Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis

Purpose@#We sought to identify the risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis. @*Methods@#The study retrospectively analyzed 497 patients who underwent laparoscopic appendectomies for uncomplicated appendicitis between January 2018 and December 2020. The patients were divided into an early discharge group (≤2 days) and a late discharge group (>2 days) based on the length of hospital stay (LOS). The patients were also divided into uneventful and complicated groups according to the need for additional treatment after standard follow-up. @*Results@#Thirty-seven patients (7.4%) were included in the late discharge group. The mean LOS of the late discharge groups was 3.9 days. There were significant differences according to age, preoperative C-reactive protein (CRP), and operative time between the 2 groups. Only operative time was significantly associated with prolonged LOS in multivariate analysis. Thirty-five patients (7.0%) were included in the complicated group. The mean duration of treatment in the uneventful and complicated groups was 7.4 and 25.3 days, respectively. Significant differences existed between the uneventful and complicated groups in preoperative body temperature, preoperative CRP levels, maximal appendix diameter, and the presence of appendicoliths. In multivariate analysis, preoperative CRP levels and maximal appendix diameter were independent predictors of delayed treatment completion. @*Conclusion@#Shorter operative time is desirable to ensure minimal hospital stay in patients with uncomplicated appendicitis. Further efforts are needed to ensure that patients with uncomplicated appendicitis do not experience delayed treatment completion after laparoscopic appendectomies.

A Case of Chiari Type 1 Malformation and Syringomyelia in Neurofibromatosis Type 1 Patient

A 26-year-old woman presented with skin pigmentation and numbness on the upper arm. More than six café au lait spots over 15 mm diameter could be seen throughout her skin. Neurofibromatosis (NF) type 1 was diagnosed based on genetic study. The brain magnetic resonance imaging (MRI) showed Chiari type 1 malformation and syringomyelia was noted in the C2 to T7 level in the spinal MRI. We suggest Chiari malformation and syringomyelia could be a rare manifestation in a patient with NF type 1.

Systematic Review of Heavy Metal Concentrations in Fish and Shellfish in Korea / 이화의대지

OBJECTIVES: Heavy metals ingested through the consumption of aquatic products can accumulate in the human body over the long-term and cause various health problems. This study aims to present comprehensive data on the amount of heavy metals found in fish and shellfish in Korea using a systematic review of studies that report on that issue. METHODS: The study used the following databases: PubMed, Korean Studies Information Service System, and Research Information Sharing Service. The search terms for PubMed included fish OR shellfish OR seafood AND mercury OR cadmium OR lead OR heavy metal AND Korea. The search terms for Korean Studies Information Service System and Research Information Sharing Service included eoryu sueun, eoryu kadeumyum, eoryu nab, eoryu jung-geumsog, paeryu sueun, paeryu kadeumyum, paeryu nab, paeryu jung-geumsog, eopaeryu sueun, eopaeryu kadeumyum, eopaeryu nab, and eopaeryu jung-geumsog. RESULTS: A total of 32 articles were selected for review. The total mercury, lead, and cadmium concentrations in fish and shellfish reported in each of the articles are summarized, as are the species of fish and shellfish with relatively high concentrations of heavy metals. Total mercury concentrations tended to be higher in predatory fish species, such as sharks, billfishes, and tuna, while lead and cadmium concentrations tended to be higher in shellfish. CONCLUSION: This paper is the first to report a comprehensive summary of the concentrations of heavy metals in fish and shellfish. This data could be used as evidence to protect Koreans from exposure to heavy metals due to the consumption of highly polluted aquatic products.

Survey on Awareness for Environmental Health Risk of Fetus and Infant in Reproductive-aged Women / 이화의대지

OBJECTIVES: The accumulated evidence shows that adult disease may have origins during the fetal period and maternal environmental exposure may affect fetus and infant health. To assess the environmental health of fetus and infants and examine women's concerns about environmental health, we designed and conducted an environmental health survey in reproductive-aged women in 2011. METHODS: A stratified multi-stage design was adopted for our survey, and 1,000 reproductive-aged women aged 25 to 39 years participated. The participants were asked to complete an electronic questionnaire using the computer-assisted web interviewing method. All the participants were married woman, and 80% had experienced pregnancy before completing the survey. RESULTS: In the study, 86.3% of the participants responded that they are worried about the environmental problems that may affect the fetus and infant. The participants responded that they were most worried about global warming and climate change (36.2%), electromagnetic waves (31.4%), and endocrine disrupting chemicals (25.1%). Moreover, participants responded that environmental problem can cause children's allergic disease, such as atopic dermatitis, metabolic syndrome and growth development. CONCLUSION: We found reproductive-aged women have high awareness of children's environmental health. We also recommended that additional surveys on mother and child environmental health be conducted to make a health policy for women, fetus and infant.

High Maternal Blood Mercury Level Is Associated with Low Verbal IQ in Children

The objective of the present study was to investigate the relationship of IQ in children with maternal blood mercury concentration during late pregnancy. The present study is a component of the Mothers and Children's Environmental Health (MOCEH) study, a multi-center birth cohort project in Korea that began in 2006. The study cohort consisted of 553 children whose mothers underwent testing for blood mercury during late pregnancy. The children were given the Korean language version of the Wechsler Preschool and Primary Scale of Intelligence, revised edition (WPPSI-R) at 60 months of age. Multivariate linear regression analysis, with adjustment for covariates, was used to assess the relationship between verbal, performance, and total IQ in children and blood mercury concentration of mothers during late pregnancy. The results of multivariate linear regression analysis indicated that a doubling of blood mercury was associated with the decrease in verbal and total IQ by 2.482 (95% confidence interval [CI], 0.749–4.214) and 2.402 (95% CI, 0.526–4.279), respectively, after adjustment. This inverse association remained after further adjustment for blood lead concentration. Fish intake is an effect modifier of child IQ. In conclusion, high maternal blood mercury level is associated with low verbal IQ in children.

Successful Treatment in Fatal Adenovirus Pneumonia with the Use of Extracorporeal Membrane Oxygenation

Severe adenovirus pneumonia that causes acute respiratory failure can occur in infants, children, and immunocompromised patients. However, severe adenovirus pneumonia is rare in adults with a normal immune system. Adenovirus pneumonia may progress to acute respiratory failure in a few hours or a few days, and its clinical course cannot be predicted. In addition, the mortality rate is very high (range, 50% to 66%). However, the optimal treatment of adenovirus pneumonia has not been established. Herein, we report the successful treatment of acute respiratory failure due to adenovirus pneumonia with extracorporeal membrane oxygenation.