Serial Changes of Heat Shock Protein 70 and Interleukin-8 in Burn Blister Fluid

BACKGROUND: It has been reported that heat shock protein 70 (HSP70) and interleukin-8 (IL-8) play an important role in cells during the wound healing process. However, there has been no report on the effect of HSP70 and IL-8 on the blisters of burn patients. OBJECTIVE: This study aimed to evaluate the serial quantitative changes of HSP70 and IL-8 in burn blisters. METHODS: Twenty-five burn patients were included, for a total of 36 cases: twenty cases on the first day, six cases on the second, five cases on the third, three cases on the fourth, and two cases on the fifth. A correlation analysis was performed to determine the relationship between the concentration of HSP70 and IL-8 and the length of the treatment period. RESULTS: The HSP70 concentration was the highest on the first day, after which it decreased down to near zero. Most HSP70 was generated during the first 12 hours after the burn accident. There was no correlation between the concentration of HSP70 on the first day and the length of the treatment period. No measurable concentration of IL-8 was detected before 5 hours, but the concentration started to increase after 11 hours. The peak value was measured on the fourth day. CONCLUSION: While HSP70 increased in the first few hours and decreased afterwards, IL-8 was produced after 11 hours and increased afterward in burn blister fluid. These findings provide new evidence on serial changes of inflammatory mediators in burn blister fluid.

A Telephone Method for Helping Lay Rescuers Perform High Quality Cardiopulmonary Resuscitation

PURPOSE: Dispatcher-assisted telephone instruction during cardiopulmonary resuscitation (CPR) improves the quality of CPR performed by laypersons. However, in Korea, CPR instruction guidelines for bystanders have not made. We therefore studied the effects of verbal instruction on the quality of chest compression. METHODS: Data from two randomized, double-blinded, controlled trials using identical methodology were combined to obtain 175 records for analysis. Subjects were randomized into either a "push as hard as you can and fast" (n=87) or "push down 5~6 cm, 100~120 rate/min" (n=88), verbal instructions in the 2011 Korea Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). Data were recorded via a Resusci(R) Anne SkillReporter(TM), Laerdal Medical mannequin. Primary outcome measures included chest compression depth and chest compression rate per minute. RESULTS: The average compression depth and speed of chest compressions did not significantly differ between the two verbal instructions. CONCLUSION: The verbal istructions provided by telephone based on the 2011 Korean Guidelines for CPR and ECC are not effective. The instructions for high quality CPR of layperson should therefore be studied.

Grayanotoxin Poisoning from Honey: A Case Report

Honey is produced by bees from nectar collected from nearby flowers. Sometimes, honey produced from the Rhododendron species is contaminated by Grayanotoxin (GTX) in Nepal and other countries. There have been reports of GTX intoxication, also known as 'mad honey disease', from honey produced in countries other than Korea. The importation of wild honey has been prohibited by the Korean Food and Drug Administration since 2005, yet it is still distributed within Korea by the occasional tourist. We report a case of GTX intoxication from contaminated honey which included the symptoms of nausea, vomiting, general weakness, dizziness, blurred vision, hypotension and sinus bradycardia. By means of infusion with normal saline and atropine sulfate, the patient's condition fully recovered within 8 hours of hospital admission, and she was discharged without any complications.

What Kind of Factors Is Influencing Resting Energy Expenditure on Major Burn Patients?

PURPOSE: Burn injury is among the most severe type of trauma that the body can sustain. The major burn increases energy expenditure as the result of its induction of the hypermetabolic and catabolic state. It is well-documented that nutritional support may improve morbidity and mortality after severe burn injury. Therefore, adequate nutritional support is essential in burned patients to prevent the detrimental consequences of overfeeding and underfeeding. The purpose of this study was to analyze the factors influencing resting energy expenditure on major burn patients. METHODS: In 199 patients with > or =20% total body surface area (TBSA) burn were monitored with 403 measurement of resting energy expenditure (REE) from January 2004 to December 2008 in burn center of the Hangang Sacred Heart Hospital. Gender, age, burn size, inhalation injury, ventilator were included in the factors which influence the REE of massive burn patients. RESULTS: The measured REE and REE/basal metabolic rate (BMR) were significantly higher in males (p<0.05). The measured REE and REE/body mass index (BMI) showed significant difference between age groups (p<0.01). The measured REE and REE/BMI showed significant difference between burn size groups (p<0.01). The measured REE, REE/BMR and REE/BMI for patients with inhalation injury were significantly higher than patients without inhalation injury (p<0.01). The measured REE, REE/BMR and REE/BMI for patient needs ventilator were significantly higher than the other group (p<0.01). CONCLUSION: Indirect calorimetry is useful in detecting variations in energy expenditure among individuals and in detecting changes in metabolism. Unlike indirect calorimetry measurements, static formulas may not consider hypermetabolic and catabolic states. Because adequate nutritional support is essential in burned patients, it should be considered the factors influencing resting energy expenditure on major burn patients.

A Developmental Process of Telemedicine, e-Health & u-Health

As Information Technology has developed, there has been a birth of new medical fields including telemedicine, e-Health, and u-Health. The differences between the new terms resulted from renewed definitions with the development of technology. However, aside from the simple change in terminology medical services that use the terms has expanded along with the change in terminology. Currently most countries use telemedicine as a part of their healthcare system. As such, related devices and services have been slated to become a totally new industry. In Korea, due to the advances in IT, Increase in medically vulnerable and aging population, and increase in the number of patients with chronic disease, telemedicine has been widely used in public healthcare system. Several developmental attempts by public and private sectors have had limited success due to legal and institutional limitations but recent changes in medical law and movement to allow tele-diagnosis and treatment in the public sector has brought in a new era. Although development of telemedicine technology may be the key, it is even more important that the development in medical services models as well as their application be on the same track. Furthermore, from the clinical and academic standpoint, the aspects of safety, efficiency, and economic viability must be thoroughly tested and applied. Most importantly, active involvement from the medical community in development of new medical technology as well as new service models for diagnosis and treatment is required. The most advanced technology would be useless if it is not being actively utilized by the medical community in the treatment and management of patients.

A Case of Tricuspid Regurgitation after Blunt Chest Trauma

Tricuspid regurgitation after blunt chest trauma is rarely seen in the emergency department. A 19-year-old patient visited our emergency department with chest discomfort after collision with his brother while skiing. Recently, Skiing as a winter sports has become popular with the Korean people, so there is an increasing tendency for patients with diverse traumas associated with ski accidents to visit the emergency department. From simple abrasions or contusions to deadly injuries with unstable vital signs, we are seeing many kind of injuries in the emergency department. We present the case report of a patient with tricuspid regurgitation after a blunt chest trauma during the skiing.

A Case of Tricuspid Regurgitation after Blunt Chest Trauma

Tricuspid regurgitation after blunt chest trauma is rarely seen in the emergency department. A 19-year-old patient visited our emergency department with chest discomfort after collision with his brother while skiing. Recently, Skiing as a winter sports has become popular with the Korean people, so there is an increasing tendency for patients with diverse traumas associated with ski accidents to visit the emergency department. From simple abrasions or contusions to deadly injuries with unstable vital signs, we are seeing many kind of injuries in the emergency department. We present the case report of a patient with tricuspid regurgitation after a blunt chest trauma during the skiing.