OBJECTIVE: Assessing the severity of injury and predicting outcomes are essential in traumatic brain injury (TBI). However, the respiratory rate and Glasgow Coma Scale (GCS) of the Revised Trauma Score (RTS) are difficult to use in the prehospital setting. This investigation aimed to develop a new prehospital trauma score for TBI (NTS-TBI) to predict mortality and disability.METHODS: We used a nationwide trauma database on severe trauma cases transported by fire departments across Korea in 2013 and 2015. NTS-TBI model 1 used systolic blood pressure < 90 mmHg, peripheral capillary oxygen saturation < 90% measured via pulse oximeter, and motor component of GCS. Model 2 comprised variables of model 1 and age >65 years. We assessed discriminative power via area under the curve (AUC) value for in-hospital mortality and disability defined according to the Glasgow Outcome Scale with scores of 2 or 3. We then compared AUC values of NTS-TBI with those of RTS.RESULTS: In total, 3,642 patients were enrolled. AUC values of NTS-TBI models 1 and 2 for mortality were 0.833 (95% confidence interval [CI], 0.815 to 0.852) and 0.852 (95% CI, 0.835 to 0.869), respectively, while AUC values for disability were 0.772 (95% CI, 0.749 to 0.796) and 0.784 (95% CI, 0.761 to 0.807), respectively. AUC values of NTS-TBI model 2 for mortality and disability were higher than those of RTS (0.819 and 0.761, respectively) (P < 0.01).CONCLUSION: Our NTS-TBI model using systolic blood pressure, motor component of GCS, oxygen saturation, and age was feasible for prehospital care and showed outstanding discriminative power for mortality.
Anoxia ; Area Under Curve ; Blood Pressure ; Brain Injuries ; Capillaries ; Fires ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hospital Mortality ; Humans ; Hypotension ; Korea ; Mortality ; Observational Study ; Oxygen ; Quality Improvement ; Respiratory Rate

In periesophageal abscesses, the inflammatory reaction occurs on the surrounding esophagus and pus cavity formation accompanies complications of endoscopic procedures or esophageal perforation induced by sharp foreign bodies. Here, we report the treatment of a periesophageal abscess with endoscopic ultrasonography-guided incision and drainage, and broad-spectrum antibiotics. Follow-up endoscopy revealed no lesion other than the incision scar. We report a case of periesophageal abscess that was treated non-surgically and review the relevant literature.
Abscess ; Anti-Bacterial Agents ; Cicatrix ; Drainage ; Endoscopy ; Endosonography ; Esophageal Perforation ; Esophagus ; Follow-Up Studies ; Foreign Bodies ; Suppuration

Behcet disease is a multisystemic disorder characterized by a chronic relapsing triple symptom complex of recurrent oral ulceration, genital ulceration, and ocular inflammation. The onset of Behcet disease is rare in old age as is whole colon involvement. We recently saw a 78-year-old female patient examined to have intestinal Behcet disease with diffuse colon ulcers. She was admitted due to multiple oral ulcers, genital ulcers, low abdominal pain, and hematochezia. Colonoscopy showed multiple well-demarcated, large, deep, bleeding ulcers from the cecum into the descending colon. The patient was diagnosed with Behcet disease and treated with steroid, colchicine, and mesalazine. This paper describes a case of Behcet disease with unusual intestinal distribution.
Abdominal Pain ; Aged ; Behcet Syndrome ; Cecum ; Colchicine ; Colon ; Colon, Descending ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Inflammation ; Mesalamine ; Oral Ulcer ; Ulcer

