Rapidly growing pediatric trampoline-related injuries in Korea: a 10-year single center retrospective study / 소아과

PURPOSE: Several published policy statements have warned against the risks associated with trampoline use and recommended safety guidelines. However, few studies have focused on trampoline-related injuries in Korea. This study aimed to assess the incidence and characteristics of pediatric trampoline-related injuries presented to Ulsan University Hospital. METHODS: We retrospectively reviewed the medical records of children aged <16 years with trampoline-related injuries who visited our Emergency Department between 2008 and 2017. RESULTS: Over the 10-year period, 178 trampoline-related injuries were reported, which represented a significant increase (P=0.016). Most (87.6%) of the injuries occurred during the last 5 study years, and a rapid increase in injuries was observed in children aged <6 years. Lower extremity injuries (62.4%) were the most common, followed by injuries of the upper extremities, head and face, and trunk, including injuries to the neck and spine. Sixty-seven children (37.6%) had fractures, and proximal tibia fractures were the most common. Fractures were significantly more common in younger children (<6 years old) than in older children (P=0.026). CONCLUSION: In Korea, the mechanism of trampoline injury is similar to that of injuries incurred in indoor trampoline parks but is characterized by smaller spaces and multiple users. Trampoline use and the incidence of trampoline-related injuries in children aged <6 years are increasing rapidly. Prohibiting the use of trampolines for children aged <6 years, restricting simultaneous use by multiple children, and ensuring adult supervision should be strictly emphasized. Public awareness and policy guidelines are needed to reduce the incidence of trampoline-related injuries.

Dual-incision laparoscopic spleen-preserving distal pancreatectomy

Laparoscopic spleen-preserving distal pancreatectomy has been widely performed for benign and borderline malignancy in the body or tail of the pancreas when there are not oncologic indications for splenectomy. As the need for minimally invasive procedures to reduce postoperative morbidity and improve the quality of life is increasing, many surgeons have attempted to reduce the number of trocars and incision size to minimize access trauma and scarring. Single-port laparoscopic spleen-preserving distal pancreatectomy is the result of these efforts; however it has many limitations such as technical difficulty and prolonged operation time. In this article, we report the first case of dual-incision laparoscopic spleen-preserving distal pancreatectomy, proving that it can be a safe and feasible minimally invasive procedure for benign or borderline malignant tumors in the body or tail of the pancreas.

Association Between Socioeconomic Status and Obesity in Adults: Evidence From the 2001 to 2009 Korea National Health and Nutrition Examination Survey / 예방의학회지

OBJECTIVES: The present study examined relationships between socioeconomic status (SES) and obesity and body mass index (BMI) as well as the effects of health-related behavioral and psychological factors on the relationships. METHODS: A cross-sectional population-based study was conducted on Korean adults aged 20 to 79 years using data from the 2001, 2005, and 2007 to 2009 Korea National Health and Nutrition Examination Survey. Multivariate logistic and linear regression models were used to estimate odds ratios of obesity and mean differences in BMI, respectively, across SES levels after controlling for health-related behavioral and psychological factors. RESULTS: We observed significant gender-specific relationships of SES with obesity and BMI after adjusting for all covariates. In men, income, but not education, showed a slightly positive association with BMI (p<0.05 in 2001 and 2005). In women, education, but not income, was inversely associated with both obesity and BMI (p<0.0001 in all datasets). These relationships were attenuated with adjusting for health-related behavioral factors, not for psychological factors. CONCLUSIONS: Results confirmed gender-specific disparities in the associations of SES with obesity and BMI among adult Korean population. Focusing on intervention for health-related behaviors may be effective to reduce social inequalities in obesity.

