PURPOSE: The overuse and misuse of antimicrobial agents and their resultant emergence of resistant microorganisms have made choices regarding antimicrobial therapy more difficult. We studied the changes of antibiotic sensitivity to the causative organisms of urinary tract infection(UTI) for recent 5 years in order to give some useful informations about the choice of adequate drug in the treatment of UTI. MATERIALS AND METHODS: We analysed 1191 uropathogens and their antibiotic sensitivities of the 1132 patients who admitted or visited the National Police Hospital and had more than 105cfu/ml on urine culture from January 1994 to December 1998 retrospectively. RESULTS: The common pathogenic organisms were E. coli(51.5%), staphylococcus(15.7%), pseudomonas(9.1%), klebsiella(7.5%) and enterobacter(4.0%), enterococcus(3.4%), proteus(3.1%) in order. The incidence of E. coli decreased from 50.8% in 1994 to 41.3% in 1998 but the incidence of other gram negative organisms like pseudomonas, klebsiella, enterobacter, proteus and acinetobacter increased from 24.8% in 1994 to 42.6% in 1998. In E. coli isolates(the majority of positive cultures), resistance to six antibiotics changed significantly: ampicillin(19.4% to 15.5%), piperacillin(44.1% to 32.0%), cephalothin(70.6% to 58.6%), gentamicin(62.8% to 60.2%), tobramycin(95.0% to 88.1%), and ciprofloxacin(87.6% to 76.3%). The sensitivity rates of the gram negative organisms including E. coli were very low in 1998 (ampicillin 11.6%, piperacillin 36.6%, and trimethoprim/sulfamethoxazole 49.3%). CONCLUSIONS: We think that E. coli is still the most important organism in the UTI but we shoud be concerned about the increasing incidence of other gram negative organisms like pseudomonas, klebsiella, enterobacter, proteus and acinetobacter. And prior to receiving the bacteriological report, using ampicillin, trimethoprim/sulfamethoxazole as the first choice in the treatment of UTI shoud be reconsidered.
Acinetobacter ; Ampicillin ; Anti-Bacterial Agents ; Anti-Infective Agents ; Enterobacter ; Humans ; Incidence ; Klebsiella ; Piperacillin ; Police ; Proteus ; Pseudomonas ; Retrospective Studies ; Urinary Tract Infections* ; Urinary Tract*

We report a case of male infertility secondary to pituitary apoplexy, which occurred as a sequela of korean hemorrhagic fever. A 32 years old male patient with past history of korean hemorrhagic fever was studied because of infertility and erectile impotence. The size of his testicles were about 8ml in Rt. and Lt. Semen analysis, endocrinologic studies, and brain MRI demonstrated hypogonadotrophic hypogonadism due to panhypopituitarism. The patient was treated with HCG (2,000 IU) administered intramuscularly three times per week for 6 months. After the treatment, improvement of male secondary sex characteristics such as hair growth and testicle size was noted. Promotion of sexual potency and improvement of semen quality were also noted. Following the treatment, his wife conceived after 6 months.
Adult ; Brain ; Erectile Dysfunction ; Hair ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Hypogonadism ; Infertility ; Infertility, Male* ; Magnetic Resonance Imaging ; Male ; Male* ; Pituitary Apoplexy* ; Semen Analysis ; Sex Characteristics ; Spouses ; Testis

The Kallmanns syndrome is the most common form of isolated hypogonadotropic hypogonadism in which anosmia or hyposmia resulting from agenesis of hypoplasia of the olfactory lobes is associated with LHRH deficiency, This syndrome is genetically heterogeneous and can be trans-mitted as an X-linked, autosomal dominant or autosomal recessive trait. The hypogonadotropic hypogonadism results in absent or incomplete pubertal development and may be associated with anosmia or hyposmia, mid-line defect(color blindness, cleft-lip or
Blindness ; Cryptorchidism ; Epiphyses ; Femur Neck ; Gonadotropin-Releasing Hormone ; Growth Plate ; Head ; Humans ; Hypogonadism ; Kallmann Syndrome ; Male ; Olfaction Disorders ; Olfactory Cortex ; Slipped Capital Femoral Epiphyses

