Impacts of Social Distancing During the COVID-19 Outbreaks in Korea: Level 1 Trauma Center Data of Domestic Incidents and Intentional Injury

Objectives@#As a protective measure to slow down the transmission of coronavirus disease 2019 in Korea, social distancing was implemented from February 29th , 2020. This study aimed to evaluate the prevalence of domestic incidents and intentional injury during March 2020 when social distancing was in effect. @*Methods@#There were 12,638 patients who visited the Level 1 trauma center of Chungnam province with injuries from domestic incidents, familial discord, and intentional injury. The prevalence of injuries during March 2020 was compared with the average of the previous 5 years, and the average for every March between 2015 and 2019. @*Results@#The prevalence of domestic incidents in March 2020 was significantly higher than the 5-year average, and the average for every March from 2015 to 2019 (p < 0.001). Familial discord (p = 0.002) and intentional injury (p = 0.031) were more frequently observed in March 2020. Adolescents showed a markedly higher level of intentional injury in March 2020 than in both the 5-year average (p = 0.031), and average for every March over the previous 5 years (p = 0.037). @*Conclusion@#The prevalence of domestic incidents and intentional injury were significantly higher during the period of social distancing in Korea. There is a need for social consensus, better policies, and psychological support services, especially if faced with a second or third wave of coronavirus disease.

Impacts of Social Distancing During the COVID-19 Outbreaks in Korea: Level 1 Trauma Center Data of Domestic Incidents and Intentional Injury

Objectives@#As a protective measure to slow down the transmission of coronavirus disease 2019 in Korea, social distancing was implemented from February 29th , 2020. This study aimed to evaluate the prevalence of domestic incidents and intentional injury during March 2020 when social distancing was in effect. @*Methods@#There were 12,638 patients who visited the Level 1 trauma center of Chungnam province with injuries from domestic incidents, familial discord, and intentional injury. The prevalence of injuries during March 2020 was compared with the average of the previous 5 years, and the average for every March between 2015 and 2019. @*Results@#The prevalence of domestic incidents in March 2020 was significantly higher than the 5-year average, and the average for every March from 2015 to 2019 (p < 0.001). Familial discord (p = 0.002) and intentional injury (p = 0.031) were more frequently observed in March 2020. Adolescents showed a markedly higher level of intentional injury in March 2020 than in both the 5-year average (p = 0.031), and average for every March over the previous 5 years (p = 0.037). @*Conclusion@#The prevalence of domestic incidents and intentional injury were significantly higher during the period of social distancing in Korea. There is a need for social consensus, better policies, and psychological support services, especially if faced with a second or third wave of coronavirus disease.

Management of Severe Trauma Patients in the Emergency Intensive Care Unit

PURPOSE: The aim of this study was to evaluate the quality of the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency intensive care unit (ICU) in consultation with intervention radiologists and surgeons. METHODS: This was a retrospective observational study conducted in an emergency ICU of a tertiary referral hospital. We enrolled consecutive patients who had been admitted to our emergency ICU with major trauma from March 2007 to September 2010. We collected data with respect to demographic findings, mechanisms of injury, the trauma and injury severity score (TRISS), emergency surgery, angiographic intervention, and 6-month mortality. Then, we compared the observed and predicted survivals of the patients. The Hosmer-Lemeshow test and calibration plots by using 10 groups, one for each decile, of predicted mortality were used to evaluate the fitness of TRISS. P-values of greater than 0.05 represent a fair calibration. RESULTS: Among 116 patients, 12 (10.34%) were dead within 6 months after admission to the ICU, and 29 (25.00%) and 38 (32.80%) patients received emergency surgery and angiographic intervention, respectively. The mean injury severity score and revised trauma score were 36.97+/-17.73 and 7.84+/-6.75, respectively. The observed survival and the predicted survival of the TRISS were 89.66% (95% confidence interval [CI]: 84.03~95.28%) and 69.85% (95% CI: 63.80~75.91%), respectively. The calibration plots showed that the observed survival of our patients was consistently higher than the predicted survival of the TRISS (p<0.001). CONCLUSION: The observed survival for the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency ICU in consultation with intervention radiologists and surgeons, was higher than the predicted survival of the TRISS.

