Staphylococcus epidermidis and other coagulase-negative staphylococci (CNS), often dismissed previously as culture contaminants, are assuming great clinical importance as true pathogens. CNS infections are associated with indwelling foreign bodies and increase along with increasing use of catheters and artificial devices inserted through the skin. CNS from nosocomial infections, particularly S. epidermidis, are usually resistant to multiple antibiotics, with more than 80% resistant to methicillin. Methicillin-resistant. epidermidis (MRSE) can become resistant to all β-lactams, cephalosporins, and carbapenems by the aquisition of a chromosomal mecA gene, which encodes penicillin-binding proteins 2a that has low affinity for β-lactams. S. epidermidis universally attaches to surface of indwelling artificial devices and catheters and produces extracellular polysaccharides, resulting in the formation of a biofilm. Biofilms increase resistance of S. epidermidis to antimicrobial agents and the potential to cause infections in patients with indwelling medical devices. The drug of choice for MRSE infection is glycopeptide antibiotics (e.g. vancomycin and teicoplanin) and cure rates have been improved by addition of gentamicin or rifampin. Recently developed noble antibiotics for Gram-positive bacteria, quinupristin/dalfopristin and linezolid, will play an important role in the treatment of serious MRSE infections. However, antibiotics alone often fail for cure and removal of indwelling medical devices may be crucial.
Anti-Bacterial Agents ; Anti-Infective Agents ; Biofilms ; Carbapenems ; Catheters ; Cephalosporins ; Cross Infection ; Foreign Bodies ; Gentamicins ; Gram-Positive Bacteria ; Humans ; Linezolid ; Methicillin ; Methicillin Resistance* ; Penicillin-Binding Proteins ; Polysaccharides ; Rifampin ; Skin ; Staphylococcus epidermidis ; Staphylococcus* ; Vancomycin

PURPOSE: In gastric cancer, metastasis to the paraaortic lymph nodes had been regarded as an incurable factor, but many cases of long term survival have been reported with dissection of metastatic paraaortic nodes. And several reports suggested survival benefit with paraaortic lymph node dissection (D4) in advanced gastric cancer. In patients with advanced gastric cancer who underwent paraaortic lymph node dissection we tried to evaluate the factors predisposing metastasis in these nodes and survival data. MATERIALS AND METHODS: The authors analyzed retrospectively pathological features of 95 patients who underwent paraacntic lymph node dissection for advanced gastric cancer at Kangnam General Hospital Public Corporation Bom May 1991 to Feb. 1998. And we also analysed survival results of 72 cases among them. We excluded 18 cases of distant metastasis (3 liver metastasis, 15 peritoneal seeding), 2 operative mortalities, 1 other disease mortality, and 2 unlmown causes of death in survival analysis. RESULTS: The frequencies of paraaortic lymph node metastasis were 0.0% (0 of 32 cases) in T2, 19.2% (10 of 52 cases) in T3, 18.2% (2 of 11 cases) in T4. And those of paraaortic lymph node metastasis were 5.8% (3 of 52 cases) in antrum, 14.3% (3 fo 21 cases) in body, 20.0% (3 of 15 cases) in cardia, and 42.9% (3 of 7 cases) in whole area. The five-year survival rates (5 YSRs) in relation to the paraaortic lymph node (No16) status was 0.096 in No16+, and 57.8Po in Nol6 with D4 of advanced gastric cancer. The 5 YSRs were 78.1%, 40.8% and 0% in T2, T3 and T4, respectively and 93.8%, 64.2%, 24.2% and 0.0% in n0, nl, n2 and n.3, respectively and 88.9%, 80.5%, 57.9% and 0.0% (47.6%) and 0.0% in stage IB, II, IIIA, IIIB and IV, respectively. CONCLUSION: The depth of gastric wall invasion and the location of primary tumor were significant predisposing factors to para-aortic lymph node metastasis in multivariate analysis (p<0.05). Survival of No16 metastasis was very poor. And three factors of T stage, n stage, and Bonmann type were also prognostically significant in terms of five year survival in cases of D4 of advanced gastric cancer in multivariate analysis (p < 0.05).
Cardia ; Causality ; Cause of Death ; Drug Therapy* ; Granisetron* ; Hospitals, General ; Humans ; Liver ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Nausea* ; Neoplasm Metastasis ; Platinum* ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate ; Vomiting*

We observed the histopathological findings in 16 patients with nevus flammeus according to the time sequence after argon laser therapy. The results were as follows : 1. Immediately after treatment There was nonspecific damage to the epidermis, upper part of the dermis and upper portion of the pilosebaceous unit to a depth of 0.4~0.5mm depth. The specific damage to the vessels, which showed thrombi formation and partial disruption of the vessel walls was seen to a depth of 0.8~0.9mm. 2. One week after treatment Crust was formed and the epidermis regenerated almost completely. The thrombi still persisted and there was partial disappearance of the vessel walls. 3. Four to 10 months after treatment The epidermis appeared normal except the rete ridge flattening. The upper dermis was diffusely fibrotic, with relatively few residual vessels, many of them with slit-like contour.
Argon* ; Dermis ; Epidermis ; Humans ; Laser Therapy ; Nevus* ; Port-Wine Stain*

