PURPOSE: Actinomycosis is still a relatively rare infection, characterized by multiple abscesses, draining sinuses and the appearance of sulfur granules, which are valuable in aiding the diagnosing the discharge of involved tissues. In most instances, the onset of an abdominal disease is preceded by inflammatory or a traumatic incident resulting in the perforation of the mucosa of the gastrointestinal tract. Intensive and prolonged antimicrobial therapy, and wide surgical excision of involved tissues are the two general principles of therapy. METHODS: We experienced 8 cases of abdominal actinomycosis after a laparotomy between March 1997 and February 2002. RESULTS: The results were as follows: 1) There was a 1: 1 male to female ratio of abdominal actinomycosis, and a mean age of 47 years. 2) The clinical features were different for each involved organ, -but, most of the clinical symptoms were nonspecific to suspect actinomycosis. 3) The frequently involved organs were mainly located lower abdomen, such as the appendix and cecum, sigmoid colon and small bowel. 4) In 60% of the patients, the predisposing factors were identifiable, these being: a previous abdominal operation, IUD and abdominal injury. 5) The preoperative diagnoses included: acute appendicitis, and periappendiceal and intra-abdominal abscesses. The pre-exploratory diagnoses were made by ultrasound and abdominal CT. 6) Explorations were performed in all patients, depending on their diagnosis, to afford the proper surgical treatment and correct diagnosis. After the operation, all the patients were treated with oral antibiotics for long period. CONCLUSION: The authors conclude that pre-exploratory cytological or culture studies, with careful history taking, for low abdominal tumors or abscesses may increase the rate of correct diagnosis, as could proper explorations.
Abdomen ; Abdominal Abscess ; Abdominal Injuries ; Abscess ; Actinomycosis* ; Anti-Bacterial Agents ; Appendicitis ; Appendix ; Causality ; Cecum ; Colon, Sigmoid ; Diagnosis ; Female ; Gastrointestinal Tract ; Humans ; Laparotomy ; Male ; Mucous Membrane ; Sulfur ; Tomography, X-Ray Computed ; Ultrasonography

A clinical and statistical study was performed on 213 neonates of hyperbilirubinemia who were admitted to department of pediatrics of Korea University Hospital from Jan. 1989 to Jun. 1991. and we studied the difference between ABO compatible group and incompatible group, such as, day of apperance of hyperbilirubinemia, tendency of bilirubin concentration change, reticulocyte, hemoglobin and duration of hyperbilirubinemia. The following results were obtained. 1) There were no difference of initial body weight and gestational age between compatible (3.0 +/- 0.72kg, 38.2 +/- 3.2 weeks) and incompatible groups (3.2 +/- 0.54kg, 39.1 +/- 2.8 weeks). 2) Onset of hyperbilirubinemia within 2 days in the incompatible group (40.5%) was earlier than the compatible group (23.5%) significantly (p<0.05). 3) Mean bilirubin level in the incompatible group was higher than the compatible group significantly (p<0.05). 4) Peak bilirubin level in the incompatible group(18.7+/-4.1mg/dl) was higher than the compatible group (14.8+/-3.4mg/dl) significantly (p<0.05). 5) There were no difference of hemoglobin level, reticulocyte count, coombs positive finding and the ratio of exchange transfusion between two groups.
Bilirubin ; Body Weight ; Gestational Age ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal* ; Infant, Newborn ; Korea ; Pediatrics ; Reticulocyte Count ; Reticulocytes ; Statistics as Topic

It is reported that patients with primary hyperparathyroidism(PHPT) have disturbances in carbohydrate metabolism: in particular, hyperinsulinemia and insulin resistance are characteristic early metabolic aberrations of this disease. However, it is not clear whether changes of insulin secretion or insulin sensitivity are observed in all patients with PHPT, including those with normal glucose tolerance. Also, it is not clear whether these changes are reversible after surgical correction of PHPT. In the present study, glucose tolerance and insulin secretion were evaluated in 2 symptomatic patients with PHPT during 100g oral glucose tolerance test before and after parathyroid adenoma removal. Comparing these patients before and after surgery, glucose tolerance was not significantly different. However, C-peptide and insulin secretion was low after surgical correction of PHPT compared to the preoperative situation. This observation suggests that insulin hypersecretion in patients with PHPT precedes glucose intolerance and this early disturbance is reversible after surgery.
C-Peptide ; Carbohydrate Metabolism ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test ; Humans ; Hyperinsulinism ; Hyperparathyroidism, Primary ; Insulin Resistance ; Insulin ; Parathyroid Neoplasms

