BACKGROUND: During a 1-month period in 2005 , a series of 4 Leclercia adecarboxylata and 8 Pseudomonas aeruginosa bacteremias were reported from patients admitted to the emergency room. METHODS: An outbreak of L. adecarboxylata and P. aeruginosa bacteremia that occurred from February to March 2005 was investigated. The infection control nurse reviewed medical records and observed the procedures of blood cultures at the clinical microbiology laboratory. Specimens were obtained for investigational cultures from alcohol sponge, tray, sink, water of sink, saline cotton, microscope, computer, and telephone. RESULTS: L. adecarboxylata was isolated from 4 patients and P. aeruginosa from 8 patients during a 1-month period. Observation of the culture procedure revealed that saline cotton was used to prevent betadin skin discoloration. The culture of the saline solution yielded a heavy growth of P. aeruginosa, which was not isolated from any other specimens. CONCLUSIONS: This was a pseudoepidemic caused by contaminated saline cotton. The use of the saline cotton was stopped, and during the follow-up period of 3 months, no additional L. adecarboxylata or P. aeruginosa bacteremia were reported.
Bacteremia ; Emergency Service, Hospital ; Enterobacteriaceae* ; Follow-Up Studies ; Humans ; Infection Control ; Medical Records ; Porifera ; Pseudomonas aeruginosa ; Skin ; Sodium Chloride ; Telephone ; Water

No abstract available.
Autonomic Pathways ; Diabetes Mellitus ; Gastroesophageal Reflux

No abstract available.

BACKGROUND/AIMS: Patients with type II diabetes mellitus (DM) were known to have higher prevalence of gastroesophageal reflux disease (GERD). Recent studies have shown that neuropathy has positive role on the development of GERD in type II DM, although its pathogenesis has not been fully understood yet. The aim of this study was to investigate whether neuropathy really contribute to the development of GERD and typical GERD symptoms in patients with type II DM in Korea. METHODS: One hundred and nineteen patients with type II DM who had given informed consents were enrolled. All patients underwent electromyography to check the presence of peripheral neuropathy, face-to-face interview to evaluate their typical GERD symptoms and esophagogastroduodenoscopy to look for the presence of erosive esophagitis. Ninety-five patients were finally included for this study and they were divided according to the presence or absence of the peripheral neuropathy. RESULTS: The mean age of 95 patients was 59.3 +/- 9.1 years and the mean disease duration of DM was 9.3 +/- 5.9 years. Typical GERD symptoms were similarly found in both groups with and without peripheral neuropathy (23.6% vs 22.8%, P = 0.921). Erosive esophagitis was more prevalent in patients with neuropathy than in those without neuropathy (31.5% vs 10.5%, P = 0.022). CONCLUSIONS: In patients with type II DM, peripheral neuropathy is an independent risk factor for the erosive esophagitis. However, peripheral neuropathy did not contribute to the presence of the typical GERD symptoms.
Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Electromyography ; Endoscopy, Digestive System ; Esophagitis ; Gastroesophageal Reflux ; Humans ; Peripheral Nervous System Diseases ; Prevalence ; Risk Factors

A congenital coronary artery fistula is a rare condition, which is an abnormal communication of the coronary artery with the ventricles or atriums or the pulmonary artery. A case of 69 year-old man, complaining of recent aggravating chest pain for 5 months is reported. The coronary angiography shows coronary artery-pulmonary artery fistula. Multidetector row CT shows coronary artery-pulmonary artery fistula combined with aortopulmonary fistula via common channel and the fistulas were surgically ligated.
Aged ; Arteries* ; Chest Pain ; Coronary Angiography* ; Coronary Vessels ; Fistula* ; Humans ; Pulmonary Artery

BACKGROUND/AIMS: Important lesions related to gastroesophageal reflux disease (GERD) are located around the gastroesophageal junction (GEJ). This study examined the distribution of endoscopic findings around the GEJ and elucidated their relationship to each other and esophageal manometric features. METHODS: Endoscopic data were collected prospectively from 2,450 consecutive diagnostic upper gastrointestinal endoscopies. The presence and degree of hiatal hernia (HH), columnar-lined esophagus (CLE), and reflux esophagitis (RE) were recorded. Esophageal manometric data were collected from 181 patients. RESULTS: The prevalence of HH, CLE, and RE was 9.8, 18.8, and 9.9%, respectively. Of all HH and CLE cases, 62.8 and 98.9%, respectively, were of the short-segment variety. Of all RE cases, 95.0% were mild. Younger age, male gender, the presence of HH, and a higher gastroesophageal flap valve (GEFV) grades were associated with the presence of RE. Increased ZAP grades were associated with increased prevalence and grades of HH, CLE, and RE. Higher GEFV grades were associated with increased prevalence and grades of HH, CLE, and RE. Lower esophageal sphincter pressure (LESP) decreased in patients with HH or RE compared to those without HH or RE. CONCLUSIONS: Endoscopic findings around the GEJ revealed that a substantial proportion of our patients showed features potentially related to GERD. In combination with other recent reports, our study implies that Korea is no longer a very-low-prevalence area of GERD, although it may predominate in silent or milder forms.
*Endoscopy, Gastrointestinal ; Esophageal Sphincter, Lower ; Esophagogastric Junction/*pathology ; Female ; Gastroesophageal Reflux/epidemiology/*pathology ; Hernia, Hiatal ; Humans ; Korea/epidemiology ; Male ; Manometry/instrumentation ; Middle Aged ; Prevalence ; Prospective Studies

