PURPOSE: Procalcitonin (PCT) and C-reactive protein (CRP) are well known inflammatory markers. This study was designed to determine whether PCT and CRP are useful as early diagnostic markers for bacteremia in cancer patients with febrile neutropenia (FN) in the emergency department (ED). MATERIALS AND METHODS: In this retrospective study, 286 episodes of FN in the ED were consecutively included between June 2009 and August 2010. From medical records, clinical characteristics including PCT and CRP were extracted and analyzed. RESULTS: Bacteremia was identified in 38 (13.3%) of the 286 episodes. The median values of PCT (2.8 ng/mL vs. 0.0 ng/mL, p=0.000) and CRP (15.9 mg/dL vs. 5.6 mg/dL, p=0.002) were significantly higher in the group with bacteremia compared to the group without bacteremia. In univariate analysis, elevated PCT (>0.5 ng/mL) and CRP (>10 mg/dL) as well as older age, hypotension, tachycardia, tachypnea, and high body temperature were significantly associated with bacteremia. On multivariate analysis, elevated PCT (>0.5 ng/mL) (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4 to 9.2; p<0.01) and tachypnea (OR, 3.4; 95% CI, 1.4 to 8.5; p<0.01) were independent early diagnostic markers for bacteremia in FN patients. The area under the curve of PCT was 74.8% (95% CI, 65.1 to 84.6%) and that of CRP was 65.5% (95% CI, 54.8 to 76.1%). With a PCT cut-off value of 0.5 ng/mL, sensitivity and specificity were 60.5% and 82.3%, respectively, while the sensitivity and specificity were 57.6% and 67.3%, respectively, with a CRP cutoff of 10 mg/dL. CONCLUSION: These findings suggest that PCT is a useful early diagnostic marker for the detection of bacteremia in FN at the ED and has better diagnostic value than CRP.
Bacteremia ; Biomarkers ; Body Temperature ; C-Reactive Protein ; Calcitonin ; Emergencies ; Humans ; Hypotension ; Medical Records ; Multivariate Analysis ; Neutropenia ; Protein Precursors ; Retrospective Studies ; Sensitivity and Specificity ; Tachycardia ; Tachypnea

PURPOSE: Procalcitonin (PCT) and C-reactive protein (CRP) are well known inflammatory markers. This study was designed to determine whether PCT and CRP are useful as early diagnostic markers for bacteremia in cancer patients with febrile neutropenia (FN) in the emergency department (ED). MATERIALS AND METHODS: In this retrospective study, 286 episodes of FN in the ED were consecutively included between June 2009 and August 2010. From medical records, clinical characteristics including PCT and CRP were extracted and analyzed. RESULTS: Bacteremia was identified in 38 (13.3%) of the 286 episodes. The median values of PCT (2.8 ng/mL vs. 0.0 ng/mL, p=0.000) and CRP (15.9 mg/dL vs. 5.6 mg/dL, p=0.002) were significantly higher in the group with bacteremia compared to the group without bacteremia. In univariate analysis, elevated PCT (>0.5 ng/mL) and CRP (>10 mg/dL) as well as older age, hypotension, tachycardia, tachypnea, and high body temperature were significantly associated with bacteremia. On multivariate analysis, elevated PCT (>0.5 ng/mL) (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4 to 9.2; p<0.01) and tachypnea (OR, 3.4; 95% CI, 1.4 to 8.5; p<0.01) were independent early diagnostic markers for bacteremia in FN patients. The area under the curve of PCT was 74.8% (95% CI, 65.1 to 84.6%) and that of CRP was 65.5% (95% CI, 54.8 to 76.1%). With a PCT cut-off value of 0.5 ng/mL, sensitivity and specificity were 60.5% and 82.3%, respectively, while the sensitivity and specificity were 57.6% and 67.3%, respectively, with a CRP cutoff of 10 mg/dL. CONCLUSION: These findings suggest that PCT is a useful early diagnostic marker for the detection of bacteremia in FN at the ED and has better diagnostic value than CRP.
Bacteremia ; Biomarkers ; Body Temperature ; C-Reactive Protein ; Calcitonin ; Emergencies ; Humans ; Hypotension ; Medical Records ; Multivariate Analysis ; Neutropenia ; Protein Precursors ; Retrospective Studies ; Sensitivity and Specificity ; Tachycardia ; Tachypnea

