Characteristics of the COVID-19 Outbreak in Korea From the Mass Infection Perspective / 예방의학회지

On December 31, 2019, the Chinese government officially announced that the country had some cases of pneumonia with an unknown cause. By February 8, 2020, there were 24 confirmed cases in Korea, and the number of cases has steadily increased since then. On March 9, 2020, the cumulative number of confirmed cases in Korea was 7382, with 51 deaths. This study examines the characteristics of the coronavirus disease 2019 (COVID-19) outbreak from the perspective of the large-scale number of confirmed COVID-19 cases and deaths. This study is significant in that it emphasizes the precautionary principle in preventing and managing infectious diseases, and makes suggestions for urgently needed public health policies.

Vasculitic Neuropathy in Cutaneous Polyarteritis Nodosa

No abstract available.

A Prospective Cohort Study on Predictive Risk Factors Causing Metabolic Syndrome within the First Two Years

BACKGROUND: This study investigates the predictive risk factors which cause metabolic syndrome and raise morbidity within the first two years by analyzing the Korea Health Examinee Cohort (KOEX) data. The study provides the basis for emphasis on the need of lifestyle modification and regular health examinations. METHODS: This prospective cohort study was conducted by analyzing data from the Health survey and examination section of Korea Health Examinee Cohort (KOEX) data. Total of 1,893 subjects were involved in basic assessments and follow up surveys conducted from years 2005 to 2010. Object of the study was to detect the predictive risk factors of metabolic syndrome within two years, by placing morbidity as the dependent variable. The severity of risk factors was compared by classifying age into decades and body mass index (BMI) into groups of either underweight, normal weight, or obese. RESULTS: The predictive risk factors of metabolic syndrome were revealed as age and BMI. The risk of metabolic syndrome increased by 1.05 fold and by 1.36 fold in correlation with increase in age and BMI, respectively. CONCLUSION: Age and BMI were shown to be the main predictive risk factors of metabolic syndrome within the first two years according to this study. Well systematized weight control programs seem inevitable for preventing metabolic disorder.

A Case of Plasmodium malariae Infection Imported from Guinea

Recently, the number of Korean travelers and workers to malaria-endemic regions has increased, and the number of patients with imported malaria cases has increased as well. In Korea, most cases of imported malaria infections are caused by Plasmodium falciparum and P. vivax. Only one report of imported P. malariae infection has been published thus far. Here, we describe a case of imported P. malariae infection that was confirmed by peripheral blood smear and nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene. A 53-yr-old man, who had stayed in the Republic of Guinea in tropical West Africa for about 40 days, experienced fever and headache for 3 days before admission. The results of rapid malaria test using the SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea) were negative, but Wright-Giemsa stained peripheral blood smear revealed Plasmodium. To identify the Plasmodium species and to examine if the patient had a mixed infection, we performed nested PCR targeting the SSU rRNA gene. P. malariae single infection was confirmed by nested PCR. Sequence analysis of the SSU rRNA gene of P. malariae showed that the isolated P. malariae was P. malariae type 2. Thus, our findings suggest that when cases of imported malaria infection are suspected, infection with P. malariae as well as P. falciparum and P. vivax should be considered. For the accurate diagnosis and treatment of imported malaria cases, we should confirm infection with Plasmodium species by PCR as well as peripheral blood smear and rapid malaria antigen test.

The Correlation Between the Smoking and Oxygen Free Radicals in Men

BACKGROUND: This study aimed to empirically investigate the determinants on oxygen free radical degree which causes biological damage focusing on smoking habit and health behaviors in daily life. METHODS: In this cross-sectional study, the subjects were adult males who submitted free radical tests among the examinees of the comprehensive medical testings at an university hospital in Suwon from 2008 to 2010. Total 497 samples were used in analyses for clarifying the relations of free radical degree to age, smoking, obesity, and other health behaviors. RESULTS: First, the degree of oxygen free radical increases by 0.164 as the age group increases (P<0.05). Second, the degree of oxygen free radical increases by 0.547 as the smoking habit increases (P<0.001). Third, the degree of oxygen free radical increases by 0.087 as the exposure to hazardous factors in workplace increases (P<0.001). CONCLUSIONS: The findings of the study imply that the smoking habit has more great influence on the increase of oxygen free radical in body than any other health behaviors. The causality of free radical to smoking and health behavior was not identified due to the limit of the cross-sectional study so it needs to be studied prospectively in the future.

Gastric Schwannoma Treated by Laparoscopic Surgery

Gastric schwannoma is a very rare gastrointestinal mesenchymal tumor. Schwannoma in the gastrointestinal tract is usually not symptomatic, and preoperative abdominal CT or endoscopic evaluation cannot distinguish it from gastrointestinal stromal tumor. Surgical resection of this tumor is adequate to achieve a good prognosis. We performed laparoscopic gastric wedge resection in two patients who had the preoperative diagnosis of gastric gastrointestinal stromal tumor. In both cases, the postoperative immunohistochemistry staining was positive for S-100 protein and it was negative for CD34, which is consistent with gastric schwannoma. We report here on two cases of gastric schwannoma along with a review of the literatures.

