PURPOSE: Diverticular disease of the colon is relatively common in western population and rare in oriental population but in recent years the incidence is steadily increasing in oriental population including Korean, so more concerns and appropriate management are required. METHODS: We reviewed 111cases who had diverticular disease in the colon from January 1988 to May 1998 in the Soonchunhyang University Chunan Hospital. Of 111 cases, 87 cases were treated conservatively and 24 cases received a surgical treatment. RESULTS: The annual incidence increased progressively for the last 10 years. The mean age of the patients at the time of diagnosis was 49.6 years and the most common age-group was forth decades (25%). The diverticula were located in the right colon 89%, left colon 7% and both side 4%. Among 24 surgically treated cases, the most common preoperative diagnosis was acute appendicitis (75%) and the correct preoperative diagnosis was made only 3 cases (13%) who had previous appendectomy history, previous diagnosed history or received barium enema due to recurrent pain attack. The surgical procedures of the colonic diverticulosis were right hemicolectomy (6 cases), ileo-ascending colectomy (6 cases), diverticulectomy (2 cases), segmental resection of transverse colon (1 case), left hemicolectomy (1 case), appendectomy (2 cases), appendectomy with drainage (3 cases), appendectomy with drainage and diverticulectomy (3 cases). The postoperative complication was wound infection in all complicated cases. There was no postoperative mortality. CONCLUSIONS: The outcome of patients in our series is satisfactory despite of diagnostic inaccuracies. Preoperative barium study is recommended in those above the 40 years of age suspected the appendicitis. We recommend surgery for patients after two or three episodes of acute diverticulitis that resolves after medical treatment with antibiotics.
Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Barium ; Chungcheongnam-do ; Colectomy ; Colon* ; Colon, Transverse ; Diagnosis ; Diverticulitis ; Diverticulosis, Colonic ; Diverticulum ; Drainage ; Enema ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Wound Infection

Congenital dislocation of the knee is a very rare condition and was first described by Chatelaine in 1822. The etiology of this condition is unknown. It is generally subclassified as simple hyperextension, subluxation, and dislocation, depending on the degree of the joint displacement and the severity of disease. There are a large of associated conditions that have been described, the most common of which are congenital dislocation of the hip, club foot, arthrogryposis, and Larsen's syndrome. The mainstay of treatment is early serial rnanipulation and splinting. Operative treatment was indicated whenever conservative treatment did not lead to satisfactory reduction. The authors experienced a case of congenital hyperextension of left knee associated with the calcaneovalgus deformity of both foot. Early closed treatment obtanied a successful reduction and satisfactory knee motion.
Arthrogryposis ; Congenital Abnormalities ; Dislocations ; Foot ; Hip ; Joints ; Knee* ; Splints

No abstract available.
Bone Marrow* ; Granulocyte Precursor Cells*

BACKGROUND: Recently, an acquired resistance to vancomycin in enterococci has become a serious clinical problem. For the prevention of further propagation of vancomycin-resistant enterococci (VRE), epidemiological study of the infection is essential, but studies on the VRE infection are rare in Korea. We conducted an analysis of the epidemiology of a VRE outbreak in a neonatal intensive care unit (NICU) to clear up the route of propagation of the VRE. METHODS: Vancomycin-resistant Enterococcus faecium (VREFM) strains were isolated from urine specimens of seven patients, rectal swabs from seven patients, and three skin swabs from two patients in the Kosin Medical Center neonatal intensive care unit, Pusan, Korea. Antimicrobial susceptibilities were tested by a disk diffusion method and agar dilution method. Genotypes of vancomycin-resistance were determined by PCR and SmaI-digested genomic enterococcal DNAs were analyzed by pulsed-field gel electrophoresis. RESULTS: All of the 17 strains of VREFM were resistant to ampicillin, vancomycin, and teicoplanin and they showed the same genotype (vanA). SmaI-digested genomic DNAs of seven strains isolated from urine were typed as I (1), II (1), IIIb (4), and IV (1). Three strains from skin swabs were I (2) and II (1). Six strains from rectal swabs were I (2), II (1), and IIIa (3). Genomic DNA typing of one isolate from a rectal swab failed. Each genomic DNA type of VREFM strains isolated from skin swabs of two patients were the same with those from urine specimens as I and II, respectively. CONCLUSIONS: This study suggests that VRE strains colonized in the intestines can cause infections after skin colonizing and can be transmitted/propagated to other people through skin contact. In conclusion, it is important for the prevention of the dissemination of VRE that controls for patients' skin hygiene, as well as hand washing by medical persons, be put in place.
Agar ; Ampicillin ; Busan ; Colon ; Diffusion ; DNA ; DNA Fingerprinting ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus faecium ; Epidemiologic Studies ; Epidemiology ; Genotype ; Hand Disinfection ; Humans ; Hygiene ; Infant, Newborn ; Intensive Care, Neonatal* ; Intestines ; Korea ; Molecular Epidemiology* ; Polymerase Chain Reaction ; Skin ; Teicoplanin ; Vancomycin

