The clinical analysis was made on 429 patients with hemorrhoids who have been dmitted and operated at the department of Surgery, Soonchunhyang University Hospital,from January, 1986 to December, 1995 and the statistical interpretation was made to get the interval changes between the 1st half of period (1986-1990) and the 2nd half of period (1991-1995). The results were as follows: 1) The average distribution rate of hemorrhoids among benign anal diseases including hemorrhoids, fistula in auto, fissure in auto, and perianal abscess in the past one decade was 44.9% and the rate of the 2nd half(49.2%) was higher than one of the 1st half(41.2%). 2) The sex ratio of male to female was 1.65: 1 and the peak incidence was at 30s in age. In the 2nd half period the number of female patients and patients in 20s & 30s of age decreased but the number of patients in 40s of age increased. 3) 27 Patients had one hemorrhoidectomy and 3 Patients, two hemorrhoidectomies before. The average interval inbetween two different hemorrhoidecomies was 11 years involving 8.5 years of the 1st half and 13.2 years of the 2nd half. 4) The frequent symptoms were mass(34.6%), pain(26.1%), and bleeding(25.1%) but there was no interval change between the 1st half and the 2nd half. 5) The patient was first seen between 1 and 5 years after symptom development with 30.1% in frequency and the patients in the 2nd half came to hospital sooner. 6) The ratio of internal, mixed, and external type was 60.9.34:5.1 and there was no interval change. 7) The predominant location of hemorrhoids were right posterior(38.5%), left lateral(33.6%), right anterior(29.8%) and left posterior(23.8%) and there was no interval change. 8) The third grade of hemorrhoids was most frequent(52.4%) with no interval change. 9) The most of patients were operated by semi-open hemorrhoidectomy with mainly modified Nesselrod method and the number of open hemorrhoidectomies in the 1st half was larger than in the 2nd half. The most common associated anal surgery with hectorrhoidectomy was lateral internal partial sphincterotomy. 10) The associated anal diseases with hemorrhoids were skin tag(11.6%), anal fistula(6.1%), anal fissure(5.4%), and anal polyp(5.1%) in the order of frequency. There was no interval change. 11) The most common method of anesthesia for hemorrhoidectomy was the caudal anewthesia(79.2%) but hemorrhoidectomy incidence under the local anesthesia was only 0.5%. There was no interval change. 12) The common post-hemorrhoidectomy complications were urinary retention(7.7%), edema(7.5%), and bleeding(2.6%) in the order of frequency with no interval change. 13) The duration of hospitalization was between 4 to 7 days(42%) and the mean time was 8.78 days. The number of patients of the 2nd half was smaller than the number of patients of the 1st half in 7 days of admission.
Abscess ; Anesthesia ; Anesthesia, Local ; Female ; Fistula ; Hemorrhoidectomy ; Hemorrhoids* ; Hospitalization ; Humans ; Incidence ; Male ; Sex Ratio ; Skin

BACKGROUND: To access the accuracy and clinical usefulness of microplate identification (ID) system for the identification of Enterobacteriaceae, we compared microplate ID system with API 20E(bioMerieux, Etoile, France). METHODS: Ninety-two cultures of Enterobacteriaceae and one isolate of Aeromonas species were simultaneously identified by microplate ID system and the API 20E. Twenty biochemical tests used in microplate ID system were lactose, sucrose, and H2S in Kligler's iron agar media; indole, sucrose, raffinose, arabinose, trehalose, adonitol, dulcitol, sorbitol, cellibiose, methy-red, phenylalanine deaminase, ornithine decarboxylase, lysine decarboxylase, arginine dihydrolase, urease, and citrate in microplate; and oxidase test. The identification was obtained by considering percent likelihood(% ID), modal frequency and ID score method. RESULTS: Among the 92 cultures of Enterobacteriaceae and one isolate of Aeromonas species, agreement rate of identification according to the % ID between microplate ID system and API 20E were 90.3% to the species level and 97.8% to the genus level. CONCLUSIONS: For the identification of clinical Enterobacteriaceae isolates, the microplate ID system compares favorably with API 20E in identification accuracy and have the advantage of costsaving and easy to use.
Aeromonas ; Agar ; Arabinose ; Arginine ; Citric Acid ; Enterobacteriaceae* ; Galactitol ; Iron ; Lactose ; Lysine ; Ornithine Decarboxylase ; Oxidoreductases ; Phenylalanine ; Raffinose ; Ribitol ; Sorbitol ; Sucrose ; Trehalose ; Urease

