In order to understand the role of mec regulator genes in the evolution of methicillin-resistant S. aureus (MRSA), the distribution of the mec regulator genes among the 66 clinical isolates of MRSA was analysed. And also the correlation between gene mutation and degree of phenotypic expression of resistance was studied. Fifty strains carried whole mec regulator region, while the mecI gene and nearly half of the 3'-end of the mecR#l gene were deleted in fifteen strains. The mecRl MS gene was detected among all of the mecA carried strains, but the mecRl PB gene was carried by 77% of the MRSA strains. At least a portion of the 5'-end region of the mecRl gene was carried by all MRSA strains tested. Forty-seven strains were finally confirmed to have mecI gene and each mecI gene of above strains was sequenced for identification of the relationship between repressor function of mecI gene on mecA transcription and MIC level of methicillin. Point mutations were detected in 11 strains of 47 strains. In 8 strains, there was one nucleotide substitution (C to T at position 202) that produced a new termination codon at position 201. In 3 strains, one nucleotide substitution from G to T at position 43 caused an amino acid substitution from Val to Phe. The MIC of methicillin of strains carrying mutated mecI genes ranged 256 ug/ ml to 1024 ug/ml. Transcription level of amplified cDNA corresponding to mecA was determined by the method of RT-PCR of extracted RNA. Total RNA was extracted from two strains with mutated mecI gene and a strain with intact mecI gene. Deletional loss or the mutational inactivation of the mecI gene did not affect the level of mecA transcription. Role of mecI gene as a strong repressor function on mecA gene seemed to be skeptical.
Amino Acid Substitution ; Codon, Terminator ; DNA, Complementary ; Genes, Regulator* ; Methicillin Resistance ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus ; Point Mutation ; RNA

The use of intravitreal corticosteroids in the management of endophthalmitis remains controversial. This study was performed to evaluate the effectiveness of dexamethasone(DXM) in Candida endophthalmitis. In rabbits, Candida albicans(3,000 blastospore: Group A, 30,000 blastopore: Group B) was inoculated intrabitreally. At 24, 48, and 72 hours postinoculation, single intravitreal dose of amphotericin B(AMP, 5microgram/0.1ml) with DXM(400microgram/0.1ml) or AMP alone was given. Clinical examination, protein analysis, electrophysiological and histopathologic measures were utilized to rate DXM effectiveness. Dosage of 5microgram AMP resulted in no culture in both Group A and B, On examinations including the electrophysiologic and histopathologic studies, eyes treated with AMP and DXM did not differ from eyes treated with AMP alone in the Group A(p>0.05). On protein analysis for vitreous in the Group B, however, eyes treated with AMP alone at 24 and 48 hours postinoculation(p<0.05). On electrophysiologic study the decrease rate of the amplitude showed the difference between at 24 hours postinoculation and at 48 or 72 hours postinoculation(p<0.05). Histologic preparations showed a mild or moderate cellular infilteration in the vitreous and swelling in the sensory retina, but small abscess in the vitreous observed when treatment was delayed more than 72 hours following inoculation in both Group A and B. DXM in the experimental Candida endophthalmitis had the beneficial effect in eyes with 30,000 blastspore inoculation and in eyes treated with AMP and DXM at 24 hours postinoculation.
Abscess ; Adrenal Cortex Hormones ; Amphotericin B ; Candida* ; Dexamethasone* ; Endophthalmitis* ; Gastrula ; Intravitreal Injections ; Rabbits ; Retina

