A Case Series of Trauma Resuscitation in the Intensive Care Unit Bypassing the Emergency Room During the Conversion to a COVID-19 Only Hospital

When a patient with severe trauma is admitted to the emergency room (ER), they are evaluated before transfer to either the intensive care unit (ICU) or operating room. To minimize the time until a definitive treatment can be provided, direct operating room resuscitation can be performed. In this hospital the ER was closed during the hospital’s transition to a coronavirus disease 2019-dedicated hospital, and direct ICU resuscitation for patients with trauma was performed for a short period. To perform effective trauma resuscitation, all ICU beds were reorganized to achieve a modified, experienced nurse: patient ratio (1:2-3) and 2 beds were assigned for trauma ICU resuscitation alone. The equipment for initial resuscitation was installed and ICU nurses received training. Consultations with the hospital administration, nursing, and pharmaceutical departments were completed in advance to avoid formal problems. Conversion of the ICU for direct resuscitation procedures was performed in 4 patients.

COVID-19 in a Patient Previously Exposed to Toxic Disinfectant from a Humidifier

In August, 2011, the Korean Public Health Surveillance declared an outbreak of pulmonary disease due to the inhalation of humidifier disinfectants (HDs), which led to approximately 20,000 deaths. In March, 2020, the World Health Organization declared coronavirus disease-2019 (COVID-19) a pandemic. In this Case Report, we present a rare case of a patient who inhaled toxic HDs and developed COVID-19. He was young and had a low risk of severe COVID-19, however, he had a critical course to recovery. He was admitted to the intensive care unit and administered high-flow oxygen via a nasal cannula. He received dexamethasone injections each day for 10 days and his condition began to improve on hospital Day 6, although radiographical findings revealed no improvement. He was discharged on hospital Day 26. Despite the patient’s chronic lung disease becoming asymptomatic, HDs could be an important risk factor affecting the clinical course of COVID-19.

Pharmacological Interventions on Surgical Intensive Care Units Initiated by Pharmacists

Purpose@#The severity of a patient’s medical condition, changing pharmacodynamics and pharmacokinetics, and variability in medication highlight the importance of pharmacological intervention by intensive care unit (ICU) specialized pharmacists. @*Methods@#Retrospective observations of ICU interventions (omission, changes in medicine, side effects, changes in administration route and dosage, redundancy, and nutritional care) performed between April 2017 and March 2018, determined by an interdisciplinary team (including a specialized ICU pharmacist and a surgical intensivist) on their surgical ICU round, were analyzed. Medicinal prescriptions were screened weekly during the surgical ICU round, and interventions were made if any corrections were necessary. Two days later another team including a surgical intensivist, a pharmacist, and a nutritionist evaluated the patients’ nutritional status (performed weekly). @*Results@#In the 23-bed ICU, the average number of patients whose prescriptions were examined was 22.38 per surgical round. There were 382 interventions made over 1 year, which was 9.68 interventions per day. The interventions were for nutritional care (161 cases, 42.2%), followed by changes in administration route and dosage (94 cases, 24.6%), omission (59 cases, 15.5%), redundancy (40 cases, 10.4%), changes in medicine (15 cases, 3.9%), and side effects (13 cases, 3.4%). @*Conclusion@#The conditions of patients admitted to ICU are typically unstable. Pharmacological interventions suggested by a specialized pharmacist may help control the changing medical condition of patients in ICU. A higher participation of pharmacists specialized in working in an interdisciplinary ICU team-based system could lead to safer treatments.

Pharmacological Interventions on Surgical Intensive Care Units Initiated by Pharmacists

