Proposed Master Plan for Reform of the National Infectious Disease Prevention and Management System in Korea

A Middle East respiratory syndrome (MERS) - coronavirus (CoV) cluster that attacked Korea in May 2015 revealed several weaknesses in Korea's health care system in the face of the crisis of an emerging infectious disease and its public health implications. This experience has shown that is necessary to prepare comprehensive countermeasures through the cooperation of civil and public agencies to prevent a second or even third MERS outbreak and to control future crises of infectious disease and public health. The MERS Policy Committee of the Korean Medical Association has thus proposed a master plan for reform of the national infectious disease prevention and management system to prepare a new framework for national infectious disease prevention and control. The specific targets of the master plan are improvement of the system of usage of medical services and of the medical culture among national health insurance subscribers, improvement of the emergency room management system to prevent the spread of infectious disease, the establishment of a support system to promote effective voluntary infectious disease prevention activities among medical institutions, the building of a public health crisis communication system in collaboration with medical organizations, the establishment of an independent Ministry of Health and capacity building of the Korea Centers for Disease Control (KCDC), the securing of an advanced research and development system in the field of prevention and control of infectious disease, and the capacity building of professional epidemiologists and personnel needed to prevent and control infectious disease. The five core strategies of the master plan have been planned by medical experts in this order of priority: the reform of the healthcare delivery system, the independence of the Ministry of Health and capacity building of the KCDC, fundraising for a public infection management fund, enforcement of medical organization infection control, and improvement of the emergency room management system.

Nutritional Status of Children with Cerebral Palsy

OBJECTIVE: To determine the nutritional status of children with cerebral palsy (CP) and to compare their anthropometric and functional indices. METHOD: Seventy children with cerebral palsy, were at class I (12), II (17), III (18), IV (9) and V (14) on Gross Motor Function Classification System (GMFCS). They varied by age from 25 to 130 months with a mean of 48 months, and consisted of spastic diplegic cerebral palsy (30), quadriplegia (28), triplegia (3), hemiplegia (4), athetoid (4) and hypotonia (1). Evaluation of weight, height, subcutaneous fat thickness, brachial circumference, Body Mass Index (BMI), level of albumin, lymphocyte and blood ferritn were conducted. To identify the factors affecting nutritional status, dietary status and symptoms of dysphagia were investigated. RESULTS: Low BMI percentile was in 23 children (32.9%) and obese condition in 3 children (4.3%). Low BMI percentile tends to frequently observed in groups III, IV, V of GMFCS. BMI percentile with subcutaneous fat thickness, Gross Motor Function Measure (GMFM) score were significantly related (p<0.05). Seen from the symptom of dysphagia, low BMI percentile was correlated with decreased tongue motion (p<0.05). CONCLUSION: Cerebral palsy children with lower GMFM score, decreased tongue motion were significantly related with low BMI percentile. Subcutaneous fat thickness can be useful tool for evaluation of malnutrition of cerebral palsy children.

The Effects of Modified Low-Dye Taping in the Patient with Heel Pad Atrophy

OBJECTIVE: To evaluate whether the change of heel pad thickness improves the pain after Modified Low-Dye Taping (MLDT) in the patient with heel pad atrophy. METHOD: Thirty-five feet of 20 volunteers with heel pad atrophy were selected for the measurement of heel-pad thickness and compressibility index (CI) of the center of calcaneus bone using ultrasound. The subjects were laid in prone with the knees flexed to 90degrees, and an electronic body weight scale was inserted beneath the anterior surface of their knees to take measurements of both UHPT (unloaded heel pad thickness) and LHPT (6 kg-loaded heel pad thickness), which were repeated 3 times respectively. CI was calculated base on LHPT divided by UHPT. After MLDT, the same method was repeated. visual analogue scale (VAS) score was checked at first visit and followed up at second visit. RESULTS: Prior to MLDT, the average value of UHPT (cm), LHPT (cm) and CI value was 0.92+/-0.11, 0.25+/-0.06 and 0.27+/-0.04 respectively. After MLDT, the average was 1.24+/-0.17 for UHPT (cm) and 0.42+/-0.11, for LHPT (cm) while CI stood at 0.33+/-0.06. VAS before MLDT was 7.35+/-1.27 and after MLDT was 3.50+/-1.36, which presented 54% of decrease than initial. CONCLUSION: It was confirmed that the average values of the heel-pad thickness, CI and VAS of patients with heel pad atrophy were improved for MLDT. Accordingly it is considered that application of MLDT is an efficacious treatment and thus further study is needed to develop foot orthoses for heel pad atrophy using the principle of MLDT.

