Contrast-Induced Nephropathy in Patients Undergoing Intravenous Contrast-Enhanced Computed Tomography in Korea: A Multi-Institutional Study in 101487 Patients

OBJECTIVE: To evaluate the prevalence of known risk factors for contrast-induced nephropathy (CIN) and their association with the actual occurrence of CIN in patients undergoing intravenous contrast-enhanced computed tomography (CECT) in Korea. MATERIALS AND METHODS: Patients who underwent CECT in 2008 were identified in the electronic medical records of 16 tertiary hospitals of Korea. Data on demographics, comorbidities, prescriptions and laboratory test results of patients were collected following a standard data extraction protocol. The baseline renal function was assessed using the estimated glomerular filtration rate (eGFR). We identified the prevalence of risk factors along the eGFR strata and evaluated their influence on the incidence of CIN, defined as a 0.5 mg/dL or 25% increase in serum creatinine after CECT. RESULTS: Of 432425 CECT examinations in 272136 patients, 140838 examinations in 101487 patients met the eligibility criteria for analysis. The mean age of the participants was 57.9 +/- 15.5 years; 25.1% of the patients were older than 70 years. The prevalence of diabetes mellitus was 11.9%, of hypertension 13.7%, of gout 0.55% and of heart failure was 1.7%. Preventive measures were used in 40238 CECT examinations (28.6%). The prevalence of risk factors and use of preventive measures increased as the renal function became worse. A CIN was occurred after 3103 (2.2%) CECT examinations, revealing a significant association with decreased eGFR, diabetes mellitus, and congestive heart failure after adjustment. CONCLUSION: Risk factors for CIN are prevalent among the patients undergoing CECT. Preventive measures were seemingly underutilized and a system is needed to improve preventive care.

Gastrojejunal Fistula with Jejunal Rotation Caused by Two Ingested Magnets in a Child: A Case Report

Among the common foreign bodies that are ingested by children, ingesting multiple magnets is known to be hazardous due to the gastrointestinal complications caused by the magnets attracting each other across the bowel walls. We present here a case of gastrojejunal fistula and jejunal rotation that was caused by two ingested magnets in a 5-year-old girl, and we also present the findings of simple abdomen radiography, a small bowel series and computed tomography. The unchanged position of the radiopaque metallic foreign bodies on the serial abdominal radiographs suggests the inadvertent ingestion of multiple magnets.

Neuronal Intestinal Dysplasia in an Infant: Case Report

Neuronal intestinal dysplasia in pediatric patients has similar clinical symptoms and often similar radiologic findings to those of Hirschsprung's disease. Yet neuronal intestinal dysplasia shows hyperplasia of the myenteric plexus for the pathology, and it requires different treatment compared with Hirschsprung disease. This disease has been reported many times in Europe but, to date, only one case has been reported in the radiologic literatures in Korea. We report here on a case of neuronal intestinal dysplasia that involved the entire colon in a two-month-old boy, and we include the radiographic findings.

Neuronal Intestinal Dysplasia in an Infant: Case Report

Neuronal intestinal dysplasia in pediatric patients has similar clinical symptoms and often similar radiologic findings to those of Hirschsprung's disease. Yet neuronal intestinal dysplasia shows hyperplasia of the myenteric plexus for the pathology, and it requires different treatment compared with Hirschsprung disease. This disease has been reported many times in Europe but, to date, only one case has been reported in the radiologic literatures in Korea. We report here on a case of neuronal intestinal dysplasia that involved the entire colon in a two-month-old boy, and we include the radiographic findings.

