OBJECTIVE: Jumping from high place for the purpose of suicide results in various damages to body area. A burst fracture of vertebrae is representative of them and we reviewed eight patients who were diagnosed with spinal burst fracture following suicide falling-down. The demographics, characteristics, performed operation, combined injuries, psychological past histories of the patients were analyzed. METHODS: A retrospective study was made of patients who are diagnosed with vertebral burst fracture from falling-down with the purpose of suicide admitted to department of neurosurgery of the author's hospital, covering the period between 2003 and 2012. RESULTS: Total eight patients were suicidal jumper. There were eleven vertebral burst fractures in eight patients and mean age was 26.5 years old. Seven patients already had psychological past history and there were various combined injuries except vertebrae burst fracture. The ankle fracture such as calcaneus, talus, navicular and malleolus was the most common injury and there were also various combined injury. CONCLUSION: Suicidal jumper is different from incidental faller in some aspects because of different injury mechanism. For managing suicidal jumper, physician had to consider patients' age, affected site, psychiatric problem and combined injuries. Each department related to the injuries of patient have to cooperate each other with departments of psychiatry and rehabilitation from beginning to end.
Ankle Fractures ; Calcaneus ; Demography ; Humans ; Neurosurgery ; Rehabilitation ; Retrospective Studies ; Spinal Fractures ; Spine ; Suicide ; Suicide, Attempted* ; Talus

PURPOSE: This study was performed for the purpose of finding causative organisms and clinical features of septic arthritis or acute osteomyelitis in children. METHODS: The study involved a retrospective review of the medical records of 63 microbiologically confirmed cases of acute pyogenic arthritis and osteomyelitis. All of the cases were brought about by community-associated infections and managed at the Seoul National University Children's Hospital or Seoul National University Bundang Hospital from June 2003 to July 2009. RESULTS: The median age of all cases was 60 months and there were 35 males and 28 females. Major involved joints included the hip joint (15 cases), knee joint (7 cases), shoulder joint (4 cases), and elbow joint (4 cases). Also, major involved bones included the femur (20 cases), tibia (13 cases), humerus (7 cases), and radius (7 cases). Staphylococcus aureus was the most commonly identified causative organism, accounting for 49 cases (77.8%). Of the 49 isolates of S. aureus, methicillin-resistant S. aureus (MRSA) accounted for 8 cases (16.3%). Group B streptococcus spp. (GBS) and Salmonella spp. accounted for 3 cases, respectively. Nafcillin or cefazolin was often prescribed as an initial empirical antibiotic. There were 9 cases that were managed by a regimen that included vancomycin as the first choice. Fifty four cases (85.7%) recovered without any complications. Methicillin-sensitive S. aureus (MSSA), responsible for 41 cases, caused chronic complications in 3 cases. Of 8 cases caused by MRSA, 1 case showed chronic complication. There were no fatal cases. CONCLUSION: S. aureus remains the most common organism causing acute pyogenic arthritis and osteomyelitis of childhood acquired in the community. The high prevalence of methicillin resistance among S. aureus should be considered carefully in the selection of initial empirical antibiotics.
Accounting ; Anti-Bacterial Agents ; Arthritis ; Arthritis, Infectious ; Cefazolin ; Child ; Elbow Joint ; Female ; Femur ; Hip Joint ; Humans ; Humerus ; Joints ; Knee Joint ; Male ; Medical Records ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Nafcillin ; Osteoarthritis ; Osteomyelitis ; Prevalence ; Radius ; Retrospective Studies ; Salmonella ; Shoulder Joint ; Staphylococcus aureus ; Streptococcus ; Tibia ; Vancomycin

Achromobacter xylosoxidans is an uncommon cause of peritonitis in patients on maintenance continuous ambulatory peritoneal dialysis (CAPD). CAPD peritonitis caused by Achromobacter xylosoxidans carries high mortality and recurrence rates because of its virulence and resistance to most antimicrobial agents. We experienced a case of CAPD peritonitis caused by Achromobacter xylosoxidans in a patient with hypertension, diabetes mellitus, and end stage renal disease. The patient was treated with intravenous imipenem/cilastatin, and the CAPD catheter was removed. However, the patient died by aspiration pneumonia on the 34th day of hospitalization.
Achromobacter ; Achromobacter denitrificans ; Anti-Infective Agents ; Catheters ; Diabetes Mellitus ; Hospitalization ; Humans ; Hypertension ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Pneumonia, Aspiration ; Recurrence

