BACKGROUND: Vertebral osteomyelitis (VO) is a rare but serious condition, and a potentially significant cause of morbidity. Methicillin-susceptible Staphylococcus aureus (MSSA) is the most common microorganism in native VO. Long-term administration of parenteral and oral antibiotics with good bioavailability and bone penetration is required for therapy. Use of oral β-lactams against staphylococcal bone and joint infections in adults is not generally recommended, but some experts recommend oral switching with β-lactams. This study aimed to describe the current status of antibiotic therapy and treatment outcomes of oral switching with β-lactams in patients with MSSA VO, and to assess risk factors for treatment failure. MATERIALS AND METHODS: This retrospective study included adult patients with MSSA VO treated at nine university hospitals in Korea between 2005 and 2014. Treatment failure was defined as infection-related death, microbiological relapse, neurologic deficits, or unplanned surgical procedures. Clinical characteristics and antibiotic therapy in the treatment success and treatment failure groups were compared. Risk factors for treatment failure were identified using the Cox proportional hazards model. RESULTS: A total of 100 patients with MSSA VO were included. All patients were treated, initially or during antibiotic therapy, with one or more parenteral antibiotics. Sixty-nine patients received one or more oral antibiotics. Antibiotic regimens were diverse and durations of parenteral and oral therapy differed, depending on the patient and the hospital. Forty-two patients were treated with parenteral and/or oral β-lactams for a total duration of more than 2 weeks. Compared with patients receiving parenteral β-lactams only, no significant difference in success rates was observed in patients who received oral β-lactams for a relatively long period. Sixteen patients had treatment failure. Old age (adjusted hazard ratio [HR] 5.600, 95% confidence interval [CI] 1.402 – 22.372, P = 0.015) and failure to improve C-reactive protein levels at follow-up (adjusted HR 3.388, 95% CI 1.168 – 9.829, P = 0.025) were independent risk factors for treatment failure. CONCLUSION In the study hospitals, diverse combinations of antibiotics and differing durations of parenteral and oral therapy were used. Based on the findings of this study, we think that switching to oral β-lactams may be safe in certain adult patients with MSSA VO. Since limited data are available on the efficacy of oral antibiotics for treatment of staphylococcal VO in adults, further evaluation of the role of oral switch therapy with β-lactams is needed.

PURPOSE: This study was attempted to grasp the factors affecting the decision-making conflicts of preoperative cancer patients. METHODS: The subjects of this study were 110 cancer patients scheduled to undergo surgeries at K university hospital. Data were collected utilizing scales for decision-making conflicts and anxiety state, and measurement tools for attitude toward treatment and, shared decision-making. RESULTS: The level of decision-making conflicts over cancer treatment of preoperative cancer patients turned out to be slightly lower than the median. There were significant correlations between shared decision-making between physicians and patients, and quality of life which was a subdomain of attitude toward treatment. In multiple regression analysis, the most powerful predictor was the shared decision-making of physicians and patients. Overall, the explanatory power of the measured variables for decisionmaking conflicts about cancer therapy was 20%. CONCLUSION: The study highlights the importance of shared decision-making and quality of life which involves attitude toward treatment. Thereby, it is deemed to be necessary to develop intervention strategies regarding decision-making conflicts about cancer treatment in consideration of these variables.
Anxiety ; Decision Making* ; Drug Therapy* ; Hand Strength ; Humans ; Quality of Life ; Weights and Measures

No abstract available.
Carney Complex* ; Hyperplasia* ; Myxoma* ; Nevus, Blue* ; Testis*

PURPOSE: To investigate correlations of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor type 2 (HER2) statuses with magnetic resonance imaging (MRI) features and clinicohistological characteristics in patients with invasive lobular carcinoma (ILC). MATERIALS AND METHODS: Data from 64 histologically confirmed ILCs were analyzed retrospectively. Preoperative breast MRI was reviewed for morphology and dynamic contrast-enhanced kinetics of the tumor. Pathologic reports were reviewed for ER, PR, and HER2 positivity, tumor size, lymph node metastasis, and the number of metastatic lymph nodes. Furthermore, there was an investigation of the MRI features and clinicohistologic characteristics, according to the ER, PR, and HER2 statuses. RESULTS: A significant difference in MRI features and clinicohistological tumor characteristics were observed only in relation to PR status. Of the 64 ILCs, 10 (15.6%) were PR negative. PR negative cancers, compared with PR positive cancers, were more likely to present as non-mass enhancement (P = 0.027); have a significantly larger mean tumor size (5.00 +/- 1.05 cm vs. 2.57 +/- 0.21 cm, P = 0.021); and have significantly more metastatic lymph nodes (P = 0.010). CONCLUSIONS: PR negative ILC presented more frequently as non-mass enhancement on MRI, with larger tumors and increased numbers of metastatic lymph nodes. Therefore, the PR status plays an important role in determining MRI features and clinicohistological characteristics of ILC.
Breast ; Carcinoma, Lobular* ; Estrogens ; Humans ; Kinetics ; Lymph Nodes ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Retrospective Studies

