Background: Korea recently established 70 emergency medical service areas. However, there are many concerns that medical resources for stroke could not be evenly distributed through the country. We aimed to compare the treatment quality and outcomes of acute stroke among the emergency medical service areas. Methods: This study analyzed the data of 28,800 patients admitted in 248 hospitals which participated in the 8th acute stroke quality assessment by Health Insurance Review and Assessment Service. Individual hospitals were regrouped into emergency service areas according to the address of the location. Assessment indicators and fatality were compared by the service areas. We defined the appropriate hospital by the performance of intravenous thrombolysis. Results: In seven service areas, there were no hospitals which received more than 10 stroke patients for 6 months. In nine service areas, there were no patients who underwent intravenous thrombolysis (IVT). Among 167 designated emergency medical centers, 50 hospitals (29.9%) responded that IVT was impossible 24 hours a day. There are 97 (39.1%) hospitals that meet the definitions of appropriate hospital. In 23 service areas (32.9%) had no appropriate or feasible hospitals. The fatality of service areas with stroke centers were 6.9% within 30 days and 15.6% within 1 year from stroke onset than those without stroke centers (7.7%, 16.9%, respectively). Conclusions There was a wide regional gap in the medical resource and the quality of treatments for acute stroke among emergency medical service areas in Korea. The poststroke fatality rate of the service areas which have stroke centers or appropriate hospitals were significantly low.

PURPOSE: The goal of oncoplastic breast surgery is to restore the appearance of the breast and improve patient satisfaction. Thus, the assessment of cosmetic results and patient-reported outcomes (PROs) using appropriately constructed and validated instruments is essential. The aim of the present study was to assess the long-term objective cosmetic results and corresponding PROs after oncoplastic breast surgery. METHODS: Cosmetic results were assessed by the patients, a medical panel, and a computer program (BCCT.core). PROs were assessed using BREAST-Q, a questionnaire that measures the perception of patients having breast surgery. The cosmetic results and PROs were analyzed in patients who underwent quadrantectomy and partial breast reconstruction utilizing the latissimus dorsi flap. RESULTS: The mean duration of the follow-up period was 91.6 months (range, 33.3-171.0 months), and mean age of the patients was 51 years old (range, 33-72 years). The mean tumor size was 2.1 cm (range, 0.9-5.5 cm). There was fair agreement between the medical panel and BCCT.core score (K = 0.32, P < 0.001), and a statistically significant correlation between the BCCT.core score and medical panel cosmetic results was identified (r = 0.606, P < 0.001). A better BCCT.core result was related to a higher PRO of each BREAST-Q domain-satisfaction with breasts (R2 = 0.070, P = 0.039), satisfaction with outcome (R2 = 0.087, P = 0.021), psychosocial well-being (R2 = 0.085, P = 0.023), sexual well-being (R2 = 0.082, P = 0.029), and satisfaction with information (R2 = 0.064, P = 0.049). CONCLUSION: Our long-term results of oncoplastic surgery achieved a high level of patient satisfaction with good cosmetic results. The medical panel and BCCT.core results correlated well with the PROs of the patients using valid, reliable, and procedure-specific measures.
Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Patient Satisfaction ; Pilot Projects* ; Quality of Life ; Superficial Back Muscles* ; Surgical Flaps

