BACKGROUND: Urinary tract infections (UTIs) are the most frequent nosocomial infections and are frequently associated with indwelling urinary catheters. It is known that adherence to standard infection control measures for urinary catheters can reduce UTIs in hospitals. This study was performed to evaluate the effect of education in reducing catheter-related UTIs (CR-UTIs) in intensive care units (ICUs) of a university hospital. METHODS: CR-UTIs were prospectively monitored for all patients with indwelling urinary catheters in ICUs from July 2006 through December 2007. Recommendations based on previously known guidelines for catheter insertion, catheter management, and specimen collection to prevent CR-UTIs were formulated and educated in March 2007. Knowledge and adherence level were evaluated before and after educating healthcare workers about the recommendations using questionnaire. Changes in knowledge and adherence level before and after education were compared by Chi-square test. Changes in the rate of CR-UTIs and urinary catheter utilization ratios were also analyzed by Fisher's exact test. RESULTS: After education, knowledge level of and adherence level to most of the recommendations were improved significantly. The rate of CR-UTIs significantly decreased by 48% from 7.43/1,000 catheter-days before intervention to 3.87/1,000 catheter-days after intervention (P=0.02). CONCLUSION: Surveillance for nosocomial infections and education for standard infection control measures are very important in preventing CR-UTIs in ICUs.
Catheters ; Cross Infection ; Delivery of Health Care ; Humans ; Infection Control ; Critical Care ; Intensive Care Units ; Prospective Studies ; Specimen Handling ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract ; Urinary Tract Infections ; Surveys and Questionnaires

BACKGROUND: Adiponectin is an adipokine that regulates lipid and glucose metabolism and has been shown to have anti-inflammatory and anti-atherogenic effects. It also plays an important role in the development of cardiovascular disease (CVD). METHODS: This study evaluated the association between adiponectin 45T/G polymorphism and cardiovascular complication in type 2 diabetes in Koreans. RESULTS: The present study included 758 patients with type 2 diabetes. The distribution of the adiponectin 45T/G polymorphism was 3.56% (n = 27) for GG, 42.35% (n = 321) for TG, and 54.09% (n = 410) for TT in patients with type 2 diabetes. The prevalence of CVD was significantly higher in subjects with the GG + TG genotype compared to those with the TT genotype (17.5% vs. 9.8%, P = 0.002). The G allele was associated with a higher risk of CVD (P = 0.002). CONCLUSION: Our findings suggest that the adiponectin 45T/G polymorphism is associated with diabetic cardiovascular complication in type 2 diabetes.
Adipokines ; Adiponectin* ; Alleles ; Cardiovascular Diseases ; Genotype ; Glucose ; Humans ; Metabolism ; Prevalence

Pyogenic granuloma (lobular capillary hemangioma) is a very common benign vascular lesion that frequently appears as a red to purple colored papule or polypoid mass. Any cutaneous or mucous membrane surface may be affected, they are rarely found intravascular or subcutaneous area. A 67-year-old female presented with a single, 0.5x0.5 cm sized movable subcutanous nodule on the right arm. A biopsy specimen showed multilobulated angiomatous nodule consisted of proliferative capillaries with fibrous septum in the subcutaneous layer. The tumor cells were positive for CD31, CD34, vimentin and smooth muscle actin. The lesion was excised and pyogenic granuloma was given as diagnosis by histopathological evaluation. The Subcutaneous type of pyogenic granuloma is rare but it should be part of the differential diagnosis of solitary nodule of extremities.
Actins ; Aged ; Arm ; Biopsy ; Capillaries ; Diagnosis, Differential ; Extremities ; Female ; Granuloma, Pyogenic ; Humans ; Mucous Membrane ; Muscle, Smooth ; Vimentin