BACKGROUND: Intraoperative fluid management should be aimed at maintaining appropriate left-sided filling pressures. The pulmonary capillary wedge pressure (PCWP) will overestimate the left ventricular end-diastolic volume (LVEDV) when ventricular compliance is markedly reduced in patients with aortic stenosis. Intraoperative transesophageal echocardiography (TEE) is useful for monitoring global left ventricular function and change of preload. This study was undertaken to evaluate preload derived by conventional invasive monitoring technique compare with preload obtained simultaneously from TEE in patients with aortic stenosis. METHODS: Fifteen patients with aortic stenosis who underwent aortic valve replacement were examined. The preload was examined by the short axis view of left ventricle with TEE at the level of the papillary muscles. For each patient, simultaneous measurements of PCWP, thermodilution cardiac output and left ventricular end-diastolic area (LVEDA) measured by TEE were made after the induction of anesthesia and after surgery. RESULTS: The correlation between echo-derived LVEDA and thermodilution cardiac index (CI) (r=0.53, p<0.05) or stroke index (SI) (r=0.56, p<0.05) was good after surgery, but the correlation was not found after induction of anesthesia. No correlation was observed between PCWP and CI or SI. CONCLUSIONS: The PCWP did not provide a reliable estimate of preload and did not allow good prediction of cardiac index. These findings demonstrate that, in patients with aortic stenosis who underwent aortic valve replacement, TEE provides a better index of left ventricular preload than conventional invasive hemodynamic monitoring particularly after surgery.
Anesthesia ; Aortic Valve ; Aortic Valve Stenosis* ; Axis, Cervical Vertebra ; Cardiac Output ; Compliance ; Echocardiography, Transesophageal* ; Heart Ventricles ; Hemodynamics* ; Humans ; Papillary Muscles ; Pulmonary Wedge Pressure ; Stroke ; Stroke Volume ; Thermodilution ; Ventricular Function, Left

Two cases of human herpesvirus-6 (HHV-6) encephalitis that occurred after allogeneic hematopoietic stem cell transplant (HSCT) are presented. Both patients reported fever, skin rashes, and neurological symptoms, characterized by disorientation, confusion and drowsy mental status. HHV-6B DNA was detected from the cerebrospinal fluid (CSF) specimens by a multiplex polymerase chain reaction (PCR) assay including EBV, CMV, HHV-6B. After treatment with intravenous gan ciclovir for 2~3 weeks, all clinical manifestations were resolved and the HHV-6B DNA was cleared from the CSF in both patients. HHV-6 should be considered as a possible cause of neurological symptoms after HSCT, and prompt antiviral treatment should be begun.
Bone Marrow Transplantation ; Cerebrospinal Fluid ; DNA ; Encephalitis ; Exanthema ; Fever ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Herpesvirus 4, Human ; Herpesvirus 6, Human ; Humans* ; Meningoencephalitis* ; Multiplex Polymerase Chain Reaction

