No abstract available.
Lung Neoplasms* ; Lung*

BACKGROUNDS : Extended spectrum beta-lactamases (ESBL) are plasmid-mediated enzymes that confer broad-spectrum resistance to aztreonam, most penicillins, and cephalosporins including ceftazidime, cefotaxime and ceftriaxone. But with most routine susceptibility tests, ESBL-producing strains may not appear to be resistant, which makes it difficult to predict the effectiveness of the beta-lactam agents. In this study, we performed several test procedures to detect ESBL in blood isolates of Klebsiella pneumoniae and examined the risk factors for bacteremia due to ESBL-producing K. pneumoniae. MATERIALS AND METHODS: Of 87 blood culture Isolates of K. pneumoniae during the first 7 month of 1996, 39 showed reduced susceptibilities to at least one of the 4 antibiotics, aztreonam, cefotaxime, ceftazidime and ceftriaxone. Twenty-three of the 39 isolates were assailable for screening for ESBL. Antibiotic resistance was tested by the agar dilution method and beta-lactamase assay using nitrocefin disks. Effect of beta-lactamase inhibition was examined by the doubledisk synergy test using aztreonam, cefotakime, ceftazldime, and ticarc illin/clavulanate disks and by ESBL Etest involving ceftazidime and cert tazidime/clavulanate. Ability to transfer the beta-lactam resistance was tested by conjugation. We also reviewed the medical records of the patients with K. pneumoniae. (21 with and 41 without ESBL) bacteremia to ananlyze their clinical characteristics. RESULTS: Of 23 strains tested, reduced susceptibilities to cefotaxime, aztreon am and ceftazidime were shown in 23, 18, and 18 strains, respectively. All strains were positive for beta-lactamase and its activity was trasfered to E. coli in all strains. Activities of beta-lactamases were shown to be inhibited by clavulanate in 21 strains by the double-disk method, but in only 15 strains by the ESBL Etest. Nineteen of 21 bacteremia were nosocomially acquired. ESBL-producing strains were associated with length of hospitalization, stay in intensive care unit, use of invasive procedures and administration of antibiotics Including penicillins and third-generation cephalosporins. CONCLUSIONS: Although an increasing incidence of and outbreaks by ESBL-producing strains are reported, detection of ESBLs has proved to be difficult. Using several testing methods such as double-disk synergy test, ESBL Etest and conjugation, we estimated that 40.9% of blood isolates of K. pneumoniae produce ESBL. We should pursue for more sensitive and reliable screening methods for the detection of ESBL.
Agar ; Anti-Bacterial Agents ; Aztreonam ; Bacteremia ; beta-Lactam Resistance ; beta-Lactamases* ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins ; Clavulanic Acid ; Disease Outbreaks ; Drug Resistance, Microbial ; Hospitalization ; Humans ; Incidence ; Intensive Care Units ; Klebsiella pneumoniae* ; Klebsiella* ; Mass Screening ; Medical Records ; Penicillins ; Pneumonia ; Risk Factors

Herein we report a 51-year-old male with angioimmunoblastic lymphadenopathy who had developed rnaculopapular eruptions after the administration of crystalline penicillin, acetylsalicylic acid and sulpyrine. Skin biopsy showed mild lyrnphohistiocytic infiltration and extravasated RBCs around the blood vessels in the upper dermis. He had run a progressively downhill course in spite of vigorous chemotherapy and ultimately died.
Aspirin ; Biopsy ; Blood Vessels ; Crystallins ; Dermis ; Dipyrone ; Drug Therapy ; Humans ; Immunoblastic Lymphadenopathy ; Lymphatic Diseases* ; Male ; Middle Aged ; Penicillins ; Skin

No abstract available.
Rectal Fistula*

Potter's syndrome including bilateral renal agenesis or polycystic renal disease, bilateral pulmonary hypoplasia and characteristic face was first described in 1946. Although a great number of cases of Potter's syndrome was reported, Potter's syndrome with adult polycystic kidney disease(Potter type III) was very rarely found. In this report, we described an autopsy case of Potter's syndrome having adult polycystic kidneys disease, bilateral pulmonary hypoplasia and characteristic face in conjunction with multiple hepatic cysts, features of congenital hepatic fibrosis and a pancreatic cyst. Microscopically, all cysts were lined by cuboidal epithelial cells, showing positive for epithelial membrane antigen and cytokeratins.
Adult* ; Autopsy* ; Epithelial Cells ; Fibrosis ; Humans ; Keratins ; Mucin-1 ; Pancreatic Cyst ; Polycystic Kidney Diseases*

