Acute limb compartment syndrome (ALCS) is defined as compound symptoms resulting from poor oxygenation and decreased nutrition supply to muscles and nerves in a tightly confined compartment. The most common cause of ALCS is tibia fracture, followed by blunt trauma to soft tissue. However, non-traumatic causes are rare. We report an iatrogenic, non-traumatic ALCS case after venoarterial extracorporeal membrane oxygen (VA-ECMO) therapy. A 14-year-old male received VA-ECMO therapy due to cardiorespiratory failure after drowning. Although he had no symptoms during therapy, leg swelling appeared 10 hours after ECMO treatment. Two days after the leg swelling, the patient underwent a fasciotomy. Unfortunately, nerve conduction studies and electromyography showed multiple neuropathies in the lower leg. Despite 2 weeks of rehabilitation with electrical stimulation, an exercise program, and physical therapy, there was no definite change in muscle strength. To our knowledge, this is the first reported case of non-traumatic ALCS after VA-ECMO therapy in Korea.
Adolescent ; Anterior Compartment Syndrome ; Compartment Syndromes* ; Drowning ; Electric Stimulation ; Electromyography ; Extracorporeal Membrane Oxygenation* ; Extremities* ; Humans ; Korea ; Leg ; Male ; Membranes ; Muscle Strength ; Muscles ; Neural Conduction ; Oxygen ; Rehabilitation ; Tibia

Background and Objectives: Recurrent epistaxis requiring emergency department (ED) visits results in increased morbidity in the elderly and associated with high health care costs. This study is to analyze the frequency and characteristics of epistaxis patients in the elderly and to find out the risk factors and effective treatment for recurrent epistaxis. Subjects and Method We studied retrospectively the clinical cases of 977 emergency patients and 155 patients, aged over 65, for the treatment of epistaxis during the last 10 years from January 2008 to January 2018. The group A, comprised of 95 patients (68.29%), was treated with an initial treatment. The group B, which comprised of 60 patients (38.71%), visited for re-bleeding following an initial treatment. Results: Patients made 2 to 10 ED visits due to re-bleeding and 32 of the 60 patients (53.5%) visited twice. The electrocauterization was the most common (61.7%) for treatment method during rebleeding, followed by posterior packing (18.3%). The factors that increases the risk of recurrent epistaxis are anticoagulants, posterior epistaxis, anterior packing, inefficient ED packing. There was no correlation between comorbidities and rebleeding. Conclusion Accurate medical history taking of anticoagulants may enable personnel to provide more effective management of these patients. The most important factors in the failure of primary care were not being able to find the precise area of bleeding and ineffective packing during the initial treatment. Therefore, it is important that we must carefully check the areas using the endoscope to decrease the failure of initial treatment of epistaxis.

Nontuberculous mycobacteria (NTM) is commonly found in the surrounding environment and can cause opportunistic infection. Mainly, it causes lymph node infection in the cervical area, which is often known to occur in children. Recently, we have experienced a case of NTM infection on a branchial cleft cyst in a 36-year old male. NTM was diagnosed by fine needle aspiration and branchial cleft cyst was confirmed by postoperative pathologic findings. We report this case with a review of literature.

Sebaceous carcinoma is extremely rare in the parotid gland. Recently, we experienced a case of carcinoma with sebaceous differentiation arising from the parotid gland in patient who was diagnosed as parotid adenoma carcinoma and underwent total parotidectomy.
A 73-year-old male visited our department for the evaluation of 3-month history of infra-auricular mass combined with pain. Radiologic finding showed lobulated enhancing and solid mass with calcification in the right parotid gland. Initially, total parotidectomy with supraomohyoid neck dissection was performed. Pathological findings showed capsulated whitish mass with hemorrhage and cystic degeneration. Immunohistochemically, CK7, CK5/6, p63 were positive and CEA was negative. The intra-operative frozen section diagnosis was mucoepidermoid carcinoma. The permanent diagnosis was changed to adenocarcinoma, NOS(not otherwise specified). Fourteen months later, the newly developed mass was noticed on the operation bed. The mass was clinically diagnosed as recurred adenocarcinoma. Revision parotidectomy was performed and pathological findings revealed that the tumor was newly developed sebaceous carcinoma. We report a case of carcinoma with sebaceous differentiation in parotid gland with a review of literature.

