In order to understand the role of mec regulator genes in the evolution of methicillin-resistant S. aureus (MRSA), the distribution of the mec regulator genes among the 66 clinical isolates of MRSA was analysed. And also the correlation between gene mutation and degree of phenotypic expression of resistance was studied. Fifty strains carried whole mec regulator region, while the mecI gene and nearly half of the 3'-end of the mecR#l gene were deleted in fifteen strains. The mecRl MS gene was detected among all of the mecA carried strains, but the mecRl PB gene was carried by 77% of the MRSA strains. At least a portion of the 5'-end region of the mecRl gene was carried by all MRSA strains tested. Forty-seven strains were finally confirmed to have mecI gene and each mecI gene of above strains was sequenced for identification of the relationship between repressor function of mecI gene on mecA transcription and MIC level of methicillin. Point mutations were detected in 11 strains of 47 strains. In 8 strains, there was one nucleotide substitution (C to T at position 202) that produced a new termination codon at position 201. In 3 strains, one nucleotide substitution from G to T at position 43 caused an amino acid substitution from Val to Phe. The MIC of methicillin of strains carrying mutated mecI genes ranged 256 ug/ ml to 1024 ug/ml. Transcription level of amplified cDNA corresponding to mecA was determined by the method of RT-PCR of extracted RNA. Total RNA was extracted from two strains with mutated mecI gene and a strain with intact mecI gene. Deletional loss or the mutational inactivation of the mecI gene did not affect the level of mecA transcription. Role of mecI gene as a strong repressor function on mecA gene seemed to be skeptical.
Amino Acid Substitution ; Codon, Terminator ; DNA, Complementary ; Genes, Regulator* ; Methicillin Resistance ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus ; Point Mutation ; RNA

The purpose of this study was to evaluate the results and complications in difficult periarticular fractures of the knee treated with a circular(Ilizarov) external fixator. The mean follow-up period was 34 months(range: 12-55 months). Of the 27 cases, 12 cases involved fractures of distal femur (two M ller type A3, four type C2, six type C3) and 15 cases involved fractures of the proximal tibia (one Schatzker type V, eight type VI, two segmental, four metaphyseal comminuted fractures). Twenty-two cases(81%) were open fractures and most of the cases were open intra-articular comminuted fractures. The average duration of external fixation was 7.7 months (9.8 months for the distal femur cases, 6.5 months for the proximal tibia cases and 11.5 months for the cases which required lengthening, and 6 months in the non-lengthening group). In 8 cases, in which bone lenthening was done, no leg length discrepancy occurred after lengthening. The mean length gained was 5.9 cm and the mean healing index was 1.8 months/cm (1.8months/cm in distal femur cases and 1.9 months/cm in proximal tibia cases). According to Neers criteria, the treatment results for cases involving distal femur fracture were as follows: six satisfactory, three unsatisfactory, three failures; cases with proximal tibia fractures had these results: nine excellent, three satisfactory, three unsatisfactory. Average range of motion was 67 degrees in distal femur fracture cases and 114 degrees in proximal tibia fracture cases. According to Paleys complication grading system, six problems, six obstacles, and eight com- plications occurred. In conclusion, the Ilizarov external fixator can be a useful treatment method in periarticular fractures of the knee with severe intra-articular or metaphyseal comminution, bone loss, severe soft tissue injury, or multiple associated injury. Its use can reduce the associated complications such as leg length discrepancy, infection, and nonunion.
External Fixators* ; Femur ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Knee* ; Leg ; Range of Motion, Articular ; Soft Tissue Injuries ; Tibia

To evaluate the possibility of the newly developed highly porous glass ceramics as a space-filler in the cavitary bone defect, we made the opening sized 1 × 0.5 cm on the medial aspect of the right proximal tibia of nine rabbits. We impacted the highly porous glass ceramics firmly to the medullary cavity of rabbit tibia through the opening. Each three were sacrificed at 4th, 8th, and 12th week and analyze in vivo reaction of the glass ceramics in rabbit tibia with radiological and histological methods. On radiological examination, radiolucent line was seen around impacted glass ceramics at 4th week, but this radiolucent line was obliterated gradually to 12th week. On histological examination, new bone formation with osteoblast was appeared at 4th week without foreign body reactions. At 8th week, newly formed bone infiltrated into the porous space between glass ceramics particles was noticed, and the surface of glass ceramics was tightly bound by newly formed bone with osteoblastic rim and mature bone, At 12th week, the amount of newly formed mature bone increased, though there was on evidence of resorption of glass ceramics particle. So, we suggest that the highly porous glass ceramics is one of the possible artificial bone graft substitutes, especially as a space-filler.
Ceramics ; Foreign Bodies ; Glass ; Osteoblasts ; Osteogenesis ; Rabbits ; Tibia ; Transplants

