BACKGROUND: Influenza is a highly infectious viral illness. The epidemics of influenza occur from the late fall to the early spring nearly every year and are responsible for several hundred thousand death per year all over the world. Influenza vaccine is the primary method for preventing influenza and its more severe complications. The efficacy of influenza vaccination have been well known in developed countries. The influenza vaccination has been recommended as one of the tentative immunization schedule for indicated persons since 1997 in Korea. But there are still no available data about them, even though nearly 5 - 8 million doses of influenza vaccine were used in a winter season. PURPOSE: To assess the clinical efficacy of influenza vaccine against influenza-like illness(ILI) among Korean elderly(age over 65). METHODS: Primary study design - a prospective field trial. Study subjects and method - We prospectively observed the 1,488 vaccinee and 1,425 non-vaccinee in a community(Nonsan city) from November 1 1998 to March 31 1999. The vaccinee were those who randomly selected 100-200 per 13 sub-region(Myon) in Nonsan city, and the non-vaccinee were those who had not vaccinated until January 1999 among the Nonsan city elderly cohort. This cohort was consisted of 5,787 elderly(over 1/3 of total elderly population) who had ever visited the community health center or 13 public health offices in Nonsan city in 1998. We followed up these two groups two times-in January and April 1999 - by telephone survey. The questionnaire included the questions about the health behaviors, medical history, socioeconomic condition, medical security type, physical function status, medical facility utilization in the season, symptom and signs of influenza-like illness, number and type of the flu, hospitalization or not. We did throat swap to isolate the virus of 490 patient who had influenza -like symptoms in the same period. RESULTS: Influenza vaccination was significantly reduced the incidence of influenza -like illness(fever or chilling sensation and cough or sore throat) in the vaccinated. The preventive effect of influenza-like illness among influenza risk group was about 32%(95% CI, 20%-44%). The illness duration of main symptoms of influenza-like illness(fever, cough) was significantly shorter in the vaccinee. The consistency of the survey was noted quite high from the analysis of the result of test-retest(104 person). CONCLUSION: Influenza vaccination significantly reduced the incidence of influenza-like illness(32%) among elderly.
Aged ; Chungcheongnam-do ; Cohort Studies ; Community Health Centers ; Cough ; Developed Countries ; Health Behavior ; Hospitalization ; Humans ; Immunization Schedule ; Incidence ; Influenza Vaccines ; Influenza, Human* ; Korea ; Pharynx ; Prospective Studies ; Public Health ; Seasons ; Sensation ; Telephone ; Vaccination* ; Surveys and Questionnaires

BACKGROUND: Intravenous catheter-related complication among the hospitalized patients has been increasing recently in Korea, since many hospitals has tried to save expenses by replacing the foreign-made catheter with domestic-made intravenous catheter. We studied the incidence rate of catheter-related complication and compared the incidence of catheter-related complication between domestic-made and foreign-made ones. We also studied to elucidate whether the morphologic characteristics of the intravenous catheter will effect the incidence of catheter-related complication. METHOD: From July 1 to Sept 30, 1998, we surveyed the incidence rate of intravenous catheter-related complication among the hospitalized patients in the wards of Medicine. Surgery, Obstetric, and Neonatal Intensive Care Unit in Guro Hospital, Korea University Medical center. We also compared the incidence of complication between domestic-made catheter (catheter A) and foreign-made catheter (catheter B) of three different gages (24G, 22G and 18G). The morphologic characteristics of intravenous catheters has been studied by electron microscopy. RESULT: Complication associated with use of intravenous catheter had been occurred 263 out of 459 cases (57.3%), among those cases, non-infectious complication and infectious complication were 173 cases (37.7%) and 90 cases (19.6%), respectively. Totally, catheter A group showed higher complication than catheter B group [62.0% (160/258) vs 51.2% (103/201), P=.021]. Analysis on the incidence rate of complication according to the products did not show significant differences in the noninfectious complication in every gage groups. However the infectious complication occurred higher in the domestic-made catheter A group than among the foreign-made catheter B group [(24G: 6% vs 0%, P=.026), (22G: 25.6% vs 9.6%, P=.001), (18G: 36.8% vs 13.4%, P=.002)]. Duration of catheter life did not show the difference between catheter A group and catheter B group [48.5hrs vs 50.3hrs, P=.474]. The analysis on risk factors for complication showed that catheter A group is highly related (odd ratio 1.85). The morphologic analysis of the catheter by using electron microscopy showed that the angles in the tip of the introducing needle of catheter Aand catheter Bare 60degrees and 45degrees , respectively, and the bevel between introducing needle and catheter sheath are 50degrees and 27degrees, respectively. CONCLUSION: There was a higher incidence rate of complication related to domestic-made catheter usage, which might influence increasing the period of the hospitalization and the expenses due to the complication. The study of cost effectiveness analysis needs to be performed regarding intravenous catheter-related complication. Morphologically, catheter A showed more blunt angle in the tip and transition area of the introducing needle than the angle of catheter B, which is considered to influence the higher complication incidence. It needs to improve the quality of domestic-made intravenous catheter.
Academic Medical Centers ; Catheter-Related Infections ; Catheters ; Cost-Benefit Analysis ; Female ; Hospitalization ; Humans ; Incidence* ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Microscopy, Electron ; Needles ; Obstetric Surgical Procedures ; Prospective Studies* ; Risk Factors

