Clinical Outcomes in Hospitalized Patients with Clostridium difficile Infection by Age Group / 대한소화기학회지

BACKGROUND/AIMS: Advanced age is a known risk factor of poor outcomes for colitis, including Clostridium difficile infection (CDI). The present study compares the clinical outcomes of young and old patients hospitalized for CDI. METHODS: The clinical records of patients admitted from January 2007 to December 2013 with a diagnosis of CDI were analyzed. Patient baseline characteristics, clinical courses, and outcomes were compared with respect to age using a cut-off 65 years. RESULTS: Of the 241,391 inpatients registered during the study period, 225 (0.1%) with a diagnosis of CDI were included in the study. The mean patient age was 67.7 years. Seventy-two patients (32.0%) were younger than 65 years and 153 patients (68.0%) were 65 years old or more. The male to female ratio in the younger group was 0.8, and 0.58 in the older group. All 225 study subjects had watery diarrhea; six patients (8.3%) complained of bloody diarrhea in the young group and 21 patients (13.7%) in the old group (p=0.246). Right colon involvement was more common in the old group (23.5% vs. 42.7%, p=0.033). Furthermore, leukocytosis (41.7% vs. 67.3%, p=0.000), a CDI score of > or =3 points (77.8% vs. 89.5%, p=0.018), and hypoalbuminemia (58.3% vs. 76.5%, p=0.005) were more common in the old group. Failure to first line treatment was more common in the old group (17 [23.6%] vs. 58 [37.9%], p=0.034). CONCLUSIONS: Severe colitis and failure to first line treatment were significantly more common in patients age 65 years or more. More aggressive initial treatment should be considered for older CDI patients.

A Case of Jejunal Diverticula Which Caused Massive Small Bowel Bleeding / 영남의대학술지

Gastrointestinal bleeding is a common cause of hospitalization. Jejunal diverticula is a rare disease and it is an unusual cause of obscure gastrointestinal bleeding. After exclusion of the more common bleeding sources, small bowel diverticula should be considered as a possible rare cause of gastrointestinal bleeding. Jejunal diverticular bleeding is difficult to diagnose and treat because the bleeding site cannot be identified by routine endoscopy and radiologic studies. An exploratory operation is sometimes needed to diagnose and treat obscure gastrointestinal bleeding. If the bleeding site is certain, then surgical resection of the bleeding part of the bowel is the procedure of choice. We report here on a case of jejunal diverticular bleeding that was diagnosed by and treated with surgical resection.

A Case of Colchicine-Induced Neutropenia in Liver Cirrhosis Patient / 영남의대학술지

Colchicine is an alkaloid that has been used for treating acute gouty arthritis, psoriasis, scleroderma and Behcet's syndrome. Colchicine decreased liver fibrosis in rats with carbon tetrachloride induced cirrhosis and in patients with many liver diseases. Therapeutic oral doses of colchicine may cause nausea, vomiting, abdominal pain and diarrhea. The adverse effect of colchicine associated with the dose is bone marrow suppression, and especially neutopenia. Neutropenia has often been reported in patients have taken an overdose of colchicine. We describe a 64-year-old female liver cirrhosis patient with neutropenia that was induced by a therapeutic dose of colchicine.

Colon Cancer with a Nonspecific Inflammatory Colonoscopic Finding / 영남의대학술지

Colon cancer is the second most common malignancy in Korea. It is classified as superficial type, the mass type, the ulcerative type, the ulceroinfiltrative type, the diffuse infiltrative type and the unclassified type according to the colonoscopic findings. We report here on a case of colon cancer that was initially misdiagnosed as acute infectious colitis at the initial presentation. A 64-year-old man visited to Yeungnam University Hospital for watery diarrhea and lower abdominal pain. Colonoscopy revealed long segmental edematous mucosa and hyperemic mucosa with stenosis in the transverse colon. He was diagnosed as having acute infectious colitis according to the colonoscopic finding. However, two days later after colonoscopy, he visited the emergency room for hematochezia. We performed computerized tomography(CT) and obtained blood samples to find the origin of the bleeding. We found thickening of the transverse colon lumen and ascites on the CT finding and an elevated level of tumor markers; we also obtained the results of the colonoscopic biopsy that was done via colonoscopy. He was finally diagnosed as having colon cancer with carcinomatosis, a poorly differentiated adenocarcinoma.

