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Biomedical subjects

C H Pai

Publications and source records attributed to C H Pai.

At least 19 recordsLinked to original sources
PubMed2003

Rhodococcus equi pneumonia in a heart transplant recipient in Korea, with emphasis on microbial diagnosis.

Rhodococcus equi is an opportunistic pathogen that usually causes infection in immunocompromised hosts. A heart transplant recipient who had been treated with amphotericin B for pulmonary aspergillosis showed newly developed multiple nodules with a central necrotic area in the right lower lobes. Cultures of several blood samples and an aspirate of the lung nodule yielded a Gram-positive coccobacillary bacterium, which was initially reported as a Corynebacterium species, but was later identified as R. equi by API CORYNE (bioMerieux SA, Marcy l'Etoile, France) and by demonstrating the production of 'equi factor'. The identification was subsequently confirmed by an R. equi-specific polymerase chain reaction (PCR). The patient was successfully treated with ciprofloxacin and azithromycin for 14 weeks. This is the first documented case of R. equi infection in Korea. There is a possibility of underestimation of R. equi infections due to the misidentification of the organism as a contaminating diphtheroid. Because R. equi will not respond to the conventional empirical therapy, the microbiology laboratory should identify R. equi in a timely manner. R. equi-specific PCR will be a useful confirmatory test in human infection.

Actinomycetales Infections↗
PubMed2001

Effect of shock wave therapy on acute fractures of the tibia: a study in a dog model.

The effect of shock wave therapy on acute fractures of the tibia was studied in eight adult dogs. A fracture with a 3-mm gap was created in both tibias and the fractures were fixed internally with a small metallic plate and screws. Each of the right limbs received 2,000 impulses of shock waves at 14 kV whereas the left limbs were used as controls. The evaluations included the callus formations based on serial radiographic examinations at 1, 4, 8, and 12 weeks and histologic examinations at 12 weeks for tissue distribution including bone tissues. Based on radiographic findings, there was no statistically significant difference in the amount of callus formation between the treated and the control groups at 8 weeks or less. However, the radiographic findings at 12 weeks statistically showed more callus formations in the treated group. In histologic examinations, there was significantly more cortical bone formation in the treated group at 12 weeks and the bone tissues were thicker, denser, and heavier. Shock wave therapy enhanced callus formation and induced cortical bone formation in acute fractures in dogs at 12 weeks. The effect of shock wave therapy seemed to be time-dependent at 3 months.

Animals↗
PubMed2000

Multicenter surveillance study for nosocomial infections in major hospitals in Korea. Nosocomial Infection Surveillance Committee of the Korean Society for Nosocomial Infection Control.

BACKGROUND: The goals of a surveillance for nosocomial infections (NIs) are to observe the magnitude and characteristics of NIs and to plan and evaluate policies and guidelines of infection control. This study was designed to determine the rate and distribution of NIs and their causative pathogens in Korean hospitals. METHODS: Prospective surveillance was performed at 15 acute care hospitals with more than 500 beds during a 3-month period from June to August 1996. The case-finding methods were laboratory-based surveillance for patients in the general wards and a direct review of medical charts done regularly for all the patients in the intensive care units. RESULTS: A total of 3162 NIs were found among 85,547 discharged patients, with an overall nosocomial infection rate of 3.70 per 100 patients discharged. Urinary tract infections constituted 30.3% of all NIs. Other infections were pneumonias, 17.2%, surgical site infections, 15.5%, and primary bloodstream infections, 14.5%. The infection rate was the highest in neurosurgery (14.21), followed by neurology (8. 62) and ontology services (6.70). The infection rate in intensive care units was higher than it was in the general wards (10.74 vs 2. 57, P =.001). The commonly isolated organisms were Staphylococcus aureus (17.2%), Pseudomonas aeruginosa (13.8%), and Escherichia coli (12.3%). CONCLUSIONS: This first multicenter surveillance study provided extensive information on the current status and trends of NIs in major hospitals in Korea. The results may contribute to the evaluation of infection control programs and the development of effective strategies in these hospitals.

Contact Tracing↗
PubMed2000

Extensor digitorum brevis rotational muscle flap for lower leg and ankle coverage.

