No abstract available.

No abstract available.
Bone Marrow Transplantation* ; Bone Marrow* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Recurrence*

PURPOSE: Prolonged stay in the emergency department (ED) have been associated with high mortality, but this association remains controversial. We examined the relationship between emergency department length of stay (EDLOS) and the mortality in critically ill patients undergoing traumatic emergency surgery. METHODS: A retrospective cohort study was conducted at an academic medical center with 257 critically ill patients undergoing traumatic emergency surgery from 2003 to 2004. Patients were classified into two groups those spending less than 4 hours in the emergency department and those spending over 4 hours. The groups were compared for hospital-mortality, and the data were entered into multinominal logistic regression, ROC curve, and life table using 12.0 version of SSPS. RESULTS: The overall mortality rate was 16.0%. Average length of stay was 220.1+/-138.5 minutes and 191.3+/-112.9 minutes in the survivors and non-survivor groups, respectively (p=0.212). Hospital-mortality and cumulative survival rate were similar in the group spending less than 4 hours to those in the group spending over 4 hours. The mortality was mainly related to the severity of the patients' condition (SAPS II). CONCLUSION: EDLOS did not affect hospital mortality, and EDLOS of more than 4 hours was not associated with worse prognosis.
Academic Medical Centers ; Cohort Studies ; Critical Illness* ; Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Length of Stay* ; Life Tables ; Logistic Models ; Mortality ; Prognosis* ; Retrospective Studies ; ROC Curve ; Survival Rate ; Survivors

PURPOSE: Outcome for critically ill patients often depends on time-sensitive critical care interventions. Thus we examined the effects of time on the mortality and the factors affecting emergency department length-of-stay (EDLOS) in hypotensive patients needing laparotomy in an emergency department. METHODS: ED records were reviewed for documentation of factors that might be associated with prolonged EDLOS, such as computed tomography, the number of standard radiographs, overcrowding, special procedures, and consultations. EDLOS was considered to consist of the time from arrival in the ED to departure from the ED. To assess the effect of multiple simultaneous factors a Cox proportional hazard model was created and a risk ratio (RR) was used to assess the effect of time on mortality. Risk ratio for death was equal to the percentage of patients with tested attributes among patients who died divided by the percent with those attributes among survivors. RESULTS: One-hundred sixteen patients met the inclusion criteria. Average time to the ED was 199.7+/-100.0 minutes. Using a Cox proportional hazards model, the independent predictors of prolonged EDLOS were determined to be additional CT for other areas outside of the abdomen, the number of standard radiographs, whether the patients had a weekend visit, and overcrowding. The risk ratio for time spent in the ED before laparotomy increased up to a time of 120 minutes, then significantly decreased below all earlier values on patients with hypotension and unreponsive to fluid therapy. The risk ratio increased after 240 minutes in patients with hypotension and responsive to fluid therapy. CONCLUSION: The probability of death showed a relationship to the EDLOS for patients who were in the EDLOS for 120 minutes or less in hypotensive abdominal injury patients needing laparotomy in the emergency department.
Abdomen ; Abdominal Injuries ; Critical Care ; Critical Illness ; Emergencies ; Fluid Therapy ; Hemorrhage ; Humans ; Hypotension ; Laparotomy ; Length of Stay ; Odds Ratio ; Proportional Hazards Models ; Referral and Consultation