A Case of Hepatocellular Carcinoma with intradural growth Presenting as Obstructive Jaundice / 영남의대학술지

The incidence of hepatocellular carcinoma presenting as obstructive jaundice is 0.7~9%. The mechanisms of obstructive jaundice include bile duct invasion by tumor, tumor thrombi, blood clots, direct bile duct compression by tumor, and intraductal tumor growth. We report a rare case of hepatocellular carcinoma with intraductal growth. A 46-year-old woman was admitted due to colicky right upper abdominal pain and jaundice for 4 days. Computed tomography showed dilatation of the left intrahepatic duct, and endoscopic retrograde cholangiography showed a filling defect in the left main intrahepatic duct. We performed a left lobectomy with a Roux-en-Y hepaticojejunostomy. The tumor was diagnosed as a hepatocellular carcinoma with intraductal growth.

Ulcerative Colitis Mimicking Acute Hemorrhagic Colitis / 영남의대학술지

Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract that affects the large bowel. Its etiology remains controversial. However, an infectious or immunologic origin is considered the primary cause. The onset of UC is typically slow and insidious, but some patients may present acutely with symptoms mimicking infectious colitis. We report a case of ulcerative colitis mimicking acute hemorrhagic colitis at initial presentation. A 60-year-old man was referred to Yeungnam University Hospital for bloody diarrhea and abdominal pain. Sigmoidoscopy revealed mildly edematous mucosa in the rectum and hyperemic mucosa with petechiae in the sigmoid colon. The patient was treated with antibiotics for several days, and his symptoms improved. However, after one month, his bloody diarrhea relapsed. Follow-up sigmoidoscopy revealed mucosal friability in the rectum and sigmoid colon. He was diagnosed with ulcerative colitis, and his symptoms were improved with mesalazine and a steroid enema.

Detection of mecA, blaZ and aac(6')-aph(2") gene of staphylococci by PCR / 대한임상병리학회지

BACKGROUND: Staphylococci are major nosocomial pathogens and reveal an increase in resistant strains such as methicillin-resistant Staphylococcus aureus. For treatment of infection and prevention of dissemination, rapid and reliable identification methods are required but the conventional bacterial identification and susceptibility tests require at least 24 hours. In this study, we evaluated the polymerase chain reaction (PCR) of the antibiotic resistant genes by comparing with the disk diffusion susceptibility test for the detection of resistance to penicillin, oxacillin and gentamicin. METHODS: A hundred-thirty-five staphylococci including 95 S. aureus and 40 S. epidermidis were from clinical specimens from June to December 2000. Antimicrobial susceptibility tests were done using the NCCLS disk diffusion method. PCRs were performed with primer sets specific for mecA, blaZ and aac(6')-aph(2"). The species-specific PCR was also used to identify S. aureus and S. epidermidis. RESULTS: All four penicillin-susceptible staphylococci were negative for blaZ and 108 of 131 penicillin resistant-staphylococci were positive for blaZ. The concordance rate for PCR of the blaZ gene and penicillin disk diffusion test was 83.0%. 110 of 115 oxacillin-resistant staphylococci were positive for mecA and all five mecA negative oxacillin-resistant strains were positive for blaZ and have the phenotype beta-Lactamase hyperproducer. One of the oxacillin-susceptible S. aureus was positive for mecA. The concordance rate of PCR for the mecA gene and oxacillin disk diffusion test and those of the aac(6')-aph(2") gene and gentamicin disk diffusion test was 95.6% and 97.8%, respectively. CONCLUSTIONS: The disk diffusion tests misdiagnosed 25% of the mecA negative staphylococci as methicillin-resistant staphylococci (MRS) and lost one of the mecA positive strain. We considered that the detection of the mecA and blaZ gene using the PCR was more useful than the disk diffusion test for detection of methicillin-resistant staphylococci.

