Antibody responses after vaccination against equine influenza in Korea in 2016–2018 / 대한수의학회지

Equine influenza (EI) is the main cause of respiratory illness in equines across the globe and is caused by equine influenza A virus (EIV-A), which has impacted the equine industry internationally because of the marginal mortality and high morbidity. In the present study, the immune responses after equine influenza vaccination were evaluated in 4,144 horses in Korea using the hemagglutination inhibition (HI) assay. The equine influenza virus (EIV), A/equine/South Africa/4/03 (H3N8), was used as the antigen in the HI assay. The mean seropositive rates were 89.2% (97.4% in 2016, 77.6% in 2017, and 92.4% in 2018). This paper highlights the advances in understanding the effects of vaccines and control strategies for mitigating the emerging menace by EIV.

Late-Onset Group B Streptococcal Meningitis Complicated with Extensive Cerebral Infarction

Group B streptococcus (GBS) is the leading cause of neonatal morbidity and mortality. Late-onset GBS disease commonly manifests as occult bacteremia or meningitis. Approximately 50% of survivors of late-onset meningitis have long-term neurologic sequelae. Cerebrovascular complications are often associated with unfavorable clinical outcomes of GBS meningitis. There have been a few reports of cerebral infarction accompanied by GBS meningitis. We report a 29-day-old girl with severe, widespread cerebral infarction due to late-onset GBS meningitis. Isolated GBS strain from this patient was serotype III, ST-19. Currently, she has cortical blindness and significant developmental delay.

Effect of Media Exposure to Language Development / 대한소아신경학회지

PURPOSE: This study was performed in order to evaluate the association of media exposure with language developmental delay. METHODS: The sample consisted of 40 patients with language developmental delay who visited the pediatric clinic of Dongtan Sacred Heart Hospital from January 2013 to July 2014. The 66 patients, who visited our clinic without language developmental delay, were included in the control group. The data were collected by using self-report questionnaires (media exposure time, contents, background media or foreground media, age of first exposure, and media exposure with or without parents), and analyzed through a t-test, Chi-square test, bivariate logistic regression model by using the SPSS-Version 21.0. RESULTS: The mean age of the language delay group was 33.6±10 months, while the male-to-female ratio was 2.6:1 in this study. In regard to media exposure time, 63% of the language delay patients were exposed to media for more than 2 hours a day, as compared to 16% of the control group (P<0.001). Among the language delay group, 90% of the patients were under 24 months old at the time of exposure to media, as compared to 58% of the control group (P<0.001). In addition, 79% of the language delay group watched media without anyone, as compared to 41% of the control group (P=0.001). CONCLUSION: Risk factors of language developmental delay were exposure to media more than 2 hours a day and toddlers under 24 months old at the time of exposure, as compared to the control group. In conclusion, longer exposure and earlier exposure to media would be risk factors in language developmental delay, and watching media alone may negatively influence the language development.

Effect of Media Exposure to Language Development / 대한소아신경학회지

PURPOSE: This study was performed in order to evaluate the association of media exposure with language developmental delay. METHODS: The sample consisted of 40 patients with language developmental delay who visited the pediatric clinic of Dongtan Sacred Heart Hospital from January 2013 to July 2014. The 66 patients, who visited our clinic without language developmental delay, were included in the control group. The data were collected by using self-report questionnaires (media exposure time, contents, background media or foreground media, age of first exposure, and media exposure with or without parents), and analyzed through a t-test, Chi-square test, bivariate logistic regression model by using the SPSS-Version 21.0. RESULTS: The mean age of the language delay group was 33.6±10 months, while the male-to-female ratio was 2.6:1 in this study. In regard to media exposure time, 63% of the language delay patients were exposed to media for more than 2 hours a day, as compared to 16% of the control group (P<0.001). Among the language delay group, 90% of the patients were under 24 months old at the time of exposure to media, as compared to 58% of the control group (P<0.001). In addition, 79% of the language delay group watched media without anyone, as compared to 41% of the control group (P=0.001). CONCLUSION: Risk factors of language developmental delay were exposure to media more than 2 hours a day and toddlers under 24 months old at the time of exposure, as compared to the control group. In conclusion, longer exposure and earlier exposure to media would be risk factors in language developmental delay, and watching media alone may negatively influence the language development.

Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation / 대한마취과학회지

BACKGROUND: The purpose of this study was to investigate the changes in airway pressure and arterial oxygenation between ventilation modes during one-lung ventilation (OLV) in patients undergoing thoracic surgery. METHODS: We enrolled 27 patients for thoracic surgery with OLV in the lateral decubitus position. The subjects received various modes of ventilation in random sequences during surgery, including volume-controlled ventilation (VCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) with a tidal volume (TV) of 8 ml/kg of actual body weight. Target-controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. After double-lumen endobronchial tube (DLT) insertion, the proper positioning of the DLT was assessed using a fiberoptic bronchoscope. Peak inspiratory pressure (Ppeak), exhaled TV, and arterial blood gas were measured 30 min after each ventilation mode. RESULTS: P(peak) was significantly reduced with the PCV-VG mode (19.6 +/- 2.5 cmH2O) compared with the VCV mode (23.2 +/- 3.1 cmH2O) (P < 0.000). However, no difference in arterial oxygen tension was noted between the groups (PCV-VG, 375.8 +/- 145.1 mmHg; VCV, 328.1 +/- 123.7 mmHg) (P = 0.063). The exhaled TV was also significantly increased in PCV-VG compared with VCV (451.4 +/- 85.4 vs. 443.9 +/- 85.9 ml; P = 0.035). CONCLUSIONS: During OLV in patients with normal lung function, although PCV-VG did not provide significantly improved arterial oxygen tension compared with VCV, PCV-VG provided significantly attenuated airway pressure despite significantly increased exhaled TV compared with VCV.

Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation / 대한마취과학회지

BACKGROUND: The purpose of this study was to investigate the changes in airway pressure and arterial oxygenation between ventilation modes during one-lung ventilation (OLV) in patients undergoing thoracic surgery. METHODS: We enrolled 27 patients for thoracic surgery with OLV in the lateral decubitus position. The subjects received various modes of ventilation in random sequences during surgery, including volume-controlled ventilation (VCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) with a tidal volume (TV) of 8 ml/kg of actual body weight. Target-controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. After double-lumen endobronchial tube (DLT) insertion, the proper positioning of the DLT was assessed using a fiberoptic bronchoscope. Peak inspiratory pressure (Ppeak), exhaled TV, and arterial blood gas were measured 30 min after each ventilation mode. RESULTS: P(peak) was significantly reduced with the PCV-VG mode (19.6 +/- 2.5 cmH2O) compared with the VCV mode (23.2 +/- 3.1 cmH2O) (P < 0.000). However, no difference in arterial oxygen tension was noted between the groups (PCV-VG, 375.8 +/- 145.1 mmHg; VCV, 328.1 +/- 123.7 mmHg) (P = 0.063). The exhaled TV was also significantly increased in PCV-VG compared with VCV (451.4 +/- 85.4 vs. 443.9 +/- 85.9 ml; P = 0.035). CONCLUSIONS: During OLV in patients with normal lung function, although PCV-VG did not provide significantly improved arterial oxygen tension compared with VCV, PCV-VG provided significantly attenuated airway pressure despite significantly increased exhaled TV compared with VCV.

The Prognostic Factors and Therapeutic Strategy for Papillary Thyroid Microcarcinoma / 대한내분비외과학회지

