No abstract available.
Gestational Age* ; Humans ; Infant*

Amniotic fluid embolism (AFE) is a rare peripartum complication with a mortality rate of 61 to 86%. The main clinical manifestations include shock, acute pulmonary edema, neurologic signs, and coagulopathies. Most diagnosis of AFE is made on the postmortem examination of the maternal pulmonary vasculature, but antemortem confirmation of amniotic fluid material by aspiration of pulmonary blood is rare. We report the first case in Korea who survived from amniotic fluid embolism confirmed by the identification of amniotic fluid debris in pulmonary artery blood. Serial echocardiographic changes of left ventricle systolic dysfunction are also described with a brief review of literatures.
Amniotic Fluid* ; Autopsy ; Diagnosis ; Echocardiography ; Embolism, Amniotic Fluid* ; Female ; Heart Ventricles* ; Korea ; Mortality ; Neurologic Manifestations ; Peripartum Period ; Pregnancy ; Pulmonary Artery ; Pulmonary Edema ; Shock

Endocarditis due to anaerobes is not a rare ocurrence. However, Clostridial endocarditis, most cases are caused by Clostridium perfringens, is an uncommon disease. Clostridium are gram positive spore forming obligate anaerobes that are found widely in soil, water, and foods. They naturally inhabit the respiratory, gastrointestinal, and female genital tract. We observed a case of Clostridium perfringens endocarditis in a 67 years old woman. Who experienced fever, chronic diarrhea and vegetation in the aortic valve.
Aged ; Aortic Valve ; Clostridium perfringens* ; Clostridium* ; Diarrhea ; Endocarditis* ; Female ; Fever ; Humans ; Soil ; Spores

Bacillus species are aerobic, gram-positive, spore forming rods that are widely distributed in soil, dust, stream, and other environmental sources and are regarded as natural organism. But certain species of the genus Bacillus, most notably B.cereus, which is associated with food-borne illness, occasionally have been implicated in the occurrence of fatal illness and complication in a compromised host. We roport a case of pneumonia and bacteremia caused by B.cereus in an 81 year-old man, who had no obvious immunologic compromise. The condition was treated with combination of roxithromycin and gentamicin.
Bacillus cereus* ; Bacillus* ; Bacteremia ; Dust ; Gentamicins ; Pneumonia* ; Rivers ; Roxithromycin ; Soil ; Spores

Polymicrobial nature of diabetic foot infection has been well documented in the literature. Initial antibiotic therapy of diabetic foot infection is usually empiric until reliable culture data is shown. This study was carried out to determine the common bacteriological flora of diabetic foot infection and antimicrobial sensitivity pattern in order to enhance possible empiric treatment. The specimens were obtained from wounds of 207 cases of diabetic foot ulcer, and the bacteriological isolation, and antimicrobial susceptibility tests of the isolates were carried out by standard microbiological methods. Staphylococcus aureus was the most common isolate, with 46.2% of recover rate among total bacterial isolated cases. Among gram-negative organisms, Pseudomonas aeruginosa was most common. Gram-positive organisms showed significant susceptibility to clindamycin, trimethoprim/sulfamethoxazole, and levofloxacin, besides vancomycin. Cefoperazone, piperacillin/tazobactam, and amikacin in addition to imipenem were most effective agents compared to gram-negative organisms. Diabetic foot infection requires use of combined antimicrobial therapy for initial management. Our results indicate that the most effective antibiotic combination for diabetic foot infection of Korean patients is clindamycin plus cefoperazone.
Amikacin ; Bacteriology* ; Cefoperazone ; Clindamycin ; Diabetic Foot* ; Humans ; Imipenem ; Levofloxacin ; Pseudomonas aeruginosa ; Staphylococcus aureus ; Ulcer* ; Vancomycin ; Wounds and Injuries

