Background: Even amid the coronavirus disease-19 (COVID-19) pandemic, the spread of multidrug-resistant bacteria and infection control are still important tasks. After recognizing the carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak that occurred in the isolation room for COVID-19, we would like to introduce what infection control measures were implemented to eradicate it. Materials and Methods: All COVID-19 patients with CRAB in any specimen admitted to the COVID-19 isolation ward of the tertiary hospital in Korea from October to November 2021 were analyzed. Results: During the outbreak, 23 patients with COVID-19 and CRAB infections were identified. The index case was an 85-year-old female referred from a long-term care facility. CRAB was identified in sputum culture in most patients (91.3%). The CRAB outbreak occurred mainly in the rooms around the index case. Environmental cultures on the floor, air inlet, air outlet, and window frame of the rooms were performed. The antimicrobial resistance patterns of CRAB from patients and the environment were identical; whole-genome sequencing analyses revealed isolated clonality. Infection control measures with enhanced environmental cleaning using 1,000 ppm sodium hypochlorite and phenolic compounds, enhanced hand hygiene, additional education, and mandatory additional gowning and gloving of COVID-19 personal protective equipment (PPE) were applied on 29 October. No CRAB infection cases occurred from 2 November for two weeks. Conclusion In addition to applying PPE and COVID-19 precautions in COVID-19 isolation wards, adhering to strict contact precautions along with environmental control can help prevent the spread of multidrug-resistant bacteria.

Background and Objectives: Evidence regarding the efficacy and safety of intracardiac echocardiography (ICE) for guidance during transcatheter aortic valve replacement (TAVR) is limited. This study aimed to compare the clinical efficacy and safety of ICE versus transesophageal echocardiography (TEE) for guiding TAVR. Methods: This prospective cohort study included patients who underwent TAVR from August 18, 2015, to June 31, 2021. Eligible patients were stratified by echocardiographic modality (ICE or TEE) and anesthesia mode (monitored anesthesia care [MAC] or general anesthesia [GA]). Primary outcome was the 1-year composite of all-cause mortality, rehospitalization for cardiovascular cause, or stroke, according to the Valve Academic Research Consortium-3 (VARC-3) definition. Propensity score matching was performed, and study outcomes were analyzed for the matched cohorts. Results: Of the 359 eligible patients, 120 patients were matched for the ICE-MAC and TEEGA groups, respectively. The incidence of primary outcome was similar between matched groups (18.3% vs. 20.0%; adjusted hazard ratio, 0.94; 95% confidence interval [CI], 0.53– 1.68; p=0.843). ICE-MAC and TEE-GA also had similar incidences of moderate-to-severe paravalvular regurgitation (PVR) (4.2% vs. 5.0%; adjusted odds ratio, 0.83; 95% CI, 0.23– 2.82; p=0.758), new permanent pacemaker implantation, and VARC-3 types 2–4 bleeding. Conclusions ICE was comparable to TEE for guidance during TAVR for the composite clinical efficacy outcome, with similar incidences of moderate-to-severe PVR, new permanent pacemaker implantation, and major bleeding. These results suggest that ICE could be a safe and effective alternative echocardiographic modality to TEE for guiding TAVR.

Xanthogranulomatous prostatitis is a rare inflammatory condition of the prostate. We report a case of xanthogranulomatous prostatitis. An 82-year-old man presented to our emergency department complaining of gross hematuria. A hard, enlarged, non-tender prostate was palpated on digital rectal examination. Urinalysis showed hematuria and pyuria, and the complete blood count (CBC) revealed leukocytosis. The prostate-specific antigen (PSA) level was elevated at 86.8 ng/ml. Computed tomography (CT) showed an enlarged prostate (volume 100 ml) that protruded into the bladder base. In the left lobe of the prostate, a 1.2x1.1-cm abscess was seen. Transurethral resection of the prostate was done. The pathological diagnosis was xanthogranulomatous prostatitis. The natural progression of the disease is unknown because of the paucity of cases and long-term follow-up reports. To evaluate the pathogenesis and long-term features of progression of this disease, more clinical cases should be collected.
Abscess ; Aged, 80 and over ; Blood Cell Count ; Digital Rectal Examination ; Emergencies ; Granuloma ; Hematuria ; Humans ; Leukocytosis ; Prostate ; Prostate-Specific Antigen ; Prostatitis ; Pyuria ; Urinalysis ; Urinary Bladder ; Urinary Tract Infections

