PURPOSE: Various studies on amniotic membrane transplantation for ocular surface reconstruction have been reported. To investigate the effect of human amniotic membrane transplantation on corneal fungal ulcer, we reviewed the records of four fungal ulcer patients. METHODS: Human amniotic membranes were transplanted to the diseased corneas under topical anesthesia within 12 hours. RESULTS: After the mean observation period of 8.5 months, cornea was stabilized in all eyes. No aggravation or rejection were observed. Secondary penetrating keratoplasty was performed in 2 cases. CONCLUSION: Amniotic membrane transplantation may be effective to promote corneal wound healing in refractory fungal ulcer and considered as a useful treatment prior to corneal transplantation.
Amnion* ; Anesthesia ; Cornea ; Corneal Transplantation ; Humans* ; Keratoplasty, Penetrating ; Ulcer* ; Wound Healing

Primary aldosteronism is due to either a unilateral adrenal adenoma or bilateral hyperplasia of the adrenal cortex in most cases. A unilateral adrenalectomy in hypertensive and hypokalemic patients, with a well-documented adrenal adenoma, is usually followed by the correction of hypokalemia in all subjects, with the cure of hypertension in 60 to 87% of patients. Here, a unique case, in which a unilateral adrenalectomy for the removal of an adrenal adenoma was followed by severe hyperkalemia, low levels of plasma renin activity and serum aldosterone, suggestive of chronic suppression of the renin-aldosterone axis, is reported. In a follow-up Lasix stimulation test on the 70th day after surgery, the suppression of the renin-aldosterone axis was resolved, indicating the suppression was transient. Patients undergoing a unilateral adrenalectomy for an aldosterone-producing adenoma should be closely followed up to avoid severe hyperkalemia.
Adenoma* ; Adrenal Cortex ; Adrenalectomy ; Aldosterone ; Axis, Cervical Vertebra ; Follow-Up Studies ; Furosemide ; Humans ; Hyperaldosteronism ; Hyperkalemia ; Hyperplasia ; Hypertension ; Hypoaldosteronism* ; Hypokalemia ; Plasma ; Renin

Abalone is popular seafood in Asia; however, allergy to abalone was rarely reported. We report a case of anaphylaxis after consumption of abalone. A 24-year-old female visited an Emergency Department, complaining of cough, dyspnea, rhinorrhea, generalized urticaria, facial edema, and wheezing that had developed 1 hour after consumption of abalone. She was discharged when her symptoms subsided after antihistamine and dexamethasone were given. One month later, she was referred to our outpatient clinic. We performed skin prick tests, measurement of serum specific IgE antibody level, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) with IgE immunoblotting. Both skin prick and specific IgE antibody tests were positive for abalone crude extract. In SDS-PAGE with IgE immunoblotting, we identified possible antigens sized 55, 100, and 25 kDa, respectively. This is the first case of abalone-induced anaphylaxis in Korea.
Ambulatory Care Facilities ; Anaphylaxis* ; Asia ; Cough ; Dexamethasone ; Dyspnea ; Edema ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Emergency Service, Hospital ; Female ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Immunoblotting ; Immunoglobulin E ; Korea ; Respiratory Sounds ; Seafood ; Shellfish ; Skin ; Sodium ; Urticaria ; Young Adult

OBJECTIVE: Decrease of platelet density by degranulation of activated platelet is well correlated with decrease of mean platelet component (MPC) value. We intended to investigate the change of MPC, mean platelet volume, and platelet count according to the stroke stage and difference between ischemic and hemorrhagic infarction. METHOD: Thirty eight patients (ischemic stroke 28 men, hemorrhagic stroke 10 men) and twenty age-matched healthy persons were included in this study. They were divided into acute stage group and subacute stage group. Each of them were sampled by venously and investigated about mean platelet component, mean platelet volume, and platelet counts. RESULTS: In ischemic stroke, there was statically (p <0.05) meaningful decrease of MPC value in acute stage (27.5+/-1.7) compared to control group (28.8+/-0.9). And MPC value in subacute stage showed meaningful increase (28.1+/-1.3) compared to acute stage but still remained in statically lower value compared to control value. In hemorrhagic stroke, there was no meaningful difference of MPC value in acute stage group (28.6+/-2.0) and subacute stage group (27.9+/-1.1) compared to control group. CONCLUSION: In ischemic stroke patients, MPC value in acute stage decreased meaningfully and this change might be useful as a landmark in predicting the activity of infarction.
Blood Platelets* ; Humans ; Infarction ; Male ; Mean Platelet Volume ; Platelet Activation ; Platelet Count ; Stroke*

