Usage Analysis of Surgical Prophylaxis of Cephalosporins and Aminoglycosides in a University Hospital

BACKGROUND: According to previous investigation on antibiotic use at Dankook University Hospital, cephalosporin and aminoglycoside were the most commonly used antibiotics accounting for 52.8% and 30.4% of total antibiotics used, respectively. In almost all cases, antibiotics were prescribed for prophylaxis rather than for treatment the ratio for prophylaxis vs. treatment intent was 3.9:1 and 3.6: 1 for cephalosporin and aminoglycoside, respectively. Thus, we performed a study to investigate the current usage of cephalosporin and aminoglycoside before and after the surgical procedures. METHODS: We retrospectively analyzed the appropriateness of prophylactic use of antibiotics on 14 major operative procedures (26.4% of total operations) for patients discharged during July, 1997. RESULTS: Among 8 kinds of operative procedure performed on 105 cases, in which prophylactic antibiotic use was recommended, appropriate antibiotic use was observed in only 2 cases of non- perforating appendectomy. For 7 operative procedures, in which use of 1st generation cephalosporin is recommended, 1st cephalosporins were used only on 37.8% (44/92) of cases, whereas 2nd cephalosporins were used for most of other cases. An average of 2.5 DDD of 2nd cephalosporin, which was a pertinent dose, was used on non-perforating appendectomy. However, on all the other 7 operative procedures, the dose exceeded the recommended dose. Inappropriate antibiotic use was observed for 6 operative procedures, for which prophylactic antibiotic use was not recommended. The combination of cephalosporin and aminoglycoside was used in all but 3 types of operative procedures. CONCLUSION: During most of the pre- and post-operative period, antibiotics were combined, overused, misused, and inappropriately used.

Usage Analysis of Surgical Prophylaxis of Cephalosporins and Aminoglycosides in a University Hospital

BACKGROUND: According to previous investigation on antibiotic use at Dankook University Hospital, cephalosporin and aminoglycoside were the most commonly used antibiotics accounting for 52.8% and 30.4% of total antibiotics used, respectively. In almost all cases, antibiotics were prescribed for prophylaxis rather than for treatment the ratio for prophylaxis vs. treatment intent was 3.9:1 and 3.6: 1 for cephalosporin and aminoglycoside, respectively. Thus, we performed a study to investigate the current usage of cephalosporin and aminoglycoside before and after the surgical procedures. METHODS: We retrospectively analyzed the appropriateness of prophylactic use of antibiotics on 14 major operative procedures (26.4% of total operations) for patients discharged during July, 1997. RESULTS: Among 8 kinds of operative procedure performed on 105 cases, in which prophylactic antibiotic use was recommended, appropriate antibiotic use was observed in only 2 cases of non- perforating appendectomy. For 7 operative procedures, in which use of 1st generation cephalosporin is recommended, 1st cephalosporins were used only on 37.8% (44/92) of cases, whereas 2nd cephalosporins were used for most of other cases. An average of 2.5 DDD of 2nd cephalosporin, which was a pertinent dose, was used on non-perforating appendectomy. However, on all the other 7 operative procedures, the dose exceeded the recommended dose. Inappropriate antibiotic use was observed for 6 operative procedures, for which prophylactic antibiotic use was not recommended. The combination of cephalosporin and aminoglycoside was used in all but 3 types of operative procedures. CONCLUSION: During most of the pre- and post-operative period, antibiotics were combined, overused, misused, and inappropriately used.

A Case of Hepatopulmonary Syndrome Diagnosed by 99mTc - MAA Perfusion Lung Scan / 대한핵의학회잡지

No abstract available.

A case of hypersensitivity pneumonitis with positive precipitin antibody to Trichosporon cutaneum / 천식및알레르기

A 25-year-old woman complaining of dyspnea on exertion, coughing, fever and chills was admitted in January, 1998. Her clinical, radiological, and pathological findings were compatible with hypersensitivity pneumonitis and precipitin antibody to Trichosporon cutaneum was detected in her serum. Although some cases of T. cutaneum-induced hypersensitivity pneumonitis developed during the winter season were reported in Japan, there had been no report of such a case in Korea. This case suggests that T. cutaneum-induced hypersensitivity pneumonitis can develop beyond the summer season in certain environments.

