Application of cold intolerance symptom severity questionnaire among vibration-exposed workers as a screening tool for the early detection of hand-arm vibration syndrome: a cross-sectional study

BACKGROUND: The detection rate of hand-arm vibration syndrome (HAVS) is very low in South Korea compared with other countries. The absence of uniform consensus and guidelines for diagnosing HAVS has been presumed to be one of the reasons. The HAVS has various manifestations including cold intolerance and its severity can be measured using the cold intolerance symptom severity (CISS) questionnaire. This study aimed to determine whether the CISS questionnaire, being used as a screening tool, can aid in the early detection of HAVS. METHODS: A total of 76 male workers with vibration-induced symptoms were enrolled as the final study participants. To compare the CISS score of healthy individuals, 41 men who had never been exposed to local vibration were included in the study. In addition to the former medical questionnaire, the participants answered the CISS questionnaire. A statistical analysis was conducted to identify the association of CISS scores with vibration induced symptom and to determine its cut off value. RESULTS: The reliability of the CISS questionnaire was proven to be good, with a total Cronbach's alpha of 0.922. The mean CISS score of the exposed group increased in every vascular stage [stage 0 = 42.6 (18.5); stage 1 = 59.4 (14.1); and over stage 2 = 60.2 (21.6)]. They were significantly higher than that of the non-exposed group. The result was fairly consistent with those in the sensorineural stage. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) of 30 were 88.5, 65.3, 76.1, 82.1 and 0.769, respectively. From the result of logistic regression, the adjusted odds ratio of both components increased by the CISS score grouped by 30s. CONCLUSIONS: The self-reported CISS questionnaire, used to measure the degree of cold intolerance, showed high agreement with the Stockholm classification of HAVS. Hence, we recommend the use of this questionnaire to assess the level of cold intolerance among vibration-exposed workers and detect individuals who are at risk of vibration-induced impairment with a cutoff value of 30. TRIAL REGISTRATION: IRB No. 2018–07–040-001. Registered on 4 September 2018.

The effect of diabetes on 4-year changes of hearing thresholds in male workers exposed to noise in a single company: a longitudinal study

BACKGROUND: Recently, several studies have assessed the association between diabetes and hearing impairment. However, the effect of diabetes on hearing impairment is not well known in diabetic patients exposed to noise, a typical cause of hearing impairment. The aim of this study is to longitudinally analyze the effect of diabetes on hearing impairment in workers exposed to similar noise levels from 2013 to 2017 who had experienced little change in their working conditions. METHODS: The study subjects included 2,087 male workers exposed to noise in a single company and who underwent health examinations at the same hospital in Ulsan city in 2013 and 2017. Hearing impairment was defined that a pure-tone average of pure-tone audiometry (PTA) thresholds at 1,000, 2,000, 3,000, and 4,000 Hz was 25 dB and over in both ears. Statistical analyses were conducted using χ2 tests, ANOVA, and Cox proportional hazard models. We analyzed covariates that might affect hearing impairment, including age; working period; levels of total cholesterol, triglyceride, and serum creatinine; smoking and alcohol history; and noise level. RESULTS: The average PTA thresholds and their average changes between 2013 and 2017 were significant in the diabetes mellitus (DM) group than those in the normal and impaired fasting glucose group. Among the subjects with the same status of fasting glucose group in 2013 and 2017, the adjusted hazard ratios for incident hearing impairment among those in the DM group compared to normal group were 3.35 (95% confidence interval [CI], 1.54–7.29) in the left ear and 5.66 (95% CI, 2.01–15.98) in the right ear. CONCLUSIONS: This study suggested that the risk of hearing impairment in the DM group was significantly higher than that in the normal group in both ears, even when exposed to similar noise levels.

Treatment Outcome and Mortality among Patients with Multidrug-resistant Tuberculosis in Tuberculosis Hospitals of the Public Sector

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.

Treatment Outcome and Mortality among Patients with Multidrug-resistant Tuberculosis in Tuberculosis Hospitals of the Public Sector

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.

