BACKGROUND/AIMS: Fecal microbiota transplantation (FMT) is a highly effective therapy for refractory and recurrent Clostridium difficile infection (CDI). Despite its excellent efficacy and recent widespread use, FMT has not been widely used in South Korea thus far. We describe our experience with FMT to treat refractory/recurrent CDI. METHODS: We conducted a chart review of patients who underwent FMT for refractory/recurrent CDI at Inha University Hospital, between March 2014 and June 2016. The demographic information, treatment data, and adverse events were reviewed. FMT was administered via colonoscopy and/or duodenoscopy. All stool donors were rigorously screened to prevent infectious disease transmission. RESULTS: FMT was performed in nine patients with refractory/recurrent CDI. All patients were dramatically cured. Bowel movement was normalized within one week after FMT. There were no procedure-related adverse events, except aspiration pneumonia in one patient. During the follow-up period (mean 11.4 months), recurrence of CDI was observed in one patient at one month after FMT due to antibiotics. CONCLUSIONS: FMT is a safe, well-tolerated and highly effective treatment for refractory/recurrent CDI. Although there are many barriers to using FMT, we expect that FMT will be widely used to treat refractory/recurrent CDI in South Korea.
Anti-Bacterial Agents ; Clostridium difficile* ; Clostridium* ; Colonoscopy ; Disease Transmission, Infectious ; Duodenoscopy ; Fecal Microbiota Transplantation* ; Follow-Up Studies ; Gastrointestinal Microbiome ; Humans ; Korea ; Pneumonia, Aspiration ; Recurrence ; Tissue Donors

PURPOSE: To investigate whether prenatal exposure to indoor fine particulate matter (PM2.5) and environmental tobacco smoke (ETS) affects susceptibility to respiratory tract infections (RTIs) in infancy, to compare their effects between prenatal and postnatal exposure, and to determine whether genetic factors modify these environmental effects. METHODS: The study population consisted of 307 birth cohort infants. A diagnosis of RTIs was based on parental report of a physician's diagnosis. Indoor PM2.5 and ETS levels were measured during pregnancy and infancy. TaqMan was used for genotyping of nuclear factor erythroid 2-related factor (Nrf2) (rs6726395), glutathione-S-transferase-pi (GSTP) 1 (rs1695), and glutathione-S-transferase-mu (GSTM) 1. Microarrays were used for genome-wide methylation analysis. RESULTS: Prenatal exposure to indoor PM2.5 increased the susceptibility of lower RTIs (LRTIs) in infancy (adjusted odds ratio [aOR]=2.11). In terms of combined exposure to both indoor PM2.5 and ETS, prenatal exposure to both pollutants increased susceptibility to LRTIs (aOR=6.56); however, this association was not found for postnatal exposure. The Nrf2 GG (aOR=23.69), GSTM1 null (aOR=8.18), and GSTP1 AG or GG (aOR=7.37) genotypes increased the combined LRTIs-promoting effects of prenatal exposure to the 2 indoor pollutants. Such effects of prenatal indoor PM2.5 and ETS exposure were not found for upper RTIs. CONCLUSIONS: Prenatal exposure to both indoor PM2.5 and ETS may increase susceptibility to LRTIs. This effect can be modified by polymorphisms in reactive oxygen species-related genes.
Cacao* ; Cohort Studies ; Diagnosis ; Genotype ; Humans ; Infant ; Methylation ; Odds Ratio ; Oxygen ; Parents ; Particulate Matter ; Parturition ; Pregnancy ; Respiratory Tract Infections* ; Smoke* ; Tobacco

