Seroprevalence of Hepatitis A Virus Antibody and Vaccination among Healthcare Workers in a Teaching Hospital / 병원감염관리

BACKGROUND: Recently, the incidence of hepatitis A virus (HAV) infection has been increasing in Korea, and an outbreak among healthcare workers (HCWs) has also been reported. This study aims to evaluate the seroepidemiology of hepatitis A among HCWs at an 820-bed teaching hospital in Korea, thereby facilitating HAV vaccination for these HCWs. METHODS: In June 2009, we assessed the total immunoglobulins against the HAV in the serum samples of 907 HCWs by using VIDAS Anti-HAV Total (bioMerieux, France). RESULTS: Seropositivity for HAV significantly increased with age (P or =61 years. CONCLUSION: Since HCWs aged 20-40 years show low seropositivity for HAV vaccination against hepatitis A should be considered in all these HCWs.

Multicenter Surgical Site Infections Surveillance System Report, 2007: In Total Hip and Total Knee Arthroplasties and Gastrectomies / 병원감염관리

BACKGROUND: A prospective multicenter study was performed to make a surgical site infections (SSI) surveillance system for hip (HRA) and knee (KRA) replacement arthroplasties and gastrectomies (GAST) in Korea. The rates, risk factors, and clinical characteristics of SSI were evaluated. METHODS: Demographic data, clinical and operative risk factors for SSI, and information of prophylactic antibiotic uses for the patients who took HRA/KRA and GAST in 7 and 5 hospitals, respectively were collected during July through December of 2007. SSI surveillance for HRA/KRA and GAST was done for 1 year and 1 month after operations, respectively. RESULTS: A total of 1,294 cases (HRA, 342; KRA, 453; GAST, 499) were monitored for SSI. The SSI rates of HRA, KRA, and GAST were 1.75 (6/342), 1.10 (5/453), and 4.41 (22/499) per 100 operations, respectively. Diabetes mellitus (DM) was more frequently accompanied and the dates of hospitalization before operations were longer in the infected group than the non-infected group of HRA. DM was more frequently found in the infected groups of KRA and GAST. Reoperation, emergent operation, and transfusion were more frequent in the infected group of GAST. Prophylactic antibiotics were used in 1,279 operations (99%) and started within 60 minutes before skin incision in 93% (1,190/1,279). The most frequently used antibiotics were 1st generation cephalosporins. Prophylactic antibiotics were used in combination in 33 operations (3%) and the median duration of antibiotic use was 4 days (0-89). CONCLUSION: The SSI rates of HRA, KRA, and GAST in this SSI surveillance system were 1.75, 1.10, and 4.41 per 100 operations, respectively.

Characteristics of Hospitals Participating in the Korean Nosocomial Infections Surveillance System 2006 / 병원감염관리

BACKGROUND: Korean Nosocomial Infections Surveillance System (KONIS) operating since July 2006 is the first nationwide monitoring system for nosocomial infections in the in the intensive care unit (lCU) with a standard protocol and web-based prompt response network in Korea. This report describes the characteristics of the KONIS hospitals compared with those of all Korean hospitals with 400 beds and over. METHODS: A survey was conducted for the 44 hospitals participating in KONIS 2006, and the data were rechecked by the KONIS hospitals through KONIS web-network. The survey form included questions about the size of the hospital, infection control personnel, nursing personnel, and the status of microbiologic laboratory. RESULTS: Compared to all Korean hospitals with 400 beds and over, the KONIS hospitals were larger in term of average number of beds (857 vs 654); the number of hospitals with 700 beds and over was over-represented in Seoul (P=0.01) and under-represented in the central/south area (P<0.001) The majority of the KONIS hospitals were major teaching university-affiliated (88,6%) and private (72.7%), but in the central/south area, public hospitals comprised up to 60%. The number of infection control professionals (ICP) averaged 1.6, hospital beds per ICP 531, and infectious disease physicians 1.3. Medical and medical combined ICUs were the major component (67,1%) of the KONIS ICUs, The lCU bed per nurse was 0.63. CONCLUSION: The KONIS 2006 hospitals were over-represented in the overall indicators in Seoul. Because no objective indicators were available regarding the patient quality, KONIS data must be interpreted in consideration of all indicators.