Odor-Dependent Hemodynamic Responses Measured with NIRS in the Main Olfactory Bulb of Anesthetized Rats

In this study, we characterize the hemodynamic changes in the main olfactory bulb of anesthetized Sprague-Dawley (SD) rats with near-infrared spectroscopy (NIRS, ISS Imagent) during presentation of two different odorants. Odorants were presented for 10 seconds with clean air via an automatic odor stimulator. Odorants are: (i) plain air as a reference (Blank), (ii) 2-Heptanone (HEP), (iii) Isopropylbenzene (IB). Our results indicated that a plain air did not cause any change in the concentrations of oxygenated (Delta[HbO2]) and deoxygenated hemoglobin (Delta[Hbr]), but HEP and IB induced strong changes. Furthermore, these odor-specific changes had regional differences within the MOB. Our results suggest that NIRS technology might be a useful tool to identify of various odorants in a non-invasive manner using animals which has a superb olfactory system.

Clinical Characteristics of the Causes of Plantar Heel Pain

OBJECTIVE: The objectives of this study were to investigate the causes of plantar heel pain and find differences in the clinical features of plantar fasciitis (PF) and fat pad atrophy (FPA), which are common causes of plantar heel pain, for use in differential diagnosis. METHOD: This retrospective study analyzed the medical records of 250 patients with plantar heel pain at the Foot Clinic of Rehabilitation Medicine at Bundang Jesaeng General Hospital from January to September, 2008. RESULTS: The subjects used in this study were 114 men and 136 women patients with a mean age of 43.8 years and mean heel pain duration of 13.3 months. Causes of plantar heel pain were PF (53.2%), FPA (14.8%), pes cavus (10.4%), PF with FPA (9.2%), pes planus (4.8%), plantar fibromatosis (4.4%), plantar fascia rupture (1.6%), neuropathy (0.8%), and small shoe syndrome (0.8%). PF and FPA were most frequently diagnosed. First-step pain in the morning, and tenderness on medial calcaneal tuberosity correlated with PF. FPA mainly involved bilateral pain, pain at night, and pain that was aggravated by standing. Heel cord tightness was the most common biomechanical abnormality of the foot. Heel spur was frequently seen in X-rays of patients with PF. CONCLUSION: Plantar heel pain can be provoked by PF, FPA, and other causes. Patients with PF or FPA typically show different characteristics in clinical features. Plantar heel pain requires differential diagnosis for appropriate treatment.

Ultrasonographic Measurement of Gastrocnemius Muscle Thickness in Spastic Cerebral Palsy and Influencing Factors

OBJECTIVE: To identify the thickness of gastrocnemius muscles (GCM) in normal children and children with spastic cerebral palsy using ultrasonography and to determine the influencing factors in order to increase the accuracy of intramuscular injection of botulinum toxin A. METHOD: Fifty-six children with spastic cerebral palsy (Group A) with no fixed contractures or operation history were involved in this study and they were compared with normal children (Group B). Children lay prone and one examiner measured the thickness of medial and lateral GCM using ultrasonography. Relationship between GCM thickness and clinical variables (age, height, weight, body mass index (BMI), calf circumference, Gross Motor Function Classification System (GMFCS) level, spasticity, number of botulinum toxin injections) were determined with Pearson's correlation. RESULTS: The thickness of medial and lateral GCM were 78.06+/-14.66 mm, 66.90+/-12.23 mm respectively, in Group A, and 103.44+/-12.04 mm, 79.95+/-9.76 mm respectively, in Group B. Medial GCM were thicker than lateral GCM in both groups. The age, height, weight, BMI, calf circumference and the thickness of GCM were higher in Group B. In group A, weight, BMI, calf circumference showed positive correlations with the thickness of medial GCM and GMFCS showed negative correlation with the thickness of medial GCM. CONCLUSION: To increase the accuracy of intramuscular injection of botulinum toxin A, we should keep in mind that the thickness of GCM may be influenced by several factors. Further controlled study including larger group is needed.

A Case of Congenital Hemolytic Anemia of Unknown Cause Combined with Gilbert's Syndrome

Congenital hemolytic anemia is mainly developed due to intrinsic defects of erythrocytes, but in some cases the cause of hemolytic anemia is unclear. Gilbert's syndrome shows mild, chronic unconjugated hyperbilirubinemia that is due to reduced UDP glucuronosyltransferase (UGT-1A1) activity and this develops because of UGT-1A1 gene mutation. We report here on a case of severe hyperbilirubinemia in a 17-year-old male who was diagnosed with congenital hemolytic anemia of an unknown cause combined with Gilbert's syndrome.

