BACKGROUND: Both the Korean Society of Infectious Diseases and The Korean Center for Diseases Control recommended MMR (measles, mumps, rubella) vaccination to health care workers (HCWs) but this had rarely been applied mainly due to economic reasons. In this paper, we report a measles outbreak initiated by two inpatients and then spread to other nine infants and three HCWs. We also report that this outbreak was successfully contained by active infection control measures. METHODS: Measles cases were determined according to CDC clinical criteria and confirmed by the level of the measles-specific IgM antibody. Suspected patients were isolated in aeration-limited areas. After measles cases in HCWs were detected, people in 26 pediatric wards were screened for measles-specific IgG antibody. MMR (measle, rubella, mumps) vaccination was applied to HCWs who were negative for measles-specific antibodies or HCWs who were exposed but not sure of their vaccination status. RESULTS: From April 21 to June 4 in 2007, measles-infected patients consisted of eleven infants (11 months old in median age) and three HCW women. Antibody screening revealed that only 73% (19 out of 26) in pediatric wards were positive for measles-specific IgG. After a medical doctor was confirmed as measles-infected, health care worker exposed to measles patients were all vaccinated without antibody test. CONCLUSION: The precise level of anti-measles antibody in adults has to be revealed by further studies involving multiple organizations. This result could be helpful for establishing a proper health care policy of MMR vaccination.
Adult ; Antibodies ; Centers for Disease Control and Prevention (U.S.) ; Communicable Diseases ; Delivery of Health Care ; Disease Outbreaks ; Female ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Infant ; Infection Control ; Inpatients ; Mass Screening ; Measles ; Mumps ; Rubella ; Tertiary Care Centers ; Vaccination

BACKGROUND: In an effort t enhance long term patency of coronary bypass grafts, utilization of arterial conduits have been on an icrease. With the same objective, we have been using the right gastroepiploic artery (RGEA) in coronary artery bypass procedures since 1998. The current paper has been undertaken with the aim of assessing the apropriateness, problems, and short term results of using the RGEA as an arterial graft conduit by studying the postoperative clinical results of 100 patients than received coronary artery bypass grafting (CARG) with this artery. MATERIAL AND METHOD: Between May of 1998 and May of 1999, an analysis of the mortality, postoperative myocardial infarction, and the need for IABP insertion as a result of low cardiac output were made between 100 consecutive patients undergoing CABG with the RGEA. There was one postoperative death due to cerebral infarction. Postoperative complications/morbidity comprised myocardial infarction in 2, cerebral infarct in 3, reoperation due to bleeding in 1, mediastinitis in 1, and low cardiac output syndrome necessitating IABP in 3 patients. Complicatons related to harvesting of the arterial grafts were not experienced in any of the patients. CONCLUSION: The results of the current data show that utilization of the RGEA in CABG is not associated with increased mortality/morbidity and demonstrates satisfactory short term results suggesting the usefulnessof this conduit as an arterial graft.
Arteries ; Cardiac Output, Low ; Cerebral Infarction ; Coronary Artery Bypass* ; Coronary Vessels* ; Gastroepiploic Artery* ; Hemorrhage ; Humans ; Mediastinitis ; Mortality ; Myocardial Infarction ; Reoperation ; Transplants