PURPOSE: To observe MR findings of vascular abnormality in Sturge-Weber syndrome and to determine the value of MRI in diagnosis. MATERIALS AND METHODS: Ten patients with Sturge-Weber syndrome (age : 3 months-32 years)were evaluated by MR imaging ; in six and four cases, respectively, the results were correlated with those of CT and angiography. We retrospectively analysed changes in the cortical vein and deep venous system, including the medullary and subependymal vein, as well as an largement of the choroid plexus, leptomeningeal enhancement, and changes in diploic space. RESULTS: In all cases except one, in which non-contrast enhanced study had been performed, varying degrees of leptomeningeal enhancement were seen. In nine cases the cortical vein became smaller; enlargement of the choroid plexus was seen in eight cases, change in the diploic space in seven (including three in which there was angiomatous involvement), and enlargement of the deep venous system in seven. In younger patients, collateral pathways were less developed and leptomeningeal angiomatous changes were more pronounced than in those who were older. CONCLUSION: MRI is a useful modality for the evaluationn of vascular changes in Sturge-Weber syndrome. These changes vary according to a patient's age and the duration of the disease.
Angiography ; Choroid Plexus ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Sturge-Weber Syndrome* ; Veins

BACKGROUND: The effect of patient-prosthesis mismatch (PPM) on the clinical outcome following aortic valve replacement (AVR) remains controversial. This study compared the surgical outcomes of AVR between patients with a patient-prosthesis mismatch and those having undergone an aortic annular enlargement. MATERIAL AND METHOD: Six hundred and twenty seven adult patients, who underwent AVR with stented bioprosthetic or mechanical valves, between January 1996 and February 2006, were evaluated. PPM was defined as an indexed effective orifice area (iEOA) < or =0.85 cm2/m2, and severe if the iEOA < or =0.65 cm2/m2. PPM was present in 103 (16.4%, PPM group) patients, and severe in 11 (1.8%, SPPM group). During the period of the study, 21 patients underwent an AVR with annular enlargement (AE group). RESULT: The mean iEOA of the AE group was larger than that of the PPM group (0.95 vs. 0.76 cm2/m2, p=0.00). The AE group had longer CPB, ACC and operation times than the PPM group, and showed a tendency toward higher operative mortality (14.3% vs. 2.9%, p=0.06). The SPPM group had higher AV pressure gradients (peak/mean) than the AE group (72/45 mmHg vs. 38/25 mmHg, p=0.02/0.06) and suffered more AV related events (AV reoperation or severe aortic stenosis)(45.5% vs. 9.5%, p=0.03). LV masses were not regressed in the patients who experienced an AV related event. CONCLUSION: During AVR in patients with a small aortic annulus, annular enlargement should be carefully applied taking into account the high risk of operative mortality due to annular enlargement and co-morbidities of patients. Aortic annular enlargement; however, should be considered as an alternative method in patients expected to have a severe PPM after an AVR.
Adult ; Aortic Valve* ; Humans ; Mortality ; Prostheses and Implants ; Reoperation ; Stents

CD44 is a glycoprotein expressed in a wide variety of cell types. Recently expression of some alternatively-spliced variants of CD44 transcripts (CD44v) has been suggested to play a potential role in tumor metastasis and the detection of CD44v containing exon 6 to 11 may be helpful for the diagnosis of cancers. Expressions of CD44v containing exon 6 to 11 were investigated in 20 human colorectal cancer samples, peripheral blood leukocytes isolated from colorectal cancer patients, and 4 colorectal cancer cell lines using reverse transcription-polymerase chain reaction and Southern blot analysis. The standard form of CD44 transcripts was expressed in all samples tested. CD44v containing exon 6 to 11 was expressed in 18 cases of colorectal cancers (sensitivity = 90%), 3 out of 4 cell lines, and one normal tissue (specificity = 95%). These results suggest that the expression of CD44v containing exon 6 to 11 can be regarded as tumor specific and that this marker may be helpful for the early diagnosis of colon cancers, if specimens from the early stage are available.
Adenocarcinoma/*genetics ; Adult ; Aged ; Antigens, CD44/*genetics ; Base Sequence ; Blotting, Southern ; Colorectal Neoplasms/diagnosis/*genetics ; DNA Primers ; Electrophoresis, Agar Gel ; Feces/chemistry/cytology ; Female ; Gene Expression Regulation, Neoplastic/genetics ; Human ; Male ; Middle Age ; Molecular Sequence Data ; Polymerase Chain Reaction ; RNA Splicing/*physiology ; RNA, Messenger/analysis ; Tumor Cells, Cultured/*physiology ; Tumor Markers, Biological