A Cases of Paraganglioma in Bladder of Patient who Visited with Acute Renal Failure / 대한신장학회지

Pheochromocytoma is a catecholamines secreting tumor that usually appears in the adrenal medulla, sympathetic ganglia and extra-adrenal chromaffin tissue. About 10% of this disease is detected in the extra-adrenal chromaffin tissue which is called paraganglioma. The three major clinical symptoms of pheochromocytoma are headache, syncope and hypertension. Approximately 0.1% of hypertensive patients have pheochromocytoma. The extra-adrenal paraganglioma is found in abdominal sympathetic nerve ganglion or Zukerkandle's organ with great frequency, but it also appears, albeit rare, in the cervical ganglion, thoracic cavity, bladder, and pelvic cavity. Some cases of paraganglioma in bladder are being reported internationally, but domestic reports are rare. We report a case of paraganglioma originating in the urinary bladder of patient who visited with acute renal failure associated with malignant hypertension. We treated him with phenoxybenzamine and later with partial cystectomy. High blood pressure was well controlled and acute renal failure was resolved.

Pyridostigmine for Treatment of Acute Colonic Pseudo-obstruction(Ogilvie's syndrome) in a Older Patient on CAPD

In acute colonic pseudo-obstruction(Ogilvie's syndrome, 1948), there is no distal obstruction but colonic obstruction symptom and distended colon is shown radiologicaly and clinically. The etiology of this syndrome are complex of any medical and surgical problem. Elderly patients who are undergoing CAPD have multiple medical problems. But among them only one case which was diagnosed with this syndrome was reported in Korea. Neostigmine is unstable medicine due to muscarinic effects if neostigmine(anticholinesterase inhibitor) has side effects to the CAPD patients with multiple medical problems, it can be fatal. We use pyridostigmine, which has less muscarinic effect, and has similiar potency compared to neostigmine to acute colonic pseudo-obstruction, and thus achieved radiological improvement.

A Case of Appendicular and Rectal Metastasis from Gastric Cancer Detected by Endoscopic Resection / 대한소화기내시경학회지

A hematogenous or lymphogenous metastasis and a direct or disseminated invasion can occur in cases of a gastrointestinal metastasis. Moreover, a hepatic or peritoneal metastasis is common in advanced gastric cancer. However, a colonic metastasis, particularly an appendicular metastasis, is quite rare. Recently, we experienced a case with an appendicular submucosal tumor-like elevated lesion and multiple rectal elevated lesions during a colonoscopy in an advanced gastric cancer patient. The appendicular lesion was resected endoscopically and a biopsy of the rectal lesions was performed. The pathologic diagnosis was an appendicular and rectal metastasis of a signet ring cell carcinoma. We describe a case of appendicular and rectal metastasis from gastric cancer. The results highlight the importance of considering a metastatic carcinoma when an appendicular or rectal mass is found incidentally in a malignant neoplasm patient.

A Case of Mesenteroaxial Gastric Volvulus Diagnosed Using Endoscopic Procedure / 대한소화기내시경학회지

Gastric volvulus is characterized by an abnormal rotation of the stomach typically 180degrees left to right around a line joining the relatively fixed pylorus and the esophagus. Gastric volvulus can be classified anatomically as organoaxial, mesenteroaxial or combined, and symptomatically as acute or chronic. Acute gastric volvulus is an extremely rare emergency surgical condition. The classical triad of gastric volvulus are severe nausea with a paradoxical inability to vomit, localized epigastric pain and an inability to pass a nasogastric tube. Gastric volvulus may be suspected on a plain radiological examination of the abdomen as well as by its symptoms. It is confirmed by the specific findings on the esophagogastroduodenoscopy. We report a case of acute mesenteroaxial gastric volvulus, that was treated using laparoscopic reduction and anterior gastropexy.

A Case of Serrated Adenoma Presenting as Colon Cancer / 대한소화기내시경학회지

Serrated adenoma (SA) is a distinct form of colorectal neoplasia and it is defined as a neoplastic lesion composed of a monotonous cell population with atypical nuclei proliferating in serrated glandular architectures. Hyperplastic polyp is considered a benign lesion with no malignant potential. However, SA progressed into frank carcinoma has been demonstrated in an individual case, and 'serrated neoplasia pathway' is suggested by some authors as an alternative to classical adenoma-carcinoma sequence. Distinguishing between hyperplastic polyp and SA is important because of the different management implications and the increased potential for neoplastic progression in the latter, but sometimes it is very difficult. SA is usually small and sessile polypoid lesion. We report a case of SA presenting as large fungating mass similar to colon cancer, diagnosed as hyperplastic polyp initially by colonoscopic biopsy and confirmed as after SA the surgery.