BACKGROUND: The combined use of small endoscopic sphincterotomy (EST) followed by endoscopic papillary large balloon dilation (EPLBD) might be associated with a lower incidence of procedure-related complications such as pancreatitis, bleeding or perforation, compared to the use of EPLBD or a large EST alone. The aim of this retrospective study was to evaluate the utility of a combined EST and EPLBD method for the removal of common bile duct (CBD) stones that could not be extracted by use of an EST and conventional techniques. METHODS: Between March 2005 and September 2006, a total of 35 patients with CBD stones were enrolled. Fourteen patients had received a previous EST, and 21 patients underwent an EST. The sphincterotomy site was then dilated with a 12~18 mm diameter balloon. RESULTS: The average number of stones was 3.6+/-2.9 (range: 110). The average maximum stone diameter was 26.11+/-8.88 mm (range: 12~50 mm). Complete stone removal was accomplished in 31 patients (88.6%). In 9 patients (25.7%), a mechanical lithotripsy was required. No episode of true pancreatitis occurred. A procedure-related perforation occurred in one patient (2.8%) and the patient was treated with NPO and antibiotics. No procedure-related bleeding or mortality was observed. The procedure was performed safely in 9 patients (25.7%) with a periampullary diverticulum and in 14 patients (40.0%) with a previous EST. CONCLUSIONS: Combined EST and EPLBD may be a safe and effective method, and may be a good alternative treatment for removing CBD stones that cannot be extracted by an EST and conventional techniques. However, prospective studies based on a large number of patients are needed.
Anti-Bacterial Agents ; Bile Ducts* ; Bile* ; Common Bile Duct ; Diverticulum ; Hemorrhage ; Humans ; Incidence ; Lithotripsy ; Mortality ; Pancreatitis ; Retrospective Studies ; Sphincterotomy, Endoscopic*

