We report a case of Mycobacterium(M.) fortuitum infection in a 65-year-old female who presented with erythematous to purplish colored tender nodules and plaques with curst and purulent discharge on both upper and lower extremities along the sites of acupuncture. The culture of surgically excised specimen in 3% Ogawa media yielded slightly yellowish colored colonies within 2 days. Several tests for identification of the species were performed and growth on 5% NaCl, negative niacin test, positive results in nitrate reduction, catalase, urease and iron uptake tests were noted. Excision of the lesions followed by administration of minocycline and ciprofloxacin showed no sign of relapse to data a year after treatment.
Acupuncture* ; Aged ; Catalase ; Ciprofloxacin ; Female ; Humans ; Iron ; Lower Extremity ; Minocycline ; Mycobacterium fortuitum* ; Mycobacterium* ; Niacin ; Recurrence ; Urease

PURPOSE: Delayed neuropsychiatric sequelae (DNS), which are thought to arise from delayed post-hypoxic leukoencephalopathy, commonly occur after recovery from acute carbon monoxide (CO) poisoning. This study was conducted in order to determine the prognostic factors for DNS in patients with CO poisoning. METHODS: This prospective study included 200 patients with CO poisoning from January 2009 to December 2013. We compared clinical variables between patients with (n=52) and without DNS (n=148). DNS was considered present when the patient had clinical symptoms and signs of DNS within six weeks after exposure to CO poisoning. RESULTS: DNS occurred at a rate of 26.0%. In univariate analysis, the prognostic factors for DNS were loss of consciousness, duration of unconsciousness, Glasgow coma scale, peripheral neuropathy, hypotension, elevated cardiac enzyme at admission, and magnetic resonance imaging (MRI) findings at admission (p<0.05), however, in multivariate analysis, the only independent prognostic factor for DNS was initial MRI findings (OR=16.977, 95% CI=3.051-94,476). Abnormal MRI findings showed significant association with DNS in both the normobaric oxygen therapy and hyperbaric oxygen therapy groups. In patients with normal MRI findings, peripheral neuropathy could predict DNS. Among MRI abnormalities, lesions in the deep white matter (OR=24.719, p=0.000) and globus pallidus (OR=7.062, p=0.001) showed significant association with DNS. Patients with DNS had good prognosis (activity of daily living of grade 1 and 2) of 86.5% and mortality of 5.8% after six months. CONCLUSION: Initial MRI finding can be used in predicting late sequelae in patients with CO poisoning.
Carbon Monoxide ; Carbon Monoxide Poisoning* ; Glasgow Coma Scale ; Globus Pallidus ; Humans ; Hyperbaric Oxygenation ; Hypotension ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Mortality ; Multivariate Analysis ; Oxygen ; Peripheral Nervous System Diseases ; Poisoning ; Prognosis ; Prospective Studies ; Unconsciousness

No abstract available.
Aging* ; Erythrocytes* ; Humans ; Lipid Peroxidation*

BACKGROUND: The circadian rhythm of circulating melatonin is regulated by the endogenous oscillators, the suprachi-asmatic nuclei, and entrained by the light-dark cycle of the environment, but it seems that the rhythm can be affected by variable lesions outside the retina-pineal pathway. We intended to know how acute cerebral infarction affects on the cir-cadian rhythm of plasma melatonin secretion. METHODS: Plasma melatonin level was measured from 64 patients with acute cerebral infarction. On admission, blood samples were collected by venipuncture at 2AM, 4AM, 10AM, and 2PM and melatonin level was measured by radioimmunoassay. The state of consciousness of each patient was assessed clini-cally and the infarction site and size were evaluated clinically and radiographically. RESULTS: Among 64 patients with acute cerebral infarction, dramatic blunting or obliteration of nocturnal melatonin surge in the blood was found in 29 patients. The circadian rhythm of melatonin secretion was absent in 12 of 35 alert patients, in 10 of 20 drowsy patients, and in 5 of 7 stuporous patients. Melatonin secretion into plasma was markedly decreased in all 2 comatose patients. Of 14 patients with brainstem lesions, 8 patients showed decreased melatonin levels with the absence of a nocturnal rise, although most of them were alert. CONCLUSIONS: This study suggests that brainstem and the initial mental state might contribute to the regulation of the circadian rhythm of plasma melatonin even though the lesion does not involve the retina-pineal pathway, but further extensive study is required to elucidate it. (J Korean Neurol Assoc 19(4):359~363, 2001)
Biological Clocks ; Brain Stem ; Cerebral Infarction* ; Circadian Rhythm* ; Coma ; Consciousness ; Humans ; Infarction ; Melatonin* ; Phlebotomy ; Photoperiod ; Pineal Gland ; Plasma ; Radioimmunoassay ; Stupor