A Case of Successful Endoscopic Therapy in Iatrogenic Perforation of the Colon during Colonoscopy / 대한소화기내시경학회지

Colonoscopy is a safe and standard procedure for diagnosis and therapy of colonic disorders. Iatrogenic colonic perforation during diagnostic colonoscopy, a rare abdominal emergency, has an 0.3~0.8% incidence rate. The choice of treatment for this complication remains controversial. Prompt operative intervention is preferred to minimize morbidity and mortality. However, operative intervention is invasive and needs a long-term recovery period. Conservative treatment is less invasive but can lead to more extensive surgery in case of treatment failure. Very important point on the treatment of iatrogenic perforation of the colon during diagnostic colonoscopy is to avoid the leaking of intestinal contents into the intraperitoneal cavity. We report here a case in which an iatrogenic perforation of the colon during diagnostic colonoscopy was successfully treated by endoscopic clip therapy.

A Case of Nasal Involvement of Sarcoidosis

Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non-caseating granulomatous inflammation of various organs. Nasal involvement of sarcoidosis is rare. Typical symptoms are nonspecific for sinonasal sarcoidosis and include nasal obstruction, postnasal drip, headache and recurrent sinus infection. We experienced a woman who had sarcoidosis involving the inferior turbinate. She was treated with en block resection, systemic steroids and immunosuppressive agents. So, we report this case with the review of literature.

Hodgkin's and Non-Hodgkin's Lymphoma of Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are considerable geographic and ethnic differences in the incidence, age distribution, and histologic subtypes of lymphoma. There are differences in outcomes of treatment and prognosis according to the stage, age, primary site, serum LDH, and performance status. We performed this study to investigate the outcomes of treatment, prognostic factors, and differences between Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). MATERIALS AND METHOD: A retrospective review was made of 84 malignant lymphoma patients involving the head and neck treated between 1993 and 2000 with chemotherapy or combined modality therapy at Hanyang University Hospital. RESULTS: Among 84 patients included in the study, 68 had NHL and 16 had HD. The median age of patients at diagnosis was 55 and 43 for patients of NHL and HD, respectively. Male patients made up 56% of the NHL patients and 75% of the HD patients. The most common extranodal site of NHL was palatine tonsil (16.2%). The most common histologic subtype was diffuse large cell lymphoma (64.7%) in NHL and mixed cellularity (43.8%) in HD. The useful prognostic factors predicting overall survival were stage, histologic subtype, serum LDH, and performance status for NHL, and age for HD. CONCLUSION: Although the characteristics of malignant lymphoma in Korea differed from those in the western countries, International Prognostic Index (IPI) still proved useful.

Variations of Surgical Anatomy in the Unilateral Sclerotic Temporal Bone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Temporal bone has a difficult anatomical structure for otologists. High resolution computed tomography (HRCT) helps locating the anatomical structure within the temporal bone. The aim of this study is to examine the anatomical relationship between the various surgical structures and pneumatization of unilateral sclerotic temporal bone using HRCT. SUBJECTS AND METHOD: We measured 11 distances and sigmoid sinus type on axial image, 6 distances on coronal image between important surgical landmarks of unilateral sclerotic temporal bone HRCT in 124 ears. The data of sclerotic side were compared with pneumatic side. RESULTS: The shortest distances from sigmoid sinus to lateral wall of mastoid cortex, middle cranial fossa, and posterior wall of external auditory canal, the shortest distance from tegmen to superior margin of lateral semicircular canal and superior wall of external auditory canal were significantly influenced by pneumatization. Half-moon and protrusion type of sigmoid sinus were dominant in sclerotic side. CONCLUSION: The location of sigmoid sinus and middle cranial fossa was affected significantly by temporal bone pneumatization.

