Effects of Basic Hospital Infection Control Methods on the Isolation Rate of Methicillin: Resistant Staphylococcus aureus / 병원감염관리

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals in Korea. The overall rate of MRSA in hospitals in Korea was estimated over 60%. Recently hospital infections caused by MRSA are getting increased and problematic in Korea, Our hospital Seoul Paik Hospital, has been trying to solve this problem. We had not applied exact methods for hospital infection control. Therefore, we adapted strict methods under the control of hospital infection control committee (HICC) and assessed the effectiveness of these methods. METHODS: Every month, the number of MRSA isolates was collected and analyzed; the results of the analysis were reported to every ward. All wards were supplied with Microshild(R) (Johnson & Johnson, Australia), Clean N' Fresh(R) (Carroll, USA), and standard paper towels. Health care workers were regularly educated for hospital infection control. The use of antibiotics was controlled by the HICC. We compared MRSA isolation rate between before and after applying the strict infection control methods under the regulation of HICC. Mann-Whitney U test, one-way ANOVA, and Chi-square test were used for statistical analysis of the results. RESULTS: After restricting the uses of antibiotics, glycopeptides and carbapenems were prescribed 15% less (20.3 vs 17.3 DDD /1000 patient-days) and 35% less (9.3 vs 6.0 DDD /1000 patient-days) respectively, compared to before restricting antibiotics. Methicillin resistance rate was decreased from 78% to 69% compared to before the methods(p=0.02). The isolation rate of MRSA was reduced by 31-42% from 2.33 to 1.35-1.60/1000 patient-days compared to before adapting strict infection control methods (p=0.04-0.07). CONCLUSION: This study showed that applying the strict infection control methods in the hospital can be effective to reduce the isolation rate of MRSA.

In vivo Effect of Systemic pam-idronate Disodium on bo_ne Resorption in Experimental Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Bone resorption of adjacent structures in aural cholesteatoma is mostly responsible for serious complication of the disease. Recent researches have been aimed at preventing bone resorption with tools of non-surgical therapy. The effect of pam-idronate disodium on systemic bone resorption is mainly attributed by its function against osteoclast recruitment and activation. In this study, we investigated the effect of systemic pam-idronate disodium on localized osteoclastic bone resorption in experimental cholesteatoma. MATERIAL AND METHODS: Experimental cholesteatomas were induced in 40 mongolian gerbils. pam-idronate disodium (Aredia(R), Ciba-Geigy Limited)were injected subcutaneously once a week in 20 gerbils (treated group)and none were injected in the other 20 gerbils (untreated group). pam-idronate disodium were injected with a dose of 2 mg/kg in 10 of the treated group (low dose group) and with a dose of 4 mg/kg in the remainder (high dose group). Gerbils were sacrificed at 12 weeks (3 month group) or 17 weeks (4 month group) after the injection. Harvested temporal bones were examined by light microscope and transmission electron microscope. RESULTS: The clinical stage of cholesteatoma tended to be more advanced in the untreated group than in the treated group although it was not statistically significant. Scores of osteoclast number per total bone length in millimeter were lower in the treated group than in the untreated, although the percentage of surface occupied by osteoclasts per total bone surface were not different between the groups. CONCLUSION: These results will provide fundamental data for further studies on the prevention and treatment of osteoclastic bone resorption in aural cholesteatoma.

A Case of Jugular Bulb Diverticulum Accompanied with Pulsatile Tinnitus / 대한이비인후과학회지

Pulsatile tinnitus is perceived as sounds that vary in frequency, intensity and duration. It is also characterised by its unique feature of rhythmicity that is synchronous with the human pulse. Clinically, it is a serious disorder because it is associated with other life threatening or curable diseases. Pulsatile tinnitus may originate from several sites including the arterial, arteriovenous, venous vessels and the myoclonus. Jugular bulb diverticulum, one of the causes of venous pulsatile tinnitus, is observed as a protrusion of the jugular vein lumen with a waist like margin. It may extend either laterally in the tympanic cavity or medially towards the petrous pyramid close to the inner ear. This leads to pulsatile tinnitus, sensorineural or conductive hearing loss and vertigo. In this paper we report a recent case in which we confirmed jugular bulb diverticulum in a 59 years-old woman whose complaint of pulsatile tinnitus was spontaneously disappeared during the follow up.