Pulmonary Hypertension in Patient with Neurofibromatosis Type 1 / 고신대학교의과대학학술지

Neurofibromatosis type 1 (NF1) is a rare genetic disease. Precapillary pulmonary hypertension (PH) with NF1 is an extremely severe complication. A 65-year-old woman was admitted in our hospital with 3-year history of gradually worsening dyspnea on exertion (New York Heart Association functional class III-IV). Considering her clinical feature and examination findings, she could be diagnosed as PH associated with NF1. She was treated with endothelin receptor antagonist. However her dyspnea was not significantly improved. This is the first Korean case of NF1 patient with PH which confirmed with right heart catheterization.

A Case of Biliary Obstruction Caused by Liver Cyst / 대한소화기학회지

Most cystic lesions of the liver are found incidentally in imaging studies because they are not symptomatic, and generally do not require treatment. Rarely, however, symptomatic hepatic cysts may develop complications and require treatment. Here, we describe a case of a 77-year-old woman who developed biliary obstruction with abdominal pain due to compression of the bile duct by a simple hepatic cyst. We confirmed the diagnosis based on symptoms and imaging studies. The patient's symptoms improved after simple cyst ablation by sclerotherapy.

Reconstruction of a Posterior Trunk Defect using a Pedicled Dorsolateral Posterior Intercostal Artery Perforator Flap

No abstract available.

A Giant Subpectoral Lipoma

No abstract available.

The Effects of Phlomis umbrosa Turcz on Osteoclast Differentiation / 체질인류학회지

Many bone-related diseases such as osteoporosis, rheumatoid arthritis are occurred by excessive bone resorbing activity of osteoclasts. Recently, many studies have been proceeded to find out the new therapeutic materials from natural products of plants. Phlomis umbrosa Turcz, one of the natural products of plants has been known to improve bone health. However, the precise effects and treatment mechanisms of Phlomis umbrosa Turcz about bone diseases has been unknown. So, we examined the effects of Phlomis umbrosa Turcz on expression of receptor activator of nuclear factor-kappaB ligand (RANKL)-induced osteoclast differentiation in bone marrow-derived macrophages (BMMs) and bone resorption. Also, we investigated the treatment mechanisms of Phlomis umbrosa Turcz relating to osteoclast differentiation. Here, we showed that Phlomis umbrosa Turcz significantly suppressed RANKL-induced osteoclast differentiation and bone resportion. Furthermore, Phlomis umbrosa Turcz suppressed the activation of NF-kappaB in bone marrow macrophage treated RANKL and M-CSF. The mRNA expression of c-Fos, nuclear factor of activated T-cells (NFAT)c1, osteoclast-associated receptor (OSCAR), tartrate-resistant acid phosphatase (TRAP) in BMMs was inhibited by Phlomis umbrosa Turcz. Integrin alphanu, beta3 relating to cell adhesion and dendritic cell-specific transmembrane protein (DC-STAMP) relating to the structure of filamentous actin (F-actin) ring and cathepsin K relating to bone resorbing activity are disrupted too. These results suggest that Phlomis umbrosa Turcz will be a good materials to treat bone diseases like osteoporosis.

Seroprevalence of Toxoplasmosis in Pregnant Women in Daejeon, Korea

BACKGROUND: Toxoplasma gondii can cause devastating disease in the fetus and newborn infant. Serologic testing of pregnant women for Toxoplasma-specific antibodies can be used to identify those women at risk of transmitting Toxoplasma gondii infection. In Korea, despite a few reports on the seroprevalence of Toxoplasma (Toxo) antibody, the incidence of acute or chronic toxoplasma infection during pregnancy has not been well established. We performed a prospective screening for Toxoplasma antibodies to obtain a basic epidemiological data on the seroprevalence of acute and chronic toxoplasma infection. METHODS: During a 6-month period, 787 pregnant women at various weeks of gestation were enrolled in the prospective study. Toxo IgG and IgM antibodies were determined by the Abbott AxSYM Toxo IgG and IgM assays. Serum specimens showing positive results of both IgG and IgM antibodies were further tested using the Abbott ARCHITECT Toxo IgG Avidity test. RESULTS: The seropositivities of Toxo-specific IgG and IgM antibodies in this cohort were 2.3% (18/787) and 0.1% (1/787), respectively. No woman showed positive results for both Toxoplasma IgG and IgM antibodies. One specimen showing IgG positive and IgM grayzone results was tested by Toxo IgG avidity test and a low avidity test result (9%) was obtained, suggesting a possible acute primary infection. CONCLUSIONS: This study was the first trial on the investigation of the seroprevalence of both IgG and IgM antibodies in Korea, and we found that the seroprevalence of the antibodies was lower than that previously reported.

