Simultaneous monitoring of penile photoelectric plethysmography, penile tumescences, penile rigidity, bulbocavernosus-ischiocavernosus EMG and EKG was attempted to investigate the age-related erectile response to short period erotic film in 50 normal males and to elucidate the range of its characteristics for the diagnosis of impotence. The results obtained were summarized as follows ; l. Variability was observed in temporal relationship between penile pulse amplitude and penile erection. Of the 45 subjects who showed erection and/or increase in penile pulse amplitude 4 categories of response could be defined : Type I was observed in 13 subjects (28.9%)-erection and increased penile pulse amplitude occurring in parallel ; Type II, in 26 subjects(57.8%)_erection with increased penile pulse amplitude during the development or decline of erection but not during maximum erection ; Type III, in 4 subjects(8. 8%)_erection with no change in penile pulse amplitude ; and Type IV, in 2 subjects (4.4 %)_increased penile pulse amplitude without any erection. These results suggest that penile erection does not exclusively depend increased penile arterial blood flow but upon the cooperative mechanisms with the action of venous blockade which corresponds flexibly to the degree of arterial blood flow. 2. Following erotic stimulation, there was tendency to delay in latency to erection with aging. However, no difference in penile tumescence and rigidity among age groups was observed. This indicates that if the subject is affected by libido owing to strong erotic stimulation, maximum erection ensues regardless of aging. 3. The fact that subjects with good erection shows enough libido and that maximum erection ensues if erection develop under strong erotic stimulation suggests visual sexual stimulation method would be useful in differentiatial diagnosis of erectile dysfunction.
Adult* ; Aging ; Diagnosis ; Electrocardiography ; Erectile Dysfunction ; Humans ; Libido ; Male ; Penile Erection ; Plethysmography

Differential diagnosis of acute scrotum is very important. As the chances of salvaging testicular function are inversely proportional to the elapsed time between onset of torsion/rupture and surgical repair of testes, prompt and accurate diagnosis is imperative. 17 patients with acute scrotum who had visited to the Department of Urology, Yeungnam University Hospital from June l985 to May l986 underwent scrotal ultrasonography to evaluate the value of scrotal ultrasonography for the differentiation of the diseases that cause acute scrotum. Scrotal ultrasonographic findings in 8 patients with acute epididymitis were enlargements of the epididymes with decreased echogenicity in 7 and enlargement of the epididymis and testis with mixed echogenicity in 1. In 3 patients with testicular torsion ultrasonogram revealed enlarged epididymis and testis with homogeneous and slightly decreased echogenicity in 1 patient of acute stage (within 24 hours) and enlarged epididymis and testes with diffuse mixed echogenicity in 2 patients. In 6 patients with scrotal trauma ultrasonogram revealed extratesticular fluid collection with well-defined intact in 1 patient of intrascrotal hematoma. 2 patients with testicular hematoma showed well-defined testes with intratesticular focal echolucent region on ultrasonogram. 3 patients with testicular rupture revealed mixed echogenicity in an injured hemiscrotum with well-defined testes in 2 out of 3.
Diagnosis* ; Diagnosis, Differential ; Epididymis ; Epididymitis ; Hematoma ; Humans ; Male ; Rupture ; Scrotum* ; Spermatic Cord Torsion ; Testis ; Ultrasonography* ; Urology

Migration of roundworms, Ascaris lumbricoies, into the biliary tract is a relatively common cause of biliary symptoms in endemic areas, but the number of reported gallbladder ascariasis was scanty even in these areas. Some diagnostic methods might provide suggestive informations, but there are no pathognomonic clinical features for biliary ascariasis, so it is discovered usually after surgical exploration, which is especially the case of gallbladder ascariasis. A young female patient with 4 months' history of right upper quadrant pain which did not respond to medical control and was aggravated recently, presented normal level of peripheral blood leukocyte count with no eosinophilia, normal liver function test, normal serum amylase level and subjectively no febrile sense. Abdominal ultrasonogram disclosed a long, thick, linear, non-motile echogenic structure, not accompanied by acoustic shadowing, within the gallbladder. The intra-and extra-hepatic bile ducts were not dilated and the pancreas was revealed as normal echogenecity and contoru. Endoscopic retrograde cholangiopancreatography was performed immediately thereafter, and it showed a thin linear filling defect in the gallbladder. Cholecystectomy was performed under the impression of gallbladder ascariasis. A mummified Ascaris lumbricoides was found in the lumen of the gallbladder. There was no stones and the histologic examination of the gallbladder revealed chronic cholecystitis.
Acoustics ; Amylases ; Ascariasis* ; Ascaris ; Ascaris lumbricoides ; Bile Ducts ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystitis ; Eosinophilia ; Female ; Gallbladder* ; Humans ; Leukocyte Count ; Liver Function Tests ; Pancreas ; Shadowing (Histology) ; Ultrasonography

