No abstract available.
Alopecia* ; Tissue Expansion Devices*

BACKGROUND: We evaluated the effectiveness of isolation measures using cohorting rooms and antimicrobial use in reducing the isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Acinetobacter baumannii (MDR-AB). METHODS: Four cohorting rooms (16 beds) for patients colonized or infected with multidrug-resistant organisms (MDRO) have been created in the general wards of our 894-bed hospital since October 2003. We prospectively evaluated the isolation rates of MRSA and MDR-AB, and amount of antimicrobial use during the 8-year study period. We also investigated the relationship between antimicrobial use density (AUD) and the isolation rates of MRSA and MDR-AB. RESULTS: After creating cohorting rooms, the isolation rates of MRSA decreased from 1.56 cases per 1,000 patient-days from 2004-2005 to 1.24 from 2006-2007 (P=0.57). The isolation rates of MDR-AB also decreased from 0.72 from 2004-2005 to 0.36 from 2010-2011 (P<0.01). The mean quarterly AUDs of glycopeptides and carbapenems were 30.17+/-6.80 and 19.5+/-7.10, respectively. There were no significant correlations between AUD values and the isolation rate of MRSA or MDR-AB. CONCLUSION: This study suggests that isolation measures using cohorting rooms to help limit the transmission of MDRO infection and colonization, especially MDR-AB, in resource-limited settings is feasible and efficacious.
Acinetobacter ; Acinetobacter baumannii ; Carbapenems ; Cohort Studies ; Colon ; Drug Resistance ; Glycopeptides ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Patient Isolation ; Patients' Rooms ; Prospective Studies

OBJECTIVE: Incidence of chronic subdural hematoma (CSDH) is gradually increasing in young adults for several reasons. In this study, we aimed to identify features of CSDH noted in young adults that distinguish the disease from CSDH diagnosed in the elderly. METHODS: One hundred eighty-two patients with CSDH who underwent a total of 218 surgical procedures between January 2003 and February 2010 were retrospectively reviewed with regard to clinical presentation, radiographic results and prognosis including recurrence. To compare younger patients with the elderly, patients were divided into three groups on the basis of age (Group A: < or =40, Group B: 41-64, Group C: > or =65 years). RESULTS: Group A showed a male predominance (p=0.0001), lower rate of recurrence (p=0.0012), shorter symptom duration (p=0.035), and fewer leading signs such as hemispheric symptoms (p=0.005) compared to Groups B and C. Radiologic findings such as maximal hematoma thickness (p<0.0001) and degree of midline shift (p=0.028) were less severe in Group A than Groups B and C. Alcoholism was the most prevalent illness in all three groups. When exempting infants with hematologic malignancy, non-recurrence, previous trauma history, headache as leading symptom, and no mortality were all common in younger adults (all p<0.05). CONCLUSION: Young adults with CSDH show less severe clinical and radiologic features as well as fewer recurrences than noted in the elderly population. Even if a clinician's index of suspicion of CSDH in young adults complaining of headache is not high, meticulous radiologic surveillance could find CSDH, leading to satisfactory results including less frequent recurrence.
Adult ; Aged ; Alcoholism ; Headache ; Hematologic Neoplasms ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Incidence ; Infant ; Male ; Prognosis ; Recurrence ; Retrospective Studies ; Young Adult

Posterior interosseous nerve(PIN) syndrome is an entrapment of the deep branch of the radial nerve just distal to the elbow joint. It is caused by acute trauma or masses compressing the nerve. We report an unusual case of PIN syndrome with wrist drop caused by compression of the nerve by anomalous vascular leash. The patient has recovered with the surgical decompression of the offending vessels and arcade of Frohse.
Decompression, Surgical ; Elbow Joint ; Humans ; Radial Nerve ; Wrist

For the physical characterization of neutron beam, dosimetric measurements had been performed to obtain physical data of KCCH cyclotron-produced neutrons for clinical use. The results are presented and compared with the data of other institutions from the literatures. The central aixs percent depth dose, build-up curves and open and wedge isodose curve values are intermediate between that of a 4 and 6 MV X-ray. The build-up level of maximum dose was at 1.35 cm and entrance dose was approximately 40%. Flatness of the beam was 9% at Dmax and less than+/-3% at the depth of 80% isodose line. Penumbra begond the 20% line is wider than corresponding photon beam. The output factors ranged 0.894 for 6 x 6 cm field to 1.187 for 30 x 30 cm field. gamma contamination of neutron beam was 4.9% at 2 cm depth in 10 x10 cm field.
Cyclotrons ; Neutrons*