OBJECTIVE: The aim of this study was to determine whether fetuses delivered prematurely because of pregnancy complications had a different neonatal outcomes than that of those bom after either spontaneous preterm labor or after premature rupture of membrane. METHODS: The study design was a retrospective analysis of 150 very low birthweight(<1500 grams) infants and their mothers who delivered preterm neonates at Samsung Medical Center. Only singleton infants without major congenital anomalies were included. The primary reason for delivery was categorized as preterm delivery because of pregnancy complications(indicated preterm delivery) or spontaneous preterm delivery. Selected neonatal outcomes were compared between infants born to women in each of these groups. RESULTS: There were some survival benefits in infants born to women who underwent indicated preterm delivery from univariate analyses. In the multiple logistic regression analysis, however, selected neonatal outcomes did not differ between the groups. CONCLUSION: We concluded that a "stressed" pregnancies confer negligible survival advantage to the very low birthweight infants.
Female ; Fetus ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Membranes ; Mothers ; Obstetric Labor, Premature ; Pregnancy Complications ; Pregnancy* ; Retrospective Studies ; Rupture

OBJECTIVE: To analyse neonatal outcomes of the very low birthweight infants born to women who underwent an indicated preterm delivery and spontaneous preterm delivery. METHODS: We performed an observational study of 150 very low birthweight(<1500 grams) infants delivered at Samsung Medical Center. The study population was limited to singleton infants without major congenital anomalies. The primary reason for delivery was categorized as indicated preterm delivery or spontaneous preterm delivery. Selected neonatal outcomes were compared between infants born to women in each of these groups. RESULTS: Univariate analyses showed some survival benefits in infants born to women who underwent indicated preterm delivery. Selected neonatal outcomes, however, did not differ between the groups in the multiple logistic regression analysis. CONCLUSION: There was no survival advantage to the very low birthweight infants born to women who underwent an indicated preterm delivery compared to those born to women with spontaneous preterm delivery.
Female ; Humans ; Infant* ; Logistic Models ; Observational Study

The purpose of this study was to examine the ultrastructural characteristic of the normal pylorus mucosa, and their structural changes induced by the ligation of common bile duct of the male rabbits weighing about 1.5 kg each. Experiment animals were divided into normal, sham operation, and experimental groups. Common bile duct ligation was performed under ether anesthesia and anjmals were sacrificed on the 1st, 3rd, 5th, 7th and 14th day after operation. The mucosal specimen of the pylorus, were fixed and embedded with common method. The sections were cut on a LKB-V ultratome, and observed under a JEM 100CX II electron microscope. The results were as follow : 1. In the early stages (1st, 3rd, 5th day groups) following the ligation, surface mucous cells have the various electron densities and shape of the mucous granules. In the late stages (7th, 14th day groups) following the ligation, many surface mucose cells containing numerous electron dense mucous granules are seen. 2. In the early stage of the ligation of bile duct, secretory function of EC cells was depressed, but in the later stage, the cells showed recovered secretory activity. 3. Secretory function of D cells was depressed on the early groups after the ligation of common bile duct, but they showed recovered secretory activity from the late groups after the ligation of the common bile duct. 4. Secretory function of G cells was activated on the early groups after the ligation of common bile duct, but they showed depressed secretory activity from the late groups after the ligation of the common bile duct. Considering the above findings, common bile duct ligation probably causes the dysfunction of the pyloric surface mucous cells that results in delayed mucous formation and secretion, and recovered mucous secretory function on the late stages. EC cells and G cells, depressed the secretory activities on the early stages and recovered on the late stages of the ligation of common bile duct. But D cells in the pyloric mucosa was activated on the early groups after the ligation of common bile duct ligation, but they was depressed secretory activities on the late groups.
Anesthesia ; Animals ; Bile Ducts ; Common Bile Duct* ; Ether ; Gastrin-Secreting Cells ; Humans ; Ligation* ; Male ; Mucous Membrane* ; Pylorus ; Rabbits ; Somatostatin-Secreting Cells

