BACKGROUND: Methicillin-resistant Staphylococcus aureus(MRSA) is an increasingly common cause of nosocomial infections worldwide. Epidemiologic investigation of MRSA outbreaks and identification of pathways of nosocomial MRSA spread require the ability to distinguish individual MRSA strains. We applied molecular tap ing of the methicillin-resistant determinant (mec) and coagulase typing in the investigation of a nosocomial MRSA infections. METHODS: We randomly selected 79 strains of mecA positive MRSA isolated from patients who visited Dong-A university Hospital from Dec. 1995 to Oct. 1996. Molecular typing of MRSA was performed by comparing the size of the mac-associated hypervariable region amplified by the polymerase chain reaction (PCR). Coagulase typing with type I-VIII antisera was also used for classification of MRSA based on its phenotype. Each isolates were classified by the combination of molecular analyses and coagulase type. RESULTS: The 79 MRSA isolates were grouped Into sin hypervariable legion (HVR) genotypes on the basis of the size of the PGR products. In coagulase typing, the most predominant type was II(46.8%) and type V was not found. Nine strains were not typable. The combination of HVR genotypes and coagulase types showed 23 different types in 79 MRSA Isolates. The strains which were repeatedly isolated from the same patients showed the same HYR genotypes and coagulate types. CONCLUSION: The combination of HVR genotypes and coagulase types is thought to be useful in epidemiolgical Investigation of nosocomial infections caused by MRSA ,because of its simplicity and reproducibility.
Classification ; Coagulase* ; Cross Infection* ; Disease Outbreaks ; Genotype ; Humans ; Immune Sera ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Molecular Typing* ; Phenotype ; Polymerase Chain Reaction ; Staphylococcus

BACKGROUND: Recent DNA polymorphism analysis using numerous DNA markers has been used to determine the parental origin of the extra chromosome 21 in Down syndrome. In this study we used seven dinucleotide repeat polymorphisms on chromosome 21 to characterize a case of rea(21q21q) and to know whether it is consistent with an isochromosome or a true Robertsonian translocation. METHODS: Cytogenetic investigation was done by conventional G banding DNA was extracted from whole blood of a proband and her parents and was amplified by PCR using seven sets of (GT)n repeat dinucleotide markers located on the long arm of chromosome 21 After electrophoresis of the PCR product in polyacrylamide gel and silver staining the parental origin and number of DNA copy were determined by visual comparison of the band intensities within and between individuals. RESULTS: Conventional cytogenetics showed that the proband had a 46.XX.re(21q21q) chromosome pattern. Parental chromosome studies were normal, therefore, the rearrangement was a de novo event. All seven DNA markers showed one or two alleles, demonstrating rea(21q21q) to be an isochromosome. For D21S215 and D21S156 markers both parents were heterozygous and the proband inherited one copy of paternal allele and two copies of maternal allele which both parents did not share. This finding was consistent with a maternally derided isochromosome. CONCLUSION: Use of dinucleotide repeat DNA polymorphisms after PCR amplification will be very useful to detect the parental origin of additional chromosome 21 or rearrangement of chromosome 21 in Down syndrome. Besides employing siltier staining of a PCR product we will be able to avoid using of radioisotopes and apply to clinical laboratory diagnosis.
Alleles ; Arm ; Chromosomes, Human, Pair 21 ; Clinical Laboratory Techniques ; Cytogenetics ; Dinucleotide Repeats* ; DNA ; Down Syndrome ; Electrophoresis ; Genetic Markers ; Humans ; Isochromosomes ; Parents ; Polymerase Chain Reaction ; Radioisotopes ; Silver Staining

PURPOSE: We applied lateral lithotomy position to the severe ureteral stricture cases supposed to fail with only retrograde approach. MATERIAL AND METHODS: From October 1997 to April 1999, 13 patients with severe ureteral stricture (lenghth>2cm or complete obstruction) supposed to fail with only retrograde approach and one patient with study. The causes of ureteral strictures were pelvic malignancy in 5, tuberculosis in 4, trauma in 2 and others in 2. The patient's ipsilateral shoulder was rotated and fixed like lateral position. And ipsilateral pelvis was elevated with sandbag or pad and rotated about 45 degrees, too. The retrograde approach was tried at first, if fail, antegrade approach was combined. RESULTS: We could insert ureteral stent via retrograde approach only in 3 patients and we needed aid of antegrade approach for passage through ureteral stricture in the other 11 patients (79%). Percutaneous antegrade approaches were combined in those 11 patients and we could pass the guide wire and indwell the stent in 10 of 11 patients (91%) using this position. CONCLUSIONS: The lateral lithotomy position was very helpful to the simultaneous retrograde and antegrade approach in severe fibrotic or malignant ureteral strictures.
Constriction, Pathologic ; Humans ; Pelvis ; Shoulder ; Stents ; Tuberculosis ; Ureter*

