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

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

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

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

PURPOSE: No valuable early marker exists for the prognosis of patients resuscitated from out-of-hospital cardiac arrest (OHCA). We compared post-resuscitation levels of several biochemical candidates and correlated them with outcomes of cardiopulmonary resuscitation (CPR). METHODS: Eligible resuscitated patients with OHCA were prospectively enrolled from December 1, 2004 to November 30, 2005. Demographic data were collected and early levels of biochemical candidates were measured both at the time of initiation of CPR and immediately after the return of spontaneous circulation (ROSC), including those of ischemia-modified albumin (IMA), procalcitonin, and S-100 protein. The ROSC over 20 minutes, survival from the emergency room (ER), survival after 1 month, and Glasgow Outcome Scale (GOS) after 1 month were evaluated for outcome. Levels of early biochemical candidates were correlated with those outcomes. RESULTS: 126 patients were eligible for analysis. 81 (64.3%) were male, and the mean age was 59.6+/-17.2 years. The rate of ROSC, survival from ER, and survival after 1 month were 40.5%, 33.3%, and 8.7%, respectively. 4 patients whose GOS was more than 4 showed good neurological outcome. The levels of S-100 protein were significantly lower in the survival group than in the non-survival group after 1 month: 1.6+/-0.8 versus 3.9+/-4.9 microgram/L at the time of initiation of CPR (p<0.01), and 1.6+/-1.1 versus 4.5+/-5.0 microgram/L immediately after ROSC (p=0.01), respectively. IMA and procalcitonin did not show any predictive value. CONCLUSION : The levels of S-100 protein was found to be useful as an early biochemical marker for prognosis following OHCA. S-100 concentrations were significantly lower in the survival group than in the non-survival group after 1 month after successful resuscitation from OHCA.
Biomarkers* ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Glasgow Outcome Scale ; Heart Arrest ; Humans ; Ischemia* ; Male ; Out-of-Hospital Cardiac Arrest* ; Prognosis* ; Prospective Studies ; Resuscitation ; S100 Proteins*

PURPOSE: No valuable early marker exists for the prognosis of patients resuscitated from out-of-hospital cardiac arrest (OHCA). We compared post-resuscitation levels of several biochemical candidates and correlated them with outcomes of cardiopulmonary resuscitation (CPR). METHODS: Eligible resuscitated patients with OHCA were prospectively enrolled from December 1, 2004 to November 30, 2005. Demographic data were collected and early levels of biochemical candidates were measured both at the time of initiation of CPR and immediately after the return of spontaneous circulation (ROSC), including those of ischemia-modified albumin (IMA), procalcitonin, and S-100 protein. The ROSC over 20 minutes, survival from the emergency room (ER), survival after 1 month, and Glasgow Outcome Scale (GOS) after 1 month were evaluated for outcome. Levels of early biochemical candidates were correlated with those outcomes. RESULTS: 126 patients were eligible for analysis. 81 (64.3%) were male, and the mean age was 59.6+/-17.2 years. The rate of ROSC, survival from ER, and survival after 1 month were 40.5%, 33.3%, and 8.7%, respectively. 4 patients whose GOS was more than 4 showed good neurological outcome. The levels of S-100 protein were significantly lower in the survival group than in the non-survival group after 1 month: 1.6+/-0.8 versus 3.9+/-4.9 microgram/L at the time of initiation of CPR (p<0.01), and 1.6+/-1.1 versus 4.5+/-5.0 microgram/L immediately after ROSC (p=0.01), respectively. IMA and procalcitonin did not show any predictive value. CONCLUSION : The levels of S-100 protein was found to be useful as an early biochemical marker for prognosis following OHCA. S-100 concentrations were significantly lower in the survival group than in the non-survival group after 1 month after successful resuscitation from OHCA.
Biomarkers* ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Glasgow Outcome Scale ; Heart Arrest ; Humans ; Ischemia* ; Male ; Out-of-Hospital Cardiac Arrest* ; Prognosis* ; Prospective Studies ; Resuscitation ; S100 Proteins*

BACKGROUND: Varix bleeding in children is infrequent but it is potentially fatal. It has characteristics different from adult age varix bleeding. But there was little clinical data about it. The purposes of this study is to detect its characteristics of varix bleeding in pediatric patients, and to help an emergency physician make a decision about the management. METHODS: We reviewed medical records of 32 patients who visit Seoul National University Hospital Pediatric Emergency center from Jan. 1, 1995 to Dec. 31, 1996. RESULTS: 1) The peak age was between 1 and 5 years of age, and the ration of males to females was 1: 1. 2) As a underlying cause, intrahepatic disease were more common than extrahepatic diseases(87.1%:12.9%). 3) 10 patients(31.3%) had URI symptoms as a precipitating factor. 4) Varix bleeding has a circardian rhythm, and occured more often during the night. 5) In Child Classification for the hepatic reserve fuction, Child C was the most common(75%). 6) Endoscopic eliminations were performed in 14 patients(43.8%). 7) According to shock classification. the ration of conservative to vasopressin treatment in class I and class II were 13(40.6%)/10(31.3%) and 6(18.8%)/3(9.4%), respectively. 8) Fever was the most common complication(43.8%), and the mortality rate was 3.1%. CONCLUSION: We suggest that the only conservative management can show a good result far pediatric varix bleeding compared to other treatment modalities.
Adult ; Child ; Classification ; Emergencies* ; Esophageal and Gastric Varices* ; Female ; Fever ; Hemorrhage* ; Humans ; Male ; Medical Records ; Mortality ; Precipitating Factors ; Seoul ; Shock ; Varicose Veins ; Vasopressins