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

OBJECT: More than 75% of women have been reported to experience premenstrual symptoms and three to eight percent of them suffer from premenstrual dysphoric disorder(PMDD). But little is known about prevalence of premenstrual syndrome(PMS) and PMDD among Korean women. The purpose of this study was to investigate the prevalence of PMDD and PMS in Korean women who attended universities at the time of survey. METHODS: One thousand four hundred and nineteen subjects were randomly selected with cluster sampling method among four women's university in Seoul. We measured the severity of premenstrual symptoms using six-point rating scale developed by the authors on the basis of the research criteria for PMDD in DSM-IV. Premenstrual worsening of symptoms was defined as increase in symptom scores of more than 75% from follicular to luteal phase score. And also, we compared characteristic symptoms, eating behaviors, and functional impairments between PMS and PMDD. RESULT: After excluding inadequate data according to our exclusion criteria, 873 of 1419 subjects(61.5%) were included in the estimation of the prevalence of PMS and PMDD. Each prevalence rate of PMS and PMDD was found to be 83.3% and 5.0% on the basis of 75% change method respectively. The most frequent symptom was physical symptoms such as headache or breast tenderness(56.4%) in PMS and 'felt irritable'(95.5%) in PMDD. Of the 44 subjects with PMDD, 39(88.6%) reported to have experienced the impairment in work or school at least once per month because of premenstrual symptoms. CONCLUSION: Our results indicate that prevalence and symptoms of PMDD in Korean university women are similar to those in western culture. The finding that mood symptoms were more frequent and severe in PMDD than in PMS implies that the former may be a disordered condition to be distinguished from the latter physiologic one.
Breast ; Diagnostic and Statistical Manual of Mental Disorders ; Epidemiology ; Feeding Behavior ; Female ; Headache ; Humans ; Luteal Phase ; Premenstrual Syndrome ; Prevalence* ; Seoul

BACKGROUND: The skin over the lower one third of the nose is less mobile and cannot be easily recruited for the closure of even small defects. In addition, the texture and color of the nose are so unique that neither distant nor nearby skin can always provide a good match. Therefore, when we reconstruct the surgical defect of lower one third of the nose, we must consider the reconstruction method, defect site or size, recurrence of the lesion such as basal cell carcinoma, patient age, general health state, and functional and cosmetic aspects. The bilobed flap is a useful tool for reconstruction of the nose but is occasionally complicated by pincushioning effect or trapdoor deformity. OBJECTIVE: The propose of this study was to evaluate the usefulness of a geometric design of bilobed flap for use in reconstructing defect on the lower one third of the nose. METHODS: From Februrary 1999 to March 2001, we reconstructed defects on the lower one third of the nose after Mohs surgery of basal cell carcinoma in 6 patients using the geometrical design of bilobed flap. Patients were reviewed for complications and cosmetic results. RESULTS: Cosmetically acceptable results were seen in all patients. Significant pincushioning and trapdoor deformity were not presented postoperatively in any patients. CONCLUSION: The geometrical design of bilobed flap is an excellent choice for reconstruction of defects of the lower one third of the nose, particularly around the nasal tip, because of the good skin match and low incidence of complication.
Carcinoma, Basal Cell* ; Congenital Abnormalities ; Humans ; Incidence ; Mohs Surgery* ; Nose* ; Recurrence ; Skin

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

PURPOSE: To retrospectively evaluate the usefulness of diffusion-weighted images, ADC maps and conventional MR images for determination of brain tumor consistency. MATERIALS AND METHODS: Twenty-three patients with brain tumor underwent MR examinations with T1, T2 and diffusion-weighted images. Regions of interest (ROIs) were drawn in the tumors, and the measured signal intensities (SI) were normalized with the contralateral side. We evaluated the correlation between SI ratios from various images and tumor consistency assessed at surgery. In three patients with both cystic and solid components, each component was evaluated independently. Qualitatively observed SIs were also correlated with tumor consistency. RESULTS: Statistical analysis revealed significant correlation between tumor consistency and ADC ratio (r = -0.586, p = 0.002), SI ratios on T2-weighted images (r = -0.497, p = 0.010), and observed SIs on T2-weighted images (r = -0.461, p = 0.018). The relative ratio of ADC value correlated with tumor consistency most strongly. CONCLUSION: The measured ratio of ADC, SI ratio and observed SI grade on T2-weighted images can provide valuable information about the consistency of brain tumor.
Brain ; Brain Neoplasms ; Humans ; Retrospective Studies

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*