PURPOSE: The objectives of this study were to define the prognostic factors of papillary microcarcinoma of the thyroid (PMCT), to analyse their histopathologic and epidemiologic characteristics and to investigate the optimal therapeutic management. METHODS: Our series included 254 consecutive patents who were affected by PMCT and who were operated on by the same surgeon between 1985 and 2002 among a total of 3,100 patients who underwent thyroid surgery. All the surgical specimens were examined in the same Department of Pathology. The prognostic factors were evaluated by uniand multivariate statistical analyses. RESULTS: The histopathologic characteristics such as vascular extension, infiltration into the adjacent parenchyma, a larger primary tumor (size ≥5 mm) or tumor in the thyroid capsule were all indicative of a poor prognosis. For the patents with poor prognostic factors and who were treated by partial thyroidectomy alone, the prevalence of recurrent disease was higher than that for the patients who were with treated by total thyroidectomy and 131 iodine administration. CONCLUSION: According to the prognostic factors, different therapeutic modalities could be proposed to treat patients with pillary thyroid microcarcinoma. It is reasonable to perform total thyroidectomy and 131 iodine therapy for patients with PMCT and who have high risk factors.

The Diagnostic Utility of PET-CT for the Preoperative Evaluation of Lymph Node Metastasis in Gastric Cancer Patients

PURPOSE: The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for detecting the lymph node (LN) metastasis of gastric cancer. MATERIALS AND METHODS: 119 patients (M:F=89:30; mean age: 64) with gastric cancer were referred for preoperative FDG-PET/CT scanning and spiral enhanced abdominal pelvic CT from June 2006 to July 2008, and these were the subjects of our study. All the patients underwent curative radical gastrectomy and lymph node dissection. A final diagnosis was made for all the patients by the histology of the surgical specimens. RESULTS: Both PET/CT and enhanced CT showed similar sensitivity for detecting regional lymph node metastasis (32.6% vs 39.5%, respectively). PET/CT was more accurate than enhanced CT for detecting regional lymph node metastasis (67.2% vs 63.0%, respectively), and PET/CT showed better specificity (86.8% vs 76.3, respectively) and a better positive predictive value (PPV) (58.3% vs 48.6%, respectively). PET/CT showed better specificity (98.0% vs 88.2%, respectively) and accuracy (79.4% vs 73.9%, respectively) than enhanced CT for detecting early gastric cancer. PET/CT showed better specificity (64.0% vs 52.0%, respectively), a better PPV (60.9% vs 57.1%), a better negative predictive value (NPV) (48.5% vs 46.4%, respectively) and better accuracy (53.6% vs 51.8%, respectively) than enhanced CT for detecting advanced gastric cancer. CONCLUSION: FDG-PET/CT is more usefulness than enhanced CT for making the preoperative diagnosis of regional LN metastases from gastric cancers.

Predicting Hypocalcemia after Total Thyroidectomy in Patients with Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Postoperative hypocalcemia is a common complication compared with the other complications following total thyroidectomy due to thyroid carcinoma. We evaluated the incidence of transient and permanent hypocalcemia and the preservation status of the parathyroid glands following total thyroidectomy due to thyroid carcinoma. METHODS: We analyzed a total of 145 cases of total thyroidectomy due to thyroid carcinoma. The preservation status of the prarathyroid glands after total thyroidectomy was classified as intact preservation or ischemic change, according to the number of intact preserved parathyroid glands in group 1 (more than 2), group 2 (1) or group 3 (0). RESULTS: Permanent hypocalcemia was not found in group 1. The rate of transient or permanent hypocalcemia was significantly lower in group 2 than that in group 3 (P< 0.05). CONCLUSION: The parathyroid glands should be preserved to minimize the occurrence of hypocalemia after performing total thyroidectomy. The number of intact preserved parathyroid glands can be a good indicator for predicting the occurrence of post-total thyroidectomy hypocalcemia.

Comparison between Regional Cerebral Oxygen Saturation and Jugular Bulb Venous Oxygen Saturation in Patients Undergoing OPCAB Surgery / 대한마취과학회지

