No abstract available.
Gelatin Sponge, Absorbable* ; Hemorrhage* ; Thrombin*

Tuberculosis can involve any part of the gastrointestinal tract but 80~90% of patients present the disease in the ileocecal region. The cases of colon cancer coexisting with colonic tuberculosis are relatively rare and ascending colon is the predominant site of the combined disease. A 46-year-old man, without specific past medical or family history, showed multiple colonic polyps and ulcers on colonoscopic examination. After surgery, the surgical specimen disclosed adenocarcinoma in the ascending colon, eleven adenomatous polyps throughout the colon, and multiple tuberculous ulcers in the entire colon. Tuberculosis of terminal ileum was also accompanied. The association of colonic tuberculosis and colon cancer with multiple polyps in this case may have been coincidental. The preoperative colonoscopic examination and pathologic diagnosis by frozen section during operation are necessary for the adequate treatment.
Adenocarcinoma ; Adenomatous Polyps ; Colon* ; Colon, Ascending ; Colonic Neoplasms* ; Colonic Polyps ; Diagnosis ; Frozen Sections ; Gastrointestinal Tract ; Humans ; Ileum ; Middle Aged ; Polyps ; Tuberculosis* ; Ulcer

PURPOSE: This study describes how often complementary and alternative medical (CAM) therapies, what patterns of CAM therapies utilization, what types of CAM therapies and why CAM therapies are used in children and adolescent with chronic disease. METHODS: We interviewed and filled out questionnaires with parents of patients suffering from asthma, atopic dermatitis, congenital myopathy, epilepsy and so on from Mar 2004 to Aug 2004. RESULTS: Two hundred fifty two parents answered questionnaires; 160 cases (63.5 percent) had used CAM therapies. Utilization of CAM therapies according to each chronic disease was as follows: congenital myopathy (100 percent), atopic dermatitis (91.1 percent), asthma (72.5 percent), chronic diarrhea (50.0 percent), epilepsy (17.1 percent) etc. Types of CAM therapy were as follows: dietary supplement (31.1 percent), herb medicine (23.4 percent), massage (14.2 percent), acupuncture (4.6 percent) etc. Sixty four (40.0 percent) case underwent more than two types of CAM therapies simultaneously. One hundred thirty three (83.1 percent) case were asked through non-medical prescription. Ninety nine (61.9 percent) case were recognized positive effect of CAM therapies. Parents' and childrens' ages were influential factors in CAM therapies utilization: the older the parents and the younger the children, the higher the utilization. CONCLUSION: Although patients receive treatment with western medicine, many of them not only undergo CAM therapies, especially more than two types, but also recognize the positive effects of CAM therapies. As a result, we suggest that it is easy to use of CAM therapies, and the positive effects of CAM therapies are prominent, domestically. Therefore, medical approach and study about the effectiveness and side effects of CAM therapies is necessary to avoid the imprudent use of such therapies.
Acupuncture ; Adolescent* ; Asthma ; Child* ; Chronic Disease* ; Dermatitis, Atopic ; Diarrhea ; Dietary Supplements ; Epilepsy ; Humans ; Massage ; Muscular Diseases ; Parents ; Prescriptions ; Surveys and Questionnaires

Non-faecalis and non-faecium enterococci are an occasional cause of bacteremia, and some cases of infective endocarditis caused by these pathogens have been reported. However, the rate of infective endocarditis in non-faecalis and non-faecium enterococcal bacteremia is still undetermined. We compared the clinical features and the rate of infective endocarditis of 70 cases of non-faecalis and non-faecium enterococcal bacteremia with those of 65 cases of Enterococcus faecalis bacteremia. Non-faecalis and non-faecium enterococcal bacteremia was more frequently associated with biliary tract infection and polymicrobial bacteremia, and was less frequently associated with infective endocarditis, than was E. faecalis bacteremia (57% vs. 28%, p<0.01; 47% vs. 31%, p=0.05; 1% vs. 14%, p<0.01, respectively).
Bacteremia ; Biliary Tract ; Endocarditis ; Enterococcus faecalis

