There are approximately 20 known species of the genus Cryptosporidium, and among these, 8 infect immunocompetent or immunocompromised humans. C. hominis and C. parvum most commonly infect humans. Differentiating between them is important for evaluating potential sources of infection. We report here the development of a simple and accurate real-time PCR-based restriction fragment length polymorphism (RFLP) method to distinguish between C. parvum and C. hominis. Using the CP2 gene as the target, we found that both Cryptosporidium species yielded 224 bp products. In the subsequent RFLP method using TaqI, 2 bands (99 and 125 bp) specific to C. hominis were detected. Using this method, we detected C. hominis infection in 1 of 21 patients with diarrhea, suggesting that this method could facilitate the detection of C. hominis infections.
Child ; Cryptosporidiosis/*diagnosis/*parasitology ; Cryptosporidium/*classification/*genetics ; Female ; Genotype ; Humans ; Polymerase Chain Reaction/methods ; Polymorphism, Restriction Fragment Length ; Sensitivity and Specificity

To understand protozoan, viral, and bacterial infections in diarrheal patients, we analyzed positivity and mixed-infection status with 3 protozoans, 4 viruses, and 10 bacteria in hospitalized diarrheal patients during 2004-2006 in the Republic of Korea. A total of 76,652 stool samples were collected from 96 hospitals across the nation. The positivity for protozoa, viruses, and bacteria was 129, 1,759, and 1,797 per 10,000 persons, respectively. Especially, Cryptosporidium parvum was highly mixed-infected with rotavirus among pediatric diarrheal patients (29.5 per 100 C. parvum positive cases), and Entamoeba histolytica was mixed-infected with Clostridium perfringens (10.3 per 100 E. histolytica positive cases) in protozoan-diarrheal patients. Those infected with rotavirus and C. perfringens constituted relatively high proportions among mixed infection cases from January to April. The positivity for rotavirus among viral infection for those aged < or = 5 years was significantly higher, while C. perfringens among bacterial infection was higher for > or = 50 years. The information for association of viral and bacterial infections with enteropathogenic protozoa in diarrheal patients may contribute to improvement of care for diarrhea as well as development of control strategies for diarrheal diseases in Korea.

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.
Acute Disease ; Adult ; Diagnosis, Differential ; Duodenal Diseases/*diagnosis/pathology/surgery ; Duodenal Ulcer/*complications ; Hematoma/*diagnosis/pathology/surgery ; *Hemostasis, Endoscopic ; Humans ; Male ; Pancreatitis/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*therapy ; Postoperative Complications ; Tomography, X-Ray Computed

Tricuspid regurgitation after blunt chest trauma is rarely seen in the emergency department. A 19-year-old patient visited our emergency department with chest discomfort after collision with his brother while skiing. Recently, Skiing as a winter sports has become popular with the Korean people, so there is an increasing tendency for patients with diverse traumas associated with ski accidents to visit the emergency department. From simple abrasions or contusions to deadly injuries with unstable vital signs, we are seeing many kind of injuries in the emergency department. We present the case report of a patient with tricuspid regurgitation after a blunt chest trauma during the skiing.
Contusions ; Emergency Service, Hospital ; Humans ; Siblings ; Skiing ; Sports ; Thorax* ; Tricuspid Valve Insufficiency* ; Vital Signs ; Young Adult

Tricuspid regurgitation after blunt chest trauma is rarely seen in the emergency department. A 19-year-old patient visited our emergency department with chest discomfort after collision with his brother while skiing. Recently, Skiing as a winter sports has become popular with the Korean people, so there is an increasing tendency for patients with diverse traumas associated with ski accidents to visit the emergency department. From simple abrasions or contusions to deadly injuries with unstable vital signs, we are seeing many kind of injuries in the emergency department. We present the case report of a patient with tricuspid regurgitation after a blunt chest trauma during the skiing.
Contusions ; Emergency Service, Hospital ; Humans ; Siblings ; Skiing ; Sports ; Thorax* ; Tricuspid Valve Insufficiency* ; Vital Signs ; Young Adult

