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

Human cytomegalovirus (HCMV) isolated from Korean patients is different in the antigenic and genomic structure of gB from the laboratory-adapted strain. To dissect the reactivity to HCMV glycoprotein B (gB) domains, each domain gene of gB of HCMV SNUCH1, Korean isolate, was amplified from the extracted DNA of the virus-infected fibroblasts with the specific primers by polymerase chain reaction (PCR). Amplified DNA was cloned into pcDNA3. Immunofluorescent staining and western blot analysis revealed that the expressed gB in mammalian cells was immunoreactive and equivalent to the naturally expressed gB in virus-infected fibroblasts. The antigenic component reactive with monoclonal antibodies, MCMVA 57, 88, and 98 appeared at the D3 domain of gB molecule, and that with MCMVA 66 and 135 at the D2b domain. Antibody titer was measured with HCMV-infected fibroblasts and the domains of gB expressed in mammalian cells. There was no correlation between the antibody titer to the whole HCMV and neutralizing antibody titer, and between the antibody titer to whole HCMV and whole gB. It was more reasonable to use whole gB than whole HCMV in the comparison with the neutralizing antibody titer. D3 was representative domain in gB molecule in the anti-gB reactivity. Conclusively it is highly recommendable to use the representing isolates in Korea and its domains for the detection of antibody or the analysis of antigen in the aspect of immunological properties and molecular structures.
Antibodies, Monoclonal ; Antibodies, Neutralizing* ; Blotting, Western ; Clone Cells ; Cytomegalovirus* ; DNA ; Epitopes* ; Fibroblasts ; Glycoproteins ; Humans* ; Korea* ; Molecular Structure ; Polymerase Chain Reaction

No abstract available.
Classification* ; Humans ; Spinal Cord* ; Urodynamics*

Cleft Lip ; Congenital Abnormalities ; Humans ; Palate ; Rhinoplasty

BACKGROUND: The Technicon Immuno I utilizes various enzymatic kinetic analysis with colorimetric detection and magnetic particles. We evaluated this fully automated random-access immunoassay system which can perform latex agglutination and magnetic-separation sandwich/ competitive immunoassay. METHODS: We evaluated the assay precision, lower limits of detection, linearity, recovery, sample to sample carry-over, analytical interferences and comparison with other various methods for the following analytes: thyroxine (T4), thyroid stimulating hormone (TSH), free thyroxine (FT4), luteinizing hormone (LH), follicular stimulating hormone (FSH), prostate specific antigen (PSA), alpha-fetoprotein (AFP), carcino-embryonic antigen (CEA), CA 19-9, and digoxin. RESULTS: Satisfactory results were obtained for within-run and between-day precision in most analytes. Lower limits of detection were slightly higher than claimed by the manufacturer. The linearity was acceptable, but there were proportional errors for CEA and FT4. The recovery rates were also good except for PSA. Sample to sample carry-over was not detected. No significant analytical interference was caused by hemoglobin (up to 2,000 mg/L), lipid (up to 85 mmol/L) and bilirubin (up to 325 mol/L) except for digoxin, FT4 and PSA. The Technicon Immuno I assay correlated well with the comparison methods in most analytes, but the proportional biases were found for PSA and LH. CONCLUSIONS: The Technicon Immuno I is a satisfactory system for clinical use in most cases but more study would be requried for FT4. Especially, this system can replace the radioimmunoassay for FSH and LH.
Agglutination ; alpha-Fetoproteins ; Bias (Epidemiology) ; Bilirubin ; Digoxin ; Immunoassay* ; Latex ; Limit of Detection ; Luteinizing Hormone ; Prostate-Specific Antigen ; Radioimmunoassay ; Thyrotropin ; Thyroxine

BACKGROUND: The diagnosis of malaria has been usually made using microscopic examination of Wright stained thin blood films in Korean army. This method is labor-intensive, time consuming and requires the microscopic expertise. Therefore, the alternative techniques, rapid diagnostic test, have been sought for use in Korean army. We performed a comparison of the OptiMAL test with GENEDIA Malaria (P. vivax) Ab Rapid I, II to assess its sensitivity and specificity of Plasmodium vivax malaria. METHODS: Blood specimen were collected from 51 patients who were presented and initially diagnosed for P. vivax by the microscopy of blood smears and from 30 control patients without malaria infection at the Capital Armed Forces General Hospital (CAFGH) between October 2000 and February 2001. Among the 51 patients, we also collected 24 samples from 24 patients at 2 or 3 days after therapy. The OptiMAL test and GENEDIA Malaria (P. vivax) Ab Rapid I, II were performed according to the manufacturer's instructions on all samples respectively. RESULTS: Compared with the blood film, sensitivities and specificities of the OptiMAL test, GENEDIA Malaria (P. vivax) Ab Rapid I and GENEDIA Malaria (P. vivax) Ab Rapid II were 94.1~100% (29/29), 80.4~83.3%, 96.1~96.7% respectively. One case was interpreted as 'undetermined' by OptiMAL test. In 24 patients during therapy, the sensitivities of the OptiMAL test, GENEDIA Malaria (P. vivax) Ab Rapid I and GENEDIA Malaria (P. vivax) Ab Rapid II on 8 specimens with mean 120/microliter parasitemia and 16 specimens with negative parasitemia were 75~43.8%, 87.5~81.3%, 100~100% respectively. CONCLUSION: Our data demonstrated that the sensitivity and specificity of the GENEDIA Malaria (P. vivax) Ab Rapid I were not satisfactory, but the sensitivity and specificity of the OptiMAL test and GENEDIA Malaria (P. vivax) Ab Rapid II were relatively high and useful diagnostic tests for diagnosis of P. vivax in areas like the militaries where laboratory facilities are poor or non-existent.
Arm ; Diagnosis* ; Diagnostic Tests, Routine ; Hospitals, General ; Humans ; Malaria* ; Malaria, Vivax ; Microscopy ; Military Personnel* ; Parasitemia ; Plasmodium vivax* ; Plasmodium* ; Sensitivity and Specificity

BACKGROUND: Automated border detection (ABD) echocardiography is a convenient and objective tool in the estimation of left atrial (LA) area and function when compared to the off-line, two-dimensional echocardiographic method that requires manual tracing of the endocardial border. In addition, the applicability of the ABD system to instantaneously derive LA area and function may provide a noninvasive method to assess the diastolic interaction between the left ventricle and the left atrium. METHOD: 53 patients with a normal sinus rhythm and an apical four chamber view of LA area (in which at least 75% of the endocardium was clearly visible) were selected for this study. The on-line echocardiographic assessment of LA areas and function with automated boundary detection was performed and compared with the off-line estimation. From the instantaneous cavity area displayed by the ABD system, the extents of left atrial area decrease resulting from rapid ventricular filling (D) and atrial contraction (AC) were measured. The D/AC ratio was compared with the transmitral Doppler flow velocity E/A ratio. RESULTS: 1) The end-systolic area (ESA) and the end-diastolic area (EDA) of the left atrium, diastolic atrial emptying index (AEMI) and the systolic atrial expansion index (AEXI) with the ABD system were not different from those with the off-line, manually trace method. 2) ESA, EDA, AEMI and AEXI determined by the ABD system and the off-line method showed strong correlations (r=0.87, 0.79, 0.52 and 0.49 respectively). 3) D/AC ratio with the ABD system correlated significantly with the transmitral Doppler velocity E/A ratio (r=0.70). CONCLUSION: The ABD system may be used in the assessment of LA area and LA function and the diastolic interaction between the left atrium and the left ventricle.
Echocardiography* ; Endocardium ; Heart Atria ; Heart Ventricles ; Humans

337 spinal cord injured patients had been followed up for urologic management in Korea Veterans Hospital. 106 spinal cord injured patients, admitted due to urologic complications from 1990 to 1995, were analyzed. The level of cord injury was cervical in 26, thoracic in 63 and lumbar in 17 patients. The voiding method was suprapubic cystostomy in 32, clean intermittent catheterization in 27, self-voiding in 25, condom catheter in 14, urethral catheter in 6 and others in 2 patients. The common urologic complications were acute pyelonephritis, bladder stone, epididymitis, vesicoureteral reflux, low vesical compliance, autonomic dysreflexia and bladder tumor. Medical treatments for urologic complications were performed for 79 cases (46%) and surgical treatments for 92 cases (54%) We conclude that periodic urologic follow-up will be needed for early detection and management of urologic complications due to spinal cord injury.
Autonomic Dysreflexia ; Catheters ; Compliance ; Condoms ; Cystostomy ; Epididymitis ; Follow-Up Studies ; Hospitals, Veterans ; Humans ; Intermittent Urethral Catheterization ; Korea ; Male ; Pyelonephritis ; Spinal Cord Injuries ; Spinal Cord* ; Urinary Bladder Calculi ; Urinary Bladder Neoplasms ; Urinary Catheters ; Vesico-Ureteral Reflux

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

PURPOSE: In order to avoid functional disability that may be caused by radical excision or amputation in extremity soft tissue sarcomas, authors employed limb-conserving surgery together with extemal radiation therapy plus interstitial brachytherapy. MATERIALS AND METHODS: From June 1995 to Febrary 1997, 10 extremity soft tissue sarcoma patients were treated with limb-conserving surgery and external radiation therapy plus interstitial brachytherapy. In six patients, whose histologic diagnoses were made at the time of surgery, wide or marginal excision and interstitial brachytherapy was done 4 weeks before postoperative external radiation therapy. In four patients whose histologic confinnations were done before definitive treatment, preoperative external radiation therapy was given 4 weeks before surgery and interstitial brachytherapy. The types of surgery were wide excision in five patients, and marginal excision in five patients. Gross or microscopic residual was left at the surgical resection margins in four patients. The brachytherapy dose ranged from 17.5 Gy to 24 Gy and external beam radiation did from 40 Gy to 45 Gy. RESULTS: With the median follow-up duration of 21.5 months(range: 13 to 29 months); one local recurrence, and three new distant metastases were observed. There were three patients with wound complications attributable to the current treatment regimen. CONCLUSION: Satisfactory local tumor control may be achievable with limb-conserving surgery and external radiation therapy plus brachytherapy in patients with extremity soft tissue sarcomas, while more caution should be used to avoid wound problems.
Amputation ; Brachytherapy* ; Diagnosis ; Extremities* ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Sarcoma* ; Wounds and Injuries