BACKGROUND: With increase of antibiotics use and invasive procedures, infections caused by multi-resistant Acinetobacter baumannii (MRAB) are increasing. Recently, we experienced the outbreak of- nosocomial infections caused by MRAB resistant to imipenem and cefoperazone/sulbactam in intensive care units (ICU) and general ward. We analyzed the clinical characteristics of the infected patients and antibiotic susceptibility of the organisms. And surveillance cultures and IRS-PCR were performed to find out the transmission route. METHODS: We collected data from physical examination and clinical records. We performed surveillance cultures of environment, patients not infected with MRAB in ICU, and hands of health care workers. RESULTS: Between November 1996 and June 1997, 49 strains of MRAB were isolated from the 26 patients hospitalized in Kangnam St. Mary' s Hospital. The lower respiratory infection (13 cases) was the most common infection and sputum was the most common sources (47.1%). All strains of MRAB showed the same genotype. In disk diffusion test, all strains were resistant to piperacillin, gentamicin, amikacin, ceftazidime, cefoperazone/sulbactam, aztreonam, imipencm, ciprofloxacin. From the surveillance cultures, the genotypically identical strains were isolated from ventilator Y-piece, the floor of ICU, and hands of health care workers. It suggested that this strain was transmitted through ventilatory device or hands of health care workers. We instructed all the health care workers to wash hands, to disinfect hospital environment completely. Since July 1997, no further case has occurred. CONCLUSIONS: Since A. baumannii could be transmitted through ventilatory devices and the hands of health care workers, it is important to wash hands and to disinfect hospital environment completely.
Acinetobacter baumannii* ; Acinetobacter* ; Amikacin ; Anti-Bacterial Agents ; Aztreonam ; Ceftazidime ; Ciprofloxacin ; Cross Infection* ; Delivery of Health Care ; Diffusion ; Genotype ; Gentamicins ; Hand ; Humans ; Imipenem* ; Critical Care Units ; Patients' Rooms ; Physical Examination ; Piperacillin ; Sputum ; Ventilators, Mechanical

BACKGROUND: Cleaning and disinfection of fiberoptic bronchoscope requires careful attention, especially to mycobacterium species because the contamination of mycobacteria could raise confusion on diagnosis. Recently, we detected contamination of Wydex(R) solution used in bronchoscope washer with Mycobacterium chelonae. In this study, we evaluated the mycobactericidal effect of 12 kinds of disinfectants for M. chelonae. METHOD: To evaluate the bactericidal effect of Wydex(R) 2%, Cidex(R) 2.25%, Cidex(R) 3%, Bacteriokiller (BK) disinfectant, Perasafe(R), HICLO-S(R), Lamicine(R), ethanol, Instrusept(R), Virkon(R), Betadine(R), and Vipon(R) against M. chelonae, culture was performed after exposure of two M. chelonae strains (ATCC 35749, the type strain and the strain isolated from contaminated Wydex(R) solution) to each disinfectant solution. The growth of organism was examined for up to 8 weeks. RESULTS: Growth of M. chelonae (reference strain of ATCC 35749 and isolated strain) was observed after a week incubation for Wydex(R) 2%, Cidex(R) (2.25%, 3%) and control. For BK disinfectant and Perasafe(R), they grew after 2-3 weeks, and 3-4 weeks, respectively. For HICLO-S(R) and Lamicine(R), only the contaminated strain grew after two and three weeks, respectively. For ethanol, Virkon(R), Betadine(R), Vipon(R), and Instrusept(R) , growth was not observed from either strain. CONCLUSIONS: On the basis of these results, Instrusept(R), virkon(R), ethanol, Betadine(R), and Vipon(R) were effective for the disinfection of M. chelonae. Especially, Instrusept(R) was thought to be useful as a disinfectant for bronchoscopes because it has advantages including non-corrosiveness, chemical stability, and non-irritativeness. And additional washing with ethanol might be effective. The finding that strain isolated from contaminated bronchoscopes was more resistant to disinfectants than reference strain suggested that the more resistant strains are selected throughout the improper disinfection.
Bronchoscopes ; Diagnosis ; Disinfectants* ; Disinfection ; Ethanol ; Mycobacterium chelonae* ; Mycobacterium*

