Adapter-based Safety Injection System for Prevention of Wrong Route and Wrong Patient Medication Errors

Wrong-route or -patient medication errors due to human mistakes have been considered difficult to resolve in clinical settings. In this study, we suggest a safety injection system that can help to prevent an injection when a mismatch exists between the drug and route or patient. For this, we prepared two distinct adapters with key and keyhole patterns specifically assigned to a pair of drug and route or patient. When connected to a syringe tip and its counterpart, a catheter injection-port, respectively, the adapters allowed for a seamless connection only with their matching patterns. In this study, each of the adapters possessed a specific key and keyhole pattern at one end and the other end was shaped to be a universal fit for syringe tips or catheter injection-ports in clinical use. With the scheme proposed herein, we could generate 27,000 patterns, depending on the location and shape of the key tooth in the adapters. With a rapid prototyping technique, multiple distinct pairs of adapters could be prepared in a relatively short period of time and thus, we envision that a specific adapter pair can be produced on-site after patient hospitalization, much like patient identification barcodes.

Seroprevalence of IgG Anti-HAV in Hospital Employees below 40 Years Old / 대한소화기학회지

BACKGROUND/AIMS: Hepatitis A is an acute infectious disease transmitted by fecal-oral route. As the incidence of hepatitis A has been increased in Gwangju and Chonnam province of Korea recently, the number of hepatitis A patients in hospital employees has also increased. Thus, we investigated the seroprevalence of IgG anti-HAV in hospital employees below 40 years old. METHODS: We analysed the seroprevalence of anti-HAV IgG from 1,002 Chonnam national university hospital empolyees (men: 190, women: 812) who were below 40 years old. The age group was divided by 5 years; 21-25 years old 199 (19.9%), 26-30 years old 426 (42.5%), 31-35 years old 215 (21.5%), 36-40 years old 162 (16.1%). RESULTS: Overall seropositive rate of IgG anti-HAV was 32.8% (329/1,002). The seropositive rate of men was 40.5% (77/190) and that of women was 31.0% (252/812). The seropositive rates of each age group were 1.5% (3/199) in 21-25 years old, 21.6% (92/426) in 26-30 years old, 48.4% (104/215) in 31-35 years old, and 80.2% (130/162) in 36-40 years old. The seropositivity rate of the high risk group (doctors, nurses, technicians) was 28.9% (234/809). CONCLUSIONS: The seropositive rate of IgG anti-HAV was the lowest in early twenties of hospital employees and below 50% in early thirties. Therefore, hepatitis A vaccination may be warranted in the hospital empolyees below the early thirties.

A Case of Incidentally Found Primary Esophageal Bezoar in a Patient with Situs Inversus Totalis / 대한소화기내시경학회지

Situs inversus totalis (SIT) is very rare autosomal recessive condition, and patients with SIT have complete mirror image reversal of the thoracic and abdominal viscera. There have been no case reports of esophageal bezoar in a patient with situs inversus totalis. Bezoars are retained concretions of indigestible foreign material, including food material, vegetable material and hair, and they are usually founded in the stomach, small intestine and rectum. Esophageal bezoars are very rare, but they are known to occur in patients with anatomical defects or esophageal motility disorders. The treatment of esophageal bezoar is usually based on endoscopic fragmentation and extraction, dissolution with papain, cellulose, pancreatic enzyme and/or Coca cola. We report here on a case of an endoscopically treated primary esophageal bezoar in a patient with situs inversus totalis, and the patient experienced no complications from the treatment.

Gastric Wall Abscess Caused by a Fish Bone and Treated with Endoscopic Management / 대한소화기내시경학회지

Intramural gastric abscess is a rare condition representing a localized form of suppurative gastritis. According to the extent of the disorder, suppurative gastritis is classified into diffuse and localized types. The diffuse or phlegmonous type is more common and involves the entire stomach with inflammation spreading to all layers from the submucosa. The localized form referred to as "intramural gastric abscess" accounts for 5% to 15% of cases. The pathogenic mechanism includes direct invasion by microorganisms and hematogenous spread from a distant source. Cases are usually diagnosed with a combination of imaging modalities such as ultrasound, computed tomography, endoscopic ultrasound, and esophagogastroduodenoscopy. Herein we report a case of intramural gastric abscess that developed following ingestion of a fish bone. It was successfully treated with endoscopic incision and drainage of pus.

