Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.
*Hepatectomy/statistics & numerical data ; Humans ; *Laparoscopy/statistics & numerical data ; Liver/*surgery ; Liver Diseases/pathology/surgery ; Liver Neoplasms/pathology/surgery ; Postoperative Complications/epidemiology ; Questionnaires ; Republic of Korea

BACKGROUND: The purpose of this study is to know the healthcare-associated infection (HAI)s in small and medium sized hospitals, less than 400 beds. METHODS: We had web based surveillance for HAIs in 27 hospitals from August to October 2010. The surveillance performed in 1-2 ICUs and 1 general ward in each hospitals by CDC definition. And for the multi-drug resistant organisms (MDROs), we reviewed all of blood culture results. RESULTS: We identified 319 HAIs among 269,436 patients days. The HAIs rate was 1.18 (CI 1.05-1.32)/1,000 patient-days. Urinary tract infection was the most common HAI (52.4%) in this study followed by pneumonia (18.9%), blood-stream infections (14.2%), surgical site infection (7.9%), and others (6.6%). There were 76.5% of device associated infections in UTI, 46.7% in BSI, and 18.3% in pneumonia. The rate of HAIs in ICU was higher than that of in general ward (4.6 vs 0.9/1,000 patient-days). However, the indwelling catheter associated urinary tract infection rate was lower in ICU (2.6 vs 4.4/1,000 device days). There were no significant differences in central line-associated blood stream infection rate (1.5 vs 1.8) and ventilator-associated pneumonia rate (3.0 vs 0.0). The common microorganisms found in HAIs were Escherichia coli (19.8%), Staphylococcus aureus (13.1%), and Pseudomonas aeruginosa (12.7%). Moreover, 90.9% of S. aureus were resistant to methicillin, and 38.2% of P. aeruginosa and 44.4% of Acinetobacter baumannii were resistant to imipenem. Total of 66 MDROs were isolated from blood culture and the result shows that the MRSA was 84.6% (56 case), carbapenmen-resistant Acinetobacter spp. was 10.6% (7 case), and vancomycin-resistant enterococci was 4.6% (3 case). CONCLUSION: The characteristics of HAIs in small and medium sized hospitals will be contributed to the decision making of governance policy for infection control and to provide comparable data for these hospitals.
Acinetobacter ; Acinetobacter baumannii ; Catheters, Indwelling ; Centers for Disease Control and Prevention (U.S.) ; Decision Making ; Escherichia coli ; Humans ; Imipenem ; Infection Control ; Methicillin ; Methicillin-Resistant Staphylococcus aureus ; Patients' Rooms ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pseudomonas aeruginosa ; Rivers ; Staphylococcus aureus ; Urinary Tract Infections

A hemodialysis room is the healthcare facility utmost demanding an infection control because dialysis patients have chronic serious underlying conditions and high risks of bloodborne infection due to a indwelling intravascular catheter, a frequent exposure to bloods or body fluids, and a blood transfusion as well as a hemodialysis room can be a mixing vessel to encounter both hospital-acquired pathogens and community-acquird pathogens. Therefore the Korean Society for Nosocomial Infection Control (KOSNIC) purposed to develop a guideline for the infection control in a hemodialysis room with support of Korean Center for Disease Control (KCDC). This guideline was composed of 11 chapters including vascular access control, dialysis water, microbiological and chemical monitoring of dialysis water and dialysates, components and passage of dialysates, maintenance of dialysis machines, disinfection, waste management, infection surveillance, aseptic techniques and standard precaution, environmental control, prevention of bloodborne infections and 5 appendices composing basic infection control techniques. This is the first official guideline approved by KOSNIC and KCDC of the infection control in a hemodialysis room in Korea. Here the guideline was published except appendices and entire guideline including those can be downloaded on hompages of KOSNIC (http://www.kosnic.org/) and KCDC (http//www.cdc.go.kr/).
Blood Transfusion ; Body Fluids ; Catheters ; Centers for Disease Control and Prevention (U.S.) ; Cross Infection ; Delivery of Health Care ; Dialysis ; Dialysis Solutions ; Disinfection ; Glycosaminoglycans ; Humans ; Infection Control ; Korea ; Renal Dialysis ; Waste Management ; Water

