BACKGROUND: Urinary tract is the most common site of nosocomial infections, accounting for 35% of all nosocomial infections. About 80-90% of these urinary tract infections are associated with urethral catheter insertion. Recently, we experienced an outbreak of nosocomial UTI (urinary tract infection) caused by Candida spp. in the surgical ICU (SICU) and we investigated the cause of UTI outbreak. METHODS: We collected data from clinical records and observed the current methods of care of urethral catheters in the SlCU. During the outbreak, we investigated the current procedures and maintenance care of urethral catheter insertion and educated the staff on the correct methods of the catheter insertion and care. We performed surveillance cultures of unused new urine bags, RESULTS: Between May 2000 and June 2000, 17 Candida spp. strains were isolated from urines of 17 patients hospitalized in the SICU of National Health Insurance Corporation Ilsan Hospital. All infections were attributed to the care of urethral catheter insertion and contaminated bags. We identified that routine bladder irrigation and emptying urine to a common urinal have been done incorrectly during the outbreak period. Rodotorula spp. was isolated from 4 urine bags (50% contamination rate) out of 8 unused new urine bags by surveillance cultures. CONCLUSION: The causes of the UTI outbreak caused by Candida spp. was terminated by outbreak investigation and change of contaminated urine bag.
Candida* ; Catheters ; Cross Infection ; Humans ; National Health Programs ; Urinary Bladder ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

No abstract available.

A total of 152 strains of Streptococcus pyogenes were isolated from patients with pharyngitis, scarlet fever, skin infection, or invasive streptococcal infections in Seoul, Korea from January 1988 to December 1999. All isolates were epidemiologically characterized to decide phenotypes by T protein serotype and serum opacity factor (OF) detection. Genetic diversity of the isolates were analyzed by emm genotyping and pulsed-field gel electrophoresis (PFGE). T protein serotype showed 17 kinds in distribution and T12 (40.1% of study strains), T4 (19.1%), and T1 (7.9%) were the prevalent ones. When sources of S. pyogenes isolates were analyzed by T serotype distribution, T12 type was predominant in pharyngitis and skin infection isolates which contributed to 30 strains (49.2%) and 11 strains (18.0%), respectively. When T serotype of S. pyogenes isolates were analyzed by emm genotype distribution, of the 61 isolates of T12 type, 48 strains (78.7%) belonged to the emm type 12 (M12) and of the 29 isolates of T4 type, 27 strains (93.1%) belonged to the emm genotype 4 (M4). PFGE of genomic DNA of different emm genotype (emm12, emm4 and emm1) showed distinctive patterns. When the DNA of same emm gene type isolates were analyzed genetic relatedness by PFGE pattern, emm4, emm1, and emm12 types showed over 90%, 75%, and 70% of genetic similarity, respectively. Therefore, it was suggested that these emm genotype isolates were closely related genetically whereas among the isolates of other emm genotypes showed less than 30% of genetic similarity. Show genotypes are more diverse in comparison with phenotypes. In even epidemiologically unrealated isolates, genetic subtypes appeared correlated. The phenotypic and genotypic analysis used in the study were discriminative and appropriate for epidemiological study of S. pyogenes.
DNA ; Electrophoresis, Gel, Pulsed-Field ; Epidemiologic Studies ; Genetic Variation ; Genotype ; Humans ; Korea* ; Pharyngitis ; Phenotype ; Scarlet Fever ; Seoul* ; Skin ; Streptococcal Infections ; Streptococcus pyogenes* ; Streptococcus*

Gastric ulcer bleeding in neonatal period, mainly in preterm newborn babies or in neonates treated in intensive care units, is relatively frequent, However the occurrence of significant gastric ulcer bleeding in healthy full term infants is unusual. We experienced a case of massive upper gastrointestinal (GI) bleeding in a 3-day-old healthy full term infant. Endoscopic examination confirmed the presence of gastric ulcerations. Treatment was initiated with transfusion and histamine 2 receptor antagonist, and the clinical signs resolved. Mother's serum antibody to Helicobacter pylori (H. pylori) was positive. We collected stool of the patient including other 17 infants in the intensive care unit. A highly sensitive semi-nested PCR for H. pylori DNA was performed, but all infants including the patient revealed negative. H. pylori infection is not related with upper GI bleeding in healthy full term infants. In conclusion, the diagnosis of upper GI bleeding in infant can be easily made by means of pediatric endoscopy, which is a simple and a well tolerated examination.
Blood Transfusion ; Endoscopy, Gastrointestinal ; Female ; Histamine Antagonists/therapeutic use ; Humans ; Infant, Newborn ; Peptic Ulcer Hemorrhage/*diagnosis/drug therapy/therapy ; Stomach Ulcer/*complications

