Role of Atypical Pathogens and the Antibiotic Prescription Pattern in Acute Bronchitis: A Multicenter Study in Korea

The role of atypical bacteria and the effect of antibiotic treatments in acute bronchitis are still not clear. This study was conducted at 22 hospitals (17 primary care clinics and 5 university hospitals) in Korea. Outpatients (aged > or = 18 yr) who had an acute illness with a new cough and sputum (< or = 30 days) were enrolled in 2013. Multiplex real-time polymerase chain reaction (RT-PCR) was used to detect five atypical bacteria. A total of 435 patients were diagnosed as having acute bronchitis (vs. probable pneumonia, n = 75), and 1.8% (n = 8) were positive for atypical pathogens (Bordetella pertussis, n = 3; B. parapertussis, n = 0; Mycoplasma pneumoniae, n = 1; Chlamydophila pneumoniae, n = 3; Legionella pneumophila, n = 1). Among clinical symptoms and signs, only post-tussive vomiting was more frequent in patients with atypical pathogens than those without (P = 0.024). In all, 72.2% of the enrolled patients received antibiotic treatment at their first visits, and beta-lactams (29.4%) and quinolones (20.5%) were the most commonly prescribed agents. In conclusion, our study demonstrates that the incidence of atypical pathogens is low in patients with acute bronchitis, and the rate of antibiotic prescriptions is high.

Epidemiological Aspects of Pertussis among Adults and Adolescents in a Korean Outpatient Setting: A Multicenter, PCR-Based Study

Epidemiological data of Bordetella pertussis infection among adolescents and adults are limited in Korea. Patients (> or = 11 yr of age) with a bothersome cough for less than 30 days were enrolled during a 1-yr period at 22 hospitals in Korea. Nasopharyngeal swabs were collected for polymerase chain reaction (PCR) and for bacteriologic culture. In total, 490 patients were finally enrolled, and 34 (6.9%) patients tested positive for B. pertussis; cough duration (14.0 days [7.0-21.0 days]) and age distribution were diverse. The incidence was the highest in secondary referral hospitals, compared to primary care clinics or tertiary referral hospitals (24/226 [10.6%] vs. 3/88 [3.4%] vs. 7/176 [4.0%], P = 0.012), and the peak incidence was observed in February and August (15.8% and 15.9%), with no confirmed cases between March and June. In the multivariate analysis, post-tussive vomiting was significantly associated with pertussis (odds ratio, 2.508; 95% confidence interval, 1.146-5.486) and secondary referral hospital showed a borderline significance. In conclusion, using a PCR-based method, 6.9% of adolescent and adult patients with an acute cough illness had pertussis infection in an outpatient setting. However, hospital levels and seasonal trends must be taken into account to develop a better strategy for controlling pertussis.

Contrast Enhancement for X-ray Images Based on Combined Enhancement of Scaling and Wavelet Coefficients / 의학물리

An applied technique of contrast enhancement for X-ray image is proposed which is based on combined enhancement of scaling and wavelet coefficients in discrete wavelet transform space. Conventional contrast enhancement methods such as contrast limited adaptive histogram equalization (CLAHE), multi-scale image contrast amplification (MUSICA) and gamma correction were applied on scaling coefficients to enhance the contrast of an original. In order to enhance the detail as well as reduce the blurring caused by up scaling of contrast modified scale coefficients from lower resolution, the sigmoid manipulation function was used to manipulate wavelet coefficients. The contrast detail mammography (CDMAM) phantom was imaged and processed to measure the image line profile of results and contrast to noise ratio (CNR) comparatively. The proposed technique produced better results than direct application of various contrast enhancement methods on image itself. The proposed method can enhance contrast, and also suppress the amplification of noise components in a single process. It could be useful for various applications in medical, industrial and graphical images where contrast and detail are of importance.

Surgery in the Only Hearing Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Management of chronic ear disease which affects the only hearing ear has been a topic of much debate since chronic ear disease runs the risk of damage to the inner ear. Cholesteatoma and uncontrolled otitis media can induce the sensorineural hearing loss, therefore, surgical removal of diseased tissue is sometimes unavoidable. MATERIALS AND METHOD: Tympanoplasty with mastoidectomy on the only hearing ears was performed in 9 patients. of whom four had cholesteatoma and five had mastoiditis. RESULTS: Compared to the preoperative air conduction hearing level, 3 cases showed improvement in the postoperative hearing level showed, whereas the remaining 6 cases did not show improvement.

Aberrant Internal Carotid Artery in the Middle Ear / 대한이비인후과학회지

Aberrant internal carotid artery in the middle ear is rarely seen and is usually of little clinical significance if diagnosed correctly. Misdiagnosis and malmanagement, however, can lead to serious complications such as massive bleeding and neurologic sequelae. Authors experienced two cases of aberrant internal carotid artery in the middle ear, which were diagnosed by carotid angiography and temporal bone spiral CT. Here we are reporting these cases with a discussion on efficacy of spiral CT in diagnosing this anomaly.