Coenzyme Q is concentrated in Golgi apparatus membranes and mitochondria, but not in other membranes. Although it is difficult to prove the metabolic action of coenzyme Q administered exogenously in clinical cases, the effect of this substance can be evaluated by criteria based on clinical findings. In an attempt to evaluate the effect of coenzyme Q for the treatment of 67 patients(male 26 cases, female 41 cases) of congestive heart failure, we administered Coenzyme Q1030mg daily for 4 to 8 weeks. Most of them were valvular heart disease(74.6%) and hypertension (14.9%). Clinical effects were evaluated at least 4 weeks later by the criteria using a scoring method of severity of congestive heart failure which was devised by Ishiyama, etc. In summary, a definite effect was found in 13 cases(19%) and a mild effect was observed in 46 cases(69%). During treatment there were no significant side effects, and also no significant changes in heart rate and blood pressure.
Blood Pressure ; Estrogens, Conjugated (USP)* ; Female ; Golgi Apparatus ; Heart ; Heart Failure* ; Heart Rate ; Humans ; Hypertension ; Membranes ; Mitochondria ; Research Design ; Ubiquinone

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

In order to investigate the changes in the scotopic and photopic ERG induced by the acJrninistrations of retino-toxic agents, 30mg/kg of body weight of sodium iodate and sodium iodoacetate were given in albino rabbits intravenously. Animals were anesthetized with intra venous urethane injection (1.5g/kg) and the pupils were dilated with atropine. The eye was stimulated with a single light flash (800 lux at the animals eye) of 200 msec duration. Prior to the recording of the scotopic ERG, animals were preadapted to light of 150 lux for 30 minutes. During dark adaptation, b-potential increased rapidly for the first 6-8 minutes followed by slow augmentation in normal eye. On the cessation of dark adaptation, b-potential dropped immediately, its decrease amounting up to 80% of the maximal potential attained during dark adaptation. By the administration of sodium iodate, c-wave disappeared immediately accompanied by apparent increase in the slow cornea-negative potential. No changes were noted in the b-potential during the first hour after iodate. Slow recovery phase during dark adaptation disappeared. Thereafter, b-potential diminished progressively with deepening of the slow negative wave. In some cases, b-wave almost extinguished 3 hours after iodate, and in another cases, some recovery of the b-wave was noted 48 hours after iodate administration. Iodoacetate produced immediate fall of b-potential with slow decrease of negative potential which progressed to the complete disappearance of the whole ERG responses. In some cases, b-wave reappeared 5 hours after iodoacetate, with prolongation of its duration. At 24-48 hours after the administration, no electrical response to light stimulus was elicited. From the obtained ERG findings, it can be deduced that the functions of the pigment epithelium could be disturbed secondary to the degenerations of visual cells. No correlation could be demonstrated between the ERG changes and the EOG changes after administration the toxic agents. Histological examinations of eyes at various intervals after administrations of retinotoxic agents revealed the degenerations of the pigment epithelium, sensory organelles of the visual cells and inflammatory changes in the choroid by iodate; and destruction of visual cells with preservations of the pigment epithelium by iodoacetate.
Animals ; Atropine ; Body Weight ; Choroid ; Dark Adaptation ; Electrooculography ; Epithelium ; Iodoacetic Acid ; Organelles ; Pupil ; Rabbits ; Retinal Degeneration* ; Retinaldehyde* ; Sodium ; Urethane

The antihypertensive effects of diltiazem was observed in 30 cases of essential hypertension, and following results were obtained. 1) Mean decrease in systolic and diastolic blood pressure by oral diltiazem was 42.0+/-2.5mmHg and 17.8+/-1.7mmHg. The results of antihypertensive therapy revealed good control in 50% fair control in 30% poor in 17% and failure in 3% of the cases. In 80% of the cases, good or fair control of Hypertension which means drop of diastolic pressure to the level of less than 100mmhg was observed. 2) Mean drop in heart rate was 21+/-2 beats/min. 3) Daily dose was 90-180mg. 4) The side effect of oral Diltiazem was mild headache and dizziness, respectively one case.
Blood Pressure ; Diltiazem* ; Dizziness ; Headache ; Heart Rate ; Hypertension

