No abstract available.
Animals ; Neurons* ; Neuropeptides* ; Rats*

PURPOSE: The purpose of this study is to analyze types of shared medical decision making by health professionals in a decision making position. METHODS: The Q-methodology was used. Q sample was constructed with a total of 35 Q-statements that were offered with a 9-point rating scale. The statements were structured to generate answers that would form a shape of a normal distribution. Answers to Q sample were analyzed using a QUANL PC program. RESULTS: Four types of shared medical decision making were identified. Type I is patient-centered decision making, Type II is physician-centered, Type III is health professional-centered and Type IV is patient-family-centered. CONCLUSION: Study results indicate that it is recommended to develop an education program based on the four types of shared medical decision making so that health professionals can be provided with different approaches according to their decision making style.
Decision Making* ; Education ; Health Occupations ; Humans ; Terminally Ill*

OBJECTIVES: To study epidemiologic characteristics and prognostic factors of emergency laparotomy patients due to abdominal trauma. METHODS: From Jan 2006 to Dec 2008, 116 patients enrolled in this study. Inclusion criteria for patients were abdominal trauma patients with emergency laparotomy. Age, sex, ED access, transportation, previous history, time, injured organ, combined injury, initial mental status, revised trauma score, laboratory finding, mortality ware reviewed. RESULTS: Trauma was most common at 40s and at night. Men has three time more common than women. Trauma etiology was traffic accident (64 cases, 55.2%), stab injuries (31 cases, 26.7%), violence (11 cases, 9.5%). Most commonly injured organs were the small intestine, the mesentery was a following. Combined injuries were extremities fractures, head and neck injuries, chest trauma, pelvis trauma, respectively. The average time of prehospital interval was 186.49 +/- 233.29 minutes and Emergency department stay time was 270.50 +/- 180.08 minutes. The average hospitalization was 22.84 +/- 38.02 days. In a univariate logistic regression study, age (odds ratio [OR]: 1.364), systolic blood pressure below 90mmHg (OR 4.460), Hemoglobin (OR 2.380), Revised trauma score (OR 0.902), initial mental status (OR 3.394) were significant prognostic factor. CONCLUSIONS: The result of this study indicated that age, systolic blood pressure below 90mmHg, hemoglobin, revised trauma score, initial mental status were prognostic factor of emergency laparotomy patients due to abdominal trauma. When treating patients with abdominal trauma, we could be considered these prognostic factors. In addition, to establish therapeutic plan will be helpful.
Accidents, Traffic ; Blood Pressure ; Emergencies ; Extremities ; Female ; Head ; Hemoglobins ; Hospitalization ; Humans ; Intestine, Small ; Laparotomy ; Logistic Models ; Male ; Mesentery ; Neck Injuries ; Pelvis ; Thorax ; Transportation ; Violence

OBJECTS: There was a trend to perform fusion and instrumentation in spinal stenosis surgery, because of extensive decompression and instability. However, the introduction of microscope in spine operation can minimize the range of excision of anatomical structure and reduced the decompressin level in the multiple lesions and the incidence of spinal fusion. The purpose of this study were to assess the outcome of this procedure in 3 years follow up and to identify the clinical features of the patients and technical aspects of the operation that were associated with a poor outcome. MATERIALS AND METHODS: Twenty-one patients were identified as having had a microscopic decompression without arthrodesis, for degenerative lumbar spinal stenosis over 60 years or their who had osteoporosis with Saville's index 2 or higher. The follow up period was more than 3 years. The clinical results was evaluated by Kim's criteria. RESULTS: Eleven cases were above good results in two levels involved 14 cases, 2 cases above good results in three levels involved 5 cases and 1 case above good results in four levels involved 2 cases. In the cases of affected duration, 7 cases are less than 1 year or more than 5 years each 6 cases and 2 cases were above good results by the criteria. We concluded that the long-term outcome of decompressive surgery in the elderly is good; it does not differ from that reported for younger patients . CONCLUSIONS: Selective microscopic decompression is one of the effective method for the elderly patients or patients with osteoporosis in addition to multiple stenotic lesions.
Aged ; Arthrodesis ; Decompression* ; Follow-Up Studies* ; Humans ; Incidence ; Osteoporosis* ; Spinal Fusion ; Spinal Stenosis* ; Spine

