Klebsiella ornithinolytica is a very rare type of Klebsiella species isolated from human and environment and is currently reported to be the cause of bacteremia. However, there have been no data on the clinical implication of K. ornithinolytica bacteremia.

We have analyzed 9 cases of K. ornithinolytica bacteremia diagnosed at Ewha Womans Medical Center from 2003 to 2006. All available clinical and microbial data were analyzed.

All 9 cases were community acquired. The causes of bacteremia were hepatobiliary disease(66.7%), Primary bacteremia(22.2%) and spontaneous bacterial peritonitis(11.1%). Underlying diseases were colon cancer, type 2 diabetes, hypertension and hepatobiliary disease. In 44.4% patients, there were no underlying diseases. Acute renal failure and shock occurred in 33.3% patients. All of the isolated strain were resistant to ampicillin, and only 1 case was resistant to cephalothin, piperacillin/tazobactam.

K. ornithinolytica bacteremia is commonly community acquired, especially in patients with hepatobiliary disease. Higher mortality was associated with acute renal failure and shock.

This study was performed to investigate the functional roles of hypoxia and HIF-1 α, leading to expression of VEGF and FGF in the pathogenesis of endometriosis.

From September 2005 to february 2006, endometrial stromal cells were obtained from the patients with or without endometrosis at the Department of Obstetrics and Gynecology of Ewha Womans University Dongdaemun Hospital. These cells were cultured and treated with 100uM desferrioxamine (DFO) for 0hr and 2hr. After the extraction of total RNA, RT-PCR was performed and the expression level of HIF-1 α, VEGF and FGF mRNA were measured by β-actin as 1. Statistical analysis was performed by Wilcoxon signed rank test and Mann-Whitney U test (SPSS 12.0 version). A p value of 0.05 was considered as the limit for statistical significance.

Chemical hypoxia condition with DFO in normal endometrium results m the up-regulation of HIF-1 α, but it was significantly decreased in the eutopic endometrium of the patients with endometriosis. The expression of VEGF in normal control group was not changed, but it was increased in endometriosis group under chemical hypoxia. Hypoxia with DFO induced the overexpression of FGF in endometriosis group, compared that it was slightly decreased in normal endometrium.

Hypoxia and subsequent production of HIF-1 α might regulate angiogenesis by the expression of VEGF and FGF, that is related to the pathogenesis of endometriosis. However, further studies are warranted to confirm.

The piriformis syndrome appears to be more common because it is often underdiagnosed and undertreated. This syndrome is caused by compression or irritation of the sciatic nerve by the piriformis muscle as it passes through the sciatic notch. This entrapment neuropathy presents as pain, numbness, paresthesias, and associated weakness in the distribution of the sciatic nerve. In this article. we present the clinical symptoms, anatomy of the piriformis muscle, and the technique and result of the injection therapy with local anesthetics and steroid.

A 72-year-old woman presented with 7 days history of severe pain in the right buttock, hip, numbness of the right thigh. Previous management had included non-steroidal anti-inflammatory drug and physical therapy in local orthopedic clinic. Her past medical history was unremarkable. Her right side buttock was tender and discomfort was increased by right hip flexion, adduction and internal rotation with pain radiating to the anterior thigh. The her leg lenghts were equal, the strenght of right hip abductors and abduction was normal. Also low back range of motion and neurological examination were normal. Radiographs of the lumbosacral spine, pelvis and the hip joint were unremarkable. The she didn't respond to conservative treatment including physcal theraphy combined with the use antiimflammatory drugs, analgesics and muscle relaxants.

One week later she received an injection of 0.5% mepibacaine HCI 8cc and methyl-predanisolone(Depomedrol) 40mg into the medal right piriformis muscle. She reported that the 3 days after the injection, her right buttock pain had resolved and 7 days after the injection the pain resolved completely and she resumed normal activities and continued pain free.

