Vibrio vulntficus is a halophilic, gram-negative, motile, marine rod tha is capable of causing rapidly progressing, life-threatening infection in human. The illnesses associated with this organism can be categorized clinically as four groups such as wound infection, primary sept cemia, gastrointestinal illness, and other infection. The clinica1 manifestation of patients with primarys pticemia can vary from fever and chills alone to a more severe illness including secondary skin lesions, multisystem organ failure and shock. Several skin lesions are found in patients with this septicemia, including edema, blister, gangrene, localized swelling, and papura and, less comrnonly, cyanosis, maule and patch, papule, wheal, and pustule. The cutaneous lesions appear mostly on the legs. The hist pathologic findings differ according to the clinieal stage(inflammatory, bullous, and gangrenous) of the lesions. Mortality is very high. The organism is isolated mostly from skin lesion and/or blood. Vibrio vulnifices is sensitive to chloramphenicol, gentamicin, tubramycin, tetracycline, and 3rd generation cephalosporins. Most cases occur during the summer montlis, in men and in person 40 or more year of age. The illness begin with septicemia, often within 2 days of the consumption of various kinds of raw seafood such as fish, shell- fish, and brown seaweed. Patierts frequently have preexisting liver diseae and/or alcohol abuse. For prevention of Vibrio vulni ficus infections, persons with liver diseases or alcohol abuse should avoid consuming or handling raw seafood. Clinicians should start appropriate therapy promptly in patients with chronic underlying disease and a recent history of raw seafood con umption who present with unexplained febrile illness.
Alcoholism ; Blister ; Cephalosporins ; Chills ; Chloramphenicol ; Cyanosis ; Edema ; Epidemiology ; Fever ; Ficus ; Gangrene ; Gentamicins ; Humans ; Leg ; Liver ; Liver Diseases ; Male ; Mortality ; Seafood ; Seaweed ; Sepsis ; Shock ; Skin ; Tetracycline ; Vibrio vulnificus* ; Vibrio* ; Wound Infection

From the leprosy patients hospitalized at the Korean National Leprosarium on Snrokdo Island, forty-five leprosy patients with plantar ulcers were selected randomly for microbiological studies. A total of 84 strains of bacteria, with the most common being Neieseria sicca (25 strains: 29.8%), 34 strains (40. 5%) were present as a pure growth and 50 strains (59. 5%) were present in ulcers with multiple infection. Antibiotic susceptibility tests indicated that bacterial isolates were rather highly susceptible to gentarnicin and kanamycin, but varying degree of isolates were resistant to 12 antibiotics including streptomycin, rifampicin, lincomycin, penicillin, terramycin and colimycin etc. From a total of 30 plantar ulcers, 17 ulcers produced 24 strains of fungi and 1 strain of Balanticlium coli. They consisted of 17 strains of saprophytic fungi (70. 8%) and 7 strains of yeast-like fungi (29. 2%). Of the culture media for Balantidium coli, Sabourauds glucos medium is the most specific and selective that the author found.
Anti-Bacterial Agents ; Bacteria ; Balantidium ; Colistin ; Culture Media ; Foot Ulcer* ; Fungi ; Humans ; Kanamycin ; Leprosy* ; Lincomycin ; Oxytetracycline ; Penicillins ; Rifampin ; Streptomycin ; Ulcer

PURPOSE: It is difficult to determine the activity of tuberculosis radiologically. Therefore there have been efforts to assess the activity using radiopharmaceuticals such as 67Ga, 99mTc-tetrofosmin, and 99mTc-MIBI. But there may be some discrepancy in defining the term 'activity' between clinicians and nuclear physicians. While negative conversion of sputum acid fast bacilli (AFB) is defined as 'disappearance of activity' by clinicians, a loss of uptake in previously positive lesion is accepted as 'disappearance of activity' by nuclear physicians. We designed a prospective study to see if the negative conversion of sputum AFB could directly match the disappearance of radioactivity of the lesion. MATERALS AND METHODS: Fifteen patients with bacteriologically confirmed active localized pulmonary tuberculosis were scanned 10 and 60 min after intravenous injection of 550 MBq 99mTc-MIBI. In 6 patients, who showed negative conversion of sputum AFB after 3-7 months of chemotherapy, 99mTc-MIBI scan was repeated. For the purpose of comparison, target/nontarget ratios of the lesions were determined. RESULTS: 12/15 (80%) patients with active pulmonary tuberculosis showed increased uptake of 99mTc-MIBI in tuberculous lesion. After negative conversion of sputum AFB, 5/6 (83%) patients still showed increased uptake, although the intensity of uptake decreased. CONCLUSION: Uptake of radioactivity decreased but did not disappear after negative conversion of sputum AFB. 99mTc-MIBI scan may be useful to address the degree of inflammation of pulmonary tuberculous lesion, but the uptake did not directly match the activity defined by positivity of sputum AFB. We nuclear physicians might have used the term 'activity' somewhat differently from clinicians who treat patients with tuberculosis.
Drug Therapy ; Humans ; Inflammation ; Injections, Intravenous ; Prospective Studies ; Radioactivity ; Radiopharmaceuticals ; Sputum ; Tuberculosis* ; Tuberculosis, Pulmonary*

