Risk factors and etiology of surgical site infection after radical neck dissection in patients with head and neck cancer

BACKGROUND/AIMS: Surgical site infection (SSI) is a major complication after radical neck dissection (RND) in patients with head and neck cancer (HNC). We investigated the incidence, risk factors, and etiology of SSI among patients who underwent RND. METHODS: A retrospective cohort study was performed on HNC patients, excluding those with thyroid cancer, who underwent first RND at a teaching hospital between January 2006 and June 2010. Medical records were collected and analyzed to evaluate the risk factors and microbiological etiologies. RESULTS: A total of 370 patients underwent first RND. The overall incidence of SSI was 19.7% (73/370). Multivariate analysis showed that male sex (odds ratio [OR], 4.281; p = 0.004), cardiovascular diseases (OR, 1.941; p = 0.020), large amount of blood loss during surgery (OR, 4.213; p = 0.001), and surgery lasting longer than 6 hours (OR, 4.213; p = 0.002) were significantly associated with SSI. The most common causative pathogen was Staphylococcus aureus (32.6%), and 93.2% of S. aureus isolates were methicillin-resistant. Klebsiella pneumoniae (13/92, 14.1%), Pseudomonas aeruginosa (11/92, 12.0%), and Enterococcus species (11/92, 12.0%) were also frequently detected. CONCLUSIONS: Based on our results, we predict that certain groups of patients are at high risk for SSIs after major HNC surgery. Preventive measures or close monitoring in these patients may be required to reduce the likelihood of postoperative SSIs. Furthermore, even though additional research is required, we would consider changing the prophylactic antibiotic regimens according to the causative organisms.

The prevalence of bronchial hyperresponsiveness in elementary school children and its associated factors

PURPOSE: We investigated the prevalence of bronchial hyperresponsiveness (BHR) and its associated factors in population-based elementary school children. METHODS: Methacholine bronchial provocation tests were performed on 1,151 elementary school children and BHR was defined as PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second [FEV1]) or =25 ppb (aOR, 2.118; P=0.025), and sensitization to mites (aOR, 1.705; P=0.034) were associated with BHR. Preterm birth (aOR, 2.056; P=0.068) showed borderline significance. The associated factors for BHR with atopy were lower body mass index (aOR, 0.838; P=0.005), preterm birth (aOR, 4.361; P=0.003), and FeNO > or =25 ppb (aOR, 2.161; P=0.043). Younger age (aOR, 0.810; P=0.037) and higher blood eosinophil % (aOR, 1.296; P<0.001) were associated with BHR without atopy. CONCLUSION: The prevalence of BHR decreased with age in elementary school children. Younger age, preterm birth, eosinophilia, sensitization to mites, lower lung function, and higher FeNO level were independently associated with BHR.

A Case of Pulmonary Hemosiderosis that was Dissolved by an Oral Prednisolone and the Milk Avoidance / 소아알레르기및호흡기학회지

A 29-month-old boy presented with fever, dyspnea, and paleness. He was initially diagnosed with pneumonia and severe sepsis. Although he was treated with intravenous antibiotics and high dose methylprednisolone, dyspnea and paleness recurred two times. Under suspicion of pulmonary hemosiderosis, we performed video-assisted thoracoscopic lung biopsy and bronchoalveolar lavage on him and found hemosiderin-laden macrophages in both specimens. Despite thorough history and laboratory examination, we could not find any pathologic or serologic evidence for primary and secondary causes of pulmonary hemosiderosis except for one that indicating Heiner's syndrome. After taking oral prednisolone he showed improvement of anemia and dyspnea, which was maintained by milk avoidance. Based on the history and the existence of immunoglobulin G antibodies against milk components, we are considering it as the case of Heiner's syndrome.

Development of RT-PCR Method to Detect Various Human Enteric Viruses

Human enteric viruses are one of the major causes of acute gastroenteritis outbreaks. A rapid and precise detection of virus is critical for prompt diagnosis. For this purpose, nucleic acid-based techniques such as reverse transcription (RT)-PCR have been developed. Although RT-PCR is a rapid, specific and sensitive method to detect virus, many steps or reactions are required, especially when various types of viruses are targeted. In this study, we developed a quick and effective method to detect human enteric viruses with a few reactions. Our candidate viruses were as follows: one DNA virus (adenovirus: AdV) and seven RNA viruses including poliovirus (PV), coxsackievirus A (CoxA) and B (CoxB), human rotavirus (HRV), hepatitis A virus (HAV), norovirus (NorV), and astrovirus (AstV). With this amount of samples, theoretically, a total of fifteen biomolecular reactions have to be performed, which include seven RT reactions and eight subsequent PCR with specific primers in each case. Specific primers, enterovirus universal primers, and random primers were applied independently to compare the outcomes of RT and PCR steps in each viral sample. We found that random 9-mer is ideal for the RT reactions of RNA viruses with negligible differences in sensitivity and specificity of viral detection except HRV. Hence, HRV cDNA generated by HRV-specific primer and AdV DNA were amplified in a single tube by duplex PCR. The cDNAs generated by RT using random 9-mers were divided into two reaction tubes without losing sensitivity: one duplex PCR detects enteroviruses (PV, CoxA, CoxB) and HAV, the other detects NorV and AstV. In conclusion, it is possible to detect eight enteric viruses with a substantially reduced number of reactions, which are composed of five reactions, two RT and three PCR reactions.

