BACKGROUND: With increase of antibiotics use and invasive procedures, infections caused by multi-resistant Acinetobacter baumannii (MRAB) are increasing. Recently, we experienced the outbreak of- nosocomial infections caused by MRAB resistant to imipenem and cefoperazone/sulbactam in intensive care units (ICU) and general ward. We analyzed the clinical characteristics of the infected patients and antibiotic susceptibility of the organisms. And surveillance cultures and IRS-PCR were performed to find out the transmission route. METHODS: We collected data from physical examination and clinical records. We performed surveillance cultures of environment, patients not infected with MRAB in ICU, and hands of health care workers. RESULTS: Between November 1996 and June 1997, 49 strains of MRAB were isolated from the 26 patients hospitalized in Kangnam St. Mary' s Hospital. The lower respiratory infection (13 cases) was the most common infection and sputum was the most common sources (47.1%). All strains of MRAB showed the same genotype. In disk diffusion test, all strains were resistant to piperacillin, gentamicin, amikacin, ceftazidime, cefoperazone/sulbactam, aztreonam, imipencm, ciprofloxacin. From the surveillance cultures, the genotypically identical strains were isolated from ventilator Y-piece, the floor of ICU, and hands of health care workers. It suggested that this strain was transmitted through ventilatory device or hands of health care workers. We instructed all the health care workers to wash hands, to disinfect hospital environment completely. Since July 1997, no further case has occurred. CONCLUSIONS: Since A. baumannii could be transmitted through ventilatory devices and the hands of health care workers, it is important to wash hands and to disinfect hospital environment completely.
Acinetobacter baumannii* ; Acinetobacter* ; Amikacin ; Anti-Bacterial Agents ; Aztreonam ; Ceftazidime ; Ciprofloxacin ; Cross Infection* ; Delivery of Health Care ; Diffusion ; Genotype ; Gentamicins ; Hand ; Humans ; Imipenem* ; Critical Care Units ; Patients' Rooms ; Physical Examination ; Piperacillin ; Sputum ; Ventilators, Mechanical

BACKGROUND: Cleaning and disinfection of fiberoptic bronchoscope requires careful attention, especially to mycobacterium species because the contamination of mycobacteria could raise confusion on diagnosis. Recently, we detected contamination of Wydex(R) solution used in bronchoscope washer with Mycobacterium chelonae. In this study, we evaluated the mycobactericidal effect of 12 kinds of disinfectants for M. chelonae. METHOD: To evaluate the bactericidal effect of Wydex(R) 2%, Cidex(R) 2.25%, Cidex(R) 3%, Bacteriokiller (BK) disinfectant, Perasafe(R), HICLO-S(R), Lamicine(R), ethanol, Instrusept(R), Virkon(R), Betadine(R), and Vipon(R) against M. chelonae, culture was performed after exposure of two M. chelonae strains (ATCC 35749, the type strain and the strain isolated from contaminated Wydex(R) solution) to each disinfectant solution. The growth of organism was examined for up to 8 weeks. RESULTS: Growth of M. chelonae (reference strain of ATCC 35749 and isolated strain) was observed after a week incubation for Wydex(R) 2%, Cidex(R) (2.25%, 3%) and control. For BK disinfectant and Perasafe(R), they grew after 2-3 weeks, and 3-4 weeks, respectively. For HICLO-S(R) and Lamicine(R), only the contaminated strain grew after two and three weeks, respectively. For ethanol, Virkon(R), Betadine(R), Vipon(R), and Instrusept(R) , growth was not observed from either strain. CONCLUSIONS: On the basis of these results, Instrusept(R), virkon(R), ethanol, Betadine(R), and Vipon(R) were effective for the disinfection of M. chelonae. Especially, Instrusept(R) was thought to be useful as a disinfectant for bronchoscopes because it has advantages including non-corrosiveness, chemical stability, and non-irritativeness. And additional washing with ethanol might be effective. The finding that strain isolated from contaminated bronchoscopes was more resistant to disinfectants than reference strain suggested that the more resistant strains are selected throughout the improper disinfection.
Bronchoscopes ; Diagnosis ; Disinfectants* ; Disinfection ; Ethanol ; Mycobacterium chelonae* ; Mycobacterium*

