The goals of this study were to identify first-line drug resistance in new and previously treated tuberculosis (TB) cases and to determine risk factors for multidrugresistant TB (MDR-TB) at a private referral center in Korea. All patients with cultureconfirmed pulmonary TB over a 2-yr period between July 2002 and June 2004 were prospectively included in this study. In total, 637 patients were included; 512 (80.4%) were new cases, and 125 (19.6%) were previously treated cases. Resistance to at least one first-line drug was identified in 11.7% of new cases and 41.6% of previously treated cases. MDR-TB was detected in 3.9% of new cases and 27.2% of previously treated cases. The proportion of extensively drug-resistant TB among MDR-TB patients was 16.7% (9/54). Factors associated with MDR-TB included age under 45 yr, previous TB treatment, and the presence of cavitation on chest radiography. Rates of first-line drug resistance are high, particularly in previously treated patients, in the private sector in Korea. This underscores the need for an improved control program, coupled with early diagnosis of MDR-TB, to reduce the spread and development of resistance.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antitubercular Agents/pharmacology/therapeutic use ; Drug Resistance, Bacterial ; Drug Resistance, Multiple ; Female ; Hospitals/statistics & numerical data ; Humans ; Korea/epidemiology ; Logistic Models ; Male ; Middle Aged ; Mycobacterium tuberculosis/*drug effects ; Prospective Studies ; Referral and Consultation ; Risk Factors ; Tuberculosis, Multidrug-Resistant/*drug therapy/epidemiology/microbiology ; Tuberculosis, Pulmonary/*drug therapy/microbiology

BACKGROUND: There has been a gradual increase in the number of newly diagnosed cases of Mycobacterium avium complex (MAC) pulmonary disease. However, the optimal therapeutic regimen for the disease has not yet established and there is no report about the treatment outcome of MAC pulmonary disease in Korea. This study examined the effect of clarithromycin-based regimen in patients with pulmonary MAC disease without a HIV infection. MATERIALS AND METHODS: Fifty-six patients with pulmonary MAC disease were diagnosed according to the American Thoracic Society criteria from January 2000 to December 2003 at this hospital. Of these patients, 15 were treated with clarithromycin, rifampin, and ethambutol for more than 6 months, together with streptomycin initially (first 6 months) in 8 patients. RESULTS: Six months after the treatment, the sputum cultures converted from positive to negative in 8 patients (53%) and the radiological findings improved in 10 (67%). At 12 months 4 patients (44%) achieved sputum negative conversion and 6 patients out of 9 patients (67%) who were treated for more than 12 months showed radiological improvement. Overall, the sputum findings converted to negative in nine patients (60%) who underwent medical treatment. A pulmonary resection was successfully performed in one patient. Only one patient discontinued the treatment due to side effects such as gastrointestinal intolerance and optic neuritis. CONCLUSION: A combined regimen containing clarithromycin is relatively safe and tolerable even in the elderly outpatients. However, the results of this combined chemotherapy were unsatisfactory and new companion drugs for MAC pulmonary disease are needed. A resection may be considered for localized disease.
Aged ; Clarithromycin ; Drug Therapy ; Ethambutol ; Friends ; HIV Infections ; Humans ; Korea ; Lung Diseases* ; Mycobacterium avium Complex* ; Mycobacterium avium* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Optic Neuritis ; Outpatients ; Rifampin ; Sputum ; Streptomycin ; Treatment Outcome