A Case of Primary Pancreatic Lymphoma That Manifested with Acute Pancreatitis and Obstructive Jaundice / 대한소화기내시경학회지

Primary pancreatic lymphoma (PPL) is a rare form of extranodal lymphoma, and this accounts for less than 0.5% of all pancreatic tumors. Differentiating PPL from pancreatic adenocarcinoma is important because the prognosis and survival of PPL is much better than those of pancreatic adenocarcinoma. Although the treatment usually consists of a combination of chemotherapy and radiation therapy, PPL patient with biliary tract or gastrointestinal obstruction should undergo biliary or gastric bypass to relieve the symptoms. Herein, we describe a case of PPL with acute pancreatitis and obstructive jaundice, and the patient was successfully managed with endoscopic retrograde pancreatic and biliary drainage.

The Clinical Usefulness of a Tiger Catheter in Diagnostic Coronary Angiography via the Transradial Approach

BACKGROUND AND OBJECTIVES: The most important complications of the transradial coronary approach during coronary artery angiography are occlusion of the radial artery and arterial spasm which are known to be influenced by catheter size, procedure time, and repeat procedures. The purpose of this study was to evaluate the usefulness of a Tiger catheter (TC) which was designed for the selection of right and left coronary artery ostia simultaneously, compared with the Judgkins catheter (JC) during transradial coronary angiography (CAG). SUBJECTS AND METHODS: One hundred forty-four patients were randomized between groups who underwent CAG with a standard 5F JC or a TC. The procedure time and vasospasm of the radial artery, which were expressed as stenosis of the vessel diameter, were examined using a transradial approach. Four parts of the blood vessel diameter were measured at baseline, during injection of the vasodilator, and at the end of the procedure. RESULTS: There were no significant differences in gender, age, weight, or other cardiovascular risk factors between the two groups of patients. CAG was successfully performed using a TC in 89% of the patients. A TC was associated with a significantly shorter total procedure time than the JC for diagnostic CAG (451+/-120.4 vs. 542.3+/-180.5 sec, p=0.001), respectively. There was no significant difference in stenosis between the two groups (36% vs. 41% in TC and JC, respectively, p=0.358). There were no angiographic or clinical complications in each group. CONCLUSION: This study showed that the TC is associated with decreased total CAG procedure time compared with the JC.

The Clinical Effects and Radial Artery Vasodilation After High Dose Nicorandil Solution During Coronary Angiography via the Radial Artery

BACKGROUND AND OBJECTIVES: A spasm of the radial artery is one of the most common complications of coronary angiography (CAG) via the transradial approach (TR), and this spasm sometimes disturbs the procedure. Nicorandil has recently shown dose-dependent dilatation of the blood vessels and ischemic preconditioning. This study was designed to evaluate the clinical effects and radial artery vasodilation of high dose nicorandil solution during CAG via the radial artery. SUBJECTS AND METHODS: This study was a prospective, randomized study to compare the effects of 12 mg of nicorandil (the Nicorandil group) and 10 mL of a cocktail solution (nitroglycerine 200 microgram mixed with verapamil 100 microgram) (the Cocktail group) in 146 patients. Vasospasms, which were expressed as the stenosis of the radial artery were examined at 2 parts of the radial artery. RESULTS: There were no significant difference of gender, age and risk factors for the 2 groups of patients. The reductions in the systolic and diastolic blood pressure (BP) 1 minute after drug administration were 33.6+/-11.4/10.4+/-7.7 mmHg in the Nicorandil group and 12.8+/-9.8/3.8+/-5.3 mmHg in the Cocktail group (p<0.001). Both vasodilating agents showed significant radial artery vasodilation after administration of the drugs (p<0.005 for all). The minimal luminal diameter (MLD) after drug administration was more dilated in the Nicorandil group than that in the Cocktail group (0.63+/-0.25 mm vs. 0.48+/-0.19 mm, respectively, p=0.013). CONCLUSION: Nicorandil solution was more effective for inducing vasodilation of the radial artery, but it was not clinical superior to the cocktail solution.