Analysis of Acquired Resistance Genes in Stenotrophomonas maltophilia / 대한진단검사의학회지

BACKGROUND: Stenotrophomonas maltophilia is a gram-negative bacillus and a nosocomial pathogen in immunocompromised patients. Trimethoprim/sulfamethoxazole (TMP/SMX) is the drug of choice for treating S. maltophilia infection; however, resistance to TMP/SMX is increasing. In this study, we investigated the relationship between the incidence of TMP/SMX resistance and the presence of sul genes and mobile elements. METHODS: A total of 120 S. maltophilia isolates were collected from 3 university hospitals between April 2007 and April 2009. Antimicrobial susceptibilities were determined using the disk diffusion method. PCR and DNA sequencing were conducted for the detection of sul1, sul2, class 1 integron, and ISCR2 element. Repetitive extragenic palindromic sequence-based PCR (REP-PCR) was carried out to evaluate the genetic relatedness. RESULTS: The TMP/SMX-resistant (R) isolates harbored a significantly higher proportion of sul1 gene and class 1 integron than TMP/SMX-susceptible (S) isolates (P<0.001). Seventeen of 28 isolates with sul1 also had a class 1 integron, but none of the isolates without sul1 had a class 1 integron. The identified gene cassettes within class 1 integrons include aacA4, aadA1, aac6'-II, and qac. None of the 120 isolates carried sul2, glmM, or ISCR2 element. REP-PCR did not show any genetic relatedness among the isolates. CONCLUSIONS: In Korea, the resistance of S. maltophilia isolates to TMP/SMX is due to sul1 within a class 1 integron rather than to sul2. The class 1 integron also harbors multiple antibiotic resistance genes in addition to sul1, and therefore it could mediate multidrug resistance in S. maltophilia.

A Case of Recurrent Bowel Perforation in a Patient with Churg-Strauss Syndrome / 대한류마티스학회지

Churg-Strauss syndrome is a rare systemic disorder characterized by asthma, eosionphilia and necrotizing vasculitis affecting small-to-medium-sized vessels. Although it is frequently associated with gastrointestinal mucosal lesions, recurrent bowel perforation is rare and potentially life threatening. We report a case of a 66-year-old man with Churg-Strauss syndrome, who presented with recurrent small bowel perforation. He was admitted with abdominal pain developed previous night, who had a previous small bowel perforation history treated with laparoscopic closure 5 months ago. Laboratory data showed remarkable eosinophilia. Physical examination indicated positive signs of peritoneal irritation in the entire abdomen, and abdominal computed tomography scanning showed edematous small bowel with intra-abdominal free air, suggesting intestinal perforation. He underwent laparoscopic small bowel closure and was treated with steroid.

A Neurofibroma Confused with Sarcomatous Transformation on F-18 FDG PET/CT in Neurofibromatosis-1 / 핵의학분자영상

We present a patient with high 18F-fluorodeoxyglucose (FDG) uptake detected in a neurofibroma that was confused with sarcomatous transformation on a positron emission tomography/computed tomography (PET/CT) scan. A 39-year-old male patient with a 20-year history of neurofibromatosis-1 (NF-1) performed FDG PET/CT scan for the evaluation of lesions with sarcomatous transformation. The FDG PET/CT images demonstrated varying degrees of increased FDG uptake in the multiple nodules throughout whole body. The left pelvic mass with the highest FDG uptake had a maximum standardized uptake values (maxSUV) 5.0 and surgical resection was performed. Histological analysis confirmed the presence of a benign neurofibroma infiltrated with inflammatory cells.

