BACKGROUND: A rehabilitation hospital has the characteristics of longer hospital stay, a variety of medical and paramedical personnels involved in treatment, and more probability of the primary care giver being a nonmedical person. The purpose of this study is to describe the characteristics of nosocomial infection in a rehabilitation hospitals METHODS: Surveillance was done in a rehabilitation hospital affiliated university hospital from June to August 1996, May to June 1997, and July to September 1999. Nosocomial infection was investigated by an infection control practitioner (JCP) according to the Center for Disease Control and Prevention (CDC)'s definitions visiting the rehabilitation wards regularly. RESULTS: The overall NI rates were 3.83 in 1996, 4.42 in 1997 and 1.91 in 1999 per 1,000 patient days, and the urinary tract infection (UTI) rates were 2.82 in 1996, 2.87 in 1997 and 1.07 in 1999 per 1,000 patient days. Both of overall NI rate and UTI rate in 1999 decreased significantly compared with that in 1996 and 1997 (P<0.001). Comparing the ward specific NI rate, the average NI rate of the spinal cord injury ward was the highest (5.67 per 1,000 patient days) and that of the pediatric rehabilitation ward was the lowest (0.83 per 1,000 patient days). UTI constituted of the largest proportion of NIs. The distribution of UTI showed a decreasing tendency from 73.47% in 1996 to 56.00% in 1999, but the distribution of gastrointestinal infection showed an increasing tendency from 4.08% and 5.40% in 1997 and 1996 to 24.00% in 1999. The commonly isolated organisms were E. coli (33.63%), Enterococcus spp. (12.73%) and C. difficile (7.27%). It reflected that the main infection was UTI. CONCLUSION: The main NI in rehabilitation hospital was the UTI. It means that the infection control program of rehabilitation hospital should be focused on the control of UTI. Surveillance in the rehabilitation hospital enabled us to describe the characteristics of nosocomial infection in the rehabilitation hospital. NI rate was decreased through continuous communications and educations with factual datum and involvement of various medical and paramedical personnels. These results show that NI surveillance is crucial for an efficient infection control program.
Allied Health Personnel ; Centers for Disease Control and Prevention (U.S.) ; Cross Infection* ; Enterococcus ; Humans ; Infection Control ; Infection Control Practitioners ; Length of Stay ; Primary Health Care ; Rehabilitation* ; Spinal Cord Injuries ; Urinary Tract Infections

No abstract available.
Burns*

Deep skin and soft tissue defects with exposed bone and tendon is difficult to treat, because skin graft rarely survives and flap surgery is sacrifice of donor site. Since "Stage I" membrane was developed by Yannas and Bruke in 1980, numerous kinds of artificial skin have been developed. The adaptability of "Terudermis", developed by the Terumo Co., as an artificial skin composed of sponge made of a fibrillar atelocollagen and a heat-denatured atelocollagen, was clinically evaluated on application to 13 cases presenting deep skin and soft tissue defect with exposed bones and tendons from October 1997 to march 1998. Terudermis has the advantage of allowing early incorporation of fibroblasts and capillaries into its collagen sponge due to very weak dehydrothermal cross-linking. Before Terudermis graft, several days of wet dressing and debridement were required to prepare healthy well-vascularized bed because Terudermis was weak on unsanitary wounds. After bed preparation, Terudermis was grafted like usual skin graft. Tie-over bolster dressing or compressive dressing was used case by case. The dressing was opened 2~3 days after Terudermis grafting. Wet dressing was done daily until the skin graft was done. Autologous skin graft was done 2-3 weeks after Terudermis graft. Our clinical results indicated that Terudermis was beneficial in treating 77% of our patients. Through the use of this new method, treatment of severe skin and soft tissue defects that are usually treated by musculocutaneous or other conventional skin flaps can be replaced by Terudermis as an new artificial dermis.
Bandages ; Capillaries ; Collagen ; Debridement ; Dermis ; Fibroblasts ; Humans ; Membranes ; Porifera ; Skin ; Skin, Artificial ; Tendons ; Tissue Donors ; Transplants ; Wounds and Injuries*

No abstract available.
Femur*

No abstract available.

In order to provide the basic data about the hip joint arthroplasty, we measured the femoral head diameter, offset and position in normal 150 males and 150 females using a standardized roentgenographic technique that provided views perpendicular to the plane of the femoral neck in which the focus centered on the lesser trochanter of the femur. We obtained 11.4% of magnification rate by comparing the real size of femoral marker with radiologic size. The result of this study are as following: The mean femoral head diameter was 46.4 ±4.1mm in male and 45.1±3.8mm in female. The mean femoral head offset was 39.2±4.8mm in male and 37.8±4.6mm in female. The mean femoral head position was 48.9±3.2mm in male and 47.6±3.6mm in female.
Adult ; Arthroplasty ; Female ; Femur ; Femur Neck ; Head ; Hip Joint ; Humans ; Male

