No abstract available.
Fruit* ; Pregnancy*

No abstract available.
Mastoid*

Epidural hematoma after epidural catheterization is very rare but one of serious complications. Although true incidence and origin is unknown yet, coagulopathies and anticoagulant therapy are predominant risk factors. Other risk factors are NSAIDs treatment and ankylosing spondylitis. We experienced a case of epidural hematoma without any risk factors after epidural catheterization for postoperative pain control. We performed epidural catheterization before operation and postoperatively the patient received continuous epidural infusion for postoperative pain control. On the first operative day, the patient was noted to have developed complete paraplegia and hypoesthesia below L1 and anesthesia below L2 level. Immediately after noting we performed TL-spine MRI and epidural hematoma at T10 level was diagnosed and treated by decompressive laminectomy. But she has not fully recovered yet.
Anesthesia ; Anti-Inflammatory Agents, Non-Steroidal ; Catheterization* ; Catheters* ; Hematoma* ; Humans ; Hypesthesia ; Incidence ; Laminectomy ; Magnetic Resonance Imaging ; Pain, Postoperative ; Paraplegia ; Risk Factors ; Spondylitis, Ankylosing

Mediastinal teratoma is one of the most common lesions found in the anterior mediastinum, accounting for 8~13% of all mediastinal tumors. This tumor is incidentally detected by routine chest roentgengography, but pericardial perforation or pleural effusion occurs rarely. In our patient cardiac tamponade was developed due to anterior chest wall contusion, we confirmed the anterior mediastinal tumor. Vital signs were stabilized after the pericardiocentesis, and the patient underwent the tumor resection in the anterior mediastinum for a definite treatment. On histologic examination, the tumor revealed cystic structures composed of mature squamous epithelium, pilosebaceous glands, mature fat tissue, gastrointestinal mucosa, respiratory epithelium, and pancreatic tissues.
Cardiac Tamponade* ; Contusions ; Epithelium ; Humans ; Mediastinal Cyst* ; Mediastinum ; Pericardiocentesis ; Pleural Effusion ; Respiratory Mucosa ; Teratoma* ; Thoracic Wall ; Thorax ; Vital Signs

No abstract available.
Candidemia* ; Humans

Metallic fixations devices are widely used in the surgical management of fractures and dislocations of shoulder. It is known that Kirschner wire (K-wire) may migrate into the thoracic cavity or other organs may occur. We report a case in which a K-wire previously placed in the clavicle migrated into the thoracic cavity without causing any trauma to the major vascular structures and was removed successfully by thoracoscopic surgery.
Clavicle ; Dislocations ; Foreign-Body Migration ; Shoulder ; Thoracic Cavity* ; Thoracoscopy*

BACKGROUND: The incidence of invasive aspergillosis has been increasing as the number of severe immunocompromised hosts has increased. We reviewed representative cases of invasive aspergillosis to describe clinical manifestations and treatment outcome. METHODS: We identified 40 cases of invasive aspergillosis on the ground of pathologic and radiologic findings from January 1991 to December 2000 and reviewed medical records and laboratory data. RESULTS: Forty cases of invasive aspergillosis included 28 'definite' cases and 12 'probable' cases. Major involved organs of invasive aspergillosis were lung (n=23, 57.5%), sinus (n=11, 27.5%), brain (n=3, 7.5%), spine (n=1, 2.5%), skull (n=1, 2.5%), and small bowel (n=1, 2.5%). Underlying diseases and risk factors were hematologic malignancies (n=21, 52.5%), high-dose steroid treatment (n=8, 20%), post-transplantation of solid organ (n=2, 5%), and ectopic ACTH syndrome (n=1, 2.5%). Immunocompetent hosts including DM patients were 8 cases (20%) and their major involved sites were sinus (n=4) and brain (n=2). Crude mortality rate of total invasive aspergillosis after 3 months and 12 months were 30% and 47.5%, respectively. 3-month and 12-month mortality rate for pulmonary aspergillosis (n=23) were 39%, 61% and those for extrapulmonary aspergillosis (n=17) were 18 %, 29%. Patients with hematologic malignancy (n=21) were in 33%, 57%, other immunocompromised hosts (n=11) were in 45%, 45%, and immunocompetent hosts (n=8) were in 0%, 25%. Patients with aggravated underlying diseases and sustained risk factors (n=20) were in 60%, 70% and patients with improved underlying diseases and no risk factor (n=20) were in 0%, 20%. CONCLUSION: Invasive aspergillosis mainly developed in severe immunocompromised hosts, but invasive sinus aspergillosis and cerebral aspergillosis occasionally developed in apparently immunocompetent hosts. The degree of immunosuppression and severity of underlying diseases affected the treatment outcome of invasive aspergillosis.
ACTH Syndrome, Ectopic ; Aspergillosis* ; Brain ; Hematologic Neoplasms ; Humans ; Immunocompromised Host ; Immunosuppression ; Incidence ; Lung ; Medical Records ; Mortality ; Pulmonary Aspergillosis ; Risk Factors ; Skull ; Spine ; Treatment Outcome*