Clinical Experience of Mesenchymal Hamartoma of Liver

Purpose: Mesenchymal hamartoma of the liver (MHL) is an uncommon benign disease of childhood, yet its biology and pathogenesis are still unknown. It is difficult to diagnose from other hepatic tumors, and malignant transformation can occur. It has caused a debate regarding choice of the proper management of each neoplasm of liver in childhood. Methods: We analyzed histologically confirmed MHLs from 1998 to 2008. Results: Six patients presented at a median age of 21months, with a painless abdominal mass. Gastrointestinal symptoms were present in two patients. Abdominal ultrasonography and CT scans revealed a cystic, septated mass within the liver in all patients. Three patients underwent major hepatic resections, one had a simple excision of the tumor, and two were observed after biopsy. The median follow up period was 46months (range 6-115months), and there were neither recurrences of tumors nor complications, in patients who underwent surgical treatment. Conclusion: Resectable mesenchymal hamartoma of the liver in childhood with normal liver function studies can be cured by complete excision without complications and without recurrence.

A Case of Non-Clostridial Gangrenous Panophthalmitis

PURPOSE: To report a case of non-clostridial gangrenous panophthalmitis extended directly from adjacent gangrenous skin infection METHODS: A 62-year-old woman, with diabetes mellitus, was admitted to ICU after explorative laparotomy for panperitonitis, retroperitoneal hemorrhage, and disseminated intravascular coagulation caused by traffic accident. She was referred to the ophthalmologic department because of necrotizing skin infection and panophthalmitis extended directly from an adjacent skin infection, which had developed after superficial abrasion on the left forehead. RESULTS: Necrotizing gangrenous skin infection with subcutaneous emphysema had rapidly progressed to her left face and there was panophthalmitis with subconjunctival gas bubbles. Proteus mirabilis, Serratia marcescens, Enterobacter aerogenes, and Enterococcus faecalis were cultured from the skin wound and aqueous humor, Acinetobacter baumannii, and Serratia marcescens were cultured from sump drainage. She died after 3 days because of sepsis, acute renal failure, and multiple organ failure. CONCLUSIONS: Physicians should always keep in mind that a serious infectious disease like non-clostridial gas gangrene can develop even from a superficial skin wound in immunocompromised patients like diabetics.

Canalicular Trephination with Lacrimal Trephine and Endoscopic DCR

PURPOSE: The purpose of this study is to evaluate surgical outcomes of canalicular trephination with lacrimal trephine and endoscopic dacryocystorhinostomy in patiens with common canalicular or canalicular obstruction. METHODS: 35 patients (38 eyes) diagnosed as common canalicular or canalicular obstruction undergoing surgery between December 1999 and August 2003. Patients have been followed up more than 5 months after surgery. RESULTS: The average age of patients was 57.3 years old and the average follow-up period was 7.1 months. The overall success rate was 92.1%. With obstructions within lower canaliculus, the success rate was 75.0%. The success rate of the cases with obstructions within upper canaliculus and upper and lower canaliculus was 100%, and the success rate of the cases with obstructions within common canaliculus was 95.2%. CONCLUSIONS: The surgical success rate of canalicular trephination with lacrimal trephine and endonasal dacryocystorhinostomy was better than canaliculodacryocystorhinostomy and this seems to be adequate as an primary procedure before Jones tube bypass surgery.

A Case of Optic Neuritis Involving Optic Chiasm

PURPOSE: To report a case of optic neuritis with incongruous homonymous hemianopia involving optic chiasm. METHODS: A twenty five year old female patient complaining of decreased visual acuity in left eye for 4 days was referred from department of neurology. Best corrected visual acuity was 1.0 in the right eye and counting fingers at 20 cm in the left eye. Left afferent pupillary defect was detected. The conventional magnetic resonance image was normal, however on FLAIR image high signal intensity lesion involving left anterior portion of optic nerve, optic chiasm and both optic tract was noted. However the lesion was not easily detected on T2-weighted image. On enhanced MRI image, the lesion was partially enhanced. Visual field showed incongruous homonymous right hemianopia. VEP showed no evoked potentials in left eye stimulation by checkboard pattern and normal response in right eye stimulation. The patient had normal CSF studies and had been treated with high dose intravenous steroid. After 19 days, visual acuity and magnetic resonance image was markedly improved. RESULTS: We experienced a case of optic neuritis with incongruous homonymous hemianopia involving optic chiasm and report this case with literature review as we believe that our case is the first case in our country.

