Background and Objectives: Anti-adhesion agents based on hyaluronate-carboxymethyl cellulose (HA-CMC) are widely used in thyroid surgery to reduce postoperative adhesions. However, concerns persist that higher application volumes may increase postoperative drainage and prolong hospitalization. This study aimed to evaluate the impact of different doses of an HA-CMC solution (Guardix-SGⓇ ) on postoperative drainage and clinical outcomes after hemithyroidectomy. Materials and Methods: This prospective study included 107 patients who underwent hemithyroidectomy with central neck lymph node dissection for thyroid cancer between January and October 2024. Patients were randomly assigned to receive either 3 g (n=57) or 6 g (n=50) of Guardix-SGⓇ intraoperatively.Postoperative drainage volume, drain duration, and length of hospital stay were compared between groups.Analysis of covariance and quantile regression were performed to assess the effects of HA-CMC dose and clinical covariates on drainage outcomes. Results: Baseline demographic and pathological characteristics were comparable between the two groups. Total postoperative drainage volume did not differ significantly between the 3 g and 6 g groups, even after adjustment for hospital stay (p=0.283), nor did drain duration. Quantile regression analysis revealed that hypertension was independently associated with increased drainage volume in higher quantiles (0.25– 0.75), whereas the dose of HA-CMC solution had no significant effect across any quantile. Conclusion Application of a higher dose (6 g) of HA-CMC solution did not increase postoperative drainage or prolong drain duration after hemithyroidectomy. These findings support the safe and effective use of higher-dose Guardix-SGⓇ in thyroid surgery.

Purpose: Triple-negative breast cancer (TNBC) is a heterogeneous and aggressive subtype of breast cancer associated with poor clinical outcomes. Although programmed death ligand 1 (PD-L1) expression has emerged as both a prognostic and predictive biomarker, its utility remains limited, especially in PD-L1-negative tumors. The identification of additional molecular markers is crucial for improving prognostic stratification and guiding treatment strategies. Methods: Formalin-fixed, paraffin-embedded tumor tissues from 38 patients with TNBC were analyzed. PD-L1 expression was assessed using immunohistochemistry and categorized as positive or negative. Whole-exome sequencing was performed, and somatic variants were analyzed using Maftools. Mutational signatures were compared with the Catalogue Of Somatic Mutations In Cancer reference profiles. Survival analyses were performed to evaluate the prognostic significance of the identified variants. Results: Mutational landscape analysis revealed that C>T and G>A transitions were the most frequent base substitutions. PD-L1-negative tumors exhibited a predominance of single-base substitution (SBS) 5, whereas PD-L1-positive tumors resembled SBS6, reflecting potential differences in the underlying mutational processes. Comparative analysis identified 12 PD-L1-negative-specific and seven PD-L1-positive-specific variants. Among PD-L1-negative tumors, mutations in ANGPTL5 and KIAA1549L were significantly associated with worse overall survival. Conclusion Our findings highlight distinct mutational profiles and prognostic variants according to PD-L1 status in TNBC. ANGPTL5 and KIAA1549L variants may serve as potential prognostic markers for PD-L1-negative tumors. These results underscore the value of incorporating genomic information to refine the prognostic stratification of TNBC.

BACKGROUND: Escherichia coli and Klebsiella pneumoniae are two of the most common causes of urinary tract infection. The purpose of this study was to compare clinical characteristics and antimicrobial susceptibility of acute pyelonephritis (APN) between E. coli and K. pneumoniae. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients with APN due to E. coli and K. pneumoniae between February 2014 and October 2017. RESULTS: A total 329 patients were enrolled; 258 cases of E. coli and 71 cases of K. pneumoniae. Among them, 219 cases were categorized into community-onset APN; 194 cases of E. coli and 25 cases of K. pneumoniae, and 110 patients were categorized into healthcare-associated APN; 64 cases of E. coli and 46 cases of K. pneumoniae. Catheter-associated APN was more frequently observed in K. pneumoniae in both community-onset and healthcare-associated APN. Neurogenic bladder, obstructive uropathy, urinary tract stone, bacteremia, and severe APN were more related to E. coli in healthcare-associated APN. In multivariate analysis, urinary catheter was more associated with K. pneumoniae (odds ratio [OR] 9.643, 95% confidence intervals [CI] 4.919-18.904, P = 0.001) and neurogenic bladder was more associated with E. coli (OR 3.765, 95% CI 1.112-12.772, P = 0.033). Extended-spectrum β-lactamase (ESBL) production was observed in 29.0% of E. coli in community-onset APN. Among ESBL, antimicrobial susceptibility of piperacillin/tazobactam was significantly higher in E. coli and ciprofloxacin was significantly higher in K. pneumoniae. CONCLUSION K. pneumoniae were more associated with urinary catheter while E. coli tended to be more associated with urogenital problems. ESBL positivity showed no significance in healthcare-associated APN. In community-onset APN, ESBL producing E. coli was more observed than K. pneumoniae.

