• Journal of Yeungnam Medical Science
• /
• 제26권2호
• /
• pp.137-142
• /
• 2009

Nontuberculous mycobacterial infections are a rare, but clinically important cause of infections in continuous ambulatory peritoneal dialysis (CAPD) patients. This is typically suspected when a patient does not respond to treatment with the usual antibiotics. We describe here a case of $Mycobacterium$ $abscessus$ exit site infection with abdominal wall abscess formation that was associated with CAPD, which required peritoneal catheter removal, surgical debridement of the abscess and long term antibiotic therapy.

• Journal of Yeungnam Medical Science
• /
• 제16권2호
• /
• pp.347-356
• /
• 1999

복막 투석은 혈액 투석 및 신 이식과 함께 말기 신 질환의 중요한 치료 방법의 하나로 성공적인 복막 투석을 위해서는 복막 투석에 따른 여러 합병증을 줄이는 것이 필수적이다. 그러나 도관 출구 감염이나 복막염 등 투석 관련 감염은 여전히 도관 제거로 인한 복막 투석의 중단을 유발하는 중요한 원인이 되고 있다. 영남대학 의과대학 부속병원에서 1993년 10월부터 1999년 2월까지 복막 투석을 시행 후 추적 가능한 139명의 환자를 대상으로 도관 출구 감염과 복막염의 발생 빈도 및 원인 균주, 도관 제거의 빈도 및 원인 균주, 도관 전환술의 성적, 그리고 mupirocin ointment 사용 전과 사용 후의 도관 출구 감염의 빈도 차이 등을 후향 분석하였다. 복막 투석을 시행한 총 환자-투석기간은 2,401개월이었고 도관 출구 감염은 36명의 환자에서 105례 발생하여 발생 빈도는 1/22.8 환자-개월이었고 복막염은 67명의 환자에서 112례 발생하여 그 빈도는 1/21.4 환자-개윌로 나타났다. 대다수 출구 감염의 경우 일반적인 투약에 잘 반응하였으나 치료에 불응하여 도관 전환술을 시행한 7명 중 5명은 메티실린 저항성 포도상 구균(Methicillin Resistant, Staphylococcus aureus, MRSA), 2명은 Pseudomonas aeruginosa에 의한 감염이었다. revision후 3명에서 감염이 재발하였으나 한 명은 항생제에 바로 치유되었고 또 한 명은 second revision으로 치료하였으며 나머지 한 명은 MRSA에 의한 반복 감염이 지속되어 결국 도관 제거와 동시에 도관 재삽입을 시행하였다. 재발에 대한 치료 후 평균 추적기간 14.0개월 동안 더 이상의 출구 감염은 없었다. 1998년 10월부터 1999년 2월까지 mupirocin을 국소 도포 한 34명의 환자를 살펴보면, pre-mupirocin 기간의 총 투석기간은 687개월이었고 그 기간동안 도관 출구 감염이 54례 발생하여 발생 빈도는 1/12.7 환자-개월로 나타났으나 mupirocin 기간의 경우 총 투석기간 136개월 동안 4례 발생하여 그 빈도가 1/34.0 환자-개월로 유의하게(P<0.01) 감소하였다. 도관 출구 감염의 72.2%가 SA에 의한 것으로 조기에 적절한 항생제 치료를 함으로써 대부분 완치되었고 일부 약제에 잘 반응하지 않고 반복 감염되어 도관 탈락의 위험이 있는 경우에도 도관 전환술을 통하여 비교적 안전하고 효과적으로 난치성 출구 감염을 치유할 수 있었다. 그리고 도관 출구 부위에 mupirocin을 간헐적으로 국소 도포 함으로써 포도상 구균(Staphylococcus aureus)에 의한 출구 감염을 예방할 수 있었다. 그러나 이러한 도관 전환술과 mupirocin의 장기적인 효과 및 부작용에 대해서는 보다 많은 환자군을 대상으로 하는 전향적 연구가 있어야 할 것으로 생각된다.

• Journal of Chest Surgery
• /
• 제26권6호
• /
• pp.483-487
• /
• 1993

From July 1990 to August 1992,78 Hickman catheters and 22 chemoports were inserted in 98 patients for chemotherapy.We analyzed the clinical data of these patients. The results were as follows: 1]Mean age of patients was 42.8$\pm$1.6[SE] years 2]Male to female ratio was 1.09:1 3]The diseases of the cases were leukemia[66] ,lymphoma[8], stomach cancer[8],uterine cervix cancer[5],ovarian cancer[4],lung cancer[3],aplastic anemia[2],maxillary gland cancer[1],pancreas cancer[1],malignant mesothelioma[1] and multiple myeloma[1] 4]Mean values of preoperative WBC counts,platelet counts,PT and APTT were 31,500$\pm$ 8,132[SE]/mm,104,000$\pm$ 12,200 [SE]/mm,82$\pm$ 1.9[SE]% and 32$\pm$ 0.8[SE] sec,respectively. 5]The average duration of catheter uses was 121.7$\pm$ 17.3[SE]days. 6]The complications were subcutaneous tunnel bleeding or hematoma[2],exit site or subcutaneous tunnel infection[2] and catheter related septicemia[1]. 7]The causes of catheter removal were patient`s death or hopeless discharge[22],completion of treatment[6],subcutaneus hematoma or bleeding[2],exit site or subcutaneous tunnel infection[2] and catheter related septicemia[1].So,we concluded that Hickman catheter and chemoport were useful vascular access for chemotherapy in patients with malignant diseases, with low rate of complication and longterm duration.

