The purpose of this article is to provide an overview of pesticide poisoning in South Korea and the relevant epidemiologic characteristics. During the period of 1996-2005, an approximate average of twenty-five hundred fatalities occurred per year due to pesticide poisoning, while age-standardized mortality rates by pesticide poisoning significantly increased from 4.42 to 6.42 per 100,000 population. Intentional self-poisoning was the primary cause of death due to pesticides (84.8% of total pesticide poisoning deaths). The prevalence of non-fatal pesticide poisoning among farmers varied from 5.7% to 86.7%. Paraquat was the leading causative agent for pesticide poisoning, followed by organophosphate insecticides. A variety of work-related factors such as pesticide usage, pesticide application days, hazardous practices and poor personal hygiene were significantly related with pesticide poisoning. The majority of the poisoned were male, elderly individuals possessing low levels of education and residing in rural areas. The number of pesticide poisoning cases was the highest during the growing season of May to August. Further evaluation of the incidence and risk factors of pesticide poisoning at the national level in South Korea is warranted to reduce the number of victims of pesticide poisoning.

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Objective: In urological operations, many endourological procedures and pre-existing urinary tract infections may cause surgical complications. It is essential to identify the risk factors for surgical site infections (SSI) and determine additional influences.
Patients and Methods: In the present retrospective investigation, a total of 324 patients who underwent open urological surgery between January 2003 and December 2007 at Anjo-Kosei Hospital were assessed for SSI along with possible associated factors.
Results: Forty-four cases (13.6%) proved positive for SSIs during the surveillance period. Among these, 31 demonstrated incisional SSI and 13 demonstrated deep/organ space SSI. Greater age and body mass index, low preoperative haemoglobin levels, long preoperative hospital stay, prolonged operation time and increased blood loss during surgery were all positively associated with SSI in general. For the deep/organ space SSI cases, advanced age, low preoperative haemoglobin levels, long preoperative hospital stay and prolonged operation time were significant factors.
Conclusion: This study identified several independent predictors of SSI in general, as well as deep/organ space infection, for urological open surgery at our hospital. The results provided a basis for urologists to decrease the incidence of urological SSI.

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Background: Little information has been collected on the prevalence of hypertension in different rural parts of Japan, using similar methods for sample selection and based on similar diagnostic criteria, and epidemiological studies are urgently needed in each Japanese rural county to determine the baseline against which future trends in risk factor levels can be assessed in order to be able to plan appropriate preventive strategies.
Objective: To study the prevalence and its relationship to risk factors of hypertension without controlled drug treatment in rural populations.
Materials and Methods: Three cross-sectional surveys were conducted in the Akita (north), Gifu (middle) and Fukuoka (south) regions during 2004-2005 using study subjects (n=1778) aged 40-79 years who participated in a health check-up program. Blood pressure was measured by a trained nurse. Information concerning their history of hypertension and lifestyle was obtained by self-administered questionnaires.
Results: When comparing the three regions, the prevalence of hypertension (≥140/90 mmHg) without controlled drug treatment demonstrated a significant difference among males (16.8%, 22.1% and 12.7% in Akita, Gifu and Fukuoka, respectively; p<0.05). However, no significant difference was seen among females (14.4%, 16.0% and 16.5% in Akita, Gifu and Fukuoka, respectively). According to a multivariate logistic regression analysis for these two groups in each of the three regions, the odds ratio (OR) showed that obesity (body mass index≥25 kg/m²) was strongly associated with the Hypertensive (-) group among females in two regions (ORs of 2.32 for both Akita and Fukuoka). Physical inactivity (average daily physical activity energy expenditure<300 kcal), alcohol drinking (alcohol intake≥44 g/day and/or frequency of drinking≥5 days/week), cigarette smoking (Brinkman index≥400) and a stressful lifestyle were not significantly associated with the Hypertensive (-) group among these rural populations.
Conclusions: Therefore, hypertension in females in rural Japan may be controlled by a reduction in body weight.

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Tubo-ovarian abscess (TOA) requires admission to hospital, i.v. antibiotics and, possibly, aspiration or surgery. A 35-year-old woman who was G2P1 was brought into the emergency department because of acute abdomen. A transvaginal ultrasonography demonstrated bilateral cystic adnexal tumors and a moderate amount of ascites suspected to be puss. Laparoscopic examination revealed that the left and right adnexa each formed an inflammatory mass. The left and right tubo-ovarian abscesses both formed masses, and the ovaries were indistinguishable from the tubes and other inflammatory tissues. Laparoscopic bilateral salpingo-oophorectomy was indispensable. Bacterial culture showed no bacterial growth. Performance of laparoscopic bilateral salpingo-oophorectomy was indispensable due to bilateral tubo-ovarian abscesses in this patient.

