BACKGROUND: Diagnosis of paucibacillary leprosy is difficult owing to lack of sensitive diagnostic tools. Recently, several investigators have studied the use of polymerase chain reaction(PCR) to detect Mycobacterium leprae. Using nested-PCR the sensitivity and specificity of DNA amplification is considerably improved. OBJECTIVE: The purpose of investigation is to assess the efficacy to nested-PCR which is applied to formalin-fixed, paraffin-embedded biopsies material of patients with leprosy. METHODS: Biopsy samples were taken from patients with lepromatous(11 patients) and tuberculoid (10 patients) leprosy, fixed in formalin, and embedded in paraffin. The DNA from samples was extracted and amplified through 25 cycles by using the outside pairs of primer(L1 and L2). The second amplification was allowed to proceed through 15 cycles using inside pairs of primer(L3 and L4). RESULTS: All twenty one samples showed 347-base-pair products. To confirm that the 347-bp product did correspond to the expected portion of the M. leprae groEL gene, the amplified product was digested with Pst I. Pst I digestion yielded 254-and 93-bp fragments, as predicted from the sequence of the M. leprae gene. The sensitivity was that a single organism was identified by nested-PCR. CONCLUSION: The nested-PCR is sensitive, specific, and simple diagnostic tool for leprosy.
Biopsy ; Diagnosis ; Digestion ; DNA* ; Formaldehyde ; Humans ; Leprosy ; Leprosy, Paucibacillary ; Mycobacterium leprae* ; Mycobacterium* ; Paraffin* ; Polymerase Chain Reaction* ; Research Personnel ; Sensitivity and Specificity

Chronic postirradiation changes of skin reflect the injury of dermal structures particularly the vasculature and connective tissue. The clinical signs include atrophy, partial or complete destruc tion of cutaneous appendatges, telangiectasis, sclerosis of underlying tissue, pigrnentary changes, and in rare instances, ulceration with or without var ious premalignant and malignant neoplasms. The patient, was a 65-year-old man, who had been exposed to a large amount. of X-ray irradi- ation on his hands incidentally or accidentally for a long time. The skin changes of his hand were thickening and hardening of all digits loss or focal consttict,ion of digits, and keratotic papules. Epidermal hyperplasia and fibrous thickening of collagen bundles were found on skin biopsy. Gradual narrowingal of the bony caliber with eventual resorption was noticed on radiologic examination. It has been rarely reported in the literature that chronic radiation dermatitis develops severe and unusal manifestions such as acrosclerosis and loss of digit due to osteoradionecrosis.
Aged ; Atrophy ; Biopsy ; Collagen ; Connective Tissue ; Dermatitis* ; Hand ; Humans ; Hyperplasia ; Osteoradionecrosis* ; Sclerosis ; Skin ; Telangiectasis ; Ulcer

BACKGROUND: It is well known that the cutaneous tuberculosis especially skin tuberculids is difficult to detect early and make a confirm diagnosis because the organism is seldom detected in a lesion by conventional methods such as AFB stain and culture. The polymerase chain reaction is a very powerful molecular biological tool in diagnosing infectious, neoplastic and genetic diseases. It has the merit of employing various samples, and to improving sensitivity by the modification of PCR techniques. Usage of the routinely formalin-fixed paraffin-embedded tissue as a sample for PCR is very useful in clinical examination, however the sensitivity and specificity have been known to be decreased. OBJECTIVE: To evaluate the efficacy of the nested-PCR in the diagnosis of different types of cutaneous tuberculosis, we tried to detect the DNA of Mycobacterium tuberculosis from routinely formalin-fixed paraffin-embedded tissue. METHODS: The various cutaneous tuberculosis and infectious granulomatous disease were retrospecitively selected by the findings of clinical, histopathological and bacterial culture. There were 9 cases of lupus vulgaris, 4 tuberculosis verrucosa cutis, 2 papulonecrotic tuberculid, 2 erythema induratum and 4 lupus miliaris disseminatus faciei. To amplify the 123bp DNA fragment of a repeated insertion sequence IS6110, two pairs of primers composing outside and inside primers were applied. RESULTS: The positive band was found in 10(91% ) of lupus vulgaris, 3 of tuberculosis verrucosa cutis, 1 papulonecrotic tuberculid and 1 erythema induratum. Four of the LMDF and 5 of the infectious granulomatous diseases were negative. CONCLUSION: The nested-PCR using routinely formalin-fixed paraffin-embedded tissue is a useful diagnostic tool if combined with the result of other clinical data. Also it may provide further insight into pathogenesis of skin tuberculids and the differential diagnosis of granulomatous skin diseases.
Diagnosis ; Diagnosis, Differential ; DNA ; Erythema Induratum ; Lupus Vulgaris ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Skin Diseases ; Skin* ; Tuberculosis ; Tuberculosis, Cutaneous*

