Early and severe indirect hyperbilirubinemia as a manifestation of galactosemia.

Classic galactosemia results from mutations in the galactose-1-phosphate uridyl transferase gene and causes infants to present with jaundice after initiation of lactose containing formulas. Jaundice associated with galactosemia is often thought to have a prominent direct fraction. We report an infant with galactosemia who presented with severe jaundice from indirect hyperbilirubinemia and met criteria for an exchange transfusion within 48 h after milk ingestion.

Changes in external ear resonance after 3 types of surgery in the patients with chronic otitis media.

OBJECTIVE: This study was designed to identify the external ear resonance characteristics of patients with tympanic membrane perforation and to investigate subsequent changes in external ear resonance, depending on the length of the postoperative period and which of 3 different types of operation was performed: tympanoplasty with canal wall-up mastoidectomy, epitympanoplasty, and canal wall-down mastoidectomy. STUDY DESIGN AND SETTING: A total of 227 ears of 188 patients and 96 control ears comprised the study. We measured the gain and frequency of the first peak of external ear resonance with a real ear analyzer. RESULTS: Gain and frequency of the first peak recorded in the preoperative group did not differ from those of the control group. However, negative peaks appeared around 1 to 1.5 kHz in half of these ears. The gain increased markedly in all 3 postoperative groups. The canal wall-down mastoidectomy and epitympanoplasty groups showed significantly lower frequencies compared with the tympanoplasty with canal wall-up mastoidectomy and control groups, but there was no difference between them. The increased gain diminished over time, but the peak gain did not equalize with that of the controls, even after 15 months. CONCLUSIONS: Additional gain should be considered of around 1 to 1.5 kHz for hearing aid users with tympanic membrane perforation. Postoperative changes in external ear resonance should be expected in patients with chronic otitis media, suggesting that fine readjustments of the hearing aid may be necessary.

Changes in external ear resonance after ventilation tube (Grommet) insertion in children with otitis media with effusion.

OBJECTIVE: As otitis media with effusion is common in children, the effects of a ventilation tube should be taken into account in the prescription of hearing aids for children. In ears with a ventilation tube, the external auditory canal communicates directly with the middle ear space, and so the impedance of the middle ear may change. Consequently, this will affect external-ear resonance. The aim of this study is to observe the effects of the tympanic membrane perforations caused by the ventilation tube on external-ear resonance. We selected 30 ears with otitis media with effusion to measure external-ear resonance before and after ventilation tube insertion. We compared the external-ear resonance of a control group with that of the otitis media with the effusion group and two types of ventilation-tube groups, respectively. In the subjects who have otitis media with effusion, the average gain of the peak resonance was larger than that in the control group. After ventilation-tube insertion, the amplitude of the gain decreased to the same level as the control group, but a characteristic negative gain appeared around 1000 Hz in about half of all cases. This negative gain was observed more frequently in the ventilation tube with a larger diameter. The raised peak resonance gain in the otitis media with effusion group decreased to a level roughly the same as that of the control group after ventilation-tube insertion. Provision of an additional gain in the low frequencies around 1000 Hz should be considered for patients with a ventilation tube when prescribing hearing aids.

Infection status of dragonflies with Plagiorchis muris metacercariae in Korea.

Plagiorchis muris has been found in both house and field rats as well as in humans. The infection status of the second intermediate hosts of P. muris is prerequisite in understanding their biological features in an ecosystem. Six species of dragonflies were caught in a wide range of areas in Korea; and they were Sympetrum darwinianum, S. eroticum, S. pedomontanum, S. infuscatum, Pantala flavoscens, Calopteryx atrata, and Orthetrum albistylum speciosum. The occurrence of P. muris metacercariae in dragonflies was nationwide with various infection rates. The metacercarial burden of P. muris in the surveyed areas was the highest in S. eroticum followed by S. darwinianum, S. pedomontanum, and C. atrata. The highest infection rate by P. muris metacercariae was found in S. darwinianum followed by S. eroticum. The metacercarial burden was particularly heavy in the dragonflies found in Hamyang-gun and Kosong-gun, Kyongsangnam-do. It is, therefore, likely that dragonflies play a significant role as the second intermediate host in the life cycle of P. muris in Korea.

Surface ultrastructure of juvenile and adult stages of Centrocestus armatus.