Evaluation of Lung Injury Score as a Prognostic Factor of Critical Care Management in Multiple Trauma Patients with Chest Injury

PURPOSE: Chest injuries in multiple trauma patients are major predisposing factor for increased length of stay in intensive care unit, prolonged mechanical ventilator, and respiratory complications such as pneumonia. The aim of this study is the evaluation of lung injury score as a risk factor for prolonged management in intensive care unit (ICU). METHODS: Between June to August in 2011, 46 patients admitted to shock and trauma center in our hospital and 24 patients had associated chest damage without traumatic brain injury. Retrospectively, we calculated injury severity score (ISS), lung injury score, and the number of fractured ribs and performed nonparametric correlation analysis with length of stay in ICU and mechanical ventilator support. RESULTS: Calculated lung injury score(<48 hours) was median 1(0-3) and ISS was median 30(8-38) in study population. They had median 2(0-14) fractured ribs. There were 2 bilateral fractures and 2 flail chest. Ventilator support was needed in 11(45.8%) of them for median 39 hours(6-166). The ISS of ventilator support group was median 34(24-34) and lung injury score was median 1.7(1.3-2.5). Tracheostomy was performed in one patient and it was only complicated case and ICU stay days was median 9(4-16). In correlation analysis, Lung injury score and ISS were significant with the length of stay in ICU but the number of fractured ribs and lung injury score were predicting factors for prolonged mechanical ventilator support. CONCLUSION: Lung injury score could be a possible prognostic factor for the prediction of increased length of stay in ICU and need for mechanical ventilator support.

Comparative Study of the Clinical Features and Treatment for Right and Left Colonic Diverticulitis

PURPOSE: Colonic diverticulitis is an uncommon disease in Korea, but the incidence of the disease is increasing. The right colon is the more preferred site for diverticulitis in Korea, but the incidence of left diverticulitis is increasing. Therefore, comparing the clinical features and treatments for right diverticulitis with those for left diverticulitis may help us to treat the disease more properly. METHODS: This study was performed retrospectively by reviewing the medical records of 96 patients with colonic diverticulitis, in whom either conservative or operative treatments were performed. RESULTS: Eighty-six patients had right diverticulitis (RD), and 10 patients had left diverticulitis (LD). The mean age of the patients was older for LD. Sixteen patients (18.6%) with RD had complications, and 7 patients (8.1%) underwent operations. On the other hand, 4 patients (40%) with LD had complications, and 3 patients (30%) underwent operations. The rates of complications and operations among old-aged patients were higher. The operations for 7 patients with RD who underwent surgery were 6 ileocecectomies and 1 diverticulectomy. On the other hand, the operations for the 3 patients with LD who underwent surgery were 2 resections and anastomoses and 1 diverticulectomy. The reasons for the operations were abscess formation, recurrence, perforation, and development of generalized peritonitis without response to conservative treatment. CONCLUSION: The incidence of LD is lower than that of RD in Korea, but the rate of complications and operations seems higher in LD. Therefore, patients who complain of left lower abdominal pain need to be thoroughly examined for LD.

Ultrasound Elastography in Differential Diagnosis of Benign and Malignant Thyroid Nodules / 대한내분비외과학회지

PURPOSE: The study evaluated elastography, a technique that allows differentiation between pathological and normal tissue by determination of tissue hardness. METHODS: From March 2009 to April 2010, 25 consecutive patients with thyroid nodules who were referred for surgical treatment were examined in this prospective study. Thirty nodules in these patients were examined by conventional ultrasound, ultrasound elastography, and fine needle aspiration cytology. Lesions were scored (1~3) according to hardness based on the Ueno classification system. The final diagnosis was based on histopathologic results. RESULTS: Of the 30 thyroid nodules, four were classified as benign and 26 were malignant. Two of the nodules with an elastography score of 1 were benign and 17 nodules whose elastography score was 3 were malignant. Two benign nodules and nine malignant nodules had an elastography score of 2. Applying an elastography score exceeding 2 as a indicator for malignancy determined that the sensitivity and specificity of the ultrasound elastography was 100.0% and 50.0%, respectively, the positive and negativepredictive values were 92.9% and 100.0%, respectively, and the accuracy of the technique was 93.3%. CONCLUSION: Ultrasound elastography may be a useful adjunct to ultrasonography in the identification of indeterminate thyroid nodules for which tissue diagnosis is required.