No abstract available.
Animals ; Lymphocyte Subsets* ; Lymphocytes* ; Rats*

This paper reports our experiences in laparoscopically assisted surgical staging (LASS) to manage the patients with early-stage endometrial cancer. From March 1996 to March 1999, we performed LASS in 6 patients with clincal stage I adenocarcinoma of the endometrium. We performed laparoscopic-assisted vaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy (BSO) and intraoperative frozen-section (IFS) diagnosis. The depth of myometrial invasion, tumor differentiation, histologic types, cervical invasion, and adnexal involvement were determined by IFS diagnosis. Laparoscopic pelvic and/or para-aortic lymphadenectomies were performed based on the grade of the tumor and depth of myometrial invasion. One patient was discovered to have tumor metastases in pelvic peritoneum and uterosacral ligaments, and underwent only para-aortic lymphadenectomy for determining field of radiation therapy. 2 out of 5 patients only underwent LAVH with BSO and peroitoneal washing cytology. Three other patients underwent LAVH with BSO, peritoneal washing cytology and pelvic lymphadenectomy because they were identified by IFS diagnosis as intermediate risk group for nodal metastasis. The mean age of the patients was 46.4 years. Total length of the operation time ranged from 100 minutes to 305 minutes and the mean was 187.5 minutes. The mean hemoglobin decrement after the surgery was 0.9 gm/dl. No one recieved blood transfusion. The average number of pelvic and para-aortic lymph nodes removed were 16.7 and 18, respectively. After the surgery, the patients passed gas after an average of 2.0 days and urinated urine after an average of 3.8 days. No one had complication after LASS. Based on our experiences, LASS might be an alternative to the traditional surgical approach in patients with early-stage endometrial carcinoma.
Adenocarcinoma ; Blood Transfusion ; Diagnosis ; Endometrial Neoplasms* ; Endometrium ; Female ; Humans ; Hysterectomy, Vaginal ; Ligaments ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Peritoneum

PURPOSE: To report a case of prolonged bilateral inferior altitudinal visual field defect in a young migraine patient. CASE SUMMARY: A 13-year-old female patient presented with bilateral disturbance of visual acuity and visual field, which had begun one month before. She complained of headache, with recently increasing frequency, that occurred 3 or 4 days a week for about 2~3 hours duration, sometimes accompanied by nausea and located in the frontotemporal and retrobulbar area. Brain magnetic resonance imaging showed no abnormal finding in the brain and orbit. Her visual acuity was hand motion in both eyes and Humphrey visual field test showed bilateral inferior altitudinal visual field defect. Pupillary resonse was normal and extraocular muscle movement, anterior segment and fundus were also normal in ophthalmologic examination. Her best corrected visual acuity was 1.0 in both eyes by fogging method, but bilateral inferior altitudinal visual field defect persisted for 6 months follow-up. CONCLUSIONS: Bilateral inferior altitudinal visual field defect can be developed in a migraine patient without other causes. Careful examinations to rule out other causes such as ischemic optic neuropathy or brain infarct should be performed in a migraine patient who complains of visual disturbance.
Adolescent ; Brain ; Epilepsy ; Eye ; Female ; Hand ; Headache ; Humans ; Magnetic Resonance Imaging ; Migraine Disorders ; Muscles ; Nausea ; Optic Neuropathy, Ischemic ; Orbit ; Visual Acuity ; Visual Field Tests ; Visual Fields ; Weather

PURPOSE: Accommodation and convergence, the main factors of near vision complex on near vision associated with miosis are essential ocular movements for binocularity. Therefore, we attempted to find appropriate treatments for anomalies of accommodation and convergence. METHODS: The basic theories and anomalies of accommodation and convergence were reviewed. Various treatment modalities for anomalies of convergence were discussed and treatment guidelines were proposed. RESULTS: Anomalies of convergence were classified into convergence insufficiency, convergence insufficiency associated with accommodative insufficiency, convergence paralysis, convergence spasm, and convergence excess. Treatment was divided into non-surgical and surgical methods which include not only vision therapy and optical treatment using a prism after cycloplegic refraction, but also rectus muscle surgery. CONCLUSIONS: The choice of effective treatments according to various causes is necessary for anomalies of accommodation and convergence through complete eye examinations. Thus, not only simple refractive error measurement and glasses prescription for best corrected visual acuity are necessary, but also active treatment by fundamental ophthalmic and neurologic evaluation in hospitals.
Eye ; Eyeglasses ; Glass ; Miosis ; Muscles ; Ocular Motility Disorders ; Paralysis ; Prescriptions ; Refractive Errors ; Spasm ; Telescopes ; Vision, Ocular ; Visual Acuity

