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

OBJECTIVES: Magnetic resonance imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) is a newly emerging non-invasive technique for the treatment of uterine fibroids. The purpose of this study is to review the clinical impact of MRgFUS. METHODS: This study examined 157 patients. The high intensity focused ultrasound (HIFU) utilized in this study was Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, the Netherlands) and Sonalleve HIFU system. The patients were followed in post-operative Month 1, Month 3, and Month 6 to investigate any change. Then, these were further classified according to the use of uterine stimulant (oxytocin) in parallel, Funaki Type of uterine fibroid, HIFU intensity, and non-perfused volume (NPV) ratio. RESULTS: When the uterine stimulant was utilized, the HIFU intensity was measured at significantly lower levels, compared with the group not using uterine stimulant, and treatment duration was significantly. The NPV ratio was found significantly higher in the group using uterine stimulant. Concerning the correlation between Funaki Type of uterine fibroid and average sonication power, it was found that the closer to Type I, the lower the sonication power, the shorter the treatment duration, and the higher the NPV ratio significantly. CONCLUSIONS: In this study, it was found that the lower the Funaki Types of uterine fibroids, and the higher the NPV ratio immediately after the operation, the larger the uterine fibroid volume decrease and SSS change were. Also, if uterine stimulant was used in parallel in treatment, treatment duration and HIFU intensity could become shorter and lower.
Delivery of Health Care ; High-Intensity Focused Ultrasound Ablation ; Humans ; Leiomyoma* ; Magnetic Resonance Imaging ; Myoma ; Oxytocin ; Sonication ; Ultrasonography*

OBJECTIVES: This report seeks to introduce some cases of the patients who received magnetic resonance imaging (MRI)-guided high intensity focused ultrasound (HIFU) surgery (MRgFUS)-based intramural uterine fibroids treatment where the post-MRgFUS intramural uterine fibroids decreased in its volume and protruded towards the endometrial cavity to be expelled by hysteroscopy. METHODS: Of the 157 patients who had received MRgFUS treatment in the Obstetrics and Gynecology of the Hospital from March, 2015 to February, 2016; this study examined 6 of the cases where, after high intensity focused ultrasound treatment, intramural uterine fibroids protruded towards the endometrial cavity to be removed by hysteroscopic myomectomy. The high intensity focused ultrasound utilized in the cases were Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, The Netherlands) and Sonalleve HIFU system. RESULTS: The volume of fibroids ranged from 26.0 cm³ to 199.5 cm³, averaging 95.6 cm³. The major axis length ranged from 4.0 cm to 8.2 cm, averaging 6.3 cm. Fibroid location in all of the patients was in intramural uterine before treatment but after the high intensity focused ultrasound treatment, the fibroids were observed to protrude towards the endometrial cavity in at least Day 5 or up to Day 73 to allow hysteroscopic myomectomy. CONCLUSIONS: In some cases, after an intramural uterine fibroid is treated with MRgFUS, fibroid volume is decreased and the fibroid protrudes towards the endometrial cavity. In this case, hysteroscopic myomectomy can be a useful solution.
Delivery of Health Care ; Gynecology ; High-Intensity Focused Ultrasound Ablation ; Humans ; Hysteroscopy ; Leiomyoma* ; Magnetic Resonance Imaging ; Obstetrics ; Ultrasonography* ; Uterine Myomectomy

We report a case of ruptured mycotic aneurysm involving innominate artery requiring an urgent surgical treatment. A 62-yr-old woman presented with fever and dyspnea. Previously, she was diagnosed with colon cancer and received right hemicolectomy and one cycle of adjuvant chemotherapy. On echocardiogram, pericardial effusion was noted and emergency pericardiocentesis was performed. CT scan revealed aortic aneurysm involving ascending aorta and innominate artery, and thrombi surrounding those structures. Patch repair of the defect in the ascending aorta and ringed Goretex graft to bypass the innominate and ascending aorta were performed. We believe that this is the first case of ruptured mycotic aneurysm involving innominate artery.
Aneurysm, Infected/*surgery ; Aorta/pathology ; Aortic Aneurysm/surgery ; Brachiocephalic Trunk/pathology ; Colonic Neoplasms/drug therapy/surgery ; Female ; Human ; Middle Aged ; Tomography, X-Ray Computed ; Transplants