Application of a Scoring System to the Diagnosis of Acute Appendicitis

PURPOSE: Acute appendicitis is one of the most common diseases requiring surgical treatment. Delayed diagnosis, which causes complications like perforation of the appendix, abscess formation, or misdiagnosis, leads to unnecessary surgery. Many scoring systems have been suggested for the diagnosis of acute appendicitis. This study aims to evaluate the clinical value of previous scoring systems. METHODS: This study was conducted with a total of 270 patients who had visited the National Police Hospital (NPH) Emergency Room for acute abdominal symptoms from January to June 2008. The Alvarado and the Ohmann scores were applied retrospectively based on the patients' records. We found 3 criteria which were relatively objective and clinically meaningful; then, we designed a new 10 points scoring system. RESULTS: The sensitivity and the specificity of the Alvarado scoring system were 83.23% and 64.42%, respectively, whereas those of the Ohmann scoring system were 74.85% and 66.35%, respectively. The sensitivity and the specificity of the NPH scoring system were found to be 78.4% and 68.9%, respectively. The Ohmann scoring system showed a little lower sensitivity, and the NPH scoring system showed a little higher specificity, but the differences were not statistically significant. CONCLUSION: Our study indicates that the scoring systems considered are not useful diagnostic methods for primary screening and diagnosis of acute appendicitis.

Eosinophilic Gastroenteritis Causing Gastro- intestinal Obstruction

Eosinophilic gastrointestinal disorder is uncommon and it has rarely been reported. The presence of increased numbers of eosinophils in the biopsy specimens of the gastrointestinal tract, the infiltration of eosionophils in intestinal crypts and gastric glands, the absence of involvement of other organs and the exclusion of other causes of eosinophilia support the diagnosis of eosinophilic gastroenteritis. This is characterized by infiltration of eosinophils in the gastrointestinal wall, and it's associated with protein-losing enteropathy, hypoalbuminemia, motility abnormalities and ascites. Although it is an idiopathic disorder, allergic and immunologic etiologies have been suggested. Steroid is the treatment of choice, but an operation is necessary in case of a surgical abdomen or if the patient is refractory to steroid therapy. Recently, authors experience 2 cases of eosinophilic gastroenteritis causing gastro-intestinal obstruction, and report here with clinical evaluation and literature review.

Incidental Adenomyoma of Stomach Associated with Early Gastric Cancer

An adenomyoma of the gastrointestinal tract is a rare, benign, tumor-like condition histologically characterized by glandular structures embedded within a smooth muscle stroma. An adenomyoma has been considered to be as an abortive variant of an ectopic pancreas. An ectopic pancreas is defined as the presence of pancreatic tissue that lacks anatomic and vascular continuity with the main body of the pancreas. Common sites of an ectopic pancreas are the stomach, duodenum, and upper jejunum. An adenomyoma may rarely undergo a malignant transformation or cystic dystrophy. Recently, the authors an experienced a case of an incidental adenomyoma of the stomach associated with early gastric carcinoma. We report that case here.

SMV Thrombosis on Taking Oral Contraceptive with Protein C and Protein S Deficiency

Mesenteric venous thrombosis (MVT) is uncommon, but it is often aggravated to a lethal form of intestinal ischemia. Multiple risk factors are associated with mesenteric venous thrombosis, including hypercoagulable or inflammatory states, previous abdominal surgery, abdominal trauma, portal hypertension and oral contraceptives. The use of estrogen-containing oral contraceptives accounts for 4% to 5% of all the cases of MVT. Oral contraceptives have been reported to decrease antithrombin III, increase the levels of prothrombin complex factor and factor VIII, and to inhibit the fibrinolytic system. We describe here a case of 42-year-old woman who had taken oral contraceptives for 7 years and she was diagnosed to have Protein C and Protein S deficiency, and superior mesenteric venous (SMV) and portal vein thrombosis. She underwent segmental resection of the small bowel. She was later discharged without suffering with short bowel syndrome or any other complications.

