BACKGROUND: Recent data suggest that the colonization rate of group B streptococci(GBS) in pregnant women and the incidence of neonatal infections by GBS is increasing trend in Korea, but the antimicrobial susceptibilities and serotypes in pregnant women have not been reported in Korea. So, we studied to define the antimicrobial susceptibility patterns and frequency of serotypes of GBS in pregnant women. METHODS: The susceptibility and serotyping of 60 GBS isolates from 27 pregnant women and four isolates from their two neonates were tested by an agar dilution method and agglutination test, respectively. The typing sera used in this study were Ia, Ib, II, III, IV, and V. RESULTS: Minimal inhibitory concentration range of 60 GBS from pregnant women were penicillin G 0.015-0.12 microgram/ml, vancomycin 0.5-2 microgram/ml, clindamycin 0.015-4.0 microgram/ml, chloramphenicol 2-4 microgram/ml, erythromycin 0.015-2 microgram/ml, tetracycline 0.5-256 microgram/ml, cephalothin 0.12-0.25 microgram/ml, ceftriaxone 0.03-0.12 microgram/ml, respectively. The resistance rate of GBS were 6.7% to clindamycin, 0% to erythromycin, and 98.3% to tetracycline. Most of GBS serotypes from pregnant women in decreasing order were Ib(48.3%), Ia(24.1%), III(20.7%). CONCLUSION: All GBS strains isolated from pregnant women are highly susceptible to commonly used antimicrobial agents with the exception of tetracycline. The low prevalence of severe neonatal GBS infections in Korea is not due to the absence of serotype III, but probably due to a low genital carriage rate of GBS by pregnant women.
Agar ; Agglutination Tests ; Anti-Infective Agents ; Ceftriaxone ; Cephalothin ; Chloramphenicol ; Clindamycin ; Colon ; Erythromycin ; Female ; Humans ; Incidence ; Infant, Newborn ; Korea ; Penicillin G ; Pregnant Women* ; Prevalence ; Serotyping ; Tetracycline ; Vancomycin

BACKGROUND: Candidemia has increased with an increasing number of people in the high risk group and so has become more important. This study was conducted to investigate the isolation rate of Candida species from candidemia patients and the change in rate of antifungal resistance. METHODS: At a single tertiary care hospital, 1,120 blood cultures positive for Candida species from 1997 to 2016 were investigated according to date of culture, gender, age, and hospital department. RESULTS: During the investigation period, the number of candidemia patients increased from 14 in 1997 to 84 in 2016. The most common organism identified during the two decades was Candida albicans (40.8%), followed by Candida parapsilosis (24.1%), Candida tropicalis (13.2%), and Candida glabrata (12.8%). C. glabrata was relatively common in females (45.5%) compared to males. The age group 40-89 years was more frequently infected than other age groups, and the most frequent isolates according to age group were C. albicans in neonate (66.7%), C. parapsilosis in 1-9-year-olds (41.7%), and C. glabrata in those aged ≥60 years (range; 13.3%–20.0%). According to the visited departments, C. albicans, C. glabrata, and Candida haemulonii were more common in medical departments, while C. parapsilosis was more common in surgical departments. In the antifungal susceptibility test, a rising trend of azole resistance among C. albicans and C. glabrata was observed in recent years. CONCLUSION: In this study, it was confirmed that the isolation rate of Candida species in blood is different by age, gender, and hospital department, and the distribution of isolated Candida species changed over time. The resistance patterns of antifungal agents are also changing, and continuous monitoring and proper selection of antifungal agents are necessary.
Antifungal Agents ; Candida albicans ; Candida glabrata ; Candida tropicalis ; Candida* ; Candidemia* ; Danazol ; Drug Resistance, Fungal* ; Female ; Hospital Departments ; Humans ; Infant, Newborn ; Male ; Prevalence* ; Tertiary Healthcare*