Development of Flexible Interface Software for Autoanalyzer using Unidirectional and ASTM Bidirectional Protocol / 대한임상병리학회지

BACKGROUND: The Laboratory Information Management System (LIMS) requires instrument interfacing for good efficiency. However, most instrument interfacing cannot be used easily because instruments have different interface protocols and database systems are different in each hospital LIMS. Therefore, it is necessary to establish flexible interface software that would be useful for various instrument interfacing and can be handled by laboratory workers. METHODS: We categorized the raw data acquisition format of instruments into 7 classification according to the field delimiter, the field position and the test ID, and created software so that anyone could make the interface protocols for any instrument that supports the unidirectional or ASTM interface protocol, according to classification. The software also provides various functions, such as host communications and printing. RESULTS: With this software, we have interfaced 23 instruments without program languages (C, C++, Basic, Pascal, etc.) coding. It took about 1-4 hours for each instrument interface. The software supports a maximum of 8 simultaneous instrument connections with one personal computer. Also, it is possible to retrieve acquisition data from instruments with Microsoft Excel without LIMS. CONCLUSTIONS: The advantages of this software are as follows; 1. Markedly shortens the input time for data generated from automated instruments and reduces errors of manual data entry, 2. Effective increase in host computer performance, 3. Significantly saves time and cost for instrument interfacing. Therefore, this software was considered to be very useful for laboratory instrument interfacing.

Cytocentrifuge Gram stain method and urine dipstick test as a screening test of bacteriuria / 대한임상병리학회지

BACKGROUND: Rapid detection of bacteriuria is desirable for diagnosis and treatment of urinary tract infections. The aim of this study was to assess the usefulness of the cytocentrifuge Gram stain, uncentrifuged Gram stain, and urinary nitrite, leukocyte esterase to determine the exclusion of urine culture. METHODS: A cytocentrifuge Gram stain procedure and urine dipstick test were performed to screen for bacteriuria using 155 random fresh urine specimens submitted for routine culture. The authors compared the results of the cytocentrifuge Gram stain, urinary nitrite, leukocyte esterase and multiapplication of three tests with the results of culture. Result: Compared with positive urine culture(>105CFU/mL), cytocentrifuge Gram stain had a good negative predictive value(96.0%) and sensitivity(89.1%). The urinary nitrite and leukocyte esterase test had very low sensitivity(27.0%, 45.9%), respectively. The multiapplication of cytocentrifuge Gram stain, urinary nitrite and leukocyte esterase had a excellent negative predictive value(98.9%) and sensitivity(97.3%), and agree with urine culture positive(36/37 cases, 97.3%). CONCLUSION: Multiapplication of urinary cytocentrifuge Gram stain, nitrite and leukocyte esterase test is a useful screening test for the rapid exclusion of bacteriuria and provides rapid morphologic information about suspected pathogens in cases with positive urine culture.

Detection Rate of Extended-Spectrum beta-Lactamase Producers in Klebsiella pneumoniae and Escherichia coli Isolated at Yeungnam University Medical Center / 영남의대학술지

BACKGROUND: Extended-spectrum beta-lactamases(ESBL) are enzymes that confer resistance to oxyimino-beta-lactams as well as to penicillins and cephalosporins. Strains of Klebsiella pneumoniae and Escherichia coli that produce ESBL have been increasingly prevalent in many countries. The purpose of this study was to investigate the ESBL production rate of K. pneumoniae and E. coli at the in Yeungnam University Medical Center. MATERIALS AND METHODS: Thirty-one isolates of K. pneumoniae and twenty-five isolates of E. coli were examined for ESBL by double disk synergy test, using 20/10microgram ticarcillin/clavulanic acid and 30microgram oxymino-beta-lactam(ceftazidime, ceftriaxone and aztreonam) disks. RESULTS: Fifty-two percent of K. pneumoniae and sixteen percent of E. coli isolates revealed double disk synersism. Majority of ESBL-producing strains(fifty-five percent) were isolated from patients in the intensive care unit. CONCLUSION: ESBL production of K. pneumoniae and E. coli were also common at the Yeungnam Univercity Medical Center and pose a serious problem for antimicrobial therapy.