Purpose: To construct a urologic cancer database using a standardized, reproducible method, and to assess preliminary characteristics of this cohort. Materials and Methods: Patients with prostate, bladder, and kidney cancers who were enrolled with diagnostic codes in the electronic medical record (EMR) at Asan Medical Center from 2007–2016 were included. Research Electronic Data Capture (REDCap) was used to design the Asan Medical Center-Urologic Cancer Database (AMC-UCD). The process included developing a data dictionary, applying branching logic, mapping clinical data warehouse structures, alpha testing, clinical record summary testing, creating “standards of procedure,” importing data, and entering data. Descriptive statistics were used to identify rates of surgeries and numbers of patients. Results: Clinical variables (n=407) were selected to develop a data dictionary from REDCap. In total, 20,198 urologic cancer patients visited our institution from 2007–2016 (bladder cancer, 4,616; kidney cancer, 5,750; prostate cancer, 10,330). The overall numbers of patients and surgeries increased over time, with robotic surgeries rapidly growing over a decade. The most common treatment for urologic cancer was surgery, followed by chemotherapy and radiation therapy. Conclusions Using a standardized method, the AMC-UCD fosters multidisciplinary research. This constructed database provides access to clinical statistics to effectively assist research. Preliminary data should be refined through EMR chart review. The successful organization of data from 2007–2016 provides a framework for future periods of investigation and prospective models.

BACKGROUND: Hepatitis B virus (HBV) infection leads to hepatic and extrahepatic manifestations including chronic kidney disease (CKD). However, the association between HBV and CKD is not clear. This study investigated the association between chronic HBV infection and CKD in a nationwide multicenter study. METHODS: A total of 265,086 subjects who underwent health-check examinations in 33 hospitals from January 2015 to December 2015 were enrolled. HBV surface antigen (HBsAg) positive cases (n = 10,048), and age- and gender-matched HBsAg negative controls (n = 40,192) were identified. CKD was defined as a glomerular filtration rate (GFR) < 60 mL/min/1.73 m² or proteinuria as at least grade 2+ of urine protein. RESULTS: HBsAg positive cases showed a significantly higher prevalence of GFR < 60 mL/min/1.73 m² (3.3%), and proteinuria (18.9%) than that of the controls (2.6%, P < 0.001, and 14.1%, P < 0.001, respectively). In the multivariate analysis, HBsAg positivity was an independent factor associated with GFR < 60 mL/min/1.73 m² along with age, blood levels of albumin, bilirubin, anemia, and hemoglobin A1c (HbA1c). Likewise, HBsAg positivity was an independent factor for proteinuria along with age, male, blood levels of bilirubin, protein, albumin, and HbA1c. A subgroup analysis showed that HBsAg positive men but not women had a significantly increased risk for GFR < 60 mL/min/1.73 m². CONCLUSION: Chronic HBV infection was significantly associated with a GFR < 60 mL/min/1.73 m² and proteinuria (≥ 2+). Therefore, clinical concern about CKD in chronic HBV infected patients, especially in male, is warranted.
Anemia ; Antigens, Surface ; Bilirubin ; Case-Control Studies* ; Female ; Glomerular Filtration Rate ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Male ; Multivariate Analysis ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic*

BACKGROUND/AIMS: While gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea. METHODS: The data of 1,308 episodes of GVB (males:females=1062:246, age=55.0+/-11.0 years, mean+/-SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated. RESULTS: The initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001). CONCLUSIONS: The clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Endoscopy ; Esophageal and Gastric Varices/*diagnosis/mortality/therapy ; Female ; *Gastrointestinal Hemorrhage ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prognosis ; Republic of Korea ; Retrospective Studies ; Sclerotherapy ; Severity of Illness Index ; Treatment Outcome ; Young Adult

