BACKGROUND: As the population of immunocompromised patients continues to grow, the incidence of infections caused by opportunistic filamentous fungi will continue to increase. Inhalation of fungal spores which are found in the environmental air precedes infection with molds. We investigated the relative frequency of various molds recovered from hospital air as compared to isolates from clinical specimens. METHODS: Air samples were taken from 83 sites in Chonnam University Hospital during December 1997. Air sampler (Biotest, Germany) with Rose Bengal agar strip (Biotest, Germany) was calibrated to take 40 liters of air. The strips were incubated at 37degrees C for 2-14 days. The results of air cultures were compared with those from the clinical specimens during a year (1997). RESULTS: Of 83 air samples cultured, 61 (73.5%) were positive for molds: 43 (51.8%) samples with 1-2 CFU, 15 (18.1 %) samples with 3-5 CFU, and 3 (3.6%) samples with > 5 CFU. A total of 184 molds were isolated and the most frequently recovered molds were Cladosporium (26.0%), followed by Penicillium (25.5%), Aspergillus (18.5%) and Alternaria (9.8%). The most frequently isolated molds from clinical specimens were Aspergillus (62.8%) and Fusarium (20.2%). For Aspergillus species, A. flavus (28,8%) and A. fumigates (25.4%) were predominant among the clinical isolates, whereas A sydowii (44.1%) and A. niger (38.2%) were common in the hospital air. CONCLUSION: This result shows that Cladosporium and Penicillium are the predominant molds in the hospital air and the relative frequency of molds recovered from hospital air is quite different from those of clinical isolates.
Agar ; Alternaria ; Aspergillus ; Cladosporium ; Fungi* ; Fusarium ; Immunocompromised Host ; Incidence ; Inhalation ; Jeollanam-do ; Niger ; Penicillium ; Rose Bengal ; Spores, Fungal

Cancer of the vulva accounts for approximately 0.5% of all gynecologic malignancies. At diagnosis, one-third of these cases is detected in an advanced stage (FIGO stages III, IV), and local extension of primary vulvar cancer may involve adjacent midline structures such as the clitoris, urethra, vagina, and anus. Initial surgical therapy of such locally advanced primary cancers may compromise the functional integrity of midline structures, necessitating ultraradical surgery including pelvic exenteration. In view of the relatively elderly age of the patients and the morbidity of this ultraradical dissection, concomitant chemoradiation therapy - that the efficacy had been proven in head and neck cancer, anal cancer has approached for patients with locally advanced vulvar cancer. We experienced a case of stage III vulvar cancer patient, who underwent concomitant chemoradiation therapy with 5-fluorouracil(FU) and cisplatin and who showed complete response. So, we report this case with brief review of the literatures.
Aged ; Anal Canal ; Anus Neoplasms ; Cisplatin ; Clitoris ; Diagnosis ; Female ; Head and Neck Neoplasms ; Humans ; Pelvic Exenteration ; Urethra ; Vagina ; Vulvar Neoplasms*

