In 2010, we proposed the first Korean Guidelines for the Prevention of Venous Thromboembolism (VTE). It was applicable to Korean patients, by modifying the contents of the second edition of the Japanese guidelines for the prevention of VTE and the 8th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines. From 2007 to 2011, we conducted a nationwide study regarding the incidence of VTE after major surgery using the Health Insurance Review and Assessment Service (HIRA) database. In addition, we have considered the 9th edition of the ACCP Evidenced-Based Clinical Practice Guidelines, published in 2012. It emphasized the importance of clinically relevant events as opposed to asymptomatic outcomes with preferences for both thrombotic and bleeding outcomes. Thus, in the development of the new Korean guidelines, three major points were addressed: 1) the new guidelines stratify patients into 4 risk groups (very low, low, moderate, and high) according to the actual incidence of symptomatic VTE from the HIRA databases; 2) the recommended optimal VTE prophylaxis for each group was modified according to condition-specific thrombotic and bleeding risks; 3) guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and/or physician advice.
Age Factors ; Anticoagulants/adverse effects/*therapeutic use ; Asian Continental Ancestry Group ; Evidence-Based Medicine ; Heparin, Low-Molecular-Weight/therapeutic use ; Humans ; *Mechanical Thrombolysis ; Neoplasms/complications/surgery ; Republic of Korea ; Risk Assessment ; Surgical Procedures, Operative/adverse effects ; Venous Thromboembolism/etiology/prevention & control/*therapy

BACKGROUND/AIMS: The aim of this study was to describe the types and causes of liver disease in patients from a single community hospital in Korea between April 2005 and May 2010. METHODS: A cohort of patients who visited the liver clinic of the hospital during the aforementioned time period were consecutively enrolled (n=6,307). Consistent diagnostic criteria for each liver disease were set by a single, experienced hepatologist, and the diagnosis of all of the enrolled patients was confirmed by retrospective review of their medical records. RESULTS: Among the 6,307 patients, 528 (8.4%) were classified as acute hepatitis, 3,957 (62.7%) as chronic hepatitis, 767 (12.2%) as liver cirrhosis, 509 (8.1%) as primary liver cancer, and 546 (8.7%) as a benign liver mass or other diseases. The etiologies in the acute hepatitis group in decreasing order of prevalence were hepatitis A (44.3%), toxic hepatitis (32.4%), other hepatitis viruses (13.8%), and cryptogenic hepatitis (9.1%). In the chronic hepatitis group, 51.2% of cases were attributed to viral hepatitis, 33.3% to nonalcoholic fatty liver disease, and 13.0% to alcoholic liver disease (ALD). Of the cirrhoses, 73.4% were attributable to viral causes and 18.1% to alcohol. Of the hepatocellular carcinoma cases, 86.6% were attributed to viral hepatitis and 11.6% to ALD. Among the benign tumors, hemangioma comprised 52.2% and cystic liver disease comprised 33.7%. CONCLUSIONS: Knowledge of the current status of the type and cause of liver disease in Korea may be valuable as a basis for evaluating changing trends in liver disease in that country.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/adverse effects ; Carcinoma, Hepatocellular/epidemiology/etiology/pathology ; Chronic Disease ; Cohort Studies ; Fatty Liver/epidemiology ; Female ; Hepatitis/epidemiology ; Hepatitis, Viral, Human/complications/epidemiology ; Humans ; Liver Cirrhosis/epidemiology/etiology ; Liver Diseases/*diagnosis/epidemiology ; Liver Diseases, Alcoholic/complications/epidemiology ; Liver Neoplasms/epidemiology/etiology/pathology ; Male ; Middle Aged ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Young Adult