Characterization of a New Integron Containing VIM-2 Metallo-beta-Lactamase Gene Cassette in an Isolate of Morganella morganii from a Urine Specimen / 대한비뇨기과학회지

PURPOSE: The main objectives of this work were to characterize the mechanism of resistance to imipenem of Morganella morganii KU158 isolated in Busan, Korea and to analyze the structure of the integron, which carries the resistance gene that confers resistance to imipenem. MATERIALS AND METHODS: Antimicrobial susceptibilities of M. morganii KU158 were tested by using the disk diffusion method. The modified Hodge and EDTA-disk synergy tests were performed for the screening of metallo-beta-lactamase-producing isolates. blaIMP and blaVIM genes were detected using the polymerase chain reaction (PCR) amplification. To detect the presence of the integron, the PCR method was used. The PCR product was cloned through the use of primers, 5'CS-F and 3'CS-R, and it was used to determine the sequence of the integron through the dideoxy-mediated chain termination method. RESULTS: M. morganii KU158 was intermediately resistant to imipenem and showed a positive result for the modified Hodge and EDTA-disk synergy tests, which suggest the production of metallo-beta-lactamase, and also was positive in the PCR result for the detection of blaVIM gene. The genotype of the PCR product from the blaVIM gene was blaVIM-2. Sequencing of the 5,031 bp-cloned fragment revealed the structure of the class I integron, such as the 5'-CS element containing an Intl1 integrase gene with its own promoter region, the attI1 recombination site, and the 3'-CS element containing qacE1. The integron contained insert gene cassettes blaVIM-2, aac(6')-Ib, aadA1, "orfII", and "orfIII". The blaVIM-2 gene was located immediately downstream of the aac(6')-Ib gene. CONCLUSIONS: M. morganii KU158 acquired the resistance to imipenem through the production of metallo-beta-lactamase VIM-2. The gradual increase in the number of VIM-2-producing bacterial species may indicate the highly mobile nature of the blaVIM-2 cassette. The spread of blaVIM-2 could compromise the future usefulness of carbapenem in treating gram-negative bacilli infections.

Body Composition before and after the Marathon Run

OBJECTIVE: We studied the effect of marathon running on body composition without fluid and food restriction. METHOD: The subjects were 17 nonprofessional male athletes, aged from 27 years to 47 years, who participated in a marathon run. Body composition was measured before and after marathon run with bioelectrical impedance analysis. RESULTS: After the marathon, body mass was decreased by 1.99 +/- 0.51 kg (p<0.0001), fat mass was decreased by 4.81 +/- 2.64 kg (p<0.0001), percent body fat mass was decreased by 6.11 +/- 3.67% (p<0.0001), and body mass index was decreased by 0.69 +/- 0.19 kg/m2 (p<0.0001). Circumferences of upper arm, abdomen, hip, and thigh were significantly reduced by 0.5 +/- 0.2 cm, 3.0 +/- 2.88 cm, 2.33 +/- 2.3 cm, and 0.71 1.18 cm, respectively. Lean body mass was increased by 2.82 +/- 2.63 kg (p=0.001). Total body water was increased by 1.97 1.84 liter (p=0.001). CONCLUSION: These results demonstrated that marathon run reduced body fat mass and preserved lean body mass.

The Effect of Sub-threshold 1 Hz and 20 Hz Repetitive Transcranial Magnetic Stimulation on Corticospinal Excitability

OBJECTIVE: This explored whether the effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on corticospinal excitability are dependent on the stimulation frequency. METHOD: Ten subjects were investigated using either 20 Hz or 1 Hz rTMS. To reduce inter-individual variability, we explored same subject in one week interval with different frequency. TMS was conducted with intensity of 90% of motor threshold. The effect of rTMS with EMG amplitude evoked in First Dorsal Interossei by TMS. Test motor evoked potentials were evaluated with intensity of 110% of motor threshold before rTMS, during the interval and immediately, 5 minutes, 20 minutes after the end of train. RESULTS: The analysis showed a significant decrease of cortical excitability after 1 Hz rTMS and an increase after 20 Hz rTMS. In low-frequency, Motor Evoked Potential (MEP) amplitude decreased quickly after initial 300 pulses stimulation. In high-frequency, there were some variation of individual MEP in the response to rTMS. The changes of MEP amplitude after 1200 stimulation continued until 20 minutes. CONCLUSION: These results provided basic evidence of rTMS for modulation of cortical excitability and could be further applied in patients group.