Hemochromatosis is an inherited genetic disorder of iron metabolism which can also occur as a secondary result of iron-overload. It leads to organ damage such as cardiomyopathy, liver cirrhosis, hypogonadism, and diabetes. This paper discusses a case of secondary hemochromatosis associated with repeated transfusions, presenting as asymptomatic hypoparathyroidism and subclinical hypothyroidism with multiple organ involvement. The 29-year-old female, who had severe aplastic anemia, received multiple transfusions totaling approximately 1,400 units of red blood cells over 15 years. During her routine laboratory examination, hypocalcemia was detected with decreased intact parathyroid hormone and increased thyroid stimulating hormone. Serum ferritin, iron, and total iron binding capacity had increased to 27,583.03 ng/mL, 291 microg/dL, and 389 microg/dL, respectively. She had unusually bronze skin and computed tomography revealed iron deposition in the thyroid, liver, and heart. Multiorgan involvement as seen in this case is rare in hemochromatosis associated with secondary transfusions. To the best of the author's knowledge, this is the first case report in Korea of hypoparathyroidism and subclinical hypothyroidism due to iron deposition in the parathyroid and thyroid gland.
Adult ; Anemia, Aplastic ; Cardiomyopathies ; Erythrocytes ; Female ; Ferritins ; Heart ; Hemochromatosis* ; Humans ; Hypocalcemia ; Hypogonadism ; Hypoparathyroidism* ; Hypothyroidism* ; Iron ; Korea ; Liver ; Liver Cirrhosis ; Metabolism ; Parathyroid Hormone ; Skin ; Thyroid Gland ; Thyrotropin

The incisional hernia through trocar site is an uncommon complication of gynecologic laparoscopy. Its incidence is less than 1% and most of them are occurring through 10 mm trocar site. Small bowel herniation through 5 mm trocar site is very rare. Furthermore, 5 mm trocar site bowel herniation with drain tube in situ has not yet been reported. We present a case of small bowel herniation through 5 mm trocar site with drain tube in situ and its reduction by laparoscopy with a brief review of literature.
Drainage ; Hernia ; Incidence ; Laparoscopy ; Surgical Instruments

PURPOSE: Radical surgical extirpation in advanced breast cancer patients produces extensive loss of skin with large defects requiring plastic surgical procedures for the closure. Many reconstructive methods exist, the choice of which depends upon the characteristic of the wound, extent of resection and patient comorbidities. For adequate coverage of the large skin defects following resection of advanced breast cancer, current authors have performed a thoracoabdominal flap. METHODS: From August 2008 to June 2009, 4 cases of thoraco-abdominal flap were performed for chest wall reconstruction after mastectomy of advanced breast cancer. Flap dissection was entirely performed in a subfascial plane and the flap involving the external oblique abdominal muscle. The flap was rotated clockwise in left chest wall defects and counterclockwise in right chest defects and the donor site was closed directly. RESULTS: Their mean age, 55.7 years and the average follow-up interval was 9 months. Patients' oncologic status ranged from stage IIIc to stage IV, it was classified according to the TNM staging system. Flap dimensions ranged between 15 x 15 and 25 x 25 cm. One flap sustained a partial loss at the distal margin and revision with pectoralis major musculocutaneous island flap. CONCLUSION: Large chest wall reconstructions are usually required after radical excision of advanced cancer stages patients with poor general conditions. Thoracoabdominal flap is a simple, quick single-stage procedure, and offer to patient fast recovery, low complication rate, enabling further concomitant adjuvant therapy.
Abdominal Muscles ; Breast ; Breast Neoplasms ; Comorbidity ; Follow-Up Studies ; Humans ; Mastectomy ; Neoplasm Staging ; Skin ; Thoracic Wall ; Thorax ; Tissue Donors

PURPOSE: Intravascular papillary endothelial hyperplasia(IPEH), also known as Masson's pseudoangiosarcoma, is a rare disease which is now considered as a reactive process of the endothelium rather than a benign neoplasm. It can occur in any blood vessels in the body but more common in the head and neck region as a solitary, often tender, bluish or reddish nodule. IPEH is characterized by the development of endothelial-lined papillary projections in a vascular lumen, usually associated with thrombotic material, the endothelial cells in the papillary structures showing only slight atypia and occasional mitotic Figures, the absence of tissue necrosis. METHODS: 8 patients with IPEH were enrolled in the study from 2002 to 2007. All 8 lesions were surgically excised for histopathologic diagnosis. RESULTS: 4 patients were female. The duration of the lesions ranged from 3 months to 15 years. The tumors were first noted between the ages of 20 and 72 years. 4 patients had lesions on the head; 2 on the toe; 1 on the back; and 1 on the finger, respectively. All lesions were solitary, ranged in size from 2mm to 27 mm. There were no recurrences. CONCLUSION: The clinical appearance of IPEH is not specific, presented as a primary neoplasm, and the diagnosis can be established by microscopic examination. Complete surgical excision is the best choice of therapy for patients with IPEH, and is both diagnostic and curative. Awareness of this lesion will prevent incorrect diagnosis and overly aggressive treatment.
Blood Vessels ; Endothelial Cells ; Endothelium ; Female ; Fingers ; Head ; Humans ; Hyperplasia ; Neck ; Necrosis ; Rare Diseases ; Recurrence

