Background: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. Methods: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. Results: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI;additionally, age (65–74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. Conclusions Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.

PURPOSE: The purpose of this study is to evaluate the effect of diabetes mellitus (DM) and preoperative glycemic control on prognosis in Korean patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). MATERIALS AND METHODS: A total of 566 patients who underwent RNU at six institutions between 2004 and 2014 were reviewed retrospectively. Kaplan-Meier and Cox regression analyses were performed to assess the association between DM, preoperative glycemic control, and recurrence-free, cancer-specific, and overall survival. RESULTS: The median follow-up period was 33.8 months (interquartile range, 41.4 months). A total of 135 patients (23.8%) had DM and 67 patients (11.8%) had poor preoperative glycemic control. Patients with poor preoperative glycemic control had significantly shorter median recurrence-free, cancer-specific, and overall survival than patients with good preoperative glycemic control and non-diabetics (all, p=0.001). In multivariable Cox regression analysis, DM with poor preoperative glycemic control showed association with worse recurrence-free survival (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.31 to 3.90; p=0.003), cancer-specific survival (HR, 2.96; 95% CI, 1.80 to 4.87; p=0.001), and overall survival (HR, 2.13; 95% CI, 1.40 to 3.22; p=0.001). CONCLUSION: Diabetic UTUC patients with poor preoperative glycemic control had significantly worse oncologic outcomes than diabetic UTUC patients with good preoperative glycemic control and non-diabetics. Further investigation is needed to elucidate the exact mechanism underlying the impact of glycemic control on UTUC treatment outcome.
Carcinoma, Transitional Cell ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Prognosis* ; Retrospective Studies ; Treatment Outcome

Ureteral obstruction may develop in immunocompromised patients with an Aspergillus fungal infection. Infections can progress to invasive aspergillosis, which is highly lethal. We report a case of a 56-year-old man with alcoholic cirrhosis of the liver and diabetes. He had ureteral aspergilloma, discovered as a saprophytic whitish mass. It was treated by ureteroscopic removal, however, he refused antifungal treatment. His condition progressed to invasive aspergillosis, and died from sepsis and hepatorenal syndrome.
Aspergillosis/diagnosis/*etiology ; Diabetes Complications ; Fatal Outcome ; Humans ; Immunocompromised Host ; Liver Cirrhosis, Alcoholic/complications ; Male ; Middle Aged ; Ureteral Diseases/diagnosis/*etiology ; Ureteral Obstruction/diagnosis/etiology

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.
Aged ; Angiography ; Choroid ; Ethnic Groups ; Eye ; Female ; Fluorescein ; Humans ; Hypertension ; Incidence ; Korea ; Macular Degeneration ; Male ; Membranes ; Photography ; Retinaldehyde ; Smoke ; Smoking ; Specialization

OBJECTIVES: As automobile part manufacturing is characterized by high speed and high repetition, observation methods which are usually utilized for static posture are inappropriate to evaluate musculoskeleatal risk factors. This study quantified the risk factors of musculoskeletal disorders on the forearm and suggested exposure limits by estimating the risk factors using surface electromyography (EMG) and electrogoniometer. METHODS: Ten percent of the total workers at 3 automobile part manufacturing factories were randomly selected, and 99 male workers were recruited as study subjects. The study was conducted during May 2003 to September 2004. The workers were equipped with electrogoniometers on the wrist and the elbow, surface EMGs on the skin of the flexor digitorum superficialis (FDS) and extensor carpi radialis (ECR) muscles, and the heart beat recorder during work as indicators of joint movement, local muscle tension and physical work load, respectively. RESULTS: After controlling for age, body mass index and job stress, wrist flexion maximum angle, FDS relative activity (RA) and ECR RA were significantly associated with forearm musculoskeletal symptoms. The odds ratios of the forearm were 5.0(95% CI: 1.1-22.7), 14.0(95% CI: 1.5-128.8) and 7.3(95% CI: 1.1-49.4) for wrist flexion maximum angle more than 76 degrees, FDS RA more than 2.8%, and ECR RA more than 3.5%, respectively. CONCLUSIONS: Joint angle and focal muscle activity were associated with forearm musculoskeletal symptoms. To reduce forearm musculoskeletal symptoms among automobile part manufacturers, the wrist flexion angle, and FDS and ECR activity need to be reduced below the guidelines recommended in this study.
Automobiles* ; Body Mass Index ; Elbow ; Electromyography* ; Forearm ; Heart ; Humans ; Joints ; Male ; Muscle Tonus ; Muscles ; Odds Ratio ; Posture ; Risk Factors* ; Skin ; Wrist

