Medical record of 66 eyes which had undergone pars plana vitrectomy for the treatment of proliferative diabetic retinopathy were reviewed to study their clinical features, incidences and types of complications, visual outcome, and visual prognostic factors. The final visual outcome showed the improvement in 50[76%] eyes, no change in 13[20%]eyes, and the worsening in 3[4%] eyes. Preoperative prognostic factors favoring final visual acuity included the followings:1]insulin dependent diabetes mellitus which developed before 30 years of age, 2]absence of iris neovascularization, 3]absence of tractional macular detachment. Postoperative complications included vitreous hemorrhage in 34[52%]eyes, cataract in 12[19%]eyes, increased intraocular pressure in 6[10%]eyes, rhegmatogenous retinal detachment in 4[6%]eyes, choroidal effusion in 3[5%]eyes, corneal epithelial defect in 2[3%]eyes, neovascular glaucoma in 1[2%] eye. Postoperative complications associated with poor visual outcome were rhegmatogenous retinal detachment and neovascular glaucoma.Intraoperative complication of iatrogenic retinal tear did not seem to deteriorate the final visual acuity.
Cataract ; Choroid ; Diabetes Mellitus ; Diabetic Retinopathy* ; Glaucoma, Neovascular ; Incidence ; Intraocular Pressure ; Iris ; Medical Records ; Postoperative Complications ; Retinal Detachment ; Retinal Perforations ; Traction ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

The subjects, under 18 old, 2,694 children who visited ER during 199H, were surveyed by the Triage and other statical data. The results were as follows : 1. The male to female ratio was 1.7 : 1, and the toddler(1-4 old) was the majority. 2. Triage : critical 1.3%, acute 14.6%, urgent 29.5%, nonemergent 54.6%. 3. The reasons of visiting ER : 1) The children had diseases(46.5%), injury (36.9%), TA(5.6%) and toxication(1.0%). 2) In diseases, male to female ratio was 1.5 : 1 and in injury, male to female was 2 : 1. 3) Among the children having in TA, 12-18 old groups was the majority(34.9%). 4. The time of visiting ; the 20 : 00-22 : 00 was the majority(16.9%). 5. By monthly and seasonal distribution ; Jan. (9.7%?), Mar. and May(9%) respectively, Dec. and July(6.7%) respectively. The children who visited ER in spring and autumn showed higher portion than those of summer and winter. 6. Results : admission(27.4%), discharge(68.4%), operations(2.8%), and DOA and DAA(0.4%). The mortality of the infancy and toddler groups was 83.3%. The infancy group showed the highest rate of admission. 7. The time of staying in ER : 1-2 hrs was the major group(23.3%) and the average was 4.6 hours. 8. By clinical departments ; Ped, was 34.4%, PS was 20.8.%, Dental Surgery was 10.3% and Dermatology was 0.9%. 9. The types of visiting : the group who visited by themselves was 80%, transfer from the primary and secondary clinic was 17% and OPD was 3.0%. 10. The traffic means ; by the own cars and taxi were 87.6%, by hospital ambulance was 6.1% and by 119 ambulance was 4.3%.
Ambulances ; Child* ; Dermatology ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Male ; Mortality ; Seasons ; Triage* ; Child Health

The purpose of this study is to analyze ER patient's Triage and other statistical data. The subjects were 12,618 patients who visited the ER during the year 1998. The study showed the following results; 1. The male vs female ratio was 1.3 : 1.0, the male were in the majority (56.6%), and the age range of 20-29 old was the majority (15.3). The patients who visited ER at 8-10 pm were the majority (11.5%). On Sunday the number of patients who visited the ER were 2,189, and the majority were 17.4%. On Saturday the number of patients was visited the ER were 1,944 patients the second majority (15.4%). Their traffic means : the general passenger cars (75.5%), 119 or hospital ambulance (11.3%). 2. The reasons of visiting ER were : diseases (59.2%), injuries (23.7%). The disease vs injury ratio was 100 : 69. 3. Triage : urgent 40.7%, non-urgent 38.2%, acute 17.8%, and critical 3.2%. 4. The time of waiting and staying in the ER by the Triaget: the average time was 572 minutes (9.53 hrs.). The majority of critical patients (20.5%), acute patients (24.7%) and urgent patients (21.2%) stayed 12-24 hrs., but the majority of non-emergent (27.8%) stayed not longer than one hour. 5. Treatments by the Triage : the 42.9% of critical patients, and 61.3% of acute patients, 57.5% of urgent patients were admitted. But 91.8% of the non-emergents were discharged and 4.7% was admitted. Mortality of total ER visiter were 1.7%. DAA portion was 0.86%. 26.6% of the critical patients were DAA. DAA vs DOA ratio was 1.3 : 1.0. 6. Visiting time, monthly and seasonal distribution by the Triage : the majority of critical patients (12.2%), visited 10-12 am. The majority of acute (12.9%) and urgent (11.7%) visited 4-6 pm, but the majority of non-emergents (15.1%) visited during 8-10 pm. Autumn visiter were the majority (27.6%). The percentage of non-emergent visited in Spring was 41.4% and Autumn was 41.3%. The percentage of urgents who visited in the Summer was 45.3% and the Winter was 40.4%. By clinical departments: the 48.0% of critical patients was NS. The 45.5% of acute and the 33.6% of urgent patients were IM. But the majority of non-emergent patients was PS (21.2%), and the second majority of non-emergent patients was oral Surgery (12.8%).
Ambulances ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Male ; Mortality ; Seasons ; Surgery, Oral ; Triage*

