BACKGROUND: Several factors contribute to differences in Streptococcus pneumoniae serotype distribution. We investigated the serotype distribution and antimicrobial resistance of S. pneumoniae isolated between 2014 and 2016 in Korea. METHODS: We collected a total of 1,855 S. pneumoniae isolates from 44 hospitals between May 2014 and May 2016, and analyzed the serotypes by sequential multiplex PCR. We investigated the distribution of each serotype by patient age, source of the clinical specimen, and antimicrobial resistance pattern. RESULTS: The most common serotypes were 11A (10.1%), followed by 19A (8.8%), 3 (8.5%), 34 (8.1%), 23A (7.3%), and 35B (6.2%). The major invasive serotypes were 3 (12.6%), 19A (7.8%), 34 (7.8%), 10A (6.8%), and 11A (6.8%). Serotypes 10A, 15B, 19A, and 12F were more common in patients ≤5 years old, while serotype 3 was more common in patients ≥65 years old compared with the other age groups. The coverage rates of pneumococcal conjugate vaccine (PCV)7, PCV10, PCV13, and pneumococcal polysaccharide vaccine 23 were 11.8%, 12.12%, 33.3%, and 53.6%, respectively. Of the 1,855 isolates, 857 (46.2%) were multi-drug resistant (MDR), with serotypes 11A and 19A predominant among the MDR strains. The resistance rates against penicillin, cefotaxime, and levofloxacin were 22.8%, 12.5%, and 9.4%, respectively. CONCLUSIONS: There were significant changes in the major S. pneumoniae serotypes in the community. Non-PCV13 serotypes increased in patients ≤5 years old following the introduction of national immunization programs with the 10- and 13-polyvalent vaccines.
Cefotaxime ; Humans ; Immunization Programs ; Korea ; Levofloxacin ; Multiplex Polymerase Chain Reaction ; Penicillins ; Pneumococcal Vaccines ; Pneumonia ; Serogroup ; Streptococcus pneumoniae ; Streptococcus ; Vaccines

BACKGROUND: Although cardiopulmonary resuscitation(CPR) is a very effective therapy in cardiac arrest, it is hard to prove the true effectiveness of CPR. Several studies about out-of-hospital and emergency department CPR exist, but only a few reports about in-hospital CPR are available. This study was designed to investigate in-hospital cardiac arrest, to analyze the result of CPR, and to evaluate the problems associated with in-hospital CPR. METHODS: A clinical analysis of 71 cases of in-hospital CPR announcement from January 2000 to August 2000 was performed. The initial rhythm on cardiac arrest, return of spontaneous circulation(ROSC), and the survivals were analyzed in the case of the 46 true cardiac arrest patients. RESULTS: During 8 months, there were 71 cases of in-hospital CPR announcement. Among them, there were 46 cases of true cardiac arrest and 25 cases of non-cardiac arrest. Of the 46 true cardiac-arrest cases, 27(58.7%) experienced ROSC, 15(32.6) survived for over 24 hours, and 7(15.2%) survived to be discharged. The initial rhythms on cardiac arrest were 30 cases(65.2%) of asystole, 14(30.4%) of PEA(pulseless electrical activity), and 2(4.3%) of ventricular fibrillation, with ROSC being 17 cases(56.7%), 9(64.3%) and 1(50.0%) cases and discharged survivors being 4 cases(13.3%), 3(21.4%) and 0(0.0%) cases, respectively. CONCLUSION: Extraordinarily high proportions of asystole and PEA were seen in the initial rhythm of cardiac arrest, and those were associated with high survival rates. Although further study is needed to evaluate the course leading to this high proportion of asystole and PEA, this result suggests that if the EMS system in the hospital is activated promptly and systematically, a better outcome will be achieved in case of cardiac arrest with asystole and PEA.
Cardiopulmonary Resuscitation* ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Peas ; Survival Rate ; Survivors ; Tertiary Care Centers* ; Ventricular Fibrillation

