Experiences of localization and removal of non-palpable subdermal contraceptive implants with ultrasound

OBJECTIVE: The aim of this study was to present experiences in localization and removal of non-palpable subdermal contraceptive implants with ultrasonography. METHODS: Medical records from January 1, 2016, to April 30, 2018, were retrospectively reviewed for 21 patients who were referred to a single institution and had an impalpable implant despite following the removal instruction. In all the cases, more than one attempt was made to remove the implant before referral. The rod was detected using radiography and ultrasonography. In all the cases, localization of the single implant was achieved with ultrasonography. The distal depth of the rod was measured, and skin marking was made following the echogenicity. The implants were subsequently removed under anesthesia. RESULTS: In 18 cases, the rods were localized using ultrasonography and successfully removed under local anesthesia. In the other three cases, removal with local anesthesia failed. Although the rod was detected successful with ultrasonography, the implants were removed under general anesthesia in the operating room. The depth from skin to rod, measured with ultrasonography, was >12.0 mm in all the cases and located deep in the muscular layer in the failure cases. The depth of the implants positively correlated with the time spent for removal (r=0.525; P=0.015). CONCLUSION: High frequency ultrasonography is a highly accurate tool for localization and measurement of the skin-to-rod depth. It is also useful for removing non-palpable implants. If the depth of the implant is >12.0 mm, removal of the implant in the operating room under general anesthesia is recommended.

Combination of clinical and laboratory characteristics may serve as a potential diagnostic marker for torsion on mature cystic teratomas

OBJECTIVE: The objective of this study was to evaluate clinical and laboratory characteristics of torsion on mature cystic teratomas (MCTs). In addition, we examined whether these factors could be helpful in diagnosing MCT torsion. METHODS: A retrospective medical record review was conducted for 384 patients who had undergone surgery and histologically verified ovarian MCTs at single university hospital between July 2006 and May 2017. Patients with or without torsion groups were compared with respect to clinical presentation, laboratory findings and surgical course. In addition, statistically significant indicators of the factors were additionally evaluated for diagnostic value. RESULTS: White blood cell (WBC) count, neutrophil count, neutrophil to lymphocyte (N/L) ratio, and tumor size were higher in the torsion group (n=24) than in the control group (n=360; P≤0.005 for all). The age was younger in the torsion group than in the control (P=0.009). In the area under the curve (AUC) of the 5 factors obtained by univariate and multivariate logistic regression, the age was 0.657, the WBC count was 0.838, the neutrophil count was 0.806, the N/L ratio was 0.725, and the cyst size was 0.705. Receiver operating characteristic analysis indicated that the AUC for the combined use of age, WBC count, neutrophil count, N/L ratio, and tumor size was 0.898 (95% confidence interval, 0.833–0.962; P < 0.001). CONCLUSION: The combined measurement of age, WBC count, neutrophil count, N/L ratio, and tumor size may be used as a potential diagnostic marker for the torsion on MCTs.

Clinical use of oral contraceptives

Since first introduction of oral contraceptive pills in 1960, with increased women's right of sexual decision, oral contraceptives had been used widely around the globe as a highly effective and safe contraceptive method. The physiological mechanisms of oral contraceptives were a reduced maturation of ovarian follicles and blocked ovulation to fertile women. Also, oral pills induce uterine endometrial decidualization, thickening of cervical mucus, disturbance of intrauterine sperm movement and embryo implantation. However, in addition to providing effective reversible contraception to fertile women, oral contraceptive pills offer various non-contraceptive benefits to numerous conditions. In this review, we summarize the list of currently available oral contraceptive pills in Korea and discuss non-contraceptive indications of oral contraceptives pills.

Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim's technique and comparison to laparotomy

OBJECTIVE: This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim's technique and to compare the surgical outcomes with those of laparotomy. METHODS: Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim's technique using a specially designed 30×30-cm²-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. RESULTS: In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; P<0.001). The number of postoperative general diet build-up days was also significantly shorter for the SPLS group (median, 1 [1 to 4] vs. 3 [2 to 16] days; P<0.001). Immediate post-operative pain score was lower in the SPLS group (median, 2.0 [0 to 8] vs. 4.0 [0 to 8]; P=0.045). Patient-controlled anesthesia was used less in the SPLS group (61.9% vs. 100%). CONCLUSION: SPLS was successful in removing most large ovarian tumors without rupture and showed quicker recovery and less immediate post-operative pain in comparison to laparotomy. SPLS using SW Kim's technique could be a feasible solution to removing huge ovarian tumors.

Effect of Preincubation of Blood Culture Bottles in a BacT/Alert Unit Outside Laboratory Operating Hours on Detection Time / 대한임상미생물학회지

BACKGROUND: The pre-storage condition of blood culture bottles prior to entering the automated blood culture system may affect the time to detection (TTD) of microorganisms and the final report days. METHODS: We compared the TTD and final report days according to the pre-incubation conditions after laboratory operating hours: room temperature (RT) vs. a BacT/Alert unit (BioMerieux Inc.) for 3 months respectively. All bottles were inserted into the main BacT/Alert system the next morning. RESULTS: TTD was significantly reduced by pre-incubating bottles in a BacT/Alert unit (median, 8.4 h) compared to pre-storage at RT (median, 12.4 h) (P< 0.001). The final report of bacterial identification and drug susceptibility within 2 days was available for 24.4% of bottles pre-incubated in a BacT/Alert unit compared to 14.9% of those incubated at RT. The false positive results were significantly higher for pre-incubation in a BacT/Alert unit (0.81%) than for that (0.29%) at RT (P<0.001). CONCLUSION: If a clinical microbiology laboratory is not operational for 24 hours, an automated blood culture unit might be a good alternative to reduce TTD and allow the submission of a faster final report compared to pre-storage at RT. However, false positive readings increased more than two-fold by pre-incubation in a BacT/Alert unit.

Overview of Korean Community Health Survey

In 2008, the Korean Centers for Disease Control and Prevention (KCDC) initiated Korean Community Health Survey (KCHS), the first nationwide survey to provide data that could be used to plan, implement, monitor and evaluate community health promotion and disease prevention program. This community-based cross-sectional survey has been conducted by 253 community health centers, 36 community universities and 1,500 interviewers. The KCHS standardized questionnaire is developed jointly by KCDC staff, a working group of health indicators standardization subcommittee and 16 metropolitan cities and provinces with 253 regional sites. The KCHS was administered by trained interviewers and the quality control of KCHS was improved by introduction of computer-assisted personal interview in 2010. The questionnaire was reviewed annually so that revised and/or new questions could be added based on public health policy. The additional questions included the fixed and rotating cores, emerging issues and optional modules. The standardized questionnaire of KCHS covered a wide variety of health topics, which could be used to assess the prevalence of personal health behaviors related to causes of disease. The KCHS data allows that the differences of health issues among provinces can be directly compared. Furthermore, the provinces can use these data for their own cost-effective health interventions to improve health promotion and disease prevention.

Quality Assessment of Ultrasonographic Equipment Using an ATS-539 Multipurpose Phantom

PURPOSE: To determine the rate of congruence and to standardize assessment of US (ultrasound) phantom images with the use of an ATS-539 multipurpose phantom for US equipment currently utilized in Korea MATERIALS AND METHODS: US phantom images were scanned with a 3.0-5.0 MHz convex transducer and were digitized by use of an analogue-digital converter. Members of a committee with consent evaluated the US phantom images from 108 types of ultrasound equipment. The dead zone, vertical and horizontal measurement, axial/lateral resolution, focal zone, sensitivity, functional resolution and gray scale/dynamic range were evaluated. Congruence or incongruence of ultrasound equipment was determined based on the results of dead zone, axial/lateral resolution and gray scale/dynamic range measurements. Other factors were evaluated for the possibility as criteria with the use of the Mann-Whitney U test and receiver operator characteristic (ROC) curve analysis. RESULTS: The dead zone, axial/lateral resolution and gray scale/dynamic range were 91.7%, 94.4% and 76.9%, respectively, for suitable US equipment. Considering all three factors, 78 types of ultrasound equipment were passed. The congruence rate of focal zone and functional resolution were 62.4% and 69.3% of the US equipment, respectively. CONCLUSION: Of the US equipment, 72.2% of the equipment was acceptable based on the dead zone, axial/lateral resolution, and gray scale/dynamic range measurements as determined with the use of an ATS-539 phantom. Focal zone and 8 mm-functional resolution can be useful as a standard in the assessment of a US phantom image.

