Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea

Background@#Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database. @*Methods@#We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC. @*Results@#The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, P = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96–1.09]). @*Conclusion@#This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.

Modification and Validation of a Complaint-Oriented Emergency Department Triage System:A Multicenter Observational Study

Purpose@#The objective of this study was to modify and validate an emergency department (ED) triage system with improved prediction performance on hospital outcomes by modifying the Korean Triage and Acuity Scale (KTAS). @*Materials and Methods@#We performed a retrospective observational study at three academic universities in South Korea. The KTAS code, determined by the chief complaint and the selected modifier of a patient, was used to derive the Modified KTAS (MKTAS). We calculated the area under the receiver operating characteristics curve (AUC) and the test characteristics to evaluate the performance of MKTAS to predict hospital mortality, critical outcome, and admission. @*Results@#A total of 272402 and 128831 ED visits were used for the derivation and validation of MKTAS, respectively. Compared to KTAS, MKTAS had significantly higher AUC values for the prediction of hospital mortality [MKTAS 0.826 (0.818–0.835) vs. KTAS 0.794 (0.784–0.803)], critical outcome [MKTAS 0.836 (0.830–0.841) vs. 0.798 (0.792–0.804)], and admission [MKTAS 0.725 (0.723– 0.728) vs. KTAS 0.685 (0.682–0.688)]. The sensitivity for predicting hospital mortality and critical outcome, as well as the specificity for predicting admission, were significantly improved. @*Conclusion@#MKTAS was derived by modifying the KTAS, and then validated. Compared with KTAS, MKTAS showed better discriminating ability to predict hospital outcomes. Continuous efforts to evaluate and modify widely used triage systems are required to improve their performance.

Effect of Emergency Department Video-nystagmography for Patients with Dizziness

PURPOSE: We evaluated the effects of emergency department (ED)-based video-nystagmography (VNG) testing on consultation with other departments and length of ED stay of patients with dizziness. METHODS: A before-and-after study was performed at a tertiary ED from May 13, 2011 to May 12, 2012. Adult patients (age> or =15 years) with dizziness were enrolled, excluding patients with incomplete information. We defined the before- and after-phase according to implanting of the ED-based VNG test. The VNG test was performed by an internship physician supervised by 2nd or 3rd grade emergency medicine residents. Primary outcome was any consultation to other specialty departments and the secondary outcome was the length of stay at the ED. The adjusted odds ratios (ORs) with 95% confidence interval (95% CI) for outcomes by phase were estimated using multivariate logistic regression analysis adjusting for potential co-variates. RESULTS: Of 1,485 eligible patients, 1,449 patients (male: 37.0%, mean age: 59.2+/-15.5 years) were enrolled (415 in the before-phase and 1,034 in the after-phase). The final diagnosis group was stroke (4.8%), peripheral vestibulopathy (44.9%), other specific disease (29.0%), and non-diagnostic symptom (21.4%). The consultation request was more reduced in the after-phase (38.1%) than the before-phase (52.5%). The LOS was not changed between both phases (7.4+/-7.5 hours versus 7.4+/-7.3 hours, p=0.76). The adjusted OR (95% CI) for the consultation of after-phase compared to before-phase was 0.46(0.35, 0.61), while the adjusted OR (95% CI) for LOS was 1.39(0.99, 1.95). CONCLUSION: Implementation of ED-based VNG test significantly reduced the consultation with other specialty departments, while LOS was not affected.

Development of Secondary Triage Rules for Interfacility Transfer of Patients with Traumatic Brain Injury

PURPOSE: This study was aimed to develop secondary triage rule for decision of interfacility transfer to higher level of trauma center for patients with traumatic brain injury (TBI). METHODS: In a prospective observational study from August 2006 to December 2007 conducted in an urban tertiary emergency department, data were obtained from patients more than 15 years old and with TBI. Primary outcome was defined as meaningful positive CT findings. Secondary outcome was defined as meaningful intervention. Non-adjusted univariated logistic regression model was derived from result of chi-square test and adjusted model was derived using stepwise selection manner. Hosman-Lemeshow test for the goodness of fit was used. RESULTS: Total number of eligible patients with traumatic brain injury was 653. Primary outcome was positive in 103 patients and secondary outcome was positive in 42 patients. In univariate logistic regression, risk factors were age over 65(OR: 2.40), history of cerebrovascular disease(OR: 7.08), fall over two meter(OR: 6.28), pedestrian struck(OR: 18.5), headache(OR: 2.18), vomiting(OR: 3.03), disorientation(OR: 5.37), any evidence of open fracture(OR: 24.03), Glasgow coma sacle less than 13(OR: 4.97), Racoon's eye sign (OR: 2.50). These 10 risk factors were statistically significant in adjusted model which was derived using stepwise selected manner. Hosman-Lemeshow test for the goodness of fit was used and chi-square was 1.307(p=0.86). This decision rule had a sensitivity of 93.48%, a specificity of 41.13%, and a negative predictive value of 97.32%. CONCLUSION: A sensitive clinical decision rule with high negative predictive value for detection of abnormal CT lesions which need transfer to higher level of trauma center was developed.

