Family Outbreak of Trichinosis After Eating a Raw Meat of Wild Swine

Trichinosis is a worldwide parasitic infection caused by ingesting an uncooked raw meat containing viable larvae of nematode Trichinella. Although most cases have been reported in Western countries, the incidence has decreased due to strict control of meat handlings and improved hygiene in these countries. In Korea, the first case of Trichinella spiralis was reported in a patient who ingested an uncooked badger. We have also experienced four cases of Trichinella spiralis infestation among family members who showed typical clinical manifestations and laboratory findings after ingesting raw wild swine meat, and herein report the finding.

Family Outbreak of Trichinosis After Eating a Raw Meat of Wild Swine

Trichinosis is a worldwide parasitic infection caused by ingesting an uncooked raw meat containing viable larvae of nematode Trichinella. Although most cases have been reported in Western countries, the incidence has decreased due to strict control of meat handlings and improved hygiene in these countries. In Korea, the first case of Trichinella spiralis was reported in a patient who ingested an uncooked badger. We have also experienced four cases of Trichinella spiralis infestation among family members who showed typical clinical manifestations and laboratory findings after ingesting raw wild swine meat, and herein report the finding.

The Anaylsis of Mortality Rate According to CTP Score and MELD Score in Patients with Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: The Model for End-Stage Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The MELD score is a reliable measurement of mortality risk and is suitable for a disease severity index in patients with end-stage liver disease. We examined the validity of the MELD as a disease severity index for patients with end-stage liver disease. METHODS: We investigated the 379 patients with liver cirrhosis hospitalized between January 1995 and May 2001. We retrospectively reviewed the hospital records to verify the diagnosis of cirrhosis and to collect exact patient information about their demographic data, portal hypertensive complications and laboratory data. The ability to classify patients with liver cirrhosis according to their risk of death was examined using the concordance c-statistic. RESULTS: The MELD score performed well in predicting death within 3 months with a c-statistic of 0.73 with etiology and 0.71 without etiology. The significant clinical, laboratory variables on 3 month survival in patients with liver cirrhosis are serum bilirubin, ascites and hepatic encephalopathy. The addition of portal hypertensive complications to the MELD score did not improve the accuracy of the MELD score. CONCLUSIONS: The MELD score is a useful disease severity index for the patients with end-stage liver disease and provides reliable measurement of short term survival over a wide range of liver disease severity and diverse etiology.

The Usefulness of B-type Natriuretic Peptide test in Critically Ill, Noncardiac Patients / 결핵

BACKGROUND: Previous studies have suggested that a B-type natriuretic peptide(BNP) test can provide important information on diagnosis, as well as predicting the severity and prognosis of heart failure. Myocardial dysfunction is often observed in critically ill noncardiac patients admitted to the Intensive Care Unit, and the prognosis of the myocardial dysfunction needs to be determined. This study evaluated the predictability of BNP on the prognosis of critically ill noncardiac patients. METHODS: 32 ICU patients, who were hospitalized from June to October 2002 and in whom the BNP test was evaluated, were enrolled in this study. The exclusion criteria included the conditions that could increase the BNP levels irrespective of the severity, such as congestive heart failure, atrial fibrillation, ischemic heart disease, and renal insufficiencies. A triage B-Type Natriuretic Peptide test with a RIA-kit was used for the fluorescence immunoassay of BNP test. In addition, the acute physiology and the chronic health evaluation (APACHE)IIscore and mortality were recorded. RESULTS: There were 16 males and 16 females enrolled in this study. The mean age was 59 years old. The mean BNP levels between the ICU patients and control were significantly different (186.7+/-274.1pg/mL vs. 19.9+/-21.3 pg/mL, p=0.033). Among the ICU patients, there were 14(44%) patients with BNPlevels above 100 pg/mL. The APACHEIIscore was 16.5+/-7.6. In addition, there were 11 mortalities reported. The correlation between the BNP and APACHEIIscore, between the BNP and mortality were significant (r=0.443, p=0.011 & r=0.530, p=0.002). The mean BNP levels between the dead and alive groups were significantly different (384.1+/-401.7 pg/mL vs. 83.2+/-55.8 pg/mL p=0.033). However, the PaO2/FiO2 did not significantly correlate with the BNP level. CONCLUSION: This study evaluated the BNP level was elevated in critically ill, noncardiac patients. The BNP level could be a useful, noninvasive tool for predicting the prognosis of the critically ill, noncardiac patients.

The Application of B-Type Natriuretic Peptide Level of the Dyspneic Patients: Differentiation Between Cor Pulmonale and Left Ventricular Dysfunction / 결핵

BACKGROUND: The serum B-type natriuretic peptide (BNP) is released from the ventricles as a response to volume or pressure overload of the ventricles. A few studies have reported that the BNP measurements are useful in differentiating between heart failure and pulmonary causes in patients who visited the emergency department with dyspnea as the chief complaint. It is difficult to differentiate a right heart failure from a left heart failure in the emergency room. However, there is no report on the application of a BNP assay to differentiate in right heart failure from left heart failure. In this study, the BNP levels were measured from dyspneic patients in the emergency department to determine whether or not the BNP level would be useful in differentiating the cause of the dyspnea from right ventricular failure and left ventricular failure. METHOD: 89 patients who visited emergency department of the Bundang Cha Hospital with dyspnea from June 2002 to March 2003 were selected. The 29 patients from the outpatient clinics and inpatients were randomly selected as the control. RESULTS: The BNP levels of patients in the left heart failure group were significantly different from that of the patients in the right heart failure group (682+/-314 pg/mL vs. 149+/-94 pg/mL, p=0.000). When the BNP cut-off level was designated as 219 pg/mL using the receiver operating characteristic curve, the sensitivity was 94.3%, and specificity was 92.9%. In addition, the positive predictive value was 97% and the negative predictive value was 86.7% in differentiating right heart failure from left heart failure. CONCLUSION: Measurements of the serum BNP levels is an accurate and rapid method that can aid in distinguishing between right heart failure and left heart failure.

A Clinical Study of Microporous Coated Hemispherical Acetabular Cup / 대한정형외과학회잡지

In order to observe the differences in fixability and stability of the acetabular cup through the differences in cup size in relation to the size of acetabular reaming, we analyzed 75 cases of porous coated acetabular cup of Harris-Galante type which be followed up more that two years. All cases were divided into two group ; the first group (On line fit :45 cases) used with acetabular cup equal in size to the last reaming size and the second group (Press fit : 30 cases) used with acetabular cup 2mm larger than the last reaming size. For initial stability, all cases were fixed with acetabular screws. Both groups were analyzed for presence of gap, change of acetabular inclination, presence of radiolucent line, degree of displacement of vertical distance, stability and clinical results. The results were as follows; 1. The average Harris hip score was improved from 55.8 points preoperatively to 90.2 points postoperatively in the first group, from 56.9 points to 91.2 points in the second group, Clinical results are excellent in 39 cases, good in 4 cases, fair in 2 cases in the first group, and excellent in 29 cases and good in 1 case in the second group. 2. The gap between the acetabular cup and acetabulum was found initially at 17 zones in the first group but no gap at final follow up. In the second group, the gap was found at 23 zones and finally remained less that 1 mm gap was found at 3 cases in zone B1. 3. No radiologic instability of acetabular cup by Martell evaluation was noted in both 1st and 2nd group. Our data suggests that initial gap between acetabular cup and acetabulum in microporous coated acetabular cup were replaced with new bone and also, radiologic stability and good clinical results could be obtained in the second group used with acetabular cup 2 mm larger than the last reaming size.