• Journal of Chest Surgery
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• v.43 no.4
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• pp.381-386
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• 2010

Background: Sternal wound infection (SWI) is an important complication after cardiac surgery. The aim of this study was to investigate the predictors affecting sternal wound infection and preventive factors including short term Vancomycin therapy in patients who underwent coronary artery bypass grafting (CABG). Material and Method: A retrospective study was done using data collected from January 2001 through December 2007. This included 219 patients who had isolated CABG. The definition of SWI was documentation from a microbiological study and a requirement for simple closure or other surgical revision. Result: The overall incidence of SWI was 7.8% (n=17). The causative organisms were methicillin resistant Staphylococcus aureus (MRSA, n=13), methicillin resistant Staphylococcus epidermidis (n=2), Pseudomonas aeruginosa (n=1), and Candida albicans (n=1). Ten cases had deep sternal wound infection with mediastinitis; 7 cases had a superficial wound infection. Infection-related mortality was low (1/17; 6%). Diabetes mellitus (p=0.006) and smoking history (p=0.020) were factors that predicted high risk. Short term use of vancomycin decreased the incidence of MRSA-associated SWI (p=0.009). For treatment, curettage and rewiring or flap were needed in most cases (88%, n=14). Conclusion: Patients who had diabetes mellitus and a smoking history need careful management. Short term use of vancomycin is effective for prevention of SWI with MRSA.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.447-455
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• 2009

Background: Prosthetic valve endocarditis usually presents with clinical symptoms that are more severe than native valve endocarditis, and prosthetic valve endocarditis shows the spread of infection into the surrounding tissue as well as into the superficial endocardial layers. The postoperative prognosis is especially poor for valve re-replacement for the cases of active endocarditis that are unable to receive a full-course of pre-antibiotic therapy due to complications and the ensuing clinical aggravation. The aim of this study was to evaluate the clinical profiles, laboratory findings and mid-term surgical results of active prosthetic valve endocarditis. Material and Method: Among the 276 surgically treated infective endocarditis patients who were treated during the period from January 1998 to July 2008, 31 patients were treated for prosthetic valve endocarditis. Among these patients, 24 received surgical treatment for an 'active' state, and they were selected for evaluation. Result: The most frequently encountered symptom was a febrile sensation. Eight cases (33.3%) were accompanied by systemic thromboembolism, among which 5 cases (20.8%) had an affected central nervous system. 'Vegetations' were most commonly found on transesophageal echocardiography, and the 'Staphylococcus species' were the most frequent pathogens. There were 4 deaths in the immediate postoperative period, and an additional 4 patients died during the follow-up period (Mean$\pm$SD, 42.1$\pm$36.9 months). The cumulative survival rate was 79% at 1 year, 73% at 3 years, 66% at 5 year, and 49.5% at 7 years. Conclusion: The cases of active prosthetic valve endocarditis that were unable to receive a full course of preoperative antibiotics therapy generally have a poor prognosis. Nevertheless, early surgery and extensive resection of all the infected tissue is pivotal in improving the survival rate of patients with surgically treated active prosthetic valve endocarditis.

• Childhood Kidney Diseases
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• v.15 no.2
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• pp.163-171
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• 2011

Purpose : To evaluate the prevalence of vesicoureteral reflux (VUR) according to the timing of voiding cystourethrography (VCUG) in infantile urinary tract infection (UTI). Methods : The data of 134 infants (1-12 months) with renal cortical defect in $^{99m}Tc$-2, 3-dimercaptosuccinic acid ($^{99m}Tc$-DMSA) scan with a diagnosis of UTI in two hospitals from 2000 to 2010 were retrospectively analyzed. The VCUG was performed after 2 weeks from the diagnosis of UTI in Group I (n=68), and the VCUG was performed within 2 weeks from the diagnosis of UTI in Group II (n=66). Results : There were no significant differences between the two groups in the duration of fever, white blood cell count, C-reactive protein levels, and abnormalities in ultrasonography (P>0.05). There was no significant difference between the two groups in the prevelence of VUR, bilateral VUR, and severe VUR. VCUG-induced UTI was detected 16 (23.5%) of patients in whom the procedure was performed 2 weeks after the diagnosis, and none of VCUG-induced UTI occurred in those in whom the procedure was performed 2 weeks within the diagnosis. Conclusion : We conclude that the prevalence of VUR according to the timing of VCUG did not differ between the two groups in infantile UTI with renal cortical defect in DMSA scan. We also found that performing VCUG with antibiotics can decrease risk of VCUG-induced UTI.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.561-565
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• 2001