We reviewed the literature on piriformis syndrome and its signs, symptoms and treat-ments. In an isolated piriforms syndrome, the major finding include buttock tenderness from the sacrum to the greater trochanter, piriformis tenderness on rectal or vaginal examination. The patient with piriformis syndrome usually does not have neurologic deficits Through complete history, physical and neurologic examinations, the other causes of low back pain and sciatica should be eliminated. Patients who do not respond to conservative therapy are candidates for local anesthetics and steroid injection. We injected methyl prednisolone 40mg and 0.5% mepibacaine HCl 8cc into the medial right piriformis muscle. 3 days after injection, her pains of right buttock and trochanter had resolved and 7 days after the injection, she resumed normal activites and consumed free. In order to improve the reliability of proper needle placement and allow for definite and treatment, EMG-assisted or MRI guidance may utilize.

Overactive bladder(OAB) is a symptom syndrome including urinary urgency with or without urinary incontinence, usually combined with frequency and nocturia. There are lots of reports concerning the first-line treatment for OAB, the treatment is still challenging. Extracorporeal magnetic innervation(ExMI) therapy have been known to be safe and effective immediately in stress urinary incontinence and OAB. The aim of this study was to assess the effect of suprapubic magnetic innervation therapy by arm-typed plate in patients with OAB.

The selected subjects were 32 patients diagnosed with OAB between the periods of April to September, 2007. Mean age was 48.3±10.7 years old, and there were 10 males and 22 females patients. Voiding diary, International Prostatic Symptoms Score(IPSS), quality of life(QOL) questionnaire were evaluated as assessment of voiding symptoms. The treatment was performed for 15 minutes, 2 times a week, for 6 weeks with ExMI by arm-typed plate(BioCon-2000. M-Cube, Korea). All of the evaluations were repeated immediately and 3 months after treatment.

The mean urgency episodes decreased from 13.2±1.81 times to 8.7±1.95 times immediately after treatment and 9.6±2.18 times at 12 weeks after treatment(p<0.05). At 6 weeks after starting treatment, the mean frequency decreased from 5.4±1.58 times to 3.6±1.37 times(p<0.05), but the mean frequency after 6 months was 4.3±1.72 times(p>0.05). Significant improvements immediately after treatment were noted in the frequency, urgency, and QOL in IPSS, which were maintained for 3 months(p<0.05). There were improvements in mean voided volume, but these were minimal.

The symptoms of OAB are highly prevalent and significantly affect the quality of life. Effective and prompt management of OAB should be implemented. Our datas suggested that the EXMI therapy by arm-typed plate has the favorable effect on OAB and it may be persist for at least 12 months. Further studies are needed to establish the long-term efficacy of EXMI therapy in patients with symptoms of OAB.

Primary cutaneous mucinous carcinoma of the eyelid is an adenocarcinoma of the eccrine glands. These tumor is a rare ocular adnexal neoplasm that has a predilection for the periorbital and scalp region. It is more common in men and occur primarily in 50-70 year-old age range. We present the occurrence, clinical and histological features, and management of this tumour in a old male, who could exclude the presence of primary mucinous carcinoma elsewhere by extensive systemic evaluation.

A 67-year-old male presented with a small nodular erythematous nontender left lower lid lesion, which had increased in size and pigmentation over four years. Pneumoconiosis was noted on preoperative chest CT, but it was correlated with his occupational history. Lymphatic involvement was not noted on physical examination. So he underwent wide local excision with frozen section control of the margins. Clear margin were achieved and the defect was repaired with a local rotation flap.

Histologic examination showed mucinous carcinoma of the eccrine glands. A whole body screening test(PET) was performed to excluded the presence of primary mucinous carcinoma elsewhere metastating to the eyelid, or any distant spread from the eyelid lesion. PET demonstrated mildly increased hypermetabolism in both lungs and hypermetabolic lymph nodes at both supraclavicular areas and mediastinum. But extensive systemic workup, including abdominal ultrasonography, upper and lower gastrointestinal endoscope, neck CT, and lung biopsyrevealed no other abnormal lesion. Immunohistochemical markers including CEA, S-100, CK-PAN, CK7, CK-20, TTF-l were also helpful in establishing the diagnosis of the primary cutaneous mucinous carcinoma of the skin. There has been no recurrence of tumor 2 months following excision.