Background: Korea recently established 70 emergency medical service areas. However, there are many concerns that medical resources for stroke could not be evenly distributed through the country. We aimed to compare the treatment quality and outcomes of acute stroke among the emergency medical service areas. Methods: This study analyzed the data of 28,800 patients admitted in 248 hospitals which participated in the 8th acute stroke quality assessment by Health Insurance Review and Assessment Service. Individual hospitals were regrouped into emergency service areas according to the address of the location. Assessment indicators and fatality were compared by the service areas. We defined the appropriate hospital by the performance of intravenous thrombolysis. Results: In seven service areas, there were no hospitals which received more than 10 stroke patients for 6 months. In nine service areas, there were no patients who underwent intravenous thrombolysis (IVT). Among 167 designated emergency medical centers, 50 hospitals (29.9%) responded that IVT was impossible 24 hours a day. There are 97 (39.1%) hospitals that meet the definitions of appropriate hospital. In 23 service areas (32.9%) had no appropriate or feasible hospitals. The fatality of service areas with stroke centers were 6.9% within 30 days and 15.6% within 1 year from stroke onset than those without stroke centers (7.7%, 16.9%, respectively). Conclusions There was a wide regional gap in the medical resource and the quality of treatments for acute stroke among emergency medical service areas in Korea. The poststroke fatality rate of the service areas which have stroke centers or appropriate hospitals were significantly low.

Although pathology reports of thyroid tissue in ovarian teratomas are abundant, benign teratomas of the thyroid are extremely rare in adolescents and adults. Therefore, their clinical characteristics are still not well characterized. We report a case of a 54-year-old woman with a growing mass in her neck. Left lobectomy of the thyroid revealed it to be a benign thyroid teratoma composed of tissues from all three germ layers. Preoperative evaluations included thyroid ultrasonography (US), ultrasound-guided fine needle aspiration cytology (FNAC), and computed tomography (CT) of the neck. A 4.7-cm, well defined, predominantly hypoechoic mass intermingled with hyperechoic internal lesions, was observed in the inferior portion of the left thyroid lobe with substernal extension on US. The posterior extent of the nodule was not visualized due to deep attenuation of the echo. US-guided FNAC failed to reveal any thyroid follicular cells, but suggested a benign cystic tumor. Neck CT hinted at the diagnosis of teratoma because the mass contained large amounts of fat, and the margin was well defined. Extrathyroidal extension and cervical lymphadenopathy were not seen. She underwent left thyroid lobectomy, and histologic examination confirmed benign thyroid teratoma. To the best of our knowledge, this is the first case report of benign thyroid teratoma in Korea.
Adolescent ; Adult ; Biopsy, Fine-Needle ; Female ; Germ Layers ; Humans ; Korea ; Lymphatic Diseases ; Neck ; Teratoma ; Thyroid Gland

PURPOSE: The aim of this study is to report on preliminary data regarding the prevalence of major eye diseases in Korea. METHODS: We obtained data from the Korea National Health and Nutrition Examination Survey, a nation-wide cross-sectional survey and examinations of the non-institutionalized civilian population in South Korea (n = 14,606), conducted from July 2008 to December 2009. Field survey teams included an ophthalmologist, nurses, and interviewers, traveled with a mobile examination unit and performed interviews and ophthalmologic examinations. RESULTS: The prevalence of visual impairment, myopia, hyperopia and astigmatism in participants over 5 years of age was 0.4 +/- 0.1%, 53.7 +/- 0.6%, 10.7 +/- 0.4%, and 58.0 +/- 0.6%, respectively. The prevalence of strabismus and blepharoptosis in participants over 3 years of age was 1.5 +/- 0.1% and 11.0 +/- 0.8%, respectively. In participants over 40 years of age, the prevalence of cataract, pterygium, early and late age-related macular degeneration, diabetic retinopathy and glaucoma was 40.2 +/- 1.3%, 8.9 +/- 0.5%, 5.1 +/- 0.3%, 0.5 +/- 0.1%, 13.4 +/- 1.5%, and 2.1 +/- 0.2%, respectively. CONCLUSIONS: This is the first nation-wide epidemiologic study conducted in South Korea for assessment of the prevalence of eye diseases by both the Korean Ophthalmologic Society and the Korea Center for Disease Control and Prevention. This study will provide preliminary information for use in further investigation, prevention, and management of eye diseases in Korea.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Cross-Sectional Studies ; Eye Diseases/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Nutrition Surveys/*statistics & numerical data ; Prevalence ; Republic of Korea/epidemiology ; Young Adult

