Peripartum cardiomyopathy is a myocardial disease associated with pregnancy and leading to heart failure. A twenty-eight years old primipara was scheduled for a cesarean section due to a twin pregnancy. She had no previous cardiac or other systemic illness. But periodic episode of sudden hypertension, tachycardia, hypoxemia(PaO2/FiO2=58) and pulmonary edema were developed in the perioperative period. After being transferred to the intensive care unit, mechanical ventilation with positive end expiratory pressure was applied for six days and pulmonary infiltration subsided. However, two days after extubation, acute pulmonary edema redeveloped in both lung fields in spite of fluid restriction. In echocardiogram demonstrated global hypokinesia of the left ventricle with an ejection fraction of 31%. Dobutamine infusion was started and one day after infusion the pulmonary edema subsided. In conclusion echocardiogram would be helpful for diagnosis of peripartum cardiomyopathy and adequate cardiac support with assisted ventilation will improve prognosis.
Cardiomyopathies* ; Cesarean Section ; Diagnosis ; Dobutamine ; Edema ; Female ; Heart Failure ; Heart Ventricles ; Hypertension ; Hypokinesia ; Intensive Care Units ; Lung ; Perioperative Period ; Peripartum Period* ; Positive-Pressure Respiration ; Pregnancy ; Pregnancy, Twin ; Prognosis ; Pulmonary Edema* ; Respiration, Artificial ; Tachycardia ; Ventilation

No abstract available.
Humans

No abstract available.
Liver* ; Ultrasonography*

BACKGROUND: Lancet-related needlestick injuries (NSIs) occur steadily in clinical practices. Safety-engineered devices (SEDs) can systematically reduce NSIs. However, the use of SEDs is not active and no study to guide the implementation of SEDs was known in South Korea. The lancet-related NSIs may be eliminated to zero incidence using a SED lancet with effective sharp injury protection and reuse prevention features. MATERIALS AND METHODS: We implemented a SED lancet by replacing a conventional prick lancet in a tertiary hospital in a sequential approach. A spot test of the new SED was conducted for 1 month to check the acceptability in practice and a questionnaire survey was obtained from the healthcare workers (HCWs). A pilot implementation of the SED lancet in 2 wards was made for 1 year. Based on these preliminary interventions, a hospital-wide full implementation of the SED lancet was launched. The incidence of NSIs and cost expenditure before and after the intervention were compared. RESULTS: There were 29 cases of conventional prick lancet-related NSIs for 3 years before the full implementation of SED lancet. The proportion of prick lancet-related NSIs among yearly all kinds of NSIs during two years before the pilot study was average 11.7% (22/188). Pre-interventional baseline incidence of all kinds of NSIs was 7.01 per 100 HCW-years. After the full implementation of SED lancet, the lancet-related NSIs became zero in the 2nd year (P = 0.001). The average direct cost of 18,393 US dollars (USD) per year from device and post-exposure medical care before the intervention rose to 20,701 USD in the 2nd year of the intervention. The incremental cost-effectiveness ratio was 210 USD per injury avoided. CONCLUSION: The implementation of a SED lancet could eliminate the lancet-related NSIs to zero incidence. The cost increase incurred by the use of SED lancet was tolerable.
Delivery of Health Care ; Health Expenditures ; Incidence ; Korea ; Needlestick Injuries* ; Pilot Projects ; Tertiary Care Centers

BACKGROUND: Lancet-related needlestick injuries (NSIs) occur steadily in clinical practices. Safety-engineered devices (SEDs) can systematically reduce NSIs. However, the use of SEDs is not active and no study to guide the implementation of SEDs was known in South Korea. The lancet-related NSIs may be eliminated to zero incidence using a SED lancet with effective sharp injury protection and reuse prevention features. MATERIALS AND METHODS: We implemented a SED lancet by replacing a conventional prick lancet in a tertiary hospital in a sequential approach. A spot test of the new SED was conducted for 1 month to check the acceptability in practice and a questionnaire survey was obtained from the healthcare workers (HCWs). A pilot implementation of the SED lancet in 2 wards was made for 1 year. Based on these preliminary interventions, a hospital-wide full implementation of the SED lancet was launched. The incidence of NSIs and cost expenditure before and after the intervention were compared. RESULTS: There were 29 cases of conventional prick lancet-related NSIs for 3 years before the full implementation of SED lancet. The proportion of prick lancet-related NSIs among yearly all kinds of NSIs during two years before the pilot study was average 11.7% (22/188). Pre-interventional baseline incidence of all kinds of NSIs was 7.01 per 100 HCW-years. After the full implementation of SED lancet, the lancet-related NSIs became zero in the 2nd year (P = 0.001). The average direct cost of 18,393 US dollars (USD) per year from device and post-exposure medical care before the intervention rose to 20,701 USD in the 2nd year of the intervention. The incremental cost-effectiveness ratio was 210 USD per injury avoided. CONCLUSION: The implementation of a SED lancet could eliminate the lancet-related NSIs to zero incidence. The cost increase incurred by the use of SED lancet was tolerable.
Delivery of Health Care ; Health Expenditures ; Incidence ; Korea ; Needlestick Injuries* ; Pilot Projects ; Tertiary Care Centers