PURPOSE: To report a case of ocular surface squamous cell carcinoma with intraorbital extension in a patient with renal transplantation and long-term immunosuppressive therapy. CASE SUMMARY: A 59-year-old Korean male presented with a whitish mass in the medial limbus and conjunctiva of the right eye. The patient had undergone renal transplantation 17 years prior due to lupus nephritis and was on systemic immunosuppression with daily prednisolone (10 mg), tacrolimus (5 mg), and mycophenolate sodium (720 mg). The complete excision of the mass was performed and mitomycin C application and amniotic membrane transplantation on the excised area were combined. Histopathological examination revealed the mass was squamous cell carcinoma. There were no abnormal findings on the orbit computed tomography (CT). The patient was additionally treated with topical interferon alpha 2b 6 months postoperatively. One year later, a mass recurred at the same site in the right eye. The complete excision of the mass, mitomycin C application, cryotherapy, and amniotic membrane transplantation were performed. Orbit CT showed a 1.9 cm-sized intraorbital mass involving the medial rectus of the right eye. The orbital exenteration was performed and the intraorbital mass was histologically proven to be squamous cell carcinoma. CONCLUSIONS: Ocular surface squamous neoplasia in patients with renal transplantation and long-term immunosuppressive therapy should be monitored closely for the possibility of orbital invasion.
Amnion ; Carcinoma, Squamous Cell* ; Conjunctiva ; Cryotherapy ; Humans ; Immunosuppression* ; Interferon-alpha ; Kidney Transplantation ; Lupus Nephritis ; Male ; Middle Aged ; Mitomycin ; Orbit ; Prednisolone ; Sodium ; Tacrolimus

PURPOSE: Piezolith 3000(R) is one of the 3rd generation lithotriptors that uses double layered piezoelectric shock waves for the treatment of urinary stone. We evaluated the safety and effectiveness of the Piezolith 3000(R) lithotriptor and we compared it with the previous Piezolith 2300(R) lithotriptor. MATERIALS AND METHODS: We reviewed the records of 500 patients with urinary calculi who had been treated with extracorporeal shock wave lithotripsy (ESWL) from January 2002 to December 2003, but complete follow up data was available for only 385 cases. The distribution of stones, the success rate and the number of ESWL sessions according to the size and location of the stones, the auxiliary procedures and their complications were analyzed. RESULTS: There were 172 cases with renal stone and 213 cases with ureteral calculi. The success rate, defined as being stone-free or having asymptomatic residual fragments measuring 3mm or less, was 82.0% for the renal stones and 93.0% for the ureteral calculi. The overall success rate for all the calculi was 88.1%. The mean number of sessions was 3.6 for the renal stones and 2.3 for the ureteral calculi. The overall mean number of sessions was 2.8. All the treatments were performed without analgesia or sedation except for one child (5 years old) who was given oral sedation. Any serious complications or side effects such as renal hematoma were not observed. CONCLUSIONS: The Piezolith 3000(R) lithotriptor allows shorter treatment sessions and it has more comfortable positioning tools to focus on the stone. It also has the advantage of being anesthesia free and a lower morbidity rate (e.g. pain). Yet we couldn't find any difference of the success rate between the previous standard piezo-system and the Piezolith 3000 .
Analgesia ; Anesthesia ; Calculi* ; Child ; Follow-Up Studies ; Hematoma ; Humans ; Lithotripsy ; Shock* ; Ureteral Calculi ; Urinary Calculi ; Urinary Tract*

PURPOSE: The precise etiology and classification of nocturia in women is not enough. We evaluated age related changes and classified the type of nocturia by age in women. METHODS: We included 118 women 20 years or older with nocturia at least one time during night time. Subjects were divided into three groups by the age: group 1, under 40 years; group 2, 40 through 59 years; group 3, 60 years and above. The causes of nocturia and its pattern changed by age in women were evaluated using 3 days frequency volume chart. Nocturia was devided into three types: nocturnal polyuria, decreased nocturnal bladder capacity and mixed type. RESULTS: The mean age was 57.2+/-11.8 and the mean nocturnal frequency was 2.7+/-1.8. In all age group, noctural polyuria was the major cause for noturia (40.8%), followed by low nocturnal bladder capacity (23.7%). As a major cause of nocturia, there was a significant increase of the incidence of nocturnal polyuria in aged people: group 1, 32.4%; group 2, 41.0%; group 3: 47.6% (P<0.04). CONCLUSIONS: Nocturnal polyuria and decreased nocturnal bladder capacity are the major causes of nocturia in women. Nocturnal polyuria was the major cause of nocturia with age over 60 years old. In aged women, nocturnal polyuria should be considered as a main cuase of nocturia and treated based on these result.
Aged ; Female ; Humans ; Incidence ; Nocturia ; Polyuria ; Urinary Bladder