PURPOSE: To compare CT features of gastrointestinal stromal tumors (GIST) with those of lymphomas in the small intestine. MATERIALS AND METHODS: CT findings of 11 pathologically confirmed GIST patients and 10 lymphoma patients were retrospectively reviewed. CT findings were analyzed with regard to location, size, margin, growth patterns, internal character, enhancement, invasion, vascular encasement, lymphadenopathy, intestinal obstruction and ascites. RESULTS:An extraluminal mass was present in 82% (9/11) of the GIST patients versus 30% (3/10) of the lymphoma patients. Circumferential wall thickening was observed in 80% (8/10) of the lymphoma patients (p<.05). Internal necrosis or gas was present in 73% (8/11) of the GIST patients versus 10% (1/10) of the lymphoma patients (p<.05). Inhomogeneous enhancement was observed in 63% (7/11) of the GIST patients compared to homogeneous enhancement in 90% (9/10) of the lymphoma patients (p<.05). Lymphadenopathy was only observed in 80% (8/10) of the lymphoma patients (p<.05). In other findings such as fatty infiltration, ascites and intestinal obstruction there were no statistically significant differences (p>.05). CONCLUSION: Features revealed by CT scans are highly useful in differentiating GIST from lymphoma of the small intestine. Extraluminal growth and internal necrosis or gas are more common in patients with GIST compared with lymphoma. CT features of circumferential wall thickening and associated lymphadenopathy are more common in patients with lymphoma.
Ascites ; Gastrointestinal Stromal Tumors* ; Humans ; Intestinal Obstruction ; Intestine, Small* ; Lymphatic Diseases ; Lymphoma* ; Necrosis ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: To present the initial experience of percutaneous radiofrequency ablation (RFA) of inoperable primary lung cancer, and to assess the technical feasibility and potential complications. MATERIALS AND METHODS: Twenty patients with inoperable lung cancer underwent percutaneous RFA. Nineteen of 20 patients had stage III or IV non-small cell lung cancer, and the remaining one had stage I lung cancer with pulmonary dysfunction. The mean tumor size was 4.6+/-0.4 cm (range, 1.8-8.4 cm). RFA was performed with a single (n=18) or cluster (n=2) cool-tip RF electrode and a generator under CT guidance using local anesthesia and conscious sedation. Twenty tumors were treated in 28 sessions. Patients were assessed by contrast-enhanced CT in all cases at 1 week, 1 month, and 3 months. Eleven patients received chemotherapy (n=10) or radiotherapy (n=1) after RFA. RESULTS: RFA was technically successful and well tolerated in all patients. Complete necrosis was attained in 7 lesions (35%), near complete (90-99%) necrosis in 10 lesions (50%), and partial (50-89%) necrosis in 3 lesions (15%). During the mean follow up of 202 days (21 to 481 days), tumor size was decreased in 13 patients, unchanged in 3, and increased in 4. In the latter four, additional RFA was performed. One patient underwent surgery three months after RFA and the histopathologic findings showed a large cavity with thin fibrotic wall suggestive of complete necrosis. During or after the procedure, pneumothorax (n=10), moderate pain (n=4), blood tinged sputum (n=2), and pneumonia (n=2) were developed. Chest tube drainage was required in only 1 patient due to severe pneumothorax. Other patients were managed conservatively. Seven patients died at 61 to 398 days (mean, 230 days) after RFA. The remaining 13 patients were alive 21 to 481 days (mean, 187 days) after RFA. CONCLUSION: RFA appears to be a technically feasible and relatively safe procedure for the cytoreductive treatment of inoperable, non-small cell lung cancer and warrants further investigation as a complementary treatment to chemotherapy or radiation therapy.
Anesthesia, Local ; Carcinoma, Non-Small-Cell Lung ; Catheter Ablation* ; Chest Tubes ; Conscious Sedation ; Drainage ; Drug Therapy ; Electrodes ; Follow-Up Studies ; Humans ; Lung Neoplasms* ; Lung* ; Necrosis ; Pneumonia ; Pneumothorax ; Radiotherapy ; Sputum ; Tolnaftate ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is emerging as a new therapeutic method in the management of hepatocellular carcinoma (HCC). We report the results of 64 patients with a follow-up interval of 3 to 19 months. METHOD: Sixty-four patients with 82 nodules underwent ultrasound guided RFA. The mean tumor diameter was 2.5+/-1.0 cm. Laparoscopic ultrasound guided RFA was performed in 38 cases, and percutaneous ultrasound guided RFA in 26 cases. The therapeutic efficacy was evaluated by means of three-phase dynamic abdominal computed tomography (CT) performed within at least one week after ablating. The recurrence was evaluated after treatment by means of abdominal CT and alpha fetoprotein every 3 months. We calculated cumulative recurrence rates, survival rates of patients, and found out complication of RFA. RESULTS: Cumulative recurrence rates in 3, 6, 12 months after RFA was 8.8%, 15.8%, 25.9%. 12 cases were recurred during follow-up. Among them, intrahepatic recurrences were noted in 11 cases, local recurrences in 3 cases. Cumulative survival curves indicated that survival rate was 95% at the third month, 94% at the sixth month, 81% at the twelfth month. After RFA, the alpha fetoprotein level was decreased significantly after 1 month (p<0.05), and serum transaminase levels were transiently elevated (p<0.01) but returned to normal within one week. Complications of RFA were not serious, and resolved spontaneously. CONCLUSION: RFA can be considered a useful new treatment for HCC. Laparoscopic RFA is a useful procedure for the treatment of HCC regardless of its location.
Adult ; Aged ; Carcinoma, Hepatocellular/radiography/*surgery/ultrasonography ; *Catheter Ablation/adverse effects ; English Abstract ; Female ; Human ; *Laparoscopy ; Liver Neoplasms/radiography/*surgery/ultrasonography ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Tomography, X-Ray Computed ; *Ultrasonography, Interventional

