BACKGROUND: There are many reports showing the efficacy of polymerase chain reaction(PCR) for the diagnosis of Mycobacterium tuberculosis in sputum. but only few reports in extrapulmonary specimens. Because of the difficulty in establishing a diagnosis of tuberculosis in the extrapulmonary specimens there have been considerable interest in the development of a rapid sensitive diagnostic test that might be useful. Therefore we used PCR for detection of M. tuberculosis DNA in extrapulmonary specimens and compared the results of conventional acid-fast stain, culture methods and PCR assay. METHODS: Total of 63 clinical samples(10 cerebrospinal fluids, 12 pleural fluids, 1 pericardial fluid, 3 bone marrow aspirates, 1 ascitic fluid, 25 fine needle aspirates of lymph nodes, 7 urine, 1 stool and 3 tissue biopsies) in Ewha Womans University Tongdaemun hospital were analysed by the PCR. We performed the PCR using a species-specific M. tuberculosis DNA fragment(mtp 40 gene) as primers that was cloned and sequenced at recent and a 396-bp fragment was specifically amplified. We analyzed sensitivity and specificity of AFB culture and PCR for the diagnosis of extrapulomonary tuberculosis. RESULTS: The positivity of AFB smear, culture and PCR were 2(10%), 4(20%), 13(65%) out of total 20 cases diagnosed as clinically active extrapulmonary tuberculosis. respectively. All of 2 smear-positive samples and 2 of 4 culture-positive and smear-negative samples were PCR-positive. And 9 of 14 smear and culture negative specimens also gave detectable DNA products in PCR The specificity of PCR(95.4%) is compared with those of smear and culture(100.0%). CONCLUSIONS: This results suggest that the PCR assay is a sensitive and rapid diagnostic alternative to classical procedures for the diagnosis of extrapulmonary tuberculosis.
Ascitic Fluid ; Bone Marrow ; Cerebrospinal Fluid ; Clone Cells ; Diagnosis* ; Diagnostic Tests, Routine ; DNA ; Female ; Humans ; Lymph Nodes ; Mycobacterium tuberculosis ; Needles ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Sputum ; Tuberculosis*

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major cause of nosocomial infection and a molecular typing is necessary for proper epidemiologic investigations of sources and moles of spread in an outbreak. An nosocomial outbreak of MRSA in a neonatal intensive care unit at Ewha Womans University Mokdong Hospital was suspected. To investigate the clonality of isolates and control the spread of nosocomial outbreak, we performed plasmid restriction analysis of MRSA isolates from patients and medical staffs. METHODS: We studied 7 MRSA strains (umbilicus 4, blood 1, urine 1 and pus 1) from patients in a neonatal intensive care unit and the MRSA strains from nares and hands surveillance cultures of 26 medical staffs (4 medical doctors and 22 nurses). All MRSA strains were tested for antimicrobial susceptibility and plasmic analysis after EcoRI restriction. We analyzed the plasmid patterns of MRSA isolated from patients and compared with those from medical staffs. RESULTS: Ten MRSA strains (from 7 nares and 3 hands) were isolated from surveillance cultures of 26 medical staffs. Seven out of 10 MRSA strains from medical staffs revealed identical pattern of antibiogram which was the same pattern in all 7 MRSA strains from seven patients. Plasmid restriction patterns were classified 6 groups from A to F showing 2-10 bands. Six out of 7 MRSA strains from the patients showed group A(A1 5, A31) and 5 out of 10 MRSA strains from the medical staffs showed group A(A1 1, A21, A32, A41) and remainders showed different plasmid restriction analysis patterns. CONCLUSIONS: These results suggest that plasmid restriction analysis is a rapid, inexpensive, and good discriminating molecular typing of MRSA outbreak and is useful for the epidemiologic investigation of MRSA outbreaks in the clinical laboratory.
Cross Infection ; Disease Outbreaks ; Female ; Hand ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Staff ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Microbial Sensitivity Tests ; Molecular Epidemiology* ; Molecular Typing ; Plasmids* ; Suppuration

