In determining the effects of strabismus surgery, it is very important to know where the reattachment site of an extraocular muscle following recession procedure is located. Undercorrections or overcorrections after muscle surgery have been thought to be due to a postoperative positional changes of reattachment site along the surface of the globe. The author performed this experimental study to evaluate the amounts of changes of reattachment site after recession procedure in rabbit with 4 different methods of scleral fixation;direct suture with 6-0 vicryl, hang-back suture, application with Tisseel and Histoacryl. Superior rectus recession was performed in all 40 rabbit eyes, 10 eyes in each group. The distance from limbus to proximal end of recessed superior rectus muscle was measured on day 1, 2, 3, 5 and 7 postoperatively. Further measurements were followed at 2, 3, 4 and 8 weeks after recession procedure. The muscles were found an average of 0.4mm posterior to the intended position in direct suture group and 0.5 mmin hang-back suture group at one week postoperatively. But in the other two groups in which tissue adhesive agents, Tisseel and Histoacryl were used, the amount of displacement of the reattachment site were minimal of within 0.1 mm. From this experimental study, it is suggested that the positional changes of the reattachment site after recession procedure may influence the surgical corrective effects for strabismus.
Enbucrilate ; Fibrin Tissue Adhesive ; Muscles ; Polyglactin 910 ; Strabismus ; Sutures ; Tissue Adhesives

No abstract available.
Hemangioma, Cavernous*

BACKGROUND: Even after pneumococcal vaccination introduction, Streptococcus pneumoniae (pneumoccocus) is still an important cause of respiratory and invasive severe infection. Pneumococcus is resided in nasal mucosa and local or systemic infection begins with the nasal mucosa damage. We studied the indirect effect of pneumococcal conjugate vaccine (PCV) on pneumococcal nasopharyngeal carriage rates, serotypes and antimicrobial susceptibility between vaccinate and non-vaccinated children. MATERIALS AND METHODS: From January 2010 to October 2010, 379 healthy children under 5 years old from three university hospitals were recruited. Fully vaccinated children over 3 time doses of PCV and children with no vaccination history of PCV were enrolled, and nasopharyngeal aspirations were obtained from these children. Serotypes using multibead serotyping assay with multiplex PCR and antimicrobial susceptibility was analyzed. Antimicrobial susceptibilities were determined by the CLIS guideline. RESULTS: Two hundred seventy six children were received pneumococcal vaccination while 103 were not. 137 pneumococci were isolated from nasopharyngeal aspiration specimens. Nasal carriage rate was significantly low in vaccinated group (P-value; 0.001). Nasopharyngeal carriage rate was 28.6% (79/276) in vaccinate group and 56.3% (58/103) in non-vaccinated group. Among those vaccinated group, 13.0% (36/276) of the serotypes were vaccine or vaccine related type with the most common type 19F. In contrast, 31.1% (32/103) of the serotypes in non vaccinated group were vaccine or vaccine related type with the most common type 6A. The resistant rate of penicillin was 90.5%. For antimicrobial susceptibility, amoxicillin and amoxicillin/clavulanate showed high susceptibility (73.0%), but 19F and 19A serotypes were all resistant against amoxicillin. CONCLUSIONS: High nasopharyngeal carriage rate in non vaccinated group corresponded to the result of past study. However, 19F and 19A still came up as problematic serotypes with a high carriage rate and antimicrobial resistance in both vaccinated and non vaccinated groups. Also, this study showed that the resistance rate of primary oral antimicrobial agents was increased in compared to past. For solving these problems, the selective antimicrobial use with establishment of high dose amoxicillin/clavulanate regimen and active PCV immunization should be needed. Furthermore, pneumococcal carriage and serotype study concerning with antimicrobial susceptibility should be conducted in the future in 10 or 13-valent PCV received children.
Amoxicillin ; Anti-Infective Agents ; Aspirations (Psychology) ; Child ; Hospitals, University ; Humans ; Immunization ; Multiplex Polymerase Chain Reaction ; Nasal Mucosa ; Penicillins ; Porphyrins ; Serotyping ; Streptococcus ; Streptococcus pneumoniae ; Vaccination

BACKGROUND: A web-based surveillance of surgical-site infections (SSIs) in Korean Nosocomial Infections Surveillance System (KONIS) was performed to determine the incidence of SSIs after 15 operative procedures. METHODS: Forty-three hospitals participated in the surveillance system for 15 operative procedures. A year-round observation was carried out, and the duration of participation was shortened for 3 months unit. All data were collected using a real-time web-based reporting system. RESULTS: From July 2010 through June 2011, SSI surveillance data of 18,644 cases were collected from 43 hospitals. SSIs were found to occur in 2.10% of the total cases. The SSI rates after various surgeries were as follows: 4.49%, rectal surgery; 4.41%, colon surgery; 3.50%, gastric surgery; 3.12%, craniotomy; 1.25%, abdominal hysterectomy; 0.93%, laminectomy; 0.63%, cesarean section; 0.62%, gallbladder surgery; and 0.54%, vaginal hysterectomy. The interim results of implant-related surgery are given below as SSI rates: 3.78%, ventricular shunt operation; 3.23%, coronary artery bypass graft; 2.20%, cardiac surgery; 1.31%, spinal fusion; 0.96%, knee prosthesis; and 0.88%, hip prosthesis. CONCLUSION: The SSI rate was found to be 2.10% by the KONIS 2010. The maintenance of a surveillance system for SSI is very important, as it will help in decreasing SSIs via feedback to the involved surgeons and infection-control personnel.
Colon ; Coronary Artery Bypass ; Cross Infection ; Female ; Gallbladder ; Hip ; Hysterectomy, Vaginal ; Incidence ; Knee ; Surgical Procedures, Operative

