BACKGROUND: The aim of the study was to determine prevalence of potential heterogeneous vancomycin-resistant Staphylococcus aureus (h-VRSA) among methicillin-resistant S. aureus (MRSA) isolated in Korea by using Mu-3 agar and to determine the effect of in vitro vancomycin exposure on the resistance. METHODS: MRSAs isolated in 1980-1999 were screened for the presence of VISA or h-VRSA using Mu-3 agar. MIC of vancomycin was tested by NCCLS agar dilution and broth microdilution tests. Suspected h-VRSA were selected by vancomycin-containing media and change of resistance was determined by population analysis. A strain with Mu50 type growth was serially exposed to 8 pg/ml of vancomycin containing media and change of the vancomycin resistance was determined. RESULTS: Among the 455 MRSA isolates, 18 (3.9 %) grew on selective brain heart infusion agar (BHIA), and 354 (77,8%) on Mu-3 agar, 66 (14.5%) with Mu3 type growth and 78 (17.1%) with Mu50 type growth. MIC of vancomycin was 11 pg/ml for some of the isolates when inocula were approximately 10' CFU, but VISA was not present when tested by NCCLS broth microdilution test. Exposure of the isolates to van-cornycin raised the MIC. Serial exposure once to 8 pg/ml of vancomycin resulted in significant decrease of cells susceptible to 8-12 pg/ml of vancomycin. CONCLUSION: VISA was not present among the test isolates, but 34.2% were suspected to be potential h-VRSAs, suggesting possible emergence of VISA if vancomycin was administered prolonged period. It is considered that suitable screening media are vancomycin containing BHIA for VISA and Mu-3 agar for h-VRSA. The isolates showing Mu50 type growth on Mu-3 agar are not always VISA, but rather h-VRSA.
Agar* ; Brain ; Heart ; Korea ; Mass Screening ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Prevalence ; Staphylococcus aureus* ; Staphylococcus* ; Vancomycin Resistance ; Vancomycin*

No abstract available.
Skin Diseases*

Thirty-nine patients with pityrosporum folliculitis were investigated clinically and histopathologically. On clinical observation there were numerous, chronic, moderately itchy (64.1%), dome-shaped papules (89.7%) and pustules (66.7%). The most frequent sites of the lesions were the upper portion of the chest (76.9%) and back (56.4%). In biopsy specimens, abundant round and budding yeast cells were seen in a dilated hair follicle. The reptured follicle was observed in 19 specimen (48.7%). The accumulation on inflammatory cells were observed in or around the upper part of the follicle in all specimens. The effect of antimycotic treatment was excellent. After 4 weeks of treatment, 36 patients (92%) were cured and 3 (8%) had improved significantly. KOH/Parker Ink direct smear was done in 20 patients. Blue-colored round and budding yeast cells were observed under a light mcroscope in all patients. We suggest that pityrosporum folliculitis is a common disease of young and middle-aged Koreans.
Biopsy ; Folliculitis* ; Hair Follicle ; Humans ; Ink ; Malassezia* ; Saccharomycetales ; Thorax ; Yeasts

We report herein a case of subcutaneous fat necrosis in an 1-month-old abandoned female neonate who had subcutaneous nodule on the right cheek and linear cord-like subcutaneous nodule on the right upper arm which has been evident from the second post-delivery day. Hiatopathologic findings revealed massive subcutaneous fat necroais with infiltration of foreign body giant cells and inflammatory cells. Calcigm was also deposited but no needle shaped cleft was formed in the fat cells. The akin lesion resolved spontaneously after 2 months.
Adipocytes ; Arm ; Cheek ; Female ; Giant Cells, Foreign-Body ; Humans ; Infant, Newborn* ; Necrosis* ; Needles ; Subcutaneous Fat*

PURPOSE: Surface finishing of a cemented femoral stem is a subject of controversy even though the contemporary cementing techniques have improved results. Using the Versys Heritage femoral stem, we evaluated the outcome of using a polished surface. MATERIALS AND METHODS: The subjects of this study were 95 hip arthroplasties in 82 patients and we used a cemented polished femoral stem with the 3rd generation cement technique and all the surgeries were done between October 2000 and August 2003. There were 58 male patients (64 hips) and 24 female patients (31 hips). The mean age at the time of the index arthroplasty was 52.3 years (26~74 years), and the average body mass index was 24.2+/-2.75 (19.1~29.8). The average follow up period was 80.7 months (64~109 months). All the hips were evaluated clinically by the Harris hip score and the thigh pain, and they were radiologically assessed by the cement grade and the presence of osteolysis around the femoral stem, as well as the presence of stress shielding of the proximal femur. RESULTS: At the final follow up, the Harris hip score for all the patients had improved from preoperative 58.9 (17-83) to post operative 91.7 (72~100). The cement grade was measured using Barrack's method. Of the 95 hips, 45 (47.3%) cases were grade A, 48 (50.5%) cases were grade B and 2 (2.1%) cases were grade C1 at the final follow up. There was 1 case of definite loosening. Stress shielding was noted in 65 (68.4%) cases of the zero grade and 19 (20.0%) cases of the 1st grade. CONCLUSION: In this study, the cemented polished femoral stem showed excellent results at the mid term with a minimum follow up of 5 years. But a longer-term follow-up study will be needed for further understanding the implications of cemented polished femoral stem.
Arthroplasty ; Body Mass Index ; Female ; Follow-Up Studies ; Hip ; Humans ; Male ; Osteolysis ; Thigh