PURPOSE: To evaluate the MR findings of septic thrombosis of the cavernous sinus. MATERIALS AND METHODS: Eleven MR images of six patients with septic cavernous sinus thrombosis obtained over a five-year period and proven clinically or radiologically were retrospectively reviewed. The contour and enhancement pattern of the cavernous sinus, changes in the internal carotid artery, orbit, pituitary gland and sphenoid sinus, and intracranial abnormalities were analyzed and compared with the findings of follow-up studies. RESULTS: In all six patients, contrast study revealed asymmetrical enlargement of the ipsilateral cavernous sinus and multiple irregular filling defects within it. Narrowing of the cavernous portion of the ipsilateral internal carotid artery was noted in five patients, upward displacement of the ipsilateral internal carotid artery in four, ipsilateral proptosis with engorgement of the superior ophthalmic vein in two, pituitary enlargement in five, and inflammatory change in the sphenoid sinus in six. Associated intracranial abnormalities included edema and enhancement in the meninx, temporal lobe, or pons adjacent to the cavernous sinus in four patients, hydrocephalus in one, and cerebral infarction in one. Follow-up MR imaging indicated that the extent of asymmetrical enlargement of the cavernous sinus, filling defects within it, as seen on contrast study, and enlarged pituitary glands had all decreased, without significant interval change. CONCLUSION: MR imaging is useful in the diagnosis of septic cavernous sinus thrombosis. Asymmetrical enlargement of the cavernous sinus, multiple irregular filling defect within it, as seen on contrast study, and changes in the internal carotid artery are characteristic findings.
Carotid Artery, Internal ; Cavernous Sinus Thrombosis* ; Cavernous Sinus* ; Cerebral Infarction ; Diagnosis ; Edema ; Exophthalmos ; Follow-Up Studies ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging ; Orbit ; Pituitary Gland ; Pons ; Retrospective Studies ; Sphenoid Sinus ; Temporal Lobe ; Thrombophlebitis ; Thrombosis ; Veins

PURPOSE: This study was undertaken to analyze whether the p53 codon 72 single nucleotide polymorphism might be correlated with the risk and/or the prognosis of cervical cancer in Korean women. MATERIALS AND METHODS: Peripheral blood samples derived from patients with cervical squamous cell carcinoma (SCC) (n=68), cervical adenocarcinoma (n=37), cervical intraepithelial neoplasia (CIN) III (n=98) and normal controls (n=98) were examined. Germline genomic DNA was extracted from peripheral blood leukocytes and examined by PCR amplification of the specific alleles assay described by Storey et al.5 Statistical analysis was performed using the Chi-Square test or the Kaplan-Meier survival analysis, logistic regression analysis. RESULTS: The proportions of individuals who were homozygous for the proline allele, and heterozygous for the two allele, homozygous for arginine allele in each group were 15%, 47%, 38% in the SCC group; 6%, 7%, 24% in the adenocarcinoma group; 7%, 33%, 60% in the CIN III group; and 11%, 38%, 51% in the control group. No significant difference was found between the three groups (p>0.05). However there was a significant difference in the adenocarcinoma group (p<0.05). Arg/Arg homozygote reduced the risk of adenocarcinoma. No significant difference existed in 5-year survival rates in the three groups (p=0.22 in SCC, p=0.91 in adenocarcinoma). CONCLUSION: These findings suggest that Arg/Arg homozygocity of the p53 codon 72 would be a protective factor against the development of cervical adenocarcinoma.
Adenocarcinoma* ; Alleles ; Arginine ; Carcinoma, Squamous Cell ; Cervical Intraepithelial Neoplasia ; Codon* ; DNA ; Female ; Homozygote ; Humans ; Leukocytes ; Logistic Models ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Prognosis ; Proline ; Survival Rate ; Uterine Cervical Neoplasms

We experienced a case of primary sclerosing cholangitis(PSC) in a 40-year-old female who complained of jaundice and pruritus. Marked elevation of serum alkaline phophatase level, typical beaded appearance and pruned-tree appearance on endoscopic retrograde cholangiography, together with a finding of chronic obliterative fibrosing cholangitis on sono-guided gun biopsy specimen of the liver led to a confirmative diagnosis of PSC. The patient responded to ursodeoxycholic acid (UDCA), but was reluctant to treatment and died of hepatic failure 7 months later. PSC is a very rare disease in Korea. So far, only 5 cases including our present case have been reported in the Korean literature. Male-to-female ratio was 2:3 and the median age was 40(27-80 years old). Ulcerative colitis was associated in one case. Four cases involved both intra, and extrahepatic bile ducts and one case was reported to be confined in the intrahepatic bile ducts. Fatality was in 3 cases, 20 days, 36 days, and 7 months after the initial presentaion, respectively. The causes of death were acute cholangitis and sepsis in two, and hepatic failure in one. We herein report a case of PSC and clinical charateristics of the reported cases in Korea, and review the literature with an emphasis on UDCA treatment in PSC.
Adult ; Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; Biopsy ; Cause of Death ; Cholangiography ; Cholangitis ; Cholangitis, Sclerosing* ; Colitis, Ulcerative ; Diagnosis ; Female ; Humans ; Jaundice ; Korea ; Liver ; Liver Failure ; Pruritus ; Rare Diseases ; Sepsis ; Ursodeoxycholic Acid

