BACKGROUND: Hospital-wide surveillance showed an up to 9% increase in the incidence rate of the nasal transmission of methicillin-resistant Staphylococcus aureus (MRSA) among health care workers (HCWs) in a tertiary care hospital where MRSA is endemic. The purpose of this study was to investigate the knowledge of and attitude towards nasal transmission of MRSA and hand-washing practice among HCWs and determine the behavioral factors associated with the nasal transmission of MRSA. METHODS: In a 750-bed tertiary care hospital, nasal swabs from HCWs were obtained, and questionnaires with 25 questions were distributed to HCWs who were divided into 2 different groups: MRSA carriers and non-carriers. The questionnaires focused on the HCWs' knowledge about the mode of MRSA transmission and precautions against MRSA infection and their self-reported compliance for hand hygiene. RESULTS: The total number of respondents for the surveillance culture and survey were 253 (51 MRSA carriers and 202 non-carriers). There was significant difference between the 2 groups on the knowledge of precautionary measures used for the MRSA patients in the hospital (P=0.026). Compared to the MRSA carriers, the non-carriers washed their hands significantly more frequently after ventilator care (P=0.004) and used more alcohol sanitizers (P=0.023). However, no significant difference was observed in hand-washing practices of both the groups before the medical procedures, their knowledge about the mode of transmission of MRSA, and the duration of hand washing. CONCLUSION: Non-carriers replied more accurately to the questions on knowledge about the management and treatment of MRSA, and they considered interventions such as surveillance cultures and questionnaires to be an effective method in lowering the incidence of nosocomial infections. Compared to the MRSA carriers, the non-carriers showed higher hand-washing compliance.
Compliance ; Cross Infection ; Cross-Sectional Studies ; Surveys and Questionnaires ; Delivery of Health Care ; Drug Resistance ; Hand ; Hand Disinfection ; Humans ; Incidence ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Tertiary Healthcare ; Ventilators, Mechanical

BACKGROUND: Typhoid fever, caused by Salmonella enterica serotype Typhi, remams an important public health problem in Korea, and asymptomatic chronic carriers play a role in the endemicity. However, the molecular studies of S. typhi isolates are very limited. We characterized clinical isolates of S. typhi by molecular and phage typing tools for the extent of genetic diversity and relatedness among the isolates. METHODS: A total of 49 S. typhi isolates from sporadic cases of typhoid fever were collected in 3 university hospitals in Seoul during 1992 to 1998 and examined for in vitro susceptibility to 14 antimicrobials by disk diffusion method, ribotyping using PstI restriction enzyme, and pulsed-field gel electrophoresis (PFGE) using XbaI and Vi phage typing. The distribution of the epidemiological types and genomic DNA relatedness were analyzed. RESULTS: Forty-five out of 49 isolates were susceptible to all drugs tested. Thirty-two out of 47 were typable by phage typing and 56.3% possessed the phage type El or Ml. Forty-nine isolates divided into 6 different ribotypes (A to F) and 19 different PFGE types (AO through A17, BO) by ribotyping and PFGE analysis, respectively. Based on the 3 typing systems, 32 isolates divided into 17 different epidemiological types. The E1-A-A12 (phage type-ribotype-PFGE type) was most prevalent (18.8Fo) and isolated only in 1998, but distributed in various areas of isolation. The next prevalent M1-A-A1 (15.6%) was isolated from 1992 through 1998. The genetic relatedness based on PFGE analysis revealed that F (coefficient of similarity) values are 0.64 to 1.0 and 0.52 for A subtypes and BO type, respectively. CONCLUSIONS: We conclude that the circulating S. typhi strains in Seoul city show considerable genetic diversity, whereas most of them seems to be clonally related.
Bacteriophage Typing ; Bacteriophages ; Diffusion ; DNA ; Electrophoresis, Gel, Pulsed-Field ; Genetic Variation ; Hospitals, University ; Korea ; Public Health ; Ribotyping ; Salmonella enterica* ; Salmonella typhi ; Salmonella* ; Seoul* ; Typhoid Fever

Juvenile xanthogranuloma is characterized histologically by a dense, sheetlike, well-demarcated, histiocytic infiltration within the papillary and reticular dermis, with occasional extension into subcutaneous tissue, fascia, and peripheral muscle. We report a case of juvenile xanthogranuloma developed in a 5-month-old male infant which showed typical histopathologic features of juvenile xanthogranuloma, involving the papillary dermis only without deep dermal or subcutaneous change.
Dermis* ; Fascia ; Humans ; Infant ; Male ; Subcutaneous Tissue ; Xanthogranuloma, Juvenile*

