BACKGROUND: In this report, we present the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2013 through June 2014. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU) in 166 ICUs of 94 hospitals using the KONIS. Nosocomial infection (NI) rate was defined as the number of infections per 1,000 patient-days or device-days. RESULTS: A total of 2,843 NIs were found during the study period: 861 UTIs (846 were urinary catheter-associated), 1,173 BSIs (1,021 were central line-associated), and 809 PNEUs (498 were ventilator-associated). The rate of urinary catheter-associated UTIs was 1.21 per 1,000 device-days (95% confidence interval [CI]=1.13-1.29), and the urinary catheter utilization ratio was 0.84 (95% CI=0.839-0.841). The rate of central line-associated BSIs was 2.33 per 1,000 device-days (95% CI=2.20-2.48), and the utilization ratio was 0.53 (95% CI=0.529-0.531). The rate of ventilatorassociated PNEUs (VAPs) was 1.46 per 1,000 device-days (95% CI=1.34-1.60), and the utilization ratio was 0.41 (95% CI=0.409-0.411). In hospitals with more than 900 beds, although the ventilator utilization ratio was highest, the rate of VAPs was lower than in hospitals with 300-699 or 700-899 beds. CONCLUSION: BSIs were the most commonly reported nosocomial infections. Although device utilization ratios had increased, nosocomial infection rates did not differ significantly from those during the previous period (July 2012 through June 2013).
Cross Infection* ; Intensive Care Units* ; Critical Care* ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical

OBJECTIVE: Device-associated infections in the central nervous system are serious complications of procedures involving indwelling devices among neurosurgical patients. In this study, the clinical characteristics and outcome of microbiologically confirmed device-associated cerebrospinal fluid (CSF) infection were evaluated. METHODS: We performed a retrospective analysis of adult patients found to have a positive CSF culture result during a hospital admission between 1 January 2005 through 2 October 2010 in Soonchunhyang University Hospital. RESULTS: During the study period, all episodes (n=161 CSF specimens, 87 patients) involving a culture-positive CSF were enrolled. Thirty-two episodes of device-associated CSF infection were included in the analysis among the study group. Most device-associated infections were ventriculo-peritoneal shunt infections (14/32, 44%). Fever (>38degrees C) was present in 17 episodes (53%). Overall, the most common microorganism was coagulase-negative staphylococcus (7/32 [22%]). Gram-negative rods (Pseudomonas aeruginosa 6/32 [19%], Acinetobacter baumannii/haemolyticus 5/32 [16%]) were identified in culture in 16/32 (50%). Device was removed for the control of device-associated infection in 30/32 (94%). Cure rate was 69% (22/32). All patients with treatment failure (10/32, 34%) expired. CONCLUSION: It is difficult to diagnosis device-associated CSF infections early since those are frequently presented with nonspecific clinical signs and symptoms. In our study, gram-negative infections accounted for 50% of cases and the empiric antibiotics initially chosen were found to not be effective against the final identified pathogen in many cases. Device-associated CSF infections should be strongly considered a serious risk factor associated with CSF infections, and prompt initiation of broad coverage antibiotics should be started after appropriate assessment.
Acinetobacter ; Adult* ; Anti-Bacterial Agents ; Central Nervous System ; Cerebral Ventriculitis ; Cerebrospinal Fluid* ; Diagnosis ; Fever ; Humans ; Meningitis ; Retrospective Studies ; Risk Factors ; Staphylococcus ; Treatment Failure ; Ventriculoperitoneal Shunt

Cytomegalovirus (CMV) is a prevalent pathogen, with 98~100% of Korean adults showing prior exposure by serology. A primary infection, such as CMV infectious mononucleosis, is very rare. CMV infectious mononucleosis often presents an initial diagnostic problem. Patients are often hospitalized with a wide variety of clinical diagnoses including fever of unknown origin without pharyngitis and lymphadenopathy. CMV gastrointestinal infections are rare in previously immunocompetent individuals. The most common sites involved are the colon and rectum, although lesions of the stomach have also been described. It is unusual to see CMV infectious mononucleosis and CMV gastrointestinal infection in the same patient. Our patient received symptomatic treatment and fully recovered. We present a case of CMV infectious mononucleosis with gastric ulcers in a previously healthy adult.
Adult ; Colon ; Cytomegalovirus ; Fever of Unknown Origin ; Humans ; Infectious Mononucleosis ; Lymphatic Diseases ; Pharyngitis ; Rectum ; Stomach ; Stomach Ulcer

