Reconstruction of a Breast Burn Scar Using a Deep Inferior Epigastric Perforator Flap:A Case Report

Burn scar construction is one of the factors that affect the patient physically and functionally. In particular, since breast burn scars greatly affect the appearance of the breast aesthetically, reconstruction can solve this problem. Therefore, we present an example of reconstruction of burns using DIEP flaps. The asymmetry of NAC (nipple areolar complex) and sagging of the shape of the breast were resolved along with the resolution of burn scar construction.

Vaccine Effect on Household Transmission of Omicron and Delta SARS-CoV-2 Variants

Background@#We evaluated the household secondary attack rate (SAR) of the omicron and delta severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, according to the vaccination status of the index case and household contacts; further, in vaccinated index cases, we evaluated the effect of the antibody levels on household transmission. @*Methods@#A prospective cross-sectional study of 92 index cases and 197 quarantined household contacts was performed. Tests for SARS-CoV-2 variant type and antibody level were conducted in index cases, and results of polymerase chain reaction tests (during the quarantine period) were collected from contacts. Association of antibody levels in vaccinated index cases and SAR was evaluated by multivariate regression analysis. @*Results@#The SAR was higher in households exposed to omicron variant (42%) than in those exposed to delta variant (27%) (P = 0.040). SAR was 35% and 23% for unvaccinated and vaccinated delta variant exposed contacts, respectively. SAR was 44% and 41% for unvaccinated and vaccinated omicron exposed contacts, respectively. Booster dose immunisation of contacts or vaccination of index cases reduced SAR of vaccinated omicron variant exposed contacts. In a model with adjustment, anti-receptor-binding domain antibody levels in vaccinated index cases were inversely correlated with household transmission of both delta and omicron variants.Neutralising antibody levels had a similar relationship. @*Conclusion@#Immunisation of household members may help to mitigate the current pandemic.

Macronutrient Analysis of Human Milk according to Storage and Processing in Korean Mother / 대한소아소화기영양학회지

PURPOSE: As the importance of breastfeeding has been reinforced, human milk is often stored for practical reasons. Therefore, we evaluated optimal storage and processing methods for human milk from a nutritional standpoint. METHODS: Human milk samples were collected between June 2017 and February 2018. Also, data about maternal information were collected. Human milk was analyzed for macronutrients and caloric content. The samples were subdivided into groups for nutrient analysis. The control group (fresh milk) was not stored or processed. The other groups (9 groups) consisted of samples analyzed based on different storage temperatures (room temperature, refrigerated, frozen), defrosting methods (bottle warmer, room temperature thawing, microwave oven), and storage period (1 week, 1 month, 2 months) and compared with the control group. RESULTS: There was no statistically significant difference in the nutrient content of human milk among the collected samples. A significant change in the content of macronutrients in milk samples was observed under storage condition at different temperatures for 1 week with subsequent thawing with bottle warmer compared to fresh milk. Under storage at −20°C for 1 week with subsequent thawing with different defrosting methods, a significant change in the content of macronutrients in milk samples was observed compared to fresh milk. After storage at −20°C for different periods and thawing with a bottle warmer, a significant change in macronutrient content in milk samples was observed compared to fresh milk regardless of the storage period. CONCLUSION: Unlike previous guidelines, changes in macronutrient content in milk samples were observed regardless of the method of storing and thawing. Apparently, it is proposed that mothers should feed fresh human milk to their babies without storing.

The clinical usefulness of non-invasive prenatal testing in pregnancies with abnormal ultrasound findings

PURPOSE: This study aimed to evaluate the clinical usefulness of non-invasive prenatal testing (NIPT) as an alternative testing of invasive diagnostic testing in pregnancies with ultrasound abnormalities. MATERIALS AND METHODS: This was a retrospective study of pregnant women with abnormal ultrasound findings before 24 weeks of gestation between April 2016 and March 2017. Abnormal ultrasound findings included isolated increased nuchal translucency, structural anomalies, and soft markers. The NIPT or diagnostic test was conducted and NIPT detected trisomy 21 (T21), T18, T13 and sex chromosomal abnormalities. We analyzed the false positive and residual risks of NIPT based on the ultrasound findings. RESULTS: During the study period, 824 pregnant women had abnormal ultrasound findings. Among the study population, 139 patients (16.9%) underwent NIPT. When NIPT was solely performed in the patients with abnormal ultrasound findings, overall false positive risk was 2.2% and this study found residual risks of NIPT. However, the discordant results of NIPT differed according to the type of abnormal ultrasound findings. Discordant results were significant in the group with structural anomalies with 4.4% false positive rate. However, no discordant results were found in the group with single soft markers. CONCLUSION: This study found different efficacy of NIPT according to the ultrasound findings. The results emphasize the importance of individualized counseling for prenatal screening or diagnostic test based on the type of abnormal ultrasound.

