BACKGROUND: With increase of antibiotics use and invasive procedures, infections caused by multi-resistant Acinetobacter baumannii (MRAB) are increasing. Recently, we experienced the outbreak of- nosocomial infections caused by MRAB resistant to imipenem and cefoperazone/sulbactam in intensive care units (ICU) and general ward. We analyzed the clinical characteristics of the infected patients and antibiotic susceptibility of the organisms. And surveillance cultures and IRS-PCR were performed to find out the transmission route. METHODS: We collected data from physical examination and clinical records. We performed surveillance cultures of environment, patients not infected with MRAB in ICU, and hands of health care workers. RESULTS: Between November 1996 and June 1997, 49 strains of MRAB were isolated from the 26 patients hospitalized in Kangnam St. Mary' s Hospital. The lower respiratory infection (13 cases) was the most common infection and sputum was the most common sources (47.1%). All strains of MRAB showed the same genotype. In disk diffusion test, all strains were resistant to piperacillin, gentamicin, amikacin, ceftazidime, cefoperazone/sulbactam, aztreonam, imipencm, ciprofloxacin. From the surveillance cultures, the genotypically identical strains were isolated from ventilator Y-piece, the floor of ICU, and hands of health care workers. It suggested that this strain was transmitted through ventilatory device or hands of health care workers. We instructed all the health care workers to wash hands, to disinfect hospital environment completely. Since July 1997, no further case has occurred. CONCLUSIONS: Since A. baumannii could be transmitted through ventilatory devices and the hands of health care workers, it is important to wash hands and to disinfect hospital environment completely.
Acinetobacter baumannii* ; Acinetobacter* ; Amikacin ; Anti-Bacterial Agents ; Aztreonam ; Ceftazidime ; Ciprofloxacin ; Cross Infection* ; Delivery of Health Care ; Diffusion ; Genotype ; Gentamicins ; Hand ; Humans ; Imipenem* ; Critical Care Units ; Patients' Rooms ; Physical Examination ; Piperacillin ; Sputum ; Ventilators, Mechanical

OBJECTIVES: To determine changes in the incidence and pattern of eclampsia in Il Sin Christian Hospital over a 46-year period. METHODS: Information was collected from medical records of the 1910 eclamptic patients among 233,613 deliveries in Il Sin Christian Hospital from Jan. 1 1953 to Dec. 31 1998. Incidence, presentation, and management of eclampsia were reviewed retrospectively, and maternal mortality rate and perinatal mortality rate were calculated. Statistical analysis was done by Chi-squared and Fisher's exact test through two by two tables looking at relative changes between each study period. RESULTS: The overall incidence of eclampsia was 81.8 per 10,000 deliveries. The incidence of eclampsia had increased from 137.3/10,000 in 1953-1962 to 278.4/10,000 in 1963-1972, but the rate had reduced to 6.5/10,000 in 1993-1998. There was a statistically significant fall in the rate of eclampsia every decade between 1973 and 1992, but there has been steady decrease in the last study period. Convulsion occurred antepartum in 54% of patients, intrapartum in 29% and postpartum in 17%. With the reduction in the proportion of antepartum eclampsia, there has been a relative increase in that of intrapartum and postpartum eclampsia. Maternal death occurred in 59 cases among eclampsia, and maternal mortality rate was 3.1%. Maternal mortality rate had significantly decresed from 11.1% in 1953-1962 to 3.8% in 1963-1972, and there has been no maternal death from eclampsia since 1986. Postpartum eclampsia had increased death risk compared with antepartum or intrapartum eclampsia. There were 280 cases of perinatal death and overall perinatal mortality rate was 144.1 per 1000 deliveries. There was a significant decrease in the rate from 243.2/1000 in 1953-1962 to 141.5/1000 in 1963-1972, but the rate has risen steadily since 1983. CONCLUSIONS: With the improvement in antenatal care and management of eclampsia, the incidence of eclampsia and its associated maternal mortality has decreased over the last 46 years. But eclampsia still remains a significant complication of pregnancy with high maternal and perinatal mortality.
Eclampsia* ; Female ; Humans ; Incidence ; Maternal Death ; Maternal Mortality ; Medical Records ; Perinatal Mortality ; Postpartum Period ; Pregnancy ; Retrospective Studies ; Seizures

