BACKGROUND/AIMS: Cytomegalovirus (CMV) surveillance and preemptive therapy is a widely-used strategy for preventing CMV disease in transplant recipients. However, there are limited data on the incidence and patterns of CMV disease during the preemptive period. Thus, we investigated the incidence and pattern of tissue-invasive CMV disease in CMV seropositive kidney transplantation (KT) and hematopoietic stem cell transplantation (HCT) recipients during preemptive therapy. METHODS: We prospectively identified patients with tissue-invasive CMV disease among 664 KT (90%) and 496 HCT (96%) recipients who were D+/R+ (both donor and recipient seropositive) during a 4-year period. RESULTS: The incidence rates of CMV disease were 4.1/100 person-years (4%, 27/664) in KT recipients and 5.0/100 person-years (4%, 21/496) in HCT recipients. Twenty-six (96%) of the KT recipients with CMV disease had gastrointestinal CMV, whereas 17 (81%) of the HCT recipients had gastrointestinal CMV and 4 (19%) had CMV retinitis. Thus, CMV retinitis was more common among HCT recipients (p = 0.03). All 27 KT recipients with CMV disease suffered abrupt onset of CMV disease before or during preemptive therapy; 10 (48%) of the 21 HCT recipients with CMV disease were also classified in this way but the other 11 (52%) were classified as CMV disease following successful ganciclovir preemptive therapy (p < 0.001). CONCLUSIONS: The incidence of CMV disease was about 4% in both KT and HCT recipients during preemptive therapy. However, CMV retinitis and CMV disease as a relapsed infection were more frequently found among HCT recipients.
Cytomegalovirus* ; Ganciclovir ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Kidney Transplantation ; Kidney* ; Prospective Studies ; Retinitis ; Tissue Donors ; Transplant Recipients*

BACKGROUND: Inhibitory antibodies to factor VIII (FVIII) are an important complication when managing patients with hemophilia A. Immune tolerance induction (ITI) has been regarded as a useful method for eradicating inhibitors. We report the results of a retrospective study in Korean patients with hemophilia A who underwent ITI. METHODS: We reviewed the records of patients with hemophilia A with inhibitors who underwent ITI from March 2004 to December 2014. ITI was started with FVIII concentrates at 100 IU/kg, 3 times per week. The dose of FVIII was reduced according to the inhibitor titer and recovery of FVIII. Inhibitor elimination was defined as the time taken to achieve a negative inhibitor assay with no anamnestic response and normal FVIII recovery and/or normal half-life. RESULTS: In total, 17 patients with severe hemophilia A were evaluated. Complete tolerance was achieved in 14 of 17 patients (83%). The mean peak inhibitor titer before ITI was 38.4 BU/mL. The mean treatment duration was 26.2 months. The mean duration between inhibitor detection and ITI was 5.1 years in the complete tolerance group and 10.8 years in the partial tolerance and failed group. CONCLUSION: This study shows that ITI can be an effective and well-tolerated method for eradicating inhibitors. Possible influencing factors for ITI success were age at the start of ITI treatment and duration after inhibitor detection. More research to provide further insight about other factors and conditions is needed.
Antibodies ; Factor VIII ; Half-Life ; Hemophilia A* ; Humans ; Immune Tolerance* ; Retrospective Studies

BACKGROUND: Topical steroid treatment induces diverse local Wand systemic adverse effects. Several approaches have been tried to reduce the steroid-induced adverse effects. Simultaneous application of physiological lipid mixture is also suggested. OBJECTIVE: Novel vehicles for topical glucocorticoids formulation were evaluated for the efficacy of reducing side-effects and the drug delivery properties of desonide, a low potency topical steroid. METHODS: Transcutaneous permeation and skin residual amount of desonide were measured using Franz diffusion cells. The in vivo anti-inflammatory activity was evaluated using murine model. RESULTS: Topical steroids formulation containing desonide, in either cream or lotion form, were prepared using multi-lamellar emulsion (MLE), and conventional desonide formulations were employed for comparison. MLE formulations did not affect the anti-inflammatory activity of the desonide in phobol ester-induced skin inflammation model, compared with conventional formulations. While the penetrated amounts of desonide were similar for all the tested formulations at 24 hours after application, the increased lag time was observed for the MLE formulations. Interestingly, residual amount of desonide in epidermis was significantly higher in lotion type MLE formulation. Steroid-induced adverse effects, including permeability barrier function impairment, were partially prevented by MLE formulation. CONCLUSION: Topical desonide formulation using MLE as a vehicle showed a better drug delivery with increased epidermal retention. MLE also partially prevented the steroid-induced side effects, such as skin barrier impairment.
Desonide ; Diffusion ; Epidermis ; Glucocorticoids ; Inflammation ; Permeability ; Retention (Psychology) ; Skin ; Steroids