BACKGROUND: Soft tissue reconstruction around the ankle has been a challenging problem. This article reports our experience using the extensor digitorum brevis muscle flap; some technical variations are discussed. METHODS: The extensor digitorum brevis muscle flap is vascularized by the well-defined lateral tarsal artery, a branch of the dorsalis pedis artery originating at the level of the inferior extensor retinaculum. This flap was used for coverage of soft tissue defects in the lower leg and the ankle in 10 patients with various injuries. RESULTS: All flaps survived completely. Complications included delayed healing of donor skin in two cases. Flap elevation was possible even in the traumatized donor foot. CONCLUSION: The advantages of this flap include constant and reliable blood supply, easy and rapid flap dissection, adequate bulk, and one-stage procedure. However, disadvantages include the small size of the flap and the sacrifice of the dorsalis pedis artery.

Adolescent↗
PubMed2000

Vancomycin-intermediate Staphylococcus aureus in Korea.

Recent reports on some methicillin-resistant Staphylococcus aureus (MRSA) with reduced susceptibility to vancomycin have been a major concern in Korea because of the widespread use of vancomycin due to a high prevalence of MRSA in the country. We describe a 45-year-old man with long-standing pelvic abscess due to MRSA. In spite of vancomycin and teicoplanin treatment for a long period of time, the patient died from MRSA sepsis. The blood culture isolate of MRSA exhibited reduced susceptibility to vancomycin (MIC, 8 microg/ml). This is the first report of a vancomycin-intermediate S. aureus case from Korea.

Abdominal Abscess↗
PubMed2000

In vitro activities of quinupristin/dalfopristin and eight other antimicrobial agents against 360 clinical isolates from Korea.

The emergence of multi-drug resistant gram-positive cocci such as methicillin-resistant (MR) staphylococci, vancomycin-resistant (VR) enterococci, and vancomycin-intermediate resistant S. aureus (VISA) has given new urgency to the development of new antimicrobial agents. One of these is quinupristin/dalfopristin (Q/D). We decided to determine the susceptibility of gram-positive cocci isolated at two university hospitals in Seoul to Q/D and compare the results with eight other antimicrobial agents. We investigated 120 isolates of S. aureus including 49 MRSAs and one VISA, 120 isolates of coagulase negative staphylococci (CNS), 64 E. faecalis and 56 E. faecium, including seven strains of VR E. faecium. Minimum inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs) for several antimicrobials, including vancomycin and Q/D, were determined by broth microdilution. All S. aureus including VISA were susceptible to Q/D. Q/D MIC90 for both methicillin-susceptible S. aureus (MSSA) and MRSA was 0.25 g/mL. 49 (87.5%) of 56 E. faecium including six of seven VR E. faecium were susceptible to Q/D. E. faecalis were not susceptible to Q/D (only 1.5% susceptible), but were inhibited by ampicillin (94% susceptible) or vancomycin (95%). CNS was susceptible to Q/D (96% susceptible) and vancomycin (100% susceptible). One of 38 staphylococci and two of 17 E. faecium were tolerant to Q/D. In conclusion, Q/D showed excellent activity against all species of gram-positive cocci including MRSA, VISA, and VR E. faecium except E. faecalis, and may provide a valuable option for the treatment of infections caused by these emerging nosocomial pathogens of gram-positive cocci.

Anti-Bacterial Agents↗
PubMed1999

Spread of drug-resistant Streptococcus pneumoniae in Asian countries: Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study.

Antimicrobial susceptibility of 996 isolates of Streptococcus pneumoniae from clinical specimens was investigated in 11 Asian countries from September 1996 to June 1997. Korea had the greatest frequency of nonsusceptible strains to penicillin with 79.7%, followed by Japan (65.3%), Vietnam (60.8%), Thailand (57.9%), Sri Lanka (41.2%), Taiwan (38.7%), Singapore (23.1%), Indonesia (21.0%), China (9.8%), Malaysia (9.0%), and India (3.8%). Serotypes 23F and 19F were the most common. Pulsed-field gel electrophoresis (PFGE) of 154 isolates from Asian countries showed several major PFGE patterns. The serotype 23F Spanish clone shared the same PFGE pattern with strains from Korea, Japan, Singapore, Taiwan, Thailand, and Malaysia. Fingerprinting analysis of pbp1a, pbp2x, and pbp2b genes of 12 strains from six countries also showed identical fingerprints of penicillin-binding protein genes in most strains. These data suggest the possible introduction and spread of international epidemic clones into Asian countries and the increasing problems of pneumococcal drug resistance in Asian countries for the first time.