Purpose@#The severity of a patient’s medical condition, changing pharmacodynamics and pharmacokinetics, and variability in medication highlight the importance of pharmacological intervention by intensive care unit (ICU) specialized pharmacists. @*Methods@#Retrospective observations of ICU interventions (omission, changes in medicine, side effects, changes in administration route and dosage, redundancy, and nutritional care) performed between April 2017 and March 2018, determined by an interdisciplinary team (including a specialized ICU pharmacist and a surgical intensivist) on their surgical ICU round, were analyzed. Medicinal prescriptions were screened weekly during the surgical ICU round, and interventions were made if any corrections were necessary. Two days later another team including a surgical intensivist, a pharmacist, and a nutritionist evaluated the patients’ nutritional status (performed weekly). @*Results@#In the 23-bed ICU, the average number of patients whose prescriptions were examined was 22.38 per surgical round. There were 382 interventions made over 1 year, which was 9.68 interventions per day. The interventions were for nutritional care (161 cases, 42.2%), followed by changes in administration route and dosage (94 cases, 24.6%), omission (59 cases, 15.5%), redundancy (40 cases, 10.4%), changes in medicine (15 cases, 3.9%), and side effects (13 cases, 3.4%). @*Conclusion@#The conditions of patients admitted to ICU are typically unstable. Pharmacological interventions suggested by a specialized pharmacist may help control the changing medical condition of patients in ICU. A higher participation of pharmacists specialized in working in an interdisciplinary ICU team-based system could lead to safer treatments.

A Case Report of Tracheostomy for a Patient with COVID-19: How to Minimize Medical Staff and Patient Risks

Coronavirus disease was first reported in December 2019, and the World Health Organization declared it as a pandemic on March 11, 2020. The virus is known to attack various vital organs, including the respiratory system. Patients sometimes require positive pressure ventilation and tracheostomy. Because tracheostomy is a droplet-spreading procedure, medical staff should protect themselves against the risk of transmission of this contagious viral disease. In our case, we performed tracheostomy for a 70-year-old man with coronavirus disease 2019 (COVID-19) who had required more oxygen with gradual weakness of respiratory muscle to maintain his arterial oxygen saturation. We focused on the risks of the medical staffs and patients, and minimized them at the same time using temporary balloon over-inflation, pre-operative adjustment of endotracheal tube position, and attachment of a transparent film dressing to the surgical field without stopping the ventilator while following routine safety measures. Fourteen days after the tracheostomy, all participating medical staff members were healthy and asymptomatic. The patient was discharged 105 days after the COVID-19 diagnosis.

Can Robotic Gastrectomy Surpass Laparoscopic Gastrectomy by Acquiring Long-Term Experience? A Propensity Score Analysis of a 7-Year Experience at a Single Institution

PURPOSE: It is hypothesized that robotic gastrectomy may surpass laparoscopic gastrectomy after the operators acquire long-term experience and skills in the manipulation of robotic arms. This study aimed to evaluate the long-term learning curve of robotic distal gastrectomy (RDG) for gastric cancer compared with laparoscopic distal gastrectomy (LDG). MATERIALS AND METHODS: From October 2008 to December 2015, patients who underwent LDG (n=809) were matched to patients who underwent RDG (n=232) at a 1:1 ratio, by using a propensity score matching method after stratification for the operative year. The surgical outcomes, such as trends of operative time, blood loss, and complication rate, were compared between the two groups. RESULTS: The RDG group showed a longer operative time (171.3 minutes vs. 147.6 minutes, P<0.001) but less estimated blood loss (77.6 ml vs. 116.6 ml, P<0.001). The complication rate and postoperative recovery did not differ between the two groups. The RDG group showed a longer operative time and similar estimated blood loss compared with the LDG group after 5 years of experience (operative time: 159.2 minutes vs. 136.0 minutes in 2015, P=0.003; estimated blood loss: 72.9 ml vs. 78.1 ml in 2015, P=0.793). CONCLUSIONS: In terms of short-term surgical outcomes, RDG may not surpass LDG after a long-term experience with the technique.

Quality Characteristics of Yanggaeng Supplemented with Sanghwang Mushroom (Phellinus linteus) Mycelia

