Pediatric Mycoplasma pneumoniae Infection Presenting with Acute Cholestatic Hepatitis and Other Extrapulmonary Manifestations in the Absence of Pneumonia / 대한소아소화기영양학회지

Mycoplasma pneumoniae infections mainly involve respiratory tract; however, also can manifestate other symptoms by site involved. Extrapulmonary manifestations of M. pneumoniae infection are rarely known to occur without pneumonia. Herein we report a case of a 9-year-old boy who presented with acute cholestatic hepatitis in the absence of pneumonia. Rhabdomyolysis, skin rash, and initial laboratory results suspicious of disseminated intravascular coagulopathy were also observed in this patient. M. pneumoniae infection was identified by a 4-fold increase in immunoglobulin G antibodies to M. pneumoniae between acute and convalescent sera by enzyme-linked immunosorbent assay. This is the first pediatric case in Korea of M. pneumoniae infection presenting with acute cholestatic hepatitis in the absence of pneumonia.

Outcome of Alagille Syndrome Patients Who Had Previously Received Kasai Operation during Infancy: A Single Center Study / 대한소아소화기영양학회지

PURPOSE: Infants with Alagille syndrome (AGS) are occasionally misdiagnosed as biliary atresia and subsequently undergo Kasai operation. The purpose of this study was to investigate the outcome of patients with AGS who had previously received Kasai operation during infancy. METHODS: This retrospective study was conducted at the Department of Pediatrics, Samsung Medical Center. We compared the prognosis and mortality between those who had undergone Kasai operation during infancy (Kasai group) and those who had not (non-Kasai group). RESULTS: Among the 15 children with AGS, five had received Kasai operation, while 10 had not. All subjects in the Kasai group revealed neonatal cholestasis, while 70% of the non-Kasai group showed neonatal cholestasis. Liver transplantation was performed in 100% (5/5) among the Kasai group, and 20.0% (2/10) among the non-Kasai group (p=0.007). Mortality was observed in 60.0% (3/5) among the Kasai group, and 10.0% (1/10) among the non-Kasai group (p=0.077). CONCLUSION: Although overall mortality rate did not significantly differ between the two groups, the proportion of patients receiving liver transplantation was significantly higher in the non-Kasai group. The relatively worse outcome in AGS patients who had received Kasai operation may be due to the unfavorable influences of Kasai operation on the clinical course of AGS, or maybe due to neonatal cholestasis, irrespective of the Kasai operation.

The Association Between the 10-Year Risk of the Korean Stroke Risk Prediction Model and the Carotid Intima-Media Thickness

BACKGROUND: Both carotid intima-media thickness (IMT) and global risk score of cardiovascular disease were independent risk factors of stroke and heart disease. We assessed the correlation between the 10-year risk of Korean Stroke Risk Prediction model (KSRP) and carotid intima-media thickness. Additionally, from a perspective of carotid IMT measurement following KSRP risk stratification, we analyzed the difference of carotid IMT and plaque according to the KSRP risk strata. METHODS: Subjects were 282 persons who visited one hospital for the screening of stroke. The 10-year risk was calculated automatically based on the equation of KSRP model. The maximal carotid IMT and the plaque were adopted as the study variables. The sensitivity and the positive predictive value of the KSRP risk categories were calculated. RESULTS: The correlation coefficient between the KSRP risk and the maximal carotid IMT was 0.29 (p<0.01). The mean (+/-standard deviation) of KSRP risk of the group with carotid plaque was statistically significantly higher, 5.3 (+/-4.1), than that of the group without plaque, 3.3 (+/-3.1) (p< or =0.01). The sensitivity of the risk stratum with more than 6% of KSRP risk for the plaque was 28.2%. The positive predictive value of the above cut-point was 48.8%. CONCLUSIONS: The 6% of KSRP risk may be considered as the beginning point of intermediate risk stratum to recommend the carotid ultrasonography. However, generalization needs further studies for various populations.

