BACKGROUND: The erythromycin-resistance rate and phenotype distribution of Streptococcus propenes are quite different by geographical variation and study period. The aim of the present study was to determine the evolution of resistance to erythromycin and the frequency of erythromycin resistance phenotype of S. pyogenes isolated from Wonju Christian Hospital. METHODS: The minimal inhibitory concentrations (MICs) of erythromycin and clindamycin for 94 S. pyogenes isolated from clinical specimens between 1990 to 1998 were investigated. Double disk test of erythromycin (78microgram) and clindamycin (25microgram) were performed for 15 isolates of erythromycin resistant S. pyogenes to evaluate the erythromycin resistance phenotype. RESULTS: The resistance rates of 94 isolates of S. pyogenes were 16%(15/94) to erythromycin and 4%(4/94) to clindamycin. The frequency of erythromycin resistance phenotype in decreasing order were M phenotype (47%), inducible resistance phenotype (40%), and constitutive resistance phenotype (13%). Erythromycin-resistant S. pyogenes did not exist until 1993, but was isolated since 1994, and ranged from 14.0% to 24.0% during the period of 1994-1998. CONCLUSIONS: Our finding documents the emergence of high resistance rates to erythromycin in S. pyogenes at Wonju area since 1994. The M phenotype (47%) and inducible resistance phenotype (40%) account for the majority of erythromycin-resistant S. pyogenes.
Clindamycin ; Erythromycin* ; Gangwon-do ; Phenotype* ; Streptococcus pyogenes* ; Streptococcus*

No abstract available.
Fascioliasis* ; Humans*

Implanting a pacemaker is the most often used intervention for treating bradycardia. The most commonly used pacemaker is the intracardiac pacemaker, yet it can have many complications. An infected pacemaker can spread to systemic infection and the condition of the patient can quickly get worse, so if an infected pacemaker is suspected, then the pacemaker must be removed. Apart from the use of interventional methods such as a loop or a weight, we can take a more aggressive approach by using extracorporeal circulation for removal of the pacemaker. We report here on two cases in which extracorporeal circulation was used to remove the infected pacemakers.
Bradycardia ; Cardiopulmonary Bypass ; Extracorporeal Circulation ; Humans

We report a case of non-secretory plasma cell leukemia with complex chromosomal abnormalities including t (11;14)(q13;q32). A 57-year-old man was admitted to hospital due to anemia, thrombocytopenia and renal insufficiency. Bone marrow examination and peripheral blood smear revealed a large number of immature plasma cells with positivity for CD38. Monoclonal gammopathy or abnormal paraproteins were not observed in serum protein electrophoresis and immunofixation. The cytogenetic analysis showed complex chromosomal abnormalities [45, XY, -1, t (11;14)(q13;q32), t (12;17)(p13;q21)]. He was died of adult respiratory distress syndrome on the 6th hospital day.
Anemia ; Bone Marrow Examination ; Chromosome Aberrations* ; Cytogenetic Analysis ; Electrophoresis ; Humans ; Leukemia, Plasma Cell* ; Middle Aged ; Paraproteinemias ; Paraproteins ; Plasma Cells* ; Plasma* ; Renal Insufficiency ; Respiratory Distress Syndrome, Adult ; Thrombocytopenia

Cerebrospinal fluid (CSF) leak or shunt overdrainage is a well-known cause of orthostatic headaches and low CSF pressures. We report two cases of orthostatic headache with pneumocephalus on brain imaging. The orthostatic headache developed after drainage of spinal operation site and epidural block. Brain MRI revealed characteristic findings of CSF hypovolemia including pachymeningeal enhancement and mild subdural fluid collections. Air was also observed in the ventricular or subarachnoid space in both patients, which might enter the subarachnoid or ventricular space during a procedure via the pressure gradient or an injection.
Brain ; Drainage ; Headache ; Humans ; Hypovolemia ; Neuroimaging ; Pneumocephalus ; Subarachnoid Space

