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.

Since Zika virus has been spreading rapidly in the Americas from 2015, the outbreak of Zika virus infection becomes a global health emergency because it can cause neurological complications and adverse fetal outcome including microcephaly. Here, we report clinical manifestations and virus isolation findings from a case of Zika virus infection imported from Brazil. The patient, 43-year-old Korean man, developed fever, myalgia, eyeball pain, and maculopapular rash, but not neurological manifestations. Zika virus was isolated from his semen, and reverse-transcriptase PCR was positive for the virus in the blood, urine, and saliva on the 7th day of the illness but was negative on the 21st day. He recovered spontaneously without any neurological complications. He is the first case of Zika virus infection in Korea imported from Brazil.
Adult ; Brazil ; Humans ; Male ; Microscopy, Electron, Transmission ; RNA, Viral/analysis/blood/urine ; Republic of Korea ; Reverse Transcriptase Polymerase Chain Reaction ; Saliva/virology ; Semen/virology ; Travel ; Zika Virus/genetics/*isolation & purification ; Zika Virus Infection/*diagnosis/virology

PURPOSE: The aim of this study was to describe our experience of a class, using a film that deals with the social issues of human immunodeficiency virus (HIV), and the results of surveys before and after the class. METHODS: One hundred fifty-six second-year medical students were surveyed with self-questionnaires (9-point Likert scale) before, immediately after, and 2 years after a class that viewed a film ('Philadelphia', 1993). The same survey, comprising 4 items, was administered to 81 non-medical students in the same university. RESULTS: In 156 medical students, 153 (98%) answered the questionnaires. Before the class, there was no significant difference between medical and non-medical students with regard to the cognition of social isolation of HIV-infected persons (4.13 vs. 4.43, p=0.307). immediately after the class, medical student' cognition changed significantly in the positive direction on all items, irrespective of age, sex, and course grade. Two years after the class, this positive effect remained significant on 2 items: 'social isolation of HIV-infected persons' and 'casual contact with an HIV-infected person.' CONCLUSION: A film can be used to reinforce medical education in the affective domain.
Cognition ; Education, Medical ; HIV ; Humans ; Motion Pictures as Topic ; Social Isolation ; Students, Medical ; 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

High-level gentamicin resistance (HLGR) in enterococci has increased since the 1980s, but the clinical significance of the resistance and its impact on outcome have not been established. One hundred and thirty-six patients with bacteremia caused by enterococci with HLGR (HLGR group) were compared with 79 patients with bacteremia caused by enterococci without HLGR (non-HLGR group). Hematologic malignancy, neutropenia, Enterococcus faecium infection, nosocomial infection and monomicrobial bacteremia were more common in the HLGR group than the non-HLGR group, and APACHE II scores were also higher (P<0.05, in each case). Neutropenia, monomicrobial infection, stay in intensive care at culture, and use of 3rd generation cephalosporin, were independent risk factors for acquisition of HLGR enterococcal bacteremia. Fourteen-day and 30-day mortalities were higher in the HLGR group than the non-HLGR group in univariate analysis (37% vs. 15%, P=0.001; 50% vs. 22%, P<0.001). However, HLGR was not an independent risk factor for mortality due to enterococcal bacteremia in multivariate analysis. Therefore, HLGR enterococcal bacteremia is associated with more severe comorbid conditions and higher mortality than non-HLGR enterococcal bacteremia but the HLGR itself does not contribute significantly to mortality.
Adolescent ; Adult ; Aged ; Anti-Bacterial Agents/*pharmacology ; Bacteremia/diagnosis/*etiology/*mortality ; Cephalosporins/pharmacology ; Cross Infection/complications ; Drug Resistance, Bacterial ; Enterococcus/*drug effects/isolation & purification ; Female ; Gentamicins/*pharmacology ; Gram-Positive Bacterial Infections/diagnosis/*etiology/*mortality ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neutropenia/complications/mortality ; Odds Ratio ; Risk Factors ; Severity of Illness Index ; Treatment Outcome

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

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: 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

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

PURPOSE: Since 1967, The Korean Pediatric Society and Korean Government have developed Korean Growth Standards every 10 years. Last version was published in 1998. During past 40 years, Korean Growth Standards were mainly descriptive charts without any systematic nor statistical standardization. With the global epidemic of obesity, many authorities such as World Health Organization (WHO) and United States' Centers for Disease Control (CDC) have been changed their principles of growth charts to cope with the situations like ours. This article summarizes and reviews the whole developmental process of new 2007 Korean Growth Charts with discussion. METHODS: With the initiative of Division of Chronic Disease Surveillance in Korea Centers for Disease Control and Prevention, we have performed new national survey for the development of new Standards in 2005 and identified marked increase of childhood obesity and plateau of secular increment of final height in late adolescents. We have developed new Growth Standards via adapting several innovative methods, including standardization of all available raw data, which were acquired in 1997 and 2005 national survey and full application of LMS method. RESULTS: We could get new standardized charts; weight-for-age, length/height-for-age, weight-for-height, head circumference-for-age and BMI-for-age. Other non-standardized charts based on 2005 survey data were also published; waist circumference-for-age, mid-arm circumference-for-age, chest circumference-for-age and skinfold-for-age. Clinical guideline was also developed. CONCLUSION: Developmental process and results of new Korean Growth Charts are comparable with other internationally well-known Growth Standards, WHO 2006 Growth Standards and CDC Growth Charts. 2007 Korean Growth Charts are relevant especially in Korea and Korean ethnic groups.
Adolescent ; Centers for Disease Control and Prevention (U.S.) ; Chronic Disease ; Ethnic Groups ; Growth Charts ; Head ; Humans ; Korea ; Obesity ; Phosphatidylethanolamines ; Thorax ; World Health Organization