Photosensitive psoriasis is a rare disease defined as psoriasis in which the lesions deteriorate or new lesions develop after sun exposure. It should be differentiated from other photosensitive conditions that may be a vated or confused on sun-exposure. Half of the patients have a history of polymorphic light eruption(PMLE), whieh several weeks later develops into psoriasis lesions and the others have no history of preceding PMLE reaction. PUVA therapy is recommended for the treatment of choice. In this report, we describe two cases of photosensitive psoriasis. A 51-year-old woman without underlying psoriasis suffered from erythemato-squamous papular lesions on the face, neck and dorsum of hands after sun-exposure. She revealed a lowered minimal erythema dose(MED) for UVA which was confused with a photosensitive disease. But characteristic psariatic plaques on the elbow, knee and palm and histologic findings made the diagnosis photosensitive psoriasis. She showed a good result to cyclosporine therapy. The other patient, a 44-year-old woman with underlying psoriasis, experienced an exacerbation with preceding PMLE and showed a lowered erythema threshold for UVB. She was treated with sun-screen and topical corticosteroids.
Adrenal Cortex Hormones ; Adult ; Cyclosporine ; Diagnosis ; Elbow ; Erythema ; Female ; Hand ; Humans ; Knee ; Middle Aged ; Neck ; Psoriasis ; PUVA Therapy ; Rare Diseases ; Solar System

BACKGROUND: Vibrio vulnificus(V. vulnificus) is a pathogenic, marine, halophilic, Gram negative bacillus which causes fulminant infection in humans through skin wounds. or the ingestion of raw seafoods or Most cases are reported sporadically in summer in the south-western coastal area of Korea. OBJECTIVE: We studied the distribution of V. vulnificus in sea water, fishes, shellfish and sea mud from May to October in 1996 and the relationship between regional distribution and environmental factors. METHODS: We collected the sea water, sea mud, fishes and seafoods from May to October in Kunsan, Daechun, Moochangpo, Puan, Youngkwang and cultured it in Thiosulfate-Citrate-Bile salt-Sucrose(TCBS) agar, Cellobiose-Polymyxin B-Colistin(CPC) agar, and Sodium dodecyl sulfate- Polymyxin B-Sucrose(SPS) agar. At the same time we investigated environmental factors such as temperature, pH, salinity, turbidity, dissolved oxygen(DO), NO3 of sea water. RESULTS: Twelve strains(2.17%) of V. vulnificus were isolated from a total of 552 specimens. The V. vulnificas isolation rate from sea mud was higher than in sea water and shellfish. Areas where V. vulnipcus was isolated were Kunsan and Daechun. It was isolated during June, July and August. The Isolation rate was higher with CPC agar than TCBS, SPS agar. When V.vulnificus was isolated at Kunsan, the environmental factors of sea water noted were as follows: temperature, 25.3C; turbidity, 121Formazine turbidity units; salinity, 12.2%; DO, 7.3mg/L; pH, 7.37 and NO3, 1.18mg/L. CONCLUSION: CPC agar is the best medium of the three above used for the isolation of V. vulnificus from environmental samples. V. vulnificus was highly isolated in the Kunsan area because of the high water temperature and turbidity, low salinity and weak alkali state of the sea water in comparision with other areas. We suggest that high temperature and turbidity, low salinity and weak alkalinity of sea water are very important environmental factors for the growth of V. vulnificus.
Agar ; Alkalies ; Bacillus ; Eating ; Fishes ; Humans ; Hydrogen-Ion Concentration ; Jeollabuk-do ; Korea* ; Polymyxins ; Salinity ; Seafood ; Seawater* ; Shellfish ; Skin ; Sodium ; Vibrio vulnificus* ; Vibrio* ; Water ; Wounds and Injuries

