BACKGROUND: An intensive and ongoing surveillance program is effective for preventing the hospital infections. but it is time-consuming to detect all cases of hospital infections. So, labratory-based surveillance was performed with the aid of personal computer. The software 'MICRO' that coded and used privately was written in FoxPro 2.0 code. METHODS: All results of the microbiologic culture were stocked in the software and hospital infections were detected by review d an positive microbiology reports and daily ward rounds with examination of patient progress notes. If there was any suggestion or evidence of outbreak of hospital infections the data were analyzed by the 'MICRO' and reported to hospital infections control committee. RESULTS: We detected the outbreak of nosoccmial pneumonia due to a putative single species of methicillin-resistant Staphylococcus aureus in the neurosurgical ward at May, 1996. The suggestive outbreak of wound infections in the 7th ward at April, 1966 was denied by the 'MICRO'. The possible outbreak of 10th ward at May, 1996 was detected. CONCLUSIONS: We describe a surveillance method that identifies excessive rates of positive culture on patient location culture site, and organism indentification using the 'MICRO'. We were able to monitor patient-to-patient cross-infections and possible breakdowns in proper technique, and expect suggestive outbreak of infections early. These results demonstrate that computer analysis of positive culture rates by 'MICRO' is a sensitive and time-efficient method for detecting potentially preventable hospital infections.
Cross Infection* ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Microcomputers* ; Pneumonia ; Wound Infection

No abstract available.
HLA-DR Antigens*

BACKGROUND: The Amplified Mycobacterium tuberculosis Direct Test (AMTDT) has been developed for the direct detection of M. tuberculosis complex in respiratory specimens. Traditional methods for diagnosis of extrapulmonary tuberculosis such as the acid-fast bacilli (AFB) stain have their well-known limitations. We investigated the usefulness of the AMTDT for a wide range of non-respiratory specimens to establish early diagnosis of extrapulmonary tuberculosis. METHODS: 346 specimens (219 urine, 117 pleural fluid, 6 ascitic fluid, 2 lymph node, 1 gastric aspirate, and 1 pus specimens) from 340 patients referred from November 1997 to September 1998 were tested by the AMTDT. The AMTDT results were evaluated by comparing with clinical diagnosis and smear results. RESULTS: The overall sensitivity, specificity, and positive and negative predictive values of the AMTDT were 82.9%, 93.8%, 64.2%, and 97.6%, respectively. There were no difference in sensitivity and specificity between pleural fluid and urine specimens. In 31 specimens from tuberculosis patients concurrently tested with AMTDT and stain, 15 were only AMTDT positive and 4 were only stain positive. Among the results considered to be false positive, 47.2% of cases were shown as being less than 150,000 relative light units (RLU). In 30 specimens from tuberculosis patients during or after treatment, all six of the patients with reactivation or aggravation were AMTDT positive, and one case was considered to be false positive. CONCLUSIONS: Our study demonstrates the efficacy of the AMTDT in diagnosing extrapulmonary tuberculosis. Prudent interpretation of the AMTDT's results is recommended in case of that being less than 150,000 RLU.
Ascitic Fluid ; Diagnosis ; Early Diagnosis ; Humans ; Lymph Nodes ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Suppuration ; Tuberculosis

Five medical students in the fourth-year took anatomy as their elective courses for 1 month. They dissected one cadaver, and investigated Digital Report, under the course subjects as follows; (1) the shape of thyroid gland and the location of its isthmus, (2) the branches of left and right coronary arteries, (3) the number of blood vessels and bronchi on the hilum of lung, (4) topographical relationship of the renal vessels and ureter, and the shape of the renal pelvis, (5) the location and attachment of the appendix, (6) the penetration of median nerve through the pronator teres, (7) the sensory nerves and the extensor tendons on the dorsum of hand, (8) the branches of deep femoral artery. The pancreatic and live samples were processed and stained with H&E, for LM observation, since the individual had suffered from pancreatic cancer and got a Pylorus preserving pancreatico-duodenectomy (PPPD). At the last step of the elective course, students wrote small articles following the conventional method for writing manuscript. From the viewpoint of professor, the anatomy course for the fourth-year students were definitely different from that for first-year students, and had many positive effects in terms of anatomy education.
Appendix ; Blood Vessels ; Bronchi ; Cadaver ; Coronary Vessels ; Education ; Femoral Artery ; Hand ; Humans ; Kidney Pelvis ; Lung ; Median Nerve ; Pancreatic Neoplasms ; Pylorus ; Students, Medical* ; Tendons ; Thyroid Gland ; Ureter ; Writing

