The study aimed to review the current postpartum care service system and suggest measures of improvement for the public reinforcement of the private-postpartum care center (PCC). We conducted a review of literature, including an internet search, and we analyzed the in-depth interviews using questionnaires answered by workers from the 6 private-PCCs operated in Goyang city. Using these data, we derived possible measures which could improve the publicity of private-PCCs. It was found that the 11 nationwide public-PCCs had serious operating deficits, and its utilization by the vulnerable was insufficient. In areas where private-PCCs are concentrated, we can propose the following policies to strengthen publicity, rather than establishing another public-PCC. First, it is important to provide support for private-PCCs to apply cost reductions for vulnerable groups, similar to the maternal and newborn medical care of public-PCCs. Second, publicity would be strengthened by reorganizing the pregnancy and childbirth education program, while also offering additional services for mothers with stillbirths and abortions. For the integrated management of postpartum care services, this should be shifted towards reinforcing the publicity of private-PCCs, rather than operating a public-PCC in relatively concentrated private-PCC areas. Through these policies, it is expected that financial and administrative waste will be reduced, and an integrated management system for postpartum care services will be established.

The study aimed to review the current postpartum care service system and suggest measures of improvement for the public reinforcement of the private-postpartum care center (PCC). We conducted a review of literature, including an internet search, and we analyzed the in-depth interviews using questionnaires answered by workers from the 6 private-PCCs operated in Goyang city. Using these data, we derived possible measures which could improve the publicity of private-PCCs. It was found that the 11 nationwide public-PCCs had serious operating deficits, and its utilization by the vulnerable was insufficient. In areas where private-PCCs are concentrated, we can propose the following policies to strengthen publicity, rather than establishing another public-PCC. First, it is important to provide support for private-PCCs to apply cost reductions for vulnerable groups, similar to the maternal and newborn medical care of public-PCCs. Second, publicity would be strengthened by reorganizing the pregnancy and childbirth education program, while also offering additional services for mothers with stillbirths and abortions. For the integrated management of postpartum care services, this should be shifted towards reinforcing the publicity of private-PCCs, rather than operating a public-PCC in relatively concentrated private-PCC areas. Through these policies, it is expected that financial and administrative waste will be reduced, and an integrated management system for postpartum care services will be established.

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has standardized the reporting of thyroid cytology specimens. The objective of the current study was to evaluate the nationwide usage of TBSRTC and assess the malignancy rates in each category of TBSRTC in Korea. METHODS: Questionnaire surveys were used for data collection on the fine needle aspiration (FNA) of thyroid nodules at 74 institutes in 2012. The incidences and follow-up malignancy rates of each category diagnosed from January to December, 2011, in each institute were also collected and analyzed. RESULTS: Sixty out of 74 institutes answering the surveys reported the results of thyroid FNA in accordance with TBSRTC. The average malignancy rates for resected cases in 15 institutes were as follows: nondiagnostic, 45.6%; benign, 16.5%; atypical of undetermined significance, 68.8%; suspicious for follicular neoplasm (SFN), 30.2%; suspicious for malignancy, 97.5%; malignancy, 99.7%. CONCLUSIONS: More than 80% of Korean institutes were using TBSRTC as of 2012. All malignancy rates other than the SFN and malignancy categories were higher than those reported by other countries. Therefore, the guidelines for treating patients with thyroid nodules in Korea should be revisited based on the malignancy rates reported in this study.
Academies and Institutes ; Biopsy, Fine-Needle ; Data Collection ; Follow-Up Studies ; Humans ; Incidence ; Korea* ; Thyroid Gland* ; Thyroid Nodule

