BACKGROUND: This study was undertaken to compare nosocomial infection rates between intensive care units of military and civilian hospitals. METHODS: From July to December 2000, we surveyed the intensive care unit of Armed Forces Capital Hospital (AFCH). We compared device use ratios and device-day infection rates with those of Korean Society for Nosocomial Infection Control (KOSNIC) and National Nosocomial Infections Surveillance (NNIS) system. RESULTS: During the period of study, 185 cases were admitted and 24 nosocomial infections were detected: 7 cases of pneumonia, 6 urinary tract, 3 blood stream, 3 cardiovascular system, 3 surgical site infections, 1 skin and soft tissue, and 1 central nervous system infection. Ventilator, urinary catheter and central venous catheter use ratios were 0.14 (95% confidence interval, 0.12-0.16), 0.58 (0.56-0.60) and 0.33 (0.31-0.35). The ratios of NNIS were 0.41, 0.67 and 0.50. Ventilator-, urinary catheter- and central venous catheter-day infection rates were 18.69(11.36-53.32), 6.65 (3.36-14.20) and 1.95 (1.44-9.92). However, the rates of KOSNIC were 9.93, 5.29 and 3.62. The rates of NNIS were 11.24, 6.14 and 5.55. CONCLUSIONS: In AFCH ventilators were used less frequently than NNIS, but more ventilator-associated pneumonia were developed than KOSNIC and NNIS.
Arm ; Cardiovascular System ; Central Nervous System Infections ; Central Venous Catheters ; Cross Infection* ; Hospitals, Military ; Humans ; Intensive Care Units* ; Critical Care* ; Military Personnel* ; Pneumonia ; Pneumonia, Ventilator-Associated ; Rivers ; Skin ; Urinary Catheters ; Urinary Tract ; Ventilators, Mechanical

The recurrence is common problem to treat pterygium. Many surgical procedures were adopted to reduce the recurrence rate. We evaluated the surgical results of limbal conjunctival autograft transplantation (LCAT) accompanying application of 0.02% mitomycin C intraoperatively in 10 patients (10 eyes) who had a recurrent pterygium. There were 7 eyes with first recurrence and 3eyes with second recurrence. Mean age of the patients was 57.4 years, and mean follow-up period was 9.3 months. After a pterygium was excised, a sponge soaked in a solution of mitomycin C 0.02% was applied to the sclera at the site of the surgical bed for 2 minutes, then superior temporal limbal tissue was taken with conjunctival flap and transplanted to the excised area. None of all cases recurred for follow-up period and donor conjunctival site was well reepithelialized. In concluion, LCAT accompanying application of 0.02% mitomycin C intraoperatively was effective and safe method for recurrent pterygium.
Autografts* ; Follow-Up Studies ; Humans ; Mitomycin* ; Porifera ; Pterygium ; Recurrence ; Sclera ; Tissue Donors

Nonparasitic liver cysts are usually asymptomatic and require treatment when they are symptomatic. Hence, many treatment methods, such as percutaneous aspiration, aspiration followed by injection of sclerosing agents into the cyst, excision of the liver cyst, and hepatic resection have been suggested. Recently, the laparoscopic cholecystectomy has become popular, and this method has been challenged as a treatment for symptomatic nonparasitic liver cysts. To evaluate the feasibility of using and the disadvantages of laparoscopic treatment, we reviewed the medical records of 10 patients with a symptomatic nonparasitic liver cyst who were treated by laparoscopic unroofing at the Department of Surgery, Chungbuk National University Hospital. All patients were diagnosed by USG and abdominal CT. All patients had vague abominal discomfort, abdominal distension, or indigestion. The sizes of the liver cysts varied from 7 cm to 20 cm, and half of them were located in the right lobe, the other half in the left lobe. In 5 patients, the cysts were multiple. The mean operative time was 99.5 minutes, and mean hospital stay was 8 days. The follow up period was from 3 to 37 months. Two patients required a reoperation because of cyst infection and a rapidly growing cyst. Remaining cysts were identified in 4 among 8 patients, but they did not have any symptoms. In conclusion, laparoscopic unroofing is feasible as a first choice for treatment of a symptomatic liver cyst. However, in liver cyst that are located at the dome of right side or in a thickened wall, incomplete unroofing and residual cysts can be anticipated. In this case, we suggest that open cyst excision or unroofing may be better than laparoscopic unroofing.
Cholecystectomy, Laparoscopic ; Chungcheongbuk-do ; Dyspepsia ; Follow-Up Studies ; Humans ; Length of Stay ; Liver* ; Medical Records ; Operative Time ; Reoperation ; Sclerosing Solutions ; Tomography, X-Ray Computed

