BACKGROUND: Diabetic ketoacidosis(DKA) is serious acute metabolic complication and the most important cause of high morbidity and mortality of diabetes. The object of this study is to examine the clinical characteristics of patients with DKA who had a prior history of diabetes or not. METHOD: Authors reviewed retrospectively the medical records of 49 cases adimitted to Kyungpook National University Hospital from January 1991 to June 1997 with a diagnosis of DKA and classified cases as type I, type II and newly diagnosed diabetics according to prior history of diabetes. RESULTS: 1. Of 49 cases of DKA, 24(49%) were classified as type I, 17(35%) as type II from data available in the medical records, and 8(16%) had DKA as the initial manifestation of the disease. 2. The male to female ratio was 0.5 : 1 in type I, 1.1 : 1 in type II and 1.7 : 1 in newly diagnosed diabetics, and the mean age was 24.4 in type I, 57.9 in type II and 23.9 years old in newly diagnosed diabetics. 3. The mean duration between initial diagnosis of diabetes and the occurrence of DKA was 2.6 in type I and 6.9 years in type II diabetes. The occurrence of DKA within 2 years of initial diagnosis of diabetes was 54% in type I and 18% in type II diabetes, but the occurrence of DKA after 5 years of initial diagnosis of diabetes was 17% in type I and 47% in type II diabetes. 4. The precipitating factors of DKA were identified in 88% in type I, 76% in type II and 38% in newly diagnosed diabetics, and the most common precipitating factor was omission of treatment in both type I and type II(type I: 56%, type II: 35%). 5. The altered mental status was correlated with increased osmolality (p<0.05), but not with other laboratory values such as pH, bicabonate, glucose, anion gap and dehydration status(p>0.05). CONCLUSION: It is necessary to conduct early aggressive evaluation for early diagnosis and proper treatment of DKA, because DKA occurs in patients with prior history of type II diabetes and without prior diabetic history as well as patients with prior history of type I diabetes.
Acid-Base Equilibrium ; Dehydration ; Diagnosis ; Early Diagnosis ; Female ; Glucose ; Gyeongsangbuk-do ; Humans ; Hydrogen-Ion Concentration ; Male ; Medical Records ; Mortality ; Osmolar Concentration ; Precipitating Factors ; Retrospective Studies

Spontaneous pneumothorax is an accumulation of air in the pleural space with collapse of the lungs in the absence of external chest trauma. In this study, 175 cases of spontaneous pneumothorax experienced at emergency room of Kyungpook University Hospital from July 1995 to June 1996 were analyzed retrospectively. The results were summarized follows: 1. Sex ratio of male to female was 6.6:1 and the mean age was 36.7 years. 2. In clinical symptoms, dyspnea was 85 cases(48.6%), chest pain 67 cases(38.3%), chest discomfort 18 cases(10.3%), coughing 2 cases(1.1%), and others 3 cases(1.7%). 3. In etiology of spontaneous pneumothorax, primary spontaneous pneumothorax was 118 cases(67.4%) and secondary spontaneous pneumothorax 57 cases(33.6%). The underlying pathologic lesion of secondary spontaneous pneumothorax showed pulmonary tuberculosis in 50 cases(28.6%), COPD in 5 cases(2.9%), bronchial asthma in 1 case(0.6%), and pneumoconiosis in 1 case(0.6%). 4. The incidence of recurrence was as follows; no previous history in 123 cases(70.3%), second attack in 35 cases(20.0%), third attack in 15 cases(8.6%), fourth attack in 1 case(0.6%), and fifth attack in 1 case(0.6%). 5. The interval of recurrence after last attack was as follows; less than 6 months in 36 cases(69.2%), between 6 months and 1 year in 5 cases(9.6%), between 1 and 2 years in 3 cases(5.8%), between 2 and 3 years in 2 cases(3.8%), and greater than 3 years in 6 cases(11.5%). 6. In distribution of the lesion sites, left was 93 cases(53.1%), right 80 cases(45.7%), and bilateral 2 cases(1.1%). 7. In degree of lung collapse, 17 cases(9.7%) were small(<20%), 127 cases(72.6%) moderate(20-40%), and 31 cases(17.7%) large(>40%). 8. The accompanied diseases of spontaneous pneumothorax were found in 17 cases, in which hydrothorax were 14 cases and hemothorax were 3 cases. 9. The employed management were as follows; bed rest with oxygen inhalation in 6 cases(3.4%), thoracentesis in 4 cases(2.3%), closed thoracostomy in 136 cases(77.7%), and open thoracotomy in 29 cases(16.6%). 10. The reexpansion time after chest tube insertion was as follows; less than 1 day in 147 cases (89.6%), between 1 and 2 days in 12 cases(7.3%), between 2 days and 1 week in 4 cases(2.4%), and greater than 1 week in 1 case(0.6%). 11. The duration of chest tube insertion was as follows; less than 1 week in 102 cases(62.2%), between 1 and 2 weeks in 34 cases(20.7%), between 2 and 3 weeks in 14 cases(8.5%), between 3 and 4 weeks in 7 cases(4.3%), and greater than 4 weeks in 7 cases(4.3%). 12. The complications of closed thoracostomy were as follows; incomplete lung expansion in 4 cases and empyema in 1 case. 13. The indications of open thoracotomy were as follows; bleb or bullae on chest X-ray in 12 cases (41.4%), persistent air leak in 8 cases(27.6%), recurrent pneumothorax in 4 cases(13.8%), incomplete lung expansion in 3 cases(10.3%), and contralateral pneumothorax history in 2 cases(6.9%). 14. The duration of hospitalization was as follows; less than 1 week in 100 cases(57.1%), between 1 and 2 weeks in 29 cases(16.6%), between 2 and 3 weeks in 22 cases(12.6%), between 3 and 4 weeks in 9 cases(5.1%), and greater than 4 weeks in 15 cases(8.6%).
Asthma ; Bed Rest ; Blister ; Chest Pain ; Chest Tubes ; Cough ; Dyspnea ; Emergency Service, Hospital ; Empyema ; Female ; Gyeongsangbuk-do ; Hemothorax ; Hospitalization ; Humans ; Hydrothorax ; Incidence ; Inhalation ; Lung ; Male ; Oxygen ; Pneumoconiosis ; Pneumothorax* ; Pulmonary Atelectasis ; Pulmonary Disease, Chronic Obstructive ; Recurrence ; Retrospective Studies ; Sex Ratio ; Thoracostomy ; Thoracotomy ; Thorax ; Tuberculosis, Pulmonary

