No abstract available.
Temporal Bone* ; Tympanic Membrane*

PURPOSE: To investigate the clinical potential of multifocal electroretinography (mf-ERG) for the evaluation of residual retinal function in retinitis pigmentosa (RP). METHODS: From a group of 41 patients with RP examined for full-field and mf-ERGs, 24 patients were selected in whom the full-field ERGs were non-detectable. Data from the mf-ERGs of this group were reviewed retrospectively. Patients were divided into two groups based on best corrected visual acuity (BCVA); Group A, with a BCVA of less than 0.5, and group B with a BCVA greater than 0.5. The amplitudes and implicit times of Ring 1 and Ring 2 among six concentric rings were measured for comparison between mf-ERG groups. RESULTS: In the mf-ERGs, the amplitudes of Ring 1 and Ring 2 were reduced and implicit time was delayed in all 48 eyes of 24 patients in whom scotopic and photopic responses were non-detectable in full-field ERGs, whereas, there were no detectable responses in Rings 3 thru 6. There was a greater reduction in amplitude and an increased delay in implicit time in group A. CONCLUSIONS: The mf-ERG can estimate the residual macular function in a group of patients with RP in whom the full-field ERG is non-recordable.
Electroretinography ; Eye ; Humans ; Retinaldehyde ; Retinitis ; Retinitis Pigmentosa ; Retrospective Studies ; Visual Acuity

PURPOSE: Drug-induced non-cardiogenic pulmonary edema has been reported on in a drug case series. For most of the agents that cause pulmonary edema, the pathogenic mechanisms that are responsible for the pulmonary edema remain unknown. We report here on the cases of suspected drug-induced pulmonary edema and we analyze the clinical characteristics. METHODS: We reviewed the medical records of 1,345 patients who had drug adverse effects and drug poisoning from January 2005 to July 2010, and 480 of these patients were admitted to the EM Department. Among them, 17 patients developed abnormal chest radiological findings and they were analyzed for any clinical characteristics, the initial symptoms, securing the airway and the clinical results. RESULTS: Seventeen patients out of 480 (3.54%) developed drug-induced abnormal chest radiographic pulmonary edema; they displayed initial symptoms that included mental change (41.2%), dyspnea (17.6%), vomiting (11.8%), etc, and some displayed no symptoms at all (11.8%). Only 3 patients out of the 11 who died or had severe pulmonary edema were able to obtain an advanced airway prior to their arrival to the EM Department. Clinical recovery was generally rapid and this was mostly completed within 6 hours. The mortality rate was 11.8% (2 of 17 patients), and the causative drugs were found to be propofol (35.3%, 6 of 17 patients), multiple drugs (41.2% or 7 out of 17) and one patient each with ephedrine, ethylene glycol, doxylamine and an unknown drug, respectively. CONCLUSION: Drug-induced pulmonary edema and deaths are not uncommon, and recovery is typically rapid with few long-term sequelae when drug administration is discontinued. Oxygen therapy and securing the airway must be performed during transportation for patients with pulmonary edema.
Doxylamine ; Dyspnea ; Ephedrine ; Ethylene Glycol ; Ethylenes ; Humans ; Medical Records ; Oxygen ; Propofol ; Pulmonary Edema ; Thorax ; Transportation ; Vomiting

The establishment and prompt reporting of critical values to patient care providers is one of the crucial requirements of clinical laboratories. Each laboratory is expected to individually establish the thresholds of critical values and periodically update the lists. In this study, we attempted to investigate the status of critical value reporting (CVR) systems in Korean clinical laboratories and develop adequate guidelines based on comparative reviews examining expert consensus. In responses from 11 clinical laboratories, the number of test items with a critical value threshold was 9.4 on average (standard deviation=5.0). Some of the test items, especially ammonia, lactate, and carboxyhemoglobin, lacked critical value thresholds despite having been recommended by expert opinions and guidelines. The upper limit of critical value thresholds showed variability, with glucose showing the largest difference among laboratories (range, 450–700 mg/ dL; coefficient of variation=14.7%). When evaluating the appropriateness of establishing critical value for a particular test, it is generally recommended to consider the “actionability” factors, which consist of effectiveness in decreasing mortality, availability of immediate response systems, and inclusion of the decision-making process in the institution’s critical pathway of standard patient care. As for the optimal value of individual thresholds, laboratory managers should review three quantitative markers: the ratio of CVR cases in total reported results, the ratio of confirmed CVR and responses by clinicians in total CVR cases, and the turnaround time of the tests assigned with critical value thresholds.

