BACKGROUND: This study was conducted to investigate whether the preoperative nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) was a risk factor for surgical site infections and nosocomial infections in open heart surgery patients. METHODS: From June 10, 2002 to October 30, 2002, data were collected by prospective surveillance carried out by infection control nurses. Nasal swabs were taken from patients (N= 106) on the day before surgery. The swabs were incubated in staphylococcal broth for 24 hours, and then it was incubated on mannitol salt agar for 24 hours. Muller-Hinton agar supplemented with oxacillin (6 microgram/mL) was used to identify MRSA. RESULTS: Among the study patients (N=106), four(4/106, 3.8%) were identified as MRSA carriers and nine (9/103 , 8.7%) developed nosocomial infections, including three patients (3/103 , 2.9%) who had postoperative mediastinitis Preoperative nasal carriage of MRSA was not associated with nosocomial infections nor surgical site infections (P>0.05). However, the length of hospital stay prior to nasal swab or surgery was found to be associated with MRSA carriage (OR=1.108, 95%CI: 1.026-1.197) or nosocomial infections (OR=1.087, 95%CI: 1.017-1.161). Additionally, the patients with nosocomial infections were more likely than those without to stay in the hospital for a longer period after surgery (P<0.00l). CONCLUSION: Preoperative nasal carriage of MRSA by the patient was not identified as a risk factor for surgical site infection and nosocomial infections in open heart surgery.
Agar ; Cross Infection* ; Humans ; Infection Control ; Length of Stay ; Mannitol ; Mediastinitis ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Oxacillin ; Prospective Studies ; Risk Factors ; Thoracic Surgery*

BACKGROUND: Leukocytes have been shown to be an undesirable contaminants in platelet transfusions because these contaminants may develop various adverse consequences. Current platelet products by plateletpheresis are heavily contaminated with leukocytes. Recently, new platelet apheresis system (COBE Spectra LRSTM) was designed to make it possible to collect platelets with very low leukocytes contamination. We evaluated the COBE Spectra LRSTM by comparing it with COBE Spectra. METHODS: Plateletpheresis procedures were performed on 75 normal donors; 45 procedures for COBE Spectra LRSTM and 30 procedures for COBE Spectra. We evaluated platelet yields, processing times, efficiency, and leukocytes content on two apheresis machines. RESULTS: Comparative results of COBE Spectra LRSTM with COBE Spectra were as follows: the mean processing time per unit was 97 min and 91 min, the efficiency per unit was 38.4 +/- 11.5% and 46.9 +/- 12.1%, the mean leukocytes contamination per unit was 6.1x104 and 2.1x106 respectively (p<0.01). The platelet yields per unit were 2.79 +/- 1.04x1011 with COBE Spectra LRSTM and 3.13 +/- 0.91x1011 with COBE Spectra (p>0.05). CONCLUSIONS: Platelet collections with COBE Spectra LRSTM demonstrated comparable platelet yields and strikingly low WBC contamination. This study indicate that the COBE Spectra LRSTM is an efficient and reliable system for the collection of platelets with very low residual WBC levels. It seems that leukocyte reduction filter for platelet products by COBE Spectra LRSTM is not necessary for further removal of leukocytes to prevent alloimmunization, non-hemolytic transfusion reactions, certain viral and bacterial infections.
Bacterial Infections ; Blood Component Removal ; Blood Group Incompatibility ; Blood Platelets ; Humans ; Leukocytes ; Platelet Transfusion ; Plateletpheresis ; Tissue Donors

