• Journal of Chest Surgery
• /
• v.42 no.6
• /
• pp.763-769
• /
• 2009

Background: In the majority of cases, sternal instability and wound infection concomitantly present after a cardiac operation following conventional median sternotomy, and these complications have a major influence on the postoperative course. The aim of this study is to compare the results of the different sternal wiring techniques of sternal infection. Material and Method: Between April 2004 and December 2008, 157 adult patients underwent cardiac in group A, whereas 71 patients who had undergone modified Robicsek sternal wiring were included in group B. The incidences of sternal wound complications in the two groups were assessed. Result: The mean age of the group B patients was older than that of the group A patients ($61{\pm}10$ years vs $57{\pm}13$ years). The incidence of preoperative left ventricular dysfunction (ejection fraction <30%), chronic obstructive pulmonary disease, renal failure requiring dialysis and diabetes mellitus were significantly higher in Group B, whereas the other perioperative risk factors for infection were not significantly different between the two groups. Two patients in group A experienced superficial wound infection, whereas 4 patients in group B displayed superficial wound infection, but the difference was not statistically significant (p=0.255). Yet poststernotomy deep sternal wound infection appeared in 6 patients of group A, whereas none of the patients in group B displayed this malady. Conclusion: The modified Robicsek sternal wiring technique showed greater sternal stability even for the patient with a high risk for infection, and the technique caused a lower incidence of deep sternal wound infection.

• Journal of Chest Surgery
• /
• v.42 no.6
• /
• pp.732-737
• /
• 2009

Background: Many video-assisted thoracic surgery (VATS) lobectomies are performed as a potential alternative to thoracotomy despite the controversy about the safety and the associated morbidity/mortality rates. Material and Method: Between November 2006 and August 2008, we performed 87 lobectomies (VATS 36, Thoracotomy 51) and we retrospectively reviewed the surgical treatment results. A VATS lobectomy was performed by a 4~5 cm thoracotomy without rib spreading and this included anatomic hilar dissection, individual vessel and bronchus stapling and lymph node dissection. Result: We studied 52 male and 35 female patients whose age ranged from 6 to 79 (average age: $59.8{\pm}15.0$ years). The cases were diagnosed with lung cancer (66) (SQC 24, ADC 38, others 4), pulmonary metastasis (2), carcinoid (2) and benign diseases (17). There was no intraoperative death. Postoperative complications were seen in 5 (15.6%) VATS and 33 (64.7%) thoracotomies, and perioperative death caused by adult respiratory distress syndrome occurred in 1 (2.8%) VATS and 3 (5.9%) thoracotomies. Three patients Underwent conversion to thoracotomy (8.3%). The mean time to chest tube removal was 6 days for VATS and 9.4 days for thoracotomy (p<0.001), and the mean length of the hospital stay was 8 days for VATS and 12.8 days for thoracotomy (p<0.001). Conclusion: VATS lobectomy can be performed safely with low morbidity/mortality rates. Furthermore, all the patients benefited from earlier postoperative rehabilitation and less pain and they were candidates for an earlier return to normal activities.

• Journal of Veterinary Clinics
• /
• v.24 no.2
• /
• pp.99-103
• /
• 2007

The antibacterial efficacy of 0.1% (w/v) chitosan solution against Staphylococcus intermedius isolated from a dog with superficial pyoderma was evaluated in vitro and in vivo. The exposure time for the 0.1% chitosan solutions at different pH to be able to eliminate the bacterial cells and the effect of pH of the solutions on antibacterial activity was tested at the same time in vitro. The antibacterial activity of chitosan was compared to other antibacterial agents including 2.5% benzoyl peroxide, 0.5% chlorhexidine acetate, 0.1% chitosan solution combined with 2.5% benzoyl peroxide and chitosan combined with 0.5% chlorhexidine using a modified detergent scrub quantitative technique in 10 adult mongrel dogs in vivo. They were able to eliminate a number of bacteria after the exposure time of 10 minutes at varying degrees according to the pH of the solutions. The antibacterial activity of chitosan was inversely affected by pH with higher activity at lower pH value. The 0.1% chitosan solution was also efficacious against Staphylococcus intermedius in vivo. The combinations of chitosan with benzoyl peroxide and with chlorhexidine were shown to exert higher activity when compared to those of chitosan alone and benzoyl peroxide or chlorhexidine alone. The 0.1% chitosan solution was considered to be efficacious against Staphylococcus intermedius isolated from a dog with superficial pyoderma in both in vivo and in vitro and have a potential for the clinical applications in the treatment or pyoderma in dogs.