Transhiatal gastric transposition of a long gap esophageal atresia

Transhiatal gastric transposition was performed in a long gap esophageal atresia without tracheoesophageal fistula. The patient was a 12 months old female infant with previous stamm-type gastrostomy. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal blind pouches of esophagus were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up into the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was safely performed in the neck. There were neither anastomotic leak nor early anastomotic stricture. The oral feeding was quickly established. There was no clinical evidence of regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. The low morbidity combined with satisfactory functional result indicates that the transhiatal gastric transposition is a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.

Flow cytometric analysis of peripheral blood lymphocyte subsets using monoclonal antibodies in leprosy / 대한피부과학회지

No abstract available.

Detection of Phenolic Glycolipid I of Mycobacterium leprae and Antibodies to the Antigen in Sera from Leprosy Patients and Their Contacts

Serum specimens from leprosy patients, their contacts and controls were examined for the presence of phenolic glycolipid I (PGL-I), a Mycobacterium leprae specific antigen, and antibodies to the antigen using enzyme-linked immunosorbent assays. Of 12 lepromatous patients with less than 2 years of therapy, 11(91.7%) were seropositive to PGL-l, thus indicating that new lepromatous cases can be identified by detecting anti-PGL-l antibodies. In contrast 88(56.4%) of 156 lepromatous patiens treated more than 2 years were positve. Moreover, only 69(40.8%) were seropositve among 169 lepromatous patients in the leprosy resettlement villages. The mean antibody level also declined significantly in proportion to the duration of chemotherapy. This may suggest the possibility of monitoring chemotherapy by detecting anti-PGL-l antibodies. The prevalence of anti-PGL-l antibodies among 200 controls from a high endemic area for leprosy was 5.5% and was significantly higher than that(1.5%) among 200 controls from a low endemic area. Of 103 household contacts in the resettlement villages, 10(9.7%) were seropositive, reflecting the frequent chance of exposure to M. leprae. However, PGL-l was not detected many in any of the sera from controls, contacts, and inactive lepromatous patients having the anti-PGL-l antibodies; on the other hand, 6(50%) of 12 lepromatous patients treated less than 2 years had detectable PGL-l in their sera. The results thus indicate that PGL-l detection may be more suitable for monitoring the effectiveness of chemotherapy and that it may be necessary to examine for the presence of PGL-l in sera from contacts and normal populations for confirming M. leprae infection.

Imbalance in T Lymphocyte Subsets in Erythema Nodosum Leprosum / 대한피부과학회지

A study was performed to investigate a relationship between the status of T lymphocyte subsets in the peripheral blood and the pathogenesis of erythema nodosum leprosum (ENL) reactions. T lymphocyte subsets, B lymphocytes and serum immnnoglobulin levels were explored in 40 leprosy patients (10 tuberculoid (TT), 17 lepromatous (LL), and 13 lepromatous with ENL). In patients with LL, suppressor cells increased and helper cell diminished, resulting in a decrease in the helper/suppressor (Th/Ts) ratio to 0.86 + 0.20, as compared with controls (1. 77 + 0.41). But in ENL patients, there was a significant diminution of suppressor cells and an increase of helper cells, resulting in an increase in Th/Ts ratio to 2.08 + 0.30. Four weeks after treatment of ENL, Th/Ts ratio decreased to l.18+ 0.31 again. The mean percentages of B cells and serum immunoglobulin levels in with LL. and ENL increased significantly compared with controls. Only IgG increased in patients with ENL compared with patients with LL. The results in patiients with TT did not differ significantly from those of controls. The findings suggest that cell-mediated immune responses, imbalance in T lymphocyte subsets, may play a role in the pathogenesis of ENL, either directly or by inducing an antibody critical to the formation of the immune complex

Clinico-Epidemiological Study on Leprosy Patients in Children

No abstract available.

In Situ Characterization of Immune Cells in the Annular Lesion of Leprosy / 대한피부과학회지

To characterize the immunopathologic phenotype of the cells in the lesional ti.:sue and to further examine the mechanism of the development of the annular lesions in leprosy, we have studied immune cells (T lymphocyte and its subsets, Langerhans cells, and HLA-DR antigen expressing cells) at different anatomical sites inside, active border, and outside normal skin in the annular lesions of leprosy. We took biopsy specimens from 4 patients of BT type, then processed the specimens by the staining methods eif indirect immunoperoxidase with monoclonal antibodies. In the active border the number of T cell was over 50g of the total cells infiltrated in the dermis. Helper T cells were dominant in number, and about three fourths of the cells were positive for HLA-DR staining. In two patients they had expression of DR antigen on the surfaces of the keratinocytes in the epidermis, in contrast to that of the inside, even the intensities were not. strong. At the inside of the annular lesions T cells were about 40% and the ratio of helper/suppressor T cell was approxiinately 1: 1, However, HLA-DR positive immune cells were not more than 10g among the total infiltrates. Langerha,ns cells were increased in number and in size either in the border or at the inside of the annular lesions. With these results we presume that the T cell mediated imrnune responses against Mycobacterium leprae may play an important role in the formation and extension of the annular lesions in leprosy.