OBJECTIVE: To describe the angiographic embolization as a safe and an effective alternative treatment in the management of obstetrical hemorrhage and in preserving fertility. METHODS: Between March 1999 and May 2003, 43 patients at Asan Medical Center underwent angiographic embolization for the management of obstetrical hemorrhage. All cases received arterial embolization because of obstetrical hemorrhage unresponsive to conservative management or prophylaxis for massive obstetrical hemorrhage. Medical records were reviewed and detailed to collect adequate clinical data such as clinical status, underlying conditions, amount of transfusion, embolization sites, materials of embolization, duration of the procedure, complications associated with embolization, hospital stay, and the success rate. Patients were contacted by telephone to obtain long-term outcome for menstruation, desire for conception, and subsequent pregnancies. RESULTS: We have experienced the clinical successful embolization in 37 (86.0%) of 43 patients of obstetrical hemorrhage resulting from various causes. The main cause of hemorrhage was atony of uterus (n=17), followed by abnormal placentation (n=6), genital tract laceration (n=5). The average amount of blood transfusion was 7.0 units (range; 0-36 units). The average length of the time for the procedure was 68.2 minutes (range; 30-150 minutes). The average duration of hospitalization was 6.4 days (range; 3-20 days). The main complication after embolization was numbness and pain on right lower extremities in 5 cases and vessel dissection occurred in 1 case. But there was no major complication related to the procedure. We were able to follow up 28 patients. In all cases menses resumed spontaneously soon after the procedure. Seven cases of long-term follow-up became pregnant, and 3 cases of them completed gestations giving birth to healthy babies. CONCLUSION: The results suggest that angiographic embolization is a relatively noninvasive and highly effective method for the management of obstetrical hemorrhage and a useful technique for preserving fertility.
Blood Transfusion ; Chungcheongnam-do ; Female ; Fertility ; Fertilization ; Follow-Up Studies ; Hemorrhage* ; Hospitalization ; Humans ; Hypesthesia ; Lacerations ; Length of Stay ; Lower Extremity ; Medical Records ; Menstruation ; Parturition ; Placentation ; Pregnancy ; Telephone ; Uterus

BACKGROUND: Tight control of blood pressure in patients with coronary artery disease is critical, especially in the setting of long-standing hypertension and left ventricular dysfunction. With off-pump coronary artery bypass graft (CABG), hypertension usually occurs after the sternotomy, along with an increase in heart rate and filling pressure. In order to minimize hypertension during this period, nitroglycerin or nicardipine was prophylactically infused. METHODS: Twenty patients scheduled to undergo an off-pump CABG from April to August, 2001, were selected and divided into two groups. Group I (n = 10) received nicardipine and Group II (n = 10) received nitroglycerin. Before the skin incision, nicardipine (0.5 - 1.0ng/kg/min) or nitroglycerin (0.5 - 1.0ng/kg/min) was continuously infused. Mean arterial pressure (MAP), heart rate (HR), mean pulmonary artery pressure (mPAP), pulmonary artery occlusion pressure (PAOP), cardiac index (CI), and the systemic vascular resistance index (SVRI) were repeatedly measured at the stages of preincision, postincision, poststernotomy, pericardium open, and 10 min after reperfusion. RESULTS: Although MAP after the sternotomy was increased compared with preincision, it remained within a normal range. Similarly, HR, mPAP, and PAOP were all within a normal range despite increases. The CI was within a normal range at all stages in both groups, and there were no significant difference between the two groups. In group I, the SVRI was significantly decreased compared with group II when pericardium was opened. CONCLUSIONS: Both nicardipine and nitroglycerin were effective in preventing or attenuating hypertension after sternotomy with the hemodynamic stability.
Arterial Pressure ; Blood Pressure ; Coronary Artery Bypass, Off-Pump* ; Coronary Artery Disease ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Nicardipine* ; Nitroglycerin* ; Pericardium ; Pulmonary Artery ; Reference Values ; Reperfusion ; Skin ; Sternotomy ; Transplants* ; Vascular Resistance ; Ventricular Dysfunction, Left

