The most common etiologic agents of neonatal osteomyelitis in the last decades were Staphylococcus aureus, Group B streptococcus, and E. coli, but Klebsiella pneumoniae as a cause of neonatal osteomyelitis appears to be rare. Klebsiella pneumoniae is one of the most important organisms associated with hospital acquired infections in the neonate and outbreaks with multiresistant strains have been reported from neonatal intensive care units around the world. These multiresistant Klebsiella pneumoniae have been shown to produce tranferable plasmid mediated beta-lactamases that are able to hydrolyze oxyimmino- beta-lactamas and these confer resistance to the third generation cephalosporin and named extended spectrum beta-lactamase producing Klebsiella pneumoniae. We experienced two cases of neonatal osteomyelitis due to extended spectrum lactamase producing Klebsiella pneumoniae in our neonatal intensive care unit during the same period. To our knowledge this represents the first documented neonatal osteomyelitise to extended spectrum beta-lactamase producing Klebsiellae pneumoniae in Korea.
beta-Lactamases* ; Disease Outbreaks ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Osteomyelitis* ; Plasmids ; Pneumonia ; Staphylococcus aureus ; Streptococcus

BACKGROUND: Autoimmune hemolytic anemias are characterized by autoantibodies recognizing antigens on the Individual's own red blood cells, resulting in immune- mediated hemolysis. Blood transfusions have been regarded as hazardous in patients with autoimmune hemolytic anemia (AIHA) because of potential intensification of hemolysis and a presumed high incidence of alloimmunization. METHODS: We examined the pretransfusion and posttransfusion hemoglobin levels in 6 patients with autoantibodies in their sera, which showed panagglutinations with all bloods tested in the compatibility testing. They received 'least' incompatible blood because of inability to find compatible blood. RESULTS: When we compared pretransfusion hemoglobin level with posttransfusion hemoglobin level, in 5 of 6 patients with AIHA, the hemoglobin levels were increased after red cell transfusion. 4 patient who did not respond to transfusion therapy initially had an increase in hemoglobin level after steroid treatment. Any signs or symptoms indicating hemolytic transfusion reaction were not observed ducting the transfusion period in all patients. CONCLUSIONS: The decision to transfuse in AIHA should consider multiple factors including the patient's clinical status, the potential benefit of transfusion, the potential response to other therapeutic modalities, but must never be regarded as contraindicated, even though the compatibility test may be strongly incompatible.
Anemia, Hemolytic* ; Anemia, Hemolytic, Autoimmune ; Autoantibodies ; Blood Group Incompatibility ; Blood Transfusion ; Erythrocyte Transfusion* ; Erythrocytes* ; Hemolysis ; Humans ; Incidence

BACKGROUND: Autoimmune hemolytic anemias are characterized by autoantibodies recognizing antigens on the Individual's own red blood cells, resulting in immune- mediated hemolysis. Blood transfusions have been regarded as hazardous in patients with autoimmune hemolytic anemia (AIHA) because of potential intensification of hemolysis and a presumed high incidence of alloimmunization. METHODS: We examined the pretransfusion and posttransfusion hemoglobin levels in 6 patients with autoantibodies in their sera, which showed panagglutinations with all bloods tested in the compatibility testing. They received 'least' incompatible blood because of inability to find compatible blood. RESULTS: When we compared pretransfusion hemoglobin level with posttransfusion hemoglobin level, in 5 of 6 patients with AIHA, the hemoglobin levels were increased after red cell transfusion. 4 patient who did not respond to transfusion therapy initially had an increase in hemoglobin level after steroid treatment. Any signs or symptoms indicating hemolytic transfusion reaction were not observed ducting the transfusion period in all patients. CONCLUSIONS: The decision to transfuse in AIHA should consider multiple factors including the patient's clinical status, the potential benefit of transfusion, the potential response to other therapeutic modalities, but must never be regarded as contraindicated, even though the compatibility test may be strongly incompatible.
Anemia, Hemolytic* ; Anemia, Hemolytic, Autoimmune ; Autoantibodies ; Blood Group Incompatibility ; Blood Transfusion ; Erythrocyte Transfusion* ; Erythrocytes* ; Hemolysis ; Humans ; Incidence

