Reye syndrome is a rapidly progressive encephalopathy with hepatic dysfunction, which often begins several days after apparent recovery from a viral illness, especially varicella or influenza A or B. Salicylate use was identified as a major precipitating factor for the development of Reye syndrome. With the recommendation to avoid use of salicylates in children, Reye syndrome has virtually disappeared in recent years. We report a case of Reye syndrome in a 5-month-old infant who had been treated with intravenous immunoglobulin and aspirin under the diagnosis of Kawasaki disease, and showed symptoms of sudden onset of irritability, rigidity, decreased activity, vomiting, poor appetite, lethargy, liver dysfunction without jaundice, coagulopathy, and hyperammonemia.
Appetite ; Aspirin ; Chickenpox ; Child ; Humans ; Hyperammonemia ; Immunoglobulins ; Infant ; Influenza, Human ; Jaundice ; Lethargy ; Liver Diseases ; Mucocutaneous Lymph Node Syndrome ; Precipitating Factors ; Reye Syndrome ; Salicylates ; Vomiting

BACKGROUND: Cleaning and disinfection of fiberoptic bronchoscope requires careful attention, especially to mycobacterium species because the contamination of mycobacteria could raise confusion on diagnosis. Recently, we detected contamination of Wydex(R) solution used in bronchoscope washer with Mycobacterium chelonae. In this study, we evaluated the mycobactericidal effect of 12 kinds of disinfectants for M. chelonae. METHOD: To evaluate the bactericidal effect of Wydex(R) 2%, Cidex(R) 2.25%, Cidex(R) 3%, Bacteriokiller (BK) disinfectant, Perasafe(R), HICLO-S(R), Lamicine(R), ethanol, Instrusept(R), Virkon(R), Betadine(R), and Vipon(R) against M. chelonae, culture was performed after exposure of two M. chelonae strains (ATCC 35749, the type strain and the strain isolated from contaminated Wydex(R) solution) to each disinfectant solution. The growth of organism was examined for up to 8 weeks. RESULTS: Growth of M. chelonae (reference strain of ATCC 35749 and isolated strain) was observed after a week incubation for Wydex(R) 2%, Cidex(R) (2.25%, 3%) and control. For BK disinfectant and Perasafe(R), they grew after 2-3 weeks, and 3-4 weeks, respectively. For HICLO-S(R) and Lamicine(R), only the contaminated strain grew after two and three weeks, respectively. For ethanol, Virkon(R), Betadine(R), Vipon(R), and Instrusept(R) , growth was not observed from either strain. CONCLUSIONS: On the basis of these results, Instrusept(R), virkon(R), ethanol, Betadine(R), and Vipon(R) were effective for the disinfection of M. chelonae. Especially, Instrusept(R) was thought to be useful as a disinfectant for bronchoscopes because it has advantages including non-corrosiveness, chemical stability, and non-irritativeness. And additional washing with ethanol might be effective. The finding that strain isolated from contaminated bronchoscopes was more resistant to disinfectants than reference strain suggested that the more resistant strains are selected throughout the improper disinfection.
Bronchoscopes ; Diagnosis ; Disinfectants* ; Disinfection ; Ethanol ; Mycobacterium chelonae* ; Mycobacterium*

Aneurysms of superior mesenteric artery (SMA) represent an uncommon but important vascular disease. High mortality rates from rupture of aneurysm and thrombosis of SMA are reported. These lesions are most often infectious in etiology. In the case of relatively abundant collaterals, aneurysm exclusion or SMA ligation is a safe surgical method to prevent serious complications. But in insufficient collaterals, stent-grafting of aneurysm or reconstruction of mesenteric blood flow is unavoidable. Recently we treated a 49-year-old man with SMA pseudoaneurysm and its large orifice located at near the enlarged jejunal branch which is a main collateral of mesenteric blood flow.
Aneurysm ; Aneurysm, False* ; Humans ; Ligation ; Mesenteric Artery, Superior* ; Middle Aged ; Mortality ; Rupture ; Thrombosis ; Vascular Diseases

No abstract available.
Dermoscopy ; Melanoma*

No abstract available.
Condylomata Acuminata* ; Dermoscopy* ; Diagnosis, Differential* ; Lymphangioma* ; Vulva*