Risk Factors for Mortality in Patients with Serratia marcescens Bacteremia

PURPOSE: Over the last 30 years, Serratia marcescens (S. marcescens) has emerged as an important pathogen, and a common cause of nosocomial infections. The aim of this study was to identify risk factors associated with mortality in patients with S. marcescens bacteremia. MATERIALS AND METHODS: We performed a retrospective cohort study of 98 patients who had one or more blood cultures positive for S. marcescens between January 2006 and December 2012 in a tertiary care hospital in Seoul, South Korea. Multiple risk factors were compared with association with 28-day all-cause mortality. RESULTS: The 28-day mortality was 22.4% (22/98 episodes). In a univariate analysis, the onset of bacteremia during the intensive care unit stay (p=0.020), serum albumin level (p=0.011), serum C-reactive protein level (p=0.041), presence of indwelling urinary catheter (p=0.023), and Sequential Oran Failure Assessment (SOFA) score at the onset of bacteremia (p<0.001) were significantly different between patients in the fatal and non-fatal groups. In a multivariate analysis, lower serum albumin level and an elevated SOFA score were independently associated with 28-day mortality [adjusted odds ratio (OR) 0.206, 95% confidential interval (CI) 0.044-0.960, p=0.040, and adjusted OR 1.474, 95% CI 1.200-1.810, p<0.001, respectively]. CONCLUSION: Lower serum albumin level and an elevated SOFA score were significantly associated with adverse outcomes in patients with S. marcescens bacteremia.

A Case of Infective Endocarditis Caused by Community-Acquired Acinetobacter baumannii / 대한내과학회지

Acinetobacter baumannii has become an important pathogen that causes healthcare-associated infections, including pneumonia, bacteremia, and urinary tract infection. Only sporadic cases of infective endocarditis (IE) have been reported worldwide, and in particular, community-acquired IE caused by A. baumannii is very rare. To our knowledge, no case has ever been reported in Korea. We report a 30-year-old woman who recovered from native-valve community-acquired IE caused by A. baumannii. She did not have any underlying diseases and presented with left-sided weakness, dysarthria, and fever. On investigation of acute cerebral infarction, a vegetation on her anterior mitral leaflet was found in echocardiography, and A. baumannii was cultured from the blood. In this case, A. baumannii showed intermediate resistance to cefotaxime and was sensitive to all other antibiotics. She underwent antibiotic therapy with cefoperazone/sulbactam for 5 weeks, without surgery. Consequently, the vegetation was absent in follow-up echocardiography, and no complications related to IE developed.

Encephalitis due to Acute Human Immunodeficiency Virus Infection

Clinical presentations associated with acute human immunodeficiency virus (HIV) infection are various and nonspecific. Neurologic manifestations may accompany acute HIV infection. Aseptic meningitis has been described in several reports; however, acute encephalitis during acute HIV infection is rare. Some studies have suggested that antiretroviral therapy for treatment of symptomatic acute HIV infection could be beneficial, especially in severe cases. Encephalitis is life-threatening; therefore, early diagnosis and antiretroviral therapy may be needed. We report on a case of encephalitis associated with acute HIV infection. The patient received early antiretroviral therapy and recovered from encephalitis without neurological sequelae.

Analysis of Antimicrobial Resistance of Helicobacter pylori in Gwangju, Chonnam Provinces

BACKGROUND/AIMS: A triple therapy, comprised of a proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole, is the most commonly used treatment for Helicobacter pylori (H. pylori) eradication. But, H. pylori have become resistant to antimicrobial agents, reducing eradication rates. Thus, we investigated the distribution of minimal inhibitory concentration (MIC) for these drugs and analyzed the factors that affect it. MATERIALS AND METHODS: From July 2008 through December 2009, we performed tissue culture with gastric mucosa from 51 patients who were infected with H. pylori and measured MIC by Epsilometer test (E-test). RESULTS: The mean age of the group was 56.8+/-13.8 years, and the male to female ratio was 2:1. Resistance rates of H. pylori to amoxillin, clarithromycin, metronidazole, ciprofloxacin, levofloxacin, tetracycline were 2%, 15.7%, 21.6%, 25.5%, 25.5%, and 0%, respectively. Statistically, there were no significant relationship between resistance rate and other factors including age, sex, alcohol or smoking. Follow up test revealed eradication failure in 4 of 22 patients but, MIC for amoxillin and clarithromycin of these four patients were considered to belong to the susceptible group. Three patients belonging to the clarithromycin-resistant group (MIC>256 microg/mL), were eradicated. In addition, one of the three patients showed resistant to not only clarithromycin (MIC 12 microg/mL), but also amoxiciliin (MIC 0.6 microg/mL). CONCLUSIONS: The microbial susceptability test of each antibiotics does not accurately reflecte successful eradication, but further investigation is needed to identify the factors that influence the eradication of H. pylori.

