Erysipelothrix rhusiopathiae is an uncommon pathogen in human, which causes zoonotic infection. The most common type of human disease with E. rhusiopathiae is a localized skin infection (erysipeloed). E. rhusiopathiae endocarditis is very rare, which usually develops in normal heart valves and causes a variety of complications leading to valve replacement. We described a case of E. rhusiopathiae endocarditis which developed in a 56-year-old man without a predisposing valvular heart disease. In this case, aortic valve and mitral valve were involved and emergency valve replacement was required, which improved patient's condition markedly. Intravenous therapy with penicillin G and subsequent ceftriaxone were given for 8 weeks after surgery and he was recovered without relapse.
Aortic Valve ; Ceftriaxone ; Emergencies ; Endocarditis* ; Erysipelothrix* ; Heart Valve Diseases ; Heart Valves ; Humans ; Middle Aged ; Mitral Valve ; Penicillin G ; Recurrence ; Skin ; Zoonoses

BACKGROUND/AIMS: The internet has become an important source of medical information not only for doctors but also for patients. Therefore, this study evaluated the quality of medical information on endoscopy under conscious sedation on the internet in Korea. METHODS: 147 patients (mean age: 51 years, male:female 76:71) who visited the gastroenterology clinic were surveyed using a questionnaire about use of medical information on the Internet. The first 20 Internet sites using the key word 'endoscopy under sedation' were retrieved from the 5 most frequently used Internet search engines. The quality of information from a total of 63 websites was evaluated using a checklist. RESULTS: Among a total 63 sites about endoscopy under sedation, 46 sites (73.0%) were made by private hospitals or private clinics and 60 sites (95%) were made for patients. The definition of endoscopy under conscious sedation was accurately mentioned in only 7 sites (11%). The complications and risk factors were mentioned in 29 sites (46%). CONCLUSIONS: Most websites made by private hospitals or private clinics overempha sized the merits of sedation. Websites with a more balanced point of view by official organizations may help improve the quality of medical information on the Internet.
Checklist ; Conscious Sedation* ; Endoscopy* ; Gastroenterology ; Hospitals, Private ; Humans ; Internet ; Korea ; Risk Factors ; Search Engine ; Surveys and Questionnaires

Epidemiologic studies have suggested the association between environmental exposure to volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) and the increased risk of incurring asthma. Yet there is little data regarding the relationship between personal exposure to air pollution and the incidence of asthma in children. This study was designed to evaluate the effect of exposure to air pollution on children with asthma by using exposure biomarkers. We assessed the exposure level to VOCs by measuring urinary concentrations of hippuric acid and muconic acid, and PAHs by 1-OH pyrene and 2-naphthol in 30 children with asthma and 30 children without asthma (control). The mean level of hippuric acid was 0.158+/-0.169micromol/mol creatinine in the asthma group and 0.148+/-0.249micromol/mol creatinine in the control group, with no statistical significance noted (p=0.30). The mean concentration of muconic acid was higher in the asthma group than in the control group (7.630+/-8.915micromol/mol creatinine vs. 3.390+/-4.526micromol/mol creatinine p=0.01). The mean level of urinary 1-OHP was higher in the asthma group (0.430+/-0.343micromol/mol creatinine) than the control group (0.239+/-0.175micromol/mol creatinine), which was statistically significant (p=0.03). There was no difference in the mean concentration of 2-NAP between the two groups (9.864+/-10.037micromol/mol in the asthma group vs. 9.157+/-9.640micromol/mol in the control group, p=0.96). In conclusion, this study suggests that VOCs and PAHs have some role in asthma.
Air Pollutants/*pharmacology ; Asthma/*physiopathology/urine ; Case-Control Studies ; Child, Preschool ; Creatinine/urine ; Female ; Hippurates/urine ; Humans ; Male ; Naphthols/urine ; Organic Chemicals/chemistry/*pharmacology ; Polycyclic Hydrocarbons, Aromatic/*pharmacology ; Pyrenes/metabolism ; Sorbic Acid/*analogs & derivatives/metabolism ; Volatilization

