The 56-kilodalton protein genes of Orientia tsutsugamushi TA678, TA686, TA716, TA763 strains were amplified by PCR. The amplified products were sequenced and cloned into pIH821 vector. The recombinant proteins were expressed in Escherichia coli as fusion proteins with maltose binding protein. The recombinant proteins were purified and used for the sensitization of sheep RBCs and the reactivity of the recombinant 56-kDa proteins of Orientia tsutsugamushi TA 678, TA686, TA716 strains were analyzed with 40 sera from scrub typhus patients in Korea, 40 sera from scrub typhus in Thailand, Malaysia and Philippines. The 56-kDa protein coding DNA sequence of Orientia tsutsugamushi TA678, TA686, TA716 show 70 to 88% homology with other known strains and four variable regions are also observed. 39 of 40 sera from scrub typhus patients in Korea showed the strongest reactivity to the recombinant protein of Boryong strain and one sera showed the strongest reactivity to the recombinant protein of Gilliam strain. 14 of 40 sera from patients in Thailand, Malaysia and Philippines showed the strongest reactivity to the recombinant protein of TA686 strain and 12 sera showed the strongest reactivity to the recombinant protein of TA716 strain. No serum from patients in Thailand, Malaysia and Philippines showed the strongest reactivity to the recombinant protein of Boryong strain.
Asian Continental Ancestry Group* ; Base Sequence ; Chungcheongnam-do ; Clinical Coding ; Clone Cells ; Cloning, Molecular* ; Escherichia coli ; Hemagglutination Tests* ; Hemagglutination* ; Humans ; Korea ; Malaysia ; Maltose-Binding Proteins ; Orientia tsutsugamushi* ; Philippines ; Polymerase Chain Reaction ; Recombinant Proteins ; Scrub Typhus ; Sheep ; Thailand

OBJECTIVES: Thyroid cancer patients may experience emotional distress during cancer treatment including surgical operation and radioactive iodine treatment. The aims of this prospective study were to investigate changes of anxiety and depressive symptoms in patients with differentiated thyroid cancer(DTC) under preoperative, postoperative and short-term hypothyroidism state. METHODS: Using the Hospital Anxiety and Depression scale(HAD) and the Distress Thermometer, we sequentially assessed the levels of anxiety, depression and distress in 41 DTC patients at 3 time points such as preoperative state, postoperative state and short-term hypothyroidism state. RESULTS: The HAD-anxiety score was significantly higher in preoperative state(6.93+/-3.97) than postoperative state(4.22+/-2.92) and short-term hypothyroidism state(4.93+/-3.64). Any other significant change in depression or distress thermometer score was not observed. Especially, difference of HADS score between the distress and none-distress groups was significant in preoperative state and post-operative state, but the difference become not significant in the short-term hypothyroidism state. CONCLUSIONS: Induced thyroid hormone deficiency during cancer treatment does not significantly affect emotional distress in patient with DTC. Anxiety and depression in these patients may be associated with distress of the patient before active cancer treatment.
Anxiety ; Dapsone ; Depression ; Humans ; Hypothyroidism ; Iodine ; Prospective Studies ; Thermometers ; Thyroid Gland ; Thyroid Neoplasms

Orientia tsutsugamushi is obligate intracellular bacterium that grows within the cytoplasm of the eukaryotic host cells. Therefore capability of the attachment, entry into the host cell and intracellular survival should be critical process for oriential infection. In this study we investigated the cellular invasion mechanism of Orientia tsutsugamushi and the role of transmembrane heparan sulfate proteoglycan, which binds diverse components at the cellular microenvironment and is implicated as host cell receptors for a variety of microbial pathogens. First of all Orientia tsutsugamushi can invade a wide range of nonprofessional phagocytic cells including fibroblast, epithelial cells a#nd endothelial cells of various host species, including B and T lymphocytes. Thus, it was postulated that the attachment of O. tsutsugamushi requires the recognition of ubiquitous surface structures of many kinds of host cells. Treatments with heparan sulfate and heparin inhibited the infection of Orientia tsutsugamushi in dose-dependent manner for L cell, mouse fibroblast, whereas other glycosaminoglycans such as chondroitin sulfate had no effect. Collectively, these findings provide strong evidence that initial interaction with heparan sulfate proteoglycan is required for the oriential invasion into host cells.
Animals ; Cellular Microenvironment ; Chondroitin Sulfates ; Cytoplasm ; Endothelial Cells ; Epithelial Cells ; Eukaryotic Cells* ; Fibroblasts ; Glycosaminoglycans ; Heparan Sulfate Proteoglycans ; Heparin ; Heparitin Sulfate ; Mice ; Orientia tsutsugamushi* ; Phagocytes ; T-Lymphocytes

