Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

The role of atypical bacteria and the effect of antibiotic treatments in acute bronchitis are still not clear. This study was conducted at 22 hospitals (17 primary care clinics and 5 university hospitals) in Korea. Outpatients (aged > or = 18 yr) who had an acute illness with a new cough and sputum (< or = 30 days) were enrolled in 2013. Multiplex real-time polymerase chain reaction (RT-PCR) was used to detect five atypical bacteria. A total of 435 patients were diagnosed as having acute bronchitis (vs. probable pneumonia, n = 75), and 1.8% (n = 8) were positive for atypical pathogens (Bordetella pertussis, n = 3; B. parapertussis, n = 0; Mycoplasma pneumoniae, n = 1; Chlamydophila pneumoniae, n = 3; Legionella pneumophila, n = 1). Among clinical symptoms and signs, only post-tussive vomiting was more frequent in patients with atypical pathogens than those without (P = 0.024). In all, 72.2% of the enrolled patients received antibiotic treatment at their first visits, and beta-lactams (29.4%) and quinolones (20.5%) were the most commonly prescribed agents. In conclusion, our study demonstrates that the incidence of atypical pathogens is low in patients with acute bronchitis, and the rate of antibiotic prescriptions is high.
Anti-Bacterial Agents/therapeutic use ; Bordetella parapertussis/genetics/*isolation & purification ; Bordetella pertussis/genetics/*isolation & purification ; Bronchitis/drug therapy/*microbiology ; Chlamydophila pneumoniae/genetics/*isolation & purification ; Community-Acquired Infections/microbiology ; Female ; Humans ; Hypertension/complications ; Legionella pneumophila/genetics/*isolation & purification ; Male ; Middle Aged ; Mycoplasma pneumoniae/genetics/*isolation & purification ; Real-Time Polymerase Chain Reaction ; Republic of Korea ; Sputum/microbiology

Ochrobactrum anthropi is an oxidase-producing, non-lactose-fermenting, gram-negative bacillus that is frequently isolated from the environment including sinks, baths, soil, and hospital water sources. Recently O. anthropi have been reported as an emerging opportunistic pathogen in immunocompromised patients, particularly in those with indwelling venous catheters. Most O. anthropi were highly resistant to beta-lactam antibiotics except carbapenem. We report a case of O. anthropi bacteremia with an unusual pattern of antibiotic resistance compared to previous reports. A 47-year-old woman undergoing camptobell/cisplatin chemotherapy via indwelling venous catheter (chemoport) for stage IV ovarian cancer, had septicemia due to O. anthropi of unknown origin. The isolates were resistant to all beta-lactams and meropenem and susceptible to aminoglycoside, ciprofloxacin, and trimethoprim-sulfamethoxazole. She recovered from sepsis with combination treatment with imipenem and ciprofloxacin for 3 weeks.
Anti-Bacterial Agents ; Bacillus ; Bacteremia ; Baths ; beta-Lactams ; Catheters ; Ciprofloxacin ; Drug Resistance, Microbial ; Female ; Humans ; Imipenem ; Immunocompromised Host ; Middle Aged ; Ochrobactrum ; Ochrobactrum anthropi ; Ovarian Neoplasms ; Sepsis ; Soil ; Thienamycins ; Trimethoprim, Sulfamethoxazole Drug Combination

Ochrobactrum anthropi is an oxidase-producing, non-lactose-fermenting, gram-negative bacillus that is frequently isolated from the environment including sinks, baths, soil, and hospital water sources. Recently O. anthropi have been reported as an emerging opportunistic pathogen in immunocompromised patients, particularly in those with indwelling venous catheters. Most O. anthropi were highly resistant to beta-lactam antibiotics except carbapenem. We report a case of O. anthropi bacteremia with an unusual pattern of antibiotic resistance compared to previous reports. A 47-year-old woman undergoing camptobell/cisplatin chemotherapy via indwelling venous catheter (chemoport) for stage IV ovarian cancer, had septicemia due to O. anthropi of unknown origin. The isolates were resistant to all beta-lactams and meropenem and susceptible to aminoglycoside, ciprofloxacin, and trimethoprim-sulfamethoxazole. She recovered from sepsis with combination treatment with imipenem and ciprofloxacin for 3 weeks.
Anti-Bacterial Agents ; Bacillus ; Bacteremia ; Baths ; beta-Lactams ; Catheters ; Ciprofloxacin ; Drug Resistance, Microbial ; Female ; Humans ; Imipenem ; Immunocompromised Host ; Middle Aged ; Ochrobactrum ; Ochrobactrum anthropi ; Ovarian Neoplasms ; Sepsis ; Soil ; Thienamycins ; Trimethoprim, Sulfamethoxazole Drug Combination