BACKGROUND: It is well known that the cutaneous tuberculosis especially skin tuberculids is difficult to detect early and make a confirm diagnosis because the organism is seldom detected in a lesion by conventional methods such as AFB stain and culture. The polymerase chain reaction is a very powerful molecular biological tool in diagnosing infectious, neoplastic and genetic diseases. It has the merit of employing various samples, and to improving sensitivity by the modification of PCR techniques. Usage of the routinely formalin-fixed paraffin-embedded tissue as a sample for PCR is very useful in clinical examination, however the sensitivity and specificity have been known to be decreased. OBJECTIVE: To evaluate the efficacy of the nested-PCR in the diagnosis of different types of cutaneous tuberculosis, we tried to detect the DNA of Mycobacterium tuberculosis from routinely formalin-fixed paraffin-embedded tissue. METHODS: The various cutaneous tuberculosis and infectious granulomatous disease were retrospecitively selected by the findings of clinical, histopathological and bacterial culture. There were 9 cases of lupus vulgaris, 4 tuberculosis verrucosa cutis, 2 papulonecrotic tuberculid, 2 erythema induratum and 4 lupus miliaris disseminatus faciei. To amplify the 123bp DNA fragment of a repeated insertion sequence IS6110, two pairs of primers composing outside and inside primers were applied. RESULTS: The positive band was found in 10(91% ) of lupus vulgaris, 3 of tuberculosis verrucosa cutis, 1 papulonecrotic tuberculid and 1 erythema induratum. Four of the LMDF and 5 of the infectious granulomatous diseases were negative. CONCLUSION: The nested-PCR using routinely formalin-fixed paraffin-embedded tissue is a useful diagnostic tool if combined with the result of other clinical data. Also it may provide further insight into pathogenesis of skin tuberculids and the differential diagnosis of granulomatous skin diseases.
Diagnosis ; Diagnosis, Differential ; DNA ; Erythema Induratum ; Lupus Vulgaris ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Skin Diseases ; Skin* ; Tuberculosis ; Tuberculosis, Cutaneous*

Acute myocardial infarction (AMI) is rare in patients with idiopathic thrombocytopenic purpura (ITP). We describe a case of an AMI during thrombocytopenia in a patient with chronic ITP. A 47-yr-old woman presented with anterior chest pain and a low platelet count (21,000/microliter) at admission. Urgent coronary angiography revealed total occlusion of proximal right coronary artery and primary percutaneous coronary intervention (PCI) was performed successfully. This case suggests that primary PCI may be a therapeutic option for an AMI in patients with ITP, even though the patient had severe thrombocytopenia.
Purpura, Thrombocytopenic, Idiopathic/*complications/drug therapy ; Myocardial Infarction/*complications/*therapy ; Middle Aged ; Immunoglobulins, Intravenous/administration & dosage/adverse effects ; Humans ; Heparin/administration & dosage/adverse effects ; Female ; Anticoagulants/administration & dosage/adverse effects ; *Angioplasty, Transluminal, Percutaneous Coronary