Neuroleptic malignant syndrome(NMS) is an uncommon but potentially fatal idiosyncratic reaction to neuroleptics, characterized by muscular rigidity, fever, autonomic dysfunction, and altered consciousness. The major theories to explain NMS is central dopaminergic blockade, but it is unclear. Risperidone is a new antipsychotic drug, a benzisoxazole derivative that blocks dopamine D2 receptor and serotonin type 2 receptor. The comparatively greater serotonin-blocking activity is believed to give risperidone the specific property of not causing any more extrapyramidal side effects than conventional antipsychotics at the optimal dose of 4-8mg/day. It is postulated that risperidone is unlikely to cause NMS. Here, we report a case of risperidone induced neuroleptic malignant syndrome.
Antipsychotic Agents ; Consciousness ; Fever ; Muscle Rigidity ; Neuroleptic Malignant Syndrome* ; Receptors, Dopamine D2 ; Risperidone ; Serotonin

Congenital melanocytic nevus(CMN) constitute a well-known risk factor in the development of malignant melanoma, but melanoma developing in newborn and infants are extremely rare. We describe a case of proliferating nodules within CMN at the age of 13 months. Like our case it is difficult to manage the proliferating lesions within CMN in infants. So we carefully suggest the indications of preventive excision when proliferating lesions occur within CMN as follows; 1) preventive excision is postponed until the age of two when the proliferating lesions are slowly growing, 2) surgical excision is needed when the lesions are rapidly growing exceeding 1 cm in size even though it is before the age of two.
Humans ; Infant ; Infant, Newborn ; Melanoma ; Nevus, Pigmented* ; Risk Factors

Fat can be prominet around the aortic root and within the right atrioventricular (AV) groove (1). At times, the fat can be globular, suggesting a mass especially on echocardiography. Computed tomography (CT) and masnetic resonance (MR) images are well suited for characterization of fat in and around the heart (1, 2). This report illustrates CT and MR findings of a very unusual case of prominent fat lump in the left AV groove.
Echocardiography ; Heart

Fibrolipoma is an uncommon variant of lipomas which shows a distinct pathologic findings with both component of mature adipose cells and broad bands of dense fibrous connective tissue. A 30-year-old woman developed an 5×7cm sized, indurated, ill-defined, subcutaneous mass on the right axilla. Microscopically, the tumor contained broad bands of dense connective tissue with mature adipose tissue scattered throughout the mass, but it did not show encapsulation. The lesion was excised and she showed no evidence of recurrence after 6 months of follow-up.
Adipose Tissue ; Adult ; Axilla ; Connective Tissue ; Female ; Follow-Up Studies ; Humans ; Lipoma ; Recurrence

This study was performed to assess the recurrence rate and the factors related with the recurrence of leprosy and to use the data obtained from the present study for the basis for the prevention of leprosy, among those leprosy patients who were registered and managed by a Catholic Skin Clinic located in the Taegu metropolitan city between January of 1960 to October of 1999. We conducted the present study with 1,245 leprosy patients except 31 who were being treated for active leprosy. Using a structured record sheet, the data were collected using the chart of the patient, and the collected data were analyzed using SPSS program ver 9.0 and Fisher's exact test and chi-square-test was performed. Among 1,245 subjects, the sex distribution was 690 males (55.4%) and 555 females (44.6%). The age at the time of initial occurrence of leprosy was the most prevalent in patients' teen years with 528 patients(42.3%) followed by in their 20's with 366 patients (29.3%). The most prevalent type of leprosy at the initial occurrence of leprosy was type L with 730 patients(58.6%), and the condition of the bacteria at the time of initial occurrence of leprosy was negative in 509 patients(40.8%) and positive in 285 patients(22.9%). The overall recurrence rate was 13.2%. According to gender, males showed the recurrence rate of 15.7% and females 10.1%, showing a higher recurrence rate in males. The recurrence rate according to the type of leprosy was 31.6% of I type with the most prevalence. Among those patients who were initially diagnosed with mycobacterium leprae, 21.1% showed recurrence, and the recurrence rate was significantly higher than in negative mycobacterium leprae patients with 3.3%. The recurrence rate according to the age of initial occurrence of leprosy was the highest in those patients who developed leprosy in their teen years with 17.2%, followed by those who had leprosy in between 20-29 years with 13.4%. According to the administered medication, among those 152 patients who took DDS alone, showed 90.8% recurrence rate; among 1,009 patients took in DDS and switched to MDT, 2.5% showed recurrence; and among patients who were treated with MDT, only 1.2% showed recurrence with the lowest level of recurrence rate. With these results, in the case of DDS treatment cases, in male patients, the positive mycobacterium leprae patients at the time of initial occurrence of leprosy, the type of leprosy being I, and the age of the initial occurrence of leprosy being low; it is important to raise the compliance through education and follow-up. In the future, extensive and in-depth studies are needed to be done in the recurrence of leprosy to elucidate the factors of recurrence and the plans to prevent recurrence need to be established from the public health and policy areas.
Adolescent ; Bacteria ; Compliance ; Daegu ; Education ; Female ; Humans ; Leprosy* ; Male ; Mycobacterium leprae ; Prevalence ; Public Health ; Recurrence* ; Sex Distribution ; Skin