Thirty five male Sprague-Dawley rats were treated with cadmium chloride solution ranging from 0.2 to 3.2mg CdCl2/kg by intravenous single injection. At 48 hours after administration of cadmium, total cadmium, MT bound cadmium and histopathologic finding in liver, kidney, lung, heart, testis, metallothionein in liver, kidney and total cadmium in blood were examined. Tissue cadmium concentration was highest in liver, followed by in kidney, heart, lung and testis. Cadmium bound to metallothionein(MT-Cd) and ratio of MT-Cd to total cadmium were increased in liver and kidney dependently of cadmium exposure dose, but not significantly changed in other organs. On histopathologic finding, the most susceptible organ was heart in considering cadmium exposed dose, but testis in considering cadmium concentration. Blood cadmium concentration was increased with dose-dependent pattern, and significantly correlated with tissue cadmium concentration, so that we may estimate tissue cadmium concentration by measurement of blood cadmium concentration. Metallothionein in liver and kidney was increased with dose-dependent pattern, higher in liver than in kidney, and was significantly correlated with tissue cadmium concentration. However, metallothionein induction efficiency of tissue cadmium(microgram MT/microgram Cd) was greater in liver than in kidney, and reverse to tissue concentration or exposed dose of cadmium.
Animals ; Cadmium Chloride ; Cadmium* ; Heart ; Humans ; Kidney ; Liver ; Lung ; Male ; Metallothionein* ; Rats* ; Rats, Sprague-Dawley ; Testis

No abstract available.
Pulmonary Atelectasis*

Five cases of histologically proven polymorphic reticulosis were examined with computed tomography(CT). CT findings were mucosal thickening along the septal and lateral walls of the nasal cavities(n=4), obliteration of the contour of the nasopharynx(n=4), involvement of the paranasal sinuses (n=2), destruction of the nasal septum and/or sinus walls(n=3) and mass in the palate, tonsil or neck (n=1). CT examination was helpful in determining the extent of the disease in the nasal cavity and paranasal sinuses. However, lesions in the palate and tonsils could not be easily evaluated with CT. CT findings of polymorphic reticulosis are nonspecific and granulomatous diseases may show similar CT findings.
Granuloma, Lethal Midline* ; Nasal Cavity ; Nasal Septum ; Neck ; Palate ; Palatine Tonsil ; Paranasal Sinuses

After the report of the first case of pandemic influenza A virus H1N1 on April 2009, this infection caused more than 16 thousands deaths world-widely. Postinfectious cough is known to be one of the important causes of chronic cough. We experienced five cases of persistent cough, which developed after influenza A virus H1N1 infection. All of the cases showed bronchial hyperreactivity by methacholine inhalation challenge. We prescribed steroids, which resulted in complete symptomatic recovery within 50 days, but the bronchial hyperreactivity was not normalized. We describe these five cases in regard to clinical characteristics, methacholine challenge test, and anti-inflammatory treatment.
Bronchial Hyperreactivity ; Cough ; Influenza A virus ; Influenza, Human ; Inhalation ; Methacholine Chloride ; Pandemics ; Steroids