Diagnostic Significance of the Serologic Test Using Multiple Antigens of Mycobacterium Tuberculosis by ELISA / 결핵

BACKGROUND: Diagnosis by smear and/or cultures of the Mycobacterium tuberculosis from body fluid or biopsy specimen is "Gold standard". However the sensitivity of the direct microscopy is relatively l ow and culture of mycobacteria is time consuming. Despite an explosion in the techniques of rapid identification of mycobacteria by molecular genetic means, it is laborious and expensive and then rapid, inexpensive serodiagnosis is interested in diagnosis of tuberculosis. But sensitivity and specificity of known serologic antigen is not full sufficient level and then new antigen develop and combination cocktails of new develped antigens by ELISA are needed. METHOD: To compare the efficacy of different mycobacterial specific antigen and to assess the applicability of the combination of several different antigens in the diagnosis of tuberculosis, five ELISA tests derived 14KDa, 16KDa, 19KDa, 23KDa, 38KDa were evaluated in 57 active pulmonary patient and 24 inactive post-therapy follow up patient and 48 normal control. RESULTS: The optical densities of ELISA test with 14KDa, 16KDa, 19KDa, 23KDa, 38KDa were significantly higher in active tuberculosis cases than in normal control(P<0.001, P<0.001, P<0.027, P<0.001, P<0.001) and those with 16KDa, 38KDa were significant higher in active tuberculosis cases than in inactive post-therapy follow up cases(P<0.01, P<0.001) and those of 14KDa, 16KDa, 23KDa, 38KDa were significant higher in inactive post-therapy follow up cases than in normal control(P<0.008, P<0.01, P<0.006, P<0.001). The sensitivity of 14KDa, 16KDa, 19KDa, 23KDa, 38KDa in active pulmonary patient cases was 42.1%, 43.9%, 15.8%, 28.0%, 70.2%, respectively and the specificity of 14KDa, 16KDa, 19KDa, 23KDa, 38KDa in active pulmonary patient cases was 95.8%, 95.8%, 91.7%, 89.6%, 93.8%, respectively. The sensitivity and specificity of combination 38KDa with 16KDa was 87% and 93.7%. CONCLUSION: The sensitivity andspecificity of new antigens for serodiagnosis of the tuberculosis still remains limited at around 70%, which makes its a poor diagnostic tool for disease confirmation. A combination of cocktail antigens provided by cut-off value adjustment for serodiagnosis of tuberculosis some improved diagnostic yield than single antigen serologic test.

Postoperative Clinical Courses according to the Length of Preoperative Drug Therapy in Pulmonary Tuberculosis / 결핵

BACKGROUND: Though surgery plays an important role in the management of patients with Mycobacterium tuberculosis infection, there is little information regarding the timing of resection. We tried to f ind out the ideal timing of operation. METHOD: A retrospective review was performed in 69 patients underwent pulmonary resection for pulmonary tuberculosis between January 1993 and December 1997. They were categorized into various groups according to the length of preoperative specific drug therapy. The rates of treatment failure, realpse and complication in each group were compared statistically by x2-test. RESULTS: Eighty one point two percent were men and 18.8% women with a median age of 33 years(range, 16 to 63 years). The mean number of resistant drugs was 3.1(range, 0 to 9). Patients were treated properatively with multidrug regimens, which mean number of preoperative specific drugs was 4.6, in an effort to reduce the mycobacterial burden with the mean length of preoperative drug therapy, 5.0 months. Postoperative treatment was conducted for a mean period of 13.0 months with a mean number of postoperative specific drugs, 4.4. Postoperative treatment failures were confirmed in 8 among 69 patients(11.6%). 2 of these 8 patients were showed up in the preoperative 3 to 4 months medication group and each of the rest was occurred in the preoperative 2 to 3, 5 to 6, 6 to 7, 12 to 13, 17 to 18 months, less than one month medication group, respectively. 59 of 69 patients were available for evaluation of the relapse rate with the mean duration of the postoperative follow-up, 19.8 months. In 4 patients bacterial relapse was confirmed(6.8%). Each of these 4 was in the preoperative 1 to 2, 2 to 3, 3 to 4, 5 to 6 months medication group, Categorized into various groups according to the length of preoperative specific therapy, there were no statistical significances of the treatment failure rate, relapse rate and complication rate in the groups. There were seven treatment failures of 28 who were AFB culture positive until the time of operation(25%, p<0.01). Categorized the preoperative AFB culture positive group into various groups according to the length of preoperative drug therapy, there were no statistical significances, either. CONCLUSION: We believe that operation plays an important ancillary role in the treatment of pulmonary tuberculosis. Our results indicate that the timing of resection according to the length of preoperative drug therapy may not cause trouble.

