Enterotoxigenic B. pagilis (ETBF) strains which produce a 20 kDa zinc metalloprotease toxin (BFI) have been associated with diarrheal disease of animals and young children. Using B. pngilis toxin gene (bfi) from strain 86-5443-2-2 (piglet isolate) as a probe, the gene was identified in 74/77 human and animal ETBF strains but only 2/97 non-toxigenic B. fragilis (NTBF) strains. The region flanking bp was mapped with several restriction enzymes and 8 resriction fragments aacent to bft were used to probe colony blots of 77 KTBF and 97 NTBF strains. All 74 bft-positive ETBF strains hybridized to the 8 probes spanning a ca. 18 kb chromosomal region; however, this 18 kb region was absent in the 3 ETBF strains lacking p, and 47 of the 97 (48%) NTBF strains lacked the entire 18 kb region. Of note, the 2 NTBF strains containing btf did not have a ca. 12 kb region upstream of btfp. A ca. 9 kb fragment flanking the btf gene has been sequenced. Analysis of this data revealed several open reading frames (ORF) of which 3 are of particular interest (ORFs 1, 2 and 3). ORF1 and ORF3 encode proteins with significant homology to mobilization proteins, and ORF2 encodes a protein with significant homology to metalloprotease proteins, but only 50% similarity and 30% identity to BFf. These results suggest: 1) the btf genes are flanked by at least 18 kb of DNA largely unique to ETBF strains indicating a putative pathogenic island, 2) another metalloprotease protein present in ETBF strains may contribute to the pathogenicity and variable virulence of these diarrheagenic strains and 3) the pathogenic island may be mobiTized among different Bacteroides strains, and possibly among different species of intestinal bacteria.
Animals ; Bacteria ; Bacteroides fragilis* ; Bacteroides* ; Child ; DNA ; Genomic Islands* ; Humans ; Open Reading Frames ; Virulence* ; Zinc

PURPOSE: Cortical dysplasia (CD) designates a diverse group of malformations resulting from one or more abnormalities in the development of the cerebral cortex. We investigated the findings of interictal SPECT and the diagnostic usefulness of interical and ictal SPECT according to pathological grading (PG) in comparison with MRI. MATERIALS AND METHODS: This study included 16 patients (M:F=9:7, age: 19.9+/-11.8 yrs) with pathologically proven CD. Tc-99m ECD SPECT was performed in all patients: interictal 11, interictal and ictal 3, ictal 2. MRI were obtained in all patients and image analysis was done blindly as to the result of SPECT. Pathologic findings of CD were classified into grade 1 (G1, dyslamination), grade 2 (G2, dysplastic neurons) and grade 3 (G3, balloon cells). We compared SPECT with MRI in lesions-to-lesions and analyzed the result according to PG. RESULTS: In SPECT and MRI, 38 and 27 lesions were visually recognized. In 14 interictal SPECT, variable findings in 35 lesions were demonstrated: 26 were hypoperfusion, 7 hyperperfusion, 2 heterotopic perfusion in the white matter. By comparison between two studies, missed lesions were founded: SPECT were 1 lesion, MRI 12. Review of missed 12 lesions of MRI were followed according to PG; G1 patients were 16.7% (4/19), G2 40.0% (6/15), and G3 50% (2/4). CONCLUSION: Interictal SPECT in CD showed variable findings such as hypoperfusion, hyperperfusion or heterotopic perfusion. However, for detection of missed CD on MRI, SPECT may help to detect a functional abnormality of the lesion with high PG.
Cerebral Cortex ; Humans ; Magnetic Resonance Imaging* ; Malformations of Cortical Development* ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

