Objective: To investigate changes in blood glucose level after steroid injection in patients with type 2 diabetes mellitus (DM) and factors affecting those changes. Methods: We retrospectively studied 51 patients with type 2 DM who underwent steroid injection for shoulder and back pain. Mean fasting blood sugar (FBS) levels for 7 days before steroid injection was used as the baseline blood glucose level, which was compared with FBS levels for 14 days after steroid injection. We compared the differences in blood glucose changes between HbA1c >7% and HbA1c ≤7% groups and those between insulin and non-insulin treated groups. Demographic data, injection site, and steroid dose were analyzed. Results: Compared to baseline, blood glucose significantly (p=0.012) elevated 1 day after steroid injection but not 2 days after injection. In the HbA1c >7% and insulin groups, blood glucose was significantly increased 1 day after injection compared to that in the HbA1c ≤7% (p=0.011) and non-insulin (p=0.024) groups, respectively. Higher HbA1c level before injection was significantly (p=0.003) associated with the degree of blood glucose increase 1 day after injection. No significant differences were noted in the degree of blood glucose increase according to injection site or steroid dose. Conclusion Higher HbA1c level was associated with greater elevation in blood glucose 1 day after steroid injection. Careful monitoring of blood glucose is required on the first day after steroid injection in patients with poorly controlled DM.

BACKGROUND: We thought that nitroimidazoles including metronidazole had been overused empirically for treatment of trichomoniasis in Korea. But there were not any reports about in vitro-drug susceptibility and distribution of resistant strains of Trichomonas vaginalis up to date. Therefore, we made an experiment in order to observe the susceptibility of clinical isolates of T. vaginalis to a variety of antiprotozoal agents. METHODS: Twenty-six strains of T. vaginalis isolated from 217 patients afflicted with the increased vaginal discharge were tested by Meingassner's microtiter plate method in newly devised anaerobic box, in which anaerobic and microaerobic conditions were more easily manipulated. The agents used in this study for testing the minimal lethal concentration (MLC) to the clinical isolates were as follows; nitroimidazoles, doxycycline, Zinc sulfate and gentian violet as chemotherapeutic agents and povidone-iodine as vaginal cleansing agents were studied. RESULTS: In anaerobic culture, according to anaerobic resistance cut-point (minimal lethal concentration >3.1 microgram/mL) proposed by M ller etc., metronidazole (MTZ)-, tinidazole (TNZ)-and ornidazole (ONZ)-resistant strains were four (4/26, 15.4%), two (2/26, 7.7 %) and two (2/26, 7.7%) strains, respectively. Among these resistant strains, two strains (G7 and G16) were resistant to two drugs and one strain (G20) resistant to three drugs concomitantly. Their resistance range was narrow as 6.25~12.5 microgram/mL. MLC of clotrimazole was > or = 2,000 microgram/mL in all strains, econazole was as high as 62.5~250 microgram/mL and miconazole was also high as 62.5~> or = 2,000 microgram/mL. In microaerobic culture (O2 concentration <5%), all strains showed lower MLC to MTZ, TNZ and ONZ than >100 microgram/ mL (aerobic resistance cut-point proposed by M ller etc.). MLC of doxycycline ranged 62.5 to 250 microgram/mL both in microaerobic and anaerobic conditions. All strains of T. vaginalis growed well in 3,000 microgram/mL of povidone-iodine. 22 strains (84.6%) among 26 T. vaginalis strains showed MLCs of 3.5 mM~7.0 mM to zinc sulfate. Gentian violet showed 15.6~62.5 microgram/mL of MLC. CONCLUSION: In absolute anaerobic culture, 4 strains (15.4%) among 26 T. vaginalis strains were resistant to metronidazole. But these 4 strains were not resistant in microaerobic culture depending on Miler's aerobic resistance cut-point (>50~100 microgram/mL), the value decided in normal O2 pressure. Vaginal PO2 is 0~28mm Hg (median 1 mmHg) at healthy or trichomonas-infected women. Therefore, we think that his aerobic resistance cut-point value is hard to be available in microaerobic condition and microaerobic resistance guide-line is to be established newly.
Anti-Infective Agents ; Antiprotozoal Agents* ; Clotrimazole ; Detergents ; Doxycycline ; Econazole ; Female ; Gentian Violet ; Humans ; Korea ; Metronidazole ; Miconazole ; Nitroimidazoles ; Ornidazole ; Povidone-Iodine ; Tinidazole ; Trichomonas vaginalis* ; Trichomonas* ; Vaginal Discharge ; Zinc Sulfate