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the value of microbubble destruction using low-frequency ultrasound for enhancing gene delivery to skeletal muscles of laboratory animals. MATERIALS AND METHODS: Lac-Z gene was injected into 21 mouse anterior tibialis muscles. Seven muscles received the gene only, and seven each received either 20-kHz ultrasound exposure or ultrasound-PESDA (perfluorocarbon-exposed sonicated albumin) destruction, respectively, following the injection; the extent of Lac-Z expression was then compared. Luciferase gene was injected into the muscles (N=80). The muscles were divided into two groups according to the mixture; in the first group saline was used as the mixture solute, with PESDA used in the second group. The groups were subdivided into two groups, one receiv 10 seconds of ultrasound at the injection site after injection, and the other that received no further intervention. Luciferase activities were measured and compared. RESULTS: The proportions of Lac-Z stained cells were 0, 5.7+/-1.2 and 7.7+/-1.7%, respectively, showing a significant stepwise increase microbubble destruction (p<0.05). Luciferase activities were as follows: Luciferase only (Group 1, N=17), 5727+/-2178 RLU/mg; luciferase plus PESDA (Group 2, N=17), 1170+/-470.7 RLU/mg; luciferase plus ultrasound (Group 3, N=17), 16480+/-5239 RLU/mg; and luciferase plus PESDA destruction (Group 4, N=17), 49910+/-16500 RLU/mg. The activity in group 4 was significantly higher than in group 1 (p<0.01), showing an 8.7-fold increase in gene delivery due to microbubble destruction. CONCLUSION: Microbubble destruction using low-frequency ultrasound is an efficient method for increasing the efficacy of direct gene delivery to skeletal muscles.
Animals ; Animals, Laboratory ; Genetic Therapy ; Luciferases ; Mice* ; Microbubbles* ; Muscle, Skeletal* ; Muscles ; Ultrasonography*

BACKGROUND/AIMS: Safety of endoscopic procedures has been a major issue over the last 10 years. Most endoscopy units use 2% glutaraldehyde and automated endoscope reprocessors (AERs) for disinfecting gastrointestinal endoscopes. We attempted an in-use evaluation of the current reprocessing procedures. METHODS: Thirty flexible endoscopes were randomly collected just after upper endoscopic examinations and were disinfected using 2% glutaraldehyde in an AER. Cultures were taken from biopsy channels (S-1), tip of the insertion tubes (S-2), umbilical cords (S-3), and angulation knobs (S-4). RESULTS: In 63.3% (19/30) of endoscopes, there was no microbial contamination after disinfection procedures. The culture positive rates of S-1, S-2, S-3, and S-4 samples were 20.0%, 0.0%, 3.3%, and 20.0%, respectively. Microorganisms of 13 species were identified, but there was no pathogen related with reported infectious complications after endoscopic procedures. CONCLUSIONS: Current disinfection procedure using 2% glutaraldehyde and an AER appears to be very effective in decontaminating patient-used endoscopes. Low level microbial contamination of endoscopes after conventional reprocessing methods may not impose great risk on patients.
Biopsy ; Disinfection* ; Endoscopes* ; Endoscopes, Gastrointestinal ; Endoscopy ; Glutaral* ; Humans ; Umbilical Cord

BACKGROUND AND OBJECTIVES: The Maze operation is known to be an effective measure for restoring sinus rhythm in patients with atrial fibrillation (AF). The purpose of this study was to identify the relationship of pre- and post-operative left atrial volume (LAV) and diameter (LAD) with successful restoration of sinus rhythm in the Maze operation. SUBJECTS AND METHODS: The subjects for this study were 28 patients who underwent open-heart surgery in conjunction with the Maze-III operation for chronic AF from October, 2002, to April, 2003. Electrocardiographic and transthoracic echocardiographic studies were done pre-operatively and three months post-operatively. LAV and LAD were assessed and corrected for body surface area (LAV index=LAV/BSA, LAD index=LAD/BSA). RESULTS: Sinus rhythm was restored and maintained in 22 of the 28 patients (78.6%). Between the group with successful restoration of sinus rhythm (Group A;n=22) and the group with unsuccessful restoration (Group B;n=6), there was no difference in age, gender, and NYHA functional class. The duration of AF in group A was significantly shorter than that of B (3.6+/-2.7 years versus 15.8+/-7.5 years, p=0.003). Group A and B did not show any difference in pre-operative left ventricular ejection fraction. However, pre-operative LAV index in group A was significantly smaller than that of group B (80.7+/-22.4 mL/m2 versus 118.1+/-42.5 mL/m2, p=0.048). In group A, the LAV index (80.7+/-22.4 mL/m2 versus 52.8+/-14.7 mL/m2, p<0.001) and LAD index (35.4+/-5.3 mm/m2 versus 31.7+/-4.7 mm/m2, p=0.001) decreased significantly three months after the operation. In group B, however, no significant changes are found in the LAV index (118.1+/-42.5 mL/m2 versus 89.2+/-38.9 mL/m2, p=0.116) and LAD index (39.1+/-7.9 mm/m2 versus 36.2+/-9.2 mm/m2, p=0.144). CONCLUSION: Pre-operative LAV index measured by echocardiography and the duration of AF were significant predictors of successful sinus rhythm restoration after the Maze operation. Significant reduction of the LAV index after the Maze operation was found in patients whose rhythm was successfully restored and maintained.
Atrial Fibrillation ; Body Surface Area ; Echocardiography ; Electrocardiography ; Humans ; Stroke Volume

