BACKGROUND: Compared with conventional routes of delivering potent analgesics to postoperative patients, transdermal administration of fentanyl offers the advantages of simplicity and noninvasiveness. The analgesic efficacy and safty of transdermal fentanyl patch (TDFP) were evaluated postoperatively. METHOD: TDFP releasing 25 mcg/hr (Group 1) or placebo (Group 2) were applied to 40 women 6 hours before total abdominal hysterectomy under the general anesthesia. Postoperatively, self-administered intravenous fentanyl was maintained with a 20-mcg incremental dose and a 10-min. locking interval. Each group was assessed following 48 hours with respects to vital signs, VAS pain scores, hourly-used fentanyl doses, satisfaction scores and side effects. RESULT: VAS observed 24 hours, 36 hours after operation were significantly lower in group 1 than group 2. Hourly-used fentanyl doses were significantly lower in group 1 than group 2 at 2 hours, 6 hours, 12 hours and 24 hours after operation. The incidence of side effects were similar between group 1 and group 2. CONCLUSION: TDFP-25 mcg applied 6 hours before operation provides supplementary analges-ia after the postoperative period without significant side effects such as respiratory depression.
Administration, Cutaneous ; Analgesics ; Anesthesia, General ; Female ; Fentanyl* ; Humans ; Hysterectomy* ; Incidence ; Postoperative Period ; Respiratory Insufficiency ; Vital Signs

Total abdominal hysterectomy was considered an inadequate treatment method for invasive cervical cancer. Usually the procedure was inadvertently performed on patients who were thought preoperatively to have benign conditions. Survival for patients with gross disease remaining after inappropriate hysterectomy is poor. So, early cancer detection and proper management with precise pretreatment staging is necessary to avoid inadequate hysterectomy, especially in cases of gross residual disease. Cervical cancer typically recurs at the vaginal vault or in the pelvis; however it can recur distantly in the abdomen or lung. Although recurrences have been reported at laparoscopic trocar sites, it is unusual to have recurrence in the abdominal wall after laparotomy. A case of isolated metastasis to the abdominal wall after treatment of unexpected invasive cervical cancer found at total hysterectomy is presented with a brief review of the literature.
Abdomen ; Abdominal Wall* ; Humans ; Hysterectomy* ; Laparotomy ; Lung ; Neoplasm Metastasis* ; Pelvis ; Recurrence ; Surgical Instruments ; Uterine Cervical Neoplasms*

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become a one of the most important causes of nosocomial infections, and use of vancomycin for the treatment of MRSA infection has increased. Unfortunately, vancomycin-resistant enterococcus have been reported, as well as vancomycin-resistant S. aureus. Arbekacin is an antibacterial agent and belongs to the aminoglycoside family of antibiotics. It was introduced to treat MRSA infection. We studied the clinical and bacteriological efficacy and safety of arbekacin compared to vancomycin in the treatment of infections caused by MRSA. MATERIALS AND METHODS: This was a retrospective case-control study of patients who were admitted to tertiary Hospital from January 1st, 2009 to December 31st, 2010, and received the antibiotics arbekacin or vancomycin. All the skin and soft tissue MRSA infected patients who received arbekacin or vancomycin were enrolled during the study period. The bacteriological efficacy response (BER) was classified with improved and failure. The improved BER was defined as no growth of MRSA, where failure was defined as growth of MRSA, culture at the end of therapy or during treatment. Clinical efficacy response (CER) was classified as improved and failure. Improved CER was defined as resolution or reduction of the majority of signs and symptoms related to the original infection. Failure was defined as no resolution and no reduction of majority of the signs and symptoms, or worsening of one or more signs and symptoms, or new symptoms or signs associated with the original infection or a new infection. RESULTS: Totally, 122 patients (63/99 in arbekacin, 59/168 in vancomycin group) with skin and soft tissue infection who recieved arbekacin or vancomcyin at least 4 days were enrolled and analysed. The bacteriological efficacy response [improved, arbekacin vs vancomycin; 73.0% (46/63), 95% confidence interval (CI) 60.3 to 83.4% vs 83.1% (49/59), 95% CI 71.0 to 91.6%] and clinical efficacy response [improved, arbekacin vs vancomycin; 67.2% (41/61), 95% CI 52.0 to 76.7% vs 78.0% (46/59), 95% CI 65.3 to 87.7%] were similar between the two groups (P=0.264, 0.265). The complication rate was significantly higher in the vancomycin group [29/59(49.2%), 95% CI 35.9 to 62.5%] than arbekacin [10/63(15.9%), 95% CI 8.4 to 29.0%] (P<0.001). CONCLUSIONS: Arbekacin could be considered as an alternative antibiotics for vancomycin in skin and soft tissue infection with MRSA. However, further prospective randomized trials are needed to confirm this finding.
Anti-Bacterial Agents ; Case-Control Studies ; Cross Infection ; Dibekacin ; Enterococcus ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Tertiary Care Centers ; Vancomycin