BACKGROUND: This study was conducted to evaluate risk factors for infection and treatment outcome of bloodstream infection due to extended spectrum beta-lactamases(ESBL)-producing K. pneumoniae. METHODS: ESBL production was evaluated by NCCLS guidelines and/or double-disk synergy test in K. pneumoniae blood isolates stored from January, 1998 to April, 2002. Sixty patients with bloodstream infection due to ESBL-producing K. pneumoniae (case patients) were compared with 159 matched control patients with bloodstream infection of non-ESBL-producing K. pneumoniae. Retrospective case-control study was performed. RESULTS: There were no significant differences in age, sex, APACHE II score, and the primary site of infection between the case and control groups. In multivariate analysis, significant independent risk factors associated with bloodstream infection due to ESBL-producing K. pneumoniae were urinary catheterization, invasive procedure within previous 72 hours, and the number of antibiotics administered within previous 30 days. In clinical response at 72 hours after initial antibiotic treatment, complete response rate was higher in the controls (13.3% vs. 40.3%, respectively, P<0.001), however, treatment failure rate was higher in the cases (33.3% vs. 11.9%, respectively, P<0.001). Overall 7- day mortality rates in the cases and the controls were was 20% (12/60) and 15.7% (25/159) (P= 0.451), respectively, and overall 30-day mortality rates were 30% (18/60) and 24.5% (39/159), respectively (P=0.410). When the patients with bloodstream infection of ESBL-producing organism were evaluated and the patients who received inadequate definitive antibiotic treatment were excluded, delayed effective antibiotic treatment was found to be not associated with higher mortality. CONCLUSION: In patients infected with ESBL-producing K. pneumoniae bacteremia, clinical response rate at 72 hours after antimicrobial therapy was lower, but the increase of mortality rate was not significant. Delayed effective antibiotic treatment was not associated with higher mortality, when definitive appropriate antibiotic treatment was prescribed.
Anti-Bacterial Agents ; APACHE ; Bacteremia ; beta-Lactamases* ; Case-Control Studies ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Mortality ; Multivariate Analysis ; Pneumonia ; Retrospective Studies ; Risk Factors* ; Treatment Failure ; Treatment Outcome* ; Urinary Catheterization ; Urinary Catheters

BACKGROUND: Since the introduction of HAART (Highly Active Anti-Retroviral Therapy), metabolic com- plications have been reported with varying prevalence. We performed a retrospective study to evaluate the incidence and risk factors of metabolic complications arising in Korean HIV/AIDS patients. MATERIALS AND METHODS: 66 HIV positive patients on combination therapy between 1998 June to 2002 June with at least 1 protease inhibitor (PI) or/and Non-nucleoside reverse transcriptase inhibitors (NNRTI) were reviewed. Hyperglycemia was defined as serum glucose >140 mg/dL on 2 or more occasions; diabetes as any random serum glucose >200 mg/dl; hypercholesterolemia as serum cholesterol >240 mg/dL; hypertriglyceridemia as serum triglyceride >200 mg/dL. We used SPSS version 9.0 for statistical analysis. One way ANOVA was used to compare the treatment groups. Multinominal logistic regression analysis was used for risk factor analysis. RESULTS: 66 patients were analyzed and total duration of follow up was 138 patient-years. The incidence of metabolic complication was 20.3%. Incidence of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, and diabetes were 12.3%, 5.8%. 1.4%, 4.3% respectively. On risk factor analysis, factors contributing to the development of metabolic complication were age>35 years (P= 0.020) and baseline serum triglyceride >140 mg/dL (P=0.001). Baseline CD4 count <170/mm3 (P= 0.054) and use of stavudine >6 months (P=0.055) were associated with development of metabolic complications with borderline significance. CONCLUSION: The incidence of metabolic complication among Korean HIV/AIDS patients receiving HAART is 20.3%. Older age and high baseline triglyceride were risk factors for development of metabolic complications.
Antiretroviral Therapy, Highly Active ; Blood Glucose ; CD4 Lymphocyte Count ; Cholesterol ; Follow-Up Studies ; HIV ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Hypertriglyceridemia ; Incidence ; Logistic Models ; Prevalence ; Protease Inhibitors ; Retrospective Studies ; Reverse Transcriptase Inhibitors ; Risk Factors ; Stavudine ; Triglycerides

BACKGROUND: Nation-wide outbreak of acute hemorrhagic conjunctivitis occurred in the summer, 2002 in South Korea. We identified the causative agent of this outbreak through virus culture and molecular biological techniques. METHODS: Polymerase chain reaction (PCR) was carried out with direct conjunctival swab samples and cell culture supernatants. Conjunctival swab was done at a community based-eye clinic in Seoul, September 2002. Initial screening for adenovirus and enterovirus was performed. Nested PCR for adenovirus was done with adenovirus common primers using direct swab sample, and reverse transcription PCR (RT-PCR) for enterovirus was done with enterovirus common primers. RT-PCR with primer 188/222 for VP1 region of enterovirus was done, if initial screening test was positive. PCR product was sequenced, and homology searching, compared to prototype strains, was done for serotyping. Protease 3C region of coxsackievirus A24v was amplified and sequenced with primer D1/U2. The sequence of this region was compared to those of viral isolates, which had been obtained from several Asian outbreaks since 1970. RESULTS: Conjunctival swabs were performed in 88 patients. Thirty nine (44%) samples out of the 88 were culture positive on HeLa or MRC-5 cells. Nine (100%) out of 9 culture supernatants, randomly selected from 39 culture positve samples, were positive for coxsackievirus A24v-specific RT-PCR. Phylogenetic analysis showed that sequences from 14 culture positive supernatants, randomly selected from 39 culture positive samples, clustered into a time-related, but distinct lineage, with Asian strains. CONCLUSIONS: We identified the causative agent of the epidemic hemorrhagic conjunctivits in year 2002 as coxsackievirus A24v.
Adenoviridae ; Asian Continental Ancestry Group ; Cell Culture Techniques ; Conjunctivitis, Acute Hemorrhagic* ; Disease Outbreaks ; Enterovirus ; Enterovirus C, Human* ; Humans ; Korea* ; Mass Screening ; Polymerase Chain Reaction ; Reverse Transcription ; Seoul ; Serotyping