OBJECTIVES: To examine the prophylactic antibiotic use in reducing surgical site infection. METHODS: This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates. RESULTS: The study population consisted of 16 348 patients (1588 gastrectomies, 2327 cholecystectomies, 1,384 colectomies, 3977 hysterectomies and 7072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy. CONCLUSIONS: This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.
Adolescent ; Adult ; Antibiotic Prophylaxis/*standards ; Female ; Humans ; Male ; *Quality Indicators, Health Care ; Republic of Korea ; Retrospective Studies ; Surgical Wound Infection/*prevention & control ; Young Adult

A 48-year-old woman visited the emergency department with shock due to a urinary tract infection. The patient, who had a history of hypertension and diabetes mellitus, presented with precordial ST-segment elevation and Q waves, along with an increase of cardiac enzymes. An echocardiography showed moderately reduced systolic function, severe apical left ventricular ballooning, and a dynamic left ventricular outflow tract obstruction with a pressure gradient of 109 mmHg. Coronary angiography demonstrated normal coronary arteries. At the 1-month echocardiographic follow-up, the apical ballooning and left ventricular systolic function had recovered completely. There was no residual left ventricular intra-cavity gradient at rest, but it was induced in low-dose dobutamine stress-echocardiography. We demonstrated that dynamic left midventricular obstruction in the setting of either increased catecholamine stress or hypovolemia could develop Tako-tsubo cardiomyopathy.
Coronary Angiography ; Coronary Vessels ; Diabetes Mellitus ; Dobutamine ; Echocardiography ; Echocardiography, Stress ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Hypovolemia ; Middle Aged ; Shock ; Takotsubo Cardiomyopathy ; Urinary Tract Infections ; Ventricular Outflow Obstruction

PURPOSE:This study was a pilot study to develop structure, clinical performance and outcome measurement and criteria for increasing number of dialysis facilities and patients to provide quality of care. METHODS:The six components of developing quality indicators for hemodialysis were as follows: 1) Organizing expert panel members. 2) Selecting the area: to reflect stakeholders' opinion, structured interviews were done. And literature reviews were performed to investigate guidelines and quality measurements of foreign countries. 3) Selecting clinical performance indicators: From experts' opinions and literature review. 4) Developing candidate indicators. 5) Performing demonstration survey: Systemic sampling was performed and 43 facilities were participated in self-answered medical record survey. 6) Based on preliminary evaluation model, final indicators were selected from expert panel reviews. RESULTS:Eleven measures of structure, thirteen performance measures of process and nine monitoring measures of outcome were developed based on literature review and clinical practice guideline. As for criterion-related validity, those of process and outcome were most high and in case of face validity, those of structure and process were most high. The most valid quality indicators were the rate of internal medicine specialist, dialysis frequency per doctor, whether or not keeping emergency equipment, examination of water quality, hemodialysis adequacy (Kt/V), monitoring arterial venous graft for stenosis maintenance of iron storage, and administration of supplemental iron. CONCLUSION:By developing quality indicators of hemodialysis and performing demonstration evaluation, quality of care for hemodialysis patients is expected to be improved, so as to promote hemodialysis patients' health and improve on quality of life.
Constriction, Pathologic ; Delivery of Health Care ; Dialysis ; Emergencies ; Humans ; Internal Medicine ; Iron ; Medical Records ; Pilot Projects ; Quality Indicators, Health Care ; Quality of Health Care ; Quality of Life ; Renal Dialysis ; Specialization ; Transplants ; Water Quality

