ABSTRACT
Merkel cell carcinoma (MCC), a rare cutaneous neuroendocrine carcinoma, is most common in sun-exposed areas of aged individuals. Merkel cell polyomavirus (MCPyV) is one causative agent of MCC. Cases of MCC concurrent with other skin tumors, especially squamous cell carcinoma, are rarely reported. Immunohistochemical staining is performed using antibodies to the MCPyV large-T antigen (CM2B4) only in select cases. To date, no cases of MCPyV have been reported in Korea. Here we report a case of MCC concurrent with squamous cell carcinoma in an aged man and discuss the pathogenesis of the case through CM2B4 staining.
ABSTRACT
Purpose@#In 2015, the South Korean government legislated the Act for the Improvement of Training Conditions and Status of Medical Residents (Medical Resident Act). This study investigated changes in the working and learning environment pre- and post-implementation of the Medical Resident Act in 2017, as well as changes in training conditions by year post-implementation. @*Methods@#An annual cross-sectional voluntary survey was conducted by the Korean Intern Resident Association (KIRA) between 2016 and 2019. The learning and working environment, including extended shift length, rest time, learning goals, and job satisfaction, were compared by institution type, training year, and specialty. @*Results@#Of the 55,727 enrollees in the KIRA, 15,029 trainees took the survey, and the number of survey participants increased year by year (from 2,984 in 2016 to 4,700 in 2019). Overall working hours tended to decrease; however, interns worked the most (114 hours in 2016, 88 hours in 2019; P<0.001). Having 10 hours or more of break time has gradually become more common (P<0.001). Lunch breaks per week decreased from 5 in 2017 to 4 in 2019 (P<0.001). Trainees’ sense of educational deprivation due to physician assistants increased from 17.5% in 2016 to 25.6% in 2018 (P<0.001). Awareness of tasks and program/work achievement goals increased from 29.2% in 2016 to 58.3% in 2018 (P<0.001). Satisfaction with the learning environment increased over time, whereas satisfaction with working conditions varied. @*Conclusion@#The Medical Resident Act has brought promising changes to the training of medical residents in Korea, as well as their satisfaction with the training environment.
ABSTRACT
Purpose@#In 2015, the South Korean government legislated the Act for the Improvement of Training Conditions and Status of Medical Residents (Medical Resident Act). This study investigated changes in the working and learning environment pre- and post-implementation of the Medical Resident Act in 2017, as well as changes in training conditions by year post-implementation. @*Methods@#An annual cross-sectional voluntary survey was conducted by the Korean Intern Resident Association (KIRA) between 2016 and 2019. The learning and working environment, including extended shift length, rest time, learning goals, and job satisfaction, were compared by institution type, training year, and specialty. @*Results@#Of the 55,727 enrollees in the KIRA, 15,029 trainees took the survey, and the number of survey participants increased year by year (from 2,984 in 2016 to 4,700 in 2019). Overall working hours tended to decrease; however, interns worked the most (114 hours in 2016, 88 hours in 2019; P<0.001). Having 10 hours or more of break time has gradually become more common (P<0.001). Lunch breaks per week decreased from 5 in 2017 to 4 in 2019 (P<0.001). Trainees’ sense of educational deprivation due to physician assistants increased from 17.5% in 2016 to 25.6% in 2018 (P<0.001). Awareness of tasks and program/work achievement goals increased from 29.2% in 2016 to 58.3% in 2018 (P<0.001). Satisfaction with the learning environment increased over time, whereas satisfaction with working conditions varied. @*Conclusion@#The Medical Resident Act has brought promising changes to the training of medical residents in Korea, as well as their satisfaction with the training environment.
