Etiology and Clinical Features of Acute Bacterial Gastroenteritis in Children Mananged at a Secondary Hospital

PURPOSE: Acute bacterial gastroenteritis (ABG) can cause more severe symptoms than acute viral gastroenteritis in children. This study was aimed at determining the etiologic trends and to examine the clinical characteristics of ABG in children. METHODS: We sent stool samples from the children with acute gastroenteritis who were treated at a secondary hospital located in Seoul, Korea between January 2011 and December 2014 to Seoul Metropolitan Government Research Institute of Public Health and Environment to find the causative organisms. Clinical characteristics of patient were analyzed through a medical records review. RESULTS: Out of 664 stool samples, 183 (27.6%) yielded bacterial pathogens. Staphylococcus aureus was the most common bacterial pathogen, found in 72 cases (39.3%), even though it was only tested for since 2012. The monthly isolation rate was the highest (24.6%) in August. The isolation rate of Campylobacter spp. by patient's age group was high (16.7%) in the 12- to 18-year-age group (P =0.04). In patients with bloody stool, Campylobacter spp. was the most commonly isolated (31.0%, P =0.04). When comparing C-reactive protein, the Salmonella spp.- or Campylobacter spp.-isolated group showed higher values than the S. aureus - or pathogenic Escherichia coli -isolated group (5.7±0.6 mg/dL vs. 2.1±0.3 mg/dL, P <0.01). CONCLUSIONS: S. aureus, Salmonella spp., pathogenic E. coli , and Campylobacter spp. were important pathogens of ABG among children. Considering the differences in pathogens found according to age, a clinical symptom and inflammation index might be helpful in assuming the causative organism.

Feasibility of three-dimensional reconstruction and automated measurement of fetal long bones using 5D Long Bone

OBJECTIVE: To evaluate the feasibility of five-dimensional Long Bone (5D LB), a new technique that automatically archives, reconstructs images, and measures lengths of fetal long bones, to assess whether the direction of volume sweep influences fetal long bone measurements in three-dimensional (3D) ultrasound and 5D LB, and to compare measurements of fetal long bone lengths obtained with 5D LB and those obtained with conventional two-dimensional (2D) and manual 3D techniques. METHODS: This prospective study included 39 singleton pregnancies at 26+0 to 32+0 weeks of gestation. Multiple pregnancies, fetuses with multiple congenital anomalies, and mothers with underlying medical diseases were excluded. Fetal long bones of the lower extremities-the femur, tibia, and fibula were measured by 2D and 3D ultrasound, and 5D LB, by an expert and non-expert examiner. First, we analyzed the 3D ultrasound and 5D LB data according to 2 different sweeping angles. We analyzed intra- and inter-observer variability and agreement between ultrasound techniques. Paired t-test, interclass correlation coefficient, and Bland-Altman plot and Passing-Bablok regression were used for statistical analysis. RESULTS: There was no statistical difference between long bone measurements analyzed according to 2 different volume-sweeping angles by 3D ultrasound and 5D LB. Intra- and inter-observer variability were not significantly different among all 3 ultrasound techniques. Comparing 2D ultrasound and 5D LB, the interclass correlation coefficient for femur, tibia, and fibula was 0.91, 0.92, and 0.89, respectively. CONCLUSION: 5D LB is reproducible and comparable with conventional 2D and 3D ultrasound techniques for fetal long bone measurement.

An Outbreak of Mumps in a High School, Seoul, 2013

PURPOSE: This study investigated an outbreak of mumps affecting students in a high school (S high school) in Seoul, with an evaluation of the diagnostic utility of the mumps polymerase chain reaction (PCR) assay. METHODS: S high school students that presented to health care providers with mumps symptoms between April 2013 and July 2013 were surveyed for the monthly distribution of symptom onset and their grade level. Mumps PCR assays were performed using buccal swabs from some of these students. RESULTS: During the survey period, 77 students presented with suspected cases of mumps. The monthly distribution of symptom onset was as follows: one in April, 17 in May, 54 in June, and five in July. With regard to grade level, 26 students were in their first year, 28 were in their second year, and 23 were in their third year. Of the 18 students tested with PCR assays, five had positive results. Samples were collected within 3 days of symptom onset in 15 of the 18 students, and positive PCR results were obtained in five of these 15 students. The PCR results of the remaining three students from whom samples were collected more than 3 days after the onset of symptoms were negative (P=0.24). CONCLUSIONS: We evaluated the epidemiological aspects of an outbreak of mumps in a high school. Mumps PCR might be epidemiologically useful if performed within 3 days of the onset of symptoms in suspected cases.