Vasospasm has been known as one of the most potent causes of delayed ischemic neurologic deficits (DINDs) after aneurysmal subarachnoid hemorrhage (SAH). An established effective therapy for vasospasm has been used in preventing cerebral ischemia. Nevertheless, several reports suggested the possibility that there may be other causes of DINDs from the cases which couldn't be explained by hemodynamic vasospasm. Authors experienced two cases of thromboembolic infarction as a cause of DINDs after aneurysmal SAH. We propose that thromboembolism can be a considerable cause of DINDs independent of hemodynamic vasospasm.
Aneurysm ; Brain Ischemia ; Hemodynamics ; Infarction ; Neurologic Manifestations ; Subarachnoid Hemorrhage ; Thromboembolism

OBJECTIVE: Recently, the definition of occult osteoporotic vertebral fracture has been established, and its clinical significance has come to our interest. We report the effect of early percutaneous vertebroplasty in occult osteoporotic vertebral fracture. METHODS: From January 2006 to January 2008, we performed percutaneous vertebroplasty for 50 levels in 47 patients. 21 levels (21 patients) of them were classified into occult osteoporotic vertebral fracture group, 29 levels (26 patients) were categorized into control group (not occult osteoporotic vertebral fracture) by the Pham T..s criteria. We obtained VAS score and measured the compression ratio at first hospital day and 1 day, 1 month, 3 months after procedure. RESULTS: There are noticeable improvements in VAS score. The mean VAS score at admission was 6.44 in occult group and 6.15 in control group, which changed 2.23 in occult group and 2.68 in control group after procedure. The compression rate was 1.008, 1.018, 1.016 in occult group and 0.862, 0.891, 0.881 in control group at admission and 1 month, 3 months after procedure. The conservative effect for vertebral height was higher than control group (p=0.011). CONCLUSION: Percutaneous vertebroplasty in occult osteoporotic compression fracture provided significant pain relief and conservative effect for vertebral height. It is probable that it can lower the rate of secondary adjacent vertebral compression fracture.
Fractures, Compression ; Humans ; Vertebroplasty

Gastroesophageal reflux disease (GERD) is defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. In the last decade, GERD has been increasing in Korea. Seventeen consensus statements for the treatment of GERD were developed using the modified Delphi approach. Acid suppression treatments, such as proton pump inhibitors (PPIs), histmine-2 receptor antagonists and antacids are effective in the control of GERD-related symptoms. Among them, PPIs are the most effective medication. Standard dose PPI is recommended as the initial treatment of erosive esophagitis (for 8 weeks) and non-erosive reflux disease (at least for 4 weeks). Long-term continuous PPI or on-demand therapy is required for the majority of GERD patients after the initial treatment. Anti-reflux surgery can be considered in well selected patients. Prokinetic agents and mucosal protective drugs have limited roles. Twice daily PPI therapy can be tried to control extra-esophageal symptoms of GERD. For symptomatic patients with Barrett's esophagus, long-term treatment with PPI is required. Further studies are strongly needed to develop better treatment strategies for Korean patients with GERD.
Antacids/therapeutic use ; Antidepressive Agents/therapeutic use ; Drug Therapy, Combination ; Gastroesophageal Reflux/surgery/*therapy ; Histamine Antagonists/therapeutic use ; Humans ; Muscle Relaxants, Central/therapeutic use ; Proton Pump Inhibitors/therapeutic use

Insulin autoimmune syndrome is an uncommon cause of hypoglycemia. According to the type of antibody, it can be classified as caused by insulin or insulin receptor autoantibodies. Generally, insulin autoimmune syndrome develops following exposure to exogenous insulin or sulfhydryl medications, although insulin or insulin receptor antibody may also occur spontaneously. We treated a 54-year-old woman who developed spontaneous hypoglycemia. The patient had repeated hypoglycemia despite the infusion of dextrose solution. Her serum insulin, c-peptide, and insulin autoantibody were elevated, even during the hypoglycemic periods. Insulin receptor autoantibody and HLA-cw4/B62/DR4 were positive. After steroid and diazoxide treatment, the hypoglycemic symptoms improved gradually. No further hypoglycemic episodes occurred after tapering the medication over 1 year. We present a case of insulin autoimmune syndrome with positive insulin and insulin receptor autoantibodies.
Autoantibodies ; C-Peptide ; Diazoxide ; Female ; Glucose ; Humans ; Hypoglycemia ; Insulin ; Middle Aged ; Receptor, Insulin

Submucosal tumors in the gastrointestinal tract are covered with a mucous membrane such as the surrounding tissue. Therefore, the use of endoscopic biopsy to diagnose submucosal tumors is not as effective as that for epithelial tumors. Although imaging tools such as ultrasonography or computed tomography have made great advances, it is still difficult to diagnose submucosal tumors before resection. The surgical resection of tumors is the most accurate diagnostic method, yet less invasive endoscopic resection has been preferred in recent years. We report herein on a rare case of ganglionueroma arising from the Ampulla of Vater and this lesion was incidentally found during performance of routine esohagogastroduodenoscopy. The lesion was diagnosed as a ganglioneuroma, and it was successfully removed through endoscopic resection.
Ampulla of Vater ; Biopsy ; Ganglioneuroma ; Gastrointestinal Tract ; Mucous Membrane