BACKGROUND: Hypoperfusion during manipulation of the heart in off-pump coronary artery bypass (OPCAB) surgery may lead to postoperative neurological complications. Therefore, it will be necessary to monitor cerebral function during OPCAB surgery. In this study, we compared regional cerebral oxygenation (rSO2) by near-infrared spectroscopy (NIRS) with jugular bulb venous oxygen saturation (SjvO2) and assessed whether rSO2 measured by NIRS could be an alternative method of SjvO2 during OPCAB surgery. METHODS: A total of 20 patients who underwent OPCAB surgery were studied. A fiberoptic catheter was placed in the right jugular bulb to measure SjvO2 while a cerebral oximeter based on NIRS, INVOS 5100B was used to monitor rSO2. Radial arterial and jugular bulb blood samples were drawn simultaneously from baseline every hour during operation. The values of rSO2 were compared with SjvO2 values. RESULTS: For all data points (n = 78) for all patients combined, rSO2 values were significantly correlated with SjvO2 values (r = 0.513, P < 0.0001). There were significant correlations between arterial carbon dioxide and values of SjvO2 (r = 0.393, P = 0.0002) and rSO2 (r = 0.432, P < 0.0001). CONCLUSIONS: We concluded that NIRS correlates with SjvO2 in this patient population. These findings suggest that near-infrared spectroscopy may be useful in assessing cerebral oxygenation during OPCAB surgery.

Treatment of Partial Thickness Skin Defect with Cultured Allogenic Keratinocytes (Kaloderm.)

PURPOSE: Grafting with autograft skin remains the most effective method for treating skin defects. When insufficient donor sites are present or patients are afraid of the operation, a skin graft is impossible. Cultured allogenic keratinocytes speed wound healing by providing cover and by producing growth factors and extracellular matrix protein. We report an application of cultured allogenic keratinocytes (Kaloderm., Tegoscience, Seoul, Korea) in the treatment of an acute partial thickness skin defect. METHODS: From March 2005 to January 2006, 20 patients with a partial thickness skin defect were treated with cultured allogenic keratinocytes. The wound was covered with a sheet of cultured allogenic keratinocytes and ointment with Bactigras. gauze. The wound was inspected every two or three days. We regarded completion of epithelialization as wound healing. RESULTS: The mean period between time of injury and time of Kaloderm. application was 7.5 days. The time taken from application of Kaloderm. to complete closure of the wounds was 7.2 days. CONCLUSION: In view of the favorable outcome, cultured allogenic keratinocytes are safe and effective biologic dressing materials for use in the treatment of open wounds.

Clinical Analysis of Death in Trauma Patients

PURPOSE: Trauma is the 5th most common leading cause of death in Korea, but there has been no appropriate management system for patients until now. We analyzed the main causes of death in trauma patients by comparing the characteristics of those patients with the characteristics of patients who survived. We feel this analysis should have a positive effect on the development of an appropriate trauma management system in Korea. METHODS: We retrospectively reviewed trauma patients who had been admitted to the Department of General Surgery from February 2002 to February 2007. We compared several expected risk factors between the mortality and the survival group. Data on the transportation, arrival time at the emergency center, amount of transfusion, initial shock index, cause of death, and initial physical condition according to RTS (Revised trauma score), ISS (Injury severity score) and TRISS (Trauma and Injury Severity Score) were collected. Patients with ISS lower than 12 were excluded. RESULTS: Three hundred sixty-six(366) patients with multiple injuries were included. There were 40 patients in the mortality group and 326 patients in the survival group. The mean arrival time (minutes) to emergency center was longer in the mortality group (137.6 vs 93.6 p 0.04). The total amount of transfusion (ml) was larger in the mortality group (7139 vs 2470 p 0.01). The initial shock index was higher in the mortality group (1.45 vs 1.17 p<0.01). The RTS, ISS, and TRISS were not statistically different between the groups. In the multivariate analysis, mean arrival time and initial shock index were important factors for survival. CONCLUSION: If the mortality rate of trauma patients is to be reduced , the arrival time at the emergency center should be minimized. Improvement of the emergency medical transfer service system is very important for achieving that.

