BACKGROUND: The purpose of this study was to discover ways to screen urine culture specimens through Gram stains, urine stick analyses and microscopic examinations for the laboratory cost saving. METHODS: One hundred and fifty-eight urine specimens for culture were included. Fifty uL of urine were inoculated onto one well each of 10-well slide, dried on the hot plate, and Gram-stained. The results combined with routine urinalyses including urine nitrite and leukocyte esterase, and pyuria, were compared with the routine culture results. RESULTS: The screening of bacteriuria by Gram stains, urinalyses and microscopic examinations revealed the high sensitivity (91.9%) and negative predictive value(95.5%) with cost saving of 41.8% of inoculating media. Not considering the Gram stains, the screening revealed 83.8% sensitivity and 92.5% negative predictive value, even if the cost saving of inoculating media were as high as 50.1%. CONCLUSION: It was demonstrated that it was sensitive and economic and produced rapid preliminary results to screen bacteriuria by the Gram stains combined with urinalyses and microscopic examinations.
Bacteriuria ; Coloring Agents ; Cost Savings ; Leukocytes ; Mass Screening* ; Pyuria ; Urinalysis*

BACKGROUND: Mycobacterial false-positive cultures have rarely been recognized in Korea, even though the rate of false-positive cultures of Mycobaterium tuberculosis has ranged from 0.4% to 4.0%. We estimated the false-positive rates by the review of medical records from whom mycobacterial cultures were requested, retrospeaively, after a bout of false-positive cultures was discovered in specimens treated in a single day. METHODS: Of the total 2,245 specimens, including 337 positive cultures of mycobacteria, during the period of January and June 1999, seventy-two specimens that showed colonies less than or equal to 5 colonies were reviewed, and classified as tuberculosis-likely group, tuberculosis-unlikely group and unclassifiable group by the clinical and radiological evidences, anti-tuberculosis therapy, and microbiological results. RESULTS: Tuberculosis-unlikely group was 21 specimens from 20 patients, and unclassifiable group was five specimens from four patients. So, the false-positive rates were estimated as 0.9- 1.1% of total cultures and 6.2-7.7% of positive cultures, according to excluding or including the unclassifiable group. CONCLUSION: Care should be taken for lowering false-positive mycobacterial cultures. Especially when a culture turned out to be positive with low colony isolates, more careful interpretations should be preceded before reporting the results by the review of medical records and communication with physician in charge.
Humans ; Incidence* ; Korea ; Medical Records ; Mycobacterium tuberculosis* ; Mycobacterium* ; Tuberculosis

The effects of statins on insulin resistance and new-onset diabetes are unclear. The purpose of this study was to evaluate the effects of rosuvastatin on insulin resistance and adiponectin in patients with mild to moderate hypertension. In a randomized, prospective, single-blind study, 53 hypertensive patients were randomly assigned to the control group (n=26) or the rosuvastatin (20 mg once daily) group (n=27) during an 8-week treatment period. Both groups showed significant improvements in systolic blood pressure and flow-mediated dilation (FMD) after 8 weeks of treatment. Rosuvastatin treatment improved total cholesterol, low-density lipoprotein (LDL)-cholesterol, and triglyceride levels. The control and rosuvastatin treatment groups did not differ significantly in the change in HbA1c (3.0+/-10.1% vs. -1.3+/-12.7%; p=0.33), fasting glucose (-1.3+/-18.0% vs. 2.5+/-24.1%; p=0.69), or fasting insulin levels (5.2+/-70.5% vs. 22.6+/-133.2%; p=0.27) from baseline. Furthermore, the control and rosuvastatin treatment groups did not differ significantly in the change in the QUICKI insulin sensitivity index (mean change, 2.2+/-11.6% vs. 3.6+/-11.9%; p=0.64) or the HOMA index (11.6+/-94.9% vs. 32.4+/-176.7%; p=0.44). The plasma adiponectin level increased significantly in the rosuvastatin treatment group (p=0.046), but did not differ significantly from that in the control group (mean change, 23.2+/-28.4% vs. 23.1+/-27.6%; p=0.36). Eight weeks of rosuvastatin (20 mg) therapy resulted in no significant improvement or deterioration in fasting glucose levels, insulin resistance, or adiponectin levels in patients with mild to moderate hypertension.
Adiponectin ; Blood Glucose ; Blood Pressure ; Cholesterol ; Fasting ; Fluorobenzenes ; Glucose ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertension ; Insulin ; Insulin Resistance ; Lipoproteins ; Plasma ; Prospective Studies ; Pyrimidines ; Single-Blind Method ; Sulfonamides ; Rosuvastatin Calcium