BACKGROUND: To examine whether nonemergency patients can be identified and be safely triaged out of the emergency department. METHODS: Adult patients(16 years or older) who visited to the emergency department were prospectively studied from July 1 to August 31, 1997. Authors developed a new triage composed of vital signs, mental status, chief complaints, etiology, and a mode of transfer. Chi-square test and a discriminant analysis were applied for statistical analysis. RESULTS: In a discriminant analysis, mode of transfer, chief complaint, age, heart rate, mental status, etiology, and body temperature were significant variables in order. In a canonical discriminant value at group mean, a nonemergent value is 0.450 and a emergent value -0.219. CONCLUSIONS: In simply applicable triage method, mode of transfer and chief complaints are more important than vital sign and mental status. This method is useful in disaster situation and non-medical personnel may use this triage method easily. But some patients are not triaged by this triage method, thus more studies and discussions are necessary.
Adult ; Body Temperature ; Disasters ; Emergencies* ; Emergency Service, Hospital* ; Heart Rate ; Humans ; Prospective Studies ; Triage* ; Vital Signs

BACKGROUND: The goal of this study is to identify the factors that predict mortality in elderly trauma patients. METHOD: We reviewed retrospectively the medical record of 144 cases of geriatric trauma admitted to Kyungpook National University Hospital firm January 1998 to December 1998. We evaluated the general characteristics, mechanisms of injury, Revised Trauma Score(RTS), Injury Severity Score(ISS), Probability of survival(Ps) by TRISS(Trauma and Injury Severity Score) method, amount of blood transfused, preexisting disease, complications, length of stay, and mortality. RESULTS: 1. The mean age was 75.39+/-7.89 years old, and male to female ratio was 0.89 : 1. 2. The mechanisms of injury were primarily frills(56.3%) followed by bicycle or motorcycle(13.9%), and pedestrian injuries(13.2%) and motor vehicle accidents(6.9%). 3. The mean Glasgow Coma Scale(GCS), RTS and ISS ate 13.3+/-3.5, 7.2+/-1.4 and 14.2 +/-11.6 respectively. 4. The actual mortality rate was 18.1% (26/144). But by TRISS method, predicted mortality rate was 9.3%(12.5/144), excess mortality rate was 108% and Z score was 3.99 indicating that actual number of death exceed predicted number of death. 5. Between the survivors and nonsurvivors, the insults were significantly different as follows ; systolic blood pressure(141.9+/-28.3 vs. 116.8+/-48.7 mmHg), GCS(14.3+/-2.0 vs. 9.0 +/-5.1), RTS(7.8+/-0.7 vs 5.4+/-2.3), ISS(11.3+/-5.6 vs 27.2+/-20.2), Ps by TRISS(0.97+/-0.06 vs 0.65+/-0.37), preexisting diseases(50.8 vs 69.8%). CONCLUSION: Geriatric patients are more likely to die after trauma than other age groups. The cause of higher actual mortality rate compared to predicted mortality rate was considered as the higher incidence of delayed death due to sepsis or multiple organ failure. In order to reduce the mortality, even with relatively stable initial vile sign, invasive hemodynamic monitoring and intensive treatment are recommended and also, prevention and treatment of nosocomial infection are very important.
Aged ; Coma ; Cross Infection ; Female ; Gyeongsangbuk-do ; Hemodynamics ; Humans ; Incidence ; Length of Stay ; Male ; Medical Records ; Mortality* ; Motor Vehicles ; Multiple Organ Failure ; Preexisting Condition Coverage ; Retrospective Studies ; Sepsis ; Survivors