BACKGROUND: Recently, The number of patients who have been complaining of the vertigo or dizziness has been increasing due to rapid growth of elderly population and senile disease. The differentiation of dizzy patients is not familiar to most emergency physicians. This study was designed to differentiate true vertigo and to investigate the clinical difference among central vertigo, peripheral vertigo, and other causes of dizziness. METHODS: The authors analyzed the cases of 237 dizzy patients who visited the emergency department of Chonnam University Hospital during the recent 2 years. For the base of dizziness, associated past illnesses, severity, nystagmus type, and the causes of central and peripheral vertigo. RESULTS: Female patients were 142(59.9%) and male patients were 95(40.1%). The most common age group was the 6th decade. The origin of dizziness was classified as peripheral cause(25.3%), central cause(32.9%), and others(41.8%). As to nature of the dizziness, the rotatory sense was dominant in peripheral vertigo and the floating sense and blurred vision in central vertigo. Peripheral vertigo was triggered by position change of head and body, and central vertigo by the eye movement. Audiograms I showed that most patients with central vertigo had normal hearing, but 46.7% of thoswith peripheral vertigo had an abnormal hearing disturbance. Nystagmus was more prevalent in peripheral vertigo CONCLUSION: History taking and physical examination played an important role in the diagnosis of dizzy patients. An important part of the diagnosis of a dizzy patient could be to evaluate the peripheral origin, the central origin and others causes. Because central vertigo may be associated with a significant neurological pathology, special radiological studies, including MRI and CT, are mandatory to rule out a devastating brain lesion.
Aged ; Brain ; Diagnosis ; Dizziness* ; Emergencies ; Emergency Service, Hospital ; Eye Movements ; Female ; Head ; Hearing ; Humans ; Jeollanam-do ; Magnetic Resonance Imaging ; Male ; Pathology ; Physical Examination ; Vertigo

BACKGROUND: While inositol phospholipid-specific phospholipase C (PLC) plays a central role in signal transduction pathways, little is known about its role in the vascular response to injury. Recent studies have shown that phospholipase C-gamma1 (PLC-gamma1) is required for PDGF-induced DNA synthesis and angiotensin II signaling. This study was undertaken to determine the potential involvement of PLC-gamma1 in the in vivo response to vascular injury. METHODS: Vascular injury was achieved in the left common carotid artery of six-month-old male Wistar rats. The expression of PLC-gamma1 was evaluated at serial time points by immunohistochemistry and Western blot analysis following balloon de-endothelialization of the rat carotid artery. RESULTS: In the denuded carotid artery at 1 week, the neointima became thicker in a symmetrical manner with respect to the long axis. A strong expression of PLC-gamma1 at one week after injury was seen primarily in the thin layers of neointima. This increased immunoreactivity of PLC-gamma1 persisted at 2-3 weeks after injury, coinciding with the time when neointima gains of its mass. At 4 weeks after injury, staining intensity slightly declined but levels remained elevated. As determined by Western blot analysis, the amount of PLC-gamma1 was about 3-fold higher at 3 weeks after injury compared to uninjured vessels (p<0.01). CONCLUSION: These results suggest that the amplification of traffic within signal transduction pathways involving PLC-gamma1 occurs and may play a significant role in neointima formation following arterial injury.
Angiotensin II ; Animals ; Axis, Cervical Vertebra ; Blotting, Western ; Carotid Arteries* ; Carotid Artery, Common ; DNA ; Humans ; Immunohistochemistry ; Inositol ; Male ; Neointima ; Phospholipases* ; Rats* ; Rats, Wistar ; Signal Transduction ; Type C Phospholipases ; Vascular System Injuries