Hyperkalemic periodic paralysis is characterized by episodic flaccid paralysis of the skeletal muscles due to an increase in serum potassium concentrations. Primary hyperkalemic periodic paralysis is caused by point mutations in SCN4A, encoding a voltage-gated skeletal muscle sodium channel. However, hyperkalemia-related diseases, such as renal failure, adrenal insufficiency, hypoaldosteronism, and chronic diuretic use, can induce secondary hyperkalemic periodic paralysis. Diagnosis of this disease is based on clinical features, nerve conduction studies, and a DNA sequence analysis. In cases of diagnostic uncertainty, a provocation test can be used to ensure the correct diagnosis. Here, we report a case of secondary hyperkalemic periodic paralysis with hyperkalemia that was induced by diabetic nephropathy, and review the relevant literature.
Adrenal Insufficiency ; Diabetic Nephropathies ; Dietary Sucrose ; Hyperkalemia ; Hypoaldosteronism ; Muscle, Skeletal ; Neural Conduction ; Paralysis ; Paralysis, Hyperkalemic Periodic ; Point Mutation ; Potassium ; Renal Insufficiency ; Sequence Analysis, DNA ; Sodium Channels ; Uncertainty

The percutaneous endoscopic gastrostomy is used for nutritional support in patients requiring prolonged tubal feeding. Unfortunately, numerous complications, such as infection, stomal leak, fever, local pain, ileus and tube occlusion, have been reported since its introduction. The buried bumper syndrome is a rare but well-recognized long-term complication. The tight anchorage between the internal and external bumpers leads to gastric mucosal erosion and embedding of the internal bumper into the gastric wall, obstructing feeding. Our case involves an elderly patient with a buried bumper syndrome complicated by an abdominal wall abscess. A similar case has not been reported in Korea before. This article reports our findings and management with a review of the literature.
Abdominal Wall ; Abscess ; Aged ; Fever ; Gastrostomy ; Humans ; Ileus ; Korea ; Nutritional Support

Foreign bodies in the gastrointestinal tract often cause serious complications, such as perforation, obstruction, abscess formation, or hemorrhage. This is a case in which a patient visited our hospital and complained of a vague lower abdominal pain that had been present for three months. She had an intrauterine device (IUD) inserted five years earlier. The abdominal X-ray, computed tomography and colonoscopy revealed that the IUD had penetrated into the descending colon. We tried to remove the IUD by colonoscopy but failed due to pain, so we removed the IUD surgically. Thus, we report a case in which a previously inserted IUD had penetrated into the descending colon and was surgically removed. We also present a brief review of the literature.
Abdominal Pain ; Abscess ; Colon, Descending ; Colonoscopy ; Foreign Bodies ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Intrauterine Devices

BACKGROUND: The increasing incidence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) has become a serious worldwide problem. However, there is insufficient data regarding the current status of MDR-TB and XDR-TB in Korea. This study examined the recent status of MDR- and XDR-TB using the data from 7 laboratories, in which almost all drug susceptibility tests (DST) for Mycobacterium tuberculosis were performed. METHODS: The patients' identification data and DST results were collected from all 7 laboratories from 2001 to 2006 and the number of patients with MDR-TB and XDR-TB were calculated. RESULTS: The number of DSTs was 140,638 for 6 years with an increasing incidence each year (p<0.001). The number of DST with MDR results was 18,510 and personal identifying information was obtained in 16,640 (89.9%) tests. The number of MDR-TB patients from 2001 to 2006 was 2,329, 2,496, 2,374, 2,300, 2,354, and 2,178, respectively, when counting the duplications in a year as one patient. The number of MDR-TB patients when counting the duplications in 6 years as one patient was 2,281, 1,977, 1,620, 1,446, 1,512, and 1,373, respectively. When the same method was adopted, the number of XDR-TB patients was 191, 238, 282, 260, 272, and 264, respectively, and 189, 150, 130, 90, 122, and 110 patients, respectively. CONCLUSION: Despite the national efforts to control TB, there are still a large number of MDR- and XDR-TB patients in Korea.
Extensively Drug-Resistant Tuberculosis ; Humans ; Incidence ; Korea ; Microbial Sensitivity Tests ; Mycobacterium tuberculosis ; Tuberculosis, Multidrug-Resistant

