A Case Study of Ischemic Monomelic Neuropathy with Brachial-Cephalic Arteriovenous Fistula / 대한혈관외과학회지

Ischemic monomelic neuropathy (IMN) is recognized as a rare ischemic neuropathy caused by vascular access originating from the brachial artery leading to hemodialysis. IMN is characterized by acute painful muscle weakness shortly after surgery and neuronal axon loss without necrosis of adjacent tissues. In chronic diabetic patients with polyneuropathy, brachial vascular access surgeries include the risk of IMN, necessitating immediate surgical treatment such as banding or ligation. In the above case, we chose to close brachial-cephalic arteriovenous fistula for IMN with no short-term neurologic improvement, however, significant neurological and clinical improvement was observed in long-term follow-up. Here, we present a case of IMN with serial nerve conduction evaluations indicating the improved long-terms outcomes.

An Epidemiological Investigation on an Outbreak of Shigellosis in a Special School for Handicapped in Yeongcheon-si and in a Rehabilitation Facility in Gyeongsan-si, Korea, 2008 / 農村醫學 地域保健

OBJECTIVES: In September 2008, an outbreak of diarrhea occurred among students attending Y school in Yeongcheon-si. Shigella sonnei was cultured from some of the rectal swabs. An epidemiological investigation was carried out to determine the source of the infection and the mode of transmission of the shigellosis outbreak. METHODS: The index case lived in the D rehabilitation facility in Gyeongsan-si and an additional epidemiological investigation was carried out there. The cases could not be questioned due to their mental handicaps. The teachers were interviewed instead. A patient case was defined as a resident with diarrhea more than one time a day from September 18 to September 26, 2008 or a resident with confirmed Shigella sonnei at the Y school or the D rehabilitation facility. RESULTS: The attack rate was 1.2% (8 persons) among 659 persons in the Y school and D rehabilitation facility. Five persons were microbiologically confirmed to have the infection and three persons were diagnosed on the basis of symptoms. Shigella sonnei was cultured from five of the 659 rectal swabs. However, 80 environmental specimens including drinking water, preserved foods, and cooking utensils were negative. All eight patients were Y school students and had been living in group boarding and lodging. Six of them lived in the D rehabilitation facility and two lived in the dormitory at the Y school. Five cases showed pulsed-field gel electrophoresis patterns that were identical for Shigella sonnei. CONCLUSIONS: The results of this study showed that the infection source of the shigellosis outbreak, in the two places, were identical. It is likely that the infections initially spread from a teacher or volunteer and then among the students.

An Epidemiological Investigation on an Outbreak of Bacillus Cereus Food Poisoning in a Girls' High School in Sangju-si, Korea, 2008 / 한국역학회지

PURPOSE: In May 2008, a diarrhea outbreak occurred among students of in a girls' high school (S school) in Sangju-si, Korea. An epidemiological investigation was carried out to clarify the cause and transmission route of the outbreak. METHODS: S school has been providing meals directly since July 2007. We conducted a questionnaire survey among 591 persons, and examined 283 rectal swabs and 98 environmental specimens. The patient case was defined as a member of S school who had diarrhea more than one time in a day, accompanied with one or more symptoms among abdominal pain or tenesmus from May 19th to May 26th 2008. RESULTS: The attack rate was 24.0%. Bacillus cereus were cultured from three of the rectal swabs and five of the preserved foods. It was suspicious that contamination was possible in seasoning vegetables, and we found some foods were seasoned with spices after being cooled by moving cooler for about 20 minutes. Enterotoxin positive B. cereus were cultured from two foods cooled by moving cooler. Enterotoxin negative B. cereus were cultured from two environmental specimens of the moving cooler. CONCLUSIONS: We presumed the cause of the diarrhea outbreak in S school was food poisoning by B. cereus. Because enterotoxin positive B. cereus were cultured from rectal swabs and foods, and the symptoms were corresponded. We estimated the outbreak was occurred by this process that B. cereus in the moving cooler contaminated foods during cooling and then rapidly proliferated.

