An atypical case of Lemierre syndrome following oropharyngeal infection / 고신대학교의과대학학술지

Lemierre syndrome is characterized by anaerobic bacterial infection in the head and neck and clinical or radiological evidence of internal jugular vein thrombophlebitis. The most common pathogens are Fusobacterium species, particularly Fusobacterium necrophorum. Septic emboli resulting from infected thrombophlebitis of the internal jugular vein leads to metastatic infections involving lung, liver, kidney, bone and central nervous system. The accurate diagnosis and treatment is important because it may be associated with a high mortality rate if untreated. We present a case of 28-year-old man with an atypical history for the diagnosis of Lemierre syndrome, which showed no definite evidence of internal jugular thrombophlebitis.

Insulin autoimmune syndrome associated with alpha-lipoic acid in a young woman with no concomitant disease / 영남의대학술지

Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia, extremely high serum insulin levels, and high titers of autoantibodies against endogenous insulin, in the absence of exogenous insulin injection. IAS often occurs following exposure to sulfhydryl-containing drugs, including alpha-lipoic acid (ALA). A 30-year-old woman without diabetes visited our outpatient clinic with recurrent hypoglycemia. She had been taken ALA for weight reduction since 3 weeks ago. Further hypoglycemia work up revealed very high insulin levels, C-Peptide levels and positive insulin antibodies. And conventional imaging examinations were negative for insulinoma or other pancreatic tumors. Finally, the diagnosis of Insulin autoimmune syndrome (IAS) was made. Following the cessation of ALA, hypoglycemia improved, with no medication, and the patient experienced no further hypoglycemic attacks over the next month. The use of ALA as a nutritional supplement is increasing. We report a case of IAS associated with ALA in a non-diabetic patient.

Insulin autoimmune syndrome associated with alpha-lipoic acid in a young woman with no concomitant disease / 영남의대학술지

Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia, extremely high serum insulin levels, and high titers of autoantibodies against endogenous insulin, in the absence of exogenous insulin injection. IAS often occurs following exposure to sulfhydryl-containing drugs, including alpha-lipoic acid (ALA). A 30-year-old woman without diabetes visited our outpatient clinic with recurrent hypoglycemia. She had been taken ALA for weight reduction since 3 weeks ago. Further hypoglycemia work up revealed very high insulin levels, C-Peptide levels and positive insulin antibodies. And conventional imaging examinations were negative for insulinoma or other pancreatic tumors. Finally, the diagnosis of Insulin autoimmune syndrome (IAS) was made. Following the cessation of ALA, hypoglycemia improved, with no medication, and the patient experienced no further hypoglycemic attacks over the next month. The use of ALA as a nutritional supplement is increasing. We report a case of IAS associated with ALA in a non-diabetic patient.

Keratinization of Lung Squamous Cell Carcinoma Is Associated with Poor Clinical Outcome / 결핵및호흡기질환

BACKGROUND: Although the World Health Organization (WHO) classification of lung squamous cell carcinoma (SCC) was revised in 2015, its clinical implications for lung SCC subsets remain unclear. We investigated whether the morphologic characteristics of lung SCC, including keratinization, were associated with clinical parameters and clinical outcome of patients. METHODS: A total of 81 patients who underwent curative surgical resection of diagnosed lung SCC, were enrolled in this study. Attributes such as keratinization, tumor budding, single cell invasion, and nuclear size within the tumor, as well as immunohistochemistry of Bcl-xL and pS6 expressions, were evaluated. RESULTS: The keratinizing and nonkeratinizing subtypes did not differ with respect to age, sex, TNM stage, and morphologic parameters such as nuclear diameter, tumor budding, and single cell invasion at the tumor edge. Most patients with the keratinizing subtype (98.0%) had a history of smoking, whereas the nonkeratinizing group had a relatively higher proportion of never-smokers relative to the keratinizing group (24.0% vs. 2.0%; p=0.008, chi-square test). Expression of pS6 (a surrogate marker of mammalian target of rapamycin complex 1 [mTORC1] signaling that regulates keratinocyte differentiation), and Bcl-xL (a key anti-apoptotic molecule that may inhibit keratinization), did not correlate significantly with the presence of keratinization. Patients with the keratinizing subtype had a significantly shorter overall survival (85.2 months vs. 135.7 months, p=0.010, log-rank test), and a multivariate analysis showed that keratinization was an independent, poor prognostic factor (hazard ratio, 2.389; 95% confidence interval, 1.090–5.233; p=0.030). CONCLUSION: In lung SCC, keratinization is associated with a poor prognosis, and might be associated with smoking.

