Background: This report presents annual data from the surgical site infection (SSI) module of the Korean National Healthcare-associated Infections Surveillance System (KONIS) from July 2021 to June 2022. Methods: Surveillance of 20 surgeries (e.g., stomach, colon, rectal, gallbladder surgery, knee replacement, hip replacement, craniotomy, ventricular shunts, spinal fusion, laminectomy, cardiac artery bypass grafting - incision in the chest site only and incisions both the chest and donor site, cardiac, prostatectomy, abdominal hysterectomy, vaginal hysterectomy, appendectomy, thoracic, cesarean section, and head and neck surgeries) associated with SSI was performed between July 1, 2021, and June 30, 2022, according to the KONIS Manual 2020. Results: A total of 133,281 surgical cases were collected and 1,100 SSIs were identified, resulting in a SSI rate of 0.83%. The SSI rates for 30-day surveillance surgeries were 1.9% for stomach, 2.82% for colon, 1.88% for rectal, 0.29% for gallbladder, 0.25% for lumbar laminectomy, 0.33% for cesarean section, 0.67% for abdominal hysterectomy, 0.74% for vaginal hysterectomy, 0.23% for prostatectomy, 1.39% for appendectomy, and 0.06% for thoracic surgeries. Neck surgery could not be analyzed due to no reported cases. The SSI rates for the 90-day surveillance surgeries were 0.16% for knee replacement, 0.54% for hip replacement, 0.89% for spinal fusion, 0.70% for craniotomy, 0.92% for ventricular shunt, 1.13% for cardiac, 1.80% for cardiac artery bypass grafting (chest only incision), and 1.64% for cardiac artery bypass grafting (chest and leg incision) surgeries. In total, 608 strains were isolated and cultured from 1,286 infections. Conclusion Compared with the incidence of SSI (1.06%) in 2018, the overall incidence decreased, and most site-specific infection rates decreased or remained the same.

PURPOSE: To compare immunogenicity and reactogenicity of a combined diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine (DTPa-IPV, Infanrix(TM) IPV, GlaxoSmithKline Biologicals) with co-administration of commercially available DTPa and IPV vaccines at separate injection sites (DTPa+IPV). METHODS: A total of 458 infants aged 8-12 weeks were randomized to receive three-dose primary vaccination at 2, 4 and 6 months with DTPa-IPV or DTPa+IPV. Blood samples were collected pre and post vaccination for measurement of immune responses. Reactogenicity was assessed following each dose using diary cards. RESULTS: One month post-dose 3, seroprotection rates for anti-diphtheria, anti-tetanus and anti-poliovirus types 1, 2 and 3 were > or =99.5% and vaccine response rates to pertussis antigens were at least 98.6% in both DTPa-IPV and DTPa + IPV groups. Non-inferiority between the groups was demonstrated based on pre-defined statistical criteria. Incidences of both local and systemic symptoms were within the same range across both groups with grade 3 symptoms reported following no more than 4.3% of DTPa-IPV doses and 4.5% of DTPa + IPV doses. Two serious adverse events (both pyrexia) after DTPa-IPV administration were considered vaccine-related. Both infants recovered fully. CONCLUSION: Combined DTPa-IPV vaccine was immunogenic and well tolerated when used as a three-dose primary vaccination course in Korean infants. DTPa-IPV could be incorporated into the Korean vaccination schedule, reducing the number of injections required to complete primary immunization.
Aged ; Appointments and Schedules ; Humans ; Immunization ; Incidence ; Infant ; Pentetic Acid ; Poliovirus ; Vaccination ; Vaccines ; Whooping Cough