Imaging Findings of Brain Death on 3-Tesla MRI

OBJECTIVE: To demonstrate the usefulness of 3-tesla (3T) magnetic resonance imaging (MRI) including T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), time-of-flight (TOF) magnetic resonance angiography (MRA), T2*-weighted gradient recalled echo (GRE), and susceptibility weighted imaging (SWI) in diagnosing brain death. MATERIALS AND METHODS: Magnetic resonance imaging findings for 10 patients with clinically verified brain death (group I) and seven patients with comatose or stuporous mentality who did not meet the clinical criteria of brain death (group II) were retrospectively reviewed. RESULTS: Tonsilar herniation and loss of intraarterial flow signal voids (LIFSV) on T2WI were highly sensitive and specific findings for the diagnosis of brain death (p < 0.001 and < 0.001, respectively). DWI, TOF-MRA, and GRE findings were statistically different between the two groups (p = 0.015, 0.029, and 0.003, respectively). However, cortical high signal intensities in T2WI and SWI findings were not statistically different between the two group (p = 0.412 and 1.0, respectively). CONCLUSION: T2-weighted imaging, DWI, and MRA using 3T MRI may be useful for diagnosing brain death. However, SWI findings are not specific due to high false positive findings.

Occupational Chronic Obstructive Pulmonary Disease Cases Evaluated by Workers' Compensation in Korea / 대한산업의학회지

OBJECTIVES: To analyse the characteristics of occupational COPD (Chronic obstructive pulmonary disease) cases that were evaluated by the Occupational Safety and Health Research Institute (OSHRI) of the Korea Occupational Safety & Health Agency (KOSHA). METHODS: Using the OSHRI database from KOSHA, we collected 13 cases of occupational COPD that had been evaluated from 1998 to 2007. RESULTS: Four cases had been evaluated as occupational COPD: 1) a nonsmoking road sweeper exposed to automobile exhaust gases and trash dust; 2) an oxygen welding worker exposed to cadmium fumes; 3) a cotton mill air conditioner cleaning worker exposed to cotton dust; and 4) a foundry grinding worker exposed to dust, gases, vapors and fumes. Nine cases had been evaluated as non-occupational COPD: 1) 4 cases in which smoking was determined to be the main cause rather than occupational exposure; 2) 1 case that was evaluated as another respiratory disease (severe tuberculosis sequelae); 3) 1 case that had been misdiagnosed as COPD; 4) 2 cases in which the exposure levels in the workplace environments were too low; and 5) 1 case that had developed before the employment. Among these 13 cases, a shipyard grinding worker had been evaluated in 2006 as having had a low occupational hazard, but a similar case (a foundry grinding worker) was evaluated as having had a high hazard in 2007. CONCLUSIONS: Proper evaluation of occupational COPD demands an accurate diagnosis of COPD itself and also the exclusion of other respiratory diseases that have similar symptoms; an investigation of the relevant occupatioonal hazards and the amount of the exposure; and a consideration of smoking history. The evaluation should also take into account any substantial loss of life due to occupational hazards as well as any disease-free periods.

The Study of an Automated External Defibrillator (AED) Use by 119 Rescuers in Gyeonggi-do

