We evaluated the distribution of bacterial flora in conjunctiva of eyeball donor and antibiotic sensitivity of the cultured bacteria. Specimens were obtained from inferior conjunctiva cul de sac with sterile cotton-tipped applicator between 1-5 hours after death and plated on routine agar plates. Antibiotic sensitivity test was done by disk diffusion method. From 1994 to 1995, a total number of 338 specimens were collected from donor eyes. Among them, 191(56.5%) were culture positive and 147(43.5%) were culture negative. Among cultured 125 signle organisms, 86 organisms(68.8%) were Gram positive bacteria, 37(29.6%) Gram negative bacteria and 2(1.6%) fungi. Coagulase Negative Staphylococcus (CNS) (29.2%) and Pseudomonas aeruginosa (10.9%) were the most commonly isolated microorganisms. Antibiotic sensitivity test demonstrated a high rate of resistance in common pathogenic microorganisms such as CNS, Staphylococcus aureus and Pseudomonas aeruginosa. These microorganisms showed antibiotic resistance even to fluoroquinolone. Thus, aseptic enucleation and proper antibacterial treatment are prerequisite for the preparation of the donor cornea.
Agar ; Bacteria ; Coagulase ; Conjunctiva* ; Cornea ; Diffusion ; Drug Resistance, Microbial ; Fungi ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Pseudomonas aeruginosa ; Staphylococcus ; Staphylococcus aureus ; Tissue Donors*

BACKGROUND: Chronic cough is a common clinical problem to which various etiologies are attributable; postnasal drip, asthma, gastroesophageal reflux (GER) and chronic bronchitis, However, in some cases, no particular etiology can be confirmed. OBJECTIVE: This study was aimed to evaluate cough sensitivity and the clinical manifestations of patients with idiopathic chronic cough. MATERIALS AND METHODS: We recruited 70 non-smoking patients who had been coughing for more than 3 weeks without any history, symptoms or signs of rhinitis, sinusitis, typical asthma, GER or recent upper respiratory infection episodes. Nineteen healthy controls were also enrolled. Bronchial provocation tests with methacholine, capsaicin and distilled water (DW) were performed. RESULTS: Thirteen patients were positive to rnethacholine test (PC20 < 25mg/ml) and defined as cough variant asthma. The others are classified into idiopathic chronic cough. By capsaicin and DW challenge tests, idiopathic cough patients could be divided into two groups, i.e., increased cough sensitivity (ICS) and normal cough sensitivity (NCS) groups. DW- induced cough counts were negatively correlated with C7 (lowest capsaicin concentration inducing continuous 7 or more coughs) (r=-0.739, p<0.001). No difference was found in clinical features such as age, sex, atopy, or peripheral eosinophil counts between these two groups but cough counts per cough burst were significantly higher in the ICS group. CONCLUSION: The heterogeneity in cough sensitivity of idiopathic chronic cough patients may refiect different pathophysiologic mechanisms. It is unclear whether patients with NCS merely have habitual or psychogenic cough or not. These suggest that different therapentic strategies should be established on idiopathic chronic cough patients according to cough sensitivity.
Asthma ; Bronchial Provocation Tests ; Bronchitis, Chronic ; Capsaicin ; Cough* ; Eosinophils ; Gastroesophageal Reflux ; Humans ; Methacholine Chloride ; Population Characteristics ; Rhinitis ; Sinusitis ; Water

PURPOSE: Among the various stoma complications, the parastomal hernia (PSH) is the most common. Prevention of PSH is very important to improve the quality of life and to prevent further serious complications. The aim of this study was to analyze the incidence and the risk factors of PSH. METHODS: From January 2002 and October 2008, we retrospectively reviewed 165 patients who underwent an end colostomy. As a routine oncologic follow-up, abdomino-pelvic computed tomography was used to examine the occurrence of the PSH. The associations of age, sex, body mass index (BMI), history of steroid use and comorbidities to the development of the PSH were analyzed. The median duration of the follow-up was 36 months (0 to 99 months). RESULTS: During follow-up, 50 patients developed a PSH and the 5-year cumulative incidence rate of a PSH, obtained by using the Kaplan-Meier method, was 37.8%. In the multivariate COX analysis, female gender (hazard ratio [HR], 3.29; 95% confidence interval [CI], 1.77 to 6.11; P < 0.0001), age over 60 years (HR, 2.37; 95% CI, 1.26 to 4.46; P = 0.01), BMI more than 25 kg/m2 (HR, 1.8; 95% CI, 1.02 to 3.16; P = 0.04), and hypertension (HR, 2.08; 95% CI, 1.14 to 3.81; P = 0.02) were all independent risk factors for the development of a PSH. CONCLUSION: The 5-year incidence rate of a PSH was 37.8%. The significant risk factors of a PSH were as follows: female gender, age over 60 years, BMI more than 25 kg/m2, and hypertension. Using a prophylactic mesh during colostomy formation might be advisable when the patients have these factors.
Body Mass Index ; Colostomy ; Comorbidity ; Female ; Follow-Up Studies ; Hernia ; Humans ; Hypertension ; Incidence ; Quality of Life ; Retrospective Studies ; Risk Factors