Migration of roundworms, Ascaris lumbricoies, into the biliary tract is a relatively common cause of biliary symptoms in endemic areas, but the number of reported gallbladder ascariasis was scanty even in these areas. Some diagnostic methods might provide suggestive informations, but there are no pathognomonic clinical features for biliary ascariasis, so it is discovered usually after surgical exploration, which is especially the case of gallbladder ascariasis. A young female patient with 4 months' history of right upper quadrant pain which did not respond to medical control and was aggravated recently, presented normal level of peripheral blood leukocyte count with no eosinophilia, normal liver function test, normal serum amylase level and subjectively no febrile sense. Abdominal ultrasonogram disclosed a long, thick, linear, non-motile echogenic structure, not accompanied by acoustic shadowing, within the gallbladder. The intra-and extra-hepatic bile ducts were not dilated and the pancreas was revealed as normal echogenecity and contoru. Endoscopic retrograde cholangiopancreatography was performed immediately thereafter, and it showed a thin linear filling defect in the gallbladder. Cholecystectomy was performed under the impression of gallbladder ascariasis. A mummified Ascaris lumbricoides was found in the lumen of the gallbladder. There was no stones and the histologic examination of the gallbladder revealed chronic cholecystitis.
Acoustics ; Amylases ; Ascariasis* ; Ascaris ; Ascaris lumbricoides ; Bile Ducts ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystitis ; Eosinophilia ; Female ; Gallbladder* ; Humans ; Leukocyte Count ; Liver Function Tests ; Pancreas ; Shadowing (Histology) ; Ultrasonography

Etomidate and midazolam are the most popular drugs among the induction agents for emergent endotracheal intubation. The purpose of this study was to compare the incidence of adrenal insufficiency and mortality between the septic shock patients who received etomidate (ETM group) and those who received midazolam (MDZ group). Between November 2004 and September 2006, 65 patients were analyzed in this study. The hospital mortality rate was 36% in the ETM group (n=25) and 50% in the MDZ group (n=40), which was not statistically significant (p=0.269). The incidence of relative adrenal insufficiency was significantly higher in the ETM group than in the MDZ group (84% and 48%, respectively; p=0.003). On multivariate analysis, the use of etomidate was the only significant factor affecting the incidence of relative adrenal insufficiency (odds radio, 5.59; 95% confidence interval, 1.61- 19.4). In conclusion, we think that physicians who treat patients with septic shock should be aware that etomidate can cause adrenal insufficiency, and should start corticosteroids if etomidate is administered.
Adrenal Cortex Hormones/therapeutic use ; Adrenal Insufficiency/chemically induced/complications ; Aged ; Anesthetics, Intravenous/*adverse effects ; Etomidate/*adverse effects ; Female ; Humans ; *Intubation, Intratracheal ; Male ; Midazolam/*adverse effects ; Middle Aged ; Retrospective Studies ; Shock, Septic/complications/drug therapy/*mortality

