STUDY DESIGN: We have analyzed the laparoscopic lateral retroperitoneal approach of the L4-5 interspace to the miniopen retroperitoneal approach for lateral lumbar interbody fusion. OBJECTIVES: To prospectively compare the laparoscopic lateral retroperitoneal approach of the L4-5 interspace to the miniopen retroperitoneal approach for lateral lumbar interbody fusion Summary of Background Data : The introduction of laparoscopic techniques in 1993 has stimulated a great deal of discussion regarding the risks and benefits of such minimally invasive approaches. In many centers the anterior endoscopic approach to L5-S1 has become routine. However exposure at L4-5 can be much more difficult. MATERIALS AND METHODS: From 1997 to 1999 thirty eight patients were entered into a prospective study. These patients were all undergoing anterior interbody fusion at the L4-5 level. The patients were divided into two groups for analysis. Group I patients underwent anterior interbody fusion utilizing threaded interbody devices placed via laparoscopic lateral retroperitoneal approach. Group II patients underwent anterior lumbar interbody fusion using threaded interbody devices placed via a miniopen retroperitoneal approach. RESULTS: In Group I, Operation time was 48 minutes longer than Group II (p=0.035) but there were no significant statistical differences in bleeding amount and hospitalization period. Parethesia and tingling sensation of thigh were developed in two cases of Group I patients, one case of Group II patients but they were gradually diminished. In Group I, only one cage was inserted in five cases of patients (28%) who had an inadequate exposure of L4-5 area. However, all of the patients in Group II (100%) had an adequate exposure of L4-5 area. CONCLUSION: The surgical results of laparoscopic technique was not superior to miniopen technique.
Hemorrhage ; Hospitalization ; Humans ; Prospective Studies* ; Risk Assessment ; Sensation ; Thigh

No abstract available.

Hemangiopericytoma of the bone is a rare malignant tumor, which usually originates in the femur and the pelvic bone of the adult. Heman-giopericytoma is often not a primary tumor but a secondary tumor associated with extraskeletal metastasis. We experienced a case of hemangiopericytoma, which originated from the retroperitoneum and had multiple metastasis to the scapula, proximal femur, cervical spine, and which converted from low grade to high grade.
Adult ; Femur ; Hemangiopericytoma* ; Humans ; Neoplasm Metastasis* ; Pelvic Bones ; Scapula ; Spine

Purpose: Epstein-Barr virus (EBV) infection is related to infectious mononucleosis or nasopharyngeal cancer, and its epidemiology may change according to the socioeconomic development of communities. This study aimed to evaluate the recent epidemiology of EBV seropositive rate in Korea. Methods: We retrospectively reviewed EBV serology test results obtained from a part of clinical care at Samsung Medical Center, Seoul, South Korea, from January 2000 to December 2017. Results: The EBV seropositive rate in 26,527 subjects during the study period was 81.0% (21,485/26,527): 44.4% (2,716/6,122) in subjects aged 0–9 years, 75.8% (2,077/2,739) in those aged 10–19 years, and 94.5% (16,692/17,666) in those aged ≥20 years. The EBV seropositive rate decreased from 89.4% (8,592/9,616) in 2000–2008 to 76.2% (12,893/16,911) in 2009– 2017 (P<0.001). Especially, the EBV seropositive rate in subjects aged 0–19 years significantly decreased from 2000–2008 to 2009–2017 (0–9 years, 62.8% [1,172/1,866] in 2000–2008 and 36.3% [1,544/4,256] in 2009–2017; 10–19 years, 83.8% [745/858] in 2000–2008 and 70.8% (1,332/1,881) in 2009–2017) (P<0.001). Conclusions The EBV seropositive rate in children has decreased in the last 20 years. As the age of patients with primary EBV infection increased, there is a need for interest in clinical manifestation, such as infectious mononucleosis, in adolescents and young adults.