Patients who have complex endocarditis with involvement of both the aortic and mitral valves and intervalvular fibrous skeleton are among the most difficult to treat and still have the highest surgical mortality and morbidity rates. We report one case of aortic and mitral valve replacement with reconstruction of the fibrous skeleton performed in a 55-year-old female patient who had an aortic annular abscess and both the aortic and mitral prosthetic valve endocarditis with destruction of the fibrous skeleton. Previously, she had undergone redo double valve replacement\`, Transesophageal echocardiogram showed the paravalvular defect at the noncoronary aortic sinus and abnormal sinus tract along the fibrous skeleton. Emergent operation was performed due to positive blood cultures of staphylococcus epidermidis and persistent sepsis despite appropriate antibiotic therapy. After aortotomy extended to the roof of left atrium, both prosthetic valves and destroyed fibrous skeleton were completely resected and the aortic annular abscess was debrided and closed with a bovine pericardial patch. Reconstructions of both aortic and mitral annuli and the fibrous skeleton were done by using two separate bovine pericardial patches in triangular shape and mechanical valves were implanted. Postoperatively, adequate antibiotic therapies were continued and the patient was discharged at the postoperative 72 days without evidence of recurrence of endocarditis. Transthoracic echocardiogram of the postoperative 8 months shows no paravalvular leakage or recurrence of endocarditis and the patient has been followed up with no symptom.

• Pediatric Infection and Vaccine
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• v.7 no.2
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• pp.211-217
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• 2000

Purpose : Salmonellosis including typhoid fever is still prevalent in Korea. Recently it has been reported that the incidence of salmonella gastroenteritis is increasing with a reduction of typhoid fever. We studied the clinical and laboratory features of salmonellosis. Methods : We evaluated the clinical records of 83 patients with salmonellosis who had been confirmed by stool culture from 1994 to 1999. Results : Annual incidence of salmonellosis showed an increasing tendency during recent 4 years. Seasonally, summer(45.8%) was the most prevalent, followed by fall(32.5%). Male to female ratio was 1.4 : 1. In age distribution, 64 cases(77.1%) were under 5 year-old, and 18 cases(21.7%) were younger than 1 year-old. Clinical features included diarrhea(96.4%), fever(91.6%), vomiting(49.4%), bloody stool(42.1%), abdominal pain(40.1%) and tenesmus(12.0%). In serogroups, there was no group A and group B, group C, group D(including 2 cases of S.typhi) and group E were in 41.0%(34 cases), 3.6%(3 csaes), 51.8%(43cases) and 3.6%(3 cases), respectively. In Widal test, 5 cases(13.5%) and 1 case(2.7%) of group B, C and E(total 37 cases) were observed the O titer above 1 : 80 and 1 : 320, respectively. However, in 36 cases of group D, 19 cases(52.7%) and 9 cases(25.0%) were above the O titer 1 : 80 and 1 : 320, respectively. Antibiotics resistant rates to ampicillin, trimethoprim/sulfamethoxazole and chloramphenicol were 23.2%, 10.1% and 51.4%, respectively. Conclusion : Salmonellosis has become a common cause of gastroenteritis in children, especially under the pre-school age. Isolation of salmonella is neccessary for accurate diagnosis of gastroenteritis and typhoid fever. A careful attention of the use of antibiotics is needed to reduce the muilti-drug resistant strains.

• Pediatric Infection and Vaccine
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• v.11 no.2
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• pp.183-191
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• 2004