The Study of CYFRA 21-1 and Epidermal Growth Factor Receptor Levels in Cancer Tissue of Bronchogenic Carcinoma Patients / 대한흉부외과학회지

CYFRA 21-1 is known to be a cytokeratin 19 fragment, and it can be detected by using two specific monoclonal antibodies (KS 19-1 and BM 19-21) and can be clinically applied as a useful circulating tumor marker. The epidermal growth factor receptor (EGF-R) expression was evaluated and characterized by its tyrosine protein kinase activity and by its ligand-stimulated autophosphorylation, a property shared with other peptide growth factor receptors. Autocrine or paracrine action was initiated by a growth factor, or by a transforming growth factor alpha, which had an extensive homology with EGF and which also stimulated tyrosine kinase activity on the EGF-R. The CYFRA 21-1 and the EGF-R levels in 30 patients with primary lung tumors were investigated. There were 24 patients with squamous cell carcinomas and 6 patients with adenocarcinomas. Specimen 5 mm3 in size were sampled at three different locations ; the main lesion, the boundary between the lesion and the unaffected tissue, and the unaffected tissue of the patients. The results were as follows : 1. The CYFRA 21-1 concentration in the cancer boundary, the most malignant region,(348.6+/-89.9 ng/ml) was the lowest value. The CYFRA 21-1 concentration in unaffected tissue,(718.4+/-77.8 ng/ml) was higher than that in the main lesion. which had intact cellularity. 2. The EGF-R concentration in the main lesion was higher than that in the unaffected tissue, and the EGF-R concentration in a squamous cell cacinoma was higher than that in an adenocarcinoma. also, the EGF-R concentration in the cancer boundary was highest at stage I, II. The EGF-R concentration was higher in the main cancer lesion that in the unaffected tissue at stage III, IV. 3. The CYFRA 21-1 was a cytoplasmic skeleton and the EGF-R was a cell-wall component; there was no correlation. In conclusion, CYFRA 21-1 was abundant in the cytoplasm but had a higher concentration in the unaffected tissue than in the main cancer lesion. The CYFRA 21-1 concentration of the tissue did not reflect the amount of cancer activity, the EGF-R was located in the cell membrane, the level of tissue that reflects cancer activity, so the main cancer lesion had a higher concentration than the unaffected tissue. CYFRA 21-1 is not a useful tumor maker at the tissue level. Because the EGF-R concentration reflected the cancer activity, its a useful tumor marker for lung cancer.

Surgical Treatment of Traumatic Rib Fracture with Judet's Rib Struts / 대한흉부외과학회지

Judet's rib struts which are designed for osteosynthesis are made of stainless steel. This report describes clinical analysis of our experiences of 30 cases with the operative stabilization of multiple rib fractures with Judet's rib struts from December, 1995, to December, 1996 in Chungmoo Hospital, Chounan. Our indications for operative stabilization were as follows: 14 cases in flail chest, 8 cases in severe displacement of rib including segmental fractures, 7 cases in additional procedures during intrathoracic operation, and 1 case in other cause. Postoperative artificial ventilation is needed in only 1 case for 5 days and posto- perative complications were few: 2 cases of hemopneumothorax, 2 cases of alcohol with- drawal delirium, and 1 case of postoperative hepatitis. Average duration of hospital admission who have limited thoracic injuries was 10.5 days. Though more comparative studies is necessary, we find this technique to be better than previously published methods, since it provides better stabilization and immobilization of the ribs and shortening the duration of hospital admission.