Bacteroides fragilis is a Gram negative nonsporulating anaerobic rod bacterium that makes up about 1 to 2% of the norrnal human colonic microflora. In 1984, Myer et al. reported that some strains of B. fragilis produce enterotoxin and cause diarrheal disease in cattle and human. Since then it has been termed enterotoxigenic B. fragilis (ETBF). In this study, we tried to detect enterotoxin gene from 37 B. fragilis strains, isolated in Korean patients, to confirm the existence of ETBF and usefulness of PCR as a rapid diagnosis method. By this method, we identified 9 ETBF strains and confirmed their pathogenesis by cytotoxicity test. No significant cross- reactivity with other anaerobes or aerobes was observed. Thus, the PCR method may be considered useful for the sensitive and rapid detection of anaerobic infections. And the entire amplified PCR mixture was ligated into a pT7Blue T-vector and transformed into E. coli. When the nucleotide sequences of cloned PCR products were compared with reported enterotoxin gene, pBF529 inserted DNA sequence was nearly in good agreement with it but pBF570 inserted DNA sequence showed some difference at nucleotide 270-300. A search for nucleotide sequence homologies revealed that pBF529 exhibited 99%, but pBF570 indicated only 90% identity with reported enterotoxin gene. According to these results, it was suggested that ETBF toxin can be differentiated into at least 2 subtypes.
Animals ; Bacteroides fragilis* ; Bacteroides* ; Base Sequence ; Cattle ; Clone Cells ; Colon ; Diagnosis ; Enterotoxins* ; Humans ; Korea* ; Polymerase Chain Reaction*

BACKGROUND: Clostridium difficile is known as the major cause of nosocomially acquired diarrhea. Various phenotypic and genotypic methods have been used to subtype C. difficile strains. The purpose of the present study is to evaluate several typing methods which can be used as tools for subtyping C. difficile isolates for epidemiological studies. METHODS: In two Korean tertiary care hospitals, a total of 81 C. difficile isolates were collected from symptomatic, hospitalized patients in 1998. All isolates were examined for the release of toxin A and toxin B by PCR assay and cell culture assay. Also arbitrarily primed-PCR and PCR-ribotyping profiles were determined for the typing of C. difficile strains on a genetic level. RESULTS: The toxin B gene was detected in 65.4% (54/81) of isolates by both PCR assay and cell cultureassay. Nine types were identified with T-7 primer, and 13 types were identified with PG-05 primer in AP- PCR. Sixteen types were identified in PCR-ribotyping. When two typing methods were compared, reproducibility by PCR-ribotyping was 100%, while it was only 83% and 33% AP-PCR with primer T-7, and PG-05, respectively. The discrimination index was 0.88 for PCR-ribotyping, 0.82 for AP-PCR with primer T-7 and 0.81 with primer PG-05. CONCLUSION: These data suggest that PCR-ribotyping provides a reproducible, discriminatory, and simple alternative to conventional molecular approaches for typing strains of C. difficile.
Cell Culture Techniques ; Clostridium difficile* ; Clostridium* ; Diarrhea ; Discrimination (Psychology) ; Epidemiologic Studies ; Humans ; Polymerase Chain Reaction ; Tertiary Healthcare

OBJECTIVES: Posttraumatic stress disorder(PTSD) has devastating effects on multiple aspects of the quality of life(QoL). Therefore, the purpose of this study is to compare the QoL between PTSD group and non-PTSD group, and identify the variables affecting the QoL of the Vietnam War veterans. METHODS: We recruited 39 veterans with PTSD and 43 veterans without PTSD, all of whom had deployed to the Vietnam War. We used the Korean version of Mini International Neuropsychiatric Interview-Plus, the Korean version of Clinician-Administered PTSD Scale, Combat Exposure Scale and the Korean version of World Health Organization Quality of Life Assessment Instrument abbreviated version. We used independent samples t-test to identify the differences between PTSD and non-PTSD group in each domains of the quality of life. We also used stepwise multiple linear regression analysis to figure out the variables affecting the QoL of the Vietnam War veterans. RESULTS: In the PTSD group, all domains of the QoL and the QoL total score(p<0.01) were significantly lower than those in the non-PTSD group. In the Vietnam War veterans, PTSD, major depressive disorder and education levels were the variables affecting the QoL. Among these, PTSD uniquely explained the QoL of the overall and general health(beta=-1.411, R2=0.180), the physical health domain(beta=-2.806, R2=0.089) and the total score (beta=-11.479, R2=0.104). CONCLUSIONS: These results suggest that among the Vietnam War veterans, the QoL of the PTSD group is significantly lower than that of the non-PTSD group. Among the combat exposed veterans, PTSD may be one of the main reasons that affect the multiple domains of the QoL.
Depressive Disorder, Major ; Humans ; Linear Models ; Quality of Life ; Stress Disorders, Post-Traumatic ; Veterans ; Vietnam ; World Health Organization

