BACKGROUND: It is well known that Methicillin-resistant Staphylococcus aureus (MRSA) is hardly controllable organism among pathogens of nosocomial infection. The MRSA infection control measures have been initiated at a brand new tertiary care teaching hospital which was opened in June, 1994. However, the control measures did bring out little effect. In 1997, reenforcement of all control measures were practiced in intensive care units. The measures brought out a significant improvement in reducing the incidence of MRSA infection, subsequently the same control measures were implemented through-out the entire inpatient area. METHODS: The following control measures have been reenforced since March 1997: first, application of thorough surveillance of confirmed MRSA infected patients: second, providing cohort care: third, enforcing handwashing practices after patient contact; fourth, establishing infected patients isolation zone: fifth, tagging infected patient's bed and medical record, providing disinfectant spray for washing hands, identifying and treating carriers among patient contact staffs, separate disposal of contaminated wastes, and finally repeating education of nursing staff and family members of the patients. Each month the number of incidence in MRSA nosocomial infection were followed and the leu supervisors were notified the outcome. RESULTS: The incidence of MRSA infection started to decline soon after the initiation of the control measures, from 132% in March 1997 to 5.8% in July 1997. In 1998, the infection rate maintained close to 2-3%. There had been 467 MRSA infected cases (5.7%) out of 8,253 discharges during the study period; among them 319 cases were infected once; 40 cases twice; 15 cases three times: four cases four times and 1 case seven times. The order of preference of organs infected are lungs (56.3%), wounds(11.8%), blood (7.9%), and urinary tract (1.9%). The highest incidence of this infection was found in Medicine (34.8%) and Neurosurgery (22.8%) CONCLUSION: The implementation and reenforcement of infection control measures are key to successful control of nosocomial infection, in particular, hand washing of patient contact staffs and eradication of carriers could be the most effective measures.
Cohort Studies ; Cross Infection* ; Education ; Hand ; Hand Disinfection ; Hospitals, Teaching ; Humans ; Incidence ; Infection Control ; Inpatients ; Intensive Care Units* ; Critical Care* ; Lung ; Medical Records ; Methicillin-Resistant Staphylococcus aureus* ; Neurosurgery ; Nursing Staff ; Tertiary Healthcare ; Urinary Tract

Angiosarcoma is a rare malignant vascular tumor of endothelial cell origin. Most lesions of cutaneous angiosarcoma occur over the face and scalp. We experienced a case of angiosarcoma of the scalp in a 63-year-old man. Multiple pea-sized erythematous papules and nodules developed on the forehead 6 months ago. Thereafter, the lesions have extended to make violaceous, compressible and hemorrhagic plaques. On histologic examination, there were irregular, often anastomosing vascular channels lined by the atypical endothelial cells in the dermis.
Dermis ; Endothelial Cells ; Forehead ; Hemangiosarcoma* ; Humans ; Middle Aged ; Scalp*

The effect of topical steroid application on clinical results of 215 eyes(126 patients) performed with excimer laser photorefractive keratectomy (PRK) from July 1993 to July 1994 was evaluated, postopertively. The range of myopia was between -2.5 and -11.5 diopter and followed for 9 months after PRK with Summit Omnimed(TM). Topical corticosteroid or non-steroidal antiinflammatory drug (NSAID) was not applied for one month after operation in all cases. After one month, in cases of 115 eyes showing myopic regression of more than -1 diopter or stromal haziness of more than grade 1(delayed steroid group; DSG), 0.1% fluorometholone was applied 4 times daily for 4 weeks, then tapered according to the planned schedule. 46.5% (100 eyes, non-steroid group;NSG) did not show the myopic regression nor stromal haziness without treatment of fluorometholone throughout the follow-up period. Uncorrected visual acuity, spherical equivalent and corneal haziness were evaluated 1, 2, 4, 8, 12, 24, 36 week after operation. 73%(73 eyes) of NSG and 27%(30 eyes) of DSG showed a myopia less than 6.0 diopters preoperatively. The proportion of male was 36% in NSG and 50.4% in DSG. 88.1% of male high myopia(>6.0 diopters) needed 0.1% fluorometholone, while 17.6% of female moderate and mild myopia( Appointments and Schedules ; Female ; Fluorometholone ; Follow-Up Studies ; Humans ; Incidence ; Lasers, Excimer* ; Male ; Myopia ; Photorefractive Keratectomy* ; Visual Acuity

