Skin atrophy is one of the most common side effects of topical steroid use and results from decreased skin proalphaI collagen mRNA production due to specific alterations in collagen gene transcription or from reduced collagen mRNA stability. This report describes a case of a 8 year-old-girl who visited our hospital with a complaint of ambiguous genitalia. She was observed to have atrophic labia majora and atrophic striae resembling scrotal rugae. However, her serum levels of FSH, LH, 17-KS, 17-OHCS, 5-DHT, DHT and DHEA-S were all in normal range and her karyotype was 46,XX. Abdominal and pelvic ultrasonogram showed a normal uterus and ovaries. Careful history taking revealed frequent use of steroid ointment due to vulvar pruritus for 2 years and she was finally diagnosed to have atrophy of external genitalia induced by long-term use of topical steroid.
Atrophy* ; Collagen ; Disorders of Sex Development ; Female ; Genitalia* ; Karyotype ; Ovary ; Pruritus ; Reference Values ; RNA Stability ; RNA, Messenger ; Skin ; Ultrasonography ; Uterus

BACKGROUND: For the detection of transitional cell carcinoma (TCC) of the bladder, we compared the sensitivities and specificities between the ThinPrep test and Melanoma Antigen Gene (MAGE) test with voided urine (V), drained urine (D), and irrigated urine (I). METHODS: We randomly selected 10 patients of a non-cancer group and 20 patients of a cancer group. V, D, and I were obtained preoperatively, and equally divided into two parts for the ThinPrep test and MAGE reverse transcriptase polymerase chain reaction (RT-PCR). The cystoscopic finding was used as the reference standard for detection of bladder cancer. The results of ThinPrep test and MAGE RT-PCR were compared according to cancer grade and stage. RESULTS: The overall sensitivities of ThinPrep test were 45%, 85% and 85% for V, D, and I, respec-tively, while those of MAGE test were 50%, 85%, and 65%. Detection rate from drainage urine was considerably higher than that of voided urine in both methods (P<0.05). The specificities were 100% for all types of urine specimens with ThinPrep test and 100%, 90%, and 90% for V, D, and I, respectively, using MAGE test, without any statistically significant differences. CONCLUSIONS: For the detection of bladder cancer, MAGE RT-PCR and ThinPrep test showed a comparable sensitivity and specificity, and drained urine revealed the best detection rate. MAGE RT-PCR might be utilized as another marker of bladder cancer using urine specimens.
Adult ; Aged ; Aged, 80 and over ; Antigens, Neoplasm/*genetics ; Carcinoma, Transitional Cell/*diagnosis/pathology ; Cytodiagnosis/*methods ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Proteins/*genetics ; RNA, Neoplasm/urine ; Reverse Transcriptase Polymerase Chain Reaction/*methods ; Sensitivity and Specificity ; Urinalysis ; Urinary Bladder Neoplasms/*diagnosis/pathology ; Urine/*cytology

BACKGROUND: In the United States, the Centers for Disease Control and Prevention recorded a 20-fold increase in the incidence of vancomycin-resistant enterococci (VRE) associated with nosocomial infections between 1989 and 1991. Although VRE has been reported in Korea since 1992, infections caused by these organisms are still extremely rare in Pusan, Korea. Therefore, a point prevalence culture survey was carried out to investigate the prevalence of intestinal colonization with VRE among patients admitted to Kosin Medical Center, which can predict the appearance of clinical infections with VRE. METHODS: Between July 1997 and August 1997, stool specimens were obtained from 303 patients. Specimens were placed in bile esculin azide broth containing vancomycin (64 microgram/mL) and aatreonam (60 microgram/mL). Cultures were done for 48 hours at 37degrees C, and turbid solutions were subcultured on blood agar. Minimal inhibitory concentrations (MIC) of vancomycin and teicoplanin to Enterococcus isolates were determined by Etest on Mueller-Hinton agar. For amplification of the vanA, vanB, and vanC genes, polymerase chain reactions were performed. RESULTS: VRE isolates were isolated from 6 of the patients (2%). Four of them were identified as E. faecium, and 1 was identified as E. avium, and 1 was identified as Enterococcus spp. All of them were highly resistant to vancomycin (MICs >256 microgram/mL), and they were also resistant to teicoplanin (MICs 32-->256 microgram/mL). All of 6 VRE strains carried vanA gene. CONCLUSION: The colonization of VRE was not infrequent among the patients of a university hospital in Pusan, Korea. Moreover, a large proportion of the colonizing VRE was revealed Enterococcus faecium with vanA gene, which implies quite a possibility of a sudden rising of infections by this organism in the near future. So we propose that the vancomycin susceptibility test should be done for every enterococcal isolate from clinical specimens and the intestinal colonization rate of VRE should be closely monitored at regular intervals for the purpose of surveillance 50 that proper establishment of plans for the prevention of this troublesome pathogen's spread can be promptly made.
Agar ; Bile ; Busan ; Centers for Disease Control and Prevention (U.S.) ; Colon* ; Cross Infection ; Enterococcus ; Enterococcus faecium ; Esculin ; Humans ; Incidence ; Korea ; Polymerase Chain Reaction ; Prevalence ; Teicoplanin ; United States ; Vancomycin