40 cases of bile duct carcinoma gathered over a 6-year period at Kosin Medical College were reviewed and theirclinical and cholangiographic findings were as follows: 1. There were 29 males and 11 females (the ratio of men towomen, 2.6:1) ranging from 37 to 74 years of age. The majority (70% of cases) were in 4th & 5th decades. 2.Clinical symptoms and signs: jaundice in 95%, RUQ or epigastric pain in 75%, pruritus in 52.5%, dark urine in 35%,weight loss in 32.5%, fever and chills in 22.5%, clay colored stool in 12.5%, and palpable mass in 12.5%. 3.Lab,findings: elevated serum total bilirubin(above 20.0mg% in 45%, 10.0-19.0mg% in 22.5%, 5.0-9.9mg% in 20%,1.3-4,9mg% in 5%), elevated alkaline phosphatase in 95%. Clonorchiasis were noted in 17.5%. 4. Histologic findingswere adenocarcinoma in most cases. 5. The location of bile duct carcinoma were common hepatic duct in 35%, commonbile duct in 32.5%, porta hepatis in 12.5%, junction with cystic duct in 10% and diffuse form in 10%. 6. In 33cases, PTC or post-operative cholangiographic examination were done. And the most frequent findings weredilatation of the proximal bile duct and abrupt narrowing or complete obstruction of distal lumen. In 27cases(82%), complete obstruction of bile duct was noted. Attempts were made to analyze the type of obstruction:Constricted type in 39%, Nipple type in 18%, round or flat type (smooth or slightly irregular) in 15%, andserratd type in 9%. Incomplete obstruction were noted in 6 cases(18%). Among them, abrupt narrowing of lumen wasnoted in 9% and diffuse narrowing in 9%. 7. ERCP was done in 7 cases. Findings were constricted type in 42.6%,constricted and slightly irregular type in 14.3%, downward convexity in 14.3%, diffuse irregular narrowing in14.3% and intraluminal filling defect in 14.3%.
Adenocarcinoma ; Alkaline Phosphatase ; Bile Ducts ; Bile ; Chills ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchiasis ; Cystic Duct ; Female ; Fever ; Hepatic Duct, Common ; Humans ; Jaundice ; Male ; Nipples ; Pruritus

BACKGROUND: Nosocomial urinary tract infection (UTI) accounts for 35% of the nosocomial infection and 80-90% of them are associated with urethral catheters. Recently, we experienced an outbreak of nosocomial UTI caused by multidrug-resistant Pseudomonas aeruginosa in neurosurgical intensive care unit (NSICU). METHODS: We investigated clinical records of the patients and observed the methods of care of urethral catheters in NSICU. Identification of P. aeruginose was done by API NE (API system; bioMerieux, France) and antibiotic susceptibility tests were done by disk diffusion method. Random Amplification of Polymorphic DNA (RAPD) assay was used as a genotyping method. RESULTS: Between November 1997 and January 1998, 11 P. aeruginosa strains were isolated from the urine of 11 patients hospitalized in NSICU of Kangnam St. Mary's Hospital. Routine regular bladder irrigation, and emptying urine with common urinal had been done falsely. Antibiogram of the isolates showed resistance to multiple antibiotics including imipenem, gentamicin. amikacin, piperacillin, ciprofloxacin, ceftazidime, and cefoperazone/sulbactam. RAPD of the outbreak strains showed clonal relatedness, which was different from those of other clinical strains, We instructed all the health care workers to stop bladder Irrigation, and to use the separate urinals for each patient. Thereafter, no further case of P. aeruginosa UTI has occurred. CONCLUSION: An outbreak of UTI, caused by a single clone of P. aeruginosa, was confirmed by RAPD and was eradicated after correction of false practice on care-of urinary catheter.
Amikacin ; Anti-Bacterial Agents ; Ceftazidime ; Ciprofloxacin ; Clone Cells ; Cross Infection ; Delivery of Health Care ; Diffusion ; DNA ; Drug Resistance, Multiple ; Gentamicins ; Humans ; Imipenem ; Intensive Care Units ; Microbial Sensitivity Tests ; Piperacillin ; Pseudomonas aeruginosa* ; Pseudomonas* ; Urinary Bladder ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