• 가정∙방문간호학회지
• /
• 제16권2호
• /
• pp.98-107
• /
• 2009

Purpose: The objective of this study was to identify the effects of a telephone follow-up program on patient compliance, urea kinetic modeling and incidence of infection in patients with continuous ambulatory peritoneal dialysis (CAPD). Method: A pretest-posttest design with a nonequivalent control group was used to examine the effects of a telephone follow-up program for 12 weeks in a group of 39 CAPD patients. The telephone follow-up group of 17 patients received telephone follow-up 10 min once a week for 1 month and 10 min twice a month for 2 months during 12 weeks compared to control group of 22 who patients received usual care. Results: The telephone follow-up group showed no significant changes in patient compliance and urea kinetic modeling, although patients with CAPD receiving a telephone follow-up showed reduced incidence of exit site infection during the intervention compared with the control group. Conclusion: Telephone follow-up program for CAPD patients may decrease the incidence of exit site infection. Future studies with a larger sample be done utilizing diet and exercise reinforcement program combined with telephone follow-up as a nursing intervention for patients with CAPD.

• 기본간호학회지
• /
• 제5권2호
• /
• pp.313-323
• /
• 1998

This study was a descriptive research on the level of self-care available to continous ambulatory peritoneal dialysis patients (hereinafter referred to as 'CAPD patient') related to the specific area of infection management. The method employed for the collection of data was a modified instrument of the self-care survey essentially based on Young Sook Choi's instrument. The relevant data was collected from september 1, 1996 to september 30, 1996. The subjects were provided with an open-ended question regarding the reasons behind why they did not seek self-care. The answers provided about self-care compliance were analyzed by SPSS for frequency, percentage, mean, t-test, ANOVA. Reasons for non-compliance were analyzed by content analysis. The results of the study were as follows : 1. The percentage of patients engaging in self-care were according to the following self performed tasks : preparation of dialysis : 30.58 points Dialysate exchange procedures : 49.40 points - Two bag type : 50.50 points - Spike type : 48.80 points - Neo type : 48.90 points Catheter exit site care : 25.13 points More specifically, in relation to the preparation of dialysis as referred to above, those patients engaging in self care was relatively high with respect to the cleaning of the dialysis before use and for the preservation of peritosol. However, in dialysate exchange procedures, data revealed that those patients engaging in self-care are relatively low with respect to putting on a mask during the performance of peritosol exchange. Similary in peritosol exchange procedure and catheter exit care, low levels of self-care performance were found in the area of putting on a mask during the peritosol exchange procedures and catheter line testing procedures, respectively. 2. In general characteristics, there appeared to be no distinction in self-care compliance among CAPD patients. 3. The main reasons for non-compliance were based in the following factor : intellectual, attitude, enviromental surrounding and physical. As a result of the foregoing finding, nurses should provide adequate assistance to promote self-care compliance by CAPD patients by checking the preparation of dialysis, dialysate exchange procedure, and catheter exit site care which recieved low point in this research.

• Advances in Computational Design
• /
• 제7권4호
• /
• pp.345-369
• /
• 2022

Infectious disease emergency hospitals are usually temporarily built during the pneumonia epidemic with higher requirements regarding diagnosis and treatment efficiency, hygiene and safety, and infection control.This study aims to identify how the Building Information Modeling (BIM) + Industrialized Building System (IBS) approach could rapidly deliver an infectious disease hospital and develop site epidemic spreading algorithms. Coronavirus-19 pneumonia construction site spreading algorithm model mind map and block diagram of the construction site epidemic spreading algorithm model were developed. BIM+IBS approach could maximize the repetition of reinforced components and reduce the number of particular components. Huoshenshan Hospital adopted IBS and BIM in the construction, which reduced the workload of on-site operations and avoided later rectification. BIM+IBS integrated information on building materials, building planning, building participants, and construction machinery, and realized construction visualization control and parametric design. The delivery of Huoshenshan Hospital was during the most critical period of the Coronavirus-19 pneumonia epidemic. The development of a construction site epidemic spreading algorithm provided theoretical and numerical support for prevention. The agent-based analysis on hospital evacuation observed "arched" congestion formed at the evacuation exit, indicating behavioral blindness caused by fear in emergencies.

• Advances in pediatric surgery
• /
• 제17권2호
• /
• pp.125-132
• /
• 2011

The aim of this study was to compare peritoneal dialysis catheter insertion by the open method to the laparoscopic method. Twenty four laparoscopic and 10 open peritoneal dialysis catheter placements were performed in children between 2001 and 2008. Patient characteristics, operation related data, procedural complications and clinical outcome were compared. Although there were no cases of catheter obstruction, exit site infection or bleeding in the laparoscopic group, compared to the open method, there was no statistically significant difference between the two groups. Catheter removal rate due to complication was high in the open group and catheter survival rate was high in the laparoscopic group. We concluded that laparoscopic peritoneal dialysis catheter placement is feasible in children of all age groups with at least equivalent functional results compared to the open method. An advantage of laparoscopic catheter insertion is removal of the great omentum and easy fixation of the catheter to the abdominal wall.

