Out-of-hospital cardiac arrest: incidence, patient characteristics, outcomes, and trends over time between 2012 and 2018 in an urban city

Objective@#This study aimed to determine the incidence, characteristics, and outcomes of out-of-hospital cardiac arrests (OHCA) and to investigate the trends for the same in Changwon city, South Korea between 2012 and 2018. @*Methods@#We analyzed a list of adult cardiac arrest cases occurring between 2012 and 2018 from the OHCA surveillance registry and the Changwon Fire Department’s emergency medical services database. The trends in the incidence and resuscitation-related characteristics were assessed using nonparametric tests for trends across ordered groups. The predictors of the primary outcome were investigated using multivariable logistic regression. The primary outcome was a good neurological outcome at hospital discharge. @*Results@#A total of 2,951 OHCAs were attended by the emergency medical services and of these, 2,834 were included in this study. Overall, the proportion of patients discharged with a good neurologic outcome was 4.7% (133/2,834). Both OHCA survival and good neurologic outcomes improved significantly over time, from 4.9% and 2.1%, respectively, in 2012 to 10.3% and 7.4% in 2018 (P<0.001). The Utstein comparator (bystander-witnessed arrests presenting with initial shockable rhythm) increased over the study period (P-for-trend<0.001). Age, response time, scene time, in-hospital cardiopulmonary resuscitation (CPR) time, witness presence, cardiac origin, and shockable rhythm were associated with good neurologic outcomes. @*Conclusion@#With the gradual increase in the proportion of patients with witnessed cardiac arrests, bystander CPR, and initial shockable rhythm, the rate of survival and a good neurologic outcome at discharge also increased annually.

Pediatric out-of-hospital cardiac arrest: incidence and outcomes in an urban city

Objective@#The aim of this study was to examine the incidence and outcomes of pediatric out-of-hospital cardiac arrests (OHCA) in Changwon city, South Korea. @*Methods@#From the Out-of-Hospital Cardiac Arrest Surveillance registry and the Changwon Fire Department’s Emergency Medical Services data, we obtained a list of 119 assessed pediatric OHCAs occurred between January 2012 and December 2018. We analyzed basic demographic variables, the location of cardiac arrest, witnessed status, bystander cardiopulmonary resuscitation (CPR), time variables for CPR, dispatcher-assisted CPR, initial cardiac rhythm, automated defibrillator use, and clinical outcomes at hospital discharge. @*Results@#A total of 2,954 OHCAs occurred during the study period, of which 72 were pediatric OHCAs. The rate of witnessed cardiac arrest was 30.6% (22/72), and bystander CPR was performed in 29 patients (40.3%). The rate of cardiac arrest occurring in public places was 16.7% (12/72). The rate of shockable rhythm in the initial electrocardiogram rhythm was 8.3% (6/72). Twelve patients (16.7%) survived to admission. The proportion of survivors discharged was 4.3% (3/70), and the rate of discharge with a good prognosis was 2.8% (2/70). @*Conclusion@#The incidence rate of pediatric OHCA was low in Changwon city. The survival rate was also low. Thus, studies with larger sample sizes and continuous monitoring in the community are needed.

Associations among the Degree of Nonalcoholic Fatty Liver Disease, Metabolic Syndrome, Degree of Obesity in Children, and Parental Obesity / 대한소아소화기영양학회지

PURPOSE: To analyze the associations among the degrees of nonalcoholic fatty liver disease (NAFLD) by ultrasonography and metabolic syndrome, degrees of obesity in children, and degrees of parental obesity. METHODS: A total of 198 children with obesity who visited a pediatric obesity clinic were prospectively enrolled in this study. The severity of NAFLD based on ultrasonography was classified into no, mild, moderate, or severe NAFLD group. The degree of obesity based on the percentage over standard weight for height per sex was classified into mild, moderate, or severe. RESULTS: Of 132 patients evaluated for the degree of NAFLD and metabolic syndrome, the p-value of correlation between the two factors was 0.009. Therefore, metabolic syndrome might significantly affect the degree of NAFLD. Of 158 patients evaluated for the degree of NAFLD and the degree of obesity, the p-value of correlation between the two factors was 0.122. Of 154 patients evaluated for the degree of obesity and father's obesity, the p-value was 0.076. Of 159 patients evaluated for the degree of obesity and mother's obesity, the p-value was 0.000, indicating that mother's obesity could significantly affect the degree of obesity in children. Of 142 patients evaluated for the degree of obesity and metabolic syndrome, the p-value was 0.288. CONCLUSION: Metabolic syndrome might significantly affect the degree of nonalcoholic fatty liver in children. In addition, mother's obesity might be a significant factor that affects the degree of obesity in children.