BACKGROUND: Diagnosis of AMI in the patients presenting with chest pain of an atypical nature or with a nondiagnostic ECG requires the evaluation of certain biochemical markers. Biochemical markers most often used for the early detection of myocardial damage are CK-MBact, troponin, and myoglobin. The clinical value of measuring serum myoglobin was compared to that of troponin and CK-MBact in the patient with acute chest pain syndrome. METHOD: We studied timed, sequential measurements of serum myoglobin, CK-MBact and troponin-T obtained from 72 patients who were admitted for the evaluation of suspected AMI within 12 hours after the chest pain onset. Patients with a history of recent trauma, cardiogenic shock, renal failure, or who had received recent cardiopulmonary resuscitation were excluded. We calculated the sensitivity, specificity, negative predictive value, and positive predictive value. Data were analyzed with the Chi-square test for differences in proportion. A value of p<0.05 was considered statistically significant. RESULT: 1) The mean time from symptom onset to arrival at the emergency department was 3.5+/-0.6 hours. 2) There were no statistical differences in age, sex and risk factors between AMI, angina pectoris and atypical chest pain group. 3) The negative predictive value of myoglobin was significantly higher than those of CK-MBact and troponin-T from 3 to 6 hours after the onset of chest pain. 4) The time to peak of myoglobin level was shorter than those of CK-MBact and troponin-T in AMI patients. CONCLUSION: Within 3 to 6 hours after the onset of symptoms, myoglobin is a better marker than CK-MBact or troponin-T in ruling out AMI for the patient with acute chest pain syndrome.
Angina Pectoris ; Biomarkers* ; Cardiopulmonary Resuscitation ; Chest Pain ; Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Humans ; Myocardial Infarction* ; Myoglobin* ; Renal Insufficiency ; Risk Factors ; Sensitivity and Specificity ; Shock, Cardiogenic ; Troponin ; Troponin T

BACKGROUND: Cell cycle progression is governed by cell cycle regulators and inhibitors such as the cyclin dependent kinases (CDK), p27(Kip1), p21(WAF1/Cip1) and p53. The purpose of this study was to correlate expressions of p34(cdc2), p27(Kip1), p21(WAF1/Cip1) and p53 with the various clinicopathologic prognostic parameters of human breast cancers. METHODS: The paraffin-embedded tissue sections from 102 patients with human breast carcinomas were examined by performing immunohistochemical staining. The primary antibodies used for immunohistochemical staining were mouse monoclonal antibody to human p34(cdc2), p27(Kip1), p21(WAF1/Cip1), p53, ER and PR. RESULTS: The expression rates of p34(cdc2), p21(WAF1/Cip1) and p53 were 29.3%, 40.2% and 49.1% in breast carcinomas, respectively. In normal breast tissues, p34(cdc2), p21(WAF1/Cip1) and p53 were not expressed. The p34(cdc2) was expressed in the cytoplasm of cancer cells. The expression rate of p27(Kip1) was 29.3% in breast carcinomas and 100% in normal breast tissues, so the loss of p27(Kip1) expression in breast cancer was noted. The high expression of p21(WAF1/Cip1) in neoplastic cells was associated with the p53 expression (p=0.03). The expression of p27(Kip1) was correlated with that of the progesterone receptor (PR) (p=0.04) and the expression of p21(WAF1/Cip1) was correlated with that of positivity for estrogen receptor (ER) (p=0.04) and PR (p=0.04). No correlation was demonstrated between the mean patient survival and the expression rate of p34(cdc2), p27(Kip1), p21(WAF1/Cip1) and p53. CONCLUSIONS: The loss of the normal cell growth cycle by the abnormal expression of cyclin dependent kinases and their inhibitors and the steroid hormones may play an important role in human breast carcinogenesis. The p53 dependent p21(WAF1/Cip1) pathway, the p27(Kip1) protein loss and the cdc2 overexpression were important in development and progression of human breast cancer.
Animals ; Antibodies ; Breast Neoplasms ; Breast* ; Carcinogenesis ; Cell Cycle ; Cyclin-Dependent Kinases ; Cytoplasm ; Estrogens ; Humans* ; Mice ; Receptors, Progesterone

