Standardized Database of 12-Lead Electrocardiograms with a Common Standard for the Promotion of Cardiovascular Research: KURIAS-ECG / 대한의료정보학회지

Objectives@#Electrocardiography (ECG)-based diagnosis by experts cannot maintain uniform quality because individual differences may occur. Previous public databases can be used for clinical studies, but there is no common standard that would allow databases to be combined. For this reason, it is difficult to conduct research that derives results by combining databases. Recent commercial ECG machines offer diagnoses similar to those of a physician. Therefore, the purpose of this study was to construct a standardized ECG database using computerized diagnoses. @*Methods@#The constructed database was standardized using Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and Observational Medical Outcomes Partnership–common data model (OMOP-CDM), and data were then categorized into 10 groups based on the Minnesota classification. In addition, to extract high-quality waveforms, poor-quality ECGs were removed, and database bias was minimized by extracting at least 2,000 cases for each group. To check database quality, the difference in baseline displacement according to whether poor ECGs were removed was analyzed, and the usefulness of the database was verified with seven classification models using waveforms. @*Results@#The standardized KURIAS-ECG database consists of high-quality ECGs from 13,862 patients, with about 20,000 data points, making it possible to obtain more than 2,000 for each Minnesota classification. An artificial intelligence classification model using the data extracted through SNOMED-CT showed an average accuracy of 88.03%. @*Conclusions@#The KURIAS-ECG database contains standardized ECG data extracted from various machines. The proposed protocol should promote cardiovascular disease research using big data and artificial intelligence.

A Case of Cryptococcal Abscess Involving Deep Neck Space in an Immunocompetent Patient / 대한이비인후과학회지

The encapsulated yeast, Cryptococcus, has rapidly risen to a worldwide major opportunistic fungal pathogen. Infection with Cryptococcus neoformans usually occurs in immunocompromised host and but may occur also occur in immunocompetent patients. Cryptococccal infection commonly involves the lung or central nervous system; it can disseminate to any organ. However, Cryptococcal abscess in deep neck space is rare. We report an immunocompe-tent patient, who was 60-years-old with cryptococcal abscess in deep neck space. Incisional biopsy of the involved soft tissue revealed the presence of Cryptococcus neoformans. Abscess culture also yielded Cryptococcus. Surgical debriment and antifungal therapy resulted in cure.

Analysis of Associated Symptoms of Bell's Palsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate associated symptoms in patients with Bell's palsy and prognosis according to associated symptoms. SUBJECTS AND METHOD: Seventy-four patients with Bell's palsy were enrolled in this study. We evaluated the degree of facial palsy with Facial Nerve Grading System 2.0. The grade of facial palsy was determined as initial facial palsy at admission and as final facial palsy at visit after 3 months. Afterwards, we examined symptoms (such as otalgia, facial numbness, taste disturbance, eye problems, hyperacusis, and tinnitus) and co-morbid diseases (such as diabetes mellitus and hypertension) associated with facial palsy. After 3 months of the onset of facial palsy, we examined the changes in the associated symptoms. RESULTS: At admission, 71.6 percent of all patients had symptoms associated with facial palsy. Of the associated symptoms, facial numbness and taste disturbance were the most common, which were still found in 23% of the patients after 3 months of the onset of facial palsy. Patients with a high initial grade of facial palsy were accompanied by taste disturbance and hyperacusis more than by other symptoms. Also patients who had auricular pain during the recovery period of Bell's palsy showed poor prognosis. Compared to non-hypertension patients, for patients with hypertension, taste disturbance was more common during the early period whereas eye problems were more common during the recovery period. CONCLUSION: Patients with Bell's palsy had diverse symptoms associated with facial palsy. During the early period of Bell's palsy, we concluded that there was no correlation between the symptoms and the prognosis. However, patients with pain around the ear during the recovery period showed poor recovery of facial palsy.

