BACKGROUND: The prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is increasing rapidly worldwide. Treatment options for ESBL-producing E. coli are limited, and infections caused by this organism are associated with improper antibiotic use, a long hospital stay, and increased mortality. Thus, the assessment and early recognition of the risk factors of nosocomial infections due to ESBL-producing E. coli are important for the infection control and proper treatment. METHODS: A case-control study was performed that included nosocomial episodes of ESBL-producing E. coli bacteremia at a tertiary care hospital from January 2004 to December 2007. For each case patient, three controls were randomly selected and data on predisposing factors were collected. RESULTS: Fifty-five cases of nosocomial ESBL-producing E. coli bacteremia were studied. Carbapenem usage (OR: 11.3, 95% CI: 1.1-115.9, p=0.041), quinolone usage (OR: 4.5, 95% CI: 1.1-18.8, p=0.042), biliary obstructive disease (OR: 11.8, 95% CI: 3.0-46.7, p<0.001) and the APACHE II score (OR: 1.3, 95% CI: 1.2- 1.5, p<0.001) were analyzed as independent risk factors of nosocomial ESBL-producing E. coli bacteremia. CONCLUSION: Our results showed that physicians caring for patients with risk factors of nosocomial bacteremia should consider ESBL-producing E. coli as the causative organisms of the disease.
APACHE ; Bacteremia* ; beta-Lactamases* ; Case-Control Studies ; Causality ; Cross Infection ; Escherichia coli* ; Escherichia* ; Humans ; Infection Control ; Length of Stay ; Mortality ; Prevalence ; Risk Factors* ; Tertiary Healthcare

BACKGROUND: The prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is increasing rapidly worldwide. Treatment options for ESBL-producing E. coli are limited, and infections caused by this organism are associated with improper antibiotic use, a long hospital stay, and increased mortality. Thus, the assessment and early recognition of the risk factors of nosocomial infections due to ESBL-producing E. coli are important for the infection control and proper treatment. METHODS: A case-control study was performed that included nosocomial episodes of ESBL-producing E. coli bacteremia at a tertiary care hospital from January 2004 to December 2007. For each case patient, three controls were randomly selected and data on predisposing factors were collected. RESULTS: Fifty-five cases of nosocomial ESBL-producing E. coli bacteremia were studied. Carbapenem usage (OR: 11.3, 95% CI: 1.1-115.9, p=0.041), quinolone usage (OR: 4.5, 95% CI: 1.1-18.8, p=0.042), biliary obstructive disease (OR: 11.8, 95% CI: 3.0-46.7, p<0.001) and the APACHE II score (OR: 1.3, 95% CI: 1.2- 1.5, p<0.001) were analyzed as independent risk factors of nosocomial ESBL-producing E. coli bacteremia. CONCLUSION: Our results showed that physicians caring for patients with risk factors of nosocomial bacteremia should consider ESBL-producing E. coli as the causative organisms of the disease.
APACHE ; Bacteremia* ; beta-Lactamases* ; Case-Control Studies ; Causality ; Cross Infection ; Escherichia coli* ; Escherichia* ; Humans ; Infection Control ; Length of Stay ; Mortality ; Prevalence ; Risk Factors* ; Tertiary Healthcare

BACKGROUND: Stenotrophomonas maltophilia is one of several opportunistic pathogens of growing significance. Several studies on the molecular epidemiology of S. maltophilia have shown clinical isolates to be genetically diverse. MATERIALS AND METHODS: A total of 121 clinical isolates tentatively identified as S. malophilia from seven tertiary-care hospitals in Korea from 2007 to 2011 were included. Species and groups were identified using partial gyrB gene sequences and antimicrobial susceptibility testing was performed using a broth microdilution method. Multi locus variable number of tandem repeat analysis (MLVA) surveys are used for subtyping. RESULTS: Based on partial gyrB gene sequences, 118 isolates were identified as belonging to the S. maltophilia complex. For all S. maltophilia isolates, the resistance rates to trimethoprime-sulfamethoxazole (TMP/SMX) and levofloxacin were the highest (both, 30.5%). Resistance rate to ceftazidime was 28.0%. 11.0% and 11.9% of 118 S. maltophilia isolates displayed resistance to piperacillin/tazobactam and tigecycline, respectively. Clade 1 and Clade 2 were definitely distinguished from the data of MLVA with amplification of loci. All 118 isolates were classified into several clusters as its identification. CONCLUSION: Because of high resistance rates to TMP/SMX and levofloxacin, the clinical laboratory department should consider providing the data about other antimicrobial agents and treatment of S. maltophilia infections with a combination of antimicrobials can be considered in the current practice. The MLVA evaluated in this study provides a fast, portable, relatively low cost genotyping method that can be employed in genotypic linkage or transmission networks comparing to analysis of the gyrB gene.
Anti-Infective Agents ; Ceftazidime ; Korea ; Levofloxacin ; Methods ; Molecular Epidemiology ; Stenotrophomonas maltophilia* ; Stenotrophomonas* ; Tandem Repeat Sequences*