Sarcomatoid squamous cell carcinoma (SSCC) is composed of squamous cell carcinoma element and spindle cell element, and can occur in any organ, such as the lung, skin and esophagus. But SSCC in uterine cervix is very rare. The prognosis of SSCC is poorer than squamous cell carcinoma (SCC) of uterine cervix. We report here a case of SSCC of uterine cervix with a brief review of literature.
Carcinoma, Squamous Cell ; Cervix Uteri ; Esophagus ; Female ; Lung ; Prognosis ; Skin

Primary reninism is a rare cause of hypertension manifesting along with hypokalemia. A high level of plasma renin activity and a high level of serum aldosterone are the whole markers of primary reninism. Upon making the diagnosis of primary reninism, other more common causes of aldosteronism must be differentiated, such as renovascular hypertension and primary aldosteronism. Primary reninism is commonly caused by juxtaglomerular cell tumor, which is one of the curable causes of hypertension, and this can be successfully treated by conservative surgery. We report here on a case of primary reninism that was caused by juxtaglomerular cell tumor that developed in a 22-year-old female patient. She was recently diagnosed with hypertension and hypokalemia. She had markedly elevated plasma renin activity and an increased serum aldosterone concentration. Computed tomography revealed a mass located in the right kidney and selective renal vein sampling suggested that the mass was secreting an excess of renin. Right nephrectomy was done and her hypertension with hypokalemia was successfully treated. We report here a case of primary reninism that presented with juxtaglomerular cell tumor along with a review of the literature
Aldosterone ; Diagnosis ; Female ; Humans ; Hyperaldosteronism ; Hypertension* ; Hypertension, Renovascular ; Hypokalemia* ; Kidney ; Nephrectomy ; Plasma ; Renal Veins ; Renin* ; Young Adult

BACKGROUND: Large amounts of antigen may produce false low values on immunoradiometric assays due to the so-called high-dose hook effect. The physicians' awareness of the possibility of the "high-dose hook effect" will prevent preoperative misdiagnosis. The study was designed to identify the frequency and clinical features of patients with pituitary macroadenomas in whom a high-dose PRL hook effect was documented. METHODS: Our retrospective study involved 42 patients with non-functioning pituitary adenomas (tumor diameter >30mm) who underwent transsphenoidal microsurgery from between Jan 1999 to Aug 2004, and 6 patients with non-functioning pituitary adenoma(tumor diameter>30mm) were selected for prospective study from Sep 2003 to Feb 2004. Our retrospective study also involved 13 patients with macroprolactinoma for the comparison of the clinical features. RESULTS: 1) The presence of a high-dose hook effect was retrospectively suggested when the PRL levels increased in 4 out of the 42 patients with non- functioning adenomas(tumor diameter >30mm) after surgery. Post-operative immunohistochemical staining of their pituitary specimens revealed the tumors to be prolactinoma. 2) Prospectively, dilution testing of the specimens obtained before surgery was done in the 6 patients, and one patient presented with a case of the hook effect. The patient's prolactin level was measured at 53.1ng/mL before dilution and this was increased up to 22,600ng/mL upon the 1:1000 dilution. 3) Conclusively, the hook effect was seen in 5 of the 48 patients(10.4%) with non-functioning pituitary adenoma(tumor diameter >30mm) 4) Compared with other 2 patient groups(the macroprolactinoma(N=13) group, and the non-functioning pituitary tumor(N=43) group), the high-dose PRL hook effect is more likely to be observed in male patients with large pituitary tumors. CONCLUSION: In order to avoid the high-dose hook effect, PRL should be assayed at 1:100~1:200 or even higher dilutions of serum from all patients(and especially the male patients) with large pituitary tumors
Diagnostic Errors ; Humans ; Immunoradiometric Assay ; Male ; Microsurgery ; Pituitary Neoplasms ; Prolactin ; Prolactinoma* ; Prospective Studies ; Retrospective Studies