STUDY DESIGN: Case report OBJECTIVES: We report a case of surgically proven tophaceous gout of the lumbar spine at the L5-S1 level in a 43-year-old man that mimicked infectious spondylodiscitis and epidural abscess on magnetic resonance (MR) images. SUMMARY OF LITERATURE REVIEW: Some patients have chronic back pain with an epidural mass. Among the many causes of epidural masses, tophaceous gout of the lumbar spine is very rare. MATERIALS AND METHODS: A 43-year-old man presented with fever and chronic back pain with radiating pain. In an MR image of L4-5, an abnormal subcutaneous mass was found in the posterior epidural space. The subcutaneous mass was isointense on T1-weighted images compared with the intervertebral disc, and focally and strongly hyperintense and heterogeneous on T2-weighted images. After the intravenous administration of gadolinium contrast, the mass was fairly homogenous, with a low signal intensity and without enhancement. With the diagnosis of infective spondylitis with epidural abscess, we performed a decompressive mass resection. RESULTS: The pathologic examination revealed multinuclear giant cells and amorphous crystalline fibrous tissue. The lesion was diagnosed as tophaceous gout. CONCLUSIONS: This case underscores the importance of considering tophaceous gout in the differential diagnosis of an epidural mass in a patient with chronic back pain.
Administration, Intravenous ; Adult ; Back Pain ; Crystallins ; Diagnosis ; Diagnosis, Differential ; Discitis ; Epidural Abscess ; Epidural Space ; Fever ; Gadolinium ; Giant Cells ; Gout ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Spine ; Spondylitis

OBJECTIVES: We report a case of surgically proven tophaceous gout of the lumbar spine at the L5-S1 level in a 43-year-old man that mimicked infectious spondylodiscitis and epidural abscess on magnetic resonance (MR) images.SUMMARY OF LITERATURE REVIEW: Some patients have chronic back pain with an epidural mass. Among the many causes of epidural masses, tophaceous gout of the lumbar spine is very rare. MATERIALS AND METHODS: A 43-year-old man presented with fever and chronic back pain with radiating pain. In an MR image of L4-5, an abnormal subcutaneous mass was found in the posterior epidural space. The subcutaneous mass was isointense on T1-weighted images compared with the intervertebral disc, and focally and strongly hyperintense and heterogeneous on T2-weighted images. After the intravenous administration of gadolinium contrast, the mass was fairly homogenous, with a low signal intensity and without enhancement. With the diagnosis of infective spondylitis with epidural abscess, we performed a decompressive mass resection. RESULTS: The pathologic examination revealed multinuclear giant cells and amorphous crystalline fibrous tissue. The lesion was diagnosed as tophaceous gout. CONCLUSIONS This case underscores the importance of considering tophaceous gout in the differential diagnosis of an epidural mass in a patient with chronic back pain.

BACKGROUND: Traditional visual reading of patch-test reactions is a rather subjective method, lacking the sensitivity and reproducibility needed in experimental studies. Recently the laser Doppler perfusion imaging (LDPI) has been used to measure objectively the increase in superficial blood flow which results in the appearance of erythema. OBJECTIVE: We designed this study to examine the relationship between the LDPI measurement and visual reading after patch test to several different irritants. METHODS: In this study, reading of erythema in experimentally-induced irritant contact dermatitis was performed visually and by laser Doppler perfusion imaging (LDPI). In addition, we investigated whether the LDPI measurement was appropriate in the routine patch test clinic. RESULTS: A close correlation was shown between the 2 methods (r=0.9046, p<0.001) and the LDPI producing mean adjusted perfusion values (APVs) was able to discriminate between the different visual grades. CONCLUSION: LDPI is a valuable instrument to objectively assess intensity of irritant patch-test reaction, and is indeed one of the few methods which overcomes the inter-individual variations in visual reading, but this instrument is not appropriate to use routinely in patch test clinic because of unacceptably long measurement time.
Dermatitis, Contact ; Erythema ; Irritants ; Methods ; Patch Tests ; Perfusion Imaging* ; Perfusion*

No Abstract available.
Academic Medical Centers* ; Infection Control*

High-flow priapism is caused by sustained arterial inflow into the spaces from a lacerated cavernosal artery. This typically follows perineal trauma. Iatrogenic high-flow priapism occasionally follows the treatment of low-flow priapism and is a diagnostic and therapeutic challenge. Herein, we reported a case of iatrogenic high-flow priapism which developed after treatment of-flow priapism.
Arteries ; Priapism*

