Pilot Project of Special Emergency Medical Service Team for Anaphylaxis in Gangwon-do, Korea: Results from an Online Questionnaire Survey

Background@#Early recognition and prompt intramuscular epinephrine administration are critical for the treatment of anaphylaxis. The special emergency medical service team (SEMST) is a reorganization plan that incorporates first-level emergency medical technicians (EMTs) and nurses from Korea to give the authority to administer epinephrine. This study evaluates the experience of SEMST and aims to investigate further needs in the pre-hospital management of anaphylaxis. @*Methods@#An online survey of 29 questions on the Gangwon-do 119 EMST was conducted.IBM SPSS Statistics ver. 20.0 (IBM Co., Armonk, NY, USA) and R ver.4.0.3. were used for statistical analysis. @*Results@#A total of 428 (44.6%) participants responded to the questionnaire, and 55.6% (238/428) experienced anaphylaxis. The common presumed cause was insect sting/animal bites at 84.5% (201/238), followed by food (7.6%, 18/238), and drugs (6.3%, 15/238). The frequency of occurrence was highest for tourist attractions (58.6%, 167/285), followed by homes (31.9%, 91/285) and workplace (3.5%, 10/285). Among 136 medical personnel (31.8%) who were currently active or had been active as the SEMST, 95 (70.0%) experienced anaphylaxis, and 58 (61.1%) used epinephrine, which was significantly lower in the nonSEMST group (n = 36, 25.2%). The biggest difficulty in pre-hospital treatment was the limitation of drug administration authority (23.4%, 22/95). The lack of experience and tricky treatment are the chief difficulties in pediatric anaphylaxis. The percentage of correct answers regarding anaphylaxis awareness was significantly higher in the educated (n = 374) than in the non-educated group (n = 54), both for diagnosis (24.9% vs. 11.1%) and treatment (73.5% vs. 37.0%). @*Conclusion@#Proper administration of epinephrine is particularly important for pre-hospital anaphylaxis management in rural areas. Expanding SEMST and conducting periodic education using virtual experiences is necessary.

KOBIO, the First Web-based Korean Biologics Registry Operated With a Unified Platform Among Distinct Disease Entities

The KOrean College of Rheumatology BIOlogics and targeted therapy (KOBIO) registry is a nationwide observational cohort that captures detailed data on exposure of patients to biologic and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs). This registry was launched in December 2012 with an aim to prospectively investigate clinical manifestations and outcomes of patients with rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis who initiated a biologic or targeted synthetic DMARD or switched to another. Demographic data, disease activity, current treatment, adverse events, terms based on Medical Dictionary for Regulatory Activities, and so on are registered for patients who are then followed up annually in a web-based unified platform. The KOBIO registry also recruits and collects data of patients with RA on conventional DMARDs for comparison. As of today, more than 5,500 patients were enrolled from 47 academic and community Rheumatology centers across Korea. The KOBIO registry has evolved to become a powerful database for clinical research to improve clinical outcomes and quality of treatment.

KOBIO, the First Web-based Korean Biologics Registry Operated With a Unified Platform Among Distinct Disease Entities

The KOrean College of Rheumatology BIOlogics and targeted therapy (KOBIO) registry is a nationwide observational cohort that captures detailed data on exposure of patients to biologic and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs). This registry was launched in December 2012 with an aim to prospectively investigate clinical manifestations and outcomes of patients with rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis who initiated a biologic or targeted synthetic DMARD or switched to another. Demographic data, disease activity, current treatment, adverse events, terms based on Medical Dictionary for Regulatory Activities, and so on are registered for patients who are then followed up annually in a web-based unified platform. The KOBIO registry also recruits and collects data of patients with RA on conventional DMARDs for comparison. As of today, more than 5,500 patients were enrolled from 47 academic and community Rheumatology centers across Korea. The KOBIO registry has evolved to become a powerful database for clinical research to improve clinical outcomes and quality of treatment.

Comparison of long-term biliary complications between open and laparoscopic choledochal cyst excision in children

Purpose@#Cyst excision with hepaticojejunostomy has been the classic procedure for treating choledochal cysts, and the use of laparoscopic treatment has been favored recently. The purpose of this study was to compare the long-term biliary complication of laparoscopic operation with open surgery for choledochal cyst presenting in children. @*Methods@#A retrospective study comparing the laparoscopic and open procedures was performed in 185 patients with choledochal cyst in a single children’s hospital. There were 109 patients who were operated with open surgery, and 76 patients operated with laparoscopic surgery. The primary outcome was long-term biliary complications and the secondary outcome included operative time, intraoperative transfusion, length of hospital stay, and other late postoperative complications. @*Results@#In the patient’s demographics, there was no significant difference between the 2 groups. Notably, it was shown that the operative time was longer in the laparoscopic group. The number of patients requiring blood transfusion intraoperatively was lower in the laparoscopic group. It was noted that the hospital stay was not statistically different. The duration to resumption of diet and duration of drainage were longer in the laparoscopic group. Biliary complications were shown to be significantly higher in the open group. The risk factor for long-term biliary complications was noted with the intraoperative transfusion. @*Conclusion@#The use of a laparoscopic choledochal cyst excision with hepaticojejunostomy is a safe and feasible technique in a young patient. The long-term biliary complication was lower compared to open surgery, rendering this a good option for pediatric patients.

