No abstract available.
Edema* ; Hemoptysis* ; Lower Extremity*

BACKGROUND: There is increasing concern in many countries about the problem of drug-resistant tuberculosis. Prevalence of primary drug-resistant tuberculosis is the optimal epidemiological indicator for long term monitoring of national tuberculosis control program. Our purpose was The purpose of our study is to assess clinical characteristics and socioeconomic status of patients with drug-resistant tuberculosis. METHODS: We studied 68 cases with durg-resistant Mycobacterium tuberculosis infection diagnosed at the Ewha Womans University Mokdong Hospital from March, 1995 to February, 2000. RESULTS: Patients with primary drug-resistant tuberculosis(PDR) were younger(39.6±16.3 years vs. 48.2±16.5 years; p<0.05), had more population of less than more were under the age of 40 years aged-group(62.9% vs. 36.4%; p<0.05) and were more highly educated than those with acquired drug-resistant tuberculosis(ADR)(38.9% vs. 11.1%; p<0.05). In patients with ADR, the rates of familial history of tuberculosis and living in a rented house residence in a rented house were increased higher than compared with to those of patients with PDR. Patients with ADR had more involved lobes(2.0±0.8 vs. 1.4±0.7; p<0.01) and longer treatment duration than those with PDR(18.3±7.2 months vs. 10.6±6.3 months; p<0.05). Patients with ADR showed larger numbers of resistant were resistant to more number of drugs, lower hospitalization rate and higher rate of self-interruption of medication than those with PDR. In patients with PDR, mono-drug resistance was increased, whereas poly-and multi-drug resistances were decreased compared with those with ADR. Resistance to isoniazid was the highest among antituberculosis drugs, and resistance to isoniazid in patients with ADR was higher than that in patients with PDR(90.9% vs. 71.4%; p<0.05). CONCLUSIONS: Patients with ADR were more likely to include more population be of lower socioeconomic class, and patients with PDR seem seemed to be young and socially active population. For control of drug-resistant Mycobacterium tuberculosis infection, proper isolation and prevention of patient with drug-resistant tuberculosis are needed.
Female ; Hospitalization ; Humans ; Isoniazid ; Mycobacterium tuberculosis ; Prevalence ; Social Class ; Tuberculosis ; Tuberculosis, Multidrug-Resistant*

BACKGROUNDS : Extended spectrum beta-lactamases (ESBL) are plasmid-mediated enzymes that confer broad-spectrum resistance to aztreonam, most penicillins, and cephalosporins including ceftazidime, cefotaxime and ceftriaxone. But with most routine susceptibility tests, ESBL-producing strains may not appear to be resistant, which makes it difficult to predict the effectiveness of the beta-lactam agents. In this study, we performed several test procedures to detect ESBL in blood isolates of Klebsiella pneumoniae and examined the risk factors for bacteremia due to ESBL-producing K. pneumoniae. MATERIALS AND METHODS: Of 87 blood culture Isolates of K. pneumoniae during the first 7 month of 1996, 39 showed reduced susceptibilities to at least one of the 4 antibiotics, aztreonam, cefotaxime, ceftazidime and ceftriaxone. Twenty-three of the 39 isolates were assailable for screening for ESBL. Antibiotic resistance was tested by the agar dilution method and beta-lactamase assay using nitrocefin disks. Effect of beta-lactamase inhibition was examined by the doubledisk synergy test using aztreonam, cefotakime, ceftazldime, and ticarc illin/clavulanate disks and by ESBL Etest involving ceftazidime and cert tazidime/clavulanate. Ability to transfer the beta-lactam resistance was tested by conjugation. We also reviewed the medical records of the patients with K. pneumoniae. (21 with and 41 without ESBL) bacteremia to ananlyze their clinical characteristics. RESULTS: Of 23 strains tested, reduced susceptibilities to cefotaxime, aztreon am and ceftazidime were shown in 23, 18, and 18 strains, respectively. All strains were positive for beta-lactamase and its activity was trasfered to E. coli in all strains. Activities of beta-lactamases were shown to be inhibited by clavulanate in 21 strains by the double-disk method, but in only 15 strains by the ESBL Etest. Nineteen of 21 bacteremia were nosocomially acquired. ESBL-producing strains were associated with length of hospitalization, stay in intensive care unit, use of invasive procedures and administration of antibiotics Including penicillins and third-generation cephalosporins. CONCLUSIONS: Although an increasing incidence of and outbreaks by ESBL-producing strains are reported, detection of ESBLs has proved to be difficult. Using several testing methods such as double-disk synergy test, ESBL Etest and conjugation, we estimated that 40.9% of blood isolates of K. pneumoniae produce ESBL. We should pursue for more sensitive and reliable screening methods for the detection of ESBL.
Agar ; Anti-Bacterial Agents ; Aztreonam ; Bacteremia ; beta-Lactam Resistance ; beta-Lactamases* ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins ; Clavulanic Acid ; Disease Outbreaks ; Drug Resistance, Microbial ; Hospitalization ; Humans ; Incidence ; Intensive Care Units ; Klebsiella pneumoniae* ; Klebsiella* ; Mass Screening ; Medical Records ; Penicillins ; Pneumonia ; Risk Factors

