Longitudinal Stress Fracture of the Ulna: Forearm Splint in a Military Cook With Wok Pot Use

Stress fractures of the upper extremities are rare. Here we report the case of a 20-year old man who presented with left forearm pain for 6 weeks. He worked as a military cook and used a wok pot. Plain radiography showed periosteal reaction with cortical thickening at the midportion of the ulnar shaft without a transverse fracture line. Magnetic resonance imaging showed diffuse bone marrow edema along the ulnar shaft. Segmental cortical thickening with periosteal edema was observed on the volar side of the midshaft of the ulna. Although a typical transverse fracture line was not clearly visible, T2-hyperintense curvilinear foci were observed within the cortical thickening. Coronal T1-weighted enhanced imaging demonstrated an obliquely elongated abnormality within the cortical thickening. A longitudinal stress fracture of the ulna, of the intracortical subtype, was diagnosed. Follow-up plain radiography and computed tomography confirmed an ongoing solid union after plaster cast application. The non-neutral posture while using a straighthandled wok for flipping and repeated action likely caused cumulative trauma to the patient’s upper extremity. Clinical history taking and imaging studies using cross-sectional images may facilitate the early and accurate diagnosis of an unusual pattern of ulnar stress fracture.

Organized Hematoma of the Maxillary Sinus: Surgical Excision by Midfacial Degloving Approach

Organized hematoma of maxillary sinus is a rare pathologically benign mass in which pressure in the hematoma increases as it undergoes a process of organization, causing the deformation of the surrounding tissue, mimicking malignancies. The midfacial degloving approach can be used when extensive exposure is required in the treatment of lesions or traumas in the midfacial area with intranasal and intraoral incisions. We report a surgical excision case of organized hematoma of maxillary sinus using midfacial degloving approach without major complications and recurrence after one-year follow up.

Fecal Microbiota Transplantation against Gut Colonization Using a Multidrug-Resistant Organism / 대한임상미생물학회지

Background@#Fecal microbiota transplantation against gut colonization using a multidrugresistant organism is a technique used to treat infections through normalizing the gut microbiota via fecal microbiota transplantation in patients with confirmed colonization by carbapenem-resistant Enterobacteriaceae (CRE) or vancomycin-resistant enterococci (VRE) based on a fecal culture test within the past one week. In this study, we aimed to determinethe safety and effectiveness of this technique. @*Methods@#The safety and effectiveness were assessed via a systematic review. A literature search was conducted using five Korean databases, such as KoreaMed, and international databases, including Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library. @*Results@#Main results are described here. From the studies retrieved using the aforementioned search strategy, the remaining 581 studies were screened using the inclusion and exclusion criteria, resulting in the selection of nine studies for further consideration. In terms of safety, many studies reported deaths and adverse reactions associated with different causes. Fewer studies reported the rate of colonization; however, the effect of colony rate was inconsistent when compared to no treatment group. Additionally, none of the studies assessed the recurrence rate, a decrease in the prevalence of diseases related to infection by multidrugresistant bacteria, and the quality of life. @*Conclusion@#Fecal bacterial colonization for the decolonization of intestinal multidrugresistant bacteria was evaluated using a technique that requires further research as there is insufficient literature evidence to validate its safety and efficacy in treating infections through normalizing the intestinal flora of patients with confirmed colonization by CRE or VRE.

Fecal Microbiota Transplantation against Gut Colonization Using a Multidrug-Resistant Organism / 대한임상미생물학회지

Background@#Fecal microbiota transplantation against gut colonization using a multidrugresistant organism is a technique used to treat infections through normalizing the gut microbiota via fecal microbiota transplantation in patients with confirmed colonization by carbapenem-resistant Enterobacteriaceae (CRE) or vancomycin-resistant enterococci (VRE) based on a fecal culture test within the past one week. In this study, we aimed to determinethe safety and effectiveness of this technique. @*Methods@#The safety and effectiveness were assessed via a systematic review. A literature search was conducted using five Korean databases, such as KoreaMed, and international databases, including Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library. @*Results@#Main results are described here. From the studies retrieved using the aforementioned search strategy, the remaining 581 studies were screened using the inclusion and exclusion criteria, resulting in the selection of nine studies for further consideration. In terms of safety, many studies reported deaths and adverse reactions associated with different causes. Fewer studies reported the rate of colonization; however, the effect of colony rate was inconsistent when compared to no treatment group. Additionally, none of the studies assessed the recurrence rate, a decrease in the prevalence of diseases related to infection by multidrugresistant bacteria, and the quality of life. @*Conclusion@#Fecal bacterial colonization for the decolonization of intestinal multidrugresistant bacteria was evaluated using a technique that requires further research as there is insufficient literature evidence to validate its safety and efficacy in treating infections through normalizing the intestinal flora of patients with confirmed colonization by CRE or VRE.

