PURPOSE: The aim of this study was to analyze the influence of a trauma team's management. METHODS: A total of 181 patients with severe trauma were retrospectively divided into two groups. Of these 181 patients, 81 patients without a trauma team admitted between April and October 2008 were assigned to Group 1, and 100 patients with a Trauma team admitted between April and October 2009 were assigned to Group II. We compared general characteristics, the length of stay in the emergency department (ED) and treatment outcomes (24-h packed RBC transfusion, length of intensive care unit (ICU) stay, length of hospital stay, in-hospital mortality, 24-h mortality) between these two groups. RESULTS: The length of stay in the ED was significantly reduced in Group II compared to Group I (p=0.025). No significant differences were found in mean arterial pressure, Glasgow Coma Scale, Revised Trauma Score, Injury Severity Score, in-hospital mortality and 24-h mortality between the two groups. However, Group II had a lower amount of 24-h packed RBC transfusion and a shorter length of ICU and hospital stay than Group I, although these differences were not statistically significant. CONCLUSION: Through the establishment of a trauma team, the length of stay in the ED can be reduced remarkably. Furthermore, the need for 24-h packed RBC transfusions and the length of stay in the ICU and hospital were found to be decreased in patients managed by a trauma team.
Arterial Pressure ; Emergencies ; Glasgow Coma Scale ; Hospital Mortality ; Humans ; Injury Severity Score ; Intensive Care Units ; Length of Stay ; Retrospective Studies

We investigated a topographical distribution of managanese, and immunohistochemical density of tyrosine hydroxylase (TH), and histopathologic findings in globus pallidus and substantia nigra according to manganese dose and time course in the brain of rats which received MnCl2 intravenously. Topographical distribution of manganese was also investigated after injection of FeCl2. The manganese concentrations of brain in control and experimental group were highest in pituitary gland and thalamus, and lowest in the cerebral cortex. The manganese concentration of blood was increased proportionally to the dose administered, and the biological half-life of blood manganese was between 21 and 42 days. The manganese concentrations of brain were increased proportionally to the dose, and increase rate was highest in olfactory bulb, and the biological half-lives of brain manganese ranged from 42 days to 90 or more days; the longest were observed in pituitary gland, medulla oblongata and cerebral cortex. In case of administration of FeCl2, the manganese concentrations of brain were higher than that of control group in dose of 2.5 mg/kg, and decreased proportionally to the administered dose, resulting in lower level compared with control group in high dose of FeCl2 administered. Significantly decreased number of nerve cell and increased gliosis in globus pallidus were observed in experimental group, which were closely correlated with the duration after manganese injection, but no significant change of number of nerve cell expressing TH and gliosis were observed in substantia nigra. Density of immunohistochemical reaction for TH in globus pallidus made little difference between control and experimental group. These results suggest that pathology of manganese intoxication is caused by the loss of nerve cells in globus pallidus, and closely correlated with the duration after manganese exposure.
Animals ; Brain* ; Cerebral Cortex ; Gliosis ; Globus Pallidus ; Half-Life ; Manganese* ; Medulla Oblongata ; Neurons ; Olfactory Bulb ; Pathology ; Pituitary Gland ; Rats* ; Substantia Nigra ; Thalamus ; Tyrosine 3-Monooxygenase

In the development of a cancer, unlimited cell proliferation has been believed to play an important role. In addition, a programmed cell death called apoptosis, which is regulated by several oncogenes and tumor suppressor genes, has been suggested to be another important different pathway of carcinogenesis. Recently, several reports on cell proliferation capacity and apoptosis in the development of human liver disease have been published, but the cell proliferation index and its relationship between the expression of the bcl-2 and p53 genes involving apoptosis has not yet been discussed in view of the clinical differences of primary and metastatic liver cancer. In this study, we investigated the cell proliferation index and expression of p53 and bcl-2 in the tumorous and non-tumorous portions of both hepatocellular carcinoma and metastatic liver cancer. The expression of p53 was observed in both hepatocellular carcinoma and metastatic liver cancer, but bcl-2 expression was observed neither in hepatocellular carcinoma nor in metastatic liver cancer. In hepatocellular carcinoma, the p53 positive group showed a higher Ki-67 score (cell proliferation index) and more tumor numbers than the p53 negative group (p<0.05). In metastatic liver cancer, the results were the same as in hepatocellular carcinoma (p<0.05). However, we could not correlate the p53 expression and its prognostic significance in hepatocellular carcinoma.
Adult ; Aged ; Carcinoma, Hepatocellular/pathology* ; Carcinoma, Hepatocellular/metabolism* ; Cell Division/physiology ; Female ; Human ; Liver Neoplasms/secondary ; Liver Neoplasms/pathology* ; Liver Neoplasms/metabolism* ; Male ; Middle Age ; Protein p53/metabolism* ; Proto-Oncogene Proteins c-bcl-2/metabolism*

