BACKGROUND: The erythromycin-resistance rate and phenotype distribution of Streptococcus propenes are quite different by geographical variation and study period. The aim of the present study was to determine the evolution of resistance to erythromycin and the frequency of erythromycin resistance phenotype of S. pyogenes isolated from Wonju Christian Hospital. METHODS: The minimal inhibitory concentrations (MICs) of erythromycin and clindamycin for 94 S. pyogenes isolated from clinical specimens between 1990 to 1998 were investigated. Double disk test of erythromycin (78microgram) and clindamycin (25microgram) were performed for 15 isolates of erythromycin resistant S. pyogenes to evaluate the erythromycin resistance phenotype. RESULTS: The resistance rates of 94 isolates of S. pyogenes were 16%(15/94) to erythromycin and 4%(4/94) to clindamycin. The frequency of erythromycin resistance phenotype in decreasing order were M phenotype (47%), inducible resistance phenotype (40%), and constitutive resistance phenotype (13%). Erythromycin-resistant S. pyogenes did not exist until 1993, but was isolated since 1994, and ranged from 14.0% to 24.0% during the period of 1994-1998. CONCLUSIONS: Our finding documents the emergence of high resistance rates to erythromycin in S. pyogenes at Wonju area since 1994. The M phenotype (47%) and inducible resistance phenotype (40%) account for the majority of erythromycin-resistant S. pyogenes.
Clindamycin ; Erythromycin* ; Gangwon-do ; Phenotype* ; Streptococcus pyogenes* ; Streptococcus*

Proptosis after a subgaleal hematoma (SGH) is a rare condition that may require immediate intervention to prevent visual loss. A 12-year-old boy presented with localized SGH in the left parietal area after hair-pulling. The SGH was massively expanded on the entire scalp on the 3rd day of the trauma. On the next day after the massive expansion, proptosis of the right eye occurred suddenly. Emergent needle aspiration of the SGH was performed, and the proptosis improved slightly. Fortunately, his vision did not deteriorate. After all, he was diagnosed with coagulation factor IX deficiency (hemophilia B). The supraorbital notch could be a passage of the SGH to extend into the subperiosteal space of the orbit.

The tarsal tunnel is located beneath the flexor retinaculum, which connects the medial malleolus and calacaneus. The tarsal tunnel contains the posterior tibialis tendon, flexor digitorum longus tendon, posterior tibial artery and vein, posterior tibial nerve, and flexor halluces longus tendon. Tarsal tunnel syndrome is a compressive neuropathy of posterior tibial nerve and its branches under the flexor retinaculum. The etiologies of tarsal tunnel syndrome are space-occupying lesion, hypertrophied flexor retinaculum, osteophytes, tarsal coalition, varicose vein, and trauma. The symptoms are foot pain and hypoesthesia or paresthesia at dermatome according to involving nerve branches. Clinical diagnosis can be obtained from a detailed history and physical examination such as compressive test at the tarsal tunnel area. Ultrasonography and magnetic resonance imaging can reveal the space-occupying lesion, such as ganglion, lipoma, and neuroma. The initial treatments of tarsal tunnel syndrome are conservative management, such as physical therapy, night splint, and steroid injection. Surgical decompression is indicated after failure of conservative managements. Variable results of surgical treatment have been reported. Favorable result after decompression could be obtained from young patients, early onset symptoms, and space-occupying lesion.
Decompression ; Decompression, Surgical ; Diagnosis ; Foot ; Ganglion Cysts ; Humans ; Hypesthesia ; Lipoma ; Magnetic Resonance Imaging ; Neuroma ; Osteophyte ; Paresthesia ; Physical Examination ; Splints ; Tarsal Tunnel Syndrome* ; Tendons ; Tibial Arteries ; Tibial Nerve ; Ultrasonography ; Varicose Veins ; Veins

Although rapid diagnosis of human babesiosis usually can be made by microscopic examination of thin and thick blood smears, differentiation between Babesia microti and Plasmodium falciparum can be quite difficult. The parasite is often not visualized in the early course of infection or in a partially treated case and the young trophozoites of these two organisms are similar. Recently, we experienced a case, which was thought as human babesiosis initially by microscopic examination of the Giemsa-stained thin blood smears, but was finally diagno-sed as P. falcifarum infection by indirect immunofluorescent antibody assay and polymerase chain reaction. The patient was treated successfully with quinine and clindamycin, which are effective in both infections. When differential diagnosis is difficult, we suggest combination therapy of quinine and clindamycin as an empirical regimen.
Animals ; Babesia microti ; Babesiosis ; Clindamycin* ; Diagnosis ; Diagnosis, Differential ; Humans ; Parasites ; Plasmodium falciparum ; Polymerase Chain Reaction ; Quinine* ; Trophozoites