PURPOSE: Supernumerary nipple or polythelia is one of the developmental anomalies occurring at the embryonic stage and this anomaly usually arises from the milk line. While this atypical feature is determined during early developmental stage, it may not come out obviously or become troublesome until puberty or lactation. Moreover, sometimes it is confused with a pigmented nevus. METHODS: Case 1, a 18-year-old woman with intramammary supernumerary breast consisted of another nipple with middle sized areola on the right lower breast was admitted for a 2.8 x 3.1 cm-sized mass on the right breast which was starting appeared 1 year earlier. The preliminary cytological examination of the material obtained by needle aspiration biopsy from the mass was revealed by fibroadenoma with no malignant change. The patient had the surgical excision of the mass and accessory breast. Case 2, a 16 year-old woman admitted for intra-areolar polythelia of the left breast, even she doesn't have any family history of polythelia. Since she wanted surgical correction of her atypical nipple for aesthetic and psychological reasons, we reconstructed the areola using transposition flaps in an S-plasty design. RESULTS: Case 1, the excised supernumerary nipple showed following histological features. In the superficial layer, an acanthotic and hyperpigmented epithelium with elongated rete ridges was found. In the dermis, there were follicles with hairs surrounded by hypertrophic sebaceous glands. In the deepest portion, abundant secretory glomerules and excretory ducts of apocrine gland type were observed. Case 2, follow-up visits 3 months after the procedure showed a satisfactory result with good shape and projection of the nipple. CONCLUSION: We report two cases of aberrant mammary tissue who underwent surgical correction, including complete breast (with nipple, areola, and glandular tissue) and intra-areolar polythelia according to the Kajava's classification, and the results were satisfactory.
Adolescent ; Apocrine Glands ; Biopsy, Needle ; Breast ; Dermis ; Epithelium ; Female ; Fibroadenoma ; Follow-Up Studies ; Hair ; Humans ; Lactation ; Milk ; Needles ; Nevus, Pigmented ; Nipples ; Puberty ; Sebaceous Glands

PURPOSE: Supernumerary nipple or polythelia is one of the developmental anomalies occurring at the embryonic stage and this anomaly usually arises from the milk line. While this atypical feature is determined during early developmental stage, it may not come out obviously or become troublesome until puberty or lactation. Moreover, sometimes it is confused with a pigmented nevus. METHODS: Case 1, a 18-year-old woman with intramammary supernumerary breast consisted of another nipple with middle sized areola on the right lower breast was admitted for a 2.8 x 3.1 cm-sized mass on the right breast which was starting appeared 1 year earlier. The preliminary cytological examination of the material obtained by needle aspiration biopsy from the mass was revealed by fibroadenoma with no malignant change. The patient had the surgical excision of the mass and accessory breast. Case 2, a 16 year-old woman admitted for intra-areolar polythelia of the left breast, even she doesn't have any family history of polythelia. Since she wanted surgical correction of her atypical nipple for aesthetic and psychological reasons, we reconstructed the areola using transposition flaps in an S-plasty design. RESULTS: Case 1, the excised supernumerary nipple showed following histological features. In the superficial layer, an acanthotic and hyperpigmented epithelium with elongated rete ridges was found. In the dermis, there were follicles with hairs surrounded by hypertrophic sebaceous glands. In the deepest portion, abundant secretory glomerules and excretory ducts of apocrine gland type were observed. Case 2, follow-up visits 3 months after the procedure showed a satisfactory result with good shape and projection of the nipple. CONCLUSION: We report two cases of aberrant mammary tissue who underwent surgical correction, including complete breast (with nipple, areola, and glandular tissue) and intra-areolar polythelia according to the Kajava's classification, and the results were satisfactory.
Adolescent ; Apocrine Glands ; Biopsy, Needle ; Breast ; Dermis ; Epithelium ; Female ; Fibroadenoma ; Follow-Up Studies ; Hair ; Humans ; Lactation ; Milk ; Needles ; Nevus, Pigmented ; Nipples ; Puberty ; Sebaceous Glands

