BACKGROUND: This study investigated the effectiveness of reinforced contact precautions and active surveillance cultures (ASCs) in reducing the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections (HAIs). METHODS: A before- and after-experimental study was performed at the intensive care unit (ICU) in a university-affiliated hospital. Reinforced contact precautions were applied to all patients, and ASCs for MRSA were performed for newly admitted patients at the time of admission and once a week thereafter. The HAIs were investigated in accordance with the National Nosocomial Infections Surveillance (NNIS) definitions and compared before and after the interventions. The data were analyzed using descriptive statistics. RESULTS: The number of HAIs caused by MRSA decreased from 2.2 to 0.5 per 100 patients discharged (P=0.02) and from 3.6 to 1.0 per 1,000 patient-days (P=0.032). The number of overall HAIs decreased from 7.6 to 4.0 per 100 patients discharged (P=0.011) and from 12.7 to 7.3 per 1,000 patient-days (P=0.034). The invasive device-associated infections caused by MRSA and other pathogens decreased, but the decrease was not statistically significant. CONCLUSION: Reinforced contact precautions and ASCs were effective in decreasing both MRSA infections and overall HAIs in the ICU. Further, it was assumed that the incidence of device-associated infections would have decreased if the intervention period was extended.
Cross Infection ; Humans ; Incidence ; Critical Care ; Intensive Care Units ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus

BACKGROUND: Massive bleeding, inability to identify important landmarks and structures, and necessity for a blood transfusion have been the usual problems of hemangioma excision. OBJECTIVE: We introduce a CO2 laser excision technique as a surgical method for the treatment of hemangioma of the lips and demonstrate its benefits. METHODS: In 4 patients with nevus flammeus of hemiface and accompanying hemangioma of the lips, excision of the hemangioma was performed using a focused beam from a CO2 laser under local anesthesia. RESULTS: Excellent to good results were achieved with minimal blood losses in all patients. No or minimal post-operative pain and edema and no significant complications were observed. CONCLUSION:The CO2 laser excision technique is recommended since it renders less textural change, greater volume reduction, hemostasis and an overall good cosmetic outcome than defocused modes or conventional scalpel surgery.
Anesthesia, Local ; Blood Transfusion ; Edema ; Hemangioma* ; Hemorrhage ; Hemostasis ; Humans ; Lasers, Gas* ; Lip* ; Port-Wine Stain

No abstract available.
Humans ; Infant* ; Urinary Tract Infections* ; Urinary Tract*

OBJECTIVES: To determine the level of mRNA expression of various members of the matrix metalloproteinase and tissue inhibitors in uterine leiomyoma compared with unaffected myometrium. Materials & Method: 30 cases of portions of leiomyoma and myometrium were collected immediately followimg hysterectomy. Thirteen cases were from proliferative phase and seventeen were from secretory phase of menstrual cycle. The mean age was 43.7years old. The level of expression of mRNAs of interstitial collagenase, gelatinase, stromelysin, TIMP-1,-2,-3 was determined by reverse transcriptase-polymerase chain reaction(RT-PCR) and normalized to GAPDH(glyceraldehyde-3-phosphate dehydrogenase) mRNA. RESULTS: Myometrium and leiomyoma expressed all the members of above mentioned matrix metalloproteinase family and tissue inhibitors. Leiomyoma expressed a significantly higher level of stromelysin-3 during secretory phase, an extremely lower level of 92kDa gelatinase and a significantly lower level of TIMP-3. The immunohistochemical localization of TIMP-3 was smooth muscle cell and arteriole wall of myometrium and leiomyoma. CONCLUSIONS: The increased expression of stromelysin-3 in uterine leiomyoma compared with myometrium suggests that this MMP may be involved in the formation of a more fibrous extracellular matrix in leiomyoma. The extremely lower expression of 92kDa gelatinase of leiomyoma means that leiomyoma do not invade myometrium and forms a separated mass. Decreased expression of TIMP-3 of leiomyoma suggests that TIMP-3 is required for differentiation and homeostasis of extracellular matrix of normal myometrium and function as a suppressive role of tumor development
Animals ; Arterioles ; Extracellular Matrix ; Female ; Gelatinases ; Homeostasis ; Humans ; Hysterectomy ; Leiomyoma* ; Matrix Metalloproteinase 1 ; Matrix Metalloproteinase 3 ; Menstrual Cycle ; Mice ; Myocytes, Smooth Muscle ; Myometrium* ; RNA, Messenger ; Tissue Inhibitor of Metalloproteinase-3

No abstract available.
Acquired Immunodeficiency Syndrome ; HIV ; Humans ; Molluscum Contagiosum*