Changes in the evolution of the antigenic profiles and morphology during coccoid conversion of Helicobacter pylori

OBJECTIVES: The significance of the coccoid forms of H. pylori is still controversial and the questions of whether these forms are viable and infective or degenerative are still open. We induced conversion from rod to coccoid forms and studied morphological changes and antigenic evolutions during this conversion and, thereby, elucidated the viability of coccoid forms. METHODS: The H. pylori strain (C001) used for Western blotting was isolated from the patient with gastric cancer. The antigenic evolution during coccoid conversion of H. pylori was studied by Western blotting, using different sera from thirty patients known to be culture positive. These sera were used to reveal the total antigens of the strain cultured for 2 days (100% rod) and 15 days (> 99% coccoid). After SDS-PAGE, with 10% separating gel of total antigens (rod and coccoid), transblotting (Trans-Blot electrophoretic cell, Bio-Rad) was taken onto a nitrocellulose membrane (Bio-Rad). Then, the blots, with human sera diluted at 1/100, were developed with color reaction by goat serum anti-human IgG with alkaline phosphatase and BCIP. RESULTS: The antigenic profiles were not changed in 46.7% (14/30 cases) and were changed in 53.3% (16/30 cases) during coccoid conversion. Antigenic fractions changed during coccoid conversion were protein band at 120 kDa and band at 35 kDa, and were not detected in coccus forms. The rest of the profiles were identical between rod and coccoid forms. The protein which disappeared include CagA (120 kDa) and porin, or adhesin (35 kDa). The morphological changes during coccoid conversion were U shaped at day 7, doughnut shaped at day 9 and full coccoid at day 15. CONCLUSIONS: The results showed that coccoid forms of H. pylori retain cellular structures similar to rod form, and some of the antigens (CagA and porin) disappeared during coccoid conversion. Therefore, coccoid form might be viable and represent one of the stages of H. pylori biological cycle.

Evaluation of Clinicopathologic and Prognostic Significance of nm23 protein in stage III Gastric Adenocarcinoma / 대한내과학회지

OBJECTIVE: Gene expression of nm23 has been investigated in a number of tumors, including breast cancer, colon cancer, malignant melanoma, and hepatocellular carcinoma. Its down-regulation has been shown to be associated with metastasis or disease progression in some of the tumors. This study was carried out to define the relationship between nm23 protein expression and clinicopathological variables. METHODS: nm23 protein levels were investigated in 64 surgically resected specimens of stage III gastric cancer by immunohistochemical method, and association with clinicopathological parameters and survival rates were determined. RESULTS: The overall expression rates of nm23 was 68.7 %. There was no significant difference between nm23 protein expression and clinicopathological variables such as age, sex, stage, histology, tumor depth, number of metastatic nodes, tumor size, site and method of operation. Statistically, no significant differences between nm23 protein expression and overall survival rates were found. CONCLUSIONS: These results suggest that nm23 protein expression is an unsatisfactory prognostic indicator in stage III gastric adenocarcinoma.

A Case of Diabetes Insipidus Following Tuberculous Meningitis / 대한내과학회지

Tuberculous menigitis is relatively common disease and delay in treatment is associated with many neurologic sequelae. Of the neurologic disorder, diabets insipidus is extreamly rare. Diabetes insipidus is a syndrome characterized by the excretion of abnormally large volumes of dilute urine. It is divided into central diabets insipidus, nephrogenic diabetes insipidus, primary polydipsia and gestational daibetes insipidus. In this four type of diabetes insipidus, central diabetes insipidus is a polyuric disorder results from a lack of sufficient antidiuretic hormone to effect appropriate concentration of the urine for water conservration. We report a 25-year old male who had prolonged head ache and subsequently followed by polyuria. He was dia gonsed as the tuberculous meningitis by laboratory find ing and smear of CSF, and diagnosed central diabetes insipidus by serum osmolality & Na+ & AVP (arginine va sopressin), urine osmolality & specific gravity, adminis tration of vasopressin. He maintained the water balance of body by administration of vasopressin, but without im provement of mental status, sudden cardiac arrest occurs on 20th hospital day

A prospective study for spectrum and frequency of chronic cough in patients visiting out-patient clinic / 천식및알레르기

BACKGROUND: Chronic cough is commonly defined as a persistent or recurrent cough exceeding 3 weeks duration and the prevalence of chronic cough is reported to range from 14-23% among non-smoking adults. Irwin et al previously reported that common causes of chronic cough are postnasal drip syndrome asthma, and gastroesophageal reflux using the anatomic and diagnostic protocol. OBJECTIVE: To determine the spectrum and frequency of chronic cough and to aid establishing algorithmic approach for chronic cough. MATERIALS AND METHOD: We prospectively evaluated 105 consecutive and unselected immunocompetent patients complaining of chronic cough utilizing modified anatomic and diagnostic protocol proposed by Irwin et al. Initial diagnosis was made by history, physical examination and laboratory test including spirometry, methacholine provocation test, and 24 hour pH monitoring. Specific treatment was done based upon initial diagnosis and cough score was compared before and after treatment. Reassessment was done in case of treatment failure. RESULT: The causes of cough were determined in 100 of 105 patients(95% ). Cough was due to one condition in 94.8% and two in 15.2%. 121 causes of cough were identified and their spectrum and frequency were found to be postnasal drip syndrome (39.3% ), asthma (32.2% ), gasteroesophageal reflux (14.1%), chronic bronchitis (5.0%), others (4.1%: drug-induced, bronchiolitis, endobronchial tuberculosis, and lung cancer). History about nasal symptoms was useful, but history about gastroesophageal reflux were not useful for the diagnosis. CONCLUSION: The results suggest that anatomic and diagnostic approach for evaluating chronic cough is also useful in Korea and the most common causes of chronic cough are postnasal drip syndrome, asthma and gastroesophageal reflux.