Clinical characteristics of Korean acute myocardial infarction patients who are younger than 40 years old / 대한내과학회지

BACKGROUND/AIMS: It is known that mortality increases with age for patients who suffer with acute myocardial infarction (AMI). Yet there isn't much data on the clinical characteristics and long-term prognosis of young patients with AMI. METHODS: We analyzed two groups of patients with AMI who underwent coronary angiogram : 108 patients younger than 40 years as group I and 64 patients over 70 years old as group II. We compared the baseline clinical characteristics, the echocardiographic and coronary angiographic findings, and the major adverse cardiac event (MACE). RESULTS: Male gender (94.4% vs. 56.1%, respectively, p<0.001), smoking (78.7% vs. 46.9%, respectively, p<0.001) and hyperlipidemia (45.4% vs. 14.1%, respectively, p<0.001) were more frequent in group I, whereas hypertension (23.1% vs. 40.6%, respectively, p=0.015) and diabetes (11.6% vs. 34.4%, respectively, p<0.001) were more common in group II. The left ventricular ejection fraction (55.1+/-12.2% vs. 50.5+/-14.1%, respectively, p=0.042) was higher in group I. The serum levels of high sensitivity C-reactive protein (1.7+/-2.6 vs. 3.4+/-4.4 mg/L, respectively, p=0.015) and homocysteine (11.5+/-7.0 vs. 15.3+/-9.7 microgram/L, respectively, p=0.029) were higher in group II. One vessel disease (78.7% vs. 59.4%, respectively, p=0.007) and good Thrombolysis In Myocardial Infarction (TIMI) flow (TIMI II-III, 58.3% vs. 41.2%, respectively, p=0.040) were more common in group 1. There were no differences between the two groups for the development of MACE during the 28+/-21 months of clinical follow-up, but cardiac death was lower in group I than in group II (2.1% vs. 15.4%, respectively, p=0.002). CONCLUSIONS: Male gender, smoking and hyperlipidemia were the major risk factors of Korean young AMI patients. In addition, single vessel disease and good TIMI flow were more frequent and cardiac death was less frequent in the younger AMI patients.

Erratum: Bone scan appearance and biochemical markers of the bone metabolism in hemodialysis patients / 대한내과학회지

No abstract available.

A Case of Acute Pancreatitis Caused by the Migration of a Feeding Gastrostomy Tube / 대한소화기내시경학회지

A feeding gastrostomy tube is used to provide chronic nutritional support for patients who have a swallowing disability. Serious complications associated with feeding gastrostomy are rare. However, dislocation of the gastrostomy tube into the duodenum can lead to serious complications. There have been 7 reports in which the gastrostomy tube used for enteral feeding was associated with acute pancreatitis. But there have been no reports of pancreatitis associated with feeding gastrostomy in Korea. Further, all the reported cases were associated with both pancreatitis and cholangitis secondary to the compression of the major papilla by the percutaneous endoscopic gastrostomy tube. To the best our knowledge, this is the first report of acute pancreatitis, without cholangitis, that was induced by the compression of migrating surgical gastrostomy tube. Herein, we report on a case of a 68-year-old Korean male diagnosed with acute pancreatitis, and this was induced by the migration of a surgical gastrostomy tube.

Is cardiovascular disease more common in Vietnam veterans exposed to agent orange? / 대한내과학회지

BACKGROUND: TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin), a material of agent orange, was reported as a deadly poison in spite of its presence at extremely small doses. It has been reported that TCDD can cause various kinds of cancers and harmful effects on humans. However, a correlation between exposure to TCDD and cardiovascular disease is not yet known. Thus, we intended to examine the correlation between TCDD exposure and cardiovascular disease through an analysis of coronary angiograms in veterans of the Vietnam War. METHODS: A consecutive 115 patients undergoing coronary angiograms between April 2004 and June 2005 at Gwangju Veterans Hospital were analyzed. The patients were divided into two groups: 57 patients exposed to TCDD (Group I, average age 59.2+/-4.2 years) and 58 patients that were not exposed to TCDD (Group II, Average age 60.1+/-5.6 years). The clinical and coronary angiographic findings were evaluated. RESULTS: Baseline clinical characteristics, inflammatory markers and echocardiographic parameters were not different between patients in the two groups. The incidence of diabetes (43.9% vs. 25.0%, p=0.035) and hyperlipidemia (47.4% vs. 27.6%, p=0.028) were higher in group I patients than group II patients. Significant coronary artery stenosis was more common in group I (45 cases, 78.9%) thanin group II (33 cases, 56.9%) (p=0.011). CONCLUSIONS: There was a higher incidence of diabetes, hyperlipidemia, and significant coronary artery stenosis in patients that underwent a diagnostic coronary angiogram that were previously exposed to TCDD.