Surveillance of Acute Gastroenteritis in Seoul, Korea, During May 2004 and June 2007

Acute gastroenteritis (AGE), which is one of the most common diseases worldwide, primarily occurs in infants and young children in both developed and developing countries. To investigate the prevalence of AGE in Korea, 6,788 stool specimens collected from hospitalized patients with AGE in Seoul, Korea from March 2004 to June 2007 were analyzed by enzyme immunoassay, reverse transcription-PCR, DNA sequencing and phylogenetic analysis. Enteric viruses and bacteria were detected in 2,955 (43.5%) and 1,389 (20.5%) specimens, respectively. Among the enteric viruses detected, rotavirus (19.7%) and norovirus (18.9%) were the predominant causative agents, followed by adenovirus (2.5%) and astrovirus (2.4%). Staphylococcus aureus was the most commonly observed bacteria (8.0~19.2%). The epidemic peaks of the enteric viruses were October to December for norovirus, January to May for rotavirus, and August to October for adenovirus. The seasonal activity of rotavirus was shifted from winter to late spring. However, astrovirus did not display seasonal activity in this study. Although viral AGE primarily occurred in patients younger than 5 years of age, the incidence of viral AGE in children aged 6 to 14 years was significant. The results of this study will contribute to the currently available epidemiological data and improve public health and hygiene via amelioration of diagnostic methods and longitudinal surveillance.

Human Cytomegalovirus Induces Intercellular Adhesion Molecule-1 Expression in a Monocytic Cell Line, THP-1

It has been reported that inflammatory diseases such as pneumonitis, retinitis, and hepatitis are associated with human cytomegalovirus (HCMV). Intercellular adhesion molecule (ICAM)-1 is an important inflammatory mediator, helping monocytes adhere to endothelial cells when tissues are infected by pathogen including the HCMV. However, little is known about the mechanism of ICAM-1 stimulation by the HCMV infection in monocytes. In this study, a monocytic cell line THP-1 was used to understand ICAM-1 expression by the HCMV infection. Flow cytometric analyses demonstrated that ICAM-1 was stimulated by the HCMV in THP-1 cells with maximum at 24 hours post infection. The stimulated ICAM-1 expression was dependent on the amount of input virus. In order to understand the mechanism of ICAM-1 stimulation during the HCMV infection, cells were treated with specific inhibitors of key elements in inflammation: NF-kappaB inhibitor PDTC, cyclooxygenase 2 inhibitor NS398, and MEK inhibitor PD98059. Flow cytometric analyses revealed that ICAM-1 expression was decreased when treated with PDTC, but not with NS398 or PD98059. Thus, it is suggested that HCMV-induced ICAM-1 expression in THP-1 cells is associates with NF-kappaB.

A case of congenital retroperitoneal immature teratoma: Prenatally diagnosed as Neuroblastoma / 대한산부인과학회지

Through a routine antenatal ultrasound examination of 37-year-old woman at 38 weeks' gestation, a 6 cm-diameter mixed solid and cystic mass was found in the left suprarenal area of her fetus. The following antenatal magnetic resonance image showed a larger cystic mass with a central solid component. The surgical exploration of the mass was performed in 50 days after delivery and by the pathologic examination a grade III immature teratoma was found. The retroperitoneal immature teratomas are extremely rare in childhood. To our Knowledge this is the first reported case about congenital retroperitoneal immature teratoma. The immature teratoma should be included in the differential diagnosis of fetal suprarenal mass and the serum alpha-fetoprotein level should be included in the initial laboratory examination at birth.

