A 63 Year-old-lady has had substernal chest pain on exertion for 8 years. The chest pain has been increased over the last 3 years. A continuous murmur was heard at the left second to third inercostal spaces along the left sternal border. The electrocardiogram showed the inverted T-waves in the precordial leads. The right heart catheterization revealed 5% oxygen step up between RV and PA. The right sided pressures were normal. The coronary arteriography revealed markedly tortuous vessels starting shortly after the left main stem coronary artery was normally originated. One of the large vessel was shown to be drained into the pulmonary artery. In the operation room, without using heart-lung machine this abnormally drained vessel was simply ligated at it's draining site into pulmonary artery. After the operation the patient is feeling well with little symptoms and the continuous murmur is no longer heard.
Angiography ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Vessels* ; Electrocardiography ; Heart-Lung Machine ; Humans ; Middle Aged* ; Oxygen ; Pulmonary Artery*

BACKGROUND: Antimicrobial resistance of Streptococcus pneumoniae presents a challenge to the clinicians in developing countries, particularly against the acute respiratory tract infections, including pneumonia. The present study was to evaluate the carriage rate and the antimicrobial resistance of S. pneumoniae isolated from children at a day-care center. METHODS: Oropharyngeal swabs were done every month for one year in 64 children at a day-care center in Seoul, Korea. Minimum inhibitory concentrations (MICs) of 9 antimicrobial agents (penicillin, ceftriaxone, cefuroxime, erythromycin, chloramphenicol, tetracycline, vancomycin, ciprofloxacin, cefpirome) were determined by agar-dilution method. RESULTS: The ages of the children ranged from 13 to 60 months (mean: 31 months). The overall carriage- rate of pneumococci was 26%, which was highest in December (46%) and lowest in July (3%). A total number of 105 strains of S. pneumoniae were isolated from 404 throat swabs and 68 strains among these were available for MIC tests. Only 8 (12%) strains were susceptible to penicillin, while 50 (73%) were intermediate and 10 (15%) were resistant. The isolates also exhibited high rates of resistance to other beta- lactams (53% and 21% were resistant to cefuroxime and ceftriaxone, respectively). The resistance rates to the other antimicrobial agents were also remarkable; 90% and 88% were resistant to erythromycin and tetracycline, respectively. However, 75% of isolates were susceptible to chloramphenicol and 100% were susceptible to vancomycin. CONCLUSION: There was a high rate of pharyngeal carriage of penicillin-resistant S. pneumoniae among children attending day-care center. Surveillance of pharyngeal cultures may provide useful information the treatment guideline of pneumococcal infections.
Anti-Infective Agents ; Ceftriaxone ; Cefuroxime ; Child* ; Chloramphenicol ; Ciprofloxacin ; Colon* ; Developing Countries ; Erythromycin ; Humans ; Korea* ; Lactams ; Microbial Sensitivity Tests ; Penicillins ; Pharynx ; Pneumococcal Infections ; Pneumonia ; Respiratory Tract Infections ; Seoul* ; Streptococcus pneumoniae* ; Streptococcus* ; Tetracycline ; Vancomycin

Intertrochanteric fractures are common in older age group. Recently better implant design and surgical technique have improved clinical results. But still many patients suffer from high morbidity and mortality, because of accompanying osteoporosis and various senile diseases. From January 1991 to June 1994, we treated 54 patients older than 70 years with intertrochanteric fractures of femur. Among them, 23 patients were followed up at our hospital and the other patients were informed from police station. Lost follow up was ten patients and final follow up were 44 patients. Mortality was analyzed for the detection of causative factors, such as age, sex, associated medical problems. type of fracture, degree of osteoporosis, type of operation, internal between injury and operation and duration of admission. The results were as follows; 1. 26 patients survived and 18 patients died(Mortality rate :40.9%) 2. 10 patients died within 1 year(Mortality rate :22.7%) 3. Mortality was related to associated medical problems, interval between in jury and operation and type of fracture, which were statistically significant(P < 0.05).
Aged ; Femur ; Follow-Up Studies ; Hip Fractures ; Humans ; Mortality ; Osteoporosis ; Police

Reiter`s disease can no longer be considerded a rare and relatively benign syndrome, defined by the clinical triad of urethritis, conjunctivitis and arthritis. In the etiology of Reiter`s disease, it can be regarded as a post-infectious syndrome after certain enteric disease or veneral infection and usually occurs in patients between 20 and 40 years old, with a male to female ratio of 10:1 in dysenteric cases and 50:1 in veneral cases. The diagnosis of Reiter`s disease should quite obious when the clinical manifestation of non specific urethritis, conjunctivitis, arthritis and mucocutaneous lesions. Recently, HLA-B27 antigen is strogly associated with Reiter`s syndrome and may be diagnosticlly useful when HLA-B27 is positive. There is no specific therapy for Reiter`s disease, but conservative treatement is aviable of acute stage oir recurrence of the disease. We have experienced a case of Reiter`s syndrome in 27 years old male and reproted with review of some literatures.
Adult ; Arthritis ; Conjunctivitis ; Diagnosis ; Female ; HLA-B27 Antigen ; Humans ; Male ; Recurrence ; Urethritis

