Sarcoidosis, in general, has a low mortality rate. But cardiac sarcoidosis (CS) is a serious condition which may lead to death. Here, we report a rare case of CS that was treated by heart transplantation. A 47-year-old male had occasional syncopes and atypical chest pain. Ventricular tachycardia with right bundle branch block was noted by electrocardiogram. Multiple fixed myocardial perfusion defects in the interventricular septum and both the inferior-posterior ventricular walls were observed by thallium scan. Coronary angiography was unremarkable. Neither perihilar nor mediastinal lymphadenopathy was noted. The patient also suffered three times from tonic-clonic generalized seizures in 3 years, but no neurologic abnormalities were detected. The explanted heart displayed multiple white patches on the endomyocardial surface, measuring up to 8x7 cm. On microscopic examination, the lesion consisted of multiple well-formed and confluent granulomas with numerous scattered multinucleated giant cells, CD68-positive epithelioid histiocytes, and T-lymphocytes. Neither microorganisms nor foreign material was identified on special stain and culture study. It has been six months since the heart transplant, and the patient has been doing well.
Bundle-Branch Block ; Chest Pain ; Coronary Angiography ; Electrocardiography ; Giant Cells ; Granuloma ; Heart ; Heart Transplantation* ; Histiocytes ; Humans ; Lymphatic Diseases ; Male ; Middle Aged ; Mortality ; Perfusion ; Sarcoidosis* ; Seizures ; Syncope ; T-Lymphocytes ; Tachycardia, Ventricular ; Thallium

Coccidioidomycosis is an endemic disease found in the southwestern part of North America. Travellers who visit the endemic area may carry the infection. We report a case of pulmonary coccidioidomycosis in a 74-year-old woman. She was healthy before visiting Arizona, U.S.A twice. After returning home, she began to complain of intermittent dry coughing. The symptom was mild, however, and she was treated symptomatically. Later a chest radiograph, which was taken 4 years after the onset of the symptom, showed a solitary pulmonary nodule in the right upper lobe. By percutaneous needle aspiration, a few clusters of atypical cells were noted in the necrotic background. A right upper and middle lobectomy was done. A 1.5 x 1.5 x 1.2 cm sized tan nodule was present in otherwise normal lung parenchyma. Microscopically, the nodule consisted of aggregates of multiple solid granulomas inside of which was mostly necrotic. Neutrophils and nuclear debris were scattered along the periphery of the necrotic foci. Numerous multinucleated giant cells were associated with the granulomas. In the necrotic area, mature spherules of Coccidioides immitis, which were 30-100 microm in diameter, were present. They contained numerous endospores which ranged from 5 to 15 microm and were also noted in multinucleated giant cells. The diagnosis of coccidioidomycosis was made. She is doing well after the resection.
Aged ; Case Report ; Coccidioides* ; Coccidioidomycosis/pathology ; Coccidioidomycosis/microbiology* ; Female ; Human ; Korea ; Lung Diseases, Fungal/pathology ; Lung Diseases, Fungal/microbiology*

Polyporoid and corticioid fungi are among the most important wood-decay fungi. Not only do they contribute to nutrient cycling by decomposing wood debris, but they are also valuable sources for natural products. Polyporoid and corticioid wood-inhabiting fungi were investigated in Odaesan National Park. Fruit bodies were collected and identified based on morphological and molecular analyses using 28S and internal transcribed spacer regions of DNA sequences. As a result, a total of 149 species, 69 genera, 22 families, and 11 orders were recognized. Half (74 species) of the species were polypores, and the other half (75 species) were corticioid fungi. Most of the species belonged to Polyporales (92 species) followed by Hymenochaetales (33 species) and Russulales (11 species). At the genus level, a high number of species was observed from Steccherinum, Hyphodontia, Phanerochaete, Postia, and Trametes. Concerning distribution, almost all the species could be found below 1,000 m, and only 20% of the species were observed from above 1,000 m. Stereum subtomentosum, Trametes versicolor, T. hirsuta, T. pubescens, Bjerkandera adusta, and Ganoderma applanatum had wide distribution areas. Deciduous wood was the preferred substrate for the collected species. Sixty-three species were new to this region, and 21 species were new to Korea, of which 17 species were described and illustrated.
Base Sequence ; Biological Products ; Classification ; Coriolaceae ; Fruit ; Fungi* ; Ganoderma ; Humans ; Korea* ; Parks, Recreational* ; Phanerochaete ; Polyporales ; Trametes ; Wood

