Managerial Strategy for the Transportation and Transfusion Period for the Blood Components at Hospitals: An Opinion / 대한수혈학회지

For a safe and efficient blood transfusion, the transportation period of blood components from the blood bank to the patient and the transfusion period of blood components should be under control. Based on the ‘30-minute rule’ and the guidelines of other countries, the author presents a managerial strategy for blood components not permitted to be returned to the blood bank because of exposure to uncontrolled temperatures for more than 30 minutes. Moreover, the transfusion period specified for each blood component is suggested as additional managerial indicators through the recommended transfusion period presented in the revised transfusion guidelines.

Can a Two Simple Stitches Method Provide Secure Fixation Strength in Biceps Tenodesis?:Biomechanical Evaluation of Various Suture Techniques

Background@#The purpose of this study was to compare the initial fixation strength between four different suture methods for the long head of the biceps. @*Methods@#Forty-eight fresh frozen porcine flexor hallucis longus tendons (mean width at suture site, 8.5 ± 0.9 mm) and phalanx bones were randomly assigned to one of the four arthroscopic biceps tenodesis techniques: simple stitch (SS), mattress suture (MS), lasso-loop (LL), and two simple stitches (2SS). A biceps tenodesis was performed according to the four techniques using all-suture type suture anchors (1.9-mm SUTUREFIX anchor with No. 1 ULTRABRAID sutures). Biomechanical evaluations were performed to test load to failure (N), stiffness (N/mm), stress (N/m 2 ), and mode of failure. @*Results@#As for the SS, MS, LL, and 2SS, the mean load to failure was 50.9 ± 14.61 N, 82.3 ± 24.8 N, 116.2 ± 26.7 N, and 130.8 ± 22.5 N (p < 0.001), respectively; mean stiffness was 6.1 ± 1.3 N/mm, 6.7 ± 2.6 N/mm, 7.8 ± 1.4 N/mm, and 8.1 ± 4.2 N/mm, respectively (p = 0.258); and mean stress was 0.7 ± 0.3 N/m 2 , 1.4 ± 0.8 N/m 2 , 2.9 ± 0.7 N/m 2 , and 2.7 ± 0.8 N/m 2 , respectively (p < 0.001). All the failures happened by the suture cutting through the tendon along its longitudinal fibers. @*Conclusions@#Neither the SS nor the MS method was enough to securely fix the biceps tendon with a significantly lower mechanical strength; however, the 2SS method showed similar initial fixation strength as the LL technique.

Metastasis of renal cell carcinoma around suture anchor implants

We present an unusual case of bone metastases from renal cell carcinoma around orthopedic implants in a 78-year-old female with osteolytic, expansile, highly vascularized, malignant infiltration around suture anchors in the proximal humerus. The patient had undergone arthroscopic rotator cuff repair using suture anchor implants 6 years previously. After diagnosis of bone metastasis, she was successfully treated with metastasectomy and internal fixation using a plate and screws, with cement augmentation. This report is the first to document metastases around a suture anchor in a bone and suggests the vulnerability of suture anchor implants to tumor metastasis.

Metastasis of renal cell carcinoma around suture anchor implants

We present an unusual case of bone metastases from renal cell carcinoma around orthopedic implants in a 78-year-old female with osteolytic, expansile, highly vascularized, malignant infiltration around suture anchors in the proximal humerus. The patient had undergone arthroscopic rotator cuff repair using suture anchor implants 6 years previously. After diagnosis of bone metastasis, she was successfully treated with metastasectomy and internal fixation using a plate and screws, with cement augmentation. This report is the first to document metastases around a suture anchor in a bone and suggests the vulnerability of suture anchor implants to tumor metastasis.