Purpose: The treatment strategy of Distractive-Flexion Injury (DFI) depends on the preoperative reduction, and anterior surgery is usually sufficient for closely reduced DFI. In contrast, reduction-failed injuries should be reduced by more complex procedures. This study evaluated the risk factors of closed reduction and identified the factors that can predict reducibility. Materials and Methods: Fifty patients who underwent surgical treatment due to unstable DFI (Allen stage 2 or higher) from 1994 to 2018 were enrolled in this study. All patients underwent Gardner–Wells tongs traction preoperatively. The patients were subdivided into two groups (group A: reduced, group B: failed reduction). The degree of dislocation and subluxation of the facet joints were analyzed by computed tomography. The major injured facet (MIF) joint was defined as a dislocated joint with more damage, and the opposite facet joint was defined as a minor injured facet joint (mIF) with subluxation. The severity of a MIF injury was analyzed by vertically dividing into quarters of the dislocated facet joint. The severity of the mIF injury was analyzed by dividing the subluxated articular surface facet into quarters. The degree of soft tissue injury was measured by magnetic resonance imaging and divided into three grades. The correlation between preoperative reducibility and other variables was analyzed. Results: Group A contained 27 cases (DFI 2=21, DFI 3=6), and there were 23 cases in group B (nine partial reduction and 14 failures, DFI 2=13, DFI 3=9, DFI 4=1). In DFI 2, the more severe dislocation (D3 and D4), the higher the probability of reduction failure (p=0.001), and the probability of reduction failure increased with less subluxation (S1) (p=0.033). In DFI 3 and 4, the grade of dislocation (D4) also appeared to correlate with the reducibility (p=0.016). Conclusion The degree of facet involvement could be used as a diagnostic and therapeutic tool in treating DFI of the lower cervical spine. In particular, in DFI 2, severe dislocation (50% or more) or mild subluxation (25% or less), and 75% or more dislocation in DFI 3 and 4 may be a risk factor for interrupting closed traction reduction.

OBJECTIVES: Aluminum step wedge (ASW) equivalent radiodensity (eRD) has been used to quantify restorative material's radiodensity. The aim of this study was to evaluate the effects of image acquisition control (IAC) of a digital X-ray system on the radiodensity quantification under different exposure time settings. MATERIALS AND METHODS: Three 1-mm thick restorative material samples with various opacities were prepared. Samples were radiographed alongside an ASW using one of three digital radiographic modes (linear mapping (L), nonlinear mapping (N), and nonlinear mapping and automatic exposure control activated (E)) under 3 exposure time settings (underexposure, normal-exposure, and overexposure). The ASW eRD of restorative materials, attenuation coefficients and contrasts of ASW, and the correlation coefficient of linear relationship between logarithms of gray-scale value and thicknesses of ASW were compared under 9 conditions. RESULTS: The ASW eRD measurements of restorative materials by three digital radiographic modes were statistically different (p = 0.049) but clinically similar. The relationship between logarithms of background corrected grey scale value and thickness of ASW was highly linear but attenuation coefficients and contrasts varied significantly among 3 radiographic modes. Varying exposure times did not affect ASW eRD significantly. CONCLUSIONS: Even though different digital radiographic modes induced large variation on attenuation of coefficient and contrast of ASW, E mode improved diagnostic quality of the image significantly under the under-exposure condition by improving contrasts, while maintaining ASW eRDs of restorative materials similar. Under the condition of this study, underexposure time may be acceptable clinically with digital X-ray system using automatic gain control that reduces radiation exposure for patient.
Aluminum ; Humans ; Radiographic Image Enhancement

