Botox Therapy for Deep Nasolabial Fold and Bitterness Furrow after Facial Nerve Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Facial sequelae after facial paralysis cause serious functional and aesthetical problems including facial asymmetry, symkinesis and facial crease. The most common aesthetical problem is facial furrow and crease induced by facial hyperkinestic movement due to incomplete facial recovery. The aim of this study is to investigate the efficacy of botulinum toxin A injection in patients with deep nasolabial fold and bitterness furrow after facial paralysis. SUBJECTS AND METHOD: Thirty-five patients who recovered partially from facial paralysis, had deep nasolabial fold and bitterness furrow with or without facial asymmetry. Botulinum toxin A intramuscular injection on perioral area for mouth corner deviation, subcutaneous injection on deepen nasolabial fold, and intramuscular injection on bitterness furrows had improved lower facial symmetry and cosmetic configuration without Pseudo Bell's palsy. RESULTS: Of 26 patients who had facial palsy side nasolabial fold before the injection, 21 patients improved. Of the 21 patients who had facial palsy side bitterness furrow, 16 patients improved after the injection. Of 11 patients who had contralateral nasolabial fold, 4 patients improved after the injection. Of 13 patients who had contralateral bitterness furrow, 7 patients improved after the injection. CONCLUSION: After botulinum toxin A injection, the patients showed marked improvement of nasolabial fold, bitterness furrow and lower facial asymmetry.

The Difference of External Auditory Canal pH in 3 Groups of Otitis Externa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The change of pH in the external auditory canal (EAC) is an important factor in the pathogenesis of otitis externa. However, there is a lack of study focused in this area. Thus, we investigated the differences in the pH in the EAC between several different patient groups of otitis externa and the control group. SUBJECTS AND METHOD: There were 100 patients with otitis externa and 150 normal controls participated in this study. Patients with otitis externa were divided into 3 groups; acute or subacute infective otitis externa, chronic infective otitis externa and chronic allergic otitis externa. The pH of the EAC was measured in otitis externa patients and control subjects on their first visit. RESULTS: The mean EAC pH of the normal control subjects was significantly higher than that of the skin of other parts of the body. The pH difference among the 3 patient groups was statistically significant (the pH of acute or subacute infective otitis externa=6.83+/-0.64; the pH of chronic infective otitis externa=6.16+/-0.67 and the pH of chronic allergic otitis externa=5.78+/-0.59). CONCLUSION: The change in the pH of EAC can be considered as a predisposing factor of otitis externa. We quantified the level of pH at the EAC among three groups of otitis externa patients, and the results showed that the pH difference among the three patient groups was statistically significant. This study warrants a further investigation focusing on the proper choice of eardrops for otitis externa patients according to their pH at the EAC.

Changes in Preventable Death Rates and Traumatic Care Systems in Korea

PURPOSE: This study was performed in order to determine the changes over time in preventable and potentially preventable traumatic death rates, and to assess the factors that affected the deaths of trauma patients which occurred in Korean pre-hospital and hospital settings. METHODS: All trauma deaths occurring either in the emergency department (ED) or after admission at twenty Korean hospitals between August 2009 and July 2010 were retrospectively analyzed. The deaths were initially reviewed by a team of multidisciplinary specialists and classified into non-preventable, potentially preventable, and preventable deaths. Only preventable and potentially preventable deaths were the subject of our analysis. Structured data extraction included patient demographics, vital signs, injury severity, probability of survival, preventability of mortality, reported errors in the evaluation and management of the patient, and classification of error types (system, judgment, knowledge). RESULTS: During the study period, 446 trauma victims died in the ED or within 7 days after admission. The mean age was 52 years, 74.1% were men and the mean time from injury to death was 35.6 hours. The most common cause of death was head injury (44.7%) followed by hemorrhage (30.8%) and multi-organ failure (8.0%). The rates of preventable/potentially preventable deaths were 35.2% overall and 29.8% when limited to patients surviving to admission. Of all death classifications, 31.2% were potentially preventable and 4.0% were preventable. Errors leading to preventable death occurred in the emergency department (51.2%), pre-hospital setting (30.3%) and during inter-hospital transfer (60.8%). Most errors were related to clinical management (48.4%) and structural problems in the emergency medical system (36.5%). CONCLUSION: The preventable death rates for Korean trauma victims were higher than those found in other developed countries, possibly due to poorly established emergency medical systems for trauma victims in pre-hospital and hospital settings. A system wide approach based on the emergency medical system and well-developed in-hospital trauma teams should be adopted in order to improve the quality of care of trauma victims in Korea.

