The Rate of Nasal Colonization of Methicillin-resistant Staphylococcus aureus at Admission to Intensive Care Units in a Secondary Hospital: The Importance of Nasogastric Tube / 병원감염관리

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization has been known as a predictor of intensive care unit (ICU)-acquired MRSA infections. We performed this study to survey the nasal colonization of MRSA among the patients admitted to an ICU and analyze risk factors associated with the colonization. METHODS: A retrospective 1:1 matched case-control study was conducted with patients admitted to the ICU from March to December 2010 at Samsung Changwon Hospital. RESULTS: A total of 602 patients among 846 patients admitted to the ICU during the study period were evaluated. The prevalence of nasal MRSA colonization was 67 (11.1%) of 602. Other factors, including underlying renal disease (odds ratio [OR]=12.37, 95% confidence interval [CI] 3.60-42.54; P<0.001), MRSA infection within the previous 3 months (OR=7.43, 95% CI 1.31-42.05; P=0.023), nursing home resident within the previous 1 month (OR=6.25, 95% CI 1.82-21.53; P=0.004), surgical procedure within the previous 1 month (OR=5.93, 95% CI 1.86-18.85; P=0.003), and current use of nasogastric tube (OR=4.98, 95% CI 1.84-13.45; P=0.002) were independently associated with nasal MRSA colonization in patients admitted to ICU. CONCLUSION: A significant number of patients admitted to the ICU in a secondary hospital were colonized with MRSA. The present study showed the possible impact of the presence of a nasogastric tube on the nasal colonization by MRSA. More effective infection control procedures must be developed for patients with nasogastric tube use.

A Case of Bronchobiliary Fistula as a Complication of Radiofrequency Ablation / 결핵및호흡기질환

Bronchobiliary fistula (BBF), defined as an abnormal communication between the biliary duct and bronchial trees, is a very rare condition. Bilioptysis is a pathognomonic finding for BBF. We studied a 58-year-old man, who had a BBF complicated by liver biloma that occurred after radiofrequency ablation. The diagnosis was confirmed by the presence of bile-stained sputum and an Endoscopic Retrograde Cholangio-Pancreatography. BBF was treated successfully by endoscopic sphincterotomy and biliary drainage with insertion of a double pig-tail plastic stent into the biloma. We suggest that the optimal choice of treatment modality for BBF depends on the natural course of the underlying disease, and the status of the biliary stricture.

A Case of Hepatocellular Carcinoma with Progressive Metastasis to the Oral Cavity / 대한내과학회지

Hepatocellular carcinoma (HCC) usually metastasizes to the lung, breast, lymph nodes, gastrointestinal tract, bone, kidney, and/or adrenal gland. Metastasis of HCC to the hard palate and tonsils is a rare phenomenon. Thus, we report a case of HCC with metastasis to the hard palate and both tonsils in a 45-year-old man. The patient was admitted to our hospital with a complaint of oral bleeding. Physical examination revealed a bleeding tumor located in the hard palate and histological examination showed metastasis from HCC. The patient died 2 months later due to multiple organ failure, although bleeding was controlled by radiotherapy.

A Case of Diffuse Alveolar Hemorrhage with Glomerulonephritis after Propylthiouracil Treatment / 결핵및호흡기질환

Propylthiouracil (PTU) is one of the most common drugs used in the treatment of Graves' disease. There are a number of side effects found with PTU use including fever, rash, arthralgia, and flu-like symptoms. Recently antineutrophil cytoplasmic antibodies (ANCA) positive vasculitis after PTU treatment was reported as a rare side effect, which can cause diffuse alveolar hemorrhage and glomerulonephritis. A 45-year-old woman with Graves' disease had been treated with PTU for five months, complained of hemoptysis due to pulmonary alveolar hemorrhage causing anemia, and also had hematuria. Simple chest X-ray and HRCT showed bilateral consolidation and bronchoalveolar lavage fluid revealed alveolar hemorrhage. A serologic test was positive for ANCA against myeloperoxidase and proteinase-3. Such findings suggested that the presence of PTU induced ANCA positive vasculitis. Cessation of PTU and the administration of high dose steroids improved the clinical manifestation, radiologic and serologic findings. We observed ANCA titer serially for 6 years. During the follow up period, ANCA titer decreased slowly and stayed within the acceptable upper normal limit.

A Case of Tracheal Leiomyoma Treated by Electrosurgical Resection Under Rigid Bronchoscopy / 대한내과학회지

Leiomyoma of the tracheobroncheal tree is a very rare benign tumor of the lung. Airway obstructive symptoms can be similar to those of asthma; therefore, delayed or misdiagnosis is common. Although surgical resection with bronchoplastic reconstruction has long been the standard treatment, improvements in the technique have led to therapeutic bronchoscopy replacing surgery for treatment of benign tumors of the tracheobroncheal tree. We report a case of tracheal leiomyoma that was successfully resected under rigid bronchoscopy using an electrosurgical unit and bronchial snare.

A Case of Tracheal Leiomyoma Treated by Electrosurgical Resection Under Rigid Bronchoscopy / 대한내과학회지

Leiomyoma of the tracheobroncheal tree is a very rare benign tumor of the lung. Airway obstructive symptoms can be similar to those of asthma; therefore, delayed or misdiagnosis is common. Although surgical resection with bronchoplastic reconstruction has long been the standard treatment, improvements in the technique have led to therapeutic bronchoscopy replacing surgery for treatment of benign tumors of the tracheobroncheal tree. We report a case of tracheal leiomyoma that was successfully resected under rigid bronchoscopy using an electrosurgical unit and bronchial snare.