ABSTRACT
BACKGROUND: Due to advances in various diagnostic methods, recent studies reported changes in the pattern of etiology of fever of unknown origin (FUO). To identify the current pattern of the causes of FUO, we analyzed the etiology of recently diagnosed FUO at a university hospital in Korea. MATERIALS AND METHODS: We reviewed 69 cases that fulfilled the criteria of classic FUO and retrospectively analyzed the etiology and decisive methods of diagnosis. RESULTS: The etioloies of FUO were infectious disease, non-infectious inflammatory disease, malignancy and miscellaneous cases in 22 (31.9%), 8 (11.6%), 4 (2.3%) and 21 (30.4%) patients, respectively. In 15 (21.7%) cases the cause could not be identified. Among infectious diseases, tuberculosis and suspected typhoid fever were the most common causes of infection (8 case, 11.7%) with tuberculosis being the most common confirmed infection. Adult onset Still's disease (13 cases, 4.4%) and drug-related fever (13 cases, 18.8%) were the most common cause of non-infectious inflammatory disease and miscellaneous causes, respectively. Decisive methods of final diagnosis were by observation of clinical course in 35 (64.8%), radiologic examination in 10 (18.5%), serologic or biochemical test in 5 (9.3%) and tissue biopsy in 4 (7.4%); none were diagnosed by culture. CONCLUSION: Infection remains the most common etiology of classic FUO in Korea and observing the clinical course is the most commonly used method for decisive diagnosis and its importance should be emphasized in approaching patients with FUO.
Subject(s)
Adult , Humans , Biopsy , Communicable Diseases , Diagnosis , Fever of Unknown Origin , Fever , Korea , Retrospective Studies , Still's Disease, Adult-Onset , Tuberculosis , Typhoid FeverABSTRACT
BACKGROUND: Target point mutation of DNA topoisomerase, which is the typical mode of quinolone resistance, cannot explain high level resistance to quinolones. Therefore, many authors looked into over expression of efflux pump as the possibility. After quantificating the arcA mRNA, which controls AcrAB- TolC, the authors tried to find out the difference in the expression of arcA mRNA according to MIC of ciprofloxacin. The authors also tried to determine the usefulness of real time PCR, which is more reproducible and takes less time than preexisting immunoblot assay, through quantification of acrA. MATERIAL AND METHODS: Mutations in topoisomerase (GyrA, ParC) of 20 quinolone resistant E. coli isolates were identified by PCR and direct DNA sequencing. AcrA level was measured by real time PCR. GAPDH of E.coli was used as endogenous control. The expression of acrA was confirmed through northern hybridization method, the results obtained by real time PCR were compared. RESULTS: 1) Topoisomerase mutations were found in all quinolone resistant E. coli strains. 2) AcrA expression in fluoroquinolone-resistant E. coli was quantified by using real time PCR. There was no relationship between the ratio of acrA expression to GAPDH and MIC of ciprofloxacin. 3) With Northern hybridization, we compared the band of acrA to that of GAPDH in compactness and area. No difference in the expression according to MIC could be found. 4) The results of AcrA/GAPDH were significantly correlated between the real-time PCR and northern blot (P<0.05, correlation coefficiency 0.98). CONCLUSION: In this study, no relationship between overexpression of AcrA gene and high level fluoroquinolone resistance. Therefore, we assume that mechanism other than AcrAB efflux pump is involved in and contribute to high-level fluoroquinolone resistance. However, the degree of efflux pump expression could be confirmed with real time PCR using acrA mRNA. Therefore, real time PCR could be used in the molecular biologic study on the mechanism of resistance to antibiotics.