No abstract available.
Coronary Artery Bypass* ; Coronary Vessels* ; Mortality*

To investigate determinants of health care utilization of the physically, disabled over 20 years old in age living in Taegu city, a self-administered questionnaire survey was carried out for 337 disabled persons with chronic illness from April to July, 1997. Health care utilization rate was 81.9%(69.l% for hospital or clinic and 12.8% for pharmacy). Marital status, job, health concern, and response to illness showed statistically, significant relationship with health care utilization(p<0.05). By, path analysis, job, economic status, medical security type and response to illness had a significant direct effect on health care utilization(p<0.05), however, health concern and regular source of care had an indirect effect. The reasons of no health utilization were due to economic problem(31.l%), no symptom(18.0%), inconvenience to seek care or no accompanying persons to be helped(14.8%), unseriousness of the severity of the illness(14.8%), too busy to be treated or no free time(8.2%), hopeless prognosis to be treated(6.6%) in order. In conclusion, it is recommended that the program for expanding medicaid, improving socioeconomic status by getting a job and health education to increase the health Concern toward physically disabled should be implemented to increase health care utilization rate.
Chronic Disease ; Daegu ; Delivery of Health Care* ; Disabled Persons* ; Health Education ; Humans ; Marital Status ; Medicaid ; Prognosis ; Surveys and Questionnaires ; Social Class ; Young Adult

PURPOSES: This study was conducted to determine the source of infection and mode of transmission of the shigellosis outbreak on March 27, 1998 at a primary school in Taegu city. METHODS: On-site interview using a standard questionnaire and rectal swab were conducted to 1,629 peoples who ate lunch on March 26 and 1,389 peoples who contacted with suspected cases. And bacteriological examination for 91 environmental materials and 25 food items were performed. RESULTS: Of the 1,629 persons who ate lunch on March 26, seventy three had culture-confirmed S. sonnei infection(first attack rate: 4.5%). And additional fifty four had shigellosis among those 1,389 persons who might be exposed to the suspected cases(second attack rate: 3.9%). A total of 730 persons who complained one of four typical symptoms or more were treated as suspected cases(first attack rate of suspected cases: 44.8%). S. sonnei was never isolated from water, foods, and other environmental materials. The median incubation period was estimated about two days. The common symptom reported were diarrhea(88.7%), fever(73.4%), abdominal pain(54.7%), and vomiting episode(38.4%) in order. The shorter duration of the outbreak and the large proportion of cases involving students who ate lunch on March 26 are consistent with fecal-oral transmission, although the limited epidemiologic data obtainable do not clearly define the route of transmission. CONCLUSIONS: Thus the outbreak reported here appear to be related to the unsanitary conditions of food facility in this school.
Daegu* ; Disease Outbreaks ; Dysentery, Bacillary ; Humans ; Incidence ; Lunch ; Shigella sonnei* ; Shigella* ; Vomiting ; Surveys and Questionnaires

The accumulation of fluid in the pericardium in an amount sufficient to cause serious obstruction to the inflow of blood to the ventricles results in cardiac tamponade. This complication may be fatal if it is not recognized and treated promptly. We report a case of cardiac tamponade caused by acute pancreatitis, which resolved after catheter drainage.
Cardiac Tamponade* ; Catheters ; Drainage ; Pancreatitis* ; Pericardium

PURPOSE: Very few cases of neuroendocrine tumor of the stomach have been reported in Korea. The prognosis of gastric neuroendocrine tumors is known to be poorer than that of ordinary gastric carcinomas. The purpose of this retrospective study was to review the clinicopathologic features of seven cases of this unusual gastric tumor. METHODS: Excluding the tumor containing only sparse neuroendocrine differentiation, we resected 7 typical neuroendocrine tumors from January 1995 to December 1997 at Asan Medical Center; 2,346 gastric cancer patients were treated surgically during the same period. Average follow up period was 22.6 months. RESULTS: A typical well demarcated tumor margin was observed in four of the seven cases. The entire tumor was located on the distal stomach. Even when the tumor had deep ulcerations, the tumor cells had not infiltrated the serosal layer. Three cases showed recurrence of disease. All the recurrences were found in the liver within 12 months, and two of them, who were not indicated for chemotherapy, died within 10 months after diagnosis of recurrence. One patient with a recurrence was treated with systemic chemotherapy just after the diagnosis and was still alive after 29 months. CONCLUSION: Gastric neuroendocrine tumor frequently recurs the liver even in an early stage and especially when preoperative CEA is increased. We experienced a case of successful control of hepatic metastasis by using systemic chemotherapy.
Chungcheongnam-do ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Korea ; Liver ; Neoplasm Metastasis ; Neuroendocrine Tumors* ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms ; Stomach* ; Ulcer