Perception of Child Abuse and Child Disciplinary Practice among Adults Abused as Children: Comparison to General Population

OBJECTIVES: The aim of this study was to compare differences in perception and knowledge of child abuse and child disciplinary practices according to the history of child abuse victimization. METHODS: A questionnaire survey on child abuse was conducted with 491 adults raising children. We compared the perception and knowledge of child abuse and child disciplinary practices between two groups of adults with and without a history of childhood abuse victimization. RESULTS: The group with a history of childhood abuse had lower levels of knowledge of child abuse (F=6.990, p<0.01) and engaged in more negative disciplinary practices (F=5.974, p<0.05) than those without. However, no differences in the perception of child abuse were observed between the two groups. CONCLUSION: The results suggest that adults with a history of childhood abuse have lower levels of knowledge of child abuse and use more negative disciplinary practices in raising their children. This highlights the need to administer not only educational but also more direct hands-on interventions to vulnerable parents in order to foster healthy parenting and disciplinary practices.

Comparison of Methicillin-Resistant Staphylococcus aureus Community-Acquired and Healthcare-Associated Pneumonia

PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only healthcare-associated pneumonia (HCAP) but also community-acquired pneumonia (CAP). We determined the impact of MRSA on differences in clinical characteristics, courses, and outcomes between CAP and HCAP. MATERIALS AND METHODS: We conducted a retrospective observational study on 78 adult patients admitted with MRSA pneumonia at a university-affiliated tertiary hospital between January 2008 and December 2011. We compared baseline characteristics, chest radiographs, treatment outcomes, and drug resistance patterns between the CAP and HCAP groups. RESULTS: Of the 78 patients with MRSA pneumonia, 57 (73.1%) were HCAP and 21 (26.9%) were CAP. MRSA infection history in the previous year (29.8% vs. 14.3%, p=0.244) tended to be more common in HCAP than in CAP. Despite similar Pneumonia Severity Index scores (151 in CAP vs. 142 in HCAP), intubation rates (38.1% vs. 17.5%; p=0.072) and intensive care unit admission (42.9% vs. 22.8%; p=0.095) tended to be higher in the CAP group, while 28-day mortality was higher in the HCAP group (14.3% vs. 26.3%; p=0.368), although without statistical significance. All patients showed sensitivity to vancomycin and linezolid; meanwhile, HCAP patients showed greater resistance to gentamicin than CAP patients (58.3% vs. 16.6%; p=0.037). The median total hospital charges were 6899 American dollars for CAP and 5715 American dollars for HCAP (p=0.161). CONCLUSION: MRSA pneumonia showed significantly differences in baseline characteristics, chest radiographs, treatment outcomes, and medical expenses between HCAP and CAP groups.

A Nationwide Survey of Lymphangioleiomyomatosis in Korea: Recent Increase in Newly Diagnosed Patients

In 2007, the Korean Interstitial Lung Disease Society had collected clinical data of patients who have diagnosed as Lymphangioleiomyomatosis (LAM) since 1990 through nationwide survey, which showed that LAM patients had increased sharply after 2004. The present study was performed to show the clinical features of Korean patients with LAM, and to establish the reason for the recent increase in the diagnosis. All 63 patients were women and the mean age at diagnosis was 36 yr. The most common presenting symptom was dyspnea and 8 patients had tuberous sclerosis complex. The survival rate at 5 yr after diagnosis was 84%. Compared with patients diagnosed after 2004 (n=34), the patients diagnosed before 2004 (n=29) complained with dyspnea more (P=0.016) and had lower FEV1% predicted (P=0.003), and DLco% predicted (P=0.042). The higher proportion of patients diagnosed after 2004 showed the normal chest radiography, and they were detected by routine chest CT screening (P=0.016). This study showed that clinical features of Korean patients with LAM were not different from those reported elsewhere. It is concluded that the reason for the increase of newly diagnosed patients is the result of increase in detection of the early stage LAM by the widespread use of chest CT screening.