A 35-year-old man was admitted with a 20 day history of generalized edema and muscular weakness of the lower extremities. He was alert with a pale puffy face and an ejection murmur was heard at the cardiac apex. The electrocardiogram disclosed low voltage, first degree atrioventricular block, and a right bundle branch block. During the hospitalization an intractable diastolic hypotension developed, which measured 0 mmHg at the lowest point. At that time the echocardiogram revealed a dilated, akinetic right ventricle. Eventually a multiorgan failure developed and an autopsy following his death presented a fibrofatty replacement of the right ventricular myocardium. This might be a case of an arrhythmogenic right ventricular dysplasia/cardiomyopathy, which is usually characterized clinically by a ventricular tachycardia and may cause a sudden death in young adults.
Adult ; Atrioventricular Block ; Autopsy* ; Bundle-Branch Block ; Death, Sudden ; Edema ; Electrocardiography ; Heart Ventricles ; Hospitalization ; Humans ; Hypotension ; Lower Extremity ; Muscle Weakness ; Myocardium ; Systolic Murmurs ; Tachycardia, Ventricular ; Young Adult

PURPOSE: The purpose of this study was to evaluate the short- and long-term effectivensess of intracavitary urokinase with percutaneous catheter drainage in Ioculated thoracic empyemas. MATERIALS AND METHODS: 15 patients were identified as second stage of Ioculated thoracic empyema by estimating nature of pleural fluid, chest PA, lateral decubitus view and CT scan. Under the guidance of fluoroscopy or ultrasound, catheter was inserted percutaneously. Instillation of urokinase was started when amount of drained fluid became less than 30ml per day with 100,000U of urokinase mixed with 100ml of normal saline. Trial of urokinase was repeated until complete drainage of empyema was demonstrated on plain chest film obtained after 48 hours. RESULTS: Successful complete drainage was achieved in 14 of 15 patients. In long-term study, complete resorption was demonstrated in 11 of 12 patients. Average dosage of used urokinase was 330,000U and mean duration of catherter insertion was 35 days. CONCLUSION: lntracavitary urokinase with percutaneous catheter drainage is a safe and effective method to facilitate drainage of Ioculated empyema and to prevent recurrence.
Catheters ; Drainage ; Empyema ; Empyema, Pleural* ; Fluoroscopy ; Humans ; Recurrence ; Thorax ; Tomography, X-Ray Computed ; Ultrasonography ; Urokinase-Type Plasminogen Activator*