BACKGROUND: There is no clear dermatologic definition to describe sensitive skin which usually includes subjective and psychological meanings. Some individuals exhibit exaggerated response, especially on the face, ranging from itching to intense adverse reaction like erythema, wheal, and eczema in comparison to normal ones when exposed to external irritants, allergens, environmental changes or internal stimulants. OBJECTIVE: To diagnose sensitive skin, lactic acid sting test is well known to represent a person who has subjective symptoms like itching, burning, prickling and stinging. We tried to compare several lactic acid sting tests to search for sensitive skin conveniently and rationally. METHODS: A total of 50 panelists (25 people of sensitive group and 25 people of control group, respectively) were selected by the method of self-assessment questionnaires related to sensitive skin. The panelists were tested on face, by conditioning 3 variances (5% or 10% Lactic acid, Hydration, Hilltop chamber), in 2 week intervals, 8 times totally. RESULTS: When lactic acid sting tests were performed using Hilltop chamber, there were more positive responders in sensitive group(p<0.05). There was statistically a significant difference between the 2 groups in the comparison of mean values of lactic acid sting scores (p<0.05). Sensitive group showed higher sting scores and exhibited much more difference with time (p<0.05). CONCLUSION: Our experiment showed that occlusive technique using Hilltop chamber was an inspiring and useful method of several lactic acid sting tests to find out sensitive skin.
Allergens ; Bites and Stings* ; Burns ; Eczema ; Erythema ; Humans ; Irritants ; Lactic Acid* ; Pruritus ; Self-Assessment ; Skin* ; Surveys and Questionnaires

The objective of this study was to find out whether the unilateral distraction of mandible has an influence on temporomandibular joint and if it does, how significant the influence is. Four beagle dogs were used in this study. Each dog had two implants placed into the left mandible. The mandible was distracted for 14days with an distraction device as an amount of 0.75mm, twice per day after osteotomy between two implants. Each animals were sacrificed at the second, fourth, sixth and eighth week after the total distraction amount of 10.5mm were gotten. Upon embedding and staining, the specimens were evaluated with a light microscope. The results were as follows. 1. For the second week group, the articular cartilage and osteoid seam of temporal bone and condyle were relatively well maintained. There were not any significant differences between distraction side and non distraction side. 2. For the fourth week group, the periosteal reaction was activated and the articular cartilage and osteoid seam of temporal bone and condyle were severely thickened-especially at posterior portion of distraction side. This findings revealed that the unilateral distraction forces has more influence on distraction side than on non distraction side, and on posterior portion than on anterior portion. 3. For the sixth and eighth week group, the thickness of meniscus in distraction side gradually recovered to the initial level. The thickened articular cartilage and osteoid seam of temporal bone and condyle were decreased in distraction side and showed relatively stable in non distraction side. From this results, we suggest that several considerations are required such as using an occlusal splint, maintaining the stability of bone distraction device and evaluating bone distraction rate to minimize the damages of temporomandibular joint tissues in early stage of distraction side.
Animals ; Cartilage, Articular ; Dogs ; Mandible* ; Occlusal Splints ; Osteotomy ; Temporal Bone ; Temporomandibular Joint*

BACKGROUND: Osteoporosis, one of the most common metabolic bone disease, might be influenced by the severity of Parkinson's disease (PD). Objectives : We investigated the relationship between the Bone Mineral Density (BMD) and the severity of PD in postmenopausal and senile women. METHODS: We measured BMD of lumbar spine (L1-L4) by Dual energy X-ray absorptiometry (DEXA; Hologic QDR-4500A). We compared BMD between patient group (30 patients with PD) and control (183 postmenopausal and senile health women). The patients were divided into two groups according to osteoporosis and analyzed the following potential factors influencing BMD in PD; age, duration of symptom, age of onset, Hoehn and Yahr stage (H-Y stage), UPDRS motor score, duration of treatment, body mass index (BMI), dominant symptom such as tremor or rigidity. RESULTS: 1. BMD was significantly decreased with aging (p <0.01) in control group, but BMD tend to decreased with aging in PD (p=0.08). 2. BMD of patient group was significantly lower than that of control group (p<0.001). 3. BMD of osteoporosis group was significantly related to BMI (p<0.05) and conversely related to H-Y staging(p <0.05), UPDRS motor score (p <0.01). 4. However, BMD of osteoporosis group were not related to age, duration of symptom, age of onset, dominant symptom and duration of treatment (p>0.05). CONCLUSION: Osteoporosis is related to H-Y stage, UPDRS motor score and BMI as well as aging in PD.
Absorptiometry, Photon ; Age of Onset ; Aging ; Body Mass Index ; Bone Density* ; Bone Diseases, Metabolic ; Female ; Humans ; Osteoporosis ; Parkinson Disease* ; Spine ; Tremor