PURPOSE: The purpose of this study was to compare the rate of bloodstream infections associated with use of central venous catheters (CVCs) by an emergency department (ED) versus an intensive care unit (ICU). METHODS: Using the hospital administrative and billing database, we identified patients who received CVCs between January 1, 2006, and December 31, 2009 in the ED and ICU at an academic, urban hospital with an annual census of 55,000. We performed a structured, explicit chart review to determine durations of catheterization and rates of bloodstream infections. RESULTS: We screened 4,088 charts and identified 1,480 patients with CVCs that were administered in the ED, (total of 12,888 catheter-days with 47 bloodstream infections), and 982 patients with CVCs that were administered in the ICU (13,326 catheter-days with 52 bloodstream infections). The rate of bloodstream infections associated with CVCs placed in the ED was 3.65 per 1,000 catheter-days (95% confidence interval 2.68 to 4.85), and the rate of bloodstream infections in the ICU was 3.75 per 1,000 catheter-days (95% confidence interval 2.91 to 5.12). The median duration of catheterization was 6.0 days in the ED, and 10.0 days in the ICU. Among the infected CVCs, the median duration of catheterization was 12.0 days in the ED, and 14.0 days in the ICU. Of 1480 total CVCs administered in the ED, 897 were placed in the subclavian veins (61%), 554 in the internal jugular (37%), and 29 were placed in femoral veins (2%). Of the total 982 CVCs administered in the ICU, 779 were placed in the subclavian veins (79%), 158 in the internal jugular veins (16%), and 45 in femoral veins (4.3%). CONCLUSION: The rate of bloodstream infections in the ED is comparable to those in the ICU. The duration of catheterization was found to be a more important factor than the CVC insertion location.
Catheter-Related Infections ; Catheterization ; Catheterization, Central Venous ; Catheters ; Censuses ; Central Venous Catheters ; Emergencies ; Femoral Vein ; Hospitals, Urban ; Humans ; Critical Care ; Intensive Care Units ; Jugular Veins ; Subclavian Vein

Foreign bodies that migrate outside the esophagus into the mediastinum or soft tissues usually cause respiratory symptoms. Also, esophageal foreign body granulomas that cause tracheal stenosis, lobar atelectasis, and bronchoesophageal fistulas are reported as complications. Foreign bodies can become lodged above esophageal strictures, and chronically-embedded esophageal foreign bodies can induce stricture formation, although these are less common. This is rare case report that the trachea was directly compressed due to impacted esophagus by foreign body.
Constriction, Pathologic ; Dyspnea ; Esophagus ; Fistula ; Foreign Bodies ; Granuloma, Foreign-Body ; Mediastinum ; Pulmonary Atelectasis ; Trachea ; Tracheal Stenosis

PURPOSE: To study tissue adhesive effectiveness in with laceration at various body sites. METHODS: From January 2007 to December 2009, we collected the data of laceration patients treated using tissue adhesive in the emergency department of a university hospital. Data concerning treatment satisfaction were collected twice and analyzed. RESULTS: Of the 8665 patients with laceration, 196 (mean age 23 years, 106 males) were treated using tissue adhesive. Many of the 196 patients were <15-years-of-age. Involved body sites mainly comprised head/neck, followed by the upper extremities. The procedure was the most rapid of all treatments. CONCLUSION: Emergency physicians can reliably use tissue adhesive treatment for various lacerations in the emergency setting.
Emergencies ; Humans ; Lacerations ; Tissue Adhesives ; Upper Extremity

PURPOSE: The purpose of this study was to investigate the relationship between patients with a neuropsychiatric history and features of their suicide attempt, in order to analyze the risk associated with psychiatrist prescribed drugs. METHODS: We retrospectively investigated cases of intentional overdose drug ingestion in patients greater than 14 years of age who visited OO emergency medical center between January 1, 2008 and July 31, 2010. We evaluated patient medical records to ascertain their age, sex, neuropsychiatric history, and components of ingested intoxicant. Information regarding any suicide reattempt was obtained after discharge through follow up telephone survey. SPSS version 13.0 was used for statistical analysis. Fisher's exact test was performed with p<0.05 considered statistically significant. RESULTS: Ninety-six of 209 patients (46%) had a past history of psychological problems. Among those 96 patients with a history of psychological problems, 46(48%) used an overdose of the medicine prescribed by their psychologist in order to attempt suicide. However, for patients without a history of psychological problems, intoxication by neuropsychiatric drugs was insignificant. Neuropsychiatric patients required greater follow up care after discharge and exhibited significantly more suicide reattempts. CONCLUSION: This study revealed that patients sometimes use the medicine prescribed by their psychologist to attempt suicide. Therefore, an exhaustive plan to control the medicines prescribed to psychiatric patients should be established.
Eating ; Emergencies ; Follow-Up Studies ; Humans ; Medical Records ; Psychiatry ; Retrospective Studies ; Suicide ; Telephone

