An 88-year-old woman complained of right quadrant abdominal pain and severe edema in both legs. She had a history of pulmonary embolism one month ago. Abdomen CT showed a huge hepatic cyst compressing the intrahepatic portion of the inferior vena cava (IVC). The venogram CT showed multifocal thrombosis in the iliocaval and both lower extremity veins. Percutaneous hepatic cyst drainage was carried out. Fluid analysis presented leukocytosis, which suggested an infected hepatic cyst. To prevent secondary pulmonary thromboembolism, an IVC filter was inserted before catheter drainage for the hepatic cyst. One week later, abdominal pain was relieved. Then, sclerotherapy for the remnant hepatic cyst was performed by ethanol. Follow-up CT showed an increased amount of thrombosis in the iliocaval and left calf vein, but the IVC filter prevented another thromboembolic event successfully. The patient started dabigatran, a new oral anticoagulant, and compression stockings were applied to both legs. After one month, no visible thrombosis in the pelvis or either extremity was detected in abdominal CT. This case suggests that a huge hepatic cyst, especially with infection, should be considered as a possible cause of deep vein thrombosis if no other risk factors for thromboembolism exist.
Abdomen ; Abdominal Pain ; Aged, 80 and over ; Catheters ; Dabigatran ; Drainage* ; Edema ; Ethanol ; Extremities ; Female ; Follow-Up Studies ; Humans ; Leg ; Leukocytosis ; Liver ; Lower Extremity ; Pelvis ; Pulmonary Embolism ; Risk Factors ; Sclerotherapy ; Stockings, Compression ; Thromboembolism ; Thrombosis ; Tomography, X-Ray Computed ; Veins ; Vena Cava Filters* ; Vena Cava, Inferior* ; Venous Thrombosis*

Twin anemia-polycythemia sequence (TAPS) is characterized by the transfer of blood via intertwin vascular anastomoses in a single placenta. It differs from twin-twin transfusion syndrome (TTTS) in that amniotic fluid levels remain normal during pregnancy. Since the concept of TAPS was first introduced in 2007, some cases have been reported abroad, but no such a case has been reported in Korea. Here, we report the first case of spontaneous TAPS in Korea.
Amniotic Fluid ; Female ; Humans ; Korea ; Placenta ; Pregnancy ; Twins*

BACKGROUND AND PURPOSE: A substantial proportion of patients with atrial fibrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or after a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy. METHODS: AIS patients with AF hospitalized within 7 days of onset were identified from a prospective nine-center stroke registry database. Two cohorts were defined: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score > or =2. RESULTS: Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. The rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. These rates varied widely for both cohorts, with interhospital differences being statistically significant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence. CONCLUSIONS: This study shows that antithrombotic use in AIS patients with AF might be not optimal before and after stroke in Korea.
Atrial Fibrillation* ; Cerebral Infarction ; Cohort Studies ; Coronary Disease ; Drug Therapy ; Drug Utilization Review ; Guideline Adherence ; Heart Failure ; Humans ; Korea* ; Male ; Morinda ; Observational Study* ; Prospective Studies ; Stroke*

To investigate the possibility of transmission of CTX-M-producing Escherichia coli isolates among humans and animals, we compared CTX-M-producing E. coli isolates showing the same genotype from humans and dogs in Korea. Sixteen CTX-M-producing E. coli isolates from animals were selected and their genotypes were identified using MLST. Among clinical CTX-M-producing E. coli isolates from humans, which have been identified in previous studies, 12 isolates showing the same STs with those of E. coli isolates from animals were selected. For these 28 CTX-M-producing E. coli isolates, identification of bla CTX-M genes and their genetic environments, antimicrobial susceptibility testing, extended MLST, and PFGE were performed. Some CTX-M-producing E. coli isolates from humans showed the same genotypes, such as ST10, ST38, ST58, and ST95, but different CTX-M enzymes and PFGE patterns. Thus, it can be concluded that dissemination of ESBL-producing E. coli isolates between humans and animals is rare so far.
Animals* ; Dogs ; Escherichia coli* ; Escherichia* ; Genotype ; Humans* ; Korea*

BACKGROUND AND PURPOSE: Symptomatic steno-occlusion (SYSO) in acute ischemic stroke has a significant impact on treatment options and prognosis. However, the prevalence, distribution, clinical characteristics, and outcome of SYSO are not well known. METHODS: We retrospectively identified 3,451 patients hospitalized because of ischemic stroke within 24 hours of symptom onset at 9 stroke centers in South Korea. Patients who did not undergo magnetic resonance imaging were excluded. SYSO was defined as stenosis or occlusion of cerebral arteries with relevant ischemic lesions in the corresponding arterial territory. The number, location, and severity of SYSOs and their effects on functional outcome were analyzed. RESULTS: In total, 1,929 of 3,057 subjects (63.1%) had SYSO. The most frequently affected vessels were the middle cerebral artery (34.6%), extracranial internal carotid artery (14%), vertebral artery (12.4%), and basilar artery (8.7%). SYSO predicted poor outcome on the modified Rankin Scale 3-6 (odds ratio, 1.77; 95% confidence interval, 1.46-2.15) with adjustments. Involvement of 2 or more vessels was observed in 30.6% of patients with SYSO and independently increased the risk of poor outcome (odds ratio, 2.76; 95% confidence interval, 2.12-3.59). The severity of SYSO was associated with outcome and showed a significant dose-response trend (P<0.001). The effect of SYSO on outcome did not significantly differ by individual arterial location (P for contrast=0.21). CONCLUSIONS: Approximately 60% of patients with acute ischemic stroke had SYSO, and the severity and number were inversely correlated with outcome. The results suggest that SYSO could predict stroke outcome.
Basilar Artery ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebral Infarction* ; Cerebrovascular Disorders ; Constriction, Pathologic ; Hospital Distribution Systems ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Prevalence* ; Prognosis ; Republic of Korea ; Retrospective Studies ; Stroke ; Vertebral Artery