The incisional hernia through trocar site is an uncommon complication of gynecologic laparoscopy. Its incidence is less than 1% and most of them are occurring through 10 mm trocar site. Small bowel herniation through 5 mm trocar site is very rare. Furthermore, 5 mm trocar site bowel herniation with drain tube in situ has not yet been reported. We present a case of small bowel herniation through 5 mm trocar site with drain tube in situ and its reduction by laparoscopy with a brief review of literature.
Drainage ; Hernia ; Incidence ; Laparoscopy ; Surgical Instruments

OBJECTIVE: The objective of this study is to evaluate the safety and the clinical efficacy of the laparoscopic myomectomy through analyzing several operation factors. METHODS: There were 185 cases of laparoscopic myomectomy between January 2004 and December 2008 at the department of obstetrics and gynecology in Hanyang University Guri Hospital. Retrospectively many factors of the operation were analyzed. The factors include the size, number and type of the myoma, BMI (body mass index), operation method, operation time, and complication and the prognosis of the operation. RESULTS: For the type of myomas, 115 (62.2%) cases were intramural myomas, 38 (20.5%) cases were subserosal types and 32 (17.3%) cases were mixed types. The average diameter of the biggest myoma was 6.67+/-0.16 cm (range, 2.5~15 cm) and the average number of the myoma was 2.07+/-0.15 (range, 1~15). Previous operation history and pelvic adhesion did not show correlation with the operation time. The size, type and number of myoma and the operation methods showed correlation with the operation time. According to myoma size and number, we divided the cases into two groups, low risk group (122 cases) and high risk group (63 cases). The analysis showed that post-operation hemoglobin drop (2.89+/-0.10 g/dL vs. 4.03+/-0.23 g/dL) and blood transfusion amount (2.89+/-0.10 pints vs. 4.03+/-0.23 pints) as well as the operation time (137.58+/-4.37 min vs. 193.73+/-9.88 min) showed noticeable increase in the high risk group. CONCLUSION: This statistics show that laparoscopic myomectomy is now being applied to patients with larger and more myomas. Factors affecting operation time were the weight of myomas, number of myomas, type of myomas, number of trocars and methods of resected myomas removal. Also, operation time and post-operative hemoglobin drop increased in the high risk group.
Blood Transfusion ; Gynecology ; Hemoglobins ; Humans ; Laparoscopy ; Myoma ; Obstetrics ; Prognosis ; Retrospective Studies ; Surgical Instruments

We present an unusual case in which a patient was diagnosed with the preeclampsia associated with a partial hydatidiform mole and bilateral theca-lutein cysts. The patient newly developed proteinuric hypertension at 16 weeks' gestation. Ultrasound findings showed small multiple cystic spaces in the placenta and a live singleton fetus. Triploid 69, XXX was confirmed at karyotype analysis. Intrauterine fetal death was found at 18 weeks' gestation and termination of pregnancy was performed, and a partial hydatidiform mole was confirmed at pathologic examination. Torsion of bilateral theca-lutein cysts was developed at postpartum one week. Detorsion and aspiration of the bilateral theca-lutein cysts were performed under the laparoscopy.
Female ; Fetal Death ; Fetus ; Humans ; Hydatidiform Mole ; Hypertension ; Karyotype ; Laparoscopy ; Placenta ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Triploidy

