BACKGROUND: Rapid and accurate identification of methicillin-resistant Staphylococcus (MRSA) is very important for patients because they are one of the most common etiologic agents of hospital infection. Conventional identification methods for MRSA are influenced by various factors such as pH, concentration of salt, conditions of media. METHODS: 53 methicillin resistant staphylococcus strains identified by ATB plus system (Biomerieux, France) were preformed the polymerase chain reaction (PCR), Southern blot hybridization fort the detection of mec A gene, and subcultured in Meuller-Hinton media containing 4 microgram/mL oxacillin for the comparison. RESULTS: The correlation of detection rate of mec A gene PCR and ATB plus systems was 81.6%. The correlation of mec A gene PCR and MRSA on Mueller-Hinton media containing 4 microgram/mL oxacillin was 80%. We confirmed by Southern blot hybridization the amplified mer A gene originated from chromosome of MRSA. As the results of oxacillin sensitivity test, minimal inhibitory concentrations of MRSA were distributed between 40 microgram/mL and 320 microgram/mL. When compared with executing time, ATB plus system took 24 hours, but PCR took 5 hours for identification. CONCLUSION: We concluded that mec A gone PCR techniques were simple and rapid for detection of MRSA comparative to conventional methods.
Blotting, Southern ; Cross Infection ; Genes, vif ; Humans ; Hydrogen-Ion Concentration ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Oxacillin ; Polymerase Chain Reaction* ; Staphylococcus

We reviewed 46 hips of the 36 patients treated with free vascularized fibular graft for avascular necrosis of femoral head with a mean follow-up of 39.9 months (ranging from 2 years to 6 years 4 months). There were thirty-four men and two women. The mean age of patients at the time of operation was 36.6 years (ranging from seventeen to fifty-seven years). The procedure was performed on both hips in ten patients. Of the 46 hips, twenty-nine were idiopathic, ten alcoholic, six steroid induced, and one traumatic. According to Ficats stage, there were eighteen in Stage 2A, fifteen in Stage 2B and thirteen in Stage 3. According to Ohzonos classification, there were four in Type 1B, forty in Type 1C and one in Type 3B. Clinical assessments according to the cause and severity of the disease were evaluated using Harris hip scoring system. Thirty-two hips(69.6%) were excellent, 9 hips(19.6%) were good, 2 hips(4.3%) were fair, and 3 hips(6.5%) were poor. Therefore clinically satisfactory results, including excellent and good, were obtained in 41 hips(89.2%). Radiographic assessments according to healing of avascular necrosis lesion and collapsing the femoral head postoperatively were performed. Thirty hips(65.2%) were excellent, 9 hips(19.6%) were good, 4 hips(8.7%) were fair, and 3 hips(6.5%) were poor. Therefore radiographic satisfactory results were obtained in 39 hips(84.8%). Clinical and radiographic assessments according to Ohzonos classification were also evaluated. Clinically satisfactory result were obtained in 6 hips(100%) of Type 1A and 3B in 33 hips(82.5%) of Type 1C. The etiological factors didn t affect the results. There were two cases of peroneal nerve palsy in which one was irreversible and one case of clawing of great toe as complications. In conclusion, free vascularized fibular graft appears to be a very effective method for Ficats stage 2A, 2B, and early stage 3 of symptomatic avascular necrosis of femoral head, in Ohzonos Type 1C which have a high incidence of collapse.
Alcoholics ; Animals ; Classification ; Female ; Follow-Up Studies ; Head* ; Hip ; Hoof and Claw ; Humans ; Incidence ; Male ; Necrosis* ; Paralysis ; Peroneal Nerve ; Toes ; Transplants*