OBJECTIVE: Studies have suggested that the 5, 10-methylenetetrahydrofolate reductase (MTHFR) C677T mutation (alanine --< valine) is a risk factor for atherosclerotic disease. We assessed the association between MTHFR gene polymorphism and carotid atherosclerosis in patients with rheumatoid arthritis (RA). METHODS: Forty postmenopausal RA women (mean age: 58+/-5 years, mean duration of RA 14+/-5 years) treated with low dose methotrexate, other concurrent disease modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs, steroid (prednisolone < or =5 mg/day) and folic acid (> or =1 mg/day) were studied. The genetic polymorphism was detected by the polymerase chain reaction. We measured intima-media thickness (IMT) and plaques of the common carotid arteries by ultrasonography, and evaluated relations among the known risk factors for atherosclerosis, the genetic polymorphism, RA outcomes (Steinbrocker's radiological stage and functional class defined by the ACR criteria) and markers of inflammation (erythrocyte sedimentation rate and C-reactive protein). RESULTS: Among the 40 subjects, 12 had MTHFR genotype CC, 24 genotype CT, and 4 genotype TT. The frequencies of the MTHFR C and T allele were 0.6 and 0.4, respectively. Between the subjects with the CC genotype and those with the mutant T allele, there was no difference in age, body mass index, blood pressure (BP), lipid, duration of RA, RA outcome indices, rheumatoid factor, acute phase reactants and IMT. Carotid IMT was positively associated with age, systolic BP and antihypertensive drug use. There was no significant association between carotid IMT and the MTHFR C677T mutation. CONCLUSION: It is assumed that there was no significant relationship between the MTHFR C677T polymorphism and carotid atherosclerosis in Korean postmenopausal RA women.
Acute-Phase Proteins ; Alleles ; Antirheumatic Agents ; Arthritis, Rheumatoid* ; Atherosclerosis ; Blood Pressure ; Body Mass Index ; Carotid Artery Diseases* ; Carotid Artery, Common ; Female ; Folic Acid ; Genotype ; Humans ; Inflammation ; Methotrexate ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Oxidoreductases ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Rheumatoid Factor ; Risk Factors ; Ultrasonography

BACKGROUND AND OBJECTIVES: We assessed the ability of portable echocardiography (with contrasts) to clearly delineate the cardiac structure, and evaluated the impact of its use on the diagnosis and management of critically ill patients in Korea. SUBJECTS AND METHODS: We prospectively enrolled 123 patients (mean age 66+/-16 years), who underwent portable transthoracic echocardiography (with contrast) for image enhancement at 12 medical centers. The quality of the global left ventricular (LV) images, the number of the regional LV segments visualized, the ability to visualize the LV apex and the right ventricle (RV), and any changes in the diagnostic procedure and treatment strategy were compared before and after the contrast. RESULTS: Of the 123 patients, 52 (42%) were using mechanical ventilators. The amount of poor or uninterpretable images decreased from 48% to 5% (p<0.001), after the contrast. Before the contrast, 15.6+/-1.1 of 16 LV segments were seen, which improved to 15.9+/-0.6 segments (p=0.001) after the contrast. The ability to visualize the LV apex increased from 47% to 94% (p<0.001), while the inability to clearly visualize the RV decreased from 46% to 19% (p<0.001). Changes in the diagnostic procedure (for example, not requiring other types of imaging studies) were observed in 18% of the patients, and the treatment plan (medication) was altered in 26% of patients after the contrast echocardiography. CONCLUSION: The use of a contrast agent during the portable echocardiography, in intensive care settings, can improve the image quality and impact the diagnostic procedures and treatment for Korean patients.
Critical Illness ; Diagnosis ; Echocardiography* ; Heart Ventricles ; Humans ; Image Enhancement ; Critical Care* ; Korea ; Prospective Studies ; Ventilators, Mechanical

