Background/Aims: Recent reports suggest that the biliary self-expandable metallic stent (SEMS) is highly effective for maintaining hemostasis when endoscopic hemostasis fails in endoscopic retrograde cholangiopancreatography (ERCP)-related bleeding. We compared whether temporary SEMS offers better efficacy than angioembolization for refractory immediate ERCP-related bleeding. Methods: Patients who underwent SEMS placement or underwent angioembolization for bleeding control in refractory immediate ERCP-related bleeding were included in the retrospective analysis. We evaluated the hemostasis success rate, severity of bleeding, change in hemoglobin levels, amount of transfusion, and delay to the start of hemostasis. Results: A total of 27 patients with SEMS and 13 patients who underwent angioembolization were enrolled. More transfusions were needed in the angioembolization group (1.0±1.4 units vs. 2.5±2.0 units; p=0.034). SEMS failure was successfully rescued by angioembolization. The partially covered SEMS (n=23, 85.1%) was generally used, and the median stent-indwelling time was 4 days. The mean delay to the start of angioembolization was 95.2±142.9 (range, 9–491) min. Conclusions Temporary SEMS had similar results to those of angioembolization (96.3% vs. 92.3%; p=0.588). Immediate SEMS insertion is considered a bridge treatment modality for immediate refractory ERCP-related bleeding. Angioembolization still has a role as rescue therapy when SEMS does not work effectively.

PURPOSE: Patient delays in seeking treatment of stroke and Emergency Department delays are major factors in preventing the use of thrombolytic therapy for stroke. For the achievement of rapid diagnosis and treatment in the emergency center, a unified and systematic confrontation of symptoms and good team cooperation are essential. METHODS: Various departments involved in the management of acute stroke in the ED conferred to discuss ways to minimize door-to-CT and door-to-drug times in the ED. This team formulated the BEST (Brain salvage through Emergent Stroke Therapy) protocol to optimize the treatment of acute stroke patients. Our study employed the BEST protocol for four month during the period from October, 2004 to February, 2005. Inclusion criteria for the protocol were admission to our Hospital's ED with an acute neurologic symptoms and an onset time of less than 12 hours. RESULTS: Ninety-six patients, including fifty-eight men were enrolled in the study. Reasons for acute neurologic changes were ischemic stroke (66 patients), hemorrhagic stroke (22 patients), and metabolic causes (8 patients). Of the 66 ischemic stroke patients, 11 received tissue plasminogen activator (tPA) and 2 were administered Intraarterial Urokinase (IAUK). Door-to-CT times before and after initiation of the BEST protocol were 47+/-19 minutes and 26+/-12 minutes, respectively (p-value=0.024). And door-to-drug times before and after the BEST protocol were 96+/-16 minutes and 67+/-28 minutes, respectively (pvalue=0.035). CONCLUSION: Assembly of a specific "stroke team"and implementation of a well-designed protocol allows the most efficient evaluation and treatment of patients with acute stroke, thus minimizing both door-to-CT and door-to-drug times.
Cerebral Infarction ; Diagnosis* ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Medical Records ; Neurologic Manifestations* ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator

BACKGROUND: North Korea's economic and public health problems began in the early 1990s as a result of the gradual loss of economic support from its communist allies, combined with an inordinate number of natural disasters. The decline in public health has increased the incidence of tuberculosis in North Koreans and refugees. This study investigated tuberculosis situation in North Korean refugees in order to prepare for the future impact of tuberculosis control in Korea. MATERIAL AND METHODS: From 2001 to 2005, tuberculosis patients among North Korean refugees who were diagnosed before or after arriving in South Korea, based on the official records of OO hospital, were enrolled in this study. The demographic and clinical data of the cases were evaluated retrospectively. RESULTS: A total of 42 TB cases were reviewed during the study period. Of these, 37 (88.1%) cases were pulmonary TB. based on the cases identified among the number of North Korean refugees' arriving each year, the annual incidence of pulmonary TB were 900 per 100,000 in 2004, 700 in 2003, The number of smear-positive patients was 20 (47.6%) and the number of culture-positive patients was 18 (42.9%). Of the M. tuberculosis isolates, 2 cases were found to be susceptible to all anti-TB drugs available, 4 were resistant to isoniazid, and 3 were multi-drug resistant. CONCLUSION: The prevalence of pulmonary TB in North Korean Refugees is high. In addition, North Korean refugees suffer from more severe tuberculosis in bacteriological and radiological aspects.
Disasters ; Humans ; Incidence ; Isoniazid ; Korea ; Prevalence ; Public Health ; Refugees* ; Retrospective Studies ; Tuberculosis*

