The glucose nonfermenting gram-negative bacilli encountered about 10% of all gram-negative bacilli isolated from clinical material. Therefore, a rapid and correct identification of glucose nonfermenting gram-negative bacilli is impotent for a better management of infectious disease. There are many conventional systems for the identification of glucose nonfermenting gram-negative bacilli but most of them have problems and difficulties. Commercial Kit Systems exist and they are too expensive for daily use in Korea because of high cost. Based on 12 selected tests we propose a new code system, MCRCODE-N for rapid and inexpensive identification of glucose nonfermenting gram-negative bacilli. The selective 12 tests are oxidase, glucose oxidation motihty, urease, DNase arginine dehydrolase, nitrate reduction, gelatin Liquefaction, esculin hydrolysis, mannitol oxidation, maltose oxidation, Lactose oxidation. The 12 tests are divided 4 group and then each group has 3 tests. The result of each group is expressed by the number as below. The positive test is given by specific number (1st test=1, 2nd test=2, 3rd test=4), while any negative result is 0. Each 3 numbers of one group are added and make number of 1 digit. Four digit number is referred to the code book of MCRCODE-N system or MCRCODE system using computer (Apple-II model) created by authors. This MCRCODE-N system is suitable ones for out use in Korea. We propose the MCRCODE-N system for clinical use.
Arginine ; Clinical Coding* ; Communicable Diseases ; Deoxyribonucleases ; Esculin ; Gelatin ; Glucose Oxidase ; Glucose* ; Hydrolysis ; Korea ; Lactose ; Maltose ; Mannitol ; Urease

Granular cell tumor(GCT) has been identified in all organ systems, most often in the oral cavity and subcutaneous tissue. GCT of the esophagus has been considered rare. However, this neoplasm is being recognized with increased frequency since the use of fiberoptic endoscopy has become widespread. We report 5 cases of granular cell tumors involving the esophagus, all of which were incidentally found. Four additional cases of GCT which appeared in the Korean literature were reviewed.
Endoscopy ; Esophagus* ; Granular Cell Tumor* ; Mouth ; Subcutaneous Tissue

Solitary osseous plasmacytoma accounts for 3-5% of plasma cell tumor and are assumed to have a fairly good prognosis, with long duration of relapse free survival after local irradiation. A 64 year old woman with a lytic lesion involving left iliac bone was diagnosed as a solitary plasmacytoma, with a negative work-up for coexisting plasma cell disorders. Three months after irradiation of 5,400 cGy, the patient was readmitted with hypercalcemia and mass in left forehead and left gingiva. New multiple osteolytic lesions were developed. A aspiration cytology of forehead mass and curetted specimen of right femur due to pathologic fracture revealed plasmacytoma. MRI of thoracolumbar spine revealed abnormal high signal intensity in the L2 body, T8 and T9 vertebrae. Serum protein electropheresis revealed monoclonal gammopathy of IgG-kappa type. This aggressive case of solitary plasmacytoma, evolving into multiple myeloma after brief duration of remission, is in sharp contrast with the natural course of a solitary plasmacytoma.
Female ; Femur ; Forehead ; Fractures, Spontaneous ; Gingiva ; Humans ; Hypercalcemia ; Magnetic Resonance Imaging ; Middle Aged ; Multiple Myeloma* ; Paraproteinemias ; Plasma Cells ; Plasmacytoma* ; Prognosis ; Radiotherapy ; Recurrence ; Spine

A 54 year-old woman presented with bilateral fatigable blepharoptosis with diurnal fluctuation and diplopia for 10 days. She had a 3 year history of hypertension and showed symptoms of bilateral ptosis, supranuclear upward gaze palsy, and vertical diplopia with the pupils promptly constricting to light. Bell's phenomenon and vertical oculocephalic responses were intact but an impaired convergence was noted in both eyes. A intramuscular neostigmine test was negative. T1 and T2-wighted MRI of the brain showed a small round high signal intensity lesion in the periaqueductal gray (PAG) region. Therefore, she was diagnosed with a midbrain ptosis due to midbrain hemorrhage. The PAG lesion was suggested as contributing to the fatigable blepharoptosis and supranuclear upward gaze palsy in the patient. We recommend that patients with clinical features of myasthenia limited to the ocular muscles and, having risk factors for cerebrovascular disease, be thoroughly evaluated for intracranial lesions if warranted.
Blepharoptosis ; Brain ; Diplopia ; Female ; Hemorrhage* ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Mesencephalon* ; Middle Aged ; Muscles ; Neostigmine ; Paralysis ; Periaqueductal Gray ; Pupil ; Risk Factors