No abstract available.
Humans

Aerococcus viridans, a catalase-negative gram-positive coccus rarely causing bacteremia, was isolated from blood cultures of a 52-yr-old man under the gran-ulocytopenic condition. The isolate showed the typical characteristics of A. viridans, i.e., tetrad arrangements in gram stain, positive pyrrolidonyl aminopeptidase (PYR) and negative leucine aminopeptidase (LAP) reactions, and no growth at 45 degrees C.The isolate was revealed to be highly resistant to penicillin, erythromycin, clindamycin, and ceftriaxone, although most strains of A. viridans isolated from the previously reported patients were susceptible to penicillin and other commonly used antibiotics. Even though A. viridans is rarely associated with human infections, it could be a potential causative agent of bacteremia, especially in immunocompromised patients.
Agranulocytosis/*complications/microbiology/physiopathology ; Bacteremia/*complications/microbiology/physiopathology ; Ceftriaxone/pharmacology ; Clindamycin/pharmacology ; *Drug Resistance, Multiple, Bacterial ; Erythromycin/pharmacology ; Gram-Positive Bacterial Infections/*complications/microbiology/physiopathology ; Humans ; Male ; Middle Aged ; Penicillins/*pharmacology ; Streptococcaceae/*drug effects/isolation & purification

BACKGROUND: One of major consideration of any identification (ID) system is the cost. Commercial kits, however, are too expensive. The aim of this study was to evaluate the clinical usefulness of the computerized ID system based on the conventional minimal biochemical tests for the identification of clinical isolates of Enterobacteriaceae. METHODS: During June 1996 to April 1997, Enterobacteriaceae were tested by triple sugar iron, motility, indole, ornithine decarboxylase, and citrate, and 2-4 biochemical tests were tested additionally according to the characteristics of colony on MacConkey agar. We also compared the conventional ID system with API Rapid 32E (ATB system, bioMrieux, France) to determine the accuracy of conventional ID system. RESULTS: Among the 3,652 strains of Enterobacteriaceae, 84.4% were identified by conventional tests. The identification rate of Enterobacteriaceae by conventional tests; K. pneumoniae, E. coli, P. stuartii, M. morganii, and P. mirabilis were more than 80%; K. oxytoca, Enterobacter, and S. marcescens were ranged from 70% to 80%; P. vulgaris, P. rettgeri, and C. freundii were less than 70%. Among the 133 isolates tested simultaneously by two ID systems, each of one strain of M. morganii, E. cloacae, and S. marcescens on conventional minimal biochemical tests were identified as E. coli, E. sakazakii, and S. liquefaciens by commercial kit. CONCLUSIONS: Our computerized ID system based on the minimal biochemical tests was found to offer simple, reliable and economic in the identification of clinical isolates of Enterobacteriaceae. And further studies are needed for the improvement of accuracy and identification rate.
Agar ; Citric Acid ; Cloaca ; Enterobacter ; Enterobacteriaceae* ; Iron ; Mirabilis ; Ornithine Decarboxylase ; Pneumonia

