The Diagnostic Usefulness of Ultrasound-Guided Peritoneal Biopsy for the Solitary Peritoneal Thickening of an Unknown Cause Visualized as Only Infiltrated Fat Tissue on a CT Scan

PURPOSE@#To assess the usefulness of an ultrasound (US)-guided peritoneal biopsy for the solitary peritoneal thickening visualized as only infiltrated fat on a computed tomography (CT) scan.@*MATERIALS AND METHODS@#This retrospective study included 36 patients (16 males, 20 females; mean age, 51.7 years) who underwent a US-guided biopsy for the solitary peritoneal thickening of unknown cause visualized as only infiltrated fat without an apparent mass formation on a CT scan. The rate of the specific histopathological diagnosis and accuracy for the diagnosis of malignant disease was assessed.@*RESULTS@#The procedure was technically successful with the acquisition of an adequate amount of the specimen for microscopic examination from all patients. A specific histopathological diagnosis was made in 31/36 patients (86.1%): peritoneal carcinomatosis in 15/31 (48.4%), tuberculous peritonitis in 15/31 (48.4%) and panniculitis in 1/31 (3.2%). A non-specific histopathological diagnosis was made in 5/36 (13.9%): chronic inflammation in 4/5 (80%) and mesothelial hyperplasia in 1/5 (20%). The procedure showed sensitivity of 83.3%, with a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 85.7%, and an accuracy rate of 86.1% for the diagnosis of malignant diseases.@*CONCLUSION@#The US-guided peritoneal biopsy is a fairly accurate diagnostic procedure for the peritoneal thickening visualized as only infiltrated fat on a CT scan, and it can be used before performing laparoscopic or an open biopsy.

Clinical chemistry values in elderly Korean people: single institutional study

Laboratory values change with age and interpreting laboratory results from elderly people using the reference intervals for younger adults may not be appropriate. The authors investigated the distribution patterns of routine chemistry values from elderly people to determine whether current reference intervals are also valid for elderly people. A total of 1,215 persons older than 65 years and 1,827 healthy adults below 65 years of age were evaluated. Blood samples were collected after an overnight fast and analyzed for chemistry tests. Computing the central 95th percentile showed that the total protein, albumin, ALP, LD, creatinine, uric acid, triglyceride, HDL-cholesterol, and electrolytes of elderly people were within the standard reference intervals used in our laboratory. For AST and ALT, the upper range of the central 95th percentile in the elderly population was found to be outside the common reference interval. However, the central 90th percentile values of AST and ALT were compatible with the common reference intervals. GGT, BUN, total cholesterol, LDL-cholesterol, and glucose showed higher values than the upper limits of the reference intervals. For common clinical chemistry tests, the common reference values in general should be applicable to elderly people, even though some parameters showed wider distributions in the elderly.

Proposal of Laboratory Test Panel Based on Patients' Chief Complaints in Emergency Department / 대한진단검사의학회지

BACKGROUND: A test panel is a group of tests that are simultaneously performed for diagnosis and follow-up of patients. Organ-specific or disease-specific test panels are currently available. Since the patient's chief complaint plays a key role in obtaining the personal and medical history and performing physical examinations, we proposed a test panel based on the chief complaints of the patients. METHODS: We collected data from 3,127 adults with apparent symptoms who visited the emergency department from April 2009 to May 2009. Subsequently, we classified the patients' chief complaints, ordered the laboratory tests on the basis of these complaints, considered the patients' disease entities, and reviewed the relevant literature. RESULTS: The patients were categorized into 14 groups on the basis of the most common chief complaints presented in the emergency department. We first selected the basic test panels and then organized the test panel for each chief complaint to enable differential diagnosis. CONCLUSIONS: We proposed test panels based on the chief complaints of the patients; these test panels could allow rapid diagnosis and be more useful than the organ-specific or disease-specific tests in critical pathway development. The next step will be evaluating the efficiency and cost effectiveness of the test panel that we suggested.

Annual average cancer incidence and trend of cancer incidence in Daegu for 5 years, 1997~2001 / 한국역학회지

PURPOSE: This study is conducted to identify the annual average cancer incidence and the trend of cancer incidence in Daegu during the 5-year period from 1997 to 2001. METHOD: Data on newly diagnosed cancer patients from 1997 to 2001 were collected with a standard registration form. Medical record reviewers visited hospitals if necessary, to detect missing cancer patients. RESULTS: The annual average overall number of cancer patient was 4,606 (male 2,529 and female 2,077). The crude average annual incidence of cancer in male were 211.8 (ASR 251.4) and 169.8 (ASR 151.3) in female. Five major cancers in male were stomach (ASR 60.3), bronchus and lung (ASR 44.8), liver and intrahepatic bile ducts (ASR 40.7), rectum (ASR 11.2), and colon (ASR 10.8). However, in women, those were stomach (ASR 25.3), breast (ASR 19.8), cervix (ASR 14.9), bronchus and lung (ASR 12.7), liver and intrahepatic bile ducts (ASR 11.1). Increases in incidence were found for colon cancer for both sexes, rectal cancer for males, and lung and breast cancer for females. Decreases were shown for liver cancer for both sexes and stomach and cervical cancer for females. CONCLUSIONS: Primary prevention of cancer based on results of this study remains important.

