The need for a relaparotomy shortly after an initial abdominal operation indicates a serious complication and may frequently constitute a surgical failure. Many of the postoperative symptoms that might indicate the onset of complications may be masked by the usual postoperative course. Reported findings vary widely. Thus there is no clear picture for a surgeon to use as a guide. In an attempt to obtain more definite guidelines regarding the indications for and the timing of reintervention a retrospective study based on a 7-year survey was undertaken to assess the problem of reoperation after abdominal surgery. This study consisted of a retrospective clinical analysis made an 95 patients who required reoperation due to postoperative complications and planned stage operations during 7 years from January 1990 to December 1996. The number of reoperations was 95 cases (24%) among 3932 patients who had undergone abdominal operations at our department. The sex distribution for the reoperations was 58 males and 37 cases in females. The peak age incidence was the 6th decade in 25 cases(26.3%). The most common physical findings of the patient who required reoperations were abdominal pain and tenderness (56.8%). The main cause necessitating reoperation was intestinal obstruction (25.3%). The most common types of reoperations were common bile duct exploration with T-tube insertion(24.2%). The time interval between initial operation and reoperation was within 10 days in 10 cases (10.5%) and 25 months grouped in separate admission in 36 cases (37.9%). The most frequent complication was wound infection(15.8%) and the mortality rate was 4 cases (4.2%). Conservative treatment cannot be recommended for severe complications, such as postoperative bleeding or peritonitis, due to free anastomotic leakage. However, in doubtful cases, when there is mild peritonitis of an undetermined origin, ileus, well-controlled billiary or duodenal leaks, and the like, the high mortality associated with reintervention should be borne in mind. In these cases, conservative treatment with close supervision of the patient may prove the most prudent course.
Abdomen ; Abdominal Pain ; Anastomotic Leak ; Common Bile Duct ; Female ; Hemorrhage ; Humans ; Ileus ; Incidence ; Intestinal Obstruction ; Male ; Masks ; Mortality ; Organization and Administration ; Peritonitis ; Postoperative Complications ; Reoperation* ; Retrospective Studies ; Sex Distribution ; Wounds and Injuries

Objectives: This study investigated causative strains and their antibiotic sensitivity in patients who were hospitalized for maxillofacial odontogenic infections at a tertiary center in South Korea over the past 10 years with the aim of providing guidelines for the selection of appropriate empirical antibiotics. Materials and Methods: Patients with head and neck fascial space abscesses due to odontogenic infections who underwent incision and drainage surgery with pus culture tests between 2013 and 2022 at the Department of Oral and Maxillofacial Surgery, Dankook University Hospital were included. The bacterial isolates and antibiotic sensitivity of each strain were analyzed for 2013-2022, 2013-2017, and 2018-2022. The affected fascial spaces were classified into primary, secondary, and deep neck spaces. Results: In the 192 patients included in this study, 302 strains were detected. Viridans streptococcus had the highest frequency (51.7%), followed by Prevotella spp. (16.9%), Staphylococcus spp. (5.6%), and Klebsiella pneumoniae (4.6%). The identification rate of viridans streptococcus significantly increased from 41.8% in 2013-2017 to 60.9% in 2018-2022. Viridans streptococcus showed an antibiotic sensitivity of 80.5% to ampicillin; the sensitivity to penicillin antibiotics decreased over the study period. Antibiotic susceptibility was approximately 94% for third-generation cephalosporins.K. pneumoniae, which was identified at a high percentage in patients with deep neck space infection, showed increasing antibiotic resistance to most antibiotics over the study period. Conclusion Viridans streptococcus was identified in head and neck fascial space abscesses with the highest frequency. Empirical antibiotics should be effective against this strain; penicillin antibiotics are considered inappropriate. For effective treatment of deep neck space abscesses, bacterial culture and antibiotic sensitivity tests performed as soon as possible are essential.