Purpose : The purpose of this study was to compare the clinical features of staphylococcal scalded skin syndrome(SSSS) isolated methicillin-resistant Staphylococcal aureus(MRSA) with those of SSSS isolated methicillin-sensitive Staphylococcal aureus(MSSA) in children. Methods : We retrospectively reviewed the medical records and microbiological results of 36 cases of SSSS who were admitted to the Pediatric Department of Ulsan Dong-Kang General Hospital from Jan. 1999 to Dec. 2003. Results : Among 36 cases, there were 7 generalized types, 1 abortive type in MRSA group and 5 generalized types, 6 abortive types in MSSA group. The peak incidence of age was between 2 and 5 years in both groups. SSSS were diagnosed with increasing frequency. Most of MRSA group were diagnosed in 2003(6/8). The peak seasonal incidence was fall and winter in both groups. Facial lesion was observed in all cases followed by flexural lesion in both groups. Staphylococci were isolated from the skin and throat most frequently in both groups. Upper respiratory illness and conjunctivitis were most common preceding infections in both groups. Among 8 cases of MRSA group, 4 cases were treated completely with ampicillin-sulbactam. There was no significant difference of mean duration of admission between MRSA group and MSSA group. Conclusion : There was no significant difference of clinical features between MRSA group and MSSA group although generalized types of SSSS were more common in MRSA group than in MSSA group.

• Childhood Kidney Diseases
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• v.17 no.2
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• pp.65-72
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• 2013

Purpose: Urinary tract infection (UTI) caused by gram-positive uropathogens is usually hospital-acquired and associated with predisposing conditions. However, the incidence of gram-positive bacteria in community-acquired UTIs has recently increased worldwide. We aimed to investigate the clinical significance of UTI and associated genitourinary malformations in young children with febrile UTIs caused by gram-positive bacteria. Methods: We retrospectively reviewed the medical records of 566 patients (age, <1 year) who visited the Korea University Medical Center for febrile UTIs between January 2008 and May 2013. We classified the patients into the following two groups: gram-positive (P group) and gram-negative (N group), according to the results of urine culture. The fever duration; white blood cell (WBC) counts and C-reactive protein (CRP) levels in peripheral blood; and the presence of hydronephrosis, cortical defects, vesicoureteral reflux (VUR), and renal scarring were compared between the two groups. Results: The number of patients with gram-positive bacteria was 23 (4.1%) and with gram-negative bacteria was 543 (95.9%). The most common pathogen was Escherichia coli, and Enterococcus faecalis showed the highest incidence among gram-positive uropathogens. Patients with gram-positive bacteria showed longer fever duration compared to that in patients with gram-negative bacteria (P vs. N, $3.4{\pm}1.2$ vs. $2.9{\pm}1.6$ days, P <0.05). The incidence of VUR was increased in the gram-positive group compared to that in the gram-negative group (P vs. N, 55.6 vs. 17.8%, P<0.05). However, there were no significant differences in other laboratory and radiologic findings. Conclusion: The findings of our study show that community-acquired UTIs in patients younger than 1 year of age, caused by gram-positive uropathogens, can be associated with prolonged fever duration and the presence of VUR.

• Proceedings of the Korean Aquaculture Society Conference
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• 2003.10a
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• pp.80-81
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• 2003