• Journal of Veterinary Clinics
• /
• v.28 no.5
• /
• pp.479-485
• /
• 2011

The cardiopulmonary responses during total intravenous anesthesia (TIVA) between remifentanil/propofol infusion and remifentanil/ketamine infusion in dogs were compared. Fourteen healthy adult beagle dogs were premedicated with acepromazine (0.1 mg/kg, SC) and medetomidine (20 ${\mu}g$/kg, IV), and anesthetized for 3 hr with remifentanil (0.5 ${\mu}g$/kg/min)/propofol (loading dose: 1 mg/kg, CRI: 0.3 mg/kg/min) CRI (group 'P') or remifentanil/ ketamine (loading dose : 5 mg/kg, CRI: 0.1 mg/kg/min) CRI (group 'K'), respectively. Hemodynamics, blood gas analysis and behavioral changes during recovery were measured. The level of anesthesia was determined by toe-web clamping test. The level of surgical anesthesia was maintained throughout the experiment in both groups. Systolic arterial pressure, mean arterial pressure, $PaO_2$ and $SpO_2$ in group 'K' were significantly higher than in group 'P', and were maintained near the normal ranges. In addition, $PaO_2$ in group 'K' was significantly lower than in group 'P'. However, diastolic arterial pressure, heart rate and respiratory rate were not significantly differed. Mean extubation time from the end of infusion was significantly reduced in group 'K', but mean sitting time was significantly reduced in group 'P'. Mean head-up time and mean walking time were not significantly differed. In group 'K', brief muscle rigidity, head waving and licking during recovery were observed. In conclusion, infusion rate of ketamine (0.1 mg/ kg/min) with remifentanil (0.5 ${\mu}g$/kg/min) is an appropriate for obtaining the surgical plane of anesthesia. These results showed that group 'K' had better cardiopulmonary function than group 'P'. That is, remifentanil/ketamine CRI is better TIVA protocol than remifentanil/propofol CRI for 3 hr surgery.

• Parasites, Hosts and Diseases
• /
• v.29 no.3
• /
• pp.293-310
• /
• 1991

Clonorchis sinensis is a common parasite of man in Korea. Researches on the specific antigens of C. sinensis would be valuable not only because those elucidate the molecular characteristics of this fluke but also because it is applicable to immunodiagnosis. Although many monoclonal antibodies have been used in the field of parasite immunology, few articles on monoclonal antibodies against C. sinensis have been published so far. The aim of this study was to analyse C. sinensis antigens recognized by monoclonal antibodies, and to set up ELISA-inhibition test using C. sinensis specific monoclonal antibodies for improved specificity of immunodiagnostic tests. By fusion between spleen cells of the mice immunized with C. sinensis water-soluble crude adult worm antigens and plasmacytoma cells of mouse origin, 29 hybridoma clones secreting anti-C. sinensis monoclonal antibodies were made, and 8 clones among those were found specific. After cell cloning, isotypes of 6 selected specific monoclonal anti- bodies were determined to be IgGl, IgG2b and IgA. Four exposed antigenic determinants of natural infection were recognized by different specific monoclonal antibodies. By enzyme-immunoelectrotransfer blot, 10 KD, 34 KD antigenic determinants were found to be reacted with CsHyb 0714-20, CsHyb 0605-10 monoclonal antibodies, respectively, The antigenic determinant recognized by CsHyb 0714-20 monoclonal antibody was revealed to be located at the surface and parenchyme of a parasite by indirect immunoauorescent antibody technique, and those reacted with CsHyb 0605-10, CsHyb 0714-25 monoclonal antibodies were found at the parenchyme and intestine. The antigenic determinant reacted with CsHyb 0605-23 monoclonal antibody was found mainly around the uterine eggs. Four antigenic determinants recognized by specific monoclonal antibodies were all found to be present in the early eluted fractions of C. sinensis antigens separated by Sephadex G-200 gel filtration. By conventional ELISA, 75% of clonorchiasis cases were found positive, but 7.1% of normal controls and 37.5% of paragonimiasis cases showed false positives. However, by ELISA-inhibition test using C. sinensis specific monoclonal antibody (CsHyb 0605-23), 77.1% of clonorchiasis cases were found positive, and there were no false positives in normal controls or paragonimiasis cases, indicating 100% specificity. The ELISA- inhibition test using monoclonal antibodies was found to have same sensitivity and definitely high specificity in comparison with conventional ELISA for serodiagnosis of human clonorchiasis.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.2 no.2
• /
• pp.194-203
• /
• 1999