BACKGROUND: A rapid increase in antimicrobial-resistant bacteria has become a serious problem in Korea. Moreover, the antibiotic resistance problem has worsened noticeably during the past several years. The aim of this study was to determine the prevalence of resistance among frequently isolated gram-positive and -negative bacteria in Korea. METHODS: Routine susceptibility data for medically important bacteria isolated during 6 months of 2003 were collected from 12 university and general hospital laboratories in Korea. RESULTS: The proportion of methicillin-resistant Staphylococcus aureus (MRSA) was 66%; however, vancomycin-resistant strains were not detected. The rates of vancomycin-resistant Enterococcus faecium and penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) were 22% and 73%, respectively. The resistance rates to 3rd generation cephalosporins and monobactam were: Escherichia coli 8-12%, Klebsiella pneumoniae 18-22%, Citrobacter freundii 22-32%, Enterobacter cloacae 34-37%, and Serratia marcescens 12-21%, respectively. Imipenem resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa were 23% and 25%, respectively. CONCLUSIONS: Antimicrobial resistant strains were already prevalent among the clinically important isolates, especially, MRSA, PNSP, and extended-spectrum cephalosporin resistant gram-negative bacilli in Korea. The imipenem-resistant rates of A. baumannii and P. aeruginosa increased, respectively, from 13% and 20% in 2002 to 23% and 25% in 2003. The results of this study will provide a basis for proper treatment of bacterial infections and prevention of spread of resistant bacteria. A continuous nationwide surveillance of antimicrobial resistance is very important and should be performed.
Acinetobacter baumannii ; Bacteria* ; Bacterial Infections ; Cephalosporins ; Citrobacter freundii ; Drug Resistance, Microbial ; Enterobacter cloacae ; Enterococcus faecium ; Escherichia coli ; Hospitals, General ; Imipenem ; Klebsiella pneumoniae ; Korea* ; Methicillin-Resistant Staphylococcus aureus ; Prevalence ; Pseudomonas aeruginosa ; Serratia marcescens ; Streptococcus pneumoniae

BACKGROUND: The aims of this study were to survey nationwide susceptibilities of Escherichia coli and Klebsiella pneumoniae isolates against cefotaxime and to determine the prevalences of CTX-Mtype extended-spectrum beta-lactamases(ESBLs). METHODS: During the period of February to July, 2003, E. coli and K. pneumoniae isolates were collected from 12 hospitals. Antimicrobial susceptibilities to cefotaxime were tested by the disk diffusion method. ESBL production was determined by the double disk synergy test. Cefotaxime-resistance of the ESBL-producers was transfered to E. coli DH5alphaand E. coli Top10-F by transformation. MICs of beta-lactam antibiotics were determined by the agar dilution method. Searches for blaCTX-M genes was performed by PCR amplication; pIs of beta-lactamases were determined by isoelectric focusing. RESULTS: Among 230 isolates of E. coli and 232 isolates of K. pneumoniae, 27 (11.7%) and 79 (34.1%) were intermediate or resistant to cefotaxime, respectively. Twenty-four (10.4%) isolates of E. coli and 58 (25.0%) K. pneumoniae isolates showed positive results in the double disk synergy test. Three isolates of E. coli and 13 K. pneumoniae isolates harbored blaCTX-M-3 gene, 4 E. coli isolates harbored blaCTX-M-15 gene, and 1 E. coli and 5 K. pneumoniae isolates harbored blaCTX-M-14 gene. CONCLUSION: E. coli and K. pneumoniae isolates producing CTX-M-type ESBLs were not uncommon in Korean hospitals. It is thought that periodical surveys are necessary for inspecting the spread of CTX-M-type ESBL genes are necessary.
Agar ; Anti-Bacterial Agents ; beta-Lactamases ; Cefotaxime ; Diffusion ; Escherichia coli* ; Escherichia* ; Isoelectric Focusing ; Klebsiella pneumoniae* ; Klebsiella* ; Korea* ; Pneumonia ; Polymerase Chain Reaction ; Prevalence*