BACKGROUND: Sevoflurane has been used to provide an inhaled induction by using a vital capacity breath, which is fast and has few side effects. We compared the clinical effects of a vital capacity inhalation induction (VCII) with sevoflurane in patients of preoxygenation or air-breathing before anesthetic induction. METHODS: After IRB approval, patients were randomly assigned to receive preoxygenation (O2 group, 70 patients) or air breathing (Air group, 70 patients) via SIBI (Single Breath Induction) connectorTM before VCII with 8% sevoflurane in 75% N2O/O2 from primed circuit. The clinical characteristics were compared between two groups in respect to prolongation of breath holding after loss of consciousness (response to verbal command) and side effects (airway, hemodynamic, motor) during VCII. RESULTS: O2 group showed lower incidence (60.0% vs. 87.1%, P < 0.05) and shorter duration (27.1 s vs. 36.4 s, P < 0.05) in prolongation of breath holding than Air group. Otherwise, there were no significant differences in clinical effects between two groups. CONCLUSIONS: We found that preoxygenation reduces the incidence and duration of prolongation of breath holding during VCII with sevoflurane compared with air-ventilation before VCII. We suggest that the prolongation of breath holding might be related to Hering-Breuer response to maximal lung inflation during VCII.
Apnea ; Breath Holding ; Ethics Committees, Research ; Hemodynamics ; Humans ; Incidence ; Inflation, Economic ; Inhalation* ; Lung ; Respiration* ; Unconsciousness ; Ventilation* ; Vital Capacity*

BACKGROUND: Vasoplegic syndrome is an increasingly recognized disease in perioperative medicine and is characterized by severe hypotension, normal or elevated cardiac output, and decreased systemic vascular resistance. It occurs commonly after cardiopulmonary bypass but may also occur after other types of surgery.CASE: Vasoplegic syndrome developed in our patient during posterior lumbar interbody fusion because of administering nicardipine after phenylephrine. However, the blood pressure did not increase as expected despite simultaneous use of norepinephrine and vasopressin to increase the reduced systemic vascular resistance.CONCLUSIONS: We present a case of vasoplegic syndrome that developed during posterior lumbar interbody fusion and was treated successfully with methylene blue.
Blood Pressure ; Cardiac Output ; Cardiopulmonary Bypass ; Humans ; Hypotension ; Methylene Blue ; Nicardipine ; Norepinephrine ; Phenylephrine ; Vascular Resistance ; Vasoplegia ; Vasopressins

Objective: The Risk-Rescue Rating Scale (RRRS) is generally implemented to predict the lethality of suicide attempts, whereas the Acute Physiology and Chronic Health Evaluation II (APACHE-II) scoring system is applied as an accurate measure of the severity of patient condition of patients admitted to intensive care units (ICUs). Using the RRRS and APACHE-II scores, in this study, we aimed to investigate the factors related to ICU admissions of deliberate self-poisoning (DSP) patients admitted to emergency departments (EDs). Methods: The epidemiologic and psychologic factors, electronic medical records, and laboratory tests of DSP patients were prospectively collected and analyzed. We divided the patients into two groups, an ICU admission group and a nonICU admission group. Results: This study included 387 patients, 333 (86.0%) of which were in the non-ICU group and 54 (14.0%) in the ICU admission group. Multivariate logistic analysis was conducted to independently associate the ICU admissions with RRRS (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.27-1.55; P<0.01), APACHE-II scores (OR, 1.11; 95% CI, 1.03- 1.21; P=0.01), and amylase values (OR, 1.01; 95% CI, 1.00-1.01; P=0.02). A receiver operating characteristics (ROC) curve analysis of the decision for admission to the ICU yielded the following scores for RRRS and APACHE II—cutoff values of 39.5 and 8.5, sensitivity of 96% and 66.0%, specificity of 74.0% and 75.1%, and area under the ROC curve (AUC) values of 0.95 and 0.74, respectively (P<0.01). Conclusion The RRRS and APACHE-II scores could be used to determine ICU admissions in DSP patients admitted to the ED.