OBJECTIVES: The Energy Expenditure Prediction ProgramTM (EEPP) has been considered as a simple and quantitative method to evaluate physical work load. However, the adoption of EEPP directly to Korean workers is problematic because it was developed in a laboratory setting for Caucasians. Therefore, this study was conducted to validate EEPP for Korean workers. METHODS: The study subjects consisted of 60 workers from two factories. Cycle ergometer test was conducted to calculate physical work capacity, and heart rate monitoring was conducted to check heart rate during work. After observing the task, energy expenditure was estimated by EEPP. RESULTS: EEPP underestimated energy expenditure less than EEHR (energy expenditure checked by heart rate) did(p<0.0001). The factors effecting EEHR were EEPP and task type. After dividing the task into regular and irregular tasks, the irregular task had a larger difference between the values from the two methods. We provided task specific regression models between EEHR and EEPP. CONCLUSIONS: Because EEPP underestimated energy expenditure, it needs to be adjusted before use with Korean workers. It is suggested that different adjusting equations are formulated for regular and irregular tasks. Further study to develop a specific energy estimation model appropriate for Koreans is needed to obtain more precise estimation.
Energy Metabolism* ; Health Expenditures ; Heart ; Heart Rate

BACKGROUND AND OBJECTIVES: The effect of electrical stimulation (ES) on vestibular compensation was investigated for 28 days after unilateral labyrinthectomy (Lx) in 24 rats. MATERIALS AND METHOD: The rats were divided into 4 groups and were treated as follows: A) Lx only, B) Lx with ES (0.6 mA) for 2 days, C) Lx with ES (0.6 mA) for 7 days, D) Lx with ES (1.2 mA) for 2 days. ES with pulse wave (10 Hz) was applied to temporal portion bilaterally (8 hr/day). Cathodal currents were transmitted to the electrode on the destructive side, anodal to that on the intact side. Postoperatively, spontaneous nystagmus (SN) was recorded with the video camera and yaw and roll head tilt (YHT, RHT) were measured using photo images. Horizontal vestibulo-ocular reflex (VOR) was evaluated at various frequencies (0.05, 0.1, 0.5, 1, 2, 3 Hz with peak angular velocity of 40degrees/sec) with the magnetic search coil system. Locomotor movement was monitored with a video camera. RESULTS: The ES groups showed faster compensation in SN, YHT, and RHT than the Lx group. At 3 days after Lx, the ES groups showed significant improvement in the gain over the whole frequency and asymmetry at low frequency compared to that of the Lx group. But the ES group had no effect on compensation of gain and asymmetry on and after 7 days of post-labyrinthectomy. There was no significant difference in vestibular compensation with respect to duration and intensity of ES. ES had no significant effect on the mean velocity and mean deviation of locomotor movements. CONCLUSION: These results suggest that ES has a favorable effect on the suppression of early static symptoms but has no effect on the compensation of dynamic symptoms after the recovery of resting discharge of the vestibular nuclei neurons.
Animals ; Compensation and Redress* ; Ear, Inner ; Electric Stimulation* ; Electrodes ; Head ; Neurons ; Rats* ; Reflex, Vestibulo-Ocular ; Vestibular Nuclei

PURPOSE: Laparoscopic cholecystectomy has been performed even in case of acute cholecystitis and GB empyema with increasing experience of laparoscopic surgery. Many previous studies has been recommended early laparoscopic cholecystectomy in acute cholecystitis. METHODS: From February, 1997 to January, 2000, 364 patients were attempted to laparoscopic cholecystectomy and 71 patients of them were attempted to laparoscopic cholecystectomy due to acute cholecytitis. They were divided into 4 groups based on the time of operation form the onset of symptom. These groups were compared in conversion rate and postoperative clinical outcomes, such as operation time, time of bowel movement, starting diet, starting soft diet and discharge. The affecting factors on conversion were analyzed (age, sex, fever, murphy sign, accompanying pancreatitis, SGOT/SGPT, alkaline phosphatase, GB wall thickening, WBC count). RESULTS: Among 71 patients who were attempt to laparoscopic cholecystectomy in acute cholecystitis, 20 patients (28.1%) required converting to open surgery. There were no statistically significant difference in clinical outcomes and conversion rate between four groups (p>0.568). In univariate analyis, high frequency of conversion to open surgery in acute cholecystitis was observed in male (p=0.012). CONCLUSION: Even though conversion rate to open surgery is still high in acute cholecystitis, the time of laparoscopic surgery in acute cholecystits does not affect on the conversion rate and postoperative clinical outcomes. Considering of the hospital stay and its related economic problems, laparoscopic cholecystectomy should be attempted as soon as possible without hesitation. It may be due to advanced laparoscopic techniques and experiences.
Alkaline Phosphatase ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute* ; Conversion to Open Surgery ; Diet ; Empyema ; Fever ; Humans ; Laparoscopy ; Length of Stay ; Male ; Pancreatitis