Small Cell Carcinoma of the Urinary Bladder: CT and MR Imaging Findings

OBJECTIVE: Primary small cell carcinoma (SCC) is a rare aggressive malignancy of the urinary bladder, with identical histopathology to that of the lung. The treatment and prognosis of bladder SCC are somewhat different from those of more frequent transitional cell carcinoma. The purpose of this study was to analyze the CT and MR imaging findings of bladder SCC. MATERIALS AND METHODS: Six adult patients (five males and one female) with pathologically proven SCC of the urinary bladder who had undergone pelvic CT and/or MR imaging were included in this study. The radiologic findings were retrospectively evaluated in terms of tumor location, texture, calcification, depth of invasion, perivesical extension, lymph node involvement, and local or distant metastasis, by two radiologists, who established a consensus. RESULTS: CT and MR images depicted all tumors as large, ill-defined, relatively well enhancing, broad-based polypoid intramural masses with (n=3) or without (n=3) cystic portions. Their frequent location was posterior and trigonal (n=3). Calcification was found within one tumor, and lymphadenopathy in four. At T2-weighted MR images, the solid portion of the tumor was relatively hypointense. The stage at the time of diagnosis was C in three patients, and D1 in three. Follow-up imaging showed brain metastasis in one patient and liver metastasis in two. CONCLUSION: On CT and MR images, SCC of the urinary bladder appeared as a large, enhancing, broad-based polypoid mass. It was stage C or higher, and lymph nodes and distant metastasis were frequent. T2-weighted MR images showed that the solid portion of the tumor was relatively hypointense. When radiologic examinations demonstrate a bladder tumor of this kind in adults, SCC of the urinary bladder should be included in the differential diagnosis.

Characterization of Extended-Spectrum-beta-Lactamase Genes from Clinical Isolates of Enterobacter species / 대한임상미생물학회지

BACKGROUND: Among Enterobacter spp. isolates from clinical specimens in Korea, the incidence of resistance to expanded-spectrum cephalosporins is becoming an ever-increasing problem. This study was designed to determine the prevalence of expanded-spectrum cephalosporins-resistant Enterobacter spp. isolates from patients in a tertiary care hospital in Busan, Korea, and to characterize the mechanism of resistance. MATERIALS AND METHODS: Nonduplicated clinical isolates of Enterobacter spp. were collected during the period of 1999-2000 in Kosin Medical Center, Busan, Korea. Antimicrobial susceptibilities were tested by disk diffusion method. Cefotaxime-resistant or intermediate isolates were examined for extended-spectrum beta-lactamase (ESBL)-production by double disk synergy (DDS) test. Minimal inhibitory concentrations were determined by agar dilution method. For detection of blaTEM and blaSHV genes, polymerase chain reactions (PCRs) were performed, and the DNA sequences of blaTEM and blaSHV genes were determined by using dideoxy-chain termination method. RESULTS: From 1999 to 2000, a total of 306 Enterobacter spp. strains were isolated from patients in Kosin Medical Center. Forty one percents of Enterobacter spp. isolates were susceptible to cefotaxime. Among 90 isolates resistant or intermediate to cefotaxime, 26 isolates (29%) showed positive results in double disk synergy test. Among DDS-positive- isolates, 22 isolates contained both of blaTEM and blaSHV genes, while one isolate only contained blaTEM gene and two isolates only contained blaSHV gene. Among 64 DDS-negative isolates, 47 isolates contained blaTEM genes, and 12 isolates also contained blaSHV genes. Nucleotide sequence analysis of PCR products from 10 DDS-positive and 6 DDS-negative isolates, which contained both of blaTEM and blaSHV genes, revealed that blaTEM-1b and blaSHV-12 genes were the dominant types of beta-lactamase gene. CONCLUSION: Expanded-spectrum cephalosporins-resistant Enterobacter spp. were wide spread in Kosin Medical Center, Busan, Korea. Some of the resistant isolates acquired resistance by production of ESBLs, and blaSHV-12 gene was the most frequent ESBL gene in cefotaxime-resistant Enterobacter spp.

