PURPOSE: To evaluated the usefulness of pressure-flow study (PFS) as a preoperative technique, and to compare its sensitivity and specificity, with uroflow, post void residual urine and prostate volume, in benign prostatic hyperplasia patients. MATERIALS AND METHODS: The records of 109 men, with lower urinary tract symptoms that underwent a transurethral resection of prostate (TURP), between May 1995 and June 2002, were retrospectively analyzed. Fifty one patients underwent preoperative PFS and 58 did not. The PFSs were performed with an 8Fr suprapubic catheter. The results of the PFS were divided into two groups: obstructed and unobstructed, using an ICS nomogram, pQ slope or the minimal urethral opening pressure. The outcomes of the operations were estimated with IPSS and the maximal flow rate 3 month after the operations. RESULTS: With the PFS operations, 47 cases (81.0%) were obstructed and 11 (19.0%) unobstructed. The success rates of the TURP for the obstructed, unobstructed and non-invasive study groups were 87.2, 63.6 and 88.2%, respectively. The sensitivity and specificity of the PFS were 84.5 and 40.4%, respectively. The sensitivity of the maximal flow rate (or=30gm) was 50.0%. CONCLUSIONS: PFS is not a mandatory preoperative technique for men, with lower urinary tract symptoms, who undergo a TURP. However, it can decrease the TURP failure rate. Other noninvasive parameters can be preoperatively useful for men who undergo TURP, as long as they are applied compositely carefully.
Catheters ; Humans ; Lower Urinary Tract Symptoms ; Male ; Nomograms ; Prostate ; Prostatic Hyperplasia* ; Retrospective Studies ; Sensitivity and Specificity ; Transurethral Resection of Prostate ; Urodynamics

Since its introduction into clinical practice in the 1980s, endoscopic ultrasound (EUS) has been described as a good imaging modality for the diagnosis of pancreatobiliary diseases. However, differential diagnosis of certain lesions based only on B-mode ultrasound images can be challenging. Clinical use of ultrasound contrast agents has expanded the utility of EUS from that of detection to characterization of pancreatobiliary lesions based on the enhancement features of contrast-enhanced EUS (CE-EUS). Current low mechanical index techniques for CE-EUS using second-generation contrast agents have a number of distinct advantages over conventional diagnostic modalities in evaluating pancreatobiliary lesions, including real-time assessment of perfusion pattern, availability, and the absence of exposure to radiation. This article describes the technical aspects of CE-EUS and reviews the expanding indications in pancreatobiliary diseases and further development of this technique.
Biliary Tract Diseases/diagnosis/*ultrasonography ; *Contrast Media ; Diagnosis, Differential ; Endosonography/*methods ; Humans ; Medical Illustration ; Pancreatic Diseases/diagnosis/*ultrasonography

The transesophageal echocardiography (TEE) has been used for the assessment of right and left ventricular function, valvular structure and function, regional wall motion abnormalities and localization of intravascular catheters, cannular and prosthesis. We inserted the pulmonary artery catheter (PAC) under the guidance of intraoperative TEE because of the difficulty of placing PAC with the pressure tracing method in two patients. The PAC was inserted from right atrium to right ventricle with the basal four chamber view and advanced to pulmonary artery through pulmonary valve with the longitudinal view of TEE. We observed typical pulmonary arterial wave form to confirm the correct position. We suggest that the TEE can be used for successful placement of a PAC to facilitate manipulation of the catheter as an alternative method in the patients whose PAC can not be positioned with the pressure tracing method.
Catheters* ; Echocardiography, Transesophageal* ; Heart Atria ; Heart Ventricles ; Humans ; Prostheses and Implants ; Pulmonary Artery* ; Pulmonary Valve ; Ventricular Function, Left

OBJECTIVE: As an electronic health record system is implementing in Korean health care sectors, concerns about key functionalities of electronic health record systems are increasing. The purpose of this study was to identify core functions and set the priority in electronic health record systems under the Korean contexts in order to assure and improve the quality of the systems. METHODS: A survey was conducted using questionnaire developed by the study team based on literature review. The subjects were medical record administrators working at medical record department in general hospitals. RESULTS: The response rate was 59.8%(55/92). The functions which more than ninety percent of subjects responded as necessary right now and/or in near future related to 'drug alert', 'clinical guideline', 'chronic disease management', 'automated real-time surveillance', 'coded data', 'result reporting', 'de-identifying data', 'disease registry', and 'provider-provider communication and connectivity'. CONCLUSION: The results showed the high prioritized functions were decision support and health information/data management.
Electronic Health Records* ; Health Care Sector ; Hospitals, General* ; Humans ; Medical Record Administrators ; Medical Records ; Needs Assessment* ; Surveys and Questionnaires

BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

BACKGROUND: To access the accuracy and clinical usefulness of microplate identification (ID) system for the identification of Enterobacteriaceae, we compared microplate ID system with API 20E(bioMerieux, Etoile, France). METHODS: Ninety-two cultures of Enterobacteriaceae and one isolate of Aeromonas species were simultaneously identified by microplate ID system and the API 20E. Twenty biochemical tests used in microplate ID system were lactose, sucrose, and H2S in Kligler's iron agar media; indole, sucrose, raffinose, arabinose, trehalose, adonitol, dulcitol, sorbitol, cellibiose, methy-red, phenylalanine deaminase, ornithine decarboxylase, lysine decarboxylase, arginine dihydrolase, urease, and citrate in microplate; and oxidase test. The identification was obtained by considering percent likelihood(% ID), modal frequency and ID score method. RESULTS: Among the 92 cultures of Enterobacteriaceae and one isolate of Aeromonas species, agreement rate of identification according to the % ID between microplate ID system and API 20E were 90.3% to the species level and 97.8% to the genus level. CONCLUSIONS: For the identification of clinical Enterobacteriaceae isolates, the microplate ID system compares favorably with API 20E in identification accuracy and have the advantage of costsaving and easy to use.
Aeromonas ; Agar ; Arabinose ; Arginine ; Citric Acid ; Enterobacteriaceae* ; Galactitol ; Iron ; Lactose ; Lysine ; Ornithine Decarboxylase ; Oxidoreductases ; Phenylalanine ; Raffinose ; Ribitol ; Sorbitol ; Sucrose ; Trehalose ; Urease

PURPOSE: To evaluate MRI findings of malignant ovarian tumors. MATERIALS AND METHODS: MRI findings were retrospectively reviewed in 25 patients with surgically confirmed 30 malignant ovarian tumors(common epithelial tumor;23, sex cord stromal tumor;2, endodermal sinus tumor ; 1, metastatic tumor ;4). The findings evaluated were the lesion size, solid and/or cystic component, wall thickness, septal thickness, necrosis, invasion of adjacent organ, ascites, and adenopathy. RESULTS: MRI findings of the malignant ovarian tumors were as follow:Size of lesion was 5-35cm(mean 14cm) ;solid component was present in 80%(24/30);wall thickness was more than 3ram in 90%(27/30);septal thickness was more than 3ram in 70%(21/30);tumor necrosis was present in 40%(12/30%) ;invasion of adjacent organ was present in 76%(19/25);ascites was present in 56%(14/25);lymphadenopathy was present in 24% (6/25). MRI findings of absence of solid component(6/6), even wall and septal thickness(7/7, 19/19) were found only in epithelial tumors. Uneven septal thickness more than 3mm(7/11) was a predominant MRI findings of non-epithelial tumors. Well-defined cystic lesion within solid component was seen in Krukenberg tumors. CONCLUSION: Evaluation of the lesion size, internal architecture, invasion of adjacent organ, ascites, and lymphadenopathy in MRI would enable diagnosis of malignant ovarian tumors and could lead to possible differential diagnosis of epithelial tumors from non-epithelial tumors.
Ascites ; Diagnosis ; Diagnosis, Differential ; Endodermal Sinus Tumor ; Humans ; Krukenberg Tumor ; Lymphatic Diseases ; Magnetic Resonance Imaging* ; Necrosis ; Retrospective Studies

OBJECTIVES: Medically unexplained physical symptoms comprised the predominant complaints of patients with depression in clinical settings. Previously, tricyclic antidepressants, which inhibit both presynaptic reuptake of serotonin and norepinephrine, had been used to relieve pain as well as treat depression. The objective of this study was to evaluate the efficacy of venlafaxine ER, which also has the effects on both serotonin and norepinephrine, in patients suffering from depression with somatic symptoms. METHODS: The subjects were recruited from outpatients who had been treated for depression with venlafaxine ER. They were divided into two groups, based on whether they voiced somatic symptoms as their chief complaint (somatic group) or not (non-somatic group). In addition, they were also divided into two groups according to whether they met the criteria of multisomatoform disorder (DSM-IV, Primary Care Version). The duration from the time venlafaxine ER was used to the point when treatment was changed because of the recurrence of symptoms or side effects was assessed and compared using survival analysis in the two groups. RESULTS: Sixty-four patients fulfilled the inclusion criteria of this study, and 39 patients 'were placed into the somatic group', while the other 25 patients 'were placed into the non-somatic group'. The survival rates of maintenance treatment in the somatic group was significantly higher than in the non-somatic group (logrank test p=0.033), and the mean duration of maintenance treatment in the somatic group was 41.5+/-3.38 weeks, while that in the non-somatic group was 26.0+/-4.95 weeks. When the subjects were classified by the criteria of multisomatoform disorder, no significant difference was observed between the two groups (logrank test p=0.314). CONCLUSION: In the present study, treatment venlafaxine ER was maintained longer in patients suffering from depression with somatic complaints, which suggests the efficacy of venlafaxine ER on somatic symptoms of these patients. Large-scale, controlled trials are needed to confirm our findings.
Antidepressive Agents, Tricyclic ; Depression ; Depressive Disorder, Major* ; Humans ; Norepinephrine ; Outpatients ; Primary Health Care ; Recurrence ; Serotonin ; Survival Rate ; Venlafaxine Hydrochloride

