Associations between Early Hyperoxia and Long Term Neurologic Outcome in Acute Carbon Monoxide Poisoning

Purpose@#We studied the impact of arterial oxygen tension (PaO2) on the long term neurologic outcome in patients with acute carbon monoxide poisoning. @*Methods@#The study population included 311 patients who presented to emergency department with acute CO poisoning from January 2015 to January 2018. These patients underwent arterial blood gas testing at the time of presentation. The baseline demographic, clinical, laboratory, and clinical outcome data were recorded. The primary outcome of interest was the long term neurologic status. @*Results@#The normoxia group was significantly older and it had a higher incidence of diffusion weighted MRI abnormality, and this group needed multiple HBO sessions compared to the group with moderate or severe hyperoxia. Also, the incidence of altered mentality at discharge was higher in the normoxia group than that of the moderate hyperoxia group. The incidence of a poor long term neurologic outcome was 11.3%. The incidence of a poor long term neurologic outcome decreased as the PaO2 increased. The PaO2 was significantly lower in patients with a poor long term neurologic outcome than that of the patients with a good outcome 198 (165.2 to 231.1) mmHg in the good outcome group vs. 154 (119-162) mmHg in poor outcome, p<0.001). In multivariate logistic regression analysis, PaO2 was selected as an independent factor of the poor long-term neurologic outcome (OR 0.981 (95% CI: 0.968 to 0.995)) @*Conclusion@#Higher PaO2 was independently associated with a lower incidence of a poor long-term neurologic outcome.

PaCOâ‚‚ at Early Stage is Associated with Adverse Cardiovascular Events in Acute Carbon Monoxide Poisoning

PURPOSE@#The objective was to determine the association between PaCO₂ and adverse cardiovascular events (ACVEs) in carbon monoxide (CO)-poisoned patients.@*METHODS@#This retrospective study included 194 self-breathing patients after CO poisoning with an indication for hyperbaric oxygen therapy and available arterial blood gas analysis at presentation and 6 hours later. The baseline characteristics and clinical course during hospitalization were collected and compared. The mean PaCO₂ during the first 6 hours after presentation was calculated.@*RESULTS@#The incidence rates of moderate (30 mmHg< PaCO₂<35 mmHg) or severe (PaCO₂≤30 mmHg) hypocapnia at presentation after acute CO poisoning were 40.7% and 26.8%, respectively. The mean PaCO₂ during the first 6 hours was 33 (31–36.7) mmHg.The incidence of ACVEs during hospitalization was 50.5%. A significant linear trend in the incidence of ACVEs was observed across the total ranges of PaCO₂ variables. In multivariate regression analysis, mean PaCO₂ was independently associated with ACVEs (OR 0.798 (95% CI 0.641–0.997)).@*CONCLUSION@#Mean PaCO₂ during the first 6 hours was associated with increased ACVEs. Given the high incidence of ACVEs and PaCO₂ derangement and the observed association between PaCO₂ and ACVEs, this study suggests that 1) PaCO₂ should be monitored at the acute stage to predict and/or prevent ACVEs; and 2) further study is needed to validate this result and investigate early manipulation of PaCO₂ as treatment.

Missionary Medicine of Canadian Presbytery and Korean Doctors under Japanese Occupation: focusing Sung-jin and Ham-heung / 의사학

