Tularemia is a zoonosis caused by Francisella tularensis. It is primarily a disease of wild animals. Human infection is incidental and usually results from interaction with biting or blood-sucking insects, wild or domestic animals, or the environment. An increasing number of cases have been reported in several countries. However, in Korea it has not been reported until now. A 40-year old male patient visited our department on Jan 13, 1997, complaining of multiple swollen lymph-nodes on his axillae and reddish swollen left upper arm which contained an abscess at its central portion for about ten days. On Dec 25, 1996, he found a dead wild rabbit on a nearby mountainside, ate it after cooking it by himself with his hands injured. His abscess was drained and microbiologic examination was done. However no microorganism was isolated. His lymph nodes were surgically removed from both axillae, and we investigated them microbiologically and pathologically. On microbiologic examination, small aerobic gram negative coccobacilli were grown on a chocolate agar plate in an aerobic condition with 5% CO2 at 37 degrees centigrade. On H & E staining, the lymph node showed chronic granulomatous inflammation. We sent the microorganism and lymph nodes to the Centers for Disease Control and Prevention in the United States of America for the definitive diagnosis. Finally the microorganism was identified as F. tularensis by culture morphology, biological tests and immunohistochemical staining. We report the first case of F. tularensis in Korea.
Abscess ; Adult ; Agar ; Americas ; Animals ; Animals, Domestic ; Animals, Wild ; Arm ; Axilla ; Cacao ; Centers for Disease Control and Prevention (U.S.) ; Cooking ; Diagnosis ; Francisella tularensis ; Hand ; Humans ; Inflammation ; Insects ; Korea ; Lymph Nodes ; Male ; Tularemia* ; United States

PURPOSE: The aim of this study is to examine whether conventional primary closure of the bile duct without routinely inserting a T-tube could be performed after all the surgeries used to treat choldocholithiasis. METHODS: From April 2002 to July 2005, we retrospectively analyzed 125 bile duct stone disease patients who underwent primary closure of the bile duct. RESULTS: Wound infection was the most frequent surgical complications, and it showed a higher trend in the patients who had a history of previous biliary operation, and it showed a trend to be slightly higher in the recurrent biliary stone cases than that in the de novo cases. However, these findings were not statistically significant. In addition, surgical complications developed in 16 of 100 patients who were older that 60 years, whereas there was only 1 of 25 patients who developed complications for the patients younger than 60 years. The development of complications has a tendency to be higher for the older patients, yet the level was not statistically significant. In regard to postsurgical hyperamylasemia, although a statistically significant difference could not be detected, this malady developed in 3 of 12 cases in whom endoscopic nasobiliary drainage (ENBD) tubes were inserted. This showed a trend to be higher than that for 13 cases of 113 patients for whom endoscopic nasobiliary drainage tubes were not inserted. Concerning the postsurgical hospitalization period, it was significantly longer in the cases who developed complications (p=0.018), and there was a tendency for a prolonged hospitalization period for the patients who were older than 60 years, for women, recurrent cases and the cases with a history of the bile duct surgery. Yet these had no statistical significance CONCLUSION: It appears that the primary closure of bile duct is a technique that could be performed safely for all choledocolithotomy patients , and this is regardless of the size of bile duct diameter, history of surgery on the bile duct system, gender, emergency operation, age, recurrent biliary stones, the presence of presurgical nasobiliary drainage tube and the presence of concomitant diseases.
Bile Ducts* ; Bile* ; Choledocholithiasis ; Drainage ; Emergencies ; Female ; Hospitalization ; Humans ; Hyperamylasemia ; Length of Stay ; Retrospective Studies ; Wound Infection

PURPOSE: Acute urinary retention(AUR) is a serious outcome of benign prostatic hyperplasia(BPH). Although Foley indwelling catheterization is a standard treatment for the conservative management of AUR, we studied the success rate of in-and-out catheterization and the factors that favor a positive outcome of a trial treatment without using a catheter(TWOC). MATERIALS AND METHODS: We retrospectively reviewed the medical record of all 127 patients who admitted as emergency cases with primary AUR caused by BPH(from January 2002 to August 2005), and these patients underwent in-and-out catheterization or Foley indwelling catheterization and then they underwent TWOC 1 week later after the first treatment. The patients were divided into four groups: the success group(group I) or failure group(group II) that underwent in-and-out catheterization and the success group(group III) or failure group(group IV) that underwent TWOC. The factors that might influence the outcomes were assessed using logistic regression analysis and Student's t-test. RESULTS: Of the 62 patients who underwent in-and-out catheterization, 30 had no further episodes of AUR during 1-year follow up(group I) and the other patients had repeated episodes(group II). For the clinical parameters, only the retained urine volume was significantly difference between the two groups. The multivariate analysis revealed that the statistically significant influencing factor was urinary retention volume(p<0.01). CONCLUSIONS: For patients younger than 58 years old or the patients with a urinary retention volume less than 580ml, in-and-out catheterization may be considered as the first-line conservative management in preference to bothersome Foley indwelling catheterization.
Catheterization ; Catheters ; Catheters, Indwelling ; Emergencies ; Humans ; Logistic Models ; Medical Records ; Multivariate Analysis ; Prostatic Hyperplasia ; Retrospective Studies ; Urinary Catheterization ; Urinary Retention

