A PDA-Based Wireless ECG Monitoring System for u-Healthcare / 대한의료정보학회지

OBJECTIVE: The purpose of this study is to design a portable ECG monitoring system, which integrates up-to-date PDA and RF communication technology, and to acquire the subject's biomedical signal without any constraint. METHODS: The developed system is composed of a transmitter and a receiver. The transmitter has a MCU (microcontroller), three-axial acceleration sensor, ECG amplifier and Zigbee communication controller. It has two types of transmission mode, which are total signal transmission mode and HR (heart rate)/SC (step count) transmission mode. The receiver has a MCU, Serial Communication IC, and Zigbee communication controller. It forwards the received data to PDA, where the data can be stored and displayed. RESULTS: In total signal transmission mode, it can send data 60 packets per second whose transmission speed corresponds to 300 ECG samples and 60 acceleration samples. In HR/SC transmission mode, it can calculate heart rate from ECG data with 216 samples per second and step count from acceleration data and send a packet every cardiac cycle. CONCLUSION: Using this device, a new method of remote monitoring both vital sign and activity is realized. A PDA-based wireless ECG system enables patients to be monitored during their daily living, without any constraints. Also, this method will reduce medical costs in the aged society.

PDA Based Point-of-care Personal Diabetes Management System / 대한의료정보학회지

OBJECTIVE: To develop a PDA based hand-held system, which assists diabetic patients to self manage his/her blood glucose level, diet, and other related variables in a systematic way. METHODS: Personal diabetes management system(PDMS) was developed in the integrated environment of Visual Studio.net 2003. The system was configured based on the documentation resulted from extensive review on the current S/W products and internet homepages for the diabetes. RESULTS: PDMS was implemented with four main menus to manage personal information, diet, exercise, and blood glucose. It was designed to provide the quantitative health indices such as body mass index and diabetes index based on the personal physical information, pedigree, and living habits. It addition, it is capable of predicting changes of the body weight, which may remind patients of the importance of the disease management. CONCLUSION: A PDA based hand-held self management system was developed for the diabetes. The present system can be used as a mobile device within the tele-healthcare system integrated with medical center thru the internet.

A case of hypereosinophilic syndrome with pleural effusion and pulmonary embolism / 천식및알레르기

Hypereosinophilic syndrome is characterized by prolonged eosinophilia of blood and bone marrow and eosinophil-related tissue damage to variable organs without an identifiable underlying cause. We report a case of hypereosinophilic syndrome with pleural effusion and pulmonary embolism in a 29-year-old man. Chest CT and lung perfusion scan demonstrated multiple segmental perfusion defects in both lungs. After intravenous injection of methyl-prednisone for 3 weeks, blood eosinophil count and pulmonary lesions were normalized.

A Case of Acute Hepatitis E / 대한간학회지

Hepatitis E is an infectious viral disease with clinical and morphologic features of acute hepatitis. Although HEV infection is endemic in the Indian subcontinent, Southeast and Central Asia, a large outbreak of hepatitis E was identified in China. Smaller outbreaks have been observed in the Middle East, northern and western parts of Africa, and Mexico. Sporadic hepatitis E also has been observed in several countries. In nonendemic regions, the sporadic cases of hepatitis E are almost always associated with travel to HEV-endemic regions. In Korea, there has been no report on hepatitis E. Recently, we experienced a case of acute icteric hepatitis in which serologic study showed seroconversion of IgM anti-HEV. The patient did not have any travel history to an HEV-endemic area. We report this as an initial case of acute hepatitis E in Korea.

A case of eosinophilic panniculitis diagnosed in the lower extremity skin lesions with tenderness / 천식및알레르기

Eosinophilic panniculitis is characterized by prominent infiltration of eosinophils in the subcutaneous fat. Clinically it may be considered as a reactive process because most patients have an associated systemic condition. We report a case of tender subcutaneous nodules and plaques with erythema on the lower legs in a 30-year-old man with blood eosinophilia. The histologic features were characterized by massive eosinophilic infiltration in the septae and lobule in the parenchymal area of subcutaneous tissues. Despite exhaustive investigation, no obvious trigger of the panniculitis could be identified. The cutaneous lesions regressed and the eosinophil count became normal during the seven days course of treatment with intravenous corticosteroid. Another flare-up occurred about one month after treatment. The patient is presently being treated with prolonged use of alternate-day steroid without recurrence.

A case of Churg-Strauss syndrome associated with zafirlukast / 천식및알레르기

Churg-Strauss syndrome (CSS) is an eosinophil associated disease, characterized by vaculitis and granulomatosis on small vessel, asthma and eosinophil tissue infiltration. Several cases of CSS have been reported in patients treated with cysteinyl leukotriene receptor antagonist and weaned-off systemic or inhaled corticosteroids. A 39-year-old man with a history of childhood allergic rhinitis was diagnosed with bronchial asthma and his symptoms were well controlled with fluticasone propinate, salmeterol and zafirlukast. However four months later, he was admitted again with prominent skin lesions, tingling sensation on both extremities and fever. We diagnosed CSS with a history of sinusitis and bronchial asthma, marked peripheral eosinophilia, vasculitis and neuropathy. His symptoms and laboratory findings promptly improved after ten days of intravenous corticosteroid and cessation of zafirlukast without recurrence for six months during the follow-up period. We conclude that zafirlukast may cause CSS and attention should be taken when using zafirlukast.

