To study the gyrA mutations of E. coli from clinical specimens, 410 strains were isolated from 1994 to 1997 in Kyungpook National Vniversity hospital. Antimicrobial susceptibility tests, PCR and sequencing of gyrA, and in vitro induction of quinolone resistance were done. The frequency of quinolone resistant E. coli strains increased constantly during 1994 through 1996. Quinolone-resistant strains were more often resistant to unrelated antibiotics than quinolone-susceptible strains (chi-square test, p<0.05). All of the randomly selected 55 quinolone- resist#ant strains were highly resistant to nalidixic acid (NAL) but had low level resistance to fluoroquinolones. All of the 55 quinolone-resistant strains showed an amino acid substitution of Ser -> Leu (TCG -> TIG) at codon 83. In addition, four different types of amino acid substitution affecting codon 87 (Asp) were detected, 1) type I: Asn (GAC -> AAC); 2) type II: Tyr (GAC -> TAC); 3) type III: Oly (GAC -> GGC); 4) type IV: His (GAC -> CAC). The mutation of type IV has not been reported previously in quinolone-resistant E. coli strains. It is thought that the specific amino acid substitution probably affects minimum inhibitory concentrations (MIC) of quinolones because the MICs of ciprofloxacin, norfloxacin, and ofloxacin in type II were significantly higher than those of type I. By in vitro induction, MICs to quinolone-susceptible strains resulted in the increase in the MICs of all quinolones tested by 2- to 2048-fold. The induced mutants by quinolones had amino acid substitutions at codon 83, SerLeu or Asp87Asn, Gly or Tyr. Alteration of Ser83 results in the most effective increase in the MIC of quinolone such as NAL and alterations of Asp87 result in the effective increase of MIC of fluoroquinolone. These results suggest that the continuous use of quinolones might induce the specific amino acid substitution at gyrA.
Amino Acid Substitution ; Anti-Bacterial Agents ; Ciprofloxacin ; Codon ; Escherichia coli* ; Escherichia* ; Fluoroquinolones ; Gyeongsangbuk-do ; Microbial Sensitivity Tests ; Nalidixic Acid ; Norfloxacin ; Ofloxacin ; Polymerase Chain Reaction ; Quinolones

No abstract available.
Arthroplasty* ; Knee* ; Reoperation*

No abstract available.

Ganglioneruroblastoma and neuroblastoma are among commonest types of childhood malignancy and a number of unique paraneoplastic syndromes have associated with both localized and disseminated neuroblastoma. The coincidence of neuroblastoma and myoclonic encephalopathy or other paraneoplastic syndromes occurs relatively rare, and therefore, failure to recognize this association could result in delays in both diagnosis and treatment, and the result could prove to be unfortunately fatal. The mechanism which underlies the remote damaging effect of neural crest tumor, especially neuroblastoma, on the nervous system resulting in myoclonic encephalopathy is by no means clear. In addition the nature and the extent of the pathologic lesion are inconsistent. We experienced a case of myoclonic encephalopathy associated with an occult mediastinal ganglioneuroblastoma in a 22-month-old girl who was hospitalized for inability to walk without support and tilting of the head to the left side. She became increasingly ataxic, and during the hospitalization myoclonic jerks of upper extremities and head along with chaotic, rapidly flickering, multidirectional spontaneous eye movements, were noted. Laboratory data included normal complete blood count, urinalysis, BUN and creatinine, electrolytes and bone marrow. Chest X-ray and chest CT revealed a relatively well marginated right posterior mediastinal mass. In a 24 hours urine excretion test, VMA and catecholamines were increased. Over the next 2 weeks, a surgical exploration revealed a right posterior mediastinal mass. Microscopically the mass proved to be a ganglioneuroblastoma, extending to right innominate artery and right axillary lymph nodes. Within 2 weeks after the surgery, radiotherapy (2,400 rads) and chemotherapy (CTX, DTIC, VCR) were started, but corticosteroid was not used. She has been free of tumor and abnormal neurological systemic symptoms and signs for 1 1/2 year since the completion of chemotherapy. In the 3 1/2 years follow-up period, her neurologic symptoms has completely resolved by the completion of 2 years chemotherapy. We report a case of mycoclonic encephalopathy associated with hidden ganglioneuroblastoma in 22-month-old girl.
Blood Cell Count ; Bone Marrow ; Brachiocephalic Trunk ; Catecholamines ; Creatinine ; Dacarbazine ; Diagnosis ; Drug Therapy ; Electrolytes ; Epilepsies, Myoclonic* ; Eye Movements ; Female ; Follow-Up Studies ; Ganglioneuroblastoma* ; Head ; Hospitalization ; Humans ; Infant ; Lymph Nodes ; Myoclonus ; Nervous System ; Neural Crest ; Neuroblastoma ; Neurologic Manifestations ; Paraneoplastic Syndromes* ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed ; Upper Extremity ; Urinalysis

Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain.
Administration, Topical ; Anesthesia* ; Anesthesia, Local ; Anesthetics ; Benzocaine ; Child ; Dental Anxiety ; Dentistry ; Dentists ; Gels ; Humans ; Hypersensitivity ; Lidocaine ; Peripheral Nerves ; Reflex ; Sensation ; Stomatitis ; Vomiting

No abstract available.
Child* ; Humans ; Leukemia*

Conjugative R plasmids derived from 74 clinical isolates of Serratia marcescens were epidemiologically analyzed for antimicrobial resistance, EcoRI restriction endonuclease analysis and Southern hybridization with DHFR, TEM and SHV probe. 1. Resistance frequency of isolates against various B-lactam antibiotics was changed by year. 2. Twenty (27%) resistant strains transferred 32 R plasmids to E. coli or Klebsiella by mixed culture. Most strains isolated from 1994 to 1996 transferred only trimethoprim resistance but most strains isolated from 1997 did resistances against gentamicin (Gm) and B-lactams including ampicillin (Ap), carbenicillin (Cb), cefazolin (Cz), cefaloridine (Cl), cefamandole (Cn). 3. Ten plasmids of GmApCbCzC1Cn or GmApCbCzC1 pattern and 3 plasmids of TcSuGmTbApCbCzC1 pattern respectively showed identical EcoRI restriction endonuclease digestion patterns and hybridized fragment patterns with TEM-1 probe by Southern hybridization. These results indicate that the epidemic plasmids carrying blamM gene were present in this hospital in 1997 and molecular genetic analysis of R plasmids can be used to discriminate S. marcescens isolates for epidemiologic studies.
Ampicillin ; Anti-Bacterial Agents ; Carbenicillin ; Cefamandole ; Cefazolin ; Cephaloridine ; Digestion ; DNA Restriction Enzymes ; Epidemiologic Studies ; Epidemiology* ; Gentamicins ; Klebsiella ; Molecular Biology ; Plasmids ; R Factors ; Serratia marcescens* ; Serratia* ; Trimethoprim Resistance

Ninety-two strains of Serratia marcescens isolated from 5 hospitals were analyzed for plasmid profile, antimicrobial drug resistance pattern, biotyping, and production of pigment. Ninety-three percents of strains were resistant to chloramphenicol (Cm), tetracycline (Tc), sulfisoxazole (Su), cefazolin (Cz), ampicillin (Ap), and rifampin (Rf). A majority of strains were susceptible to amikacin (Ak), ciprofloxacin (Ci), and cefotaxim (Ct). Fifty-four resistance patterns were found in 94 strains and the most prevalent resistance pattern was CmTcSuApCzRf. Seventeen (17.4%) isolates could transfer their partial resistance to E. coli or Klebsiella pneumoniae by conjugation. Twenty-seven plasmid profiles in 54 strains (58.7%) were detected, however no predominant patterns were seen in isolates from each hospital. Eleven biotypes were detected. The common types were A3b (29.4%) and A8b (27.1%), predominant types were found in each hospital. Twenty strains from 4 of 5 hospitals showed consistence of 3 types. These results indicate that plasmid profile analysis, Grimont biotyping, and resistance pattern type of strains in combination are useful as an epidemiological tool for S. marcescens isolates and some of isolates were confirmed as nosocomial strains.
Amikacin ; Ampicillin ; Cefazolin ; Cefotaxime ; Chloramphenicol ; Ciprofloxacin ; Drug Resistance, Microbial ; Epidemiologic Studies* ; Klebsiella pneumoniae ; Plasmids ; Rifampin ; Serratia marcescens* ; Serratia* ; Sulfisoxazole ; Tetracycline