PURPOSE: The purpose of this study was to evaluate the short- and long-term effectivensess of intracavitary urokinase with percutaneous catheter drainage in Ioculated thoracic empyemas. MATERIALS AND METHODS: 15 patients were identified as second stage of Ioculated thoracic empyema by estimating nature of pleural fluid, chest PA, lateral decubitus view and CT scan. Under the guidance of fluoroscopy or ultrasound, catheter was inserted percutaneously. Instillation of urokinase was started when amount of drained fluid became less than 30ml per day with 100,000U of urokinase mixed with 100ml of normal saline. Trial of urokinase was repeated until complete drainage of empyema was demonstrated on plain chest film obtained after 48 hours. RESULTS: Successful complete drainage was achieved in 14 of 15 patients. In long-term study, complete resorption was demonstrated in 11 of 12 patients. Average dosage of used urokinase was 330,000U and mean duration of catherter insertion was 35 days. CONCLUSION: lntracavitary urokinase with percutaneous catheter drainage is a safe and effective method to facilitate drainage of Ioculated empyema and to prevent recurrence.
Catheters ; Drainage ; Empyema ; Empyema, Pleural* ; Fluoroscopy ; Humans ; Recurrence ; Thorax ; Tomography, X-Ray Computed ; Ultrasonography ; Urokinase-Type Plasminogen Activator*

OBJECTIVES: Idiopathic REM sleep behavior disorder (RBD) is by far the strongest clinical predictor of neurodegenerative disease available. Several potential early diagnostic markers of neurodegenerative disease including autonomic symptoms have been proposed, but they have generally not been tested in presymptomatic neurodegenerative disease. So the authors investigated autonomic symptoms and their associated factors in idiopathic RBD patients. METHODS: 52 idiopathic RBD patients and 52 controls participated in the study. Autonomic symptoms were evaluated by applying the unified multiple system atrophy rating scale (UMSARS) and measuring orthostatic systolic blood pressure drop. RESULTS: Idiopathic RBD patients showed significantly higher UMSARS subscale scores and sharper drop of orthostatic systolic blood pressure than controls. In multiple linear regression analysis, all autonomic symptoms and measured orthostatic systolic blood pressure drop were associated with RBD. In addition, orthostatic symptoms were associated with medication and age, urinary function was associated with benign prostatic hyperplasia, and measured orthostatic systolic blood pressure drop was associated with hypertension. CONCLUSION: In this study, idiopathic RBD patients showed more autonomic symptoms than controls. However, other autonomic symptoms-related factors also influenced some autonomic symptoms. Prospective studies should be performed to evaluate autonomic symptoms as a potential predictor of neurodegenerative diseases.
Aged* ; Blood Pressure ; Humans ; Hypertension ; Linear Models ; Multiple System Atrophy ; Neurodegenerative Diseases ; Prostatic Hyperplasia ; REM Sleep Behavior Disorder* ; Sleep, REM*

PURPOSE: To compare the diagnostic accuracy between fine needle and large cutting needle biopies. METHODS & MATERIALS: Chest lesion was biopsied consecutively by 19 G or 22 G fine needle and 14 G large cutting needle with interval of 10-20 min. 119 patients confirmed by operation or clinical follow-up were evaluated. RESULTS: There were 65 patient confirmed as malignant lesion and 54 confirmed as benign lesions. Diagnostic accuracy was 87.7%(57/65) for malignancy and 85.2%(46/54) for benign lesion with fine needle. With large cutting needle, it was 90.8%(59/65) for malignancy and 88.9%(48/54) for benign lesion. In the benign lesion, specific diagnostic accuray was 48.1%(26/54) with fine needle, and 64.8%(35/54) with large cutting needle biopsy, respectively. Complications were hemoptysis(n=13, 10.9%), pneumothorax(n=7, 5.9%) and mild to moderate chest pain. Although, it is impossible to compare the complications by the two types of biopsy on same lesion, 10 cases of immediate hemopytsis and more severe chest pain occurred when large cutting needle biopsy was done. CONCLUSION: No significant difference in diagnostic accuracy between fine needle and large cutting needle biopsies was observed in malignant lesion. In benign lesions, larger sample volume may increase the chance of obtaining a specific diagnosis but has no influence on overall diagnostic accuracy of benignity. Thus, we believe that fine needle aspiration biopsy is an accurate, safe, and more tolerable means to be performed as first step for diagnosis of chest lesions.
Biopsy* ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Chest Pain ; Diagnosis ; Follow-Up Studies ; Humans ; Needles* ; Thorax