Partial-Thickness Tear of Supraspinatus and Infraspinatus Tendon Revisited:Based on MR Findings

The interpretation of MRI of partial-thickness rotator cuff tears can be challenging. This review describes the anatomic considerations for diagnosing partial-thickness tears, especially supraspinatus and infraspinatus tendon and summarizes the classification of partial-thickness rotator cuff tears, as well as provides an overview on partial-thickness tears with delamination.

Study on Eating Habits and Dietary Quality according to Time Spent Using Smart Devices among Middle School Students in Incheon

The purpose of this study was to investigate the association between dietary quality and smart device use among middle school students. A total of 330 middle school students (171 boys and 159 girls) residing in Incheon participated in this questionnaire survey in June 2018. The boys and girls were divided into two groups according to their daily use time of smart devices: less than 3 hours a day (＜3 hours) and 3 hours or more a day (≥3 hours). Eating habits and dietary quality were assessed using a nutrition quotient for adolescents (NA-Q). For boys and girls, higher consumption frequency of white milk was significantly associated with less time spent using a smart device. For boys, a higher number of vegetable dishes and eating frequency of breakfast were significantly associated with the less time spent using a smart device. For girls, higher consumption frequency of processed beverages, ramyeon, and street foods was significantly associated with more time spent using a smart device. For boys and girls, those who spent more time using a smart device had significantly lower NA-Q scores, indicating low dietary quality. To sum up, more time spent using a smart device among middle school students may be associated with lower dietary quality. These results suggest the need to provide a nutrition education program and guidelines to students who use smart devices for a long time.

Study on Middle and High School Students' Use of Convenience Foods at Convenience Stores in Incheon / 대한지역사회영양학회지

OBJECTIVES: The rapidly changing dietary environment requires a study that addresses the status of middle and high school students regarding their consumption of convenience food sold at convenience stores. METHODS: This study examined adolescents' lifestyle patterns, dietary habits, and status of consuming convenience food at convenience stores. A total of 659 students (329 middle school students and 330 high school students) in Incheon participated in this questionnaire survey. RESULTS: The mean age of the subjects was 13.7 years for the middle school students, and 16.6 years for the high school students. The gender and grade distributions in the middle and high school students were similar. The middle school students reported that they spent more time using electronic devices (p<0.001) or watching TV (p<0.001) than high school students. More than 60% of middle and high school students consumed convenience food at convenience stores without statistical difference between the two groups. The main reason for consuming convenience food from convenience stores was its convenience followed by taste in both groups. Despite the high frequency of consuming convenience food, the students rarely checked the nutrition labels at the time of purchase. On the other hand, they were still most concerned about the nutritional value of the convenience foods when they consumed convenience foods. The most frequently consumed convenience food was ramyon in both groups. Significant positive correlations were observed between the frequency of consuming convenience food at convenience stores and lifestyle factors for the middle school students, including monthly allowance, time for using electronic devices, and number of private lessons. For the high school students, however, the only monthly allowance had a significant positive correlation with the consumption. CONCLUSIONS: Adolescents are increasingly exposed to convenience foods and relevant nutritional issues are a concern. Therefore, a dietary environment that is adequately formed for the healthy development of youth as well as systematic nutrient education that is appropriately designed for both middle and high school students is required.