Image Settings Affecting Nuchal Translucency Measurement Using Volume NT(TM) Software

PURPOSE: To evaluate the effects of the deviation from the mid-sagittal plane, fetal image size, tissue harmonic imaging (THI), and speckle reduction filter (SRF) on the measurement of the nuchal translucency (NT) thickness using Volume NT(TM) software. MATERIALS AND METHODS: In 79 pregnant women, NT was measured using Volume NT(TM). Firstly, the three-dimensional volumes were categorized based on the angle of deviation in 10degrees intervals from the mid-sagittal plane. Secondly, the operator downsized the fetal image to less than 50% of the screen (Method A) and by magnifying the image (Method B). Next, the image was magnified until the fetal head and thorax occupied 75% of the screen, and the NT was measured (Method C). Lastly, NT values were acquired with THI and SRF functions on, with each function alternately on, and with both functions off. RESULTS: The mean differences in NT measurements were -0.09 mm (p<0.01) between two-dimensional (2D) and a deviation of 31-40degrees and -0.10 mm (p<0.01) between 2D and 41-50degrees. The intraclass correlation coefficients (ICC) for 2D-NT and NT according to image size were 0.858, 0.923, and 0.928 for methods A, B, and C, respectively. The ICC for 2D-NT and NT with respect to the THI and SRF were 0.786, 0.761, 0.740, and 0.731 with both functions on, THI only, SRF only, and with both functions off, respectively. CONCLUSION: NT measurements made using Volume NT(TM) are affected by angle deviation from the mid-sagittal plane and fetal image size. Additionally, the highest correlation with 2D-NT was achieved when THI and SRF functions were used.

Risk Factors of Persistent Pulmonary Hypertension of the Newborn in Neonates with Respiratory Diseases / 대한주산의학회잡지

PURPOSE: This study aimed to identify the risk factors of persistent pulmonary hypertension of the newborn (PPHN) in neonates with respiratory diseases. METHODS: We retrospectively analyzed 58 term newborn infants with respiratory diseases who were admitted to the neonatal intensive care unit of the Seoul Eulji Hospital between January 2008 and July 2014 and required airway intubation and mechanical ventilation within 24 hours of admission. The infants were divided into a PPHN group and a non-PPHN group. Their clinical characteristics; diagnoses at admission; initial blood test results; and changes in vital signs, blood gas analysis results, and ventilator parameters that occurred within 48 hours of admission were investigated. RESULTS: There were 16 infants in the PPHN group and 42 infants in the non-PPHN group. The incidence of secondary PPHN was 27.6%. The incidence of PPHN was significantly higher in infants with respiratory distress syndrome (RDS) associated with extrapulmonary air leakage and meconium aspiration syndrome (MAS) with secondary RDS as the cause. Respiratory rate over 80 breaths/min (P=0.032, OR 11.3, 95%, CI 1.23-103.57) and FiO2 over 0.8 (P=0.013, OR 16.8, 95% CI 1.82-154.68), when measured 6 hours after admission, were found to be statistically significant risk factors. CONCLUSION: The results suggest that there is an increased risk of PPHN during treatment of respiratory diseases when aggravation of tachypnea and increase in ventilator parameters are observed after 6 hours of admission.

