BACKGROUND: Vancomycin-resistant enterococci (VRE) have been increasingly isolated world-wide as a nosocomial pathogen. To target infection control, epidemiologic investigations of VRE should include analysis of the resistance gene in addition to typing of strains. We performed molec-ular characterization of the vanA resistance gene to evaluate the inter or intraconstitutional spread. METHODS: Twenty isolates of VanA VRE from the Centers for Disease Control and Prevention (CDC) and 17 from Ajou University Hospital (AUH) were investigated. Minimum inhibitory concen-trations of vancomycin, teicoplanin, and ampicillin were tested by the agar dilution method. Pulsed-field gel electrophoresis (PFGE) and long PCR-restriction fragment length polymorphism (long PCR-RFLP) were performed. The long PCR negative strains were typed by ORF1-, vanS-vanH-, vanX-, vanY-vanZ-, vanZ-, and IS1216-specific PCRs. Filter matings were performed by using rifampin-resistant, fusidic acid-resistant E. faecalis J H2-2 as the recipient. RESULTS: The PFGE from the VRE of the CDC showed 15 patterns including 4 clusters and PFGE from isolates of AUH revealed 6 patterns including 3 clusters. Tn1546 amplicons were detected in 18 of 20 (90%) CDC strains and 16 of 17 (94%) AUH strains. RFLP of Tn1546 amplicons revealed 5 different patterns in the VRE of the CDC strains, and 2 patterns in the VRE of the AUH strains. The mean transfer efficiency of the CDC and the AUH strains are 3.0 X 10(-8)and 4.9 X 10(-5)transconju-gant/ donor, respectively. CONCLUSIONS: Molecular typing of isolates from the CDC suggests the horizontal spread of vanA genes among genetically diverse strains. Analysis of the VRE from the AUH shows a mixed pattern with clonal dissemination of strains and horizontal transfer of vanA.
Agar ; Ampicillin ; Centers for Disease Control and Prevention (U.S.) ; Electrophoresis, Gel, Pulsed-Field ; Furosemide ; Humans ; Infection Control ; Molecular Typing ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Teicoplanin ; Tissue Donors ; Vancomycin

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

BACKGROUND: The viability of cord blood is an important measure of product quality. Trypan blue (TB) stain is the most commonly and conveniently used method to measure the viability of the cord blood. Recently, cytometric analysis using 7-Aminoactinomycin D (7-AAD) was introduced. Staining with 7-AAD is more sensitive in detecting cellular damage than staining with TB. In addition to this, 7-AAD allows specific measurement of the viability of total nucleated cells (TNC), mononuclear cells (MNC) and CD34+ cells. In this study, we compared the viability of TNC between the TB and 7-AAD method, as well as analyzing the viability of each cell population. METHODS: From February to July 2010, 102 cord blood units were collected and assessed for the viability of TNC by the TB and 7-AAD methods. The viability of mononuclear cells (MNC) and CD34+ cells was assessed by 7-AAD method. RESULTS: The TB and 7-AAD methods were used to assess the viability of TNC, which was 90.1+/-5.7% and 68.4+/-8.0%, respectively. The viability of MNC and CD34+ cells measured by the 7-AAD method was 91.8+/-4.3% and 93.4+/-5.1%, respectively. CONCLUSION: The TNC viability of 7-AAD method was significantly lower than that of TB method. In 7-AAD method, the viabilities of MNC and CD34+ cells were significantly higher than that of TNC. As those are important prognostic factors and measures for successful engraftment after the transplantation, the measurement of the viabilities of MNC and CD34+ cells by 7-AAD method would be helpful to the quality control of the cord blood product.
Cell Survival ; Cryopreservation ; Dactinomycin ; Diminazene ; Fetal Blood ; Quality Control ; Transplants ; Trypan Blue ; Umbilical Cord

