BACKGROUND: The purpose of this study is to prove that human infection of Yersinia pseudotuberculosis might be occurred by drinking of mountain spring water contaminated with wild mice excreta through epidemiological tool. METHOD: Y. pseudotuberculosis strains which were isolated from patient stools, mountain spring water and mice excreta were analysed by serotyping of O antigen and plasmid DNA profile (Restriction Endonuclease Analysis of Plasmic DNA analysis REAP) assay Also reservoir rate of Y. pseudotuberculosis was calculated from wild mice which were captured throughout Korean mountains. RESULTS: Reservoir rate of Y. pseudotuberculosis from wild mice in Korea was 0.85% and was not higher than that in other country. The analysis of 66 strains of Y. pseudotuberculosis showed that 36 strains of serotype 15, REAP B type, 24 strains of serotype 4b, REAP D type, and 1 strain of serotype 4b, REAP new unclassifiable type, but 5 strains didn't have plasmic (serotype 15:3, 11 :2) .Especially same 4b, D type of Y. pseudotuberculosis was isolated from patient stools, mountain spring water and wild mouse (Apodemus agrarius) excretion and this fact was considered that Y. pseudotuberculosis strains from 3 groups were closely correlated epidemiologically. Also serotype 15, REAP B strains were isolated from patient stools and mountain spring water, but were not isolated from wild mice yet and 15, B type was isolated from Korea only and considered as native Korean strain which had not isolated in other countries yet. CONCLUSIONS: Human Y. pseudotuberculosis infection in Korea was occurred by drinking of contaminated mountain spring water and A. agrarius was one of main reservoir which contaminates mountain spring waters in Korea, Also above antigenic distribution of Y. pseudotuberculosis would be useful for development of ELISA kit of Korean type.
Animals ; DNA ; Drinking ; Enzyme-Linked Immunosorbent Assay ; Humans ; Korea ; Mice ; O Antigens ; Plasmids ; Serotyping ; Yersinia pseudotuberculosis* ; Yersinia*

BACKGROUND: In order to investigate transmission route of Yersinia pseudotuberculosis infection in Korea, we tried epidemiological study among human strains, mountain spring water strain and wild mouse strain which were isolated in north eastern area of Seoul on spring in 1996. METHODS: Plasmid profile (Restriction Endonuclease Analysis of Virulence Plasmid DNA analysis: REAP) assay in addition to serotyping were performed among human strains, mountain spring water strain and wild mouse strains. RESULTS: All isolates were the same O serotype of 4b and the same REAP pattern of type D. CONCLUSION: These results suggested that wild mice (especially Apodemus agrarius) were one of main reservoir of Y. pseudotuberculosis in Korea and their fecal material might contaminate mountain spring water. Most of human infections of Y. pseudotuberculosis were originated from drinking of contaminated mountain spring waters in Korea.
Animals ; DNA* ; Drinking ; Epidemiologic Studies* ; Epidemiology ; Humans ; Korea ; Mice ; Murinae ; Plasmids* ; Seoul ; Serotyping ; Virulence ; Yersinia pseudotuberculosis* ; Yersinia*

A 63-year-old man was placed on hemodialysis for the end-stage of renal disease secondary to renal artery stenosis. He was also regularly given epoetin, subcutaneously, for anemia associated with his renal disease. Rapidly progressing erythropoietin (EPO) resistant anemia and reticulocytopenia developed after 1 year of hemodialysis. The patient required frequent red blood cell transfusions. The bone marrow examination demonstrated selective erythroid hypoplasia. A detailed search for the cause of the erythroblastopenia revealed nothing, with the exception of anti-EPO antibodies (Ab). Pure red cell aplasia (PRCA) was suspected due to the anti-EPO Ab. With the immunosuppressive agent and change to the epoetin-therapy, the patient recovered his hemoglobin and reticulocyte counts. Particular attention should be paid for the possibility of PRCA due to anti-EPO Ab in patients undergoing rHuEPO therapy, with an unexplained recombinant human erythropoietin (rHuEPO) resistant anemia, especially via the subcutaneous route.
Anemia ; Antibodies* ; Bone Marrow Examination ; Erythrocyte Transfusion ; Erythropoietin ; Humans ; Middle Aged ; Red-Cell Aplasia, Pure* ; Renal Artery Obstruction ; Renal Dialysis* ; Reticulocyte Count

We report a case of colonic metastasis from ovarian cancer presented as an intraluminal fungating mass mimicking primary colon cancer 8 years after surgery for ovarian cancer. A 70-year-old woman presented with constipation. She had undergone an extended total abdominal hysterectomy with bilateral salpingo-oophorectomy for an ovarian papillary serous cystadenocarcinoma 8 years earlier. Colonoscopy showed a large fungating mass 10 cm from the anal verge that was suspected to be colorectal cancer. A computed tomography scan showed a bulky intraluminal fungating mass in the rectosigmoid junction. After a lower anterior resection and a pathologic diagnosis, a diagnosis of a papillary serous adenocarcinoma due to metastasis from an ovarian tumor was made for this patient.
Adenocarcinoma ; Aged ; Colon* ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Constipation ; Cystadenocarcinoma, Serous ; Diagnosis ; Female ; Humans ; Hysterectomy ; Neoplasm Metastasis* ; Ovarian Neoplasms*

