BACKGROUND: Few reports have documented the clinical characteristics and treatment outcomes of adult patients with Elizabethkingia meningoseptica infection. METHODS: Medical records of patients over 18 years of age and suspected of having an E. meningoseptica infection from March 1, 2006 to February 28, 2013 were reviewed retrospectively. Their clinical characteristics, antimicrobial susceptibility results, and treatment outcomes were analyzed. RESULTS: E. meningoseptica was isolated from 30 patients. Median age was 68.5 years, and infections were more frequent in males (17, 56.7%). The most common isolation source was sputum (23, 76.7%), and pneumonia was the most common condition (21, 70%) after excluding two cases of colonization. This bacterium was most susceptible to minocycline (27, 90%) and fluoroquinolones, including levofloxacin (20, 66.7%) and ciprofloxacin (18, 60%). The mortality rate due directly to E. meningoseptica infection was 20% (6/30), and uncontrolled pneumonia was the only cause of death. After isolating E. meningoseptica, the numbers of patients with pneumonia (9/9, 100% vs. 12/21, 57.1%), history of hemodialysis (5/9, 55.6% vs. 3/21, 14.3%), tracheostomy (8/9, 88.9 vs. 10/21, 47.6%), and median Charlson comorbidity index score (6 [range, 3-9] vs. 4 [range, 0-9]) were significantly higher in non-survivors than those in survivors (p < 0.05, for each). However, only 12 (40%) patients received appropriate antibiotics. CONCLUSIONS: E. meningoseptica infection most commonly presented as pneumonia in adults with severe underlying diseases. Despite the high mortality rate, the rate of appropriate antibiotic use was notably low.
Adult* ; Anti-Bacterial Agents ; Cause of Death ; Chryseobacterium ; Ciprofloxacin ; Colon ; Comorbidity ; Cross Infection ; Fluoroquinolones ; Humans ; Levofloxacin ; Male ; Medical Records ; Minocycline ; Mortality ; Pneumonia ; Renal Dialysis ; Retrospective Studies ; Sputum ; Survivors ; Tertiary Care Centers* ; Tracheostomy

Congenital bronchoesophageal fistula in the adult is rare, especially Braimbridge type III is very rare. We experienced congenital bronchoesophageal fistula associated intrapulmonary bronchogenic cyst. The patient was a 38-year-old male with chief complaints of coughing and abdominal pain 3 days before admission. Esophagogram revealed a fistulous tract between esophagus and cystic lesion in RLL. Fistulectomy and right lower and middle bilobectomy was performed. The postoperative course was uneventful.
Abdominal Pain ; Adult ; Bronchogenic Cyst* ; Cough ; Esophagus ; Fistula* ; Humans ; Male

BACKGROUND: Coronary arterigraphy has been used as a tool to assess the degree of coronary artery narrowing and the result of balloon angioplasty, which frequently underestimates the degree of atherosclerosis. Intravascular ultrasound(IVUS) can give more delicate information about plaque morphology and the result of coronary intervention. We compared qualitaive and quantitative measurement between IVUS and coronary angiography after coronary intervention. METHODS: We used 30 or 20 MHz intravascular ultrasound catheter which was connected to Hewlett Packard Sonos 1500 Intravasscular equiment in 5 coronary balloon angiopasty and 3 Palmaz-Schatz stent implantation cases. Sites of intervention were at the left anterior descending coronary artery in 7 patients and at the left circumflex artery in one patient. Quantitative coronary angiography(QCA) was done by CAAS II system. We measured referenc diameter(RD), minimal lumen diamter(MLD), Lumen and vessel cross sectional areas(LCSA,VCSA) obstraction area(OA) and plaque area(PA) and also analysed plaque morphology. RESULTS: 1) IVUS is more sensitive in the detection of eccentricity, Calcification and dissection. 2) Before intervention, the mean reference diameter was 2.87+/-0.42mm,3.07+/-0.39mm,% diameter stenosis was 52.4+/-11.6%,65.3+/-9.22% and MLD was 1.32+/-0.24mm, 1.07+/-0.23mm in IVUS and QCA, respectively, which were no statistical significance between these parameters(p>0.05). After intervention, MLD and OA increased significantly(p<0.01) com pared with basal values but there were no significant difference between MLD and OA between 2 measurements(p>0.05). Plaque area measured by IVUS decreased from 9.84 to 7.26mm2 without statistical significance(p>0.05). 3) There was a good correlation in the measurement of the reference segments before intervention but this correlation was much lower after intervention in the reference and stenosis segments between 2 methods(r=0.8723 vs 0.6538, p<0.01). CONCLUSION: IVUS is considered as a sensitive tool in the detection of calcification, eccentricity and dissection and in evaluationg the results of the coronary intervention.
Angioplasty, Balloon ; Arteries ; Atherosclerosis ; Catheters ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Humans ; Stents ; Ultrasonography*