The authors reviewed retrospectively retinal detachment(RD)s following posterior chamber intraocular lens(PC-IOL) implantation by transscleral suture fixation. One hundred twenty-two transscleral fixations of PC-IOL were performed from January, 1990 to December, 1992. The follow-up periods for this series ranged from 12 to 42 months. Six retinal detachments developed in this series. and the incidence of RD was 4.9%. There was no statistical difference between the primary operation group(unplanned posterior capsule rupture during extracapsular cataract extraction, lens dislocation/subluxation) and the secondary operation group(already aphakia after previous cataract surgery). The predisposing factors to RD were myopic eye(p=0.03), postoperative vitreous hemorrhage(p=0.001). In cases with RD, the locations of transscleral fixation sutures almost coincided with the meridians of the retinal breaks. The contributing factors to increased incidence of RD were thought to be vitreous loss during operations, vitreous traction by suturing needle or haptics of IOL, proliferative change by vitreous hemorrhage.
Aphakia ; Cataract ; Cataract Extraction ; Causality ; Follow-Up Studies ; Incidence ; Lenses, Intraocular* ; Meridians ; Needles ; Retinal Detachment* ; Retinal Perforations ; Retinaldehyde* ; Retrospective Studies ; Rupture ; Sutures ; Traction ; Vitreous Hemorrhage

No abstract available.
Drug Therapy* ; Pregnancy*

PURPOSE: The purpose of this study is to analyze the measurement differences of simple radiographs according to radiation projection angle using a phantom and to propose methods for objective analysis of simple radiographs. MATERIALS AND METHODS: We took simple radiographs with different projection angles using a C-arm image intensifier and measured five parameters of the foot on the simple radiographic images. Five parameters include lateral tibiocalcaneal angle, lateral talocalcaneal angle, naviculocuboid overlap, lateral talo-first metatarsal angle, and lateral calcaneo-first metatarsal angle. Intraobserver and interobserver reliability were verified, and then intraclass correlations of parameters were analyzed. RESULTS: Radiographic parameters of the foot showed high intraobserver and interobserver reliability. Lateral tibiocalcaneal angle has a strong negative linear relationship with rotation and a moderate negative linear relationship with tilt. Lateral talocalcaneal angle has a moderate positive linear relationship with rotation and a strong positive linear relationship with tilt. Naviculocuboid overlap has a strong positive linear relationship with rotation and a moderate positive linear relationship with tilt. Lateral talo-first metatarsal angle does not have a linear relationship with rotation and a moderate negative linear relationship with tilt. Lateral calcaneo-first metatarsal angle has a moderate positive linear relationship with rotation and tilt. CONCLUSION: More precise evaluation of the foot with a simple radiograph can be performed by understanding the changes of radiographic parameters according to radiation projection angle.
Foot* ; Metatarsal Bones ; Phantoms, Imaging ; Radiography

No abstract available.
DNA* ; Ploidies* ; Stomach Neoplasms*

PURPOSE: This study identified the characteristics differentiating node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD). METHODS: From July 2007 to June 2015, the medical records of patients with BCL, NFKD, and typical KD were retrospectively reviewed. We analyzed and compared the demographic, clinical, laboratory, and imaging characteristics of the cohorts. RESULTS: Twenty-two patients with BCL, 37 with NFKD, and 132 with typical KD were included in this study. Patients with BCL had longer durations of hospitalization than patients with NFKD. Bilateral and multiple enlarged cervical lymph nodes were associated more with NFKD than BCL. Compared with BCL patients, NFKD patients had lower platelet counts, higher percentages of neutrophils, and higher C-reactive protein (CRP) levels. NFKD patients were older and presented with higher white blood cell counts, percentages of neutrophils, absolute neutrophil counts, and CRP levels as well as lower platelet counts and alanine aminotransferase levels than typical KD patients. CONCLUSIONS: In febrile patients with cervical lymphadenopathy, the combination of bilateral and multiple enlarged nodes, low platelet count, high percentage of neutrophils, and high CRP levels should prompt consideration of NFKD for prevention of delayed diagnosis of KD.
Alanine Transaminase ; C-Reactive Protein ; Cohort Studies ; Delayed Diagnosis ; Diagnosis, Differential* ; Fever* ; Hospitalization ; Humans ; Leukocyte Count ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases* ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Platelet Count ; Retrospective Studies