PURPOSE: Previous studies have outlined mechanisms by which Mycoplasma pneumonia (M. pneumonia) infection may promote allergic lung inflammation and airway remodeling, and increasing evidence from human studies suggests that atypical bacterial infections contribute to asthma exacerbation, chronic asthma, and disease severity with changes in cytokine expression. The present study evaluated changes in serum levels of vascular endothelial growth factor (VEGF) and interleukin (IL)-5 in atopic children with Mycoplasma pneumoniae pneumonia. METHODS: We recruited a total of 72 children with pneumonia. The patients were divided into 4 groups: atopic children with M. pneumonia pneumonia (group I, n=24), non-atopic children with M. pneumonia pneumonia (group II, n=23), atopic children with viral pneumonia (group III, n=13), and non-atopic children with viral pneumonia (group IV, n=12). Serum levels of IL-5, IL-13, VEGF, and tumor necrosis factor-alpha were measured at admission and at recovery using enzyme-linked immunosorbent assays. RESULTS: Serum levels of VEGF and IL-5 were elevated in group I compared with the other groups at both admission phase and clinical recovery phase. In group I, serum levels of VEGF and IL-5 were higher at recovery phase than at admission phase (VEGF: 1,102.2+/-569.4 vs. 874.9+/-589.9 pg/mL, respectively; IL-5: 150.5+/-63.9 vs. 120.2+/-46.7 pg/mL, respectively). CONCLUSIONS: The serum levels of VEGF and IL-5 were more increased in atopic children with M. pneumonia pneumonia than in the other groups. In this group, the serum levels of VEGF and IL-5 were more increased at recovery phase than at admission phase. The results of this study suggest that increases in VEGF and IL-5 may contribute to the development of hypersensitivity during M. pneumonia infection. These cytokines may act through their respective pro-inflammatory pathways to aggravate the allergic status and induce airway hypersensitivity during M. pneumonia pneumonia in atopic children.
Airway Remodeling ; Asthma ; Bacterial Infections ; Child ; Cytokines ; Humans ; Hypersensitivity ; Interleukin-13 ; Interleukin-5 ; Interleukins ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Pneumonia, Viral ; Tumor Necrosis Factor-alpha ; Vascular Endothelial Growth Factor A

BACKGROUND: We prospectively investigated the incidence and features of late organ complications in long-term childhood cancer survivors (LTCCS) who took part in a specially designed health promotion program (HPP).METHODS: We developed our own HPP for LTCCS based on the Children's Oncology Group (COG) program, by modifying the adult HPP in Hanyang University Medical Center. The study included survivors who had received chemotherapy and/or radiotherapy for childhood cancer and had survived for at least 4 years after the end of treatment without evidence of recurrence.RESULTS: A total of 38 survivors were enrolled in the study. One or more abnormal findings were identified in 33 (87%) of the survivors, and two or more abnormal findings were present in 16 (42%) of the survivors. The most frequent type of abnormality was identified by thyroid ultrasonography, which detected benign nodules or cysts in 17 (45%) of the survivors. High-risk posttraumatic stress disorder needing medical treatment was detected in 1 of 17 survivors who were examined by psychological questionnaire.CONCLUSION: Most (87%) of childhood cancer survivors have at least 1 major or minor late effect. They must be continuously monitored after completion of treatment for early detection of late effects as well as cancer recurrence. Nationally integrated research is needed to provide standardized and comprehensive HPP for LTCCS considering domestic circumstances in Korea.
Academic Medical Centers ; Adult ; Health Promotion ; Humans ; Incidence ; Korea ; Prevalence ; Prospective Studies ; Recurrence ; Stress Disorders, Post-Traumatic ; Survivors ; Thyroid Gland