We sought to determine whether early amniocentesis is a safe and acceptable method of genetic evaluation in early pregnancy. During the 20-month period from February 1994 to September 1995, 80 consecutive early amniocentesis were performed transabdominally at 12(+3)-14(+6) weeks of gestation and 305 consecutive mid-second-trimester transabdominal amniocenteses were performed at 16(+0)-18(+0) weeks of gestation. All amniotic fluid samples were cultured using flask method. There were no significant differences between the early and mid-second-trimester amniocenteses in failed sampling, ambiguous results, pregnancy loss within 4 weeks after the procedure, pregnancy loss from 4 weeks after procedure to 28 weeks of gestation, preterm birth, and perinatal death. We may conclude that early amniocentesis is a safe and acceptable method for prenatal diagnosis.
Amniocentesis* ; Amniotic Fluid ; Female ; Pregnancy ; Premature Birth ; Prenatal Diagnosis

PURPOSE: We assessed the dynamic characteristics of 16 nebulizer/compressor combinations currently available in Korea. METHODS: The 16 nebulizer/compressor combinations(Pariboy Type 38/Long life, Pariboy Type N/ Long life, Pariboy Type N/Salter 8900, Pariboy Type N/LC, Devilbiss pulmoaid-LT/Hudson, Devilbiss pulmoaid/Hudson, Mesmed neb-300/Own, San-up 3040/Hudson, Midas(Basic)/Own, AirJolie 2/ Hudson, Thomas 1127/Salter 8900, Noel NE-2000/Salter 8900, Omron CX3/Hudson, Chang Woo CWN-100/Salter 8900, Voyage/Mefar, Chang Woo ASI-Pro/Medel jet pulse) were evaluated in terms of particle size and mass output. In addition, we determined the effects of nebulizer fill volume on mass output. RESULTS: Pariboy Type N/Long life has the highest respirable mass of 0.184 mg/min and Mesmed Neb-300/Own has the lowest 0.019 mg/min. Pariboy Type N/Long life has the highest mass output of 0.68 mg/min and the shortest mass median aerodynamic diameter(MMAD) of 3.76 m. All combinations other than Pariboy Type N/Long life produced a MMAD of over 5 m. MMAD over a 5 min nebulization ranged 3.76 to 9.83 m. There were no significant effects of fill volume on mass output. CONCLUSIONS: We concluded that there is a wide variation in performance of nebulizer/compressor combinations. The characteristics of nebulizer/compressor combinations should be considered in selecting products.
Korea* ; Nebulizers and Vaporizers ; Particle Size ; Respiratory Therapy

