Impact of Enforcement of the Act to Improve Training Conditions and the Status of Medical Residents in Emergency Abdominal Surgery

Purpose@#In 2018, the Act to Improve Training Conditions and the Status of Medical Residents (AITR) was fully implemented in South Korea. This study aimed to investigate the effects of AITR implementation on the clinical outcomes of patients who underwent emergency abdominal surgery. @*Materials and Methods@#A total of 2571 patients who underwent emergency abdominal surgery after visiting the emergency room (ER) between 2015 and 2019 was included. Electronic medical records were retrospectively reviewed. In addition, a comparative analysis was performed for patient groups treated before and after AITR implementation. @*Results@#The median patient age was 48.0 years, and 49.2% of them were male. Appendicitis was the most common diagnosis (82.6%), followed by major abdominal emergencies (9.9%) and cholecystitis (7.5%). The median time from arrival to surgery was 439 min, and 52 (2.0%) patients died. A comparison of patients who underwent surgery before (pre-AITR; 1453, 56.5%) and after (post-AITR; 1118, 43.5%) AITR implementation revealed a significant difference in age, number of residents on a 24-h shift, and diagnosis. The time from ER arrival to surgery was not significantly longer after AITR implementation than before AITR implementation (434 min vs. 443 min, p=0.230). AITR was not a significant risk factor for mortality (p=0.225). @*Conclusion@#The time from ER arrival to emergency surgery did not increase significantly after AITR implementation, and there was no difference in the patients’ clinical outcomes.

A Case ofEscherichia Coli Empyema Preceded by Gastroenteritis / 소아알레르기및호흡기학회지

Pleural empyema is characterized by presence of pus or microorganism in the pleural fluid. Most cases of empyema in children are caused by bacterial pneumonia, and the most common pathogen is Staphylococcus areus or Streptococcus pneumoniae. But other uncommon causes of empyema include esophageal rupture, mediastinal disease, tumors, sepsis, thoracic trauma, and surgery can be produced by various pathogens. We experienced a case of Escherichia coli empyema followed by gastroenteritis in 9-year-old boy.

Diversity of initial manifestations in renal tubular acidosis / 대한내과학회지

BACKGROUND: Diagnosis of RTA (renal tubular acidosis) is not easy due to its nonspecific and various manifestations. To find out the clues to diagnosis, we investigated initial manifestations, laboratory features and clinical course of RTA patients. METHODS: Thirty-seven patients with RTA type I or II, whose follow-up period was over 6 months were included in the study. We reviewed their medical records retrospectively. RESULTS: Male to female ratio was 5:32 and the average age at the time of diagnosis was 38.7 (15~60). Twenty-five patients had RTA type I, nine had type II, and three had both. The average follow-up period was 6.4 years. Initial manifestations were asthenia (54%), nausea (46%), urinary stone (24%), paresthesia (24%), lower extremity weakness (22%), and paralysis (11%). Underlying diseases at the time of diagnosis include Sjogren's syndrome (14%), SLE (8%), drug-induced nephropathy (11%), diabetic nephropathy (5.4%), Sjogren's syndrome combined with SLE (2.7%), and medullary sponge kidney (2.7%). Laboratory tests revealed acidosis with hypokalemia (59%), acidosis without hypokalemia (14%), and hypokalemia without acidosis (24%). The level of total CO2 was 22 mmol/L or lower in 27 patients. The Na:Cl ratio on the average was 1:1.26 and for 33 patients below 1:1.35. Renal function deteriorated in 8 patients and 7 of them had underlying diseases. Urinary stone developed in 2 patients with RTA type I. CONCLUSION: When patients with nonspecific symptoms show decreased levels of serum total CO2, potassium, or Na:Cl ratio, RTA should always be considered.

The Clinical Profiles and Risk Factors and Outcome of CAPD Peritonitis : A Single Center Study / 대한신장학회잡지

Peritonitis remains the leading cause of the patient dropout in CAPD in many developing countries. In Korea, 71% of CAPD patients dropout is caused by peritonitis. To elucidate an adequate guideline for treating peritonitis in our country, we analyzed clinical and bacteriologic profiles of peritonitis(1995. 1. 1- 1999. 12. 31). Two hundred and twenty eight episodes of peritonitis were developed in 127/247 patients. The incidence of peritonitis was 0.41/patient-year in general, which was decreased to 0.24/patient-year in 1999. The incidence of causative organisms were as follows; 82(36.0%) by Gram positive organisms, 38 (16.2%) by gram negative organisms, 16 cases(7.0%) by mixed organsisms, and 5 cases(2.2%) by fungus. During study period, the incidence of peritonitis by gram positive organsism was decreased while the incidence of peritonitis by gram negative organism was not changed. Recurrent infection/relapse was noted in 58 patients(45%). Peritonitis were eradicated only in 66% of the cases by initial antibiotics(cefazolin+aminoglycoside); and another 17% responded by second line antibiotics. Peritoneal catheters were removed in 38 episodes(16.7%). Patients with exit infection were more frequent in removal of catheter. Risk factor analysis was performed in 146 patients, who were newly started CAPD. There were 60 initial episodes of peritonitis(mean duration of follow up was 16.7 patient months). Sixty-five percent were free of peritonitis at the end of first year, 54% at the end of second year and 45% at the end of third year (Kaplan-Meier). Factors such as age, sex, underlying DM, were not risk factor for CAPD peritonitis. In conclusion, we observed that the incidence of peritonitis decreased every year. It was revealed however that only 66% of peritonitis can be successfully treated by first line antibiotics. Second line antibiotics such as ceftazidime may need to be introduced in early phase of CAPD peritonitis. Up to one third of patients had recurrent infection/relapse, which raised the incidence of peritonitis. Continuing education as well as better exit care is needed to improve technical survival of CAPD patients in Korea.

