BACKGROUND: Early detection and treatment of cytomegalovirus (CMV) infection is very important because CMN infection is a major cause of morbidity and mortality after organ transplantation. CMV antigenemia assay has been reported to be very sensitive and specific for detection of CMV infection among many laboratory methods. However, there is no single method correlated well with the infection state up to now. We compared the results of SHARP Signal System Assay (Digene, USA) using PCR and hybridization with those of CMV antigenemia assay (Clonab CMV-kit; Biotest AG, Germany) to evaluate their clinical usefulness. METHODS: We performed SHARP Signal Assay on whole blood samples of 125 from 56 transplanted patients submitted for CMV antigenemia at Samsung Medical Center. We compared the results with those of CMV antigenemia and evaluated the correlation with CMV disease state. RESULTS: Fifty six patients were classified as three groups; 43 patients with no evidence of CMV infection, four patients with CMV infection and 9 patients with CMV disease. Twenty four cases (19.2%) showed discrepant results between the two methods. Of the 22 cases showing positive only by SHARP Signal Assay, two cases were proved to be CMV disease, 12 cases were on antiviral treatment and remaining cases had no evidence of infection. Two cases showing positive only by CMV antigenemia were confirmed to be CMV disease. For CMV disease, the sensitivity of SHARP Signal Assay and CMV antigenemia were 85.7% and 90.5%, respectively and the specificity of them were 73.1% and 93.3%, respectively. CONCLUSIONS: CMV antigenemia is thought to be useful for early diagnosis and follow-up of antiviral treatment as a quantitative and highly specific method, and SHARP Signal Assay can be used as a complementary method because it correlates well with disease state.
Cytomegalovirus Infections* ; Cytomegalovirus* ; Diagnosis* ; Early Diagnosis ; Follow-Up Studies ; Humans ; Mortality ; Organ Transplantation ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Transplants

Dislocation of both ends of a clavicle in a 49-yesr-old man during an auto-accident is presented. The medial end of the right clavicle was severely displaced antero-inferiorly while the 1ateral end displaced posteriorly. And the clavicle was rotated along its long axis. Sever al attempts of manual and a surgical reduction through separate incision on both ends of the clavicle failed to have anatomical reduction. It was presumed that the cause of failure in reduction were delayed reduction due to combined chest injury, blockade by first rib that was broken and was anteriorly displaced as well as the complexity of the dislocation. It is speculsted that anatomic reduction in this rare injury require wider surgical exposure. Though authors failed to have anatomic reduction in present case, stabilization of the medial end of the clavicle with a strip of fascia lata after medial clavicular resection and ligament repair at the lateral end resulted in satisfactory regain of shoulder motion and cosmetic improvement.
Clavicle ; Dislocations ; Fascia Lata ; Ligaments ; Ribs ; Shoulder ; Thoracic Injuries

BACKGROUND: Enterococci exhibit intrinsic resistance or high-level minimum inhibitory concentration (MIC) to beta-lactams than other streptococci. This appears to be due to low affinity of penicillin-binding proteins and rarely production of beta-lactamase, which gives the reason of testing beta-lactamase for blood and cerebrospinal fluid isolates. Ampicillin is more effective than penicillin in vitro, and MIC of ampicillin is generally 1 dilution lower than that of penicillin. The purpose of this study is to detect beta-lactamase producing enterococci an6 to compare MICs of ampicillin and penicillin by Vitek system (bioMerieux, Hazelwood, MO, USA) with those by agar dilution method. METHODS: We collected 110 isolates of Enterococcus faecalis and 51 isolates of E. faecium from clinical specimens in 1998. MICs of antibiotics were determined by agar dilution method and Vitek system. We also performed beta-lactamase test by the Cefinase (Becton Dickinson, USA) for 512 isolates of E. faecalis and 189 isolates of E. faecium collected in 1998. RESULTS: The most common sites of isolates were blood, bile, surgical/traumatic wounds, closed and open pus and urine. MICs of ampicillin were 1 to 2 dilution lower than those of penicillin for E. faecalis (P=0.03). But there were no significant differences in MICs for E. faecium (P=0.19). Five isolates (4 E. faecalis and 1 E. faecium) were susceptible to ampicillin but resistant to penicillin. There were no beta-lactamase producing enterococci among 701 isolates tested. CONCLUSIONS: MIC by Vitek system tends to be 1 to 2 dilution lower than MIC by agar dilution method to beta-lactams, and MIC of ampicillin is 1 to 2 dilution lower than MIC of penicillin, which could result in discrepancy in interpretation of susceptibilty tests. A beta-lactamase test for enterococci is not recommeneded for routine test in Korea.
Agar ; Ampicillin ; Anti-Bacterial Agents* ; beta-Lactamases ; beta-Lactams ; Bile ; Cerebrospinal Fluid ; Enterococcus faecalis ; Enterococcus* ; Korea ; Microbial Sensitivity Tests ; Penicillin-Binding Proteins ; Penicillins ; Suppuration ; Wounds and Injuries