Myocardial bridging is defined as segmental engulfment of a major epicardial coronary artery by myocardial fibers, causing a systolic narrowing or milking effect of the coronary arterial segment. During systole, the intramuscular part of coronary artery is compressed by contraction of overbridging ventricular muscle, therefore blood flow distal to the lesion is impaired and angina pectoris or acute myocardial infarction may occur. We experienced a case of Non-Q myocardial infarction in a 42 years-old female patient with myocardial bridge at the proximal and middle part of left anterior descending coronary artery.
Adult ; Angina Pectoris ; Coronary Vessels ; Female ; Humans ; Milk ; Myocardial Bridging* ; Myocardial Infarction ; Systole

PURPOSE: We evaluated the advantages of simultaneous procedure in bilateral percutaneous nephrolithotomy for the management of bilateral renal stones. MATERIALS AND METHODS: The charts of patients with bilateral renal stones from January 1990 to April 1998 were retrospectively reviewed. We compared operative time, hospital stay, decrease in hemoglobin, and complications of simultaneous procedure with those of sequential procedure. RESULTS: Among the 13 patients with bilateral renal stones treated percutaneously, 9 patients were underwent simultaneous procedure and 4 patients were underwent sequential procedure. Mean operative time was 190 minutes in simultaneous group and 335 minutes in sequential group (p<0.05), mean hospital stay was 10.1 and 16.8 days (p<0.05) and mean decrease in hemoglobin was 2.6 and 1.6g/dl (p>0.05), respectively. Complications included blood loss requiring transfusion in 1 case and paralytic ileus in 1 of simultaneous group, and blood loss in 2 and fever in 1 of sequential group. CONCLUSIONS: Simultaneous bilateral percutaneous nephrolithotomy is a well-tolerated, safe, expeditious, and cost-effective approach to patients with bilateral renal stones at centers proficient in percutaneous techniques.
Fever ; Humans ; Intestinal Pseudo-Obstruction ; Length of Stay ; Nephrostomy, Percutaneous* ; Operative Time ; Retrospective Studies

PURPOSE: We evaluated the advantages of simultaneous procedure in bilateral percutaneous nephrolithotomy for the management of bilateral renal stones. MATERIALS AND METHODS: The charts of patients with bilateral renal stones from January 1990 to April 1998 were retrospectively reviewed. We compared operative time, hospital stay, decrease in hemoglobin, and complications of simultaneous procedure with those of sequential procedure. RESULTS: Among the 13 patients with bilateral renal stones treated percutaneously, 9 patients were underwent simultaneous procedure and 4 patients were underwent sequential procedure. Mean operative time was 190 minutes in simultaneous group and 335 minutes in sequential group (p<0.05), mean hospital stay was 10.1 and 16.8 days (p<0.05) and mean decrease in hemoglobin was 2.6 and 1.6g/dl (p>0.05), respectively. Complications included blood loss requiring transfusion in 1 case and paralytic ileus in 1 of simultaneous group, and blood loss in 2 and fever in 1 of sequential group. CONCLUSIONS: Simultaneous bilateral percutaneous nephrolithotomy is a well-tolerated, safe, expeditious, and cost-effective approach to patients with bilateral renal stones at centers proficient in percutaneous techniques.
Fever ; Humans ; Intestinal Pseudo-Obstruction ; Length of Stay ; Nephrostomy, Percutaneous* ; Operative Time ; Retrospective Studies