Objective: The present study aimed to assess the relationship between incidental abnormalities on thoracic computed tomography (CT) and mortality in a general screening population using a long-term follow-up analysis. Materials and Methods: We retrospectively collected the medical records and CT images of 840 participants (mean age ± standard deviation [SD], 58.5 ± 6.7 years; 564 male) who underwent thoracic CT at a single health promotion center between 2007 and 2010. Two thoracic radiologists independently reviewed all CT images and evaluated any incidental abnormalities (interstitial lung abnormality [ILA], emphysema, coronary artery calcification [CAC], aortic valve [AV] calcification, and pulmonary nodules). Kaplan–Meier analysis with log-rank and z-tests was performed to assess the relationship between incidental CT abnormalities and all-cause mortality in the subsequent follow-up. Cox proportional hazards regression was performed to further identify risk factors of all-cause mortality among the incidental CT abnormalities and clinical factors. Results: Among the 840 participants, 55 (6%), 171 (20%), 288 (34%), 396 (47%), and 97 (11%) had findings of ILA, emphysema, CAC, pulmonary nodule, and AV calcification, respectively, on initial CT. The participants were followed up for a mean period ± SD of 10.9 ± 1.4 years. All incidental CT abnormalities were associated with all-cause mortality in univariable analysis (p < 0.05). However, multivariable analysis further revealed fibrotic ILA as an independent risk factor for all-cause mortality (hazard ratio, 2.52 [95% confidence interval, 1.02–6.22], p = 0.046). ILA were also identified as an independent risk factor for lung cancer or respiratory disease-related deaths. Conclusion Incidental abnormalities on screening thoracic CT were associated with increased mortality during the long-term follow-up. Among incidental CT abnormalities, fibrotic ILA were independently associated with increased mortality. Appropriate management and surveillance may be required for patients with fibrotic ILA on thoracic CT obtained for general screening purposes.

OBJECTIVES: The purpose of this ex vivo study was to compare the antifungal activity of a synthetic peptide consisting of 15 amino acids at the C-terminus of human β-defensin 3 (HBD3-C15) with calcium hydroxide (CH) and Nystatin (Nys) against Candida albicans (C. albicans) biofilm. MATERIALS AND METHODS: C. albicans were grown on cover glass bottom dishes or human dentin disks for 48 hr, and then treated with HBD3-C15 (0, 12.5, 25, 50, 100, 150, 200, and 300 µg/mL), CH (100 µg/mL), and Nys (20 µg/mL) for 7 days at 37℃. On cover glass, live and dead cells in the biomass were measured by the FilmTracer Biofilm viability assay, and observed by confocal laser scanning microscopy (CLSM). On dentin, normal, diminished and ruptured cells were observed by field-emission scanning electron microscopy (FE-SEM). The results were subjected to a two-tailed t-test, a one way analysis variance and a post hoc test at a significance level of p = 0.05. RESULTS: C. albicans survival on dentin was inhibited by HBD3-C15 in a dose-dependent manner. There were fewer aggregations of C. albicans in the groups of Nys and HBD3-C15 (≥ 100 µg/mL). CLSM showed C. albicans survival was reduced by HBD3-C15 in a dose dependent manner. Nys and HBD3-C15 (≥ 100 µg/mL) showed significant fungicidal activity compared to CH group (p < 0.05). CONCLUSIONS: Synthetic HBD3-C15 peptide (≥ 100 µg/mL) and Nys exhibited significantly higher antifungal activity than CH against C. albicans by inhibiting cell survival and biofilm.
Amino Acids ; Biofilms ; Biomass ; Calcium Hydroxide ; Candida albicans ; Cell Survival ; Dentin ; Glass ; Humans* ; Microscopy, Confocal ; Microscopy, Electron, Scanning ; Nystatin

Granulomatous Mastitis (GM) is a rare chronic inflammatory lesion of the breast that clinically simulate carcinoma. The purpose of this report is to review the clinicopathological features of this clinical entity in a series of 5 cases that were diagnosed at our institute. Mammography, ultrasonography, and fine needle aspiration were performed in all cases. The treatment of choice for granulomatous mastitis is unclear. Of the 5 cases, one case underwent steroid therapy, two cases underwent anti-tuberculosis medication, and the others underwent only excision. There were no complications for the 5 cases during the follow-up periods. Therefore, the diagnosis and treatment of granulomatous mastitis should be determined on a case by case basis, by the clinician considering the various case results that have been reported on.
Biopsy, Fine-Needle ; Breast ; Diagnosis ; Follow-Up Studies ; Granulomatous Mastitis* ; Mammography ; Ultrasonography