Dermatofibrosarcoma protuberans (DFSP) is a rare, distinctive cutaneous tumor, which consists of spindle shaped ceils arranged in densely packed interlacing bundles with the storiform or cartwheel pattern. Histologically, it resembles deep growing dermatofibroma, nodular fasciitis, neurofibroma and neural sheath tumors. DFSP is one of t.he connective tissue tumors which is difficult. to diagnose histologically as well as clinically. Recently, the immunochemical staining with a monoclonal antibody to CD34 is reported to give assistance in the clear differential diagnosis of DFSP from other fibrous or neural tumors. Herein, three cases of DFSP were stained by immunohistochemical staining with S-100 protein, vimentin, factor VIII and anti-CD34 antibody in order to assess the use of anti-CD34 in the differential diagnosis of DFSP.
Connective Tissue ; Dermatofibrosarcoma* ; Diagnosis, Differential ; Factor VIII ; Fasciitis ; Histiocytoma, Benign Fibrous ; Neurofibroma ; S100 Proteins ; Vimentin

Anatomically flexor pollicis longus is different from deep finger flexors. Flexor pollicis longus tendon is unique in that it may be advanced without disturbing its blood supply, since it has no vinculum. From January 1990 to December 1992, 17 cases of patients with laceration of the flexor pollicis longus tendon were treated at Kyungpook National University Hospital. The follow up period ranged from 3 to 36 months. The results were as follows; 1. agents causing the laceration were broken bottles in 10 cases(58.8%), knives in 3 cases(17.6%) and machinary like saw in 2 cases(11.8%). 2. Totally 17 cases, 9 cases of them were located at distal to metacarpophalageal joint. 3. As associated injuries, digital nerve injuries were 4 cases(23.5%) and the recurrent branch of median nerve injuries was 1 case. 4. The surgical treatment was direct suture with or without proximal lengthening in 13 cases(76%) as primary or secondary repair and distal advancement with or without proximal lengthening in 4 cases(24%) as secondary repair. 5. Distal to metacarpophalangeal joint, the surgical treatment was direct suture with or without proximal lengthening in 3 cases as primary or secondary repair and distal advancement with or without proximal lengthening in 4 cases as secondary repair. 6. The result by Urbaniak method was excellent in 8 cases(47.0%), good in 7 cases(41.2%) and fair in 2 cases(11.8%). 7. Based on the results in these patients, it was recommended that secondary treatment for lacerations distal to the metacarpophalangeal at the wrist, as needed is bettewr than free tendon graft.
Fingers ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Joints ; Lacerations ; Median Nerve ; Metacarpophalangeal Joint ; Methods ; Sutures ; Tendon Injuries ; Tendons ; Transplants ; Wrist

The purpose of the study is to describe the cases with prepapillary or peripapillary vascular malformation who have experienced mild vitreous hemorrhage. Five patients [5 eyes], 1 male and 4 females, were included in the study.The vascular malformation was unilaterally present in all patients.Vitreous hemorrhage occurred from the area of retinal vascular malformation near or on the optic nerve, and cleared without further complications. Fluorescein angiographic feature of each eye was normal. Arteriovenous communication, secondary retinal exudation, or vascular leakage from vascular malformation was not observed. Each patient showed improvement in visual acuity of 2 lines or more. This benign, congenital vascular malformation may be non-progressive and infrequently cause mild vitreous hemorrhage.Therapeutic intervention was not necessary in these cases.
Female ; Fluorescein ; Hemorrhage ; Humans ; Male ; Optic Nerve ; Retinaldehyde ; Vascular Malformations* ; Visual Acuity ; Vitreous Hemorrhage

PURPOSE: Analyzing the systemic abnormal findings of acute retinal artery occlusion, to investigate what kinds of systemic evaluation must be performed in patients with acute retinal artery occlusion. METHODS: Thirty-three patients who had been diagnosed as acute retinal artery occlusion from July 1996 to June 2001 at Kyungpook National University Hospital were evaluated. Routine blood test, carotid doppler ultrasonography, echocardiography, routine anticoagulation study and antithrombin III assay were performed and serum protein S and protein C levels of these patients were checked. RESULTS: Seventeen of 33 were diagnosed as central retinal artery occlusion, 2 as ophthalmic artery occlusion, 10 as branch retinal artery occlusion, 4 as cilioretinal artery occlusion. Sixteen of 33 patients (48%) had abnormal findings on these systemic evaluation. Twenty-two patients had carotid doppler ultrasonography. Twelve of these 22 patients (54%) had atherosclerotic plaque in their carotid artery, and hemodynamically significant carotid stenosis (> or =60% of lumen) was found in six patients (27%). Only one patient had decreased serum levels of protein S and protein C. Two patients had abnormal findings of echocardiography. One patient had elevated serum hemoglobin and hematocrit, and so he was transferred to department of hematology and diagnosed as secondary polycythemia (Table 2). CONCLUSIONS: Many patients with acute retinal artery occlusion had various systemic disease. So, it is suggested that systemic evaluation of acute retinal artery occlusion be performed.
Antithrombin III ; Arteries ; Carotid Arteries ; Carotid Stenosis ; Echocardiography ; Gyeongsangbuk-do ; Hematocrit ; Hematologic Tests ; Hematology ; Humans ; Ophthalmic Artery ; Plaque, Atherosclerotic ; Polycythemia ; Protein C ; Protein S ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinaldehyde* ; Ultrasonography, Doppler