Changes of Symptoms and Manometric Results after Hemorrhoidectomy for Hemorrhoids with Difficulty in Evacuation

PURPOSE: We aimed to identify the need for an adjunctive internal sphincterotomy based on an evaluation of the changes in the symptoms and manometric results after a hemorrhoidectomy for hemorrhoids with difficulty in evacuation. METHODS: Twenty-five (25) patients who had hemorrhoids with difficulty in evacuation and 13 patients who had hemorrhoids without difficulty in evacuation were prospectively evaluated. Patients were interviewed about symptoms and underwent anorectal manometry before and 2 months after surgery. Difficulty in evacuation is defined as the difficulty that a patient has when trying to evacuate the rectum. RESULTS: There were significant differences in the sex ratio, the frequency of bowel movements, and the duration of bowel movements between the two groups (P<0.05). In cases with difficulty in evacuation, the frequency of bowel movements was significantly higher postoperatively and the duration of bowel movements was significantly shorter (P<0.05). The symptom of difficulty in evacuation disappeared in 21 of the as patients experiencing such a symptom, and was improved in the remaining of patients (P<0.05). Following the hemorrhoidectomy for the patients with difficulty in evacuation in the mean and the maximum resting pressure, and the maximum squeeze pressure decreased significantly (P<0.05). CONCLUSIONS: An adjunctive internal sphincterotomy was not necessary for patients who had hemorrhoids with difficulty in evacuation because following the hemorrhoidectomy, the resting pressure was significantly decreased, and the difficulty in evacuation had nearly subsided.

Clinical Analysis of Acalculous Cholecystitis

PURPOSE: Acalculous cholecystitis (ACC) is a rare, but potentially lethal disease, which occurs in critically ill patients and those recovering from non-biliary tract operations. Recently, an increase in the presentation of mild form ACC was noted to occur in outpatients. This study was performed to assess the clinical features and prognosis of ACC. METHODS: One thousand consecutive laparoscopic cholecystectomies, performed by a single surgeon at the Eulji Medical Center, between September, 2001 and May, 2005, were retrospectively analyzed. According to the clinical data, the preoperative findings, operative results and pathology reports, 35 patients were diagnosed with acalculous cholecystitis. RESULTS: No significant differences were found in the age and sex distributions, laboratory findings between ACC and calculous cholecystitis (CC) or incidence of associated diseases. The number of cases undergoing PTGBD, or with an inflammatory grade score during the operation, were higher for those with an ACC, but the operative times and conversion rates to open cholecystectomy were no different. Of the 35 ACC patients, only 20 had the true criteria of acute acalculous cholecystitis. However, the other 15 patients showed no strong evidence typical of acalculous cholecystitis. CONCLUSION: We experienced acalculous cholecystitis different from rare and lethal form of acalculous cholecystitis. But diagnosis of this mild form of ACC is also delayed due to lack of objective findings. High suspicious index of these diagnostic entities should be kept in mind and we should rule out other disease entities as soon as possible if ACC is questionable, so we can perform laparoscopic cholecystectomy safely on these mild forms of ACC.

Clinical Review of the Hepatic Resection for Hepatolithiasis: Factors Affecting Postoperative Complications / 한국간담췌외과학회지

PURPOSE: The hepatolithiasis and associated cholangitis result in liver atropy, biliary stricture, liver abscess and intrahepatic malignancy, and a hepatic resection should be performed in such cases. The technical difficulty and accompanied inflammation with a hepatic resection frequently cause postoperative complications. Therefore, the factors affecting the postoperative complications were evaluated. METHODS: Twenty one patients, with hepatolithiasis that had received a hepatectomy at the Department of Surgery, Eulji University Hospital between March 2001 and January 2003, were reviewed. RESULTS: The postoperative complications were intraabdominal abscess (7 cases), pleural effusion (3 cases), wound complication (3 cases), T-tube site leakage (1 case), cardiac arrest (1 case), acute pancreatitis (1 case), hepatitis A (1 case) and delayed gastric emptying (1 case). The overall complication rate was 57% (12/21 patients) and the most common complication was an intraabdominal abscess (7 cases). The factors that may affect these complications were analyzed. Preoperative percutaneous transhepatic biliary drainage (PTBD) increased the postoperative complications, which was statistically significant (p=0.027). Especially, preoperative PTBD and hepaticojejunostomy increased the rate of an intraabdominal abscess, which was statistically significant (p=0.026, p=0.008). CONCLUSION: With hepatolithiasis requiring hepatic resection there is a need to avoid unnecessary preoperative PTBD and bypass surgery for the reduction of postoperative complications, including an intraabdominal abscess. Conversely, it is considered important to remove every stone and avoid needless bypass surgery under an operation and for a hepatic resection to be performed after removing PTBD, where possible.