BACKGROUND: During the period from April to June 1996, an outbreak of typhoid fever occurred in SuYoung-Ku, Pusan city. We performed the molecular epidemiological analysis and drug susceptibility test for 48 isolates of Salmonella typhi from the outbreak. METHODS: Chromosomal DNA of S. typhi was digested with the restriction endonuclease Spe I and the resulting restriction polymorphism was observed on pulsed field gel electrophoresis (PFGE). Phage typing was performed using Vi-phages, and antimicrobial susceptibility test was done by Disc diffusion method. RESULTS: On phage typing, 2 isolates were M1 phage type, 2 E1 phage type and 44 untypable. The PFGE analysis on 14 to 16 chromosomal DNA restriction fragments ranged from 50 Kb to 1000kb showed 2 different patterns of restriction fragments, divided into group A and B. Forty-seven isolates belonged to group A that were allocated into A1 (42 strains), A2 (1 strain), A3 (3 strains), A4 (1 strain), and one strain was grouped into group B. In the F-value of genetic similarity of the epidemic S. typhi strains, there was low similarity (F value:0.2-0.258) between group A strains and group B strains. However, the subgroup strains (A1-A4) showed high similarity (F value:0.8-0.897) each other. The drug susceptibility test showed susceptibility to ampicillin, carbenicillin, cephalothin, chloramphenicol, tobramycin, gentamicin, kanamycin, nalidixic acid, neomycin, polymyxin B, streptomycin, tetracycline, trimethoprim-sulfamethoxazole, ciprofloxacin and norfloxacin. CONCLUSION: This study showed that phage typing and PFGE were very useful as a tool to investigate molecular analyses of epidemic S. typhi strains this study.
Ampicillin ; Bacteriophage Typing ; Bacteriophages* ; Busan* ; Carbenicillin ; Cephalothin ; Chloramphenicol ; Ciprofloxacin ; Diffusion ; DNA ; DNA Restriction Enzymes ; Electrophoresis, Gel, Pulsed-Field* ; Epidemics ; Gentamicins ; Kanamycin ; Nalidixic Acid ; Neomycin ; Norfloxacin ; Polymyxin B ; Salmonella typhi* ; Salmonella* ; Streptomycin ; Tetracycline ; Tobramycin ; Trimethoprim, Sulfamethoxazole Drug Combination ; Typhoid Fever

Mediastinal fibrosis is pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. Mediastinal fibrosis is local expression of a family of systemic fibrosing syndroms. This can result in compression of adjacent mediastinal structures. Idiopathic fibrosing syndromes include retroperitoneal fibrosis, sclerosing cholangitis of the orbit and fibrosis of the thyroid gland(Riedel's struma). The cause of these disorders is obscure, in some instance there is an underlying malignancy, infection, history of drug ingestion, or trauma with retoperitoneal bleeding. Treatment of mediastinal fibrosis depends on structures involved by the fibrotic process. The disease is self limited in most case or improved by steroids uses. We experienced a case of idopathic solerosing mediastinitis with orbital fibrous dysplasia of unknown cause, which was confirmed by open lung biopsy, so reported it with a review of literature.
Biopsy ; Cholangitis, Sclerosing ; Eating ; Fibrosis* ; Hemorrhage ; Humans ; Inflammation ; Lung ; Mediastinitis ; Orbit ; Retroperitoneal Fibrosis ; Steroids ; Thyroid Gland