BACKGROUND: Alzhiemeranjx disease (AD) and vascular dementia (VD) are common types of dementia. As a result of the development of new specific agents for AD, and because vascular dementia is a potentially preventable dementia, differentiating these diseases is of great importance. The role of EEG spectral analysis in the differential diagnosis between Alzheimer type and vascular dementia is still controversial. Since there have been few studies concerning the differential diagnosis of dementia by EEG, the present study has focused on this aspect. Usefulness of EEG in differen-tial diagnosis of dementia will be elucidated by clarifying relationship between type of dementia and spectral profile of EEG. METHODS: We analyzed the power spectra taken from 16 derivations and spectral profile was constructed by averaging twenty 2 sec epochs in three study groups (normal controls, AD and VD). Spectral profile was divided into three groups; (I) type A, showing a dominant 6.5-12 Hz peak (ii) type B, lacking a dominant peak in the 6.5-12 Hz (iii) type C, corresponding to a flat, low voltage, spectrum. To elucidate the relationship between spectral profile and other factors including diagnosis, statistical test was done. RESULTS: (1) In AD, type C profile was statistically more prevalent than in VD and type A profile was reversed. (2) In AD, Mini-Mental State Examination (MMSE) score was statistically lower in type C profile. (3) Spectral profile was not associated with age, age of symptom onset, and symptom duration. CONCLUSIONS: This study suggested that spectral profile is a useful tool for the differential diagnosis of dementia (AD and VD) and correlated with the severity of disease in AD.
Dementia ; Dementia, Vascular* ; Diagnosis ; Diagnosis, Differential* ; Electroencephalography*

In leprosy, it is generally believed that the defense against Mycobacterium leprae (M. leprae) is largely dependent on cell-mediated immunity (CMI) and there is an accumulating evidence that the patients with lepromatous leprosy have not only defective CMI specific for M. leprae, but also have generalized impairment of CMI. In contrast, the humoral immune reactivity, both specific and nonspecific, have been found to be normal or slightly increased. Recently, several investigators have enumerated the peripheral blood T and B lympocytes in patients with leprosy; however, there is no agreement as to the results. Furthermore, leprosy has been found to differ in its clinicai manifestations and immunological behaviors in different geographic areas and races. Nevertheless, there is yet no report in Korea concerning the T and B lymphocyte enumeration. The authors considered it is necessary to enumerate the peripheral blood T and B lymphocytes in Korean patients with leprosy to evaluate the immune status and the differences in the immunologic reactivity between the lepromatous and the tuberculoid spectrum of leprosy. (countinued..)
B-Lymphocytes* ; Continental Population Groups ; Humans ; Immunity, Cellular ; Korea ; Leprosy* ; Leprosy, Lepromatous ; Lymphocytes ; Mycobacterium leprae ; Research Personnel

Pseudolipomatosis of the colonic mucosa has been recognized as a lesion featured with aggregations of gaseous spaces in the lamina propria, but its pathogenesis remains still unclear. This paper describes 6 cases of pseudolipomatosis occurring in the mucosa of stomach and large intestine, and the possible factors involved in gastrointestinal endoscopic procedure to produce gaseous entrapment in the lamina propria were analysed. All cases received either gastroscopy or colonoscpy before endoscopic biopsy. Mucosal tissues from both stomach and recto-sigmoid colon revealed multiple aggregations of small air-spaces resembling fatty infiltration in the lamina propria. Rarely were similar infiltrations within the muscularis mucosae and adjacent lymphoid follicles. Evidence for pneumatosis cystoides intestinalis or ulcerative colonic lesion was not associated, although one showed a small gastric ulcer nearby. Repeated inflations and deflations of the stomach or colon during the endoscopic procedure with miner mechanical trauma by instrument to the mucosa seem to contribute to its pathogenesis.