BACKGROUND/AIMS: Ten-day sequential therapy has been evaluated as the first line therapy for Helicobacter pylori eradication but studies on sequential therapy as a second line therapy is lacking. The aim of this study was to compare the efficacy of 10-day sequential therapy and quadruple therapy as second line treatment for H. pylori eradication after failure of standard triple therapy. METHODS: Patients who did not respond to standard triple therapy for H. pylori eradication were assigned to either 10-day sequential or bismuth based quadruple therapy as second line treatment from January 2009 to December 2014 at Yeungnam University Medical Center. Post treatment H. pylori status was determined by rapid urease test, giemsa staining, or 13C-urea breath test. Eradication rate and side effects of both therapies were compared. RESULTS: A total of 158 H. pylori infected patients were included and 70 patients were treated by bismuth based quadruple therapy and 88 patients by 10-day sequential therapy. Age and sex were not significantly different between the two groups. Eradication rate was 84.3% (59/70) in quadruple group and 56.8% (50/88) in sequential group. Side effects occurred significantly higher in quadruple group than sequential group (27.1% vs. 11.4%, p=0.011). CONCLUSIONS: For second line H. pylori eradication after failure of standard triple therapy, bismuth based quadruple therapy showed significantly higher H. pylori eradication rate than 10-day sequential therapy. Further prospective studies are needed to evaluate the efficacy of 10-day sequential therapy as a second line H. pylori eradication treatment.
Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/adverse effects/pharmacology/*therapeutic use ; Bismuth/adverse effects/pharmacology/*therapeutic use ; Diarrhea/etiology ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy ; Helicobacter pylori/drug effects ; Humans ; Male ; Middle Aged ; Proton Pump Inhibitors/adverse effects/pharmacology/therapeutic use ; Retrospective Studies ; Risk Factors ; Taste Disorders/etiology ; Treatment Outcome ; Young Adult

BACKGROUND AND OBJECTIVES: Carotid artery stenting has evolved as a potential alternative to carotid endarterectomy in patients (pts) with significant carotid artery stenosis. We evaluated the feasibility and long-term outcome of carotid artery stenting in selected pts at high surgical risk. MATERIALS AND METHODS: Between May, 1996 and September 1998 we performed carotid artery stenting at 35 lesions in 25 pts. There were 23 males and 2 fe-males. Mean age was 63.2+/-6.6 (range 54 - 77). Eight four percent (21/25) of the pts had significant coronary artery disease. Sixty four percent (16/25) of the pts had significant peripheral artery lesions. Sixty percent (15/25) of the pts had neurologic symptoms or non-disabling stroke. We used Wallstent in 32 lesions and Palmaz stent in 3 lesions. Carotid stenting was undertaken in 33 internal carotid, 1 common carotid and 1 external carotid lesions. Bil-ateral carotid stenting was undertaken in forty percent (10/25) of the pts. RESULTS: Carotid stenting was successful in all lesions. One patient died due to massive cerebral hemorrhage 3 days after carotid stenting, who had und-erwent stenting as a rescue procedure for failed endarterectomy. One major stroke developed during procedure with partial recovery. For the combined endpoint of strokes and death within 30 days of procedure, the incidence was 8% and 5.7% in terms of pts and procedures, respectively. On follow-up (12+/-7 months), we found neither neurologic complications nor death. Angiographic and/or duplex sonography which were performed at 5.5 month in all (18) eligible pts with 24 lesions revealed no evidence of stent deformity or restenosis ( 50% of diameter stenosis). Mean angiographic stenosis was 20% on follow-up angiography. CONCLUSION: Carotid artery stenting can be performed with high success and low complication rate in pts with significant carotid artery stenosis especially at high surgical risk. Follow-up clinical outcome of average 12 month was good with low restenosis rate.
Angiography ; Arteries ; Carotid Arteries* ; Carotid Stenosis* ; Cerebral Hemorrhage ; Congenital Abnormalities ; Constriction, Pathologic ; Coronary Artery Disease ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies* ; Humans ; Incidence ; Male ; Neurologic Manifestations ; Stents* ; Stroke

OBJECTIVES: To identify the factors affecting users' satisfaction with the Order Communicating System(OCS) and to highlight the factors important for the successful establishment of OCS. METHODS: A Users Satisfaction survey was sent to 4,513 people, consisting of 1,503 doctors, 2,379 nurses, 255 pharmacists and 370 administrative workers in 16 hospitals which had introduced OCS. The response rate was 63.9%. Measurement of users' satisfaction was performed with the instrument which was used in Doll's study. Some aspects of Doll's instrument were adjusted according to the aims of this study. The classifying sections of this survey included age, job and status classification, computer experience , OCS education, duration of daily OCS use, type of order entering, number of personnel in the Hospital Information System's department, cost of OCS, problem frequency, proportion of work managed by hand, OCS type, and Hospital establishment type. RESULTS: There was a positive correlation between satisfaction level and managerial status throughout all job classifications. Irrespective of the importance of OCS education as a factor relating to users' satisfaction, the additional work load caused by OCS lowered users' satisfaction. Different factors affected users' satisfaction according to job and status classification. The composition of factors affecting the pharmacist and administrative worker satisfaction levels was simpler than that of the doctor and nurse levels. There were no statistically significant differences between the actual computer experience duration of daily OCS use and users' satisfaction with OCS. CONCLUSIONS: There was an understandable relationship between users' attitude to OCS and factors affecting users' satisfaction. The results of this study could be used as a basis for the successful expansion of the operation of OCS. But more detailed studies on users' satisfaction and further improvements of methodologies are required for the successful establishment of OCS.
Classification ; Education ; Hand ; Humans ; Pharmacists