BACKGROUND: To examine the influencing factors on patients' satisfaction in the emergency department(ED) far quality assurance. METHODS: Patients who visited to the ED were prospectively investigated from November 1 to December 31,1997. Authors developed questionnaire to investigate influencing factors on patients' satisfaction.4 Chi-square test and 115-REL 7.0 were applied far statistical analysis. RESULTS: Patients' satisfaction was significantly related to physical environment variables, accessibility variables, kindness of hospital personnel variables, and patient's trust for doctors variables. In path analysis, willingness for revisit was influenced by patients' satisfaction, accessibility, physical environment, patients' trust for doctors in order, and willingness for recommendation was influenced by accessibility, patients' satisfaction, and kindness of hospital personnel in order. CONCLUSIONS : The influencing factors on patients' satisfaction are physical environment, accessibility, kindness of hospital personnel, and patient's trust far doctors. Willingness far revisit and willingness far recommendation are influenced by patients' satisfaction. In spite of some limitations, the results of this study can be used as a baseline information for exploring the influencing factors on patients' satisfaction. Further comprehensive research efforts should be made on the study of patients' satisfaction in the ED.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Personnel, Hospital ; Prospective Studies ; Surveys and Questionnaires

Intrabronchial nerilemmoma is very rare disease. Neurilemmoma has been thought to arise from schwann cell, has been reported to occur in almost any anatomic location. The incidence of primary neurogenic tumors of the lung has been estimated to be 0 to 2 percent of all lung tumors. These tumors are predominantly(75%) associated with neurofibromatosis of von Recklinghausen's disease. To our knowledge, no case of benign solitary endobronchial neurilemmoma has been reported in Korea. This paper presents a case of benign solitary endobronchial neurilemmoma with a brief review of the pertinent literature. A 19 year old female visited our medical hospital with the symptoms of chest discomfort and pain. Bronchoscopy and chest CT scan revealed a mass on the left upper 1obar bronchus. Left upper lobectomy was performed successfully and histological section revealed a neurilemmoma.
Bronchi ; Bronchoscopy ; Female ; Humans ; Incidence ; Korea ; Lung ; Neurilemmoma* ; Neurofibromatoses ; Neurofibromatosis 1 ; Rare Diseases ; Thorax ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: This study was performed to evaluate the validity of optical coherence tomography 3000 (OCT3) in the diagnosis of normal tension glaucoma (NTG). METHODS: One-hundred and eighty eyes with NTG or glaucomatous optic disc changes by direct ophthalmoscope and 51 normal eyes were included. Mean deviation (MD) and pattern standard deviation (PSD) were acquired by the Humphrey visual field analyzer. Mean retinal nerve fiber layer (RNFL) thickness was measured by OCT3. We analyzed the relationships between MD and mean RNFL thickness, PSD, and mean RNFL thickness. We also analyzed differences in the change of mean RNFL thickness according to the change of visual field defect progression. RESULTS: MD and PSD were proportional to the mean RNFL thickness, using the Pearson correlation coefficient: 0.418 (p=0.001) and -0.397 (p=0.002), respectively. There was a significant decrease in the mean RNFL thickness according to the visual field defect severity. Particular, the RNFL thickness of the superior and inferior quadrants were significantly decreased in the severe visual field defect groups. The difference between the mean RNFL thicknesses in pre-perimetric glaucoma between the normal eye and early glaucoma groups was not statistically significant. CONCLUSIONS: The mean RNFL thickness measured by OCT3 could be considered as valid parameter for the diagnosis of NTG. For early diagnosis of glaucoma, however, visual field test must be considered with OCT3.
Diagnosis ; Early Diagnosis ; Glaucoma ; Low Tension Glaucoma* ; Nerve Fibers* ; Ophthalmoscopes ; Retinaldehyde* ; Tomography, Optical Coherence ; Visual Field Tests ; Visual Fields*

