Hysterosalpingography and Hysteroscopy have been used for the detection of intraute-rine pathology such as polyps, submucous myomas, intrauterine adhesion and endometrial hyperplasia or cancer. Recently the ultrasound has also been utilized for the detection of uterine pathology. Therefore the purpose of this study was to evaluate the diagnostic efficacy of SonoHysterography in detection of intrauterine pathology compared with HSG and Hysteroscopy. 32 patients underwent Sono-Hysterography and Hysteroscopy for the evaluation of the uterine pathology from september 1995 to January 1996. Nine of 32 patients had infertility problem and HSG performed prior to Sono-Hysterography and Hysteroscopy. The results are as follows : 1. The patients' ages ranged from 20 to 50 years(median 37.9). 2. All 9 patients with infertility who had positive HSG findings in uterine cavity showed the intrauterine pathology in Sono-Hysterography as well as Hysteroscopy. The detail findings are as follows :septated uterus(n=2), intrauterine adhesion :IUA(n=3), endometrial polyp(n=3), and IUA combined endmetrial hyperplasia(n=1). 3. Twenty two of 23 patients with abnormal uterine bleeding showed the intrauterne pathology and one patient had negative finding in Sono-Hysterography. However, Hysteroscopy revealed positive intrauterine pathology in 22 patients who had abnormal uterine bleeding. One patients who had positive finding in Sono-Hysterograply showed negative by Hysterography. In contrast, one patient who had negative finding in Sono-Hysterography had positive uterine pathology with polyp in Hysteroscopy. The histologic pathology in all 23 patients reported endometrial polyp(n=12), placental polyp(n=2), submucous myoma(n=1), endometrial hyperplasia(n=5), endometrial cancer(n=1), normal endometrial finding(n=2). 4. Sono-Hysterography, therefore, has a sensitivity and positive predictive value of 96.6%, 93.5% respectively. Our study showed a positive Sono-Hysterography is very predictive of the intrauterine pathology. Sono-Hysterography is safe, quick and minimal invasive procedure. So it is an invaluable technique in the evaluation of uterine cavity.
Endometrial Hyperplasia ; Female ; Humans ; Hysterosalpingography ; Hysteroscopy* ; Infertility ; Myoma ; Pathology* ; Polyps ; Ultrasonography ; Uterine Hemorrhage

BACKGROUND: Infections caused by vancomycin-resistant enterococci (VRE) are becoming increasingly prevalent throughout the world. VRE can spread by direct patient-to-patient contact as well as on the hands of personnel and contaminated environmental surfaces. The purpose of this study was to examine the incidence of VRE among total enterococci from clinical specimen and investigate the antimicrobial characteristics and resistance genotypes of isolated VRE. METHODS: A total of 790 enterococcal isolates from patients over a period of 12 months were screened for vancomycin resistance using brain heart infusion agar plates supplemented with 6 g/mL of vancomycin. The incidence of VRE among enterococcal isolates was calculated from microbiology statistics program. Twenty three isolates of VRE were tested for minimal inhibitory concentrations (MIC) of vancomycin, penicillin, and gentamicin and resistance genotypes. RESULTS: In the first half period, the incidence of VRE was 1.9%, and in the second half, the incidence increased to 7.7%. Thirteen strains were found to be highly resistant to vancomycin, penicillin and gentamicin (MIC, >128 g/mL). According to the direct PCR analyses, the frequency of vanB, vanC1, and vanC2 types was 13, 7, and 3 strains, respectively. CONCLUSIONS: Continued vigilance, strict enforcement of infection control, and curtailment of vancomycin use seem to be our best approaches to controlling this increasingly important problem. For this purposes, accurate and timely detection of vancomycin-resistance and periodic investigation for incidence are essential.
Agar ; Brain ; Genotype* ; Gentamicins ; Hand ; Heart ; Humans ; Incidence* ; Infection Control ; Penicillins ; Polymerase Chain Reaction ; Vancomycin ; Vancomycin Resistance