No abstract available.
Humans

No abstract available.
Ferritins* ; Kidney Transplantation*

Procalcitonin (PCT) is a useful bacterial infection biomarker with the potential for guiding antibiotic therapy. We evaluated the concordance of three automated PCT immunoassays: Kryptor (BRAHMS GmbH, Hennigsdorf, Germany), Atellica IM 1600 (Siemens Healthcare Diagnostics, Munich, Germany), and Cobas e801 (Roche Diagnostics, Mannheim, Germany). In 119 serum samples with a PCT concentration < 5.00 μg/L, Kryptor (reference assay) was compared with the other two immunoassays by Spearman’s rank correlation, regression analysis, and concordance at two antibiotic stewardship medical decision points: 0.25 and 0.50 μg/L. The Atellica IM 1600 and Cobas e801 results showed high correlations with those of Kryptor, with correlation coefficient (ρ) values of 0.97 and 0.99, respectively. However, negative biases were observed in both immunoassays (slope/y-intercept: 0.75/–0.00 for Atellica IM 1600; 0.88/–0.01 for Cobas e801). Atellica IM 1600 and Cobas e801 demonstrated excellent concordance with Kryptor at both medical decision points, with linearly weighted κ values of 0.90 and 0.92, respectively, despite discrepancies, which were more prominent at the 0.25 μg/L medical decision point. Based on these biases and discrepancies, the alternate use of different PCT immunoassays in repeat examinations is inadvisable. Standardization is required before comparing the results of different PCT immunoassays.

BACKGROUNDS: Epidural anesthesia before surgical stimulus may reduce or prevent subsequent pain by preemptive analgesia. We studied the effect of varied concentration of a local anesthetic agent administered through epidural catheter before operation on preemptive analgesia after an abdominal hysterectomy. METHODS: Fourty-five patients scheduled for abdominal hysterectomy were blindly randomized to receive 10 ml of 0.5% bupivacaine (group I), 0.25% bupivacaine (group II) or saline (group III) respectively before induction of anesthesia. For postoperative pain control all patients received the same analgesic regimen which was 10 ml of 0.125% bupivacaine and buprenorphine 0.15 mg after resection of the uterus. Then the epidural catheter was connected with infusion pump containing 100 ml of 0.125% bupivacaine and buprenorphine 0.45 mg. Its infusion rate was 2 ml/hour. Pain was assessed using the Visual Analogue Scale (0 = no pain to 10 = intolerable pain) on rest, motion, cough and verbal rating scale at 1, 3, 6, 24 and 48 hour after operation. Side effects were recorded at the same time intervals. RESULTS: Using the ANOVA on ranksum test, pain scores 1 hour after operation differed between groups I and III (P<0.05). In VAS in motion, the pain scores 24 hours after operation differed between groups I and III (P<0.05). In VRS, the pain scores 3 hours after operation differed between groups II and III (P<0.05), and those 24 hours after operation differed between groups I and III (P< 0.05). The incidence of motor weakness using Chi-square test in group I differed from groups II, III (P< 0.05). CONCLUSIONS: Among the 45 patients who had a postoperative pain control after abdominal hysterectomy with initial bolus injection and then continuous infusion of epidural bupivacaine and buprenorphine, postoperative pain scores of patients who had preoperative epidural injection of 10 ml of 0.5% bupivacaine (n = 15) were lower than those of saline injected patients (n = 15), but those of patients with a preoperative epidural injection of 10 ml of 0.25% bupivacaine (n = 15) were not lower than those of saline injected patients.
Analgesia ; Anesthesia ; Anesthesia, Epidural ; Bupivacaine* ; Buprenorphine ; Catheters ; Cough ; Humans ; Hysterectomy ; Incidence ; Infusion Pumps ; Injections, Epidural ; Pain, Postoperative* ; Uterus

