Xpert CARBA-R Assay for the Detection of Carbapenemase-Producing Organisms in Intensive Care Unit Patients of a Korean Tertiary Care Hospital

Carbapenemase-producing organisms (CPO) are rapidly disseminating worldwide, and their presence in tertiary care hospitals poses a significant threat to the management of nosocomial infections. There is a need to control CPO, especially in intensive care unit (ICU) patients, because these organisms are resistant to most beta-lactam antibiotics and are easily transmitted. At present, the identification of CPO is time-consuming; hence, this study focused on the use of the Xpert CARBA-R assay (Cepheid, USA) to determine intestinal colonization rates of CPO in patients admitted to the ICU of a tertiary care hospital in Korea. Forty clinical stool samples were collected and inoculated both in a CARBA-R cartridge and in conventional culture plates. The CARBA-R assay required only ~one hour to screen CPO, while the time required for conventional culture was over three days. We also found that the prevalences of intestinal colonization by carbapenem-resistant organisms and Enterobacteriaceae were 17.5% (7 out of 40) and 7.5% (3 out of 40), respectively. Among the colonizing strains, three that contained carbapenemase, including Klebsiella pneumonia carbapenemase (KPC), and imipenem (IMP) and Verona integron-mediated metallo-beta-lactamase (VIM) were found. With its convenience, the Xpert CARBA-R assay can be included in CPO surveillance strategies.

Effect of birth order on respiratory distress syndrome in preterm twin pregnancy / 대한산부인과학회지

OBJECTIVES: To determine the effect of birth order on development of respiratory distress syndrome (RDS) in twin pregnancy according to the cause of preterm birth. METHODS: A retrospective analysis of 163 live born twin pairs who delivered at 24-34 weeks of gestation from January 1997 to April 2005 was done. Intrauterine fetal deaths or cases with severe fetal malformations were excluded. Subjects were categorized into three groups according to the cause of preterm birth: a preterm labor (PTL) group, a preterm premature rupture of membrane (PPROM) group and other maternal-fetal indication group. One hundred forty four twin pairs (88.3%) were delivered by cesarean delivery. We analyzed the incidence of RDS and other morbidities such as bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and early neonatal sepsis in above three groups. Each second-twin was compared for specific outcomes directly with its first-twin birth mate. RESULTS: Overall, the first-born twin had less RDS compared to the second-born twin (p=0.02). Specifically, a reduced incidence of RDS of the first-born twin was significant in the PPROM group, regardless of neonatal sex (p=0.001). In other groups, there was no correlation between birth order and RDS. Except for RDS in the PPROM group, neonatal mortality and other morbidities were not significantly different between the first- and second-born twins. CONCLUSIONS: There is a significant decreased risk of RDS in the first-born twins from PPROM, but not from PTL or other indications.

Clinical Applicability of Absorbable Synthetic Suture Materials (Safil(R)/Safil(R) Quick/Monosyn(R)) in Obstetrical Surgeries / 대한주산의학회잡지

OBJECTIVE: To evaluate the clinical applicability and safety of absorbable synthetic suture materials (Safil(R)/Safil(R)Quick/Monosyn(R)) in obstetrical surgeries. METHODS: This clinical trial includes 100 patients who delivered vaginally and 198 patients who were undergone cesarean section from April 2004 to September 2004. In cases of vaginal delivery, patients were divided with the same number into the study group in which Safil(R) Quick was used and the control group in which chromic catgut was used for episiotomy and perineal laceration repair. In case of cesarean delivery, patients were divided into two groups. The first group which included 100 patients was subdivided with the same number into the study group in which Monosyn(R) was used and the control group in which chromic catgut was used for uterine repair. The second group which included 98 patients was subdivided with the same number into the study group in which Safil(R) was used and the control group in which Vicryl was used for rectus fascia repair. Wound healing status and complications are assessed during postoperative stage, at hospital discharge, and at postpartum out-patients follow-up. RESULTS: Compared with chromic catgut groups, Safil(R) Quick group showed no difference in hospital stay from vaginal delivery, wound healing status and surgical complications and Monosyn(R) group showed no difference in operating time, decrease in hemoglobin at postoperative day 3 and surgical complications. Safil(R) group showed no difference in operating time, postoperative pain and surgical complications compared with Vicryl group. CONCLUSION: Safil(R)/Safil(R) Quick/Monosyn(R) were equivalent with regard to most aspects of their clinical suitability and may be useful alternative suture materials in obstetrical surgeries.

Management of Patients with CIN III and Positive Margins After Cervical Conization / 대한산부인과학회잡지

OBJECTIVE: To evaluate conservative management of patients with cervical intraepithelial lesion, grade III (CIN III) and positive resection margins after cervical conization. METHODS: We reviewed records of 64 patients undergoing cervical conization revealing CIN III with positive resection margins between January 1997 and December 1999. Thirty-three (51.5%) patients underwent conization only and thirty-one (48.5%) underwent conization and subsequent hysterectomy. These patients were followed up with a Pap smear every 3-6 months and then persistence and recurrence were determined in each group. The sites of incomplete excision and HPV infection at cone and residual lesion at hysterectomy specimen were evaluated. RESULTS: Thirty-one of 33 patients receiving conservative management and all 31 patients receiving subsequent hysterectomy had negative Pap smear (P=0.262). In the group of the conservative management, one case of 11 patients with extension to the endocervical margin had positive Pap smear (P=0.577). One of 17 cases with HPV infection and one of 10 cases with negative HPV testing had positive cytology (P=0.630). In the group of subsequent hysterectomy, nine cases (42.86%) of 21 patients with extension to endocervical margin and two (22.22%) of 9 patients with extension to exocervical margin had residual lesion in hysterectomy specimen (P=0.258). Only one (8.33%) of 12 cases with positive HPV and five (50%) of 10 patients with negative HPV had residual lesion (P=0.043). CONCLUSION: Patients with CIN III and positive resection margins after cervical conization can be followed appropriately with serial cytology. Endocervical margin involvement and HPV infection were not statistically significant predictors of residual lesion, persistence and recurrence in our patients.

A Case of Metastatic Angiosarcoma of Ovary / 대한부인종양콜포스코피학회잡지

Angiosarcoma is rare malignant neoplasms, which account for less than 1% of all sarcomas. They have a wide distribution in various body organs and tissues: approximately a third of cases occur in the skin and a quarter in soft tissues. Angiosarcoma rarely involves the female reproductive system. We present a case of a 37-yaer-old woman who had primary angiosarcoma of the left breast; With metastases to the spleen and ovary.

A case of Primary Leiomyosarcoma of the Vagina / 대한산부인과학회잡지

The primary leiomyosarcoma of the vagina is very rare tumor in the female lower genital tract. A case of primary leiomyosarcoma of the vagina in the 44 years old woman was presented with lower abdominal pain and cystic and solid mass in the vagina. The mass was mainly comprised with spindle shaped cells showing moderate degree of cellular atypia and mitosis up to 8/10HPF. The mainstay of treatment is surgical excision of the primary mass. Treatment with chemotherapy or radiation therapy usually reserved for inoperable or recurrent cases. We present this case with a review of literature.