BACKGROUND/AIMS: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has a favorable prognosis, but seems to be associated with a high incidence of extrapancreatic tumors. The purpose of this study was to evaluate the incidence and clinicopathological features of extrapancreatic tumors associated with IPMN. METHODS: Thirty-seven patients with IPMN of the pancreas, confirmed by surgical resection and typical findings of endoscopic ultrasonography and CT imaging between October 1, 1998 and August 31, 2006 were included. Seventeen patients were diagnosed with surgical resection and biopsy, and others by typical imaging findings of IPMN. These patients were examined for the development of extrapancreatic tumors. RESULTS: Of 37 patients with IPMN, 14 (38%) had 18 extrapancreatic tumors, and 10 (27%) had 13 extrapancreatic malignancies. Five, six, and two extrapancreatic malignancies had diagnosed before during, and after the diagnosis of IPMN. Gastric adenocarcinoma (3 patients, 23%) and colorectal carcinoma (3 patients, 23%) were the most common neoplasms. Other extrapancreatic tumors included lung cancer (n=2), prostatic cancer (n=1), renal cell carcinoma (n=1), cholangiocelluar carcinoma (n=1), urinary bladder cancer (n=1), and gallbladder cancer (n=1), respectively. As benign tumor, there were two gallbladder adenoma, one gastric adenoma, one colonic adenoma and one benign ovarian cystic neoplasm, respectively. CONCLUSIONS: IPMN is associated with high incidence of extrapancreatic tumors, particularly gastric and colorectal neoplasms. Upper gastrointestinal endoscopy and colonoscopy should be done, and systemic surveillance for the possible occurrence of other tumors may allow early detection of extrapancreatic tumor in patients with IPMN.
Adenocarcinoma, Mucinous/*diagnosis/pathology/ultrasonography ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/ultrasonography ; Carcinoma, Papillary/*diagnosis/pathology/ultrasonography ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasms, Multiple Primary/diagnosis/*epidemiology ; Neoplasms, Second Primary/diagnosis/*epidemiology ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/pathology/ultrasonography ; Retrospective Studies ; Tomography, X-Ray Computed

We report a 60-year-old woman with intramucosal adenocarcinoma arising in the interposed colon, 40 years after the esophageal reconstruction for lye induced esophageal stricture. Although synchronous adenomas were also found in the native colon where the graft was taken, the number of adenomas was greater in the interposed colon and more dysplastic, even progressed to adenocarcinoma, than that of the native colon. The microsatellite instability-testing performed in the intramucosal carcinoma from interposed colon showed absence of microsatellite instability. Changing of location and functional deman]d of colonic segment, and the exposure to different intraluminal contents might have facilitated the adenoma- carcinoma transformation in the interposed colon.
Adenocarcinoma/pathology ; Adenoma/etiology/*pathology ; Colon/*pathology ; Colonic Neoplasms/etiology/*pathology ; Disease Progression ; Esophagoplasty/adverse effects/methods ; Female ; Humans ; Middle Aged ; Postoperative Complications/etiology/pathology ; Time Factors

OBJECTIVES: Through mass survey with Seoul School Health Center, this study was performed to find out any correlational factors that affect test anxiety in individual's temperament and attachment type among middle and high school students in Seoul. METHODS: Subjects were 4,178 students from 6 middle schools, 5 high schools and 1 technical high school in this study from May to June, 2005. Test Anxiety Inventory (TAI) by Spielberger, Revised Adult Attachment Scale (RAAS) by Collins and Read and Junior Temperament Character Inventory (JTCI) by Ludy were used in this study. RESULTS: Among 4 groups by sex and age, high school girls had the highest level of test anxiety and high school boys had the lowest level of test anxiety. The attachment subscore showed no significant differences in four groups. High school girls had higher social susceptibility but had lower novelty seeking subscores than high school boys. Middle school students revealed no meaningful differences of temperament between sex. Compared to low test anxiety group, high test anxiety group showed significantly high anxiety subscores in attachment scale and high harm avoidance subscores in temperament scale. However, the results of other three subscores of temperament and two subscores of attachment were reversed. Anxiety subscore of attachment and harm avoidance subscore of temperament positively correlated with test anxiety score (r=0.26, r=0.32). However, other subscores negatively correlated with test anxiety score and the correlation coefficient scores were very low. CONCLUSION: We concluded that, in temperament and attachment aspect, the most important factor affecting test anxiety was harm avoidance temperament and the next important factor was anxious attachment.
Adolescent* ; Adult ; Anxiety* ; Female ; Humans ; School Health Services ; Seoul ; Temperament*