The Alternaria species are dematiaceous fungi. Human infection due to dematiaceous fungi is uncommon. Most reported cases of alternariosis have occurred in patients with immunodeficiency. The majority of cases were solid-organ transplantation recipients. Cutaneous alternariosis lesions are usually asymptomatic solitary nodules, plaques of ulcers or subcutaneous cysts. Here we report a case of a 77-year-old female who presented with hemorrhagic skin necrosis in right arm that had developed from hemorrhagic bullae. Her prior medical history included iatrogenic Cushing's syndrome, hypertension, interstitial lung disease and congestive heart failure. Following administration of itraconazole, her lesions improved.
Aged ; Alternaria ; Alternariosis ; Arm ; Cushing Syndrome ; Female ; Fungi ; Heart Failure ; Humans ; Hypertension ; Itraconazole ; Lung Diseases, Interstitial ; Necrosis ; Phaeohyphomycosis ; Skin ; Ulcer

Tigecycline is a broad spectrum antibiotic which has been used for complicated intra-abdominal infection and complicated skin and soft tissue infection by multi-drug resistant bacteria. However recent meta-analysis studies have raised a concern for adverse events of tigecycline. We analyzed retrospectively adverse events, associated factors of adverse events in multi-drug resistant bacteria caused infections treated with tigecycline in Korean patients. One hundred-sixty patients treated with tigecycline from July 2009 to September 2013 were enrolled in this study. Their clinical and microbiologic data were reviewed. History of invasive procedure within 7 days and recent operation within 3 months were associated with adverse events. The most common adverse events were nausea and vomiting. Associated factors of nausea were soft tissue injury and recent operation within 3 months. In this study, nausea was the most common adverse event in patients who received tigecycline. Although it is not serious complication, monitoring of adverse events is required to increase compliance.
Bacteria ; Compliance ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Incidence* ; Intraabdominal Infections ; Nausea ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Soft Tissue Injuries ; Vomiting

BACKGROUND/AIMS: Klebsiella pneumoniae is second most common organism of gram-negative bacteremia in Korea and one of the most common cause of urinary tract infection, and intra-abdominal infection. METHODS: We compared clinical and microbiological characteristics about K. pneumoniae bacteremia in a tertiary hospital between 10 years. Group A is who had K. pneumoniae bacteremia at least one time from January 2004 to December 2005. Group B is from January 2012 to December 2013. We also analyzed antibiotic resistance, clinical manifestation of the K. pneumoniae bacteremia divided into community-acquired infections, healthcare associated infections, and nosocomial infections. RESULTS: The resistance for ampicillin, aztreonam, cefazolin, and cefotaxime significantly increased compared to 10 years ago. Extended spectrum β-lactamase positivity surged from 4.3% to 19.6%. Ten years ago, 1st, 2nd cephalosporin, and aminoglycoside were used more as empirical antibiotics. But these days, empirical antibiotics were broad spectrum such as 3rd and 4th cephalosporin. In treatment outcome, acute kidney injury decreased from 47.5% to 28.7%, and mortality decreased from 48.9% to 33.2%. In community-acquired infections, there was similar in antimicrobial resistance and mortality. In healthcare-associated and nosocomial infections, there was significantly increasing in antibiotic resistance, decreasing in mortality, and acute kidney injury. CONCLUSIONS: In community-acquired infections, broader antibiotics were more used than 10 years ago despite of similar antimicrobial resistance. When K. pneumoniae bacteremia is suspected, we recommend to use the narrow spectrum antibiotics as initial therapy if there are no healthcare-associated risk factors, because the antibiotic resistance is similar to 10 years ago in community-acquired infections.
Acute Kidney Injury ; Ampicillin ; Anti-Bacterial Agents ; Aztreonam ; Bacteremia* ; Cefazolin ; Cefotaxime ; Community-Acquired Infections ; Cross Infection ; Drug Resistance ; Drug Resistance, Microbial ; Intraabdominal Infections ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Mortality ; Pneumonia ; Risk Factors ; Tertiary Care Centers ; Treatment Outcome ; Urinary Tract Infections

