Injury Data Comparison between National and Local Emergency Centers in Korea

PURPOSE: The incidence and severity of injuries differs between each region of Korea due to socioeconomic differences. The comparative analysis between national injury data and the evaluation of regional epidemiologic characteristics is useful in establishing an injury prevention strategy for a regional community. This study was conducted in order to provide basic data for the establishment of an injury prevention strategy by priority through comparison between national injury data collected by National Emergency Department Information System (NEDIS) and injury data from regional emergency centers located in small cities, in Korea. METHODS: The study subjects were the injury patients who visited a total of 117 regional, specialized and local emergency centers from April 2009 to March 2010, as well as those who visited Konkuk University Chungju Hospital during the same period. We collected national data from the Injury Surveillance Report published by Korea Centers for Disease Control and Prevention and compared these with study hospital data collected by our own injury registration system to include gender, ratio, age, and mechanism and severity of patient injury. RESULTS: Of 3,931,573 patients who visited 117 emergency centers and 23,671 patients who visited the study hospital during the study year, the number of injury patients was 786,006 (20.0%) versus 6,177 (26.1%), respectively. 485,521 (62.0%) of the nation-wide subjects versus 4,046 (65.5%) of the study hospital subjects were male, and 298,197 (38.0%) of the nation-wide subjects versus 2,128 (34.5%) of the study hospital subjects were female. The comparison by age of the injury subjects was as follows: below 9 years (22.4% versus 16.8%), twenties (14.5% versus 16.3%) and forties (14.5% versus 15.2%). In the comparison of injury mechanism, blunt injury was higher (20.4%) in nation-wide subjects followed by slip injury (20.0%) and transport accident (19.0%). Transport accidents produced the highest cause of injury (26.0%) in the study subjects followed by slip injury (20.1%) and bunt injury (16.1%). In the severity comparison, 641,344(81.6%) versus 4797(77.8%) were mild injury patients, 139,260(17.7%) versus 1299(21.1%) were severely injured, and 3114 (0.4%) versus 69(1.1%) were fatal injuries. The causes of severe injury nation-wide included intoxication (46.3%), falls (34.8%) and machine accidents (33.3%) versus machine (46.0%), asphyxia (44.4%), intoxication (39.3%) in the study hospital, and the causes of fatal injuries nation-wide were intoxication (5.2%), drowning (4.3%), and asphyxia (4.2%), versus drowning (11.1%), asphyxia (5.6%) and intoxication (4.9%) in the study hospital. CONCLUSION: Through the comparison between study hospital with national injury data, we found that the percentage of severe and fatally injured patients was higher in the nationally with transportation related accidents being highest in terms of mechanism. The construction of a regional injury data system with ongoing comparison with national injury data may be useful in the establishment of a regional injury intervention strategy by priority.

A Case of Peritonitis Due to Achromobacter xylosoxidans subsp. xylosoxidans in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) / 대한신장학회지

Bacterial peritonitis is a well-recognized complication of continuous ambulatory peritoneal dialysis (CAPD) in patients with end-stage renal failure. Achromobacter xylosoxidans subsp. xylosoxidans is a catalase and oxidase positive, motile, nonfermentative and gram-negative rod bacterium that is a rare pathogen in humans and has rarely been reported as an opportunistic human pathogen. We present a case of peritonitis due to unusual pathogens, Achromobacter xylosoxidans subsp. xylosoxidans. A 49-year-old diabetic man undergoing CAPD for 90 days developed the first peritonitis due to Achromobacter xylosoxidans subsp. xylosoxidans. A. xylosoxidans was detected from a culture of peritoneal fluid. Susceptible antibiotic treatment was provided.

Experience of a Medical Disaster Assistance Team during the Subacute Period after the Haiti Earthquake

PURPOSE: A medical disaster assistance team from our hospital was sent to the Haiti earthquake for 7 days of medical support. METHODS: We analyzed the characteristics of patients who visited our field clinic at the scene during the subacute period after the disaster. RESULTS: We treated 120 patients over 4 days, including two patients during the preparatory period. Most patients had visited a clinic in the second half of the period. Internal medicine and pediatrics were associated with the chief complaints of most patients. Acute tonsillitis had the largest number of patients(24.6%), followed by skin infections (9.2%), contusions and sprains(8.4%), and gastric ulcers (8.4%). Most of the medications were for conservative management(68.3%). CONCLUSION: During the subacute period after the earthquake, most patients had secondary injuries, such as wound complications and complications from air and water pollution, rather than direct injuries from the earthquake. We recommend that more medical preparation than surgical preparation is required during subacute periods after an earthquake.

