Primary cutaneous aspergillosis is rare. In this report we describe primary skin infection by Aspergillus in 9 children with leukemia. The skin lesion was characterized clinically by erythematous macule and papule associated with pain and itching, followed by a rapid progression to ulcer and central black eschars with raised erythematous border at the site of venipuncture, insertion of intravenous cannula, or where arm boards had been taped to extremities. Diagnosis was confirmed by skin biopsy and wound culture. Positive revealed in 6 patients, including A. glaucus in 2 cases, A. flavus in 1 case. Treatment consisted of temporary withdrawl of anticancer chemotherapy, intravenous amphotericin B, oral flucytosine, itraconazole and/or rifampin. One patient recovered completely without antifungal medication with resolution of leukopenia. Six of eight treated patients recovered. One patient discharged against medical advice, while cutaneous aspergillosis was improving. One patient died with persistent skin lesion and neutropenia. We conclude that primary cutaneous aspergillosis is increasingly recognized in association with intravenous cannula, intravenous puncture or prolonged contact with arm boards in immunocompromised patients, and that this serious disease can be treated successfully with appropriate management.
Amphotericin B ; Arm ; Aspergillosis* ; Aspergillus ; Biopsy ; Catheters ; Child* ; Diagnosis ; Drug Therapy ; Extremities ; Flucytosine ; Humans ; Immunocompromised Host ; Itraconazole ; Leukemia ; Leukopenia ; Neutropenia ; Phlebotomy ; Pruritus ; Punctures ; Rifampin ; Skin ; Ulcer ; Wounds and Injuries

Acinetobacter species encounters frequently with clinical specimens and now accounts for a substantial proportion of endemic nosocomial infections in Korea. Recent trends indicate that the antimicrobial resistant strains of Acinetobacter species are increasing. Sixty-one strains were isolated from specimens of patients suspected of nosocomial infections during 1991 to 1996. At present, phenotypic identification of Acinetobacter using biochemical test may not be reliable and resulted in the difficulty to clarify the source of infections and epidemiological study of hospital-acquired infections. Aware of the importance of rational taxonomic proposal for these isolates, correct species identification of these organisms by molecular typing method was carried out. A total of fifty-four strains of A. calcoaceticus-A. baumannii complex species which were identified to genospecies 2 and 13 by biochemical characteristics was subjected to identify by ribotyping using restriction endonuclease EcoRI, ClaI, and SalI. Of fifty-four strains, twenty-five strains were identified as A. baumannii (genospecies 2) and twenty-one strains as genospecies 13, and six strains changed to genospecies 3, and the rest two strains were confirmed as A. haemolyticus (genospecies 4). This result suggests that the ribotyping may be of value for identification of genospecies and epidemiological information of Acinetobacter strains.
Acinetobacter baumannii* ; Acinetobacter calcoaceticus* ; Acinetobacter* ; Cross Infection ; DNA Restriction Enzymes ; Humans ; Korea ; Molecular Typing ; Ribotyping*

OBJECTIVES:The purpose of this study is to evaluate the diagnostic validity of the three published short Geriatric Depression Scales and to identify a valid and reliable alternative to the Korean version of the Geriatric Depression Scale (GDS-K) and short form Geriatric Depression Scales (SGDS-K). METHODS:All subjects were registered elderly psychiatric patients who first visited the Geriatric Psychiatry Clinic of Seoul National University Hospital in Seoul between April 1996 and May 1999. The GDS-K, SGDS-K, Hoyl GDS-5, D'Ath GDS-4, van Marwijk GDS-4 were administered. Receiver operating characteristics (ROC) curve analysis performed to investigate the diagnostic validity of the Hoyl GDS-5, D'Ath GDS-4, and van Marwijk GDS-4. RESULTS:The best trade-off between sensitivity and specificity was achieved with a Hoyl GDS-5 score of 3 (sensitivity:0.7258, specificity:0.7717), a D'Ath GDS-4 score of 3 (sensitivity:0.5968, specificity:0.7391), and a van Marwijk GDS-4 score of 3 (sensitivity:0.6613, specificity:0.7391). The area under the ROC curves of each diagnostic tool were calculated into the Hoyl GDS-5 of 0.8198, the D'Ath GDS-4 of 0.7525, and the van Marwijk GDS-4 of 0.7528. CONCLUSION:The Hoyl GDS-5 may be utilized in screening for major depression among the elderly psychiatric patients in Korea.
Aged ; Depression ; Geriatric Psychiatry ; Humans ; Korea ; Mass Screening ; ROC Curve ; Sensitivity and Specificity ; Weights and Measures