Factors Related to Quality of Life among Rural Elderly / 성인간호학회지

PURPOSE: This study was conducted to explore the degree of depression, perceived health status, chronic disease and quality of life(QOL) among rural elderly and to determine the factors related to their QOL. METHOD: The design of this study was a correlational study. The subjects were 423 elderly consisted of 157(37.1%) men and 266(62.9%) women dwelling in a rural area of N City. Data were collected from May to December, 2003 using a structured questionnaire. A stepwise multiple regression analysis was performed to identify the factors related to the QOL. RESULT: It was found that the mean score of QOL was in total with 2.15 out of 5.00 and women elderly's score was significantly lower than men(t=2.20, p=.028). Perceived health status showed statistically significant positive relationship with QOL(r=.608, p<.05), while depression(r=-.751, p<.01) and chronic illness(r=-.336, p<.01) showed statistically significant negative relationship. Depression was found to have the highest correlation with QOL among the subjects. Depression score explained QOL at the most, accounting for 36.8% of the variability, followed by perceived health(8.2%) and the number of chronic illness(.7%). Other factors related to the QOL were economic status and absence of spouse. CONCLUSION: In order to increase the QOL of rural elderly, it is necessary to decrease the depression, to increase their perceived health status and to decrease the number of chronic illness. We suggest the implementation of a program not only to promote physical health status and self-care ability but to take care of mental health for the rural elderly.

Plasma LDL Particle Sizes Affect the Blood Lipid Profile and Dietary Intakes among Korean Adults / 대한지역사회영양학회지

The purpose of this research was to examine the relationship between the plasma LDL particle size and blood lipid profile, dietary factors and anthropometric values (body mass index, waist circumference and waist/hip ratio). The subjects were 173 adults aged 23 to 81 years, selected from the Outpatient Clinic and Cardiovascular Department of the Seoul Municipal Hospital. Dietary data were obtained using a 3-day food record and analyzed using Korean and US nutrient databases. The subjects were divided into three groups by LDL particle size:type A (large buoyant LDL, > 25.5 nm, n = 96), type I (Intermediate LDL, 25.2 < or = - < or = 25.5 nm, n = 18), and type B (small dense LDL, < 25.2 nm, n = 59) groups. The type B group had higher age, waist circumference, and waist/hip ratio (WHR) than the type A and type I groups. Serum concentration of triglyceride, Apo B, LDL/HDL cholesterol ratio and atherogenic index were significantly higher in the type B group as compared to those in the other two groups. HDL cholesterol level and Apo A-I/Apo B ratio were significantly lower in the type B group than the other two groups. The plasma LDL particle size was highly correlated with triglyceride (r = -0.450), Apo B (r = -0.402) and HDL cholesterol (r = 0.418). However, there was no correlation between plasma LDL particle size and dietary intakes. This study showed that small dense LDL was an important biochemical risk factor that was associated with other risk factors.

Laparoscopic Extirpation of the Term Sized Huge Ovarian Cyst / 영남의대학술지

A 23 years old single nulligravida woman underwent laparoscopic removal of a huge cystic adnexal mass that occupied her entire abdomen, giving the appearance of a full term pregnancy. After anesthesia, a vertical infra-umbilical incision, 1 cm long, was made and a telescope was introduced through the port to determine the status of the intra-abdomen and the surface contour of the mass. A needle tipped with a laparoscopic suction apparatus was inserted into the cyst through the infra-umbilical port, directly under the mass. Subsequently, 3, 200 ml of cystic fluid was aspirated without spillage. A huge cyst, reaching to the level of the xyphoid process was effectively excised through the operative laparoscopy after prelaparoscopic drainage. Operation time was 140 minutes and hospital stay was 2 days. There were no complications during hospital stay and after discharge. It seems the size of the cyst is not a criteria for the contraindication of laparoscopic surgery.