It has been generally accepted that high density lipoprotein cholesterol (HDL-C) level decreases with menopause in women. However, recent reports show different results. There is very little data concerning perimenopausal women. To verify these findings, lipids and lipoprotein(a) +AFs-Lp(a)+AF0- levels were compared among pre-, peri- and postmenopausal women of similar mean ages. Postmenopausal women had higher HDL-C levels than premenopausal women (p+ADw-0.001) and there was no difference between peri- and postmenopausal women. LDL-C level in perimenopausal women was lower than in postmenopausal women (p+ADw-0.001) and higher than in premenopausal women with borderline significance (p+AD0-.051). Total cholesterol levels showed stepwise elevation from premenopause to postmenopause. Perimenopausal women had lower Lp(a) levels than postmenopausal women (p+ADw-0.0005) and similar levels to premenopausal women. Lp(a) levels between 0.1 to 10.0 mg/dL were the most prevalent in pre- and perimenopausal women, and those between 10.1 to 20.0 mg/dL in postmenopausal women. In conclusion, menopause itself is associated with the elevation of HDL-C level, and the postmenopausal increase of coronary artery disease is not related to postmenopausal change of HDL-C level. Perimenopausal status, although transient, may favor Lp(a) and lipid profiles for delaying atherosclerosis.
Apolipoproteins A/blood ; Arteriosclerosis/epidemiology ; Biological Markers ; Cholesterol/blood ; Comparative Study ; Cross-Sectional Studies ; FSH/blood ; Female ; Human ; Lipids/blood+ACo- ; Lipoprotein(a)/blood ; Lipoproteins, HDL Cholesterol/blood+ACo- ; Menopause/blood+ACo- ; Middle Age ; Postmenopause/blood ; Premenopause/blood ; Risk Factors

BACKGROUND AND OBJECTIVES: It has been reported that various inflammatory and immune reactions are involved in the development and progression of atherosclerosis. We tried to investigate whether the TNF receptor superfamilies are involved in the development and progression of atherosclerosis. MATERIALS AND METHOD: Thirteen carotid atheroma specimens(frozen sections : 10 cases, paraffin section : 5 cases) were obtained from the patients who underwent carotid endarterectomy at Samsung Medical Center and one normal aortic tissue was obtained from a transplantation donor in brain death. In the carotid endarterectomy specimens and a normal aortic tissue , the expressions of R110(TR1), 139(TR2) and DR3(TR3), members of the TNF receptor superfamilies were evaluated by immunohistochemical staining with monoclonal antibodies. Simultaneously, we evaluated the expressions of foam cells, smooth muscle cells, T-lymphocytes and B-lymphocytes. RESULTS: Immunohistochemical analysis identified a strong expressions of foam cells and smooth muscle cells in all atheroma. But, the expression of T-lymphocytes was minimal and that of B-lymphocytes was rare. The expression of DR3(TR3) was seen in all atheroma as strongly positive. The expression of 139(TR2) was observed well in frozen sections, but not in paraffin sections. Whereas, that of R110(TR1) was observed in paraffin sections as weakly positive, but not in frozen section. The areas where the TNF receptor superfamilies were expressed correlated to the area of foam cell presence. The expression of DR3 also correlated with expression of smooth muscle cells. In normal aortic tissue, the expression of inflammatory cells or TNF receptor superfamilies was not observed except smooth muscle cells which were observed in normal artery. CONCLUSION: Foam cells and smooth muscle cells were abundantly present in atheroma. The TNF receptor superfamilies are expressed in the atheroma and the region of expression was coincident with the presence of foam cells.
Antibodies, Monoclonal ; Arteries ; Atherosclerosis ; B-Lymphocytes ; Brain Death ; Endarterectomy, Carotid ; Foam Cells ; Frozen Sections ; Humans ; Myocytes, Smooth Muscle ; Paraffin ; Plaque, Atherosclerotic* ; Receptors, Tumor Necrosis Factor* ; T-Lymphocytes ; Tissue Donors ; Tumor Necrosis Factor-alpha*