Purpose: Young age at diagnosis has been considered a poor prognostic factor. However, considering young age itself as an independent poor prognostic factor for all breast cancers is unwarranted. We analyzed the different prognostic effects of age as a prognostic factor according to molecular subtype. Methods: We retrieved data from 1,819 patients with primary breast cancer at the breast cancer center between 2007 and 2012. We classified each molecular subtype in 3 age cohorts (<40, 40–50, and >50 years). The associations of age and molecular subtypes with relapse-free survival (RFS) and disease-specific survival (DSS) were assessed. Results: Patients aged <40 years showed a poor histologic grade, hormone receptor negative expression than older patients, and had a higher proportion of triple-negative breast cancer (TNBC) (P < 0.001). This was thought to have led to a significantly shorter RFS than that of older patients (P < 0.001). In the subgroup analysis according to molecular subtypes, the poorer RFS was observed only in patients aged <40 years with luminal type breast cancer (P < 0.001). Age was an independent prognostic factor of RFS in luminal-type breast cancer (P = 0.001). However, no difference in RFS between age groups was found for patients with other subtypes (human epidermal growth factor receptor 2 overexpression, TNBC). No significant effect between age groups was found in DSS for patients with all molecular subtypes. Conclusion Age at diagnosis of breast cancer affected prognosis differently according to molecular subtype. Age itself is not an independent prognostic factor. Age of <40 years showed a limited worse prognostic impact of recurrence in luminal type breast cancer only.

No abstract available.

BACKGROUND: The differentiation of Mycobacterium tuberculosis (MTB) from nontuberculous mycobacteria (NTM) is of primary importance for infection control and choice of antimicrobial therapy. The diagnosis of diseases caused by NTM is difficult because NTM are prevalent in the environment and have fastidious properties. In this study, we evaluated the real-time PCR-based MTB/NTM detection kit for its usefulness in discrimination of MTB and NTM species. METHODS: A total of 155 sputum specimens whose AFB staining smear and culture were positive were used for this study. Among them, 59 and 96 samples had been identified as MTB and NTM, respectively. DNA obtained from sputum specimens was subjected to analysis with MolecuTech Real MTB-ID(R) (M&D, Korea) real-time PCR-based MTB/NTM detection kit. Subsequently, the results of MolecuTech Real MTB-ID(R) were compared with AFB staining smear and culture results. RESULTS: The positive rate of MolecuTech Real MTB-ID(R) to detect MTB and NTM was 98.3% (58/59) and 97.9 (94/96), respectively, using sputum specimens. CONCLUSION: For detection of MTB/NTM, the sensitivity and specificity of MolecuTech Real MTB-ID(R) were comparable to those of conventional methods. Therefore, this study suggests the usefulness of real-time PCR-based MolecuTech Real MTB-ID(R) for rapid detection of MTB/NTM from direct specimens.
Discrimination (Psychology) ; DNA ; Infection Control ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Real-Time Polymerase Chain Reaction ; Sensitivity and Specificity ; Sputum

PURPOSE: Persistent cloaca is a rare multiple anomalous condition which involves the gastrointestinal, neurological and urogenital systems. We evaluated the clinical characteristics and urogenital anomalies of patients with persistent cloaca, and we investigated the factors that must be considered from a urological perspective. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 11 patients who were diagnosed with persistent cloaca at our institution during the last 7 years. RESULTS: Nine of the 11 patients who were followed up at the urology clinic were subjected to this study. Nonspecific abnormalities, such as antenatal hydronephrosis, were noted in 5 of 9 patients. The chief complaints upon visits to the urologic clinic were recurrent urinary tract infections in 3, preoperative evaluation before neurosurgery in 3, urinary incontinence in 1, urinary retention in 1 and an elevated creatinine level in 1. The urological anomalies included 2 cases of renal agenesis and 1 horseshoe kidney. Vesicoureteral reflux was noted in 6 patients, and 4 of these patients underwent antireflux surgery. Videourodynamic study was performed in 8 patients and all of them were diagnosed with neurogenic bladder. Currently, 5 children are on intermittent catheterization, 2 have undergone vesicostomy and 2 void spontaneously. CONCLUSIONS: Most patients with persistent cloaca had urological anomalies of the upper urinary tract and neurogenic bladder. Therefore, a multidisciplinary approach for diagnosis and treatment from various departments, including the urology, pediatric surgery, neurosurgery departments is mandatory.
Catheterization ; Catheters ; Child ; Cloaca ; Congenital Abnormalities ; Creatinine ; Cystostomy ; Humans ; Hydronephrosis ; Kidney ; Kidney Diseases ; Medical Records ; Neurosurgery ; Retrospective Studies ; Urinary Bladder, Neurogenic ; Urinary Incontinence ; Urinary Retention ; Urinary Tract ; Urinary Tract Infections ; Urogenital Abnormalities ; Urogenital System ; Urology ; Vesico-Ureteral Reflux

No abstract available.
Humans ; Patient Satisfaction*