Effects of enucleation and chemotherapy in advanced intraocular and intraorbital retinoblastoma with or without radiotherapy / 소아과

PURPOSE: Radiotherapy is effective in local treatment for retinoblastoma. However, asymmetric facial hypoplasia after radiation is a serious late effect. This study was performed to investigate the effects of enucleation and chemotherapy with or without radiotherapy in advanced intraocular and intraorbital retinoblastoma. METHODS: Between 1985 October and 2006 December, the records of thirty five patients who were diagnosed as retinoblastoma at Yeungnam University Hospital were reviewed. Advanced intraocular and intraorbital retinoblastoma patients classified as Reese-Ellsworth group III, IV, and V and Grabowski- Abramson class II were selected for the study. RESULTS: Eighteen patients were enrolled in this study. All patients were enucleated and had received chemotherapy. Nine patients received radiotherapy and nine patients didn't receive radiotherapy. Tumor cells were found on resection margin of optic nerve in five of nine patients who received radiotherapy, but none of nine who didn't receive radiotherapy. Chemotherapy included vincristine, adriamycin, cyclophosphamide, VM-26, cisplatin before 2001, and vincristine, etoposide, and carboplatin after 2001. There were no recurrences or metastases in nine patients who didn't receive radiotherapy. But two of nine patients who received radiotherapy had metastases to brain. However, all survivors who received radiotherapy had significant facial asymmetry. CONCLUSION: In advanced intraocular and intraorbital retinoblastoma without tumor cell on resection margin of optic nerve, enucleation and chemotherapy without local radiotherapy appears to be safe for long-term survival. However, in those with tumor cells on resection margin of optic nerve, enucleation and chemotherapy with local radiotherapy seems to be necessary to improve survival.

Outcome of Hematopoietic Stem Cell Transplantation: In Children and Adolescent Patients at Yeungnam University Hospital

BACKGROUND: The results of hematopoietic stem cell transplantation (HSCT) have been variable according to the patient disease status and center of treatment. We evaluated the outcome of HSCT in our pediatric and adolescent patients at Yeungnam University Hospital (YNUH). METHODS: The records of 60 patients, ages 19 years and younger, who had a HSCT at YNUH from September 1995 to December 2006 were reviewed. RESULTS: Among the 60 patients, allogeneic bone marrow transplantation (Allo-BMT) was performed in 19 (related 17, unrelated 2), cord blood transplantation (CBT) in 11 (related 1, unrelated 10), and autologous peripheral blood stem cell transplantation (Auto-PBSCT) in 30 patients. All patients engrafted. The median number of days to obtain an absolute neutrophil count >500/microL and platelet count >20,000/microL were 13 days (range, 8~48 days) and 27 days (range, 6~465 days), respectively. The treatment related mortality (TRM) of Allo-BMT, CBT and Auto-PBSCT were 21.1%, 27.3% and 10%. The three-year overall survival (OS) and event free survival (EFS) among the 60 patients were 73.3% and 63.3%. The three-year OS and EFS for Allo-BMT, CBT and Auto-PBSCT were 78.9% and 73.7%, 63.6% and 54.5% and 53.3% and 46.7%, respectively. CONCLUSION: Although the number of cases was small, the 3-year EFS of the CBT was comparable to that of the Auto-PBSCT for hematological malignancies. However, the high TRM with the CBT requires further improvement as does the high relapse rates for the Auto-PBSCT, especially in neuroblastoma patients.

Plasma B-type natriuretic peptide (BNP): a useful marker for anthracycline-induced cardiotoxicity in Korean children with cancer / 소아과

PURPOSE: The anthracyclines (AC) are widely used chemotherapeutic agents for pediatric cancers. However, the therapeutic use of these agents is limited by their cardiotoxicity. The aim of the present study was to investigate the usefulness of plasma B-type natriuretic peptide (BNP) levels as a marker for AC-induced cardiotoxicity compared to echocardiography in Korean children with cancer. METHODS: Fifty-five pediatric cancer patients who had received chemotherapy including AC were enrolled. The cumulative AC doses, clinical symptoms, and two echocardiography parameters, left ventricular fractional shortening (LVFS) and left ventricular ejection fraction (LVEF), were studied and compared with plasma BNP levels. RESULTS: In 55 patients, plasma BNP levels were measured 115 times and echocardiographies were performed 64 times. The median cumulative dose of AC was 325 mg/m2 (range 120-600; mean 345) and the median plasma BNP level was 10 pg/mL (range 5-950; mean 31). The cumulative AC doses correlated significantly with the plasma BNP levels (P=0.002). The plasma BNP levels correlated significantly with LVFS (P=0.018) and LVEF (P=0.025). Dilated cardiomyopathies were identified in three patients. LVFS and LVEF decreased and plasma BNP levels increased in a patient with acute dilated cardiomyopathy and in that with symptomatic chronic dilated cardiomyopathy. However, LVFS, LVEF and plasma BNP levels were normal in a patient with asymptomatic chronic dilated cardiomyopathy. CONCLUSION: The results of this study demonstrated that plasma BNP levels could be used as a marker for AC-induced cardiotoxicity; they showed good correlation with echocardiography findings in pediatric cancer patients. Plasma BNP levels may be used for the detection and management of AC-induced cardiotoxicity in Korean children with cancer.