Surgical treatment of the anterior skull base tumor / 대한이비인후과학회지

No abstract available.

Preperative evaluation of the mandible in patients with carcinoma of the oral cavity and tonsils / 대한이비인후과학회지

No abstract available.

Relationship between recurrence and histopathological and immunohistochemical pattern of layngeal papilloma / 대한이비인후과학회지

No abstract available.

A Case of Neurilemmoma of the Posterior Wall of the Hypopharynx / 대한이비인후과학회지

Neurilemmoma is a relatively rare benign tumor which may be derived from nerve sheath of the peripheral and cranial nerve. And it is a characteristically solitary and well-encapsulated mass. About 25% of neurilemmoma occurs in the head and neck region and therefore the vestibular nerve is most frequently involved. Neurilemmoma arising in the posterior wall of the hypopharynx is thus quite rare. In this study, we report a recent encounter with a case of neurilemmoma originating from the posterior wall of the hypopharynx in a 44 year old male patient. The tumor was successfully removed by lateral pharyngotomy under general anesthesia.

Surgery for the Base of the Tongue Cancer in Conjunction with Supraglottic Partial Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cancer arising in the base of the tongue with extension to the supraglottic larynx or cancer of the epiglottis with extension to the base of the tongue require wider surgical approach than conventional supraglottic partial laryngectomy. This paper is to review techniques and postoperative results of mandibular swing approach for resection of the base of the tongue with supraglottic larynx. MATERIALS AND METHODS: We applied mandibular swing approach for three cases of the base of tongue cancer with significant extension to supraglottis. Two patients were stage T3 and the other was T4. RESULTS: In two patients, oral feeding without aspiration was possible with 5X6, 4X5 cm sized base of the tongue resection. Reconstruction was performed using primary repair between resected margin of the tongue and thyroid cartilage. In one case, an unexpected wide submucosal tumor extension to the hypopharynx was found, so a total glossolaryngectomy had to be performed. CONCLUSION: Resection of the base of the tongue beyond foramen cecum and primary repair may be possible without jeopardizing postoperative deglutition. Mandibular swing approach in conjunction with supraglottic partial laryngectomy was useful for the base of tongue cancer with supraglottic extension.

A Case of Choristoma of Tongue Base / 대한이비인후과학회지

The choristoma is a tumor like mass of normal cells in an abnormal location. Intraoral osseous and cartilaginous choristoma is distinctly uncommon. The etiology of choristoma is unknown. It is suggested that the intraoral choristoma is a developmental lesion. Correct diagnosis can be obtained only after histopathologic examination. The treatment of choice is surgical excision. We present a case of osseous and cartilaginous choristoma, occurred on the tongue base and treated by peroral excision, with review of the literatures.

Distribution of muscle fiber types in the canine intrinsic laryngeal muscle / 대한이비인후과학회지

No abstract available.

Three cases of neurilemmoma of the nasal cavity / 대한이비인후과학회지

No abstract available.

A histochemical study of muscle fiber type distribution afterreinnervation of posterior cricoarytenoid muscle / 대한이비인후과학회지

No abstract available.

Total Intravenous Anesthesia for High Frequency Jet Ventilation in Laryngomicrosurgery / 대한마취과학회지

Total intravenous anesthesia(TIVA) is desirable technique for a number of reasons. The first is that it implies all the components of general anesthesia : hypnosis, amnesia, analgesia, and muscle relaxation by combination of several drugs and the lungs are ventilated with oxygen-enriched air. A combination of fentanyl-propofol were used as TIVA for laryngomicrosurgery (LMS) with high frequency jet ventilation(HFJV). 41 patients were studied. Glycopyrrolate was given 1 hour before anesthetic induction. Propofol 2 mg/kg was intravenously administered 1 minute after fentanyl 1.5 ug/kg intravenously injection for induction. Endotracheal intubation was performed after succinylcholine administration with internal diameter 4.0-6.0 mm LASER tube through oral cavity or 8 fr. polyethylene catheter through nasal airway. After then, HFJV was started with frequency 108-120 cycles/minute and driving pressure 2.0-2.5 kg/cm(2). The adequacy of ventilation was evaluated with arterial blood gas analysis. For maintenance a continuous propafol infusion of 10 mg/kg/hour was used for the first 10 minutes, followed by 8 mg/kg/hour for the next 10 minutes and 6 mg/kg/hour, thereafter. Continuous dripping of succinylcholine was used for muscle relaxation. The patients showed relatively stable hemodynamic status during procedure (Fig. 1). Two recovery times were as followed: the interval from cessation of infusion until opening eyes on command(4.90+/-3.41 min), and that until correct response to simple question (5.50+/-3.49 min). There was a correlation between total amount of propofol given to patients and recovery times(P<0.05)(Table 1). Interestingly. a group of patients weighed over 70 kg showed carbon dioxide retension on arterial blood gas analysis(Fig. 2). In conclusion, fentanyl-propofol cobination with muscle relaxant is proper regimen for TIVA in LMS with HFJV. More stable and better recovery are the main reasons. However, carbon dioxide retension should be consider to the patients weighed over 70 kg with the HFJV.

