BACKGROUND: Nosocomial infections caused by vancomycin-resistant enterococci (VRE) are increasing problem in Korea. Until now, no nationwide study has been performed. The aim of the present study was to monitor the antimicrobial resistance of vancomycin-resistant Enterococcus faecium (VREF). METHODS: Two hundred and two E. faecium isolated in 10 teaching hospital were studied. To detect VRE, the brain heart infusion agar containing 6 /mL vancomycin was used as the screening agar. The MIC was determined using agar dilution test. The vancomycin resistance genes (vanA, vanB & vanD) and genes (aac(6 ') Ie-aph(2 ") Ia & ant(6 ') Ia encoding the aminoglycoside-modifying enzymes were detected by multiplex PCR using specific primers. RESULTS: Thirty-nine VREF were detected from 202 isolates. All had vancomycin MICs > or =256 /mL and harboured vanA gene. No isolates revealed positive results for the vanB or vanD gene. However, the MIC range for teicoplanin was 2 to > or =256 /mL. All isolates with gentamicin MIC > or = 500 /mL gave positive results for the aac(6 ') Ie aph(2 ") Ia genes and with streptomycin > or =2000 /mL gave positive results for the ant(6 ') Ia gene. CONCLUSIONS: All VREF harboured vanA gene. According to MIC tests, 7 isolates(18%) showed intermediate or susceptible to teicoplanin. Therefore we need a study concerning the clinical meaning. The VREF in Korea contain at least one of genes encoding the aminoglycoside-modifying enzymes. This means there are only limited numbers of antibiotics to choose.
Agar ; Anti-Bacterial Agents ; Brain ; Cross Infection ; Enterococcus faecium* ; Enterococcus* ; Gentamicins ; Heart ; Hospitals, Teaching ; Korea* ; Mass Screening ; Multiplex Polymerase Chain Reaction ; Streptomycin ; Teicoplanin ; Vancomycin ; Vancomycin Resistance

Prevent vaginal bleeding before and after conservative management of cervical pregnancy is the important part of the treatment. We can choose two methode for the conservative management of cervical pregnancy. One is curettage and bleeding control, and the other is using fetocidal agent. Most frequently used fetocidal agent is methotrexate. But additional treatment would be needed after single dose of MTX, and for multiple dosage of MTX, one should be hospitalized about 7 to 10 days. We have used H2O2 intracervical irrigation through enema syringe for conservative management of cervical pregnancy, which is very useful and has no risk of consequent bleeding. So we report it with brief review of literatures.
Curettage ; Enema ; Hemorrhage ; Methotrexate ; Pregnancy* ; Syringes ; Uterine Hemorrhage

Intraventricular hemorrhage is common in premature infants, and post-hemorrhagic hydrocephalus may follow. Rarely, intraventricular hemorrhage can occur in utero and may lead to congenital hydrocephalus. In most cases no underlying disease is identified. The fetus may be compromised by intrauterine hypoxia leading to hemorrhage. Fetal hydrocephalus can be identified by ultrasonography, but the hemorrhagic lesion can be identified with high sensitivity by magnetic resonance imaging. There are neurologic deficit in neonate with fetal hydrocephalus. Early surgical treatment is recommended for neurodevelopmental outcome. We experienced a case of congenital hydrocephalus associated with fetal intraventricular hemorrhage in our hospital. We report the case with a brief review of the literature.
Anoxia ; Fetus ; Hemorrhage ; Humans ; Hydrocephalus ; Infant, Newborn ; Infant, Premature ; Magnetic Resonance Imaging ; Neurologic Manifestations

PURPOSE: We examined the ability of preschool aged children to meet the American Thoracic Society (ATS) and European Resiratory Society (ERS) goals for spirometry quality and tried to find out the major factor for improving the rate of success of spiromety test in this age group. METHODS: Spirometry was performed in 2-6 aged 155 children with chronic cough or suspicious asthma with the recording of maneuver quality measures of forced expiratory time, end-of-test volume, back-extrapolated volume (Vbe), and forced vital capacity (FVC), as well as flow-volume curve. The subjects were tested several times and the two best results in each subject were selected. All criteria for quality control were suggested by ATS/ERS guidelines. The criteria for starting of the test was Vbe <80 mL and Vbe/FVC <12.5%. The criteria for repeatability of the test was that second highest FVC and FEV1 are within 100 mL or 10% of the highest value, whichever is greater. For the criteria for termination of the test for preschool aged children, we evaluated the flow-volume curve RESULTS: As getting older, the success rate of spirometry increased and rapidly increased after 3 years old. Total success rate of the test was 59.4% (2 years old - 14.3%, 3 years old - 53.7%, 4 years old - 65.1%, 5 years old - 69.7%, 6 years old - 70.8%). The percentage of failure to meet the criteria for starting the test was 6.5%, repeatability of the test was 12.3% and end of the test was 31%. There was a significant difference only in age between success group and failure group. Evaluating the quality control criteria of previous studies, the success rate increased with age. CONCLUSION: About 60% of preschool aged children met ATS/ERS goals for spirometry test performance and the success rate was highly correlated with age. It is clearly needed that developing more feasible and suitable criteria for quality control of spirometry test in preschool aged children.
Aged ; Asthma ; Child ; Child, Preschool ; Cough ; Humans ; Quality Control ; Spirometry ; Vital Capacity