Massive intravascular hemolysis secondary to Clostridium perfringens septicemia is rare but often fatal. We report a case of a fatal clostridial hemolytic complication in a 71-year-old woman with probable refractory anemia. The patient was admitted to the emergency room due to a comatose mental state and a high fever. Laboratory analysis showed massive hemolysis. She died from severe anemia two hours after admission. The next day, blood cultures grew gram positive cocci and boxcarshaped gram positive rods, which were identified as coagulase-negative staphylococci and C. perfringens, respectively.
Aged ; Anemia ; Anemia, Refractory ; Clostridium perfringens* ; Clostridium* ; Coma ; Emergency Service, Hospital ; Female ; Fever ; Gram-Positive Cocci ; Gram-Positive Rods ; Hemolysis ; Humans ; Sepsis*

BACKGROUND AND OBJECTIVE: There has been little clinical data on the treatment outcome of patients with acute asthma attack in Korea. We designed a management protocol of acute asthma, and analyzed clinical p arameters obtained from this protocol. METHOD: A total of 32 cases with acute asthma were treated with oxygen, beta2 agonist, and methylprednisolone. Ipratropium was added in cases of severe attack. After 90 minutes, intravenous aminophylline was given to the patients with poor response. RESULT: Beta2 agonist and methylprednisolone were sufficient for symptom control in 17 cases. Ipratropium and aminophylline were added in 6 and 9 cases, respectively. There was no difference in improvement of PEF, heart rate, respiratory rate, PaO2, PaCO2, and SaO2 at 90 minutes and 8 hours between beta2 agonist inhalation and subcutaneous group. Serum potassium concentration levels significantly decreased in patients treated with ipratropium of aminophylline(n=15, 4.17+/-0.45 vs. 3.99+/-0.35mM/L, p<0.05), compared with patients using only beta2 agonist and methylprednisolone(n=17, 3.89+/-0.30 vs. 4.14+/-0.45mM/L, p>0.05). CONCLUSION: Subcutaneous beta2 agonist may be an alternative to inhalant beta2 agonist for the emergency treatment of acute asthma, and we think a consensus regarding use of aminophylline in the emergency room should be made.
Aminophylline ; Asthma* ; Consensus ; Emergency Service, Hospital ; Emergency Treatment ; Heart Rate ; Humans ; Inhalation ; Ipratropium ; Korea ; Methylprednisolone ; Oxygen ; Potassium ; Respiratory Rate ; Treatment Outcome*

Technological advances in video camera, high resolution monitors and optical systems have produced considerable process in endoscopic surgery. Recently we have experienced transthoracic endoscopic sympathectomy(TES) for the treatment of Buerger's disease of both hands in a 47 years old male healthy patient. For the TES, one lung ventilation is necessary to provide adequate surgical access, so this patient had general anesthesia with a disposable left sided Robertshaw double lumen endobronchial tube. The patient was monitored for arterial pressure, herat rate, ECG, pulse oximetry, end-tidal carbon dioxide concentration, peak inspired airway pressure and arterial blood gas analysis. Potenial intraoperative problems wese hypoxemia during one-lung anesthesia, hypotension and hypercarbia occurred by insufflation of carbon dioxide into the chest cavity. Our patient also developed moderate hypoxemia which was corrected by application of high frequency jet ventilation with low driving pressure during right sided operation, and increased significantly arterial carbon dioxide tension about 8-12 mmHg during one lung ansthesia. We reviewed our experience and discussed the anesthetic technique and perioperative problems encounterd in the patient undergoing transthoracic endoscopic sympathectomy for Buerger's disease.
Anesthesia* ; Anesthesia, General ; Anoxia ; Arterial Pressure ; Blood Gas Analysis ; Carbon Dioxide ; Electrocardiography ; Hand ; High-Frequency Jet Ventilation ; Humans ; Hypotension ; Insufflation ; Lung ; Male ; Middle Aged ; One-Lung Ventilation ; Optical Devices ; Oximetry ; Sympathectomy* ; Thorax ; Thromboangiitis Obliterans