Purpose: Childhood pancreatitis has more various and somewhat different etiology than adult. Until now the analysis of severity in childhood pancreatitis were not well-known, although several studies have been made. Therefore, we studied the etiology and complications in childhood pancreatitis and analyzed whether Ranson and CT criteria could be applicated to evaluate the severity of childhood pancreatitis patients. Methods: The records of 30 patients with pancreatitis under 15 years of ages who were diagnosed in Asan medical center were reviewed. Age, sex, history, etiology, clinical features and treatment was reviewed in all patients but complications, Ranson and CT criteria were available in only 12 patients. Correlation between the number of complications and both Ranson and CT criteria were calculated with Spearman correlation coefficient. Results: 1. Median age at diagnosis was 7.3 years of age. 28 cases were acute pancreatitis and 2 cases were chronic pancreatitis. 2. Etiology: choledochal cyst(8 cases), drug (7 cases), trauma (4 cases), infection (3 cases), biliary stone or bile sludge (3 cases), idiopathic (2 cases) Hemolytic uremic syndrome, pancreatic duct obstruction, iatrogenic (1 case). 3. Local complications were ascites (5 cases), pseudocyts (4 cases) and systemic complications were hyperglycemia (4 cases), hypocalcemia (3 cases), pleural effusion (3 cases), etc. 4. Positive correlation was found between the number of complication and Ranson creteria (r=0.78, P=0.0016) and between the number of complication and CT criteria (r=0.65, P=0.015) in 13 cases. Conclusion: A trial to search the biliary duct anomaly may help to find the causes of childhood idiopathic pancreatitis, and both Ranson and CT criteria can be applicated to pediatric patients to evaluate the severity of childhood pancreatitis.

• Pediatric Infection and Vaccine
• /
• v.4 no.2
• /
• pp.232-239
• /
• 1997

Purpose: The incidence of hepatitis A virus(HAV) infection has markedly decreased in the last 20 years due to industrialization and improvements in the standard of living and hygiene in Korea. The reduction in seroprevalence rates indicates infection potential for young adult population, and a need for vaccinations in high-risk adults and children groups has been suggested. In this study we evaluated the seroprevalence rates and natural infection rates of hepatitis A in children and adolescent to obtain the basic data for vaccination of hepatitis A. Methods: A total of 334 children and adolescent subjects below 20 years old in Kyonggi-do province were examined for HAV antibody and seroprevalence rates in each age group was investigated. In 584 elementary school students residing in Kyonggi-do province, serum samples collected in 1993 and 1996 from the same subjects for investigation of natural seroconversion rates. Method of testing antibody was enzyme immunoassay. Results: 1) The seropositive rate of HAV in 334 subjects aged below 20 years old was 5.4%. According to age, the seropositive rates were 27.3% in infant group, 0.0% in 1~4 year-old group, 0.0% in 5~9 year-old group, 2.9% in 10~14 year-old group and 15.0% in 15~19 year-old group. 2) In the study of 584 elementary school children, only one subject showed seropositive in 1993, and in 1996 three different subjects showed seropositive results(0.5%); the natural seroconversion rate during 3 years was 0.5%. 3) The seroprevalence rates of below 20 year-old subjects reported in previous studies were 63.8% in 1979 and 47.3% in 1989 while the present study showed the rate at 5.4%. Conclusion: Since natural antibody formation is rarely occurring, there is a high risk for apparent hepatitis A infection in adults. Therefore vaccination in high risk groups is essential at present, and in order to reduce the chance for hepatitis A infection in adults, vaccination in children may be needed.

