No abstract available.
Child* ; Edema* ; Gallbladder* ; Humans

PURPOSE: We investigated the effect of anticholinergic drug treatment before midurethral sling surgery in patients with mixed urinary incontinence(MUI). MATERIALS AND METHODS: Between January 2004 and December 2006, 112 female patients with MUI were evaluated. Forty-seven patients were not medicated with anticholinergic drugs(Group A) and 65 patients were medicated with anticholinergic drugs(Group B) for 2 weeks or more(2-8 weeks, mean 2.34+/-1.02) before the midurethral sling operation. After the midurethral sling operation, the patients were followed up for 4 weeks or more(4-48 weeks, Group A is 7.83+/-8.70, Group B is 6.77+/-7.58). Cure of the incontinence after the procedure was defined as the absence of subjective symptoms such as frequency, urgency, urge incontinence and the absence of objective leakage on stress testing. All other cases were considered failures. RESULTS: There were no significant differences between the group that was not medicated preoperatively (Group A) and the group that was preoperatively medicated(Group B)(cure rate of Group A was 87.2% and Group B was 89.2%, p=0.745) in the cure rate for pure stress urinary incontinence. However, comparison of the postoperative results for the MUI showed significant differences (cure rate of Group A was 63.8% and Group B was 81.6%, p=0.035). The cure rate was significantly higher in the preoperatively medicated patients than in the patients who were not preoperatively medicated with regard to the MUI. CONCLUSIONS: Our findings suggest that treatment with anticholinergic medications before a midurethral sling operation improves the cure rate in patients with MUI.
Exercise Test ; Female ; Humans ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Urge

BACKGROUND: Current guidelines of advanced trauma life support recommend open thoracotomy when pericardiocentesis reveals bloody pericardial effusion in patients with blunt chest trauma. However, open thoracotomy may not be always required for treating patients alive until arriving emergency department, because rapid accumulation of the blood into pericardial space results in immediate death at scene. We report our experiences of treating traumatic pericardial effusion, and discuss the therapeutic modality in patients with traumatic pericardial effusion. METHODS: The study consisted of 37 patients(20 males and 17 females with the mean age 42) sustaining traumatic pericardial effusion. The patients were divided according to treatment modality into 3 groups(group I : patients receiving conservative management, group II : patients treated with pericardiocentesis, group III : patients required emergency thoracotomy). We compared clinical presentations, hemodynamic profiles and echocardiographic findings among three groups. RESULTS: Cardiac tamponade was present in 14 of 37 patients. Pericardiocentesis was performed in 13 patients, and open thoracotomy in 4 patients. Pericardiocentesis was curative in 9 patients. Thoracotomy was performed in only 3(24%) of 13 patients required pericardiocentesis. 3(75%) of 4 patients having moderate or severe pericardial effusion from penetrating injury were required open thoracotomy. CONCLUSION: In selected patients who have traumatic pericardial effusion by blunt chest injury, pericardiocentesis may be curative, and thoracotomy may not be inquired as long as bleeding via indwelling pericardial catheter is not sustained after pericardiocentesis.
Advanced Trauma Life Support Care ; Cardiac Tamponade ; Catheters ; Echocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Hemodynamics ; Hemorrhage ; Humans ; Male ; Pericardial Effusion* ; Pericardiocentesis ; Thoracic Injuries ; Thoracotomy ; Thorax

BACKGROUND AND PURPOSE: The purpose of this study is to compare two clinical predictive rules, the pre-arrestmorbidity(PAM) index and the prognosis-after-resuscitation(PAR) score, which predict failure to survive following in-hospital cardiopulmonary resuscitation(CPR). METHOD: The study population consisted of 162 consecutive adult patients who underwent CPR at Wonju Christian Hospital over a year period. The PAM index and PAR score were calculated from the most recent data available for each variable prior to cardiac arrest. Each predictive tool was compared between the group of discharge alive and the group of in-hospital mortality. Performance of the predictive scores was also compared by receiver-operating characteristic(ROC) curves where appropriate. RESULTS: PAM index of study population was 4.39+/-2.69 and PAR score was 2.99+/-3.36. PAM index in the group of discharge alive was 1.87+/-2.79, and PAM index in the group of ih-hospital mortality was 4.51+/-2.62. PAR score in the group of discharge alive was 0.75+/-1.75, and PAR score in the group of in-hospital mortality was 3.1+/-3.4. The PAM index identified 15 patients with a score>8, while the PAR score identified 39 patients with a score>4, none of whom survived. The sensitivity of the PAR score for the prediction of failure to survive was 25%, while that of the PAM index was 10%; neither index incorrectly identified a patient as a non-survivor who eventually survived. Both of predictive methods were not significantly different in the ROC curve. CONCLUSION: Although further confirmation is necessary, PAM index and PAR score may provide useful prognostic information to physicians and patients involved with decisions about do-no- resuscitate orders.
Adult ; Cardiopulmonary Resuscitation* ; Gangwon-do ; Heart Arrest ; Hospital Mortality ; Humans ; Mortality ; ROC Curve