In East Asia during the second half of the 19th century, overseas mission work by Protestant churches thrived. Missionaries built schools and hospitals and effectively used them for evangelism. In the 20th century when Social Gospel Movement was expanding, medical work has been recognized as a significant mission service in and by itself. This article reviewed the construction and characteristics of missions work conducted by Canadian Presbytery; missionary doctors and Korean doctors who worked at the mission hospitals; why the missionary medical work had to stop; and career paths taken by Korean doctors upon liberation from Japanese occupation. The Canadian Presbytery missionaries, unlike other denomination missionaries, were rather critical of Imperial Japan, but supportive towards Koreans. This could have stemmed from the reflection of their own experience of once a colony of British Empire and also their value system that promotes egalitarian, democratic and progressive theology. The Sung-jin and Ham-heung Mission Bases were a community, interacting organically as a 'Triangle of Church, School and Hospital.' The missionaries mobilized the graduates from Christian schools and organized a Young Men's Christian Association (YMCA). Some of the graduates were trained to become medical doctors or assistants and worked at mission hospitals. Missionary doctors' approaches to balancing evangelism and medical practice varied. For example, Robert Grieson went through confusion and struggled to balance conflicting roles as a pastor for evangelism and also as a physician. Kate McMillan, on the other hand, had less burden for evangelism than Grieson, and focused on medical work by taking advantage of the opportunity that, as a woman, she can easily approach Korean women. Still another case was Florence Murray who practised evangelism within the hospital setting, and successfully carried out the role as a hospital administrator, going beyond 'women's work' as McMillan did. Korean doctors and assistants who worked at the mission hospitals had seen the spread of Protestantism in their youth; had received modern education; had experienced the fall of own country in 1910 and nationwide protest against Japan in 1919. The majority of them were graduates of Severance Medical College, the hub of missionary medicine at the time. After the resignation from the mission hospitals, 80 percent of them became self-employed general practitioners. The operations of the mission hospitals began to contract in 1930 due to tightened control by Imperial Japan. Shrine worship imposed on Christians caused internal conflict and division among missionaries and brought about changes in the form and contents of the mission organization. The incidence of the assault of Dr. Grieson brought about the dissolution of Sung-jin mission base and the interruption of the operation of Je-dong Hospital. As the Pacific War expanded, missionaries were driven out of Korea and returned home. In conclusion, the missions work by Canadian Presbytery missionaries had greatly impacted Protestantism in Korea. The characteristics of Canadian Presbytery were manifested in their support of Korean nationalism movement, openness for Social Gospel, and maintaining equal footing with Korean Christians. Specifically we note the influence of these characteristics in Chosun doctors who had worked in the mission hospitals. They operated their own hospitals or clinics in a manner similar to the mission hospitals by providing treatment for poor patients free of charge or for a nominal fee and treating the patients in a kind and humanistic way. After the 1945 Liberation, Korean doctors'career paths split into two directions. most of them defected to South Korea and chose the path to work as general practitioners. A few of them remained in North Korea and became educator of new doctors. It is meaningful that former doctors of Canadian missionary hosptal became dean of 2 medical colleges among 3 of all in early North Korea. This article does not cover the comparative analysis of the medical work by the missionaries of Canadian Presbytery and other denominations. It is desirable to include this analysis of the contents and the comparison in a future study of Korean doctors who participated in the mission hospitals, by denomination and by geographical region.

Formation of Medical Education in North Korea: 1945-1948 / 의사학

This study focuses on the formation of medical education in North Korea from 1945 to 1948 in terms of the centralization of medical education, and on the process and significance of the systemization of medical education. Doctors of the past trained under the Japanese colonial system lived and worked as liberalists. More than half of these doctors who were in North Korea defected to South Korea after the country was liberated. Thus the North Korean regime faced the urgent task of cultivating new doctors who would 'serve the state and people.' Since the autumn of 1945, right after national liberation, Local People's Committees organized and implemented medical education autonomously. Following the establishment of the Provisional People's Committee of North Korea, democratic reform was launched, leading to the centralized administration of education. Consequently, medical educational institutions were realigned, with some elevated to medical colleges and others shut down. The North Korean state criticised the liberalistic attitude of doctors and the bureaucratic style of health administration, and tried to reform their political consciousness through political inculcation programs. The state also grant doctors living and housing privileges, which show its endeavor to build 'state medicine'. By 1947, a medical education system was established in which the education administration was put in charge of training new doctors while the health administration was put in charge of nurturing and retraining health workers. In this way, the state was the principal agent that actively established a centralized administrative system in the process of the formation of medical education in North Korea following national liberation. Another agent was deeply involved in this process - the faculty that was directly in charge of educating the new doctors. Studying the medical faculty remains another research task for the future. By exploring how the knowledge, generational experience, socio-political consciousness and world views adopted by these teachers during the colonial era were manifested in their pedagogy after national liberation will shed more light on the 'prototype' of North Korean medical education.

3-D FEA on the intrusion of mandibular anterior segment using orthodontic miniscrews / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to analyze the stress distribution and the displacement pattern of mandibular anterior teeth under various intrusive force vectors according to the position of orthodontic miniscrews and hooks, using three-dimensional finite element analysis. METHODS: A three-dimensional finite element model was constructed to simulate mandibular teeth, periodontal ligament, and alveolar bone. The displacement of individual tooth on three-dimensional planes and the von Mises stress distribution were compared when various intrusion force vectors were applied. RESULTS: Intrusive forces applied to 4 mandibular anterior teeth largely resulted in remarkable labial tipping of the segment according to the miniscrew position. All 6 mandibular anterior teeth were labially tipped and the stress concentrated on the labiogingival area by intrusive force from miniscrews placed mesial to the canine. The distointrusive force vector led to pure intrusion and the stress was evenly distributed in the whole periodontal ligament when the hook was placed between the central and lateral incisors and the miniscrew was placed distal to the canine. CONCLUSIONS: Within the limits of this study, it can be concluded that predictable pure intrusion of the 6 anterior teeth segment may be accomplished using miniscrews placed distal to the canine and hooks located between the central and lateral incisors.

Treatment Outcome and Mortality among Patients with Multidrug-resistant Tuberculosis in Tuberculosis Hospitals of the Public Sector

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.