BACKGROUND: Efforts to reduce the wastage of blood components are necessary because of the shortage of blood components. To find ways of reducing the blood component wastage, we monitored the trends and reasons for wastage and we analyzed this data. METHODS: We have investigated and analyzed the amount and reasons for wastage from 2003 to 2005 by reviewing the wastage statements, and the information on these wastage statements was classified according to several aspects. Ouestions about the reasons for wastage and the methods for reducing such wastage were created and these were widely distributed to the doctors and nurses working at Pusan University Hospital. The results of the survey were analyzed. RESULTS: The wastage rates of blood component from 2003 to 2005 had a tendency to slightly decline: 1.49% in 2003, 1.26% in 2004 and 1.23% in 2005. The most frequent reason for wastage was the improvement in the patient's condition and the second most frequent reason was death of the patient. The favorite answers for the question about the most likely reason for wastage were related to different aspects of medicine, and also to the improvement in the patient's condition (52.6%) and the death of patient (22.6%) for the aspect of blood management, the most frequent answers were overcharge (43.3%) and delay of blood returning (17.7%). The analysis of the pattern of wastage showed that only 5 departments were responsible for 71.5%~78.1% of the wastage. CONCLUSION: Systematic and active management of the transfusion process, along with intensive cooperation of clinicians, is needed to prevent a considerable amount of blood component wastage.
Humans

Trichinellosis is one of the most widespread helminthic zoonoses. Unlike other parasitic infestation, it has been reported in advanced countries where there is a great amount of meat consumption such as Europe and America. In Korea, trichinellosis has been suspected to be prevalent for a long time, but it had not been reported up to 1997. However, three reports of human trichinellosis were published recently. An outbreak of trichinellosis caused by ingestion of raw wild boar occurred in Inje-gun, Gangwon-do, Korea, in Mar 2003. 13 people ate raw wild boar meat together, and then they had high fever, myalgia, facial edema, etc. Hematologic and biochemical examinations revealed leukocytosis, eosinophilia, and elevated AST, ALT, LDH, CPK. Muscle biopsy in rectus femoralis was performed in one index case, we detected two parasites in muscle fibers. And we measured specific antibody titers against Trichinella spiralis ES Ag in 12 patients. More than 3~4 fold higher antibody titer was noted in 11 patients compared with normal controls. We treated these cases with albendazole and steroid for 5 days.
Albendazole ; Americas ; Biopsy ; Disease Outbreaks ; Eating* ; Edema ; Eosinophilia ; Europe ; Fever ; Gangwon-do ; Helminths ; Humans ; Korea ; Leukocytosis ; Meat ; Myalgia ; Parasites ; Sus scrofa* ; Swine Diseases ; Trichinella spiralis ; Trichinellosis* ; Zoonoses