PURPOSE: To evaluate and analyze the clinical characteristics and history of patients with hemoperitoneum due to ovarian rupture. METHODS: Subjects were fertile females who visited the emergency department between January 2006 and December 2008. We did retrospective chart reviews only for patients diagnosed with hemoperitoneum. We investigated the characteristics and history of enrolled patients. RESULTS: A total of 76 females (mean age = 28 years) were enrolled. Of the 76, 32 (41.8%) were initially checked for coitus history by emergency physicians (EP). Of the 76, 52 (68.4%) were operated on and the remaining 24 (31.6%) were only observed. Only 4 patients had knowledge of a history of ovarian cysts. CONCLUSION: Coitus history and ovarian cyst history should be done by EPs during the initial examination of fertile females who complain of lower abdominal pain.
Abdominal Pain ; Coitus ; Emergencies ; Female ; Hemoperitoneum ; Humans ; Medical History Taking ; Ovarian Cysts ; Retrospective Studies ; Rupture

PURPOSE: To study characteristics of bicycle and motorcycle injured patients in a university hospital and in an edited national injury surveillance report. METHODS: Between July 2007 and January 2010, we collected data on bicycle and motorcycle injured patients in a university hospital. First, we compared the characteristics of each group. Second, we analyzed injury severity using their injury severity score (ISS) and their revised trauma score (RTS). We compared the categories of an edited national injury surveillance report with our university-acquired data. RESULTS: The total number of patients in traffic accidents was 4,111 (including 204 bicycle riders and 165 motorcycle riders). For those in bicycle accidents, a large fraction was < 10 years old or > 51 years old. For those in motorcycle accidents. Those in motorcycle accidents had an increased proportion of liver cirrhosis and of previous experience with a similar accident. Bicycle accidents had a higher proportion of cases where just the driver or just the passenger was injured. Just falling was the most cause of injury. Others were injured by collision with a car or by both. Motorcycle riders who wore helmets were better protected. Most accidents occurred after 19:00: motorcycle accidents most frequently between 0:00 and 7:00 and between 13:00 and 18:00 hours. Injury severity score were not different. Admission to the hospital and fatalities were highest for motorcycle accidents. The place of injury and alcohol intoxication status were reported for traffic accidents. CONCLUSION: Bicycle and motorcycle injuries were already considered as important factors in traffic accidents included in the injury surveillance report. More factors, including age, time, past history, etc. should be added.
Accidents, Traffic ; Head Protective Devices ; Humans ; Hypogonadism ; Injury Severity Score ; Liver Cirrhosis ; Mitochondrial Diseases ; Motorcycles ; Ophthalmoplegia

PURPOSE: The purpose of this study was to determine whether continuous capnography monitoring detects adverse respiratory and airway events earlier than pulse oximetry and the clinical exam can during intramuscular ketamine for procedural sedation in children. METHODS: This study was a prospective observational study conducted from April 2009 to March 2010 in an urban Korean teaching hospital. Pediatric patients who needed procedural sedation for primary closure were enrolled. After patients received intramuscular ketamine, they were monitored using clinical ventilation assessment, pulse oximetry and capnography. Adverse respiratory and airway events were recorded RESULTS: A total of 91 patients were enrolled. Of the 91 patients, 16 (17%) had adverse respiratory events; 5 had hypoxia. Capnography was 100% sensitive for predicting hypoxia and apnea. CONCLUSION: When intramuscular ketamine is administered for procedural sedation in children, capnography allows early detection of adverse respiratory events.
Anoxia ; Apnea ; Capnography ; Child ; Conscious Sedation ; Hospitals, Teaching ; Humans ; Ketamine ; Oximetry ; Prospective Studies ; Ventilation