Many advances, including the development of antibiotics, the advent of diagnostic techniques and the use of nonsurgical drainage have decreased the mortality rate of pyogenic liver abscess. But, early prompt diagnosis and proper treatment is mandatory in gas-forming pyogenic liver abscess because it may run a fulminating course to death. Gas-forming pyogenic liver abscess mostly occurred to old diabetics. Symptoms of duration are shorter and the prognosis is poorer in the gas-forming than in the non-gas-forming liver abscess. We report three cases of gas-forming pyogenic liver abscess which occurred in old diabetic patients. They were successfully managed by parenteral antibiotics and early percutaneous drainage under sonographic guidance. Early and adequate drainage of pus by pigtail catheter may play a crucial role on the treatment of gas-forming liver abscess.
Anti-Bacterial Agents ; Catheters* ; Diabetes Mellitus ; Diagnosis ; Drainage* ; Humans ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Mortality ; Prognosis ; Suppuration ; Ultrasonography

BACKGROUND: Voriconazole is a potent new triazole antifungal agent expected to be particularly useful for the treatment of invasive aspergillosis. However, in vitro susceptibility of voriconazole for clinical strains of Aspergillus species isolated in Korea has not been fully surveyed. OBJECTIVE: We determined minimum inhibitory concentrations (MICs) of voriconazole for clinical Aspergillus isolates. METHODS: A total of 100 clinical isolates of Aspergillus species (40 A. fumigatus, 24 A. flavus, 17 A. niger, 17 A. terreus and 2 A. nidulans) was tested. In vitro voriconazole susceptibility testing was accomplished utilizing the National Committee for Clinical Laboratory Standards (NCCLS) broth microdilution method M38-A. MIC of voriconazole was determined using RPMI medium at 48 h of incubation. RESULTS: Among the 100 isolates of Aspergillus species tested, 98% were inhibited by < or = 1 microgram/mL of voriconazole. The MICs of voriconazole ranged from 0.125 to 2 microgram/mL (geometric mean MIC, 0.52 microgram/mL). The MIC50 (MIC at which 50% of the isolates tested were inhibited) and MIC90 were 0.5 and 1.0 microgram/mL for all Aspergillus species, respectively. The strains showing MIC> or =2 microgram/mL were 0/40 (0%) in A. fumigatus, 1/24 (4%) in A. flavus, 1/17 (6%) in A. niger, 0/17 (0%) in A. terreus, and 0/2 (0%) in A. nidulans. CONCLUSION: These data demonstrate promising in-vitro activity of voriconazole against clinical strains of Aspergillus species isolated from Korean patients.
Aspergillosis ; Aspergillus* ; Humans ; Korea ; Microbial Sensitivity Tests ; Niger

Toxic effects of ozone, 4-(N-methyl-N-nitrosamino)-1-(3- pyridyl)-1-butanone (NNK), and/or dibutyl phthalate (DBP) were examined through NF-kappaB, AP-1, Nrf2, and osteopontin (OPN) in lungs and livers of B6C3F1 mice. Electrophoretic mobility shift assay (EMSA) indicated that mice treated with combination of toxicants induced high NF-kappaB activities. Expression levels of p105, p65, and p50 proteins increased in all treated mice, whereas IkB activity was inhibited in NNK-, DBP-, and combination-treated ones. All treated mice except ozone-treated one showed high AP-1 binding activities. Expression levels of c-fos, c-jun, junB, jun D, Nrf2, and OPN proteins increased in all treated mice. Additive interactions were frequently noted from two-toxicant combination mice compared to ozone-treated one. These results indicate treatment of mixture of toxicants increased toxicity through NF-kappaB, AP-1, Nrf2, and OPN. Our data could be applied to the elucidation of mechanism as well as the risk assessment of mixture-induced toxicity.
Animals ; Blotting, Western ; DNA-Binding Proteins/*metabolism ; Dibutyl Phthalate/*toxicity ; Electrophoretic Mobility Shift Assay ; Kidney/*drug effects/metabolism ; Liver/*drug effects/metabolism ; Mice ; Mice, Inbred Strains ; NF-E2-Related Factor 2 ; NF-kappa B/metabolism ; Nitrosamines/*toxicity ; Osteopontin ; Ozone/*toxicity ; Proto-Oncogene Proteins/metabolism ; Risk Assessment ; Sialoglycoproteins/*metabolism ; Trans-Activators/metabolism ; Transcription Factor AP-1/metabolism