Dermatofibrosarcoma protuberans is a tumor of intermediate malignancy, characterized by its aggressive local growth and marked propensity to recur after surgical excision. Dermatofibrosarcoma protuberans is most frequently located on the trunk or proximal extremities and rarely occurs on the face. In most cases, the tumor initially occurs as an asymptomatic, indurated plaque that slowly increases in size, and then develops multiple firm nodules. We report a case of a 39-year-old female who presented with a 10-year history of asymptomatic, brownish and hypopigmented plaques on the right side of her upper forehead. They gradually extended downwards and erythematous nodules appeared on the superior border of pre-existing brownish plaques 8 months ago. Histopathological examination of a nodule showed spindle-shaped cells with a storiform pattern in the dermis, and that of the plaques showed a parallel pattern. The tumor cells were stained positive for CD 34 upon immunohistochemical staining.
Adult ; Dermatofibrosarcoma* ; Dermis ; Extremities ; Female ; Forehead ; Humans

OBJECTIVES: Computer-based patient record (CPR, Electronic medical record) improves the quality of medical record which reflects the quality of clinical practice. It provides more efficient and convenient way of input, retrieval, storage, communication and management of medical data. The purpose of this study was to develop a practical domestic model and theoretical basis for CPR for psychiatric patients. This model can be applied in other clinical departments. METHODS: The contents and types of items to be included in the data-base were determined through consensus meetings of investigators on the basis of our previous works on the 'comprehensive assessment of symptoms and history in psychiatric disorders' and analysis of structure and items of medical records. The computer program(Asan Medical Center Psychiatric Information System, APIS, version 1.0) was developed using Oracle 7-3-4, Power builder 4.0, Hangul Windows NT and TCP/IP as a programming, development tools, system operation and transmission protocol. RESULTS: The characteristics of APIS are as follows. 1) APIS ensures comprehensive and high quality psychiatric record through combinations of free-text and structured data format and through many available 'help pop-up windows' of required items for better documentations. 2) APIS provides convenient and efficient ways of data input, particularly for narrative input of texts, with various tools such as 'template copy', various 'pop-up lists for block or phrase copy'. 3) APIS enables users to create and modify the template files or scales for research. 4) APIS which adopted principles of POMR (Problem Oriented Medical Record) makes cumbersome management of problem titles very convenient 5) APIS also provides additional statistics necessary for hospital audit and managements as well as mail communication and schedule management of department. 6) Access to APIS requires authorized ID and password where several levels of privileges (view only, edit allowed, master) are assigned to secure the data. And also modification of data was not allowed after completion of medical record except by persons with master ID. User's password and the data before modification can be traced. CONCLUSIONS: Our study results demonstrate the practical model and theoretical basis for CPR for psychiatric patients. We believe that this model and methods contained in this program can also be applied for developments of CPR for other clinical departments.
Appointments and Schedules ; Cardiopulmonary Resuscitation ; Consensus ; Documentation ; Electronic Health Records ; Humans ; Information Systems ; Medical Informatics ; Medical Records ; Medical Records Systems, Computerized* ; Postal Service ; Research Personnel ; Weights and Measures