PURPOSE: Acute pyelonephritis of growing kidneys may result in renal scarring. TGF-beta, inflammatory cytokine, has been suggested to play an important role in promoting renal scarring through apoptosis, suppression of cellular proliferation and fibrosis. We observed the effects of a potent anti-inflammatory agent, methylprednisolone on apoptosis and renal scarring in experimentally induced acute pyelonephritic weaning rats. MATERIALS AND METHODS: To induce ascending pyelonephritis a saline solution containing Escherichia coli type ATCC No. 25922, pili-form (107 bacteria/mL) was infused into the bladder through the 16-guage silicone cannula for 48 hours to 102 three-week-old Sprague-Dawley rats (50-60g). Experimental groups were divided into three groups according to the treatment protocols, group I (ceftriaxone only, n=31), group II (methylprednisolone+ceftriaxone n=28), control group (n=43) was not treated. Histopathologic scores of inflammatory changes, fibrosis and tubular atrophy, the apoptosis index and TGF-beta1 expression score were observed at post-infection 1 and 3 week. Datas were analysed using ANOVA test and P value below 0.05 was interpreted as significant. RESULTS: The mortality rate (21.4%) of group II was not different to the control group (41.9%) and group I (32.3%). The inflammatory score of group II (0.8+/-0.87) at week 1 was significantly lower than those of the control group (2.3+/-0.87) and Group I (1.7+/-0.79) (P<0.05). Apoptosis index of group II (2.9+/-2.15) at week 1 was significantly lower than (10.0+/-0.95) and group 1 (8.3+/-2.53) (P<0.05). TGF-beta1 expression score of group II (0.8+/-0.72) at week 1 was significantly lower than those of the control group (1.9+/-0.68) and group I (1.8+/-0.60) (P<0.05). The fibrosis score of group II (1.1+/-0.10) at week 3 was significantly lower than that of the group I (1.8+/-0.83) (P<0.05). CONCLUSION: Combined treatment with methylprednisolone and ceftriaxone reduced inflammation, fibrosis, apoptosis and TGF-beta expression in acute pyelonephritic weaning rats, compared to ceftriaxone alone. Anti-inflammatory agent supplemented to antibiotics could prevent renal scarring more effectively.
Animals ; Anti-Bacterial Agents ; Apoptosis* ; Atrophy ; Catheters ; Ceftriaxone ; Cell Proliferation ; Cicatrix* ; Clinical Protocols ; Escherichia coli ; Fibrosis ; Inflammation ; Kidney ; Methylprednisolone* ; Mortality ; Pyelonephritis ; Rats* ; Rats, Sprague-Dawley ; Silicones ; Sodium Chloride ; Transforming Growth Factor beta* ; Transforming Growth Factor beta1 ; Urinary Bladder ; Weaning*

PURPOSE: Concentrations of prostaglandin(PG) in the central nervous system is very low in physiologic conditions and are known to increase in response to febrile convulsions. And, intracerebroventricular injection of prostaglandin E-2(PGE) in unanesthetized cats is accompanied by a rise in body temperature, a decrease in convulsions, and a modulation of the convulsive thresholds, but the possible physiological role of different PGs in induction, termination, and recurrences of seizure activity is not clear. We observed the change of PGE according to temperatures in first febrile convulsions, and the relationship between the recurrence of febrile convulsions and PGE. METHOD: In the present study, the body temperatures of patients with initial febrile convulsions were measured. Spinal taps were performed. All CSF samples were stored in a deep freezer at 30degrees C until the time of analysis and tested by Prostaglandin E2 [125I] assay system, Biotra Assays, Amersham Inc. Most children were treated with antipyretics immediately and tepid water massage. 105 patients with febrile convulsions could be studied for 36 months and the times of recurrence after first febrile convulsion during those period were measured. During febrile convulsions, no anticonvulsants were used. Based on 105 children with febrile convulsions, we analyzed the results. RESULTS: The results were as follows : The levels of PGE at temperature 38.4 degrees C, 38.5 degrees C temperature 39.4 degrees C, and temperature 39.5 degrees C were 27.7+/-21.0 pg/mL, 83.6+/-38.3 pg/mL, and 205.6+/-40.0 pg/mL. The levels of PGE during 3 months recurrence group were 79.1+/-15.8 pg/mL, those during 4-6 months recurrence group were 134.9+/-74.6 pg/mL, those during 7-9 months recurrence group were 118.9+/-39.9 pg/mL, those during 10-12 months recurrence group were 133.5+/-69.2 pg/mL, those during 13-18 months recurrence group were 106.5+/-106.4 pg/mL, those during 19-24 months recurrence group were 123.7+/-100.6 pg/mL, and those during 25-36 months recurrence group were 142.1+/-172.5 pg/mL. CONCLUSION: Significantly elevated concentrations of PGE in febrile convulsions were found and related to increased body temperature. In the recurrent groups of febrile convulsions, there was no relationship between PGE levels and recurrences time of febrile convulsions. It is not clear that increased PGE levels are, at least in part, to be related to recurrences of febrile convulsions. We think that more comprehensive research is needed to clarify the role of increased PGE in first febrile convulsion and the relationship to recurrences of febrile convulsions.
Animals ; Anticonvulsants ; Antipyretics ; Body Temperature ; Cats ; Central Nervous System ; Child ; Dinoprostone ; Humans ; Massage ; Prostaglandins E ; Recurrence* ; Seizures ; Seizures, Febrile* ; Spinal Puncture ; Water