BACKGROUND: Asymptomatic vancomycin-resistant enterococci (VRE) colonization precedes infection. VRE-colonized patients serve as silent reservoirs of enterococci that go on to colonize other patients. Rapidly identifying colonized patients is crucial to prevent the spread of VRE. The culture-based method of VRE screening is time-consuming. We evaluated the diagnostic performance of a recently developed multiplex real-time PCR for the detection of VRE. METHODS: We obtained 105 rectal swabs from patients who were being monitored for carriage of VRE. After 24 hour incubation of swabs in enterococcosel broth (EB) supplemented with 6 microg/mL vancomycin, multiplex real-time PCR was performed using the Anyplex(TM) VanR Real-time Detection (VanR) kit (Seegene, Inc., Seoul, Korea). The results of multiplex real-time PCR were compared to those of culture. We evaluated the specificity and detection limits of multiplex real-time PCR using VanR for VRE. RESULTS: A total of 96/105 (91.4%) samples were VRE positive according to multiplex real-time PCR with EB while 85/105 (80.9%) samples were positive in culture. Eleven discordant results (10.4%) (multiplex real-time PCR positive, culture negative) were noted. All non-enterococcal bacteria and vancomycin-susceptible enterococci were negative. The DNA detection limits of VanR were 0.035 pg per reaction (3 microL) for Enterococcus faecium and 0.35 pg for Enterococcus faecalis. CONCLUSION: The application of multiplex real-time PCR after EB incubation allows rapid and sensitive detection in 26-28 hours for VRE screening from rectal swabs. This method could facilitate the timely implementation of contact isolation to prevent the spread of VRE.
Bacteria ; Colon ; DNA ; Enterococcus ; Enterococcus faecium ; Humans ; Limit of Detection ; Mass Screening ; Real-Time Polymerase Chain Reaction ; Sensitivity and Specificity ; Vancomycin

Anhidrotic ectodermal dysplasia is a rare genetic disorder characterized by absence or diminished numbers of structures derived from the ectoderm, and it is reported to be inherited as an x-linked recessive trait. It is recognized clinically by anhidrosis, hypotrichosis, anodontia or reduced numbers of teeth with deformed shape and characteristic facial features. In addition, otolaryngological manifestations include atrophic rhinitis, sensorineural hearing loss, and conductive hearing loss and satyr ear, among others. Early diagnosis of anhidrotic ectodermal dysplasia can prevent fatal hyperpyrexia and appropriate genetic counseling can be followed to make a reasonable future plans for the pediatric patient. A 2-month-old infant was referred with symptoms of intermittent nasal obstruction and crust formation in both nasal cavities. The nasal endoscope demonstrated atrophic changes of nasal mucosa and radiologic study showed an unerupted conical shaped tooth. The diagnosis of anhidrotic ectodermal dysplasia was confirmed with the finger impression test that revealed deficiency of sweat pores. We report a case of anhidrotic ectodermal dysplasia with a review of the literature.
Anodontia ; Diagnosis ; Ear ; Early Diagnosis ; Ectoderm ; Ectodermal Dysplasia* ; Endoscopes ; Fingers ; Genetic Counseling ; Hearing Loss, Conductive ; Hearing Loss, Sensorineural ; Humans ; Hypohidrosis ; Hypotrichosis ; Infant ; Nasal Cavity ; Nasal Mucosa ; Nasal Obstruction ; Rhinitis, Atrophic* ; Sweat ; Tooth

BACKGROUND: Survivors of childhood cancers are recommended to receive revaccinations after chemotherapy, although the universally recommended vaccination schedule for such children has not been established. We evaluated immune response following post-chemotherapy vaccinations in childhood cancer survivors.METHODS: The study included 59 patients who survived at least 5 years after completion of chemotherapy without evidence of recurrence. The patients received hepatitis-B virus (HBV) and measles, mumps, and rubella (MMR) vaccines 1 year after finishing chemotherapy according to our institutional protocol. Immune response to HBV and MMR vaccines was measured and seropositivity and factors hindering immune response to HBV and MMR vaccines were analyzed.RESULTS: The seropositivity for HBV was 88%; with a higher rate in patients with non-hematologic malignancies (100%, 18/18) than those with hematologic malignancies (78.3%, 18/23) (P=0.05) and reciprocally associated with the duration of chemotherapy (P=0.0043). The seropositivity for MMR viruses was 61%, 37% and 83% respectively, showing significantly lower response to mumps and was not different between hematologic malignancy group and non-hematologic malignancy group. Unlike HBV, the duration of chemotherapy did not affect seropositivity for MMR viruses. Ten children who failed to be immune to any of the MMR viruses received booster vaccination which resulted in seropositivity of 60% (3/5), 56% (4/9), 100% (2/2) respectively.CONCLUSION: Longer duration of chemotherapy and underlying hematologic malignancies were adversely associated with achieving immune response to HBV vaccine, but not to MMR vaccine. Our results also underline the need for booster vaccinations in non-responders to vaccinations post-chemotherapy.
Appointments and Schedules ; Child ; Drug Therapy ; Hematologic Neoplasms ; Hepatitis B virus ; Humans ; Immunization, Secondary ; Measles ; Measles-Mumps-Rubella Vaccine ; Mumps ; Recurrence ; Rubella ; Survivors ; Vaccination ; Vaccines

