BACKGROUND: This study was undertaken to identify the contaminants of saline and classify microorganisms of saline used in surgical procedures so that an appropriate timing and method of saline exchange could be considered. Forty surgeries performed by a single surgeon at a 1,500-bed hospital were investigated. METHODS: Samples of 50 mL from the saline used in each operation were collected at each of three stages of the surgical procedure: pre-skin incision, post-specimen incision and skin suture, and the microorganisms of these samples were classified. RESULTS: The most frequently isolated microorganisms from saline after the exposure to air were coagulase-negative staphylococci, micrococci and non-enterococci. In case of exchanged saline used in surgical procedures, the numbers of coagulase-negative staphylococci, micrococci, Alcaligenes species were decreased than those of unexchanged saline, but Enterococcus, Escherichia coli. Enterobacter agglomerans, Klebsiella species and Pasteurella multocida appeared. Sampling demonstrated that saline used in biliary tract surgery had Enterococcus, Alcaligenes species, E. coli, Enterobacter agglomerans, Klebsiella species and Pasteurella multocida, but saline used in gastrectomy and mastectomy had coagulase-negative staphylococcus and micrococcus. CONCLUSIONS: The important risk factor for tile contamination of saline used in surgery is not the airborne bacteria of the operating room but contaminated operative tissues. This microbiological study has shown that saline may carry considerable loads of pathogenic organisms. To reduce the possibilities of contamination of saline used to surgery, therefore, both the timing and method of saline exchange should be reconsidered, especially for prolonged surgical procedures and clean-contaminated, contaminated, or dirty/infected operations.
Alcaligenes ; Bacteria ; Biliary Tract ; Enterobacter ; Enterococcus ; Escherichia coli ; Gastrectomy ; Klebsiella ; Mastectomy ; Micrococcus ; Operating Rooms ; Pasteurella multocida ; Risk Factors ; Skin ; Staphylococcus ; Sutures

No abstract available.
Sleep Initiation and Maintenance Disorders*

This study was designed to investigate the relationship among variables to assess the effect of bladder training and pelvic muscle exercise on female urinary incontinence. A total of 50 women, recruited from Incheon area through a newsletter advertisement, were assigned to 3 groups : 13 to the control group, 19 to the bladder training group and 18 to the Kegel (pelvic muscle) exercise group. Treatment protocol lasted for 8 weeks, and study measurements were taken at the beginning, 5 week and 9 week of treatment. Peak pressure, average pressure and duration time of pelvic muscle contraction were evaluated by a perineometer ; urinary incontinence scores by the urinary incontinence scale ; amount of leaked urine and ratio (the amount leaked urine/single urinary volume after a pad test) by a 30-minutes pad test ; frequency of micturition, nocturia and single urinary volume through a urinary diary. Measurements of baseline, 5 week and 9 week were analyzed using Pearson's correlation. In conclusion, the important variables to assess the effect of bladder training and pelvic muscle exercise for 4 weeks are peak pressure, average pressure, duration, leaked urine amount, ratio, frequency of micturition and single urinary volume. The important variables to assess the effect of bladder training and pelvic muscle exercise for 8 weeks are duration, leaked urine amount, ratio, frequency of micturition, frequency of nocturia and single urinary volume.
Clinical Protocols ; Female* ; Humans ; Incheon ; Muscle Contraction ; Nocturia ; Periodicals as Topic ; Urinary Bladder* ; Urinary Incontinence* ; Urination

PURPOSE: In the treatment of symptomatic renal cysts, sclerotherapy has high recurrence rate. Laparoacopic cyst excision has high success rate but has some limitations concerning expensive devices, CO2 use and requiring trained laparoscopist. We conceived less invasive surgical technique for renal cyst excision. MATERIALS AND METHODS: The method is as follows. 1) Minimal skin incision of camera port size at PCN site nearest to the cyst. 2) Access to retroperitoneum by Kelly clamp and finger dilatation. 3) Finger dissection with or without ballooning. 4) Aspiration of cystic fluid. 5) Drawing the redundant cyst wall out of the incision. 6) Excision of the redundant cyst wall by open surgical method. RESULTS: Clinical trials of 5 patients have been performed since March 1999, with a mean age for the patients of 60 years old (range, 56-66), cyst size of 8.3cm (7.7-9.8), wound length of 2.4cm (2.1-3), operation time of 28 minutes (20-35) and blood loss of 1.6 Hb (0.5-3). There was no drain insertion except in one case, and no use of narcotics post op 2 days. Patients were discharged post op 3 days (2-5). There is no evidence of recurrence in short term follow up (mean 8 months, range 3-15). CONCLUSIONS: Though limited trials, we think expected merits over conventional laparoscopic surgery are better or comparative cosmetic results, no CO2 use, short operation time, less technical expertise and additionally economical advantages. If necessary, conversion to laparoscopic surgery, using the initial incision as camera port is possible during the procedures. So we suggest trial of this method before conventional laparoscopic renal cyst excision.
Dilatation ; Fingers ; Follow-Up Studies ; Humans ; Laparoscopy ; Middle Aged ; Narcotics ; Pregnenolone Carbonitrile ; Professional Competence ; Recurrence ; Sclerotherapy ; Skin ; Wounds and Injuries