Right internal jugular vein is preferred for central venous catheter insertion because of fewer complications. However, insertion-related complications can occur such as arterial puncture, pneumothorax, and hemothorax. Arrhythmia can also occur, but it has been reported to temporarily occur only during guidewire insertion. We report a case of symptomatic paroxysmal atrial fibrillation induced by right internal jugular venous catheterization for hemodialysis. The chest X-ray taken after insertion of the catheter showed that the catheter was advanced too deeply into right atrium from an unusually lower puncture site. The atrial fibrillation persisted nearly 24 hours and was corrected by removal of the catheter. We experienced that paroxysmal atrial fibrillation can be complicated by central venous catheterization, and appropriate selection of puncture site and catheter length is important to avoid it.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Catheterization* ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Heart Atria ; Hemothorax ; Jugular Veins ; Pneumothorax ; Punctures ; Renal Dialysis* ; Thorax

BACKGROUND: Vancomycin-resistant enterococci (VRE) are multi-drug resistant organisms that have emerged as important nosocomial pathogens in recent years. Patients with burn injury are highly vulnerable to VRE infection. We evaluated the colonization and infection rate of VRE among severe burn patients. MATERIALS AND METHODS: We retrospectively reviewed VRE isolation in a tertiary hospital burn center from January 2000 to December 2003. We analyzed and compared the clinical characteristics of VRE colonized (isolated in rectal swab) and infected patients. We also analyzed the risk factors of mortality in VRE infection group by using univariate and multivariate analyses. RESULTS: VRE was isolated from 104 of severe burn patients. Mean percent of total body surface area of 104 patients was 45.43+/-22.15%. The most commonly isolated VRE was Enterococcus faecium (82.6%). The VRE infection rate of VRE colonization group was 19/93 (20.4%). There were no differences in clinical characteristics, underlying conditions, and isolates species between VRE colonization and infection groups. The mortality rate of VRE infection group was 40%. The risk factors for mortality were bacteremia (P=0.001) and mechanical ventilation (P=0.024) in univariate analysis. However, independent risk factor for death was only VRE bacteremia [odd ratio=32.803, 95% confidence interval (2.884, 373.129), P=0.005] in multivariate analysis. CONCLUSION: Significant portion of severe burn patients with VRE colonization could progress to VRE infection. Severe burn patients with VRE bacteremia have higher risk of death than patients without VRE bacteremia.
Bacteremia ; Body Surface Area ; Burn Units ; Burns* ; Colon ; Enterococcus ; Enterococcus faecium ; Humans ; Mortality* ; Multivariate Analysis ; Respiration, Artificial ; Retrospective Studies ; Risk Factors* ; Tertiary Care Centers ; Vancomycin Resistance

