The paint gun is an industrial instrument which ejects paint through a small opening with pressure of l,500 to 3,000 Ib/inch. In case of the paint-gun injury, the paint penetrates through a tiny wound of skin and spreads widely along the fascial plane or tendon sheath. It destroys the tissues rapidly. Moreover, the toxicity of the paint material evokes acute inflammatory reaction which is accompanied by localized swelling, erythema, heat and sometimes generalized symptoms (i.e fever). Local toxic reaction leads to swelling, circulatory disturhance and foIlowed hy gangrene of the tissue. Sometimes tissue condition is too desperate to survive and bring about amputation unfortunately. Authors treated eleven patients of the paint gun injury f'rom March 1988 to April 1995. The paint materials were removed thoroughly via large skin incision as immediately as possible after the injury. Usually the wound is left to be open for seven to ten days and is followed by delayed primary wound closure. In our experience of three cases of delayed removal( two, five and seven days after injury), the outcomes were poor with problems of pain, sensory disturhance, limitation of finger motio, and two cases of digit amputation. On doing paint gun injection, right hand was used to hold the paint-gun and left hand was used to hold the cable. Our study showed right hands were injured mainly(nine cases). It means the paint gun injury is caused by inattention of work partner.
Amputation ; Erythema ; Fingers ; Gangrene ; Hand ; Hot Temperature ; Humans ; Paint* ; Skin ; Tendons ; Wounds and Injuries

A new bioelectrical impedance method has been developed and evaluated. The electrodes; were made of stainless steel and electrical interfaces were created by an upright subject gripping hand electrodes and stepping onto foot electrodes. Eight tactile electrodes were in contact with surfaces of both hands and feet; thumb, palm and fingers, front sole, and rear sole. Automatic on-off switches were used to change current pathways and to measure voltage differences for target segments. Segmental body resistances and whole body resistance(RWHOLE)were measured in 60 healthy subjects. Segmental resistances of right arm(RRA), left arm(RLA), trunk(RT), right leg(RRL) and left leg(RLL)were310.0+/-61.6 omega, 316.9+/-64.6 omega, 25.1+/-3.4 omega, 236.8+/-31.2 omega and 237.6+/-30.4 omega, respectively. Individual segmental impedance indexes(Ht2/RRA, Ht2/RT, and Ht2 /RLA) were closely related to lean body mass(LBM)as measured by densitometry ranged from r=0.925 to 0.960. Ht2/(RRA+RT+RLA) predicted LBM slightly better(r=0.969) than the traditional index, Ht2/RWHOLE(r=0.964), supporting the accuracy of the segmental measurement. A multiple regression equation utilizing Ht2/RRA, Ht2/RT and Ht2/RRL predicted LBM with r=0.971. Ht2/RRA term of the regression contributed to more than 40% of the LBM prediction, indicating that lean mass of arm represented whole body LBM more closely than other body segments. The new bioimpedance method was characterized by upright posture, eight tactile electrodes, segmental measurements and utilization of electronic switches in comparison with the traditional method. The measurement with this new method was extremely reproducible, quick and easy to use.
Adipose Tissue ; Arm ; Body Composition* ; Densitometry ; Electric Impedance* ; Electrodes ; Fingers ; Foot ; Hand ; Hand Strength ; Posture ; Stainless Steel ; Thumb

Animals ; Dental Implants ; Female ; Hand ; Humans ; Intercellular Signaling Peptides and Proteins ; Male ; Osseointegration ; Osteogenesis ; Plants ; Polymerase Chain Reaction ; Titanium

From the prudent use of quinolone in clinical practice, quinolone-resistant E. coli strains are being isolated with increasing frequency in the community as well as in the hospital. To analyze the risk factors, clinical features and prognosis of QREC, we reviewed the microbiologic records of E. coli bacteremia patients, estimated the quinolone consumption and performed the PFGE to compare genetic diversity. From 1994 to 1998, 40 episodes of QREC bacteremia were observed, 15 cases (37.5%) were hospital acquired. Overall, there is significant correlation between the increased incidence of QREC bacteremia and the upward trend in quinolone use in the hospital as out-and in-patients medication (P=0.003, r=0.98). When we compare the 40 case patients with 80 simultaneous control patients who had quinolone-susceptible E. coli bacteremia, the case patients more frequently had chronic underlying illness, prior use of quinolones and other antibiotics. Quinolone resistance was not significantly associated with higher mortality. A logistic regression analysis identified prior quinolone (P=0.001) use and prior use of other antibiotics (P=0.04) as the only independent risk factors for QREC bacteremia. 10-or 8-different PFGE patterns were observed in QREC isolates from community and hospital. They revealed little evidence of clonal spread, and may have emerged in direct response to the selective pressure exerted by antibiotic use.
Anti-Bacterial Agents ; Bacteremia* ; Genetic Variation ; Humans ; Incidence ; Logistic Models ; Mortality ; Prognosis ; Quinolones ; Risk Factors