Korean Nosocomial Infections Surveillance System (KONIS) Report: Data Summary from July through September 2006 / 병원감염관리

BACKGROUND: THe Korean Society for Nosocomial Infection Control (KOSNIC) orfanized the Korean Nosocomial Infections Surveillance System (KONIS) to establish a nationwide database of Nosocomial infection (NI) rate in the intensive care units (ICUs) of Korean hospitals. This report is a summary of the data from July through September 2006. METHODS: The KONIS performed a prospective sruveillance for nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 76 ICUs in 44 hospitals. NI rates were calculated as the numbers of infections per 1,000 patient-days or device-days. RESULTS: A total of 846 nosocomial infections were fOlllld during the study period: 407 UTIs (397 cases were urinary catheter-associated), 204 BSIs (182 were central line-associated), and 235 PNEUs (161 were ventilator-associated). The rate of urinary catheter-associated UTIs was 4.61 cases per 1,000 device-days and urinary catheter utilization ratio was 0.83. The rate of central line-associated BSIs was 3.16 and the utilization ratio was 0.55. The rate of ventilator-associated PNEUs was 3.80 and the utilization ratio was 0.41. Although the ventilator utilization ratio was lower in the hospitals with 400-699 beds than in the hospitals with more than 900 beds, the rate of ventilator-associated pneumonia was higher in the smaller hospitals than in the larger ones. The rates of all three device-associated infections were the highest in the neurosurgical ICUs and the rates were the lowest in the surgical ICUs. CONCLUSION: This study may contribute to the development of effective strategies for NI control according to the size of hospital and the type of ICUs.

A Case of Superimposed Tuberculous Peritonitis on Chemical Peritonitis Arising in Ruptured Both Ovarian Cystic Teratoma / 대한산부인과학회잡지

Rupture of teratoma is rare. Ovary cystic teratoma was occurred 95% in benign ovary tumor, but chemical peritonitis arising from ruptured cystic teratoma is a scarce case. Peritoneal tuberculosis is also rare disease nowadays. It causes easily fatigue, abdominal distension, intermittent abdominal pain and ascities insidiously. We have recently experienced a case of chemical peritonits from ruptured both ovary cystic teratoma of ovary with superimposed peritoneal tuberculosis in 44 year-old woman and report our scarce case with a brief review of the literature.

Dose-Related Effects of Steroid on the Experimental Arthritis in Rabbits

OBJECTIVE: To investigate dose-related effects of repeated intraarticular steroid injection on the experimental arthritis. METHOD: Twenty-four adult male rabbits received Zymosan A into their right knee joint for experimental arthritis. After a week, they were injected with 2 mg (group I; n=9), 10 mg (group II; n=7) or 20 mg (group III; n=8) triamcinolone acetonide into their right knee weekly interval for 4 weeks. We measured weekly changes of the weight and the mediolateral diameter of both knees for the calculation of edema index. 99mTechnetium pertechnate (99mTc) uptake measurement were performed before the first steroid injection and a week after the final steroid injection. All rabbits were sacrificed and histologic examinations of their proximal tibia were performed. RESULTS: A progressive weight loss and changes of edema index were evident for all rabbits (p0.05). In the histological findings, fibrillation-frayings and fissures of the surface were similar in all rabbits, but loss of nuclear stains and cyst formations were increased prominently in group III than group I (p<0.05). CONCLUSION: Low-dose repeated steroid intraarticular injections are safe and effective treatment in arthritis though no definite evidence of chondroprotection, and high-dose steroid injections accelerate degeneration of the arthritic cartilage.

Clinicopathologic Study on the Primary Malignant Tumors of The Fallopian Tube / 대한산부인과학회잡지

Objective The aim of this study was to evaluate the clinicopathologic findings of eight patients with primary cancer of fallopian tube diagnosed and treated in the department of Obstetrics and Gynecology, University of Ulsan, Asan Medical Center for nine years. Methods Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and survival of patients were reviewed retrospectively. Results The patients with primary cancer of fallopian tube constituted 0.4% of all gynecologic malignancies encountered during this period. The age of patients ranged 42 to 70 years(mean+/- S.D.; 53.9+/-9.9) and half of patients were postmenopausal and two patients were nulliparous. Patients were treated by simple or radical hysterectomy and bilateral salpingoophorectomy with or without omentectomy and five patients received postoperative chemotherapy. The FIGO surgical stages of the patients were I(4 cases), II(2 cases), III(1 case) and IV(1 case). There were 3 cases of adenocarcinoma, 3 cases of malignant mixed Mullerian tumor, 1 case of undifferentiated carcinoma and 1 case of serous cystic tumor of low malignancy potential. Serum CA 125 values were followed during treatment and decreased during clinical remission and increased at the time of tumor progression. The mean follow-up duration was 24.3(+28.3) months and 7 patients were alive free of disease and one patients with stage Ic died of the disease. Conclusion Primary fallopian tube cancer is an extremely rare malignancy of the female genitalia and preoperative diagnosis of this disease is difficult. Cytoreductive surgery and postoperative combination chemotherapy seem to be effective treatment and CA 125 value could reflect the disease status during the treatment and follow-up of patients.