PURPOSE: Efonidipine, which inhibits both T- and L-type calcium channels, has been shown to be effective in reducing proteinuria and preserve renal function. This study was conducted to compare the effects of efonidipine versus amlodipine on the management of hypertension and proteinuria in patients with chronic kidney disease (CKD) receiving ACE inhibitors or ARB. METHODS: This study included 41 CKD patients who were at stages 2-4 and had a urine spot protein/ creatinine ratio of >0.5. Patients were administered amlodipine (5 mg/day) and efonidipine (40 mg/ day) for 3 months in a cross-over design. Blood pressure and spot urine protein/creatinine ratio were compared before and after the cross-over treatment. RESULTS: There were 24 male patients and 17 female patients. The mean age of the patients was 55.9+/-12.9 years. When the patients' medication was changed to eponidifine, we obtained the following results. First, there were no significant changes in blood pressure and serum creatinine. Second, the urine spot protein/creatinine ratio was significantly decreased (before the cross-over, 2.9+/-2.6; after the cross-over, 2.3+/-1.9 g/g; p=0.02). Finally, the reduction rate of proteinuria was significantly higher in patients with CKD at stages 2-3 than in those with CKD at stage 4 after the cross-over (stage 2, - 26.1%; stage 3, -17%; stage 4, +12.8%; p=0.03). CONCLUSION: It is concluded that efonidipine may significantly decrease proteinuria compared with amlodipine in CKD patients receiving ACE inhibitors or ARB. Further double-blind clinical trials with a larger sample size are needed to confirm our results.
Amlodipine ; Angiotensin-Converting Enzyme Inhibitors ; Blood Pressure ; Calcium Channels, L-Type ; Creatinine ; Cross-Over Studies ; Dihydropyridines ; Female ; Humans ; Hypertension ; Male ; Nitrophenols ; Organophosphorus Compounds ; Proteinuria ; Renal Insufficiency, Chronic ; Sample Size

BACKGROUND: Several factors had been suggested to contribute to the development of hypertension in chronic glomerulonephritis (GN). This study was conducted to find the association of baseline blood pressure (BP) with pathophysiologic findings and later renal progression in chronic GN. METHODS: Clinico-pathological findings including serum creatinine (Cr), proteinuria, pathological findings, and urinary Na excretion were analyzed in a total of 233 patients with IgA nephropathy from The Kyung-Hee Cohort of GN. Glomerular surface area (GSA) was measured by imaging analysis and urine angiotensinogen (AGT) concentrations by human ELISA kits. RESULTS: Systolic BP was ≥130mmHg in 124 patients (53%). Systolic BP was negatively correlated with follow-up eGFR (r=−0.32, p<0.0001) and positively serum uric acid concentrations, while it had no significant relationships with initial serum Cr and eGFR. As compared with patients with systolic BP<130 mmHg, those with ≥130 mmHg were older and showed higher serum Cr, proteinuria, 24 hr urinary Na excretion, mean GSA, and T-I fibrosis, lower follow-up eGFR, and steeper decline in slope of eGFR. The results in patients with normal serum Cr concentrations were comparable to those in whole group. Systolic BP was positively correlated with age, baseline and follow-up proteinuria, serum uric acid concentrations and IgM deposit and negatively with follow-up eGFR. In subgroup analysis, systolic BP was also positively correlated with mean GSA and urinary AGT concentrations. CONCLUSION This study showed that baseline systolic BP is related to urinary Na excretion, glomerulomegaly, T-I fibrosis and later renal progression in patients with IgA nephropathy.

The Y-TEC(R) system is an equipment for the peritoneoscopic placement of peritoneal dialysis catheter. The advantage of this method is the direct visualization of peritoneal cavity by using a small diameter minitrocar and dilatable guide. But this method has some limitations because of the expensive equipment and the difficulty in being expert at peritoneoscopy. We placed the CAPD catheter by using a minitrocar without peritoneoscopy(so called Modified Y- tec(R) system) in 44 patients who had no history of major abdominal surgery(MY-group), the classic Y- tec(R) system in 8 patients(Y-group), and surgical method in 13 patients with history of major abdominal surgery(S-group) and compared the effecacy and safety of three methods. In conclusion, the short and long term results of blind minitrocar placements were comparable to, or better than the surgical and other percutaneous methods of catheter implantation when they were used in the patients without history of major abdominal surgery.
Catheters* ; Humans ; Laparoscopy ; Peritoneal Cavity ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory

PURPOSE: Transforming growth factor-beta1 (TGF-beta1) has an important role in the pathogenesis of renal damage; it enhances extracellular matrix production. Urinary TGF-beta1 excretion has been shown to be significantly increased in patients with IgA nephropathy. The aim of the present study was to evaluate the effect of spironolactone on urinary TGF-beta1 levels in patients with IgA nephropathy. METHODS: TGF-beta1 was measured by enzyme-linked immunosorbent assay in random urine specimens from 35 patients with IgA nephropathy. The patients were assigned to a spironolactone group, prednisolone group or losartan group. They were treated over an 8-week period. Urine samples were tested at the beginning and the end of the treatment period. RESULTS: The patients with IgA nephropathy (n=35) had a higher urinary excretion of TGF-beta1 than normal controls (n=13). Urinary TGF-beta1 excretion was positively correlated with proteinuria and pathological grading but not with serum creatinine. After 8 weeks of treatment, losartan (n=13) and prednisolone (n=11) therapy induced a significant reduction in both urinary protein and TGF-beta1 excretion. After treatment with spironolactone (n=11), urinary protein and TGF-beta1 excretion were decreased. However, the decrease was not statistically significant. There was a significant correlation between the urinary TGF-beta1 excretion and the serum aldosterone (r=0.84; p<0.01); however, treatment with spironolactone abolished this correlation. CONCLUSION: This study provides evidence that endogenous aldosterone influences urinary TGF-beta1 excretion in patients with IgA nephropathy.
Aldosterone ; Creatinine ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Losartan ; Prednisolone ; Proteinuria ; Spironolactone* ; Transforming Growth Factor beta1*

PURPOSE: In IgA nephropathy (IgAN), crescent formation appears to represent a nonspecific response to severe injury to the glomerular capillary wall. This study was performed to evaluate the clinicopathological manifestations of the crescents and their effects on the clinical courses of IgAN. METHODS: The patients diagnosed IgAN were included and the information about their renal biopsies, chemistries and immunohistochemistry findings were collected retrospectively. Some patients that have similar renal function and protenuria were followed up for 12 months to examine the effects of crescents on the renal prognosis. RESULTS: 38 patients with crescents and 177 patients without crescents were enrolled. The patients with IgAN with crescents showed significantly lower renal function (MDRD eGFR 58.5 vs 88.4 ml/min/1.73m2), higher blood pressure, larger amount of proteinuria and more severe hematuria than those patients without crescents. In pathologic findings, HS Lee grades were higher (2.9 vs 1.9). When we selected patients with mildly decreased renal function (serum creatinine <2.5 mg/dL, PCR 0.5-8 g/gCr), the patients with crescents presented lower renal function and higher proteinuria but no statistical significance. After 12 months of treatment, the patients with crescents showed significantly lower renal function (MDRD eGFR 78.6 vs 96.5 ml/min/1.73m2) and higher proteinuria (0.9 vs 0.6 g/gCr). CONCLUSION: The patients with IgAN with crescents showed more deteriorated clinicopathological findings than those without crescents. Despite aggressive treatments, they presented a significantly decreased renal function and larger amount of proteinuria after 1 year. So crescents are supposed to have poor effects on the clinical course.
Biopsy ; Blood Pressure ; Capillaries ; Creatinine ; Glomerulonephritis, IGA ; Hematuria ; Humans ; Immunoglobulin A ; Immunohistochemistry ; Polymerase Chain Reaction ; Proteinuria ; Retrospective Studies

OBJECTIVES: The purpose of the present study was to compare the general condition of peritonitis through a study of three connector systems : The Straight transfer set with Spike-and-Pork system(SPS), The Straight transfer set with Luer-Lock system(SLS), and The Y-set with Two Bag system(YS). METHODS: We reviewed our experience with 134 patients from 1988.1 to 1995.12. According to various kinds of connector system, we divided cases into 3 groups : The SPS(1988. 1-1991. 3) was used on 55 patients(mean age 47+/-2, M:F=30:25); The SLS(1991.4-1993.8) on 45 patients(mean age 55+/-1, M:F=30:15); and The YS(1993.9-1995.12) on 34 patients(mean age 49+/-5, M:F=15:19). RESULTS: 1) Total CAPD duration was 1.22 patient year in SPS, 1.08 in SLS, and 0.96 in YS. The incidence of peritonitis is 1.71 episodes per patient year in SPS, 1.03 in SLS, and 0.61 in YS. 2) Among the causative organisms of peritonitis, coagulase negative Staphylococcus was most common in the three groups(SPS:10.4%, SLS:10%, YS:20%). In SPS and SLS, S. aureus(7.7%, 8%), Pseudomonas(6.5%, 8%), E. coli(5.2%, 6%) were present in decreasing order. In YS, Pseudomonas (15%), S. aureus(15%), E. coli(10%) were present in decreasing order. There were no growth of organisms in 55.9% of SPS, 38% of SLS, and 30% of YS. 3) The probability of experiencing the first peritonitis at 1, 3, 6, and 12 months was 21.4%, 21.4%, 21.4%, and 23.9% respectively in SPS, 3.4%, 34.5%, 34.5%, and 10.3% respectively in SLS, and 0%, 28.5%, 35.7%, and 28.5% respectively in YS. 4) In the response to the treatment of peritonitis, 59.7% of the peritonitis episodes in SPS, 72% in SLS, and 85% in YS were cured with antibiotics. In 37.7% of the peritonitis episodes in SPS, 24% in SLS, and 10% in YS, the catheter was removed due to fungal, tubercolous, recurrent, or peritonitis not responding to antibiotics. 2 patients in SPS, 2 patients in SLS, and 1 patient in YS died due to peritonitis. 5) The catheter survival rate at 3, 6, 12 months was 72%, 63.6%, and 40% respectively in SPS, 89%, 78.3%, and 46.7% respectively in SLS, and 94%, 85.3%, and 76.6% respectively in YS. CONCLUSION: Our study suggests that there is a relationship between the development of connector system and a decrease of peritonitis in CAPD.
Anti-Bacterial Agents ; Catheters ; Coagulase ; Humans ; Incidence ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis* ; Pseudomonas ; Staphylococcus ; Survival Rate