OBJECTIVE: End-tidal partial pressure of carbon dioxide(PETCO2) is often used as an estimate of arterial partial pressure of carbon dioxide(PaCO2), with the understanding that PaCO2 usually exceeds PETCO2. During craniotomies, because hyperventilation is used to therapeutically lower intracranial pressure, the difference between arterial and end-tidal partial pressure of carbon dioxide(P(a-ET)CO2) has therapeutic implications. To determine how much information concerning neurosurgical operation and clinical outcome is provided by the PETCO2, PaCO2 and P(a-ET)CO2 during surgery, we evaluated 81 patients who had neurosurgical operation. METHODS: There were 51 males and 30 females with a mean age of 50.3 years(range 7-85 years). After the induction of general anesthesia, body temperature was maintained in a normothermia, endtidal CO2 was maintained 28-34mmHg and the systolic blood pressure was kept 90-120mmHg. ETCO2, PaCO2 and regional cortical blood flow(rCoBF) were checked at the time of dura closure. Neurologic outcome was evaluated at 8 hours after operation to rule out other factors which may influence on the patient's long-term outcome. Data were collected and compared by student's t-test or chi-square analysis. RESULTS: The PaCO2 was 34.6+/-5.2mmHg(range, 24.9-54.8), PETCO2 was 29.9+/-4.1mmHg(range, 20.0-45.0) and P(a-ET)CO2 was 4.7+/-3.5mmHg(range, -1.1-18.6). The correlation between the PaCO2 and PETCO2 was statistically significant(PETCO2=13.3-0.57xPaCO2). But there was no correlation of rCoBF with PaCO2 and ETCO2. P(a-ET)CO2 values less than 8mmHg were correlated well with good neurologic outcome compared with higher P(a-ET)CO2 patients. PaCO2, rCoBF, mean arterial blood pressure, arterial pH and initial Glasgow coma scale showed statistically significant correlation with neurologic outcome(p<0.05). CONCLUSION: Based on our study, P(a-ET)CO2 value could be used as a good prognostic factor during the neurosurgical operation and anesthesiologist should be tried to decrease this value. And in patients who has a intact brain autoregulation, rCoBF was not influenced by PaCO2 and ETCO2, entirely.
Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Body Temperature ; Brain ; Carbon Dioxide* ; Carbon* ; Craniotomy ; Female ; Glasgow Coma Scale ; Homeostasis ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation ; Intracranial Pressure ; Male ; Partial Pressure*

BACKGROUND: Patients undergoing cardiac surgery employing cardiopulmonary bypass frequently require transfusion of homologous blood products and, therefore, are exposed to the risk of transfusions. A administration of autologous platelet-rich plasma may reduce homologous transfusion and attendant risks. This study was designed to investigate the effect of preoperative collection of platelet-rich plasma on the requirement of homologous transfusion and postoperative blood loss in patients undergoing open heart surgery. METHODS: Twenty seven patients undergoing cardiac surgery were divided into control group(n=11) and autologous platelet-rich plasmaphereris(PRP) group(n=16). Autologous platelet-rich plasma was retransfused after offbypass. Hematocrit, platelet count, PT(prothrombin time), PTT(partial thromboplastin time), postoperative blood loss and transfusion requirement were measured. RESULTS: There was no statistical significance between control and PRP group in homologous transfusion and postoperative blood loss. There was no difference in hemoatocrit, platelet count, PT or PTT on immediate post surgery or on day 1. CONCLUSIONS: Autologous platelet-rich plasma did not reduce postoperative blood loss or transfusion reguirements in cardiac surgery.
Cardiopulmonary Bypass ; Hematocrit ; Humans ; Platelet Count ; Platelet-Rich Plasma* ; Postoperative Hemorrhage* ; Thoracic Surgery* ; Thromboplastin

BACKGROUND: Amphotericin B dexoycholate is currently the standard empirical antifungal therapy for neutropenic patients with hematologic malignancies and who also have persistent fever that does not respond to antibacterial therapy. The antifungal triazoles offer a potentially safer and effective treatment alternative to Amphotericin B dexoycholate. METHODS: We assessed the efficacy and safety of intravenous itraconazole, as compared with the efficacy and safety of amphotericin B deoxycholate, as an empirical antifungal therapeutic agent in a matched case-control clinical trial from June 2004 to August 2005. RESULTS: Efficacy was evaluated in 96 patients (48 received itraconazole and 48 received amphotericin B deoxycholate) and all the patients who received the study drugs were evaluated for safety. The baseline demographic characteristics were well matched. The overall success rates were 47.9% for itraconazole and 43.8% for amphotericin B deoxycholate (% difference: 4.1 % [95% confidence interval for the difference: -15.8 to 24]), which fulfilled the statistical criteria for the non-inferiority of itraconazole. The proportions of patients who survived for at least seven days after discontinuation of therapy or who were prematurely discontinued from the study were not significantly different between the two groups. The rates of breakthrough fungal infections and resolution of fever during neutropenia were similar in both groups. More patients who received amphotericin B deoxycholate developed nephrotoxicity, hypokalemia or infusion-related events than did those patients who received itraconazole (nephrotoxicity: 16.7% vs. 1.8%, hypokalemia: 66.7% vs. 24.6%, and infusion-related events: 41.7% vs. 3.5%, respectively). CONCLUSIONS: Intravenous itraconazole is as effective as amphotericin B deoxycholate and it is generally better tolerated than amphotericin B deoxycholate when it is given as empirical antifungal therapy for Korean patients with persistent neutropenic fever.
Neutropenia/drug therapy/*physiopathology ; Male ; Itraconazole/*administration & dosage/therapeutic use ; Infusions, Intravenous ; Humans ; Hematologic Neoplasms/*drug therapy/physiopathology ; Fever/drug therapy/*physiopathology ; Female ; Chronic Disease ; Case-Control Studies ; Antifungal Agents/*administration & dosage/therapeutic use ; Amphotericin B/*administration & dosage/therapeutic use ; Adult