Clinicopathological Features of Replication Error-positive Tumors in Single or Multiple Gastric Carcinomas / 대한암학회지

PURPOSE: Replication error (RER) is an important mechanism in the gastric carcinogenesis and known to contribute to the pathogenesis of multiple gastric carcinomas (GCs). A proportion of sporadic GCs are RER-positive and RER-positive GCs have been reported to have distinct clinicopathological features. The purpose of the present study included whether there are characteristic clinicopathological features of RER-positive GCs and whether there is a difference of RER frequency between single and multiple GC in age-matched patients. MATERIALS AND METHODS: We analyzed 96 cases of single GC and 19 cases of multiple GC for the RER status using 7 microsatellite loci to assess their clinicopathological features. RESULT: Ten cases (10%) of 96 single GCs and five cases (26.3%) of 19 multiple GCs were RER-positive. However, comparison of RER frequency between single and multiple GCs in patients older than 60 years revealed no significant difference. Jn single GCs, RER-positive tumors showed a proclivity toward older age, antral location, and elevated gross type (Borrmann 2 or EGC IIa or I). Multiple GCs with RER showed a female-sex preponderance. Clinicopathological features of RER-positive tumors were similar in both single and multiple GCs. CONCLUSION: The present study revealed that RER-positive tumors had distinct clinico- pathological features and there was no significant difference of RER frequency between single and multiple GC in elderly patients. Our data suggests that RER contributes to the pathogenesis of GC, either single or multiple, in aged patients.

The Brenner Tumors of The Ovary: A Clinicopathologic Study / 대한부인종양콜포스코피학회잡지

The aim of this study was to evaluate the clinicopathologic findings of twelve patients with Brenner tumor of the ovary diagnosed and treated in the department of Gynecology and Obstetrics, University of Ulsan, Asan Medical Center for nine years. Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and results of follow-up were reviewed retrospectively. The patients with Brenner tumor constituted 0.54% of all epithelial ovarian tumor ecountered during this period. The age of patents ranged from 47 to 79 years (mean+/-S.D.; 60.1+/-11.9) and the mean parity was 3.3. Eleven cases except one, who had FIGO stage Ia disease, had benign tumors. The tumor size ranged from 0.5 to 12 cm (mean+/-S.D.; 4.8+/-3.8 cm). Uterine adenomyosis was the most frequently associated disease (58.3%) and all tumors were unilateral. Total abdominal hysterectomy with unilateral or bilateral salpingoophorectomy were performed in all patients and no further postoperative adjuvant treatments were done even in the patient with malignant tumor, who is alive without evidence of disease.

The Brenner Tumors of The Ovary: A Clinicopathologic Study / 대한부인종양콜포스코피학회잡지

The aim of this study was to evaluate the clinicopathologic findings of twelve patients with Brenner tumor of the ovary diagnosed and treated in the department of Gynecology and Obstetrics, University of Ulsan, Asan Medical Center for nine years. Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and results of follow-up were reviewed retrospectively. The patients with Brenner tumor constituted 0.54% of all epithelial ovarian tumor ecountered during this period. The age of patents ranged from 47 to 79 years (mean+/-S.D.; 60.1+/-11.9) and the mean parity was 3.3. Eleven cases except one, who had FIGO stage Ia disease, had benign tumors. The tumor size ranged from 0.5 to 12 cm (mean+/-S.D.; 4.8+/-3.8 cm). Uterine adenomyosis was the most frequently associated disease (58.3%) and all tumors were unilateral. Total abdominal hysterectomy with unilateral or bilateral salpingoophorectomy were performed in all patients and no further postoperative adjuvant treatments were done even in the patient with malignant tumor, who is alive without evidence of disease.