Cavernous hemangiomas of the gastrointestinal tract are extremely rare. In particular, the diagnosis of small bowel hemangiomas is very difficult in children. A 13-year-old boy presented at the outpatient clinic with dizziness and fatigue. The patient was previously diagnosed with iron-deficiency anemia at 3 years of age and had been treated with iron supplements continuously and pure red cell transfusion intermittently. Laboratory tests indicated that the patient currently had iron-deficiency anemia. There was no evidence of gross bleeding, such as hematemesis or bloody stool. Laboratory findings indicated no bleeding tendency. Gastroduodenoscopy and colonoscopy results were negative. To obtain a definitive diagnosis, the patient underwent capsule endoscopy. A purplish stalked mass was found in the jejunum, and the mass was excised successfully. We report of a 13-year-old boy who presented with severe and recurrent iron-deficiency anemia caused by a cavernous hemangioma in the small bowel without symptoms of gastrointestinal bleeding.
Adolescent ; Ambulatory Care Facilities ; Anemia, Iron-Deficiency* ; Capsule Endoscopy* ; Child* ; Colonoscopy ; Diagnosis ; Dizziness ; Fatigue ; Gastrointestinal Tract ; Hemangioma ; Hemangioma, Cavernous* ; Hematemesis ; Hemorrhage ; Humans ; Iron ; Jejunum ; Male

PURPOSE: This study was done to develop an evidence-based nursing clinical practice guideline for Moisture associated skin damage (MASD) prevention and management for patients in Korea. METHODS: The guideline adaptation process was used and conducted according to the guideline adaptation manual developed by the Korean Hospital Nurses Association. It consists of three main phases and 9 modules including a total of 24 steps. RESULTS: The adapted MASD clinical practice guideline consisted of 4 sections, 8 domains and 28 recommendations. The number of recommendations in each section was: 7 on MASD assessment, 14 on MASD prevention and management, 4 on education, and 3 on organizational policy. Of the recommendations, 3.6% were marked as A grade, 28.6% as B grade, and 67.8% as C grade. CONCLUSION: This MASD clinical practice guideline is the first to be developed in Korea. The developed guideline will contribute to standardized and consistent MASD prevention and management. The guideline can be recommended for dissemination and utilization by nurses nationwide to improve the quality of MASD prevention and management. Regular revision is recommended.
Dermatitis, Irritant ; Education ; Evidence-Based Nursing ; Evidence-Based Practice ; Humans ; Intertrigo ; Korea ; Organizational Policy ; Skin Care ; Skin

Background: Endoscope-assisted surgery is a surgical method that has been used in oral and maxillofacial surgical fields. It provides good illumination, clear, and magnified visualization of the operative field. The purpose of this article is to describe the early clinical experiences to conduct minimally invasive surgery with endoscope-assisted enucleation of cysts on the jaw. It appears that this approach may be a superior alternative to the conventional approach. Methods: In this study, 24 patients (9 females, 15 males, average age 41.5) underwent endoscope-assisted cyst enucleation under general anesthesia. All operations were done by one surgeon. The cases were classified depending on whether bone penetration occurred at the cyst site. The cystic lesions were enucleated using an endoscope with a 0°, 1.9 mm diameter, or a 30°, 2.7 mm diameter. Two bony windows were used for the insertion of a syringe for irrigation, curettes, suction tips, sinus blades, surgical drills, and an endoscope. An additional small channel was made for the insertion of endoscopic instruments. Results: The 24 patients who underwent cyst enucleation were regularly observed for 3 to 12 months to evaluate for complications. Although some patients experienced swelling and numbness, these symptoms did not persist, and the patients soon returned to normal and there was no sign of recurrence. Conclusions The results of this study have suggested the possibility of minimally invasive surgery with endoscopes when it comes to cyst removal in the oral and maxillofacial region. Nevertheless, this study has limitations designed as a preliminary report focusing on the feasibility of endoscope-assisted cyst enucleation in the oral and maxillofacial regions.