The incidence of bacteremia in human immunodeficiency virus (HIV)-infected patients is significantly decreased by highly active antiretroviral therapy (HAART). However, bacteremia remains a major cause of morbidity and mortality in HIV-infected patients. A 43-year-old male who had fever and cough for 1 week presented to the emergency room. He was diagnosed with acquired immunodeficiency syndrome combined with atypical pneumonia and started on antibiotics plus HAART. After 3 days, Streptococcus pneumoniae was grown in blood cultures. Three weeks later, acid-fast bacilli cultures of blood and bronchoalveolar lavage fluid grew Mycobacterium avium complex (MAC); hence, the patient was treated with antimycobacterial drugs. HIV-infected patients with persistent fever despite administration of appropriate antibiotics should be examined for simultaneous infection by other organisms, such as nontuberculous mycobacteria. We report a case of simultaneous detection of MAC and S. pneumoniae in the blood of a treatment-naïve HIV-infected patient.
Acquired Immunodeficiency Syndrome* ; Adult ; Anti-Bacterial Agents ; Antiretroviral Therapy, Highly Active ; Bacteremia ; Bronchoalveolar Lavage Fluid ; Cough ; Diagnosis* ; Emergency Service, Hospital ; Fever ; HIV ; Humans ; Incidence ; Male ; Mortality ; Mycobacterium avium Complex* ; Mycobacterium avium* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Pneumonia ; Sepsis* ; Streptococcus pneumoniae

Candidemia is increasing cause of mortality, especially in intensive care unit patients. And Candida endophthalmitis, developed with or without symptoms, has poor outcome. Prompt use of antifungal agents and early diagnosis of Candida endophthalmitis are clinically important to treat candidemia. In this study, we compared clinical, microbiological, ophthalmological characteristics and treatment outcomes whether infectious disease (ID) specialists mediate candidemia or not in a tertiary hospital by retrospective chart review. Group A includes patients who had candidemia at least one time from January 2012 to July 2013, without ID specialists mediation. Group B includes patients who had candidemia at least one time from August 2013 to December 2014, with ID specialists surveillances and mediations. We compared clinical manifestations of candidemia, uses of antifungal agent, ophthalmologic evaluations and treatment outcomes between two groups. In group A, rate of ophthalmologic evaluations was 4.4% and mean duration was 64.60 hours from blood culture to use of antifungal agents. In group B, the rate of ophthalmologic evaluations was 43.2% and mean duration was 50.15 hours. There was no statistically significant difference in clinical characteristics and 30-day mortality between two groups. Increasing rate of ophthalmologic evaluations and decreasing mean duration from blood culture to use of antifungal agents was shown in surveillance and mediation group.
Antifungal Agents* ; Candida ; Candidemia* ; Communicable Diseases ; Early Diagnosis ; Endophthalmitis ; Humans ; Intensive Care Units ; Mortality ; Negotiating ; Retrospective Studies ; Specialization ; Tertiary Care Centers

Kikuchi-Fujimoto disease (KFD) is a benign, self-limiting disease, with a specific histopathology. It can be diagnosed clinically, and specific symptoms include fever and cervical lymphadenopathy. The histological finding of KFD in cervical lymph nodes includes necrotizing lymphadenitis. KFD needs conservative treatments. If KFD persists for a long period, steroids or nonsteroidal antiinflammatory drugs can be used to control symptoms. Previous studies have reported the treatment of KFD with hydroxychloroquine (HC) in patients unresponsive to steroids. Herein, we report a case of a 25-year-old female patient diagnosed with KFD unresponsive to steroids, and was successfully treated with HC.
Adult ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Hydroxychloroquine* ; Lymph Nodes ; Lymphadenitis ; Lymphatic Diseases ; Steroids

Thrombocytopenia is a common manifestation of rickettsial disease. However, the pathogenesis of thrombocytopenia in many rickettsial diseases is poorly understood. Thrombocytopenia may be associated with consumption due to widespread endothelial damage or disseminated intravascular coagulation, hypersplenism, decreased marrow production, and immune-mediated platelet destruction. Some reports have found anti-platelet antibodies detected in thrombocytopenic patients with rickettsial disease. In addition to thrombocytopenia, facial palsy and Guillain-Barre syndrome were also reported as immune-mediated phenomena in scrub typhus. Here we report a case diagnosed as immune-mediated thrombocytopenia associated with scrub typhus. This is the first report of immune thrombocytopenic purpura (ITP) associated with scrub typhus in Korea. The patient exhibited eschar with a high titer of anti-tsutsugamushi antibody, thrombocytopenia, severe gastrointestinal hemorrhage, and purpura on the lower region of both legs. After steroid treatment, the sustained thrombocytopenia recovered.
Antibodies ; Blood Platelets ; Bone Marrow ; Disseminated Intravascular Coagulation ; Facial Paralysis ; Gastrointestinal Hemorrhage ; Guillain-Barre Syndrome ; Humans ; Hypersplenism ; Korea ; Leg ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Scrub Typhus* ; Thrombocytopenia