Using the 15 strains of Vibrio eulnificus isolated from the blood and tissue fluid of the patients with primary septicemia, cultural characteristics were studied on various media. The media to be used in culturing Vibrio vulnificus should contain sodium chloride, because it could not survive on the media without NaCl. The organism grew poorly or not at all on the media with eosin-y, methylene blue, crystal violet, or azide, because these substances suppress its growth. Vibrio vulnificus grew well in the enrichment media such as brain heart infusion, tryptic soy broth, and nutrient broth with 0. 5% NaCl.
Brain ; Cultural Characteristics* ; Gentian Violet ; Heart ; Humans ; Methylene Blue ; Sepsis ; Sodium Chloride ; Vibrio vulnificus* ; Vibrio*

Membranous glomerulonephropathy (MGN) is the most common primary cause of the nephrotic syndrome in adults, accounting for about 20% of the cases in most series. MGN is idiopathic in the majority of cases, however approximately 25% of adults have identifiable causes (secondary MGN). To evaluate the clinical and pathologic characteristics of MGN, we reviewed the clinical data and renal biopsies from 141 cases of MGN. The mean age of the patients at biopsy was 43 years old, but patients of all age were seen (range from 3 to 76 years of age). There were 88 males and 53 females. There were 99 idiopathic MGN cases and 42 secondary MGN cases. The associated causes of secondary MGN included hepatitis B infection (18 cases), SLE (10 cases), drugs (4 cases), post-transplantation MGN (5 cases), diabetes mellitus (4 cases), syphilis (1 case) and hepatitis B infection associated with rheumatoid arthritis. The prevalence of histologic stages by Ehrenreich and Churg was as follows. Stage I was 24 cases, stage II was 72 cases, stage III was 35 cases, and stage IV was 9 cases. All patients had proteinuria. Nephrotic syndrome was observed in 39%, edema in 73%, microscopic hematuria in 49%, gross hematuria in 28%, hypertension in 13%, and the serum creatinine level above 1.5 mg/dl was in 13%. Cases with glomerulosclerosis was observed in 45 cases with an increased percentage of glomerulosclerosis in the higher grade. Immunofluorescence (IF) examination showed predominantly granular IgG (118 cases) and C3 (84 cases) stainings along the glomerular capillary wall. In idiopathic MGN, sparse mesangial IF staining was noted up to 10% of the cases. However, mesangial IF staining in SLE was observed in 33%, hepatitis B infection in 28% and diabetes mellitus in 50%. An electron microscopic examination revealed subepithelial electron dense deposits of immune complex in all cases. The prevalence of mesangial and subendothelial electron dense deposit in idiopathic MGN was present in 19% and 6%, respectively. In SLE cases, mesangial and subendothelial deposits were observed in 78% and 56%, respectively. In hepatitis B infection, mesangial and subendothelial deposits were observed in 54% and 69%, respectively. In conclusion, immune deposits in the mesangium are scanty in idiopathic MGN, and if pronounced this should increase suspicion of underlying systemic diseases, such as SLE or other infectious diseases.
Adult ; Antigen-Antibody Complex ; Arthritis, Rheumatoid ; Biopsy ; Capillaries ; Communicable Diseases ; Creatinine ; Diabetes Mellitus ; Edema ; Female ; Fluorescent Antibody Technique ; Glomerulonephritis, Membranous* ; Hematuria ; Hepatitis B ; Humans ; Hypertension ; Immunoglobulin G ; Male ; Nephrotic Syndrome ; Prevalence ; Proteinuria ; Syphilis