No abstract available.
Humans ; Nephritis, Interstitial* ; Nephrotic Syndrome*

BACKGROUND: Bone mineral density (BMD) is influenced by genetic, hormonal, and environmental factors. Long-term antiepileptic drug (AED) use also causes osteopenia or osteoporosis that have been most extensively described in institutionalized patients. But, the mechanism of these abnormalities is unclear. The objective of this study is to determine the effect of AED on bone density and to explain the pathophysiologic mechanisms by analyzing bone related factors. METHODS: We prospectively examined BMD by dual-energy X-ray absorptiometry in 45 patients with epilepsy. We measured the serum calcium, phosphorus, protein, alkaline phosphatase (ALP), bone specific ALP, vitamin D and osteocalcin to analyze the factors that influence bone metabolism. RESULTS: BMD was significantly lower in the patient group than in the control group (p<0.05). 13% of patients had osteopenia and 3% of patients had osteoporosis. The level of bone specific ALP was higher in the patient group, but the level of vitamin D was not different, implying that BMD is decreased by the direct effect of antiepileptic drugs. There was a weak negative correlation and marginal significance between BMD and the duration of therapy in the patient group (r=-0.407, p<0.05). CONCLUSIONS: Long-term antiepileptic drug therapy in patients who have seizures causes significant bone loss in the lumbar spine even in the absence of vitamin D deficiency. In addition, the degree of bone mineral density was weakly related with the therapeutic duration of antiepileptic drugs. The regular evaluation of BMD in patients with long-term antiepileptic drugs might be helpful to prevent decreases in BMD.
Absorptiometry, Photon ; Alkaline Phosphatase ; Anticonvulsants* ; Bone Density* ; Bone Diseases, Metabolic ; Calcium ; Drug Therapy ; Epilepsy ; Humans ; Metabolism* ; Osteocalcin ; Osteoporosis ; Phosphorus ; Prospective Studies ; Seizures ; Spine ; Vitamin D ; Vitamin D Deficiency

We report a case of a congenital, melanocytic nevus showing spontaneous regression. At birth, a pigmented lesion, 4 × 6.5cm, was already present on the scalp. At the age of 20 days, the center of the lesion became crusted with a purulent discharge. Following healing of the inflammed lesion, the nevus showed a tendency to regress, starting from the previously inflammed site. At the age of 11 months, the nevus showed marked regression, leaving an atrophic and depigmented center with pea-sized papules and a thin, pigmented rim. Skin sections taken from the central depigmented area showed marked fibrosis and scanty nevus cell nests in the dermis. Histological examination of the pea-sized papule in the center of the lesion repealed large epithelioid cells with abundant cytoplasm dispersed between the collagen fibers; it resembled a spindle cell and epithelioid cell nevus with epithelioid cells predominating. There were no clinical or histologically malignant changes.
Collagen ; Cytoplasm ; Dermis ; Epithelioid Cells ; Fibrosis ; Nevus ; Nevus, Pigmented* ; Parturition ; Scalp ; Skin

After publishing 2001 version of the Korean Medication Algorithm for Schizophrenia, the strategy of pharmacologic treatment for schizophrenia has been altered with the rapid advancement in the area of psychopharmacology. Currently, the feasibility of this algorithm has been evaluated. Guidelines require updating when significant new evidence appears. Recently, several guidelines of the treatment of schizophrenia including the APA practice guideline, the Expert Consensus Guideline Series and the Texas Medication Algorithm Project (TMAP) Antipsychotic Algorithm for Schizophrenia were revised. In this review, the authors briefly discussed the problems and limitations of the Korean Medication Algorithm for Schizophrenia and presented the direction of future revision on the model of above-mentioned guidelines.
Consensus ; Drug Therapy ; Methods* ; Practice Guidelines as Topic ; Psychopharmacology ; Schizophrenia* ; Texas

After subarachnoid hemorrhage, transient hypoglycorrhachia is not unusual but prolonged hypoglycorrhachia has been reported rarely. We report a 67-year-old woman who show prolonged hypoglycorrhachia for more than one month after subarahnoid hemorrhage without evidences of infection and malignancy.
Aged ; Female ; Hemorrhage ; Humans ; Subarachnoid Hemorrhage*