• Pediatric Infection and Vaccine
• /
• v.18 no.2
• /
• pp.135-142
• /
• 2011

Purpose : Hospital associated infection (HAI) caused by multidrug-resistant (MDR) microorganisms has been recognized as an important issue in the world, especially in critically ill patients such as the patients admitted in the intensive care unit. There are fewer papers about MDR-HAI in pediatric patients compared to adult patients. In this study, we investigated the incidence and associated factors of MDR-HAI in children admitted to the intensive care unit (ICU) of a university hospital. Methods : We retrospectively evaluated 135 children who were admitted in ICU for at least 3 days between January 2009 and December 2010. HAI cases were divided into MDR-HAI group and non-MDR-HAI group. Clinical characteristics and various associated factors were compared between those groups. Results : In 39 patients, 45 cases of ICU-related HAI were developed. ICU-related HAI incidence was 47.7 per 1000 patientdays. Thirty-six cases (80.0%) were MDR-HAI. Acinetobacter baumannii was isolated more commonly in MDR-HAI group. And the followings were found more frequently in MDR-HAI group than non-MDR-HAI group: medical condition as an indication for ICU admission, mechanical ventilation, urinary catheterization and previous use of broad-spectrum antibiotics. Among the risk factors, previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. Conclusion : ICU-related HAI incidence was higher than previously reported. Previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. To investigate the characteristics of MDR-HAI in children admitted in ICU, further studies with a larger sample size over a longer period of time are warranted.

• Pediatric Infection and Vaccine
• /
• v.18 no.2
• /
• pp.124-134
• /
• 2011

Purpose : We have tried to search all concerning data on the policies of hepatitis B vaccination or surveillance of medical equipments that can transmit blood mediated diseases, including disposable syringe, in Republic of Korea, to propose references to other medical professionals. Methods : Data from domestic journals, government websites, computerized newspapers, etc. were reviewed. The data were arranged into four categories (governmental policies on hepatitis B control, hepatitis B mass immunization program in school, using process of hepatitis B vaccine, and policies on medical equipments surveillance, including disposable syringes, which is considered as source of blood mediated infection), and the periodic changes on each subjects in policies were reviewed. Results : Due to growing social concerns on hepatitis B in early 1980s, swift introduction and production of hepatitis B vaccine was made. After establishment of "5 year project for eradication of hepatitis B" in late 1983, number of vaccinated population jumped up to 6 million within 2 years (1984-85). However, since the immunization targets were mainly adult, not infant, this project was annulled in late 1985. Following this project, hepatitis B mass immunization program in school was carried out. In year 1995, hepatitis B vaccine was included in national immunization program. The use of disposable syringe was recommended from year 1980 but legislated in year 1985, finally. Conclusion : The mainstay in controlling hepatitis B in Republic of Korea was coordination of prompt introduction of vaccine, mass immunization, high vaccination coverage rate, or use of disposable syringes. However, since there is lack of official data available, it is urgent to arrange and computerize all government data related to infectious diseases.

• Journal of Preventive Medicine and Public Health
• /
• v.22 no.3 s.27
• /
• pp.389-397
• /
• 1989

To identify the problems in child rearing practice of employed mothers in urban poor area, all of 201 women with children under 6 years old living in Yun San 3 Dong, a poor area of Pusan city, were interviewed with a questionnaire by a trained interviewer from 10th April to 10th May 1989. Among 201 women, 51 women were employed and 150 women were unemployed. Of the employed mothers 78.5% got their jobs because of economical need and 31.4% of them worker for 60-69 hours per week. Their average monthly income was 100,000-190,000 Won in 33.4% and 200,000-290,000 Won in 25.4% Breast milk was fed in 66.0% of the children of unemployed mothers while 49.0 of the children of the employed mothers were breast-fed (p<0.05). The most common reason for not breast feeding was shortage of breast milk among unemployed mothers (58.9%) but that of the employed mothers was their job(63.6%). The basic immunization for children was completed in 70.5% of children of employed mothers as compared with 82.0% of the children of the unemployed mothers were completely immunized (p>0.1). Accident experience rate of children among the employed mothers was 23.5 a and that of the children of the unemployed mothers was 17.3% . The most common cause of acident in children of the unemployed mothers was carelessness while they were playing(34.6%) but in children of the employed mothers it was traffic accident(25.0%) and falling(25.0%). Most of the traffic accidents took place while the children's brother or sister of age under 14 years were baby sitting. When the accident took place 73.1% of the unemployed mothers were just at home, but 58.3% of the employed mothers were out of home for work. In case of the employed mothers, 58.7% of their children were looked after by an adult mainly grandparents, 15.7% by the children's brothers and sisters under 14 years old, and 3.9% of the children were left alone. A majority of the unemployed mothers wanted to get a job if someone could take care of their children. To facilitate the women employment and for the safety and health of the children, good nurseries for working mothers need to be established at a cost they can afford.