Terminal Ileal Burkitt's Lymphoma in an Adult

A Burkitt's lymphoma is a rare disease belonging to the aggressive non-Hodgkin's lymphomas, which usually occurs in children or adolescents. Burkitt's lymphoma was first reported in the medical literature as a jaw sarcoma of East African children, and those of the gastrointestinal tract occurring in adults have rarely been reported in Korea. Herein, we report an unusual case of a primary intestinal Burkitt's lymphoma, presenting with a palpable abdominal mass and abdominal pain, in a 46-year-old man. An ileocecectomy was performed, and the diagnosis confirmed by histological examination.

Donor Quality of Life in Living Donor Liver Transplantation / 대한이식학회지

PURPOSE: The safety of donors and the impact on quality of life (QOL) was the most important thing in living donor liver transplantation (LDLT). METHODS: Questionnaires were sent to 50 donors who were followed up more than 4 months after LDLT from December 2001 to January 2003 (response rate 92.0%). The control group was selected the same number of the general public (n=42). The questionnaire consisted of donors characteristics, medical and psychosocial outcomes, and global QOL (KHP 1.0). Follow-up investigations were also performed at out patient clinic 1, 4, and 12 months after discharge. RESULTS: The donors were more prevalent in male patient (63.0%) and most common in twenties (23.8%). The relations to the recipients were 17 offsprings (37.0%), 12 parents (26.1%), 6 spouses (13.0%), and et cetera. There was no perioperative transfusion, reoperation, and none of the donors died or has suffered life-threatening complications. Average length of hospital stay is 11.4+/-4.5 days. The mean recovery time was 1~3 months in a half of them. All donors resumed their predonation occupation or regular activity and felt no limitation. Most donors were satisfied with their donation (95.6%) and their current life (87.0%) after operation. The score of QOL examined by KHP 1.0 showed that physica role of donors were more restricted but emotional health was better than that of the general public. CONCLUSIONS: Most donors in LDLT felt it to be good, but some limitation ofl their physical role despite of their physical recoveries. Donor follow-up needs to be emphasized and followed more systemically.

Clinicopathologic Study on Clear Cell Hepatocellular Carcinoma / 한국간담췌외과학회지

BACKGROUND: Clear cell hepatocelluar carcinoma (CHCC) is a well defined type of hepatocellular carcinoma (HCC) in which a large number of tumor cells have clear cytoplasm that is not stained by hematoxylin and eosin stain. It is generally reported that CHCC has a favorable prognosis compared with that of conventional non-CHCC.1 The reasons for the better prognosis are not clear. To date the clinicopathologic features of CHCC of the liver have not been fully elucidated. In the present study we compared the clinicopathologic features of 56 cases of CHCC with those of 479 cases of non-CHCC and report here hoping to further understanding of CHCC. METHODS: 535 consecutive cases that were curatively resected from Jan. 1992 to Dec. 1997 in Seoul National University Hospital were reviewed. The cases were divided into clear cell HCC (56 cases) and non-clear cell HCC (479 cases). Clinical and pathological findings were compared between two groups. RESULTS: Clinically there is no significant difference in sex or =2) of clear cell HCC was 3.8% (2/56), lower than the finding of 13.1% (62/479) for non-clear cell HCC. (p<0.05) CONCLUSION: It was concluded that clear cell HCC has no significant difference in clinicopathologic features except tumor number.

A 12-year Experience from 1990 to 2001 in Performing Curative Hepatic Resection for Hepatocellular Carcinoma / 한국간담췌외과학회지