Diagnoses of cystic lesions in the pancreas are increasing in clinical practice because of the wider use of imaging studies. The selection of appropriate treatment depends on the ability to distinguish between benign and malignant cysts. However, cystic pancreatic neoplasms sometimes misdiagnosed as pseudocysts, and managed incorrectly. We report herein the case of a pancreatic mucinous cystadenoma, misdiagnosed as a pseudocyst and managed by internal drainage. A 36-year-old woman initially had a cystojejunostomy under the diagnosis of a pseudocyst, but subsequently suffered from epigastric pain and fever due to cyst infection. A distal pancreatectomy, encompassing the previous cystojejunostomy anastomosis site, was performed 2 years after the initial operation and a mucinous cystadenoma was confirmed by histopathologic examination. Although pseudocysts are predominantly cystic lesions in the pancreas, cystic neoplasms should be considered before deciding the treatment strategy because the misdiagnosis a cystic neoplasm as a pseudocyst may result in serious problems.
Adult ; Cystadenoma, Mucinous* ; Diagnosis ; Diagnostic Errors ; Drainage* ; Female ; Fever ; Humans ; Mucins* ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms ; Pancreatic Pseudocyst*

BACKGROUND: Topoisomerase II (topo II) is a major target of anthracyclines and epipodophyllotoxins for anticancer treatment. The expression of topo II is low in drug resistant cell lines. High levels of glutathione S-transferase (GST)pi have been associated with emergence of cell lines resistant to alkylating agents or adriamycin. METHODS: By immunostaining with paraffin embedded bone marrow tissues, the expression of topo II alpha and GSTpi was investigated in 51 patients with acute myeloid leukemia (AML), and the relation of topo II alpha and GSTpi expression to treatment response in 29 patients with AML following induction chemotherapy was also evaluated. RESULTS: Topo II positive cells varied from less than 1% to 60% of leukemic cells and 20 (39.2%) were negative for topo II (positive cells<10%). Treatment response following chemotherapy was not related to topo II. 26 (51.0%) were positive for GSTpi. GSTpi expression was related to treatment resistance of the patients following chemotherapy. In the patients who showed both topo II alpha negative and GSTpi positive, the frequency of treatment resistance following chemotherapy was high. CONCLUSIONS: This study suggests that immunostaining of topo II alpha and GSTpi with the bone marrow paraffin sections of AML patients can be useful to predict the treatment response following chemotherapy and that further study including more patients with prospective study may substantiate topo II alpha and GSTpi as multidrug resistant markers.
Alkylating Agents ; Anthracyclines ; Bone Marrow ; Cell Line ; DNA Topoisomerases, Type II* ; Doxorubicin ; Drug Resistance, Multiple ; Drug Therapy ; Glutathione S-Transferase pi* ; Glutathione Transferase* ; Glutathione* ; Humans ; Immunohistochemistry ; Induction Chemotherapy ; Leukemia, Myeloid, Acute* ; Paraffin ; Podophyllotoxin

Intestinal obstruction is a rare but important complication of pregnancy and puerperium leading to increased maternal and fetal motality. Diagnosis is often delayed or missed because many of the manifestations of intestinal obstruction such as nausea, vomiting and abdominal pain can be interpreted as pregnancy related symptoms. This delay in diagnosis or misdiagnosis, reluctance to surgery during pregnancy are thought to be responsible for the high maternal and fetal death rate. So we report a case of postpartum small bowel obstruction following vaginal delivery with a review of the literature.
Abdominal Pain ; Diagnosis ; Diagnostic Errors ; Fetal Death ; Intestinal Obstruction ; Nausea ; Postpartum Period* ; Pregnancy ; Vomiting