Wegener's granulomatosis (WG) is a systemic disease characterized by necrotizing granulomas and vasculitis involving the upper and lower respiratory tract as well as the kidneys. Limited form of WG usually involves the head and neck, lacks renal involvement, and may not progress to generalized disease. We report the case of limited form of WG who presented not systemic symptom but several times relapsed multiple ulcerating lesions on the face, uveitis and keratoconjunctivitis. A 23 year-old female initially presented with ulcerative skin lesions on the left cheek and nose. The skin lesion had commenced as an ulcerative and nodulopapular lesion on her right cheek initially, 8 months ago. Subsequently, there was progression of the disease to her left cheek and nose. The patient was treated with oral prednisolone and oral cyclophosphamide. Two weeks later, skin lesion had started to heal, oral prednisolone tapered to 15 mg. Eight weeks later, all of skin lesions were healed well. With silicone gel sheets and Laser therapies, we gained excellent cosmetic results. In the aesthetic aspect, early recognition of rare variants of limited form of WG, facial chronic ulcerative wounds that are nonresponsive to conservative treatment, is very important as appropriate therapy can prevent facial mutilation.
Cheek ; Cosmetics ; Cyclophosphamide ; Female ; Granuloma ; Head ; Humans ; Keratoconjunctivitis ; Kidney ; Laser Therapy ; Neck ; Nose ; Prednisolone ; Respiratory System ; Silicone Gels ; Skin ; Ulcer ; Uveitis ; Vasculitis ; Wegener Granulomatosis

BACKGROUND: Streptococcus pyogenes causes most often pharyngitis or tonsillitis but may also be responsible for severe diseases including bacteremia and pneumonia. Recent publications from several geographic areas showed high rates of resistance to erythromycin and newer macrolides, often used in patients allergic to penicillin, in clinical isolates of S. pyogenes. METHODS: Minimum inhibitory concentration of 31 strains of S. pyogenes, isolated at the Seoul National University Children's Hospital from October 1991 through April 1998, were determined for penicillin, ceftriaxone, vancomycin, clindamycin, erythromycin, roxythromycin, and clarithromycin by agar dilution method or E-test. In addition, clinical features of the patients from whom the organisms were isolated were reviewed retrospectively. RESULTS: Of the 28 patients whose medical records were reviewed, the most common clinical presentations were soft-tissue infection (8 cases) and pharyngitis (5 cases). Other presentations included bacteremia without focus, pneumonia, vaginitis, lymphadenitis, omphalitis (two of each); primary peritonitis, rheumatic fever with carditis, scarlet fever, acute otitis media, and disseminated disease (one of each). All of the isolates were susceptible to penicillin, ceftriaxone, and vancomycin. However, 5 isolates (16%) were resistant to erythromycin, and all of the erythromycin-resistant strains were resistant to roxythromycin and clarithromycin as well. Three of these erythromycin-resistant strains were also resistant to clindamycin. CONCLUSION: S. pyogenes may cause serious infections in children. Emergence of resistance in clinical isolates of S. pyogenes to macrolides and clindamycin should be considered in empirical antimicrobial therapy of suspected group A streptococcal infections and in establishment of antibiotic policy in Korea.
Agar ; Bacteremia ; Ceftriaxone ; Child* ; Clarithromycin ; Clindamycin ; Erythromycin ; Humans ; Korea ; Lymphadenitis ; Macrolides ; Medical Records ; Microbial Sensitivity Tests ; Myocarditis ; Otitis Media ; Palatine Tonsil ; Penicillins ; Peritonitis ; Pharyngitis ; Pneumonia ; Retrospective Studies ; Rheumatic Fever ; Scarlet Fever ; Seoul ; Streptococcal Infections ; Streptococcus pyogenes* ; Streptococcus* ; Tonsillitis ; Vaginitis ; Vancomycin