BACKGROUND: We studied the clinical significance of nontuberculous mycobacteria (NTM) recovered from respiratory specimens for six months in a tertiary referral center. METHODS: We identified all NTM isolates from sputum or bronchial washing from October, 2001 to March, 2002, using polymerase chain reaction-restriction fragment length polymorphism analysis method amplifying the rpoB gene. Patients were classified as having definite, probable, or unlikely NTM disease as defined by the American Thoracic Society and the British Thoracic Society guidelines. RESULTS: 261 isolates of NTM recovered from 162 patients. In 162 patients, M. avium complex (MAC) was the most common species comprising 29.6% (n=48), which was followed by M. fortuitum complex (n=46, 28.4%), M. abscessus (n=26, 16.0%). 29 (17.9%) patients had definite NTM disease, and 13 (8.0%) had probable NTM disease. The common organisms involved in NTM diseases were MAC (n=23, 54.8%), M. abscessus (n=12, 28.6%). In a univariate analysis, predictive factors that were related to NTM disease were BMI <18.5 kg/m2, presence of symptoms, previous history of antituberculous treatment, positive sputum smear, presence of infiltrative, nodular or cavitary lesions at chest radiography, and isolation of MAC or M. abscessus. In a multivariate analysis, isolation of MAC or M. abscessus (OR 16.3, 95% CI 4.2~62.7, p<0.001), cavity at chest radiography (OR 4.8, 95% CI 1.4~16.6, p=0.012), and positive sputum smear (OR 4.3, 95% CI 1.4~13.3, p=0.012) were found to be variables independently associated with pulmonary disease. CONCLSUION: Epidemiology of NTM pulmonary disease in Korea is different from that in other countries. A high index of clinical suspicion as well as an accurate identification of the isolates would be required for the diagnosis of NTM pulmonary disease.
Diagnosis ; Epidemiology ; Humans ; Korea ; Lung Diseases ; Multivariate Analysis ; Mycobacterium avium Complex ; Mycobacterium chelonae ; Nontuberculous Mycobacteria* ; Radiography ; Sputum ; Tertiary Care Centers ; Thorax

Mycobacterium kansasii is the second most common cause of nontuberculous mycobacterial pulmonary disease in Western countries and Japan. The clinical and radiological features of pulmonary disease caused by M. kansasii usually resemble those of pulmonary tuberculosis including cavitary infiltrates with an upper lobe predilection. It is also now apparent that patients with M. kansasii pulmonary disease can present with noncavitary nodular bronchiectatic infiltrates similar to lung diseases of M.avium complex. With rifampin-containing regimens, treatment success rates are almost 100%. Timely diagnosis before the development of extensive disease and effective overall treatment strategies are very important to ensure that patients receive the appropriate medications for a sufficiently long period of time. To our knowledge, there has been no Korean case report of M. kansasii pulmonary disease in the immunocompetent patient until now. We report three cases of M. kansasii pulmonary disease in immunocompetent adult patients.
Adult ; Diagnosis ; Humans ; Japan ; Korea ; Lung Diseases* ; Mycobacterium kansasii* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Tuberculosis, Pulmonary

Alfa-interferon(IFN) has become the major therapeutic modality for chronic viral hepatitis. The spectrum of side effects is one of the main drawbacks of this treatment. Alfa-INF is known to lead to neuropsychiatric sym ptoms. Neuropsychiatric toxicity, including cognitive dys function, irritability, personality changes and emotional instability cause interpersonal problems, discontinuation of work and domestic discord. Other more serious IFN- induced signs of neurotoxicity include delirium, depres sion and seizures. The psychiatric side effects fell into three categories: an organic personality syndrome charac terized by irritability, and short temper; an organic affective syndrome marked by extreme emotional lability, depression and tearfulness; and a delirium marked by clouding of consciousness, agitation, paranoia, and suicial potential. These complications are thought to be revers ible with dose reduction or cessation of therapy. There fore it is important that physicians, patients and their families are informed about the potential risk of the emotional and psychiatric disturbances that can occur during alfa-INF therapy. We report three patients who had neuropsychiatric complications during long-term interferon alfa therapy.
Consciousness ; Delirium ; Depression ; Dihydroergotamine ; Hepatitis* ; Humans ; Interferon-alpha* ; Interferons* ; Paranoid Disorders ; Seizures