The present study was carried out to examine the toxicity and target organs of oral cholera vaccine (OCV) after repeated oral administration in Sprague-Dawley rats for 6 weeks (3 administrations, once every 2 weeks). OCV is an inactivated oral cholera vaccine that contains Vibrio cholerae and confers protection against cholera caused by V. cholera serogroups O1 (Inaba and Ogawa serotypes) and O139 (strain 4260B). The animals were orally administered either OCV placebo (negative control) or OCV at a dose equivalent to 240 times the anticipated human dose. Throughout the administration period, no significant change was detected in clinical signs, body weight, food or water consumption, urinalysis results, hematological and clinical biochemistry test results, organ weights, necropsy, or histopathological examination results. Minor changes were found in hematological and clinical biochemistry tests; however, these changes were within normal ranges. The above results suggest that oral administration of OCV in rats did not induce any toxicologically meaningful changes, and the target organs could not be determined. This study was conducted in accordance with the guidelines established by Good Laboratory Practice (2009-183, KFDA, December 22, 2009) and the OECD Principles of Good Laboratory Practice (1997).
Administration, Oral ; Animals ; Biochemistry ; Body Weight ; Cholera ; Drinking ; Humans ; Organ Size ; Rats ; Rats, Sprague-Dawley ; Reference Values ; Urinalysis ; Vibrio cholerae

The purpose of this study was to investigate the clinical, laboratory, and pathologic characteristics of dense deposit disease (DDD) in Korean children and to determine whether these characteristics differ between Korean and American children with DDD. In 2010, we sent a structured protocol about DDD to pediatric nephrologists throughout Korea. The data collected were compared with previously published data on 14 American children with DDD. Korean children had lower 24-hr urine protein excretion and higher serum albumin levels than American children. The light microscopic findings revealed that a higher percentage of Korean children had membranoproliferative glomerulonephritis patterns (Korean, 77.8%; American, 28.6%, P = 0.036), whereas a higher percentage of American children had crescents (Korean, 0%; American, 78.6%, P < 0.001). The findings from the electron microscopy revealed that Korean children were more likely to have segmental electron dense deposits in the lamina densa of the glomerular basement membrane (Korean, 100%; American, 28.6%, P = 0.002); mesangial deposit was more frequent in American children (Korean, 66.7%; American, 100%, P = 0.047). The histological findings revealed that Korean children with DDD were more likely to show membranoproliferative glomerulonephritis patterns than American children. The degree of proteinuria and hypoalbuminemia was milder in Korean children than American children.
Adolescent ; Asian Continental Ancestry Group ; Child ; Child, Preschool ; Creatinine/blood ; Edema/etiology ; Female ; Glomerulonephritis, Membranoproliferative/*pathology ; Hematuria/etiology ; Humans ; Infant ; Infant, Newborn ; Male ; Microscopy, Electron ; Proteinuria/etiology ; Republic of Korea ; Serum Albumin/analysis ; United States

To evaluate the effects of cyclosporin A (CyA) on clinical outcome and pathologic changes in children with IgA nephropathy (IgAN), we retrospectively evaluated 14 children (mean age 8.9+/-2.9 yr; eight males, six females) who were treated with CyA and steroids. The starting dose of CyA was 5 mg/kg per day, and the drug level was maintained at 100-200 ng/mL. The mean CyA level was 183.8+/-48.3 ng/mL (range 120.7-276.0 ng/mL) and the mean duration of CyA therapy was 10.9+/-1.9 months (range 8-12 months). After CyA therapy the mean 24 hr urinary protein excretion declined from 107.1+/-35.1 mg/m2/hr to 7.4+/-2.4 mg/m2/hr (P<0.001) and serum albumin increased from 3.3+/-0.6 g/dL to 4.3+/-0.3 g/dL (P<0.001). At a follow-up biopsy the histological grade of IgAN was improved in seven (50%) of the 14 patients, remained the same in three (21%), and was aggravated in four (29%). Serum creatinine, creatinine clearance, and blood pressure did not differ before and after CyA therapy. Two patients (14%) showed CyA-induced nephrotoxicity at the second biopsy. Our findings indicate that CyA therapy may be effective in reducing proteinuria and regressing renal pathology in a subset of children with IgAN.
Angiotensin-Converting Enzyme Inhibitors/*administration & dosage ; Child ; Cyclosporine/*administration & dosage ; Drug Combinations ; Female ; Glomerulonephritis, IGA/*diagnosis/*drug therapy ; Humans ; Immunosuppressive Agents/administration & dosage ; Male ; Steroids/*administration & dosage ; Treatment Outcome