ABSTRACT
Background@#We investigated how 100-g oral glucose tolerance test (OGTT) results can be used to predict adverse pregnancy outcomes in gestational diabetes mellitus (GDM) patients. @*Methods@#We analyzed 1,059 pregnant women who completed the 100-g OGTT between 24 and 28 weeks of gestation. We compared the risk of adverse pregnancy outcomes according to OGTT patterns by latent profile analysis (LPA), numbers to meet the OGTT criteria, and area under the curve (AUC) of the OGTT graph. Adverse pregnancy outcomes were defined as a composite of preterm birth, macrosomia, large for gestational age, low APGAR score at 1 minute, and pregnancy-induced hypertension. @*Results@#Overall, 257 participants were diagnosed with GDM, with a median age of 34 years. An LPA led to three different clusters of OGTT patterns; however, there were no significant associations between the clusters and adverse pregnancy outcomes after adjusting for confounders. Notwithstanding, the risk of adverse pregnancy outcome increased with an increase in number to meet the OGTT criteria (P for trend=0.011); odds ratios in a full adjustment model were 1.27 (95% confidence interval [CI], 0.72 to 2.23), 2.16 (95% CI, 1.21 to 3.85), and 2.32 (95% CI, 0.66 to 8.15) in those meeting the 2, 3, and 4 criteria, respectively. The AUCs of the OGTT curves also distinguished the patients at risk of adverse pregnancy outcomes; the larger the AUC, the higher the risk (P for trend=0.007). @*Conclusion@#The total number of abnormal values and calculated AUCs for the 100-g OGTT may facilitate tailored management of patients with GDM by predicting adverse pregnancy outcomes.
ABSTRACT
Objective@#Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and is both unpredictable and inevitable. While uterotonic drugs are routinely recommended, there is ongoing debate on the ideal intervention to control uterine bleeding. This review aims to compare the use of non-pharmacologic treatments with peripartum hysterectomy in cases of life-threatening uncontrolled obstetric hemorrhage. The review’s objective is to use a network meta-analysis to help prevent maternal deaths and rank the treatments according to success rates. @*Methods@#We searched MEDLINE (PubMed), Embase, and the Cochrane Library, from January 2014 until December 2018. A second search was carried out in April 2019 before the final data analysis. Network meta-analysis allows for the calculation of the effect size between treatment groups through indirect treatment comparison. @*Results@#We confirmed that balloon-assisted management is the best intervention for uncontrolled postpartum bleeding with pharmacologic treatment. This is followed by uterine artery embolization and surgical procedures, which can help avoid the need for a hysterectomy. The balloon tamponade demonstrated lower failure rate than the surgical procedure with odds ratio (OR) of 0.44 and 95% confidence intervals (CIs) 0.50–30.54. Uterine artery embolization had a lower risk for hysterectomy than the surgical procedure group (OR, 0.74; 95% CI, 0.22–2.50). @*Conclusion@#For the quick treatment of postpartum bleeding, balloon tamponade is the best method for uncontrolled postpartum bleeding with pharmacologic treatment, followed by uterine artery embolization and surgical procedures.
ABSTRACT
Objective@#To provide updates on maternal, infant, and perinatal mortality using the national population data of South Korea between 2009 and 2017 and describe the mortality rate by target groups, timing, or causes of events to provide a basis for detecting vulnerable populations and ensuring timely medical and political interventions. @*Methods@#Pregnancy-related mortality in women, as well as deaths of infants, in South Korea was identified using population data from Statistics Korea. Records from death certificates, cremation reports on infant and fetal deaths, and the complementary cause-of-death investigation system were reviewed for the 2009–2017 period. @*Results@#A total of 461 maternal deaths, 11,717 infant deaths, and 12,249 perinatal deaths, including fetal deaths over 28 gestational weeks, were identified from 3,945,159 live births between 2009 and 2017. The maternal mortality ratio was 13.5 deaths per 100,000 live births in 2009 and decreased to 7.8 in 2017. Only the rate of deaths related to hypertensive disorders showed an increasing tendency. Both the infant and perinatal mortality rates improved (from 3.2 deaths per 1,000 live births in 2009 to 2.8 in 2017 and from 3.5 to 2.7, respectively). Among the external causes of infant mortality, assaults including homicides accounted for 25% (n=150), and this proportion was constant throughout the study period. @*Conclusion@#Overall improvements were observed in all maternal, infant, and perinatal mortality measures. In-depth analysis and interventions with respect to certain causes, such as hypertensive disorders in mothers or assaults in infants, should be considered priority issues.