PURPOSE: Whereas sexual function has long been assumed to be an important component of adult men's lives, the impact of sexual dysfunction has not been estimated in parallel to other modern disease entities. We compared the seriousness of erectile dysfunction (ED) with that of other diseases by use of self-administered questionnaires. MATERIALS AND METHODS: Between January 2012 and July 2012, 434 healthy male volunteers (group 1) and 263 ED patients (group 2) were enrolled. The questionnaire consisted of the following: "If you must undergo only one disease in all your life, which disease could you select among these items or ED?" The comparative disease entities included hypertension, diabetes mellitus (oral hypoglycemic agent/insulin injection), hemodialysis, myocardial infarction, herpes zoster, chronic sinusitis, chronic otitis media, gastric cancer (early/late), lung cancer (early/late), liver cancer (early/late), and dementia. RESULTS: Group 1 recognized ED as being a more serious disease than hypertension, diabetes mellitus (oral hypoglycemic agent), herpes zoster, chronic sinusitis, and chronic otitis media. In comparison, group 2 recognized ED as being a more serious condition than diabetes mellitus (insulin injection) and dementia (p<0.001 and p<0.001, respectively). In particular, ED was deemed to be more serious than hemodialysis, gastric cancer (early), lung cancer (early), and liver cancer (early) by men in group 2 in their 30s to 40s, and these results were statistically significant compared with the same age subgroups in group 1 (p<0.001, p<0.007, p<0.02, and p<0.007, respectively). CONCLUSIONS: In contrast with their healthy counterparts, Korean men with ED recognized ED as being as serious as hemodialysis, dementia, and early stage cancer, which reflects the severe bother of ED in Korean patients.
Adult ; Dementia ; Diabetes Mellitus ; Erectile Dysfunction ; Herpes Zoster ; Humans ; Hypertension ; Liver Neoplasms ; Lung Neoplasms ; Male ; Myocardial Infarction ; Otitis Media ; Quality of Life ; Renal Dialysis ; Sinusitis ; Stomach Neoplasms

Complicating intramural hematoma is an interesting, relatively unusual condition. Various etiologic factors have been described, with the most common being blunt trauma, anticoagulant therapy, Henoch-Sch nlein purpura and blood dyscrasias. Most intramural hematomas resolve spontaneously with conservative treatment, and the prognosis is good. However, if the abdominal pain or obstruction does not resolve with medical management over seven to ten days, complications such as infarction or peritonitis may occur, and surgical intervention might be required. We report a case of intramural hematoma of duodenum treated with percutaneous drainage and embolization of bleeding focus which was complicated with acute pancreatitis after anticoagulation treatment in a patient with recurrent history of deep vein thrombosis. In addition, we reviewed reports of intramural hematoma of the duodenum and treatment strategies.
Adult ; Anticoagulants/therapeutic use ; Catheterization ; *Drainage ; Duodenal Diseases/*diagnosis/*therapy ; Fluoroscopy ; Hematoma/*diagnosis/*therapy ; Humans ; Male ; Thrombolytic Therapy ; Tomography, X-Ray Computed