Antiproliferative Effect of NS-398, a Cyclooxygenase-2 Inhibitor, in Pancreatic Cancer Cell Lines

PURPOSE: Selective cyclooxygenase (COX)-2 inhibitors have been reported to inhibit cancer cell proliferation. We investigated the effects of NS-398, a selective COX-2 inhibitor, on cell proliferation in human pancreatic cancer cell lines. METHODS: Human pancreatic cancer cell lines, Aspc-1, Capan-1, and Capan-2 were used. We used western blot and/or RT-PCR to evaluate COX-2 and vascular endothelial growth factor expression. Antiproliferative effects were measured by MTT assay, apoptosis assay and cell cycle analysis. Epidermal growth factor (EGF) and troglitazone were used for combined treatment. RESULTS: COX-2 was relatively overexpressed in Capan-1 and Capan- 2, but minimal in Aspc-1 cell line. COX-2 mRNA expression was upregulated by 50 microM of NS-398 in Aspc-1 cell line but was downregulated at 100 microM in all cell lines. Treatment with NS-398 increased cell population of G0/G1 phase and also induced early apoptotic changes in a dose-dependent manner in all three cell lines. Combined treatment with EGF or troglitazone did not seem to affect antiproliferative effects of NS-398. All three cell lines expressed vascular endothelial growth factor constitutively and its expression was downregulated by treatment with NS-398. Pretreatment with NS-398 prior to radiation exposure increased radiosensitivity in Capan-2 cells. CONCLUSION: COX-2 expression was variable in pancreatic cancer cell lines. NS-398 inhibited pancreatic cancer cell proliferation by inducing apoptosis and cell cycle arrest in a dose-dependent manner. Treatment with NS-398 also inhibited expression of VEGF and enhanced radiosensitivity in pancreatic cancer cell lines. COX-2 inhibitors might be promising potential therapeutic agents for patients with pancreatic cancer.

Bacteremia in Pediatric Cancer Patients: Causative Organisms and Antibiotic Sensitivities / 소아과

PURPOSE: Bacteremia in immunocompromised pediatric cancer patients can lead to high morbidity and mortality, if not treated early and properly. The incidence and antibiotic sensitivities to common pathogens of bacteremia in pediatric cancer patients are liable to change, according to region and time. We investigated the causative organisms and antibiotic sensitivities of bacteremia in pediatric cancer patients to assess the adequacy of empiric antimicrobial therapy. METHODS: From September 1995 to August 2003, we retrospectively evaluated 58 episodes in 39 pediatric cancer patients with bacteremia treated at the Pediatric Department of Yeungnam University Hospital. We investigated and analyzed the causative organisms and the antibiotic sensitivity test results by reviewing the records of the microbiologically proven positive blood culture results. RESULTS: The incidence of bacteremia in pediatric cancer patients in this study was 5.7 percent (58 episodes out of 1, 022 occasions of blood cultures). Gram-positive organisms were isolated more often than gram-negative organisms (63.8 percent vs 36.2 percent) in the following order: Staphylococcus epidermidis (37.9 percent), Staphylococcus aureus (17.3 percent), Escherichia coli (12 percent), Streptococcus (8.6 percent), Enterobacter (6.9 percent), Klesiella (6.9 percent), Serratia (3.5 percent), Acinetobacter (3.5 percent), Proteus (1.7 percent) and Morganella morganii (1.7 percent). In antibiotic sensitivity tests, only six of 37 isolates (16 percent) of gram positive bacteria were sensitive to penicillin and 15 of 37 isolates (40 percent) were sensitive to oxacillin. All except one Staphylococcus aureus were sensitive to vancomycin and all except one Staphylococcus epidermidis were sensitive to teicoplanin among 37 isolates of gram positive bacteria. In the case of gram negative bacteria, two of 21 isolates (10 percent) and four of 21 isolates (19 percent) were sensitive to cefotaxime and ceftazidime, respectively. Only six of 21 isolates (29 percent) were sensitive to aminoglycoside, but all 21 isolates (100 percent) were sensitive to imipenem. All seven isolates tested after the year 2000 were sensitive to meropenem. CONCLUSION: In conclusion, we should choose the proper antimicrobials in treating pediatric cancer patients with suspected bacteremia, reflecting the increasing episodes of gram positive bacteremia and polymicrobial resistance of gram positive and negative organisms.