PURPOSE: We prospectively evaluated the surgical outcomes of single scrotal incision orchiopexy in children with a palpable undescended testis compared with the traditional two incision orchiopexy. MATERIALS AND METHODS: A total of 398 orchiopexies (292 children) were included and randomly assigned to the single scrotal incision orchiopexy group (Group I, 147 children, 201 testes) or the traditional inguinal incision orchiopexy group (Group II, 145 children, 197 testes). The final number of patients enrolled (excluding those lost to follow-up) was 107 children (146 testes) in group I and 105 children (141 testes) in group II. Success was defined as no complications, postoperative intrascrotal location of the testis, and no conversion to the traditional inguinal approach. Surgical outcomes and complications were compared between the two groups. Testicular location, complications, and subjective satisfaction rate were assessed at the follow-up evaluation at least 12 months postoperatively. RESULTS: The overall success rate in group I was 92.5% in 135 of 146 testes; the remaining 9 testes required conversion to traditional two incision orchiopexy. In group II, orchiopexy was successful in 136 of 141 testes (96.5%). The operation time and hospital stay were significantly shorter in group I (40.5+/-25.9 minutes, 2.1+/-0.8 days) than in group II (62.3+/-35.6 minutes, 2.5+/-0.7 days), respectively (p<0.001, p=0.03). Postoperative complications were found in two cases (hematoma, wound dehiscence) in group I and in one case (wound dehiscence) in group II; all cases with complications recovered with conservative care. The subjective rate of satisfaction with the cosmetic result was 96.6% in group I and 96.5% in group II (p=0.97). CONCLUSIONS: We conclude that single scrotal incision orchiopexy is a simple technique that is associated with a shorter operation time and hospital stay than the traditional method and that is more feasible cosmetically.
Child ; Cosmetics ; Cryptorchidism ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Orchiopexy ; Postoperative Complications ; Prospective Studies ; Scrotum ; Testis

PURPOSE: Transurethral resection of bladder tumor (TURBT) can be a challenging procedure for an inexperienced surgeon. We suggest an easy technique for TURBT, which we have named the "grasp and bite" technique. We describe this technique and compare its effectiveness and safety with that of conventional TURBT. MATERIALS AND METHODS: Monopolar TURBT (24-Fr Karl Storz) was performed in 35 patients who had superficial bladder tumors. After defining the tumor margin, the tumor and surrounding mucosa were grasped by use of a loop electrode and resectoscope sheath. With tight grasping, linear moving resection was performed. The patients' demographic, intraoperative, and postoperative data were analyzed between the conventional and grasp and bite TURBT groups. RESULTS: Of 35 patients, 16 patients underwent conventional TURBT (group 1), and the other 19 patients underwent grasp and bite TURBT (group 2). Both groups were similar in age, tumor multiplicity, size, anesthesia method, and location. Grasp and bite TURBT could be performed as safely and effectively as conventional TURBT. There were no significant differences in irrigation duration, urethral catheterization, postoperative hemoglobin drop, or length of hospital stay. No significant side effects such as bladder perforation, severe obturator reflex, or persistent bleeding occurred. There were no significant pathological differences between specimens according to the type of resection technique. CONCLUSIONS: The grasp and bite TURBT technique was feasible for superficial bladder tumors. It may be a good tool for inexperienced surgeons owing to its convenient and easy manner.
Aged ; Cystoscopy ; Electrodes ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Urinary Bladder/pathology/*surgery ; Urinary Bladder Neoplasms/pathology/*surgery ; Urologic Surgical Procedures/instrumentation/*methods

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

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