PURPOSE: Ibuprofen is used for prevention and treatment of patent ductus arteriosus as an alternative drug of indomethacin in very premature infants. We aimed to determine the effect of prophylactic ibuprofen on patent ductus arteriosus and clinical outcomes in preterm infants less than 1,250 g. METHODS: A retrospective review of 39 preterm infants who were admitted to our neonatal intensive care unit from November 2009 to July 2010 was performed. Patients were divided into a prophylactic group (n=13) and a matched historical control group (n=26), where prophylactic ibuprofen were administrated within 24 hours after birth. The rate of ductal closure, side-effects of drug treatment and clinical outcomes were compared between two groups. RESULTS: Comparison of the prophylactic and control groups revealed no significant differences in the rate of ductal closure (69.2% vs 77.7%, P=0.825) and surgical ligation (23.1% vs 30.8%, P=0.719). Occurrence of bowel perforation was more frequent in the prophylactic group than the control group, but was not significant (30.8% vs 11.5%, P=0.194). The frequency of intraventricular hemorrhage (grade> or =3) and other outcomes did not differ between the groups. CONCLUSION: Ibuprofen prophylaxis in preterm infants did not decrease the rate of ductal closure, the need for surgical ligation and the incidence of intraventricular hemorrhage. Further studies are needed to investigate the beneficial effect and associated adverse events attributed to ibuprofen prophylaxis.
Birth Weight ; Ductus Arteriosus, Patent ; Hemorrhage ; Humans ; Ibuprofen ; Incidence ; Indomethacin ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Ligation ; Parturition ; Retrospective Studies

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate and compare the incidence and the characteristics of parameters of cervical vestibular-evoked myogenic potentials (cVEMPs) using air-conducted (AC) and bone-conducted (BC) stimulations in normal subjects. SUBJECTS AND METHOD: Twenty-four normal subjects (48 ears) with normal hearing and no previous history of dizziness were included. cVEMP responses were recorded by surface electrodes on sternocleidomastiod muscles in response to AC and BC stimuli sequentially. Variances of parameters, including thresholds, amplitudes and interaural amplitude difference ratios (IADR), were analyzed and compared. RESULTS: cVEMP responses were clearly observed in all 48 ears in both AC and BC cVEMP tests. There was no significant difference in latencies (p1 and n1). However, the thresholds in BC cVEMP testing were significantly lower than those in AC cVEMP testing, when compared to the maximum stimulation level. Interaural amplitude difference ratios showed no significant difference in between the two tests, although amplitudes at maximum stimulation intensity in BC cVEMP testing were significantly larger than those in AC cVEMP testing. CONCLUSION: This study shows that BC cVEMP testing shows lower thresholds compared to AC cVEMP testing in normal subjects, suggesting that the threshold value can be used as a parameter in detecting vestibular dysfunction in the clinic. Further studies in patients with various vestibular disorders are needed.
Dizziness ; Ear ; Electrodes ; Hearing ; Humans ; Incidence ; Muscles ; Vestibular Evoked Myogenic Potentials ; Vibration

BACKGROUND: We retrospectively analyzed the clinical data to describe the characteristics of lesions, extent of disease, and outcomes in patients with neonatal presentation of Langerhans cell histiocytosis (LCH).METHODS: Clinical data obtained from neonate diagnosed with LCH at Asan Medical Center between March 1998 and May 2010 were studied. A review of the medical records, analyzing the clinical parameters such as age when signs and symptoms initially manifested, morphologic characteristics of lesions, age at diagnosis, additional organ involvement, therapy administered, course, and outcome, including delayed sequelae was done.RESULTS: Among seventy nine (36 female, 43 males) patients, 6 patients (3 female, 3 male) were presented symptoms within 4 weeks after birth and diagnosed with neonatal LCH (7.6%). Median age of the 6 patients was 11.5 (5-42) days and LCH was diagnosed based on the CD1a positivity. At diagnosis, 4 patients showed single system (SS) LCH (66.7%) whereas 2 patients had multisystem (MS) LCH (33.3%) and skin lesions were the most common initial manifestation (83.3%). The probability of event free survival at 12 years was 83.3%.CONCLUSION: Skin lesion was the most prominent manifestation of the neonatal LCH with complete spontaneous involution. A multi-organ evaluation at the time of diagnosis is important to ascertain the possibility of multisystem involvement with LCH.
Disease-Free Survival ; Female ; Histiocytosis, Langerhans-Cell ; Humans ; Infant, Newborn ; Medical Records ; Parturition ; Retrospective Studies ; Skin