BACKGROUND/AIMS: We evaluated the clinical features of ciprofloxacin-resistant Proteus mirabilis bacteremia and risk factors for ciprofloxacin resistance. METHODS: From October 2000 to July 2009, 37 patients with clinically significant P. mirabilis bacteremia were identified and data from patients with ciprofloxacin-resistant and ciprofloxacin-susceptible P. mirabilis bacteremia were compared. RESULTS: The most common underlying diseases were neurologic disease (37.8%) and solid tumors (29.7%). The most common site of infection was the urinary tract (35.1%). Ten of the 37 patients (27.0%) were infected with ciprofloxacin-resistant isolates, and univariate analysis revealed a significant relationship between ciprofloxacin-resistant P. mirabilis bacteremia and neurologic disease, recent operation, L-tube insertion, percutaneous tube use, and extended-spectrum beta-lactamase (ESBL) production (all p < 0.05). ESBL was detected in six of 10 (60%) ciprofloxacin-resistant isolates, while only three of 27 (11%) ciprofloxacin-susceptible isolates produced ESBL (p = 0.005). In a logistic regression analysis, ESBL production remained a significant factor associated with ciprofloxacin resistance, after adjusting for other variables. CONCLUSIONS: These data indicate a close association between ciprofloxacin resistance and ESBL-production in P. mirabilis bacteremia. This association is particularly troublesome because the therapeutic options for serious infections caused by ESBL-producing P. mirabilis are severely restricted.
Adult ; Aged ; Anti-Infective Agents/*pharmacology ; Bacteremia/*drug therapy ; Ciprofloxacin/*pharmacology ; Drug Resistance, Bacterial ; Female ; Humans ; Male ; Middle Aged ; Proteus Infections/*drug therapy ; Proteus mirabilis/*drug effects/enzymology ; Risk Factors ; beta-Lactamases/*biosynthesis

A mycotic aneurysm is a localized, irreversible arterial dilatation resulting from destruction of the vessel wall by infection. Pathogens causing mycotic aneurysms include Gram-positive and -negative bacteria, mycobacteria, and fungi. Klebsiella pneumoniae is a common pathogen causing urinary tract infections, nosocomial pneumonia, soft tissue infection, pyogenic liver abscesses, and endophthalmitis, while mycotic aneurysms caused by K. pneumoniae are rare. Recently, the number of cases of endogenous K. pneumoniae endophthalmitis associated with K. pneumoniae-induced pyogenic liver abscesses has increased in Southern Asia, but there have been no reports of K. pneumoniae mycotic aneurysms accompanied by endophthalmitis. Here, we report the case of a man who had a K. pneumoniae mycotic aneurysm accompanied by endophthalmitis and, ultimately, lost sight in both eyes. The early diagnosis of associated endophthalmitis requires a high index of suspicion by the physician.
Aneurysm, Infected ; Aorta ; Asia ; Bacteria ; Dilatation ; Early Diagnosis ; Endophthalmitis ; Eye ; Fungi ; Glycosaminoglycans ; Klebsiella ; Klebsiella pneumoniae ; Liver Abscess, Pyogenic ; Pneumonia ; Soft Tissue Infections ; Urinary Tract Infections

Non-typhoidal Salmonella species are important foodborne pathogens that can cause gastroenteritis, bacteremia, and subsequent focal infections. Non-typhoidal salmonellosis is problematic, particularly in immunocompromised hosts. Any anatomical site can be affected by this pathogen via hematogenous seeding and may develop local infections. However, cervical lymphadenitis caused by non-typhoidal Salmonella species is rarely reported. Herein, we have reported a case of cervical lymphadenitis caused by group D non-typhoidal Salmonella associated with lymphoma.
Bacteremia ; Focal Infection ; Gastroenteritis ; Immunocompromised Host ; Lymphadenitis ; Lymphoma ; Salmonella ; Salmonella Infections ; Seeds