PURPOSE: Approximately 10% of the general population in western countries have gallstones. The compositions of gallstones, however, vary with location and ethnicity. The purpose of this study is to analyze the gallbladder stones of patients in Chungbuk and mainly to compare the compositions of the gallstones with those in other reports. METHODS: The patients in this study included gallbladder stone patients (N=318) who were operated on in Chungbuk National University Hospital from January 1992 to December 1997. By gross inspection of their cut surface structures, the gallstones were classified as pure cholesterol stones, mixed stones, brown stones, and black pigment stones. The chemical compositions of the stones (N=35) that were collected during January and February 1997 were analyzed using high- pressure liquid chromatography (HPLC). RESULTS: By inspection, 31 (9.7%) stones were classified as pure cholesterol stones, 54 (17%) as mixed stones, 27 (8.5%) as brown stones, and 206 (64.8%) as black pigment stones. The results of HPLC analysis were as follows; 5 (15%) stones had cholesterol contents higher than 90% of their composition, 5 (15%) stones 50 to 90%, and 25 (70%) stones less than 20%. CONCLUSION: Of the galldder stones of patients in Chungbuk 73.3% were pigment stones. This result was compatible with the HPLC results (70% of the stones have less than a 20% cholesterol content). The classification of the gallbladder stones of the patients in Chungbuk shows that the incidence of black pigment stones is very high while that of cholesterol stones is low. The difference is even greater when compared with the data in other papers published in Korea. The causes of the difference be remained to be clarified.
Cholesterol ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Chungcheongbuk-do* ; Classification ; Gallbladder* ; Gallstones ; Humans ; Incidence ; Korea

The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologists. Many anesthesiologists use a narrow endotracheal tube for airway control. This, however, can lead to complications such as tracheal mucosal trauma, tracheal perforation or bleeding. The ASA difficult airway algorithm recommends the use of supraglottic airway devices in a failed intubation/ventilation scenario. In this report, we present a case of failed intubation in a patient with subglottic stenosis successfully managed during an i-gel(TM) supraglottic airway device. The device provided a good seal, and allowed for controlled mechanical ventilation with acceptable peak pressures while the patient was in the beach-chair position.
Airway Management ; Constriction, Pathologic ; Hemorrhage ; Humans ; Intubation ; Respiration, Artificial

PURPOSE: For the reconstruction of the ankle joint as well as the soft tissue defect in the distal lower leg, a free flap or a local flap has been used, and because of the condition of patients, if a complex microvascular surgery under general anesthesia could not be performed, it could be reconstructed by using the distally based lateral supramalleolar fascio-cutaneous island flap using the perforating branch of the peroneal artery in the ankle area. METHODS: The study subjects were 4 male patients between 53 years and 73 years of age. 2 cases were tissue defect in the medial malleolus area due to systemic diseases such as gouty arthritis accompanied traffic accident, diabetes mellitus foot, atherosclerotic obliterans, etc., 1 case was the defect in the pretibia area, and 1 case was the defect underneath the lateral malleolus, which was reconstructed by the distally based lateral supramalleolar fascio-cutaneous island flap. The donor area was the skin harvested from the groin , and the full thickness skin graft was performed. The size of the flap varied from 4 X 3 cm to 9 X 6 cm. As the flap border, the medial side was to the tibialis anterior tendon, the lateral side was to the fibula crest, and the proximal area was less than the fibula size. RESULTS: The consequence is that, in total 4 cases, the congestion in the flap began from 12 hours after the surgery, and the progression of congestion was ceased on the 5th day after the surgery, and finally epidermal bulla and sloughing, partial necrosis was developed. After the end of necrosis, the defect area was reconstructed successfully by the second full thickness skin graft. CONCLUSION: Although the distally based lateral supramalleolar fascio-cutaneous island flap has the shortcoming of requiring the second skin graft, it has the advantages that it does not require a long complex microsurgery, the flap itself is thin, it is similar to the color of the skin in the recipient area, and it does not leave a big scar in the donor area. Therefore, it is thought that for the cases who could not undergo a long complex surgery due to systemic diseases or the cases of patients whose condition of the recipient area is not suitable for microsurgery, the lateral supramalleolar fascio-cutaneous island flap is very useful for the reconstruction of the distal lower leg and the ankle joint area.
Accidents, Traffic ; Anesthesia, General ; Ankle Joint ; Ankle* ; Arteries ; Arthritis, Gouty ; Cicatrix ; Diabetes Mellitus ; Estrogens, Conjugated (USP) ; Fibula ; Foot* ; Free Tissue Flaps ; Groin ; Humans ; Leg ; Male ; Microsurgery ; Necrosis ; Skin ; Tendons ; Tissue Donors ; Transplants