The Reappraisal of the Slide-Swing Skin Flap: A Versatile Technique for Surgical Defects

BACKGROUND: The slide-swing skin flap is a combination of transposition and adjacent skin sliding and can be used to close large, round defects with a flap that is smaller than the primary defect to produce aesthetically good results. OBJECTIVE: To evaluate the efficacy and safety of the slide-swing skin flap for various surgical defects caused by skin tumor excisions. METHODS: This retrospective case series, which includes 33 Asian patients between the ages of 25 and 86 years, describes the slide-swing skin flap after primary excision for malignant or premalignant skin conditions. The outcomes were assessed 12 weeks after surgery using the patient and observer scar assessment scale (POSAS). RESULTS: Patients were 25 male and 8 female, and the causes of surgery were various malignant skin tumors including malignant melanoma, dermatofibrosarcoma protuberans, and malignant nodular hidradenoma. Tumors were on the lower limb in eleven patients, back in nine patients, chest in five patients, face in three patients, buttock in three patients and two patients had tumors in other locations. The mean defect size was 3.5×3.1±1.9×2.2 cm (range, 1.4×0.9~9.0×12.0 cm). The mean patient POSAS total score was 9.7±3.0 and mean patient overall opinion score was 1.8±0.7. The mean observer POSAS total score was 11.0±2.7 and mean observer overall opinion score was 1.9±0.5. All flaps survived and postoperative recoveries were uneventful. CONCLUSION: The slide-swing skin flap is highly versatile and can be used to cover various surgical defects, irrespective of size and location, with excellent functional and cosmetic results.

Study on Middle and High School Students' Use of Convenience Foods at Convenience Stores in Incheon / 대한지역사회영양학회지

OBJECTIVES: The rapidly changing dietary environment requires a study that addresses the status of middle and high school students regarding their consumption of convenience food sold at convenience stores. METHODS: This study examined adolescents' lifestyle patterns, dietary habits, and status of consuming convenience food at convenience stores. A total of 659 students (329 middle school students and 330 high school students) in Incheon participated in this questionnaire survey. RESULTS: The mean age of the subjects was 13.7 years for the middle school students, and 16.6 years for the high school students. The gender and grade distributions in the middle and high school students were similar. The middle school students reported that they spent more time using electronic devices (p<0.001) or watching TV (p<0.001) than high school students. More than 60% of middle and high school students consumed convenience food at convenience stores without statistical difference between the two groups. The main reason for consuming convenience food from convenience stores was its convenience followed by taste in both groups. Despite the high frequency of consuming convenience food, the students rarely checked the nutrition labels at the time of purchase. On the other hand, they were still most concerned about the nutritional value of the convenience foods when they consumed convenience foods. The most frequently consumed convenience food was ramyon in both groups. Significant positive correlations were observed between the frequency of consuming convenience food at convenience stores and lifestyle factors for the middle school students, including monthly allowance, time for using electronic devices, and number of private lessons. For the high school students, however, the only monthly allowance had a significant positive correlation with the consumption. CONCLUSIONS: Adolescents are increasingly exposed to convenience foods and relevant nutritional issues are a concern. Therefore, a dietary environment that is adequately formed for the healthy development of youth as well as systematic nutrient education that is appropriately designed for both middle and high school students is required.

Three Cases of Pachydermodactyly / 대한피부과학회지

Pachydermodactyly (PDD) is a rare, benign form of digital fibromatosis that is characterized by asymptomatic soft tissue swellings on the back and side of the proximal interphalangeal joint areas of the fingers. We report three cases of young male patients who presented with bilateral swelling of the fingers. Histopathologic examination showed epidermal hyperplasia with acanthosis and hyperkeratosis. Collagen fibers in the reticular dermis were thickened and irregularly arranged, and deposition of mucin in the dermis was observed. Since pachydermodactyly usually affects adolescent males with joint swelling, it is often confused with rheumatologic diseases. Here, we report three cases diagnosed with pachydermodactyly based on clinical manifestations and histopathological examination.

In Situ Ingenol Mebutate Treatment for Squamous Cell Carcinoma of the Scalp / 대한피부과학회지

No abstract available.

Analysis of the 119 emergency situation control center usage including dispatcher-assisted cardiopulmonary resuscitation instructions