Radiological Analysis of Osteoarthritis of the Second Metatarsophlangeal and Tarsometatarsal Joint / 대한족부족관절학회지

PURPOSE: The aim of this study was to investigate the radiological characteristics of the osteoarthritis of the second metatarsophalangeal (MTP) and tarsometatarsal (TMT) joint. MATERIALS AND METHODS: Between January 2002 and August 2010, 27 patients (33 feet) who had second metatarsal osteoarthritis (OA) were reviewed retrospectively. Group 1 was 14 patients (17 feet) with second MTP joint OA. Group 2 was 13 patients (16 feet) with second TMT joint OA. Group 3 was 24 patients (25 feet) had hallux valgus without second metatarsal (MT) OA as control. Weight bearing foot anteroposterior (AP) and lateral view were checked, and measured hallux valgus angle, metatarsus adductus angle (MAA), second MT functional length, first and second MT length by Hardy & Clapham method on AP view, angle of second MT with horizontal plane, calcaneal pitch, talo-first MT on lateral view. RESULTS: On weight bearing foot AP view, second MT functional length of group 1, 2, 3 was 2.4 mm, -0.1 mm, 0.7 mm and MAA of group 1, 2, 3 was 17.7degrees, 17.7degrees, 14.5degrees. Second MT functional length of group 1 was longer than control group and it was statistically significant. MAA was significant different between group 1-3 and group 2-3. Angle of second MT with horizontal plane of group 2 was smaller than control group and it was statistically significant. Other radiographic parameters have no statistical significance. CONCLUSION: Group 1 has long functional length of second MT and group 2 has small angle of second MT with horizontal plane.

Clinical practice guideline for dementia by Clinical Research Center for Dementia of South Korea

The Clinical Research Center for Dementia of South Korea (CREDOS), a nation-wide clinical dementia research group, has prepared clinical practice guidelines (CPG) for dementia tailored to the Korean population. In this article, a summary of the CREDOS CPG is presented with the Korean and English version of full report included in the appendix. The CREDOS CPG in intended not only for psychiatrists and neurologists, but also internists, family physicians, and other primary care physicians involved in the prevention and early diagnosis of dementia. While our CPG for dementia mainly covers Alzheimer's disease (AD) and vascular dementia (VaD), it also includes mild cognitive impairment (MCI) and vascular MCI, which are currently known to be the preclinical stages of AD or VaD, respectively, with emphasis placed on early diagnosis. The CREDOS CPG aims to achieve the following goals by developing CPG for dementia: to establish evidence-based, objective and clear clinical standards for dementia; to improve the clinical decision-making process for patients with dementia; to provide scientific and systematic scales to aid in the work of dementia specialists; to suggest comprehensive and systematic healthcare services tailored to each dementia subtype. The CREDOS CPG focuses on diagnosis and evaluation of clinical practice available domestically, and provides useful concepts of dementia. Its emphasis is on etiologies and epidemiology, diagnostic criteria and evaluation, neuropsychological tests, behavioral and psychological symptoms, the activities of daily living, laboratory tests, and brain imaging.

The Comparison of the Results Between AO Internal Fixator (Long lever-arm) and Screw-Rod System (Short lever-arm) Through Posterior Approach in Unstable Thoracolumbar Fractures / 대한척추외과학회지

STUDY DESIGN: Prospective study. OBJECTIVES: To analyze the outcome of posterior reduction and fixation with the AO internal fixator and with the screw-rod system in unstable thoracolumbar fractures and to investigate differences in effectiveness between the two methods. SUMMARY OF LITERATURE REVIEW: In unstable thoracolumbar fractures, fixation with the AO internal fixator is an effective method for posterior reduction. However, the results of correction are quite variable. MATERIALS AND METHODS: We analyzed 51 patients with unstable thoracolumbar fractures who underwent correction through posterior approach between 1997 and 2003. We divided the patients into two groups: Patients in Group A (25 cases) were treated with the AO internal fixator, and patients in Group B (26 cases) were treated with the screw-rod system. We added transpedicular bone grafts for 17 patients in Group A. We evaluated correction of deformity (anterior and posterior height of vertebral body, sagittal index, disc height), loss of correction, spinal canal clearance, and neurological recovery. RESULTS: Comparing correction of deformity, we saw better results in Group A than in Group B in regards to sagittal index and anterior height of vertebral body. However, we saw a higher degree of correction loss in the anterior height of the vertebral body in Group A. We grafted autogenous bone into the fracture site by transpedicular approach for 17 patients in Group A. We saw less correction loss in the anterior vertebral body height and sagittal index. In regard to spinal canal clearance, we saw better results in Group A (18%) than in Group B (10%). As for neurological recovery, we could not find any statistically significant difference between the two groups. CONCLUSIONS: Through an operative procedure, we could achieve better results in restoration of anterior vertebral height and canal clearance with the AO internal fixator system. Further study is necessary to keep the reduced state of vertebral height.