PURPOSE: Dentists suffer back, neck and shoulder pain during their careers due to bad operating posture. If dentists have a good operating posture ergonomically, there would be less pain and discomfort in the shoulder and back. Therefore, dentists should learn the Home position which enables dentists to approach a stable posture ergonomically. This study was to compare tooth preparation in the Home position and the Random position, and evaluate the clinical efficacy of the Home position. MATERIALS AND METHODS: Tooth preparation for fixed partial denture was performed on the maxillary left 2nd premolar and maxillary left 2nd molar at the two different operating positions were compared. The amount of occlusal reduction, marginal width, subgingival margin depth, and convergence angle were measured. A T-test was performed separately to compare the results of the Random position and the Home position. RESULTS: 1. The amounts of average thickness of occlusal reduction on fossa were deficient to the ordered ones in the Random position and the Home position (P > .05). 2. The average subgingival margin depth of prepared margin on maxillary left 2nd premolar, maxillary left 2nd molar were excessive in the Random position than in the Home position. On the maxillary left 2nd premolar, there was no statistical difference in the Random position and the Home position except Distal midline, DL line angle, Lingual midline, ML line angle (P < .05). On the maxillary left 2nd molar, there was no statistical difference in the Random position and the Home position (P < .05). 3. Average convergence angle in the Random position and the Home position were excessive compared to the ordered angle. There was no statistical difference in the Random position and the Home position (P > .05). 4. Analysis of pearson correlation : In the Random position, the amounts of average thickness of occlusal reduction, the average subgingival margin depth of prepared margin, convergence angle were significantly associated with each other (P < .05). But in the Home position, they were not significantly associated with each other (P < .05). 5. The time needed for preparation in the Home position was faster or equal than that of the Random position as time went on. CONCLUSION: In conclusion, there were no significant differences between Home postion and Random position in measures of occlusal reduction, marginal width, marginal depth, convergence angle. However, preparation time and incidence of damaging adjacent teeth were less in Home position than in Random position. Therefore, if trained properly, Home position which is more ergonomically stable can be adopted for clinical use.
Bicuspid ; Dentists ; Denture, Partial, Fixed ; Humans ; Incidence ; Molar ; Neck ; Posture ; Shoulder ; Shoulder Pain ; Tooth ; Tooth Preparation

STUDY DESIGN: Retrospective study. PURPOSE: To determine the prevalence of high risk patient with osteopenia requiring pharmacologic treatment and investigate the difference of 10-year fracture probability whether bone mineral density (BMD) include or not in Korean FRAX model. OVERVIEW OF LITERATURE: Many people with the fracture have osteopenia rather than osteoporosis, and BMD alone could be considered as a chance to prevent fracture. METHODS: Three hundred sixty-nine patients who was diagnosed as osteopenia were divided into two groups according to age (group 1, under 65 years; group 2, over 65 years), and 10-year fracture probabilities were calculated by FRAX algorithm with and without femur neck T-score. RESULTS: The high risk patients of the fracture who had above 3% of 10-year hip fracture probability were 15 cases in group 1 and 121 cases in group 2. In 193 patients of group 1, the mean 10-year fracture probability with BMD was significantly higher than the results without BMD (hip fracture: p=0.04, major osteoporotic fracture: p=0.01). Unlike the results of the group 1, the mean 10-year fracture probability without BMD was significantly higher than the results with BMD in 176 patients of group 2 (hip fracture: p=0.01, major osteoporotic fracture: p=0.01). CONCLUSIONS: Total of 136 cases (36.8%) as a high risk of the fracture with osteopenia could be overlooked treatment eligibility in Korean. The Korean FRAX model without BMD could be effective in predicting fracture risk especially in the individuals who were over 65 years.
Bone Density ; Bone Diseases, Metabolic* ; Femur Neck ; Hip ; Humans ; Osteoporosis ; Osteoporotic Fractures ; Prevalence ; Retrospective Studies ; Risk Assessment