Use of Stereoscopic Microscope for Practice of Microsurgical Skill

PURPOSE: Microsurgery is an essential technique in plastic and reconstructive surgery. However, microsurgical suturing and handling of the instrument are difficult for beginners, and who requires a steep learning curve. Therefore, methods for improving the technical skill are needed. The authors describe the value of a small stereoscopic microscope as a training tool. MATERIALS AND METHODS: A small stereoscopic microscope was used to help improve the microsurgical skill. Monofilament 10-0 Nylon and a surgical rubber globe were used as a suture material and education material, respectively RESULT: Stereoscopic view of the operation field was obtained and basic microsurgical suture was possible. CONCLUSION: The stereoscopic microscope is an effective training tool for beginners of microsurgery with benefits in cost and usefulness in small place.

Characterization of Class 1 Integrons in Metallo-beta-lactamase-producing Pseudomonas aeruginosa / 대한임상미생물학회지

BACKGROUND: The genes of metallo-beta-lactamase (MBL), a powerful carbapenemase, are carried as a part of the mobile gene cassettes inserted into integrons playing an important role in rapid dissemination of antibiotic resistance genes among bacterial isolates. In this study, we investigated carbapenemase genes and class 1 integrons integrated into the gene cassettes in imipenem-non susceptible P. aeruginosa. METHODS: From July 2006 to March 2008, 81 consecutive, non-duplicate, imipenem-non susceptible P. aeruginosa were isolated at Chungnam National University Hospital in Chungcheong province of Korea. The modified Hodge and double disk synergy tests were conducted for the screening of carbapenemase and MBL production, respectively, and PCR and DNA sequencing were performed for the detection of carbapenemase genes and class 1 integron gene cassettes. We also employed the repetitive element sequence-based (Rep)-PCR method for an epidemiologic study. RESULTS: MBLs were detected in 13.6% (11/81) of imipenem-non susceptible P. aeruginosa. Ten isolates were found to carry blaIMP-1, whereas 1 isolate was found to carry a blaVIM-2. All of the IMP-1-producing strains harbored 4.0 kb class 1 integron containing chloramphenicol, aminoglycoside, and beta-lactam- resistant genes. However, blaIMP-1 was not detected at class 1 integron. A 2.5 kb class 1 integron harboring blaVIM-2 was detected in a VIIM-2- producing strain. One identical pattern was observed in ten IMP-1 producing strains. CONCLUSION: IMP-1 producing P. aeruginosa strains are currently distributed throughout Chungcheong province of Korea. In particular, all of the strains harbored class 1 integrons containing variant antibiotic resistance gene cassettes.

Characteristics of aac(6')-Ib-cr Gene in Extended-Spectrum beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolated from Chungnam Area / 대한진단검사의학회지

BACKGROUND: Concomitant quinolone resistance in extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae is a crucial problem in the clinical management of infections. In foreign countries, the fluoroquinolone acetylating aminoglycoside-(6)-N-acetyltransferase (aac[6']-Ib-cr) gene, a novel plasmid-mediated quinolone resistance determinant has been reported to occur in conjunction with qnr. We aim to investigate the prevalence and characteristics of concomitant aac(6')-Ib-cr and qnr expression in ESBL-producing Escherichia coli and Klebsiella pneumoniae in Korea. METHODS: Between December 2007 and April 2008, we collected 60 and 69 clonally unrelated non-repetitive clinical isolates of ESBL-producing E. coli and K. pneumoniae, respectively. We studied the expressions of 11 types of ESBL-encoding genes, 4 types of 16s rRNA methylase genes; rmtA, rmtB, rmtC and armA, 3 types of qnr genes; qnrA, qnrB, qnrS and aac(6')-Ib. The presence of aac(6')-Ib-cr variants was detected by sequencing. The involvement of integrons was studied using multiplex PCR and sequencing of gene-cassette arrays. Conjugation experiments were performed to confirm plasmid-mediated resistance and the relationships among coharbored genes. RESULTS: We observed a high prevalence of the cr variant (61.1%) of aac(6')-Ib, and the prevalence of this variant in qnr and aac(6')-Ib-coharboring isolates (67.4%) was higher than in qnr-negative isolates (51.7%). The high prevalence of the cr variant was significantly related to the high minimum inhibitory concentrations (MICs) of ciprofloxacin, tobramycin, and amikacin and indicated the statistically significant roles of qnrB, qnrS, rmtA, and rmtB in quinolone and aminoglycoside resistance. CONCLUSIONS: The aac(6')-Ib-cr variants were widespread and showed significant relation to the high-level quinolone and aminoglycoside resistance in ESBL-producing E. coli and K. pneumoniae.