Purpose: Despite decreased prevalence of tuberculosis, the incidence of the diseases associated with nontuberculous mycobacteria (NTM) has been increasing in South Korea and around the world. The present retrospective study was conducted to determine longitudinal changes in the epidemiology and distribution of NTM over 13 years at a tertiary care hospital in Korea. Materials and Methods: We retrospectively analyzed data on Mycobacterium species over 13 years (January 2007 to December 2019) by utilizing the laboratory information system. Mycobacterium species were identified using biochemical tests and PCR-restriction fragment length polymorphism and Mycobacteria GenoBlot assays. Results: After excluding duplicates from the initial pool of 17996 mycobacterial isolates, 7674 strains were analyzed and 2984 (38.9%) NTM were isolated. The proportion of NTM continuously increased over the 13-year period, from 17.0% in 2007 to 57.5% in 2019. Among the NTM isolates, the most common species were Mycobacterium intracellulare (50.6%), M. avium (18.3%), M. fortuitum complex (4.9%), M. abscessus (4.5%), M. gordonae (3.3%), M. kansasii (1.1%), M. chelonae (1.0%), and M. massiliense (0.9%).In patients over the age of 70 years, the proportion of NTM among the isolates increased from 26.6% in 2007 to 62.0% in 2019, and that of M. intracellulare isolates among the NTM increased from 13.9% (11/79) in 2007 to 37.4% (175/468) in 2019. Conclusion The number of NTM isolates continuously increased over the study period, and the increase in the proportion of M. intracellulare in patients aged over 70 years was notable.

Purpose: Despite decreased prevalence of tuberculosis, the incidence of the diseases associated with nontuberculous mycobacteria (NTM) has been increasing in South Korea and around the world. The present retrospective study was conducted to determine longitudinal changes in the epidemiology and distribution of NTM over 13 years at a tertiary care hospital in Korea. Materials and Methods: We retrospectively analyzed data on Mycobacterium species over 13 years (January 2007 to December 2019) by utilizing the laboratory information system. Mycobacterium species were identified using biochemical tests and PCR-restriction fragment length polymorphism and Mycobacteria GenoBlot assays. Results: After excluding duplicates from the initial pool of 17996 mycobacterial isolates, 7674 strains were analyzed and 2984 (38.9%) NTM were isolated. The proportion of NTM continuously increased over the 13-year period, from 17.0% in 2007 to 57.5% in 2019. Among the NTM isolates, the most common species were Mycobacterium intracellulare (50.6%), M. avium (18.3%), M. fortuitum complex (4.9%), M. abscessus (4.5%), M. gordonae (3.3%), M. kansasii (1.1%), M. chelonae (1.0%), and M. massiliense (0.9%).In patients over the age of 70 years, the proportion of NTM among the isolates increased from 26.6% in 2007 to 62.0% in 2019, and that of M. intracellulare isolates among the NTM increased from 13.9% (11/79) in 2007 to 37.4% (175/468) in 2019. Conclusion The number of NTM isolates continuously increased over the study period, and the increase in the proportion of M. intracellulare in patients aged over 70 years was notable.

