Purpose: To report a case of keratitis caused by Brevundimonas diminuta/vesicularis.Case summary: A 20-year-old man presented with decreased visual acuity and glare in his right eye from 2 days earlier. At the first visit, slit lamp examination revealed a 1.5 × 1.5 mm2-sized stromal infiltration, an edematous cornea and endothelial deposits in the center of the right eye. Microbiological examinations were performed from corneal scrapings. Treatment was started with topical eye drops (fortified cefazolin, fortified tobramycin) as empirical antibiotics. After several days, the cultures revealed Brevundimonas diminuta/vesicularis. After treatment with empirical antibiotic eye drops, the symptoms and visual acuity improved. Conclusions We report a case of infectious keratitis caused by Brevundimonas diminuta/vesicularis, which has never previously been reported in the Republic of Korea.

An avulsion fracture of the anterolateral tibial epiphysis or Tillaux fracture is commonly seen in adolescents, reported first by Paul Jules Tillaux in 1892. Adolescent Tillaux fracture occurs during the period when the lateral physis is still open and the anterior-inferior tibiofibular ligament is stronger than the physis, so rarely occurs in adults. An avulsion fracture of the posterior inferior tibiofibular ligament, Volkmann fracture, occurs counterpart of Tillaux fracture. In this study, a tennis player injured during sliding and diagnosed as the rare simultaneous Tillaux-Chaput fracture and Volkmann fracture, is reported with the mechanism of injury, clinical importance of syndesmosis, sprain, and fracture of the ankle joint.

PURPOSE: To compare the antibiotic release kinetics of the implant coated with antibiotic-impregnated polymers MATERIALS AND METHODS: Authors used polylactic acid (PLA) and polylactic-co-glycolic acid (PLGA) as the biodegradable carriers, gentamicin sulfate as the antibiotic and Steinmann pin as the implant. Ten Steinmann pins were coated with gentamicin of each 10, 20 and 30% mixture of PLA or PLGA for the elution kinetics study. In the elution study, total 60 coated implants were incubated in 10 mL of phosphate buffered saline (PBS) at 37 delta C and sampled at 6 hrs, 1, 3, 6, 9, 12, 15, 20, and 25 days. Assays were performed with fluorescence polarization immunoassay. Statistical analysis was done with SAS release 2.01. RESULTS: Released concentration of GM decreased with time. Minimum inhibitory concentration was maintained until 6th day on PLA 10% subgroup, 9th day in the 20 and 30% subgroups, until 6th day on PLGA 20% subgroup, and 3rd day in the 10 and 30% subgroups. Released concentrations were significantly higher in all PLA subgroups than in PLGA as a parameter of sampled time (all p<0.05). There was no statistical difference between PLA 20 and 30% subgroup after 12th sampled day (p=0.2636). CONCLUSION: PLA-GM group showed higher effective concentration for longer time than PLGA-GM group. 20 and 30% subgroups of PLA-GM showed prolonged maintenance of minimum inhibitory concentration compared with 10% subgroup, but there was no difference between the two groups.
Fluorescence Polarization Immunoassay ; Gentamicins ; Kinetics* ; Microbial Sensitivity Tests ; Polymers*

Acardiac fetus in triplet pregnancy is a very rare, fatal congenital anomaly that had not been reported in Korea. It only occurs in multiple gestations associated with placental vascular anastomoses between the affected fetus and its co-twin. The major complications associated with acardiac fetus in triplet pregnancy are congestive heart failure in normal pumping fetus, maternal polyhydramnios, preterm labor, intrauterine fetal death, etc, and perinatal diagnosis can be made with the perinatal ultrasonographic examination. We report a case of acardiac fetus in a spontaneous triplet pregnancy at 23 weeks of gestational age with a brief review of the literature.
Diagnosis ; Female ; Fetal Death ; Fetus* ; Gestational Age ; Heart Failure ; Humans ; Korea ; Obstetric Labor, Premature ; Polyhydramnios ; Pregnancy ; Pregnancy, Triplet* ; Triplets*

BACKGROUND: Different types of injury to the sciatic nerve branches produces different levels of each kind of nociception. In this study, we undertook to identify the nature of the partial sciatic nerve injury that affects nociceptive reaction to subcutaneous formalin injection, and to determine the branch of the sciatic nerve involved. METHODS: Sprague-Dawley rats were randomly divided into 4 groups, control group (n = 9) in which a sham operation was performed, a sural nerve transection group (n = 5), a tibial nerve transection group (n = 5), and a common peroneal nerve transection group (n = 5). Under enflurane anesthesia, sural, tibial, or common peroneal nerves were injured and responses to formalin test were compared for the four groups 24 hours after surgery. RESULTS: Pain behavior in the tibial and common peroneal nerve transected groups reduced in phase 2, but not in phase 1, while sural nerve transected group showed no change in response in either phase. CONCLUSIONS: Tibial and common peroneal nerves mainly affect phase 2 reaction in the formalin test in this partial sciatic nerve injury model.
Anesthesia ; Animals ; Control Groups ; Enflurane ; Formaldehyde* ; Models, Animal ; Nociception ; Pain Measurement* ; Peroneal Nerve ; Rats* ; Rats, Sprague-Dawley ; Sciatic Nerve* ; Sciatic Neuropathy ; Sural Nerve ; Tibial Nerve