Irritated Seborrheic Keratosis of the External Auditory Canal which Caused Conductive Hearing Loss / 대한이비인후과학회지

Seborrheic keratoses are common superficial benign epithelial lesions of the skin. However, sometimes they can develop into malignant lesions including in situ change, basal cell carcinoma or squamous cell carcinoma. These lesions can be located anywhere on the skin, but auricular involvement is extremely rare. We report an unusual case of a large irritated seborrheic keratosis of the auricle, which caused conductive hearing loss by obstructing the external auditory meatus. We also reviewed and discuss the etiology, differential diagnosis and treatment strategy of these benign disfiguring lesions.

Dissemination of IMP-1 and OXA Type beta-Lactamase in Carbapenem-resistant Acinetobacter baumannii / 대한진단검사의학회지

BACKGROUND: Acinetobacter baumannii is an aerobic, gram-negative, glucose-nonfermenting bacterium, which has emerged as a serious opportunistic pathogen. In recent years, the increasing instance of carbapenem-resistant A. baumannii producing metallo-beta-lactamases (MBLs) or OXAtype beta-lactamases is causing a serious clinical problem. In this study, we investigated the prevalence of Ambler class A, B, and D beta-lactamases and their extended-spectrum derivatives in carbapenem-resistant A. baumannii isolates. METHODS: A total of 31 consecutive, non-duplicate, carbapenem-resistant A. baumannii were isolated from three university hospitals in the Chungcheong province of Korea. The modified Hodge and inhibitor-potentiated disk diffusion tests were conducted for the screening of carbapenemase and MBL production, respectively. PCR and DNA sequencing were performed for the detection of beta-lactamase genes. We also employed the enterobacterial repetitive intergenic consensus (ERIC)-PCR method for the epidemiologic study. RESULTS: Twenty-three of 31 isolates harbored bla(OXA-2) (51.6%), bla(OXA-23) (22.6%), bla(IMP-1) (48.4%),and bla(VIM-2) (3.2%). All of the OXA-2-producing strains also evidenced MBLs. The strains that harbored bla(OXA-23) were isolated only in hospital C, and only in a limited fashion. The ERIC-PCR pattern of the five OXA-23 strains indicated that the isolates were closely related in terms of clonality. The six strains producing IMP-1 isolated from hospital A were confirmed to be identical strains. CONCLUSIONS: A. baumannii strains harboring IMP-1 or OXA-type beta-lactamases are currently widely distributed throughout the Chungcheong province of Korea. The most notable finding in this study was that a bla(OXA-2)-producing A. baumannii harboring MBL, which has not been previously reported, can also lead to outbreaks.

Evaluation of Two Automated Instruments for Pre-transfusion Testing: AutoVue Innova and Techno TwinStation / 대한진단검사의학회지

