Methicillin-resistant Staphylococcus aureus colony variants (SCVs) are frequently auxotrophic for hemin, menadione, thiamine, and CO2 involved in biosynthesis of the electron transport chain element. This phenotype grows slowly, and forms very small, nonhemolytic colonies in routine culture, so it may be led to the misidentification of this organism. We isolated an organism with catalase-positive, gram-positive cocci in cluster from the urine of a 55-years-old woman with persistent and relapsing bladder stone, who had undergone the antibiotic treatment with cefotaxime, ceftizoxime, amikacin, and/or micronomicin, intermittently for three years. The possibility of SCVs should have been ruled out because this organism didn't grow on Mueller-Hinton agar (MHA) for the susceptibility test. It formed small colonies on blood agar plate overnight, and grew only on MHA with supplement of hemin, or with 5% CO2. This organism was coagulase-positive, DNase-positive, manitol-salt positive, and identified as S. aureus with VITEK GPI card. The susceptibility test could be performed after adding hemin(1mg/mL) into bacterial suspension and showed susceptibility against vancomycin, teicoplanin, and rifampin. Because these phenotypes can be misidentifide as other non-pathogenic organisms due to their atypical characteristics, we should consider SCVs in case of small, nonhemolytic colonies with catalase-positive, gram-positive cocci in cluster, showing no growth on MHA. In addition, infections caused by SCVs are recently recognized in relation to persistent and relapsing infection, so they could be isolated from the patients with long-term antibiotic therapy.
Agar ; Amikacin ; Cefotaxime ; Ceftizoxime ; Electron Transport ; Female ; Gram-Positive Cocci ; Hemin ; Humans ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Phenotype ; Rifampin ; Teicoplanin ; Thiamine ; Urinary Bladder Calculi* ; Urinary Bladder* ; Vancomycin ; Vitamin K 3

Acute cerebral infarctions are rare in children, however, they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient's survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokineinduced vascular inflammation.
Brain ; Cerebral Infarction* ; Child ; Child, Preschool ; Decompressive Craniectomy ; Diagnosis ; Enoxaparin ; Humans ; Immunoglobulins ; Inflammation ; Levofloxacin ; Magnetic Resonance Imaging ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia, Mycoplasma* ; Stroke ; Thrombophilia ; Thrombosis ; Vasculitis

Severe irradiation on head may result functional alterations of central nervous system. In this study, the irradiation effect on the cerebellar cortex following heavy X-irradiation on head was studied ultrastructurally. Radiation was produced with the linear accelerator ML-4MV[Mitshubishi Co.], and rats weighing about 200gm each were exposed their heads within the radiation areas of 30cm x 30cm, under the radiation distance of 80cm, and with the radiation depth of 1.2 cm. Radiation doses were 3,000rads or 6,000rads, respectively. Animals were sacrificed on 6 hours, 2 days or 6 days following the radiation. Under anesthesia, animals were perfused with 1% glutaraldehyde-1% paraformaldehyde solution. Two hours after the perfusion, brain were taken out and refixed over night in the perfusion fixative. Small blocks of cerebellar hemispheric cortices were refixed 2 hours in 2% osmium tetroxide solution. Fixed tissues were dehydrated in alcohol, embedded in araldite mixture, and cut with ultratome. Ultrathin sections were contrasted with uranyl acetate and lead citrate solutions, and observed with electron microscope. The results obstained were as follow : 1. On 6th hour following X-irradiations, many cerebellar cortical neurons showed increased electron densities, more complicated nuclear infoldings, depletion of synaptic vesicles, expansion of astroglial territories, etc. 2. On 2nd day following X-irradiations, many organelle-rich cells such as Purkinje cells and Golgi cells were darkly degenerated. Numerous myelin figures formed by the cisternal fusions of Golgi apparatus or granular endoplasmic reticula were observed. Cytoplasmic processes of activated astroglial cells were expanded around capillaries and between granule cells. 3. On 6th day following X-irradiations, morphology of neuropil and neurones in the cerebellar cortex was generally restored, except the expanded territories of astroglial cells. From the above results, it was concluded that the release ofneurotransmitters and transcapillary leakage of blood substance were occurred on 6 hours after heavy X-irradiations. And severe alterations were produced on 2 day after X-irradiation, but the condition was generally restored on 6th day following X-irradiation.
Anesthesia ; Animals ; Brain ; Capillaries ; Central Nervous System ; Cerebellar Cortex* ; Citric Acid ; Cytoplasm ; Golgi Apparatus ; Head ; Myelin Sheath ; Neurons ; Neuropil ; Osmium Tetroxide ; Particle Accelerators ; Perfusion ; Purkinje Cells ; Radiation Effects* ; Rats* ; Synaptic Vesicles