The incidence of protein and energy malnutrition is about 20-40% in patients on maintenance dialysis and it is an important determinant of morbidity and mortality in end-stage renal disease. The traditional methods of nutritional assessment such as body measurement and dietary assessment are relatively ineffective because of operator dependency. Biochemical data, also, have the difficulty in early detection of malnutrition. Therefore more precise and simple method such as bioelectrical impedance analysis(BIA) was needed. We perfomed a study of 25 maintenance hemodialysis patients who were clinically stable and had been on dialysis over 3 months to identify the relationship between lean body mass(LBM) by BIA and other nutritional indicators. Mean age was 43+/-12 years, sex ratio, M:F=1:1.3, and mean dialysis duration, 56+/-38.9 month. Three patients were diabetes mellitus(12%), Delivered Kt/ Vurea, serum albumin, and %LBM were 1.5+/-0.2/ session, 4.1+/-0.4g/dl and 76.5 +/-10.5%, respectively. Patients were divided into 2 groups; group I whose %LBM was less than 75%, and group II whose %LBM was more than 75%. Patients were significantly older in group I, but sex ratio, percentage of diabetes mellitus, dialysis duration were not significantly different between two groups. Serum cholesterol(175.3+/-35.2 vs. 142.5+/-24.7mg/dL) was significantly higher and serum creatinine(12.4+/-2.7 vs. 16.2+/-4.3mg/dL) was significantly lower in group I. Serum albumin and insulin-like growth factor-I (IGF-I) were similar between two groups. On data measured by BIA, LBM(67.9+/-6.1 vs. 84.4+/-1.9%), height2/resistance(39.4+/-4.3 vs. 52.7+/-8.5) were significantly lower in group I. %Body fat was significantly higher in group I(31.3+/-4.6 vs. 15.7+/-6.7%). Dietary protein intake(30+/-13.5 vs. 41.7+/-14.6g/day) and total calorie intake(1239.9+/-272.3 vs. 1329.4+/-375.0 Cal/day) were higher in group II. %LBM correlates positively with serum creatinine (r=0.41, p<0.05) and dietary protein intake(r=0.51, p<0.05), but negatively with age(r=-0.59, p<0.05) and cholesterol(r=-0.52, p<0.05). In conclusion, %LBM by BIA in maintenance hemodialysis patients appears to be well correlated with traditional nutritional study.
Creatinine ; Diabetes Mellitus ; Dialysis ; Dietary Proteins ; Electric Impedance* ; Humans ; Incidence ; Kidney Failure, Chronic ; Malnutrition ; Mortality ; Nutrition Assessment ; Renal Dialysis* ; Serum Albumin ; Sex Ratio

BACKGROUND: Exercise-induced coronary spasm is occasionally recognized in patients with variant angina, but the patterns of exercise-induced coronary spasm and its relation to clinical features are still not clear. METHODS: Eight consecutive patients with variant angina without significant stenosis of the coronary artery performed serial treadmill exercise tests during early morning, late morning, and in the afternoon. The subjects repeated the tests after administration of atropine and doxazosin or phentolamine. RESULTS: (Upon drug administration), anginal episodes with ST-segment changes (elevation 5, depression 1) Occurred repeatedly in 6 of the 8 patients during early morning; the episodes occurred in only 2 patients during the afternoon exercise test. Four patients showed exercise-induced angina and ST-segment changes during early morning but not in the afternoon, and 2 of them showed mild episodes of exercise-induced angina and ST-segment changes during late morning. Three of the four patients had the characteristic clinical history of angina in early morning during usual activities but not during daytime activities despite the activities being more strenuous. Another 2 patients showed both exercise-induced ST-segment elevation and angina in early morning and afternoon, and they had the characteristic history of more episodes at night and in early morning but only occasionally in the daytime with or without relation to activity. One of the two patients showed intermittent ST-segment elevation during the exercise test. The other two patients had exercise-induced episodes neither in the early morning nor in the afternoon; they had a characteristic history of episodes only at night during sleep but never in the early morning nor in the daytime. Atropine did not suppress the exercise-induced angina in 4 of 5 patients studied. Doxazosin or phentolamine suppressed the exercise-induced episodes in 3 of 5 patients studied but aggravated spontaneous episodes in 3 patients. CONCLUSION: These data suggest that there's possibility of presence of different patterns of exercise-induced coronary spasm, which may be induced by different mechanisms from those in spontaneous episodes in patients with variant angina.
Atropine ; Constriction, Pathologic ; Coronary Vessels ; Depression ; Doxazosin ; Exercise Test ; Humans ; Phentolamine ; Spasm*