BACKGROUND: Nosocomial urinary tract infection (UTI) accounts for 35% of the nosocomial infection and 80-90% of them are associated with urethral catheters. Recently, we experienced an outbreak of nosocomial UTI caused by multidrug-resistant Pseudomonas aeruginosa in neurosurgical intensive care unit (NSICU). METHODS: We investigated clinical records of the patients and observed the methods of care of urethral catheters in NSICU. Identification of P. aeruginose was done by API NE (API system; bioMerieux, France) and antibiotic susceptibility tests were done by disk diffusion method. Random Amplification of Polymorphic DNA (RAPD) assay was used as a genotyping method. RESULTS: Between November 1997 and January 1998, 11 P. aeruginosa strains were isolated from the urine of 11 patients hospitalized in NSICU of Kangnam St. Mary's Hospital. Routine regular bladder irrigation, and emptying urine with common urinal had been done falsely. Antibiogram of the isolates showed resistance to multiple antibiotics including imipenem, gentamicin. amikacin, piperacillin, ciprofloxacin, ceftazidime, and cefoperazone/sulbactam. RAPD of the outbreak strains showed clonal relatedness, which was different from those of other clinical strains, We instructed all the health care workers to stop bladder Irrigation, and to use the separate urinals for each patient. Thereafter, no further case of P. aeruginosa UTI has occurred. CONCLUSION: An outbreak of UTI, caused by a single clone of P. aeruginosa, was confirmed by RAPD and was eradicated after correction of false practice on care-of urinary catheter.
Amikacin ; Anti-Bacterial Agents ; Ceftazidime ; Ciprofloxacin ; Clone Cells ; Cross Infection ; Delivery of Health Care ; Diffusion ; DNA ; Drug Resistance, Multiple ; Gentamicins ; Humans ; Imipenem ; Intensive Care Units ; Microbial Sensitivity Tests ; Piperacillin ; Pseudomonas aeruginosa* ; Pseudomonas* ; Urinary Bladder ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: This study aimed at identifying the effects of improved methods of endotracheal suction and hand washing on incidence of nosocomial pneumonia (NP) in the neurosurgical ICU. METHOD: Repeated training of nurses about hand washing and adherence of the single use of suction catheter and sterile normal saline of endotracheal suction was provided. Then hand washing compliance of nurses before and after training was investigated. and the incidence of NP in all patients hospitalized for more than 72 hours in the neurosurgical ICU was investigated from Sep 1, 2000 to Jan 31, 2001 (2nd surveillance). The NP rate of that period was compared with the incidence of the 1st surveillance period, from Sep 1, 1999 to Jan 31, 2000. The data were analyzed with chi-square-test. Fisher's exact test and logistic regression analysis by SAS 8.0. RESULT: The proportion of hand washing performance increased from 15.6% to 46.8%. The rates of NP per patient during 1st surveillance and 2nd surveillance were 10.3%, 3.9%(p=0.01) patient-days rates of NP were 10.0 cases/1,000 patient days, 4.1 cases/1,000 patient days(p=0.04), and ventilator-days rates of NP were 67.6 cases/1.000 ventilator days, 16.2 cases/1,000 ventilator days(p=0.00) respectively. Out of 29 isolates, 18 were methicillin-resistant Staphylococcus aureus, which was the most frequently isolated microorganism. The risk factors associated with incidence of NP were age, length of stay, Glasgow coma scale, diabetes mellitus, duration of intubation, insertion of endotracheal tube, duration of tracheostomy, presence of tracheostomy, duration of ventilator, use of ventilator, and insertion of nasogastric tube. CONCLUSION: These results showed that single use of suction catheters and sterile normal saline and increased compliance of hand washing were important factors to decrease the incidence of NP.
Catheters ; Compliance ; Diabetes Mellitus ; Glasgow Coma Scale ; Hand Disinfection* ; Hand* ; Humans ; Incidence* ; Intensive Care Units* ; Critical Care* ; Intubation ; Length of Stay ; Logistic Models ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia* ; Risk Factors ; Suction* ; Tracheostomy ; Ventilators, Mechanical

