Adult ; Anesthesia ; Colloids ; Dizziness ; Equidae ; Fluid Therapy ; Headache ; Humans ; Orthognathic Surgery ; Postoperative Period ; Pulmonary Edema ; Surveys and Questionnaires ; Sleep Stages ; Surgery, Oral ; Thirst

Objective: : Spontaneous intracranial hemorrhage is a life-threatening disease, and non-lesional spontaneous intraparenchymal hemorrhage (nIPH) and aneurysmal subarachnoid hemorrhage (aSAH) are the leading causes of spontaneous intracranial hemorrhage. Only a few studies have assessed the association between prior physical activity or triggering events and the occurrence of nIPH or aSAH. The purpose of this study is to investigate the role of specific physical activities and triggering events in the occurrence of nIPH and aSAH. Methods: : We retrospectively reviewed 824 consecutive patients with spontaneous intracranial hemorrhage between January 2010 and December 2018. Among the 824 patients, 132 patients were excluded due to insufficient clinical data and other etiologies of spontaneous intracranial hemorrhage. The medical records of 692 patients were reviewed, and the following parameters were assessed : age, sex, history of hypertension, smoking, history of stroke, use of antiplatelet or anticoagulation agents, season and time of onset, physical activities performed according to the metabolic equivalents, and triggering event at onset. Events that suddenly raised the blood pressure such as sudden postural changes, defecation or urination, sexual intercourse, unexpected emotional stress, sauna bath, and medical examination were defined as triggering events. These clinical data were compared between the nIPH and aSAH groups. Results: : Both nIPH and aSAH most commonly occurred during non-strenuous physical activity, and there was no significant difference between the two groups (p=0.524). Thirty-two patients (6.6%) in the nIPH group and 39 patients (8.1%) in the aSAH group experienced triggering events at onset, and there was a significant difference between the two groups (p=0.034). The most common triggering events were defecation or urination in both groups. Conclusion : Specific physical activity dose no affect the incidence of nIPH and aSAH. The relationship between the occurrence of intracranial hemorrhage and triggering events is higher in aSAH than nIPH.

PURPOSE: In the past 30 years, the chemotherapeutic approach to advanced colorectal cancer has remained major challenge. Fluorinated pyrimidine has been the main active drugs, and cisplatin was introduced under clinical conditions. Because of the renal and hematologic toxicity of cisplatin, oxaliplatin was developed. The purpose of this study was to assess the clinical response to and the side effects of oxaliplatin chemotherapy. METHODS: From January 1999, 11 patients who received oxaliplatin chemotherapy entered this study. There were 9 males and 2 females, and their ages varied from 40 to 71 years old. The mean ECOG scale was 1. According to TNM staging, 2 was stage 2 at diagnosis, 5 at stage 3, and 4 at stage 4. Totally, we performed 57 cycles of oxaliplatin chemotherapy. Labaratory data and toxicity were assessed for each cycle according to the WHO scale. Ten (10) patients have received follow-up CT since treatment. RESULTS: Grade 1 anemia occurred in 68% of the cycles, grade 2 in 20%, and grade 3 in 12%. Grade 1 thrombocytopenia occurred in 35% of the cycles and grade 2 in 14%. Grade 1 leukopenia and neutropenia occurred in 27% and 25% of the cycles, respectively. Grade 1 stomatitis occurred in 12% of the cycles and grade 2 in 2%. Grade 1 nausea occurred in 44% of the cycles. Grade 1 vomiting occurred in 14% of the cycles and grade 2 in 4%. Grade 1 diarrhea occurred in 10% of the cycles and grade 2 in 4%. Nephrotoxicity was absent, and typical oxaliplatin neurotoxicity was reported as grade 1 in 2% of the cycles. No complete response was observed, and oxaliplatin che motherapy induced one partial remission. CONCLUSION: There was a mild hematologic and alimentary side effect. There were no renal and few neurologic side effects, but the response to oxaliplatin was poor.
Aged ; Anemia ; Cisplatin ; Colorectal Neoplasms* ; Diagnosis ; Diarrhea ; Drug Therapy* ; Female ; Follow-Up Studies ; Humans ; Leukopenia ; Male ; Nausea ; Neoplasm Staging ; Neutropenia ; Stomatitis ; Thrombocytopenia ; Vomiting

PURPOSE: Korean Acuity and Triage Scale (KTAS) has been used nationally since 2016 for triage in emergency departments. After the newly developed triage tool was applied, there have been few studies of the validity of pediatric KTAS. The purpose of this study was to evaluate the validity of KTAS in children under the age of 15 who visited a single children's hospital. METHODS: This retrospective study was conducted on 7,011 pediatric patients under the age of 15 who visited a single child hospital between January 1 and December 31, 2016, the difference in the admission rate, intensive care unit admission rate, length of stay in the emergency department, and total hospital cost in emergency department were analyzed using the KTAS level. RESULTS: The number of patients triaged as KTAS IV was highest with 48.2%. The length of stay was longest in KTAS I and shortest in KTAS V. The medical cost in emergency department was highest in KTAS I and lowest in KTAS V. All dependent variables except for the intensive care unit admission rate showed significant differences according to the KTAS level. CONCLUSION: When the KTAS of the newly developed five level triage system was applied to pediatric patients, there were statistically significant difference in hospitalization, length of stay in emergency department, and total cost to the emergency department according to the KTAS level. Therefore, it will be necessary to evaluate the validity of KTAS through multicenter studies including hospitals with various characteristics.
Child ; Emergencies* ; Emergency Service, Hospital* ; Hospital Costs ; Hospitalization ; Humans ; Intensive Care Units ; Length of Stay ; Retrospective Studies ; Triage*