Expression of Laminin Activities in Rabbit Tracheal Mucosal Wound Healing Following CO2 Laser Incision / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Accuracy and predictability of damage to soft tissue and cartilage are important factors in choosing the most suitable laser for laryngotracheal operations. Hemostasis is also major significance when treating highly vascular lesions inside the tracheobronchial tree. The CO2 laser has a 10.6micormeter infrared wavelength and can be used to vaporize and excise tissue accurately with minimal thermal damage to surrounding tissues. Laminin is a family of extracellular matrix glycoproteins localized in the basement membrane that separates epithelial cells from the underlying stroma. The biological activities of laminin to promote cell migration, growth and differentiation, suggest that laminin may have important roles in wound repair. MATERIALS AND METHODS: The histologic changes and the expression of laminin activities following incision of tracheal mucosa by CO2 laser were studied over a period of 7 days in a rabbit model. RESULTS: Some laminin positive fragments of the epithelial basement membranes could be seen in the wound at 12 hours. At 3 days, initial re-epithelialization was evident in the healing laser wound and an intensive positive staining for laminin was found in newly developed epithelial tissue. Re-epithelialization had proceeded to near completion by day 7 of surgery and the basement membranes containing laminin were much less conspicuous in the subepithelium at laser receiving sites than in the normal mucosa. CONCLUSION: Laminin plays an essential role in the initial cell proliferation of the basal cell layer by forming important landmarks for the migration of the epithelial cells.

A case of recurrent pneumoparotitis in a wind instrumentalist / 대한이비인후과학회지

Pneumoparotitis is a rare cause of enlargement of the parotid gland. Hence, it is often misdiagnosed and therefore incorrectly treated. We report, with the clinical presentation and radiographic findings, a case of pneumoparotitis due to trumpet playing. Swelling of the parotid gland was initiated by air being forced through the Stensen`s duct, resulting in the insufflation of air into the acini of the parotid gland. Recurrent parotid insufflation is not entirely benign and may predispose the parotid gland to sialectasia, recurrent parotitis, subcutaneous emphysema, and even mediastinal emphysema.

Changes of external ear resonance before and after surgery in chronic otitis media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: External ear resonance (EER) can normally increase the sound pressure level at the tympanic membrane by as much as 20 dB at the frequency between 2 and 4 kHz. Perforation of tympanic membrane (TMP) may alter the resonance characteristics. Surgical modifications of the external auditory canal by tympanoplasty may also change the EER features. We aimed to analyze the EER of patients with the TMP before and after surgery. MATERIALS AND MEHTOD: This study comprised of 130 patients (135 ears) with chronic otitis media. We checked EERs before and after the surgery. The preoperative group was divided into two groups according to perforation size. Postoperatively, the EER was checked at 3, 6, 9, 12 months or after 15 months. We compared these data with the control group which comprised of 96 adult ears. RESULTS: In the preoperative group, the peak resonant gain and the frequency were not different from the control's and the peculiar negative peaks appeared around 1500 Hz in half of the cases. No significant differences were found in the first peak gains according to the perforation size. The negative peaks appeared deeper in the larger perforation group. After tympanoplasty, the gain markedly increased. As time passed, the gain tended to decrease, but did not equalize with the control's data. CONCLUSION: Additional gain should be considered in the frequency of around 1 kHz for hearing aid users with the TMP. We could expect alterations of EER after tympanoplasty, suggesting that these changes should be considered at the time of fitting hearing aids.

The Anti-tumor Effect of Adoptive Immunotherapy with Dendritic Cells Cultured from the Bone Marrow in a Murine Squamous Cell Carcinoma Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is known that patients with malignant tumor often have depressed antitumor immunity. Much information has been generated about a biologically-based therapy, which can induce or activate antitumor cytotoxic T lymphocytes (CTL) capable of recognizing the antigens associated with the major histocompatibility complex molecules (MHC). Optimal induction of CTL seems to require contact with antigenic peptides presented by antigen presenting cell (APC). Dendritic cells (DC) are currently considered to be the most effective and professional APC. MATERIALS AND METHODS: With an injection of SCC cells (1x105) to the back of C3H mouse, a consistent and immunocompetent experimental animal tumor model was achieved. DCs were successfully cultured from the bone marrow of C3H mouse, and phenotypically they expressed high levels of co-stimulatory molecules and abundant MHC. Cultured DCs were intraperitoneally injected into the tumor-established mouse. RESULTS: In the treated group, tumor sizes were smaller, infiltration to the adjacent structures were limited. T cells extracted from the spleen of the treated group showed better proliferative and cytolytic activity toward tumor cells. The results of this study suggest that DCs have an effect to suppress the growth of tumors and to induce higher T cell reactivity toward tumor cells. CONCLUSION: These results may help in proceeding further immunologic approaches to reduce the morbidity and mortality in patients with the head and neck SCC.