BACKGROUND AND OBJECTIVES: Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE. SUBJECTS AND METHODS: The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD. RESULTS: The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only. CONCLUSION: TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE.
Axis, Cervical Vertebra ; Biomarkers ; Dilatation ; Echocardiography ; Electrocardiography ; Heart ; Hominidae ; Humans ; Hypokinesia ; Medical Records ; Natriuretic Peptide, Brain ; Prognosis ; Pulmonary Embolism ; Retrospective Studies ; Sensitivity and Specificity ; Ventricular Dysfunction, Right

Danon disease is characterized clinically by the triad of cardiomyopathy, myopathy and mental retardation. It was originally reported as a lysosomal glycogen storage disease with normal acid maltase by Danon. Danon disease results from mutations in lysosome associated membrane protein-2 (LAMP-2) gene. The LAMP-2 gene is located on Xq24-25. We report a case of suspected Danon disease in patient who had hypertrophic cardiomyopathy and mental retardation along with abnormal findings in electromyography.
alpha-Glucosidases ; Cardiomyopathies ; Cardiomyopathy, Hypertrophic ; Glycogen Storage Disease ; Glycogen Storage Disease Type IIb ; Humans ; Intellectual Disability ; Lysosomes ; Membranes ; Muscular Diseases

Persistent tricuspid regurgitation (TR) caused by infarction or ischemia of right ventricle (RV) is rare and has not been reported by coronary vasospasm previously. We reported the two cases of patients with persistent right heart failure (HF) and severe TR by coronary vasospasm. After RV infarction or ischemia, two-dimensional (2D) echocardiographic examination revealed normal left ventricular function, but RV hypokinesia, RV and tricuspid annular dilation, and severe TR with normal appearance of tricuspid valve itself. Subsequent coronary angiography and cardiac catheterization revealed coronary vasospasm without significant coronary artery stenosis and pulmonary hypertension. Repeated echocardiography showed persistent right HF and severe TR at 5 years and 4 months later in respective cases. In conclusion, we suggest that RV infarction or ischemia with coronary vasospasm can be one of the causes for isolated TR and tricuspid annular dilation.
Cardiac Catheterization ; Cardiac Catheters ; Coronary Angiography ; Coronary Stenosis ; Coronary Vasospasm* ; Echocardiography ; Heart Failure* ; Heart Ventricles ; Heart* ; Humans ; Hypertension, Pulmonary ; Hypokinesia ; Infarction ; Ischemia ; Tricuspid Valve ; Tricuspid Valve Insufficiency* ; Ventricular Function, Left

To identify risk factors and causative organisms, and to evaluate clinical manifestations, methods and results of treatment in infectious keratitis, an epidemiological study was performed prospectively under the identical protocol from April 1995 to March 2000.Logistic regression analysis was used to evaluate possible risk factors. The 1474 cases of infectious keratitis reported from 22 hospitals were studied. Five hundred forty-four organisms(442 bacteria, 82 fungi, 20 A c a n t h a m o e b a)were detected in 1320 eyes with infectious keratitis excluding 154 herpetic keratitis. The Pseudomonas aeruginosa was the most common organism in bacterial keratitis, and Fusariumspp. was the major isolate in fungal keratitis. Contact lens wear and occupation(industry, forester, miner, fisherman)were the risk factors for bacterial keratitis. Risk factors in fungal keratitis were fifth decade of age, farmer, and systemic diseases(diabetes mellitus etc.). Risk factors in herpetic keratitis were male and occupation(office worker, service, student, housewife). Risk factors in Acanthamoeba keratitis was contact lens wear.
Acanthamoeba Keratitis ; Bacteria ; Epidemiologic Studies ; Epidemiology* ; Fungi ; Humans ; Keratitis ; Keratitis, Herpetic ; Male ; Prospective Studies ; Pseudomonas aeruginosa ; Risk Factors