BACKGROUND: The medicolegal problems can be occurred in all medical field, Especially ED can be more exposed to the legal claims due to the very nature of ED business and characteristics of ED patient (or their family member). All emergency physicians, as a ED manager, should be concerned about the law associated with emergency cairo for handling the medicolegal problem. So they can deal with and prevent the legally risky situations that may be occurred in ED practice. Ultimately we can reduce the risk of a malpractice lawsuit and provide good emergency care services. SUGGESTION: The authors would like to suggest several items that we have thought the ED physicians and managers always have to remember to manage the medicolegally risky situations. 1. Every member of ED health care team must be trained in understanding the patients' wants and desires. 2. The emergency physicians and nurses must realize that they are the best risk management tools in the hospital. 3. ED physician should have the knowledge of the law associated with emergency health care. 4. Develop the system that can share the informations about the medicolegal events which were experienced by each ED health care providers of every health care institutes. 5. We should never forget the time honored sentences, 'Good medicine is good law'.
Academies and Institutes ; Commerce ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Empathy* ; Health Personnel ; Humans ; Jurisprudence ; Malpractice ; Patient Care Team ; Risk Management

BACKGROUND: Plasmodium vivax malaria was recently re-presenting infectious disease in Korea since was being controlled for about 10 years age, but has been increasing years by year in the soldiers or farmers working at the near Demilitarized Zone(DMZ). So we analyzed the Characteristics of the patients diagnosed as malaria since 1997 in Yeungnam university hospital. METHODS: From January 1997 to August 1999, the 23 patients complainted of the febrile and chilly sense were diagnosed as Plasmodium vivax malaria in Yeungnam university hospital. We analyzed the patient's records for clinical findings(i.e. clinical symptoms and signs), occupation and regions of working or visiting, laboratory findings, treatment and its results, etc. RESULTS: Male patients were 21 and female patients were 2 among the total 23 patients, the 19 of 21 male patients were soldiers discharged from military services. All patients had been visited or worked near the DMZ, as the northern part of Kyungki-do(21 cases) or Kangwon-do(2 cases). And all patients complainted of delayed onset(means 6 months) of fever and chills after working or visiting at this zones. On physical examination, liver or spleen were palpated initially at least 1 finger breadth in 9 cases(39.1%), and peripheral blood smears showed the infected RBCs(i.e. gametocyte, ring form, schizont, trophozoite) in all cases, and 21 cases(91.3%) showed thrombocytopenia. All patients were treated by the combined regimen of 2-days hydroxychloroquine and 14-days primaquine. All cases showed clinical and laboratory improvement initially, but 5 cases were recurred after 2 months and showed re-improvement. And none of 23 cases showed the significant complications and deaths after medical treatment. CONCLUSION: Plasmodium vivax malarial infection is currently re-presenting disease near the DMZ. So we should consider the active prevention and management of malaria.
Chills ; Communicable Diseases ; Female ; Fever ; Fingers ; Humans ; Hydroxychloroquine ; Korea ; Liver ; Malaria ; Malaria, Vivax* ; Male ; Military Personnel ; Occupations ; Physical Examination ; Plasmodium vivax* ; Plasmodium* ; Primaquine ; Schizonts ; Spleen ; Thrombocytopenia

The series comprised 424 cutaneous reactions to drugs treated at the department of Dermatology, Medical college of Korea University, during the years 1969-1975. The whole series comprised 211 male(49. 8%) and 213 female(50. 2%) patients. Exanthernatous eruptions are the most frequent of all cutaneous manifestation of drug reactions. Antipyretic analgesics, antibiotics and antibacterial drugs were the three group inducing most drug reactions in the present study, following by herb drugs. Of the antipyretic anaIgesics, acetylsalicylic acid was the ones most of the involved, and sulfonamides were the most frequent cause of skin reactions induced by antibacterial drugs and penicillin and tetracycline were the frequent cause of skin reactions induced by antibiotics.
Analgesics ; Anti-Bacterial Agents ; Aspirin ; Dermatology ; Drug Eruptions* ; Humans ; Korea ; Penicillins ; Skin ; Sulfonamides ; Tetracycline