Hand-foot syndrome (HFS) is a well-known adverse event associated with capecitabine, a prodrug of 5-Fluorouracil (5-FU). HFS manifests as acral erythema, with swelling and dysesthesia of the palms and plantar aspects of the feet, which in the absence of dosage reduction or drug cessation, progresses to moist desquamation and ulceration, resulting in serious infections and loss of function. We report a case of HFS, with scleroderma-like changes, apparently induced by capecitabine. In our case, capecitabine, given in the recommended dosage was observed to lead to hyperpigmentation of the palms and soles, followed by a distinct keratoderma-like thickening unfamiliar to usual cases of HFS. This case may provide important clues for revising the definition of HFS, and allow the formation of effective preventive strategies for this side effect of chemotherapy.
Administration, Oral ; Aged ; Antimetabolites, Antineoplastic/administration & dosage/*adverse effects ; Deoxycytidine/administration & dosage/adverse effects/*analogs & derivatives ; Fluorouracil/administration & dosage/adverse effects/*analogs & derivatives ; Foot Dermatoses/*chemically induced/diagnosis ; Hand Dermatoses/*chemically induced/diagnosis ; Humans ; Male ; Risk Factors ; Scleroderma, Localized/*chemically induced/diagnosis

Gastric cancer patients with severe liver dysfunction secondary to hepatic metastases have limited treatment options. Most cytotoxic drugs have a narrow therapeutic index. Although both capecitabine and oxaliplatin have been well tolerated as single agents for patients with severe hepatic dysfunction, the combination of these drugs has not been investigated. We report here on a case of successful treatment of a patient suffering with severe liver dysfunction and metastatic gastric cancer; the patient was treated with a combination of capecitabine and oxaliplatin (XELOX). The initial bilirubin level of the patient was 10.9 mg/dL. After two cycles of treatment, his bilirubin level decreased to 2.1 mg/dL. He has experienced an excellent radiological response and he has received six cycles of XELOX chemotherapy. XELOX chemotherapy is feasible and it can be associated with positive outcomes for the patients suffering with metastatic gastric cancer and severe liver dysfunction.
Stomach Neoplasms/complications/*pathology/surgery ; Prodrugs ; Organoplatinum Compounds/*therapeutic use ; Middle Aged ; Male ; Liver Neoplasms/complications/*drug therapy/secondary ; Liver Function Tests ; Liver Failure/diagnosis/drug therapy/*etiology ; Humans ; Gastrectomy ; Follow-Up Studies ; Fluorouracil/*analogs & derivatives/therapeutic use ; Drug Therapy, Combination ; Deoxycytidine/*analogs & derivatives/therapeutic use ; Antineoplastic Agents/*therapeutic use ; Adenocarcinoma/complications/secondary/*therapy

BACKGROUDN: To evaluate the activity and safety of docetaxel and cisplatin for advanced gastric cancer as a first-line chemotherapy treatment. METHODS: Between December 2001 and February 2006, forty-two patients with recurrent or metastatic gastric cancer were enrolled. Docetaxel (75 mg/m2) was administered as a 1-hour intravenous infusion on day 1 and cisplatin (60 mg/m2) was also administered as a 30-minute intravenous infusion on day 1 every three weeks until disease progression or severe toxicity was detected. The response was assessed every 2 cycles. The toxicities were evaluated for every course of chemotherapy according to NCI toxicity criteria. RESULTS: The median age of the patients was 66 (range, 33~77) years. Among the forty-two patients, 38 were male. Twenty-seven patients had an Eastern Cooperative Oncology Group performance score of 0 or 1 and fifteen patients had a score of 2. All patients had adenocarcinoma. Thirty-three of the forty-two patients were assessable for response. Partial responses were observed in 14 patients. The overall response rate was 42.4% (95% C.I., 25.259.6%) and the median response duration was 5.7 (range, 1.4~17.2) months. The median overall survival of all patients was 8.1 (range, 1.2~47.0) months. During a total of 170 cycles, granulocytopenia worse than National Cancer Institute toxicity grade 3 occurred in 7.6% of the patients, thrombocytopenia in 0.6% and anemia in 3.5%, respectively. No deaths resulting from toxicity were observed. Non-hematologic toxicities were minor and were easily controlled. CONCLUSION: Combination chemotherapy with docetaxel and cisplatin has a tolerable efficacy with acceptable toxicities in patients with advanced gastric cancer as a first-line treatment.
Adenocarcinoma ; Agranulocytosis ; Anemia ; Cisplatin* ; Disease Progression ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Infusions, Intravenous ; Male ; National Cancer Institute (U.S.) ; Stomach Neoplasms* ; Thrombocytopenia