• Journal of Yeungnam Medical Science
• /
• 제34권1호
• /
• pp.119-122
• /
• 2017

Peritoneal dialysis (PD) is associated with the development of various complications, such as exit site infection or peritonitis, and rarely, intestinal obstruction in prolonged PD patients with recurrent peritonitis. However, post-colonoscopy acute intestinal obstruction has not been reported in PD patients to date. Herein, we report a case of severe ileus after a colonoscopy without previous episodes of peritonitis in a PD patient. A 51-year-old man undergoing PD for 7 years visited our emergency department due to severe abdominal pain and vomiting after colonoscopic polypectomy. A simple abdominal radiography and abdominal computed tomography showed ileus with collapsed distal ileal loop. A peritoneal dialysate study revealed no evidence of peritonitis. The patient was treated with decompression therapy, and ileus was successfully treated without complications. This case suggests that it is not only necessary to prevent peritonitis, but also important to monitor the development of ileus after colonoscopy in PD patients.

• Journal of Korean Neurosurgical Society
• /
• 제46권4호
• /
• pp.340-345
• /
• 2009

Objective : We investigated the locations of compressing vessels in hemifacial spasm. To approach compression sites, we described and evaluated the efficacy of the infranuchal infrafloccular (INIF) approach. Methods : A retrospective review of 31 consecutive patients who underwent microvascular decompression (MVD) through INIF with a minimum follow-up of 1 year was performed. Along the intracranial facial nerve, we classified the compression sites into the transitional zone (TRZ), the central nervous system (CNS) segment and the peripheral nervous system (PNS) segment. The INIF approach was used to inspect the CNS segment and the TRZ. Subdural patch graft technique was used in order to achieve watertight dural closure. The cranioplasty was performed using polymethylmethacrylate. The outcome and procedure-related morbidities were evaluated. Results : Twenty-nine patients (93%) showed complete disappearance of spasm. In two patients, the spasm was resolved gradually in 2 and 4 weeks, respectively. Late recurrence was noted in one patient (3%). The TRZ has been identified as the only compression site in 19 cases (61.3%), both the TRZ and CNS segment in 11 (35.5%) and the CNS segment only in 1 (3.2%). There was no patient having a compressing vessel in the PNS segment. Infection as a result of cerebrospinal fluid leak occurred in one patient (3%). Delayed transient facial weakness occurred in one patient. Conclusion : The TRZ and the CNS segment were more vulnerable area to the compression of vessels. We suggest that surgical avenue with the INIF approach provides early identification of this area.

• Advances in pediatric surgery
• /
• 제12권2호
• /
• pp.167-174
• /
• 2006

Central venous catheter (CVC) for long-term venous access is indispensable for various reasons including hyperalimentation, frequent blood sampling, frequent IV drug use in pediatric patients. We report clinical experience of surgical neonates in whom CVC was inserted primarily via great saphenous vein into suprarenal inferior vena cava. From March 2004 to March 2006, we performed CVC insertion via saphenous vein - contralateral side to main wound - into suprarenal inferior vena cava in surgeries of neonates. 2.7Fr or 4.2Fr, single lumen, tunneled Broviac catheters (Bard Access system, Inc, Salt Lake City, Utah) were used. Skin exit site of tunneled catheter was located in ipsilateral flank area just below edge lower rib. At the end of the procedure, location of the catheter tip was confirmed by plain radiography of abdomen. We retrospectively reviewed the admission records of the patients including nursing staff charts. Nine (50.0 %) patients were male and nine (50.0%) were female. Median gestational age was 38 weeks (range, 29-42 weeks) and median birth weight was 3,105 gm (range, 1,040-3,720 gm). Median age at catheter insertion was 38.5 days (range, 1-236 days). The purpose of CVC insertion was short-and long-term hyperalimentation in nine (50.0 %) patients. CVC insertion was performed in operation room under general anesthesia in sixteen (88.9 %) patients (in these cases, CVC insertion was performed just prior to concurrent operation) and neonatal intensive care unit (NICU) under local anesthesia with adequate sedation in two (11.2%). During the admission period (total catheter-indwelling time: 553 days), CVC functioned well without any significant side effects. Transient swelling of the ipsilateral leg (n=1, 5.6 %) and transient migration of catheter tip (n=1, 5.6 %) were noted, which did not affect function of the indwelled CVC. Mean catheter-indwelling time was 30.7days (range, 3-72 days). All catheters were removed electively except two mortality case. Complications, such as thrombosis, infection, kinking or extravasation of drugs, were not observed in our study period. Tunneled trans-great saphenous vein inferior vena cava catheters are not only comparable to cervical CVCs in terms of function and complication rates, but also very beneficial in selected patients, especially those in whom cervical approach is technically impossible or contraindicated.