BACKGROUND/AIMS: The aim of this study was to evaluate the effect of alpha-interferon (IFN) on liver histology as well as on activation of hepatic stellate cell ( HSC) and trans for ming growth fact or beta-1 (TGF beta-1) expression. We had also investigated the clinical usefulness of TGFbeta-1 and alpha-smooth muscle actin (alpha-SMA) expression in liver tissue for predicting a response to alpha-IFN therapy in chronic hepat it is B. METHODS: We studied the expression of TGFbeta-1 and alpha-SMA in liver biopsys pecimens from 51 chronic hepatitis B pat ients. Using immunohistochemical staining and a semiquant it ative scoring met hod, we also evaluated TGF-beta1 and alpha-SMA expression in liver stellate cells before and after alpha-IFN therapy in liver tissue from rebiopsys pecimen of the 12 chronic hepatitis B pat ients. Recombinant IFN alpha-2b (Intron A) in doses of 6 MU/ d was given to patients intramus cularly three times per week for 6 months (total doses , 432 MU). The patients were divided into two groups according to serum alanine aminotransferase levels as well as HBV- DNA and HBeAg s eroconversion stat e. Histological grading and staging scores were according to modified Histological Activity Index (HAI) grading systems of Ishak (1995). RESULTS: The index of portal inflammation and total scores of HAI grading significantly decreased in biopsies after alpha-IFN treatment, but the scores of fibrosis staging showed no significant change in biopsies after IFN treatment. A significant decrease in alpha-SMA expression, especially in periportal area, was found, but the change of TGFbeta-1 expression was not significant. The immunoreactivity of alpha-SMA was significantly lower in responders than in non-responders, whereas the diffference of immunoreactivity of TGF-beta1 between these two groups was not found. CONCLUSIONS: These findings suggest that alpha-IFN therapy may reduce the necroinflammatory activity in liver tissues of chronic B viral hepatitis and that the degree of alpha-SMA expression before treatment may be employed as a pottent predicting indicator for the therapeutic efficacy of IFN-alpha.
Actins ; Alanine Transaminase ; Biopsy ; DNA ; Fibrosis ; Hepatic Stellate Cells ; Hepatitis ; Hepatitis B e Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Inflammation ; Interferon-alpha ; Interferons* ; Liver* ; Transforming Growth Factor beta1*

Idiopathic hemochromatosis is hereditary hemochromatosis without secondary cause. Hereditary hemochromatosis is a common disorder of iron metabolism with a prevalence of 1 case per 250-300 persons. Affected individuals absorb excessive amounts of dietary iron for a long time and tissue iron deposition results in skin discoloration, arthropathy, hepatic cirrhosis, heart cirrhosis, heart failure, diabetes mellitus and impotence. Early diagnosis and institution of phlebotomy treatment will prevent these manifestations and normalize life expectancy. We report a case of hemochromatosis in 65-year-old male of no transfusion and iron ingestion history who was anti-HCV(+), chronic alcoholic, hepatic iron index>2.24.
Aged ; Alcoholics ; Diabetes Mellitus ; Early Diagnosis ; Eating ; Erectile Dysfunction ; Fibrosis ; Heart ; Heart Failure ; Hemochromatosis* ; Humans ; Iron ; Iron, Dietary ; Life Expectancy ; Liver Cirrhosis ; Male ; Metabolism ; Phlebotomy ; Prevalence ; Skin