PURPOSE: The umbilical cord blood has been considered as an alternative source of hematopoietic stem cells for transplantation. The CD34+ is known as a common stem cell antigen and the CD34+ CD38- immunophenotype reportedly defines a primitive subpopulation of progenitor cells. In this study the frequency of CD34+ and CD34+ CD38- hematopoietic stem/progenitor cells in placental/cord blood (UCB), and adult peripheral blood (PB) were determined. METHODS: Between July and September 1998, 27 collections of UCB were performed at the obstetric units of Hanyang University Hospital. Fifteen adult PB samples were also obtained for control. RESULTS: The frequency of total CD34+ cells in UCB was higher (1.13+/-0.58% vs 0.46+/-0.30%, P=0.0002) than PB and the frequency of CD34+ CD38- cells in UCB was also greater (0.02+/-0.02 vs 0.01+/-0.01, P=0.035) than PB. The majority of UCB- and PB-derived CD34+ cells expressed CD38- antigen (98.22+/-2.11% in UCB and 97.85+/-2.56% in PB). The frequency of CD38- expression by UCB derived CD34+ cells was slightly higher (not statistically significant) than that by PB derived CD34+ cells. The frequency of CD34+ cells was increased linearly with birth weight (r=0.413). CONCLUSION: These results suggest that UCB could be a useful source of highly primitive hematopoietic stem cells for marrow reconstitution after bone marrow ablation.
Adult* ; Birth Weight ; Bone Marrow ; Fetal Blood* ; Hematopoietic Stem Cells ; Humans ; Stem Cells

BACKGROUND: This study focused on the association between preoperative serum carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (Cyfra 21-1) levels and pathologic parameters in patients with resected non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: The records of 527 patients who underwent pulmonary resection of NSCLC were reviewed. The association between preoperative serum CEA and Cyfra 21-1 levels and variables that had p-values of less than 0.05 in a t-test or one-way analyses of variance was analyzed by multiple linear regression. RESULTS: The mean serum CEA and Cyfra 21-1 levels prior to surgery were 6.8+/-23.1 mg/dL (range, 0.01 to 390.8 mg/dL) and 5.4+/-12.3 mg/dL (range, 0.65 to 140.2 mg/dL). The serum CEA levels were associated with tumor (T) and lymph node (N) stage and histology. The serum Cyfra 21-1 levels were associated with T stage, tumor size, and histology. Multiple linear regression indicated that serum CEA levels were associated with T (T3/4 vs. T1: beta=8.463, p=0.010) and N stage (N2/3 vs. N0: beta=9.208, p<0.001) and histology (adenocarcinoma vs. squamous cell: beta=6.838, p=0.001), and serum Cyfra 21-1 levels were associated with tumor size (beta=2.579, p<0.001) and histology (squamous cell vs. adenocarcinoma: beta=4.420, p=0.020). CONCLUSION: Serum CEA level was correlated with T and N stage, and Cyfra 21-1 with tumor size. CEA and Cyfra 21-1 showed histologic correlation. CEA is mainly elevated in adenocarcinoma and Cyfra 21-1 in squamous cell carcinoma. These results might be helpful for predicting pathologic status in preoperative NSCLC.
Adenocarcinoma ; Antigens, Neoplasm ; Carcinoembryonic Antigen ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Humans ; Keratin-19 ; Keratins ; Linear Models ; Lung Neoplasms ; Lymph Nodes

