BACKGROUND/AIMS: Fecal microbiota transplantation (FMT) is a highly effective therapy for refractory and recurrent Clostridium difficile infection (CDI). Despite its excellent efficacy and recent widespread use, FMT has not been widely used in South Korea thus far. We describe our experience with FMT to treat refractory/recurrent CDI. METHODS: We conducted a chart review of patients who underwent FMT for refractory/recurrent CDI at Inha University Hospital, between March 2014 and June 2016. The demographic information, treatment data, and adverse events were reviewed. FMT was administered via colonoscopy and/or duodenoscopy. All stool donors were rigorously screened to prevent infectious disease transmission. RESULTS: FMT was performed in nine patients with refractory/recurrent CDI. All patients were dramatically cured. Bowel movement was normalized within one week after FMT. There were no procedure-related adverse events, except aspiration pneumonia in one patient. During the follow-up period (mean 11.4 months), recurrence of CDI was observed in one patient at one month after FMT due to antibiotics. CONCLUSIONS: FMT is a safe, well-tolerated and highly effective treatment for refractory/recurrent CDI. Although there are many barriers to using FMT, we expect that FMT will be widely used to treat refractory/recurrent CDI in South Korea.
Anti-Bacterial Agents ; Clostridium difficile* ; Clostridium* ; Colonoscopy ; Disease Transmission, Infectious ; Duodenoscopy ; Fecal Microbiota Transplantation* ; Follow-Up Studies ; Gastrointestinal Microbiome ; Humans ; Korea ; Pneumonia, Aspiration ; Recurrence ; Tissue Donors

Corynebacterium minutissimum is a non-spore forming, gram-positive, aerobic or facultative anaerobic bacillus. It is the causative organism of erythrasma, a common superficial infection of skin, which typically presents as reddish-brown macular patches. To date, it has rarely been found to cause invasive disease, although other non-diphtheria corynebacteria are becoming increasingly common as opportunistic pathogens. We report on a rare case of abdominal infection due to C. minutissimum in an immunocompetent adult who was successfully treated with intravenous amoxicillin/sulbactam.
Abdomen ; Adult ; Bacillus ; Corynebacterium* ; Erythrasma ; Humans ; Skin

OBJECTIVE: To investigate the pain-related behaviors and the changes of CX3CR1 expression in the dorsal root ganglion (DRG) in a rat model of lumbar disc herniation. METHOD: A total of 90 male Sprague-Dawley rats were used. A laminectomy was performed to expose left L5 nerve roots and corresponding DRG. Autologous nucleus puplosus was implanted on the left L5 nerve root proximal to the DRG without mechanical compression. Sham operation was also done with the same procedure as mentioned above. Thermal hyperalgesia and mechanical allodynia were assessed at 1, 5, 10, 20 and 30 days after surgery. Real time PCR and immunohistochemistry after behavioral test were performed. RESULTS: In the lumbar disc herniation rats, significant reduction of thermal withdrawal latency indicating thermal hyperalgesia was shown on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and peaked on day 10 (p<0.05) and maintained throughout day 30 (p<0.05). The reduction of mechanical allodynia threshold, indicating mechanical allodynia, was observed on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and continued throughout day 30 (p<0.01). Real time PCR showed the decrease in mRNA expression of CX3CR1 in the ipsilateral DRG on day 1 (p<0.05) and the significant increase on day 20 (p<0.05). The immunoreactivity for CX3CR1 was also increased in ipsilateral DRG on day 10 and 20. CONCLUSION: These data suggest that lumbar disc herniation induces thermal hyperalgesia and mechanical allodynia and upregulates the expression of CX3CR1 in dorsal root ganglion. Expression of CX3CR1 might be associated with subacute neuropathic pain after intervertebral disc herniation.
Animals ; Diagnosis-Related Groups ; Ganglia, Spinal ; Humans ; Hyperalgesia ; Immunohistochemistry ; Intervertebral Disc ; Laminectomy ; Male ; Neuralgia ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Salicylamides ; Spinal Nerve Roots

