BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals in Korea. The overall rate of MRSA in hospitals in Korea was estimated over 60%. Recently hospital infections caused by MRSA are getting increased and problematic in Korea, Our hospital Seoul Paik Hospital, has been trying to solve this problem. We had not applied exact methods for hospital infection control. Therefore, we adapted strict methods under the control of hospital infection control committee (HICC) and assessed the effectiveness of these methods. METHODS: Every month, the number of MRSA isolates was collected and analyzed; the results of the analysis were reported to every ward. All wards were supplied with Microshild(R) (Johnson & Johnson, Australia), Clean N' Fresh(R) (Carroll, USA), and standard paper towels. Health care workers were regularly educated for hospital infection control. The use of antibiotics was controlled by the HICC. We compared MRSA isolation rate between before and after applying the strict infection control methods under the regulation of HICC. Mann-Whitney U test, one-way ANOVA, and Chi-square test were used for statistical analysis of the results. RESULTS: After restricting the uses of antibiotics, glycopeptides and carbapenems were prescribed 15% less (20.3 vs 17.3 DDD /1000 patient-days) and 35% less (9.3 vs 6.0 DDD /1000 patient-days) respectively, compared to before restricting antibiotics. Methicillin resistance rate was decreased from 78% to 69% compared to before the methods(p=0.02). The isolation rate of MRSA was reduced by 31-42% from 2.33 to 1.35-1.60/1000 patient-days compared to before adapting strict infection control methods (p=0.04-0.07). CONCLUSION: This study showed that applying the strict infection control methods in the hospital can be effective to reduce the isolation rate of MRSA.
Anti-Bacterial Agents ; Carbapenems ; Cross Infection* ; Delivery of Health Care ; Dichlorodiphenyldichloroethane ; Glycopeptides ; Infection Control ; Korea ; Methicillin Resistance ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus ; Seoul ; Staphylococcus aureus* ; Staphylococcus*

The efficacy of antibiotic prophylaxis in radical prostatectomy (RP) remains to be established. We retrospectively compared the occurrence of perioperative infections after RP between the 2 different antibiotic protocols. This study involved 428 cases of laparoscopic radical prostatectomy (LRP). After excluding patients who had no perioperative urine culture data, 313 consecutive patients who underwent LRP for prostate carcinoma were classified into 2 groups according to the duration of antimicrobial prophylaxis. To group 1 (153 patients), a second-generation cephalosporin was administered for less than 2 days, whilst the remaining 160 patients in group 2 were administered the drug for more than 2 days. The overall incidence of postoperative bacteriuria was 50.8%, being significantly higher in group 1 (56.9%) than in group 2 (45%). The incidence of surgical site infection (SSI) was significantly higher in group 1 (5.2%) than in group 2 (0.6%). Multivariate analysis revealed that old age, duration of antibiotics for more than 2 days, and duration of Foley catheter placement were independently associated with postoperative infectious complications (all, P < 0.05). Multivariate analysis revealed that duration of antibiotics for more than 2 days, duration of Foley catheter placement, and duration of surgical drain placement were independently associated with postoperative SSI (all, P < 0.05). The incidence of postoperative bacteriuria and SSI were higher in patients who received antibiotics for a short duration. Based on our results, we demonstrated that the outcome of postoperative infectious complications is dependent on old age, short antibiotic administration duration, and prolonged Foley catheterization. Prolonged drain placement is associated with SSI, whilst a longer duration of antibiotics use and prolonged Foley catheterization are associated with a decrease in the incidence of SSI.
Anti-Bacterial Agents ; Antibiotic Prophylaxis* ; Bacteriuria ; Catheters ; Humans ; Incidence ; Multivariate Analysis ; Prostate ; Prostatectomy* ; Retrospective Studies ; Surgical Wound Infection ; Urinary Catheterization

We experienced a case of fetal supraventricular tachycardia (SVT) with fetal ascites diagnosed at 29 weeks of gestation in 29 year-old primigravida woman. Transplacental fetal therapy with maternal oral antiarrhythmic agent (verapamil, diltiazem) resulted in restoration of normal fetal sinus rhythm and disappearance of fetal ascites. At birth, the infant did not show any cardiac arrhythmia and hydropic appearance.
Adult ; Arrhythmias, Cardiac ; Ascites* ; Diltiazem ; Female ; Fetal Therapies ; Humans ; Hydrops Fetalis ; Infant ; Parturition ; Pregnancy ; Tachycardia, Supraventricular* ; Verapamil

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a very rare hematological malignancy in children that is characterized by bruise-like skin lesions, with or without bone marrow involvement. Because the clinical course of BPDCN is highly aggressive and fatal in adults, allogeneic hematopoietic stem cell transplantation (HSCT) is recommended as the optimal treatment. Due to its rarity, the pediatric experience with BPDCN is limited and standard treatment has so far not been defined. We report a case of a 14-year-old boy with BPDCN involving the skin, bone marrow and lymph nodes. The patient was treated with high-risk group acute lymphoblastic leukemia protocol. He achieved a complete remission after induction chemotherapy and still maintains clinical remission without HSCT for 17 months after initial diagnosis.
Adolescent ; Adult ; Bone Marrow ; Child ; Dendritic Cells ; Diagnosis ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation ; Humans ; Induction Chemotherapy ; Lymph Nodes ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Skin

Pregnancy complicated by aplastic anemia is uncommon condition with the significant morbidity and mortality rates. the main complication to mother is hemorrhage due to thrombocytopenia and sepsis due to leukopenia and mortality rate in pregnancy complicated by aplastic anemia is more than 20%. But it remain controversy whether pregnancy play a pathogenic role in the development of the disease. We experienced a patient with severe aplastic anemia in pregnancy who was treated with supportive transfusion of red blood cells and platelets and so we present it here with brief review of literature.
Anemia, Aplastic* ; Erythrocytes ; Hemorrhage ; Humans ; Leukopenia ; Mortality ; Mothers ; Pregnancy* ; Sepsis ; Thrombocytopenia

PURPOSE: To investigate patients who had transrectal ultrasonography (TRUS)-guided prostate biopsy to define the role of the serum testosterone level in predicting prostate cancer risk and its association with a high Gleason score. MATERIALS AND METHODS: A total of 568 patients who underwent prostate biopsy were entered in this study. We divided the patients into two groups according to serum testosterone level (median level, 3.85 ng/ml): the high-testosterone group (n=285) and the low-testosterone group (n=283). Multivariate regression analysis was used to define the effect of age, prostate volume, serum prostate-specific antigen (PSA) level and PSA density, and serum testosterone level on the risk of prostate cancer and a high Gleason score. RESULTS: Baseline characteristics did not differ significantly between the two groups. Compared with the high-testosterone group, the low-testosterone group had a significantly higher prostate cancer incidence (38.9% vs. 29.5%, p=0.018). Factors associated with an increased risk of prostate cancer were increased age (odds ratio [OR]=1.08, 95% confidence interval [CI]=1.25-3.16, p=0.001), a high serum PSA level (OR=3.35, 95% CI=2.63-4.25, p=0.001), a low prostate volume (OR=0.183, 95% CI=0.11-0.30, p=0.001), and a low serum testosterone level (OR=1.99, 95% CI=1.25-3.16, p=0.001). Among these, only the serum PSA level was a strong predictor of high-grade prostate cancer (Gleason score > or =7) (OR=2.19, 95% CI=1.57-2.95, p=0.001). CONCLUSIONS: Patients with lower levels of serum testosterone had a higher risk of prostate cancer than did patients with high serum testosterone. Even though a lower serum testosterone level was a predictor of prostate cancer risk, it was not associated with an increased risk of high-grade prostate cancer.
Biopsy ; Cohort Studies ; Humans ; Incidence ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Risk Factors ; Testosterone

Rat hippocampal precursor cells isolated from hippocampi of embryonic day 16.5 (E16.5) rat embryos were found to proliferate in the presence of basic fibroblast growth factor. Addition of soluble neural cell adhesion molecule (NCAM) to these precursor cells reduced cell proliferation in a dose dependent manner and enhanced the induction of precursor cells' differentiation to the neuronal lineage. Given these findings that NCAM induces the differentiation of hippocampal precursor cells, we investigated possible effects of NCAM on the expression of basic helix-loop-helix (bHLH) transcription factors during the differentiation. Soluble NCAM upregulated the transcription of bHLH transcription factors, neurogenin1 and NeuroD, but decreased HES5. Western blot analysis showed that NCAM increased the expression levels of CaMKII, p-MAPK, GluR1 and NR1 but decreased p-STAT3. These results support a role for NCAM in the inhibition of proliferation and the induction of neural differentiation of hippocampal neural precursor cells, and act as developmental regulators of the bHLH families, ultimately leading to the generation of glutamatergic neural cell types in the differentiation of hippocampal precursor cells.
Animals ; Apoptosis/drug effects ; Cell Differentiation/*drug effects ; Cell Division/drug effects ; Cell Lineage/drug effects ; Cells, Cultured ; Helix-Loop-Helix Motifs ; Hippocampus/*cytology/*drug effects ; Neural Cell Adhesion Molecules/*pharmacology ; Neurons/cytology/*drug effects/metabolism ; RNA, Messenger/genetics/metabolism ; Rats ; Receptors, Glutamate/*metabolism ; Signal Transduction ; Stem Cells/cytology/*drug effects ; Transcription Factors/genetics/metabolism