The Relationship between Serum Cholesterol Levels and Dietary Fatty Acid Patterns, Plasma Fatty Acids, and Other Lipid Profile among Korean Adults / 대한지역사회영양학회지

The purposes of this research were to assess dietary fatty acid patterns and to elucidate the relationship between the serum cholesterol levels and dietary fatty acid patterns, plasma fatty acid compositions, BMI (body mass index), and other lipid profile. The subjects were 151 adults aged 23 to 80 years, selected from the Outpatient Clinic and Cardiovascular Department of the Seoul Municipal Hospital. Dietary data were obtained using three day food records. Sixteen dietary fatty acids were analyzed using Korean and US nutrient databases. The subjects were divided into three serum cholesterol levels: desirable ( or = 200 - or = 240 mg/dl, N = 72) groups. The high-risk group had higher BMI, waist, and waist to hip ratio (WHR) than the desirable and borderline-risk groups. Serum concentrations of triglyceride, LDL cholesterol and LDL/HDL cholesterol ratio were significantly higher in the high-risk group as compared to those in the other two groups. The serum cholesterol levels were highly correlated with BMI (r = 0.435), triglyceride (r = 0.425) and LDL/HDL cholesterol (r = 0.870) ratio. The highest fatty acid intake was from oleic acid (33 - 34% of total fatty acid intakes), which was followed by linoleic acid (27%), palmitic acid (19%), and stearic acid (7%). There was no correlation between the serum cholesterol levels and the dietary fatty acid intakes, polyunsaturated/monounsaturated/saturated fatty acids (P/M/S) and omega6/omega3 ratios. The correlation between plasma fatty acids such as myristic acid, oleic acid, linoleic acid, and docosahexaenoic acid and serum cholesterol levels was also weak.

A Study of Accident-Prevention Education, Accidents and School Facilities for Safety Perceived by Elementary Schoolers / 아동간호학회지

This study was conducted to obtain a basic information related to a more systematic safety education and measures against children's accidents by a descriptive survey with regard to accidents actually experienced by elementary schoolers, their perceived safety education activities and school facilities to their safety lives. The data was collected among 1,654 pupils, belonging to the 5th and 6th grades in Pusan from Nov. 20 to Dec. 1, 2000. The data was analyzed using SPSSWIN(7.5). The results were as follows ; 1. According to the perception by elementary schoolers, they received safety life instruction at school in most cases from teachers in charge of their own class (41.0%). Such safety education was provided often during formal classes(24.4%). Traffic guidance was given by parents, highest in frequency(67.3%). 2. Matters as most often treated during safety life instruction were safety knowledge or dangerous things(37.5%). A majority of notices of school safety instruction were presented sometimes(48.4%). Source of knowledge about safety lives included teacher (35.3%), parents(32.9%), TV and newspaper (29.9%). As a source of knowledge of emergency treatment, school nurses were accounted for 41.3% that was highest. 3.Among the 1,654 students, 91.8% experienced at least more than one case of safety accident. The most frequent type and cause of safety accident were wound(33.7%). and self-carelessness(38.4%) respectively. In most cases, the subject experienced such accident during a break time(32.2%) and at a playgrounds. Part of body as most often damaged by accidents were arms and legs, 25.4% higher than any other sides problem solving measures against the accident were taken by school nurse in most cases, 44.8% in percentage point. 4. Those students' perceived safety management of school facilities showed that they considered classroom facilities as most safe (61.6%), while playground facilities as least safe(42.8%). They also responded that the treatment of glass fragments or stones at playground is the most important item of safety management.