Among the causes of pure red cell aplasia, human parvovirus B19 has been shown to be cytotoxic to erythroid progenitor cells in the bone marrow associated with chronic hemolytic anemia with rapidly dividing erythroids and persistently to be suppression of erythropoiesis in immunocompromised individuals related with failure to produce neutralizing antibody to the virus. In a patient with hereditary spherocytosis presenting acute onset of reticulocytopenia during hospitalization, who had shown severe anemia and prodromal symptoms including fever, fatigue and dizziness, infection of parvovirus Bl9 was proven by the presence of IgM and IgG antibodies to parvovirus Bl9, the detection of viral DNA using PCR technique in her serum and the decreased erythroid cells, especially late normoblasts in bone marrow, Also in the other who was diagnosed as hereditary elliptocytosis and complained of fever, headache, abdominal pain and diarrhea, an episode of reticulocytopenia and the nearly absence of late normoblasts in the bone marrow were observed. IgM antibodies to parvovirus Bl9 and the viral DNA were detected in her serum, too.
Abdominal Pain ; Anemia ; Anemia, Hemolytic ; Antibodies ; Antibodies, Neutralizing ; Bone Marrow ; Diarrhea ; Dizziness ; DNA, Viral ; Elliptocytosis, Hereditary* ; Erythroblasts ; Erythroid Cells ; Erythroid Precursor Cells ; Erythropoiesis ; Fatigue ; Fever ; Headache ; Hospitalization ; Humans* ; Immunoglobulin G ; Immunoglobulin M ; Parvovirus B19, Human ; Parvovirus* ; Polymerase Chain Reaction ; Prodromal Symptoms ; Red-Cell Aplasia, Pure

Among the causes of pure red cell aplasia, human parvovirus B19 has been shown to be cytotoxic to erythroid progenitor cells in the bone marrow associated with chronic hemolytic anemia with rapidly dividing erythroids and persistently to be suppression of erythropoiesis in immunocompromised individuals related with failure to produce neutralizing antibody to the virus. In a patient with hereditary spherocytosis presenting acute onset of reticulocytopenia during hospitalization, who had shown severe anemia and prodromal symptoms including fever, fatigue and dizziness, infection of parvovirus Bl9 was proven by the presence of IgM and IgG antibodies to parvovirus Bl9, the detection of viral DNA using PCR technique in her serum and the decreased erythroid cells, especially late normoblasts in bone marrow, Also in the other who was diagnosed as hereditary elliptocytosis and complained of fever, headache, abdominal pain and diarrhea, an episode of reticulocytopenia and the nearly absence of late normoblasts in the bone marrow were observed. IgM antibodies to parvovirus Bl9 and the viral DNA were detected in her serum, too.
Abdominal Pain ; Anemia ; Anemia, Hemolytic ; Antibodies ; Antibodies, Neutralizing ; Bone Marrow ; Diarrhea ; Dizziness ; DNA, Viral ; Elliptocytosis, Hereditary* ; Erythroblasts ; Erythroid Cells ; Erythroid Precursor Cells ; Erythropoiesis ; Fatigue ; Fever ; Headache ; Hospitalization ; Humans* ; Immunoglobulin G ; Immunoglobulin M ; Parvovirus B19, Human ; Parvovirus* ; Polymerase Chain Reaction ; Prodromal Symptoms ; Red-Cell Aplasia, Pure

Alveolar soft-part sarcoma is a rare malignant neoplasm. It occurs most commonly in the deep tissue of the extremity, particularly in the anterior aspect of the thigh. It usually presents as a slow-growing, painless mass with little functional impairment. Because of the relative lack of symptoms, it may be easily overlooked. The course of the disease tends to be long but unrelenting, and local recurrences are frequent. There were no lifetime cures in the reported cases. This tumor is relatively unknown to orthopaedic surgeons, and a wider knowledge of its characteristics may lead to its more frequent recognization, Recently, two cases of alveolar soft-part sarcoma were encountered on the orthopaedic department of Dong-kang Hospital, Ulsan. In case 1, the tumor was found in the vastus lateralis muscle; and in case 2, vastus intermedius muscle. The authors will present these cases in detail to provide a glance at this very rare but more frequently recognizable tumor, the alveolar soft-part sarcorna.
Extremities ; Quadriceps Muscle ; Recurrence ; Sarcoma ; Sarcoma, Alveolar Soft Part ; Surgeons ; Thigh ; Ulsan