BACKGROUND AND OBJECTIVES: The octapeptide hormone of the renin-angiotensin system, angiotensin ii, regulates a wide variety of physiological responses including salt and water balance, blood pressure, and vascular tone. Contradictory results have been reported regarding the effects of angiotensin ii on vascular smooth mu-scle cell (VSMC) proliferation. The aim of the present study was to investigate the direct effect of angiotensin ii on the growth of VSMC. MATERIALS AND METHOD: Rat aortic smooth muscle cells were obtained by the combined collagenase and elastase methods. Cells between the 4th and 8th passages were used for the experiments. Cultures were treated daily for 3 days with either angiotensin ii alone or angiotensin ii with equimolar concentrations of saralasin. Incorporated radioactivity of [3H]thymidine and [14C]phenylalanine was measured by liquid scintillation spectrometry. RESULTS: Angiotensin ii increased [14C]phenyalanine incor-poration about 20-30%, and saralasin completely blocked the stimulation by angiotensin ii. However, there was no significant increase in [3H]thymidine incorporation by angiotensin ii stimulation in this study. CONCLUSION: These results suggest that angiotensin ii alone induces cellular hypertrophy but has no detectable mitogenic activity in cultured rat aortic VSMC.
Angiotensin II* ; Angiotensins* ; Animals ; Blood Pressure ; Collagenases ; Hypertrophy ; Muscle, Smooth, Vascular* ; Myocytes, Smooth Muscle ; Pancreatic Elastase ; Radioactivity ; Rats ; Renin-Angiotensin System ; Saralasin ; Spectrum Analysis

The aim of this study was to investigate the efficacy of simvastatin to improved lipid profiles in hypercholesterolemic Korean patients. METHODS: From 25 hospitals in Korea, 478 hypercholesterolemic patients were enrolled from November 1996 to April 1998. The inclusion criteria was hypercholesterolemia over 240 mg/dl after diet therapy for 1 month or hypercholesterolemia over 220 mg/dl in patients with definite evidence of ischemic heart disease. Simvastatin 10mg was started and doubled up to 40mg if total cholesterol level remained higher than 200 mg/dl at monthly check. Of 478 subjects, 344 patients in whom study protocol was not violated were analyzed. RESULTS: Male to female ratio was 27:73 and 47% of the subjects were in 6th decade. Hypertension, coronary artery disease, and diabetes mellitus were present in 30, 10, and 4% of the subjects. Baseline lipid profile (mean of total cholesterol-LDL-HDL-triglyceride mg/dl) was 274-185-52-188. The dose of simvastatin for 3 months was 10/10/10mg in 61% of subjects, 10/20/20mg in 21%, 10/10/20mg in 7%, and 10/20/40mg in 12%. The change of total cholesterol level(before-4wk-8wk-12wk-withdrawal 4wk) was 274-209- 205-198-250, and the maximal reduction rate was 27%. The change of LDL-cholesterol was 185-123-116-110-159, with maximal reduction rate 39%. The change of HDL-cholesterol was 52-54-56-55-54, with maximal increase rate 9%. The change of tryglyceride was 188-161- 164-162-189, with maximal reduction rate 15%. The value before/after treatment of ApoA1, ApoB, and Lp(a) was 129/129, 138/83, and 9.3/10.7, respectively. The level of LDL-cholesterol at the end of treatment was below 100mg/dl in 36% of subjects, 100-130 in 45%, 130-160 in 16%, and over 160mg/dl in 4%. The reduction rate of LDL-cholesterol was different between subjects whose LDL decreased below 100 and those whose LDL did not decrease below 130mg/dl, which suggests the existence of the individual difference of responsiveness to simvastatin. There were only 3 subjects (0.9%) who showed increase of liver enzyme over 3 times as the upper normal limit. Conclusion: Simvastatin is effective in improving lipid profiles in hypercholesterolemic Korean patients without serious side effects.
Apolipoproteins B ; Cholesterol ; Coronary Artery Disease ; Diabetes Mellitus ; Diet Therapy ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Individuality ; Korea ; Liver ; Male ; Myocardial Ischemia ; Simvastatin*