One hundred gastric cancer patients who underwent total gastrectomy and Roux-en-Y, end-to-side esophagojejunostomy by using stapling devices were analyzed with regard to their operative results. The median time required for the anastomosis was 18 minutes (range of 15 to 45 minutes). A cartridge of 25 mm in diameter was preferred (85% of 25 mm vs. 15% of 28 mm). In 92 patients, procedures were uneventful. Intraoperative problems happened in 8 patients: Two misfirings of stapler due to mechanical problems, in 6 patients, doughnut tissues were incomplete. Mechanical problems were solved by a change of the stapler and for incomplete doughnut tissues, anastomosis was simply reinforced (2 cases) or reanastomosed with restaplings (4 cases). Anastomotic leakage occurred in 2 patients but it was seen only in radiological studies. During the follow up period, two cases of anastomotic stricture were found and they were treated with endoscopic dilatations. There was no operative mortality nor other complication. In addition, routine use of the Levin tube after total gastrectomy was appraised by comparing postoperative courses. Twenty patients were randomly divided into two groups; for 10 patients the Levin tube was removed at the recovery room and for another 10 patients the Levin tube was indwelled until peristalsis returned. Timing of the tube removal did not affect the duration of the hospital stay and starting day of oral intake. We think that the stapler, when properly used, can facilitate the esophagojejunostomy safely and routine use of the Levin tube after total gastrectomy may be unnecessary.
Adult ; Aged ; *Anastomosis, Roux-en-Y ; *Esophagostomy ; Female ; *Gastrectomy ; Human ; *Jejunostomy ; Male ; Middle Age ; *Surgical Staplers

Recent development and advances in arthroscopic surgical techniques for Anterior Cruciate Ligament(ACL) reconstruction have led to the single-incision techniques. Several potential pitfalls in the classic single-incision techniques were found and it has become necessary to develop a new, simpler method to overcome these problems. Seventy-five cases of arthroscope-assisted ACL reconstruction were prospectively studied. The radiologic results were compared between the group in which femoral tunnel preparation was performed by the tibia tunnel(classic technique, 35 cases) and the group in which the anteromedial portal was employed(modified technique, 40 cases). Significantly better results were obtained at the angle formed by the bone graft and the interference screw, the angle between the femoral tunnel axis and the anatomic axis of the femur, and the angle between the femoral tunnel axis and tibial tunnel axis in the modified technique(P<0.05). This study presents a modified arthroscope-assisted ACL reconstruction technique that uses the anteromedial portal for femoral tunnel preparation and insertion of interference screw. In the modified ACL reconstruction technique, the femoral tunnel preparation and femoral graft fixation were accomplished in the same direction and the femoral tunnel preparation was performed regardless of the tibial tunnel preparation, this allows the surgeon to handle the arthroscope freely and advance more posteriorly to get a better view of the posterior cortex.
Anterior Cruciate Ligament ; Arthroscopes ; Arthroscopy ; Axis, Cervical Vertebra ; Femur ; Knee ; Prospective Studies ; Tibia ; Transplants

Hemolytic property is a specific feature of bacteria to obtain iron which is essential for its survival in host tissues. Therefore, it is thought to be one of several factors of virulence. The purpose of this study was to investigate the hemolytic properties of Prevotella nigrescens isolated from the teeth diagnosed as pulp necrosis and apical periodontitis under the presence of hemolysin inhibitors such as NaN3 and dithiothreitol, heat, various pH and cultural conditions. The results were as follows; 1. Clinically isolated P. nigrescens strains and standard P. nigrscens ATCC 33563 showed hemolytic activity. 2. P. nigrescens showed higher hemolytic activity against human erythrocytes than sheep or horse erythrocytes. 3. NaN3 and dithiothreitol (DTT) reduced the hemolytic activity of P. nigrescens in a dose dependent manner (p < 0.05). 4. Optimal pH for the maximum hemolytic activity of P. nigrescens was 4.0 and the hemolysin was stable under the 50degrees C, but the hemolytic activity was significantly decreased at 95degrees C. 5. P. nigrescens cultured in 10% CO2 condition showed higher hemolytic activity than the bacteria cultured in the anaerobic condition.
Bacteria ; Dental Pulp Necrosis ; Dithiothreitol ; Erythrocytes ; Horses ; Hot Temperature ; Humans ; Hydrogen-Ion Concentration ; Iron ; Periapical Periodontitis ; Prevotella nigrescens* ; Prevotella* ; Sheep ; Sodium Azide ; Tooth ; Virulence