Lactococcus lactis cremoris infections are very rare in humans. We experienced liver abscess and empyema due to L. lactis cremoris in an immunocompetent adult. A 42-yr-old man was admitted with fever and abdominal pain. Abdominal computed tomography (CT) revealed a liver abscess and chest CT showed loculated pleural effusion consistent with empyema. L. lactis cremoris was isolated from culture of the abscess material and blood. The patient was treated with pus drainage from liver abscess, video-assisted thoracoscopic decortications for empyema, and antibiotics including cefotaxime and levofloxacin. The patient was completely recovered with the treatment. To our knowledge, this is the first report of a L. lactis cremoris infection in Korea.
Adult ; Anti-Bacterial Agents/therapeutic use ; Cefotaxime/therapeutic use ; Drainage ; Empyema/*diagnosis/*microbiology/surgery ; Gram-Positive Bacterial Infections/complications/*diagnosis/drug therapy ; Humans ; *Lactococcus lactis/drug effects/isolation & purification ; Liver Abscess/*diagnosis/*microbiology ; Male ; Microbial Sensitivity Tests ; Ofloxacin/therapeutic use ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

The intracranial meningioma associated with hidden cerebral aneurysm is rare. We experienced a patient with subarachnoid hemorrhage (SAH) due to the rupture of cerebral aneurysm during intracranial meningioma removal, although preoperative 6-vessel angiographic study did not reveal aneurysmal dilatation. During operation, tumor was resected piece by piece, and totally removed, grossly. After removal of tumor, the brain swollen suddenly along with hypertension and bradycardia suspecting Cushing's reflex was developed. Emergent postoperative CT and CT-angiographic study revealed large amount of SAH and ruptured aneurysmal dilation of A3 segment of anterior cerebral artery. She died from brainstem failure on 4th postoperative day. We report a rare case of anesthesia for coexisting intracranial meningioma and intracranial aneurysm.
Anesthesia ; Aneurysm ; Aneurysm, Ruptured ; Anterior Cerebral Artery ; Bradycardia ; Brain ; Brain Stem ; Dilatation ; Humans ; Hypertension ; Intracranial Aneurysm* ; Meningioma* ; Reflex* ; Rupture ; Subarachnoid Hemorrhage

BACKGROUND: This randomized study was designed to evaluate the analgesic effectiveness and to determine the optimal dose of remifentanil when administered as intermittent bolus injection during infiltration of local anesthetics for patients undergoing plastic surgery. METHODS: Forty five ASA I or II patients undergoing plastic surgery were randomly assigned to one of the three bolus doses of remifentanil injection. Five minutes after receiving midazolam 0.05 mg/kg IV, remifentanil was injected intravenously one minute before the infiltration of local anesthetics: A bolus of remifentanil 0.25microgram/kg was injected in Group R0.25 (n = 15), 0.50 microgram/kg in Group R0.5 (n = 15), or 0.75microgram/kg in Group R0.75 (n = 15). After assessment of the patients' Observer's Assessment of Alertness/Sedation (OAA/S) scale, the subjective pain level during local anesthetic infiltration was evaluated. Respiratory rate, SpO2, mean blood pressure, and heart rate were recorded during the study period. Postoperative nausea/vomiting and patient's satisfaction were checked by telephone call. RESULTS: OAA/S scale values were similar among the three groups (3-4). The number of the patients who complained of moderate or severe pain level is significantly higher in group R0.25 than in group R0.5 or group R0.75 (P < 0.05). Adverse events such as hypoventilation, desaturation, and bradycardia were observed with significantly high frequency in R0.75 than in other two groups (P < 0.05). All three groups showed no occurrence of hypotension or postoperative nausea/vomiting. CONCLUSIONS: The above results demonstrate that intermittent bolus injection of remifentanil 0.50microgram/kg is recommended to accomplish desirable pain control during local anesthetic infiltration in those who received midazolam 0.05 mg/kg.
Anesthetics, Local ; Blood Pressure ; Bradycardia ; Heart Rate ; Humans ; Hypotension ; Hypoventilation ; Midazolam ; Respiratory Rate ; Surgery, Plastic* ; Telephone