Delta-Shaped Gastroduodenostomy after Totally Laparoscopic Distal Gastrectomy: A Comparison Analysis between Early and Late Experience

PURPOSE: We conducted this study to evaluate the feasibility and the safety of a delta-shaped gastroduodenostomy after totally laparoscopic distal gastrectomy (TLDG) and to know about the factors having influence on surgeons' performance of anastomosis and technical details of this operation. METHODS: The clinical characteristics and the surgical results of 57 consecutive patients with delta-shaped gastroduodenostomy after TLDG at Incheon St. Mary's Hospital were reviewed. The patients were divided into 2 groups (before and after 20 cases) and their clinical characteristics and surgical results were compared. The factors which influenced the anastomotic time and the technical details of the operation were also investigated. RESULTS: There was no difference in age, gender, body mass index, surgical results except for operation time, anastomotic time, and starting day of oral feeding between the 2 groups. The experience of the surgeon was the only factor that influenced the anastomotic time. CONCLUSION: Delta-shaped gastroduodenostomy is a feasible and safe procedure even in the early years of a surgeon's career. It could feasibly be done in less than 20 minutes in relatively experienced hands.

A case of exophytic pedunculated gastrointestinal stromal tumor with cystic changes / 대한내과학회지

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and cystic changes are commonly observed. However, there have been few reports of cases of exophytic pedunculated GIST with cystic changes. Here, we report a 45-year-old man who presented with a palpable mass in the left upper quadrant of the abdomen. The mucosal folds were endoscopically abnormal, but there was no mucosal lesion. Computed tomography demonstrated a large, low-density cystic lesion surrounding an enhanced nodule in the greater curvature of the gastric body, and there was no tumor infiltration to other organs. The patient underwent hemigastrectomy and the lesion was shown to be an exophytic pedunculated cystic tumor. Histopathological examination showed epithelioid cells with marked hemorrhaging. Immunohistochemical examination indicated that most of the tumor cell cytoplasm was positive for the c-kit protein (CD117) and CD34. The tumor was diagnosed as an exophytic pedunculated GIST of the stomach with cystic changes.

Strangulated Small Bowel Herniation Through a 12-mm Trocar Site In an Obese Patient / 대한내시경복강경외과학회지

A trocar site hernia is a rare complication after laparoscopic surgery. Hence, a trocar site that's larger than 10 mm should be closed to prevent complications. Here we describe a case of strangulated small bowel herniation through a 12 mm-trocar site even though the fascia had been closed. A 78-year-old obese (BMI 30.7 kg/m2) patient with rectal cancer underwent an uncomplicated laparoscopic low anterior resection. On the eighth post-operative day, she presented with a right lower quadrant painful mass, and abdominal CT showed small bowel herniation through the right lower quadrant 12-mm trocar site. In the surgical field, the small bowel was resected via the extended trocar site wound and the fascial defect was repaired.

Placenta Increta Complicating a First Trimester Abortion: A Case Report / 대한산부인과학회잡지

Placenta increta is a life-threatening complication of pregnancy and usually presented in the early postpartum period with hemorrhage during difficult placental removal. Placenta increta may also complicate first and early second-trimester pregnancy loss, causing profuse post- curettage hemorrhage. We have confirmed a case of placenta increta in which emergency hysterectomy was performed due to acute profuse vaginal bleeding following dilatation curretage during the first trimester pregnancy. So we present it with a brief review of the concerned literatures.

A Case of Van Wyk-Grumbach Syndrome / 대한소아내분비학회지

Van Wyk-Grumbach Syndrome is an advanced sexual development in association with primary hypothyroidism. The clinical feature in this syndrome is more consistent with stimulation of the FSH receptor by the markedly elevated TSH levels. Treatment of the hypothyroidism results in a rapid return to normal of the biochemical and clinical manifestations. We experienced a case of Van Wyk-Grumbach Syndrome and report with the brief review of related literature.