OBJECTIVE: Analyses of the status of 119 emergency situation control center (119 ESCC) usage are lacking. Therefore, this study investigated the status of the 119 ESCC usage, including dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) instructions. METHODS: The emergency activity daily reports and emergency instruction sheets of 119 ESCC from January to December 2016 were reviewed. For more accurate status analysis, the computerized data of the 1339 Emergency Medical Information Center from January to December 2011 were also reviewed. RESULTS: In 2016, the total usage of the 119 ESCC was 1,393,876 calls, which was 27.8% lower than the 1,930,977 calls in 2011. Of the 1,393,876 eligible calls, the most common call was hospital guidance (n=743,799, 53.4%), followed by first aid (n=397,620, 28.5%), disease consultation (n=150,128, 10.8%), medical oversight (n=81,174, 5.8%), and interhospital transfer (n=5,123, 0.4%). Regarding the user number per 10,000 persons, Daejeon was the greatest at 57.2, whereas Changwon was the lowest at 11.5. A total number of DA-CPR was 19,439. The time from the call to chest compression were 173±88.6 seconds in the subjects having previous cardiopulmonary resuscitation training and 184.0±88.2 in the subjects having no such training (P < 0.001). CONCLUSION: The ratio of first aid instructions, including DA-CPR, among total usage of the 119 ESCC increased but the overall usage of the 119 ESCC decreased. Therefore, further efforts will be needed to improve the quality and professionality of the information provided through the operation of 119 ESCC.

Multiple Lentigines Arising in Sites of Resolving Psoriatic Plaques after Treatment with Ustekinumab

No abstract available.

Efficacy of embryo transfer on day 2 versus day 3 according to maternal age in patients with normal ovarian response / 대한생식의학회지

OBJECTIVE: Delaying embryo transfer (ET) enables us to select among the embryos available for transfer and is associated with positive effects on implantation and pregnancy outcomes. However, the optimal day for ET of human cleavage-stage embryos remains controversial. METHODS: A retrospective study of 3,124 in vitro fertilization/intracytoplasmic sperm injection cycles (2,440 patients) was conducted. We compared the effects of day 2 and 3 ET on rates of implantation and pregnancy outcomes between young maternal age (YMA; <38 years old, n=2,295) and old maternal age (OMA; ≥38 years old, n=829) patient groups. RESULTS: The YMA and OMA groups did not differ in terms of patient characteristics except for the proportion of unexplained factor infertility, which was significantly greater in the OMA group, and the proportion of arrested embryos, which was significantly greater in the YMA group. However, the biochemical pregnancy, clinical pregnancy, ongoing pregnancy, abortion, and implantation rates per cycle were not significantly different between day 2 and 3 ET in the YMA group or the OMA group. CONCLUSION: We suggest that offering patients the opportunity to decide which day would be suitable for ET could be part of a patient-friendly protocol that takes into consideration an infertile woman's circumstances and work schedule by allowing ET to be performed on day 2 instead of the traditional transfer on day 3.

Gender Differences between Metabolic Syndrome and Mental Health Problems in Adults Using Community Health Services / 신경정신의학

OBJECTIVES: The objective of this study was to examine the and gender difference between metabolic syndrome and clinical psychiatric characteristics. METHODS: This study was conducted in local habitants who visited one community health service from July to August 2014. 318 local habitants who have not been diagnosed with psychiatric disorders were evaluated using Center for Epidemiological Studies-Depression Scale (CES-D), Reynold Suicidal Ideation Questionnaire (SIQ, Reynolds), Rosenberg Self-Esteem Scale (SES), Korean version of WHO Quality of Life Scale-Abbreviated Version (WHOQOL-BREF), and EuroQol-5 Dimension (EQ-5D). Differences in demographic characteristics of both gender were analyzed. RESULTS: In women, the group with metabolic syndrome showed significantly lower alcohol drinking frequency (p<0.001), educational level (p<0.001) compared to the group without syndrome. Women with metabolic syndrome had lower scores for physical health (p=0.002), environment (p=0.007) on WHOQOL-BREF than those without the syndrome. However, CES-D, EQ-5D, SIQ, Reynolds, and SES show no differences. Among men, no difference was observed in all scales. In addition, in women, logistic regression analysis showed that after adjusting for confounders, metabolic syndrome group had lower score for physical health (p=0.009), environment (p=0.042) on WHOQOL-BREF than the group without syndrome. CONCLUSION: Our study showed an association of metabolic syndrome with poor physical health, environment in women.