BACKGROUND: Cefditoren is a third generation orally administered cephalosporin with excellent activity against respiratory pathogens. This study was performed to determine the comparative antibacterial activity of cefditoren against clinical isolates of respiratory tract infection. MATERIALS AND METHODS: According to the NCCLS guideline, in vitro activities of cefditoren and other antibiotics were tested against respiratory pathogens including 117 isolates of Streptococcus pneumoniae, 60 isolates of Haemophilus influenzae, and 31 isolates of Moraxella catarrhalis. RESULTS: The level of cefditoren activity against S. pneumoniae (MIC50/90, 0.5/1 microgram/mL) was superior to amoxicillin+/-clavulanate (MIC50/90, 4/16 microgram/mL), clarithromycin (MIC50/90, >32/>32 microgram/mL), and most of the marketed cephalosporins (MIC50/90, 8-64/16-128 microgram/mL). Although the MIC of cefditoren was relatively higher than those of new fluoroquinolone agents (MIC50/90, 0.03-1/0.06-1 microgram/mL), it was comparable to ceftriaxone (MIC50/90, 0.5/1 microgram/mL). In addition, cefditoren was active against two quinolone resistant pneumococci strains with MIC of 0.5 microgram/mL. In detail, cefditoren was active against pneumococci strains with MIC50 and MIC90 values of 0.015/0.12, 0.12/0.5, and 0.5/1 microgram/mL for penicillin-susceptible, -intermediate, and -resistant pneumococci, respectively. Cefditoren was also active against all respiratory isolates of H. influenzae (MIC50/90, 0.03/0.06 microgram/mL) and M. catarrhalis (MIC50/90, 0.03/0.05 microgram/mL) irrespective of beta-lactamase production or ampicillin resistance. CONCLUSION: Cefditoren is considered to be a good option for outpatient treatment of respiratory infections, particulary if there is concern about S. pneumoniae infection with decreased susceptibility to penicillin or beta-lactamase producing organisms.
Ampicillin Resistance ; Anti-Bacterial Agents ; beta-Lactamases ; Ceftriaxone ; Cephalosporins ; Clarithromycin ; Haemophilus influenzae ; Humans ; Influenza, Human ; Moraxella (Branhamella) catarrhalis ; Outpatients ; Penicillins ; Pneumonia ; Respiratory Tract Infections ; Streptococcus pneumoniae

BACKGROUND: Cefditoren is a third generation orally administered cephalosporin with excellent activity against respiratory pathogens. This study was performed to determine the comparative antibacterial activity of cefditoren against clinical isolates of respiratory tract infection. MATERIALS AND METHODS: According to the NCCLS guideline, in vitro activities of cefditoren and other antibiotics were tested against respiratory pathogens including 117 isolates of Streptococcus pneumoniae, 60 isolates of Haemophilus influenzae, and 31 isolates of Moraxella catarrhalis. RESULTS: The level of cefditoren activity against S. pneumoniae (MIC50/90, 0.5/1 microgram/mL) was superior to amoxicillin+/-clavulanate (MIC50/90, 4/16 microgram/mL), clarithromycin (MIC50/90, >32/>32 microgram/mL), and most of the marketed cephalosporins (MIC50/90, 8-64/16-128 microgram/mL). Although the MIC of cefditoren was relatively higher than those of new fluoroquinolone agents (MIC50/90, 0.03-1/0.06-1 microgram/mL), it was comparable to ceftriaxone (MIC50/90, 0.5/1 microgram/mL). In addition, cefditoren was active against two quinolone resistant pneumococci strains with MIC of 0.5 microgram/mL. In detail, cefditoren was active against pneumococci strains with MIC50 and MIC90 values of 0.015/0.12, 0.12/0.5, and 0.5/1 microgram/mL for penicillin-susceptible, -intermediate, and -resistant pneumococci, respectively. Cefditoren was also active against all respiratory isolates of H. influenzae (MIC50/90, 0.03/0.06 microgram/mL) and M. catarrhalis (MIC50/90, 0.03/0.05 microgram/mL) irrespective of beta-lactamase production or ampicillin resistance. CONCLUSION: Cefditoren is considered to be a good option for outpatient treatment of respiratory infections, particulary if there is concern about S. pneumoniae infection with decreased susceptibility to penicillin or beta-lactamase producing organisms.
Ampicillin Resistance ; Anti-Bacterial Agents ; beta-Lactamases ; Ceftriaxone ; Cephalosporins ; Clarithromycin ; Haemophilus influenzae ; Humans ; Influenza, Human ; Moraxella (Branhamella) catarrhalis ; Outpatients ; Penicillins ; Pneumonia ; Respiratory Tract Infections ; Streptococcus pneumoniae