OBJECTIVE: Patients with low acuity who need hospitalization may be at risk if they do not receive proper treatment in overcrowded emergency rooms. This study was conducted to investigate factors affecting the hospitalization of patients with low acuity of Korean Triage and Acuity Scale (KTAS). METHODS: This study was a retrospective chart review analysis of patients aged 15 years or older who had triaged as KTAS 4 and 5 grades when visiting a local emergency medical center from January 1, 2016 to December 31, 2017. Multivariate logistic analysis was performed to analyze the effects of age, sex, reasons for visiting, visiting route, ambulance utilization, KTAS grade and major category on patient admission. RESULTS: A total of 10,540 patients were enrolled and the odds ratio (OR) increased with age from those aged over 34 years (P < 0.001). Patients that triaged as KTAS grade 5 (adjusted OR, 1.57; 95% confidence interval [CI], 1.36–1.82), had a condition caused by disease (adjusted OR, 2.31; 95% CI, 2.00–2.68), and visited by using an ambulance (public: adjusted OR, 1.05; 95% CI, 0.91–1.22; private: adjusted OR, 4.60; 95% CI, 3.85–5.49) were more likely to be hospitalized. Individuals in the “general” major category were more likely to be hospitalized than those falling into other major categories (P < 0.001). CONCLUSION: The factors influencing the hospitalization of patients with low acuity were age, reasons for visiting, visiting route, ambulance utilization, KTAS grade and major category on patient admission.
Accidental Falls ; Ambulances ; Emergencies* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Odds Ratio ; Patient Admission ; Retrospective Studies ; Risk Factors ; Triage

PURPOSE: No previous study has assessed elderly pedestrian traffic accidents based on a nationwide database. This study aimed to help primary physicians who examine patients in emergency departments to determine and make prompt and accurate treatment decisions. METHODS: This study used data from the Emergency Department-based Injury Indepth Surveillance from 2013 to 2017, managed by the Korea Centers for Disease Control and Prevention. Pedestrians aged ≥65 years were included, and using multivariate logistic regression multiple factors were analyzed to determine their relationship with injury severity. RESULTS: Of 227,695 subjects, 6,498 were included, of whom 2,065 (31.8%) were severely injured. There were more female than male patients in all severity groups. Most accidents occurred in the afternoon and on general roads. In the multivariate analysis, the odds ratio (OR) of injury severity for male pedestrians was 1.165 (95% confidence interval: 1.034–1.313, p=0.012). Older age of patients and the use of ambulances were associated with greater injury severity. The accident time affected the degree of injury severity; i.e., compared to dawn, injury severity increased in the morning (OR: 1.246, p=0.047) and decreased at night (OR: 0.678, p<0.001). A significant difference was noted in the correlation between the type of vehicle causing the accident and the accident severity; i.e., motorcycle accidents had lower severity than bicycle accidents (OR: 0.582, p=0.047). CONCLUSIONS Injury severity was correlated with sex, age, transportation to the ED, TA onset time, and type of vehicle. The study results suggest that injury severity may be positively reflected in initial assessments and overall integrated treatments by physicians and in the related policies.

Depression is common in the patients with rheumatoid arthritis (RA). Estimates of the prevalence of depression in the patients with RA have ranged from 14 to 46%, depending on the criteria used and the patient subgroups studied. Our objectives were to show how frequently depression occur among patients with RA, to compare depression in RA and osteoarthritis (OA) patients, and to identify the disease and sociodemographic variables with which depression are associated. Subjects included in this study were 119 RA patients, and 140 OA patients. The Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depression. The Korean health assessment questionnaire (KHAQ) was used to assess physical function in patients with RA. The associations of sociodemographic variables, disability, severity and other variables with CES-D score were evaluated by multiple regression analysis. RESULTS: When CES-D cut-off score of 25 was used, 54 (50.9%) of 106 RA patients, and 32(23.5%) of 122 OA patients had scores suggestive of depression, and the difference was still significant after adjusting age, sex, disease duration, pain scale and fatigue scale (p<0.05). RA patients had higher mean scores on CES-D than OA patients after adjusting above variables, too (p<0.05). The bivariate analysis showed that age, sex, education level, fatigue scale, pain scale, KHAQ-disability score, WBC, ESR were significantly associated with CES-D scores in RA patients; and the duration of disease, pain scale and fatigue scale were associated with those in OA patients (p<0.05). By stepwise selection in multiple logistic regression model, the age, pain scale and KHAQ-disability score were selected as significant independent variables in RA patients. In OA patients, the duration of disease and pain scale were selected as significant independent variables. CONCLUSION: RA patients are significantly more depressed than OA patients, and the associated factors with depression are patient? age, pain scale and KHAQ disability score in RA.
Arthritis, Rheumatoid* ; Depression* ; Education ; Fatigue ; Humans ; Logistic Models ; Osteoarthritis ; Prevalence ; Surveys and Questionnaires