An analysis of domestic and foreign cohort studies of disaster victims can suggest directions for domestic cohort studies of disaster. Research papers on disaster cohorts were found with search engines such as PubMed and RISS. The key words used were disaster, trauma, cohort, and posttraumatic stress disorder (PTSD). Foreign research papers on human-made disaster (n=16), technological disaster (n=11), natural disaster (n=12), and domestic research papers on disaster (n=6) were reviewed. Analysis revealed that domestic cohort research on disaster victims is lacking compared to foreign countries. This results in the current limitations in planning for active intervention and support for disaster victims. To establish appropriate crisis intervention and management plans for disaster situations, a cohort study of disaster victims should be actively implemented through epidemiologic survey and assessment of risk factors on mental health, PTSD, depression, anxiety and other deleterious outcomes.
Anxiety ; Cohort Studies* ; Crisis Intervention ; Depression ; Disaster Victims* ; Disasters* ; Mental Health ; Risk Factors ; Search Engine ; Stress Disorders, Post-Traumatic

Cerebral malaria means that the patient with demonstrable asexual forms of Plasmodium falciparum in peripheral blood smear who have disturbed mental state and in whom other causes of encephalopathy, such as bacterial, fungal, or viral meningoenoephalitides, drug intoxications other metabolic disease have been excluded. In cerebral malaria, the mortality rate is up to 30% and most of death is within 96 hours, so is known as neurological emergency that urgent treatment should be required. A 42 years old male patients admitted our emergency room with spiking fever 2 days before admission and drowsy mental state at the moming of admission day. The patient traveled in Africal 2 weeks ago. On physical and neurologic examination, the hepatomegaly, drowsy mental state and divergent eyeball was observed. Brain CT scan was normal but pulmonary edema was seen in chest PA and mild increased protein(76mg/dl) was observed in spinal tapping. In peripheral blood smear, severe thrombocytopenia and trophozoa of ring form and band form wer found so diagnosed as mixed infected cerebral malaria. The patient was started the treatment of chloroguine and tetracycline and recovered 2 weeks after treatment. Cerebral malaria should be once considered as differential diagnosis in patients with unknown origin fever and mental confusion in intemalized society like modem.
Adult ; Brain ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital ; Fever ; Fever of Unknown Origin ; Hepatomegaly ; Humans ; Malaria, Cerebral* ; Male ; Metabolic Diseases ; Modems ; Mortality ; Neurologic Examination ; Plasmodium falciparum ; Pulmonary Edema ; Spinal Puncture ; Tetracycline ; Thorax ; Thrombocytopenia ; Tomography, X-Ray Computed

BACKGROUND: Intestinal alkaline phosphatase (ALP) is more prevalent in individuals of blood group B or O secretors and increases after a meal, especially, high-fat diet. The purpose of this study was to evaluate the prevalence and clinical significance of intestinal ALP in the sera of healthy adults. METHODS: Whole blood specimens were obtained from 42 healthy adults after fasting for at least 8 hours, and again at 2 hours after a regular meal. ALP was measured by TBA-200FR and analyzed for isoenzymes by Helena REP system. We also tested their ABO blood groups using GENEDIA anti-A and anti-B sera. RESULTS: The levels of fasting ALP, postprandial ALP, and the difference between the fasting and postprandial ALP (ALP difference) were 57.6+/-20.8 (12-111) IU/L, 62.3+/-17.4 (27-120) IU/L, and 4.6+/-15.4 (-8~63) IU/L, respectively. Delta (delta) ALP was 27.6+/-86.3 (-11.4~312.5)%. Among the 42 subjects, 6 were blood group A, 16 group B, 10 group AB, and 10 group O. Intestinal isoenzyme of ALP was detected in two subjects, both of whom were blood group O. The differences in fasting ALP, postprandial ALP, ALP difference, and delta ALP between ABO blood groups were statistically not significant. CONCLUSIONS: Intestinal ALP was detected in 5% of healthy adults, especially, in 20% of blood group O. Intestinal ALP has been known to be of no specific clinical significance. However, when ALP is measured in a non-fasting sample, the presence of intestinal ALP could result in an abnormally high ALP and subsequent unnecessary tests. Therefore, it is recommended that ALP should be measured only after fasting.
Adult* ; Alkaline Phosphatase* ; Blood Group Antigens ; Diet, High-Fat ; Fasting ; Humans ; Isoenzymes ; Meals ; Prevalence*