PURPOSE: The 7th AJCC tumor node metastasis (TNM) staging system modified the classification of the lymph node metastasis widely compared to the 6th edition. To evaluate the prognostic predictability of the new TNM staging system, we analyzed the survival rate of the gastric cancer patients assessed by the 7th staging system. MATERIALS AND METHODS: Among 2,083 patients who underwent resection for gastric cancer at the department of surgery, Hanyang Medical Center from July 1992 to December 2009, This study retrospectively reviewed 5-year survival rate (5YSR) of 624 patients (TanyN3M0: 464 patients, TanyNanyM1: 160 patients) focusing on the number of metastatic lymph node and distant metastasis. We evaluated the applicability of the new staging system. RESULTS: There were no significant differences in 5YSR between stage IIIC with more than 29 metastatic lymph nodes and stage IV (P=0.053). No significant differences were observed between stage IIIB with more than 28 metastatic lymph nodes and stage IV (P=0.093). Distinct survival differences were present between patients who were categorized as TanyN3M0 with 7 to 32 metastatic lymph nodes and stage IV. But patients with more than 33 metastatic lymph nodes did not show any significant differences compared to stage IV (P=0.055). Among patients with TanyN3M0, statistical significances were seen between patients with 7 to 30 metastatic lymph nodes and those with more than 31 metastatic lymph nodes. CONCLUSIONS: In the new staging system, modifications of N classification is mandatory to improve prognostic prediction. Further study involving a greater number of cases is required to demonstrate the most appropriate cutoffs for N classification.
Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

It has been approximately 30 years since Child-Turcotte-Pugh score has been used as a predictor of mortality in patients with liver cirrhosis and hepatocellular carcinoma (HCC). Recently, new prognostic models such as Model for End-Stage Liver disease (MELD), Short- and Long-term Prognostic Indices (STPI and LTPI), Rockall score, and Emory score were proposed for predicting survival in patients with liver cirrhosis treated by transjugular intrahepatic portosystemic shunt (TIPS). In MELD scoring, three independent variables which showed a wide range of results including serum creatinine, serum bilirubin and international normalization ratio (INR) of prothrombin time were evaluated in log(e) scale in comparison with simply categorized-into-three scoring system of Child-Turcotte-Pugh. The etiology of liver cirrhosis was applied to the score of MELD: alcoholic or cholestatic, 0; viral or others, 1. Concurrent statistic (C-statistic) of MELD (0.73-0.84) was slightly superior or insignificantly different to that (0.67-0.809) of Child-Turcotte-Pugh score. In February 2002, UNOS status 2a and 2b were replaced with MELD score for priority allocation of liver transplantation. MELD score does not reflect the severity of patients with HCC or metabolic disorders. For assessing prognosis in patients with liver cirrhosis or HCC, there seems little reason to replace the well established Child-Turcotte-Pugh score. Herein the literatures was briefly reviewed.
Bilirubin/blood ; Carcinoma, Hepatocellular/*classification/mortality ; Creatinine/blood ; Humans ; International Normalized Ratio ; Liver Cirrhosis/*classification/mortality/surgery ; Liver Neoplasms/*classification/mortality ; Portasystemic Shunt, Transjugular Intrahepatic ; Prognosis ; ROC Curve ; Risk Factors ; *Severity of Illness Index ; Survival Rate

No abstract available.
Humans* ; Idiopathic Pulmonary Fibrosis*

PURPOSE: We evaluated the early results and the learning curve of laparoscopic radical prostatectomy in the first 150 patients. MATERIALS AND METHODS: Between July 2001 and March 2007, 150 consecutive patients with clinically organ-confined prostate cancer underwent laparoscopic radical prostatectomy. For evaluation of the learning curve, morbidity, oncologic, and functional results of the first 50(group 1) and last 50(group 3) procedures were compared. RESULTSs: The mean operating time and hospital stay was 289+/-66 minutes and 6.3+/-2.9 days, respectively. The median postoperative period of an indwelling Foley catheter was 5 days(range, 3-46 days). The intraoperative complication rate, including transfusion, was 15.3%. A positive surgical margin rate was 37.3%. After a mean follow-up of 33.5 months, a PSA relapse was observed in 39(33.6%) patients. The continence rate was 77.1, 92.2, and 93.7% at 1, 6, and 12 months. Analysis of the learning curve revealed significant differences in the operating time, hospital stay, intraoperative complication rate, and indwelling Foley catheter days, whereas the postoperative complication rate, mean estimated blood loss, positive surgical margin rate, and continence rate 6 months postoperatively showed no influence. CONCLUSIONS: Although laparoscopic radical prostatectomy requires significant expertise with a learning curve, the morbidity is low and the oncologic continence result was promising. The learning curve for laparoscopic radical prostatectomy depends not only on the technical skills, but also on the self-perceived definition. It is likely that no complete plateau of the learning curve exists for any article. Standardized expectations and reporting of outcomes could help to better define the true learning curve for laparoscopic radical prostatectomy.