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a frequent complication of liver cirrhosis, with prevalence ranging from 5% to 25% during hospitalization. Enteric aerobic gram-negative bacteria are the most common causative organisms of SBP. Long term fluoroquinolone administration to cirrhotic patients reduces the risk of SBP but induces high level resistance to antibiotics. In this study, we compare the incidence, clinical characteristics of SBP and antibiotics-resistance of organisms isolated from ciprofloxacin-treated cirrhotic patients with those in cirrhotic patients not receiving fluoroquinone prophylaxis. METHODS: Retrospective analysis was done. 55 ciprofloxacin-treated patients and 92 control patients were selected from cirrhotic patients, they were followed up in Korea university Guro hospital from August 1994 to July 1998. Clinical and laboratory data were compared in both group. RESULTS: We found a significantly lower incidence of SBP in ciprofloxacin-treated patients [27% (15/55) vs 44% (41/92); P=0.03]. There were no significant difference in admission duration, treatment duration, cure rates and mortality. Gram-negative bacilli, especially E. coli are most frequent bacteria isolated from ascites on both groups (60.0% vs 53.6%). Ciprofloxacin resistant gram-negative bacilli were isolated more frequently in the treated group [50% (5/10) vs 16% (5/31); P=0.03]. Methicillin resistant gram-positive cocci were isolated more frequently in the treated group, also. The therapeutic response of SBP were good in spite of ciprofloxacin resistance (90%). High serum creatinine concentration was independent risk factor for poor prognosis of SBP. CONCLUSION: Selective gut decontamination with long term ciprofloxacin in severe cirrhotic patients reduces incidence and recurrence of SBP, but has no significant influence on clinical features and prognosis of SBP. The prevalence of ciprofloxacin resistant gram-negative bacilli and methicillin resistant gram-positive bacilli increased in ciprofloxacin treated group. These findings should be taken into account when weighting the advantage and disadvantage of selective gut decontamination with ciprofloxacin.
Anti-Bacterial Agents ; Ascites ; Bacteria ; Ciprofloxacin* ; Creatinine ; Decontamination* ; Gram-Negative Bacteria ; Gram-Positive Cocci ; Hospitalization ; Humans ; Incidence ; Korea ; Liver Cirrhosis* ; Liver* ; Methicillin Resistance ; Mortality ; Peritonitis ; Prevalence ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors

Meningococcal disease is still a major cause of sporadic endemic and epidemic diseases throughout the world. In Korea meningococcal epidemics have been documented occasionally in military recruits, where as sporadic cases rarely reported. Meningococcemia represents a part of the various spectrum of the illness, and its clinical manifestations varied from mild fever to fulminant catastrophic events within a few hours after onset of symptoms. We experienced a case of a sporadic fulminant meningococcemia presenting with fever, petechiae, and purpura. The patient was a 21-year old female nursing school student. She had high fever, petechiae and purpura on both lower extremities, which spreaded to the whole body with peripheral gangrene during her admission days. Despite the treatment with ceftriaxone and chloramphenicol, refractory shock developed. She expired on the third day after onset of symptoms. Neisseria meningitidis was cultured from the blood after she died.
Ceftriaxone ; Chloramphenicol ; Female ; Fever ; Gangrene ; Humans ; Korea ; Lower Extremity ; Military Personnel ; Neisseria meningitidis ; Purpura ; Schools, Nursing ; Shock ; Young Adult

FISH is suggested as a possible method to detect the numerical and structural abnormalities of chromosomes in interphase nucleus. We performed this study to discuss the clinical usefulness of FISH in uncultured amniocytes and to set up the cut-off value for further study. We collected amniotic fluid samples from patients whose chromosome studies were recommended due to screen positive for Down and Edword syndrome in triple marker test using maternal serum. The centromeric probe for chromosome 18 and the locus-specific probe for chromosome 21 were used and the results were compared to their karyotypes. We could find 2 cases of trisony 21 and 2 cases of trisony 18 and the other cases represented normal karyotypes. The accuracies were 91% for disomy 18, 89% for trisomy 18, 92% for disomy 21 and 88% for trisomy 21. Therefore FISH technique is a possible method to detect the chromosomal abnormalities in uncultured amniocytes and the use of locus-specific probe for chromosome 21 would be more useful for detecting the aneuploidy of chromosome 21 than 13/21 centromeric probe.
Amniotic Fluid ; Aneuploidy ; Chromosome Aberrations ; Chromosomes, Human, Pair 18 ; Chromosomes, Human, Pair 21 ; Down Syndrome* ; Female ; Fluorescence* ; Humans ; In Situ Hybridization* ; In Situ Hybridization, Fluorescence ; Interphase ; Karyotype ; Trisomy

