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.
Agammaglobulinemia*

Werniche's encephalopathy is clinically characterized by the acute onset of global confusion, ataxia, gaze paresis, and nystagmus. It result from a deficiency in thiamine, an essential coenzyme in intermediate carbohydrate metabolism. The prompt use of thiamine prevents progression of the disease and reverses those lesions that have not yet progressed to the point of fixed structural change. We experienced a case of Wemiches encephalopathy associated with hyperemesis gravidarum, which happens to the patient who are injected only dextrose without thiamine. Therefore, we emphasize the need of thiamine replacement in hyperemesis gravidarum.
Ataxia ; Carbohydrate Metabolism ; Female ; Glucose ; Humans ; Hyperemesis Gravidarum ; Paresis ; Pregnancy ; Thiamine

No abstract available.

Fetal bilateral renal agenesis is a lethal congenital anomaly. An early and reliable prenatal diagnosis is extremely important as it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, and the empty renal fossae. However, severe oligohydramnios makes it difficult to diagnose the disease because of poor sonographic resolution. We present a case of fetal bilateral renal agenesis diagnosed by ultrasonography after amnioinfusion at 19 weeks gestation.
Diagnosis ; Female ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Ultrasonography ; Ultrasonography, Prenatal* ; Urinary Bladder

OBJECTIVE: To determine the changes of nitric oxide production in preeclampsia, the concentration of nitric oxide metabolite, nitrite, was measured in umbilical vein after perfusing plasma from normal pregnant women and preeclamptic pregnant women. MATERIAL AND METHOD: 15 normal and 15 preeclamptic umbilical cords were obtained at the time of cesarean section. Two pieces of umbilical cord in equal length(20 cm in length) were prepared from each umbilical cord. Two pieces of umbilical cord were connected in parallel in a perfusion chamber. One piece of umbilical cord was perfused sequentially for 20-minutes' interval with the perfusates in the order of cord buffer, cord buffer including 15% normal pregnant serum, 15% normal pregnant serum with histamine(10-5mol/L), 15% normal pregnant serum with calcium ionophore A23187(5 mol/L) and the other one was perfused exactly same way using 15% preeclamptic serum instead of 15% normal pregnant serum. All the perfusates used were gassed with 95% O2 and 5% CO2 and warmed to 37degree C. Perfusates were collected in eppendorf tube and freezed at -70degree C until assayed. NO was measured by means of Greiss reaction. one way ANOVA and paired t-test were used where appropriate and p-value < 0.05 was considered significant. RESULTS: NO production in normal umbilical cords was not different regardless of perfusate. Although adding histamine and calcium ionophore, the NO production was slightly increased but statistically not significant in both groups. NO production in preeclamtic umbilical cords was significantly increased with 15% preclamptic serum(15% normal serum vs. 15% preeclamptic serum; 0.060+/-0.016microgram/ml/min vs 0.075+/-0.014microgram/ml/min, p<0.05). CONCLUSION: The preeclamptic sera may not affect the production of NO in the human umbilical vein endothelial cells. The biologic significance of increased NO production in preeclamptic umbilical cord with perfusing preeclamptic serum is unknown, but it might be compensation for the vasoconstriction of preeclampsia.
Calcium ; Cesarean Section ; Compensation and Redress ; Female ; Histamine ; Human Umbilical Vein Endothelial Cells ; Humans ; Nitric Oxide* ; Perfusion ; Plasma ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women ; Umbilical Cord ; Umbilical Veins ; Vasoconstriction

OBJECTIVE: The changes of the production of nitric oxide in preeclampsia are still controversial. To determine the changes of nitric oxide production in preeclamptic pregnancies, NOS activity and eNOS and iNOS expression in preeclamptic placentae were compared with those in normal placentae, and to determine the changes of nitirc oxide production according to the sites of placenta, NOS activity and eNOS expression in preeclamptic placentae were also compared with those in normal placentae. METHODS: Human placentae were obtained from 15 normal and 15 preeclamptic pregnant women at the time of cesarean section. NOS activity was assessed by measuring the conversion of [3H]-arginine into [3H]-citrulline. The eNOS and iNOS expression were assessed by using western blot analysis. Data were analyzed by Student t-test and paired t-test where appropriate. RESULTS: The NOS activity(judged by measurement of [3H]-citrulline production) was significantly increased in preeclamptic placentae compared to normal(P<0.05). In normal and preeclamptic pregnant placentae, the NOS activity in main stem villi was increased compared to that in terminal villi. However, the difference of NOS activity between main stem villi and terminal villi was not significant(P>0.05). Quantification of the autoradiographic images demonstrated that the integrated optical density of the immunoreactive bands of eNOS were significantly lower in preeclamptic placentae compared to normal(p<0.05). Conversely, the integrated optical densities of the bands of iNOS were significantly higher in preeclamptic placentae compared to normal(p<0.05). CONCLUSIONS: Although the eNOS expression in preeclamptic placentae was lower than that in normal placentae, the NOS activity was significantly higher in preeclamptic placentae than that in normal in this study. These are result from increased production of iNOS in the compensatory mechanisms for the decreased nitric oxide production in pre-eclamptic placentae.
Blotting, Western ; Cesarean Section ; Female ; Humans* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Placenta* ; Pre-Eclampsia ; Pregnancy* ; Pregnant Women