OBJECTIVE: To investigate whether a computer-aided diagnosis (CAD) system based on a deep learning framework (deep learning-based CAD) improves the diagnostic performance of radiologists in differentiating between malignant and benign masses on breast ultrasound (US). MATERIALS AND METHODS: B-mode US images were prospectively obtained for 253 breast masses (173 benign, 80 malignant) in 226 consecutive patients. Breast mass US findings were retrospectively analyzed by deep learning-based CAD and four radiologists. In predicting malignancy, the CAD results were dichotomized (possibly benign vs. possibly malignant). The radiologists independently assessed Breast Imaging Reporting and Data System final assessments for two datasets (US images alone or with CAD). For each dataset, the radiologists' final assessments were classified as positive (category 4a or higher) and negative (category 3 or lower). The diagnostic performances of the radiologists for the two datasets (US alone vs. US with CAD) were compared. RESULTS: When the CAD results were added to the US images, the radiologists showed significant improvement in specificity (range of all radiologists for US alone vs. US with CAD: 72.8–92.5% vs. 82.1–93.1%; p < 0.001), accuracy (77.9–88.9% vs. 86.2–90.9%; p = 0.038), and positive predictive value (PPV) (60.2–83.3% vs. 70.4–85.2%; p = 0.001). However, there were no significant changes in sensitivity (81.3–88.8% vs. 86.3–95.0%; p = 0.120) and negative predictive value (91.4–93.5% vs. 92.9–97.3%; p = 0.259). CONCLUSION: Deep learning-based CAD could improve radiologists' diagnostic performance by increasing their specificity, accuracy, and PPV in differentiating between malignant and benign masses on breast US.
Breast ; Dataset ; Diagnosis ; Humans ; Information Systems ; Learning ; Prospective Studies ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography ; Ultrasonography, Mammary

Fibroelastolytic papulosis of the neck (FEPN) encompasses a spectrum of two disorders that were previously reported as pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) and white fibrous papulosis of the neck (WFPN). The clinical presentation of FEPN is asymptomatic to mildly pruritic whitish-yellow papules that may coalesce into cobblestone patterned plaques that resemble pseudoxanthoma elasticum (PXE). The histology is characterized by a decrease or loss of elastic fibers in the papillary dermis and this is sometimes accompanied by a minimal or nodular increase of dermal collagen fibers. We report here on a 28-year-old Korean man with asymptomatic, multiple, skin-colored to slightly yellowish, match-head sized, cobblestone-patterned papules on the neck, and these were histologically consistent with FEPN and the papules showed slightly increased dermal collagen associated with decreased and fragmented elastic fibers, elastin and tropoelastin. The pathogenesis of FEPN in this case might have been related with mild dermal inflammation, followed by fragmentation, elastolysis and increased dermal collagen.
Adult ; Collagen ; Dermis ; Elastic Tissue ; Elastin ; Humans ; Inflammation ; Neck ; Pseudoxanthoma Elasticum ; Tropoelastin

No abstract available.
Uterus*

An intracranial hemorrhage is a fatal complication associated with general anesthesia. It can occur in patients with an intracranial aneurysm, hypertension, cerebral vascular malformation, and blood dyscrasia, etc. A sudden hemodynamic change during intubation and extubation in general anesthesia is dangerous, particularly in these patients. We encountered an intraventricular hemorrhage in a 42 year old pregnant woman after a cesarean section. The patient was induced with 300 mg of thiopental and 45 mg of rocuronium. The anesthesia was maintained with N2O/O2 and sevoflurane after endotracheal intubation. Five hours after surgery, the patient had a seizure at the ward. A MRI and CT scan of the brain showed a right intraventricular and basal ganglia hematoma. The CT 3-D brain angiography showed an unruptured small aneurysm on the right posterior communicating artery.
Adult ; Anesthesia ; Anesthesia, General* ; Aneurysm ; Angiography ; Arteries ; Basal Ganglia ; Brain ; Cerebral Hemorrhage ; Cesarean Section* ; Female ; Hematoma ; Hemodynamics ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Intubation ; Intubation, Intratracheal ; Magnetic Resonance Imaging ; Pregnancy ; Pregnant Women ; Seizures ; Thiopental ; Tomography, X-Ray Computed ; Vascular Malformations

Systemic lupus erythematosus (SLE) is a multisystemic disease that can involve the gastrointestinal tract, liver, and biliary system. Symptomatic pancreatic involvement, however, has rarely been reported. It may be part of the primary disease process, such as vasculitic or autoimmune etiology, or associated with drug therapy, in particular corticosteroid. We report here a lupus patient who developed severe pancreatitis within 30 hours of initiation of corticosteroid therapy; we also discuss the relation between pancreatitis and systemic lupus erythematosus.
Biliary Tract ; Drug Therapy ; Gastrointestinal Tract ; Humans ; Liver ; Lupus Erythematosus, Systemic* ; Pancreatitis*