BACKGROUND: Community-acquired pneumonia (CAP) is more frequent in the elderly and results in higher morbidity and mortality. Korea is undergoing extraordinary demographic change. Elderly patients constitute an even-increasing proportion of the population but there have been few studies on the epidemiological investigation of the CAP in the elderly. The purpose of this study was to characterize the background, etiology, clinical course and outcome of CAP in elderly compared with younger patients. METHODS: During the study period (from 1st January to 31th December 1997), 214 patients with CAP were reviewed with regard to epidemiological, clinical, laboratory and microbiological data. 119 elderly patients (> or =65 years-old of age) were compared with 95 younger patients (<65 years-old of age). The both groups were compared with each others in terms of variables related to CAP. RESULTS: Comparison of epidemiological data between older and younger patients revealed a high prevalence of alcoholics (40% vs 56%), current smoker (33% vs 56%), malignancy (8% vs 24%) in the elderly. In terms of complication and clinical manifestation, shock (1% vs 6%), intubation (6% vs 20%), mechanical ventilation apply (5% vs 18%), respiratory failure (2% vs 12%), dyspnea (26% vs 56%), altered consciousness (0% vs 13%), extrapulmonary symptom (11% vs 18%) and bilateral infiltration (8% vs 20%) showed higher incidence in the elderly than in the younger patients. Causative organisms are identified in 47% (56/119) of elderly patients: those identified most frequently were S. pneumoniae (25%), K. pneumoniae (20%), S. aureus (16%), other Gram-negative bacilli (13%) and H. influenzae (11%). The overall mortality were significantly higher in the elderly patients (24%) than younger patients (5%). Two independent risk factors, those were related to the mortality of the elderly:higher APACHE II score (RR:3.43, 95% CI=1.43~7.21) and requirement of endotracheal tube (RR:4.73; 95% CI=1.72~16.5). CONCLUSION: CAP in the elderly shows more serious clinical and abnormal laboratory features than younger patients. In elderly, S. pneumoniae was the most common causative organism for CAP but other agents, particularly K. pneumoniae was isolated frequently. The severity of illness at initial presentation such as high APACHE II score and requirement of endotracheal tube were the major variables affecting the outcome.
Aged* ; Alcoholics ; APACHE ; Consciousness ; Dyspnea ; Humans ; Incidence ; Influenza, Human ; Intubation ; Korea ; Mortality ; Pneumonia* ; Prevalence ; Respiration, Artificial ; Respiratory Insufficiency ; Risk Factors ; Shock

Clostridium septicum is a toxin producing anaerobic, motile, spore-forming, spindle shaped Gram positive rod that may cause devastating systemic illness in patients with neutropenia and underlying hematologic or gastrointestinal malignancy. Clostridium septicum sepsis usually have fulminating clinical courses, and unless the appropriate antibiotics are administered soon after admission, the outcome is fatal. We experienced a case of sepsis due to Clostridium septicum, in a 65-year-old woman with peripheral T-cell lymphoma and diabetes mellitus. She was admitted due to abdominal pain, fever, chilling, nausea, vomiting and watery diarrhea, followed by rapidly progressive course. This patient was not improved by intensive care and continuous antibiotic therapy, expired at the 4th hospital day. Clostridium septicum grew from premortem blood cultures.
Abdominal Pain ; Aged ; Anti-Bacterial Agents ; Clostridium septicum* ; Clostridium* ; Diabetes Mellitus ; Diarrhea ; Female ; Fever ; Humans ; Critical Care ; Lymphoma, T-Cell, Peripheral ; Nausea ; Neutropenia ; Sepsis* ; Vomiting

PURPOSE: It was reported that 25% to 75% patients with a periampullary cancer were found to be unresectable after exploratory surgery. The aim of this study was to evaluate the role of a prophylactic gastrojejunostomy in patients with an unresectable periampullary cancer. METHODS: During January 1999 to April 2004, a prophylactic gastrojejunostomy (GJ group) or no gastrojejunostomy (non-GJ group) was carried out for an unresectable periampullary cancer without a gastric outlet obstruction in 42 patients. The clinicopathological characteristics, postoperative complications and time survival were evaluated retrospectively. RESULTS: Of the 42 patients, a prophylactic gastrojejunostomy was performed in 24 cases. There were no immediate postoperative deaths in both groups, and the postoperative morbidity rate was similar in both groups (GJ group 10% vs non-GJ group 7%). There were no differences in the mean postoperative hospital stay (GJ group 29.5 days vs non-GJ group 26.8 days) and mean survival (GJ group 7.5 months vs non-GJ group 8.1 months) between the two groups. In the 5 of the non-GJ group (27%), a postoperative gastric outlet obstruction had developed. The median interval time between the initial exploration and the postoperative gastrojejunostomy was 4.1 months. CONCLUSION: Although a small number of patients developed a postoperative gastric outlet obstruction in the non-GJ group, the prophylactic gastrojejunostomy did not increase the number of postoperative complications or the length of hospitalstay. However, several patients who did not received the prophylactic gastrojejunostomy developed a duodenal obstruction. Furthermore they needed a prophylactic gastrojejunostomy. These results suggest that a prophylactic gastrojejunostomy is a necessary and feasible procedure for patients with an unresectable periampullary cancer without duodenal obstructive symptoms.
Bile Ducts ; Duodenal Obstruction ; Gastric Bypass* ; Gastric Outlet Obstruction ; Humans ; Length of Stay ; Pancreas ; Postoperative Complications ; Retrospective Studies