BACKGROUND: Neuroaxial morphine may produce nausea and vomiting due to cephalad migration. Though it improves post- operative pain, it may have serious complication delaying recovery. The aim of this study was to investigate the efficacy of prophylactic antiemetics such as conventional metoclopramide or more expensive ondansetron. METHODS: Eighty-seven patients who underwent orthopedic knee arthroscopic surgery under epidural anesthesia were randomly assigned to three groups, which are (a) normal saline intravenous injection control group (Group C), (b) metoclopramide intravenous injection and intranasal spray study group (Group M), (c) ondansetron inravenous injection group (Group O). Before the end of surgery, all patients were given 3 mg of morphine and 2 mg of butorphanol mixture via epidural catheter for postoperative pain control. The anesthesia were all standardized. Post-operative nausea and vomiting were observed and used as outcome variables and postoperative pain, itching, somnolence, dizziness, urinary retention were also observed. RESULTS: The incidence of postoperative nausea was significantly lower in Group M (P = 0.0296) and Group O (P = 0.005) compared with Group C. The incidence of postoperative vomiting was significantly lower in Group O (P = 0.01) compared with Group C. But statistically no difference was noted in vomiting between Group C and Group M (P = 0.0579). CONCLUSIONS: The results suggest that ondansetron and metoclopramide are effective in reducing the incidence of post-operative nausea. But ondansetron is more effective in reducing the incidence of post-operative morphine induced vomiting.
Anesthesia ; Anesthesia, Epidural ; Antiemetics ; Arthroscopy ; Butorphanol ; Catheters ; Dizziness ; Humans ; Incidence ; Injections, Intravenous ; Knee ; Metoclopramide* ; Morphine ; Nausea ; Ondansetron* ; Orthopedics ; Pain, Postoperative ; Postoperative Nausea and Vomiting* ; Pruritus ; Urinary Retention ; Vomiting

For determining the distribution of specific IgE and IgG-subclass antibodies and their role in allergic disorders, we measured the serum levels of specific IgG-subclass and IgE antibodies to Dermatophagoides farinae (Df) on 60 atopic children, aged between 8 to 12. All of them had positive skin test to Df, and was grouped into three: children with asthma only (group 1), with rhinitis (group 2), and with them together (group 3). Every data were compared with that of 47 nomal children. ELISA (for IgG and IgG-subclass) and RIA (for IgE) were used. The results are as following. 1) Specific IgE-antibody is significantly higher in all three allergic groups, compared with normal control group. But there was no significant difference between three allergy groups. 2) Specific IgG, IgG1, IgG2 IgG4-antibodies were higher than those in normal control group, but IgG3 was not significant. IgG1 and IgG2 were elevated particularly in patients with asthma and rhintis, but IgG4 was elevated in asthma group. 3) The linear correlation between specific IgE and IgG1-antibody was significant (r=0.286), but IgG4 did not have this correlation with IgE. In conclusion, the levels of specific IgE is essential for the diagnosis of allergies, and IgG1 and IgG4 seem to participate in allergic reactions with a different mechanism.
Antibodies ; Asthma ; Child* ; Dermatophagoides farinae* ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulin G ; Pyroglyphidae* ; Rhinitis ; Skin Tests

BACKGROUND: Pelviscopic techniques have rapidly increased in therapeutic procedures as well as diagnostic procedures because of the many benefits associated with much smaller incisions than traditional open techniques. But the deliberate pneumoperitoneum with carbon dioxide during pelviscopic surgery may cause some problems-hypercarbia, pneumomentum, subcutaneous or mediastinal emphysema, pneumothorax, hypoxemia, hypotension, cardiovascular collapse and cardiac dysrhythmia. METHOD: We observed the changes of blood pressure (systolic, mean, diastolic), pulse rate, PaCO2, PaO2, peak inspiratory airway pressure and expired tidal volume at 10 minute after induction of general anesthesia (control value), 30 minutes and 60 minutes after insufflation of CO2 and Trendelenburg position. RESULTS: The blood pressure, PaCO2 and peak inspiratory airway pressure were increased significantly than control values (p<0.05). The changes of pulse rate and expired tidal volume were not statistically significant in comparison to control values. The PaO2 was decreased significantly (p<0.05). CONCLUSION: To minimize the risk of CO2 retension and unstability of cardiovascular system during pelviscopy under the Trendelenburg position, we must monitor the vital signs and the arterial blood gas status continuously and carefully.
Anesthesia, General* ; Anoxia ; Arrhythmias, Cardiac ; Blood Pressure ; Carbon Dioxide ; Cardiovascular System ; Head-Down Tilt* ; Heart Rate ; Hypotension ; Insufflation* ; Mediastinal Emphysema ; Pneumoperitoneum ; Pneumothorax ; Tidal Volume ; Vital Signs