PURPOSE: Resonance Frequency Analysis(RFA) technique can be used as an effective method in measuring the implant stability and documenting the clinical results. This technique also determines how stable the implant is before performing a prosthetic practice. Having become one the guidelines of the implant therapy whose final objective is the immediate loading, the Osstell(TM) mentor is giving a lot of information to the clinicians recently. In this communication, experiments were performed to investigate how reliable the measured ISQ values by Osstell(TM) mentor are, and to see if those are also stable even after sterilization. As five objectives: 1) How stable measured ISQ values after fixation Smartpeg(TM)s for 400 times. 2) How stable measured ISQ values after 'attach-detach'Smartpeg(TM)s for 400 times. 3) How stable measured ISQ values after clinical sterilization methods. 4) How stable measured ISQ values after repeatedly sterilization in autoclave for 10 times. 5) What is the critical temperature which is lost the magnetism of Smartpeg(TM). MATERIALS AND METHODS: Clinical sterilization methods(Autoclave sterilization, Dentistar sterilization, Ultra violet sterilization, Vacuum dry unit sterilization, Boiling water sterilization, combined H(2)O(2) and Alcohol sterilization). Smartpeg(TM)s. D3 Block bone(3x9x2cm). Osstem implant(phi 4.1-10mm). Osstell(TM) mentor. Individual experiment was used 8 number of Smartpeg(TM)s and they had measured to ISQ values of before experiment and after experiment. RESULTS: 1. The measured ISQ values did not change after fixation Smartpeg(TM)s for 400 times. 2. There was no significant changes in the measured ISQ values of 'attach-detach Smartpeg(TM)s' for 400 times. 3. The measured ISQ values did not change after the usual clinical sterilization methods. 4. The measured ISQ values did not change after sterilization in autoclave for 10 times. 5. It was impossible to exactly measure the critical temperature which is lost the magnetism of Smartpeg(TM)s. But, the results was resulted to lost its magnetism in higher temperature than 150 degrees C/10 minute. CONCLUSION: The measured ISQ values showed insignificant differences in case of no changes in the magnetism of the Smartpeg(TM)s. It seems that the Smartpeg(TM)s can be used repeatedly in every measurement if the original magnetisms of the Smartpeg(TM)s can be recognized. There seems to be no significant changes in the measured ISQ values of 'attach-detach Smartpeg(TM)s' only if the screw pitches were unimpaired. The clinical sterilization methods seems acceptable because the result was resulted to lost its magnetism in higher temperature than 150 degrees C/10minute.
Humans ; Magnets ; Mentors ; Sterilization ; Vacuum ; Viola ; Water

PURPOSE: To evaluate the outcome of coronary lesions for efficacy of dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD). METHODS: Retrospective studies were performed on 438 cases of KD treated with one or two episode of high-dose IVIG and 24 cases with dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD) at this hospital from June 2000 to January 2004. 2D echocardiogram was done at admission, 2 months later and every 2 or 3 months when coronary lesion had improved more than 2 months later. RESULTS: In 108(24.7%) of 438 cases with IVIG therapy only, 10(41.7%) of 24 cases with dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD), coronary abnormality had been shown by initial 2D-echocardiogram examined at acute stage. In 10(2.3%) of 438 patients with IVIG therapy only, and in 3(12.5%) of 24 cases with additional IVIG retreatment, coronary lesions were still remained at follow-up echocardiogram. Even though it had tendency to increase the coronary lesions in the group with dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD), there was no significant differences about the incidence of coronary lesions between two groups. There was no significant differences in age, sex, and other clinical findings between two groups. CONCLUSION: The combination therapy with high doses of IVIG and aspirin in KD is the standard treatment but not always effective. The dexamethasone therapy may be another treatment of choice after additional immunoglobulin(IVIG) retreated in IVIG- resistant Kawasaki disease(KD).
Aspirin ; Dexamethasone* ; Follow-Up Studies ; Humans ; Immunoglobulins, Intravenous ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Retreatment ; Retrospective Studies