BACKGROUND/AIMS: Hepatic resection is an accepted therapeutic modality for hepatocellular carcinoma (HCC). In the present study, surgical results are analyzed with an aim toward further improving the treatment of HCC. METHODS: We reviewed 831 patients with HCC who underwent a curative hepatic resection in Seoul National University Hospital from 1990 to 2001. We analyzed age, sex, GOT/ GPT, alpha-fetoprotein (alpha FP), HBsAg, anti-HCV, Child classification, size and number of tumor, extent of resection, resection margin, and perioperative transfusion. RESULTS: 1-, 3-, and 5-year overall survival rates were 91.1%, 79.8%, and 71.7%. 1-, 3-, and 5-year disease-free survival rates were 66.9%, 39.3%, and 29.8%. Risk factors of multivariate analysis of recurrence were GOT (>40 IU/L), alpha FP (>20 ng/dl), Child classification (B and C), tumor number (> or =2), tumor size (>5 cm), and extent of resection (major hepatectomy). Prognostic factors of multivariate analysis of overall survival rate were GOT, tumor number, and extent of resection. CONCLUSION: Although the recurrence rate is still high, identifying an individual patient who is at risk of tumor recurrence (GOT>40 IU/L, alpha FP>20 ng/dl, Child B and C, tumor number> or =2, tumor size >5 cm, and major hepatectomy) is helpful to estimate disease-free survival.

Isolation and Culture of Pig Hepatocyte in Large Scale for the Application of Bioartificial Liver System / 대한간학회지

BACKGROUND/AIMS: Acute hepatic failure is a serious problem. Its mortality reaches up to 80%. Only liver transplantation has been accepted as a definite treatment for patients with hepatic failure but shortage of donor organs is the main obstacle of this approach. A possible solution to this problem is a bioartificial liver system, perfusion of patients blood to isolated hepatocyte. In this study, we performed the isolation and culture of pig hepatocyte in large scale for the application of bioartificial liver system. METHODS: Hepatocyte isolation was performed by two-step collagenase method via portal vein perfusion in 10kg female pigs. After that, we compared the functional differences of the spheroid culture to the monolayer culture of hepatocyte. The viability and the function of hepatocyte were assessed using trypan-blue exclusion test and the measurement of the rate of ureagenesis and ammonia removal. RESULTS: The average viability and yield of hepatocyte were 86.8 +/- 8.0 % and 7.8 +/- 5.4 X 10(9), respectively. The spheroid culture was superior to the monolayer culture in functional aspect of hepatocyte, and their differences, especially for ammonia removal, were more apparent in parallel with culture time. CONCLUSIONS: For hepatocyte isolation, we obtained sufficient viability and yield of hepatocyte for clinical usage of bioartificial liver system. The function of hepatocyte seems to be better in the spheroid culture than in the monolayer culture. Further studies are needed for application of bioartificial liver system in clinical setting.

A Study of the mecI, mecA and femA Genes of Methicillin-Resistant Staphylococci / 대한임상병리학회지

BACKGROUND: Staphylococcus aures and Staphylococcus epidermidis are those of the important pathogens that have revealed the increase of methicillin resistance. Because of increasing prevalence of staphylococci resistant to one or more antimicrobial agents, it is necessary to determine the antibiotic susceptibility of these microorganisms. Methicillin resistance is due to the production of PBP2', which is encoded by mecA gene in the chromosome. PBP 2' shows low affinity to the all of beta-lactam drugs. Therefore, the determination of gene is considered as a correct method for the antibiotic treatment procedures. METHOD: In order to examine effectiveness of detecting mecA and femA genes for the identification of methicillin resistant S. aureus (MRSA) and mecI gene in high-level-resistant MRSA, the presence of these genes in S. aureus and S. epidermidis was investigated by PCR. The types of genes were compared with phenotype by agar dilution method and investigated with MIC of methicillin. RESULTS: 1. The mecA gene detection was useful for the identification of MRSA with MRSA 100% and methicillin susceptable S. aureus (MSSA) 2.7% (P0.001). 2. The femA gene detection was useful for the S. aureus identification (P0.001). CONCLUSION: The study concluded that the detection of both the mecA and femA genes from staphylococci by the PCR method had been considered as a correct and useful method in the identification of MRSA. mecI gene has been deemed as a repressor gene for high-level-resistant MRSA that is clinically useful as a standard. However, it is considered that the investigation should be done with later detected nucleotide sequencing of the mecI gene.