BACKGROUND: Single staining is commonly performed for practical pathologic diagnoses. However, this method is limited in its ability to specify cellular morphology and immunophenotype and often requires consumption of limited tissue. This study aimed to describe an optimized protocol for multiple in situ hybridization (ISH) and immunohistochemistry (IHC). METHODS: The quality of multistaining was evaluated by carefully changing each step of ISH and IHC in an angioimmunoblastic T-cell lymphoma (AITL) case on a Ventana BenchMark XT automated immunostainer. The optimized protocols were also performed using another immunostainer and in 15 cases of five Epstein-Barr virus (EBV)–associated malignancies using formalin-fixed paraffin-embedded tissue. RESULTS: The quality of various ISH-IHC staining protocols was semi-quantitatively evaluated. The best EBV-encoded RNA (EBER)-ISH/double IHC staining quality, equivalent to single staining, was obtained using the following considerations: initial EBER-ISH application, use of protease and antigen retrieval reagent (cell conditioning 1 [CC1] treatment time was minimized due to impact on tissue quality), additional baking/deparaffinization not needed, and reduced dilution ratio and increased reaction time for primary antibody compared with single immunostaining. Furthermore, shorter second CC1 treatment time yielded better results. Multiple staining was the best quality in another immunostainer and for different types of EBV-associated malignancies when it was performed in the same manner as for the Ventana BenchMark XT as determined for AITL. CONCLUSIONS: EBER-ISH and double IHC could be easily used in clinical practice with currently available automated immunostainers and adjustment of reagent treatment time, dilution ratio, and antibody reaction time.
Benchmarking ; Diagnosis ; Herpesvirus 4, Human ; Immunohistochemistry ; In Situ Hybridization ; Lymphoma, T-Cell ; Methods ; Reaction Time ; RNA

Background and Objectives: There has been a long debate on whether intraoperative parathyroid hormone (IOPTH) monitoring is mandatory or not in the excision of a single abnormal parathyroid gland. The aim of this study is to suggest a new criteron of IOPTH monitoring. Subjects and Method We retrospectively analyzed 31 patients who underwent parathyroidectomy from 2005 to 2019. Patients had IOPTH not measured and those with secondary hyperparathyroidism were excluded. IOPTH was measured preoperatively (EX00), at 10 minutes (EX10) and 20 minutes (EX20) after the excision and analyzed. We determined the surgery as a ‘successful excision of lesion (SEOUL)’ when it met the following criteria: criterion 1) the level of EX10 or EX20 decreased under the upper normal or under upper limit of parathyroid hormone (65 pg/mL); criterion 2) EX20 decreased below 50% of EX00 and less than 195 pg/ mL (3 times the upper normal limit); criterion 3) multiglandular disease. Results: Twenty-five patients among 31 patients were included this study (M:F=8:17). Twenty- two patients were suspected of single lesion and three patients of multiple lesions on preoperative images (99mTc-sestamibi scan, neck CT, and PET-CT). IOPTH of EX00, EX10, and EX20 were 488.92±658.74, 121.36±134.73, and 92.44±111.55 pg/mL, respectively. Sixty-four percent patients (16/25) met the criterion 1. Six patients (24%) successfully excised a lesion meeting the criterion 2. Three patients had multiglandular disease, meeting the criterion 3. Conclusion Our new criteria suggest when we could stop the procedure. If the level of IOPTH does not meet the SEOUL criteria, it means that there might be more lesions.

BACKGROUND: This study reports the incidences of measles in Koea and the epidemiologic characteristics for the incidence reported for the period 1980~1999. It provides the epidemeologic adta for measles before implementing the catch-up campaign in 2001. METHODS: We obtained information for the survey from the data for the incidence reported from health centers. Incidences per 100,000 population were calculated for the 1963~1999. And the following variables were studied: seasonal or regional distribution for the 1980~1999. RESULTS: The incidence rate of measles declined after the systemic immunization in 1990, the outbreak of measles occurred periodically and incidences per 100,000 population increased from 8.4 cases in 1990 to 17.7 in 1994. In 1990 and 1994, measles cases centered around the 5~6th month. On the other hand, in non-epidemic year measles cases were scattered around the year. The incidence rates of measles by the province were greatly defferent whenever the outbreak of measles occurred. CONCLUSION: In 1990s, the outbreak of measles occurred periodically at the interval of 4 years until 1994. The seasonal distribution may be caused by Iimitation of transmission due to the increased measles immunity in outbreak region. Our results showed that the measles outbreak did not occur in the specific province, but it occurred nationwide whenever measles outbreak occurred, even though the incidence rates of the provinces were different.
Epidemiology ; Hand ; Immunization ; Incidence* ; Korea* ; Measles* ; Seasons