A Case of Sclerosing Stromal Tumor of the Ovary / 대한산부인과학회잡지

Sclerosing stromal tumor (SST) is a rare benign ovarian neoplasm and predominantly affects young women in the second and third decades with distinctive clinical features like irregular mensturation and dysmenorrhea. SST is usually solid and the possibility of malignancy should be considered. Recently some authors reported it is possible to predict the presence of this tumor preoperatively on the basis of the contrast enhanced magnetic resonance imaging (MRI) findings. We experienced a case of sclerosing stromal tumor of the ovary with characteristic clinical, pathologic and radiologic findings. We report this case with a brief review of the literature.

Impact of Neoadjuvant Chemotherapy on Postoperative Morbidity in Locally Advanced Cervical Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to test the hypothesis that neoadjuvant chemotherapy (NACT) does not increase morbidity in patients undergoing radical hysterectomy with lymphadenectomy for locally advanced cervical cancer. MATERIALS AND METGODS: A retrospective study was undertaken of 140 patients with locally advanced cervical cancer (FIGO stage Ia to IIb) who underwent radical hysterectomy with lymphadenectomy by the same surgeon at the same hospital. Among the 140 patients, 39 received NACT followed by radical hysterectomy with pelvic lymphadenectomy (NACT group). This group received three cycles consisting of cisplatin 100 mg/m2/day on day 1 and 5-fluorouracil 1000 mg/m2/day from day 1 to 5. The NACT group was compared, in terms of intraoperative morbidity and postoperative morbidity, with the other 101 patients who underwent radical hysterectomy with lymphadenectomy but without chemotherapy (surgery-only group). RESULTS: There were no significant differences in mean age, body weight or height between the two groups. The only significant difference was that the NACT patients had higher stages of cancer. The incidence of intraoperative morbidity did not differ between the NACT and surgery only patients. We considered the operation duration, amount of blood loss and need for transfusion as indicators of intraoperative morbidity. We could not find any significant differences in the duration of suprapubic catheterization, days of hemovac drainage, amount of drained hemovac fluid, days of hospitalization or postoperative febrile morbidity between the NACT and surgery-only groups. Patients in the surgery-only group had more postoperative complications (ureteral obstruction, intestinal obstruction, lymphocyst, lymphedema, and death) than the NACT group, although not to a statistically significant degree (P>0.05). CONCLUSION: In this retrospective review, there was no evidence that NACT increased intraoperative or postoperative morbidity in patients with locally advanced cervical cancer. As this was a retrospective study, other prospective, randomized studies are needed to confirm these results.

A Study on the Life Style in Clients with Colo-Rectal Cancer / 성인간호학회지

PURPOSE: This study was to prepare the basic data for prevention of colo-rectal cancer and protection against its spread. METHOD: The subjects for the study were 204 patients with colo-rectal cancer from the G.S. wards of five general hospitals in Busan for the period of June 1 to September 1, 2001. The instrument used was a questionaire which was developed by Junho Shin(1995). The data was analyzed by descriptive statistics, McNemar test, x2 test, paired t-test, and ANOVA. RESULT: 1. 57% of the studied subjects were male, 42.7% were more than 60 years old, 54.9% were of standard physique, 49.5% were the Buddhists, 50.5% were the middle or high school graduates, 83.8% were city dwellers, 48% were jobless, 69.6% had no-history of alimentary disease, 44.1% had no-family history of cancer, 82.8% were married. 2. Constipation(x2=36.45, p=0.0001) in clients showed a significant positive association for the pre- diagnosed, but diarrhea(x2=3.947, p=0.047) showed a significant positive association for the post-diagnosed. The preference for high seasonings(t=6.23, p=0.0001) and animal fat (t=8.35, p=0.0001) was higher significantly in the pre-diagnosed, but physical activities(x2= 30.22, p=0.0001), an eutrophic or tonic medicine(x2=30.22, p=0.0001), was of and vegetables(t=-6.20, p=0.0001) was higher significantly in the post-diagnosed. 3. There were significant differences in the life style of the pre-diagnosed according to the general characteristics except religion. CONCLUSION: Results of the above study reveal we should be very sensitive to the change of defecation styles and consider the necessity of improving life styles as regards eating habits. When an education program is developed, the general characteristics of the subjects need to be considered.

Study On The Critical Maintenance Period Of Millipore Filter Membrane In Rats

The purpose of this study is to evaluate the critical maintenance period of absorbable membrane for guided bone regeneration. Fortynine Sprague-Dawley rats weighing about 300g were divided into seven groups. An 8 mm circular full-thickness defect in calvarial bone was made and then cellular acetate porous filter (Millipore filter(R)) was placed on the calvarial bone defect. The filter was removed at 2, 3, 4, 5, 6, 8 and 11 weeks after placement. Rats were sacrificed at 12 weeks the placement of cellular acetate porous filter. The specimens were stained with Hematoxylin-Eosin and observed under light microscope. The amount of regenerated bone was measured from both margin of calvarial bone defect (unit : mm). The results were as follows. Bone regeneration of each experimental group was increased gradually and the bond defect was almost completely filled with new bone in 5-, 6-, 8-, and 11-week experimental group. Histologic findings showed mild inflammatory response and granulation tissue formation without apparent adverse effects on the healing process. In 11-week experimental group, the bone defect was completely filled with new bone containing abundant osteoid which was oriented to the dural side and contribute to bony thickening. We suggest that non-absorbable membrane and bioabsorbable membrane presumably should remain intact for longer than 5 weeks to be effective.