The Effect of the Transfusion Indication Verification Program on the Appropriateness of Fresh Frozen Plasma Transfusion / 대한수혈학회지

Background@#Fresh frozen plasma (FFP) has been inappropriately using in spite of limited transfusion indications. Our institution applied the transfusion indication data-entry to a computerized order system in February 2018. Physicians should select the indication during transfusion order. In January 2019, the warning pop-up additionally applied for informing whether or not the coagulation test results correspond to FFP transfusion indications. We investigated the effects of a new applied program on the appropriateness of FFP transfusion. @*Methods@#By comparing the appropriateness of transfusion before applying the transfusion indication data-entry, we investigated whether there were improvements of appropriateness after applying the transfusion indication data-entry and after applying the warning pop-up. We compared the percentages of performing pre-transfusion coagulation tests and transfusion among FFP requests before and after applying the warning pop-up. @*Results@#After applying the transfusion indication data-entry, the appropriateness improved from 54.5% to 66.7%. The appropriateness of the surgery department was the lowest compared with that of the medical departments and emergency departments. The warning pop-up would be effective to induce pre-transfusion coagulation tests from surgery departments and emergency department. However, there was no further improvement in the appropriateness. Many requests from the surgery departments did not lead to transfusion. As the results of the analysis conducted by dividing each department that belonged to surgery departments, we could determine the wrong transfusion practice specific to each department. @*Conclusion@#The transfusion indication data-entry contributed to improving the appropriateness of FFP transfusion. Department-specific education and real-time auditing are needed for further improvement.

Effects of the new diagnosis-related group-based payment system and the increased incentive policy rates on the utilization rate of diagnostic laboratory test in Korea

A new diagnosis-related group (DRG) based payment system has been implemented in most public hospitals in Korea. We investigated the effects of the new DRG system and its incentive policy on the utilization rate of diagnostic laboratory tests. Three groups were categorized; 36 hospitals under the new DRG system (participant group), 72 hospitals (control-1) matching with 36 participants according to the number of beds, and 42 tertiary hospitals (control-2). The patients of acute myocardial infarction, cerebral infarction, type 2 diabetes mellitus, and gonarthrosis receiving total arthroplasty were included. We analyzed the mean length of stay and the number of diagnostic laboratory tests conducted during hospitalization of the three groups according to the new DRG system and the incentive policy rates under the new DRG system. Before participating in the new DRG system, the number of diagnostic laboratory tests in the participant group was less than that in the two control groups for all four diseases. However, although the participant group’s length of stay decreased under the new DRG system, the number of diagnostic laboratory tests increased as the maximum incentive policy rate increased. The increment of the number of diagnostic laboratory tests was prominent in the period of a maximum of 35% incentive policy rates. Finally, the number of diagnostic laboratory tests of the participant group was similar to or exceeded that of the control-2 group. The new DRG system’s incentive policy rates played a driving force on the increased utilization rate of the diagnostic laboratory test. For preparing in advance for the change in incentive policy rates, monitoring and guidelines for the utilization of diagnostic laboratory tests are necessary.

Mixed Infection with Plasmodium falciparum and Plasmodium ovale in a Returned Traveller: the First Case in Korea

Mixed-species malaria infections are often unrecognized or underestimated. We hereby report the first described case of mixed infection with Plasmodium falciparum and Plasmodium ovale malaria in a returned traveller in Korea. In August 2016, a 25-year-old returned traveller from Cameroon and Democratic Republic of Congo presented with fever. He was diagnosed as P. falciparum malaria and successfully treated with artesunate. And 5 weeks after the completion of treatment, he presented with fever and diagnosed as P. ovale infection. P. ovale infection is a rare cause of malaria and often shows delayed presentation due to its dormant liver stage as hypnozoites. At re-presentation, the immunochromatographic test and microscopic examinations of our patient did not reveal P. ovale, which was only detected via polymerase chain reaction (PCR) assay. This case highlights the importance of considering malaria infection even in persons who have previously received malaria treatment. It also shows the usefulness of PCR testing for diagnosing P. ovale infections, which often present with a low level of parasitaemia.

