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*

A case of gallbladder empyema caused by Pediococcus pentosaceus is discussed. This appears to be the first reported case of gallbladder empyema caused by this organism. The laboratory method to identify this vancomycin-resistant gram-positive cocci and antimicrobial susceptibility of this organism are described.
Cholecystitis* ; Gallbladder* ; Gram-Positive Cocci ; Pediococcus*

Myotonia dystrophica(Synonym: Myotonia atrophica, Dystrophia myotonia, Steinert's disease) is a autosomal dominant hereditary multisystemic disorder involving several organs besides skeletal muscle, and commonly called with myotonia congenita, paramyotonia congenita as myotonia. Although most cases are of adult onset, where a mother has the disease, neonatal dystrophia myotonia can occur in her offspring. The main feature is a steadily progressive muscle dystrophy, complicated by myotonia, which is a failure of muscles to relax normally after a forceful contraction. Steinert in 1909 was the first to report the finding of atrophic testes and baldness in patients with myotonia dystrophica, and the other clinical feature of myotonia dystrophica were reported by many authors after that time. We are reporting a case of myotonia dystrophica, which showing familial history with brief review of literature.
Adult ; Alopecia ; Humans ; Mothers ; Muscle, Skeletal ; Muscles ; Myotonia Congenita ; Myotonia ; Myotonic Disorders ; Myotonic Dystrophy ; Testis

PURPOSE: Although, urgent intubation is commonly thought to be associated with a high complication rate and poor outcome, early intubation before deterioration and airway compromise is recommended. We designed a study to evaluate the factors associated with the mortality rate of non-traumatic patients intubated in an emergency department (ED). METHODS: Data were retrieved retrospectively from the patient registry for patients >15-years-of-age who had received ED intubation from June 1, 2007 to June 30, 2008. Patient demographic data, clinical and laboratory findings, vital signs, and specific data concerning intubation procedures were included. Acute physiologic and chronic health evaluation (APACHE) II scores were calculated for every patient. RESULTS: From the initial 241 non-traumatic ED intubated patients, 115 were excluded for out-of-hospital arrests, inadequate data, and undetected esophageal intubation. The remaining 126 patients were enrolled in this study. Sixty (47.6%) patients died during hospital treatment. From multivariate logistic regression analysis, respiratory rate and the time from ED arrival to intubation were associated with increased mortality, which showed an odds ratio (95% Cl) of 1.081 (1.026~1.141) and 1.428 (1.066~1.91), respectively. CONCLUSION: The increase in respiratory rate and the time interval of intubation from ED arrival to intubation in non-traumatic patients are related to increased in-hospital mortality.
Emergencies ; Hospital Mortality ; Humans ; Intubation ; Logistic Models ; Odds Ratio ; Respiratory Rate ; Retrospective Studies ; Time Factors ; Vital Signs

This study was conducted to fine out the preventive effects of chitosan and chitosan oligomer on the disorders of hepatic functions and lipid metabolism induced by 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD), using adult male rats (SD) for four weeks. Rats were fed chitosan (4%) or chitosan oligomer (4%) diets respectively before 3weeks of TCDD treatment (50 ug/kg BW) by intraperitoneal injection and then continually supplied these diets for one week until being sacrificed. The elevation of serum total and LDL cholesterol levels induced by TCDD treatment was significantly reduced in the rats fed chitosan diets. The increment of liver triglyceride levels caused by TCDD treatment was tended to suppress in all rats fed chitosan and chitosan oligomer diets. Fecal total lipid and cholesterol excretion were high levels in the rats fed chitosan diets. The hepatic cytosolic catalase activities significantly decreased by TCDD treatment appeared recovering trend by chitosan diets. In hepatic microsomal cytochrome p-450, NADPH cytochrome p-450 reductase, ethoxycoumarin-o-deethylase (ECOD) and benzphetamin N-demethylase (BPND), chitosan than chitosan oligomer diets apparently decreased the increasing levels by TCDD treatment. In histochemical observation, the fat droplets and apoptosis of hepatocytes by TCDD treatment were markedly alleviated by chitosan and chitosan oligomer diets. These results indicate that chitosan, more than chitosan oligomer can exert preventive effects on some disorders of hepatic functions and lipids accumulation by TCDD.
Adult ; Animals ; Apoptosis ; Catalase ; Chitosan* ; Cholesterol ; Cholesterol, LDL ; Cytochrome P-450 Enzyme System ; Cytosol ; Diet ; Hepatocytes ; Humans ; Injections, Intraperitoneal ; Lipid Metabolism* ; Liver ; Male ; NADPH-Ferrihemoprotein Reductase ; Rats* ; Tetrachlorodibenzodioxin* ; Triglycerides