In recent years, there has been a rapid decrease in amphibian populations worldwide, and infectious diseases have been associated with this decline. Diseased frogs inhabiting Korea were collected from fields, and the diseases were identified by morphological and molecular analyses. Two fungal diseases-saprolegniasis and chromomycosis-were detected in the frogs. Saprolegniasis caused by Saprolegnia spp. was found in Rana plancyi chosenica from Gangwon-do and Rana huanrenensis from Chungbuk. Chromomycosis, which is caused by infection with Cladosporium cladosporioides, was detected in Rana catesbeiana from Busan.
Amphibians ; Chromoblastomycosis ; Cladosporium ; Communicable Diseases ; Korea ; Rana catesbeiana ; Ranidae ; Saprolegnia

Malignant mixed mullerian tumor (MMMT) is rare and has pathologically carcinoma and sarcoma components. Among them, primary peritoneal MMMTs are extremely rare, and their proper treatment and prognosis are not well-known. We experienced a case of primary peritoneal origin MMMT, so we report it with a brief review of the literatures.
Peritoneum ; Prognosis ; Sarcoma

OBJECTIVE: Postoperative acute renal failure (PO-ARF) is an important cause of mortality among surgical patients. Although there have been many reports on PO-ARF after cardiac surgery and liver transplantation, less is known about the risk of PO-ARF after gynecologic operations. We aimed to investigate the risk of PO-ARF on gynecologic malignancy operations. METHODS: 1,155 patients' medical charts were reviewed who underwent therapeutic surgery for gynecologic malignancies from January 1, 2005 to December 31, 2007, at the Asan Medical Center, Seoul, Korea. RESULTS: Of these, 10 patients, comprising 0.89% of those who underwent radical hysterectomies and 0.86% of those who underwent debulking operations, were diagnosed with PO-ARF. Their mean age was 61.9+/-10.1 years. Five patients had preoperative risk factors. Mean operating time was 360.8+/-96.2 minutes. Five patients experienced intra-operative hypotension and all patients were given blood transfusions during surgery. Eight patients underwent hemodialysis, with two continuing on dialysis to date. Only two patients fully recovered. CONCLUSION: Patients undergoing surgery for gynecologic malignancies may be at high risk for PO-ARF, because of old age, long operation times, and profuse bleeding. It is necessary to monitor these patients for postoperative renal function and urine output. If a postoperative oliguric state is detected, aggressive volume expansion should be started immediately, followed by hemodialysis.
Acute Kidney Injury ; Blood Transfusion ; Dialysis ; Hemorrhage ; Humans ; Hypotension ; Hysterectomy ; Korea ; Liver Transplantation ; Organothiophosphorus Compounds ; Renal Dialysis ; Risk Factors ; Thoracic Surgery

OBJECTIVE: To provide clinical information for the best diagnosis and treatment of primary malignant cervical lymphoma based on the information obtained from these cases. METHODS: Between 1989 and 2006, six women with primary malignant cervical lymphoma were diagnosed and treated at our institution. Data were obtained from their medical records and were retrospectively analyzed. RESULTS: The mean patient age at the time of diagnosis was 63 (range 19-74). The chief complaint was vaginal bleeding in five women and the voiding difficulty for one woman. five of six patient had the cervical lesions (erosion and tumoral mass), while the other was non specific cervical findings. The Papanicolaou test was performed on three women, one of whom was HSIL. All six patients were confirmed with cervical lymphoma through the pathologic diagnosis. Surgical treatment (radical hysterectomy with bilateral salpingo- oophorectomy, pelvic lymph node dissection, and para-aortic lymph node dissection) was performed in one case, simple hysterectomy with complementary chemotherapy in two, and chemotherapy in one. Two patients refused treatment. Among four patients treated, one experienced recurrence in an ovary and the others have remained in remission. CONCLUSION: Primary malignant cervical lymphoma is a rare malignancy. Physicians can miss early detection of this disease because of its 'silent' symptoms and very low incidence. The accumulated data regarding this tumor can make it easy to detect at an early stage, thereby allowing it to be successfully treated. Further studies should be conducted to obtain further information regarding the cervical lymphoma.
Cervix Uteri ; Diagnosis ; Drug Therapy ; Female ; Humans ; Hysterectomy ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Lymphoma* ; Medical Records ; Ovariectomy ; Ovary ; Papanicolaou Test ; Recurrence ; Retrospective Studies ; Uterine Hemorrhage

