The presently used impairment rating guidelines in Korea do not accurately reflect the injury in various lung diseases. Therefore, they need to be made more objective and quantitative with new measurements, using indicators to more precisely represent impairment in the major respiratory diseases. We develop a respiratory impairment rating guideline to ensure that the same grade or impairment rating would be obtained regardless of surgeons who determinate it. Specialists in respiratory medicine and thoracic surgeons determined the impairment grades. Moreover, the impairment should be irreversible for more than 6 months. The impairment rating depends on the level of forced vital capacity, forced expiratory volume 1 second, diffusion capacity of carbon monoxide, arterial oxygen pressure, and arterial carbon dioxide pressure. The degree of whole body impairment is defined by each grade: first 81-95%, second 66-80%, third 51-65%, fourth 36-50%, and fifth 21-35%. In conclusion, we develop a respiratory impairment rating guideline for Koreans. Any qualified specialist can easily use it and judge objective scoring.
*Disability Evaluation ; Humans ; Korea ; Lung Diseases/classification/diagnosis ; Program Development ; Pulmonary Ventilation/physiology ; Respiratory Insufficiency/classification/*diagnosis ; Severity of Illness Index

PURPOSE: There have been few case reports and studies on acute pancreatitis associated with organophosphate (OP) poisoning. We investigated prevalence, general characteristics, trends of lipase levels, and findings of computed tomography (CT) in acute pancreatitis associated with OP poisoning. METHODS: A retrospective review was conducted of 84 consecutive cases of organophosphate insecticide poisoning that were diagnosed and treated at the Emergency Department of the Wonju Severance Christian Hospital from January 2008 to April 2012. RESULTS: Acute pancreatitis was seen in 14 patients (16.7%). In pancreatitis patients, diagnosis was made at ED presentation in eight patients (57.1%) and after hospital day (HD) #2 in six patients (42.9%). In the subgroup of patients with an elevated lipase level, after OP poisoning time of peak lipase level and time to normalization were 3.6 (IQR 2.2-5.6) h and 50.6 (IQR 26.7-86.1) h, respectively. CTs were all grade A according to Balthazar classification. Significant differences were observed between the pancreatitis vs. non-pancreatitis groups in terms of ingested amounts [300 (IQR 125-450) mL vs. 100 (IQR 30-200) mL, p=0.007], pH [7.26 (IQR 7.11-7.36) vs. 7.35 (IQR 7.27-7.40), p=0.048], and serum lactate [5.85 (IQR 3.53-9.53) mmol/L vs. 3.39 (IQR 2.31-5.99) mmol/L, p=0.037], respectively. No statistical differences in terms of respiratory failure requiring ventilator care, shock, pneumonia, and AKI were observed between the pancreatitis vs. non-pancreatitis groups. No statistical differences in terms of total admission length, ICU admission length, and mortality were observed between the pancreatitis vs. non-pancreatitis groups. CONCLUSION: The prevalence of acute pancreatitis in OP poisoning was 16.7%. After OP poisoning time of peak lipase level and time to normalization were 3.6 (IQR 2.2-5.6) h and 50.6 (IQR 26.7-86.1) h, respectively. In the acute pancreatitis group, ingested amounts, serum lactate were higher and serum pH was less than in the non-pancreatitis group.
Classification ; Diagnosis ; Emergency Service, Hospital ; Gangwon-do ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid ; Lipase* ; Mortality ; Organophosphates* ; Pancreatitis* ; Pneumonia ; Poisoning ; Prevalence ; Respiratory Insufficiency ; Retrospective Studies ; Shock ; Ventilators, Mechanical

PURPOSE: Most patients with thyroid cancer have a good prognosis. However, it has been difficult to study a large number of patients succumbing to thyroid carcinoma due to the low mortality rate and the long follow-up period associated with differentiated thyroid cancer. Therefore, we evaluated characteristics of metastasis and deaths, sites of metastasis, difference of survival from pathologic classification and treatments and the cause of deaths. METHODS: From June 1995 to December 2003, fifty-four patients who died due to distant metastasis and recurrence of thyroid cancer in Samsung Seoul Medical Center were analyzed. RESULTS: We analyzed cause of death in 55 fatal cases. Single fatal conditions could not be specified in 13 patients. In the remaining 42 patients, respiratory failure (57.1%) was the most common specific fatal condition, followed by airway obstruction (26.2%), renal failure (7.1%) and sepsis (7.1%). According to histologic subtype, overall survival and relapse survival were statistically significant (P<0.005). However, No significant difference in disease free survival was observed (P=0.09). CONCLUSION: Early diagnosis and suitable treatment were also important factors for thyroid cancer. There was shorter relapse survival length in papillary cancers than that of follicular cancers. Anaplastic cancers had a poorer survival. We couldn't find difference of relapse survival result from the treatments of metastatic thyroid cancer.
Airway Obstruction ; Cause of Death ; Classification ; Disease-Free Survival ; Early Diagnosis ; Follow-Up Studies ; Humans ; Mortality ; Neoplasm Metastasis* ; Prognosis ; Recurrence ; Renal Insufficiency ; Respiratory Insufficiency ; Seoul ; Sepsis ; Thyroid Gland* ; Thyroid Neoplasms*