OBJECTIVE: To evaluate the frequency of complex regional pain syndrome (CRPS) and to determine the risk of CRPS after stroke according to the degree of shoulder subluxation by quantitative radiographic analysis. METHOD: Sixty-four stroke patients (40 male; 24 female, mean age: 59.2 10.4) were included in the study. All subjects underwent a clinical examination that included spasticity and Brunnstrom stage; and a radiologic examination. The diagnosis of CRPS was based on clinical criteria and three-phase scintigraphies. The degree of shoulder subluxation was assessed by the distance between inferomedial point of acromion and the center of humeral head and glenoid fossa. RESULTS: CRPS after stroke occurred in 34 patients (53%). There were significant differences in Brunnstrom stage and shoulder subluxation between the CRPS groups and the non CRPS groups. Among radiographic measurements, vertical distance ratio (involved/uninvolved) and oblique distance ratio indicated a strong correlation with CRPS (p<0.01). Among clinical variables and radiographic measurements, oblique ratio was the most valuable determinant of the risk for CRPS. CONCLUSION: Shoulder subluxation shows a significant correlation with CRPS after stroke. We suggest oblique ratio as a useful measurement of shoulder subluxation to estimate the risk of CRPS.
Acromion ; Diagnosis ; Female ; Humans ; Humeral Head ; Male ; Muscle Spasticity ; Shoulder* ; Stroke*

PURPOSE:To identify the main toxic gas released from salted radish in rice bran(Dan-Mu-Ji) and to introduce the radiological findings of the patient who was exposed to the gas. MATERIALS AND METHODS: Chest radiographs and CT scans of one survivor among three men who were exposed to the gas from Dan-Mu-Ji were reviewed. Gas obtained from the closed bottle containing Dan-Mu-Ji was analized by using the gas chromatography. RESULTS: The radiographic examinations of the survivor were suggestive of pulmonary edema with it's rapidly improving consolidations in both lung. The headspace gas within the bottle containing Dan-Mu-Ji was mainly composed with carbon dioxide, ethyl alcohol and hydrogen sulfide, of which hydrogen sulfide was considered the main toxic gas released. CONCLUSION: Under the anaerobic condition, Dan-Mu-Ji released toxic hydrogen sulfide. Inhalation of hydrogen sulfide might produce non-cardiogenic pulmonary edema.
Anoxia* ; Carbon Dioxide ; Chromatography, Gas ; Ethanol ; Humans ; Hydrogen Sulfide ; Inhalation ; Lung ; Male ; Pulmonary Edema ; Radiography, Thoracic ; Raphanus* ; Survivors ; Tomography, X-Ray Computed

Patients with Peutz-Jeghers syndrome often suffer complications of the polyps, such as intussusception, bowel obstruction, and bleeding. Furthermore, repeated operations may be required in some patients, which may result in short-bowel syndrome. Intraoperative enteroscopy during a laparotomy for this syndrome was introduced. This can avert multiple enterotomies and decrease bowel resection segments. We report the cases of three consecutive patients with Peutz-Jeghers syndrome who recently underwent intraoperative enteroscopy via enterotomy with successful removal of most small-bowel polyps. The large polyps of the jejunum required an enterotomy for their removal, but smaller polyps at the lower ileum were identified and removed by using intra-operative total enteroscopy. A more complete polypectomy can be performed using this technique, thus allowing patients with Peutz- Jeghers syndrome a longer interval between laparotomies and a reduction in the symptoms attributed to polyps.
Endoscopy ; Hemorrhage ; Humans ; Ileum ; Intestinal Polyps ; Intraoperative Care ; Intussusception ; Jejunum ; Laparotomy ; Peutz-Jeghers Syndrome* ; Polyps