Clinical Effect of Left Ventricular Dysfunction in Patients with Mitral Stenosis after Mitral Valve Replacement

BACKGROUND: Mitral stenosis (MS) remains one of the important heart diseases. There are many factors that influence the clinical outcomes, and little is known about how left ventricular (LV) dysfunction clinically affects the prognosis of the patient with MS after mitral valve replacement (MVR). We reviewed our clinical experiences of MVR in patients with MS who had LV dysfunction. METHODS: Between January 1991 and January 2013, 110 patients with MS who underwent MVR were analyzed and divided into two groups according to ejection fraction (EF). Group 1 (EF≤45%) included 13 patients and group 2 (EF>45%) included 97 patients. RESULTS: Thromboembolism occurred in 8 patients after MVR (group 1: n=3, 23.1%; group 2: n=5, 5.2%) and its incidence was significantly higher in group 1 than in group 2 (p=0.014). There were 3 deaths each in groups 1 and 2 during follow-up. The overall rate of cardiac-related death in group 1 was significantly higher than in group 2 (group 1: n=3, 23.1%; group 2: n=3, 3.1%; p=0.007). The cumulative survival rate at 1 and 15 years was 83.9% and 69.9% in group 1 and 97.9% and 96.3% in group 2 (p=0.004). The Cox regression analysis revealed that survival was significantly associated with postoperative stroke (p=0.011, odds ratio=10.304). CONCLUSION: This study identified postoperative stroke as an adverse prognostic factor in patients with MS after MVR, and as more prevalent in patients with LV dysfunction. Postoperative stroke should be reduced to improve clinical outcomes for patients. Preventive care should be made in multiple ways, such as management of LV dysfunction, atrial fibrillation, and anticoagulation.

Visceral Debranching Thoracic Endovascular Aneurysm Repair for Chronic Dissecting Thoracoabdominal Aortic Aneurysm

Type II chronic dissecting thoracoabdominal aortic aneurysms are a surgically challenging disease. The conventional thoracoabdominal aortic aneurysm repair technique using cardiopulmonary bypass is a high-risk procedure. However, a recently developed endovascular technique may be an alternative treatment for the disease, but faces the obstacle of lesional restriction. This new technique uses a hybrid strategy to overcome the limits of endovascular thoracoabdominal aortic aneurysm repair. Herein, we report on a successful outcome after performing the hybrid visceral debranching procedure.

Left Atrial Myxoma Presenting with Unusual Cystic Form

Cardiac myxomas are the most common primary benign tumors of uncertain etiology. They usually present as polypoid or oval-shaped masses projecting into a heart chamber from the interatrial septum and have a soft, gelatinous consistency without a cystic structure. We report a case of left atrial myxoma with a single cystic form.

Outcomes of Mitral Valve Repair: Quadrangular Resection versus Chordal Replacement

BACKGROUND: Mitral valve repair for posterior mitral leaflet (PML) prolapse has been considered to be a standard treatment because of its high success rate and high level of patient satisfaction. The aim of this study was to evaluate the clinical results of two different techniques of PML prolapse, quadrangular resection (QR) and chordal replacement (CR). MATERIALS AND METHODS: The subjects consisted of 56 patients who had undergone mitral valve repair for PML prolapse between November 1997 and December 2010. The patients were divided into two groups according to surgical technique. Among them, 31 patients underwent QR (group QR) and 25 patients had CR (group CR). We reviewed the medical records of the patients retrospectively to compare the clinical outcomes of both groups. RESULTS: After mitral valve repair, the degree of mitral regurgitation (MR) in both groups decreased to the to a mild degree or less and the amount of remnant MR was slightly higher in the CR group but it was not statistically different. Three patients received mitral valve-related reoperation (2 in the QR group and 1 in the CR group). Freedom from mitral valve-related reoperation at 7 years was 93% for the QR group and 96% for the CR group and was not significantly different between the two groups. CONCLUSION: Both QR and CR showed excellent long-term results and were considered equally effective methods for PML prolapse.