BACKGROUND: Despite the advances in total laboratory automation, a considerable amount of work in blood banks is still done using outdated manual methods. Some automated pre-transfusion testing instruments have recently been developed. Of these, we evaluated and compared the AutoVue Innova (Ortho, USA) and the Techno TwinStation (DiaMed AG, Switzerland). METHODS: Forward and reverse ABO/Rh typing and unexpected antibody screening and identification tests were performed on 4,628 samples using the manual method and the two automated instruments. Two different anticoagulants (EDTA and citrate) were compared in ABO/Rh typing and unexpected antibody screening tests. Titrating studies were conducted on the following 7 dilutions using 5 samples of irregular antibodies with anti-E, anti-E & -c, anti-D, and anti-Le(a) with anti-Fy(a): 1:2, 1:4, 1:8, 1:16, 1:32, 1:64, and 1:128. The test throughput per hour, the time required to perform 1 and 100 tests, and a simulation test for total events occurring in 1 day were also measured. RESULTS: No erroneous results were reported between the two instruments and the manual method. Discrepancies observed in 10 cases (0.4%) of ABO/Rh typing were of higher intensity with AutoVue Innova than with the manual method. AutoVue Innova exhibited the highest sensitivity in the titrating study and throughput performance compared with the manual method and the Techno TwinStation. Especially in the throughput and time required to complete 100 antibody screening tests, AutoVue Innova had a 3.3- and 3.5-fold higher performance, respectively, than Techno TwinStation. CONCLUSIONS: Because both of the two fully automated instruments (AutoVue Innova and Techno TwinStation) had high levels of accuracy and performance, it is expected that use of fully automated instruments will reduce human labor, turnaround time, and operator error in the blood bank.

Characteristics of Acquired beta-lactamase Gene in Clinical Isolates of Multidrug-resistant Pseudomonas aeruginosa / 대한임상미생물학회지

BACKGROUND: Recently, there have been reports of infections with multidrug-resistant Pseudomonas aeruginosa. To determine the mechanism of the resistance, we investigated the prevalence of Ambler class A and D beta-lactamases, their extended-spectrum derivatives, and class B and D carbapenemase in multidrug-resistant P. aeruginosa isolates. METHODS: During the period of March 2006 to May 2007, clinical isolates of multidrug-resistant P. aeruginosa were collected from patients in Chungnam National University Hospital, Daejeon, Korea. Inhibitor-potentiated disk diffusion tests were used for the screening of metallo-beta-lactamase (MBL) production. PCR and DNA sequencing were conducted for the detection of beta-lactamase genes. We also employed the enterobacterial repetitive intergenic consensus (ERIC)- PCR method for an epidemiologic study. RESULTS: A total of 37 consecutive, non-duplicate, multidrug-resistant P. aeruginosa were isolated. Twenty- nine of 37 isolates harbored blaOXA-10 (56.8%), blaOXA-2 (18.9%), and blaOXA-1 (5.4%). Only one isolate produced IMP-1, and it also harbored blaOXA-1. None harbored Ambler class A beta-lactamase or class D carbapenemase. The strains producing OXA type beta-lactamases showed a significantly higher resistance to aminoglycoside compared to non-producers. The ERIC-PCR pattern of the 19 OXA-10 producing strains indicated that the isolates were closely related in terms of clonality. CONCLUSION: OXA type beta-lactamases are the most prevalent among the acquired beta-lactamases produced by multidrug-resistant P. aeruginosa isolated at a university hospital in Chungcheong Province. Besides beta-lactam antibiotics, the strains harboring OXA type beta-lactamase showed a significantly higher resistance to aminoglycoside and qunolone.

c-fos mRNA Expression in the Vestibular System following Hypergravity Stimulation in Rats

Altered environmental gravity, including both hypo- and hypergravity, may result in space adaptation syndrome. To explore the characteristics of this adaptive plasticity, the expression of immediate early gene c-fos mRNA in the vestibular related tissues following an exposure to hypergravity stimulus was determined in rats. The animals were subjected to a force of 2 g (twice earth's gravity) for 1, 3, or 12 h, and were examined poststimulus at 0, 2, 6, 12, and 24 h. RT-PCR (reverse transcription polymerase chain reaction) and real-time quantitative RT-PCR were adopted to analyze temporal changes in the expression of c-fos mRNA. The hypergravity stimulus increased the expression of c-fos mRNA in the vestibular ganglion, medial vestibular nucleus, inferior vestibular nucleus, hippocampus, cerebellum, and cortex. The peak expression occurred at 0 h poststimulation in animals stimulated with hypergravity for 1 h, and at 6 h poststimulus in those stimulated for 3 h. In contrast, those stimulated for 12 h exhibited dual peaks at 0 and 12 h poststimulus. Bilateral labyrinthectomy markedly attenuated the degree of c-fos mRNA expression. Glutamate receptor antagonist also dramatically attenuated the degree of c-fos mRNA expression. These results indicate that expression of c-fos mRNA in response to hypergravity occurs in the vestibular related tissues of the central nervous system, in which peripheral vestibular receptors and glutamate receptors play an important role. The temporal pattern of c-fos mRNA expression depended on the duration of the hypergravity stimulus.

