducted the randomized 2-year trials of conjugated equine estrogen (Premarin(R) 0.625 mg/day) with or without cyclic progesterone(medroxyprogesterone acetate : MPA 10 mg/day for 12 days) in 105 postmenopausal women. Bone mineral density was measured in the lumbar vertebrae(L2-L4) using dual energy X-ray absorptiometry(DEXA) at the beginning of the treatment, 6 onths, 12 months and 24 months later, respectively. In Premarin only group, bone mineral density at 6 months and 12 months after treatment did not show significant difference from baseline value. But bone mineral density on 24 months after treatment showed significantly increased value(p value<0.05) than that of initial. In Premarin plus MPA group, bone mineral density at 12 months and 24 months after treatment showed significantly increased than baseline(p value<0.05). And compared with Premarin only group, Premarin plus MPA group showed significant increase in spinal bone density after 2 years treatment(p value<0.05). These results suggest that the addition of MPA in estrogen replacement therapy appears to increase in bone mineral density more than unopposed estrogen. Thus combination of estrogen and progesterone appeared to be effective long-term prophylactic treatment regimen upon postmenopausal bone loss.
Bone Density* ; Cardiovascular Diseases ; Estrogen Replacement Therapy* ; Estrogens* ; Estrogens, Conjugated (USP) ; Female ; Humans ; Incidence ; Osteoporosis ; Osteoporosis, Postmenopausal ; Progesterone*

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) has long been recognized as a random phenomenon. Recent studies, however, suggest that activation sequence during atrial fibrillation is not entirely disorganized and organized activations as the transitional rhythm exists in the process of conversion from atrial fibrillation to atrial flutter. The purpose of this study is to characterize the process and significance of transitional rhythm during conversion of atrial fibrillation to atrial flutter. MATERIALS AND METHODS: In 9 patients with paroxysmal atrial fibrillation, 13 episodes that atrial fibrillation spontaneously converted to atrial flutter during electrophysiological study were analyzed. To map the right atrium (RA), 10 bipolar Halo catheter was positioned in the lateral free wall of the RA and multielectrode catheters were positioned in the coronary sinus, high RA, and His bundle area, respectively. Calculation of cycle length (CL) was performed with digital caliper during atrial fibrillation and atrial flutter. Direction of activation sequences was compared between transitional rhythm and following atrial flutter. RESULTS: During conversion of atrial fibrillation to atrial flutter, characteristic findings were observed as follows. 1) There was a gradual increase in atrial fibrillation cycle length before transitional rhythm. 2) A pause appeared in atrial fibrillation immediately prior to transitional rhythm, and between transitional rhythm and following atrial flutter. 3) Direction of activation sequences of the transitional rhythm to atrial flutter was concordant in 9 episodes and discordant in 4 episodes. 4) Spontaneous termination of atrial flutter (n=3) was also preceded by organized rhythm showing different sequence of activations from those of atrial flutter. CONCLUSION: A stereotypical pattern of activation sequence exists in the process of conversion of atrial fibrillation to atrial flutter. The occurrence of transitional rhythm influences the activation sequence of atrial flutter. Spontaneous termination of atrial flutter also preceded by transiently changing pattern of activation.
Atrial Fibrillation* ; Atrial Flutter* ; Bundle of His ; Catheters ; Coronary Sinus ; Heart Atria ; Humans

BACKGROUND AND PURPOSE: Left ventricular hypertrophy (LVH) is a well known cardiovascular risk factor, independent of hypertension, even in the absence of epicardial coronary artery disease. Possible mechanisms have been proposed, including increased LV mass, reduced coronary flow reserve (CFR) and diastolic filling abnormalities. However, the relations among LV hypertrophy, diastolic function, hypertension and coronary flow reserve (CFR) in patients with chest pain and normal coronary angiograms have not been well defined. SUBJECTS AND METHOD: Twenty-six patients with chest pain and normal coronary angiograms were included. LV mass, isovolumic relaxation time (IVRT), deceleration time (DT) and E/A ratio were assessed by 2-D echo-cardiography. Coronary blood flow velocity before and after intracoronary adenosine were measured using intracoronary Doppler wire (FIoWire). CFR was defined as ratio of peak flow velocity after adenosine to baseline flow velocity. Subjects were devided into 4 groups according to presence of LVH and hypertension and the parameters were compared among groups. RESULTS: FR was lower (p<0.01) in the groups with either hypertension or LVH or both than in the groups without them. The decrement in CFR was not linearly related to the degree of LVH (r=0.31, p=0.135). Although there were modest increment in IVRT and DT and decrement in E/A ratio in the groups with hypertension or LVH or both, there was no statistical significance. CONCLUSION: These findings suggest that the underlying mechanism of impaired CFR in patients with LVH or hypertension may be the consequence of primary coronary microvascular lesion rather than the process of left ventricular hypertrophy.
Adenosine ; Blood Flow Velocity ; Chest Pain* ; Coronary Artery Disease ; Deceleration ; Humans ; Hypertension ; Hypertrophy ; Hypertrophy, Left Ventricular ; Relaxation ; Risk Factors ; Thorax*