PURPOSE: Burn wound infection, sepsis and organ failure have been major causes of death in massive burn patient. Because it is difficult to fundamentally prevent bacterial colonization by medical treatment, the need of surgical intervention is advocated by many authors. Therefore the effects of early excision and optimal time were studied. METHODS: Twenty four patients with thermal injuries, on whom early excision of eschar was performed, between June and Aug. 2003, were studied. Fascial excision over third and fourth degree burns and tangential excision over indeterminate areas were performed. Superficial and deep layers of eschar was separated and cultivated, and bacterial colony counts performed. The patients were divided into two groups: a colony count equal or greater than 10(5)/g (group A) and less than 10(5)/g (group B), and studied. The plasma endotoxin levels were assayed and compared. RESULTS: Sepsis occurred at a higher rate when the bacterial colony counts were equal or greater than 10(5)/g at the wound site. Bacterial colonization appears to be greatly increased on the 4th in of escharectomy in superficial layers, and on the 5th in deep layers, in old aged or young child patients tends to occur earlier and with greater severity. The microorganism isolated in all patients was Pseudomonas aeruginosa. There was no statistical difference in the plasma endotoxin levels between groups A and B. CONCLUSION: It is suggested that all massive burn injuries would be better treated with early excision, within 3 days after burns, especially in old aged or young child patients.
Burns* ; Cause of Death ; Child ; Colon ; Humans ; Plasma ; Pseudomonas aeruginosa ; Sepsis ; Wound Infection ; Wounds and Injuries

PURPOSE: Severe burns induce multiple derangements in normal homeostasis. In this conditions, the value of proper nutritional supports can not be overemphasized. The purpose of this study was to evaluate the nutritional, immunological, catabolic and clinical effects of early enteral support in major burn patients. METHODS: The subjects were 49 major burned adults admitted to the Hangang Sacred Heart Hospital between June 1, 2003 and August 31, 2003. The patients qualified for study participation if they were over 20 years of age, sustained burns in excess of a 35% total body surface area or a 25% full-thickness burn. The early feeding (EF) group started enteral feeding within 48 hours of injury, and the delayed feeding (DF) group started after 48 hours. Each patients received entreral feeing through a nasogastric tube. The calorifice requirements were calculated by a modified Long's formula. Enteral feeding was discontinued when the patients could voluntarily orally take at least 60~70 percent of their estimated calorific or protein needs. The serum prealbumin, transferrin and immunoglobulin (IgG, IgA and IgM) concentrations, total lymphocyte counts and cortisol were monitored as a nutritional, immunological and catabolic marker. The clinical outcomes of the two groups were compared. RESULTS: Several of the markers were in an arithmtically high state for the EF group, but these were not statistical significance. There were no significant differences in the clinical outcomes between the two groups. CONCLUSION: More active trials and many-sided studies will be needed to maximize the effect of early enteral nutritional support as a method to improve treatment for major burned patients.
Adult ; Body Surface Area ; Burns* ; Enteral Nutrition* ; Fees and Charges ; Heart ; Homeostasis ; Humans ; Hydrocortisone ; Immunoglobulin A ; Immunoglobulins ; Lymphocyte Count ; Nutritional Support ; Prealbumin ; Transferrin

In Seoul, a majority of plant communities have undergone significant changes over the last few decades; however, how wood decay fungi have responded and adapted to the changes in vegetation remains unknown. Through an ongoing investigation of Korean indigenous fungi, ca. 300 specimens with poroid basidiocarp were collected in Seoul during 2008~2012. Morphological examination and molecular analysis using the internal transcribed spacer and nuclear large subunit ribosomal DNA region sequences helped identify 38 species belonging to 28 genera, 10 families, and 5 orders in this area. Among them, three polypores, Abundisporus pubertatis, Coriolopsis strumosa, and Perenniporia maackiae were found to be new to South Korea.
Basidiomycota ; Classification ; DNA, Ribosomal ; Fruiting Bodies, Fungal ; Fungi* ; Humans ; Korea ; Maackia ; Phylogeny ; Plants ; Seoul ; Wood*