PURPOSE: To determine the clinical and radiological features of peripheral osteoma of the mandible (POM) in a Korean population and to compare with previous reports. MATERIALS AND METHODS: Sixteen cases of POM found in 15 Korean patients who visited Seoul National University Dental Hospital between 1980 and 1998 were reviewed to determine their clinical and radiological features. RESULTS: The 15 patients, five males and ten females, ranged in age from 22 to 69 years, with a mean age of 40.7 years. Six POMs were located on the buccal side of the mandibular body and five on the lingual aspect of the mandibular body and five on the lower border of the mandible. The duration of the lesion ranged between 1 and 10 years. The size of the lesions, in their great diameter, ranged from 6 mm to 26 mm, with a mean of 14.1 mm. Six POMs were pedunculated, nine sessile, and one bell-shaped. Eleven POMs were compact types and five were cancellous ones. CONCLUSION: The clinical and radiological features of these Korean series were broadly consistent with those of non-Korean populations reported previously. The principal difference was that all POMs under 35 year-old age were compact types.
Adult ; Female ; Humans ; Male ; Mandible* ; Osteoma* ; Seoul

PURPOSE: We explored the relationship between the use of each medical intervention and the length of time between do-not-resuscitate (DNR) consent and death in Korea. MATERIALS AND METHODS: A total of 295 terminal cancer patients participated in this retrospective study. Invasive interventions (e.g., cardiopulmonary resuscitation, intubation, and hemodialysis), less invasive interventions (e.g., transfusion, antibiotic use, inotropic use, and laboratory tests), and the time interval between the DNR order and death were evaluated. The subjects were divided into three groups based on the amount of time between DNR consent and death (G1, time interval ≤ 1 day; G2, time interval > 1 day to ≤ 3 days; and G3, time interval > 3 days). RESULTS: In general, there were fewer transfusions and laboratory tests near death. Invasive interventions tended to be implemented only in the G1 group. There was also less inotrope use and fewer laboratory tests in the G3 group than G1 and G2. Moreover, the G3 group received fewer less invasive interventions than those in G1 (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03 to 0.84; 3 days before death, and OR, 0.16; 95% CI, 0.04 to 0.59; the day before death). The frequency of less invasive interventions both 1 and 3 days before death was significantly lower for the G3 group than the G1 (p ≤ 0.001) and G2 group compared to G1 (p=0.001). CONCLUSION: Earlier attainment of DNR permission was associated with reduced use of medical intervention. Thus, physicians should discuss death with terminal cancer patients at the earliest practical time to prevent unnecessary and uncomfortable procedures and reduce health care costs.
Cardiopulmonary Resuscitation ; Health Care Costs ; Humans ; Intubation ; Korea* ; Resuscitation Orders ; Retrospective Studies ; Terminal Care

This study was performed to evaluate whether increasing hemoglobin before ascent by prophylactic erythropoietin injections prevents acute mountain sickness (AMS). This open-label, randomized, controlled trial involved 39 healthy volunteers with hemoglobin < or =15.5 g/dL who were divided randomly into erythropoietin (n=20) and control (n=19) groups. Epoetin alpha 10,000 IU injections were given weekly for four consecutive weeks. On day 1, and 7 days after the last injection (day 29), oxygen saturation (SaO2), and hemoglobin were measured. The subjects departed Seoul on day 30 and arrived at Annapurna base camp (ABC, 4,130 m) on day 34. AMS was diagnosed when headache and Lake Louise score (LLS) of > or =3 were present. Immediate descent criteria followed US Army recommendations. Two groups differ in hemoglobin levels on day 29 (15.4+/-1.1 vs 14.2+/-1.0 g/dL, P=0.001). At ABC, erythropoietin group had a significantly lower mean LLS, AMS incidence, and number of subjects who met immediate descent criteria. Multiple logistic regression analysis showed that SaO2<87% and control group, but not hemoglobin<15.0 g/dL, independently predicted satisfaction of immediate descent criteria. Erythropoietin-related adverse effects were not observed. In conclusion, erythropoietin may be an effective prophylaxis for AMS.(Clinical Trial Registry Number; NCT 01665781).
Acute Disease ; Adult ; Altitude Sickness/diagnosis/epidemiology/*prevention & control ; Blood Pressure/physiology ; Drug Administration Schedule ; Erythropoietin/*therapeutic use ; Female ; Headache/physiopathology ; Hemoglobins/analysis ; Humans ; Incidence ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Oxygen/blood ; Questionnaires ; Recombinant Proteins/therapeutic use