A case of primary squamous cell carcinoma of the liver / 대한내과학회지

Primary squamous cell carcinoma of the liver is very rare. It has previously been reported to arise from the lining of developmental hepatic cyst or in hepatic teratoma. Also, there are published reports of the occurrence of such a tumor in association with intrahepatic cholesterol stones, hypercalcemia in a cirrhotic liver, and clonorchiasis. The previous reports showed male predominance. The prognosis of this tumor is extremely grave, and no case has survived more than one year. A 73-year-old woman was found to have a primary squamous cell carcinoma of the liver. The tumor, which measured 11x7 cm and located in the left hepatic lobe, was diagnosed by percutanous biopsy. No evidence of other primary foci was demonstrated in systemic workup. Left hepatectomy was done. In computed scan on 4 months after operation, tumor seedings were revealed on right hepatic lobe, omentum and several lymph nodes. She died on 6 months after operation.

A Case of Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia / 대한간학회지

Distinction of hepatocellular carcinoma from benign entities such as focal nodular hyperplasia is important because failure of prompt diagnosis could result in a missed opportunity for curative resection. The differential deagnosis, especially among focal nodular hyperplasia and adenoma and even hepatocellualr carcinoma, may have difficult; and when using inly a single imaging method, the diagnosis is often equivocal. Therefore, a combination of imaging modalities is preferred. For focal nodular hyperplasia, the combination of computerized tomography (CT ), magnetic resonance imaging (MRI), and radionuclide scintigraphy showed a high sensitivity and specificity. But, histologic examination is required for the differential diagnos is of hepatic mass. We report a case of hepatocellular carcinoma without clinical evidence of malignancy or serum elevation of tumor marker, that mimicked the CT , MRI, and radionuclide scint igraphic appearance of focal nodular hyperplasia.

The Evaluation for Hepatitis B and Hepatitis C Virus Infection in Aplastic Anemia / 대한내과학회지

OBJECTIVE: Aplastic anemia is a rare but serious complication of viral hepatitis. Both aplastic anemia and viral hepatitis are more common in Korea than in the Western countries. It is necessary to study about the relationship between them. METHODS: Twenty-three patients with aplastic anemia visiting Chonnam University Hospital from 1995 to 1996 were studied for positivity of hepatitis B virus (HBV) and hepatitis C virus (HCV) to investigate the association of hepatitis virus infection with aplastic anemia. The surface antigen of HBV (HBsAg) and anti-HCV in sera were tested by EIA(enzyme immunoassay), and the presence of HBV-DNA and HCV-RNA in both sera and bone marrow cells was examined by the polymerase chain reaction (PCR). RESULTS: The positivities of HBsAg and anti-HCV in 23 patients with aplastic anemia were 4.3% (1 patient) and 8.7% (2 patients), respectively. The positivity of HBsAg is similar to that of HBsAg in general population of Korea. The positivity of anti-HCV is higher than that of anti-HCV in general population of Korea. One patient had HBV DNA and 3 patients had HCV RNA in their sera. All of the 3 hepatitis C viremic patients received 11 to 15 units of blood products in the past. None of the patients showed the evidence of recent viral hepatitis infection. HBV DNA and HCV RNA were not detected by the PCR in bone marrow cells in any of the patients. CONCLUSION: This study suggests that the HBV or HCV might not be a causative agent of aplastic anemia. The higher positivity of anti-HCV in the patients might be due to passive transmission of HCV after transfusion of blood products.

A case of Marfan syndrome with acute monoblastic leukemia

We report on an 18-year-old man who had both acute monoblastic leukemia and Marfan syndrome. A diagnosis of Marfan syndrome was established by those characteristics of arachnodactyly, ectopia lentis, mitral valve prolapse, and mitral regurgitation. Findings on bone marrow examination of the patient showed that most of nucleated cells were monoblasts and immunophenotype of those cells showed CD13+, CD33+, CD56+, and HLA-DR+. To our knowledge, this is the second report of leukemia in Marfan syndrome in the world.

A Study on the Positivities of Anti - HCV by Second - Generation ELISA in Rural Area of Chonnam Province / 대한내과학회지