BACKGROUND: For the detection of Mycobacterium tuberculosis complex (MTB), PCR is known to be sensitive, specific, and rapid compared to the conventional methods of acid-fast-bacilli (AFB) smear and culture. We evaluated a new approach for MTB detection using real-time PCR. METHODS: The specificity of real-time PCR was evaluated using 20 MTB isolates and 37 nontuberculous mycobacteria (NTM) isolates identified by AccuProbe Mycobacterium tuberculosis complex colony identification test (Gen-Probe Inc., USA) and Myco-ID (M&D, Korea). One hundred sputum specimens (50 AFB smear-positive and 50 negative specimens) were analyzed using real-time PCR and Amplicor Mycobacterium tuberculosis test (Roche, Germany). The results of real-time PCR positives (55 samples) and negatives (598 samples) were analyzed by AFB smear and culture. RESULTS: The real-time PCR assay accurately discriminated between MTB and NTM species. Realtime PCR and Amplicor test yielded the same results in 96.0% (96/100) of the sputum specimens tested. The sensitivity and specificity of real-time PCR based on AFB culture were 97.4% and 88.5%, respectively. Of the 55 real-time PCR positive specimens, 83.6% (46/55) were culture-positive, 30.9% (17/55) were smear-positive, 52.7% (29/55) were smear-negative and culture-positive, and 14.5% (8/55) were both smear and culture-negative. Among the 598 real-time PCR negative specimens, 60 were not tested for AFB smear or culture and 10 were contaminated. Of the remaining 528 specimens, 478 (90.5%) were both smear and culture-negative and 39 (7.4%) were culture-positive. CONCLUSIONS: For the detection of MTB, real-time PCR was sensitive and specific and comparable to conventional methods. It can be used for rapid identification of M. tuberculosis in clinical laboratories.
*Bacterial Typing Techniques ; Computer Systems ; Humans ; Mycobacterium tuberculosis/classification/genetics/*isolation & purification ; Polymerase Chain Reaction/*methods ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; Tuberculosis/*microbiology

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

Thickening of tubular basement membrane and progressive tubulointerstitial fibrosis has been reported as important components of diabetic nephropathy, In order to investigate the mechanisms of tubulinterstitial changes in diabetic nephropathy, we evaluated the effects of a high concentration of glucose(25mM; 450mg/dL) on glucose transporter GLUT1 level, fibronectin production and tissue inhibitors of metalloproteinases (TIMP)-1 concentration in renal tubular(LLC-PK1) cells. As the effect of high glucose-induced alteration in LLC-PK1 cells, the expression of facilitative glueose transporter, GLUT1 was decreased after longer than 24-hours exposure to 25mM glucose, compared to control(5.6mM). The administration of protein kinase C (PKC) inhibitor GF109203X(10 microM) did not show significant effect on high glucose-induced decrease of GLUT1 level. On western blot analysis of fibronectin production, The exposure of LLC-PK cells to 25mM glucose for 48 hours significantly increasc4 fibro- nectin production, dose-dependently. The addition of GF102903X at the concentration of 10pM induced the significant increase of fibronectin level in LLC-PK1cells under glucose-free condition, whereas there was no significant effect on the high glucose-induced increase of fibronectin production. The addition of anti-TGF-beta antibody at 30 microgram/mL partly inhibited the high glucose-induced increase of fibronectin production. Concerning the changes of tissue inhibitor of metallo-proteinase(TIMP)-1 levels in the presence of high glucose, the exposure to high glucose for 24 and 43 hours increased TIMP-1 levels in culture supernatant of LLC-PK1 cells, dose-dependently. The TIMP-1 levels of 48-hour exposure to 15 and 25mM glucose were also significantly higher than those of 24-hourexposure. The treatment with 10 microM GF102903X or 30 microgram/mL anti-TGF-Beta antibody had no significant effects on TIMP-1 levels measured under the high glucose culture condition. In conclusion, the expression of facilitative glucose transporter, GLUT1 is inhibited and the production of fibronectin is increased in renal tubular cells cultured in the presence of high concentration of glucose, which is partly mediated by TGF-beta. The TIMP-1 level is also increased under high glucose culture condition. The enhanced productions of fibronectin and TIMP-1 of renal tubular cells under high glucose concentration may contribute to tubulointerstitial fibrosis that occurs in diabetic nephropathy.
Animals ; Basement Membrane ; Blotting, Western ; Diabetic Nephropathies ; Epithelial Cells* ; Extracellular Matrix* ; Fibronectins ; Fibrosis ; Glucose Transport Proteins, Facilitative ; Glucose* ; LLC-PK1 Cells ; Metalloproteases ; Protein Kinase C ; Swine ; Tissue Inhibitor of Metalloproteinase-1 ; Transforming Growth Factor beta