Changes of Serum ADH Level during Matoidectomy under General Anesthesia / 대한마취과학회지

BACKGROUND: Markedly reduced urine have been commonly observed during mastoidectomy under general anesthesia. The aim of study was to evaluate the surgery-related mechanism of reduced urine during mastoidectomy. METHODS: 11 patients undergoing mastoidectomy were studied. Blood samples were drawn from CVP line inserted through right internal jugular vein just before drilling (Pre-D); at 15 min after drilling (D-15); at the time closest to the inner ear (CHP-1); at 15 min (CHP-2) and 30 min (CHP-3) after CHP-1 and just before emergence (End). MAP, HR, temperature, CVP, and urine output (UO) were recorded at each period. 0.9% normal saline with room temperature was used to irrigate surgical field. Serum ADH, and the osmolalities (serum and urine) were measured. In 6 patients, serum TSH and FSH were measured, simultaneously. RESULTS: There were no significant hemodynamic changes during procedure. UO was decreased in 50% during and after the drilling. No differences showed in UO between before and after the drilling of CHP. Plasma ADH level after the CHP was increased 2-3 fold than before. Serum osmolality was unchanged throughout the periods, while the urine osmolality was significantly increased after the period of CHP. FSH was not changed during the periods and TSH was decreased slightly than in Pre-D. CONCLUSIONS: The reduced urine output during mastoidectomy may be influenced by the drilling-related vibration, which may affect the supraoptico-hypophyseal tract, resulting in ADH release. The irrigated isotonic saline with higher osmolality (308 mOsm/kgH2O) than plasma osmolality may partly contributed to the increased ADH.

Indication of Interventional Treatment in Abdominal and Pelvic Trauma

PURPOSE: The aim of this study was to evaluate and establish the indications of interventional artery embolization in patients with a traumatic liver, spleen and pelvis injury. METHODS: 91 patients with a traumatic liver, spleen and pelvis injury, who had been treated with interventional arterial embolization from April 1992 to April 2004, were included in this retrospective study. The abdominal pelvic injuries were classified according to the CT scan findings based on the injury scale of the American Association for the Surgery of Trauma. The mechanism of trauma, initial vital signs, initial hemoglobin, hospital length, transfusion amount, shock index and fluid resuscitation amount were surveyed. All the patients underwent angiography. If there was evidence of an active hemorrhage during angiography, interventional arterial embolization with Gelfoam or stainless coil was performed. RESULTS: Among the 91 patients with a traumatic liver, spleen and pelvis injury, 25 out of 30 patients treated by hepatic arterial embolization, 36 out of 42 patients by splenic artery embolization and 14 out of 19 patients by pelvic artery embolization showed successful outcomes that were supported by shock index improvement (P<0.05), less fluid resuscitation requirements (P<0.05) and less packed red blood cell (RBC) requirements (P<0.05). CONCLUSION: Interventional artery embolization is a preferable non-surgical management for patient with a traumatic liver, spleen and pelvis injury. These results suggests that the indications of interventional arterial embolization are a shock index <1, transfusion amount to maintain a Hg level of 10 g/dl <3 pint per day and fluid resuscitation amount <2,000 ml per 2 hours.

Simultaneous Correction of Depressed Scar Using Dermofat Graft Harvested during Scar Revision

While no scar can be completely erased, most linear facial scars can result in a relatively good scar after revision. However, in case of round shaped depressed scar, the scar is often lengthened following an incisional technique. This study focuses on the technique of dermofat graft harvested from the adjacent scars for correction of depressed scars. 18 patients having multiple facial scars with a depressed scar among 375 patients who had undergone scar revision were treated from June 2003 to May 2004. Dermofat was harvested from the adjacent linear scar, then it was deepithelialized, reshaped, and grafted to the depressed scar through a small incision. Cosmetic results were generally good. Complications were overcorrection in 4 patients; hyperpigmentation occured in 1 patient. However, 13 patients were satisfied with the results. The advantages of our technique are as follows: it does not require additional operation; dermofat graft has low absorbable rate; it can maintain the volume with an adequate texture.