Prehospital Cardiopulmonary Resuscitation by 119 Emergency Medical Technician (EMT) for Increasing the Rate of Return of Spontaneous Circulation; National-Wide 119 EMT Survey

PURPOSE: The out-of-hospital cardiac arrest (OHCA) survival rate of patients in Korea is lower than the global average and it might be caused by an extremely low rate of return of spontaneous circulation in the prehospital field. The authors identified obstacles that disturb on-scene performance of cardiopulmonary resuscitation (CPR) for a certain period from 119 emergency medical technicians (EMTs) through a nation-wide paper survey. METHODS: A total of 1273 first grade EMTs and nurses were surveyed. CPR time performed on the scene (without transfer), CPR experiences, self-assessment of CPR skill performance, and both obstacles to performance of CPR on the scene and solutions to overcoming them for continuous on-scene CPR were investigated using a 28-item questionnaire. RESULTS: The average for work experience and the number of CPR experiences of subjects was 6.8+/-4.5 years and 1.9+/-1.7 times/month, respectively. Survey results for CPR times on the scene showed an average of 4.2+/-2.4 minutes, approximately two periods of CPR (30:2x5 cycles). Obstacles to CPR on the scene were investigated as complaints of family members in 791(62.1%) and fatigue lowering CPR quality due to lack of human resources in 536(41.0%); 627(49.3%) of the subjects answered that they had received complaints due to a long stay on the scene. CONCLUSION: In order to increase the survival rate of OHCA patients, CPR on the scene is needed during a certain period in order to achieve a return of spontaneous circulation. Education, amelioration of guidelines, and support for the EMT administrative system are also needed.

Prehospital Cardiopulmonary Resuscitation by 119 Emergency Medical Technician (EMT) for Increasing the Rate of Return of Spontaneous Circulation; National-Wide 119 EMT Survey

PURPOSE: The out-of-hospital cardiac arrest (OHCA) survival rate of patients in Korea is lower than the global average and it might be caused by an extremely low rate of return of spontaneous circulation in the prehospital field. The authors identified obstacles that disturb on-scene performance of cardiopulmonary resuscitation (CPR) for a certain period from 119 emergency medical technicians (EMTs) through a nation-wide paper survey. METHODS: A total of 1273 first grade EMTs and nurses were surveyed. CPR time performed on the scene (without transfer), CPR experiences, self-assessment of CPR skill performance, and both obstacles to performance of CPR on the scene and solutions to overcoming them for continuous on-scene CPR were investigated using a 28-item questionnaire. RESULTS: The average for work experience and the number of CPR experiences of subjects was 6.8+/-4.5 years and 1.9+/-1.7 times/month, respectively. Survey results for CPR times on the scene showed an average of 4.2+/-2.4 minutes, approximately two periods of CPR (30:2x5 cycles). Obstacles to CPR on the scene were investigated as complaints of family members in 791(62.1%) and fatigue lowering CPR quality due to lack of human resources in 536(41.0%); 627(49.3%) of the subjects answered that they had received complaints due to a long stay on the scene. CONCLUSION: In order to increase the survival rate of OHCA patients, CPR on the scene is needed during a certain period in order to achieve a return of spontaneous circulation. Education, amelioration of guidelines, and support for the EMT administrative system are also needed.

Multiple Hypercoagulability Disorders at Presentation of Non-Small-Cell Lung Cancer / 결핵및호흡기질환

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.

Multiple Hypercoagulability Disorders at Presentation of Non-Small-Cell Lung Cancer / 결핵및호흡기질환

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.

The Assessment of a Patient's Chief Complaints by Emergency Medical Technicians and Residents of an Emergency Department

PURPOSE: Addressing a patient's chief complaint is the first and key element of treating patients. This study determined the effectiveness of emergency medical technician and residents of an emergency department in addressing a patient's chief complaints. If emergency and hospital personnel misunderstand the chief symptoms of patients it could result in erroneous transport and treatment, thus losing precious time in finding the proper treatment. METHODS: A retrospective chart review study was performed in 1137 patients (at least 18 years of age), who visited one university hospital, for a period of 3 months. Patients who were did not undergo trauma, addiction, and cardiac arrest were included. RESULTS: A total of 150 cases (13.2%) did not match the chief symptoms reported by 119 emergency medical personnel and emergency medicine residents. Systemic symptoms, nervous system symptoms, and psychiatric symptoms were the main categories inconsistently assessed. The rank and certification of emergency medical technicians did not make a difference, but older patients (59 years of age or older) were statistically different. The assessment fo chief symptoms by an emergency medical resident tended to be more accurate than assessment of emergency medical technicians in the final diagnosis. CONCLUSION: Systemic symptoms, nervous symptoms, and psychiatric symptoms, were chief complaines easily misreported for older patients. This likely reflects a difficulty in the evaluation of obscure symptoms in older patients. It will require specific additional training programs to improve the response to these chief complaints.