BACKGROUND: The reduction in the plasma cholinesterase (PChE) level results in slow to hydrolysis of succinylcholine (SCC) and mivacurium (MIV). The factors altering the level of the normal enzyme in human could be considered under the several conditions. We investigated in the present study whether the drugs induced decreases in normal PChE activity after administration of various muscle relaxants during anesthesia are evident and how these results should be influenced to the time course of neuromuscular blockade produced by SCC and MIV. METHODS: Young adult patients of ASA class I or II scheduled for elective surgery requiring muscle relaxation were premedicated and anesthesia was maintained with nitrous oxide in oxygen with increment of thiopentone or fentanyl as required. In the neuromuscular monitoring, surface electrodes were applied on the ulnar nerve at wrist. Supramaximal transcutaneous single twitch stimulation (1 Hz) during onset and 0.1 Hz during recovery of neuromuscular blockade induced by various muscle relaxants delivered by a peripheral nerve stimulator was applied. Twitch response of thumb adductor was measured mechanomyographically using 2 kg Load Cell Strain Gauge with thumb piece modification. Recordings were made on a Gould recorder. PChE levels were measured by the modified Garry method after induction of anesthesia and, at 3, 10, 20 and 30 min following administration of 2 x ED95 of pancuronium (PAN), vecuronium (VEC) and atracurium (ATR). Neuromuscular recordings were measured with onset time defined as lag time and manifest time, and recovery time defined as clinical duration, recovery index and total duration. RESULTS: The levels of PChE were significantly reduced after administration of PAN and VEC (p<0.05). Onset times were significantly shorten but recovery time in the group given MIV pretreated by small dose of PAN was significantly prolonged (p<0.05). And there were a evidence to prolong recovery time in the group pretreated by small dose of VEC but not significant. CONCLUSIONS: It is concluded that aminosteroidal derivative neuromuscular blocking agents have presumably evidence induced decreases in PChE activity rather than benzylisoquinolinium derivative neuromuscular blocking agents.
Anesthesia ; Atracurium ; Cholinesterases* ; Electrodes ; Fentanyl ; Humans ; Hydrolysis ; Muscle Relaxation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Nitrous Oxide ; Oxygen ; Pancuronium ; Peripheral Nerves ; Plasma* ; Succinylcholine ; Thiopental ; Thumb ; Ulnar Nerve ; Vecuronium Bromide ; Wrist ; Young Adult

The influence of thyroxine upon n the cardiac uptake of catecholamines was investigated in rabbits. A single injection of thyroxine(1.0m/kg) into rabbits did not affect the concentration of myocardial catecholamines. However, this dose of thyroxine greatly increased the cardiac uptake of catecholamine following injection of 2.0mg of norepinephrine as compared to that of untreated normal animals and it remained elevated for several hours. Similarly thyroxine also enhanced the accumulation of myocardial catecholamines following administration of dopa(60-80mg/kg) and epinephrine(1.0-1.5mg/kg).
Animal ; Catecholamines/metabolism* ; Epinephrine/metabolism ; Heart/drug effects* ; Male ; Myocardium/metabolism* ; Norepinephrine/metabolism ; Rabbits ; Thyroxine/pharmacology* ; Tritium

Treatment of rabbits with thyroxine 1 mg/kg daily for three to six days produced a hyperthyroid state as evidenced by increase in the heart rate and PBI. The hyperthyroid animals exhibited a significant shortening of the atrial refractory period. Beta adrenergic receptor blocking agents, propranolol (l0(-6)M pronethalol (5 X 10(-5)M) or MJ-1999 (5 X 10(-4)M), completely blocked the shortening of the atrial refractory period produced by the treatment with thyroxin, and with norepinephrine. Consequently, the shortening of the atrial refractory period of rabbits treated with thyroxin appears to bs mediated through stimulation of the beta adrenergic receptor in the heart. From these results, it may be concluded that the stimulation of the beta adrenergic receptor plays an important role in the alteration of cardiac function found in hyperthyroidism, and that the beta adrenergic blocking agents may be useful in treatment of the cardiac complications of hyperthyroidism.
Adrenergic beta-Antagonists/pharmacology ; Animals ; Female ; Heart Atria/*drug effects/physiopathology ; Hyperthyroidism/chemically induced/*physiopathology ; Male ; Rabbits ; Sympatholytics/*pharmacology ; Thyroxine

In an attempt to determine whether myocardial catecholamines vary from season to season, their concentration in rabbits was measured throughout the whole year by the spectrophotofluorometric method. The highest concentration of cardiac catecholamine was observed in summer. Measurement of the atrial response to norepinephrine revealed no significant alteration during the entire period of the experiment.
Animals ; Catecholamines/*analysis ; Heart/*drug effects ; Myocardium/*analysis ; Norepinephrine/*pharmacology ; Rabbits ; *Seasons