PURPOSE: The purpose of this study was to investigate the use of an AED by 119 rescuers in prehospital cardiac arrest. METHODS: 132 patients who experienced prehospital cardiac arrest and was defibrillated by 119 rescuers using AED from January 2003 to December 2004 were included in this study. They were reviewed retrospectively based on 119 rescue service records and ECG. We analyzed patients' general characteristics, types of ECG rhythm, time intervals from EMS activation to arrival and from EMS activation to the first defibrillation, numbers of defibrillation, and return of spontaneous circulation (ROSC). RESULTS: The mean age was 57.33+/-17.84 years with 92 males and 40 females. 68 patients showed shockable rhythms (coarse ventricular fibrillation 41, fine ventricular fibrillation 24, pulseless ventricular tachycardia 3) and 39 patients showed unshockable rhythms (pulseless electrical activity 19 , asystole 18, normal sinus rhythm 2) as an initial rhythm at EMS arrival. Unshockable rhythms were changed to shockable rhythms after cardiopulmonary resuscitation. 25 patients had no ECG rhythms on 119 rescue service records. In the patients with shockable rhythms initially (68 patients), 18 patients experienced ROSC, whereas only 1 patients experienced ROSC in the patients with unshockable rhythms initially (39 patients). The patients with shockable rhythms initially had higher ROSC rates than the patients with unshockable rhythms initially (26.1% vs 2.6%, p=0.001) and received less defibrillation than the patients with unshockable rhythms initially (1.37+/-0.60 vs 2.49+/-1.87, p=0.016). There were no significant differences in the time intervals from EMS activation to arrival (5.74+/-2.13 minutes vs 7.12+/-4.33 minutes, p=0.529) and from EMS activation to the first defibrillation (14.20+/-7.97 minutes vs 13.75+/-7.30 minutes, p=0.542) between ROSC group & non-ROSC group. There was no significant difference in ROSC between male and female (13% vs 17.5%, p=0.164). CONCLUSION: The patients with shockable rhythms initially had higher ROSC rates than the patients with unshockable rhythms initially (26.1% vs 2.6%, p=0.001) and received less defibrillation than the patients with unshockable rhythms initially (1.37+/-0.60 vs 2.49+/-1.87, p=0.016).

Patient Satisfaction in Workers' Compensation Medical Care / 대한산업의학회지

OBJECTIVES: To evaluate the patient satisfaction and its influencing factors after medical care for workrelated injuries. METHODS: A self-reported questionnaire was mailed to 921 workers who had experienced workers' compensation medical care. The data from 335 respondents (response rate was 36.4%) were merged and analysed with the data from the Korea Labor Welfare Corporation (KLWC) which contain other general information of the respondents. RESULTS: Dissatisfaction with their medical care was reported by 17.3% of the respondents. Overall patient satisfaction (OPS) was highly correlated with the medical treatment process such as hospital facility, medical therapy, surgical therapy, doctor's explanation and physical therapy. However, OPS was negatively influenced by three factors: 1) unsatisfactory hospital care during waiting period before the approval of workers' compensation, 2) forced end of the hospital care by the workers' compensation, and 3) end of the hospital care with no further improvement. CONCLUSIONS: To improve the satisfaction of patients with work-related injuries, both the practice of medical treatment and also the administrative process of workers' compensation must be reformed. These reforms are needed to improve the quality of workers' compensation medical care and prevent abnormal illness behavior such as inappropriate treatment seeking.

Predictors of Return to Work and Job Retention after Work-Related Injury or Illness / 대한산업의학회지

OBJECTIVES: This research was conducted to investigate workers'return to work rate after work-related injury or illness and to determine which factors could predict return to work and job retention. METHODS: From the documents held by the six local branches of the Korea Labor Welfare Corporation(KLWP), 2,464 cases of work-related injury or illness which had telephone numbers were identified from September to December, 2003. Data about the employment status was gained from 921 occupationally injured workers through telephone questionnaire and was merged with the electronic data obtained from KLWP with included information of the workers whose worker's compensation period was ended from 2002 to 2004. Finally the data for 516 workers was analysed by logistic regression using SAS 9.0. RESULTS: The return to work rate was 50.3% and the job retention rate was 28.3%. Decreased return to work rate was associated with old age, shorter employment duration, longer treatment duration, higher disability grade, lower average wage and manual worker. Decreased job retention rate was associated with a smaller number of employees, shorter employment duration and work in the construction industry. CONCLUSIONS: This research highlighted the numerous occupationally injured workers who couldn't return to work and the multiple factors that were associated with the return to work or job retention. Based on this and related research, rehabilitation programs which consider the issues of return to work and job retention have to be implemented.