BACKGROUND/AIMS: This study was performed to evaluate the diagnostic accuracy and clinical applications of magnetic resonance cholangiopancreatography (MRCP) compared with endoscopic retrograde cholangiopan creatography (ERCP). METHODS: Prior to carrying out ERCP, MRCP was performed on 71 patients and the two examinations were compared using a double blank test. RESULTS: The results revealed that 15 patients had choledocholithiasis, 4 gall bladder stones, 28 cholangiocarcinomas, 12 pancreatic head cancers, 2 ampulla of Vater cancers, 1 gall bladder cancer with ductal invasion, 4 other benign diseases and 5 normal conditions. For the patients with choledocholithiasis, the values of MRCP's sensitivity, specificity and accuracy were 100%, 98.2% and 98.6%, respectively, and those of ERCP's were all 100%. For the patients with malignant obstructions, the values of MRCP's sensitivity, specificity and accuracy were 90.7%, 100% and 94.4%, respectively, and the values of ERCP's were 95.3%, 92.9% and 94.4%. CONCLUSIONS: These data show that MRCP has a rather high sensitivity, specificity and accuracy in the diagnosis of the biliary tract system, and therefore MRCP can be substituted for ERCP in the aspect of diagnosis.
Ampulla of Vater ; Biliary Tract Diseases* ; Biliary Tract* ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangiopancreatography, Magnetic Resonance* ; Choledocholithiasis ; Diagnosis ; Gallbladder Neoplasms ; Head ; Humans ; Sensitivity and Specificity ; Urinary Bladder Calculi

PURPOSE: This study compares the outcomes of unilateral cataract surgery to those of bilateral cataract surgery in patients with cataract of both eyes. METHODS: Among a total of 153 patients, 61 underwent unilateral surgery and 92 bilateral surgery. RESULTS: The unilateral and bilateral surgeries were similar in demographic and ocular characteristics including visual acuity and visual function-14, except patient-reported factor, such as trouble with vision at baseline. The patient-reported factor was more serious in bilateral surgery than in unilateral surgery. The changes of three outcomes were associated not with unilateral eye or bilateral eye surgery, but with each baseline condition. CONCLUSION: The patient-reported factors such as symptom score, trouble with vision were the significant outcomes to decide unilateral or bilateral surgery in patients with cataract of both eyes. The result of unilateral or bilateral surgery did not affect the outcomes of cataract surgery after 12 months.
Cataract* ; Humans ; Visual Acuity

Lemierre's syndrome is characterized by a rare fulminant condition resulting from primary oropharyngeal infection followed by secondary septic thrombophlebitis of the internal jugular vein and metastatic infection. A forty-year-old man who had been on ventilator due to severe chest trauma, showed severe reddish inflammatory swelling of the right cervical soft tissue and newly developed pneumonia. He went into in septic condition shortly thereafter. Thrombophlebitis with central abscess in the right internal jugular vein was identified by neck CT and MRA(magnetic resonance angiography). Right cervical swelling worsened in spite of clindamycin and heparin therapy. We performed immediate surgery for removal of septic thrombus and resection of internal jugular vein. Patient's septic condition, pneumonia, and local inflammatory reaction were improved within several days after surgery.
Abscess ; Clindamycin ; Heparin ; Jugular Veins ; Lemierre Syndrome* ; Neck ; Pneumonia ; Thorax ; Thrombophlebitis ; Thrombosis ; Ventilators, Mechanical