Centrocestus armatus (Trematoda: Heterophyidae) develops rapidly and produces eggs at 3 days postinfection in albino rats. Excysted metacercariae are pear-shaped and concave ventrally, with 42-44 peg-like circumoral spines. The entire body surface is densely covered with scale-like serrated spines. On juveniles, serration of the tegumental spines is greatest in the middle of the ventral and dorsal surfaces, and decreases anteriorly and posteriorly. Ciliated sensory papillae are concentrated around the oral sucker. Several nonciliated sensory papillae (type II papillae) occur equidistantly on the acetabulum and are arranged in a linear symmetry on the dorsal surface. On adults, the serration of the tegumental spines decreases to 14-17 tips on the ventrolateral surface. The high density of tegumental spines on posterior half of the body and the distribution of type II papillae on dorsal surface are considered to be characteristic of C. armatus.

Plagiorchis muris: recovery, growth and development in albino rats.

Metacercariae of Plagiorchis muris, obtained from naturally infected dragonflies, Sympetrum eroticum, successfully established in 4-week-old albino rats up to 14 days post-infection (p.i.) but by day 28 p.i. the recovery rate had significantly decreased. The genital primordia in excysted metacercariae were differentiated into those of metraterm, Mehlis' gland, ovary and cirrus pouch, with the primordial testes appearing on day 1 p.i. The vitellaria and eggs in the uterus were present in flukes on days 2 and 4 p.i., respectively. Mature flukes were established in the lower part of the small intestine on day 5 p.i., with the peak of egg production occurring on day 14 p.i. Growth of the flukes continued up to day 28 p.i.

Surface ultrastructures of the third-stage larvae of Gnathostoma hispidum.

A scanning electron microscopic study was performed to observe the surface ultrastructures of the third-stage larvae of Gnathostoma hispidum. The early third-stage larvae (EL3) were collected from the viscera of Chinese loaches by the artificial digestion method. The advanced third-stage larvae (ADL3) were recovered from mice experimentally infected with EL3. Both larval worms were fixed with 2.5% glutaraldehyde, dehydrated in graded alcohol, dryed in critical point dryer, and coated with gold. The specimens were observed with a SEM (DS-130C). On the head bulb of both larval stage, the mouth had a pair of lateral lips of equal size and of half moon shape. Each lip had a couple of labial papillae and a small amphid located between the two papillae. The hooklets on the head bulb had single-pointed tips and curved posteriorly. The cuticular spines of EL3 were larger and more densely distributed in the anterior area (about 1.8 micron in length) and gradually decreased in size and number posteriorly. The cuticular spines in the anterior area of ADL3 were sharp-pointed and about 4.5 micron in length, and those in the middle area were about 1.75 micron. The velvety cuticular folds and dot-like cuticular spines were distributed in the posterior area. A cervical papilla was located between the 7th and 8th transverse striations. A dome-like body papilla was located at the posterior 1/4 of body. An ellipsoidal excretory pore was located between the 17th and 18th striations. From the above results, it is suggested that the characteristic SEM findings obtained from this study may be helpful on the species identification of larval Gnathostoma.

A human case of Plagiorchis muris (Tanabe, 1922: Digenea) infection in the Republic of Korea: freshwater fish as a possible source of infection.

A Korean man was found infected with Plagiorchis muris and 2 other intestinal trematodes, Echinostoma hortense and Metagonimus takahashii. No complaint of gastrointestinal discomfort due to these fluke infections was noted. The patient had a history of eating various kinds of freshwater fish caught from a small stream near his village. Freshwater fish collected from the stream were examined for trematode metacercariae by an artificial digestion technique. Unidentified metacercariae collected were administered to a Sprague-Dawley rat. One P. muris adult was recovered from the small intestine of the rat on day 8 postinfection. Thus, freshwater fish of the genera Liobagrus, Puntungia, and Odontobutis are a probable source of infection for this patient.

One human case of natural infection by Heterophyopsis continua and three other species of intestinal trematodes.

The third human case of natural infection by Heterophyopsis continua in Korea was found in Chinju, Kyongsangnam-do. The case was a 53-year-old man. He used to eat raw brackish and fresh water fish. After praziquantel treatment and purgation, H. continua were collected from the diarrheal stool together with Metagonimus yokogawai, Heterophyes nocens and Echinostoma hortense. His clinical complaints were indigestion, epigastric discomfort, poor appetite and fatigue. The complaints were considered rather due to heavy M. yokogawai infection.

Egg positive rates of Clonorchis sinensis and intestinal helminths among residents in Kagye-ri, Saengbiryang-myon, Sanchong-gun, Kyongsangnam-do.