No abstract available.
Electrocardiography* ; Family Practice* ; Humans

Although pregnancy is a medical condition that contributes to bone loss, little information is available regarding bone mineral density (BMD) in puerperal women. This cross sectional study aimed to evaluate the prevalence of low BMD in puerperal women and to identify associated risk factors. We surveyed all puerperal women who had BMD measurements taken 4–6 weeks after delivery in a tertiary university hospital, and did not have any bone loss-related comorbidities. Among the 1,561 Korean puerperal women, 566 (36.3%) had low BMD at the lumbar spine, total hip, femoral neck, and/or trochanter. Multivariate analysis revealed that underweight women had a significantly higher risk of low BMD compared with obese women at pre-pregnancy (adjusted odds ratio [aOR], 3.21; 95% confidence interval [CI], 1.83–5.63). Also, women with inadequate gestational weight gain (GWG) were 1.4 times more likely to have low BMD than women with excessive GWG (aOR, 1.42; 95% CI, 1.04–1.94). One-way ANOVA showed that BMDs at the lumbar spine and total hip were significantly different between the 4 BMI groups (both P < 0.001) and also between the 3 GWG groups (both P < 0.001). In conclusion, this study identifies a high prevalence of low BMD in puerperal women and thus suggests the need for further evaluation about the change of BMD in pregnancy and postpartum period.
Body Mass Index ; Bone Density* ; Comorbidity ; Female ; Femur ; Femur Neck ; Hip ; Humans ; Multivariate Analysis ; Odds Ratio ; Osteoporosis ; Postpartum Period ; Pregnancy ; Prevalence* ; Risk Factors* ; Spine ; Thinness ; Weight Gain

Neurilemmoma, also refired to as Schwannoma, neurinoma and perineural fibroblastoma, is well capsulated solitary tumor of Schwann cell origin. The most common sites for benign solitary neurilemmoma are the extremities or the head and neck region. In the retroperitoneum, they are commonly seen in the presacral region. It is incidentally detected and confirmed by pathologic findings. We report a case of retroperitoneal neurilemmoma arising from adjacent to kidney, in 49 years old man.
Extremities ; Head ; Humans ; Kidney* ; Middle Aged ; Neck ; Neurilemmoma*

OBJECTIVE: To evaluate the retrieval rate and accuracy of ultrasound (US)-guided 14-G semi-automated core needle biopsy (CNB) for microcalcifications in the breast. MATERIALS AND METHODS: US-guided 14-G semi-automated CNB procedures and specimen radiography were performed for 33 cases of suspicious microcalcifications apparent on sonography. The accuracy of 14-G semi-automated CNB and radiology-pathology concordance were analyzed and the microcalcification characteristics between groups with successful and failed retrieval were compared. RESULTS: Thirty lesions were successfully retrieved and the microcalcification retrieval rate was 90.9% (30/33). Thirty lesions were successfully retrieved. Twenty five were finally diagnosed as malignant (10 invasive ductal carcinoma, 15 ductal carcinoma in situ [DCIS]) and five as benign. After surgery and mammographic follow-up, the 25 malignant lesions comprised 12 invasive ductal carcinoma and 13 DCIS. Three lesions in the failed retrieval group (one DCIS and two benign) were finally diagnosed as two DCIS and one benign after surgery. The accuracy of 14-G semi-automated CNB was 90.9% (30/33) because of two DCIS underestimates and one false-negative diagnosis. The discordance rate was significantly higher in the failed retrieval group than in the successful retrieval group (66.7% vs. 6.7%; p < 0.05). Punctate calcifications were significantly more common in the failed retrieval group than in the successful retrieval group (66.7% vs. 3.7%; p < 0.05). CONCLUSION: US-guided 14-G semi-automated CNB could be a useful procedure for suspicious microcalcifications in the breast those are apparent on sonography.
Adult ; Aged ; Biopsy, Large-Core Needle/*methods/standards ; Breast/*pathology ; Breast Diseases/pathology/radiography ; Breast Neoplasms/*pathology/surgery/ultrasonography ; Calcinosis/*pathology/ultrasonography ; Carcinoma, Ductal, Breast/*pathology/ultrasonography ; Carcinoma, Intraductal, Noninfiltrating/*pathology/radiography ; Female ; Humans ; Middle Aged ; *Ultrasonography, Interventional/standards ; Young Adult

OBJECTIVE: We performed a study of the relationship between thigh circumference and serum lipids. METHODS: A total of 314,842 Korean men and women aged 30 to 79 enrolled in the Korea Medical Institute for medical examination between February 2010 and December 2011 were included. Multiple logistic regression analysis was performed to examine the association of thigh circumference with various lipid profiles after adjustment for age, body mass index (BMI), waist circumference, smoking, and exercise. RESULTS: The average age of study participants was 42.3 years (42.6 years in men and 41.9 years in women). The mean thigh circumference was 53.2 cm (54.3 cm in men and 51.5 cm in women). Thigh circumference was positively correlated with BMI and waist circumference in both men and women. Before adjusting for BMI and waist circumference, thigh circumference was also positively correlated with total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, non-HDL cholesterol, and triglyceride / HDL cholesterol ratio. However, after adjusting for those two variables, the positive correlations became almost disappeared and showed opposite direction indicating that BMI and waist circumference were qualitative confounding variables. CONCLUSIONS: A small thigh circumference was associated with increasing levels of lipid profiles including triglyceride and decreasing level of HDL cholesterol. Through additional researches, establishment of causality is necessary.
Aged ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Female ; Humans ; Korea ; Lipoproteins ; Logistic Models ; Male ; Smoke ; Smoking ; Thigh ; Waist Circumference

We report a case of chronic encapsulated intracerebellar hematoma occurring during infancy. An 18 month-old boy was admitted because for 3 months, his head could not be held upright, but fell to the left. Computed tomographic(CT) scanning and magnetic resonance imaging(MRI) of the brain revealed a round mass at the cerebellar vermis ; the lesion simulated a cerebellar tumor such as a medulloblastoma. The mass was surgically removed and found to be a well-encapsulated organized intracerebral hematoma. The characteristic clinical and radiologic findings and histopathologic features are discussed, and a survey of the literature is included.
Brain Neoplasms* ; Brain* ; Cerebellar Neoplasms ; Head ; Hematoma* ; Humans ; Infant ; Male ; Medulloblastoma