BACKGROUND: Hepatitis C virus(HCV) is well known major cause of posttransfusion hepatitis. There were a lot of studies about the prevalence of anti-HCV. But, most of these focused on healthy blood donors or patients with liver diseases in urban areas. So they may not represent the prevalence of anti-HCV in the entire Korean population. This study focused on people of a rural area which consisted of six towns near Reservoir Juam in the Chonnam province in Korea. METHODS: Nine hundred and sixty three persons were selected by multi-stage cluster sampling method from January to February in 19%, Anti-HCV and HBsAg were examined by microparticle enzyme immunoassy(MELA; Abbott Co., USA). Alanine aminotransferase(ALT) was examined by enzyme kinetic method. RESULTS: 1) The positivity of anti-HCV in all subjects was 0.9%. 2) The positivity of anti-HCV in male(1.1%) was not significantly higher than in female(0.9%). 3) The positivity of anti-HCV was 0% below the 5th decade, 0.7% in the 6th decade, 1.4% in the 7th decade, 1.7% in 8th decade, 0% above the 9th decade. There was no significant relationship between the positivity of anti-HCV and age. 4) The positivity of anti-HCV was 0.8% in normal ALT(35U/L) subjects. There was no statistical relationship between the positivity of anti-HCV and ALT level. 5) HBsAg was serologically negative in all of nine anti-HCV positive subjects. CONCLUSION: The positivity of anti-HCV was 0.9% in rural area of Korea and was similar to the prevalence of anti-HCV in urban areas.

Evaluation of the DINAMAP 8100 Automated Blood Pressure monitor: comparison with the Mercury Sphygmomanometer / 기본간호학회지

Automated blood pressure monitors have gained acceptance in many clinical settings with the increasing demand, the accurate BP measuring devices require the need for validation. We have evaluated the Dinamap 8100, an oscillometric automated blood pressure monitor, using the Mercury sphygmomanometer as a reference. Comparison of sphygmomanometers was conducted 60 patients(30-Normotensive group, 30-Hypertensive group at Seoul National University Hospital. Two trained observers took measure blood pressure(systolic/diastolic) at the same time using the Dinamap 8100 on one arm and the Mercury on the other. For each measurement, the device was randomly selected from a group of devices repletively used for the experiment. Mean readings for systolic pressure with the Dinamap 8100 in normotensive group were lower(mean difference ; 4.26mmHg) than the Mercury type. Mean readings for systolic pressure with the Dinamap 8100 in hypertensive group were lower(mean difference ; 9.05mmHg) than the Mercury type. Mean readings for diastolic pressure with the Dinamap 8100 in normotensive group were lower(mean difference ; 7.46mmHg) than the Mercury type. Mean readings for diastolic pressure with the Dinamap 8100 in hypertensive group were lower(mean difference ; 9.03mmHg) than the Mercury type. We have found that blood pressure readings with the Dinamap 8100 were lower than those with the Mercury type. we are using the Mercury type in clinics, although it has observer bias and terminal digit preference. But the Dinamap 8100 is readily portable, simple to use, and capable of preventing observer bias and terminal digit preference. The Dinamap 8100 is acceptable for blood pressure determination in subjects who are normotensive or hypertensive ones.

The Diagnostic Value of Bronchoalveolar lavage fluid microscopic study and PCR in Pulmonary tuberculosis / 결핵

BACKGROUND: We can diagnose pulmonary tuberculosis with sputum AFB smear and culture, but sputum AFB smear has low sensitivity and culture needs long period, and they are not available in the patients who can not expectorate effectively. Recently developed, PCR is a fast diagnostic tool in tuberculosis, but false positive and false negative are important problems. So, we studied the diagnostic value of bronchoalveolar lavage fluid AFB smear, culture, PCR through the bronchoscopy. METHODS: The 67 pulmonary tuberculosis patients and 43 non-pulmonary tuberculosis patients were analyzed with their sputum specimen AFB smear and culture. Also, bronchoscopy and bronchoalveolar lavage were done, and bronchoalveolar lavage fluid AFB smear, culture and PCR were done. RESULTS: 1) In the cases of pulmonary tuberculosis, the sensitivity of sputum AFB smear and culture were 32.8% and 57.4%, respectively. And the sensitivity of bronchoalveolar lavage fluid AFB smear and culture were 47.8% and 80.6%. respectively. 2) In the cases of pulmonary tuberculosis, the sensitivity and the positive predictive value(for predicting a positive culture) of PCR were 80.6% and 81.5%, respectively. 3) In the cases of sputum AFB smear-negative and culture-negative pulmonary tuberculosis, the sensitivity of bronchoalveolar lavage fluid AFB smear, culture, PCR, and the positive predictive value(for predicting a positive culture) of PCR were 23.1%, 100%, 88.5%, and 82.4%, respectively. 4) The specificity of bronchoalveolar lavage fluid PCR was 77.0%. 5) The median number of days between obtaining a specimen and starting therapy was 5 days for sputum AFB smear, 9 days for bronchoalveolar lavage fluid AFB smear, 26 days for bronchoalveolar lavage fluid PCR, 32 days for sputum culture, 56 days for bronchoalveolar lavage fluid culture. CONCLUSION: The sensitivity of bronchoalveolar lavage fluid AFB smear and culture are higher than sputum AFB smear and culture. So, the bronchoscopy must be considered for evaluating suspected cases of pulmonary tuberculosis in patients from whom smears of expectorated sputum do not reveal mycobacteria or from whom no sputum can be obtained. Especially, combined with PCR, it is expected that pulmonary tuberculosis can be diagnosed more rapidly and more accurately, so bronchoalveolar lavage fluid AFB smear and PCR can be helpful in the early treatment of pulmonary tuberculosis.