A Case of Pneumothorax Caused by Cystic Lung Metastasis of Angiosarcoma / 결핵및호흡기질환

Angiosarcoma is a rare but highly malignant tumorthat usually arises in the scalp or face of elderly males. Distant metastases favor the lung, liver, lymph nodes and skin. Metastatic pulmonary angiosarcoma commonly takes the form of a nodule but can sometimes appear as a thin-walled cyst. We report a case of 65 years-old male with a spontaneous pneumothorax, who underwent excision and radiotherapy for an angiosarcoma of the scalp 2 years ago. A chest CT scan revealed multiple cysts in the lung. The video-assisted thoracoscopic lung biopsy demonstrated subpleural cysts without tumor cells. A skin biopsy of the scalp showed an angiosarcoma. This case was diagnosed as a recurrence of an angiosarcoma with a supposed lung metastasis. This case suggests that a spontaneous pneumothorax in elderly people may be secondary to a pulmonary metastasis from an angiosarcoma of the scalp.

Localized Fibrosing Mediastinitis with Superior Vena Caval(SVC) Syndrome / 결핵및호흡기질환

Fibrosing mediastinitis is a rare disease that is characterized by the proliferation of dense fibrous tissue of the mediastinum. The pathogenesis of fibrosing mediastinitis is unknown in most cases. However, histoplasmosis, tuberculosis, autoimmune disease, radiation therapy, and other idiopathic fibroinflammatory diseases have been implicated in some cases. Most clinical features are related to an obstruction or compression of the mediastinal structure. Fibrosing mediastinitis is often progressive and occurs diffusely throughout the mediastinum. We encountered a case of fibrosing mediastinitis of a very focal lesion without evidence of mediastinal involvement. The condition was confirmed by biopsy and graft bypass surgery was performed because of SVC syndrome.

Applicability of American and European Spirometry Repeatability Criteria to Korean Adults / 결핵및호흡기질환

BACKGROUND: The objective of this study was to evaluate the clinical applicability of the repeatability criteria recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) spirometry guidelines and to determine which factors affect the repeatability of spirometry in Korean adults. METHODS: We reviewed the spirometry data of 4,663 Korean adults from the Korean National Health and Nutritional Examination Survey (KNHANES) Chronic Obstructive Pulmonary Disease Cohort (COPD cohort) and the Community-based Cohort Study VI-Fishing village/Islands (community cohort). We measured the anthropometric factors and differences between the highest and second-highest FVC (dFVC) and FEV1 (dFEV1) from prebronchodilator spirometry. Analyses included the distribution of dFVC and dFEV1, comparison of the values meeting the 1994 ATS repeatability criteria with the values meeting the 2005 ATS/ERS repeatability criteria, and the performance of linear regression for evaluating the influence of subject characteristics and the change of criteria on the spirometric variability. RESULTS: About 95% of subjects were able to reproduce FVC and FEV1 within 150 ml. The KNHANES based on the 1994 ATS guidelines showed poorer repeatability than the COPD cohort and community cohort based on the 2005 ATS/ERS guidelines. Demographic and anthropometric factors had little effect on repeatability, explaining only 0.5 to 3%. CONCLUSION: We conclude that the new spirometry repeatability criteria recommended by the 2005 ATS/ERS guidelines is also applicable to Korean adults. The repeatability of spirometry depends little on individual characteristics when an experienced technician performs testing. Therefore, we suggest that sustained efforts for public awareness of new repeatability criteria, quality control of spirograms, and education of personnel are needed for reliable spirometric results.

A Case of Concurrent Thymic Carcinoma with Systemic Lupus Erythematosus / 결핵및호흡기질환

A thymic carcinoma is a rare malignant neoplasm of the thymus epithelium, which can be distinguished from a benign or invasive thymoma. Contrary to a thymoma, the association of a thymic carcinoma and autoimmune disease is rare, with only a few cases having been reported. Herein, a case of thymic carcinoma diagnosed concurrently with systemic lupus erythematosus (SLE) is reported. A 49 year-old man presented at our clinic with myalgia. He was diagnosed with SLE, based on an oral ulcer, lymphopenia, and positive ANA and anti-Sm antibodies. Incidentally, a routine chest X-ray showed a large mediastinal mass. Pathological examination of the mediastinal mass revealed an undifferentiated thymic carcinoma, of WHO classification type C. Further work-up for staging showed multiple bone and lung metastases. With a palliative aim, he received systemic chemotherapy, but refused further chemotherapy after the 2nd course. Currently, the patient has not been followed up since the chemotherapy.

