STUDY OBJECT: To date, the study of critical illness in the emergency department has been limited. The purpose of this study was to determine the length of stay and procedures performed on critical care patient in ED, and to be help to establish Emergency physicians' education program. METHOD: We reviewed patient's medical record, who visited ED, Korea Univ. Hospital from Jan. 1996 to Jun. 1996 and admitted to ICU. We analyzed data to age, sex, clinical diagnosis, length of stay, and critical procedures in ED. RESULTS: The 12,721 patients visited ED during the study period, the 441 of 12,721 (3.50%) patients admitted to ICU. 56 patients were excluded whose medical re cords were incomplete. The study populations consisted of 165 women and 220 men. The mean age were 52 year old (median,58 year old). The mean length of stays were 606.1 (1445.9 minutes (median, 180 minutes)). One hundred sixty one of these patients (41.8 %) received one or more critical procedures. The medical critical patients were 252 cases, and surgical critical patients were 133 cases. The mean length of stay of medical critical patients was 738.8 (1748.9 minutes (median, 177.5 minutes)) in medical department,44.0% of them received critical procedures in ED. The surgical critical patients averaged 354.9 (410.7 minutes (median, 190 minutes)) and 37.6% received critical procedures. CONCLUSION: Critical ill patients stay in the ED with a substantial amount of time, before addition to the ICU. Critical ill patients who have hemodynamiccal unstable conditions, compromised cardiopulmonary functions, and neurologic deficities, were managed in ED frequently. Typical critical care procedures are commonly performed by emergency physicians. Therefore, it is important for emergency physician to prepare to critical ill patients.
Critical Care* ; Critical Illness ; Diagnosis ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Korea ; Length of Stay ; Male ; Medical Records ; Middle Aged

A case of malignant synovioma of the right knee joint is presented. Microscopically it showed sarcomatous growth of spindle cells and irregular slit spaces which were lined by tumor cells. A–K amputation has carried out on 10th hospital day and discharged on 30th hospital day without any complications.
Amputation ; Knee Joint ; Sarcoma, Synovial

A case of eosinophilic granuloma in 38-year-old male was reported. The patient was admitted with chief complaints of pain on the left thigh, tenderness and limping associated with localized swelling on upper 1/3 of left thigh. The diagnosis was confirmed by radiological evidence and biopsy findings. This case was healed completely by curettage. The review of literature was made briefly.
Adult ; Biopsy ; Curettage ; Diagnosis ; Eosinophilic Granuloma ; Eosinophils ; Humans ; Male ; Thigh

OBJECTIVE: The objective of this study was to investigate whether serum levels of vascular endothelial growth factor (VEGF) measured at ovulation triggering day reflect ovarian response in intrauterine insemination (IUI) cycles. METHODS: Forty-nine infertile women who undergoing superovulation and IUI were included. Superovulation was performed using clomiphene citrate (100 mg/d on day 3~7) in combination with human menopausal gonadotropin (150 IU every other day starting on day 5). Serum samples were obtained on the day of hCG administration and the levels of VEGF-A and estradiol were measured. The numbers of mature follicle > or =17 mm in diameter were also counted. RESULTS: Serum VEGF-A levels did not correlate with the numbers of mature follicle count nor serum estradiol levels. Serum estradiol level was positively associated with mature follicle count. Serum VEGF-A levels tended to be lower in women with mature follicle count less than three or women with more than five. CONCLUSION: Our results indicate that serum VEGF-A levels do not have an association with superovulation outcome in IUI cycles. However, a tendency of lower VEGF-A level in poor and high responder suggests that those with extreme response to superovulation may be related with abnormal angiogenesis. Further studies should be warranted in larger populations.
Clomiphene ; Estradiol ; Female ; Gonadotropins ; Humans ; Insemination* ; Ovulation* ; Superovulation ; Vascular Endothelial Growth Factor A*

Multifetal pregnancy reduction(MFPR) has been suggested to improve pregnancy outc-ome in multifetal pregnancies with three or more fetuses after assisted reproductive techn-ology(ART) such as IVF-ET program, and now it seems to be a rather safe and effective mothod to reduce perinatal loss associated with multifetal pregnancies. To investigate the effectiveness of MFPR, the perinatal outcome of twin pregnancies in IVF-ET patients was analyzed in 3 groups : Group I-12 infertile patients who had conceived more than quadru-plet pregnancy and underwent MFPR to twin pregnancy, Group II-29 patients who had conceived triplet pregnancy and underwent MFPR to twin pregnancy, and Group III-30 pat-ients who had conceived twin pregancy initially and served as control group. Among 3 gr-oups, fetal loss rate before 24 weeks of gestation, pregnancy non-reduced, complications, gestational age at delivery, and birth weight were compared. Fetal loss rate after MFPR was significantly higher in Groups I(41.7%) and Group II(17.2%) compared with Group III(3.3%), and positively correlated with the number of fetuses before MFPR in Groups I and II. However, pregnancy complication rate was not significantly different among 3 groups(41.7%, 48.3%, and 36.7%). After exclusion of fetal loss cases before 24 weeks, mean gestational age at twin delivery and mean birth weight were not significantly different among 3 groups(36.2 weeks, 36.6 weeks, and 36.1 weeks ; 2.37 kg, 2.45 kg and 2.47kg).In conclusion, MFPR in multifetal pregnancies is an ethically justified procedure that may improve perinatal outcome in cases of multifetal pregnancies.
Birth Weight ; Embryo Transfer* ; Embryonic Structures* ; Fertilization in Vitro* ; Fetus ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Complications ; Pregnancy, Triplet ; Pregnancy, Twin*