Aminoacyltransferases↗
PubMed1998

Antimicrobial resistance in enterococci.

Enterococci have emerged as a major nosocomial pathogen and as an ever-increasing problem in antimicrobial resistance. They are ubiquitous in the intestinal flora of humans and animals and inherently resistant to a wide array of antimicrobial agents, and, more alarmingly, they seem to have a potential facility for acquiring new resistance determinants, including beta-lactamase production, high-level resistance to aminoglycosides, and recently, glycopeptide resistance. Collectively, all of these properties make enterococci one of most difficult nosocomial pathogens to treat and control today. The purpose of this review was to examine the epidemiology, the mechanisms, and laboratory detection of resistance of enterococci to the two major groups of antibiotics: aminoglycosides and glycopeptides.

Aminoglycosides↗
PubMed1996

Serum levels of interleukin-8 in alcoholic liver disease: relationship with disease stage, biochemical parameters and survival.

BACKGROUND/AIMS: Interleukin-8 (IL-8), a cytokine produced by a host of cells, including monocytes, macrophages, Kupffer cells and hepatocytes, can activate neutrophils. Peripheral neutrophilia and liver neutrophil infiltration are frequently noted in patients with alcoholic liver disease. However, the relationship between IL-8 and different stages of alcoholic liver disease is uncertain. The aim of this study is to determine if a correlation exists between circulating IL-8 levels and biochemical and histological parameters and survival in alcoholic liver disease. METHODS: Serum levels of IL-8 were determined with an enzyme-linked immunosorbent assay in 166 subjects, consisting of 30 healthy controls, 26 patients with non-alcoholic fatty liver, 15 with alcoholic fatty liver, 32 with alcoholic hepatitis, 30 with alcoholic cirrhosis, 28 with chronic hepatitis B and 5 with chronic hepatitis C. RESULTS: Serum IL-8 levels were markedly elevated in patients with alcoholic hepatitis (437 +/- 51 pg/ml) when compared with all other groups (p < 0.05). Levels of IL-8 in patients with alcoholic fatty liver, alcoholic cirrhosis and viral hepatitis were higher than those in controls and in patients with non-alcoholic fatty liver. In addition, IL-8 levels were higher in patients who died (p = 0.007), and correlated with biochemical and histological parameters, and severity of liver injury: serum aspartate aminotransferase, alanine aminotransferase, total bilirubin, prothrombin time, indocyanine green retention ratio, tumor necrosis factor-alpha and peripheral neutrophil count in patients with alcoholic hepatitis. After a 2-year follow up, patients with IL-8 above 479 pg/ml had a higher mortality rate in the alcoholic hepatitis group (p = 0.033). CONCLUSIONS: These findings suggest that IL-8 is activated in alcoholic liver disease, especially in alcoholic hepatitis, and is closely correlated with liver injury. IL-8 levels can reflect the stage and severity of alcoholic liver disease, and may serve as a predictor of survival in patients with alcoholic hepatitis.

Adult↗
PubMed1996

Dynamic condylar screw for subtrochanteric femur fractures with greater trochanteric extension.

Sixteen cases of subtrochanteric femur fractures with greater trochanteric extension were treated using the AO dynamic condylar screw (DCS). All cases were treated using the principles of strict indirect reduction to achieve anatomic alignment rather than anatomic reduction, with no bone grafting, and delayed weight bearing. The overall union rate was 93.7% (15 of 16). One unique case of implant failure with varus nonunion was encountered following repeat trauma. The advantages of the implant and technique are a simplified procedure, shorter operative time, and rapid union. Using the DCS with the indirect reduction method and delayed weight bearing is an acceptable choice in subtrochanteric femur fractures with greater trochanteric involvement when other adequate implants are not available for stable fixation.

Adult↗
PubMed1995

Short-course doxycycline treatment versus conventional tetracycline therapy for scrub typhus: a multicenter randomized trial.

To assess the clinical efficacy of short-course doxycycline in the treatment of scrub typhus, we compared conventional 7-day tetracycline therapy with 3-day doxycycline therapy in 116 patients. Patients were randomized to receive either tetracycline (500 mg four times daily; n = 50) or doxycycline (100 mg twice daily; n = 66) and were followed for 4 weeks after the completion of treatment. The cure rate was 100% in the tetracycline group and 93.9% in the doxycycline group (P > .05). The two groups did not differ significantly in terms of the interval required for defervescence or for the alleviation of symptoms. There were no relapses in either group. These data suggest that 3-day doxycycline therapy is as effective as conventional 7-day tetracycline therapy for the cure of scrub typhus and the prevention of relapses.