One hundred and eighteen strains of Escherichia coli isolated from clinical specimens were epidemiologically analyzed for antimicrobial resistance, EcoRI restriction endonuclease analysis, southern hybridization with TEM and SHV probe of conjugative R plasmids. 1. Sixty-two to 73% of E. coli isolates were resistant to ampicillin, carbenicillin, sulfisomidine, and tetracycline, and 20-27% to kanamycin, gentamicin, tobramycin, and nalidixic acid. However more than 93% were susceptible to cephalosporins and all strains were highly susceptible to cefotetan, imipenem, aztreonam, and amikacin. 2. Twelve strains were susceptible to all drugs tested and the multiple resistant strains showed 65 resistance pattern types. 3. Thirty-six resistant strains(34%) transferred R plasmids to E. coli RG488 or RG176 by mixed culture. Fifty-six plasmids with 31 different resistant phenotype were obtained from them. 4. Some of 15 plasmids derived from 10 strains showed identical or similar EcoRI restriction endonuclease digestion patterns, hybridized fragment patterns with TEM probe by southern hybridization, and resistance levels of j3-lactams and aminoglycosides. These results indicate that the epidemic strains or plasmids were present in this hospital and molecular genetic analysis of R plasmids can be used to discriminate clinical isolates of multi- resistant E. coli.
Amikacin ; Aminoglycosides ; Ampicillin ; Aztreonam ; Carbenicillin ; Cefotetan ; Cephalosporins ; Digestion ; DNA Restriction Enzymes ; Escherichia coli* ; Escherichia* ; Gentamicins ; Imipenem ; Kanamycin ; Molecular Biology ; Nalidixic Acid ; Phenotype ; Plasmids ; R Factors ; Sulfisomidine ; Tetracycline ; Tobramycin

Two cases of thoracic spinal epidural hematoma are reported, which were dorsolaterally located and were caused by ruptured epidural vascular malformation. Presenting symptoms of acute spinal and abdominal pain were followed by paraparesis and loss of sphincter control. Metrizamide myelogram showed total block of dye column, and spine CT just after myelogram revealed dorsolaterally located epidural mass lesion. Total laminectomy with evacuation of hematoma and biopsy was performed in both cases. One patient recovered completely and the other patient is still paraparetic.
Abdominal Pain ; Biopsy ; Hematoma ; Hematoma, Epidural, Spinal* ; Humans ; Laminectomy ; Metrizamide ; Paraparesis ; Spine ; Vascular Malformations*

No abstract available.
Cystadenocarcinoma, Mucinous* ; Female* ; Humans ; Mucins*

PURPOSE: The purpose of the study is to compare the outcomes between three different one-layer vasovasostomy techniques: original one-layer, modified one-layer, and V-V type one-layer microsurgical vasovasostomy. MATERIALS AND METHODS: We retrospectively reviewed the charts and surgical records of all surgical procedures performed on a series of 117 consecutive patients undergoing a microsurgical one-layer, modified one-layer or V-V type one-layer vasovasostomy between May 1995 and March 2000. An original one-layer vasovasostomy was used in 48 men (group 1), a modified one-layer vasovasostomy in 35 men (group 2), and V-V type one-layer vasovasostomy in 34 men (group 3). A successful outcome (patency) was defined as sperm presenting at the follow-ups. RESULTS: The sperm concentration (million/ml) and motility (%) were as follows: in original one-layer vasovasostomy 17.5 and 32.9, in modified one-layer vasovasostomy 26.1 and 28.5 and in V-V type vasovasostomy 30.5 and 32.3. There were no significant differences in patency (85.4%, 91.4% and 91.2%) and pregnancy rate (56%, 62.5% and 63.6%) of the procedures. If the obstructive interval had been less than 4 years, patency was 87.5% and pregnancy rate was 61.5%, 5 to 9 years 95.8% and 63.4% and 10 years or more 83% and 58.3%. There were no correlations between obstructive interval and rates of patency and pregnancy. CONCLUSIONS: The patency and pregnancy rate revealed slightly better result in modified one-layer or V-V type one-layer microsurgical vasovasostomy than in original one-layer microsurgical vasovasostomy. However, they had statistically no significant differences in overall.
Follow-Up Studies ; Humans ; Infertility, Male ; Male ; Pregnancy ; Pregnancy Rate ; Retrospective Studies ; Spermatozoa ; Vasectomy ; Vasovasostomy*

Squamous cell carcinoma of bladder is best treated with a radical cystectomy. Squamous cell carcinoma of bladder invading the abdominal wall is not commonly reported and hard to manage surgically. Abdominal wall defect caused by a wide resection of squamous cell carcinoma invading abdominal wall can be reconstructed using various muscle flaps. We performed a salvage cystectomy for a patient with squamous cell carcinoma of bladder invading abdominal wall up to skin, and the abdominal wall defect was successfully reconstructed using a unilateral tensor fascia lata myocutaneous flap.
Abdominal Wall* ; Carcinoma, Squamous Cell* ; Cystectomy ; Fascia Lata* ; Fascia* ; Humans ; Myocutaneous Flap* ; Skin ; Urinary Bladder*

No abstract available.
Hyperplasia*

Thrombosis at the left ventricular outflow tract occurs without any detectable heart disease or predisposing factors only extremely rarely. A 48-year-old male visited Konkuk University Medical Center with loss of consciousness one month prior to presentation. Before he visited our hospital, he had been diagnosed with a cardiac tumor, which was located between the left atrium and posterior aortic root, and which was adjacent to both the aortic and mitral valves. Cardiac transplantation was recommended at the other hospital because of the high risk of cardiac dysfunction induced by both aortic and mitral valvular dysfunction after surgical resection. Based on preoperative transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and intra-operative transesophageal echocardiography, we considered it to be a benign tumor. Complete resection was achieved and the pathology confirmed organizing thrombus. We report a case of organizing thrombus mimicking a cardiac tumor, which was located at the mitral-aortic intervalvular fibrosa of the left ventricular outflow tract without any heart disease.
Academic Medical Centers ; Aneurysm, False ; Causality ; Echocardiography ; Echocardiography, Transesophageal ; Heart Atria ; Heart Diseases ; Heart Neoplasms* ; Heart Transplantation ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mitral Valve ; Pathology ; Thrombosis* ; Unconsciousness