Typical urodynamic findings in patients with intracranial lesion are uninhibited bladder contraction (detrusor hyperreflexia) with coordinated sphincter activity. However, the findings of urodynamic study are variable and dependent on the degree and site of intracranial lesion, the presence of underlying disease and the adequacy of initial management of voiding problems from onset of the neurologic symptoms. . In this study, we tried to investigate the urodynamic findings in 40 patients who had intracranial lesions (traumatic or organic brain disease) with voiding dysfunction. The following results were obtained. 1. Out of all 40 patients, 35 had organic brain disease such as infarct, intracranial hemorrhage, or Parkinsonism etc. and 5 had traumatic brain disease. 2. Among 40 patients, detrusor hyperreflexia was presented in 29 (72.5%), detrusor areflexia in 9 (22.5%) and normal detrusor pressure in 2 (5%). 3. In 29 cases of detrusor hyperreflexia, there was no history of urinary retention, but in 12 cases with history of urinary retention, 9 cases (75%) revealed as detrusor areflexia. 4. No specific cause except the history of urinary retention was considerable in 8 of 9 patients with detrusor areflexia. In our study, urodynamic findings in the patients with intracranial lesion who had voiding dysfunction revealed nine cases (22.5%) of detrusor areflexia and the presumptive cause of detrusor areflexia is considered to previous urinary retention. Therefore, highly individualized and programmed early urologic involvement on the basis of urodynamic study is recommended for the prevention of urinary retention in initial ""cerebral shock"" stage of cerebrovascular accident and when detrusor areflexia had been developed, intensive management for the removal of the residual urine is necessary.
Brain ; Brain Diseases ; Humans ; Intracranial Hemorrhages ; Neurologic Manifestations ; Parkinsonian Disorders ; Reflex, Abnormal ; Stroke ; Urinary Bladder ; Urinary Retention ; Urodynamics*

The authors obtained the following results through comparative investigation between experiences from authors clinical study of ureterolithotomy by posterior vertical incision devised by Gil-Vernet and Yoon`s clinical study of ureterolithotomy by posterior vertical incision and his lumbar incision. 1. Operation time was average 62 min. and blood loss was average about 50cc. So operation time and blood loss were similar to Yoon`s result but more or less reduced as compared with lumbar incision. 2. Postoperative urine leakage and ambulation time were 1 day and 2 day that were more or less reduced as compared with Yoon`s result. 3. Ipsilateral lower abdominal wall protrusion was noted postoperatively. We think, this is from subcostal nerve injury. 4. Postoperatively sensation change on subcostal nerve, ilohypogastric nerve and ilioinguinal nerve innervation sites were noted in half of all, but disappeared in several weeks. Considering above results, while posterior vertical incision has merits such as minimal operative invasion and early postoperative ambulation time, but it often notes inevitable nerve damage. So, we think better results would be gained by careful attention to nerve and vascular distribution.
Abdominal Wall ; Sensation ; Walking

Endoscopic retrograde cholangiopancreatography(ERCP) is a new diagnostic method for pancreatic and biliarydiseases which has been made possible by the development of fiberoptic duodenoscopy. It has been thought that ERCPwell serve an important role in the early detection of pancreatic cancer, but in order to detect minor lesions ofthe pancreas and improve the diagnostic accuracy of resectable pancreatic cancer, Endoscopic RetrogradeParechymography of the pancreas (ERPP) was developed recently. The authors analyzed 117 cases of ERCP performed atthe Kwangju Christian Hospital between Jan. and Dec. 1980, and compared them with the final diagnosis. The resultswere as follows; 1. Out of 117 cases, successful visualization of the duct of concern was achieved in 105 cases.Of these, 25 cases were ERPP. 2. The ratio of males to female was 1.44:1. Most patients were in the 4th to 6thdecade. 3. The commmonest clinical manifestations were upper abdominal pain (77cases), jaundice(23 cases),indigestion, vomiting and abdominal mass, in order of frequency. 4. Out of 46 cases of suspected pancreaticdiseases, the pancreatic duct was visualized in 36 cases, and 24 cases revealed pathognomonic findings. These werediagnosed as 16 cases of pancreatic cancer, 4 cases of chronic pancreatitis, 2 cases of pancreatic pseudocyst and2 cases of periampullary cancer with pancreas invasion. In pancreatic cancer findings were; encasement, localdilatation, delayed excretion, poor filling, obstruction of pancreatic duct, accompanying C.B.D. obstruction orstenosis and so called double duct sign. The chronic pancreatitis findings included; ductal dilatation (with orwtihout) obstruction, tortuosity with dilated saccular lateral branching, stone formation and the parenchymalfilling defect. 5. Out of 71 cases of suspected biliary tract diseases, the biliary tract was visualized in 57cases, and in 31 cases abnormalities were suggested; such as 20 cases of biliary stone, 1 cases of ascariasis, 1case of clonorchiasis with cholangitis, 1 case of clonorchiasis with stone, 2 cases of C.B.D. ca. 2 cases of G.B.ca, 3 cases of intrahepatic disease, 1 case of stones in the biliary tree with ampullary ca. 6. Complications ofERCP and ERPP were extremely raare. Transient abdominal distention, abdominal discomfort and elevated serumamylase were noted, but were not clinically significant.
Abdominal Pain ; Ascariasis ; Biliary Tract ; Biliary Tract Diseases ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Clonorchiasis ; Diagnosis ; Dilatation ; Duodenoscopy ; Female ; Gwangju ; Humans ; Male ; Methods ; Pancreas ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatic Pseudocyst ; Pancreatitis, Chronic ; Vomiting