Time Series Analysis between the Concentration of Air Pollutants and the Number of Respiratory Disease Outpatients in Seoul / 대한산업의학회지

OBJECTIVES: This study was conducted to investigate whether air pollution levels in Seoul have short term effects on respiratory disease outpatients. METHODS: We analyzed five air pollutants (CO, NOy, Oy, SOp, PMyp) and daily counts of outpatient for respiratory disease divided by age group ((15yrs, 15-64yrs, 65+yrs) during the period of July 1997-June 1998 using Generalized Additive Model(GAM). RESULTS: After controlling for seasonal trends, day of the week, week of the month, temperature and humidity, CO (RR=1. 041 ~ l. 051, 0-day lag) and NOy (RR=1. 024~1. 050, 3-day lag) were significantly associated with daily counts for respiratory disease in all age groups. 0, and SO, were associated, with a 3-day lag in the age group under 15 years (O RR=1. 047, 95% CI=1. 045- 1. 049 i SOp RR=1. 018, 95% CI=1. 017- l. 020) and with a 0-day lag in the age group 15 to 64 years (0, RR=1. 035, 95% CI=1. 032-1. 037; SO, RR=1. 037, 95% CI=1. 035-1. 039), in the age group over 65 years (O RR=1. 042, 95% CI=1. 033-1. 051; SO RR=1.029, 95% CI=1.022-1.036). PM was weakly associated, with a 1-day lag in the age group under 15 years (RR=1.011, 95% CI=1.010-1.013) and with a 0-day lag in the age group 15 to 64 years (RR=1. 021, 95% CI=1. 019-1. 023), in the age group over 65 years (RR=1. 025, 95% CI=1. 018-1. 032). In the two pollutant model, the magnitudes of the relative risk for CO, NOy and Oq were maintained, but SOy was not associated with daily counts for respiratory disease in the age group under 15 years after controlling for NO,. PMyp was not associated in all age groups after controlling for CO, so the association with PMyp in the single pollutant model might be confounded by CO. In this study, the impact Of PMyp on the respiratory disease was not large as compared with other pollutants. CONCLUSIONS: Air pollution in Seoul may increase the incidence of the respiratory disease, so more positive attention for the control of air pollution should be paid.

Adipose Tissue and Serum Levels of PCBs and DDE in Women with Gynecologic Benign Disease / 대한산업의학회지

OBJECTIVES: This study was purposed to determine the levels of PCBs and DDE in adipose tissue and serum and to evaluate the relations with factors affecting these levels. METHODS: We analyzed adipose tissues and sera from 52 gynecologic benign disease patients aged 27-78 years, except hormonal diseases such as breast cancer and endometriosis. We also surveyed age, education, occupation, body mass index (BMI), smoking, drinking, number of children, and duration of breastfeeding by questionnaires. Tissue and serum levels of PCBs and DDE were measured using gas chromatography. RESULTS: The median and geometric mean levels of PCBs were 48. 29 ng/g, 56. 78 ng/g for adipose tissue and 4. 67 uc/L, 4. 85 m/L for serum, and those of DDE were 142.89 ng/g, 117.06 ng/g for adipose tissue and l. 75 m/L, 2.09 ua/L for serum, respectively. Adipose tissue and serum levels for DDE showed high correlation (r=0. 310, p=0. 0002), but those of PCBs didn' t (r=0.029, p=0.2582). In analyses of the differences of the means of log transformed adipose tissue and serum PCBs and DDE levels for groups of potential covariates, only adipose tissue DDE levels were significantly associated with number of children (p=0.015), age at first birth (p=0.014) and BMI (p=0.035). In multiple regression analysis, adipose tissue DDE levels were significantly increased with decreasing number of children and increasing age at first birth. CONCLUSIONS: This study suggested that parity and adiposity were associated with levels of DDE in adipose tissue, and adipose tissue is a better biomarker than serum for evaluating the long-term exposure of organochlorines.