We present a patient who developed a psoas muscle hematoma after spinal anesthesia. He had received hemodialysis with heparin every two days because of end stage renal disease. Under the jack-knife position, he underwent spinal anesthesia and a paramedian approach was used for incision and drainage of an anal abscess. The coagulation tests were normal throughout the surgery. Eleven days after the operation, he complained of sudden onset of right buttock pain and a psoas muscle hematoma was diagnosed by CT. Although heparin is recommended after regional anesthesia, it is a major cause of delayed hematoma. Because of this potential complication, anesthesiologists and clinicians should carefully monitor the usage of anticoagulants after spinal anesthesia, and it is necessary to use active diagnostic tools such as CT for early diagnosis when hematoma formation is suspected in patients receiving anticoagulants.
Abscess ; Anesthesia, Conduction ; Anesthesia, Spinal ; Anticoagulants ; Buttocks ; Drainage ; Early Diagnosis ; Hematoma ; Heparin ; Humans ; Kidney Failure, Chronic ; Organothiophosphorus Compounds ; Psoas Muscles ; Renal Dialysis

BACKGROUND AND OBJECTIVES: Recent works have demonstrated the existence of ocular vestibular evoked myogenic potentials (OVEMPs), which reflects otolith-ocular reflex. The purpose of this study was to identify an appropriate gaze position to detect OVEMPs produced by air-conducted sound stimulation in healthy subjects. SUBJECTS AND METHOD: Twenty four healthy subjects (35 ears) were included in this study. Surface electromyographic activity was recorded from active electrodes placed inferior to each eye. Stimulation with 500 Hz short tone bursts was used to activate the vestibular end-organs. RESULTS: Sound stimulation evoked negative-positive biphasic responses on both ipsilateral and contralateral eyes, while responses were contralateral eye-dominant. Contralateral eye responses had higher response incidence and larger amplitudes. Altering the direction of gaze generally changed the incidence and size of the inter-peak amplitudes. The higher incidence and larger amplitudes were recorded when the eyes are directed to the superior and ipsilateral side to the sound stimulation. In that gaze position, the amplitude was 5.3 micronV, the first negative peak latency was 10.5 ms and the following positive peak latency was 15.4 ms on the average. CONCLUSION: OVEMPs can be evoked using an air-conducted 500 Hz tone burst and are best recorded contralaterally with a upward gaze towards the source of sound stimulation. Further changes of the test parameters are needed for higher and consistent responses.
Electrodes ; Evoked Potentials ; Eye ; Incidence ; Reflex ; Reflex, Vestibulo-Ocular ; Saccule and Utricle ; Vestibular Evoked Myogenic Potentials

BACKGROUND AND OBJECTIVES: To report the hearing results of tympanoplasty for chronic otitis media with or without cholesteatoma. SUBJECTS AND METHOD: One hundred and seventy-five patients presenting chronic otitis media with or without cholesteatoma were involved in a retrospective study. Tympanoplasties were performed by the same surgeon over a 30-month period. Audiometric results were reviewed. Audiometric results according to the following techniques were measured: tympanoplasty type 1 (T1), interposition (Si) and/or columella (Sc) over stapedial head, and interposition or columella (Fic) over footplate. The follow-up period ranged from 6 to 32 months. Audiological parameters using the average of four frequencies were assessed pre- and post-operatively. RESULTS: Overall hearing results showed postoperative air-bone gaps (ABG) < or =20 dB in 69% of cases. ABG was closed to within 20 dB in 89% for T1, 67% for Sc, 58% for Si, and 30% for Fic. ABG was closed to within 30 dB in 95% for T1, 67% for Sc, 83% for Si, and 70% for Fic. There was a significant improvement between preoperative and postoperative ABGs. The overall improvement of the air-bone gap was 8+/-13 dB. There was no significant functional difference between different surgical techniques. CONCLUSION: Our hearing results after tympanoplasties were similar to those from other studies. The hearing results observed in this study confirmed that successful results can be obtained by applying the current principles and approach to ossicular reconstruction.
Cholesteatoma ; Follow-Up Studies ; Head ; Hearing ; Humans ; Otitis ; Otitis Media ; Retrospective Studies ; Tympanoplasty