PURPOSE: Grinding with less stress on 3Y-TZP through proper selection of methods and instruments can lead to a long-term success of prosthesis. The purpose of this study was to compare the phase transformation and physical properties after zirconia surface grinding with 3 different grinding burs. MATERIALS AND METHODS: Forty disc-shaped zirconia specimens were fabricated. Each Ten specimens were ground with AllCeramic SuperMax (NTI, Kahla, Germany), Dura-Green DIA (Shofu Inc., Kyoto, Japan), and Dura-Green (Shofu Inc., Kyoto, Japan). Ten specimens were not ground and used as a control group. After the specimen grinding, XRD analysis, surface roughness test, FE-SEM imaging, and biaxial flexural strength test were performed. RESULTS: After surface grinding, small amount of monoclinic phase in all experimental groups was observed. The phase change was higher in specimens, which were ground with Dura-Green DIA and AllCeramic SuperMax burs. The roughness of surfaces increased in specimens, which were ground with Dura-Green DIA and AllCeramic SuperMax burs than control groups and ground with Dura-Green. All experimental groups showed lower flexural strength than control group, but there was no statistically significant difference between control group and ground with Dura-Green DIA and AllCeramic SuperMax burs. The specimens, which were ground with Dura- Green showed the lowest strength. CONCLUSION: The use of dedicated zirconia-specific grinding burs such as Dura-Green DIA and AllCeramic SuperMax burs decreases the grinding time and did not significantly affect the flexural strength of zirconia, and therefore, they may be recommended. However, a fine polishing process should be accompanied to reduce the surface roughness after grinding.
Prostheses and Implants

BACKGROUND: Insulin resistance syndrome has been proposed as a major promotor of atherosclerotic disease and earlier studies have implied the hyperinsulinemia itself may enhance coronary vasomotor tone. In patients with vasospastic angina, previous studies have been inconclusive whether to basal coronary artery tone is elevated at the spasm related and nonspasm related artery. This study was performed to investigate whether basal coronary artery tone is elevated ans insulin resistance syndrome correlates to vasospastic angina. If insulin resistance syndrome correlates to vasospastic angina, we also investigated whether insulin resistance syndrome correlates to basal coronary artery tone. METHODS: The study comprised 27 patients with vasospastic angina(M/F ; 19/8, mean age ; 52+/-2 year) and 21 control subjects with atypical chest pain(M/F ; 9/8, mean age ; 47+/-3 year). We assessed basal coronary artery tone by obtaining the percent increase in coronary artery diameter induced by nitroglycerin and also examined glucose and insulin response to an oral glucose load of 75g. RESULTS: 1) There were no significant differences in body surface area, abdominal hip ratio, body mass index, incidence of hypertension, lipid profile, von-Willebrand factor, fibrinogen, and microalbumin except smorking incidence [vasospastic angia ; 16(50%) vs control ; 5(24%), p<0.05)] between vasospastic angina group and control. 2) Basal coronary artery tone was greater at the nonspastic site of the spasm-related artery(28.1+/-2.2% vs 13.1+/-0.9%, p<0.0001) and non-spasm related artery(23.7+/-1.6% vs 13.1+/-0.9, p<0.0001) in the patients with vasospstic angina than in control subjects. In the patients with vasospastic angina, high activity group had a greater basal coronary artery tone than low activity group at the nonspastic site of the spasm-related artery(31.7+/-2.6 vs 20.4+/-2.7%, p<0.001) and non-spasm related artery(26.8+/-2.0 vs 19.4+/-5.8%, p<0.001). 3) Plasma glucose and serum insulin response to an oral glucose load were similar between vasospastic angina group and control subjects, and glucose area, insulin area, and insulinogenic index(delta sigma Glucose / delta sigma Insulin)(330+/-12 vs 328+/-20 mg/dl *hour, 107+/-14 vs 96+/-17uU/ml*hour, and 2.18+/-0.33 vs 2.63+/-0.46, respectively, p=NS) also did not between both groups. 4) Two group did not differ siginificantly in the prportion of glucose intolerance but glucose area and insulin area were significantly high in vasospastic angina patients with glucose intolerance than in control subjects with normal glucose tolerance(366+/-22 vs 257+/-17mg /dl*hour, 127+/-19 vs 52+/-15uU*hour, respectively, p<0.05), but basal coronary artery tone did not differ significantly between vasospastic angina patients with glucose intolerance and control subjects with normal glucose tolerance. CONCLUSION: 1) These results revealed that basal coronary artery tone is elevated at the nonspastic site of the spasm related artery and non-spastic vessel, and the disease activity associated with elevated basal coronary artery tone in vasospastic angina. 2) But these results did not reveal the correlation of hyperinsulinemia with vasospastic angina, and so we did not determine the role of hyperinsulinemia as a pathogenesis of coronary spasm and the relation between hyperinsulinemia and basal coronary artery tone.
Arteries ; Blood Glucose ; Body Mass Index ; Body Surface Area ; Coronary Vessels* ; Fibrinogen ; Glucose ; Glucose Intolerance ; Hip ; Humans ; Hyperinsulinism ; Hypertension ; Incidence ; Insulin Resistance* ; Insulin* ; Nitroglycerin ; Spasm ; Thorax