Clinical Characteristics of Urolithiasis of Children in Emergency Department

PURPOSE: The incidence of urolithiasis of children is low (18-year-of-age who visited the ED with suspicion of urolithiasis, 74 patients were selected. Exclusion criteria were age >18 years, trauma, and only hematuria on urine test. We included 40 patients diagnosed with abdominal ultrasonography, abdominal computed tomography, and IVP. We analyzed age, sex, past history, underlying disease, chief complaint, physical examination, treatment modality, complications, and recurrences of urolithiasis in children. This study was performed retrospectively. RESULTS: Chief complaints were flank pain (19 cases, 47.5%), gross hematuria (15 cases, 37.5%), and abdominal pain (14 cases, 35%). No patient had abdominal tenderness, the portion of CVA tenderness was high (62.5%). The rate of recurrence was 17.5% (7 cases). Complications of urolithiasis were present in 23 cases (57.5%); among them, the rate of complications was high when a patient had a stone at mid-ureter (p=0.024) and low when the stone was at the renal pelvis (p=0.001). CONCLUSION: The most common symtom in the patients was flank pain and the rate of CVA tenderness was not high. The common sites of urolithiasis were renal calyx and renal pelvis. The rate of complications was 57.5% and hydroureter was most common. The rate of complication was high when they had the stone at mid-ureter.

Three Cases of Traumatic Pulmonary Pseudocysts in Old Age

In old age, a traumatic pulmonary pseudocyst is an extremely rare condition that generally develops after blunt chest trauma. It is more common among pediatric and young adult patients. We report three elderly patients who presented with chest symptoms after blunt chest trauma and whose computed tomography showed post-traumatic pulmonary pseudocysts.

A Case of Multiple Intracranial Hemorrhage Associated with Enoxaparin Treatment for an Acute Myocardial Infarction after Resuscitation

We report a rare case of multiple intracerebral hemorrhage, subarachnoid hemorrhage, and intraventricular hemorrhage that developed after successful cardiopulmonary resuscitation (CPR). A 66-year-old man underwent CPR for about 10 minutes in his community hospital. At that time, his only sequela was ST depression in leads V3, and V4 with an ECG. There was no definite parenchymal lesion in the brain computed tomography (CT) scan taken in the community hospital, and the patient was transferred to Wonju christian hospital for post-resuscitation management. Upon arrival, echocardiographic findings showed akinesia of the anterior wall and anteroseptal wall together with decreased ejection fraction (34%). A cardiac enzyme assay showed a CK-MB concentration of 19.4 ng/ml and a troponin-I level of 1.66 ng/ml. He was mentally comatose and both pupils were isocoric and reflexive to light. We concluded that the cause of cardiac arrest was acute myocardial infarction (AMI), and the patient was treated with drugs including aspirin, clopidogrel, enoxaparin-sodium (1 mg/kg subcutaneous), and isosorbide dinitrate. At 10 hours after admission, a follow-up ECG showed ST elevation in lead I, aVL and all leads from V1 to V6. Right anisocoria was seen in neurologic examination at that time. A subsequent brain CT revealed multiple intracerebral hemorrhage, subarachnoid hemorrhage into all cisternal spaces, and intraventricular hemorrhage. Clotting evaluations yielded a prothrombin time (PT) of 14.6 sec., partial thromboplastin time (PTT) of 45.3 sec. and an INR of 1.32, and a hemoglobin count of 16.2 g/dL.

A Case of Medullary Thyroid Carcinoma in which the Skin Metastasis was Concurrently Present and Response Occurred to Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

Medullary thyroid carcinoma accounts for 3% of all thyroid gland malignancies. It commonly metastasizes to liver, lung, and bone. It rarely metastasizes to skin, and only a few such cases have been documented. Cutaneous metastasis suggests a poor prognosis, with a mean survival of 7.5-19 months. The most effective treatment for skin metastasis is complete surgical removal of all local and regional lesions. The response to systemic chemotherapy is typically poor. We report a case of medullary thyroid carcinoma with cutaneous metastases, which responded to chemotherapy.