PURPOSE: To investigate the prognostic significance of apoptotic rates in luteinized granulosa cells recovered from patients participating in an IVF program. METHODS: Seventy-three women underwent ovarian hyperstimulation for IVF and embryo transfer. After follicle aspiration, recovered luteinized granulosa cells were stained by Bcl2 monoclonal antibody with FITC and propidium iodide. Fluorescence was detected by flow cytometry, and apoptotic rates or Bcl2 positivities were determined on histogram. RESULTS: Pregnant group showed significantly lower apoptotic rate in luteinized granulosa cells compared with nonpregnant group (p<0.0001). Age of female, basal serum FSH levels, serum E2 concentrations at hCG day, number of oocytes aspirated, fertilization rates, number of embryos transferred and Bcl2 positivities were not different in the two groups. Apoptotic rates were correlated positively with the basal serum FSH levels. Apoptotic rates in luteinized granulosa cells of 6.14% or below could predict a successful pregnancy with sensitivity 87.5% and specificity 73.7%. CONCLUSION: Our result indicates that apoptotic rate in luteinized granulosa cells within follicular fluids can be used as an prognostic indicator for IVF success.
Apoptosis ; Embryo Transfer ; Embryonic Structures ; Female ; Fertilization ; Fertilization in Vitro* ; Flow Cytometry ; Fluorescein-5-isothiocyanate ; Fluorescence ; Follicular Fluid ; Granulosa Cells* ; Humans ; Lutein* ; Oocytes ; Pregnancy ; Propidium ; Sensitivity and Specificity

This study has attempted to show general characteristics of health centre directors who have served the post of directorship during the last 40 years. Of 3,000 such health centre directors, information on about 2,500 directors was collected. While average length of service for health center directors has increased, that of vacancy period has decreased. Rural areas have a shorter average length of service than the urban area. Rural areas have twice longer length of vacancy period per health center. Kangwon-do has the longest average length of vacancy period since 1980(2.79 months/year), and Daejeon has the shortest length of vacancy period(0.21 months/year). Chung-buk has no physician directors. The civil servant's rank for the directorship has promoted from the fifth level to the fourth level since 1990. A comparison between the physician director and non-physician director was made as follows : First, the proportion of physician directors had maintained rather high before 1980s ; 62.5% in 1963, 78.3% in 1970, 70.4% in 1980. It decreased to 44.1% in 1990 and 47.6% in 1997. Instead, non-physician directors has abruptly increased since 1980s(12.4% in 1980, 55.4% in 1990 and 50.8% in 1997). Second, physician directors mainly locate in the urban area(58.0% in 1997), but non-physician directors mainly in the rural area(67.2% in 1997). Third, since 1980, the average length of service for physician directors and for non-physician directors has become similar. Fourth, the mean age of physician directors is 45.1 years, and that of non-physician directors 55.7 years. The latter is 10 years older than the former.
Child ; Gangwon-do ; Humans ; Korea*

No abstract available.
Animals ; Female ; In Situ Hybridization ; Mice* ; Ovary*

A 36-year-old woman presented with a palpable tender mass at the left lower quadrant of the abdomen. She had suffered from constipation for five years and had a previous history of intrauterine device-use for one year. Preoperative barium enema and abdominopelvic CT showed a compatible finding of rectosigmoid colon cancer or left ovary cancer. She underwent segmental resection of the sigmoid colon along with the removal of left distal ureter, left ovary and salpinx. Pathologic examination revealed actinomycotic abscesses containing sulfur granules. Thereafter, she took parenteral ampicillin (50mg/kg/day) for one month and oral amoxicillin (250mg, tid) for 2 months consecutively. The patient has no specific problems for 6 months after surgical resection and long-term antibiotic therapy. This report may be the first of intrauterine device-associated pelvic actinomycosis involving both sigmoid colon and rectum extensively.
Actinomycosis/*complications ; Adult ; Case Report ; Colonic Diseases/*etiology/microbiology ; Female ; Human ; Intestinal Obstruction/*etiology/microbiology ; Pelvic Inflammatory Disease/*complications

The characteristic pathological lesions in ankylosing spondylitis are vertebral body osteoporosis, ankylosis of the apophyseal joints, intervertebral disc calcification, and ligamentous ossification. Calcification of the annulus fibrosis reduces the movement and elasticity of the intervertebral disc, causing this point to be the site of least resistance when the spine is subjected to trauma. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. The ligamentous fragility and multiple fused vertebral segments cause the fractured ankylosing spondylitic spine to resemble a long-bone fracture. In ankylosing spondylitis patient who have sustained minor trauma, a complete radiological study of the entire spine and not just the symptomatic region must be performed for an accurate diagnosis, so that any fracture possible along the spine can be detected and thus prevent any medicolegal problems. The authors report 4 cases of ankylosing spondylitis including 2 cases with severe neurological abnormalities that had occurred after minor trauma.
Ankylosis ; Diagnosis ; Elasticity ; Fibrosis ; Humans ; Intervertebral Disc ; Joints ; Ligaments ; Osteoporosis ; Spinal Fractures ; Spine ; Spondylitis, Ankylosing*