BACKGROUND/AIMS: The development of effective, accurate, and rapid diagnostic methods for Mycobacterium infection and mycobacterial species identification is required. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) is an easy, rapid and inexpensive technique for identifying Mycobacterium spp. METHODS: We performed PCR-RFLP to detect and identify Mycobacterium spp. from 10 sterile body fluids, including ascites, cerebrospinal fluid, pleural fluid, synovial fluid, and peritoneal dialysis fluid. Clinical samples were collected from patients with diagnoses of definite, probable or suspected mycobacterial infection. The conserved RNA polymerase genes of Mycobacterium spp. were amplified by PCR. RESULTS: The amplified 360-bp region of rpoB was digested with the restriction enzyme MspI or HaeIII. The PCRRFLP results for the clinical samples were identical to those for M. tuberculosis, M. fortuitum, M. intracellulare, and M. avium. In addition, the results of the PCR-RFLP were identical to those obtained by DNA sequencing. CONCLUSIONS: PCR-RFLP analysis of sterile body fluids may be a useful method for the diagnosis of mycobacterial infections and for the differentiation of mycobacterial species.
*Amplified Fragment Length Polymorphism Analysis ; Bacterial Proteins/*genetics ; *Bacterial Typing Techniques ; Body Fluids/*microbiology ; DNA, Bacterial/*analysis ; DNA-Directed RNA Polymerases/*genetics ; Humans ; Mycobacterium/*classification/genetics ; Mycobacterium Infections/*diagnosis/microbiology ; *Polymorphism, Restriction Fragment Length

OBJECTIVE: There are various posterior fusion techniques in managing C1-2 instability. The aim of this study is to evaluate surgical techniques and clinical results including complications of the C1 lateral mass and C2 pedicle screw fixation (C1-2 LMPSF) in atlantoaxial disorders. METHODS: From February 1997 to July 2008, 24 patients were performed C1-2 LMPSF due to C1-2 instability. Pathway of vertebral artery was classified into three groups by 3D-angiogram. Diameter of C1 lateral mass and C2 isthmus on the plain X-ray and CT was measured before operation. Surgical method was divided into four groups according to fixation site (bilateral or unilateral) and bone graft (with or without graft). Stability of C1-2 fixation was postoperatively evaluated by flexion and extension cervical lateral films. We reviewed clinical data, imaging studies and old chart retrospectively as sources for analysis. RESULTS: Among 24 patients, os odontoideum was the most common cause (16 out of 24). Four patients had anomalous vertebral artery. Mean diameters of C1 lateral mass was 9.9(range 4.2~16.4) mm at right side, 10.3 (range 3.4~14.2) mm at left side. Mean diameter of C2 isthmus was 5.8 (range 1.0~10.1) mm at right side and 5.8(range 2.1~8.2) mm at left side. Two patients showed very narrow C2 isthmus. As a result, unilateral C1-2 LMPSF was performed on 6 patients (4 for anomalous vertebral arteries and 2 for narrow C2 isthmus). 12 of 18 patients were with C1-2 interlaminar bone graft and 6 patients without bone graft. All patients showed stable C1-2 fixation by flexion and extension cervical lateral X-ray films taken at least 6 months after surgery. Five out of 8 patients who had preoperative radiculopathy only showed improved symptoms. However, Seven out of 8 patients who had myelopathy showed little neurological improvement . CONCLUSION: For C1-2 LMPSF, preoperative 3D CT-angiogram study is mandatory to identify abnormal vertebral artery and narrow C2 isthmus. Bilateral C1-2 LMPSF without bone graft is enough to obtain stable C1-2 fixation. If there is an abnormal vertebral artery or narrow C2 isthmus, unilateral C1-2 LMPSF with bone graft and wiring is alternative successful method.
Humans ; Radiculopathy ; Retrospective Studies ; Spinal Cord Diseases ; Transplants ; Vertebral Artery ; X-Ray Film

BACKGROUND: There have been no reports to evaluate the usefulness of combination therapy with glycopeptide and arbekacin in endocarditis by in vivo model. MATERIALS AND METHODS: We investigated the efficacy of the arbekacin and teicoplanin combination on glycopeptide intermediate Staphylococcus aureus (GISA) in rabbit model of endocardits. GISA Mu50 strain was used for the experiment. The rabbit model of aortic valve endocarditis as described previously was used. Treatment was started 20h later inoculation with teicoplanin alone (at 20 mg/kg of body weight intramuscularly every 12 hours for 4 days after loading dose of 40 mg/kg of body weight intramuscularly), arbekacin alone (5 mg/kg of body weight intramuscularly every 12h for 4 days), or teicoplanin plus arbekacin. The results of therapy for experimental endocarditis due to Mu50 showed that teicoplanin and arbekacin combination was more effective than the administration of both drugs alone in reducing the log10CFU/g of aortic vegetation (P<0.05). CONCLUSION: The combination of teicoplanin and arbekacin was more effective against GISA (Mu50) than both drugs alone in vivo endocarditis model.
Aortic Valve ; Body Weight ; Dibekacin ; Endocarditis ; Sprains and Strains ; Staphylococcus ; Staphylococcus aureus ; Teicoplanin

