Tumor necrosis factor-alpha (TNF-alpha) is a key component of the host defense against mycobacterial infection. Mycobacterium gordonae (M. gordonae) is one of the least virulent mycobacteria, and is generally considered non-pathogenic if detected from a clinical specimen. Here, we report a rare case of pulmonary M. gordonae infection in a patient with ulcerative colitis who had been treated with infliximab, a TNF-alpha antagonist. M. gordonae infection was treated successfully with clarithromycin, rifampin, and ethambutol. We believe this to be the first report of M. gordonae pulmonary disease associated with TNF-alpha antagonist treatment.
Clarithromycin ; Colitis, Ulcerative* ; Ethambutol ; Gordonia Bacterium ; Humans ; Lung Diseases* ; Mycobacterium* ; Nontuberculous Mycobacteria* ; Rifampin ; Tumor Necrosis Factor-alpha ; Ulcer* ; Infliximab

Epidemiological data of Bordetella pertussis infection among adolescents and adults are limited in Korea. Patients (> or = 11 yr of age) with a bothersome cough for less than 30 days were enrolled during a 1-yr period at 22 hospitals in Korea. Nasopharyngeal swabs were collected for polymerase chain reaction (PCR) and for bacteriologic culture. In total, 490 patients were finally enrolled, and 34 (6.9%) patients tested positive for B. pertussis; cough duration (14.0 days [7.0-21.0 days]) and age distribution were diverse. The incidence was the highest in secondary referral hospitals, compared to primary care clinics or tertiary referral hospitals (24/226 [10.6%] vs. 3/88 [3.4%] vs. 7/176 [4.0%], P = 0.012), and the peak incidence was observed in February and August (15.8% and 15.9%), with no confirmed cases between March and June. In the multivariate analysis, post-tussive vomiting was significantly associated with pertussis (odds ratio, 2.508; 95% confidence interval, 1.146-5.486) and secondary referral hospital showed a borderline significance. In conclusion, using a PCR-based method, 6.9% of adolescent and adult patients with an acute cough illness had pertussis infection in an outpatient setting. However, hospital levels and seasonal trends must be taken into account to develop a better strategy for controlling pertussis.
Adolescent ; Adult ; Bordetella pertussis/*genetics ; Child ; DNA, Bacterial/*analysis ; Demography ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; *Polymerase Chain Reaction ; Republic of Korea/epidemiology ; Seasons ; Vomiting/etiology ; Whooping Cough/*epidemiology/microbiology/pathology ; Young Adult

BACKGROUND: Limited data on the incidence and clinical characteristics of adult pertussis infections are available in Korea. METHODS: Thirty-one hospitals and the Korean Centers for Disease Control and Prevention collaborated to investigate the incidence and clinical characteristics of pertussis infections among adults with a bothersome cough in non-outbreak, ordinary outpatient settings. Nasopharyngeal aspirates or nasopharyngeal swabs were collected for polymerase chain reaction (PCR) and culture tests. RESULTS: The study enrolled 934 patients between September 2009 and April 2011. Five patients were diagnosed as confirmed cases, satisfying both clinical and laboratory criteria (five positive PCR and one concurrent positive culture). Among 607 patients with cough duration of at least 2 weeks, 504 satisfied the clinical criteria of the US Centers for Disease Control and Prevention (i.e., probable case). The clinical pertussis cases (i.e., both probable and confirmed cases) had a wide age distribution (45.7+/-15.5 years) and cough duration (median, 30 days; interquartile range, 18.0~50.0 days). In addition, sputum, rhinorrhea, and myalgia were less common and dyspnea was more common in the clinical cases, compared to the others (p=0.037, p=0.006, p=0.005, and p=0.030, respectively). CONCLUSION: The positive rate of pertussis infection may be low in non-outbreak, ordinary clinical settings if a PCR-based method is used. However, further prospective, well-designed, multicenter studies are needed.
Adult ; Age Distribution ; Centers for Disease Control and Prevention (U.S.) ; Cough ; Dyspnea ; Humans ; Incidence ; Outpatients ; Polymerase Chain Reaction ; Sputum ; Whooping Cough