Temporal augmentation with calvarial onlay graft during pterional craniotomy for prevention of temporal hollowing

BACKGROUND: Atrophy of muscle and fat often contributes to temporal hollowing after pterional craniotomy. However, the main cause is from the bony defect. Several methods to prevent temporal hollowing have been introduced, all with specific limitations. Autologous bone grafts are most ideal for cranial defect reconstruction. The authors investigated the effectiveness of bony defect coverage and temporal augmentation using pterional craniotomy bone flap. METHODS: This study was conducted in 100 patients who underwent brain tumor excision through pterional approach from 2015 to 2016. Group 1 underwent pterional craniotomy with temporal augmentation and group 2 without temporal augmentation. In group 1, after splitting the calvarial bone at the diploic space, the inner table was used for covering the bone defect and as an onlay graft for temporal augmentation. The outcome is evaluated by computed tomography at 1-year follow-up. RESULTS: The mean operative time for temporal augmentation was 45 minutes. The mean follow-up was 12 months. The ratio of temporal thickness of operated side to non-operated side was 0.99 in group 1 and 0.44 in group 2, which was statistically different. The mean visual analogue scale score was 1.77 in group 1 and 6.85 in group 2. CONCLUSION: This study demonstrated a surgical technique using autologous bone graft for successfully preventing the temporal hollowing and improved patient satisfaction.

Perception of Patient Safety Risk Factors and Performance Level of Safety Care Activities among Hospital Nurses / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify the level of perception of safety risk factors and the degree of performance of safety nursing activities in order to develop an education program to improve the safety of patients. METHODS: The subjects were 217 nurses from 3 university hospitals in Incheon. Data were collected with structured questionnaires and analyzed using descriptive analysis, t-test, and ANOVA using SPSS 22.0. RESULTS: The level of perception of patient's safety risk factors and safety care activities was 2.93 and 4.68, respectively. Perception of patient safety risk factors which belonging to the risk type of therapeutic devices, equipment, service and infrastructure all scored below average; also in addition, behavior, performance, and violence risk type and work system, information and communication risk type showed relatively low perception levels. Safety nursing activities showed a low level of performance in accurate communication among medical teams, management of fire and disaster, security management, use of restraints, identification of patients, and correct performance of operations and procedures. CONCLUSION: Based on these results, it is necessary to improve the safety of patients by taking proper management measures along with education.

Optimizing Outcomes in the Reconstruction of Postburn Scar Hand Deformities

PURPOSE: Reconstruction of severe postburn hand deformities with flexion or extension contractures with finger webbing deformities, large hypertrophic scars of dorsal hand are frequently encountered problems in burn hand surgery. To obtain the good results after correction of various type of postburn scar hand deformities, we have used the sophisticated reconstructive procedures such as scar contracture release, skin graft, and use of acellular dermal matrix (ADM). We report reliability and usefulness of these novel updated procedures according the type of postburn hand deformities, and reviewed the literatures. METHODS: We had 82 postburn hand deformities. Among them we selected 7 patients of severe postburn hand deformities, which had different affected sites involving over 1/3 of hand. To reconstruct the finger flexion contractures, the scar contracture release and full thickness skin graft was most frequently performed. For correction of finger webbing deformities, the 5 flap Z-plasty for 1(st) web, dorsal and volar interposition flap for 2, 3 and 4 web, FTSG were used. The diffuse hypertrophic scar of dorsum of hand was reconstructed with total excision of scars, skin coverage with one piece of medium thickness STSG, and postoperative clenched hand position. The postburn palmar contractures was reconstructed with extensive contracture release followed by resurfacing with ADM (AlloDerm™) and thin STSG. The severe postburn abduction contractures of wrist was treated by total excision of scars, ADM (CGDerm™), and thin STSG. RESULTS: After 1 month to 1.6 years follow up, relatively satisfactory results were obtained in all patients. As complications, 1 case of recurrent palmar contractures, which was reconstructed with ADM (AlloDerm™) with thin STSG, were noticed. CONCLUSION: The postburn finger flexion contractures could be managed by the scar contractures release and FTSG. This method is very safe and reliable. For reconstruction of postburn finger webbing deformities, it is mandatory to use 5-flap Z-plasty for 1(st) webbing deformities, and dorsal and volar interposition flap for 2, 3 and 4(th) webbing deformities concomitantly with resurfacing with FTSG. The diffuse hypertrophic scars of dorsum of hand was managed by total excision of scars, resurfacing with one large piece of over medium thickness STSG, and postoperative clenched hand position. After release of scar contractures of hand, acellular dermal matrix (ADM) with thin STSG can be used in case of deficient FTSG donor site.

Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation

BACKGROUND AND OBJECTIVES: Combination antiplatelet therapy reduces the risk of ischemic stroke compared with aspirin monotherapy in non-valvular atrial fibrillation (NVAF) patients. The underlying mechanism, however, remains unclear. In addition, the association between platelet inhibition and thrombogenicity in NVAF has not been evaluated. SUBJECTS AND METHODS: We randomized 60 patients with NVAF that were taking 100 mg of aspirin daily (>1 month) to adding 75 mg of clopidogrel daily (CLPD group), 100 mg of cilostazol twice daily (CILO group), or 1000 mg of omega-3 polyunsaturated fatty acid twice daily (PUFA group). Biomarkers (von Willebrand factor antigen [vWF:Ag], fibrinogen, D-dimer, and high-sensitivity C-reactive protein [hs-CRP]) and platelet reactivity (PR), which were the levels stimulated by adenosine diphosphate (ADP), thrombin-receptor agonist peptide, collagen, and arachidonic acid, were measured at baseline and 30-day follow-up. RESULTS: Combination antiplatelet therapy significantly reduced vWF:Ag and fibrinogen levels (7.7 IU/dL, p=0.015 and 15.7 mg/dL, p=0.005, respectively), but no changes were found in D-dimer and hs-CRP levels. The CLPD and CILO groups showed fibrinogen and vWF:Ag level reductions (24.9 mg/dL, p=0.015 and 9.3 IU/dL, p=0.044, respectively), whereas the PUFA group did not show any differences in biomarkers. Irrespective of regimen, the changes in fibrinogen and vWF:Ag levels were mainly associated with the change in ADP-mediated PR (r=0.339, p=0.008 and r=0.322, p=0.012, respectively). CONCLUSION: In patients with NVAF, combination antiplatelet therapy showed reductions for vWF:Ag and fibrinogen levels, which may be associated with the inhibitory levels of ADP-mediated PR. The clinical implications of these findings need to be evaluated in future trials.

Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases

As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.

Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases

As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.

Myxoid Solitary Fibrous Tumor on the Scalp

Myxoid solitary fibrous tumor (SFT) is very rare soft tissue neoplasm. It is microscopically composed of spindle cells which is individually separated by delicate band of collagen fibers. And this tumor cells are immunohisto-chemistrically highlighted by CD34. Myxoid SFT has indolent clinical course and a good prognosis, so it is important to make a diagnosis because of its morphological similarities to myxoid spindle cell neoplasms that have different prognoses and treatment. We report the case of a 20-year-old female with a myxoid SFT found in the left temporo-parietal scalp. This case report appears to be the first reported scalp occurrence of this rare tumor.

A Rare Case of Intra-Areolar Polythelia

Among various types of supernumerary nipples, intra-areolar polythelia (IAP) is an extremely rare congenital malformation. The authors report a case of a young woman with unilateral IAP on her right breast. The patient was 24 years old; she had had it since she was 5 or 6 years old, and it had enlarged 3 to 4 years before presentation to our clinic. Surgical excision was performed under local anesthesia as a prophylaxis against breast cancer and cosmetic problems.