PURPOSE: Bilateral internuclear ophthalmoplegia (INO) has been reported mostly in bilateral medial longitudinal fasciculus (MLF) lesion. To report a case who presented with typical bilateral internuclear ophthalmoplegia (INO) with no brainstem lesion on brain MRI. METHODS: Case presentation. RESULTS: Seventy two year-old woman presented with bilateral marked adduction limitation and diplopia. Bilateral marked adduction limitation did not cross midline. Nystagmus occured in abducting eye. Elevation and depression were normal in duction. Transcranial doppler revealed moderated stenosis of right internal carotid artery and severe stenosis of left intracranial internal carotid artery. Brain MRI revealed focal old infarction of right corona radiata and circumscribed acute infarction at more upper level of corona radiata, however, no pathologic finding was identified in brainstem. Initial severe exotropia was improved to 30 PD exotropia in primary position. Adduction limitation was markedly improved 2 months later but bilateral horizontal nystagmus in abducting eye persisted
Brain Stem* ; Brain* ; Carotid Artery, Internal ; Constriction, Pathologic ; Depression ; Diplopia ; Exotropia ; Female ; Humans ; Infarction ; Magnetic Resonance Imaging ; Nystagmus, Pathologic ; Ocular Motility Disorders*

A case of esophagopleural fistula after pleuropneumonectomy is reported. A 59 years old male underwent right pleuropneumonectomy due to tuberculous empyema. The postoperative small esophagopleural fistula was confirmed by esophagogram and was initially managed by a conservative treatment. There was a persistent fistula on follow up esophagogram, therefore we planned the next treatment modality for obstruction of the fistula. For poor general conditions and arrhythmia, an esophageal stent was applied as a non-surgical method. At first, a covered-form stent was inserted, but it migrated to the stomach after 3 months. By using an uncovered-form stent, a complete obstruction of the esophagopleural fistula was achieved.
Arrhythmias, Cardiac ; Empyema, Tuberculous ; Esophageal Fistula ; Fistula* ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pneumonectomy ; Stents* ; Stomach

Partial anomalous pulmonary venous connection is frequently found in any ASD(atrial septal defect) patients. These patients are usually symptomatic, therefore, easily diagnosed as just simple ASD. We experienced a case of a 37-year-old female patient with ASD in which the left upper pulmonary vein was connected to SVC by the left inominate vein. The patient was diagnosed as simple ASD previously. During cardiac catheterization, we found a meaningful oxygen saturation step up between the SVC and its upper portion. Angiogram confirmed PAPVC. The surgical correction of anastomosis of PAPVC with left atrial appendage and direct closure of ASD were done. The patient was discharged 15 days later.
Adult ; Atrial Appendage ; Cardiac Catheterization ; Cardiac Catheters ; Female ; Heart Septal Defects, Atrial* ; Humans ; Oxygen ; Pulmonary Veins ; Veins

We compared all frozen section examination of ovarian tumors during a 5 year period in our institute with permanent section diagnosis from paraffin sections. In this period, 604 ovarian tumors had frozen section examination. Final histologic diagnosis was divided into benign, low malignant potential and malignant. Sensitivity of frozen section diagnosis for malignant was 80 %, low malignant potential 73,1%, and benign 99.8%. Predictive value for malignancy was 98.5%, for low malignant potential 76.6%, and for benign disease 96.2%. Diagnostic problems occurred in huge tumors and low malignat potential mucinous tumors. Analysis of the 32 false negative(miss or under diagnosis) revealed that a sampling error was involved almostly. The cases of discrepancy between frozen section diagnosis and permanent section diagnosis, were 26/34 in mucinous tumors and 33/34 in huge size of tumors(more than 10cm). Although surgeons and pathologist are aware of the limitations of frozen section diagnosis of ovarian tumors, peroperative histologic examination can be worthwhile and prevent under or over treatment of ovarian malignancies.
Diagnosis* ; Frozen Sections* ; Mucins ; Paraffin ; Selection Bias