No abstract available.
DNA*

Amyloidosis is the definition for a group of diseases that have, in common, the infiltration of one or more tissues by an abnormal protein material-the amyloid substance, which is detected histologically by their green polarization color after Congo red staining. Despite increased interest on basic nature of amyloidosis by recent immunohistochemical or experimental study, the knowledge about the incidence and neurotoxic effect of cerebral amyloid or concomitant occurrence with brain tumor is still inchoate. We examined the incidence and clinico-pathologic characteristics of the patients with amyloid deposits in supratentorial meningiomas. Particularly about their neurotoxic effect to adjacent brain is considered one of the possible cause of seizure in 33 patients who underwent resection surgery for meningioma at the Keimyung University during the past three years. The pathological review and subgrouping by histologic type were done in all 33 specimens with sufficient size of paraffin block, defined by their morphology and polarization color after Congo red staining for diagnosis of amyloid deposits localized in the tumor. Immunohistochemical studies using monoclonal antibodies for amyloid-A protein(AA) and beta-amyloid(A beta) were evaluated to identify subtypes of amyloidosis. The rate of incidence of amyloid deposit in meningioma was 21%, i.e. seven out of thirty three cases. All laboratory findings and clinical studies did not suggest a systemic form. Seizure occurrence was one out of seven cases(14%), which was of no statistical significance. Immunohistochemical study for AA subtype was all negative, but showed all positive for A beta protein around the vessels. Recent reports has also demonstrated that Amyloid precusor protein(APP) and A beta is related in Alzheimer's disease, hereditary cerebral hemorrhage with amyloidosis-Dutch type(HCHWA-D) and amyloid angiopathy. Our research data indicates that the incidence of amyloid deposit is as high as 21% in supratentorial meningiomas. It seems that it is one of the possible cause of seizure. Nonsystemic microdeposits of amyloid and their subtype and it's relationship to neurotoxic effect in meningiomas remain to be confirmed by immunoelectron microscopic examination or immunohistochemical methods.
Alzheimer Disease ; Amyloid* ; Amyloidosis ; Antibodies, Monoclonal ; Brain ; Brain Neoplasms ; Cerebral Hemorrhage ; Congo Red ; Diagnosis ; Humans ; Incidence ; Meningioma* ; Paraffin ; Plaque, Amyloid* ; Seizures

Congenital cystic adenomatoid malformation(CCAM) is one of the most common congenital lung lesions. Clinical manifestations that show are neonatal respiratory distress, recurrent respiratory infection, pneumothorax, and hemothorax. But, there are patients who are asymptomatic until mid-childhood. The treatment of asymptomatic CCAM is controversial. There is a possibility to resolve it spontaneously, but late complications such as recurrent pulmonary infection, pneumothorax, hemothorax, and cancer, which includes bronchoalveolar carcinoma and rhabdomyocarcinoma, pleuropulmonary blastoma still remain. Some investigators advocate routine surgery for all cases of CCAM that are apparent at birth. A previously healthy 16-months-old girl who had suffered from a cough for 2 weeks was transferred to Asan Medical Center with CCAM. Due to a chest CT and fever, we first thought that she had CCAM with infection. After we treated her with antibiotics for one week, we performed surgery to confirm the diagnosis and to prevent further complication. But by surgical wedge resection, a pleuropulmonary blastoma was found. There were no evidence of metastasis and adjacent involvement. She started her chemotherapy with vincristine, actinomycin D and cyclophosphamide, and is now continuing maintenance chemotherapy with etoposide, vincristine, and Ifosfamide. We report pleuropulmonary blastoma that presented as CCAM. So we recommend surgical resection in asymptomatic CCAM to confirm the diagnosis and to prevent its malignant transformation, even not accompanied by symptoms.
Anti-Bacterial Agents ; Child ; Chungcheongnam-do ; Cough ; Cyclophosphamide ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Dactinomycin ; Diagnosis ; Drug Therapy ; Etoposide ; Female ; Fever ; Hemothorax ; Humans ; Ifosfamide ; Lung ; Maintenance Chemotherapy ; Neoplasm Metastasis ; Parturition ; Pneumothorax ; Research Personnel ; Tomography, X-Ray Computed ; Vincristine

No abstract available.
Humans