Diabetic ketoacidosis (DKA), a fatal acute diabetic complication, is characterized by severe metabolic decompensation and intravascular volume depletion. These conditions may result in hypercoagulability and prothrombic state. Pulmonary thromboembolism (PTE) could be presented as an uncommon and life-threatening complication of DKA. Reported herein is a case involving a 54-year-old male patient who was admitted with DKA due to chronic alcohol consumption and stopping the intake of oral antidiabetic drugs. After low-molecular-weight heparin and warfarin treatment because of PTE during the DKA treatment, the patient's condition improved over the week that he was discharged on insulin and warfarin.
Alcohol Drinking ; Anticoagulants ; Diabetes Complications ; Diabetic Ketoacidosis* ; Heparin, Low-Molecular-Weight ; Humans ; Hypoglycemic Agents ; Insulin ; Male ; Middle Aged ; Pulmonary Embolism* ; Thrombophilia ; Warfarin

BACKGROUND: The purpose of the study is to investigate an outbreak of rotavirus infection in a neonatal unit and to study the effectiveness of the infection control measures implemented. MATERIALS AND METHODS: We investigated an outbreak of rotavirus infection in a neonatal unit equipped with 4 newborn nursery rooms (NNRs) from Dec. 2002 through May 2003. After performing initial surveillance study in all 11 newborns and 21 staffs for stool rotavirus shedding, we observed the course of the outbreak by assessing week incidence and introducing reinforced control measures. P (VP4) genotypes of rotavirus isolates were determined to investigate the link between NNRs and the pediatric ward. RESULTS: Initial surveillance showed that 2 newborns from NNRs were infected, but none of staffs were infected. Despite initial intervention (70% alcohol based gel for hand hygiene, cohorting of the neonates, and education for staffs), new cases increased up to 9.2 cases per 100 neonate week. Even after further control measures such as using commercialized milk and recruiting new staffs, cases continued to occur with 22.2 cases per 100 neonate week. Finally, a temporary NNR was set up and disinfection of surfaces and equipments from the neonatal unit was performed, after which the outbreak ceased. All rotaviruses isolated during the outbreak from newborns in NNRs were genotype P2A, whereas isolates from the pediatric ward were genotype P1A, P1B, and P3. CONCLUSIONS: This study indicates that rotaviral diarrhea is highly transmissible and when outbreak occurs in the neonatal unit, excessive control measures such as the ward closure may be needed.
Cohort Studies ; Diarrhea ; Disinfection ; Education ; Genotype ; Hand Hygiene ; Humans ; Incidence ; Infant, Newborn ; Infection Control* ; Milk ; Nurseries ; Rotavirus Infections* ; Rotavirus*

BACKGROUND: The purpose of the study is to investigate an outbreak of rotavirus infection in a neonatal unit and to study the effectiveness of the infection control measures implemented. MATERIALS AND METHODS: We investigated an outbreak of rotavirus infection in a neonatal unit equipped with 4 newborn nursery rooms (NNRs) from Dec. 2002 through May 2003. After performing initial surveillance study in all 11 newborns and 21 staffs for stool rotavirus shedding, we observed the course of the outbreak by assessing week incidence and introducing reinforced control measures. P (VP4) genotypes of rotavirus isolates were determined to investigate the link between NNRs and the pediatric ward. RESULTS: Initial surveillance showed that 2 newborns from NNRs were infected, but none of staffs were infected. Despite initial intervention (70% alcohol based gel for hand hygiene, cohorting of the neonates, and education for staffs), new cases increased up to 9.2 cases per 100 neonate week. Even after further control measures such as using commercialized milk and recruiting new staffs, cases continued to occur with 22.2 cases per 100 neonate week. Finally, a temporary NNR was set up and disinfection of surfaces and equipments from the neonatal unit was performed, after which the outbreak ceased. All rotaviruses isolated during the outbreak from newborns in NNRs were genotype P2A, whereas isolates from the pediatric ward were genotype P1A, P1B, and P3. CONCLUSIONS: This study indicates that rotaviral diarrhea is highly transmissible and when outbreak occurs in the neonatal unit, excessive control measures such as the ward closure may be needed.
Cohort Studies ; Diarrhea ; Disinfection ; Education ; Genotype ; Hand Hygiene ; Humans ; Incidence ; Infant, Newborn ; Infection Control* ; Milk ; Nurseries ; Rotavirus Infections* ; Rotavirus*

The antiphospholipid syndrome is a multiple-system disorder characterized by persistently elevated antiphospholipid antibodies and/or arterial or venous thrombosis, thrombocytopenia, or recurrent spontaneous abortion. Various cutaneous manifestations have been associated with this disease and may be the first sign of the underlying problem. We report a case of antiphospholipid syndrome with cutaneous ulcer on the left calf of a 21-year-old woman, who has been treated with deep vein thrombosis.
Abortion, Spontaneous ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Female ; Humans ; Leg Ulcer* ; Leg* ; Pregnancy ; Thrombocytopenia ; Ulcer ; Venous Thrombosis* ; Young Adult