Large symptomatic vallecular cyst is rare, but may cause difficulty or inability in conventional tracheal intubation during induction of general anesthesia. A flexible fiberoptic bronchoscope is the most useful general purpose aid to awake intubation in the patient with a known difficult airway. We experienced a case of flexible video image fiberoptic bronchoscopic awake orotracheal intubation in a patient with the large symptomatic vallecular cyst. A 35-year-old male suffered from foreign body sensation, voice change and dyspnea one month after upper respiratory tract infection. The two step flexible fiberoptic bronchoscopic approach was performed in the management of a known difficult intubation due to a vallecular cyst. We had an uneventful general anesthesia for removal of large symptomatic vallecular cyst because we anticipated difficult intubation.
Adult ; Anesthesia, General ; Bronchoscopes ; Dyspnea ; Foreign Bodies ; Humans ; Intubation ; Male ; Respiratory Tract Infections ; Sensation ; Voice

Large symptomatic vallecular cyst is rare, but may cause difficulty or inability in conventional tracheal intubation during induction of general anesthesia. A flexible fiberoptic bronchoscope is the most useful general purpose aid to awake intubation in the patient with a known difficult airway. We experienced a case of flexible video image fiberoptic bronchoscopic awake orotracheal intubation in a patient with the large symptomatic vallecular cyst. A 35-year-old male suffered from foreign body sensation, voice change and dyspnea one month after upper respiratory tract infection. The two step flexible fiberoptic bronchoscopic approach was performed in the management of a known difficult intubation due to a vallecular cyst. We had an uneventful general anesthesia for removal of large symptomatic vallecular cyst because we anticipated difficult intubation.
Adult ; Anesthesia, General ; Bronchoscopes ; Dyspnea ; Foreign Bodies ; Humans ; Intubation ; Male ; Respiratory Tract Infections ; Sensation ; Voice

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is an operator-dependent procedure and has significant procedure-related morbidity and mortality. Magnetic resonance cholangiopancreatography (MRCP) is a safe noninvasive method for pancreatobiliary imaging. The aims of this study were to evaluate the potential impact of MRCP on performing ERCP and to evaluate the decision-making value of MRCP in patients suspicious for pancreatobiliary diseases. METHODS: Two hundreds twelve patients (M:F 108:104, mean age 59.3+/-13.7) who underwent MRCP due to clinical or sonographic suggesting pancreatobiliary disease were included. We divided patients into four groups according to their presumptive diagnosis: biliary stone (group 1), biliary tumor (group 2), gallstone pancreatitis (group 3) and other biliary diseases (group 4). RESULTS: Numbers of cases in group 1, 2, 3 and 4 were 145, 43, 17 and 7, respectively. In 144 cases (67.9%), ERCP was unnecessary and 76 cases (35.8%) required neither ERCP nor any other treatment. Thereafter, these cases were thought to be a patient group in whom the workload of performing ERCP could be reduced. CONCLUSIONS: MRCP can reduce the number and efforts doing ERCP and is helpful in decision-making for the treatment of pancreatobiliary disease. Therefore, MRCP could be the primary diagnostic tool before choosing ERCP.
Aged ; Biliary Tract Diseases/*diagnosis ; Cholangiopancreatography, Endoscopic Retrograde ; *Cholangiopancreatography, Magnetic Resonance ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Diseases/*diagnosis

BACKGROUND: Interstitial lung disease has various manifestations that are differentiated by their pathology, progress and treatment However, all manifestations eventually progresses to pulmonary fibrosis. Recent studies have shown that apoptosis of pulmonary epithelial cells might be related to pulmonary fibrosis. The correlation of the apoptotic index with the clinical manifestations, pathological findings, HRCT findings and the response to treatment were examined. METHOD: Twenty subjects (14 men, 16 women), who had been diagnosed with interstitial lung disease through an open lung biopsy, were enrolled in this study. The subtypes were one AIP, two NIP, eight BOOP, and seven UIP cases. The apoptotic index was scaled from 0-2 depending on the fraction of positive staining cells by TUNEL method. The clinical severity was assessed by a modification of a previously developed CRP scoring system. The pathologic scores were based on 4 components: fibrosis, cellularity, desquamation, and granulation. In the HRCT study, each lobe was scored by the radiologists on a scale for both fibrosis and ground-glass attenuation. The treatment response was assessed by an increase in more than 10% of the CRP score, and comparing the results 3 months before and after treatment. RESULTS: The apoptotic index showed no correlation with the CRP and HRCT scoring system. The apoptotic index correlated with the pathologic elements including fibrosis, cellularity and the desquamation score (p<0.05). Of the 16 patients who received corticosteroid therapy, 9 patients (56.3%) responded to therapy. There was no correlation between the response to corticosteroid and the apoptotic index. In the case of patients with acute and subacute ILD, the apoptotic index showed a correlation with the cellularity, desquamation, and the total histological score (p<0.05). In the case of patients with chronic ILD, the apoptotic index correlated with the fibrosis and cellularity score (p<0.05). CONCLUSION: Apoptosis of the pulmonary epithelial cells is implicated in the pathogenesis of interstitial lung disease particularly on a pathological basis.
Female ; Humans