Adult↗
PubMed1995

Treatment of porto-systemic encephalopathy with lactitol verus lactulose: a randomized controlled study.

BACKGROUND: Lactitol (beta-galactosido-sorbitol), a novel disaccharide analogue of lactulose, has been suggested as an alternative to lactulose in the treatment of portosystemic encephalopathy (PSE) in Western country. In order to assess its therapeutic effect and adverse reaction in PSE in the Chinese, we conducted this study. METHODS: Forty-one patients with PSE were enrolled in this study. Patients were randomly divided into 2 groups to receive lactitol (n = 21) or lactulose (n = 20) for 5 days. The doses of both drugs were adjusted to keep daily bowel movement of 2 to 3 times. The PSE index (mental state, EEG, asterixis, number connection test [NCT], and ammonia) was evaluated in each patient before and after treatment. Daily doses of lactitol and lactulose, stool frequency, and side effect were recorded. RESULTS: The mean dose of lactitol used was 66.3 +/- 36.4 gm and that of lactulose was 56.9 +/- 32.1 ml of lactulose. The majority of patients (37/41) gained clear consciousness after 5 days' treatment. In the lactitol group, blood ammonia, EEG, NCT, asterixis, mental status and PSE index before treatment were 208 +/- 62 micrograms/ml, 2.9 +/- 0.8, 4.0 +/- 0.0, 2.7 +/- 1.5, 2.9 +/- 0.7 and 77.1 +/- 10.5, respectively. All parameters decreased significantly after 5 days' treatment (119 +/- 50 micrograms/ml, 1.1 +/- 1.0, 2.9 +/- 1.2, 1.7 +/- 1.1, 0.7 +/- 0.7, and 34.4 +/- 16.0, p < 0.05). The lactulose group had the similar results. However, the improvement of PSE index after therapy in the lactitol group was significantly higher than that in the lactulose group (42.7 +/- 19.3 vs 31.1 +/- 13.7, p < 0.05). In addition, more patients in the lactitol group than in the lactulose group (67% vs 20%, p = 0.003) favored the taste of their assigned drugs. No patient who received lactitol experienced any side effects; however, six patients treated with lactulose complained of meteorism and flatulence, and four complained of nausea. CONCLUSIONS: Both lactitol and lactulose are effective in the treatment of PSE, though the effect of lactitol seems slightly superior to that of lactulose in our study. Lactitol is more acceptable to our patients due to better palatability and less side effects. Lactitol is another good alternative in the treatment of PSE.

Aged↗
PubMed1995

Does coronary artery disease with stressed myocardial ischemia alter heart rate variability?

BACKGROUND: Research has shown that decreased heart rate variability (HRV) is independently associated with increased mortality after acute myocardial infarction. However, the relationship between HRV and myocardial ischemia still remains controversial. The purposes of this study were (1) to determine the relationship between HRV and atherosclerosis of the coronary artery; and (2) to determine the relationship between HRV and the extent of coronary stenosis in patients with stressed myocardial ischemia. METHODS: Forty-six patients, 41 males and 5 females, were included in this study. Ages ranged from 50 years to 79 years. Seventeen volunteers served as the control group, which was comprised of 15 males and 2 females of ages ranging from 40 years to 74 years. For each patient a left ventriculogram and a coronary angiogram were performed. According to their coronary angiograms, patients were divided into normal coronary artery group, atherosclerotic coronary artery group and significant coronary artery disease group. An ambulatory EKG was performed on each patient and volunteer. Heart rate variability was defined as SDNN, SDANN, rMSSD, and pNN50 in time domain measures; and low and high frequency in frequency domain measures. RESULTS: There were no significant differences in all variables of heart rate variability between the atherosclerotic coronary artery group and normal coronary artery group. In addition, there were no significant differences in all variables between the significant coronary artery disease group and the control group or between the significant coronary artery disease group and the normal coronary artery group. CONCLUSIONS: These studies have shown that atherosclerotic or significant coronary artery disease with stressed myocardial ischemia does not impair 24-hour heart rate variability.