Since Klemm introduced the concept of antibiotic-containing bone cement for the treatment of chronic osteomyelitis, a number of studies have demonstrated the positive results of this therapy. It has been proved that antibiotic-containing bone cement continuously releases high levels of atibiotics locally into the infected and avascular wound environment. Antibiotic-containing bone cement provides several distinct advantages over irrigation-suction drainage. The major objective of this study is to analyze the results of therapy using antibiotic-containing bone cement beads for chronic osteomyelitis. The authors analyzed 21 cases of chronic osteomyelitis in patients who had been treated by saucerization and antibiotic-containing bone cement beads at Chosun University Hospital, between February 1990 and January 1993. Each patient's case was followed for at least thirteen months after operation. The results are as follows: 1. The causes of osteomyelitis were postoperative complications(10 patients), open fracture(8 patients), and hematogenous osteomyelitis(3 patients). 2. Staphylococcus aureus was the most common organism causing osteomyelitis, followed by Pseudomonas. 3. The femur was the most common location of lesion(11 patients) followed by the tibia(7 patients), the humerus(2 patients) and the ulna (1 patients). 4. Pus drainage was stopped in 13 cases with one insertion of the beads, in 2 cases with two insertions and in 2 cases with three insertions. 5. Therapy using antibiotic-containing bone cement beads can be regraded as an effective method of increasing local antibacterial activity by releasing the antibiotic into surrounding tissue over a continuous period in the treatment of chronic osteomyelitis. Antibiotic-containing bone cement beads are useful in the treatment of chronic osteomyelitis.
Drainage ; Femur ; Humans ; Methods ; Osteomyelitis ; Pseudomonas ; Staphylococcus aureus ; Suppuration ; Ulna ; Wounds and Injuries

Segmental fracture of the femoral shaft is known as an unusual injury, usually caused by severe force and associated with marked damage to the soft tissue, and is difficult to treat due to these causes it is a controversal topic in regard to the treatment. Authors analysed 14 cases of segmental fracture of the femoral shaft, except cases associated with hip fracture, which had received operative treatment at Dept. of Orthopaedic Surgery, College of Medicine, Chosun University, from Jan. 1985 to Dec. 1990. The results are summarized as follows; 1. Of 14 cases, there were 12 cases of male and 2 cases of female: male was predominant. Most cases were at their 3rd and 6th decades of age. 2. Traffic accidents were the main causes of injury(11 out of 14 cases.) 3. There were 13 closed fracture and 1 open fracture. 4. In most cases, they accompanied injuries to other vital organ. Among 14 cases, 5 cases accompanied head injury. 5. We treated these fracture by flexible intramedullary nailing in 7 cases, open reduction and internal fixation with plate in 5 cases, locked intramedullary nailing in 2 cases. Bony union was more rapid in the distal fracture than in the proximal fracture. 6. Among 14 cases, primary bone grafting was done in 2 cases. In the group where primary bone grafting had not been done, dealyed union appeared but nonunion was not seen. 7. We could obtain rapid bony union and decreased operation time in the cases which were treated with intramedullary fixation, and thought that intramedullary fixation was a relatively good method in type of this fracture.
Accidents, Traffic ; Bone Transplantation ; Craniocerebral Trauma ; Female ; Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Open ; Hip ; Humans ; Male ; Methods

Calcaneus was the most commonly involved bone among the tarsal bone fracture. Many different methods have been tried for the treatment of fractures of the calcaneus in order to search for better results. But there is no general agreement on the treatment of the fracture of the calcaneus, especially involving the subtalar joint. From Jan. 1986 to Jan. 1990, 25 feet in 20 patients of calcaneal fractures involving the subtalar joint were treated by closed reduction & percutaneous pinning at the Dept. of Orthopedic Surgery, Chosun University Hospital and the results were as follows; 1. Of these intra-articular fractures, 15 fractures were tongue type and 10 fractures were joint depression type by Essex-Lopresti classification. 2. According to the Salama unit system, the results of treatment were excellent or good in 11 cases of 15 tongue types and 6 cases of 10 joint depression types. 3. The results were excellent in which reduction is achieved near anatomical reduction. 4. Even if the joint depression type fracture which is not severely comminuted, the treatment with closed reduction & percutaneous pinning is thought to be good method.
Calcaneus ; Classification ; Depression ; Foot ; Humans ; Intra-Articular Fractures ; Joints ; Methods ; Orthopedics ; Subtalar Joint ; Tarsal Bones ; Tongue