To evaluate the health risk of the workplace environment of a general hospital toward the hospital workers, a questionnaire survey on the perception of risk at the workplace environment and environmental measurements at 27 locations with 240 workers in the hospital were made from October 25th, 1993 to October 30th, 1994. The results were as follows; 1. By the environmental measurements, 86 workers(36%) were found to be exposed to poor or harmful degree of general illumination, 193 workers(80%) were exposed to poor or harmful local illumination, 34 workers(14%) were exposed to poor or harmful degree of thermal condition and l80 workers(75%) were exposed to poor or harmful noise level, but nobody was exposed to poor or harmful dust and toluene concentration. Also nobody was exposed to poor or harmful level of radiation or anticancer/antibiotic agents. 2. The subjective perceptions on the environmental conditions felt by the workers were different from the objective findings by the environmental measurements. The workers underscored the poor illumination state and overscored the dust concentrations. Also workers oversensitized about the thermal condition, the noise level, the radiation level, the toluene concentration and anticancer/antibiotic agents. 3. The sources of noise were the dialogue(179 workers) and the office instruments(131workers). The sources of dust came from the clothes(108 workers) and the building materials(79 workers). 4. The questionnaire survey showed that the 28 workers were exposed to poor or harmful level of the antibiotics, 10 workers to alkali or acid and 6 workers to drug dust in the pharmacy but the above findings could not be proved by the environmental measurements.
Alkalies ; Anti-Bacterial Agents ; Dust ; Hospitals, General* ; Lighting ; Noise ; Pharmacy ; Surveys and Questionnaires ; Toluene

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: 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*

A case of clear cell adenocarcinoma arising in the female urinary bladder, which is accompanied by endometriosis of the urinary bladder and the uterus, is reported. The carcinoma protruded into the vesical lumen as a fungating mass, and had a tubulocyotic pattern. The tumor cell had intracytoplasmic glycogen and electron microscopically short microvilli on their surface, resembling clear cell acenocarcinoma of the female genital tract including ovary. This is the fourth case report of clear cell adenocarcinoma complicating vesical endometriosis, and may support the view that clear cell carcinome arises from endometriosis which, in turn, from the Mullerian remnant.
Female ; Humans ; Adenocarcinoma

A case of clear cell adenocarcinoma arising in the female urinary bladder, which is accompanied by endometriosis of the urinary bladder and the uterus, is reported. The carcinoma protruded into the vesical lumen as a fungating mass, and had a tubulocyotic pattern. The tumor cell had intracytoplasmic glycogen and electron microscopically short microvilli on their surface, resembling clear cell acenocarcinoma of the female genital tract including ovary. This is the fourth case report of clear cell adenocarcinoma complicating vesical endometriosis, and may support the view that clear cell carcinome arises from endometriosis which, in turn, from the Mullerian remnant.
Female ; Humans ; Adenocarcinoma

To find the characteristics of the subjective symptoms and its related factors among the patients with the cervicobrachial syndrome, an interview survey was made toward 137 patients complaining the symptoms in cervicobrachial area out of 313 workers occupied in a microwave-oven assembling factory from December 1993 to February 1994. Results were as follows : 1. The patients were classified by the severity of the syndrome as 6 persons (4.4%) at grade I (the mildest grade), 48 persons (35.0%) at grade II, 47 persons (34.4%) at grade III-1, 11 persons (8.0%) at grade III-2 and 25 persons (18.2%) at grade IV. 2. Only 3.6% of the total patients under the study felt the main symptoms of the cervicobrachial syndrome 36 months before this study, and then the number of patients increased gradually, but the incidence of the syndrome increased suddenly from 25.1% to 74.9% since the factory had elevated the height of the belt conveyer-worktables from 75.0cm to 87.7 cm 13 months before the study. 3. Although the higher percentage of the female workers felt the subjective symptoms including the pain at the neck and shoulder, the discomfort or pain at the back and the discomfort or pain at the wrist or the finger than male workers significantly (p<0.05). The male workers, however, showed more abnormal X-ray findings than the female workers significantly (p<0.05). 4. Between the prevalence of the cervicbbrachial syndrome and the number of actual workers occupied at the factory during last-24 months, a negative correlation (r=-0.508~r=-0.665) was observed. 5. The measured workplace environment of the studied factory (average temperature: 13.3 degrees C, average noise: 78.8 dB, average illumination: 241.4 Lux) was the poorer condition than the recommended level (17degrees C or more, lower than 75 dB and 400 Lux or more). 6. Neither items to check the cervicobrachial syndrome during the entrance and health maintenance examinations nor early treatment program for the syndrome were found, at the factory. In conclusion, the primary cause of the cervicobrachial syndrome of the workers were considered due to their repeated monotonous motions on the neck, the shoulder, the arms and the hands for a long duration (2-3 years) with the uncomfortable working posture under the uncomfortable workplace environments, and the condition got aggravated due to the inappropriated health management program for its secondary prevention.
Arm ; Female ; Fingers ; Hand ; Humans ; Incidence ; Lighting ; Male ; Neck ; Noise ; Posture ; Prevalence ; Questionnaires* ; Secondary Prevention ; Shoulder ; Wrist

Black adenoma is known to be a rare variant of adrenal cortical adenoma containing characteristic abundant lipofuscin pigments in the cytoplasm. Almost all of them are nonfunctioning and only occasionally they are associated with Cushing's syndrome or primary hyperaldosteronism. We present two cases of black cortical adenoma of the adrenal gland associated with Cushing's syndrome in a 24-year-old woman and a 64-year-old man. This report dealt with clinical and pathologic presentation including ultrastructural identification of lipofuscin pigment.
Female ; Male ; Humans ; Adenoma

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

Meningiomas are usually thought of as firm solid tumors and most standard references make no mention of cystic meningiomas. Although several cases of cystic meningioma have been reported in the literature and their neuroradiological features discussed, the rarity of this entity makes its preoperative diagnosis difficult. Recently, the authors encountered a case of cystic meningioma, which was thought as ependymal cyst or infarction, preoperatively. In this report the authors discussed its clinical, neuroradiological and pathological characteristics with brief reviews of the literature.
Cysts ; Meningioma

No abstract available.
Gastroschisis* ; Hernia, Umbilical*