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

BACKGROUND/AIMS: To investigate abnormalities in blood electrolyte levels during severe hypoglycemia in Korean patients with type 2 diabetes mellitus (T2DM) in a clinical setting. METHODS: Blood electrolyte levels in adult T2DM patients during severe hypoglycemia were collected from January 1, 2008 to December 31, 2012. Patients who maintained normal serum creatinine and blood urea nitrogen levels were utilized in the study. Severe hypoglycemia was defined as a condition requiring medical assistance, such as administering carbohydrates when serum glucose levels less than 70 mg/dL were observed, in conjunction with other symptoms of hypoglycemia. RESULTS: A total of 1,068 patients who visited the emergency room with severe hypoglycemia were screened, of which 219 patients were included in this study. The incidence of abnormal levels for any electrolyte was 47%. Hypokalemia (< 3.5 mmol/L) was the most common type of electrolyte disturbance observed at 21.9%. A decrease in serum potassium levels was associated with decreases in blood glucose levels (r = 0.151, p = 0.025). During severe hypoglycemia, median blood glucose levels, incidence of tachycardia (> 100 beats per minute) and severe hypertension (> or = 180/120 mmHg) were 30 mg/dL (range, 14 to 62) and 35 mg/dL (range, 10 to 69; p = 0.04), 18.8% and 7.2% (p = 0.02), and 20.8% and 10.2% (p = 0.05) in the hypokalemia and normokalemia groups, respectively. CONCLUSIONS: During severe hypoglycemia, hypokalemia occurred in 21.9% of T2DM patients and was associated with tachycardia and severe hypertension. Therefore, the results suggest that severe hypoglycemia may increase cardiovascular events in T2DM.
Aged ; Aged, 80 and over ; Biomarkers/blood ; Blood Glucose/drug effects/*metabolism ; Diabetes Mellitus, Type 2/blood/diagnosis/drug therapy/*epidemiology ; Emergency Service, Hospital ; Female ; Humans ; Hypertension/chemically induced/epidemiology ; Hypoglycemia/blood/chemically induced/diagnosis/*epidemiology/therapy ; Hypoglycemic Agents/adverse effects ; Hypokalemia/blood/chemically induced/diagnosis/*epidemiology ; Male ; Middle Aged ; Potassium/*blood ; Republic of Korea/epidemiology ; Risk Factors ; Severity of Illness Index ; Tachycardia/chemically induced/epidemiology ; *Water-Electrolyte Balance/drug effects

Lymphoid tumors of the orbit are rare, and sometimes it is not possible either clinically or histologically to differentiate between lymphoid tumor and pseudolymphoma. Some authors assert that the degree of cytologic differentiation appears to be the single most important factor for determining the prognosis of patients with orbital lymphoid lesions. However, the cytomorphologic basis is not so helpful to diagnose and classify our case, which shows some discrepancy between pathological findings and clinical and radiological findings. At first we misdiagnosed our case as orbital malignant lymphoma on the basis of cytomorphology and immunohistochemical study. But no responce to local intensive radiotherapy and the follow up study of the patient suggest orbital pseudolymphoma.
Follow-Up Studies

We describe a group of 3 cases of invasive meningococcal disease that occurred in a military training camp in April 2011. All three patients were hospitalized. Ultimately, two patients recovered and one died. One patient had meningitis, one patient had septicemia and meningitis, and the other had no definite septicemia or meningitis. Neisseria meningitidis serogroup W-135 was detected in the serum and cerebrospinal fluid (CSF) of all patients by real-time polymerase chain reaction. In the one case of mortality, two strains were isolated from the patient's blood and CSF. Using multilocus sequence typing analysis, these strains were identified as a novel sequence type, ST-8912. Special attention is required for the meningococcal disease in military camp because the military personnels are in high risk of contact transmission.
DNA, Bacterial/blood/cerebrospinal fluid ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Male ; Meningitis/complications/*diagnosis/microbiology ; Military Personnel ; Multilocus Sequence Typing ; Neisseria meningitidis, Serogroup W-135/genetics/*isolation & purification ; Real-Time Polymerase Chain Reaction ; Sepsis/complications/*diagnosis/microbiology ; Young Adult

Neonatal meningitis caused by the Group B beta-hemolytic streptococcus was first reported in 1958. In recent years this organism has assumed major importance in the etiology of neonatal infection. In Korea, this organism is likely to play an increasing role in neonatal infection. So this investigation was designed to report the 9 cases of Group Bbeta-hemolytic streptococcus infected neonates admitted to the NICU, department of Pediatrics, Hanil Hospital from January 1990 to June 1993. The results were as followings. 1) Onset of disease was between 12days and 32 days of age and male to female ratio is 1:2. 2) Two cases were delivered by c-section, seven cases were by NFSD and all of the infants had normal birth weight with full term at delivery. Maternal obstetric and neonatal complications were not detected in all cases. 3) The common presenting symptoms were fever in all cases, seizure in 6 cases, feeding difficulty, lethargy, vomiting, etc. 4) Group Bbeta-hemolytic streptococcus was isolated in CSF of all cases and in blood of 6 cases. 5) There were abnormal brain CT findings in 4 cases of group Bbeta-hemolytic streptococcal meningitis. 6) The sensitive antibiotics were Cefotaxime, Cefazoline, Erythromycin, Ampicillin, Chloramphenicol, Clindamyucin and Penicillin. 7) All cases were reconvered except one case that expired on the 1st day of admission and 6 cases were followed up for the period of 2months to 33months without neurologic sequelae, of which 1 case revealed decreased wave on Lt. hemisphere in ABR.
Ampicillin ; Anti-Bacterial Agents ; Birth Weight ; Brain ; Cefazolin ; Cefotaxime ; Chloramphenicol ; Erythromycin ; Female ; Fever ; Humans ; Infant ; Infant, Newborn ; Korea ; Lethargy ; Male ; Meningitis* ; Pediatrics ; Penicillins ; Seizures ; Streptococcus ; Vomiting