Transplantation of ABO-nmatched solid organs has been associated with the development of immune hemolysis due to donor-erived antibodies produced by passenger lymphocytes in the graft, called "Passenger Lymphocyte Syndrome". In a liver transplantation, about 40% of patients at risk has detectable donor-erived antibodies and hemolytic anemia occurs in 29% of patients. It is characterized by hemoglobinemia, a rapid fall in hemoglobin, hyperbilirubinemia, and an excessive red cell transfusion requirement occurring 1 to 3 weeks after the transplantation. These clinical findings are accompanied by the laboratory findings of a positive direct antiglobulin test and the detection of unexpected antibodies in the patients' red cell eluate and serum. Both the hemolytic anemia and serology resolve over the course of weeks to months. To the best of our knowledge, this is the first case of hemolytic anemia due to passenger lymphocyte syndrome after ABO-nmatched liver transplantation in Korea.
Anemia, Hemolytic ; Antibodies ; Coombs Test ; Hemolysis ; Humans ; Hyperbilirubinemia ; Korea ; Liver Transplantation ; Liver* ; Lymphocytes* ; Transplants

BACKGROUND: It has been reported that hypercholesterolemia is associated with coronary heart disease and that alcohol intake has influence on the lipid metabolism. This study was conducted to evaluate the relations between alcohol intake and serum lipid level. METHODS: We reviewed 906 subjects who had visited for routine checkup at family practice of Hanil hospital and then excluded 130 subjects with DM, renal disease, thyroid disease, hepatic disease or drug administration which might have influence on serum lipids. From the remaining 776 subjects, we obtained the amount and the frequency of alcohol drinking during the previous 2 weeks and the duration of alcohol intake, using a formed questionnaire. The alcohol dependence score was recorded by the National Alcoholism Screening Test. The serum lipids such as total cholesterol, triglyceride, and HDL-cholesterol were tested by enzyme method and the obesity index was obtained by Broca's method. These data were analyzed by SAS/PC program RESULTS: The total number of subjects was 776. Of those, 67.7%(n=525) were male and 32.3%(n= 251) females. The mean age of subjects was 50.5 years(range 15 to 77 years). The distribution according to the obesity index was as follows ; underweight group 7.1%, normal-weight group 38.1%, overweight group 31.6%, obesity group 23.2%. The number of the drinkers was 382(49.2%) in males and 7 (0.9%) in females. The mean serum lipid level were compared and analyzed among the groups. The results were as follows ; the total cholesterol and triglyceride levels were higher in males and the HDL-cholesterol levels was higher in female. The total cholesterol and triglyceride levels increased with age and obesity index, the HDL-cholesterol level decreased with obesity index. In the relationship between alcohol intake and serum lipid levels in males, the geometric mean of triglyceride level was higher among all the variables of alcohol intake, and that of HDL-cholesterol level increased with the amount and the frequency of alcohol intake. The results of multiple regression analysis associated with age, obesity index, the amount and the frequency of alcohol intake in males were as follows ; the triglyceride level was positively associated with the amount of alcohol intake, and the HDL-cholesterol level was positively associated with the frequency of akohol intake. CONCLUSIONS: The effects of age, sex and the obesity index on the serum lipid level are remarkable, and in males, alcohol intake increases triglycaride and HDL-cholesterol levels. Further study is needed to find out about whether alcohol intake have influences on coronary heart disease according to serum lipid levels.
Alcohol Drinking ; Alcoholism ; Cholesterol ; Coronary Disease ; Family Practice ; Female ; Humans ; Hypercholesterolemia ; Lipid Metabolism ; Male ; Mass Screening ; Obesity ; Overweight ; Thinness ; Thyroid Diseases ; Triglycerides ; Surveys and Questionnaires