OBJECTIVE: To investigate the effects of continuous repetitive transcranial magnetic stimulation (rTMS) on pain response in spinal cord injured rat. METHOD: Forty Sprague-Dawley rats (200~250 grams, female) were used. Thoracic spinal cord (T9) was contused using New York University (NYU) spinal cord impactor. Ten gram weight rod was dropped from a height of 25 mm to produce spinal cord contusion model with moderate injury. The animals were randomly assigned to two groups: one exposed to real magnetic stimulation (real-rTMS group) and the other not exposed to magnetic stimulation (sham-rTMS group). rTMS was applied for 8 weeks. To assess the effect of continuous rTMS on below-level pain responses after spinal cord injury (SCI), the hindpaw withdrawal response for thermal stimuli, cold stimuli and mechanical stimuli were compared between two groups. RESULTS: Behavioral response for pain showed that hindpaw withdrawal response for cold stimuli was reduced significantly from 4 weeks after SCI in real-rTMS group compared with sham group (p<0.05). CONCLUSION: These results suggest that continuous rTMS may have beneficial effects on attenuation of cold allodynia after SCI, and it might be an additional non-invasive therapeutic method in patients with chronic neuropathic pain after SCI.
Animals ; Cold Temperature ; Humans ; Hyperalgesia ; Magnetics ; Magnets ; Neuralgia ; New York ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Spinal Cord ; Spinal Cord Injuries ; Transcranial Magnetic Stimulation

OBJECTIVE: To investigate the aspiration of saliva itself in bedridden patients with brain lesion using the response of radionuclide salivagram, and its association with patient characteristics and clinical factors. METHOD: Thirty two patients (21 men and 11 women) in bedridden state with brain lesion were performed the radionuclide salivagram. (99m)Tc sulfur colloid (1.0 mCi in a drop of saline) was instilled into patients' tongue with supine position. The sequential images were obtained at first 5 minutes and 10 minutes interval for 1 hour, and evaluated the presence of saliva aspiration as the entrance of tracer into major airways or lung parenchyma. The characteristics of patients and the states of cooperation, drooling, tracheostomy, and method of feed were also assessed. RESULTS: Seven out of 32 subjects exhibited positive response of saliva aspiration by radionuclide salivagram. Men, uncooperative, and anterior drooling was significantly associated with positive finding of salivagram (p<0.05). CONCLUSION: In bedridden patients with brain lesion, it seems that radionuclide salivagram may be one of methods for detection of the aspiration of saliva itself.
Brain ; Colloids ; Humans ; Lung ; Male ; Saliva ; Sialorrhea ; Sulfur ; Supine Position ; Tongue ; Tracheostomy

Spinal cord infarction is uncommon and accounts for only 1% of all strokes in comparison with cerebral infarction. Furthermore, posterior spinal cord infarction is particularly rare because of an anastomotic network of direct penetrating vessels and plexus of pial vessels fed by the paired posterior spinal arteries. We report a case of unilateral posterior spinal artery infarction on lower medulla and upper cervical spinal cord in a patient of 60-year-old woman. She complained of continuous headache for several weeks and suddenly presented right facial paresthesia, slow progression of motor weakness and proprioceptive sensory loss on right extremity, and voiding difficulty. Magnetic resonance and computed tomography imaging studies confirmed acute infarction at the right posterolateral aspect of the lower medulla and upper cervical cord (C1-2 level) with right vertebral artery hypoplasia. Transcranial doppler sonography also showed right vertebral artery hypoplasia rather than stenosis with atherosclerosis.
Arteries ; Atherosclerosis ; Cerebral Infarction ; Constriction, Pathologic ; Extremities ; Female ; Headache ; Humans ; Infarction ; Magnetic Resonance Spectroscopy ; Middle Aged ; Paresthesia ; Spinal Cord ; Stroke ; Ultrasonography, Doppler, Transcranial ; Vertebral Artery