Double Outlet of Right Ventricle in Criss-Cross Heart: Surgical Experience of One Case / 대한흉부외과학회지

Criss-cross heart which is a cardiac malformation caused by abnormal rotation of the ventricles early in embryonic development, is rare but a double outlet of right ventricle in criss-cross heart is very rare. We experienced a case of criss-cross heart which is situs solitus, concordant atrioventricular connection and double outlet of right ventricle with remote ventricular septal defect of perimembranous inlet type. A 4-years old female was diagnosed as a double outlet of right ventricle in criss-cross heart after echocardiography, cardiac catheterization and cardiac angiography. The surgical correction was a intraventricular reconstruction of left ventricular outflow with 3/4 circle of 20 mm Hemashield vascular graft from the ventricular septal defect to the aorta. The patient had a temporary atrioventricular block but was recovered uneventfully, and a postoperative echocardiogram showed no left ventricular outflow obstruction, no intracardiac shunt.

Clinical Observation on Benign Prostatic Hypertrophy / 대한비뇨기과학회지

A clinical study was made on 32 cases of benign prostatic hypertrophy admitted to the Department of Urology. Chungnam National University Hospital during the period from June, 1974 to July, 1976. The results are summarized as follows: 1) During this period, 225 patients hospitalized, 32 cases were B.P.H., giving a rate of 14.2 % revealed the increasing tendency in incidence than other previous reports in Korea. 2) Mean amount of residual urine was 290 ml. 3) In urine culture, bacteriuria more than 100,000 colonies/cc. was presented in 21 cases(65.5%). Most common organisms were E. Coli(21.9%), Staph, aureus(12.5 %) and Staph, albus(12.5%). 4) Pre-existing diseases before operation were discovered in 19 cases(59.4%), related to senility. 5) Mean weight of removed prostatic tissue was 34.1gm. 6) Post-operative gross hematuria was disappeared average 4.2 days on retropubic prostatectomy and average 5.4 days on suprapubic prostatectomy. 7) Indwelling catheter was earlier removed on retropubic prostatectomy than on suprapubic prostatectomy. The average duration of indwelling catheterization was 7.2 days on retropubic prostatectomy and 11.3 days on suprapubic prostatectomy. 8) Post-operative complication were acute epididymitis on 1 case(4.2%), acute pyelonephritis on 2 cases(8.3%) and temporary incontinence on 11 cases (45.8%).

Clinical Observation on Tumors of the Genito-urinary Tract / 대한비뇨기과학회지

A clinical observation was made on 80 cases of genito-urinary tract tumors of the in-patients in the Department of Urology, Chungnam University Hospital during 3.5 years, from January 1974 to June 1977. The following results were obtained. 1. During this period, of 348 cases hospitalized, 80 cases (76 males. 4 females) had tumors of the genito-urinary tracts, giving a rate of 22.9%.2. In 80 cases of genito-urinary tract tumors, 46 cases (57.5%) were benign tumors and 32 cases (40.0%) were malignant tumors. Of the benign tumors, B.P.H. was the most common tumors and of the malignant tumors, bladder cancer was the most common tumors. 3. The majority of the patients(87.5%) were distributed over age of 40 years, showing highest incidence at 60-69 years. 4. In 80 cases of the genito-urinary tract tumors, 46 cases(57.5%) were prostatic, 17 cases (21.2%) vesical, 9 cases(11.2%) renal, each 3 cases(3.7%) penile and testicular, and 2 cases (2.5%) urethral. 5. Histopsthologically, B.P.H. was observed in 49.3% of all operated tumors, transitional cell carcinoma of bladder in 16.9% and adenocarcinoma of prostate in 5.7%. 6. Operation was performed in 71 cases (88.7%).