BACKGROUND: A right thoracoscopic thoracic sympathicotomy involves the removal of T2 and T3 sympathetic chains. Since part of the sympathetic fibers to the heart traverse these two ganglia, we examined the hemodynamic changes during a thoracoscopic thoracic sympathicotomy in primary hyperhidrosis. METHODS: Noninvasive cardiac output monitoring was done on the both side of the neck and chest. A physiograph for measuring of continuous blood flow was taken from the right index finger and a thermometer was placed in the right palm. Following endotracheal intubation was done with double lumen endotracheal tube, anesthesia was maintained with isoflurane. Sympathicotomies were done for T2-3 during one lung ventilation. Heart rate (HR), mean arterial pressure (MAP), systemic vascular resistance index (SVRI), cardiac index (CI), accelerated contractility index (ACI), end-diastolic index (EDI), and temperature were recorded at arrival, before sympathicotomy, after sympathicotomy at 1, 2, 3, 4 and 5 minuets. The blood flow of the right index finger was recorded before and after the sympathicotomy. RESULTS: Concurrent with initiation of the sympathicotomy, MAP and SVRI were reduced, but the CI was elevated. It was accompanied with right palmar temperature elevation and an increase in the blood flow of the right index finger. CONCLUSIONS: A thoracoscopic thoracic sympathicotomy reduces MAP and SVRI and elevates CI, palmar temperature, and blood flow. We concluded that the hemodynamic changes during a thoracoscopic thoracic sympathicotomy seems to be the peripheral vasodilatation.
Adrenergic Fibers ; Anesthesia ; Arterial Pressure ; Cardiac Output ; Fingers ; Ganglia ; Heart ; Heart Rate ; Hemodynamics* ; Hyperhidrosis* ; Intubation, Intratracheal ; Isoflurane ; Neck ; One-Lung Ventilation ; Thermometers ; Thorax ; Vascular Resistance ; Vasodilation

Drugs for acute blood pressure control are often required during a cardiovascular operation. Hypertension frequently occurs in an off-pump coronary artery bypass graft. The purpose of this study was to evaluate the effect of nicardipine on hemodynamic change. Twenty adult patients were studied. Anesthesia was induced intravenously with thiopental (4 mg/kg), vecuronium (1 mg/kg), and fentanyl (4microgram/kg), and maintained with 100% O2 and isoflurane 1 1.5 Vol%. When systolic blood pressure rose above 150 mmHg, nicardipine 1 mg was administrated intravenously. Immediately after the nicardipine bolus injection, nicardipine was infused continuously 0.5 4microgram/kg/min. Thereafter, hemodynamic data was recorded. Systolic blood pressure decreased, but cardiac index significantly increased after an intravenous administration of nicardipine and was maintained during the study. There was no incidence of tachycardia. It was concluded that acute blood pressure control using nicardipine could be suitable and safe in patients with an off-pump CABG.
Administration, Intravenous ; Adult ; Anesthesia ; Blood Pressure ; Coronary Artery Bypass, Off-Pump* ; Fentanyl ; Hemodynamics* ; Humans ; Hypertension* ; Incidence ; Isoflurane ; Nicardipine* ; Tachycardia ; Thiopental ; Transplants* ; Vecuronium Bromide

BACKGROUND: Stellate ganglion block (SGB) is the most common nerve block procedure in pain clinics. To evaluate changes in the hemodynamics and peripheral blood flow on the affected extremity after SGB, SGB was performed unilaterally one at a time on the right and left stellate ganglions by injecting 1% mepivacaine 10 ml without epinephrine in a designated healthy man. METHODS: SGB was repeated 16 times in one subject (right side SGB: 8, left side SGB: 8) by the same clinician. The mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and peripheral blood flow were measured in the supine position before (control), and 3, 6, 9, 12, and 15 minutes after SGB using thoracic electrical bioimpedence (Bioz system A-10043, Cardiodynamics, USA), sphygomanometer, and flow meter. RESULTS: The values after SGB including MAP, HR, CI, and SVRI increased slightly compared to the control value. However, peripheral blood flow increased significantly (p < 0.05). The SGB did not affect systematic hemodynamics and the comparison between left and right SGB in hemodynamic changes were not clinically significant. Following SGB, ptosis (100%), nasal stiffness (100%), skin temperature elevation (100%), hoarseness (100%), numbness (81%), dizziness (25%), and swallowing difficulty (25%) were observed. CONCLUSIONS: We concluded that SGB showed to be a hemodynamically safe clinical technique.
Arterial Pressure ; Deglutition ; Dizziness ; Epinephrine ; Extremities ; Heart Rate ; Hemodynamics* ; Hoarseness ; Hypesthesia ; Mepivacaine ; Nerve Block ; Pain Clinics ; Skin Temperature ; Stellate Ganglion* ; Supine Position ; Vascular Resistance