PURPOSE: To characterize the MR findings for a differential diagnosis and to make a plan for treatment by interventional technique of the vascular masses with/without hypertrophic feeding vessels of the head and neck. SUBJCETS AND METHODS: Seven patients with vascular masses of the head and neck proved by pathology, angiography, clinical findings were included. Vascular masses included 4 venous malformations, a capillary hemangioma, and a hemangiopericytoma, a hemangioma combined with arteriovenous malformation. 7 patients had MR studies with 1.0T and 1.5T using routine TI-, T2- weighted spin echo sequences, and contrast enhancement. 4 MR angiography, 3 inversion recovery, and 6 contrast angiography were studied from 7 patients RESULTS: All vascular masses demonstrated higher than muscle signal intensity on Tl-weighted images, bright signal intensity on T2-weighted images, and prominent enhancement, except AV hemangioma combined with prominent arteriovenous malformation on postcontrast scan. Three hemangiomas demonstrated distinct serpiginous signal voids. Venous malformations demonstrated venous lakes seen as homogenous regions of high signal intensity and phleboliths seen as low signal foci on images. Inversion recovery was the best pulse sequence for evaluation of the extent of lesion. CONCLUSION: MR findings of the vascular masses of the head and neck are useful in delineating the extent of the disease, differentiating venous malformation or cavernous hemangioma from other hemangiomatous lesions including hypertrophic feeding vessels, and making a plan for treatment by interventional technique also.
Angiography ; Arteriovenous Malformations ; Diagnosis, Differential* ; Head* ; Hemangioma ; Hemangioma, Capillary ; Hemangioma, Cavernous ; Hemangiopericytoma ; Humans ; Lakes ; Neck* ; Pathology

BACKGROUND: Left ventricular hypertrophy is common in chronic renal failure patients and may contribute increased risk of cardiovascular morbidity and mortality. We evaluated the left ventricular morphology and function in renal transplant recipients to find the relationship between hemodynamic changes and morphologic and functional improvement after transplantation. METHODS: Serial echocardiographic evaluations were performed in 27 adults(20 men and 7 women) at the time of transplantaion and posttransplantation 1 month and 4 months. The average duration of hemodialysis was 16+/-24 months(mean+/-S.D.). RESULTS: At the time of transplantation, the hematocrit level was 21+/-6% and posttransplantation 1 month and 4 months, that was increased to 39+/-5% and 42+/-7%, respectively(p<0.001). Left ventricular mass index by echocardiography was decreased significantly from 246+/-87g/m2(pre-KT) to 169+/-38g/m2(post-KT 1 month) and 153+/-40g/m2(post-KT 4 months), respectively (p<0.001). Interventricular septal thickness and left ventricular posterior wall thickness were decreased significantly after 4 months of transplantation. Left ventricular systolic and diastolic dimensions were also decreased significantly after 1 month and 4 months of transplantation. Left ventricular volumes and cardiac output were also decreased significantly. But A/E ratio, ejection fraction and fractional shortening did not change significantly. CONCLUSION: These findings showed that pretransplant high output state was resolved radipidly(within 1 month) but the diastolic function did not improved after transplantation 1 month and 4 months.
Cardiac Output ; Echocardiography* ; Hematocrit ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Mortality ; Renal Dialysis ; Transplantation*

Sclerosing cholangitis is cholestatic disease, characterized by progressive fibrotic inflammation and obliteration af intrahepatic bile ducts and extrahepatic bile ducts and sometimes associated with ulcerative colitis. The pathogenesis of this disease is not understood well. In this disease, however, have been proposed infectious agent, endotoxin of bacteria and immunological event. In Europe and U.S.A., the incidence of sclerosing cholangitis associated with ulcerative colitis was between 2,4 and 4.0 percent. The association is strongest in patients with pancolitis, with a prevalenee of 5.5 percent, compared with patients with disease confined to the distal colon, with a prevalence of 0.5 percent. But, in Korea, it has not been reported sclerosing cholangitis associated with ulcerative colitis. A 30-year old man was diagnosed as an ulcerative colitis 9 years ago and has been followed up, intermittently. Recently, he has experienced hematochezia and dizziness. Colonoscopy showed active ulcerative colitis(pancolitis), blood chemistry elevated alkaline phosphatase and y-GTP. ERCP and liver biopsy specimen revealed sclerosing cholangitis. we concluded that this case was a sclerosing cholangitis as a complication of ulcerative colitis and the first case report of primary sclerosing cholangitis with ulcerative colitis in Korea, Hence, we reported a case of primary sclerosing cholangitis with ulcerative colitis with a review of literatures.
Adult ; Alkaline Phosphatase ; Bacteria ; Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; Biopsy ; Chemistry ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing* ; Colitis, Ulcerative* ; Colon ; Colonoscopy ; Dizziness ; Europe ; Gastrointestinal Hemorrhage ; Humans ; Incidence ; Inflammation ; Korea ; Liver ; Prevalence ; Ulcer*