In modem medical industries as in others, it has been emphasized by many experts such as Dr. Mayer and Dr. Donabedean that there should be quality assurance activities applying statistical knowledges in the processes of medical management and medical staff themselves for the better medical care and customer satisfaction. Three of our quality assurance programs for the purpose of shortening the treatment time In the department of emergency medicine in Keimyung University, Dong-San Medical Center had been carried out during the period of June 94 through December 95. Our methodology was mainly the process emphasized ; finding the causes of delaying factors in various processes related to the works of nurses, doctors, laboratory services, radiology services etc. in the emergency room, holding various meetings among the related groups with genuine discussions, notifying the new results in each step, encouraging the positive ones and also applying the new leadership technics. During the period of June 94 through December 95(for 1.5 years), the average E.R. patient treatment time from registrations to dispositions had been reduced by about 2 hours (from 5 hours 3 minutes to 2 hours 5 minutes) and its variations among the different specialities had been narrowed down to significant degree (p<0.05) revealing the preprogram base line standard deviation of 2.43 to 1.28 in post program through continuous quality assurance programs. It was also noted that the successful results of Q/A program have been closely related to the fact that the process should be designed and redesigned repeatly as needed and that all the participants related were actively involved in the planning and redesigning processes.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leadership ; Medical Staff ; Modems

Radioimmunotherapy (RIT) is a therapy that takes advantage of the “cross-fire” effect of emitted radiation by radionuclides conjugated to tumor-directed monoclonal antibodies (mAb) (including those fragments) or peptides. While RIT has been successfully employed for the treatment of lymphoma, mostly with radiolabeled antibodies against CD20 [⁹⁰yttrium (⁹⁰Y)-ibritumomab tiuxetan; Zevalin® and (131)iodine ((131)I)-tositumomab; Bexxar®], its use in solid tumors is more challenging, so far. Immuno-PET, a tool for tracking and quantification of mAbs with PET in vivo, is an exciting novel option to improve diagnostic imaging and guide mAbbased therapy. RIT in solid tumors including head and neck cancer may be an alternative treatment with advances in various biological, chemical, and treatment procedures, and it may help to reduce unnecessary exposure and enhance the therapeutic efficacy. Also, immuno-PET based on RIT might play an important role in cancer staging, in patients or targets selection of targeted therapeutics and in monitoring the response of targeted therapeutics as precision medicine. In this review, fundamentals of RIT/immune-PET and current knowledge of the preclinical/clinical trials in RIT for solid tumor including head and neck cancer are reviewed.
Antibodies ; Antibodies, Monoclonal ; Carcinoma, Squamous Cell ; Diagnostic Imaging ; Head and Neck Neoplasms* ; Head* ; Humans ; Lymphoma ; Neoplasm Staging ; Peptides ; Precision Medicine ; Radioimmunotherapy* ; Radioisotopes

Miller-Dieter syndrome consists of severe type I lissencephaly, abnormal facial appearance, and sometimes other birth defects. Lissencephaly is a brain malformation manifested by a smooth cerebral surface, thickened cortical mantle, and microscopic evidence of incomplete neuronal migration. It comprises the agyria-pachygyria spectrum of malformation, thus excluding polymicrogyria and other cortical dysplasia. Type I lissencephaly results from abnormal migration between about 10 and 14 weeks gestaion. The brain is often small, and the ventricle is enlarged posteriorly The corpus callosum may be small or absent. The structural pattern of the cerebral hemispheres and ventricles is distintly immature, reminiscent of fetal brain. The superficial cellular layer resembles an immature cortex, with some separation into zones similar to layers III, V, and VI of normal cortex, although the cell population is decreased. In 1963 Miller described a malformation syndrome in a brother and sister with postnatal growth deficiency, craniofacial defects, and serious abnormalities of neurologic function. Autopsy at 3 and 4month of age, respectively, revealed lissencephaly. Subsequently, Dieker reported four additional patients with this disorder and referred to it as the 'lissencephaly syndrome'. We have experienced a case with this syndrome. Then we report this rare case with brief review of literature.
Autopsy ; Brain ; Cerebrum ; Congenital Abnormalities ; Corpus Callosum ; Humans ; Lissencephaly ; Malformations of Cortical Development ; Neurons ; Siblings