Effects of Estrogen Receptor Polymorphisms on Bone Markers and Serum Lipid Levels / 대한진단검사의학회지

BACKGROUND: In post-menopausal women, osteoporosis and cardiovascular diseases which are partly due to estrogen deficiency, occur more common than in pre-menopause women. Estrogen action is supposed to be mediated by an estrogen receptor (ER) and two polymorphisms of the ER gene in particular, Pvu II and Xba I, have been described for several years for genetic association studies. Authors have investigated the frequencies and patterns of the ER gene polymorphisms and their association with bone markers and lipid levels. METHODS: For 121 women who visited the health promotion center of Kyungpook National University Hospital, the ER gene polymorphisms were determined by the Pvu II and Xba I restriction enzymes following polymerase chain reaction. RESULTS: The distributions of ER Pvu II and Xba I restriction fragment length polymorphisms were as follows: PP 15.7%, Pp 47.9%, pp 36.4% and XX 5.8%, Xx 31.4%, xx 62.8%, respectively. And in a combination of two polymorphisms, ppxx was the most common, followed by PpXx, Ppxx, PPXx, PPXX and PPxx in that order. No significant genotypic differences were found in bone mineral density, bone markers and menopausal status. LDL cholesterol and triglyceride levels were significantly different by genotypes in premenopausal women (P<0.05). CONCLUSIONS: The results suggest that ER polymorphisms might be associated with LDL cholesterol and triglyceride levels. Further evaluation in a larger population would be helpful to determine the effects of ER polymorphisms on lipid metabolism and therapeutic trial for cardiovascular diseases in women.

The Needle Stick Injuries of Interns and Residents Working in Hospitals in a City / 대한산업의학회지

OBJECTIVES: This study was conducted in order to assess the experience of needle stick injury among interns and residents working in hospitals during the previous 4 months. METHODS: We conducted a questionnaire survey of 695 interns and residents working in two university hospitals and one general hospital in Tague city. Four hundred and forty three of those questioned(63.7 %) fully responded. RESULTS: Two hundred of the respondents(45.1 %) suffered at least one injury. Respondents suffered an average of 1.8 injuries. 96.5 % of interns, 40.6 % of surgical residents and 34.4 % of non-surgical residents suffered at least one injury. According to multiple logistic regression, Intern status and an increased amount of working time is associated with high risk of needle stick injury. CONCLUSIONS: This study demonstrates that interns and residents suffer a high rate of needle stick injury.

Comparision of Maternal Characteristics and Birth Weight among Five Different Categories of Medical Facility for Delivery in Taegu / 예방의학회지

This study was conducted to compare the maternal characteristics, and birth weight of infants delivered at five different categories of medical facility in Taegu to examine the risk level of pregnant women and children by the medical facility for delivery. The study population included 1,410 pregnant women who delivered a baby at one of nine medical facilities (3 university hospitals, 2 general hospitals, 2 private clinics, 1 midwife clinic, 1 MCH center) in Taegu in April, 1987(April and May, 1987 for K university hospital). Pregnant women were interviewed to ask the age and educational level of woman, payment of medical fee, birth order, delivery method. Birth weight of infant was obtained from medical record. Mean ages of the women delivering at the university hospitals(27.5 years) and at general hospitals(26.7 years) were higher than those at midwife clinic(25.4 years) and at MCH center(26.1 years). Also, mean years of school education were higher in women of university hospitals(12.7 years) and general hospitals(12.2 years) than in women of midwife clinic(9.2 years) and MCH center (9.3 years). The percentages of women covered by the medical insurance were far greater in the university hospitals(78.1%) and general hospitals(82.9%) than in private clinics(44.3%), midwife clinic(29.1%) and MCH center (5.4%). Infants born at the MCH center were mostly the second birth (47.3%) while 56.0% to 61.7% of infants born at all the other medical facilities were the first birth more women delivering at the university hospitals had history of spontaneous abortion as well as still birth than the women delivering at the other medical facilities. The preterm birth rate (11.4%) and low birthweight incidence rates(5.8-13.0%) in university hospitals were significantly higher than those of other medical facilities. Accordingly, c-section rates showed a wide variation among the medical facilities. Study findings revealed that most of women delivering at the university hospitals and general hospitals are in the middle of or upper socio-economic class and obstetrically high risk group regardless of socioeconomic class while the women delivering at the midwife clinic and MCH center are low risk group of low socioeconomic class. Therefore, the data of a specific medical facility are highly limited in interpretation and can not be generalized.