ABSTRACT
Objective@#Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and is both unpredictable and inevitable. While uterotonic drugs are routinely recommended, there is ongoing debate on the ideal intervention to control uterine bleeding. This review aims to compare the use of non-pharmacologic treatments with peripartum hysterectomy in cases of life-threatening uncontrolled obstetric hemorrhage. The review’s objective is to use a network meta-analysis to help prevent maternal deaths and rank the treatments according to success rates. @*Methods@#We searched MEDLINE (PubMed), Embase, and the Cochrane Library, from January 2014 until December 2018. A second search was carried out in April 2019 before the final data analysis. Network meta-analysis allows for the calculation of the effect size between treatment groups through indirect treatment comparison. @*Results@#We confirmed that balloon-assisted management is the best intervention for uncontrolled postpartum bleeding with pharmacologic treatment. This is followed by uterine artery embolization and surgical procedures, which can help avoid the need for a hysterectomy. The balloon tamponade demonstrated lower failure rate than the surgical procedure with odds ratio (OR) of 0.44 and 95% confidence intervals (CIs) 0.50–30.54. Uterine artery embolization had a lower risk for hysterectomy than the surgical procedure group (OR, 0.74; 95% CI, 0.22–2.50). @*Conclusion@#For the quick treatment of postpartum bleeding, balloon tamponade is the best method for uncontrolled postpartum bleeding with pharmacologic treatment, followed by uterine artery embolization and surgical procedures.
ABSTRACT
Objective@#To provide updates on maternal, infant, and perinatal mortality using the national population data of South Korea between 2009 and 2017 and describe the mortality rate by target groups, timing, or causes of events to provide a basis for detecting vulnerable populations and ensuring timely medical and political interventions. @*Methods@#Pregnancy-related mortality in women, as well as deaths of infants, in South Korea was identified using population data from Statistics Korea. Records from death certificates, cremation reports on infant and fetal deaths, and the complementary cause-of-death investigation system were reviewed for the 2009–2017 period. @*Results@#A total of 461 maternal deaths, 11,717 infant deaths, and 12,249 perinatal deaths, including fetal deaths over 28 gestational weeks, were identified from 3,945,159 live births between 2009 and 2017. The maternal mortality ratio was 13.5 deaths per 100,000 live births in 2009 and decreased to 7.8 in 2017. Only the rate of deaths related to hypertensive disorders showed an increasing tendency. Both the infant and perinatal mortality rates improved (from 3.2 deaths per 1,000 live births in 2009 to 2.8 in 2017 and from 3.5 to 2.7, respectively). Among the external causes of infant mortality, assaults including homicides accounted for 25% (n=150), and this proportion was constant throughout the study period. @*Conclusion@#Overall improvements were observed in all maternal, infant, and perinatal mortality measures. In-depth analysis and interventions with respect to certain causes, such as hypertensive disorders in mothers or assaults in infants, should be considered priority issues.
ABSTRACT
There have been few studies investigating the association between atopic dermatitis (AD) and prenatal exposure to heavy metals. We aimed to evaluate whether prenatal exposure to heavy metals is associated with the development or severity of AD in a birth cohort study. A total of 331 subjects were followed from birth for a median duration of 60.0 months. The presence and severity of AD were evaluated at ages 6 and 12 months, and regularly once a year thereafter. The concentrations of lead, mercury, chromium, and cadmium in umbilical cord blood were measured by inductively coupled plasma mass spectrometry. Cord blood mononuclear cells (CBMCs) were isolated and stimulated for analysis of cytokine production using ELISA. Heavy metal levels in cord blood were not associated with the development of AD until 24 months of age. However, a positive correlation was observed between the duration of AD and lead levels in cord blood (p=0.002). AD severity was also positively associated with chromium concentrations in cord blood (p=0.037), while cord blood levels of lead, mercury, and cadmium were not significantly associated with AD severity (p=0.562, p=0.054, and p=0.055, respectively). Interleukin-13 production in CBMCs was positively related with lead and chromium levels in cord blood (p=0.021 and p=0.015, respectively). Prenatal exposure to lead and chromium is associated with the persistence and severity of AD, and the immune reaction toward a Th2 polarization.