To compare the antimicrobial efficacy of several antibiotics in the treatment of ciprofloxacin and methicillin-resistant staphylococcus aureus(MCRSA)keratitis, we established a rabbit keratitis model by using MCRSA isolated from keratitis patient. A strain of MCRSA, approroximately 100 colony forming units in 10 microliterof phosphate buffered saline was injected intrastromally into the each cornea of New Zealand white rabbits. 30 rabbtits(30 eyes)were randomly divided into 5 groups and treated with either 0.3%ciprofloxacin, 0.3%trovafloxacin, 5%vancomycin, 5%cefazolin, or sterile deionized water.Topical antibiotics were administered every 15 min for 6 hours(750microliter). Rabbits were sacrified 1hour after the last eyedrop, and excised corneas were homogenized, diluted, and plated on BAP medium.Bacterial colonyforming units per cornea were quantified after 48-hour incubation. Aqueous humor were collected from each eye and drug concentration was counted with HPLC. The log1 0 value of colony forming units(CFUs)of vancomycin treated group was 4.85+/-0.64;ciprofloxacin, 6.16+/-0.46;trovafloxacin, 6.58+/-0.29;cefazolin, 6.25+/-0.25;and sterile deionized water, 6.57+/-0.33.In view of mean CFU, vancomycin showed greater antimicrobial activity and it was statistically significant(p<0.05). However, all of these treatment did not completely sterilize any corneas with 6-hour treatment. From these results, only topical vancomycin(5%)represented effective antimicrobial activity with short-term treatment in rabbit keratitis with MCRSA.
Anti-Bacterial Agents* ; Aqueous Humor ; Chromatography, High Pressure Liquid ; Ciprofloxacin ; Cornea ; Humans ; Keratitis* ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Rabbits ; Staphylococcus ; Stem Cells ; Vancomycin ; Water

PURPOSE: Physician competency in end-of-life (EOL) care is becoming increasingly important. This study investigated the EOL care curricula in Korean medical schools.METHODS: Questionnaires were issued to the faculty members responsible for the EOL care curricula at each of the medical schools. These included questions on the structure and content of the curricula, teaching methods, and faculty members' attitudes to the curricula.RESULTS: Characteristics of the EOL care curricula were compiled from 27 (66%) of the 41 medical schools. All of the medical schools taught essential aspects of the EOL care curriculum either as a separate course or embedded within other medical education courses. The mean time spent on EOL care teaching was 10 hrs (range, 2~32 hrs). The most frequently taught topics were delivering bad news (100%) and symptom management (74%). When the palliative care education assessment tool (PEAT) was used to evaluate the curricula, a median of 11 PEAT objectives was met (range, 2~26; maximum, 83). More than two teaching methods were used in most of the curricula. However, lectures were the only teaching method used by three medical schools. 78% of faculty members who were responsible for curriculum reported dissatisfaction with it, whereas 18% believed that the time allotted to it was adequate. Only 7% of these faculty members believed that their students were adequately prepared to practice EOL care.CONCLUSION: There is a need to improve EOL care education in basic medical curricula and to take a more systematic approach to achieving learning outcomes.
Curriculum ; Education ; Education, Medical ; Hospice Care ; Humans ; Learning ; Lectures ; Palliative Care ; Schools, Medical ; Soil ; Teaching ; Terminal Care

We aimed to assess one-year persistence with antihypertensive therapy (AHT) among newly treated uncomplicated hypertensive patients in Korea and to evaluate the effect of initial therapeutic classes on persistence. We retrospectively analyzed a random sample of 20% of newly treated uncomplicated hypertensive patients (n = 45,787) in 2012 from the National Health Insurance claims database. This group was classified into six cohorts based on initial AHT class. We then measured treatment persistence, allowing a prescription gap of 60 days. Adherence to AHT was assessed with the medication possession ratio. Calcium channel blockers (CCB, 43.7%) and angiotensin receptor blockers (ARB, 40.3%) were most commonly prescribed as initial monotherapy. Overall, 62.1% and 42.0% were persistent with any AHT and initial class at one year, respectively, and 64.2% were adherent to antihypertensive treatment. Compared with ARBs, the risk of AHT discontinuation was significantly increased with initial use of thiazide diuretics (hazard ratio [HR], 3.16; 95% confidence interval [CI] 2.96-3.74) and beta blockers (HR, 1.86; CI, 1.77-1.95) and was minimally increased with CCBs (HR, 1.12; CI, 1.08-1.15). In conclusion, persistence and adherence to AHT are suboptimal, but the differences are meaningful in persistence and adherence between initial AHT classes.
Adolescent ; Adrenergic beta-Antagonists/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Angiotensin Receptor Antagonists/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Antihypertensive Agents/classification/*therapeutic use ; Calcium Channel Blockers/therapeutic use ; Cohort Studies ; Female ; Humans ; Hypertension/*drug therapy ; Male ; Medication Adherence ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Sodium Chloride Symporter Inhibitors/therapeutic use ; Young Adult