PURPOSE: Acute appendicitis is one of the more challenging disease entities to diagnose. Early and correct diagnosis is necessary to decrease morbidity and mortality. The diagnosis of acute appendicitis does not depend on a single modality because it is often difficult and the symptoms of appendicitis can change with time. The Alvarado score is a sensitive and specific tool for diagnosis of appendicitis. But the effectiveness of a single Alvarado score for diagnosis of acute appendicitis can be less meaningful due to diagnostic difficulties. The purpose of this study was to evaluate the usefulness of repeatedly checked Alvarado scores in acute abdomen patients as a diagnostic tool for acute appendicitis. METHODS: A total of 196 patents who visited our ER with acute abdominal pain between March 2008 and February 2009 were enrolled. Emergency physicians checked the initial Alvarado score and re-checked that score after 3 hours of observation. We prospectively compared the results between (a) the initial and the 3 hours Alvarado scores and (b) the final pathology. RESULTS: We measured diagnostic for the initial Alvarado score and the 3 hours Alvarado score groups. The sensitivities of the two groups for detecting appendcitis were 85.1% and 92.0%, respectively; specificities were 81.6% and 89.0%; positive predictive values were 78.7% and 87.0%; negative predictive values were 87.3% and 93.3%; accuracy scores were 83.2% and 90.3%. All diagnostic values of the 3 hours Alvarado score group were superior to those of the initial Alvarado score group. CONCLUSION: Repeatedly checked Alvarado scores provides a superior diagnostic accuracy to the initial Alvarado score alone. Thus, we can say that repeatedly checked 3 hours Alvarado scores are more useful for diagnosing acute appendicitis than an initial, one-time checking of the Alvarado score. This new scoring system will be particularly useful to physicians who are working in health care facilities where computerized tomography or ultra-sonography is not available.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Delivery of Health Care ; Diagnosis, Differential ; Emergencies ; Humans ; Mass Screening ; Prospective Studies ; Severity of Illness Index

BACKGROUND: For the treatment of primary varicose vein of greater saphenous vein(GSV) due to reflux from incompetent saphenofemoral junction(SFJ), several methods such as ligation and stripping, or duplex-guided sclerotherapy have traditionally been introduced. As for sclerotherapy, the recurrence rate has been reported to be very high. In spite of higher success rate, traditional high ligation with stripping of GSV requires several days' admission with general anesthesia and several more days before returning to normal daily life. New modalities, which are less invasive and possibly have lower recurrence to rate with a chance for early ambulation, are being proposed. They are such as endovenous radiofrequency(RF) therapy, endovenous laser therapy, etc. OBJECTIVE: We tried to evaluate the efficacy and safety of endovenous RF therapy as an alternative to high ligation and stripping in case of GSV varicosity in mild to moderate degrees. METHODS: Both GSV varicosities and varicosed tributaries are marked by doppler and/or ultrasonic imaging. A catheter connected to RF generator is inserted proximally through the incision of vein wall percutaneously, usually above or below the knee. After confirming position of the SFJ using ultrasound, the catheter is progressed as far as to 1-2cm below the SFJ. Then, the generator is activated and the catheter withdrawn slowly for complete heating and occlusion of the target vein. Additional ambulatory phlebectomy or sclerotherapy is optional. We wrap the limbs with self-adhesive short stretch bandage for 2-3 days and encourage the patient to walk regularly and wear compressive stocking later. RESULTS: We performed endoluminal RF treatment on 10 legs of 9 patients(5 males and 4 females). Follow-up intervals varied from 2 to 10 months. Patients were generally satisfied with improvement of symptom. On the clinical evaluation with doppler and duplex examination, there were a few blood flows except only some segments of GSV in 7 patients CONCLUSION: Although endoluminal RF therapy may have a somewhat higher recurrence rate than that of traditional high ligation with stripping of GSV, endoluminal RF therapy is expected to have several advantages over traditional surgery, including less invasiveness, no need for admission or general / spinal anesthesia, earlier return to normal daily life, and finally easy performance, especially for the dermatologist.
Anesthesia, General ; Anesthesia, Spinal ; Bandages ; Catheters ; Early Ambulation ; Extremities ; Follow-Up Studies ; Heating* ; Hot Temperature* ; Humans ; Knee ; Laser Therapy ; Leg ; Ligation ; Male ; Recurrence ; Saphenous Vein* ; Sclerotherapy ; Ultrasonography ; Varicose Veins* ; Veins