A Case of Native Valve Infective Endocarditis Caused by Bacillus cereus

Bacillus cereus is a ubiquitous organism that often contaminates microbiological cultures but rarely causes serious infections in humans. It is the causative organism of infective endocarditis (IE), a disease typically associated with intravenous (IV) drug abusers. Thus, almost all reported cases have involved the tricuspid valve. We report a case of native mitral valve (MV) IE caused by B. cereus in a 54 year-old man with moderate MV regurgitation but no apparent history of IV drug use. He presented with fever and dyspnea on exertion, symptoms which had been ongoing for 2 months. B. cereus infection was determined by blood culture examination. A transthoracic echocardiography revealed that mobile vegetations had attached to the MV. He was treated with IV antibiotics for a total of 6 weeks and received MV replacement surgery. He has maintained a good clinical recovery without complications since discharge.

A Case of Septic Arthritis Caused by Persistent MRSA Bacteremia with Successful Treatment Through Linezolid

Vancomycin is the primary antibiotic administered for treatment of methicillin-resistant S. aureus (MRSA) infection; however, treatment failure of vancomycin is currently not uncommon in patients with in vitro vancomycin susceptibile S. aureus (MIC < or = 2 microg/mL) infection. In this report, we describe a case of septic arthritis caused by persistent MRSA bacteremia and treated successfully with linezolid after failure of initial vancomycin therapy.

Multicystic Mass Infection in the Subcutaneous Tissue around Joint Developed by Aspergillus in a Liver Transplant Patient

Invasive aspergillosis can be occured in immune-compromised patients with hematopoietic stem cell transplantation, solid organ transplantation and prolonged neutropenia. The major area of invasive aspergillosis involves the sinopulmonary tract but can occur around the joint areas rarely. A 72-year-old man, who had received a liver transplant 6 years earlier, presented with a mass lesion around the right knee joint that developed 3 year earlier. Knee MRI revealed a multicystic subcutaneous mass around the knee joint. An excision was performed, and many fungal hyphae that were morphologically most consistent with Aspergillus spp. were observed in tissue. After amphotericin B therapy for 2 weeks, the patient did not show any evidence of a recurrence of invasive aspergillosis for 15 months. As Aspergillus spp. can cause a range of infections in solid organ transplants, invasive aspergillosis must be considered in patients with a recurrent cystic mass lesion.

A Case of Baclofen-Induced Encephalopathy in a Patient with ESRD on Continuous Ambulatory Peritoneal Dialysis / 대한신장학회지

Baclofen (beta-4-chlorophenyl-gamma-aminobutyric acid), a gamma-aminobutyric acid (GABA) derivative, is commonly used for relief of spinal-origin spasm or pain. Baclofen is eliminated predominantly by the kidneys, putting patients with impaired renal function at particular risk for baclofen accumulation. The authors report on a case of baclofen-induced encephalopathy in a patient on continuous ambulatory peritoneal dialysis (CAPD). A 56 year old patient with ESRD on CAPD was admitted due to stuporous mental status after baclofen treatment. Brain imaging showed no specific abnormality. After intensive treatment of CAPD for 3 days, neurologic abnormality was completely recovered. Baclofen should not be recommended for patients with renal dysfunction. Although the best-known treatment choice for baclofen toxicity is hemodialysis, intensive CAPD can also be considered as an option for treatment of baclofen toxicity.