No abstract available.
Gastroschisis* ; Hernia, Umbilical*

PURPOSE: To investigate the difference in donor corneal cell changes after penetrating keratoplasty in various corneal diseases. METHODS: Subjects included 36 eyes from 35 people with at least 6 months of follow-up who had undergone penetrating keratoplasty between August 2000 and December 2002. The patients were classified into three groups based on the state of the corneal endothelium. Changes in cell density, polymorphisms, and polymegathism of the donor cornea were compared between groups. Results were analyzed by ANOVA. RESULTS: The overall corneal endothelial cell density after grafting was lower, but the differences in endothelial cell states between the recipient cases were not statistically significant. The change in corneal endothelial cell density showed a significantly higher difference (p=0.0013) when patients had either undergone a rejection episode during recovery or recurred herpetic uveitis. CONCLUSIONS: The preoperative state of the corneal endothelium may affect the survival of donor corneal endothelium after grafting. However, rejection of the transplant contributes more significantly to the survival of the donor corneal endothelium than other factors. We suggest close observation and keen therapy with respect to rejection after grafting.
Cell Count ; Cornea ; Corneal Diseases ; Corneal Transplantation* ; Endothelial Cells ; Endothelium, Corneal* ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating ; Tissue Donors* ; Transplants ; Uveitis

PURPOSE: To investigate the difference in donor corneal cell changes after penetrating keratoplasty in various corneal diseases. METHODS: Subjects included 36 eyes from 35 people with at least 6 months of follow-up who had undergone penetrating keratoplasty between August 2000 and December 2002. The patients were classified into three groups based on the state of the corneal endothelium. Changes in cell density, polymorphisms, and polymegathism of the donor cornea were compared between groups. Results were analyzed by ANOVA. RESULTS: The overall corneal endothelial cell density after grafting was lower, but the differences in endothelial cell states between the recipient cases were not statistically significant. The change in corneal endothelial cell density showed a significantly higher difference (p=0.0013) when patients had either undergone a rejection episode during recovery or recurred herpetic uveitis. CONCLUSIONS: The preoperative state of the corneal endothelium may affect the survival of donor corneal endothelium after grafting. However, rejection of the transplant contributes more significantly to the survival of the donor corneal endothelium than other factors. We suggest close observation and keen therapy with respect to rejection after grafting.
Cell Count ; Cornea ; Corneal Diseases ; Corneal Transplantation* ; Endothelial Cells ; Endothelium, Corneal* ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating ; Tissue Donors* ; Transplants ; Uveitis