PURPOSE: This study was to examine the factors affecting prostate cancer screening behavior in Korean men using the health belief model (HBM). METHODS: It was a descriptive cross-sectional survey. A total of 121 participants answered questionnaires which included general characteristics, knowledge, and HBM variables related to prostate cancer and prostate cancer screening tests. RESULTS: Only 18 participants (14.9%) had had a prostate cancer screening test before. Participants who had had a prostate cancer screening test were more likely to perceive lower health status (odds ratio: 0.61 [95% confidence interval: 0.39, 0.93]), higher perceived sensitivity (odds ratio: 3.55 [95% confidence interval: 1.11, 11.36]), and higher self-efficacy (odds ratio: 5.77 [95% confidence interval: 1.51, 22.08]) than participants who had not had a test. CONCLUSION: We recommend developing an educational program which can increase the level of perceived sensitivity and self-efficacy to involve themselves in prostate cancer screening test actively.
Cross-Sectional Studies ; Early Detection of Cancer ; Health Behavior ; Humans ; Male ; Mass Screening* ; Prostate* ; Prostatic Neoplasms*

PURPOSE: To find the risk factors associated with coronory artery lesions, non-responsiveness to intravenous immunoglobulin(IVIG) treatment, and recurrences in Kawasaki disease patients. METHODS: We retrospectively analyzed 1,000 Kawasaki disease patients who were admitted to Yonsei University Medical Center from September 1990 to December 2003. We compared between responder and non-responder groups to IVIG treatment as well as between relapsed and non-relapsed groups, and as to the relapsed group, we also compared variables between patients in their first and second attack states. Finally, factors associated with longer-fever duration from disease onset were evaluated. RESULTS: Longer fever durations before and after IVIG treatment, male sex, lower Hgb and Hct level, higher WBC count and segmented WBC proportion, and higher CRP and Harada's score were related with coronary artery lesions. Non-responsiveness was related to higher WBC count, segmented WBC proportion, CRP, SGPT, Harada's score, and pyuria. Moderate-to-severe coronary artery dilatations and recurrences were more commonly seen among the non-responder group. No significant predictive factors for recurrence were found. In the relapsed group, lower WBC count, CRP, and shorter fever duration from disease onset were observed in their second attack state. Fever duration from disease onset showed positive correlation with WBC count, CRP, and Harada's score and negative correlation with Hgb levels. CONCLUSION: Higher WBC count, CRP, and higher Harada's score were related to both higher incidences of coronary artery lesions and non-responsiveness to IVIG treatment, and these factors were also related with longer fever duration. Non-responders to IVIG treatment showed higher recurrence rate and more moderate-to-severe coronary artery dilatations than responders.
Academic Medical Centers ; Alanine Transaminase ; Arteries ; Coronary Vessels ; Dilatation ; Fever ; Humans ; Immunoglobulins, Intravenous ; Incidence ; Male ; Mucocutaneous Lymph Node Syndrome* ; Pyuria ; Recurrence ; Retrospective Studies ; Risk Factors ; Treatment Failure ; Treatment Outcome