Cimetidine, and H2-receptor blocker, is associated with a direct inhibition of liver microsomal enzymes and a decrease in liver blood flow which results in a variety of clinically significant drug interactions, but its effects on the action of muscle relaxants have not been established. Recently, Kambam et al(1987) reported that the duraion of action of succinylcholine was prolonged 2~2.5 times by cimetidine. The effects of cimetidine, ranitidine, and famotidine, on duration of action of succinylcholine and vecuronium were studied. Sixty ASA class 1 or 2 patients scheduled for elective exploratory laprotomies were randomly divided into two groups as follows: Succinylcholine Group(n=40, 1mg/kg) control group(n=10), cimetidine group(n=10): 300mg ph hs & 1 hour before induction, ranitidine group(n=10): 150mg po hs & 1 hour before induction, famotidine group(n=10) : 40mg po hs only. Vecuronimu Group(n=20, 0.08mg/kg) control group(n=10), famotidine group(n=10): 40 mg po hs only. All patients were premedicated with hydroxyzine(1.5mg/kg) and Robinul 0.2mg IM, 1 hour before anesthesia. Anesthesia was induced with thiopental sodium 5~6mg/kg and succinylcholine 1mg/kg or vecuronium 0.08mg/kg. Tracheal intubation was performed at 75~!00% block as monitored by train-of-four stimulation of the ulnar nerve at 2Hz, 20 seconds apart(ABM, Datex). Anesthesis was maintained with 50% nitrous oxide, oxygen, and 2% enflurane. The duration of action of the muscle relaxants was measured from injection of muscle relaxant to the time of 25% recovery of first twitch height on train-of-four stimulation. The results were as follows: 1) The duration of succinylcholine was prolonged significantly by the H2-receptor blockers, 8.3+/-1.49 minutes with cimetidine, 9.8+/-1.98 minutes with ranitidine, and 10.3+/-2.48 minutes in the famotidine group as compared to 6.9+/-1.43 minutes in the control(p<0.05). 2) The duration of action of vecuronium was not affected significantly by the H2-receptor blocker, 26.5+/-4.72 minutes in the famotidine group as compared to 23.6+/-4.52 minutes in the control(p>0.05).
Anesthesia ; Cimetidine ; Drug Interactions ; Enflurane ; Famotidine ; Humans ; Hydrogen-Ion Concentration ; Intubation ; Liver ; Nitrous Oxide ; Oxygen ; Ranitidine ; Succinylcholine* ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide*

The acute Achilles tendon rupture usually occurs to the people who participate in sports-related activities between 30 and 40 years of age. Recently surgical repair is the standard treatment in acute Achilles tendon rupture. After the Achilles tendon rupture in the left ankle, a 30-years old young man had been suffered from re-rupturing within three months after the primary repair. 2 years later, right-side Achilles tendon was reruptured after primary repair consequently. In the revision surgery, we performed V-Y advancement of the gastrocnemius-soleus fascia and reinforcement of the semitendinosus tendon. None of the English-literature was reported about using the semitendinosus tendon in revision surgery of the Achilles tendon retear previously. Therefore, we report this case and surgical technique because of the simple technique and the excellent results.
Achilles Tendon* ; Adult ; Ankle ; Fascia ; Humans ; Rupture ; Tendons* ; Transplants*

PURPOSE: Tension-free hernioplasty has become the most popular procedure for the repair of groin hernias in the United States and United Kingdom. The purpose of this study is to describe a 7-year personal experience with Lichtenstein's tension-free groin hernia repair under local anesthesia. METHODS: We retrospectively studied the clinical outcome of 321 cases of Lichtenstein repairs, performed consecutively by an experienced surgeon between Jan. 1994 and Dec. 2000. RESULTS: Of the 321 cases, 242 (75.4%) were indirect, 34 (10.6%) were direct, 8 (2.5%) were femoral, 7 (2.2%) were pantaloon, and 30 (9.3%) were recurred hernias. The mean age was 55 years; 91% were male. The mean number of injections of analgesics required in the postoperative period was 3.2. The mean hospital stay following repair was 2.7 days. Complications occurred in 23 cases (7.1%). Most of these were minor, consisting of five cases of bruising or hematomas (1.6%), four superficial infections (1.3%), three seromas (0.9%), two hydroceles (0.6%), six patients with persisting groin pain for more than a month (1.8%), one foreign body granuloma, one urinary retention, and one testicular atrophy. There were no recurrences or operative deaths. CONCLUSION: Lichtenstein's tension-free hernioplasty is an easy and simple technique with less pain, minor complications and only rare instances of recurrence. This procedure can be performed on a same-day basis under local anesthesia. Lichtenstein repair may be the most promising technique for the repair of groin hernias.
Analgesics ; Anesthesia, Local ; Atrophy ; Granuloma, Foreign-Body ; Great Britain ; Groin* ; Hematoma ; Hernia* ; Herniorrhaphy ; Humans ; Length of Stay ; Male ; Postoperative Period ; Recurrence ; Retrospective Studies ; Seroma ; United States ; Urinary Retention