OBJECTIVE: The objective of this study is to evaluate the safety and the clinical efficacy of the laparoscopic myomectomy through analyzing several operation factors. METHODS: There were 185 cases of laparoscopic myomectomy between January 2004 and December 2008 at the department of obstetrics and gynecology in Hanyang University Guri Hospital. Retrospectively many factors of the operation were analyzed. The factors include the size, number and type of the myoma, BMI (body mass index), operation method, operation time, and complication and the prognosis of the operation. RESULTS: For the type of myomas, 115 (62.2%) cases were intramural myomas, 38 (20.5%) cases were subserosal types and 32 (17.3%) cases were mixed types. The average diameter of the biggest myoma was 6.67+/-0.16 cm (range, 2.5~15 cm) and the average number of the myoma was 2.07+/-0.15 (range, 1~15). Previous operation history and pelvic adhesion did not show correlation with the operation time. The size, type and number of myoma and the operation methods showed correlation with the operation time. According to myoma size and number, we divided the cases into two groups, low risk group (122 cases) and high risk group (63 cases). The analysis showed that post-operation hemoglobin drop (2.89+/-0.10 g/dL vs. 4.03+/-0.23 g/dL) and blood transfusion amount (2.89+/-0.10 pints vs. 4.03+/-0.23 pints) as well as the operation time (137.58+/-4.37 min vs. 193.73+/-9.88 min) showed noticeable increase in the high risk group. CONCLUSION: This statistics show that laparoscopic myomectomy is now being applied to patients with larger and more myomas. Factors affecting operation time were the weight of myomas, number of myomas, type of myomas, number of trocars and methods of resected myomas removal. Also, operation time and post-operative hemoglobin drop increased in the high risk group.
Blood Transfusion ; Gynecology ; Hemoglobins ; Humans ; Laparoscopy ; Myoma ; Obstetrics ; Prognosis ; Retrospective Studies ; Surgical Instruments

PURPOSE: This study aimed to define the relationship among self-care, symptom experiences, and health-related quality of life(HRQoL) according to the severity of disease in chronic obstructive pulmonary disease(COPD) patients. METHODS: The participants, 195 COPD patients, were recruited at a pulmonology clinic of a universityaffiliated medical center in B metropolitan city. Inclusion criteria were patients who were diagnosed as COPD and had less than 0.7 of FEV1/FVC(Forced Expiratory Volume for 1 second/Forced Vital Capacity) ratio. The severity was classified with GOLD(Global initiative for Obstructive Lung Disease) stages, FEV1% predicted value from mild to very severe. The data were gathered by the medical records and self-reported questionnaires. RESULTS: The self-care, symptom experience, and HRQoL were all significantly different by COPD severity based on pulmonary function(p<.05). There were significant moderate negative relationships between symptom experiences and self-care(r=-.54, p<.001) and between symptom experiences and HRQoL(r=-.64, p<.001). There was a moderate positive correlation between self-care and HRQoL(r=.63, p<.001). CONCLUSION: It suggests that the assessment of disease severity based on pulmonary function and subjective symptom experience in patients with COPD may be a key component to develop a tailored self-management program and to improve their quality of life.
Humans ; Lung ; Medical Records ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Medicine ; Quality of Life ; Self Care