BACKGROUND: It is well known that Methicillin-resistant Staphylococcus aureus (MRSA) is hardly controllable organism among pathogens of nosocomial infection. The MRSA infection control measures have been initiated at a brand new tertiary care teaching hospital which was opened in June, 1994. However, the control measures did bring out little effect. In 1997, reenforcement of all control measures were practiced in intensive care units. The measures brought out a significant improvement in reducing the incidence of MRSA infection, subsequently the same control measures were implemented through-out the entire inpatient area. METHODS: The following control measures have been reenforced since March 1997: first, application of thorough surveillance of confirmed MRSA infected patients: second, providing cohort care: third, enforcing handwashing practices after patient contact; fourth, establishing infected patients isolation zone: fifth, tagging infected patient's bed and medical record, providing disinfectant spray for washing hands, identifying and treating carriers among patient contact staffs, separate disposal of contaminated wastes, and finally repeating education of nursing staff and family members of the patients. Each month the number of incidence in MRSA nosocomial infection were followed and the leu supervisors were notified the outcome. RESULTS: The incidence of MRSA infection started to decline soon after the initiation of the control measures, from 132% in March 1997 to 5.8% in July 1997. In 1998, the infection rate maintained close to 2-3%. There had been 467 MRSA infected cases (5.7%) out of 8,253 discharges during the study period; among them 319 cases were infected once; 40 cases twice; 15 cases three times: four cases four times and 1 case seven times. The order of preference of organs infected are lungs (56.3%), wounds(11.8%), blood (7.9%), and urinary tract (1.9%). The highest incidence of this infection was found in Medicine (34.8%) and Neurosurgery (22.8%) CONCLUSION: The implementation and reenforcement of infection control measures are key to successful control of nosocomial infection, in particular, hand washing of patient contact staffs and eradication of carriers could be the most effective measures.
Cohort Studies ; Cross Infection* ; Education ; Hand ; Hand Disinfection ; Hospitals, Teaching ; Humans ; Incidence ; Infection Control ; Inpatients ; Intensive Care Units* ; Critical Care* ; Lung ; Medical Records ; Methicillin-Resistant Staphylococcus aureus* ; Neurosurgery ; Nursing Staff ; Tertiary Healthcare ; Urinary Tract

No abstract available.
Glomerulonephritis, Membranous*

Acute necrotizing encephalopathy is a recently established disease entity, proposed by Mizuguchi et al in 1995, that shows a characteristic symmetric and multifocal involvement of both thalamus, brainstem tegmentum, cerebral periventricular white matter, and cerebellar medulla. It is known to be prevalent in Japan and other Far Ease countries. The etiology of the acute necrotizing encephalopathy remains unknown. The typical course of acute necrotizing encephalopathy is the development of the irreversible neurologic symptoms related to brain lesions. The diagnosis can be made on the basis of the combination of a typical clinical profile and characteristic radiologic findings. We experienced a first case of acute necrotizing encephalopathy in a 9 month old boy in Korea. We report this case with the brief review of related literatures.
Brain ; Brain Stem ; Diagnosis ; Humans ; Infant ; Japan ; Korea ; Male ; Neurologic Manifestations ; Thalamus

Purpose: This study aimed to identify the prevalence of fatigue and its associated factors leading to the fatigue among Korean commercial airline pilots. Methods: An anonymous, web-based questionnaire collecting data on sleep related characteristics was completed by airline pilots. The final 1,029 samples of completed questionnaires were analyzed. The association of the risk factors with fatigue was determined using logistic regression analysis. Results: The prevalence of fatigue was 60% (Fatigue Severity Scale index≥3.2), disturbed sleep 28% (Pittsburgh Sleep Quality Index≥9), daytime sleepiness 17% (Epworth Sleepiness Scale≥10), and sleep apnea (Berlin Questionnaire≥2) 11%. Thefully adjusted logistic regression showed that quality of life (odds ratio [OR]=0.16, confidence interval [CI]=0.11–0.24), daytime sleepiness (OR=1.26, CI=1.18–1.34), sleep quality (OR=1.44, CI=1.29–1.61), mental workload (OR=1.10, CI=1.05–1.14),vigorous physical activity (OR=0.82, CI=0.72–0.92), late starts (OR=1.25, CI=1.06–1.46) and average weekly flying hours (OR=1.02, CI=1.00–1.03) were associated with higher levels of fatigue. Conclusion Lower quality of life, disturbed sleep, more subjective sleepiness, shorter sleep duration, higher mental workload, less vigorous physical activity, frequent late starts, and longer flying hour were shown to be risk factors for fatigue in airline pilots.These findings should be taken into account in the development of sleep and fatigue countermeasures for airline pilots.