OBJECTIVE: This study was purposed to find the ideal carrier waveform in burst wave in Functional Electrical Stimulation (FES) for upper limbs after selection of proper site of electrode. METHOD: The 10 healthy men's non-dominant hands were studied. In 5 muscles (adductor pollicis, flexor digitorum sublimis, flexor pollicis longus, extensor digitorum communis and extensor pollicis brevis), the site where electric stimulus induced the best of purposed response was selected. A burst wave contains three carrier waveforms : sine, triphasic & rectangular. The amount of mean current was measured during key grip and open motion. Discomfort of subject was scored by three degree and compared among three waveforms. RESULTS: The amount of mean current in key grip and open motion is lowest at triphasic wave (31.3 mA, 50.5 mA) and highest at rectangular wave (79.4 mA, 82.1 mA). For the discomfort, rectangular waveform provoke the greatest discomfort in key grip and open motion. There is no statistical difference between sine and triphasic waveform. CONCLUSION: In FES of upper limbs, triangular wave can be an useful carrier waveform which require less amount of current for performing the same motion and less discomfort than rectangular or sine waveform.
Electric Stimulation* ; Electrodes ; Hand ; Hand Strength ; Muscles ; Upper Extremity*

Multiple cerebral infarctions coexisting with peripheral artery occlusion have been rarely reported and occur only in specific conditions. Also, the characteristics of thrombosis related to the outbreak of the coronavirus disease 2019 (COVID-19) have been observed and studied recently. We report a case of concurrent multiple cerebral infarctions and peripheral embolism in a patient with a recent history of COVID-19 infection. A 62-year-old male patient who had recently been infected with COVID-19 presented to our emergency department with left hemiparesis. Supportive treatments were given post the diagnosis of multiple cerebral infarctions in the right cerebral hemisphere. During the supportive treatments, motor weakness was seen in the right upper extremity. Computed tomography revealed thrombi in the right axillary, brachiocephalic, and brachial arteries. The patient was already taking antiplatelet and anticoagulant agents and had no other underlying disease to develop such occlusions except his recent history of COVID-19 infection. We checked his laboratory tests for coagulation profiles throughout the hospitalization to verify a possible cause. We believe that large thrombi formation due to COVID-19 can simultaneously cause embolism in the cerebrum and peripheral regions. This pathology can result in symptoms that could make diagnosis difficult, delaying treatment decisions. This report, therefore, suggests that it is necessary to take into account a patient’s history of COVID-19 infection in such situations, especially when the patient presents with symptoms of a stroke.

Infective endocarditis is still one of the important fatal diseases, especially with systemic embolic manifestations. Infective endocarditis is often misdiagnosed because of variability of systemic embolic manifestations. We have experienced 3 cases of infective endocarditis with systemic embolic manifestations who were initially misdiagnosed as other infectious diseases. Case 1 is a 66 year-old man, who was admitted to our hospital with dyspnea , fever and petechia. His chest X-ray showed rapid decrease of cardiomegaly and pulmonary congestion in two days. At 1 week after discharge he was readmitted for recurrent fever. On the follow-up echocardiography, mitral regurgitation was newly detected. Case 2 is a 75 year-old man, who was admitted to neurology department with sudden left hemiplegia and headache, in whom it was initially difficult to differentiate from ischemic brain infarction. Case 3 is a 29 year-old man, who was admitted to neurosurgery department with fever and back pain, in whom it was initially difficult to diffrentiate from tuberculous spondylitis in early radiologic study. All 3 cases were treated effectively with appropriate antibiotic therapy and discharged with improvement of symptoms. We report 3 cases of systemic embolic manifestations complicated by infective endocarditis with a brief review of literatures.
Adult ; Aged ; Back Pain ; Brain Infarction ; Cardiomegaly ; Communicable Diseases ; Dyspnea ; Echocardiography ; Embolism ; Endocarditis* ; Estrogens, Conjugated (USP) ; Fever ; Follow-Up Studies ; Headache ; Hemiplegia ; Humans ; Mitral Valve Insufficiency ; Neurology ; Neurosurgery ; Spondylitis ; Thorax