PURPOSE: This study was performed to evaluate the compliance with, and adequacy of, the Korean national guidelines which had been recommended until 2011 for isolation of patients with group 1 nationally notifiable infectious diseases (NNIDs), namely cholera, typhoid fever, paratyphoid fever, shigellosis, and enterohemorrhagic Escherichia coli (EHEC) infection. MATERIALS AND METHODS: We evaluated the clinical and microbiological characteristics of confirmed cases of group 1 NNIDs and compliance with the guidelines in 20 Korean hospitals nationwide in 2000-2010. We also compared the Korean guidelines with international guidelines. RESULTS: Among 528 confirmed cases (8 cases of cholera, 232 of typhoid fever, 81 of paratyphoid fever, 175 of shigellosis, and 32 EHEC infections), strict compliance with the Korean guideline was achieved in only 2.6% to 50.0%, depending on the disease. While the Korean guidelines recommend isolation of all patients with group 1 NNIDs, international guidelines recommend selective patient isolation and screening for fecal shedding, depending on the type of disease and patient status. CONCLUSION: Compliance with the previous national guidelines for group 1 NNIDs in Korea was generally very low. Further studies are needed to evaluate whether compliance was improved after implementation of the new guideline in 2012.
Cholera ; Communicable Disease Control ; Communicable Diseases* ; Compliance* ; Dysentery, Bacillary ; Enterohemorrhagic Escherichia coli ; Guideline Adherence ; Humans ; Korea* ; Mass Screening ; Methods ; Paratyphoid Fever ; Patient Isolation ; Typhoid Fever

BACKGROUND: Necrotizing fasciitis (NF) is an infrequent but potentially lethal infection characterized by rapid progressive destruction of fascia and fat, concomitant systemic toxicity, and high fatality. In spite of the clinical significance of NF, only limited data is available regarding the clinical characteristics of patients with NF in Korea. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had been diagnosed as community-acquired NF in 9 centers of the Republic of Korea between January 2000 and November 2010. RESULTS: During the study period, a total of 103 patients had a community-acquired NF. Of sixty six cases with causative microorganisms identified, the majority (55, 83.3%) had monomicrobial infections. Whereas streptococci were the most common cause of NF in patients without underlying diseases (16/24, 66.7%), variable organisms, such as staphylococci, streptococci, Enterobacteriaceae, and non-fermentative Gram-negative bacilli were causative organisms of NF in patients with underlying diseases. The majority of patients with NF caused by Vibrio vulnificus or Aeromonas hydrophila (7/9, 77.8%) had liver cirrhosis or alcoholism. Surgery to counteract NF was performed in 60.2% of patients with NF (62/102), and mean time to surgery was 3 days. In-hospital mortality was observed in 21 of 99 patients with available data (21.2%). In multivariate analysis, the presence of solid tumors (adjusted OR [aOR]=63.88, 95% CI=2.58-1580.61, P=0.011), shock (aOR= 24.19, 95% CI=2.00-292.19, P=0.012), bacteremia (aOR=87.53, 95% CI=3.99-1921.46, P=0.005), and Gram-negative bacilli infections (aOR=437.11, 95% CI=4.67-40956.82, P=0.009) were associated with in-hospital mortality. CONCLUSIONS: Streptococci were predominant causative organisms of community-acquired NF in patients without underlying diseases. However, in patients with underlying diseases, variable organisms such as staphylococci, streptococci, Enterobacteriaceae, or non-fermentative Gram-negative bacilli were isolated. NF caused by V. vulnificus or A. hydrophila occurred frequently in patients with liver cirrhosis or alcoholism.
Aeromonas hydrophila ; Alcoholism ; Bacteremia ; Enterobacteriaceae ; Fascia ; Fasciitis, Necrotizing ; Hospital Mortality ; Humans ; Liver Cirrhosis ; Medical Records ; Multivariate Analysis ; Republic of Korea ; Retrospective Studies ; Shock ; Vibrio vulnificus