Enlargement of bone tunnels has been noted on plain X-rays following arthroscopic ACL reconstruction. The cause of this widening is unclear, but it has been hypothesized that it may be due to either mechanical or biological cases. Ishibashi et al. reported anatomical proximal fixation resulted in the most stable reconstructed knee, with increasing instability as the level of fixation moved away from the tibial plateau. The purpose of this study is to determine if any difference exists in the amount of enlargement of the femoral tunnel following arhotoscopic ACL reconstruction with position of interference screw fixation and instability, and to know the factors which affected to the enlargement of the femoral tunnels. Total 39 patients were retrospectively reviewed for tunnel measurements radiologically at one year post-operation. (27 patients received bone-patellar tendon-bone autograft, 12 patients received bone-patellar tendon-bone autograft and Kennedy LAD-ligament augmentation device). The surgery was performed using an arthroscopic single and double incision technique. AP and lateral X-rays were obtained and the tunnels were measured by two independent observers using a digital caplper. The measurements were made at the widest part of the tunnel. Correction for magnification was performed by comparing the measured width of the interference screw used for fixation of the graft with its actual width. Statistical analysis was performed using a one-way analysis of variance(ANOVA) and t-test. 1. Radiographic tunnel enlargement of femoral side was average 2.42 mm (bone-patellar tendon-bone autograft : 2.36 mm, Kennedy-LAD and autograft : 2.56 mm)(p>0.05). 2. According to the position of the interference screw, the femoral tunnel enlargement were 2.25 mm in anatomical fixation, 2.40 mm in mid-tunnel fixation, 2.62 mm in mid-tunnel fixation, 2.62 mm in outer-tunnel fixation(p < 0.05). 3. The femoral enlargement according to the overall results(Clancy, 1982) were 2.39 mm in above good result group and 2.50 mm in below fair result group(p < 0.05). Tunnel enlargement group of femoral side was related to a distance between femoral articular surface and the position of interference screw. We conclude that femoral tunnel enlargement following arthoscopic bone tendon-bone ACL reconstruction is related to the mechanical effect rather than the properties of grafts and the clinical results.
Autografts ; Humans ; Knee ; Retrospective Studies ; Transplants

PURPOSE: Chlamydia pneumoniae (CP) infection seems to be related to atherosclerotic diseases. A prospective sero- epidemiologic study was performed to analyze the relationship between CP infection and peripheral vascular disease in Korean patients. The aims of this study were to find the prevalences of CP antibody in the serum and CP antigens in the vascular tissues, and to analyze the differences between several disease groups. METHODS: Our subjects included a total of 61 patients (76 vascular tissues) who had undergone operative procedures for peripheral vascular diseases. They were classified into 3 groups: Group 1; 14 abdominal aortic aneurysm, Group 2; 15 atherosclerosis obliterans, and Group 3; 32 varicose vein cases. The CP antibody titers were determined using the microimmunofluorescence test (MIF) and the CP antigen in the vascular tissues with a semi-nested polymerase chain reaction (PCR) and an in situ hybridization technique (ISH). RESULTS: The prevalences of chronic or past CP infection from the MIF (IgG antibody titer > or = 1: 32) in Groups 1, 2 and 3 were 78.6, 73.3, and 68.8% respectively, but with statistically significant differences. The prevalences of PCR- positive tissues in Groups 1, 2 and 3 were 21.4, 6.7, and 0% respectively. There was no CP DNA detected in the venous tissue. CP DNA was detected more frequently in aneurysmal disease than atherosclerosis obliterans, but this was not statistically significant(p=0.265). In comparison with the varicose veins, aortic aneurysms showed a significantly higher PCR positivity ratio (p=0.002), and a similar result was seen with ISH. There was no relationship between CP antigen positivity and the known risk factors for atherosclerosis. CONCLUSION: A high prevalence of CP antibodies was observed in the serum of Korean patients with vascular disease, which matched that in western populations. CP DNA was also detected in atherosclerotic tissues, which was especially high in aneurysmal disease, implying a possible causative role of CP infection in the pathogenesis of the atherosclerotic disease. This is the first report on the prevalence of CP in vascular tissues in Korean population.
Aneurysm ; Antibodies ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Arterial Occlusive Diseases* ; Atherosclerosis ; Chlamydia* ; Chlamydophila pneumoniae* ; DNA ; Epidemiologic Studies ; Humans ; In Situ Hybridization ; Peripheral Vascular Diseases ; Polymerase Chain Reaction ; Prevalence ; Prospective Studies ; Risk Factors ; Surgical Procedures, Operative ; Varicose Veins ; Vascular Diseases