Diagnostic Approach to a Patient with a Pleural Effusion Including Ultrasound-guided Paracentesis Performed by a Medical Resident / 결핵및호흡기질환

BACKGROUND: A patient with a pleural effusion that is difficult to safely drain by a "blind" thoracentesis procedure is generally referred to a radiologist for ultrasound-guided thoracentesis. But such a referral increases the cost and the patient's inconvenience, and it causes delay in the diagnostic procedures. If ultrasound-guided thoracentesis is performed as a bedside procedure by a medical resident, then this will reduce the previously mentioned problems. So these patients with pleural effusions were treated by medical residents at our medical center, and the procedures included bedside ultrasound-guided thoracenteses. METHODS: We studied 89 cases of pleural effusions from March 2003 to June 2005. A "blind" thoracentesis was performed if the amount of pleural effusion was moderate or large. Bedside ultrasound-guided thoracentesis was performed for small or loculated effusions or for the cases that failed with performing a "blind" thoracentesis. RESULTS: "Blind" thoracenteses were performed in 79 cases that had a moderate or large amount of uncomplicated pleural effusions and the success rate was 93.7% (74/79 cases). Ultrasound-guided thoracentesis by the medical residents was performed in 15 cases and the success rate was 66.7% (10/15 cases). The 5 failedcases included all 3 cases with loculated effusions and 2 cases with a small amount of pleural effusion. All the failed cases were referred to one radiologist and they were then successfully treated. If we exclude the 3 cases with loculated pleural effusions, the success rate of ultrasound-guided thoracentesis by the medical residents increased up to 83% (10/12 cases). Two cases of complications (1 pneumothorax, 1 hydrohemothorax) occurred during ultrasound-guided thoracentesis. CONCLUSION: Ultrasound-guided thoracentesis performed as a bedside procedure by a medical resident may be relatively effective and safe. If a patient has a loculated effusion, then it would be better to first refer the patient to a radiologist.

A Significant Discrepancy of Uptake between I-131 MIBG and F-18 FDG in a Patient With Malignant Paraganglioma / 핵의학분자영상

A 38-year-old man who was diagnosed with malignant paraganglioma underwent computed tomography (CT) and I-131 metaiodobenzylguanidine (MIBG) san. CT showed extensive lymph node enlargement in right iliac area and retroperitoneum with severe hydronephrosis and mass on posterior bladder wall. However, I-131 MIBG scan didn't showed abnormal uptake. He also underwent F-18 fluorodeoxyglucose (FDG) positron emisson tomography/CT for localizing accurate tumor site. F-18 FDG PET/CT showed multiple metastases of left supraclavicular, hilar, mediastinal para-aortic, inguinal, right iliac lymph nodes, lung, vertebrae, and pelvis. There are a few reports showing that the F-18 FDG PET/CT is helpful for staging and localizing tumor site of patients who are diagnosed with negative on the MIBG scans. Thus, we report a case with paraganglioma which showed negative I-131 MIBG scan, but revealed multiple intense hypermetabolic foci in F-18 FDG PET/CT.

A comparative study of the clinical features and hematobiochemical indices between the lung-uptake group and the non-lung-uptake group of malarial patients undergoing liver scanning / 대한내과학회지

BACKGROUND: Lung uptake during liver scanning has been considered as a passing phenomenon related to several diseases, and especially infectious diseases and malignancy. Some reports have shown diffuse lung uptake during liver scanning of malarial patients. Therefore, we tried to determine the relationship between the abnormalities of the clinical features, including the hematobiochemical indices and the lung uptake during liver scanning, by analyzing the information of the malarial patients. METHODS: We performed 99mTechnethium(Tc)-sulfur colloid liver scanning on 20 of the 45 malarial patients who were admitted from 1999 to 2004. We divided them into two groups, the Lung-Uptake (LU) group and the Non-Lung-Uptake (NLU) group. We analyzed the hematobiochemical indices and clinical features, including the respiratory symptoms, between the two groups. RESULTS: 10 of the 20 malarial patients showed lung uptake on the liver scan. The mean platelet counts were 74,000/L and 165,000/L, respectively, in the LU group and the NLU group (p=0.012). Also, the mean total cholesterol levels were 80.3 mg/dL and 105.7 mg/dL, respectively, in the LU group and the NLU group (p=0.033). The scores ofthe bone marrow (BM) uptake in the LU group were higher than those in the NLU group (p=0.008). Yet the other values such as Hb, ALT, albumin and total bilirubin were not statistically significant, nor were the peak body temperatureand other features. CONCLUSIONS: Half of the patients had lung uptake on the liver scanning, and this may be considered as a characteristic of vivax malaria. The BM uptake during liver scanning in the LU group was more increased, and this is supposed to be a consequence of hyperstimulated reticuloendothelial system, which was accompanied by thrombocytopenia and a lower level of total cholesterol in malarial patients.