PURPOSE: In spite of curative surgery and early postoperative intraperitoneal chemotherapy, the prognosis of patients with gastric cancer involving the serosal surface is poor. The aim of this study was to analyze p53 protein overexpression in these patients and to clarify the usefulness of p53 mutation as a prognostic indicator. METHODS: p53 protein overexpression was assessed by immunohistochemistry in 123 gastric cancer specimens. The correlation between p53 protein overexpression and clinicopathologic parameters and prognosis of the patients were analyzed. RESULTS: Overexpression of p53 protein was identified in 67 (54.5%) tumors and was more frequent in differentiated tumors than in undifferentiated tumors (67.4% vs. 46.8%; P=0.026). However, there were no statistically significant differences in the frequency of p53 protein overexpression according to age, sex, depth of invasion, lymph node metastasis, distant metastasis, pathologic stage, and Lauren classification. There was no statistically significant difference in 5-year survival rate according to the p53 protein overexpression (P=0.565). CONCLUSION: Overexpression of p53 protein could not predict the effectiveness of early postoperative intraperitoneal chemotherapy. Therefore, it could not be used as a prognostic indicator in patients with advanced gastric cancer who underwent gastrectomy and early postoperative intraperitoneal chemotherapy.
Gastrectomy ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms ; Survival Rate ; Tumor Suppressor Protein p53

PURPOSE: The purpose of this study is to develop a practical method for determining accurate marker positions for prostate cancer radiotherapy using CT images and kV x-ray images obtained from the use of the on-board imager (OBI). MATERIALS AND METHODS: Three gold seed markers were implanted into the reference position inside a prostate gland by a urologist. Multiple digital image processing techniques were used to determine seed marker position and the center-of-mass (COM) technique was employed to determine a representative reference seed marker position. A setup discrepancy can be estimated by comparing a computed COMOBI with the reference COMCT. A proposed algorithm was applied to a seed phantom and to four prostate cancer patients with seed implants treated in our clinic. RESULTS: In the phantom study, the calculated COMCT and COMOBI agreed with COMactual within a millimeter. The algorithm also could localize each seed marker correctly and calculated COMCT and COMOBI for all CT and kV x-ray image sets, respectively. Discrepancies of setup errors between 2D-2D matching results using the OBI application and results using the proposed algorithm were less than one millimeter for each axis. The setup error of each patient was in the range of 0.1+/-2.7~1.8+/-6.6 mm in the AP direction, 0.8+/-1.6~2.0+/-2.7 mm in the SI direction and -0.9+/-1.5~2.8+/-3.0 mm in the lateral direction, even though the setup error was quite patient dependent. CONCLUSION: As it took less than 10 seconds to evaluate a setup discrepancy, it can be helpful to reduce the setup correction time while minimizing subjective factors that may be user dependent. However, the on-line correction process should be integrated into the treatment machine control system for a more reliable procedure.
Axis, Cervical Vertebra ; Humans ; Prostate ; Prostatic Neoplasms ; Radiotherapy