No abstract available.
Aged ; Bone Neoplasms/diagnosis/*secondary ; Carcinoma, Hepatocellular/diagnosis/etiology/*secondary ; Diagnosis, Differential ; Female ; Fractures, Bone/*diagnosis ; Hepatitis B, Chronic/*complications ; Humans ; Liver Cirrhosis/complications ; *Liver Neoplasms/diagnosis/etiology ; Osteoporosis/complications ; Pelvic Bones/*injuries

BACKGROUND: A nationwide prospective multicenter study was performed in Korea to determine the incidence and risk factors for surgical site infections (SSI) after craniotomies (CRAN), ventricular shunt operations (VS), gastric operations (GAST), colon operations (COLO), rectal operations (RECT), hip joint replacements (HJR), and knee joint replacements (KJR). METHODS: We collected data regarding demographics, clinical and operative risk factors for SSI, and antibiotics administered to the patients who underwent CRAN in 18 hospitals, VS in 19 hospitals, GAST in 19 hospitals, COLO in 19 hospitals, RECT in 19 hospitals, HJR in 24 hospitals, and KJR in 23 hospitals between January and December 2009. All the data were collected using a real-time web-based reporting system. RESULTS: The SSI rate of CRAN, VS, GAST, COLO, RECT, HJR, and KJR was 3.68 (22/1,169), 5.96 (14/235), 4.25 (75/1,763), 3.37 (22/653), 5.83 (27/463), 1.93 (23/1,190), and 2.63 (30/1,139), respectively, per 100 operations. The only significant risk factor for SSI after CRAN was postoperative cerebrospinal fluid leakage. The independent risk factors for SSI after GAST were multiple procedure, reoperation, infection of other sites, and transfusion. In HJR, the duration of preoperative hospital stay and operation time were longer, and the need for general anesthesia, transfusion, and steroid use and the incidence of contaminated/dirty wound, obesity, and infection of other sites were significantly increased in the infected group. In KJR, the duration of preoperative hospital stay was longer and the need for reoperation was significantly higher in the infected group, and in addition, the incidence of SSI was higher among males. CONCLUSION: The maintenance of surveillance on SSI is very important because surveillance provides valuable information to the surgeon and infection control personnel, which in turn helps decrease the incidence of SSI.
Anesthesia, General ; Anti-Bacterial Agents ; Colon ; Craniotomy ; Demography ; Hip Joint ; Humans ; Incidence ; Infection Control ; Knee Joint ; Korea ; Length of Stay ; Male ; Obesity ; Reoperation ; Risk Factors

Good's syndrome (GS) is a rare cause of acquired combined B- and T-cell immunodeficiency in adults. GS is also known as a rare form of paraneoplastic syndrome of thymoma that may persist after thymectomy. Some reported GS cases have been related to various diseases as a result of humoral immunodeficiency, but no report to date has related GS to cytomegalovirus (CMV) retinitis in Korea. We report two cases of CMV retinitis as a manifestation of GS with severe cellular immunodeficiency. In the first case, a 61-year-old woman was diagnosed with GS manifesting as CMV retinitis combined with coincident pulmonary tuberculosis and soft-tissue tuberculosis. In the second case, a 56-year-old man had CMV retinitis and CMV pneumonia. Both patients had a history of thymoma and had received total thymectomies, and were diagnosed with GS a few years thereafter.
Adult ; Cytomegalovirus ; Cytomegalovirus Retinitis ; Female ; Humans ; Immunologic Deficiency Syndromes ; Korea ; Middle Aged ; Paraneoplastic Syndromes ; Pneumonia ; Retinitis ; T-Lymphocytes ; Thymectomy ; Thymoma ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND/AIMS: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are predominantly known as medication-induced diseases. However, at our institution, we have experienced more cases of non-drug-related SJS and TEN than expected. Therefore, we studied the difference between non-drug-related and drug-related SJS and TEN in terms of clinical characteristics and prognoses. METHODS: The etiologies, clinical characteristics, and treatment outcomes for 82 adult patients with SJS and TEN were retrospectively reviewed. RESULTS: A total of 71 patients (86.6%) were classified as having SJS, and the other 11 patients (13.4%) were classified as having TEN. Drug-related cases were more common (43, 52.4%) than non-drug-related cases (39, 47.6%). Anticonvulsants (12/82, 14.6%) and antibiotics (9/82, 11%) were the most common causative medications. Anemia (p = 0.017) and C-reactive protein of > or = 5 mg/dL (p = 0.026) were more common in the drug-related cases than in the non-drug-related cases. Intravenous steroid therapy was used as the main treatment regimen (70/82, 85.4%). Of the 82 patients, 8 (9.8%) died during the clinical course. A univariate analysis for mortality showed statistical significance for the following: kidney function abnormality, pneumonia, hemoglobin of < 10 g/dL, and combined underlying diseases. In a multivariate analysis, only pneumonia was statistically significant (odds ratio, 25.79; p = 0.009). CONCLUSIONS: Drugs were the most frequent cause of these diseases. However, non-drug-related causes also contributed to a significant proportion of cases. Physicians should keep this in mind when documenting patient history. In addition, early recognition and treatment may be important for better outcomes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Epidermal Necrolysis, Toxic/diagnosis/*etiology/mortality/*therapy ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Republic of Korea ; Risk Assessment ; Risk Factors ; Stevens-Johnson Syndrome/chemically induced/diagnosis/*etiology/mortality/*therapy ; Survival Analysis ; Treatment Outcome ; Young Adult

