We analysed retrospectively pharmacokinetic parameters of gentamicin and amikacin in 44 and 58 Korean pediatric patients, respectively, with normal renal function. Pharmacokinetic parameters were calculated from two concentrations in serum by method of Sawchuck. There was wide individual variation in peak serum concentrations of gentamicin and amikacin, Administration of the usually recommended doses yielded subtherapeutic concentrations in 47% and 82%, respectevely, of patients in the peak concentrations of gentamicin and amikacin. The volumes of distribution of gentamicin and amikacin in children of over 1 year of age were 0.37+/-0.13L/kg and 0.41+/-0.13L/kg which are greater than those reported from the western countries. We conclude that the wide individual variation and high frequency of subtherapeutic levels in the peak concentrations of gentamicin and amikacin obtained by usually recommended dosage as well as the narrow safety margin of these drugs necessitate monitoring of serum concentration and adjustment of individual dosage regimen early in the course of treatment with aminoglycosides.
Amikacin* ; Aminoglycosides ; Child* ; Gentamicins* ; Humans ; Pharmacokinetics* ; Retrospective Studies

BACKGROUND: Pitted keratolysis is a superficial bacterial infection which usually affects the pressure bearing areas of the feet. Some bacterial organisms were identified as etiologic agents, including Corynebacterium species, Micrococcus species and Dermatophilus congolensis. However, in Korea, studies to prove the causative organisms have not been performed. OBJECTIVE: We performed this study to identify causative organisms of pitted keratolysis in Korea. METHOD: Twelve normal healthy men and 27 pitted keratolysis patients were enrolled. We cultured the scraped specimens of the stratum corneum and identified the cultured organisms. We compared the cultured organisms of pitted keratolysis group with those of control group. We also compared the distribution of cultured organisms in pitted keratolysis with and without tinea pedis. RESULT: Micrococcus species and Corynebacterium species were identified in pitted keratolysis group much more frequently than in normal control group. In most cases of pitted keratolysis combined with tinea pedis, the identified organisms were Micrococcus species. CONCLUSION: Micrococcus species and Corynebacterium species are thought to be the major causative organisms of pitted keratolysis in Korea. Micrococcus species might play a certain antagonistic role, especially in patients of pitted keratolysis with tinea pedis.
Bacterial Infections ; Corynebacterium ; Foot ; Humans ; Korea ; Male ; Micrococcus ; Tinea Pedis

A 29-year-old woman presented with bloody diarrhea, abdominal pain, hemolytic anemia, thrombocytopenia, and acute renal failure. She was diagnosed with Escherichia coli O104:H4-associated hemolytic-uremic syndrome (HUS) and treated with plasmapheresis and hemodialysis for 3 weeks. She recovered without sequelae. To the best of our knowledge, this is the first report of Escherichia coli O104:H4-associated HUS in Korea. We recommend that Escherichia coli O104:H4, as well as the more common O157:H7, be considered in the diagnosis of bloody diarrhea-associated HUS.
Humans ; Hemolytic-Uremic Syndrome/*microbiology ; Female ; Escherichia coli Infections/*complications ; Escherichia coli/*classification ; Adult

BACKGROUND: Massive release of glutamate plays an important role in ischemic neuronal injury, and modification of this process may provide neuroprotection. We studied the protective effects of the N- methyl-D-aspartate receptor antagonist ketamine on hind limb motor function and glutamate receptor of gene expression in an experimental model of spinal cord ischemia. METHODS: Transient spinal cord ischemia was induced by 15 min of thoracic aortic occlusion in 24 anesthetized Sprague-Dawly rats. Rats were randomly assigned to one of three treatment groups (n = 8 each): C group, no intervention; K30 group, ketamine 30 mg/kg intravenously; or K50 group, ketamine 50 mg/kg intravenously. Normothermia (38degreesC) was maintained during ischemia. After spinal ischemia neurologic function was evaluated immediately and after 1, 2 and 3 hours. After 3 hours rats were euthanized and spinal cords were removed for the assay of NMDAR and mGluR5 mRNA. RESULTS: Neurologic outcome was better in the K30 group than the C or K50 group (P < 0.05). The NMDAR mRNA expression of the K30 and K50 group were greater than those of the C group. The mGluR5 mRNA expression increased after spinal ischemia. There were no differences between groups. CONCLUSIONS: In this study demonstrated that treatment with ketamine 30 mg/kg intravenously before ischemia increases tolerance of spinal cord motor neurons in a period of normothermic ischemia.
Animals ; Extremities ; Gene Expression* ; Glutamic Acid* ; Ischemia ; Ketamine* ; Models, Theoretical ; Motor Neurons ; Neurons ; Rats* ; Receptors, Glutamate* ; RNA, Messenger ; Spinal Cord ; Spinal Cord Ischemia