BACKGROUND: Although erysipelas and cellulitis are common soft tissue infectious diseases, there have been a few studies which investigate clinical characteristics and causative organisms in Korea. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had been diagnosed with erysipelas or cellulitis from ten general hospitals between January 2009 and February 2011. RESULTS: During the study period, a total of 144 patients with erysipelas and 735 with cellulitis were recruited. The mean age of erysipelas patients was 53.6 years, and that of cellulitis patients was 47.5 years. Diabetes mellitus was the most common underlying disease in both groups. The most common site of erysipelas was the face (80.6%) and that of cellulitis was the lower extremity (64.9%). Culture studies have been done in 31.9% (46/144) of patients with erysipelas, and 41.1% (302/735) with cellulites. Causative organisms were identified in 3 patients (2.1%) with erysipelas and 57 (7.8%) with cellulitis. Streptococcus pyogenes was isolated from two patients with erysipelas, and group G streptococcus from one. Staphylococcus aureus (44.0%) was the most common isolate in patients with cellulitis, followed by streptococci (27.1%), Enteobateriaceae (11.9%), and Vibrio species (6.8%). First-generation cephalosporin was the most commonly used antimicrobial agent in both groups. CONCLUSIONS: beta-hemolytic streptococcus and S. aureus were the most common causative organisms of patients with erysipelas and cellulitis.
Cellulitis ; Communicable Diseases ; Diabetes Mellitus ; Erysipelas ; Hospitals, General ; Humans ; Lower Extremity ; Medical Records ; Retrospective Studies ; Staphylococcus aureus ; Streptococcus ; Streptococcus pyogenes ; Vibrio

Composite pheochromocytoma-ganglioneuroma is one of the mixed neuroendocrine-neural tumors composed of pheochromocytoma and other neural crest derivatives. To date, less than 50 cases of composite pheochromocytoma have been reported, and about 70% of the accompanying tumors were ganglioneuromas. Here, we describe six cases of composite pheochromocytoma-ganglioneuromas in five men and one woman, aged 33 to 64. The size of the tumors ranged from 3.0 to 11.0 cm, and four out of the six presented with intermittent onset of hypertension, palpitation, or dizziness. Microscopically, each tumor was composed of large pleomorphic shaped chromaffin cells arranged in the Zellballen patterns characteristic of pheochromocytoma, and they were mixed with clusters of mature ganglion cells and bundles of spindle-shaped Schwann cells characteristic of ganglioneuroma of variable proportions. All were successfully treated laparoscopically, and none were associated with multiple endocrine neoplasm syndrome or neurofibromatosis. Preoperative diagnosis of a composite pheochromocytoma-ganglioneuroma is impossible because of the low incidence rate, and the radiological findings and symptoms are similar to those of typical pheochromocytomas. Although the significance of microscopic detection of the nonpheochromocytoma component from pheochromocytoma has not yet been clarified, microscopic identification of the composite pheochromocytoma-ganglioneuroma is important because cumulative cases are used in an effort to predict the behavior of this composite tumor.
Adrenal Glands ; Aged ; Chromaffin Cells ; Dizziness ; Female ; Ganglion Cysts ; Ganglioneuroma ; Humans ; Hypertension ; Incidence ; Male ; Neural Crest ; Pheochromocytoma ; Schwann Cells

PURPOSE: The aim of this study was to assess the efficacy and safety of recent-generation patent ductus arteriosus (PDA) closure devices applied by a new selection strategy according to the characteristics of each PDA. METHODS: From February 2003 to January 2006, 138 patients underwent transcatheter closure of PDA (study group). According to the size and morphology of each ductus, a COOK Detachable Coil or "flex" PFM Nit-Occlud was used for a small ductus (group 1, n=43); "medium" PFM Nit-Occlud (group 2, n=49) for a moderate ductus; and an Amplatzer Duct Occluder (group 3, n=46) for a large ductus. The 83 patients who underwent transcatheter closure of PDA from February 2000 to January 2003 were defined as the comparison group. The Qp/Qs ratio, pulmonary/aorta pressure ratio, and MD of the ductus were compared. Immediate and follow-up results including residual shunts and complications were also evaluated and compared among groups. RESULTS: In all 138 patients, complete occlusions were confirmed without major complications, while procedure failure (n=2, 2.2%), device embolization (n=1, 1.1%), and persistent residual shunt (n=4, 4.5%) were documented in the comparison group. Total complication rates were lower in the study group than in the comparison group (study group, 1.4%; comparison group, 9.0%; P<0.05). CONCLUSION: A novel strategy adopting the merits of various recent-generation devices for transcatheter closure of PDA provides excellent clinical results with minimal risk.
Cardiac Catheterization ; Ductus Arteriosus ; Ductus Arteriosus, Patent ; Follow-Up Studies ; Humans

Melioidosis is an infectious disease caused by a gram-negative saprophyte bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. It mostly infects adults with predisposing conditions, mainly diabetes mellitus. The lung is the most commonly affected organ. The spectrum of melioidois in human varies from subclinical to overwhelming protean manifestations resembling other acute and chronic bacterial infections. We report herein a case of septicemia and septic pneumonia due to Burkholderia pseudomallei in 47-year-old man with diabetes mellitus who has history of traveling to Malaysia. This is the first report of melioidosis in Korea.
Adult ; Asia, Southeastern ; Australia ; Bacterial Infections ; Burkholderia pseudomallei* ; Burkholderia* ; Communicable Diseases ; Diabetes Mellitus ; Humans ; Korea ; Lung ; Malaysia ; Melioidosis ; Middle Aged ; Pneumonia* ; Sepsis*