PURPOSE: To report a case with proptosis associated with orbital panniculitis. METHODS: A 34-old-year man with unilateral proptosis for 1 month presented with diffuse swelling and redness in the eyelid and conjunctiva. His systemic symptoms were high fever, headache, nausea, diarrhea, dizziness, weight loss, malaise and hepatosplenomegaly. He had subcutaneous nodules on the inguinal region, the pubis, and the upper abdomen. Ophthalmic examinations, orbit magnetic resonance imaging(MRI), and biopsy from orbital tissue were performed. RESULTS: The right eye revealed proptosis(22/14/102, Hertel's exophthalmometer), but other ocular findings including the fundus were normal. Diffuse infilterative lesions and definite proptosis were shown on orbit MRI. Biopsy specimen of orbital tissue revealed histiocytes containing nuclei and nuclear debris, mononuclear cells infiltration, and the characteristic 'bean-bag' cell i.e., macrophage exhibiting hemophagocytosis, which is histopathological characteristic of cytophagic histiocytic panniculitis. Proptosis, swelling and redness of the eyelid improved gradually following systemic corticosteroid therapy to control the disease. CONCLUSION: This report describes a rare finding of proptosis as the manifesting sign of orbital panniculitis.
Abdomen ; Biopsy ; Conjunctiva ; Diarrhea ; Dizziness ; Exophthalmos* ; Eyelids ; Fever ; Headache ; Histiocytes ; Macrophages ; Magnetic Resonance Imaging ; Nausea ; Orbit* ; Panniculitis* ; Weight Loss

The case reported here, concerns a spontaneous low-flow fistula between the carotid arterial network and the cavernous sinus, with ophthalmological symptoms such as conjunctival congestion and diplopia in a 41-year-old woman. The patient has suffered from diabetes without trauma history. Patient's ocular symptoms and signs were only present in the left eye with best-corrected visual acuity 0.04 at the time of presentation. Other ophthalmic findings were exophthalmos, elevated intraocular pressure, and visual field defects. Enlarged extraocular muscles and proptosis were found on orbital computed tomography leading to the misdiagnosis of orbial pseudotumor or thyroid rbitopathy. Carotid angiography showed dural carotid-cavernous sinus fistula, which involved left-side internal and external carotid arterial network and right-side internal carotid arterial network. Orbital color Doppler imaging showed a flow reversal with a systolic component in the enlarged superior ophthalmic vein. We were able to diagnose dural carotid-cavernous sinus fistula. Dural carotid-cavernous sinus fistula was closed successfully by embolization via the vein without omplication. The visual acuity, proptosis, and dilated and tortuous vessels of the conjunctiva improved.
Adult ; Angiography ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Conjunctiva ; Diagnostic Errors ; Diplopia ; Estrogens, Conjugated (USP) ; Exophthalmos ; Female ; Fistula* ; Humans ; Intraocular Pressure ; Muscles ; Orbit ; Thyroid Gland ; Veins ; Visual Acuity ; Visual Fields

One hundred fifty bacteriae isolated in significant numbers from 96 specimens of urine of the 45 in-patients with long-term indwelling catheter were evaluated from January, 1978 to July. 1979 and the following results were obtained; 1. In 20 patients (44.4%), positive urine culture was obtained within 10 days after indwelled catheter in the urinary tract and 97.9% of the patients revealed the positive urine culture within 20 days after that. 2. Of 150 bacterial strains isolated by cultures of the urine, 96% was gram-negative bacteria and 4% was gram-positive. Isolated organisms included klebsiella(27.4%), E.coli(23.3%). proteus(14.7%), pseudomonas(12.0%). coliform bacilli(10.0%). other gram-negative organism (8.6%), staphylococcus(2.7%) and streptococcus (l.3%) in order of frequency. 3. In 4 patients(8.9%), bacteremia was developed. Isolated organism from blood culture and those from urine culture were same. The mortality rate was 50%.
Bacteremia ; Bacteria ; Catheters ; Catheters, Indwelling* ; Gram-Negative Bacteria ; Humans ; Mortality ; Streptococcus ; Urinary Tract Infections* ; Urinary Tract*