Comparison of Abdominal Computerized Tomography and Clinical Findings in Atypical Appendicitis

PURPOSE: The frequency of computerized tomography (CT) for diagnosing of atypical acute appendicitis, as ordered by emergency physicians, was noted. According to abdominal CT findings, the severity of acute appendicitis is divided into six grades that are used for diagnosis and treatment. However, whether or not the laboratory and clinical findings of atypical acute appendicitis have a relation to the grading of abdominal CT scans is unknown. This study was performed to evaluate the correlation between CT grades and symptoms, signs and operative and pathologic findings of atypical acute appendicitis. METHODS: This study included 412 patients who were admitted and underwent an appendectomy from January 2004 to June 2005. An abdominal and pelvic CT scan was performed in 114 patients who had atypical presentations in the emergency room. The abdominal and pelvic CT scales were correlated with clinical signs, laboratory findings, and pathology reports. The CT scale for appendicitis is a sixgrade scale from normal (grade 0) to periappendiceal abscess (grade 5). RESULTS: Sixty-six patients were male and 48 were female, and the mean age was 50.7+/-22.0 years old. On the abdominal CT, grade 0 (normal) was 3 patients (2.6%), grade 1 (probable appendicitis) 5 (4.4%), grade 2 (appendicitis) 17 (14.8%), grade 3 (appendicitis with periappendicitis) 47 (40.9%), grade 4 (appendicitis with rupture) 30 (26.1%), and grade 5 (complicated appendicitis) 12 (10.4%). There was no significant difference between CT grades and either local tenderness or rebound tenderness in the right lower quadrant abdomen (p>0.296). However increased body temperature correlated with higher CT grades (p=0.01). There were significant differences in the neutrophil count (p<0.001), but not the white blood cell count (p=0.493). The severity of pathology of acute appendicitis correlated with the CT grade (R=0.468, p=0.004). CONCLUSION: There was no significant correlation of local and rebound tenderness on right lower quadrant abdomen and of white blood cell count with CT grading in appendicitis, but there was a high correlation of body temperature and of neutrophil counts with the CT grades of appendicitis for patients with atypical appendicitis. The CT grades of appendicitis also correlated with the pathology.

Comparison of Abdominal Computerized Tomography and Clinical Findings in Atypical Appendicitis

PURPOSE: The frequency of computerized tomography (CT) for diagnosing of atypical acute appendicitis, as ordered by emergency physicians, was noted. According to abdominal CT findings, the severity of acute appendicitis is divided into six grades that are used for diagnosis and treatment. However, whether or not the laboratory and clinical findings of atypical acute appendicitis have a relation to the grading of abdominal CT scans is unknown. This study was performed to evaluate the correlation between CT grades and symptoms, signs and operative and pathologic findings of atypical acute appendicitis. METHODS: This study included 412 patients who were admitted and underwent an appendectomy from January 2004 to June 2005. An abdominal and pelvic CT scan was performed in 114 patients who had atypical presentations in the emergency room. The abdominal and pelvic CT scales were correlated with clinical signs, laboratory findings, and pathology reports. The CT scale for appendicitis is a sixgrade scale from normal (grade 0) to periappendiceal abscess (grade 5). RESULTS: Sixty-six patients were male and 48 were female, and the mean age was 50.7+/-22.0 years old. On the abdominal CT, grade 0 (normal) was 3 patients (2.6%), grade 1 (probable appendicitis) 5 (4.4%), grade 2 (appendicitis) 17 (14.8%), grade 3 (appendicitis with periappendicitis) 47 (40.9%), grade 4 (appendicitis with rupture) 30 (26.1%), and grade 5 (complicated appendicitis) 12 (10.4%). There was no significant difference between CT grades and either local tenderness or rebound tenderness in the right lower quadrant abdomen (p>0.296). However increased body temperature correlated with higher CT grades (p=0.01). There were significant differences in the neutrophil count (p<0.001), but not the white blood cell count (p=0.493). The severity of pathology of acute appendicitis correlated with the CT grade (R=0.468, p=0.004). CONCLUSION: There was no significant correlation of local and rebound tenderness on right lower quadrant abdomen and of white blood cell count with CT grading in appendicitis, but there was a high correlation of body temperature and of neutrophil counts with the CT grades of appendicitis for patients with atypical appendicitis. The CT grades of appendicitis also correlated with the pathology.