BACKGROUND/AIMS: Frequent pathogens of nosocomial meningitis were investigated and the adequacy of empiric antibiotic therapy was assessed. Outcomes of nosocomial meningitis were also evaluated. METHODS: Ninety-one patients, who were diagnosed and treated for nosocomial meningitis at a single tertiary hospital in Daegu, Korea for 10 years, were included. Medical record and electronic laboratory data on the causative pathogens, antibiotics used, and outcomes were retrospectively investigated. RESULTS: Coagulase-negative Staphylococcus (40.9%) was the most common pathogen, followed by Acinetobacter (32.5%). Both were cultured as a single organism in cerebrospinal fluid (CSF). Seventy-eight patients (85.7%) had infections related to external ventricular drains (EVD). The most common empirical antibiotics were extended-spectrum beta-lactam antibiotics plus vancomycin (35/91, 38.6%). Of the 27 patients who had cultured Acinetobacter in CSF, 10 (37%) were given the wrong empirical antibiotic treatment. Seven of the 27 patients (26.9%) with cultured Acinetobacter died, and overall mortality of the 91 patients was 16.5%. In the multivariate analysis, the presence of combined septic shock (p < 0.001) and a persistent EVD state (p = 0.021) were associated with a poor prognosis. CONCLUSIONS: Acinetobacter is one of the leading pathogens of nosocomial meningitis and may lead to inadequate coverage of empiric antibiotic therapy due to increasing resistance. An EVD should be removed early in cases of suspected nosocomial meningitis, and carbapenem might be required for the poor treatment response.
Acinetobacter/classification/*isolation & purification ; Acinetobacter Infections/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Cerebrospinal Fluid/microbiology ; Cross Infection/cerebrospinal fluid/diagnosis/*microbiology/mortality/*therapy ; Drug Resistance, Bacterial ; Female ; Humans ; Logistic Models ; Male ; Meningitis, Bacterial/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology/mortality ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Staphylococcal Infections/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology/mortality ; Staphylococcus/classification/*isolation & purification ; Time Factors ; Treatment Outcome ; Young Adult

Objective: To identify the relationship between dysphagia, dietary level, and pulmonary function in post-stroke patients. Methods: Thirty-six post-stroke patients with dysphagia, who were hospitalized from June 2017 to October 2017 in the Department of Rehabilitation Medicine at a tertiary hospital, were analyzed retrospectively. The video-fluoroscopic swallowing study (VFSS) and videofluoroscopic dysphagia scale (VDS) were used to assess dysphagia. The vital capacity (VC) and peak cough flow (PCF) were used to assess the pulmonary function. Upon admission, the patients were divided into three groups according to their dietary level (tube feeding, dysphagia diet, and general diet). The correlation between dysphagia and pulmonary function was analyzed using an independent t-test test with the optimal points, and the relationship between the diet level and pulmonary function was evaluated using a one-way analysis of the variance. Results: Significant correlations between the pulmonary function and sub-items of VDS were found in “oral transit time” with VC, “vallecullar residue” and “aspiration” with PCF, and “triggering of pharyngeal swallow”, “VDS total score” with VC and PCF. The dietary levels upon admission had a significant correlation with VC and PCF. The VC among groups divided according to three diet levels showed statistically significant differences. Conclusion This study revealed the relationship between the pulmonary function and dysphagia in post-stroke patients. Moreover, the pulmonary function correlated with dietary level, even though it was not confirmed that it affected dietary levels. The clinical importance of the pulmonary function in post-stroke patients with dysphagia should be emphasized. In addition, a large-scale study is needed to determine the correlation between the pulmonary function and swallowing difficulty