A Clinical and Epidemiological Analysis on an Outbreak of Typhoid Fever During 1996 Summer Through Autumn in Chunju Area / 감염

BACKGROUND: We experienced an outbreak of typhoid fever in Chunju area which manifested as severe symptoms and signs, and variable complications. To chracterize the epidemic and to identify a possible source of infection, the clinical findings of patients from the outbreak were analyzed, and the patterns of antimicrobial susceptibility and phage typing of Salmonella Typhi isolates were determined. METHODS: We analyzed a total of 232 patients from the outbreak who admitted to Chunju Presbyterian Medical Center during 1996 August through October. The medical records of the patients were reviewed retrospectively. All isolates of S. Typhi from the outbreak were analyzed for serotyping, antibiogram, and phage typing. Phage typing were performed using Vi- phages for 50 strains isolated from the patients who showed atypical clinical manifestations and unusal complications. RESULTS: The outbreak attacked mainly young femalegroup. The complications observed were: 155 casesof hepatitis, 47 pancytopenia, 20 acute pancreatitis, 13 urinary tract infection, 12 intestinal hemorrhage, 5 disseminated intravascular coagulation, 4 meningitis, 3 septic shock, 2 sensorineural hearing loss, 2 myocardial ischemia, 2 pneumonia, 1 stillbirth, and 1 death. S. Typhi were isolated in 129 cases including 111 from blood, 17 stool and 1 urine. All isolates were susceptible to all antimicrobial agents tested. All 50 isolates from severe patients with unusal complications were identified as Salmonella, serogroup D1, serotype Typhi, phage type D1. CONCLUSIONS: We experienced an outbreak of typhoid fever associated with severe, atypical symptoms and unusual complications, caused by Salmonella, serogroup D1, serotype Typhi, phage type D1.

Prognostic Value of p53 and Proliferating Cell Nuclear Antigen ( PCNA ) in Stage 3 Gastric Carcinoma / 대한암학회지

PURPOSE: We evaluated the prognostic significance of p53 and proliferating cell nuclear antigen(PCNA) in stage III gastric carcinoma to determine the correlation between the p53 and PCNA expression and various clinicopathological parameters. MATERIALS AND METHODS: The expression of p53 and PCNA were studied immunohistochemically in 64 cases of stage III gastric carcinomas with paraffin-embedded tissue specimens which were obtained surgically at the department of surgery, Presbyterian Medical Center from 1991 to 1992. Both expression were compared with known factors of prognosis. Survival rate and other clinicopathological parameters were analysed. RESULTS: Expression rates of p53 and high PCNA group were 40.6% and 26.6%, respectively. There was no significant correlation between the p53 and PCNA expression and various clinicopathological variables such as age, sex, stage, histology, tumor depth, number of metastatic node, tumor size, site and method of operation. To analyse survival, we evaluated overall survival according to the extent of p53 and PCNA expression. No significant correlations between the p53 and PCNA expression and overall survival were found. CONCLUSION: These results suggest that the p53 and PCNA expression seems to be hard to use as a prognostic indicator in stage III gastric carcinoma.

A Case of Occult Papillary Carcinoma of Thyroid, Invaded Trachea and Esophagus / 결핵

Occult papillary adenocarcinoma of the thyroid is known to be indolent, slow metastatic, and has a good prognosis. Occult thyroid carcinoma presenting as a blood-borne metastasis without obvious cervical lymph node involvement is extremely rare. A 65-year-old male patient was visited for hoarseness, dysphagia, and shortness of breath. Bronchoscopy with biopsy revealed a papillary carcinoma of thyroid by immunohistochemical staining. Head & neck CT revealed that involving both the upper esophagus and the posterior tracheal wall, extending into the mediastinum along the upper thoracic spine at T1-T2. We have experienced a rare case of occult papillary carcinoma which invaded the trachea, esophagus and fascia of thoracic spine. Treatment was initiated with radioactive iodine and external bean therapy.

A Case of Typhoid Fever Complicated by Sensorineural Hearing Loss, Acute Pancreatitis and Hepatitis / 감염

Typhoid fever is an acute systemic febrile disease caused by Salmonella Typhi, characterized by persistent fever, headache, abdominal pain, diarrhea and rose spots. Salmonella infection can lead to diffuse organ involvement including bone, lung, thyroid, kidney, liver, spleen, heart, intestine and skin. While a variety of complications may be seen in typhoid fever, sensorineural hearing loss or pancreatitis has been rarely observed. Recently, we experienced a case of typhoid fever complicated by sensorineural hearing loss, acute pancreatitis and hepatitis in a 21-year-old female patient, who was improved with ceftriaxone and ciprofloxacin administration and supportive care. We report this case with a review of the literature.