BACKGROUND: Many studies to reduce serum lipoprotein(a) are done because serum lipoprotein(a) has been known to be an independent risk factor of coronary artery disease along with age, smoking, diabetes, hypertension, and hyperlipidemia. Till now, oral estrogen/androgen therapy, niacin analogue and plasmapheresis are known therapeutic methods. This study examined the relative effects of three antihyperlipidemic agents, acipimox, lovastatin, fenofibrate. METHODS: Among 70 subjects (male-19, female-51) with their serum cholesterol level of more than 240mg/dL, 56 subjects who were completed 2 months antihyperlipidemic treatment (acipimox-20, lovastatin-18, fenofibrate-18) were examined for baseline total cholesterol, HDL cholesterol, triglyceride, and lipoprotein(a) and were followed up 2 months later. RESULTS: Mean values of each group for acipimox, lovastatin, fenofibrate were as follows: total cholesterol (268.1+/-19.03, 287.1+/-36.42, 268.9+/-25.99), HDL cholesterol (43.5+/-10.99, 42.7+/-11.88, 37.9+/-8.20), triglyceride (226.1+/-165.03, 260.4+/-175.98, 234.3+/-124.33), LDL cholesterol (179.3+/-30.40, 192.3+/-41.52, 184.1+/-38.08), lipoprotein(a) (26.2+/-15.32,34.8+/-18.56,29.9+/-12.58). Mean percentile reduction of lipoprotein(a) was acipimox-41.4%(P<0.0001), lovastatin-22.2%(P<0.0001), fenofibrate-16.1%(P<0.05), and p value was less than 0.05 in the comparison of groups. Lipoprotein(a) showed no relations with age, sex, BMI, WHR, smoking, total cholesterol, HDL cholesterol, triglyceride and LDL cholesterol. After 2 months treatment, mean reduction percentages of total cholesterol was acipimox-12.2%(P<0.0001), lovastatin-17.6%(P<0.0001), fenofibrate-8.85%(P<0.05). LDL cholesterol was acipimox-16.12%(P<0.0001), lovastatin-22.89%(P<0.0001), fenofibrate-12.06% (P<0.05). Triglyceride was acipimox-17.24%(P<0.0001), lovastatin-17.39%(P<0.0001), fenofibrate-9,78%(P<0.05). HDL cholesterol was elevated in acipimox-17.24%(P<0.05), lovastatin-16.10%(P<0.05) and fenofibrate-12.06(P<0.05). In total cholesterol(P<0.05) and LDL cholesterol(P<0.05), there were significant differences among 3 groups, but not in HDLcholesterol and triglycerides. CONCLUSION: In two months treatment of acipimox, lovastatin and fenofibrate in hyperlipidemic patients, lipoprotein(a), known for independent risk factor of coronary artery disease, was reduced significantly in the order of acipimox, lovastatin and fenofibrate.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Coronary Artery Disease ; Fenofibrate ; Humans ; Hyperlipidemias ; Hypertension ; Lipoprotein(a)* ; Lovastatin ; Niacin ; Plasmapheresis ; Risk Factors ; Smoke ; Smoking ; Triglycerides

No abstract available.
Craniopharyngioma*

No abstract available.
Thorax*

BACKGROUND: Episode of Enterococcal bacteremia has increasingly been reported for the past 15 years in USA, but there have been few systematic studies on its occurrence among Korean children. This study was carried out to determine the epidemiologic, clinical and laboratory characteristics of enterococcal bacteremia in Korean children. METHODS: Fifty episodes of enterococcal bacteremia among Korean children were retrospectively analyzed. Clinical and microbiological data were collected for all episodes of enterococcal bacteremia which occurried during 9-year period between November, 1992, and August, 2001 at the Seoul National University Children's Hospital. RESULTS: Significant underlying diseases were present in 47 (94%) episodes, including cardiac or abdominal surgery (44%), cardiac disease (30%), and chronic gastrointestinal disorders (16%). Thirty- eight (76%) episodes were nosocomial in origin, and 14 (28%) episodes were polymicrobial bacteremia. The source of bacteremia was identified in 16 (32%) episodes, intravascular device being the most common identifiable source. Of the 47 isolates identified at species level, 20 strains were Enterococcus faecium, 26 Enterococcus faecalis and one Enterococcus avium. Seventy-two percent of E. faecium cases were resistant to ampicillin. 36 cases (80%) had high-level resistance to gentamicin and sixteen cases (36%) to streptomycin. There was no strain resistant to vancomycin. Three clinical patterns were identified; self-limited bacteremia, 20%; low grade sepsis with favorable outcome after specific therapy, 42%; severe and prolonged infection, 30%; and unclassified, 8%. The overall mortality rate was 10.8%. CONCLUSION: Enterococcal bacteremia in children was usually nosocomial and comprised a heterogeneous group. The majority of cases occurred in children with serious underlying diseases. The frequency of high-level resistance to gentamicin in enterococcal isolates was high.
Ampicillin ; Bacteremia* ; Child ; Enterococcus ; Enterococcus faecalis ; Enterococcus faecium ; Gentamicins ; Heart Diseases ; Hospitals, Pediatric* ; Humans ; Mortality ; Retrospective Studies ; Seoul ; Sepsis ; Streptomycin ; Vancomycin