Birth Registration Rate and Accuracy of Reported Birth Date in Rural Area / 예방의학회지

To measure the birth registration rate and the validity of birth registration data in rural area, all of the 4,014 married women under 49 years of age who had not been sterilized in Gunwee county of Kyungpook province were followed by Myun health workers for 2 years from April 1, 1985 to March 31, 1987 and 766 births were detected. All of the birth registration records of Myun offices were reviewed on September 30, 1987 and 944 births which occurred within the above mentioned period were found. Actual birth date obtained by follow-up study were compared with the birth date on registration card. Among 766 births detected by follow-up study, 576 births(75.2%) which were reported within 6 months after birth were ascertained on the official registration records and 96 births(12.5%) were not found on the records although mother stated that the birth was registered. The registration rate within legal due date was 61.3% among 576 births detected by follow-up study and also ascertained on the official records. The registration rate within legal due date was lower in mothers under 20 years of age and above 35 years and in mothers who had only primary education. It was decreased as the birth order increased. The registration rate was higher in births occurred from October to March than births occurred from April to September. All of the births of 7 neonatal deaths were not reported. The registered birth date was consistent with the actual birth date in 78.0%. Birth date on record was earlier than the actual birth date in 6.8% and later in 15.3%. The consistency rate was lower in mothers above 35 years of age(54.5%), and in infants of 4th birth order and above(56.3%). The rate was increased as the maternal education level increased. The rate of boys was higher than that of girls. A higher percentage(17.4%) of infants born in March was registered with earlier date than the actual birth date and most of these registered birth dates were lunar calendar date. This might be related with the age for entering the primary school. The study findings revealed that the birth registration rate within legal due date and accuracy of report have been increased in recent years, but the infant mortality rate derived from the birth registration seems to be very inaccurate. It is suggested to let the medical personnel who delivered the baby report the birth by mail directly to the current address of parent while infants delivered at home without professional attendant may comply with the present registration system.

Hepatitis B Virus Infection Rate of Medical School Students in Taegu / 예방의학회지

To determine the hepatitis B virus infection rate of medical school students and appropriate time for immunization with hepatitis B vaccine, 385 students in the 1st, 2nd and 3rd grades of Medical School of Kyungpook National University who had not been vaccinated and volunteered to participate in this study were tested for HBsAg, anti-HBs and anti-HBc with radioimmunoassay method (Abbortt Lab. kit). A questionnaire was administered to ask the history of transfusion, acupuncture and surgery. HBsAg positive students were retested 16 months after the initial test. Overall HBsAg positive rate was 6.8% and the age adjusted rate for male (7.2%) was higher than that for female (4.9%). Anti-HBs positive rate was 35.8% (36.1% for male, 37.9% for male) and anti-HBc positive rate was 45.5% (46.5% for male, 44.7% for femaleP. Overall hepatitis B virus (HBV) infection rats was 49.1% and the infection rate for male (50.3%) was slightly higher than that for female (46.5%). HBsAg positive rate and infection rate were increased as the grade increased but it was attributed to the age distribution of the students. HBsAg positive rate for 20 years old students was 1.7%; 21 years, 6.6%; 22 years, 6.1%; 23 years, 12.2%; and 24 years and older, 6.4%. HBV infection rate showed an increasing trend as age increased; 45.8% for 20 years, 41.5% for 21 years, 49.5% for 22 years, 55.5% for 23 years and 59.6% for 24 years and older. The age differences in HBsAg positive rates and HBV infection rates did not reach the statistical significance level of 0.05. However, these findings and similar age differences in HBsAg positive rates and HBV infection rates observed in other study suggest that there is a significant age differences. Study of the same age group in other schools and different social classes is warranted to confirm the age difference. Clarification of the reason for such differences would provide a clue to identify the major route of HBV transmission in this age group. Among 26 HBsAg positive students in the initial test, only one student was active hepatitis patient. Out of 24 students who had follow-up test after 16 months 22 students were positive for HBsAg and two students became HBsAg negative and anti-HBs positive. It is obvious that nearly one-half of the medical school students were infected with HBV before 20 years of age and the HBV infection occurs in medical school. Thus, it is recommended to test all the students for HBV infection soon after the admission to the medical school and immunize all the susceptible students with hepatitis B vaccine and give booster as they start to practice at a hospital.