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

BACKGROUND: Recent advances of percutaneous coronary intervention (PCI) and transradial coronary intervention (TRI) have made it possible to reduce the local complication rate and the time until a return to ambulation. The aim of this study is to assess the safety and the patient satisfaction of the TRI-based one-day admission program for PCI. METHODS: Total 230 consecutive patients underwent TRI on the day of admission, according to pre-determined inclusion criteria, from May 2001 to October 2003. The subjects were examined for clinical and angiographic characteristics. The patients having a same-day discharge were telephone-interviewed one day and seven days after discharge to assess late complications and the patients' satisfaction. RESULTS: The mean age of the subjects was 59+/-9 years and 77.4% were male patients. 169 (73.4%) had stable angina and 37 (16.1%) had unstable angina. Stents were implanted in 178 cases (69.3%). Of the 230 patients who underwent TRI, 206 patients (89.6%) could discharge on the same day after the procedure. The procedure was successful in 98.5%. The average hospital stay for them was 9.4+/-1.4 hours. Two subjects reported hematoma near the puncture site within 24 hours after discharge, and one reported this problem 7 days after discharge. During the follow-up, there were no cases reporting chest pain needing rehospitalization or such complications as subacute vessel closure. No deaths, myocardial infarctions or revascularization were noted during the follow-up period. The majority of the patients (n=197, 95.6%) were satisfied with the same-day admission and discharge. CONCLUSIONS: Same day admission and discharge after TRI seems to be safe as well as satisfactory for not low-risk patients.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Chest Pain ; Coronary Disease ; Follow-Up Studies ; Hematoma ; Humans ; Length of Stay ; Male ; Myocardial Infarction ; Patient Satisfaction ; Percutaneous Coronary Intervention ; Punctures ; Radial Artery ; Stents ; Walking

BACKGROUND: Fundamental echocardiography has some drawbacks in patients with difficult-to-image echocardiograms. The aim of this study is to evaluate impact of contrast echocardiography (CE) on ventricular function assessment and clinical diagnosis in routine clinical echocardiography. METHODS: Two hundred sixty patients were prospectively enrolled over 3 years in 12 medical centers in Korea. General image quality, the number of distinguishable segments, ability to assess regional wall motion, left ventricular (LV) apex and right ventricle (RV) visualization, LV ejection fraction, changes in diagnostic or treatment plan were documented after echocardiography with and without ultrasound contrast agent. RESULTS: Poor or uninterpretable general image was 31% before contrast use, and decreased to 2% (p<0.05) after contrast use. The average number of visualized LV segments was 9.53 before contrast use, and increased to 14.46 (p<0.001) after contrast use. The percentage of poor or not seen LV regional wall motion was decreased from 28.4% to 3.5% (p<0.001). The percentage of poor or not seen LV apex and RV was decreased from 49.4% to 2.4% (p<0.001), from 30.5% to 10.5% (p<0.001), respectively. Changes in diagnostic procedure and treatment plan after CE were 30% and 29.6%, respectively. CONCLUSION: Compared to fundamental echocardiography, CE impacted LV function assessment and clinical decision making in Korean patients who undergo routine echocardiography.
Asian Continental Ancestry Group ; Clinical Decision-Making ; Diagnosis* ; Echocardiography* ; Heart Ventricles ; Humans ; Korea ; Prospective Studies ; Ultrasonography ; Ventricular Function*

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

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