Maternal and neonatal outcomes in Korean women with type 2 diabetes

BACKGROUND/AIMS: The purpose of this study was to compare maternal and neonatal outcomes in Korean women with type 2 diabetes and nondiabetic controls. METHODS: We performed a retrospective survey of 200 pregnancies in women with type 2 diabetes (n = 100) and nondiabetic controls (n = 100) who delivered from 2003 to 2010 at Cheil General Hospital & Women’s Healthcare Center, Korea. We compared maternal characteristics as well as maternal and neonatal outcomes between groups matched by age, pre-pregnancy weight, body mass index, parity, and gestational age at delivery. RESULTS: The number of infants that were small for gestational age and the rate of major congenital malformations were not significantly different. However, women with type 2 diabetes showed a slightly higher risk for primary caesarean section (35.0% vs. 18.0%, p = 0.006) as well as pre-eclampsia (10.0% vs. 2.0%, p = 0.017), infections during pregnancy (26.0% vs. 2.0%, p < 0.001), neonatal weight (3,370 ± 552.0 vs. 3,196 ± 543.3, p = 0.025), large for gestational age (22.0% vs. 9.0%, p = 0.011), and macrosomia (15.0% vs. 5.0%, p = 0.018) compared to nondiabetic controls. CONCLUSIONS: Maternal and neonatal outcomes for women with type 2 diabetes were worse than those for nondiabetic controls. Diabetic women have a higher risk for primary caesarean section, pre-eclampsia, infections during pregnancy, large neonatal birth weight, large for gestational age, and macrosomia.

Trends in Research on the Security of Medical Information in Korea: Focused on Information Privacy Security in Hospitals / 대한의료정보학회지

OBJECTIVES: Information technology involves a risk of privacy violation in providing easy access to confidential information,such as personal information and medical information through the Internet. In this study, we investigated medical information security to gain a better understanding of trends in research related to medical information security. METHODS: We researched papers published on ‘의료정보’ and ‘medical information’ in various Korean journals during a 10-year period from 2005 to 2015. We also analyzed these journal papers for each fiscal year; these papers were categorized into the areas of literature research and empirical research, and were further subdivided according to themes and subjects. RESULTS: It was confirmed that 48 papers were submitted to 35 academic journals. There were 33 (68.8%) literature review articles, and analysis of secondary data was not carried out at all. In terms of empirical research, 8 (16.7%) surveys and 7 (14.6%) program developments were studied. As a result of analyzing these papers according to the research theme by research method, 17 (35.4%) papers on laws, systems, and policies were the most numerous. It was found that among the literature research papers on medical personnel were the most common, and among the empirical research papers, research on experts in information protection and medical personnel were the most common. CONCLUSIONS: We suggest that further research should be done in terms of social perception, human resource development, and technology development to improve risk management in medical information systems.

Effects and Satisfaction of Medical Device Safety Information Reporting System Using Electronic Medical Record / 대한의료정보학회지

OBJECTIVES: This paper describes an evaluation study on the effectiveness of developing an in-hospital medical device safety information reporting system for managing safety information, including adverse incident data related to medical devices, following the enactment of the Medical Device Act in Korea. METHODS: Medical device safety information reports were analyzed for 190 cases that took place prior to the application of a medical device safety information reporting system and during a period when the reporting system was used. Also, questionnaires were used to measure the effectiveness of the medical device safety information reporting system. The analysis was based on the questionnaire responses of 15 reporters who submitted reports in both the pre- and post-reporting system periods. RESULTS: Sixty-two reports were submitted in paper form, but after the system was set up, this number more than doubled to 128 reports in electronic form. In terms of itemized reporting, a total of 45 items were reported. Before the system was used, 23 items had been reported, but this increased to 32 items after the system was put to use. All survey variables of satisfaction received a mean of over 3 points, while positive attitude, potential benefits, and positive benefits all exceeded 4 points, each receiving 4.20, 4.20, and 4.13, respectively. Among the variables, time-consuming and decision-making had the lowest mean values, each receiving 3.53. Satisfaction was found to be high for system quality and user satisfaction, but relatively low for time-consuming and decision-making. CONCLUSIONS: We were able to verify that effective reporting and monitoring of adverse incidents and the safety of medical devices can be implemented through the establishment of an in-hospital medical device safety information reporting system that can enhance patient safety and medical device risk management.

Maternal and Neonatal Outcomes in Korean Women with Type 1 and Type 2 Diabetes

BACKGROUND: The purpose of this study was to evaluate maternal and neonatal outcomes in Korean women with type 1 diabetes and type 2 diabetes. METHODS: We performed a retrospective survey of 163 pregnancies in women with type 1 diabetes (n=13) and type 2 diabetes (n=150) treated from 2003 to 2010 at Cheil General Hospital & Women's Healthcare Center, Korea. We compared maternal characteristics as well as maternal and neonatal outcomes between groups. RESULTS: Differences in glycosylated hemoglobin between type 1 and type 2 diabetes were not significant. Birth weight (3,501+/-689.6 g vs. 3,366+/-531.4 g) and rate of major congenital malformations (7.7% vs. 5.6%) were not significantly different. However, women with type 1 diabetes had higher rates of preeclampsia (38.5% vs. 8.2%, P=0.006), large for gestational age (LGA; 46.2% vs. 20.4%, P=0.004), macrosomia (38.5% vs. 13.4%, P=0.032), and admission for neonatal care (41.7% vs. 14.8%, P=0.03) than women with type 2 diabetes. CONCLUSION: Maternal and neonatal outcomes for women with type 1 diabetes were poorer than for women with type 2 diabetes, especially preeclampsia, LGA, macrosomia and admission to the neonatal intensive care unit.