Estimate Hearing Recovery Rate Using Statistical Analysis of Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden deafness is not rare but its pathophysiology has not been fully determined and treatment is controversial at present. There is much debate regarding the prognostic factors in sudden deafness patients. Various studies have been done to find out factors concerned with the recovery of sudden deafness, but there are still many unknown components as the probability of recovery from sudden deafness depends on many factors. The aim of this study is to identify an expectation of recovery by regression formula. SUBJECTS AND METHOD: We reviewed the records of 241 patients who were admitted for treatment between 2002 and 2005 under the initial diagnosis of idiopathic sudden hearing loss. The patients were treated with steroid, vasodilator and plasma expander. Improvement of hearing was measured by Siegel's criteria and correcting rate. Prognostic factors that might be associated with the degree of hearing recovery were classified and analyzed by the optimal scale regression analysis method using SPSS ver. 12.0. RESULTS: Siegel's criteria and correcting rate have statistical correlation with respect to age, initial hearing level, patterns of pure tone audiogram and duration of initial treatment from onset to hearing improvement after treatment. Vertigo is not associated with hearing improvement. CONCLUSION: The initial hearing level, patterns of pure tone audiogram and duration of initial treatment from onset are associated with the degree of hearing recovery. We produced a calculating model of hearing improvement based on factors affecting hearing improvement.

Availability of Spectral Gradient Acoustic Reflectometry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Spectral gradient acoustic reflectometry (SGAR) determines the probability of middle ear fluid by measuring the response of the tympanic membrane to a sound. To assess the sensitivity and specificity of SGAR for the diagnosis of otitis media with effusion (OME) in the Korean population, we compared accurate diagnostic rates of OME obtained from SGAR and tympanometry. Pneumatic otoscope was used for diagnostic standard of OME. SUBJECTS AND METHOD: SGAR and tympanometry were performed on 488 ears from May 27th, 2008 to July 30th, 2008. Exclusion criteria were the presence of tympanic membrane perforation, and/or pressure equalization tubes, noncompliance, otorrhea, external auditory canal stenosis and signs of acute inflammation such as fever or otalgia. In all cases, pneumatic otoscopic examination was conducted and diagnostic accurate rates of OME were calculated in SGAR and tympanogram. RESULTS: Using spectral gradients of 3 or higher as breakpoints for indicating OME, in the case of pediatrics under 2 years old, with the sensitivity of 58.3%, specificity of 94.7%, positive predictive value (PPV) of 77.8% and negative predictive value (NPV) of 87.8%. In the case of the pediatrics between 2 and 12 years old, it showed the sensitivity of 67.2%, specificity of 90.3%, PPV of 74.5% and NPV of 86.8%. In the case of the pediatrics over 12 years old, they showed sensitivity of 87.3%, specificity of 88.8%, PPV of 67.6% and NPV of 96.3%. CONCLUSION: SGAR has the higher tendency of specificity and NPV, and will be a useful screeningtest with good portability and economical efficiency.

Development of a Decision Support Program to minimize Health Insurance Claims Reject: 20% albumin infusion and perineal care procedure / 대한의료정보학회지

This study was focused on developing a computerized decision support program for physician order entry of 20% albumin infusion and perineal care procedures in order to minimize inpatients'insurance claims rejects. The frequency of inpatients health insurance reimbursement claims rejects of a 800-bed tertiary care teaching university hospital in Seoul area was reviewed and the most common two orders of the reject were chosen for the study. The order decision support program was designed on the basis of Korean Health Insurance Reimbursement Guidelines. The server system used for the study was ProLiant 7000 and Pentium III was used for the program development. Windows 2000 was used as the operating system, MS SQL v7.o was used for the database. The software development languages were Visual basic V6.0 and Spread v3.0. This Decision Support Program was proven to be very useful when doctors and nurses wanted to reflect the Health Insurance Reimbursement Guidelines in their ordering practices.

