INTRODUCTION: To prevent hemodialysis-related infections, it is important to maintain hemodialysis system without microbial contamination. In May 2003, routine surveillance showed that dialysis water from dialysis port was contaminated with bacteria. To identify the causes of the contamination, we conducted an investigation as follows. METHODS: Patients undergoing dialysis were carefully monitored to see whether evidences of pyrogenic reactions or infections were present. Factors that could have influence on bacterial contamination in hemodialysis systems were thoroughly examined. In addition, microbiologic surveillances were done 7 times in 1 month. RESULTS: Although pyrogenic reactions or bacteremia did not occur, R. pickettii was repeatedly isolated above the Association for the Advancement of Medical Instrumentation (AAMI) standards from almost all dialysis units. Bacterial counts of specimens were higher in the proximal part of the water supply tube than the other parts in all dialysis machines. The colony count of R. pickettii exceeded the maximum level of technical limit in the specimens collected from the dialysis machines in the early morning after intermission of 48 hours. The structure of the supply tube was suspected as the origin of the colonization because stagnant water is a reservoir for bacterial multiplication. After remodeling the structure of the water supply tube, neither R. pickettii nor any other bacteria were isolated. CONCLUSION: Our investigation successfully identified the source of R. pickettii contamination of reverse osmosis water. Appropriate corrective measures for water distribution systems of hemodialysis center could prevent outbreak of dialysis-associated illnesses.
Bacteremia ; Bacteria ; Bacterial Load ; Colon ; Dialysis ; Humans ; Osmosis ; Ralstonia ; Ralstonia pickettii ; Renal Dialysis ; Water ; Water Supply

A hospital-based case-control study was carried out to investigate the risk factors of uterine cervical cancer in korea. Information on a wide-range of life-styles, which might be related with uterine cervix cancer, has been routinely collected through a dual application of the self-administered questionnaire and the direct interview by a well-trained nurse at the Department of Gynecology, Seoul National University Hospitals since 1992. The number of cervical cancer cases, histologically confirmed at the hospital, were 284. Included were 939 women as controls, who were free of past history of any malignancies. Adjusted odds ratio and 95% confidence limits were based on the unconditional logistic regression model. The multivariate logistic model was constructed under the consideration of biologic characteristics on the natural history of the malignancy. In the multivariate results, the uterine cervical cancer risk was higher in women of shorter height(P(trend) <0.05), less educated spouse (P(trend) < 0.001), multiple marriages(adjusted OR=2,70,95% C.I. 1.64~4.47), ever had a family history (adjusted OR=2.14., 95 % C.I. l.18~3.89), multiparity (P(trend) < 0.001), and early age at first delivery (P(trend) < 0.001). These results strongly suggest that the uterine cervix cancer might be related to the reproductive factors, and probably with sexual behaviour of both women and men in Korea.
Case-Control Studies* ; Cervix Uteri* ; Female ; Gynecology ; Hospitals, University ; Humans ; Korea* ; Logistic Models ; Male ; Natural History ; Odds Ratio ; Parity ; Population Characteristics ; Surveys and Questionnaires ; Risk Factors* ; Seoul ; Spouses ; Uterine Cervical Neoplasms

A 60-yr-old man developed progressive gait disturbance and limb ataxia at the age of 52. Family history was absent for neurological disorders. Examinations showed pure cerebellar syndrome. There was no retinal degeneration for 7 yr. A brain MRI done at the age of 56 showed atrophy of the cerebellar hemispheres and vermis. Genetic test confirmed the spinocerebellar ataxia type 7 with CAG repeat number of 42.
Brain/pathology ; Humans ; Korea ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retinal Degeneration/genetics/*pathology ; Spinocerebellar Ataxias/genetics/*pathology ; Trinucleotide Repeat Expansion

PURPOSE: Early detection of diabetic nephropathy is very important for prevention of renal failure. Determination of microalbuminuria has been suggested as an early predictor of diabetic nephropathy, but it is tend to be erroneous and inaccurate, especially in childhood. The aim of this study is to show clinical values of serum cystatin C and beta(2)-microglobulin in the assessment of renal function in diabetic children and adolescents. METHODS: Ninety four type 1 and 2 diabetic patients with normoalbuminuria (n=78), microalbuminuria (n= 15) and macroalbuminuria (n=1) were enrolled. Serum concentration of cystatin C, beta2-microglobulin, creatinine, urinary microalbumin levels and creatinine clearances were determined. RESULTS: In patients with microalbuminuria, serum concentration of cystatin C was increased significantly in comparison to patients with normoalbuminuria (P<0.05), while no differences were observed for beta2- microglobulin levels. Serum creatinine concentrations were not different between both groups. Serum concentration of cystatin C was positively correlated with serum beta2-microglobulin and serum creatinine. The serum concentration of beta2-microglobulin was not correlated with the decrease of renal function significantly. CONCLUSION: Serum cystatin C is a useful endogenous marker in assessment of renal function in pediatric diabetic patients.
Child ; Creatinine ; Cystatin C ; Diabetic Nephropathies ; Humans ; Renal Insufficiency