OBJECTIVE: The aim of this study was to evaluate the positive rate of squamous cell carcinoma antigen (SCC), carcinoembryonic antigen (CEA), and CA-125 according to clinical stage and histology. We also determine the rate of normalization of SCC after surgical and radiation therapy. RESULTS: In 222 patients with cervical cancer, the pre-treatment positive rate of SCC, CEA, and CA- 125 were 38.7%, 24.3%, and 19.8%, respectively. The positive rate of SCC by clinical stage were 12.9% for stage I, 60.5% for stage II, 88.2% for stage III, and 87.5% for stage IV. The positive rate of CEA by stage were 7.8% for stage I, 36.4% for stage II, 83.3% for stage III, and 75% for stage IV. The positive rate of CA-125 by stage were 5.9% for stage I, 23.3% for stage II, 83.3% for stage III, and 75% for stage IV. The positive rates of SCC, CEA, and CA-125 were significantly increased by clinical stage. According to histology, the positive rate of SCC (39.8%) was more significantly higher than the positive rates of other tumor makers in squamous cell carcinoma of the uterine cervix. The positive rate of CA-125 was higher than the positive rate of other tumor markers in adenocarcinoma and adenosquamous carcinoma of the uterine cervix, but it was not statistically significant difference. CONCLUSION: SCC have been shown to be higher positive rate than any other tumor markers in patients with cervical cancer. The positive rates of SCC, CEA, and CA-125 were significantly increased by clinical stage. Concomitant measurement of SCC, CEA, and CA-125 may be more useful than measurement of SCC alone, and further study was needed.
Adenocarcinoma ; Carcinoembryonic Antigen ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Humans ; Biomarkers, Tumor* ; Uterine Cervical Neoplasms*

BACKGROUND AND OBJECTIVES: Pulmonary arterial stenosis is a relatively common complication after corrective operation of congenital heart disease. Unilateral stenosis of pulmonary arteries could result in decrease perfusion of affected lung, pulmonary regurgitation, or elevation of right ventricular pressure. Eventually there are increasing risks of right ventricular failure, arrhythmia, or sudden death. However we have limited data of pulmonary arterial stent in paediatric population as the treatment of branch pulmonary stenosis. This study aimed at validating the effectiveness and investigating complications of pulmonary arterial stent implantation in a single institution during mid-term follow up period. SUBJECTS AND METHODS: A total of 42 patients (50 stents) were implanted for treating branch pulmonary arterial stenosis. We used cardiac catheterization for comparing diameter after stent implantation directly and lung perfusion scan indirectly. We also investigated any adverse effect relating the procedure. RESULTS: Percent stenosis of stenotic lesions were decreased from 54.1+/-10.7% to 22.8+/-12.5% (p<0.001) and degree of decrement in affected lung perfusion was declined from 22.7+/-8.0% to 10.3+/-9.0% (p<0.001) immediately and lasts during mid-term follow up period. Complication rate relating the procedure was 12% (6 out of 12) and there was no mortality case. CONCLUSION: This series showed immediate and short term effectiveness of pulmonary arterial stent in congenital heart defects. We concluded that percutaneous transcatheter implantation of pulmonary arterial stent was safe and effective during short and mid-term follow up period.
Arrhythmias, Cardiac ; Cardiac Catheterization ; Cardiac Catheters ; Catheterization ; Constriction, Pathologic ; Death, Sudden ; Follow-Up Studies ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Lung ; Perfusion ; Pulmonary Artery ; Pulmonary Valve Insufficiency ; Pulmonary Valve Stenosis ; Stents ; Ventricular Pressure