Correction of Unilateral Ptosis of the Gluteal Fold after Liposuction: A Case Report

A 37-year-old woman complained of unilateral ptotic gluteal fold in her left gluteal area. She had undergone two times of liposuction procedures on her buttocks, thighs, and flanks five years and two years ago. Initially, we marked a 16x5cm2 elliptical design over the ptotic gluteal skin on her standing position. The elliptical area was deepithelialized and two 6cm long separate transverse incisions were made on the dermis of the deepithelialized skin flaps. Through these incisions, blunt dissections down to the gluteal fascia were carried out. Using 2-0 PDS sutures, the edges of the incisions were anchored to the gluteal fascia at the predetermined level corresponding to the inferior border of the gluteus muscle. Upper and lower dermal flaps were incorporated in a layered fashion(3-0 and 4-0 PDS) and the remaining skin was approximated with 5-0 nylon sutures in a continuous manner. Symmetry was achieved postoperatively and the scar was negligible because it was concealed in the gluteal crease. In conclusion, the anchoring technique of deepithelialized skin flaps to the gluteal fascia is very useful for correction of the buttock ptosis, especially resulting from closed degloving injuries, and applicable for the patients who have lost their natural infragluteal fold.

Clinical Experiences and Considerations of Large-Volume Liposuction

A review of recent reports showed that many surgeons define large-volume liposuction as the removal of over 5000ml of total aspirate. However, no clinical reports of single procedures in Korean involving aspirate volume of 5000 ml or greater have been presented. From May 2002 to December 2004, 59 patients with age averaging 31.2 years old underwent large-volume liposuction. Liposuction was performed using the superwet technique and a Lipomatic(R) vibropneumatic system. Clinical data, which included; body weight changes and BMIs at a postoperative 2 months, hemoglobin and hematocrit at a postoperative 2 days, operative time, and volume of infiltrate and aspirate, were evaluated. The average volumes of infiltrate and aspirate were 6916.7+/-1665.8ml and 6549.6+/-1787.2ml, respectively. Mean patient weight had decreased from 62.96+/-14.21 to 58.61+/-13.43kg with an average weight loss of 4.35kg, and mean body mass index from 23.84+/-3.91 to 22.17+/-3.70kg/m2 with an average drop of 1.67kg/m2; equivalent to a fall in weight per liter of aspirated volume of 0.66+/-0.09kg/L. Falls in hemoglobin and hematocrit per liter of aspirate volume were 0.46+/-0.07g/dl/L and 1.70+/-0.35%/L, respectively. Mean operative time per liter of aspirate was 39.6+/-2.1min/L. Complications were palpable skin irregularity in 5 patients; hyperpigmentation scars occurred in 5 patients; 2 of the heaviest women required blood transfusions; and 1 patient experienced prolonged edema. One major complication of subclinical fat embolism occurred. Cosmetic results were generally good. In conclusion, if patients are properly selected and fluid resuscitations are performed adequately, single stage liposuction involving aspirations of greater than 5000ml can be undertaken safely in Korean.

A Study on the Knowledge about the Plastic Surgery(II)

The authors presented 'A study on the knowledge about the field of plastic surgery(I)' decade ago. Since then, the cognition toward a plastic surgery might be altered by the evolution of internet and social atmosphere taking count of outward appearance. Therefore the authors studied again about the cognition to the plastic surgery. The subjects were total 1812 of high school and college students residing in Seoul, Korea from October through December in 2003 and 1812 students are consisted of 839 male and 973 female. The contents of questionnaire are as follows: 1. The cognition to the plastic surgery. 2. The cognition to the difference between plastic surgery and orthopedic surgery. 3. The cognition to the operation performing in the filed of plastic surgery. 4. The known operation kinds of plastic surgery. 5. The experience of plastic surgery operation. We compared the results of this survey with that in 1992. The results of research showed 15.1% increase in the cognition to the plastic surgery, 5.6% increase in the cognition to the difference between plastic surgery and orthopedic surgery and 9% increase in the cognition to the operation performing in the filed of plastic surgery. In the known operation kinds of plastic surgery, a double-eyelid operation was the most well known and followed by rhinoplasty and augmentation mammoplasty, but in 1992, a double-eyelid operation was followed by rhinoplasty and rhytidectomy. In the experience of plastic surgery operation, the result showed 6.3 %, which has more than doubled in the last 10 years. Increase of the cognition to the plastic surgery is inspired, but that results is localized to aesthetic field.