Effects of chest compression only cardiopulmonary resuscitation training on retention of correct cardiopulmonary resuscitation knowledge

OBJECTIVE: Performing high quality cardiopulmonary resuscitation (CPR) is important for improving the survival rate with a good neurological outcome and fewer complications. The retention of accurate CPR knowledge is essential for providing high quality CPR. This study examined the effects of chest compression only CPR training on the retention of correct CPR knowledge. METHODS: In December 2016, an interview survey to target the study population was conducted by trained interviewers, using a structured questionnaire. The respondents' general characteristics, status of CPR education, and knowledge and willingness regarding CPR were investigated. Pearson's chi-square tests and multivariate logistic regression analyses were used to determine which education-related factors affected the correct skill knowledge of performing CPR. RESULTS: Among the respondents, there are 80 persons (17.4%) who answered correctly in the questions regarding the skills of performing CPR. The respondents who had a willingness to perform CPR to family and strangers were 90.2% and 44.9% respectively. Through multivariable analysis, the factors related to correct skill knowledge in performing CPR in the didactic with practice group were people who had undergone CPR training within 2 years (odds ratio [OR], 2.293; 95% confidence interval [CI], 1.311–4.009), and person who had undergone chest compression only CPR training (OR, 2.044; 95% CI, 1.033–4.042). CONCLUSION: Chest compression only type of CPR training and the experience of CPR education within 2 years were associated with accurate skill knowledge of performing CPR.

General Characteristics for Poisoning-Induced Transient or Sustained Hyperammonemia

PURPOSE: In patients with altered mentality caused by drugs or unknown causes, ammonia is checked to facilitate differential diagnosis or diagnose hepatic coma. This helps early prevention and treatment of brain damage due to hyperammonemia. This study was conducted to evaluate clinical characteristics of intoxicated adult patients with hyperammonemia. METHODS: We evaluated 95 patients with hyperammonemia among intoxicated patients above the age of 15 who visited our ED from January 2013 to December 2015. We analyzed the demographic characteristics and type of poisoning substance, reason for ingestion, toxicological characteristics such as elapsed time from ingestion to hospital visit, lab, clinical progression and complications. Data were evaluated using the student's t test or Mann-Whitney U test for continuous variables, and Chi-square test and Fisher's exact test for frequency analysis of categorical variables. RESULTS: When compared to healthy individuals, patients with hyperammonemia showed statistical significance on their SOFA score (p=0.016) and poison severity score (p<0.001). Additionally, patients with hyperammonemia showed significantly different initial serum AST level (p=0.012) and maximum serum AST level during the hospital stay (p=0.026) when compared to healthy individuals. Moreover, individuals with sustained hyperammonemia compared to transient hyperammonemia showed clinically significant SOFA scores (p<0.001), poison severity scores (p=0.007), mortality rates in the ICU (p=0.021), as well as different duration of hospital stay (p=0.037), serum creatinine level (p=0.002), erythrocyte sedimentation rate (p=0.025), and serum myoglobin (p=0.015). CONCLUSION: Most poisoning-induced hyperammonemia cases were transient and recovered without special treatment. Therefore, hyperammonemia is almost non-specific among poisoning patients.

The Clinical Spectrum of Gastroesophagel Reflux Disease in Korea / 대한소화관운동학회지

BACKGROUND/AIM: Heartburn, which was the most common symptom of reflux disease, was unreliably interpreted by Korean patients. Our aim was to evaluate the clinical spectrum of gastroesophageal reflux disease(GERD) in Korea. METHODS: Patients who were diagnosed by an endoscopy or ambulatory pH monitoring at a tertiary medical facility were given a validated questionnaire and the clinical spectrums were prospectively investigated. RESULTS: Seventy one patients were included. Heartburn was occurring in 39 patients and the frequency of heartburn on two or more days a week were found in only 12 patients. Negative impact of reflux symptoms on health related well being were found in 16 patients. The reflux related atypical symptoms were hoarseness(55%), globus sensation(45%), cough(25%), and chest pain(20%). Twenty two patients complained of epigastric pain or discomfort more than 6 times a year, with 13 patients listing abdominal pain as the most bothersome one. The clinical spectrums were not different between endoscopy negative patients and those with esophagitis. CONCLUSIONS: Typical reflux symptoms are absent in a substantial proportion of Korean patients with GERD. True dyspepsia could result from gastroesophageal reflux. GERD needs to be clarified in patients with chronic laryngeal symptoms, cough or chest pain.