Treatment of Acetabular Column Fractures with Limited Open Reduction and Screw Fixation

PURPOSE: To evaluate the results of limited open reduction and screw fixation of acetabular fractures. MATERIALS AND METHODS: Six acetabular fractures were treated with fluoroscopic guided screw fixation. The mean age was 46 years old and mean follow-up period was 18 months. There were 3 anterior column fractures, 2 transverse fractures and 1 both column fracture. Anterior column screw fixation was used in 5 cases and posterior column fixation in 1 case. Limited ilioinguinal approach was used in 4 cases and percutaneous screw fixation in 2 cases. RESULTS: The mean union time was 16.6 weeks. The postoperative radiographic results revealed 2 cases with an anatomic reduction and 4 cases with an imperfect reduction. The clinical results showed 1 case with excellent, 4 cases with good and 1 case with fair. Regarding complication, there was 1 case of SI joint penestration without clinical symptoms. CONCLUSION: Limited open reduction and screw fixation can be a useful alternative treatment for acetabular fractures in patients with minimally displaced fracture, severe multisystem trauma and soft tissue injury not suitable to traditional treatment.

The Patient Monitoring Information ARS. Call System / 대한의료정보학회지

This study is to develop a system which offers the auto-response and the auto-call about the patient monitoring information of the heart rate, NIBP, SpO2 and overall status from a patient monitor to registered users. After detecting a dial tone by a developed ARS and confirming a registered user, this system offers the information of a required patient by ARS voice. If a user registered to an auto-calling service, this system can offer a patient monitoring information automatically and periodically for a user' s setting to a user' s hand-phone or beeper by the voice or the number. Additionally, when the patient' s emergency situation to happen, this system calls the emergency state to an registered user' s hand-phone or beeper by the voice or the number. All of the information of patient monitoring is managed by the SQL database system for easy to the data extraction and the service of the statistical information effectively.

Newly-Developde Psychosis Following Temporal Lobectomy : 2 Cases / 대한간질학회지

Psychosis is the most severe psychiatric complication of epilepsy surgery, We report two cases of newly-developed psychosis after temporal lobectomy, First case is a 46-year-old man with mesial temporal lobe epilepsy who presented recurrent postictal psychosis 1 year after right temporal lobectomy. Second case is a 44-years-old woman who presented chronic psychosis 6 month after left temporal lobectomy. Main psychotic symptoms were paranoid persecutory delusion. The common features in both cases were middle age, ling duration of epilepsy, and bilateral independent spike on preoperative EEG. Even if postoperative psychosis is rare, careful observation is needed because temporal lobectomy is an ever-increasing treatment.

Study of Brain Atrophy in Korean

449 hospital patients with no pathologic brain CT findings, 30 yrs of age or older, were selected for the study of cerebral atrophy during the 30 months, from January 1980 to June 1983, at dept. of internal medicine, Hanyang Univ. hospital & following results were obtained. 1) Thoses in male group, A gradually progressive increase in the degree of cerebral atrophy score in the 3rd, 4th & late 5th decades was followed by a dramatic increase in the late 6th & 7th decades. 2) Those in female group, A gradually progressive increase in the degree of cerebral atrophy.

Study of Brain Atrophy in Korean

449 hospital patients with no pathologic brain CT findings, 30 yrs of age or older, were selected for the study of cerebral atrophy during the 30 months, from January 1980 to June 1983, at dept. of internal medicine, Hanyang Univ. hospital & following results were obtained. 1) Thoses in male group, A gradually progressive increase in the degree of cerebral atrophy score in the 3rd, 4th & late 5th decades was followed by a dramatic increase in the late 6th & 7th decades. 2) Those in female group, A gradually progressive increase in the degree of cerebral atrophy.