BACKGROUND: Vancomycin-resistant enterococci (VRE) are multi-drug resistant organisms that have emerged as important nosocomial pathogens in recent years. Patients with burn injury are highly vulnerable to VRE infection. We evaluated the colonization and infection rate of VRE among severe burn patients. MATERIALS AND METHODS: We retrospectively reviewed VRE isolation in a tertiary hospital burn center from January 2000 to December 2003. We analyzed and compared the clinical characteristics of VRE colonized (isolated in rectal swab) and infected patients. We also analyzed the risk factors of mortality in VRE infection group by using univariate and multivariate analyses. RESULTS: VRE was isolated from 104 of severe burn patients. Mean percent of total body surface area of 104 patients was 45.43+/-22.15%. The most commonly isolated VRE was Enterococcus faecium (82.6%). The VRE infection rate of VRE colonization group was 19/93 (20.4%). There were no differences in clinical characteristics, underlying conditions, and isolates species between VRE colonization and infection groups. The mortality rate of VRE infection group was 40%. The risk factors for mortality were bacteremia (P=0.001) and mechanical ventilation (P=0.024) in univariate analysis. However, independent risk factor for death was only VRE bacteremia [odd ratio=32.803, 95% confidence interval (2.884, 373.129), P=0.005] in multivariate analysis. CONCLUSION: Significant portion of severe burn patients with VRE colonization could progress to VRE infection. Severe burn patients with VRE bacteremia have higher risk of death than patients without VRE bacteremia.
Bacteremia ; Body Surface Area ; Burn Units ; Burns* ; Colon ; Enterococcus ; Enterococcus faecium ; Humans ; Mortality* ; Multivariate Analysis ; Respiration, Artificial ; Retrospective Studies ; Risk Factors* ; Tertiary Care Centers ; Vancomycin Resistance

Background: In 2017, Korea implemented nationwide latent tuberculosis infection (LTBI) project targeting healthcare workers (HCWs). We aimed to assess its performance using the cascade of care model. Methods: We included 45,503 employees of medical institutions with positive interferongamma release assay result who participated between March 2017 and December 2018. We described percentages of LTBI participants completing each step in the cascade of care.Poisson regression model was conducted to assess individual characteristics and factors associated with not-visiting clinics for further care, not-initiating LTBI treatment, and notcompleting treatment. Results: Proportions of visiting clinics and initiating and completing treatment in HCWs were 54.9%, 38.5%, and 32.0%, respectively. Despite of less likelihood of visiting clinics and initiating LTBI treatment, older age ≥ 65 years were more likely to complete treatment (adjusted relative risk [aRR], 0.80; 95% confidence interval [CI], 0.64–0.99), compared to young age < 35 years. Compared to nurses, doctors were less likely to visit clinic; however, were more likely to initiate treatment (aRR, 0.88; 95% CI, 0.81–0.96). Those who visited public health centers were associated with not-initiating treatment (aRR, 1.34; 95% CI, 1.29–1.40). When treated at private hospitals, 9-month isoniazid monotherapy was less likely to complete treatment, compared to 3-month isoniazid and rifampicin combination therapy (aRR, 1.33; 95% CI, 1.16–1.53). Conclusion Among employees of medical institutions with LTBI, only one third completed treatment. Age, occupation, treatment center, and initial regimen were significantly related to LTBI treatment performance indicators. Rifampicin-based short treatment regimens were effective under standard of care.

Coccidioidomycosis is caused by a dimorphous fungus, Coccidioides, which consists of two species, C. immitis and C. posadasii. Although these organisms are genetically distinct and do not exchange DNA, they appear identical phenotypically and the disease or immune response to the organisms is also identical. Coccidioides grows as a mycelium in the soil and is mainly found in Southwestern United States, northwestern Mexico, and Argentina. An infection usually results from inhaling the spores of the fungus in an endemic area. Patients with a localized infection and no risk factors for complications often require only a periodic reassessment to demonstrate the resolution of the self-limited process. However, patients with extensive spread of infection or high risk of complications as a result of immunosuppression or other preexisting factors require a variety of treatment strategies such as antifungal therapy, surgical debridement, or both. Korea is not endemic area of a coccidioidomycosis. We report a case of disseminated coccidioidomycosis involving the lung and skin, which was detected incidentally after sunburn in a 69 year-old Korean male with diabetes mellitus and iatrogenic Cushings syndrome, with a review of the relevant literature.
Aged ; Argentina ; Coccidioides ; Coccidioidomycosis* ; Debridement ; Diabetes Mellitus* ; DNA ; Fungi ; Humans ; Immunosuppression ; Inhalation ; Korea ; Lung* ; Male ; Mexico ; Mycelium ; Risk Factors ; Skin* ; Soil ; Southwestern United States ; Spores ; Sunburn