Heterotopic pregnancy with coexistiong intrauterine and extrauterine pregnancy, is a rare event in natural pregnancy. However, in recent years, the increase in the incidence of pelvic inflammatory disease and use of assisted reproductive technology had led to an increase in the frequency of heterotopic pregnancy. When the diagnosis of heterotopic pregnancy is delayed, maternal mortality and morbidity may be increased, and unwanted loss of intrauterine pregnancy may occur. Therefore, the early diagnosis of heterotopic pregnancy is clinically important, and clinicians have to consider the possibility of heterotopic pregnancy and conduct careful and thorough evaluation if suspected. We experienced a case of heterotopic pregnancy in a woman in the absence of the known risk factors. She underwent underwent spontaneous abortion of intrauterine pregnancy at postoperative 4th day, after laparoscopic salpingectomy for left tubal pregnancy. We report this case with brief review of literature.
Abortion, Spontaneous ; Diagnosis ; Early Diagnosis ; Female ; Humans ; Incidence ; Maternal Mortality ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Pregnancy, Tubal* ; Reproductive Techniques, Assisted ; Risk Factors ; Salpingectomy

Heterotopic pregnancy with coexistiong intrauterine and extrauterine pregnancy, is a rare event in natural pregnancy. However, in recent years, the increase in the incidence of pelvic inflammatory disease and use of assisted reproductive technology had led to an increase in the frequency of heterotopic pregnancy. When the diagnosis of heterotopic pregnancy is delayed, maternal mortality and morbidity may be increased, and unwanted loss of intrauterine pregnancy may occur. Therefore, the early diagnosis of heterotopic pregnancy is clinically important, and clinicians have to consider the possibility of heterotopic pregnancy and conduct careful and thorough evaluation if suspected. We experienced a case of heterotopic pregnancy in a woman in the absence of the known risk factors. She underwent underwent spontaneous abortion of intrauterine pregnancy at postoperative 4th day, after laparoscopic salpingectomy for left tubal pregnancy. We report this case with brief review of literature.
Abortion, Spontaneous ; Diagnosis ; Early Diagnosis ; Female ; Humans ; Incidence ; Maternal Mortality ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Pregnancy, Tubal* ; Reproductive Techniques, Assisted ; Risk Factors ; Salpingectomy

PURPOSE: The human carcinoembryonic antigen (CEA) is expressed in several tumor types, including colorectal cancer, and is a tumor-associated antigen used as a target for antigen-specific immunotheraphy. CEA is a self-antigen associated with development, expressed in fetal cells and rarely expressed in normal colorectal epithelial cells. The induction of immune response to CEA is very difficult. In this study, we attempted to increase the tumor immunity specific to CEA by using dendritic cells pulsed with fusion proteins of CEA and Tat (transactivator of transcription), which transduces extracellular proteins into cytoplasm and causes antigens to be presented with MHC class I pathway. METHODS: The Tat gene was amplified in the PNL4-3 HIV plasmid and then inserted into PCEP4 plasmid vector. The CEA gene was cloned from cDNA from LoVo human colorectal cell line and then amplified through polymerase chain reaction method. After cloning of PCEP4 plasmid vector, the dendritic cell was sensitized and internalized with CEA and Tat-CEA protein. Then the Western blot analysis of the expression of CEA in the gene-modified dendritic cell and the immunofluorescent staining of the expression of CEA in CEA or Tat-CEA-pulsed dendritic cell were performed. A detection of IFN-gamma-releasing CD8 cell and a cytotoxicity of T-cell were was assesed using ELISPOT assay. The Immunoglobulin (Ig) G isotypes were analyzed with enzyme-linked immunosorbent assay. The statistical significance was assessed using Students t-test. RESULTS: CEA pulsed in dendritic cells was distributed over the cell surface and TatCEA was observed in the cytoplasm. The cellular immune responses by immunization with dendritic cells pulsed with TatCEA (322/10(4) lymphocytes) were significantly increased compared with those with CEA (244/10(4) lymphocytes) by IFN-gamma ELISPOT assay (P<0.05). The cytotoxic T lymphocyte (CTL) activity using mouse T-cell, EL-4 pulsed peptide (EAQNTTYL) as target cells was 23.3+/-2.75% (E:T=1:100) in the CEA group and 22.9+/-2.23% (E:T=1:100) in the TatCEA group. In ELISA analysis of the IgG isotype, the titer of IgG2a and IgG3, representing Th1 immune response, was lower than that of IgG1, representing Th2 immune response, in both the CEA group and the TatCEA group. CONCLUSIONS: These results suggest that TatCEA could be used for the development of a tumor vaccine and cellular immunotherapy using CTLs induced in vitro.
Animals ; Blotting, Western ; Carcinoembryonic Antigen ; Cell Line ; Clone Cells ; Cloning, Organism ; Colorectal Neoplasms ; Cytoplasm ; Dendritic Cells ; DNA, Complementary ; Enzyme-Linked Immunosorbent Assay ; Enzyme-Linked Immunospot Assay ; Epithelial Cells ; Equidae ; Genes, tat ; HIV ; Humans ; Immunity, Cellular ; Immunization ; Immunoglobulin G ; Immunoglobulins ; Immunotherapy ; Lymphocytes ; Mice ; Plasmids ; Polymerase Chain Reaction ; T-Lymphocytes