Prevalence and Mechanism of Third-Generation Cephalosporins-Resistant Escherichia coli and Klebsiella pneumoniae Strains Isolated from Clinical Specimen / 대한임상미생물학회지

BACKGROUND: Among Gram-negative pathogens in Korea, the incidence of resistance to thirdgeneration cephalosporins is becoming an ever-increasing problem. This study was designed to determine the prevalence of third-generation cephalosporins-resistant Escherichia coli and Klebsiella pneumoniae isolates from patients in a tertiary care hospital in Busan, Korea, and to characterize the mechanism of resistance. METHODS: A total of 710 E. coli and 237 K. pneumoniae non-duplicate isolates were collected from patients in Kosin Medical Center in 1999. Antimicrobial susceptibilities were tested by the disk diffusion method. Extended-spectrum beta-lactamase (ESBL) production was determined by the double disk synergy test. MICs were determined by the agar dilution method. Searches for blaTEM, blaSHV, and blaCMY genes in cefotaxime-resistant or intermediate isolates were performed by PCR amplification. PCR products were used to determine the sequence of resistance genes by the dideoxy-chain termination method. RESULTS: Seven percent of E. coli and 25% of K. pneumoniae isolates were resistant to cefotaxime. Among the isolates with decreased susceptibility to cefotaxime, 69% (18/26) of E. coli and 80% (20/25) of K. pneumoniae isolates showed positive results in double disk synergy test. Banding patterns of PCR amplification showed that the blaTEM, blaSHV, and blaCMY genes were harboured by 71% (20/28), 86% (24/28) and 14% (4/28) of isolates with decreased susceptibility to cefotaxime,respectively. Seventy-one percent (20/28) of the isolates contained more than two types of beta- lactamase genes. Nucleotide sequence analysis of PCR products revealed that blaSHV-12 and blaTEM-1b were the dominant types of beta-lactamase gene. In addition, we also identified blaTEM-52, blaSHV-5, and a new ESBL gene named blaTEM-17b. CONCLUSIONS: Third-generation cephalosporins-resistant E. coli and K. pneumoniae are wide spread in Kosin Medical Center, Busan, Korea. Most of the isolates with decreased susceptibility to cefotaxime had blaTEM and/or blaSHV, and some isolates harboured blaCMY genes that may confer resistance against cephamycins. The spread of these beta-lactamase genes could compromise the future usefulness of third-generation cephalosporins for the treatment of infections caused by E. coli and K. pneumoniae.

A Case Of Sclerosing Stromal Tumor Of The Ovary / 대한산부인과학회잡지

Sclerosing stromal tumor, which was first described by Chalvardjian and Scully in 1973, is a very rare benign tumor of the ovary. This tumor differs from the fibroma, thecoma and lipoid cell tumor clinically and pathologically by showing prominent pseudolobular pattern and hypervascularity. We experienced a case of sclerosing stromal tumor of the ovary in 38 year-old woman. We report this case with a brief review of the literature.

The Biocompatibility of Human Osteoblasts to Porous Coated Nickel-Titanium Alloy (porous NiTi alloy) with Thermal Shape Memory / 대한정형외과연구학회지

PURPOSE: This research is to clarify utilization and efficiency of porous coated NiTi alloy by observing its affinity on human osteoblast. In this study, the biocompatibility of porous NiTi alloy was analyzed by investigating the biological activity and growth patterns of osteoblasts on NiTi alloy in vitro, followed by comparative analysis of their activity on commercial titanium based alloy (TBA) and tissue culture polystyrene (TCP), as a control. MATERIALS AND METHODS: The human osteoblasts were obtained from the iliac crest of a normal adult and cultured with routine maneuver. A seeding of cultured human osteoblasts to each group (NiTi alloy : experimental 1 group, TBA: experimental 2 group, TCP: control group) was done at the 15th day of primary culture. At the 4th, 7th and 10th seeding day, we observed the morphology of cultured cells on the surface of materials using scanning electron microscope and measured the amount of biosynthesis of cell protein and activity of alkaline phosphatase. RESULTS: In the scanning electron microscope study, the osteoblasts in experimental 1 and 2 groups were proliferated well in similar levels. However in control group, growth of osteoblasts were significantly retarded than experimental 1 and 2 groups. And the biosynthesis of proteins and activity of alkaline phosphatase were significantly increased in experimental 1 and 2 groups time dependently but decreased apparently in control group. CONCLUSION: The porous NiTi alloy which was proved to have good affinity and biocompatibility on human osteoblasts could be used as one of press-fit implants in orthopaedic fields.