Kostmann's disease is a rare hematologic disease entity which is characterized by persistent neutropenia and recurrent bacterial infections since early in infancy. The authors experienced a 2-month-old female infant with disseminated bacterial skin infection since 3 weeks of age and persistent neutropenia. Diagnosis was made by neutropenia in the peripheral blood, maturation arrest of myeloid hemopoiesis at myelocyte stage in the finding of bone marrow aspiration and improving response of neutropenia with G-CSF administration. She had experienced 4 episodes of sepsis and one episode of acute otitis externa during follow-up until 14 months of age.
Bacterial Infections ; Bone Marrow ; Bone Marrow Transplantation ; Diagnosis ; Female ; Follow-Up Studies ; Granulocyte Colony-Stimulating Factor ; Granulocyte Precursor Cells ; Hematologic Diseases ; Humans ; Infant ; Neutropenia ; Otitis Externa ; Sepsis ; Skin

Helicobacter pylori (H. pylori) commonly infects humans worldwide. However, only limited proportions of infected populations develop clinical manifestations ranging from asymptomatic gastritis to gastric cancer. A Korean nationwide survey revealed that the overall H. pylori seroprevalence was 66.9% in 1998, and significantly decreased in later years in all age groups to 59.6% in 2005 and 54.4% in 2011. In terms of geographical regions, the seroprevalence trended significantly downward in most areas over time, except in Kyungsang and Kangwon. The various outcomes of H. pylori infection are caused by imbalances between bacterial virulence factors, host factors including genetic diversity, and environmental influences. H. pylori infection triggers responses by almost all forms of innate and acquired immunity. In the present review, we describe the epidemiology and pathophysiology of H. pylori infection in Korea. A better understanding of the prevalence trend and the mechanisms of immune responses to H. pylori infection will allow public health authorities to develop novel therapeutic strategies.
Adaptive Immunity ; Epidemiology* ; Gangwon-do ; Gastritis ; Genetic Variation ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea* ; Prevalence ; Public Health ; Seroepidemiologic Studies ; Stomach Neoplasms ; Virulence Factors

The diagnostic possibility and the incidence of ectopic pregnancy are increasing due to several factor. Furthermore, radioimmunoassay of serum β-HCG and US make it possible to diagnose early before the tubal rupture. A conventional surgical approach has been considered as a choice of treatments. Until recent years, however, surgery may have considerable risk of infertility and sugical hazard. In view of the natural tendency of some ectopic pregnancies to terminate in tubal abortion or complete resorption, we tried to cure ectopic pregnancy with nonsurgical transcervical intervention. Five of 8 patients with unruptured tubal pregnancies, it was possible to inject PGF2a into the tubes or gestational sac. 4 of them were ended up with satisfactory reduction of serum β-HCG level and improvement of symptoms & signs. In only one patient, β-HCG level remained a high level continuously, so salpingectomy was done. As a result, we consider that fluoroscopy-guided transcervical interventional procedure is a useful treatment modality for early unruptured ectopic pregnancy.
Abortion, Spontaneous ; Female ; Gestational Sac ; Humans ; Incidence ; Infertility ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Radioimmunoassay ; Rupture ; Salpingectomy

The diagnostic possibility and the incidence of ectopic pregnancy are increasing due to several factor. Furthermore, radioimmunoassay of serum β-HCG and US make it possible to diagnose early before the tubal rupture. A conventional surgical approach has been considered as a choice of treatments. Until recent years, however, surgery may have considerable risk of infertility and sugical hazard. In view of the natural tendency of some ectopic pregnancies to terminate in tubal abortion or complete resorption, we tried to cure ectopic pregnancy with nonsurgical transcervical intervention. Five of 8 patients with unruptured tubal pregnancies, it was possible to inject PGF2a into the tubes or gestational sac. 4 of them were ended up with satisfactory reduction of serum β-HCG level and improvement of symptoms & signs. In only one patient, β-HCG level remained a high level continuously, so salpingectomy was done. As a result, we consider that fluoroscopy-guided transcervical interventional procedure is a useful treatment modality for early unruptured ectopic pregnancy.
Abortion, Spontaneous ; Female ; Gestational Sac ; Humans ; Incidence ; Infertility ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Radioimmunoassay ; Rupture ; Salpingectomy