A Case of Pulmonary Sarcoidosis Combined with Neurosarcoidosis / 결핵및호흡기질환

Sarcoidosis is a multi-systemic syndrome of an unknown etiology, and it is characterized by the formation of multiple noncaseating granulomas that disrupt the architecture and function of the tissues in which they reside. The most commonly affected organs are lung, skin and lymph nodes. Overt clinical involvement of the nervous system is uncommon and this occurs in about 5% of all patients during the course of their disease. The most common manifestations are granulomatous leptomeningitis, cranial nerve palsy, electrolyte or other endocrinologic abnormalities, but isolated memory impairment is a rare manifestation. This is a case of 59 years-old male with recent memory impairment, and he was previously diagnosed with pulmonary sarcoidosis by transbronchial lung biopsy. The brain MRI imaging revealed the leptomeningeal and parenchymal involvement of sarcoidosis. He was treated with high dose corticosteroid and his memory function was improved to nearly a normal level. We report here on a case of successful treatment of pulmonary sarcoidosis combined with neurosarcoidosis with using high dose corticosteroid, and the patient presented with recent memory impairment.

A Case of Successful Management of Sarcoidosis with Chylothorax Using Octreotide / 결핵및호흡기질환

Sarcoidosis is a multi-system granulomatous disorder of an unknown etiology and affects individuals worldwide. It is characterized pathologically by the presence of non-caseating granulomas in more than one involved organ. However, pleural involvement of sarcoidosis is rare and there are no reported cases in Korea. Traditionally, sarcoidosis has often been treated with systemic corticosteroids or cytotoxic agents. In particular, chylothorax with sarcoidosis is usually treated with corticosteroid for approximately 3~6 months, followed by repeated therapeutic thoracentesis, talc pleurodesis, dietary treatment, or thoracic duct ligation where needed. We encountered a 46 years old female patient presenting with cough, dyspnea and both hilar lymphadenopathy (stage I) on chest radiograph. The patient was diagnosed with a non-caseating granuloma, sarcoidosis by a mediastinoscopic biopsy. For one month, she had suffered from dyspnea due to right side pleural effusion, which was clearly identified as a chylothorax on thoracentesis. Corticosteroid therapy with dietary adjustment was ineffective. She was treated successfully with a subcutaneous injection of octreotide for 3 weeks and oral corticosteroid. We report a case of successful and rapid treatment of chylothorax associated with sarcoidosis using octreotide and oral corticosteroid.

Intraoral Excision of the Submandibular Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Removal of the submandibular gland is often required for chronic inflammatory diseases and for benign tumors such as pleomorphic adenoma. The usual submandibular surgery can be performed through cervical approach, but this approach has disadvantages such as external scar and injury to the mandibular branch of the facial nerve. MATERIAL AND METHODS: Twenty-nine cases of submandibular gland disorders were analysed in view of surgical technique and complications. RESULTS: The submandibular gland was easily exposed intraorally by incision of the floor of the mouth extending posteriorly. Early postoperative complications were temporary paresis of lingual nerve, and temporary limitation of tongue movement. There were no late complications. CONCLUSIONS: The advantages of this technique are the avoidance of an external scar and nerve injury. We suggest this approach in the deliberate excision of chronically inflammed salivary gland and benign tumors as an alternative approach to the standard cervical approach.

The Clinical Experience of Hydroxyapatite Implantation using Autologous Sclera and Vicryl Mesh

The hydroxyapatite implant, recetnly widely used new intraorbital implant, in light, highly biocompatible, characterized by easy fibrovascular proliferation. Thus, when inserted after evisceration, it has some beneficial effect cosmetically: it can cause less protrusion of implant or alteration of position and can have good artificial eye motion by linking to the implant. However, in case of hydroxyapatite implantation after evisceration with the cornea preserved, there is a risk of cornea melting by contact with the implant, and in case with the cornea preserved of the eyeball size being too small, hydroxyapatite implant is impossible after evisceration. Hydroxyapatite implantation is done after enucleation using donor sclera, which is not readily available in Korea. Thus we inserted hydroxyapatite implant covered with circular from of Vicryl mesh on endothelium after evisceration in 11 eyes, and inserted hydroxyapatite implant using autologous sclera with Vicryl mesh after enucleation in 3 eyes, in which 18 mm-sized implant could not be implanted after evisceration from August 195 to July 1996. Follow-up examination was done during 6 to 20 (mean 12.9) months postoperatively. Motion of extraocular muscle was very good. During follow-up examination, adverse effects such as conjunctival wound dehiscence and exposure or protrusion of hydroxyapatite implant through the conjunctiva didn`t occur. It should be considered an excellent operative method, because the hydroxyapatite implantation using autologous sclera with Vicryl mesh decreases the risk of exposure or protrusion of the implant and can be performed without the use of donor sclera.