Genotypes of Metallo-beta-Lactamases Produced by Imipenem-Resistant Acinetobacter spp. Isolates from Clinical Specimens / 감염

BACKGROUND: Carbapenem-resistant Acinetobacter spp. are being isolated with increasing frequency from clinical sources. This study was designed to determine the resistance mechanism to carbapenems of Acinetobacter spp. isolates from patients of a tertiary care hospital in Busan, Korea. METHODS: Nonduplicated clinical isolates of Acinetobacter spp. resistant to carbapenems were collected during the period of 2000-2001 in Kosin Medical Center, Busan, Korea. Antimicrobial susceptibilities were tested by disk diffusion method. Carbapenem-resistant Acinetobacter spp. isolates were examined for metallo-beta-lactamase-production by modified Hodge and EDTA-disk synergy tests. For the detection of blaIMP-1 and blaVIM-2 genes, polymerase chain reactions (PCR) were performed, and the DNA sequences of amplified products were determined by using dideoxy- chain termination method. RESULTS: Among 21 clinical isolates of Acinetobacter spp. intermediate or resistant to carbapenems, 17 isolates showed positive reactions in modified Hodge and EDTA-disk synergy tests. Nine isolates showed positive reaction in PCR for the detection of blaIMP-1 genes, and 8 isolates showed positive reaction in PCR for the detection of blaVIM-2 genes. Sequencing of amplified products showed that they were blaIMP-1 or blaVIM-2 genes. CONCLUSION: Acinetobacter spp. isolates with carbapenem-resistance are not uncommon in Kosin Medical Center, and most of the carbapenem-resistant isolates acquired resistance by production of IMP-1 or VIM-2 metallo-beta-lactamases. The spread of metallo-beta-lactamase genes could compromise the future usefulness of carbapenem for the treatment of gram-negative bacilli infections.

Evaluation of Nerve Block after Phenol and Ethanol Injection

OBJECTIVE :To evaluate the axonal degeneration after nerve block with phenol and ethanol injection into tibial nerve. METHOD: Tibial nerves of thirty Sprague-Dawley rats were exposed. For the developement of neuropathic pain, the method of intraneural injection was performed. Five percent phenol, 90% ethanol or normal saline were injected into the epineurial sheath of tibial nerve at each group. The mechanical and thermal allodynia were evaluated in post- injection 1, 2, 3, and 4 weeks. The mechanical allodynia was evaluated by withdrawal response to 10 stimulations with von Frey hair. Thermal allodynia was tested by withdrawal response to 5 stimulations with acetone. Motor nerve conduction study was performed in post-injection 1, 2, and 4 weeks. RESULTS: In behavioral test, the experimental group exhibited increased withdrawal response to mechanical and cold stim ulation, but there was no significant difference between two groups, phenol and ethanol groups. In motor nerve conduc tion study, compound motor action potential amplitude loss were observed in experimental group, but there was no significant difference between two groups, phenol and ethanol groups. CONCLUSION: These results suggest that axonal degeneration of ethanol is roughly similar to those of phenol block.