Prenatally Diagnosed Uncommon Mosaic Autosomal Trisomy

Prenatal diagnosis of rare autosome mosaicism involvingchromosomes other than chromosome 13, 18, 21 or the sex chromosome is encountered prognostic dilemma during genetic counseling. We report four cases of level III uncommon mosaicism of trisomy 5, 16 and 20,diagnosed prenatally. In case 1 with mosaic trisomy 20, there was a higher mosaic ratio of trisomy 20 in the repeat amniocentesis (62.1%) than in the first (36.6%) with normal fetal ultrasound finding except for a relatively small aorta on a 3-vessel view of the fetal heart. Case 2 showed a low rate of mosaic trisomy 20 (5.25%) in cultured amniocytes but normal karyotype in the repeat amniocentesis, who delivered a normal healthy baby. Case 3 showed a 13.6% of trisomy 16 mosaicism in the 30 cells of cultured amniocytes. Sixty cells from a fetal blood sample at termination showed non-mosaic 46,XX normal karyotype, while skin fibroblasts had 22.5% trisomy 16 in 40 metaphases. The autopsy showed ventricular septal defect (VSD). Case 4 with low grade mosaicism (10.5%) of trisomy 5 resulted in elective termination, though the ultrasoumd showed growsly normal fetus. Although level III mosaicism is regarded as true mosaicism, it is difficult to predict the outcome of the fetus with rare mosaic autosome trisomy. Therefore mosaic autosome trisomy of fetus should be carefully interpreted with more various approaches including repeat sampling and targeted fetal ultrasound.

A case of osteomalacia due to vitamin D deficiency in a 36-year-old woman / 대한내과학회지

Osteomalacia is characterized by defective mineralization of bone tissue, which leads to an accumulation of unmineralized bone matrix. The various potential causes of osteomalacia include vitamin D-associated metabolic disorders, absorption disorders, cancer, and drugs. While reports of osteomalacia caused by nutritional deficiency and inadequate sunlight exposure are rare in Korea, we recently experienced a case of osteomalacia due to vitamin D deficiency in a 36-year-old woman. The patient was a strict vegetarian, and over the previous 3 years, she had worked solely at night and reported suffering from multiple bone pain for 6 months. Dual-energy X-ray absorptiometry revealed a T-score of -4.9 and Z-score of -4.5 at the lumbar portion of the spine (L1-4). The serum 25(OH)D level was 7.6 ng/mL, and an iliac bone biopsy showed increased osteoid thickness compatible with osteomalacia. The patient's symptoms of generalized bone pain improved after vitamin D and calcium supplementation.

Laparoscopic Wedge Resection of GISTs Involving the Second Portion of the Duodenum

The optimal surgical procedure for treatment of gastrointestinal stromal tumors (GISTs) of the duodenum remains undefined. Therefore, various surgical procedures have been introduced as treatment options for duodenal GISTs. Due to the anatomical complexity, the laparoscopic approach has been considered as a contraindication. Especially for GISTs located at the second portion of the duodenum, a laparoscopic wedge resection is technically difficult to perform. We describe the surgical technique of laparoscopic wedge resection with hand-sewn closure for GISTs that involve the second portion of the duodenum.

Pericentric Inversion of the X Chromosome in a Male with Azoospermia and in the Family of a Pregnant Female Carrier

We report on two cases of pericentric inversion of X chromosome. The cases were found in a 40-year- old man with azoospermia and in a family of a 38-year-old pregnant woman. The first case with 46,Y,inv(X)(p22.1q27) had concentrations of LH, prolactin, estradiol, and testosterone that were within normal ranges; however, FSH levels were elevated. Testis biopsy revealed maturation arrest at the primary and secondary spermatocytes without spermatozoa. There were no microdeletions in the 6 loci of chromosome Y. For the second case, the cytogenetic study of the pregnant woman referring for advanced maternal age and a family history of inversion X chromosome was 46,X,inv(X)(p22.11q27.2). The karyotype of her fetus was 46,X,inv(X)(p22.1q27). Among other family members, the karyotypes of an older sister in pregnancy and her fetus were 46,X,inv(X)(p22.11q27.2), and 46,Y,inv(X), respectively. The proband's father was 46,Y,inv(X)(p22.11q27.2). All carriers in the family discussed above were fertile and phenotypically normal. In addition, the ratio of inactivation of inv(X) by RBG-banding was discordant between the two sisters, with the older sister having only 4.1% of cells carrying inactivated inv(X) while the proband had a 69.5% incidence of late replicating inv(X). Therefore, we suggest that the cause of azoospermia in the first case might be related to inversion X chromosome with positional effect. Also, the family of the second case showing normal phenotype of the balanced inv(X) might be not affected any positional effect of genes.

Laparoscopic Cystogastrostomy for the Patient of Pancreatic Pseudocyst with Intra-abdominal Adhesion

A large symptomatic and unresolved pancreatic pseudocyst is treated surgically by internal drainage to a neighboring adherent viscus. Recently the various minimal invasive approaches have been used to treat this condition. A 30- year-old man who had been in clinical follow-up for a chronic pancreatitis. For the necrotizing pancreatitis, the patient had undergone surgical debridement and external drainage 5 years, and 3 years ago, respectively. Abdominal ultrasonography and computed tomography revealed 8.2x7.7 cm sized pseudocyst in the body of pancreas. Endoscopic internal fistula formation was tried, but it was failed due to bleeding. We underwent adhesiotomy and cystogastrostomy totally with laparoscopic techniques. The patient started a diet on the 5th postoperative day and discharged on the 11th postoperative day. There was no postoperative complicationand no recurrence during 6 months. Laparoscopic cystogastrostomy is safe and feasible method in the pancreatic pseudocyst even in case of severe abdominal adhesion.

