Influence of Military Service on Tetanus Antibody Titer in Korean Adults

PURPOSE: Most Korean veterans receive a tetanus immunization as part of military service. Both tetanus toxoid and immunoglobulin are given to injured patients that present to the emergency department, regardless of their tetanus antibody titer and history of military service. The goal of this study was to determine the tetanus antibody titer and history of military service among patients presenting to the emergency room. METHODS: Seven hundred and seventy patients visited the emergency department after an injury from April 2008 to June 2009. The samples obtained were tested using a Tetanus Immunoglobulin G ELISA (enzyme-linked immunosorbent assay) method. The tetanus antibody titer was analyzed according to time, five years after entrance into military service and also between veterans and nonveterans. RESULTS: Subjects that had safe antibody titers that were protective against tetanus up to 20 years after entrance into military accounted for 60%. Those with a history of military service were more likely to have protective antibody levels (> or =0.1 IU/ml, odds ratio 2.41, 95% CI 1.613-3.596) and mean antibody titers (p<0.001). In the subjects between 20 and 45 years of age those with a history of military service were more likely to have statistically significant antibody titers. In addition, male veterans were more likely to have significant antibody titers compared to the males and females that were not veterans (p=0.015 and p<0.001); however, there were no significant differences between the males and females that were not veterans. CONCLUSION: The results of this study showed that until about 20 years after entrance into military service, 60% of the subjects had protective tetanus antibody titers. The history of military service influenced tetanus antibody titers until about 45 years of age.

Small Bowel Volvulus in Adults: A case report

Small bowel volvulus in adults is very rare and occasionally occurs due to congenital midgut malrotation. The most common cause of small bowel volvulus is adhesions (74%), and other causes are Crohn's disease (7%), neoplasia (5%), hernia (2%), radiation (1%), and miscellaneous (11%). Presenting symptoms may be acute or present periodically during a longer period of time with a condition that is intermittent or recurrent because of spontaneous detorsion of the volvulus. Diagnostic imaging studies are plain abdominal film, ultrasonography, abdominal CT, and angiography. Abdominal CT is the most accurate. The most frequent CT finding is "Whirlpool sign." Other findings are bowel-loop dilatation, bowel-wall thickening, beak signs, mesenteric alterations, and extraluminal fluid. The mortality rate associated with small bowel volvulus in adults is 10~67%. We report a case of small bowel volvulus in adults.

Difficult Intubation due to Diffuse Type of Tracheo-bronchial Stenosis (complete tracheal rings) from Pulmonary Arterial Sling: A case report

Pulmonary arterial sling, a rare developmental vascular anomaly forms a sling around the distal trachea and the proximal right main bronchus, where it sometimes makes tracheo-bronchial stenosis. Tracheobronchial stenosis from pulmonary arterial sling may produce non-specific symptoms of stridor, noisy breathing, dyspnea, recurrent upper respiratory tract infection, chronic cough, and dysphagia. The diagnosis of this anomaly begins with a high index of suspicion because of the lack of pathognomonic finding on usual evaluation. In this case, initial difficult intubation makes us evaluate further. Other cases reported the diagnosis is established by imaging studies, usually MRI and angiography. But, when our case was evaluated, we used cervico-thoracic enhanced computered tomography and tracheal fluoroscopy. Up to now, tracheobronchial stenosis from vascular anomaly is a rare and challenging disorder with a poor prognosis. However, early exact diagnosis would make us perform the accurate surgical treatment and reduce the mortality and morbidity.

The Results of Arthroscopic Meniscal Repair Evaluated by Second-Look Arthroscopy

The purpose of this study is to morphologically evaluate the results of arthroscopic meniscal repair by sec- ond-look arthroscopy. We performed the arthroscopic meniscal repair in 40 menisci of 39 knees between March 1994 and August 1997. Among them, 18 menisci of 17 knees were evaluated by second-look arthroscopy at 3 rnonths postoperatively. Lateral meniscus was 9 and medial meniscus was 9. The morpho- logical results were classified with completely healed, incompletely healed, and failed. The overall results showed that 13 menisci completely healed, 3 menisci incompletely healed, 2 menisci failed. The type of tear was 14 peripheral longitudinal tears, 1 oblique tear(incompletely healed), 1 transverse tear(completely healed with augmentation of fibrin clot), 1 tear at posterior tibial attachment, and 1 complex tear(completely healed). 3 menisci had associated lesions that had not been treated, of which 1 incompletely healed, 2 failed. Chronic cases, in which time interval between injury and repair was 6 weeks later, were 8 menisci(4 completely healed, 2 incompletely healed, and 2 failed). 10 long peripheral longitudinal tears of more fhan 2.5cm were resulted in 6 completely healed, 2 incompletely healed, and 2 failed. 5 longitudinal tear with a wide peripher- al rim(>2mm) were resulted in 1 completely healed, 2 incompletely healed, and 2 failed. The good result was expected when the tear was repaired in acute phase after injury and associated lesion was treated. For chronic tears, tears of avascular zone and wide longitudinal tears, the healing enhancement techniques such as fibrin clot insertion, abrasion of meniscus and synovium, and trephination must be taken into consideration.