A leukemoid reaction is usually associated with malignancies of the lung, stomach, and thyroid. In contrast, urothelial cell carcinoma is rarely associated with leukemoid reactions, with few cases reported over the past 30 years. Here, we describe a patient with urothelial cell carcinoma who exhibited a leukemoid reaction. The patient had an elevated white blood cell count and experienced a rapid and aggressive clinical course, terminating in death. For urothelial cell carcinoma patients exhibiting a leukemoid reaction, removal of the inciting tumor is the definitive treatment. However, considering the aggressive nature of these tumors, if the patient is unsuitable for radical surgical management, palliative chemotherapy should be considered.
Drug Therapy ; Humans ; Leukemoid Reaction* ; Leukocyte Count ; Lung ; Paraneoplastic Syndromes* ; Prognosis* ; Stomach ; Thyroid Gland

PURPOSE: To evaluate the functional changes, postop delirium and complications after cemented bipolar hemiarthroplasty for the femur neck fractures in patients aged around ninety. MATERIALS AND METHODS: Between May 1995 and April 2002, of the twenty seven patients, 17 who follow-up for at least one year were included in this study. Walking ability, activity of daily living, mental status, chronic illness, postoperative delirium and complications were evaluated retrospectively using Yoon's walking class, ADL scale, MMSE-K score, ASA classification, DSM IV respectively. RESULTS: The walking ability was decreased to 2.4 from 3.3 tendency of reliance in ADL scale was increased to 8.3 from 4.5, MMSE-K score was decreased to 15.9 from 21.7. There was no significant change in status of chronic illness. Postoperative delirium occurred in eight (47%) cases and all of them recovered completely. complications included bladder problem in eleven (66%) cases, temporary respiratory distress in two (12%) cases, hip dislocation in two (12%) cases, infection in one (6%) case. Overall thirteen (78%) cases were able to walk with supports. CONCLUSION: This study indicates that physicians treation femur neck fractures in patients aged around ninety must anticipate worsening of the functional changes more especially in regard to walking level, activity of daily living and mental status, little changes of chronic disease status, complete recovery of postop delirium and high complication rate
Activities of Daily Living ; Chronic Disease ; Classification ; Delirium ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Follow-Up Studies ; Hemiarthroplasty* ; Hip Dislocation ; Humans ; Retrospective Studies ; Urinary Bladder ; Walking

Trisomy 18, called Edward syndrome, occurs in about 3500-8000 births. It is much more common at conception, with about 95% of cases resulting in spontaneous abortion or stillbirth. Postnatal survival is poor, with the majority of patients dying in early infancy. Characteristic findings include cardiac malformations, mental retardation, growth retardation, a prominent occiput, micrognathia, clenched hands, and rocker-bottom feet, omphalocele. The prenatal sonographic findings of our case include delayed growth, omphalocele, wrist joint fixation, choroid plexus cyst, hydramnios and postnatal gross findings include growth retardation, omphalocele, wirst joint fixation, absence of radius, syndactyly, focal absence of phalanges and flexion deformities of fingers and toes. We report a case of prenatally diagnosed Edward syndrome, which is confirmed by chromosome analysis, with brief review of related literatures.
Abortion, Spontaneous ; Choroid Plexus ; Congenital Abnormalities ; Female ; Fertilization ; Fingers ; Foot ; Hand ; Hernia, Umbilical ; Humans ; Intellectual Disability ; Joints ; Parturition ; Polyhydramnios ; Pregnancy ; Radius ; Stillbirth ; Syndactyly ; Toes ; Trisomy ; Ultrasonography ; Ultrasonography, Prenatal ; Wrist Joint