BACKGROUND: Causative bacterial agents of infectious diarrheal disease were traditionally diagnosed by stool cultures. Stool culture, however, has a problem because of relatively low sensitivity and long turnaround time. In this study, we evaluated multiplex PCR applied on stool specimens directly to diagnose enteropathogenic bacteria. METHODS: From June to September 2009, 173 diarrheal stools submitted for stool cultures were tested by Seeplex(R) Diarrhea ACE Detection kit (Seegene, Korea) to detect 10 enteropathogenic bacteria. Specimens were cultured for Salmonella, Shigella, Vibrio, and Yersinia. Late 50 specimens were also cultured for Campylobacter. The specimens positive for verotoxin-producing Escherichia coli (VTEC) were further subcultured for detecting enterohaemorrhagic Escherichia coli O157:H7. Electronic medical records were reviewed for clinical and laboratory findings. RESULTS: Of 173 specimens, multiplex PCR and cultures identified enteropathogens in 36 (20.8%) and 8 specimens (4.6%), respectively. While multiplex PCR detected 5 Salmonella, 15 Campylobacter, 1 Vibrio, 4 Clostridium difficiles toxin B, 5 Clostridium perfringens, 1 Yersinia enterocolitica, 5 Aeromonas, and 2 VTEC, cultures detected 5 Salmonella, 1 Vibrio, 1 Y. enterocolitica, 1 Aeromonas, and 2 E. coli O157:H7. CONCLUSION: Multiplex PCR would be useful to detect Campylobacter, VTEC and C. perfringens, as well as have equivalent sensitivity to conventional culture for ordinary enteropathogens such as Salmonella, Shigella, Vibrio, Y. enterocolitica. Direct application of multiplex PCR combined with conventional cultures on stool warrants remarkable improvement of sensitivity to diagnose enteropathogenic bacteria.
Aeromonas ; Bacteria ; Campylobacter ; Clostridium ; Clostridium perfringens ; Diarrhea ; Dysentery ; Electronic Health Records ; Escherichia coli ; Multiplex Polymerase Chain Reaction ; Salmonella ; Shiga-Toxigenic Escherichia coli ; Shigella ; Vibrio ; Yersinia ; Yersinia enterocolitica

OBJECTIVE: to describe our experience and examine the frequency of gynecologic laparoscopy complication performed in a secondary care hospital. METHODS: We retrospectively studied 262 patients were treated by gynecologic laparoscopy (mean age 43 yrs). Period of study were from March 2003 through March 2005 in one teaching hospital. Data were analyzed using SPSS for windows software. Frequency and descriptive statistics were calculated. RESULTS: The overall number of complication in 262 laparoscopies was 16 (6.1%). 5 ureter injuries, 3 stump disruption, 2 troca site hematoma, 1 bladder injury, 1 small bowel injury, 1 post operative bowel obstruction, 1 leg neuropathy, 1 leg weakness, 1 massive bleeding. The complication rates were analysed by type of surgery. We evaluated correlation with variable factors. Our complication rates were higher to those reported in the literature and were significantly different by type of surgery. Complications were related to variable factors of blood transfusion and anesthetic time. CONCLUSION: The complication rate occurred at higher rates in our institution. All patients complications developed were treated and none sustained long-term morbidity. However, operative laparoscopy should be performed carefully. Early recognition of injuries, preferably intraoperatively, with immediate appropriate treatment is crucial. It is also important to be alert to early manifestations of complications in the postoperative observation period.
Blood Transfusion ; Hematoma ; Hemorrhage ; Hospitals, Teaching ; Humans ; Laparoscopy* ; Leg ; Retrospective Studies ; Secondary Care ; Ureter ; Urinary Bladder