Emergency medicine(EM) is the specialty of evaluating, stabilizing and initiating treatment for patients with life or limb-threatening illnesses or injuries. Techniques unique to the specialty of EM are the triage systems, quick stabilization methods, and emergency surgery procedures. The field of EM encompasses areas such as emergency department management, disaster planning and management, the management of emergency medical service(EMS) systems, research into such areas as brain and heart resuscitation, trauma and disaster management, survival medicine, and environmental emergencies(cold and heat injuries, poisioning, decompression sickness and barotrauma). Today, in addition to providing emergency care, the emergency specialists have moral and legal obligations to assess and report probable cases of child and spouse abuse, sexual assault, and alcohol and drug abuse. Future, the EM should provide surveillance, identification, intervention, and evaluation of injury and disease, therefore EM will remain as a key component of evolving community health care system.
Brain ; Child ; Community Health Services ; Decompression Sickness ; Disaster Planning ; Disasters ; Emergencies* ; Emergency Medical Services ; Emergency Medicine* ; Emergency Service, Hospital ; Heart ; Hot Temperature ; Humans ; Jurisprudence ; Resuscitation ; Specialization ; Spouse Abuse ; Substance-Related Disorders ; Triage

No abstract available.
Bile Ducts* ; Bile*

We observed a significant sign in postenhancement CT of liver cirrhosis, that is visualization of portalvenous branches. During postenhancement CT scanning of liver, the portal vein can not be identifed in liverparenchyme in 84% of patients without known cirrhosis (including chronic active hepatitis). Two have the samehemodynamic changes in that there is diffuse fibrosis and resultant decrease in vascular bed. Visualization ofintrahepatic portal branches in postenhancement CT is because of decreased diffusion ability and portalhypertension.
Diffusion ; Fibrosis ; Hemodynamics ; Humans ; Liver Cirrhosis ; Liver ; Portal Vein ; Tomography, X-Ray Computed

This study investigated the antidepressant efficacy and it's impact on the quality of life of depressed patients. We performed Hamilton Depression Rating Scale(HDRS), and Montgomery-Asberg Depression Rating Scale(MADRS), and Health-related Quality of Life Questionnaire(HQLQ) to both tricyclic antidepressant(TCA) and sertraline groups. There were 16 subjects in the study. The tricyclic group had 9 subjects and the sertraline group had 7. The TCA and sertraline produced a similar degree of response. Both groups experienced a reduction of 70% or more in mean HDRS and MADRS total score after 6wks. In HQLQ, the TCAs group also showed improved bed disability days, alertness behavior, and social interaction, the sertraline group showed improved health perception, alertness behavior, home management, and social interaction. We suggested that the improvement of "Quality of life" were not in proportion to the clinical symptom's improvement. Therefore, clinicians should consider the benefit of antidepressant treatment in terms of quality of life.
Depression ; Humans ; Interpersonal Relations ; Quality of Life* ; Sertraline

The phamacotherapy of depression has reduced morbidity and improved outcome for many depressive patients. A wide range of classical and new antidepressants are available for their treatment. However, 30-40% of all patients do not respond sufficiently to the initial treatment and present adverse effects. Pharmacogenetics studies the genetic basis of an individual's ability to respond to pharmacotherapy. Recently, some reports on serotonin transporter gene polymorphisms and their influence on the response to antidepressive therapy provide an interesting diagnostic tool in assessing the chances of response to antidepressants. We also investigated the relationship between serotonin transprter polymorphisms(5-HTTLPR) and the long-term effect of the antidepressant treatment. 128 depressive patients were enrolled into 2nd year study. The therapeutic response of each subset was not different at 8th, 16th week. but the subset with homozygote(l/l) of long variant showed a better therapeutic response to antidepressant than the heterozygote(l/s) of long and short variant, which showed a better therapeutic response than the subset with homozygote(s/s) of short variant at 1st year and 2nd year after the antidepressant treatment. This result shows that the serotonin transporter polymorphisms may be related to the long-term effect of antidepressant treatment. The potential for pharmacogenomics. the use of genetic increasing attention pharmacogenomics will contribute to individualize drug choice by using genotype to predict positive clinical outcomes, adverse reactions, and levels of drug metabolism. Personalized medicine the use of marker-assisted diagnosis and targeted therapies derived from an individual molecular profile, will impact the antidepressant therapy and this approach will replace the traditional trial-and-error practice of medicine.
Antidepressive Agents ; Depression ; Depressive Disorder* ; Diagnosis ; Drug Therapy ; Genotype ; Humans ; Precision Medicine ; Metabolism ; Pharmacogenetics* ; Serotonin ; Serotonin Plasma Membrane Transport Proteins

No abstract available.
Pleasure*

Chilaiditis syndrome is very rare clinical condition that interposed of the hepatic flexure of large bowels between the liver and diaphragm. Clinically it is characterized by abdominal pain that becomes increasingly worse during the day and is often accentuated by deep breathing. On radiologic studies, it shows gas within the hepatic flexure interposed between the liver and diaphragm, which is simulating a pneumoperitoneum. A case was admitted at emergency care center of Yeungnam university hospital and we report it.
Abdominal Pain ; Chilaiditi Syndrome* ; Diaphragm ; Emergency Medical Services ; Liver ; Pneumoperitoneum* ; Respiration