PURPOSE: A tracheostomy is an important, life-saving procedure to maintain a patent airway. Our aim was to evaluate the effects and safety of tracheostomies done by emergency physicians. METHODS: This was a retrospective study conducted in the emergency intensive care unit (ICU) of a regional emergency medical center. We enrolled consecutive patients who had a tracheostomy in the emergency ICU between November 2004 and September 2008. We collected data on demographic characteristics, diagnosis at admission, the indication for a tracheostomy, time from intubation to tracheostomy, weaning success, time from tracheostomy to weaning, hospital stay, survival discharge, and complications. We divided the patients into two groups: the EM group included patients who had a tracheostomy done by an emergency physician; the OL group had it done by an otolaryngologists. We then made between-groups comparisons. RESULTS: One hundred forty six patients were enrolled in this study. Of the 146 patients, 94 were included in the EM group and 52 in the OL group. There was no significant difference in the demographic characteristics except age, diagnosis at admission, indication of tracheostomy, time from intubation to tracheostomy, weaning success, time from tracheostomy to weaning, hospital stay, and survival discharge between the two groups. There was no significant difference in demographic characteristics? or in the incidence of complications between the two groups. CONCLUSION: Tracheostomy done by emergency physicians are as effective and safe as ones done by otolaryngologists.
Emergencies ; Emergency Medicine ; Humans ; Incidence ; Intensive Care Units ; Intubation ; Length of Stay ; Otolaryngology ; Postoperative Complications ; Retrospective Studies ; Tracheostomy ; Treatment Outcome ; Weaning

PURPOSE: The purpose of this study was to evaluate the appropriateness of prehospital emergency care by 119 rescue services in Seoul. METHODS: We enrolled all patients who used 119 rescue services in Seoul between January and Sepember 2006 and analyzed the 119 ambulance patient care record databases. Major emergencies were defined and categorized into four groups: cardiopulmonary complaint (CP), neurologic complaint (NR), cardiorespiratory arrest (CA) and major trauma (MT). Interventions provided by emergency medical technicians were scored as 2:essential, 1:optional and 0:unnecessary in each category of major emergency. We summed scores of provided interventions per patient and graded them into four levels for conducting the appropriateness review. Multivariate logistic regression analysis was performed to determine the relationship of risk factors to the appropriateness of intervention. RESULTS: Total number of cases was 171,112 of which 36,065 were major emergencies. The proportion of "very low" level appropriate was 40.1% for CP (N=11,522). 49.3% for NR (N=15,239), 14.5% for CA (N=1,591), and 32.7% for MT (N=7,713). The proportion of "high" level was less than 3% except for CA(11.3%). Variables affecting the "moderate" or "high" level of appropriateness of prehospital emergency care, as determined by multivariate logistic regression analysis, were age > or =65(OR: 1.425, 95% CI: 1.337-1.520), female gender (OR: 0.880, 95% CI: 0.828-0.935), and type of complaint in the order CP (OR: 0.181, 95% CI: 0.161-0.204), NR (OR: 0.184, 95% CI: 0.164-0.207), and MT (OR: 0.202, 95% CI: 0.178-0.229). CONCLUSION: The prehospital emergency care of 119 rescue services in Seoul was frequently inappropriate and was influenced by patient's age, gender and chief complaints.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Female ; Humans ; Logistic Models ; Patient Care ; Regional Health Planning ; Risk Factors

BACKGROUND/AIMS: The rate of laparoscopic appendectomy has been gradually increasing. The following studies were conducted to compare laparoscopic appendectomy (LA) with open appendectomy (OA). METHODS: We compared retrospectively 48 patients in the LA group with 135 patients in the OA group, all of whom were operated at Anam hospital, Korea University, from January 1996 to January 1997. Documentation included information such as age, sex, diagnostic method, postoperative diagnosis, misdiagnosis rate, operative time, conversion to open appendectomy, analgesics injection, hospital stay, and complicatians. RESULTS: 1) The mean age and male to female ratio were 28.5 years and 1: 2.4 in LA group, and 34.1 years and 1: 1.1 in OA group, respectively. 2) An abdominal sonogram was perfomed in 18.8% of the LA group and 28.9% in OA group (p < 0.05). 3) The operative time was 68.4 minutes in the LA group and 53.7 minutes in the OA group (p<0.05). 4) The number of analgesic injections was 1.23 in the LA group and 2.65 in the OA group (p<0.05). 5) The postoperative hospital stay was 3.38 days in the LA group and 3.84 days in the OA group (p > 0.05). 6) The complication rate was 10.9% in the LA group and 15,5% in the OA group (p >0.05), but the wound infection rate was 2.2% in the LA group and 8.5% in the OA group (p<0.05). CONCLUSIONS: LA is a safe and effective operation for acute appendicitis, and is particularly superior to OA in regard to diagnosis, postoperative pain, wound infection, and cosmetic benefits.
Analgesics ; Appendectomy* ; Appendicitis ; Diagnosis ; Diagnostic Errors ; Female ; Humans ; Korea ; Length of Stay ; Male ; Operative Time ; Pain, Postoperative ; Retrospective Studies ; Wound Infection