BACKGROUND: Coagulase negative staphylococcus (CNS) spp. is a major pathogenic organism of nosocomial and community-acquired urianry tract infections, and causes infrctions in the immunocompromised host, and in particular, bloodstream infetions in patent with indwelling devices. High prevalance of methicillin resistance has been noticed in CNS which also have been recongnized as an important multidrug resistant pathogen. The optimal phenotypic method for detecting methicillin resistance still remains controversial, and new guidelines for detecting methicillin resistance of CNS was proposed by NCCLS in January 1999. We evaluated the relationship between mecA gene by PCR method and antimicrobial susceptibility tests according to the new NCCLS guidelines. METHODS: A total of 82 CNS isolates were examined for MICs and penicillin MICs by disk diffusion and agar dilution method according to NCCLS guidelines, and detections, and detection of mecA gene by PCR. RESULT: In disk diffusion method, 66 strains (80.5%) and 63 strains (76.8%) showed resistance to penicillin and oxacillin, respectively, and in agar dilution method, 71 strains(86.6%) and 53 strains (64.6%), respectively. In PCR method, mecA genes were detected in 49 strains(59.8%). Comparing with mecA gene detection by PCR method, the sensitivity of disk diffusion and agar dilution method was 95.8% and 89.8%, repectively. However, the sensitivity of disk diffusion and agar dilution method was 65.3% and 75.5%, respectively using previous NCCLS criteria. CONCLUSION: The new criteria of NCCLS detects the methicillin resistance induced by mecA gene more sensitively than previous one.
Agar ; Coagulase* ; Diffusion ; Immunocompromised Host ; Methicillin Resistance ; Oxacillin ; Penicillins ; Polymerase Chain Reaction ; Staphylococcus*

No abstract available.

No abstract available.

No abstract available.
Breast* ; Female ; Humans

Dermatologist should be aware of the practical importance of proper selection of ski.n lesions for histologic examination, the correct methods for performing biopsy, and steps involved in tissue preparation. They should be acquainted with factors producing various artifacts and ways to prevent these changes. This study was undertaken to investigate the artifacts of 300 dermatopathologic tissue sections which prepared by 3 general hospitals in Seoul in 1983. The results were summarized as follows. [.The percentage of artifacts produced by selection of inapropriate lesion was 4. 0% artifacts during biopsy procedure was 18. 3% inadequate size and depth of specimen was 7. 3%, faulty embedding was 12. 0%, tissue tearing or loss was 49. 3% artifactal dermoepidermal separation was 3.0%, linear knife marking was 17.0% thick or thin section was 8. 3% tissue overlapping was 12. 0% uneven stiining or precipitation was 3. 7%, and foreign body contamination was 3, 7% The percentage of good specimen was 21, 7% diagnostic was 56. 3% not diagnostic but suggestive was 8.7% and reading impossible was 13. 3% 3. The major causes of reading impossible specimen which attributed to the procedures of dermatologist were 40.0% to the proccss of technician were 47.5% and to both were 12. 5%
Artifacts* ; Biopsy* ; Foreign Bodies ; Hospitals, General ; Seoul ; Skin*

Seventeen patients with classical rheumatoid arthritis have been treated with gold sodium thiomalate(G.S.T) injection and followed up for 1.7 years on average. The results obtained are as follows: 1. Clinical improvement was obtained in 12(70.3%) out of 17 cases, but only in 5 cases(29.3%) marked and persisting improvement was obtained. Such improvement was first noticed when the total dose of the gold sodium thiomalate reached 500mg or more, and also noticed about 10 weeks after initiation of G.S.T therapy. 2. Changes in laboratory parameters such as hemoglobin, hematocrit, eosinophilia, titers of rheumatoid factor and C-reactive protein, and proteinuria began to appear at the time of the clinical improvement. 3. Adverse reaction consisted mostly of mucocutaneous lesions. The main causes of drop-out during therapy also are severe skin rashes and pruritus. Most of the adverse reactions appeared when the total dose of G.S.T. administered reached over 500mg. In two severe cases skin rashes terminated the gold therapy. Our findings suggest, because of high incidence of adverse reaction during G.S.T therapy, repeated careful clinical and laboratory examination of the patient are mandatory especially when the total dose of G.S.T is reached 500mg. In spite of the well documented reports of the maintenance gold therapy for rheumatoid arthritis it is felt that the maintenance gold therapy should be studied further before it can be safely used as a routine in daily rheumatology practice because of its toxicity.
Arthritis ; Arthritis, Rheumatoid ; C-Reactive Protein ; Eosinophilia ; Exanthema ; Gold Sodium Thiomalate ; Hematocrit ; Humans ; Incidence ; Proteinuria ; Pruritus ; Rheumatoid Factor ; Rheumatology ; Sodium

Between May 1982 and October 1983, arthroscopic meniscectomy had been performed in 54 knees between ages of 11 and 70 years. There were 32 male patients and 22 female patients in this series. The mean follow-up was 20 months, ranging from 15 months to 33 months. Postoperative complications developed were retropatellar tenderness and effusion. No infection, thrombophlebitis or instability occurred postoperatively. The aim of this study was to evaluate the effect of the various possible prognostic factors upon the developtnent of the above mentioned complications. The factors included were 1) shape of tear, 2) ligamentous injury, 3) degenerative arthritia, 4) discoid lateral meniscus, 5) quadriceps atrophy, 6) sites of meniscus(medial or lateral) & extent of excision, 7) preoperative retropatellar tenderness and 8) method of rehabilitation. The findings were statistically analyzed by the Chi-square test (df-1) & Fisher's direct probability method. The results obtained were as follows; 1. The rate of development of postoperative effusion was significantly high in cases of quadriceps atrophy (P<0.01) and preoperative retropatellar tenderness(P<0.01). 2. The rate of deveopment of postoperative retropatellar tenderness was significantly high in case of discoid lateral meniscus (P <0.01). 3. There was no significant correlation between complications and other factors including shape of tear, preoperative degerative arthritis, site of meniscus & extent of excision and methods of rehabilitation.
Arthritis ; Atrophy ; Female ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Male ; Menisci, Tibial ; Methods ; Postoperative Complications ; Prognosis ; Rehabilitation ; Tears ; Thrombophlebitis