In order to investigate the anti-proliferative effect of 3-hydroxy-3-methylglutaryl coenzyme. A reductase inhibitor, we evaluated the effects of lovastatin on DNA replication and the proliferation of rat mesangial and aortic smooth muscle cells, both of which were mesenchymal origin cells. Proliferations were determined by measuring [3H]thymidine uptake, and counting the number of cells. Growth-arrested mesangial and aortic smooth muscle cells were exposed to platelet-derived growth factor (PDGF), endothelin (ET) and angiotensin II (Ang II) to stimulate mitogenesis. All agents exhibited dose-dependent stimulation of [3H] thymidine uptake. PDGF was more potent than the others. Ang II increased [3H] thymidine uptake without demonstrable mitogenic activity. Lovastatin inhibited PDGF (10 ng/ml in mesangial cell, 25 ng/ml in smooth muscle cell)-, ET (10(-7)M)- and Ang II (10(-7)M)-induced [3H] thymidine uptake significantly in a dose-dependent manner in both cells. The increase of cell number in response to PDGF and ET treatment were also inhibited at 10 microM of lovastatin. The inhibitory effect of lovastatin was largely overcome in the presence of exogenous mevalonate at 200 microM, with 75.5% restoration from lovastatin-induced inhibition on PDGF-induced [3H] thymidine uptake in mesangial cells (77.8% in aortic smooth muscle cells). However, the addition of cholesterol did not prevent inhibition by lovastatin. In conclusion, lovastatin had an inhibitory effect on mesangial and aortic smooth muscle cell proliferation, and mevalonate was essential for DNA replication in both types of cells. Lovastatin may reduce glomerular and atherosclerotic injury through an anti-proliferative effect on mesangial and vascular smooth muscle cells, in addition to lowering circulating lipids.
Angiotensin II/pharmacology ; Animal ; Aorta/cytology/drug effects ; Cell Division/drug effects ; Cells, Cultured ; Endothelins/pharmacology ; Glomerular Mesangium/cytology/*drug effects ; Lovastatin/*pharmacology ; Male ; Muscle, Smooth, Vascular/cytology/*drug effects ; Platelet-Derived Growth Factor/pharmacology ; Rats ; Rats, Sprague-Dawley ; Support, Non-U.S. Gov't ; Thymidine/metabolism

PURPOSE: Pseudomembranous colitis (PMC) occurs rarely in children, but its incidences are increasing due to frequent antibiotic use. We investigated the incidence and clinical characteristics of PMC accompanied by bacterial enteritis-like symptoms in children. METHODS: Between November 2003 and July 2007 at the Department of Pediatrics, Dongsan Medical Center, we analyzed the medical records of consecutive patients who received antibiotics in the past 1 month, developed bacterial enteritis-like symptoms, and were diagnosed with PMC based on sigmoidoscopy examination and histological findings. RESULTS: Among 22 patients who underwent sigmoidoscopy and biopsy examinations, 11 (50%) were diagnosed with PMC. These 11 patients were aged 2 months-12 years, among whom 5 patients (45.5%) were less than 1 year old. The clinical symptoms were bloody diarrhea (28.6%), abdominal pain or colic (28.6%), watery or mucoid diarrhea (23.8%), vomiting (9.5%), and fever (9.5%). The antibiotics used were penicillins (55.6%), macrolides (27.8%), cephalosporins (11.1%), and aminoglycosides (5.6%). The period of antibiotic use was 3-14 days. The interval between the initial antibiotic exposure and the onset of symptoms was 5-21 days. The results of stool examination of all patients were negative for Clostridium difficile toxin A. Patient distribution according to the degree of PMC was as follows: grade I, 18.2% (2 cases); grade II, 27.3% (3); grade III, 36.4% (4); and grade IV, 18.2% (2). PMC did not recur in any case. CONCLUSION: PMC is not a rare disease in children. If pediatric patients receiving antibiotics manifest symptoms like bacterial enteritis, PMC should be suspected. Endoscopy and biopsy should be applied as aggressive diagnostic approaches to detect this condition.
Abdominal Pain ; Aged ; Aminoglycosides ; Anti-Bacterial Agents ; Bacterial Toxins ; Biopsy ; Cephalosporins ; Child ; Clostridium difficile ; Colic ; Diarrhea ; Endoscopy ; Enteritis ; Enterocolitis, Pseudomembranous ; Enterotoxins ; Fever ; Humans ; Incidence ; Korea ; Macrolides ; Medical Records ; Pediatrics ; Penicillins ; Rare Diseases ; Sigmoidoscopy ; Vomiting

No abstract available.
Lymphoma*

We evaluated the relationship between preoperative risk factors[gestational age, birth weight, postconceptual age and weight at operation, duration of operation, duration of anesthesia, abnormalities in neurosonogram, bronchopulmonary dysplasia]and apnea with or without bradycardia, for which mechanical ventilation was necessary after general anesthesia in the surgical treatment of retinopathy of prematurity[ROP]. Thirty-eight patients [21%]developed apnea and thirteen patients[7%]had bradycardia out of 183 patients. Retrospective study was performed and risk factors were analyzed by logistic regression. Gestational age, birth weight, postconceptual age and weight at operation and bronchopulmonary dysplasia showed the positive correlation with postanesthetic apnea and bradycardia. Duration of operation showed the positive correlation with postanesthetic apnea but not with postanesthetic bradycardia. In logistic regression without confoundings, weight at operation and bronchopulmonary dysplasia were correlated with postanesthetic apnea. Receiver operating characteristic curve analysis revealed that patients with weight under 2, 600gm at operation suffered from apnea more frequently than those with weight over 2, 600gm. In conclusion, patients with weight under 2600gm or bronchopulmonary dysplasia are at greater risk for postanesthetic apnea and optimal pre-and postanesthetic management should be prepared for these patients.
Anesthesia ; Anesthesia, General* ; Apnea* ; Birth Weight ; Bradycardia ; Bronchopulmonary Dysplasia ; Gestational Age ; Humans ; Infant, Newborn ; Logistic Models ; Respiration, Artificial ; Retinopathy of Prematurity* ; Retrospective Studies ; Risk Factors* ; ROC Curve