BACKGROUND: This study focused on the association between preoperative serum carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (Cyfra 21-1) levels and pathologic parameters in patients with resected non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: The records of 527 patients who underwent pulmonary resection of NSCLC were reviewed. The association between preoperative serum CEA and Cyfra 21-1 levels and variables that had p-values of less than 0.05 in a t-test or one-way analyses of variance was analyzed by multiple linear regression. RESULTS: The mean serum CEA and Cyfra 21-1 levels prior to surgery were 6.8+/-23.1 mg/dL (range, 0.01 to 390.8 mg/dL) and 5.4+/-12.3 mg/dL (range, 0.65 to 140.2 mg/dL). The serum CEA levels were associated with tumor (T) and lymph node (N) stage and histology. The serum Cyfra 21-1 levels were associated with T stage, tumor size, and histology. Multiple linear regression indicated that serum CEA levels were associated with T (T3/4 vs. T1: beta=8.463, p=0.010) and N stage (N2/3 vs. N0: beta=9.208, p<0.001) and histology (adenocarcinoma vs. squamous cell: beta=6.838, p=0.001), and serum Cyfra 21-1 levels were associated with tumor size (beta=2.579, p<0.001) and histology (squamous cell vs. adenocarcinoma: beta=4.420, p=0.020). CONCLUSION: Serum CEA level was correlated with T and N stage, and Cyfra 21-1 with tumor size. CEA and Cyfra 21-1 showed histologic correlation. CEA is mainly elevated in adenocarcinoma and Cyfra 21-1 in squamous cell carcinoma. These results might be helpful for predicting pathologic status in preoperative NSCLC.
Adenocarcinoma ; Antigens, Neoplasm ; Carcinoembryonic Antigen ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Humans ; Keratin-19 ; Keratins ; Linear Models ; Lung Neoplasms ; Lymph Nodes

Hemorrhage associated with an intracranial neoplasm is a rare event and can produce a serious outcome. Most of the intracranial hemorrhages in brain tumors are in the subarachnoid, intracerebral, or subdural area and cases of intratumoral or intraventricular hemorrhage are relatively rare. The authors report two cases of brain tumors associated with intratumoral and intraventricular hemorrhage which occurred during the preoperative embolization. The diagnoses were petro-clival hemangiopericytoma and suspected intraventricular meningioma. There was no specific precipitating factor for the bleeding. We discuss the possible mechanisms of intracranial hemorrhage in these cases, and stress the unexpected complication when performing preoperative embolization.
Brain Neoplasms* ; Brain* ; Diagnosis ; Hemangiopericytoma ; Hemorrhage ; Intracranial Hemorrhages* ; Meningioma ; Precipitating Factors

BACKGROUND: The diagnostic significance of the serological detection of antibodies to Helicobacter pylori (H. pylori) has been reported by many investigators. But the comparison data between the various serological kits were not established in Korea. METHODS: Forty nine patients with upper gastrointestinal symptoms were studied from June 1997 to September 1997 in Yonsei University College of Medicine, Severance hospital. Endoscopic gastric biopsy specimens were obtained for microscopic examination of the bacteria and rapid urease test (CLO test). The sera of these patients were obtained for the serological test at the same time. The six commercial kits (Cobas Core II, G.A.P. test IgG, PYLORAGEN, QuickVue, BIOCARD Helicobacter pylori IgG, EZ-H.P.) for the detection H. pylori antibodies were evaluated for diagnosis and screening of H. pylori infection. RESULTS: Sensitivities for the six kits were from 71% to 96%, specificities were from 24% to 71%, positive predictive values were from 68% to 81%, negative predictive values were from 60% to 80%, respectively. There were statistically significant differences in four groups, between G.A.P. test and Cobas Core, G.A.P. test and PYLORAGEN, QuickVue and Cobas Core, QuickVue and PYLORAGEN. CONCLUSIONS: Sensitivities and specificities obtained in different studies revealed as great differences in the results with the same kits as between the results obtained with different kits in the same study. So, the serologic method alone for the diagnosis of H. pylori infection is not recommended. But in the screening of H. pylori infection, it can be used, because sensitivities and negative predictive values are relatively high.
Antibodies ; Bacteria ; Biopsy ; Diagnosis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G* ; Korea ; Mass Screening ; Research Personnel ; Serologic Tests ; Urease

No abstract available.
Cerebral Ventricles* ; Hydrocephalus*

A 62-year-old woman was evaluated for tinnitis and headache. Magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case.
Arteriovenous Malformations/diagnosis ; Arteriovenous Malformations/complications* ; Carotid Artery, External/pathology ; Carotid Artery, Internal/pathology ; Case Report ; Cerebral Angiography ; Dura Mater/pathology ; Female ; Human ; Jugular Veins/pathology ; Magnetic Resonance Imaging ; Meningeal Neoplasms/diagnosis ; Meningeal Neoplasms/complications* ; Meningioma/diagnosis ; Meningioma/complications* ; Middle Age