A Case of Primary Tracheal Schwannoma / 고신대학교의과대학학술지

Although benign nerve sheath tumors have been described, primary tracheal schwannomas are extremely rare. We report a case of primary tracheal schwannoma, a rare benign nerve sheath tumor in a 58-year-old man with atypical symptoms of chronic cough, sputum and dyspnea for 2 months. Chest computerized tomography showed a 1.7 cm polypoid lesion in posterior wall of mid trachea. The results of bronchoscopic biopsy and immuno-histo-chemical studies were consistent with schwannoma. A surgical treatment of tumor resection and tracheal reconstruction by end-to-end anastomosis was performed.

Association of Specific Immunoglobulin E to Staphylococcal Enterotoxin with Airway Hyperresponsiveness in Asthma Patients / 결핵및호흡기질환

BACKGROUND: Specific immunoglobulin E (IgE) sensitization to staphylococcal enterotoxin (SE) has been recently considered to be related to allergic disease, including asthma. Despite studies on specific IgE (sIgE) to SE and its relationship to asthma diagnosis and severity, the association of sIgE to SE with airway hyperresponsiveness (AHR) remains unclear. METHODS: We enrolled 81 asthma patients admitted to the Severance Hospital in Korea from March 1, 2013, to February 28, 2015 and retrospectively reviewed the electronic medical records of the enrolled subjects. The serum levels of sIgE to SE (A/B) of all subjects was measured using the ImmunoCAP 250 (Phadia) system with SE-sIgE positive defined as >0.10 kU/mL. RESULTS: The SE-sIgE level was not significantly correlated with asthma severity (forced expiratory volume in 1 second [FEV₁], FEV₁/forced vital capacity, sputum eosinophils, and serum eosinophils), whereas the SE-sIgE level in patients with positive AHR (mean±standard error of the mean, 0.606±0.273 kU/mL) was significantly higher than that in patients with negative AHR (0.062±0.015 kU/mL, p=0.034). In regression analysis, SE sensitization (sIgE to SE ≥0.010 kU/mL) was a significant risk factor for AHR, after adjustment for age, sex, FEV₁, and sputum eosinophils (odds ratio, 7.090; 95% confidence interval, 1.180–42.600; p=0.032). Prevalence of SE sensitization was higher in patients with allergic rhinitis and non-atopic asthma patients, as compared to patients without allergic rhinitis and atopic asthma patients, respectively, but without statistical significance. CONCLUSION: SE sensitization is significantly associated with AHR.

Neurosyphilis Presenting with Multiple Cranial Neuropathy

Neurosyphilis can present with various clinical symptoms. We report a patient with multiple cranial neuropathy that, mimicked tuberculosis, but was finally diagnosed as neurosyphilis. A 38-year-old man was admitted due to subacutely progressive hearing loss. Brain MRI revealed multiple dural enhanced masses on contrast-enhanced T1 weighted images. Brain biopsy of the dural enhanced lesion revealed chronic granulomatous inflammation with coagulation necrosis, compatible with syphilitic gumma. Serum venereal disease research laboratory and fluorescent treponemal antibody absorption test results were positive. Treatment with penicillin resolved the patient's symptom.