Persistent Staphylococcus aureus bacteremia is frequently defined as bacteremia persisting for > or =7 days despite proper antibiotic therapy. Its treatment includes removal of all infection foci and proper antibiotic therapy. Vancomycin remains the antibiotic of choice in MRSA bacteremia. Alternative agents, linezolid or daptomycin, are available, but a consensus regarding management of persistent MRSA bacteremia on vancomycin failure is still lacking. We report a case of a 60-year-old male who received thoracoabdominal aorta replacement operation due to dissecting aneurysm of the ascending and descending aorta. Surgical site infection and bacteremia caused by MRSA occured, and wound debridement operations were performed. The patient was treated with vancomycin in therapeutic doses but MRSA bacteremia persisted for 168 days in a row. Although the inserted aortic graft was the most probable source of persistent bacteremia, surgical removal was impossible. Linezolid was administered as an alternative antibiotic but had to be discontinued from time to time due to thrombocytopenia induced by this agent. In the end, MRSA bacteremia was successfully managed by alternating vancomycin-linezolid therapy.
Acetamides ; Aneurysm, Dissecting ; Aorta ; Aorta, Thoracic ; Bacteremia ; Consensus ; Daptomycin ; Debridement ; Humans ; Linezolid ; Male ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Oxazolidinones ; Staphylococcus aureus ; Thrombocytopenia ; Transplants ; Treatment Failure ; Vancomycin

Persistent Staphylococcus aureus bacteremia is frequently defined as bacteremia persisting for > or =7 days despite proper antibiotic therapy. Its treatment includes removal of all infection foci and proper antibiotic therapy. Vancomycin remains the antibiotic of choice in MRSA bacteremia. Alternative agents, linezolid or daptomycin, are available, but a consensus regarding management of persistent MRSA bacteremia on vancomycin failure is still lacking. We report a case of a 60-year-old male who received thoracoabdominal aorta replacement operation due to dissecting aneurysm of the ascending and descending aorta. Surgical site infection and bacteremia caused by MRSA occured, and wound debridement operations were performed. The patient was treated with vancomycin in therapeutic doses but MRSA bacteremia persisted for 168 days in a row. Although the inserted aortic graft was the most probable source of persistent bacteremia, surgical removal was impossible. Linezolid was administered as an alternative antibiotic but had to be discontinued from time to time due to thrombocytopenia induced by this agent. In the end, MRSA bacteremia was successfully managed by alternating vancomycin-linezolid therapy.
Acetamides ; Aneurysm, Dissecting ; Aorta ; Aorta, Thoracic ; Bacteremia ; Consensus ; Daptomycin ; Debridement ; Humans ; Linezolid ; Male ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Oxazolidinones ; Staphylococcus aureus ; Thrombocytopenia ; Transplants ; Treatment Failure ; Vancomycin

BACKGROUND: There have been bone mass studies for the treatment of osteoporosis, nonetheless, little attention has been paid to the management of osteopenia. This study was to evaluate the effects of estrogen, alendronate and their combination on bone mineral density and bone metabolism in the postmenopausal women with osteopenia. METHODS: A total of 150 healthy regional patients with osteopenia from Busan were enrolled in prospective randomized clinical trial and randomly assigned to receive conjugated equine estrogen (group I), alendronate (group II), or combination of the two (group III). Assessments included BMD of L2-4 spines and femur neck by DEXA and markers of bone turnover including serum osteocalcin, total alkaline phosphatase and urine deoxydyridinoline (Dpd). BMD and markers of bone turnover were re-evaluated at 6 and 12 months after the treatment. RESULTS: BMD of the lumbar spines increased significantly at 12 months after treatment in the three groups (P<0.05). BMD of the femur neck increased at 12 months after treatment in the three groups, but significantly in group III (P<0.05). Serum osteocalcin decreased at 12 months after treatment in the three groups, but only significantly in group III. Urine Dpd decreased at 12 months after treatment in three groups, but significantly in group, II and III (P<0.05). Serum total alkaline phosphatase decreased at 12 months after treatment in only group III (P<0.05). There was more favorable benefit for group III in BMD of the lumbar spines and serum osteocalcin and urine Dpd at 12 months after treatment compared to group, II and III (P<0.05). CONCLUSION: These results indicated a favorable benefit of conjugated equine estrogen, alendronate, or combination of the two in BMD and important markers of bone turnover. The combined treatment with conjugated equine estrogen and alendronate was more effective in postmenopausal women with osteopenia. Long-term studies are required to confirm these results.
Alendronate ; Alkaline Phosphatase ; Bone Density* ; Bone Diseases, Metabolic* ; Busan ; Estrogens ; Female ; Femur Neck ; Humans ; Metabolism* ; Osteocalcin ; Osteoporosis ; Prospective Studies ; Spine