Ulnar neuropathy around the elbow in patients with rheumatoid arthritis can occur by synovial invasion, flexion contracture or valgus deformity of the elbow. However, attritional rupture of the ulnar nerve by medial osteophyte with synovial invasion of the rheumatoid elbow is extremely rare. We reported a case of attritional rupture of the ulnar nerve by medial osteophyte in 62 years-old male with rheumatoid arthritis. Exact diagnosis and proper treatment are required if symptoms of ulnar neuropathy present in rheumatoid arthritis with contracture and valgus deformity of the elbow.
Arthritis, Rheumatoid ; Congenital Abnormalities ; Contracture ; Elbow ; Humans ; Male ; Osteophyte ; Rupture ; Ulnar Nerve ; Ulnar Neuropathies

We report an unusual case of venous thrombosis complicated by pyogenic psoas muscle abscess in a patient with chronic biliary tract disease. A 64-year-old woman presented with high fever and progressive back and left flank pain. She had been admitted because of recurrent cholangitis and liver abscess 7 months ago. Both abscess and blood cultures had revealed Klebsiella pneumoniae and she had improved with treatment of antibiotics and percutaneous drainage of abscess. Computed tomography demonstrated psoas abscess and thrombosis of inferior vena cava and left iliac vein adjacent to abscess. Several days later, abscess culture showed Klebsiella pneumoniae. Because there was no evidence of deep vein thrombosis and the thrombosis was confined only to the vein adjacent to the abscess, we considered that the thrombosis would be associated with the abscess. She was immediately treated with percutaneous drainage of abscess and antibiotics. Follow-up computed tomography demonstrated complete disappearance of both psoas abscess and venous thrombosis.
Abscess* ; Anti-Bacterial Agents* ; Biliary Tract Diseases ; Cholangitis ; Drainage* ; Female ; Fever ; Flank Pain ; Follow-Up Studies ; Humans ; Iliac Vein ; Klebsiella pneumoniae ; Liver Abscess ; Middle Aged ; Psoas Abscess* ; Psoas Muscles ; Thrombosis ; Veins ; Vena Cava, Inferior ; Venous Thrombosis*

Neuroendocrine tumor is a very heterogenous group arising from the neuroendocrine cells. Especially, large cell neuroendocrine tumor of the ovary is a extremely rare aggressive neoplasm, characteristically arising in association with a surface epithelial tumor. This report describes a mixed type of large cell neuroendocrine carcinoma and adenocarcinoma of the ovary. A 63-year old woman presented with abdominal distension and discomfort underwent staging laparotomy under the impression of ovarian cancer. The operation revealed an small ovarian mass with invasion of multiple region in peritoneal cavity by the tumor. Immunohistochemical and ultrastructural analysis confirmed the neuroendocrine nature of the tumor. The adenocarcinoma in this case is mixture of mucinous and endometrioid type. A diagnosis of stage IIIc mixed large cell neuroendocrine tumor and adenocarcinoma of the ovary was rendered. She is subsequently being treated with Paclitaxel and Carboplatin combination chemotherapy.
Adenocarcinoma* ; Carboplatin ; Carcinoma, Neuroendocrine ; Diagnosis ; Drug Therapy, Combination ; Female ; Humans ; Laparotomy ; Middle Aged ; Mucins ; Neuroendocrine Cells ; Neuroendocrine Tumors* ; Ovarian Neoplasms ; Ovary* ; Paclitaxel ; Peritoneal Cavity

BACKGROUND: The aim of this study was to analyze the clinical manifestations and efficacy of treatment regimens in order to determine the adequate combination of anti-tuberculotic agent and duration of treatment for tuberculous lymphadenitis. METHODS: We made a review of 373 patients with tuberculous lymphadenitis, who were admitted to four medical college hospitals in Taegu Korea from 1989 to 1998, and their diagnoses were confirmed histologically and bacteriologically. RESULTS: The incidence of tuberculous lymphadenitis was 71.3% in women and 57.7% were between the ages of 20 and 39 years. The most common symptom was painless swelling. The most commonly involved lymph nodes were unilateral superficial cervical lymph node groups. Tuberculous lymphadenitis was accompanied with active pulmonary tuberculosis, commonly. The sensitivity of fine needle aspiration(FNA) in tuberculous lymphadenitis was 79.6% and 92.2% of the patients had a strong positive reaction to the tuberculin skin test. The most commonly prescribed anti-tuberculotic regimen was the combination of INF, RMP, EMB and PZA(62.6%). Eighty percent of patient were treated for 9-12 months. There was no significantly difference in the recurrence rate of tuberculous lymphadenitis between the combinations of anti-tuberculotic agent, including INF and RMP, and between the durations of treatment, for a period of 6 months of treatment, for a period of 6 months of more. CONCLUSION: The combination of FNA cytologic examination and tuberculin skin test may be helpful in the diagnosis of tuberculous lymphadenitis. We propose that the combination of anti-tuberculotic agents, INH, RMP, EMB, and PZA, be prescribed to patients for 6 to 9 months.
Daegu ; Diagnosis ; Female ; Humans ; Incidence ; Korea ; Lymph Nodes ; Needles ; Recurrence ; Skin Tests ; Tuberculin ; Tuberculosis, Lymph Node* ; Tuberculosis, Pulmonary