BACKGROUND: A tourniquet is often used during limb surgery to minimize surgical bleeding and to keep the clear surgical field. However the tourniquet is associated with severe hemodynamic changes and tourniquet-induced hypertension. We investigated the incidences of tourniquet-induced hypertension by tourniquet duration and anesthetic methods. METHODS: One hundred thirteen patients who underwent a total knee arthroplasty were assigned into four groups according to the types of anesthesia; general anesthesia (group I, n = 30), general anesthesia and intravenous adjuvants (group II, n = 30), general and epidural anesthesia (group III, n = 22), and spinal anesthesia (group IV, n = 31). Mean arterial pressure and heart rate were recorded at ward, before induction, one minute after tourniquet inflation and every 10 minutes until 60 mininutes. The extremity was exsanguinated and a tourniquet pressure of 350 mmHg (9 cm width) was applied in all groups. RESULTS: The mean arterial pressure increased in group I and II during the tourniquet inflation period. The incidence of tourniquet-induced hypertension was higher in group I (6.7%) than other groups but there was no statistical significance among the groups. Heart rates were not changed in any groups. CONCLUSIONS: We concluded that the shorter the tourniquet time the less the occurrence of tourniquet-induced hypertension under any type of anesthesia.
Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Inhalation ; Anesthesia, Spinal ; Arterial Pressure ; Arthroplasty* ; Extremities ; Heart Rate ; Hemodynamics ; Hemorrhage ; Humans ; Hypertension* ; Incidence ; Inflation, Economic ; Knee* ; Tourniquets*

This study was carried out to examine the effects of nutrition education program developed by Jincheon Public Health Center on preschool children's nutrition knowledge and dietary habits and the parents' dietary attitudes. The subjects of this study were five- and six-year-old children as well as their parents. A 5-week nutrition education program was implemented to 104 children in five day care centers, and 107 children in three day care centers were investigated as a control group. Activity tools designed for each lesson such as puzzles, food magnets, story, songs, Pierrot costume, and balls were used. Nutrition knowledge and dietary habits of children and dietary attitudes of parents were evaluated before and after education. Mean nutrition knowledge score in the education group was significantly higher than that in the control group after education (p < 0.001). Mean dietary habit score of three questions (three meals a day, eating at fixed time, eating breakfast) in the education group was also significantly higher than that in the control group after education (p < 0.01). In addition, parents in the education group showed significantly higher mean dietary attitude score than those in the control group even though they did not receive education (p < 0.001). Our nutrition education program was found to be effective in improving nutrition knowledge and dietary habits in preschool children as well as improving dietary attitudes in their parents.
Child ; Child, Preschool ; Day Care, Medical ; Eating ; Food Habits ; Humans ; Magnets ; Meals ; Parents ; Public Health ; Singing

BACKGROUND: Enterococci are a leading cause of nosocomial infection and the emergence of resistant strain to various antibiotics including vancomycin is increasingly serious problems among enterococci. And the risk of spread of glycopeptide genes to other Gram-positive cocci makes the problems more serious. To evaluate the presence of vancomycin-resistant enterococci (VRE) in Ewha Womans University Hospital (EWUH), we screened hospitalized patients for fecal colonization and clinical isolates. METHODS: We screened VRE in 574 stool specimens requested for routine cultures and 91 perirectal swabs or stool specimens from patients who reside in intensive care unit and hemato-oncologic ward in Mookdong and Tongdaemoon EWUH from December 1996 through April 1997. And 295 enterococcal species isolated from various clinical specimens were also included. To detect VRE, specimens were cultured in BHI agar medium including 6 g/mL of vancomycin and to determine the antibiotic susceptibility pattern, broth microdilution test using VITEK GPS-IZ, disk diffusion test and standard agar dilution test were performed. Multiplex PCR was done to determine the genotypes of VRE. RESULTS: Nine enterococci (0.9%) were interpreted as VRE in standard agar dilution method. Two (0.3%) out of 665 were from stool speciemens for surveillence cuture and 7 (2.3%) out of 295 were from various clinical specimens for ordinary cultures including 5 E. casseliflavus, 2 E. gallinarum, 1 E. flavescens and 1 Enterococcus species. All isolates showed low-level resistance against vancomycin (8-16 g/mL) by standard agar dilution. But both disk diffusion method and VITEK system demonstrated difficulties in detecting low-level resistance. The genotypes of VRE were classified as van C-1 in 2 isolates and as van C-2 in 6 isolates except 1 isolates, which was unclassifiable in our study. CONCLUSIONS: Even though VRE with high- or medium-level resistance against glycopeptide was not detected in EWUH from this period of investigation, the possibility of presence of VRE is impanding because several teaching hospitals already reported the presence of VRE in clinical isolates and fecal colonization. So continuous surveillence and strict infection control measures must be implemented to detect and prevent transmission of VRE infection.
Agar ; Anti-Bacterial Agents ; Colon ; Cross Infection ; Diffusion ; Enterococcus ; Female ; Genotype* ; Gram-Positive Cocci ; Hospitals, Teaching ; Humans ; Infection Control ; Intensive Care Units ; Multiplex Polymerase Chain Reaction ; Polymerase Chain Reaction* ; Prevalence* ; Vancomycin