Reference Intervals of Hematology and Clinical Chemistry Analytes for 1-Year-Old Korean Children

BACKGROUND: Reference intervals need to be established according to age. We established reference intervals of hematology and chemistry from community-based healthy 1-yr-old children and analyzed their iron status according to the feeding methods during the first six months after birth. METHODS: A total of 887 children who received a medical check-up between 2010 and 2014 at Boramae Hospital (Seoul, Korea) were enrolled. A total of 534 children (247 boys and 287 girls) were enrolled as reference individuals after the exclusion of data obtained from children with suspected iron deficiency. Hematology and clinical chemistry analytes were measured, and the reference value of each analyte was estimated by using parametric (mean±2 SD) or nonparametric methods (2.5-97.5th percentile). Iron, total iron-binding capacity, and ferritin were measured, and transferrin saturation was calculated. RESULTS: As there were no differences in the mean values between boys and girls, we established the reference intervals for 1-yr-old children regardless of sex. The analysis of serum iron status according to feeding methods during the first six months revealed higher iron, ferritin, and transferrin saturation levels in children exclusively or mainly fed formula than in children exclusively or mainly fed breast milk. CONCLUSIONS: We established reference intervals of hematology and clinical chemistry analytes from community-based healthy children at one year of age. These reference intervals will be useful for interpreting results of medical check-ups at one year of age.

Fingertip Reconstruction with Perionychial Flaps

PURPOSE: Out of nail components, nail plate, nail fold, paronychium, hyponychium, nail bed, and matrices are referred to as the perionychium. The authors report the outcomes of perionychial flap for reconstruction of fingertip injuries with nail bed injuries. METHODS: We performed 8 cases of perionychial flap for fingertip injuries with nail bed injuries between January 2012 and December 2015, and analyzed the outcomes of the reconstruction surgery. The patients evaluated the aesthetic results on a four-point scale, and we measured and evaluated the ratio of axis length of the nail plate compared with collateral side of normal nail plate. RESULTS: The mean follow up period was 8.4 months, and range of motion of distal interphalangeal joints and sensation of the reconstructed pulp were normal in all patients. After reconstructive surgery the nail plates regrew up to 80% in average compared to the normal side, and the satisfactory score were good to excellent as 3.8 point in average. CONCLUSION: The reconstruction of fingertip injuries with nail bed injuries using perionychial flap including paronychium and hyponychium is safe and easy procedure and aesthetic outcomes were excellent. The authors consider the perionychial flap as a useful technique for fingertip reconstruction.

Pregnancy Outcomes in Women with Moyamoya Disease: Experiences at a Single Center in Korea

PURPOSE: Moyamoya disease (MMD) occurs predominantly in Korean and Japanese women. The aim of this study was to investigate clinical features and pregnancy outcomes in women with MMD. MATERIALS AND METHODS: We conducted a retrospective chart review of women with MMD who visited our Department of Obstetrics and Gynecology between January 2005 and October 2013. For all study subjects, clinical features, demographic characteristics, and perinatal outcomes were recorded. RESULTS: We identified 28 pregnancies in 22 patients who had been diagnosed with MMD. The mean maternal age at delivery was 31.9+/-3.5 years old. The mean gestational age at delivery was 38.0+/-0.9 weeks. Among the 28 pregnancies, 25 (92.5%) underwent cesarean section; 19 (76.0%) of them were performed under regional anesthesia and six (24.0%) under general anesthesia. The mean newborn weight was 3233.7+/-348.2 g. The 5-minute Apgar score in 85% of the newborns was higher than 8, with no other apparent complications. During the puerperal period, transient ischemic attack symptom or seizure occurred in 4 cases, although patients recovered within a few days. CONCLUSION: For pregnant women with MMD, it is important to control blood pressure and prevent hyperventilation during the intrapartum period, and the best methods of delivery and anesthesia should be considered to avoid unfavorable sequelae. Additionally, a multidisciplinary approach (i.e., neurosurgery) is necessary to constantly manage underlying diseases.