PURPOSE: We examined the ability of preschool aged children to meet the American Thoracic Society (ATS) and European Resiratory Society (ERS) goals for spirometry quality and tried to find out the major factor for improving the rate of success of spiromety test in this age group. METHODS: Spirometry was performed in 2-6 aged 155 children with chronic cough or suspicious asthma with the recording of maneuver quality measures of forced expiratory time, end-of-test volume, back-extrapolated volume (Vbe), and forced vital capacity (FVC), as well as flow-volume curve. The subjects were tested several times and the two best results in each subject were selected. All criteria for quality control were suggested by ATS/ERS guidelines. The criteria for starting of the test was Vbe <80 mL and Vbe/FVC <12.5%. The criteria for repeatability of the test was that second highest FVC and FEV1 are within 100 mL or 10% of the highest value, whichever is greater. For the criteria for termination of the test for preschool aged children, we evaluated the flow-volume curve RESULTS: As getting older, the success rate of spirometry increased and rapidly increased after 3 years old. Total success rate of the test was 59.4% (2 years old - 14.3%, 3 years old - 53.7%, 4 years old - 65.1%, 5 years old - 69.7%, 6 years old - 70.8%). The percentage of failure to meet the criteria for starting the test was 6.5%, repeatability of the test was 12.3% and end of the test was 31%. There was a significant difference only in age between success group and failure group. Evaluating the quality control criteria of previous studies, the success rate increased with age. CONCLUSION: About 60% of preschool aged children met ATS/ERS goals for spirometry test performance and the success rate was highly correlated with age. It is clearly needed that developing more feasible and suitable criteria for quality control of spirometry test in preschool aged children.
Aged ; Asthma ; Child ; Child, Preschool ; Cough ; Humans ; Quality Control ; Spirometry ; Vital Capacity

OBJECTIVES: Vulnerability marker in biological relatives of schizophrenia may be very useful in identifying the propensity for the development of schizophrenia. This study suggests that the relatives at risk for genetically developing schizophrenia have impairments in several domains of cognition, social function and affective function as a vulnerability marker. METHODS: A neurocognitve function test, a social function test and an affective function test were administered to fifteen healthy relatives from families with two or more patients with schizophrenia (geneticallly high risk subjects). Fifteen healthy controls matched for age and gender were recruited in this study. RESULTS: Compared to the control subject, the genetic high risk subjects performed significantly more poorly in the selective attention and recall memory of neurocognitive function. The high risk subjects also had lower scores in independence-performance and independence-competence of the social function test and emotion control of the affective function test. CONCLUSION: Selective attention, recall memory, independence-performance, independence-competence and emotion control ability may be a valuable marker for genetic study of schizophrenia.
Cognition* ; Humans ; Memory ; Schizophrenia*

BACKGROUND: The widespread dissemination of Tn1546 has been attributed to transposition into plasmid or transferable elements. The transposition has been achieved through the activity of insertion sequences. Genetic diversity in Tn1546 includes integration of IS elements such as IS1216V, IS1251, IS1476 and IS1542. We investigated molecular typing and the distribution of insertion sequences in vanA-containing Enterococcus faecium isolated from patients in a teaching hospital. METHODS: Sixteen strains of vanA-containing E. faecium isolated from Ajou university hospital were analyzed. PCR amplification of internal regions of Tn1546 was performed and PCR amplicons were directly sequenced on both DNA strands by the dideoxy termination method. RESULTS: For all 16 isolates, IS1216V sequences were located within Tn1546. IS1542 sequences were detected in the genome of 9 isolates. One isolate contained IS1216V in the vanS intragenic region. The structural analysis of Tn1546 in VRE isolates produced three different groups by the presence of the insertion sequences. Group I was characterized by deletions of orf1 and orf2 and IS1216V insertion in the vanXY intergenic region. Group II represented IS1542 in the orf2-vanR and IS1216V in the vanXY intergenic region with deletion of orf1 region. Group III represented IS1542 in the orf2-vanR and IS1216V in the vanXY intergenic region without any deletion. CONCLUSIONS: Most of Korean isolates contained IS1216V and IS1542 sequences. Transposon typing of isolates in this study revealed a similarity to the European's. The identification of insertion sequence within vanA gene cluster can be a useful tool in epidemiological investigations.
DNA ; DNA Transposable Elements ; DNA, Intergenic ; Enterococcus faecium* ; Enterococcus* ; Genetic Variation ; Genome ; Hospitals, Teaching* ; Humans ; Molecular Typing ; Multigene Family ; Plasmids ; Polymerase Chain Reaction