Differentiation of Tuberculous Pneumonia and Community-acquired Pneumonia: Usefulness of Chest Radiography and Serum CA-125

PURPOSE: To determine whether tuberculous pneumonia can be distinguished from community-acquired pneumonia on the basis of chest radiographic findings only and the diagnostic utility of differences in serum CA-125 levels. MATERIALS AND METHODS: Forty-five patients with a high fever (>38 'C) in whom chest radiography revealed lobar consolidation were retrospectively studied. In 27 cases, the presence of acid-fast bacilli in sputum (n=21), the isolation of Mycobacterium tuberculosis from bronchoscopic biopsy tissue and sputum cultures (n=16), and improvement in the findings of serial radiography and in clinical symptoms during antituberculous therapy (n=1) let to a diagnosis of tuberculous pneumonia. A diagnosis of community-acquired pneumonia (n=18) was based on improvement in the serial radiographic findings obtained during antibacterial therapy (n=16), and the isolation of bacteria from sputum and pleural fluid culture (n=2). On the basis of independently analysed findings, radiologist determined the presence or absence of nodular density, cavitary lesions and loss of lung volume, while two radiologists differentiated between tuberculous pneumonia and community-acquired pneumonia. RESULT: Initial chest radiographs of tuberculous pneumonia revealed nodular density in 89% of cases, cavitary lesions in 29%, and loss of lung volume nodular density was in 26%, while those of community-acquired pneumonia demonstrated nodular density in only 22%, cavitary lesions in 6%, and loss of lung volume in none was a significant statistical difference in nodular density, cavitary lesions and loss of lung voume (p<0.005). The average serum CA-125 level in tuberculous pneumonia was 306.5 (range, 21.3 -1078) U/ml, whereas the average level in community-acquired pneumonia was 38.0 (range, 11.3 -114.8) U/ml (p<0.005). CONCLUSION: Initial chest radiography can differentiate between tuberculous and community-acquired pneumonia on the basis of nodular density, cavitary lesions and loss of lung volume and differences in CA-125 levels also provide a useful means of differentiating between these pneumonias.

Low Attenuation on High Resolution Computed Tomography in Pulmonary Embolism: An Experimental Study in Pigs

PURPOSE: To evaluate the incidence and type of low attenuation seen on high resolution computed tomography (HRCT) performed after artificially induced pulmonary embolism. MATERIALS AND METHODS: Using permanent embolic materials, pulmonary embolism was induced in ten Yorkshire pigs. Pre- and postembolic pulmonary angiography was performed, and HRCT was performed immediately and 1, 3, and 6 weeks after embolization. The incidence and type of low attenuation of all segments, as seen on HRCT, was evaluated. Low attenuation was classified as mottled, lobular, segmental, or peripheral. The pigs were sacrified after 6 weeks and contact radiographs were obtained. RESULTS: Low attenuation developed in eight of ten pigs. Pulmonary angiography revealed arterial occlusion in 15 large and 19 small segmental arteries (34 of 45 segments). In the remaining 11 segments, follow-up HRCT demonstrated areas of low attenuation. This was present in 25 of 35 segments (71%) as seen on HRCT images obtained immediately; in 16 of 41 segments (39 %) on images obtained 1 week after embolization; in 17 of 41 segments (41 %) on those acquired at 3 weeks; and in 25 of 45 segments (56 %) on those acquired at 6 weeks. The overall incidence of low attenuation was 83/166 (50 %). The types of low attenuation were mottled in 32/83 cases, lobular in 13/83, segmental in 13/83, and peripheral in 25/83. In large segmental arterial occlusion, the incidence of low attenuation on HRCT was 100% immediately, 57% at 1 week, 60% at 3 weeks, and 80 % at 6 weeks. In small segmental arterial occlusion, the incidence was 47%, 25 %, 11 %, and 21 % respectively. The overall incidence of low attenuation was 40/55 (73 %) in large segmental arterial occlusion and 18/71 ( 25%) in small segmental arterial occlusion. CONCLUSION: Low attenuation on HRCT is a finding of pulmonary embolism and is more common on HRCT performed immediately after embolization (71%) and in large segmental arterial occlusion (73%). Low attenuation on HRCT is an ancillary finding and may be useful in the diagnosis of pulmonary embolism.