OBJECTIVE: To evaluate efficacy and safety of local injection of potassium chloride (KCl) and methotrexate (MTX) in the treatment of cornual pregnancy. METHODS: We retrospectively reviewed all cases of cornual pregnancy treated conservatively from 2005 through August 2007. Eight cases were identified and two cases were heterotopic interstitial pregnancy. All cases were managed with local injection of KCl or methotrexate under ultrasound guidance and 2 cases were treated with intra-muscular injection of MTX in combination. After the procedure all cases with cardiac activity was confirmed to be aborted by ultrasound. Also serial follow-up sonographic examination and serum beta-hCG measurement were performed. RESULTS: The mean initial beta-hCG level was 53,331.6 mIU/mL and ranged from 14,332 mIU/mL to 125,721 mIU/mL. Mean gestational age was 48.3 days from 40 to 65 days. All cases were aborted successfully and follow up beta-hCG were declined abruptly. Two cases of heterotopic pregnancy resulted in successful deliveries at full term. CONCLUSION: Cornual resection or hysterectomy should no longer be the first line of treatment for hemodynamically stable patients with cornual pregnancy. They can be successfully treated through local injection of MTX or KCl by ultrasound guidance.
Follow-Up Studies ; Gestational Age ; Humans ; Hysterectomy ; Methotrexate ; Potassium ; Potassium Chloride ; Pregnancy ; Pregnancy, Heterotopic ; Retrospective Studies

Monoamniotic twin pregnancies are relatively rare, but perinatal mortality is high about 30-70%. The major cause of fetal death is cord accident, congenital anomalies, twin-twin transfusion syndrome, and intrauterine growth restriction. Especially cord entanglement occurs; perinatal mortality is about 50%. So the active management of monoamniotic twins to reduce the complication of cord entanglement is important. This is a case of monoamniotic twin pregnancy with cord entanglement and both fetuses survival by elective cesarean section at 32+4 weeks after medical amnioreduction and intensive fetal surveillance.
Cesarean Section ; Female ; Fetal Death ; Fetus ; Humans ; Perinatal Mortality ; Pregnancy ; Pregnancy, Twin

OBJECTIVE: To investigate the effects of functional magnetic stimulation (FMS) on the functional recovery in a rat model of spinal cord injury (SCI). METHOD: Forty-five Sprague-Dawley rats (200~250 grams, female) were used. Rats were laminectomized and the T9 segment of spinal cord was contused using New York University (NYU) spinal impactor. Ten gram weight rod was dropped from a height of 25 mm to produce moderately contused spinal cord injury model. The animals were randomly assigned to 2 groups: one exposed to FMS (FMS group) and the other not exposed to FMS (non-FMS group). Transcranial functional magnetic stimulation was noninvasively applied for 4 weeks. To compare the results between FMS group and non-FMS group, motor functions were evaluated with the Basso, Beattie, and Bresnahan (BBB) locomtor rating scale and inclined plane test, and somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) were also recorded. RESULTS: There was a significant difference in locomotor recovery between FMS group and non-FMS group (p<0.05). Measurement of MEP was also indicated that amplitude of MEP in FMS group is larger than that in non-FMS group. CONCLUSION: These results indicate that FMS may have beneficial effects on motor recovery after spinal cord injury and the benefits of FMS could be an additional non-invasive therapeutic method for clinical trials in patients with spinal cord injury.
Animals ; Evoked Potentials, Motor ; Evoked Potentials, Somatosensory ; Humans ; Magnetics ; Magnets ; New York ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; Spinal Cord Injuries

Sacral insufficiency fractures are not uncommon cause of low back pain in elderly women with osteoporosis. The characteristics of sacral insufficiency fractures may not be related with neurological compromise. Their associated rate of neurological complication has been reported approximately 2%. The neurological complication, which is due to stretching or compression of nerve roots, is related with bony displacement. We present the case of an elderly women who developed S1 radiculopathy secondary to sacral insufficiency fracture with no evidence of fracture line.
Aged ; Female ; Fractures, Stress* ; Humans ; Low Back Pain ; Osteoporosis ; Radiculopathy*