A Neuropsychological Study of Frontal Lobe Function in Obsessive-compulsive Disorder / 신경정신의학

OBJECTIVES: Non-verbal memory deficits, impairments in executive function and deficits in visuospartial functions have been repeatedly reported in subjects with obsessive-compulsive disorder (OCD). The present study aimed to evaluate the frontal lobe function using neuro-psychological test in subjects with OCD and normal control. METHODS: A battery of neuropsychological tests (Wisconsin Card Sorting test, Rey-Osterrieth Complex Figure test, Controlled Oral Word Association test, Trail Making test, Verbal Learning test) reflecting frontal lobe function was administrated to 32 OCD patients and 28 healthy comparison subjects. RESULT: There were no significant differences in age, years of education, or estimated IQ between the groups. Scores in category fluency, immediate recall and delayed recall of Rey-Osterrieth Complex Figure test in OCD subjects were significantly lower than those of healthy comparison subjects (ANCOVA, F=15.07, df=58, p< .001; ANCOVA, F=6.33, df=57, p=0.015; ANCOVA, F=5.53, df=57, p=0.022, respectively). CONCLUSION: OCD patients had selective deficits in task involving non-verbal memory and categorical word fluency relative to healthy comparisons.

A Study of Genetic Inheritance of Bromidrosis

Bromidrosis is a disorder characterized by rancid body odor which influences a patient's social life and mental health. The therapeutic modalities and the mechanism of bromidrosis have been carefully studied, however, there have been few reports about the genetic inheritance of bromidrosis. We investigated the family history of 42 patients who were operated on for bromidrosis and followed up to the third generation in 10 cases. The results were as follows: Results of investigation which were followed up the second generation. The fathers of five patients and the mothers of 11 patients had bromidrosis in 18 male patients. The fathers of six patients and the mothers of 12 patients had bromidrosis in 24 female patients. Thirty-four patient (81.0%) among a total of 42 have a single parent with bromidrosis. Result of investigation which were followed up to the third generation Bromidrosis was occurred in 17 of 42 patients (40.5%) in the second generation, and 18 of 27 patients (66.7%) in the third generation. In one case, a father transmitted bromidrosis to his three sons, and as a result, X-linked inheritance could be ruled out Bromidrosis was not skipped in every generation of all families. We on conclude that bromidrosis is an autosomal dominant inherited disorder.

Early Surgery for Poor-Grade Aneurysmal Subarachnoid Hemorrhage

In order to determine the effect of early surgery on poor grade subarachnoid hemorrhage(SAH) patients. 88 such patients were evaluated between January, 1990 and January, 1996. Clinical grade on admission was Hunt-Hess grade IV(n=58) and V(n=30). The protocol involved the use of computed tomography(CT) scanning to diagnose SAH and to obtain evidence of the destruction of vital brain function, involving massive cerebral infarction with midline shift, dominant basal ganglia or brain stem hematoma. Patients were assigned to either the early surgery group(n=54: surgery performed within 3 days of the first hemorrhage) or the non-surgical group(n=33). In seventeen of 58 in Hunt-Hess grade IV patients, the outcome was good(GOS 4 and 5); 15 of these were in the early surgery group. In only one of 30 Hunt Hess grade V patients was there a good outcome, however. Among Hunt-Hess grade IV patients, mortality was 36.8% in the early surgery group and 60% in the non-surgical group; in the Hunt-Hess grade V group, the corresponding figures were 75% and 100%. In conclusion, it is recommended that to prevent rebleeding and other complications, Hunt-Hess grade IV patients, especially those that showing destruction of vital brain function, should undergo early surgery. With regard to early surgery, non-operation and the existence of evidence of destruction of vital brain function, grade V patients showed no difference in terms of their mortality and morbidity rate.

Long Term Follow up Results of Threaded Fusion Cage(T.F.C.) in Surgical Treatment of Spondylolisthesis

The goal of operation in spondylolisthesis is improving radiculopathy and relieving lower back pain preventing further progression of the slip, through decompression of neural elements and fusion of spinal pseudoarthrosis, respectively. The author performed the posterior lumbar interbody fusion technique using a Threaded Fusion Cage(T.F.C.) for 41 patients as the surgical treatment for mild spondylolisthesis. All patients enrolled in the study were implanted with a T.F.C. at a single unstable level. We have investigated the outcome results for at least one year(mean 25.8 months). Of these patients 95% have shown solid fusions. Using the Prolo scale for economic and functional rating, the combined results of excellent, good score is 51%, but clinically symptomatic improvement is 66%. Therefore, posterior lumbar interbody fusion using T.F.C. was useful in treatment of mild degree spondylolisthesis.