BACKGROUND: QT dispersion(QTd) has been shown to be ventricular electrical instability, especially predictor of ventricular arrythmia and indicator of antiarrythmic effect. It was reported that there was a relationship between acute myocardial infarction and increased QTd in that QTd is dependent of the degree of reperfusion as well as the site and size of infarction. In this study, we intended to verify a significant association between myocardial ischemia and QTd by comparing the changes in QTd with or without chest pain in patients with unstable angina who had proven myocardial ischemic changes. METHOD: We studied 20 patients (12 men and 8 women : mean age, 58+/-3.4 years) with unstable angina who had proven myocardial ischemic changes and perfusion defect by 24 hour Holter monitoring, Treadmill test, or coronary angiography. Each case was measured QTd during chest patin and resting state 24 hours after chest pain. All standard 12-lead ECGs were recorded at a speed of 25 mm/sec and examined retrospectively by one observer. QTd corrected for heart rate (QTcd) was calculated by Bazett's formula. The difference of QTd was assessed by comparing by paired t-test. RESULTS: The mean values of QTd were 117.9+/-49.9 msec and 69.7+/-30.2 msec with existence and the absence of chest pain. There was significant increment of QTd when the paients with unstable angina had chest pain(p<0.01). QTcd also significantly increased with the mean value of 119.7+/-57.1 and 74.9+/-36.6 msec (p=0.015). CONCLUSIONS: The results of this study clarified the change of QTd with myocardial ischemia. We expect QTd using a single, noninvasive method to indicate that the chest pain is induced by myocardial ischemic changes. For the furture, it may be possible to study as to the significance of QTd as a predictor of cardiovascular accidents in patients with unstable angina by measuring the serial QTd.
Angina, Unstable ; Arrhythmias, Cardiac ; Chest Pain ; Coronary Angiography* ; Coronary Stenosis* ; Coronary Vessels* ; Electrocardiography ; Electrocardiography, Ambulatory ; Exercise Test ; Female ; Heart Rate ; Humans ; Infarction ; Male ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Reperfusion ; Retrospective Studies ; Thorax

Subacute thyroiditis is a frequent benign thyroid disease associated with previous viral upper respiratory tract infection. Known complications of this disease are long-standing subclinical hypothyroidism, persistent anterior neck pain and rarely Graves disease. In general, thyroid abscess is an uncommon disease because of anatomic isolation of the gland and its rich system of drainage for blood and lymph. Especially, development of thyroid abscess in subacute thyroiditis is extremely rare phenomenan, but significant bad outcomes can be resulted. Its clinical BACKGROUND containes immune-suppressed state, anatomic defect, presence of underlying other thyroid disease and of non-thyroidal infectious foci. We experienced a case of subacute thyroiditis complicated with streptococcal thyroid abscess during glucocorticoid therapy. The patient was a 19-year-old female who was admitted due to anterior neck pain for 1 month. Typical subacute thyroiditis was suggested from initial laboratory findings including CBC, erythrocyte sedimentation rate, serum T3, T4, TSH levels, thyroid scan & thyroid uptake. But during oral prednisolone therapy, unexpected bacterial thyroid abscess was developed. We report this unusual case with review of literatures.
Abscess ; Blood Sedimentation ; Drainage ; Female ; Graves Disease ; Humans ; Hypothyroidism ; Neck Pain ; Prednisolone ; Respiratory Tract Infections ; Thyroid Diseases ; Thyroid Gland* ; Thyroiditis, Subacute* ; Young Adult

Traumatic rupture of the corpus cavernosum of the penis is rare and has been reported infrequently. We experienced 4 cases of penile fracture for recent 2 years. They occurred during coitus(1 case), masturbation(2 cases), and through blunt trauma(1 case). The former 3 cases were treated with immediate surgical intervention about 12 hours after injury. When the last case patient visited hospital 5 days after injury, the penile abscess treated immediately with surgical intervention had developed. Surgery consisted of complete evacuation of the hematoma or pus and repairing of the tear at the tunica albuginea. The results were excellent, with complete early recovery of erectile function. Delayed wound healing was observed only in a patient who underwent surgery about 5 days after injury, but this did not cause any complication afterward. In our experiences, immediate surgical treatment is recommended in patients with fracture of the penis.
Abscess ; Hematoma ; Humans ; Male ; Penis ; Rupture ; Suppuration ; Wound Healing

PURPOSE: FP(5-FU, Cisplatin) combination is one of the most active regimen for the advanced gastric cancer with a response rate of 50~60%. In spite of this high response rate, there is little evidence that FP regimen results in survival benefit for patients with advanced gastric cancer. This study was performed to evaluate the efficacy and toxicity of this regimen with the addition of levamisole, an immunomodulatory agent, known as enhancing the antitumor effects of 5-FU in other cancer. MATERIALS AND METHODS: Previously untreated patients with metastatic or recurrent gastric cancer were treated with 5-FU(1000 mg/M2 civ, D1~5), cisplatin(60 mg/M2 iv, Dl) every 3 weeks, and levamisole(150 mg/day, Dl~3) every 2 weeks. The major endpoints were response rate, response duration, and toxicities. RESULTS: Between June 1992 and Aug. 1996, thirty three patients were included in this study. Patients received 2~18 cycles of chemotherapy(median 5). Among the evaluable 31 patients, 18 patients(58%, 95% C.I. 40.4~75.7) showed objective responses including one(3.2%) clinical complete response. The median response duration was 7.7 months(95% C.I. 3.6~11.8). During total of 189 cycles of chemotherapy, 79 episodes(41.7%) of leucopenia were observed. There was no death from concurrent infection. CONCLUSION: FPL combination therapy is at least as effective as conventional FP chemotherapy, but resulted in somewhat more myelosuppression.
Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Fluorouracil* ; Humans ; Levamisole* ; Stomach Neoplasms