Venous thrombosis is uncommon in young individuals. Hypereosinophilia is a rare cause of thrombosis that usually involves the heart and small vessels like retinal vessels. We report a case of massive deep vein thrombosis that developed in a young patient with hypereosinophilia who was successfully treated with continuous local infusion of urokinase.
Eosinophilia* ; Heart ; Humans ; Retinal Vessels ; Thrombosis ; Urokinase-Type Plasminogen Activator* ; Venous Thrombosis*

PURPOSE: Asthma inhalation therapy is important for the treatment of childhood asthma. Therefore, it is necessary to educate patients on the correct inhalation techniques. The purpose of this study was to determine the effectiveness and necessity of educating patients on the correct inhalation techniques. METHODS: A total of 86 patients with bronchial asthma and who were over 7 years old were enrolled and educated on handling inhaler devices for 2 years. The inhaler devices used were the diskus (n=27), turbuhaler (n=12) and metered dose inhaler with a spacer (n=47). Trained pharmacists provided the education. Four steps (breathing out prior to inhalation, inhalation, holding the breath, exhaling slowly) that were critical for handling each device were evaluated and each step was scored as good, fair or poor. We evaluated the symptom score (daytime cough, nighttime cough, sleep disturbance and limitation of activity) and lung function before treatment and 4 weeks later. RESULTS: Over 90.0% of the diskus users performed fair to good in each step. The symptom score and lung function at 4 weeks later after education were significantly improved (P=0.000). The turbuhaler users all performed fair to good on each step. The symptom score was significantly improved (P<0.005), but the lung function was not difference. Over 95% of the users of a metered dose inhaler with a spacer performed moderate to good on each step. The symptom score and lung function were significantly improved (P<0.05). CONCLUSION: The structured, detailed education on inhaler devices by trained specialists was very important for performing correct inhalation therapy to control asthma, and repeated education might be also necessary.
Asthma ; Cough ; Exhalation ; Handling (Psychology) ; Humans ; Inhalation ; Lung ; Metered Dose Inhalers ; Nebulizers and Vaporizers ; Pharmacists ; Respiratory Therapy ; Specialization

PURPOSE: To report a case of infectious crystalline keratopathy caused by Alternaria in the corneal center. CASE SUMMARY: A 66-year-old male visited our clinic with right ocular pain and visual loss after corneal trauma caused by a foreign body hitting his right eye while performing farm work 1 month prior to his visit. The patient had no history of corneal surgery and long-term use of topical corticosteroid. A corneal epithelial defect and whitish snowflake margin infiltration around the corneal stroma were observed in the corneal center, but there was an absence of conjunctival injection and anterior segment inflammation. Cultures and a biopsy of the corneal scrapings revealed Alternaria species fungus. The patient was treated with 1% topical voriconazole and 0.5% moxifloxacin, together with oral voriconazole (400 mg/day). After 2 months of treatment, the disease was completely cured, with a minute corneal opacity. CONCLUSIONS: We successfully treated a rare case of infectious crystalline keratopathy caused by Alternaria, which has not been previously reported in the Republic of Korea.
Aged ; Agriculture ; Alternaria ; Biopsy ; Corneal Injuries ; Corneal Opacity ; Corneal Stroma ; Crystallins ; Foreign Bodies ; Fungi ; Humans ; Inflammation ; Male ; Republic of Korea ; Voriconazole

Background: Regeneration of soft tissue defects is essential for adipose tissue pathologies and disease, trauma, or injury-induced damage. Here, we show that umbilical cord blood-derived mesenchymal stem cells could potentially be tailored and used for the reconstruction of specific damaged sites. Adipogenesis can be exploited in soft tissue reconstruction. Also, primary cilia play a role in the control of adipogenesis. Methods: The adipogenic differentiation capacity of mesenchymal stem cells (MSCs) was shown to influence ciliogenesis. MSCs transfected with intraflagellar transport 88 (IFT88) small interfering RNA (siRNA), which blocks the assembly and maintenance of cilia, were examined to confirm the relationship between adipogenesis and ciliogenesis. Also, 1,2-Bis(2-aminophenoxy) ethane-N,N,N′,N′-tetraacetic acid tetrakis(acetoxymethyl ester) (BAPTA-AM), calcium chelator, inhibited the ciliogenesis of MSCs in adipogenic differentiation. Results: IFT88-knockdown led to decreased cilia formation and limitation of cilia elongation in adipogenesis. Additionally, intracellular calcium triggered cilia formation in MSCs adipogenesis. Interestingly, intracellular calcium cannot overcome the inhibition of adipogenesis caused by low numbers of cilia in MSCs. Conclusion Our data suggested that ciliogenesis was negatively regulated by Wnt5a/β-catenin signaling during adipogenesis. Thus, we suggest that calcium induction triggers adipogenesis and ciliogenesis.

PURPOSE: Leptomeningeal cyst or growing skull fracture can occur in young infants or children following head trauma. We present MR imaging findings in five children with growing skull fracture. MATERIALS AND METHODS: We reviewed the MR images of five children (M: F=2:3) with growing skull fracture. The mean age was 7.5 years. The time interval between the occurrence of head trauma and the presentation of growing skull fracture varied from three months to 12 years. We reviewed the precontrast CT scans and/or the plain skull radiographs in those patients for whom these studies were available. RESULTS: The most common location of the growing skull fracture was the parietal bone (n=3). On the MR images, there were bone defects with posttraumatic cystic encephalomalacia or porencephalic cysts. Marginal bony thickening and diploic space widening were noted in four patients. MR imaging was excellent for visualizing the parenchymal changes and pericranial lesions. CONCLUSION: In children with growing skull fracture, MR imaging can clearly depict trauma-related parenchymal changes, pericerebral lesions as well as bony edge thickening with remodeling.
Arachnoid Cysts ; Child* ; Craniocerebral Trauma ; Encephalomalacia ; Humans ; Infant ; Magnetic Resonance Imaging ; Parietal Bone ; Skull Fractures* ; Skull* ; Tomography, X-Ray Computed

No abstract available.
Histiocytosis, Langerhans-Cell* ; Scabies*