Vasoseminal vesiculography was performed on 40 asymptomatic men. Considerable variability in the appearance of the normal adult seminal tract was seen. The average lengths of the left and right ampullae were 4.23+/-0.77cm and 4.09+/-0.78cm respectively. Most ampullaes (75%) began at the vesicular fundus; the remainder projected either slightly more lateral (18%) or medial (7%) to the fundus. The average lengths of the left and right vesicle were 3.21+/-0.61cm and 3.24+/-0.49cm respectively ; the average widths were 1.36+/-0.30cm and 1.36+/-0.27cm. Eighty-seven per cent of subjects had symmetric-appearing vesicles. The average lengths or the left and right ejaculatory duct were 12.7+/-0.27mm and 13.0+/-0.59mm respectively; the average widths were 1.9+/-0.59mm and 1.8+/-0.58mm. Two normal configurations were noted; straight (70% ) and curved (30%). All ducts appeared symmetric. Criteria for normality are presented and the radiographic techniques were reviewed.
Adult ; Ejaculatory Ducts ; Humans ; Male

BACKGROUND: While sleeping, humans frequently change their position; this is done to avoid direct and excessive pressure on the body surface, and is considered to be very important for the prevention of pressure sores. A patient who is under general anesthesia, however, cannot perform this reflex movement; maintaining the same position during an entire operation causes concentrated pressure on specific body surfaces, and this may result in complications such as allopecia, back pain, pressure sores and peripheral nerve damage. Because little is known about the relationship between surgical position and pressure on the body surface, position is in most clinical situations decided on the basis of experience and informed guesswork. In order to qualitatively and quantitatively determine weight-bearing areas, pressure on the body surface of patients was evaluated under general anesthesia. METHOD: Ten patients scheduled for elective surgery were selected for this study. They were all aged over 20 and ASA class 1. A mattress equipped with a force sensing resistor was placed on the operating table and used to determine pressure on the body surface. Pressure was measured before and after anesthesia was induced in the supine, lateral and prone position. The signal generated by this mattress was processed using an analogue-digital (AD) converter, then displayed as pressure distribution on a computer screen. Pressure points were compared qualitatively, and for quantitative measurement were digitally expressed. 'Pressure' here is mean pressure at each point calculated among ten patients. RESULTS: In the supine position, pressure was concentrated on the shoulder and sacral areas. Pressure distribution in these areas was 29.8% (shoulder) and 26.0% (sacral area) before anesthesia was induced, and 20.3% (shoulder) and 25.8% (sacral area) after induction. In the lateral position, the shoulder and trochanteric areas were identified as the main weight-bearing areas; pressure distribution was 11.2% and 8.1% before induction, and 21.6% and 15.3% after induction, respectively. In the prone position, the chest and abdomen were the main weight-bearing areas. Pressure distribution in the chest area was 30.8% before induction and 24.4% after. Operating table tilt in each surgical position also produced marked changes in pressure distribution. CONCLUSIONS: In each surgical position, weight-bearing areas were qualitatively and quantitatively determined before and after anesthesia.
Abdomen ; Anesthesia ; Anesthesia, General* ; Back Pain ; Femur ; Human Body* ; Humans* ; Operating Tables ; Peripheral Nerves ; Pressure Ulcer ; Prone Position ; Reflex ; Shoulder ; Supine Position ; Thorax ; Weight-Bearing

Hamartoma is a very rare congenital tumor. A few cases of hamartomatous pol yps in the stomach were reported. Most of harrurtomatous polyps in the stomach occur in patients of polyposis coli. We have experienced four cases of gastric hamartomatous polyps without polyposis coli. There are some differences between previously reported cases and ours. In our casee, the distribution of age is from fourth to ninth decade, men and women ratio is 1: 1. The number of polyps are one in three cases and two in one case. The size of polyps is from 5mm to 12 mm. The location of polyps are various, but most common in antrum. We have experienced four cases which were different from previously reported ones and report them with a brief review of literatures.
Adenomatous Polyposis Coli* ; Female ; Hamartoma ; Humans ; Male ; Polyps* ; Stomach