A Case of Churg-Strauss Syndrome with Appendicitis and Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Churg-Strauss Syndrome is a disorder of hypereosinophilia and systemic vasculitis in subjects with asthma and allergic rhinitis. Clinically, a multiple organ system can be involved with various manifestations of disease of lung, heart, skin, musculoskeletal system, nervous system, gastrointestinal and hepatobiliary tract. We experienced a case of Churg- Strauss syndrome presenting as the appendicitis and the lower gastrointestinal bleeding in a 37-year-old male patient with acute lower abdominal pain. He also showed peripheral eosinophilia, bronchial asthma, and mononeuritis multiplex. He initially received a high dose corticosteroid and was maintained with low doses of corticosteroid, cyclophosphomide and exchange plasmapheresis.

Clinical Significance of Hepatic Arterioportal Shunts in Patients with Hepatocellular Carcinoma / 대한내과학회지

Arterioportal (AP) shunt is related to hepatocellular carcinoma (HCC) with variable frequency but its clinical significance is not well known. We retrospectively studied the prevalence and clinical significance including mortality of the AP shunt combined with HCC. METHODS: The clinical data and radiologic features of HCC patients who were performed hepatic angiography from 1992 to 1997 at St. Mary's Hospital in Korea were reviewed. The data of HCC patients with AP shunt were compared with that of randomized samples of HCC patients without AP shunt. RESULTS: The prevalence of AP shunt in HCC was 7.3%(45/616 HCC patients). There was no significant difference in clinical symptoms and signs such as ascites, encephalopathy, or variceal bleeding and laboratory findings between the HCC patients with AP shunt and those without. The AP shunt was more common in diffuse, poorly demarcated, large HCC. Especially, portal vein thrombosis (PVT) was one of the most common causes of AP shunt. Cumulative survival rate of the HCC patients with AP shunt was lower than that of those without. But only the size of HCC was significantly related with poor prognosis. CONCLUSION: AP shunt occurred in some HCC which was large in size or combined with PVT. AP shunt did not increase the severity of symptoms and signs, but decreased the survival because of its relation to tumor size.

A Case of Congenital Hepatic Fibrosis Associated with Polycystic Kidney Disease / 대한소화기내시경학회지

Congenital hepatic fibrosis is a developmental abnormality that may appear either sporadically or in a familial form. It is an inherited disease defined pathologically by bands of fibrous tissue within the liver, and is occasionally associated with cystic kidney disease. A 21-year-old woman was admitted to our hospital for evaluation of pancytopenia. She showed esophageal varices, hepatomegaly and splenomegaly, but had normal results on her liver function test. Peripheral stigmata of chronic liver disease such as palmar erythema or spider angioma was not found. Hepatosplenomegaly, polycystic kidney and psoas muscle cyst were detected through an abdominal CT and MRI. The patient is diagnosis was confirmed as congenital hepatic fibrosis using laparoscopic liver biopsy. The first case of congenital hepatic fibrosis associated with polycystic kidney disease in Korea is herein reported.