The association between non-islet cell tumors and fasting hypoglycemia has been recognized since 1929. The humoral mediator of this non-islet cell tumor hypoglycemia(NICTH) is now known as IGF-II. Hypoglycemia develops commonly in the course of hepatocellular carcinoma(HCC), mostly late in the course and usually mild to moderate in severity. Rarely, severe hypoglycemia occurs early in the course of HCC, suggesting NICTH. We report a case of HCC in which hypoglycemic coma due to NICTH was the presenting symptom.A 52-year-old man developed mental confusion and seizures in the early morning. At emergency room, he was found to have severe hypoglycemia. Circulating levels of insulin, C-peptide, insulinlike growth factor-I(IGF-I) and growth hormone were reduced during hypoglycemia. Diagnostic work-up revealed that he had unresectable HCC. During admission, infusion of more than 400g of dextrose per day in addition to meals was required to prevent hypoglycemia. Because the chemotherapy was refused, he was transferred to a local hospital to receive infusions of dextrose.
Adenoma, Islet Cell ; C-Peptide ; Coma ; Drug Therapy ; Emergency Service, Hospital ; Glucose ; Growth Hormone ; Humans ; Hypoglycemia ; Insulin ; Insulin-Like Growth Factor II ; Islets of Langerhans ; Meals ; Middle Aged ; Seizures

The authors reviewed the radiographs and medical records of 134 consecutive patients who underwent chemonucleolysis and automated percutaneous lumbar discectomy(APLD) between March 1990 and December 1994 at our institute. Among the 34 consecutive patients, 90 patients underwent chemonucleolysis and the other remaining patients underwent APLD using a nucleotome. The results are summarized as follows: 1) In both groups, predominent patients were of young age and males. 2) The most common lesion was in L4-5 interspace in both groups 3) The posteior lateral type showed high incidence in APLD group. 4) The results were better in the younger age group and when spinal CT demonstrated posterior lateral type in both groups. 5) The results showed relatively good success rate of 84.4% in chemonucleolysis group and 88.6% in APLD group. 6) Better results can be anticipated when patients are carefully selected and operated on with a higher skillful technique.
Diskectomy* ; Humans ; Incidence ; Intervertebral Disc Chemolysis ; Male ; Medical Records ; Spine*

BACKGROUND: The average duration of diabetes and predictive factors of macrovascular complications in Korean diabetic patients remain to be elucidated. This study examines the average duration of diabetes up to the onset of macrovascular complications and clinically important factors of early development of these complications in Korean type 2 diabetic patients. METHODS: Clinical characteristics in type 2 diabetics with (n = 121) and without macrovascular complications (n = 115) were analyzed. In addition, early onset (< or = 5 years, n = 54) and late onset groups (> 5 years, n = 67) were compared, as were the clinical characteristics between male and female patients in the macrovascular complications group. RESULTS: The average duration of diabetes was 8.7 +/- 7.8 years in the macrovascular complications group. Average age, systolic and diastolic blood pressures and smoking history were all higher in the macrovascular complications group than the control group. However, HbA1c levels and prevalence of microvascular complications were higher in the controls. Average age was lower in the early onset group and many more patients of that group had a smoking history. In the analysis based on sex, marcrovascular complications developed earlier in male patients. In addition, the prevalence of family history of diabetes was higher in males and 77.8% of male patients had a smoking history (female: 3.4%). CONCLUSION: Our study confirms that older age, high blood pressure and smoking history are major risk factors for the development of macrovascular complications. Moreover, a smoking history in males can be both risk and predictive factors for earlier development of macrovascular complications in Korean type 2 diabetic patients. We also found that several clinical characteristics including age, family history of diabetes, hypertension and smoking history, vary between the sexes, and these findings can provide useful indices for the prevention of macrovascular complications.
Diabetes Complications ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Hypertension ; Male ; Prevalence ; Risk Factors ; Smoke ; Smoking