BACKGROUND: The Korean-Mini-Mental Status Examination (K-MMSE) is a dementia-screening test that can be easily applied in both community and clinical settings. However, in 20% to 30% of cases, the K-MMSE produces a false negative response. This suggests that it is necessary to evaluate the accuracy of K-MMSE as a screening test for dementia, which can be achieved through comparison of K-MMSE and Seoul Neuropsychological Screening Battery (SNSB)-II results. METHODS: The study included 713 subjects (male 534, female 179; mean age, 69.3±6.9 years). All subjects were assessed using K-MMSE and SNSB-II tests, the results of which were divided into normal and abnormal in 15 percentile standards. RESULTS: The sensitivity of the K-MMSE was 48.7%, with a specificity of 89.9%. The incidence of false positive and negative results totaled 10.1% and 51.2%, respectively. In addition, the positive predictive value of the K-MMSE was 87.1%, while the negative predictive value was 55.6%. The false-negative group showed cognitive impairments in regions of memory and executive function. Subsequently, in the false-positive group, subjects demonstrated reduced performance in memory recall, time orientation, attention, and calculation of K-MMSE items. CONCLUSION: The results obtained in the study suggest that cognitive function might still be impaired even if an individual obtained a normal score on the K-MMSE. If the K-MMSE is combined with tests of memory or executive function, the accuracy of dementia diagnosis could be greatly improved.
Cognition ; Cognition Disorders ; Dementia ; Diagnosis ; Executive Function ; Female ; Humans ; Incidence ; Mass Screening* ; Memory ; Sensitivity and Specificity ; Seoul*

With a purpose to find out natural transition of endemicity of Malayan filariasis in inland Korea, a survey was conducted in June 1980 in Isan-Myeon of Yongpung-Gun (former Yongju-Gun) where an epidemiological investigation had been carried out in 1973 without any control activities such as chemotherapy. Five sample villages were surveyed for microfilaremia by 20 microliter night blood examination among inhabitants and the results of the surveys conducted in 1973 and 1980 were compared to determine natural transition of the endemicity of malayan filariasis during the period of the last 7 years. The current microfilaria rate among inhabitants in the 5 villages was 2.2 percent on the average (male: 1.6 percent, female: 2.8 percent) from 370 persons examined. By village, the rates were 5.9 percent (number of persons examined: 34) in Baranggol, 0 percent (30) in Guitonggl, 4.2 percent (72) in Alseonggol, 0 percent(65) in Jangjagol and 1.8 percent (169) in Saehae. Extremely low microfilaria rate was noted in young age groups. By age group, no positive case was found in those age groups below 30-39 years except 10-14 age group in which 2 positives (4.4 percent) were found. Two positives each were found in the respective age groups of 40-49(3.2 percent), 50-59 (4.4 percent) and over 60 (3.4 percent). In evaluation of the natural transition of the endemicity during the period of the last 7 years, the microfilaria rate turned out from 13.1 percent in 1973 to 2.2 percent in 1980. The difference in the microfilaria rate was 10.9 percent and the natural reduction rate per year was 1.6 percent on the average. From the examination of 35 cases which had revealed microfilaremia 7 years ago, 85.7 percent(30) of them were found to have converted to microfilaria negatives. On the other hand, from the 151 cases which had revealed no microfilaria in 1973, only 0.7 percent (1) of them was found to have converted to microfilaria positive. In the intensity of microfilaremia, the number of microfilaria/20 microliter blood per positive case was 11.0 in 1973 and 9.1 in 1980. The number of microfilaria/20 microliter per examinee was 1.4 in 1973 and 0.2 in 1980, thus reduced to 1/7 during the period of the 7 years. The retarding endemicity of malayan filariasis in inland Korea was considered to be resulted in by the gradual increase of environmental factors in relation to ecology of vector mosquitoes, which adversely affect to the transmission of malayan filariasis. Followings are suggested to be the factors which control the transmission of the malayan filariasis in this area: Inhabitants are the only natural final host of Brugia malayi infection in this area, gradual elevation of living standards of the inhabitants, gradual awakening of consciousness and behavior among inhabitants to protect themselves from mosquito biting using such as mosquito nets and insecticide sprays, preference of animal bait of vector mosquitoes, Anopheles sinensis, increase in number of domestic animals and fowls being raised in the village areas which play a major part of blood donors to vector mosquitoes, and relatively short (3-4 months) period of mosquito season in a year.
parasitology-helminth-nematoda ; Brugia malayi ; epidemiology