BACKGROUND: Waldenstrom's Macroglobulinemia (WM) is a low grade lymphoproliferative disorder that produces monoclonal immunoglobulin M (IgM). Information on the clinical feature and outcome of Korean patients with WM is scanty. METHODS: Patients with WM newly diagnosed at 5 university hospitals in Daegu and Gyeongju from 1990 to 2002 were enrolled. Data on 14 patients were retrospectively analyzed. RESULTS: The median age at diagnosis was 66 years (range: 48~77) and the male/female ratio was 6:1. All patients except one were symptomatic at presentation. Anemia was observed in all patients and beta2 microglobulin was elevated in 90% of patients. Overall response rate was 45% in the patients treated with alkylating agent and steroid. The median survival of our patients was 39 months (95% confidence interval:13.7~64.3 months) and the only factor associated with poor survival was albumin level by univariate analysis. CONCLUSION: Incidence of WM was lower and the median survival of our patients was shorter than that of Western reports. Further studies are needed to confirm prognostic factors and risk adapted treatment guideline of Korean WM patients.
Anemia ; Daegu ; Diagnosis ; Gyeongsangbuk-do ; Hospitals, University ; Humans ; Immunoglobulin M ; Incidence ; Korea ; Lymphoproliferative Disorders ; Retrospective Studies ; Waldenstrom Macroglobulinemia*

BACKGROUND: Since the introduction of warm blood cardioplegic myocardial protection, the results of numerous clinical trials have been reported. However , the increased reliance oncrystalloid cardioplegia with longer cross clamp time, the controversies surrounding the issue of right ventricular protection with retrograde cardioplegia, and problems of securing a good operative field of vision have all been pointed out as unresolved. To overcome these shortcomings, Antonio et al, in 1995 published the use of intermittent warm blood cardioplegia by admixing potassium only with good clinical results. The obj ectives of the current investigation were to assess the effects and applicability of warm blood cardioplegia with potassium only. MATERIAL AND METHOD: From May of 1998 to January of 1999, the results of coronary surgery or open heart surgery in 70 patients under intermittent warm blood potassium only cardioplegia were compared with the results of 70 case matched patients undergoing similar operations with intermittent cold blood cardioplegia. RESULT: The amount of cardioplegic solution required during cardiopulmonary bypass(1463+/-68.0 min, 3584+/-179 min, p<0.001), the time to recovery of consciousness postoperatively(3.5+/-0.4 min, 4.9+/-0.8 min, p=0.044), intubation duration(10.8+/-0.8 hr , 13.2+/-0.6 hr , p=0.017), and the inci-dence of rrhythmia requiring the use of lidocaine(75.2+/-6.8 mg, 114.5+/-7.2 mg, p=0.006), which were found to be less in the warm potassium only group were statistically significant. However, the differences in postoperative cardiac enzymne elevation and postoperative mortality and morbidity were statistically insignificant. CONCLUSION: The current study showed warm intermittent potassium only blood cardioplegia to be at least equally effective as cold intermittent blood cardioplegia in providing myocardial protection. Furthermore, the reduction in cardiopulmonary bypass, mental recovery and intubation times strongly support the use of this method for intraopertaive myocardial protection.
Cardioplegic Solutions ; Cardiopulmonary Bypass ; Consciousness ; Heart Arrest, Induced* ; Humans ; Intubation ; Mortality ; Potassium* ; Thoracic Surgery