BACKGROUND: Diabetes has a critical effect on elderly diabetic patients' quality of life. Elderly diabetic patients have many difficulties in diabetes self-management because their physical, psychological and social functions are decreased as a result of the aging process. Therefore, we evaluated the current status of self-management and barriers in elderly diabetic patients METHODS: The sample was 124 elderly diabetic patients (over 61 years) who visited a hospital and two senior welfare centers in Seoul from July to August 2006. The results of the study were analyzed by descriptive statistics, ANOVA, T-test, and hierarchical regression. RESULTS: 1) Diabetes self-management was composed of insulin injection, diet, exercise, foot management, smoking and drinking alcohol. An average score of self-management in the elderly diabetic patients was 4.5784. In demographic variables, only job status showed a significant effect on self-management. 2) Barriers such as 'forgetting taking diet and medication', 'being interrupted by others', and 'lack of family and social support' were significant factors in diabetes self-management. 3) These barriers for diabetes self-management were still significant in the case of controlling demographic and clinical variables. CONCLUSION: Diabetic educator should identify the significant factors that affect patient's self-management such as whether they have a full-time job, or the type of their job. In addition, diabetes education should focus on assertiveness training to deal with various interpersonal barriers and empowerment for enhancing patient's self-efficacy. These approaches would benefit patients who experience barriers of diabetes self-management
Aged ; Aging ; Assertiveness ; Diet ; Drinking ; Foot ; Humans ; Insulin ; Power (Psychology) ; Quality of Life ; Self Care ; Smoke ; Smoking

PURPOSE: Kawasaki disease(KD) is a multisystemic inflammatory vasculitis of unknown etiology, but immunological abnormalities have been documented and implicated in the pathogenesis of KD. Matrix metalloproteinases(MMPs) have proteolytic activity against connective tissue proteins, and increased activity of MMPs and a quantitative imbalance between MMP and tissue inhibitor of MMP (TIMP) can result in several pathologic conditions. MMP and TIMP may also be involved in the formation of coronary arterial lesions in KD. METHODS: Serum levels of MMP1, MMP2, MMP9, TIMP1, TIMP2, interleukin(IL)-6 and tumor necrosis factor(TNF)-alpha were measured in 27 KD patients(group I, 10 patients with normal coronary artery; group II, 17 patients with coronary arterial lesions) and 15 healthy children(group III). Blood samples from each study group were drawn before and after intravenous immunoglobulin(IVIG) therapy and in the convalescent stage. RESULTS: The MMP9 levels and MMP9/TIMP2 ratios before and after IVIG therapy were significantly higher in group II. The MMP9 levels were significantly higher before IVIG therapy, and decreased through the convalescent stage. The IL-6 and TNF-alpha levels were also significantly higher in group II than in the other groups. The serum MMP9 levels showed significantly positive correlation with the circulating leukocyte counts and IL-6 levels. CONCLUSION: The increased levels of MMP and the imbalance between MMP and TIMP increase the susceptibility to the coronary arterial lesions in KD. The cytokines including IL-6 and TNF-alpha are also important in the activation of MMP and formation of coronary arterial lesions in KD.
Connective Tissue ; Coronary Vessels ; Cytokines* ; Humans ; Immunoglobulins, Intravenous ; Interleukin-6 ; Leukocyte Count ; Matrix Metalloproteinases* ; Mucocutaneous Lymph Node Syndrome* ; Necrosis ; Tumor Necrosis Factor-alpha ; Vasculitis