The Usefulness of Levin Tube Inserted Drip Infusion Spiral CT: Comparison with Conventional Method in SubtotalGastrectomy Patients

PURPOSE: To access the usefulness of newly designed Leven tube inserted drip infusion spiral CT for theevaluation of remnant stomach and anastomosis site in patients who have undergone subtotal gastrectomy for stomachcancer. MATERIAL AND METHODS: A new technique named Levin tube inserted drip infusion spiral CT was used toprospectively study 23 patients. A 16Fr Levin tube was inserted into the remnant stomach ; 500ml of tap water wasdrip infused just before CT scanning and an additional 500ml of water was infused during IV contrast injection.Water was infused by gravity, using a water bottle suspended at a height of 90cm(Group A). The 31 patients whounderwent conventional spiral CT scanning immediately after the divided ingestion of 900ml diluted gastrografinwere selected as a control group(Group B). The anatomic delineation of the anastomosis site was graded by tworadiologists as excellent(3), good(2), fair(1) or poor(0). To evaluate the degree of distension, the maximaldiameters of remnant stomach and the anastomosis site, and the thickness of the stomach wall, were also measured. RESULTS: In group A, anatomic delineation of the anastomosis site was excellent, compared to group B(mean score:2.91 vs 1.19, P<0.01). In addition, the maximum diameters of remnant stomach and anastomosis site weresignificantly larger in group A than in group B(transverse A-P remnant stomach and anastomosis site : 92.4+/-16.0mm, 97.6+/-26.5mm, 29.7+/-7.3mm vs 50.6+/-12.9mm, 53.5+/-14.4mm, 7.7+/-4.4mm, P<0.01). The mean thickness of distended stomach wallin group A was 3.2+/-1.7mm ; in group B, measurement was possible in only a few cases, but their number was too smallfor comparison. CONCLUSION: In patients who had undergone subtobal gastrectomy, Levin tube inserted drip infusionspiral CT showed excellent anatomic delineation of the site of anastomosis and remnant stomach. We found thatbecause it increases the distension of remnant stomach and the anastomosis site, this technique is effective forthe evaluation of postoperative stomach.

Clinical significance of CA125 level in tuberculous pneumonia / 결핵

BACKGROUND: In case of tuberculous pneumonia, differentiation from bacterial lobar pneumonia is sometimes very difficult because clinical symptoms, signs and radiological images are very similar. So we investigated the usefulness of CA125, which is known to increase in tuberculous diseases, in differential diagnosis between tuberculous pneumonia (TBPN) and community acquired bacterial lobar pneumonia (LP). METHODS: Serum CA125 level was measured in 20 patients with TBPN (female 12 male 8: mean age 36.1 years) and 14 patients with LP (female 5 male 9: mean age 45.1 years) by radioimmunoassay (Centocor(R) CA125 RIA kit). RESULTS: 1) The serum CA125 level in TBPN (333.7 283.5 u/ml) was higher than in LP (60.9 66.2 u/ml). (P 0.05) 4) Following up of serum CA125 level after initiation of antituberculosis treatment showed rapid decline and approach to near normal range in 6 months. CONCLUSION: High serum CA125 level (> 195 u/ml) was useful in differential diagnosis of TBPN from LP.

Primary Pulmonary Lymphoma: A Report of 2 Cases

PURPOSE: Primary pulmonary lymphoma(PPL) arising in the lung as the initial site is very rare. Authors experienced two cases of PPL and report the radiologic findings and clinical characteristics with a brief reviewof the literature. METHODS AND MATERIALS: Plain chest radiograph and enhanced axial CT scan of the chest were taken. We analyzed radiologic findings of the two cases and correlated with broncoscopic and pathologic findings. RESULTS: Plain chest radiograph showed a mass like consolidative lesion on RML without peripheral atelectasis. Chest CT scan revealed a mass like consolidation with airbronchogram and the absence of a hilar mass or thoracic adenopathy. Percutaneous needle aspiration and biopsy(PCNA and PCNB) of the RML mass confirmed B-cell lymphoma, in both cases. CONCLUSION: PPL must be included in the differential diagnosis of chronic alveolar consolidation such as bronchioloalveolar cell carcinoma.