Background: Preoperative concerns of patients undergoing total hip arthroplasty (THA) and their complaints during the initial postoperative period are not well investigated. We evaluated preoperative concerns of patients and patient-perceived problems during the operation and initial 5 days after the operation. Methods: One hundred and thirty-two patients, who underwent primary THA at a tertiary referral hospital, were surveyed using a questionnaire and a face-to-face interview 1 day before the operation, operation day, and postoperative days 1, 2, 3, and 4. The severity of pain was assessed daily using a visual analog scale. Results: The most common preoperative concern was the severity of pain after the surgery (65.2%), followed by the need of transfusion (34.8%) and postoperative rehabilitation (32.6%). Among 29 patients who could recall the experience during the operation, 12 (41.4%) suffered from shoulder pain on the contralateral side, and 6 (20.7%) answered that hammering sound had been annoying. After returning to the ward, 29 patients (22.0%) suffered from nausea, 8 (6.1%) complained of back pain, and 7 (5.3%) had ipsilateral knee pain. On postoperative day 1, 7 patients (5.3%) had persistent back pain, 8 (6.1%) had headache, and 5 (3.8%) suffered from nausea. On postoperative day 2, nine patients (6.8%) complained of radiating pain due to aggravation of preexisting spinal stenosis, 7 (5.3%) complained of weakness of the hip flexor due to periarticular injection of ropivacaine during the operation, and 5 (3.8%) had dressing-related skin problem at the wound. On postoperative days 3 and 4, patients had no problem other than hip pain. The mean pain score was the highest (3.1 ± 1.0) on postoperative day 1. Conclusions The results of this study might provide information needed to solve problems and improve satisfaction of patients undergoing THA.

GMH/IVH(Germinal martrix-Intraventricular hemorrhage ) is an inportant factor that influences on the mortality rate of low-birth-weight infants. The real-time high resolution sonography with a mechanical sector scanner is a convenient and useful method for the detection and follow-up study of intracranial hemorrhage in low-birth-weight infants. Authors analysed 112 cases of neurosonographic findings in low-birth-weight infants, weighing less than 2,500gm. The incidence of GMH/IVH was 54.5%. The severity of GMH/IVH was classified into 4 grades(I-IV) and their percentages were 41%, 41% 8.1%, and 9.9%, respectively. The onset of GMH/IVH was within the first week after birth in 75.4% of cases. The overall mortality rate of low-birth-weight infants with GMH/IVH was 18% (4% for grade I, 12% for grade II, 40% for grade III and 83% for grade IV). In the follow-up study of 61 cases, complete absorption was seen in 25 cases, rebleeding in 5 cases, cystic change in 24 cases, ventriculomegaly in 9 cases and hydrocephalus in 7 cases. The incidence of GMH/IVH in neonates with pathologic lung conditions was 82.5% and that with normal lung conditions was 39%. In conclusion, sonography is very useful in the diagnosis and follow-up of GMH/IVH in low-birth-weight infants. Our study is the first step in the further study of the relationship between GMH/IVH and neuromotor outcome.
Absorption ; Diagnosis ; Follow-Up Studies* ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Infant* ; Infant, Low Birth Weight ; Infant, Newborn ; Intracranial Hemorrhages ; Lung ; Methods ; Mortality ; Parturition