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Non-tubercuous mycobacterial (NTM) infection in peritoneal dialysis (PD) patients has been rarely reported. We report a case of a 55-year-old female on continuous ambulatory peritoneal dialysis (CAPD). After a 2-year-history of recurrent exit-site infection of a PD catheter caused by Mycobacterium abscessus (M. abscessus), the patient was admitted to the hospital with signs of peritonitis. Since the same species, M. abscessus, was isolated from the CAPD effluent, multiple antibiotics were administered. However, the treatments could not relieve the symptoms of her infection. Consequently, the PD catheter was removed. Her condition gradually recovered over the course of subsequent, long-term, empirical antimicrobial therapies. NTMs, especially a rapidly growing NTM infection, have rarely been reported in PD patients and are commonly resistant to a variety of antimicrobial agents. Routine acid-fast staining is most likely helpful in promptly initiating treatment against NTM infection in PD patients. Moreover, an appropriate treatment regimen for a rapidly growing NTM infection should be established by accumulating data from cases as reported here.

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We present here a case of gouty synovitis of the knee in a patient with partial hypoxanthine-guanine phosphoribosyl transferase deficiency (Kelley-Seegmiller syndrome), which is an inherited purine metabolic disorder. Magnetic resonance images and computed tomography showed a diffuse mass with stippled calcification around the posterior cruciate ligament (PCL) in the posterior intercondylar notch. Arthroscopic examination revealed that the articular surfaces and menisci in the affected knee were almost completely covered with white chalky monosodium urate (MSU) crystals. The diffuse mass around the PCL was composed of proliferative synovial villi covered with MSU crystals that looked like "snow covered trees". Arthroscopic total synovectomy was performed. The posterior trans-septal portal was especially useful for removal of the proliferative villi around the PCL. To our knowledge, this is the first report of arthroscopic examination in a patient with Kelley-Seegmiller syndrome.

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In the future, we will have more aged patients, more cases of bilateral total hip arthroplasty (THA) and more cases of bilateral revision THA. There are not, however, many reports of long-term follow-up of bilateral revision THA. We report a case of bilateral revision THA followed up for 11 years. A 74-year-old woman presented with bilateral painful hip in 1996. She had undergone left THA in 1984 and right THA in 1986 at another hospital. Her JOA(Japan Orthopaedic Association) scores on her first visit (right/left) were 32 points/31 points. Plain radiographs revealed a clear zone in her bilateral proximal femur. We diagnosed her as having looseness of bilateral THA. She required bilateral revision THA and underwent left revision THA (Charnley) in January 1997 (14 years after the original operation) and right revision THA (Charnley) in July 1997 (12 years after the original operation). After bilateral revision THA, we were able to follow up this patient for 11 years. She had no complaints about her bilateral hip joints, and X-ray examination showed no looseness. The JOA scores and range of motion illustrate the good result achieved for this case.

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Intestinal anisakiasis is rarely diagnosed because it is thought to be uncommon and is poorly recognized. It produces severe abdominal pain and an inflammatory reaction often resulting in reactive intestinal obstruction, which is sometimes treated with an unnecessary laparotomy as acute abdomen or intestinal obstruction. We reported a 58-year-old female with acute intestinal obstruction caused by intestinal anisakiasis, which resulted in a self-limiting clinical course. The diagnosis was based on a history of recent ingestion of raw fish and abdominal computed tomographic findings of partial thickening of the intestinal wall accompanied by focal luminal narrowing with ascites. In spite of the severity of the abdominal pain, the bowel obstruction induced by inflammation and edema was resolved with conservative treatment after three weeks. Accordingly, intestinal anisakiasis was considered in the differential diagnosis of intestinal obstruction, which can be treated with conservative therapy.

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Background: Necrotizing fasciitis is a rare but severe condition associated with high mortality. We encountered a patient with severe and rapidly progressing necrotizing fasciitis.
Patient: A 40-year-old male was hit by a tractor and received a wide laceration wound spanning the length of his posterior thigh. Soon after the accident, the wound was washed and debridement was performed. Two days postoperatively, we observed septic changes in the wound and diagnosed this condition as necrotizing fasciitis. Consequently, the patient's leg was amputated at the thigh. The patient, however, developed toxic shock syndrome after the amputation. Endotoxin adsorption using a polymyxin B-immobilized fiber column was performed for 2 days. Finally, a hip joint amputation was performed after 11 days, following which the patient's general condition gradually improved.
Discussion: Treatment for necrotizing fasciitis should be initiated promptly. Early debridement is associated with a significant decrease in mortality. In severe conditions, endotoxin and cytokine removal by blood purification is one of the most effective treatments. Although group A streptococci are widely known as "flesh-eating bacteria," we should also consider a wide variety of pathogenic organisms to be the probable cause of severe necrotizing fasciitis.
Conclusion: Management of necrotizing fasciitis requires careful investigation as well as an aggressive therapeutic approach, which may include urgent surgical intervention. In addition to surgery, endotoxin adsorption therapy should be considered.

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