Subject(s)
Cacao , Cadmium , Chromium , Cohort Studies , Dermatitis, Atopic , Enzyme-Linked Immunosorbent Assay , Fetal Blood , Interleukin-13 , Mass Spectrometry , Metals, Heavy , Parturition , Plasma , Umbilical CordABSTRACT
BACKGROUND: There have been many voices highlighting the necessity of preconception care as a preventive approach to achieve better pregnancy outcomes for health promotion of mothers and babies. It is important to get preconception care for both men and women, as they play equally important roles for healthy pregnancy. Also, awareness and knowledge of men and women about their health are important factors for behavioral changes for preconception care. PURPOSE: The purpose of this study is to analyze the level of awareness about men and women's preconception care and knowledge of the determinants of healthy pregnancy by gender. Our second goal was to compare men and women's level of awareness and knowledge on it. METHODS: The participants were 500 males and females (aged over 19 years and under 49 years old) either living or working in Seoul city. The data collection period of the study was from July to December, 2017. An online survey was conducted using a panel of online vendors. Then the collected data were analyzed using SPSS 24.0. RESULTS: Awareness about both men and women's preconception care was significantly higher in women than in men (p=0.004, p=0.002). Furthermore, there was a significant difference between men and women (p=0.00) in the total score of knowledge on the determinants of preconception care, including smoking, alcohol drinking, age, folic acid intake, and check-up for infectious disease (p=0.00; means women 8.20±1.95 and men 7.27±2.38). Significant gender differences were also found on some items, such as men's alcohol drinking, men's age, men's check-up for infectious disease, women's intake of folic acid, women's check-up for infectious disease. The level of knowledge on men's folic acid intake was the lowest in both men and women. CONCLUSION: Based on the results on the analysis of gender differences in the awareness and knowledge about preconception care, it is necessary to develop and implement preconception care programs based on the gender perspective approach to make women and men equally share responsibility of the birth result.
Subject(s)
Female , Humans , Male , Pregnancy , Alcohol Drinking , Commerce , Communicable Diseases , Data Collection , Folic Acid , Health Promotion , Mothers , Parturition , Preconception Care , Pregnancy Outcome , Seoul , Smoke , Smoking , VoiceABSTRACT
PURPOSE: To identify the potential risk factors for preterm birth (PTB) in women with advanced maternal age in the Korean population. METHODS: We selected the data of 531 pregnant women and singletons in the Korean Preterm Collaborate Network Study. Among the data, we analyzed variables related to demographic characteristics, lifestyle factors, and delivery information. Maternal age was divided into two groups: younger ( < 35 years) and advanced (≥35 years). Multiple logistic regression analysis was performed to identify the potential risk factors for PTB in advanced maternal age. RESULTS: In advanced maternal age, education level, occupation, passive smoking, iron intake, and parity showed significant differences between term birth and PTB. In particular, women who were exposed to passive smoking (odds ratio [OR]=2.83, confidence interval [CI]=1.14~7.04) and had folic acid intake during pregnancy (OR=2.67, CI=1.11~6.43) were at a significantly increased risk of PTB, after adjusting for all variables. CONCLUSION: This study indicates that smoking and lifestyle factors are the potential risk factors for PTB in advanced maternal age.
Subject(s)
Female , Humans , Pregnancy , Education , Folic Acid , Iron , Life Style , Logistic Models , Maternal Age , Occupations , Parity , Pregnant Women , Premature Birth , Risk Factors , Smoke , Smoking , Term Birth , Tobacco Smoke PollutionABSTRACT
PURPOSE: Although home renovation exposure during childhood has been identified as a risk factor for the development of allergy, there is limited information on the association between prenatal exposure to home renovation and cord blood (CB) IgE response. The aims of this study were to identify the effect of prenatal exposure to home renovation on CB IgE levels, and to investigate whether this exposure interacts with neonatal genes and whether the effect can be modified by maternal atopy. METHODS: This study included 1,002 mother-neonate pairs from the COhort for Childhood Origin of Asthma and allergic diseases (COCOA). Prenatal environmental factors were collected using a questionnaire. The levels of CB IgE were measured by the ImmunoCAP system, and DNA was extracted from CB. RESULTS: Exposure to home renovation during the prenatal period was associated with significantly higher levels of CB IgE only in neonates from atopic mothers, and the effect of renovation exposure on CB IgE levels persisted from 31 months before birth. Furthermore, prenatal exposure to home renovation increased the risk of CB IgE response interacting with polymorphisms of NRF2 and GSTP1 genes only in neonates from atopic mothers. CONCLUSIONS: Maternal atopy modified the effect of prenatal exposure to home renovation on CB serum IgE response as well as the interaction between the exposure and neonatal genes involved in the oxidative stress pathway. These findings suggest that the genetically susceptible offspring of atopic mothers may be more vulnerable to the effect of prenatal exposure to home renovation on the development of allergy.