BACKGROUND: The extracellular matrix constitutes the dermis supporting an overlying epidermal lining. A small portion of the cell component includes fibroblasts and mast cells, a large amount of fibrous tissue as struct ural proteins, intra-and extracellular adhesive molecules, and extracellular macromolecules, glyccsarninoglycan(GAG) and proteoglycan make up the dermal connective tissue. GAGs, polysacchavide chains secreted by fibroblasts, are the main macromolecules of the extracellular matrix. GAG chains occupy large amounts of extracellular space and form hydrated gels. The various manifestations observed during the cutaneous intrinsic aging process reflect the age-related changes of dermal connective tissue. OBJECTIVE: This study was directed to observe the age-related changes of GAG in human abdominal skin without the influences of photoaeging. MaTERIALS AND METHODS: The subjects involved in this study were grouped according to the age span of 10 years. A minimum of 3 skin samples were included in each age group. After permission, three to five grams of skin samples without known underlying skin diseases were obtained from the pat,ients who were subjected to open abdominal surgery under general anesthesia. GAGs were extracted and purified by repeated cetylpyridium chloride-ethanol precipitation from each skin sample. The qualitative and quantitative analysis of GAGs was carried out with the action of specific GAG degradirig enzymes. RESULTS: The amount of GAGs per gram skin tissue decreased slowly until the 4th decade and thereafter. A statistically- significant reduction in the amount of GAGs was noted between the age groups of under 10 and that of 51-60. This pattern of decline was similar with tte change of the hyaluronic acid content in gram skin tissue. The content of chondroitin sulfate and heparan sulfate also decreased as a function of ageing. The compositional ratio of GAGs showed no age related changes. The water content measured by acetone dehydration was reduced to a significant level up to the age group of over 30 years. CONCLUSION: These results imply that the wrinkling and laxity of skin during the chronological ageing process reflect the age-related reduction of GAGs and the water content of the skin.
Acetone ; Adhesives ; Aging ; Anesthesia, General ; Cellular Structures ; Cetylpyridinium ; Chondroitin Sulfates ; Connective Tissue ; Dehydration ; Dermis ; Extracellular Matrix ; Extracellular Space ; Fibroblasts ; Gels ; Heparitin Sulfate ; Humans* ; Hyaluronic Acid ; Mast Cells ; Proteoglycans ; Skin Diseases ; Skin* ; Water

Vibrio vulnificus is a halophilic gram-negative, marine bacterium which causes fulminating and potentially fatal human disease. A new sensitive and specific serogrouping procedure was developed for identifying V. vulnificus. Reference antis:ra(01-014) to V. vulnificus were prepared by vaccinated rabbits with heat-killed bacteria, and the antisera were examined whether erogrouping test will be available for rapid and sensitive identification method of V. vulnifiius or not. All of thirty-seven clinical strains tested were agglutinated with 5 kinds of aritisera such as 04A, 01, 013, 03, and 014. Of these serovar 04A was predominant(75.7%). The author investigated the correlation among certain serovars, consumed seafoods, and nortality rate to verify whether the serovar is of pognostic value. There was no significant orrelation among them. These results suggest theart serogrouping procedure could be of value in rapidly identifying V. vulnificus.
Bacteria ; Humans ; Immune Sera ; Rabbits ; Seafood ; Vibrio vulnificus* ; Vibrio*

BACKGROUND: Form the 1970's calcium channel blockers have been used as one of the most effective drugs for antihypertensive therapy. Nilvadipine(Nivadil(R)) is a new vessel-selective calcium channel blocker with a markedly high oral bioaviliability and a long elimination half-life time. To evaluate the efficacy and side effects of nilvadipine, daily monotherapy was done in 22 patients with essential hypertension. METHOD: After more than 2 weeks of previous drug wash-out periods, Nilvadipine 8-12mg was administered daily in 2 or 3 divided dosage for 8 weeks in patients with mild to severe essential hypertension. The sitting blood pressure(BP) and heart rate were measured before and 2, 4, 8 weeks after medication. RESULT: Systolic and diastolic BP were significantly reduced at 2 weeks after medication and no further significant BP reduction were noted throughout the remainer of the trial(4 to 8 weeks). Normotension(diastolic BP < or =90mmHg) was achieved in 14 cases(67%) after 8 weeks therapy and in 7 cases(33%) BP reduced effectively. The side effect noted were headache and facial flushing in 2 cases and in one of them the medication were discontinued. And fatigue, dizziness were complaint in 1 case respectively. There were no significant laboratory changes before and after nilvadipine therapy. CONCLUSION: It can be concluded that nilvadipine(Nivadil(R)) monotherapy is effective in many patients with essential hypertension and a clinical study of combined therapy with other antihypertensive agents in larger numbers of patients will be needed.
Antihypertensive Agents ; Calcium Channel Blockers ; Calcium Channels ; Dizziness ; Fatigue ; Flushing ; Half-Life ; Headache ; Heart Rate ; Humans ; Hypertension*