A case of chronic neutrophilic leukemia / 대한내과학회지

Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative disorder characterized by clonal proliferation of mature neutrophils, hepatosplenomegaly, elevated leukocyte alkaline phosphatase score (ALP score) and a negative Philadelphia chromosome. To date, approximately 150 cases have been reported in the literature, including some cases presenting with a 'leukemic' state reflected by a neutrophilic reaction. The term 'true' CNL, recently introduced by Reilly, highlights the need for more experience with CNL cases to improve the diagnostic criteria. In Korea, about 10 cases have been reported in the literature and some of those cases did not meet the WHO diagnostic criteria for CNL. We present a typical case of CNL in a 66-year-old man who complained of general weakness and weight loss. On admission, the white blood cell count from the peripheral blood was 175,600/L with 80% segmented neutrophils. The cytogenic study was negative for the Philadelphia chromosome and had a normal karyotype.

A Case of HELLP Syndrome with Liver Infarction and Cerebral Venous Thrombosis

We describe a rare case of cerebral venous thrombosis and liver infarction with HELLP syndrome in a 25-year-old woman with eclampsia. She had complained of epigastric pain and had visited a local hospital for treatment. Also, signs of fetal distress were presented. After an emergency cesarean section, generalized tonic-clonic seizure occurred twice at a 10-minute interval. The patients was transferred to our emergency room, and the neurologic examination at that time, revealed a deep drowsy mentality and positive Babinski's sign; the deep tendon reflex was two positive. The laboratory findings revealed thrombocytopenia, an elevated liver function test, abnormal coagulation profiles. A bilateral ischemic change with left basal ganglia hemorrhage was seen on brain CT, and multiple foci of ill defined low-density lesions, mainly in the subcapsular portion of the liver and perivascular space, were visible on the abdominal CT. There was a faint showing of the deep venous system on the angiogram of both carotid arteries and a cerebral venous thrombosis was confirmed by using 4-vessel angiography. During the following 2 days, the cerebral hemorrhage and the low-density lesion were resolved through applications of heparin, and the patient returned to a nearly alert mental status. Finally she died of a hemorrhagic shock as a complication of disseminated intravascular coagulation.

Resuscitation Outcomes and Clinical Characteristics Based on the Initial ECG Rhythm in Prehospital Traumatic Cardiac Arrest Patients

PURPOSE: The purpose of this study was to investigate the outcome of resuscitation and the clinical characteristics of patients with prehospital traumatic cardiac arrest. METHODS: We conducted a 14-year retrospective study of all pulseless patients with trauma for whom cardiopulmonary resuscitation (CPR) was initiated in an in-hospital setting during the period of January 1991 through February 2004. RESULTS: Four hundred nine patients, 287 males and 122 females, were included in this study. The mean age was 42+/-18 years (range 1-93 years). Eighty patients had pulseless electrical activity (PEA) rhythm, and three hundred twenty-nine patients had asystole rhythm on the initial ECG upon arrival at our emergency room. There were no significant differences in the interval from collapse to start of ACLS (27.1+/-33.4 min. vs 36.9+/-70.1 min., p=0.220), the duration of cardiopulmonary resuscitation (25.0+/-13.7 min. vs 26.4+/-9.9 min., p=0.394), the survival rates for more than 24 hours (5.0% vs 2.4%, p=0.221), and the number of patients discharged alive (1.3% vs 0.6%, p=0.545) between the PEA group and the asystole group. However patients in PEA group had a much higher return of spontaneous circulation (ROSC) rate than those in the asystole rhythm (52.5% vs 31.0%, p.0.001). The survival rates of narrow QRS tend to be higher than ones of wide QRS in ECG rhythm after ROSC (13.5% vs 7.4%, p=0.057). However, there was no difference in the survival discharge rate (p=0.196). There was no difference in 24 hours survival rate between the group that received defibrillation and the group that did not (0.9% vs 3.7%, p=0.099). The most common cause of death was a hemorrhagic shock. CONCLUSION: There was no difference in survival rate between the PEA and the asystole at an initial ECG rhythm. The overall survival rate of patients with prehospital cardiac arrest after trauma is very poor.