Purpose: To report a case of subacute methicillin-resistant coagulase-negative Staphylococcus hominis endophthalmitis after re-operation for penetrating keratoplasty in a patient who had a penetrating keratoplasty rejection.Case summary: A 74-year-old man with underlying diabetes and hypertension who underwent bilateral penetrating keratoplasty at another hospital underwent penetrating keratoplasty reoperation due to corneal transplant rejection in the right eye. He had a history of end-stage glaucoma in the right eye and the visual acuity was finger counting at 30 cm. About 25 days postoperatively, the corneal epithelial defect was first found. Treatment based on suspicion of herpes simplex virus infection did not result in improvement and endophthalmitis was suspected in the right eye about 35 days after surgery. Anterior chamber irrigation, pars planar vitrectomy, and intravitreal antibiotic injection were performed. Culture revealed methicillin-resistant coagulase negative Staphylococcus hominis. After 2 months of treatment, the anterior chamber and vitreous inflammation decreased and best corrected visual acuity in the right eye recovered to 0.06. Conclusions Subacute endophthalmitis caused by methicillin-resistant coagulase-negative Staphylococcus may occur after penetrating keratoplasty. Transplant failure due to infection can be avoided with vitrectomy and antibiotic treatment at the right time.

Congenital pulmonary lymphangiectasia (CPL) is a rare lymphatic pulmonary abnormality. CPL with respiratory distress has a poor prognosis, and is frequently fatal in neonates. We report a case of pneumonectomy for CPL in a newborn. An infant girl, born at 39 weeks' after an uncomplicated pregnancy, exhibited respiratory distress 1 hr after birth, which necessitated intubation and aggressive ventilator care. Right pneumonectomy was performed after her symptoms worsened. Histologic examination indicated CPL. She is currently 12 months old and developing normally. Pneumonectomy can be considered for treating respiratory symptoms for improving chances of survival in cases with unilateral CPL.
Female ; Gestational Age ; Humans ; Infant, Newborn ; Lung/pathology ; Lung Diseases/*congenital/diagnosis/pathology/radiography ; Lymphangiectasis/*congenital/diagnosis/pathology/radiography ; Lymphatic Vessels/pathology ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Ulcerative colitis (UC) is a chronic inflammatory bowel disease with heterogeneous clinical features. Data on the disease course and prognosis of UC patients who have been regularly treated are lacking. We aimed to investigate relapse rates of UC in remission and factors related to relapse. METHODS: We retrospectively analyzed clinical courses of 84 patients (43 males, median age 43 years, ranged 20-73 years) diagnosed as UC at Ajou University Hospital between January 1997 and December 2005 based on clinical, endoscopic and pathologic findings, and who were regularly followed for at least one year after the remission. RESULTS: Study subjects consisted of 32 proctitis (38%), 21 left-sided colitis (25%), and 31 subtotal or total colitis (37%). Of 84 patients, relapse was observed in 52 patients (62%) during the follow-up period (ranged 1-9 years). The relapse rate was 24%, 41%, 51%, 65%, 71%, and 79% at 1 year, 2 years, 3 years, 4 years, 5 years and 6 years, respectively. Among sex, age, hemoglobin, ESR, and the extent of disease on admission, decrease of hemoglobin level was the only independent factor related to relapse (odds ratio=2.67, 95% CI (1.32-5.42), p<0.01). CONCLUSIONS: In Korea, relapse of UC in remission is not rare. Decrease of hemoglobin level is an independent risk factor related to its relapse, while the extent of disease is not.
Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Antimetabolites/therapeutic use ; Azathioprine/therapeutic use ; Chronic Disease ; Colitis, Ulcerative/*diagnosis/*epidemiology/therapy ; Data Interpretation, Statistical ; Female ; Follow-Up Studies ; Hemoglobins/analysis ; Humans ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Odds Ratio ; Recurrence ; Retrospective Studies ; Risk Factors ; Time Factors