In this study we estimated a geometric correlation among digitally reconstructed radiographic image (DRRI), kV x-ray image (kVXI) from the On-Board Imager (OBI) and electric portal image (EPI). To verify geometric correspondence of DRRI, kVXI and EPI, specially designed phantom with indexed 6 ball bearings (BBs) were employed. After accurate setup of the phantom on a treatment couch using orthogonal EPIs, we acquired set of orthogonal kVXIs and EPIs then compared the absolute positions of the center of the BBs calculated at each phantom plane for kVXI and EPI respectively. We also checked matching result for obliquely incident beam (gantry angle of 315 degrees) after 2D-2D matching provided by OBI application. A reference EPI obtained after initial setup of the phantom was compared with 10 series of EPIs acquired after each 2D-2D matching. Imaginary setup errors were generated from -5 mm to 5 mm at each couch motion direction. Calculated positions of all center positions of the BBs at three different images were agreed with the actual points within a millimeter and each other. Calculated center positions of the BBs from the reference and obtained EPIs after 2D-2D matching agreed within a millimeter. We could tentatively conclude that the OBI system was mechanically quite reliable for image guided radiation therapy (IGRT) purpose.
Radiotherapy, Image-Guided

The incidence of acute leukemia in pregnancy is estimated to be about 1 per 75000 pregnancies, and the incidence of lymphocytic leukemia is known to be lower than myelocytic leukemia. Pregnancy dose not affect the course of acute leukemia, but thrombocytopenia, anemia and leukopenia resulting from leukemia may lead to hemorrhage, infection, and insufficient supply of oxygen and nutrition to fetus. The most important factor for chemotherapy is gestational age. Since no evidence on adverse effect of chemotherapeutic agents on fetus when given after the first trimester, aggressive chemotherapy is recommended during pregnancy. However, during chemotherapy, caution regarding risk of spontaneous abortion, intrauterine fetal growth retardation, teratogenicity, intrauterine fetal death, fetal immunosupression and preterm labor should be taken. Acute leukemia in pregnancy is extremely rare, so treatment and management of the pregnant mother bearing viable fetus in her 3rd trimester is not established clearly. We experienced a patient with acute lymphocytic leukemia who was first diagnosed at 27 gestational weeks and immediately started with chemotherapy. But due to preterm labor and impending fetal distress, emergency cesarean section was performed at 28 gestational weeks. We present this patient along with past experiences of acute leukemia in pregnancy.
Abortion, Spontaneous ; Anemia ; Cesarean Section ; Drug Therapy ; Emergencies ; Female ; Fetal Death ; Fetal Distress ; Fetal Growth Retardation ; Fetus ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Leukemia ; Leukemia, Lymphoid ; Leukemia, Myeloid ; Leukopenia ; Mothers ; Obstetric Labor, Premature ; Oxygen ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Pregnancy Trimester, First ; Pregnancy* ; Thrombocytopenia

PURPOSE: The purpose of this study is to evaluate the usefulness and necessity of an emergency medical service director program for board certified emergency physicians. METHODS: A retrospective analysis of records of direct medical advice provided by board certified emergency physicians in the Busan area from April 1, 2011 to July 11, 2011 was conducted. The medical and legal validity of the medical direction was evaluated by two independent emergency physicians with experience and certification in the field of medical control. RESULTS: Fifteen emergency physicians provided direct medical control during the study period. Five of them were certified as an emergency medical service (EMS) director by the Korean council of EMS physicians (KCEMSP), and the other 10 were not. An analysis of 992 cases of direct medical direction was performed. No differences in the diagnostic appropriateness and medical validity of medical advice were observed between the two groups. A significant difference was observed in legal validity (p=0.048). However, in multivariate analysis, experience as a certified emergency physician was a significant factor determining legal validity (p=0.02), while certification by the KCEMSP was not significant. CONCLUSION: The current EMS director certification program did not have a significant influence on the appropriateness of direct medical direction. EMS director courses and emergency medicine residency programs are in need of improvement in the legal aspect of prehospital emergency service.
Certification ; Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medicine ; Humans ; Internship and Residency ; Jurisprudence ; Multivariate Analysis ; Physician Executives ; Retrospective Studies