Acute subdural hematoma (ASDH) induced by a bridging vein (BV) rupture is considered a catastrophic head injury, especially in the elderly. Epidemiological studies have shown a much higher incidence rate of BV-induced ASDH in the elderly compared to younger adults, along with elevated morbidity and mortality, and poor outcomes. Brain atrophy can be a risk factor contributing to the increased risk of ASDH in elderly trauma patients. Considering this, prophylactic ligation of the impending breakage in the BV may reduce the risk of rebleeding and treat the ASDH. Here, we report a relevant case.

PURPOSE: Recurrent abdominal pain syndrome (RAPS) is not uncommon in school-aged children, but the etiology and pathogenesis are not understood well. But recent studies suggest that motility disorder makes up a majority of the pathogenesis. The aim of this study was to investigate gastric emptying time (GET) which is a method to evaluate gastrointestinal motility in patients with recurrent abdominal pain syndrome. METHODS: Radionuclide GET was investigated in 34 patients who visited the Department of Pediatrics, Pusan National University Hospital due to recurrent abdominal pain from January 1996 to June 1997. After 8 hours of fasting, the patient received two pieces of toast and a fried egg tagged with 2 mci of 99mTc albumin colloid and sequential counting was accomplished. We calculated the geometric mean of two counts measured from AP-PA scans and investigated 60 minutes of intragastric radionuclide retention rate. RESULTS: A total of 34 patients (12 boys, 22 girls, M : F=1 : 1.8) participated in this study. The age ranged from 5 to 12 years and the mean age was 8.8 years. Associated symptoms were headache (7 patients), nausea (7 patients), constipation (2 patients), vomiting (1 patient), and diarrhea (1 patient). Anti-Helicobacter pylori IgG Ab was positive in 4 cases. Endoscopic gastritis was found in 6 cases. The mean of 60 minutes of intragastric radionuclide retention rate was 72 +/- 17% and 27 cases (79%) were delayed significantly. CONCLUSION: The results of our study suggest that delayed gastric emptying time is a cause of abdominal pain in patients with recurrent abdominal pain syndrome.
Abdominal Pain* ; Busan ; Child ; Colloids ; Constipation ; Diarrhea ; Fasting ; Female ; Gastric Emptying* ; Gastritis ; Gastrointestinal Motility ; Headache ; Humans ; Immunoglobulin G ; Nausea ; Ovum ; Pediatrics ; Vomiting

No abstract available.
Follow-Up Studies* ; Hydronephrosis*

BACKGROUND: Morphine for the intravenous patient controlled analgesia (IV-PCA) provides effective postoperative pain control, but it has side effects such as itching, nausea and vomiting. Meanwhile, butorphanol, a synthetic potent agonist-antagonist narcotic with low incidence of adverse side effects and minimal addiction, produce adequate analgesia for postoperative pain. The purpose of this study was to compare the suitability of butorphanol combining with or without morphine with that of morphine in terms of relieving postoperative pain and incidence of side effects. METHODS: Sixty ASA physical status I or II female patients undergoing total abdominal hysterectomy were randomly allocated into one of three groups according to type of drug used (n=20 for each group). The groups were divided to group M (morphine 100 mg), group M B (morphine 50 mg+butorphanol 10 mg) and group B (butorphanol 20 mg). Drugs for each group mixed with 90 ml of normal saline (total amount: 100 ml) for infusion. Loading dose, PCA dose, lockout interval, mode of infusion was 0.05 ml/kg, 0.02 ml/kg, 8 minute, and PCA only, respectively. In each group, visual analog scale (VAS), pain score, sedation score, degree of satisfaction, total amount of drug used, history of attempt/injetion and incidence of side effects were checked. RESULTS: There were no significant differences in analgesic effects and degree of satisfaction among three groups, but incidence of side effects (especially pruritis) were less in group M+B and B compared with group M (p<0.05). CONCLUSIONS: Butorphanol showed comparable postoperative pain relief and marked less side effects compared with morphine. Butorphanol was considered as a useful drug for postoperative pain relief using IV-PCA.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics ; Butorphanol* ; Female ; Humans ; Hysterectomy ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Pruritus ; Visual Analog Scale ; Vomiting