OBJECTIVE: To evaluate whether twin discordancy is a risk factor for adverse perinatal and neonatal outcomes. METHODS: Three hundred and seventy-five twin gestations over 28 weeks of gestation were included in this retrospective study. Medical records of mothers and infants were reviewed. Pregnancies were divided into 2 groups according to the birth weight discordancy(%) between twin neonates(group I;less than 25%, group II;25% or more). Birth weight discordancy was calculated from following formula; (birth weight of larger twin-birth weight of smaller twin)/birth weight of larger twin x 100. Perinatal and neonatal outcomes in group I and II were compared with each other. Also, difference in the outcomes between the smaller and larger twins of group II was evaluated. To evaluate whether birth weight discordancy is an independent variable in predicting poor perinatal and neonatal outcomes, multiple logistic regression analysis was used. RESULTS: Thirty-seven gestations(9.9%) were documented to belong to group II. Group II showed significantly higher incidence of preeclampsia, placenta previa, and small for gestational age infants(p<0.01, p<0.05 and p<0.001, respectively). The group also showed higher incidence of adverse neonatal outcomes(admission to neonatal intensive care unit, respiratory distress syndrome, pneumonia, bronchopulmonary dysplasia, patent ductus arteriosus, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, sepsis, congenital anomaly, neonatal death, p<0.01). Outcomes of the larger and smaller twins of group II were not significantly different with each other except small for gestational age infants(p<0.005). However, birth weight discordancy was not an independent variable in predicting adverse perinatal and neonatal outcomes. CONCLUSION: Fetal growth discordancy of 25% or more should be regarded as a risk factor for adverse perinatal and neonatal outcomes in twin gestations. However it is not an independent factor in predicting adverse perinatal and neonatal outcomes.
Birth Weight ; Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Fetal Development* ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Logistic Models ; Medical Records ; Mothers ; Placenta Previa ; Pneumonia ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Retinopathy of Prematurity ; Retrospective Studies ; Risk Factors* ; Sepsis

BACKGROUND: Hepatitis B vaccination schedule commonly used in Korea is divided largely into 0, 1, 2 month scheduled vaccination group(0, 1, 2 group) and 0, 1, 6 month scheduled vaccination gorup(0, 1, 6 group). The only difference bet.ween two groups is the interval from 2nd dose to 3rd dose. This st,udy had been carried out, to find whether t.he difference of vaccination interval influence the vaccination complet,ion rate or not. METHODS: Study objects are 135 persons over 20 years old who had heptitis B vaccination more than once in injection room of Dongkuk University Kyong-ju Hospital from Jan. 1st in 1996 to Dec. 31th in 1996. Data about vaccination completion were gathered from record book of injection room and telephone interview. RESULTS: Hepatitis B vaccination completion rate is 73.8% in 0, 1, 2 group and 72.5% in 0, 1, 6 group. The reasons for incomplete vaccination are forgetting vaccinat.ion date(36.4% in 0, 1, 2 group and 50% in 0, 1, 6 group), having no time to spare for vaccination(54.5% in 0, 1, 2 group and 43% in 0, 1, 6 group) and knowing positive HBsAb before completion of scheduled vaccination(9.1% in 0, 1, 2 group and 7% in 0, 1, 6 group). CONCLUSIONS: There is no difference in Hepatitis B vaccination complet,ion rate bet.ween 0, 1, 2 group and 0, 1, 6 group.
Appointments and Schedules ; Gyeongsangbuk-do ; Hepatitis B* ; Hepatitis* ; Humans ; Interviews as Topic ; Korea ; Vaccination* ; Young Adult

Acupuncture with gold needle insertion is utilized in Oriental medicine, and the effect of therapy is represented by anti-inflammatory and analgesic function, But sometimes the needle is erroneously inserted into abdominal organs, and then it may cause dangerous complications. We report a case of multiple gold needles in the abdominal organs without having definete clinical symptoms.
Acupuncture* ; Medicine, East Asian Traditional ; Needles* ; Radiography*