BACKGROUND: There have been no reports to evaluate the usefulness of combination therapy with glycopeptide and arbekacin in endocarditis by in vivo model. MATERIALS AND METHODS: We investigated the efficacy of the arbekacin and teicoplanin combination on glycopeptide intermediate Staphylococcus aureus (GISA) in rabbit model of endocardits. GISA Mu50 strain was used for the experiment. The rabbit model of aortic valve endocarditis as described previously was used. Treatment was started 20h later inoculation with teicoplanin alone (at 20 mg/kg of body weight intramuscularly every 12 hours for 4 days after loading dose of 40 mg/kg of body weight intramuscularly), arbekacin alone (5 mg/kg of body weight intramuscularly every 12h for 4 days), or teicoplanin plus arbekacin. The results of therapy for experimental endocarditis due to Mu50 showed that teicoplanin and arbekacin combination was more effective than the administration of both drugs alone in reducing the log10CFU/g of aortic vegetation (P<0.05). CONCLUSION: The combination of teicoplanin and arbekacin was more effective against GISA (Mu50) than both drugs alone in vivo endocarditis model.
Aortic Valve ; Body Weight ; Dibekacin ; Endocarditis ; Sprains and Strains ; Staphylococcus ; Staphylococcus aureus ; Teicoplanin

In Korea, as the prevalence of acquired immune deficiency syndrome (AIDS) increases, various opportunistic infections are becoming a problem. Progressive multifocal leukoencephalopathy (PML) is postulated to be associated with impaired cellular immunity and can be more frequently encountered these days primarily due to increasing incidence of AIDS. Neurologic deficits and brain imaging study together strongly suggest PML, but confirmatory diagnosis can be made only by cerebrospinal fluid study or tissue biopsy. In Korea few cases of confirmed PML in AIDS patients have been reported, and herein we offer our experience of a case of PML who underwent brain biopsy for confirmative diagnosis.
Acquired Immunodeficiency Syndrome* ; Biopsy ; Brain ; Cerebrospinal Fluid ; Diagnosis ; HIV ; Humans ; Immunity, Cellular ; Incidence ; Korea ; Leukoencephalopathy, Progressive Multifocal* ; Neuroimaging ; Neurologic Manifestations ; Opportunistic Infections ; Prevalence

In Korea, as the prevalence of acquired immune deficiency syndrome (AIDS) increases, various opportunistic infections are becoming a problem. Progressive multifocal leukoencephalopathy (PML) is postulated to be associated with impaired cellular immunity and can be more frequently encountered these days primarily due to increasing incidence of AIDS. Neurologic deficits and brain imaging study together strongly suggest PML, but confirmatory diagnosis can be made only by cerebrospinal fluid study or tissue biopsy. In Korea few cases of confirmed PML in AIDS patients have been reported, and herein we offer our experience of a case of PML who underwent brain biopsy for confirmative diagnosis.
Acquired Immunodeficiency Syndrome* ; Biopsy ; Brain ; Cerebrospinal Fluid ; Diagnosis ; HIV ; Humans ; Immunity, Cellular ; Incidence ; Korea ; Leukoencephalopathy, Progressive Multifocal* ; Neuroimaging ; Neurologic Manifestations ; Opportunistic Infections ; Prevalence

BACKGROUND: Pneumocystis carinii pneumonia (PCP) is one of the most common cause of infection in patients with HIV infection. Recently, the incidence of PCP have been increasing in immunocompromised hosts without HIV infection. We compared the clinical characteristics of PCP between HIV infected and non-infected persons. PATIENTS AND METHODS: We retrospectively reviewed the charts of 25 patients diagnosed as PCP from 1996 to 2002. Age, sex, underlying conditions, use of immunosuppressants, clinical courses, laboratory findings, treatment and prognosis were compared between HIV infected and non-infected persons. RESULTS: Twenty-five patients with PCP were identified. 16 were HIV infected, and 9 were HIV non-infected. The mean age of overall patients was 43.4+/-13.2 years. Underlying conditions in HIV non-infected persons were hematologic malignancy (7 cases), solid organ transplant (1 case), and autoimmune disease (1 case). Seven cases (77.8%) of HIV non-infected persons had a history of steroid use. Mean duration of symptoms was longer in HIV infected persons than in HIV non-infected persons, but it was not statistically significant. PaO2 was lower in HIV infected persons (61.2+/-16.9 mmHg vs.65.4+/-15.4), but it was not statistically significant. Chest X ray showed typical ground glass opacity in 12 cases (75%) of HIV infected persons and in 4 cases (44.4%) of HIV non-infected persons. Twelve cases (75%) of HIV infected persons were treated with steroid, as were 6 cases (66.7%) of HIV non-infected persons. Ventilator care was needed in 6 cases (37.5%) of HIV infected persons and in 2 cases (22.2%) of HIV non-infected persons. Mortality of HIV infected persons was 50%, and that of HIV non-infected persons was 11.1%. CONCLUSIONS: PCP showed some different clinical characteristics between HIV infected and non-infected persons. Prospective studies regarding the risk factors of PCP, prophylaxis, treatment and prognosis in HIV infected and non-infected persons are warranted.
Autoimmune Diseases ; Glass ; Hematologic Neoplasms ; HIV Infections ; HIV* ; Humans ; Immunocompromised Host ; Immunosuppressive Agents ; Incidence ; Mortality ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia, Pneumocystis* ; Prognosis ; Retrospective Studies ; Risk Factors ; Thorax ; Transplants ; Ventilators, Mechanical