The aim of this study was to investigate the efficacy of simvastatin to improved lipid profiles in hypercholesterolemic Korean patients. METHODS: From 25 hospitals in Korea, 478 hypercholesterolemic patients were enrolled from November 1996 to April 1998. The inclusion criteria was hypercholesterolemia over 240 mg/dl after diet therapy for 1 month or hypercholesterolemia over 220 mg/dl in patients with definite evidence of ischemic heart disease. Simvastatin 10mg was started and doubled up to 40mg if total cholesterol level remained higher than 200 mg/dl at monthly check. Of 478 subjects, 344 patients in whom study protocol was not violated were analyzed. RESULTS: Male to female ratio was 27:73 and 47% of the subjects were in 6th decade. Hypertension, coronary artery disease, and diabetes mellitus were present in 30, 10, and 4% of the subjects. Baseline lipid profile (mean of total cholesterol-LDL-HDL-triglyceride mg/dl) was 274-185-52-188. The dose of simvastatin for 3 months was 10/10/10mg in 61% of subjects, 10/20/20mg in 21%, 10/10/20mg in 7%, and 10/20/40mg in 12%. The change of total cholesterol level(before-4wk-8wk-12wk-withdrawal 4wk) was 274-209- 205-198-250, and the maximal reduction rate was 27%. The change of LDL-cholesterol was 185-123-116-110-159, with maximal reduction rate 39%. The change of HDL-cholesterol was 52-54-56-55-54, with maximal increase rate 9%. The change of tryglyceride was 188-161- 164-162-189, with maximal reduction rate 15%. The value before/after treatment of ApoA1, ApoB, and Lp(a) was 129/129, 138/83, and 9.3/10.7, respectively. The level of LDL-cholesterol at the end of treatment was below 100mg/dl in 36% of subjects, 100-130 in 45%, 130-160 in 16%, and over 160mg/dl in 4%. The reduction rate of LDL-cholesterol was different between subjects whose LDL decreased below 100 and those whose LDL did not decrease below 130mg/dl, which suggests the existence of the individual difference of responsiveness to simvastatin. There were only 3 subjects (0.9%) who showed increase of liver enzyme over 3 times as the upper normal limit. Conclusion: Simvastatin is effective in improving lipid profiles in hypercholesterolemic Korean patients without serious side effects.
Apolipoproteins B ; Cholesterol ; Coronary Artery Disease ; Diabetes Mellitus ; Diet Therapy ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Individuality ; Korea ; Liver ; Male ; Myocardial Ischemia ; Simvastatin*

Chloroma (granulocytic sarcoma) indicates an extramedullary leukemic cell collection. It often develops in the course of, or as a presenting sign of leukemia. Cardiac chloroma is uncommon and rarely detected as a mass. We report the first case of cardiac chloroma in a patient with acute lymphocytic leukemia in Korea. A 73-year-old man was admitted because of exertional dyspnea, orthopnea and generalized weakness. Thrombocytopenia and immature leukocytes were detected in the peripheral blood. An X-ray film of the chest showed mild cardiome-galy and bilateral pleural effusion. Transthoracic and transesophageal echocardiography showed a low echogenic mass at the lateral wall of the right ventricle. The size of the mass was about 6x4 cm. MRI of the chest showed right ventricular mass with slightly increased inhomogeneous signal intensity. Bone marrow aspiration and biopsy confirmed that he had a L3 FAB subtype of acute lymphocytic leukemia. Induction chemotherapy with vincristine, prednisolone, daunorubicin resulted in hematologic complete remission. At 6 weeks after the induction chemotherapy, transesophageal echocardiography demonstrated disappearance of the right ventricular mass which suggested that it was a cardiac chloroma complicating acute lymphocytic leukemia.
Aged ; Biopsy ; Bone Marrow ; Daunorubicin ; Dyspnea ; Echocardiography, Transesophageal ; Heart Ventricles ; Humans ; Induction Chemotherapy ; Korea ; Leukemia ; Leukocytes ; Magnetic Resonance Imaging ; Pleural Effusion ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prednisolone ; Sarcoma, Myeloid* ; Thorax ; Thrombocytopenia ; Vincristine ; X-Ray Film