PURPOSE: To investigate the chemotherapeutic effect of quercetin against cancer cells, signaling pathway of apoptosis was explored in human pancreatic cells. METHODS: Various anticancer drugs including adriamycin, cisplatin, 5-fluorouracil (5-FU) and gemcitabine were used. Cell viability was measured by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphe-nyltetra zolium bromide assay. Apoptosis was determined by 4'-6-diamidino-2-phenylindole nuclei staining and flow cytometry in PANC-1 cells treated with 50 microg/mL quercetin for 24 hours. Expression of endoplas mic reticulum (ER) stress mediators including, Grp78/Bip, p-PERK, PERK, ATF4, ATF6 and GADD153/CHOP proteins were measured by Western blot analysis. Mitochondrial membrane potential was measured by fluorescence staining with JC-1, rhodamine 123. Quercetin induced the apoptosis of PANC-1, which was characterized as nucleic acid and genomic DNA fragmentation, chromatin condensation, and sub-G0/G1 fraction of cell cycle increase. But not adriamycin, cisplatin, gemcitabine, and 5-FU. PANC-1 cells were markedly sensitive to quercetin. RESULTS: Treatment with quercetin resulted in the increased accumulation of intracellular Ca2+ ion. Treatment with quercetin also increased the expression of Grp78/Bip and GADD153/CHOP protein and induced mitochondrial dysfunction. Quercetin exerted cytotoxicity against human pancreatic cancer cells via ER stress-mediated apoptotic signaling including reactive oxygen species production and mitochondrial dysfunction. CONCLUSION: These data suggest that quercetin may be an important modulator of chemosensitivity of cancer cells against anticancer chemotherapeutic agents.
Apoptosis* ; Benzimidazoles ; Blotting, Western ; Carbocyanines ; Cell Cycle ; Cell Survival ; Chromatin ; Cisplatin ; Deoxycytidine ; DNA Fragmentation ; Doxorubicin ; Drug Therapy ; Flow Cytometry ; Fluorescence ; Fluorouracil ; Humans ; Membrane Potential, Mitochondrial ; Pancreatic Neoplasms ; Quercetin* ; Reactive Oxygen Species ; Reticulum ; Rhodamine 123

OBJECTIVE: To evaluate the impact of radiation dose and reconstruction algorithms on radiologists' preferences, and whether an iterative reconstruction in image space (IRIS) can be used for dose reduction in chest CT. MATERIALS AND METHODS: Standard dose chest CT (SDCT) in 50 patients and low dose chest CT (LDCT) in another 50 patients were performed, using a dual-source CT, with 120 kVp and same reference mAs (50 mAs for SDCT and 25 mAs for LDCT) employed to both tubes by modifying the dual-energy scan mode. Full-dose data were obtained by combining the data from both tubes and half-dose data were separated from one tube. These were reconstructed by using a filtered back projection (FBP) and IRIS: full-dose FBP (F-FBP); full-dose IRIS (F-IRIS); half-dose FBP (H-FBP) and half-dose IRIS (H-IRIS). Ten H-IRIS/F-IRIS, 10 H-FBP/H-IRIS, 40 F-FBP/F-IRIS and 40 F-FBP/H-IRIS pairs of each SDCT and LDCT were randomized. The preference for clinical usage was determined by two radiologists with a 5-point-scale system for the followings: noise, contrast, and sharpness of mediastinum and lung. RESULTS: Radiologists preferred IRIS over FBP images in the same radiation dose for the evaluation of the lungs in both SDCT (p = 0.035) and LDCT (p < 0.001). When comparing between H-IRIS and F-IRIS, decreased radiation resulted in decreased preference. Observers preferred H-IRIS over F-FBP for the lungs in both SDCT and LDCT, even with reduced radiation dose by half in IRIS image (p < 0.05). CONCLUSION: Radiologists' preference may be influenced by both radiation dose and reconstruction algorithm. According to our preliminary results, dose reduction at 50% with IRIS may be feasible for lung parenchymal evaluation.
Adolescent ; Adult ; Aged ; *Attitude of Health Personnel ; Contrast Media ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; *Radiation Dosage ; Radiographic Image Enhancement/*methods ; *Radiography, Thoracic ; *Radiology ; Tomography, X-Ray Computed/*methods ; Young Adult