Polyarteritis nodosa is a systemic necrotizing vasculitis that affects mainly small and medium-sized arteries that involve multiple organs. In addition to the systemic involvement of classical vasculitis, localized vasculitis involves blood vessels within a confined vascular distribution or single organ without clinical evidence of generalized inflammation. Localized vasculitis of the gastrointestinal tract is a rare entity. In particular, a limited involvement of the small bowel is an unusual manifestation of polyarteritis nodosa. In this report, we describe a case of biopsy-proven polyarteritis nodosa presenting as small bowel bleeding without other systemic manifestations.
Arteries ; Blood Vessels ; Gastrointestinal Tract ; Hemorrhage ; Inflammation ; Polyarteritis Nodosa ; Vasculitis

The nonstructural protein 4 (NSP4) of rotavirus encoded by gene 10, plays an important role in rotavirus pathogenicity. In this study, NSP4 gene sequences of human rotaviruses circulating in Seoul, Korea between March 2004 and April 2005 were determined. The nucleotide sequence data indicated that the NSP4 genes of human rotavirus Korean isolates were 750 or 751 bases in length and encoded one open reading frame of 175 amino acids with two glycosylation sites. The NSP4 of Korean isolates exhibited amino acid sequence homologies between 59.4% and 98.9%. The NSP4 of CAU4 and CAU15 showed a high degree of amino acid sequence homologies with NSP4 genotype A viruses, but the NSP4 of CAU5, CAU6, CAU11, CAU14, CAU16 and CAU22 exhibited a high degree of amino acid sequence homologies with NSP4 genotype B viruses. Interestingly, CAU3 and CAU7 showed low degree of amino acid sequence homology with those of currently described NSP4 genotypes A to D and belonged a distinct lineage on the phylogenetic tree. These findings suggests that distinct NSP4 type was circulating among human rotavirus strains in the local community of Seoul and raising intriguing questions regarding possible explanations for new genotype.
Amino Acid Sequence ; Amino Acids ; Base Sequence ; Genetic Variation* ; Genotype ; Glycosylation ; Herpesvirus 1, Cercopithecine ; Humans* ; Korea ; Open Reading Frames ; Rotavirus* ; Seoul* ; Sequence Homology, Amino Acid ; Virulence

PURPOSE: To evaluate the mean width of anterior commissure of true vocal cord in Korean adults by measuringits dimension on spiral CT scans. MATERIALS AND METHODS: We reviewed the CT scans of 53 Korean adults(age range,23-73years; mean age 39.2years; M:F=41:12) without laryngeal disorders. Spiral CT scanning was performed aroundthe anterior commissure with 1mm slice thickness and table incrementation for 15 seconds. The anteroposteriorwidth of the anterior commissure was measured on CT scan where the true vocal cord and arytenoid, cricoid andthyroid cartilages were all present. We determined the mean width of the anterior commissure and whether there wasa relationship between age and the width of the anterior commissure. RESULTS: The width of the anteriorcommissure was between 0.9mm and 2.3mm ; mean width was 1.60+/-0.38mm(mean+/-SD). Using two SDs above the mean wouldhave defined 2.36mm as the upper limit of normal width. Statistically, no significant correlation existed betweenthe age and the width of the anterior commissure(p>0.05). CONCLUSION: An awareuess of the normal width range ofthe anterior commissure in Korean adults evaluated by spiral CT enhances the possibility of early detection ofinvasion of the anterior commissure by glottic cancer.
Adult* ; Cartilage ; Humans ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Vocal Cords*

BACKGROUND: Antimicrobial resistance (AMR) is an issue not only with regard to public health, but also in terms of economic impact. AMR surveillance has mainly been carried out in general hospitals, and not in nursing hospitals. This study was conducted to investigate the AMR rate for bacterial strains isolated from nursing hospital samples.METHODS: Antimicrobial susceptibility testing (AST) results from a total of 23,518 bacterial isolates recovered from clinical specimens taken in 61 nursing hosals were analyzed. AST was conducted using Vitek 2 with AST cards specific for the bacterial strains.RESULTS: A total of 19,357 Gram-negative and 4,161 Gram-positive bacterial strains were isolated. Pseudomonas aeruginosa (n=6,384) and Escherichia coli (n=5,468) were the most prevalent bacterial species and, among Gram-positive bacteria, Staphylococcus aureus (n=1,565) was common. The AMR rate was high for the following strains: cefotaxime-resistant Klebsiella pneumoniae, 77.4%; cefotaxime-resistant E. coli, 70.6%; imipenem-resistant Acinetobacter baumannii, 90.3%; imipenem-resistant P. aeruginosa, 49.3%; oxacillin-resistant S. aureus, 81.1%, penicillin-resistant Enterococcus faecalis, 44.8%, and vancomycin-resistant Enterococcus faecium, 53.5%. AMR rate change varied by bacterial species and antimicrobial drug.CONCLUSION: AMR rates of major pathogens from nursing hospitals were higher than those from general hospitals with the exception of imipenem-resistant A. baumannii. Continuous monitoring and infection control strategies are needed.
Acinetobacter baumannii ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Gram-Positive Bacteria ; Hospitals, General ; Infection Control ; Klebsiella pneumoniae ; Nursing ; Pseudomonas aeruginosa ; Public Health ; Staphylococcus aureus