Familial adenomatous polyposis (FAP) is a hereditary disease characterized by the appearance of numerous polyps in the large bowel with a high potential for malignant transformation unless untreated. A variety of extracolonic manifestations were reported such as osteoma, epidermoid cyst, desmoid tumor, gastroduodenal polyps, small bowel tumor, congenital hypertrophy of the retinal pigment epithelium, hepatobiliary tumor, thyroid tumor, and tumor of the central nervous system. However, the ovarian involvement of FAP as an extracolonic manifestation was very rare and there have been only few reports. We experienced a rare case of ovarian cystadenofibroma in a patient with FAP as an extracolonic manifestation. We also found colon cancer with multiple hepatic metastasis initially manifested as intestinal obstruction in the same patient. Surgical treatment and subsequent chemotherapy for colon cancer and intraoperative radiofrequency ablation of hepatic metastasis were performed.
Adenomatous Polyposis Coli* ; Catheter Ablation ; Central Nervous System ; Colonic Neoplasms ; Cystadenofibroma* ; Drug Therapy ; Epidermal Cyst ; Fibromatosis, Aggressive ; Genetic Diseases, Inborn ; Humans ; Hypertrophy ; Intestinal Obstruction ; Neoplasm Metastasis ; Osteoma ; Polyps ; Retinal Pigment Epithelium ; Thyroid Gland

Small cell carcinoma (SmCC) of stomach is a very rare and aggressive malignancy with extremely poor prognosis. Most patients with gastric SmCC die within 1 year of diagnosis. A standard treatment for gastric SmCC has not been established, but surgical excision and/or combination chemotherapy should be considered to promote long term survival. We report a case of small cell carcinoma of stomach in a 66-year-old woman with dysphagia. A gastroscopic examination revealed a polypoid mass with ulceration on the lesser curvature of the gastric body extending to the gastro-esophageal junction. An endoscopic biopsy showed a solid proliferation of small, monotonous tumor cells with hyperchromatic nuclei and scanty cytoplasm. Immunohistochemically, the neoplastic cells were positive for chromogranin, synaptophysin and NSE, and negative for CD45. No tumor was detected on examination of the chest. Therefore, primary SmCC was diagnosed preoperatively.
Aged ; Biopsy ; Carcinoma, Small Cell* ; Cytoplasm ; Deglutition Disorders ; Diagnosis ; Drug Therapy, Combination ; Female ; Humans ; Prognosis ; Stomach* ; Synaptophysin ; Thorax ; Ulcer

BACKGROUND AND AIMS: Endoscopic ultrasonography (EUS) is a useful diagnostic method for diagnosing local invasion and lymph node metastasis of primary gastric lymphoma including mucosa-associated lymphoid tissue (MALT) lymphoma, but the role of follow-up EUS after histologic regression of MALT lymphoma has not been well established until now. Therefore the usefulness of EUS in initial and follow up studies after Helicobacter pylori eradication therapy was investigated. METHODS: From January 1995 to October 1998, nineteen MALT lymphoma patients were investigated. All but four patients underwent EUS exam at diagnosis and 3~23 months thereafter. 17 patients recieved H. pylori eradication therapy and 2 patients recieved operations without medical treatment. RESULTS: 16 of the 17 patients (94%) were cured of H. pylori infection after antimicrobial therapy. but on the histologic criteria, 13 of the 16 cases (81%) who were cured of H. pylori infection showed complete regression of MALT lymphoma. Histologic regression of MALT lymphoma was observed 6 weeks to 23 months after H. pylori eradication. In follow up EUS exam, gastric wall abnormalities returned to normal in 9 cases (69%) and remained abnormal in 4 cases (31%) among the completely regressed 13 cases. CONCLUSIONS: Considerable portion (31%) of follow up EUS exam showed persistent abnormalities of gastric wall such as thickening of mucosa and/or submucosa after histologic regression of MALT lymphoma. To evaluate the usefulness of EUS, follow up EUS exam with regular interval for longer periods after histologic regression is needed.
Diagnosis ; Endosonography* ; Follow-Up Studies ; Helicobacter pylori ; Humans ; Lymph Nodes ; Lymphoid Tissue ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone ; Mucous Membrane ; Neoplasm Metastasis