OBJECTIVES: The aim of this study is to investigate the association between serum uric acid level and metabolic syndrome according to menopausal status in Korean women. METHODS: A total of 2,241 women who visited to the health promotion center at Pusan National University Hospital from 2010 to 2014 were included in this cross-sectional study. Self-report questionnaires and interviews with healthcare providers were used to assess disease history, medication history, menstrual history and body size measuring. Anthropometric measurements and laboratory results were compared as presence of metabolic syndrome and menopausal status by student-t test. Logistic regression analysis was performed between presence of metabolic syndrome and presumable predictive factors, such as age, menopause and serum uric acid. RESULTS: The prevalence rate of metabolic syndrome were 7.45% (63/846) in pre-menopausal group and 23.87% (333/1395) in menopausal group. Serum uric acid level was higher in menopausal women than premenopausal women (4.6 +/- 1.1 vs. 4.3 +/- 0.9. P = 0.000). And, its concentration was also higher in metabolic syndrome than normal women regarding of menopausal statue (premenopause 4.7 +/- 1.1 vs. 4.2 +/- 0.8, P = 0.001, menopause 4.9 +/- 1.3 vs. 4.5 +/- 1.0, P = 0.000). Multiple logistic regression analysis showed serum uric acid and age have relationship with metabolic syndrome (OR: 1.453, 95% confidence interval [CI]: 1.074-1.111, P = 0.000; OR: 1.092, 95% CI: 1.305-1.619, P = 0.000). CONCLUSION: We could find out some potential of uric acid as predictive factor for metabolic syndrome in premenopausal and menopausal group. Further investigation is required to clarify the relationship between serum uric acid, menopause and metabolic syndrome.
Body Size ; Busan ; Cross-Sectional Studies ; Female ; Health Personnel ; Health Promotion ; Humans ; Incidence* ; Logistic Models ; Menopause ; Metabolic Syndrome X ; Prevalence ; Surveys and Questionnaires ; Uric Acid*

OBJECTIVE: There are conflicting reports about whether individual anxiety disorders are independently associated with suicidal ideation and suicide attempts. We examined whether anxiety disorders are related to suicidal ideation and suicide attempts in a community sample of South Korean adults. METHODS: In-person interviews based on the South Korean version of the Composite International Diagnostic Interview were conducted to diagnose mental disorders. Multivariate logistic regression analysis was performed to examine whether anxiety disorders were associated with suicidal ideation and suicide attempts. Each regression model treated lifetime diagnosis of anxiety disorders as independent variables. Sociodemographic characteristics, cohabitation status, lifetime history of mood disorders, alcohol use disorders, and psychotic disorders were included as covariates. RESULTS: Nationally representative sample of 6,510 South Korean adults aged 18–64 years was recruited. Multivariate analysis adjusted for psychiatric comorbidity and sociodemographic variables revealed that generalized anxiety disorder (GAD) [2.34, 95% confidence interval (CI) (1.27, 4.33)], post-traumatic stress disorder (PTSD) (3.50, 95% CI: 2.16, 5.68), specific phobia (1.55, 95% CI: 1.14, 2.11), social phobia (2.97, 95% CI: 1.27, 6.94), and obsessive-compulsive disorder (OCD) (5.58, 95% CI: 2.70, 11.6) were associated with suicidal ideation, whereas only social phobia (3.78, 95% CI: 1.41, 10.1) and PTSD (5.13, 95% CI: 2.81, 9.37) were associated with suicide attempts. CONCLUSION: Individual anxiety disorders are independently associated with suicidal ideation and/or suicide attempts. The importance of the early detection of anxiety disorders and of assessing the suicide risk in individuals with anxiety disorders is emphasized.
Adult* ; Anxiety Disorders* ; Anxiety* ; Comorbidity ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders* ; Humans ; Logistic Models ; Mental Disorders ; Mood Disorders ; Multivariate Analysis ; Obsessive-Compulsive Disorder ; Panic Disorder ; Phobic Disorders ; Psychotic Disorders ; Stress Disorders, Post-Traumatic ; Suicidal Ideation ; Suicide

PURPOSE: The diagnosis of acute thoracic spinal fractures is often missed by plain radiography, alone. The purpose of this study was to compare the accuracy of radionuclide imaging with radiography, thoracic for detection of acute thoracic spinal fractures and to propose radionuclide imaging as screening tests for the diagnosis of acute thoracic spinal fractures before thoracic spine CT or MRI. METHODS: Out of the patients who were admitted to our medical center, Emergency Medicine Department for trauma from June 1, 2001, to February 28, 2003. We are retrospectively studied 67 patients who had undergone radionuclide imaging and thoracic MRI to detect acute thoracic spinal fractures. Because of their symptoms those 67 patients were suspected of having thoracic compression fractures, but those fractures had not been detected on plain thoracic spine radiographics. RESULTS: In 19 patients, 43 acute thoracic spinal fractures were detected by thoracic MRI, in 17 patients, 29 acute thoracic spinal fractures were detected by radionuclide imaging (67.4%) and in 11 patients, 14 acute thoracic spinal fractures were detected by radiography, thoracic (32.6%). The diagnostic agreement of radionuclide imaging with thoracic MRI (Kappa=0.771) was higher than that of plain radiography, thoracic with thoracic MRI (Kappa=0.439). The sensitivity, specificity, and accuracy of radionuclide imaging were 67.4%, 100%, and 93.9%, respectively, and those of plain radiography, thoracic were 32.6%, 100%, and 87.3%. The sensitivity and accuracy of radionuclide imaging for the diagnosis of acute thoracic spinal fractures were significantly higher than those of plain radiography, thoracic (p<0.05). CONCLUSION: Radionuclide imaging is more sensitive and accurate in detecting acute thoracic spinal fractures than plain thoracic spine radiography. Further study is required to prove whether radionuclide imaging is a useful screening test for acute thoracic spinal fractures instead of performing expensive thoracic spine CT or MRI.
Diagnosis* ; Emergency Medicine ; Fractures, Compression ; Humans ; Magnetic Resonance Imaging ; Mass Screening* ; Radiography ; Radiography, Thoracic ; Radionuclide Imaging* ; Retrospective Studies ; Sensitivity and Specificity ; Spinal Fractures* ; Spine