A Study on Circulating Immune Complexes in Leprosy Sera / 대한피부과학회지

Recent studies indicated that cellular and humoral immune reactions against Afycobacterium leprae may be involved in the development of some of the pathological manifestations. In lepromatous leprosy one might anticipate the formation of immune complexes from concomitant occurrence of large amounts of mycobacteria and corresponding antibodies. Indeed, there are some evidences of an involvement of immune complexes in the pathogenesis of erythema nodosum leprosum(ENL), mainly based on clinical and pathological studies. Some of numerous immune cornplex tests have been applied for the study of leprosy, But no single test has yet been shown to be the rnost sensitive and the most specific for the entire spectrum of circulating immune complexes. Furthermore. Leprosy has been found to differ in its clinical manifestations and immunological behaviors in different geographic areas and races. The authors considered it is necessary to determine the circulating immune complexes in Korean patients with leprosy to evaluate the immune status and the differences in the immunologic reactivity between the lepromatous and the tuberculoid spectrum of Ieprosy.

A Study on Peripheral Blood T and B Lymphocytes in Leprosy / 대한피부과학회지

In leprosy, it is generally believed that the defense against Mycobacterium leprae (M. leprae) is largely dependent on cell-mediated immunity (CMI) and there is an accumulating evidence that the patients with lepromatous leprosy have not only defective CMI specific for M. leprae, but also have generalized impairment of CMI. In contrast, the humoral immune reactivity, both specific and nonspecific, have been found to be normal or slightly increased. Recently, several investigators have enumerated the peripheral blood T and B lympocytes in patients with leprosy; however, there is no agreement as to the results. Furthermore, leprosy has been found to differ in its clinicai manifestations and immunological behaviors in different geographic areas and races. Nevertheless, there is yet no report in Korea concerning the T and B lymphocyte enumeration. The authors considered it is necessary to enumerate the peripheral blood T and B lymphocytes in Korean patients with leprosy to evaluate the immune status and the differences in the immunologic reactivity between the lepromatous and the tuberculoid spectrum of leprosy. (countinued..)

A Study on Normal Lymphocyte Transfer Test in Patients with Leprosy / 대한피부과학회지

Normal lymphocyte transfer (NLT) test is composed of two peaks of delaycd. hypersensitivity reaction of erythema and/or induration developed at the site of intradermal inoculatioa of allogenic lymphocyte. It has been suggested that NLT test is a px.siblc homograft raaction, how var tlv exact mecha.nism is remained to be resolved. In leprosy, there has been accumulating evidenc. indicating defective cell mediated. immunity detected by varioua immunological tests. The present study was undertaken to evaluate the immune capability of patients with leprosy using NLT test. A total of 20 hea,lthy volunteers, 20 lepromatous and 22 tuberculoid leprosy patients who were under antileprosy chemotherapy with DDS for varying periods, entered this study. Lymphocytes from hepatitis associati antigen (HAA) negative donor were isolated with Ficoll- Hypaque density gradient method and the cell concentration was adjusted by normal saline so as to give 2, 5 million cells per 0. 1 ml. Each recipient was given 0. 1 ml lymphocyte suspension on the flexor surface of th right forearm intrad.ermally using 1 ml tuberculi n syringe with a 26 gauge needle. The appearance and the size of induration was checked daily for 2 weeks. In this atudy, the NLT reaction pattem was classified as follows: a. normal pattem showing the first peak and second peak of reaction. b. first peak only showing the first peak, but no second peak, of reaction. c. flat pattem showing neitger the first peak nor the second peak of reaction The results were as follows: 1. There were normal pattem in sixteen persons(80%) and first peak only in 4 persons(20%) among twenty healthy human volunteers. 2. There were normal pattem in four patients(20%), first peak only in six patients(30%) and flat pattem in ten patients(50%) among twenty letromatous leprosy patients. 3. There were normal pattem in twelve patients(54.5%), first peak only in eight patients(36.4%) and flat pattem in two patients(9.1%) among twenty-two tuberouloid leprosy patients. These findings suggest that NLT test may be useful in evaluating the immune capability in leprosy and host factor in belived to be important in the development of both first and second peaks of NLT test.