BACKGROUND: Psoriatic lesions have reduced water-holding capacity and show increased transepidermal water loss (TEWL). The effect of D-PUVA therapy, which combines topical calcipotriol and PUVA therapy, on epidermal barrier function has not yet been evaluated. OBJECTIVE: The purpose of this study was to verify the change of TEWL in lesional and normal skin according to D-PUVA therapy in psoriasis patients. METHODS: TEWL was measured consecutively by TEWAMETER TM210®, in 13 psoriasis patients who received D-PUVA therapy. Clinical grading was done according to psoriasis severity index (PSI). RESULTS: TEWL of psoriatic lesion decreased as D-PUVA continued. TEWL of normal-looking skin gradually increased, although the increase was trivial. Clinical grading of scale and in-filtration followed the pattern of PSI in the decrease of TEWL, while that of erythema did not. CONCLUSION: In psoriatic plaques, TEWL was decreased according to the improvement. In normal-looking skin, D-PUVA therapy caused only a little effect on TEWL.
Erythema ; Humans ; Psoriasis ; PUVA Therapy ; Skin ; Water*

OBJECTIVE: The AMSLU(TM) cage is a newly developed instrument, that utilizes concept of the key-stone graft in posterior lumbar interbody fusion. The authors try to prove the short-term efficacy of AMSLU(TM) cage in surgical treatment of degenerative cervical disc disease. METHODS: We investigate clinical and radiological features of 24 patients who underwent anterior cervical fusion with AMSLU(TM) cage during the period between January 2001 and February 2002. Clinical and radiological results were assessed by using Odom's criteria and regular follow-up of radiographs, respectively. RESULTS: All patients included in this study had been followed by at least 6 months. Except 3 patients, all patients underwent single-level operation, and among remaining 21 patients, C5-6 was the most commonly involved level (17 cases). Symptomatic improvement was found in 22 cases (91%). Evidence of bone fusion was invariably found by the end of the postoperative 6 months in every case and increase of disc height was also shown in all patients. Neither operation-related nor instrument-related complications was seen. CONCLUSION: Anterior cervical fusion with AMSLU(TM) cage has several advantages over the preexisting instruments, such as easy maneurability, avoidance of donor site complications, and anatomical contour which renders it to endure lateral shearing force and its relatively large contact area.
Follow-Up Studies ; Humans ; Tissue Donors ; Transplants

OBJECTIVE: Lumbar lordotic curve on L4 to S1 level is important in maintaining spinal sagittal alignment. Although there has been no definite report in lordotic value, loss of lumbar lordotic curve may lead to pathologic change especially in degenerative lumbar disease. This study examines the changes of lumbar lordotic curve after posterior lumbar interbody fusion with wedge shape cage. METHODS: We studied 45patients who had undergone posterior lumbar interbody fusion with wedge shape cage and screw fixation due to degenerative lumbar disease. Preoperative and postoperative lateral radiographs were taken and one independent observer measured the change of lordotic curve and height of intervertebral space where cages were placed. Segmental lordotic curve angle was measured by Cobb method. Height of intervertebral space was measured by averaging the sum of anterior, posterior, and midpoint interbody distance. Clinical outcome was assessed on Prolo scale at 1month of postoperative period. RESULTS: Nineteen paired wedge shape cages were placed on L4-5 level and 6 paired same cages were inserted on L5-S1 level. Among them, 18patients showed increased segmental lordotic curve angle. Mean increased segmental lordotic curve angle after placing the wedge shape cages was 1.96? Mean increased disc height was 3.21mm. No cases showed retropulsion of cage. The clinical success rate on Prolo's scale was 92.0%. CONCLUSION: Posterior lumbar interbody fusion with wedge shape cage provides increased lordotic curve, increased height of intervertebral space, and satisfactory clinical outcome in a short-term period.
Postoperative Period

Large surgical defects of the face can often be difficult to repair. And so, extensive adjacent tissue transfer may be necessary and may result in significant scars and possible flap compromise. Often there may be less donor tissue available than is necessary to achieve closure. Four cases of malignant tumors on the face were removed by Mohs micrographic surgery, followed by reconstruction of large defects utilizing a purse-string suture and a full-thickness graft. This method enabled dermatologist to reconstruct large surgical defects of the face with a relatively small full-thickness graft. In our cases, there were no significant complications and the results were cosmetically acceptable.
Cicatrix ; Humans ; Mohs Surgery ; Sutures* ; Tissue Donors ; Transplants