OBJECTIVE: Our purpose was to evaluate the pregnancy outcome and the advantages of laparoscopic tubal reanastomosis. METHOD: During 16 months, January 1996 to April 1997, thirty-two patient had underwent laparoscopic tubal reanastomosis in Pudang CHA General Hospital. The mean age of the patients was 36.1+/-4.3 years(mean+/-SD; range 26 to 47 years). RESULT: The intrauterine pregnancy rate of laparoscopic tubal reanastomosis was 72.4%(21/29). Data comparing laparoscopic procedure retrospectively to tubal reversal by laparotomy was also evaluated. The mean interval from operation to pregnancy was similar in the two groups (p=0.9). The operation time was sigoificantly longer for laparoscopy (215.3+/-35.5 minutes) than for laparotomy(159.7+/-52.3 minutes). Nevertheless, the intensity of postoperative pain was lower (p<0.05) in patient who underwent laparoscopy than in patient who underwent laparotomy. Also, the mean hospital stay (3.6+/-2.3 days for laparoscopy, 6.1+/-0.5 days for laparotomy) was shortened(p<0.05) after laparoscopy compared with laparotomy. CONCLUSION: Laparoscopic tubal reanastomosis may offer the benefits of lower postoperative pain and shorten recovery time in comparison with laparotomy. Therefore, considering the high pregnancy rate in minimal follow up period of 6 month, laparoscopic tubal reanastomosis could be an alternative procedure to microsurgical laparotomy in patients requesting reversal of sterilization.
Female ; Fertility* ; Follow-Up Studies ; Hospitals, General ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Pain, Postoperative ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; Sterilization ; Sterilization Reversal*

Balloon-tipped, flow-directed (Swan-Ganz) catheters are used commonly for monitoring of cardiac function in patients undergoing cardiac surgical procedures. We report a case of pulmonary hypertension with hypoxemia which may be caused by incorrect positioning of pulmonary artery catheter (PAC) during CABG. Pulmonary arterial pressure (PAP) of 70/40 mmHg which was nearly high as systemic pressure was measured when we tried to wean patient from cardiopulmonary bypass. But, TEE (transesophageal echocardiography) showed nonspecific finding. PAP decreased soon and maintained about 33/16 mmHg for a few minutes. But, the PAP elevated high to 70/40 mmHg again and the arteral oxygen tension (PaO2) decreased to 61.2 mmHg. When we withdrew the PAC to the depth of 35 cm, the PAP and systolic pressure returned to normal range and PaO2 elevaed to 320 mmHg. End tidal CO2 was elevated from 30 mmHg to 35 mmHg.
Anoxia* ; Arterial Pressure ; Blood Pressure ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; Catheters* ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Hypertension, Pulmonary* ; Oxygen ; Pulmonary Artery ; Reference Values