Since the start of the antibiotic era, syphilis has become rare. However, in recent times, it has tended to be prevalent concomitantly with human immunodeficiency virus (HIV) infection and coinfection in North America and Europe. Now, such cases are expected to increase in elsewhere including Korea. A 40-year-old male patient visited hospital complaining of a headache for about one month. Brain computed tomography and magnetic resonance imaging, showed leptomeninged enhancing mass with edema an right porisylvian region, which was suspected to be glioma. Patient underwent a blood test and was diagnosed with syphilis and acquired immune deficiency syndrome. Partial cortical and subcortical resection were performed after small craniotomy. The dura was thick, adhered to the brain cortex, and was accompanied by hyperemic change of the cortex. The pathologic diagnosis was meningovascular syphilis (MS) in HIV infection. After the operation, the patient was treated with aqueous penicillin G. Thereafter, he had no neurological deficit except intermittent headache. At first, this case was suspected to be glioma, but it was eventually diagnosed as MS in HIV coinfection. At this point the case was judged to be worth reporting.
Acquired Immunodeficiency Syndrome ; Adult ; Brain ; Coinfection ; Craniotomy ; Edema ; Europe ; Glioma ; Headache ; Hematologic Tests ; HIV ; HIV Infections ; Humans ; Korea ; Magnetic Resonance Imaging ; Male ; Neurosyphilis ; North America ; Penicillin G ; Syphilis

PURPOSE: Measurement of transmission dose is useful for in vivo dosimetry. In this study, previous algorithm for estimation of transmission dose was modified for use in cases with tissue deficit. MATERIALS AND METHODS: The beam data was measured with flat solid phantom in various conditions of tissue deficit. New algorithm for correction of transmission dose for tissue deficit was developed by physical reasoning. The algorithm was tested in experimental settings with irregular contours mimicking breast cancer patients using multiple sheets of solid phantoms. RESULTS: The correction algorithm for tissue deficit could accurately reflect the effect of tissue deficit with errors within +-1.0% in most situations and within +-3.0% in experimental settings with irregular contours mimicking breast cancer treatment set-up. CONCLUSION: Developed algorithm could accurately reflect the effect of tissue deficit and irregularly shaped body contour on transmission dosimetry.
Breast Neoplasms ; Humans

PURPOSE: Measurement of transmission dose is useful for in vivo dosimetry. In this study, the algorithm for estimating the transmission dose for open radiation fields was modified for application to partially blocked radiation fields. MATERIALS AND METHODS: The beam data was measured with a flat solid phantom with various blocked fields. A new correction algorithm for partially blocked radiation field was developed from the measured data. This algorithm was tested in some settings simulating clinical treatment with an irregular field shape. RESULTS: The correction algorithm for the beam block could accurately reflect the effect of the beam block, with an error within +/-1.0%, with both square fields and irregularly shaped fields. CONCLUSION: This algorithm can accurately estimate the transmission dose in most radiation treatment settings, including irregularly shaped field.

The vast majority of ampullary tumors are epithelial in nature and are either adenoma or adenocarcinoma. Rarely lymphoma or mucinous and squamous elements may be found. Primary lymphoma of pancreaticobiliary region are exceedingly rare, and mostly nodal. Recently, we have experienced a 29-year-old woman with primary malignant lymphoma of the ampulla of Vater with recurrent acute pancreatitis and jaundice. On duodenoscopy, bulging ampulla with normal overlying duodenal mucosa was observed. Endoscopic sphincterotomy was done and tumor inside the ampulla was exposed. ERCP showed high grade biliary and pancreatic ductal strictures extending from the papillary orifice, with upstream ductal dilatation, respectively. With endoscopic biopsy alone, the tumor was confirmed as B-cell lymphoma histologically.
Adenocarcinoma ; Adenoma ; Adult ; Ampulla of Vater* ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Dilatation ; Duodenoscopy ; Female ; Humans ; Jaundice ; Lymphoma* ; Lymphoma, B-Cell ; Mucins ; Mucous Membrane ; Pancreatic Ducts ; Pancreatitis ; Sphincterotomy, Endoscopic

