A clinical observation was made on 29 cases of bladder rupture who were admitted to the Department of Urology, In Je Medical College Paik Hospital in Pusan during the period from June, 1979 to August, 1983. The results are as followings; 1. Of 133 cases of genitourinary tract injury, bladder rupture were 29 cases (21.7%), there composed intraperitoneal bladder rupture 19 cases, extraperitoneal bladder rupture 10 cases. 2. The 29 cases Comprised 19 males and 10 females (male:female=l.9:1). The most prevalent age group of bladder rupture was 20 to 29 years, showing 13 cases of the total cases (44.8%). 3. The causes of bladder rupture were traffic accident observed in 11 cases (37.9%), direct blow 7 cases (24.1%), iatrogenic 4 cases (13.8%), stab wound 3 cases (10.3%) and spontaneous bladder rupture was seen in 1 case (3.5%). 4. The common symptoms and signs of bladder rupture were abdominal pain, lower abdominal distension and gross hematuria, so on. 5. The common associated injuries with bladder rupture were pelvic bone fracture 10 cases (34.5), Cerebral contusion 7 cases (24.1%), rib fracture 4 cases (13.8%), rupture of posterior urethra 3 cases (10.3%), so on. 6. The retrograde cystography was the most likely to accurately diagnose a ruptured bladder, but 1 case was revealed false negative cystograms because of the large hematoma within the pelvic cavity. 7. In all cases, immediate bladder repair and indwelling urethral catheter, with or without suprapubic cystostomy were performed. 8. We experienced postoperative complications such as, voiding difficulty, vesicocutaneous fistula and epididymo-orchitis, etc.
Abdominal Pain ; Accidents, Traffic ; Busan ; Contusions ; Cystostomy ; Female ; Fistula ; Hematoma ; Hematuria ; Humans ; Male ; Pelvic Bones ; Postoperative Complications ; Rib Fractures ; Rupture* ; Urethra ; Urinary Bladder* ; Urinary Catheters ; Urology ; Wounds, Stab

A clinical observation was made on 29 cases of bladder rupture who were admitted to the Department of Urology, In Je Medical College Paik Hospital in Pusan during the period from June, 1979 to August, 1983. The results are as followings; 1. Of 133 cases of genitourinary tract injury, bladder rupture were 29 cases (21.7%), there composed intraperitoneal bladder rupture 19 cases, extraperitoneal bladder rupture 10 cases. 2. The 29 cases Comprised 19 males and 10 females (male:female=l.9:1). The most prevalent age group of bladder rupture was 20 to 29 years, showing 13 cases of the total cases (44.8%). 3. The causes of bladder rupture were traffic accident observed in 11 cases (37.9%), direct blow 7 cases (24.1%), iatrogenic 4 cases (13.8%), stab wound 3 cases (10.3%) and spontaneous bladder rupture was seen in 1 case (3.5%). 4. The common symptoms and signs of bladder rupture were abdominal pain, lower abdominal distension and gross hematuria, so on. 5. The common associated injuries with bladder rupture were pelvic bone fracture 10 cases (34.5), Cerebral contusion 7 cases (24.1%), rib fracture 4 cases (13.8%), rupture of posterior urethra 3 cases (10.3%), so on. 6. The retrograde cystography was the most likely to accurately diagnose a ruptured bladder, but 1 case was revealed false negative cystograms because of the large hematoma within the pelvic cavity. 7. In all cases, immediate bladder repair and indwelling urethral catheter, with or without suprapubic cystostomy were performed. 8. We experienced postoperative complications such as, voiding difficulty, vesicocutaneous fistula and epididymo-orchitis, etc.
Abdominal Pain ; Accidents, Traffic ; Busan ; Contusions ; Cystostomy ; Female ; Fistula ; Hematoma ; Hematuria ; Humans ; Male ; Pelvic Bones ; Postoperative Complications ; Rib Fractures ; Rupture* ; Urethra ; Urinary Bladder* ; Urinary Catheters ; Urology ; Wounds, Stab

Penile traumatic fracture is reported infrequently in the world. A review of the literature suggests that immediate surgical intervention is the treatment of choice. Herein we report on 2 cases with penile fracture, review the literature.