Treatment Outcome and Mortality among Patients with Multidrug-resistant Tuberculosis in Tuberculosis Hospitals of the Public Sector

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.

The Recent Status of Multidrug- and Extensively Drug-Resistant Tuberculosis in Korea / 결핵및호흡기질환

BACKGROUND: The increasing incidence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) has become a serious worldwide problem. However, there is insufficient data regarding the current status of MDR-TB and XDR-TB in Korea. This study examined the recent status of MDR- and XDR-TB using the data from 7 laboratories, in which almost all drug susceptibility tests (DST) for Mycobacterium tuberculosis were performed. METHODS: The patients' identification data and DST results were collected from all 7 laboratories from 2001 to 2006 and the number of patients with MDR-TB and XDR-TB were calculated. RESULTS: The number of DSTs was 140,638 for 6 years with an increasing incidence each year (p<0.001). The number of DST with MDR results was 18,510 and personal identifying information was obtained in 16,640 (89.9%) tests. The number of MDR-TB patients from 2001 to 2006 was 2,329, 2,496, 2,374, 2,300, 2,354, and 2,178, respectively, when counting the duplications in a year as one patient. The number of MDR-TB patients when counting the duplications in 6 years as one patient was 2,281, 1,977, 1,620, 1,446, 1,512, and 1,373, respectively. When the same method was adopted, the number of XDR-TB patients was 191, 238, 282, 260, 272, and 264, respectively, and 189, 150, 130, 90, 122, and 110 patients, respectively. CONCLUSION: Despite the national efforts to control TB, there are still a large number of MDR- and XDR-TB patients in Korea.

Factors influencing the axes of anterior teeth during SWA en masse sliding retraction with orthodontic mini-implant anchorage: a finite element study / 대한치과교정학회지

OBJECTIVE: With development of the skeletal anchorage system, orthodontic mini-implant (OMI) assisted en masse sliding retraction has become part of general orthodontic treatment. But compared to the emphasis on successful anchorage preparation, the control of anterior teeth axis has not been emphasized enough. METHODS: A 3-D finite element Base model of maxillary dental arch and a Lingual tipping model with lingually inclined anterior teeth were constructed. To evaluate factors influencing the axis of anterior teeth when OMI was used as anchorage, models were simulated with 2 mm or 5 mm retraction hooks and/or by the addition of 4 mm of compensating curve (CC) on the main archwire. The stress distribution on the roots and a 25000 times enlarged axis graph were evaluated. RESULTS: Intrusive component of retraction force directed postero-superiorly from the 2 mm height hook did not reduce the lingual tipping of anterior teeth. When hook height was increased to 5 mm, lateral incisor showed crown-labial and root-lingual torque and uncontrolled tipping of the canine was increased. 4 mm of CC added to the main archwire also induced crown-labial and root-lingual torque of the lateral incisor but uncontrolled tipping of the canine was decreased. Lingual tipping model showed very similar results compared with the Base model. CONCLUSION: The results of this study showed that height of the hook and compensating curve on the main archwire can influence the axis of anterior teeth. These data can be used as guidelines for clinical application.

A case of pulmonary actinomycosis accompanied by hemoptysis / 결핵

No abstract available.

Clinical features of sulfite-sensitive asthmatics / 결핵

No abstract available.

A case of sarcoidosis accompanied by azoospermia / 결핵

No abstract available.

Significant changes of bronchial responsiveness to methacholine after early asthmatic reaction to toluene diisocyanate (TDI) in a TDI-sensitive asthmatic worker

Current asthma is often diagnostically excluded by the presence of normal bronchial responsiveness. We report on a TDI-induced occupational asthma patient with normal bronchial responsiveness. He had suffered from shortness of breath during and after TDI exposure for several months. His initial methacholine bronchial challenge test showed a negative response. The bronchoprovacation test with TDI showed an isolated immediate bronchoconstriction. The following methacholine bronchial challenge tests revealed that the bronchial hyperresponsiveness developed seven hours after the TDI challenge (methacholine PC20:5.1 mg/ml), progressed up until 24 hours, and returned to normal on the seventh day. This case provides evidence that the response of the airway to TDI may not always be accompanied by bronchial hyperresponsiveness to methacholine. Screening programs utilizing methacholine challenges may not always identify TDI-sensitized asthmatic workers.

Ocular Findings in the Acquired Immunodeficiency Syndrome

The Acquired Immunodeficiency Syndrome(AIDS) is defined as a reliably diagnosed disease that is at least moderately indicative of an underlying cellular immunodeficiency in a person who has no known cause of underlying cellular immunodeficiency. The AIDS is caused by the human T-lymphotropic virus type III. We report here on a 32-year-old Korean male with AIDS. Detailed ophthalmic examinations were done and several cottonwool spots were found in both eyes. Other ocular findings of AIDS were not seen in this patient.