A Case of a Gastric Gastrointestinal Stromal Tumor with a Fistula and Gastrointestinal Bleeding / 대한소화기내시경학회지

There has been much debate on the origin, differentiation and prognosis of gastrointestinal stromal tumors (GIST). Based on recent studies, we consider Cajal interstitial cell as the origin of a GIST. The common symptoms of a GIST are abdominal pain, hemorrhage, and the presence of a mass. However, there are few reported cases of a GIST with abscess pockets that communicate with the lumen of the stomach via a fistula. We report a case of a GIST of the stomach presenting with an abscess and a fistula communicating with the lumen of the stomach. An 84-year-old man presented with continuous fever and general weakness. We were able to diagnose the disease by an endoscopic examination, CT scan, biopsy and by cellular immunohistochemical staining.

A Case of Multiple Myeloma with Pulmonary Thromboembolism Diagnosed by Transthoracic Echocardiography

Cancer is a major risk factor for pulmonary thromboembolism. Occasionally, the thromboembolic event occurs before the diagnosis of cancer. We report a rare case of massive pulmonary thromboembolism with multiple myeloma diagnosed by transthoracic echocardiography.

Dry eye in patients with fibromyalgia / 대한내과학회지

BACKGROUND: Dry eye is a disorder of the tear film caused by reduced tear production or excessive tear evaporation. A high incidence of sicca symptoms has been noted in fibromyalgia (FM) patients resulting in serious complications. This study was conducted to evaluate the incidence of dry eye by pathogenic mechanisms and to investigate the relationship between dry eye and symptom severity in FM patients. METHODS: Fifty patients that visited Maryknoll Hospital between March 2006 and December 2006 were included in the study. Enrolled patients underwent a Korean fibromyalgia impact questionnaire (KFIQ), ocular surface disease index (OSDI), Schirmer test and tear break up test (TBUT). The KFIQ and OSDI are used to assess the severity of fibromyalgia symptoms and dry eye symptoms, respectively. The Schirmer test and TBUT are used to assess reduced tear production and excessive tear evaporation, respectively. We assessed the OSDI, Schirmer test, TBUT, age and disease duration in terms of the KFIQ. RESULTS: The incidence of dry eye was high in FM patients (12.0% by the Schirmer test and 92.0% by the TBUT test). The OSDI positively correlated with the KFIQ (p=0.006). A positive correlation was observed between the Schirmer test and the KFIQ (p=0.024), but not between the TBUT and the KFIQ. CONCLUSIONS: In this study, dry eye was found to be common in FM patients. Excessive tear evaporation was a more common cause of dry eye than reduced tear production. The patients with more severe dry eye symptoms tend to have more severe FM symptoms.

Assessment of Left Ventricular Function in Symptomatic Patients with Myocardial Bridge using Two-Dimensional Strain

BACKGROUND AND OBJECTIVES: We wanted to perform quantitative echocardiographic assessment of myocardial function in the patients with myocardial bridge by measuring 2-dimensional strain with using newly developed software. SUBJECTS AND METHODS: Novel computer software was used for tracking heart tissue on echocardiography, and we conducted an advanced wall-motion analysis for 18 symptomatic patients (mean age: 57.1+/-9.7 years, 10 female) with myocardial bridging of the left anterior descending coronary artery and also 20 age-matched healthy controls. The conventional wall-motion scoring was normal in all the patients, and the software was able to adequately track their heart tissue. RESULTS: The maximal angiographic systolic lumen diameter reduction within the myocardial bridges was 71+/-12.6% at rest, with a persistent diameter reduction of 31.2+/-11.3%. The radial strain and displacement of the anterior segments were more significantly reduced than that of the posterior segments at the level of the papillary muscle (30.9+/-13.8% vs. 51.8+/-17.3% and 4.8+/-0.9 vs. 5.9+/-1.5, respectively, all p<0.05), and this showed a plateau (39% and 33%, respectively) or biphasic (50% and 56%, respectively) pattern. The time from the R wave on electrocardiography to the transition from regional systole to early diastolic lengthening (Tr) was significantly delayed in the patients with myocardial bridge more than that for the controls (497+/-20.4 ms vs. 348+/-12.5 ms, respectively, p<0.05). CONCLUSION: Delayed systolic contraction and diastolic relaxation are important mechanisms that contribute to ischemia in the patients with myocardial bridge. 2-dimensional strain can be used to achieve real-time wall-motion analysis, and it has the potential to improve the identification and functional quantification of myocardial Bridge.