Recent studies indicated that cellular and humoral immune reactions against Afycobacterium leprae may be involved in the development of some of the pathological manifestations. In lepromatous leprosy one might anticipate the formation of immune complexes from concomitant occurrence of large amounts of mycobacteria and corresponding antibodies. Indeed, there are some evidences of an involvement of immune complexes in the pathogenesis of erythema nodosum leprosum(ENL), mainly based on clinical and pathological studies. Some of numerous immune cornplex tests have been applied for the study of leprosy, But no single test has yet been shown to be the rnost sensitive and the most specific for the entire spectrum of circulating immune complexes. Furthermore. Leprosy has been found to differ in its clinical manifestations and immunological behaviors in different geographic areas and races. The authors considered it is necessary to determine the circulating immune complexes in Korean patients with leprosy to evaluate the immune status and the differences in the immunologic reactivity between the lepromatous and the tuberculoid spectrum of Ieprosy.
Antibodies ; Antigen-Antibody Complex* ; Continental Population Groups ; Erythema Nodosum ; Humans ; Leprosy* ; Leprosy, Lepromatous

OBJECTIVE: to investigate the effect of high glucose and spent peritoneal dialysate on the TGF-beta1 synthesis of cultured human peritoneal MC(HPMC); to examine the effect of costimulation with high glucose or dialysate and cytokines, interleukin-1beta(IL-1beta) and tumor necrosis factor-alpha(TNF-alpha), on transforming growth factor(TGF-beta1) synthesis of HPMC. DISIGN: HPMCs were exposed to different concentrations of glucose(30, 60 & 90 mM/L) or spent peritoneal dialysate for 48 hours in the absence or presence of IL-1beta(1ng/ml) and TNF-alpha(1ng/ml). TGF-beta1 mRNA expression was assessed by Northern blot analysis and TGF-beta1 protein synthesis and release by Western blot analysis with immunoprecipitation. RESULTS: Exposure of MC to high glucose condition(30mM, 60mM & 90mM of D- glucose) induced 2.3-, 3.6- and 4.0-fold increases in TGF-beta1 mRNA expression of MC with enhanced TGF-beta1 protein synthesis and secretion into the media. Incubation with spent dialysate also significantly increased TGF-beta1 mRNA expression & protein secretion compared to control media(P<0.05) Stimulation with IL-1beta(1ng/ml) or TNF-alpha(1ng/ml) significantly increased TGF-beta1 mRNA expression after 48 hours above the control level by 2.7-fold and 2.1-fold, respectively. However, TNF-alpha-induced increase in TGF-beta1 mRNA expression was not translated into TGF-beta1 protein secretion whereas IL-1beta stimulation induced a significant increase in TGF-beta1 protein secretion as well as TGF-beta1 mRNA expression. Combined stimulation of high glucose or spent dialysate together with IL-1beta or TNF-alpha showed a greater increase in TGF-beta1 mRNA expression and protein secretion compared to stimulation with high glucose or spent dialysate alone. CONCLUSION: Our results clearly show that high glucose concentration of peritoneal dialysate and spent dialysate themselves might be sufficient to stimulate the production of TGF-beta1 by peritoneal mesothelial cell. This state of chronic induction of TGF-beta1 is further exaggerated in the presence of peritonitis because of stimulatory effect of proinflammatory cytokines, resulting in the augmented TGF-beta1 synthesis, thus promoting peritoneal fibrosis.
Blotting, Northern ; Blotting, Western ; Cytokines ; Glucose ; Humans* ; Immunoprecipitation ; Necrosis ; Peritoneal Fibrosis ; Peritonitis ; RNA, Messenger ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha

Ommaya reservoir implantation has been used for sterile assessment into ventricular CSF or direct chemotherapy of chronic meningitis and meningeal involvement of malignancy since 1963. We experienced two cases with chronic meningitis, one was tuberculous meningitis with obstructive hydrocephalus which was not improved by repetitive shunt and the other was cryptococcal meningitis which was not improved by traditional chemotherapy of intravenous amphotericin B and oral flucytosine. Ommaya reservoir was implanted for daily CSF drainage of intractable hydrocephalus in the first patient and for direct injection of amphotericin B into ventricle in the second patient. Both of two cases were successfully managed by the reservoir. Therefore, Ommaya reservoir could be useful in patients with chronic meningitis which are not improved by traditional management.
Amphotericin B ; Drainage ; Drug Therapy ; Flucytosine ; Humans ; Hydrocephalus ; Meningitis ; Meningitis, Cryptococcal ; Tuberculosis, Meningeal