PURPOSE: Gastrointestinal stromal tumors (GISTs) are the most common form of mesenchymal tumor of the gastrointestinal tract. Recently, tyrosine kinase inhibitors have improved the treatment of GISTs, and their diagnosis facilitated by immunohistochemical markers. The aim of this paper was to study the clinicopathological features of GISTs of the stomach and determine the accuracy of a new grading system and the prognostic factors. METHODS: Patients with mesenchymal tumors of the stomach, operated on between 1982 and 2004, were identified using medical and pathological files. Immunohistochemical staining for KIT (CD117), CD34, smooth muscle actin (SMA), desmin and s-100 protein were performed, and the diagnoses reviewed. Cases were classified into either the very low, low, intermediate or high risk groups according to National Institutes of Health (NIH) consensus symposium. RESULTS: 78 mesenchymal tumors were reanalyzed, and with the supportive use of immunohistochemical markers, 71 (91%) of the gastrointestinal mesenchymal tumors were shown to be GISTs. The tumors often coexpressed KIT and CD34 (90%) and were variably positive for SMA (18%), s-100 protein (11%) and desmin (23%). With a median follow-up of 73.9 months (range 1~228 months), a recurrence occurred in 10 (14%) patients. Analyses demonstrated that the mitotic index (P<0.001) and tumor size (P<0.001) were significant prognostic factors for survival. The new grading system showed a significant difference between the risk groups and the survival rates (P<0.001). CONCLUSION: Immunohistochemical staining is needed to distinguish GISTs from other mesenchymal tumors. The tumor size and mitotic count are significant prognostic factors for GISTs. The new grading system (2001 NIH) for classifying the 4 risk groups of GISTs, according to the tumor size and the mitotic count, is useful in the evaluation of the tumor behavior.
Actins ; Consensus ; Desmin ; Diagnosis* ; Follow-Up Studies ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Mitotic Index ; Muscle, Smooth ; National Institutes of Health (U.S.) ; Prognosis* ; Protein-Tyrosine Kinases ; Recurrence ; S100 Proteins ; Stomach* ; Survival Rate

PURPOSE: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. RESULTS: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. CONCLUSION: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional horacotomy.
Abdominal Injuries ; Academic Medical Centers ; Arteries ; Diaphragm ; Heart ; Hemorrhage ; Humans ; Kidney ; Liver ; Lung ; Medical Records ; Multiple Organ Failure ; Pancreas ; Pelvic Bones ; Rupture ; Spine ; Spleen ; Stents ; Survival Rate ; Transplants

PURPOSE: The aim of this study was to compare the distribution and risk from hand positions applied at the center of the chest (CoC) versus the inter-nipple line (INL) during external chest compression by novice rescuers. METHODS: This simulation study included 105 participants. The participants were given photographs of the unexposed male chest and asked to mark a cross at the center of the chest and at the midpoint of the inter-nipple line. The range of contact with the chest was estimated by measuring the participants' palm width. The median and distribution of the two points were then compared and analyzed to determine whether the range in contact with the chest involved the xiphoid process. RESULTS: The level of the INL was approximately 0.8 cm higher at the sternum than the CoC (p<0.001), while the standard deviation of the CoC [1.8(0.6-3.8)] was higher than that of the INL [1.2(0.4-2.4)] (p<0.001). There were more cases in which the palm range involved the xiphoid process in the CoC group [15(14.3%)] than the INL group [1(0.9%)] (p<0.001). CONCLUSION: For male adult patients, chest compression at the level of the INL by novice rescuers is safer and more intensive than compression at the level of the CoC.
Adult ; Cardiopulmonary Resuscitation ; Hand ; Heart Massage ; Humans ; Male ; Nipples ; Sternum ; Thorax* ; Xiphoid Bone