To evaluate the differences between current and past surgical treatment of intussusception, the medical records of 48 intussusception patients who underwent surgical treatment over 4 years (1975-1978, Group A) were reviewed and compared to the medical records of 75 intussusception patients who underwent surgical treatment over 4 years (1995-1998, Group B). Sex ratio is male predominant in both group (2.7:1 vs 1.6:1) and mean age of operation is 6.7+/-5.0 month (Group A) and 8.1+/-7.0 month (Group B). Major symptoms and signs of both groups are vomiting, hematochezia and irritability. White blood cell count of peripheral blood in both groups had no significant difference (12,417+/-4,446/mm3 vs 12,297+/-4,531/mm3). In operation methods, group A had significantly higher bowel resection rate over group B (31.3% vs 14.7%, p<0.05). In group A, 2 patients were died after operation, but group B have no operative mortality. Admission period after operation is significantly short in Group B (7.5+/-2.7 day vs 5.4+/-2.1 day, p<0.01). These results suggest there were no significant difference in characters of patients between Group A and B. But surgical treatment of intussusception in 1990s was more conservative than that in 1970s. We expect that recent surgical treatment lead early recovery from operation and early discharge from hospital.
Gastrointestinal Hemorrhage ; Humans ; Intussusception* ; Leukocyte Count ; Male ; Medical Records ; Mortality ; Sex Ratio ; Vomiting

PURPOSE: We compared estimates of ejection fraction (EF) determined by gated Tl-201 perfusion SPECT (g-TI-SPECT) with those by gated blood pool (GBP) scan. MATERIALS AND METHODS: Eighteen subjects underwent g-TI-SPECT and GBP scan. After reconstruction of g-TI-SPECT, we measured EF with Cedars software. The comparison of the EF with g-TI-SPECT and GHP scan was assessed by correlation analysis and Bland Altman plot. RESULTS: The estimates of EF were significantly different (p<0.05) with g-TI-SPECT (40%+/-14%) and GBP scan (43%+/-14%). There was an excellent correlation of EF between e-TI-SPECT and GBP scan (r=0.94, p<0.001). The mean difference of EF between GRP scan and g-TI- SPECT was +3.2%, Ninety-five percent limits of agreement were +9,8%. EF between g-TI-SPECT and GBP scan were in poor agreement. CONCLUSION: The estimates of EF by g-TI-SPECT was well correlated with those by GBP scan. However, EF of g-TI-SPECT doesn't agree with EF of GBP scan. EF of g-TI-SPECT cant be used interchangeably with EF of GBP scan.
Perfusion* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: We evaluate the clinical results of conservative treatment in patients with acute anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS: From January 2010 to May 2013, 49 patients with acute ACL injury who received conservative treatment were selected as subjects. All ruptures were diagnosed by magnetic resonance imaging (MRI). Sixteen patients had partial ruptures and 33 patients had complete ruptures. The average age was 37.6 years; males were 39, and females were 10. Conservative treatment included a long leg cast for 6 weeks and isotonic exercise for quadriceps and hamstring. Knee joint instability was evaluated with the side-to-side difference using the Telos device. Tegner activity score, International Knee Documentation Committee (IKDC) subjective score, and range of motion in the joint were assessed in all patients. RESULTS: In the final follow-up, the mean value of the Tegner activity score was 6.30 points (3-8 points), and the mean value of the IKDC score was 84.7 points (51.7-97.7 points). The mean value of side-to-side difference using the Telos device was 2.74 points (0.51-7.46 points). CONCLUSION: Our study suggests that acute ACL injury diagnosed by MRI can be treated conservatively in appropriate patients, with favorable results.
Anterior Cruciate Ligament* ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Knee Joint ; Leg ; Magnetic Resonance Imaging ; Male ; Range of Motion, Articular ; Rupture