A Prospective Study for Comparing the Effects of Macrolide and Second-generation Cephalosporin on the Treatment of Pneumonia among Combat Policemen / 결핵및호흡기질환

BACKGROUND: The study of pneumonia among young men living in a group is rare. prospective study was conducted to determine the etiology, and compare the effects of macrolide and second-generation cephalosporin on the treatment of pneumonia among combat policemen. PATIENTS AND METHODS: From January 2003 to April 2004, Fifty-two patients with pneumonia were treated with either azithromycin(n=25) or cefuroxime(n=27). In order to determine the cause of the pneumonia, culture studies and serologic tests for antibodies to Mycoplasma pneumoniae and Chlamydia pneumoniae were carried out. During the two weeks of medication, the Chest X-rays, blood tests and culture studies(if necessary) were followed weekly. A serologic study was followed at the end of the second week. RESULTS: The main pathogens for pneumonia among combat policemen were Mycoplasma pneumoniae(50.0%), Chlamydia pneumoniae(10.8%), and Streptococcus pneumoniae(3.8%). The treatment was successful in most cases(51/52 cases, 98.1%). The effects of azithromycin and cefuroxime were similar (96.0% vs 100%, p>5). In one patient who had taken azithromycin, the clinical and radiological findings did not improved until intravenous second generation ce?phalosporin had been infused. CONCLUSION: Atypical pathogens were the main causes of the pneumonia in the combat policemen, and the effects of macrolide and second generation cephalosporin for pneumonia were similar. However, further studies will be needed to determine if single therapy with macrolide is possible.

A case of peripheral T-cell lymphoma with Reed-Sternberg like cells associated with Epstein-Barr virus / 대한내과학회지

The Reed-Sternberg like cells (RS-like cells) are by no means specific to Hodgkin lymphoma, but they have been reported in various other lymphoproliferative disorders, including infectious mononucleosis. Many studies have postulated that Epstein-Barr virus (EBV) infection may play a role in the development of RS-like cells in non-Hodgkin's lymphoma. There are many accounts in the literature about these RS-like cells in lymph node aspirates and biopsies creating diagnostic confusion with Hodgkin lymphoma, but no report in Korea. We experienced a case of a 44 year-old male patient who had multiple lymph nodes enlargement with the history of treatment of Hodgkin lymphoma 15 years ago. At this time, this patient was diagnosed as peripheral T-cell lymphoma with RS-like cells associated with EBV in lymph node biopsy. Here, we report this case with a review of the relevant literature.

Comparison Study of the Pulmonary Function and Serum Carboxyhemoglobin Level Between the Traffic Policmen and Clerk Policemen / 결핵