The throat swabs obtained from 1,098 adults and 432 children patients with respiratory diseases were examined for Mycoplasma pneumoniae infection detected by culture and polymerase chain reaction (PCR). Antimicrobial susceptibilities of the resulting 60 M. pneumoniae isolates were evaluated by testing minimum inhibitory concentrations (MICs) of erythromycin, minocycline, tetracycline, josamycin, sparfloxacin, ofloxacin, and ciprofloxacin by a broth micro-dilution method. In a preliminary screening, the detection rate of M. pneumoniae by PCR was 29.2% (277/948) for the adults and 28.3% (90/318) for the children. In the second survey, the isolation rate of M. pneumoniae by culture was 29.3% (44/150) for the adults, and 14.0% (16/114) for the children. The PCR detection rate was 36.7% (55/150) for the adults and 23.7% (27/114) for the children. The MIC90s of the M. pneumoniae isolates were 0.015 mg/ml for erythromycin, lower than 0.03 mg/ml for josamycin, 0.06 mg/ml for sparfloxacin and minocycline, 0.12 mg/ml for tetracycline, 0.5 mg/ml for ofloxacin and CFC-222, and 1.0 mg/ml for ciprofloxacin. The isolates were susceptible to erythromycin, josamycin, sparfloxacin, minocycline, tetracycline, and ofloxacin, but the 63.3% of them was resistant to ciprofloxacin. These results indicate that the PCR method has a significant potential as a rapid and sensitive method for early detection of M. pneumoniae infection in clinical specimens as compared with the culture method, but the PCR method could not provide any information concerning the biological chracteristics of M. pneumoniae strains. Erythromycin, josamycin, sparfloxacin, minocycline, and tetracycline could be recommended as the antimicrobial agents of choice in Korea.
Adult ; Anti-Infective Agents ; Child ; Ciprofloxacin ; Erythromycin ; Humans ; Josamycin ; Korea ; Mass Screening ; Microbial Sensitivity Tests ; Minocycline ; Mycoplasma pneumoniae* ; Mycoplasma* ; Ofloxacin ; Pharynx ; Pneumonia* ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction ; Tetracycline

PURPOSE: Trauma is one of the leading causes of death, especially among young people. Life-threatening conditions are very common in multiple-traumatized patients due to concurrent multi-organ injuries. Treating such severely injured patients is time critical. However, in Korea, the transfer of severely injured patients is not uncommon due to the lack of a mature trauma care system. In developed countries, the preventable trauma death rate is very low, but the rate is still very high in Korea. This study's objective was to demonstrate the current serious state in which severely injured patients have to be transferred from a Regional Emergency Medical Center even though it actually serves as a trauma center. METHODS: Ajou University Medical Center is a tertiary hospital that serves as a trauma center in Gyeonggi-do. The medical records at Ajou University Medical Center for a 1-year period from January 1, 2008, to December 31, 2008, were retrospectively reviewed. A severely injured patient was defined as a patient who showed more than 15 point on the ISS (injury severity score) scale. We investigated the clinical characteristics of such patients and the causes of transfer. RESULTS: Out of 81,718 patients who visited the Regional Emergency Medical Center, 19,731 (24.1%) were injured patients. Among them, 108 severely-injured patients were transferred from one Regional Emergency Medical Center to other hospitals. The male-to-female ratio was about 3.5:1, and the mean ISS was 23.08. The most common mechanism of injury was traffic accidents (41.7%). A major cause of transfer was the shortage of intensive care units (44.4%); another was for emergent operation (27.8%). Most of the hospitals that received the severely-injured patients were secondary hospitals (86.1%). CONCLUSION: Although the Regional Emergency Medical Center played a role as a trauma center, actually, severely-injured patients had to be transferred to other hospitals for several reasons. Most reasons were related with the deficiencies in the trauma care system. If a mature trauma care system is well-organized, the numbers of transfer of severely injured patients will be reduced significantly.
Academic Medical Centers ; Accidents, Traffic ; Cause of Death ; Developed Countries ; Emergencies ; Humans ; Injury Severity Score ; Intensive Care Units ; Korea ; Medical Records ; Retrospective Studies ; Tertiary Care Centers ; Trauma Centers