PURPOSE: Although numerous etiological models of premenstrual syndrome(PMS) such as the biochemical, hormonal, psychosocial models have been proposed, there is no consistent conclusion. Especially, in psychosocial model, state-dependent changes in the perception of stressors according to menstrual cycle phases was suggested for PMS. In this study, we investigated relationship between menstrual cycle and daily minor stressors in young women, and vulnerability to minor stressors in young women with PMS. METHODS: 46 female college students completed modified daily rating form(DRF) of premenstrual symptoms which based on DSM-IV criteria for PMDD, and daily stress inventory(DSI) during at least one menstrual cycle. If the mean score of at least one DRF item during premenstrual phase were more than 3 on 6 point scale and 30% increase in symptom severity during premenstrual phase compared with during postmenstrual phase, they were referred as PMS group(N=20), and the others as non-PMS group(N=26). The event, impact, and impact/event ratio scores of DSI were compared in two groups. Data were analyzed by analysis of variance with repeated measure ANOVA. And post hoc simple; repeated contrast test were performed when indicated by significant repeated measure ANOVA. RESULTS: In all subjects, the event and the impact scores in premenstrual and menstrual phases were significantly higher than in postmenstrual phase. Among the DSI categories, the impact scores of interpersonal problem and cognitive stressors in premenstrual and menstrual phases were significantly higher than in postmenstrual phase. In PMS group, there was a significant difference between premenstrual and postmenstrual phase in the impact score but not in the event score, and the event and the impact scores were significantly increased in menstrual phase than postmenstrual phase. In non-PMS group, the event and the impact scores in premenstrual and menstrual phases were significantly higher than in postmenstrual phase. There was no significant difference in the impact/event ratio scores in both groups. Between the PMS and non-PMS group, there was significant difference in the impact/event ratio scores in premenstrual phase, but not in the event score and the impact scores at any phase. CONCLUSION: Young women may experience more daily minor stressors and may be impacted more severely in premenstrual and menstrual phases than in postmenstrual phase. In premenstrual phase, the young women with PMS are likely to have more vulnerability to daily minor stressors than controls. Further studies using larger sample size with varied age are required.
Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Life Change Events* ; Menstrual Cycle ; Premenstrual Syndrome* ; Sample Size

Eosinophilic gastroenteritis is a rare disorder of the stomach, small intestine and colon, characterized by variable eosinophilic infiltration of the bowel wall and peripheral blood eosinophilia, abnormal gastrointestinal symptoms and signs. The pathogenesis of this disease still remains unknown, but several studies support allergic or immunologic etiology. Considerable variability in clinical presentation depends on the site of the gastrointestinal tract and the depth of bowel wall involvement. Herein we experienced a case of eosinophilic gastroenteritis confined to small intestine presenting progressive weight loss, abdominal pain and diarrhea. Enteroscopic findings showed diffuse multiple nodularity of mucosal folds in small bowel, especially duodenum and proximal jejunum. Jejunal and duodenal biopsy specimen demonstrated marked eosinophilic infiltration. These symptoms and signs were improved within 3 weeks after short course of prednisone therapy.
Abdominal Pain ; Biopsy ; Colon ; Diarrhea ; Duodenum ; Enteritis* ; Eosinophilia ; Eosinophils* ; Gastroenteritis ; Gastrointestinal Tract ; Intestine, Small ; Jejunum ; Prednisone ; Stomach ; Weight Loss

Transient receptor potential vanilloid 1 (TRPV1) affects mood and neuroplasticity in the brain, where its role is poorly understood. In the present study we investigated whether capsaicin (8-methyl-N-vanillyl-trans-6-nonenamide), an agonist of TRPV1, induced chromatin remodeling and thereby altered gene expression related to synaptic plasticity. We found that capsaicin treatment resulted in upregulation of histone deacetylase 2 (HDAC2) in the mouse hippocampus and HDAC2 was enriched at Psd95, synaptophysin, GLUR1, GLUR2 promoters. Viral-mediated hippocampal knockdown of HDAC2 induced expression of Synapsin I and prevented the detrimental effects of capsaicin on Synapsin I expression in mice, supporting the role of HDAC2 in regulation of capsaicin-induced Synapsin I expression. Taken together, our findings implicate HDAC2 in capsaicin-induced transcriptional regulation of synaptic molecules and support the view that HDAC2 is a molecular link between TRPV1 activity and synaptic plasticity.