Background: Arthrocentesis of the temporomandibular joint (TMJ) is an easy, highly efficient, minimally invasive procedure for treating temporomandibular joint disorders (TMDs). However, in some cases of mouth opening limitation (MOL), routine arthrocentesis is ineffective due to severe fibrotic adhesion in the superior joint space of the TMJ. In this condition, mechanical lysis of the adhesions might be needed to resolve the MOL, as well as other symptoms, such as chronic pain. Currently, this can be achieved by arthroscopic surgery or open TMJ surgery. The objective of this study was to introduce and evaluate our trial of the adhesion lysis procedure during arthrocentesis of the TMJ using normal 18-gauge needles. Results: In this study, 40 patients with MOL due to disc derangement underwent conventional arthrocentesis at first and then physical detachment was conducted using the same needle. The change in maximum mouth opening (MMO) and the pain at the TMJ were recorded before, during, and after treatment according to our protocol. The mean increase in MMO after conventional arthrocentesis was 6.6 ± 4.2mm. The mean increase in MMO after the detachment procedure with the same needle was 4.2 ± 2.0 mm. The MMO in ten patients was significantly increased after the detachment procedure than after arthrocentesis alone. In all cases, the pain intensity in the TMJ significantly decreased over time, whereas the MMO increased over time. No adverse effect was observed in all joints during our observation periods. Conclusion We confirmed that our simple lysis procedure with the same needle of the arthrocentesis of the TMJ could not only improve the MMO more than after a conventional arthrocentesis but also resolve severe adhesion of the joint space that was ineffective by conventional arthrocentesis. Although this additional lysis procedure is simple, it might reduce the number of cases of more invasive procedures such as arthroscopic surgery or open TMJ surgery.

BACKGROUND: Invasive aspergillosis (IA) is an important cause of morbidity and mortality among immunocompromised patients. However, IA is difficult to diagnose, especially in the aforementioned patient group. Recently, galactomannan assay (GMA) using enzyme immunoassay has been introduced in Korea. We evaluated its diagnostic usefulness in the diagnosis of IA and we analyzed the results according to the underlying diseases. MATERIALS AND METHODS: All patients who underwent GMA during the period from October 2007 to June 2008 were evaluated retrospectively. According to the criteria of European Organization for Research and Treatment of Cancer/Mycoses Study Group, IA was classified into four clinical categories: 'proven', 'probable', 'possible', and 'non' IA. Patients with 'proven' and 'probable' IA were used as the reference standards for IA. GMA was performed using Platelia Aspergillus EIA (Bio-Rad, Hercules, CA, USA). Optical density index > or =0.5 was considered positive. RESULTS: Of the 144 patients who underwent GMA, two patients were classificed as 'proven' IA and sixteen patients were 'probable' IA. Overall sensitivity, specificity, positive predictive value, and negative predictive value of the assay were 50% (95% confidence interval [CI95], 26-74%), 88% (CI95, 81-93%), 38% (CI95, 19-59%), and 93% (CI95, 86-97%), respectively. Among the 99 patients with underlying hematologic diseases, GMA showed 67% (CI95, 35-90%) sensitivity and 89% (CI95, 80-94%) specificity, whereas in 45 patients with underlying diseases other than hematologic diseases, sensitivity and specificity of the assay were 17% (CI95, 0-64%) and 87% (CI95, 73-96%), respectively. CONCLUSION: GMA showed high specificity, irrespective of the patient population. However, sensitivity of GMA was low and the assay was less sensitive in patients with underlying diseases other than hematologic diseases than in patients with hematologic diseases.
Aspergillosis ; Aspergillus ; Hematologic Diseases ; Humans ; Immunocompromised Host ; Immunoenzyme Techniques ; Korea ; Mannans ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: C-reactive protein (CRP) is an acute phase reactant produced in the liver. To assess the influence of liver dysfunction on the production of CRP, we evaluated CRP response to E. coli bacteremia in patients with or without liver cirrhosis (LC). METHODS: 30 LC patients who developed spontaneous peritonitis with E. coli bacteremia were enrolled in the study. Baseline values of total bilirubin, serum albumin, and prothrombin time were obtained within 2 months prior to infection. Liver dysfunction was categorized according to the Child-Pugh score. 30 patients with E. coli bacteremia who had no underlying liver dysfunction were included as a control group. Matched-control of 30 LC patients without evidence of acute infection was also included. The peak CRP values were compared among the groups. RESULTS: In the patients with E. coli bacteremia, the mean value of peak CRP was 7.3 (+/- 5.0) mg/dL in LC patients, 17.9 (+/- 8.3) mg/dL in patients without liver dysfunction (p<0.001). In the advanced LC patients with Child-Pugh class C, the level of CRP was 5.2 (+/- 3.3) mg/dL in patients with E. coli bacteremia, 0.5 (+/- 0.4) mg/dL in patients without acute infection (P<0.001). Child-Pugh score had correlation with decrease of CRP (linear regression test, P=0.004). CONCLUSION: CRP response during E. coli bacteremia was attenuated but maintained even in patients with advanced liver dysfunction.
Bacteremia* ; Bilirubin ; C-Reactive Protein* ; Escherichia coli* ; Escherichia* ; Humans ; Liver Cirrhosis* ; Liver Diseases* ; Liver* ; Peritonitis ; Prothrombin Time ; Serum Albumin