OBJECTIVE: Spinal tuberculosis-associated symptoms are not so unique as to immediately indicate the proper diagnosis in most cases. Distinguishing spinal tuberculosis (Pott's disease) from pyogenic spondylitis is often difficult, and lesions metastatic from systemic malignancy are the other major entity from which spinal tuberculosis must be distinguished. CLINICAL PRESENTATION: A 27-year-old male patient presented with a history of back pain after a minor trauma 1 month ago. Computed tomography and magnetic resonance imaging of the thoracic spine showed multiple osteolytic bone lesions at the bodies of T9, T10 and T11 vertebrae and the spinous processes of T12 and L1. Other noncontiguous osteolytic lesions were noted at S2 body and right sacro-iliac joint. INTERVENTION: To confirm the pathologic diagnosis, the patient underwent an open biopsy for the T12 and L1 spinous process lesions and a percutaneous transpedicular biopsy on T9, T10, T11 lesions. Frozen biopsy was reported as compatible with chronic granulomatous caseating necrosis without malignant cells. The final diagnosis was an atypical presentation of multiple spinal tuberculosis. The patient received an appropriate enteral anti-tuberculosis therapy and recovered without any complications. Follow-up MRI taken after a year of medical treatment revealed marked resolution of the lesions. CONCLUSION: Current research indicates the incidence of multi-level noncontiguous, remote vertebral tuberculosis is 1.1% to 16%. Because tuberculous spondylitis could represent variant and atypical pattern, the disease should be considered in differential diagnosis along with other diseases such as metastatic neoplasm, pyogenic spondylitis, especially when the radiologic studies are revealing multiple spinal lesions.
Adult ; Back Pain ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Magnetic Resonance Imaging ; Male ; Necrosis ; Spine ; Spondylitis ; Tuberculosis ; Tuberculosis, Spinal*

PURPOSE: To evaluate the usefulness of screening liver ultrasonography (US) for hepatocellular carcinoma (HCC) detection in patients with chronic hepatitis or hepatic cirrhosis caused by hepatitis B virus (HBV). MATERIALS AND METHODS: A retrospective study was performed with 1,189 patients with clinical hepatopathy caused by HBV who underwent screening liver US for HCC detection at least twice. All patients were followed up with liver US examinations (mean, 8.3 times), CT, or MR for at least 3 months (range, 3-102 months; mean, 47 months) for the detection of HCC. The study population was divided into two groups: chronic hepatitis (n=492) and hepatic cirrhosis (n=697), which was further divided into two groups with (n=156) or without (n=541) evident shrinkage. The radiologic examinations that had detected HCC for the first time were analyzed and compared between the groups. RESULTS: Among 20 (4.1%) patients with chronic hepatitis and 132 (18.9%) patients with hepatic cirrhosis diagnosed as HCC, screening US was the modality of detection in 17 (85.0%) of 20 patients with chronic hepatitis and 76 (57.6%) of 132 patients with hepatic cirrhosis (p=0.038, Chi-square test). The detection rate of HCC on screening US between the chronic hepatitis and hepatic cirrhosis with evident shrinkage (51.4%, 19/37) showed a significant difference (p=0.027, Chi-square test). CONCLUSION: For chronic liver disease caused by HBV, screening US for HCC detection is more useful in patients with chronic hepatitis than with hepatic cirrhosis with evident shrinkage.
Carcinoma, Hepatocellular* ; Early Detection of Cancer ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Hepatitis, Chronic* ; Humans ; Liver ; Liver Cirrhosis* ; Liver Diseases ; Mass Screening* ; Retrospective Studies ; Ultrasonography*