Bcl-2 Expression in Endometrial Hyperplasia and Carcinoma / 대한암학회지

PURPOSE: To speculate the role of bcl-2 protooncogene in endometrial carcinogenesis by determination of the expression of bcl-2 in endometrial hyperplasia and carcinoma. MATERIALS AND METHODS: We studied bcl-2 expression by an immunohistochemical method in the paraffin-embedded blocks of 78 patients with endometrial hyperplasia, 64 with simple hyperpasia, 9 with complex hyperplasia and 5 with atypical hyperplasia respectively, and 33 endometrial carcinoma treated at Asan Medical Center from June, 1989 to May, 1997. Intensity of bcl-2 staining was scored on a scale of 0 to 4, calibrated by comparison with stromal lymphocytes, which always received a score of 4. RESULTS: The results of this study showed that bcl-2 was relatively highly expressed in simple (n= 64), complex (n=9) and atypical hyperplasias (n=5) with mean staining scores of 2.95+/-1.09 (Mean+Standard Deviation), 2.78+/-1.20 and 3.60+/-0.89 respectively, which showed no difference among histologic types. In endometrial carcinoma, the expression of bcl-2 was significantly down regulated (mean score=1.76+/-1.35) compared with that of hyperplasia, and did not conelate with FIGO surgical stage. However, grade III tumor showed significantly lower expression that grade I or II tumor. CONCLUSION: Bcl-2 expression is down regulated in endometrial carcinoma than endo- metrial hyperplasia, and correlates with tumor grade, which suggest that bcl-2 expression might be the result of carcinogenesis or bcl-2 plays only an adjunctive role in the endometrial carcinogenesis.

Primary Clear Cell Carcinoma of the Ovary ; An Analysis of 9 Cases with Review of the Literature / 대한산부인과학회잡지

Clear cell carcinoma of the ovary is a clinicopathologic entity with distinct morphologic characteristics and known to be associated with poor prognosis irrespective of stage and prognostic benefits of chemotherapy have not been evidently demonstrated. This represents 2-3.6% of all ovarian malignancies. From October, 1991 to January, 1998, nine patients with primary clear cell carcinoma of the ovary treated in the deptartment of Gynecology and Obstetrics, University of Ulsan, Asan Medical Center were identified, and clinical and histologic review(including architectural pattern, mitotic activity, nuclear grading) was performed retrospectively. The age of the patients ranged from 30 to 67 year(mean+S.D.; 46.0+11.8) and the mean parity was 1.2 (+1.3). Five(55.6%) of nine patients had elevated level of CA 125. The size of the tumors varied from 3 cm to 20 cm with the mean maximal diameter of 12.1 (+6.3) cm. The FIGO stages of the patients were IC(6 cases, 66.7%), IIC (2 cases, 22.2%) and IV(1 case, 11.1%). All patients except one were treated by total abdominal hysterectomy and bilateral salpingoophorectomy with or without omentectomy and pelvic lymph node dissection. All except two were received postoperative chemotherapy with regimens such as CEC (cyclophosphamide + epirubicin + carboplatin), TC(taxol + carboplatin), CC(cyclophosphamide + carboplatin) or CAP (cyclophosphamide + adriamycin + cisplatin). The mean follow-up duration was 14.6 (+ 8.6) months and 8 patients were free of disease and one patient with stage IV disease died of disease during postoperative chemotherapy(4 months after surgery).

Quantitative Pathologic Variables as Prognostic Factors in Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

No abstract available.

CD30 (Ber H2) Distribution in Hodgkin's Disease and non-Hodgkin's Lymphoma

Forty one cases of Hodgkin's disease and non-Hodgkin's lymphomas were immunohisto-chemi-cally studied for the presence of CD30 antigen on the paraffin embedded formaldehyde fixed tissue by using Ber H2(CD30) monoclonal antibody (Dakopatts, diluted l : 20) and avidin biotin peroxidase complex technique seventy five %(6/8) of Hodgkin's lymphoma and 27% (9/33) of non-Hodgkin's lymphomas were CD30 positive. Five of l7 diffuse large cell and immunoblastic lymphoma and one large cell anaplastic lymphoma showed large numbers of CD30 positive cells. Occasional CD30 positive cells were found in one of 2 angiommunoblastic lymphadenopathy-like T cell lymphoma, one of 4 small lymphocytic lymphoma and one unclassified lymphoma. Immunophenotypically l6% of B cell lymphoma and 42% of T cell lymphoma showed CD30 positivity. six cases of Hodgkin's disease except lymphocyte predominance showed positive tumor cells. Our results show that CD30 is more widespread in histologic subtypes of lymphomas and is not specific for the diagnosis of Hodgkin's disease.