Any compound which disrupts the integrity of psychological aspects of performance, in particular, cognitive ability and psychomotor function analogous to the psychological behaviors of routine life, is known to be behaviorally toxic. A significant level of behavioral toxicity will interfere with patient safety and quality of life, and also may be counter-therapeutic by exacerbating the condition that the drug was prescribed for. Now, behavioral toxicity of psychotropic drugs has become one of the main growth areas of psychopharmacological research. Evaluation of the potential of drug-induced behavioral toxicity is important not only to the experimental researcher involved in human psychopharmacology, but also to the clinical practitioner treating psychiatric patients. This article attempts to describe behavioral toxicity of the three classes of psychotropic drugs-benzodiazepines, antidepressants and neuroleptics. After a brief discussion of some methodological issues arising in the investigation of behavioral toxicity, each of these drug classes is reviewed in the context of practical importance rather than purely scientific concern. The last session summarizes some suggestions for future studies on drug-induced behavioral toxicity.
Antidepressive Agents ; Antipsychotic Agents ; Humans ; Patient Safety ; Psychopharmacology ; Psychotropic Drugs* ; Quality of Life

Twenty to twenty-five percent of patients are reported to experience problems with anorectal function after low anterior resection, complaining particularly urgency of defecation and minor fecal leakage, but the mechanisms underlying its cause and the recovery process are not well understood. We designed this study to elucidate the mechanism of anorectal functional problems and its recovery process after low anterior resection for rectal cancer by autonomic nerve preserving procedure. Standardized interviews and anorectal physiologic studies including balloon proctometry and manometry were performed in 32 patients preoperatively, and at 1 month, 3 months, 6 months and 1 year after the operation. Postoperatively stool frequency increased, the ability to defer defecation and discriminate stool characters were compromised, and anal incontinence scores increased, which recovered progressively by 6~12 months after the operation. Balloon proctometry showed that threshold volume, urgent volume and maximal tolerable volume decreased remarkably after the operation. The latter two parameters recovered considerably by 1 year after the operation. Rectal compliance also decreased significantly but it showed no evidence of recovery by 1 year after the operation. Anorectal manometry showed that maximum anal resting pressure decreased significantly after the operation which recovered significantly by 1 year after the operation. Maximum anal squeeze pressure showed no significant decrease after the operation. In most patients rectoanal inhibitory reflex was abolished after the operation, which recovered only in some cases by after 1 year. The group of short residual rectum(<4 cm, N=18) showed more impairment in continence and decrease in neorectal capacity and compliance than that of the long residual rectum(> or =4 cm, N=14). These results suggest impairment in fecal continence occurs due to decrease in rectal capacity, compliance, and anal canal pressure, and loss of rectoanal inhibitory reflex. Autonomic nerve preserving procedure could not prevent the decrease in resting anal pressure. Continence recovers clinically with increase in neorectal capacity, compliance and anal canal pressure but not with recovery of rectoanal inhibitory reflex. The length of the residual rectum seems to play an important role in the degree of impairment of continence and good continence can be expected when the residual rectum is more than 4 cm.
Anal Canal ; Autonomic Pathways ; Compliance ; Defecation ; Humans ; Manometry ; Rectal Neoplasms ; Rectum ; Reflex

Histiocytosis X is characterized by aggregates of Langerhans cells with other inflammatory cells. These Langerhans cells are antigen-presenting cells to T lymphocytes and identified by characteristic morphology, ultrastructural demonstration of Birbeck granules and immunologic reactivity with OKT-6 and HLA-DR antibodies. In this report, the tumor arising in a 2-years-old baby was examined byimmunostaining with several macrophage/dendritic cell markers. The main tumor cells showed cytoplasmic and nuclear staining with S-100 protein and ring-like surface and paranuclear staining with PNA. However, they were negative for follicular dendritic cell marker CD21, macrophage markers lysozyme, Mac 387, alpha-1 antitrypsin and CD68, and interdigitating reticulum cell marker ID4 and ID5. These observations demonstrate the usefulness of S-100 protein and PNA for the identification of Langerhans cells in paraffin-embedded tissue.

A case of torsion of the right cryptorchid testis was herein reported. The patient was 6-year-old boy who was rolled on a staircase and traumatized his right inguinal area. There after painful and tender swelling developed on the area, and it spent 4 days prior to visit our department The involved cryptorchid testis showed dark reddish discoloration and external rotation of 360 degrees and was removed because of no re-establishment of blood supply in spite of detorsion for 30 minutes.
Child ; Humans ; Male ; Testis*

Case 1 was a 55-year-old housewife with the 1-year history of mild recurrent gross hematuria and recent history of massive hematuria following radiation treatment for uterine cancer 7 years ago. Various conservative treatments showed no effect but complete hemostasis was obtained immediately after instillation of 100 ml of 4% formalin solution for 30 minutes under sedation. And to date, there has been no recurrence of hematuria or significant complications for 5 months after the treatment. Case 2 was a 45-year-old housewife with the 3-month history of symptomless gross hematuria following irradiation for a gynecologic malignancy 8 years ago. Complete hemostasis was obtained one day after instillation of 100 ml of 4% formalin solution for 30 minutes under sedation. and to date, there has been no recurrence of hematuria or any complications for 2 months after the treatment. Postradiation vesical bleeding is a very difficult condition to control and may result in total cystectomy and urinary diversion. The treatment by intravesical instillation of formalin solution for the intractable vesical bleeding is simple to perform, shows excellent effect and no significant complications, and is a highly recommendable mode of treatment for massive, uncontrollable vesical bleeding before total cystectomy and urinary diversion.
Administration, Intravesical* ; Cystectomy ; Formaldehyde* ; Hematuria ; Hemorrhage* ; Hemostasis ; Humans ; Middle Aged ; Recurrence ; Urinary Diversion ; Uterine Neoplasms

No abstract available.
Humans* ; Membranes*