BACKGROUND: Vancomycin-resistant enterococci (VRE) have been increasingly isolated worldwide as a nosocomial pathogen. In Korea, because avoparcin has been used as a growth promoter in animal feed, vanA-containing enterococci have been found in animals. The aim of this study is to understand the epidimiology of VRE isolated from chicken of diverse geographic areas. METHODS: Thirty eight isolates of VanA VRE from chicken of diverse geographic areas were investigated. Multiplex PCR was used to confirm the genotype of VRE. Long PCR and restriction fragment length polymorphism (long PCR-RFLP) were performed to analyze the structure of Tn1546. If the RFLP pattern was different from the prototype, PCR amplification of internal regions of Tn1546 and subsequent sequencing analysis was performed. RESULTS: All 38 isolates harbored vanA gene and divided into 3 types by long PCR-RFLP. Thirty five isolates (92%) were classified as type I. Two isolates and one isolate were belonging to type II and type III, respectively. Type II revealed an insertion of IS1216V in vanX-vanY intergenic region. IS element integrated type III did not match any previously reqorted seguence. CONCLUSION: Structural analysis of vanA gene cluster from chicken revealed that the majority of isolates (type I) have indistinguishable structure to E. fecium BM4147. This results indicated horizontal spread of resistance gene among isolates from chicken. Genetic rearrangement of Tn1546 was infrequently detected in Korea.
Animal Feed ; Animals ; Chickens ; DNA Transposable Elements ; DNA, Intergenic ; Genotype ; Korea* ; Multigene Family ; Multiplex Polymerase Chain Reaction ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Poultry*

PURPOSE: To evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of benign prostatic hyperplasia (BPH) with intravesical prostatic protrusion (IPP). MATERIALS AND METHODS: This study was conducted on 389 BPH patients who underwent PVP with the 120 W HPS laser from April 2009 to August 2011. The patients were divided into groups according to IPP: group I was defined as IPP of 0 to 5 mm (n=216), group II as IPP of 5 to 10 mm (n=135), and group III as IPP above 10 mm (n=38). Prostate volume, prostate-specific antigen, International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), and postvoid residual volume (PVR) were assessed and checked at postoperative 1, 3, 6, and 12 months. RESULTS: There was a significant difference in the mean prostate size in each group (p<0.05). The preoperative total IPSS score, IPSS voiding symptom score, and quality of life score were not significantly different. However, the IPSS storage symptom score was significantly different between groups 1 and 2 and group 3. IPSS scores, Qmax, and PVR at postoperative 1, 3, 6, and 12 months showed significant improvement compared with preoperative values. CONCLUSIONS: The degree of IPP can affect storage symptoms. However, there is no significant correlation between the degree of IPP and postoperative results. Also, the degree of IPP does not affect short- and long-term PVP results. Proper elimination of bladder outlet obstruction is important for symptomatic relief.
Humans ; Indoles ; Laser Therapy ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Quality of Life ; Residual Volume ; Urinary Bladder Neck Obstruction ; Volatilization

PURPOSE: Diabetes is underdiagnosed. Higher-risk populations, such as emergency department (ED) patients, may provide an opportunity for identification of undiagnosed diabetes. Prior studies have indicated that hemoglobin A1c (HbA1c) is effective in the screening detection of diabetes. The objective of this study was to evaluate the correlation between random plasma glucose and HbA1c in Korean ED patients with unknown diabetes status and to determine the value of ED glucose level as a screening tool for diabetes. METHODS: This was a prospective nonconsecutive case series of adults aged > or =18-years-of-age presenting to the ED with acute illness that involved acquisition of a a plasma glucose sample for clinical management. From June 1-June 30, 2009, consenting patients with no prior history of diabetes underwent additional testing for HbA1c level. ED glucose results were stratified based on outpatient American Diabetes Association Fasting Plasma Glucose classifications. Two HbA1c cut-off points (6.1% and 6.5%) were selected as the optimum cut-offs for identifying diabetes based on International Expert Committee. RESULTS: There were 423 patients enrolled. The ED glucose levels were correlated with the HbA1c levels (r=0.488, p<0.001). There were few patients (n=10) with a glucose level > or =200 mg/dL, but most (90%) had an elevated HbA1c level. CONCLUSION: Based on the frequencies of elevated HbA1c levels among patients with elevated ED glucose values, a clinically relevant portion of hyperglycemic patients may have undiagnosed diabetes. ED patients with hyperglycemia may warrant referral for confirmatory diabetes testing.
Adult ; Aged ; Diabetes Mellitus ; Emergencies ; Fasting ; Glucose ; Hemoglobin A ; Hemoglobins ; Humans ; Hyperglycemia ; Korea ; Mass Screening ; Outpatients ; Plasma ; Prospective Studies ; Referral and Consultation