BACKGROUND: In clinical microbiology the accurate and rapid identification of members of the family Enterobacteriaceae is essential for diagnostic and therapeutic purposes and for epidemiologic studies. Accuracy of identification system depends mainly on data base such as positive rate of biochemical reactions, relative frequency of occurrence of biotype, and isolation frequency of microorganisms. The purpose of this study was to analyze the isolation rate and biotype frequency of the family Enterobacteriaceae isolated from tertiary care hospital in Korea. METHODS: Isolation frequency of the family Enterobacteriaceae isolated from clinical specimens during the period of January 1998 to June 1998 were analyzed. And biochemical phenotypes of 2,022 isolates tested by 10 tube system consisting of 14 conventional biochemical tests were also analyzed. RESULTS: Isolation rate of the family Enterobacteriaceae to the genus level in order of decreasing frequency were Escherichia (37.0%), Serratia (15.9%), Klebsiella (14.9%), Enterobacter (11.1%), Providencia (8.1%), Citrobacter (2.8%), Proteus (2.5%), Morganella (2.4%), Salmonella (2.4%), and Cedecea (0.7%). Among the genus of the family Enterobacteriaceae, Budvicia, Edwardsiella, Ewingella, Hafnia, Kluyvera, Leminorella, Moellerella, Shigella, Tatumella, Xenorhabdus, Yersinia, and Yokenella were not isolated. The number of species and genus of the family Enterobacteriaceae by this study were 48 and 12, respectively. Over 95% of all clinical isolates belonged to only 25 species. CONCLUSIONS: Although these data about frequency of relative isolation rate and biotype patterns of the family Enterobacteriaceae is inadequate according to species and genus, yet these data will be utilized for the application and development of identification method of the family Enterobacteriaceae.
Citrobacter ; Edwardsiella ; Enterobacter ; Enterobacteriaceae* ; Escherichia ; Hafnia ; Humans ; Klebsiella ; Kluyvera ; Korea ; Morganella ; Phenotype ; Proteus ; Providencia ; Salmonella ; Serratia ; Shigella ; Tertiary Healthcare ; Xenorhabdus ; Yersinia

OBJECTIVES: Neurobiological models for obsessive-compulsive disorder(OCD) have consistently implicated prefrontal-striatal circuits in the pathophysiology of this disorder. But, prior studies have inconsistently found alteration in caudate and frontal lobe volumes in patients with OCD. This study was undertaken in the hope that semi-automated linear transformation methods would elucidate the morphometric differences of various parts of brain between OCD and normal control group. METHODS: Thirteen patients meeting the DSM-IV criteria for OCD, and 9 psychiatrically normal comparison subjects participated in the study. 3-D brain MRIs using Spoiled gradient-recalled (SPGR) sequence were acquired for each subjects. After spatially normalized according to Talairach and Tournoux's coordinates, the gray and white matters were segmented by semiautomated methods using fuzzy algorithm. Each lobal volumes was measured according to Talairach and Tournoux's coordinates, and the region of interests of caudate nuclei was manually traced. The frontal lobe was divided into 3 subregions; dorsolateral prefrontal cortex, orbital frontal cortex, mesial frontal cortex accoring to the coordinates and Broadman's cytoarchitectonics. RESULTS: Only the volume of left and right frontal gray matter showed a significant difference between OCD and normal subjects. In OCD, the frontal gray matter volume was increased in tendency. There's no difference in laterality and no coorelation with clinical severities. CONCLUSION: Findings of increased frontal gray matter volumes in patients implicate a structural abnormality of these brain regions in the pathophysiology of OCD. The increased frontal gray matter volumes reflect a epiphenomena due to increased cerebral blood flows and metabolic rates before the structural changes may occur.
Brain* ; Caudate Nucleus ; Diagnostic and Statistical Manual of Mental Disorders ; Frontal Lobe ; Hope ; Humans ; Magnetic Resonance Imaging* ; Obsessive-Compulsive Disorder* ; Orbit ; Prefrontal Cortex

Accessory axillary breast tissue has received little attention in the surgical literature although it is not an uncommon kind of aberrant breast tissue. Twenty-six patients who have been treated with an exicision of accessory breast tissue from January 1988 to June 1995 at the Department of Surgery, College of Medicine, Soonchunhyang University were analyzed retrospectively. The age of the patients ranged from 18 to 58 years, median age, 34 years. All were female including two postmenopausal females. We observed a palpable mass in the left axillae in 6 patients, in the right axillae in 8 patients and in the both axilla in 12 patients. Of the 41 masses of 26 patients, 19 masses were located on tne anterior axillary line, 20 masses on the midlle axillary line and 2 masses on the posterior axillary line. The size of the accessory breast tissue ranged from 0.5 to 8cm, with a median of 3.4cm. The presenting symptoms were mass in all cases, pain in 12 cases, growing mass in 4 cases and redness in one case. Histological diagnosis of total 41 masses revealed 28 normal breast tissue, 9 fibrocystic disease, 1 ductal ectasia, 1 fibroadenoma, 1 fibrocystic disease with ductal ectasia and 1 infiltrating ductal carcinoma. There were no typical clinical characteristics for differential diagnosis preoperatively. Of a total of 38 excisional operations, 4 complications developed (two hematoma, one wound infection and one skin tag). The postoperative hospital stay ranged from 1 to 17 days. The accessory breast tissue might be regarded as a more important disease than before, because various pathologic changes could occur in it including malignant change. Early diagnosis and correct excision are usually recommended.
Axilla* ; Breast* ; Carcinoma, Ductal ; Diagnosis ; Diagnosis, Differential ; Dilatation, Pathologic ; Early Diagnosis ; Female ; Fibroadenoma ; Hematoma ; Humans ; Length of Stay ; Retrospective Studies ; Skin ; Wound Infection