Subject(s)
Humans , Infant, Newborn , Asthma , Cohort Studies , DNA , Fetal Blood , Gene-Environment Interaction , Hypersensitivity , Immunoglobulin E , Mothers , Oxidative Stress , Parturition , Polymorphism, Single Nucleotide , Reactive Oxygen Species , Risk FactorsABSTRACT
BACKGROUND AND OBJECTIVES: The band-importance function (BIF) refers to a value characterizing the relative importance of different frequencies to speech intelligibility. The purpose of this study was to derive the BIF for the Korean standard sentence lists for adults (KS-SL-A). SUBJECTS AND METHODS: In this study, sentences from the KS-SL-A were used as the speech material. Twenty-six normal-hearing Korean listeners participated and intelligibility scores in 8 filters with 3 signal-to-noise ratio conditions were obtained. Based on the intelligibility score percentages, the BIF for the KS-SL-A was derived by using an established protocol. RESULTS: Band-importance weights varied across frequency bands. The most important frequency region was around 316 Hz (20.0%), and the importance of the frequency bands below the center frequency (CF) of 1,778 Hz was 59.6%. Therefore, low frequencies below the CF of 1,778 Hz were more important than high frequencies above the CF of 1,778 Hz. CONCLUSIONS: The BIF for KS-SL-A could be applied towards developing a hearing aid fitting formulae for Korean listeners.
Subject(s)
Adult , Humans , Hearing Aids , Signal-To-Noise Ratio , Speech Intelligibility , Weights and MeasuresABSTRACT
Previous studies suggest that maternal characteristics may be associated with neonatal outcomes. However, the influence of maternal characteristics on birth weight (BW) has not been adequately determined in Korean populations. We investigated associations between maternal characteristics and BW in a sample of 813 Korean women living in the Seoul metropolitan area, Korea recruited using data from the prospective hospital-based COhort for Childhood Origin of Asthma and allergic diseases (COCOA) between 2007 and 2011. The mean maternal age at delivery was 32.3 +/- 3.5 yr and prepregnancy maternal body mass index (BMI) was 20.7 +/- 2.5 kg/m2. The mean BW of infant was 3,196 +/- 406 g. The overall prevalence of a maternal history of allergic disease was 32.9% and the overall prevalence of allergic symptoms was 65.1%. In multivariate regression models, prepregnancy maternal BMI and gestational age at delivery were positively and a maternal history of allergic disease and nulliparity were negatively associated with BW (all P < 0.05). Presence of allergic symptoms in the mother was not associated with BW. In conclusion, prepregnancy maternal BMI, gestational age at delivery, a maternal history of allergic disease, and nulliparity may be associated with BW, respectively.