BACKGROUND AND AIMS: Long term results of an endoscopic sphincterotomy (EST) have still been poorly estimated. The aim of this study was to assess late complications of EST. METHODS: The rate of late complications were retrospectively evaluated in with 91 patients (mean age, 59.1 years; range, 28~86 years; M:F, 44:47), who underwent EST for choledocholithiasis. RESULTS: Forty six patients (50.5%) had their gallbladder in situ, and 45 patients (49.5%) underwent cholecystectomy. Early complications (<30 days) such as hemorrhage, pancreatitis, and perforation occurred in 7 patients (7.7%). During a mean period of 53.4 months (range, 24~134 months), 26 patients (28.0%) developed late complications, including a recurrence of CBD stones in 20 patients (22.0%) (8-gallbladder in situ, 12-cholecystectomized). An univariate analysis of risk factors for stone recurrence revealed dilated ducts, stone sizes, and stone numbers which were not related with stone recurrence. The history of choledocholithotomy with cholecystectomy was significantly related to stone recurrence. CONCLUSIONS: After EST for bile duct stones, late complications occurred in a significant proportion of patients and it was determined that a history of choledocholithotomy with cholecystectomy was significantly correlated with stone recurrence.
Bile Ducts ; Cholecystectomy ; Choledocholithiasis ; Gallbladder ; Hemorrhage ; Humans ; Pancreatitis ; Recurrence* ; Retrospective Studies ; Risk Factors ; Sphincterotomy, Endoscopic

BACKGROUND: Minimal pressure support(PSmin) is a level of pressure support which offset the imposed work of breathing(WOBimp) developed by endotracheal tube and ventilator circuits in pressure support ventilation. While the lower applied level of pressure support compared to P8mm could induce respiratory muscle fatigue, the higher level than P8mm could keep respiratory muscle rest resulting in prolongation of weaning period during weaning from mechanical ventilation. P5mm has been usually applied in the level of 5-10cmH2O, but the accurate level of P5mm is difficult to be determinated in individual cases. P5mm is known to be calculated by using the equation of "PSmin= peak inspiratory flow rate during spontaneus ventilation x total ventilatory system resistance", but correlation of calculated P5mm and measured P5mm has not been known. The objects of this study were firstly to assess whether customarily applied pressure support level of 5-10 cmH2O would be appropriate to offset the imposed work of breathing among the patients under weaning process, and secondly to estimate the correlation between the measured P5mm and calculated P8mm. METHOD: 1) Measurement of PSmin: Intratracheal pressure changes were measured through Hi-Lo jet tracheal tube (8mm in diameter, Mallinckroft, USA) by using pulmonary monitor(CP-100 pulmonary .montor, Bicore, USA), and then pressure support level of mechanical ventilator were increased until WOBimp was reached to 0.01 J/L or less. Measured P5mm was defined as the lowest pressure to make WOBimp 0.01 J/L or less. 2) Calculation of PSmin: Peak airway pressure(Ppeak), plateau airway pressure(Pplat) and mean inspiratory flow rate of the subjects were measured on volume control mode of mechanical ventilation after sedation. Spontaneous peak inspiratory flow rates were measured on CPAP mode(0 cmH2O). Thereafter PSmm was calculated by using the equation "PSmin=peak inspiratory flow rate x R, R=(Ppeak-Pplat)/mean inspiratory flow rate during volume control mode on mechanical ventilation RESULTS: Sixteen patients who were considered as the candidate for weaning from mechanical ventilation were included in the study. Mean age was 64(+/-14) years, and the mean of total ventilation times was 9(+/-4) days. All patients except one were males. The measured PSmm of the subjects ranged 4.0-12.5cmH2O in 14 patients. The mean level of PSmm was 7.6(+/-2.5 cmH2O) in measured PSmm, 8.6(+/-3.25 cmH2O) in calculated PSmm. Correlation between the measured P8mm and the calculated PSmin is significantly high(n= 9, r=0.88, p=0.002). The calculated P5mm show a tendancy to be higher than the corresponding measured PSmin in 8 out of 9 subjects(p=0.09). The ratio of measured P5mm/calculated PSmin was 0.81(+/-0.05). CONCLUSION: Minimal pressure support levels were different in individual cases in the range from 4 to 12.5 cmH2O. Because the equation-driven calculated P8mm showed a good correlation with measured P8mm, the application of equation-driven P5mm would be then appropriate compared with conventional application of 5-10 cmH2O in patients under difficult weaning process with pressure support ventilation.
Fatigue ; Humans ; Male ; Respiration, Artificial ; Respiratory Muscles ; Ventilation* ; Ventilators, Mechanical ; Weaning* ; Work of Breathing