BACKGROUND AND OBJECTIVES: The optimal anti-thrombotic strategy for primary stenting in acute myocardial infarction (AMI) is still controversial. We evaluated prospectively the efficacy and safety of low-molecular-weight-heparin (LMWH) for primary stenting in AMI. MATERIALS AND METHOD: From 1/1997 to 7/1998, 54 AMI pts underwent primary stenting with 96% of procedural success rate (52/54). Of these, five pts were excluded from the study for warfarinization or use of GP II b/ III a inhibitor despite of successful stenting (TIMI 3 flow and less than 30% of residual stenosis). In 47 pts included in the study, 5,000-10,000 U of unfractionated heparin was administered (IV/bolus) bofore primary stenting. After sheath removal, LMWH(Fraxiparine, 7500 U/S.C.BID) maintained for 10.6+/-5.7 days. Aspirin and ticlopidine (500mg/day for > or =4 weeks) were given before stenting. Pts were followed to determine early (0-30 days) and late (31-180 days) major adverse cardiac events (MACE). Subsequent revascularization involving other coronary arteries did not constitute an end point. RESULTS: In 47 Pts (M:F=32:15, age=57.7+/-11.3 yrs, range: 37-88), 50 stents (Nir:38, micro:7, Jo:5, LAD:LCX:RCA-=24:9:14) were implanted. Their immediate post-stenting MLD and diameter-stenosis (%) were 2.9+/-0.4 mm, 4.3+/-8.7%, respectively. No patient showed sub-acute stent thrombosis or major bleeding requiring blood transfusion or surgery. During 0-30 days, the primary combined end point occurred in 2 (4.2%):one repeated angioplasty for in-stent restenosis; one hospital death for pump failure (1 of 2 Killip IV pts at admission). 44 patients were followed for 180 days and additional three TVR (3/44(6.8%), one CABG, one repeated angioplasty and one recurrrent myocardial infarction)occurred between 30-180 days due to recurrent ischemia. CONCLUSION:Anti-thrombotic therapy with LMWH (Fraxiparine) is safe and feasible for primary stenting in AMI. But to illuminate the impact on the clinical outcomes such as major adverse cardiac events and restenosis, we need more large and controlled study.
Angioplasty ; Aspirin ; Blood Transfusion ; Coronary Vessels ; Hemorrhage ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Ischemia ; Myocardial Infarction* ; Prospective Studies ; Stents* ; Thrombosis ; Ticlopidine ; Warfarin

BACKGROUND AND OBJECTIVES: Various intravenous (IV) antiarrhythmic drugs in patients with atrial fibrillation (AF) refractory to electrical cardiooversion have been attempted. We assessed the efficacy of IV propafenone in patients with AF who failed to achieve normal sinus rhythm using standard external direct current (DC) cardioversion. SUBJECTS AND METHODS: Of the 77 AF patients who underwent a DC cardioversion, 18, who were refractory for up to a maximal 360 joules of external DC cardioversion, were included in this study. Propafenone was infused for 10 minutes at doses of 2 mg/kg (n=3), 2.5 mg/kg (n=8), and 3 mg/kg (n=7) followed by repeated DC cardioversion. RESULTS: The mean age of the patients receiving propafenone was 55+/-14 years and 21% were women. The mean ejection fraction and the average diameter of the left atrium were 56+/-5% and 42+/-7 mm, respectively. The AF cycle length increased following propafenone infusion form 160+/-23 ms to 278+/-62 ms (p<0.05). The AF converted to a normal sinus rhythm following propafenone infusion in three patients. Thirteen patients were successfully cardioverted following IV propafenone infusion, with a mean accumulated energy of 410+/-216 joules (689+/-373 joules prior to propafenone infusion, p<0.05). Cardioversion failed in 2 patients;therefore, the success rate of the cardioversion in patients who received IV propafenone was 88.9% (16/18). No significant adverse effects were observed. CONCLUSION: IV propafenone can be safely used to enhance the efficacy of cardioversion in patients with AF refractory to transthoracic DC cardioversion.
Anti-Arrhythmia Agents ; Atrial Fibrillation* ; Electric Countershock* ; Female ; Heart Atria ; Humans ; Propafenone*