Validity of the Intraining Examinations and the Board Examinations -An Experience in the Korean Society of Otolaryngology / 한국의학교육

The korean society of otolaryngology has had and experience on intraining examination since 1992. We also had the fortieth annual board examination for specialist in 1997. But we have no evidence on the validity of these tests yet. The aim of this study is to examine the validity of the intraining examinations as a tool of formative evaluation, to present a personal progress index demonstrating constructive validity, and to examine the validity of the board examination as a tool of summative evaluation. We did statistic analysis on the consecutive personal scores of 1995 and 1996 intraining examinations, and 1997 written and oral board examinations. Analysis of the averages, standard deviations, distribution curves, and Wilcoxon singed rank test on the scores of 1995 and 1996 intraining examinations demonstrated the constructive validity. Chi-square test revealed that those who had low scores in intraining examinations of two consecutive years had low scores in 1997 board examinations and personal progress index demonstrated the predictive validity. Correlation and linear regression analysis demonstrated a strong correlation between 1997 written and oral board examination. Analysis of the averages, standard deviations, distribution curves, and Spearman rank correlation coefficient revealed that 1997 written board examination had higher concurrent validity than the that of oral examination.

Retropharyngeal Lymph Node Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Little information about the surgical anatomy and technique for retropharyngeal node dissection has been published. The purpose of this study was to review our surgical technique and results of retropharyngeal lymph node dissection. MATERIALS AND METHODS: Eleven advanced oropharyngeal and hypopharyngeal squamous cell carcinoma patients who had been treated with resection of primary tumor and standard neck dissection including retropharyngeal lymph node dissection from 1994 to 1999 were evaluated retrospectively. RESULTS: One of 11 patients had positive retropharyngeal lymph node. The surgical technique used for retropharyngeal lymph node dissection were total laryngopharyngectomy, mandibular splitting or mandibulectomy approach. There was no specific complication of retropharyngeal lymph node dissection except one case of Horner's syndrome. CONCLUSION: Retropharyngeal lymph node dissection was a safe procedure, bet it required total laryngopharyngectomy, madibular splitting or mandibulectomy approach. It was possible to remove retropharyngeal lymph made en-bloc with primary tumor in most cases.

Primary carcinoid tumor of the larynx

A case of laryngeal carcinoid in a 54-year-old Korean female is reported and discussed. This tumor is extremely rare in the larynx and there have been just over twenty cases reported in the literature to date. The case showed an initial histologic finding of epithelial dysplasia and was finally confirmed to be a carcinoid tumor. Laryngeal carcinoids are often atypical histologically and may be misdiagnosed as undifferentiated carcinoma. An electron microscopic study revealed neurosecretory-type granules. Although the patient underwent a total laryngectomy and radical neck dissection, multiple hepatic metastasis was noted postoperatively.

A Case of Wound Infection Caused by Vibrio damsela / 감염

Vibrio damsela was isolated from a wound infection of a 71 year-old patient with chronic renal failure. She complained of severe pain, swelling and erythema in her right hand and fingers, which developed after a puncture injury by a crab, Portunus trituberculatus. Her wound infection was improved after pus drainage and antibiotic therapy. This represents the first reported case of wound infection due to V. damsela in Korea.

A Case of Chronic Lymphocytic Leukemia with Trisomy 12 detected by Fluorescence in situ Hybridization (FISH) / 대한임상병리학회지

We report a case of B-cell chronic lymphocytic leukemia (CLL) with trisomy 12 detected by FISH using chromosome 12 alpha-satellite Probe (Oncor , USA) in uncultured interphase cells. Chromosome studies did not produce an analyzable metaphase by standard short term culture and revealed only normal female karyotype by B cell mitogen (phorbol 12-myristate 13-acetate) stimulated 96 hr culture. The patient, a 59-year-old female, did not have hepatomegaly, splenomegaly, lymphadenopathy and any other symptoms. The peripheral blood of the patient showed marked lymphocytosis (WBC : 28,300/microL, Lymphocyte: 80%) and the diagnosis by immunophenotyping was B cell CLL:CD5, CDl9, CD2O, SmIg, HLA-DR positive.

A Case of Chronic Lymphocytic Leukemia with Trisomy 12 detected by Fluorescence in situ Hybridization (FISH) / 대한임상병리학회지

We report a case of B-cell chronic lymphocytic leukemia (CLL) with trisomy 12 detected by FISH using chromosome 12 alpha-satellite Probe (Oncor , USA) in uncultured interphase cells. Chromosome studies did not produce an analyzable metaphase by standard short term culture and revealed only normal female karyotype by B cell mitogen (phorbol 12-myristate 13-acetate) stimulated 96 hr culture. The patient, a 59-year-old female, did not have hepatomegaly, splenomegaly, lymphadenopathy and any other symptoms. The peripheral blood of the patient showed marked lymphocytosis (WBC : 28,300/microL, Lymphocyte: 80%) and the diagnosis by immunophenotyping was B cell CLL:CD5, CDl9, CD2O, SmIg, HLA-DR positive.