Primary cardiac tumors are rare, with a prevalence of 0.001–0.2%. Among such tumors, cardiac hemangioendotheliomas are some of the most uncommon. In Korea, there have been no reports of hemangioendothelioma occurring in the heart of infants. We herein report a case of an infant that was admitted to our medical center and presented with cough and a runny nose. The initial diagnosis was acute bronchiolitis. Cardiomegaly was observed on chest radiography. Echocardiography revealed a tumor measuring 3.5×4.0 cm in the right atrium. The infant was transferred to a tertiary medical center for tumor excision. The excised lesion was 3.8×3×3.2 cm in size, and biopsy confirmed a diagnosis of hemangioendothelioma. In this case report, we describe our experience with a rare case involving cardiac tumor in an infant with an upper respiratory tract infection.
Biopsy ; Bronchiolitis ; Cardiomegaly ; Cough ; Diagnosis ; Echocardiography ; Heart ; Heart Atria ; Heart Neoplasms ; Hemangioendothelioma ; Humans ; Infant ; Korea ; Nose ; Prevalence ; Radiography ; Respiratory Tract Infections ; Thorax ; Twins

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of ear infections. We attempted to evaluate the clinical usefulness of arbekacin in treating chronic suppurative otitis media (CSOM) by comparing its clinical efficacy and toxicity with those of vancomycin. Efficacy was classified according to bacterial elimination or bacteriologic failure and improved or failed clinical efficacy response. Ninety-five subjects were diagnosed with CSOM caused by MRSA. Twenty of these subjects were treated with arbekacin, and 36 with vancomycin. The bacteriological efficacy (bacterial elimination, arbekacin vs. vancomycin: 85.0% vs. 97.2%) and improved clinical efficacy (arbekacin vs. vancomycin; 90.0% vs. 97.2%) were not different between the two groups. However, the rate of complications was higher in the vancomycin group (33.3%) than in the arbekacin group (5.0%) (P=0.020). In addition, a total of 12 adverse reactions were observed in the vancomycin group; two for hepatotoxicity, one for nephrotoxicity, eight for leukopenia, two for skin rash, and one for drug fever. It is suggested that arbekacin be a good alternative drug to vancomycin in treatment of CSOM caused by MRSA.
Adult ; Aged ; Anti-Bacterial Agents/administration & dosage ; Chronic Disease ; Dibekacin/administration & dosage/*analogs & derivatives ; Female ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus/*drug effects ; Middle Aged ; Otitis Media, Suppurative/diagnosis/*drug therapy/microbiology ; Staphylococcal Infections/diagnosis/*drug therapy/microbiology ; Treatment Outcome ; Vancomycin/*administration & dosage ; Young Adult

PURPOSE: Sudoriferous cyst usually occurs on the face, and especially on the ear and scalp as a solitary cystic mass. It is derived from the sweat glands of Moll and results from the obstruction of excretory ducts with the retention of fluid. In the eyelid, it is usually seen as small and firm vesicle arising at the eyelid margin. If it rarely occurs on the orbit, it develops from orbital ectopic epithelial cells predetermined to form glands of Moll. We experienced a case of sudoriferous cyst on eyelid which was adhered to levator aponeurosis and it disappeared when patient closed eyes. METHODS: A 55-year-old women suffered palpable mass on left upper eyelid without pain that had been present for 25 years. Orbital computed tomographic finding showed a oval mass(2.1x0.6x0.6cm size) inside upper eyelid and it invaded the orbit. The mass was completely excised under general anesthesia and histopathological examination was followed. RESULTS: Cystic mass was purple color and it was located in superiorly to tarsal plate. The mass was adhered to levator aponeurosis and levator palpabrae superioris muscle between the fat layer of post-orbital septum and the Whitnall ligament. The mass was completely excised without injury of aponeurosis and muscle. Microscopically, the lesion was a solitary cyst lined by two layers of cuboidal epithelial cells and innermost cells displaying eosinophilic cytoplasm with apical expansions. CONCLUSION: Sudoriferous cyst usually occurs on eyelid margin. But in this case, cystic mass occurred on upper eyelid and disappeared when patient closed the eyes because it was partially adhered to levator aponeurosis and levator palpebrae superioris muscle. Therefore, if sudoriferous cyst occurs on eyelid, it is necessary to excised the mass carefully.
Anesthesia, General ; Bone Cysts ; Cytoplasm ; Ear ; Eosinophils ; Epithelial Cells ; Eye ; Eyelids ; Female ; Humans ; Ligaments ; Middle Aged ; Muscles ; Orbit ; Retention (Psychology) ; Scalp ; Sweat Glands