Hyponatremia is a frequent condition of body fluid and electrolyte imbalance encountered in clinical practice. However, rhabdomyolysis has rarely been reported in association with hyponatremia. We experienced a 56-year-old woman who had developed symptomatic hyponatremia after prolonged nausea and subsequent rhabdomyolysis. Hyponatremia was probably mediated by hypersecretion of antidiuretic hormones.The woman had developed severe hypotonic hyponatremia with an alternation in mental status after suffering from severe nausea and vomiting for x months/years. She recovered with intensive supportive therapy, including hypertonic saline administration. One day after hospitalization, she complained of thigh pains; furthermore her serum creatine phosphokinase level had increased. She was treated with alkaline diuresis. Renal failure or compartment syndrome did not complicate the clinical course. The patient was discharged and returned to her normal daily activities. The possibility of rhabdomyolysis should be considered in patients with acute hyponatremia who have developed muscle pain.
Body Fluids ; Compartment Syndromes ; Creatine Kinase ; Diuresis ; Female ; Hospitalization ; Humans ; Hyponatremia* ; Middle Aged ; Myalgia ; Nausea ; Renal Insufficiency ; Rhabdomyolysis* ; Thigh ; Vomiting

A 15-year-old adolescent with unilateral multiple adrenal pheochromocytoma had an episode of subcortical intracerebral hemorrhage and seizure 6 weeks before the surgery. He was pretreated with terazosin, losartan, atenolol and levetiracetam for 2 weeks. Dexmedetomidine was started in the preoperative waiting area, and a combination of dexmedetomidine and remifentanil was continuously infused for most of anesthetic time. To control blood pressure, bolus injection of remifentanil and low-dose infusion of sodium nitroprusside, nicardipine, and esmolol were administered during three adrenergic crises. There was minimal post-resection hypotension, and his trachea was extubated safely 20 min after the surgery. He was discharged without noticeable complication. His catecholamine levels showed the steadily decreasing pattern during the operation in this case. Though a combination of dexmedetomidine and remifentanil may not prevent the hemodynamic instability impeccably during the tumor manipulation, this combination seems to be the way of interrupting release of catecholamines and minimizing hemodynamic fluctuations.
Adolescent ; Atenolol ; Blood Pressure ; Catecholamines ; Cerebral Hemorrhage ; Dexmedetomidine ; Hemodynamics ; Humans ; Hypotension ; Losartan ; Nicardipine ; Nitroprusside ; Pheochromocytoma ; Piperidines ; Piracetam ; Prazosin ; Propanolamines ; Seizures ; Trachea