BACKGROUND: LB20304(gemifloxacin) is a new fluoroquinolone antibacterial agent with excellent activity against both Gram-negative and Gram-positive organisms. In vitro studies using clinical isolates have shown gemifloxacin to be highly active against penicillin-resistant strains of S. pneumoniae and in contrast to other reference quinolones, gemifloxacin retained good activity against clinical isolates of S. pneumoniae that were resistant to other members of the quinolone class. Therefore, gemifloxacin is thought to be effective in treating acute bacterial exacerbation of chronic bronchitis(AECB). The objective of this study was to evaluate the efficacy and safety of oral gemifloxacin at doses of 160mg or 320mg once daily for 7 days for the treatment of AECB in Korean adult population. METHODS: This was a randomized, multicenter, double-blind, parallel group Phase II study to assess the clinical and antibacterial efficacy and safety of oral gemifloxacin for the treatment of AECB. Treatment Group A (67 patients) took oral gemifloxacin 160mg once daily for seven days and treatment Group B (70 patients) took oral gemifloxacin 320mg once daily for seven days. RESULTS: The demographic profiles of the two treatment groups were similar. The clinical response at follow-up was 84.2% in the gemifloxacin 160-mg group, and 88.7% in the gemifloxacin-320 mg group, showing no statistically significant difference between two treatment groups(p=0.49). The clinical response at the end of therapy was 96.5% in the 160-mg group, and 96.4% in the 320-mg group. The bacteriological response at the end of therapy and follow-up were 81.8% and 78.9%, respectively, in the 160-mg group, and 86.4% and 84.2%, respectively, in the 320-mg group, showing no statistically significant difference between two treatment groups(p=0.68 and 0.68, respectively). S. pneumoniae(12 isolates) and H. influenzae(10 isolates) were the most prevalent pathogens. The MICs were lower for gemifloxacin than other quinolones against these key pathogens, and for S. pneumoniae, the MICs for gemifloxacin were considerably lower(< or = 0.03 ug/mL) than those for other quinolones, beta-lactams and acrolides. In the period on-therapy plus 30 days post-therapy, a total of 18 patients(26.9%) in the gemifloxacin 160mg group and 22 patients(31.4%) in the 320mg group reported at least one adverse event(AE). The most frequently reported AE was abdominal pain(3/67 patients, 4.5%) in the gemifloxacin 160mg group and increased level of hepatic enzyme(5/70 patients, 7.1%) in the 320mg group. The overall AE profiles for the two treatment groups were similar. Two out of 67 patients(3.0%) in the gemifloxacin 160mg group and 1/70 patients(1.4%) in the 320mg group reported at least one serious AE, however, none of which was considered by the investigator to be of suspected or probable relationship to study medication. CONCLUSION: The results of this study showed that gemifloxacin at doses of 160mg or 320mg once daily for 7 days in the treatment of acute exacerbations of chronic bronchitis(AECB) in adult Koreans was a very effective and safe treatment both clinically and bacteriologically.
Adult* ; beta-Lactams ; Bronchitis, Chronic* ; Double-Blind Method* ; Follow-Up Studies ; Humans ; Mesylates* ; Pneumonia ; Quinolones ; Research Personnel