BACKGROUND: Urinary tract infections (UTIs) are the most frequent nosocomial infections and are frequently associated with indwelling urinary catheters. It is known that adherence to standard infection control measures for urinary catheters can reduce UTIs in hospitals. This study was performed to evaluate the effect of education in reducing catheter-related UTIs (CR-UTIs) in intensive care units (ICUs) of a university hospital. METHODS: CR-UTIs were prospectively monitored for all patients with indwelling urinary catheters in ICUs from July 2006 through December 2007. Recommendations based on previously known guidelines for catheter insertion, catheter management, and specimen collection to prevent CR-UTIs were formulated and educated in March 2007. Knowledge and adherence level were evaluated before and after educating healthcare workers about the recommendations using questionnaire. Changes in knowledge and adherence level before and after education were compared by Chi-square test. Changes in the rate of CR-UTIs and urinary catheter utilization ratios were also analyzed by Fisher's exact test. RESULTS: After education, knowledge level of and adherence level to most of the recommendations were improved significantly. The rate of CR-UTIs significantly decreased by 48% from 7.43/1,000 catheter-days before intervention to 3.87/1,000 catheter-days after intervention (P=0.02). CONCLUSION: Surveillance for nosocomial infections and education for standard infection control measures are very important in preventing CR-UTIs in ICUs.
Catheters ; Cross Infection ; Delivery of Health Care ; Humans ; Infection Control ; Critical Care ; Intensive Care Units ; Prospective Studies ; Specimen Handling ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract ; Urinary Tract Infections ; Surveys and Questionnaires

Sarcomatoid carcinomas are malignant epithelial neoplasms in which the tumor cells assume a partial or complete spindle cell pattern of growth, leading to the erroneous classification of some true carcinomas as sarcomas. These spindle cells are malignant and manifest various amount of both vimentin and cytokeratin. Positive reaction of some of the spindle cells for cytokeratin antibodies is confirmatory. Clinical features do not differ significantly from those of patients with high-grade transitional cell carcinoma. So far, 13 cases of sarcomatoid transitional cell carcinoma of the renal pelvis have been reported in English and Korean literature. In this report, we describe clinicopathologic features of recently observed two cases of sarcomatoid transitional cell carcinoma of the renal pelvis and summarize the pathologic findings of previously reported cases with review of the literature.
Antibodies ; Carcinoma ; Carcinoma, Transitional Cell* ; Carcinosarcoma ; Classification ; Humans ; Keratins ; Kidney Pelvis* ; Sarcoma ; Vimentin

A 73-year-old woman with chronic hepatitis C was hospitalized with proximal muscle weakness and generalized muscle pain. The patient was diagnosed as rhabdomyolysis with myoglobinuric acute renal failure. But there was no history of muscle compression, ingestion of drugs which can cause rhabdomyolysis, or alcohol abuse. The initial clinical features and laboratory findings showed no evidence of infectious myopathy or electrolyte abnormality. The electromyography and muscle biopsy was performed and polymyositis was diagnosed. Polymyositis, an idiopathic inflammatory myopathy, can cause rhabdomyolysis, but myoglobinuric acute renal failure due to polymyositis is very rare. We report a case of myoglobinuric acute renal failure caused by polymyositis with review of the literatures.
Acute Kidney Injury* ; Aged ; Alcoholism ; Biopsy ; Eating ; Electromyography ; Female ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Muscle Weakness ; Muscular Diseases ; Myalgia ; Myoglobinuria ; Myositis ; Polymyositis* ; Rhabdomyolysis