BACKGROUND: Microcirculatory derangement in sepsis plays a crucial role in the impairment of tissue oxygenation that can lead to multi-organ failure and death. The change of RBC rheology in sepsis has been known to be important factors in microcirculatory derangement. Several studies have demonstrated that RBCs have decreased deformability in sepsis. We investigated the relationship between multi-organ failure and spherical index of RBC estimated by flow cytometer in critically ill patients with or without sepsis compared with the relationship in healthy volunteers. METHODS: Fourteen non-septic critically ill patients, 18 septic patients and 10 healthy volunteers were evaluated. We obtained peripheral venous blood from each patient and analyzed the change of RBC shape using flow cytometer (Becton Dickinson FACSCalibur) within 90 minute. The change of RBC shape was accessed with spherical index (M2/M1). A decrease in M2/M1 was correlated with the sphericity of the RBC and considered to have a lower capacity to alter their shape when placed in microcirculation. Multi-organ failure was accessed with sequential organ failure assessment (SOFA) score. RESULTS: The M2/M1 ratio of healthy volunteers, non-septic patients and septic patients were 2.25+/-0.08, 2.16+/-0.39 and 2.05+/-0.53, respectively. But, there was no significant difference between each group (p>0.05). And, there was no significant correlation between M2/M1 ratio of septic and non- septic patients and SOFA score (p>0.05, r2= -0.13). CONCLUSIONS: In our study, the spherical index of RBC was not associated with multi-organ failure in sepsis. But, further studies may be needed to evaluate the role of RBC rheology in sepsis.
Critical Illness ; Healthy Volunteers ; Humans ; Microcirculation ; Oxygen ; Rheology ; Sepsis*

BACKGROUND: When organ transplantation or HLA-matched platelet transfusion is considered, accu-rate identification of HLA antibody specificity in the recipient's serum is very important. In this study, we report our experience in an international quality control program. METHODS: For external quality control in a HLA antibody test, the International Serum Exchange Program distributes serum samples, generally showing polyspecific reactivity for cross-reactive epitope groups (CREGs), to participating laboratories: 4 samples per survey, 10 surveys per year. Participating in the program from May 1998 to August 2000 (24 surveys), we performed HLA antibody identification of 96 serum samples by the AHG-CDC (anti-human globulin-complement dependent cytotoxicity) method using frozen lymphocyte trays (36 lymphocyte panels). We compared the results of our laboratory with those of the total participants (all methods combined, 72 to 92 laboratories per survey) using the analyzed survey results distributed by the program organizer. RESULTS: We analyzed the survey results for the antibodies to relatively common HLA antigens in Koreans (antigen frequency >1%). For the HLA antibodies detected in >or=20% of participants, our detection rate was higher by 10-15% than that of all laboratories (HLA-A, 76% vs 65%; HLA-B, 73% vs 57%). And for the HLA antibodies detected in >or=50% of the participants, our detection rate was as high as 88% for HLA-A and 87% for HLA-B. Our detection rate for a few antibody specificities was lower than that of all laboratories, namely HLA-A1, A3, B35, and B55. Among these, A1, A3, and B55 were of lower incidence antigens in Koreans (antigen frequency 3-4%), indicating that the low detection rate was due to a limitation in the composition of lymphocyte panels. CONCLUSIONS: In general, our detection rate of HLA antibodies was superior to the average detection rate of the total participant laboratories. We would be able to improve the low detection rate for a few antibody specificities to lower incidence antigens by refining the composition of lymphocyte panels.
Antibodies ; Antibody Specificity ; HLA Antigens ; HLA-A Antigens ; HLA-A1 Antigen ; HLA-B Antigens ; Incidence ; Lymphocytes ; Organ Transplantation ; Platelet Transfusion ; Quality Control ; Transplants