Subject(s)
Adult , Female , Humans , Infant, Newborn , Male , Pregnancy , Birth Weight , Body Mass Index , Cohort Studies , Gestational Age , Hypersensitivity/diagnosis , Linear Models , Mothers , Parity , Republic of Korea/epidemiologyABSTRACT
PURPOSE: Previous studies suggest that the concentration of 25-hydroxyvitamin D [25(OH)D] in cord blood may show an inverse association with respiratory tract infections (RTI) during childhood. The aim of the present study was to examine the influence of 25(OH)D concentrations in cord blood on infant RTI in a Korean birth cohort. METHODS: The levels of 25(OH)D in cord blood obtained from 525 Korean newborns in the prospective COhort for Childhood Origin of Asthma and allergic diseases were examined. The primary outcome variable of interest was the prevalence of RTI at 6-month follow-up, as diagnosed by pediatricians and pediatric allergy and pulmonology specialists. RTI included acute nasopharyngitis, rhinosinusitis, otitis media, croup, tracheobronchitis, bronchiolitis, and pneumonia. RESULTS: The median concentration of 25(OH)D in cord blood was 32.0 nmol/L (interquartile range, 21.4 to 53.2). One hundred and eighty neonates (34.3%) showed 25(OH)D concentrations less than 25.0 nmol/L, 292 (55.6%) showed 25(OH)D concentrations of 25.0-74.9 nmol/L, and 53 (10.1%) showed concentrations of > or =75.0 nmol/L. Adjusting for the season of birth, multivitamin intake during pregnancy, and exposure to passive smoking during pregnancy, 25(OH)D concentrations showed an inverse association with the risk of acquiring acute nasopharyngitis by 6 months of age (P for trend=0.0004). CONCLUSION: The results show that 89.9% of healthy newborns in Korea are born with vitamin D insufficiency or deficiency (55.6% and 34.3%, respectively). Cord blood vitamin D insufficiency or deficiency in healthy neonates is associated with an increased risk of acute nasopharyngitis by 6 months of age. More time spent outdoors and more intensified vitamin D supplementation for pregnant women may be needed to prevent the onset of acute nasopharyngitis in infants.
Subject(s)
Humans , Infant , Infant, Newborn , Pregnancy , Asthma , Bronchiolitis , Cohort Studies , Croup , Fetal Blood , Follow-Up Studies , Hypersensitivity , Korea , Nasopharyngitis , Otitis Media , Parturition , Pregnant Women , Prevalence , Prospective Studies , Respiratory System Abnormalities , Respiratory Tract Infections , Seasons , Specialization , Tobacco Smoke Pollution , Vitamin DABSTRACT
Since the risk of developing allergic disease increases in individuals exposed to allergens previously, even during the neonatal period, the immunologic status of a fetus may be important in the subsequent development of allergy. We evaluated the fetal factors to predict atopic dermatitis (AD) at 12 months in 412 infants of a COhort for Childhood Origin of Asthma and Allergic Diseases (COCOA) in the general Korean population. Cord blood mononuclear cells (CBMCs) were stimulated with ovalbumin and phytohemagglutinin and cellular proliferative response and concentrations of interleukin-13 and interferon-gamma, were measured. The risk of developing AD was greater in boys than girls (OR 1.97, 95% CI 1.26-3.09), infants delivered by cesarean section than vaginally (OR 1.93, 95% CI 1.14-3.26) and infants with than without parental history of AD (OR 2.34, 95% CI 1.29-4.24). The CBMC proliferative response to phytohemagglutinin stimulation was higher in infants with than without AD (P = 0.048), but no difference was observed in ovalbumin-stimulated cells (P = 0.771). Risk factors for the development of AD at 12 months include male gender, delivery by cesarean section and parental history of AD. Increased CBMC proliferative response to phytohemagglutinin stimulation may predict the development of AD at 12 months.
Subject(s)
Adult , Female , Humans , Infant , Male , Pregnancy , Cell Proliferation , Cesarean Section , Dermatitis, Atopic/diagnosis , Fetal Blood/cytology , Interferon-gamma/metabolism , Interleukin-13/metabolism , Leukocytes, Mononuclear/drug effects , Odds Ratio , Ovalbumin/toxicity , Phytohemagglutinins/toxicity , Predictive Value of Tests , Risk Factors , Sex FactorsABSTRACT
Since the risk of developing allergic disease increases in individuals exposed to allergens previously, even during the neonatal period, the immunologic status of a fetus may be important in the subsequent development of allergy. We evaluated the fetal factors to predict atopic dermatitis (AD) at 12 months in 412 infants of a COhort for Childhood Origin of Asthma and Allergic Diseases (COCOA) in the general Korean population. Cord blood mononuclear cells (CBMCs) were stimulated with ovalbumin and phytohemagglutinin and cellular proliferative response and concentrations of interleukin-13 and interferon-gamma, were measured. The risk of developing AD was greater in boys than girls (OR 1.97, 95% CI 1.26-3.09), infants delivered by cesarean section than vaginally (OR 1.93, 95% CI 1.14-3.26) and infants with than without parental history of AD (OR 2.34, 95% CI 1.29-4.24). The CBMC proliferative response to phytohemagglutinin stimulation was higher in infants with than without AD (P = 0.048), but no difference was observed in ovalbumin-stimulated cells (P = 0.771). Risk factors for the development of AD at 12 months include male gender, delivery by cesarean section and parental history of AD. Increased CBMC proliferative response to phytohemagglutinin stimulation may predict the development of AD at 12 months.