BACKGROUND: A large number of pollutants such as sulfur dioxide, nitric oxide, carbon monoxide, particulate matter, and ozone influence on the body. These pollutants put a burden on the lung and the sequelae resulting from the oxidative stress are thought to contribute to the development of fibrotic lung disease, emphysema, chronic bronchitis and lung cancer. Also, carbon monoxide generated from the incomplete combustion of carbon-containing compounds is an important component of air pollution caused by traffic exhaust fumes and has the toxic effect of tissue hypoxia and produce various systemic and neurologic complications. The objective of this study is to compare the difference of pulmonary function and serum carboxyhemoglobin(CO-Hb) level between the traffic policemen and clerk policemen. METHODS: Three hundred and twenty-nine of traffic policemen, and one hundred and thirty clerk policemen were included between 2001 May and 2002 August. The policemen who took part in this study were asked to fill out a questionnaire which included questions on age, smoking, drinking, years of working, work-related symptoms and past medical history. The serum CO-Hb level was measured by using carboxyoximeter. Pulmonary function test was done by using automated spirometer. Additional tests, such as elecrocardiogram, urinalysis, chest radiography, blood chemistry, and CBC, were also done. RESULTS: FEV1(%) was 97.1+/-0.85%, and 105.7+/-1.21%(p<0.05). FVC(%) was 94.6+/-0.67%, and 102.1+/-1.09%, respectively(p<0.05). Serum CO-Hb level was 2.4+/-0.06%, and 1.8+/-0.08%(p<0.05). After correction of confounding factors (age, smoking), significant variables were FVC(%), FEV1(%) and serum CO-Hb level(%)(p<0.05). CONCLUSION: Long exposure to air pollution may influence the pulmonary function and serum CO-Hb level. But, further prospective cohort study will be needed to elucidate detailed influences of specific pollutants on pulmonary function and serum carboxyhemoglobin level.

Severe Hypercalcemia in Oliguric Phase of Acute Renal Failure Associated with Rhabdomyolysis / 대한신장학회잡지

Hypercalcemia rarely develops in patients with acute renal failure associated with rhabdomyolysis. If hypercalcemia occurs, it happens mostly in diuretic phase and rarely in oliguric phase. Secondary hyperparathyroidism, abnormal metabolism of Vitamin D, immobilization of patient, and release of calcium from injured muscle are considered as possible pathogenetic mechanisms of hypercalcemia in acute renal failure associated with rhabdomyolysis. Among them, dissolution of calcium from injured muscle into extracellular fluid is accepted as the major mechanism of pathogenesis of hypercalcemia. A twenty year old male patient, combat policeman, developed syncope in the course of regular physical training. He was diagnosed of acute renal failure associated with rhabdomyolysis at the hospital he initially visited. After being subjected to three sessions of acute hemodialysis, he was transferred to our hospital. During the treatment, laboratory test was performed upon his continuous complaints of lower extremity weakness. It showed severe hypercalcemia with plasma calcium level of 17.6 mg/dL. He was in oliguric phase at the time of this severe hypercalcemia. Patient's lower extremity weakness was gradually improved by hemodialysis using low calcium dialysate. He was discharged after his renal function became normal. He has been followed on regular basis.

Correlation of srum collagen type IV levels with histo-pathological findings assessed by liver biopsy in hepatitis B carrier with normal liver function test / 대한내과학회지

BACKGROUND: We compared the results of liver biopsy and the levels of serum type IV collagen of the hepatitis B carriers with normal liver function test (LFT) to evaluate the clinical usefulness of serum type IV collagen in predicting the progression of histopathological findings. METHODS : Thirty one chronic hepatitis B carriers with normal LFT and no significant clinical symptoms, who were Korean combat police, were classified into three groups according to their histologic results of the liver biopsies. The classification followed the standard proposed by Korean Society of Pathology. Blood samplings for serum type IVcollagen (reference : less than 5 ng/mL) were done in the morning of the same day of the liver biopsy. RESULTS: Of thirty one patients, thirteen patients showed normal histologic findings (41.9%, Group A), eleven patients revealed histologic abnormalities without fibrosis (35.5%, Group B) and seven patients were with fibrosis on liver biopsy (22.6%, Group C). Serum type IV collagen levels of Group A, B and C were 3.53 +/- .57 ng/mL, 3.56 +/- .17 ng/mL and 3.97 +/- .88 ng/mL, respectively. The average of serum type IV collagen levels of Group C was higher than of Group B and the average of Group B higher than that of Group A without any statistical significance (p > 0.05). The averages of serum type IV collagen of eighteen patients with histologic abnormalities (Group B and C) and twenty four patients without fibrosis (Group A and B) were 3.73 +/- 1.06 ng/mL and 3.55 +/- .88 ng/mL respectively. Upon comparison of these averages with the those of Group A and C, no statistical significance was established (p > 0.05). CONCLUSION : In chronic hepatitis B carriers with normal LFT findings, levels of serum type IV collagen were elevated along with histologic severities without statistical significance, therefore can not represent the changing degree of the histologic findings. Liver biopsy is considered to be one of the most accurate tool to assess the histologic status of the liver.