BACKGROUND: Yersinia pseudotuberculosis, a member of genus Enterobactericeae, is a main etiologic organism of diarrhea in childhood. Because a mouse and a unchlorinated spring water are main reservoirs of Y. pseudotuberculosis, the strains from a contaminated spring water and mouse could be involved in human epidemic. The purpose of this study was to investigate a clonality between the strains from patients and those from an unchlorinated spring water and a mouse by restriction enzyme analysis of plasmid DNA and pulsed-field gel electrophoresis (PFGE). METHOD: We isolated 15 Y. pseudotuberculosis strains including 8 isolates from patients (S1-S8), 6 isolates from mountain water (W1-W6), 1 isolate from a mouse (M1) in northeast area of Seoul. Plasmid and chromosomal DNA of all strains were analyzed by REAP with Bam H1 restriction and by PFGE with Xba I restriction , respectively. RESULTS: Restriction enzyme analysis of plasmid DNA was classified into type B and type D. All 7 strains of serotype 15 were classified as type B and 8 strains of serotype 4b were classified as type D. PFGE were classified into 6 different types. Among them, strains of PFGE type I, II, III, IV belong to Y. pseudotuberculosis serotype 15 and Y. pseudotuberculosis 4b strains were classified into PFGE type V, VI. S1 and W1 were classified into PFGE type I . S8, W6 and M1 were classfied into PFGE type VI. CONCLUSIONS: PFGE revealed clonality among strains from patients, a water and a mouse. PFGE was more discriminative than REAP to characterize the Y. pseudotuberculosis outbreaks in Korea.
Animals ; Diarrhea ; Disease Outbreaks ; DNA* ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Korea* ; Mice ; Plasmids* ; Restriction Mapping* ; Seoul ; Yersinia pseudotuberculosis* ; Yersinia*

PURPOSE: The purpose of this study was to analyze effects of a community-based case management program for clients with hypertension living in the community. METHODS: The research design was a one group pre and post-test design with 30 participants with hypertension who agreed to participate in the 8-12 week case management program provided by case managers from the National Health Insurance Corporation in 2002. Data were collected three times, before and after the case management services, and 6 months later. Outcomes included changes in blood pressure, knowledge of hypertension and daily life practices, including alcohol consumption, smoking, exercise, and medication adherence. RESULTS: Repeated-measures ANOVA and post-hoc tests of means revealed significant differences before and after service for systolic blood pressure, daily life practices (monitoring body weight and BP, low salt and cholesterol and high vegetable diet, and stress-relief practices), and exercise. The goal for medication adherence was attained after service. Significant improvements from baseline to 6 months after service were observed in measures of salt and vegetables in diet. There were no significant differences on hypertension knowledge, alcohol consumption or smoking behavior between before service and after, and at 6 months. CONCLUSION: The findings provide preliminary evidence that case management intervention can have positive outcomes on BP control, daily life practices, exercise, and medication adherence for clients with hypertension. However, additional interventions are needed to sustain long-term effects.
Activities of Daily Living ; Aged ; Alcohol Drinking/prevention & control/psychology ; Blood Pressure ; Case Management/*organization & administration ; Community Health Services ; Diet, Sodium-Restricted ; Female ; Humans ; Hypertension/psychology/*therapy ; Korea ; Male ; Medication Adherence/psychology ; Middle Aged ; Patient Education as Topic ; Smoking Cessation/psychology

We evaluated the clinical characteristics of patients with SO dyskinesia(n=16) who were confirmed by ERCP manometry during past 5 years. They were 14 male and 2 female and mean age was 52-year-old(range, 32-75). According to the criteria suggested by Hogan and Geenen, 13 patients were classified into biliary type and 3 patients into pancreatic type. Among the patients with biliary type(n=13), 12 patients fulfilled the criteria for group II dysfunction of SO and 1 patient for group III. Among the patients with pancreatic type(n=3), all fulfilled the criteria for group II. The manometric abnormalities were increased basal pressure(n=4), tachyoddia(n=7), increased retrograde propagation(n=3), tachyoddia and increased retrograde propagation(n=l), and tachyoddia and increased basal pressure(n=l). As treatment, 12 patients received conventional endoscopic sphincterotomy and 3 patients received endoscopic pancreatic sphincterotomy in addition to conventional endoscopic sphincterotomy. Satisfactory results (complete absence or marked reduction of pain) were obtained in 13(87%) out of 15 patients by endoscopic treatment. In conclusion, SO dyskinesia is not so common disease and the detection of patients with SO dyskinesia may increase by frequent application of ERCP manometry.
Cholangiopancreatography, Endoscopic Retrograde ; Dyskinesias ; Female ; Humans ; Male ; Manometry ; Sphincter of Oddi Dysfunction* ; Sphincter of Oddi* ; Sphincterotomy, Endoscopic

Fungal peritonitis is one of the leading causes of patient dropout from continuous ambulatory peritoneal dialysis (CAPD) therapy. Although the most causative agents of peritonitis associated with CAPD are bacteria, fungi are implicated in up to 10% of cases. The most common organism of fungal peritonitis is Candida specises, but Trichosporon beigelii was reported as a rare causative agent of fungal peritonitis. We experienced a case of CAPD peritonitis by Trichosporon beigelii, which was treated with CAPD catheter removal, and antifungal agents with amphotericin B and fluconazole. Thus, we report our experience of CAPD peritonitis caused by Trichosporon beigelii and review of the literature.
Amphotericin B ; Antifungal Agents ; Bacteria ; Candida ; Catheters ; Fluconazole ; Fungi ; Humans ; Patient Dropouts ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Trichosporon*