BACKGROUND: A rapid increase of antimicrobial-resistant bacteria has become a serious problem in many countries. The aim of this study was to determine the prevalence of resistance among frequently isolated gram-positive and -negative bacteria in Korea. METHODS: Data of routine antimicrobial susceptibility test for medically important bacteria, isolated during 3 months of 2002, were collected from 12 university and 1 commercial laboratories in Korea. RESULTS: The proportions of methicillin-resistant Staphylococcus aureus (MRSA) were 60-88%, but vancomycin-resistant S. aureus was not detected. Among the Enterococcus faecium isolates, the resistance rate to vancomycin was 29%. The resistance rates of Escherichia coli and Klebsiella pneumoniae: 11% and 24% to cefotaxime, respectively, and 12% and 21% to cefoxitin, respectively. The resistance rates of Citrobacter freundii, Enterobacter cloacae, and Serratia marcescens: 28%, 34% and 21% to cefotaxime, respectively, <1%, 8% and 14% to cefepime, respectively. The resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa were: 65% and 37% to piperacillin, 64% and 19% to ceftazidime, 13% and 20% to imipenem, respectively. The resistant rates varied according to the hospital size. The resistance rates were generally higher among the isolates in the hospitals with more than 1,000 beds. The rates of penicillin-nonsusceptible Streptococcus pneumoniae were 58-90%. Among the Haemophilus influenzae isolates, 55-68% were resistant to ampicillin. CONCLUSIONS: Antimicrobial resistant strains were prevalent among the medically important clinical isolates, especially, MRSA, vancomycin-resistant enterococci, extended-spectrum -lactamase- or AmpC -lactamase-producing E. coli and K. pneumoniae, third generation cephalosporin-resistant C. freundii, E. cloacae and S. marcescens, imipenem-resistant A. baumannii and P. aeruginosa, penicillin-nonsusceptible S. pneumoniae and ampicillin-resistant H. influenzae. The antimicrobial resistance has become a serious problem in Korea.
Acinetobacter baumannii ; Ampicillin ; Bacteria* ; Cefotaxime ; Cefoxitin ; Ceftazidime ; Citrobacter freundii ; Cloaca ; Enterobacter cloacae ; Enterococcus faecium ; Escherichia coli ; Haemophilus influenzae ; Health Facility Size ; Imipenem ; Influenza, Human ; Klebsiella pneumoniae ; Korea* ; Methicillin-Resistant Staphylococcus aureus ; Piperacillin ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa ; Serratia marcescens ; Streptococcus pneumoniae ; Vancomycin

BACKGROUND: The aim of this study was to determine a nation-wide prevalence of Ambler class A and D extended-spectrum-lactamases (ESBL) in Klebsiella pneumoniae isolates in Korea. METHODS: During the period of April to May 2005, 189 isolates of K.pneumoniae were collected from 11 Korean hospitals. Antimicrobial susceptibilities to ceftazidime and cefotaxime were tested by the disk diffusion method, and ESBL production was determined by double-disk synergy test. Determinants of ceftazidime or cefotaxime-resistance were transferred to Escherichia coli J53 (azide-resistant) by transconjugation. Genotypes of class A and D ESBL genes were determined by PCR amplification and sequencing. RESULTS: One hundred-sixty isolates of K.pneumoniae showed positive results in double-disk synergy test. The most prevalent ESBL was SHV-12 (n=148). Also detected were genes encoding ESBLs including TEM-52 (n=1), SHV-2a (n=2), CTX-M-3 (n=15), CTX-M-9 (n=6), CTX-M-12 (n=2), CTX-M-14 (n=9), CTX-M-15 (n=1), PER-1 (n=1), GES-5 (n=3), and OXA-30 (n=2) beta-lactamases. CONCLUSION: With the emergence of CTX-M-12, PER-1, and OXA-30 beta-lactamases, the ESBLs in K.pneumoniae isolates are becoming more diverse in Korea.
beta-Lactamases ; Cefotaxime ; Ceftazidime ; Diffusion ; Escherichia coli ; Genotype ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Polymerase Chain Reaction ; Prevalence