Subject(s)
Adult , Female , Humans , Infant , Male , Pregnancy , Cell Proliferation , Cesarean Section , Dermatitis, Atopic/diagnosis , Fetal Blood/cytology , Interferon-gamma/metabolism , Interleukin-13/metabolism , Leukocytes, Mononuclear/drug effects , Odds Ratio , Ovalbumin/toxicity , Phytohemagglutinins/toxicity , Predictive Value of Tests , Risk Factors , Sex FactorsABSTRACT
Multiple primary cancers are defined as more than two primary cancers occuring in one patient, synchronously or metachronously. Detection of multiple primary cancers have been increased gradually, because of the improvement of diagnostic and therapeutic tools. Nevertheless, synchronous triple primary cancers have been regarded as rare disease. Here, we report a case of synchronous triple primary cancers occurring in the stomach, colon and liver. The patient was a 68-year-old man who complained intermittent dyspepsia. All of these cancers were diagnosed by upper and lower GI endoscopy, and abdominal CT scans in early stages. The patient was managed successfully with endoscopic submucosal dissection and radiofrequency ablation.
Subject(s)
Aged , Humans , Colon , Dyspepsia , Endoscopy , Liver , Rare Diseases , StomachABSTRACT
Vibrio cholerae non-O1 mainly causes gastroenteritis and rarely causes extraintestinal infections, such as bacteremia. Skin and soft tissue infections are also possible, but the incidence rate is very low. Although the most common cause of pyomyositis is Staphylococcus aureus, Gram-negative organisms such as Vibrio species may also cause pyomyositis in patients with chronic liver disease. Pyomyositis caused by Vibrio cholerae non-O1 has not been reported in Korea. Here, we report a case of pyomyositis caused by V. cholerae non-O1 bacteremia in a patient with liver cirrhosis following seafood exposure. This case study suggests that V. cholerae, as well as V. vulnificus, should be considered when soft tissue infections occur in patients with liver cirrhosis after seafood exposure. In addition, physicians should consider imaging studies for a prompt diagnosis if the patient complains of severe pain disproportionate to the skin manifestation.
Subject(s)
Humans , Bacteremia , Cholera , Gastroenteritis , Incidence , Korea , Liver , Liver Cirrhosis , Liver Diseases , Pyomyositis , Seafood , Skin , Skin Manifestations , Soft Tissue Infections , Staphylococcus aureus , Vibrio , Vibrio cholerae , Vibrio cholerae non-O1ABSTRACT
BACKGROUND/AIMS: Leptospirosis is a zoonotic disease of global importance. In addition, pulmonary involvement of this disease has been increasingly reported in recent decades. The present study was performed to analyze the clinical features of leptospirosis experienced during recent years and to investigate the clinical significance of pulmonary involvement. METHODS: Patients with serologically confirmed leptospirosis who visited Chonnam National University Hospital from 2001 to 2007 were enrolled in this study. Epidemiologic characteristics, clinical features, laboratory findings, and outcomes of patients with leptospirosis were analyzed. RESULTS: Among a total of 68 patients, 47 (69.1%) had a history of occupational exposure. Fever (88.2%), myalgia (80.9%), headache (69.1%), hypotension (51.5%), dyspnea (44.1%), and abdominal pain (55.9%) were commonly observed. The overall case fatality rate was 5.8%. In the group of patients with pulmonary involvement (n=44), dyspnea, hemoptysis, renal dysfunction, and thrombocytopenia were more frequently observed than in patients without pulmonary involvement (n=24). Mixed type presentations and the use of mechanical ventilation were more commonly observed in patients with pulmonary involvement as compared to patients without pulmonary involvement. CONCLUSIONS: Leptospirosis with pulmonary involvement is common and may have severe clinical outcomes. Therefore, close monitoring and intensive care is important for patients with leptospirosis and pulmonary involvement.