Patterns of Gastroesophageal Reflux and Esophageal Motility in Patients with Mild Reflux Esophagitis / 대한소화기내시경학회지

BACKGROUND AND AIMS: The major complications of reflux esophagitis are stricture formation and Barrett's esophagus. In Korea, the incidence of these complications is low and most patients with reflux esophagitis undergo a mild clinical course. The purpose of this study was to investigate patterns of acid reflux and esophageal motility in mild reflux esophagitis in Korea. METHODS: Using conventional manometry and 24-hour ambulatory pH monitoring, we were investigated esophageal motility and patterns of gastroesophageal reflux in 41 patients with reflux esophagitis Savary-Miller (S-M) Ib using on endoscopy. The total supine, and upright reflux periods, as well as frequency and duration of reflux episodes were determined from the 24-hour pH monitoring record using standard software. Pathologic reflux was defined when the percentage of the total time with pH less than 4 (acid exposure time) exceeded 4%. RESULTS: Pathologic reflux was observed in 17 patients (41.5%), who were categorized into upright refluxers (70.6%), supine refluxers (11.8%), and combined refluxers (17.6%). Patients with reflux esophagitis did not differ in lower esophageal sphincter pressure from the normal subjects. There were two patients (4.9%) with a lower esophageal pressure > or =10 mmHg and four patients (9.8%) with hiatal hernia. Failed peristalsis was seen in 4 patients (9.8%). CONCLUSIONS: A high proportion of upright reflux and low incidence of esophageal peristaltic dysfunction may contribute to the low incidence of stricture formation and Barrett's esophagus in patients with mild reflux esophagitis in Korea.

Gastroesophageal Reflux in Patients with Chronic Laryngeal Symptoms / 대한소화관운동학회지

BACKGROUND/AIMS: The aim of our study was to evaluate the role of gastroesophageal reflux in patients with chronic laryngeal symptoms. METHODS: Fourty-four patients with chronic laryngeal symptoms had not responded to empirical therapies of otolaryngologist, mean age 44.3 years, were studied. They were evaluated with esophageal manometry and 24 hour ambulatory pH monitoring with 2 channel antimony probe. The pathologic reflux was defined as the percentage of total time that the pH was below 4.0 exceeded 4.0%. RESULTS: 1) Chronic laryngeal symptoms were sorethroat (57%), horeseness (50%), globus sensation (14%). 2) Six of the 44 patients had the pathologic reflux at the lower esophagus, four had the pathologic reflux at the upper esophagus. 3) Three (50%) of the 6 patients with pathologic reflux at the lower esophagus were upright refluxer, two (33%) were supine refluxer, and one (16%) was mixed refluxer. Three (75%) of the 4 patients with pathologic reflux at the upper esophagus were uprght refluxer, and one (25%) was supine refluxer. 4) Eleven of the 44 patients had symptoms of heartburn and chest pain. Seven of the 11 patients were more than 50% of the symptom index at the upper esophagus, Eight were at lower esophagus. Six (13.6%) of the 44 patients with positive symptom index did not have pathologic reflux. In summary, chronic laryngeal symptoms were related to acid reflux in twelve (27.2%) of the 44 patients. CONCLUSION: We suggest that some patients with chronic laryngeal symptoms in Korean may have abnormal gastroesophageal reflux.

A Case of Nutcracker Esophagus Associated with Gastroesophageal Reflux: Normalization of Manometry Finding after Omeprazole Therapy / 대한소화관운동학회지

Gastroesophageal reflux disease (GERD) is thought to be caused by an incompetent lower esophageal sphincter, either because of a chronic hypotonia or an increased frequency of transient lower esophageal sphincter relaxation. Thus, it seems paradoxical under nutcracker esophagus to consider gastroesophageal reflux as a possible diagnosis, particularly in the patient presenting with chest pain. Current therapy in nutcracker esophagus is aimed at reducing the high amplitude peristaltic contractions characteristic of this disorder. Treatment directed at reducing contraction can decrease lower esophageal sphincter pressure and may exacerbate gastroesophageal reflux. It is not easy to treat a case of nutcracker esophagus associated with GERD. We report a 38-year-old male with nutcracker esophagus associated with GERD who lost the diagnostic features of nutcracker esophagus after 6 week of antireflux therapy.