Epidemiology of Burns in Korea from 2010 to 2014

PURPOSE: The epidemiology of burns in Korea has been sporadically reported in the treatis based on data from one burn center or hospital. The nationwide epidemiological study for burns in the Korea is scarce. It is necessary to establish the national medical plan for providing the specialized burn care for burn victims, burn prevention and burn safety for publics. METHODS: This study is done based on the burn patients data receiving medical treatment, from the Korea National Health Insurance Service during 2010~2014. We reviewed the following issues; the average annual burn incidence, and tendency of burn occurrence in every year, sex distribution of burn patients, the yearly numbers of pediatric burn patients, incidence of specific-age pediatric burn patients, incidence of burns by specific-age group, and prevalent sites of burns. RESULTS: 1) The average annual burn patient is 545,462 in 2010~2014. The average annual incidence of burn patients per 100,000 population is 1,091. The total annual numbers of burn patient is gradually increasing in tendency. 2) Male and female sex ratio is 39 (the mean 214,832 male burn patients per year): 61 (the mean 330,630 female burn patients per year). 3) The average pediatric burn patient (1~15 age) is 123,934 and it consists of 22.7% of the average annual burn patients during 2010~2014. 4) The most prevalent age of pediatric burns revealed at the age of 1 (21.7%). The incidence of burn patients of 1~2 age occupy 38.4% of the total pediatric burn patients. 5) The four age group-specific burn incidence are classified as pediatric group (0~15 age) 22.7% (123,934 patients), adolescence-middle age group (16~39 age) 32.3% (176,288 patients), middle-old age group (40~74 age) 41.9% (228,427 patients), super old age group (over 75) 3.1% (16,813 patients). 6) The mean yearly burn sites was 567,200. Among them, the most prevalent site of burn was hand (32.8%), and followed by upper extremities (13.5%), lower extremities (13.4%), face (10.5%), foot (10.1%), trunk (6.6%). the unspecified area and etc (13%), respiratory tract (0.1%). CONCLUSION: Based on the data from the Korea National Health Insurance Service, the average annual burn incidence is mean 545,462 burn patients during 2010~2014 in Korea, and revealed increasing in tendency. This epidemiological data can be attribute to providing the specialized burn care to domestic burn victims, and to establish the plans for burn prediction and prevention, and burn safety.

Relationship between Food Behavior and Level of Attention Deficit Hyperactivity Disorder in Elementary School Students in Suwon-si, Korea

The purpose of this study was to investigate the correlation between food behavior and Attention Deficit Hyperactivity Disorder (ADHD) score in elementary students in Suwon-si, Gyeonggi-do. Two hundreds and thirty two students (113 male and 119 female) in grades 4~6 participated. We assessed food behavior by using Nutrition Quotient (NQ). NQ was examined by an NQ questionnaire, which consisted of 19 food behavior checklist items. Their items were grouped into five categories: balance, diversity, moderation, regularity, and practice. All data were statistically analyzed by SPSS 18.0. Among the five factors, NQ for food behavior and balance factor showed the lowest score, whereas that of diversity factor showed the highest score. The final Nutrition Quotient (NQ) score weighted on such five factors was 62.59 points. The average level of ADHD by Conners-Wells Adolescent Self-Report Scale (Short Form) [CASS(S)] was 17.02 points out of a total of 81 points. Six students (2.2%) who scored more than 41 points were classified as ADHD risk. By gender, male students (19.76 points) showed a higher CASS(S) score than female students (14.41 points) did. There was a significant negative correlation between NQ and CASS(S) score (r=-0.445, P<0.001). Multiple regression determined the effects of moderation (Exp(beta)=-0.193, P<0.01) and practice (Exp(beta)=-0.345, P<0.001) on CASS(S) score. In conclusion, distinctive nutritional education is needed for students with a high level of ADHD to help their understanding considering their different levels of attention.