BACKGROUND: Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) are major pathogens in community and hospital. And they sometimes cause the outbreak in hospital in the immunocompromised patients. Pulsed-field gel electrophoresis (PFGE) has been regarded as a standard method for genotyping in epidemiologic studies, but it is laborious and time-consuming. Infrequent restriction site-polymerase chain reaction (IRS-PCR), a new genotyping methods, was performed to compare the applicability with PFGE. METHODS: We performed PFGE and IRS-PCR on S. aurues (n=120) and E. coli (n=117) which were collected clinically in 4 different hospitals. We assessed each method in terms of discriminatory power, quality, and efficiency. RESULTS: In E. coli, the discriminatory power of IRS-PCR was 46.7apprx86.7%, and that of PFGE was 88.9apprx96.7% according to hospital. But in S. aurues, the discriminatory power of IRS-PCR was 20apprx56.7%, and that of PFGE was 40apprx90% according to hospital. The typicality and reproducibility of IRS-PCR were 100% of each. PFGE needed four days to complete the procedure, but IRS-PCR could be performed within one day, IRS-PCR showed better resolution than PFGE. CONCLUSION: In case of gram negative bacteria (like E. coli), IRS-PCR could be a reliable alternative for epidemiologic typing due to better efficiency and comparable discriminatory power. But in the case of gram positive bacteria (like S. aureus), IRS-PCR does not seem to be suitable for the strain-to-strain differentiation. More trials and changes of restriction enzymes or primers could reveal the efficacy of IRS-PCR in the field of molecular typing.
Electrophoresis, Gel, Pulsed-Field* ; Escherichia coli* ; Escherichia* ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Immunocompromised Host ; Molecular Typing* ; Staphylococcus aureus* ; Staphylococcus*

BACKGROUND: Insulin resistance has been identified as one of the risk factor of atherosclerosis. Hypertension, obesity, glucose intolerance and dyslipidemia could induce atherosclerosis through mechanism of insulin resistance. And there are some reports that hyperinsulinemia itself could induce coronary artery disease(CAD). Then we planed to investigate relationship between CAD and insulin resistance. And smoking is also known as one major risk factor of CAD. So we also investigated the relationship between smoking and insulin resistance in the CAD patients. METHODS: Among 36 subjects in whom coronary angiography was done, we grouped 25 subjects who had stenotic coronary artery as a CAD group and 11 subjects without stenosis as control group. We compared insulin and glucose response to oral glucose load(75g), serum lipid concentrations, blood pressure, and degree of obesity between two groups. We also divided CAD group into smoking and nonsmoking subgroups, compared the above parameters. RESULTS: 1) There were no significant difference in body mass index, blood pressure, creatinine, cholesterol, HDL-cholesterol, between the CAD group and the control group. There were significantly higher incidence of smokers in CAD group. 2) Insulin concentration at 120 minutes after glucose load were significantly higher in the CAD group than the control group. 3) In the CAD group, fasting plasma insulin concentration insulin area, peak plasma insulin concentration and insulin concentration at 60,90,120 minutes after glucose load were significantly higher in non-smoking group. CONCLUSION: Enhanced insulin reponse such as higher insulin concentration 60 minutes after glucose load in the CAD group suggests that insulin resistance is a risk factor of CAD. And insulin response was more pronounced in the non-smoker subgroup than smoker subgroup in the CAD patients. Thus role of insulin resistance in provoking coronary artery disease is more important in the non-smoker.
Atherosclerosis ; Blood Pressure ; Body Mass Index ; Cholesterol ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Creatinine ; Dyslipidemias ; Fasting ; Glucose ; Glucose Intolerance ; Humans ; Hyperinsulinism ; Hypertension ; Incidence ; Insulin Resistance* ; Insulin* ; Obesity ; Plasma ; Risk Factors ; Smoke ; Smoking