BACKGROUND: Oncogenes and EGF-Receptor(EGFR) may be involved n different stages of the multistep carcinogenesis process. A specific pattern of karyotypic abnormalities in solid tumors can be detected by cytogenetic methods. OBJECTIVE: This study is intnded to observe the cytomolecular kiologic chracterization of c-myc, erb B and EGFR genes in squasnous cell carcinoma(SCC) of the skin and cervix. METHODS: We have eytogenet,ically examined the short-term culturs from SCC. The rearrangement, amplification or expressi.on of erb B, c-myc, and EGFR genes were studied by Southern blot, analysis of genomic DNA and by slot blot analysis of tota! RNA extracted from biopsies of normal skin and SCC tissues. EGFR expression was examined immunohistochemially using monoclonal antibodies and the localizat,ion of the c-myc oncogene mRNA by in situ hybridization. RESULTS: A remarkably structural aberration was del 6(q21-qter) counted 20 metaphases among 28 metaphases ana1yzed. In nunierical aberration, all chromosomes were lost or gained randomly. Amenploid including triploid and tetraploid were observed in 8 metaphases, 6 tumor cells contained marker chromosome. In Southern blot analysis, rearrangement and amglificaton of EGFR in primary squamous cell carcinoma of cervix uteri and skin respectively. In slot blot analysis, the levels of c-myc, erb B and EGFR mRNA increaaed respectively 3.5, 2.5 and 2.8 times in SCC when compared to normal tissues. In immunoperoxidase stain, EGFR was present, in SCC where keratinocytes with strong cyto-plasmic staining but no membr, line labelling, where as in normal skin the were primarily present in t,he membrane and cytoplasm of basal cells. In situ hybridization with c-myc cDNAs allowed detection of grains representative of biotin labelled cDNA-mRNA hybrids in the frozden section of SCC tissues. CONCLUSION: These results suggest that specific patterns of karyotypir abnormalites, rearrangement, or amplification of EGFR gene, and overexpression of oncogenes and EGFR gene may be associated with the carcinogenesis of SCC.
Antibodies, Monoclonal ; Biopsy ; Biotin ; Blotting, Southern ; Carcinogenesis ; Carcinoma, Squamous Cell* ; Edible Grain ; Cervix Uteri ; Cytogenetics ; Cytoplasm ; DNA ; DNA, Complementary ; Epidermal Growth Factor* ; Female ; Genes, erbB-1 ; In Situ Hybridization ; Keratinocytes ; Membranes ; Metaphase ; Oncogenes ; RNA ; RNA, Messenger ; Skin ; Tetraploidy ; Triploidy

Opsoclonus-myoclonus syndrome (OMS) is a rare neurologic disorder characterized by progressive opsoclonus (irregular, rapid, horizontal and vertical eye movements), myoclonus, cerebellar dysfunction and severe hypotonia. Here we present the case of a 19-year-old man with OMS induced by mumps virus infection. Emergency physicians should know about the typical presentation of OMS and make a proper response.
Cerebellar Diseases ; Emergencies ; Eye ; Humans ; Mumps ; Mumps virus ; Muscle Hypotonia ; Myoclonus ; Nervous System Diseases ; Ocular Motility Disorders ; Opsoclonus-Myoclonus Syndrome ; Young Adult

The simultaneous occurrence of a renal cell carcinoma and a urothelial carcinoma in the same kidney is uncommon. Here we report the case of a 79-year-old woman with ipsilateral synchronous renal cell carcinoma and urothelial carcinoma. She was referred to our hospital for gross hematuria and right flank pain. A computed tomography scan showed a 15x20 mm enhanced lesion on the upper calyx and a 12x15 mm mass on the lateral aspect of the right kidney. We thus suspected a renal pelvis tumor and performed right hand assisted laparoscopic nephroureterectomy with bladder cuff excision (HALSNU). Gross findings were multiple, pale yellowish papillary masses on the upper and lower major calices, of which the largest one measured 16x20 mm. A separated solid mass measuring 12x16 mm was also noted on the anterior midportion of the kidney. The former was a urothelial carcinoma and the latter was a chromophobe renal cell carcinoma. We present a rare case of a chromophobe renal cell carcinoma and a urothelial carcinoma in the same kidney.
Aged ; Carcinoma, Renal Cell ; Female ; Flank Pain ; Hand ; Hematuria ; Humans ; Kidney ; Kidney Pelvis ; Urinary Bladder