PURPOSE: Frontal lobe disease may cause disorders of storage as well as voiding. The aim of this study was to elucidate the reliability of the urodynamic difference of an exact anatomical lesion within the frontal lobe. MATERIALS AND METHODS: 29 patients who had only frontal lobe lesions, without any other cause for neurogenic bladder, were evaluated by an urodynamic study. The frontal lobe lesions were classified into anterior, medial, posterior and lateral aspects, and the patients evaluated by an urodynamic study and MRI. RESULTS: From the urodynamic study on the 29 patients, 27 showed neurogenic detrusor overactivity (93.1%), with the other 2 (6.9%) showing normal findings. On electromyographic findings (EMG), uninhibited relaxation of sphincter was seen in 20 cases (69.0%), and the other 9 were normal (31.0%). It appeared that medial aspects within the frontal lobe lesions were particularly important in uninhibited relaxation of the sphincter. In this study, an urodynamic study showed variable findings, and the EMG especially showed different results depending on the location of the lesion within the frontal lobe. CONCLUSIONS: Variable findings from the urodynamic study were found in patients within the frontal lobe lesions. Thus, the correct urodynamic study for effective treatments should be analyzed.
Frontal Lobe* ; Humans ; Magnetic Resonance Imaging* ; Relaxation ; Urinary Bladder, Neurogenic ; Urodynamics*

PURPOSE: The cause of lower urinary tract symptoms(LUTS) without diseased causes of urodynamics in men is unclear. The aim of this study was to elucidate reliability of difference of LUTS and its treatment by urodynamic study. MATERIALS AND METHODS: Urodynamic study of 124 patients with LUTS were evaluated by age, international prostate symptom score(IPSS) and PSA. The group of patients were divided according to the chief complaint as irritative symptom group(n=72) and obstructive symptom group(n=42). RESULTS: In irritative symptoms group, 29 patients showed stable bladder which combined with bladder outlet obstruction(BOO)(n=11), detrusor underactivity(DU)(n=2) and normal finding(n=6). 43 patients showed unstable bladder which combined with BOO(n=11) and only detrusor overactivity(DO)(n=32). In obstructive symptoms group, 41 patients showed stable bladder that combined BOO(n=13), DU(n=17) and normal finding(n=11), 11 patients showed unstable bladder that BOO(n=1) and DO(n=10). CONCLUSION: LUTS in men are common and often misdiagnosed. Thus, We must treat the LUTS patients with individual therapy based on urodynamic findings.
Humans ; Lower Urinary Tract Symptoms* ; Male ; Multiple Endocrine Neoplasia Type 1 ; Prostate* ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urodynamics*

No abstract available.
Humans

BACKGROUND: In both infants and children, increased hormonal and metabolic responses to open heart surgery may be directly related to postoperative complications. Anesthestic management including regional anesthesia can substantially attenuate a perioperative stress response and targeted therapy may improve the outcome. In this study, our objectives were to quantify the extent of pain control, and to evaluate the safety and efficacy of caudal morphine or meperidine. METHODS: Seventy-five pediatric patients undergoing a open heart surgery were randomly assigned to three groups according to receiving morphine (group M, n = 25), or meperidine (group D, n = 25) caudally, and a control group (group C). Caudal morphine 30ng/kg with 0.15% bupivacaine 1 ml/kg or meperidine 2 mg/kg with 0.15% bupivacaine 1 ml/kg was injected after anesthetic induction. Pain score and side effects were evaluated immediate postoperatively, 12, 24, and 48 hr postoperatively in the intensive care unit and consciousness recovery and extubation time were checked. RESULTS: Patients in the groups M and D had significantly lower pain scores than the group C. Recovery and extubation time were shorter in the groups M and D. Incidence of nausea and vomiting was significantly higher in the group M than in the groups D and C. CONCLUSIONS: Caudal morphine and meperidine reduced postoperative pain and facilitated extubation.
Anesthesia, Conduction ; Bupivacaine* ; Child ; Consciousness ; Heart* ; Humans ; Incidence ; Infant ; Intensive Care Units ; Meperidine* ; Morphine* ; Nausea ; Pain, Postoperative ; Postoperative Complications ; Thoracic Surgery* ; Vomiting