Backgound: The placement of stents in coronary arteries has been shown to reduce acute closure and restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the subacute stent thrombosis and hemorrhagic complications associated with the anticoagulant regimen. It's known that the complete stent deployment with high pressure inflation and new antiplatelet agents are effective in reduction of subacute thrombosis and hemorrhage. So we evaluated initial results (success and complication rate) after high pressure-stent deployment with new anticoagulation protocol. METHODS: One hundred and ninety one patients with 201 lesions were treated with 231 stents of various types. The high pressure balloon inflation and antiplatelets agents were used in all cases. Final high pressure balloon inflation guided by IVUS were performed in 23 consecutive cases with incomplete stent deployment according to angiographic findings. RESULTS: 1) The indications of stenting (n=210) were De novo in 124 (59%), bailout procedure in 57 (27%), suboptimal result after PTCA in 19 (8%), and restenosis after PTCA in 14 (6%). The location of lesions were LAD in 101, RCA in 67, circumflex in 28, ramus intermedius in 3, and LMT artery in 2 lesions. Angiographic morphologic characteristics were type A in 2, type B in 158 (B1: 57, B2: 101), and type C in 22 lesions. 2) The angiographic and clinical success rate was 96% (192/201) and 92% (186/201) respectively. 3) In angiographic analysis, the baseline average reference vessel dirmeter was 3.33+/-0.35 mm. Baseline minimum lumen diameter (MLD) was 0.58+/-0.29 mm, with baseline percent diameter stenosis of 82.86+/-8.64%. The final stent diameter was 3.37+/-0.29 mm, with mean final percent stenosis of 0.63+/-8.25. The mean MLD after stenting was significantly increased (p<0.001). The mean MLD within stent increased 14%, from 2.91+/-0.39 mm at the nominal balloon inflation (inflation pressure=7 atm) to 3.37+/-0.29 mm at high pressure balloon inflation (inflation pressure <0A65B>12atm) (p<0.001). The length of lesions in GR I (cook), GR II, and Micro II stents were significantly longer than ones in PS, Cordis, Wiktor, Nir (p<0.001). 4) In intravascular ultrasound analysis, the mean lumen CSA at the tightest point within stent increased 11%, from 8.4+/-2.4 mm2 at the intial intravascular ultrasound to 9.4+/-2.1 mm2 at the final intravascular ultrasound (p<0.001). 5) The procedural and postprocedural complications were 2 acute closures associated with AMI and emergent CABG, 1 subacute closure which was revascularized by bail out stenting, 5 major hemorrhage requiring transfusion associated with 1 CVA and 2 metabolic acidosis induced by acute renal failure, and 5 death. CONCLUSION: The high pressure stent deployment procedure and new anticoagulation protocol associating tidopidine and aspirin without coumadin or prolonged heparin infusion allow us to obtain an acceptably low subacute thrombosis or bleeding complication rate. These results are encouraging and allow a wide use of coronary stenting.
Acidosis ; Acute Kidney Injury ; Angioplasty, Balloon ; Arteries ; Aspirin ; Constriction, Pathologic ; Coronary Vessels* ; Hemorrhage ; Heparin ; Humans ; Inflation, Economic ; Platelet Aggregation Inhibitors* ; Stents* ; Thrombosis ; Ultrasonography ; Warfarin

Chronic inflammatory demyelinating polyradiculoneuropathy(CIDP) is a rare acquired demyelinating disease of peripheral nervous system(PNS), characterized by relapsing or progressive proximal and distal muscle weakness with possible sensory loss. It is one of several chronic neuropathic syndromes that are believed to have an autoimmune etiology. We experienced a case of CIDP in a 3-month-old boy associated with perianal abscess by Klebsiella pneumoniae who had a precipitous onset of symptoms after anesthesia. He was treated with intravenous immunoglobuline with little improvement but showed a remarkable clinical and electrophysiologic improvement after methylprednisolone pulse therapy. We report this case with a brief review of related literature.
Abscess* ; Anesthesia ; Demyelinating Diseases ; Humans ; Immunoglobulins ; Infant ; Klebsiella pneumoniae* ; Klebsiella* ; Male ; Methylprednisolone ; Muscle Weakness ; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating*