BACKGROUND AND OBJECTIVES: After the first acute myocardial infarction (AMI), a considerable proportion of patients are newly diagnosed with diabetes mellitus (DM). However, in AMI, controversy remains regarding the disparity in prognosis between previously diagnosed DM (known-DM) and newly diagnosed DM (new-DM). METHODS: The study included 10,455 patients with AMI (non-DM, 6,236; new-DM, 659; known-DM, 3,560) admitted to one of 15 participating centers in Korea between November 2011 and January 2016 (average follow-up, 523 days). We compared the characteristics and clinical course of patients with known-DM and those with new- or non-DM. RESULTS: Compared to patients with known-DM, those with new-DM or non-DM were younger, more likely to be male, and less likely to have hypertension, dyslipidemia, prior stroke, angina, or myocardial infarction. Compared to patients with new-DM or non-DM (reference), those with known-DM had higher risks of major adverse cardiac events (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.06–1.35; p=0.004), cardiac death (HR, 1.26; 95% CI, 1.01–1.57; p=0.042), and congestive heart failure (HR, 1.58; 95% CI, 1.20–2.08). Unlike known-DM, new-DM did not increase the risk of cardiac events (including death). CONCLUSIONS: Known-DM was associated with a significantly higher risk of cardiovascular events after AMI, while new-DM had a similar risk of cardiac events as that noted for non-DM. There were different cardiovascular outcomes according to diabetes status in patients with AMI.
Death ; Diabetes Mellitus ; Dyslipidemias ; Follow-Up Studies ; Heart Failure ; Humans ; Hypertension ; Korea ; Male ; Myocardial Infarction ; Prognosis ; Stroke

Background/Aims: To examine the prevalence and clinical characteristics of apparent treatment-resistant hypertension among ambulatory hypertensive patients. Methods: We enrolled adult ambulatory hypertensive patients at 13 well-qualified general hospitals in Korea from January to June 2012. Apparent resistant hypertension was defined as an elevated blood pressure > 140/90 mmHg with the use of three antihypertensive agents, including diuretics, or ≥ 4 antihypertensives, regardless of the blood pressure. Controlled hypertension was defined as a blood pressure within the target using three antihypertensives, including diuretics. Results: Among 16,915 hypertensive patients, 1,172 (6.9%) had controlled hypertension, and 1,514 (8.9%) had apparent treatment-resistant hypertension. Patients with apparent treatment-resistant hypertension had an earlier onset of hypertension (56.8 years vs. 58.8 years, p = 0.007) and higher body mass index (26.3 kg/m2 vs. 24.9 kg/m2, p < 0.001) than those with controlled hypertension. Drug compliance did not differ between groups. In the multivariable analysis, earlier onset of hypertension (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99; p < 0.001) and the presence of comorbidities (OR, 2.06; 95% CI, 1.27 to 3.35; p < 0.001), such as diabetes mellitus, ischemic heart disease, heart failure, and chronic kidney disease, were independent predictors. Among the patients with apparent treatment-resistant hypertension, only 5.2% were receiving ≥ 2 antihypertensives at maximally tolerated doses. Conclusions Apparent treatment-resistant hypertension prevalence is 8.9% among ambulatory hypertensive patients in Korea. An earlier onset of hypertension and the presence of comorbidities are independent predictors. Optimization of medical treatment may reduce the rate of apparent treatment-resistant hypertension.