PURPOSE: Salmonella species is one of the most common causative organisms of acute gastroenteritis in neonates. There have been some reports of outbreaks of Salmonella species in neonates, but none was caused by Salmonella london. Pulsed-Filed Gel Electrophoresis (PFGE) was used to compare and analyze 6 isolates of S. london from the formula-fed neonates in Chunan city from late June through early July in the year of 2000. METHODS: In June and July 2000, we performed culture from blood and stool of 5 patients who admitted in Soonchunhyang Chunan Hospital. We performed a molecular analysis based on plasmid profile and pulsed-filed gel electrophoresis (PFGE). We reviewed their hospital records retrospectively. The affected babies were isolated during hospitalization and discharged home as soon as possible. In addition, hand washing, cleaning, and disinfection were intensified to prevent the spread to other babies. RESULTS: We isolated 6 strains of S. london from stool or blood samples of five patients, who were 9 to 14 days old and had fever, diarrhea, poor feeding or weight loss. The specimens for culture of Salmonella species were obtained on the admission day of every patient. All Salmonella species showed the same biochemical reactions as slant/ butt on KIA -/+, H2S +, gas +, motility +, indole -, ornitine decarboxylase +, lysine decarboxylase +, and citrate utilization +. They also showed agglutinations by Salmonella serogroup E antisera. They were susceptible to all antimicrobial agents tested by NCCLS disk diffusion method. The clonality of isolates was confirmed by PFGE after digestion with Xba I and revealed the similar band patterns of S. london. CONCLUSION: We have reported the outbreak of S. london of the formula-fed neonates in Chunan city from late June through early July in the year of 2000. Pulsed-Filed Gel Electrophoresis (PFGE) would be essential for the molecular and epidemiologic studies for the outbreaks caused by Salmonella species.
Anti-Infective Agents ; Chungcheongnam-do ; Citric Acid ; Diarrhea ; Diffusion ; Digestion ; Disease Outbreaks ; Disinfection ; Electrophoresis ; Electrophoresis, Gel, Pulsed-Field* ; Fever ; Gastroenteritis ; Hand Disinfection ; Hospital Records ; Hospitalization ; Humans ; Immune Sera ; Infant, Newborn ; Lysine ; Plasmids ; Retrospective Studies ; Salmonella* ; Weight Loss

No abstract available.
Humans* ; Placenta* ; Pregnancy*

BACKGROUND: Vancomycin resistance in enterococci is an emerging problem in Korea. It has become a worldwide problem and nosocomial spread of vancomycin-resistant enterococci (VRE) is very difficult to control. METHODS: Twenty-six strains of vancomycin-resistant Enterococcus faecium, which were isolated from clinical specimens at Soonchunhyang Chunan Hospital from September 1997 to July 1998, were evaluated to determine the antimicrobial susceptibility pattern, the vancomycin resistance genotypes, and their clinical characteristics. RESULTS: All strains were resistant to multiple antibiotics and resistant to vancomycin with MICs in excess of 256 g/ml. All isolates proved to have the vanA gene by the polymerase chain reaction. However, most of them were considered to be colonizations rather than infections from the clinical point of view. They were all cultured from patients who were being hospitalized or had been hospitalized in a neonatal intensive care unit or pediatric wards. Fourteen of 24 patients whose cultures were positive for VRE had a previous use of broad spectrum -lactam and/or vancomycin. CONCLUSIONS: Our cases indicate the importance of nosocomial spread of VRE via person-to-person transmission in a limited space. In order to prevent and control infection and colonization with VRE, a comprehensive and strategic plan such as the recommendations of the CDC's Hospital Infection Control Practices Advisory Committee, may be necessary.
Advisory Committees ; Anti-Bacterial Agents ; Chungcheongnam-do ; Colon ; Cross Infection ; Enterococcus faecium* ; Enterococcus* ; Genotype ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Polymerase Chain Reaction ; Vancomycin ; Vancomycin Resistance

The term 'primary melanocytic neoplasm' covers a wide disease spectrum, from well differentiated meningeal melanocytoma to malignant melanoma, its most aggressive malignant counterpart. Previous reports have shown that due to the paramagnetic effect of melanin, melanocytic neoplasms show high signal intensity on T1-weighted images and very low signal intensity on T2-weighted images, with relatively homogeneous contrast enhancement. The differentiation of leptomeningeal malignant melanoma from benign melanocytoma is important because of their different prognosis but on the basis of imaging findings alone is difficult. Ultrastructural immunohistochemical analysis is a possible alternative. We report the imaging findings of rare primary malignant melanoma, revealed by noncontrast-enhanced CT as a high-density mass, and demonstrating high signal intensity on T1-weighted images, and very low signal intensity on T2WI, with relatively good contrast enhancement.
Melanins ; Melanoma* ; Prognosis