Genetic polymorphisms may be linked to inter-individual differences in erythropoietin (EPO) resistance. We investigated the -511C/T polymorphism of the IL-1B gene and the I/D polymorphism of the ACE gene for any association with EPO resistance index (ERI) in maintenance hemodialysis patients (n=167). Because EPO responsiveness is multi-factorial, we also included other possible influences (age, sex, time on dialysis, ACE inhibitor or angiotensin receptor blocker use, ferritin, transferrin saturation, intact PTH, high sensitivity C-reactive protein, albumin, Kt/V, and presence of diabetes mellitus) on ERI in our analyses. Multiple regression analysis showed significant association of the IL-1B-511CC and ACE DD polymorphisms with ERI (P=0.038 and P=0.004 in the recessive model, respectively). The combination (C) of alleles of two loci showed that C1 (I-T) was significantly associated with ERI in the co-dominant and recessive models (P=0.005 and P=0.0001, respectively). Subjects who did not carry C1 showed significantly decreased ERI (10.10+/-5.15 IU/kg weight/g hemoglobin) compared to other study subjects (C1/C1 and C1/-; 12.97+/-4.90 and 15.12+/-7.43 IU/kg weight/g hemoglobin, respectively). Our study indicates that the IL-1B-511C/T and ACE I/D polymorphisms may be useful genetic markers of EPO requirement in hemodialysis patients. These findings might also provide a new perspective on therapeutic approaches to the treatment of end stage renal disease patients with anemia.
Adult ; Aged ; *Drug Resistance ; Erythropoietin/*administration & dosage ; Female ; Humans ; Interleukin-1beta/*genetics ; Korea ; Male ; Middle Aged ; Peptidyl-Dipeptidase A/*genetics ; *Polymorphism, Genetic ; *Renal Dialysis

The authors describe the revision case of a 58-year-old man who presented with pain in the neck and both shoulders after C4-5 cervical total disc replacement (C-TDR) and C5-6 anterior cervical discectomy and fusion (ACDF), and in whom there was evidence of instability with sagittal translation at the C4-5 TDR level and of a herniated cervical disc (HCD) at the left side of C3-4. The revision surgery was performed as follows: previous plate removal at the C5-6 level, artificial disc removal and ACDF at the C4-5 level with cage and previous plate insertion, and TDR at the C3-4 level using the previously implanted C4/5 artificial disc. If instability develops at the level of an artificial disc, we perform additional posterior fusion or anterior removal of the artificial disc and fusion. However, if we encounter combined adjacent segment disc disease, we may reuse the unstable segment artificial disc at the adjacent segment and perform salvage anterior fusion on the unstable segment. This is the first report issued on the management of instability after previous C-TDR involving a switch to ACDF and the use of new TDR at the adjacent level. Furthermore, we conceptually recommend a solution to an emerging problem of adjacent segment disease due to the heterotopic ossification(HO) after C-TDR.
Diskectomy ; Humans ; Middle Aged ; Neck ; Ossification, Heterotopic ; Recycling ; Shoulder ; Total Disc Replacement