PURPOSE: Motion effects in parallel magnetic resonance imaging (MRI) are investigated. Parallel MRI is known to be robust to motion due to its reduced acquisition time. However, if there are some involuntary motions such as heart or respiratory motions involved during the acquisition of the parallel MRI, motion artifacts would be even worse than those in conventional (non-parallel) MRI. In this paper, we defined several types of motions, and their effects in parallel MRI are investigated in comparisons with conventional MRI. MATERIALS AND METHODS: In order to investigate motion effects in parallel MRI, 5 types of motions are considered. Type-1 and 2 are periodic motions with different amplitudes and periods. Type-3 and 4 are segment-based linear motions, where they are stationary during the segment. Type-5 is a uniform random motion. For the simulation, Cartesian and spiral grid based parallel and non-parallel (conventional) MRI are used. RESULTS: Based on the motions defined, moving artifacts in the parallel and non-parallel MRI are investigated. From the simulation, non-parallel MRI shows smaller root mean square error (RMSE) values than the parallel MRI for the periodic (type-1 and 2) motions. Parallel MRI shows less motion artifacts for linear (type-3 and 4) motions where motions are reduced with shorter acquisition time. Similar motion artifacts are observed for the random motion (type-5). CONCLUSION: In this paper, we simulate the motion effects in parallel MRI. Parallel MRI is effective in the reduction of motion artifacts when motion is reduced by the shorter acquisition time. However, conventional MRI shows better image quality than the parallel MRI when fast periodic motions are involved.
Artifacts ; Computer Simulation ; Heart ; Magnetic Resonance Imaging

PURPOSE: The 12-lead electrocardiogram has limitation for detection of lateral wall myocardial infarction (MI). Therefore, this study was conducted to compare the location of leads V5 and V6 with the left ventricle (LV) lateral wall using multidetector computed tomography (MDCT) and propose new additional leads for detection of lateral wall MI. METHODS: From 120 study subjects who underwent chest MDCT, we measured the angle (Θ) between the midsagittal plane and long axis of LV on the coronal imaging of MDCT. Using this, another angle (90-Θ) between the long axis of LV and leads V5 and V6 was calculated. After the location of the leads V5 and V6 was identified using axial and coronal images of MDCT, the positional relationship between leads V5 and V6 and the lateral wall was compared based on the thoracic spine. RESULTS: The Θ and 90-Θ was 52.2°±10.3°and 37.8°±10.3°, respectively. Leads V5 and V6 faced the LV lateral wall very obliquely. The score of leads V5 and V6 position based on the thoracic spine was 6.9±1.8 points as the level of lower part of 9th vertebral body. Meanwhile, the lateral wall of LV was 4.7±2.2 points as the lower part of the 8th vertebral body. Thus, leads V5 and V6 were located lower by the height of one thoracic vertebral body than the lateral wall of LV on coronal images (p < 0.001). CONCLUSION: Leads V5 and V6 are inappropriate for detection of the lateral wall MI. To diagnose that more efficiently, we propose the new additional leads, elevated V5 and elevated V6, located two or three intercostal spaces upward from leads V5 and V6.
Coronary Vessels ; Electrocardiography ; Heart Ventricles ; Multidetector Computed Tomography ; Myocardial Infarction ; Spine ; Thorax