No abstract available.
Erythropoietin* ; Humans* ; Renal Dialysis*

BACKGROUND: Nosocomial urinary tract infection (UTI) accounts for 35% of the nosocomial infection and 80-90% of them are associated with urethral catheters. Recently, we experienced an outbreak of nosocomial UTI caused by multidrug-resistant Pseudomonas aeruginosa in neurosurgical intensive care unit (NSICU). METHODS: We investigated clinical records of the patients and observed the methods of care of urethral catheters in NSICU. Identification of P. aeruginose was done by API NE (API system; bioMerieux, France) and antibiotic susceptibility tests were done by disk diffusion method. Random Amplification of Polymorphic DNA (RAPD) assay was used as a genotyping method. RESULTS: Between November 1997 and January 1998, 11 P. aeruginosa strains were isolated from the urine of 11 patients hospitalized in NSICU of Kangnam St. Mary's Hospital. Routine regular bladder irrigation, and emptying urine with common urinal had been done falsely. Antibiogram of the isolates showed resistance to multiple antibiotics including imipenem, gentamicin. amikacin, piperacillin, ciprofloxacin, ceftazidime, and cefoperazone/sulbactam. RAPD of the outbreak strains showed clonal relatedness, which was different from those of other clinical strains, We instructed all the health care workers to stop bladder Irrigation, and to use the separate urinals for each patient. Thereafter, no further case of P. aeruginosa UTI has occurred. CONCLUSION: An outbreak of UTI, caused by a single clone of P. aeruginosa, was confirmed by RAPD and was eradicated after correction of false practice on care-of urinary catheter.
Amikacin ; Anti-Bacterial Agents ; Ceftazidime ; Ciprofloxacin ; Clone Cells ; Cross Infection ; Delivery of Health Care ; Diffusion ; DNA ; Drug Resistance, Multiple ; Gentamicins ; Humans ; Imipenem ; Intensive Care Units ; Microbial Sensitivity Tests ; Piperacillin ; Pseudomonas aeruginosa* ; Pseudomonas* ; Urinary Bladder ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: Antimicrobial resistance to third-generation cephalosporins in gram-negative bacteria, especially Enterobacter, Citrobacter, and Serratia spp., is increasing. The resistance mechanism of these organisms are hyperproduction of AmpC beta-lactamase and plasmid-mediated extended-spectrum beta-lactamase (ESBL). This study was to determine the occurrence of AmpC hyperproduction and ESBLs in E. cloacae, C. freundii, and S. marcescens over a 3-month period in 2002. METHODS: We tested total of 619 consecutive, nonduplicate isolates (229 E. cloacae, 183 C. freundii, 207 S. marcescens) from 12 university hospitals and a commercial laboratory in Korea. Antimicrobial susceptibilities were tested using the disk diffusion method. AmpC hyperproduction was defined as nonsusceptible to cefotaxime or ceftazidime for E. cloacae and C. freundii and as nonsusceptible to cefotaxime for S. marcescens. ESBL production was determined by the double disk synergy test. RESULTS: Among the E. cloacae, C. freundii and S. marcescens derepressed strains were 20.5%, 30.1%, and 31.4% and ESBL producers were 23.6%, 10.9%, and 15.5%, respectively. The AmpC derepressed strains and ESBL producers revealed lower susceptibility rates for ciprofloxacin, piperacillin, piperacillin-tazobactam and aminoglycosides. CONCLUSIONS: These data reveal that the occurrence of AmpC derepressants and ESBL producers among E. cloacae, C. freundii and S. marcescens is relatively high. Continued nationwide surveillance is necessary to provide information on the spread of these important mechanisms of resistance to beta-lactams.
Aminoglycosides ; beta-Lactamases ; beta-Lactams ; Cefotaxime ; Ceftazidime ; Cephalosporins ; Ciprofloxacin ; Citrobacter ; Citrobacter freundii* ; Cloaca ; Diffusion ; Enterobacter ; Enterobacter cloacae* ; Gram-Negative Bacteria ; Hospitals, University ; Korea ; Piperacillin ; Serratia ; Serratia marcescens*