Gastrointestinal Disease in Children with Iron Deficiency Anemia

PURPOSE: The authors performed this study to find out the associated GI disease and H. pylori infection in children with iron-deficiency anemia(IDA). METHODS: Twenty-six children older than 2 years with IDA and no history of insufficient iron intake were investigated from 1994 to 1998. Gastrofiberoscopic examination and biopsy and rapid urease test were performed with serum H. pylori IgG. Colonofiberoscopic examination and colon study were performed in indicated cases. Combination therapy were used for H. pylori infection. RESULTS: There were 14 males and 12 females, and 69% of total patients were aged 10 to 15 years. GI diseases were revealed in 23 patients. 17 with H. pylori-associated gastroduodenal diseases(8 nodular duodenitis, 7 nodular gastritis, 5 duodenal ulcer, 4 superficial gastritis, 2 gastric ulcer, 1 hemorrhagic duodenitis), 2 with nodular duodenitis, 1 with reflux esophagitis, 1 with duodenal ulcer, 1 with intestinal tuberculosis, and 1 with ulcerative colitis. Of 12 patients with recurrent IDA, 8 had H. pylori-associated gastroduodenal diseases and IDA did not recur after the treatment for H. pylori infection in these 8 patients. The preceeding causes of IDA in 3 with no GI disease were menorrhagia, chronic ITP, and excessive ingestion of raw milk. CONCLUSION: Our results showed that GI diseases should be suspected in children with IDA regardless of abdominal symptoms and H. pylori infection may have an important role in developing IDA. In most children with recurrent IDA, H. pylori-associated gastroduodenal diseases should be considered as well as other preceeding causes of IDA.

A Study on the Factors affecting Pesticide Poisoning of a Rural Population / 대한산업의학회지

The purpose of this study is to examine the pesticide use and the relationship between keeping the safety rules or use of protective equipments, and poisoning experience. For Puksan province, Choonchun county, we obtained questionnaire data concerning pesticide poisoning and relating factors from 143 people who have farmed and have sprayed pesticides. Important results are follows: 1. The rate of experiences of pesticide poisoning was 33%, and the major symptoms were dizziness(39. 13%), vomiting(20.87%), and visual opacity(11.30%). The most frequent use of pesticide was paraquat(23. 76%), and the next was organophosphates(18.35%). 2. Logistic regression and chi-square analyses showed that duration of spraying per day, following dose limits, and spraying back against wind are significantly associated with poisoning experiences(x2=5.620, p0.018, OR=0.326, CJ=0.109-0.968, OR=0.302, OR=0.097-0.939 respectively). But no associations between poisoning experiences and age, sex, use of protective equipments, and attendance of safety education. Based on these data, despite limitations in exposure assessment and recall biases, it may be necessary to devise a counterplan for development of effective safety education that prevents pesticide poisoning such as popular education in CATA pesticide project, as well as prohibition of use of hazardous pesticides that proved to be fatal.

Change in Nutritional Status of Elementary School Children

PURPOSE: The purpose of this study is to compare the present nutritional status with that of previous surveys done in Korea and other advance countries. METHODS: We measured the arm circumference and triceps skinfold thickness of 1,009 students of Hanyang Elementary School. We analyzed the arm muscle area and arm fat area. We analyzed the lomgitudinal height and weight of 6th grade children. We used an obesity index to estimate the prevalence of obesity. RESULTS: The mean height increased to 4.2-6.6cm in boys, 3.7-6.3cm in girls and the mean weight increased to 3.7-9.7kg in boys, 3.2-8.2kg in girls. The median of arm circumference increased to 7-44mm in boys, 8-36mm in girls. The median of triceps skinfold thickness increased to 1.7-7.8mm in boys, 2.3-6.4mm in girls. The mean of arm muscle area increased to 1.0-7.4cm2 in boys, 0.2-5.4cm2 in girls. The mean of arm fat area increased to 2.4-9.6cm2 in boys, 3.0-8.9cm2 in girls. The prevalence of obesity was 27% in boys and 24% in girls. CONCLUSION: Current data revealed marked increase in arm circumference, triceps skinfold thickness, arm muscle area and arm fat area than those of previous standard data established in Korea, 1984, approaching 1981 U.S standards. The increase in arm fat area and increased prevalence of obesity suggest an increased intake of calorie with relative deficiency in physical activity.