Stools of the residents in a village in Saengbiryang-myon, Sanchong-gun, Kyongsangnam-do were examined for the eggs of intestinal helminths. In 1987, infection rate of 76 residents by Clonorchis sinensis was 80.3% with mean eggs per gram of feces (EPG) 27,781. C. sinensis-infected persons were treated once with praziquantel 60 mg/kg, q.i.d. Seventeen persons (22.4%) infected by Metagonimus yokogawai was coinfected with C. sinensis. In 1993, C. sinensis egg positive rate was 48.4% with mean EPG 5,929. Reinfection rate of follow-up cases by C. sinensis was 55.2% during 5 years and 5 months. Infection rate by M. yokogawai was 3.2%. This village was an endemic focus of clonorchiasis occurring reinfection high.

Intestinal trematode infections in the villagers in Koje-myon, Kochang-gun, Kyongsangnam-do, Korea.

An epidemiological study for the intestinal trematode infection of the villagers was done in Koje-myon, Kochang-gun, Kyongsangnam-do, Korea in March, 1994. Of 116 stool specimens examined, total helminthic ova positive cases were 13 (11.2%) and cumulative ova positive cases 21 (18.1%): Echinostoma hortense 11 cases (9.5%), Metagonimus sp. 6 cases (5.2%), and Clonorchis sinensis 4 cases (3.4%). After the treatment and purgation, variable numbers of E. hortense, 6 to 227 per person, were collected from 7 echinostome egg positive cases, together with M. takahashii in 6 cases. Three adult flukes of E. cinetorchis were collected from one person and one Stellantchasmus falcatus was recovered from another case. This mountainous village was proved to be one of the endemic foci of echinostomiasis in Korea.

Liver function in Clonorchis sinensis-infected rabbits.

Nine rabbits were fed with Clonorchis sinensis metacercariae (MC) and the blood samples chronologically obtained were analyzed biochemically. Rabbits infected by less than 100 flukes were grouped into Group I, and by 100-250 flukes into Group II. The serum level of alanine aminotransferase (ALT) was increased from 3 weeks after the infection of the metacercariae (AIM) and showed a peak at 8 weeks, and decreased from 12 weeks AIM. The serum level of aspartate aminotransferase (AST) was raised to 92.3 +/- 65.4 U/L at 3 weeks AIM and stayed high until 8 weeks, then lowered thereafter. The serum level of gamma-glutamyl transpeptidase (gamma-GT) was increased rapidly to the highest value (18.9 +/- 14.6 U/L) at 16 weeks AIM, and decreased to the control level after 20 weeks. The serum level of alkaline phosphatase (ALP) was headed down from the early infection to 52 weeks AIM. The serum cholesterol level was increased from 8 weeks and reached at a peak 16 weeks AIM, and decreased thereafter to the control level. It is suggested that serum ALT, AST, ALP and gamma-GT tests be useful to diagnose the early infection of C. sinensis.

[Worm recovery rate and small intestinal lesions of albino rats coinfected with Fibricola seoulensis and Metagonimus yokogawai].

Worm recovery rates and pathologic changes in small intestine of albino rats were observed after concurrent and challenge infections with metacercariae (MC) of Fibricola seoulensis and Metagonimus yokogawai, and compared with those of single infection groups. Albino rats in concurrent infection group were killed 20 days after feeding with 1,000 MC of each fluke. Rats in challenge infection group were fed with 1,000 MC of F. seoulensis and challenged by 1,000 MC of M. yokogawai 10 days after primary infection, then killed 10 days thereafter. In concurrent infection group, mean number of F. seoulensis and M. yokogawai recovered, 250 and 118 respectively, were similar to those of single infection groups. However, more flukes were collected from the duodenum and less flukes were from the ileum than from single infection group. In challenge infection group, the recovery rate of F. seoulensis was similar to that of single infection group and the distribution of the flukes was similar to that of concurrent infection group. Mean number of M. yokogawai, 69, was significantly lower than that of single infection group. Its distribution, however, extended to the duodenum and most of the flukes were recovered from the jejunum. In concurrent infection group, villi of the duodenum were more markedly thickened, fused and shortened than those in F. seoulensis single infection group. The crypt epithelium appeared to be hyperplastic and inflammatory cell infiltration into the villous stroma was mild. Villous atrophy in the jejunum and ileum was milder than in M. yokogawai single infection group. In challenge infection group, the findings were similar to those of concurrent infection group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study on the effectiveness of modified Kato's cellophane thick smear and Stoll's dilution egg counting technique for quantitative fecal examination of helminth eggs].