BACKGROUND: Modified Diamond medium (MDM) supplemented with 10% heat-inactivated horse serum, streptomycin, penicillin G, and mycostatin is commonly used for the isolation of Trichomonas vaginalis from vaginal swab. But, judging from our experience, the above usual MDM antibiotic composition was frequently contaminated with facultative anaerobes, and isolation rate of T. vaginalis was no more than 12% in 142 korean woman patients whose chief complaints were foul odored, increased vaginal discharge. This isolation rate is low in comparison with reports of another countries including U.S.A (about 15~30%) and could be attributed to the prevalence of antibiotic resistance in Korea. So, we exploited more selective antibiotic compositions in modified Diamond medium for pure isolation of T. vaginalis. METHODS: We used new self-devised anaerobic pack for sample maintenance and tested several antibacterial and antifungal agent combinations in modified Diamond medium supplemented with 5% human erythrocyte lysate and 5% heat-inactivated human serum in the place of 10% horse serum with the object of increased and pure isolation of T. vaginalis. Several drugs and chemicals were tested to fourteen wild strains isolated in a local clinic, in the hope of finding the agents that have no effect on T. vaginalis growth in high drug concentrations. Anaerobic jar was used for culture of T. vaginalis and cell count performed in the improved Neubauer's haemocytometer. RESULTS: Strains of T. vaginalis grew batter in modified Diamond medium supplemented with 5% human erythrocyte lysate and 5% heat-inactivated human serum (mean 1.166X106, about 5.83 fold) than 10% horse serum (mean 2.0X105 after 48 hours culture), and their growth rate in the former was more rapid than the latter in early grow phase. On the basis of this results, we examined selectivity of modified Diamond media supplemented with several antibacterial and antifungal combinations by a double blind test. Isolation rate in the conventional modified Diamond's medium (combination A; 10% horse serum, streptomycin 1,200 microgram/mL, penicillin G 1,500 unit/mL, mycostatin 37.5 microgram/mL, pH 6.2) was 9/73 (12.3%) while in modified Diamond medium supplemented with 5% human erythrocyte lysate and 5% heat-inactivated human serum, isolation rates in various drug combinations were as follows; Combination B (cefazolin 100 microgram/mL, streptomycin 1,200 microgram/mL, clindamycin 150 microgram/mL, pH 6.5), combination C (bacitracin 14.6 unit/mL, streptomycin 1,200 microgram/mL, clindamycin 150 microgram/mL pH 6.5) and combination D (vancomycin 100 microgram/mL, streptomycin 1,200 microgram/mL, clindamycin 150 microgram/mL pH 6.5) were all 11/73 (15.0%). Combination D allowed the least bacterial growth rate. CONCLUSION: We consider that a new modified Diamond medium supplemented with 5% human erythrocyte lysate, 5% heat-inactivated human serum and combination D might be provide the highest selection for Trichomonas vaginalis pure isolation from vaginal swabs.
Cell Count ; Clindamycin ; Diamond ; Drug Combinations ; Drug Resistance, Microbial ; Erythrocytes ; Female ; Hope ; Horses ; Humans ; Hydrogen-Ion Concentration ; Korea ; Nystatin ; Odors ; Penicillin G ; Prevalence ; Streptomycin ; Trichomonas vaginalis* ; Trichomonas* ; Vaginal Discharge

PURPOSE: To determine whether rat eyes develop increases in intraocular pressure (IOP) in response to a topically applied corticosteroid and to investigate the relationship between ocular hypertension and apoptosis of retinal ganglion cells. METHODS: IOP was monitored by rebound tonometry in a group of 10 rats that received topically administered dexamethasone in both eyes (experimental) and in another group of 5 rats that received artificial tears (control) three times daily for 4 weeks after the establishment of baseline IOP values. Only eyes that increased by more than 50% compared with the basal IOP were administered once per day for 5 weeks. After 8 weeks, selective immunofluorescence stain for retinal ganglion cells and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) stain were conducted. RESULTS: Among 20 experimental eyes, 11 eyes (55%) showed a greater than 50% increase in IOP compared with basal IOP. After 8 weeks, the mean IOPs for the experimental and control groups were 11.8 +/- 1.4 mm Hg and 18.5 +/- 1.0 mm Hg, respectively (p < 0.01). The counts of central retinal ganglion cells (RGCs) were 2718 +/- 240 and 2612 +/- 443, respectively (p = 0.294). The results of the TUNEL stain also showed no differences. CONCLUSIONS: Rat eyes exhibit a steroid-induced ocular hypertensive response with no local complications. However, maintaining ocular hypertension increased by 50% for two months was not enough to detect changes in RGCs.
Animals ; Apoptosis ; Dexamethasone ; DNA Nucleotidylexotransferase ; Fluorescent Antibody Technique ; In Situ Nick-End Labeling ; Intraocular Pressure ; Manometry ; Mice* ; Ocular Hypertension* ; Ophthalmic Solutions ; Rats ; Retinal Ganglion Cells