Traumatic Intracranial Aneurysms in Children

PURPOSE: To describe the imaging findings of traumatic intracranial aneurysms (TICA) in children. MATERIALS AND METHODS: Five boys aged 3-15 (mean, 7) years with surgically confirmed TICA were included in this study. All had a history of nonpenetrating head trauma, and they underwent precontrast CT imaging immediately after the injury and follow-up CT or MRI. In all cases, angiography revealed the presence of aneurysms, which at surgery were shown to be pseudoaneurysms with severe adhesions. RESULTS: Angiography demonstrated that all aneurysms were located in the anterior cerebral artery (ACA) or its branches. The precise locations were the A2 segment of the ACA, the site of origin of the callosomarginal artery or its first branch, or of the anterior internal frontal artery, or between the first and second branch of the pericallosal artery. In all patients, precontrast CT performed immediately after trauma depicted subarachnoid hemorrhage (SAH) in the anterior interhemispheric fissure (AIHF). Follow-up precontrast CT showed nodular high density around the anterior falx in three, recurrent SAH in the AIHF in two, and intracerebral hemorrhage (ICH) with intraventricular hemorrhage in two. In two patients with a nodular high-density lesion, nodular enhancement was demonstrated at postcontrast CT, and in one, follow-up MRI revealed a nodular signal void around the anterior falx; nodular enhancement was seen at postcontrast imaging, and MR angiogram depicted a saccular aneurysm. In one patient, MRI demonstrated infarction in the caudate nucleus and ACA territory. CONCLUSION: If, after head injury, an area of nodular high density is revealed by CT, or a signal void by MRI, or if SAH or ICH is present around the anterior falx, the possibility of TICA should be considered.

Comparison of Results Between Internal Fixation of Both Bones and Internal Fixation of the Only Tibia for Distal Tibial and Fibular Fractures / 대한정형외과학회잡지

PURPOSE: This study undertaken to evaluate the clinical results between the fixation of both bones and the fixation of the only tibia for extra-articular distal tibial and fibular fracture, and to know if the fixation of both bones could be needed. MATERIALS AND METHODS: In a retrospective study from 1994 to 1999, thirty-seven patients who underwent internal fixation with plate and screws for both bones (Group I : 17 cases) and only tibia (Group II : 20 cases) for extra-articular distal 1/3 tibial and distal 1/4 fibular fractures, which were above distal tibio-fibular syndesmosis, were evaluated the period of union, range of motion and operative time. RESULTS: The union period of tibia was 124 days (Group I) and 126 days (Group II) and the cases of full ROM were 16 / 17 cases (94.1%) in Group I and 18 / 20 cases (90.0%) in Group II. The mean score was 94.6 points in Group I and 91.3 points in Group II by Baird scoring system (P>0.05), and the operative time was 147 minutes (Group I) and 106 minutes (Group II) (P<0.05). CONCLUSION: The clinical results in extra-articular distal tibial and fibular fractures, which were distal 1/4 and above distal tibio-fibular syndemosis, treated with internal fixation of the only tibia were as good as internal fixation of both bones. We thought that there is no need to fix distal fibular fracture in these cases.

Inflammatory Myofibroblastic Tumor of Perineal Soft Tissue: A Case Report

Inflammatory myofibroblastic tumor is a rare benign condition of unknown etiology, and it may simulate malignancy. It is composed of myofibroblast, plasma cells and histiocytes and is found in lung, the liver, orbit, skin, mesentery, retroperitoneum and maxillary sinus. We report a case of inflammatory myofibroblastic tumor of perineal subcutaneous fat in a 35-year-old woman who complained of a palpable mass. Ultrasonography revealed a well-marginated lobulated hypoechoic lesion with peripheral poorly-defined hyperechoic strands in the subcutaneous fat of the right perineum. The lesion demonstrated low signal intensity on T1-weighted images and of heterogenous high signal intensity on T2-weighted images, compared with surrounding muscle. After intravenous injection of gadolinium, it showed clear homogeneous enhancement but poorlydefined adjacent strands. The final histologic diagnosis was inflammatory myofibroblastic tumor.