Panner's disease, osteonecrosis of the capitellum of the elbow, was first reported by Panner in 1927. The disease occurs mainly in boys between 6 and 15 years old and shows unilateral distribution. Pain, stiffness, localized tenderness over the lateral condyle of the elbow, and decreased range of motion are the typical clinical symptoms. Conservative treatment is generally recommended for patients in the early stage of this disease. A few cases of Panner's disease have been reported and few are related to long-term follow-up results. To the best of our knowledge, all reported cases were over six years. Therefore, we report on a five-year-old boy diagnosed as Panner's disease that showed resorption and regeneration of the humeral capitellum with no limitation of motion over three years. The current study was exempted from review by the institutional review board because it was a single retrospective case report. Informed consent was obtained from the patient's guardian.
Child* ; Elbow ; Ethics Committees, Research ; Follow-Up Studies ; Humans ; Informed Consent ; Male ; Osteochondrosis ; Osteonecrosis ; Range of Motion, Articular ; Regeneration ; Retrospective Studies

PURPOSE: This correlation study was performed to examine Korean adults' perceptions and attitudes towards death with dignity and the withdrawal of life sustaining treatment and to identify factors that predict their attitude towards death with dignity. METHODS: The study was conducted using convenience sampling of 291 adults from three towns of a metropolitan city in Korea. Data were collected using structured questionnaires which surveyed people's perception about and attitudes towards withdrawal of life sustaining treatment and scaled their attitude towards death with dignity. Data were analyzed by using descriptive statistics, Pearson correlation coefficients and multiple regression. RESULTS: The attitude towards the withdrawal of life sustaining treatment and death with dignity showed a significant positive correlation (r=0.49, P<0.001). For attitudes towards death with dignity, significant predictors were attitudes towards the withdrawal of life sustaining treatment, age, religion, a proper withdrawal process and advanced medical directives, which explained 49.3% of total variance. CONCLUSION: The results of this study may contribute to development of a new medical decision-making system including nurses' appropriate roles in the process of withdrawing life sustaining treatment and advanced medical directives.
Adult ; Humanism ; Humans ; Korea ; Life Support Care ; Right to Die ; Statistics as Topic

As a adjuvant, 99m Tc-IDA complex cholescintigraphy has been used to differentiate the causes of jaundice,hepatocellular jaundice from the obstructive jaundice. So we conducted the retrospective study from the 41 casesof cholescintigraphy from the Mar, 83 to Sept. 84 at the Dept. of radiology in the Sonnchyunhyang university todetermine the etiology and differential points in the diagnosing the Jaundice. The following results wereobtainend; 1. As a 1st-ordered parameter, the leading edge hepatic parenchymal transit time was very significant in differentiating the causes of jaundice, among the hepatocellular jaundice, obstructive jaundice due to tumor,and obstructive jaundice due to cholelithiasis. (P<0.01 by X2-test) 2. As a 2nd-ordered parameter, hepaticclearance was very significant in differentiating the hepatocellular jaundice from the jaundice due to partialbiliary obstruction. (P>0.01 by t-test) 3. The difference in hepatic clearance between the biliary obstruction dueto tumor and that of the cholelithiasis, was not significant. (P>0.05 by X2-test) 4. The difference in bile ductdilatation among the hepatocellular jaundice obstructive jaundice due to tumor, and obstructive jaundice due tocholelithiasis, was singnificant in differentiating the causes of jaundice. (P<0.05 by X2-test) 5. Intrahepaticstone showed scintigraphic pooling with partial stasis. 6. Cholescintigraphy was useful to differentiated the Rotor's syndrome from the Dubin-Johnson syndrome, supplying the additional criteria.
Bile ; Cholelithiasis ; Jaundice ; Jaundice, Chronic Idiopathic ; Jaundice, Obstructive ; Retrospective Studies