Chronic intestinal pseudo-obstruction syndrome (CIPS) is a rare clinical condition in which impaired intestinal propulsion causes recurrent symptoms of bowel obstruction in the absence of mechanical obstruction. CIPS can be present as either primary or secondary although the latter is rare in children compared with adults. The primary abnormality consists of a degeneration of either the muscularis propria (visceral myopathy), or the myenteric plexus (visceral neuropathy). A 19 year old woman was recently admitted with recurrent abdominal distension and diarrhea. An abdominal plain X-ray revealed a marked dilated stomach and duodenum with some air-fluid levels. A small bowel series showed a diffusely dilated small bowel with multifocal angulation and spiculation. Computed tomograpy also revealed a dilated small bowel and distal ileal wall thickening. The patient was treated by duodenojejunostomy and ileal resection. Histologically the intestine showed thinning of the proper muscle layer with degeneration of smooth muscle cells replaced by fibrosis. Based on the specific histopathologic finding, in addition to the clinical history, physical finding and radiological evaluation, a diagnosis of sporadic visceral myopathy was rendered. The patient was treated through total parenteral nutrition with neostigmine, prokinetics, octreotide, and erythromycin postoperatively. However, she underwent ileostomy due to poor response from these therapies. After ileostomy, she improved without a recurrence of severe symptoms.
Adult ; Child ; Diagnosis ; Diarrhea ; Duodenum ; Erythromycin ; Female ; Fibrosis ; Humans ; Ileostomy ; Intestinal Pseudo-Obstruction* ; Intestines ; Myenteric Plexus ; Myocytes, Smooth Muscle ; Neostigmine ; Octreotide ; Parenteral Nutrition, Total ; Recurrence ; Stomach ; Young Adult

Chronic intestinal pseudo-obstruction syndrome (CIPS) is a rare clinical condition in which impaired intestinal propulsion causes recurrent symptoms of bowel obstruction in the absence of mechanical obstruction. CIPS can be present as either primary or secondary although the latter is rare in children compared with adults. The primary abnormality consists of a degeneration of either the muscularis propria (visceral myopathy), or the myenteric plexus (visceral neuropathy). A 19 year old woman was recently admitted with recurrent abdominal distension and diarrhea. An abdominal plain X-ray revealed a marked dilated stomach and duodenum with some air-fluid levels. A small bowel series showed a diffusely dilated small bowel with multifocal angulation and spiculation. Computed tomograpy also revealed a dilated small bowel and distal ileal wall thickening. The patient was treated by duodenojejunostomy and ileal resection. Histologically the intestine showed thinning of the proper muscle layer with degeneration of smooth muscle cells replaced by fibrosis. Based on the specific histopathologic finding, in addition to the clinical history, physical finding and radiological evaluation, a diagnosis of sporadic visceral myopathy was rendered. The patient was treated through total parenteral nutrition with neostigmine, prokinetics, octreotide, and erythromycin postoperatively. However, she underwent ileostomy due to poor response from these therapies. After ileostomy, she improved without a recurrence of severe symptoms.
Adult ; Child ; Diagnosis ; Diarrhea ; Duodenum ; Erythromycin ; Female ; Fibrosis ; Humans ; Ileostomy ; Intestinal Pseudo-Obstruction* ; Intestines ; Myenteric Plexus ; Myocytes, Smooth Muscle ; Neostigmine ; Octreotide ; Parenteral Nutrition, Total ; Recurrence ; Stomach ; Young Adult

No abstract available.
Cartilage* ; Transplants*