CT-Guided Sclerotherapy for Simple Renal Cysts: Value of Ethanol Concentration Monitoring

OBJECTIVE: The aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts. MATERIALS AND METHODS: Sixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination. RESULTS: After the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 +/- 2.0 cm and 2.3 +/- 2.9 cm, respectively, in group A, and 8.4 +/- 1.7 cm and 0.8 +/- 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group. CONCLUSION: Monitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.

Antimicrobial Susceptibities and PFGE Patterns of Vancomycin-Resistant Enterococcus isolated from Clinical Specimens and Chickens / 대한진단검사의학회지

BACKGROUND: Enterococcal infections have become extremely difficult to manage because of an increase in antibiotic resistance among enterococci. In Europe, the use of avoparcin in animals was reported to be the cause of vancomycin-resistant enterococci (VRE) transmission to humans. In this study, we performed antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE) to characterize the genetic relatedness of VRE of human and chicken. METHODS: Ninety strains of VRE were isolated from clinical specimens in three University hospitals located in Seoul and Kyungi province in 2001-2002. Thirty isolates of VRE were collected from four chicken farms located in areas remotely distanced from each other. The isolates were identified to the species level by conventional biochemical tests and commercial kits. Antimicrobial susceptibilities were tested by the NCCLS disk diffusion and agar dilution methods. For a molecular epidemiologic analysis, PFGE was performed. RESULTS: Among the 90 clinical isolates were 73 vancomycin-resistant Enterococcus faecium (VREFM) and 17 vancomycin-resistant E. faecalis (VREFA). The resistant rates of VREFA to ampicillin, levofloxacin and tetracycline were 0%, 100%, and 100%, respectively, and for VREFM, 100%, 96%, and 26%, respectively. However, the resistant rates of VREFM isolated from chicken were 19% to ampicillin, 0% to levofloxacin, and 100% to tetracycline. The PFGE patterns of genomic DNA of the clinical isolates were very diverse, suggesting a polyclonal spread of VRE, although some isolates had an identical PFGE pattern, indicating a mini-outbreak due to a clonal spread. The PFGE patterns of genomic DNA of the chicken isolates were very different from those of the human isolates. CONCLUSIONS: VRE isolates from human and chicken showed very different antimicrobial susceptibilities and PFGE patterns. These results suggest that VRE isolated from human and chicken are not closely related genetically.