The purpose of this study was to analyze the minimum two year clinical and radiological results of revision total hip arthroplasties using allogenic chip bone graft and cement in acetabular bone deficiencies. Thirty six revision total hip arthroplasties that had been performed in thirty four patients between Sep. 1992 and May. 1994 at Seoul Paik Hospital and had followed more than two years were included in this study. The clinical result was evaluated by Harris hip score. The mean Harris hip score was 48 points preoperatively, 88 points at final follow-up, a mean of 3 years after revision. In radiological evaluation, osseous union between grafted bone and host bone was seen within 4 months in thirty two hips (89%), a complete grafted bone-cement radiolucent line of two millimeter or more in at least one zone was seen in seven hips (19%) and acetabular component migration was seen in six hips (17%) at postoperative 3 year follow-up radiograph. At the time of follow-up, five hips (14%) had been revised a second time: three for aseptic acetabular loosening, two for infection. In conclusion, we recommend the technique using allogenic chip bone graft and cement to reconstruct the acetabular bone deficiencies in revision total hip arthroplasties, though other technique will be recommend in severe segmental acetabular deficiencies or previous infection.
Acetabulum* ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies ; Hip ; Humans ; Seoul ; Transplants*

Four hundred and sixty five randomly selected clones from a cDNA library of Blattella germanica were partially sequenced and searched using BLAST as a means of analyzing the transcribed sequences of its genome. A total of 363 expressed sequence tags (ESTs) were generated from 465 clones after editing and trimming the vector and ambiguous sequences. About 42% (154/363) of these clones showed significant homology with other data base registered genes. These new B. germanica genes constituted a broad range of transcripts distributed among ribosomal proteins, energy metabolism, allergens, proteases, protease inhibitors, enzymes, translation, cell signaling pathways, and proteins of unknown function. Eighty clones were not well-matched by database searches, and these represent new B. germanica-specific ESTs. Some genes which drew our attention are discussed. The information obtained increases our understanding of the B. germanica genome.
Sequence Alignment ; Reverse Transcriptase Polymerase Chain Reaction ; Molecular Sequence Data ; Male ; Female ; *Expressed Sequence Tags ; Blattellidae/*genetics ; Base Sequence ; Animals

BACKGROUND: We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients. METHODS: From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study. RESULTS: Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006). CONCLUSIONS: In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.
Coma ; Embolization, Therapeutic ; Emergency Service, Hospital ; Humans ; Incidence ; Liver* ; Mortality* ; Odds Ratio ; Patient Admission ; Prognosis ; Retrospective Studies ; Time Factors

Amyloidosis comprises a diverse group of systemic and local diseases characterized by organ involvement by the extracellular deposition of fibrils composed of subunits of a variety of normal serum proteins. Secondary amyloidosis is caused by the deposition of amyloid A(AA) protein in chronic inflammatory disease. Juvenile rheumatoid arthritis(JRA) has been known to be the most common cause of secondary amyloidosis. We experienced one case of secondary renal amyloidosis in a 12-year-old girl who had suffered from JRA for several years who had visited our renal clinic to evaluate the proteinuria with microscopic hematuria which was detected by chance at school urine screening examination. Apple green birefringence was observed under polarized light with Congo red stain and characteristic electron microscopic findings was also noted in renal tissues which was obtained by percutaneous renal biopsy. In our knowledge, this is the first case report of secondary renal amyloidosis developed in pediatric age in Korea.
Amyloid ; Amyloidosis* ; Arthritis, Juvenile* ; Biopsy ; Birefringence ; Blood Proteins ; Child* ; Congo Red ; Female ; Hematuria ; Humans ; Korea ; Mass Screening ; Proteinuria

Epidermoid cysts in the kidney have rarely been reported, and in most cases its pathogenesis has not been well understood. We report a case of an epidermoid cyst in a kidney with nephrolithiasis in a 61-year-old man. A pyelonephrolithotomy was performed on the patient four years ago to treat nephrolithiasis of the left kidney. During the follow-up, a newly developed mass was discovered three years ago and the mass has recently increased in size. A unilateral nephrectomy was performed under the clinical impression of renal cell carcinoma. Gross examination revealed a well encapsulated cystic mass measuring 3.0 x 2.0 x 2.0 cm and containing lumps of soft whitish material, in the upper pole of the left kidney. This location was the same as that of previous nephrolithiasis. Microscopic examination revealed typical findings of an epidermoid cyst. We suspect that the chronic irritation induced by renal stones may be associated with the development of the epidermoid cyst in this case.
Carcinoma, Renal Cell ; Epidermal Cyst* ; Follow-Up Studies ; Humans ; Kidney* ; Middle Aged ; Nephrectomy ; Nephrolithiasis*