A 16-year-old male patient was diagnosed as chondroid osteosarcoma of the left humeral shaft. He showed normal serum creatinine level and no complications following the first course of high-dose methotrexate (HD-MTX) chemotherapy with a total dose of 12g/m2. After the 2nd HD-MTX chemotherapy with the same dosage as in the 1st course, plasma MTX levels soared up to 72micromol/L and serum creatinine level increased to 1.39mg/dL. We failed to lower the plasma MTX levels and to recover the renal function by high-dose leucovorin rescue and plasmapheresis. Plasma MTX level was successfully lowered after three consecutive total plasma exchanges and the withdrawal of aceclofenac which was suspected as an aggravating agent. No rebound in plasma MTX level was observed. We report that total plasma exchanges were effective in a patient with renal failure and delayed MTX excretion which occurred after HD-MTX chemotherapy.
Acute Kidney Injury* ; Adolescent ; Creatinine ; Drug Therapy ; Humans ; Leucovorin ; Male ; Methotrexate ; Osteosarcoma ; Plasma Exchange* ; Plasma* ; Plasmapheresis ; Renal Insufficiency

PURPOSE: To apply a distributed circuit theory, to develop a head-size transverse electromagnetic(TEM) resonator coil for a home-built 3T whole-body MRI system and to report an efficiency of the coil. MATERIALS AND METHODS: The dimension of TEM resonator with 16 cavity element, the diameter of copper rod was 0.63cm and its length was 13.75cm. As raw materials, the purity of copper rod was 98% and the dielectric constant of teflon was 2.08. RESULTS: The TEM head-size resonator with 16cavity elements exhibiting 9-mode resonances was robust to the surrounding influences owing to the self-shielding structure. The isolation of quadrature with a human brain was 364 and the ratio of Q(unloaded/Q(loaded) was 2.9. CONCLUSION: It was successfully demonstrated that the TEM head-size resonator with high Q factor can provide high quality MR images at 3T MRI system. Also, the TEM resonator coil has an advantage for a fine tune with length adjustment of each cavity elements. Thus, it is expected that the TEM resonator at 3T, even higher field could be used in the clinical and research studies in near future.
Brain ; Copper ; Head* ; Humans ; Magnetic Resonance Imaging* ; Polytetrafluoroethylene

PURPOSE: Authors tried to enhance the safety and accuracy of radiosurgery by verifying stereotctic target point in actual treatment position prior to irradiation. MATERIALS AND METHODS: Before the actual treatment, several sections of anthropomorphic head phantom were used to create a condition of unknown coordinated of the target point. A film was sandwitched between the phantom sections and punctured by sharp needle tip. The tip of the needle represented the target point. The head phantom was fixed to the stereotactic ring and CT scan was done with CT localizer attached to the ring. After the CT scanning, the stereotactic coordinates of the target point were determined. The head phantom was secured to accelerator's treatment couch and the movement of laser isocenter to the stereotactic coordinates determined by CT scanning was performed using target positioner. Accelerator's anteroposterior and lateral portal films were taken using angiographic localizers. The stereotactic coordinates determined by analysis of portal films were compared with the stereotactic coordinates previously determined by CT scanning. Following the correction of discrepancy, the head phantom was irradiated using a stereotactic thechnique of several arcs. After the irradiation, the film which was sandwitched between the phantom sections was developed and the degree of coincidence between the center of the radiation distribution with the target point represented by the hole in the film was measured. In the treatment of actual patients, the way of determining the stereotactic coordinates with CT localizers and angiographic localizers between two sets of coordinates, we proceeded to the irradiation of the actual patient. RESULTS: In the phantom study, the agreement between the center of the radiation distribution and the localized target point was very good. By measuring optical density profiles of the sandwitched film along axes that intersected the target point, authors could confirm the discrepancy was 0.3mm. In the treatment of an actual patient, the discrepancy between the stereotactic coordinates with CT localizers and angiographic localizers was 0.6mm. CONCLUSION: By verifying stereotactic target point in actual treatment position prio to irradiation, the accuracy and safety of streotactic radiosurgery procedure were established.
Head ; Humans ; Needles ; Radiosurgery* ; Tomography, X-Ray Computed