Lymphoceles are the most frequent surgical complications following kidney transplantation. Symptomatic lymphoceles following kidney transplantation are managed best by surgical marsupialization with intraperitoneal drainage. We performed laparoscopic intraperitoneal drainage in a patient with a large lymphocele and secondary hydronephrosis following a kidney transplant.
Drainage* ; Humans ; Hydronephrosis ; Kidney Transplantation ; Kidney* ; Laparoscopy ; Lymphocele* ; Transplantation

BACKGROUND: Nosocomial urinary tract infection (UTI) accounts for 35% of the nosocomial infection and 80-90% of them are associated with urethral catheters. Recently, we experienced an outbreak of nosocomial UTI caused by multidrug-resistant Pseudomonas aeruginosa in neurosurgical intensive care unit (NSICU). METHODS: We investigated clinical records of the patients and observed the methods of care of urethral catheters in NSICU. Identification of P. aeruginose was done by API NE (API system; bioMerieux, France) and antibiotic susceptibility tests were done by disk diffusion method. Random Amplification of Polymorphic DNA (RAPD) assay was used as a genotyping method. RESULTS: Between November 1997 and January 1998, 11 P. aeruginosa strains were isolated from the urine of 11 patients hospitalized in NSICU of Kangnam St. Mary's Hospital. Routine regular bladder irrigation, and emptying urine with common urinal had been done falsely. Antibiogram of the isolates showed resistance to multiple antibiotics including imipenem, gentamicin. amikacin, piperacillin, ciprofloxacin, ceftazidime, and cefoperazone/sulbactam. RAPD of the outbreak strains showed clonal relatedness, which was different from those of other clinical strains, We instructed all the health care workers to stop bladder Irrigation, and to use the separate urinals for each patient. Thereafter, no further case of P. aeruginosa UTI has occurred. CONCLUSION: An outbreak of UTI, caused by a single clone of P. aeruginosa, was confirmed by RAPD and was eradicated after correction of false practice on care-of urinary catheter.
Amikacin ; Anti-Bacterial Agents ; Ceftazidime ; Ciprofloxacin ; Clone Cells ; Cross Infection ; Delivery of Health Care ; Diffusion ; DNA ; Drug Resistance, Multiple ; Gentamicins ; Humans ; Imipenem ; Intensive Care Units ; Microbial Sensitivity Tests ; Piperacillin ; Pseudomonas aeruginosa* ; Pseudomonas* ; Urinary Bladder ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

OBJECTIVE: The dissecting aneurysms of vertebral artery with various clinical manifestations have been increasingly reported with recent advent of diagnostic tools such as 3-Dimension computed tomography angiogram, magnetic resonance image and conventional angiogram. The authors analyzed the various treatment modalities according to their clinical presentations of vertebral artery dissecting aneurysms. METHODS: At the author's institution between March 2001 and February 2004, 28 patients were managed under diagnose of vertebral artery dissection. The medical record and neuroimaging studies of patients were reviewed retrospectively. RESULTS: Seven patients were presented with subarchnoid hemorrhage and 2 patients with mass effect. The other 12 patients were presented with ischemic stroke and 7 patients with headache or neck pain. 19 patients were treated with endovascular coils or stent. The other 8 patients were treated conservatively. and one patient was treated with operation. We had no endovascular treatment-related complications. Sixteen patients who underwent endovascular treatment survived with good recovery. but one patient died and 2 patients were in poor neurological status. Among patients with mass effect, one patient was treated with operation. and the other one patient with endovascular coils. We obtained optimal treatment results with improvement of myelopathy in both patients. CONCLUSION: The choice of the treatment of vertebral artery dissecting aneurysm of patients, clinical characteristics, and relation with posterior inferior cererebellar artery. The endovascular treatment using stent with/without coiling could be the treatment of choice if preservation of the vertebral artery is necessory.
Aneurysm, Dissecting* ; Arteries ; Headache ; Hemorrhage ; Humans ; Medical Records ; Neck Pain ; Neuroimaging ; Retrospective Studies ; Spinal Cord Diseases ; Stents ; Stroke ; Vertebral Artery Dissection ; Vertebral Artery*