BACKGROUND: Post-transplant infections by antibiotic-resistant bacteria (ARB) are increasing in prevalence because of the wide use of broad-spectrum antibiotics. At our center, the perioperative prophylaxis for liver transplant recipients consistes of cefoperazone/sulbactam and ampicillin. When the recipient develops signs of infection, the initial antibiotics are empirically replaced with meropenem and vancomycin. We analyzed the epidemiology of ARB to assess the appropriateness of replacing empirical antibiotics during the first month after liver transplantation. METHODS: We reviewed 88 patients who had undergone living donor liver transplant between January 2006 and September 2007. RESULTS: Two hundred and seventy-six strains of bacteria were microbiologically documented in 75 liver transplant recipients. The most common bacteria was Staphylocococcus aureus (27%), followed by coagulase-negative staphylococci (CNS, 20%), Enterococcus species (18%) and Klebsiella species (7%). Our data on the resistance pattern showed that 87.8% and 71.4% of the S. aureus and CNS were resistant to methicillin, respectively; 88% of the Enterococcus species were resistant to ampicillin and 24% to vancomycin; and 62% of all enteric gram-negative bacilli (GNB) were resistant to 3rd generation cephalosporins. No strains of meropenem-resistant GNB were detected. Only one glucose non-fermentative GNB was resistant to all antibiotics except aminoglyco sides and colistin. CONCLUSIONS: Mainly methicillin-resistant gram- positive bacterial strains, including S. aureus and CNS, can colonize in early period after transplantation. According to the epidemiologic data on the high prevalence of antibiotic-resistant organisms, the empirical treatment regimen at our center is considered as appropriate. However, shifting down to less-broad-spectrum antibiotics after the pathogens are confirmed is essential to lowering the rate of ARB.
Ampicillin ; Anti-Bacterial Agents ; Bacteria ; Cephalosporins ; Colistin ; Colon ; Enterococcus ; Glucose ; Humans ; Klebsiella ; Liver ; Liver Transplantation ; Living Donors ; Methicillin ; Methicillin Resistance ; Prevalence ; Thienamycins ; Transplants ; Vancomycin

A 50-year-old woman with incidentally detected multiple gastric polyps and biopsy-proven neuroendocrine tumor (NET) was referred to our hospital. More than 10 polypoid lesions (less than 15 mm) with normal gastric mucosa were detected from the gastric body to the fundus. The serum level of gastrin was within the normal limits. There was no evidence of atrophic changes on endoscopy and serologic marker as pepsinogen I/II ratio. Computed tomography of the abdomen and pelvis revealed no evidence of metastatic lesions. She refused surgery, and we performed endoscopic polypectomy for almost all the gastric polyps that were greater than 5 mm. Although the histological examination revealed that all the removed polys were diagnosed as NET G1, three of them extended to the lateral or vertical resection margins, while two exhibited lymphovascular invasion. A follow-up upper endoscopy that was performed 6 months after the diagnosis showed multiple remnant gastric polyps that were suggestive of remnant gastric NET.
Abdomen ; Diagnosis ; Endoscopy ; Female ; Follow-Up Studies ; Gastric Mucosa ; Gastrins ; Humans ; Middle Aged ; Neuroendocrine Tumors* ; Pelvis ; Pepsinogen A ; Polyps ; Stomach

Yersinia enterocolitica infection in adults in Korea is reported rarely. Therefore, the possibility of Yersinia infection as a cause of abdominal pain may be overlooked. Because its clinical features are similar to those of acute appendicitis or other diseases that require operations, Yersinia enterocolitis should be diagnosed before surgery. We recently experienced a case of Y. enterocolitica enterocolitis accompanied by postoperative colonic adhesion. A 39-year-old female patient with a 5-year history of asymptomatic uterine myoma underwent transabdominal hysterectomy due to abdominal pain. However, the pain worsened. On CT, diffuse swelling of the right colon and adhesion of the sigmoid colon with luminal narrowing were found. Colonoscopy showed multiple aphthous ulcers with mucosal hyperemia from the cecum to the sigmoid colon. Multiplex PCR with stool specimens, a hemagglutination test for Y. enterocolitica O:3, and tissue culture were positive for Y. enterocolitica. After fluids and antibiotic therapy, her symptoms were relieved.
Abdominal Pain ; Adult ; Appendicitis ; Cecum ; Colon ; Colon, Sigmoid ; Colonoscopy ; Enterocolitis ; Female ; Hemagglutination Tests ; Humans ; Hyperemia ; Hysterectomy ; Korea ; Multiplex Polymerase Chain Reaction ; Myoma ; Phenobarbital ; Stomatitis, Aphthous ; Yersinia ; Yersinia enterocolitica ; Yersinia Infections

BACKGROUND: An assessment of the presence and the degree of reversibility of airflow obstruction is clinically important in patients with asthma or chronic obstructive pulmonary disease. However, the time responses of spirometric parameters in response to bronchodilator have not been well investigated. METHODS: We studied 15 patients with asthma. Spirometric and mini-Wright peak expiratory flow measurements were performed at 15, 30, 45, and 60 minutes after using single dose(200 micro gram) of inhaled bronchodilator, salbutamol. RESULTS: The mean values of forced expiratory volume in one second(FEV1) and forced vital capicaty(FVC) were significantly increased at 60 minutes after using bronchodilator in comparison to 15 minutes. And peak expiratory flow rate measured by either mass flow sensor or mini-Wright peak flow meter were significantly increased at 45 minutes after using bronchodilator in comparison to 15 minutes. CONCLUSIONS: To appropriate evaluation of the bronchodilator response in patients with reversible airflow limitation, it would be useful measuring either FEV1 or PEF at the later time point 60 or 45 minutes in comparison to 15 minutes after using bronchodilator.
Albuterol* ; Asthma ; Forced Expiratory Volume ; Humans ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive