Exact titration of anti-HBs with mIU/mL unit is necessary in evaluating the success of HBV vaccination or in making a decision to increase the dose of HBV vaccination. Data of distribution of anti-HBs titers can contribute to cutting of public health costs by reducing unnecessary HBV booster doses. Moreover, anti-HBc is also an important marker for differentiation of vaccination-induced anti-HBs from infection-acquired anti-HBs. However, not much study about these subjects has been done in Korea. So we evaluated anti-HBs associated with anti-HBc and vaccination history. HBsAg and anti-HBs tests were done in 1,465 cases. The positive rates of HBsAg and anti-HBs were 4.5% and 74.6%, respectively. Anti-HBs positive rate was higher in the vaccinated group than that in the non-vaccinated group. The rates of anti-HBs positive cases with lower titers (10-< 100 mIU/mL) were 31.9%, while cases with higher titers (> or = 100 mIU/mL) were 68.1%. This suggested about 70% of anti-HBs-positive Korean adults (about 53% of the general adult population) have long-lasting immunity against HBV infection and may not require booster doses of HBV vaccination for a long time. Anti-HBs titers in the vaccine-induced anti-HBs group were higher than those in the infection-acquired anti-HBs group. No statistical differences were noted between male and female or among age groups. 25.7% of the HBsAg (-)/anti-HBs (-) group showed anti-HBc positive and HBV-DNA was detected in 11.1% among HBsAg (-)/anti-HBs (-)/anti-HBcAb (+) cases. Further study about post vaccination anti-HBs titer decay in Korean should be performed to help cut vaccination costs.
Adult ; Age Distribution ; Aged ; Female ; Hepatitis B Antibodies/analysis* ; Hepatitis B Surface Antigens/immunology* ; Hepatitis B Vaccines/therapeutic use ; Human ; Immunization ; Korea ; Male ; Medical Records ; Middle Age ; Sex Distribution

In May 2015, we conducted a voluntary online survey on laboratory diagnostic assays for Clostridium difficile infection (CDI) across clinical microbiology laboratories in Korea. Responses were obtained from 66 laboratories, including 61 hospitals and five commercial laboratories. Among them, nine laboratories reported having not conducted CDI assays. The toxin AB enzyme immunoassay (toxin AB EIA), nucleic acid amplification test (NAAT), and C. difficile culture, alone or in combination with other assays, were used in 51 (89.5%), 37 (64.9%), and 37 (64.9%) of the remaining 57 laboratories, respectively, and 23 (40.4%) of the laboratories performed all three assays. Only one laboratory used the glutamate dehydrogenase assay. Nine laboratories used the toxin AB EIA as a stand-alone assay. The median (range) of examined specimens in one month for the toxin AB EIA, NAAT, and C. difficile culture was 160 (50–2,060), 70 (7–720), and 130 (9–750), respectively. These findings serve as valuable basic data regarding the current status of laboratory diagnosis of CDI in Korea, offering guidance for improved implementation.
Clinical Laboratory Techniques ; Clostridium difficile ; Clostridium ; Glutamate Dehydrogenase ; Immunoenzyme Techniques ; Korea ; Nucleic Acid Amplification Techniques

Background: Various methods are used for the diagnosis of Clostridioides difficile infection (CDI). We systematically analyzed and investigated the performance of current laboratory diagnostic methods for CDI. Methods: We performed systematic review and meta-analysis of studies in PubMed, Web of Science, Cochrane Library, and KoreaMed. The following methods were evaluated: glutamate dehydrogenase (GDH) enzyme immunoassays (GDH EIAs), toxin A and B detection by enzyme immunoassays (toxin AB EIAs), and nucleic acid amplification tests (NAATs) for C. difficile toxin genes. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each method were calculated. Results: Based on 39 studies, the pooled sensitivities/specificities were 92.7%/94.6%, 57.9%/97.0%, and 90.0%/95.8% for GDH EIAs, toxin AB EIAs, and NAATs, respectively, compared with those of toxigenic culture. The pooled sensitivities of automated EIAs were significantly higher than those of non-automated EIAs for both GDH and toxins A and B.The pooled sensitivity of Xpert C. difficile was significantly higher than those of other NAATs. PPVs increased as CDI prevalence increased, and NPVs were excellent when CDI prevalence was low; at CDI prevalence of 5%, PPV = 37%–65% and NPV = 97%–100%;at CDI prevalence of 50%, PPV = 92%–97% and NPV = 65%–98%. Conclusions Toxin AB EIAs still show unsatisfactory sensitivity, whereas GDH EIAs and NAATs show relatively high sensitivity. However, toxin AB EIAs are the most specific tests. This study may provide useful information for CDI diagnosis.

The primary rhabdomyosarcoma of the brain is very rare. There are only 14 cases reported in the literatures till 1975, and the majority of them were arised in the cerebellum. The intracranial rhabdomyosarcomas may be originated from the multipotent mesenchymal cells of aberrent muscle tissue in the leptomeninges. The histological 3 types are adult pleomorphic, alveolar and embryonal type. The demonstration of cross-striation is confirmed for diagnosis of this tumor. All of these tumors tend to have a short clinical course, but the survival time seems to be slightly improved by surgical excision followed by radiotherapy. We have recently experienced one case of primary rhabdomyosarcoma in the left cerebellopontine angle of 9 year-old girl, which was confirmed by operation and complete autopsy.
Adult ; Autopsy ; Brain ; Cerebellopontine Angle ; Cerebellum ; Child ; Diagnosis ; Female ; Humans ; Radiotherapy ; Rhabdomyosarcoma*

OBJECTIVE: To estimate the probable cause and the time of cerebral insult in cerebral palsy (CP) based on MRI findings and risk factors. METHOD: The subjects comprised all sixty-seven patients with CP showing abnormal MRI findings between March 1999 and September 2001 at the Catholic University of Korea, St. Mary's Hospital. A detailed medical history was available for all patients including those not born in our hospital. They ranged in age from two months to five years. We analyzed the brain magnetic resonance (MR) findings of patients with CP to correlate the probable cause and the time of cerebral insult through the consideration of medical histories including prenatal, perinatal and postnatal histories. RESULTS: Of the 67 MRIs, abnormalities were the followings; periventricular leukomalacias (PVLs) in 49 cases, cortical or subcortical infarction in 4 cases, brain atrophy in 7 cases, neuronal migration disorder in 4 cases, and delayed myelination in 3 cases. Among the patients with PVL, perinatal risk factors were responsible for cerebral insult in preterm, but pre- and perinatal contribution were similar in patients born at full term. Among the patients with cerebral infarction, only one case with meningitis at 11 months was suspected for cerebral insult. These patients had no risk factor as a peri- or post-natal etiology. Four patients with neuronal migration disorder had no risk factor for peri- or postnatal etiology except for the one who was a twin. CONCLUSION: Review of brain MRI findings such as PVL, infarct, neuronal migration disorder and a detailed medical history including prenatal and perinatal etiology would be a useful method to estimate the probable cause and the time of cerebral insult in CP.
Atrophy ; Brain ; Cerebral Infarction ; Cerebral Palsy* ; Humans ; Infant, Newborn ; Korea ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging ; Meningitis ; Myelin Sheath ; Neuronal Migration Disorders ; Risk Factors ; Twins

A 59-year-old woman was scheduled for mitral valvuloplasty and Maze operation. As operation was planed to use the robotically controlled camera (Aesop 3000, Computermotion(r), USA) for the minimally invasive robot-assisted thoracotomy, a superior vena cava (SVC) cannula (Femoral arterial cannula [21 Fr], Medtronic(r), USA) was inserted in the right internal jugular vein. After insertion of the SVC cannula, a pulmonary artery (PA) catheter (Swan-Ganz CCOmbo V [7.5 Fr], Edwards(r), USA) was inserted through an advanced venous access device (AVA 3Xi [8.5 Fr], Edwards(r), USA) in the right subclavian vein. The tip of the PA catheter could not be advanced into SVC and blood was not regurgitated. In the chest AP X-ray, it was found that the advanced venous access device was kinked by the SVC cannula. So the advanced venous access device was withdrawn about 5 cm and the PA catheter was advanced easily to the destination.
Catheters* ; Female ; Humans ; Jugular Veins ; Middle Aged ; Pulmonary Artery* ; Subclavian Vein ; Thoracic Surgery* ; Thoracotomy ; Thorax ; Vena Cava, Superior*

BACKGROUND: The disposable patient-controlled analgesia (PCA) devices are convenient for portability and management. An ideal PCA can be developed as an electronic device with various functions of safety and control. Recently, Accumate 1000(R) was developed as an electronic pump in Korea, and has passed the relevant laboratory criteria of safety and efficacy. We conducted a clinical study on the safety and efficacy when the device is applied to patients. METHODS: Fentanyl 1,500microgram, ketorolac 180 mg, and ondansetron 8 mg were used for PCA. Continuous infusion rate, bolus dose, and lockout time were set at 1 ml/h, 1 ml, and 15 min, respectively. Fifty patients were monitored for 48 h. The safety of Accumate 1000(R) was evaluated by backflow and siphonage, auto-clamp function, and lockout time intraoperatively. The efficacy was evaluated by the accuracy of bolus and total infused dose, and the satisfaction rates of patients and users. RESULTS: Backflow and siphonage did not occur, and the auto-clamp function was excellent. There was no bolus infusion during lockout time, and the bolus dose was infused accurately after lockout time. For the accuracy of the total infused dose, the mean and median value of performance error between the infused and target doses were -0.55%, and -0.29%, respectively. Noise, button sense, and convenience of cable were rated as satisfactory by 90%, 78%, and 84%, of patients respectively. CONCLUSIONS: The safety and efficacy of Accumate 1000(R) were established by clinical trial. We can provide patients with the more precise and optimal analgesia. The history of drug infusion can be used as research data.
Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Ketorolac ; Korea ; Noise ; Ondansetron ; Passive Cutaneous Anaphylaxis

No abstract available.
Nephrotic Syndrome* ; Prenatal Diagnosis*

Since it has been proposed that chorionic villus sampling could be an etiology of limb reduction defect, the relation between limb defect and chorionic villus sampling remains controversial. We experienced a case of limb reduction defect after chorionic villus sampling at 9 gestational weeks and report the case with brief review of literature.
Chorion* ; Chorionic Villi Sampling* ; Chorionic Villi* ; Extremities* ; Female ; Pregnancy

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals in Korea. The overall rate of MRSA in hospitals in Korea was estimated over 60%. Recently hospital infections caused by MRSA are getting increased and problematic in Korea, Our hospital Seoul Paik Hospital, has been trying to solve this problem. We had not applied exact methods for hospital infection control. Therefore, we adapted strict methods under the control of hospital infection control committee (HICC) and assessed the effectiveness of these methods. METHODS: Every month, the number of MRSA isolates was collected and analyzed; the results of the analysis were reported to every ward. All wards were supplied with Microshild(R) (Johnson & Johnson, Australia), Clean N' Fresh(R) (Carroll, USA), and standard paper towels. Health care workers were regularly educated for hospital infection control. The use of antibiotics was controlled by the HICC. We compared MRSA isolation rate between before and after applying the strict infection control methods under the regulation of HICC. Mann-Whitney U test, one-way ANOVA, and Chi-square test were used for statistical analysis of the results. RESULTS: After restricting the uses of antibiotics, glycopeptides and carbapenems were prescribed 15% less (20.3 vs 17.3 DDD /1000 patient-days) and 35% less (9.3 vs 6.0 DDD /1000 patient-days) respectively, compared to before restricting antibiotics. Methicillin resistance rate was decreased from 78% to 69% compared to before the methods(p=0.02). The isolation rate of MRSA was reduced by 31-42% from 2.33 to 1.35-1.60/1000 patient-days compared to before adapting strict infection control methods (p=0.04-0.07). CONCLUSION: This study showed that applying the strict infection control methods in the hospital can be effective to reduce the isolation rate of MRSA.
Anti-Bacterial Agents ; Carbapenems ; Cross Infection* ; Delivery of Health Care ; Dichlorodiphenyldichloroethane ; Glycopeptides ; Infection Control ; Korea ; Methicillin Resistance ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus ; Seoul ; Staphylococcus aureus* ; Staphylococcus*