No abstract available.
Liver Abscess* ; Liver*

BACKGROUND: It has been suggested that diabetic patients are under high oxidative stress and plasma MDA concentration is a reliable marker for oxidative stress. However, some studies showed that plasma MDA is not a good marker for oxidative stress. Reeently, the total radical-trapping antioxidant parameter (TRAPc) has been proposed as a marker for the overall antioxidant property of plasma samples. Therefore, in this study, we tried to evaluate whether MDA and TRAPc are reliable markers of the oxidative stress-antioxidant system or not. METHODS: The plasma samples from 67 type 2 diabetic patients and 31 normal subjects were collected. The plasma MDA, protein-bound SH groups, uric acid and vitamin C were determined by fluorophotometry or spectrophotometry. Plasma vitamin E concentration was analyzed by HPLC. Calculated TRAP (TRAPc) were determined by the proposed calculation methods. RESULTS: 1. Diabetic patients had significantly lower TRAPc, compared with normal subjects. 2. SH groups, uric acid, vitamin C and vitamin E were not different between the two groups. 3. MDA and MDA/TG were significantly higher in diabetic subjects. CONCLUSION: From the results of this study, TRAPc seems to be a reliable parameter of overall plasma antioxidant system and the plasma MDA may be used as a marker of oxidative stress, but further long-term logitudinal studies are needed.
Ascorbic Acid ; Chromatography, High Pressure Liquid ; Fluorophotometry ; Humans ; Oxidative Stress ; Plasma ; Spectrophotometry ; Uric Acid ; Vitamin E ; Vitamins

No abstract available.
Rectovaginal Fistula*

OBJECTIVES: The purpose of this study was to assess the clinical features, microbiologic results, and the efficacy of perineal hygienic care of pediatric vulvovaginitis. METHODS: Forty-two unselected premenarcheal patients with symptoms or signs of vulvovaginitis who were attended the outpatient pediatric and adolescent gynecology clinic at Pundang CHA General Hospital from August 1997, to September 1999 were systematically interviewed and examined using a standardized format, studied microbiologically, and followed the efficacy of perineal hygienic measures prospectively. RESULTS: The median age of the patients was 4.8 years (range 2.9 years to 10.9 years). Vaginal complaints of 42 patients were discharge(79%), genital pain or irritation(31%), odor(17%), pruritus(14%), and vaginal bleeding(7%). On physical examination, vaginal discharge and vulvar erythema were noted in 17(40%) and 22(52%) patients, respectively. Aerobic bacteria or yeast excluding vaginal normal flora were found in 24 of 42 patients(57%). Convincing evidence of specific pathogens was found in 9 of 42 patients(21%) including one case of pinworm infestation. Isolated pathogens were H. influenza(3), S. pyogenes(2), K. pneumonia(2) and N. gonorrhea(1). No patients were found to have chlamydial infection or trichomoniasis. In 14 patients, risk factors were identified such as swimming(14%), bubble bath(5%), sexual abuse(5%), genital trauma(5%) and foreign body(2%). After two weeks instructions of perineal hygienic care, 26(62%) of 42 patients revealed complete resolution of symptoms and signs of vaginitis without antibiotics. Efficacies of perineal hygienic care were 94%(17/18) in the patients with normal flora alone, 60%(9/15) in the patients with organisms suspected for nonspecific infection and 0%(0/9) in the patients with specific pathogens(p<0.05). CONCLUSION: Majority(62%) of the pediatric patients with symptoms or signs of vulvovaginitis were cured with perineal hygienic care alone. And the efficacy of hygienic measure were higher in the patients without specific pathogens(79%, 26/33). Therefore, proper physical examination, microbiologic study and appropriate instructions of perineal hygienic care were more important than empirical antibiotic treatment in initial management of pediatric vulvovaginitis.
Adolescent ; Anti-Bacterial Agents ; Bacteria, Aerobic ; Enterobius ; Erythema ; Gynecology ; Hospitals, General ; Humans ; Outpatients ; Physical Examination ; Prospective Studies ; Risk Factors ; Vaginal Discharge ; Vaginitis ; Vulvovaginitis* ; Yeasts

No abstract available.
Humans