OBJECTIVES: While there have recently been efforts to improve public health service at a governmental level, there is actually insufficient research on awareness of the roles related to public health service among hospital employees. This study examined role perception and function performance related to public health service among the medical staff in a national hospital. METHODS: 15% were randomly sampled from each type of occupation among the medical staff in a national university hospital, a survey was conducted in 323 persons, and there were a total of 265 participants (80.2%): 103 doctors(38.9%), 98 nurses (37.0%), and 64 others (24.1%). RESULTS: The hospital employees had insufficient awareness of their roles as public health service providers in terms of six required items for public health service: 1) services for supporting establishment, implementation, and assessment of public health service policies, 2) participation in the health service activities and support services by central or local governments, 3) technological support and educational services for private health service institutions, 4) health service for unprivileged brackets, 5) health service that requires association with other areas dealing with geriatric, disabled, and mentally-disordered people, and 6) health service for children and mothers. CONCLUSIONS: In general, since the hospital employees had insufficient awareness of their roles and responsibilities as public health service providers, it is necessary to secure manpower exclusively in charge of public health service and provide education about strategic public health service.
Child ; Cognition ; Fees and Charges ; Health Services ; Humans ; Medical Staff ; Occupations ; Public Health ; United States Public Health Service

OBJECTIVES: Endobronchial foreign body impaction is a medical emergency because of the air way obstruction. Therefore, immediate foreign body removal is crucial in such situations. Recently, there have been several reports about cryoprobe use as a tool for removal of foreign bodies. In this study, we determined the efficacy and complications of foreign body removal using a cryoprobe during flexible bronchoscopy. METHODS: This is a retrospective review of 27 patients who visited Kosin University Gospel Hospital from August 2007 to August 2010 with respiratory symptoms due to a foreign body in the airway. There were 17 males and 10 females, aged from 7 to 78 years. The foreign bodies were more frequently located (55%) in the right bronchus. The cryoprobe was inserted through the forceps channel of the flexible bronchoscope under local anesthesia. The lesion was quickly frozen for 5 seconds at -80degrees C, and the bronchoscope was removed with the probe after crystal formation on the contacted area. RESULTS: The success rate of removal of foreign bodies was 85% (23/27) using the cryoprobe. One case of broncholith did not undergo attempted removal because of the possibility of excessive hemorrhage by the tight bronchus impaction, and three cases (plastic,silicon,and implant) failed due to limited crystal formation. There were no severe hemorrhages, arrhythmias, or casualties during the procedure. CONCLUSIONS: The removal of foreign body using a cryoprobe during flexible bronchoscopy was shown to be safe and effective. The nature of the material should be attempted before removing a foreign body.
Anesthesia, Local ; Arrhythmias, Cardiac ; Bronchi ; Bronchoscopes ; Bronchoscopy* ; Emergencies ; Female ; Foreign Bodies* ; Hemorrhage ; Humans ; Male ; Retrospective Studies ; Surgical Instruments

OBJECTIVE: Our purpose was to estimate the prevalence of hepatitis C virus seropositivity and define the risk factors for HCV infection in a group of pregnant women and the effect of HCV infection to mother and baby at the time of delivery. METHODS: From March 1997 to February 1998, 5655 women who delivered over 20 gestational weeks at our hospital were screened for HCV-Antibody(RIA), and the samples of most of HCV-Ab positive cases were analyzed for HCV-RNA by polymerase chain reaction(PCR). We also studied the risk factors for HCV infection, the effect of HCV infection to mothers and neonates at delivery. RESULTS: Of 5655 mothers 25 (0.44%) were HCV-Ab positive, and 20 of HCV-Ab positive mothers were analyzed for HCV-RNA by PCR. Of 20 HCV-Ab positive mothers 12 cases (60%) were HCV-RNA positive. Risk factors significantly more prevalent among HCV-seropositive patients were : a history of habitual intraveneous drug use, a history of smoking, alcohol drinking during pregnancy, having liver cirrhorsis. The proportions who had received a blood transfusion, had a history or ongoing syphilis or were positive for hepatitis B virus surface antigen were not significantly different between seropositive and seronegative women. Liver function test at delivery was abnormal in 4 cases(16%) of HCV-Ab positive group. And the number of abnomal liver function test cases in HCV-Ab negative group were 47(0.83%). This had statistical difference. In neonates at delivery, all 20 neonates of 20 ones having HCV-Ab positive mother were HCV-Ab positive. But only 2 cases of 20 babies were HCV-RNA positive. CONCLUSION: Mothers who have risk factors such as injecting drug use, smoking, alchohol drinking and liver cirrhorsis, should undergo HCV-Ab testing and quantitative HCV-RNA testing by PCR. More advanced studies about vertical transmission of HCV infection are needed.
Alcohol Drinking ; Antigens, Surface ; Blood Transfusion ; Drinking ; Female ; Hepacivirus* ; Hepatitis B virus ; Hepatitis C* ; Hepatitis* ; Humans ; Infant, Newborn ; Liver ; Liver Function Tests ; Mothers ; Polymerase Chain Reaction ; Pregnancy* ; Pregnant Women ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Syphilis