We report a 58-year-old man who developed synchronous gastric non-Hodgkin`s lymphoma (NHL) and renal cell carcinoma. He presented with epigastric discomfort for 2 months. Endoscopic finding of the stomach disclosed a large inegular ulceration with nodular margin on the upper body. Constrast enhanced CT scan of the abdomen showed an ulceration and focal wall thickening in the greater curvature side of stomach, and an enhanced bulging mass in the left kidney incidentally. The tissue obtained by radical proximal gastrectomy and nephrectomy showed diffuse large B-cell lymphoma on stomach and chromophobic type of renal cell carcinoma on kidney. To our knowledge, this is the first report of synchronous gastric NHL and renal cell carcinoma in Korea.
Abdomen ; Carcinoma, Renal Cell* ; Gastrectomy ; Hodgkin Disease* ; Humans ; Kidney ; Korea ; Lymphoma ; Lymphoma, B-Cell ; Middle Aged ; Nephrectomy ; Stomach ; Tomography, X-Ray Computed ; Ulcer

Traditionally, the repair of displaced anterior wall fractures of the frontal sinus has involved open reduction and internal fixation. Recent development of instrument and techniques for endoscopic brow-lifting has allowed access to anterior wall fractures of the frontal sinus without the need for a coronal incision. A 32-year-old man presented with a depressed anterior wall of the frontal sinus and underwent endoscopic reduction of the fracture. Through two small incisions above the hairline, an endoscope and instruments were inserted after the elevation of the forehead skin over the depressed anterior wall. Depressed bone fragments were successfully reduced with a bone hook inserted through a small incision over the forehead. The authors report this case with a brief literature review focusing on the endoscopic reduction of the anterior wall fracture of the frontal sinus.
Adult ; Endoscopes ; Forehead ; Frontal Sinus ; Humans ; Skin

PURPOSE: The development of contralateral reflux after successful unilateral antireflux surgery has led to controversy regarding etiology. Our aim was to analyze the incidence of newly developed contralateral reflux after successful unilateral Cohen's reimplantation in patients with grade III and IV reflux and to explain the postoperative trigonal distortion responsible for new contralateral reflux with case-control study. MATERIALS AND METHODS: We compared the incidence and outcome of contralateral reflux between the medical group with prophylactic antibiotics and the surgical group with unilateral Cohen's reimplantation in patients with unilateral vesicoureteral reflux. We retrospectively reviewed the records of 84 children seen in a 17-year period who had grade III (48 patients) and IV (36 patients) primary unilateral vesicoureteral reflux. Unilateral Cohen's reimplantation was done in 48 patients and prophylactic chemotherapy was done in 36 patients. RESULTS: Overall contralateral reflux developed in 13.8% of patients who underwent medical treatment and 14.6% of patients who underwent unilateral Cohen's reimplantation. In patients with grade III reflux, 13% of patients with medical treatment and 12% of patients with unilateral Cohen's reimplantation had contralateral reflux. Twelve patients with contralateral reflux had grade I (7 patients) and grade II (5 patients) reflux and resolved spontaneously within 18.2 months. CONCLUSIONS: The likelihood of trigonal distortion as the etiology of contralateral reflux is low given the similar incidence in cross-trigonal Cohen's reimplantation group and medical group with prophylactic chemotherapy in patients with grade III and IV primary vesicourerteral reflux.
Anti-Bacterial Agents ; Case-Control Studies* ; Child ; Drug Therapy ; Humans ; Incidence ; Replantation* ; Retrospective Studies ; Vesico-Ureteral Reflux*

Objective: The utilization of emergency medical services (EMS) varies widely among communities. In this study, we aimed to evaluate the relationship between the use of EMS by patients with ST-elevation myocardial infarction (STEMI) and the individual and neighborhood characteristics of these patients. Methods: We performed a secondary analysis of data from the Cardiovascular Disease Surveillance project, which included patients diagnosed with STEMI at 29 emergency centers in South Korea. Our analysis included only patients living in Seoul, and the primary outcome measured was the use of EMS. While the clinical variables of the patients were collected from the Cardiovascular Disease Surveillance registry, the 2010 National Census data was used to identify neighborhood variables such as population density, income, age, and residence type. We used a 3-level hierarchical logistic regression to estimate the effects of neighborhood-level factors on EMS use by individual patients. Results: We evaluated 1,634 patients with STEMI from 2007 to 2012. The neighborhoods were grouped into 25 counties. The regional rates of EMS use varied from 18.3% to 46.5%. The final adjusted logistic model revealed that the use of EMS was significantly associated with the average number of households (neighborhood level factor) and symptoms of syncope, cardiac arrest, and history of cardiovascular disease (individual level factors). Conclusion The individual levels factors had a greater influence on the use of EMS compared to the neighborhood-level factors.