The most common cause of hyponatremia in hospitalized patients is syndrome of inappropriate antidiuretic hormone secretion (SIADH) characterized by water retention leading to decreased serum sodium concentration and osmolality. Since the report of Schwartz and his co-workers1), this syndrome has been described in various clinical settings. There are some reports on SIADH associated with Guillain-Barre syndrome in the literature2-6). However, to our knowledge, there was only one reported case of SIADH associated with Guillain-Barre syndrome in Korea
Guillain-Barre Syndrome* ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome* ; Korea ; Osmolar Concentration ; Sodium ; Water

BACKGOUND: The present study examined whether a blockade of nitric oxide (NO) synthesis affects the regulation of aquaporin (AQP) water channels in rats subjected to renal ischemia/reperfusion (I/R). METHODS: Renal I/R was experimentally induced by clamping the left renal artery for 60 minutes in rats. The rats were kept for 7 days thereafter, during which they were supplied with tap water containing NG-nitro-L-arginine methyl ester (L-NAME, 100 mg/L). The expression of AQP1-3 was determined in the kidney by Western blot analysis. RESULTS: In renal I/R injury, the expression of AQP2 was significantly decreased. The treatment with L-NAME further diminished the expression of AQP2. Although the expression of either AQP1 or AQP3 was not significantly altered in the kidney subjected to I/R, it was also significantly decreased by the treatment with L-NAME. CONCLUSION: It is suggested that endogenous NO system should play a role in the regulation of AQP water channels in rat kidney subjected to I/R injury.
Animals ; Aquaporins* ; Blotting, Western ; Constriction ; Ischemia ; Kidney* ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Rats* ; Renal Artery ; Reperfusion

PURPOSE: We validate the 7th American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system for gastric cancer and propose a new staging system that reflects the prognostic significances of each of T and N category. METHODS: Data from 5,957 patients who underwent curative gastrectomies from 2000 to 2007 at 4 university hospitals in Daegu Metropolitan city in Korea were analyzed for the validation of the 7th AJCC/UICC staging system for gastric cancer. The hazard ratios of the respective T and N categories were estimated and converted to weightings and summated to make prognostic score (P-score). Homogeneity and stage grouping were determined according to the P-scores. RESULTS: In the 7th AJCC/UICC staging system for gastric cancer, poor discrimination was noted between stages IIB and IIIA (P = 0.152). In addition, heterogeneity in stage IIB (P = 0.021) and a small gap in 5-year survival rates (1.7%) between stages IA and IB were noted. A new proposed staging system was generated on the basis of P-scores and demonstrated more discrimination between stages and more homogeneity within stages. The new staging system reflects the different prognostic impacts of N3a and N3b. CONCLUSION: Several controversial issues of the 7th AJCC/UICC staging system for gastric cancer were reconfirmed in the present analysis. The TNM system based on P-score appears to be more scientifically accurate than the 7th AJCC/UICC staging system for gastric cancer.
Daegu ; Discrimination (Psychology) ; Gastrectomy ; Hospitals, University ; Humans ; Joints ; Korea ; Population Characteristics ; Retrospective Studies* ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: The objective of the present study was to assess the efficacy and safety of iron sucrose by determining the subsequent change in hemoglobin (Hgb), hematocrit (Hct), transferrin saturation (TAST), serum ferritin values and blood pressures in hemodialysis patients receiving Epoetin. METHODS: A total of 19 adult patients who had been receiving hemodialysis three times a week at Chonnam Natinal University Hospital were assigned. Their Hgb level was less than 10 g/dL and their serum ferritin level was less than 100 ng/mL, and/or TSAT was less than 20%. Iron sucrose was administered as 1,000 mg in 10 divided doses diluted in 100 mL normal saline over the last 60 minutes during hemodialysis with a one-time prior test dose of 20 mg on 10 consecutive dialysis sessions. Iron sucrose dosage was adjusted to 25-100 mg/week depending on serum ferritin level, and TSAT in the following 3 months. Epoetin administration was stopped due to insurance regulation when Hgb level was more than 10 g/dL and Hct level was more than 30 %. To evaluate efficacy of iron sucrose, assessment of serum iron parameters and anemia indices was determined just before the first dose (baseline), at 1 month after the first dose (loading) and then, monthly for 3 months (maintenance). To evaluate safety of iron sucrose, we recorded blood pressure 1 hour before and at the time of completion of iron sucrose injection, and also recorded blood pressure during observation sessions before dialysis and at intervals of 2 hours and 4 hours after starting dialysis. We determined routine serum chemistry and hematologic results at 1 month after the first dose and compared results with those obtained at baseline. RESULTS: 1,000 mg iron surcose injection in 10 divided dose (loading) produced a significant rise in Hgb, Hct, serum iron, serum ferritin, TSAT, MCV and MCH at 1 month after first dose (respectively p<0.001, p<0.001, p<0.01, p<0.001, p<0.01, p<0.01, p< 0.01). During the following maintenance period of 3 months, Hgb, Hct, serrum ferritin, and TSAT level remained more elevated than at baseline respectively. In 19 enrolled patients, we experienced no serious adverse drug reactions and no significant changes in intradialytic blood pressure associated with iron sucrose administration. Serum albumin concentrations was higher at 1 month than at base line and however, changes in other serum chemistry and hematologic results were not statistically significant. CONCLUSION: Intravenous iron sucrose administration is an efficient and safe method to supply iron in end-stage renal disease patients receiving Epoetin with iron deficiency, who are undergoing hemodialysis.
Adult ; Anemia ; Blood Pressure ; Chemistry ; Dialysis ; Drug-Related Side Effects and Adverse Reactions ; Ferritins ; Hematocrit ; Humans ; Insurance ; Iron* ; Jeollanam-do ; Kidney Failure, Chronic ; Renal Dialysis* ; Serum Albumin ; Sucrose* ; Transferrin