Validation of a Monitoring System for CPR Quality in a Manikin Model

PURPOSE: The 2005 resuscitation guidelines stipulate the need for monitoring CPR (cardiopulmonary resuscitation) quality. Recently, several clinical investigations have shown that a real time monitoring and feedback system is effective for improving the quality of chest compressions during resuscitation. However little data exists regarding the accuracy of the monitoring system using an accelerometer sensor and a pressure sensor for the measuring of compression rate and depth. Our goal for this study was to investigate how well chest compression rate and depth can be estimated using the monitoring system. METHODS: Thirty seconds of continuous chest compressions were delivered on a standard skillmeter manikin lying on the floor with the monitoring system. The chest compressions were delivered with variations in compression rate (67~142 /min) and with variations in compression depth (22~61 mm). A total of 120 sets of compressions were delivered for validation of rate and depth. RESULTS: The correlation coefficient for compression rate between the monitoring system and the standard method was 0.999 (p<0.001), and Bland-Altman analysis showed a mean bias of -0.10+/-0.77/min, with limits of agreement ranging from -1.60 to 1.40 /min. The correlation coefficient for compression depth between two methods was 0.983 (p<0.001), and Bland-Altman analysis showed a mean bias of 4.2+/-2.0 mm, with limits of agreement ranging from 0.24 to 8.10 mm. CONCLUSION: Compared with a skillmeter manikin, a monitoring system for the quality of CPR estimates chest compression rate precisely, but overestimates chest compression depth by an average of 10.3%.

The Effect and Appropriateness of CPR Training in Elementary School Children

PURPOSE: We undertook this study to evaluate the effects and the appropriateness of CPR training for elementary school children. METHODS: The Kangwon National University developed a "Human Body Explorer Program", where local fifth and sixth grade students would learn about the human body. The 72 students who participated in this program were used in this study. The subjects were evaluated by comparing CPR data collected from nurses working at Kangwon National University Hospital. The education sessions consisted of a 30 minute video tape and slides; then, under the supervision of their teacher, the subjects were asked to practice what they had seen. Ten criteria were used to evaluate the subject's CPR proficiency. The CPR skill sessions used Laerdal's HeartSim(R) 4000, and the data stored from the HeartSim(R) 4000 were collected for further analysis. A statistical analysis was done using the SPSS statistical software package. A pvalue< 0.05 was considered to statistically significant. RESULTS: A total of 72 subjects were evaluated. Their average age was 13.2+/-0.5 years. The subjects had very little experience with CPR education(0.17) prior to this study. The data gathered were compared to the evaluation table and yielded an average score of 20.53. The criteria used in the study had the following results: The assessing responsiveness(2.0/2.0), activating the EMS (calling for help) (1.99/2.0), checking for breathing(3.47/4.0), and compression to ventilation ratio of 15:2(1.6/2.0) showed to be at the 80 percentile. However the follow criteria showed a less than 80 percentile: opening the airway(1.54/2.0), mouth-to-mouth breathing(2.04/4.0), checking the carotid pulse(2.0/4.0), chest compression(1.88/4.0), chest compression velocity(1.02/4.0), and reassessment(1.44/2.0). The data from the manikin was extrapolated, and upon examination, we found the following: Correct ventilation was 25+/-31%, insufficient ventilation was 67+/-38% and excessive ventilation was 3+/-10%. Correct chest compression was 9+/-23% and insufficient compression was 91+/-23%, and excessive compression was absent. We compared these scores to the score from nurses of Kangwon University Hospital and found that elementary school children scored higher in all variables except in rate of chest compression. The scores were statistically significant (p<0.05) in total score, check for breathing, and reassessment. The skills evaluation showed that the adults scored higher than the elementary school children. All variables were significant (p<0.05). CONCLUSION: We found that elementary school children were superior to adult counterparts in understanding the CPR scheme. An expansion of CPR training to elementary school children is needed.

A Study of the Investigative Method of Cause of Death for Making out a Death Certificate