Recent Trends of Antigenic Variation in Bordetella pertussis Isolates in Korea

Pertussis is a representative vaccine-preventable disease. However, there have been recent outbreaks in countries where even higher vaccination against the disease. One reason is the emergence of antigenic variants, which are different to vaccine type. In Korea, reported cases have rapidly increased since 2009. Therefore, we analyzed genotype of strains isolated in 2011-2012 by multilocus sequence typing method. As expected, the genotype profiles of tested genes dramatically changed. The major sequence type changed from ST1 to ST2, and new sequence type (ST8) appeared. In the minimum spanning tree, recent isolates belonging to the ACC-I-ST3 subgroup were detected that were composed of ST2, ST3, and ST6. In particular, the ST2 frequency increased to 81%. The novel ST8 was linked to the increased frequency of ST2. In addition, toxic strains carrying the ptxP3 promoter type were confirmed. This ptxP3 type emerged from 2009 and its frequency had increased to 100% in 2012. Based on these results, it can be inferred that the genotypic changes in the currently circulating strains are strongly associated with the recent increasing of pertussis in Korea. Therefore, the surveillance system should be strengthened, and genetic characterization of the isolates should be expanded to the whole genome sequence level.

Epidemic by Salmonella I 4,5,12:i:- and Characteristics of Isolates in Korea

BACKGROUND: Salmonella I 4,[5],12:i:- was first reported as a new serovar by the Spanish National Reference Laboratory in 1997. Thereafter, several outbreaks caused by this serovar have been reported, indicating worldwide transmission. MATERIALS AND METHODS: Stool samples and patient data were collected from diarrhea cases in an outbreak at Daegu city in 2008. Salmonella isolates were characterized by phage typing, antibiotic resistance profile and flagella gene deletion. Deposited isolates in the EnterNet-Korea, acute diarrheal surveillance system, were also screened for this serovar. RESULTS: Isolates from diarrhea patients in the Daegu outbreak (2008) were identified as Salmonella I 4,[5],12:i:-. Screening the deposited isolates in the EnteroNet-Korea revealed that an unidentifed isolate in 2001 was the Salmonella I 4,[5], 12:i:-. CONCLUSIONS: Salmonella I 4,[5],12:i:-. was the causative pathogen of the 2008 foodborne outbreak of salmonellosis in Daegu City. Retrospective screening revealed that Salmonella I 4,[5],12:i:- was present in Korea as early as 2001.

Clinical Characteristics and Etiology of Travelers' Diarrhea among Korean Travelers Visiting South-East Asia

The morbidity of travelers' diarrhea (TD) is still high. This study examined the incidence of common pathogens and characteristics of TD among Korean travelers who visited South-East Asian countries. We performed a prospective study involving 479 Korean travelers with diarrheal disease from February 2009 to April 2009 and stool samples were examined and questionnaire surveys were done after arrival. Enterotoxigenic Escherichia coli (ETEC) was found in 36.0% of TD cases, as were the following: Enteroaggregative Escherichia coli (EAEC) in 27.0%, Vibrio parahaemolyticus in 13.1%, and Norovirus in 11.5%. The detected rate of classic TD was higher in men (P = 0.007), in patients who had a shorter duration trip (P = 0.023) and in patients who drank more than 1 liter of water per day (P = 0.037). Positive stool culture rates were higher in men (P = 0.005), in hospitalized patients (P = 0.013). and in those who consumed impure water or raw foods (P = 0.033). A higher severity of disease corresponded to a significantly higher culture positivity rate (P = 0.029). We should consider the possibility of other pathogens in addition to ETEC in patients with TD who visit South-East Asia. Travelers need to educate about risk factors associated with TD.

A Case of Multidrug-Resistant Salmonella enterica Serovar Typhi Treated with a Bench to Bedside Approach

We report a relapsed case of a 25 year-old man with multi-drug resistant Salmonella serovar Typhi (MDRST) bacteremia who had recently returned from travel in India. Due to unresponsiveness to ciprofloxacin and ceftriaxone, we examined the strain's resistance to quinolones and extended-spectrum beta-lactamases (ESBLs). The strain had a single gyrA mutation at codon 83 (Ser83Phe), which explains its decreased susceptibility to fluoroquinolone and resistance to nalidixic acid. In the screening tests of ESBLs, TEM-1 was positive, which is beta-lactamase but not ESBL. The patient was finally successfully treated with meropenem and aztreonam. In the presence of clinical unresponsiveness despite favorable sensitivity tests, further laboratory evaluations are needed, which should include studies of genes related to antibiotic resistance and ESBLs. In addition, further prospective trials should be done about the possible inclusion of antibiotics not yet mentioned in the current guidelines. With MDRST on the rise worldwide, the most optimal and effective line of antibiotic defense needs to be devised.