BACKGROUND AND OBJECTIVES: beta-catenin has an essential role in intercellular adhesion and signal transduction. The Adenomatous poliposis coli (APC) protein interacts with beta-catenin in a multi-protein complex to regulate the level of expression of beta-catenin. Mutations in beta-catenin or APC gene can lead to the accumulation of beta-catenin in the cytosol and the nucleus. This study was designed to investigate the expression of APC and beta-catenin in laryngeal cancer. SUBJECTS AND METHOD: Immunohistochemical methods were used to determine the beta-catenin and APC protein expression in 15 laryngeal cancers. Results were correlated with clinicopathological parameters. RESULTS: beta-catenin expression to the plasma membrane was reduced or absent in 11 of 15 cases (73%) of the laryngeal cancers. Cytoplasmic expression of the beta-catenin was seen in 6 out of 15 cases (40%). APC immunoactivity was negative in 5 of 15 (33%) of the laryngeal cancers. One of the six cytoplasmic expressions of the beta-catenin was negative for APC immunoactivity, and one of the five negative for APC immunoactivity was cytoplasmic expression of the beta-catenin. CONCLUSION: There was no correlation between beta-catenin and APC protein in the analysis. This finding suggests that cytoplasmic expression of the beta-catenin resulted not from the APC mutation but from the beta-catenin mutation and abnormal Wnt signal. Only the expression of the beta-catenin in cytoplasm was associated with lymph node metastasis.
beta Catenin* ; Carcinoma, Squamous Cell* ; Cell Membrane ; Cytoplasm ; Cytosol ; Genes, APC ; Laryngeal Neoplasms* ; Lymph Nodes ; Neoplasm Metastasis ; Signal Transduction

PURPOSE: Acinetobacter species are aerobic gram-negative rods that can be widely found in nature and are a part of the normal flora of humans. The most clinical isolates of A. baumannii reflect infection rather than colonization. Recent reports suggest that the organisms cause serious and often fetal nosocomial infection such as ventilator-associated pneumonia. METHODS: From March to September 1998, we experienced thirty clinical isolates of A. baumannii in fifteen patients in Sonchunhyang University Chunan Hospital neonatal intensive care unit. Clinical characteristics, bacteriologic investigation, and molecular epidemiologic investigation by randomly amplified polymorphic DNA (RAPD) method was performed. RESULTS: The number of clinical isolates of A. baumannii were thirty and the number of Acinetobacter cases were fifteen. The duration of hospitalization and ventilator support were significantly longer in the patient group than in the control group. The most common culture site of A. baumannii was the endotracheal tube (83.3%). The thirty clinical isolates showed resistance to the most commonly used antibiotics. The RAPD result of A. baumannii isolated from fifteen patients showed the same band patterns, designating they were of the same strain. Surveillance cultures of medical staffs' hands, incubators, and ventilators failed to identify the source of infections. CONCLUSOIN: It is possible to have an outbreak of A. baumannii in a neonatal intensive care unit. In A. baumannii infection, the durations of hospitalization and ventilator support were significantly longer. It is very difficult to discover the source of A. baumannii outbreak.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; Chungcheongnam-do ; Colon ; Cross Infection ; DNA ; Hand ; Hospitalization ; Humans ; Incubators ; Infant, Newborn ; Intensive Care, Neonatal* ; Pneumonia, Ventilator-Associated ; Ventilators, Mechanical