PURPOSE: We address investigative or analytical methods to report death in drawing up a death certificate. METHOD: This study was based on the death certificates completed at the emergency department, Kangwon University hospital, from September 2003 to August 2005. The data were collected through notices about drawing up death certificates and included the death certificate and the medical records in the emergency department. RESULTS: The research subjects were 29,059 patients who came to the emergency room during the period of study. Death certificates or medical certificates of death were issued to 793 of these. As to the place of death, 537 (72.5%) deaths occurred at home, 1 (0.1%) in medical institutions, 12 (1.6%) in public institutions, 48 (6.5%) patients was dead on arrival, 2 (0.3%) at industrial factories, 20 (2.7%) on road, 120 (16.2%) at other places and 1 (0.13%) was not defined. As to the types of death, death from disease was the highest (445, 60.1%), and death from external causes was next (168, 22.7%), followed by death from other or unknown causes (128, 17.3%). For death from external causes, traffic accident was 24 (14.1%), poisoning was 13 (7.6%), accidental fall was 18 (10.6%), accidental drowning was 27, 15.9%), suicide was (64, 37.6%), murder was 1 (0.6%), and other was 23 (13.5%). The study on the cause of death, 92 (16.4%) of 562 patients was found to have been helped in diagnosing the cause of death. However, in the case of death from external causes, except for death from disease, 109 patients were surveyed, the study helped to identify the cause of death in only 46 (42.2%). Likewise, in 14 (60.7%) of 23 patients the study helped to identify the cause of death as sudden death. CONCLUSION: Simple X-rays and laboratory examinations were used to determine the cause of death when drawing up a death certificate, and these helped more in identifying the causes of death from external causes than in identifying the causes of death from diseases. Especially, these worked much better for sudden death.

A Study of the Effectiveness of CPR Training to the Personnels of Nursing Department in the Hospital

PURPOSE: We undertook this study to evaluate the pertinence of yearly CPR training for three years in hospital. METHODS: We evaluated 106 participants (79 registered nurses, 17 assistant nurses, 10 medical technicians who were not emergency medical technicians). We performed the education once a year for three years. We used color slides and videos for the lecture. We used a CPR training manikin for training in the CPR skills. For the evaluation, we used a list involving 10 items about understanding the CPR scheme and the CPR training program. We divided the 106 participants based on frequency of training, occupation and career. RESULTS: The mean number of points for understanding the CPR scheme was 17.5 points out of 28. The mean number of points for check for breathing, rescue breathing, pulse check, and chest compression were 2.5, 2.3, 1.7, and 1.7, respectively out of 4 points. In CPR skills, appropriate rescue breathing was 37+/-31%, and appropriate chest compression was 62+/-39%. There were no significant statistical differences based on frequency of CPR training or career. There were significant statistical differences based on occupation. CONCLUSION: Our yearly CPR training in the hospital was not pertinent in improving the ability to perform CPR. Different CPR training methods are needed for different occupation. We think that further study are needed to develope effective CPR training methods and to identify the appropriate re-training interval.

Clinical Investigation of an Acute Allergic Reaction in a Patient Admitted to the Emergency Department of a College Hospital in a Small City

PURPOSE: Emergency department visits for acute allergic reactions are common. However, relatively little is known about the characteristics of patients who visit the emergency department for such reactions. We undertook this study to evaluate the frequency, the cause, the severity, the treatment and the prognosis of patients admitted for allergic reactions to a college hospital in a city. METHODS: We studied 724 patients visiting two emergency departments of college hospitals during the years 2002-2003. Clinical symptoms involved pruritus, dyspnea, hoarseness, nausea, vomiting, abdominal pain, diarrhea, dizziness, and seizure. Physical examinations involved vital signs, urticaria, rash, local edema, angioedema, rhinitis/conjunctivitis, wheezing, stridor, cyanosis, and laryngeal edema. We divided the causative agents into drugs, insects, foods, and others. We classified the treatments of the allergic reaction as antihistamines, corticosteroids, epinephrine, oxygen, and hydration. We divided patients into mild, moderate, and severe acute hypersensitivity groups. RESULTS: In order of frequency, clinical symptoms were pruritus (88.1%), urticaria (72.4%), rash (68.9%), local edema (11.7%), etc. The causative agents were foods (53.0%), unknown origin (29.1%), insects (11.0%), and drugs (6.8%). Antihistamine, corticosteroid, epinephrine were injected in 93.4%, 89.1%, 2.3% of the patients, respectively. The mild, moderate, and severe groups were 87%, 9.8%, and 3.2% of the patients, respectively. CONCLUSION: For patients with allergic symptoms visiting to the university-affiliated teaching hospitals in a small city, foods were the major causative agent, but drugs and insects provoked more severe allergic reactions.

Rhabdomyolysis after SCUBA Diving: A Case Report

Recently, self-contained underwater breathing apparatus (SCUBA) diving's popularity has been increasing tremendously. Most diving injuries are related to the behavior of the gas and to pressure changes during descent and ascent. A scuba diver at depths greater than 7 m may accumulate a tissue partial presure of nitrogen large enough that, on ascent to the surface, nitrogen exist the tissues rapidly, forming bubbles in the blood and other organs, which is known as decompression sickness (DCS). Although both of these bubble disorders can, in theory, cause injury to skeletal muscles (rhabdomyolysis), the case are report here demonstrates the potential for massive muscle necrosis after scuba diving. We report a case of rhabdomyolysis presented with general weakness after scuba diving.