Bone scan appearance and biochemical markers of the bone metabolism in hemodialysis patients / 대한내과학회지

BACKGROUND: The gold standard for a diagnosis of ROD is performing a bone biopsy. We need other non-invasive diagnostic techniques because of this procedure's invasiveness. In this study, we evaluated the value of a radionucleotide bone scan and the various biochemical markers for determining the bone metabolism in hemodialysis patients . METHODS: This study evaluated 118 hemodialysis patients who underwent 99mTc-MDP bone scanning and blood tests for such biochemical markers as osteocalcin and c-terminal telopeptide of type I collagen. Two nuclear medicine physicians read the bone scan images semi-quantitatively for six bone areas and the soft tissue, and they assigned a score of 0, 1 or 2 to the findings. RESULTS: The patients were categorized into 3 classes: iPTH or =200 pg/mL. For the group with a iPTH > or =200 pg/mL, the Ca, P product, alkaline phophatase and osteocalcin levels were increased, and the serum aluminum level was decreased compared to the other groups. When the bone scans were analyzed, the sum of the bone uptake scores was higher in the group with an iPTH > or =200 pg/mL while the soft tissue uptake score was higher in the group with an iPTH <50 pg/mL. The most common type of patient was a patient with an iPTH <50 pg/mL, and adynamic bone disease may be the most prevalent type of ROD. CONCLUSIONS: The bone scan findings correlated with the iPTH level in hemodialysis patients. Bone scans can provide additional information if this is combined with other biological markers. We stillneed to confirm its usefulness by conducting a comparative study with using bone biopsy.

A Case of Colonic Metastatic Malignant Melanoma of Unknown Origin / 대한소화기내시경학회지

A metastatic melanoma to the gastrointestinal tract is observed in 1.5~4.4% of all melanoma patients. However, colonic and rectal involvement is less common. A 72-year-old woman was admitted due to abdominal pain and poor oral intake for 20 days. She had a 3 x 4 cm-sized mass on her right inguinal area 4 month ago, which was diagnosed as a malignant melanoma of the inguinal lymph node on excision biopsy. A large exophytic mass with an irregular ulcerlated, whitish patch, erythematous surface was observed in the hepatic flexure during colonoscopy. A histology diagnosis of a metastatic melanoma was made by an optical microscopy examination of the biopsies obtained during the colonscopy, and palliative right hemicolectomy was performed on account of a potential intestinal obstruction. We report a case of a metastatic melanoma of the colon with a review of the relevant literature.

Histopathology of the Inferior Turbinate Showing Compensatory Hypertrophy in Patients with Deviated Nasal Septum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Deviation of the nasal septum toward one side is often associated with an outgrowth of the inferior turbinate, which occupies the expansive space of the contralateral nasal cavity. It is assumed that this contrabalanced mechanism characterized by compensatory hypertrophy has originated to protect the more patent nasal side from excessive airflow with its drying and crusting effect. We tried to investigate histologic differences of inferior turbinate mucosa of both sides in patients with nasal septal deviation. MATERIALS AND METHOD: Specimens were taken from the anterior portion of inferior turbinates of 15 patients with deviated nasal septum and compensatory hypertrophy of the inferior turbinate. After staining by hematoxylin-eosin, the histologic differences of bilateral turbinate mucosa were examined under light microscope. RESULTS: Epithelia of both sides showed normal or epithelial exfoliation. The number of submucosal glands was significantly higher in the opposite side than in the hypertrophied side. Inflammatory cell infiltration was more severe in the hypertrophied side than in the opposite side. CONCLUSION: Above results suggest that heavy infiltration of inflammatory cells and decreased number of glands in the hypertrophied side might result from aerodynamic change originated from difference of area of airway.