The classic type of Kaposi's sarcoma, or multifocal hemorrhagic sarcoma histologically characterized by proliferating fibroblastic and microvascular elements was described by Kaposi as a relatively rare neoplasm. During the past nine years, we experienced three cases of sporadic, classic Kaposi's sarcomas. They were presented as multiple papules, macules and nodules on the skin of the hands, lower logs and feet without systemic involvement. Histologically, Kaposi's sarcoma is divided into three stages, early patch, plaque and nodular stages. The nodular lesions(case 1, 2 and 3) showed extensive proliferatiion of spindle shaped, somewhat pleomorphic cells having dark prominent nuclei, proliferation of small vessels with solid aggregates of endothelial cells, and extravasation of erythrocytes. In early patch stage(case 3), widely dilated, anastomosing, thin-walled vascular spaces are noted in the upper half of the dermis. In plaque stage(case I and 3), there are proliferation of spindle shaped cells with extravasated erythrocytes and aggregates of blood vessels lined by prominent endothelial cells.

PURPOSE: The objective of this study was to examine the factors associated with initiation and continuation of breastfeeding among Korean women in relation to their employment status. METHODS: Data were collected using a web-based self-administered questionnaire from 1,031 Korean mothers living in Seoul with babies younger than 24 months. Demographic characteristics, education on breastfeeding, rooming in, breastfeeding during hospital stay, and breastfeeding knowledge were examined. Multivariate logistic regression analyses were performed to identify factors associated with initiation and continuation at 1, 6 and 12 months according to mothers' employment status. RESULTS: Breastfeeding initiation rates were similar regardless of mothers' employment status. Continuation rates decreased for both groups of mothers, but were significantly lower among employed mothers at all duration points. Unemployed mothers who were able to keep their babies in the same room during the hospital stay were more likely to initiate breastfeeding. The factor that was consistently associated with breastfeeding continuation for all duration points among unemployed mothers was whether the mother breastfed during the hospital stay. Higher knowledge scores and having an infant with atopic dermatitis were also associated with breastfeeding continuation at 6 months and 12 months, respectively for unemployed mothers, and receiving education on breastfeeding was associated with 12-month continuation for employed mothers. CONCLUSION: These results emphasize the significant roles of hospitals for breastfeeding initiation and continuation, with rooming-in, initial breastfeeding practice and education during hospital stay as important practices. In addition, for working mothers to continue their breastfeeding, significant support from the workplace is crucial.
Adult ; Asian Continental Ancestry Group ; Breast Feeding/*statistics & numerical data ; Dermatitis, Atopic/pathology ; *Employment ; Female ; Humans ; Infant ; Infant, Newborn ; Internet ; Logistic Models ; Male ; Mothers/psychology ; Odds Ratio ; Republic of Korea ; Social Support ; Surveys and Questionnaires ; Workplace

BACKGROUND: To investigate the sleep disorders related to chronic insomnia and compare the characteristics of each group. METHODS: We registered 191 patients (female 56.0%, age 61.7 years) who have complained about symptoms of insomnia for more than three months and assessed sleep disorders related chronic insomnia by analyzing their polysomnography (PSG) parameters, demographics, and questionnaires (Insomnia Severity Index, Beck Depression Inventory, Pittsburg Sleep Quality Index, and Epworth Sleepiness Scale, and World Health Organization Quality of Life Assessment Instrument abbreviated version). RESULTS: Patients were categorized into groups of primary insomnia (PI, 51.8%, n=99), comorbid insomnia with obstructive sleep apnea (CIO, 38.7%, n=74), and comorbid insomnia with periodic limb movement disorder (CIP, 9.4%, n=18). CIO was older and more obese than PI and CIP. The proportion of males was the highest in CIO. Arousal index of PSG was higher in CIO and CIP than in PI. Other parameters and the results of questionnaires were not different among groups. CONCLUSIONS: About a half of patients with chronic insomnia symptoms (48.2%) had considerable sleep disorders associated with insomnia. Our study suggests that the PSG as well as history taking and demographics are necessary to clarify the relevant conditions of chronic insomnia disorder for appropriate treatment.
Arousal ; Demography ; Depression ; Humans ; Male ; Nocturnal Myoclonus Syndrome ; Polysomnography ; Quality of Life ; Sleep Apnea, Obstructive ; Sleep Initiation and Maintenance Disorders ; Sleep Wake Disorders ; World Health Organization