Investigation of Outbreak caused by Shigella flexneri

BACKGROUND: Most of the shigellosis outbreak in Korea was caused by Shigella sonnei since late 1990's. In contrast, outbreak by Shigella flexneri were rare since late 1990's. Currently, we experienced the shigellosis outbreak by S.flexneri and described the results of investigation. METHODS: We recruited employees from company "A" who had a meal at least once at the company's cafeteria from Dec 23th, 2002 to Dec 26th, 2002. We surveyed the symptoms, food items, and history of travel of eligible persons and their family members. For the microbiological examination, we collected specimen from eligible persons and their family. Collected specimens were cultured for bacteriologic agents and viruses. Epidemiological relationship among the isolates were analyzed by pulsed field gel electrophoresis (PFGE). RESULTS: Among the eligible persons, one hundred ten were symptomatic (110/258, 42,6%). Eighty- two were confirmed bacteriologically. Day of symptom onset showed a unipolar pattern. Diarrhea was the most common symptom among the symptomatic patients (110/110, 100%). The other symptoms included abdominal pain (81.8%), tenesmus (70.0%), headache (63.6%), nausea (61.8%), febrile sense (59.1%), and vomiting (24.5%). Lunch on 24th Dec was the most significant risk factor of the outbreak (RR=6.46, 3.56< or =95% CI< or =11.75). All isolates of the outbreak has the same pattern on PFGE analysis and the PFGE pattern was not similar compared with other S.flexneri isolates from Korea. CONCLUSION: This is the largest and unique outbreak by S.flexneri since 2000 in Korea. The outbreak has the same origin according to the PFGE pattern and epidemic characteristics. Considering rarity of S.flexneri among shigellosis in Korea, surveillance for S.flexneri should be enhanced.

Investigation of Outbreak caused by Shigella flexneri

BACKGROUND: Most of the shigellosis outbreak in Korea was caused by Shigella sonnei since late 1990's. In contrast, outbreak by Shigella flexneri were rare since late 1990's. Currently, we experienced the shigellosis outbreak by S.flexneri and described the results of investigation. METHODS: We recruited employees from company "A" who had a meal at least once at the company's cafeteria from Dec 23th, 2002 to Dec 26th, 2002. We surveyed the symptoms, food items, and history of travel of eligible persons and their family members. For the microbiological examination, we collected specimen from eligible persons and their family. Collected specimens were cultured for bacteriologic agents and viruses. Epidemiological relationship among the isolates were analyzed by pulsed field gel electrophoresis (PFGE). RESULTS: Among the eligible persons, one hundred ten were symptomatic (110/258, 42,6%). Eighty- two were confirmed bacteriologically. Day of symptom onset showed a unipolar pattern. Diarrhea was the most common symptom among the symptomatic patients (110/110, 100%). The other symptoms included abdominal pain (81.8%), tenesmus (70.0%), headache (63.6%), nausea (61.8%), febrile sense (59.1%), and vomiting (24.5%). Lunch on 24th Dec was the most significant risk factor of the outbreak (RR=6.46, 3.56< or =95% CI< or =11.75). All isolates of the outbreak has the same pattern on PFGE analysis and the PFGE pattern was not similar compared with other S.flexneri isolates from Korea. CONCLUSION: This is the largest and unique outbreak by S.flexneri since 2000 in Korea. The outbreak has the same origin according to the PFGE pattern and epidemic characteristics. Considering rarity of S.flexneri among shigellosis in Korea, surveillance for S.flexneri should be enhanced.