The Incidence of Complication and Decreased Visual Acuity in Traumatic Hyphema Patients According to the Amount of Blood Clot

We reviewed the medical records of 122 patients (122 eyes) who had been admitted for the traumatic hyphema at the Wallace memorial Baptist Hospital between January 1993 and June 1996, excluding perforating eye injury. And according to the degree of hyphema, the incidence of its complications such as early glaucoma, late glaucoma, rebleeding, or conreal staining , and decreased final visual acuity was analyzed. The degree of hyphema was graded by the amount of the anterior chamber filled with blood clot after layering of the red blood cells: Grade I was defined as less than one third of anterior chamber, Grade II as one third to one half of it, Grade III as one half to nearly total of it, or Grade IV as total of it. The early or late glaucoma was defined as intraocular pressure using Goldmann` s applanation tonometer of 21mmHg or more on admission or at about 1 month after admission. The decreased final visual acuity is defined as final corrected visual acuity using Hans chart of 0.5 or less. Of 122 eyes, there were 92 eyes(75.4%) in Grade I, 20 eyes(16.4%) in Grade II, 6 eyes(4.9%) in Grade III, or 4 eyes(12.3%) in Grade IV. According to the grade, the incidence of early glaucoma was 10.9%(10 eyes) in Grade I, 25.0%(5 eyes) in Grade II, 16.7%(1 eye) in Grade III, or 25.0%(1eye) in Grade IV; that of late glaucoma was 3.3%(3eyes) in Grade I, 5.0%(1 eye) in Grade II, zero in Grade III, or 25%(1 eye) in Grade IV; that of rebleeding was zero in Grade I, 10.0%(2 eyes) in Grade II, 50.0%(3 eyes) in Grade III, or 50.0%(2 eyes) in Grade IV; that of conreal staining was 50.0%(2 eyes) in Grade IV but zero in Grade I, Grade II or Grade III; and that of decreased final visual acuity was 8.7%(8 eyes) in Grade I, 20.0%(4 eyes) in Grade II, 33.3%(2 eyes) in Grade III or 25%(1 eye) in Grade IV. The higher the grade, the higher the incidence of its complication and decreased final visual acuity not showing the statistical significance (P>0.05). However, the incidence of rebleeding and decreased final visual acuity was higher in Grade II to IV groups showing the statistical significance in comparison with Grade I(P<0.01). Therefore, it is considered that diagnosis, treatment , and follow-up should be made correctly and attentively in Grade II to IV groups than in Grade I.

The Analysis of Human Tear Proteins Using Protein Electrophoresis

The proportion of tear proteins is different markedly in various ocular diseases, so its measurement may be of considerable diagnostic value in certain ocular conditions. We studied prospectively proportion of tear proteins in 50 normal adult Koreans. 25 male and 25 female, by using protein electrophoresis. Four fractions were demonstrated by protein electrophoresis using cellulose acetate membrane: Fraction 1 represents as tear-specific prealbumin(TSP1) and albumin, fraction 2 as other tear-specific prealbumin(TSP2), fraction 3 as lactotransferrin and immunoglobulin, and fraction 4 as lysozyme. In this study, the proportion of tear proteins in fraction 1 to 4 were 33.4%, 1.1%, 44.2%, and 21.2% respectively. With age, the proportion of fraction 4 decreased, and its decrease was not statistically significant difference. There was no statistically significant difference between age groups in fractions 1,2 or 3. Difference of proportion of tear proteins between the sex was not statistically significant in any of the fractions. Further studies on the tear proteins may be helpful in diagnosing some ocular conditions.