BACKGROUND: Burn is one of the most common illness in primary care. Most burns are partial skin thickness burns. The purpose of this study was to evaluate the use ofSilvadene (silver sulfadiazine) ointment (antibacterial agent) and DuoDERMR (artificial syntheticmaterial). METHODS: The subjects of this study were 46 patients with partial skin thickness burns who had visited a general hospital burn clinic from May 1, 2002 to June 30, 2002. They were randomly assigned to the silvadine ointment or DuoDERMR group. The patients were evaluated for pain, the number of dressing change, the ease of dressing application and removal, limitation of activity, comfortableness, satisfaction with the appearance, sleep disturbance, treatment cost, and the number of days for complete epithelialization. RESULTS: DuoDERMR treated burns had a fewer dressing change (3.19 times vs 5.36 times), less time for dressing change (4.13 min vs 6.26 min) and less cost (P<0.01). But there was no statistical difference in the number of days for complete epithelialization (P=0.197) and it depended on the size of the wounds (P=0.005). The cost of treatment was related with the number of dressing change (P=0.000). CONCLUSION: Treatment methods had no effect on duration of treatment but artificial synthetic material was shown to reduce the time for dressing and the cost.
Bandages ; Burns* ; Health Care Costs ; Hospitals, General ; Humans ; Primary Health Care ; Skin* ; Wounds and Injuries

PURPOSE: The purpose of this study is to investigate the changes of osteoclast differentiation inhibition according to the period of precipitation when titanium disks were immersed in Modified simulated body fluid (mSBF). MATERIALS AND METHODS: Titanium alloy (Ti grade III) disks with machined surfaces and anodized surfaces were immersed in distilled water and mSBF, respectively. The immersion periods were 7 days, 14 days, 21 days and 28 days, and the control group was immersed in distilled water for each period. RAW 264.7 cells capable of differentiating into osteoclasts were used to measure the number of adherent cells, the measurement of TRAP activity, and the expression pattern of NFATc1 by western blotting. RESULTS: The degree of inhibition of osteoclast differentiation was found to be statistically significant when the disks were immersed in mSBF for more than 14 days on both machined surfaces and anodized surfaces. There was no correlation between immersion time and cell attachment. When the disks were immersed for more than 14 days, TRAP activity was decreased and NFATc1 expression was inhibited. Futhermore, the decrease in TRAP activity and the inhibition of NFATc1 expression remained unchanged. CONCLUSION: Immersion of titanium disks in mSBF for more than 14 days can prevent RAW 264.7 cells from differentiating into osteoclasts. Inhibition activity does not change even if the immersion period is for more than 14 days.
Alloys ; Blotting, Western ; Body Fluids ; Immersion ; Osteoclasts ; RAW 264.7 Cells ; Titanium ; Water

Dental Occlusion ; Humans ; Malocclusion ; Mandible ; Masks ; Maxilla ; Orthognathic Surgery ; Osteotomy, Sagittal Split Ramus ; Photography

Objectives: With the surge in the elderly population, a growing interest in the prevention and treatment of geriatric diseases has been observed, along with awareness of the severity of problems associated with dementia, a cognitive impairment. The purpose of this study was to investigate the correlation between chewing ability and cognitive function among elderly people residing in a rural area. Methods: A total of 162 elderly individuals, aged between 65 and 97 years, were surveyed. Trained examiners conducted interviews and assessments of chewing ability, on the basis of the number of remaining teeth, denture status, masticatory performance evaluating gum, ShadeEye-NCC measuring overall change in color of the gum (ΔE), and T-Scan® III analyzing distribution of occlusion patterns. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination-Dementia Screening (MMSE-DS) tool. Results: Participants with a low score in the MMSE-DS were found to have distinguishably lower denture need, smaller number of remaining teeth, and lesser color change in the masticatory performance evaluating gum. In the cognitive impairment group, a tendency of having unilateral and anterior occlusion led to occlusal discomfort and chewing difficulties. Conclusions The study highlights important associations between chewing ability and cognitive function. The finding corroborates that tooth loss may be a predictive risk factor for cognitive impairment.