PURPOSE: Acute cholangitis is a life-threatening biliary complication. Medical treatment is the first-line therapy in patients with acute cholangitis, but those who fail to respond to antibiotic treatment require urgent biliary decompression. This study was undertaken in order to determine predictive factors for emergency endoscopic retrograde cholangiopancreatography (ERCP). METHODS: This was a retrospective observation study with data from Daegu Catholic University Hospital, Emergency Department (ED). Between Jan 2005 and Dec 2007, 317 patients were enrolled into this study. Inclusion criteria for patients were a final diagnosis: acute cholangitis, and an ERCP from ED visit. We defined emergency ERCP, as ERCP done within 24 hours of an ED visit. We analyzed the medical data by using SPSS 14.0 and compared the Emergency ERCP group to the Elective (Non emergency) ERCP group with regard to age, sex, vital signs on ED, symptom onset time, mortality, and various laboratory tests. RESULTS: Access to ED and laboratory tests (such as aspartate transaminase (AST) and alanine transaminase (ALT) were factors that showed statistically significant differences between the ERCP group (n=289) and Elective ERCP group (n=28) by the Chi-square test and the t-test by each. There were no statistical differences in other factors by independent t test or Chi-square test. Multiple logistic regression showed access to ED; a laboratory test such as AST were predictive factors for emergency ERCP. CONCLUSION: The result of this study indicates that the EP (Emergency physician) should pay attention to the acute cholangitis patients who visit the ED with an abnormal laboratory test. In the timely consultation to the endoscopist, EP plays a key role in the treatment of acute cholangitis.
Alanine Transaminase ; Aspartate Aminotransferases ; Bile Duct Diseases ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Decompression ; Emergencies ; Humans ; Logistic Models ; Retrospective Studies ; Vital Signs

PURPOSE: Sudden cardiac death is still a major cause of death and a burden to national public health. Out-of-hospital cardiac arrest (OHCA) patients achieving field Return of spontaneous circulation (ROSC) have better survival rates and good neurological outcomes. The study was designed for analysis of prehospital and hospital clinical characteristics of Heartsaver patients surviving OHCA of cardiac origin. METHODS: A retrospective study was conducted on 31 Heartsaver patients surviving OHCA by Emergency Medical Service (EMS) from March, 2011 to May, 2014; 24 cardiogenic-Heartsaver patients were enrolled in this study. They were divided into the myocardial infarction group (MI group) and the non-myocardial infarction group (Non-MI group) by final diagnosis for comparison of prehospital and in-hospital characteristics. RESULTS: The etiology of cardiac arrest cause of cardiogenic-Heartsaver was categorized according to five groups, including myocardial infarction (29.2%), Brugada syndrome (25.0%), idiopathic ventricular fibrillation (25.0%), idiopathic ventricular tachycardia (8.3%), and coronary spasm (12.5%). Most patients had good neurological outcomes, Cerebral Performance Categories scale (CPC) median was 1.0(1.0-1.0). The MI group showed higher average age (57.1+/-6.49 vs 52.3+/-13.0, p=0.036), high incidence of ST-segment elevation (42.9%), and nonspecific-ST or T-wave change (24.9%) in electrocardiogram (ECG) after ROSC, higher incidence of regional wall motion abnormality in Echocardiography (85.7% vs 23.5%, p=0.009), and higher peak level of CK-MB, troponin I within 12 hours (p=0.005, p=0.014). Some Non-MI patients had undergone an electrophysiologic study and received an implantable cardioverter defibrillator. CONCLUSION: Cardiogenic OHCA patients should be examined by cardiac enzyme, ECG, echocardiography, and coronary angiography in order to differentiate etiology. Besides, to prevent sudden cardiac death from fatal arrhythmia, electrophysiologic study and implantable cardioverter defibrillator insertion therapy must be considered.
Arrhythmias, Cardiac ; Brugada Syndrome ; Cause of Death ; Coronary Angiography ; Death, Sudden, Cardiac ; Defibrillators ; Diagnosis ; Echocardiography ; Electrocardiography ; Emergency Medical Services ; Heart Arrest ; Humans ; Incidence ; Infarction ; Myocardial Infarction ; Out-of-Hospital Cardiac Arrest* ; Public Health ; Retrospective Studies ; Spasm ; Survival Rate ; Tachycardia, Ventricular ; Troponin I ; Ventricular Fibrillation

Colonoscopy is a routinely performed diagnostic and therapeutic procedure for colorectal diseases. Abdominal pain after colonoscopy is a relatively common complication; however, hemoperitoneum is a very rare complication. We report a case of a 51-year-old male patient who suffered from a left upper quadrant pain after diagnostic colonoscopy at a healthcare promotion center. He had a routine screening test, including computed tomography (CT), and the follow-up CT showed an iatrogenic hemoperitoneum without a definite spleen injury. That is complication is rare, but potentially life-threatening. We recommend a high suspicion for this complication for its early diagnosis and proper treatment.
Abdominal Pain ; Colonoscopy* ; Delivery of Health Care ; Early Diagnosis ; Follow-Up Studies ; Hemoperitoneum* ; Humans ; Male ; Mass Screening ; Middle Aged ; Spleen