New Tension-free Suture Method in the Forehead Reduction and Scalp Reduction

A variety of treatments has been used to correct long forehead and frontal alopecia. These include forehead reduction (scalp reduction), hair graft and flap transfer. Among these procedures, forehead reduction (scalp reduction) is the most simple and effective method. In this procedure, various fixation techniques of scalp flap to cranial bone are used to prevent retraction of the scalp. We used Sherlock (or Piranha) screw to anchor the scalp flap to cranial bone. Between August 1998 and May 2000, this technique had been performed for 37 patients. Average follow-up period was 15 months. For forehead reduction (scalp reduction), the scalp was elevated back to the occipital region through a pretrichial incision, and relaxation incisions of galea was made at a right angle to the vector of advancement. The Sherlock (or Piranha) screw was fixed to the cranial bone. The entire scalp was then repositioned anteriorly, advancing the hairline caudally and shortening the forehead. Retraction of the scalp was prevented by anchoring the galeal fascia to the cranial bone using Sherlock (or Piranha) screws. This technique allows sufficient advancement of the scalp and a tension-free closure. Postoperatively scar widening was less than that of other methods. There were not any infection, hematoma, hair loss nor permanent paresthesia on scalp. In 2 cases, screws were palpable and we removed a screw for 1 case. Advantages of using Sherlock (or Piranha) screw are that the procedure is easy and simple, and sufficient advancement of the scalp, tension-free closure, and less scar widening can be achieved. Disadvantages of this procedure include cost of screw and palpability of screw. In conclusion, by using Sherlock (or Piranha) screw, the procedure was simple and we could get aesthetically good results.

Cranioplasty with Absorbable Plates for Craniosynostosis

With the introduction of smaller metallic plating systems, many surgeons have adopted their use for craniofacial procedures in infants and small children. However, this metallic plating system had problems associated with the use of plates and screw in infants and children. These problems include intracranial migration of material, cranial growth restriction, foreign body reaction and infection. Absorbable plating system has been used as solution of these problems. In this study, absorbable plates (BioSorbFX, BIONX IMPLANTS inc.) composed of a copolymer of polylactic and polyglycolic acid were used in the reconstruction of pediatric craniofacial deformities. In 4 patients who were diagnosed with craniosynostosis between 10 and 36 months of age, absorbable plates were implanted. Follow-up periods were from 6 months to 18 months. Postoperatively, circumferential length of head was increased and cranial bone growth was symmetric. No complications were seen with this use, including infection, overlying soft tissue reaction, reconstructive instability, or underlying osteolysis around the screws. In secondary reconstructive surgery of patient with Crouzon's disease, we found out that no residual traces of polymer were evident visually and all osteotomy sites were healed completely without underlying osteolysis. These results demonstrate the safety and effectiveness of this copolymeric material for pediatric craniofacial applications.

The Outcome of the Un-operated Contralateral Hand in Bilateral Carpal Tunnel Syndrome

It is not well known how the un-operated contralateral hand behaves in bilateral carpal tunnel syndrome(CTS). Out of 324 CTS patients, we studied 20 who had carpal tunnel release on one hand only, in order to evaluate the postoperative outcome of the un-operated contralateral hand in bilateral carpal tunnel syndrome. All 324 patients were subject to clinical and electrodiagnostic studies on both hands. This study group was composed of patients who had bilateral CTS, diagnosed clinically and electrophysiologically, but who had surgery done only on the hand with the most pronounced symptoms. The results of the electrodiagnosis were categorized according to the severity of median nerve damage (mild, moderate, severe). The decision for surgery was based on clinical assessment and electrodiagnostic study. The outcome and postoperative clinical course of the un-operated contralateral hand were evaluated by EMG and telephone survey. This method of survey was used because of the patients' residence area spread throughout the country. Within one year, all 20 operated hands showed significant improvement. Regarding progress of the un-operated contralateral hand, 10 patients showed improvement of one grade, while five patients showed three grades of improvements. In five other patients, there was no change whatsoever. The postoperative EMG findings of the un-operated contralateral hand did not commensurate with the symptoms. However, regardless of EMG results, the un-operated contralateral hand showed improvement that was of statistical significance(p < 0.0001).

Mechanism of antitumor effect of ursolic acid from eriobotryo japonica / 대한암학회지

No abstract available.