A variety of solid tumors can metastasize to bone marrow. In rare cases actual circulating neoplastic cells can be identified, accounting for usually only a low proportion of total white blood cells. It is well known that hematologic malignancies are often associated with mediastinal germ cell tumors, but huge tumor cell burden resulting in leukemia-like presentation is a very rare manifestation. We report here a case of malignant germ cell tumor with leukemia-like infiltration of bone marrow. A 19-year-old man was admitted for dyspnea for several months. Computer tomographic scan revealed that he had a huge mass at anterior mediastinum with a large amount of pleural effusion. His pleural fluid had many numbers of large, pleomorphic atypical cells. Peripheral blood also contained atypical cells with similar morphology. On bone marrow biopsy, diffuse infiltration of tumor cells were noted suggesting acute leukemia, but immunophenotyping ruled out the possibility of hematologic malignancy. His serum alpha-fetoprotein and beta-human chorionic gonadotropin levels were markedly elevated, which was consistent with the diagnosis of primary germ cell tumor. Cytogenetically the tumor cells showed hyper-triploidy. After induction chemotherapy with cisplatin, etoposide and bleomycin, the size of the tumor was regressed and the patient's symptoms were improved.
alpha-Fetoproteins ; Biopsy ; Bleomycin ; Bone Marrow* ; Chorionic Gonadotropin ; Cisplatin ; Diagnosis ; Dyspnea ; Etoposide ; Germ Cells* ; Hematologic Neoplasms ; Humans ; Immunophenotyping ; Induction Chemotherapy ; Leukemia ; Leukocytes ; Mediastinum ; Neoplasms, Germ Cell and Embryonal* ; Neoplastic Cells, Circulating ; Pleural Effusion ; Young Adult

The present study aimed to investigate the osteogenic potentials of differentiated osteoblast-like cells (DOCs) induced from bone marrow-derived mesenchymal stem cells (MSCs) on beta-tricalcium phosphate (beta-TCP) with recombinant human bone morphogenetic protein (rhBMP-2) in vitro. Osteoblast differentiation was induced in confluent cultures by adding 100 nM dexamethasone, 10 mM beta-glycerophosphate, 50 mM L-ascorbic acid. The Alizarin red S staining and reverse transcriptase-polymerase chain reaction (RT-PCR) were perfomed to examine the mRNA expression of alkaline phosphatase (ALP), bone sialoprotein (BSP), osteocalcin (OCN), receptor activator for nuclear factor kappaB ligand (RANKL), runt-related transcription factor 2 (RUNX2), collagen-I (COL-I). There were no significant differences in the osteogenic potentials of DOCs induced from MSCs on beta-TCP(+/-). According to the incubation period, there were significant increasing of Alizadin red S staining in the induction 3 weeks. The mRNA expression of ALP, RUNX2, and RANKL were higher in DOCs/beta-TCP(-) than DOCs/beta-TCP(+). According to rhBMP-2 concentrations, the mRNA expression of BSP was significantly increased in DOCs/beta-TCP(+) compared to that of DOCs/beta-TCP(-) on rhBMP 10 ng/ml. Our study presented the beta-TCP will have the possibility that calcium phosphate directly affect the osteoblastic differentiation of the bone marrowderived MSCs.
Alkaline Phosphatase ; Anthraquinones ; Ascorbic Acid ; Bone Morphogenetic Proteins ; Calcium ; Calcium Phosphates ; Dexamethasone ; Durapatite ; Glycerophosphates ; Humans ; Integrin-Binding Sialoprotein ; Mesenchymal Stromal Cells ; Osteoblasts ; Osteocalcin ; Osteogenesis ; RNA, Messenger ; Transcription Factors