A total of 197 fecal specimens was prepared for quantitative examination of helminth eggs by modified Kato's cellophane thick smear (M.C.T.S.) and Stoll's dilution egg counting technique (D.E.C.T.). The comparative effectiveness of two techniques was evaluated and conversion function was deduced. The average time required for the microscopic examination on one slide by M.C.T.S. was 12.6 minutes and that of D.E.C.T. was 14.6 minutes. M.C.T.S. showed lower false negative rate than D.E.C.T. in light worm burden cases. Functions to convert the counts obtained by M.C.T.S. to E.P.G. by Stoll's dilution egg counting technique were 47.86 x 10(0.87) logM.C.T.S. in A. lumbricoides, 41.69 x 10(0.82) logM.C.T.S. in T. trichiura and 63.10 x 10(0.85) logM.C.T.S. in C. sinensis. It was suggested M.C.T.S. be better than D.E.C.T. for the quantitative examination of intestinal helminthiases such as A. lumbricoides, T. trichiura, and C. sinensis infections even in the cases with low worm burden.

[Intestinal parasite infections among inhabitants in two islands of Tongyeong-gun, Kyeongsangnam-do].

This study was performed to evaluate the status of intestinal parasitic infections among the inhabitants in two islands (Chu-do and Doomi-do) of Tongyeong-gun, Kyeongsangnam-do (Province), from August to September, 1989. A total of 189 stool specimens was collected from the inhabitants of 3 villages and examined by Kato's cellophane thick smear and formalin-ether sedimentation techniques. Stoll's dilution egg counting technique was done for the quantitative examination of helminth eggs. The overall positive rate of intestinal parasites was 30.2%. The egg positive rate of Ascaris lumbricoides was 2.1%, that of Trichuris trichiura 24.3%, hookworm 2.1%, Trichostrongylus orientalis 0.5%, Clonorchis sinensis 1.1%, heterophyid 1.6%, and Taenia species 2.6%. The cyst positive rate of Giardia lamblia was 1.6% and that of Entamoeba coli 0.5%. In T. trichiura infection, the egg positive rate of females (29.9%) was much higher than that of males (17.2%). Among the age groups, 10-19 year group showed the highest infection rate, 32.4%. It was revealed that the prevalence of intestinal parasitic infections among the inhibitants of remote islands should be still high in comparison with ever-reported ones in urban or rural areas.

[Study on Centrocestus armatus in Korea. I. Infection status of Zacco platypus and Z. temminckii with the metacercariae of C. armatus].

This study was performed to observe the infection rate and infection intensity of fresh water fish such as pale chub (Z. platypus) and dark chub (Z. temminckii) with the metacercariae of C. armatus. The fish were caught in several rivers and streams from June to September, 1988 and examined by artificial digestion technique. Total 370 fish were caught at 19 rivers. The metacercarial (C. armatus) infection rate and average burden in Z. platypus were 86.8% and 224, and those in Z. temminckii were 78.5% and 131. The infection rate and burden per fish were 73.4% and 32 in the fish caught from the Han river, and 88.0% and 44 from the Youngsan river. All fish caught from the Keum and the Tamjin river were infected and their mean metacercarial density was 45 and 59 respectively. The infection rate and density in fish caught from the Seomjin and Nagdong rivers were 100% and 119, and 81.0% and 348 respectively. From this study, it is confirmed that C. armatus is widely distributed along 5 major rivers in Korea.

Study on Centrocestus armatus in Korea. II. Recovery rate, growth and development of worms in albino rats.

Some biological characteristics of Centrocestus armatus were studied using albino rats as its experimental host. The metacercariae were collected from Zacco platypus by artificial digestion method. Laboratory rats (Wistar) were fed each 100 or 200 metacercariae and sacrificed on 1, 2, 3, 4, 5, 6, 8, 14 and 28 days after infection to recover worms of various ages. The average recovery rate was 10.7% from 82 rats. The rate decreased rather slowly for the first 8 days but showed a steep decrease thereafter. Of the worms, 35.5% were recovered from the duodenum and 62.5% from the jejunum. At metacercarial stage, body length was 293 microns and body width 144 microns. At adult stage, the length and width reached 382 microns and 214 microns respectively at 14 days after infection. The testes and Mehlis' gland were recognized at metacercarial stage, whereas the ovarian analage appeared on the 1st day of infection, seminal vesicle and vitellaria on the 2nd day, and seminal receptacle and uterine eggs on the 3rd day. Until 8 days after infection the genital organs developed continuously and the number of uterine eggs increased. The above results show that albino rats are one of useful experimental hosts for C. armatus and the worms can develop to adults in 3 days after infection.