Clinical Characteristics and Prognosis of Gastrointestinal Stromal Tumors of Stomach

PURPOSE: Gastrointestinal stromal tumorsm (GISTs) are the most common mesenchymal tumors that arise anywhere in the tubular GI tract. The prognosis for GSTIs is important because f GISTs may metastasiwx in the liver or the abdominal cavity in an early stage. For the reason we examined the tumor size, the mitotic number, ki 67, p53, and c-kit mutation as independent prognostic factor for GISTs. MATERIALS AND METHODS: A retrospective study was conducted in 76 patients who had been re-evaluated for confirmation of diagnosis between Jan 1998 and Dec. 2001. at Catholic University of medicine. RESULTS: There were significant difference between the tumor size, mitotic indices, ki 67, c-kit mutations and the 5-years survival rates. Tumor size (> or = 5 cm) and mitotic index (> or = 5/50 HPF) were statistically related to a significantly poor prognosis (P=0.017 and P=0.042, respectively). c-kit mutations in exon 11 were found in 7 cases c-kit mutation was observed more frequently in high risk patients, and there was a significant difference between c-kit mutation and survival (P=0.037). Elevated ki 67 was noted in 34 out of the 76 cases. High risk patients showed elevated ki67 index more frequently and there was significant relation with the survival rate (P=0.0417). CONCLUSION: We think that tumor size, mitotic index, Ki 67 and c-kit mutation are as independent prognostic factors for GISTs, but more research is needed.

Clinical Features of Liver Abscess Developed after Radiofrequency Ablation and Transarterial Chemoembolization for Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) have been applied for treating hepatocellular carcinoma (HCC), but procedure-related complications can be a serious problem. This study was conducted to evaluate the clinical features of HCC patients who developed liver abscess after RFA and TACE, as compared to those patients without malignancy. METHODS: In our center, from December 1999 to March 2004, 31 cases of liver abscess developed after local treatment of HCC (13/751 after RFA and 18/8417 after TAE), which correspond to 5.1% of the total cases (602) of liver abscess. We evaluated the patients' clinical features, the abscess characteristics, the bacteriology, treatment modality, hospital days and mortality, as compared to those characteristics of 263 abscess patients without malignancy. RESULTS: The time required to diagnose liver abscess was longer in the TACE group (24.8+/-16.5 days) compared to that of the other two groups (12.2+/-9.0 days in the RFA group, 9.6+/-7.5 days in the controls, P=0.001). Gas-forming liver abscess is most frequently found in the RFA groups (76.9%). There were more hospitalized days for the TACE groups than for the RFA group and the controls (34.7+/-19.8 vs. 15.2+/-9.2 vs. 18.6+/-10.9 days, respectively, P<0.001). Two patients (11%) in the TACE group died of sepsis and liver failure. CONCLUSIONS: For the patients with prolonged fever after RFA and especially after TACE for HCC, a diagnosis of liver abscess should be suspected earlier to reduce the morbidity and mortality due to liver abscess per se and also the sepsis-related decompensation of the liver.

Patients' Gender Preference for Colonoscopist / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonoscopy is anticipated as embarrassing and uncomfortable procedure. However, the patients' gender preference for doctor has not been well evaluated in those undergoing colonoscopy. This study was to assess patients' preference for gender and age of colonoscopist. METHODS: A total of one hundread and ninety eight patients (118 males and 80 females) scheduled for colonoscopy were prospectively asked to answer the questionnaires consisting of patient characteristics, preference for gender of colonoscopist, and the period they can wait until their preferred colonoscopist would be acceptable. RESULTS: Among male patients, 51% expressed a gender preference (47% for male and 4% for female colonoscopist) and 52% of female expressed two gender preference (26% for male and 26% for female colonoscopist), and colonoscopists in their forties were preferred the most. Aged female patients and male patients with family history of colorectal cancer preferred a male colonoscopist. The strength of gender preference shown by the period they could wait was weak. CONCLUSIONS: Half of the female and male patients showed gender preference in choosing a colonoscopist. Among the patients expressing a gender preference, most male patients preferred the same gender whereas half of female preferred the opposite gender.