BACKGROUND: A curriculum in medical school should help doctors achieve professional attitude, ethics and values by socialization process. However, existing knowledge-based curriculum has lots of shortcomings to reach these ideal goals. This study was operated to investigate the effect of a 'service-learning program' for premedical students in medical college of Korea University. METHODS: The survey was conducted from July 3 2006 to 5 at Chungbuk Eumsung Kkottongnae. A total of 99 students completed surveys; before and after the intervention. The questionnaire was consisting of necessity and goal of the program and it also include assessment of students' attitude and contents of the program. Each item was assessed by using 5-Likert scale. For comparing the items, we practiced paired t-test. RESULTS: 97 (response rate 97.9%) students completed survey. 53 students (54.6%) agreed 'the program is really needed.' About the questions: 'self-development from program', 'the program will be helpful for medical activity in the future.' students gave positive answers. The participants' attitude, interest was significantly increased. Also 'the motivation', 'appropriation of the program and time allocation', 'general satisfaction' were all increased. CONCLUSION: 54.6% of participants thought a service-learning program was necessary for a medical curriculum and this program would be helpful to get self-development and professionalism. Active attending for a service-learning program increased interest and motivation. It will be needed further study about the long-term effect of a service-learning program.
Curriculum ; Education, Medical ; Humans ; Korea ; Learning ; Motivation ; Schools, Medical ; Socialization ; Students, Premedical ; Surveys and Questionnaires

BACKGROUND: The National Institutes of Health Stroke Scale (NIHSS) is regarded as a valid and reliable tool to measure the severity of neurological deficits in acute stroke, but has been criticized for its complexity and variability. Therefore, the modified NIHSS (mNIHSS) was developed, eliminating redundant and less reliable items from the full version of the NIHSS. The aim of the present study was to evaluate the validity of the mNIHSS according to the subtypes of stroke and the location of affected arterial territories. METHODS: The severity of stroke in 155 patients with acute cerebral infarction was measured. Each patient was evaluated by two neurologists using both the NIHSS and mNIHSS, and the stroke subtype was determined according to the TOAST classification. The vascular territory of lesion was classified into an anterior and posterior circulation. The criterion-related validity was evaluated by the Pearson Correlation Coefficient between the NIHSS and mNIHSS scores. RESULTS: When considering the NIHSS scores as the gold criteria, the Pearson correlation coefficients of the mNIHSS were 0.96 in the subtype of large artery atherosclerosis, 0.91 in small vessel occlusion, 0.98 in cardioembolism, and 0.99 in undetermined etiology. On the other hand, the correlation coefficient was 0.98 in patients with an anterior circulation infarction, and was 0.94 in patients with a posterior circulation infarction. CONCLUSIONS: The criterion-related validity of the mNIHSS scoring system was very high in general. However, the correlations were relatively low in patients with the TOAST subtype of small vessel occlusion and also a posterior circulation infarction.
Arteries ; Atherosclerosis ; Cerebral Infarction* ; Classification* ; Hand ; Humans ; Infarction ; National Institutes of Health (U.S.) ; Stroke*