The purpose of this study was to investigate children's nutrient intakes by school lunch. Evaluation of nutrient intakes by school lunch for three days was conducted with 86 children in urban and 64 children in rural of Jeonbuk area. The results of this study were as follows. 1) With respect to amounts of provided nutrients in school lunch, CPF (carbohydrate : protein : fat) energy ratio was 48.6 : 19.7 : 31.6 in urban and was 46.7 : 20.5 : 32.7 in rural. Compared to 1/3 RDA (RDA) of children for 10-12 years, folic acid and zinc were provided below 50 % of RDA. Protein, fat, phosphorus, vitamin B1, vitamin B2, niacin, vitamin C and vitamin E were provided above 125 % of RDA. There were no differences in amounts of provided nutrients-except calcium, vitamin A, vitamin B6, folic acid and zinc-between urban and rural. 2) With respect to amounts of nutrient intakes, CPF energy ratio was 51.1 : 17.4 : 31.5 in urban and 47.5 : 19.7 : 32.7 in rural. Compared to RDA, folic and zinc were below 50 % of RDA. Iron and vitamin B6 were below 75 % of RDA. Protein, fat, phosphorus and vitamin E were above 125 % of RDA. There were significant differences in nutrient intakes between urban and rural. The children in rural showed higher levels of nutrient intakes-energy, carbohydrate, protein, fat, calcium, phosphorus, iron, zinc, vitamins and folic acid-compared to those of children in urban. These results suggest that programs are needed for providing adequate nutrient intakes for children in school lunch and for improving nutrient intakes of children in urban.
Ascorbic Acid ; Calcium ; Child ; Folic Acid ; Humans ; Iron ; Jeollabuk-do* ; Lunch* ; Niacin ; Phosphorus ; Riboflavin ; Thiamine ; Vitamin A ; Vitamin B 6 ; Vitamin E ; Vitamins ; Zinc

BACKGROUND: There have been several reports of patients with a severe hydroa vacciniforme (HV)-like eruption from Asia and Latin America. The cutaneous lesions are present in both sun-exposed and nonexposed areas in these patients unlike true HV. Several patients have died of malignant hematologic malignancies. The latent Epstein-Barr virus (EBV) infection has been detected in the skin lesions of the patients. OBJECTIVE: To describe clinical, histological, immunohistochemical, and molecular pathological features of the patients with EBV associated lymphoproliferative lesion presenting as a HV-like eruption. METHODS: The clinical, histological, and immunohistochemical features of 16 patients were reviewed. The presence of T-cell receptor (TCR)-gamma gene rearrangement was investigated using polymerase chain reaction (PCR) technique. Photoprovocation by repetitive UVA exposure was performed in five patients. In situ hybridization was performed to detect mRNA for EBV in the lesional skin biopsy specimen, lymph node biopsy specimen, mucosal biopsy specimen of stomach, and the skin biopsy specimen of photo-provoked site. PCR was performed to detect DNA for EBV in the skin biopsy specimens of 6 patients and peripheral mononuclear cells of 2 patients. RESULTS: The severity of the skin lesion and the clinical course varied among the patients. Skin biopsy specimens obtained from a papule or a vesicle showed perivascular and periadnexal infiltrate of lymphoid cells with T-cell phenotype. However, clonal TCR-gamma gene rearrangement was not detected in all 8 patients. Papules or vesicles were induced by repetitive UVA exposure in 5 patients. A latent EBV infection was demonstrated in all the tested samples, such as lesional skin, lymph node, gastric mucosa, peripheral blood mononuclear cells, and the photo-provoked lesion. CONCLUSION: EBV associated lymphoproliferative lesion presenting as a HV-like eruption is a novel disease that is not related to classic HV. Repetitive irradiation of UVA can induce the skin lesion in some patients with EBV associated lymphoproliferative lesion presenting as a HV-like eruption.
Biopsy