PURPOSES: There have been many efforts to improve the service of emergency centers. In spite of these, no evidence is showing any landmark advancement of emergency services, especially in the hospital stage, exists. We need some efficient standard criteria to evaluate emergency service in the hospital stage, and a useful method might utilize the overcrowding index. We want to know the change in the overcrowding index at a regional emergency center after injury area administration. Injury area means an area in which only an assigned duty physician manages patients with injuries such as those from traffic accidents, falls, assualts, collisions, lacerations, amputations, burns, intoxication, asphyxia, drowning, animal bites, sexual assualts, etc. METHODS: We started to operate an injury area in our emergency department from late 2004, and from January to June in 2004 and in 2005, we collected patients' data, age, sex, assigned department, and result from hospital order communication system to figure out overcrowding indices and result indices. We found the daily number of patients, the turnover rate, the admission rate, the ICU admission rate, the emergency operation rate, the ED stay duration, and the ED patient volume to be overcrowding indices. Also we found the withdrawal rate, the transfer rate, and mortality to be result indices. We compared these indices between 2004 to 2005 by using a t-test. RESULTS: There was a significant increase in the daily number of visiting patients in 2005, overcrowding indices, such as the turnover rate, the admission rate, the ICU admission rate, and the emergency operation rate, also showed statistically significant increases in 2005 (P<0.001). As for the result indices, there was a noticeable decrease in the number of withdrawals (11.77/day in 2004 to 4.53/day in 2005). CONCLUSION: Operating an injury area in a mildly overcrowded local emergency center is beneficial. Evaluating the effect of operating an injury area and it's impact on hospital finances by conducting a similar study analyziing patients for a longer duration would be valuable.
Accidents, Traffic ; Amputation ; Animals ; Asphyxia ; Burns ; Drowning ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Lacerations ; Mortality

PURPOSE: This study was aimed to develop secondary triage rule for decision of interfacility transfer to higher level of trauma center for patients with traumatic brain injury (TBI). METHODS: In a prospective observational study from August 2006 to December 2007 conducted in an urban tertiary emergency department, data were obtained from patients more than 15 years old and with TBI. Primary outcome was defined as meaningful positive CT findings. Secondary outcome was defined as meaningful intervention. Non-adjusted univariated logistic regression model was derived from result of chi-square test and adjusted model was derived using stepwise selection manner. Hosman-Lemeshow test for the goodness of fit was used. RESULTS: Total number of eligible patients with traumatic brain injury was 653. Primary outcome was positive in 103 patients and secondary outcome was positive in 42 patients. In univariate logistic regression, risk factors were age over 65(OR: 2.40), history of cerebrovascular disease(OR: 7.08), fall over two meter(OR: 6.28), pedestrian struck(OR: 18.5), headache(OR: 2.18), vomiting(OR: 3.03), disorientation(OR: 5.37), any evidence of open fracture(OR: 24.03), Glasgow coma sacle less than 13(OR: 4.97), Racoon's eye sign (OR: 2.50). These 10 risk factors were statistically significant in adjusted model which was derived using stepwise selected manner. Hosman-Lemeshow test for the goodness of fit was used and chi-square was 1.307(p=0.86). This decision rule had a sensitivity of 93.48%, a specificity of 41.13%, and a negative predictive value of 97.32%. CONCLUSION: A sensitive clinical decision rule with high negative predictive value for detection of abnormal CT lesions which need transfer to higher level of trauma center was developed.
Brain Injuries ; Coma ; Emergencies ; Eye ; Humans ; Logistic Models ; Prospective Studies ; Risk Factors ; Sensitivity and Specificity ; Trauma Centers ; Triage