Subject(s)
Anti-Bacterial Agents , Blotting, Northern , Ciprofloxacin , DNA Topoisomerases, Type I , Escherichia , Fluoroquinolones , Point Mutation , Polymerase Chain Reaction , Quinolones , Real-Time Polymerase Chain Reaction , RNA, Messenger , Sequence Analysis, DNAABSTRACT
BACKGROUND: Due to advances in various diagnostic methods, recent studies reported changes in the pattern of etiology of fever of unknown origin (FUO). To identify the current pattern of the causes of FUO, we analyzed the etiology of recently diagnosed FUO at a university hospital in Korea. MATERIALS AND METHODS: We reviewed 69 cases that fulfilled the criteria of classic FUO and retrospectively analyzed the etiology and decisive methods of diagnosis. RESULTS: The etioloies of FUO were infectious disease, non-infectious inflammatory disease, malignancy and miscellaneous cases in 22 (31.9%), 8 (11.6%), 4 (2.3%) and 21 (30.4%) patients, respectively. In 15 (21.7%) cases the cause could not be identified. Among infectious diseases, tuberculosis and suspected typhoid fever were the most common causes of infection (8 case, 11.7%) with tuberculosis being the most common confirmed infection. Adult onset Still's disease (13 cases, 4.4%) and drug-related fever (13 cases, 18.8%) were the most common cause of non-infectious inflammatory disease and miscellaneous causes, respectively. Decisive methods of final diagnosis were by observation of clinical course in 35 (64.8%), radiologic examination in 10 (18.5%), serologic or biochemical test in 5 (9.3%) and tissue biopsy in 4 (7.4%); none were diagnosed by culture. CONCLUSION: Infection remains the most common etiology of classic FUO in Korea and observing the clinical course is the most commonly used method for decisive diagnosis and its importance should be emphasized in approaching patients with FUO.
Subject(s)
Adult , Humans , Biopsy , Communicable Diseases , Diagnosis , Fever of Unknown Origin , Fever , Korea , Retrospective Studies , Still's Disease, Adult-Onset , Tuberculosis , Typhoid FeverABSTRACT
BACKGROUND: Target point mutation of DNA topoisomerase, which is the typical mode of quinolone resistance, cannot explain high level resistance to quinolones. Therefore, many authors looked into over expression of efflux pump as the possibility. After quantificating the arcA mRNA, which controls AcrAB- TolC, the authors tried to find out the difference in the expression of arcA mRNA according to MIC of ciprofloxacin. The authors also tried to determine the usefulness of real time PCR, which is more reproducible and takes less time than preexisting immunoblot assay, through quantification of acrA. MATERIAL AND METHODS: Mutations in topoisomerase (GyrA, ParC) of 20 quinolone resistant E. coli isolates were identified by PCR and direct DNA sequencing. AcrA level was measured by real time PCR. GAPDH of E.coli was used as endogenous control. The expression of acrA was confirmed through northern hybridization method, the results obtained by real time PCR were compared. RESULTS: 1) Topoisomerase mutations were found in all quinolone resistant E. coli strains. 2) AcrA expression in fluoroquinolone-resistant E. coli was quantified by using real time PCR. There was no relationship between the ratio of acrA expression to GAPDH and MIC of ciprofloxacin. 3) With Northern hybridization, we compared the band of acrA to that of GAPDH in compactness and area. No difference in the expression according to MIC could be found. 4) The results of AcrA/GAPDH were significantly correlated between the real-time PCR and northern blot (P<0.05, correlation coefficiency 0.98). CONCLUSION: In this study, no relationship between overexpression of AcrA gene and high level fluoroquinolone resistance. Therefore, we assume that mechanism other than AcrAB efflux pump is involved in and contribute to high-level fluoroquinolone resistance. However, the degree of efflux pump expression could be confirmed with real time PCR using acrA mRNA. Therefore, real time PCR could be used in the molecular biologic study on the mechanism of resistance to antibiotics.