Early Diagnosis of Rifampin-Resistant Mycobacterium tuberculosis by Gene Analysis of RNA Polymerase B Subunit

PURPOSE: The control of tuberculosis is seriously threatened worldwide by the recently emerging multidrug-resistant Mycobacterium tuberculosis. As a result, early detection of drug resistant M.tuberculosis strain has become very important but conventional laboratory methods are time consuming and delayed results often affect patients adversely in controlling tuberculosis. The authors studied the usefulness of the line probe assay to determine the mutaion in rpoB gene of rifampin resistant M.tuberculosis and to find out if this method can substitute conventional methods in the detection of resistant strain. METHODS: This study employed 40 clinical samples of M.tuberculosis which had been determined by culture and drug sensitivity test. After amplification of rpoB-the gene for the B subunit of the RNA polymerase-by PCR, the amplified products were hybridized with specific oligonucleotide probes immobilized on nitrocellulose strip and direct DNA sequencing was also performed. The results were compared with those of the classical susceptibility test. RESULTS: Among the 40 samples, 10 were identified as drug resistant strain by classical drug susceptibility test. Three of the ten resistant samples were rifampin resistant strains, which were identified by either method. All mutations were clustered within the region of 69bp of rpoB and all were single nucleotide mutations. Two isolates had a TCG->TTG(serine->leucine) mutation in codon 522. One isolate had a CAC->CTC(histidine->leucine) mutation in codon 526. CONCLUSION: In contrast to culture and sensitivity tests, line probe assay is an easy and speedy method for detecting rifampin resistant M.tuberculosis in clinical samples as well as a helpful tool for choosing antituberculosis drug in children.

Acute Mesenteric Ischemic Disease

Acute mesenteric ischemia remains to cause high mortality in spite of the marked development of diagnostic tools and surgical techniques in the area of vascular surgery. The reason why the disease has a high mortality is mainly the delayed diagnosis. If diagnosis and treatment are established early enough to prevent irreversible change of bowel, the prognosis might be favorable. Twenty patients with a disease of acute mesenteric ischemia who received surgical or interventional treatment were studied by retrospective manner. There were 12 men and 8 women. The mean age was 57.3 years (22~81 years). Underlying cardiovascular disease including valvular lesion and arrhythmia was the most commonly associated disease. The etiologies of ischemia were embolism of superior mesenteric artery in 9 cases, thrombosis of superior mesenteric artery in 1, thrombosis of superior mesenteric vein in 5, one non-occlusive (vasoconstrictive) mesenteric ischemia and unknown in 4 cases. Two patients received radiological interventional treatment with urokinase and papaverine respectively. Eighteen patients were undergone surgical treatment including revascularization and bowel resection. Second-look procedures for bowel resection were performed in 4 cases. Complications occured in 10 cases, wound infection in 5, sepsis in 3, short bowel syndrome in 2 and anastomotic site leakage in 2. Early postoperative mortality occured in 3 cases and late mortality in 2. The cornerstone in the management of the disease is early diagnosis and prompt interventional (radiologic or surgical) treatments before irreversible change was established. Therefore, with a high index of suspicion, early and aggressive angiographic diagnosis and interventional procedures should be carried out.

Solid and Papillary Epithelial Neoplasm of the Pancreas in Children

Six children with solid and papillary epithelial neoplasm of the pancreas were studied retrospective manner. There were 2 boys and 4 girls in this series. The mean age at operation was 11 years (range, 8 to 13 years). There were three incidental abdominal masses, two nontender abdominal masses and one tender abdominal mass. The size ranged from 6.5x6.0cm to 10.5x8.0cm. Five tumors were located in the head of pancreas, whereas one tumor was in the tail of pancreas. On exploration, all patients had no local invasion or metastasis. All patients underwent complete resection, which included three pylorus-preserving pancreaticoduodenectomy, two Whipple's operation and one distal pancreatectomy. All patients had the characteristic histologic pattern of a solid and papillary epithelial neoplasm of the pancreas. All patients are alive with a mean follow up of 5.0 years (range, 0.5 to 12.0 years) without recurrence. Compare to the adult, solid and papillary epithelial neoplasm of the pancreas in children had a slight higher incidence in male. We speculate that this tumor have the characteristic of low-grade malignancy. So complete resection is the treatment of choice for the neoplasm arising anywhere in the pancreas.