The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital / 대한구급학회지

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.

The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital / 대한중환자의학회지

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.

Diagnostic Value of Cochlear Hydrops Analysis Masking Procedure in Meniere's Disease in Comparison with Electrocochleography / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Patients with Meniere's disease often present with a great variety of symptoms, especially at the onset of the disease. However, there is no single test that is definitive for making the diagnosis of Meniere's disease. Recently, a new diagnostic test, the cochlear hydrops analysis masking procedure (CHAMP) was introduced as a test for endolymphatic hydrops. The aim of this study is to evaluate the diagnostic value of CHAMP test in Meniere's disease in comparison with that of electrocochleography. MATERIALS AND METHODS: The CHAMP test and electrocochleography were simultaneously performed in 14 cases of definite Meniere's disease and 8 normal healthy volunteers (16 ears). Positive criteria were defined as being more than 0.35 in summating potential/action potential (SP/AP) ratio, 0.3 ms or less in latency delay and 0.95 or less in complex amplitude ratio. Measured parameters from each test were compared between the groups, and sensitivity and specificity of each test in diagnosing Meniere's disease were calculated. RESULTS: There was no significant difference in the SP/AP ratio of electrocochleography between the Meniere's disease and control groups. In CHAMP test, the latency delay was shorter and the complex amplitude ratio was smaller (p<0.001). While taking positive results from both test parameters, the sensitivity and specificity of CHAMP test were 85.7% and 87.5%, respectively. CONCLUSION: The CHAMP seems to be a clinically useful tool in diagnosing Meniere's disease and might be better than electrocochleography to detect endolymphatic hydrops.

A Case of Rhabdomyosarcoma in Pharynx / 대한이비인후과학회지

Rhabdomyosarcoma is a highly aggressive malignant tumor with an incidence of 1/500,000 children per year. It originates from mesenchymal cell to invade soft tissue, developing into a highly aggressive malignant tumor. Rhabdomyosarcoma consists of the following four pathologic groups-embryonal, botryoid, alveolar, and pleomorphic type. While head and neck is the most common site of the embryonal rhabdomyosarcoma, the pharynx is rarely reported as a primary site of rhabdomyosarcoma. Recently, the 5-year survival rate of rhabdomyosarcoma has been greatly increased by combining therapy with radical surgery, although it still has poor prognosis. We present a case of rhabdomyosarcoma in the pharynx.

A Case of Maxillary Sinusitis after Sinus Floor Augmentation / 대한이비인후과학회지

Sinus floor augmentation is essential for successful dental implantation in patients with alveolar bone height less than 10 mm. However, maxillary sinusitis has been reported to occur in 8-20% of patients after sinus floor augmentation. We present a case of maxillary sinusitis due to sequestrum of bone cement fragment into the maxillary sinus ostium after sinus floor augmentation.

The Effect of Smoking on Outcome in Endoscopic Sinus Surgery

BACKGROUND AND OBJECTIVES: This study is designed to assess the effect of smoking on the outcome of endoscopic sinus surgery. MATERIALS AND METHODS: A total of 66 patients who underwent endoscopic sinus surgery with the diagnosis of chronic sinusitis were evaluated. They were divided into 3 groups; non-smoking, quit-smoking and still-smoking groups. Preoperative and postoperative visual analogue scale (VAS), Sinonasal Outcome Test (SNOT), and endoscopic score for each group were obtained and compared. RESULTS: There were statistically significant correlations between VAS, SNOT score and smoking. However, all patients showed a similar degree of improvement on the subjective symptoms regardless of smoking or nonsmoking. And, postoperative relief of subjective symptoms was not apparent after smoking cessation. In objective findings, postoperative endoscopic scores were 1.6 in non-smoking group, 1.8 in quit-smoking group and 2.7 in still-smoking group. Stillsmoking group had the worst endoscopic result, However, these differences did not reach a statistical significance. CONCLUSION: This study suggests that smoking had a negative effect on subjective symptoms but not in objective endoscopic findings. In addition, the cessation of smoking after sinus surgery may have no meaningful benefit on the outcome of surgery.