PURPOSE: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract. Recent studies have revealed much of the biological and genetics underpinning GISTs. METHODS: KIT, PDGFRA, NF2 and GPHN mutations were examined by PCR-SSCP and DNA sequencing. Immunohistochemical analyses of CD117, CD34, SMA, S-100 and desmin were performed in 11 GISTs cases, and each tumor classified as being either very low, low, intermediate or high risk. RESULTS: Mutation in exon 11 of KIT was identified in 6 of the 11 GISTs, but mutations in exon 9, 13 and 17 of KIT were not detected. Three cases lacking KIT mutations showed PDGFRA mutations. No NF2 mutations were detected. GPHN gene mutation in exon 1 was identified in one case, which showed a simple point mutation in exon 11 of KIT. In a correlation between the mutation types and risk of aggressive behavior, four tumors involved multiple ( >2 codons) KIT mutations and one showed a point mutation of KIT plus a GPHN mutation were high risk, but one tumor with a point mutation of KIT showed a low risk. Three tumors having a PDGFRA mutation were of intermediate or very low risk. CONCLUSION: Mutations at exon 9, 13 or 17 of KIT and a NF2 mutation are considered rare in sporadic GIST. KIT and PDGFRA mutations appeared to be alternatives. A GPHN mutation occurring with a KIT mutation may be a secondary change in the pathogenesis of GIST, as the KIT mutation is a major event in GIST. KIT mutant GIST may have a poorer prognosis than PDGFRA mutant GIST.
Desmin ; Exons ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Genetics ; Point Mutation ; Prognosis ; Sequence Analysis, DNA

BACKGROUND: Diabetic cardiac autonomic neuropathy (CAN) is one of the important complications of diabetes. It is characterized by reduced heart rate variability (HRV). METHODS: In this randomized, double-blind, placebo-controlled, multicenter trial, 75 patients were randomly assigned to one of two groups. One group (n=41) received α-lipoic acid (ALA) at an oral dose of 600 mg/day for the first 12 weeks and then 1,200 mg/day for the next 12 weeks. The other group (n=34) received placebo treatment for 24 weeks. CAN was assessed by measuring HRVs in people with diabetes. RESULTS: Most of the baseline measures for HRVs were similar between the ALA and placebo groups. Although there were no statistically significant HRV changes in the ALA group compared to the placebo group after 24 weeks of trial, we found a positive tendency in some of the HRV parameters of the ALA group. The standard deviations of normal-to-normal RR intervals in the standing position increased by 1.87 ms in the ALA group but decreased by −3.97 ms in the placebo group (P=0.06). The power spectrum of the low frequency (LF) band in the standing position increased by 15.77 ms² in the ALA group, whereas it declined by −15.04 ms² in the placebo group (P=0.08). The high frequency/LF ratio in the upright position increased by 0.35 in the ALA group, whereas it declined by −0.42 in the placebo group (P=0.06). There were no differences between the two groups regarding rates of adverse events. CONCLUSION: Although a slight improvement tendency was seen in HRV in the ALA group, there were no statistically significant HRV changes in the ALA group compared to the placebo group after 24 weeks of trial. However, the high oral dose of ALA was well-tolerated.
Diabetes Mellitus, Type 2* ; Heart Rate* ; Heart* ; Humans ; Korea* ; Multicenter Studies as Topic ; Posture ; Thioctic Acid

BACKGROUND AND OBJECTIVES: The high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, has been known to be elevated in patients with coronary artery disease. However, there is controversy about the predictive value of hs-CRP after acute myocardial infarction (MI). Therefore, we evaluated the impact of ischemic time on the predictive value of hs-CRP in ST-segment elevation myocardial infarction (STEMI) patients who were treated by primary percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: We enrolled 5123 STEMI patients treated by primary PCI from the Korean Working Group in Myocardial Infarction and divided enrolled patients into four groups by symptom-to-balloon time (SBT) and level of hs-CRP (Group I: SBT <6 hours and hs-CRP <3 mg/L, Group II: SBT <6 hours and hs-CRP > or =3 mg/L, Group III: SBT > or =6 hours and hs-CRP <3 mg/L, and Group IV: SBT > or =6 hours and hs-CRP > or =3 mg/L). To evaluate the impact of ischemic time on the predictive value of hs-CRP in STEMI patients, we compared the cumulative cardiac event-free survival rate between these four groups. RESULTS: The sum of the cumulative incidence of all-cause mortality and recurrence of MI was higher in Group IV than in the other groups. However, there was no significant difference among Group I, Group II, and Group III. The Cox-regression analyses showed that an elevated level of hs-CRP (> or =3 mg/L) was an independent predictor of long-term cardiovascular outcomes only among late-presenting STEMI patients (p=0.017, hazard ratio=2.462). CONCLUSION: For STEMI patients with a long ischemic time (> or =6 hours), an elevated level of hs-CRP is a poor prognostic factor of long-term cardiovascular outcomes.
Coronary Artery Disease ; Disease-Free Survival ; Humans ; Incidence ; Inflammation ; Myocardial Infarction* ; Myocardial Reperfusion ; Percutaneous Coronary Intervention* ; Recurrence