BACKGROUND AND OBJECTIVES: Some patients with Kawasaki disease (KD) present with fever and cervical lymphadenopathy alone. The purpose of this study was to characterize the clinical features of these unusual KD patients and determine whether this is a severe form of KD associated with increased risks of intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs). SUBJECTS AND METHODS: A total of 146 children with KD were reviewed retrospectively, and classified into two groups according to initial clinical features. Those presenting with only fever and cervical lymphadenopathy (LKD) were classified as LKD patients. Other-KD patients included all except the LKD patients. RESULTS: Among 146 KD patients, 13 (8.9%) were classified as LKD patients. The LKD patients were significantly older and admitted earlier. The duration between fever onset and KD diagnosis was significantly longer in the LKD patients (5.9 days vs. 4.9 days, p=0.023). The frequency of IVIG resistance was not different between the two groups., In the LKD patients, the incidence of CALs was significantly higher in the acute phase, and without significant difference in the convalescent phase. The percentage of neutrophils and C-reactive protein, albumin, and total bilirubin levels were significantly higher in LKD patients. CONCLUSION: Even though LKD patients were older, admitted earlier, and had higher inflammatory marker levels, they did not have a greater risk of CALs or IVIG resistance. However, echocardiography may be helpful in the acute stage if patients have only fever and cervical lymphadenopathy and are unresponsive to empirical antibiotics.
Anti-Bacterial Agents ; Bilirubin ; C-Reactive Protein ; Child ; Coronary Vessels ; Diagnosis ; Echocardiography ; Fever* ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Lymphatic Diseases* ; Mucocutaneous Lymph Node Syndrome* ; Neck ; Neutrophils ; Retrospective Studies

Microinvasive carcinoma of the uterine cervix(FIGO stage IA) has been reported as highly curable disease even with conservative surgery such as conization and simple hysterectomy. Nevertheless, the surgical management for microinvasive carcinomas has been proposed varying from conservative surgery to radical hysterectomy with pelvic nodes dissection according to different diagnostic criterias for microinvasive carcinoma. We reviewed 512 patients who had been diagnosed as microinvasive carcinoma of the uterine cervix at the Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center from Jan. 1988 to Dec. 1995. Among them, 376 patients were included in this study satisfying guided criterias such as proper management and follow up more than at least one year, and they were analyzed retrospectively based on the clinicopathologic characteristics, pattern of surgical management and postoperative status. (continue)
Cervix Uteri* ; Conization ; Delivery of Health Care ; Diagnosis* ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Obstetrics ; Retrospective Studies

The authors report the case of a 25 year old woman with a chronic corticosteroid-refractory nephrotic syndrome complicated by myocardial infarction. The thromboembolism, especially acute myocardial infarction, is the most serious complication of nephrotic syndrome. Until now many mechanisms have been studied about thromboem bolism including coronary artery disease in nephrotic syndrome, but not clear. Hypercoagulability and prolonged hyperlipidemia are known as the principal contributing factors in this complication. In addition, use of steroid as therapeutic trial and hypovolemic state induced by vigorous diuretics will affect the thromboembolism, too. In this case, several coagulation abnormality and prolonged hyperlipidemia are observed. On admission day, this patient had deep vein thrombosis and then was complicated by pulmonary thromboembolism. Despite of anticoagulant and thrombolytic therapy, she experienced acute myocardial infarction on fourth day after admission. After onset of myocardial infarction, by thrombolytics and prolonged anticoagulant therapy, this nephrotic patient was relieved and discharged without other serious complication. We recommend anticoagulant and antiplatelet agent therpy in risky patient of nephrotic syndrome. We present this case with review of literature.
Adult ; Coronary Artery Disease ; Diuretics ; Female ; Humans ; Hyperlipidemias ; Hypovolemia ; Myocardial Infarction* ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Pulmonary Embolism ; Thromboembolism ; Thrombolytic Therapy ; Thrombophilia ; Venous Thrombosis