BACKGROUND: Limited data are available on the current status of cytology practices in Korea. This nationwide study presents Korean cytology statistics from 2015. METHODS: A nationwide survey was conducted in 2016 as a part of the mandatory quality-control program by the Korean Society for Cytopathology. The questionnaire was sent to 208 medical institutions performing cytopathologic examinations in Korea. Individual institutions were asked to submit their annual cytology statistical reports and gynecologic cytology-histology correlation data for 2015. RESULTS: Responses were obtained from 206 medical institutions including 83 university hospitals, 87 general hospitals, and 36 commercial laboratories. A total of 8,284,952 cytologic examinations were performed in 2015, primarily in commercial laboratories (74.9%). The most common cytology specimens were gynecologic samples (81.3%). Conventional smears and liquid-based cytology were performed in 6,190,526 (74.7%) and 2,094,426 (25.3%) cases, respectively. The overall diagnostic concordance rate between cytologic and histologic diagnoses of uterine cervical samples was 70.5%. Discordant cases were classified into three categories: category A (minimal clinical impact, 17.4%), category B (moderate clinical impact, 10.2%), and category C (major clinical impact, 1.9%). The ratio of atypical squamous cells of undetermined significance to squamous intraepithelial lesion was 1.6 in university hospitals, 2.9 in general hospitals, and 4.9 in commercial laboratories. CONCLUSIONS: This survey reveals the current status and trend of cytology practices in Korea. The results of this study can serve as basic data for the establishment of nationwide cytopathology policies and quality improvement guidelines in Korean medical institutions.
Atypical Squamous Cells of the Cervix ; Diagnosis ; Hospitals, General ; Hospitals, University ; Korea* ; Quality Improvement ; Squamous Intraepithelial Lesions of the Cervix

OBJECTIVE: To estimate the cardiovascular (CV) and gastrointestinal (GI) risks of etoricoxib in the treatment of osteoarthritis (OA) compared to a placebo and other non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: A systematic review of randomized, controlled trials (RCTs) of etoricoxib were performed. Bayesian network meta-analysis was used over a duration of 12 weeks. The incidence of CV and GI events for a duration ≥26 weeks were also tabulated and presented using descriptive statistics. RESULTS: From this search, 10 studies were identified. Of these, 6 and 5 RCTs that measured the CV and GI events at 12 weeks were included in meta-analysis. They showed that etoricoxib did not increase the CV events compared to the placebo or NSAIDs during the 12 week period (odds ratio [OR]=0.59 compared to celecoxib, OR=0.89 with ibuprofen, OR=0.70 with placebo, and OR=2.16 with naproxen). The risk of GI events was comparable to that of most comparators, with the exception of naproxen, which had a significantly lower risk of GI events (OR=0.18) during the 12 week period. For a duration ≥26 weeks, the incidence of CV and GI events with etoricoxib increased with increasing duration. CONCLUSION: Etoricoxib is an alternative short-term treatment option for OA, showing comparable CV and GI complications to other NSAIDs. Nevertheless, further studies will be needed to elucidate the long-term safety of etoricoxib in the treatment of OA.
Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Celecoxib ; Ibuprofen ; Incidence ; Naproxen ; Osteoarthritis*