Is the Modified AIMS65 Score Suitable for Distinguishing the Low Risk Group and the High Risk Group for Patients with Upper Gastrointestinal Bleeding?

PURPOSE: The goal of this study was to increase the performance of the AIMS65 score in the prediction of outcomes in upper gastrointestinal bleeding by modifying the AIMS65 score. METHODS: Data were collected retrospectively between January 2015 and June 2015. A total of 212 adult patients, who visited the emergency department with an upper gastrointestinal hemorrhage during this period were included for analysis. High risk patients were defined as follows: those who needed an endoscopic or surgical hemostasis, suffered rebleeding, hospitalized in an intensive care unit, and those who were deceased within 30 days or required a blood transfusion. The seven parameters of the modified AIMS65 score were as follows: Albumin levels, international normalized ratio (prothrombin time), altered mental status, systolic blood pressure, age>65 years, hemoglobin levels, and heart rate. RESULTS: The high-risk group was comprised of 163 patients, while the low risk group was comprised of 49 patients. The areas under the curve for AIMS65 and modified AIMS65 scores were 0.727 (95% confidence interval, 0.662-0.786) and 0.847 (95% confidence interval, 0.791-0.892), respectively, which were significantly different (p<0.001). The AIMS65 score had a sensitivity of 53.0% and a specificity of 78.5% at a score of 0. The modified AIMS65 score had a sensitivity of 22.4% and a specificity of 99.3% at a score of 0. For the modified AIMS65 score of 3 or lower, the sensitivity was 97.9% with a specificity of 21.4%. CONCLUSION: The modified AIMS65 score was effective in distinguishing between the low-risk group and the high-risk group among patients with upper gastrointestinal bleeding.

Risk Factors of Post-Operative Recidivism in Congenital Cholesteatoma of the Middle Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There is no general consensus on the risk factors affecting the recurrence or residual disease (recidivism) after surgery of congenital cholesteatoma of the middle ear. In this study, we analyzed clinical characteristics of recidivistic cases after the surgery and compared those of non-recurrent cases to investigate the risk factors regarding the post-operative recidivism of the disease. SUBJECTS AND METHOD: Data were collected from retrospective chart reviews and computerized database of patients who have underwent surgeries at Kangdong and Hallym University Sacred Heart Hospital during the last 24 years. All surgeries, consisting of 95 primary cases and 24 revision cases, were performed by the same surgeon. RESULTS: Recurrence was detected in 24 cases of the 95 patients (including 4 cases, of which primary surgeries were done at other hospitals). Among the risk factors affecting post-operative recidivism such as sex, age, symptom, disease duration, type of cholesteatoma, mastoid pneumatization, ossicle status, and stage of disease, factors of longer symptom duration, poor mastoid pneumatization, older age, poor mastoid pneumatization, advanced or recurrent cholesteatoma were significantly related to the recidivism of disease. CONCLUSION: Longer symptom duration, poor mastoid pneumatization, and advanced or recurrent cholesteatoma were revealed as high risk factors for post-operative recidivism in this study.

Comparisons of Three Indicators for Frey's Syndrome: Subjective Symptoms, Minor's Starch Iodine Test, and Infrared Thermography

OBJECTIVES: To correlate Frey's syndrome with subjective symptoms, Minor's starch iodine test results, and infrared thermography measurements, and to discuss the utility of thermography as a quantitative diagnostic method. METHODS: This study included 59 patients who underwent unilateral parotidectomy. A subjective clinical questionnaire and an objective Minor's starch iodine test were performed to evaluate the incidence of Frey's syndrome. Infrared thermography was performed, and the subjects were divided into seven groups according to the temperature differences between operated and unoperated sites. The thermal differences were correlated with the results from Minor's starch iodine test and the subjective symptoms questionnaire. RESULTS: Of the 59 patients, 20 patients (33.9%) reported subjective symptoms after eating; 30 patients (50.8%) tested positive for Minor's starch iodine test, 19 patients (63.3%) of which reported subjective symptoms. Of the 29 patients who were negative for the iodine test, 2 patients (6.9%) reported subjective symptoms. Thus, subjective symptoms were well correlated with Minor's starch iodine test (r=0.589, P<0.001). As the thermal differences with infrared thermography increased, the number of patients with subjective symptoms increased (chi2=22.5, P<0.001). Using infrared thermography, the mean temperature difference in the positive group for the iodine test was 0.82degrees C+/-0.26degrees C, and that in the negative group was 0.10degrees C+/-0.47degrees C. With increased thermal differences, more patients showed positivity in the iodine test (chi2=29.9, P<0.001). CONCLUSION: Subjective symptoms, Minor's starch iodine test, and infrared thermography are well correlated with one another. Quantitative thermography provides clues for the wide variation in the incidence of Frey's syndrome, and could be a useful method for diagnosing and studying Frey's syndrome.