HO-1 Reduces the Severity of Trinitrobenzene Sulfonic Acid-induced Colitis through Suppression of NF-kappaB Activation / 대한해부학회지

Heme oxygenage-1 (HO-1), rate-limiting enzyme in heme catabolism, has been known to show strong immune-suppressive properties although its mechanisms are not completely understood. In this study, the authors investigated the mechanism whereby HO-1 has anti-inflammatory properties in trinitrobenzene sulfonic acid (TNBS)-induced colitis. Body weight was evaluated and tumor necrosis factor (TNF-alpha), interleukin (IL)-1beta and intercellular adhesion molecule-1 (ICAM-1) were detected by immunohistochemical staining. Heme oxygenase-1 (HO-1) expression was analyzed by Western blot and immunohistochemical staining. In a mouse model, HO-1 inducer, cobalt-protoporphyrin IX (CoPPIX) administration significantly improved the clinical symptoms and histopathologic changes of trinitrobenzene sulfonic acid (TNBS) colitis as well as significantly suppressed the expression of several inflammatory mediators such as TNF-alpha, IL-1beta and ICAM-1 induced by TNBS. Furthermore CoPPIX suppressed NF-kappaB activation that is an important transcription factor for expression of proinflammatory mediators in TNBS colitis while HO-1 activity inhibitor, zinc protoporphyrin IX (ZnPPIX) reversed the protective effects of CoPPIX in TNBS colitis. Collectively, these results suggest that HO-1 exerts anti-inflammatory effects by down-regulation of NF-kappaB activity via induction of HO-1 during pathogenesis of TNBS-induced colitis.

Expression of mRNA for Monocyte Chemoattractant Protein-1 in the Sciatic Nerve and Hindlimb Muscle Following Denervation

Migration of inflammatory cells into damaged tissue is essential to host defense mechanisms and immune responses. Monocyte chemoattractant protein-1(MCP-1), a member of the CC or beta-chemokine family is a powerful leukocyte recruitment factor that is relatively specific for monocyte/macrophage. The purpose of present study was to evaluate temporal change of expression of mRNA for MCP-1 in the sciatic nerve and hindlimb muscle of Sprague-Dawley rat. The mid-portion of the sciatic nerve was exposed, cut under aseptic condition and then animals were sacrificed 1, 2, 3, 7, 14 days after denervation of the sciatic nerve. Semiquantitative RT-PCR method and image analysis system were used to analyze change in expression of mRNA for MCP-1. Expression of mRNA for MCP-1 in the distal stump of the denervated sciatic nerve was up-regulated within 1 day and peaked on the second day following transection of the sciatic nerve. Thereafter high expression of mRNA for MCP-1 lasted for 7 days after transection of the nerve. However the expression of mRNA for MCP-1 was rapidly decreased on the 14th day after denervation. Temporal change of expression of mRNA for MCP-1 in the proximal portion of the denervated sciatic nerve was very similar with that of distal one. The gastrocnemius muscle also showed significant increase in expression of mRNA for MCP-1 on the 1st day with maximal expression on the 7th day after denervation of the sciatic nerve. In contrast, the expression of mRNA for MCP-1 in the soleus muscle was lower than the gastrocnemius muscle in the course of the denervation-induced atrophy. Additionally alpha-lipoic acid, a potent antioxidant that is used in treatment for diabetic neuropathy, suppressed significantly expression of mRNA for MCP-1 in the denervated sciatic nerve but not in atrophied hindlimb muscles.