PURPOSE: To investigate whether allelic polymorphism of haptoglobin (Hp) is associated with premature rupture of membrane (PROM), the Hp phenotypes of pregnant women with PROM were analyzed. PATIENTS AND METHODS: The Hp phenotypes of 221 pregnant Korean women (187 control and 34 PROM patients) were determined by benzidine/hydrogen peroxide staining, following native polyacrylamide gel electrophoresis of hemoglobin-mixed sera. The Hp allele frequencies were calculated from the data of Hp phenotypes, and overall association with PROM was evaluated using Pearson Chi-Square test. RESULTS: The polymorphic distribution of the patients cohort who underwent a normal delivery (control group) was similar to that of healthy Koreans. In contrast, however, patients with PROM showed significantly higher occurrence of the Hp 1-1 phenotype than control group (23.5% vs 8.0%). Hp 2-2 phenotype was lower in PROM cohort (38.2%) than in the control group (48.7%). The Hp1 allele frequency in PROM group was significantly higher than that in the control group (0.426 vs 0.297, p = 0.034) with odds ratio of 1.762 (95% CI: 1.038 - 2.991). CONCLUSION: These findings suggest that pregnant Korean women who possess Hp1 allele (expressed as Hp 1-1 phenotype) have higher incidence of PROM than women with Hp2 allele (expressed as Hp 2-2 phenotype). This is the first study that evaluated the significance of Hp polymorphism with respect to the development of PROM.
Adult ; Asian Continental Ancestry Group/*statistics & numerical data ; Female ; Fetal Membranes, Premature Rupture/*ethnology/*genetics ; Gene Frequency ; Genetic Predisposition to Disease/ethnology ; Haptoglobins/*genetics ; Humans ; Incidence ; Infant, Newborn ; Korea/epidemiology ; Phenotype ; *Polymorphism, Genetic ; Pregnancy

BACKGROUND: Tourniquets are widely used to provide a clean surgical field but can induce variable hemodynamic and metabolic changes. Sevoflurane is one of anesthetic agents used for unstable or elderly patients, and propofol can be used for smooth induction and early recovery with few side effects. This study evaluated the differences in the hemodynamic and metabolic changes after the application of a tourniquet under general anesthesia with sevoflurane or propofol for total knee replacement (TKR). METHODS: Thirty elderly female patients scheduled to undergo TKR were allocated into two groups, the general anesthesia with sevoflurane group (S group, n = 15) or the propofol group (P group, n = 15). The hemodynamic parameters such as the mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), cardiac index (CI), stroke volume (SV), systemic vascular resistance (SVR), and arterial blood analysis were checked immediately before (control, T1), at 5 (T2), 30 (T3) and 60 minute (T4) after inflation, and at 5 (T5) and 30 minutes after (T6) deflation. RESULTS: Compared with T1, the MAP increased significantly at T2, T3, and T4 in both groups. The increase in the SVR after inflating the tourniquet and the decrease in the SVR after deflation were lower in the P group than in the S group. The metabolic changes after deflating the tourniquet were similar in both groups. CONCLUSIONS: Compared with sevoflurane, propofol did not significantly decrease the hemodynamic and metabolic changes after placing a tourniquet during TKR for elderly patients. therefore, both sevoflurane and propofol are acceptable anesthetics for TKR in geriatric patients.
Aged ; Anesthesia, General* ; Anesthetics ; Arterial Pressure ; Arthroplasty, Replacement, Knee* ; Central Venous Pressure ; Female ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Inflation, Economic ; Knee ; Propofol* ; Stroke Volume ; Tourniquets* ; Vascular Resistance