The principal objective of this study was to examine the quality characteristics of yanggaeng supplemented with powder derived from Sanghwang mushroom (Phellinus linteus) mycelia. We analyzed the potential of utilizing Phellinus linteus mycelia as a functional food material by estimating total polyphenol and flavonoid contents, electron-donating abilities, as well as antioxidative activities of the water and ethanol extracts of Sanghwang mushroom mycelia. The total phenol and flavonoid contents of ethanol extracts from Phellinus linteus mycelia were 0.69 mg/ml and 0.16 mg/ml, respectively, while the contents from the water extract of Phellinus linteus mycelia were 0.66 mg/ml and 0.22 mg/ml, respectively. The electron-donating abilities of ethanol and water extracts from Phellinus linteus mycelia were 88.64 and 90.29%, respectively. The ABTS radical scavenging activities of ethanol and water extracts from Phellinus linteus mycelia were 89.74 and 71.35%, respectively. In terms of color values, as the level of powder increased, the value of L (lightness) decreased, whereas those of a (redness) and b (yellowness) increased. In regard to the mechanical properties of the samples, we noted significant differences in hardness, springiness, chewiness, and gumminess (P<0.05). The results of the sensory evaluation showed that the score from SHM (Sanghwang mushroom mycelia) with 4% powder was significantly higher than other samples in terms of sweetness, color, taste, texture and overall quality (P<0.05). Taken together, the recommended level of Phellinus linteus mycelia powder in yanggaeng is 4% for optimal sensory characteristics.

The Impact of Body Weight Change on Bone Mineral Density of the Lumbar Spine in Perimenopausal Women: A Retrospective, One-year Follow-up Study / 가정의학회지

BACKGROUND: Low body weight was one of the risk factors of osteoporosis. Little is known about the correlation between body weight change and bone mineral density (BMD) in Korean women. Therefore, this study was designed to reveal the impact of body weight change on BMD of the lumbar spine in perimenopausal women. METHODS: 105 healthy perimenopausal women aged between 44 and 50 years old were enrolled from August 2002 to March 2009. BMD was measured by dual energy X-ray absorptiometry. Partial correlation coefficients between body weight change and BMD change were calculated after the adjustments for several variables. BMD changes among groups based on BMI and the percentage change in body weight during 1-year follow-up period were compared. RESULTS: At both baseline and year 1, BMD of lumbar spine tended to be associated more with body weight. There was a significant association between body weight change and BMD change in lumbar spine during 1-year follow-up period. The weight gain group relatively showed an increase in BMD of lumbar spines than weight loss group. There was no BMD change in BMI less than 23 kg/m2 group, but in case of BMI more than 23 kg/m2 group, BMD in weight gain group increased more than the weight maintaining group. CONCLUSION: This study demonstrated that body weight change is associated with change in BMD of lumbar spine in perimenopausal women especially if they are overweight.

A bacteriologic study upon infectious conditions of orthopaedic in-patients / 대한정형외과학회잡지

No abstract available.

Usefulness of a ureteral stent insertion after ureteroscopic stone extraction / 대한비뇨기과학회지

After ureterosoopic stone extraction, temporary ureteral catheter or stent insertion has been performed routinely in order to reduce postoperative pain and other complications even in patients without significant visible damage b the ureter endoscopically. However. it brines considerable discomfort to the patients. In this study. 67 patients with no significant damage to the ureter after ureteroscopic stone extraction were divided into two groups to evaluate the usefulness of temporary ureteral stent insertion. In 35 cases. group 1. a ureteral stent was inserted after stone extraction and in 32 cases. group 2. a stent was not inserted after stone extraction. Then the incidence of postoperative flank pain. dysuria. gross hematuria present for more than 24 hours. fever. admission du. ration. urinalysis and urine culture at postoperative 1 week and 2 weeks. and IVP at postoperative 3 months were investigated. In order to evaluate the relationship of operating time b the incidence or complications, each group divided into those taking more than one hour in operating time and those taking less than one hour. The following results were obtained ; 1. There was no significant difference in the incidence of complications between two groups, except for flank pain. The incidence of flank pain was 11.4% (4 cases) in group 1 and 40.6% (13 cases) in group 2. showing a significant difference (p<0.05). 2. In operations taking more than one hour. stented group showed a significant decrease(p<0.025) in the incidence of flank pain but in operations taking less than one hour, there was no significant difference between two groups. From the above results. it seems that a ureteral stent insertion is not necessary after ureteroscopic stone extraction in case of operating time less than 1 hour and no significant ureteral injury notified. But. ureteral stent insertion is helpful to reduce postoperative flank pain in case of operative time more than 1 hour.