The Clinical Results of Clear Lens Extraction with Posterior Chamber Intraocular Lens Implantation for the Correction of High Myopia

We retrospectively studied 26 eyes of 16 patients(male :9 patients, female:7 patients, mean age:39.3 years)who received clear lens extraction by phacoemulsification and low-power posterior chamber intraocular lens implantation. To investigate the effectiveness of clear lens extraction, visual acuity, refractive results, and intraoperative and postoperative complication were analyzed. The mean follow-up was 14.7 months. For reasons of lattice degeneration, retinal tear, or hole, we performed argon laser photocoagulation before clear lens extraction in 84.6% of patients. The IOL power was calculated using the SRK/T formula. Uncorrected visual acuity improved in all cases, with 65.4%of eyes achieving 20/40 or better and 23.1%, 20/25 or better. Corrected visual acuity improved in all cases, the percentage of eyes achieving corrected visual acutiy of 20/40 or better increased from 69.2%preoperatively to 100%postoperatively and the percentage of 20/25 or better, from 3.8%to 80.8%.The mean postoperative spherical equivalent was -15.85D (-10.25 to -23D), 50%of eyes were within 1.0D of the goal diopter and 100%were within 2.0D of the goal diopter.No intraoperative complications occurred.During the follow-up, 42.3% of eyes developed mild posterior capsule opacification and 1 eye(3.8%) received a YAG laser posterior capsulotomy 22 months postoperatively. No retinal tear, retinal detachment, or cystoid macular edema was observed. Clear lens extraction with low-power IOL implantation was effective for the correction of high myopia but additative cases and longer follow-up periods are needed to fully assess the complication.

Management of Essential Blepharospasm: Botulinum Toxin A Treatment and Orbicularis Myectomy Operation

To investigate results of treatment with essential blepharospasm, patients were evaluated by results of treatment with botulinum toxin A and myectomy operation. Seventy patients of the essential blepharospasm who received local injection of botulinum toxin or orbicularis muscle extirpative surgery were evaluated according to results and complications of the treatment modality over a 7-year period. Fifty-six patients[80%] were primarily treated with botulinum toxin and 14 patients[20%] underwent myectomy operation as the primary treatment. Of the 56 patients, 8[14.3%] were treated later with myectomy operation. In botulinum toxin treatment, the mean subjective improvement was found in 89.2% of the patients, and the mean effective durations of essential blepharospasm were 12.7 weeks. Severity and frequency grades in eyelid spasm were significantly lower after injection[P=.000]. Tearing, dry eye, and headche were the most frequent complications and ptosis was observed in 2 cases[2.0%]. In the orbicularis myectomy operation, 13 patients[59.1%] were carried out through a brow incisions, 1[4.5%] through a blepharoplasty incisions, and 8[36.4%] through both. Fourteen patients[63.6%] had acceptable control of blepharospasm throughout follow-up after the upper lid orbicularis stripping procedure alone. We believe that botulinum toxin is the treatment of first choice because of its higher acceptance rate. Surgery is reserved for botulinum toxin failure. In otherwise fit patients, myectomy is the treatment of first choice.

Clinical Analysis of Large Recession of Bimedial Rectus Muscles in Esotropia

Nineteen patients with large angle esotropia who have undergone bimedial rectus recession ranging from 7 to 8 millimeters were evaluated. We retrospectively reviewed preoperative and postoperative visual acuity, deviation, ocular motility, fusion, stereoacuity in all patients. The mean preoperative deviation was 76 prism diopters, ranging from 65 to 95 prism diopters and the mean postoperative follow up interval was 55.6 months, ranging from 26 to 80 months. The overall successful rate(horizontal orthotropia within+/-10 prism diopters) was 42.1%(8/19). The rate of undercorrection was 47.7%(9/19) and the rate of delayed consecutive exotropia was 10.5%(2/19). Fusion at near was found in 36.8%(7/19) and stereopsos of 200 seconds or better was found in 15.8%(3/19) of patients postoperatively.We observed no limitation of adduction or convergence. If reoperation was necessary, there still remain other untouched horizontal muscles on which to operate.Therefore, 7 to 8 millimeter medical rectus recession is the first effective procedure for the correction of large angle esotropia with deviations of more than 65 prism diopters.