BACKGROUND: Decision about life sustaining treatments ought to be based on the patient's informed preferences. This study was to see if there were any differences in acceptance by patients, their primary care givers and doctors for end-of-life care according to situations, and if any, to analyse the factors related with different attitudes. METHODS: A structured questionnaire survey of end-of-life care preferences was performed on 162 cancer patients and their primary care givers in four university hospitals and one general hospital from March 1, 1999 to February 29, 2000. A similar survey was done for doctors practicing at the above hospitals during the same period to investigate their attitudes toward providing end-of-life care to an assumed nearly bed-ridden patients. ANOVA, t-test and Wilcoxon rank sum test were used to compare acceptance of intervention among the groups or according to the various situations. Factors presumed to be related to the acceptance were sought and analysed by stepwise multiple regression. RESULTS: The difference in acceptance of intervention between the primary care giver group and the doctor group was not significant in almost every situation, showing significantly higher than the patient group (P<0.001). All three groups showed higher acceptance when a therapeutic intervention rather than a diagnostic test was proposed (P<0.001), when expected survival was 30 days rather than 7 (P<0.01), and when the therapeutic intervention was thought as non-invasive rather than invasive (P<0.001). The less anxious the patient was, the higher the acceptance from the patient. Patients with a religion had higher acceptance rate than non-religious patients. Primary care givers who expected cure of the disease accepted more of the postulated care than those who did not (P<0.05). Wives or mother-in-laws of patients showed lower acceptance than those in other relationship (P<0.05). The longer the patient had been diagnosed with cancer, the higher the acceptance of the primary care giver (P<0.1). Direct relatives showed higher acceptance than that of collaterals (P<0.1). Family doctors specializing in family medicine had lower acceptance than doctors of other specialties and interns (P<0.05). CONCLUSION: The acceptance of intervention by patients was lower than that of primary care givers and doctors and depended on the expected survival and the type of intervention.
Attitude to Death ; Diagnostic Tests, Routine ; Hospitals, General ; Hospitals, University ; Humans ; Palliative Care ; Primary Health Care* ; Spouses ; Surveys and Questionnaires

To understand the seroepidemiological patterns of haemorrhagic fever with renal syndrome in Korea, a nation-wide survey collaborated with fourteen clinics was carried out from 1994 to 1996. Sera of 4,547 patients with acute febrile episodes were tested by indirect immunofluorescent antibody test and the seroepidemiological analysis including sex, age, seasonal and regional distributions were performed. According to the results obtained in this study, the epidemiological characteristics of haemorrhagic fever with renal syndrome in Korea were summarized as follows: 1. Seropositive rate of hemorrhagic fever with renal syndrome among the patients with acute febrile episodes was 6.4% by the cut-off point of 1:40. 2. Among the seropositives, male outnumbered female and the ratio of males to females was 2.0:1.0. 3. Seventy six % of the seropositive patients were 21-60 years old. 4. The number of seropositive cases increased from October and reached maximum in December and began to decrease gradually from January. 5. The geographical distribution of the seropositives cover most areas including Cheju province in Korea.
Female ; Fever ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Jeju-do ; Korea* ; Male ; Seasons

PURPOSE: To make a focal trough (image layer) for an average maxillary dental arch of 6-year-old korean in panoramic radiography. MATERIALS AND METHODS: Phantom for the maxillary dental arch was designed using intercanine width, intermolar width, tooth size, and interdental spacing to record the data of 6-year-old child. The characteristics of pre-corrected panoramic machine (for adult) was evaluated using the phantom, resolution test pattern for margin of the image layer, and metal ball for the center of the image layer. Panoramic image layer of the child was developed by means of decreasing the speed of film-cassette and positioning the phantom backwards, and then the characteristics of post-corrected panoramic machine (for child) were reevaluated. RESULTS: At post-corrected panoramic image layer, beam projection angles at all interdental areas increased for about 2.6-3.8 degrees, the position of the image layer was shifted toward the rotation center for about 2.5 mm at the deciduous central incisior area. The width of image layer decreased at all areas. CONCLUSION: Increased beam projection angle will reduce the disadvantage of tooth overlap, and the same form between the center of the image layer and dental arch will improve image resolution.
Child* ; Dental Arch ; Humans ; Radiography, Panoramic ; Tooth

BACKGROUND: Pneumoperitoneum for a gynecologic laparoscopic surgery induces hemodynamic changes. We evaluated the effects of nicardipine on induction, maintenance, and recovery. METHODS: Thirty patients scheduled for gynecologic laparoscopic surgery were randomly allocated to two groups: control group (placebo group, n = 15), group N (nicardipine group, 10 microgram/kg followed by 0.5-2.0 microgram/kg/min). The systolic arterial pressure, mean arterial pressure, and heart rate were measured at preinduction, induction, intubation and 5, 10, 15, 20 min after insufflation. Loss of consciousness, induction dose, effective site concentration, propofol maintenance dose (the maintenance dose of propofol from intubation to end of anesthesia, PMD) were also measured. Propofol was titrated to maintain a bispectal index value of 40-60. RESULTS: There was a significant difference in PMD between two groups. The PMD of group N was significantaly less than group C. Nicardipine adminstration attenuated increase in the blood pressure, but did not affect on heart rates during CO2 insufflation. CONCLUSIONS: Co-administration of nicardipine was effective in attenuating the hemodynamic changes after pneumoperitoneum during gynecologic laparoscopic surgery, without changes of induction and recovery.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Insufflation ; Intubation ; Laparoscopy* ; Nicardipine* ; Pneumoperitoneum ; Propofol ; Unconsciousness