OBJECTIVES: Shunt-dependent hydrocephalus is the major sequela after subarachnoid hemorrhage (SAH) and this continues to be a major source of morbidity for these patients. The prevalence and risk factors are not clear, despite the significant clinical and basic science research that's been done. We analyze the risk factors of shunt-dependent hydrocephalus such as the clinical and radiological parameters, the treatment modality and the peri-operative preparation. METHODS: We collected data on 475 patients with aneurysmal SAH and who were admitted to our hospital between January 1996 and January 2005. We retrospectively analyzed the age, gender, Hunt-Hess grade, Fisher grade, hypertension, intraventricular hemorrhage (IVH), rebleeding, vasospasm, location of aneurysm, treatment modality, timing of surgery, lumbar drainage, external ventricular drainage (EVD) and the prognosis as risk factors. RESULTS: 22.1% (105/475) of the aneurysmal SAH patients developed shunt-dependent hydrocephalus. Univariate analysis revealed that the patient's age, Hunt Hess grade, IVH, rebleeding, vasospasm, location of aneurysm, timing of operation, lumbar drainage, EVD and the prognosis had statistically significant correlation with the development of shunt-dependent hydrocephalus (p<0.05). Through multivariate regression analysis, the aneurysms located in the posterior circulation, use of lumbar drainage and the cases with acute hydrocephalus showed a high prevalence of shunt-dependent hydrocephalus. CONCLUSION: Among the numerous factors, only lumbar drainage was a partially controllable factor. Further analysis of the clinical factors associated with CSF drainage and re-evaluation of the indications for drainage are needed.
Aneurysm* ; Drainage ; Hemorrhage ; Humans ; Hydrocephalus* ; Hypertension ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Factors* ; Subarachnoid Hemorrhage*

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as a sensorineural hearing loss which develops abruptly without definitive causes. Stellate ganglion block (SGB) has been used as one of the treatment modalities in ISSNHL. However, published data establishing the effect of SGB has been slim. We conducted this study to evaluate the effect of SGB according to the factors that may influence the prognosis of the disease. METHODS: We reviewed the records of 343 patients. The control group was managed with medications, and the SGB group was managed with SGB and the same medications. SGB was performed with 5 ml of 1.0% mepivacaine. The pure-tone audiogram was performed after the therapy and Siegel's criteria was used to define the recovery of hearing. RESULTS: The recovery rate of the SGB group was higher than that of the control group (58.1% vs. 42.1%, P < 0.05). The SGB group had a higher recovery rate than the control group in patients treated within 7 days from the onset of symptoms (66.9% vs. 44.1%, P < 0.05), without diabetes mellitus (58.5% vs. 44.9%, P < 0.05), without dizziness (61.6% vs. 44.6%, P < 0.05), or whose initial hearing loss was between 71 and 90 dB (69.4% vs. 38.9%, P < 0.05). CONCLUSIONS: SGB is thought to be a useful therapy for ISSNHL, especially in the patients treated within 7 days, without diabetes mellitus, dizziness, or whose initial hearing loss was severe.
Diabetes Mellitus ; Dizziness ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural* ; Humans ; Mepivacaine ; Prognosis ; Stellate Ganglion*

Posttraumatic high-flow communications between the intracavernous internal carotid artery (ICA) and the cavernous sinus may give rise to two different pathological entities. A connection from the intracavernous ICA system can theoretically connect with two different structures; the vein of the plexus (CCF) or the perivascular bare spaces between the veins (pseudoaneurysm). A CCF and a pseudoaneurysm can be present in the same patient. A 24-year-old man was admitted to our hospital due to sudden mental deterioration. Carotid angiography revealed a CCF, which had occurred after a trauma 5 years earlier, associated with left visual disturbance and skull base fractures. The treatment of choice was permanent coil occlusion of the intracavernous ICA at the level of the lesion. The collateral circulation was evaluated before the endovascular treatment using a balloon test occlusion (BTO). During the BTO, adequate collateral circulation was defined as symmetric angiographic filling of both hemispheres. A continuous neurological examination was performed during the procedure. The follow-up angiography showed a persistent aneurysm occlusion. We report our experience of the successful endovascular treatment of combined lesions with a review of the relevant literature.
Aneurysm ; Aneurysm, False* ; Angiography ; Carotid Artery, Internal ; Cavernous Sinus ; Collateral Circulation ; Fistula* ; Follow-Up Studies ; Humans ; Neurologic Examination ; Skull Base ; Veins ; Young Adult