40 cases of bile duct carcinoma gathered over a 6-year period at Kosin Medical College were reviewed and theirclinical and cholangiographic findings were as follows: 1. There were 29 males and 11 females (the ratio of men towomen, 2.6:1) ranging from 37 to 74 years of age. The majority (70% of cases) were in 4th & 5th decades. 2.Clinical symptoms and signs: jaundice in 95%, RUQ or epigastric pain in 75%, pruritus in 52.5%, dark urine in 35%,weight loss in 32.5%, fever and chills in 22.5%, clay colored stool in 12.5%, and palpable mass in 12.5%. 3.Lab,findings: elevated serum total bilirubin(above 20.0mg% in 45%, 10.0-19.0mg% in 22.5%, 5.0-9.9mg% in 20%,1.3-4,9mg% in 5%), elevated alkaline phosphatase in 95%. Clonorchiasis were noted in 17.5%. 4. Histologic findingswere adenocarcinoma in most cases. 5. The location of bile duct carcinoma were common hepatic duct in 35%, commonbile duct in 32.5%, porta hepatis in 12.5%, junction with cystic duct in 10% and diffuse form in 10%. 6. In 33cases, PTC or post-operative cholangiographic examination were done. And the most frequent findings weredilatation of the proximal bile duct and abrupt narrowing or complete obstruction of distal lumen. In 27cases(82%), complete obstruction of bile duct was noted. Attempts were made to analyze the type of obstruction:Constricted type in 39%, Nipple type in 18%, round or flat type (smooth or slightly irregular) in 15%, andserratd type in 9%. Incomplete obstruction were noted in 6 cases(18%). Among them, abrupt narrowing of lumen wasnoted in 9% and diffuse narrowing in 9%. 7. ERCP was done in 7 cases. Findings were constricted type in 42.6%,constricted and slightly irregular type in 14.3%, downward convexity in 14.3%, diffuse irregular narrowing in14.3% and intraluminal filling defect in 14.3%.
Adenocarcinoma ; Alkaline Phosphatase ; Bile Ducts ; Bile ; Chills ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchiasis ; Cystic Duct ; Female ; Fever ; Hepatic Duct, Common ; Humans ; Jaundice ; Male ; Nipples ; Pruritus

PURPOSE: To report one case of Parinaud syndrome after intracranial hemorrhage. CASE SUMMARY: A 45-year-old man visited our emergency department complaining of right-sided weakness and right-sided hypoesthesia. Intracranial hemorrhage in the left thalamus and intraventricular hemorrhage were noted upon brain computed tomography, and the patient was admitted to the department of neurosurgery. He complained of diplopia and upgaze palsy, and he was referred to the department of ophthalmology. The patient exhibited convergence-retraction nystagmus, light-near dissociation and vertical gaze limitation within 15 degrees. The best-corrected visual acuity of both eyes was 20/20, but convergence-retraction nystagmus and light-near dissociation still remained. Upgaze palsy was also not improved. CONCLUSIONS: Once symptoms manifest, Parinaud syndrome does not resolve except in patients with hydrocephalus. If the findings persist for more than 6 months, the likelihood of complete resolution is very small. We reported a case of typical Parinaud syndrome with upgaze palsy, convergence-retraction nystagmus and light-near dissociation after thalamic and intraventricular hemorrhage.
Brain ; Diplopia ; Dissociative Disorders ; Emergencies ; Eye ; Hemorrhage ; Humans ; Hydrocephalus ; Hypesthesia ; Intracranial Hemorrhages ; Middle Aged ; Neurosurgery ; Ocular Motility Disorders ; Ophthalmology ; Paralysis ; Thalamus ; Visual Acuity

Magnetic resonance imaging (MRI) is a highly reliable tool for diagnosing ankylosing spondylitis. MRI can identify cartilage abnormalities, subcortical erosions, bone marrow edema with inflammation, and synovial enhancement. Subchondral sclerosis and juxta-articular fat deposition are noted in the chronic stage of ankylosing spondylitis. Spinal changes associated with spondyloarthropathy are florid anterior spondylitis (or Romanus lesion), florid diskitis (Anderson lesion), ankylosis, and arthritis of the apophyseal and costovertebral joints. A MRI grading system for inflammation in sacroiliac joints and the spine could help clinicians evaluate the anti-inflammatory efficacy of therapeutics. Newer technologies based on MRI are aimed at broadening the diagnostic scope and facilitating the quantification of active inflammation but still require extensive validation.
Ankylosis ; Arthritis ; Bone Marrow ; Cartilage ; Discitis ; Edema ; Inflammation ; Joints ; Magnetic Resonance Imaging ; Sacroiliac Joint ; Sacroiliitis ; Sclerosis ; Spine ; Spondylarthropathies ; Spondylitis ; Spondylitis, Ankylosing