Malignant mixed mllerian tumor of the ovary: a case report preoperatively diagnosed as endometrioid adenocarcinoma by MR imaging / 대한산부인과학회잡지

Malignant mixed mllerian tumors (MMMTs) are unusual neoplasms occurring mostly in the endometrium. In the ovary, they are very rare and represent less than 1% of all ovarian malignancies. They are highly aggressive neoplasms comprising histologically of both epithelial and mesenchymal components. The cell type cannot be determined on the basis of appearance at magnetic resonance (MR) imaging, computed tomography (CT), or ultrasonography (US) but we diagnosed this case as endometrioid adenocarcinoma by MR imaging. Although the pathologic evaluation revealed the ovarian MMMT, mesenchymal components was very minute in the background of endometrioid adenocarcinoma components. The patient received the screening tests of ovarian carcinoma including transvaginal ultrasonography only 3months ago and she got negative results. During the exploration, a 15-cm sized mass looked like it has rapidly grown and ruptured spontaneously preoperatively. Herein we report a case of ovarian MMMT, which was diagnosed preoperatively as endometrioid adenocarcinoma by MR imaging with review of literatures.

Old Abdominal Pregnancy Presenting as an Ovarian Neoplasm

Abdominal pregnancy is extremely rare, but even more unusual is the prolonged retention of an advanced abdominal pregnancy with lithopedion formation. The presentation of lithopedion as an ovarian tumor without a symptom has not been reported in Korea. A 63-yr-old, gravida 2, para 1, woman was referred to us with an abominal mass. Pelvic examination revealed normal postmenopaused uterus and a fetal head-sized movable hard mass in the lower abdomen. The computed tomographic scan showed a densely echogenic mass of 10-cm in diameter as an ovarian neoplasm. Laparotomy disclosed a lithopedion, of which the bones and cartilages were well preserved. There have been controversies on the treatment of lithopedion. Although some cases are stable for a long time, the morbidity increases when the operation is performed in an elderly patient. So we believe that the surgical intervention should be done as soon as possible after thorough consideration of the morbidity and the risk.

A case of adult extrarenal Wilms' tumor originated from retroperitoneum / 대한내과학회지

Wilms' tumor is the most common malignant abdominal tumor in the adolescent and pediatric period, whereas adult Wilms' tumor is uncommon. Wilms' tumor often originates in the kidney. Extrarenal Wilms' tumor is rare and has been considered "unstageable". Therefore, treatment and long-term survival have not been uniformly reported. We report a 24 year-old female who developed extrarenal Wilms' tumor, in the retroperitoneal space. She was misdiagnosed for ovarian neoplasm and underwent debulking operation, by which Wilms' tumor was confirmed. Palliative chemotherapy and radiotherapy were performed.

Growth Suppression by Adenovirus-mediated Gene Transfer of p16/INK4a in Glioma Cell Lines

No abstract available.

The Effect of Exercise Therapy for Benign Paroxysmal Positional Vertigo

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder that often resolves spontaneously. It was long believed that the condition was caused by inorganic particles in the cupula of the posterior semicircular canal. Management of this condition includes medication, surgery, physical exercise and more recently particle repositioning maneuvers. Among the various therapies, exercise therapy (ET) reported by Brandt-Daroff was based on the theory of cupulolithiasis and is designed to treat BPPV through dispersion of the debris from the cupula. METHODS: Fifty four patients with BPPV were treated with ET to determine the effectiveness. Fifteen additional patients with BPPV were treated with only medication and served as a control group. RESULT: Forty eight of 54 cases (88.9%) treated with ET showed improvement after 2 weeks. With medication alone, 8 of the 15 cases (53.4%) showed improvement after 2 weeks. CONCLUSIONS: The most important benefit of this maneuver seemed to be more expedient recovery than that with medication alone.