BACKGROUND: Hypertension is a main cause of heart blood vessel disease. To diagnose and treat hypertension, it is necessary to measure blood pressure accurately. There are various factors that influence blood pressure. According to real clinical demonstrators and some recent studies, blood pressure differences between right and left arms are often observed. This study was intended to know whether the differences are really found and wheather the correlation exists between mid-arm circumferences and the blood pressure differences according to right-handed or left-handed which were considered as an important factor in affecting blood pressures. METHODS: One hundred sixty nine college freshmen of year 2001 were chosen. Among them, 103 were right- handed and 66 left-handed. Which arms to be checked first were determined randomly. This sequence was repeated two times on each person. Their mid-arm circumferences were measured, also. RESULTS: For right-handed persons, systolic blood pressure in right arm (119.2+/-12.3 mmHg) was significantly higher than in left arm (118.0+/-12.0 mmHg) (P<0.005). But diastolic blood pressure differences between right arm (75.3+/-10.0 mmHg) and left arm (75.0+/-9.5 mmHg) was not significant statistically. For left-handed persons, systolic blood pressure was 120.3+/-9.9 mmHg in right arm and 120.0+/-10.3 mmHg in left arm. However, diastolic blood pressure in right arm (76.7 9.4 mmHg) was significantly higher than in left arm (75.0+/-8.6 mmHg) (P<0.005). For right handed persons, their arm circumferences (26.2+/-2.8 cm) were significantly thicker than left ones (25.9+/-2.9 cm). For left-handed, left arm circumference (25.9+/-2.7 cm) was significantly thicker than right one (25.5+/-2.6 cm). As for the blood pressure difference in arm tested order, the first measured systolic blood pressure (right arm; 120.9+/-11.7 mmHg, left arm; 120.0+/-11.9 mmHg) was significantly higher than the second measured one (right arm; 118.3+/-11.8 mmHg, left arm; 117.8+/-11.6 mmHg) (P<0.005). However, the first measured diastolic blood pressure (right arm; 76.3+/-10.5 mmHg, left arm; 75.5+/-9.4 mmHg) did not have more significance than the second measured one (right arm; 75.4+/-9.9 mmHg, left arm; 74.6+/-10.8 mmHg). CONCLUSION: The right-handed person's blood pressure was higher in the right arm, but for the left-handed persons it was not significantly different in both arms. The second measurement of blood pressure was lower than the first measurement in both arms. The arm circumference depending on the right/left-handedness influenced the blood pressure, but clear correlation between them was not observed. Therefore, if possible, when the blood pressure is measured, it is advised to check blood pressure in both arms before diagnosing hypertension.
Arm* ; Blood Pressure* ; Blood Vessels ; Hand ; Heart ; Humans ; Hypertension

PURPOSE: To investigate the significance of the cortex-hilum (CH) area ratio and longitudinal-transverse (LT) axis ratio and the blood flow pattern for diagnosis of metastatic axillary lymph nodes by ultrasound in breast cancer patients. METHODS: From October 2005 to July 2006, we prospectively evaluated axillary nodes with ultrasound in 205 consecutive patients who had category 4B, 4C or 5 breast lesions according to the Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-Ultrasound(R)). Among the 205, there were 24 patients who had pathologic verification of breast cancer and axillary lymph node status. For a total of 80 axillary nodes we measured the areas of the cortex and hilum of lymph nodes and calculated the area ratio. We also measured the length of the longitudinal and transverse axis of the lymph nodes and calculated the length ratio. We evaluated the blood flow pattern on power Doppler imaging and classified each lymph node into a central or peripheral pattern. Diagnostic performance was analyzed according to positive criteria for lymph node metastasis (CH area ratio >2, LT axis ratio <2, peripheral type on power Doppler imaging). RESULTS: The sensitivity of the CH area ratio was superior to that of the LT axis ratio (94.1% vs. 82.3%, p=0.031) and to that of the blood flow pattern (94.1% vs. 29.4%, p=0.009). For specificity, all three evaluating parameters had high values (89.1-95.6%) and no significant differences were found (p=0.121). The CH area ratio had a better positive predictive value than the LT axis ratio (94.1% vs. 80.0%, p=0.030) and power Doppler imaging (94.1% vs. 66.6%, p=0.028). For the negative predictive value, the CH area ratio was superior to the LT axis ratio (95.6% vs. 86.6%, p=0.035) and the blood flow pattern (95.6% vs. 63.0%, p=0.027). CONCLUSION: We recommend the CH area ratio of an axillary lymph node on ultrasound as a quantitative indicator for the classification of lymph nodes. The CH area ratio can improve diagnostic performance when compared with the LT axis ratio or blood flow pattern.
Axis, Cervical Vertebra ; Breast ; Breast Neoplasms ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Metastasis ; Prospective Studies ; Sensitivity and Specificity