Analysis of 50 Cases of Renal Injury which Occurred in the Last 6 Years / 대한비뇨기과학회지

In an effort to characterize the trend of renal injury of recent years, we reviewed the charts and x-ray films of 50 patients with renal trauma which occurred in the last 6 years. They were 42 males and 8 females with a mean age of 26.4 years (range: 5 to 66) and most of them are younger generation. The main causes of injury were related to falling down in 21 cases (42%) and traffic accident in 17 cases (34%), followed by stab injury in 7 cases and assault in 5 cases. The severity of renal injury was classified using the renal injury scale which was published by the Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) in 1989. According to radiologic and operative findings, they were classified as follows; Grade I, 4 cases; Grade II, 7 cases; Grade III, 12 cases; Grade IV, 23 cases; and Grade V, 4 cases. Of the 50 patients, 39 had gross hematuria and remaining 11 patients had microscopic hematuria. There was no correlation between the degree of hematuria and the severity of renal injury (p=0.098). The major combined other organ injuries were hemoperitoneum in 12 cases, fracture of extremities in 8 cases, liver laceration in 5 cases, hemopneumothorax in 4 cases and intestinal perforation in 2 cases. Surgical treatment was performed in 27 cases (54%) and the remaining 23 cases (46%) which were renal laceration of various degrees without intraperitoneal injuries were managed conservatively.

Study on the Chromosome 13 and 17 of Prostatic Cancers by Fluorescence In Situ Hybridization Technique / 대한비뇨기과학회지

To detect the numerical changes of the chromosome 13 and 17, containing tumor suppressor genes (retinoblastoma gene and p53) in normal tissue, intraepithelial neoplasm and carcinoma of the prostate, the Fluorescence In Situ Hybridization technique with paraffin embedded tissue was done. Materials observed in this study consisted of the 14 cases of localized carcinoma (T2aN 0M0) and 1 case of locally infiltrating cancer (T3aN2M0). The chromosomal number changes were counted at normal tissue, intraepithelial neoplasm and neoplastic gland at the same radical prostatectomy specimen. The results were as follows: 1. There were no significant chromosomal number changes between 13 and 17 in each group 2. The normal non-neoplastic duct, intraepithelial neoplasm and neoplastic gland of the experimental group showed no significant difference in chromosomal change. 3. There were significant changes more than 30% in chromosomal numbers between control Y chromosome and experimental chromosome 13 and 17 in each group. 4. With the results collected from this study, chromosomal aberration in number in prostate biopsy could represent the already established initiation of the cancerous change in prostate and the chromosomal aberration detection method would be a good early diagnostic modality to detect the high risk group who will develop the prostate cancer.

Transrectal ultrasonography: evaluation of bladder wall inversion in cervical cancer / 대한비뇨기과학회지

Forty eight patients with cervical cancer underwent cystoscopy, computed tomography and transrectal and transvaginal ultrasonography. Transrectal ultrasonography was as accurate as computed tomography in the evaluation of the bladder wall invasion in cervical cancer. Most patients with bullous edema in cystoscopy appeared to have invasive lesions in transrectal ultrasonography. Transrectal ultrasonography was superior to transvaginal one in the evaluation of the posterior well of the bladder. In conclusion. transrectal ultrasonography is an another good diagnostic method for the evaluation of the bladder wall invasion in cervical cancer.

Knowledge and Practice of College Entrants Toward Hepatitis B / 예방의학회지

In order to designate a status necessary for establishment of preventive measures and guidelines of health education against hepatitis B in the course of secondary school education, knowledge and practice toward hepatitis B virus infection was surveyed by a questionnaire method on total of 4,855 college entrants in the academic year of 1987 and analyzed the data collected using IBM PC(Trigem 88-II) with SAS package program. About two percent of college entrants had past history of HBV infections not showing any difference between both sexes and geographical regions. About one third(33.7%) of total students had tested hepatitis B surface antigen(HBsAg), only 4% had tested hepatitis B surface antibody(HBsAb) and vaccination rate amounted to 24.6%, one fourth of total subjects. Both serological tests and vaccination were most commonly performed during adolescence, showing higher rates in female students than in male students. The rates also seemed to be higher in those from urban cities than those from rural cities. Students who had acquired correct knowledge that hepatitis B was infected by virus were amounted to 78.5% of college entrants, and remaining 21.5% had misunderstood that rickettsia, bacteria, fungi or parasites were casual agents. Female students were better aware of the causal agents than male students but there was no difference between places of growth. As for mode of transmission of HBV, 51.5% of male students and 47.7% of female students had correct knowledge. A very few student had known that fact that HBV was transmitted by body fluids such as tear (6.9%), nasal discharge(10.1%) and semen or vaginal secretion(19.2%) and majority(75%) of students had misunderstood that hepatitis B virus would be transmitted per os through food ingestion. Approximately one half(48.9%) of college entrants had correctly whom to be vaccinated. Approximately one half of the students knew that hepatoma(57.8%) and liver cirrhosis(57.4%) might complicate with hepatitis B virus infection, whereas 12.0% of the students responded that bronchitis was one of the complications of hepatitis B infection. In summary of the above results, we highly recommend that health education program for eradication of hepatitis B virus infection should be introduced in curricula of secondary school education in this country.