BACKGROUND: In the year 1996, there were some outbreaks of Salmonella typhi infection in Pusan and therefore, the incidence of S. typhi infection was markedly increased in comparison with the previous year. To differentiate the isolates epidemiologically, a random amplified polymorphic DNA(RAPD) fingerprinting method has been developed. METHODS: A total of 9 arbitrary primers were screened with S. typhi strains isolated in Pusan, 1996. This allowed selection of a panel of primers capable of detecting DNA polymorphisms among S. typhi isolates. This panel was used to examine 54 strains of S. typhi, which had been isolated in Pusan including the cases of outbreaks that was previously characterized by phage typing. RESULTS: Four single primers and one combination of two primers were selected to discriminate the S. typhi isolates. RAPD analysis resolved the 54 strains into 20 different subtypes. At least two outbreaks were found by RAPD analysis. The isolates of E1 phage type, which are the most common in Korea, were perfectly differentiated with each other, except the strains isolated within the outbreaks. CONCLUSION: The RAPD approach is the useful epidemiologic tool to S. typhi subtyping, which is providing high discriminatory power. There were at least two outbreaks when the epidemic Salmonella infections of Pusan in 1996 had been occurred. The primers or their comb ination capable to discriminate the S. typhi isolates were described.
Animals ; Bacteriophage Typing ; Bacteriophages ; Busan ; Comb and Wattles ; Dermatoglyphics ; Disease Outbreaks ; DNA* ; Incidence ; Korea ; Molecular Typing* ; Salmonella Infections ; Salmonella typhi* ; Salmonella*

Adult T-cell leukemia/lymphoma (ATLL) is an often aggressive and fatal malignancy of mature CD4+ T lymphocytes, characterized by leukemia, lymphadenopathy, hypercalcemia and lytic bone lesions. Diagnosis of ATLL is based cm abnormal T lymphocytes in the peripheral blood and histologically and cytologically proven lymphoid malignancy with T cell surface antigens. Anti-HTLV-I serum antibodies and demonstration of clonality to HTLV-I proviral DNA are included. We report a case of ATLL in a 64-year-old man who had a painful nodule on the right cheek and multiple scattered papules and nodules on the trunk for 2 months. He had multiple cervical and axillary lymph node enlargements and hepatosplenomegaly. On laboratory finding peripheral leukocytes count was 33,400/mm3 with 63% atypical lymphocytes. Clover-shaped lyrnphocytes with multilobulated nuclei were found in peripheral blood and bone marrow. Histologic findings showed dense bandlike infiltrations of atypical lymphocytes in the dermis with angiocentricity. The surface phenotype of these abnormal cells were CD2+, CD3+, CD4+, CD30+ and HLA-DR+ and HTLV-I specific antibodies were found.
Adult* ; Antibodies ; Antigens, Surface ; Bone Marrow ; Cheek ; Dermis ; Diagnosis ; DNA ; Human T-lymphotropic virus 1 ; Humans ; Hypercalcemia ; Leukemia ; Leukemia-Lymphoma, Adult T-Cell* ; Leukocytes ; Lymph Nodes ; Lymphatic Diseases ; Lymphocytes ; Lymphoma* ; Middle Aged ; Phenotype ; T-Lymphocytes

BACKGROUND: Several risk factors related with vancomycin-resistant Enterococcus (VRE) colonization are well known, but the direct relatedness of the use of glycopeptides with VRE colonization is not confirmed yet. So we evaluated the influence of the use of glycopeptides and other variables, as risk factors on intestinal colonization with VRE. METHODS: In glycopeptide-administered inpatients group, multiple stool specimens were collected on the day of glycopeptides administration, and weekly after that, until VRE were detected. In the inpatients and outpatients control groups, stool were obtained with point survey. The specimens were inoculated on m-enterococcus agar with 6mg/L vancomycin. The phenotypes and genotypes of resistance of the VRE isolates were confirmed by disk diffusion and agar dilution tests, and polymerase chain reaction. RESULTS: Of the 361 patients(530 specimens), twelve VRE(3.3%) were isolated. The rates of intestinal colonizations were not significantly differed between the inpatients groups with or without glycopeptides administration, which are 5.1 and 4.1%, respectively. The colonization rates were significantly higher in the patients with 30 or more hospital stay, and in those with three or more antimicrobial administrations. vanA and vanC genes were amplified in the isolates. CONCLUSIONS: It is demonstrated that the use of glycopeptides is not a direct risk factor of intestinal colonization of VRE in Pusan National University Hospital, in which the prescription of glycopeptides is rigidly controlled. But, a shortened stay in the hospital will diminish the intestinal colonization of VRE.
Agar ; Busan ; Colon* ; Diffusion ; Enterococcus* ; Genotype ; Glycopeptides* ; Humans ; Inpatients ; Length of Stay ; Outpatients ; Phenotype ; Polymerase Chain Reaction ; Prescriptions ; Risk Factors* ; Vancomycin