BACKGROUND: The aims of this study were to survey the nation-wide susceptibilities of Klebsiella pneumoniae isolates against ceftazidime and cefotaxime and to determine the prevalence of class A extended-spectrum beta-lactamases (ESBLs). METHODS: During the period of February to July 2004, K. pneumoniae isolates intermediate or resistant to ceftazidime and/or cefotaxime were collected from 12 hospitals in Korea. Antimicrobial susceptibilities were determined by the disk diffusion and the agar dilution methods and ESBL-production was by double-disk synergy test. Ceftazidime or cefotaxime-resistance determinants of the ESBLproducers were transfered to Escherichia coli J53 by transconjugation. Searches for class A ESBL genes were performed by PCR amplication. RESULTS: Among 212 clinical K. pneumoniae isolates, 172 (81%) isolates showed positive results in double-disk synergy test; the most prevalent ESBL was SHV-12 (n=104). Genes encoding ESBLs including SHV-2 (n=6), SHV-2a (n=17), CTX-M-3 (n=18), CTX-M-9 (n=6), CTX-M-12 (n=1), CTX-M- 14 (n=27), CTX-M-15 (n=3), and a novel CTX-M-type beta-lactamases were also detected. CONCLUSIONS: It is concluded that diversity of ESBLs in K. pneumoniae isolates are increasing in Korea. CTX-M-12 has never been reported in Asia, and a novel CTX-M-type ESBL has emerged.
Agar ; Asia ; beta-Lactamases ; Cefotaxime ; Ceftazidime ; Diffusion ; Escherichia coli ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Pneumonia ; Polymerase Chain Reaction ; Prevalence

BACKGROUND: A rapid increase in antimicrobial-resistant bacteria has become a serious problem in many countries including Korea, but the rate and pattern of antimicrobial resistance may vary significantly depending on countries and even on hospitals. The aim of this study was to determine the nationwide prevalence of resistance among frequently isolated bacterial pathogens in Korea. METHODS: Routine susceptibility data for medically important bacterial pathogens from 12 university hospital and general hospital laboratories in Korea were analysed by patient group. These pathogens had been isolated during the period from April to November in 2004. RESULTS: The proportion of methicillin-resistant Staphylococcus aureus (MRSA) was 67%. Van-comycin-resistance rate of Enterococcus faecalis was 1% and that of E.faecium was 20%. The resistance rates of Streptococcus pneumoniae to penicillin and Haemophilus influenzae to ampicillin were 70% and 54%, respectively. The resistant rates of Escherichia coli and Klebsiella pneumoniae were 7-10% and 26-31% to the 3rd generation cephalosporin, respectively. The resistance rates to 3rd generation cephalosporin were 22-30% in Citrobacter freundii, 35-44% in Enterobacter cloacae and 15-22 % in Serratia marcescens. Imipenem resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii were 26% and 17%. Cotrimoxazole and levofloxacin resistance rates of Stenotrophomonas maltophilia were 46% and 44%, respectively. CONCLUSION: Antimicrobial resistance rates of clinically important pathogens in Korea were still high and were generally higher among the bacteria isolated from the intensive care unit patients. Strict infection control and continuous nationwide surveillance program will be required to manage the antimicrobial resistance problem.
Acinetobacter baumannii ; Ampicillin ; Bacteria* ; Citrobacter freundii ; Enterobacter cloacae ; Enterococcus faecalis ; Escherichia coli ; Haemophilus influenzae ; Hospitals, General ; Humans ; Imipenem ; Infection Control ; Intensive Care Units ; Klebsiella pneumoniae ; Korea* ; Levofloxacin ; Methicillin-Resistant Staphylococcus aureus ; Penicillins ; Prevalence ; Pseudomonas aeruginosa ; Serratia marcescens ; Stenotrophomonas maltophilia ; Streptococcus pneumoniae ; Trimethoprim, Sulfamethoxazole Drug Combination