A 38-year-old man who was diagnosed with malignant paraganglioma underwent computed tomography (CT) and I-131 metaiodobenzylguanidine (MIBG) san. CT showed extensive lymph node enlargement in right iliac area and retroperitoneum with severe hydronephrosis and mass on posterior bladder wall. However, I-131 MIBG scan didn't showed abnormal uptake. He also underwent F-18 fluorodeoxyglucose (FDG) positron emisson tomography/CT for localizing accurate tumor site. F-18 FDG PET/CT showed multiple metastases of left supraclavicular, hilar, mediastinal para-aortic, inguinal, right iliac lymph nodes, lung, vertebrae, and pelvis. There are a few reports showing that the F-18 FDG PET/CT is helpful for staging and localizing tumor site of patients who are diagnosed with negative on the MIBG scans. Thus, we report a case with paraganglioma which showed negative I-131 MIBG scan, but revealed multiple intense hypermetabolic foci in F-18 FDG PET/CT.
3-Iodobenzylguanidine* ; Adult ; Electrons ; Humans ; Hydronephrosis ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Paraganglioma* ; Pelvis ; Positron-Emission Tomography and Computed Tomography ; Spine ; Urinary Bladder

A preterm female infant born at 27 weeks of gestation with a birth weight of 990 g developed acute hypotonia, apnea, hypotension and bradycardia mimicking septic shock syndrome at 14h after birth. Laboratory tests indicated a severe hypermagnesemia of 45 mg/dL. The renal function, complete blood count and maternal blood concentrations of magnesium were normal, and the blood cultures were negative. The patient recovered with treatment including exchange transfusion. However, the etiology of the severe hypermagnesemia remains unknown.
Apnea ; Birth Weight ; Blood Cell Count ; Bradycardia ; Female ; Humans ; Hypotension ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Magnesium ; Muscle Hypotonia ; Parturition ; Pregnancy ; Shock, Septic

BACKGROUND AND OBJECTIVES: Despite significant improvement in the field of angioplasty, restenosis remains a major obstacle to the long-term success of the procedure. Radiation can effectively inhibit neointimal hyperplasia by causing the arrest of mitosis during cell division and limiting proliferation by reducing the number of regenerating clonal progenitors. Balloon injury could induce the cell adhesion molecule, ICAM-1 and VCAM-1, on SMCs and regenerating endothelial cells (ECs). ICAM-1 and/or VCAM-1 may play a role in the progression of neointimal hyperplasia induced by balloon injury and external radiation may effectively inhibit neointimal hyperplasia by attenuating their expression. The purpose of this study was to examine the effect of external radiation against ICAM-1 and VCAM-1 on neointimal hyperplasia after balloon injury in rat carotid arteries. MATERIAL AND METHODS: A standardized carotid balloon catheter arterial injury was produced in 51 rats and external beam radiation with doses from 5-20 Gy were delivered in 28 rats (radiation treated group) at 24 hours after injury. To investigate the effect of the external radiation on neointimal hyperplasia, the intima area and the intima/medial area of arteries were measured at day 14 after injury. The expressions of ICAM-1 and VCAM-1 at day 2, day 7, and day 10 after injury were studied in control group and radiation treated group by immunohistochemistry. RESULTS: Means of intimal area and intima/medial ratio in radiation treated group were significantly lower than those in control group and significantly reduced with increasing radiation dosage. At day 2 after injury, medial SMCs of injury group extensively expressed ICAM-1, while it was focally expressed with 10 Gy radiation treated group. At day 7 and day 10 after injury, ICAM-1 expression on medial SMCs was attenuated and neointimal ICAM-1 expression was increased. As compared with control group, ICAM-1 expression after radiation was weak and focal just around the internal elastic lamina. At 2 days after injury, medial SMCs moderately expressed VCAM-1, which was weakly and focally expressed with 10 Gy radiation treated group. At day 7 and day 10 after injury, focal expression of VCAM-1 was noted around the internal elastic lamina, but there was no VCAM-1 expression on neointima with radiation. CONCLUSION: External radiation after carotid arterial injury may potentially inhibit SMC proliferation and neointimal hyperplasia, and balloon injury-induced or upregulated expressions of ICAM-1 and VCAM-1 may be attenuated with external radiation.
Angioplasty ; Animals ; Arteries ; Carotid Arteries ; Catheters ; Cell Adhesion* ; Cell Division ; Endothelial Cells ; Hyperplasia* ; Immunohistochemistry ; Intercellular Adhesion Molecule-1* ; Mitosis ; Neointima ; Radiation Dosage ; Rats* ; Vascular Cell Adhesion Molecule-1