BACKGROUND: Insertion/Deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene has been postulated as a risk factor for coronary artery disease. However, controversies exist whether deletion polymorphism in the ACE gene and/or high levels of ACE activity may be a risk factor for coronary artery disease (CAD). We investigated the association of the I/D polymorphism of the ACE gene and serum ACE activity in Korean patients with CAD. METHODS: Study subjects were 629 patients who underwent coronary angiography. CAD group (n=77) was subdivided according to either clinical manifestation or the number of diseased vessels on angiography. The control group comprised 152 patients who did not have a significant coronary lesion. Low risk group (n=5) was defined as subjects with age <55 years, a body mass index (BMI) <26 kg/m2 and a plasma ApoB <125 mg/dl. RESULTS: 1) The genotype and allele frequencies of ACE gene polymorphism were not different between control (DD:DI:II=.20:0.48:0.32, D:I=.44:0.56) and CAD group (DD:DI:II=.18:0.46:0.36, D:I=.41:0.59). 2) When the CAD group was subdivided into stable angina (SA) and acute coronary syndrome (ACS) group, neither ACE genotype nor allele frequencies differed between the SA and ACS group. 3) There was no significant association between the ACE polymorphism and the severity of CAD, as assessed by the number of diseased coronary vessels. 4) A significant difference in serum ACE activity was apparent among ACE genotypes in both controls and CAD subjects. Serum ACE activity in individuals with the DD genotype was significantly greater than that in individuals with DI or II genotypes. 5) There was no difference in serum ACE activity between controls and the CAD subjects of all genotypes or of the same genotype. 6) There was no association between the ACE polymorphism or serum AC activity and CAD in the low risk group. CONCLUSIONS: We have shown that neither the ACE I/D polymorphism nor serum ACE activity act as an independent risk factor in the development of CAD in Korean. This result indicates that the gene polymorphism and variation in serum ACE activity are not risk factors for CAD in this population.
Acute Coronary Syndrome ; Angina, Stable ; Angiography ; Apolipoproteins B ; Body Mass Index ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Gene Frequency ; Genotype ; Humans ; Peptidyl-Dipeptidase A ; Plasma ; Risk Factors

MEN1 is characterized by the combined occurrence of tumors of the parathyroids, pancreatic islet cells and the anterior pituitary. Pancreatic islet cell tumors occur in 40% of MEN1 patients. Pancreatic polypeptidomas occur most commonly but they are asymptomatic. Gastrinomas are the second most common type. VIPomas are rare and there has been no report of a case in Korea so far. We encountered a case of pancreatic VIPoma in MEN Type I. A 49 year old man was referred from his local hospital presenting with a sudden onset of an explosive watery diarrhea of 3 months duration. Abnormal findings in his blood chemistry were hypercalcemia and hypokalemia. The 99mTc-sestamibi sintigraphy showed an increased uptake in right lower parathyroid gland. Abdominal CT demonstrated a mass of 6x4 cm in tail of the pancreas and multiple lesions in both hepatic lobes. Serum levels of VIP hormones were elevated. Subtotal parathyroidectomy and subtotal pancreatectomy were done. Postoperatively his symptoms were improved transiently, however the patient showed repetitive attacks of watery diarrhea. So in order to palliate his symptoms, an RF ablation of the metastatic liver masses was performed. After that therapy his clinical symptoms were reduced dramatically. Unfortunately, the patients condition worsened again. Despite of continuous octreotide therapy, interferon and two courses of combination chemotherapy, the hepatic metastases failed to regress and the patient died 10 months after the diagnosis of a metastatic VIPoma. This is the first report of pancreatic VIPoma in MEN type I in Korea.
Chemistry ; Diagnosis ; Diarrhea* ; Drug Therapy, Combination ; Gastrinoma ; Humans ; Hypercalcemia ; Hypokalemia ; Interferons ; Islets of Langerhans ; Korea ; Liver ; Male ; Middle Aged ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Neoplasm Metastasis ; Octreotide ; Pancreas ; Pancreatectomy ; Parathyroid Glands ; Parathyroidectomy ; Technetium Tc 99m Sestamibi ; Tomography, X-Ray Computed ; Vipoma