Donor-specific anti-human leukocyte antigen antibodies (DSA) following kidney transplantation predict the evolution of humoral rejection and reduced graft survival. Rapid, complete elimination of DSA during antibody-mediated rejection (AMR) is rarely achieved with traditional antihumoral therapies. We report the case of a 39-year-old female who was admitted for increasing azotemia and diagnosed with AMR based on diffusely positive histological changes on C4d immunostaining. In this case, bortezomib reversed the histological changes and induced a reduction in DSA. Proteasome-inhibitor-based combination therapy is a potential means for rapid DSA elimination in antibody-mediated rejection in renal transplant recipients.
Adult ; Antibodies ; Azotemia ; Boronic Acids ; Complement C4b ; Female ; Graft Survival ; HLA Antigens ; Humans ; Kidney Transplantation ; Leukocytes ; Peptide Fragments ; Proteasome Inhibitors ; Pyrazines ; Rejection (Psychology) ; Transplants ; Bortezomib

Donor-specific anti-human leukocyte antigen antibodies (DSA) following kidney transplantation predict the evolution of humoral rejection and reduced graft survival. Rapid, complete elimination of DSA during antibody-mediated rejection (AMR) is rarely achieved with traditional antihumoral therapies. We report the case of a 39-year-old female who was admitted for increasing azotemia and diagnosed with AMR based on diffusely positive histological changes on C4d immunostaining. In this case, bortezomib reversed the histological changes and induced a reduction in DSA. Proteasome-inhibitor-based combination therapy is a potential means for rapid DSA elimination in antibody-mediated rejection in renal transplant recipients.
Adult ; Antibodies ; Azotemia ; Boronic Acids ; Complement C4b ; Female ; Graft Survival ; HLA Antigens ; Humans ; Kidney Transplantation ; Leukocytes ; Peptide Fragments ; Proteasome Inhibitors ; Pyrazines ; Rejection (Psychology) ; Transplants ; Bortezomib

In order to study the functions of migration inhibitory factor (MIF) as macrophage activating cytokine and to investigate the possibility of MIF cDNA as gene therapeutic agent or adjuvant, we produced recombinant MIF (rMIF), anti-MIF antibody and pcDNA I plasmid containing mMIF cDNA (mMIF plasmid). We have investigated the effects of recombinant mMIF or mMIF plasmid on the expression of immune response-related gene in the mouse peritoneal macrophage or splenocyte. Recombinant mMIF produced by Baculovirus expression system was biologically active; it increased mRNA expression of tumor necrosis factor (TNF)-a, Interleukin (IL)-1, IL-6, granulocyte monocyte-colony stimulating factor (GM-CSF), nitric oxide synthase (NOS), Fas and Bcl-x when applied to the cultures of mouse peritoneal macrophage. Anti-mMIF antibody blocked these effects of mMIF on macrophage. Plasmid DNA carrying MIF cDNA inoculated into mouse peritoneal cavity also increased mRNA transcriptions from TNF, IL-1, IL-6, IL-12, GM-CSF, NOS genes of peritoneal macrophage. It enhanced proliferation of splenocyte stimulated with phorbol myristate acetate and IL-2 mRNA expression of splenocytes. Frorn these results, we conclude that rMIF is a strong macrophage activating factor and especially MIF plasmid can be used as an immune potentiating DNA drug in gene therapy for cancer or DNA adjuvant in vaccination in future.
Animals ; Baculoviridae ; DNA ; DNA, Complementary* ; Genetic Therapy ; Granulocyte-Macrophage Colony-Stimulating Factor ; Granulocytes ; Interleukin-1 ; Interleukin-12 ; Interleukin-2 ; Interleukin-6 ; Interleukins ; Macrophages* ; Macrophages, Peritoneal ; Mice ; Nitric Oxide Synthase ; Peritoneal Cavity ; Plasmids ; RNA, Messenger* ; Tetradecanoylphorbol Acetate ; Tumor Necrosis Factor-alpha ; Vaccination