PURPOSE: This paper reports on the development a program to foster 'good doctors' who care for their patients with humanism and self-directed learning ability. METHODS: In order to develop the program, Korea University College of Medicine established educational committees. In collaboration, these committees discussed the direction for curriculum reorganization, performed a needs analysis of specified programs, and built realistic strategies for program management. Based upon the needs analyses, through literature review and survey studies, committee discussions and benchmarking of other medical schools, three programs were developed for rearing humanism and self-directed learning ability in medical students were developed: Service learning by experiential learning; Doctoring by small group activities; and Communication skills program by various small group activities. RESULTS: The evaluation by the pre-medical students who participated in the service learning program for one week reveals that through service learning, pre-medical students had an opportunity to obtain the attitudes that encompass the sanctity and dignity of human life and an understanding of cultural, social and religious customs and beliefs that differ from his or her own. In addition, the pre-medical students came to realize that patients' most difficult problems might be caused by non-medical factors as well as medical factors. CONCLUSION: It is needed to grope for the way that leads the active participation of students in the continuous linkage of substantial post-work evaluation and next learning of volunteering in order to make the program of educating the public spirit more than self-learning of experience.
Benchmarking ; Cooperative Behavior ; Curriculum* ; Education, Medical ; Humanism ; Humans ; Korea ; Learning* ; Problem-Based Learning ; Schools, Medical ; Students, Medical

BACKGROUND: Pressure-induced skin breakdown is not only a painful inconvenience to the patient, but it is also associated with a prolonged hospital stay. This study examined the incidence of pressure-induced skin breakdown in attempt to identify the associated risk factors during elective surgery. METHODS: Data were collected from 808 subjects who underwent orthopedic, thoracic, neuro- or plastic surgery over a six-month period. The data included age, gender, weight, height, body mass index, ASA status, surgical position, operation time, estimated blood loss, preoperative hemoglobin concentration, serum albumin, co-morbidity, and intraoperative hypotension. The patient's skin was inspected closely within 24 hours after surgery. The sites and severity of skin breakdown were assessed. RESULTS: Of the 808 patients in this study, 192 patients (23.8%) developed skin breakdown during surgery. The incidence of blisters, abrasion, or blister and abrasion was 6.1%. The patient's weight, operation time, estimated blood loss, malignancy, and intraoperative hypotension were significantly related to the development of skin breakdown (P < 0.05). The incidence of pressure-induced skin breakdown was highest in the prone position (P = 0.000). Age, gender, body mass index, hypertension, diabetes, preoperative hemoglobin and albumin level were not found to be risk factors of skin breakdown. CONCLUSIONS: The early identification of a patient at risk is a first step in a scientifically based approach for preventing the development of pressure sores. Although intervention will not always prevent the development of pressure sores, a medical team must recognize the risk factors associated with skin breakdown and carry out careful intervention during the perioperative period.
Blister ; Body Height ; Body Mass Index ; Humans ; Hypertension ; Hypotension ; Incidence* ; Length of Stay ; Orthopedics ; Perioperative Period ; Pressure Ulcer ; Prone Position ; Risk Factors* ; Serum Albumin ; Skin* ; Surgery, Plastic

Nontraumatic spontaneous intramural hematoma is an infrequent complication of the use of oral anticoagulants. The most commonly affected site is the jejunum followed by ileum and duodenum. The symptoms can vary depending on the location and size of hematoma. Patients with intramural hematoma usually present with abdominal pain, nausea and vomiting, but rarely present with hematuria, pancreatitis, cholangitis. An obstructive jaundice and acute cholecystitis has not been reported as a secondary cause of duodenal intramural hematoma in Korea so far. Here, we report spontaneous duodenal intramural hematoma caused by anticoagulant therapy that associated with transient obstructive jaundice and acute cholecystitis in a 79-year-old man, which was successfully managed conservative management. In addition, we reviewed reports of intramural hematoma with literature review.
Abdominal Pain ; Aged ; Ampulla of Vater* ; Anticoagulants ; Cholangitis ; Cholecystitis ; Cholecystitis, Acute* ; Duodenum ; Hematoma* ; Hematuria ; Humans ; Ileum ; Jaundice, Obstructive* ; Jejunum ; Korea ; Nausea ; Pancreatitis ; Vomiting