BACKGROUND: Candida species are not only the leading cause of nosocomial fungal infections but also the important cause of infections in the immunocompromised hosts. Epidemiologic study of nosocomial candidiasis has been difficult because of the lack of a reliable typing system. We performed molecular epidemiologic study by using RFA and Southem hybridization for typing of candida isolates from patiients. METHODS: A total of 27 candida isolates from 19 immunocompromised patients were studied. Morphotyping and biotyping were done by germ tube test and API 20C system, respectively. Candidial chromosomal DNA was extracted, digested with EcoRI, HindalII and RFA was done. Southem hybridization of chromosomal DNA was also done with digoxigen-labelled Candial albicans-specific DNA probe. RESULTS: The time-period of development of oral candidiasis after admission was 5-14 days (mean: 8 days). C.albicans was the most common species (19), followed by C tropiadis (2), C glabn#zta (2), C.paratropicalis (2), and C parapsilosis (1). The subtypes of Candida species by RFA of chromosomal DNA were C. albieans, 12 types , C tropicalis, 2 types, C glabrata, 2 types ; C.parapsilasis, 1 type ; C. paratropicalis, 1 type. For 7 (87.5%) of 8 patients, RFA pattern of one isolate was identical to that of the other isolates. CONCLUSION: RFA of candidial chromosomal DNA results were obtainable within days. RFA showed high reproducibility, typeability and good discrimination power between isolates, provided a robust system that may be used rapidly to identify outbreaks of nosocomial candidiasis.
Candida ; Candidiasis* ; Candidiasis, Oral ; Cross Infection ; Discrimination (Psychology) ; Disease Outbreaks ; DNA ; Epidemiologic Studies* ; Epidemiology ; Humans ; Immunocompromised Host

OBJECTIVE: The golden standard of serodiagnosis of HFRS is IFA(indirect immunofluorescence antibody test). However, positive IFA for IgG antibody does not always correlate with current infection because IFA may be positive due to past exposure to Hantaan virus such as subclincal infection or due to vaccination in endemic area. So supplementary diagnostic method is needed to diagnosis of HFRS with more accuracy. METHODS: In this study, the usefulness of IgG avidity assay with 8 mole/l urea in diagnosis of HFRS was investigated. Serum samples from 45 patients with acute phase HFRS and 79 residents of endemic area, who had HFRS antibody were tested for IgG avidity. RESULTS: The distribution of IgG avidity index of HFRS antibody was different acute phase of HFRS patients from endemic area residents(p<0.001). Patients with acute phase HFRS exhibited lower avidity of Hantaan virus-specific IgG (mode of 64 of avidity index), in contrast endemic area resident had a higher avidity (mode of 4 of avidity index). CONCLUSION: The IgG avidity assay should assist in the diagnosis of acute phase HFRS and may be used to identify recent infection and past exposure to Hantaan virus.
Diagnosis* ; Fluorescent Antibody Technique ; Hantaan virus* ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Immunoglobulin G* ; Serologic Tests ; Urea ; Vaccination

BACKGROUND: Vancomcyin-resistant enterococci(VRE) have become one of major nosocomial pathogens in USA and Europe since 1986. In Korea, only a few cases of VRE infection were reported until now. We investigated the rate of vancomycin resistance among clinical enterococcal isolates, characterized the genotypes of VRE isolates by using polymerase chain reaction (PCR), and analyzed the molecular relatedness of those isolates by using pulsed field gel electrophoresis(PFGE) technique. METHODS: Standard disk diffusion test, break point screening test and measurement of minimal inhibitory concentraion(MIC) were used for identification of VRE. Duplex vanA-vanB PCR for genotyping of vancomcyin resistance, and PFGE for molecular epidemiologic analysis were performed. RESULTS: Incidence of VRE among clinical enterococcal isolates during the study period(July, 1995~June,1996) was 1.0%(2/202). Two strains among 68 suspicious VRE, which were identified by disk diffusion method, were confirmed as true VRE by break point screening and MIC test. MIC of both VRE isolates were same(vancomycin : 512microgram/ml, teicoplanin 64microgram/ ml). Both VRE isolates were confirmed as vanA genotypes by duplex PCR and identical clones by PFGE and dendrogram analysis. CONCLUSION: Frequency of VRE among clinical enterococcal isolates is still very low(1%) in this hospital. We reported two VRE isolates which were confirmed by MIC determination and PCR genotyping. Judicious surveillance study of VRE and strict control of vancomycin usage are required to prevent the emergence and dissemination of VRE.
Clone Cells ; Diffusion ; Europe ; Genotype ; Incidence ; Korea ; Mass Screening ; Polymerase Chain Reaction ; Teicoplanin ; Vancomycin ; Vancomycin Resistance