Epidemiological Characterization of Shigella flexneri Isolates in Korea and the Analysis of Pulsed - Field Gel Electrophoresis Patterns

We investigated the molecular epidemiological characteristics of the Shigella flexneri strains primarily isolated in the provincial health center from 1998 to 1999. Among 289 isolates of S. flexneri, 270 isolates (93A%) were confirmed as S. flexneri serotype 2a. The monthly isolation rate of S. flexneri strains was different from that of S, sonnei. S. flexneri strains were not isolated from July to August in 1998 but were isolated rarely during the same period in 1999. Shigella strains were isolated at higher rates in the areas of Chungbuk (64.4%), Busan (8.2%), Jeonnam (6.8%) in 1998 and in the areas of Busan (10.6%), Gangwon (9.3%), Gyeongnam (29.2%), Jeonbuk (4.2%) and Jeonnam (20.8%) in 1999. In these areas, the large outbreaks occurred with relatively high isolation rates of Shigella strain. Among 289 strains, 172 (59.5%) S. flexneri strains were isolated from female patients. Eighty-eight (30.4%) Shigella strains were isolated among the high risk age group of over 61 years. With the antimicrobial susceptibility tests, 284 isolates (98.3%) showed multiple resistance to more than four antibiotics, but all isolates were sensitive to ciprofloxacin, ceftriaxone and cefoxitin. We could divide on isolates into 5 groups (A, B, C, D and E) by analyzing PFGE patterns. Group A subdivided as 16 subgroups and 270 (93.4%) strains belong to the group A. The PFGE patterns of strains isolated from outbreaks revealed that the was only little difference corresponding one to three bands among strains. This result indicates that our isolates are genetically related.

The value of human chorionic gonadotropin as a predictor of pregnancy - induced hypertension / 대한산부인과학회잡지

No abstract available.

A Case of Arteriovenous Malformation of the Uterus / 대한산부인과학회잡지

Arteiovenous malformation of the uterus is an extremely rare and becomes one of the causes of severe uterine bleeding. Because uterine bleeding can be aggravated with diagnostic dilatation and curettage, an accurate diagnosis should be achieved before the intervention. This malformation may be congenital or acquired. In the past, the diagnosis is usually made retrospectively after hysterectomy, however, recently it may be made before management by ultrasound, doppler ultrasound, pelvic angiography, magnetic resonance imaging, etc.. We have experienced one case of arteriovenous malformation of the uterus, which is presented with a brief review of the literatures.

A Clinical Study Following Macrosurgical Procedures for Tubal REversal / 대한산부인과학회잡지

From January 1989 to December 1994, 105 cases of Macrosugical tubal reversal were performed and 87 cases of them were followed up for more than 1 year postoperatively in the Department of Obstetrics and Gynecology, Pohang St. Mary's Hospital. The result were as follows;1. The mean age of the patients was 31.7 years and 93.1% of them had been sterilized by laparoscopic sterilization. 2. Average inteval between sterilization and tubal reversal was 43.3 months. 3. The reasons for requesting reversal of sterilization were remarrigae 41.5%, chagne of attitude 33.3%, loss of children 25.2%. 4. The distributions of the site of tubal anastomosis were isthmic-ampullar 58.6%, isthmic-isthmic 24.1%, cornual-isthmic 8.1%. 5. The postoperative tubal length was 5.0 cm or more in 78.0%. 6. The overall pregnancy rate after tubal reversal was 68.9% and the outcome of the pregnancy was as follows; term pregnancy 74.6%, premature delivery 1.8%, opontaneous abortion 10.9%, ectopic pregnancy 9.1%, pregnancy state 3.3%.

A Case of Hemorrhagic Colitis Complicated by Hemolytic Uremic Syndrome / 감염

We report a case of hemolytic uremic syndrome (HUS) associated with hemorrhagic colitis. A 35-year-old man was admitted to a local hospital because of abdominal pain and watery diarrhea that had developed about 6 hours after taking roast beef. He was treated with intravenous fluids and antibiotics, but watery diarrhea changed to bloody in nature from the next day. He was transferred to our hospital due to progressive ascites and jaundice on his 8th day of illness. Examinations revealed ascites, jaundice, microangiopathic hemolytic anemia, thrombocytopenia and uremia. Sorbitol-negative Escherichia coli was isolated from his stool, which proved as Shiga-like toxin-negative E. coli, serotype O25. His conditions improved markedly after three times of plasmapheresis and intravenous fluid therapy, and the organism was not isolated from the follow-up stool culture.