Abalone is popular seafood in Asia; however, allergy to abalone was rarely reported. We report a case of anaphylaxis after consumption of abalone. A 24-year-old female visited an Emergency Department, complaining of cough, dyspnea, rhinorrhea, generalized urticaria, facial edema, and wheezing that had developed 1 hour after consumption of abalone. She was discharged when her symptoms subsided after antihistamine and dexamethasone were given. One month later, she was referred to our outpatient clinic. We performed skin prick tests, measurement of serum specific IgE antibody level, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) with IgE immunoblotting. Both skin prick and specific IgE antibody tests were positive for abalone crude extract. In SDS-PAGE with IgE immunoblotting, we identified possible antigens sized 55, 100, and 25 kDa, respectively. This is the first case of abalone-induced anaphylaxis in Korea.
Ambulatory Care Facilities ; Anaphylaxis* ; Asia ; Cough ; Dexamethasone ; Dyspnea ; Edema ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Emergency Service, Hospital ; Female ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Immunoblotting ; Immunoglobulin E ; Korea ; Respiratory Sounds ; Seafood ; Shellfish ; Skin ; Sodium ; Urticaria ; Young Adult

PURPOSE: Veterinary researchers are exposed to variable animal allergens. However, sensitization to them and allergic symptoms during exposure to them in this group are not sufficiently evaluated worldwide, especially in Korea. The objective of this study is to evaluate sensitization to animal allergens and allergic symptoms during exposure to them in Korean veterinary researchers. METHODS: Thirty-two veterinary researchers who participated in the 2016 annual symposium of the Korean Society of Veterinary Science were asked to answer questionnaires regarding allergic symptoms during animal exposure and underwent skin prick tests for animal allergens. Animal allergens consisted of chicken feather and 10 mammals, epithelia as well as cow's milk, hen's egg, and 7 animal types of meat. RESULTS: There were 13 subjects who complained of allergic symptoms during exposure to certain animal epithelia and 19 who did not. Between the 2 groups, there were no differences in age, sex, underlying allergic disease, family history of allergy, current occupation and its duration, numbers and specie of contact animals, or daily contact time. Meanwhile, the sensitization rates to mouse, horse, rabbit, and guinea pig were significantly higher in the symptomatic group. Rhinoconjunctivitis symptoms were the most common allergic symptoms related to animal exposure were most common followed by dermatologic symptom, and symptom of lower respiratory tract. CONCLUSION: We found that sensitizations to some animal epithelia were more frequent in Korean veterinary researchers with allergic symptoms during exposure to animal compared to those without it, and their most common symptoms were rhinoconjunctivitis symptoms.
Allergens* ; Animals* ; Chickens ; Feathers ; Guinea Pigs ; Horses ; Humans ; Hypersensitivity ; Korea ; Mammals ; Meat ; Mice ; Milk ; Occupations ; Ovum ; Respiratory System ; Skin

Evidence suggests that diabetes mellitus (DM) is associated with idiopathic pulmonary fibrosis (IPF). According to the new IPF guidelines, high-resolution computed tomography (HRCT) is an essential means of diagnosing IPF. We investigated the relationship between IPF and DM in patients treated between 2003 and 2007. Newly diagnosed IPF patients in large university teaching hospitals in Korea were enrolled from January 2003 to December 2007. We retrospectively analyzed 1,685 patients using the interstitial lung disease (ILD) registry. In total, 299 IPF patients (17.8%) also had DM. The mean age of our subjects was 68.0 +/- 9.4 yr. HRCT showed significantly more reticular and honeycomb patterns in IPF patients with DM than in IPF patients without DM (P = 0.014, P = 0.028, respectively). Furthermore, significantly higher incidences of hypertension, cardiovascular diseases, and other malignancies (except lung cancer) were found in IPF patients with DM than in IPF patients without DM. In conclusion, IPF patients with DM are more likely to have the usual interstitial pneumonia (UIP) pattern, including reticular and honeycomb patterns, on HRCT than are those without DM.
Aged ; Cardiovascular Diseases/epidemiology/etiology ; Diabetes Mellitus, Type 2/*complications ; Female ; Humans ; Hypertension/epidemiology/etiology ; Idiopathic Pulmonary Fibrosis/complications/*diagnosis/radiography ; Incidence ; Male ; Middle Aged ; Neoplasms/epidemiology/etiology ; Registries ; Republic of Korea/epidemiology ; Retrospective Studies ; Tomography, X-Ray Computed