Eighty-nine isolates of Enterobacter spp. from two university hospitals were analyzed by phenotypic and genotypic characteristics for epidemiologic investigation. Most strains were isolated from sputum, urine, wound, pus and catheter tip. Most isolates of Enterobacter spp. were resistant to ampicillin, cefazolin and cefoxitin and 39% of E. cloacae isolates were also resistant to other cephalosporins and aminoglycoside antibiotics except amikacin but all strains were highly susceptible to imipenem and ciprofloxacin. Twenty-six antimicrobial resistance patterns were obtained from E. clacae, but E. aerogenes showed only 4 patterns. Fourty-two plasmid profiles were identified, but plasmid was not detected from 28.4% of E. cloacae and 58% of E. aerogenes. Six biotypes from E. cloacae and three biotypes from E. aerogenes were obtained by carbohydrate metabolism. Fourteen strains of E. cloacae carried conjugative R plasmids and these plasmids were further analyzed. Among them, ten plasmids showed identical antibiogram, molecular weight, and pI value by isoelectric focusing and nearly identical restriction endonuclease fragment pattern. Their parental strains had identical antibiogram, biotype, plasmid profile, and were isolated from 4 different specimens including 6 catheter tips of different patients. But most clinical isolates showed various types of combination and seemed to be different strains. These results indicate that the epidemic strain were present in this hospital and the combination of antibiogram and plasmid analysis can be used to discriminate the epidemic strains of multi-resistant E. cloacae.
Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Carbohydrate Metabolism ; Catheters ; Cefazolin ; Cefoxitin ; Cephalosporins ; Ciprofloxacin ; Cloaca ; DNA Restriction Enzymes ; Enterobacter* ; Hospitals, University ; Humans ; Imipenem ; Isoelectric Focusing ; Microbial Sensitivity Tests ; Molecular Weight ; Parents ; Plasmids ; R Factors ; Sputum ; Suppuration ; Wounds and Injuries

One hundred of clinical isolates of Klebsiella spp. from three hospitals were analyzed by phenotypic and genotypic characteristics for epidemiologic investigation. Almost all isolates of Klebsiella spp. showed highly resistance to ampicillin, and carbenicillin and 4.5-7.9% of K. pneumoniae isolates were also resistant to cefotaxime and ceftazidime, and 10-15% to aminoglycoside antibiotics except amikacin. However, all strains were highly susceptible to imipenem, cefotetan, amikacin and ciprofloxacin. All Koxytoca strains were susceptible to antimicrobials tested except Ap, Am and Cb. Twelve strains of K. pneumoniae hybridized with TEM or SHV probe and extended spectrum B-lactamases from 7 strains were TEM type. Eleven conjugative R plasmids and their parental strains were analyzed. Among them, three couples of plasmids showed identical or nearly identical resistance phenotypes of B-lactams and aminoglycosides, molecular weights, and pI values by isoelectric focusing, and hybridized fragment patterns with TEM probe by Southern hybridization, EcoR1 restriction endonuclease fragment patterns. Their parental strains were isolated from sputum, tissue, and ascites of patients and had similar characteristics. These results indicate that the epidemic strains or epidemic plasmids were present in this hospital and antimicrobial resistance anlysis can be used to discriminate clinical isolates of multi-resistant K. pneumoniae.
Amikacin ; Aminoglycosides ; Ampicillin ; Anti-Bacterial Agents ; Ascites ; Carbenicillin ; Cefotaxime ; Cefotetan ; Ceftazidime ; Ciprofloxacin ; DNA Restriction Enzymes ; Epidemiology* ; Family Characteristics ; Humans ; Imipenem ; Isoelectric Focusing ; Klebsiella* ; Molecular Weight ; Parents ; Phenotype ; Plasmids ; Pneumonia ; R Factors ; Sputum