A Case of Treatment of Serum EB Virus Antibody Positive Patient Presented with Evans Syndrome / 대한혈액학회지

Evans syndrome is defined as the simultaneous or sequential occurrence of Coombs- positive hemolytic anemia and idiopathic thrombocytopenia. The clinical course is characterized by periods of remission and exacerbation with variable, and often disappointing responses to therapy. We experienced a case of serum Epstein-Barr virus antibody positive patient presented with Evans syndrome in a 31-year-old woman whose chief complaints were dyspnea and general weakness and whose disease responded to the multimodality therapy including prednisolone, plasmapheresis, intravenous immunoglobulin (IVIG), and alternate-day cyclosporine A and prednisolone. This is the encouraging report of the use of multimodality treatment with prednisolone, plasmapheresis, IVIG, and cyclosporine A and prednisolone in a serum EV virus antibody positive patient presented with Evans syndrome.

The Hemolytic Uremic Syndrome Associated with Periappendiceal Abscess / 대한신장학회잡지

The hemolytic uremic syndrome (HUS) is clinically characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The unique cause has not been determined but some bacteria such as E. coli was regarded as the causative agent of HUS in infant. A 30-year-old male patient was admitted due to acute abdomen. In operating field, the periappendiceal abscess was found, so the appendectomy with the drainage of abscess was performed. Initial hemoglobin level was 16.2g/dL but abruptly developed anemia (12.6g/dL) and thrombocytopenia (27000/mm3) was detected at hospital day 3. The urinary outflow was totally absent, the serum creatinine was 12.8mg/dL and the LDH was 3,650IU/L. The peripheral blood smear showed strong evidence of microangiopathic hemolysis. We performed total plasma exchange and hemodialysis under the diagnosis of HUS. The patient's renal function was markedly improved and the last creatinine was 1.9mg/dl. To our knowledge, this is the first report of HUS associated with periappendiceal abscess in Korea. We present a case and the review of literature.

A Case of Obstructive Uropathy Accompanied with Severe Hypernatremia / 대한신장학회잡지

The severe hypernatremia and hyperosmolar dehydration may occur in the patient with partial urinary tract obstruction. The altered tubular function may be the cause of hypernatremia, but it is not generally appreciated. We experienced a case of severe hypernatremia in a 64-year-old male who had suffered from benign prostate hypertrophy with both hydronephrosis. The mental status was lethargic and the serum sodium showed severe hypernatremia(193mEq/L). The urine specific gravity showed hypotonicity. This suggested that the nephrogenic diabetes insipidus was involved in the pathogenesis of hypernatremia. The hypernatremia may be aggravated by the avoidance of water intake, which is due to decreased thirst sensorium in the elderly. The foley catheter was inserted and postobstructive diuresis was occurred. Initially, the patient was managed with isotonic saline and then with half saline. The hypernatremia resolved after 10 days and the patient's status was fully recovered. To our knowledge, this is the first case of obstructive uropathy accompanied with severe hypernatremia in Korea.

Analysis of 15 Cases of Ischemic Colitis Induced by Increased Abdominal Pressure / 대한소화기내시경학회지

It was suggested that temporary vascular insufficiency within the wall of the colon causes iachemic colitis. So, motivated by this fact, we studied and analyzed 15 cases of iachemic colitis, which were confirmed by the diagnostic criteria of Nagasako(1982), through 32 months from January, 1993 to August, 1995 at Our Lady of Mercy Hospital, Incheon.(continue...)

Analysis of 15 Cases of Ischemic Colitis Induced by Increased Abdominal Pressure / 대한소화기내시경학회지

It was suggested that temporary vascular insufficiency within the wall of the colon causes iachemic colitis. So, motivated by this fact, we studied and analyzed 15 cases of iachemic colitis, which were confirmed by the diagnostic criteria of Nagasako(1982), through 32 months from January, 1993 to August, 1995 at Our Lady of Mercy Hospital, Incheon.(continue...)