Painful nociceptive informations are well known to be transferred from nociceptors through spinal dorsal horn not only in different pathways but also in diverse nature depending on the type of noxious stimuli. There have been some controversies about the role of neuropeptide somatostatin in the transmission of the nociceptive information to the dorsal horn cells of the spinal cord. We performed the study in order to elucidate the effects of somatostatin on transmission of noxious stimuli in the spinal dorsal horn, comparing with those of morphine. Using carbon-filamented microelectrode, the single cell activities of wide dynamic range(WDR) neuron were recorded extracellularly at the lumbosacral enlargement of the spinal cord in cats after noxious mechanical(squeeze), thermal(heat lamp), and cold(dry ice) stimulation to the receptive field. The sciatic nerve was stimulated electrically to evoke, A4-fiber and C-fiber each other. Data were compiled into single pass time histograms or postsimulus time histograms. Twenty micro-gram of somatostatin was injected intravenously to study the changes of single cell activities in 20 minutes, which were compared with the effects of morphine(2m/kg). Then naloxone was administrated(0.1mg/kg) to know whether it antagonized the effects of somatostatin and morphine And those finding were also observed in inverted WDR cells. In WDR cell, somatostain decreased the cellular responses to noxious heat stimuli in 6cell(n=9), but increased those to cold stimuli in 4 cells(n=6). And the responses to noxious mechanical stimuli were so diverse that they were slightly increased in 7 cells(164%), decreased in 5 cells, and were not changed in 6 cells(n=18). A-response, the response to peripheral Ad-afferent activation, showed a tendency to be facilitated(n=6/9), while C-response had a slightly depressed tendency(n=4/9). Morphine strongly suppressed the responses of dorsal horn neurons to noxious heat(n=9/13), cold(n=2/2), mechanical stimuli(n=16/19) and electrical A-response(n=7/10), C-response(n=6/7). Following subsequent injection of naloxone, the effects of morphine on noxious stimuli evoked response were fully reversed but those of somatostatin were not antagonized. There was significant difference between the reversal effects of naloxone on morphine and somatostatin(p<0.05). From the above results it is concluded that somatostatin suppresses the transmission of nociceptive heat stimuli, especially via C-fiber, while facilitates that of nociceptive mechanical and cold stimuli via Adelta-fiber in spinal dorsal horn cells. Also the somatostatin appears to have different nociceptive mechanism from morphine.
Animals ; Cats* ; Horns ; Hot Temperature ; Microelectrodes ; Morphine* ; Naloxone ; Neurons ; Neuropeptides ; Nociceptors ; Peripheral Nerves* ; Posterior Horn Cells* ; Sciatic Nerve ; Somatostatin* ; Spinal Cord

OBJECTIVE: Prescription patterns have changed rapidly due to the development of new drugs, results of new researches, and increment of clinician's experience. The goal of this study was to examine and compare the trend of prescription patterns for major depressive disorder at a university hospital between year 2001 and 2006. METHODS: We evaluated the medication usage of inpatients with major depressive disorder in 2001 and 2006, including antidepressants used as the first choice, switching, and combination, and various augmentation agents. And we evaluated the time to switching and combination of antidepressant in 2001 and 2006. RESULTS: The antidepressants used as first line drug were SSRIs (49.3%), mirtazapine (24.0%), and TCAs (4.8%) in 2001, and SSRIs (50.0%), mirtazapine (24.7%) and venlafaxine (19.0%) in 2006, in frequency order. The antidepressants used as switching drug were TCAs (33.3%), mirtazapine (25.0%), and nefazodone (16.7%) in 2001, and SSRIs (33.3%), mirtazapine (33.3%), and venlafaxine (19.0%) in 2006. As combination treatment, SSRIs and TCAs combination was used mostly by far in 2001 (87.5%), but in 2006, various combination were used including SSRIs and mirtazapine, SSRIs and TCAs, mirtazapine and venlafaxine (36.8%, 23.6%, 18.4%, respectively). The time to combination in 2001 and 2006 year were not different significantly (17.4+/-7.9 day vs 18.0+/-12.9 day, respectively; p=0.829) but the time to switching was significantly shorter in 2006 than in 2001 (13.1+/-7.5 day vs 24.1+/-11.7day; p=0.009). The use of typical antipsychotics as augmentation agent decreased and the use of atypical antipsychotics increased significantly in 2006. Most frequently used atypical antipsychotic was quetiapine in 2006. The use of thyroid hormone and trazodone were significantly decreased in 2006, but the use of mood stabilizer was not changed between 2001 and 2006. While the use of lithium decreased, the use of lamotrigine increased in 2006. CONCLUSION: The results of the present study suggested that there were lots of change in prescription patterns for major depressive disorder between 2001 and 2006. Especially, these changes could be seen in use of various antidepressants, increment in use of atypical antipsychotics and lamotrigine. It can reflect not only the current progress of psychopharmacology and clinical experience, but also the clinical complexity of treatment of depression.
Antidepressive Agents ; Antipsychotic Agents ; Depression ; Depressive Disorder, Major* ; Humans ; Inpatients* ; Lithium ; Prescriptions ; Psychopharmacology ; Thyroid Gland ; Trazodone ; Quetiapine Fumarate ; Venlafaxine Hydrochloride