양식 생물의 질병 제어는 예방과 치료를 통해 이루어진다. 그러나 항생제의 오ㆍ남용으로 인하여 약제 내성균의 증가와 치료 효과가 감소하고, 나아가 식품안전성 문제로 양식생물의 소비를 위축시켜왔다. 따라서 질병이 발생한 후에 시행하는 화학약품 치료법은 이미 한계에 달하였다. 이에 따라 사전에 질병을 차단하는 예방법인 vaccine이나 질병에 대한 저항능력을 키우는 비특이적 면역 증강물질에 대한 관심이 꾸준히 높아지고 있다. 해조류에는 다량의 lectin이 포함되어 있는데, Lectin은 당에 결합하는 단백질의 총체적인 이름으로, defence molecule로 작용하여 어류가 섭취할 경우 외래 항원으로 인식하여 지속적으로 면역 기능을 활성화시키는 것으로 알려져 있다. 따라서 본 연구는 돌돔사료에 kelf meal을 첨가하여 공급한 후 이들의 성장과 비특이적 면역기구에 미치는 효과를 조사하였다. 실험사료는 상업용 kelf meal을 0%, 2%, 5% 첨가하고, 2반복으로 500L FRP 탱크에서 8주간 사육하였다. 실험어류는 40g 내외의 돌돔을 대상으로 하였고, 사료공급 4주 및 8주에 각 실험구의 돌돔을 대상으로 비특이적 면역기구에 미치는 효과를 조사하였다. 체액성 면역 조사로는 혈청 및 점액 lysozyme 활성과 Escherichia coli에 대한 혈청 내 보체의 살균 능력을 조사하였고, 세포성 면역 조사는 전신 식세포의 NBT 환원 실험과 말초혈액의 식세포 식균능을 측정하였다. 식균능 시험은 Escherichia coli FKC (formalin killed cell)에 대한 식균율 및 식균지수로 나타내었다. 나아가 돌돔 말초혈액의 혈구조성에 미치는 영향을 조사하기 위하여 적혈구 5,000 세포당 임파구, 전구, 호중구의 수를 계수하였다. 8주간의 사육결과 사료계수는 각각 1.20, 1.25, 1.42로 대조구와 2% 첨가구는 큰 차이가 없었으나, 5% 첨가구는 나빠지는 경향을 보였다. 사료섭취량은 kelf meal의 첨가량이 늘어나면서 감소하는 경향이었다. 비특이적인 면역 기구에 대한 자극 효과는 체액성 면역의 지표로 측정한 lysozyme의 활성도는 혈청과 점액 모두에서 대조구보다 실험구에서 활성이 높았고, 혈청 lysozyme 활성은 5% 첨가구에서 가장 높았다. 혈청 내 보체의 살균능은 실험구간 차이가 없었다. 세포성 면역의 지표로 측정한 전신 식세포의 $O_2$ 생성능(NBT 환원능)은 5% 첨가구에서 가장 높았다. 말초 혈액의 식균능은 식균율과 식균지수 모두 실험구에서 높았고, 특히 5% 첨가구에서 가장 높았다. 말초 혈액 혈구조성의 변화는 임파구와 전구의 경우 실험구에서 높았으나 호중구에서는 차이가 없었다. 이상의 결과, 양식 돌돔에 kelf meal을 2% 첨가하는 것이 사료계수에 큰 영향을 미치지 않고, 돌돔의 체액성 및 세포성 면역을 적절히 자극하는 것으로 나타나, 돌돔의 기능성 사료 첨가물로서 이용 효과가 있을 것으로 기대된다.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.16 no.2
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• pp.57-61
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• 2016

Isovaleric acidemia (IVA) is an autosomal recessively inherited organic acid disorder due to a defect of the enzyme isovaleryl-CoA dehydrogenase in the leucine metabolic pathway. Deficiency of this enzyme results in the accumulation of derivatives of isovaleryl-CoA. In acute illness in IVA, isovaleric acid and its derivatives accumulate and profound metabolic acidosis with ketosis, characteristic pungent body odor, hypoglycemia, and hyperammonemia can be developed. Additionally, recurrent vomiting, failure to thrive, developmental delay, epilepsy and mental retardation are chronic presenting symptoms and signs for IVA. On the result of newborn screening for inherited metabolic disorders, increased levels of isovalerylcarnitine (C5) are shown. However, C5 elevation can be accompanied with short/branched-chain acyl-CoA dehydrogenase (SBCAD) and therapy with certain antibiotics containing pivalic acid. Quantitative measurement of organic acids in urine and acylcarnitine profiles in plasma are necessary to differential diagnosis. Molecular genetic analysis of the IVD gene for IVA and ACADSB is also helpful to confirm IVA and SBCAD deficiency, respectively. Considering that IVA can be associated with significant morbidity and mortality at acute presentation of metabolic crisis, early diagnosis prior to the onset of symptoms by newborn screening enable to introduction of early treatment and prevention of acute and chronic complications.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.630-636
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• 1996

Bronchiolitis obliterans organizing pneumonia(BOOP) is a pathologic entity characterized by the formation of plugs of fibrous tissue in bronchioles and alveolar ducts. It clad been described in association with several connective tissue diseases, i.e. systemic lupus erythematosus, Behcet's disease, polymyositis-dermatomyositis, polymyalgia rheumatica and Sjogren's syndrome. Recently, there were few additional reports on BOOP, anteceded by rheumatoid arthritis. We clad experienced a case of 60 years old female patient who clad been admitted for acute respiratory difficulty and abnormal chest roentgenographic findings. She was diagnosed as having rhematoid arthritis 20 years ago. On the course of our treatment, she did not respond to antibiotics. Moreover, no microorganism grew in the sputum and blood. Thus, the bronchoscopic biopsy was done. The patient showed a dramatic response to steroid therapy, and the pathologic bindings of the bronchoscopic biopsy confirmed as BOOP. To our knowledge, this is the first reported case of BOOP anteceded by rheumatoid arthritis in Korea.