Dense deposit disease (DDD) is a rare primary glomerulonephritis characterized by continuous band- like intramembranous dense deposits detectable on electron microscopy. We describe a case of DDD with sequential mesangial proliferative glomerulonephritis, membranoproliferative glomerulonephritis, minor glomerular alterations, and a second round of mesangial proliferative glomerulonephritis during a 13-year period. Electron dense deposits were typical of DDD in the first and second biopsies taken one year apart. However, deposits dissolved and the glomerular cellularity and basement membrane normalized with clinical remission, which was achieved by a course of immunosuppressive therapy lasting seven years. The fourth biopsy was performed due to recurrence of microscopic hematuria and showed predominant mesangial IgA deposits without glomerular capillary alteration, which was interpreted as development of IgA nephropathy after remission of DDD or coexistence with nearly healed DDD in this patient.
Basement Membrane ; Biopsy ; Capillaries ; Dichlorodiphenyldichloroethane ; Electrons ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Hematuria ; Immunoglobulin A ; Microscopy, Electron ; Recurrence

PURPOSE: This study comparedthe effectiveness and safety of laparoscopic adrenalectomy with conventional open adrenalectomy for the treatment of pheochromocytoma. METHODS: Medical records of 100 patients who underwent surgical removal of pheochromocytoma (open adrenalectomy, n=59; laparoscopic adrenalectomy, n=39) at Samsung Medical Center from June 1995 to August 2007 were retrospectively reviewed. RESULTS: To draw an appropriate comparison, patients with a tumor less than 7 cm in size were evaluated (open adrenalectomy, n=23; laparoscopic adrenalectomy n=31). No statistically significant differences were evident according to age, gender and tumor size. The mean operating time was 158 min for the open surgery group and 114 minfor the laparoscopic group (P<0.01). The mean postoperative hospital stay was 10.4 days following open surgery and 5.6 days following laparoscopic surgery (P<0.01). The mean volume of the estimated blood loss for the laparoscopic surgery group (482 ml) was less than for the open surgery group (mean 229 ml) (P=0.06), and the time to first oral intake was 1.7 days after laparoscopic adrenalectomy and 3.5 days after open surgery (P<0.01). The frequency of using analgesics for postoperative pain after laparoscopic adrenalectomy was markedly lower than following conventional open adrenalectomy. There was no recurrence or complications during the follow-up periods (mean: 30 months). CONCLUSION: Laparoscopic adrenalectomy offers advantages of less postoperative pain, shorter operative time and a shorter hospital stay as compared with conventional open adrenalectomy. Laparoscopic adrenalectomy for treating pheochromocytoma is a minimally invasive alternative to conventional open adrenalectomy.
Adrenalectomy* ; Analgesics ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Medical Records ; Operative Time ; Pain, Postoperative ; Pheochromocytoma* ; Recurrence ; Retrospective Studies

The purpose of this study was to compare the apical leakage of the root canal filled with the System B and the EndoTwinn (the combined application of heat and ultrasonic vibration). Sixty extracted premolars with straight root were cleaned and shaped to size 35. Group SB was obturated using System B and Group ET was filled with EndoTwinn. A size 35 of 0.06 tapered gutta- percha and Adseal were used and the plugger which could be introduced to 4 mm short of working length was selected in the obturation procedure. As the positive control, Group PC was not filled. In Group SB, ET and PC, all external surfaces of each tooth were coated with nail varnish leaving only 1 mm area around the apical foramen. In the negative control of Group NSB and Group NET, all of external tooth surface including apical foramen was coated with the nail varnish. The specimens were immersed in methylene blue dye solution for 2 days. Then the specimens were sectioned at each 1 mm from apex to 5 mm level. The final score of one specimen was given by summing up of the points at all levels. The dye leakage of Group ET was significantly less than that observed in Group SB (p < 0.05). And the frequency of gutta-percha pulling out from root canal when the plugger was removed was more often with the System B than with EndoTwinn but there was no significant difference.
Bicuspid ; Dental Pulp Cavity ; Gutta-Percha ; Hot Temperature ; Methylene Blue ; Paint ; Tooth ; Tooth Apex ; Ultrasonics