Background: Spine-hip discordance (SHD) increases fracture risk. However, its prevalence and clinical implications have not been investigated in patients with hip fractures. This study determined the prevalence and association of SHD with mortality and investigated the cause of SHD in patients with hip fractures. Methods: This study included patients admitted for fragility hip fractures between 2011 and 2020. All patients underwent dual energy X-ray absorptiometry and anteroposterior and lateral views of the lumbosacral spine during admission. Data on demographics, diagnosis, American Society of Anesthesiologists score, and mortality were collected. A T-score difference of more than 1.5 between L1-4 and the femur neck was considered discordant, and 3 groups (lumbar low [LL] discordance, no discordance [ND], and femur neck low [FL] discordance) were compared. In the discordance group, lumbar radiographs were reviewed to determine the cause of discordance. Results: Among 1,220 eligible patients, 130 were excluded due to patient refusal or bilateral hip implantation; therefore, this study included 1,090 patients (271 male and 819 female). The prevalence of LL, ND, and FL was 4.4%, 66.4% and 29.2% in men and 3.9%, 76.1%, and 20.0% women. Mortality was not associated with discordance. The most common causes of discordance were physiological in the LL group and pathological in the FL group for both sexes. Conclusions Patients with hip fractures showed lower rates of ND and higher rates of FL compared to the general population. True discordance should be carefully judged for pathological and artifact reasons. The clinical implications of SHD require further investigation.

PURPOSE: To evaluate the efficacy of continuous drug delivery system using microinfusion pump by animal study METHODS: Schirmer test was performed after connecting the microinfusion pump at the superior fornix of rabbit eye. The pump was settled to instill artificial tears. We also evaluated the efficacy of continuous 0.1% fluorometholone infusion after alkali burn induced by 1N NaOH. RESULTS: Average change in Schirmer tear test value was 12.0mm/5min. The recovery after alkali burn was improved in the eye of continuous infusion of steroid eye drops. CONCLUSIONS: Microinfusion pump was thought to be useful as a continuous eye drops delivery system. It would be applicable to infuse artificial tears continuously in severe dry eye patients and to infuse antibiotic eye drops in infectous eye disease patients.
Alkalies ; Animals ; Burns ; Drug Delivery Systems ; Eye Diseases ; Fluorometholone ; Humans ; Ophthalmic Solutions ; Tears

PURPOSE: To evaluate the possibility of short-term dry eye model in rabbits by injection of concanavalin A (conA) to the lacrimal and haderian gland of rabbits. METHODS: We injected conA (10 mg/ml, 0.05 ml) to the lacrimal and haderian gland of rabbits twice to induce inflammation of lacrimal gland and compared with saline-injected control by lacrimal gland biopsy with H&E staining for identification of inflammation. The ratio of lacrimal secretion was evaluated by Schirmer test (preinjection vs. postinjection of conA) for 10 days and the number of goblet cells was counted in 10 consecutive high power field using impression cytology with PAS staining. The corneal & conjunctival apoptotic cell deaths were investigated with TUNEL staining 10 days after injection. RESULTS: Infiltration of inflammatory cells and destructed normal architecture of lacrimal gland was found only in conA injected group till 10 days. The Schirmer test showed marked reduction (0.56+/-0.26) by 5days after injection compared with control group (1.07+/-0.35) (p=0.02) and its significant difference was maintained till 10days. The number of goblet cell was 9.70+/-5.03/x200HPF, which was statistically significant decreased compared to control (47.50+/-17.13/x200HPF) at 10 days (p=0.00). Apoptotic cells were increased in injected eye (26.20+/-4.27) compared with those in control (16.60+/-2.70). CONCLUSIONS: Injection of conA to lacrimal glands in rabbit shows decrease of lacrimal secretion and similar cytological changes of the cornea and conjunctiva in human dry eye patients. It suggests its possible feasibility of short-term dry eye animal model for the 10 days.
Animals* ; Biopsy ; Cell Death ; Concanavalin A* ; Conjunctiva ; Cornea ; Goblet Cells ; Humans ; In Situ Nick-End Labeling ; Inflammation ; Lacrimal Apparatus ; Models, Animal* ; Rabbits