Hepatic Metastasis from Choriocarcinoma: Angiographic Findings in Two Cases

We report two cases of hepatic metastases from choriocarcinoma in women of childbearing age in whom imaging studies performed at presentation revealed the presence of liver masses, and who had clinically progressive anemia or intraabdominal hemorrhage. CT demonstrated heterogeneously enhanced liver masses. Characteristic angiographic findings included hypervascular hepatic masses with aneurysmal dilatations of the peripheral hepatic arteries at the arterial phase and persistent vascular lakes at the venous phase.

The effect of surfactant therapy for acute lung injury induced by intratracheal endotoxin instillation in rats examination of the lung / 결핵

BACKGROUND: Acute lung injury is an hypoxic respiratory failure resulting from damage to the alveolar-capillary membrane, which can be developed by a variety of systemic inflammatory diseases. In this study the therapeutic effects of intra-tracheal pulmonary surfactant instillation was evaluated in the intratracheal endotoxin induced acute lung injury model of a rat. METHODS: 20 Twenty Sprague-Dawley rats were divided into 4 groups, and normal saline (2 ml/kg, for group 1) or LPS (5 mg/kg, for group 2, 3, and 4) was instilled into the trachea respectively. Either normal saline (2 ml/kg, for group 1 & 2, 30 min later) or bovine surfactant (15 mg/kg, 30 min later for group 3, 5 hr later for group 5) was instilled into the trachea. The therapeutic effect of intratracheal surfactant therapy was evaluated with one chamber body plethysmography (respiratory frequency, tidal volume and enhanced pause), ABGA, BAL fluid analysis (cell count with differential, protein concentration) and pathologic examination of the lung. RESULTS: Intratracheal endotoxin instillation induced increase in increased the respiration rate, decrease in decreased the tidal volume and increase in increased the Penh in all group of rats. Intratracehal instillation of surfactant decreased Penh, increased arterial oxygen tension, decreased protein concentration of BAL fluid and decreased lung inflammation in at both time times of administration (30 minute and 5 hour after endotoxin instillation). CONCLUSION: Intratracheal instillation of surfactant would be can be a beneficial therapeutic modality as discovered in the acute lung injury model of rats induced by intratracheal LPS intillation. It deserves to be evaluated in the fortreatment of human acute lung injury.

Follow-Up Study of 6-Month Short Course Chemotherapyfor Pulmonary Tuberculosis with 2SKHRZ/4HRZ / 결핵

Background: Many clinicians have experienced the difficulty of decision on termination of antituberculosis chemotherapy after the 6th month due to relapse of disease. There is still controversy in the effect of 2S(K)HRZ/4HRZ 6-month short course chemotherapy including pyrazinamide for 6 months in patients with pulmonary tuberculosis. And there is no long term follow-up study of 6-month short course chemotherapy for pulmonary tuberculosis in korea. So we had performed the study to find the result of 6-month antituberculosis chemotherapy for 4 years. Method: We studied prospectively the effect of 2S(K)HRZ/4HRZ in one hundred-fifty patients with pulmonary tuberculosis and followed up fifty-nine patients for more than 1 year to 4 years after the completion of 6-month short course therapy. Results: 1) Out of one hundred-fifty patients, seventy-two patients(48%) completed the prescribed 6-month chemotherapy. Sixty-eight patients(45.3%) have experienced premature discontinuation and the most common cause of premature discontinuation was drop-out against advice(thirty-six patients, 24%). Ten patients(6.7%) were treated beyond the 6 months mainly due to irregular treatment. 2) Fifty-nine patients(81.9%) among seventy-two patients with completed treatment have been followed up for more than 1 year and 32 patients(44.4%) for more than 4 years. There was three relapse patients of whom two patients have experienced relapse of pulmonary tuberculosis within 1 year after the termination of chemotherapy. 3) Among one hundred-thirty-four patients who have been assessible for more than two months of chemotherapy, including the patients who experienced within 2 months, there were eighty-two patients(61.2%) who have experienced adverse reactions and the treament regimen was changed only in thirteen patients(9.7%). The most frequent cause of adverse reactions was arthralgia and/or hyperuricemia, which had occurred in 33 patients(24.6%). Conclusion: In a university hospital in Korea, 6-month short course chemotherapy of 2S(K)HRZ/4HRZ had unnegligible relapses and premature discontinuation. Therefore, change of the regimen might be carefully considered by drug susceptibility results. Close monitoring of patients, retrial of sputum exam and radiologic evaluation during treatment might be required in the endemic area of drug resistant strains like in Korea. Further study about the effect of 6-month short course chemotherapy including pyrazinamide for 6-month might be needed.