BACKGROUND/AIMS: Telemedicine is a convenient and efficient tool for remote education in various fields. The telemedicine system can also be used to educate doctors and medical students. The aim of our study was to establish the effectiveness of the telemedical system for use in a live endoscopic multichannel demonstration conference and to test the effectiveness and usefulness of a multicenter-based live endoscopic demonstration through live, interactive, high resolution video transmission using advanced networks and the digital video transport system (DVTS). METHODS: This study is a prospective multicenter pilot study. A live demonstration of an endoscopic submucosal dissection (ESD) and an endoscopic retrograde cholangiopancreatography (ERCP) using advanced network technology was performed. RESULTS: The DVTS successfully transmitted uncompressed, high-resolution, digital lectures with endoscopy video during a multichannel endoscopic live demonstration of ESD and ERCP over multiple advanced networks. The overall satisfaction rating when the endoscopic lecture demonstration was performed by combining DVTS was generally good. CONCLUSIONS: We believe that a multicenter-based live endoscopic demonstration is a very effective conferencing method when using advanced networks and DVTS.
Cholangiopancreatography, Endoscopic Retrograde ; Endoscopy ; Humans ; International Educational Exchange ; Internet ; Lectures ; Pilot Projects ; Prospective Studies ; Students, Medical ; Telemedicine

OBJECTIVE: Actinomycosis is a rare entity, especially in the female genital tract, which presents some difficulties in establishing a correct preoperative diagnosis. Pelvic actinomycosis can mimick pelvic or intra- abdominal malignancy leading to mutilating surgical exercise. The authors surveyed 12 cases of pelvic actinomycosis for advice to detection and treatment of the pelvic actinomycosis. METHODS: The authors studied retrospectively 12 cases which have admitted to Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center for pelvic actinomycosis from January. 1, 1991 to December. 31, 2000. RESULTS: 41.7% of the cases occurred in 31-40 years age group, 91.7% of cases associated with intrauterine devices for 5-21 years. Most common complaints were abdominal pain and palpable mass, and other complaints were vaginal discharge, bowel habit change, nausea, vomiting and fever. The actinomycosis lesions involved one or both ovaries in all 12 cases. In 11 cases, the lesions extended to other areas, such as the uterus, parametrium, pelvic walls, cul-de-sac, colon and bladder. All patients underwent surgery that included removal of the lesions with ipsilateral or bilateral adnexa and, in specific cases, with extension of the lesions, hysterectomy, colostomy and primary repair of bladder or rectum. After surgery, 9 patients were treated with penicillin and the duration of treatment was 12 months in 2 patients, 6 months in 3, < or = 3 months in 3 and one patient was being treated for 2 months. Other 3 patients were treated with metronidazole, cephalosporin and aminoglycoside during 1-3 weeks. All patients were alive and well. CONCLUSION: It is needed to make an earlier and more correct diagnosis of actinomycosis, and high-dose intravenous antibiotic therapy can reduce the risk of nearby pelvic structure injuries. In cases of pelvic actinomycosis where the abscess can be completely resectable, a shorter period of antibiotic therapy can be required.
Abdominal Pain ; Abscess ; Actinomycosis* ; Chungcheongnam-do ; Colon ; Colostomy ; Diagnosis ; Female ; Fever ; Gynecology ; Humans ; Hysterectomy ; Intrauterine Devices ; Metronidazole ; Nausea ; Obstetrics ; Ovary ; Penicillins ; Rectum ; Retrospective Studies ; Ulsan ; Urinary Bladder ; Uterus ; Vaginal Discharge ; Vomiting

A thymic carcinoma is a rare malignant neoplasm of the thymus epithelium, which can be distinguished from a benign or invasive thymoma. Contrary to a thymoma, the association of a thymic carcinoma and autoimmune disease is rare, with only a few cases having been reported. Herein, a case of thymic carcinoma diagnosed concurrently with systemic lupus erythematosus (SLE) is reported. A 49 year-old man presented at our clinic with myalgia. He was diagnosed with SLE, based on an oral ulcer, lymphopenia, and positive ANA and anti-Sm antibodies. Incidentally, a routine chest X-ray showed a large mediastinal mass. Pathological examination of the mediastinal mass revealed an undifferentiated thymic carcinoma, of WHO classification type C. Further work-up for staging showed multiple bone and lung metastases. With a palliative aim, he received systemic chemotherapy, but refused further chemotherapy after the 2nd course. Currently, the patient has not been followed up since the chemotherapy.
Antibodies ; Autoimmune Diseases ; Classification ; Drug Therapy ; Epithelium ; Humans ; Lung ; Lupus Erythematosus, Systemic* ; Lymphopenia ; Middle Aged ; Myalgia ; Neoplasm Metastasis ; Oral Ulcer ; Thorax ; Thymoma* ; Thymus Gland