PURPOSE: Anastomotic leakage following surgery is one of the most significant causes of morbidity and mortality. Therefore, prevention of anastomotic leakage is crucial for safe rectal surgery. The aim of this study is to determine the effect of Mallecot(R) insertion on the prevention of anastomotic leakage after low rectal anastomosis. METHODS: From January 2002 to December 2006, 264 rectal cancer surgeries were performed in one center and by one surgeon. Among them, 110 cases whose anastomosis was located below 6 cm from the anal verge were collected and reviewed retrospectively. We made a diverting stoma on 6 out of 20 patients with high risk of anastomotic leakage, and inserted Mallecot(R) on the remaining 14 patients transanally. Removal of Mallecot(R) was done at the 7th postoperative day after a digital rectal examination to identify the completeness of anastomosis had been performed. RESULTS: Totally, anastomotic leakage occurred in 8 of 110 patients (73%). Among the 90 patients without any preventive measures, 7 incidents of anastomotic leakage were observed; on the other hand, 1 of 14 patients with Mallecot(R) insertion suffered anastomotic leakage. In two of the patients with leakage, including 1 in the Mallecot(R) group, the leakage was resolved via percutaneous drainage; in the other 6 patients were reoperated. CONCLUSIONS: The importance of preventing an anastomotic leakage after low rectal surgery cannot be overemphasized to reduce morbidity and to improve the prognosis. In addition, Mallecot(R) insertion may be an alternative method for diverting stoma formation.
Anastomotic Leak ; Digital Rectal Examination ; Drainage ; Hand ; Humans ; Mortality ; Prognosis ; Rectal Neoplasms ; Retrospective Studies

BACKGROUND: The selection of identification (ID) system of Enterobacteriaceae depends mainly on accuracy of identification system, cost of operation and convenience of testing. Commercial ID kits are easy to use but too expensive. Therefore, we designed a computerized ID system based on 10 tubes which were composed of 14 conventional biochemical tests to identify the Enterobacteriaceae and Vibrionaceae. The purpose of this present study was to assess the clinical usefulness of 10 tube system as an identification system for Enterobacteriaceae in clinical microbiology laboratories. METHODS: During the period of January 1998, 189 Enterobacteriaceae and 2 Aeromonas spp. consecutively isolated from clinical specimens were simultaneously identified by 10 tube system and the API rapid ID 32 E. Fourteen conventional biochemical tests used in 10 tube system were lactose, sucrose, and H2S in Kligler's iron agar media; motility, indole, and ornithine decarboxylase in motility-indole-ornithine decarboxylase agar media; citrate, urease, lysine decarboxylase, phenylalanine deaminase, arginine dihydrolase, arabinose, trehalose, and adonitol. Identification program used in 10 tube system were % ID method and ID score method. RESULTS: Among the 191 isolates, agreement rate of identification between 10 tube system and API rapid ID 32 E were 96.0% to the species level and 99.4% to the genus level. And identification accuracy of 10 tube system was 90.6% to the species level and 93.2% to the genus level. CONCLUSIONS: 10 tube system has been shown to be an accurate, cost-effective alternative to the use of commercial kit systems for identification of Enterobacteriaceae.
Aeromonas ; Agar ; Arabinose ; Arginine ; Citric Acid ; Enterobacteriaceae* ; Iron ; Lactose ; Lysine ; Ornithine Decarboxylase ; Phenylalanine ; Ribitol ; Sucrose ; Trehalose ; Urease ; Vibrionaceae