BACKGROUND AND OBJECTIVES: The optimal treatment for in-stent restenosis(SR) s controversial, although intracoronary radiation therapy(CRT) as provided the most consistent results to date. This study was designed to assess the early and late angiographic results, and to find independent predictors of recurrent restenosis, following cutting balloon angioplasty(BA) or ISR. SUBJECTS AND METHODS: Eighty patients(7 lesions) ith first time ISR underwent CBA and systematic follow-up(U) ngiography. A conventional balloon was used before, or after, the CBA, if required. ICRT was used in 18 lesions(1%). A multivariate logistic regression analysis was performed.(why?) RESULTS: he ISR was focal(n=2, 37%), diffuse or proliferative(n=1, 58%) nd occlusive(n=4, 5%). Procedural success was achieved in all 87 lesions(00%). No significant edge dissection occurred. The pre- and post-procedural diameter stenoses(S) ere 81.5+/-10.8% and 6.7+/-6.0%, respectively, and the pre- and post-procedural MLD(efine MLD?) .71+/-0.44 mm and 2.85+/-0.32mm, respectively, with 2.14+/-0.44mm of acute gain. A FU angiography was performed in 54(8%) f the 69 lesions treated with CBA alone. The overall angiographic restenosis rate was 24%(3/54), with 9%(/22) n the focal ISR and 34%(1/32) n the diffuse or occlusive ISR. The FU DS and MLD were 32.0+/-23.4% and 2.1+/-0.7mm, respectively, with 0.79+/-0.69mm of late loss. The length of a restenotic lesion(R 12.2, 95% CI:1.3-115.2, p=.0286) as an independent predictor of recurrent restenosis. CONCLUSION: CBA is a simple and efficient first line treatment for ISR, with an acceptable restenosis rate, and the length of a restenotic lesion is an independent predictor of recurrent restenosis. In diffuse or occlusive ISR, more definite treatment modalities, such as ICRT combined with CBA or debulking techniques, might be required to reduce recurrent restenosis.
Angiography ; Angioplasty ; Angioplasty, Balloon* ; Coronary Restenosis ; Logistic Models ; Stents

Helicobacter pylori has a diversity of vacA allelic types. The purpose of this study was to correlate the vacA status and the clinical outcome. After constructing specific primers for the vacA signal sequence, H. pylori-positive antral biopsy specimens were examined for the vacA status in 25 gastric ulcers, 31 duodenal ulcers, 22 gastric cancers, 42 chronic gastritis, and 8 gastroduodenal ulcers. The relationship between the vacA allele and the clinical disease was examined. The vacA genotype s1c/m1 is predominant in Korea (71/128, 55.5%). Other strains including s1b or s2 were not found in this study. s1c/m1 was more prominent in duodenal ulcers, than in gastric ulcers (p=0.041) and cancer (p=0.029). Seven out of 8 patients with gastric and coexistent duodenal ulcers had the s1c/m1 allele. No statistical differences in the positive rates of the s1a/m1, s1a/m2, and s1c/m2 alleles among the disease groups were found. In conclusion, s1c/m1 is the main vacA allele in Korea and it is particularly associated with duodenal ulcers.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; *Alleles ; Amino Acid Sequence/genetics ; Bacterial Proteins/*genetics/metabolism ; Child ; Helicobacter Infections/physiopathology/virology ; Helicobacter pylori/*genetics ; Human ; Korea ; Middle Age ; Molecular Sequence Data