Clinical Significance of Nerve Root Enhancement in Contrast-Enhanced MR Imaging of the Postoperative Lumbar Spine

PURPOSE: To determine the significance of nerve root contrast enhancement in patients with residual or recurrent symptomatic postoperative lumbar spine. MATERIALS AND METHODS: Eighty-eight patients with 116 postoperative lumbar disc lesions causing radiating back pain underwent enhanced MR imaging. Intradural nerve root enhancement was quantified by pixel measurement, and affected nerve roots were compared before and after contrast administration. Extradural nerve root enhancement was assessed visually, and nerve root enhancement and clinical symptoms were correlated. Associated lesions such as recurrent disc herniation, scar tissue, nerve root thickening and nerve root displacement were also evaluated. RESULTS: Of 26 cases(22.4%) involving intradural nerve root enhancement, 22 (84.6%) showed significant clinical symptoms (p=0.002). and of 59 (50.9%) demonstrating extradural enhancement, clinical symptoms showed significant correlation in 47 (79.7%) (p=0.001). Nerve root enhancement, including eleven cases where this was both intra-and extradural, showed highly significant association with clinical symptoms in 74 of the 116 cases (63.8%) (p=0.000). Among 33 cases (28.4%) of recurrent disc herniation, nerve root enhancement was observed in 28 (84.8%) and in 24 of these 28 (85.7%), significant correlation with clinical symptoms was observed (p=0.000). Where epidural fibrosis was present, correlation between nerve root enhancement and clinical symptoms was not significant (p>0.05). Nerve root thickening and displaced nerve root were, however, significantly associated with symptoms(87.2% and 88.6%, respectively). CONCLUSION: In patients with postoperative lumbar spine, the association between nerve root enhancement revealed by MRI and clinical symptoms was highly significant.

A Case of Disseminated Trichosporon beigelii Infection in a Patient with Myelodysplastic Syndrome after Chemotherapy

Trichosporonosis is a potentially life-threatening infection with Trichosporon beigelii, the causative agent of white piedra. The systemic infection by this fungus has been most frequently described in immunocompromised hosts with neutropenia. Here, we report the first patient with disseminated infection by T. beigelii in Korea, acquired during a period of severe neutropenia after chemo-therapy for myelodysplastic syndrome. The patient recovered from the infection after an early-intensified treatment with amphotericin B and a rapid neutrophil recovery. The disseminated infection by T. beigelii is still rare, however, is an emerging fatal mycosis in immunocompromised patients with severe neutropenia.

The Direct Myocardial Depressant Effect of Methylmethacrylate Monomer in vitro: Mechanical and Electrophysiological Actions / 대한마취과학회지

BACKGROUND: Methylmethacrylate monomer (MMA) bone cement has been associated with sudden systemic hypotension. The present study was aimed to explore the mechanism of direct myocardial depressant actions of MMA. METHODS: The isometric contraction of isolated guinea pig's right ventricular papillary muscle was measured. Normal and slow action potentials were evaluated by a conventional micro-electrode technique. The effects of MMA on sarcoplasmic reticulum (SR) function were evaluated by its effect on: rapid cooling contractures, rested state contraction of rat papillary muscle in normal Tyrode's solution and of guinea pig's papillary muscle in low Na+ Tyrode's solution. To measure the inward calcium currents (ICa), whole cell patch clamp techniques were applied. RESULTS: MMA caused a dose-dependent depression of the peak force (PF) and maximal rate of peak force (dF/dt-max). About a 30% depression of PF was shown at rested state (RS) contraction in rat myocardium and under low Na+ Tyrode's solution in guinea pig myocardium, respectively. In the 26 mM K+ Tyrode's solution, MMA caused dose-dependent depression of late force development without alteration in early force development. MMA depressed rapid cooling contracture accompanied by prolongation of time to peak contracture. MMA did not alter the amplitude or maximum depolarization rate of normal and slow action potentials. Action potential durations were significantly reduced. In patch clamp studies, MMA reduced ICa in a dose-dependent manner. CONCLUSIONS: MMA depressed cardiac contractility in a dose-dependent manner and may be partly related to the depression of Ca2+ influx through the cardiac membrane. SR Ca2+ release seems to be mildly inhibited by MMA. Based on common clinical concentrations, the direct myocardial depressant effect of MMA may not be a main cause of hypotension during an operation.