In patients with primary aldosteronism who have bilateral adrenal incidentalomas, it is important to identify which adrenal gland is secreting excess aldosterone. Traditionally, adrenal vein sampling (AVS) has been performed for lateralization despite its invasiveness. Here we report a case of bilateral adrenal incidentaloma in which 18-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) was used to identify the functional adrenal mass. A 53-yr-old man was referred to our clinic due to bilateral adrenal incidentalomas (right: 1 cm, left: 2.5 cm) on computed tomography (CT). Given his history of colon cancer, FDG-PET/CT scanning was used to rule out metastasis. Although there was focal hot uptake lesion in the right adrenal gland, the patient was suspected primary aldosteronism clinically more than metastasis because of the patient's underlying hypertension with hypokalemia. It was consistent with the results of AVS. Based on these findings, we propose that FDG-PET/CT can be used instead of AVS to identify the source of primary aldosteronism between two bilateral adrenal incidentalomas.
Adrenal Gland Neoplasms/*diagnosis/pathology/radionuclide imaging ; Adrenal Glands/pathology/surgery ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Hyperaldosteronism/*diagnosis/pathology ; Hypertension/diagnosis ; Hypokalemia/diagnosis ; Male ; Middle Aged ; Positron-Emission Tomography and Computed Tomography

Persistence is dormant phenotypic variants of regular cells that are tolerant to antibiotics. The persistent cells did not acquire antibiotic resistance genetically, being produced in response to antibiotic stress. Because of dormant phenotypic variants due to little or no cell-wall synthesis, translation, or topoisomerase activity, persistent cells show antibiotic tolerance. Recently, such persistent cells have been reported in many bacterial pathogens and are known to play significant roles in clinical settings, particularly in chronic diseases such as cystic fibrosis. Therefore, development of anti-persister drug and appropriate antibiotic treatment are required to eliminate the persisters and to prevent the development of antibiotic resistance. Screening of genes related to persister formation would lead to new drugs to combat persisters during infection. By reviewing recent publications, we summarize phenomenon of survival and tolerance in persistent cells.
Anti-Bacterial Agents ; Chronic Disease ; Cystic Fibrosis ; Drug Resistance, Microbial ; Mass Screening

A 47-year-old male with recurrent abnormal behavior for ten years was referred to our clinic. He was diagnosed with insulinoma and cognitive dysfunction. Persistent hypoglycemia leads to a high risk of cognitive dysfunction in diabetic patients. However, cognitive dysfunction associated with insulinoma is rare. In this case study, cognitive dysfunction was confirmed by neurological testing.
Humans ; Hypoglycemia ; Insulinoma ; Male

BACKGROUND/AIMS: The prevalence of occult HBV infection (OBI) in patients with chronic hepatitis C (CHC) in Korea has not been reported. Additionally, it is unclear whether OBI influences treatment outcome in CHC patients. We investigated the prevalence of OBI and its impact on treatment outcome in patients with CHC. METHODS: Seventy-six patients with CHC were enrolled and treated with pegylated or conventional interferon and ribavirin. Hepatitis B virus (HBV) DNA was detected by nested polymerase chain reaction. RESULTS: Among the 68 patients who completed treatment and follow-up, HBV DNA was detected in serum from nine (13.2%) patients, liver tissue from 10 (14.7%), and serum or liver tissue from 15 (22.1%). OBI was diagnosed in nine (12.7%) control subjects. No difference in the prevalence of OBI between patients with CHC and controls was observed (13.2 vs. 12.0%; p = 0.92). No significant differences in age, sex, genotype 1 frequency, amount of hepatitis C virus RNA, anti-hepatitis B surface antigen/anti-hepatitis B core-IgG seropositivity, staging, or histology grading were observed in patients with or without HBV DNA. Sustained virological response was achieved in 73.3% of patients with OBI and 83.0% without OBI (p = 0.46). CONCLUSIONS: These results demonstrate that a significant proportion of patients with CHC have occult HBV infection and that OBI does not affect treatment outcome in patients with CHC.
DNA ; Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis B virus ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Korea ; Liver ; Prevalence ; Ribavirin ; RNA ; Treatment Outcome

The integrated cell culture-PCR (ICC-PCR) method has been suggested as an improved method for detection of viruses in water environments. We tested 57 source waters including finished water samples in Gyeonggi-do for enteric viral contamination using total culturable virus assay (TCVA) using BGMK cells and ICC-PCR. Nineteen of the 57 source water samples (33.3%) exhibited the cytopathic effect (CPE) on BGMK cells and no finished water did exhibited CPE. Nineteen samples (33.3%) of the 57 were positive for reoviruses. For the enteroviruses, only 3 samples (5.3%) of the 57 samples showed positive results. By using ICC-PCR method, 202 flasks from source water samples were positive for enteroviruses and reoviruses. Three samples from source water were positive for both viruses. However, any flasks tested was not co-infected with two types of viruses. While the enteric viral frequencies in TCVA and ICC-PCR were similar, the viral frequency for reoviruses at first passage in two type of method was higher in ICC-PCR (94.7%) than TCVA (56.9%).
Enterovirus ; Viruses ; Water