Aged↗
PubMed1995

Measurements of heart rate variability in patients with unexplained syncope.

BACKGROUND: Syncope is a common clinical issue with complex and heterogenous etiologies. Research has shown a large proportion of syncope remained unexplained, even after serial investigations. Head-up tilt test with or without isoproterenol infusion could elicit a recurrence in most patients with unexplained syncope. Therefore, autonomically neural-mediated bradycardia and hypotension have been cited as the mainstays of the mechanism. Since the autonomic function can be reflected by heart rate rariability, this study proposed to determine 24-hour heart rate variability in patients with unexplained syncope. METHODS: Fifteen patients, 14 males and 1 female, who were defined as showing symptoms of unexplained syncope, were the subjects of this study. Their ages ranged from 38 years to 79 years. Seventeen healthy volunteers matching in age and sex served as the control group. For each patient and volunteer, 24-hour ambulatory electrocardiographic monitoring was done. Heart rate variability was defined as SDNN index, SDNN, SDANN, rMSSD, and pNN50 in time domain measures; and low, high, and total frequency in frequency domain measures. RESULTS: There was a significantly lower value at low frequency, high frequency, total frequency, rMSSD, and pNN50 in the syncope group than in the control group (p < 0.05). There was no significant difference in SDNN, SDNN index, SDANN and LF/HF ratio between these two groups. CONCLUSIONS: Patients with unexplained syncope had autonomic withdrawal; this was the case either in both sympathetic and parasympathetic components without changing the sympatho-vagal balance, or in purely parasympathetic component.

Adult↗
PubMed1994

Traumatic dislocations of the distal carpal row.

13 patients who sustained high-energy crush or blast injury of the carpal bones were reviewed after a mean follow-up period of 30 months. These complex injuries resulted in unusual disruptions of the distal carpal row and adjacent metacarpals. Frequent involvement of the carpometacarpal (CM) joints and violation of the proximal carpal row were also demonstrated. Nine were open injuries, with the majority accompanied by significant soft tissue damage. Treatment included either closed reduction or open reduction and Kirschner wire fixation, and soft tissue procedures as indicated. In this series, the majority of the open injuries gave unfavourable functional results despite adequate carpal alignment. Several cases had disastrous outcomes related to associated vascular injuries. Closed injuries, on the contrary, followed a relatively benign course. Nevertheless, decreased grip strength persisted in both groups for a long time. Patients with such a complex carpal injury should expect a less favourable prognosis due to the severe nature of the trauma.

Adolescent↗
PubMed1994

Detection of the H1-j strain of Salmonella typhi among Korean isolates by the polymerase chain reaction.

Salmonella typhi, the etiologic agent of typhoid fever, typically has only a phase-1 flagellar antigen, H1-d (fliC). While most strains of S. typhi have H1-d antigen, 10-20% of Indonesian isolates have been reported to possess H1-j antigen instead. To investigate the presence H1-j strains of S. typhi isolates in Korea, where typhoid fever is still a common infectious problem, we used the polymerase chain reaction (PCR) with a pair of oligonucleotides primers that specifically amplified the flagellin gene of S. typhi. Of 375 isolates of S. typhi tested, only one was shown to possess the H1-j antigen, which was shown by the presence of a 1,269-basepair fragment on agarose gel electrophoresis after the PCR. The isolate with the H1-j antigen was cultured from a Korean-Indonesian man who was already symptomatic in Indonesia and was thought to be an Indonesian strain. Because 375 strains tested in this study were collected from cases with typhoid fever in different regions of Korea during the period from 1986 to 1991, it could be concluded that the mutation rate to j antigen is negligible among S. typhi endemic in Korea.

Antigens, Bacterial↗
PubMed1994

Dupuytren's contracture: report of a Taiwanese case.

This case of Dupuytren's contracture was seen in a 65-year-old Taiwanese male farmer patient. The patient complained of a progressive inability to fully extend the ring and middle fingers of his dominant hand over the last three years. Clinically, a longitudinal cord-like mass surrounded the distal palmar crease of the hand and digital flexion contraction of the ring finger was more affected than the middle finger. Histopathologically, the excised tissue was of a mixed, moderate and scantily cellular type. After surgical treatment by limited fasciectomy, the patient's hand recovered fully. No recurrent contracture was noted after three years of follow-up.

Aged↗