Timing of Surgical Management of Papillary Thyroid Cancer Diagnosed during Pregnancy

BACKGROUND AND OBJECTIVES: Although the thyroid cancer occurs in every one of 1000 pregnant women, the optimal timing of surgery is still uncertain. The aim of this study is to propose the timing of surgical management of papillary thyroid cancer in pregnant woman. MATERIALS AND METHODS: The authors reviewed the medical records of papillary thyroid cancer patients diagnosed during pregnancy in our hospital from May 1st, 2013 to April 30th, 2015. We analyzed the changes of radiologic and pathologic findings during prenatal and postpartum period. RESULTS: 17 of 4978 patients were diagnosed with papillary thyroid cancer. 10 of 17 patients enrolled in this study. Each size of thyroid cancer in 1st trimester, in 2nd trimester, in 3rd trimester, and after delivery was 11.30±6.01 mm, 12.74±7.79 mm, 13.82±9.93 mm, and 13.82±8.19 mm, respectively. No patient showed the recurrence or death after surgery. CONCLUSION: There was no statistical significance on the prognosis of papillary thyroid cancer during prenatal and postpartum period. The authors propose that the surgical treatment of papillary thyroid cancer diagnosed during pregnancy could be delayed after delivery.

Timing of Surgical Management of Papillary Thyroid Cancer Diagnosed during Pregnancy

BACKGROUND AND OBJECTIVES: Although the thyroid cancer occurs in every one of 1000 pregnant women, the optimal timing of surgery is still uncertain. The aim of this study is to propose the timing of surgical management of papillary thyroid cancer in pregnant woman. MATERIALS AND METHODS: The authors reviewed the medical records of papillary thyroid cancer patients diagnosed during pregnancy in our hospital from May 1st, 2013 to April 30th, 2015. We analyzed the changes of radiologic and pathologic findings during prenatal and postpartum period. RESULTS: 17 of 4978 patients were diagnosed with papillary thyroid cancer. 10 of 17 patients enrolled in this study. Each size of thyroid cancer in 1st trimester, in 2nd trimester, in 3rd trimester, and after delivery was 11.30±6.01 mm, 12.74±7.79 mm, 13.82±9.93 mm, and 13.82±8.19 mm, respectively. No patient showed the recurrence or death after surgery. CONCLUSION: There was no statistical significance on the prognosis of papillary thyroid cancer during prenatal and postpartum period. The authors propose that the surgical treatment of papillary thyroid cancer diagnosed during pregnancy could be delayed after delivery.

Clinical Review and Operative Management in Patients of Symptomatic Hepatic Cysts / 한국간담췌외과학회지

BACKGROUND/AIMS: Hepatic cysts are incidentally found at laparotomy or through abdominal imaging studies. When they become symptomatic, treatment is indicated. The aim of this study is to evaluate many options of their management, especially about surgical methods. METHODS: Data were retrospectively analyzed from the clinical charts of 21 patients undergoing surgery for symptomatic hepatic cysts from January, 1995, through December, 2002 in department of Surgery, Pusan University Hosipital. Charts were obtained from the original hosipital referral. We considered the following variables for analysis: age, sex, symptoms, hepatic cyst location, size, operative methods, histological confirm, postoperative morbidity and mortality, length of postoperative hosipital stay, and follow-up outcome. RESULTS: Mean age of the 21 patients was 53 years. The ratio of male and female was 1:4.3. Their main symptoms were right upper quadrant pain or discomfort, epigastric pain, and abdominal distension. Rarely, palpable mass, dyspepsia, mild jaundice, and acute abdominal pain from ruptured hepatic cyst were observed. Preoperative abdominal ultrasound and computed tomographic scannig were done in all patients. The mean size of hepatic cysts was 9.04 cm in computed tomographic scanning. The 61.9% of patients had the location in right lobe. Simple cyst was characterized by homogeneous, low attenuated and unilocular mass in computed tomographic scanning: in difference, biliary cystadenoma, internal intervening septation and papillary infoldings with cyst itself. Fifteen patients underwent partial cystectomy and 4, complete cystectomy and 1, non-anatomical hepatic resection and 1, left lateral segmentectomy. Hepatic cysts were consisting of 15 cases of simple cyst, 4 cases of biliary cystadenoma, 1 case of Caroli's disease and 1 case of polycystic liver disease. Postoperative complication was bile leakage in one case. No symptomatic recurrence occured during a mean follow-up period of 42.5 months. CONCLUSION: According to the characteristics of symptomatic hepatic cyst, proper operative methods of management were considered. More long-term follow-up is necessary but in simple cyst in histological type, partial cystectomy can be the acceptable technique, complete cystectomy or hepatic resection should be perfomed in biliary cystadenoma for recurrence and malignant potential.

Central Somatosensory Conduction Time in Head Injured Patient

The central somatosensory conduction time(CCT) was measured by recording the cerebral and spinal evoked potentials following median nerve stimulation in 24 traumatic brain injury patients. The findings of evoked potential study correlated to the functional independence measure(FIM), mini mental status examination(MMSE) and Glasgow outcome scale(GOS). The CCT of head injured patients was prolonged compared to that of the controls. The CCT with stimulation of the affected side was significantly prolonged compared to that with non- affected side. Abnormal CCT was related to the poor functional status measured by FIM and GOS. There`s no significant difference between groups of absent evoked potential and prolonged CCT by FIM score. These results suggest that the CCT correlates with the functional status of head injured patients. Follow up studies are required to evaluate whether the CCT could be a valuable prognostic indicator or not.