BACKGROUND: In the diagnosis of acute myocardial infarction, measurement of CK-MB is widely used as an enzyme test, but it needs special instruments, lacks specificity in the presence of concomitant skeletal muscle injuries, and has narrow diagnostic time window. Cardiac specific troponin T-a new marker for the diagnosis of myocardial injury-is now available. Besides the quantitative assay, rapid qualitative asay is also possible with the development of rapid assay Kit. We studied about the efficacy of the Troponin T rapid assay Kit in early doagnosis of actue myocardial infarction in the emergency room. METHODS: Total Ck, Ck-MB, LDH and serum troponin T activities were determined when the patients arrived at the emergency room and at the same time Troponin T rapid assay kit test was done. Final diagnosis was made through the serial measurement of CK, CK-MB and LDH. Diagnostic efficacy of each rest was evaluated. RESULTS: Overall diagnostic sensitivity and specificity of Troponin T rapid assay kit were 0.97 and 0.91. When evaluated only with the initial results, Troponin T rapid assay kit showed sensitivity 0.87, specificity 0.97, serum troponin T 0.75, 0.92, and Ck-Mb 0.81,0.95. In one patient who was finally diagnosed as a septic shock, Ck-MB was elevated but serum troponin T was not and Troponin T rapid assay kit test showed negative result. CONCLUSION: Troponin T rapid assay kit test seems to show nearly the same sensitivity and specificity in diagnosis of acute myocardial infarction compared to CK-MB. This test can be done simply and easily in a short time. Thus, with the use of this test, morbidity, mortality and economic loss due to misdiagnosis and delay of diagnosis of myocardial infarction might be reduced.
Diagnosis ; Diagnostic Errors ; Early Diagnosis* ; Emergency Service, Hospital ; Humans ; Mortality ; Muscle, Skeletal ; Myocardial Infarction* ; Sensitivity and Specificity ; Shock, Septic ; Troponin T* ; Troponin*

PURPOSE: Gallbladder (GB) wall thickening can be found in various conditions unrelated to intrinsic GB disease. We investigated the predisposing etiologies and the outcome of acalculous GB wall thickening in children. METHODS: We retrospectively analyzed 67 children with acalculous GB wall thickening who had visited our institute from June 2010 to June 2013. GB wall thickening was defined as a GB wall diameter >3.5 mm on abdominal ultrasound examination or computed tomography. Underlying diseases associated with GB wall thickening, treatment, and outcomes were studied. RESULTS: There were 36 boys and 31 girls (mean age, 8.5+/-4.8 years [range, 7 months-16 years]). Systemic infection in 24 patients (35.8%), acute hepatitis in 18 (26.9%), systemic disease in 11 (16.4%), hemophagocytic lymphohistiocytosis in 4 (6.0%), acute pancreatitis in 3 (4.5%), and specific liver disease in 3 (4.5%) predisposed patients to GB wall thickening. Systemic infections were caused by bacteria in 10 patients (41.7%), viruses in 5 patients (20.8%), and fungi in 2 patients (8.3%). Systemic diseases observed were systemic lupus erythematosus in 2, drug-induced hypersensitivity in 2, congestive heart failure in 2, renal disorder in 2. Sixty-one patients (91.0%) received symptomatic treatments or treatment for underlying diseases. Five patients (7.5%) died from underlying diseases. Cholecystectomy was performed in 3 patients during treatment of the underlying disease. CONCLUSION: A wide range of extracholecystic conditions cause diffuse GB wall thickening that resolves spontaneously or with treatment of underlying diseases. Surgical treatments should be avoided if there are no definite clinical manifestations of cholecystitis.
Acalculous Cholecystitis ; Bacteria ; Child* ; Cholecystectomy ; Cholecystitis ; Female ; Fungi ; Gallbladder* ; Heart Failure ; Hepatitis ; Humans ; Hypersensitivity ; Liver Diseases ; Lupus Erythematosus, Systemic ; Lymphohistiocytosis, Hemophagocytic ; Pancreatitis ; Retrospective Studies ; Ultrasonography