PURPOSE: While there is an urgent need for diagnosis and therapeutic intervention in patients with primary immunodeficiency diseases (PIDs), current genetic tests have drawbacks. We retrospectively reviewed the usefulness of flow cytometry (FCM) as a quick tool for immunophenotyping and functional assays in patients suspected to have PIDs at a single tertiary care institute.METHODS: Between January 2001 and June 2018, patients suspected of having PIDs were subjected to FCM tests, including lymphocyte subset analysis, detection of surface- or intracellular-target proteins, and functional analysis of immune cells, at Samsung Medical Center, Seoul, Korea. The genetic diagnosis was performed using Sanger or diagnostic exome sequencing.RESULTS: Of 60 patients diagnosed with definite or probable PID according to the European Society of Immune Deficiencies criteria, 24 patients were provided with useful information about immunological dysfunction after initial FCM testing. In 10 patients, the PID diagnosis was based on abnormal findings in FCM testing without genetic tests. The FCM findings provided strong evidence for the diagnosis of severe combined immunodeficiency (n = 6), X-linked chronic granulomatous diseases (CGD) (n = 6), leukocyte adhesion deficiency type 1 (n = 3), X-linked agammaglobulinemia (n = 11), autoimmune lymphoproliferative syndrome-FASLG (n = 1), and familial hemophagocytic lymphohistiocytosis type 2 (n = 1), and probable evidence for autosomal recessive-CGD (n = 2), autosomal dominant-hyper-immunoglobulin E (IgE)-syndrome (n = 1), and STAT1 gain-of-function mutation (n = 1). In PIDs derived from PIK3CD (n = 2), LRBA (n = 2), and CTLA4 mutations (n = 3), the FCM test provided useful evidence of immune abnormalities and a tool for treatment monitoring.CONCLUSIONS: The initial application of FCM, particularly with known protein targets on immune cells, would facilitate the timely diagnosis of PIDs and thus would support clinical decisions and improve the clinical outcome.
Agammaglobulinemia ; Diagnosis ; Exome ; Flow Cytometry ; Genetic Testing ; Granulomatous Disease, Chronic ; Humans ; Immunophenotyping ; Korea ; Leukocytes ; Lymphocyte Subsets ; Lymphohistiocytosis, Hemophagocytic ; Phenotype ; Retrospective Studies ; Seoul ; Severe Combined Immunodeficiency ; Tertiary Healthcare

PURPOSE: Cytomegalovirus (CMV) infection is mostly asymptomatic but can be detrimental to certain hosts. We investigated changes of CMV seroprevalence in Koreans before and after the year 2000. METHODS: We reviewed laboratory values of patients who were tested for CMV immunoglobulin G (IgG) at Samsung Medical Center, Seoul, Korea, from January 1995 to December 2015. Changes in seroprevalence were analyzed by gender, age, region, and tested year period (period 1, 1995–2005 vs. period 2, 2006–2015). RESULTS: Overall CMV seropositivity was 94.1% (10,900/11,584). There was no significant difference for CMV seropositivity among the two periods (94.2% vs. 94.1%) (P=0.862). CMV seropositivity in the 11 to 20-year age group in period 2 (78.8%) was significantly lower than that of period 1 (89.9%) (P=0.001). The seropositivity of individuals aged 31–40 years (97.4%) was significantly higher than that of younger age groups (P < 0.001) and lower than that of older age groups (P < 0.001). Of 2,441 females of reproductive age (from 15 to 49), CMV seropositivity was 97% (2,467/2,441). The seropositivity in women aged 20–24-years was higher than that of men in the same age group (97.6% vs. 85.6%, P=0.003). No significant difference was observed among different regions. CONCLUSIONS: Overall CMV seropositivity of Koreans was estimated to be 94% and the average seropositivity of reproductive women was 97%. Monitoring of the changes in seroprevalence including the reproductive age group is needed in the future.
Cytomegalovirus ; Female ; Humans ; Immunoglobulin G ; Korea ; Male ; Seoul ; Seroepidemiologic Studies

Panton-Valentine leukocidin (PVL)-positive USA300 clone has been the most successful community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clone spreading in North America. In contrast, PVL-negative ST72-CA-MRSA has been predominant in Korea, and there has been no report of infections by the USA300 strain except only one case report of perianal infection. Here, we describe the first case of pneumonia caused by the USA300 strain following pandemic influenza A (H1N1) in Korea. A 50-year-old man was admitted with fever and cough and chest radiograph showed pneumonic consolidation at the right lower lung zone. He received a ventilator support because of respiratory failure. PCR for pandemic influenza A (H1N1) in nasopharyngeal swab was positive, and culture of sputum and endotracheal aspirate grew MRSA. Typing of the isolate revealed that it was PVL-positive, ST 8-MRSA-SCCmec type IV. The analysis of the PFGE patterns showed that this isolate was the same pulsotype as the USA300 strain.
Community-Acquired Infections/*etiology/microbiology ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human/*complications ; Male ; *Methicillin-Resistant Staphylococcus aureus/classification/isolation & purification ; Middle Aged ; Pneumonia, Staphylococcal/*etiology/microbiology ; Republic of Korea ; Staphylococcal Infections/*etiology/microbiology