Subject(s)
Anti-Bacterial Agents , Blotting, Northern , Ciprofloxacin , DNA Topoisomerases, Type I , Escherichia , Fluoroquinolones , Point Mutation , Polymerase Chain Reaction , Quinolones , Real-Time Polymerase Chain Reaction , RNA, Messenger , Sequence Analysis, DNAABSTRACT
OBJECTIVE: Locking of the knee is usually attributed to a tear of meoiscus, or to a loose body that rnechanically obstructs the motion of joint. A less frequently recognized cause of a locked knee is a partial tear of the ACL. The purpose of this study is to report that the partial tear of,the ACL at the femoral attachment site of posterolateral bundle provided a mechanical obstruction in the knW, and it is convicted the injury mechanism of isolated ACL. MATEIRALS AND METHODS: The author presents 16 cases in which the torn ACL was observed knee locking under arthroscopy fram February 1993 to June 1996. Patients ages ranged from 22 to 54 years. The mechanism of injuries were 6 sports activity (Ski 4, Soccer 1, Badminton 1), 4 slip down, 3 pedestrian car accidents and 3 unknown causes with especially low velocity injuries. Although the chief complain in each case was knee pain, all had locking knee that, on physical examination, locked from 5 to 20 of full extension, and 4 locked full flexion. The positive Lachman test was obtained 3 of the 16 paiients. Associated intraarticular injuries were 2 tears of the medial meniscus, 1 lateral meniscus. RESULTS: The average time to arthroscopy was 3 nonths with a range of 1 month to 10 rnonths. An arthroscopic diagnosis and treatment were performed and meniscal tears were ruled out as the cause of locking in all patients. The injury mechanism of isolated ACL was the hyperextensioo of the knee with leg I/R and especially low velocity injuries. The ACL was found to have a partial tear at the site of femoral attachment of an estimated P-L bundle. The torn segment of the ACL to become interposed between the lateral femoral condyle and the latera1 tibial condyle and to act as mechanical block was demcinstrated. CONCLUSION: In all cases, the torn portion of the ACL was excised under arthroscopy and knee locking was resolved.
Subject(s)
Humans , Arthroscopy , Diagnosis , Joints , Knee , Leg , Menisci, Tibial , Physical Examination , Racquet Sports , Soccer , SportsABSTRACT
INTRODUCTION: The reconstructions of posterior cruciate ligament (PCL) has been increasing because of increased incidence of insufficiency of the PCL and improved surgical skill Arthroscopic operation is known better than open in cruciate ligamet reconstruction in many respects. Arthroscopic PCL reconstruction, especially using hanstring tendon has some benefits. This study is retrospective study analyzing 20 patients treated by arthroscopically assisted PCL reconstruction using hamstring tendon. ALATERIAL AND METHODS: From November 1993 to June 1996, 20 patients with PCL insufficiency had heen treated by arthroscopically assisted PCL reconstruction using double-looped hamstring (semitendinosus and gracilis) tendon by first author. The isometric point was located slightly posterosuperior than anatomic attachment in femur and 0.8-1.0cm below articular margin in tibia. They were confirmed by intraoperative fluoroscopy. The remnants of intact PCL bundle and meniscofemoral ligaments were preserved and added to the graft. They were nineteen men and one women, with a mean age 31.8 years (range, 15-56 years). RESULTS: The results were as follows; 1. The patients were followed from 13 months to 44 months after operation (average 2years and 2months ). 2. Post operative neurovascular irjuries were not found. 3. No revision case was observed and second operations were made in two cases with posterolateral rotatory instability after primary reconstruction. 4. All patient has no symptom of instability after operation. S. At last follow up, Lyshohn knee scores improved from 62 preoperatively to 89 postoperati.vely on average. CONCLUSION: Arthroscopically assisted PCL reconstruction using double-looped hamstring (semitendinosus and gracilis) tendon is easier and less damage than using bone-patellar tendon-bone graft. It preserves intact meniscofemoral ligament, some intact fibers of PCL bundle and quadriceps mechanism. We think it is a effective treatment for PCL insufficiency patients."