OBJECTIVE: We investigated the efficacy and safety of pandemic H1N1 vaccine in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients, and evaluated its correlation with serum cytokine level. METHODS: A total of 43 RA patients and 31 SLE patients were enrolled in the study and were compared with age, sex-matched 40 healthy controls (HC). The blood samples drawn from selected patients before vaccination and in post-vaccination at week 4 were assayed in one session to measure the titers of antibodies against haemagglutinin specific for influenza virus strains: A/California/7/2009 NYMC X-179A (H1N1). Serum IL17 and CXCL13 levels were measured in the same session by enzyme-linked immunosorbent assay. The association of serum cytokine level with anti-influenza antibody titer and mean fold increase (MFI) was investigated. Each specific side effect after vaccination was monitored in both the patients and control groups. RESULTS: The geometric mean antibody titer (GMT) for pre- and post-vaccination at week 4 was not significantly different between RA and HC, SLE and HC. The seroconversion rate in HC and RA was not significantly different, whereas the seroprotection rate is significantly higher in HC (82.5%) than RA (55.8%) (p<0.05). MFI in HC, RA, SLE were 19.65, 6.00 and 6.06, which were significantly higher in HC. Serum IL17 level was 6.28+/-2.89 pg/mL and 7.56+/-3.34 pg/mL in pre-, post-vaccination SLE patients, 33.85+/-15.62 pg/mL and 38.04+/-18.60 pg/mL in RA patients and was significantly lower in SLE patients. Serum CXCL13 level was 518.73+/-720.29 pg/mL and 431.53+/-601.23 pg/mL in pre-, post-vaccination SLE patients, which was significantly higher than HC (149.64+/-248.81 pg/mL and 147.36+/-213.92 pg/mL in each pre-, post-vaccination) and was not significantly different with the level of RA patients. In SLE patients, significant correlations were detected between cytokine level and post-vaccination antibody titer (r=0.22 p=0.026 between IL 17 and GMT; r=0.44, p<0.05 between CXCL13 and GMT). CONCLUSION: The increase in post-vaccination antibody titer is weaker in both RA and SLE patients group than the HC group. Post-vaccination antibody titer was positively correlated with B lymphocyte chemoattractant and CXCL13 in SLE patients, but not in RA patients.
Antibodies ; Arthritis, Rheumatoid ; Enzyme-Linked Immunosorbent Assay ; Humans ; Influenza, Human ; Interleukin-17 ; Lupus Erythematosus, Systemic ; Lymphocytes ; Orthomyxoviridae ; Pandemics ; Vaccination

Paratuberculosis (PTB) is a major disease problem worldwide, and causes major economic losses in the dairy industry. Although PTB has been reported in Korea, no studies have been conducted to determine its prevalence and no program has been developed to control the disease. In this study, the sera of beef (n = 1,056) and dairy cattle (n = 1,105) from all provinces in Korea were tested to determine the prevalence of PTB using two different ELISA: an 'in house' modified absorbed ELISA (P-ELISA) based on sonicated antigen from Mycobacterium avium subsp. paratuberculosis ATCC 19698, and a commercial ELISA (C-ELISA). Receiver operating characteristic analysis was used to determine the cutoff point for P-ELISA. Based on C-ELISA results, the area under the curve for P-ELISA was 0.913 (95% CI, 0.883 to 0.943). Using a cutoff point of 0.100, P-ELISA showed a sensitivity of 62.0% and a specificity of 93.7%. The kappa value and the percent agreement between the two ELISAs were 0.322 and 92.5%, respectively. Both ELISAs showed a significant correlation between age and seropositivity (p < 0.01). According to C-ELISA, 71 of 2,161 sera (3.3%, 95 CI, 2.6% to 4.1%) were test-positive. The national true prevalence of PTB was estimated to be 7.1%. The findings suggest that a control program should be implemented to limit the spread of this disease, and that P-ELISA could be used as a screening test that produces results similar to C-ELISA.
Animals ; Antibodies, Bacterial/blood ; Cattle ; Cattle Diseases/*epidemiology/*microbiology ; Enzyme-Linked Immunosorbent Assay/veterinary ; Female ; Korea/epidemiology ; Male ; Mycobacterium avium subsp. paratuberculosis/*isolation & purification ; Paratuberculosis/blood/*epidemiology ; ROC Curve ; Sensitivity and Specificity ; Seroepidemiologic Studies