BACKGROUND AND OBJECTIVES: Asian sand dust (ASD) is known to aggravate the respiratory symptoms in patients with bronchial asthma. However, the effect of ASD in allergic rhinitis is not known. The objective of this study was to investigate whether ASD can activate the allergic inflammation in allergic mouse model. MATERIALS AND METHOD: Forty female BALB/c mice were divided into 4 groups. Group 1 was nebulized with saline and group 2 with ASD. Group 3 was nebulized with ovalbumin (OVA) only and Group 4 with OVA plus ASD after intraperitoneal injection with OVA. The allergic symptom scores were checked. The mouse OVA specific IgE/IgG1, IL-4, IL-5 and IFN-gamma were measured by ELISA. The nasal mucosa was examined for the expression of IL-4 and IL-5 by immunohistochemical stain. RESULTS: The average symptom score was increased in Group 4 compared to Group 3 (p< 0.05). The IgE was significantly increased in Group 4 compared to Group 3 (p< 0.01). The IL-4 level of nasal lavagefluid (NALF) was significantly increased in Group 4 compared to Group 3 (p< 0.05). The IL-5 level showed no significant difference between the Group 3 and Group 4 both in the serum and NALF. The level of IFN-gamma was not changed in NALF. Immunohistochemical staining showed that the positive cells for IL-4 were expressed in epithelial layer and submucous gland and the positive cells were more increased in Group 4 than in Group 3. CONCLUSION: In allergic mouse model, ASD has shown to activate the allergic inflammatory reaction by the stimuli of Th2 cytokineproduction.
Animals ; Asian Continental Ancestry Group ; Asthma ; Cytokines ; Dust ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin E ; Inflammation ; Injections, Intraperitoneal ; Interleukin-4 ; Interleukin-5 ; Mice ; Nasal Mucosa ; Ovalbumin ; Ovum ; Rhinitis ; Rhinitis, Allergic, Perennial ; Silicon Dioxide

PURPOSE: The purpose of this study was to compare the surgical outcomes of two different surgical methods for varicocelectomy, and to assess the effects of varicocelectomy on semen parameters in subinfertile men. MATERIALS AND METHODS: This study included 63 patients with clinically palpable varicocele and abnormal semen parameters who underwent varicocelectomy. Thirty-three patients underwent laparoscopic varicocelectomy, and 30 received microsurgical inguinal varicocelectomy. Semen analyses were performed 5.3 months later, and compared with the pre-operative data. RESULTS: The mean age of patients was 32.1+/-1.3 years old. Comparison of the semen parameters between pre and post-varicocelectomy revealed significant improvement in the sperm count (p<0.05). In laparoscopic and microsurgical inguinal varicocelectomy, the sperm counts were increased from 16.2+/-4.3 to 30.6+/-7.5 and from 15.4+/-3.8 to 37.5+/-7.7, respectively. Sperm motility also tended to improve. CONCLUSIONS: Varicocelectomy enhanced semen parameters after both laparoscopic and microsurgical methods. In subfertile men, early varicocelectomy is recommended.
Humans ; Male ; Semen ; Semen Analysis ; Sperm Count ; Sperm Motility ; Varicocele

PURPOSE: The purpose of this study was to compare the surgical outcomes of two different surgical methods for varicocelectomy, and to assess the effects of varicocelectomy on semen parameters in subinfertile men. MATERIALS AND METHODS: This study included 63 patients with clinically palpable varicocele and abnormal semen parameters who underwent varicocelectomy. Thirty-three patients underwent laparoscopic varicocelectomy, and 30 received microsurgical inguinal varicocelectomy. Semen analyses were performed 5.3 months later, and compared with the pre-operative data. RESULTS: The mean age of patients was 32.1+/-1.3 years old. Comparison of the semen parameters between pre and post-varicocelectomy revealed significant improvement in the sperm count (p<0.05). In laparoscopic and microsurgical inguinal varicocelectomy, the sperm counts were increased from 16.2+/-4.3 to 30.6+/-7.5 and from 15.4+/-3.8 to 37.5+/-7.7, respectively. Sperm motility also tended to improve. CONCLUSIONS: Varicocelectomy enhanced semen parameters after both laparoscopic and microsurgical methods. In subfertile men, early varicocelectomy is recommended.
Humans ; Male ; Semen ; Semen Analysis ; Sperm Count ; Sperm Motility ; Varicocele