PURPOSE: To determine whether an analysis of two-phase spiral CT features provides a sound basis for differential diagnosis between gallbladder carcinoma and cholecystitis. MATERIALS AND METHODS: We reviewed a total of 89 cases of gallbladder carcinoma (n=35) or cholecystitis (n=54) in patients who had undergone two-phase spiral CT. For this, a GE Highspeed Advantage scanner (GE Medical Systems, Milwaukee, U.S.A.) was used. A total of 120ml of contrast material was injected at a rate of 2 -3 ml/sec. Arterial and venous phase scans were obtained 35 and 65 seconds, respectively, after the initiation of contrast infusion. All cases of gallbladder carcinoma and 468 of cholecystitis (of a total of 482) were confirmed by histopathology. We reviewed the two phase spiral CT features, analyzing and assessing thickness of the lesion, the enhancement pattern seen during the arterial and the venous phase, invasion of the liver, pericholecystic fat infiltration, dilatation of intrahepatic ducts, and other associated findings. RESULTS: Mean wall thickness was 12.6 mm in the gallbladder carcinoma group, and 7.2 mm in the cholecystitis group. The common enhancement patterns seen in gallbladder carcinoma were a highly enhanced thick inner wall layer during the arterial phase which became iso attenuated with adjacent liver parenchyma during the venous phase (16/35; 45.7%), and 2) a highly enhanced thick inner wall layer during both the arterial and the venous phase (8/35; 22.9%). The most common enhancement pattern in cholecystitis cases was an iso attenuated thin inner wall layer during both the arterial and the venous phase (44/54; 81.5%). Findings of intrahepatic mass formation by direct invasion (9/35), lymph node enlargement (12/35), and metastasis to other organs (7/35) occurred only in cases of gallbladder carcinoma. Dilatation of intrahepatic ducts was more frequent in cases of gallbladder carcinoma (18/35, 51.4%) than of cholecystitis (10/54, 18.5%). The incidence of pericholecystic fat infiltration and fluid collection was not significantly different between the gallbladder cancer and cholecystitis groups. CONCLUSION: Gallbladder carcinoma and cholecystitis varied in terms of wall thickness, enhancement pattern, and intrahepatic ductal dilatation, as seen on two phase spiral CT. Findings of liver invasion, lymph node enlargement and distant metastasis strongly suggested gallbladder carcinoma. These results suggested that gallbladder carcinoma and cholecystitis can be distinguished by analysis of their two phase spiral CT features.
Cholecystitis* ; Diagnosis, Differential* ; Dilatation ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Incidence ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Tomography, Spiral Computed*

Heterotopic gastric mucosa in the upper esophagus is frequently found during endoscopic examination. Although most patients with heterotopic gastric mucosa of the upper esophagus, referred as inlet patch, are asymptomatic, symptomatic patients with complications resulting from this ectopic mucosa have also been reported. Acid secretion by the inlet patch has been suggested in some reports. We report a case of heterotopic gastric mucosa in the upper esophagus, with secretion of acid, demonstrated by continuous ambulatory pH monitoring, and the improvement of pharyngeal symptoms after the use of a proton pump inhibitor.
Adult ; Ambulatory Care ; Anti-Ulcer Agents/administration & dosage ; Case Report ; Choristoma/diagnosis* ; Esophageal Diseases/drug therapy ; Esophageal Diseases/diagnosis* ; Esophagoscopy ; Gastric Acid/secretion* ; Gastric Mucosa/secretion* ; Human ; Hydrogen-Ion Concentration ; Male ; Monitoring, Physiologic/methods ; Prognosis

OBJECTIVES: To analyze factors associated with elderly falls in a community dwelling, a comparatively important, but somewhat neglected, health matter. METHODS: Data came from personal interview surveys using a questionnaire of 552 people aged 65 or older living in a community. Socioeconomic, and health related characteristics were investigated as independent variables and experiences of falling in the previous year as the dependent variable. RESULTS: 118(21.4%) of the elderly subjects experienced a fall in the previous year. 24 subjects experienced more than two falls, accounting for 20.3% of the elderly fall victims studied. Factors affecting the falls were families living together, level of daily activity, heart disease, and aconuresis;, therefore an elderly person who lives alone, lives independently, has heart disease, or suffers urinary incontinence had a demonstrated increased chance of falling. CONCLUSION: Groups at risk for falling included elderly persons living alone, living independently, suffering heart disease, or experiencing urinary incontinence. When an elderly fall prevention program is developed and implemented, these results should be considered.
Accidental Falls ; Aged* ; Heart Diseases ; Humans ; Prevalence* ; Questionnaires ; Urinary Incontinence