A Case of Monochorea Caused by a Striatal Lesion

The sudden onset of involuntary movement is usually attributed to a vascular lesion in the contralateral deep hemispheric structure. A majority of involuntary movement cases record that all the limbs on one side are affected. The concurrence of venous and cavernous malformations may be relatively rare, but is important because of the possibility of bleeding which should be related to the presence of cavernous angioma. A 67-year-old woman was admitted to our hospital to be evaluated for choreic movement restricted to the right leg for 20 days. A brain MRI revealed hemorrhage with the cavernous angioma involving the left striatum and adjacent venous angioma. Haloperidol diminished the monochoreic movement. We report monochoreic movement restricted to the right leg due to a left striatal lesion.

A Clinical study on Pulmonary Function after Intermaxillary Fixation

Intermaxillary fixation is routine procedure to oral and maxillofacial area in jaw bone fracture, surgical correction of jaw deformity, osseus reconstruction of jaw. After transoral surgery, accompanied by intermaxillary fixation, dysphagia or airway obstruction may be followed due to blood clot, vomitus, or laryngeal spasm resulting from irritation by blood or secretions. Lingual or pharyngeal edema is other contributing factors of airway obstruction. In addition, intermaxillary fixation itself may cause obstruction of airway. In this study, pulmonary function test and arterial blood gas analysis were evaluated before and after intermaxillary fixation in 30 patients suffered from mandibular fractures. Comparative analysis was performed by estimated values. The results were as followed. 1. The spirometric values of FEV1, FEV1/FVC and FEF25-75% without intermaxillary fixation were reduced from 97.57%, 85.1%, 98.3,% to 71.7%, 66.5%, 61.2% with intermaxillary fixation, indicating the presence of obstructive pulmonary impairment. 2. Spirometric value of MVV, as the most influencing value of sensitive to extrapulmonary factors, was changed from 84.5% to 46.48%. 3. After intermaxillary fixation, the spirometric value of FVC, as indicator of restrictive pattern of pulmonary function, was not reduced significantly as measured from 94.47% to 89.97%. 4. O2 saturation of arterial blood gas analysis without intermaxillary fixation was 97.86%. While intermaxillary fixation, O2 saturation was 97.47%. The results indicate that careful airway management is mandatory undergoing intermaxillary fixation of various oral and maxillofacial surgery.

Familial Periodic Vertigo and Ataxia: A Case Report

Familial periodic vertigo and ataxia is a rare, disabling condition of autosomal dominant episodes of vertigo and/or ataxia, sometimes associated with other brain stem symptoms such as diplopia, weakness and dysarthria. These attacks typically begin in early childhood or early adulthood, last for hours to days. Attacks may occur daily, or may be separated by longer intervals. We present a family with familial periodic vertigo and ataxia. A 20-year-old woman presented recurrent paroxysmal vertigo, nausea, vomiting and ataxia lasting for 2 to 4 hours since middle school age. Recently daily attacks disabled her from daily living activity. Neurologic examination in the attack-free interval revealed downbeat nystagmus at neutral position and bilateral gaze evoked coarse horizontal nystagmus. Her mother, 47-year-old female also had recurrent vertigo, ataxia and dysarthria lasting for 1 to 2 hours since childhood. Their symptoms are precipitated by fatigue, exertion, emotional stress and alcohol. Both patients showed good response to acetazolamide and flunarizine even though showed persistent objective nystamus

Comparative Analysis between Natural Evacuation and Irrigation Technique in Patients with Colostomy

Sixty-three patients with permanent sigmoid colostomy were surveyed to evaluate their satisfaction and complications with the "irrigation technique" and the "atural evacuation" of the colostomy management (irrigation technique; 32 patients, natural evacuation; 31 patients). All patients had colostomy for at least 12 months without disease recurrence. Each patient was interviewed in addition to standard questionnaire. The irrigation was not associated with any major complication including colonic perforation. The irrigation was used younger age group than the natural evacuation (53+/-10 vs. 62+/-12, P=0.01). The frequency of bowel movement was lower in the irrigation than in the natural evacuation (5.1+/-2.5/wk vs. 10.8+/-9.0/wk, P=0.04). Five patients (16%) of the irrigation experienced spontaneous bowel action but only one patient suffered from it. The time spent for managing irrigation was 59+/-13 minutes. Twenty-three patients (74%) of the natural evacuation suffered from one or moreproblems such as expensive apparatus, leakage, skin irritation or odor. Sixteen patients (52%) of the natural evacuation and 2 patients (6%) of the irrigation were restricted in social activity (P=0.0001). Thirteen patients (42%) of the natural evacuation and 1 patient (3%) of the irrigation were dissatisfied with colostomy management (P=0.002). Thus, the irrigation technique seems to be more effective and satisfactory method for managing colostomy without compromising patient's social activity when it is performed in appropriately selected patients.